1. REPRODUCTIVE HEALTH and HUMAN RIGHTS Edelina P. de la Paz, MD Executive Director, HAIN Associate Professor, UP College of Medicine LU 5 AY 2011-2012 College of Medicine, UP Manila

2. Reproductive Health (RH) Definition: International Conference on Population and Development/WHO, 1994 Within the framework of PHC…health as a state of complete physical, mental and social well being, and not merely the absence of disease or infirmity, RH addresses the reproductive processes, functions and system at all stages of life. It implies that people are able to have a satisfying and safe sex life and they have the capability to reproduce and the freedom to decide if, when, and how often to do so.

3. Reproductive Rights Implicit in this are the rights of women and men to be informed and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and to provide couples with the best choice of having a healthy infant

4. Reproductive Health Care The constellation of methods, techniques, and services that contribute to reproductive health and well being by preventing and solving reproductive health problems It also includes sexual health, the purpose of which is the enhancement of life and personal relations, and not merely counseling and care related to reproduction and sexually transmitted infections.

5. RH, Development and Rights: ICPD (International Conf on Population and Development) Program of Action 1994 Important population and development objectives and goals: - sustained economic growth in the context of sustainable development - education, especially for girls - gender equity and equality - infant, child and maternal mortality reduction - universal access to reproductive health services, including family planning and sexual health

6. DOH Program, DOH 1995- 1998: 10 ELEMENTS Maternal and child health (MCH), Maternal Care and Nutrition Family Planning (FP) information and services Prevention and Management of Sexually Transmitted Illnesses (STIs) including HIV infection and AIDS Sexuality and Reproductive Health Education Prevention and Treatment of Infertility and Sexual Dysfunctions

7. DOH Program, DOH 1995- 1998: 10 ELEMENTS Prevention and Management of Abortion and its Complications (PMAC) Treatment of Reproductive Tract Cancers and other Gyne conditions Elimination of Violence Against Women (VAW) Male Involvement and Participation in RH Adolescent Reproductive Health (ARH)

8. DOH 1998-2000 Administrative Order reaffirming Reproductive Health Program Restated TFR reduction as DOH goal AO on PMAC Registered Postinor as Emergency Contraceptive

9. DOH Actions 2001-2009 Banning of Postinor (Levonorgestrel 750 mcg) by end 2001 Endorsement of only Natural Family Planning (NFP), including shunting of funds Administrative Order on Contraceptive Self Reliance

10. DOH Actions Jan-June 2010 Review of Reproductive Health Program Recommendation of both Natural and Artificial Family Planning Methods

11. DOH Actions July 2010- present Followed President Noynoy’s initial statement of RH being a priority in the executive and legislative programs Subsequently Pnoy said RH no longer in the priority legislative agenda but says that he continues to support RH DOH RH program has yet to be clearly defined

12. Trends in the status of Reproductive Health Maternal and Child Health --reduction in maternal mortality by one half of the 1990 levels by 2000 and a further one half by 2015 --expand the provision of maternal health services in the context of primary health care, i.e, based on the concept of informed choices, should include education on safe motherhood, prenatal care (ICPD)

13. Targets in RH Reduce maternal mortality rate by three quarters by 2015 (half by 2000, half by 2015) Increase access to reproductive health services to 60% by 2005, 80% by 2010, and 100% by 2015 (MDG 5:Target 7,8)

14. Maternal Mortality NDHS data: MMR/100,000 live births 1993 209 1995 179.1 1998 172 2003 162 2008 152 --slow decrease in maternal death --increasing number of pregnant women in high risk category --UNFPA 1999 studies: major causes of maternal deaths are post-partum hemorrhage, eclampsia, severe infection and abortion

15. Infant Mortality NDHS: IMR/1000 LB UFMR/1000 LB 1990 57 80 1996 35.1 49 1998 36 48.4 2003 29 40 The leading causes of infant mortality are respiratory conditions of the fetus,congenital anomalies, diarrhea, measles, nutritional deficiencies

16. Maternal and Child Health The lack of access to quality health care is a major determinant in maternal and child mortality --pre natal care --post partum care --skilled delivery attendants during delivery --immunization

17. Family Planning Family Planning By the year 2005, provide universal access to a full range of safe and reliable family planning methods Countries should seek to identify and remove all the major barriers to the utilization of family planning services (ICPD)

18. Violence against Women …protect women from all kinds of economic discrimination and from sexual harassment Countries should take full measures to eliminate all forms of exploitation, abuse, harassment and violence against women VAW has grave reproductive health impact: unwanted pregnancy, STIs/HIV, gyne disorders, resorting to unsafe abortion, pregnancy complications, pelvic inflammatory disease (ICPD)

19. Reproductive Cancers Make accessible…referral…for and further diagnosis and treatment for… breast cancer and cancers of the reproductive system The Philippines has the highest rate in breast cancer in Asia

20. Adolescent Reproductive Health …ensure that the programs and attitude of health care providers do not restrict the access of adolescents to appropriate services and the information they need, including on sexually transmitted diseases and sexual abuse (ICPD)

21. Abortion UP Population Institute study: -- 403,000 to 1.32 million women undergo induced abortion each year -- young mothers account for 17% of induced abortions and 6% of spontaneous abortion --12% of all maternal deaths are due to abortion --36% of women who are treated for abortion complications in various hospitals are young women

22. WHY WE NEED EFFECTIVE REPRODUCTIVE HEALTH LEGISLATION AND PROGRAMS URGENTLY: Significant, possibly undeclining MMR- 152/100,000 or 3,000 deaths/year High unmet need for effective contraception – 52% High rates of unsafe abortion – majority of abortions estimated at 400,000/year, resulting in 80,000 complications Increasing unprotected sex among young people Significant and increasing incidence of rape – over 3,000/year

23. Reproductive Health Bills Senate Bill 2378 Sen. Miriam Defensor Santiago “An Act Providing for a National Policy on Reproductive Health and Population and Development

24. Reproductive Health Bills House Bill 4244 consolidated bill from HB Nos 96, 101, 513, 1160, 1520 and 3387 “An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development and for other Purposes OR “ The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011

25. Reproductive Health Bill (HB 4244) Declaration of Policy - State guarantees universal basic human right to RH by all persons, particularly of parents, couples, and women consistent with their religious convictions, cultural beliefs, and demands of responsible parenthood - No discrimination against any person on grounds of sex, age, religion, sexual orientation, disabilities, political affiliation and ethnicity

26. - The State recognizes and guarantees the promotion of gender equality, equity and women’s empowerment as a health and human rights concern - The State recognizes and guarantees the promotion of the welfare and rights of children

27. - The State likewise guarantees universal access to medically safe, legal, affordable, effective and quality RH services, methods, devices, supplies and relevant information and education thereon, even as it prioritizes the needs of women and children among other underprivileged sectors - The State shall eradicate discriminatory practices, laws, and policies that infringe on a person’s exercise of RH rights

28. Guiding principles - Freedom of Choice - Respect for RH and rights - Effective RH Care - Provision of Medically safe, legal, accessible, affordable, and effective RH care services and supplies - Effective natural and modern methods of FP

29. Other sections - Midwives for skilled attendance - Emergency Obstetric and Neonatal Care - Access to Family Planning - Maternal and Newborn Health Care in Crisis Situations - Maternal Death Review - Family Planning supplies as essential medicines

30. - Procurement and Distribution of Family Planning Supplies - Integration of Responsible Parenthood and Family Planning Component in Anti Poverty Programs - Roles of Government in Family Planning Programs - Benefits for Serious and Life Threatening RH Conditions

31. - Mobile Health Care Service - Mandatory Age-Approppriate RH and Sexuality Education - Additional Duty of the Local Population Officer - Certificate of Compliance - Capability Building of BHWs - Ideal Family Size

32. - Employers’ Responsibilities - Pro Bono Services for Indigent Women - Sexual and RH Programs for Persons with Disabilities - Right to RH Care Information - Implementing Mechanisms DOH and Local health units t ensure implementation of RH care program

33. - Reporting Requirements - Congressional Oversight Committee - Prohibited Acts - withholding of information and services - restricts the delivery of services and supplies - maliciously engage in disinformation

34. - Penalties Imprisonment from 1 month-6 months Fine of P10,000 to P50,000 - Appropriations include in annual GAA under DOH and POPCOM - Implementing Rules and Regulations

35. 12 UniversallyAccepted Reproducitve Health and Rights Key Concepts 1. The Right to Life 2. The Right to Liberty and Security of the Person 3. The Right to Equality and to be Free from all forms of Discrimination 4. The Right to Privacy

36. 5. The Right to Freedom of Thought 6. The Right to Information and Education 7. The Right to Choose Whether or Not to Marry and to Found and Plan a Family 8. The Right to Decide Whether or When to Have Children

37. 9. The Right to Health Care and Health Protection 10. The Right to Benefits of Scientific Progress 11. The Right to Freedom of Assembly and Political Participation 12. The Right to be Free from Torture and Ill Treatment

38. Health as a Human Right Primary Health Care Access to quality health care at all times Rights based Approach Sexual and reproductive rights are human rights. Their goal is for each person to lead a fulfilling life free from discrimination, as well as foreseeable and avoidable risks.

39. Each person, including an adolescent, has a right to health care. Only by respecting and demanding respect through sexual and reproductive rights can good sexual and reproductive health be achieved by everyone.

40. Responsibilities For every right, there is a responsibility. Each person has the duty and responsibility to respect the rights of others. Men and women have equal capabilities, rights and responsibilities to make informed choices and act on these choices.

41. REFERENCES: Reproductive Health bills filed in Congress “Ten Years After Cairo: Between Commitment and Realization of Reproductive Health in the Philippines” edited by Elizabeth Aguiling Pangalangan ReproCen

42. “Adolescent Reproductive Health Modules for High School Students” - A guide for teachers and guidance counselors (5 modules) developed by Marita V.T. Reyes, et al a project of ReproCen, and Social Medicine Unit, UP College of Medicine, UP Manila

43. Thank you