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The Philippines is over 80% Catholic, and by 2050, is expected to have below replacement level fertility rates, even without Duterte's executive order. Photo: Philippines President Rodrigo Duterte.

Duterte Ignores Supreme Court, Orders Action on Controversial Reproductive Health Law

Executive Order Issued by Philippine President Threatens to Create Constitutional Crisis


Philippine President Rodrigo Duterte has signed an executive order mandating the immediate and full implementation of the controversial Responsible Parenthood and Reproductive Health Act of 2012 (RPRH). According to the Duterte Administration, the new executive order (EO) aims to “intensify and accelerate” efforts to eliminate all “unmet need for modern family planning” for low-income households by 2018.

Since 2014, the RPRH Act has been under a temporary restraining order (TRO) from the Philippine Supreme Court. The Court blocked the law from going into effect after evidence that the country’s Food and Drug Administration (FDA) had violated drug approval protocols for a number of contraceptive drugs. The Court also expressed concern that several artificial contraceptives approved for distribution under the RPRH Act were abortifacient in nature. Because the Constitution of the Philippines explicitly protects life from the moment of conception, abortifacients are prohibited under Philippine law.

The executive order seeks to mobilize the RPRH Act despite the Court’s TRO in a direct challenge to the authority of the Court to stand by its decision. The Duterte Administration has accused the Supreme Court of taking too long to resolve the case.

“This EO will pressure the Supreme Court to stop dillydallying on this TRO,” said Director-General of the National Economic and Development Authority Ernesto Pernia at a press briefing at the presidential palace according to Rappler .

Duterte has long been a supporter of the RPRH Act, having supported a similar initiative as mayor of Davao. The executive order calls on the Department of Health (DOH) to “map areas to locate couples and individuals with unmet need for modern family planning” and to “accelerate the implementation of RPRH law” by mobilizing the state to increase the distribution of and referrals for contraceptives and to generate demand for birth control. The executive order also directs the Department of Education to implement “comprehensive sexuality education” in public schools across the country.

While the EO calls for mobilization of artificial methods of contraception, no similar effort is made to promote natural family planning methods. Many Catholics and pro-life advocates in the Philippines have condemned the EO as unlawful and biased against natural methods of fertility regulation.

“The President is exposing himself to a taxpayer’s suit if the execution of RH services and products using the budget derived from taxes only includes artificial methods,” says Eric B. Manalang, President of Pro-Life Philippines, the pro-life group that filed the original petition against the RPRH Act with the Supreme Court in 2013. “The RH Law in spirit and definition is to be neutrally implemented without bias for or against Natural Family Planning or artificial methods,” Manalang said.

“The issuance of EO No.12 is not a legal ground for the Supreme Court to lift the TRO. We remain steadfast in our faith that the Supreme Court will continue to safeguard the right to life and other rights enshrined in our Constitution,” said Attorney Maria Conception Noche, President of Alliance for the Family Foundation Philippines, Inc., another pro-life organization that has been instrumental in opposing the RPRH Act at the Supreme Court.

“EO No.12…[makes] no mention about other provisions such as providing obstetric and newborn care services, upgraded medical facilities and equipment and skilled health workers which would be highly beneficial for the poor, the mothers and children,” Noche says.

While the Court’s TRO remains in place, Pernia has suggested that the President’s EO could provide a way for some local officials to circumvent the Supreme Court’s restraining order.

“With the EO, there might be some municipalities or local governments that can get around the TRO by letting NGOs implement [programs],” Pernia said .

The EO is not the first attempt by the Duterte Administration to circumvent the rule of law. The United Nations and human rights groups worldwide have condemned President Duterte for calling for extrajudicial killings of drug dealers and other criminals. Since Duterte took office last year, it is estimated that over 6,200 people have been killed by vigilantes without trial or proof of guilt. Duterte himself has publicly admitted to carrying out extrajudicial killings in the past.

While contraceptive prevalence in the Philippines has increased in recent years, artificial contraception remains relatively unpopular throughout much of the overwhelmingly Catholic country. For many Filipino Catholics, artificial methods of contraception (i.e. “modern” methods) are contrary to their religious beliefs and constitute a violation of human dignity by rejecting an openness to life and by commoditizing children and spouses.

The RPRH Act has run into serious opposition from many Filipinos who see the law as an intrusion on their values and a corrupting element in society that will lead to lax attitudes on sexual mores and could open the door for the legalization of abortion on-demand. Controversy surrounding the RPRH Act was so great that the Philippine Congress rejected funding for the law’s contraceptive provisions in the government budget last year.

Concern over possible abortifacient mechanisms of certain contraceptives has led the Supreme Court to direct the FDA to conduct hearings to ensure that approved methods on the Essential Drug List are not abortifacient in nature.

IUDs in particular could present a special challenge to the full implementation of the RPRH Act as the law calls specifically for this method, among many others, to be part of the ramping-up of contraceptive procurement. While IUDs function primarily by preventing conception, it is likely that they rely on postfertilization effects as well, causing early-term abortions.

In one study, a fertilized egg was found in an levonorgestrel IUS user at a rate higher than the expected failure rate for the IUD. [1] A number of studies have observed that IUDs create a proinflammatory endometrial environment, inducing macrophages to attack unfertilized ova. [2] Several studies have also found that while IUD users were less likely to have an ectopic pregnancy than women not using IUDs, when pregnancy did occur, the pregnancy was much more likely to be ectopic.[3] Since an embryo in an ectopic pregnancy is not viable, IUDs under these rare circumstances reduce the likelihood that the embryo will survive and are for that reason abortifacient.

The Duterte Administration asserts that “zero unmet need” for contraception is necessary to curb population growth in order to reduce poverty, teen pregnancy, and maternal deaths. As Philippine Congressman Edcel Lagman put it , “unbridled population growth stunts socio-economic development and aggravates poverty.”

However, there is no evidence that stemming population growth reduces poverty. If the economy is growing sufficiently, and new jobs are being created in adequate numbers, then poverty will rapidly diminish regardless of the rate of population growth. Without adequate growth, it matters very little what the population growth rate is—poverty will not decrease in a society where vast segments of the population remain unemployed, underemployed, or otherwise excluded from the market due to socioeconomic barriers.

High unemployment, not the number or density of people, has been a cause of poverty across much of the Philippines. Unemployment remains high in many rural areas in part due to barriers with securing land rights and a lack of access to financial services which makes investment and creating jobs difficult. For much of the Philippines’ rural poor, unsustainable agricultural practices have made farming land and fisheries less profitable. While Filipinos are generally well-educated (less than 5 percent of the population has no formal education and a relatively high percentage of the population attains four-year college or advanced degrees) among some of the Philippines poorest, illiteracy rates remain high, hampering socio-economic mobility.

RPRH supporters have pointed to the fact that the Philippines is one of the most densely populated countries in the world as a reason for needing population control policies. But the population of many of the world’s wealthiest countries—places like Japan, Belgium, the Netherlands, and Singapore—are even more densely populated. Indeed, the state of New Jersey averages 470 people per square kilometer, which is far more densely populated than the Philippines with 343 people per square kilometer. Yet few (aside from perhaps New Yorkers) would consider New Jersey to be overpopulated. According to the U.S. Census Bureau, New Jersey ranks fifth in the U.S. for per capita income and third in terms of median household income.[4]

Poverty in the Philippines is not likely to increase even if current population growth trends continue. In 2015, the Philippines was the world’s 12th most populous nation and the 33rd largest economy. Goldman Sachs projects that by 2050 the Philippines will be the world’s 14th largest economy. At the same time, the Philippines population ranking will have fallen one place to become the world’s 13th most populous country. Even without ramping-up contraceptive procurement, the Philippines is projected to have below replacement fertility by 2050.

Maternal mortality is not contingent on contraceptive prevalence either. Rather, access to a skilled birth attendant at the time of birth is the strongest predictor of the maternal mortality rate. In the Philippines, only 73% of births are attended by a skilled health worker or midwife and only 84% of pregnant women receive the minimum of four antenatal care visits recommended by the World Health Organization. [5] By comparison, in Thailand, where the maternal mortality rate is much lower than the Philippines, 99.6% of birth are attended by a skilled midwife and 93.4% of women receive four or more antenatal visits. [6]

Increasing contraceptive prevalence is not a panacea for lowering maternal mortality. Bangladesh, Myanmar, Nepal, Laos, South Africa, Nicaragua, and Suriname, just to name a few examples, all have higher contraceptive prevalence rates than the Philippines [7] but have not been able to achieve maternal mortality rates as low [8] as those found in the Philippines today.

 

 

 


[1] Ortiz ME, Croxatto HB. Copper-T intrauterine device and levonorgestrel intrauterine system: biological bases of their mechanism of action. Contraception 2007; 75: S16-S30.

[2] Ibid.

[3] Approximately 1% of all pregnancies are ectopic; however, for women using the levonorgestrel IUS, over half of pregnancies were found to be ectopic. See: Backman T, Rauramo I, Huhtala S, Koskenvuo M. Pregnancy during the use of levonorgestrel intrauterine system. Am J Obstet Gynecol 2004; 190: 50–54.

[4] Includes ranking for the District of Columbia. See U.S. Census Bureau. “Selected Economic Characteristics.” Document ID: DP03. 2011-2015 American Community Survey, 5-Year Estimates.

[5] Philippine Statistics Authority, ICF International. Philippines National Demographic and Health Survey 2013. Manila, Philippines and Rockville, Maryland: PSA, ICF International; 2014.

[6] National Statistical Office, UNICEF, Thailand Ministry of Public Health. Thailand Multiple Indicator Cluster Survey 2012. Thailand, 2013.

[7] United Nations Department of Economic and Social Affairs, Population Division. Model-based estimates and projections of family planning indicators 2015. New York: United Nations, 2015.

[8] World Health Organization. Trends in Maternal Mortality: 1990-2015; estimates by WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division. Geneva: World Health Organization, 2015.

 

Article updated 11:00 AM, 18 Jan 2017 to include a comment from Alliance for the Family Foundation Philippines, Inc.

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