Member Article

Never has there been a more controversial law in the past decade than the Reproductive Health Law (“RH Law”).  After a long and contentious battle in Congress, the law was finally passed. But the fervent opposition by the so-called Pro-life groups (chief among them the Catholic Church) endures.

Four days after the approval of the law’s Implementing Rules and Regulations (“IRR”), the Supreme Court on March 19, 2013, halted its implementation, issuing a 120-day status quo ante order. The status quo ante order was later extended indefinitely by the Court after the 120-day period expired.

With the approval of the law’s IRR, staunch critics have once again harped on its imperfections. On the other hand, proponents have asked the public not to focus on these imperfections but rather look at the good points of the law and the IRR. Here’s a quick look at the salient provisions of the IRR, approved on March 15, 2013.

Salient provisions of the IRR

1.   Youth Access to Reproductive Health Services

One of the more controversial provisions of the law is the provision on parental consent needed for minors to have access to reproductive health services. Section 7 of the law provides:

No person shall be denied information and access to family planning services, whether natural or artificial: provided, that minors will not be allowed access to modern methods of family planning without the written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage.

Rule 4, Section 4.07 of the IRR, inserted details to the abovementioned provision by enumerating the requirements for a minor’s access to family planning services which includes the following: (a) written consent from parent or guardian; and (b) written documentation proving that the minor has had a previous pregnancy or is already a parent.

Critics have characterized these requirements as absurd because if a minor asks for parental consent to have access to family planning services, then it would be tantamount to admitting that he or she is sexually active. On the other hand, the proponents of the law have explained that this restriction is necessary in order not to encourage dispensing contraceptives to minors which would encourage them to have sex.

2.   Improved Access to Family Planning Services

The IRR highlights improved access to family planning services which includes the following:

a.   Service Delivery Standards- Rule 4 of the IRR provides a detailed enumeration of the information and services related to responsible parenthood and reproductive health. Some of the important provisions deal with ensuring access to family planning methods through accredited public health facilities which includes the following services: (a) fertility awareness and family planning information and education; (b) interpersonal communication and counseling services; (c) provision of modern family planning methods which shall include dispensing of medically safe, legal, and non-abortifacient health products and procedures, among others; (d) infertility services; and (e) referral services.

Rule 4, Sections 4.08 and 4.09 are specific provisions on victim-survivors of gender-based violence and persons with disabilities.

b.   Service Delivery Network- Rule 5 of the IRR provides for the integration and coordination of the network of health facilities and providers within the provinces and cities.

One innovation added by the IRR is the Mobile Health Care Service (MHCS) where the provincial, city, municipal or district hospital may be provided by the local government with a van or other means of transportation to be used for the delivery of health care goods and integrated services to its constituents. The MHCS would also be used to disseminate information on reproductive health (Section 5.12).

Upgrading of Health Care Facilities to provide for emergency obstetric and newborn care is also provided for under Rule 5, Sections 5.16 and 5.17.

Private Hospitals are mandated to provide a full range of family planning methods (unless owned and operated by a religious group or classified as non-maternity specialty hospital) as part of their annual licensing and accreditation requirements. Under Rule 5, Section 5.22, a private hospital or health care facility may be exempted from this requirement upon submission of pertinent documents enumerated under this section, one of which is an affidavit stating the modern family planning methods that the facility refuses to provide and the reasons for its objection (Rule 5, Section 5.22).

Aside from private hospitals, private health professionals may also legally refuse to deliver reproductive health care services or information as a “conscientious objector” by submitting to the DOH an affidavit stating the modern family planning methods that he or she refuses to provide and his or her reasons for objection in addition to other requirements as determined by the DOH. (Rule 5, Section 5.23) On the other hand, a public skilled health professional may also be exempted upon more stringent requirements under Section 5.24 of Rule 5.

With regard to the abovementioned exemptions, the DOH is given 60 days from effectivity of the IRR to develop guidelines for its implementation. These exemptions are important because there are corresponding penalties for knowingly withholding information or restricting dissemination regarding reproductive health programs (Rule 16, Section 16.01,a,1.) or for refusing to extend quality health care services and information on account of the person’s religious convictions, personal circumstances, gender, etc. (Rule 16, Section 16.01,a,3).

A provision which deals with gender-sensitivity is also included under Rule 5, Section 5.27, which states that health care providers shall be provided with training on gender-sensitive handling of clients.

3.   Wide Information Campaign on RH Rights and Services

The IRR also emphasizes the importance of public awareness and education by dedicating one whole chapter on it. Indeed, the most effective way of ensuring that the goals of the RH Law are met is to make sure the people are made aware of the rights emanating from it and the implications of such rights.

The DOH and the LGU’s are called on to initiate and sustain a “heightened nationwide multi-media campaign” to raise public awareness on responsible parenthood and reproductive health and rights (Rule 10, Sec. 10.1.) and to develop, within six months from the effectivity of the IRR, a comprehensive “health promotion and communication plan” to raise public awareness on the reproductive rights and responsible parenthood (Rule 10, Section 10.02).

There is also an emphasis on the kind of message that should be used in public awareness campaigns. It shall be evidence-based, values-based, culturally-sensitive and clear, and should be able to resonate with the audience (Rule 10, Section 10.03). The multimedia health promotion and communication strategies under the IRR include television, radio, cinema, print, mobile technology, web-based and social media platforms (Rule 10, Section 10.08).

An important aspect of the public awareness campaign is the integration of responsible parenthood and reproductive health education into the school curriculum and in community-based education programs, and indigenous learning systems as provided for under Rule 11 of the IRR. The Department of Education is tasked with the implementation of the provisions under this rule where it is given 90 days from the effectivity of the IRR to integrate across all subjects, responsible parenthood and reproductive health information into its curriculum (Rule 11, Sec. 11.02).

This integration would provide education on sexuality to individuals at a discerning age so that they can be guided in their actions and thus, make informed decisions regarding their reproductive health.

4.   Maternal Death Review and Fetal and Infant Death Review

One of the oft-repeated advantages of the RH Law according to its advocates is the prevention of maternal deaths, which they attributed to the lack of government intervention in addressing the reproductive health problems that beset the marginalized and depressed communities in the country. The urgent enforcement of reproductive health rights, it is argued, would quell this problem.

In line with the goal of the law, Rule 14 of the IRR mandates all LGUs, national and local government hospitals, and other public health units to conduct an annual review of maternal deaths and fetal and infant deaths in order to help in the development of women’s health and safe motherhood. Through the annual reviews, which would be submitted to the Department of Health, the systemic gaps, clinical factors, and institutional issues that contributed to the reported deaths would be identified, and this would pave the way to concrete action and intervention plans to address these gaps.

Conclusion

The RH Law’s IRR is vital in translating the law into an operational framework to accomplish its stated goals of reducing maternal mortality and empowering women. However, whether or not the law and the IRR will succeed in achieving these goals will depend first and foremost on the Supreme Court’s ruling on the constitutionality of the law.  Oral arguments for and against the law have just been concluded in the Supreme Court.  Let’s wait and see how the Court will rule on the issue.

(Imee Manguiat and Melissa Asuncion A. Ursua co-authored this post.)