DOH Sec. Cabral's speech on sexual and reproductive health

This speech was delivered by the Philippine's Department of Health Secretary Dr. Esperanza I. Cabral at a policy forum titled "Changing Course to Achieve the MDG-5" organized by Likhaan on 28 May 2010.

From left to right: DOH Sec. Cabral; Likhaan Executive Director Dr. Junice D. Melgar; Likhaan Board Chair Dr. Sylvia Estrada-Claudio; Packard Foundation Senior Country Adviser Dr. Michael Tan; former DOH Sec. Dr. Alberto Romualdez; and UNFPA Country Rep. Ms. Suneeta Mukherjee.

To all reproductive health advocates present, a pleasant morning to all of you.

We cannot overemphasize the importance of addressing the issue of sexual and reproductive health in our national development plans. Our core problems of poverty and hunger, overpopulation and underdevelopment, maternal and child mortality, as well as gender inequality, are intimately linked with our lack of attention to adequate sexual and reproductive health services for our people. Sadly, the Guttmacher Institute has reported that over the past decade, contraceptive use has hardly increased in the country, even as the number of unwanted pregnancies and deaths from clandestine abortions skyrocket, reflecting the restrictive atmosphere of sexual and reproductive health here in the Philippines. That has been largely because of the State’s failure to provide easier access to such. Yet free access to all forms of reproductive health services, including artificial contraception, have proven to be crucial factors in improving other health outcomes. Let me quote from the Secretary General’s report during the 43^rd Session of the United Nations Commission on Population and Development in New York which I attended last month:

Sexual and reproductive health interventions are a good investment and the benefits of such interventions are far-reaching. Providing women with both family planning and maternal and newborn health services would result in a decline in maternal deaths by an estimated 70 per cent compared to a decline of 57 per cent only if developing countries invested in maternal and newborn health care alone. If contraceptive needs were adequately addressed, the reduction in unintended pregnancies would result in considerable declines in abortion and related health complications. It is estimated that the number of women requiring medical care for complications from unsafe abortion would decline by 73 per cent. It is also estimated that meeting the need for both family planning and maternal and newborn health services would result in a reduction by more than 60 per cent of healthy years of life lost owing to disability and premature death among women and newborns as measured in disability-adjusted life years (DALYS). More women would survive hemorrhage and infection, fewer would suffer from fistula, infertility and other pregnancy/childbirth-related health problems, and newborns would have a better chance of surviving asphyxia, low birth weight and infection.

Despite these benefits, my short time in the Department of Health as Secretary has really given me a hands on experience on how limited our options are, as far as pursuing reproductive health is concerned. While there is no codified law that bans the use of artificial contraception in the country, religious and political considerations virtually have the same effect. Our continuing laissez faire attitude towards sexual and reproductive health has made it even harder for advocates to bring down entrenched social and cultural barriers. As it stands, the provision of these services are left to the consideration of the local government units by virtue of devolution. However, most LGUs will not do so, either for fear of a backlash from the religious establishment or simply because they don’t realize the importance of providing them. The lack of compelling legislation means that we can’t force them to do otherwise.

State policy also does not provide for public funding for reproductive health services other than the natural methods of family planning, which means that the promotion of modern methods have had to depend solely on foreign aid, which by the way is dwindling with each passing year. If nothing drastically changes, there will come a day when there will be no money at all allotted for alternative sexual and reproductive health products and services, to the detriment of public interest.

Part of more than a hundred leaders and stakeholders who attended the forum.

A perfect example of the Department of Health’s limitations was the recent condom brouhaha that accompanied our Valentine’s Day promotions. Ironically, we did not even spend any taxpayer’s money for the condoms, which were provided by a private company. We also had concrete guidelines and safeguards for the event to ensure that only adults will get hold of the contraceptives, which were not even for the purpose of birth control, but to stop the spread of HIV/AIDS. Yet we were publicly flogged for months for a supposedly immoral and licentious activity that destroyed public morals and corrupted the youth. And that was just for distributing condoms. Imagine if we put sexual and reproductive health as part of national health policy, by providing mandatory provision of products and services, as well as mandatory coverage of such under social health insurance. The negative reaction would probably be ten times as enormous.

You may have also heard in the news about how a lawyer plans to sue a celebrity endorser of condoms, supposedly for violating the Consumer Act’s ban on the promotion of “immoral” products. That may be stretching the limits of interpretation a little bit, but it is a reflection of how determined they are in frustrating sexual and reproductive health initiatives at every turn. Imagine if a local Court upholds that particular lawyer’s argument. It would be very hard to mitigate the damage it could do. These are but a few of the many disheartening incidents that have unfortunately characterized the Philippine reproductive health situation over the past few years.

In light of these difficulties, the only solution seems to be for Congress to pass enabling legislation that will promote access to services, and champion freedom of information and choice. If only the Department of Health and the local government units would be properly empowered with the legal mandate, as well as the resources, to undertake the delivery of these services, much can be done to improve outcomes across a wide variety of development indices – not just in health, but even in economic growth and productivity, in education, in social welfare, so on and so forth. The possibilities are limitless. Yet faced with these glowing projections, the only defenses that have been put up against reproductive health involve vague arguments of how it will destroy family ties or corrupt morals or promote sexual promiscuity. They may not be as compelling, but they have certainly been effective in blocking our efforts.

If we are ever to see any progress in our advocacy, I think that the discussion on sexual and reproductive health, especially on the part of those who oppose it, must be taken to a whole new different level. The discourse must transcend the rigid plane of spirituality and morality, and into the plane of hard science and economics, of human rights, good governance and sustainable development. There must be a realization that reproductive health is a pressing public health concern that must be addressed decisively in all levels of government. There must be a sense of urgency in the implementation of reproductive health policies, because with each passing year that we do nothing, millions of Filipinos will remain bogged down in the clutches of poverty and disease.

While we respect the view of those who take a contrary position, we also must not allow our voices to be drowned out. We have always been for healthy debate, but the problem arises when one paradigm goes on to constitute the dominant policy to the exclusion of others. That is exactly what is happening with us now.

I don’t believe that we are asking for too much. We do not call for the total abolition of the State policy exclusively promoting “natural” reproductive health services. What we merely ask for is an equal chance, a level playing field where Filipinos choose freely. I believe that it is about time we gave credit to the ability of people to make an intelligent choice, instead of expecting them to act like animals when given access to modern reproductive health methods. We can only hope that sooner rather than later, our national leadership will come to realize the impact of this institutionalized neglect on our country and society. In the meantime, our efforts to educate and inform our people, as well as lobby for the appropriate legislative measures, will have to continue. We in the Department of Health are making do with what limited resources we have. Eventually, I hope that the cramped space we are moving in now will expand into wider opportunities for better public health outcomes, especially for the next administration.

Thank you and once again, good morning.