Potential Public Health Ramifications of the Philippine Reproductive Health Bill (I)

Yesterday, Philippine president Benigno ‘Noynoy’ Aquino III declared his support for The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011, more commonly referred to as the RH bill. The bill has been a contentious issue for the past several months, although its history predates its reputation. First introduced to Congress in 1998, the bill aims to guarantee reproductive, maternal and child health and ensure universal access to methods and information on birth control.

This blog is the first part of a two-part series that will address different aspects of the Philippine RH bill and highlight what public health goals the bill is trying to achieve.

Maternal and child health and mortality

The maternal mortality ratio (MMR) in the Philippines (94 deaths per 100,000 live births) may be low when compared to other nations such as Afghanistan (1,400 deaths). However, contrasted with some of its regional neighbours including Thailand and Singapore (48 and 6 deaths respectively), the Philippines is still several steps behind. The RH bill seeks to reduce this ratio through a series of measures, including the employment of midwives for skilled birthing attendance and emergency obstetric and neonatal care personnel, equipment and supplies at hospitals, with special provisions for those in geographically isolated and depressed areas.

According to the Philippine Department of Health (DOH), ten to eleven maternal deaths daily could be reduced if they had access to basic healthcare and essential minerals like iron and calcium. They also stated that effective family planning could reduce maternal mortality by about 32 per cent. The RH bill aims to achieve this by calling for universal availability and access to information on maternal, infant and child health and nutrition practices (i.e. breastfeeding). These provisions of the bill will also aid the Philippines towards achieving the 5^th Millennium Development Goal (MDG) – to reduce the MMR by three-quarters and achieve universal access to reproductive health by 2015.

Additionally, the RH bill touches on the contentious issue of abortion. Official estimates in 2005 put annual abortions at 400,000 to 500,000, and rising, the World Health Organization (WHO) estimates nearly 800,000 cases per year. According to the DOH, nearly 100,000 women who have unsafe abortions every year end up hospitalised due to post-procedure complications. Although abortion is still recognised as illegal and punishable by law (the bill itself calls for the proscription of abortion), the RH bill states that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counselled in a humane, non-judgmental and compassionate manner” – a measure that will undoubtedly further the maternal health cause.

Despite the evident public health benefits that could occur if the RH bill were to be passed, it remains to be seen whether President Aquino’s newly minted support will be enough to pass the bill. More importantly, it is yet unknown the political will needed to support the passing and effective implementation of the bill will prevail over the politically and religiously-centered controversies that currently dominate the RH bill conversation.