The History and Authors of Reproductive Health Bill free essay sample

Reproductive Health Bill The Reproductive Health bills, popularly known as the RH Bill, are Philippine bills aiming to guarantee universal access to methods and information on birth control and maternal care. The bills have become the center of a contentious national debate. There are presently two bills with the same goals: House Bill No. 4244 or An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health, and Population and Development, and For Other Purposes introduced by Albay 1st district Representative Edcel Lagman, and Senate Bill No. 378 or An Act Providing For a National Policy on Reproductive Health and Population and Development introduced by Senator Miriam Defensor Santiago. While there is general agreement about its provisions on maternal and child health, there is great debate on its key proposal that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills (BCPs) and IUDs, as the government continues to disseminate information on their use through all health care centers. The bill is highly divisive, with experts, academics, religious institutions, and major political figures supporting and opposing it, often criticizing the government and each other in the process. The issue is so divisive that at one point, the Catholic Bishops Conference of the Philippines threatened to excommunicate the President, Benigno Aquino III if he supported the bill. Debates and rallies for and against the bill, with tens of thousand participating, have been happening all over the country. Background The first time the Reproductive Health Bill was proposed was in 1998. During the present 15th Congress, the RH Bills filed are those authored by (1) House Minority Leader Edcel Lagman of Albay, HB 96; (2) Iloilo Rep. Janette Garin, HB 101, (3) Akbayan Representatives Kaka Bag-ao Walden Bello; HB 513, (4) Muntinlupa Representative Rodolfo Biazon, HB 1160, (5) Iloilo Representative Augusto Syjuco, HB 1520, (6) Gabriela Rep. Luzviminda Ilagan. In the Senate, Sen. Michael Angelo F. Perolina has filed her own version of the RH bill which, she says, will be part of the country’s commitment to international covenants. On January 31, 2011, the House of Representatives Committee on Population and Family Relations voted to consolidate all House versions of the bill, which is entitled An Act Providing for a Comprehensive Policy on Responsible Parenthood, Reproductive Health and Population Development and for Other Purposes. Stated purpose cv writing service birmingham One of the main concerns of the bill, according to the Explanatory Note, is that the population of the Philippines makes it â€Å"the 10th most populous nation in the world today†, that the Filipino women’s fertility rate is â€Å"at the upper bracket of 606 countries. † It states that studies and surveys â€Å"show that the Filipinos are responsive to having smaller-sized families through free choice of family planning methods. † It also refers to studies which â€Å"show that rapid population growth exacerbates poverty while poverty spawns rapid population growth. And so it aims for improved quality of life through a â€Å"consistent and coherent national population policy. † History According to the Senate Policy Brief titled Promoting Reproductive Health, the history of reproductive health in the Philippines dates back to 1967 when leaders of 12 countries including the Philippines Ferdinand Marcos signed the Declaration on Population. The Phili ppines agreed that the population problem be considered as the principal element for long-term economic development. Thus, the Population Commission (Popcom) was created to push for a lower family size norm and provide information and services to lower fertility rates. Starting 1967, the USAID started shouldering 80% of the total family planning commodities (contraceptives) of the country, which amounted to US$ 3 Million annually. US National Security Memorandum: paramount importance of world population control through programs of UN and USAID. In 1975, the United States adopted as its policy the National Security Study Memorandum 200: Implications of Worldwide Population Growth for U. S. Security and Overseas Interests (NSSM200). The policy gives paramount importance to population control measures and the promotion of contraception among 13 populous countries, including the Philippines to control rapid population growth which they deem to be inimical to the socio-political and economic growth of these countries and to the national interests of the United States, since the U. S. economy will require large and increasing amounts of minerals from abroad, and these countries can produce destabilizing opposition forces against the United States. It recommends the US leadership to influence national leaders and that improved world-wide support for population-related efforts should be sought through increased emphasis on mass media and other population education and motivation programs by the U. N. , USIA, and USAID. Different presidents had different points of emphasis. President Marcos pushed for a systematic distribution of contraceptives all over the country, a policy that was called coercive, by its leading administrator. The Cory Aquino administration focused on giving couples the right to have the number of children they prefer, while the Ramos presidency shifted from population control to population management. Estrada used mixed methods of reducing fertility rates, while Arroyo focused on mainstreaming natural family planning, while stating that contraceptives are openly sold in the country. In 1989, the Philippine Legislators’ Committee on Population and Development (PLCPD) was established, dedicated to the formulation of viable public policies requiring legislation on population management and socio-economic development. In 2000, the Philippines signed the Millennium Declaration and committed to attain the MDG goals by 2015, including promoting gender equality and health. In 2003, USAID started its phase out of a 33 year old program by which free contraceptives where given to the country. Aid recipients such as the Philippines faced the challenge to fund its own contraception program. In 2004, the Department of Health introduced the Philippines Contraceptive Self-Reliance Strategy, arranging for the replacement of these donations with domestically provided contraceptives. In August 2010, the government announced a collaborative work with the USAID in implementing a comprehensive marketing and communications strategy in favor of family planning called May Plano Ako (I Have a Plan). Key definitions House Bills 101 and 513, and Senate Bill 2378 define the term reproductive health care as follows: Reproductive Health Care refers to the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. This implies that people are able to have a satisfying and safe sex life, that they have the capability to reproduce and the freedom to decide if, when and how often to do so, provided that these are not against the law. This further implies that women and men attain equal relationships in matters related to sexual relations and reproduction. House Bill 96 replaces have a satisfying and safe sex life with enjoy responsible and safe sex but is otherwise identical in its definition. House Bill 1160 omits a satisfying and but is otherwise identical. House Bill 3387 omits the word complete before physical, and replaces attain with are afforded, but is otherwise identical. Reproductive Rights are defined by House Bills 101, 513, 1160, 3387, and Senate Bill 2378 as follows: the rights of individuals and couples, to decide freely and responsibly whether or not to have children; the number, spacing and timing of their children; to make other decisions concerning reproduction free of discrimination, coercion and violence; to have the information and means to do so; and to attain the highest standard of sexual and reproductive health. House Bill 96 replaces other decisions with allied decisions, but is otherwise identical. The opposition says that by supporting such definitions, the country will guarantee this same right of having a satisfying and safe sex life and the freedom of decision to unmarried children and teenagers, since they are people and individuals. They argue that this will lead to promiscuity among the young. [8] They say that the terminology is part of deceptive verbal engineering since RH is not in favor of reproduction, and contraceptives are not healthy, but RH is presented as something good. Bill content Sections The basic content of the Consolidated Reproductive Health Bill is divided into the following sections. 1. Title 2. Declaration of Policy 3. Guiding Principles 4. Definition of Terms 5. Midwives for Skilled Attendance 6. Emergency Obstetric Care 7. Access to Family Planning 8. Maternal and Newborn Health Care in Crisis Situations 9. Maternal Death Review 10. Family Planning Supplies as Essential Medicines 11. Procurement and Distribution of Family Planning Supplies 12. Integration of Family Planning and Responsible Parenthood Component in Anti-Poverty Programs 13. Roles of Local Government in Family Planning Programs 14. Benefits for Serious and Life-Threatening Reproductive Health Conditions 15. Mobile Health Care Service 16. Mandatory Age-Appropriate Reproductive Health and Sexuality Education 17. Additional Duty of the Local Population Officer 18. Certificate of Compliance 19. Capability Building of Barangay Health Workers 20. Ideal Family Size 21. Employers’ Responsibilities 22. Pro Bono Services for Indigent Women 23. Sexual And Reproductive Health Programs For Persons With Disabilities (PWDs) 24. Right to Reproductive Health Care Information 25. Implementing Mechanisms 6. Reporting Requirements 27. Congressional Oversight Committee 28. Prohibited Acts 29. Penalties 30. Appropriations 31. Implementing Rules and Regulations 32. Separability Clause 33. Repealing Clause 34. Effectivity Summary of major provisions The bill mandates the government to â€Å"promote, without bias, all effective natural and modern methods of family planni ng that are medically safe and legal. † Although abortion is recognized as illegal and punishable by law, the bill states that â€Å"the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a umane, non-judgmental and compassionate manner. † The bill calls for a â€Å"multi-dimensional approach† integrates a component of family planning and responsible parenthood into all government anti-poverty programs. Under the bill, age-appropriate reproductive health and sexuality education is required from grade five to fourth year high school using â€Å"life-skills and other approaches. † The bill also mandates the Department of Labor and Employment to guarantee the reproductive health rights of its female employees. Companies with less than 200 workers are required to enter into partnership with health care providers in their area for the delivery of reproductive health services. Employers are obliged to monitor pregnant working employees among their workforce and ensure they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that they are employed. The national government and local governments will ensure the availability of reproductive health care services, including family planning and prenatal care. Any person or public official who prohibits or restricts the delivery of legal and medically safe reproductive health care services will be meted penalty by imprisonment or a fine. Summary of support and criticism Proponents argue: (1) Economic studies, especially the experience in Asia, show that rapid population growth and high fertility rates, especially among the poor, exacerbate poverty and make it harder for the government to address it. (2) Empirical studies show that poverty incidence is higher among big families. Smaller families and wider birth intervals could allow families to invest more in each child’s education, health, nutrition and eventually reduce poverty and hunger at the household level. (3) Ten to eleven maternal deaths daily could be reduced if they had access to basic healthcare and essential minerals like iron and calcium, according to the DOH; (4) Studies show that 44% of the pregnancies in the poorest quintile are unanticipated, and among the poorest women who would like to avoid pregnancy, at least 41% do not use any contraceptive method because of lack of information or access. nd Among the poorest families, 22% of married women of reproductive age express a desire to avoid pregnancies but are still not using any family planning method, (5) use of contraception, which the World Health Organization has listed as essential medicines, will lower the rate of abortions as it has done in other parts of the world, according to the Guttmacher Institute. 6) An SWS survey of 2 008 showed that 71% of the respondents are in favor of the bill, (7) at the heart of the bill is the free choice given to people on the use of reproductive health, enabling the people, especially the poor to have the number of children they want and can care for. Opponents of the bill argue that: (1) The worlds leading scientific experts have resolved the issues related to the bill and show that the RH Bill is based on wrong economics as the 2003 Rand Corporation study shows that there is little cross-country evidence that population growth impedes or promotes economic growth. 2) The bill takes away limited government funds from treating many high priority medical and food needs and transfers them to fund harmful and deadly devices. The latest studies in scientific journals and organizations show that the ordinary birth control pill, and the IUD are abortifacient to fertilized eggs: they kill young human embryos, who as such are human beings equally worthy of respect, making the bil l unconstitutional. 3) Leading secular social scientists like Nobel prize winner, George Akerlof and US National Defense Consultant, Lionel Tiger, have shown empirical evidence that contraceptives have deleterious social effects (abortion, premarital sex, female impoverishment, fatherless children, teenage pregnancies, and poverty). Harvard Director Edward Green concluded that the best studies show that more condoms promote the spread of AIDS. Combined estrogen-progestogen oral contraceptives (the most common type prescribed globally) are carcinogenic, and confers other serious health risks. The increased usage of contraceptives, which implies that some babies are unwanted, will eventually lead to more abortion. (4) Peoples freedom to access contraceptives is not restricted by any opposing law, being available in family planning NGOs, stores, etc. The country is not a welfare state: taxpayers money should not be used for personal practices that are harmful and immoral; it can be used to inform people of the harm of BCPs. (5) A 2009 survey showed that 92% rejected the bill when informed of its detailed provisions and penalties. 6) The penal provisions constitute a violation of free choice and conscience, and establishes religious persecution. President Aquino stated he was not an author of the bill. He also stated that he gives full support to a firm population policy, educating parents to be responsible, providing contraceptives to those who ask for them, but he refuses to promote contraceptive use. He said that his position is more aptly called responsible parenthood ra ther than reproductive health. Economic and demographic premises The Philippines is densely populated, with a density over 300 per squared kilometer, and the population growth rate is 2. 04 (2007 Census), 1. 957% (2010 est. by CIA World Fact Book), or 1. 85% (2005-2010 high variant estimate by the UN Population Division, World Population Prospects: The 2008 Revision) coming from 3. 1 in 1960. The 2010 total fertility rate (TFR) is 3. 23 births per woman, from a TFR of 7 in 1960. In addition, the total fertility rate for the richest quintile of the population is 2. 0, which is about one third the TFR of the poorest quintile (5. children per woman). The TFR for women with college education is 2. 3, about half that of women with only an elementary education (4. 5 children per woman). Congressman Lagman states that the bill recognizes the verifiable link between a huge population and poverty. Unbridled population growth stunts socioeconomic development and aggravates poverty. The University of the Philippines School of Economics presented two papers in support of the bill: Population and Poverty: the Real Score (2004), and Population, Poverty, Politics and the Reproductive Health Bill (2008). According to these economists, which include Solita Monsod, Gerardo Sicat, Cayetano Paderanga, Ernesto M. Pernia, and Stella Alabastro-Quimbo, rapid population growth and high fertility rates, especially among the poor, do exacerbate poverty and make it harder for the government to address it, while at the same time clarifying that it would be extreme to view population growth as the principal cause of poverty that would justify the government resorting to draconian and coercive measures to deal with the problem (e. g. denial of basic services and subsidies to families with more than two children). They illustrate the connection between rapid population growth and poverty by comparing the economic growth and population growth rates of Thailand, Indonesia, and the Philippines, wherein the first two grew more rapidly than the Philippines due to lower population growth rates. They stressed that the experience from across Asia indicates that a population policy cum government-funded [fa mily planning] program has been a critical complement to sound economic policy and poverty reduction. In Population and Poverty, Aniceto Orbeta, Jr, showed that poverty incidence is higher among big families: 57. 3% of Filipino families with seven children are in poverty while only 23. 8% of families who have two children live below the poverty threshold. Percentage of population living below poverty line (2003). Darker areas mean more poverty. Proponents argue that smaller families and wider birth intervals resulting from the use of contraceptives allow families to invest more in each child’s education, health, nutrition and eventually reduce poverty and hunger at the household level. At the national level, fertility reduction cuts the cost of social services with fewer people attending school or seeking medical care and as demand eases for housing, transportation, jobs, water, food and other natural resources. The Asian Development Bank in 2004 also listed a large population as one of the major causes of poverty in the country, together with weak macroeconomic management, employment issues, an underperforming agricultural sector and an unfinished land reform Criticism of premises Opposing the bill, Former Finance Secretary Roberto de Ocampo wrote that it is truly disingenuous for anyone to proceed on the premise that the poor are to blame for the nation’s poverty. He emphasized that the government should apply the principle of first things first and focus on the root causes of the poverty (e. g. poor governance, corruption) and apply many other alternatives to solve the problem (e. g. giving up pork barrel, raising tax collection efficiency). They also point to the five factors for high economic growth and reduction of poverty shown by the 2008 Commission on Growth and Development headed by Nobel prize winner Michael Spence, which does not include population control. Opponents also refer to a 2003 Rand Corporation study which concluded that there is little cross-country evidence that population growth impedes or promotes economic growth population neutralism has in fact been the predominant school in thinking among academics about population growth for the last half-century. In his Primer which critiques the bill, Economist Roberto de Vera refers to Nobel prize winner Simon Kuznetss study which concludes that â€Å"no clear association appears to exist in the present sample of countries, or is likely to exist in other developed countries, between rates of growth of population and of product per capita. Julian Simon compared parallel countries such as North and South Korea, East and West Germany whose birthrates were pra ctically the same but whose economic growth was entirely different due to different governance factors. De Vera says that similar conclusions have been arrived at by the US National Research Council in 1986 and in the UN Population Fund (UNFPA) Consultative Meeting of Economists in 1992 and the studies of Hanushek and Wommann (2007), Doppelhoffer, Miller, Sala-I-Martin (2004), Ahlburg (1996), etc. The other Nobel Prize winner who expressed the same view is Gary Becker. De Vera also states that from 1961–2000, as Philippine population increased almost three times, poverty decreased from 59% to 34%. He stressed that the more probable cause of poor families is not family size but the limited schooling of the household head: 78% to 90% of the poor households had heads with no high school diploma, preventing them from getting good paying jobs. He refers to studies which show that 90% of the time the poor want the children they have: as helpers in the farm and investment for a secure old age. Instead of aiming at population decrease, De Vera stressed that the country should focus through education on cashing in on a possible â€Å"demographic dividend,† a period of rapid economic growth that can happens when the labor force is growing faster than the dependents (children and elderly), thus reducing poverty significantly. In a recent development, two authors of the Reproductive Health Bill changed their stand on the provisions of the bill regarding population and development. Reps. Emerciana de Jesus and Luzviminda Ilagan wanted to delete three provisions which state that gender equality and women empowerment are central elements of reproductive health and population and development, which integrate responsible parenthood and family planning programs into anti-poverty initiatives, and which name the Population Commission as a coordinating body. The two party-list representatives strongly state that poverty is not due to over-population but because of inequality and corruption. [42] Maternal health and deaths The proponents state that RH will mean: (1) Information and access to natural and modern family planning (2) Maternal, infant and child health and nutrition (3) Promotion of breast feeding (4) Prevention of abortion and management of post-abortion complications (5) Adolescent and youth health (6) Prevention and management of reproductive tract infections, HIV/AIDS and STDs (7) Elimination of violence against women (8) Counseling on sexuality and sexual and reproductive health (9) Treatment of breast and reproductive tract cancers (10) Male involvement and participation in RH; (11) Prevention and treatment of infertility and (12) RH education for the youth. There is general agreement on the health provisions of the RH bill, except for the provisions on contraception and family planning devices that have moral and health implications, and provisions on sex education done in schools. The Department of Health states that family planning can reduce maternal mortality by about 32 percent. [13] The bill is meant to prevent maternal deaths related to pregnancy and childbirth, said Clara Padilla of Engender Rights. She reported that Daily, there are 11 women dying while giving birth in the Philippines. These preventable deaths could have been avoided if more Filipino women have access to reproductive health information and healthcare. Regarding these figures, Francisco Tatad of the International Right to Life Federation and former Senator wrote that If correct, experience has shown (as in Gattaran, Cagayan and Sorsogon, Sorsogon) that the incidence of maternal death arising from such complications could be fully mitigated and brought down to ze ro simply by providing adequate basic and emergency obstetrics care and skilled medical personnel and services, without any need for a law on the distribution of contraceptives. [24] The key to solving maternal deaths, according to the Senate Policy Brief on reproductive health, is the establishment of birthing centers. Family planning The majority of Filipinos are in favor of family planning. The Catholic Church teaches the necessity of responsible parenthood and correct family planning (one child at a time depending on ones circumstances), while at the same time teaching that large families are a sign of Gods blessings. It teaches that modern natural family planning, a method of fertility awareness, is in accord with Gods design, as couples give themselves to each other as they are. The RH bill intends to help couples to have government funded access to artificial contraception methods as well. [citation needed] Unmet need Using data from the 2008 National Demographic and Health Survey, Lagman stated that Twenty-two percent of married Filipino women have an unmet need for family planning services, an increase by more than one-third since the 2003 National Demographic and Housing Survey. Our women are having more children than they desire, as seen in the gap between desired fertility (2. 5 children) and actual fertility (3. 5 children), implying a significant unmet need for reproductive health services, state some Ateneo de Manila University professors. The Bill provides that The State shall assist couples, parents and individuals to achieve their desired family size within the context of responsible parenthood for sustainable development and encourage them to have two children as the ideal family size. [9][38] Basing itself on demographic surveys, Likhaan, a non-government organization for womens health, stated that the most common reasons why women with unmet need in the Philippines do not practice contraception are health concerns about contraceptive methods, including a fear of side effects. 44% reported these reasons in 2008. The second largest category of reasons is that many believe they are unlikely to become pregnant—41% in 2008. Their specific reasons include having sex infrequently, experiencing lactational amenorrhea (temporary infertility while nursing) and being less fecund than normal. 43] Writing against the bill, Bernardo Villegas wrote about the Myth of Unmet Family Planning Needs, citing development economi st Lant Pritchett who said that the term unmet need is an elitist construct, an imposition of a need on the poor, disrespectful of their real preferences. Pritchett said that it is based on a discrepancy identified by the analyst through the comparison of responses to items in separate blocks of the questionnaire and is an inference on the part of the researcher, not a condition reported by the respondents themselves. Pritchett argued this term is applied to women who are not sexually active, are infecund, whose husband is absent, etc. thus bloating the numbers to favor the pharmaceutical companies and those with a population control agenda. Villegas stressed: Because [the poor] have been deprived of the infrastructures they need, such as farm-to-market roads, irrigation systems, post-harvest facilities and other support services that the State neglected to provide them, the only economic resources they have are their children. He also challenged that he is willing to bet that if the government will provide cash money to the poor to buy condoms, the poor will use the cash for food and basic needs, thus exploding the myth. [44] Access One of the main concerns of the proponents is the perceived lack of access to family planning devices such as contraceptives and sterilization. The bill intends to provide universal access through government funding, complementing thus private sector initiatives for family planning services, such as those offered by the International Planned Parenthood Federation (IPPF) which supports the Family Planning Organizations of the Philippines and the 97 organizations of the Philippine NGO Council. The opposition argues that Access to contraceptives is free and unrestricted and that the proposed law is pushing an open door. [24] They say that these family planning items are available to the citizens and many local government units and NGOs provide these for free. Congressman Teddyboy Locsin argued, echoed by a Business Mirror editorial, that the poor can afford condoms since they can pay for other items such as cellphone load. Opponents also argue that Philippine government is not a welfare state, and taxpayers are not bound to provide for all the wants and desires of its citizenry, including their vanity needs, promiscuous actions and needs artificially created by elitist, imperialist and eugenicist forces; nor should taxpayers pay for drugs that are objectively dangerous (carcinogenic) and immoral. They argue that the Philippines should give priority to providing access to medicines that treat real diseases. [19][24] Birth control pill The UP School of Economics argues, in contrast, that there is lack of access especially for poor people, because contraceptive use is extremely low among them and Among the poorest families, 22% of married women of reproductive age express a desire to avoid pregnancies but are still not using any family planning method. [9] They say that lack of access leads to a number of serious problems which demand attention: (1) too many and too closely-spaced children raises the risk of illness and premature deaths (for mother and child alike), (2) the health risks associated with mistimed and unwanted pregnancies are higher for adolescent mothers, as they are more likely to have complications during labor, (3) women who have mistimed pregnancies are constrained to rely more on public education and health services and other publicly provided goods and services, further complicating limited public resources, (4) families are not able to achieve their desired family size. Thus the UP economists strongly and unequivocally support the thrust of the bill to enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions. [9] Proponents argue that government-funded access is the key to breaking the inter-generational poverty that many people are trapped in. [9][38] Abortion One of the bills components is prevention of abortion and management of post-abortion co mplications. It provides that the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner. It also states that abortion remains a crime and is punishable, as the Constitution declares that â€Å"the State shall equally protect the life of the mother and the life of the unborn from conception. [45] Opposing the bill, the Faculty of Medicine of the catholic University of Santo Tomas, the Philippine Nurses Association (with at least 368,589 members), the Bioethics Society of the Philippines, Catholic Physicians’ Guild of the Philippines stated that â€Å"the antiabortion stance of the bill is contradicted by the promotion of contraceptive agents (IUD and hormonal contraceptives) which actually act after fertilization and are potentially abortifacient agents. †[46] Opposition refers to a 2000 study of a scientific journal of the American Medical Association, i n which a meta-analysis of 94 studies provides evidence that when a common birth control pill fails to prevent ovulation, postfertilization effects are operative to prevent clinically recognized pregnancy. [20] They also point to the American Journal of Obstetrics and Gynecology (2005), which concluded that the IUD brings about the destruction of the early embryo,[21] thus is deemed to kill five-day old babies. 8] Jo Imbong, founder of the Abay Pamilya Foundation, reported that Lagman said in a House hearing that the bill would protect human life from implantation,'[47] and not from fertilization, noting at the same time that the Records of the Constitutional Commission state that â€Å"Human life begins at fertilization. †[47][48] After referring to many standard textbooks of medicine and human embryology to affirm this as true,[49] the anti-RH bill citizens argue that the human embryo already has the complete genetic code and is thus a distinct human life beginning its own new life cycle. They say that the embryo is an individual, self-coordinated and self-organizing subject belonging to the species homo sapiens: a human being by nature and thus a person equally worthy of respect. 22] 5-day old human embryo called a blastocyst, which comprises 70-100 cells. Proponents argue that research by the Guttmacher Institute, involved in advancing international reproductive health, reveals that the use of contraceptives can reduce abortion rates by 85%. Proponents such as 14 Ateneo de Manila University professors, argued thus: Studies show that the majority of women who go for an abortion are married or in a consensual union (91%), the mother of three or more children (57%), and poor (68%) (Juarez, Cabigon, and Singh 2005). For these women, terminating a pregnancy is an anguished choice they make in the face of severe constraints. When women who had attempted an abortion were asked their reasons for doing so, their top three responses were: they could not afford the economic cost of raising another child (72%); their pregnancy occurred too soon after the last one (57%); and they already have enough children (54%). One in ten women (13%) who had attempted an abortion revealed that this was because her pregnancy resulted from forced sex (ibid. ). Thus, for these women, abortion has become a family planning method, in the absence of information on and access to any reliable means to prevent an unplanned and unwanted pregnancy. [38] The bill, said Clara Padilla of EnGender Rights Inc, will help reduce the number of abortions by providing increased access to information and services on modern contraceptive methods, that in turn will reduce the number of unwanted and often aborted pregnancies. [50] Opponents of the bill argue that the Guttmacher Institute is the research arm of International Planned Parenthood and t hat the latter is the largest promoter of artificial birth control and abortion worldwide. [19] Opponents argue that new data thwarts the myth that contraception lowers abortions. [51] Ang Kapatiran Party (AKP) in their Position Paper stated that The Guttmacher Institutes own study in 2003 showed simultaneous increases both abortion rates and contraceptive use in the United States, Cuba, Denmark, Netherlands, Singapore, and South Korea. [52] The AKP argues that Since contraceptives will not reduce unplanned pregnancy, they will not reduce abortion rates either and may increase them. [52] Both sides of the debate accuse the other side of deception and misleading the public. The pro-RH people accuse the anti-RH group of misleading the public by calling the bill an abortion bill, when the bill states that abortion remains a crime and is punishable. The anti-RH advocates accuse the RH supporters of deceiving the public regarding the true meaning of reproductive health, since US Secretar y Hillary Clinton said that RH includes abortion,[53] and that RH includes the pill where postfertilization effects are operative[21] and the IUD which brings about the destruction of the early embryo, according to the American Medical Association and the American Journal of Obstetrics and Gynecology. [21] Contraceptives Morality and social effects Another central issue is the morality of contraception. Around 81% of Filipinos are Catholics, and the Catholic Church teaches that extramarital sex and contraception are moral evils, since they desecrate sex which is intrinsically linked to new human beings whose lives are sacred. Contraception, says the church, also makes spouses lie about their total self gift to their spouse, by not surrendering their personal fertility. [54] Prolifers refer to economy Nobel prize winner George Akerlof who found that wide use of contraceptives led to premarital sex, illegitimate children, undomesticated men, crimes and abortions. However, 14 professors from Ateneo de Manila University, a prominent Catholic University, considering the empirical evidence of the dire socio-economic conditions of the Filipino poor, urged that the bill be passed to help them. They argued: As Catholics and Filipinos, we share the hope and mission of building a Church of the Poor. We are thus deeply disturbed and saddened by calls made by some members of the Catholic Church to reject a proposed legislation that promises to improve the wellbeing of Filipino families, especially the lives of women, children, adolescents, and the poor. They announced that Catholic social teachings recognize the primacy of the well-formed conscience over wooden compliance to directives from political and religious authorities, urging Catholic authorities to withdraw their opposition the bill. 38] Citing Catholic documents and scientific studies, they reasoned that the RH Bill is pro-life, pro-women, pro-poor, pro-youth, and pro-informed choice. They e mphasized that the bill promotes quality of life, by enabling couples, especially the poor, to bring into the world only the number of children they believe they can care for and nurture to become healthy and productive members of our society. [38] Thus, they entitled their paper as Catholics Can Support the RH Bill in Good Conscience. [38] In response, the Ateneo administration announced its unity with Catholic teaching and that it had serious objections to the present bill. [55] The catholic University of Santo Tomass student paper, The Varsitarian expressed shock about what they see as the professors erroneous conscience, and ignorance of economic science and medicine. [41] 42 prominent international Catholic scholars, including Janet E. Smith, Peter Kreeft, William E. May, and Joseph W. Koterski, S. J. , responded to the faculty of the Ateneo, saying that â€Å"It is never lawful, even for the gravest reasons, to do evil that good may come of it, that the bill disrespects poor people, and focuses primarily on providing services to curb the number of children of the poor, while doing little to remedy their situation. [56] Proponents such as Lagman also stressed that official Catholic teaching itself, expressed in the Encyclical Humanae Vitae issued only forty years ago in 1964, is not infallible. [15] He said that the Papal Commission on Birth Control, which included ranking prelates and theologians, recommended that the Church change its teaching on contraception as it concluded that â€Å"the regulation of conception appears necessary for many couples who wish to achieve a responsible, open and reasonable parenthood in today’s circumstances. † The editorial of the Philippine Daily Inquirer, moreover, stated that Catholic teaching is only a religious teaching and should not be imposed with intolerance on a secular state. Responding to the Inquirer, opponents of the bill said that science and secular moral reasoning show the objective truth that contraception is evil and disastrous for society, and therefore a secular state should stand by this evidence. Thus they cite the 15 non-religious reasons against contraception provided by the Ethics Guide of the secular BBC which includes the loss of potential beneficent human life, causing widespread moral promiscuity, weakening family life, being unnatural and anti-life. [57] They stress that it is the errors of conscience pushed by the dictatorship of relativism rather than the objective truth and the good that is imposing itself on people. They say that Catholic Church doctrine on contraception has been the same since its beginning,[57] taught by bishops around the world, thus part of infallible ordinary magisterium. [58] Prestigious secular and anti-Catholic social scientists are also reported to have found empirical evidence linking contraception and a variety of social ills: more premarital sex, fatherless children, and abortion; decline of marriage, crimes by unmarried men, poverty, social pathology (George Akerlof, Nobel prize winner);[25] heightened spread of AIDS (Edward C. Green, Harvard Director for AIDS);[27] breakdown of families, female impoverishment, trouble in the relationship between the sexes, and single motherhood (Lionel Tiger). 26][59] Opponents argue that misery is not the result of the church which they say is the largest charitable organization in the world, but of a breakdown in moral sense that gives order to society, nor does misery come from parents who bring up children in faithfulness, disc ipline, love and respect for life, but from those who strip human beings of moral dignity and responsibility, by treating them as mere machines, which they believe contraception does. [60] Health reasons In Medical Issues in the Reproductive Health Bill, Dr. Angelita Miguel-Aguirre refers to meta-analyses at scientific journals that show oral contraceptives (OCs) are unsafe. 19] A meta-analysis of the Stroke Journal concluded that OCs confer risk of first ischemic stroke. [31] The World Health Organization (WHO) announced the findings of The International Agency for Research on Cancer (IARC) in 2007 that there is sufficient evidence in humans for the carcinogecity of combined estrogen-progestogen contraceptives. [28][29] The Journal of Clinical Endocrinology Metabolism also concluded in 2005 that a rigorous meta-analysis of the literature suggests that current use of low-dose OCs significantly increases the risk of both cardiac and vascular arterial events. [30] In its list of esse ntial medicines, WHO stated that these drugs have been questioned and will be reviewed by its Expert Committee. 14] The World Health Organization announced scientific findings that the pill causes cancer and kept it in its list of essential medicines Opponents also say that being pregnant with a child is not a disease but a blessing, and that there are real diseases among the leading causes of mortality that should take on a higher priority, given the limited budget. They refer to data from the Department of Health as to the leading causes of death in the Philippines, and the daily death toll per 100,000 women are: (1) Heart diseases 80; (2) Vascular diseases 63; (3) Cancer 51; (4) Pneumonia 45; (5) Tuberculosis 23; (6) Diabetes 22; (7) Lower chronic respiratory diseases – 16. [24][61] Dr. Aguirre of the Makati Medical Society also said that The health risks of the pill actually outweighs by far the risks of pregnancy and childbirth to a womans health. [19] Proponents s uch as E. Ansioco of Democratic Socialist Women of the Philippines argued that The World Health Organization (WHO) includes contraceptives in its Model Lists of Essential Drugs and thus are safe medicines. [13][14] Medical and scientific evidence, says the main proponent, shows that all the possible medical risks connected with contraceptives are infinitely lower than the risks of an actual pregnancy and everyday activities The risk of dying within a year of using pills is 1 in 200,000. The risk of dying from a vasectomy is 1 in 1 million and the risk of dying from using an IUD is 1 in 10 million. But the risk of dying from a pregnancy is 1 in 10,000. [15] In Facts on Barriers to Contraceptive Use in the Philippines, Likhaan made the following projection: If all women who wanted to avoid pregnancy used modern methods, there ould be 1. 6 million fewer pregnancies each year in the Philippines. Unintended births would drop by 800,000, abortions would decline by 500,000 and miscarriages would dec line by 200,000. Expanding modern contraceptive use to all women at risk for unintended pregnancy would prevent 2,100 maternal deaths each year. It would also reap savings on medical care for pregnant women and newborns that would more than offset the additional spending on modern HIV/AIDS The RH bill provides for prevention and treatment of HIV/AIDS and other, STIs/STDs, especially since the number of HIV cases among the young nearly tripled from 41 in 2007 to 110 in 2008. 50] Primary among the means is distribution of condoms. The proponents applauded government efforts last February 2010 when it distributed condoms in some areas of Manila. On the other side of the debate, Dr. Rene Josef Bullecer, Director of AIDS-Free Philippines, said that in 1987, Thailand had 112 AIDS cases, more or less the same number as the Philippines (135). By the year 2003, there were around 750,000 cases in Thailand, where there was an intense campaign for the 100% Condom Use Program, while there were o nly 1,935 cases in the Philippines, whose population is around 30% greater than Thailands. [62][63] Pro-life groups refer to the Director of Harvards Aid Prevention Center, Edward C. Green, who said that the best evidence agrees with Benedict XVIs statement that condom distribution risked exacerbating the spread of the virus, because availability of condoms leads to riskier sexual Sexuality Education To achieve its goals, the bill provides for mandatory reproductive health education and that it be taught in an age-appropriate manner by adequately trained teachers starting from Grade 5 up to Fourth Year High School. Opposition to the bill is concerned about early sexualization of the youth and say that sexuality education promoters themselves state that it has led to more teenage pregnancies and illegitimacy. They stressed that what is needed is chastity education, especially taught by their parents, rather than sex education in school. Proponents refer to the latest UNESCO study dated December 2009 which concluded that sexuality education did not encourage early initiation into sex, but actually increased the age at which people first engage in sexual activity. [64] Opinion polls Proponents refer to many surveys conducted by two prominent locally based organizations (SWS and Pulse Asia) which show majority support for the bill. A survey conducted in 2008 by the Social Weather Stations, commissioned by the Forum for Family Planning and Development (FFPD), a non-government advocacy group, showed that 68 percent of Filipinos agree that there should be a law requiring government to distribute legal contraceptives. 65] SWS President and RH Bill proponent, Mahar Mangahas reported that the survey found 71 percent in favor [of the RH Bill], 21 percent undecided, and a mere 8 percent opposed. Among those who originally knew of the bill, the score is 84 percent in favor, and 6 percent opposed. Among those who learned of the bill for the first time because of the survey, the score is 59 percent in favor, versus 11 percent opposed. [16][65] Pulse Asia reported that in an October 2008 survey most Filipinos are aware of the reproductive health bill pending at the House of Representatives (68%) and are in favor of the bill (63%). [66] In December 2010, Pulse Asia announced based on the results of an October 2010 survey, 69% of the Filipinos are in favor of the bill. Saying that nation-wide surveys are financed by wealthy, foreign-funded political lobby groups to create a bandwagon effect, Senator Tatad remarked that an objective measure of Filipino preference is the consistent top electoral success of the pro-life party-list, Buhay Hayaan Yumabong (Let Life Flourish). [24] President of Prolife Philippines, Lito Atienza, said that the surveys conducted by SWS and Pulse Asia were misleading, because the participants were not fully informed of the bill, were merely aware of it, and informed that it was about health and modern methods. Instead he referred to the Filipino Family survey of December 2009 conducted by the HBA International (an affiliate of Louis Harris Associates) together with the personnel of Asia Research Organization (the Philippine affiliate of Gallup International). The survey concluded that 92% of people in Metro Manila rejected the bill, 85 percent are not aware that once passed the RH bill would allow teenagers to secure abortifacient devices and substances without their parents’ knowledge and consent. 90 percent do not agree that Congress should appropriate P2 billion to the detriment of other essential medicines for free children’s vaccinations, treatment of dreaded diseases and other more important health and medical concerns. [32] Mangahas acknowledged that the SWS surveys did not include the penalties. [67] Rallies and TV Debate From late 2010 to the present, there have been rallies for and against the bill. The pro-life rallies against the bill where in: Manila (March 25) 40,000[68] 200,000,[69][70] Mindanao 50,000,[71] Manila (Feb 13) 10,000[72] 50,000,[73] Bacolod 20,000,[74] Cebu 10,000 to 12,000,[75] Balanga 10,000,[76] Lucena 8,000,[77] Dipolog 10,000 and Pagadian 8,000,[78] Maasin, Leyte 6000 to 7000,[79][80] Manila Knights of Columbus March (March 2011) 7000,[81] Legazpi 4000,[82] Iloilo 4000,[83] San Pablo, Quezon 2000,[84] Quiapo (Oct) 1500. [85] The pro-RH rallies were: Batasan 1500,[86] CBCP complex 1000[87] A TV Debate was also hosted by ABS-CBN last May 2011. Leaders of both sides, including Rep. Lagman and Rep. Golez were present. According to the ABS-CBN news which reported on the results: In the SMS poll, 69. 58% of votes cast reject the RH bill while 30. 42% support it. In the separate online poll held on the Harapan microsite that livestreamed the debate, 63. 91% support the RH bill while 36. 09% oppose it. [88] Penalties There is mandatory sexuality education starting grade 5, and malicious disinformation is penalized. [7] All health care service providers which provide reproductive health services, including faith-based hospital administrators, may be imprisoned or fined if they refuse to provide family planning services such as tubal ligation and vasectomy. The same may happen to employers who do not provide free services to employees. 7] Imprisonment ranges from (1) month to six (6) months or a fine ranging from Ten Thousand Pesos (P10,000. 00) to Fifty Thousand Pesos (P50,000. 00). [7] Former Finance Secretary, Roberto de Ocampo, stated that these punitive provisions are tantamount to an affront to ci vil liberties and smack of religious persecution. [33] Defending the bill, Dr. Felipe Medalla, former dean of the School of Economics of UP, said that Although the poor’s access to family planning services can be improved even without the law, the absence of the law makes it easier to block the program. Separation of church and state Because 81% of Filipinos are Catholics, the Catholic Church exerts a strong influence in public life. Its staunch opposition to the bill has drawn the ire of non-Catholics and Catholics alike who support the bill, and they invoke the principle of separation of church and state to stop the church. Fr. Joaquin Bernas, S. J, one of the drafters of the Philippine Constitution and a prominent lawyer and writer, explained that the concept of separation of church and state is directed towards the state, rather than the church, as it is a political concept. Technically it means â€Å"non-establishment of religion†, as the Constitution stated that â€Å"No law shall be passed respecting an establishment of religion † It means that the state should be guided by the principle that it should support no specific religion. This means that government funding should not be allocated for building churches or mosques, and not favor any particular religion. It does not prevent the church, parents, supervisors, teachers and other moral educators from expressing their views and educating their wards on the morality of their personal and social actions. Proponents, on the other hand, state that the church should not meddle in matters of the state, and should focus on religious matters, not political matters. Culture war and its implications The national debate is seen as part of a wider culture war. [89][90] Passage or non-passage of the bill have negative implications depending on the views. Proponents state that the non-passage of the bill will mean keeping the Philippines in a backward state and unable to achieve the Millennium Development Goals, especially the points on poverty alleviation and maternal health. It will mean reneging on international commitments and will slow down modernization. Also the poor will not have free access to family planning support that many have expressed desires to have, and thus will have more children than they can care for, and will not have the money to invest in education to break the intergenerational poverty they are trapped in. Proponents also accuse the Catholic Church of holding the Philippines hostage and violating the separation of church and state. [91] They argue that a decreased population growth will lead to improved quality of life and economic development. Opponents of the bill see the bill as allowing the Filipinos to be fooled by the deceptive manipulations of American imperialism and eugenicist control, using United Nations Agencies for its own national interests, and to use Philippines own national funds to kill the youngest Filipinos, harm its own mothers, and encourage immorality. They see the bill as an act of disrespect and ingratitude to the Catholic Church that works for the poor and the sick, and for the education and development of Filipinos. [24][90] They accuse the Philippine Legislators Committee on Population and Development as essentially a foreign body that has drafted the bills, and that its 2008 lobbying fund of two billion pesos comes from the David and Lucile Packard Foundation, IPPF and UNFPA the latter two both well known for their global agenda to legalize abortion. [90] They say that a two-child policy will make the country fail to cash in on a possible demographic dividend of rapid economic growth, and great reduction of poverty, a chance for complete modernization without destruction of human life and promotion of immorality. [39] Status Legislature On January 31, 2011, six different bills were consolidated into a single RH Bill which was then unanimously approved for plenary debate by the House Committee on Population and Family Relations. On February 7, 2011, the bill was scheduled to go before the House Appropriations Committee. February 16, 2011 the bill was endorsed by the House Appropriations Committee with amendment and referred back to the Population Committee for finalizing the language. President and Cabinet President Noynoy Aquino will provide contraceptives to parents who ask, but will not promote its use. President Noynoy Aquino during the presidential campaign said that it confounds him why he is always associated with the RH Bill and reiterated that he is neither an author nor a co-author, much less did he sign the committee report regarding the bill. He said that he will fully support the crafting of a firm policy that will address the serious problem on population. [34] At the same time, Aquino said that artificial contraception was a matter of choice and conscience and that health professionals who fool people into using artificial contraceptives should be penalized. As a Catholic, Aquino said he himself was not promoting artificial contraception but believes that the government should be able to provide it to Filipinos who ask for it. Aquino stressed: I’m a Catholic, I’m not promoting it. My position is more aptly called responsible parenthood rather than reproductive health. [35] According to Rina Jimenez David who is pro-RH, during the â€Å"Women Deliver Philippines† Conference held September 2010, Dinky Soliman, Aquinos Secretary of Social Welfare and Development, said that choice and access† constituted the keystone of the Aquino government’s policy, reiterating the administration’s support for the pending reproductive health bills. [92] The Cabinet and the CBCP have agreed to have a joint campaign providing full information on the advantages and risks of contraceptives, natural and artificial family planning and responsible parenthood. They have established a technical working group for this purpose. They also agreed that government will not be an instrument to enforce or violate the conscience of the people about these issues. Compromise and alternatives Senate PresidentJuan Ponce Enrile, Congressman Roilo Golez and Buhay party-list separately filed bills that seek to restrict abortion and birth control use. These bills have been seen either as a nullification of the RH Bill, its alternative, or as a way of achieving unity among the populace, since the RH Bill proponents have stated their concern in preventing abortion. Presidential candidate Gilbert Teodoro or Gibo suggested a cash transfer from the government to individuals wanting access to family planning methods, whether natural or artificial. The individuals can then make use of the cash they receive to purchase birth control devices they may choose, thus guaranteeing freedom of choice. [93] The Loyola School of Theology and the John J. Carroll Institute on State and Church Issues issued 9 Talking Points on the RH Bill. Among other points, they proposed a study on the meaning of conception in the Constitution, and if it means fertilization, abortifacients are to be banned even now and regardless of whether the RH Bill is passed. They also proposed parallel programs for providing information and training, one for Natural Family Planning (NFP) and another for artificial methods of family planning. [94] Recent Events In September 2010, Aquino during this visit to the US reiterated his stand that he is in favor of responsible parenthood and respects the decision of each couple as to the number of children they want, and if they need the government support for contraception, then the government will provide it. This statement has created a furor as Catholic church leaders say that Aquino has sold out the Filipino soul in exchange for some measly aid from the United States. The President of the Catholic Bishops Conference said that there can possibly be an excommunication of the President if he continues on with his stance. Pro RH Bill Senators encouraged the President to be steadfast to do his duties towards the state. The Presidents spokesperson Edwin Lacierda explained that the President has not changed his stand and is reaching out to the prelates and said that the President himself has not made any decision in support of the Reproductive Health Bill as he is still studying the document. Lacierda said that the Executive Branch is not involved in the passage of the RH bill, saying the measures fate rests solely on the legislative branch. Filipino Freethinkers, an association of agnostics, atheists, progressives, etc. , who have been very active in the fight in favor of the RH bill, stepped up the pressure, creating more controversy that fired up renewed interest in the bill on both sides. On 30 September 2010, one of the freethinkers, Carlos Celdran staged a protest action against the Catholic Church, holding a sign which read DAMASO a reference to the villainous, corrupt clergyman Father Damaso of the novel Noli Me Tangere by Filipino revolutionary writer Jose Rizal and shouting stop getting involved in politics! A fan page, Free Carlos Celdran was created in Facebook, which generated 23,808 fans in 24 hours. Francisco Montalvan of the Inquirer said that in the end the Damasos are the scheming, corrupt and deceptive people, implying that the pro-death advocates are these, while the Cardinal Rosales who started a nationwide fund for the poor is very far from Damaso. Meanwhile, the Imam Council of the Philippines, the top leaders of the Moslem population which at 4. M constitutes 5% of the Philippine population, declared that they are against contraceptives since using them underestimates God, and makes one lose morality in the process. During the first public hear ing on Nov 24, the chair of the Committee on Population handling the bill said that there is no instruction from the Speaker of the House to expedite the bill. Upon the call of anti-RH congressmen, the Committee Chair decided to refer the bill also to the Committee on Health, since the bill is about Reproductive Health. Leader of the pro-RH group, Elizabeth Ansioco, said that the bill is doomed if it is referred to the Committee on Health. Anti-RH Deputy Speaker Congressman Pablo Garcia said the members of the Committee on Health know of the WHO announcement on the carcinogenicity of combined estrogen-progestogen oral contraceptives. House Speaker Belmonte said that Congress is not likely to rush the legislation of the bill and will tackle it in plenary early next year. Belmonte said it is better that highly contentious bills be given more attention. On 3 December, the Senate cut the proposed budget of P 880M for contraceptives down to P 8M for condoms since other contraceptives violated the Constitutions ban on abortifacients, and Senator Tito Sotto III said that his constituents never asked for contraceptives. Iglesia ni Cristo (INC) has expressed support for the Reproductive Health (RH) Bill. In a letter to House population and family relations committee chairman Rep. Rogelio Espina on October 2010, INC Executive Minister Eduardo Manalo said the bill needs to be passed. International reactions European Union European Union Ambassador to the Philippines Alistair MacDonald said We have all seen the figures on illegal abortion a year in the Philippines and I very much hope that both Houses of Congress will take these issues into account in producing a reproductive health legislation which will really help people make their own choices and to provide for their families. [95] MacDonald said that lack of effective access to reproductive health services in the Philippines was antithetical to the country’s struggle against poverty and It seems to me extremely unlikely that the Philippines will be able to meet its commitment under the MDGs under the present policy. [95] MacDonald noted that the total fertility rate for the richest quintile of the population is 2. 0, while the total fertility rate of the poorest quintile is 5. 9. The total fertility rate for women with a college education is 2. 3, about half that of women with only elementary education (4. 5). He mentioned that the lack of access to RH services is anti-women, citing the slow decline in the maternal mortality ratio in the Philippines. He also said surveys suggest that the total wanted fertility rate for the Philippines is 2. 4 children, or below the actual TFR of 3. 3 children. [95] International scholars An international group of conservative catholic scholars, including George Weigel, Mary Ann Glendon, Thomas Lickona have expressed opposition to the bill in a one-page ad in the major newspapers of the Philippines, entitled Population Control Does Not Reduce Poverty. They refer to the RAND Corporation study of 2003, which states that Most economic analysis has examined the statistical correlation between population and economic growth and found little significant connection here is little cross-country evidence that population growth impedes or promotes economic growth The neutralist theory has been the dominant view since the mid-1980s population neutralism has in fact been the predominant school in thinking among academics about population growth for the last half-century. [17] The international scholars stress ed that Corruption, lack of education, and lack of opportunity cause poverty. The poor are victims of poverty, not the cause of poverty HB 96 seeks to establish a government-managed program of population management and demographic targets in the Philippines. This policy is based on incorrect economics assumptions. Reproductive health bill: Facts, fallacies By Rep. Edcel Lagman Philippine Daily Inquirer THE BILL IS NATIONAL IN SCOPE, COMPREHENSIVE, rights-based and provides adequate funding to the population program. It is a departure from the present setup in which the provision for reproductive health services is devolved to