Reproductive Health Bill--Updated Article

Note: This is an updated article on RH Bill from Legalwiki. See also this article from the Wikipedia. -- jsalvador

Reproductive Health Bill

One of the most controversial bills pending in Congress, primarily brought about by the strong and active opposition by the Roman Catholic Church, is the Reproductive Health Bill. This is not the first time that a proposed law on reproductive health has been filed in Congress and the bills were not uniformly referred to as the Reproductive Health Bill or RH Bill, which term is used basically for convenience to refer to bills of similar nature.

Legislative History

As early as the 11th Congress, House Bill No. 8110 was already filed, proposing to establish an integrated population and development policy through a law which is supposed to be known Integrated Population and Development Act of 1999. During the 12th Congress, House Bill No. 4110 was filed, seeking to establish a reproductive health care act, or The Reproductive Health Care Agenda Act of 2001. The following bills were filed during the 13th Congress: Senate Bill No. 1280 (13th Congress), proposing The Reproductive Health Care Act, and House Bill No. 16, or the Reproductive Health Act of 2004 (House Bill). Senate Bill No. 3122 (The Reproductive Health and Population and Development Act of 2009) and House Bill No. 5043 (14th Congress) (Reproductive Health and Population Development Act of 2008) were filed during the 14th Congress. H.B. 5043 is in substitution to H.B. Nos. 17, 812, 2753 and 3970. None of these bills were passed. 

In the 15th Congress, Senate Bill No. 2378 (15th Congress) was filed in the Senate by Sen. Miriam Defensor Santiago, while the following bills were filed in the House of Representatives: House Bill No. 96 (15th Congress) by Hon. Edcel C. Lagman, House Bill No. 101 by Hon. Janette Garin, House Bill No. 513 (Hons. Kaka Bag-ao and Walden Bello, Akbayan), House Bill No. 1160 by Hon. Rodolfo G. Biazon, and House Bill No. 3387. (Hons. L.C. Ilagan, E.A. De Jesus, Gabriela Women's Party). These bills were subsequently consolidated and substituted by House Bill 4244 (15th Congress). 

Salient Points of House Bill 4244

H.B. 4244, which proposes a law which shall be known as the The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011, provides for a comprehensive policy on responsible parenthood, reproductive health, and population and development, and for other purposes. 

Responsible Parenthood refers to the will, ability and commitment of parents to adequately respond to the needs and aspirations of the family and children by responsibly and freely exercising their reproductive health rights.

Reproductive Health is 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.  

Population and Development refers to a program that aims to: (1) help couples and parents achieve their desired family size; (2) improve reproductive health of individuals by addressing reproductive health problems; (3) contribute to decreased maternal and infant mortality rates and early child mortality; (4) reduce incidence of teenage pregnancy; and (5) recognize the linkage between population and sustainable human development. The Department of Health and the Local Health Units in cities and municipalities shall serve as the lead agencies, with the Population Commission (POPCOM), as an attached agency of DOH, shall serving as the coordinating body. 

Reproductive Health Rights refer to the rights of couples, individuals and women to decide freely and responsibly whether or not to have children; to determine the number, spacing and timing of their children; to make decisions concerning reproduction free of discrimination, coercion and violence; to have relevant information; and to attain the highest condition of sexual and reproductive health.

Maternal Health

The explanatory note of one of the House Bills substituted by H.B. 4244, House Bill No. 96 (15th Congress), explains that the bill is primarily a health measure, seeking to improve maternal, newborn and child health and nutrition and reduce maternal, infant and child mortality. The death of 500,000 women worldwide annually due to complications related to pregnancy and childbirth is both an aberration and a gross social injustice. In the Philippines 11 mothers die daily. 

Midwives for skilled attendance

The Local Government Units (LGUs) with the assistance of the Department of Health (DOH), shall employ an adequate number of midwives to achieve a minimum ratio of one (1) fulltime skilled birth attendant for every one hundred fifty (150) deliveries per year, to be based on the annual number of actual deliveries or live births for the past two years; Provided, That people in geographically isolated and depressed areas shall be provided the same level of access. 

Emergency obstetric care

Each province and city, with the assistance of the DOH, shall establish or upgrade hospitals with adequate and qualified personnel, equipment and supplies to be able to provide emergency obstetric care. For every 500,000 population, there shall be at least one (1) hospital with comprehensive emergency obstetric care and four (4) hospitals or other health facilities with basic emergency obstetric care; Provided, That people in geographically isolated and depressed areas shall be provided the same level of access. 

Maternal and newborn health care in crisis situations

Local government units and the Department of Health shall ensure that a Minimum Initial Service Package (MISP) for reproductive health, including maternal and neonatal health care kits and services as defined by the DOH, will be given proper attention in crisis situations such as disasters and humanitarian crises. MISP shall become part of all responses by national agencies at the onset of crisis and emergencies. Temporary facilities such as evacuation centers and refugee camps shall be equipped to respond to the special needs in the following situations: normal and complicated deliveries, pregnancy complications, miscarriage and post-abortion complications, spread of HIV/AIDS and STIs, and sexual and gender-based violence. 

Maternal death review

Maternal Death Review refers to a qualitative and in-depth study of the causes of maternal death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies. All Local Government Units (LGUs), national and local government hospitals, and other public health units shall conduct annual maternal death review in accordance with the guidelines set by the DOH.

Reproductive Health Care

Reproductive Health Care refers to the access to a full range of methods, facilities, services and supplies that contribute to reproductive health and well-being by preventing and solving reproductive health-related problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations. The elements of reproductive health care include: (1) family planning information and services; (2) maternal, infant and child health and nutrition, including breastfeeding; (3) proscription of abortion and management of abortion complications; (4) adolescent and youth reproductive health; (5) prevention and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections (STIs); (6) elimination of violence against women; (7) education and counseling on sexuality and reproductive health; (8) treatment of breast and reproductive tract cancers and other gynecological conditions and disorders; (9) male responsibility and participation in reproductive health; (10) prevention and treatment of infertility and sexual dysfunction; (11) reproductive health education for the adolescents; and (12) mental health aspects of RH care. 

Right to Reproductive Health Care Information

The government shall guarantee the right of any person to provide or receive non-fraudulent information about the availability of reproductive health care services, including family planning, and prenatal care. The DOH and the Philippine Information Agency (PIA) shall initiate and sustain a heightened nationwide multi-media campaign to raise the level of public awareness of the protection and promotion of reproductive health and rights including family planning and population and development. 

Benefits for Serious and Life-Threatening Reproductive Health Conditions

All serious and life threatening reproductive health conditions such as HIV and AIDS, breast and reproductive tract cancers, obstetric complications, menopausal and post-menopausal related conditions shall be given the maximum benefits as provided by PhilHealth programs. 

Mobile Health Care Service

Each Congressional District shall be provided with at least one Mobile Health Care Service (MHCS) in the form of a van or other means of transportation appropriate to coastal or mountainous areas. The MHCS shall deliver health care goods and services to constituents, more particularly to the poor and needy, and shall be used to disseminate knowledge and information on reproductive health. The purchase of the MHCS shall be funded from the Priority Development Assistance Fund (PDAF) of each Congressional District. The operation and maintenance of the MHCS shall be subject to an agreement entered into between the district representative and the recipient focal municipality or city. The MHCS shall be operated by skilled health providers and adequately equipped with a wide range of reproductive health care materials and information dissemination devices and equipment, the latter including, but not limited to, a television set for audio-visual presentations. All MHCS shall be operated by a focal city or municipality within a congressional district. 

Pro Bono Services for Indigent Women

Private and non-government reproductive health care service providers, including but not limited to gynecologists and obstetricians, are mandated to provide at least 48 hours annually of reproductive health services ranging from providing information and education, to rendering medical services free of charge to indigent and low income patients, especially to pregnant adolescents. These 48 hours annual pro bono services shall be included as prerequisite in the accreditation under the PhilHealth. 

Sexual and reproductive health programs for Persons With Disabilities (PWDs).

Cities and municipalities must ensure that barriers to reproductive health services for persons with disabilities are obliterated through: (a) providing physical access, and resolving transportation and proximity issues to clinics, hospitals and places where public health education is provided, contraceptives are sold or distributed or other places where reproductive health services are provided; (b) adapting examination tables and other laboratory procedures to the needs and conditions of persons with disabilities; (c) increasing access to information and communication materials on sexual and reproductive health in braille, large print, simple language, and pictures; (d) providing continuing education and inclusion rights of persons with disabilities among health-care providers; and (e) undertaking activities to raise awareness and address misconceptions among the general public on the stigma and their lack of knowledge on the sexual and reproductive health needs and rights of persons with disabilities. 

Additional duty of the local population officer

Each Local Population Officer of every city and municipality shall furnish free instructions and information on family planning, responsible parenthood, breastfeeding, infant nutrition and other relevant aspects of the law to all applicants for marriage license. In the absence of a local Population Officer, a Family Planning Officer under the Local Health Office shall discharge the additional duty of the Population Officer. 

Capability building of barangay health workers

Barangay Health Workers and other community-based health workers shall undergo training on the promotion of reproductive health and shall receive at least 10% increase in honoraria, upon successful completion of training. The amount necessary for the increase in honoraria shall be charged against the Maintenance and Other Operating Expenses (MOOE) component of the Conditional Cash Transfer (CCT) program of the DSWD. In the event the CCT is phased out, the funding sources shall be charged against the Gender and Development (GAD) budget or the development fund component of the Internal Revenue Allotment (IRA).

Family Planning

Family Planning refers to a program which enables couples, individuals and women to decide freely and responsibly the number and spacing of their children, acquire relevant information on reproductive health care, services and supplies and have access to a full range of safe, legal, affordable, effective and modern methods of limiting and spacing pregnancy. 

Ideal family size

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. Attaining the ideal family size is neither mandatory nor compulsory. No punitive action shall be imposed on parents having more than two children. 

Integration of family planning and responsible parenthood component in anti-poverty programs

A multi-dimensional approach shall be adopted in the implementation of policies and programs to fight poverty. Towards this end, the DOH shall endeavor to integrate a family planning and responsible parenthood component into all anti-poverty programs of government, with corresponding fund support. The DOH shall provide such programs technical support, including capacity-building and monitoring. 

Access to family planning

All accredited health facilities shall provide a full range of modern family planning methods, except in specialty hospitals which may render such services on optional basis. For poor patients, such services shall be fully covered by PhilHealth Insurance and/or government financial assistance on a no balance billing. After the use of any PhilHealth benefit involving childbirth and all other pregnancy-related services, if the beneficiary wishes to space or prevent her next pregnancy, PhilHealth shall pay for the full cost of family planning. 

Requirement for Marriage License

No marriage license shall be issued by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office certifying that they had duly received adequate instructions and information on family planning, responsible parenthood, breastfeeding and infant nutrition. 

Roles of local government in family planning programs

The LGUs shall ensure that poor families receive preferential access to services, commodities and programs for family planning. The role of Population Officers at municipal, city and barangay levels in the family planning effort shall be strengthened. The Barangay Health Workers and Volunteers shall be capacitated to give priority to family planning work. 

Family planning supplies

Products and supplies for modern family planning methods shall be part of the National Drug Formulary and the same shall be included in the regular purchase of essential medicines and supplies of all national and local hospitals and other government health units. 

Procurement and distribution of family planning supplies

The DOH shall spearhead the efficient procurement, distribution to Local Government Units (LGUs) and usage-monitoring of family planning supplies for the whole country. The DOH shall coordinate with all appropriate LGUs to plan and implement this procurement and distribution program. The supply and budget allotments shall be based on, among others, the current levels and projections of the following: (a) number of women of reproductive age and couples who want to space or limit their children; (b) contraceptive prevalence rate, by type of method used; and (c) Cost of family planning supplies.

Sex Education

The bill provides for a Reproductive Health and Sexuality Education, which refers to a lifelong learning process of providing and acquiring complete, accurate and relevant information and education on reproductive health and sexuality through life skills education and other approaches. It shall be taught by adequately trained teachers in formal and non-formal educational system starting from Grade Five up to Fourth Year High School using life-skills and other approaches. Reproductive Health and Sexuality Education shall commence at the start of the school year immediately following one (1) year from the effectivity of this Act to allow the training of concerned teachers. The Department of Education (DepEd), the Commission on Higher Education (CHED), the Technical Education and Skills Development Authority (TESDA), the Department of Social Welfare and Development (DSWD), and the Department of Health (DOH) shall formulate the Reproductive Health and Sexuality Education curriculum. Such curriculum shall be common to both public and private schools, out of school youth, and enrollees in the Alternative Learning System (ALS) based on, but not limited to, the following, the psycho-social and the physical wellbeing, the demography and reproductive health, and the legal aspects of reproductive health. 

Age-appropriate reproductive health and sexuality education shall be integrated in all relevant subjects and shall include, but not limited to, the following topics:

• Values formation;

• Knowledge and skills in self protection against discrimination, sexual violence and abuse, and teen pregnancy;

• Physical, social and emotional changes in adolescents;

• Children’s and women’s rights;

• Fertility awareness;

• STI, HIV and AIDS;

• Population and development;

• Responsible relationship;

• Family planning methods;

• Proscription and hazards of abortion;

• Gender and development; and

• Responsible parenthood.

The DepEd, CHED, DSWD, TESDA, and DOH shall provide concerned parents with adequate and relevant scientific materials on the age-appropriate topics and manner of teaching reproductive health education to their children.

Employers’ responsibilities

The Department of Labor and Employment (DOLE) shall ensure that employers respect the reproductive rights of workers. The term employer refers to any natural or juridical person who hires the services of a worker, but does not include any labor organization or any of its officers or agents except when acting as an employer. Employers shall comply with the following:

• Reproductive health services. Consistent with the intent of Article 134 of the Labor Code, employers with more than 200 employees shall provide reproductive health services to all employees in their own respective health facilities. Those with less than 200 workers shall enter into partnerships with hospitals, health facilities, and/or health professionals in their areas for the delivery of reproductive health services.

• Information. Employers shall furnish in writing the following information to all employees and applicants:

·    The medical and health benefits which workers are entitled to, including maternity and paternity leave benefits and the availability of family planning services;

·     The reproductive health hazards associated with work, including hazards that may affect their reproductive functions especially pregnant women; and

·        The availability of health facilities for workers.

• Pregnant workers. Employers are obliged to monitor pregnant working employees among their workforce and ensure that they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that the pregnant employee is employed in their company or organization. These paid pre-natal medical leaves shall be reimbursable from the Social Security System (SSS) or the Government Service Insurance System (GSIS), as the case may be.

Prohibited acts

The bill imposes criminal penalties for certain violations. The penalty includes imprisonment ranging from one (1) month to six (6) months or a fine of Ten Thousand Pesos (PhP10,000) to Fifty Thousand Pesos (PhP50,000.00), or both, at the discretion of the court. An offender who is a public official or employee shall also suffer the accessory penalty of dismissal from the government service and forfeiture of retirement benefits. If the offender is a juridical person, the penalty shall be imposed upon the president or any responsible officer. The following acts are prohibited:

• Any healthcare service provider, whether public or private, who shall:

·  Knowingly withhold information or restrict the dissemination thereof, and/or intentionally provide incorrect information regarding programs and services on reproductive health, including the right to informed choice and access to a full range of legal, medically-safe and effective family planning methods. 

·   Refuse to perform legal and medically-safe reproductive health procedures on any person of legal age on the ground of lack of third party consent or authorization. In case of married persons, the mutual consent of the spouses shall be preferred. However, in case of disagreement, the decision of the one undergoing the procedure shall prevail. In the case of abused minors where parents and/or other family members are the respondent, accused or convicted perpetrators as certified by the proper prosecutorial office or court, no prior parental consent shall be necessary. 

·        Refuse to extend health care services and information on account of the person’s marital status, gender, sexual orientation, age, religion, personal circumstances, or nature of work. The conscientious objection of a healthcare service provider based on his/her ethical or religious beliefs shall be respected. However, the conscientious objector shall immediately refer the person seeking such care and services to another healthcare service provider within the same facility or one which is conveniently accessible who is willing to provide the requisite information and services. The person is not in an emergency condition or serious case as defined in Republic Act No. 8344 penalizing the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency and serious cases.

• Any public official who, personally or through a subordinate, prohibits or restricts the delivery of legal and medically-safe reproductive health care services, including family planning; or forces, coerces or induces any person to use such services.

• Any employer or his representative who shall require an employee or applicant, as a condition for employment or continued employment, to undergo sterilization or use or not use any family planning method; neither shall pregnancy be a ground for non-hiring or termination of employment.

• Any person who shall falsify a Certificate of Compliance.

• Any person who maliciously engages in disinformation about the intent or provisions of this law.

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