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Understanding the impact of the reproductive health law: an inquirer's guide to optimal reproductive health.

Introduction

The Reproductive Health Law (RHL) in the Philippines has been a controversial topic since it was enacted in 2012. The law aims to provide universal access to family planning methods, including contraceptives, and promote reproductive health education. Despite its passage, there are still challenges that have prevented its full implementation. In this blog post, we will explore the importance of the RHL, its advantages, controversies, and challenges.

Advantages of the Reproductive Health Law

The RHL is essential because it offers several benefits, such as:

Improved Maternal and Child Health

In the Philippines, about 11 women die every day from pregnancy-related complications. Most maternal deaths occur during childbirth. The RHL provides access to maternal healthcare and family planning information and services, reducing maternal deaths and promoting better child health outcomes.

Reduced Poverty

Poverty is one of the leading causes of poor health outcomes in the Philippines. By promoting family planning, the RHL provides families with opportunities to plan their futures and have better control over their finances. It allows them to invest in education, business, and other ventures that can improve their lives’ quality, breaking the cycle of poverty.

Gender Equality and Women Empowerment

The RHL addresses gender inequality by empowering women to make informed choices about their sexual and reproductive health. It enables them to decide when to marry or start a family, pursue education and careers, and protect themselves from unwanted pregnancies, resulting in equal opportunities for women.

Controversies Surrounding the Reproductive Health Law

Despite its many advantages, the RHL has been met with controversy. There are various objections to the law, such as:

Religious Objections

The Catholic Church has a significant influence on Philippine society, and it opposes the RHL, believing that it promotes contraception and abortion, which are against its teachings. Religious leaders argue that the law violates their religious freedom and conscience.

Human Rights Issues

The RHL mandates sex education in schools, but some organizations oppose this, claiming that it promotes premarital sex and undermines traditional Filipino family values. There are also concerns that the law may discriminate against couples who choose not to use contraception or those who have large families. These groups believe that the government should not interfere with their private lives and decisions.

Challenges to Implementing the Reproductive Health Law

In addition to controversies, several challenges have hindered the full implementation of the RHL, such as:

Limited Access to Family Planning Resources

In many areas, especially in rural communities, access to family planning information and services remains limited. Some individuals may be unaware of the existence of contraceptives and the benefits of family planning.

Lack of Funding and Support

Lack of funding and support has hampered the law’s ability to achieve its goals fully. Many public health facilities lack the resources and training needed to provide quality maternal and reproductive healthcare. Additionally, some policymakers do not prioritize reproductive health in their agendas, limiting the resources allocated to initiatives promoting reproductive health.

Resistance from Local Governments

Despite the federal mandate, some local governments resist implementing the RHL due to cultural and religious beliefs or political opposition. This resistance has resulted in inconsistent policy and service delivery at the local level, creating confusion among providers and patients.

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The Reproductive Health Law in the Philippines: Pros and Cons

The Philippine government passed the Reproductive Health (RH) Law in 2012 to promote the reproductive health of Filipinos, especially women, by ensuring universal access to reproductive health services, information, and products.

The RH Law provides numerous benefits for individuals, families, and the entire society. Here are some of the pros:

1. Reduced maternal mortality rate: The law promotes maternal health by giving mothers access to family planning methods, prenatal care, and safe childbirth services. This leads to a lower risk of maternal death and complications during pregnancy and childbirth.

2. Improved family planning: The RH Law recognizes the right of couples and individuals to make informed choices about their reproductive health. It provides them with information and access to a wide range of family planning methods, including natural methods, artificial contraception, and sterilization procedures.

3. Increased awareness and education: The law mandates the inclusion of RH education in schools, as well as the dissemination of information and services related to RH issues. This can lead to increased awareness among young people and adults about their reproductive health rights and options.

4. Gender equality: The RH Law recognizes the reproductive rights of women, particularly their right to make decisions regarding their health, fertility, and sexuality. This promotes gender equality by empowering women to take control of their own bodies and lives.

Despite its many benefits, the RH Law has also faced opposition from various groups who have raised concerns about its impact on Filipino culture, morality, and religious beliefs. Here are some of the cons:

1. Violation of religious beliefs: Some religious groups have opposed the RH Law, arguing that it promotes promiscuity and undermines traditional family values. They believe that contraception and other forms of artificial birth control are a sin against God, and therefore, the law violates their religious beliefs.

2. Unintended consequences: Critics also fear that the RH Law could lead to unintended consequences, such as an increase in premarital sex, teenage pregnancies, sexually transmitted infections (STIs), and abortions.

3. Funding issues: The implementation of the RH Law requires substantial funding for the provision of health services and products. The government has faced challenges in securing sufficient funding, which could compromise the quality and accessibility of reproductive health services.

Despite the challenges and opposition, the implementation of the RH Law has already yielded numerous benefits for Filipinos. These benefits include:

1. Improved maternal health: Since the implementation of the RH Law, the rate of maternal deaths in the Philippines has decreased from 221 per 100,000 live births in 2011 to 120 per 100,000 live births in 2019. This is a significant improvement in the health and well-being of mothers in the country.

2. Increased access to family planning: The RH Law has made family planning services and products more accessible to Filipinos, particularly those in rural areas and low-income communities. This has empowered them to make informed choices about their reproductive health and effectively plan their families.

3. Enhanced education and awareness: The law has helped improve the knowledge and awareness of Filipinos about reproductive health issues, including the benefits and risks of various family planning methods. This has helped dispel myths and misconceptions about contraception and promote responsible, healthy sexual behavior.

4. Gender equality: The RH Law has contributed to promoting gender equality by empowering women and men to make informed choices about their reproductive health. It recognizes the importance of women’s autonomy, dignity, and rights and promotes their access to comprehensive reproductive health services.

The Reproductive Health Law has been a controversial but necessary step towards improving the reproductive health and well-being of Filipinos. Despite the opposition and challenges it has faced, the law has already yielded significant benefits for individuals, families, and society. With continued support and implementation, the RH Law can help pave the way towards a healthier and more equitable future for all Filipinos.

Frequently Asked Questions About Reproductive Health Law Inquirer

What is the reproductive health law inquirer.

The Reproductive Health Law Inquirer is an online magazine that provides news and analysis on the implementation of the Reproductive Health Law in the Philippines.

What is the Reproductive Health Law?

The Reproductive Health Law is a law in the Philippines that promotes access to reproductive health services and information, including family planning, maternal health and sexuality education.

What are the benefits of the Reproductive Health Law?

The Reproductive Health Law seeks to improve maternal and child health by providing access to a range of modern contraceptive methods, and it promotes gender equality by encouraging women to have control over their own reproductive health.

What are some concerns about the Reproductive Health Law?

Some critics of the Reproductive Health Law express concerns over its promotion of contraception and its perceived conflict with religious values. Others worry about the cost of implementing the law, as well as its potential impact on population control policies.

What role do healthcare providers play in implementing the Reproductive Health Law?

Healthcare providers play a crucial role in implementing the Reproductive Health Law by providing access to modern contraceptive methods, as well as reproductive health education and counseling services.

How can individuals support the implementation of the Reproductive Health Law?

Individuals can support the implementation of the Reproductive Health Law by advocating for reproductive rights and education, as well as by respecting the choices and decisions of those seeking access to reproductive health care and information.

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Inside the Philippines’ long journey towards reproductive health

PhD candidate in Medical Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam

Disclosure statement

Gideon Lasco does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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On January 9 2017, Philippine President Rodrigo Duterte signed an executive order calling for universal access to modern family planning methods. The document also called for accelerated implementation of the country’s Reproductive Health Law .

Popularly known as the “RH law”, the measure was passed in 2012 but was suspended by the Supreme Court , following objections from religious groups that alleged the law violated the rights to religion and free speech.

Duterte’s order was welcomed even by some of his fiercest critics. Human Rights Watch, for instance, called it a “bright spot in the administration’s otherwise horrendous human rights record via its abusive ‘war on drugs’”. Aside from promoting family planning, the RH law covers wide-ranging provisions for emergency obstetric care, sex education, and maternal and child health.

But the very fact that such seemingly anodyne health matters even have to be affirmed attests to the contested nature of reproductive health issues in the Philippines. Just one day after Duterte signed the executive order, Luis Cardinal Tagle, Manila’s archbishop, reiterated that the Church “is against any law that promotes both natural and artificial family planning methods.”

Politically and morally contentious

Viewed in a broader historical frame, the ongoing debate is a continuation of the Philippines’ long journey towards reproductive health - and its having been turned into a political and moral issue by various actors . It’s also inexorably bound to the Church’s long-running enmeshment in the politics of a country where 80% of the people are, at least nominally, Catholic .

The Catholic Church’s opposition to population control and artificial contraception goes beyond the Philippine’s shores. Pope Paul VI’s _Humanae Vitae _ (1968) made the Church’s stance a matter of dogma, and it has since been affirmed by successive popes .

Initially, the Church’s stand didn’t seem to have much of an impact on Philippine policy. Just a year after Humanae Vitae , then-president Ferndinand Marcos established a Population Commission that sought to control population growth.

And in 1973, a new, Marcos-backed constitution called on the government “to achieve and maintain population levels most conducive to the national welfare.”

But the situation changed in the 1980s, when the people turned against Marcos’ corrupt and authoritarian government (which, it should pointed out, ultimately proved ineffective in its population control efforts). The Church was instrumental in the 1986 EDSA People Power Revolution that deposed and forced Marcos into exile.

The new president, Cory Aquino, was much more pliant to the Church’s wishes. The 1987 “Cory Constitution” enshrined “the life of the mother and the life of the unborn from conception”. Tellingly, it omitted any reference to population control.

A succession of presidents would continue to toe the Church’s line. Gloria Arroyo - another beneficiary of a Church-backed “revolution” - would be the most ardent, making it state policy to promote only “natural” family planning methods . This was despite scientific consensus that such methods are ineffective , and the fact that a majority of Filipinos actually support artificial contraception .

Regardless of presidents’ acquiescence to the Church, support for an RH law slowly but steadily grew. In 1999, the first of many RH bills was filed in Congress . Ironically, it was Cory’s son Benigno Aquino III (Arroyo’s successor), who ultimately got the law passed .

Duterte, who took over from Aquino in 2016, was equally vocal in his support for reproductive health. In his first national address , he stressed that the RH law should be implemented “so that couples especially the poor will have freedom of informed choice on the number and spacing of children.”

Growing population, rising HIV

The politics of the RH Law notwithstanding, its rationale in the Philippines are quite clear.

Population growth remains very high. From 31.7 million when Marcos took office in 1965 , it is expected that there will be 105 million Filipinos by the end of 2017 - an astounding tripling in just over 50 years.

Economists agree that while “poverty is a complex phenomenon”, “rapid population growth and high fertility rates, especially among the poor, do exacerbate poverty and make it harder for the government to address it.” In 2012, 30 economists from the University of the Philippines affirmed the role of the RH bill in population growth and consequently in poverty reduction.

In addition, there is an alarming increase in HIV infection rates that makes the Philippines one of the few countries to actually register growing prevalence. HIV prevention is actually the health ministry’s main rationale for condom distribution and promotion . But that too is unacceptable to anti-RH advocates who argue that it would breed immorality .

Moving forward

Some observers have noted that the Church’s infuence in Philippine politics is waning , citing its failure to stop the RH law. But while its power may have diminished, it remains an important political actor.

In the same month as Duterte’s executive order, the Department of Education announced that it would block the distribution of condoms in schools, caving in to pressure from the Church . The RH Law itself, in an attempt to appease the Church, includes “natural methods” and “responsible parenthood” in its language, and mentions “religious convictions” seven times.

Is there a chance that the Church will change its position? Pope Francis’ recent pronouncement that contraception is a “lesser evil” than abortion - at least in cases of Zika - raised some hope. Ultimately, however, his statement was rightfully seen as a change in tone - not in substance .

Judging from the Philippine bishops’ latest rhetoric , which casts contraceptive use as “immoral”, it’s highly unlikely that the Church will change its mind.

Even so, the fact that two presidents - belonging to two opposing political camps - have supported reproductive health raises hopes that it is becoming a post-political, post-ecclesiastical issue.

After a long journey, there’s reason to hope that the RH law will finally be implemented in full in the Philippines, and with it, badly-needed population and HIV control programs.

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10 Years, 10 Lessons: Implementing the Reproductive Health Law in the Philippines

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Reproductive health (RH) advocates and champions in the Philippines faced a tough 14-year long battle against powerful groups and strong oppositions to turn the Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No. 10354) into a landmark law in December 2012. Known as the RH Law, it provides universal and free access to modern contraceptive methods, mandates age- and development-appropriate reproductive health education in government schools, and recognizes a woman’s right to postabortion care in the Philippines as part of the right to reproductive healthcare.

Enactment, however, did not guarantee immediate success. The law still had to overcome legal battles for four more years (2013 to 2017)—from overcoming challenges on the constitutionality of  temporary restraining orders on contraception  use—to those who were opposed to implementing its rules and regulations.

On December 17, 2022, RH champions, advocates, and other stakeholders gathered once again to mark the 10th year anniversary of the RH Law. Various government officials, lawmakers, and representatives from civil society organizations reminisced about their struggles, reflecting on the challenges and lessons a decade after the law’s enactment and calling on government and key partners for additional commitments moving forward. There have been noteworthy successes, with public support and demand for FP/RH remaining strong and with other FP/RH-related bills becoming laws. Yet, challenges still exist, including declining budgets and finding ways to integrate the law into local government units. As the former Executive Director of the Commission on Population and Development (POPCOM) Dr. Juan Antonio Perez III said, “After the first decade of the RH Law, there is still work to do.”

Since the enactment of the RH Law in 2012, what lessons have RH champions and advocates learned? Here are 10 lessons from 10 years of implementing the RH Law in the Philippines.

1. It is not enough to make an RH bill a law—it is important to give it teeth.

Giving the law “teeth” means ensuring that it has clear implementing rules and regulations backed by a sufficient budget to move it forward. It also means having joint oversight meetings of various agencies and stakeholders to consistently monitor its implementation and resource mobilization.

“It is not just about crafting a bill, legislating it, and putting it into a law. What is more important is implementing it,” emphasized former Department of Health (DOH) Secretary and now Iloilo 1st District Representative Janette Garin.

2. An RH law is nothing without consistent, adequate funding.

Government leaders, both at the national and local levels, may verbally support a law, but there needs to be funding for implementation. The national government should give clear instructions to the Ministry of Budget or Finance to allocate, on an annual basis, adequate funding for the law and if possible, create a multi-year costed implementation plan for FP/RH initiatives. At the local government level, ensure that FP/RH program implementation is included in annual budget plans.

Walden Bello, one of the principal sponsors of the Philippines’ RH Bill, also shared his thoughts on this: “A major step to address the funding issue would be for the law’s implementation being designated by Congress as a ‘priority medical concern,’ which would entitle it to the level of funding such a designation mandates.”

3. Wisely spending the budget allocated for FP/RH provides indisputable evidence to continue funding and implementing the law.

Spend the bigger percentage of the government’s allocated budget for FP/RH on services, not on administrative costs. Most of the time, the government spends a large portion of its FP/RH program budget on training and seminars and less on procuring commodities or improving services. Spending on administrative matters is necessary, but an FP/RH program should not be purely administrative in nature because people also need support and services—both of which are essential components.

According to former DOH Secretary Garin, “If the budget is spent mostly on administrative costs and there are no services provided, surely, it will be a big stone against the law…I amended things so that the budget for reproductive health will really be spent on people. That is why, when the law was challenged in the Supreme Court, we did not have difficulty showing that ‘Here we are, already implementing the law that will actually transcend to services for women.’”

4. Political will is key and priceless to successful implementation.

Clichéd as it may seem, it is political will that propels government leaders to find ways to fund and speed up implementation within their respective jurisdictions. Political will moves leaders to purchase and distribute contraceptives, to provide comprehensive FP/RH services, and to implement comprehensive sexuality education (CSE) programs despite opposition from influential anti-RH groups at both the national and local levels.

“Local governments have access to the resources. It is really a matter of prioritizing…We have a very small budget in our city but if you know that you need to put your heart and your funds where it should be, it is possible,” shared Isabela City Mayor Djalia Hataman of Basilan, a province in the southernmost part of the Philippines.

Most importantly, lead implementing agencies, such as the Ministry of Health, must be at the forefront of having the political will to advocate for sufficient funds, provide support, and enforce the RH law.

5. Mobilize the most relevant government agencies to implement the law.

It seems logical and easy to understand, yet the importance of relevance is sometimes overlooked. Beyond the Ministry of Health, determine which government agency is best placed to implement the law. Engage the agency focused on population and development. Involve the agency responsible for appropriating the budget for the RH law. Work with the Ministry of Education to integrate CSE into the basic curriculum. Most importantly, ensure that the law and its implementing rules and regulations clearly state the roles and responsibilities of these relevant government agencies.

6. In a decentralized form of government, the power is with local government leaders. Make them your allies.

The devolution of the health system in the Philippines puts the power and the money to implement the RH Law in the hands of local chief executives. Advocates helped them become allies by regularly supporting them and educating them on how prioritizing FP/RH is an effective use of scarce resources that ultimately translates to material cost savings, which can then be reinvested in other priority sectors.

As Mayor Hataman shared, “It was Likhaan* who molded me to be who I am right now. They introduced me to reproductive health and it was my experience working on RH that developed me on how to prioritize and operate FP/RH programs in my city.” (*Likhaan is a non-government, nonprofit organization in the Philippines established in 1995 to respond to the sexual and reproductive health needs of women experiencing poverty.)

Consequently, her city is the only local government unit in the southern Philippines’ Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) region that has lowered its teenage pregnancy rates.

Another way to make local government an ally is to make it easy and simple for them to implement the RH law and integrate FP/RH activities within their development plans. As the Philippines Legislators’ Committee on Population and Development (PLCPD) put it, “Integration and streamlining of RH activities into a comprehensive set of services that local government units can adopt…is crucial given the…devolution of governance.”

7. Relentlessly educate national and local governments on the cost effectiveness of funding and implementing FP/RH initiatives.

RH advocates and champions must continuously sensitize the national government, especially economic managers, to the idea that providing FP/RH services is one of the most effective ways to develop a country.

According to Dr. Ernesto Pernia, former secretary of the Philippines’ National Economic Development Authority (NEDA), international trade and providing FP/RH services are the most important ways of boosting a country’s development. However, the former is dependent on external factors, whereas the latter is well within local leadership’s control.

In addition, Congressman Edcel Lagman, one of the primary authors and a staunch advocate of the RH Law, emphasized that RH advocates must continuously make government leaders understand that more budget for RH means more savings on healthcare: “We should be able to tell government that when we are budgeting for infrastructure projects, the beneficiaries are lesser. We should be able to give an adequate budget to RH, which requires a lesser budget, but has limitless beneficiaries…this is very important to attaining sustainable human development. The government does not see this. I think the government should be able to know that and that should come for us.”

8. Use public sentiment to one’s advantage.

Instead of simply clashing with unyielding opposition during hours-long debates on the passage of the RH bill happening within the Congress’ plenary hall, advocates brought the issue to the public. Legislators and activists in the Philippines came together and learned from each other on the best ways to increase popular attention to this landmark legislation. Once the public’s consciousness was raised, support for the issue increased, further putting pressure on the government and the opposition.

Senator Pia Cayetano, one of the proponents of the RH bill, said, “Strong political will and a solid partnership with civil society are vital in propelling progressive legislation.”

9. Know who is for you and against you.

Work with those who are for you: Make them your ally, learn from each other, share resources, and strategize together to make a breakthrough. Do not underestimate the opposition. They will always find loopholes to subvert the new law. Know them well. Always be prepared by doing research and creating solid, evidence-based arguments in favor of your position. Present your stance to legislators willing to listen, not to unyielding, dogmatic opposition. In the case of the Philippines, the most challenging opposition is the Catholic hierarchy and its surrogates in Congress.

Ateneo de Manila University Professor Mary Racelis shared, “Legislators will never read a 17-page [document] so we put together a four-page statement declaration sent to Congress…We never have to influence the bishops, they would not listen to us anyway.”

10. A strong, determined, and persistent RH movement, composed of different sectors, is crucial to move forward and sustain the gains of RH law implementation.

The RH bill became a law because of the vibrant and dedicated RH movement—composed of advocates and champions from the grassroots, civil society organizations, non-government organizations, academia, and the private sector—that came together to ensure its full implementation after long years of hard-fought battle. Adding to the movement’s strength is the support from dedicated, passionate, and committed advocates at the executive and legislative branches of the government. The ardent support of former President Noynoy Aquino has been pivotal in enacting the law.

According to former POPCOM Executive Director Perez, FP/RH initiatives saw success in increasing family planning use from 4 million users of modern FP in 2013 to 7.9 million users in 2021, even with reduced budgets for RH law implementation. This improvement is thanks to the dedication of health workers, volunteers, population workers, local government partners, and civil society partners who remained committed to RH work despite these challenges.

“It is not just a fight of one group, there is a need to help each other… persistent and consistent efforts are needed to get where we want,” said attorney Elizabeth Aguiling-Pangalangan, Director of the Institute of Human Rights at the University of the Philippines Law Center.

It has been a decade since the enactment of the RH Law. It is a big win that brings high-quality health care to people who menstruate, and it has had a positive impact for millions of individuals and families in the Philippines. It is a significant achievement for lawmakers as well. Nevertheless, the work continues for RH champions and advocates seeking to protect and advance women’s reproductive health and rights in the Philippines.

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Regional Knowledge Management Officer, Asia, Johns Hopkins Center for Communication Programs

Grace Gayoso-Pasion is currently the Asia Regional Knowledge Management (KM) Officer for Knowledge SUCCESS at the Johns Hopkins Center for Communications Program. More known as Gayo, she is a development communication professional with nearly two decades of experience in communication, public speaking, behavior change communication, training and development, and knowledge management. Spending most of her career in the nonprofit sector, specifically in the public health field, she has worked on the challenging task of teaching complex medical and health concepts to urban and rural poor in the Philippines, most of whom never finished primary or secondary school. She is a longtime advocate for simplicity in speaking and writing. After completing her graduate degree in communications from Nanyang Technological University (NTU) in Singapore as an ASEAN scholar, she has been working in regional KM and communication roles for international development organizations assisting various Asian countries with improving their health communication and KM skills. She is based in the Philippines.

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Philippine Supreme Court Upholds Historic Reproductive Health Law

Millions of filipinos will finally have universal, free access to contraception and expanded reproductive health education, the center’s recent work in the philippines..

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04.08.14 (PRESS RELEASE) After more than a year deliberating the constitutionality of the country’s historic Reproductive Health Law passed in 2012, the Philippine Supreme Court has upheld the law.

The Responsible Parenthood and Reproductive Health Act of 2012, known as the RH Law, is a groundbreaking law that guarantees universal and free access to nearly all modern contraceptives for all citizens, including impoverished communities, at government health centers. The law also mandates reproductive health education in government schools and recognizes a woman’s right to post-abortion care as part of the right to reproductive healthcare.

“With universal and free access to modern contraception, millions of Filipino women will finally be able to regain control of their fertility, health, and lives,”  said Nancy Northup, president and CEO at the Center for Reproductive Rights.  “The Reproductive Health Law is a historic step forward for all women in the Philippines, empowering them to make their own decisions about their health and families and participate more fully and equally in their society.”

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President Benigno S. Aquino III  signed the RH Law in December 2012 , which was immediately challenged in court by various conservative Catholic groups. On March 19, the Supreme Court issued a status quo ante order for 120 days that was later extended indefinitely, halting the RH Law from going into effect. Fourteen petitions questioning the constitutionality of the law on the grounds that it violated a range of rights, including freedom of religion and speech, were consolidated for oral arguments that began on July 9, 2013 that continued through August 2013.

In today’s decision the Supreme Court struck down a number of provisions in the RH Law. Health care providers will be able to deny reproductive health services to patients based on their personal or religious beliefs in non-emergency situations. Spousal consent for women in non life-threatening circumstances will be required to access reproductive health care. Parental consent will also be required for minors seeking medical attention who have been pregnant or had a miscarriage. Petitioners in the case will now have 15 days to appeal the Supreme Court decision.

“While it’s concerning that certain provisions in the Reproductive Health Law were struck down, the Supreme Court has put women first and now the benefits of this law can finally become a reality for millions of Filipinos,”  said Melissa Upreti, regional director for Asia at the Center.  “Women have waited long enough for the reproductive health services and information they deserve, and the government must now move quickly to implement all the necessary policies and programs without delay.”

Around the world, the unmet need for safe and effective contraceptive services is staggering: roughly 222 million women in developing countries who want to avoid pregnancy rely on traditional contraceptives, such as the rhythm method, with high failure rates or do not use a contraceptive method at all.

The Filipino government’s long-standing hostility towards modern contraception has contributed to 4,500 women dying from pregnancy complications, 800,000 unintended births and 475,000 illegal abortions each year.

The Center for Reproductive Rights has worked on reproductive health issues throughout Asia, with major campaigns addressing issues ranging from maternal mortality in India to access to modern contraception in the Philippines. In  Manila , the Center has documented the human rights violations that stem from an executive order that effectively bans access to modern contraceptives and that prevents women from protecting their health and exercising reproductive autonomy.

In March 2011, the Center and UNFPA released the joint briefing paper,  The Right to Contraceptive Information and Services for Women and Adolescents , demonstrating how access to family planning information and services is a fundamental human right that States are obligated to actively respect, protect, and fulfill.

“With universal and free access to modern contraception, millions of Filipino women will finally be able to regain control of their fertility, health, and lives,”  said Nancy Northup, president and CEO at the Center for Reproductive Rights.  “The Reproductive Health Law is a historic step forward for all women in the Philippines, empowering them to make their own decisions about their health and families and participate more fully and equally in their society.”

President Benigno S. Aquino III  signed the RH Law in December 2012 , which was immediately challenged in court by various conservative Catholic groups. On March 19, the Supreme Court issued a status quo ante order for 120 days that was later extended indefinitely, halting the RH Law from going into effect. Fourteen petitions questioning the constitutionality of the law on the grounds that it violated a range of rights, including freedom of religion and speech, were consolidated for oral arguments that began on July 9, 2013 that continued through August 2013.

“While it’s concerning that certain provisions in the Reproductive Health Law were struck down, the Supreme Court has put women first and now the benefits of this law can finally become a reality for millions of Filipinos,”  said Melissa Upreti, regional director for Asia at the Center.  “Women have waited long enough for the reproductive health services and information they deserve, and the government must now move quickly to implement all the necessary policies and programs without delay.”

The Center for Reproductive Rights has worked on reproductive health issues throughout Asia, with major campaigns addressing issues ranging from maternal mortality in India to access to modern contraception in the Philippines. In  Manila , the Center has documented the human rights violations that stem from an executive order that effectively bans access to modern contraceptives and that prevents women from protecting their health and exercising reproductive autonomy.

In March 2011, the Center and UNFPA released the joint briefing paper,  The Right to Contraceptive Information and Services for Women and Adolescents , demonstrating how access to family planning information and services s a fundamental human right that States are obligated to actively respect, protect, and fulfill.

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Assessment of country policies affecting reproductive health for adolescents in the Philippines

Junice l. d. melgar.

1 Likhaan Center for Women’s Health, Quezon City, Philippines

Alfredo R. Melgar

Mario philip r. festin.

2 Department of Reproductive Health and Research/ Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva, Switzerland

Andrea J. Hoopes

3 Adolescent Center, Kaiser Permanente Washington, Seattle, Washington USA

Venkatraman Chandra-Mouli

Associated data.

The data and material used in the analyses of the paper are available upon request from the authors.

Adolescents in the Philippines face many legal, social and political barriers to access sexual and reproductive health (SRH) services, putting them at higher risk of unplanned pregnancy, abortion, sexually transmitted infections and HIV, and other health and development problems.

This study aims to evaluate whether current normative documents on SRH in the Philippines are in concurrence with adolescents’ human rights principles using the World Health Organization (WHO) Guidance and Recommendations on ensuring human rights in the provision of contraceptive information and services.

The review focused on policies and normative guidance documents which included the national reproductive health law, its implementing rules and regulations, and the Supreme Court decisions on the law, and documents cited in the government’s Adolescent and Youth Health Programme. Also included were documents identified through keyword searches in an online database of the health department. We assessed these documents on their agreement or non-agreement with WHO recommendations, and the presence or absence of adolescent-specific content.

Of nine WHO summary recommendations, Philippine normative documents are in agreement with four, namely on acceptability, participation, accountability, and quality, and have adolescent-specific provisions in three. Philippine normative documents are partly in agreement with the remaining five WHO summary recommendations—nondiscrimination, availability, accessibility, informed decision-making, and privacy. Of twenty-four WHO sub-recommendations, Philippine normative documents are in agreement with fifteen, not in agreement with five, and partly in agreement with four. Two possible factors may explain the many documents with conflicting contents: devolution of the Philippine health system, and the deep social and policy divide on sexual and reproductive health.

Many Philippine-governmental norms and standards are in agreement with adolescents’ human rights to contraceptive information and services as recommended by the WHO. However, a significant number are restrictive, reflecting the strong influence of conservative religious beliefs.

Recommendations

We recommend: 1) further elaboration of the laws and policies that are fully in agreement with WHO recommendations; 2) a more liberal interpretation of the law to ensure the provision, delivery and access to reproductive health care services, and to promote, protect and fulfill women’s reproductive health and rights; and 3) popularization of ethical and human rights norms.

Plain English summary

Adolescents in the Philippines are prevented from full access to sexual and reproductive health (SRH) services by legal obstacles, social and cultural restrictions, and their lack of meaningful political power. This exposes them to SRH problems like unplanned pregnancy, abortion, sexually transmitted infections and HIV— all with serious health and social consequences.

This study aims to assess whether the current laws and policies on SRH in the Philippines respond to the needs and rights of adolescents to contraceptive information and services. It uses a WHO document providing guidance and recommendations on ensuring human rights in the provision of contraceptive information and services.

We reviewed a new law on reproductive health and its implementing rules, Supreme Court decisions on the law, documents of the national adolescent health programme, and other policies and guidance from the Department of Health. We assessed if Philippine laws and policies are in agreement with WHO recommendations, and if these are specific or relevant to adolescents. The study results show that Philippine laws and policies are in agreement with four of nine WHO summary recommendations—acceptability, participation, accountability, and quality; and partly in agreement with five—nondiscrimination, availability, accessibility, informed decision-making, and privacy. We also found that of the 24 WHO sub-recommendations, Philippine laws and policies are in agreement with 15, partly in agreement with 4, and not in agreement with 5. The latter norms reflect the strong influence of conservative beliefs that look at contraceptives as inherently wrong and improper for adolescents’ use.

The study urges the implementation of laws and policies in agreement with the WHO recommendations. It also urges a more liberal interpretation of the law to ensure SRH access and the protection and promotion of girls’ and women’s reproductive health rights. A final recommendation is to explore changing the law while popularizing ethical and human rights norms.

Introduction

Adolescents in the Philippines, both unmarried and married, face many sexual and reproductive health risks stemming from early, unprotected, and/or unwanted sexual activity [ 1 ]. Adolescent girls are particularly vulnerable to unintended pregnancies and maternal morbidity and mortality, including sequelae arising from unsafe abortions. Young parents often have to stop their education, limiting employment opportunities as adults. Policies that ensure and improve adolescents’ access to contraceptive information and services can reduce these health and social problems. This article examines how the Philippines’ new reproductive health law, Supreme Court rulings, and related policies impact on the specific needs of adolescents.

Among women between age 15–19, 10.1% report having been pregnant in 2013, up from 6.5% in 1993. The annual birth rate in this age group has remained almost constant in the last 20 years— from 50 births per 1000 in 1993 to 57 in 2013. In sharp contrast, all other age groups recorded steady declines in the same period. [ 2 ]. The country’s teen birth rate is currently higher than the average of 40 per 1000 for the South East Asian region and 15 per 1000 for the Western Pacific region [ 3 ].

Most adolescents report practicing abstinence as their main method to avoid pregnancy. However, this behavior is changing slowly towards more engaging in sexual activity. Among teenage women 15–19, those reporting ever having sex rose from 9.1% in 1993 to 14.7 in 2013. Modern contraceptive use in this age group also rose from 0.7 to 2.4% in the same period. While contraceptive use may be increasing, the prevalence rate is still low compared to the proportion of adolescents already having sex. Low contraceptive use persists even among adolescents who are married formally or in informal unions. In 2013, among all age groups of married women, adolescents had the lowest rate of use at 20.6% and the highest unmet need at 28.7% [ 2 ].

Adolescent pregnancies contribute to maternal deaths [ 4 , 5 ]. Although the methods used in the country [ 6 , 7 ] cannot accurately measure maternal mortality by age groups, it is generally accepted that preventing unintended pregnancies can prevent maternal deaths [ 5 ]. Adolescents are particularly at risk because they have less access to contraceptive services [ 8 ]. Adolescent pregnancies have been shown to contribute to early childhood deaths. According to the 2013 demographic and health survey (DHS), “mother’s age less than 18 (risk ratio = 2.13) is the single factor most associated with increased risk of under-5 mortality in the Philippines.” [ 2 ].

The government started a population growth reduction programme in the late 1960s with the goal of promoting socio-economic development. Fertility reduction through modern contraception was the primary strategy [ 9 ]. This phase lasted until the mid-1980s almost entirely under a martial law government. After the regime was ousted in 1986, a period of policy drift followed [ 10 ]. The Catholic hierarchy played a crucial role in the ouster and became very influential in the new government that took over and began to limit government programmes on contraception and family planning. Around this time, the International Conference on Population and Development took place in 1994, introducing a new framework of reproductive health and rights and dropping the centrality of population growth reduction. The Department of Health (DOH) of the Philippines adopted this framework in 1998 and there were various attempts at resuming and strengthening a national population and reproductive health programme. In the ensuing years, however, conservatives repeatedly defeated efforts to pass a law on reproductive health and rights that would ensure public funding and sustainability of this work.

In December 2012, after years of campaigning by civil society organizations, the “Responsible Parenthood and Reproductive Health Act” or reproductive health (RH) law was finally enacted [ 11 ]. For adolescents, the RH law mandated the provision of comprehensive sexuality education. On contraceptive services, however, the law required parental consent for minors, unless the adolescent had been pregnant before. Three months later, the Supreme Court halted the implementation of the law after conservative groups challenged its constitutionality. It took more than a year for the Supreme Court to rule that the RH law is generally constitutional, except for eight provisions that it nullified. Among the provisions removed is the parental consent exception for minors with a previous pregnancy [ 12 ].

Given the evolution of the legislative context through the past few decades, this study aims to evaluate whether current Philippine policies agree with the human rights framework developed by WHO on access to quality contraceptive information and services. This first attempt to review and analyze policies on adolescents’ sexual and reproductive health in the Philippines would allow a deeper insight on how these various historical events and policy changes have affected the present national normative guidelines that would determine the range and quality of services available to the clients, with adolescents in particular.

In 2014, WHO published “Ensuring Human Rights in the Provision of Contraceptive Information and Services” [ 13 ], which aims to provide guidance on priority actions that should be taken to ensure that the different human rights dimensions are systematically and clearly integrated into the provision of contraceptive information and services. It is based on evidence that the respect, protection, and fulfillment of human rights contribute to positive sexual health outcomes. This document was the basis to evaluate whether Philippine normative documents such as laws, policies, and guides conform with human rights standards. The WHO document has nine summary recommendations or headers, namely non-discrimination, availability, accessibility, acceptability, quality, informed decision-making, privacy and confidentiality, participation, and accountability. These headers organize and summarize 24 sub-recommendations. The full text of all recommendations and sub-recommendations are in Table  2 in the results section.

Assessment of WHO summary recommendations and sub-recommendations in Philippine normative documents

Selection of documents

This assessment was to generate a broad and current list of normative documents to review, using three sets of procedures and approaches. The first and core set of documents included the main national laws and policies on reproductive health, namely, the current RH law (2012), its latest implementing rules and regulations (2017), the various Supreme Court decisions on the law (2014–2017), and a Presidential order for the law’s strict implementation (2017). One of the WHO recommendations included access to safe abortion, and for this, the document used was the Revised Penal Code’s section on abortion (1930). These are the core normative documents on contraception and reproductive rights in the Philippines [ 11 , 12 , 14 – 19 ]. We also reviewed the DOH’s latest family planning clinical practice guidelines and its postpartum supplement (2014, FP CPG), and the Department of Education’s curriculum guide on health (2016). These documents contain the country’s specific guidelines on contraceptive services, information, and education [ 20 – 22 ].

The second set of documents came from those used in the DOH’s Adolescent and Youth Health Programme [ 23 ]. These include a training manual on adolescent health, which contains standards for adolescent-friendly care; an adolescent job aid manual; and guidelines on behaviour change communication strategies for preventing adolescent pregnancies [ 24 – 26 ].

The next set of documents was from the DOH’s online database of policies [ 27 ]. A search strategy in the database included keywords “reproductive health,” “family planning,” “contraceptive,” “contraception,” “adolescent,” “youth,” “HIV,” and “AIDS.” We further narrowed the search on policies classified as an “administrative order,” and on those from 1990 up to 2017. We removed documents that were not on contraception, or those that have been superseded by the RH law and its implementing policies.

Classification based on WHO’s summary recommendations and sub-recommendations

Each document was reviewed in relation to the WHO human rights recommendations and assessed if it targeted adolescents. We then summarized and classified the normative documents’ congruence with the WHO’s sub-recommendations based on the following five categories:

• A. - Normative guidance specific to adolescents is present and in agreement with WHO sub-recommendations
• B. - Normative guidance for the general population but relevant to adolescents is present and in agreement with WHO sub-recommendations
• C. - Normative guidance on WHO sub-recommendations is not present
• D. - Normative guidance for the general population but relevant to adolescents is present, but not in agreement with WHO sub-recommendations
• E. - Normative guidance specific to adolescents is present, but not in agreement with WHO sub-recommendations

This scale was expanded from that developed by Hoopes et al. in analyzing normative documents in South Africa [ 28 ], using three categories. We added the last two categories to reflect the status of Philippine policies more appropriately.

As a final step, we classified normative guidance in the country as in agreement, partly in agreement, or not in agreement with WHO’s summary recommendations. We used “in agreement” when all sub-recommendations are in group A or B; “partly in agreement” when only part of the sub-commendations are in group A or B; and “not in agreement” when all are in group D or E.

Handling of conflicting provisions

During the review and assessment, we found a few cases wherein topics or legal provisions were in conflict. One example is the FP clinical practice guidelines (CPG) having a section on the use of emergency contraception (EC). However, the RH law prohibits the availability and use of EC in government hospitals. In these few cases, we added enforceability as a factor in categorization. Based on the country’s legal system, documents are broadly classified into three types based on levels of enforceability [ 29 ]. From the highest to the lowest level of enforceability, these are laws, implementing policies, and technical guides or guidelines. Laws include the current constitution, decisions of the Supreme Court, and legislative statutes. Implementing policies include executive orders, implementing rules and regulations and administrative orders. These policies should be based on specific laws and are used to run and administer offices and programmes. Technical guides or guidelines include training guides, clinical practice guidelines, operations manuals, school curricula, and best practice recommendations. In the above example, the RH law takes precedence over the FP CPG.

Analysis team

A table of the key statements from the documents and assessments was developed and circulated to all 5 authors. Three Filipino authors reached a consensus on the category for each sub-recommendation after several rounds of reviews and discussions. Another Filipino expert on Family Planning served as an external reviewer who validated the findings. Other authors helped with the analysis and clarification.

Based on the search strategies and the three selection procedures described above, we used nine documents selected for review [ 30 – 38 ] with 23 normative guidance documents. Except for the penal code, these were issued from 2009 to 2017. Table  1 lists these documents in full, grouped by selection procedure used and sorted chronologically.

List of normative documents reviewed for this study grouped by search selection procedure used and chronologically [separate file]

Of nine WHO summary recommendations, Philippine normative documents are in agreement with four, namely on acceptability, participation, accountability, and quality. Documents with the first three recommendations had provisions specific to adolescents (Category A), with those with the last one had provisions for the general population, but relevant to adolescents (Category B). Philippine normative documents are partly in agreement with the remaining five WHO summary recommendations, namely on nondiscrimination, availability, accessibility, informed decision-making, and privacy.

Of twenty-four WHO sub-recommendations, Philippine normative documents are in agreement with fifteen, are partly in agreement with four, and are not in agreement with five. Table  2 displays the full analyses of the various policy documents in relation to the WHO standards, which will be described in more detail below.

Non-discrimination: Partly in agreement with summary recommendation

Non-discrimination in information and services (e).

The RH law invokes respect for human rights of all persons and non-discrimination explicitly and repeatedly. However, it does not allow minors access to modern contraception without “written consent from their parents or guardian/s” [ 11 ]. The law’s restriction overrides a Presidential order to accelerate family planning (FP) and to achieve “zero unmet need for modern contraception” [ 17 ].

Special attention to disadvantaged and marginalized populations (a)

The RH law calls for prioritizing the needs of women, children, and other underprivileged and vulnerable sectors [ 11 ]. An implementation policy for adolescent health and development mandates equity and inclusion for marginalized and vulnerable adolescents [ 36 ].

Availability: Partly in agreement with summary recommendation

Integration of contraceptives, including emergency contraception, into essential medicines (b, d).

The RH law mandates that modern contraceptives should be certified as essential medicines, and should be purchased and distributed by the government throughout the country. [ 11 ]. The Food and Drug Administration (FDA) must first certify that the contraceptive is not an abortifacient, defined as “any drug or device that induces abortion, or the destruction of a fetus inside the mother’s womb, or the prevention of the fertilized ovum to reach and be implanted in the mother’s womb.” Budgets and logistics are specified per level of the service delivery network at all levels, from outposts and primary health centers to hospitals [ 15 , 34 ]. However, government hospitals and local government health facilities are not allowed to purchase or acquire emergency contraceptive pills (ECP) [ 11 ]. Private facilities are not expressly included in the prohibition; therefore, the FP CPG on ECPs would apply [ 20 ].

Accessibility: Partly in agreement with summary recommendation

Scientifically accurate, comprehensive sexuality education (a).

The RH law requires “age- and development-appropriate” RH and life skills education for adolescents in formal and non-formal schools [ 11 ]. Policies mandate the inclusion of “gender-sensitive and rights-based” sexuality education in the curriculum [ 15 ], and modern FP methods in the education department’s K to 12 standards [ 22 ].

Elimination of financial barriers to contraceptive use by marginalized populations (a)

The RH law requires the health department to provide free contraceptive supplies to poor and marginalized families [ 11 ]. An implementation policy asks for the development of an “adolescent health benefits package” in the social health insurance system. The same policy calls for the mobilization of local government and private funds to ensure the provision of health services and FP supplies for adolescents [ 36 ]. A technical guide on adolescent-friendly health care services recommends free health services for adolescents [ 26 ].

Improving access for those with difficulties in accessing services, including safe abortion according to existing WHO guidelines (e, d)

The RH law provides various mechanisms to overcome geographic, financial and social barriers and thereby facilitate access to contraceptive information and services [ 11 , 15 ]. However, contraceptive access by adolescents is partly constrained by the requirement for parental consent and the restriction on ECP procurement and distribution. Induced abortion is prohibited by the general penal code, with no explicit exception allowing conditional use [ 19 ].

Special efforts for displaced populations, in crisis settings and survivors of sexual violence (b, d)

The RH law mandates access to contraceptive information and services by people in difficult circumstances, including survivors of violence and those in crisis and disaster situations. A policy describing a Minimum Initial Service Package (MISP) directs the government to provide these and other reproductive health services during disasters [ 11 , 32 ]. The FP CPG recommends the provision of regular and emergency contraceptive services during emergency and crisis situations [ 20 ]. However, legal restrictions to minors and the use and availability of emergency contraception are still in place [ 11 ].

Contraceptive information and services within HIV testing, treatment and care (b)

The RH law defines a package of 12 RH care elements that include FP, adolescent RH (ARH), and the prevention and management of STIs, HIV, and AIDS [ 11 ]. Integrated services at all levels of the health care delivery system are directed by law’s implementing policies [ 15 , 34 ]. The FP CPG includes integration guidance for FP providers [ 15 ].

Contraceptive information and services during antenatal and postpartum care (a)

The RH law and its implementing rules define and mandate an integrated package that includes contraception, ARH, antenatal and postpartum care which must be provided in a service delivery network [ 11 , 15 , 34 ]. The FP CPG and its postpartum FP supplement provide guidance on the provision of postpartum contraception [ 20 , 21 ]. The technical guidance on adolescent health services discusses counseling on contraception for pregnant adolescents [ 25 ].

Contraceptive information and services routinely integrated with abortion (d) and post-abortion care (a)

The RH law reiterates the penal code’s prohibition on abortion. However, it mandates the treatment of post-abortion complications in a “humane, non-judgmental and compassionate manner” as part of the RH care package [ 11 ]. The health department’s post-abortion policy orders the provision of supportive counseling and full access to contraception [ 31 ]. The FP CPG recommends a range of contraceptive options post-abortion [ 20 ].

Mobile outreach services to improve access to contraceptive information and services (a)

The RH law recommends the deployment of Mobile Health Care Service vehicles to deliver contraceptive supplies and services to hard-to-reach and underserved areas [ 11 ]. Implementing policies define the mechanisms for operating and sustaining these vehicles [ 15 ]. For adolescents, a technical guide recommends outreach services for those in hard-to-reach areas [ 26 ].

Elimination of spousal authorization (d)

The Supreme Court’s decision on the RH law requires spousal consent, although there are no penalties for health providers who skip this procedure [ 11 , 12 ]. The FP CPG which are issued after the Supreme Court ruling, requires “spousal consent… prior to undergoing permanent surgical contraceptive methods” [ 20 ].

Elimination of parental and guardian authorization (e)

The Supreme Court decision requires all minors to have parental consent to access contraceptive services in public facilities, although there are no penalties for skipping it [ 11 , 12 ]. The FP CPG reiterates this requirement [ 20 ].

Acceptability: In agreement with summary recommendation

Gender-sensitive counselling, education, based on accurate information, with skills building tailored to needs (a).

An implementing policy mandates gender-sensitivity training for health providers to develop respect for privacy and confidentiality, and non-judgmental attitudes. Training must also include building sensitivity to the particular needs of adolescents, building counseling skills, and mechanisms of referral of victims of gender-based violence. Information for all patients must be “scientific, correct, evidence-based and comprehensible” [ 15 ].

Management of side-effects; appropriate referrals (a)

The FP CPG describes the standard management of contraceptive side effects, including those specific to adolescents [ 20 ]. The RH law’s implementing policy requires health providers to ensure that referred patients are seen by another health provider “within the same hour” [ 15 ]. The Supreme Court allowed “conscientious objectors” to refuse to refer, except when the patient is in an emergency [ 12 ]. However, the implementing policy contains detailed steps that a provider must follow—including registration and public notice—before acquiring a conscientious objector status [ 15 ].

Quality of contraceptive information and services: In agreement with summary recommendation

Quality assurance processes, including medical standards of care and client feedback (b).

The RH law requires quality of care in service provision [ 11 ]. The law’s implementing policy include client-side factors in monitoring and evaluating services, such as cultural preferences, time and financial limitations, distance from facilities, and perception on the conduct of health providers [ 15 , 34 ]. The FP CPG emphasizes informed choice and respect for clients’ rights in its quality assurance guidance [ 20 ].

Quality in long-acting reversible contraceptives or LARCs (b)

The FP CPG instructs providers that counseling should explain the benefits and side effects of LARCS, as well as the procedures for their insertion and removal. It also clarifies that requests for removal should not be refused or delayed [ 20 ].

Competency-based training and supervision of health care personnel (b)

The RH law’s implementing policy requires the health department to conduct baseline competency assessments, competency-based trainings, and regular monitoring and evaluation of all providers to ensure quality of care [ 15 ]. The FP CPG discusses supportive supervision, post-training evaluation and monitoring, and regular updates for healthcare providers [ 20 ].

Informed decision-making: Partly in agreement with summary recommendation

Evidenced-based information, education, and counseling to ensure informed choice (b).

The RH law emphasizes informed choice as a guiding principle, which is defined and elaborated by a specific policy on informed choice and voluntarism [ 11 , 38 ]. The law’s implementing policy requires the health department to develop local language information materials on contraception, including contraindications and side effects. These must be scientifically correct, evidence-based and comprehensible [ 15 ].

Making informed choices without discrimination (e)

The RH law’s implementing policy requires all public health facilities to provide full contraceptive information and services that are “age-, capacity-, and development- appropriate.” These must be available to all clients regardless of “age, sex, gender, disability, marital status, or background” [ 15 ]. An implementing policy emphasizes the human rights of adolescents “to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health.” The rights of the adolescents include access to “life-saving interventions, as long as he/she is mature enough to face the consequences” [ 36 ]. However, the requirement for written parental consent before minors can access contraceptive services severely restricts informed choice [ 11 , 12 ].

Privacy and confidentiality: Partly in agreement with summary recommendation

Privacy and confidentiality (a, e).

One of the technical guides contains standards on respecting the right to privacy of adolescents [ 26 ]. However, the standards do not include contraceptive services. Another technical guide advises that when there is a conflict between restrictive policies and the adolescent’s best interests, the provider needs to draw on his or her personal experience and other knowledgeable people [ 25 ]. However, the law’s requirement for parental consent limits the privacy and confidentiality rights of minors who want contraceptives [ 11 , 12 ].

Participation: In agreement with summary recommendation

People’s engagement in policy design, implementation, monitoring (a).

The RH law mandates the active participation of young people’s organizations in sexual and reproductive health programmes [ 11 ]. Two implementing policies mandate self-empowering activities and participation in governance as vital means for achieving SRH [ 15 , 33 ]. A Presidential order tasks its youth arm, the National Youth Commission, to integrate adolescent reproductive health with youth development programmes [ 17 ].

Accountability: In agreement with summary recommendation

Effective accountability mechanisms in place and accessible (a).

The RH law upholds choice and human rights. It prohibits and penalizes acts that prevent access to RH information and services, or those that induce or coerce anyone to use such services. The law enumerates government officials, health providers, employers and private companies as potential violators [ 11 , 12 ]. The law’s implementing policy requires an RH Officer in all facilities who must receive and act on complaints regarding violations of the law. The implementing policy also tasks the Commission on Human Rights to receive complaints [ 15 ].

Evaluation and monitoring to ensure quality and human rights (a)

The RH law requires the health department to submit progress reports every year, and participate in an oversight review by the legislature every five years. The law’s implementing policy defines monitoring standards for the RH programme within a service delivery network [ 15 , 34 ]. A Presidential order elaborates further the monitoring and reporting of FP services [ 17 ]. For adolescents, a technical guide recommends the creation of a national technical working group to monitor and evaluate compliance with set standards [ 26 ].

Certain parts of the Philippines normative documents are strongly in agreement with the human rights of adolescents in contraception. These include the focus on disadvantaged and vulnerable groups and persons; attention to critical health system elements such as staffing, financing, and supply chains; the integration of RH services in all levels of the health system; and the explicit call to citizens’ participation and accountability.

However, certain parts of existing laws and policies impose substantial restrictions on human rights. These include the requirement for parental and spousal consent; the prohibition on emergency contraceptives in public hospitals; the need for certification that contraceptives are not abortifacients; and the wide latitude given to conscientious objectors. The penal code criminalizes abortion with no explicit exception—none for rape, health risks or life-threatening pregnancies.

The RH law and conservative political movements

The restrictive parts of Philippine norms are rooted in conservative beliefs and values espoused mainly by the Catholic hierarchy and the so-called “pro-life” movement. Conservatives believe that modern contraception thwarts the natural procreative process, destroys embryonic life, undermines the family, weakens parental rights over children, and promotes sexual license. These religious beliefs are used in political action by advocates adept at working and influencing the executive, legislative and judicial departments [ 39 , 40 ]. In 1987, they successfully introduced a policy in the Philippine constitution that protects “unborn” life. It commits the State to “equally protect the life of the mother and the life of the unborn from conception.”

Since then, this provision has been used to block or roll back progressive initiatives in SRH [ 12 , 41 , 42 ]. Pro-life chief executives banned FP services in the City of Manila and other local governments (2000–2010). The FDA delisted an emergency contraceptive pill and the multi-use drug misoprostol after petitions by pro-life groups (2001–2002). The health department focused on “natural” FP methods (2003–2010) when a politician close to Catholic bishops became President. The education department stopped a pilot module on adolescent sexuality education after pro-life groups tied it up in court litigation (2009).

The passage of the RH law in 2012 signals a shift in public opinion. A comfortable majority of the population now accepts publicly-funded SRH programmes, including FP. However, challenges to the law persist, mainly through the courts. In 2015, a pro-life group convinced the Supreme Court to stop the government’s use of progestin implants and to recall the non-abortifacient certifications issued to 48 contraceptives [ 16 , 18 ]. The restraining order lasted over two years, caused shortages in contraceptive supplies and distribution and denied some women their preferred method [ 40 ]. The FDA restarted their process and ruled again in November 2017 that all questioned contraceptives were non-abortifacient [ 14 ], which lifted the restraining order. Soon after, a network calling itself Pro-Life Coalition began an online signature campaign to reverse the FDA decision.

Controversy about sexuality education and contraception education for adolescents

The RH law envisions the inclusion of adolescents in the RH programme, but mainly through education and counseling. While the law mentions RH services, it is silent on contraception for adolescents. There is a strong mandate to provide comprehensive RH education in all mainstream and alternative schools. The curriculum must be age- and development- appropriate. The comprehensive and developmental approach would correct the old practice of doing isolated lessons in specific grades, such as teaching contraceptive methods in Grade 10. The law identifies critical subjects that should be taught but does not explicitly include sexuality and contraception. It advises flexibility in deciding topics and methodology based on consultations with stakeholders like parents and other “interest” groups.

Two reasons can explain this caution. In 2009, the education department was stopped and brought to court by a pro-life group for pilot-testing a high school sexuality education module. Though the education department eventually won the case, it never reintroduced the module [ 40 ]. In 2014, pro-life groups argued that sexuality education violates the primary duty of parents over their children, which makes the RH law unconstitutional. The Supreme Court dismissed this argument for being premature as there was no curriculum yet to oppose [ 12 ]. Pro-life groups could revive their case once a comprehensive curriculum is released.

The technical guides on contraceptive services and information reflect the equivocation of the law. Most guidance materials recommend abstinence as the best behavior for all adolescents regardless of their specific life situation. The guides are silent on relevant factors such as age, marital status, experience of sexual violence, and capacity for responsible decision-making. They promote abstinence-only or abstinence-centered values and practices. A representative guide, the Behavior Change Communication sourcebook [ 24 ], presents abstinence as the best way to prevent adolescent pregnancies; advises sexually active adolescents to return to abstinence; and recommends the exclusion of abstinent adolescents from public education sessions on contraception for fear they get the misimpression that sex is permissible as long as it is protected.

Devolution and health policies system

The Philippine health system is highly decentralized with significant powers and functions transferred to 1600 local governments (i.e., provinces, cities, and municipalities). The restructuring was part of a broader government devolution mandated by the Constitution and implemented by a 1991 law [ 43 , 44 ]. Devolved health functions include financing and budgeting, operating facilities from health posts to provincial hospitals, hiring and managing health personnel, and creating local health policies and programmes. There are, in effect, two parallel health systems: national and local health systems.

The national health department develops policies for the national health system and operates some tertiary care hospitals. Local health offices implement programmes under the authority of local chief executives. Without a national law, the concept of “local autonomy” provides local chief executives the power to ignore or sideline national health policies and programmes. For example, the mayor of Manila banned contraceptive services in local health facilities in 2000 because of his objections based on his religious beliefs. It took a new mayor to partly restore services in 2012 [ 45 ]. Local officials may also refuse to cooperate with other local officials because of political or personal differences.

This situation can result in a disparate, poorly-integrated health system that could also account for the country’s stagnating performance in areas like tuberculosis control, immunization, FP and maternal mortality reduction. The health department has identified fragmentation as a critical problem for many years now but has been unable to address it because of local government autonomy. The RH law and its implementing policies provide measures for health system strengthening and integration, but only an amendment of the devolution law may provide a strategic solution.

Conclusion and recommendations

Many Philippine norms are in agreement with adolescents’ human rights to contraceptive information and services as recommended by the WHO. However, a significant number are restrictive, reflecting the strong influence of conservative religious beliefs.

To continue progress, we recommend the following:

• Encourage the further elaboration of policies that are in agreement with WHO recommendations, and based on scientific evidence
• Encourage government offices involved in implementing the RH law to create policies for institutionalizing the involvement of adolescents and young people decision-making on SRH, particularly contraception, and provide for their training and ongoing support.
• Support the education department’s efforts to shift from an abstinence-only framework to comprehensive sexuality education in its K to 12 curriculum through targeted technical support.
• Update the health department’s policies to enable the provision of contraceptive services to adolescents which are allowed by the RH law, such as services to adolescents aged 18 and above; minors who have consent from their parents or guardians; and minors consulting in private and NGO facilities, which are not explicitly covered by the prohibition in the law.
• Flesh out the health department’s guidelines on the financing of adolescent health services with a policy specifying how different agencies, notably the social health insurance agency, national health units, local governments, and other funding partners can support contraceptive services to adolescents who are legally qualified to receive such services.
• Amend the health department’s technical guide on behavior change communications to remove its abstinence-centered and sex-negative content and to be in agreement with the education department’s Comprehensive Sexuality Education framework.
• 2. Encourage the legal clarification of restrictive parts of the RH law based on Section 27 which states that the law must be “liberally construed to ensure the provision, delivery and access to reproductive health care services, and to promote, protect and fulfill women’s reproductive health and rights.”
• Issuance by the health department of a legal opinion clarifying that while the law recognizes spousal consent, it does not include penalties for those who prefer to omit this procedure.
• Issuance by the health department of a legal opinion clarifying that the prohibition on the procurement, distribution, and provision of emergency contraception pertains only to government hospitals and therefore does not apply to private and nongovernment providers.
• 3. Explore the amendment of restrictive laws or restrictive parts in these laws.
• Conduct legal research, including on the impact of restrictive policies and legal options.
• Popularize ethical and human rights norms.

Limitations

The research focused on the content of normative documents, not their actual implementation in practice. It is possible that reality may not correspond with what is written. The study occurred amidst two major political changes: the national elections in mid-2016 that resulted in a new set of elected officials at the highest levels; and Supreme Court rulings on contraception in 2015, 2016, and 2017, which affected contraceptive access generally. We incorporated new documents released during these years but may have missed important developing changes or trends.

Acknowledgments

The authors would like to acknowledge Bernabe Marinduque of the University of the Philippines Manila who reviewed and made comments on the document, and Rubee Dev for her careful proof reading of the final draft.

Funding for the development of this paper was through the WHO RHR Strengthening Family planning and Contraceptive services using WHO contraception guidelines -WHO FP-Umbrella project, supported by a grant from the Bill and Melinda Gates Foundation. The BMGF did not have any other roles in the conduct of the study nor the preparation of the manuscript.

Availability of data and materials

Authors’ contributions.

Five authors worked on the study. VCM and AH had previously used similar analyses in two previous papers. VCM, MF, and JM designed the approach to the study and the format of the reporting. JM (supported by MF) reviewed the policies from 2015 to 2017 and wrote the draft; AM developed the categories and the tables for the policies from 2000 to 2014 and edited the final draft (with MF); VCM, MF, and AH provided inputs in the analyses and discussions. All authors read and approved the final manuscript.

Ethics approval and consent to participate

As this was a review of existing legal and policy documents, and no human participants were involved in a research study, no ethics approval and consent to participate were required.

Consent for publication

The manuscript does not contain any individual’s data, and individual consent for publication is not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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The Reproductive Health law

Republic Act No. 10354

S. No. 2865 H. No. 4244

Republic of the Philippines Congress of the Philippines Metro Manila Fifteenth Congress Third Regular Session

Begun and held in Metro Manila, on Monday, the twenty-third day of July, two thousand twelve.

[ REPUBLIC ACT NO. 10354 ]

AN ACT PROVIDING FOR A NATIONAL POLICY ON RESPONSIBLE PARENTHOOD AND REPRODUCTIVE HEALTH

Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:

SECTION 1.  Title . – This Act shall be known as “The Responsible Parenthood and Reproductive Health Act of 2012″.

SEC. 2.  Declaration of Policy . – The State recognizes and guarantees the human rights of all persons including their right to equality and nondiscrimination of these rights, the right to sustainable human development, the right to health which includes reproductive health, the right to education and information, and the right to choose and make decisions for themselves in accordance with their religious convictions, ethics, cultural beliefs, and the demands of responsible parenthood.

Pursuant to the declaration of State policies under Section 12, Article II of the 1987 Philippine Constitution, it is the duty of the State to protect and strengthen the family as a basic autonomous social institution and equally protect the life of the mother and the life of the unborn from conception. The State shall protect and promote the right to health of women especially mothers in particular and of the people in general and instill health consciousness among them. The family is the natural and fundamental unit of society. The State shall likewise protect and advance the right of families in particular and the people in general to a balanced and healthful environment in accord with the rhythm and harmony of nature. The State also recognizes and guarantees the promotion and equal protection of the welfare and rights of children, the youth, and the unborn.

Moreover, the State recognizes and guarantees the promotion of gender equality, gender equity, women empowerment and dignity as a health and human rights concern and as a social responsibility. The advancement and protection of women’s human rights shall be central to the efforts of the State to address reproductive health care.

The State recognizes marriage as an inviolable social institution and the foundation of the family which in turn is the foundation of the nation. Pursuant thereto, the State shall defend:

(a) The right of spouses to found a family in accordance with their religious convictions and the demands of responsible parenthood;

(b) The right of children to assistance, including proper care and nutrition, and special protection from all forms of neglect, abuse, cruelty, exploitation, and other conditions prejudicial to their development;

(c) The right of the family to a family living wage and income; and

(d) The right of families or family associations to participate in the planning and implementation of policies and programs

The State likewise guarantees universal access to medically-safe, non-abortifacient, effective, legal, affordable, and quality reproductive health care services, methods, devices, supplies which do not prevent the implantation of a fertilized ovum as determined by the Food and Drug Administration (FDA) and relevant information and education thereon according to the priority needs of women, children and other underprivileged sectors, giving preferential access to those identified through the National Household Targeting System for Poverty Reduction (NHTS-PR) and other government measures of identifying marginalization, who shall be voluntary beneficiaries of reproductive health care, services and supplies for free. ■ •

The State shall eradicate discriminatory practices, laws and policies that infringe on a person’s exercise of reproductive health rights.

The State shall also promote openness to life;  Provided,  That parents bring forth to the world only those children whom they can raise in a truly humane way.

SEC. 3.  Guiding Principles for Implementation.  – This Act declares the following as guiding principles:

(a) The right to make free and informed decisions, which is central to the exercise of any right, shall not be subjected to any form of coercion and must be fully guaranteed by the State, like the right itself;

(b) Respect for protection and fulfillment of reproductive health and rights which seek to promote the rights and welfare of every person particularly couples, adult individuals, women and adolescents;

(c) Since human resource is among the principal assets of the country, effective and quality reproductive health care services must be given primacy to ensure maternal and child health, the health of the unborn, safe delivery and birth of healthy children, and sound replacement rate, in line with the State’s duty to promote the right to health, responsible parenthood, social justice and full human development;

(d) The provision of ethical and medically safe, legal, accessible, affordable, non-abortifacient, effective and quality reproductive health care services and supplies is essential in the promotion of people’s right to health, especially those of women, the poor, and the marginalized, and shall be incorporated as a component of basic health care;

(e) The State shall promote and provide information and access, without bias, to all methods of family planning, including effective natural and modern methods which have been proven medically safe, legal, non-abortifacient, and effective in accordance with scientific and evidence-based medical research standards such as those registered and approved by the FDA for the poor and marginalized as identified through the NHTS-PR and other government measures of identifying marginalization:  Provided , That the State shall also provide funding support to promote modern natural methods of family planning, especially the Billings Ovulation Method, consistent with the needs of acceptors and their religious convictions;

(f) The State shall promote programs that: (1) enable individuals and couples to have the number of children they desire with due consideration to the health, particularly of women, and the resources available and affordable to them and in accordance with existing laws, public morals and their religious convictions:  Provided , That no one shall be deprived, for economic reasons, of the rights to have children; (2) achieve equitable allocation and utilization of resources; (3) ensure effective partnership among national government, local government units (LGUs) and the private sector in the design, implementation, coordination, integration, monitoring and evaluation of people-centered programs to enhance the quality of life and environmental protection; (4) conduct studies to analyze demographic trends including demographic dividends from sound population policies towards sustainable human development in keeping with the principles of gender equality, protection of mothers and children, born and unborn and the promotion and protection of women’s reproductive rights and health; and (5) conduct scientific studies to determine the safety and efficacy of alternative medicines and methods for reproductive health care development;

(g) The provision of reproductive health care, information and supplies giving priority to poor beneficiaries as identified through the NHTS-PR and other government measures of identifying marginalization must be the primary responsibility of the national government consistent with its obligation to respect, protect and promote the right to health and the right to life;

(h) The State shall respect individuals’ preferences and choice of family planning methods that are in accordance with their religious convictions and cultural beliefs, taking into consideration the State’s obligations under various human rights instruments;

(i) Active participation by nongovernment organizations (NGOs), women’s and people’s organizations, civil society, faith-based organizations, the religious sector and communities is crucial to ensure that reproductive health and population and development policies, plans, and programs will address the priority needs of women, the poor, and the marginalized;

(j) While this Act recognizes that abortion is illegal and punishable by law, the government shall ensure that all women needing care for post-abortive complications and all other complications arising from pregnancy, labor and delivery and related issues shall be treated and counseled in a humane, nonjudgmental and compassionate manner in accordance with law and medical ethics;

(k) Each family shall have the right to determine its ideal family size:  Provided, however , That the State shall equip each parent with the necessary information on all aspects of family life, including reproductive health and responsible parenthood, in order to make that determination;

(l) There shall be no demographic or population targets and the mitigation, promotion and/or stabilization of the population growth rate is incidental to the advancement of reproductive health;

(m) Gender equality and women empowerment are central elements of reproductive health and population and development;

(n) The resources of the country must be made to serve the entire population, especially the poor, and allocations thereof must be adequate and effective:  Provided , That the life of the unborn is protected;

(o) Development is a multi-faceted process that calls for the harmonization and integration of policies, plans, programs and projects that seek to uplift the quality of life of the people, more particularly the poor, the needy and the marginalized; and

(p) That a comprehensive reproductive health program addresses the needs of people throughout their life cycle.

SEC. 4.  Definition of Terms . – For the purpose of this Act, the following terms shall be defined as follows:

(a)  Abortifacient  refers to any drug or device that induces abortion or the destruction of a fetus inside the mother’s womb or the prevention of the fertilized ovum to reach and be implanted in the mother’s womb upon determination of the FDA.

(b)  Adolescent  refers to young people between the ages of ten (10) to nineteen (19) years who are in transition from childhood to adulthood.

(c)  Basic Emergency Obstetric and Newborn Care (BEMONC)  refers to lifesaving services for emergency maternal and newborn conditions/complications being provided by a health facility or professional to include the following services: administration of parenteral oxytocic drugs, administration of dose of parenteral anticonvulsants, administration of parenteral antibiotics, administration of maternal steroids for preterm labor, performance of assisted vaginal deliveries, removal of retained placental products, and manual removal of retained placenta. It also includes neonatal interventions which include at the minimum: newborn resuscitation, provision of warmth, and referral, blood transfusion where possible.

(d)  Comprehensive Emergency Obstetric and Newborn Care (CEMONC)  refers to lifesaving services for emergency maternal and newborn conditions/complications as in Basic Emergency Obstetric and Newborn Care plus the provision of surgical delivery (caesarian section) and blood bank services, and other highly specialized obstetric interventions. It also includes emergency neonatal care which includes at the minimum: newborn resuscitation, treatment of neonatal sepsis infection, oxygen support, and antenatal administration of (maternal) steroids for threatened premature delivery.

(e)  Family planning  refers to a program which enables couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so, and to have access to a full range of safe, affordable, effective, non-abortifacient modem natural and artificial methods of planning pregnancy.

(f)  Fetal and infant death review  refers to a qualitative and in-depth study of the causes of fetal and infant death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies.

(g)  Gender equality  refers to the principle of equality between women and men and equal rights to enjoy conditions in realizing their full human potentials to contribute to, and benefit from, the results of development, with the State recognizing that all human beings are free and equal in dignity and rights. It entails equality in opportunities, in the allocation of resources or benefits, or in access to services in furtherance of the rights to health and sustainable human development among others, without discrimination.

(h)  Gender equity  refers to the policies, instruments, programs and actions that address the disadvantaged position of women in society by providing preferential treatment and affirmative action. It entails fairness and justice in the distribution of benefits and responsibilities between women and men, and often requires women-specific projects and programs to end existing inequalities. This concept recognizes that while reproductive health involves women and men, it is more critical for women’s health.

(i)  Male responsibility  refers to the involvement, commitment, accountability and responsibility of males in all areas of sexual health and reproductive health, as well as the care of reproductive health concerns specific to men.

(j)  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.

(k)  Maternal health  refers to the health of a woman of reproductive age including, but not limited to, during pregnancy, childbirth and the postpartum period.

(l)  Modern methods of family  planning refers to safe, effective, non-abortifacient and legal methods, whether natural or artificial, that are registered with the FDA, to plan pregnancy.

(m)  Natural family planning  refers to a variety of methods used to plan or prevent pregnancy based on identifying the woman’s fertile days.

(n)  Public health care service provider  refers to: (1) public health care institution, which is duly licensed and accredited and devoted primarily to the maintenance and operation of facilities for health promotion, disease prevention, diagnosis, treatment and care of individuals suffering from illness, disease, injury, disability or deformity, or in need of obstetrical or other medical and nursing care; (2) public health care professional, who is a doctor of medicine, a nurse or a midwife; (3) public health worker engaged in the delivery of health care services; or (4) barangay health worker who has undergone training programs under any accredited government and NGO and who voluntarily renders primarily health care services in the community after having been accredited to function as such by the local health board in accordance with the guideline’s promulgated by the Department of Health (DOH).

(o)  Poor  refers to members of households identified as poor through the NHTS-PR by the Department of Social Welfare and Development (DSWD) or any subsequent system used by the national government in identifying the poor.

(p)  Reproductive Health (RH)  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 responsible, safe, consensual and satisfying sex life, that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. This further implies that women and men attain equal relationships in matters related to sexual relations and reproduction.

(q)  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 addressing 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 the following:

(1) Family planning information and services which shall include as a first priority making women of reproductive age fully aware of their respective cycles to make them aware of when fertilization is highly probable, as well as highly improbable;

(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 guidance and counseling;

(5) Prevention, treatment and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections (STIs);

(6) Elimination of violence against women and children and other forms of sexual and gender-based violence;

(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 involvement and men’s reproductive health;

(10) Prevention, treatment and management of infertility and sexual dysfunction;

(11) Reproductive health education for the adolescents; and

(12) Mental health aspect of reproductive health care.

(r)  Reproductive health care program  refers to the systematic and integrated provision of reproductive health care to all citizens prioritizing women, the poor, marginalized and those invulnerable or crisis situations.

(s)  Reproductive health rights  refers to 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 health and reproductive health:  Provided, however , That reproductive health rights do not include abortion, and access to abortifacients.

(t)  Reproductive health and sexuality education  refers to a lifelong learning process of providing and acquiring complete, accurate and relevant age- and development-appropriate information and education on reproductive health and sexuality through life skills education and other approaches.

(u)  Reproductive Tract Infection (RTI)  refers to sexually transmitted infections (STIs), and other types of infections affecting the reproductive system.

(v)  Responsible parenthood  refers to the will and ability of a parent to respond to the needs and aspirations of the family and children. It is likewise a shared responsibility between parents to determine and achieve the desired number of children, spacing and timing of their children according to their own family life aspirations, taking into account psychological preparedness, health status, sociocultural and economic concerns consistent with their religious convictions.

(w)  Sexual health  refers to a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrimination and violence.

(x)  Sexually Transmitted Infection (STI)  refers to any infection that may be acquired or passed on through sexual contact, use of IV, intravenous drug needles, childbirth and breastfeeding.

(y)  Skilled birth attendance  refers to childbirth managed by a skilled health professional including the enabling conditions of necessary equipment and support of a functioning health system, including transport and referral faculties for emergency obstetric care.

(z)  Skilled health professional  refers to a midwife, doctor or nurse, who has been educated and trained in the skills needed to manage normal and complicated pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.

(aa)  Sustainable human development  refers to bringing people, particularly the poor and vulnerable, to the center of development process, the central purpose of which is the creation of an enabling environment in which all can enjoy long, healthy and productive lives, done in the manner that promotes their rights and protects the life opportunities of future generations and the natural ecosystem on which all life depends.

SEC. 5.  Hiring of Skilled Health Professionals for Maternal Health Care and Skilled Birth Attendance .

– The LGUs shall endeavor to hire an adequate number of nurses, midwives and other skilled health professionals for maternal health care and skilled birth attendance to achieve an ideal skilled health professional-to-patient ratio taking into consideration DOH targets:  Provided , That people in geographically isolated or highly populated and depressed areas shall be provided the same level of access to health care:  Provided, further , That the national government shall provide additional and necessary funding and other necessary assistance for the effective implementation of this provision.

For the purposes of this Act, midwives and nurses shall be allowed to administer lifesaving drugs such as, but not limited to, oxytocin and magnesium sulfate, in accordance with the guidelines set by the DOH, under emergency conditions and when there are no physicians available: Provided , That they are properly trained and certified to administer these lifesaving drugs.

SEC. 6.  Health Care Facilities . – Each LGU, upon its determination of the necessity based on well-supported data provided by its local health office shall endeavor to establish or upgrade hospitals and facilities with adequate and qualified personnel, equipment and supplies to be able to provide emergency obstetric and newborn care:  Provided , That people in geographically isolated or highly populated and depressed areas shall have the same level of access and shall not be neglected by providing other means such as home visits or mobile health care clinics as needed: Provided, further , That the national government shall provide additional and necessary funding and other necessary assistance for the effective implementation of this provision.

SEC. 7.  Access to Family Planning . – All accredited public health facilities shall provide a full range of modern family planning methods, which shall also include medical consultations, supplies and necessary and reasonable procedures for poor and marginalized couples having infertility issues who desire to have children:  Provided , That family planning services shall likewise be extended by private health facilities to paying patients with the option to grant free care and services to indigents, except in the case of non-maternity specialty hospitals and hospitals owned and operated by a religious group, but they have the option to provide such full range of modern family planning methods:  Provided, further , That these hospitals shall immediately refer the person seeking such care and services to another health facility which is conveniently accessible:  Provided, finally , That the person is not in an emergency condition or serious case as defined in Republic Act No. 8344.

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

SEC. 8.  Maternal Death Review and Fetal and Infant Death Review . – All LGUs, national and local government hospitals, and other public health units shall conduct an annual Maternal Death Review and Fetal and Infant Death Review in accordance with the guidelines set by the DOH. Such review should result in an evidence-based programming and budgeting process that would contribute to the development of more responsive reproductive health services to promote women’s health and safe motherhood.

SEC. 9.  The Philippine National Drug Formulary System and Family Planning Supplies . – The National Drug Formulary shall include hormonal contraceptives, intrauterine devices, injectables and other safe, legal, non-abortifacient and effective family planning products and supplies. The Philippine National Drug Formulary System (PNDFS) shall be observed in selecting drugs including family planning supplies that will be included or removed from the Essential Drugs List (EDL) in accordance with existing practice and in consultation with reputable medical associations in the Philippines. For the purpose of this Act, any product or supply included or to be included in the EDL must have a certification from the FDA that said product and supply is made available on the condition that it is not to be used as an abortifacient.

These products and supplies shall also be included in the regular purchase of essential medicines and supplies of all national hospitals:  Provided, further , That the foregoing offices shall not purchase or acquire by any means emergency contraceptive pills, postcoital pills, abortifacients that will be used for such purpose and their other forms or equivalent.

SEC. 10.  Procurement and Distribution of Family Planning Supplies . – The DOH shall procure, distribute to LGUs and monitor the usage of family planning supplies for the whole country. The DOH shall coordinate with all appropriate local government bodies 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.

Provided , That LGUs may implement its own procurement, distribution and monitoring program consistent with the overall provisions of this Act and the guidelines of the DOH.

SEC. 11.  Integration of Responsible Parenthood and Family Planning Component in Anti-Poverty Programs . – A multidimensional approach shall be adopted in the implementation of policies and programs to fight poverty. Towards this end, the DOH shall implement programs prioritizing full access of poor and marginalized women as identified through the NHTS-PR and other government measures of identifying marginalization to reproductive health care, services, products and programs. The DOH shall provide such programs, technical support, including capacity building and monitoring.

SEC. 12.  PhilHealth 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, and obstetric complications, and menopausal and post-menopausal-related conditions shall be given the maximum benefits, including the provision of Anti-Retroviral Medicines (ARVs), as provided in the guidelines set by the Philippine Health Insurance Corporation (PHIC).

SEC. 13.  Mobile Health Care Service . – The national or the local government may provide each provincial, city, municipal and district hospital with a Mobile Health Care Service (MHCS) in the form of a van or other means of transportation appropriate to its terrain, taking into consideration the health care needs of each LGU. The MHCS shall deliver health care goods and services to its constituents, more particularly to the poor and needy, as well as disseminate knowledge and information on reproductive health. The MHCS shall be operated by skilled health providers and adequately equipped with a wide range of 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 LGUs of provinces and highly urbanized cities.

SEC. 14.  Age- and Development-Appropriate Reproductive Health Education . – The State shall provide age- and development-appropriate reproductive health education to adolescents which shall be taught by adequately trained teachers informal and nonformal educational system and integrated in relevant subjects such as, but not limited to, values formation; knowledge and skills in self-protection against discrimination; sexual abuse and violence against women and children and other forms of gender based violence and teen pregnancy; physical, social and emotional changes in adolescents; women’s rights and children’s rights; responsible teenage behavior; gender and development; and responsible parenthood:  Provided , That flexibility in the formulation and adoption of appropriate course content, scope and methodology in each educational level or group shall be allowed only after consultations with parents-teachers-community associations, school officials and other interest groups. The Department of Education (DepED) shall formulate a curriculum which shall be used by public schools and may be adopted by private schools.

SEC. 15.  Certificate of Compliance . – 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 responsible parenthood, family planning, breastfeeding and infant nutrition.

SEC. 16.  Capacity Building of Barangay Health Workers (BHWs) . – The DOH shall be responsible for disseminating information and providing training programs to the LGUs. The LGUs, with the technical assistance of the DOH, shall be responsible for the training of BHWs and other barangay volunteers on the promotion of reproductive health. The DOH shall provide the LGUs with medical supplies and equipment needed by BHWs to carry out their functions effectively:  Provided, further , That the national government shall provide additional and necessary funding and other necessary assistance for the effective implementation of this provision including the possible provision of additional honoraria for BHWs.

SEC. 17.  Pro Bono Services for Indigent Women . – Private and nongovernment reproductive healthcare service providers including, but not limited to, gynecologists and obstetricians, are encouraged to provide at least forty-eight (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 as identified through the NHTS-PR and other government measures of identifying marginalization, especially to pregnant adolescents. The forty-eight (48) hours annual  pro bono  services shall be included as a prerequisite in the accreditation under the PhilHealth.

SEC. 18.  Sexual and Reproductive Health Programs for Persons with Disabilities (PWDs) . – The cities and municipalities shall endeavor that barriers to reproductive health services for PWDs are obliterated by the following:

(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 PWDs;

(c) Increasing access to information and communication materials on sexual and reproductive health in braille, large print, simple language, sign language and pictures;

(d) Providing continuing education and inclusion of rights of PWDs 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 PWDs.

SEC. 19.  Duties and Responsibilities . – (a) Pursuant to the herein declared policy, the DOH shall serve as the lead agency for the implementation of this Act and shall integrate in their regular operations the following functions:

(1) Fully and efficiently implement the reproductive health care program;

(2) Ensure people’s access to medically safe, non-abortifacient, legal, quality and affordable reproductive health goods and services; and

(3) Perform such other functions necessary to attain the purposes of this Act.

(b) The DOH, in coordination with the PHIC, as may be applicable, shall:

(1) Strengthen the capacities of health regulatory agencies to ensure safe, high quality, accessible and affordable reproductive health services and commodities with the concurrent strengthening and enforcement of regulatory mandates and mechanisms;

(2) Facilitate the involvement and participation of NGOs and the private sector in reproductive health care service delivery and in the production, distribution and delivery of quality reproductive health and family planning supplies and commodities to make them accessible and affordable to ordinary citizens;

(3) Engage the services, skills and proficiencies of experts in natural family planning who shall provide the necessary training for all BHWs;

(4) Supervise and provide assistance to LGUs in the delivery of reproductive health care services and in the purchase of family planning goods and supplies; and

(5) Furnish LGUs, through their respective local health offices, appropriate information and resources to keep the latter updated on current studies and researches relating to family planning, responsible parenthood, breastfeeding and infant nutrition.

(c) The FDA shall issue strict guidelines with respect to the use of contraceptives, taking into consideration the side effects or other harmful effects of their use.

(d) Corporate citizens shall exercise prudence in advertising its products or services through all forms of media, especially on matters relating to sexuality, further taking into consideration its influence on children and the youth.

SEC. 20.  Public Awareness . – The DOH and the LGUs shall initiate and sustain a heightened nationwide multimedia-campaign to raise the level of public awareness on the protection and promotion of reproductive health and rights including, but not limited to, maternal health and nutrition, family planning and responsible parenthood information and services, adolescent and youth reproductive health, guidance and counseling and other elements of reproductive health care under Section 4(q).

Education and information materials to be developed and disseminated for this purpose shall be reviewed regularly to ensure their effectiveness and relevance.

SEC. 21.  Reporting Requirements . – Before the end of April each year, the DOH shall submit to the President of the Philippines and Congress an annual consolidated report, which shall provide a definitive and comprehensive assessment of the implementation of its programs and those of other government agencies and instrumentalities and recommend priorities for executive and legislative actions. The report shall be printed and distributed to all national agencies, the LGUs, NGOs and private sector organizations involved in said programs.

The annual report shall evaluate the content, implementation, and impact of all policies related to reproductive health and family planning to ensure that such policies promote, protect and fulfill women’s reproductive health and rights.

SEC. 22.  Congressional Oversight Committee on Reproductive Health Act . – There is hereby created a Congressional Oversight Committee (COC) composed of five (5) members each from the Senate and the House of Representatives. The members from the Senate and the House of Representatives shall be appointed by the Senate President and the Speaker, respectively, with at least one (1) member representing the Minority.

The COC shall be headed by the respective Chairs of the Committee on Health and Demography of the Senate and the Committee on Population and Family Relations of the House of Representatives. The Secretariat of the COC shall come from the existing Secretariat personnel of the Senate and the House of Representatives committees concerned.

The COC shall monitor and ensure the effective implementation of this Act, recommend the necessary remedial legislation or administrative measures, and shall conduct a review of this Act every five (5) years from its effectivity. The COC shall perform such other duties and functions as may be necessary to attain the objectives of tins Act.

SEC. 23.  Prohibited Acts . – The following acts are prohibited:

(a) Any health care service provider, whether public or private, who shall:

(1) 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, non-abortifacient and effective family planning methods;

(2) Refuse to perform legal and medically-safe reproductive health procedures on any person of legal age on the ground of lack of consent or authorization of the following persons in the following instances:

(i) Spousal consent in case of married persons:  Provided , That in case of disagreement, the decision of the one undergoing the procedure shall prevail; and

(ii) Parental consent or that of the person exercising parental authority in the case of abused minors, where the parent or the person exercising parental authority is the respondent, accused or convicted perpetrator as certified by the proper prosecutorial office of the court. In the case of minors, the written consent of parents or legal guardian or, in their absence, persons exercising parental authority or next-of-kin shall be required only in elective surgical procedures and in no case shall consent be required in emergency or serious cases as defined in Republic Act No. 8344; and

(3) Refuse to extend quality health care services and information on account of the person’s marital status, gender, age, religious convictions, personal circumstances, or nature of work:  Provided , That the conscientious objection of a health care 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 health care service provider within the same facility or one which is conveniently accessible:  Provided, further , That the person is not in an emergency condition or serious case as defined in Republic Act No. 8344, which penalizes the refusal of hospitals and medical clinics to administer appropriate initial medical treatment and support in emergency and serious cases;

(b) Any public officer, elected or appointed, specifically charged with the duty to implement the provisions hereof, 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; or refuses to allocate, approve or release any budget for reproductive health care services, or to support reproductive health programs; or shall do any act that hinders the full implementation of a reproductive health program as mandated by this Act;

(c) Any employer who shall suggest, require, unduly influence or cause any applicant for employment or an employee to submit himself/herself to sterilization, use any modern methods of family planning, or not use such methods as a condition for employment, continued employment, promotion or the provision of employment benefits. Further, pregnancy or the number of children shall not be a ground for non-hiring or termination from employment;

(d) Any person who shall falsify a Certificate of Compliance as required in Section 15 of this Act; and

(e) Any pharmaceutical company, whether domestic or multinational, or its agents or distributors, which directly or indirectly colludes with government officials, whether appointed or elected, in the distribution, procurement and/or sale by the national government and LGUs of modern family planning supplies, products and devices.

SEC. 24.  Penalties . – Any violation of this Act or commission of the foregoing prohibited acts shall be penalized by imprisonment ranging from one (1) month to six (6) months or a fine of Ten thousand pesos (P10,000.00) to One hundred thousand pesos (P100,000.00), or both such fine and imprisonment at the discretion of the competent court:  Provided , That, if the offender is a public officer, elected or appointed, he/she shall also suffer the penalty of suspension not exceeding one (1) year or removal and forfeiture of retirement benefits depending on the gravity of the offense after due notice and hearing by the appropriate body or agency.

If the offender is a juridical person, the penalty shall be imposed upon the president or any responsible officer. An offender who is an alien shall, after service of sentence, be deported immediately without further proceedings by the Bureau of Immigration. If the offender is a pharmaceutical company, its agent and/or distributor, their license or permit to operate or conduct business in the Philippines shall be perpetually revoked, and a fine triple the amount involved in the violation shall be imposed.

SEC. 25.  Appropriations . – The amounts appropriated in the current annual General Appropriations Act (GAA) for reproductive health and natural and artificial family planning and responsible parenthood under the DOH and other concerned agencies shall be allocated and utilized for the implementation of this Act. Such additional sums necessary to provide for the upgrading of faculties necessary to meet BEMONC and CEMONC standards; the training and deployment of skilled health providers; natural and artificial family planning commodity requirements as outlined in Section 10, and for other reproductive health and responsible parenthood services, shall be included in the subsequent years’ general appropriations. The Gender and Development (GAD) funds of LGUs and national agencies may be a source of funding for the implementation of this Act.

SEC. 26.  Implementing Rules and Regulations (IRR) . – Within sixty (60) days from the effectivity of this Act, the DOH Secretary or his/her designated representative as Chairperson, the authorized representative/s of DepED, DSWD, Philippine Commission on Women, PHIC, Department of the Interior and Local Government, National Economic and Development Authority, League of Provinces, League of Cities, and League of Municipalities, together with NGOs, faith-based organizations, people’s, women’s and young people’s organizations, shall jointly promulgate the rules and regulations for the effective implementation of this Act. At least four (4) members of the IRR drafting committee, to be selected by the DOH Secretary, shall come from NGOs.

SEC. 27.  Interpretation Clause . – This Act shall be liberally construed to ensure the provision, delivery and access to reproductive health care services, and to promote, protect and fulfill women’s reproductive health and rights.

SEC. 28.  Separability Clause . – If any part or provision of this Act is held invalid or unconstitutional, the other provisions not affected thereby shall remain in force and effect.

SEC. 29.  Repealing Clause . – Except for prevailing laws against abortion, any law, presidential decree or issuance, executive order, letter of instruction, administrative order, rule or regulation contrary to or is inconsistent with the provisions of this Act including Republic Act No. 7392, otherwise known as the Midwifery Act, is hereby repealed, modified or amended accordingly.

SEC 30.  Effectivity . – This Act shall take effect fifteen (15) days after its publication in at least two (2) newspapers of general circulation.

(Sgd.)  FELICIANO BELMONTE JR. Speaker of the House of Representatives

(Sgd.)  JUAN PONCE ENRILE President of the Senate

This Act which is a consolidation of Senate Bill No. 2865 and House Bill No. 4244 was finally passed by the Senate and the House of Representatives on December 19, 2012.

(Sgd.)  MARILYN B. BARUA-YAP Secretary General House of Representatives

(Sgd.)  EMMA LIRIO-REYES Secretary of the Senate

Approved: DEC 21 2012

(Sgd.)  BENIGNO S. AQUINO III President of the Philippines

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RH law: The long and rough road

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This is AI generated summarization, which may have errors. For context, always refer to the full article.

MANILA, Philippines – Thirteen years and 4 months since it was first filed in Congress, the Philippines has enacted a law funding the distribution of free contraceptives, requiring government hospitals to provide reproductive health (RH) services, and mandating public schools to teach sex education.

It’s not a perfect law. The delivery of RH services remains the primary responsbility of the national government – not local government units – and optional for most private hospitals. Except in special cases, minors need parental consent to access family planning methods. Sex education is also optional for private schools.

Still, it’s a big leap for the Philippines where the powerful Catholic Church launched a war against “evil” contraceptives. The new law illegalizes contraception bans previously in place in Manila City and posh community Ayala, Alabang.

It was a long and rough road to the passage of the RH bill. It’s a culmination of the hard work of a battalion of RH advocates – inside and outside Congress – and a President who stepped up to complete the job. ( READ: Aquino on RH bill: From half-baked to urgent )

It was impossible without the allies of President Benigno Aquino III in the Liberal Party (LP) – both in the Senate and the House of Representatives – who worked their magic to get the final votes needed to pass the measure.

It was a harder battle in the House than the Senate. The truth is it could have lost if not for the series of calculated moves taken to keep it alive.

There were several meetings between the bishops, solons, and RH advocates between September and November to attempt a compromise bill.

Initially, Aquino would only call House members to meetings in Malacañang to explain why an RH law is needed. But when crunch time came, Rappler sources confirm that he joined party leaders in personally phoning representatives. The instructions: vote in favor or skip the session.

The 11th hour certification of the RH bill as urgent was the necessary finishing touch to make sure that the Malacañang timeline is followed – have an RH law before Christmas.

“It (certification) was driven more by the lack of physical time in the Senate. But it helped that the bill was moving positively in the House. It also signaled the President’s desire to put a positive closure to the debate. Somehow, things converged at the last minute,” LP stalwart and budget Secretary Butch Abad – also a key player in the passage of the RH bill – told Rappler.

The first steps

The Philippine Legislators’ Committee on Population and Development (PLCPD) traces the first step of the RH law to House Bill 8110 filed on August 16, 1999. It was the 11th Congress.

The proposed “Integrated Population and Development Act of 1999” pushed for “universal access to reproductive health services, including family planning and sexual health.”

Five solons filed the first bill and among them was the daughter of 15th Congress RH bill sponsor Albay Rep Edcel Lagman – Cielo Krisel Lagman-Luistro. The other four are Luwalhati Antonino, Carlos Cojuangco, Bellaflor Angara-Castillo, Nereus Acosta, and Edith Yotono-Villanueva.

Nothing came out of HB 8110. In the succeeding 12th Congress, Rep Bellaflor Angara filed a similar bill. HB 4110 was the first bill to be called the “RH bill.”

The bill was refiled and refiled until it made progress in the 14th Congress. It reached the stage in the legislative process where the entire House could debate it in plenary. The national debate, the war, began. Lagman, Iloilo Rep Janette Garin, and Akbayan Rep Risa Hontiveros took the cudgels for the RH bill.

As the Catholic Church launched its war against the RH bill, big names also started coming out to support the measure. It was during the 14th Congress that the professors of the UP School of Economics and professors of Ateneo De Manila University, among others, issued statements supporting it.

The seeds were planted.

“Let me say that this is the baby of the House. We initiated this in the House. The version in the Senate was a replica of the the House version,” an elated Lagman told reporters the night the measure was ratified.

The passage of the RH bill is the gold medallion Lagman wished for his last term in the House.

Belmonte’s promise

It was Lagman who withstood in plenary hours and hours of relentless attacks coming from the critics of the bill.

“Everyday was a struggle and everyday was difficult. The length of interpellation and debate as well as the period of individual amendments would really be trying times. You have to be patient in order to see through the enactment of this measure,” he said.

But Lagman is the first to credit the House leadership for its successful passage. “The commitment of the House leadership to have the bill voted upon was a great help. It was unlike in the previous Congresses, where leadership was either negative or ambivalent,” said Lagman.

House Speaker Feliciano “Sonny” Belmonte Jr is pro-RH. Quezon City had a similar measure when he was Mayor.

Belmonte promised to put the RH bill to a vote, whatever the result to put a closure to the long debated measure. How it got there was the responsibility of House Majority Leader Neptali Gonzales II, also pro-RH.

In corporate parlance, Belmonte is the CEO. Gonzales is the COO. It is the task of Gonzales to make sure plenary sessions proceed according to the agenda.

But they had to tread very carefully. The RH bill is one for the books. It wasn’t like other bills that they could ram down everyone’s throats. Never has the recent Congress seen a proposed measure so divisive. Never has plenary debates been as highly charged. (READ: Liberal Party divided on RH bill )

Lagman and Garin continued to defend the bill in the 15th Congress. Akbayan Rep Arlene “Kaka” Bag-ao took on the cause from Hontiveros.

The debates took forever. It was science versus religion. It was going nowhere.

But all of a sudden in August 2012,  the House leadership prevailed over the members to agree to vote on the termination of the debates. They set the date on August 7, 2012.

Belmonte took the risk. There was a possibility that the RH bill could have lost that vote. But President Aquino stepped in.

Aquino and his men

On August 6, a day before the scheduled vote, Aquino called all members of the House to a lunch meeting in Malacañang to appeal to them to vote in favor of terminating debates on the RH bill so it can proceed to the period of amendments.

It was a surprise move but it wasn’t too difficult a request. Even the most rabid critics of the RH bill accommodated the President. Anyway, the RH bill still had a long way to go in the legislative process. (READ: House ends debates on RH bill )

The war was just beginning to heat up and critics were successfully using parliamentary tactics to prevent the bill from further moving forward. (READ: Tool vs RH bill: Privilege Speeches )

The period of amendments did not start until November 26, nearly four months since they ended the debates. (READ: Small victory for RH bill in House )

December came and there were 3 session weeks left in the year. Time was  running out. It was time for the President to step in again.

On December 3, Aquino called the House members to another meeting to Malacañang to appeal to them to finally put the RH bill to a vote.

It would happen 9 days later.

C lose vote!

The President’s support for the RH bill has to be put in context. It must pass because he staked his name on it. LP had to back him because losing the vote would reflect terribly on the party.

December 12 was the moment of truth. It was an emotional second reading vote that took 5 hours to finish because many solons felt it was necessary to explain their votes – particularly to the bishops present in plenary.

Based on its own count, the House leadership expected a victory by about 10 votes. But they knew the Catholic Church was working as hard as they were. What stronger message can be sent than sending Malacañang’s armada to the House?

LP president and DOTC Secretary Manuel Roxas II, budget secretary Butch Abad, Communications Secretary Ricky Carandang, and Presidential spokesperson Edwin Lacierda trooped to the House. They stayed in the South Lounge, the hang out place of solons that is off limits to the media.

But to their surprise, some of the anti-RH representatives they thought they persuaded to cast “Yes” votes didn’t deliver. Phone lines burned in the middle of voting to win over “swayable” anti-RH members who have not voted. Gonzales’s men – members of the House Rules Committee – were going around the plenary courting last-minute votes.

In spite all those efforts, it was a victory by only 9 votes — 113 to 104. Among the LP members, 43 voted in favor and 26 voted against. The vote was split down the middle for coalition allies Nationalist People’s Coalition (17-15 in favor) and Nacionalista Party (8-8).

RH advocates celebrated the victory but also feared that the vote could change in the 3rd and final reading.

If the 3rd reading vote was wider, 133 -79, it was because Aquino had already certified it as urgent. The additional 20 votes is the difference between the 27 lawmakers who were absent in the second reading vote but showed up to cast yes votes in the 3rd reading vote and the 7 who previously voted yes but were absent in the final vote.

LP, too, worked harder on its members. The LP vote would change to 51 in favor and 15 against. Among those absent are key party leaders known to be anti-RH.

“ Lahat na yun. Nakausap. Nakumbinsi. Natakot. Napaliwanagan ,” a House leader explained.

C hurch lobby

If there’s anyone who still doubts the power of the Catholic Church, the second reading vote in the House of Representatives is proof.

As vigorously as the Aquino administration, the Catholic Church persevered to push its agenda. (READ: Bishops wanted the vote to happen as close as possible to the 2013 campaign period )

The bishops used all the tricks in the hat. Solons received SMS messages from their bishops, invitations to meetings, images of saints, and letters.

Many of the solons were afraid. Whatever the surveys say on general support for the RH bill, some believed in the Catholic vote.

Minority Leader Quezon Rep Danilo Suarez said there remains religious community leaders who will always follow what the Catholic Church says. That, he said, is the Catholic vote.

The House minority bloc was a big loss to RH bill. Suarez and at least 7 other members who were originally RH bill co-authors later withdrew their support.

Two reasons are being cited for the change of heart: RH bill sponsor Lagman’s tiff with Suarez over the House minority leadership position and the return of former President now Pampanga Rep Gloria Arroyo to the House after a months-long house arrest. She is known to be anti-RH.

Church-goers themselves, other solons were afraid of the treatment they and their children would get from the bishops. After the bill was passed, pro-RH solons spoke of uncomfortable Christmas gatherings in the presence of their bishops.

It was frustrating, said Batanes Rep Henedina Abad. “I have been formed within the paradigm of faith that does justice. My faith has always been a source of strength. Catholic leaders, priests and bishops had always been my source of strength so it is so frustrating when they have different standards in terms of what is right and what is wrong. This is more personal rather than political,” she told Rappler after the ratification of the RH bill in the House.

RH advocates claim they always had the vote to pass the RH bill. But they acknowledged that they started losing votes since the anti-RH rally that the Catholic Bishops’ Conference of the Philippines (CBCP) organized in the People’s Power Monument in February 2011.

In September, a Malacanang official mediated a meeting between the bishops and the House members to attempt a compromise bill.

At least three meetings were held in a hotel in Makati. Bishops actively contributed inputs to the RH bill. The result is the substitute bill that Gonzales presented to the plenary on November 26. In a funny twist of events, Lagman had to protect the bishops’ amendments against anti-RH solons who wanted some of them deleted.

In spite the bishops’ inputs, the Church did not – could not – support the measure. Some of the bishops who sat down with the representatives showed up in the House gallery on voting day.

But the efforts were not wasted. The cooperation shown by the bishops succeeded in persuading House members – who supported the measure but would rather not antagonize the Church – to cast “yes” votes.

Senate junks Enrile’s amendments

Dynamics at the Senate were totally different from the House of Representatives.

Two Senate leaders were the most rabid critics of the RH bill: Senate President Juan Ponce Enrile and Majority Leader Vicente Sotto III.

The plagiarism issue against Sotto was both a boon and a bane. It put Sotto – who poised to be the biggest critic of the bill – on the defensive. But the issue also diverted the Senate’s attention away from the bill itself. Malacañang was expecting the Senate to approve the measure much earlier than the House but they lost a lot of time.

The LP members worked on the senators to secure the necessary vote. But “test vote” happened when Enrile proposed killer amendments and lost.

“It became clear [that the RH bill had the vote in the Senate] during the voting on amendments propounded by Senate President Juan Ponce Enrile. It helped that the House passed on 2nd reading. That accelerated Senate deliberations,” said Abad.

The final vote was 13-8 in favor of the RH bill.

President Aquino’s certification was necessary, most especially for the Senate. Time was running out. The Senate was planning to put it to 3rd reading vote on the last day of session for 2012. That would have pushed the RH bill timeline to 2013.

It is widely believed that with the looming presidential elections, the next Congress is not going to be a good environment for divisive measures like the RH bill. One prospective presidential candidate is anti-RH.

Aquino understands this. He himself softened on the RH bill during the 2010 campaign.

At the end of the day, there was a golden opportunity to pass the RH bill and Malacañang grabbed it. – Rappler.com

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Opinion Arizona’s conservatives brought this political nightmare on themselves

The problem bedeviling Republicans on abortion right now isn’t leaving the contentious issue to the states. It’s leaving abortion rights in the hands of state supreme courts, which Republicans have carefully remolded in a more conservative direction — one that is now inflicting untold political damage on the party.

The country’s been reminded over the past few years about the critical role state courts play in overseeing fractious issues, from drawing voting districts to refereeing abortion rights. That’s made state high courts, especially in states where justices are elected, new political battlegrounds, with multimillion-dollar campaigns. In Wisconsin, the battle for control over the state Supreme Court last year cost an eye-popping $51 million and shifted control to liberals for the first time in 15 years.

I have sharply criticized judicial elections, but at least that method gives voters some say in what rights they are granted. What’s happened in recent days in Florida and Arizona is the predictable and intended result of a different and more insidious form of politicization of the judiciary: court-packing by Republican governors.

The effectiveness of that tactic was on vivid display this week in Arizona. For more than a half-century, the state had five Supreme Court justices. Then came Republican Gov. Doug Ducey. In 2016, the Republican-controlled state legislature — over the objections of the sitting justices — expanded the court to seven. As a result, Ducey was able to name five of the seven justices sitting today; the other two were named by his Republican predecessor, Jan Brewer.

Ducey rejected suggestions that he was engaging in court-packing, noting that an independent merit selection panel screens candidates and sends recommendations to him. But as a prescient 2020 Politico Magazine story recounted , Ducey made it a goal to shift the Supreme Court to the right. When the judicial nominating commission rejected the application of Bill Montgomery, a prosecutor allied with former Maricopa County Sheriff Joe Arpaio, Ducey replaced the three commissioners who had voted against Montgomery — and proceeded to name Montgomery to the high court.

That effort paid off — or backfired — this week. The court reinstated Arizona’s 1864 abortion law , which prohibits the procedure except to save the life of the mother. After initially resisting calls to step aside, Montgomery recused himself on the basis of previous statements he had made on abortion, including calling Planned Parenthood, a party in the case, “responsible for the greatest generational genocide known to man.”

But four Ducey appointees were still left — and they voted as a bloc to revive the Civil War-era abortion law. The majority professed to be following a course of judicial restraint. “A policy matter of this gravity must ultimately be resolved by our citizens through the legislature or the initiative process,” wrote Justice John R. Lopez IV. “Today, we decline to make this weighty policy decision because such judgments are reserved for our citizens. Instead, we merely follow our limited constitutional role and duty to interpret the law as written.”

Of course, the “citizens” whose judgment the court respected didn’t include women — they couldn’t vote in 1864. Arizona wouldn’t become a state until 47 years later.

The Arizona court didn’t have to come out this way, even after the U.S. Supreme Court eliminated the right to abortion in Dobbs v. Jackson Women’s Health Organization . In 2022, as the Supreme Court was considering Dobbs, Arizona passed a new law — it didn’t take effect until after Dobbs was decided — that prohibited abortion, “except in a medical emergency,” after 15 weeks. There was no hint in that measure that this new law would suddenly become inoperative if Roe were overturned. No “trigger” mechanism, like those adopted in other states, provided that the 1864 law would spring back to life if Roe were overruled.

The majority’s contention to the contrary rests on an accompanying “construction provision” stating that the 2022 law didn’t repeal the earlier ban. As the dissenting justices noted, however, the legislature could have easily said it wanted to revive the absolute abortion ban if Roe were gone. “Undoubtedly, the legislature knew how to use trigger clauses because it has explicitly inserted them into other abortion-related session laws,” the dissent said.

This isn’t judicial restraint — it’s judicial activism. And now Arizona Republicans are reaping what Ducey and his allies sowed.

The same is happening in Florida, although the goings-on there have received less attention. Like in Arizona, all seven justices on the Florida Supreme Court were named by Republican governors, five by Gov. Ron DeSantis .

The governor has made reshaping the judiciary a central part of his tenure — “Judicial activism ends, right here and right now,” DeSantis pledged in his inaugural address — and his picks have shifted the court sharply to the right. “A newly constituted, conservative court,” with appointments “I hoped would judge in the mold of U.S. Supreme Court Justice Clarence Thomas,” DeSantis wrote in his book.

Hence, the latest pair of abortion rulings this month from the Florida Supreme Court. In one case, the court rejected a challenge to the state’s 15-week abortion law — a decision that effectively allows a new, even stricter six-week ban to go into effect. In the second case, the court permitted a proposed constitutional amendment to protect abortion rights to appear on the November ballot.

This might sound like a split-the-difference approach. Don’t be fooled. In the ballot measure case, three dissenting justices, all appointed by DeSantis, raised the question , not posed by the advocates themselves, of whether and how the Florida Constitution protects the rights of fetuses — a claim of “fetal personhood” that came up in the Alabama in vitro fertilization case and that is the next frontier in the legal abortion wars.

“The exercise of a ‘right’ to an abortion literally results in a devastating infringement on the right of another person: the right to live,” wrote Justice Renatha Francis. “And our Florida Constitution recognizes that ‘life’ is a ‘basic right’ for ‘all natural persons.’ One must recognize the unborn’s competing right to life and the State’s moral duty to protect that life.” Justice Jamie Grosshans, joined by Justice Meredith Sasso, said it wasn’t yet clear how Florida’s constitutional protections “apply to the unborn and, if so, what the scope of those rights could be.”

That’s just three. But a fourth DeSantis appointee who ruled to allow the ballot measure to go forward, Chief Justice Carlos G. Muñiz, raised the question of fetal rights at oral argument, and an ominous footnote in the majority opinion noted that the “constitutional status of a preborn child … presents complex and unsettled questions.”

In other words, don’t count on us upholding your ballot measure even if it does get the required 60 percent vote. So much for letting the people decide.

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Trump and Mike Johnson zero in on noncitizen voting. It’s already illegal and very rare.

Former President Donald Trump and House Speaker Mike Johnson pitched new legislation to crack down on noncitizen voting on Friday, despite the fact the practice is already illegal and occurs rarely.

Johnson said House Republicans would introduce a bill to require documentary proof of citizenship to register to vote, speaking at Mar-a-Lago next to Trump as he seeks to fend off threats from his right flank.

“It seems like common sense, I’m sure all of us would agree that we only want U.S. citizens to vote in U.S. elections,” Johnson said, falsely suggesting that “so many people” are registering to vote when they obtain welfare benefits.

It is already a crime to register or vote as a noncitizen in all state and federal elections, though Washington, D.C., and a handful of municipalities in California, Maryland and Vermont allow noncitizen voting in local elections.

And few individuals break those laws.

“This is a crime where not only are the consequences really high and the payoff really low — you’re not getting millions of dollars, it’s not robbing a bank, you get to cast one ballot,” said Sean Morales-Doyle, a lawyer at the Brennan Center for Justice. “But what also makes this somewhat unique is that committing this crime actually entails the creation of a government record of your crime.”

Registering to vote and casting a ballot both leaves a paper trail that elected officials are required by law to routinely review. Some records are available to the public, as well.

“It’s very easy to catch, and you will get caught,” Morales-Doyle added.

The consequences are sweeping, too: noncitizens can face jail time, fines or deportation for voting illegally. Registering to vote alone could carry a five-year prison sentence, according to the Brennan Center.

On the flip side, Morales-Doyle said, requiring documentary proof of citizenship could disenfranchise millions of Americans who do not have access to passports or birth certificates.

Several states have tried to require documentary proof of citizenship in the past, but federal law currently prohibits it in federal elections. Arizona requires it for state elections, alone.

Many have investigated noncitizen voting and found little evidence of it. The Brennan Center found just 30 suspected noncitizen votes amid 23.5 million votes in 2016 , suggesting that suspected noncitizen votes accounted for 0.0001 % of votes cast. Trump’s own election integrity commission disbanded without releasing evidence of voter fraud, even though he’d claimed 3 million undocumented immigrants had voted in 2016 costing him the popular vote.

But Johnson and Trump have both long advanced baseless claims about election integrity. Johnson repeatedly promoted conspiracy theories about the 2020 election and its voting machines being rigged, and he recruited Republicans to back a lawsuit seeking to overturn states where Trump lost.

For Trump, however, the proposal fuses two of his favorite talking points: immigration and voter fraud. 

“It’s the sort of story that if you’re inclined to not like immigrants in the first place feels truthy,” said Justin Levitt, a former Biden advisor on democracy issues and election policy expert. “I think that has helped it stayed politically potent even if it hasn’t gotten more true.”

Levitt said when noncitizens do vote, it’s typically a misunderstanding or mistake. He said he recalled an instance where California residents in the process of naturalizing were told they had been granted citizenship and immediately left naturalization interviews to register to vote. They had not been formally sworn in as citizens, however, and therefore were not eligible yet.

Jane C. Timm is a senior reporter for NBC News.

Other Papers Say: Emphasize law enforcement

The following editorial originally appeared in The Seattle Times:

A recent spate of horrendous collisions and nose-thumbing at rules should prompt serious thinking around the laudable state and local goals of no traffic deaths in six years.

It’s not always the roads. Sometimes it’s the drivers.

And, as with so many other signs of societal stress, it comes down to a lack of law enforcement and weak consequences for behaviors that put the entire community at risk.

Consider the case of 18-year-old Chase Daniel Jones, charged with four counts of vehicular homicide after he drove his Audi A4 at 112 mph into a Renton intersection on March 19, killing Andrea Hudson, 38, along with three children of close friends who were passengers in her car: Boyd Buster Brown, 12; Matilda Wilcoxson, 13; and Eloise Wilcoxson, 12. Two of Hudson’s children were severely injured and were hospitalized in intensive care.

It was the third vehicle Jones totaled in a crash involving excessive speed in less than a year, according to charging documents filed by the King County Prosecutor.

Then there is Miles Hudson, aka “Belltown Hellcat,”recently charged by the Seattle City Attorney’s Office with of reckless driving stemming from a video Hudson posted that showed a driver racing another car at speeds up to 107 mph.

As Seattle Times reporter Paige Cornwell noted: “Hudson said he considers himself an Instagram influencer. In one video, which has 6.6 million views, the driver films himself behind the wheel and says it’s 2 a.m., then revs the engine multiple times. He told the officer who pulled him over last week that he was going to continue and that the money he made filming videos had paid for the car.”

WSDOT’s Target Zero campaign to reduce traffic fatalities to zero by 2030 is a “data-driven, long-term plan to identify priorities and solutions, create goals and develop a common understanding among the agencies working to keep Washingtonians safe.”

Speaking of data, let’s look at Seattle Police Department statistics for “Computer-Aided Dispatch” events — all activities that draw cops’ attention.

There were 92,101 traffic-related incidents in 2019. Last year, that dropped to 42,569 — a reduction of more than half.

This is, of course, a direct function of fewer cops. Since 2019, more than 700 officers have left SPD. As of January, SPD had only 913 deployable officers, the lowest level since the 1990s. And the city’s population boomed in the same period.

In a December report, the Washington Association of Sheriffs and Police Chiefs noted the per capita rate of law enforcement officers statewide fell to 1.3 per thousand — the lowest ever recorded, again. For over a dozen years, Washington has had the nation’s fewest law enforcement officers per capita.

So, yes, we need to build safer roads. But unless we pay just as much attention to who is — and who should not be — driving on them, needless deaths will surely continue.

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Guest Essay

What Worries Me Most About a Trump Presidency

By Caroline Fredrickson

Ms. Fredrickson is an adviser at the Open Markets Institute, a senior fellow at the Brennan Center for Justice and a visiting professor of law at Georgetown University.

There are almost daily headlines now describing what Donald Trump would do if elected: the mass deportations, the pardons handed out to his friends and golf buddies, the Justice Department settling scores and waging personal vendettas. The former president has even promised violence if the election goes against him, warning that it could be a “ blood bath .”

But as worrying as these prospects are, they are far from the biggest threats he poses. What we should fear most is Mr. Trump transforming our government into a modern-day Tammany Hall, installing a kleptocratic leadership that will be difficult if not impossible to dislodge.

I do not discount the possibility of state-sponsored violence, and I worry deeply about the politicization of the civil service . But those are, for the most part, threats and theories, and while they need to be taken seriously, people should be paying more attention to a far more likely reality: that Mr. Trump would spend much of his time in office enriching himself. He failed spectacularly as an insurrectionist and as a disrupter of the civil service, and his clownish and chaotic style may well lead to failure again — but he has succeeded time and time again in the art of the steal. If his grift continues into a second term, it will not only contribute to the fraying trust Americans have in their institutions, but also impair our ability to lead the world through a series of escalating crises.

Recall how Mr. Trump operated in his first term. Not only did he keep his stake in more than a hundred businesses, he made it a practice to visit his properties around the country, forcing taxpayers to pay for rooms and amenities at Trump hotels for the Secret Service and other staff members who accompanied him — money that went straight into his bank accounts and those of his business partners. Those interested in currying favor with the president, from foreign governments to would-be government contractors, knew to spend money at his hotels and golf clubs. According to internal Trump hotel documents, T-Mobile executives spent over $195,000 at the Trump Washington Hotel after announcing a planned merger with Sprint in April 2018. Two years later, the merger was approved.

Government, like fish, rots from the head down. Mr. Trump’s example freed up cabinet members to award huge contracts to their friends, business associates and political allies, while others ran their departments like personal fiefs. After the State Department’s inspector general was fired , Secretary of State Mike Pompeo’s use of official trips for clandestine meetings with conservative donors and allegations that his family misused staff members for tasks like walking his dog, picking up his wife from the airport and fetching his takeout came to light. And, in addition to being accused of improperly accepting gifts from those seeking influence, several other cabinet members were alleged to have used government funds for private travel . These may seem like banal infractions, but taken together, they are a reflection of who Mr. Trump is and how he governs.

Throughout his life, through Trump-branded wine, chocolate bars, sneakers, NFTs, ties, MAGA paraphernalia, a $59.99 Bible (of all things ) and, most recently, his Truth Social meme stock ploy, he has shown an unstoppable drive to enrich himself at all costs. He sees politics, like business, as a zero-sum game in which he wins only if someone else loses. These are the instincts that drive corruption, kleptocracy and grift. And, if past is prologue, we’re looking at a much more damaging sequel.

In a second term, Mr. Trump will have more freedom and power to undertake grift. He has already vowed to use pardons to protect supporters and possibly even himself from efforts to curb corruption (which may explain the nonchalance with which his son-in-law Jared Kushner has greeted criticism about the conflicts of interest raised by his recent real estate investments in Serbia and Albania, as well as the Saudi, Qatari and Emirati investments in his wealth fund). And he and his political advisers are building a deep bench of committed and loyal employees who could corrode and potentially destroy mechanisms of accountability in government, paving the way for kleptocratic leaders to entrench themselves in the bureaucracy where many would be able to remain past Mr. Trump’s term. And the mere presence of a phalanx of unquestioning lieutenants in the civil service will ensure that other civil servants fear retribution for objecting to the self-enrichment.

Naturally, I worry about other things, too, particularly the possibility of political violence. Mr. Trump could well claim he has won the election no matter the vote count and call on his supporters to rise up to ensure his takeover. Even before the votes are cast, his supporters are threatening election officials, judicial officials and state legislators, trying to intimidate them into either helping Mr. Trump or stepping aside to be replaced by Trumpists.

But legal, law enforcement and security obstacles are still in place to slow down or stop these efforts. We must remember that this time around, President Biden will still be president, able to control the military and federal law enforcement, and Congress has amended the outdated and vague Electoral Count Act to make it much harder for Mr. Trump’s congressional allies to contest a Trump loss in the electoral college or on Capitol Hill.

No such guardrails exist to curb Trumpian corruption. The Supreme Court, itself corrupt , has made it virtually impossible to prosecute even the most blatant corruption by government officials.

In a kleptocracy, corruption is a feature, not a bug, where politicians apply the law inconsistently , favoring friends and punishing enemies. By controlling government assets and handing them out to friends and family — and dangling possibilities in front of would-be supporters — as well as using politically motivated prosecutions, kleptocrats cement their control of government and disempower opponents. We need only recall Russia’s erstwhile effort to create a democracy: It quickly drained away into the pockets of Vladimir Putin and his oligarchs, leading to the hopelessness and acquiescence of Russian citizens once they realized they could no longer change their situation through democratic means.

Now we face that danger at home. If Mr. Trump wins, America will have a leader invested in his own personal power, both financial and punitive, and supported by a much more capable team. When lucrative contracts are handed out to Trumpist loyalists regardless of merit and dissident voices are targeted and silenced, America’s leadership on the global stage will dissolve when it’s needed most.

The consequences will echo for generations if we lack the ability and the will to attack problems like climate change, mass migration, a new space race and multiple wars. Nothing of substance will be done, Mr. Trump’s cronies will continue to act with impunity, and millions of Americans — already worried that elites are held to a different standard than regular people are — will lose even more confidence in their government, convinced that everyone in Washington is out for himself.

This combination of passivity on the one hand and impunity on the other could be fatal for our democracy. This is the true danger Mr. Trump poses.

Caroline Fredrickson is an adviser at the Open Markets Institute, a senior fellow at the Brennan Center for Justice and a visiting professor of law at Georgetown University.

The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips . And here’s our email: [email protected] .

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Panama Papers: trial begins of 27 Mossack Fonseca employees

Law firm’s founders among those to face money laundering charges after leak of 11.5m files in 2016

A criminal trial of 27 employees working for the law firm at the heart of the Panama Papers on money laundering charges has commenced in a Panamanian court.

Eight years ago, leaked financial records from the law firm Mossack Fonseca sparked international outrage at the use of offshore companies by wealthy individuals to commit tax fraud and hide assets.

In 2016, files from Mossack Fonseca were leaked to reporters at the German newspaper Süddeutsche Zeitung and shared with the US-based International Consortium of Investigative Journalists. Reporters from more than 100 media organisations, including the Guardian, collaborated to investigate the 11.5m files.

The firm’s founders, Jürgen Mossack and Ramón Fonseca Mora, are among those facing charges. They have previously denied any allegations against them, arguing that they had no control over the offshore companies that the firm set up for its clients. If convicted, they reportedly face up to 12 years in prison.

According to the Associated Press , Mossack attended the hearing to declare his innocence, telling reporters outside the courtroom that he was “very optimistic”. A representative for Fonseca told the court that his client was in hospital.

Battered by international criticism, Panama adopted new legislation modernising the country’s legal definition of money laundering in 2019. Aspects of the charges against the Mossack Fonseca employees concern activities predating the change in the law, which could complicate prosecutors’ attempts to convict them, according to the International Consortium of Investigative Journalists .

Panama’s supreme court previously ruled that creating shell companies used for tax fraud could not be considered a crime if the companies in question were created prior to 2019.

Mossack and Fonseca were both acquitted of separate charges two years ago after a judge directed that the firm did not handle or attempt to hide money stolen from Brazil as part of a major corruption scandal involving the state oil company codenamed Lava Jato or the Car Wash.

Offshore companies linked more than 100 politicians from around the world, including 12 national leaders, were discovered by journalists analysing the Panama Papers. They included $2bn in an offshore company belonging to the Russian cellist Sergei Roldugin, the friend of the President Vladimir Putin.

Nawaz Sharif , then prime minister of Pakistan, and Sigmundur Davíð Gunnlaugsson , prime minister of Iceland, were both forced from office amid public fury at hidden offshore wealth connected to their families.

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Sharif was disqualified from office and sentenced to 10 years’ imprisonment by the Pakistani supreme court after reporters discovered undeclared real estate secretly owned by his family through offshore companies. Gunnlaugsson was forced to resign after it was revealed that he had never declared his family’s ownership of an offshore company with a $1m claim against one of Iceland’s failed banks.

After publication of the Panama Papers investigation, countries around the world initiated proceedings to recover unpaid taxes that had been hidden using offshore companies. By 2021 more than $1.36bn in fines and penalties for unpaid taxes were said to have been recovered by exchequers around the world, including $253m recovered by HMRC in the UK.

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