responsible parenthood and reproductive health act of 2012 essay

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.

Approved: DEC 21 2012

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

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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.

Contributor Information

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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, share this story, the center’s recent work in the philippines..

Victory for Children’s Rights: Ending Child Marriage in the Philippines

Law supported by the Center adds serious penalties to combat the harmful practice.

For recent updates on the Center’s Work in the Philippines, click here. 

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.”

The Philippines Decriminalizes Consensual Adolescent Sexual Activity

For the first time, adolescents in the country are recognized as rights holders who have sexual autonomy.

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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Open Access

Peer-reviewed

Research Article

Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines

Roles Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Supervision, Validation, Writing – original draft

* E-mail: [email protected]

Affiliation Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan

Roles Data curation, Formal analysis, Methodology, Writing – original draft

Affiliation Partnership for Maternal, Newborn and Child Health, Geneva, Switzerland

Roles Conceptualization, Methodology, Writing – original draft, Writing – review & editing

Affiliation Independent consultant, maternal and child health, Iowa City, United States of America

Roles Conceptualization, Methodology, Validation, Writing – review & editing

Affiliation World Health Organization Philippines Country Office, Manila, Philippines

Affiliation Responsible Parenthood and Reproductive Health National Implementation Team (RP-RH NIT), Department of Health, Manila, Philippines

Roles Conceptualization, Funding acquisition, Methodology, Supervision, Validation, Writing – original draft, Writing – review & editing

Affiliation Division of NCD and Health through Life-Course, Reproductive, Maternal, Newborn, Child and Adolescent Health, World Health Organization Regional Office of the Western Pacific, Manila, Philippines

• Mari Nagai, 
• Saverio Bellizzi, 
• John Murray, 
• Jacqueline Kitong, 
• Esperanza I. Cabral, 
• Howard L. Sobel

• Published: July 25, 2019
• https://doi.org/10.1371/journal.pone.0218187
• Reader Comments

In the Philippines, one in four pregnancies are unintended and 610 000 unsafe abortions are performed each year. This study explored the association between missed opportunities to provide family planning counseling, quality of counseling and its impact on utilization of effective contraception in the Philippines.

One-hundred-one nationally representative health facilities were randomly selected from five levels of the health system. Sexually-active women 18–49 years old, wanting to delay or limit childbearing, attending primary care clinics between April 24 and August 8, 2017 were included. Data on contraceptive use, counseling and availability were collected using interviews and facility assessments. Effective contraceptive methods were defined as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use.

849 women were recruited of whom 51.1% currently used effective contraceptive methods, 20.6% were former effective method users and 28.3% had never used an effective method. Of 1664 cumulative clinic visits reported by women in the previous year, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility, with 83.7% having a missed counseling opportunity on the day of the interview. Most women (55.9%) reported health concerns about modern contraception, with 2.9% receiving counseling addressing their concerns. Only 0.6% of former users and 2.1% never-users said they would consider starting a modern contraceptive in the future. Short and long acting reversible contraceptive methods were available in 93% and 68% of facilities respectively.

Conclusions

Missed opportunities to provide family planning counseling are widespread in the Philippines. Delivery of effective contraceptive methods requires that wider legal, policy, social, cultural, and structural barriers are addressed, coupled with systems approaches for improving availability and quality of counseling at all primary health care contacts.

Citation: Nagai M, Bellizzi S, Murray J, Kitong J, Cabral EI, Sobel HL (2019) Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines. PLoS ONE 14(7): e0218187. https://doi.org/10.1371/journal.pone.0218187

Editor: Elizabeth Ann Micks, University of Washington, UNITED STATES

Received: January 12, 2019; Accepted: May 28, 2019; Published: July 25, 2019

Copyright: © 2019 Nagai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: Data collection was funded by World Health Organization (WHO) Regional Office of the Western Pacific. The funder was involved with study design, data analysis, and preparation of the manuscript. SB, JK, and HS are affiliated with WHO. The specific role of these authors is articulated in the 'author contributions' section.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Unintended pregnancies remain an important public health problem worldwide. Between 2010 and 2014, there were an estimated 62 unintended pregnancies per 1000 women aged 15–44 years each year, with rates ranging from 112 in East Africa to 28 in Western Europe [ 1 ]. In Philippines, 54% of all pregnancies (1.9 million pregnancies) are reported to be unintended and around 610 000 unsafe abortions are performed each year [ 2 ]. Nine percent of women 15 to 19 years of age have begun child bearing [ 3 ].

In 2017, the modern contraceptive prevalence rate (CPR) in the Philippines was estimated to be 40% among married women of reproductive age and 17% among unmarried sexually active women [ 3 ]. The modern CPR increased only 2% between 2013 and 2017, with rates being much lower in some populations. Forty-six percent of married women used no contraceptive method in 2017 and 14% a traditional method, a decline from 16.7% in 2008; only 10% of women used long acting reversible contraceptives (LARCs) such as IUDs and implants [ 3 ]. Among sexually active unmarried women, traditional methods were used by 15% [ 3 ].

Women who are fecund, sexually active and who want no more children or to delay the next child, but are not using any method of contraception, are defined as having an “unmet need for family planning”. The unmet need for family planning among married women of reproductive age in Philippines was 17% in 2017, with the demand met by modern methods estimated to be 57%. Among unmarried sexually active women the unmet need increases to 49% and the demand met by modern methods falls to 22% [ 3 ]. As a consequence of the low contraceptive met need, 68% of unintended pregnancies occur in women not using any method and 24% in those using traditional methods [ 4 ]. Those using LARCs rarely have unintended pregnancies [ 5 ].

Several barriers to accessing family planning services have been observed in the Philippines. A 2013 survey found that maintenance of virginity until marriage was important for 83% of women aged 15–24, even though 14% of 15–19 year-olds and 49% of those aged 20–24 years experienced first sexual intercourse before marriage [ 6 ]. This social norm paradoxically discourages use of contraception by unmarried women. In addition, infrequent sex was commonly stated as a reason why women with an unintended pregnancy did not use modern methods. Among married women with an unmet need, half cite inappropriate health concerns as a reason not using modern methods including weight loss, chemical toxicity due to prolonged use, excessive bleeding, the buildup of blood if menstruation stops, loss of physical strength, debilitating headaches or stomach aches, and fears that devices that get lost inside the body [ 7 ]. Religion-based opposition to contraception was reported as a barrier by only 3%-6% of women and accessibility of methods by 2% to 7% [ 7 ].

Although the family planning program in the Philippines began in 1971 and was one of the strongest in Asia, religious concerns, rapid decentralization and various legal interventions have restricted implementation. The Responsible Parenthood and Reproductive Health Act of 2012, designed to re-vitalize family planning service provision, was not put into place until 2017 when legal and programmatic barriers had been overcome [ 8 ].

In response, the Department of Health in Philippines sought to identify strategies to improve family planning programming. Improvement of uptake of modern methods of contraception, especially LARCs, became an important public health priority. Experience from other countries in Asia has shown that facility-based contraceptive counseling is often poor [ 9 , 10 ]. Women are often dissatisfied with clinic visits, because they are unable to discuss their concerns and receive insufficient information about their options. Additionally, providers frequently have inaccurate knowledge about contraceptive methods, including out-of-date information [ 11 , 12 , 13 , 14 ]. For these reasons, this study was designed to review current counseling practices as a key barrier to uptake of contraception. Since the government health insurance provider (Philhealth) provides coverage for 66% of the population, with 56% of women currently obtaining contraception at public health facilities [ 3 ], the study was designed to focus on practices in the public sector. The objectives were to identify the extent of missed opportunities to provide family planning counselling at primary care visits, whether effective counselling was provided and its impact on women’s concerns and decision making to begin use of modern contraceptives. The goal was to identify systems factors that could be targeted to improve the quality of care and to reduce unintended pregnancies.

Study design

A nationally representative cross-sectional survey design was used. One hundred one health facilities (11 national hospitals, 13 regional hospitals, 23 provincial hospitals, 27 main health centers, and 27 barangay health centers) were selected. In first stage sampling, 23 provinces were randomly selected using probability proportionate to size based on the estimated number of sexually active women with unmet need [ 15 ]. Within the sampled provinces, the provincial hospital, 1 main health center and 1 Barangay health center of the most populated Barangay were selected. Regional and national hospitals within the province were also included. The number of facilities sampled was based on estimated participants sample size (n = 820) required to allow comparisons of the proportion women using modern methods of contraception by socio-economic factors with 80% power.

At each facility, women aged 18–49 years of age, who were not currently pregnant or within 6 weeks of delivery, wanting to delay or limit childbearing on the day of the visit were eligible to for the study, to avoid confounding by stage of pregnancy, place of delivery or the early post-pregnancy period on the likelihood and quality of counseling. Questions about missed opportunities to provide family planning counseling were asked about all clinic visits in the previous year. Individual interviews using structured questionnaires were conducted with 10 women per hospital and 6 per health center. Sampled women were divided into equal groups of those currently using and not using effective contraceptive methods. We defined effective contraceptive methods as those with rates of unintended pregnancy of less than 10 per 100 women in first year of typical use (i.e., patch, oral pills, injectables, IUDs, implants and sterilization) [ 5 ]. We excluded lactational amenorrhea to focus on non-transient modern methods. Less effective contraceptive methods were defined as condoms, fertility self-monitoring (i.e, standard days method, basal body temperature) and traditional methods (i.e., withdrawal, calendar or rhythm method). Where multiple methods were used, subjects were categorized according to the most effective method used.

Data were collected from women attending the outpatient primary care clinic on the day of the survey. Primary care clinics included postnatal care, reproductive health, well child, and primary care. If more than the required number of women were in attendance, systematic sampling method was used. At five sampled health facilities, the minimum number of women were not available on the day of the survey. At these facilities, 24 (2.8%) women meeting eligibility requirements for the study and living within 1 hour of the facility were identified from clinic registers for the previous days and interviewed at their homes to obtain the minimum sample size.

A closed-ended questionnaire for women, interview guide and health facility assessment checklist were developed referring to previous research. These were finalized after two field pilot tests. To those women who preferred local dialects, the questionnaires and consent forms were translated into one of eight local dialects (Tagalog, Ilocano, Bicolano, Visayan, Ilonggo, Chavacano, Tausug, and Meranao) then validated by back-translation. Eight teams consisting of one team leader and one enumerator collected data from April 24 to August 8, 2017 using paper-based questionnaires. Enumerators near selected facilities were identified to minimize language differences across study sites. Data were collected using: 1) interviews with women on current, former and never use of effective contraceptive methods, concerns and attitudes towards contraception, and management of concerns at outpatient primary care clinics of health facilities; 2) facility assessments of the availability of family planning commodities and policies including hospital accreditation status for use of LARCs.

Study outcomes

Counseling was defined as any information or advice given about any contraceptive method during the woman's clinic visit. A missed opportunity was defined as a woman’s clinic visit at which a staff member at the health facility did not provide any counseling. When counseling was provided, quality of counseling was measured by asking the woman whether health staff asked about her concerns on family planning, helped her to find solutions to her concerns, offered her information about how different family planning methods work, or explained side-effects or problems she might have with any method. A health concern about a family planning method was defined as any perceived undesirable health effect. Accumulated facility visits were defined as the number of visits to health facilities made by interviewed women between January 1 and December 31, 2016. Accumulated missed opportunities were defined as the total number of accumulated facility visits at which health staff did not provide any family planning counseling on the day of that visit.

Data management and analysis

The team leader checked completeness and accuracy of completed paper-based questionnaires on the day of interview. Two data managers independently entered the questionnaire data into identical Excel sheets and compared using STATA version 13.1. Inconsistencies were validated with the original paper and corrected. Statistical analysis was also done using STATA.

Ethical considerations

Ethical clearance was obtained by the WHO Regional Office for the Western Pacific Ethics Review Committee on 12 January 2017, and the National Ethics Committee in the Philippine Council for Health Research and Development of the Department of Science and Technology on 1 February 2017. All women were asked for informed consent. Participants were informed of their right to refuse participation in the study, or not answer specific questions should they assent to participation and were assured of the confidentiality of the collected information. All interviews were conducted in private settings and unique identifiers were used to maintain anonymity. All paper copies are maintained in a locked file cabinet.

A total of 849 non-pregnant sexually active women, 18–49 years of age, wanting to delay or limit childbearing were included in the study. Only one woman meeting the entry criteria refused to be interviewed. Of sampled women, 51.1% (434) were currently using an effective contraceptive method, 16.5% (140) a less effective contraceptive method and 32.4% (275) no contraceptive method. Of all women, 36.7% (312) were currently using short-acting effective methods (pills, patches or injectables), 8.9% (76) LARCs (IUD or implants) and 5.5% (46) female sterilization. An additional 18.2% (155/849) of women had used short-acting effective methods in the past and 2.4% (20) had used LARCs in the past. An effective method had never been used by 28.3% (240) of women ( Fig 1 ).

• PPT PowerPoint slide
• PNG larger image
• TIFF original image

https://doi.org/10.1371/journal.pone.0218187.g001

Demographic characteristics of sampled current, former and never users were similar ( Table 1 ). Respondents were predominantly urban, aged 30 years, married or living together, with at least a high school education and 2 living children. They reported an average of 1.9 health facility visits in the past year. Philhealth insurance coverage in our sample was 71.3% with 24.7% having no health insurance. Women who had never used contraception were more likely than current users to have not graduated high school.

https://doi.org/10.1371/journal.pone.0218187.t001

Of all women, 83.7% (711/849) reported a missed opportunity for family planning counseling on the day of the interview. Missed opportunities were high regardless of contraceptive method used, residence, age group, marital status, education, number of children, or financial protection status, but highest among those younger than 21 years old, and women living together or not married ( Fig 2 ). Missed opportunities remained high across all levels of health facility and facility accreditation or certification status.

https://doi.org/10.1371/journal.pone.0218187.g002

The 849 women interviewed reported 1664 accumulated primary health care facility visits including antenatal care and postnatal care before discharge, between January 1 and December 31, 2016, not including the day of the interview. Of the 1664 accumulated health facility visits, 72.6% (1211) were missed opportunities to provide family planning counseling. Missed opportunities were found for 68.6% (587/856) of visits by current effective contraceptive method users, 73.4% (235/320) by former users and 78.9% (385/488) by never users. Overall, women not currently using any effective contraceptive method had a missed opportunity in 76.7% (620/808) of all clinic visits in 2016. Missed opportunities to provide family planning counseling were reported for 85.8% (241/281) of reproductive health clinic visits, 76.8% (182/237) of antenatal care visits, 74.7% (198/265) of postnatal care before discharge contacts, 73.7% (73/99) of postnatal care visits after discharge, 71.9% (264/367) of well-child visits, 70.7% (162/229) of sick child visits and 57.1% (68/119) of primary care visits for herself. Missed opportunities were lowest for contraceptive clinic visits, at which 32.8% (23/70) women reported that family planning counseling about any method was not provided ( Fig 3 ).

https://doi.org/10.1371/journal.pone.0218187.g003

Sixteen percent (138/849) of women received family planning counseling on the day of the interview. Of the 138 women receiving counseling, 67.4% (93) were asked if they had concerns about contraceptives, 59.4% (82) received information about how different contraceptives work and 44.9% (62) were told about possible contraceptive side-effects during the counseling. Current effective contraceptive users were more likely to receive information than former or never users. Of the 80 current users receiving family planning counseling, 75.0% (60) were asked about concerns, 66.3% (53) were given explanations about how different methods work, and 55.0% (44) were given advice about side-effects. In contrast, the same information was given less frequently to the 24 former users receiving counseling (50%, 41.6% and 37.5%, respectively) and the 34 never users receiving counseling (62.9%, 55.9% and 23.5%, respectively).

Overall, 55.9% (481/849) of women reported a total of 567 concerns about any effective contraceptive method on the day of the interview. The prevalence of concerns was 72.6% (126/175) among former users, 56.0% (242/434) among current users, and 47.5% (113/240) among never users. Only two women reported concerns that were not related to health: one woman who had never used effective contraception stated that it was illegal to use sterilization and IUDs; and another currently using injectables stated that the church did not allow the use contraception. Of all 567 concerns, 64.9% (368) were medically known side effects such as changes in bleeding patterns, irritability (mood changes), headaches and weight gain 4 , while 35.1% (199) were misperceptions. The latter included the belief that contraceptives caused uterine cancer, cysts, fetal malformations, varicose veins, and dry skin. Misperceptions accounted for 33.6% (38/113) of all concerns among current, 25.7% (44/171) former and 41.3% (117/ 283) never users. Misperceptions were particularly high about female sterilization (87.0% or 20/23 of concerns such as frequent bleeding or cause uterine cancer) and IUDs (67.6% or 50/74 of concerns were misperceptions such as movement to other organs inside the body). Misperceptions were a low proportion of concerns for implants (37.5% or 9/24 of concerns), pill (27.9% or 79/283 of concerns) and injectables (25.1% or 41/163 of concerns).

Of the 481 women with a health concern about effective contraceptive methods, 16.3% (79/481) received family planning counseling on the day of interview. Regardless of contraceptive usage status, information given to women with concerns was limited, with only 2.9% (14/481) of women reporting that their concern about a specific method(s) had been addressed by the health worker during counseling ( Fig 4 ). Only 0.6% (1/175) of former users and 2.1% (5/240) never users with concerns said they would consider starting a modern contraceptive method at the time of the interview.

https://doi.org/10.1371/journal.pone.0218187.g004

A stock of non-expired effective short-acting contraceptive methods was available at 87.5% (42/47) of government hospitals, 95.7 (45/47) of health centers, and 100% (7/7) of barangay health stations. LARCs were available in 85.1% (40/47) of government hospitals, 60% (28/47) (61%) of health centers and 1/7 (14.3%) of barangay health stations.

Of 1664 cumulative total clinic visits reported by the women wanting to delay or limit childbearing in 2016, 72.6% had a missed opportunity to receive family planning counseling at any visit regardless of level of facility or socio-economic indicators. On the day of the interview in 2017, 83.7% of women had a missed opportunity. Although 55.9% of women reported health concerns about effective contraceptives on the day of the interview, 16% with a concern received family planning counseling and only 2.9% received counseling addressing her specific concerns. Only 0.6% of former effective contraceptive method users and 2.1% never-users said they would consider starting effective contraceptive method in the future. As relatively few facilities had stock-outs, most women in our study could have received an effective contraceptive on the day of the visit, if they had received high quality of counseling, been offered a method and had decided to use it.

These findings suggest that the quantity and quality of family planning counseling provided at primary care clinic contacts in Philippines to women who wish to delay or limit childbearing is inadequate and unlikely to significantly increase the use of effective contraceptive methods. Around 20% of women attending clinics in this study had previously used an effective contraceptive method, but had discontinued use, highlighting that contraceptive services must focus not only on attracting new users but also on improving continuation rates [ 16 ]. To do this, current users should receive continued counseling at every contact, to address the emerging or ongoing concerns about methods; and past users who have stopped use targeted, where appropriate, to resume use by identifying reasons for discontinuation.

The high prevalence of missed opportunities to provide family planning counseling found in this study is consistent with other studies in both developed and developing country settings [ 17 – 19 ].

The World Health Organization recommends providing routine family planning counseling at antenatal care, postnatal care, and other contact points [ 20 – 23 ]. However, experience with integration of family planning counseling into routine primary care is mixed. Significant improvements in family planning outcomes have been seen when improved counseling or referral is integrated into both immunization clinics and general primary care clinic settings [ 24 – 26 ]. In other settings limited improvements in contraceptive use are seen with integration into other services [ 27 – 30 ]. These studies suggest that integrating family planning counseling into routine practice cannot be effective unless systems barriers at primary care clinics are addressed, including the availability of staff, patient numbers and flow, space for adequate one-on-one counseling and availability of low-risk contraceptive methods.

Client-centered counseling approaches are associated with improved method continuation. Women who report experiencing higher quality care have higher rates of contraceptive continuation and contraceptive use [ 31 – 33 ]. In reality, interactions between clients and providers are often provider-dominated, with minimal engagement with women in the process of method selection and with frequent failure of providers to deliver personalized counseling tailored to the individual women's needs and preferences [ 34 – 36 ].

Most counseling in primary care clinics in Philippines is provided by doctors, nurses and midwives. Although family planning counseling at both antenatal and postnatal care contacts is included in national policies and guidelines in Philippines [ 37 ], our findings indicate they are rarely translated into practice. Improving delivery of effective contraceptive methods requires addressing wider legal, policy, social, cultural, and structural barriers which prevent individuals from accessing and using contraception and influence the quality of counseling provided. Some recent policy initiatives in Philippines may promote improved family planning counseling. The Universal Health Coverage Act (RA11223) signed into law in Philippines in February 2019, requires that FP counseling should offered at all primary care contacts, along with a package of essential services. The Expanded Maternity Leave Act (RA11210) also signed in February 2019, increases paid maternity leave from 60 to 105 days and is designed to improve opportunities for postpartum care, including improve family planning counseling and method provision. In 2012, the Responsible Parenthood and Reproductive Health Act (RPRHA) passed, which guarantees universal and free access to modern contraceptives, in particular for poor women [ 8 ].

However, the RPRHA imposes a ban on the purchase of dedicated emergency contraceptives by national hospitals, and requires parental consent for minors to access contraceptives. These restrictions directly impose barriers to contraceptive use on poorer women and adolescent girls [ 38 ].

Although many Philippine-governmental norms and standards are in agreement with adolescents’ human rights to contraceptive information and services recommended by the WHO, a significant number are restrictive, reflecting the strong influence of conservative religious beliefs [ 39 ]. In addition, decentralization of the health system, gives local chief executives the power to ignore national health policies and programs. For example, the mayor of Manila banned contraceptive services in local health facilities in 2000 because of his own religious objections [ 40 ]. In Philippines, staff report that providers who are members of the church often face pressure not to distribute contraception and sometimes pressure from anti-reproductive health groups. Religious beliefs are not cited as important barriers among women of reproductive age, however, suggesting that if appropriate information and counseling was provided, many women would consider adopting modern methods.

There are also a number of provider perceptions that may limit counseling provision, including lack of knowledge, training, and comfort, assumptions about patient pregnancy risk, negative beliefs about contraceptive methods, a reliance on patients to initiate discussions; and limited communication with other primary care staff [ 41 , 42 , 43 ]. Our finding of 32% missed opportunities at contraception clinics suggests that provider-related perceptions and skills continue to play a role in limiting the quality of counseling in the Philippines.

Social norms are believed to be particularly important barriers in Philippines. These norms prevent women, especially adolescents and unmarried women, from accessing services and using methods effectively. The high value placed on virginity at marriage discourages women from admitting sexual activity and inappropriate health concerns [ 6 ].Women frequently do not use any contraceptive method, despite wanting to avoid pregnancy, because they do not perceive themselves to be at risk of pregnancy or they have concerns about the methods, perceptions that are reinforced by families and communities where they live [ 44 ]. In some cases, health-provider or community assumptions about needs may conflict with the women’s own assessment, especially in contexts where there has been a history of contraceptive coercion or discrimination. Providers often offer less-effective methods such as condoms to adolescents believing that LARCs are inappropriate for women who have never had a child. This is despite the fact there is no medical reason to withhold LARCs from adolescents and young women [ 45 ].

This study confirms that LARCs such as IUDs and implants are used less frequently than short acting methods in the Philippines despite being far more effective [ 5 ]. Although previous studies have shown that cost and availability are minor contributors to stoppage or non-use of family planning in general, long-acting methods require specially trained workers and upfront payments which may present barriers to use [ 46 ]. In the Philippines, the national policy allowing only accredited facilities, mostly hospitals, to administrator LARCs results in lower availability at peripheral level facilities. Alternative models, which provide on-site family planning counseling and services, have been shown to increase uptake of LARCs [ 23 ].

In summary, improving family planning counseling at all clinic contacts in the Philippines will require actions at several levels. Recognizing the role of effective contraception to improve the health and economic development of the country is the first step and should be reflected in national laws and policies. Legal barriers such as limitations on the availability of emergency contraception and requiring parental consent can be carefully re-considered and removed. National policies and guidelines should be reinforced at all levels to ensure they are consistent with WHO recommendations and to remove abstinence-centered and sex-negative content. Mechanisms to avoid local adaptations which bypass national policies and guidelines should be explored. Availability of LARCs can be increased by expanding the range of facilities where they can be provided and the number and categories of staff trained in their use. National policies, guidelines and standard operating procedures for primary care services can emphasize integrating family planning counseling at all contacts. Health worker awareness and counseling skills can be strengthened by incorporating skills into professional medical, nursing and midwifery pre-service training curricula and by providing on-the-job coaching of doctors, nurses and midwives; client-centered counseling approaches can address both relational and task-based communication focusing on common obstacles to use [ 47 ]. Development of simple screening tools may allow many counseling tasks to be done by under-employed staff at facilities, removing pressure on those providing clinical services. This approach may be particularly useful for screening current users about concerns; and for identifying and improving support for past users who have stopped use. Systems barriers to counseling need to be identified and addressed in all primary care settings. These include organization of clinic space, patient flow and time to allow counseling to take place, making adequate human resources available, task shifting to improve quality and making LARCs more widely available in primary care settings. Facility accreditation, professional licensure and performance-based financing can help to maintain the motivation of health professionals and provide incentives for prioritizing uptake of effective contraceptive methods.

This study aimed to select a nationally representative sample, based on unmet need for family planning. Since the 2014 Philippine Demographic and Health Survey calculated population-based estimates of unmet need only at the regional level, provinces within a region with higher than average unmet need may be under-represented [ 15 ]. Philhealth insurance coverage in the study population was 71.3% compared to 65.8%, in the general population; 24.7% of the sample had no health insurance compared to 9.9% in the general population [ 3 ]. Higher uninsured rates suggest that the study population may be poorer and less educated, which puts them at higher risk of not using modern methods of contraception. The sample was not weighted for different outpatient clinic attendance rates, which may differ by clinic level and could not be determined in advance. At the clinic level women were selected by order of attendance until the required number was obtained; if more than the required number was present, they were selected by systematic random sampling ordered by time of arrival. In 24 cases home visits were made to interview women who had attended on the previous day. If the characteristics of women or of counseling provided differed by time of attendance, then the sampling of women at clinics could introduce bias. In addition, the study could not control for the clinic type from which women were sampled, since various clinics often fell on certain days of the week. To mitigate these limitations of sampling, we also analyzed the data from the accumulated visits of interviewed women for previous 12 months. The universal presence of missed opportunities across all clinic types at all levels, and the consistency of findings by demographic characteristics, suggests that these factors are unlikely to produce significant biases.

Since our sample was facility-based, findings may not reflect the practices of those who have less access to public clinics or seek care less regularly. In addition, adolescents under 18 years of age were excluded, because their inclusion would have required a lengthy institutional review process which could not be completed within financial deadlines. Given the high missed opportunities among adult women, omission of these groups likely meant that our findings underestimate the extent of the problem.

We asked respondents about family planning services received on the day of the interview and at all clinic visits in 2016. A maximum period of 6 months has been suggested for the recall of non-significant events [ 48 ]. However, rates of missed opportunities did not change significantly between the day of interview and one-year accumulated visits across all demographic categories. To limit the influence of recall bias, detailed data on quality of counseling were collected only for counseling conducted on the day of interview.

Conclusions and broader implications

As in other low- and middle-income countries, the Philippines faces substantial barriers to improving reproductive health services. This study showed that the vast majority of women who wish to delay pregnancy, attending public health clinics, did not receive family planning counseling regardless of their current status of contraceptive use or clinic attended. Over half of these women had health concerns about effective contraceptive methods which were not addressed. This striking finding means that many women in contact with the health system continue to use no contraception, use traditional and other less-effective methods or stop using contraception altogether. As a consequence, many women are put at unnecessary risk of short-spaced high-risk pregnancies and cycles of high fertility, lower educational and employment potential and poverty [ 49 – 51 ]. The study shows that effective contraceptive methods are generally available and that out-of-pocket expenditure was not a major barrier. Systems approaches for improving availability and quality of contraceptive counseling at all primary health care contacts are now needed. Since similar systems problems exist across low and middle-income countries, better quantification of missed opportunities to provide contraceptive counseling and barriers to use is an urgent priority [ 52 ].

Supporting information

S1 questionnaire. questionnaire to women in english..

https://doi.org/10.1371/journal.pone.0218187.s001

S2 Questionnaire. Questionnaire to women in Bicol.

https://doi.org/10.1371/journal.pone.0218187.s002

S3 Questionnaire. Questionnaire to women in Chavacano.

https://doi.org/10.1371/journal.pone.0218187.s003

S4 Questionnaire. Questionnaire to women in Ilocano.

https://doi.org/10.1371/journal.pone.0218187.s004

S5 Questionnaire. Questionnaire to women in Ilonggo.

https://doi.org/10.1371/journal.pone.0218187.s005

S6 Questionnaire. Questionnaire to women in Meranao.

https://doi.org/10.1371/journal.pone.0218187.s006

S7 Questionnaire. Questionnaire to women in Tagalog.

https://doi.org/10.1371/journal.pone.0218187.s007

S8 Questionnaire. Questionnaire to women in Tausug.

https://doi.org/10.1371/journal.pone.0218187.s008

S9 Questionnaire. Questionnaire to women in Visaya.

https://doi.org/10.1371/journal.pone.0218187.s009

S10 Questionnaire. Facility assessment checklist.

https://doi.org/10.1371/journal.pone.0218187.s010

S1 Minimal Dataset. 1:Response of 860 women in Excel.

https://doi.org/10.1371/journal.pone.0218187.s011

S2 Minimal Dataset. 2:Response of 860 women in STATA.

https://doi.org/10.1371/journal.pone.0218187.s012

S3 Minimal Dataset. 3:Values used to build graphs.

https://doi.org/10.1371/journal.pone.0218187.s013

Acknowledgments

We are grateful for the data collection conducted by Asian Institute of Development Studies, INC, Philippines. We thank all health facilities and women who visited those facilities voluntarily participated to this study.

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The Responsible Parenthood and Reproductive Health Act

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The Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No. 10354), informally known as the Reproductive Health Law or RH Bill, is a law in the Philippines, which guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care.While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, andIUDs, as the government continues to disseminate information on their use through all health care centers.

Passage of the legislation was controversial highly divisive, with experts, academics, religious institutions, and major political figures declaring their support or opposition while it was pending in the legislature.Heated debates and rallies both supporting and opposing the RH Bill took place nationwide. The Supreme Court delayed implementation of the law in March 2013 in response to challenges. The court's status quo ante order expires on July 17, 2013, unless the high court decides to extend it. Summary of major provisions The bill mandates the government to “promote, without bias, all effective natural and modern methods of family planning that are medically safe and legal”.Although abortion is recognized as illegal and punishable by law, the bill states that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner”.

The bill calls for a “multi-dimensional approach” integrates a component of family planning and responsible parenthood into all government anti-poverty programs. [7] Age-appropriate reproductive health and sexuality education is required from grade five to fourth year high school using “life-skills and other approaches”.The bill also mandates the Department of Labor and Employment to guarantee the reproductive health rights of its female employees. Companies with fewer than 200 workers are required to enter into partnership with health care providers in their area for the delivery of reproductive health services. ] Employers with more than 200 employees shall provide reproductive health services to all employees in their own respective health facilities. Those with less than 200 workers shall enter into partnerships with health professionals for the delivery of reproductive health services.

Employers shall inform employees of the availability of family planning. They are also obliged to monitor pregnant working employees among their workforce and ensure they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that they are employed. The national government and local governments will ensure the availability of reproductive health care services like family planning and prenatal care. Any person or public official who prohibits or restricts the delivery of legal and medically safe reproductive health care services will be meted penalty by imprisonment or a fine.

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ANNUAL REPORT 2020 Responsible Parenthood and Reproductive Health Act of 2012

30 June 2021 Manila, Philippines www.doh.gov.ph

Technical writing, content editing, design and layout: Tanya Mia M. Hisanan

If you have questions about this document, please contact the Responsible Parenthood and Reproductive Health Law Secretariat:

Planning, Monitoring and Evaluation Division Commission on Population and Development (POPCOM) Acacia Lane Extension Welfareville Compound, Mandaluyong City, Metro Manila Telephone: (02) 8531-5303 Website: www.popcom.gov.ph Philippine Responsible Parenthood and Reproductive Health Act of 2012

ANNUAL REPORT 2020

30 June 2021 Manila, Philippines Acknowledgement

The 2020 Responsible Parenthood and Likhaan Center for Women’s Health: Hope Reproductive Health Law Accomplishment Basiao-Abella; Erickson Bernardo; Joy Report was prepared by the Department Salgado; and Francisco dela Tonga of Health (DOH) and the Commission on Population and Development (POPCOM) Technical Secretariat/Support Staff: Ken with technical assistance from the United Raymund B. Borling; Marites U. Cipriano; States Agency for International Development Johnna G. Ballesteros; Spencer G. Barreto; (USAID), through the ReachHealth Project Judy B. Lyn Aroy; and Ma. Bella L. Andrada implemented by the Research Triangle Institute (RTI). The team also wishes to thank the officials and staff of the following institutions and DOH and POPCOM would like to thank the agencies that have contributed to the following for their invaluable inputs in the development of the Report: completion of the Report: National Agencies Technical Advisers: Undersecretary Myrna Department of Education (DepEd) C. Cabotaje; Undersecretary Maria Rosario Philippine Commission on Women (PCW) S. Vergeire; Undersecretary Juan Antonio A. Center for the Welfare of Children (CWC) Perez III; Dr. Junice D. Melgar; Dr. Yolanda E. Oliveros; and Dr. Esperanza I. Cabral Development Agencies USAID Implementing Partners: Research Technical Reviewers: Dr. Jan Aura Laurelle V. Triangle Institute; JHU Center for Llevado; Jose Roi Avena; Noemi C. Bautista; Communications Programs; and University and Vergil De Claro Research Company Track 20 Project, Avenir Health Members of the Technical Writing Team: United Nations Children’s Fund (UNICEF) United Nations Population Fund (UNFPA) Department of Health: Dr. Cherylle Garcia Gavino; Dr. Jan Aura Laurelle V. Llevado; Civil Society Organizations: Zenaida Recidoro; Luz Tagunicar; Mary Ann 1. Brokenshire Woman Center (BWC) Pejer; Gianne Charmaine C. Malagad; Dulce 2. Cooperative Movement for Encouraging Elfa; Ken Raymund B. Borling; and DOH CHD NSV (CMEN) FP Coordinators 3. Family Planning Organization of the Philippines (FPOP) Philippine Commission on Women: Bianca 4. FriendlyCare Foundation (FriendlyCAre) Victoria O. Aljibe; and Armando G. Orcilla, Jr. 5. Integrated Midwives Association of the Philippines (IMAP) Commission on Population: Dr. Alberto Ong, 6. Likhaan Center for Women’s Health Jr.; Dir. Lydio M. Espanol, Jr.; Dir. Joyce DP (LIKHAAN) Hilvano; Aileen Serrano; Mylene Mirasol 7. Myrna’s Café Health Service Cooperative C. Quiray; Marites U. Cipriano; Jesusa R. on HIV Services (Myrna’s Café) Lugtu; Gloren R. Hinlo; Grace P. Dela Cruz; 8. Philippine Center for Population and Jose Miguel D. Dela Rosa II; Rizabel Myna Development (PCPD) M. Balmores; Aira Mari A. Galang; and other 9. Philippine Society for Responsible contributors from POPCOM Central and Parenthood, Inc. (PSRP) Regional Offices. 10. Ugat ng Kalusugan (UNK) 11. Women with Disability taking Action on Reproductive and Sexual Health (W-DARE)

4 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Message from the Health Secretary

The Department of Health, together with our essential health programs and services partners, is pleased to present the 2020 were driven to a halt as resources and Annual Report on the Implementation of the personnel were redirected to support the Republic Act No. 10354 or the Responsible pandemic response. Our country and the Parenthood and Reproductive Health Act of rest of the world suffered the dramatic loss 2012 (RPRH Law). of many lives, including the lives of health workers in the fight against COVID-19. This Report is prepared in compliance with the reporting requirements mandated Under this backdrop, we acted fast to under Section 21 of the RPRH Law and ensure the continuity of RPRH-related Rule 15 of its Implementing Rules and programs and other essential health Regulations. It details the gains, challenges, services to protect the lives of mothers and recommendations for each of the and babies. This report documents the five key result areas (KRA) of the RPRH gains and challenges we have faced and Law, namely: 1) Maternal, Neonatal, Child the innovations we put in place to deliver Health and Nutrition; 2) Family Planning; life-saving information and services on 3) Adolescent Sexuality and Reproductive sexual and reproductive health to our most Health; 4) Sexually-Transmitted Infections vulnerable population. As we push on with and HIV/AIDS; and 5) Elimination of Violence our work, may each one of us gain renewed Against Women and Children. focus and inspiration from this Report.

In 2020, we experienced and continue to experience the devastating impact of COVID-19 on our health systems. Many of

5 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Message from the Socioeconomic Planning Secretary

The COVID-19 pandemic has changed the Hence, the Duterte administration socioeconomic realities of many Filipinos. remains committed to strengthening the To address this unprecedented crisis, the implementation of the RPRH Law, as government made the difficult decision stated in the 10-point socioeconomic of imposing community quarantines to agenda. I commend all front liners, save lives and improve our healthcare medical personnel, health and population capacity. However, these necessary workers, and volunteers for providing mobility restrictions disrupted our economic Filipinos sexual and reproductive health growth and slowed down the delivery of care services despite the community key programs such as the Responsible quarantines. Parenthood and Reproductive Health (RPRH) Law. To all our stakeholders, partner government agencies, civil society organizations, the The government recognizes the role of academe, and international development family planning in securing the health of partners, let us continue working together Filipino families and unlocking economic to ensure unhampered access to growth through the demographic dividend. reproductive health services and help keep Today, access to sexual and reproductive Filipinos safe and healthy. health care services is even more critical amid the COVID-19 crisis when job and income opportunities are more limited.

6 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Message from the POPCOM Executive Director

The implementation of the Responsible danger. Without them, we would not have Parenthood and Reproductive Health anything to account for and document in this (RPRH) Law in 2020 was affected report; and more importantly, key results in extensively by external factors that limited reproductive health like family planning and population mobility and constrained health maternal and child health were maintained services as COVID-19 spread from urban to and secured from irreparable decline. some rural areas. What have we known about, and for, the The RPRH Law key result areas were RPRH Law in Year 1 of Covid-19? Have we naturally impacted, and all other indicators, made the necessary adjustments to assure a unfortunately, suffered a decline in laudable rebound in numbers next year? performance. Regardless of how long the In the meantime, the lessons learned by COVID-19 pandemic of the 21st Century Covid-19 on the Filipinos’ RPRH status will persists, the RPRH Law will remain a remain as our guiding principle in the coming guidepost of sorts on the way we will carry on years. Knowledge may be key in outsmarting with its mandates as workers of government the virus. I believe that our collective planning and health care, and as duty bearers in and shepherding of limited resources will give population and development work. us outstanding outcomes.

Allow me to take this opportunity to laud the Patuloy na naglilingkod tungo sa Matatag, Filipino health-care frontliners, the medical Maginhawa at Planadong Pamilyang Pilipino! personnel, population officers and volunteers working in the communities—those who tirelessly carried on and upheld the work at hand, especially of RPRH, despite dread and Undersecretary Juan Antonio Perez III, MD, MPH

7 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Contents

Acknowledgement...... 4 Message from DOH...... 5 Message from NEDA...... 6 Message from POPCOM...... 7 Acronyms...... 9 Executive Summary...... 11 Introduction...... 21 Budget and Financing...... 25 Key Result Area 1: Maternal, Neonatal, Child Health and Nutrition...... 33 Key Result Area 2: Family Planning...... 51 Key Result Area 3: Adolescent Sexual and Reproductive Health...... 67 Key Result Area 4: Sexually Transmitted Infections and HIV/AIDS...... 81 Key Result Area 5: Elimination of Violence against Women and Children...... 91 -

8 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Acronyms

AHD Adolescent Health and Development AIDS Acquired Immunodeficiency Syndrome ANC Antenatal Care Visits AO Administrative Order ARH Adolescent Reproductive Health ARMM Autonomous Region of Muslim Mindanao ART Antiretroviral Therapy ASRH Adolescent Sexual and Reproductive Health BEmONC Basic Emergency Obstetric and Newborn Care BHW Barangay Health Worker BTL Bilateral Tubal Ligation CEmONC Comprehensive Emergency Obstetric and Newborn Care COC Combined Oral Contraceptive CPR Contraceptive Prevalence Rate CSE Comprehensive Sexual Education CSO Civil Society Organization CWC Council for the Welfare of Children DepEd Department of Education DILG Department of the Interior and Local Government DM Department Memorandum DMPA Depot Medroxyprogesterone Acetate DOH Department of Health DOLE Department of Labor and Employment DSWD Department of Social Welfare and Development FBD Facility-based Delivery FHSIS Field Health Service Information System FP Family Planning FPCBT Family Planning Competency Based Training FPS Family Planning Survey FWS Female Sex Worker GBV Gender-based Violence GIDA Geographically Isolated and Disadvantaged Areas HARP HIV/AIDS and ART Registry HCT HIV Counselling and Testing HIV Human Immunodeficiency Virus HIV/AIDS Human Immunodeficiency Virus /Acquired Immunodeficiency Syndrome IACAT Inter-Agency Committee on Anti-trafficking IACVAWC Inter-Agency Council on Violence Against Women and their Children IEC Information, Education, and Communication IMR Infant Mortality Rate IUD Intrauterine Device KAP Key Affected Population KRA Key Results Area

9 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 LAM Lactational Amenorrhea Method LAPM Long Acting Permanent Method LCAT-VAWC Local Committees on Anti-Trafficking and Violence Against Women and Children LGU Local Government Unit M&E Monitoring and Evaluation MCP Modern Contraceptive Prevalence mCPR Modern Contraceptive Prevalence Rate MMR Maternal Mortality Ratio MNCHN Maternal, Neonatal, Child Health and Nutrition MOU Memorandum of Understanding MR Measles-Rubella MSM Men having Sex with Men NAPC National Anti-Poverty Commission NASPC National AIDS and STI Prevention and Control Program NCR National Capital Region NDHS National Demographic and Health Survey NEDA National Economic and Development Authority NGO Non-Government Organization NMR Neonatal Mortality Rate NOH National Objectives for Health NSV Non-Scalpel Vasectomy PCW Philippine Commission on Women PHIC Philippine Health Insurance Corporation PHO Provincial Health Office PLHIV People Living with HIV PNAC Philippine National AIDS Council PNP Philippine National Police POP Progestogen-Only Pill POPCOM Commission on Population and Development PSA Philippine Statistics Authority RH Reproductive Health RHU Rural Health Unit RP-FP Responsible Parenting and Family Planning RPRH Responsible Parenthood and Reproductive Health SBA Skilled Birth Attendance SRHR Sexual and Reproductive Health and Rights STI Sexually Transmitted Infection TOT Training of Trainers U4U Youth for Youth UHC Universal Health Care UNFPA United Nations Population Fund USAID United States Agency for International Development VAW Violence Against Women VAWC Violence Against Women and Children WCPU Women and Child Protection Units WRA Women of Reproductive Age

10 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012

Executive Summary

12 2020 Annual Report Responsible PhotoParenthood credits: and Reproductive Department Health of Act Health of 2012 Introduction

At the beginning of 2020, the Philippines frequently disrupted services worldwide and the rest of the world found themselves due to the COVID-19 pandemic. Similarly, suddenly faced with, what may be, the respondents of another survey spanning most challenging year in the history 29 countries around the world observed an of public health emergency response. overall decrease in access to sexual and In January 2020, the World Health reproductive health rights services because Organization declared the Coronavirus of the prioritization of the pandemic Disease 2019 (COVID-19) outbreak as a response. Threats to accessibility of such public health emergency of international services consisted of lack of finances, concern, and eventually as a global lack of transportation, closure of clinics, pandemic by 11 March 2020. restricted movement, as well as fear of infection2 . For a year now, major cities and provinces in the Philippines have been in various In the Philippines, program implementers levels of community lockdowns, with curfew of the Responsible Parenthood and restrictions, and regulated non-essential Reproductive Health (RPRH) Law face the travels. The restriction of activities was following challenges exacerbated by the intended to avert the spread of infection COVID-19 pandemic: within communities. However, this has contributed to disruptions in the delivery of 1. Insufficient human resource for full services, especially non-COVID essential implementation of essential health health services as systems shifted to services secondary to reassignment of pandemic response. Routine healthcare health staff to COVID-19 response; systems were disrupted and people faced 2. Limited access to basic health challenges in accessing care and seeking services, due to limited operating medical advice, including relief and hours, conversion of some facilities as protection from gender-based violence. dedicated COVID-19 hospitals, and limitations in transportation; A recent survey by the World Health 3. Misconceptions and fears on Organization1 found that family planning immunization, family planning side- and contraception were among the most effects, HIV stigma among its users due to lack or poor counseling; 1 World Health Organization. (2020). https://www.who.int/publications/i/item/ 2 Obstetrics and Gynaecology. (2020) WHO-2019-nCoV-EHS_continuity-sur- https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ vey-2020.1 aogs.14043

13 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 4. Increased barriers to healthcare-seeking medicines, reducing stock outs of FP behaviors due mobility restrictions and and HIV commodities, fund provision for fear of contracting the disease; and personal protective equipment 5. Record-keeping, surveillance and reporting measures were hampered With assistance from development as existing resources were tapped to partners, civil society organizations, DOH, perform COVID19-related tasks. POPCOM and the local governmen units pursued innovative strategies along the pillars of the RPRH program, namely Policy and Governance demand generation, service delivery, procurement of commodities, governance To mitigate the disruptions in RPRH-related and systems, and policy issuances. services, the Department of Health (DOH) and the Commission on Population and Development (POPCOM), acted swiftly and issued policies and guidelines that Budget and Financing would enable the continuous provision of information and services to people in most In 2020, the DOH and POPCOM allocated need of such support. a combined Php 18.88 billion for the implementation of the RPRH Law. This is 1. DC 2020-0167: Continuous Provision 29 percent lower than the Php26.58 billion of Essential Health Services During the budget in 2019 as there was a substantial COVID-19 Epidemic decline in the budget for the Health Facility 2. DM 2020-0222: Guidelines on the Enhancement Program for the DOH. Continuous Provision of Family Planning On the other hand, budget for HIV/AIDS Services during Enhanced Community program increased from Php510 million in Quarantine following the COVID-19 2019 to Php790 million in 2020. Pandemic0222 3. DM 2020-0261: Interim Guidelines on In addition, the Department of Social the Continuous Provision of Maternal Welfare and Development allocated Php Health Services during COVID-19 3.71 billion in 2020 for various activities to Pandemic support the implementation of the RPRH 4. DM 2020-0319: Interim Guidelines on law. The Philippine Commission for Women COVID-19 Management of Pregnant allocated Php3.45 million in 2020 for Women, Women About to Give Birth, programs and projects addressing violence and Newborns against women. 5. DM 2020-0341: Interim Guidelines on Provision of Health Services for The combined budget allocated by RPRH Adolescents implementing partners is pegged at Php 6. DM 2020-0351: Interim Guidelines of 22.62 billion with DOH remaining as the the Implementation of HPV Vaccination main source of funds allocating 19 percent amid COVID-19 Pandemic of its total budget of Php100 billion in 2020 General Appropriations Act budget. New normal strategies were also pursued, namely : 1) strengthening health systems PhilHealth reimbursements for reproductive response within the health care provider health services, decreased significantly network (HCPN); 2) shifting capacity by 12 percent from 2019. Specifically, building, health promotion, and provision claims in 2019 totaled to around Php of technical assistance to online platforms; 16.93 billion, while claims in 2020 was 3) ensuring continous provision of pegged at Php 14.89 billion. The decline health services through teleconsulting, in reimbursements for reproductive health client-centered approach for delivery of services may be attributed to COVID-19

14 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 induced lockdowns and restrictions. attended by skilled health professionals, Concerns on the spread of COVID-19 denoting a continuous provision of health infection have prevented facilities from services albeit interrupted. In 2020, the operating regularly in the first few months coverage of fully-immunized children is 61.5 as there was a shift to a robust pandemic percent (1,292,410 infants) of the eligible response. Gradual resumption of essential population, a decrease of 7.6 percent health services happened toward the end from the 2019 immunization coverage. of the enhanced community quarantine. Meanwhile, completely immunized children Apart from the reduced cashflow to the or those children who completed routine health facilities, additional expenses for immunization beyond one year of life PPEs have also prevented facilities from stands at 13.69 percent (290,690 children). operating except for those who managed Coverage for all antigens decreased in to avail of the Interim Reimbursement 2020 except for Pneumococcal vaccine Mechanism fund of PhilHealth, which which improved by 13 percent in the current included maternity care package facilities reporting year. as beneficiaries. A similar declining trend is shown Various development partners actively for immunizations given at birth. supported the implementation of the Coverage decreased by seven and six RPRH Law through allocation of budgetary percentage points for Hepatitis B and support. For 2020, support came from BCG, respectively, for 2020. Meanwhile, United States Agency for International postpartum women-initiated breastfeeding Development (USAID), United Nations significantly increased by 15 percentage Population Fund (UNFPA), The United points amid the COVID-19 pandemic. Nations Children’s Fund (UNICEF), The However, coverage for exclusively breastfed Korea International Cooperation Agency infants decreased to 52 percent in 2020 (KOICA), OXFAM of Canada, Global Fund from 59 percent in 2019. to Fight AIDS, Tuberculosis and Malaria, as well as other CSO supporters. Interventions. DOH enacted several policies and guidelines to maintain quality essential services for all, foremost of which are: (1) DOH Department Circular Progress in (DC) 2020-0167 Continuous Provision of Essential Health Services During Key Result Areas the COVID-19 Pandemic; and (2) DOH Department Memorandum (DM) 2020- KRA1: Maternal, Newborn, Child 0261 Interim Guidelines on the Continuous Health and Nutrition (MNCHN) Provision of Maternal Services During the COVID-19 Pandemic. DOH also continued Status and Trends. Antenatal care visits its Polio and Measles outbreak response have been relatively low for the past via the Sabayang Patak Kontra Polio and years barely reaching 60 percent of the the Measles, Rubella, Oral Polio Vaccine total eligible population. This evidently Supplemental Immunization Activity decreased during the pandemic period especially in areas where the polio virus to 53 percent from 58 in 2019. A similar was isolated and in high-risk areas for trend was noted for postpartum care which sustained measles transmission. decreased by 5 percentage points from 62 percent in 2019. While facility-based Recommendations for 2021. DOH deliveries and skilled birth attendance will pursue the development of the likewise decreased during the pandemic, Reproductive, Maternal, Newborn, 90 percent of all pregnant women still Child and Adolescent Health Policy as delivered in health facilities and were an overarching integrated plan to end

15 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 preventable deaths of women, newborns, Interventions. In light of the FP co- children and adolescents, and ensuring management of DOH and POPCOM, both their health and well-being. DOH will work agencies developed a harmonized FP to ensure that immunization is integrated communication plan supported by USAID in other primary care interventions within entitled “Think Differently about Family a facility, to decrease missed opportunities Planning: The National Family Planning for vaccination and increase vaccine Communication Strategy 2020-2022.” The confidence. Work will also be done to communication plan was integrated in ensure that efficient delivery of essential the FP Costed Implementation Plan (CIP) health services are part of a comprehensive and the National Program on Population pandemic plan. and Family Planning (NPPFP). National government agencies, LGUs, and CSOs KRA2: Family Planning adapted innovative demand generation activities for FP. Due to limited in-person Status and Trends. The DOH Fiel Health interactions, different online platforms Information System reported around (Zoom, FB Messenger) were used to 8.1 million total family planning users connect with community women. The DOH in 2020, an increase of six percent (or allotted around Php 410 million for the 460,000 users) from last year’s report. procurement of FP commodities in 2020, New acceptors of FP increased by 43 which is 33 percent higher compared to last percent, however dropouts were higher year’s budget allotment of Php309 million. at 28 percent. The dropouts in FP users POPCOM likewise procured commodities may be attributed to the difficulties in in 2020. DOH through Department accessing FP services because of the Memorandum (DM) 2020-0222, provided pandemic restrictions. Disrupted supply guidelines in the provision of FP services chain systems, particularly on the delivery during the COVID-19 pandemic allowing of commodities from the DOH Central Office service providers to give at least three to the service delivery points, also affected months’ supply of pills or condoms so as the provision of these services. According to limit movement of clients. Implementing to the Pharmaceutical Management partners, including LGUs and CSOs Information System of the DOH, the pursued innovative approaches such as average consumption in facilities for short- “FP on wheels” to ensure that needed FP acting methods has increased in 2020 services and commodities reach FP users compared in the previous 2-year reports. despite the lockdowns. Moreover, DOH, The rate of facility consumption increased with support from USAID, assisted 153 by 67 percent for POP, 26 percent for male government hospitals establish FP program condoms, 6 percent for COC, 2 percent for in hospitals to address the needs of post- injections. Meanwhile, long-acting methods partum women interested to practice FP decreased by 18 percent for implants right after delivery. and 3 percent for IUD. In June of 2020, the National Family Planning Program Recommendations for 2021. DOH and conducted a rapid assessment of availability POPCOM will work to strengthen the of FP services especially during the complementation and delineation of their lockdown period. Of those who responded, roles as co-managers of the family planning around 80 percent answered that short- program. In this regard, both agencies acting methods such as contraceptive pills, will facilitate the development of the male condoms and injections were available Responsible Parenthood and Reproductive during lockdown, while less than half Health strategic goals and directions with provided long and permanent methods. special attention to the provision of FP services during public health disasters. The completion of the five-year RPRH Law Implementation Review will also be

16 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 pursued to guide the RPRH strategic and young people make responsible planning. The Family Planning Estimation decisions about their sexual and Tool (FPET), a statistical model used by the reproductive health, including protection UN Population Division to estimate mCPR from gender-based violence. Through and other FP indicators in an annual basis various online platforms, young people will be institutionalized as a way to lessen, also received guidance on managing their if not eliminate, data biases and challenges well-being during the pandemic. Meanwhile, with data quality. through adolescent-friendly health facilities, a total of 345,522 adolescents have availed KRA3: Adolescent Sexual and of adolescent sexual and reproductive Reproductive Health (ASRH) health services in various health facilities for the whole year. In order to scale up and Status and Trends. Despite the enhance functionality of adolescent-friendly decreasing trend of registered births health facilities, a series of consultations from adolescents 15 to 19 years old, the were organized by DOH, with assistance adolescent birth rate in the country remains from USAID, to update and improve the high as it exceeds the Asia Pacific average national standards in establishing and of 35 and comes close to the global monitoring said facilities. Helplines were average of 50 (UNFPA, 2018). Moreover, also made operational by POPCOM and registry data showed that although live Jhpiego to address information and referral births among adolescents 15 to 19 are needs of adolescents during the pandemic. decreasing at 1.8 percent from 2018 to 2019, unfortunately, it is increasing among Recommendations for 2021. DOH 10 to 14 years old at 7 percent from 2018 and POPCOM, in collaboration with to 2019. The assumption for very young stakeholders, will finalize and roll-out pregnancies might be due to abuse or the National Communication Strategy gender-based violence. In terms of regional to Address Teenage Pregnancy in the situation, the National Capital Region, Philippines FY 2021-2022. A national Region IVA, and Region III showed a high advocacy campaign, aligned with number of live births among 15-year-old the communication strategy will also mothers, which is similar for ages 15- to be pursued in 2021. Aside from the 19-year-old adolescents. In terms of communication initiative, program exposure to HIV/AIDS, according to the implementers will also work to strengthen HIV/AIDS & Art of the Philippines, four the recording and reporting system for percent (3,562) of all diagnosed cases from adolescent services. This would entail the January 1984 to December 2020 were generation and dissemination of public 19 years old and younger at the time of health program reports with age (10-14 & diagnosis. Of this, six percent (221) were 15-19) and sex-disaggregation. children less than 10 years old. KRA4: Sexually Transmitted Interventions. DOH and POPCOM, Infections and HIV/AIDS with technical assistance from USAID, held a strategy development workshop Status and Trends. Based on the AIDS to address teenage pregnancy in the Epidemic Model – Spectrum, the estimated Philippines. The strategy document is number of people living with HIV (PLHIV) currently being drafted and will be finalized for 2020 has now reached 111,400. Of this, in 2021. DOH and POPCOM, together a total of 82,865 HIV cases have been with the Department of Social Welfare and reported and 4,574 were reported as deaths Development, the Department of Education to the HIV/AIDS and ART Registry of the and various development agencies and Philippines as of December 2020. Among implementing partners on the ground the 78,291 diagnosed cases who are alive, continue their efforts to assist adolescents the total number of PLHIV on antiretroviral

17 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 therapy (ART) is 47,977 as of December of local vehicles to increase testing and 2020. Of the estimated 111,400 PLHIV, treatment; 2) availability of drugs at facility 70 percent were diagnosed, 61 percent level by regular participation in the monthly were alive and on antiretroviral therapy NASPCP reporting; 3) client-centered (ART), and 94 percent of PLHIV on ART approach in delivery of ARVs and other HIV who were tested for viral load were virally services (courier, ARV, refill stations, online/ suppressed. However, only 16 percent of phone counseling/consultation, CBS); and PLHIV on ART were tested for viral load. 4) regular monitoring and use of reminder The HIV Care Cascade for 2020 has been system (SMS/FB) by case managers for adversely affected by COVID-19 pandemic schedule of ARV refillSupport rHIVda with reduced coverage across the cascade. expansion through strengthened laboratory Notably, coverage for testing, treatment and facilities and services. viral load testing needs to be significantly improved. KRA5: Elimination of Violence Against Women and Children (VAWC) Interventions. During the enforcement of community quarantines, the HIV program Status and Trends. The Philippine National adopted innovative approaches to ensure Police (PNP) recorded a total of 14,835 the continuous delivery of essential cases of violence against women (VAW) in services to patients. For example, the 2020. Violence against women and children Program ensured access to ARV refills (VAWC), per Republic Act No. 9262, remains even for transient patients, employing as the highest reported type of incident client-centered approaches for pick-up and with 10,429 cases. This was followed by delivery of ARVs such as use of available rape with 1,850 reported cases, and acts of courier services, government vehicles, lasciviousness as the third most reported transport network vehicle services, and type of VAW with 1,408 cases. With the home delivery. Moreover, CBOs and rural imposition of lockdowns and quarantine health units functioned as ARV refilling measures, the reported VAW cases stations or access points. The HIV program decreased significantly in 2020. Compared also established Regional HIV Helplines to the 2019 data, there was a 25 percent for various referral needs of displaced and decrease in reported VAW cases. Moreover, stranded PLHIVs within and outside the from 2018 to 2020, PNP recorded a total respective region operated by community- of 833 cases of VAW involving women and based organizations. In 2020, DOH young girls with disabilities. Of this, 574 designated 56 primary HIV care facilities cases of violence involved victim-survivors and 107 treatment hubs or a total of 163 who are women with disabilities aged 18 facilities nationwide to provide HIV services, years old and above. Moreover, 259 young including free antiretroviral drugs. girls with disabilities aged 0-17 years old experienced abuse from 2018 to 2020.There Recommendations for 2021. Program were 404 cases of VAW involving women implementers will support HIV treatment and young girls with disabilities recorded in facility expansion through provision of 2020. This was a 50 percent increase in the quality services and appropriate use number of cases recorded in 2019 pegged of the PhilHealth Outpatient HIV/AIDS at 269 cases of violence against women and Treatment funds package. Meanwhile, local young girls with disabilities. government units and community-based organizations will be enjoined to increase Interventions. The Philippine Commission budget allocation for HIV services and on Women, through the Secretariat, ensure accessibility and availability of HIV continued to provide remote VAW referral services. Crucial services that need to be services to clients through phone, email ensured at the field level are: 1) availability or Facebook. Victims/Informants were

18 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 connected to proper local authorities as of VAW among selected barangays necessary (i.e., police stations, women and and schools. This will be part of the child protection desks, barangay officers, assessment of RA 9262. As part of the and social welfare offices) to ensure that Results-​Based Monitoring and Evaluation they get direct assistance. This included Framework, a Survey Tool on Knowledge direct reporting and regular follow-up of and Understanding of VAW was developed. cases to concerned barangays or local However, the distribution of the survey women and children protection desks. The tool to member agencies, LGUs, and Center for the Welfare of Children and the RCAT-VAWCs was cancelled due to the Inter-Agency Council on Violence Against COVID-19 pandemic. Women and their Children (IACVAWC) initiated the preparation of a Call to Action for Women’s Protection Against Violence, which was later issued by Department of Social Welfare and Development Secretary Rolando Bautista as the IACVAWC Chairperson. The statement enjoins all service providers to ensure continuous delivery of VAW/GBV services especially in times of crisis such as the COVID-19 pandemic, and ensure the adoption of proactive interventions that can assist victims to directly report abuse without leaving their homes in light of quarantine restrictions. In 2020, the Public Attorney’s Office (PAO) served a total of 19,372 women clients with cases falling under R.A. No. 9262 (Anti-VAWC Act of 2004). Of this, 5,046 women clients were provided with judicial services and 14,326 were assisted with non-judicial services. PAO also served a total of 2,538 rape victim-survivors, wherein 1,038 rape victims were provided with judicial services and 1,500 victims were assisted with non-judicial services.

Recommendations for 2021. Finalize the review of existing protocols/guidelines and standardize services across the country during the assessment of the implementation of RA 9262 in 2021. Conduct inventory of all available services (including functional VAW desks) and dissemination of list that will serve as reference for referrals. Measure the effectiveness of demand generation activities in terms of improving the “help- seeking” behavior of survivors and decreasing the acceptability of VAWC. Enhance the survey tool and resume the survey on knowledge and understanding

19 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 2020 Context and Challenges Introduction

20 2020 Annual Report ResponsiblePhoto Parenthood credits: and Reproductive USAID/BARMMHealth Health Act of 2012 In October 2019, the Department of In the Philippines, beginning in March 2020, Health signed the Implementing Rules major cities and provinces were placed into and Regulations for Republic Act (RA) No. various levels of community lockdowns, 11223 or the Universal Health Care Act. A including restrictions in non-essential trav- historic milestone for the health sector, the els. While these are crucial in controlling UHC Act guarantees that every Filipino is the rapid spread of COVID-19, these same given equitable access to high quality and measures contributed to major disruptions affordable health care goods and services, in the access and delivery of primary health including protection against financial risk services, especially sexual and reproductive due to illness. The UHC Act aims to do this health services. through strong and more responsive health systems, improved health service delivery, Threats to RPRH Services and and equitable healthcare financing, in Impact on Women line with the dream of making the Filipino among the healthiest people in Southeast Past epidemics have taught us that routine Asia by 2022. health care services are often interrupted to give way to pandemic response3. In a Subsequently, the Responsible Parenthood study of the Ebola virus disease epidemic and Reproductive Health Act of 2012 in 2014, it was estimated that antenatal (RPRH Law), with its main objective of care coverage decreased by 22 percentage improving reproductive health outcomes points, and there were declines in the in the country, is positioned as one of the coverage of family planning (6 percentage main vehicles that would enable universal points), facility delivery (8 percentage health care in the country. points), and postnatal care (13 percentage points)4. Qualitative studies suggest that However, at the beginning of 2020, the these reductions were due to fear of sudden advent of the pandemic caused by 3 Goyal M, Singh P, Singh K, Shekhar S, the Coronavirus Disease 2019 (COVID-19) Agrawal N, Misra S. The effect of the COVID-19 seemed to have cut short efforts towards pandemic on maternal health due to delay in universal health care. As a tactic to limit seeking health care: Experience from a tertiary the spread of COVID-19, the World Health center. Int J Gynecol Obste. 2021; 15:231-235. Organization recommended personal https://doi.org/10.1002/ijgo.13457 preventive actions (cleaning/disinfection of 4 Sochas L, Channon AA, Nam S. Count- the environment, hand/respiratory hygiene, ing indirect crisis-related deaths in the context facial coverings, and cough etiquette) of a low-resilience health system: the case of maternal and neonatal health during the Ebola and social preventive measures, such as epidemic in Sierra Leone. Health Policy Plan physical/social isolation and staying at 2017; 32 (suppl 3): 32–39. home.

21 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 21 contracting Ebola virus at health facilities, work. Women also face high risks of job distrust of the health system, and rumors and income loss, and face increased risks about the source of the disease5. Similarly, of violence, exploitation, abuse or harass- in the 2003 severe acute respiratory ment during times of crisis and quarantine. syndrome epidemic, ambulatory care There is an urgent need for more support- decreased by 23.9 percent in Taiwan and ive measures for the most marginalized inpatient care decreased by 35.2 percent6. groups of women, including rural women10.

Experience in past epidemics also has Pursuing Universal Health Care shown that lack of access to essential as the New Normal health services and shut down of services unrelated to the epidemic response resulted Globally, the pandemic has laid bare long- in more deaths than the epidemic itself7. ignored risks, including inadequate health systems, gaps in social protection and COVID-19 has most severely impacted structural inequalities. It has also brought those women who already suffer from lack home the importance of basic public health, of access to services addressing their sexu- and strong health systems and emergency al and reproductive needs and rights8. preparedness, as well as the resilience of a population in the face of a pandemic, Since its outbreak, the pandemic has also lending ever greater urgency to the quest intensified violence against women and for universal health coverage (UNFPA, children, especially in the domestic sphere 2020). as lockdowns and stay-at-home orders have also compounded factors that trigger In December 2020, Health Secretary and perpetuate violence against women Francisco T. Duque III stated that the and children9. Department of Health is pushing for Universal Health Care (UHC) as the new Globally, women are at the core of the fight normal. He added that the pandemic against COVID-19 crisis. They make up did not derail the promise of UHC in the almost 70 percent of the health care work- country and instead became an opportunity force, exposing them to a greater risk of to fasttrack the implementation of the infection. In addition, women are also shoul- Universal Health Care Act, saying “This dering much of the burden at home, given pandemic has become the new arena school and child care facility closures and within which we continue to implement longstanding gender inequalities in unpaid reforms needed to fulfill the UHC promise.”11 5 Elston JWT, Moosa AJ, Moses F, et al. Impact of the Ebola outbreak on health systems and population health in Sierra Leone. J Public As early as March 2020, the national Health (Oxf) 2016; 38: 673–78. government has started issuing policies 6 Chang HJ, Huang N, Lee CH, Hsu YJ, and guidelines to minimize the barriers Hsieh CJ, Chou YJ. The impact of the SARS to accessing routine reproductive health epidemic on the utilization of medical services: services such as antenatal care, post SARS and the fear of SARS. Am J Public Health natal care, essential new born care, family 2004; 94: 562–64. planning services, as the health sector’s 7 BMC Public Health. (2021). https:// bmcpublichealth.biomedcentral.com/arti- 10 Organization for Economic Co-oper- cles/10.1186/s12889-021-10346-2 ation and Development. (2020). https://www. oecd.org/coronavirus/policy-responses/women- 8 Obstetrics and Gynecology. (2020). at-the-core-of-the-fight-against-covid-19-crisis- https://obgyn.onlinelibrary.wiley.com/doi/10.1111/ 553a8269/ aogs.14043 11 Department of Health. (2020). https:// 9 United Nations. (2020). https://www. doh.gov.ph/press-release/DOH-COVID-19-to- un.org/en/addressing-impact-covid-19-pandem- Serve-as-Stepping-Stone-Towards-UHC ic-violence-against-women-and-girls

22 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 focus shifted to COVID-19 emergency response.

The policies and guidelines focused on innovative ways of delivering essential information and services on reproductive health, including capacity building for the health work force, while protecting health staff and patients from exposure to COVID-19. Together with national partner agencies, local government units, civil society organizations, and development organizations, the health department initiated “new normal” strategies to combat the negative impact of COVID-19.

DOH has identified the following persistent challenges that will have to be addressed in pursuing universal health care as the new normal:

1. Insufficient human resource for full implementation of essential health services secondary to reassignment of health staff to COVID-19 response; 2. Limited access to basic health services, due to limited operating hours, conversion of some facilities as dedicated COVID-19 hospitals, and limitations in transportation; 3. Misconceptions and fears on immunization, family planning side- effects, HIV stigma among its users due to lack or poor counseling; 4. Increased barriers to healthcare- seeking behaviors due mobility restrictions and fear of contracting the disease; and 5. Records-keeping, surveillance and reporting measures were hampered as existing resources were tapped to perform COVID19-related tasks.

23 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Investments in the Implementation of RPRH Law Budget and Financing

24 2020 Annual Report ResponsiblePhoto Parenthood credits: and Reproductive Department Health of ActHealth of 2012 National Government led to the adjustment of budget ceilings of programs. It is important to note that HFEP Budget budget allocation is intended also for other programs of the DOH, not only for RPRH. In 2020, the Department of Health and the Commission on Population and On the other hand, POPCOM allocated Development allocated a combined Php178.30 million in 2020 to cover its Php 18.88 billion for the implementation programs on reproductive health/family of the Responsible Parenthood and planning, adolescent health development, Reproductive Health Law [Table 1]. This and population and development is 29 percent lower than the Php26.58 integration. budget in 2019. There was a substantial decline in the budget for the Health Facility Budget for HIV/AIDS program increased Enhancement Program (HFEP) for the from Php510 million in 2019 to Php790 DOH. From Php15.87 billion in 2019, this million in 2020, breaking the decreasing was reduced to Php8.35 billion in 2020, trend in budget allocation for HIV/AIDS a reduction of 47 percent. The decrease program noted in the 2019 Responsible in allocation remains to be attributed to Parenthood and Reproductive Health the shift to cash-based budgeting that Annual Report.

Table 1: Indicative National Government Budget Allocation and Obligation for RPRH 2019 and 2020 Agency/Program 2019 Adjusted 2019 Total 2020 Adjusted 2020 Total Allotment for Obligation Allotment for Obligation RPRH (in billion PhP) RPRH (in billion PhP) (in billion PhP) (in billion PhP) DOH 26.43 23.32 (88%) 18.72 11.87 (63%) • Family Health and 2.50 1.13 (46%) 2.03 1.11 (55%) Responsible Parenthood (FHRP) • Expanded Program on 7.55 6.85 (91%) 7.54 3.06 (41%) Immunization (EPI) • Health Facility Enhance- 15.87 14.89 (94%) 8.35 6.96 (83%) ment Program (HFEP) • HIV/AIDS 0.51 0.45 (89%) 0.79 0.74 (93%) POPCOM 0.18 0.17 (94%) 0.17 0.06 (35%) Total 26.58 23.49 (88%) 18.88 11.93 (63%) Source: Department of Health, 2019

25 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 1: Budget Trend for RPRH Law, 2014 to 2020

Source: General Appropriations Act Budget, 2014-2019

The Department of Social Welfare and Local Government Budget Development allocated Php 3.71 billion in 2020 for various activities to support on Family Planning the implementation of the RPRH law. Specifically, the budget covered activities In 2019, the total family planning under their Supplementary Feeding expenditures of the country amounted to Program, People Living with AIDS Program, PhP15.33 billion. This is 46 percent higher and residential care services for victim- than the 2018 FP expenditures estimated survivors of GBV. Budget allocated for at Php 10.48 million. other maternal, newborn and child health nutrition, and family planning have yet to be Of the total FP expenditures in 2019, submitted. 42 percent were contributed by local government units which spent around Php In addition, the Philippine Commission for 6.60 billion for family planning in 201912 Women allocated Php3.45 million in 2020 [Figure 2]. for programs and projects addressing violence against women. These covers Under the Responsible Parenthood and activities for the 18-Day Campaign to End Reproductive Health Act (RA 10354), LGUs VAW and operational expenses. are mandated to develop their human resources, facilities, local supply chains The combined budget allocated by RPRH and local service delivery networks, and implementing partners has amounted to provide the full range of RPRH services Php 22.62 billion with the Department within their public health facilities. They of Health remaining as the main source are also to undertake health promotion of funds for RPRH Law implementation activities to increase demand for RPRH allocating 19 percent of its total budget of Php100 billion in 2020 General 12 Family Planning Spending Assessment Appropriations Act budget. (FPSA) of the Philippines for 2019, Track 20 by Avenir Health

26 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 2: Total Family Planning Expenditures by Financing Source, 2019

Source: Family Planning Spending Assessment (FPSA) of the Philippines for 2019

services, conduct regular maternal/fetal Reported expenditures of DOH rose by and infant death reviews, as well as other almost 600 percent. This can be attributed tasks for achieving RPRH objectives13. to the FP commodity purchases of DOH, wherein the eventual lifting of the Supreme Meanwhile, spending by national agencies Court temporary restraining order on for family planning programs still hold contraceptives allowed DOH to procure the the biggest share in FP expenditures at required contraceptives of the country as 52 percent of the total expenditures or well as the deployment of health personnel Php7.98 million (USD166.09). National to LGUs to provide RH/FP services as agencies are tasked to support LGUs’ mandated by the RPRH Law. POPCOM RPRH efforts through technical and expenditures more than doubled in 2019 financial assistance for facilities upgrading as more investments for family planning and capacity-building among health was provided to fund the implementation of workers/professionals; availability of RPRH the Executive Order on Zeroing the Unmet 15 supplies and commodities, functional Need for Modern FP . RPRH service delivery networks; plans, policies, operational guidelines and Funding for family planning is locally standards in the delivery of local RPRH sourced with limited support from donor services; and communications and capacity agencies and international agencies. building activities for improving people’s USAID provides majority, if not all, of the acceptance of family planning, among support for FP from external/international 16 others14. sources . 15 FPSA, 2019 13 Process Evaluation of the Responsible 16 FPSA, 2019. Parenthood and Reproductive Health Act (RA 10354): Local Service Delivery Component, Philippine Institute for Development Studies, March 2021, Michael R.M. Abrigo, Jerome Pat- rick Cruz, Zhandra C. Tam 14 PIDS, March 2021

27 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Funding Support from PhilHealth Benefit Payment

Other Sources PhilHealth reimbursements for RH services has been on a gradual decline in the last Various development partners actively couple of years [Figure 3] owing to various supported the implementation of the factors, such as timing in getting the data RPRH Law through allocation of budgetary from PhilHealth database; delays due support. to data cleaning of claims especially for second case rates (ex. deliveries and IUD • The United States Agency for and IUD claims only); and reduced implant International Development (USAID) claims due to lack of commodities in the allocated around Php17.5 billion for facilities17. family planning, maternal, child health and nutrition, and health systems In 2020, claims paid by PhilHealth for strengthening initiatives RPRH-related services, namely, family • The United Nations Population Fund planning, maternal, infant and child health, (UNFPA) allocated Php 608 million treatment of STD and HIV/AIDS infections, for sexual and reproductive health treatment of female breast and genital programs conditions, and men’s health (male genital tract, and z-benefits11 for prostate cancer) • The United Nations Children’s Fund decreased significantly by 12 percent from (UNICEF) allocated Php675 million for 2019. Specifically, claims in 2019 totaled child’s health programs to around Php 16.93 billion, while claims in 2020 was pegged at Php 14.89 billion. • The Korea International Cooperation As in previous reports, the data should be Agency (KOICA) allocated Php288 interpreted with caution as some claims for million for child health programs 2020 are still being processed and may still be incomplete. • The OXFAM of Canada allocated Php458 milion for sexual health and The sharp decline in reimbursements empowerment for RH services may be attributed to COVID-19 induced lockdowns and • The Global Fund to Fight AIDS, restrictions. Concerns on the spread Tuberculosis and Malaria allocated of COVID-19 infection have prevented Php587 million for the HIV/AIDS facilities from operating during the first few program months of the lockdown. In public facilities, the regular provision of essential services, • Civil society organizations have also including family planning services, been supporting the implementation gradually resumed around September and of the RPRH Law. Resources are October 2020. Apart from the reduced used for providing RH services; cashflow to the health facilities, additional conducting community education expenses for purchasing personal activities, trainings, workshops, forum, protective equipment (PPEs) have also conferences; producing IEC materials; prevented facilities from operating except and assisting policy development. for those who managed to avail of the However, for this year, the Likhaan Interim Reimbursement Mechanism Center for Women’s Health has not (IRM) fund of PhilHealth, which included been able to obtain data from the field to come up with a consolidated budget 17 2019 Responsible Parenthood and report for CSOs. Reproductive Health Law, Department of Health

28 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 3: Claims paid by PhilHealth for RPRH-related services

Source: RPRH Annual Reports, 2015 to 2018, and PhilHealth data 2020

Table 2: Summary of Claims Paid by PhilHealth, 2019 and 2020 Benefit Packages 2019 2020 Amount No. of Amount No. of Claims Claims Family Planning Bilateral Tubal Ligation 5,740,000 1,626 2,288,000 692 IUD insertion 6,158,000 3,417 4,760,000 2,722 Subdermal Implant 48,567,000 17,625 43,320,000 16,880 Vasectomy 156,000 44 92,000 29 Maternal Infant and Child Health Deliveries 13,289,723,940 1,412,174 11,546,121,210 1,263,911 Newborn Care Package 2,306,884,960 984,419 2,013,815,390 880,834 Maternal Comorbidities 506,244,360 74,857 527,074,870 65,566 Conditions* Pregnancy Related 115,131,990 8,858 94,926,050 7,922 Procedures Treatment of STD and HIV/AIDS infection OutPatient HIV/AIDS 591,990,000 78,932 629,580,000 83,944 packages* Treatment of Female Breast and Genital Conditions Benefits for Breast Cancer 39,575,000 799 11,075,000 278 Benefits for Cervical 18,525,100 1,625 15,936,380 1,453 Cancer Men’s Health Benefit for Prostate Cancer 400,000 4 0 0 TOTAL 16,929,096,350 2,584,340 14,888,988,900 2,324,231 Source: 2019-2020 PhilHealth Claims Data – Corporate Planning Department, PhilHealth (unless otherwise indi- cated) *2019 and 2020 PhilHealth Stats and Charts 29 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Maternity Care Package-accredited- Similarly, claims payment for family facilities as beneficiaries. planning services in 2020, namely BTL, IUD insertion, implant, and vasectomy Maternal, infant and child health benefits decreased by 16.76 percent from the 2019 continue to hold the biggest share in figures. This is still an improvement from PhilHealth payment claims, making up 95 the 21 percent decrease in claims between percent of all RPRH related claims. Claims 2018 to 2019. Claims for subdermal implant for family planning services, including remain as the most reimbursed family benefit payments for treatment of STD and planning service, making up around 83 HIV/AIDS infection, treatment of female percent of all claims under family planning breast and genital conditions, and men’s [Table 2]. health make up only about five percent of the total RPRH-related claims paid by PhilHealth in 2020 [Table 2]. Facility Accreditation

Maternal, infant and child health benefits The percentage of municipalities and cities decreased by 12.55 percent from with at least one MCP provider has been Php16.22 in 2019 to Php14.18 in 2020. gradually increasing from 2018 to 2020. This decrease is observed in all but one of This may be attributed to the enhanced its sub-components, specifically maternal capacity of facilities to comply with and comorbidities, with a slight increase in secure the mandatory requirement of figures [Table 2]. License to Operate for accreditation of

Table 3: Number of PhilHealth Accredited Health Care Facilities and Providers 2018 2019 2020 Accredited Health Facilities Hospitals 1,253 1,271 1,292 Infirmaries/Dispensaries 661 654 623 Ambulatory Surgical Clinics 166 180 177 Primary Care Benefit (PCB) Provider 2,349 2,523 * Birthing homes/Lying-in Clinics 2,911 2,989 2,897 Stand Along Family Planning Clinics - 5 5 HIV Treatment Hubs (OHAT Providers) 86 111 153 Number of birthing homes and primary care 876 1,055 1,032 facilities providing FP services Number of municipalities with at least 1 MCP 1,078 1,190 1,368 provider (a) Total municipalities and cities (b) 1,634 1,634 1,634 Percentage of municipalities and cities with at 66% 73% 84% least 1 MCP provider (a/b) % Benefit for Prostate Cancer 400,000 4 0

TOTAL Physicians 30,135 39,017 42,944 Midwives 3,089 3,431 3,753 Number of professionals with 360 training on FP Source: 2019-2020 PhilHealth Claims Data – Corporate Planning Department, PhilHealth (unless otherwise indi- cated) *2019 and 2020 PhilHealth Stats and Charts

30 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 birthing homes. The number of accredited hospitals has also been increasing over the past three years.

In 2020, accreditation of Primary Care Benefit providers was deferred in anticipation of KonSulta (Konsultasyong Sulit at Tama), PhilHealth’s new primary care package which was planned to be rolled out that year.

The decrease in the number of accredited birthing homes and primary care facilities providing FP services in 2020 is mainly due to the non-renewal of their accreditation, given that provision of essential health services was also hampered.

The number of accredited physicians and midwives has been on the rise for the past three years. Since 2019, there were no new accredited professionals trained on family planning.

31 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 KEY RESULT AREA 1 Maternal, Newborn, Child Health and Nutrition

32 2020 Annual Report ResponsiblePhoto Parenthood credits: and Reproductive USAID/BARMMHealth Health Act of 2012 Context and Challenges

Since the passage of the RPRH Law in On the other hand, pregnant women and 2012, the government has been heavily mothers with newborns may experience investing in improving the Maternal difficulties accessing services due to Newborn Child Health and Nutrition transport disruptions and lockdown (MNCHN) Core Package of Services measures or be reluctant to come to health for women, mothers, and children. The facilities because of fear of infection18.The package consists of health services that safest place for a woman to deliver her are both preventive and curative and baby is at a functional health facility with established to lower the risk and respond a skilled birth attendant. However, during to the direct causes of maternal and the pandemic, many women may end up neonatal deaths, and improve women’s and delivering at home. In addition, women children’s health. may not choose to visit a health facility for essential antenatal and post-partum care, The COVID19 pandemic posed or even routine child vaccinations. considerable challenges for countries such as the Philippines to deliver routine This section discusses the status and life-saving interventions. Care of pregnant trends of health outcomes for maternal, women has been particularly challenged, newborn, infant, child health, and nutrition especially for adolescents seeking maternal during the COVID-19 pandemic. Unlike and other reproductive health care other reports, key interventions will focus services. on service delivery, procured commodities, and assistance to governance and systems. In addition, health facilities where pregnant Demand generation and policy issuances women usually access care may have been are subsumed in the different sections of transformed to cater only to COVID-19 the key interventions. cases or in some institutions out-patient services were closed. This may prove to be a tall order for health facilities still coping with the day-to-day provision of essential maternal and newborn health services. 18 United Nations Children’s Fund. (May 2020). https://data.unicef.org/topic/mater- nal-health/covid-19/

33 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Status and Trends

Maternal Health Outcomes While improvement in maternal health outcomes became apparent in 1990 For this reporting year, the Philippine where MMR was at 97/100,000 livebirths, Statistics Authority (PSA) Maternal Mortality data quality challenges in civil registry Ratio (MMR19) estimates will be used in the records must be taken into account. Other presentation of maternal health outcomes data sources such as the demographic as this data source provided a more recent health surveys recorded MMR in the 90s estimate of MMR, unlike in previous reports at 172 to 209/100,000 livebirths, which where we utilized old surveys conducted is high. For the past decade, MMR was from 1993 to 2017. Nonetheless, while the estimated at 111/100,000 livebirth. The data sources show different levels of MMR, most recent PSA MMR estimate in 2018 these illustrates similar trend across time. recently released in 2020 was reported at 108/100,000 livebirth. Analysis of trends showed that maternal mortality ratio had been flat for the past As emphasized in previous annual reports, years. In the 1980s, PSA MMR estimates accurate measurement of maternal showed a persistently high maternal mortality level remains an enormous mortality ratio at 127/100,000 livebirth. challenge as MMR can only be obtained from considerably large sample sizes. 19 Maternal Mortality Ratio (MMR is computed as number of maternal deaths per Henceforth, it would be difficult if not 100,000 live births. Maternal death is defined as inconsequential to compare MMR yearly the death of a woman while pregnant or within and across regions. But one message 42 days of termination of pregnancy, irrespec- is clear, women are still dying due to tive of the duration and site of the pregnancy, pregnancy-related complications every from any causes related to or aggravated by year. Working towards the Sustainable the pregnancy or its management but not Development Goals and halting from accidental or incidental causes (WHO, preventable causes of maternal deaths 2016).

Figure 4: Maternal Health Outcomes, 1993 to 2018

Source: PSA MMR Estimates 1980-2018. 2018 estimates released in 2020.

34 2020 Annual34 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 entail intensifying and strengthening the based delivery) in the past years. These efforts rendered during the Millennium problems may be especially more adverse Development Goals period. during the COVID-19 pandemic as routine healthcare services were initially disrupted. Haemorrhage and hypertension remain to be the leading causes of maternal mortality Neonatal, Infant, and Child Health which account for about 41 percent20 of direct causes. These are highly preventable Outcomes and can be averted by provision of quality Trend in infant deaths slowly declined in obstetric care which includes strengthened the past 15 years. A significant reduction BEmONC provision in primary care facility, was noted from 1990 to 1993 with a slim proper and prompt navigation mechanisms increase observed in 1998. Neonatal within the service delivery network, timely mortality rates remain relatively constant at referral of high risk cases, and access to 17 per 1,000 live births [Figure 5]. CEmONC-capable facility.

While direct clinical causes of maternal Nutrition Outcomes mortalities are officially recorded, other important factors such as quality of Based on the 2019 Expanded National antenatal care, inadequate supply of Nutrition Survey findings released in June blood and drugs in referral hospitals, 2020, stunting prevalence among 0-5 years unavailability of emergency transport, and old children decreased to 28.8 percent in untimely decision-making for early referral, 2019 from 30.3 percent in the previous greatly affect maternal and neonatal year. Meanwhile, wasting slightly increased outcomes. from 5.6 percent in 2018 to 5.8 percent in These gaps continue to be widespread 2019. Underweight prevalence remains at notwithstanding the high maternal services 19 percent, while overweight and obesity utilization rates (i.e. antenatal care, facility- decreased from 4.0 percent to 2.9 percent [Figure 6]. 20 Philippine Health Statistics, 2017, DOH.

Figure 5: Neonatal, Infant, and Child Health Outcomes, 1990-2017

Source: 1990 Technical Working Group on Maternal and Child Mortality, PSA-NSCB; National Demographic and Health Survey 1993, 1998, 2003, 2008, and 2013.

35 2020 Annual35 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of2012 2012 Figure 6: Trend of Malnutrition Prevalence Among Children Under Five The same report Years Old, 2011-2019. showed that stunting and wasting prevalence among 5-10 years old school children slightly increased from 25.2 and 8 percent in 2019, respectively. Similarly, underweight prevalence likewise increased from 24.9 to 26 percent. On the other hand, overweight and obesity decreased to 9.1 percent in 2019 Source: National Nutrition Surveys 2011-2019. from 11.6 percent in the previous survey year.

Figure 7: Trend on Malnutrition Prevalence Among School Aged Children For adolescents 10- 5-10 Years Old, 2011 to 2019 19 years old, stunting prevalence slightly increased from 26.3 percent in 2018 to 26.8 percent in 2019. Improvement was also noted in terms of wasting prevalence from 11.3 to 11.7 percent while overweight and obesity decreased from 11.6 percent to 9.8 percent [Figure 7].

Source: National Nutrition Surveys 2011-2019. Among nutritionally-at- risk pregnant women less than 20 years old, Figure 8: Trend on Malnutrition Prevalence among Adolescents 10-19 the survey showed a Years Old, 2018 and 2019. declining trend from 2015 to 2019 with significant improvement of malnutrition prevalence of 39.7 percent in 2015 to 28.5 percent in 2019. For those above 20 years old, a reduction was noted from 22.4 percent in 2015 to 18.4 percent in 2018 but significantly increased to 22.3 percent in 2019.

Source: National Nutrition Surveys 2011-2019.

36 2020 Annual36 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Figure 9: Malnutrition Prevalence Among Nutritionally-At-Risk Pregnant Women, 2015-2019.

Source: National Nutrition Surveys 2018-2019.

It must be emphasized that the above The salient points of the rapid assessment nutritional situation is pre-COVID pandemic results are as follows: and it is feared that whatever gains the • Majority of the respondents received nutrition program achieved might have been “ayuda” or assistance either in cash eroded by our recent challenges. (62.9%) or food (96.6%); The pandemic has drastically affected • Most frequent recipients of “ayuda” the lives of families due to lockdowns, are in the high-risk areas (increased loss of jobs and livelihood, among others. incidence of COVID-19 cases) of highly Thus, many families experienced hunger urbanized cities; or encountered difficulty in consuming • There is low assistance on food diversified and balanced diets, making production by the government; them vulnerable to all forms of malnutrition • Breastfeeding, either exclusive or any including micronutrient deficiency. form of breastfeeding, was still high Further, there are children who cannot (60.8% and 59.7%, respectively); access health and nutrition services • Most of the young children (93.3%) such as immunization or Vitamin A meet meal frequency; supplementation, which make them more • Barangay Health Centers are the most susceptible to infection. Day care and accessible health service facility during school children were no longer receiving pregnancy and source of nutrition supplementary feeding as face-to-face messages; classes have been shifted to distance • Loss of job is of utmost concern; learning. • Increased food insecurity among households was highest during the An online Rapid Nutrition Assessment months of April and May 2020 during was conducted by the Food and Nutrition Enhanced Community Quarantine Research Institute from November to (ECQ); December 2020 to determine the impact • Respondents who sought health and of the pandemic to nutrition. However, nutrition services for children (54.9% anthropometric measurements were for Vitamin A Supplementation, 10.6% not done due to existing infection and for Micronutrient Powder, 11.9% for prevention control measures limiting Supplementary Feeding, and 35.3% for physical contact. deworming); and • 15.5 percent of the respondents who were pregnant had no pre-natal care

37 2020 Annual37 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Key Interventions Figure 10 shows the comparison for maternal service utilization indicators pre- COVID-19 pandemic (2019) and during the pandemic (2020). Antenatal care visits had Maternal Health Services been relatively low for the past years, barely reaching 60 percent of the total eligible To ensure that the health care needs population. of mothers and babies continue to be prioritized and served, RPRH program This decreased during the pandemic to 53 implementers, led by the Department of percent from 58 in 2019. A similar trend Health and in collaboration with health is illustrated for post-partum care which facilities and local government units, decreased by 5 percentage points from worked to overcome various hurdles to 62 percent in 2019. Facility-based delivery access and service provision and skilled birth attendance marginally decreased during the pandemic, 90 percent Telemedicine was introduced through of all pregnant women still delivered in the Joint Memorandum Circular (JMC) health facilities and were attended by skilled 2020-001 of the DOH and the University health professionals. This is a manifestation of the Philippines – Manila to provide that provision of essential health services telemedicine practice guidelines. However, continued amidst the COVID-19 pandemic there are certain medical conditions as guided by the following policy issuances: that can be diagnosed only on physical (1) DOH Department Circular (DC) 2020- evaluation of a patient. For pregnancy, 0167 Continuous Provision of Essential in the absence of routine care, high risk Health Services During the COVID-19 factors in pregnant women may be missed Pandemic; and (2) DOH Department which can lead to complications. When Memorandum (DM) 2020-0261 Interim examined on a larger scale, reduced Guidelines on the Continuous Provision of number of antenatal visits and institutional Maternal Services During the COVID-19 deliveries will lead to a marked increase Pandemic. in pregnancies with complications and the need for intensive care21. 21 Goyal M, et al. 2021.

Figure 10: Maternal Health Care Services, 2019 and 2020.

Source: DOH FHSIS, 2016-2020

38 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 The latter policy served as a temporary Birth and Newborns. Health workers arrangement which allowed primary health providing maternal and newborn services facilities and birthing centers to provide were also encouraged to continue with services to high risk pregnant women pregnancy tracking and service delivery with no co-morbidities when referral to utilizing electronic platforms available a CEmONC hospital is improbable. The such as, health center Facebook page, birthing centers are required to have a text-messaging, electronic mail, telephone doctor who is at least trained on BEmONC, consulting, among others and home visits stand by ambulance or patient transport if feasible, while still adhering to strict vehicle (PTV), and a memorandum of infection prevention and control measures. agreement or understanding (MOA/MOU) Social media cards for women and health with a hospital in case an emergency workers alike were posted on DOH and referral becomes inevitable. Healthy Pilipinas Facebook pages, and similar social media platform of the Centers Meanwhile, guided by DM 2020-0178 for Health Development, Provincial, City which defines the Interim Guidelines on and Municipal Health Offices. Health Care Provider Networks during the COVID-19 Pandemic, the DOH with In terms of regional accomplishments, technical assistance from the Philippine Table 4 shows that no regions attained the Obstetrical and Gynecological Society 90 percent target in all service utilization (POGS) and the Public Health Medical indicators. However, for most of the regions, Specialist Society (PHMSS) developed more than 90 percent of pregnant women DM 2020-0319 to guide birthing center delivered in health facilities and were staff on COVID-19 Management of attended by skilled health professional. Pregnant Women, Women About to Give Region IVA served 100 percent of pregnant

Table 4: Regional Maternal Healthcare Service Utilization Indicators, 2020. Total ANC Visit Skilled Facility- Post-partum Deliveries (four visits) birth based visit attendance delivery Philippines 1,325,837 53 92 91 57 NCR 200,367 60 94 93 62 CAR 26,312 54 98 94 65 I 52,504 65 99 99 64 II 42,876 62 98 97 66 III 129,236 65 98 97 63 IVA 127,414 34 97 93 41 IVB 42,458 33 83 76 41 V 82,928 55 94 93 60 VI 84,684 52 96 95 58 VII 81,466 43 95 93 47 VIII 53,433 44 93 93 46 IX 55,357 45 86 82 47 X 83,352 74 93 85 72 XI 84,828 60 92 92 72 XII 72,277 66 91 90 70 XIII 38,386 56 94 94 58 BARMM 67,959 51 68 52 51 Source: DOH FHSIS, 2020.

39 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 women for attendance of skilled birth practices which can be prevented through personnel. Meanwhile, BARMM and Region immunizations during pregnancy. In 2020, IX fell below 80 percent in both indicators. 24 percent (508,383) of pregnant women Antenatal care and postpartum care were given at least 2 doses of Tetanus national coverage stands at a low 53 and 57 Diptheria (Td) Vaccination for the first time. percent, respectively. No regions delivered The Triple Elimination of Mother to Child ANC and post-partum care to at least 80 Transmission of Syphilis, Hepatitis B, and percent of pregnant women. Regions IVA HIV (TEMCT) intervention continued in and IVB had the lowest ANC and post- 2020. There were 262,830 and 391,730 partum coverage. pregnant women screened for HIV and syphilis, respectively. Antenatal care can be defined as the services provided by skilled health Amidst the pandemic, facility-based professionals to pregnant women aged delivery remains at 90 percent coverage. 10-49 years old in order to ensure the 59 percent of deliveries happend in public best health conditions for the mother and health facilities while 32 percent were baby dyad22. Part of ANC services is the done in private health facilities. Though provision of iron tablets with folic acid, in spite of the high facility-based delivery, iodine, and calcium carbonate throughout there is still a proportion of women giving the duration of pregnancy. In 2020, a total birth at home or had delivered accidentaly of 1,007,273 pregnant women (47.44% of while in transit to a health facility. Similarly, the eligible population) received iron, folic 90 percent of deliveries were attended acid supplementation; 786,324 women by skilled health personnel. Fifty-seven (37.04% of the eligible population) given percent of these deliveries were attended Calcium Carbonate; and 60,649 (2.86% by a physician; 32 percent by midwives, of the eligible population) received iodine and 2 percent were delivered by nurses. supplementation. It is recommended that mothers should Table 5: Antenatal Care Service Components, have at least two post-partum visits within 2019 and 2020. seven days from birth and subsequent ANC Visit Total Number of Pregnant visits follow the immunization schedule. components Women The purpose of these visits are early 2019 2020 detection and management of infections, birth complications, or other life-threatening Iron with Folic 1,279,014 1,007,273 conditions. Further, newborn postnatal Acid checks are also opportunities to give Calcium 392,247 786,324 advice to the mother on proper care Carbonate for the newborn, such as hygiene and breastfeeding. In the current reporting year, Tetanus 598,085 508,383 Diptheria 57 percent of mothers had completed two Vaccination post-partum visits. Complete 24,556 60,649 Iodine In terms of CSO accomplishments, the Family Planning Organization of the HIV Screening 93,310 262,830 Philippines (FPOP) provided 118,265 Syphillis 362,349 391,730 gynecological and obstetrics care services Screening Source: DOH FHSIS, 2019 and 2020. in FPOP chapters. Gynecological services included counselling, consultations and Maternal and neonatal tetanus are primarily management, prevention (papsmear, VIA), due to unsanitary conditions during investigation (manual breast exam, bi- delivery and poor umbilical cord care manual pelvic exam, lab test). Obstetric services included pre- and post-natal care, 22 World Health Organization, 2016

40 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 11: Deliveries by Type of Facility, 2020

Source: DOH FHSIS, 2020. Figure 12: Trend of Immunization Coverage for Fully Immunized Child, 2016-2020

Source: DOH FHSIS, 2020. and delivery while the Brokenshire Woman the guidelines on the implementation of Center (BWC) based in Davao, provided immunization services in the context of maternity care services to displaced COVID-19 outbreak. In 2020, the coverage women through direct enrollment to its of fully-immunized children (FIC) is 61.5 packaged birthing program. percent (1,292,410 infants) of the eligible population. A decrease of 7.6 percent was Infant and Child Health Services noted from the 2019 immunization coverage of children under one-year-old. Meanwhile, completely immunized children (CIC) or Immunization those children who completed routine immunization beyond one year of life stands The National Immunization Program at 13.69 percent (290,690 children). guarantees that Filipinos, especially the poor, have access to routinely recommended vaccines. To ensure uninterrupted routine immunization among children during the pandemic, the DOH issued DM 2020-0150 which laid down

41 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 13: Immunization Coverage by Antigen, 2019 and 2020.

Source: DOH FHSIS, 2020.

Figure 14: Immunization Given at Birth, 2019 and 2020.

Figure 12 illustrates the immunization Interruption of routine immunization in any coverage per antigen. Coverage for all epidemic or disaster may lead to secondary antigens decreased in 2020 except for health crisis such as measles outbreak, Pneumococcal vaccine which improved by magnifying economic consequences and 13 percent in the current reporting year. aggravating morbidity and mortality from vaccine preventable diseases. In 2020, Similar declining trend is shown for Polio and Measles outbreak response immunizations given at birth. Coverage continued. The Department of Health decreased by seven and six percentage conducted the Sabayang Patak Kontra points for Hepatitis B and BCG, Polio and the Measles, Rubella, Oral respectively, for 2020. This means that Polio Vaccine Supplemental Immunization less than 50 percent of all livebirths did not Activity in areas where the polio virus receive the first dose of BCG and Hepatitis was isolated and those in high risk areas B with 24 hours after birth or prior to for sustained measles transmission, discharge. respectively.

42 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Table 6: Sabayang Patak Kontra Polio Coverage, 2020. Round Target Areas Target Pop Eligible Vaccine Date of No. of % Popula- Campaign Children tion Vaccinat-ed 1 Basilan, Sulu 0-119 739,640 bOPV 6 - 12 Jan- 705,089 95% and Tawi-Tawi, months old uary 2020 Zambo-an- (<10 years ga City and old) Isa-bela City. Lam-bayong, Sultan Kudarat 2 Basilan, Sulu 60 months 373,570 bOPV 17 February 3,439,585 99% and Tawi-Tawi. old - 119 – 1 March Zambo-an- months old 2020 ga City and Isa-bela City. Lam-bayong, Sultan Kudarat All Mindanao 0-59 months 3,102,974 Re-gions old (<5 years old) 3 Basilan, Sulu 60 months 373,570 bOPV 20 July- 2 3,408,241 98% and Tawi-Tawi old -119 August 2020 Zamboanga City months old and Isabela City Lambayong, Sultan Kudarat

All Mindanao 0-59 months 3,102,974 Regions old (<5 years old) 1 National Capital 0-59 months 1,404,517 mOPV2 27 January 1,386,573 99% Region old (< 5 - 9 February years old) 2020 2 National Capital 0-59 months 1,404,517 mOPV2 24 February 1,432,065 102% Region old (< 5 – 8 March years old) 2020 1 Central Luzon 0-59 months 1,347,005 mOPV2 July 20 - 1,093,317 81.2% (Region III) old (< 5 1,185,005 August 16, 908,488 76.7% Rizal, Cavite, years old) 2020 Laguna (Region August IVA) 3-30, 2020

2 Central Luzon 0-59 months 1,347,005 mOPV2 14-27 Sep- 1,160,009 86.1% (Region III) old (< 5 1,185,005 tember 2020 986,319 83.2% Rizal, Cavite, years old) Laguna (Region IVA)

Source: DOH NIP, 2020.

43 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 These activities were supported by Exclusive Breastfeeding the following policy issuances: (1) Memorandum on the conduct of measles Breastfeeding is the cornerstone of infant outbreak response immunization in the and young child survival, nutrition and context of COVID-19 outbreak; (2) DM development and maternal health23 . 2020-0333 Interim Guidelines in the The World Health Organization (WHO) Implementation of a Polio Outbreak recommends that mothers with suspected or Response Immunization for cVDPV confirmed COVID-19 should be encouraged Type 2 in Regions III and IVA; and (3) to initiate or continue to breastfeed. Mothers DM 2020-0378 Interim Guidelines on the should be counselled that the benefits of Implementation of a Measles Rubella and breastfeeding substantially outweigh the Polio Supplemental Immunization Activity. potential risks for transmission24 . Mother and infant should be enabled to remain Tables 6 and 7 show the coverage for the together while rooming-in throughout the supplemental immunization activity. day and night and to practice skin-to-skin contact, including kangaroo mother care, Table 7: Coverage of the Measles, Rubella, Oral especially immediately after birth and during Polio Supplemental Immunization Activity, 2020. establishment of breastfeeding, whether Region Percent Number of they or their infants have suspected or Coverage Children confirmed COVID-1925 .

Region 1 90.5 391,087 Figure 15 shows the breastfeeding Region 2 73.5 227,009 indicators pre-COVID-19 pandemic Region IVB 63.0 199,355 (2019) and during the pandemic (2020). Postpartum women initiated breastfeeding Region 5 78.9 489,478 significantly increased by 15 percentage Region 9 91.8 330,111 points amid the COVID-19 pandemic. Region 10 91.4 420,689 23 World Health Organization, 2020 Region 11 85.9 408,046 24 World Health Organization. Clinical Region 12 83.4 386,589 management of COVID-19: Interim guidance BARMM 85.7 434,165 (27 May 2020). Geneva, Switzerland: World Philippines 83.6 3,654,978 Health Organization; 2020. World Health Organization, 2020 Source: DOH NIP, November 2020. 25

Figure 15: Breastfeeding Indicators, 2019 and 2020.

44 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 However, coverage for exclusively Nutrition Services breastfed infants decreased to 52 percent in the current reporting year from 59 in Micronutrients are essential for normal 2019. With this data, it is important that physiologic function, growth, and strengthening advocacy and communication development. Deficiencies of micronutrients to help women understand the benefits of such as vitamin A, iron, iodine, and folate breastfeeding and nurturing mother-infant are specially common during pregnancy, interaction during the COVID-19 pandemic due to increased nutrient requirements of is critically important. the mother and the developing fetus26 . Similarly, infants and children are likewise It is a fact that the pandemic has vulnerable to micronutrient deficiency undesirably affected not just the healthcare as high vitamin and mineral intake are system but the economy. Thus, during this crucial to support their rapid growth and time, food assistance including provision development. of formula milk were donated by various stakeholders to Filipinos in need. To Figure 16 shows the proportion of safeguard the importance of breastfeeding, children ages 6-11 and 11-23 months the DOH issued DM 2020-0231 providing old who completed micronutrient (MNP) the guidelines on the standard regulation supplementation. There is a significant of donations, related to EO 51 in support decrease in the provision of micronutrients to the response to emergencies, disasters, in both age groups. In the current reporting and situations where health and nutrition of year, a total of 633,804 6 to 23 months old mothers and infants and young children are children completed MNP supplementation affected. compared to the 1,007,033 children in 2019.

26 WHO. https://www.who.int/elena/titles/ micronutrients_pregnancy/en/

Figure 16: Micronutrient Supplementation Among Children 6-23 Months Old, 2019 and 2020.

Source: DOH FHSIS, 2019 and 2020.

45 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 17: Vitamin A Supplementation in Children 6-23 Months Old, 2019 and 2020.

Figure 18: Proportion of Sick Children Given Vitamin A, 2019 and 2020.

Similarly, Vitamin A supplementation in both age groups was noted. For the likewise decreased provision in 2020. While current reporting year, 56 and 51 percent there is an insignificant decline among of sick children in the 6-11 and 11-23 the 6-11 months age group, a substantial month age groups, respectively, were given decrease of 13 percent is observed in 2020 vitamin A. bringing down the accomplishment to 46 percent from 59 percent in 2019. Among A significant decline in the provision of sick children27 seen in health facilities, a vitamin A, iron, and folic acid among post- slim increase in vitamin A supplementation partum women is reported in 2020. 50 percent and 49 percent of post-partum 27 Sick children identified based on the women were given vitamin A and iron with Integrated Management of Childhood Illnesses folic acid, respectively. (IMCI) protocol. These children may have been diagnosed with pneumonia, diarrhea, or mea- sles, among others.

46 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 19: Post-partum Women Given Vitamin A, Iron, and Folic Acid, 2019 and 2020.

Figure 20: Proportion of Children and Adolescents Who Received Two Doses of Deworming Tablets, 2019 and 2020.

Infants born preterm and those with protein, malabsorption of nutrients, vitamin low birth weight are likewise given iron A deficiency, and tropical enteropathy supplements. For the current reporting among others. Figure 21 illustrates the year, a total of 24,990 infants or 1.18 coverage of deworming among children percent of the eligible population received and adolescents. There was a significant iron supplements. increase of children and adolescents who completed two doses of deworming tablets Periodic deworming among children is in 2020. important in maintaining good nutritional outcomes. Soil-transmitted helminths (STH) impair the nutritional status of individuals they infect. STH may cause loss of iron and

47 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Table 8: Procured Nutrition Commodities, 2020. Commodity Quantity Value Vitamin A (200,000 IU) 7,134,000 capsules 11,102,656.00 Iron and Folic Acid 113,740,000 tablets 35,588,702.00 Micronutrient Powder 95,360,888 sachets 80,770,672.80 Ready-to-Use Therapeutic Food 5,780 cartons of 150 sachets 15,160,995.00 (RUTF) Ready to Use Supplemen-tary 6,577,750 sachets 143,576,222.00 Food (RUSF) for chil-dren Ready to Use Supplementary 332,400 sachets 7,024,281.80 Food (RUSF) for moms Lipid-based Nutrient Supplement 332,400 sachets 7,024,281.80 for Moms Lipid-based Nutrient Supplement 5,787,738 sachets 133,117,974.00 for Children Source: DOH 2020

Procured Commodities Policy Development

A total of Php 433,365,785 was utilized to The following are the policies developed procure commodities intended for various and ratified in 2020: client groups [Table 8]. 1. Department Circular 2020-0167 Capacity building Continuous Provision of Essential Health Services During COVID-19 In 2020, capacity building activities Epidemic were all conducted virtually as the 2. Department Circular 2020-0167 COVID-19 pandemic limited face to face Continuous Provision of Essential engagements. Below were the trainings Health Services During the COVID-19 conducted: Pandemic 3. Department Memorandum 2020-0261 1. Training of Trainors on Supportive Interim Guidelines on the Continuous Supervision for Philippine Integrated Provision of Maternal Services During Management of Acute Malnutrition the COVID-19 Pandemic. (PIMAM) priority areas, and online 4. Department Memorandum 2020- trainings on Maternal Infant and Young 0178 Interim Guidelines on Health Child Nutrition and Family MUAC Care Provider Networks during the through the technical and funding COVID-19 Pandemic assistance from UNICEF 5. Department Memorandum 2020-0319 2. Basic Emergency Obstetric and COVID-19 Management of Pregnant Newborn Care (BEmONC) Training Women, Women About to Give Birth conducted by Zamboanga City Medical and Newborns Center and Ilocos Training and Regional 6. Department Memorandum 2020- Medical Center 0092 Interim Nutritional Guidelines for 3. Maternal Death Surveillance Review Women of Reproductive Age training was conducted for the following 7. Department Memorandum 2020- LGUs virtually: Lanao del Sur, Marawi 0231 Guidelines on the Standardized City, all LGUs in Calabarzon CHD and Regulation of Donations, Related Cordillera CHD to Executive Order 51, series of

48 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Recommendations

2019 Recommendations 2020 Action 2021 Recommendations

Continue the BEmONC Commencement of the Assessment Implementation of the evaluation of the Philippine EmONC recommendation from the Initiative (BEmONC Functionality BEmONC assessment Assessment) in Luzon under the DOH-PCHRD AHEAD Project, Ensure that efficient delivery November 2020 to May 2021 of essential health services are part of a comprehensive pandemic plan

Update MNHCN policy and Desk review and conduct of Develop the RMNCAHN Policy ensure technical integration workshop on the development of in 2021 with other related policies the RMNCAHN policy Include the Philippine Commission on Women’s LGBTQ+ framework on service provision protocols, particularly on gender-based violence

Continue to sustain community Comprehensive catch-up Integrate immunization in other awareness on the benefits of vaccination conducted especially for primary care interventions immunization. Polio and Measles within a facility to decrease missed opportunities for vaccination and increase Strengthen advocacy Advocacy campaign for BIDA vaccine confidence campaign on immunization Solusyon sa COVID-19 and conduct house to house visits to ensure children are vaccinated to increase herd immunity.

1986 (The Philippine Milk Code), to 9. Department Memorandum 2020-0237 Health Facilities and Workers, Local Interim Guidelines for the Delivery of Government Units, Non-Government Nutrition Services in the Context of Organizations, and Private Groups and COVID 19 Pandemic Individuals in Support to the Response 10. Department Memorandum 2020-0333 to Emergencies, Disasters, and Interim Guidelines in the Implementation Situations Where Health and Nutrition of a Polio Outbreak Response of Mothers, Infants, and Young Children Immunization for cVDPV Type 2 in are Affected Regions III and IVA 8. Department Memorandum 2020- 11. Department Memorandum 2020- 0319 Interim Guidelines on Covid19 0378 Interim Guidelines on the Management of Pregnant, Women, Implementation of a Measles Rubella Women About to Give Birth and and Polio Supplemental Immunization Newborns Activity

49 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 KEY RESULT AREA 2 Family Planning

Family Planning on Wheels Barangay Health Worker Socorro Austria (right) delivers family planning commodities to existing family planning users in Barangay Limook, Lamitan City, Basilan. (Photo credits: USAID/BARMMHealth) 50 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Context and Challenges

A recent survey by the World Health The DOH National Family Planning Organization found that family planning Program team estimated that with the and contraception were among the most decline of modern contraceptive use of frequently disrupted services worldwide about 1 and 3 percentage points, there due to the COVID-19 pandemic. Similarly, will be an additional 47,000 to 359,000 respondents of another survey spanning unintended pregnancies in 2021 to the 2.1 29 countries around the world observed million baseline of unintended pregnancies an overall decrease in access to sexual in 2020; 11,000 to 84,000 unsafe abortions and reproductive health rights services to the baseline of 496,000 unsafe abortions; because of the prioritization of the pandemic and 30 to 200 additional maternal deaths to response. Threats to accessibility of such the baseline of 2,300 maternal mortalities. services consisted of lack of finances, lack of transportation, closure of clinics, restricted Similarly, in a study conducted by the movement, as well as fear of infection28 . University of the Philippines Population Institute (UPPI) and the United Nations In the Philippines, this is particularly Population Fund (UNFPA), projections true for accessing long-acting reversible showed that around 600,000 Filipino contraceptives and permanent methods, women would not have access to which require trained healthcare workers to contraceptives available in public health administer and require clients to travel to clinics and hospitals as a result of health facilities (i.e. hospitals for permanent lockdowns. This situation may lead to a methods). A significant number of hospitals baby boom where nearly 2 million newborns had to prioritize COVID-19 services and as are expected to be born in 2021 as a result a result, delayed provision of other essential of the additional 250,000 babies caused health services such as family planning. This by movement restrictions from all over the has led to changes in contraceptive method country29. mix and even drop-outs; subsequently increasing the risk for unplanned pregnancies and possibly abortion .

As discussed in the 2019 RPRH Annual

28 World Health Organization. (August 29 Projections by the University of the 2020). https://www.who.int/publications/i/item/ Philippines Population Institute and the United WHO-2019-nCoV-EHS_continuity-survey-2020.1 Nations Population Fund

51 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Status and Trends

Report, the DOH National FP Program As the Program reviewed its strategies and undertook a paradigm shift to support the targets, the Family Planning Estimation sexual and reproductive health needs of Tool (FPET30) was adopted through DM all women 15-49 years old rather than just 2020-0336 to produce a more accurate focusing on married women. This means estimate of mCPR annually. that adolescents and sexually active unmarried women are included in the It must be noted that the mCPR generated investments of the government for family by the Field Health Service Information planning. System (FHSIS) is not considered a “true” prevalence but FP service statistics The DOH, given its commitment to a wider provided by public health facilities only, client focus, also adjusted its target for hence cannot be used as a stand-alone modern contraceptive prevalence rate source for mCPR. (mCPR) for the year 2022 to cover all women of reproductive age (WRA) from 24.9 percent in 2017 to 30 percent, now including adolescents and sexually active unmarried women. The targets were based on historical trends, current capacities, 30 The FPET is a statistical modeling used and intended coverage of FP services. by the United Nations Population Fund (UNDP) The revision of the National Objectives for that draws from 194 countries and areas world- Health in mCPR targets both at the regional wide. FPET was adopted to work with a single and national levels was institutionalized country at a time and to accept service statistics through Department Memorandum (DM) as well as survey data to establish trends. It 2020-0297. was developed by the Track20 Project (imple- mented by Avenir Health, Inc.) for the FP2020 focus countries.

Figure 21: Modern Contraceptive Prevalence Rate, 2015 - 2020

Source: Department of Health, FHSIS 2015-2019

52 2020 Annual52 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Key Interventions

In 2020, the DOH reported around 8.1 A. Demand Generation million FP Users or an mCPR of 26.3 percent for all women. The total number National communication plan. In of FP users increased by six percent (or light of the co-management of the 460,000 users) from last year’s report. Family Planning program, DOH and New acceptors of FP increased by 43 POPCOM developed a harmonized FP percent. However, dropouts were higher at communication plan supported by USAID 28 percent. The dropouts in FP users may entitled “Think Differently about Family be attributed to difficulties in accessing FP Planning: The National Family Planning services due to the pandemic restrictions. Communication Strategy 2020-2022.” The following behavioral outcomes were Measures such as social distancing, identified and prioritized: (1) increase FP community lockdown, mobility restrictions use among sexually active young people as well as fear of travelling to health without children; (2) increase FP use facilities raised concerns on accessibility among post-partum women; (3) increase of FP information and services. Disrupted couple communication; (4) shift lactational supply chain system particularly on the amenorrhea method (LAM) users to a delivery of commodities from the DOH more effective method; and (5) decrease Central Office to its regional offices as discontinuation and method shifting. well as overwhelmed health facilities Couples, delayers, service providers, also threatened the provision of these and local chief executives are the main services. audiences of the communication strategy. The communication plan was integrated in The 2020 mCPR was generated using the the FP Costed Implementation Plan (CIP) Family Planning Estimation Tool (FPET) and the National Program on Population while previous mCPR estimates until 2019 and Family Planning (NPPFP). are computed using FHSIS data. Several FP materials were developed, with support from USAID, as part of the activities under the FP communication plan. These are: family booklets written in three dialects intended for delayers who wish to space pregnancies; FP take home guides discussing every method for both clients and service providers; and various social media cards posted in social media platforms.

Communication campaigns and outreach activities. Due to the COVID-19 pandemic, national government agencies, LGUs, and CSOs adapted innovative demand generation activities for FP. With limited in-person interactions, different online platforms (Zoom, FB Messenger) were used to connect with women in communities. Figure 22: Individuals with Sexual and Reproductive Health Needs Reached during Demand Generation Activities, 2019 and 2020

Source: POPCOM, 2019 and 2020. by one percent. Attendance of non-4Ps31 Figure 23: Clients Served with FP Services, 2020 beneficiaries increased to 37 percent in 2020 from 24 percent in the previous reporting year. Seventy-eight percent (188, 091) of attendees with unmet need were provided with services on-site or through referrals.

Other demand generation activities such as Usapan Serye and pre-marriage counselling continued despite the pandemic. In addition, POPCOM, with support from USAID, also launched the It’s OK to Delay! Campaign for young, sexually Source: POPCOM, 2020. active people who want to delay their first birth. POPCOM reached a total of 1,159,767 couples and individuals through various It must be noted, that while it may seem demand generation activities such as that COVID 19 pandemic did not have an face to face Responsible Parenthood and impact on the attendance of clients on Family Planning (RPFP) Classes, Pre- demand generation activities as shown by Marriage Orientation and Counselling the data, this needs to be studied further. (PMOC), house to house visits, and online RPFP classes. The 2020 accomplishment For their part, CSOs’ Facebook pages is lower by 726,738 individuals compared were maximized as a venue for continuing to the 2019 performance [Figue 22]. discussion on FP. Key FP messages through memes and infographics were Majority of the demand generation attendees were couples. Male attendance 31 4Ps or “Pantawid Pamilyang Pilipino still remained low at three percent for Program” is a conditional cash transfer both 2019 and 2020 RPFP classes while program of the Philippine government female attendance increased minutely under the Department of Social Welfare and Development.

54 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Survey on Filipino Women’s • Among those who heard about FP, Perception of Family Planning 40 percent of them heard about core messages on the importance of FP and In November 2020, POPCOM general information on FP methods. commissioned a survey to the Social • Top three main source of FP Weather Stations (SWS) to determine the information were: Barangay health awareness of Filipinos on family planning. workers (BHW) (46%); television The following were the salient points of the (23%); and government health facilities survey results: (17%). While the least source of FP information were: Barangay Service • Thirty-eight percent of Filipinos have Point Officer (2%); population officers, heard of FP through printed materials newspaper, religious institution, and (billboards/posters) or through digital printed materials (1%); and Usap Tayo platforms, while 34 percent through Helpline (0.3%). radio. • COVID-19 pandemic (18 percent) • Of those who have heard FP though was the main reason why clients have printed materials, more females (45%) difficult access to FP services. have previously heard about FP than • While most of the FP messages are males (31%), majority of them belongs heard in Mindanao, it is also in the area to the 25-44 years old age group; where Filipinos have difficult access to awareness is higher as education FP services. increases and is highest among college • Main “top of mind” problem of women graduates. is teenage pregnancy (59%), followed • Among those who have heard about FP by physical violence (11%), unexpected in radio, Mindanao have more listeners pregnancy (11%), sexual violence at 52 percent compared to other areas; (7%), and emotional violence (7%). more females (39%) than males (29%) Interestingly, FP information and have heard about FP through radio; service accessibility is the least of the awareness is higher among those who problem (4%). finished at least elementary education (33-38%).

posted in their respective Facebook B. Service Delivery pages. CSOs noted an increase in the numbers of visit, likes and reach on For this reporting year, the FPET projected FP information and discussion on their an mCPR of 26.3 percent for all women, Facebook. The Philippine Society for which is 1.7 percentage points lower than Responsible Parenthood (PSRP) website the target 28 percent in 2020. On the other was repurposed as RH-Care Info, an online hand, POPCOM’s computation of mCPR information hub on reproductive health for married women is 59.47 percent using care. Likewise, CSOs initiated online and FHSIS and PSA population projection. The mobile phone consultation and counselling COVID-19 pandemic posed challenges in on FP. CMEN promoted no scalpel accessibility of FP services and availability vasectomy through radio and TV guesting, of commodities, as well as the disruption and posting on their social media platform. of essential health services more broadly. However, this needs further study to attribute the impacts of the COVID-19 pandemic to disruptions in FP services.

55 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 In 2020, the DOH National FP Program As government imposed strict lockdowns, commissioned a study32 entitled, health resources and services may have Contraceptive Use Coverage in the been diverted from existing programs Philippines in 2020: Results from Survey such as family planning to the COVID-19 Using the Lot Quality Assurance response. This may have led to reduced Sampling (LQAS) Methodology. This level of performance and results of essential study aims to complement and validate public health services including disruption of the FHSIS data and to provide survey essential public health services. However, data in between years of the National further study was recommended as there Demographic Health Survey (NDHS). may be other factors to be considered other than the effects of the COVID-19 pandemic. The study provided an evidence-based picture of the effects of the COVID-19 Majority of the dropouts were users of LAM pandemic to family planning service (36%), COC (20%), and injectables (18%). provision. The study revealed that nine of Women using LAM are usually reported the 17 provinces had an mCPR among as dropout after six months of child birth. married women of more than 50 percent; Around 750,000 LAM users dropped out one province - Zambonga Sibugay has a of the program which could have been computed mCPR of more than 90 percent. counselled and offered other methods of On the other hand, five of the eight other FP to prevent rapid repeat pregnancies. provinces which were included in the past It has to be noted, however, that the 2020 surveys employing LQAS methodology data is still partial and unofficial, therefore showed a fluctuation of mCPR which may interpretation is not yet conclusive. be attributed to the COVID-19 pandemic. Figure 25 illustrates the FP users by 32 Population Based Survey using Lot method mix. Oral contraceptive (OC) pills Quality Assurance Sampling (LQAS) Methodol- still remain the method of choice among ogy to Determine the Contraceptive Coverage clients (2.9 million users), followed by in 17 Provinces in the Philippines, 2020. injectable (1.5 million users), and bilateral

Figure 24: FP Service Provision 2015 - 2020

Source: Department of Health, FHSIS, 2015-2020

56 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 25: Family Planning Users by Method Mix, 2019 and 2020.

Source: Department of Health, FHSIS, 2019-2020 tubal ligation (833 thousand users). It can responded both public and private while be observed that short acting methods, for long acting and permanent methods particularly the use OC pills increased average availability is less than 50 percent. in 2020. This may be attributed to the promotion of self-care during the COVID-19 Table 9: Availability of FP methods in Health pandemic. Facilities, 2020 FP Services Public Private Average In the policy issued by the DOH through Availa- Department Memorandum (DM) 2020-0222 bility providing the guideline in the provision BTL 31% 28% 30% of FP services during the COVID-19 NSV 8% 3% 7% pandemic, service providers were allowed IUD 42% 41% 42% to give at least 3 months’ supply of pills or Implants 54% 35% 47% condom so as to limit movement of clients. On the other hand, it is significant to note Injections 93% 53% 79% that use of long acting and permanent POP 87% 51% 74% methods like IUD, BTL and NSV COC 94% 53% 79% decreased in the current reporting year. Male 92% 48% 75% These methods are generally provided in Condoms health facilities particularly in outpatient FP 95% 70% 88% department of hospitals or ambulatory Counseling clinics for the permanent methods, hence, Source: Rapid Assessment of FP Services, DOH, use of these methods were expected to 2020 decrease during the pandemic. Most of the health facilities at the beginning of the In terms of commodity inventory, the rapid lockdown prioritized COVID-19 cases. assessment showed that the use of oral contraceptive pills, specifically Progestin- Similar observations were reported in the only Pill (POP) and male condom were DOH rapid assessment of FP services higher during the community quarantine where short-acting methods were available compared to non-quarantine period. in almost 80 percent of health facilities that

57 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Table 10: FP Commodity During Community Quarantine FP Commodity Total Stocks on Average Monthly Months on Consumption Hand Consumption Hand if COVID rate during prior to COVID rate of community (over 4 months in Consumption quarantine 2020) is Used

COC Pills 12,046,687 780,965 15.4 Lower POP 711,609 83,558 8.5 Higher Injectable 2,437,032 224,906 10.8 Lower IUD 168,378 12,674 13.3 Lower Male Con-doms 3,467,230 428,973 8.1 Higher Implants 268,460 6,198 43.3 Lower Source: Rapid Assessment of FP Services during Community Lockdown and PMIS, 2020.

Table 10 presents the commodity inventory The five regions with the highest number of during community quarantine. current users were Region 4A, Region 3, NCR, Region 6, and Region 11 comprising Family Planning in Hospitals. Establishing almost half (45%) of the total users in the FP in Hospitals is a strategy to ensure country. missed opportunities are addressed among post-partum women who wanted to practice Notwithstanding the COVID-19 pandemic, family planning right after delivery. For the DOH Centers for Health Development the year, USAID supported the DOH in (CHDs) continuously receives and assisting 153 government hospitals (88 in evaluates application for Free Standing FP Luzon, 38 in Visayas and 25 in Mindanao) Clinic in order to widen service provision and 18 private hospitals (14 in Luzon and 4 particularly by the private sector. DOH CHD in Mindanao) established the FP Program Central Luzon recognized its first Free in Hospitals. Many of these hospitals Standing FP Clinic in 2020. Evaluation of were assisted by strengthening each’s FP the facility and its staff was done virtually. program implementation and completing the program elements on service delivery, Rapid Assessment of FP services. This demand generation, and policy and activity was conducted in May 2020 to systems; while others were supported in evaluate FP service provision during the crafting an action plan on FP in hospital nationwide lockdown. Almost 1,000 health adaptation. facilities in both private and public sectors participated in the assessment. Apart Family Planning Regional Performance. from the results mentioned above, other In terms of regional performance in 2020, highlights of the assessment are as follows: the National Capital Region (NCR) had the highest number of new acceptors at 165 • Ninety-seven percent of public facilities thousand while Cordillera Administrative provide FP services while 62 percent Region had the lowest at 16 thousand. One provide such services in private in four (25 percent) of the total number of facilities. dropouts in the country came from Region IVA (CALABARZON). Meanwhile, BARMM • Most of the family planning service reported the lowest number of dropouts. provision happen in primary care However, reports has to be validate since facilities. Health service providers keep majority (11 of 14) of the methods reported RHUs and BHS open. zero (0) dropouts [Figure 26].

58 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 26: Family Planning Regional Performance, 2020

• Barangay health workers and barangay health emergency response teams conduct house to house visits and provide three months’ supply of pills and condom. During the brown bag sessions, innovations such as “nurses on wheels” in Region IVA and Region II surfaced. The LGUs provided the nurses (NDPs) bikes and contracted out tricycles in order to deliver health services house to house. The contracting of tricycles did not only deliver health services but also provided jobs for the informal sector in the specific LGUs. Further, in Region V, FP Ayuda Express was launched as a teleconsult platform for FP.

The results of the rapid assessment provided the Program with the evidence that provision of a full and wide range of family planning services was disrupted LGUs and implementing partners went the extra during the nationwide community lockdown. mile to deliver needed family planning services Apart from service provision, supply chain and commodities right at their clients’ doorsteps system particularly delivery of commodities through various “FP on Wheels initiatives”. (Photo to health facilities was also interrupted. credits: IMAP, 2020) C. Procurement of Commodities

59 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Good Practice in Service Delivery during COVID-19: Family Planning Ayuda Express Teleconsultation

In the Bicol Region, couples and individuals have been availing of family planning and reproductive health services and commodities regularly and with no interruptions, thanks to an online teleconsultation platform known as “FP Ayuda Express”.

An initiative of the Region V offices of the Department of Health and the Commission on Population and Development, and the universities and colleges in the region, with support from USAID, FP Ayuda Express is an online platform aimed at breaking the barriers to accessing FP information, services and referral brought by the pandemic. Said barriers include mobility restrictions due to community lockdowns as The platform has well as fear of infection when going out of reached a total of homes and visiting health faciliities. 684,522 individuals since it was launched in The FP Ayuda Express has made it June 2020. possible for Bicolano couples and individuals needing FP and RH messages The swift set-up and to talk or chat with trained nurses, midwives operationalization of the teleconsultation and counselors from the academe who will initiative was greatly facilitated by an provide correct and reliable information and ongoing Memorandum of Agreement link them with the nearest service provider. (MOU) forged prior to the pandemic Only current users of pills and condom can between DOH and POPCOM with be resupplied with the commodities while identified academic partners (Ago Medical new users or acceptors of family planning and Educational Center (AMEC) College methods need to undergo face-to-face of Midwifery, Bicol University College counselling and physical examination. Chat of Nursing, Camarines Sur Polytechnic and call moderators document and track College – College of Health Care clients through a google form linked to a Technology, Tanchuling College – College client database. of Nursing , University of Nueva Caceres – College of Nursing, Bicol College – Apart from the teleconsultation service, it’s College of Nursing and City College of Facebook page broadcast and disseminate Naga – College of Midwifery) committing various health promotion materials on to a “Partnership among academes and family planning, maternal health services, Communities Teaming up (PACT) for importance of child immunization, and male Improved Family Planning Services in involvement in reproductive health, among Bicol”. others.

60 2020 Annual60 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Stories from the Field: Breaking Barriers to Accessing Family Planning Information and Services during COVID-19

Family Planning Teleconsultation. Various civil society organizations such as the Brokenshire Women’s Center, Family Planning Organization of the Philippines (FPOP) and Likhaan Center for Women’s Health (Likhaan) launched its own version of online teleconsultations to cater to the needs of their clients virtually. Clients availing of these teleconsultations were provided with FP information, counseling, and referred to nearby facilities for actual service provision. Various courier services such as Grab, Lalamove, among others, or even CSO personal vehicles were utilized by FPOP and Likhaan to deliver resupply of family planning commodities such as pills.

Family Planning on wheels and mobile clinics. CSOs such as FPOP, Photo credits: IMAP, 2020 FriendlyCare Foundation (in partnership A total of 491 clients were with the Philippine Center for Population Photo Caption: able to avail of FP services and commodities and Development), Integrated Midwives in the seven project sites of IMAP through Association of the Philippines (IMAP), FP on Wheels from October until December, Likhaan, and Ugat ng Kalusugan (UNK) 2020. “I am thankful that FP on Wheels is conducted several outreach activities in bringing family planning to us and I was able the form of “FP on Wheels” and mobile to save from paying for my transportation clinics in various locations all over the fare. It is hard in this COVID-19 situation as country. The conduct of these outreach motorcycle taxi fares have become expensive activities were made in consultation “, said Jeralyn Ilaga Cahulogan, a 26-year-old and in partnership with the receiving mother of two who had PSI as her chosen local government units. Minimum health family planning method during the FP on protocols such physical distancing, use of Wheels activity conducted in Loay, Bohol in face masks and face shields, and frequent November 27, 2020. disinfection were strictly observed. CSO efforts contributed the following: IMAP, with support from USAID, also • Likhaan provided 21,339 FP services to established its FP Online Shop to serve as the 19,278 clients central supply center for FP commodities for • Friendly Care, with support from PCPD midwives and other health professionals. through 19 outreach activities, provided primary health care and FP services to 1,463 women; 626 accessed PSI service

61 2020 Annual61 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 Table 11: DOH FP Procurement Plan, 2020 FP Commodities Quantity Unit Costs Cost (Php) POP 5,000,000 40.00 200,000,000.00 Male Condoms 2,500,000 1.94 4,850,000.00 IUD 80,000 74.00 5,920,000.00 Implants 302,000 650.00 196,300,000.00 FP Training Supply 1,950 2000.00 3,900,000.00 Total Cost 410,970,000.00 Source: DOH FHNRP, 2020

Table 12: Total FP Inventory and Target WRA Table 13: Total Annual Consumption of Health Beneficiaries, 2020. Facilities by Commodity Type, 2019 and 2020. FP Commod- Total FP WRA FP Com- Total Consumption % ities Inventory Beneficiaries modities 2019 2020 Change

COC Pills 12,630,101 971,546 COC Pills 9,251,283 10,326,033 12% POP 6,912,312 531,716 POP 508,707 1,088,174 114% Male Con- 10,720,781 89,340 Male 3,599,338 4,761,817 32% doms Condoms Injectables 1,652,937 330,587 Inject- 2,563,748 2,749,118 7% Implants 567,451 567,451 ables IUD 559,465 559,465 Implants 88,714 84,318 -5% Total WRA Beneficiaries 3,050,106 IUD 145,863 143,754 -1% Source: DOH, 2020. Source: DOH PMIS , 2020.

Table 14: Number of Health Facilities that Reported Stock-out of FP Commodity, 2020. Regions COC Pills POP Male Injectable Implants IUD Condoms NCR 6 10 5 42 15 51 CAR 3 3 3 3 4 5 Region 1 4 4 4 4 3 4 Region 2 0 1 1 0 1 7 Region 3 12 17 13 19 15 14 Region 4A 0 4 4 5 2 8 Region 4B 1 1 0 1 0 1 Region 5 5 18 22 23 5 23 Region 6 6 7 7 7 7 6 Region 7 2 3 2 1 2 2 Region 8 9 21 10 29 31 34 Region 9 1 2 1 1 0 2 Region 10 5 3 5 5 3 4 Region 11 0 0 0 0 0 0 Region 12 4 4 2 3 4 3 Region 13 1 4 3 1 2 8 BARMM 15 17 20 12 24 7 Philippines 74 119 102 156 118 179 Source: DOH PMIS , 2020. More than half of health facilities in NCR The DOH allotted a total of Php (69 percent) and Region 8 (59 percent) 410,970,000.00 for the procurement of FP reported stock-outs of implants. In Region commodities in 2020, which is 33 percent 4B, majority of facilities (55 percent) higher compared to last year’s budget reported stock-out of IUD. allotment of Php 309,000,000.00. The Commission on Population Continuous hand-holding and capacity and Development likewise procured development of regional FP coordinators in commodities in 2020, to wit: 118,000 PSI the monitoring of FP commodity inventory rods amounting to Php 76.7 million and was conducted by the DOH Central Office 35,000 vials of Medroxyprogesterone to avoid future stock-outs and guiding them Acetate worth Php 2,002,700.00. Table in the redistribution of FP commodities to 11 shows the total inventory of FP service delivery points. commodities in 2020. This includes the stocks on order (FP Procurement Plan DOH also received assistance from USAID in 2020) and the stocks on hand at the in collecting stock and consumption data DOH Central Warehouse and facility level for FP commodities and making projections reported through the DOH Pharmaceutical of availability of FP commodities to make Management Information System (PMIS) timely decisions about procurement and that will cater to three million WRA. supply. As a result, there have been some promising changes in the stock out situation DOH received technical assistance from of the FP commodities. USAID in terms of coming up with a directory of alternative logistics service DOH and POPCOM, with support from providers and suppliers of FP commodities/ USAID, designed a segmented warehouse The directory was shared with LGUs to and distribution system for FP commodities facilitate distribution of commodities. using POPCOM warehouses and regional offices. This would enable POPCOM to Monitoring of FP Commodity Inventory conduct subnational and up to facility- level supply chain management of FP Table 13 shows that the annual commodities. consumption for short-acting methods have increased over the year. This is notable D. Governance Systems for POP consumption which doubled from previous year’s report. There is a slight E-learnng module. The development of the decline in the total consumption of long- e-learning modules for the Family Planning acting methods which may be attributed to Competency Based Training 1 (FPCBT) COVID-19 restrictions as discussed in the commenced in 2020. The shift to online service delivery section. training for FPCBT 1 is an opportunity for self-directed of service providers. This Majority of the health facilities in the PMIS means that even during a pandemic or in a reported stock-outs33 on Implants (15 disaster, they can complete the theoretical percent) followed by IUD (12 percent). aspect of the training remotely. There were also cases of stock-outs on POP (5 percent), male condoms (5 Capacity building of community percent), injectable (4 percent) and COC health workers for resupply of pills (3 percent). Among the 17 regions, two to and condoms. CHWs play a critical four health facilities in BARMM reported role in ensuring continuous provision of stock-outs of any of the six commodities. essential health services, including FP, in the community. DOH Regional Offices, in 33 Stock-out – zero (0) stocks on hand collaboration with local government units of specific FP commodities during the time of assessment and with technical assistance from USAID,

63 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Recommendations

Harmonizing NOH and PDP NOH and PDP targets were Institutionalize the use of the targets during the Midterm harmonized. mCPR target for ALL Family Planning Estimation Review of the PDP this year. women is 30 percent by 2022. Tool to lessen if not eliminate data biases and challenges with data quality.

Setting of the national FP The National FP Program strategic Strengthen the delineation of goal, strategic directions directions were co-created with roles and complementation and multi-year costing of the the Commission on Population of DOH and POPCOM in National Program on Family and Development and other key terms of implementing the Planning (NPFP) under a stakeholders. Family Planning program in the co-management arrangement country. between DOH and POPCOM under NEDA. Include the Philippine Commission on Women’s LGBTQ+ framework on service provision protocols, particularly on gender-based violence

Review and revise the M&E A new M&E framework is currently Conduct and establish a RPRH Framework following under development. RPRH NIT strategic goals and the directional plan of the directions with special attention national FP program. to provision of FP services during pandemic or in any form of disaster.

Address the shift in the The National Family Planning Align FP service delivery and distribution mechanisms from Program heavily utilized the PMIS provider payment mechanisms a direct to service delivery in the monitoring of FP commodity to UHC Law. point mode to Regional inventory at the regional level and distribution scheme local level to guide in commodity redistribution mechanisms. Further, the Program likewise sub-allotted funds to the DOH CHDs to support procurement of additional commodities and technical assistance to the LGUs.

Conduct of the 5-Year RPRH DOH contracted out PIDS in Complete the 5-year RPRH Implementation Review the conduct of RPRH Law Law Implementation Review. implementation review. Inception report was submitted in the last quarter of 2019.

64 2020 Annual64 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 capacitated barangay health emergency response teams (BHERTs) on their roles and functions, which include resupply of condoms and pills when they do house-to- house visit during community quarantine.

E. Policy Issuances

In 2020, DOH released the following policy issuances: 1. DOH Department Memorandum 2020- 0167: Continuous provision of essential health services during the COVID-19 pandemic 2. DOH Department Memorandum 2020- 0222: Continuous provision of family planning services during Enhanced Community Quarantine 3. DOH Department Memorandum 2020- 0297: Annual Target in mCPR for National and Sub-National Level in the NOH 2017-2022 4. DOH Department Memorandum 2020- 0336 Adoption of the Family Planning Estimation Tool to Produce Annual Estimates of mCPR for the National and Regional Levels

The COVID-19 pandemic posed the

65 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 KEY RESULT AREA 3 Adolescent Sexual and Reproductive Health

Photo credits: USAID/ReachHealth Project 66 2020 Annual Report Responsible PhotoParenthood credits: and Reproductive Department Health of Act Health of 2012 Context and Challenges

greatest challenge in the implementation learning, even fewer adolescents may of adolescent sexual and reproductive have access to Comprehensive Sexuality health (ASRH) programs in 2020. Majority Education (CSE) as it often falls by the of the planned activities for demand wayside and omitted in learning packages. generation, capacity building, especially With connectivity still being a luxury rather service delivery, were interrupted due to than a right, adolescents from poorer the implementation of community lockdown households are the least likely to be able to protocols. Most of the local government access this information34. units realigned their resources for COVID-19 response, mobilizing health care The collective impacts of the COVID 19 providers to focus on COVID-19 testing, pandemic in the provision of and access to detection, isolation and treatment. ASRH information and services of young people may also exacerbate the problem of Meanwhile, community lockdowns adolescent pregnancy, particularly among also restricted young people 21 years the very young adolescents, which may old and below from going out of their also be linked to gender-based violence. homes. Instead of face-to-face classes, Confined in their homes, adolescents living adolescents attend virtual classes and rely with a violent family member, become on online platforms to communicate with more vulnerable to abuse. Data from family and friends. In a short period of time, the Philippine National Police noted an adolescents’ mobility, social connections increase in violence against young girls with and education have been turned upside disabilities 0 to 17 years old. down.

Faced with what may seem to be an uncertain future, adolescents may struggle to make sense of their new situation, especially without adult guidance and Key Interventions support. 34 Plan International. https://plan-interna- Moreover, with schools shifting to online tional.org/sexual-health/how-covid-19-threatens- girls-women

67 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Status and Trends

Since the passage of the RPRH Law in (10-14 years old) might be due to abuse 2012, the registered births from adolescent or gender-based violence. Hence, age group have been decreasing. There stronger collaboration is being made with was a 13 percent decline in reported live the Department of Social Welfare and births, or a reduction in adolescent birth Development, Department of Education, rate of seven percent between years 2012 and POPCOM. DOH is capacitating field and 2019. However, the rate of decline health workers on the detection, reporting shown here might not provide a conclusive and response to cases of gender-based evidence as there are issues on incomplete violence and conduct of psychosocial risk reports from the Civil Registry [Figure 27]. assessment for all adolescent girls and boys for proper referral and response. Despite the decreasing trend for ages 15-19, the adolescent birth rate in the Early pregnancies can be detrimental to country remains high as it exceeds the Asia very young parents, especially for girls, Pacific average of 35 and comes close to not just on their physical and mental the global average of 50 (UNFPA, 2018). health but also on the long-term effects Currently, the country is gearing towards such as compromising their education and attaining the National Objectives for Health thus seriously affecting their employment (NOH) target for adolescent birth rate of 37 opportunities in the future. per 1,000 females for ages 15-19 by 2022. In terms of regional situation, data from Moreover, registry data showed that the Philippine Statistics Authority noted although live births among adolescent that the National Capital Region, Region age group 15-19 are decreasing at 1.8 IVA and Region III showed a high number percent from 2018 to 2019, unfortunately, of live births among 15-year-old mothers, it is increasing among 10-14 years old at which is similar for ages 15 to 19-year-old 7 percent from 2018 to 2019 [Figure 28]. adolescents [Figure 29]. Assumption for very young pregnancies

Figure 27: Registered Live Births to Adolescents ages 15 to 19 and Estimated Adolescent Birth Rate

Source: Philippine Statistics Authority, Registered Live Births in the Philippines 2013-2019

68 2020 Annual68 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Figure 28: Registered Live Births to Adolescents by Age Groups 10-14 and 15-19 years old

Source: Philippine Statistics Authority, Registered Live Births in the Philippines 2016-2019

Figure 29: Number of Registered Live Births by Age and Region of Usual Residence of Mother, 2019

Source: Philippine Statistics Authority, Registered Live Births in the Philippines, 2019

69 2020 Annual69 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 The Field Health Services Information Figure 30: Mode of Transmission among Children and System of the DOH noted the same Adolescents from January 1984 to December 2020 decreasing trend in teenage pregnancy (N=3,562) especially in 2020 among mothers aged 15 to 19 years old. It must be noted however that FHSIS data for 2019 and 2020 are still for validation considering that many health facilities were utilized for COVID-19 response. Moreover, guidance on reporting of data on adolescents have only been rolled-out to health facilities.

The significant decrease in teenage pregnancy may be attributed to nationwide lockdowns imposed in the whole country since March 2020 in light of the COVID-19 pandemic, which may have reduced the total pregnancies in the country based on Source: HIV/AIDS & Art Registry of the Philippines the data from DOH. Strict stay-at-home policies were imposed, limiting movement As of December 2020 data, 3 percent of the population to curb the spread of (1) were 10-14 years old, 21 percent (8) COVI-19. School attendance and social were 15-17 years old, and 76 percent gatherings were also prohibited for most of (28) were 18-19 years old. All adolescents the year. were infected through sexual contact (7 male-female sex, 23 male-male sex, 7 According to the HIV/AIDS & Art Registry sex with both males & femalesq ). Further, of the Philippines, four percent (3,562) of five children were diagnosed with HIV in all diagnosed cases from January 1984 this reporting period. Three were infected to December 2020 were 19 years old and through mother-to-child transmission and younger at the time of diagnosis. Of this, two had no data on mode of transmission. six percent (221) were children less than 10 years old. Among children, 213 (96%) were infected through mother-to-child transmission; one (<1%) through blood transfusion; and seven (3%) had no data on mode of transmission. Subsequently, 94 percent (3,341 out of 3,562) were adolescents. Twenty-eight were 10-14 years old, 496 were 15-17 years old and 2,817 were 18-19 years old. Of the adolescents, 96 percent (3,211) were infected through sexual contact (406 male-female sex, 2,063 male-male sex, and 742 sex with both males & femalesq ), 90 (3%) were infected through sharing of infected needles, 8 (<1%) through mother-to-child transmission, and 32 (1%) had no data on mode of transmission.

70 2020 Annual70 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 and part of it is on delayed airing in A. Demand Generation local radio station. • Responsible Parenthood and Family National level Planning (RPFP) HELPLINE was launched in May 2020 to address National Strategic Communications adolescents’ need for information Planning. The Department of Health on responsible health and sexuality, (DOH) and Commission on Population including protection from gender- and Development (POPCOM), with based violence and where to go for technical assistance from USAID, held a assistance. All POPCOM regional strategy development workshop to address offices have dedicated HELPLINE teenage pregnancy in the Philippines. numbers managed by trained Representatives from community and responders. school-based youth groups participated in the planning sessions. Five key priority Siningskwela 2020: Adolescents audiences were defined, along with Amidst COVID-19. The Department of behavioral determinants to the practice Education (DepEd), in collaboration with of desired ASRH behaviors. The strategy the DOH and POPCOM, and with technical document is currently being drafted and will assistance from USAID, hosted a free be finalized in 2021. Workshop on Creating Social Media Cards and Competition. The activity aimed to POPCOM at the national level, pursued provide an avenue for adolescents to three major strategies and utilized online make sense of their current experience, platforms to reach a wider number of young encourage action-oriented solutions, and people in the country. provide an avenue for self-expression through visual arts that will be transformed • You-for-you (U4U) Teen Trail Initiative as social media cards for adolescents is an ongoing communication campaign by adolescents. DOH posted the social led by POPCOM which seeks to media cards on the Healthy Pilipinas prevent early sex among teenagers. Facebook page to raise awareness among POPCOM managed to conduct this adolescents facing new demands and flagship strategy through face-to-face challenges during COVID-19 Pandemic. and online education and awareness activities during the early part of 2020. “Ako, Tayo, at COVID-19 Conversation In its limited roll out, it was able to reach Series for Teens in the Time of 6,399 adolescents from 11 regions. Pandemic. An offshoot of Siningskwela, • Adolescent Health and Youth DOH and POPCOM, in partnership with Development School on Air Program the Society of Adolescent Medicine of is POPCOM’s alternative to in the Philippines (SAMPI) and with support classroom sessions on ASRH. In 2020, from USAID, produced and disseminated POPCOM continued to deliver key a webinar series aimed at discussing messages on ASRH using its Sexually and disseminating useful information Healthy and Personally Effective for adolescents in the time of COVID as Adolescents (SHAPE) module. The well as provide opportunities for positive AHD School on Air brought in resource coping. Adolescents moderated the online speakers from the Sangguniang educational activity while doctors from Kabataan representatives, service the SAMPI provided some guidance as providers, and local policy makers resource persons. POPCOM officially from various local government units. posted the live airing of the webinar series The program was aired regularly every in their corporate FB page. Friday via Facebook live mainstreaming Adolescent Health Webinar Series. DepEd facilitated the recording and

71 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 development of webinar videos on and communication during community adolescent health. This is in partnership quarantine, responsible use of social with several CSOs, with support from media among adolescents in time of USAID. DepEd developed communication COVID 19 crisis. AHD-related news materials based on the webinar topics and articles were also disseminated and the same were shared by DOH, POPCOM, captured by media outlets. POPCOM CSOs and youth organizations in their tapped the support of population program corporate Facebook pages. workers in such events and reached a total of 12,102 adolescents in the region. Regional level POPCOM XII launched a Digital Poster Making contest targeted for adolescents Online educational programs for young ages 13-19 years old. Teens were asked people. POPCOM Region II spearheaded to illustrate, emphasize and interpret the a Facebook Live show entitled “Dear theme of the World Population Day which Ate Charing Program” which provided a is, “Putting the Brakes on COVID-19: platform for adolescent audiences to ask How to Safeguard the Health and Rights questions about ASRH. POPCOM Region of Women and Girls now”. 12 had its own Facebook program dubbed as “Deep Talks! Anong Meron sa Kabataan Awards. Organized by POPCOM Ngayon?” The pilot episode was able to Region VIII, the Awards recognized: reach 1,541 people, gained 41 reactions, 1) Outstanding Youth Organization for 802 views and was shared 35 times. In line every Province and City; 2) AHD Model with World AIDS Day, POPCOM Region Teen for every Province and City; and XII, in collaboration with DepEd and City 3) Short Documentary Film-Making Population Offices, launched a series of Contest focusing on the theme: “How ASRH webinars to educate young people Young People can Help Respond to the on the basics of STI, HIV, and AIDS and COVID-19 Pandemic?”. Participated what they can do to address these issues. in by young people, these awards POPCOM Region XII also organized a film were done in collaboration with the showing featuring “Larawan Ng Bukas”, a Sangguniang Kabataan and the Local film about teen pregnancy and its impact Government Units in general. on development, and “Ivy”, a film about defying the culture of arranged marriages. Engaging Parents and Adolescents. Young people age 13-19 were encouraged POPCOM Region VIII gathered 120 to watch those documentary films and were participants in a “Parent-Teen Talk” given the chance to win Php 50 worth of activity at Buenavista, Agusan del Norte. load, on a weekly basis. The films were Adults and teenagers learned valuable able to engage 64, 341 young people in information on how to communicate SOCCSKSARGEN. effectively about topics related to ASRH. POPCOM Region XII held similar parent Social media campaigns. POPCOM education classes in Maguindanao Region III launched campaigns and attended by 37 adults and 70 teenagers informational videos particularly on (in separate classes). POPCOM Region Facebook and TikTok. Self-paced online VI reached a total of 12,051 adolescents sessions on puberty, human sexuality were and 523 adults through their AHD classes posted on Facebook. POPCOM Region and other adolescent-related activities developed/distributed 4,300 localized conducted with partner local government AHD flyer, AHD on COVID-19 radio units. POPCOM Region XII organized a infomercial (2 versions for adolescents Youth Camp in Maguindanao attended and parents), infographics/tarp on teenage by 35 young people who received pregnancy, radio interviews about TP, ways information on reproductive health and to strengthen parent-teen relationship COVID-19.

72 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 cyberbullying, and HIV which was produced Promotion of Comprehensive Sexuality by Optimum Minds Media Productions. Education (CSE) in Schools. POPCOM Region XII worked with the DepEd OXFAM, through its Sexual Health and Regional Office to promote CSE in schools. Empowerment (SHE) initiative, worked POPCOM XII provided DepEd with with partners to produce IEC materials learning resources such as documentary on sexual and reproductive health and films on teenage pregnancy, and early gender-based violence. Partners distributed marriage (Larawan Ng Bukas and Ivy), 24,2487 copies of IEC materials, 2,804 AHD videos on menstruation, growth and dignity kits, and 1,030 sets of personal development, male and female fertility, protection equipments for health workers STIs and HIV, sexual exploitation and and frontliners in municipalities where the trafficking, pregnancy, naming body parts, project operates. sex and gender, including tips on managing menstruation. These materials could be CSOs organized organized online used by teachers in teaching CSE through information, education and communication online learning. activities for young people ASRH during COVID-19 pandemic through Zoom, Local Level CSOs’ Facebook pages, and Messenger. For Likhaan, a chatbot named Kai was Local government units, through local programmed to provide information on population workers and volunteers, puberty, reproductive health, gender, organized “house-to-house” visits to bring sexuality and rights. It has facilitated ASRH information to young people, who access to ASRH information for young were restricted from going out of their people. Through various online platforms, homes due to lockdowns. Carrying with community youth organizers referred young them localized printed IEC materials, patients for ASRH services to CSO clinics in workers and volunteers also identified the the communities. Lastly, CSOs participated ASRH needs of young people and made in the round-table discussion on the the appropriate referrals. A total of 3,658 proposed teen pregnancy prevention bills adolescents availed of ASRH counselling with legislators in the Lower House. and services from adolescent friendly CSOs also conducted peer education and health facilities. Adolescent Life Skills and Reproductive Health Education (ALSRHE) activities Support from CSOs and other among out-of-school-youth, youth leaders Development Partners. The Council and advocates and Sangguniang ng for the Welfare of Children (CWC), in Kabataan officers. partnership with UNICEF Philippines, and in collaboration with different key partners B. Service Delivery launched a series of webinars to help young people manage their well-being Adolescent-Friendly Health Facilities. during the pandemic as well as educate There are a total of 704 barangay/rural them about youth participation. health centers accredited by DOH as adolescent-friendly health facilities in 2020. The CWC with UNICEF and Positive Specifically, there are 617 are Level 1, 52 Youth Development Network spearheaded are Level 2, and 35 are Level 3 facilities. the development of learning modules The categorization is based on the DOH targeting adolescents and young people Department Memorandum 2017-0098: on the advocacy film entitled: “Click, • Level 1: system in place to ensure that Like, and Share” that tackles the relevant adolescents are aware on where and health, protection and social issues when to obtain information and health concerning children such as mental health, service

73 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 • Level 2: protocols in place to ensure Capacity Building provision of both information and health services, including trainings and demand ADEPT. Adolescent Health Education generation activities outlined in an annual and Practical Training (ADEPT) is a toolkit plan which can be used for self- and group- • Level 3: referral pathway to link based learning, and can be conducted for 1 adolescents to other facilities in case to 2 days and can be accessed in the DOH services are not available in the center; Academy E-Learning Platform. Figure 31 peer educators available to assist with show that a total of 510 were trained with exclusive room or space to ensure ADEPT e-learning toolkit and majority were confidentiality during counseling; from Regions IVA, III and XII. functional technical working group to oversee the delivery of services for Psychosocial Assessment. DOH, with adolescents assistance from USAID, developed a training video on rapid psychosocial Through the adolescent-friendly health assessment for adolescent. The intention is facilities, a total of 345,522 adolescents to orient and train health service providers have availed of ASRH services in various on how to conduct rapid HEEADSS. health facilities for the whole year. This is in support of DOH DM 2020- Meanwhile, CSO-run health facilities 0341: Interim Guidelines on Continuous provided a total of 36,617 ASRH services, Provision of Adolescent Health Services which comprised 4,516 contraceptives, 900 During Covid-19 Pandemic. Pilot areas prenatal check-ups, 289 STI/HIV-related were identified and proposed schedules services, and 155 GBV-related services. when to conduct the training on the Rapid HEEADSS were plotted. Later, DepEd Support from CSOs and other issued OUA Memo 00-1020-0198: Advisory Development Partners. Jhpiego assisted on the Implementation of the Medical 21 municipalities in establishing and Nursing Services and the Adolescent strengthening hotlines for adolescent Reproductive Health Program for SY health, Family Planning, and gender- 2020-2021. Specified in the memo is for based violence. In total, there are 4 ASRH Regional and Division Health Personnel, hotlines, 12 on FP, and 9 on gender-based ARH Coordinators, and teachers to attend violence. These hotlines strengthen existing a self-paced online training on ADEPT and local health and community structures by the use of Rapid Psychosocial Assessment continually providing SRHR services amidst Tool. the pandemic. Jhpiego was able to provide technical assistance to 25 service providers Monitoring Framework for Teen who served as focal persons or three Pregnancy. DepEd, DOH, and POPCOM different hotlines. are lead agencies that organized the Kapit Kamay National Summit on Teen ASRH services were provided to Pregnancy last 2018. They are expected to adolescents and young people through deliver the commitments from said event. CSO clinics, community outreach Towards this, DepEd conducted a series of services, and online teleconsultations. technical meetings on the development of Adolescents and young patients availed the Logical Framework and Monitoring tool of contraceptives, pre-natal and post-natal for Teenage Pregnancy. care, STI counselling and treatment, and HIV counselling, screening, testing and Monitoring and Quality Assurance referral. C. Governance and Systems

74 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Figure 31: Number of Trained with ADEPT by Region via DOH Academy E-Learning Platforms, 2020

Source: Department of Health, 2020

In order to scale up and enhance National level functionality of adolescent-friendly health facilities, a series of consultations were In 2020, DOH released the following organized by DOH, with the assistance policies in support of adolescent sexual from USAID, to update and improve the and reproductive health: national standards in establishing and monitoring said facilities. • Department Circular No. 2020-0167: Continuous Provision of Essential Support from CSOs and other Health Services During the COVID-19 Development Partners. The CWC, Epidemic. Identified 13 essential health through the National Child Protection services to be delivered continuously Working Group (NCPWG) and UNICEF, during the COVID-19 enhanced developed a training manual intending to community quarantine. LGU shall take capacitate MHPSS service providers in the lead in the provision of essential addressing mental health and psychosocial health services through the rural/city concerns of adolescents at the height of health centers, satellite health centers, the pandemic. The Adolescent Mental birthing centers, treatment hubs and Health and Psychosocial Support Training infirmaries which shall REMAIN OPEN Manual is composed of a guide for during the enhanced community facilitators to aid the delivery of training and quarantine. six (6) learning packs that contain specific learning objectives and activities. • Department Memorandum No. 2020- 0341: Interim Guidelines on Continuous E. Policy Issuances Provision of Adolescent Health Services During COVID-19 Pandemic. Primary care facilities, including designated barangay health emergency response

75 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 team (BHERT) and hospitals shall Comprehensive ARH Policy. Nov 25 to ensure that adolescents are provided 27, 2020, attended by selected ARH focal with the following health services: persons; c) Workshop for the development 1. Sexual and Reproductive Health of the Comprehensive ARH Policy. Dec 7 (SRH) Services, to 11, 2020 attended by DepEd regional 2. Nutrition Services, division focal persons and partners. 3. Mental Health and Psychosocial Services (MHPSS), Regional level 4. Human Immunodeficiency Virus (HIV) and Acquired Immune The declaration of teenage pregnancy Deficiency Syndrome (AIDS) and as a national social emergency in 2019, Sexually Transmitted Infections prompted regional bodies such as the (STI) Services and, Regional Development Council (RDC), 5. Immunization Services local executives and legislators to issue resolutions, executive orders • Department Memorandum No. and ordinances to address adolescent 2020-0351: Interim Guidelines pregnancy in their respective areas. in the Implementation of Human Technical Working Groups on Adolescent Papillomavirus (HPV) Vaccination amid Health and Development (AHD) and similar COVID-19 Pandemic. To mitigate the bodies were also organized. COVID-19 impact on school-based immunization service and minimize the • In Western Visayas, the Regional risk of transmission during vaccination Development Committee issued RDC sessions, the Department of Health VI Resolution No. 24, Series of 2020, issues these interim guidelines to which enjoins all provinces and cities in ensure that eligible female adolescents the region to create and institutionalize are continuously provided the social protection program for teen recommended vaccination for Human parents, and to provide funding for the Papillomavirus (HPV). initiatives. • In Caraga, RDC-SDC passed the • Department Personnel Order No. Resolution No. 51-D on November 2020-2876: Creation of a National 2019 supporting the declaration of Steering Committee for the Young Teenage Pregnancy as a national Adult Fertility and Sexuality (YAFS5) social emergency. Issuance of AHDP Study. Tracking of core behaviors Guidelines during ECQ to guide that were monitored through time in population officers and workers in YAFS surveys (from 1982 to 2013) is reaching out to adolescents during this important to establish trends. To provide pandemic. strategic direction, policy and guidance, • In Bicol, the Regional Population coordination and monitor the progress Executive Board passed a resolution at of the implementation of YAFS study, a the start of the year declaring support National Steering Committee is hereby for the declaration of adolescent created which is chaired by DOH and pregnancy as a national emergency co-chaired by UPPI. requiring inter-agency action. The board also agreed to develop a DepEd, with USAID support, pursued simplified module on teen pregnancy various activities related to the development prevention in support for the resolution. of a Comprehensive Policy on Adolescen The same resolution was also passed Reproductive Health: a) Youth Consultative by the NEDA Regional Development Meeting. Nov 20, 2020, attended by student Council in Cagayan Region. government representatives and leaders; Local level b) Writeshop for the development of the

76 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 The issuance of the DILG Memorandum Circular 2020-132, “Guidelines for the Lessons Learned Establishment of the Implementing Teams of the Responsible Parenthood and • The use of social media as an Reproductive Health (RPRH) Law in LGUs” alternative channel for the provision in the third quarter of the year provided of ASRH information and trainings as impetus for local government units to put in adaptation to the COVID-19 pandemic place the needed resources and structure is expected to be the norm up to 2022 in the enhanced implementation of the despite the availability of COVID-19 RPRH Law. vaccines. This approach might pose difficulty in getting immediate feedback In Antique, the provincial government from target audiences of IEC activities. issued Resolution 764-2020, enjoining all From the online activities conducted in local government units of 18 municipalities 2020, it was challenging to measure to establish information and service the results of IEC activities since actual delivery networs for adolescent health and audiences are fluid and could hardly development. The provincial government be determined. Conduct of online also mandated the conduct of annual surveys can be adopted, but in-depth symposium on social menaces and health information may be difficult to gather. issues and concerns affecting the youth in the province of Antique through its • The conduct of house-to-house visit Provincial ordinance no. 2020-220. by barangay volunteers to disseminate Several cities and municipalities also ASRH information and gather data legislated several local policies related on the specific needs of adolescents to ASRH. In Tuguegarao, an ordinance on ASRH for referral purposes looks was legislated institutionalizing the city’s promising. This approach can be adolescent pregnancy and prevention enhanced through the mobilization of program. In the municipality of Diffun in youth development workers and youth Quirino province, several executive orders leaders at the barangay level in the were released by the local government, provision of ASRH information, adhering including the establishment and operation to strict health protocols. of an adolescent health and development teen center, creation of the municipality’s • The implementation of the CSE adolescent health and development in all regions should be pursued. committee, and the organization of The guidance of the parents in the local youth development council. In San accomplishment of modules and the Guillermo in Isabela, an executive order attendance of their children in online was released establishing its municipal classes are viable opportunities for them teen pregnancy reduction committee. to be oriented/re-oriented on ASRH.

The Philippines is battling with the fastest • Continuous operation of Helplines is growing HIV epidemic in Asia and the a means to customize the information and service needs of clients. However, there is a need for a massive informa- tion dissemination on the availability of the hotline to create awareness and generate more users of the said plat- form. Even without internet connectivity, target clients should be able to text and call anytime to enable them to immedi- ately get their needed information and referral. Recommendations

Policy issuance on DOH- Development of the Strategic DOH to develop integrated AHDP strategic directions to Framework on Addressing policy on Reproductive, address adolescent/teenage Adolescent Pregnancy Maternal, Newborn, Child, pregnancy Adolescent Health and Nutrition (RMNCAHN) wherein the strategic framework will be included Conduct of an inter-agency, Draft Inter-agency Logical Finalization of framework and multi-stakeholders Framework for the reduction of plan; presentation to members planning workshop to Teenage Pregnancy of the NSC-AYHD and other develop operational plan stakeholders and framework(whole-of- government, whole-of-society approach), unified strategies and indicators for efficiently utilization of programs and services to address teenage pregnancy

Expand the number of HIV Support HIV treatment facility treatment facilities expansion through provision of quality services and appropriate use of OHAT funds

Inter-agency collaboration on Development of the National Finalization and ratification of demand generation on CSE Comprehensive policy on the plan and improve referral pathway Adolescent Reproductive Health by or linkages to health services DepEd with consultation with DOH through different methodolo- and POPCOM gies Development of AVP re: conduct of Conduct of orientation among Psychosocial Risk Assessment for teachers Adolescents in collaboration with DepEd and USAID Roll out the facility assessments for certification Strengthening individual based on updated criteria for agency roles and capacities, functional AFHF and collaboration among DOH, POPCOM, and DEPED to improve Design social protection ARH and AHD program for adolescent mothers and adolescents at risk

Plan for the development of an adolescent benefit package among DepEd, DOH, Popcom, PhilHealth, DSWD, and CSOs

78 2020 Annual78 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of2012 2012 2019 Recommendations 2020 Action 2021 Recommendations

Finalization and policy Resolution Approving the To revitalize the quarterly issuance on the amendment Appointment and Creation of the meeting of the National of the NYC Resolution re: National Steering Committee on Steering Committee - National Steering Committee Adolescent and Youth Health Adolescent and Youth Health on Adolescent and Youth Development (NSC-AYHD) and and Development Health and Development the Composition of the Technical Working Group Committees defining its Roles and Functions approved on August 1, 2019

Develop a National Development of the National Implementation of Communication Plan on Communication Plan on Adolescent Communication Plans for Adolescent Health and Health and Developments currently AHDP Development and improve on being drafted by FOCI. Monitoring and Evaluation of National advocacy campaign ASRH Draft document of the National launching of AHD brand, airing Communication Strategy to of TVC and RC, dissemination/ Address Teenage Pregnancy in the posting of posters, social media Philippines FY 2021-2022 (as of 25 cards January 2021) Adaption of the Communication Plan by partners/stakeholders

Improvement of the Strategic Communication Plan to Address Teenage Pregnancy to include M & E Plan

Develop policy/issuance on the implementation of the Communication Plans

Generate and disseminate Age (10-14 & 15-19) and sex- Improve completeness and public health program reports disaggregation are already accuracy of FHSIS data with age (10-14 & 15-19) and incorporated in the FHSIS(annual sex-disaggregation report) Strengthen the recording and reporting system for adolescent In depth analysis on the causes and services effects of adolescent pregnancy (disaggregated by 10-13, 14-16, YAFS5 study implementation of 17-19) Phase 2 Conduct of YAFS5 Study-Phase 1 implementation Review Policy recommendations based on the Longitudinal cohort study (currently Results of LCS wave 4)

79 2020 Annual79 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 KEY RESULT AREA 4 Sexually Transmitted Infections and HIV/AIDS

80 2020 Annual Report Responsible PhotoParenthood credits: and Reproductive Department Health of Act Health of 2012 Context and Challenges

Pacific with a 207 percent increase in new HIV screening, distribution of emergency HIV infections from 2010 to 2020. Despite supply of ARVs and other HIV drugs and the rapid growth, the number of new commodities, conduct of face-to-face infections is lower compared with other community outreach activities, including countries, affording the country a window the conduct of monitoring activities which of opportunity to control the rapid spread of are essential to preventing lost to follow-up, HIV. among others. Decrease in newly diagnosed HIV cases, With the shift in key risk populations from young people still at risk of HIV infection female sex workers to males who have sex with males and people who inject drugs, the government and its partners recalibrated its programs to ensure that prevention, counseling, laboratory work-up Mandated Agency. The National and treatment services, including rapid HIV HIV, AIDS, and STI Prevention screening and delivery of tests are readily and Control Program (NASPCP) available to key risk populations. However, of the Disease Prevention and as noted in 2019, the regular delivery Control Bureau, is mandated under of such services is under threat due to the Republic Act 11166 or the the sharp drop (40%) in public sector Philippine HIV and AIDS Policy Act investment for STI/HIV/AIDS programs. to implement the health sector’s Moreover, external funding is on a gradual HIV/AIDS and STI response as decline since 2013. embodied in the AIDS Medium Term Plan (AMTP), in close coordination Under this backdrop, the COVID-19 with the Philippine National AIDS pandemic in 2020 presented additional Council (PNAC). challenges to STI/HIV/AIDS programs due to lockdowns imposed by the government to curb the spread of the virus. Strict travel restrictions and an overwhelmed health workforce battling with COVID-19 contributed to disruptions in the access and delivery of life-saving antiretroviral therapy. This has also affected availability of STI/

81 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Status and Trends

Figure 32: Number of daily new HIV cases reported, 2020 Between January to December 2020, the HIV/AIDS and ART Registry of the Philippines (HARP) reported 8,058 confirmed HIV- positive individuals or 22 people newly diagnosed with HIV per day. This represents a significant drop from the 2019 figure pegged at 12,778 or 35 daily new diagnosed cases [Figure 32]

The sharp drop in newly diagnosed HIV cases is attributed to COVID- Source: HIV/AIDS & ART Registry of the Phils (HARP), 2015 to 2020 19-related lockdowns which may Figure 33: Distribution of HIV reported cases per have restricted people’s movement. age group, 2020 It can be noted that the sharpest drop in registered cases occurred during the months of March to August 2020 and a notable increase is observed in September 2020 when lockdowns were eased in COVID-19 hotspot areas including Metro Manila.

Ninety-four percent (7,624) of the reported cases were males. The median age was 28 years old. About half of the cases (4,071) were 25 to 34 years old at the time of diagnosis. Young people aged 15 to Source: HARP data, December 2020 24 years old continue to be at risk of HIV making up 28 percent (2,241) Figure 34: Distribution of HIV reported cases by region of of newly diagnosed cases during residences, 2020 the reporting period [Figure 33].

Females diagnosed with HIV has been increasing in the past years. From January to December 2020, 434 females were diagnosed with HIV, which was three times higher compared with cases reported in 2011 (156). In addition, the total diagnosed females aged 15 to 24 years old during the same period (129) was 43 percent higher compared with 2015 figures. The regions with the greatest number of reported cases remain to be the National Capital Region with Source: HARP data, December 2020

82 2020 Annual82 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 2,485 cases (31%), followed by Region antiretroviral therapy (ART) is 47,977 as of IVA with 1,372 (17%), Region III with 1,065 December 2020. The treatment for HIV is (13%), Region VII with 552 (7%), and called antiretroviral therapy (ART) which Region XI with 331 (4%). The rest of the involves taking a combination of two or country accounted for 2,253 reported cases more HIV drugs every day for the rest of (28%) [Figure 34]. the life of a PLHIV, without interruption. Antiretroviral (ARV) drugs do not cure HIV, In terms of mode of transmission, sexual but when taken daily, ART can suppress contact among males who have sex with viral multiplication allowing a person’s males (MSM) remains as the predominant immune system to recover, overcome mode of HIV transmission at 86 percent, infections, prevent the occurrence of followed by male to female sex at 10 opportunistic infections (OIs) and other percent and sharing of infected needles at AIDS-related complications. 3 percent. Figure 35 shows that of the estimated Significant Reduction of HIV Care 111,400 PLHIV, 70 percent were diagnosed, Cascade Coverage 61 percent were alive and on antiretroviral therapy (ART), and 94 percent of PLHIV Based on the AIDS Epidemic Model – on ART who were tested for viral load Spectrum, the estimated number of people were virally suppressed. However, only 16 living with HIV (PLHIV) for 2020 has now percent of PLHIV on ART were tested for reached 111,400. Of this, a total of 82,865 viral load. HIV cases have been reported and 4,574 were reported as deaths to the HIV/AIDS The HIV Care Cascade for 2020 has been and ART Registry of the Philippines as of adversely affected by COVID-19 pandemic December 2020. with reduced coverage across the cascade. Notably, coverage for testing, treatment and Among the 78,291 diagnosed cases who viral load testing needs to be significantly are alive, the total number of PLHIV on improved. Actual and Potential Impact of COVID-19 in HIV Prevention

Figure 35: HIV Care Cascade as of December 2020

Source: HARP data, 2015 to 2020

83 2020 Annual83 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Key Interventions Results of the comparison between the pre- COVID situation in 2019 against the impact of COVID-19 in 2020 show a reduction of The primary aim of demand generation HIV prevention coverage from 26 percent initiatives under this program is to promote to 17 percent; reduction of condom use safe sex through condom use as well as from 38 percent to 36 percent; 61 percent testing, especially among key affected reduction of HIV testing; 37 percent populations. At the height of the COVID-19 reduction of newly diagnosed cases; and 28 pandemic, demand for information and percent reduction of newly enrolled PLHIV education were primarily addressed to treatment. through the use of various social media platforms (Twitter, Instagram, Facebook), Further analysis shows sustained high- digital technologies and dating applications risk behaviors among key populations: 78 (Grindr, Blued) given the restrictions for percent of MSM and TGW had anal sex face-to-face interactions. in the past 12 months; number of months with anal sex is three months; and number The Department of Health, with support of anal sex partners is still two. Lower from the Global Fund Accelerating prevention coverage, sustained high risk Community Engagement and Response behavior, lower case finding or lower on HIV Prevention (ACER) Project, diagnosis, and lower treatment coverage implemented the “Online BESHIE” results to higher estimates of PLHIV. initiative. Inspired by the concept and principle of content marketing, BESHIE Estimation, modeling and projection tool which is an acronym for Bringing Education reveals that the annual rate of new HIV on Sexual Health and HIV in the Electronic infection has doubled from 10 percent World, seeks to generate demands for HIV between 2019 and 2020 to 21 percent testing services, provide HIV prevention between 2020 and 2021. The estimated information, and offer referral service on Filipinos living with HIV in 2021 is 133,900 HIV, STI, and sexual health. and it will triple by 2030. COVID-19 has delayed the achievement of the national Apart from social media platforms, goal by one year. However, reversing the the various DOH Centers for Health trend of new HIV infections is still possible, Development (CHD) released TV as long as the HSP targets of 95-95-95 advertisements as well as mass produced and 90 percent prevention coverage are information, education, and communication (IEC) materials targeting key populations achieved by 2022. (KPs) nationwide.

At the regional level, the Ilocos Region arranged four radio programs and two social media posts on STI/HIV/AIDS prevention. DOH-CHD CAR conducted A. Demand Generation online HIV awareness on prevention and referral networks in partnership with the Department of Education, National Youth Council and Technical Education and Skills Development Authority. With POPCOM- CAR’s support, a webinar on Adolescent Sexual and Reproductive Health was also conducted highlighting STI/HIV/AIDS as one of the main topics. Central Luzon CHD effectively disseminated relevant resources including video materials for service providers, key populations and PLHIV community using online resource centers, YouTube, and Facebook Live. Bicol CHD engaged community-based Strategy. Philippine Health organizations Gayon Bicol and Gentlemen Sector – HIV Strategic Plan (HSP) Bicol for advocacy on HIV/AIDS and SRH. 2020-2022 was crafted guided by CHD MIMAROPA in partnership with local the Philippine Development Plan government units organized face-to-face (2017-2022) and Universal Health events to commemorate World AIDS Day. Care Act (UHC) of the Philippines, and aligned with the 6th AMTP for B. Service Delivery 2017-2022 and the Sustainable Development Goals (SDG) which Diagnosis and treatment hubs. To reduce include a global target to end the the gap between patient diagnosis and HIV and AIDS epidemic by 2030. treatment, the Department of Health, in collaboration with local government units Targeting high risk key have been establishing HIV Primary Care populations among MSM, Facilities and Treatment Hubs across key transgender women (TGW), geographic areas. young key populations (YKP), and persons who inject drugs In 2020, DOH designated 56 primary (PWID) in high burden areas, the HIV care facilities and 107 treatment HSP has prioritized high impact hubs or a total of 163 facilities nationwide prevention, testing, treatment to provide HIV services, including free and adherence strategies that antiretroviral drugs. DOH, through the will contribute to the achievement Philippine Health Insurance Corporation, of the 95-95-95 targets, or 95 also continued to provide out-patient HIV percent of PLHIV will know and AIDS Treatment (OHAT) package for their HIV status, 95 percent a maximum of PhP 30,000 (USD 66) per of diagnosed PLHIV receive person per year. In fact, PhilHealth issued antiretroviral therapy (ART), and a Memorandum Circular allowing the use 95 percent of PLHIV on ART are of OHAT funds of HIV treatment facilities to virally suppressed. support ARV delivery.

Worth highlighting is that the Cordilleras established its first HIV Confirmatory Testing Facility (RHIVda) in the region to ARV refills even for transient patients, under the Baguio General Hospital and employing client-centered approach for Medical Center (BGHMC). The facility pick-up and delivery of ARVs such as use has already drafted its guidelines in of available courier services, government the acceptance and processing of tests vehicles, transport network vehicle services received from within the facility and (TNVS), and home delivery. Moreover, specimen submitted from other provinces CBOs and rural health units (RHUs) or even other regions around CAR. functioned as ARV refilling stations or access points. C. Governance and Systems In Central Luzon, program implementers Diagnosis and treatment hubs. During mitigated the impact of the pandemic the enforcement of community quarantines, through the proactive implementation of the HIV Program adopted innovative guidelines, protocols, unified strategic approaches to ensure the continuous direction, and innovations that are delivery of essential services to patients. responsive to the challenging situation to For example, the Program ensured access ensure continuity of HIV and STI services,

85 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 continuous delivery of services were: Good Practice. To address the challenges of brought by COVID-19 in 1. Integration of activities and sharing of the timely delivery of services, Manila resources (TB, mental health, EREID, Social Hygiene Clinic, in partnership WASH, FP/Safe Motherhood) at the with The Project Red Ribbon, UNAIDS Center for Health Development level; and the Department of Health- Metro 2. Door-to-door ARV delivery by case Manila Center for Health Development, managers; launched the Love on Wheels Project. 3. Engaging rural health units and The Project makes use of electric community based organizations as ARV bikes which aims to ensure continuity refilling stations/access points; of services such as door-door ARV 4. Tapping volunteers and DOH staff for delivery, HIV screening, delivery of ARV delivery; IEC materials, delivery of condoms 5. Scheduling of meet ups in neighboring and lubricants, delivery of specimens municipalities to reach clients; and securing results from San 6. Utilizing OHAT funds for ARV delivery; Lazaro Hospital and transportation of 7. Use of HIV self-screening for KP; fronliners. 8. Extending and/or modifying clinic operating schedule; 9. Online advocacy, IEC dissemination, and outreach; along with other health programs. 10. Conducting telephone or E-consultation for referral, appointment, triaging of The HIV Program also established Regional patients, and provision of mental health/ HIV Helplines for various referral needs of psychosocial counseling; displaced and stranded PLHIVs within and 11. Expansion of safe places for access of outside the respective region operated by condoms and lubricants; and community-based organizations such as 12. Operation of regional helpline or Usbong ng Bulacan, POSH Bataan, and 24/7 hotline are also key innovation Lakan Community Center. The program employed to mitigate the impact of also set-up the Central Luzon HIV Konek COVID-19 pandemic (bit.ly/CLHIVKonek) to help PLHIVs and key populations gain access to relevant Local level efforts. Local governments information on HIV and STI services. have also stepped-up their efforts by providing resources and implementing Central Luzon implemented differentiated innovative HIV prevention services care approaches for testing and treatment appropriate for their locales. such as decentralization of patients and treatment access points, sundown and HIV treatment facilities expanded their weekend facility operations, courier and services to provide rapid HIV diagnostic house-to-house ARV delivery, multi-month algorithm (rHIVda) service which enabled ARV dispensing, and telemedicine. the fast tracking of confirmatory results. Additional supply of point of care viral Additional support to implement various load cartridges and access to geneXpert activities under the new normal were machines allowed for increased access to provided to HIV facilities and support viral load testing. Moreover, masks, face groups such as laptops, printers, personal shields, gloves, and disinfectants were protective equipment, non-contact alcohol made available for community outreach dispensers, and food packs. Online capacity workers conducting outreach activities and building activities were also conducted for delivery of HIV services to key populations updates and harmonization of initiatives. and PLHIV. Other innovations pursued to facilitate

86 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Package for Sexual and Reproductive Treatment facilities and various patient Health in emergencies (MISP for SRH) support groups also mounted online in the affected areas through RH Medical learning group sessions (Quaran Talks) Missions. These RH Medical Missions to provide opportunity to help clients include services for MNCHN, FP, ASRH, cope with the prevailing situation, resolve STI/HIV, and GBV. syndemic issues, and ensure continuity of treatment and improve quality of life. Information on STI and HIV were also incorporated in the Philippine Society for LGUs also pursued the following Responsible Parenthood’s RH-Care Info innovations which served as enabling website. What used to be the Business factors cited by key partners in significantly Action for Family Planning Information improving the delivery of services: (BAFP Info) website was expanded in May 2020 to include information on maternal 1. Augmentation of drugs for opportunistic health, gender-based violence (GBV), and infections (OI); sexual and reproductive health information 2. Increase in KP reach in far flung areas for young people. thru LGU-initiated community-based HIV screening (CBS); 3. Increase budget allocation of LGU As the COVID-19 pandemic raged on, (e.g. Davao Reproductive Health and Wellness Center); 4. Active involvement of CBOs for HIV service delivery; 5. Strengthened inter-facility referral mechanism and regional and national support network; 6. Provided support for PLHIVs (food supply, hygiene kits, financial support from DSWD, livelihood program such as Lakas Yakap Foundation), and 7. Release of funding support from NASPCP thru sub-allotment to Centers for Health Development.

CSO contribution. CSO online consultations’ such as that of Family Planning Organization of the Philippines’ “youRHotline” and Likhaan Center for Women’s Health’s “TeleKonsultahan” also cater to clients with STI and HIV-related concerns. Additionally, FPOP’s RH Home Delivery not just provide family planning commodities but also does refills of anti- retrovirals (ARVs).

The COVID-19 pandemic did not stop natural disasters such as typhoons from visiting the Philippines. When Super Typhoon Rolly (Goni) hit Camarines Sur and Albay in November, FPOP implemented Minimum Initial Service

87 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Recommendations

Service delivery: To ensure continuous delivery of Local government units • Ensuring availability of essential services esp. during the and community-based local vehicles to increase lockdown period, the HIV Program organizations to strengthen testing and treatment adopted innovative approaches: HIV response and ensure • Ensuring availability of • ensured access to ARV refills accessibility and availability of drugs at facility level by even for transient patients, HIV services regular participation in • use of courier services, the monthly NASPCP government vehicles, transport Increase LGU budget allocation reporting vehicle, and home delivery for HIV response • Client-centered approach • CSOs and RHUs functioned as in delivery of ARVs ARV refilling stations or access and other HIV services points. (courier, ARV, refill stations, online/phone counseling/consultation, CBS) • Regular monitoring and use of reminder system (SMS/FB) by case managers for schedule of ARV refill

Expand the implementation of In 2020, DOH designated 56 Support rHIVda expansion rHIVda primary HIV care facilities and 107 through strengthened treatment hubs or a total of 163 laboratory facilities and facilities nationwide to provide HIV services services, including free antiretroviral drugs.

88 2020 Annual88 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 89 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 KEY RESULT AREA 5 Elimination of Violence against Women and Children

Photo credits: Philippine Commission on Women

90 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 90 2019 Annual Report Responsible Parenthood and Reproductive Health Act of Context and Challenges one of the global issues highlighted is the surge of gender-based violence (GBV) at Gender-based Violence at home. UN Women referred to this as the “shadow pandemic”. The economic impact Home: The Shadow Pandemic of lockdowns contributed to concerns about family income, including tensions and • According to the Philippine strain at home. Alarmingly, lockdowns also Commission on Women (PCW), increased isolation for women living with there was an increase in the violent partners, separating them from the number of inquiries received people and resources that can best help related to violence against them35. women (VAW) via email, phone, walk-in and social media starting In the Philippines, the COVID-19 in March 2020. This coincides pandemic aggravated underlying gender with the start of the community issues and affected marginalized and quarantine measures. vulnerable sectors. The implementation of community quarantine measures • In the recent survey conducted hindered women and girls from seeking by Plan International Philippines help, reporting the abuse, and/or escaping from April 20 to May 15, 2020, their perpetrators due to the suspension of results show that the COVID-19 public transportation, strict orders to stay pandemic has had a profound home, and limited issuances of quarantine impact on the safety and passes. protection of girls and young women aged 13 to 24 years old. These factors have contributed to the Survey respondents highlighted following program implementation that aside from receiving challenges: information on access to sexual 1. Decrease in gender-based violence and reproductive health items and services, they have expressed 35 Violence against women and girls: the the need to receive guidance on shadow pandemic (2020, 6 April) Retrieved how to protect themselves from from https://www.unwomen.org/en/news/sto- harassment and violence, and ries/2020/4/statement-ed-phumzile-violence- how to report cases of gender- against-women-during-pandemic based violence, among others.

91 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 (GBV) reporting. Isolation measures, 2020. All projects and activities lined such as the implementation of community up for the year that required convening quarantines has made it difficult for of face-to-face meetings, workshops, VAW victim-survivors to personally conferences and similar events were report violence, let alone feel safe when postponed because of preventive health perpetrators are able to monitor their protocols and restrictions imposed by actions. Women who try to escape their the Inter-Agency Task Force for the abusers also face the uncertainty of being Management of Emerging Infectious stranded on the streets due to limited Diseases (IATF). Instead, these public transportation. The pandemic also activities were held online via Zoom, limited the reporting of VAWC cases Google Meet, and Cisco Webex. Also, collected at the barangay level. With IACVAWC suspended all travels, both barangays serving as frontliners in the international and local, in compliance COVID-19 response, the Department with government regulations related of the Interior and Local Government to COVID-19. Likewise, instead of suspended the monitoring and submission schools, transport hubs, and cinemas, of reports on reported VAWC cases. anti-VAW IEC materials were distributed directly to LGUs, particularly the 2. Limited availability of VAW-related barangays. services. Major service providers and resources have been directed to address Restrictions also affected the the public health crisis, such as the implementation of field activities, such mobilization of LGU workers to support the as the conduct of field-tests for the social amelioration program, distribution of standard VAW intake forms, which was relief packs, and enforcement of quarantine scheduled in the first quarter of 2020. measures. This has contributed to the However, the activity was postponed to decrease in availability of VAW-related the second semester, and areas were services for those who need it. changed. 3. Pandemic halted planned activities for

Status and Trends

Philippine National Police records. The PNP recorded a total of 14,835 cases of Table 15: VAW cases by legal violation violence against women (VAW) in 2020. Type of 2018 2019 2020 VAWC, per Republic Act No. 9262, remains Violence as the highest reported type of incident with 10,429 cases. This was followed by VAWC (R.A. 14,116 15,160 10,429 rape with 1,850 reported cases, and acts of 9262) lasciviousness as the third most reported Rape 2,319 2,341 1,850 type of VAW with 1,408 cases. Acts of 2,020 1,953 1,408 Lasciviousness With the imposition of lockdowns and Concubinage 165 204 127 quarantine measures, the reported VAW cases decreased significantly in 2020. Sexual 128 85 107 Harrassment Compared to the 2019 data, there was a 25 percent decrease in reported VAW cases. Total 18,748 19,743 14,835 On the other hand, there was a 21 percent Source: Philippine National Police, 2020 decrease in reported cases from 2018.

92 2020 Annual92 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Figure 36: Reported VAWC cases from 2018 to 2020

Source: Philipppine National Police, 2020

Table 16: Regions with the highest reported VAWC cases. Region VAWC Traf- Lascivi- Rape Con- Voy- Sexual Safe Total ficking ousness cubi- eurism Harass- Spac- nage ment es VII – Central Visayas 2,763 2 159 207 9 7 5 3 3,155 National Capital Region 1,029 14 288 295 16 31 16 28 1,717 VI – Western Visayas 1,029 3 104 146 8 4 2 2 1,378 IV-A – CALABARZON 763 2 183 270 20 19 3 4 1,264 III – Central Luzon 733 4 168 209 22 13 3 5 1,157 Total 6,397 25 902 1,127 75 74 29 42 8,671 Source: Philipppine National Police, 2020

In terms of regional data, the regions with same period in 2019 and 2020. VAW data the highest number of reported GBV cases from PNP, covering the start of community were Region VII, National Capital Region, quarantine in March 15 until December 31, Region VI, Region IV-A, and Region III. 2020, show that there were 7,576 cases Region VII has the highest recorded VAW of violence committed against women cases at 3,155 or 21 percent of the total under Republic Act (RA) 9262 or in intimate 14,835 cases reported to PNP. It is almost partner relationship. This is 39 percent three times higher than the other regions lower compared with the 12,559 cases with high incidence of violence against reported during the same period in 2019 women [Table 16]. [Table 17].

VAWC is the highest reported type of VAW The downward trend has been noted for at 6,397 cases across the five regions. cases of gender-based violence (GBV) There were a total of 1,127 cases of rape, including rape, acts of lasciviousness and 902 cases of acts of lasciviousness, and other types of abuses during lockdowns 245 cases that include anti-photo and video compared with the same period in 2019. voyeurism, anti-trafficking in persons, and violations under the Safe Spaces Act. The decrease in reported cases of violence The decrease in reporting is further against women and children could be emphasized in the comparative data of the attributed to difficulty on the part of the

93 2020 Annual93 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 VAW victim-survivors or her relatives and Table 18: VAW victims with disabilities friends to report the abuse due to the Victims with 2018 2019 2020 Total implementation of community quarantine disabilities measures and strict travel restrictions. Moreover, it would be doubly difficult for the Women (18 160 142 272 574 victims to go out because of the presence of years old and the perpetrator in their dwellings. above) Young girls (0- No 127 132 259 Furthermore, figures may be higher as 17 years old) data there are also cases being reported to Total 160 269 404 833 non-government organizations, barangays, Source: Philippine National Police, 2020 Women and Children Protection Units (WCPU), City of Local Social Welfare Department of Health VAWC Registry. Development Offices (SWDOs), and other The DOH, through its VAWC Registry service agencies. System reported 2,947 cases of violence

against women and children in 2020 while Table 17: Reported cases before and during quarantine periods the Child Protection Network, through the Women and Children Protection Units Type of Mar to Mar to (WCPUs) recorded 9,285 cases of violence Violence Dec 2019 Dec 2020 against women and children. Out of these 2,947 reported cases in the VAWC Registry VAWC (R.A. 12,559 39% difference 7,576 System, 1,967 were cases under RA 9262 9262) (Anti-VAWC Act of 2004), 572 were cases Rape 2,060 38% difference 1,415 under RA 8353 (Anti-Rape Law of 1997), Acts of 1,685 31% difference 1,043 and 295 cases under RA 7877 (Anti-Sexual Lasciviousness Harassment Law of 1995). Anti-Photo 73 10% difference 81 and Video Community VAW Desks. Based on the Voyeurism data from the Department of the Interior and Sexual 80 56% difference 35 Local Government (DILG), there were 5,121 Harrassment women who experienced physical, sexual, Trafficking 36 33% difference 24 psychological/emotional, and economic Safe Spaces 18 127% difference 41 abuse reported at the barangay VAW desks. Source: Philippine National Police, 2020 The report released by DILG only covered the period of the community quarantine (March 16 to June 15, 2020) in 10 regions. Violence against women and young girls with disabilities. From 2018 to 2020, PNP recorded a total of 833 cases of VAW in- The region with the highest number of volving women and young girls with disabil- reported VAWC cases was the NCR with ities. Of this, 574 cases of violence involved 2,286 women victim-survivors. This was victim-survivors who are women with followed by Region III with 1,437 women disabilities aged 18 years old and above. victim-survivors who sought assistance Moreover, 259 young girls with disabilities from their barangays. Most of the victim- aged 0-17 years old experienced abuse survivors reported physical abuse with 2,732 from 2018 to to 2020.There were 404 cases cases. Psychological/emotional abuse came of VAW involving women and young girls the second highest reported type of violence with disabilities recorded in 2020. This was with 1,727 cases. Barangays in the ten a 50 percent increase in the number of cas- regions recorded 631 cases of economic es recorded in 2019 pegged at 269 cases abuse and 236 sexual abuse cases. of violence against women and young girls with disabilities [Table 18].

94 2020 Annual94 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Table 19: Reported VAW cases by Barangay VAW Desks. Region Total No. of Total No. Types of Violence Barangays of Victims Physical Sexual Psycho- Economic with VAW Abuse Abuse logical/ Abuse Victims Emotional Abuse I 33 35 17 1 17 8 III 457 1,437 696 65 477 233 IV-B 73 96 68 5 28 20 V 215 301 152 36 94 25 VI 330 581 289 36 195 69 VII 182 291 189 12 95 0 VIII 47 56 35 4 23 12 XII 11 15 9 2 5 5 CAR 22 23 12 4 11 3 NCR 163 2,286 1,265 71 782 256 Total 1,533 5,121 2,732 236 1,727 631 Source: Department of the Interior and Local Government, 2020 Table 20: Action taken by Barangay VAW Desks Region Issued Referral Referred Referred Referred Referred Referred Referred BPO to to PNP to NBI for for Legal to Court to Other LSWDO Medical Assis- Orgs. Treatment tance (NGOs, FBOs, etc.) I 9 16 13 0 4 4 3 6 III 257 35 247 2 164 31 23 363 IV-B 29 5 21 0 16 0 2 14 V 72 81 83 0 42 5 22 25 VI 134 145 15 6 62 13 40 84 VII 0 98 95 2 34 13 0 87 VIII 4 35 28 0 15 2 5 2 XII 4 11 4 1 3 0 0 2 CAR 5 14 15 1 4 5 5 2 NCR 338 396 417 1 394 50 18 672 Total 852 1,196 1,073 13 738 123 118 1,257 Source: Department of the Interior and Local Government, 2020

DILG also reported that the barangay VAW 118 cases were referred to court. Barangay desks acted on 852 cases by issuing a VAW Desks also referred 13 cases to NBI barangay protection order while 1,196 cases and 1,257 cases were referred to other were referred to the local social welfare organizations such as NGOs and faith-based and development office (LSWDO). The organizations to give further assistance barangay VAW desks also made referrals to needed by the VAW victim-survivor. Data on different VAW service agencies. There were the total of number of VAW cases handled 1,073 cases referred to PNP and 738 cases by Barangay VAW Desks throughout were given referrals for medical treatment. the country remain incomplete as DILG Moreover, there were also 123 cases that suspended their monitoring activities and will were referred for legal assistance while resume in 2021.

95 2020 Annual95 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 Reponding and handling of VAW cases. Key Interventions In 2020, the Public Attorney’s Office (PAO) served a total of 19,372 women clients with cases falling under R.A. No. 9262 (Anti- A. Demand Generation VAWC Act of 2004). Of this, 5,046 women clients were provided with judicial services 18-Day Campaign to End Violence and 14,326 were assisted with non-judicial against Women (VAW). The 2020 services. PAO also served a total of 2,538 Celebration of the 18-Day Campaign rape victim-survivors, wherein 1,038 rape to End VAW focused on strengthening victims were provided with judicial services local protection mechanisms by building and 1,500 victims were assisted with non- the capacities of barangay officials in judicial services. Non-judicial services refer responding to violence against women and to instant services and outreach activities gender-based violence (GBV)incidents36. of the PAO. Instant services include legal It highlighted the roles and responsibilities counselling, preparation of documents, and of barangays as part of a VAW-free administration of oaths (notarization). On the community. other hand, outreach activities cover custodial investigation and inquest proceedings, jail The Philippine Commission on Women visitation, and legal outreach programs (PCW) conducted the “Online Talakayan (usually in the form of lectures/seminars). towards VAW-free Barangays”, a five- part webinar series aimed at enhancing Table 21: Number of cases handled people’s awareness about anti-VAW laws Status Cases Rape Cases and improving the capacities of service under R.A. providers in performing their duties as first No. 9262 responders to GBV. Each episode was Cases Pending, 3,639 985 livestreamed through the PCW Facebook Beginning page reaching a total of 3,301 online New Cases 1,536 273 attendees. The agency also launched the Received VAW Puppet Web Series on its Facebook page. The series discussed, through Total Cases 5,175 1,258 Handled stories, core messages on VAW and the different types of VAW, including sexual Terminated 3,063 575 harassment and trafficking in persons. Pending, End 2,112 683 It had a total reach of 107, 434 online Source: Public Attorney’s Office participants nationwide. The National Prosecution Service (NPS) Aside from the online webinars and web handled a total of 5,175 cases involving series, PCW distributed anti-VAW IEC women clients under R.A. No. 9262. Of this, materials in nine (9) local government 1,536 were new cases received by the Office units (LGUs) particularly in Las Pinas, of the Prosecutor and 3,639 cases were Mandaluyong, Muntinlupa, Malabon, pending at the beginning of the year. However, Valenzuela, San Juan, Quezon City, Pasig, of the total cases handled, there were and Pateros. These include primers, 3,063 cases under R.A. No. 9262 that were brochures, and posters with information on terminated and 2,112 cases remain pending at forms of VAW, actions to be taken in case the end of the year. of a VAW incident, and hotline numbers NPS also reported that in 2020, a total of 1,258 36 Annual celebration led PCW, in rape cases handled involved women victims- partnership with the Inter-Agency Council on survivors. Out of the total cases handled, Violence Against Women and their Children there were 273 new cases received and 985 (IACVAWC) from November 25 to December pending cases handled at the beginning of 12. the year. Meanwhile, 575 rape cases were terminated and 683 cases remained pending at the end of year. of service providers. IEC materials for the local authorities as necessary (i.e., police remaining eight (8) localities in NCR will be stations, WCPDs, barangay officers, and distributed in 2021. social welfare offices) to ensure that they get direct assistance. This included direct Supporting Help-seeking Behaviors reporting and regular follow-up of cases to of Survivors. The Secretariat for the concerned barangays or local women and Inter-Agency Council on Violence against children protection desks. Women and their Children (IACVAWC) The Secretariat responded to a total of made available, through the PCW website 556 VAW-related and non-VAW inquiries and Facebook page, the national VAW and concerns received through email, Hotlines to help and encourage women, phone calls/texts, and walk-ins. VAW- who are experiencing violence, to seek related inquiries include VAWC, sexual help and also for concerned citizens to harassment, rape, and photo and video report the violence. Regional hotlines were voyeurism. VAWC remained as the highest also disseminated in partnership with the reported type of violence with 291 inquiries Philippine Information Agency especially while non-VAW cases were second in areas with high VAW incidence. As of highest number of inquiries received by December 2020, VAW hotlines for Regions the Secretariat with 183 inquiries. Non- IV-B, VI, VII, IX, and XIII have been posted VAW-related inquiries include abuse from on official PIA Facebook pages and shared parents or other family members, physical by various stakeholders. injuries, cybercrimes, assistance to OFWs, employment issues, and quarantine PCW launched an online campaign concerns. #JuanaSaPanahonNgCorona to feature COVID-related discussions on the Table 22: Type of violence resported gendered impacts of COVID-19. The Type of March to March to campaign also highlighted stories from Violence December December GAD experts, women leaders, front liners, 2019 2020 government agencies, and other relevant organizations on management and VAWC 77 275 mitigation initiatives during the pandemic. Sexual 6 29 Harrassment PCW also partnered with Twitter for the Rape 15 36 launch of its #ThereIsHelp campaign. Photo and Video 0 10 #ThereIsHelp is a notification service on Voyeurism Twitter which provides valuable mental Total 98 350 health resources to vulnerable users Source: Philippine Commission on Women, 2019 who search for terms associated with suicide or self-harm. The top search PCW observed a spike of VAW-related result now includes a Tagalog notification requests for assistance at the onset of encouraging the user to reach out for help. the pandemic (March to December) which It also provides contact details of relevant registered 350 cases against 98 cases in agencies with mental health services. the same period in 2019.

B. Service Delivery Reported violence committed under RA 9262 (VAWC) more than tripled during VAW Reporting and Referral Services. the pandemic, from 77 cases in the same The Philippine Commission on Women, period (March to December) in 2019 to through the IACVAWC Secretariat, continued 275 cases in 2020. Moreover, rape cases to provide remote VAW referral services to increased by 38 or 153 percent from only clients through phone, email or Facebook. 15 cases in the same period in 2019. Victims/Informants were connected to proper

97 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Moreover, other agencies contributed the Women and Children Protection Unit. following efforts: The Department of Health, through its Women and Children Protection Units • DOH Region V integrated GBV (WCPU), provides medical assistance assessment during FP counseling. to victims in coordination with LGUs and This ensures that all FP clients are also other government health facilities. The evaluated on any forms of violence they Department issued Administrative Order may be experiencing and be given with 1-B providing for the establishment of appropriate GBV-related services and/ WCPUs in all DOH-retained hospitals to or referral. address the increasing number of patients reporting violence, rape, incest , and other • DSWD partnered with the United forms of VAW. Registered Social Workers from NASWEI (National Alliance for Social Based on the 2020 data, there are currently Work Education Incorporated) to provide 120 established units in 57 provinces, 10 online and telephone counselling and chartered cities and 22 municipalities. Six other psychosocial services to VAW private hospitals also established their victim-survivors. VAW desks as part of their women and children protection unit. DOH also trained • The Commission on Human Rights – 365 health workers in WCPUs on the 4Rs Gender Equality and Women’s Human (recognizing, reporting, recording and Rights Center (CHR-GEWRC) launched referral) of women and children abuse its public electronic reporting system of cases. GBV and VAWC cases (www.gbvcovid. report) where citizens can report During the pandemic, some provincial incidents of abuse. The system also hospitals such as the Bataan General documents which sectors informants/ Hospital and Medical Center Women and victims come from to monitor specific Child Protection Unit (WCPU) created experiences of all kinds of marginalized a mechanism on the proper handling of and vulnerable groups. gender-based violence cases ensuring confidentiality without breaching the Legal Counselling and Assistance. The minimum standard of health protocols. Commission on Human rights also posted The triage physicians were informed in on their Facebook page their hotlines advanced on the arrival of a WCPU client. to provide free legal advice and answer inquiries/concerns about human rights. Jose B. Lingad Memorial General Hospital’s WCPU facilitated the faster The Department of Justice, through the release of laboratory results and filing of Public Attorney’s Office, provides legal medico-legal requests to Records Section, assistance to victim-survivors through lessening the exposure of patients and online and telephone consultations. During relatives to other patients. The case lockdown, all PAO District Offices maintain is immediately referred to concerned skeletal operations to continue delivery of municipal social, welfare and development legal services. office.

The Supreme Court issued OCA Circular Since the Southern Philippines Medical No. 89-2020 to all Litigants, Judges and Center is being used as COVID-19 referral Court Personnel of the Second and First facility, the WCPU was transferred to Level Courts, and Members of the Bar another location to make it more accessible regarding the Implementation of Supreme to patients and to protect them from the Court Administrative Circular No. 33- virus. New protocols have been added to 2020 on the Electronic Filing of Criminal ensure the safety of both the victim and the Complaints and Information, and Posting of service providers. Bails.

98 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Established LCAT-VAWC. As of the Case Management on Gender-Based 2020, according to DILG, 57 out of 81 Violence during the COVID-19 pandemic. provinces have established their PCAT- The online training served as a strategic VAWC. In addition, 127 out of 145 cities intervention for social workers to enhance established their CCAT-VAWC, while 1,237 their capacities in managing various cases municipalities have established their MCAT- of GBV during a crisis. VAWC. The course was designed to enhance It must be noted that there are no changes the core competencies of social workers in the number of established LCAT-VAWCs based on good practices and standards from last year as data for 2020 is not yet to address Gender-Based Violence in available. DILG – National Barangays Emergencies (GBViE). It employed various Operations Office (NBOO) deferred all methodologies such as simulations, small monitoring activities on LCAT-VAWC due group discussions and case studies while to the pandemic as indicated in the DILG utilizing interactive methods such as the Memorandum Circular No. 2020-085 use of jamboard, mentimeter, and the “Adoption of Administrative Order 30 on chatbox, among others. the Interruption of Periods for Filing and Submission of Documents, Cancellation An average of sixty (60) participants, of Proceedings, Suspension of Deadlines namely regional focal persons on Women for Payment of Taxes, Fees, and Other Welfare Program of Community-based, Charges, and on the Movement of head/social workers of residential care Timelines for the Grant and Release of and facilities in 16 DSWD Field Offices, Benefits. and representatives from the Office and Bureaus of DSWD Central Office, attended C. Governance and Systems the training.

Functionality of VAW Mechanisms. Community-based Peer Monitoring. The CHR and DILG issued Joint Memorandum Commission on Human Rights (CHR), Circular No. 2020-01 which tasked LGUs to in partnership with UNFPA, conducted a ensure that prompt, effective, and survivor- community-based peer monitoring activity to centered response to GBV will be included leverage the role of community-based and as a key component in their COVID-19 people’s organizations in gathering data, response. The JMC also directs LGUs and uncovering issues, and providing evidence- barangays to provide necessary support based recommendations to address urgent such as temporary shelters, transportation, human rights issues especially during the legal assistance, and psychosocial services pandemic. The community monitoring to VAW victims. It also encourages service project focused on the situation of women providers to update and disseminate GBV and girls with disabilities in the National referral pathways, identifying clinics and/or Capital Region, Cagayan De Oro City, and hospitals able to provide medical response Cebu Province. to GBV cases without the risk of exposure. DILG deferred all monitoring activities The monitoring activity also revealed in 2020, including the reporting on the that women with disabilities are aware of functionality of VAW Desks, which will where to seek assistance and determined resume in 2021. the services providers where they could report cases of violence (ex. police/VAWC Capacity Building. As part of the help desk, barangay/purok leader, DSWD/ response and recovery plan for COVID-19, CSWD, DILG, city health office/hospital, DSWD in partnership with the United frontliners, etc.). During the monitoring, Nations Population Fund (UNFPA) participants also shared accounts of rape conducted an online webinar series on and other forms of GBV done against

99 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 women with disabilities. It provided a safe 1. Strengthening the Provisions of R.A. space among the participants to be able to No. 8353: Amending the Anti-Rape share incidents of GBV done against their Law – The House of Representatives peers. With this, CHR was also able to has approved the proposed bill which gather and document issues and cases of has been transmitted to the Senate. GBV done against women with disabilities. 2. Ensuring Women’s Equal Results of the monitoring activity captured Rights in Marriage and Family the following challenges encountered Relations – Pending at the House of by women and girls with disabilities: 1) Representatives Committee on Rules inadequate distribution and delivery of for discussion in the plenary. relief goods; 2) apparent neglect of the health needs particularly of senior citizens Another GBV-related bill, although not part and persons with disabilities; 3) lack of of the WPLA, but is also in the advance access to information on COVID-relevant stage is the “Girls Not Bride Act”. The bill matters (i.e., health precautions and social which was passed in the Senate prohibits assistance for barangays and households child marriage. It defines child marriage affected by the pandemic); 4) discrimination as “any marriage entered into where one and non-prioritization of persons with or both parties are children (persons below disabilities, among other vulnerable sectors; 18 years old), and solemnized in civil or 5) transport and mobility issues; and 6) church proceedings, or in any recognized effects on psychosocial and mental health. traditional, cultural or customary manner.

D. Policy Issuances Localization of Safe Spaces Act. In commemoration of the 18-Day Campaign Wome’s Priority Legislative Agenda to End VAW, the PCW together with DILG (WPLA). Due to the pandemic and issued on December 7, 2020 the Joint the varying priorities of the House of Memorandum Circular No. 2020-001: Representatives and Senate, most of the Guidelines on the Localization of the Safe GBV-related Women’s Priority Legislative Spaces Act. The guidelines provide for Agenda (WPLA) are still at the committee the localization of the law’s provisions by level. The WPLA include: Amending/ provincial, city, municipal and barangay Repealing the Revised Penal Code LGUs. It also includes templates for provisions on Adultery and Concubinage; the development of ordinances and Recognizing Sexual Abuse and Focusing implementation standards for reference of on the Violence and Abusive Conduct as LGU actors. Grounds for Legal Separation; Enacting the Anti-Prostitution Law; Upholding the IACVAWC issued two (2) resolutions as Right to Life and Security of Spouses follows: and Daughters by Repealing Article 247 1. Resolution No. 6-2018: Resolution of the Revised Penal Code; Enacting a Urging the Supreme Court to Assign Law Prohibiting Discrimination Based on All Gender-Based Violence Cases to Sexual Orientation, Gender Identity and Family Courts - The IACVAWC, has Expression; and Adopting Divorce in the issued a resolution, appealing to the Family Code. Supreme Court to designate Family Courts and Regional Trial Courts to Two of the legislative agendas that act as Family Courts and hear gender- are related to GBV are already in the based violence cases falling within advanced stage in either the House of the jurisdiction of the Regional Trial Representatives or Senate. These are the Court. This is to ensure that GBV cases following: are heard and tried by judges who are gender-sensitive, and for judicial

100 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 decisions to be anchored on gender Children (BCPC). This is to ensure that the equality. services of barangay VAW desks are readily available and are responsive to the needs 2. Resolution No. 1-2019: Enjoining of victims especially during the quarantine All Government Agencies and Local period where mobility is restricted. Government Units to Support the Program on Male Involvement in PCW issued Memorandum Circular No. Eliminating Violence Against Women 2020-03 which allows national government and their Children and in Achieving agencies, state colleges and universities Gender Equality and the Empowerment and government-owned or controlled of All Women and Girls - The resolution corporations to adjust their Fiscal Year categorically calls for support to 2020 GAD Plan and Budget to implement established Men Opposed to Violence GAD programs, activities and projects Everywhere or MOVE chapters and the that address gender issues and concerns creation of the same or similar male related to the COVID-19 situation. organizations espousing the same values and principles of MOVE in The policy encourages identification national government agencies, LGUs, and implementation of measures to and other government instrumentalities. prevent discrimination against women It also provides for support to MOVE and gender-based violence. Likewise, it activities and charge them to the directs agencies with mandates related Gender and Development (GAD) to addressing gender-based violence, to budget of the agency. ensure victim-survivors’ access to legal and various support services by adapting COVID-related Policy Issuances. PCW existing mechanisms to the crisis context and IACVAWC initiated the preparation of (e.g., dedicated hotlines for reporting a Call to Action for Women’s Protection gender-based violence cases, online Against Violence which was later issued by counseling, and repurposing spaces to DSWD Secretary Rolando Bautista as the expand shelters for gender-based violence IACVAWC Chairperson. survivors).

The statement enjoins all service providers to ensure continuous delivery of VAW/GBV services especially in times of crisis such as the COVID-19 pandemic, and ensure the adoption of proactive interventions that can assist victims to directly report abuse without leaving their homes in light of quarantine restrictions. The Call to Action also directed service providers to make their respective frontline services/ resources accessible online or through other alternative means to augment gaps caused by workforce limitations. Official communication lines should remain open during standard work hours and even longer for those facilitating 24/7 services.

DILG issued an Advisory addressed to all Regional Directors and BARMM regarding the activation of Barangay VAW Desks and Barangay Council for the Protection of

101 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012 Recommendations

Review the applicability of The RBMEF will be used as a Pursue amendments of RA the Results-Based Monitoring reference guide for the assessment 9262 and formulation of the and Evaluation Framework of RA 9262 which will be conducted next IACVAWC Strategic Plan (RBMEF), for possible in 2021. covering 2023-2028. recalibration of targets and strategies, set baselines and The amendment of RA 9262 will targets for indicators, and address the the grey areas and provide impetus to strengthen gaps of the law that have been and focus implementation identified in proposed bills amending according to the targeted RA 9262 filed in Congress. results. It will also allow for policy innovations that will strengthen interventions for the protection of women and children against violence.

Strengthen support to IACVAWC Resolution No.1-2019 Pursue activities that will programs on male involvement was issued and implemented in encourage male participation in in addressing VAW, including 2020 to strengthen the support to GAD-related activities through the establishment of male MOVE chapters and similar male the review of the GAD Plan and advocates groups such organizations. Budget of agencies for FY 2021 as Men Opposed to VAW using the IACVAWC Resolution Everywhere (MOVE) in No. 1-2019 as reference government agencies and local government units.

Develop a training module for DILG developed a module for the Develop and conduct the actual the capacity development of capacity building of Barangay trainer’s training for LCAT- Barangay VAW Desk Officers VAW Desk Officers and barangay VAWCs will be conducted and Barangay Chairperson. officials. A virtual writeshop in 2021 whereas the actual was conducted in 2020 on the training of barangays was Development of Training Module moved to 2022 due to the for LCAT-VAWC in Addressing pandemic. Trafficking in Persons and Gender- Based Violence.

Have a unified registry of The Standard VAW Intake Forms Develop the reporting flow cases towards a common were field-tested in Valenzuela City data sharing protocols and platform for reporting and and Region IV-B in 2020. agreement, and client code and recording of cases incident number The next step is to revise the forms based on the feedback and recommendations gathered from the field-testing.

Develop the strategic and National Strategic and Costed Disseminate and secure costed implementation plan Implementation Plan for the WCPP funding for the full (CIP) for Women and Children 2021-2025 developed implementation of the WCPP Protection Program (WCPP). CIP.

102 2020 Annual102 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 2019 Recommendations 2020 Action 2021 Recommendations

Review existing protocols/ Initial review of existing protocol ang Finalize the review of existing guidelines and standardize guidelines protocols/guidelines and services across the country; standardize services across the inventory of all available country during the assessment services (including functional of the implementation of RA VAW desks) and dissemination 9262 in 2021. of list that will serve as reference for referrals.

Provide adequate IACVAWC issued two (2) resolutions Continue monitoring of the two management, financial, to ensure the adequate support for resolutions and technical support for the implementation of IACVAWC full operationalization of the Strategic Plan 2017-2022: IACVAWC Strategic Plan 2017-2022 1. Resolution No. 2-2018: Funding Commitment for the Implementation of and Monitoring of RA 9262

2. Resolution No. 5-2018: Resolution Requesting the DBM on the Institutionalization of the IACVAWC Secretariat

Measure the effectiveness of As part of the RBMEF, a Survey Tool Enhance the survey tool demand generation activities on Knowledge and Understanding and resume the survey on in terms of improving the of VAW was developed. However, knowledge and understanding “help-seeking” behavior of the distribution of the survey tool of VAW among selected survivors and decreasing the to member agencies, LGUs, and barangays and schools. This acceptability of VAWC RCAT-VAWCs was cancelled due to will be part of the assessment the COVID-19 pandemic. of RA 9262.

103 2020 Annual103 Report2020 Annual Responsible Report Responsible Parenthood Parenthood and Reproductive and Reproductive Health Health Act Act of of 2012 2012 104 2020 Annual Report Responsible Parenthood and Reproductive Health Act of 2012

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THE SIGNIFICANCE OF THE IMPLEMENTATION OF THE RESPONSIBLE PARENTHOOD AND REPRODUCTIVE HEALTH ACT OF 2012 TO ALLEVIATE HIGH MATERNAL MORTALITY RATE IN PASIG CITY

This paper presents the possible significance of the RH Law during its early implementation in 2014.

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The Responsible Parenthood and Reproductive Health Act Essay

The Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No. 10354), informally known as the Reproductive Health Law or RH Bill, is a law in the Philippines, which guarantees universal access to methods on contraception, fertility control, sexual education, and maternal care.

While there is general agreement about its provisions on maternal and child health, there is great debate on its mandate that the Philippine government and the private sector will fund and undertake widespread distribution of family planning devices such as condoms, birth control pills, andIUDs, as the government continues to disseminate information on their use through all health care centers. The Responsible Parenthood and Reproductive Health Act Essay. Passage of the legislation was controversial highly divisive, with experts, academics, religious institutions, and major political figures declaring their support or opposition while it was pending in the legislature.

Heated debates and rallies both supporting and opposing the RH Bill took place nationwide. The Supreme Court delayed implementation of the law in March 2013 in response to challenges. The court’s status quo ante order expires on July 17, 2013, unless the high court decides to extend it. Summary of major provisions The bill mandates the government to “promote, without bias, all effective natural and modern methods of family planning that are medically safe and legal”.

Although abortion is recognized as illegal and punishable by law, the bill states that “the government shall ensure that all women needing care for post-abortion complications shall be treated and counseled in a humane, non-judgmental and compassionate manner”. The bill calls for a “multi-dimensional approach” integrates a component of family planning and responsible parenthood into all government anti-poverty programs. [7] Age-appropriate reproductive health and sexuality education is required from grade five to fourth year high school using “life-skills and other approaches”.

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The bill also mandates the Department of Labor and Employment to guarantee the reproductive health rights of its female employees. Companies with fewer than 200 workers are required to enter into partnership with health care providers in their area for the delivery of reproductive health services. ]The Responsible Parenthood and Reproductive Health Act Essay.  Employers with more than 200 employees shall provide reproductive health services to all employees in their own respective health facilities. Those with less than 200 workers shall enter into partnerships with health professionals for the delivery of reproductive health services.

Employers shall inform employees of the availability of family planning. They are also obliged to monitor pregnant working employees among their workforce and ensure they are provided paid half-day prenatal medical leaves for each month of the pregnancy period that they are employed. The national government and local governments will ensure the availability of reproductive health care services like family planning and prenatal care. Any person or public official who prohibits or restricts the delivery of legal and medically safe reproductive health care services will be meted penalty by imprisonment or a fine.

Public opinion is the aggregate of individual dispositions and beliefs with regards to important issues. Public opinion holds great importance in democracies because a democracy, by its very definition, connotes a form of government that is responsive to the people. Democracy is most often defined as a set of procedures and institutions intended to make the holders of political power directly responsible to the electorates. The quality of democratic government is measured by the responsiveness of public policymakers to the preferences of the mass public. For that reason, public opinion will always play an important role in policy-making process in the Philippines, a democratic country. Views and opinions of the general public should be taken into consideration in formulating, passing and implementing a policy.The Responsible Parenthood and Reproductive Health Act Essay. Hence, stakeholders and interests groups’ roles are very vital in affecting policy outcomes since stakeholders and interest groups are the means through which public opinion is brought in the Halls of the Congress. In view of this, the government is faced with the need to balance the conflicting views of different stakeholders, interest and pressure groups in the decision-making process. This is clearly exemplified in the controversial Reproductive Health bill.

This paper studies the different stakeholders involved in the Reproductive Health Bill and the degree in which they affect policy outcome based on the resources and resource mobilization capacities they have. The first part of this paper includes definition and the presentation of health and population situation in the Philippines. The second part focuses with the provisions, debates and proponent of RH bill. The third part provides an analysis of the different stakeholders and resources and resource mobilization capacity that they have. Lastly, the examination of how these stakeholders and interest groups can actually affect policy outcome and the degree on which they affect it.

The controversy of RH bill led to many implications. Reproductive health is now a byword that enthralled the public attention. Therefore, there is a need to define the term based on a standard definition. “Reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so” (World Health Organization). The Responsible Parenthood and Reproductive Health Act Essay.

Although this appears to be the only definition of the term in any international document, the definition implicitly implies that reproductive health includes the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant (International Conference on Population and Development, 1994).

Of the eight Millennium Development Goals, achieving universal access to reproductive health by 2015 is one of the two targets of Goal 5, Improving Maternal Health. Due to this, a comprehensive study of the reproductive health in the Philippines is greatly needed and in turn, to develop and actually implement a policy that will give Filipinos equal chances to the right to reproductive health and develop programs that will seek to address problems related to reproductive health in the country.

Over the past 30 years, developing countries’ population have rise up almost twice the rate of those in the developed and advanced countries. As an effect, a number of people have caught up with high infant mortality, low life expectancy, disease, malnutrition and illiteracy. Rapid population growth causes difficulties in managing economic and social changes, including the balancing of the fruits of economic development efforts (Leverage International, 2011).

Governments of the Third World countries and as well as of those developed nations recognized that the measurement of economic development is not based only on economic indicators such as income distribution but also by the quality of life of its people (Leverage International, 2011).

Philippines, as a developing country, experiences rapid population growth. According to the 2007 Census by the National Statistics Office (NSO), the Philippine population was 88.57 million and the estimated population as of 2010 is 94.3 million and this made the country as the 12th most populous country in the world. This high population results to high infant mortality rate which is 19.94% in 2010. The Responsible Parenthood and Reproductive Health Act Essay. In addition to this, the lifetime risk of maternal death in the Philippines is 1 in every 140, according to United Nations International Children Emergency Fund’s State of the World’s Children 2009 report. Each day, about 11 Filipino mothers – or 4,500 each year – die because of hypertensive disorders, severe hemorrhage or other labor- or abortion-related problems. The country is also part of a group of 68 countries where 97% of worldwide maternal, neonatal and child health deaths occur.

Moreover, the county is witnessing the fastest spread of the human immunodeficiency virus (HIV) in its history. Five new HIV cases are recorded everyday according to the National Epidemiology Center of the Department of Health.

High infant mortality rate, high maternal mortality rate and a number of HIV cases are not the only problems that the Philippines is experiencing in relation to reproductive health. Because of the lack of a concrete reproductive health and family planning policy and program in the country, unwanted pregnancy incidences become high. Due to this, Filipino women are forced to undergo induced abortion as one of the methods that they use to meet their reproductive goals. Although abortion is illegal in the Philippines, and despite the potential harmful consequences of an unsafe abortion for women’s health and life, many women resort to abortion to meet their family-size goals or to space births (The Guttmacher Institute, 2003).

The Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends (2005), a study conducted by Fatima Juarez, Josefina Cabigon, Susheela Singh, and Rubina Hussain for the Guttmacher Institute revealed the following: The Responsible Parenthood and Reproductive Health Act Essay.

Six in 10 Filipino women say they have experienced an unintended pregnancy at some point in their lives. About 1.43 million pregnancies each year–nearly half of all pregnancies in the Philippines–are unintended.

Some 54% of women who have ended an unintended pregnancy by abortion were not using any family planning method when they conceived. Of those who were practicing contraception, three-fourths were using a traditional method.

The average Filipino woman wants 2.5 children. In order to achieve that goal, she must spend more than 19 years using effective contraceptive methods. However, nearly half of all married women of reproductive age have an unmet need for effective contraception–that is, they are sexually active, are able to have children, do not want a child soon or ever, but are not using any form of contraception or are using traditional methods, which have high failure rates.

Aside from induced abortion that can lead to deaths, other problem due to the lack of reproductive health policy is the risk of acquiring cervical cancer. The Human Papillomavirus (HPV) is a sexually-transmitted, wart-forming virus that has been implicated in causing cancer of the cervix. This is the most common cancer in women secondary to breast cancer (Department of Health, 2008).

Due to these findings and other statistics such as high infant and mortality rates, these imply that there is an immense need for a policy to ensure the right to reproductive health in the Philippines. The Responsible Parenthood and Reproductive Health Act Essay. Although reproductive health has long been considered a basic universal human right, this right remains elusive and illusory for millions of Filipinos, especially the poor.

The first comprehensive version of reproductive health bill, House Bill 8110 or “The Integrated Population and Development Act of 1999” was filed in the 11th Congress. Twelve years after, the country still does not have a reproductive health policy and the issue of the current reproductive health bills remains a heated and controversial issue as the first RH bill.

Today, the struggle of RH advocates still continues for the passage of a comprehensive reproductive health bill.

House Bill 4244 or “The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011” is the most recent version of a reproductive health bill that was filed in the 15th Congress. H.B. 4244 is popularly known as the consolidated RH bill in substitution to the other reproductive health bills that are pending in the Congress. The other reproductive health bills are as follows:

House Bill 96 (Rep. Edcel Lagman)

“An Act Providing for a National Policy on Reproductive Health, Responsible Parenthood and Population Development and for Other Purposes”

House Bill 101 (Rep. Janette Garin)

“An Act Providing for a National Policy on Reproductive Health and Population Development and for Other Purposes”

House Bill 513 (Reps. Kaka Bag-ao and Warden Bello of Akbayan Partylist)

“An Act Providing for a National Policy on Reproductive Health and Population and Development and for Other Purposes”

House Bill 1160 (Rep. Rodolfo Biazon) The Responsible Parenthood and Reproductive Health Act Essay.

“An Act Providing for a National Policy on Reproductive Health and for Other Purposes”

House Bill 1520 (Rep. Judy Syjuco)

“An Act to Protect the Right of the People to Information on Reproductive Health Care”

House Bill 3368 (Rep. Luzviminda Ilagan and Emmi de Jesus of Gabriela Women’s Party)

“An Act Providing for a National Policy on Reproductive Health for Women and Development and for Other Purposes”

H.B 4244’s objectives are as follows:

To uphold and promote respect for life, informed choice, birth spacing and responsible parenthood in conformity with internationally recognized human rights standards.

To guarantee universal access to medically-safe, legal and quality reproductive health care services and relevant information even as it prioritizes the needs of women and children.

To realize these goals, the consolidated RH Bill has the following key provisions:

Mandates the Department of Health (DOH) and Local Health Units in cities and municipalities shall serve as the lead agencies for the implementation of this act.

Mandates the Population Commission, to be an attached agency of the Department of Health, shall serve as a coordinating body in the implementation of this Act. The Responsible Parenthood and Reproductive Health Act Essay.

Provides for the creation of an enabling environment for women and couples to make an informed choice regarding the family planning method that is best suited to their needs and personal convictions.

The LGUs and the DOH shall ensure that a Minimum Initial Service Package (MISP) for reproductive health, including maternal and neonatal health care kits and services will be given proper attention in crisis situations such as disasters and humanitarian crises.

Provides for a maternal death review in LGUs, national and local government hospitals and other public health units to decrease the incidence of maternal deaths.

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

Ensures the availability of hospital-based family planning methods such as tubal ligation, vasectomy and intrauterine device insertion in all national and local government hospitals, except in specialty hospitals.

Provides for a Mobile Health Care Service in every Congressional District to deliver health care goods and services.

Provides Mandatory Age-appropriate Reproductive Health Education starting from Grade 5 to Fourth Year High School to develop the youth into responsible adults.

The Department of Labor and Employment (DOLE) shall ensure that employees respect the reproductive health rights of workers.

Mandates private and nongovernment reproductive health care service providers to provide at least forty-eight (48) hours annually of reproductive health services free of charge to indigent and low income patients, especially to pregnant adolescents.

Mandates cities and municipalities to provide sexual and reproductive health programs for persons with disabilities (PWDs).

Mandates the inclusion of the topics on responsible parenthood, family planning, breastfeeding and infant nutrition as essential part of the information given by local Family Planning office to all applicants for marriage license.

Mandates no less than 10% increase in the honoraria of community-based volunteer workers, such as the barangay health workers, upon successful completion of training on the delivery of reproductive health care services. The Responsible Parenthood and Reproductive Health Act Essay.

Creation of Congressional Oversight Committee (COC) which shall be composed of five (5) members each from the Senate and from the House of Representatives which shall monitor and ensure the effective implementation of this Act, determine the inherent weakness and loopholes in the law, recommend the necessary remedial legislation or administrative measures and perform such other duties and functions as may be necessary to attain the objectives of this Act.

Penalizes the violator of this Act from one month to six months imprisonment or a fine ranging from ten thousand to fifty thousand pesos or both such fine and imprisonment at the discretion of the Court.

H.B 4244 covers all other six pending RH bills in the Congress but despite the clear purpose of the bill, the enactment of RH bill is long overdue.

On the other hand, RH bill advocates see the passage of the consolidated RH bill in the 15th Congress since it was already approved by the House Committee on Population and Family Relations last February 1 and it was also approved by the Committee on Appropriations with a vote of 20-3. Last March 8 which is incidentally the International Women’s Day, RH bill reached the plenary. The Responsible Parenthood and Reproductive Health Act Essay.Biliran Representative Rogelio Espina, chairman of the Committee on Population and Family Relations, delivered his sponsorship speech on Committee Report 664. Three of the six sponsors of the bill also delivered speeches urging for its passage – Minority Leader and Albay Representative Edcel Lagman, Gabriela partylist Representative Luz Ilagan and Akbayan partylist Representative Arlene “Kaka” Bag-ao.

Meanwhile, President Benigno Aquino III ordered Health Secreaty Enrique Ona to draft the Responsible Parenthood Bill that would perhaps serve as a “middle ground” between RH advocates and the Church. Moreover, the President did also not include RH bill as part of his list of policy priorities after the Church issued a pastoral letter entitled Choosing Life, Rejecting RH Bill. Though Rep. Lagman believes that the Malacañang-sponsored version of the RH bill would not be able take the place of a more comprehensive RH bill since it is limited to the issue of family planning and responsible parenthood. Moreover, Health Secretary Ona is a known advocate of reproductive health and family planning. His public pronouncements have confirmed that he, like his predecessor Sec. Espie Cabral, is unwavering in his belief that RH is a basic human right. Because of this, Cong. Lagman believes that the crafting of the Responsible Parenthood bill would and should not delay the passage of the consolidated RH bill.

Cong. Edcel Lagman of the First District of Albay is the principal author of the consolidated RH bill. According to him, the incidences of infant and maternal mortality in his own district are within the range of the national average. As a solution, they have set up lying-in clinics and birthing centers in the upland and island barangays of the first district of Albay so as to ensure that mothers in far flung barangays can be given emergency and basic obstetric care. However, the problem of maternal and infant mortality and morbidity goes beyond the First District of Albay. The preventable deaths of mothers and children happen on a national scale so the need to formulate a national policy on reproductive health is imperative. The Responsible Parenthood and Reproductive Health Act Essay.

Although he is a Catholic he believes that like many other Catholics in the country, they can be good Catholics and still support a measure like RH bill that puts a premium on quality of life and the protection and fulfilment of the basic human rights to reproductive health and sustainable human development. He also noted that the word “catholic” when used as an adjective means all-embracing, forward-looking and liberal. The antonym of catholic is conservative, narrow-minded and intolerant. That is why it is very ironic that the Catholic Church particularly the Catholic Bishops’ Conference of the Philippines (CBCP) strongly opposes RH bill.

Rep. Lagman is also the newly-elect chair of one of the ruling party in the country, the Lakas Kampi Catholic Muslim Democrats (CMD). However, because of the nature of the party system in the Philippines, this position in his party would not guarantee the passage of RH bill. According to him, his colleagues are free to support or oppose an issue as they see fit. Members of his party are not required to vote for or support RH bill. It is interesting to note that the former President and the incumbent representative of the second district of Pampanga, Rep. Gloria Arroyo, who is a member of the Lakas Kampi CMD is known to be a critic of RH bill.

In line with this, the conflicting views on RH bill do not only occur inside Congress. Central to the issue of RH bill is the political dynamics of the numerous actors involved in affecting the passage of the said bill. The different stakeholders and interest groups play important roles in the deliberation of the policy. This put the challenge to the legislators to balance and to be able to reconcile the conflicting views of these stakeholders and interest groups.

But how did citizens start to participate in the decision-making process?

Due to influx of information, there came a higher level of consciousness among citizens. People’s desire to participate in decision-making process amplified. People demand more of representation and participation in the government. In less complex times, elected representation was a sufficient means for most citizens to participate in government.  The Responsible Parenthood and Reproductive Health Act Essay.Recently, for a number of reasons, including the diversity of citizens’ cultural heritage, needs, values, and interests, that has been changing and of course, the changes brought about by modernization, there is now a strong desire for citizens to be involved broadly in governance and directly in policy decisions.

Governments, especially in developing countries, are very vulnerable and they are being assessed based on their economic and political performance. And one of the bases of a government’s political performance is its capacity to provide venues for people’s participation and involvement. Hence, views and opinions of the general public should be taken into consideration in formulating, passing and implementing a policy. For this reason, one of the biggest challenges which government faces is the need to balance the conflicting views of different interest groups in a particular policy. This problem is very much observed in the issue of coming up with a reproductive health policy in the Philippines.

Conflicting views and opinions from numerous actors and stakeholders in the reproductive health bill have always marred the passage of the said bill. Certain sectors and segments of the population will definitely be affected upon the implementation of the said policy and they also have different views regarding the passage of RH bill. However, the stakeholders who have the resources to influence or actually determine the success or failure of the reproductive health bill are the Roman Catholic Church, the women sector and pharmaceutical companies in the country. The table below shows an analysis of the four primary stakeholders in the RH bill.

From the stakeholders listed above, the Catholic Church and organized women groups are the primary actors in the debate in adopting a reproductive health policy in the country because they are the most visible in terms of their campaign for or against the said policy.

The Catholic Church is the main critic of the reproductive health bill because it argues that the policy is anti-life because it promotes the use of modern contraception measures. Also, it argues that RH bill does not really address poverty. The Responsible Parenthood and Reproductive Health Act Essay.

In the researcher’s interview with Archbishop Oscar V. Cruz and Carmelo Cruz, Catholic Bishops’ Conference of the Philippines’ (CBCP) News Editor, they said that the Catholic Church’s judgment in the political performance of former President Ferdinand Marcos that significantly contribute for making EDSA People Power I happened in 1986 is the same as their opposition to the six pending reproductive health bills in the Congress. Their opposition to the immoral regime of Pres. Marcos is the same as their opposition to an immoral policy, the reproductive health bill. (This was also written in CBCP’s Pastoral Letter entitled Choosing Life, Rejecting RH bill issued last January 30, 2011.)

Moreover, they believe that it is not the poor Filipino people who will benefit from the implementation of the reproductive health bill but the foreign owners of transnational pharmaceutical companies who will supply modern contraceptives. They also believe that if a reproductive health bill will be enacted into law, it will paved the way for the introduction and passage of other policies such as policies on divorce, mercy killing and same sex marriage. The Catholic Church believes that the passage of a reproductive health bill will deteriorate the authentic human values and as well as the Filipino cultural values in accordance to the teachings of the Church.

Archbishop Oscar V. Cruz said that although reproductive health bill can lessen infant and maternal mortality, he argued that the reason behind infant and maternal mortality and morbidity is poverty and inaccessible to basic health care services. The Responsible Parenthood and Reproductive Health Act Essay. According to him, health care services are inaccessible to poor families because of bad governance and corruption, services are not delivered to poor communities because public official corrupt the money that is intended for communities’ welfare. For these reasons, the solution to infant and maternal mortality in the country is not the reproductive health bill, the solution needs to focus to the root causes of the problem which is bad governance and poverty.

However, the Catholic hierarchy said that is not against the elimination of violence against women, the treatment of breast cancer, maternal and child health and nutrition and other elements of RH. It is only against making modern family planning methods available to women and couples and the teaching of sexuality and RH education to the youth. The Church believes that RH bill would violate the teachings of the Church specifically the 1968 encyclical Humanae Vitae which is the basis of the Church teaching that contraceptives are “intrinsically evil”.

The Church has been firm in its stand against RH bill. The Church is having dialogues to the current administration to turn down RH bills that are pending in Congress. Moreover, the Church through its archdioceses and dioceses consults representatives from each district for them to be convinced not to vote for RH bill. Also, the CBCP issues statements to inform the public why RH bill should not be enacted into law. And what is more important is the impact of the Catholic Church in shaping or influencing public opinion since majority of Filipinos are Catholics. Some officials are threatened that their stand regarding the issue on RH bill might affect their political careers.

Because of the strong opposition of the Catholic Church to adopt a reproductive health policy in the country and the resources it has to affect the decisions of public officials, the passage of the bill becomes impossible despite the need for a reproductive health policy in the country. The Responsible Parenthood and Reproductive Health Act Essay. Last January 30, CBCP issued a pastoral letter against RH bill. As an effect, the President did not include RH bill from among the Legislative Executive Development Advisory Council’s policy measures that probably would unduly delay again the passage of RH bill.

If the Catholic Church strongly oppose RH bill, organized women’s groups tell the other side of the story. Women’s organizations such as Gabriela Women’s Party and Likhaan Center for Women’s Health Inc. stalwartly campaign for the passage of RH bill. These RH advocate groups believe that the rights of people to reproductive health “do not depend on a few powerful men deciding the fate of women” (Likhaan, 2011). In the explanatory note of House Bill 3368 introduced by Gabriela Women’s Party, it states that “Filipino women do not have to die at childbirth just because they are poor, they do not have to suffer from undiagnosed cervical, breast, vulvar, ovarian or similar cancers of the reproductive system just because they do not have access to adequately staffed and equipped public health facilities… Women do not have to suffer from untreated uterine fibroid or such similar conditions just because diagnostic procedures are costly, women should not die at childbirth because their infants need them for optimum care, love and affection if children are to grow up to realize their full potential as productive and responsible members of our society.”

Due to these reasons, access to reproductive health programs, resources and services for marginalized women needs to be guaranteed by the government. A national reproductive health policy is seen to offer health care services that will basically benefit women, especially the marginalized. Advancing reproductive health rights in a comprehensive, available, accessible, acceptable, and democratic manner is a long overdue mandate of the Philippine government to its female population given the social and economic realities in the country. Hence, the approval of legislators to pass RH bill is indispensable (Likhaan, 2011). The Responsible Parenthood and Reproductive Health Act Essay.

According to Junice Demeterio-Melgar, the executive director of Likhaan and Secretary-General of Reproductive Health Advocacy Network (RHAN), family planning will save the lives of mothers because family planning changes the composition of child-bearing. This means that pregnancies in women who are considered at a higher risk of dying from pregnancy and childbirth-related causes will be dramatically reduced. These are women who are too young, too old, have had too many children or have had unremitting pregnancies. Medical experts have stated that pregnancy in women below 18 or above 35 is considered high risk. They have also emphasized that women’s bodies need anywhere from two to three years to fully recover from the rigors of pregnancy and childbirth.

Moreover, the World Health Organization concludes that if women have information and access to contraceptives and are taught to use them properly, “the fall in maternal mortality is likely to be even greater than the fall in the pregnancy rate.”

With their struggle for the passage of RH bill, women’s groups tied up with other RH advocates to pressure legislators to pass RH bill. Reproductive Health Advocacy Network (RHAN), which has forty-three (43) national organizations with no less than 10,000 members in grassroots communities nationwide, continues to have dialogues with the President and with their recent dialogue, RHAN reminded the President about his Social Contract, which included a commitment to responsible parenthood based on informed choice and support to poor families.

RHAN, specifically Likhaan, is disappointed with the President’s decision to resort to a Responsible Parenthood Bill instead of a more comprehensive RH bill. According to them, further dialogues of the President to CBCP will trap his administration into delay and inaction, or push it to drop the freedom of choice principle in the President’s promise of responsible parenthood since the Church will always disagree to any RH bill because its opposition to RH is based on the core principle of human life, it is clear that immovable religious beliefs are the bedrock of the bishops’ opposition to RH as pointed out by the recent CBCP’s pastoral letter. Further dialogues or consultations will never change the stance of the Catholic Church.

Aside from dialogues, advocates continue to hold fora and debates on the issues of RH and human development from schools and universities to service clubs and community-based organizations. In addition, they hold mobilizations and rallies in front of Congress to pressure legislators to enact the said bill.

Both stakeholders prove to be significant and effective in their campaign for or against RH bill. The Responsible Parenthood and Reproductive Health Act Essay. However, the Church as an established and one of the most powerful institutions in the country which affect public opinion has an advantage in affecting the outcome of the said policy. However, RH advocates do not only have the superiority of numbers but they also have the superiority of arguments.

Although the Church has the capacity to influence or even shape public opinion, perhaps the case on the debate on RH bill is isolated. Recent survey results show that majority of Filipino and Filipino Catholics support RH bill. Although the RH critics say that people are only misinformed about the content of the measure, advocates say that the capacity of Filipinos to understand an issue like RH, responsible parenthood and population and development should not be underestimated. People support the RH bill because they realize how important it is to become a responsible parent. Filipinos also believe that is not only important for them to be able to plan and space their children, it is equally important that the State provide information on and access to all forms of family planning methods.The Responsible Parenthood and Reproductive Health Act Essay.

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