Portions of this interview were translated from Tagalog to English.
Defining ‘Reproductive Health’
In 1994, through the Programme of Action adopted by the International Conference on Population and Development (ICPD), the United Nations defined reproductive health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity in all matters relating to the reproductive system and to its functions and processes.”
In an interview with Spheres of Influence, Dr. Sylvia Claudio, M.D., Ph.D., the current Dean of the University of the Philippines-Diliman’s College of Social Work and Community Development (CSWCD), furthers the definition by making clear inferences. “If you follow the congruences,” she said, “that would mean that if health is defined not just as the absence of illness but the attainment of the highest standard possible of health, then you would also say that health is a human right. Therefore, reproductive health is a human right.”
Supplementing Dr. Claudio’s idea of reproductive health as a human right, the ICPD stated that reproductive rights “rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health.” Moreover, the ICPD’s definition of reproductive rights includes the autonomy “to make decisions concerning reproduction free of discrimination, coercion, and violence, as expressed in human rights documents.”
The Previous State of Philippine Reproductive Health
These concepts were certainly part of Dr. Claudio’s learning when she was a student at the University of the Philippines-Diliman, but her passion for women’s health was bolstered when she started her medical career after college, serving the poor barrios (neighbourhoods) of the Philippines during the mid-1980s and early 90s to attend to the needs of underprivileged women.
Through her service in community-based health programs, she recognized that even with the goodwill these programs provided, the health needs of women were still not being met. Dr. Claudio explained that women were refused contraceptives from certain community-based health programs (especially those sponsored by the Catholic Church of the Philippines), victims of gender-based violence were ignored, and the study of women’s health was rather foreign to the public at the time. Before the movement for women’s reproductive rights, it seemed as though medical professionals “were not paying attention to women’s issues,” Dr. Claudio said. Even if they were paying attention, they “weren’t doing it right.”
One aspect of reproductive health which was often neglected was the issue of contraception. “The government [of the late dictator Ferdinand Marcos] did not want to push condoms—which are really helpful to some women and men. Instead, they wanted to push permanent methods like sterilization (a type of contraception that permanently prevents pregnancy; female sterilization is called tubular ligation, while the male version is called a vasectomy) and birth control pills.” This was all part of the government’s program to control the Philippine population, which was reportedly at risk of growing at an unmanageable rate.
Since these often invasive methods of contraception are difficult to market, the Marcos regime, according to Dr. Claudio, spent “millions of pesos on sterilization propaganda,” touting it as “cost-effective” to those stricken by poverty. At the same time, the government hid facts that could have shined a negative light on these surgeries, like how the procedures are hard to reverse and can lead to infection in some cases. Having access to these facts is crucial if a person is to make an informed choice for themselves and their family.
Since many men were fearful of vasectomies, the majority of sterilizations in the Philippines were performed on women, who were more likely to be pressured and exposed to falsehoods about the procedure. “Many times,” Dr. Claudio recalls, “contraceptives were being rammed down their throats” without giving them the proper and accurate information, violating a woman’s liberty to make decisions about her body. “Even if it was the same technology that we wanted to give to women, we didn’t want that technology under that framework because it was violating the rights.”
Likhaan Center for Women’s Health
These kinds of deficiencies in the Philippine sexual and reproductive health sector led Dr. Claudio and her fellow advocates to establish the Likhaan Center for Women’s Health, a non-profit organization that aims “to respond to women’s expressed need for sexual and reproductive rights and health services.” They provide free-of-charge women’s health services like reproductive tract infection treatment, cryotherapy for cervical cancer prevention, and medical consultations, among other practices. Despite the disruptions caused by the pandemic, they are still keeping their mission strong by offering free teleconsultations, informing women about their sexual and reproductive wellness from a distance.
Currently the Board Chair of Likhaan, as well as its co-founder (alongside Dr. Junice Melgar, M.D.), Dr. Claudio knew from the very beginning that what they are providing was “what women wanted…I knew that every day through our work in giving services to women.”
When Health And Politics Clash
Such sentiments held by Dr. Claudio on women’s health weren’t compatible with the politics of the day, which derailed the progress made by organizations like Likhaan on women’s health in the Philippines. “We would bring reproductive health services to Manila, and then [former Mayor of Manila] Lito Atienza would suddenly ban them for the next ten years. All the things we worked on, all the things we helped on would just disappear. We would be able to go forward in working with the government on some aspects of reproductive health, but then it would be banned in a complete province.”
As Dr. Claudio notes, it seemed as though whenever advocates were “one step forward,” some individuals in the government would force them to take “three steps back” through their political maneuvers. “We sat back and said, ‘This can’t be allowed, no? We keep on working and helping. Every time we move forward, we get slapped down by political forces who—we did not believe—were really thinking about women when they did those things.”
With that in mind, a thought dawned on reproductive health advocates: the Philippines needed a law that would introduce formal government policy on reproductive health, finally giving Filipinos the medical access and educational resources a person requires to make the right reproductive health choices for them.
Reproductive Health Law: The Contents
The thought later evolved into the first version of a proposed reproductive health law, which would tackle parts of reproductive health that may have been forgotten, such as male reproductive health, mental health connections to reproductive health, and sexual violence against women and children.
The current iteration of this proposal, known as the Responsible Parenthood and Reproductive Health Act of 2012 (also known as the R.H. Law), includes 12 elements such as “prevention, treatment and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections (STIs),” “proscription of abortion and management of abortion complications ” and “education and counseling on sexuality and reproductive health.” It is important to note, however, that even after this bill was introduced, all forms of abortion have remained illegal in the Philippines.
The R.H. Law, in its final legislative form, contains provisions that spurred discord among the Catholic-majority public. Two of those controversial provisions are the mandate to create a sexuality education curriculum “which shall be used by public schools and may be adopted by private schools,” and the access to free or subsidized contraceptives that would be offered at government-run medical centres.
Surviving The Struggle
Likhaan “didn’t really want to get into the struggle,” Dr. Claudio said, laughing. “We were just pushed into it.” When asked about how she felt when she and her colleagues were “pushed” into politics to champion reproductive health, she replied by stating that “not all politics [are] bad, and part of the work of healthcare is to accept that sometimes, you have to get into the politics of it. Rather, every moment of delivering supposedly ‘neutral, non-partisan’ service—it’s always political.”
A part of being in politics is to spar with opposition, and Dr. Claudio knows this all too well, hearing her fair share of other people’s misunderstandings and prejudice against the reproductive rights movement, calling out “a small minority group of people” who were fostering an “acrimonious” conversation between the two sides of the issue. “One of the misconceptions that they were saying was, ‘if we passed [the RH Bill], there would be this great surge of immorality and assault on the family,’” Dr. Claudio said.
She’s referring to the Filipino Catholic Church, which viewed the 2012 R.H. Law as encouraging “promiscuity among the youth,” remembering how their “moralistic tone” was quite severe at the time. “So that was the big lesson. Even if we won the argument, people can still be dogmatic, hard-headed, divisive, and completely undemocratic. It was a disappointing thing to have society leaders take that tone to women who had won the debate, who had fought for it. We [in the movement] were really convinced that we were doing the right thing. It’s not immoral or motivated by the things they [said we were]…like we were for the death of…whatever…society.”
In due course, when the conversations move past the animosity, thought-provoking inquiries begin. “What’s interesting about the R.H. Law, aside from the content itself and our different understandings of sexuality were many, many other things. What is sexuality? What is secularism? What is religious freedom? What is the freedom to be different in terms of religious belief?” These questions, as Dr. Claudio described, led to Catholics taking “interesting spiritual journeys” to answer these questions, with some re-defining their Catholic lives, establishing new values that called for reproductive rights, or leaving the Church altogether.
It’s easy for those who witnessed the fierce debates of the R.H. Law or those who learned about the law after the fact to portray the story in 2012 as a divisive fight between activists like Dr. Claudio and the priests of the Catholic Church. It must be noted, however, that in the month the bill was enacted (December), a survey reported that 63% of the public supported the law, while only 15% opposed it. “I started on the other foot, to be honest. When we started 20-plus years ago, many people didn’t understand the concept [of reproductive health] and many people were against it or didn’t care. But by the time we were having that debate [in 2012], large majorities of people wanted the bill…They knew the bill. They knew the provisions of the bill. Even on the most controversial aspects of the bill, pluralities [supported the bill]. For most of the bill, there were overwhelming majorities…There was no longer a divide. We had won the argument.”
R.H. Bill Passes: The Big Win
A significant moment that proved that the movement had won the arguments was when both houses of the Philippine Congress (Senate and the House of Representatives) passed the R.H. Law in December 2012 after fourteen years in legislative limbo. It’s a time Dr. Claudio can look back on very fondly. “It’s one of the most memorable moments of my life,” she said. “We were sitting in the [House] gallery, and the vote was being taken [for the bill’s second reading].” She recalled how the number of votes would increase for both ‘yes’ and ‘no’, alternating between the two options. “There were also women massed outside…when the ‘no’ votes went up, our forces were all crying outside because it was like the final struggle. And then, when the ‘yes’ votes went up, we would feel calmer.”
“Finally, when the bill passed [the second reading], I remembered that I was beside my eldest son, and then we hugged. And then, I was also beside Senator Pia Cayetano (the senate sponsor of the R.H. Bill)…and then we hugged.”
Later in the month, Dr. Claudio and other proponents met up again in the front of the House of Representatives building to spectate the R.H. Bill’s third reading vote. At the time, the Senate already passed its version of the bill, so it was only a matter of time before it would also pass in the other Congressional chamber. When the bill passed the third reading, everyone outside was “just joyous. We embraced each other…I remember, at 3 a.m., we were looking for a place to eat and celebrate, that’s all. It was, you know, a joyous occasion for us when the bill passed after years of struggle.”
Credit should be deservingly given to the prominent voices of the movement like Dr. Claudio, but Dr. Claudio herself is more inclined to sing praise about the unsung heroes. Many women from the poor communities Likhaan visited and supported, for instance, became quite knowledgeable of the legislative process. “They said, ‘Oh, thank you, Doktora Guy. You were one of the first people to cultivate [the movement].’” “I was saying, ‘No. You have to understand that it was really a struggle that was only won because large amounts of people—towards the end—were really doing what they could for the bill.’”
“So many people contributed. It wasn’t the victory of an organization or one set of people. It really took a lot because we were up against the most powerful social institution of the Philippines called the Catholic Church. So we couldn’t have won if people didn’t support that bill eventually.”
Progress Made By The R.H. Law
Although the fight for reproductive health and women’s rights is still ongoing, Dr. Claudio is confident that the progress made is worth commemorating. In 2018, the Philippine Statistics Authority reported that Filipino women’s fertility rate was 2.7 children per woman, down from 3.0 in 2013. The Commission on Population (POPCOM) correlates this development to the 40% increased use in modern family planning methods. “We knew that it would go down if women could fulfill what they felt was the right number of children for their bodies, for their health, and for their families.”
“A lot of people are beginning to understand safer sex practices, and they’re also beginning to understand what that means and how to get the proper help and technology so that they can say ‘yes’ and be safe and not hurt anybody else. A lot of people are beginning to be empowered to say ‘no.’ There is significant progress on all those aspects.”
When I asked Dr. Claudio what she thinks was the greatest accomplishment, she would say that “the biggest gain is that [reproductive health and reproductive rights are] no longer controversial…because there was such a hard struggle and people understood [the struggle], it became uncontroversial that way. They knew what it was supposed to do. They saw how important it was to debate,” saying that the people’s knowledge of the law led to the bill’s passage.
The Struggle Continues
After former President Benigno Aquino III signed the bill into law on December 21, 2012, the opposition immediately challenged it through judicial means; the appeals filed to strike down the law suspended and delayed the implementation of the law for months. On April 8, 2014, the Supreme Court of the Philippines finally ruled that the R.H. law was constitutional. However, eight provisions within the law, which include the section that allows minors to access modern family planning methods without parental consent, were struck down. Also, in 2015, the Supreme Court issued a temporary restraining order on the distribution of certain contraceptive implants.
Years after the passage, organizations and advocates are still calling for the full implementation of the R.H. Law. “I also remembered, after the bill passed in the Congress and in the Supreme Court, there were moves made by others to defund the budget [of the R.H. Law] during budget negotiations, so we were on guard,” Dr. Claudio said. “And then until the end of the Aquino administration, some of us were in the DOH (Department of Health) to make sure it was implemented.”
Additionally, Dr. Claudio warned of the “pandemic levels” of violence against women in the Philippines. The United Nations Resident Coordination (UNRC) published a press release in December 2020, which reported that “VAW [violence against women] was plaguing 1 out of every 4 Filipinas who is married or has been married at least once in their lives.” The lockdown of communities during the COVID-19 pandemic may also have resulted in increasing numbers of gender-based violence cases.
“It’s still a continuing battle,” Dr. Claudio said, “and it really has to do with how we see masculinity and femininity. We still—in some families, in some parts of the country—continue to make sexual predators of men and women, and make hapless victims of women…Also, men can also be abused, and women can also be abusive, and children—whether they’re men or women—are likely to be abused. So we have to see what it means to be a man, a woman, a child, a mother, a father. We have to look at families and what that means, so that’s a big thing.”
Unintended adolescent sexuality (including teenage pregnancies, youth acquisition of sexually transmitted infections [STIs], etc.) is another pressing issue, considering that the Philippines has one of the highest adolescent fertility rates in Southeast Asia. “Most adolescent pregnancies are unwanted or unplanned, and that has serious effects on the girl particularly. She has to stop her education; she’s the one who gets the economic setback since she wasn’t about to continue education.” She then points to the Supreme Court’s decision to require minors to receive parental consent in order to receive contraception as a major factor in the current trend.
Dr. Claudio also attributes this problem that’s plaguing the youth to poverty, the most important social determinant. Some young people “don’t see themselves getting good jobs. They don’t see themselves getting a good education. They’re not given access to pleasurable activities that are not sexual in nature and that might help them better.” When the youth are deprived of having a “psychologically-rich” environment because of poverty and other factors, then sexual activities may be their outlet to find pleasure in their lives.
The tussle for access to reproductive health services and the defence against attacks on reproductive rights in the Philippines, as well as the managing of violence against women and adolescent sexuality crises, are still strong and may not be over soon. “We still continue to fight. That’s why there’s still a women’s movement in the Philippines and a women’s reproductive health movement in the Philippines. We haven’t closed our organizations because, after the bill, there’s still a long struggle to fulfill…so that women can have the highest standard of health, which they have a right to.”