Issues on the Revised HB 4244

Reposting a commentary and critique of the amended version of the RH Bill being circulated around the internet recently by a concerned Filipino. I did not write this piece, though I share some questions that the writer posed on the effectivity and intentions of the RH Bill.

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One of the graphics pointing out the abortion-connection of the RH Bill from a recently made FB Page supporting the Bill.

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The amended version of HB 4244 has been circulated in public.  The following are some observations and questions on the latest version.   

1.     Amendments.  It would be a misnomer to call the acceptance by the anti-RH camp and the CBCP of the amendments offered by the sponsors as “compromises”.  The word “compromise” presumes that opposite sides while having different starting positions share in a desired outcome (peace in Mindanao for example in the case of the Bangsa Moro framework).  Given the intrinsically evil nature of contraceptives and contraceptive acts and the adverse consequences on families and society of a contraceptive culture, the anti-RH position can hardly agree with the inevitable outcome of the RH bill for Philippine society. The Aquino administration however seems determined to deliver an RH bill which happens to coincide with the position of Obama, Hillary Clinton, and the MCC, and as manifested by the heavy-handed way in which the period of debates in the Lower House was drastically ended last August.  If the pro-RH camp goes ahead and rams the bill through Congress, the proposed amendments may have to be accepted tactically as damage control to reduce some of the “nasty” aspects in the bill, such as the coercive provisions and the distribution of abortifacents.     

2.      Welfare economics. It seems that the House leadership has bought into the view shared by many proponents of the RH bill that they don’t really mind if the higher income couples do not practice family planning but it’s the poor who should be targeted for the government’s birth control programs.  Thus in the name of recognizing reproductive health as “universal basic human right” the key amendment to the revised  bill is the free reproductive services and supplies for the poor:  

 “[THE STATE] SHALL PRIORITIZE THE NEEDS OF POOR WOMEN AND MEN IN MARGINALIZED HOUSEHOLDS … WHO SHALL BE VOLUNTARY BENEFICIARIES OF REPRODUCTIVE HEALTH CARE, SERVICES AND SUPPLIES FOR FREE”  

 While this revision finally owns up to the ulterior motive of HB 4244 to discourage the poor from breeding, they immediately raise a lot of welfare economics questions.   

 a)   Is this really the first best, or even second-  or third- best way to help the poor?  Why prioritize free condoms, IUDs, and pills? Why not free anti-TB, anti-malaria, anti-diarrhea medicines; cheap bottled water; oral rehydration powder, etc. which would be more directed at the leading causes of illness and death among the poor?   

 b)   How will the poor be identified? The revised bill proposes: “… THROUGH THE NATIONAL HOUSEHOLD TARGETING SYSTEM FOR POVERTY REDUCTION (NHTS-PR) AND OTHER GOVERNMENT MEASURES OF IDENTIFYING MARGINALIZATION…” Is this part of the Conditional Cash Transfer apparatus? Will acceptance of contraceptives now be one of the conditions?  This NHTS-PR appears about 8 times in the revised bill and will be relied upon for eligibility for pro-bono services, anti-poverty programs, procurement and distribution to LGUs, etc.  

In effect the bill contemplates creating a class of poor Filipinos certified as such for the purpose of getting qualified as non-paying recipients of reproductive health services and supplies. This raises more questions:  

 a.     How will they be documented?  Will they be given IDs or plastic swipe cards which they can bring to drug stores to get free condoms and pills? (Unless the NHTS-PR is geared up to certify their poverty each time before they want to do the marital act).    

 b.    Will there be one ID per couple? Will they have to show a marriage certificate?  Who will keep the ID, the wife or the husband?  Shouldn’t the wife be given control of the ID?  Will a separate ID be issued to the husband who might then use it for extra- marital pursuits? 

 c.     Will an ID be issued to the other members of the poor marginalized family who have reached reproductive age?

 d.    What will be the cut-off income?  How will the government prevent poor couples from selling in a black market their free pills and condoms to non-poor couples who do not qualify?

 e.     How will the quality of the free contraceptives be controlled? Will the COA criteria apply to procure least-cost condoms that might however have high failure rates? (This will play into the hands of pro-abortion camp:   as cheap  condoms fail  there will be an increase in unwanted pregnancies among the poor.  Before long illegal abortions multiply and there would be political clamor to amend the constitution for the legalization of abortion.   This is the same slippery slope that has happened in some Catholic countries that have legalized abortion.)

 f.     The bill provides that the “(FDA) SHALL DETERMINE THE SAFETY, EFFICACY, AND CLASSIFICATION OF PRODUCTS AND SUPPLIES FOR MODERN FAMILY PLANNING METHODS PRIOR TO THEIR DISTRIBUTION, PROCUREMENT, SALE AND USE.”  Many contraceptive pills are classified as first class carcinogenics. Since the bill requires the FDA to ensure the safety of  contraceptives, when the incidence of cancer increases from the free pills distributed to the poor, will the government accept the liability and provide free cancer treatment? Or will there be a legal disclaimer at the back of each ID stating that the recipient takes the pill at her own risk and discharges the government of any liability for any harm that the pills could cause?

 c)   What is the estimated cost of providing free reproductive services and supplies to the poor?  Using round numbers 25% of Filipinos are below the poverty line according to NSCB, or 5 million of 20 million families.  Assuming 80% acceptance of free contraceptives, and P500/month cost of contraceptive supplies per family, this translates to P24 billion a year.  If you use the SWS self-rated 10 million poor families, the number goes up to P48 billion. Of course the P500 can be higher or lower depending on the contraceptives supplied.  

 a.     Following the principle of fiscal responsibility will there be revenue measures identified to fund this new expenditure program?  Will the funding come from taxes collected from the general public, including Roman Catholics?

 b.    Or will the funds come from of grants or loans form the Bill and Melinda Gates Foundation, USAID, Millenium Challenge Corporation, etc.?  

 3.     State interference in the family.  The revised version has the following clause: “THE STATE SHALL ALSO PROMOTE OPENNESS TO LIFE, PROVIDED THAT THE PARENTS BRING FORTH TO THE WORLD ONLY THOSE CHILDREN THAT THEY CAN RAISE IN A TRULY HUMANE WAY.”

 a) There is no definition of “TRULY HUMANE WAY”.  Who will determine and define this, the State? Will the State set quantitative criteria such as minimum nutritional requirements, square meters of living space per child, ownership of appliances, etc?  Will the State use present earning capacity or the expected permanent income of both parents?  How will it allow for the possible increase in income of the breadwinner in the future?

 b) Based on this clause, will the State then withdraw any support for openness to life if parents bring children whom they cannot raise in a “truly humane way”? 

 4.     Coercion to  cooperate in evil.  There is an amendment the purports to lessen the coercive nature of the section on “Prohibited acts” in the case of health care providers who may not refuse under penalties to extend family planning services, “Provided that the conscientious objection of a healthcare service provider based on his ethical or religious beliefs shall be respected; however HE/SHE SHALL, WITHOUT IN ANYWAY AGREEING OR ENDORSING THE FAMILY PLANNING SERVICE OR PROCEDURE REQUIRED BY THE PERSON CONCERNED, immediately refer the person seeking such care and services to another healthcare provider within the same facility…”

 a)   How can the State dictate the mental reservations of the health care provider? Conscientious objector na nga, eh.

 b)    Why is the state requiring the healthcare provider to violate his/her own internal disagreement  by requiring him to refer the case to another health care provider?

 c)    To whom or how will the health care professional report or register her “WITHOUT IN ANYWAY AGREEING OR ENDORSING” the contraceptive or IUD or the sterilization?   To her Mother Superior? To her Confessor? At her Particular Judgement after death?  

 5.     Other issues, new or carried over from the previous version.  Many of the provisions duplicatethe Magna Carta for Women which is already a law. The issue of penalties for doctors who refuse to treat failed abortions is already be covered by professional medical malpractice regulations and do not require a separate provision in an RH bill.  

In sum, while the revised bill has taken out some coercive provisions and tries to de-emphasizeabortifacents, it is a hodgepodge of awkward attempts to make it seemingly acceptable and reasonable.  It puts State power behind widespread distribution of morally and medically harmful contraceptives.  Unfortunately it now uses questionable welfare economics in the name of supposedly helping the poor. 

OTHER CONCERNS

1. What does the Bill say about effectiveness?  Does it provide equality to protection of life BOTH for the mother and the unborn child from conception?

2. Once a drug enlisted to be one of the very general term “Modern Family Planning Methods” has established doubtful effectiveness, does the Bill provides mechanism to remove it from free circulation?

3. If the Bill does not promote abortion, then any “abortifacient” or effect to increase likelihood of abortion (chemical or mechanical) within the list of “Modern Family Planning Products” must also be removed.  Is there a mechanism for this provided for by the Bill?

4. It is true that in the amended version of the Bill, the “Food and Drug Administration (FDA) is charged with the determination of the safety, efficacy and classification” of the Modern Family Planning products, however the same Bill must place criteria for “safety” and “efficacy”.  Moreover, products that are neither “drug” nor “food” such as condoms must also be taken cared of, unless this product is under FDA authority.

 5. Once becoming a law, will it automatically revise or amend, the Revised Penal Code?  Part of every new law is to amend or change pre-existing laws contrary to it, except the Constitution.  If “yes”, then the assumption that abortion is “already” illegal seems to become invalid eventually.

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