DISSECTING REPUBLIC ACT NO.

10354
AN ACT PPROVIDING FOR A NATIONAL POLICY
ON RESPONSIBLE PARENTHOOD AND
REPRODUCTIVE HEALTH

Medical & Public Health Issues

Dr. Liza C. Manalo, MSc.

Department of Family & Community Medicine
 Success can be taught
• The process starts with making people understand that each of
us choose to be victims or victors.
• Poverty is more than a lack of income. It is also the
consequence of specific behaviors and decisions.
• The real long term solution to poverty is not achieved by mere
luck and circumstance. It is achieved by a string of decisions.
• Set backs in life happen, but there is no special formula that
magically brings prosperity and wealth.
• It is the core belief that we, the people, have the power to
overcome wrongs, injustices, and disasters.
• It is the fundamental knowledge that we ultimately have power
over ourselves, our lives, and our pursuit of happiness.
- Reese, Nov, 2008, http://www.digitaljournal.com/article/262211
 The real answer to poverty is a two step process :

• 1st step in helping people rise from despair:

instill self worth.
– There is no self worth or self dignity found in a dole-
out.
• This does not mean that we don't lend a helping hand;
this means that the helping hand must be accompanied by
true compassion that is not attached to our own personal
agenda for the individuals we claim we want to help.
– The first step is by far the toughest. Victory over victim-hood does not
occur overnight, and people have to want that personal victory before
they can find the will to fight for personal success.
- Reese, Nov, 2008

http://www.digitaljournal.com/article/262211
 The real answer to poverty is a two step process :
2nd: Simply teach the odds to
people each year, from 3rd
grade through high school
graduation, as to who are • How Not to Be Poor:
are the poor:
• Stay in School
• High school drop-outs
• Get a Job
• Staying single
• Get Married
• Having children without a
• Don't Have Children
spouse
Out of Wedlock
• Working only part time or - NationalCenter for Policy
not working at all Analysis, Jan, 2003
http://www.ncpa.org/pub/ba428/
- 2001 U.S. Census data
 Improve
Maternal Health
 Everyday another 10 Filipino women die of
complications due to pregnancy and childbirth
• Birth attendance by
skilled personnel, a proxy Type of Assistance During Delivery
indicator for MMR, has
only slightly increased 70
from 58.8% in 1990 to 60
59.8
62.3
62.3% in 2006 (FPS) 50 52.8
56.4

Percent
• Most women in rural 40 45.3
41.3
37.1
areas prefer hilots (TBAs) 30 34.5

• Non skilled birth 20

10
attendance is worst
0
among the poor with the 1993 1998 2003 2006
rich more likely to have
skilled attendance at SBA Non-SBA

delivery than the poor

Many women still deliver without

medical attendance
The main causes of maternal deaths
could have been avoided

Source: Wagner and Claeson. 2004

 Crucial to reducing maternal deaths is having a
skilled attendant present during a delivery
• Only 60 percent of the births in the Philippines
are supervised by a skilled birth attendant.
• In the Philippine Framework for Maternal
Mortality Reduction, health workers are
identified as playing an integral part in achieving
a lower MMR in the country.
• Giving midwives access to further training in life-
saving skills could prevent up to 80 percent of
maternal deaths in the Philippines, says Rosalie
Paje, division chief of the Family Health Office
under the Department of Health (DOH).
– http://www.pogsinc.org/v2/index.php/component/content/art
icle/10/58-philippines-ranks--48-in-maternal-mortality
 Eliminating maternal deaths is POSSIBLE
Zero maternal mortality from 1994 up to 2004
Gattaran-Cagayan, Ara-asan-Surigao del Sur and
Isulan, Sultan Kudarat
• Key elements
– Pregnancy Watch
– Prepaid Perinatal Services
– Upgraded Birthing Centers
– Botica sa Birthing (Pharmacy)
– Walking Blood Bank
– Tambayan sa Birthing (Waiting Home)
– Male Motivators
 Priority interventions on the ground
DELAY # 1 DELAY # 2 DELAY # 3
Deciding to seek Reaching an Receiving EmOC
EmOC EmOC Facility at Facility

• Educate on danger • Improve access to • Ensure availability of

signs and location of transport and skilled birth attendant
EmOC facility communication
• Provide adequate drugs,
systems
• Provide alternatives equipment, blood
for financing • Prepare delivery plan transfusion
(Social/Community during antenatal visits
• Improve quality of
Health Insurance)
services for the poor,
• Establish less educated, and
Community support women who had
group (e.g.. TBA, undergone abortion
BHW)
 At the service level
Increase Demand and Utilization for
Emergency Obstetric Care (EmOC)
• Improve quality of antenatal services
– Information on danger signs and where to go
when complications arise
– Ensure provision of iron and folic acid
supplementation
• Rice biofortification
• Distribution in workplace-based settings
– Prepare delivery plans that include options for
transport and financing
• Network with traditional birth attendants (TBAs) to
identify danger signs, plan referrals
 REPUBLIC ACT NO. 10354
AN ACT PPROVIDING FOR A NATIONAL POLICY
ON RESPONSIBLE PARENTHOOD AND
REPRODUCTIVE HEALTH
is about:
• The State shall promote and provide information and
access, without bias, to all methods of family planning,
including effective natural and modern methods which
have been proven medically safe, legal, non-
abortifacient and effective in accordance with scientific
and evidence-based medical research standards such as
those registered and approved by the Food and Drug
Administration (FDA).
V 1.1 What is wrongcontraceptives? with “safe sex” and the use of

i • Contraceptives are not effective in blocking out STDs.

o • The inherent naturally occurring flaws in natural rubber
(latex) are up to 5 microns inches in size. The average
l sperm is about 50 microns in diameter, and the average
AIDS virus is about 0.1 micron in size. An AIDS virus can
a pass through a latex flaw.
t
i - Dr. C. Michael Roland of the
U.S. Naval Research Lab,
o Washington D.C, Rubber
World, June, 1993
n
V What is wrong with “safe sex” and the use of

i • 1.1
contraceptives?

There is no absolute guarantee that one will not get

o sexually transmitted diseases (STDs) and HIV even when
condom is used.
l – Most experts believe that the risk of getting HIV/AIDS
a and other sexually transmitted diseases can be greatly
reduced if a condom is used consistently and correctly.
t – Insex,"other words, sex with condoms isn't totally "safe
but it is "less risky" sex.
i – The most reliable ways to avoid transmission of STDs are
to abstain from sexual activity, or to be in a long-term
o mutually monogamous relationship with an uninfected
partner.
n - Centers for Disease Control (CDC) & US FDA
 What is wrong with “safe sex” and the use of
V 1.1 contraceptives?
• There is no absolute guarantee that one will not get
i genital HPV, the most common sexually transmitted
o infection, even when condom is used.
– For those who choose to be sexually active, condoms may
l lower the risk of HPV. To be most effective, they should be
used with every sex act, from start to finish. Condoms may
a also lower the risk of developing HPV-related diseases, such
as genital warts and cervical cancer. But HPV can infect areas
t that are not covered by a condom - so condoms may not
fully protect against HPV.
i – People can also lower their chances of getting HPV by being
o in a faithful relationship with one partner; limiting their
number of sex partners; and choosing a partner who has
n had no or few prior sex partners.
- Centers for Disease Control and Prevention (CDC)
 When Does Human Life Begin?
A Scientific Perspective
• The scientific evidence supports the conclusion that a zygote is a human
organism and that the life of a new human being commences at a
scientifically well defined “moment of conception.”
• Based on universally accepted scientific criteria, a new cell, the
human zygote, comes into existence at the moment of sperm-
egg fusion, an event that occurs in less than a second.
• Upon formation, the zygote immediately initiates a complex
sequence of events that establish the molecular conditions
required for continued embryonic development.
• The behavior of the zygote is radically unlike that of either
sperm or egg separately and is characteristic of a human
organism.

• Condic M, 2008, The Westchester Institute For Ethics & the Human Person
 When Does Human Life Begin?
At Fertilization

• Keith L. Moore, Before We Are Born: Essentials of Embryology, 7th

edition. Philadelphia, PA: Saunders, 2008. p. 2.
• T.W. Sadler, Langman's Medical Embryology, 10th edition. Philadelphia,
PA: Lippincott Williams & Wilkins, 2006. p. 11.
• Keith L. Moore, The Developing Human: Clinically Oriented
Embryology, 7th edition. Philadelphia, PA: Saunders, 2003. pp. 16, 2.
• Ronan O'Rahilly and Fabiola Miller, Human Embryology and Teratology,
3rd edition. New York: Wiley-Liss, 2001. p. 8.
• Essentials of Human Embryology, William J. Larsen, (New York:
Churchill Livingstone, 1998), 1-17.
• Carlson, Bruce M. Patten's Foundations of Embryology. 6th edition. New
York: McGraw-Hill, 1996, p. 3
• http://www.clinicquotes.com/site/story.php?id=28
 When Does Human Life Begin?
From the Pro-choice side:

Acknowledgments of life before birth

• "A facet that makes the obstetrician's burden unique in the whole field of
medicine is his double obligation; he simultaneously cares for two patients,
the mother and the infant...The essential step in the initiation of life is by
fertilization, the penetration of the ovum by a spermatozoa and the fusion
of the two cells into a single cell."
- Dr. Alan Guttmacher, Pregnancy and Birth: A Book for Expectant Parents
New American Library, Jan, 1962. He was the president of Planned
Parenthood
• "Let me say something shocking. I am perfectly willing to grant that life
begins at conception...let's not pretend it [abortion] is not a form of
killing."
- Pro-Choice activist and supporter Norman Mailer to David Frost on PBS
• "Fertilization, then, has taken place. A baby has been conceived."
- Planned Parenthood's former medical director Mary Calderone, M.D.
(Quoted by pro-choice author Magda Denes. Appears in "The Zero People:
Essays on Life" by Jeffrey Hensley, Servant Publications (March 1983) p 9.
• http://www.clinicquotes.com/site/story.php?id=28
V 1.1 What is wrong with “safe sex” and the use
of contraceptives?
i
o • Some contraceptives have post-fertilization
effects
l – Although the primary mechanism of oral
a contraceptives (OC) is inhibition of ovulation,
other alterations include changes in the cervical
t mucus, which increase the difficulty of sperm
entry into the uterus, and changes in the
i endometrium,
implantation.
which reduce the likelihood of

o - Physicians’ Desk Reference & Drug Facts and

n Comparisons
V 1.1 What is wrong with “safe sex” and the use
of contraceptives?
i Some contraceptives have post-fertilization
o effects
• “In IUD users, the low recovery of ova from the
l uterus, as well as the lack of hCG rise in more recent
studies of IUD users, suggest that the major
a postfertilization effect is destruction of the early
t embryo in the Fallopian tube, in the same way that
the major prefertilization effect is likely to be
i destruction of sperm and ova.
o • Stanford and Mikolajczyk, American Journal of
Obstetrics & Gynecology, December 2002
n
V 1.1 What is wrong with “safe sex” and the use
of contraceptives?
i Some contraceptives have post-fertilization
o effects
l • For the copper IUD, this embryocidal effect may be more a
result of inflammation and direct toxicity, whereas with the
progestin IUDs it may result more from inhibition of transport
a through the Fallopian tube, along with prevention of
implantation, preventing long-term viability of the embryo.”
t Copper IUD
• Stanford and Mikolajczyk, American Journal
i of Obstetrics & Gynecology, December 2002

o
n
 The Philippine National Drug Formulary System and
V Family Planning Supplies. - the National Drug Formulary
shall include hormonal contraceptives, intrauterine
i devices, injectables and other safe, legal, non-
abortifacient and effective family planning products
o and supplies.
l For the purpose of this act, any product or supply included or to be
included in the essential drug list must have a certification from the
a FDA that said products and supply is made available on the condition
that it is not to be used as an abortifacient.
t
These products and supplies shall also be included in the regular
i purchase of essential medicines and supplies of all national hospitals.
Provided, further, That the foregoing offices shall not purchase or
o acquire by any means emergency contraceptive pills, postcoital pills,
abortifacients that will be used for such purpose and their other
n forms or equivalent.
Criteria for Drug Selection into the Essential Drug
List and the National Drug Formulary
(WHO Technical Report Series No.825, The Use of Essential Drugs)
Relevance to disease Indicated in the treatment of prevalent diseases
Efficacy and safety Based on adequate pharmacologic studies especially
among Filipinos
Quality Must meet adequate quality control standard
including stability &, when necessary,
bioavailability
Compliance with WHO Certification Scheme on the
Quality of Pharmaceutical Products Moving in
International Commerce
Cost of treatment
regimen
Appropriateness to the
capability of health
workers at different
levels of health care
Local health problems
Benefit/Risk ratio
V What is wrong with classifying family
planning supplies as essential medicines?
i
o • Most normal, low-risk pregnancy, per se, is not a
disease, and as such does not need medicines,
l except for iron and folic acid supplementation.
a – Hence, the only “essential” medicines during
t pregnancy would be ferrous sulfate and
multivitamins.
i
o
n
 What is wrong with classifying family
V planning supplies as essential medicines?
i • Combined Oral Contraceptives (COC) are not safe, as they are

o classified as carcinogenic to humans by the World Health

Organization
l • The International Agency for Research on Cancer (IARC),
the cancer research agency of WHO, in its press release
a of the 29th of July 2005, informed of the publication of a
monograph on the carcinogenicity of combined estrogen-
t progestogen oral contraceptives (COC) and combined
estrogen-progestogen menopausal therapy (HRT), based
i on the conclusions of an international Working Group of
21 scientists from 8 countries.
o » http://www.who.int/reproductivehealth/publications/agein
g/cocs_hrt_statement.pdf
n » http://www.iarc.fr/en/media-centre/pr/2005/pr167.html
 What is wrong with classifying family
V planning supplies as essential medicines?
i• Combined Oral Contraceptives (COC) are not safe, as there is
o sufficient evidence in humans for their carcinogenicity
– Estrogen-progestogen oral contraceptives were classified in
l the Group 1 of carcinogenic agents, after a thorough review
of the published scientific evidence.
a – This evaluation was made on the basis of increased risks for
cancer of the breast among current and recent users only,
t for cancer of the cervix and for cancer of the liver in
populations that are at low risk for hepatitis B viral infection.
i » IARC Monographs on the Evaluation of Carcinogenic Risks to
Humans Volume 91 (2007)
http://monographs.iarc.fr/ENG/Monographs/vol91/mono91-
o 6E.pdf
» The Lancet Oncology, Vol 6 August 2005

n http://oncology.thelancet.com
 What is wrong with classifying family
V planning supplies as essential medicines?
i• Combined Oral Contraceptives (COC) are not
o safe, as women who were current or recent
l users of birth control pills had a slightly
a elevated risk of developing breast cancer.
– from the analysis of 54 epidemiological studies conducted by
t the Collaborative Group on Hormonal Factors in Breast
Cancer on 53,297 women with breast cancer and 100,239
i women without breast cancer
o • The risk was highest for women who started using OCs as teenagers.
» Lancet 1996; 347:1713–1727.
n
V What is wrong with classifying family
planning supplies as essential medicines?
i
o • Combined Oral Contraceptives (COC) are not
safe, as the risk for breast cancer was highest
l for women who used OCs within 5 years prior
a to diagnosis, particularly in the younger group
• From the National Cancer Institute (NCI)-sponsored study
t among women ages 20 to 34 compared with women ages
35 to 54.
i » Althuis MD, Brogan DD, Coates RJ, et al. Breast cancers among very
young premenopausal women (United States). Cancer Causes and
o Control 2003; 14(2):151–160.
» http://www.cancer.gov/cancertopics/factsheet/Risk/oral-

n contraceptives
V What is wrong with classifying family
planning supplies as essential medicines?
i • Contraceptive hormone use is linked to
o cardiovascular disease.
– Newer generation oral contraceptives (OC) indicate a persistent
l increased risk of venous thromboembolism (VTE or blood clots)
for current users.
a – Current guidelines indicate that, as with all medication,
t contraceptive hormones should be selected and initiated by
weighing risks and benefits for the individual patient.
i – Women 35 years and older should be assessed for cardiovascular
risk factors including hypertension, smoking, diabetes,
o nephropathy, and other vascular diseases, including migraines,
prior to OC use.
n – Shufelt & Bairey Merz, J Am Coll Cardiol. 2009 Jan
V What is wrong with classifying family
planning supplies as essential medicines?
i • FDA Drug Safety Communication: Updated information
about the risk of blood clots in women taking birth
o control pills containing drospirenone.
l • [4-10-2012] Based on its review of recent observational
(epidemiologic) studies, the U.S. FDA has concluded that
a drospirenone-containing birth control pills may be
associated with a higher risk for blood clots than other
t progestin-containing pills.
i • The re drug labels (Beyaz, Safyral, Yasmin and Yaz) report that some
epidemiologic studies reported as high as a three-fold increase in
the risk of blood clots for drospirenone-containing products when
o compared to products containing levonorgestrel or some other
progestins.
n • http://www.fda.gov/Drugs/DrugSafety/ucm299305.htm
 Women Sue Bayer Over Yaz Birth
Control Side Effects
• In June 2012, Bayer announced that it had
begun settling some of the approximately
11,000 Yaz lawsuits filed on behalf of women
who allegedly suffered severe side effects
after taking the drug.

• http://www.jdsupra.com/legalnews/women-sue-bayer-
over-yaz-birth-control-s-57418/
 What is wrong with classifying family
V planning supplies as essential medicines?
i Safety Labeling Changes Approved By FDA Center for
Drug Evaluation and Research (CDER) , May 2008
o Mirena (Levonorgestrel-releasing Intrauterine Device)
l WARNINGS: Ectopic Pregnancy
a • ...Up to half of pregnancies that occur with Mirena in
place are ectopic (incidence: about 1 ectopic
t pregnancy per 1000 users per year.)
– Tell women who choose Mirena about the risks of ectopic
i pregnancy, including the loss of fertility. Teach them to
recognize and report to their physician promptly any
o symptoms of ectopic pregnancy...
• http://www.fda.gov/Safety/MedWatch/SafetyInformation/Safety-
n RelatedDrugLabelingChanges/ucm119274.htm
V What is wrong with classifying family
planning supplies as essential medicines?
i
Mirena (levonorgestrel-releasing IUD) - WARNINGS
o Sepsis
l • ...In some cases, severe pain occurred within
hours of insertion followed by sepsis within days...
a Perforation
t • Perforation or penetration of the uterine wall or
cervix may occur during insertion although the
i perforation may not be detected until some time
later...
o
n – http://www.fda.gov/Safety/MedWatch/SafetyInformation/Safety-
RelatedDrugLabelingChanges/ucm119274.htm
V What is wrong with classifying family
planning supplies as essential medicines?
i
o Mirena (levonorgestrel-releasing IUD) - WARNINGS
l Ovarian Cysts
• ...Surgical intervention is not usually required.
a
Breast Cancer
t • ...Two observational studies have not provided
evidence of an increased risk of breast cancer
i during the use of Mirena.
o
– http://www.fda.gov/Safety/MedWatch/SafetyInformation/Safety-
n RelatedDrugLabelingChanges/ucm119274.htm
V What is wrong with classifying family
planning supplies as essential medicines?
i• IUDs are not safe
o – During the use of a copper IUD, menstruation tends to be
longer with a greater loss of blood; in 70% of women who
l use a hormonal IUD oligomenorrhea or even amenorrhoea
develops. In the first weeks after IUD insertion, there is an
a increased risk of pelvic inflammatory disease (PID).
• Summary of the practice guideline 'The intrauterine
t device' from the Dutch College of General Practitioners,
2009
i – A World Health Organization multi-centre study established
that pelvic inflammatory disease (PID) risk is temporally
o related to IUD insertion procedures.
n – Shapiro, Reprod Health Matters. 2004 May
 What is wrong with classifying family
V planning supplies as essential medicines?
i • IUDs are not safe
o • Innulliparous
15 studies comparing IUD performance in parous vs.
women, nulliparous women had higher rates of
l expulsion and removals due to bleeding and pain.
– Hubacher, Contraception. 2007 Jun
a • Uterine perforation is a rare yet serious complication and is
usually seen during insertion of the IUD.
t – Koltan et al, J Chin Med Assoc. 2010 Jun
• There are about 70 cases in the literature of IUDs that have
i migrated into the bladder. The resulting bladder perforation can
be complete or partial.
o – Istanbulluoglu et al, J Chin Med Assoc. 2008 Apr
• There is a reported case of a colon penetration by a copper IUD.
n – Arslan et al, Arch Gynecol Obstet. 2009
 Mirena: Lawsuits & FDA warning
• Mirena, manufactured by Bayer Pharmaceuticals, has
come under scrutiny for its dangerous side effects
and has led to many lawsuits claiming the product is
“defective and unreasonably dangerous.” Among
the many claims of negligence, Bayer is accused of
intentionally selling a dangerous product, deceptive
advertising and concealing the risk of complications.
• In reviewing the manufacturer’s script for advertising
for the product, the FDA warned Bayer in a Dec. 30,
2009, letter that the company was in violation of the
Federal Food, Drug, and Cosmetic Act. The agency
further stated that the advertising included false or
misleading presentations and misbranded the drug.
• http://www.drugwatch.com/mirena/lawsuit/
 Unjust
V Distribution of Benefits & Burdens
i REPUBLIC ACT NO. 10354
o AN ACT PPROVIDING FOR A NATIONAL
POLICY ON RESPONSIBLE PARENTHOOD AND
l REPRODUCTIVE HEALTH
a about promoting a program to “achieve
equitable allocation of resources” when
t problems pertaining to lack of “reproductive
i health” is not as prevalent nor as life-
threatening as our other health problems.
o
n
 Top Ten Leading Causes of Morbidity and
Mortality in Low-Income Countries
(WHO, 2004)
Deaths in millions
% of deaths

Lower respiratory infections 2.94 11.2

Coronary heart disease 2.47 9.4
Diarrheal diseases 1.81 6.9
HIV/AIDS 1.51 5.7
Stroke & other cerebrovascular diseases 1.48 5.6

Chronic obstructive pulmonary disease 0.94 3.6

Tuberculosis 0.91 3.5
Neonatal infections 0.90 3.4
Malaria 0.86 3.3
Prematurity and low birth weight 0.84 3.2
 What is wrong with giving priority
V to reproductive health ?
i • “Eight of the 10 leading causes of morbidity in the
Philippines are caused by infections:
o – Acute lower respiratory tract infection and pneumonia
– Acute watery diarrhea
l – Bronchitis/ bronchiolitis
– Influenza
a – Tuberculosis
– Malaria
t – Acute febrile illness
– Dengue fever
i • Among these communicable diseases, pneumonia and
tuberculosis continue to be among the 10 leading causes of
o mortality, causing a significant number of deaths across the
country.”
n -World Health Organization (WHO) Western Pacific Region Report
 What is wrong with giving priority to
V reproductive health ?
i• “Financial resources allotted by foreign donors to
o assist the Philippine Government’s programs could
actually be better spent in other pursuits than
l purchasing contraceptives.”
a• “It is also of value to demystify our perceptions about
the role of contraceptives in women’s health, women’s
t rights, and healthy families. To equate access to
i contraceptives with the reduction in maternal
morbidity and mortality is simplistic.”
o - former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
n Philippine Daily Inquirer, 9/20/04
V
i No person shall be denied information
o and access to family planning services,
whether natural or artificial: Provided,
l that minors will not be allowed access to
a modem methods of family planning
without written consent from their
t parents or guardian/s except when the
i minor is already a parent or has had a
miscarriage
o
n
V What is wrong with access to reproductive
health goods and services?
i
• Indiscriminate access to reproductive health
o goods and services without full disclosure of
l the potential for post-fertilization effects of
hormonal contraceptives constitute a
a violation of informed consent.
– The available evidence supports the hypothesis that when ovulation
t and fertilization occur in women taking oral contraceptives (OCs),
post-fertilization effects are operative on occasion to prevent clinically
recognized pregnancy.
i Oral contraceptives directly affect the endometrium. These effects
have been presumed to render the endometrium relatively
o inhospitable to implantation or to the maintenance of the
preembryo or embryo prior to clinically recognized pregnancy.
» Larimore & Stanford, Archive of Family
n Medicine, Feb 2000
 What is wrong with access to reproductive
V health goods and services?
i
• Women who believe that human life begins at
o fertilization and those who consider it is
important to distinguish between natural and
l induced embryo loss are less likely to consider
the use of a method with post-fertilization
a effects.
• In a cross-sectional survey of 755 women, aged 18-49, from Primary
Care Health Centers in Pamplona, Spain, 40% of women would not
t consider using a method that may work after fertilization but before
implantation and 57% would not consider using one that may work
after implantation.
i » de Irala et al, Biomed Central Women's Health 2007
• Among 618 women ages 18–50 in family practice and obstetrics and
gynecology clinics in Salt Lake City, Utah, and Tulsa, Oklahoma, USA,
o 34% reported they believed that life begins at fertilization and
would not use any birth control method that acts after fertilization.
» Dye et al, Biomed Central Women's Health 2005
n
A Fertility control should…
l
• Be reliable
t • Be harmless
e • Be immediately reversible
• Be inexpensive
r • Not detract from the pleasure of sexual intercourse
n • Encourage a good emotional and sexual
relationship between partners
a • Be due to the existence of a serious motive for
t avoiding the birth of another child e.g., illness in
the mother or children (genetic disorders),
i extreme poverty, etc.
• Be respectful of the Moral Law, while searching for
v the most adequate means of avoiding births
e
 Evaluation of the Effectiveness of 12-month
Multi-center Natural Fertility Regulation
Program in China

• Women of different social/education status, strata and ethnic groups

in rural and urban China readily understand the meaning of the
mucus patterns described in the Billings books and all of them accept
the method.
• The method-related pregnancy rate of the Billings Ovulation
Method™ user group was zero and their continuation rate was
significantly higher than those in the IUD group.

• 37,000 BOM teachers trained

• 2.7 Million fertile couples in regular use
• Success rate 99%
• Abortion rate dramatically reduced
• 32% of infertile couples give birth
Shao-Zhen QIAN et al, 2003
Use-effectiveness of fertility awareness
(Billings' Ovulation Method) among
the urban poor in Delhi slums
• The continuation rate of 91.86% for 12 months with a standard
error of 0.67% was surprisingly high for a sample with low
literacy and occupational status, low female work participation
rates, small family size and a preference for sons with low
motivation to use other methods.
• The 1 year efficacy rate (life table analysis) was 99.86%.
• The 1-year use-effectiveness rate was 97.43% for the 5,752
cohort.
– Dorairaj, Soc Action, 1984
Based on the presented evidence,
it is hereby recommended…

NO TO AN ACT PPROVIDING FOR A NATIONAL

POLICY ON RESPONSIBLE PARENTHOOD AND
REPRODUCTIVE HEALTH

The end does not justify the proposed means which are:
 Not reliable
 Not harmless
 Not immediately reversible
 Not inexpensive
 Not respectful of every Filipino’s beliefs and moral values
The youth is the hope of
the fatherland.
-Jose Rizal

This is no longer a statement.

It has become a challenge...
 What an abortifacient is -- and what it isn't
by Jamie Manson | Feb. 20, 2012
• The reality is that there is overwhelming scientific evidence that the
IUD and Plan B work only as contraceptives.
• When church officials argue that the IUD could be an abortifacient,
they are relying on research from the 1970s that indicated that the
IUD could affect an embryo's ability to implant. Decades of research
since has demonstrated that the IUD actually works much earlier in
the reproductive process than once thought. It does not destroy an
implanted embryo.
• The most important point that emerges from all of this research is
that, so far, there is no scientific evidence that any FDA-approved
contraception is capable of destroying an embryo. To say that any of
these drugs are abortifacient is not only misleading…
– http://ncronline.org/blogs/grace-margins/what-abortifacient-and-what-it-isnt