Dissecting the Philippine RH Law
Content
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
• 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
Success can be taught
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 doleout.
• 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 are the poor: • High school drop-outs • Staying single • Having children without a spouse • Working only part time or not working at all - 2001 U.S. Census data
• How Not to Be Poor: • Stay in School • Get a Job • Get Married • Don't Have Children Out of Wedlock
- National
Center for Policy Analysis, Jan, 2003
http://www.ncpa.org/pub/ba428/
Improve Maternal Health
Everyday another 10 Filipino women die of complications due to pregnancy and childbirth
• Birth attendance by skilled personnel, a proxy indicator for MMR, has only slightly increased from 58.8% in 1990 to 62.3% in 2006 (FPS) Most women in rural areas prefer hilots (TBAs) Non skilled birth attendance is worst among the poor with the rich more likely to have skilled attendance at delivery than the poor
Type of Assistance During Delivery
70 60 50
52.8 45.3 56.4 41.3 37.1 34.5 59.8 62.3
• •
Percent
40 30 20 10 0
1993
1998
SBA
2003
Non-SBA
2006
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 lifesaving 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 Deciding to seek EmOC • Educate on danger signs and location of EmOC facility DELAY # 2 Reaching an EmOC Facility • Improve access to transport and communication systems • Prepare delivery plan during antenatal visits DELAY # 3 Receiving EmOC at Facility • Ensure availability of skilled birth attendant • Provide adequate drugs, equipment, blood transfusion • Improve quality of services for the poor, less educated, and women who had undergone abortion
• Provide alternatives for financing (Social/Community Health Insurance)
• Establish Community support group (e.g.. TBA, 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, nonabortifacient 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 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 sperm is about 50 microns in diameter, and the average l 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
What is wrong with “safe sex” and the use of contraceptives?
What is wrong with “safe sex” and the use of V contraceptives? 1.1 i • 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 and other sexually transmitted diseases can be greatly a reduced if a condom is used consistently and correctly. with t – In other words, sexrisky"condoms isn't totally "safe sex," but it is "less sex. to avoid transmission of STDs i – The most reliable waysactivity, or to be in a long-termare to abstain from sexual mutually monogamous relationship with an uninfected o partner. n - Centers for Disease Control (CDC) & US FDA
V i o l a t i o n
What is wrong with “safe sex” and the use of 1.1 contraceptives? • There is no absolute guarantee that one will not get genital HPV, the most common sexually transmitted infection, even when condom is used.
– For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV. – People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has 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 i • Some contraceptives have post-fertilization o effects l – Although the primary mechanism of oral a contraceptives (OC) is inhibition ofinovulation, other alterations include changes the cervical mucus, which increase the difficulty of sperm t entry into the uterus, and changes in the endometrium, which reduce the likelihood of i implantation. o - Physicians’ Desk Reference & Drug Facts and Comparisons n
What is wrong with “safe sex” and the use of contraceptives?
V 1.1 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 embryo in the Fallopian tube, in the same way that t the major prefertilization effect is likely to be i destruction of sperm and ova. Mikolajczyk, American o • Stanford andGynecology, December Journal of Obstetrics & 2002 n
What is wrong with “safe sex” and the use of contraceptives?
V 1.1 i Some contraceptives have post-fertilization o effects • For the copper IUD, this embryocidal effect may be more a l 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 • Stanford and Mikolajczyk, American Journal of Obstetrics & Gynecology, December 2002 i o n
Copper IUD
What is wrong with “safe sex” and the use of contraceptives?
V i o l a t i o n
The Philippine National Drug Formulary System and Family Planning Supplies. - the National Drug Formulary shall include hormonal contraceptives, intrauterine devices, injectables and other safe, legal, nonabortifacient and effective family planning products and supplies.
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 FDA that said products and supply is made available on the condition that it is not to be used as an abortifacient.
These products and supplies shall also be included in the regular purchase of essential medicines and supplies of all national hospitals. Provided, further, That the foregoing offices shall not purchase or acquire by any means emergency contraceptive pills, postcoital pills, abortifacients that will be used for such purpose and their other forms or equivalent.
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 Efficacy and safety Quality
Indicated in the treatment of prevalent diseases
Based on adequate pharmacologic studies especially among Filipinos 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 i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines? • Most normal, low-risk pregnancy, per se, is not a disease, and as such does not need medicines, except for iron and folic acid supplementation. – Hence, the only “essential” medicines during pregnancy would be ferrous sulfate and multivitamins.
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as they are classified as carcinogenic to humans by the World Health Organization
• The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, in its press release of the 29th of July 2005, informed of the publication of a monograph on the carcinogenicity of combined estrogenprogestogen oral contraceptives (COC) and combined estrogen-progestogen menopausal therapy (HRT), based on the conclusions of an international Working Group of 21 scientists from 8 countries.
» http://www.who.int/reproductivehealth/publications/agein g/cocs_hrt_statement.pdf » http://www.iarc.fr/en/media-centre/pr/2005/pr167.html
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as there is sufficient evidence in humans for their carcinogenicity – Estrogen-progestogen oral contraceptives were classified in the Group 1 of carcinogenic agents, after a thorough review of the published scientific evidence. – This evaluation was made on the basis of increased risks for cancer of the breast among current and recent users only, for cancer of the cervix and for cancer of the liver in populations that are at low risk for hepatitis B viral infection.
» IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 91 (2007) http://monographs.iarc.fr/ENG/Monographs/vol91/mono916E.pdf » The Lancet Oncology, Vol 6 August 2005 http://oncology.thelancet.com
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as women who were current or recent users of birth control pills had a slightly elevated risk of developing breast cancer.
– from the analysis of 54 epidemiological studies conducted by the Collaborative Group on Hormonal Factors in Breast Cancer on 53,297 women with breast cancer and 100,239 women without breast cancer
• The risk was highest for women who started using OCs as teenagers. » Lancet 1996; 347:1713–1727.
V i • o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as the risk for breast cancer was highest for women who used OCs within 5 years prior to diagnosis, particularly in the younger group
• From the National Cancer Institute (NCI)-sponsored study among women ages 20 to 34 compared with women ages 35 to 54.
» Althuis MD, Brogan DD, Coates RJ, et al. Breast cancers among very young premenopausal women (United States). Cancer Causes and Control 2003; 14(2):151–160. » http://www.cancer.gov/cancertopics/factsheet/Risk/oralcontraceptives
V i • o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Contraceptive hormone use is linked to cardiovascular disease.
– Newer generation oral contraceptives (OC) indicate a persistent increased risk of venous thromboembolism (VTE or blood clots) for current users. – Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. – Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy, and other vascular diseases, including migraines, prior to OC use. – Shufelt & Bairey Merz, J Am Coll Cardiol. 2009 Jan
V i • o l • a t i o n
What is wrong with classifying family planning supplies as essential medicines?
FDA Drug Safety Communication: Updated information about the risk of blood clots in women taking birth control pills containing drospirenone. [4-10-2012] Based on its review of recent observational (epidemiologic) studies, the U.S. FDA has concluded that drospirenone-containing birth control pills may be associated with a higher risk for blood clots than other progestin-containing pills.
• 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 compared to products containing levonorgestrel or some other progestins. • 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-bayerover-yaz-birth-control-s-57418/
V 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/Safetyn RelatedDrugLabelingChanges/ucm119274.htm
What is wrong with classifying family planning supplies as essential medicines?
V i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines? Mirena (levonorgestrel-releasing IUD) - WARNINGS Sepsis • ...In some cases, severe pain occurred within hours of insertion followed by sepsis within days... Perforation • Perforation or penetration of the uterine wall or cervix may occur during insertion although the perforation may not be detected until some time later...
– http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyRelatedDrugLabelingChanges/ucm119274.htm
V i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Mirena (levonorgestrel-releasing IUD) - WARNINGS
Ovarian Cysts • ...Surgical intervention is not usually required. Breast Cancer • ...Two observational studies have not provided evidence of an increased risk of breast cancer during the use of Mirena.
– http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyRelatedDrugLabelingChanges/ucm119274.htm
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
IUDs are not safe
– During the use of a copper IUD, menstruation tends to be longer with a greater loss of blood; in 70% of women who use a hormonal IUD oligomenorrhea or even amenorrhoea develops. In the first weeks after IUD insertion, there is an increased risk of pelvic inflammatory disease (PID). • Summary of the practice guideline 'The intrauterine device' from the Dutch College of General Practitioners, 2009 – A World Health Organization multi-centre study established that pelvic inflammatory disease (PID) risk is temporally related to IUD insertion procedures.
– Shapiro, Reprod Health Matters. 2004 May
V i • IUDs are not safe comparing IUD performance in parous vs. o • In 15 studieswomen, nulliparous women had higher rates of nulliparous l expulsion and removals due to bleeding and pain. – Hubacher, Contraception. 2007 Jun perforation is a rare serious a • Uterineseen during insertionyet the IUD.complication and is usually of 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
What is wrong with classifying family planning supplies as essential medicines?
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/
V i o l a t i o n
Unjust Distribution of Benefits & Burdens
REPUBLIC ACT NO. 10354 AN ACT PPROVIDING FOR A NATIONAL POLICY ON RESPONSIBLE PARENTHOOD AND REPRODUCTIVE HEALTH about promoting a program to “achieve equitable allocation of resources” when problems pertaining to lack of “reproductive health” is not as prevalent nor as lifethreatening as our other health problems.
Top Ten Leading Causes of Morbidity and Mortality in Low-Income Countries
(WHO, 2004)
Deaths in millions % of deaths
Lower respiratory infections Coronary heart disease
2.94 2.47
11.2 9.4
Diarrheal diseases
HIV/AIDS Stroke & other cerebrovascular diseases Chronic obstructive pulmonary disease Tuberculosis Neonatal infections Malaria Prematurity and low birth weight
1.81
1.51 1.48 0.94 0.91 0.90 0.86 0.84
6.9
5.7 5.6 3.6 3.5 3.4 3.3 3.2
V i • o l a t i • o n
What is wrong with giving priority to reproductive health ?
“Eight of the 10 leading causes of morbidity in the Philippines are caused by infections:
– Acute lower respiratory tract infection and pneumonia – Acute watery diarrhea – Bronchitis/ bronchiolitis – Influenza – Tuberculosis – Malaria – Acute febrile illness – Dengue fever Among these communicable diseases, pneumonia and tuberculosis continue to be among the 10 leading causes of mortality, causing a significant number of deaths across the country.”
-World Health Organization (WHO) Western Pacific Region Report
V i• o l a• t i o n
What is wrong with giving priority to reproductive health ?
“Financial resources allotted by foreign donors to assist the Philippine Government’s programs could actually be better spent in other pursuits than purchasing contraceptives.”
“It is also of value to demystify our perceptions about the role of contraceptives in women’s health, women’s rights, and healthy families. To equate access to contraceptives with the reduction in maternal morbidity and mortality is simplistic.”
- former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
Philippine Daily Inquirer, 9/20/04
V i o l a t i o n
No person shall be denied information and access to family planning services, whether natural or artificial: Provided, that minors will not be allowed access to modem methods of family planning without written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage
V i • o l a t i o n
What is wrong with access to reproductive health goods and services? Indiscriminate access to reproductive health goods and services without full disclosure of the potential for post-fertilization effects of hormonal contraceptives constitute a violation of informed consent.
– The available evidence supports the hypothesis that when ovulation and fertilization occur in women taking oral contraceptives (OCs), post-fertilization effects are operative on occasion to prevent clinically recognized pregnancy.
Oral contraceptives directly affect the endometrium. These effects have been presumed to render the endometrium relatively inhospitable to implantation or to the maintenance of the preembryo or embryo prior to clinically recognized pregnancy.
» Larimore & Stanford, Archive of Family Medicine, Feb 2000
V i • o l a t i o n
What is wrong with access to reproductive health goods and services?
Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss are less likely to consider the use of a method with post-fertilization 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 consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. » 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, 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
A l t e r n a t i v e
Fertility control should…
• • • • • • Be reliable Be harmless Be immediately reversible Be inexpensive Not detract from the pleasure of sexual intercourse Encourage a good emotional and sexual relationship between partners • Be due to the existence of a serious motive for avoiding the birth of another child e.g., illness in the mother or children (genetic disorders), extreme poverty, etc. • Be respectful of the Moral Law, while searching for the most adequate means of avoiding births
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
Shao-Zhen QIAN et al, 2003
• 32% of infertile couples give birth
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
Medical & Public Health Issues
Dr. Liza C. Manalo, MSc. Department of Family & Community Medicine
• 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
Success can be taught
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 doleout.
• 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 are the poor: • High school drop-outs • Staying single • Having children without a spouse • Working only part time or not working at all - 2001 U.S. Census data
• How Not to Be Poor: • Stay in School • Get a Job • Get Married • Don't Have Children Out of Wedlock
- National
Center for Policy Analysis, Jan, 2003
http://www.ncpa.org/pub/ba428/
Improve Maternal Health
Everyday another 10 Filipino women die of complications due to pregnancy and childbirth
• Birth attendance by skilled personnel, a proxy indicator for MMR, has only slightly increased from 58.8% in 1990 to 62.3% in 2006 (FPS) Most women in rural areas prefer hilots (TBAs) Non skilled birth attendance is worst among the poor with the rich more likely to have skilled attendance at delivery than the poor
Type of Assistance During Delivery
70 60 50
52.8 45.3 56.4 41.3 37.1 34.5 59.8 62.3
• •
Percent
40 30 20 10 0
1993
1998
SBA
2003
Non-SBA
2006
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 lifesaving 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 Deciding to seek EmOC • Educate on danger signs and location of EmOC facility DELAY # 2 Reaching an EmOC Facility • Improve access to transport and communication systems • Prepare delivery plan during antenatal visits DELAY # 3 Receiving EmOC at Facility • Ensure availability of skilled birth attendant • Provide adequate drugs, equipment, blood transfusion • Improve quality of services for the poor, less educated, and women who had undergone abortion
• Provide alternatives for financing (Social/Community Health Insurance)
• Establish Community support group (e.g.. TBA, 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, nonabortifacient 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 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 sperm is about 50 microns in diameter, and the average l 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
What is wrong with “safe sex” and the use of contraceptives?
What is wrong with “safe sex” and the use of V contraceptives? 1.1 i • 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 and other sexually transmitted diseases can be greatly a reduced if a condom is used consistently and correctly. with t – In other words, sexrisky"condoms isn't totally "safe sex," but it is "less sex. to avoid transmission of STDs i – The most reliable waysactivity, or to be in a long-termare to abstain from sexual mutually monogamous relationship with an uninfected o partner. n - Centers for Disease Control (CDC) & US FDA
V i o l a t i o n
What is wrong with “safe sex” and the use of 1.1 contraceptives? • There is no absolute guarantee that one will not get genital HPV, the most common sexually transmitted infection, even when condom is used.
– For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV. – People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has 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 i • Some contraceptives have post-fertilization o effects l – Although the primary mechanism of oral a contraceptives (OC) is inhibition ofinovulation, other alterations include changes the cervical mucus, which increase the difficulty of sperm t entry into the uterus, and changes in the endometrium, which reduce the likelihood of i implantation. o - Physicians’ Desk Reference & Drug Facts and Comparisons n
What is wrong with “safe sex” and the use of contraceptives?
V 1.1 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 embryo in the Fallopian tube, in the same way that t the major prefertilization effect is likely to be i destruction of sperm and ova. Mikolajczyk, American o • Stanford andGynecology, December Journal of Obstetrics & 2002 n
What is wrong with “safe sex” and the use of contraceptives?
V 1.1 i Some contraceptives have post-fertilization o effects • For the copper IUD, this embryocidal effect may be more a l 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 • Stanford and Mikolajczyk, American Journal of Obstetrics & Gynecology, December 2002 i o n
Copper IUD
What is wrong with “safe sex” and the use of contraceptives?
V i o l a t i o n
The Philippine National Drug Formulary System and Family Planning Supplies. - the National Drug Formulary shall include hormonal contraceptives, intrauterine devices, injectables and other safe, legal, nonabortifacient and effective family planning products and supplies.
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 FDA that said products and supply is made available on the condition that it is not to be used as an abortifacient.
These products and supplies shall also be included in the regular purchase of essential medicines and supplies of all national hospitals. Provided, further, That the foregoing offices shall not purchase or acquire by any means emergency contraceptive pills, postcoital pills, abortifacients that will be used for such purpose and their other forms or equivalent.
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 Efficacy and safety Quality
Indicated in the treatment of prevalent diseases
Based on adequate pharmacologic studies especially among Filipinos 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 i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines? • Most normal, low-risk pregnancy, per se, is not a disease, and as such does not need medicines, except for iron and folic acid supplementation. – Hence, the only “essential” medicines during pregnancy would be ferrous sulfate and multivitamins.
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as they are classified as carcinogenic to humans by the World Health Organization
• The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, in its press release of the 29th of July 2005, informed of the publication of a monograph on the carcinogenicity of combined estrogenprogestogen oral contraceptives (COC) and combined estrogen-progestogen menopausal therapy (HRT), based on the conclusions of an international Working Group of 21 scientists from 8 countries.
» http://www.who.int/reproductivehealth/publications/agein g/cocs_hrt_statement.pdf » http://www.iarc.fr/en/media-centre/pr/2005/pr167.html
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as there is sufficient evidence in humans for their carcinogenicity – Estrogen-progestogen oral contraceptives were classified in the Group 1 of carcinogenic agents, after a thorough review of the published scientific evidence. – This evaluation was made on the basis of increased risks for cancer of the breast among current and recent users only, for cancer of the cervix and for cancer of the liver in populations that are at low risk for hepatitis B viral infection.
» IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 91 (2007) http://monographs.iarc.fr/ENG/Monographs/vol91/mono916E.pdf » The Lancet Oncology, Vol 6 August 2005 http://oncology.thelancet.com
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as women who were current or recent users of birth control pills had a slightly elevated risk of developing breast cancer.
– from the analysis of 54 epidemiological studies conducted by the Collaborative Group on Hormonal Factors in Breast Cancer on 53,297 women with breast cancer and 100,239 women without breast cancer
• The risk was highest for women who started using OCs as teenagers. » Lancet 1996; 347:1713–1727.
V i • o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Combined Oral Contraceptives (COC) are not safe, as the risk for breast cancer was highest for women who used OCs within 5 years prior to diagnosis, particularly in the younger group
• From the National Cancer Institute (NCI)-sponsored study among women ages 20 to 34 compared with women ages 35 to 54.
» Althuis MD, Brogan DD, Coates RJ, et al. Breast cancers among very young premenopausal women (United States). Cancer Causes and Control 2003; 14(2):151–160. » http://www.cancer.gov/cancertopics/factsheet/Risk/oralcontraceptives
V i • o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Contraceptive hormone use is linked to cardiovascular disease.
– Newer generation oral contraceptives (OC) indicate a persistent increased risk of venous thromboembolism (VTE or blood clots) for current users. – Current guidelines indicate that, as with all medication, contraceptive hormones should be selected and initiated by weighing risks and benefits for the individual patient. – Women 35 years and older should be assessed for cardiovascular risk factors including hypertension, smoking, diabetes, nephropathy, and other vascular diseases, including migraines, prior to OC use. – Shufelt & Bairey Merz, J Am Coll Cardiol. 2009 Jan
V i • o l • a t i o n
What is wrong with classifying family planning supplies as essential medicines?
FDA Drug Safety Communication: Updated information about the risk of blood clots in women taking birth control pills containing drospirenone. [4-10-2012] Based on its review of recent observational (epidemiologic) studies, the U.S. FDA has concluded that drospirenone-containing birth control pills may be associated with a higher risk for blood clots than other progestin-containing pills.
• 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 compared to products containing levonorgestrel or some other progestins. • 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-bayerover-yaz-birth-control-s-57418/
V 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/Safetyn RelatedDrugLabelingChanges/ucm119274.htm
What is wrong with classifying family planning supplies as essential medicines?
V i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines? Mirena (levonorgestrel-releasing IUD) - WARNINGS Sepsis • ...In some cases, severe pain occurred within hours of insertion followed by sepsis within days... Perforation • Perforation or penetration of the uterine wall or cervix may occur during insertion although the perforation may not be detected until some time later...
– http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyRelatedDrugLabelingChanges/ucm119274.htm
V i o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
Mirena (levonorgestrel-releasing IUD) - WARNINGS
Ovarian Cysts • ...Surgical intervention is not usually required. Breast Cancer • ...Two observational studies have not provided evidence of an increased risk of breast cancer during the use of Mirena.
– http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyRelatedDrugLabelingChanges/ucm119274.htm
V i• o l a t i o n
What is wrong with classifying family planning supplies as essential medicines?
IUDs are not safe
– During the use of a copper IUD, menstruation tends to be longer with a greater loss of blood; in 70% of women who use a hormonal IUD oligomenorrhea or even amenorrhoea develops. In the first weeks after IUD insertion, there is an increased risk of pelvic inflammatory disease (PID). • Summary of the practice guideline 'The intrauterine device' from the Dutch College of General Practitioners, 2009 – A World Health Organization multi-centre study established that pelvic inflammatory disease (PID) risk is temporally related to IUD insertion procedures.
– Shapiro, Reprod Health Matters. 2004 May
V i • IUDs are not safe comparing IUD performance in parous vs. o • In 15 studieswomen, nulliparous women had higher rates of nulliparous l expulsion and removals due to bleeding and pain. – Hubacher, Contraception. 2007 Jun perforation is a rare serious a • Uterineseen during insertionyet the IUD.complication and is usually of 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
What is wrong with classifying family planning supplies as essential medicines?
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/
V i o l a t i o n
Unjust Distribution of Benefits & Burdens
REPUBLIC ACT NO. 10354 AN ACT PPROVIDING FOR A NATIONAL POLICY ON RESPONSIBLE PARENTHOOD AND REPRODUCTIVE HEALTH about promoting a program to “achieve equitable allocation of resources” when problems pertaining to lack of “reproductive health” is not as prevalent nor as lifethreatening as our other health problems.
Top Ten Leading Causes of Morbidity and Mortality in Low-Income Countries
(WHO, 2004)
Deaths in millions % of deaths
Lower respiratory infections Coronary heart disease
2.94 2.47
11.2 9.4
Diarrheal diseases
HIV/AIDS Stroke & other cerebrovascular diseases Chronic obstructive pulmonary disease Tuberculosis Neonatal infections Malaria Prematurity and low birth weight
1.81
1.51 1.48 0.94 0.91 0.90 0.86 0.84
6.9
5.7 5.6 3.6 3.5 3.4 3.3 3.2
V i • o l a t i • o n
What is wrong with giving priority to reproductive health ?
“Eight of the 10 leading causes of morbidity in the Philippines are caused by infections:
– Acute lower respiratory tract infection and pneumonia – Acute watery diarrhea – Bronchitis/ bronchiolitis – Influenza – Tuberculosis – Malaria – Acute febrile illness – Dengue fever Among these communicable diseases, pneumonia and tuberculosis continue to be among the 10 leading causes of mortality, causing a significant number of deaths across the country.”
-World Health Organization (WHO) Western Pacific Region Report
V i• o l a• t i o n
What is wrong with giving priority to reproductive health ?
“Financial resources allotted by foreign donors to assist the Philippine Government’s programs could actually be better spent in other pursuits than purchasing contraceptives.”
“It is also of value to demystify our perceptions about the role of contraceptives in women’s health, women’s rights, and healthy families. To equate access to contraceptives with the reduction in maternal morbidity and mortality is simplistic.”
- former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
Philippine Daily Inquirer, 9/20/04
V i o l a t i o n
No person shall be denied information and access to family planning services, whether natural or artificial: Provided, that minors will not be allowed access to modem methods of family planning without written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage
V i • o l a t i o n
What is wrong with access to reproductive health goods and services? Indiscriminate access to reproductive health goods and services without full disclosure of the potential for post-fertilization effects of hormonal contraceptives constitute a violation of informed consent.
– The available evidence supports the hypothesis that when ovulation and fertilization occur in women taking oral contraceptives (OCs), post-fertilization effects are operative on occasion to prevent clinically recognized pregnancy.
Oral contraceptives directly affect the endometrium. These effects have been presumed to render the endometrium relatively inhospitable to implantation or to the maintenance of the preembryo or embryo prior to clinically recognized pregnancy.
» Larimore & Stanford, Archive of Family Medicine, Feb 2000
V i • o l a t i o n
What is wrong with access to reproductive health goods and services?
Women who believe that human life begins at fertilization and those who consider it is important to distinguish between natural and induced embryo loss are less likely to consider the use of a method with post-fertilization 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 consider using a method that may work after fertilization but before implantation and 57% would not consider using one that may work after implantation. » 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, 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
A l t e r n a t i v e
Fertility control should…
• • • • • • Be reliable Be harmless Be immediately reversible Be inexpensive Not detract from the pleasure of sexual intercourse Encourage a good emotional and sexual relationship between partners • Be due to the existence of a serious motive for avoiding the birth of another child e.g., illness in the mother or children (genetic disorders), extreme poverty, etc. • Be respectful of the Moral Law, while searching for the most adequate means of avoiding births
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
Shao-Zhen QIAN et al, 2003
• 32% of infertile couples give birth
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
