REPRODUCTIVE HEALTH ACT:

ACT: MEDICAL & ETHICAL ISSUES

By Maria Fidelis C. Manalo, MD, MSc.1

1Consultant and Faculty, Department of Community & Family Medicine, Far Eastern University - Nicanor Reyes
Medical Foundation, Fairview, Quezon City 1119, Philippines. Email: mcmanalo@feu-nrmf.ph

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 It is the objectives of this position
paper: 1) to increase the awareness and
sensitivity of medical students and
practitioners to ethical problems that they
confront as they render reproductive health
care; 2) to develop an understanding of
bioethical concepts and principles and be
able to apply them in the analysis of
bioethical issues in reproductive health care;
and 3) to help readers to develop a mature
reasoning and to act according to sound
ethical judgment.
There are many instances when
healthcare matters require an ethical
approach. We cannot follow the principle:
“Everything that can be done ought to be
done.” Medical practice is subject to certain
ethical limitations.
Human dignity must be the central
value for the financing of development. A
true concern for the development of peoples
cannot afford to be reductionistic, but must
respect the genuine claims of both
economics and morality.
Such an authentic concern must
prize the close relationship between the
centrality of the human person and
economic activity, stressing the subjective
character of human work and its place in
human creativity.
The matter of Reproductive Health
Care and the provisions of the house bills
pertaining to it will be evaluated based on
the following bioethical principles:
beneficence & non-maleficence, justice and
autonomy.
PRINCIPLES OF BENEFICENCE AND
NON-MALEFICENCE
The bioethical principles of
beneficence and non-maleficence require of
health service providers to do things for the
patient’s benefit and to avoid doing him
harm. The Hippocratic Oath says thus: “I
will use treatment to help the sick according
to my ability and judgment, but will never
use anything to injure or wrong them.” The
health care professionals have the duty to do
or promote good and the duty to remove or
prevent evil or harm.
1. Reproductive Health and Population
and Development Act of 2010 (House Bill
HB 96 and Senate Bill SB 2378) is about
education & promotion of safe sex and
use of modern contraceptive devises.
(Sec. 13, Mandatory Age-Appropriate
Reproductive Health and Sexuality
Education, HB 96 and SB 2378)
What is wrong with “safe sex” and the use
of contraceptives?
1. Contraceptives are not effective in
blocking out STDs.
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 AIDS virus is about 0.1 micron in
size. An AIDS virus can pass through a latex
flaw. (Dr. C. Michael Roland of the U.S.
Naval Research Lab, Washington D.C,
Rubber World, June, 1993)
The greater danger of infection lies
in the propensity of condoms to burst, tear
and slip off frequently. (Brian Clowes,
http://www.lifeissues.net/)
There is no absolute guarantee that
one will not get sexually transmitted
diseases (STDs) and HIV even when
condom is used.
Most experts believe that the risk of
getting HIV/AIDS and other sexually
transmitted diseases can be greatly reduced
if a condom is used consistently and
correctly. In other words, sex with condoms
isn't totally "safe sex," but it is "less risky"
sex. The most reliable ways to avoid
transmission of STDs are to abstain from
sexual activity, or to be in a long-term
mutually monogamous relationship with an
uninfected partner. (Centers for Disease
Control (CDC) & US FDA)
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2. Some contraceptives are abortifacient.
Birth control pills are synthetic
steroid hormones that mimic the way real
estrogen and progestin works in a woman's
body. The pill prevents ovulation - no new
eggs are released by a woman on the pill
since her body is tricked into believing she
is already pregnant.
Although the primary mechanism of
oral contraceptives (OC) is inhibition of
ovulation, other alterations include changes
in the cervical mucus, which increase the
difficulty of sperm entry into the uterus, and
changes in the endometrium, which reduce
the likelihood of implantation. (Physicians’
Desk Reference & Drug Facts and
Comparisons)
"Family planning" experts have
always recognized that the high failure rate
of contraceptives would lead to more
abortions.
Oral contraceptives (OCs) have a
method failure rate of 0.3 % and user failure
rate of 8% during the first year. As such, if a
woman uses the combined pill or the
minipill, she has a 34% chance of an
unintended pregnancy in five years and a
57% chance of a pregnancy in 10 years.
Abortion statistician Christopher
Tietze stated that: "The safest regimen of
control for the unmarried and for married
child-spacers is the use of traditional
methods [of contraception] backed up by
abortion; but if this regimen is commenced
early in the child-bearing years, it is likely to
involve several abortions in the course of
her reproductive career for each woman who
chooses it." (Brian Clowes, The Facts of
Life, http://www.hli.org/)
Many women present for
“emergency contraception” following
consensual but unprotected sexual
intercourse and in some cases aggravated
sexual assault. Hormonal emergency
contraception (morning-after pill or Yuzpe
method) is supposed to substantially
decrease the likelihood of an unwanted or
unintended pregnancy when taken within
24-72 hours of unprotected intercourse.
Similar to the other hormonal
contraceptives, the major mechanism is
inhibition or delay of ovulation (US Food
and Drug Administration, 1997). Other
mechanisms include sperm penetration,
tubal motility, and alteration of the
endometrium (post-fertilization effect).
Established pregnancies are supposedly not
harmed. (Williams Obstetrics, 22nd Ed,
2005)
EllaOne – a new five day morning-
after pill that claims to be ‘emergency
contraception’ – can in fact act as an
abortion-inducing drug. It can prevent an
embryo from receiving nourishment from its
mother’s womb, thereby aborting the
pregnancy. The drug’s chemical
composition and function are nearly
identical to a commonly used abortion drug
known as RU-486. The drug has been on
sale in the UK for a year and has been
approved by the US Food and Drug
Administration earlier this year.
(Lifesitenews.com, 18 October 2010)
“In IUD users, the low recovery of
ova from the uterus, as well as the lack of
hCG rise in more recent studies of IUD
users, suggest that the major postfertilization
effect is destruction of the early embryo in
the Fallopian tube, in the same way that the
major prefertilization effect is likely to be
destruction of sperm and ova.
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 through the
Fallopian tube, along with prevention of
implantation, preventing long-term viability
of the embryo.” (Stanford and Mikolajczyk,
American Journal of Obstetrics &
Gynecology, December 2002)
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3. Contraceptives harm the body in
numerous ways. (see Table 1)

Table 1. Adverse Effects of Contraceptive Methods

Contraceptive Adverse Effects

Methods
Oral contraceptives increased risk of thromboembolic disorders (deep vein thrombosis,
pulmonary embolism), stroke, hypertension, increased risk of
myocardial infarction in smokers, migraine headache, aberrations in the
levels of several nutrients, stimulatory effect on some cancers, other
metabolic effects

Injectable same as oral contraceptives

Contraceptives
(Depo-Provera) and
Progestin Implants
(Norplant)

Hormonal nausea and vomiting

Emergency
Contraception
(morning-after pill or
Yuzpe method)

Intrauterine devices • uterine perforation and abortion, uterine cramping and bleeding,
(IUDs) menorrhagia, infection, ectopic pregnancies;

• if there’s pregnancy with IUD in utero – late abortion, sepsis,

preterm birth

Mifepristone (RU • effective up to 17 days after intercourse (Weiss, 1993)

486)
• nausea, vomiting, gastrointestinal cramping, hemorrhage due to
partial expulsion of pregnancy, intra-abdominal hemorrhage from
an early unsuspected ectopic pregnancy

Tubal sterilization anesthetic complications, inadvertent injury of adjacent structures,

pulmonary embolism (rare), failure to produce sterility with subsequent
development of ectopic pregnancy

Vasectomy an almost twofold risk of prostatic cancer in men less than 55 years old
(Lesko et al, 1999)

(Williams Obstetrics - 22nd ed (2005) – McGraw Hill Professional)

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 The best evidence continues to
suggest that the increased risk of
cardiovascular side effects (especially
venous thromboembolism or VTE,
manifesting as deep venous thrombosis of
the leg or pulmonary embolism), in oral
contraceptive (OC) users is a class effect,
dependent on the estrogen dose and duration
of use, and independent of the progestogen
used. (Shapiro & Dinger. J Fam Plann
Reprod Health Care. 2010 Jan)
use. The risk clearly differed by type of
progestogen and dose of estrogen. (van
Hylckama Vlieg, British Medical Journal,
2009)
2. Reproductive Health and Population
and Development Act of 2010 is about
classifying making family planning
supplies as essential medicine
(Sec. 9, Family Planning Supplies as
Essential Medicines, HB 96 and SB 2378)

In a national cohort study in

Denmark from 1995 to 2005 involving
Danish women aged 15-49 with no history
of cardiovascular or malignant disease, a
total of 4,213 venous thrombotic events
were observed, 2, 045 of which were in
current users of oral contraceptives. The
overall absolute risk of VTE per 10 000
woman years in current users of oral
contraceptives was 6.29, vs. 3.01 in non-
users. (Lidegaard et al, British Medical
Journal. 2009 Aug)
In a population based case-control
study in the Netherlands of 1,524 patients
and 1,760 controls, involving
premenopausal women <50 years old who
were not pregnant, not within four weeks
postpartum, and not using a hormone
excreting intrauterine device or depot
contraceptive, results showed that currently
available oral contraceptives increased the
risk of VTE fivefold compared with non-
Table 2. Criteria for Drug Selection into Essential Drug List & National Drug Formulary
What is wrong with classifying family
planning supplies as essential medicines?
The National Drug Committee, the body in
charge of developing the Formulary,
followed a systematic process in deciding on
the drugs list. With the support of the Action
Programme on Essential Drugs, guidelines
were first developed in 1990 for selecting
drugs, based on the WHO Technical Report
Series No.825, The Use of Essential Drugs.
Criteria included relevance to prevalent
diseases, efficacy and safety and quality. In
cases where national standards are not
established, the WHO Certification Scheme
on the Quality of Pharmaceutical Products
Moving in International Commerce is
requested. The cost of treatment regimen is
also taken into account, as are the
capabilities of health workers at different
levels of health care; and benefit/risk ratio
(see Table 2).

Criteria
Relevance to disease indicated in the treatment of prevalent diseases
Quality must meet adequate quality control standard including stability and
when necessary bioavailability; compliance with WHO
Certification Scheme on the Quality of Pharmaceutical Products
Moving in International Commerce – product manufactured in
accordance with CGMP and records whether or not the product has
been approved for marketing in the country of origin.
Cost of treatment regimen
Appropriateness to the capability
of health workers at different
levels of health care.
Local health problems
Benefit/Risk ratio

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 Most normal, low-risk pregnancy,
per se, is not a disease, and as such does not
need medicines, except for iron and folic
acid-multivitamin supplementation. Hence,
the only “essential” medicines during
pregnancy would be ferrous sulfate and folic
acid-multivitamins.
Hormonal contraceptives (and
injectables) are not safe, as has already been
shown by meta-analysis of case-control
studies. Use of oral contraceptives (OCs)
was associated with almost twofold
statistically significant increased risk of
premenopausal breast cancer in general and
across various patterns of OC use. The
association between OC use and breast
cancer risk was greatest for parous women
who used OCs 4 or more years before first
full term pregnancy. (Kahlenborn et al,
Mayo Clinic Proceedings. 2006).
Contraceptive hormone use is linked
to cardiovascular disease. Newer generation
oral contraceptives (OC) indicate a
persistent increased risk of venous
thromboembolism 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)
Depot medroxyprogesterone acetate
(DMPA) suppresses pituitary gonadotrophin
output, thus, suppressing ovulation.
Estrogen production from the ovary is also
strongly inhibited, and the resulting estrogen
deficiency has a detrimental impact on bone.
DMPA may be particularly detrimental in
young women, as it may impede attainment
of peak bone mass. (Albertazzi et al,
Contraception. 2006 Jun) DMPA use
seemed to be associated with a statistically
significant increased risk of fractures, in a
case control study among Danish women
(Vestergaard et al, Contraception. 2008
Dec)
Intrauterine devices (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)
In 15 studies comparing IUD
performance in parous vs. nulliparous
women, nulliparous women had higher rates
of expulsion and removals due to bleeding
and pain. (Hubacher, Contraception. 2007
Jun)
Uterine perforation is a rare yet
serious complication and is usually seen
during insertion of the IUD. (Koltan et al, J
Chin Med Assoc. 2010 Jun) There are about
70 cases in the literature of IUDs that have
migrated into the bladder. The resulting
bladder perforation can be complete or
partial. (Istanbulluoglu et al, J Chin Med
Assoc. 2008 Apr) There is a reported case of
a colon penetration by a copper IUD.
(Arslan et al, Arch Gynecol Obstet. 2009)
Various contraceptive methods or
reproductive patterns may play a role in the
etiology of cancer. There is an association of
contraceptive methods, including oral
contraceptives (OC) and tubal sterilization
(TS), with overall and site-specific cancer.
In a large prospective cohort study from
1996 to 2006 of 66,661 Chinese women in
Shanghai, 76.7% of whom used
contraception, 2,250 women were diagnosed
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with cancer during a median follow-up time
of 7.5 years. Use of any contraceptive
method was associated with increased risk
of rectal cancer and reduced risk of thyroid
cancer. Risk of gallbladder cancer increased
with ever use of oral contraceptives (OC).
Ever having a tubal sterilization (TS) was
associated with increased uterine body
cancer and decreased risk of stomach
cancer. There are no findings of any
contraceptive method being related to the
risk of ovarian cancer but the analyses were
based on few events. (Dorjgochoo et al, Int
J Cancer. 2009 May)
PRINCIPLE OF JUSTICE
The principle of justice includes
respect or recognition of a right that belongs
to others, either to God or to fellowmen. It
demands giving to others what is due them.
Distributive justice is the aspect of
justice that pertains to a fair scheme of
distributing society’s benefits and burdens to
its members. The presumed benefits are
receiving medical care and treatment. The
presumed burdens are paying for care and
partaking in experimental research.
3. Reproductive Health and Population
and Development Act of 2010 is about
promoting a program to “achieve
equitable allocation of resources”
(Sec. 3, Guiding Principles, HB 96), when
problems pertaining to lack of
“reproductive health” is not as prevalent
or as life-threatening as our other health
problems.
The government’s health programs
should address and give priority to the top
10 leading causes of morbidity and
mortality. (see Table 3)

Table 3. The 10 leading causes of death by broad income group (2004) according to
the World Health Organization

Low-income countries 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 and 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

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What is wrong with giving priority to
reproductive health?
In the Philippines, eight of the 10
leading causes of morbidity are caused by
infections. They are: acute lower respiratory
tract infection and pneumonia; acute watery
diarrhea; bronchitis/ bronchiolitis; influenza;
tuberculosis; malaria; acute febrile illness;
and 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)
Former Department of Health
(DOH) Secretary Dr. Manuel M. Dayrit, has
commented: “While we have all become
accustomed to the longstanding situation in
which donated contraceptives were widely
distributed free-of-charge, this may not
necessarily have been the best approach for
the nation to take in addressing the needs of
the people. Statistics will show that the
prevalence of contraceptive use has long
since leveled off, and there is really no
massive clamor among the Filipino people
to have more and more free contraceptives.
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.” (Philippine Daily Inquirer,
9/20/04)
The principle of justice demands
equal distribution of burdens. Justice
demands that giving undue burden to an
individual requires his informed consent, he
must understand what is involved in the
burden and voluntarily accept it. Often it
involves the virtue of charity. However,
should the reproductive health bill be passed
into a law, it will guarantee universal access
to health care services, methods, devices and
supplies. If efforts are not made to ensure
informed consent from the prospective users
of artificial contraceptives, eventually, it
will be the poor and uneducated who will
suffer more from the burden of their adverse
effects. The rich and the educated would
know better.
When did the birth control
movement begin? It began during the late
18th century, when people started
questioning the earth's ability to sustain a
large population. Prior to the 1800s, the
death rate had offset the birth rate, so the
overall population of the Earth remained the
same. However, scientific advances during
the 18th and 19th centuries resulted in better
food supplies, control of diseases, and safer
work environments for people living in
developed countries. The result of these
advances were longer life spans and an
increase in the world's population. Thus
birth control came to be regarded as a
solution to overpopulation.
In the early 1900s Margaret Higgins
Sanger (1883–1966) founded what became
known as the birth control movement in the
United States. While working as a nurse in
the poor neighborhoods of New York
City, she came to be aware of the effects of
unplanned and unwelcome pregnancies. Her
mother's health had suffered as she bore
eleven children. She came to believe in the
importance to women's lives and women's
health of the availability of birth control, a
term which she's credited with inventing. In
1912, Sanger gave up nursing work to
dedicate herself to the distribution of birth
control information. In 1916, Sanger set up
the first birth control clinic in the United
States. In 1927 Sanger helped organize the
first World Population Conference in
Geneva. During the 1930s, it was discovered
that hormones prevented ovulation in
rabbits. In 1950, while in her 80s, Sanger
underwrote the research necessary to create
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the first human birth control pill. Sanger
raised $150,000 for the project. The birth
control pill was introduced to the public in
the early 1960s.
According to Dr. Alan F.
Guttmacher, president of the Planned
Parenthood World-Wide Association, it was
Mrs. Sanger who convinced America and
the world that control of conception is a
basic human right and like other human
rights must be equally available to all.
Sanger's American Birth Control League,
established in 1921, became the Planned
Parenthood Federation of America in 1946
and led to the establishment of more than
250 Planned Parenthood Centers in 150
cities throughout the country. The
movement is now worldwide, with 38
member organizations and projects in 88
countries. Planned Parenthood is the largest
abortion provider in the world.
The eugenics circle held that some
races and individual members of the human
species were genetically superior to others
These superior members should be
encouraged to reproduce, while the births of
inferior members such as the poor or
minorities were to be regulated. Their
ultimate solution to the problem of poverty
was simple: Eliminate the poor.
In Birth Control Review May 1919,
Sanger wrote, "More children from the fit,
less from the unfit - that is the chief aim of
birth control." The Birth Control Review
November 1921 edition declared, "Birth
control: to create a race of thoroughbreds."
Sanger outlined her philosophy in
her 1922 book Pivot of Civilization. In it she
sharply criticized philanthropists who
provided free maternity care to poor
mothers. According to Sanger, these acts of
generosity "encourage the healthier and
more normal sections of the world to
shoulder the burden of unthinking and
indiscriminate fecundity of others; which
brings with it, as I think the reader must
agree, a dead weight of human waste.
Instead of decreasing and aiming to
eliminate the stocks that are most
detrimental to the future of the race and the
world, it tends to render them to a menacing
degree dominant.
The founder of Planned Parenthood
saw contraception, sterilization and
eventually abortion as the panacea for
eliminating all human suffering. In
Margaret Sanger: Father of Modern
Society, author Elasah Drogin observed:
"Through the 284 pages of Pivot of
Civilization, there is not one word written
about fair labor laws, fair housing
requirements, a more equitable distribution
of wealth, or even the simple responsibility
of caring for one's neighbor."
Sanger's disdain for certain
members of society was not confined to the
poor, whom she often referred to as "human
weeds." It targeted minorities such as
blacks. In a private letter to Clarence
Gamble dated Oct. 19, 1939, she revealed
her ultimate goal toward blacks and how it
could best be attained. "The most successful
educational approach to the Negro is
through a religious appeal," she wrote. "We
do not want word to go out that we want to
exterminate the Negro population, and the
minister is the man who can straighten out
that idea if it ever occurs to any of their
more rebellious members."
The following lines from Pivot of
Civilization allow a particularly telling
glimpse of Sanger's "compassion" and her
motives. "Remember our motto: if we must
have welfare, give it to the rich, not to the
poor . ... We are paying for and even
submitting to the dictates of an ever-
increasing, unceasingly spawning class of
human beings who never should have been
born at all."
Sanger's views naturally led her to
strike out against the institution of marriage
and the family. "The marriage bed," she
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wrote, "is the most degenerating influence in
the social order." Sanger advocated instead a
"voluntary association" between sexual
partners. She thus sought to supplant the
family as the most fundamental unit of
society with relationships directed toward
the sexual gratification of cooperating
individuals. (Walter Schu, National
Catholic Register, May, 1999)
Are the proponents and supporters
of the Reproductive Health Bills aware of
these historical facts?
PRINCIPLE OF AUTONOMY
The principle of autonomy upholds
the patient’s option to choose based on
respect for his free will. A patient has the
moral right, as an individual person, to
determine what is good for himself. This
right of self-determination include the right
to informed consent, informed decision,
informed choice and the tight to refusal of
treatment. It is the duty of the physician to
perform or omit an action corresponding to
the patient’s right.
The rights to informed consent,
decision and choice guarantees the patient’s
right to receive all necessary information
concerning diagnosis and medical
intervention, before that treatment is
administered, in order to be able to give
willing and uncoerced consent based on
his/her value system. The elements of
informed consent include disclosure by the
health professional of the nature of the
intervention, its expected risks, and benefits
and alternatives available, comprehension,
and competence of the patient .
According to the Patient’s Bill of
Rights: “The patient has the right to refuse
treatment to the extent permitted by law and
to be informed of the medical consequences
of his action.” A patient may refuse medical
treatment because their religious convictions
prohibit them from doing so.
4. Reproductive Health Population and
Development Act of 2010 is about
ensuring people’s access to medically safe,
legal, effective, quality and affordable
reproductive health goods and services.
(Implementing Mechanisms, Sec. 20, HB
96 AND Sec. 17, SB 2378)
What is wrong with access to reproductive
health goods and services?
Former Department of Health
(DOH) Secretary Dr. Manuel M. Dayrit,
MD is known to have commented: “Equally
flawed is the much-publicized argument that
women are accorded the rights they deserve
when they are made to use contraceptives.
Majority of women who use these products
are not wholly aware of the many effects
they have on their health and lives, and of
the other approaches that are available to
them. It is our belief that women’s rights,
reproductive rights, and the right to health
could only be realized within an
environment of informed choice.”
(Philippine Daily Inquirer, 9/20/04)
Indiscriminate access to
reproductive health goods and services
without full disclosure of the potential for
post-fertilization effects of hormonal
contraceptives constitutes 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)
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 Indiscriminate access to What are the arguments and the evidence on
reproductive health goods and services abstinence only vs. comprehensive sex
without full disclosure of the potential for education programs?
post-fertilization effects of hormonal
contraceptives constitute a violation of the
patient’s right to refuse treatment.
Comprehensive Sex Education
Physicians should understand and
respect the beliefs of patients who consider or “Abstinence-Plus” Education:
human life to be present and valuable from
Includes discussions of issues such as
the moment of fertilization. Patients should
perception of personal risk, costs and
be made fully aware of this information so
benefits of preventive behaviors, sexual
that they can consent to or refuse the use of
decision making, refusal skills, and condom
oral contraceptives. (Larimore & Stanford,
use for safe sex
Archive of Family Medicine, Feb 2000)
Explores the context for and meanings
Women who believe that human life
involved in sex
begins at fertilization and those who
consider it is important to distinguish Acknowledges that many teenagers will
between natural and induced embryo loss become sexually active
are less likely to consider the use of a
method with post-fertilization effects. Teaches and promotes contraception
In a cross-sectional survey of 755 Discussion topics include substance abuse,
women, aged 18-49, from Primary Care contraception, abortion, and AIDS/STDs
Health Centers in Pamplona, Spain, 40% of
women would not consider using a method Emphasizes avoidance of unprotected sex
that may work after fertilization but before through abstinence or using protection
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 Abstinence Education:

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)
5. The Reproductive Health and
Population and Development Act of 2010
is about mandatory age-appropriate
reproductive health and sexuality
education. (Sec. 13, HB 96 and SB 2378).
Includes discussions of values, character
building, and, in some cases, refusal
skills
Encourages abstinence from high-risk
behavior, including sexual activity
Discussion topics include friendship,
love and dating, self-respect, decision-
making, alcohol abuse, drug abuse,
physical fitness and nutrition, and
AIDS/STDs

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What is wrong with age-appropriate
mandatory reproductive health and
sexuality education?
The harmful effects of early sexual
activity are well documented. They include
sexually transmitted diseases, teen
pregnancy, and out-of-wedlock
childbearing.
As well, teen sexual activity is
linked to emotional problems, such as
depression, and increased risk of suicide.
Abstinence education programs,
which encourage teens to delay the onset of
sexual activity, are effective in curbing such
problems.
Opponents of abstinence education,
however, claim that abstinence programs
don’t work and that there has been “no
scientific evidence that abstinence programs
are effective.” (Pardue, Web Memo, May
2005)
The ill effects of sex education
programs that merely promote "safe sex"
were made evident in a study published in
2004. In England, the government’s Teen-
Age Pregnancy Unit’s strategy involves
explicit sex education in schools, often
conducted by nurses without teachers
present. It also hands out free condoms and
send birthday cards when girls reach 14
asking them to attend confidential health
checks without their parents. In Scotland,
sex education programs were introduced to
distribute free morning-after pills and
condoms. These approaches have failed to
tackle the rise in STDs, unwanted
conceptions, and abortion levels.
(“Abstinence education shows its wisdom,”
zenit.org, Oct 9, 2004)
At least 10 studies have shown the
positive effects of abstinence programs.
The study by Dr. Robert Lerner
published in the Institute for Youth
Development’s peer-reviewed journal
Adolescent & Family Health in 2004
evaluated the effectiveness of the Best
Friends abstinence education program which
began in 1987 and currently operates in
more than 100 schools across the United
States. Its curriculum consists of a
character-building program for girls in the
fifth or sixth grade, including at least 110
hours of instruction, mentoring, and group
activities throughout the year. A companion
program for boys, Best Men, began in 2000.
Junior-high and middle school-aged
girls who participated in the Best Friends
program, when compared to their peers who
did not participate, were:
• Six-and-a-half times more likely to
remain sexually abstinent;
• Nearly two times more likely to
abstain from drinking alcohol;
• Eight times more likely to abstain
from drug use; and
• Over two times more likely to
refrain from smoking
In an analysis of the causes of the
decline in non-marital birth and pregnancy
rates for teens from 1991 to 1995, increased
abstinence among 15- to 19-year-old teens
accounted for at least two-thirds (67%) of
the drop in teen pregnancy rates. Increased
abstinence also accounted for more than half
(51%) of the decline in teen birthrates.
(Mohn et al, Adolescent and Family Health,
April 2003)
In a study looking at the changes in
sexual behaviors among high school
students and the decline in teen pregnancy
rates in the 1990’s, results showed that 53
percent of the decline in teen pregnancy
rates can be attributed to decreased sexual
experience among teens aged 15- 17 years
old, while only 47 percent of the decline is
attributed to increased use of contraception
among teens. (Santelli et al. Journal of
Adolescent Health, August 2004)
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 In a poll on what parents want taught in
sex education programs, the overwhelming
majority of parents (91%) want schools to
teach that adolescents should be expected to
abstain from sexual activity during high
school years. Only 7 percent of parents
believe that it is okay for teens in high
school to engage in sexual intercourse as
long as they use condoms, which is the
predominant theme of “comprehensive” sex
education. (Rector et al, Backgrounder,
January 2004)
Teens themselves welcome the
abstinence message and appear to be
heeding it.
A poll by the National Campaign to
Prevent Teen Pregnancy found that a clear
majority of adolescents (69%) agree that it is
not okay for high school teens to engage in
sexual intercourse. (With One Voice,
December 2004)
The Centers for Disease Control’s
(CDC) Youth Risk Behavior Survey
(YRBS) shows that the number of teens who
have ever had sexual intercourse has fallen
seven percent in the last 12 years, from 54
percent in 1991 to 46 percent in 2003.
(“Youth Online: Comprehensive Results”
http://apps.nccd.cdc.gov/yrbss)
Summary of the Evidence &
Recommendations
The available evidence as presented
supports the valid opposition of those
against the Reproductive Health and
Population and Development Act of 2010 on
the grounds that the provisions of the RH
Bill as such could constitute violations of
the bioethical principles cited and the
practice of sound medicine on the part of the
health service providers.
Physicians and policy makers
should understand and respect the beliefs of
patients who consider human life to be
present and valuable from the moment of
fertilization.
Since the State, in accordance with
the provisions of the Philippine constitution,
recognizes and guarantees the exercise of
the universal basic rights of every man,
including that of the unborn, regardless of
gender, religious convictions and cultural
beliefs, then major amendments to the
proposed RH Bill have to be made before
they can even be deliberated upon by our
lawmakers, much less approved and passed
as a law.
The end of meeting the Millennium
Development Goals (MDG) by 2015 does
not and cannot justify the means of
providing universal access to reproductive
health care services and methods when these
have not been proven medically safe, legal
and licit in all aspects.
All licensed medical practitioners
swear by the Hippocratic Oath which says:
“I will not accede to pretensions that are
directed to the administration of poison nor
induce to anyone suggestions of the kind. I
will abstain from administering
abortifacients to women. While I continue
keep this Oath unviolated, may it be granted
to me to enjoy life and the practice of the art
and science of medicine with the blessing of
the Almighty and respected by my peers and
society, but should I trespass and violate this
Oath, may the reverse be my lot.”
Indeed, should healthcare providers
trespass and violate the Hippocratic Oath
which abides by the bioethical principles of
beneficence, non-maleficence, justice, and
autonomy when they render reproductive
health care, may the reverse be their lot.
"The moral causes of prosperity ...
reside in a constellation of virtues:
industriousness, competence, order, honesty,
initiative, frugality, thrift, spirit of service,
keeping one’s word, daring -- in short, love
for work well done. No system or social
structure can resolve, as if by magic, the
problem of poverty outside these virtues."
(John Paul II, “Address to the U.N.
Economic Commission for Latin America
and the Caribbean,” April, 1987)
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