For a long time, the Roman Catholic Church in the Philippines, and politicians who support the church’s oppositional stance towards reproductive health, thwarted the passage and implementation of the Responsible Parenthood and Reproductive Health Act of 2012. In a country where abortion is illegal, the Reproductive Health Act guarantees ‘universal access to medically safe, non-abortifacient, effective, legal, affordable and quality reproductive health care services, methods, supplies and devices’, including treatment for post-abortive complications and contraceptives ‘which do not prevent implantation of a fertilized ovum’. It also mandates raising public awareness on reproductive health especially among adolescents, including how to protect themselves against sexual abuse and violence.
After finally passing in 2012, the Reproductive Health Act stalled in the Supreme Court due to pleas to reverse it. But in April the Supreme Court dismissed these efforts. Now, for the first time, 9.1 million Filipinos will receive sex education in public schools, free contraceptives (for marginalised populations) and safe, post-abortive care.
Sex education in public schools has particularly spurred debate. The Roman Catholic Church in the Philippines argues that instead of having sex education in schools, the Philippines can more effectively reduce poverty by eliminating government corruption and creating jobs for all. Despite the church’s stance, 70 per cent of the Philippines’ population supported the Reproductive Health Act, despite 80 per cent of the population being Catholic.
Due to a lack of employment opportunities, Filipino workers have sought work abroad to support their families, often leaving their children behind in the Philippines. This dynamic has led to teen pregnancy and single parenthood for some youths. Teen pregnancies in the Philippines have more than doubled over the past 10 years, according to a recent study.
Currently, over 50 per cent of the Philippines population is under 18 years old. Poverty, and a lack of knowledge about how to reduce sexual risk and pregnancy, has made young women more vulnerable to sex trafficking and forced thousands to flock from rural areas to cities. Many have ended up in the sex trade (for example amongst the approximately 2000 female bar and spa workers in Quezon City, Metro Manila) as a way to support their families and children.
Equally alarming, HIV among youth increased ten-fold in the Philippines in 2013, compared to 2006. The HIV crisis is especially affecting young men and men who have sex with men. In 2012, the Philippines was one of only nine countries worldwide with a rise in HIV. Age-appropriate sex education, especially around tolerance, sexual risks and the correct use of condoms as well as other contraceptives, could make a dramatic difference in curbing HIV infections and population growth.
In a 2013 survey I undertook in Metro Manila of 100 males and females in the sex trade, only 20 per cent of male and 20 per cent of female street sex workers and 65 per cent of venue-based female bar or spa workers ever received a HIV test. Over half had children: 18 per cent had a child under 18 years and 22 per cent had three or more children. Sixteen per cent had used drugs in the previous three months and 59 per cent had experienced sexual or physical violence from clients. They underwent a brief HIV sexual risk reduction intervention that integrated reproductive rights training — a model that could be implemented in both the formal and informal educational sectors.
The Philippines must now decide on how to implement sex education not only in schools but also for out of school youth and high risk populations, such as those engaged in substance use and the sex trade. One thing is certain — the Reproductive Health Act has enormous potential to impact population growth and minimise sexual risk, but only if it is implemented. For this to happen, the country must first agree upon a sex education curriculum. Next, lawmakers and educational institutions at local government levels must back its implementation.
Dr. Lianne Urada is an Assistant Professor in the Division of Global Public Health, UC San Diego.