New President, New Foreign Policy Changes Would Improve Women's Lives

Historically speaking, the ties that bind the US and the Philippines are a complex web of many relations. More than political, socio-economic or even cultural, many of those ties are also personal. Over four million Filipino migrants live in the United States, making up approximately forty-four percent of the estimated nine million migrant Filipino population. Because of these ties, Filipinos take a special interest in US politics, not as mere spectators but also as a barometer of sorts for local trends and politics.  Unquestionably, the results of the 2008 US presidential election will affect reproductive health policies in the Philippines. 

In fact, if there is one sure thing a change in administration in the US can affect in the Philippine situation, it would have to be the area of reproductive health care. Recently, the US financial crisis has even been used as an excuse by the opposition to delay reproductive health legislation. But more than any direct or causal effect, any change in US politics which can revitalize support for bodies like the United Nations Population Fund (UNFPA), and reorient the policy frame of the USAID, will go a long way in creating more breathing space for local reproductive health advocacy.  

The Bush administration continuously withheld committed funds to the UNFPA since 2001 (which by June 2008 totalled $235 million) and its conservative policies on sex education, abortion and prostitution, have made their way into policies connected to aid, such as the prostitution pledge in the PEPFAR and the revival of the Mexico policy, or global gag rule, which prohibits grantee institutions from supporting any pro-choice position.  

Meanwhile, in the halls of Philippine Congress today, proponents of the reproductive health care act are working to pass the draft bill and as usual, the influential Catholic hierarchy is putting up a stiff opposition. But supporters of reproductive health (RH) legislation are also gaining ground and there is a strong possibility that the bill might make it out of Congress this time around. Part of the package of RH care in the bill addresses the provision of universal access to family planning methods. 

At its height, USAID's aggressive contraceptive donations to the Philippines reached an all time high of 100 million cycles of pills worldwide on an annual basis, beginning 1973. These donations continued for over thirty years, beginning with an end to condom donations in 2002; pills in 2003; and then finally Intra-Uterine Devices by 2008. Since the USAID phase-out, many NGOs and advocates in the local reproductive health movement have also been actively engaging local governments to step up financing family planning supplies, especially since the current national government under Gloria Macapagal Arroyo has refused to allocate a budget for contraceptives. 

Arguably, this debacle over the government budget on family planning and RH care is an issue of local politics, and mainly due to Arroyo's staunchly conservative Catholic position on only supporting natural family planning to the exclusion of all other methods. Many note that her position has kept the Roman Catholic hierarchy at bay in terms of joining movements calling for her impeachment and resignation after evidence of cheating in the 2004 Presidential elections was discovered.  

In the Philippine context, however, the realization of reproductive health care will take more than a policy enactment. For many years now, primary health care, including the important referral chains on which a system of quality reproductive health services depends, have been threatened. Under the auspices of a highly contested "health sector reform" agenda, public hospitals have been privatized and the cost of health care (which arguably has always been high in the Philippines), is soaring. The cost of medicine is likewise relatively high in the Philippines and while the social security package of health care for employed Filipino members (Philhealth) has been extended to include a family planning service like tubal ligation, it does not, however, mean that the service is always accessible nor available in provincial hospitals.  

In recent years USAID has also been involved in various aspects of health sector reform (HSR) in the Philippines. Among its most recent projects is support for a "contraceptive self reliance" (CSR) policy in which local governments are engaged to secure contraceptive availability in their jurisdictions. This policy direction is in line with the decentralization of health care delivery which was officially ushered in by the Local Government Code in 1991.  

While "health sector reform" is a highly contested issue, more often than not, the equity goals in the Philippine HSR have been at odds with the very market-oriented approaches that have been undertaken under the same agenda. The USAID promoted CSR for instance can address contraceptive availability at the local level but it does not really make it sustainable or affordable because prices remain high since each local government unit has to haggle for its purchases.  

Furthermore, this scheme of marketization in health under the CSR positions people not as patients and system members but as mere "consumers" and "purchasers" of contraceptives and the local government as a supplier of products and not necessarily of health care. In the end, the absence of a coherent policy framework which puts contraceptive availability in the context of holistic reproductive health care as a human right makes the reform and equity goals behind HSR seem like doublespeak. 

Without a doubt, the results of the 2008 US Presidential elections will have an impact on the Philippines. While it isn't likely that the effect will be anything immediate or necessarily revolutionary, any reversal of the conservative political frame reflected in the outgoing Bush administration's policies, will certainly be most welcome. It won't solve any of our problems. But a pro-women's rights position by the White House will certainly create much needed breathing room for advocates to be able to work more effectively for RH care in the country.