The Accessibility of Reproductive Healthcare amidst the COVID-19 Pandemic in the Philippines

Written and compiled by: Jeanina P., Kim J., Vanessa I., Cam S., Olivia A.

Artwork by: Gabriela S., Victoria A., Ally M.

Last July 4, 2020, Amarela Philippines held their first ever webinar, “Amarela Talks No. 1”, through Facebook Live, entitled “The Accessibility of Reproductive Healthcare amidst the COVID-19 Pandemic in the Philippines”. The event was moderated by Jenina Co, the Chairperson of Amarela PH, along with Aly Barranda, Amarela PH’s Co-Chairperson. The speakers for this webinar were Senator Risa Hontiveros, Ms. Samira Gutoc, and Mr. Iori Kato.

Senator Risa Hontiveros is the Chairperson of the Senate Committee on Women, Children, Family Relations, and Gender Equality. She championed fourteen landmark laws, including the historic Expanded Maternity Leave Law, the Philippine Mental Health Law, and the Safe Streets and Public Spaces Law or the “Bawal Bastos Law”. Ms. Samira Ali Gutoc-Tomawis, on the other hand, is the former ARMM legislator and Commissioner of the Bangsamoro Transition Commission. She is a civic and youth leader, a speaker, a journalist, a women’s rights and peace advocate, as well as a receiver of the N-Peace award from the United Nations Development Program. Lastly, Mr. Iori Kato is the representative of the United Nations Population Fund or the “UNFPA” Philippine Country Office. He is known for his wealth of experience in many fields such as strategic planning, gender and human rights issues, humanitarian response, and financial and human resources management.

A round-table discussion was the main agenda for the webinar, and this is how it went:

What are your thoughts on the prioritization of women’s reproductive health now that a pandemic is on the loose?

Sen. Risa Hontiveros acknowledges the challenge to ensure women’s access to responsible parenthood, reproductive health, information, and services. Despite it being an 8-year-old law, it ends up becoming their (Filipinos & Congress) responsibility to remind and criticize different parts of the government that are supposed to ensure that women’s rights under the law are upheld and exercised. This includes the government as a whole, the Department of Health, and Congress. With the ongoing pandemic, it gives the government the opportunity to put aside the concern on sexual and reproductive health when it should be given utmost importance especially during COVID-19; this is to highlight that the vulnerable sectors within the women’s community are at more of a disadvantage as compared to others. Sen. Hontiveros hopes that the hardships our country continues to face up to this day will lead to lessons that we can utilize, wherein we can find more methods to sustain information, supplies, and services to women.

Ms. Samira Gutoc mentions the importance of a comprehensive approach in crisis management, especially the possession and practice of a gender lens. In relation, Reproductive Health services, also known as RH services, are not being dealt with because no one in the task force is championing for it and there is an absence of a gender expert to aid in crafting the budget allocation. This puts RH services at a big disadvantage because due to the small budget and little-to-no support from the task force, it will continuously be put on the back burner until the government can acknowledge their importance. Ms. Gutoc highlights the importance of information, especially in times of the pandemic. It is not enough to protect the frontliners but to empower citizens through education via online channels. This is to allow those who are disabled and crippled to get information in a place that is convenient for them. Additionally, this calls attention to the lack of accessible information on reproductive health, which disables the advocacy.

Mr. Iori Kato states the importance of men to engage in advocacy and dialogue, specifically for women’s rights and gender equality. The question is pertinent to his agency (UNFPA) for the reason that their goal is to attain universal access to sexual & reproductive health and rights for all, by achieving the “Three Zeros” by 2030. This can be achieved through the country ensuring the continuity of essential services such as reproductive health and family planning. Additionally, the government should provide proper medical support, specifically mental and psychosocial support, to maternal frontline workers as they continue to handle the effects of the pandemic. Mr. Kato lastly mentions the need to provide proper reproductive health information to the youth as this will aid in achieving his agency’s goal.

What would you believe is considerably lacking in the system, and if there were any, what could be the possible cause for this?

Opening up the discussion on why there is a flaw in the healthcare system, especially how people overlook women’s rights for safe spaces to properly deliver children, Ms. Samira Gutoc mentions the cultural aspect in the Filipino society, she expresses how we are oriented not to talk about our bodies. “Tayo ay nahihiya pagusapan ang sex”, she says. Even if reproductive and sexual healthcare is meant to be implemented, we do not see it being “properly” practiced or taught. She says that our faith and traditions as Filipinos fail to encourage us to discuss these topics, to the point where we were even taught to accept abuse and violence against our bodies. Given this, Ms. Gutoc brings to light how we should respect our bodies and that consent is important, calling out how men and women should learn to understand if someone does not want to engage in sexual intercourse. Ms. Gutoc expresses how “private” things need to be made public and how education regarding this is important.

Sen. Risa Hontiveros reiterates Ms. Gutoc’s words and says, “What used to be confined only in the bedroom, should be brought to the classroom”, agreeing on the importance of sexual education. She talks about how in assessing the state of our public health system, we focus on the economics and even the politics of it. She then emphasizes how culture is so important to understand where we start from and how to act on it—not only to improve the public health system in times of a pandemic but all throughout— and says that bringing up the role of culture will liberate our worldview and bring health to all. Looking at the economics of the public health system, Sen. Hontiveros introduces how a new landmark law, the Universal Healthcare Law, is in the works for implementation, aimed to shift into a primary healthcare approach to especially cater for those geographically isolated and in the disadvantaged areas that do not have regular health promotions, development of health-seeking habits and regular checkups from doctors and nurses. These are the communities who are far from health facilities just tolerate when they have beginnings of illnesses and ill health, then they are forced to make the extra effort to go to the clinic or the hospital—which is an extra expense—but by that time their illness may have become more serious, making it harder to treat and more expensive. Sen. Hontiveros explains how the Universal Healthcare Law will ensure that all health laws are properly implemented, given that there is a need for improvement in human resources, especially since the ideal doctor to patient ratio is 1:33 but data from 2016 shows that we are short of 15,000 doctors. On the subject of budget, our health programs are not new to budget cuts, such as the epidemiology and disease surveillance who had P263M in 2019 but were reduced to P115M in 2020. She explains that politics plays a role in the underdevelopment of our public health system, and expresses how politicians, activists, advocates are all called upon to exercise political will and participation to turn the government’s attention to really prioritize the health needs of the people.

Mr. Iori Kato then talks about the healthcare institutions in the Philippines, in which he expresses that the Philippines has done impressive achievements in some senses, but it could have been better in others, given the economic status of the country. Although there are said achievements, he states in his presentation that there is a lack in sexual reproductive health information and services, combined with discriminatory socio-cultural practices and limited decision-making power, and even sexual/gender-based violence, preventing the full exercise of sexual and reproductive health rights. Sir Iori expounds on how there is a problem in the implementation of programs for Responsible Parenthood and Reproductive Health, due to the insufficient financial human resources at a local level, as well as the insufficient participation and empowerment of women themselves in the decision-making and monitoring of the implementation.

Do you know of any accessible health care services for women amid this pandemic?

To start the discussion, Sen. Risa Hontiveros briefly shares four health care services that she knows of. These services are Likhaan Clinics, Roots of Health, Lunas Collective, and International Justice Mission (IJM). [For more information, you may visit their respective Facebook page or refer to the webinar consolidation pub posted on the Amarela Philippines’ social media accounts]

Meanwhile, Ms. Samira Gutoc stresses the importance of groups involved in reproductive health (RH) to be readily available on the phone. This is essential since a major issue in the accessibility of health care services, specifically in rural areas, is Wi-Fi. In addition, she mentions that RH has been a long withstanding service that is yet to be prioritized in hospitals. Due to these concerns, many citizens who are afraid of visiting hospitals are left with no choice but to stay at home even when at risk of death. This leads Ms. Gutoc to ask Sen. Hontiveros, “Bawal ba ang hilot?”, pertaining to the traditional healers in rural communities. She explains that these healers are the only RH consultants that the citizens in the community have access to especially during the time of the pandemic.

Sen. Risa Hontiveros responds by agreeing to Ms. Gutoc’s statement and highlighting the role that should be given to the traditional healers. She says, “Traditional healers should be incorporated into the community health teams with the doctors, nurses, midwives, and Barangay Health Workers (BHWs) who may be available.” Through this, the community health teams can be capacitated and can benefit from the closeness and credibility that these hilots have within the community.

Lastly, Mr. Iori Kato addresses the question by asking, “Why not all services?”. He says that everyone should have access to the service and information they want to avail regardless of their demographics or upbringing. This is also applicable to services like RH, which should be part of the essentials–meaning no compromise–and should be available amidst the pandemic. However, Mr. Kato recognizes that due to the pandemic, there is a decrease in access and actual utilization of RH services. In response, UNFPA has been making a handbook to augment the current healthcare challenges faced by the national and local government units. This was done through the donation of PPEs to the Department of Health (DOH) and frontline workers across Luzon, Metro Manila, and Bangsamoro (BARMM). Furthermore, they have launched an RH initiative called rh-care.info; launched an online system for gender-based violence reporting, in partnership with the Commission on Human Rights; initiated a 24/7 Ligtas-Buntis helpline for pregnant women in Cavite, Laguna, Batangas, Rizal, and Quezon; and worked with Mental Health Association - Lipa Batangas to provide online mental and psychosocial support.

What menstrual products are recommended to be sustainable and also available, yet affordable as well? Do you have any recommendations?

Sen. Risa Hontiveros mentions the sanitary napkin, something familiar to many of us and the most accessible and cheaper to most Filipinos, then introduces products that focus on sustainability, such as menstrual cups, reusable pads, and period panties, which are mostly sold online. However, taking into consideration the lives of the most vulnerable, they might have not yet heard about these alternatives. Through advocacies and programs like Amarela’s, Sen. Hontiveros urges these private companies to sell sanitary napkins to shift to more sustainable products over time through research and development, but keep an eye on making these new ecologically-friendly products more accessible, especially to those who are economically vulnerable.

Ms. Samira Gutoc adds on how access to water is still a major issue, expressing how the government’s campaign for handwashing is insensitive. She suggests that they must also remind service providers of the value of access to water and public toilets, stating how water accessibility and proper sanitation are as valuable as menstrual products. Ms. Gutoc then mentions how even sanitary napkins are a luxury, not only to women but also to those who are displaced or the internally displaced persons (IDPs), in which many use malong or other cloths for their period. These are reused by washing, which then reiterates the problem of water accessibility.

Sir Iori Kato raises a question: “While there could be many options, we should also ask: do all women in the Philippines have enough resources to have the same access and choices to menstrual products?”. Sir Kato explains that in some rural areas, women use a pasador, a menstrual pad made out of cloth since the cost of disposable sanitary napkins is expensive. He then proposes that humanitarian relief should include sanitary products in hygiene kits, to ensure the safety of women, since they are often not treated as a priority. He says that menstruation would not stop when a pandemic or a calamity hits. Furthermore, he also proposes to mainstream gender concern into any and all sectors such as water, sanitation, food, etc., reiterating his answer from a previous question which is the importance of including women in decision-making processes.

With the current rise in sexual violence victims speaking up about their experiences, how can social media be of more help to the victims?

Ms. Samira Gutoc would like to note how social media is both an enabler and disabler. The reason for this is because the youth still need to continuously be educated on the advantages and disadvantages of social media. However, it is of utmost importance to be a supporter and listener when utilizing chat rooms.

Sen. Risa Hontiveros highlights some of the positive aspects of social media. Social media is an aspect of support; allowing women and allies to be present, to listen, and to give moral support to one another while seeking their justice in their time of healing. In some cases, social media is the only apparent space for victim-survivors to speak of their experiences. It is important to recognize the need to restore social media to be more of a safe space and community. This can be achieved through the eradication of victim shaming and blaming, fake news, propaganda, and negatives that weaponize social media. If individuals are able to take care of each other online, this can translate to taking care of each other offline.

Mr. Iori Kato explains the need to utilize social media for both prevention and response to gender-based violence (also known as GBV) in the Philippines. As 70% of Filipinos are active social media users, with most of the youth being connected, solutions can be provided to defy the problems posed by the lockdown. This can be done through 4 domains: a platform for advocacies and campaigns, venue for major support, and connect GBV survivors and service providers, a platform of data gathering, and a platform of accountability. With these domains, it will aid in the promulgation of both information and solutions for GBV. It is important to take advantage of the number of users on social media for the victim-survivors’ advantage.

What more can the government do to improve Reproductive Health Care in the Philippines? And what can we do to clamor for better policies for RH?

Ms. Samira Gutoc starts by suggesting a “tri-partnership” between the government, the private sector, and the people, which she hopes will allow non-government organizations (NGOs) to be well represented in the Inter-agency Task Force. She adds that indigenizing RH campaigns in local dialects, such as translating senate hearings in Bisaya, may result in a greater representation of the civil society. Ms. Gutoc then emphasizes the importance of RH in protecting the quality of life of the marginalized and heavily burdened and urges corporate sectors to invest in RH programs for their companies. RH cannot be at the last of our priorities–it is still vital and coequal–because prevention of the death of our women is as much the future of humanity.

Next, Sen. Risa Hontiveros addresses the latter question as she provides suggestions on the projects that Amarela Philippines can initiate. First, she asks Amarela to sustain organizational discussions through social media and to open the conversation to the public–described as a marketplace of ideas. Then, she stresses the importance of applying the useful insights gained from this webinar to further support the organization’s future programs and projects. To close, Sen. Hontiveros has expectations that Amarela can contribute to the creation of Senate bills, resolutions, and proposed projects; and keep in touch with Mr. Kato and the UNFPA, Ms. Gutoc’s team, and Sen. Hontiveros’ Senate Committee on Women, Children, Family Relations, and Gender Equality for possible mutual support and future partnerships.

Mr. Iori Kato shares that even before the outbreak, RH in the Philippines did not seem so perfect as there is much room for improvement. He points out the importance of integrating RH system-strengthening as an integral part of the national and local government’s mid- to long-term socio-economic recovery plans from COVID-19. The backbone should be in strengthening the RH system and ensuring that RH information and commodities are provided as part of the essentials– it should not be ignored, disrupted, or less prioritized. With this, he suggests combating the resource restraints and lack of access to RH commodities by coming up with innovative solutions such as reverse engineering. Some examples include the introduction of Maguindanao’s RH clinic model, house-to-house delivery of pills, condom delivery, house-to-house injectables by midwives, flexibility in resupplying family planning commodities, and utilizing SMS, social media, or community radio in sharing information on resupplying commodities. From this, Mr. Kato expresses that its focus is to leave no one behind. To end, he then talks about how women can convert men and enemies to their side as friends. In his words, “We make a movement, we sustain it, and we don’t give up.”

After the round-table discussion, the speakers held an Open Forum and answered the following questions, provided by the participants:

For Sen. Hontiveros: How will the recently passed ATL affect the reproductive health situation in the Philippines?

Senator Risa Hontiveros states that the implementation of "a landscape changing law" such as the Anti-Terrorism Law amidst the pandemic was unexpected due to COVID-19, the reproductive health, and economic crisis. Although its implementation is not the "mother of all crisis," she calls the law as another part of a "continuing democracy crisis." She also added that the implementation of the law will make it challenging for women and girls to access reproductive health services. Despite this, she urges the audience that this should push them even more to help one another and to ensure that access to reproductive health will not be neglected and women's rights will not be derogated.

What are the govt's initiatives regarding the accessibility of RH for women in prison, poverty, and/or remote areas?

Senator Risa Hontiveros identifies the sub-sectors of women who are among the priority target participants in reproductive health programs. These sub-sectors include poor women, young women, prisoners, and those who are part of geographically isolated disadvantaged areas (GIDA). She explains that women who are part of the GIDA are among the priority target participants since their location and the unequal allocation of resources prevents them from having access to health and reproductive health services. Women prisoners are also included among the priority target participants since they are "often forgotten" and the congestion in Philippine jails--particularly the Correctional Institute of Women (CIW) , puts them at risk of infections such as COVID-19, Tuberculosis, HIV/AIDs, and other illnesses. She also states that the government will look into the situation and the necessary responses needed to accommodate all subsectors of women.

What are your stances on abortion and what do you suggest for family planning? But wouldn’t that be against pro-life ideology?

Senator Risa Hontiveros states that pro-life Filipinos will certainly be against the policy proposal of abortion. She mentioned that in the making of the Reproductive Health Bill, there were already some in the women’s movement who wanted to include abortion rights in it. However, after thorough discussions and debates, they came to a consensus of “one battle at a time”. She claimed that winning the RH law was difficult enough. There was also no guarantee that it would get enough funds in the country’s annual budget. It took them about a decade and a half, as well as another year in the Supreme Court before it was upheld as constitutional. Reproductive Health service providers also have to withstand some Local Government Units so as not to deprioritize, more so ban the RH services. With that being said, they came to an agreement to set aside the debate on abortion rights for another legislative battle. Nonetheless, the senator believes that the topic of abortion should be discussed, as it is already stated in the Reproductive Health Law that women who are suffering from post-abortion complications must be taken care of. There is a need to address the maternal mortality rate coming out of numerous illegal and unsafe abortions in the country, which are actually results of the RH law not being fully implemented. She remarks that although the outcome of this debate is unpredictable, it is a necessary conversation.

Sir Iori Kato declares that the UNFPA has, on no account, supported abortion. They believe that it is caused by a failure of family planning, comprehensive sexual education, and eradication of sexual violence. However, he states that the sad reality is, the Philippines has about 600,000 to 750,000 cases of abortion. As they accept that abortion is somewhat inevitable, he insists that post-abortion care, both bodily and psychosocially speaking, is a must for those who have gone through with the procedure. Our country’s data, based on the National Demographic and Health Survey 2017, shows that very few utilize family planning methods. The survey reveals that narrowly 21% of married adolescent girls (aged 15-19) use modern family planning methods; while only 19% of unmarried adolescent girls, who are sexually active, use these kinds of methods. This entails that among girls who have no intention of getting pregnant, only 1 out of 5 use contraceptives. With that in mind, Sir Kato asserts that if the same practices are continued, we may only see an increment in these numbers. Therefore, in order to make a real difference, different tactics must be used

How can we ensure victims who speak out against GBV are protected when leaders at a national level continue to promote & celebrate misogynistic behavior?

Sen. Risa Hontiveros responds with an elaboration of her experience the day the Safe Spaces Law, or the Bawal Bastos Law was implemented. While she was optimistic about the implementation, Sen. Hontiveros, unfortunately, had to respond to some media questions by saying, “...although at the very highest level of government right now, there is a platform used as a bully pulpit for very sexist and misogynistic ideas and language and even exhortations to action.” She explains how under the constitution, the occupant of that office is immune from suit, while he/she is an occupying officer, though it will be a different question once he/she steps down from power and continues to behave that way. Even in the next 2 years, when we are seeking an enabling environment for our concerns, combatting sexism and misogyny throughout our society, Sen. Hontiveros expresses her hope and sentiments that through the passage of the Bawal Bastos Law, it would prompt us to call out unacceptable behavior and by law, these acts are penalized. She goes on to say that in cumulative ways, that we must keep a stand against these acts, not to feel intimidation from any a bully pulpit and an anti-terrorism law. We should continue to act on these advocacies that protect Filipino women even under COVID-19, quarantine protocols and conditions, and the health and economic crisis while keeping in mind safety precautions. Sen. Hontiveros states that it will change the culture of sexism and misogyny which fuels violence and armed conflict such as sexual violence. With that being said, she concludes that regardless of whatever unacceptable language we hear in the next 2 years, we should make our main political and social project ourselves—the Filipino people.

Mr. Iori echoes Sen. Hontiveros on how the transformation of culture is the only way to go to prevent gender-based violence (GBV), in which social norms that condone violence should change. He then clarifies that this should not only be limited to violence against women and girls but to stopping all sorts of violence. Moreover, he urges that violence should not be used to sort out different opinions or interests, reiterating that it is a must to abolish the culture of condoning violence. To support the points that were stated, he proposes that there should be comprehensive sexual education (CSE) and education implemented at home. Once these initiatives are carried out, he states that our duties—as Filipinos are to express our support in order for a positive response and to avoid a culture of impunity, since not all women are comfortable reporting their cases, and there are instances wherein these cases are not even being indicted, prompting women to give up. Mr. Kato suggests a solution: to increase the number of women involved in all layers of society, government institutions, and decision-making bodies such as law enforcement, the military, and the police. The UN has worked with the police and armed forces to increase the number of women at the managerial level and include GBV courses as part of their induction training. He concludes his presentation by saying that we can aim at zero percent of GBV when the importance of women’s participation in planning, implementation, and monitoring is taken into account.

Before concluding the webinar, Ms. Samira Gutoc wanted to emphasize and reiterate that equal access to Reproductive Health, as well as bodily care, is a must. She advises the audience not to fear talking to cops and soldiers, for she, herself, had to sit in dialogues with these armed forces, as they can truly impact the status and life situations of internally displaced persons. Moving on, the student moderators summed up the Open Forum with the conclusion that the fight for Reproductive Health rights, first and foremost, was already a difficult battle. The situation just got much more complicated considering the current political climate.

Moreover, as it is put into perspective that women will constantly be “pushed down” and compelled to cling to the submissive stereotype in today’s society, the moderators expressed their deep gratitude towards Sen. Hontiveros and Ms. Gutoc. They have been unendingly championing and fighting for women’s rights, despite the huge challenge–specifically, in the world of politics wherein, male dominance and misogyny is extremely prevalent. Certainly, Mr. Kato was acknowledged and thanked as well for being an exceptional example for men all over the world. He definitely proved that men can be feminists too and also lend a hand in the fight for women’s rights.

As the event comes to a close, the moderators urge the audience to keep safe and stay at home. They add that going out must only be done to purchase essentials in order to help one another contain the virus. On a different front, the moderators prompt the audience to refuse anything that might frighten them into oppression, in line with recent events. And finally, they wish that this fight for women’s rights ultimately leads to making the country a better place altogether.