Dissecting the Reproductive Health Law Policy Process
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Slides intended for interactive discussion on the policy process behind the Philippines' Reproductive Health law (RA 10354), following the framework of Walt and Gilson (1994)'s health policy triangle and the legislative threshold of Gray (2004).
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Dissecting the Reproductive Health Law Policy Process
- 1. Dissecting the Reproductive Health Law Policy Process Albert Francis E. Domingo, MD, MSc 26 January 2016 | Ateneo de Manila University
- 2. Dissecting the RH Law Policy Process: Outline 1. Review of the power play involved using the ‘health policy triangle’ 2. Overcoming the legislation threshold 3. Values enshrined in law vs scientific evidence
- 3. 1. Content, Context, Process and Actors Review of the power play involved using the ‘health policy triangle’
- 4. Context Actors Content Process Walt and Gilson (1994), as cited in Buse et al. (2012)
- 6. Context Actors Content Process 209 172 162 221 0 50 100 150 200 250 300 1993 NDS 1998 NDHS 2006 FPS 2011 FHS Numberofmaternal deaths per100,000livebirths
- 12. Context Actors Content Process Walt and Gilson (1994), as cited in Buse et al. (2012)
- 14. “ With the rise of the Hebrew state, a new term had to be coined to describe the relation of the Hebrew state with the Mosaic religion: theocracy. The authority and power of the state was ascribed to God. The Mosaic creed was not merely regarded as the religion of the state, it was (at least until Saul) the state itself… As man of God, Moses decided when the people should travel and when to pitch camp, when they should make war and when peace... religious motivation was primary and all-embracing: sacrifices were made and Israel was prohibited from exacting usury, mistreating aliens or using false weights, all because God commanded these. Estrada v. Escritor, A.M. No. P-02-1651 (2003)
- 15. “ There was a union of church and state and Catholicism was the state religion under the Spanish Constitution of 1876. Civil authorities exercised religious functions and the friars exercised civil powers... The coming of the Americans to our country, however, changed this state-church scheme for with the advent of this regime, the unique American experiment of separation of church and state was transported to Philippine soil. Estrada v. Escritor, A.M. No. P-02-1651 (2003)
- 16. “ The Catholic Church hierarchy has maintained its traditional stance against modern family planning (FP) methods, particularly modern (also referred to as “artificial”) contraceptives… Caught between a hard Church and a soft State are the overwhelming majority of Filipinos… Pernia et al. (2008) http://holesinthefoam.us/state-vs-church/
- 17. 2. Dura lex, sed lex Overcoming the legislation threshold
- 18. Factors in Health Policy Change OLD POLICY NEW POLICY Ideological inspirations Change in circumstances Evidence Common sense From research From experience Reference: Gray, 2004 (Fig 7.8, p. 291; p. 292) NOTE: Policy makers operate on a timescale that does not generally admit of delays that research will take.
- 19. The Legislation Threshold Oppositiontolegislation Reference: Gray, 2004 (Fig 7.9, p. 296) There is an inverse relationship between the magnitude of a health problem and the strength of opposition to legislation framed to prevent it. Number of people affected Media interest Strong evidence Opposition by “industry” Policy has adverse effects High cost of intervention
- 20. Values (?) Dominate Policy-making ▣Politics tends to be driven by beliefs patronage ▣It is the values returns on investment (ROI) politicians believe to be important that dominate decision-making about policy. Such decisions will be tempered by the availability of resources. ▣But, resource allocation can also be based on beliefs and values patronage and ROI ▣Can a shortage of resources force policy-makers to consider the evidence and alter policy as a result? Reference: Gray, 2004 (p. 287)
- 21. 3. Not Unconstitutional, but... Values enshrined in law vs. scientific evidence
- 22. “ ...the issue before this honorable court is not when life begins… The Constitution, in Article II, Section 12 textually commands the State to protect the life of the unborn from conception – but it does not define the term “conception”. While delegates to the 1986 Constitutional Commission disagreed as to its meaning, they agreed that Article II, Section 12 was intended to constitutionally bar any congress or any court from ever adopting in this jurisdiction the decision of the United States Supreme Court in the case of Roe v. Wade. Solicitor General Francis H. Jardeleza, at the Oral Arguments on Imbong v. Ochoa
- 23. “ ...when life begins is not the issue… twenty-six years after the advent of Article II,Section 12 – and that is a quarter of a century of advances in science and medicine, Congress passed the RH Law. Even then, the Congress, just like the Constitutional Commission, was divided on the question of when life begins. Congress chose not to answer the question. Solicitor General Francis H. Jardeleza, at the Oral Arguments on Imbong v. Ochoa
- 24. “ The constitutional question at hand is: whether or not the Congress, in the exercise of its police power, enact[ed] the RH Law – a social legislation that provides women with universal access to effective, legal, non-abortifacient contraceptive drugs and devices, and to services and information thereon. Solicitor General Francis H. Jardeleza, at the Oral Arguments on Imbong v. Ochoa
- 25. “ Majority of the Members of the Court are of the position that the question of [when] life begins is a scientific and medical issue that should not be decided, at this stage, without proper hearing and evidence… From the Decision in Imbong v. Ochoa
- 26. The RH Law is Not Unconstitutional, but… 1. The requirement to refer patients seeking MFP methods is restricted 2. Parental consent is needed for minors to access MFP methods 3. Health care providers not disseminating information on RH cannot be punished 4. The consent of the spouse is required for married individuals to undergo RH procedures 5. Health care providers not referring non-emergent patients for RH services or information cannot be punished 6. Any public officer hindering full RH implementation or not supporting RH cannot be punished 7. Any conscientious objector cannot be required to render pro- bono service to be accredited by PhilHealth 8. An abortifacient is any drug or device that can destroy a fetus or prevent the implantation of a fertilized ovum 9. Health service providers who will require parental consent from minors not in emergencies or serious situations cannot be punished
- 29. Credits Special thanks to all the people who made and released these awesome resources for free: ▣ Presentation template by SlidesCarnival ▣ Justice icons by Arthur Shlain ▣ Photographs by Unsplash
Notes de l'éditeur
- Note: in the demographic perspective, context = overpopulation. In the health perspective, context = high maternal mortality.
- Note: in the demographic perspective, context = overpopulation. In the health perspective, context = high maternal mortality. Image from: http://grey.com/philippines/news/key/inakup-araw/id/3784/
- Family planning is just one of the many components of ‘reproductive health care’ Image from http://jsi.ge/eng/facts/birthcontrol.php
- Image from: gov.ph
- Image from: http://www.popcults.com/top-10-movie-props-i-want-for-my-collection/
- Image from: http://indayvarona.com/tag/noli-me-tangere/
- Population, Poverty, Politics and the Reproductive Health Bill Image from: http://holesinthefoam.us/state-vs-church/
- The law is harsh but it is the law
- Although the idea underpinning the introduction of any organizational change may reflect the ideology of the political party in power, or that of an individual, pressure group or think tank, the decision taken can be based on evidence. The nature of the evidence may be: (1) the experience of what happened since the last change in service financing and organization; or (2) derived from research findings. However, the amount of research evidence available on which to base healthcare policy is often limited, and politicians may argue that the introduction of a particular policy is supported by common sense. Reference: Gray, 2004 (p. 291)
- Strong evidence is now a necessary prerequisite before any public health policy can be introduced, but the converse is not true: the existence of strong evidence indicating the need for a public health policy does not necessarily result in such a policy being introduced. Greater obstacles are faced when using the law to implement a public health policy with the aim of protecting individuals from their own inclinations – the paternalistic role of law. (Example: Tobacco policy; next up: salt & sugar.) Powerful evidence is needed to show that such legislation is not only effective but also safe. Evidence-based policy making is of paramount importance in developing countries. However, the availability of research evidence may be limited because the performance of RCTs (i.e., Implementation Research) in countries with limited resources can be problematic. Reference: Gray, 2004 (p. 297)
- The law is harsh but it is the law