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M edical Issues

The Consolidated Reproductive Health Bill


in the House of Representatives

Dr. Angelita Miguel-Aguirre, M.D., FPCP


Fellow and Diplomate, Philippine College of Physicians
Professor 1, University of Santo Tomas,
Dept. of Medicine and Dept. of Bioethics

Chairperson, Committee on Ethics, Makati Medical Society

Society of Catholic Social Scientists, Steubenville, Ohio (Member)


National Catholic Bioethics Center (NCBC) Boston (Member)
Does reproductive health promote and protect the health of women?
The “modern methods” of family planning referred to are birth control pills,
intrauterine device (IUD), barrier methods (condoms/diaphragms) and sterilization
(ligation for women and vasectomy for men).

Birth Control Pills


Bir th control pills (BCP) have been largely promoted as a panacea for women
interested in family planning yet even its promoters agree that when they claim
that it is ‘safe’, it does not mean that it has no adverse effects. Indeed there are
numerous side effects which unfortunately are not made known to the general
public. For example on top of numerous studies showing its carcinogenic
properties since the development of the synthetic estrogens in 1938 by Sir Edward
Charles Dodds finally the International Agency for Research on Cancer (IARC) of
the World Health Organization (WHO) announced on July 29, 2005 that after a
thorough review of the published scientific literature, it has concluded that
combined estrogen-progestogen oral contraceptives (and combined estrogen
–progestogen menopausal therapy) are carcinogenic to humans (Group I
categor y. This categor y is used when there is sufficient evidence of
carcinogenicity in humans.)
Prior to this, a respected journalist from Columbia University, Barbara Seaman
after years of research, published books exposing estrogen’s detrimental effect
on the health of women notable among them The Doctor’s Case Against the Pill
and The Greatest Experiment Ever Performed on Women. Exploding the Estrogen
Myth. Barbara Seaman is a co-founder of the National Women’s Health Network,
a women’s advocacy group in Washington D.C. that refuses money from the
drug industry as par t of its charter.

The listed major adverse effects of the pill on women

1. Cancers, Heart Attacks and Strokes


Breast cancer, cervical cancer, liver cancer, premature hypertension and
coronar y ar ter y disease resulting in hear t attacks and strokes,
thromboembolism / pulmonary embolism. Other adverse effects are decreased
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libido, infertility, leg cramps, gallstone formation, nausea, bloatedness, etc.
Although some women may notice improvement in their complexion others
may develop acne with it. It is claimed to reduce the risk of ovarian cancer. But
evidently this is outweighed by its numerous risks for more common forms of
cancer. Unfortunately the side effects mostly discussed with potential users
are simply headaches, increased weight or increased appetite or other minor
side effects to qualify for ‘informed choice’. In the U.S. when the pill is advertised
all these adverse effects are disclosed at the end of the advertisement for
‘informed choice’ but in developing countries women suffer from these side
effects without knowing that this hormone was responsible for it. [They do not
warn about its being a potential abor tifacient because abortion is legal and
done at practically ALL stages of pregnancy.]

The top three causes of mortality in our country are 1st – Diseases of the
Heart 2nd -Disease of the Vascular System and 3 rd – Malignant Neoplasm. We
should know how many of these casualties are women who suffered from the
adverse effects of synthetic estrogen as they do in developed countries. Please
take note that next to lung cancer, breast cancer is the most common cause of
malignancy in our country and only 5 to 10 % of those women who develop
breast CA have genetic predisposition.

[Indonesia has looked into the risk of breast cancer among Indonesian women
by age at first use of the pill (Bustan Contraception 1993). For women who
started at age 22 and below they have been found to have a 210% risk, for
women 22-26, 70 % and for 27 and up 60% risk of developing breast CA.]

2. Other effects of Birth Control Pills - it works as a chemical


abortifacient
Although the primary effect of the BCP is

1. to prevent ovulation and


2. to change the cervical mucus which increases the difficulty of sperm entry
into the uterus, in 1978 (sometime after abortion became legal in the U.S.
in January 1973), a third effect has been listed in drug references and
textbooks of pharmacology that is
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3. it causes changes in the lining of the uterus which makes it hostile to
implantation or nidation.

References: - U.S. PHYSICIANS DRUG REFERENCE 1978, p. 1817;


1997 p. 2746
- BASIC & CLINICAL PHARMACOLOGY
Ber tram G. Katzung, M.D., PhD, 8th ed. 2001, p. 693
- Up to Date On Line 15.1, 2007

Therefore it works as a chemical abor tifacient as a backup effect in case the


women had a breakthrough ovulation which was eventually fer tilized. Various
references including that of the Textbook of Contraceptive Practice. Cambridge:
Cambridge University Press allude to this possibility in 2 to 10 % of the cycles of
women taking the pill.

The fact that NO medicine works 100% is also attested to by the Alan Guttmacher
Institute, the official research arm of International Planned Parenthood Federation
(IPPF) the largest promoter of ar tificial bir th control and abor tion worldwide.
One of its publications states that although the pill is supposed to reach an
effectiveness of over 99%, in practice the rate is much lower. Between 1.9% and
18.1% of women will experience an ‘unplanned pregnancy’ in the first year of
using the pill (therefore contributing to the so-called unwanted pregnancy). This
failure rate is also attested to by studies on contraceptive failure among the
married, the unmarried not co-habiting, and the cohabiting, the highest
contraceptive failure based on the study of Fu, H. ( graph enclosed ) is among
the co-habiting who will largely consider that pregnancy as ‘unwanted’ after
sexual indulgence, and will most likely end up to abor tion.

This largely explains the slippery slope described by Valorie Riches. Once a
contraceptive mentality sets in abor tion is not too far behind because of high
contraceptive failure. As Alfred Moran, chief executive officer of Planned
Parenthood of New York City, wrote in the New York Times in 1983 -”Until we
reach the millennium when we have a perfect contraceptive, when every
pregnancy is planned and all children are born wanted, Planned Parenthood will
continue to provide not only sex education and contraception but also abortion.”

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In fact their observation is that no population control is successful without
resorting to abor tion, the ‘perfect’ back-up, - which is to kill an innocent child,
the highest form of child abuse!

The Intrauterine Device


Another abortifacient is the IUD. It is NOT a contraceptive, “the IUD acts primarily
by preventing the embryo from implanting – not by preventing conception. It is
therefore an abor tifacient, not a contraceptive” as attested to by Dr. Jerome
Lejeune, expert on Fundamental Genetics, University of Paris. The Reproductive
System, Principle of Anatomy & Physiology, Tortora and Grabowski (9th edition c
2000;Chapter 28, p. 1009) also provides the same description of its effect- IUDs
cause changes in the uterine lining that prevent implantation of the fertilized
ovum. This effect is known both to its promoters and manufacturers and because
of high incidence of litigations suffered by women from adverse effects in the
U.S. they generally have to sign a seven page document before this is inser ted.
In the local setting – there are places where they don’t sign anything, in some
places one page, in one city 3 pages but its abor tifacient properties are not
mentioned. This must be par t of informed decision.

Both the BCPs and the IUD violate Ar ticle 2 Section 12 which states that life
must be respected from the moment of conception until natural death”.

Please take note that even pro-choice lawyers recognize the abor tifacient
properties of the pill and IUD because they have successfully used it in the
legalization process of abortion in America. As Ruth Colker, a Tulane Law School
Professor (Dallas Morning News, 23A, February 6, 1992 ) argued on the
opposition to the Louisiana Law Banning abor tion:

“Because nearly all birth control devices, except the diaphragm and
condom, operate between the time of conception… and implantation…,
the statute would appear to ban most contraceptives.”

Atty. Frank Sussman, lawyer for Missouri abortion clinics also used these
arguments before the U.S. Supreme Court, April 27, 1989:

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“…IUDs and low dose birth control pills act as abortifacients.”

According to Bernard N. Nathanson M.D. a known Obstetrician – Gynecologist


and former director of the World’s Largest AB Clinic in America and N.Y. City’s
Center for Reproductive & Sexual Health -

“EXPERTS who deny the abortifacient properties of the pill and IUD
have actually transferred the beginning of life from fertilization to
implantation or nidation.

This is what the American College of Obstetrician and Gynecologist (ACOG)


has done in the U.S. so; they have formed the ‘Association of Obstetrician & GYN
for Life’.

Dr Nathanson himself was at the forefront of the Birth Control Industry and
presided over 60,000 AB & Co-founder of NARAL. He helped make abortion
legal in the U.S. But now he has recognized the sacredness of life and the error
of his previous advocacy (when he realized its horror through ultrasound and
eventually presented his documentary entitled “Silent Scream”).

Please note that doctors and scientists in Embryology, Anatomy and Physiology
who study life in its early stages of development recognize and define life as
beginning from fertilization, after all what will implant if there’s no fertilization?

We therefore see the legalization of these drugs and devices which can act as
abor tifacients to be the entry point for the eventual legalization of abor tion on
demand in our country. This is the universal experience in ALL countries where
this was done. Bir th Control does not stop with contraception it is inclusive of
abor tion to complete the cycle of the culture of death.

We therefore submit that although this bill includes prevention of abor tion as
an element in this reproductive health care, inevitably it actually condones and
promotes it.

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The Barrier Methods – Condoms and Diaphragms
The Barrier methods – condoms and diaphragms are not abortifacient but they
have the highest failure rate varying from 4–30 % depending on the age group
surveyed. It therefore contributes considerably to the so called “unwanted
pregnancies” which end up in abortion. It condones promiscuity and since it
does not protect 100% it contributes to increased incidence of sexually transmitted
disease /infection (STD/STI).

The number of people infected with HIV infection in this country has been
described by infectious specialist as low and slow. In 2003 it reported 1,892
and in 2005 – over 2000 cases were reported although that has been extrapolated
to 20,000 and more but still much lower than countries where condom is widely
promoted and readily available. In Thailand by 2003, 750,000 people are infected
whereas in the U.S. 700,000 are infected. There was a time in mid 1990’s when
it was reported to be 1 million. So responsible health care workers in the U.S.
recognized that the best way to address the problem is risk elimination rather
than simply risk reduction. They embarked in the promotion of abstinence program
and self-mastery programs (“True Love Waits”) which was star ted by the
Methodists. When this was launched half a million kids signed up. This program
contributed greatly to the reduction of STI’s.

The Human Papilloma virus (HPV) is another dreadful virus transmitted through
promiscuous sex and the major cause of cervical cancer. Barrier methods are
not effective here since shedding occurs from widespread areas of the perineum.
HPV cause war ts anywhere on the skin and mucous membranes. And men can
be asymptomatic carriers. This information must be well disseminated.

Sterilization – Tubal Ligation and Vasectomy


Sterilization in the form of ligation and vasectomy is considered a form of
mutilation and violates the ethical principles of totality and stewardship. We cannot
remove or destroy any par t of our body that is not diseased. Does tubal ligation
work 100% ? No. 1.85% failure rate usually results to high risk Ectopic pregnancy

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Adverse effects of Tubal Ligation
• Hemorrhage & bleeding*
• increased risk of heavy menses in the long term*
• Increased future gynecologic rate of surgery including hysterectomy*
• adverse anesthesia effects*
• post tubal ligation syndrome*

Adverse effects of Vasectomy


On the other hand, vasectomy has resulted to the development of autoimmune
response disorders, e.g.
• thrombophlebitis
• prolonged fever
• generalized lymph node enlargement
• recurrent infection
• skin eruptions
• multiple sclerosis
• liver dysfunction
• rheumatoid ar thritis
• risk of prostate cancer
• exacerbates atherosclerosis (hardening of the arteries )

Other adverse effects noted are :


• Psychological disorders
• Bleeding
• Infection on the incision site
• Sperm granuloma
• Pain in the scrotum
• Formation of kidney stones
• Congestive epididymitis
• Chronic post vasectomy pain

In the original oath of Hippocrates, the Greek Physician who lived 460–377
B.C., the following are stated “I will not give a women a pessary to produce
abortion… with purity and holiness I will pass my life and practice my art…I

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will not castrate anyone. Not even those laboring under the stone and will shun
men who are practitioners of this work.”

These practices therefore are not new. They have done it even during the ancient
times. These are pagan practices being imposed on us.

Maternal and Infant Mortality


Maternal and Infant mortality – since the 1940’s to the 1990’s up to the present
time, inspite of the low budget for health care, the maternal and infant mortality
rate have been progressively going down. From 1998 to 2004 the maternal
mortality rate repor ted by DOH is 1 per thousand. The ideal is less than that.
Mortality is mostly secondary to hemorrhage and hypertension. Therefore we
must improve our prenatal and maternal health care and we must have good
blood banks. The health risks of the pill actually outweighs by far the risks of
pregnancy and childbirth to a woman’s health. It would be wise for government
instead to invest on Basic Obstetric Care and Emergency Obstetric Care equipment
and services and provide skilled medical staff for childbir th centers.

The Overpopulation Theory


The overpopulation theory of Paul Ehrlich as the cause of poverty has long
been debunked by Julian Simon, an American demographer who expounds that
“ it is not slower population growth that will bring prosperity but rather it is
prosperity that will slow population growth”. Even those who actively promoted
birth control in the 1970’s attest to the fact that the tangible reduction in fertility rate
observed in the 80’s and 90’s were due to more men and women delaying marriage
because they were going to school and pursuing higher education. The best way to
exit poverty and develop responsible parents is therefore education. Everyone must
have access to basic education and vocational and technology courses must be
readily accessible to the less privileged.
The Nobel peace prize winner in Economics in 1992, Professor Gary Becker of
Chicago proved that “ It is demographic dynamism that is an important factor in
economic expansion… there is a clear relationship between investment in human
capital and alleviation of poverty.”

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The western world recognized the error of active birth control too late, so now
most of the developed nations and the Group of 8 are graying. Why are our caregivers
and workers needed in these countries? Because they no longer have the manpower
to provide even their basic services. Recruiters from one European country expressed
the need for 30,000 nurses to care for their elderly population (some of whom probably
refused to have children to begin with, or aborted them). America does not feel this
as much because it continues to have a strong immigrant population.

Metro Manila is overcrowded because 13% of our population live in NCR which is
0.2 or 1/5 of 1% of the entire land area of the Philippines. People flock to the city
because nothing much is going on in their home provinces. Our problem is not
overpopulation but population maldistribution. The concentration of population in the
urban areas is due to the underdevelopment of the countryside.
From the 1968 to 1994, eight billion pesos (P 8 billion) have reportedly been spent
for population control. Did we genuinely help the poor improve their lives with that
kind of money spent in family planning? It could have benefited them more if this
kind of money was spent on education and building schools in far flung areas so they
do not hold classes under the trees, or increase farm to market roads to help our
agriculture, implementation of the irrigation bill, more roads and bridges, housing for
the poor, basic services, from garbage collection to clean environment and more !
Now we understand the budget for this program has even doubled. We must set our
priorities correctly.

Reproductive Health Education


The Sex Education Module has been in place in the Philippines since the 1970’s
- at the time entitled population education program - and the second edition was
implemented in 1992. So this current 3 rd edition now entitled Reproductive Health
is not new except that it is much more explicit on sexual techniques rather than
values education. These modules were patterned after the Sex Information and
Education Modules of the U.S. (SIECUS) originally developed by Mary Calderone
and Alfred Kinsey of Kinsey Institute and was implemented in the American
schools in the 1960’s. If some educators find some of its contents pornographic,
it is because Kinsey Institute also supports materials like Playboy, Penthouse

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and Hustler based on the research work of Eichel and Judith Reisman ( Ref.
enclosed).

The dismal outcome of these modules on the sexual morality of young people
were evident on the fact that by 1991 the U.S. Institute of Research disclosed
that 55 % of the kids aged 15-19 are sexually active although unmarried. So it is
no wonder that we are also reaping the fruits of these modules in our country
today. THE REASON WE SEE INCREASED CASUAL SEXUAL ACTIVITY AMONG THE YOUNG
IS NOT BECAUSE THEY LACK INFORMATION BUT BECAUSE THE WERE GIVEN TOO MUCH OF
IT, TOO SOON, AND INAPPROPRIATELY. SEX WAS REDUCED TO JUST WHAT PEOPLE DO
RATHER THAN AN EXPRESSION OF WHO THEY ARE WITHIN THE CONTEXT OF MARRIAGE.

To address this problem responsible and concerned parents in America banded


together to star t home schooling which was initiated by the Methodist and
subsequently many more Christians and Catholics followed so that by 1999 over
2 million kids in America are in home schooling. They were observed to do better
in performance in math, science, language, literature, etc. because the children
were focused on the appropriate learning skills. More impor tantly these kids
have high moral standards. As the people behind this movement say they will be
the bright future of America.

Human reproduction must be taught in biology scientifically similar to the way


all the other organ systems are taught e.g. the circulatory, the respiratory, the
gastrointestinal, etc. so that young people will appreciate the value of human life
from the moment of conception and its different stages of development until the
baby is born. Consequently they will treat every human life with respect. Since
Human Sexuality is multifaceted, the emotional, social, and spiritual dimensions
of spousal relationship and its responsibility can be discussed in social studies
and values and character education. It need not be taught is all subjects including
math, language, literature,etc in a spiralling curriculum which is unnecessary.

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The Natural Way of Spacing Children
The natural way of spacing children is the Billing’s ovulation method. It is NOT
a contraceptive; it is a way of life. It is more than 99 % effective as attested to by
the World Health Organization (WHO) study and therefore comparable to the pill
with the advantage that - it has no adverse effects and at no expense, not
abor tifacient, it does not objectify women, among users there is low incidence
of divorce as attested to by a U.S. study because spouses communicate about
the responsibility of parenthood which is mostly just imposed on women.
Disadvantage? It requires values education and respect for fer tility and nobody
makes money out of it.

Serious Concerns on the Bill


This bill therefore poses a number of serious concerns in relation to the Ethical
Principles of:

1- TRUTH TELLING and FULL DISCLOSURE.


2- INFORMED DECISION and AUTONOMY
3- RIGHT OF CONSCIENCE
4- ALLOCATION OF SCARCE RESOURCE
5- RIGHT TO LIFE

We therefore submit that much of the intent and purpose of the consolidated
bill are actually in place and being implemented to the detriment of many. It
should NOT be legislated. Many of its provisions require serious thought and
deliberation on how the misconceptions and inaccurate information can be
rectified for the genuine benefit of women and the Filipino family.

We propose that the allocation of precious resources for this bill be used instead
to boost the funding for education, basic services and primary and preventive
health care.

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