*This is an excerpt from PKKK’s Rural Women Status Report on CEDAW 2011.
The ratification of CEDAW (Convention on the Elimination of All Forms of Discrimination Against Women), which is described as international bill of rights of women, by the Philippine government implies its commitment to uphold gender equality and women’s empowerment and to eradicate whatever forms of discrimination exist in the Philippine setting, in all sectors and conditions including gender-based violence and health. And yet eradication of discrimination and biases against rural women remains elusive due to the following: (1) absence of national and local government support to provide the health needs of the people particularly the poor; and (2) inequality issues such as and cultural barriers, Catholic Church influence on the enactment of reproductive health bill; (3) and lack of gender-sensitivity and gender-responsiveness of local government units.
Many Filipinos, especially rural women are unable to access and use of health care. Compared with other Asian countries, health expenditure in the Philippines registered 3.8 percent which is way below the five percent standard set by the World Health Organization for developing countries. Our health sector is grossly underfunded by at least 40%, representing the cost of unmet needs of many of our people (ABI 2011).
Immediate enactment of a national reproductive health bill is further delayed with strong opposition and influence of the Catholic Church. For 12 years, RH bill is being debated in the Philippine Congress.
Gender-based violence affects women and children and the whole family tremendously. Of the number of VAWC cases received/monitored by PKKK, less than 10% were able to pursue justice due to limited means and little access to support/services. Undocumented cases of VAWC and trafficking prevail, despite being public knowledge within the community and VAWC have become accepted in the community’s culture/way of living.
Health and Reproductive Health
Women’s health is directly linked with reproductive health and directly associated with maternal mortality rate (MMR), morbidity rate (MR) and child health (IMR) for infants. Compared to other Asian countries, the Philippines has the worst health performance, both for maternal mortality and infant mortality. According to Save the Children Report 2009, substantial number of mothers are dying numbering to 4,000 a year (11 mothers dying per day) of preventable and treatable complications of pregnancy and childbirth. The government is targeting to reduce deaths at a faster pace, from the present record of 162 deaths for every 100,000 to 52 per 100,000 by year 2015.
About one in every 30 children dies before his or her fifth birthday. Childhood mortality continues to decline. Infant mortality rate for the period 2004-2008 is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003 (NDHS Survey 2008).
Post-natal care has registered remarkable improvements when the government intensified its immunization program in the 1990s. During this time, the rate 90 % of fully immunized children was reached. However, there was an observed decline since 1998. Hence, the national immunization program was again launched in 2004, 2007 and 2010 and expanded its coverage.
Breastfeeding within the first hour after birth can prevent 22% of neo-natal deaths, while breastfeeding within the first day after birth can prevent 16% of neo-natal deaths. The country’s breastfeeding prevalence is at 88 percent over the last two decades. While prevalence of exclusively breastfeeding percent among infants under six months has remained at 34 percent over the period of 2003-2008. With Proclamation No. 1113 issued in 2005 declaring August 1-7 of every year as World Breastfeeding Week and the enactment of Republic Act 10028 also known as Expanding the Promotion of Breastfeeding in 2009, more mother would breastfed their infants as the law encourages government offices and private establishments provide lactation stations for working mothers.
Maternal deaths can be address if the government will ensure that all women and newborns have skilled care during pregnancy, childbirth and the immediate post natal care period. Such care is to be provided by skilled birth attendant: midwives, nurses and doctors. This means all births should take place in well-provided birthing facilities, discouraging home deliveries, especially without trained birth attendants. The Philippine Department of Health has adopted this as a national Maternal Newborn Child Health and Nutrition (MNCHN) strategy.
The absence of RH bill and non-support of some local government units on RH and FP doesn’t encourage families to seriously manage the number of children. We have yet to see more local governments provide for local policies on population and development and allocate funds for the expansion of contraceptive self-reliance, which is a DOH Administrative Order, requiring LGUs to take on the responsibility of providing for contraceptive commodities in their local territorial jurisdictions.
The Catholic Church sees the passage of the RH Bill to be promoting promiscuity among the youth. The Church’s position on RH can be traced back from its patriarchal viewpoint of being the caretaker and moral-keeper among the people it rules over. The moral ascendancy it portrays implies unequal treatment to people, with beliefs different from it, particularly the women, whose decisions on child-bearing are not consulted.
Apart from the lack of national policy on RH, other issues that also hampered CSOs’ advocacies’ and interventions programs on RH and FP implementation are phasing out of foreign assistance on free contraceptives; inadequate funds or no specific budget line item for FP commodities in some of the LGUs’ budgets; lack of available and accessible local health facilities, information, education campaign and services; and low male involvement in FP and low acceptance of no-scalpel vasectomy (a male-directed FP method).
Aquino Health Agenda (AHA): Universal Health Care for all Filipinos
The Department of Health (DOH) Administrative Order No. 2010-0036 titled, “The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos” aims to provide every Filipino of the highest possible quality of health care that is accessible, efficient, equitably distributed, adequately funded, fairly financed, and appropriately used by an informed and empowered public by (1) strengthening the National Health Insurance Program (NHIP) as the prime mover in improving financial risk protection; (2) generating resources to modernize and sustain health facilities; and (3) improving the provision of public health services to achieve the Millennium Development Goals (MDGs).
For 2011, the government has set aside P3.5 billion for the National Health Insurance Program to cover about 4.7 million poor families and 1.4 million squatter households. This will be released after a new guideline is finalized and issued by the DBM, PhilHealth and the DOH. This amount will be increased to P12 billion in 2012 and benefit some 5.7 million poor families with wider health-care coverage.
Data shows that less than 50 percent among rural women have access to health insurance; of which less than 10 percent are landless workers.
While total health expenditure has been increasing for the past two years, majority of this has been due to out-of-pocket expenditure by family and individuals. This means this has not really addressed the needs of the poorer sector, only those with money that can afford out of pocket payments benefited.
The AHA espoused the Formula One strategy which heavily depends on the local government’s performance and awareness about good governance, provisions can become available. Quality of service also varies across areas.
Gender-Based Violence: On Violence Against Women and Children
The problem of violence against women and children is present across classes, races, and culture (even among the lumads). Examples of incidence of violence are: physical assault/abuse, womanizing of husbands, mental/psychological and financial abuse. Victims of violence find it difficult to break away from the cycle of violence they are in because women usually lack the resources to support their children, they have become dependent on their husbands/ partners, fear of the negative impression/ judgment from the community people/society, they get the blame as to being the cause of the violent behaviors of their husbands, and unresponsive local government to support their cause.
The unresponsiveness of the LGU can be attributed to low level of awareness about women’s rights, family responsibility and related laws and the dominance still of the patriarchal mindset of our society. Hence, people (whether the women victims and the LGU officials) would rather remain quiet about the problem and keep it to themselves.
Slow and loose implementation of the Anti-VAWC law and other related laws at the local level can be attributed to many LGU authorities lack of information and understanding of these laws. Extensive education and orientation sessions should be done among the LGU employees, the different agencies including division school officials of the Department of Education.
Also, one hindering factor in pursuing the case is the multiplicity of needs and requirements that victims-survivors have to attend to. Families and relatives of victims often give up or accede to settlement rather than filing a case because of financial constraint and the cumbersome judicial process they have to undergo which they themselves are not knowledgeable about.
The Philippine Women’s Commission (formerly National Commission on the Role of Filipino Women) reports that the Philippines has made gains, in the last ten years, in institutionalizing policies addressing violence against women. Considered landmark laws are RA 7877 addressing sexual harassment; RA 8353 on rape and marital rape; RA 9208 on trafficking in persons, especially women and children; RA 9262 on violence against women and children and RA 8504 on the Philippine HIV-AIDS law. In terms of implementation, the Philippine government set up mechanisms to address facility in implementation and monitoring. First, is the creation of the Inter-Agency Council Against Trafficking (IACAT). Second, is the Inter-agency Council on Violence Against Women and Children (IACVAWC).