RH, the economy and critical lessons from our ASEAN neighbors

Lila Ramos Shahani is assistant secretary of the National Anti-Poverty Commission (NAPC). She is also adjunct faculty of the Center for Development Management at the Asian Institute of Management (AIM) and a doctoral candidate at Oxford University. This piece was published in the October 17, 2011 edition of the BusinessWorld, pages S1/4 to S1/5.

 

Debates on the controversial Reproductive Health (RH) bill have become increasingly heated in recent months. In a nutshell, anti-RH votes are impelled by a combination of conservative moral doctrine and realpolitik considerations. RH advocates study, with deepening concern, our worsening economic performance and the crushing poverty throughout the archipelago.

While all politics may ultimately be local, there is still much to be gained by examining what has worked for our Association of Southeast Asian (ASEAN) neighbors with smaller family sizes and lower incidences of poverty.

Three such neighbors—Thailand, Indonesia and Vietnam —offer us important lessons. In all three, there was a latent public demand for reproductive health assistance from the government: laws were passed, establishing government RH policies, and grassroots organizations formed fairly quickly to help enact them.

As Walden Bello has demonstrated, Thailand remains a favored comparison because, back in the 1970s, Thailand and the Philippines shared remarkably similar circumstances. Both nations had populations of about 36.7 million growing at around 3 % per annum; by 2007, however, our growth rate was still at a high 2.04 %, while Thailand’s was already as low as 0.8 %. By 2008, there were 90 million Filipinos and only 66.5 million Thais.

To put these figures into perspective, consider that this difference (about 25 million) is almost the entire population of Malaysia. If all Malaysians had moved to Thailand, its per capita GDP of $4,043 would have been closer to the $1,847 per capita GDP we had in this country. Indeed, had we addressed population growth at the same time that Thailand did, we might now be a net exporter of rice, with an estimated surplus of 3 million metric tons.

In Vietnam, we observe consistent government policy and grassroots organization on the issue. Their population in 1989—64.7 million to our 60.1 million— was down to 88.2 million by 2010, compared to 94.01 million Filipinos that year.

The RH bill opponents would have us believe that poverty can be addressed by promoting economic growth and reducing social inequality alone. Vietnam’s experience demonstrates that this isn’t necessarily so: the early 1990s saw Vietnam shift from traditional, centralized socialism to modern, market-based socialism. But its inequality level, as reflected in the Gini Index, has consistently remained the lowest in ASEAN. All factors considered, Vietnam’s case suggests that focusing solely on social inequality, far from ensuring economic growth, can do little more than redistribute poverty. In fact, without an RH policy, Vietnam’s population estimates for today would be closer to 104.4 million.

In Indonesia, we see a combination of top-down leadership effectively combining with grassroots organization, but we also observe additional points of instruction. As in the Philippines, Islamic leaders did not oppose family planning. More surprising to us here, neither did the Catholic Church. Instead, they deemed family planning to be a moral choice best made on the basis of information — in fact, the attitude of the Catholic hierarchy was clearly discernible when it approved the distribution of a government family planning booklet describing different methods of artificial contraception.

But perhaps the greatest lesson from Indonesia is the danger of wavering support: the Asian financial crisis of 1998 saw a reduction in their RH budget, which may have been responsible for the country’s abortion numbers subsequently rising to a high 1.2 million annually, leading President Yudhoyono to seek increased government resources specifically for reproductive health.

At 3.3 %, the Philippines has a significantly higher fertility rate than Thailand (1.8%), Indonesia (2.2%) or Vietnam (2.1%). Besides the highest birthrate in Asia, our abortion statistics are nothing short of alarming.

The Philippines sees approximately 500,000 induced abortions annually. According to a recent UC Berkeley report, 68% ofFilipinas who undergo induced abortions are poor; 91% are married; 57% have more than 3 children; and 87% are Catholic. Asked why they even sought abortions, 72% cited the expense of child-raising; 54% say they already have enough children; and 57% report that the pregnancy occurred too soon after their last one.

These facts are grim indeed: in 2000, 78, 901 women were hospitalized for injuries from unsafe abortions and another 961,000 for unintended pregnancies brought to term. If these figures remain un-compelling to some, it may be useful to note that the combined cost of those hospitalizations is approximately P5.5 billion. In contrast, the RH bill’s family planning component would potentially cost a far smaller P3.5 billion per year.

All told, the World Health Organization estimates that 19% of all maternal deaths in Southeast Asia in any given year are due to unsafe abortions. Of course, no ASEAN country endorses abortion as a method of family planning. But numerous studies demonstrate that the availability of family planning methods and information can reduce the number of abortions by almost half. Indeed, many Catholic countries (Panama, Guatemala, Brazil, Colombia, Dominican Republic, El Salvador, Honduras, Nicaragua, Venezuela, Paraguay and Ireland) prohibit abortion as a family planning method, while vigorously promoting contraceptive use.

There are more pressing questions: Are we willing to remain one of the top 10 political and environmental hot spots in the world simply because we’ve neglected to craft a forward-looking and realistic family planning policy?

What of the fact that over ten women die everyday from complications during childbirth, many of them resulting from illegal abortions?

Can we live with being the world’s 12th most populous nation, 5th in global hunger and 4th in the number of child prostitutes?

Perhaps, once and for all, we could finally begin to learn from our neighbors in the region, many of whom have progressed by leaps and bounds while, dismally, we continue to trail far behind.


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