Likhaan and the Struggle for Reproductive Rights in the Philippines

By Rita Morbia

Like many women’s health advocates in the Philippines, Dr. Junice Melgar (photo), the Director and cofounder of Likhaan [1], traces her days as an activist to living under the cloud of the Marcos dictatorship. She remembers barbed wire around her high school and the military rummaging through students’ personal effects. Later as a medical student, she joined the national liberation struggle. It was a difficult time—one of secrecy, fear and violence.

Junice was involved in providing free medical services to rural communities, particularly women. Listening to them she realized the depth of entrenched patriarchal attitudes and the suffering they caused countless women. It awakened the feminist in her.

Junice was also inspired by the agency of women in the communities where she worked. The women did their own political analyses and proposed solutions. “My job,” says Junice, “was to ensure that these women could speak and act on their own behalf.”

In the post-Marcos period, Junice and other health activists, including Dr. Sylvia Estrada-Claudio—the current Chair of Likhaan’s board of directors—formed Likhaan, one of the Philippine’s leading women’s health organizations. Likhaan works in three basic areas: delivery of primary healthcare through clinics for women by trained community health workers, support for grassroots organizing with women and youth groups, and research-based advocacy on national issues.

Sylvia recalls Likhann’s early approach: “Like any group of community organizers, we started by listening to the women about their problems and what they thought were the causes. We listened also to their dreams and how they thought they might achieve them. Then, we began to exchange our own views and opinions with them. In short, we took them seriously. For many of the women, it was the first time that anyone took them as serious political actors. It was an important first step.”

Likhaan’s philosophy and approach remains essentially the same today. It is infused with a women’s rights agenda locally and nationally, an emphasis on empowerment, and the creation of space for dialogue, learning, and transformation.

Likhaan Clinics

Likhaan has clinics in six large urban poor communities of metro Manila and two community organizing programs in the central Philippines. The clinic staff members are women, often already trusted leaders, from the communities themselves who have undergone training to become community health workers. They deliver comprehensive primary healthcare with an emphasis on reproductive and sexual health. These clinics see over 30,000 patients annually. They serve women seeking pre- and post-natal obstetric care, information and access to contraception, care for post-abortion related complications (abortion is illegal in the Philippines), respite and solutions for domestic violence, and youth interested in learning about sexual health. The clinics are often hubs in the community for information and organizing.

A number of principles  underpin the way Likhaan delivers clinical care. First, Likhaan support the belief that poverty does not justify substandard care and consequently, the organization is uncompromising about a high quality of care for all its patients, largely women and children. Second, Likhaan strongly promotes the responsibility of the State to provide universal healthcare, including reproductive and sexual health. The organization  views its clinics as a cost-effective, high quality, and compassionate model for the government, not as a replacement. Clinics are an entry point for organizing and complements Likhaan’s national policy advocacy work on universal healthcare and reproductive health. Third, Likhaan broke with the prevailing tradition of Filipino peoples organizations when it began and insisted on paying their community health workers a decent wage, recognizing the burden that all women and particularly poor women who chose to become community health workers already carried.

Organizing

Likhaan has always nurtured women’s organizations and youth groups from the communities where they are active. These groups have been involved in both national and local advocacy work as well as addressing the social determinants of health such as housing and non-discrimination. Youth groups are active in areas such as peer sex education and LGBTQ rights—radical in a predominantly Catholic country. A major success story has been the establishment of PiLaKK [2], a growing federation of 20 of these community-based organizations with over 4,000 members. PiLaKK gives communities a stronger voice and the opportunity to pool resources and learn from each other. Members have been active in initiatives such as the “reproductive health sentinels” where they are trained to look for and identify obstetric and other medical emergencies in the community and provide appropriate assistance. Likhaan’s organizing work has helped women and youth from extremely impoverished communities have an important voice in debates and take part in activities that can profoundly affect the quality of their lives.

Research-based Advocacy

In a 2009 brief [3] written in conjunction with the University of the Philippines Population Institute and the US-based Guttmacher Institute, Likhaan issued the following statement:

Currently, more than half of all pregnancies in the Philippines are unintended—that is, they occur too soon, too close together or after a couple already has as many children as they want. Consequently, many women give birth to more children than they want or can care for, and others turn to unsafe abortion. Maternal and infant mortality are unacceptably high, especially among disadvantaged women—those who are poor, live in rural areas or have little education.

Perhaps the most important development in the Philippines today in the area of reproductive health and rights is the Reproductive Health (RH) Bill. For many advocates its enactment will be the culmination of decades of struggle. Providing healthcare is a shared responsibility in the Philippines between the national government and municipalities called local government units (LGUs). The LGUs determine budget allocations, including to contraception, creating a very poor national patchwork of delivery and support for family planning services.

Since 2000, as a consequence of the Catholic Church’s influence, there has effectively been a ban on the provision of contraceptives in Manila—in contravention of both the Filipino Constitution and obligations under international treaties. With a population of just under two million, the results have been devastating, particularly for poor women. The impacts are documented in a 2007 report Imposing Misery: The Impact of Manila’s Ban on Contraception [4] co-authored by Likhaan in collaboration with two other organizations.

In 2004, these impacts were compounded by wide-ranging public sector cuts to the provision of contraception, due in part to USAID’s withdrawal of support for family planning as well as the then President, Gloria Macapagal Arroyo’s fundamentalist views. The national budget supported only Catholic Church-approved natural family planning methods, not “artificial” contraceptives. Private sector procurement of contraceptives by women surged almost three fold and surveys indicated that cost was a significant barrier to contraceptive use.  Likhaan’s research found that “three in 10 Filipino women at risk for unintended pregnancy do not practise contraception. These women account for nearly seven in 10 unintended pregnancies.” Though the policy context has changed, the damage has been done.

The RH Bill

Enter the Reproductive Health Bill. Provisions in the RH Bill would mandate national and local support for safe and legal modern methods of family planning, access to emergency obstetric care for women as well as pre- and post-natal care, access to non-judgmental care for post-abortion complications (despite the illegality of abortion in the Philippines), and health and sexuality education for youth. Proponents believe that these reforms would promote equity for women, significantly reduce maternal and child mortality and decrease unintended pregnancies. The RH Bill could reduce an astonishing 2,000 maternal deaths annually.

Given the bill’s popular support, the high level of support in the Philippines Congress and the support of the current President Aquino, Likhaan had hoped it would have passed by now. However, opposition has been vociferous. There have been claims of promoting “immorality, promiscuity and bestiality” or that it would result in Filipinos becoming an “endangered species.” The President has been threatened with ex-communication. Walden Bello, a congressional representative of Akbayan (Citizen’s Action Party) stated that: "One wishes that one could characterize the debate as a laudable exercise in democracy." It has become, instead, an exercise on how to use parliamentary procedures to derail democracy. The same questions have been repeatedly raised by the anti-RH interpellators, and it has become increasingly clear that, not having the votes to prevent the passage of the bill in the House, they have resorted to the equivalent of a filibuster to delay the bill from coming to a vote on the floor.

The RH Bill is likely to pass sooner or later. But as the women in the communities of Manila where Likhaan works have often stated, “even if it doesn’t we will continue to fight.

RH Bill adopted! Read the recent and exiting news [5] published in December 2012 in The Guardian.

Canada

Dr. Sylvia Estrada-Claudio speaking in Canada several years ago said that, “we have a saying back home, when the over-developed North sneezes, we get pneumonia.” She went on to describe what “pneumonia” looked like with respect to the privatization of healthcare. As advocates in the Philippines sit on the cusp of a major victory with respect to reproductive rights and health, it begs the question of whether or not we’re catching a cold here in Canada.

Rita Morbia is the Executive Director of Inter Pares, a social justice organization based in Ottawa.