The

in
Medical & Ethical Issues
Reproductive Health Care
Objectives:
1. To increase the awareness and sensitivity
of medical students and practitioners to
ethical problems that they confront as they
render reproductive health care.
2. To develop an understanding of bioethical
concepts and principles and be able to apply
them in the analysis of bioethical issues in
reproductive health care.
3. To develop a mature reasoning and act
according to sound ethical judgment.
 There are many instance when
healthcare matters require an
ethical approach.
We cannot follow the principle:
“Everything that can be done
ought to be done.”
Medical practice is subject to certain
ethical limitations.
Human dignity must be the central
value for the financing of
development.
A true concern for the development
of peoples cannot afford to be
reductionistic, but must respect the
genuine claims of both economics and
morality.
Such an authentic concern must
prize the close relationship between
the centrality of the human person
and economic activity, stressing the
subjective character of human work
and its place in human creativity.
Reproductive Health Care:
Medical & Ethical Issues

Principle of Beneficence &
Non-Maleficence

Principle of Justice

Principle of Autonomy
P Beneficence and
r 1 Non-Maleficence
Patient benefit and avoidance of harm
i
“ I will use treatment to help the sick
n according to my ability and judgment,
c but will never use anything to injure or
wrong them.”
i - Hippocratic Oath
p
You have the duty to do or promote good and
l the duty to remove or prevent evil or harm.

e
V Reproductive Health and
i 1.1 Population and
Development Act of 2010
o is about education &
l promotion of safe sex and
use of modern
a contraceptive devises.
t See Sec. 13, Mandatory Age-Appropriate
Reproductive Health and Sexuality Education,
i HB 96

o
n
V What is wrong with “safe sex”
and the use of contraceptives?
i 1.1
o Contraceptives are not effective in blocking out

STDs.
l The inherent naturally occurring flaws in natural


rubber (latex) are up to 5 microns inches in size. The

a average sperm is about 50 microns in diameter, and
the average AIDS virus is about 0.1 micron in size. An
t AIDS virus can pass through a latex flaw.
- Dr. C. Michael Roland of the U.S. Naval Research Lab,
i Washington D.C, Rubber World, June, 1993
The greater danger of infection lies in the propensity

o of condoms to burst, tear and slip off frequently
- Brian Clowes, http://www.lifeissues.net/
n
V What is wrong with “safe sex”
1.1 and the use of contraceptives?
i
There is no absolute guarantee that one will not get

o sexually transmitted diseases (STDs) and HIV even

when condom is used.
l Most experts believe that the risk of getting HIV/AIDS

and other sexually transmitted diseases can be
a greatly reduced if a condom is used consistently and
correctly.
t In other words, sex with condoms isn't totally "safe

sex," but it is "less risky" sex.
i The most reliable ways to avoid transmission of

STDs are to abstain from sexual activity, or to be in a
o long-term mutually monogamous relationship with an
uninfected partner.
n - Centers for Disease Control (CDC) & US FDA
V 1.1 What is wrong with “safe sex”
and the use of contraceptives?
i
Some contraceptives are abortifacient.
o

l Although
 the primary mechanism of oral
contraceptives (OC) is inhibition of ovulation,
a other alterations include changes in the cervical
mucus, which increase the difficulty of sperm
entry into the uterus, and changes in the
t endometrium,
implantation.
which reduce the likelihood of

i - Physicians’ Desk Reference & Drug Facts and Comparisons

o
n
V 1.1 What is wrong with “safe sex”
and the use of contraceptives?
i "Family planning" experts have always

o recognized that the high failure rate of

contraceptives would lead to more abortions.
l Oral contraceptives (OCs) have a method failure rate of 0.3 %


a woman uses the combined pill or the minipill, she has a 34%
and user failure rate of 8% during the first year. As such, if a

chance of an unintended pregnancy in five years and an 57%

t chance of a pregnancy in 10 years.
 Abortion statistician Christopher Tietze stated that : "The safest
i regimen of control for the unmarried and for married child-spacers is
the use of traditional methods [of contraception] backed up by
o abortion; but if this regimen is commenced early in the child-bearing
years, it is likely to involve several abortions in the course of her
reproductive career for each woman who chooses it."
n – Brian Clowes, The Facts of Life (http://www.hli.org/)
V What is wrong with “safe sex”
1.1 and the use of contraceptives?
i
Some “Emergency Contraception” (EC) are


o abortifacient.
Many women present for “emergency contraception” following


l consensual but unprotected sexual intercourse and in some

cases aggravated sexual assault. Hormonal emergency
contraception (morning-after pill or Yuzpe method) is
a supposed to substantially decrease the likelihood of an
unwanted or unintended pregnancy when taken within 24-72
t hours of unprotected intercourse.
i Similar
 to the other hormonal contraceptives, the major
mechanism is inhibition or delay of ovulation (US Food and
Drug Administration, 1997). Other mechanisms include sperm
o penetration, tubal motility, and alteration of the endometrium
(post-fertilization effect). Established pregnancies are
n supposedly not harmed.
– Williams Obstetrics, 22nd Ed, 2005
V What is wrong with “safe sex”
1.1 and the use of contraceptives?
i
Some “Emergency Contraception” (EC) are
o abortifacient.

l EllaOne – a new five day morning-after pill that claims to


be ‘emergency contraception’ – can in fact act as an
abortion-inducing drug. It can prevent an embryo from
a receiving nourishment from its mother’s womb,
thereby aborting the pregnancy.
t The drug’s chemical composition and function are nearly

identical to a commonly used abortion drug known as
i RU-486.
The drug has been on sale in the UK for a year and has


o been approved by the US Food and Drug Administration

earlier this year.

n – Lifesitenews.com, 18 October 2010

V What is wrong with “safe sex”
1.1 and the use of contraceptives?
i
o Some
contraceptives are abortifacient.
“In IUD users, the low recovery of ova from the uterus, as


l well as the lack of hCG rise in more recent studies of IUD

users, suggest that the major postfertilization effect is
destruction of the early embryo in the Fallopian tube,
a in the same way that the major prefertilization effect is
likely to be destruction of sperm and ova.

t For the copper IUD, this embryocidal effect may be more a


result of inflammation and direct toxicity, whereas with the
i progestin IUDs it may result more from inhibition of
transport through the Fallopian tube, along with prevention
of implantation, preventing long-term viability of the
o embryo.”

Stanford and Mikolajczyk, American Journal of Obstetrics &

n 
Gynecology, December 2002
V Ref.
Contraceptives harm the body in numerous ways
nd
Williams Obstetrics - 22 ed (2005) – McGraw Hill Professional
i  Oral contraceptives:  Injectable
o increased risk of
thromboembolic
Contraceptives (Depo-
Provera) and Progestin
disorders (deep vein
l thrombosis, pulmonary
Implants (Norplant):
- same as oral
embolism), stroke,
contraceptives.
a hypertension,
increased risk of  Hormonal Emergency
myocardial infarction in Contraception
t smokers, migraine (morning-after pill or
Yuzpe method):
headache, aberrations
i in the levels of several
nutrients, stimulatory
- nausea and vomiting

o effect on some
cancers, other
metabolic effects
n
V Contraceptives harm the body in numerous ways
i
o The best evidence continues to suggest that the

increased risk of cardiovascular side effects
l (especially venous thromboembolism or VTE,
manifesting as deep venous thrombosis of the leg or
a pulmonary embolism), in oral contraceptive (OC)
users is a class effect, dependent on the estrogen
t dose and duration of use, and independent of the
progestogen used.
i
o Shapiro & Dinger. J Fam Plann Reprod Health Care. 2010 Jan


n
 Contraceptives harm the body in numerous ways
V
i
 The overall absolute risk of VTE per 10 000 woman years in in
current users of oral contraceptives was 6.29 (vs. 3.01 in non-
users).
o  National cohort study, Denmark, 1995-2005, Danish women aged 15-49
with no history of cardiovascular or malignant disease.

l  In total, 4,213 venous thrombotic events were observed, 2, 045 in current

users of oral contraceptives.
– Lidegaard et al, British Medical Journal. 2009 Aug
a
 Currently available oral contraceptives increased the risk of VTE
t fivefold compared with non-use. The risk clearly differed by type
of progestogen and dose of estrogen.

i  Population based case-control study in the Netherlands, 1524 patients and

1760 controls. Premenopausal women <50 years old who were not
pregnant, not within four weeks postpartum, and not using a hormone

o excreting intrauterine device or depot contraceptive.

– van Hylckama Vlieg, British Medical Journal, 2009

n
V Contraceptives harm the body in numerous ways
nd
Ref. Williams Obstetrics - 22 ed (2005) – McGraw Hill Professional
i
o Intrauterine devices
  Mifepristone (RU 486):
(IUDs): effective up to 17 days
l and abortion, uterine
uterine perforation

after intercourse (Weiss,
cramping and 1993)
a bleeding,  nausea, vomiting,
menorrhagia, gastrointestinal
t infection, ectopic
pregnancies;
cramping, hemorrhage
due to partial expulsion
i ifwiththere’s
 pregnancy
IUD in utero –
of pregnancy, intra-
abdominal hemorrhage
late abortion, sepsis,
o preterm birth from an early
unsuspected ectopic
n pregnancy
V Contraceptives harm the body in numerous ways
nd
Ref. Williams Obstetrics - 22 ed (2005) – McGraw Hill Professional
i
o
Tubal sterilization: Vasectomy:
l 
anesthetic

an almost twofold risk of
complications, prostatic cancer in men
a inadvertent injury of
adjacent structures,
less than 55 years old
(Lesko et al, 1999)
t pulmonary embolism
(rare), failure to
produce sterility with
i subsequent
development of ectopic
o pregnancy

n
V Reproductive Health and
i 1.2 Population and
o Development Act of 2010
is about classifying
l making family planning
supplies as essential
a medicine
t See Sec. 9, Family Planning Supplies as
Essential Medicines, HB 96
i
o
n
 Criteria for Drug Selection into the Essential Drug
List and the National Drug Formulary
(WHO Technical Report Series No.825, The Use of Essential Drugs)

Relevance to disease Indicated in the treatment of prevalent diseases

Efficacy and safety Based on adequate pharmacologic studies especially
among Filipinos
Quality Must meet adequate quality control standard including
stability &, when necessary, bioavailability
Compliance with WHO Certification Scheme on the
Quality of Pharmaceutical Products Moving in
International Commerce
Cost of treatment regimen

Appropriateness to the
capability of health
workers at different
levels of health care
Local health problems

Benefit/Risk ratio
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Most normal, low-risk pregnancy, per se, is not

a disease, and as such does not need

l medicines, except for iron and multivitamin
a supplementation.
Hence, the only “essential” medicines during


t pregnancy would be ferrous sulfate and

multivitamins.
i
o
n
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Hormonal contraceptives (and injectables) are not

safe, as has already been shown by meta-analysis

l of case-control studies
a almost twofold statistically significant increased risk of
Use of oral contraceptives (OCs) was associated with


premenopausal breast cancer in general and across

t various patterns of OC use.
The association between OC use and breast cancer risk
i 
was greatest for parous women who used OCs 4 or
more years before first full term pregnancy.
o • Kahlenborn et al, Mayo Clinic Proceedings. 2006

n
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Contraceptive hormone use is linked to

l cardiovascular disease.
 Newer generation oral contraceptives (OC) indicate a persistent
a increased risk of venous thromboembolism for current users.
Current guidelines indicate that, as with all medication, contraceptive
t 

hormones should be selected and initiated by weighing risks and

benefits for the individual patient.
i  Women 35 years and older should be assessed for cardiovascular
risk factors including hypertension, smoking, diabetes, nephropathy,
o and other vascular diseases, including migraines, prior to OC use.
• Shufelt & Bairey Merz, J Am Coll Cardiol. 2009 Jan
n
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Depot medroxyprogesterone acetate (DMPA)


use may be associated with an increased risk
l of fractures
a  DMPA suppresses pituitary gonadotrophin output, thus, suppressing
ovulation. Estrogen production from the ovary is also strongly
inhibited, and the resulting estrogen deficiency has a detrimental
t impact on bone. DMPA may be particularly detrimental in young
women, as it may impede attainment of peak bone mass.

i DMPA use seemed to be associated with a statistically significant


 Albertazzi et al, Contraception. 2006 Jun

increased risk of fractures, in a case control study among Danish

o women
 Vestergaard et al, Contraception. 2008 Dec
n
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Intrauterine devices (IUDs) are not safe

During the use of a copper IUD, menstruation tends to be

l 

longer with a greater loss of blood; in 70% of women who use

a hormonal IUD oligomenorrhea or even amenorrhoea
a develops. In the first weeks after IUD insertion, there is an
increased risk of pelvic inflammatory disease (PID).
t  Summary of the practice guideline 'The intrauterine device' from

i ,
the Dutch College of General Practitioners 2009
A World Health Organization multi-centre study established


o that pelvic inflammatory disease (PID) risk is temporally

related to IUD insertion procedures.
n • Shapiro, Reprod Health Matters. 2004 May
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Intrauterine devices (IUDs) are not safe


In 15 studies comparing IUD performance in parous vs. nulliparous


l women, nulliparous women had higher rates of expulsion and

removals due to bleeding and pain.
a Uterine perforation is a rare yet serious complication and is usually

 Hubacher, Contraception. 2007 Jun

seen during insertion of the IUD.

t  Koltan et al, J Chin Med Assoc. 2010 Jun
There are about 70 cases in the literature of IUDs that have

i migrated into the bladder. The resulting bladder perforation can
be complete or partial.
o There is a reported case of a colon penetration by a copper IUD.

 Istanbulluoglu et al, J Chin Med Assoc. 2008 Apr

n  Arslan et al, Arch Gynecol Obstet. 2009

V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o There is an association of contraceptive methods,

including oral contraceptives (OC) and tubal

l sterilization (TS), with overall and site-specific
a In a large prospective cohort study from 1996 to 2006 of
cancer.


t 66,661 Chinese women in Shanghai, 76.7% of whom used

contraception, 2,250 women were diagnosed with cancer
i during a median follow-up time of 7.5 years.
 Dorjgochoo et al, Int J Cancer. 2009 May
o
n
V What is wrong with classifying
family planning supplies as
i 1.2 essential medicines?
o Various contraceptive methods or reproductive patterns

may play a role in the etiology of cancer.

l  Use of any contraceptive method was associated with increased
risk of rectal cancer and reduced risk of thyroid cancer.
a  Risk of gallbladder cancer increased with ever use of oral
contraceptives (OC).
t  Ever having a tubal sterilization (TS) was associated with
increased uterine body cancer and decreased risk of stomach
i cancer.
 There are no findings of any contraceptive method being related
o to the risk of ovarian cancer but the analyses were based on few
events.
n  Dorjgochoo et al, Int J Cancer. 2009 May
P
r
i
2 Principle of Justice
Respect or Recognition of a
Right that Belongs to Others,
either to God or to Fellowmen
n Distributive justice is the aspect of justice that
pertains to a fair scheme of distributing society’s
c benefits and burdens to its members.

The presumed benefits are receiving medical
i care and treatment.

The presumed burdens are paying for care and
p partaking in experimental research.

l Give to others what is due them.

e
V Unjust

i 2.1 Distribution of Benefits &

Burdens
o
Reproductive Health and Population
l and Development Act of 2010 is about
promoting a program to “achieve
a equitable allocation of resources” when
problems pertaining to lack of
t “reproductive health” is not as
prevalent nor as life-threatening as our
i other health problems.
o See Sec. 3, Guiding Principles, HB 96

n
 Top Ten Leading Causes of Morbidity and
Mortality in Low-Income Countries
(WHO, 2004)
Deaths in
% of deaths
millions
Lower respiratory infections 2.94 11.2
Coronary heart disease 2.47 9.4
Diarrheal diseases 1.81 6.9
HIV/AIDS 1.51 5.7
Stroke & other cerebrovascular diseases 1.48 5.6
Chronic obstructive pulmonary disease 0.94 3.6
Tuberculosis 0.91 3.5
Neonatal infections 0.90 3.4
Malaria 0.86 3.3
Prematurity and low birth weight 0.84 3.2
V What is wrong with giving
i 2.1 priority to reproductive
health ?
o

“Eight of the 10 leading causes of morbidity in
the Philippines are caused by infections. They
l are: acute lower respiratory tract infection and
pneumonia; acute watery diarrhea; bronchitis/
a bronchiolitis; influenza; tuberculosis; malaria;
acute febrile illness; and dengue fever.
t

Among these communicable diseases,
i pneumonia and tuberculosis continue to be
among the 10 leading causes of mortality,
o causing a significant number of deaths across
the country.”
n -World Health Organization (WHO) Western Pacific Region Report
V What is wrong with giving

i 2.1 priority to reproductive

health ?
o
“While we have all become accustomed to the
longstanding situation in which donated
l contraceptives were widely distributed free-of-
charge, this may not necessarily have been
the best approach for the nation to take in
a addressing the needs of the people.
t
Statistics will show that the prevalence of
contraceptive use has long since leveled off,
and there is really no massive clamor among
i the Filipino people to have more and more free
contraceptives.
o
- former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
n Philippine Daily Inquirer, 9/20/04
V What is wrong with giving
i 2.1 priority to reproductive
health ?
o
“Financial resources allotted by foreign donors to
l assist the Philippine Government’s programs could
actually be better spent in other pursuits than
a purchasing contraceptives.”

“It is also of value to demystify our perceptions about the
t role of contraceptives in women’s health, women’s rights,
and healthy families. To equate access to
i contraceptives with the reduction in maternal
o morbidity and mortality is simplistic.”
- former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
n Philippine Daily Inquirer, 9/20/04
P
r
i
2 Principle of Justice
Equal Distribution of Burdens

n Justice demands that giving undue

c burden to an individual requires his informed
i consent, he must understand what is
p involved in the burden and voluntarily accept
l it. Often it involves the virtue of charity.

e
V Population control:
i 2.2 its’ about Eugenics
Margaret Sanger
o of Planned Parenthood
Founder

l In Her Own Words Margaret Sanger (1883-1966)

a On the rights of the handicapped and mentally ill,

t and racial minorities:
"More children from the fit, less from the unfit -- that is the

i chief aim of birth control." - Birth Control Review, May 1919, p. 12

On the purpose of birth control:
o The purpose in promoting birth control was "to create a race of
thoroughbreds," - Birth Control Review, Nov. 1921, p. 2

n
V
i
2.2 Unjust Distribution of Burdens
Eugenics in America
o
"Our failure to segregate morons who are increasing and multiplying ...
l demonstrates our foolhardy and extravagant sentimentalism ...
[Philanthropists] encourage the healthier and more normal sections
of the world to shoulder the burden of unthinking and indiscriminate
a fecundity of others; which brings with it, as I think the reader must
agree, a dead weight of human waste. Instead of decreasing and
t aiming to eliminate the stocks that are most detrimental to the future
of the race and the world, it tends to render them to a menacing
degree dominant ... We are paying for, and even submitting to, the
i dictates of an ever-increasing, unceasingly spawning class of
human beings who never should have been born at all."

o - Margaret Sanger. The Pivot of Civilization, 1922

n
V Population Control:
i 2.2 it’s about Eugenics
o
The eugenics circle held that some races and individual
l members of the human species were genetically superior
to others These superior members should be encouraged
a to reproduce, while the births of inferior members such as
the poor or minorities were to be regulated.
t
i Their ultimate solution to the problem of poverty was
simple: Eliminate the poor.
o - Walter Schu, "Margaret Sanger's Century."
National Catholic Register, May, 1999
n
P
r
i
3 Principle of Autonomy
The Patient’s Option to Choose
Based on Respect for this Free Will

A patient has the moral right, as an individual

n person, to determine what is good for himself.
This right of self-determination include:
c
Right to informed consent
i
Right to informed decision

Right to informed choice
p
Right to refusal of treatment

l It is the duty of the physician to perform or omit an

action corresponding to the patient’s right.
e
P
r
i
3 Rights to Informed Consent,
Decision & Choice
To receive all necessary information concerning
diagnosis and medical intervention, before that
n treatment is administered, in order to be able to
give willing and uncoerced consent based on
c his/her value system. Elements of informed
consent:
i
Disclosure by the health professional of the
p nature of the intervention, its expected risks,
and benefits and alternatives available
l
Comprehension of the patient

Voluntariness of the patient
e
Competence of the patient
P
r
i
3


Right to Refusal of Treatment

“The patient has the right to refuse treatment to

n the extent permitted by law and to be informed
c of the medical consequences of his action.”

i - Patient’s Bill of Rights

p
A patient may refuse medical treatment because

their religious convictions prohibit them from
l doing so.
e
V
i
3.1
o Reproductive Health
Population and Development
l Act of 2010 is about ensuring
a people’s access to medically
safe, legal, effective, quality
t and affordable reproductive
i health goods and services .
o See Sec. 20, Implementing Mechanisms, HB 96

n
V What is wrong with access
i 3.1 to reproductive health
goods and services?
o
“Equally flawed is the much-publicized argument that
women are accorded the rights they deserve when they
l are made to use contraceptives. Majority of women who
use these products are not wholly aware of the many
a effects they have on their health and lives, and of the
other approaches that are available to them.”
t
It is our belief that women’s rights, reproductive rights, and
i the right to health could only be realized within an
environment of informed choice.
o - former Department of Health (DOH) Secretary Manuel M. Dayrit, MD, MSc
Philippine Daily Inquirer, 9/20/04
n
 What is wrong with access
V to reproductive health
i
3.1 goods and services?

o
Indiscriminate access to reproductive health

goods and services without full disclosure of the
l potential for post-fertilization effects of hormonal
contraceptives constitute a violation of informed
a consent.
 The available evidence supports the hypothesis that when
t ovulation and fertilization occur in women taking oral
contraceptives (OCs), post-fertilization effects are operative on
occasion to prevent clinically recognized pregnancy.
i Oral contraceptives directly affect the endometrium. These
effects have been presumed to render the endometrium
relatively inhospitable to implantation or to the maintenance of
o the preembryo or embryo prior to clinically recognized
pregnancy.

n – Larimore & Stanford, Archive of Family Medicine, Feb 2000

 What is wrong with access
V
i 3.1 to reproductive health
goods and services?
Indiscriminate access to reproductive health
o

goods and services without full disclosure of the
l potential for post-fertilization effects of hormonal
contraceptives constitute a violation of the
a patient’s right to refuse treatment.
Physicians should understand and respect the beliefs of
t 
patients who consider human life to be present and valuable
from the moment of fertilization. Patients should be made
i fully aware of this information so that they can consent to or
refuse the use of oral contraceptives.

o – Larimore & Stanford, Archive of Family Medicine, Feb 2000

n
 What is wrong with access
V to reproductive health
i 3.1 goods and services?
Women who believe that human life begins at
o


fertilization and those who consider it is important
to distinguish between natural and induced
l embryo loss are less likely to consider the use of
a method with post-fertilization effects.
a  In a cross-sectional survey of 755 women, aged 18-49, from
Primary Care Health Centers in Pamplona, Spain, 40% of
women would not consider using a method that may work after
t fertilization but before implantation and 57% would not
consider using one that may work after implantation.

i 
– de Irala et al, Biomed Central Women's Health 2007
Among 618 women ages 18–50 in family practice and
obstetrics and gynecology clinics in Salt Lake City, Utah, and
o Tulsa, Oklahoma, USA, 34% reported they believed that life
begins at fertilization and would not use any birth control
method that acts after fertilization.
n – Dye et al, Biomed Central Women's Health 2005
V
i 3.2
o The Reproductive Health and
l Population and Development
Act of 2010 is about
a mandatory
t age-appropriate reproductive
i health and sexuality education
o See Sec. 13, HB 96

n
 Abstinence Only vs. Comprehensive Sex Education:
What are the arguments? What is the evidence?

Comprehensive Sex Education Abstinence-only education

Or “Abstinence-Plus” Education

Include discussions of issues such as
Includes discussions of values,
perception of personal risk, costs and
benefits of preventive behaviors,
sexual decision making, refusal skills,
and condom use for safe sex

Explores the context for and
meanings involved in sex

Acknowledges that many teenagers
will become sexually active

Teaches and promotes contraception

Discussion topics include substance
abuse, contraception, abortion, and
AIDS/STDs

Emphasizes avoidance of
unprotected sex through abstinence
or using protection
- Collins et al, AIDS Policy Research Center & Center for AIDS Prevention Studies,
character building, and, in some
cases, refusal skills

Encourages abstinence from
high-risk behavior, including
sexual activity

Discussion topics include
friendship, love and dating,
self-respect, decision-making,
alcohol abuse, drug abuse,
physical fitness and nutrition,
and AIDS/STDs
Policy Monograph Series – March 2002
 US National Organizations in Support of
Comprehensive Sex Education vs.
Abstinence Only Education
Comprehensive Sex Education
Or “Abstinence-Plus” Education

Sexuality Information and Education
Council of the United States
(SIECUS)

Advocates for Youth

American Academy of Pediatrics

American College of Obstetricians
and Gynecologists

American Medical Association

American Public Health Association

National Education Association

National Medical Association

National School Boards Association

Society for Adolescent Medicine
- Collins et al, AIDS Policy Research Center & Center for AIDS Prevention Studies,
Abstinence-only education

Concerned Women for America

Eagle Forum

Family Research Council

Focus on the Family

The Heritage Foundation

Medical Institute for Sexual
Health (MISH)

National Coalition for
Abstinence Education

STOP Planned Parenthood
International
Policy Monograph Series – March 2002
 What is wrong with
V mandatory reproductive
i 3.2 health and sexuality
education?
o
The harmful effects of early sexual activity are well documented.
l They include sexually transmitted diseases, teen pregnancy, and
out-of-wedlock childbearing.
a
As well, teen sexual activity is linked to emotional problems, such
as depression, and increased risk of suicide.
t
Abstinence education programs, which encourage teens to delay
the onset of sexual activity, are effective in curbing such problems.
i
Opponents of abstinence education, however, claim that abstinence
programs don’t work and that there has been “no scientific evidence
o that abstinence programs are effective.”
 Web Memo, The Heritage Foundation, May 2005
n
 Sex Education in the U.S.
30 years later

About 840,000 teens become pregnant each year. One third
of these pregnancies end in abortion. Over 3 out of 4 teen
births are out-of-wedlock.

There are more abortions now: 1.4 million annually (35-40
million in total since abortion was legalized).
Why? Because abortion is the “back up contraceptive.”

There are more illegitimate children: 6% then, 31% now.

There are more sexually transmitted diseases (STDs): 12
then, 50 now.
- ALLiance for the FAMILY Foundation Philippines, Inc (ALFI), July 2004
 Ill Effects of Sex Education
Programs Promoting “Safe Sex”

In England, the government’s Teen-Age Pregnancy Unit’s
strategy involves explicit sex education in schools, often
conducted by nurses without teachers present. It also hands
out free condoms and send birthday cards when girls reach
14 asking them to attend confidential health checks without
their parents.

In Scotland, sex education programs were introduced to
distribute free morning-after pills and condoms.

These approaches have failed to tackle the rise in STDs,
unwanted conceptions, and abortion levels.

-”Abstinence education shows its wisdom”

http://www.zenit.org (Oct 9, 2004)
 More Evidence of the Effectiveness of
Abstinence Education Programs

At least 10 studies have shown the positive effects of
abstinence programs.

The Best Friends abstinence education program began in
1987 and currently operates in more than 100 schools
across the United States.

Its curriculum consists of a character-building program for
girls in the fifth or sixth grade, including at least 110 hours of
instruction, mentoring, and group activities throughout the
year.

A companion program for boys, Best Men, began in 2000.
• Robert Lerner, Adolescent & Family Health, April 2005
 More Evidence of the Effectiveness of
Abstinence Education Programs

Junior-high and middle school-aged girls who
participated in the Best Friends program, when
compared to their peers who did not participate,
were:
 Six-and-a-half times more likely to remain sexually
abstinent;
 Nearly two times more likely to abstain from drinking
alcohol;
 Eight times more likely to abstain from drug use; and
 Over two times more likely to refrain from smoking
 Robert Lerner, Adolescent and Family Health, 2004
 More Evidence of the Effectiveness of
Abstinence Education Programs

In an analysis of the causes of the decline in non-
marital birth and pregnancy rates for teens from
1991 to 1995, increased abstinence among 15- to
19-year-old teens accounted for at least two-thirds
(67%) of the drop in teen pregnancy rates.

Increased abstinence also accounted for more than
half (51%) of the decline in teen birthrates.

 Mohn et al, Adolescent and Family Health, April 2003

 More Evidence of the Effectiveness of
Abstinence Education Programs

In a study looking at the changes in sexual behaviors
among high school students and the decline in teen
pregnancy rates in the 1990’s, results showed that 53
percent of the decline in teen pregnancy rates can be
attributed to decreased sexual experience among teens
aged 15- 17 years old, while only 47 percent of the decline
is attributed to increased use of contraception among teens.

 Santelli et al. Journal of Adolescent Health, August 2004

 More Evidence of the Effectiveness of
Abstinence Education Programs

In a poll on what parents want taught in sex education
programs, the overwhelming majority of parents (91%) want
schools to teach that adolescents should be expected to
abstain from sexual activity during high school years.

Only 7 percent of parents believe that it is okay for teens in
high school to engage in sexual intercourse as long as they
use condoms, which is the predominant theme of
“comprehensive” sex education.

 Rector et al , Backgrounder, January 2004

 More Evidence of the Effectiveness of
Abstinence Education Programs

Teens themselves welcome the abstinence message and
appear to be heeding it.

A poll by the National Campaign to Prevent Teen Pregnancy
found that a clear majority of adolescents (69%) agree that it
is not okay for high school teens to engage in sexual
intercourse.
 With One Voice, December 2004

The Centers for Disease Control’s (CDC) Youth Risk
Behavior Survey (YRBS) shows that the number of teens
who have ever had sexual intercourse has fallen seven
percent in the last 12 years, from 54 percent in 1991 to 46
percent in 2003.
 “Youth Online: Comprehensive Results”
http://apps.nccd.cdc.gov/yrbss.
 Summary of the Evidence &
Recommendations

The available evidence as presented supports the
valid opposition of those against the Reproductive
Health and Population and Development Act of
2010 on the grounds that the provisions of the RH
Bill as such could constitute violations of the
bioethical principles cited and the practice of sound
medicine on the part of the health service providers.

Physicians and policy makers should understand
and respect the beliefs of patients who consider
human life to be present and valuable from the
moment of fertilization.
 Summary of the Evidence &
Recommendations

Since the State, in accordance with the provisions of the
Philippine constitution, recognizes and guarantees the
exercise of the universal basic rights of every man,
including that of the unborn, regardless of gender, religious
convictions and cultural beliefs, then major amendments to
the proposed RH Bill have to be made before they can
even be deliberated upon by our lawmakers, much less
approved and passed as a law.

The end of meeting the Millennium Development Goals
(MDG) by 2015 does not and cannot justify the means of
providing universal access to reproductive health care
services and methods when these have not been proven
medically safe, legal and licit in all aspects.
 Respect for the dignity of man
demands the safeguarding of his
identity as man

Man’s identity consists in the following:
 Man is a creature made according to the image of the Creator.
Man is called to cooperate with God to obtain his salvation and
eternal happiness.
 Man, being a corporeal and spiritual creature, is rational and
free. Man is the most noble of all creatures. He is endowed
with such dignity that he should never be considered nor
treated as an “object”. He is not “something” but “someone.”
 Every human person, with his irrepeatable and unique
singularity, is sacred. It is the origin of his human rights and
duties. It is the basis for equality and fraternity, surpassing any
consideration of gender, race, social status, culture, etc.
• Gaudium et Spes, no. 14
The medical profession is always
at the service of man and of life
“ I will not accede to pretensions that are
directed to the administration of poison nor
induce to anyone suggestions of the kind. I
will abstain from administering
abortifacients to women.
While I continue keep this Oath unviolated,
may it be granted to me to enjoy life and the
practice of the art and science of medicine with
the blessing of the Almighty and respected by
my peers and society, but should I trespass and
violate this Oath, may the reverse be my lot.”
- Hippocratic Oath
Poverty alleviation demands growth
in the virtues

"The moral causes of prosperity ... reside in a

constellation of virtues: industriousness,
competence, order, honesty, initiative, frugality,
thrift, spirit of service, keeping one's word, daring -
- in short, love for work well done. No system or
social structure can resolve, as if by magic,
the problem of poverty outside these virtues."

- John Paul II, “Address to the U.N. Economic Commission

for Latin America and the Caribbean,” April, 1987, cited the
International Conference on Financing for Development,
Monterrey, Mexico, March 2002
 It’s a CHILD, not a CHOICE!
Your mother gave you the gift of life,
pass it on....
 ABOUT THE AUTHOR

DR. MARIA FIDELIS MANALO, MSc.

Epidemiology & Biostatistics, Research Methods, and

Bioethics Lecturer

Consultant, Palliative Care Service

Faculty, Department of Community & Family Medicine
Far Eastern University-Nicanor Reyes Medical Foundation
Fairview, Quezon City 1118
Philippines
Telephone: (63)(2) 4270213
Email: mcmanalo@feu-nrmf.ph