Philippine Responsible Parenthood and Reproductive Health Act

Policy, constitutional bases, and intent

Section 2 recognizes and guarantees human rights relating to reproductive health, including the right to equality and non-discrimination, the right to health (including reproductive health), the right to education and information, and the right to choose and make decisions in accordance with religious convictions, ethics, cultural beliefs, and responsible parenthood.
Section 2 declares the State’s duty to protect and strengthen the family and to equally protect the life of the mother and the life of the unborn from conception.
Section 2 commits to universal access to medically-safe, non-abortifacient, effective, legal, affordable, and quality reproductive health care services, methods, devices, supplies and relevant information and education, with preferential access for those identified through the National Household Targeting System for Poverty Reduction (NHTS-PR) and other government measures of identifying marginalization, who are voluntary beneficiaries for free.
Section 2 requires eradication of discriminatory practices, laws, and policies that infringe on a person’s exercise of reproductive health rights and promotes openness to life, with the proviso that parents bring forth children they can raise humanely.
Section 2 guarantees promotion of gender equality, gender equity, women empowerment and dignity as a health and human rights concern and central to efforts to address reproductive health care.
Section 2 recognizes marriage as an inviolable social institution and the foundation of the family, and the State shall defend rights of spouses, children, families (including family living wage and income), and families/family associations to participate in planning and implementation of policies and programs.
Section 2 affirms that reproductive health rights do not include abortion, while the State ensures humane treatment and counseling for post-abortive complications and complications arising from pregnancy, labor, delivery, and related issues.

Implementation principles and life-cycle program approach

Section 3 declares that free and informed decisions central to exercising rights shall not be subjected to coercion and must be fully guaranteed.
Section 3 requires primacy of effective and quality reproductive health care services to ensure maternal and child health, health of the unborn, safe delivery and birth of healthy children, and sound replacement rate.
Section 3 mandates inclusion of ethical and medically safe, legal, accessible, affordable, non-abortifacient, effective and quality reproductive health care services and supplies as a component of basic health care.
Section 3 requires the State to promote information and access without bias to all methods of family planning, including effective natural and modern methods proven medically safe, legal, non-abortifacient, and effective, consistent with FDA-registered and approved methods for the poor and marginalized under NHTS-PR and related systems.
Section 3 requires funding support to promote modern natural methods, especially the Billings Ovulation Method, consistent with acceptors’ needs and religious convictions.
Section 3 states there shall be no demographic or population targets, and mitigation/stabilization of population growth is incidental to advancement of reproductive health.
Section 3 requires that a comprehensive reproductive health program addresses needs throughout the life cycle.
Section 3 affirms that reproductive health care, information, and supplies with priority to poor beneficiaries are the primary responsibility of the national government.

Core definitions governing the Act

Abortifacient means any drug or device that induces abortion or destroys a fetus inside the womb, or prevents a fertilized ovum from reaching and being implanted, upon determination of the FDA. Section 4(a).
Adolescent refers to young people between ten (10) and nineteen (19) years. Section 4(b).
Basic Emergency Obstetric and Newborn Care (BEMONC) includes specified lifesaving maternal and newborn services (including parenteral oxytocic drugs, parenteral anticonvulsants, parenteral antibiotics, maternal steroids for preterm labor, assisted vaginal deliveries, removal of retained placental products, and manual removal of retained placenta) plus neonatal interventions including newborn resuscitation, warmth, and referral. Section 4(c).
Comprehensive Emergency Obstetric and Newborn Care (CEMONC) includes BEMONC services plus surgical delivery (caesarian section), blood bank services, and other specialized obstetric interventions, and includes emergency neonatal care (including newborn resuscitation, treatment of neonatal sepsis infection, oxygen support, and antenatal administration of (maternal) steroids for threatened premature delivery). Section 4(d).
Family planning enables couples and individuals to decide freely and responsibly the number and spacing of children and to have information and means to do so, with access to a full range of safe, affordable, effective, non-abortifacient modern natural and artificial methods of planning pregnancy. Section 4(e).
Family planning and related definitions distinguish Modern methods of family planning (safe, effective, non-abortifacient, legal methods registered with the FDA) and Natural family planning (methods based on identifying fertile days). Sections 4(l) and 4(m).
Fetal and infant death review and Maternal death review are qualitative and in-depth studies of causes intended to prevent future deaths through changes to programs, plans, and policies. Sections 4(f) and 4(j).
Reproductive Health (RH) is complete physical, mental and social well-being in matters relating to the reproductive system and its functions and processes, including responsible and safe consensual sex life and freedom to decide if, when, and how often to reproduce. Section 4(p).
Reproductive health care includes access to a full range of methods, facilities, services and supplies contributing to reproductive health and well-being and enumerates its elements (including family planning information and services; maternal, infant and child health and nutrition including breastfeeding; prohibition of abortion and management of abortion complications; adolescent and youth guidance and counseling; prevention/treatment of RTIs, HIV and AIDS and STIs; elimination of violence; sexuality education; treatment of cancers and gynecological conditions; male responsibility; infertility and sexual dysfunction management; adolescent reproductive health education; and mental health aspects). Section 4(q).
Reproductive health rights include rights to decide freely and responsibly whether or not to have children and decisions on number, spacing, and timing, free of discrimination, coercion, and violence, with information and means, and attainment of highest standard of sexual health and reproductive health; provided that reproductive health rights do not include abortion and access to abortifacients. Section 4(s).
Responsible parenthood is the will and ability to respond to family and children needs and aspirations and to share responsibility for desired number, spacing, and timing consistent with religious convictions and considering psychological preparedness, health status, sociocultural and economic concerns. Section 4(v).
Skilled birth attendance is childbirth managed by a skilled health professional with enabling conditions for a functioning health system, including transport and referral facilities for emergency obstetric care. Section 4(y).
Skilled health professional means a midwife, doctor, or nurse educated and trained for normal and complicated pregnancies, childbirth, immediate postnatal period, and identification, management, and referral of complications. Section 4(z).
Poor refers to household members identified as poor through NHTS-PR by DSWD or any subsequent national government system for identifying the poor. Section 4(o).
Public health care service provider includes specified public health care institutions, professionals, public health workers delivering services, and barangay health workers accredited under DOH guidelines by the local health board. Section 4(n).
Sexual health means state of physical, mental and social well-being in relation to sexuality requiring positive, respectful, pleasurable and safe sexual experiences free from coercion, discrimination, and violence. Section 4(w).
Sustainable human development centers people—especially the poor and vulnerable—in development with long, healthy, productive lives and protection of life opportunities of future generations and the natural ecosystem. Section 4(aa).

Health personnel, facilities, and service access

Section 5 directs LGUs to endeavor to hire an adequate number of nurses, midwives and other skilled health professionals for maternal health care and skilled birth attendance to achieve an ideal professional-to-patient ratio considering DOH targets.
Section 5 requires equal access for people in geographically isolated or highly populated and depressed areas.
Section 5 provides that the national government shall provide additional and necessary funding and assistance for effective implementation.
Section 5 allows midwives and nurses to administer lifesaving drugs such as oxytocin and magnesium sulfate under emergency conditions when there are no physicians available, in accordance with DOH guidelines, if properly trained and certified.
Section 6 requires each LGU, based on well-supported data from its local health office, to establish or upgrade hospitals and facilities with adequate and qualified personnel, equipment, and supplies to provide emergency obstetric and newborn care.
Section 6 requires equal access for geographically isolated or highly populated and depressed areas and prevents neglect by requiring other means such as home visits or mobile health care clinics as needed.
Section 6 directs the national government to provide additional and necessary funding and assistance for effective implementation.

Family planning access and minors’ consent

Section 7 mandates that all accredited public health facilities provide a full range of modern family planning methods, including medical consultations, supplies, and necessary and reasonable procedures for poor and marginalized couples with infertility issues who desire to have children.
Section 7 requires private health facilities to extend the full range of modern family planning methods to paying patients with an option to grant free care and services to indigents.
Section 7 exempts only non-maternity specialty hospitals and hospitals owned and operated by a religious group from the mandatory extension to indigents, but grants them an option to provide such full range.
Section 7 requires exempt hospitals to immediately refer persons seeking care to another conveniently accessible health facility.
Section 7 bars denial when the person is not in an emergency condition or serious case as defined in Republic Act No. 8344.
Section 7 provides that no person shall be denied information and access to family planning services, whether natural or artificial.
Section 7 prohibits minors from access to modern methods of family planning without written consent from their parents or guardian/s, except when the minor is already a parent or has had a miscarriage.

Maternal and fetal-infant review

Section 8 requires all LGUs, national and local government hospitals, and other public health units to conduct an annual Maternal Death Review and Fetal and Infant Death Review.
Section 8 requires the reviews to be conducted in accordance with DOH guidelines and to result in an evidence-based programming and budgeting process for more responsive reproductive health services promoting women’s health and safe motherhood.

Drug formulary, essential medicines, and contraceptive limits

Section 9 requires the National Drug Formulary to include hormonal contraceptives, intrauterine devices, injectables and other safe, legal, non-abortifacient and effective family planning products and supplies.
Section 9 requires observance of the Philippine National Drug Formulary System (PNDFS) when selecting family planning supplies for inclusion or removal in the Essential Drugs List (EDL), including consultation with reputable medical associations in the Philippines.
Section 9 requires that any product or supply included or to be included in the EDL must have an FDA certification that the product and supply are made available on the condition that they are not to be used as an abortifacient.
Section 9 requires these products and supplies to be included in the regular purchase of essential medicines and supplies of all national hospitals.
Section 9 prohibits these offices from purchasing or acquiring by any means emergency contraceptive pills, postcoital pills, abortifacients that will be used for such purpose and their other forms or equivalent.

DOH procurement, distribution, and monitoring

Section 10 requires the DOH to procure, distribute to LGUs, and monitor usage of family planning supplies nationwide.
Section 10 requires DOH coordination with appropriate local government bodies for planning and implementing the procurement and distribution program.
Section 10 requires that supply and budget allotments be based among others on:
- the number of women of reproductive age and couples who want to space or limit children,
- contraceptive prevalence rate by type of method used, and
- cost of family planning supplies.
Section 10 permits LGUs to implement their own procurement, distribution and monitoring program consistent with the Act and DOH guidelines.

Anti-poverty integration of reproductive health

Section 11 requires a multidimensional approach in fighting poverty through implementation of policies and programs.
Section 11 requires DOH to implement programs prioritizing full access of poor and marginalized women (identified through NHTS-PR and other government marginalization systems) to reproductive health care, services, products, and programs.
Section 11 requires DOH to provide such programs with technical support, including capacity building and monitoring.

PhilHealth coverage for serious reproductive conditions

Section 12 requires serious and life-threatening reproductive health conditions, including HIV and AIDS, breast and reproductive tract cancers, obstetric complications, and menopausal and post-menopausal-related conditions, to receive the maximum benefits, including provision of Anti-Retroviral Medicines (ARVs), under PHIC guidelines.

Mobile health care service for LGU deployment

Section 13 permits national or local government provision of a Mobile Health Care Service (MHCS) to each provincial, city, municipal and district hospital in forms such as a van or transportation appropriate to terrain and LGU health care needs.
Section 13 requires MHCS to deliver health care goods and services to constituents, more particularly the poor and needy, and to disseminate reproductive health knowledge and information.
Section 13 requires MHCS to be operated by skilled health providers and adequately equipped with a wide range of health care materials and information dissemination devices, including a television set for audio-visual presentations.
Section 13 requires MHCS to be operated by LGUs of provinces and highly urbanized cities.

Reproductive health education for adolescents

Section 14 requires age- and development-appropriate reproductive health education for adolescents.
Section 14 requires integration in relevant subjects and teaching by adequately trained teachers in informal and nonformal educational systems, including values formation and education on self-protection against discrimination, sexual abuse and violence, gender-based violence, teen pregnancy, physical/social/emotional changes, women’s rights and children’s rights, responsible teenage behavior, gender and development, and responsible parenthood.
Section 14 allows flexibility in formulation/adoption of appropriate course content, scope, and methodology only after consultations with parents-teachers-community associations, school officials, and other interest groups.
Section 14 requires DepEd to formulate the curriculum used by public schools and that may be adopted by private schools.

Certificate of Compliance before marriage licensing

Section 15 prohibits issuance of a marriage license by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office.
Section 15 requires the Certificate of Compliance to certify that applicants received adequate instructions and information on responsible parenthood, family planning, breastfeeding, and infant nutrition.

Barangay health worker training and supplies

Section 16 tasks DOH with disseminating information and providing training programs to LGUs.
Section 16 assigns LGUs, with DOH technical assistance, responsibility for training BHWs and other barangay volunteers for promotion of reproductive health.
Section 16 requires DOH to provide medical supplies and equipment needed by BHWs to carry out their functions effectively.
Section 16 directs national government to provide additional and necessary funding and assistance, including possible provision of additional honoraria for BHWs.

Pro bono services and PhilHealth accreditation prerequisite

Section 17 encourages private and non-government reproductive healthcare service providers, including gynecologists and obstetricians, to provide at least forty-eight (48) hours annually of reproductive health services free of charge to indigent and low-income patients identified through NHTS-PR and other government marginalization systems, especially to pregnant adolescents.
Section 17 requires that the forty-eight (48) hours annual pro bono services be included as a prerequisite in accreditation under PhilHealth.

Reproductive health access for persons with disabilities

Section 18 directs cities and municipalities to endeavor to obliterate barriers to reproductive health services for PWDs by:
- providing physical access and resolving transportation and proximity issues,
- adapting examination tables and laboratory procedures to PWD needs and conditions,
- increasing access to information and communication materials in braille, large print, simple language, sign language, and pictures,
- providing continuing education and inclusion of rights of PWDs among health care providers, and
- undertaking public awareness activities to address misconceptions, stigma, and lack of knowledge on sexual and reproductive health needs and rights of PWDs.

Government duties and regulatory responsibilities

Section 19 designates DOH as the lead agency to implement the Act and integrate reproductive health care program functions into regular operations, including ensuring people’s access to medically safe, non-abortifacient, legal, quality and affordable reproductive health goods and services.
Section 19 requires DOH, in coordination with PHIC as applicable, to strengthen health regulatory agencies for safe, high quality, accessible and affordable reproductive health services and commodities and enforce regulatory mandates and mechanisms.
Section 19 requires DOH to facilitate involvement of NGOs and the private sector in delivery of reproductive health care and in production, distribution, and delivery of quality reproductive health and family planning supplies and commodities.
Section 19 requires DOH to engage natural family planning experts to train all BHWs.
Section 19 requires DOH to supervise and assist LGUs in delivering reproductive health care services and purchasing family planning goods and supplies.
Section 19 requires DOH, through local health offices, to furnish updated information and resources on studies and research relating to family planning, responsible parenthood, breastfeeding and infant nutrition.
Section 19 requires FDA to issue strict guidelines with respect to use of contraceptives considering side effects or other harmful effects.
Section 19 requires corporate citizens to exercise prudence in advertising products or services through all media, especially on matters relating to sexuality, considering influence on children and youth.

Public awareness and education campaigns

Section 20 requires DOH and LGUs to initiate and sustain a heightened nationwide multimedia campaign raising public awareness on protection and promotion of reproductive health and rights.
Section 20 requires dissemination covering maternal health and nutrition, family planning and responsible parenthood, adolescent and youth reproductive health, guidance and counseling, and other elements under Section 4(q).
Section 20 requires education and information materials to be reviewed regularly to ensure effectiveness and relevance.

Reporting and congressional oversight

Section 21 requires DOH, before the end of April each year, to submit to the President of the Philippines and Congress an annual consolidated report assessing implementation of its programs and those of other government agencies and instrumentalities, and to recommend priorities for executive and legislative actions.
Section 21 requires the annual report be printed and distributed to all national agencies, LGUs, NGOs, and private sector organizations involved in the programs.
Section 21 requires evaluation of the content, implementation, and impact of all policies related to reproductive health and family planning to ensure such policies promote, protect and fulfill women’s reproductive health and rights.
Section 22 creates a Congressional Oversight Committee (COC) composed of five (5) members each from the Senate and the House of Representatives with at least one (1) member representing the Minority.
Section 22 requires Senate President and Speaker to appoint members, and requires the COC to be headed by the respective Chairs of the Senate Committee on Health and Demography and the House Committee on Population and Family Relations.
Section 22 requires the COC Secretariat to come from existing Secretariat personnel of the concerned Senate and House committees.
Section 22 requires the COC to monitor and ensure effective implementation, recommend remedial legislation or administrative measures, and review the Act every five (5) years from effectivity.

Prohibited acts

Section 23(a) prohibits any health care service provider, public or private, from:
- knowingly withholding information, restricting dissemination, and/or intentionally providing incorrect information regarding reproductive health programs and services including the right to informed choice and access to legal, medically-safe, non-abortifacient, effective family planning methods;
- refusing to perform legal and medically-safe reproductive health procedures on a person of legal age based on lack of consent or authorization, with these rules:
  - for married persons, spousal consent is required, but in case of disagreement, the decision of the one undergoing the procedure prevails; and
  - for abused minors where the parent or person exercising parental authority is the respondent, accused or convicted perpetrator as certified by the proper prosecutorial office of the court, parental or authority consent is required only in elective surgical procedures, and no consent is required in emergency or serious cases as defined in Republic Act No. 8344; and
- refusing quality health care services and information due to marital status, gender, age, religious convictions, personal circumstances, or nature of work, while recognizing that conscientious objection based on ethical or religious beliefs must be respected but requires immediate referral to another conveniently accessible provider within the same facility or one that is conveniently accessible, and referral exceptions apply when the person is not in an emergency condition or serious case as defined in Republic Act No. 8344.
Section 23(b) prohibits any public officer charged with implementing the Act, personally or through a subordinate, from prohibiting or restricting delivery of legal and medically-safe reproductive health care services (including family planning), forcing/coercing/inducing persons to use such services, refusing to allocate/approve/release budgets for reproductive health services or programs, or hindering full implementation.
Section 23(c) prohibits any employer from suggesting, requiring, unduly influencing, or causing applicants or employees to undergo sterilization, use modern methods of family planning, or not use such methods as a condition for employment, continued employment, promotion, or provision of employment benefits.
Section 23(c) prohibits pregnancy or number of children as a ground for non-hiring or termination from employment.
Section 23(d) prohibits falsification of the Certificate of Compliance required under Section 15.
Section 23(e) prohibits any pharmaceutical company, domestic or multinational, or its agents or distributors, from colluding with government officials in distribution, procurement and/or sale by the national government and LGUs of modern family planning supplies, products and devices.

Criminal penalties and special consequences

Section 24 provides that any violation of the Act or commission of any prohibited act is punishable by imprisonment of one (1) month to six (6) months and/or a fine of Ten thousand pesos (P10,000.00) to One hundred thousand pesos (P100,000.00) at the discretion of the competent court.
Section 24 provides that if the offender is a public officer (elected or appointed), the penalty includes suspension not exceeding one (1) year or removal and forfeiture of retirement benefits depending on the gravity of the offense, after due notice and hearing by the appropriate body or agency.
Section 24 provides that if the offender is a juridical person, the penalty is imposed upon the president or any responsible officer.
Section 24 provides that if the offender is an alien, after service of sentence, deportation occurs immediately without further proceedings by the Bureau of Immigration.
Section 24 provides that if the offender is a pharmaceutical company, its agent and/or distributor’s license or permit to operate or conduct business in the Philippines is perpetually revoked, and a fine triple the amount involved in the violation is imposed.

Appropriations and funding sources

Section 25 requires that amounts appropriated in the current annual General Appropriations Act (GAA) for reproductive health and natural and artificial family planning and responsible parenthood under the DOH and other concerned agencies be allocated and utilized for implementing the Act.
Section 25 requires that additional sums necessary for upgrading facilities to meet BEMONC and CEMONC standards, training and deployment of skilled health providers, natural and artificial family planning commodity requirements under Section 10, and other reproductive health and responsible parenthood services be included in subsequent years’ GAA.
Section 25 allows the Gender and Development (GAD) funds of LGUs and national agencies to be a source of funding for implementation.

Implementing rules and regulations deadline

Section 26 requires joint promulgation of the Implementing Rules and Regulations (IRR) within sixty (60) days from the effectivity of the Act.
Section 26 requires the IRR to be issued by the DOH Secretary (or designated representative as Chairperson) together with authorized representatives of DepEd, DSWD, Philippine Commission on Women, PHIC, DILG, NEDA, League of Provinces, League of Cities, and League of Municipalities, with NGOs and faith-based organizations, and people’s/women’s/young people’s organizations.
Section 26 requires at least four (4) members of the IRR drafting committee to come from NGOs, selected by the DOH Secretary.

Interpretation, separability, and repeals

Section 27 directs liberal construction to ensure provision, delivery, and access to reproductive health care services and to promote, protect and fulfill women’s reproductive health and rights.
Section 28 provides separability: if any part or provision is held invalid or unconstitutional, remaining provisions not affected remain in force and effect.
Section 29 repeals, modifies, or amends inconsistent laws, presidential decrees or issuances, executive orders, letters of instruction, administrative orders, rules, or regulations, except for prevailing laws against abortion, including Republic Act No. 7392 (otherwise known as the Midwifery Act), to the extent of inconsistency.