Philippine Responsible Parenthood and Reproductive Health Act

Declaration of state policy and purpose

The State recognizes and guarantees human rights, including equality and nondiscrimination, the right to health (including reproductive health), the right to education and information, and the right to choose and make decisions consistent with religious convictions, ethics, cultural beliefs, and the demands of responsible parenthood (Section 2).
The State recognizes its constitutional duties to protect and strengthen the family and to equally protect the life of the mother and the life of the unborn from conception, and to instill health consciousness (Section 2).
The State guarantees 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 free preferential access for those identified through NHTS-PR and other government measures of identifying marginalization (Section 2).
The State must eradicate discriminatory practices, laws, and policies that infringe on a person’s exercise of reproductive health rights (Section 2).
The State recognizes marriage as an inviolable social institution and defends the rights connected to founding a family, protecting children, and enabling participation of families or family associations in planning and implementation of policies and programs (Section 2).
The State promotes openness to life, and provides that parents bring forth to the world only those children whom they can raise in a truly humane way (Section 2).

Guiding principles for implementation

The right to make free and informed decisions is central and must be guaranteed without coercion (Section 3).
The Act requires prioritization of effective and quality reproductive health care services to ensure maternal and child health, safe delivery, and birth of healthy children, in line with the State’s duties toward health, responsible parenthood, social justice, and full human development (Section 3).
The Act establishes that provision of ethical and medically safe, legal, accessible, affordable, non-abortifacient, effective, and quality reproductive health care services and supplies must be incorporated as a component of basic health care (Section 3).
The State must provide 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, with standards based on scientific and evidence-based medical research and FDA-registered/approved methods for the poor and marginalized identified through NHTS-PR and other identifying measures (Section 3).
The State provides funding support to promote modern natural methods of family planning, especially the Billings Ovulation Method, consistent with the needs of acceptors and their religious convictions (Section 3).
The Act prohibits demographic or population targets and states that mitigation/promotion/stabilization of population growth is incidental to advancement of reproductive health (Section 3).
The Act requires that reproductive health care programs address needs throughout a person’s life cycle (Section 3).

Definitions that control the Act

Abortifacient means any drug or device that induces abortion or destroys a fetus inside the mother’s womb, or prevents the fertilized ovum from reaching and being implanted upon determination of the FDA (Section 4(a)).
Adolescent refers to young people between ten (10) to nineteen (19) years (Section 4(b)).
Basic Emergency Obstetric and Newborn Care (BEMONC) includes specific lifesaving maternal and newborn interventions, including administration of 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; it also includes at minimum newborn resuscitation, warmth, and referral (Section 4(c)).
Comprehensive Emergency Obstetric and Newborn Care (CEMONC) includes BEMONC plus surgical delivery (caesarian section), blood bank services, and other highly specialized obstetric interventions; it also includes emergency neonatal care at minimum: newborn resuscitation, treatment of neonatal sepsis infection, oxygen support, and antenatal administration of maternal steroids for threatened premature delivery (Section 4(d)).
Family planning is a program enabling couples and individuals to decide freely and responsibly the number and spacing of children and to have information and means to do so, and access to a full range of safe, affordable, effective, non-abortifacient modern natural and artificial methods of planning pregnancy (Section 4(e)).
Modern methods of family planning are safe, effective, non-abortifacient and legal methods, whether natural or artificial, registered with the FDA (Section 4(l)).
Natural family planning refers to methods based on identifying the woman’s fertile days (Section 4(m)).
Poor means members of households identified as poor through NHTS-PR by DSWD or any subsequent system used by the national government to identify the poor (Section 4(o)).
Reproductive Health (RH) is complete physical, mental, and social well-being and not merely absence of disease or infirmity, in matters relating to the reproductive system and processes (Section 4(p)).
Reproductive health care includes access to a full range of methods, facilities, services, and supplies addressing reproductive health-related problems, including sexual health; it enumerates its elements, including:
- family planning information and services (first priority making women of reproductive age fully aware of cycles of fertilization probability);
- maternal, infant and child health and nutrition including breastfeeding;
- proscription of abortion and management of abortion complications;
- adolescent and youth reproductive health guidance and counseling;
- prevention/treatment/management of RTIs, HIV and AIDS, and STIs;
- elimination of violence against women and children and other sexual and gender-based violence;
- education and counseling on sexuality and reproductive health;
- treatment of breast and reproductive tract cancers and gynecological conditions/disorders;
- male responsibility and involvement;
- prevention/treatment/management of infertility and sexual dysfunction;
- reproductive health education for adolescents; and
- mental health aspect of reproductive health care (Section 4(q)).
Reproductive health rights allow individuals and couples to decide freely and responsibly whether to have children; decide the number, spacing, and timing; make other reproduction decisions free of discrimination, coercion, and violence; access information and means; and attain highest standard of sexual health and reproductive health—provided however reproductive health rights do not include abortion, and access to abortifacients (Section 4(s)).
Responsible parenthood is the will and ability of a parent to respond to family and children needs and aspirations, shared responsibility to determine and achieve desired number, spacing, and timing consistent with religious convictions (Section 4(v)).
Skilled birth attendance refers to childbirth managed by a skilled health professional with enabling conditions and functioning health system support including transport/referral faculties for emergency obstetric care (Section 4(y)).
Skilled health professional means a midwife, doctor, or nurse educated and trained to manage normal and complicated pregnancies, childbirth, and immediate postnatal period, and identify/manage/referral of complications (Section 4(z)).

Coverage: who must do what

Local government units (LGUs) must endeavor to hire sufficient nurses, midwives, and other skilled health professionals for maternal health care and skilled birth attendance, considering DOH targets (Section 5).
LGUs must endeavor to establish or upgrade hospitals and facilities capable of providing emergency obstetric and newborn care based on necessity supported by data from the local health office (Section 6).
All accredited public health facilities must provide a full range of modern family planning methods, including medical consultations, and necessary reasonable procedures for poor and marginalized couples with infertility issues who desire to have children (Section 7).
Private health facilities must extend family planning services to paying patients with the option to grant free care and services to indigents, with limitations for non-maternity specialty hospitals and hospitals owned and operated by a religious group, subject to immediate referral (Section 7).
Annual Maternal Death Review and Fetal and Infant Death Review must be conducted by all LGUs, national and local government hospitals, and other public health units (Section 8).
The DOH must serve as lead agency and integrate implementation of the reproductive health care program, ensuring access to medically safe, non-abortifacient, legal, quality and affordable reproductive health goods and services (Section 19).
The FDA must issue strict guidelines with respect to the use of contraceptives, considering side effects or other harmful effects (Section 19(c)).
The DOH and LGUs must conduct a heightened nationwide multimedia campaign to raise public awareness of reproductive health and rights and reproductive health care elements (Section 20).
Before the end of April each year, the DOH must submit an annual consolidated report to the President and Congress (Section 21).

Access to family planning and related duties

Accredited public health facilities must provide a full range of modern family planning methods, and must include medical consultations and necessary reasonable procedures for poor and marginalized couples with infertility issues who desire children (Section 7).
Family planning services must be extended by private health facilities to paying patients, with option to grant free care and services to indigents (Section 7).
Non-maternity specialty hospitals and hospitals owned and operated by a religious group are allowed the option to provide a full range of modern family planning methods; they must immediately refer a person seeking such care and services to a conveniently accessible facility (Section 7).
No person shall be denied information and access to family planning services (natural or artificial) (Section 7).
Access for minors to modern methods of family planning is restricted: minors are not allowed access without written consent from their parents or guardian/s, except when the minor is already a parent or has had a miscarriage (Section 7).
The Act requires LGU and national government facilities to provide emergency-safe care framework: where refusal triggers are involved, the Act recognizes Republic Act No. 8344 conditions, and prohibited acts carve out emergencies/serious cases where appropriate (Section 7 and Section 23).

Skilled health professionals, facilities, supplies, and delivery

LGUs must endeavor to hire enough skilled health professionals to reach an ideal ratio considering DOH targets (Section 5).
People in geographically isolated or highly populated and depressed areas must be provided the same level of access to health care (Sections 5 and 6).
Midwives and nurses are allowed to administer lifesaving drugs such as oxytocin and magnesium sulfate under emergency conditions when there are no physicians available, provided they are properly trained and certified and in accordance with DOH guidelines (Section 5).
Each LGU must endeavor to establish or upgrade hospitals and facilities with adequate and qualified personnel, equipment, and supplies to provide emergency obstetric and newborn care (Section 6).
The national government must provide additional and necessary funding and other assistance for implementation of skilled professional hiring and facility establishment/upgrading (Sections 5 and 6).
The DOH must procure, distribute to LGUs, and monitor usage of family planning supplies nationwide, coordinating with appropriate local government bodies (Section 10).
DOH supply and budget allotments must be based among others on:
- number of women of reproductive age and couples who want to space or limit children;
- contraceptive prevalence rate by type of method; and
- cost of family planning supplies (Section 10).
LGUs may implement their own procurement, distribution, and monitoring consistent with the Act and DOH guidelines (Section 10).
The National Drug Formulary must include hormonal contraceptives, intrauterine devices, injectables, and other safe, legal, non-abortifacient and effective family planning products and supplies (Section 9).
The PNDFS must be observed in selecting drugs for inclusion/removal in the Essential Drugs List in accordance with practice and in consultation with reputable medical associations, with FDA certification that any product/supply is made available on the condition it is not to be used as an abortifacient (Section 9).
National hospitals must include these products and supplies in regular purchases of essential medicines and supplies (Section 9).
Government offices must not purchase or acquire emergency contraceptive pills, postcoital pills, abortifacients for such purpose, or their other forms or equivalent (Section 9).

Education, compliance certificate, and community health workers

The State must provide age- and development-appropriate reproductive health education to adolescents, taught by adequately trained teachers, in formal and nonformal educational systems and integrated into relevant subjects; DepED must formulate a curriculum for public schools, adoptable by private schools (Section 14).
Course content, scope, and methodology flexibility at each educational level/group is allowed only after consultations with parents-teachers-community associations, school officials, and other interest groups (Section 14).
A Certificate of Compliance is required before any marriage license issuance: no marriage license shall be issued by the Local Civil Registrar unless the applicants present a Certificate of Compliance issued for free by the local Family Planning Office certifying that they received adequate instructions and information on responsible parenthood, family planning, breastfeeding, and infant nutrition (Section 15).
The DOH must disseminate information and provide training programs to LGUs; LGUs must train Barangay Health Workers (BHWs) and other barangay volunteers with DOH technical assistance (Section 16).
The DOH must provide LGUs with medical supplies and equipment needed by BHWs (Section 16).
The national government must provide additional and necessary funding and assistance for effective implementation, including possible additional honoraria for BHWs (Section 16).
The DOH must engage experts in natural family planning to provide necessary training for all BHWs (Section 19(b)(3)).

Reviews, benefits, mobile services, and PWD access

LGUs, national and local government hospitals, and other public health units must conduct an annual Maternal Death Review and Fetal and Infant Death Review in accordance with DOH guidelines, resulting in evidence-based programming and budgeting for more responsive reproductive health services (Section 8).
The Act requires PhilHealth maximum benefits for serious and life-threatening reproductive health conditions, including provision of Anti-Retroviral Medicines (ARVs), consistent with PHIC guidelines; conditions expressly include HIV and AIDS, breast and reproductive tract cancers, obstetric complications, and menopausal/post-menopausal-related conditions (Section 12).
The national or local government may provide each provincial, city, municipal, and district hospital with a Mobile Health Care Service (MHCS) in a van or appropriate transportation form, operated by LGUs of provinces and highly urbanized cities, delivering health care goods and services especially to the poor and needy and disseminating reproductive health knowledge and information (Section 13).
MHCS must be operated by skilled health providers and be adequately equipped with health care materials and information dissemination devices/equipment, including a television set for audio-visual presentations (Section 13).
Cities and municipalities must endeavor to obliterate barriers to reproductive health services for PWDs by:
- providing physical access and addressing transportation/proximity issues;
- adapting examination tables and laboratory procedures;
- increasing access to information and communication materials in braille, large print, simple language, sign language, and pictures;
- providing continuing education and inclusion of PWD rights among health care providers; and
- undertaking awareness activities to address stigma and lack of knowledge on PWDs’ sexual and reproductive health needs and rights (Section 18).

Programs, public awareness, and oversight/reporting

The DOH must implement programs prioritizing full access of poor and marginalized women identified through NHTS-PR and other identifying measures to reproductive health care, services, products, and programs, using a multidimensional approach to fight poverty (Section 11).
The DOH must provide technical support, including capacity building and monitoring (Section 11).
The DOH and LGUs must initiate and sustain a heightened nationwide multimedia campaign on protection and promotion of reproductive health and rights, including maternal health and nutrition, family planning and responsible parenthood information and services, adolescent and youth reproductive health, guidance and counseling, and other reproductive health care elements (Section 20).
The DOH must submit before end of April each year an annual consolidated report to the President and Congress assessing implementation and recommending priorities for executive and legislative actions, and must print and distribute it to national agencies, LGUs, NGOs, and private sector organizations involved (Section 21).
The annual report must evaluate content, implementation, and impact of policies related to reproductive health and family planning to ensure they promote, protect, and fulfill women’s reproductive health and rights (Section 21).
A Congressional Oversight Committee (COC) is created with five (5) members each from the Senate and the House of Representatives, including at least one (1) minority representative, with leadership by the respective Chairs of the Senate Committee on Health and Demography and House Committee on Population and Family Relations (Section 22).
The COC secretariat must come from existing Secretariat personnel of the concerned Senate and House committees (Section 22).
The COC must monitor and ensure effective implementation, recommend remedial legislation or administrative measures, and review the Act every five (5) years from effectivity (Section 22).

Prohibited acts and criminal penalties

Health care service providers (public or private) are prohibited from:
- knowingly withholding information or restricting dissemination, and/or intentionally providing incorrect information regarding reproductive health programs and services including informed choice and access to the full range of legal, medically safe, non-abortifacient and effective family planning methods (Section 23(a)(1));
- refusing to perform legal and medically-safe reproductive health procedures on persons of legal age due to lack of consent/authorization, subject to specific rules on spousal consent and consent exceptions for abused minors with respondent parent/authority, and special handling of emergencies/serious cases as defined in Republic Act No. 8344 (Section 23(a)(2));
- refusing to extend quality health care services and information based on marital status, gender, age, religious convictions, personal circumstances, or nature of work, subject to respect for conscientious objection with immediate referral and the exception for emergencies/serious cases defined in Republic Act No. 8344 (Section 23(a)(3)).
Public officers specifically charged with implementing the Act are prohibited from personally or through subordinates prohibiting/restricting 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, refusing to support reproductive health programs, or doing any act that hinders full implementation (Section 23(b)).
Employers are prohibited from suggesting, requiring, unduly influencing, or causing applicants or employees to undergo sterilization, use modern family planning methods, or refrain from using such methods as a condition for employment, continued employment, promotion, or employment benefits, and pregnancy or number of children is prohibited as a ground for non-hiring or termination (Section 23(c)).
Any person is prohibited from falsifying a Certificate of Compliance required in Section 15 (Section 23(d)).
Any pharmaceutical company, whether domestic or multinational, or its agents or distributors, is prohibited from colluding with government officials in the distribution, procurement, and/or sale by the national government and LGUs of modern family planning supplies, products, and devices (Section 23(e)).
Violations of the Act or commission of prohibited acts are penalized by imprisonment of one (1) month to six (6) months or a fine of PHP 10,000.00 to PHP 100,000.00, or both, at the discretion of the competent court (Section 24).
If the offender is a public officer (elected or appointed), the court imposes additional penalties of 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).
If the offender is a juridical person, penalties are imposed on the president or any responsible officer (Section 24).
If the offender is an alien, after service of sentence, the offender is deported immediately without further proceedings by the Bureau of Immigration (Section 24).
If the offender is a pharmaceutical company, its agent and/or distributor, its 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 (Section 24).

Implementation, IRR, appropriations, and related mechanisms

The DOH and designated co-drafters must jointly promulgate implementing rules and regulations within sixty (60) days from effectivity; the IRR drafting includes representatives of DepED, DSWD, Philippine Commission on Women, PHIC, Department of the Interior and Local Government, National Economic and Development Authority, League of Provinces, League of Cities, and League of Municipalities, together with NGOs, faith-based organizations, people’s, women’s, and young people’s organizations (Section 26).
At least four (4) members of the IRR drafting committee must come from NGOs, selected by the DOH Secretary (Section 26).
The Act directs that amounts appropriated in the current annual General Appropriations Act (GAA) for reproductive health and natural and artificial family planning and responsible parenthood under DOH and other concerned agencies must be allocated and utilized for implementation (Section 25).
Additional sums 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 must be included in subsequent years’ General Appropriations (Section 25).
Gender and Development (GAD) funds of LGUs and national agencies may be a source of funding for implementation (Section 25).
Private and nongovernment reproductive healthcare service providers are encouraged 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 identifying measures, especially to pregnant adolescents, with pro bono hours included as a prerequisite in PhilHealth accreditation (Section 17).

Separability, repeals, and construction

If any part or provision of the Act is held invalid or unconstitutional, the remaining provisions continue in force and effect (Section 28).
The Act repeals, modifies, or amends all laws, presidential decrees or issuances, executive orders, letters of instruction, administrative orders, rules, or regulations inconsistent with it, including Republic Act No. 7392, known as the Midwifery Act, except for prevailing laws against abortion (Section 29).
The Act mandates that it be liberally construed to ensure provision, delivery, and access to reproductive health care services and to promote, protect, and fulfill women’s reproductive health and rights (Section 27).