Historically speaking, the
ties that bind the US and the Philippines are a complex web of many
relations. More than political, socio-economic or even cultural, many
of those ties are also personal. Over four million Filipino migrants
live in the United States, making up approximately forty-four percent
of the estimated nine million migrant Filipino population. Because of
these ties, Filipinos take a special interest in US politics, not as
mere spectators but also as a barometer of sorts for local trends and
politics.  Unquestionably, the results of the 2008 US presidential election will affect reproductive health policies in the Philippines. 

In fact, if there is one sure thing
a change in administration in the US can affect in the Philippine situation,
it would have to be the area of reproductive health care. Recently,
the US financial crisis has even been used as an excuse by the opposition to
delay reproductive health legislation.
But more than any direct or causal effect, any change in US politics
which can revitalize support for bodies like the United Nations Population
Fund (UNFPA), and reorient the policy frame of the USAID, will go a
long way in creating more breathing space for local reproductive health
advocacy.  

The Bush administration
continuously withheld committed funds to the UNFPA since 2001 (which by June 2008 totalled $235 million) and its conservative policies on sex education,
abortion and prostitution, have made their way into policies connected
to aid, such as the prostitution pledge in the PEPFAR and the revival of the Mexico policy, or global gag rule, which prohibits grantee institutions
from supporting any pro-choice position.  

Meanwhile, in the halls of
Philippine Congress today, proponents of the reproductive health care
act are working to pass the draft bill and as usual, the influential
Catholic hierarchy is putting up a stiff opposition. But supporters
of reproductive health (RH) legislation are also gaining ground and there is a strong possibility
that the bill might make it out of Congress this time around. Part of
the package of RH care in the bill addresses the provision of universal
access to family planning methods. 

At its height, USAID’s aggressive
contraceptive donations to the Philippines reached an all time high
of 100 million cycles of pills worldwide on an annual basis, beginning
1973. These donations continued for over thirty years, beginning with
an end to condom donations in 2002; pills in 2003; and then finally Intra-Uterine
Devices by 2008. Since the USAID phase-out, many NGOs and advocates
in the local reproductive health movement have also been actively engaging
local governments to step up financing family planning supplies, especially since
the current national government under Gloria Macapagal Arroyo has refused
to allocate a budget for contraceptives. 

Arguably, this debacle over
the government budget on family planning and RH care is an issue of
local politics, and mainly due to Arroyo’s staunchly conservative
Catholic position on only supporting natural family planning to the
exclusion of all other methods. Many note that her position has kept
the Roman Catholic hierarchy at bay in terms of joining movements calling
for her impeachment and resignation after evidence of cheating in the
2004 Presidential elections was discovered.  

In the Philippine context,
however, the realization of reproductive health care will take more
than a policy enactment. For many years now, primary health care, including
the important referral chains on which a system of quality reproductive
health services depends, have been threatened. Under the auspices of
a highly contested "health sector reform" agenda, public hospitals
have been privatized and the cost of health care (which arguably has
always been high in the Philippines), is soaring. The cost of medicine
is likewise relatively high in the Philippines and while the social
security package of health care for employed Filipino members (Philhealth)
has been extended to include a family planning service like tubal
ligation, it does not, however, mean that the service is always accessible
nor available in provincial hospitals.  

In recent years USAID has
also been involved in various aspects of health sector reform (HSR) in the
Philippines. Among its most recent projects is support for a "contraceptive
self reliance" (CSR) policy in which local governments are engaged
to secure contraceptive availability in their jurisdictions. This policy
direction is in line with the decentralization of health care delivery
which was officially ushered in by the Local Government Code in 1991.  

While "health sector reform"
is a highly contested issue, more often than not, the equity goals in
the Philippine HSR have been at odds with the very market-oriented approaches
that have been undertaken under the same agenda. The USAID promoted
CSR for instance can address contraceptive availability at the local
level but it does not really make it sustainable or affordable because
prices remain high since each local government unit has to haggle for
its purchases.  

Furthermore, this scheme of
marketization in health under the CSR positions people not as patients
and system members but as mere "consumers" and "purchasers" of contraceptives
and the local government as a supplier of products and not necessarily
of health care. In the end, the absence of a coherent policy framework
which puts contraceptive availability in the context of holistic reproductive
health care as a human right makes the reform and equity goals behind
HSR seem like doublespeak. 

Without a doubt, the results
of the 2008 US Presidential elections will have an impact on the Philippines.
While it isn’t likely that the effect will be anything immediate or
necessarily revolutionary, any reversal of the conservative political frame reflected
in the outgoing Bush administration’s policies, will certainly be
most welcome.
It won’t solve any of our problems. But a pro-women’s rights position
by the White House will certainly create much needed breathing room
for advocates to be able to work more effectively for RH care in the
country.