Here in the Philippines, thanks to Wikileaks, we know that not only American money is behind our “Reproductive Health Bill”, but that the American State Department is pressuring our president to pass the bill.

Heaven knows that the Philippines does need access to cheaper Birth control, but it’s not as if it’s not available: they sell condoms next to the gum in the grocery stores, and the pharmacies have posters on where to go to get prescriptions for the pill.

It’s not as if  the fertility rate isn’t falling:

So are Filipina women using Family planning? Yes, but about 20 percent are on Natural Family planning, 20 percent on the pill etc. and about 20 percent on “traditional methods.

Traditional methods include herbs, withdrawal, and of course prolonged breast feeding of children.

So the rate is falling, and if the population is growing, part of this is due to the “demographic lag”, i.e. longer living that means more older people are now alive than in the past.

Let’s have a reality check here.One third of women here give birth without a fully trained birth attendant, but we will push the pill  on them? It’s quite hard to recruit medical personnel to live in isolated villages and towns far from their homes to work long hours for a low salary.

So how is forcing pious Catholic (and Muslim) doctors and midwives to pressure their patients into using chemical birth control at government health facilities going to improve the ability to recruit them to work in isolated rural villages (when a job in the US or Saudi pays better and won’t force them to commit a sin?)

Earth to Obama: There is an alternative: The private sector.

When I worked in Africa, the apartheid government was disliked, so most family planning was pushed via “pill ladies”: in every small village there was a woman, usually a teacher or a teacher’s wife or a small business owner, who could advise women in family planning and prescribe the pill.

Many women admired these ladies and saw them as a successful role model, so their views were more respected than the medical personnel who were often from other tribes or countries and viewed as “outsiders”.

A similar grass roots program in conservative Muslim Bangladesh was seen as successful in lowering population growth there.

And it had an advantage: it allowed church sponsored hospitals to stay open.

When I worked at a Catholic hospital in an isolated area of Africa,  we did not give out birth control, but promoted prolonged breast feeding and natural family planning to space childbirth.

Since both these methods were traditional, they were accepted. However, if the women’s husband objected, well, we knew the pill ladies were around, so we didn’t have to compromise out religious beliefs, and the patients, who traditionally spaced children with natural methods, didn’t view Family planning as something coerced on them by an outsider. (I use the word “Coerced”, since a doctor suggesting family planning in the hospital might be viewed as a threat to withhold medical care if they didn’t agree). With the Pill Ladies, the women had a choice.

The dirty little secret is that Public health doctors have to work with the culture to be successful. It’s a reality based occupation.

Which brings us to the USA.

Right now the Obama administration has ordered Catholic institutions to pay for insurance that includes chemical birth control and the abortion causing morning after pill.

The Washington Post suggests this was a peace offering to the pro abortion wing of the Democratic party because the HHS allowed regulations to stop very young teens from buying the morning after pill without a prescription.

So it seems to be more of a political than a medical decision.

As in the Philippines, the elitists around President Obama seem clueless to the fact that some people, including the Catholic bishops and the nuns who run health care organizations, might object to their agenda, and might oppose him.

Even those in the “peace and justice” left wing of American Catholicism who supported the health care bill against exactly this objection now see his actions as a betrayal of their support and a move  against religious freedom:

From the the National Catholic Reporter:

To borrow from Emile Zola: J’Accuse!

I accuse you, Mr. President, of dishonoring your own vision by this shameful decision.

I accuse you, Mr. President, of failing to live out the respect for diversity that you so properly and beautifully proclaimed as a cardinal virtue at Notre Dame. Or, are we to believe that diversity is only to be lauded when it advances the interests of those with whom we agree? That’s not diversity. That’s misuse of a noble principle for ignoble ends.

So from an anthropological viewpoint, the Obama administration, which claims to be sensitive to diversity, is actually imperialistic when it comes to pushing a social agenda on those who disagree with him, not just overseas but now inside the United states.

So yes, the Philippines needs a Reproductive Health bill, but not one that destroys the consciences of patients and health care providers.

And yes, America needs a health care bill, but not one that demands that Catholics and Catholic institutions be pushed to the sidelines as outcasts.

The real question is why President Obama, who, after all, spent his childhood in religiously diverse and tolerant Indonesia, seems clueless to all of this.

———————————————————————————

Nancy Reyes is a retired physician living in the rural Philippines. She has done public health work in both the US and in Africa. She is a Democrat.