In August 2019, I had the opportunity to visit with Likhaan in Manila, Philippines. Likhaan is a unique organization which, through direct sexual and reproductive health service provision in marginalized communities, organizes grassroots large-scale support for legal and policy reform in the building of a humane health care system. Their work is extraordinary, grounded in the lives of the people they serve, and grown from a deep respect for community-based knowledge, care and resilience. The work of Likhaan is therefore often relayed in first-person stories, with laughter and sometimes with tears, and always with deep respect, compassion and commitment.
I began my visit with Likhaan’s community health workers and promoters in the urban poor communities of Tondo, Manila, where we talked with clients about their experiences of sex, sexual health and pregnancy, and more importantly, how these issues were intimately bound to a much broader sense of social and economic well-being, their capacity to care for their families, to earn a livelihood, to stay healthy and to live a happy life. When we stopped for lunch in one of Likhaan’s community clinics, I saw how this holistic sense of health carried across the clinic threshold and into the quality and care of their clinical work. This was not simply a community-based clinic, but indeed, the community’s clinic.
This introduction to the context of Likhaan’s work was critical for the main purpose of my visit, namely, to discuss legal and policy strategies to address unsafe abortion in the Philippines. Likhaan first convened a workshop with members of the sexual and reproductive health and rights community, many of whom had struggled together for decades to pass the RH law. This was the starting point for our strategic discussions on harm reduction and abortion pathways. I asked: What can we do to make abortion safe moving on from and within the RH Law?
I asked this question not because I thought the law was any defeat or half-measure, but rather because I thought it was a powerful law, one of the best I’ve seen. When you learn about the struggle for the law, you appreciate its compromises, frustrations but also its aspirations – aspirations that provide a great set of resources for future work. These aspirations included strong human rights guarantees of universal access to medically safe, effective, legal, affordable and quality reproductive health services and supplies, and provisions for enforcement of these rights against restrictions on information and services, or other measures to hinder their full implementation. The law is also strongly rooted in social justice, with a promise that state resources must serve all, especially the poor and marginalized. Within this frame, I also included the law’s recognition of the family as a social institution, the struggle of parents to bring forth into the world children they can raise in a truly humane way, and the guarantee that no one shall be deprived of the right to have children for economic reasons.
What then about safe abortion in the law? We could focus on the simple proscription of abortion, a restatement of the criminal law, but that would be to ignore the reproductive health care that encompasses, sits all around safe and dignified abortion. The recognition in the RH law that contraceptive access is critical to reducing illegal and unsafe abortion. That PAC is critical to addressing illegal and unsafe abortion. Moreover the 2018 national PAC policy, seeks to prevent ‘unsafe’ illegal abortions, and thereby supports a harm reduction approach, that is, the many services – that can be provided in the community and in the clinic – to keep people safe or safer during an illegal abortion, to prevent unsafe illegal abortions or at least, to reduce their risks and harms and to thereby uphold the right to health of every Filipino. In this way, harm reduction keeps with the tradition of Likhaan in accepting the reality of abortion, and the humanity of those affected by it. In a concrete exercise of strategic thinking, we then considered the critical abortion pathways in the Philippine context and asked: What health care information, services and practice can help to reduce risk and vulnerability? What law or policy might support such action? Short of the decriminalization of abortion, how can we help to protect and promote the health and lives of women in the communities we serve?
The following week Likhaan hosted a large public forum which asked these same questions in the context of ICPD 8.25, human rights and justice in the Philippines. I delivered a keynote speech on the evolving global consensus on abortion rights in international law since ICPD. I endeavoured to show not only how far we have come, but also how expansive our ideas have become on what abortion rights mean and what they entail. How we have moved away from the single and absolute question of whether abortion should be criminalized or not, towards accepting the reality of abortion as part of comprehensive sexual and reproductive rights and justice. In some ways, abortion decriminalization is simple. The harder task always is what comes next. Since abortion was decriminalized in Canada, we have struggled for over 30 years to build a positive legislative framework for reproductive health and justice. When the time comes in the Philippines, I believe we will find much guidance for the future of abortion rights in the RH law – a law which I came to truly understand as a local expression of global aspirations for sexual and reproductive rights and justice in its strong human rights guarantees, its ethics of social justice and its vision of reproductive health and well-being as inseparable from the lives of people in their families, communities and societies. These are the achievements of Likhaan and its allies which will carry their advocacy forward.
During my time with Likhaan – visiting in the community, chatting with clinicians, talking strategy with legal advocates, and sharing pride with the Canadian ambassador for our support of their work – I gained such appreciation for Likhaan’s commitment to ‘find a way’ by drawing on the strength and will of those around them.
With funding from Global Affairs Canada, Inter Pares and Likhaan are currently building on many years of collaboration to scale up work on sexual and reproductive health in poor communities of Metro Manila and in rural East Samar in the Philippines. Expert exchanges, like the one detailed above, are part of this work.
I gained such appreciation for Likhaan’s commitment to ‘find a way’ by drawing on the strength and will of those around them.