POSITION PAPER ON THE RH BILLS

BY FACULTY, STUDENTS, AND ALUMNI OF THE UNIVERSITY OF THE PHILIPPINES

READING LIST

* of special interest
** of outstanding interest

CONTENTS

I. Population is not an obstacle to development.

II. The government should focus more on creating jobs and strengthening
education.

III. A growing concern: our fertility rate is progressively decreasing.

IV. The government should channel its limited resources to address the
leading causes of death.

V. Condoms are not a wise investment.

VI. Oral contraceptive pills are dangerous to women’s health.

I. Population is not an obstacle to development: Cutting down on
population is counterproductive.
A. There is insignificant empirical association between population growth and
economic development.

1. De Vera, Robert. “A Primer on the proposed Reproductive Health, Responsible

Parenthood, and Population Development Consolidated Bill.” 11 Sept. 2008. Last
accessed on 2 Jan. 2011. <http://www.scribd.com/doc/21622530/Demographic-
Economic-Historical-Evidence-vs-RH-Bill> **
Economist Dr. Robert de Vera offers historical, economic, and demographic evidence for
the flawed and long-debunked Malthusian view on which the RH bills are largely based,
that “too many people” means “more poor people”. He reasons that “bad governance and
bad economic policies and not a fast, growing population, are the real causes of poverty”.
2. Kling, Jeff and Pritchett, Lant. “Where in the world is population growth bad?”
Policy Research Working Paper Series 1391. Washington, DC: The World Bank,
1994. *
3. Levine, Ross and Renelt, David. “A Sensitivity Analysis of Cross-Country
Growth Regressions.” The American Economic Review 82.4 (1992): 942-963. *
4. Ahlburg, Dennis. “Population Growth and Poverty.” The Impact of Population
Growth on Well-being in Developing Countries. Eds. Ahlburg, Kelley, and
Mason. New York: Springer-Verlag, 1996. 219-258. *
5. Kuznets, Simon. Modern Economic Growth: Rate, Structure and Spread. New
Haven: New Haven and Yale University Press, 1966. 67-68. **
6. Kuznets, Simon. “Population and Economic Growth.” Population Problems.
Proceedings of the American Philosophical Society 1967 3, 170-93. Reprinted in
Population, Capital and Growth: Selected Essays. New York: W.W. Norton &
Co., 1973. 1-48. *
7. Kuznets, Simon. “Modern Economic Growth: Findings and Reflections. Nobel
Prize Lecture.” Nobel Prize. 1971. Last accessed on 12 Dec. 2010
<http://nobelprize.org/nobel_prizes/economics/ laureates/1971/kuznets-
lecture.html> **
Kuzents’s main finding was the insignificant empirical association between population
growth rates and output per capita. He asserts that it is rather the rate at which technology
grows and the ability of the population to employ these new technologies efficiently and
widely that permit economic progress. The basic obstacles to economic growth arise from
the limited capabilities of the institutions (political, social, legal, cultural, economic) to
adjust. A more rapid population growth may promote economic development through a
positive impact on the society's state of knowledge.
8. Sala-I-Martin, Xavier, Doppelhofer, Gernot, and Miller, Ronald. "Determinants of
Long-Term Growth: A Bayesian Averaging of Classical Estimates (BACE)
Approach." The American Economic Review 94.4 (2004): 813-835. **
The study shows that the average annual growth from 1960 to 1990 was not robustly
correlated to economic growth. Rather, it was the relative price of investment, primary
school enrollment, and the initial level of real GDP per capita that strongly affected the
observed economic growth.
9. Simon, Julian. The Ultimate Resource 2. Princeton, NJ: Princeton University
Press, 1996. **
10. Simon, Julian. Interview: Population Growth Benefits the Environment. Acton
Institute. Date of interview unspecified. Last accessed on 1 Jan. 2011.
 <http://www.acton.org/pub/religion-liberty/volume-5-number-2/population-
growth-benefits-environment> **
“Every agricultural economist knows that people have been eating better since World
War II, the period for which we have data. Every resource economist knows that natural
resources have become cheaper rather than more expensive. Every demographer knows
that life expectancy in the wealthy countries has gone up from under 30 years at birth
200 years ago to over 75 years at birth today. And life expectancy has risen in the poor
countries from perhaps 35 years at birth only 50 years ago to 60-65-70 years at birth
today. Those are the facts which are known by the economists and demographers who
study these subjects.”
11. Kanlungan ng Buhay. “The Philippine population is not exploding, and therefore
we do not need the population control expenditures on contraception and sex
education proposed by the reproductive health rights bill/s.” Position paper
presented to the Congressional Committee on Population and Development on 15
Dec. 2010.
Kanlungan ng Buhay is an NGO of concerned businessmen promoting Family and Life.
Trustee: Jose S. Sandejas, PhD.
12. Villegas, Bernardo. “The Myth of Unmet Family Planning Needs.” Manila
Bulletin. 30 Aug. 2010.

B. A more rapid population growth, if properly managed, will promote economic

development.

1. Becker, Gary. “Human Capital and Poverty.” Essay delivered as an address in

Rome, March 1996. Last accessed on 2 Jan. 2011 <
http://econ171.wordpress.com/gary-becker- human-capital-and-poverty> **
2. Becker, Gary. “The Economic Way of Looking at Life. Nobel Prize Lecture.”
Nobel Prize. 1992. Last accessed on 12 Dec. 2010.
<http://nobelprize.org/nobel_prizes/economics/laureates/1992/becker-
lecture.html> *
“Human capital refers to the skills, education, health, and training of individuals. The
importance of human capital to growth is perhaps excessively illustrated by the
outstanding records of Japan, Taiwan, Hong Kong, South Korea, and other fast-growing
Asian economies. They are obvious examples because they lack natural resources–which
typically is overstated greatly as a determinant of economic performance–and face
discrimination against their exports in the West. Nevertheless, they have managed to
grow extremely rapidly in significant part because they have had a well-trained, well-
educated, and hard-working labor force, and dedicated parents.”
3. Hanushek, Eric and Woessmann, Ludger. “The Role of School Improvement in
Economic Development.” NBER Working Paper Series Vol. w12832 (2007). Last
accessed on 1 Jan. 2010. <http://ssrn.com/abstract=958484> **
4. Hanushek, Eric and Woessmann, Ludger. “The Role of Education Quality for
Economic Growth.” Policy Research Working Paper Series 4122. Washington,
DC: The World Bank, 2007. **
Educational quality - measured by what people know – has powerful effects on
individual earnings, on the distribution of income, and on economic growth. Just
providing added resources to schools in unlikely to be successful; improving the quality
of schools will take structural changes in institutions.
5. Population Growth and Economic Development: Report on the Consultative
Meeting of Economists Convened by the United Nations Population Fund, 28-29
Sept. 1992, New York. Last accessed on 2 Jan. 2011.
<http://www.un.org/popin/unfpa/ pubs/econmeet/econmeet.html> *
 It is clear that population growth will not lead to higher growth of income per
capita...population increases are not sufficient to create change and economic
development. The latter results from a complex sequence of events including changes in
institutions, incentives, property rights, parliamentary mechanisms, and political
stability.

II. Given our limited funds, the government should focus more on
creating jobs and strengthening education.
1. Asian Development Bank. Key Indicators for Asia and the Pacific 2010: The rise
of Asia's Middle Class. 41st ed. Manila: Asian Development Bank, 2010. **
The middle class has increased rapidly in size and purchasing power as strong economic
growth in the past two decades has helped reduce poverty significantly and lift previously
poor households into the middle class. Two factors were reported to drive the creation and
sustenance of a middle class: a) stable, secure, well-paid jobs with good benefits, and b)
higher education.
2. Wennekers, S and Thurik, R. “Linking Entrepreneurship and Economic Growth.”
Small Business Economics 13.1 (1999): 27-56.*
Encouraging innovative economic participation, i.e. entrepreneurship, creates jobs and
thus contributes to economic growth.
3. “The middle Class in Emerging Markets: Two Billion more bourgeois.” The
Economist. 12 Feb. 2009. Last accessed on 1 Jan. 2011.
<http://www.economist.com/node/13109687> **
4.“A special report on the new middle classes in emerging markets: Burgeoning
bourgeoisie.” The Economist. 12 Feb. 2009. Last accessed on 1 Jan. 2011.
<http://www.economist.com/ node/13063298> *
These two articles from the Economist deduce the idea that job participation in emerging
countries lifts up people from poverty thus creating the middle class. This allows people to
participate more in their assertion of their political rights, acquisition of latest fashion
trends, explore and travel more touristic places, etc. The people now possess an increased
purchasing power which is the main factor behind the improvement in the quality of life.
5. Orozco, Viany and Wheary, Jennifer. “Funding Higher Education is good for Job
Creation.” The Hill. 5 Feb. 2010. Last accessed on 1 Jan. 2011.
<http://thehill.com/opinion/op-ed/ 79927-funding-higher-education-is-good-for-
job-creation> **
6. Wheary, Jennifer and Orozco, Viany. Graduated Succes: Sustainable Economic
Opportunity Through One- and Two-Year Credentials (Post secondary Success
Series). New York: Demos, 2010. **
“Public investments in higher education have been - and will continue to be - invaluable in
job generation and supporting a strong middle class. “
7. Balisacan, Arsenio and Pernia, Ernesto. “What Else Besides Growth Matters to
Poverty Reduction?” ERD Policy Brief Series No. 5 Manila: Asian Development
Bank, 2002. *
This essay highlights that the economic growth in the Philippines from the 1980s through
the 1990s has an insignificant effect in the welfare of the poor. More than economic
growth, institutional adjustments will play a bigger role in poverty reduction.
III. A growing concern for the Philippines is its progressively
decreasing fertility rate; the RH bill will just exacerbate this as it did
for other countries.
A. Fertility rates in the Philippines are progressively decreasing.

1. Population Reference Bureau Staff. “Transitions in World Population.”

Population Bulletin 59.1 (2004). *
2. The CIA World Factbook. Last accessed on 6 Dec. 2010.
<http://www.cia.gov/library/publications/the-world-
factbook/rankorder/2127rank.html> *
3. Google Public Data. “World Bank – World Development Indicators.” 6 Dec.
2010. <http://www.google.com/publicdata?ds=wb-
wdi&ctype=l&strail=false&nselm=h&met_y=sp_dyn_tfrt_in&scale_y=lin&ind_y
=false&rdim=country&idim=country:PHL&tstart=-
315619200000&tunit=Y&tlen=48&hl=en&dl=en.> *
4. Costello M and Casterline JB. "Fertility decline in the Philippines: Current status,
future prospects." Completing the Fertility Translation. United Nations
Publications, 2009. 529-538. Last accessed on 2 Jan. 2011. <http://www.un.org/
esa/population/publications/completingfertility/completingfertility.htm> **
Our Total Fertility Rate (TFR) has declined by more than 50% in less than 50 years:
from an average rate of 7 in 1960 to an average rate of 3.1 in 2008. Our TFR is
expected to reach the replacement level of 2.1 in 2025 without massive government
intervention like the passing of a population control or RH bill. The passing of an RH
bill will only cause unnaturally fast the TFR decline to replacement level.

B. Countries that have adopted a population control program such as the RH bill
are now suffering what economists refer to as “demographic winter” and the
“fertility trap”.

1. "The future of Japan, The Japan syndrome: The biggest lesson the country may
yet teach the world is about the growth-sapping effects of aging." The Economist.
18 Nov. 2010. Last accessed on 6 Dec. 2010. <http://www.economist.com/node/
17522568> **
2. "A special report on Japan, The dearth of births: Why are so few young Japanese
willing to procreate?" The Economist. 18 Nov. 2010. Last accessed on 6 Dec.
2010. <http://www.economist.com/ node/17492838?story_id=17492838> **
The November print issue of The Economist entitled “Japan’s burden” spells out the
effects of an ageing population and it would be foolhardy for us as a nation to push
ourselves deliberately towards that direction.
3. Chamie, Joseph. “Low Fertility: Can Governments Make a Difference?"
Population Division United Nations during Session 105: International Responses
to Low Fertility in Annual Meeting Population Association of America (PAA),
Boston, Massachusetts. 2 Apr. 2004. Last accessed on 6 Dec. 2010.
<http://paa2004. princeton.edu/download.asp?submissionId=42278> *
In 2004, Joseph Chamie, Director of the UN Population Division, reported that 60
countries have TFRs below 2.1 which means these countries are in danger of
experiencing an ageing population, if not resolved. He asserted that the efforts of these
countries to raise fertility rates are not enough to bring them back to replacement levels.
 Many of these countries are now asking their people to have more children through an
incentive system.
4. "The EU's baby blues: Birth rates in the European Union are falling fast." BBC
News. London. 27 Mar. 2006. Last accessed on 2 Jan. 2010.
<http://news.bbc.co.uk/2/hi/europe/4768644.stm> *
In the first of a series of reports on motherhood and the role of the state in encouraging
couples to have more children, BBC News's Clare Murphy asks why governments are
so concerned about the size of their populations.
5. "Europe's population, Suddenly, the old world looks younger Reports of Europe's
death are somewhat exaggerated." The Economist. 14 Jun. 2010. Last accessed on
6 Dec. 2010. <http://www.economist.com/node/9334869> *
Countries with fertility rates of below 1.5 are struggling in a fertility trap. The low
fertility belt runs from the Mediterranean to central and Eastern Europe, embracing
both old and new parts of the continent. [But some European countries are starting to
recover.]
6. Cosgrove-Mather, Bootie. "European Birth Rate Declines: Population Growth In
E.U. Has Flipped From Positive To Negative." CBS News World. 27 Mar. 2003.
Last accessed on 6 Dec. 2010.
<http://www.cbsnews.com/stories/2003/03/27/world/main546441.shtml> **
The momentum for population growth in the 15-nation European Union has flipped
from positive to negative and the trend could strongly influence population numbers
throughout the 21st century.
7. Directorate-General for Health and Consumers of the European Union (EU).
Major and Chronic Diseases Report, Executive Summary. Luxembourg: European
Communities, 2008.
"Due to the ageing of the population in Europe, cancer incidence cases are expected to
increase, thus constituting a major public health issue for Europe."

IV. Through the DOH, the government has to direct its funds and
efforts to address the leading causes of death in our country.
A. The government should wisely allocate its health funds to address the major
causes of death in our country.

1. World Health Organization (WHO). “Mortality Country Fact Sheet 2006.” Last
accessed on 2 Jan. 2011. <http://www.who.int/
whosis/mort/profiles/mort_wpro_phl_philippines.pdf>
This gives data on the leading causes of death in the Philippines, average life
expectancy, under age of 5 mortality and its causes. The main causes of death in the
country include: lower respiratory tract infections, ischaemic heart disease,
tuberculosis, hypertensive heart disease, perinatal conditions, cerebrovascular disease,
violence, diarrhoeal diseases, diabetes mellitus and chronic obstructive pulmonary
disease.
2. United Nations Children’s Fund (UNICEF). “UNICEF Statistics: Philippines at a
glance.” Last accessed on 24 Dec. 2010.
<http://www.unicef.org/infobycountry/philippines_statistics.html>
B. The government can intensify efforts in addressing parameters such as child
healthcare and nutrition.

1. United Nations Children’s Fund (UNICEF). “UNICEF Statistics: Thailand.

Malaysia. Vietnam. Indonesia: at a glance.” Last accessed on 13 Jan. 2011.
<http://www.unicef.org/infobycountry/
Thailand_statistics.html>,<http://www.unicef.org/infobycountry/malaysia_statisti
cs.html>,<http://www.unicef.org/infobycountry/vietnam_statistics.html>,<http://
www.unicef.org/infobycountry/indonesia_statistics.html>
2. Department of Health (DOH). Official website. Last accessed on 13 Jan.2011.
<http://www.doh.gov.ph>
The Philippines ranks 81st in terms of under 5-mortality at 32 per 1,000 live births in
2008 behind ASEAN neighbors Thailand and Vietnam both at 125th at 14 deaths and
Malaysia at 158th at 6 deaths.
Another key health concern in the Philippines is childhood nutrition. Twenty-one
percent of the under-5 Filipino children are moderately to severely underweight by
WHO standards, while 34% are moderately and severely stunted. This pales in
comparison to Thailand where 7% are underweight and 16% are stunted. Our
statistics on the aforementioned is fairly similar to those of Indonesia and Vietnam.
Access to healthcare is another issue. Only 50% of Filipino children under 5 years
old suspected of having pneumonia are taken to an appropriate health care provider.
This is in stark contrast with Thailand where 84% get to be seen by a health care
provider, 83% in Vietnam, and 66% in Indonesia. It is commendable however that
the Philippines has done better than its neighbors in addressing diarrhea with oral
rehydration and continued feeding- which 76% of Filipino children with diarrhea
receive.
The aforementioned data do not imply that the government is not doing anything
about it. The Department of Health does have efforts to address these with programs
on food fortification, child health, nutrition, and pneumonia. The data however
suggest that these efforts must be intensified and be significantly given more attention
to.

V. Condoms are not a wise investment. They do not offer the real
solution to the problem of AIDS.

A. The Philippines has the lowest incidence of HIV cases after Bangladesh, whereas
Thailand, the model in condom promotion in Asia, has the highest.

1. Bullecer, Rene. Telling the Truth: AIDS Rates for Thailand and the Philippines.
Human Life International. 2004. **
In 1987, Thailand had 112 HIV/AIDS cases while the Philippines had slightly more at
135 cases. More than 15 years later, in 2003, the number of HIV/AIDS cases in
Thailand rose to 750,000, an effect largely due to the successful 100% Condom Use
Program widely endorsed by the government. On the contrary, the Philippines, due to
its relatively low rates of condom use and the firm opposition of the Church and some
government officials against condoms and the safe-sex mentality, had only 1,935
cases and this, considering that its population is 30% more than that of Thailand. The
author adds that “In 1991, the World Health Organization (WHO) AIDS Program
forecasted that by 1999 Thailand would have 60,000 to 80,000 cases, and that the
Philippines would experience between 80,000 and 90,000 cases of HIV/AIDS”. In
1999, there were 755,000 cases in Thailand (65,000 deaths) and 1,005 in the
Philippines (225 deaths)”.
The author, Rene Josef Bullecer MD, is Director of AIDS-Free Philippines.
 2. Asian Development Bank. Key Indicators for Asia and the Pacific 2010: The rise
of Asia's Middle Class. 41st ed. Manila: Asian Development Bank, 2010.
3. Hermann C, Green E, Chin J, Taguiwalo, M, and Cortez, C. Evaluation of the
Philippines AIDS Surveillance and Education Project. Philippines: USAID, 8
May 2001.
4. United States Agency for International Development (USAID). “HIV/AIDS
Health Profile in Asia.” Last accessed on 6 Dec. 2010.
<http://www.usaid.gov/our_work/global_health/aids/Countries/asia/hiv_summary
_asia.pdf>
5. Department of Health (DOH). “Philippine HIV and AIDS Registry.” September
2010. Last accessed on 6 Dec. 2010.
<http://www.doh.gov.ph/files/NEC_HIV_Sept-AIDSreg2010.pdf>

B. Condoms are not 100% effective in preventing HIV/AIDS transmission.

1. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually

Transmitted Disease Prevention prepared by the National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Department of Health and
Human Services, 20 Jul. 2001. Last accessed on 3 Jan. 2011. <
http://www.niaid.nih.gov/about/organization/dmid/documents/condomreport.pdf>
“Available scientific evidence indicates that the condom reduces the risk of
AIDS/HIV by 85%.” This means though that there’s a significant 15% risk that
remains. With continuous use, this risk increases dramatically: one can contract HIV
in 15 out of 100 instances of protected sex (i.e., sex while using a condom).”
2. World Health Organization (WHO). “Effectiveness of Male Latex Condoms in
Protecting against Pregnancy and Sexually Transmitted Infections” in Information
Fact Sheet #243, Jun. 2000.
“Estimated pregnancy rates during perfect use of condoms, that is for those who
report using the method exactly as it should be used (correctly) and at every act of
intercourse (consistently), is 3 percent at 12 months (…) The pregnancy rate during
typical use can be much higher (10-14%) than for perfect use, but this is due
primarily to inconsistent and incorrect use, not to condom failure.”
Here, it is important to distinguish the big difference between theory (“perfect use”)
and practice (“typical use”): “perfect practice” means assuming that all conditions are
optimal whereas “typical use” involves both instances when the condom is
“perfectly” used and imperfectly used. Nonetheless, even when “perfectly” used, still
some risk remains.
3. Kelly J and St. Lawrence J. “Cautions about Condoms in Prevention of AIDS.”
Lancet 1.8528 (1987): 323.
“The possible consequences of condom failure when one partner is HIV infected are
serious enough and the likelihood of failure sufficiently high that condom use by risk
groups should not be described as ‘safe sex'. (...) Condoms have a substantial failure
rate: 13-15% of women whose male partners use condoms as the sole method of
contraception become pregnant within one year.”
4. Lopez Trujillo, Alfonso Cardinal. “Family Values versus Safe Sex.” 1 Dec. 2003.
Last accessed on 3 Jan. 2011. < http://www.pop.org/content/family-values-vs-
safe-sex-1403> **
A comprehensive analysis of the position of the Catholic Church on condoms in
AIDS prevention programs.
The author argues that the mere fact that condoms allows a 15% window for
pregnancy to occur also means that there also exists a 15% possibility of getting
infected. Moreover, the author points out that whereas pregnancy can only occur
during a determined period of time when a woman is fertile, infection with STDs can
 occur on any day.
5. Suaudeau J. “Sesso sicuro” Lexicon, pp. 795-817 and Lelkens M. “AIDS: il
preservativo non preserva. Documentazione di una truffa.” Studi Cattolici 405
(1994): 718-723. [in Italian]
Studies on latex, the primary material of which condoms are made, in some instances,
may allow passage of particles bigger than HIV.
In addition, further studies even by the US Food and Drug Administration point to the
possibility of “holes and weak spots in condoms”. This draws attention to the fact that
condoms, like any company product, are not exempted from manufacturing defects.
6. Baker RF, Sherwin R, Bernstein GS and Nakamura RM. “Precautions When
Lightning Strikes During the Monsoon: The Effect of Ozone on Condoms. “
JAMA 260.10 (1988): 1404-1405. *
This study points to the susceptibility of condoms to degradation possibly due to its
exposure to sunlight, heat (including body heat when placed in pockets or wallets),
humidity, pressure, certain spermicides and even to atmospheric ozone.
This danger certainly does not exclude the damage that shipping, handling, and
storage can potentially cause to condoms during distribution.
7. Davis K and Weller S. “The Effectiveness of Condoms in Reducing Heterosexual
Transmission of HIV.” Family Planning Perspectives 31.9 (1999): 272-279; and
8. “If Someone tells You a Condom will keep you Safe…”, The Medical Institute
for Sexual Health, Austin, Texas [Brochure].
Another important source of failure of condoms is that they are often improperly
used.
“When given a basic list of procedures for correct condom use, less than half of
sexually active adolescents report they use condoms correctly. (…) Good intentions
won’t protect you. About 15 percent of couples who rely on condoms to avoid
pregnancy will still get pregnant within the first year of use. And even if you did
manage to use them consistently and correctly, 2-4 percent of condoms leak, break or
slip off. And you’re not just at risk for pregnancy.”

C. High rates of condom use and availability have been associated with high
HIV/AIDS prevalence rates.

1. Hearst N and Hulley SB. “Preventing the Heterosexual Spread of AIDS. Are We
Giving Our Patients the Best Advice?” JAMA 259 (1998): 2428-2432.
That condoms do not provide total protection against the transmission of HIV and
STIs is compounded by the fact that the “safe sex” campaigns have led not to an
increase in prudence, but to an increase in sexual promiscuity and condom use.
2. Population Research Institute Review (May-June 2003), p. 10
A summary of data taken from the Harvard School of Public Health, UNAIDS, and
the Kaiser Family Foundation points out to an almost parallel increase of condom
distributed by the USAID and the spread of HIV/AIDS from 1984-2003.
3. “Condom Lobby Drives AIDS Debate Besides Abstinence Success in Africa.”
Friday Fax 5.51 (2002).
“As AIDS sweeps across Africa, Uganda remains a lone success story, as millions of
Ugandans have embraced traditional sexual morality, including sexual abstinence
outside of marriage and fidelity within marriage, in order to avoid infection. But the
international AIDS community has been reluctant to promote this strategy elsewhere,
continuing, instead, to place its faith in condoms.”

D. Risk compensation and false security: People take more sexual risks because
they feel safer than is actually justified when using condoms.

1. Green E. “The Pope may be right.” The Washington Post. 29 Mar. 2009. **
This provocative article by Dr. Edward Green, senior research scientist at Harvard
 School of Public Health and past director of the AIDS Prevention Research Project at
the Harvard Center for Population and Development studies, called to re-address the
ineffectiveness of the current condom-based AIDS prevention program in Africa.
Green argues that the distribution and marketing of condoms would not solve the
AIDS epidemic in Africa and that it might even exacerbate it. Further, he claims that
greater condom availability and condom use have been associated with higher HIV
infection rates. He agrees with the Pope in that monogamy and faithfulness is the
solution.
Risk compensation, he explains, is the explanation for how high rates of condom use
have led to increased HIV/AIDS prevalence rates. Condoms give people the false
security: “when people think they're made safe by using condoms at least some of the
time, they actually engage in riskier sex.”
See also: William Crawley. “The Pope is right about condoms, says Harvard HIV
expert.” BBC. 29 Mar. 2009. Last accessed on 6 Dec.
2010.<http://www.bbc.co.uk/blogs/ni/2009/03/aids_expert_who_defended_the_p.htm
l>
2. Green E. Rethinking AIDS Prevention: Learning from Successes in Developing
Countries. Westport, CT: Praeger, 2003. *
“The largely medical solutions funded by major donors have had little impact in
Africa, the continent hardest hit by AIDS. Instead, relatively simple, low-cost
behavioral change programs--stressing increased monogamy and delayed sexual
activity for young people--have made the greatest headway in fighting or preventing
the disease's spread. Ugandans pioneered these simple, sustainable interventions and
achieved significant results.”
3. Hanley M & de Irala J. Affirming Love, Avoiding AIDS: What Africa can Teach
the West. Philadelphia: National Catholic Bioethics Center, 2010. **
This book discusses the science behind AIDS prevention and what truly is effective in
curbing the deadly epidemic.
4. Fitch JT, Sine C, Hager WD, Mann J, Adam MB, and McIlhaney J. “Condom
Effectiveness. Factors that Influence Risk Reduction” Sexually Transmitted
Diseases 12 (2002): 811-817. **
Risk compensation can also be explained in terms of the significant cumulative risk
factor involved in condom use. Fitch et al. write, “For example, an intervention that
is 99.8% effective for a single episode of intercourse can yield an 18% cumulative
failure rate with 100 exposures.”
In their own words, the contraceptive advocacy group International Planned
Parenthood Federation (IPFF) writes “the risk of contracting AIDS during so-called
‘protected sex’ approaches 100 percent as the number of episodes of sexual
intercourse increases.” See: Human Life International, Fact Sheet on Condom Failure
and Willard Cates. How Much Do Condoms Protect Against Sexually Transmitted
Diseases?, in IPPF Medical Bulletin, 31 (Feb 1997) 1: 2-3.
What needs to be assessed therefore is not only the risk involved in each single
condom use, but also of its continued use, a risk that dramatically increases in the
long run. (Family Values versus Safe Sex. Alfonso Lopez Trujillo, December 1,
2003)
5. Cook, Michael. “African AIDS: the facts that demolish the myth.” Mercatornet.
21 Mar. 2009. Last accessed on 3 Jan. 2011. <
http://www.mercatornet.com/articles/view/african_aids_the_facts_that_demolish_
the_myths/>
6. Lopez Trujillo, Alfonso Cardinal. “Family Values versus Safe Sex.” 1 Dec. 2003.
Last accessed on 3 Jan. 2011. < http://www.pop.org/content/family-values-vs-
safe-sex-1403> **
A comprehensive analysis of the position of the Catholic Church on condoms in
AIDS prevention programs.
The author argues that the current AIDS prevention campaign with condoms provides
false security. He writes, “To claim that it is ‘technically correct’ to say that the
condom ‘provides protection’ (leading people to think they are fully protected), when
 in fact one actually means that it ‘provides partial protection’, or ‘85-90% protection’,
or ‘relative protection’, is to lead many to their death. To emphasize that the condom
‘reduces risks’, but hiding the fact that it ‘does not eliminate risks’, leads to
confusion.”
7. Green, Edward and Ruark, Allison Herling. “AIDS and the Churches: Getting the
Story Right.” First Things. Apr 2008. Last accessed on 3 Jan. 2011.
<http://www.firstthings.com/ article/2008/03/002-aids-and-the-churches-getting-
the-story-right-27>
Green disproves the myth that the global HIV/AIDS epidemic continues in Africa
because there are not enough condoms. This myth is driven "not by evidence, but by
ideology, stereotypes, and false assumptions. (…) It results in efforts that are at best
ineffective and at worst harmful, while the AIDS epidemic continues to spread and
exact a devastating toll in human lives".
8. Shelton, James. Ten myths and one truth about generalised HIV epidemics.
Lancet 370.9602 (2007): 1809-1811.
Shelton, of the US Agency for International Development, says that one of the ten
damaging myths about the HIV epidemic is that condoms are the answer. "Condoms
alone have limited impact in generalized epidemics [as in Africa].”

E. The link between contraception use and abortion incidence:

1. Dueñas JL, Lete I, Bermejo R, Arbat A, Pérez-Campos E, Martínez-Salmeán J,

Serrano I, Doval JL, and Coll C. “Trends in the use of contraceptive methods and
voluntary interruption of pregnancy in the Spanish population during 1997-2007.”
Contraception 83.1 (2011): 82-7.
This recent ten-year study sheds light on the strong correlation between increased
elective abortion from 5.52 to 11.49 per 1000 women and increased overall use of
contraceptive methods from 49.1% to 79.9%. According to the Spanish study, the
most commonly used methods are condoms with increased use from 21% to 38.8%
followed by the pill from 14.2% to 20.3%.

F. Human papillomavirus (HPV) infection, by far the most common STD and a
risk factor for cervical cancer among other diseases, is not prevented by
condoms.

1. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually

Transmitted Disease Prevention prepared by the National Institute of Allergy and
Infectious Diseases, National Institutes of Health, Department of Health and
Human Services, 20 Jul. 2001. Last accessed on 3 Jan. 2011. <
http://www.niaid.nih.gov/about/organization/dmid/documents/condomreport.pdf>
*
No evidence was found that condom use reduced the risk of HPV infection, but study
results did suggest that condom use might afford some reduction in risk of HPV-
associated diseases, including genital warts in men and cervical neoplasia in women.
Nonetheless, studies conclude that condom use pose as a factor in the risk of
acquiring HPV infection.
2. Centers for Disease Control and Prevention. “National Vital Statistics Report”,
49.12 (2001).
HPV is a very important STD associated with cervical cancer, which in the US kills
many more women than the HIV.
3. Ho GYF, et al. “Natural History of Cervicovaginal Papillomavirus Infection in
Young Women.” New England Journal of Medicine 338.1 (1998): 423-428.
VI. Oral contraceptive pills (OCPs) are dangerous to women’s health,
much more than we know.
A. OCPs are labeled as Group 1 carcinogens by the International Agency for
Research on Cancer (IARC).

1. International Agency for Research on Cancer (IARC). IARC monographs on the

evaluation of carcinogenic risks to humans, volume 72, hormonal contraception
and post-menopausal hormonal therapy. Lyon: IARC, 1999. **
“There is sufficient evidence in humans for the carcinogenicity of combined oral
estrogen-progestogen contraceptives.” Studies show an increased risk of breast cancer
which was greater for women under age 35 at the time of diagnosis and who had
begun using contraceptives before their 20th birthday.
2. Cogliano V, Grosse Y, Baan R, Straif K, Secretan B, El Ghissassi F, WHO
International Agency for Research on Cancer. “Carcinogenicity of combined
oestrogen-progestagen contraceptives and menopausal treatment.” Lancet
Oncology 6 (2005): 552-553. **
The risk of developing breast cancer is elevated in women who have used OCPs
compared to those have never used them. However, the risk normalizes when OCPs
are discontinued for at least 10 years. The biopsies obtained from women who
participated in the study show that OCP use increases the proliferation of mammary
epithelial cells.

B. Use of OCPs or chemical contraceptives is associated with an increased risk of

premenopausal breast cancer, especially when used before the first full-term
pregnancy in women.

1. Kahlenborn C, Modugno F, Potter DM, and Severs WB. “Oral contraceptive use
as a risk factor for premenopausal breast cancer: a meta-analysis.” Mayo Clinic
Proceedings 81 (2006): 1290-302. **
This meta-analysis of over 34 studies conducted in several countries (1980s-present)
reveals that OCPs increase the risk of premenopausal breast cancer especially among
young women. In general, OCP use is associated with an increased risk of 19% across
various patterns of OCP use. Highest increased risk of up to 52% was observed
among those who have used OCPs for 4 or more years before their first pregnancy.
2. Skegg DCG, Noonan EA, et al. Depot medroxyprogesterone acetate and breast
cancer [A pooled analysis of the World Health Organization and New Zealand
studies]. JAMA (1995): 799-804. **
The results of two major world studies have shown that women who take common
injectable contraceptive, Depo-Provera, also called “the Shot”, for two years or more
before age 25 have at least a 190% increased risk of developing breast cancer.

C. A higher risk of breast cancer is associated with OCP use among post-
menopausal women in addition to other complications.

1. Writing group from the Women's Health Initiative Randomized controlled trial.
“Risks and benefits of estrogen plus progestin in healthy postmenopausal
women.” JAMA 288 (2002): 321-33. **
This massive randomized controlled trial of combined treatment of oral contraceptive
pills (0.625 mg/d combined equine estrogens and 2.5 mg/d medroxyprogestine) was
 conducted in 16,608 healthy post-menopausal women: 8,5066 were randomly given
hormonal treatment whereas the other 8,102 were given placebo. After a follow-up of
an average of 5.2 years, the trial was stopped because of a significant increase of 26%
risk of breast cancer was detected among hormone-treated volunteers. In addition,
hormone-treated women presented higher risks of cerebrovascular diseases (41%
higher), myocardial infarction (29% higher), and pulmonary embolisms (112%
higher). However, lower risks were observed for the following: hip fracture (34%
lower), colorectal cancer (37% lower), and endometrial cancer (17% lower).

D. Other studies on the breast cancer and OCP link:

1. Clemons M and Goss P. “Estrogen and the risk of breast cancer.” New England
Journal of Medicine 344 (2001): 276-85.
An extensive review about the risk of breast cancer and estrogen imbalance, a fact
well established for over 100 years now.
2. Colditz G. “Epidemiology and Prevention of Breast Cancer.” Cancer Epidemiol
Biomarkers Prev 14 (2005): 768-72.
3. McMahon B. “Epidemiology and the causes of breast cancer.” International
Journal of Cancer 118 (2006): 2373- 78.
Epidemiological studies show high frequency of breast cancer in countries where
OCP use is high.

E. OCP use is associated with increased risk of cervical cancer.

1. Moreno et al. “Effect of oral contraceptives on risk of cervical cancer in women

with human papillomavirus infection: the IARC multicentric case-control study.”
Lancet 359 (2002): 1085-92
OCP use for 5-9 years leads to 2.82x more risk of cervical cancer. If OCPs are used
for 10 or more years, the risk factor increases to 4.03x.
2. Herrero et al. “Injectable contraceptives and risk of invasive cervical cancer:
evidence of an association.” International Journal of Cancer 46 (1990): 5-7. **
This study found that women who had received injectable progestins (i.e., usually
Depo-Provera or norethisterone enanthate) for at least 5 years suffered a 430%
increased risk of developing cervical cancer.

F. OCPs have also been shown to increase the risk of vascular diseases, including
heart attack, venous thrombosis and stroke.

1. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone

Contraception. “Acute myocardial infarction and combined oral contraceptives:
results of an international multicentre case-control study.” Lancet 349 (1997):
1202–09. *
The odds ratio for acute myocardial infarction was 5.01 (95% CI 2.54-9.90) for women
with OCP use who have frequent coexistence of other risk factors such as smoking history
and hypertension. Few events however occurred with OCP users without coexistent risk
factors.
2. Hannaford P. “Cardiovascular Events Associated With Different Combined Oral
Contraceptives: A Review Of Current Data.” Drug Safety 22.5 (2000): 361-371.
This paper gives a summary of the findings of studies investigating the association
between OCP use and the following:
i. Myocardial infarction (MI): increased risk of MI among OCP users versus non-
OCP users.
ii. Ischemic stroke: increased risk of ischemic stroke (non- hemorrhagic) among OCP
 users vs. non- OCP users. Relative risk is at 3-4.
iii. Hemorrhagic stroke: no convincing evidence of a link between OCP use and
hemorrhagic stroke.
iv. Venoust Thromboembolism (VTE): Increased risk of VTE among OCP users
versus non-OCP users. This finding has been consistent across multiple studies.
The paper also gives an overview as to the possible molecular mechanism behind
OCPs and cardiovascular effects.
3. Vandenbroucke JP, Rosing J, Bloemenkamp KWM, et al. “Oral contraceptives
and the risk of venous thrombosis.” New England Journal of Medicine 344
(2001): 1527-35. **
This classic review takes up in detail the molecular mechanisms that delineate the risk
of thromboembolism associated with use of combined contraceptives. This highly
cited article disproves the long-held view that cardiovascular complications can be
avoided when estrogen dosage is reduced.
4. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJ, and
Rosendaal FR. “The venous thrombotic risk of oral contraceptives, effects of
oestrogen dose and progestogen type: results of the MEGA case-control study.”
British Medical Journal 339 (2009): b2921. *
A large-sample study that aims to accurately identify the risks of venous
thromboembolism specifically associated with each progestogen. In summary, recent
contraceptives (Desogestrel, Cyproterone, and Drospirenone) multiply the risk by a
factor of 5. The risk factor increases to more than 12 during the three first months of
use.
5. Herrington. “Hormone replacement therapy and heart disease. Replacing dogma
with data.” Circulation 107 (2003): 2-4.
6. Tanis BC and Rosendaal FR. “Venous and arterial thrombosis during oral
contraceptive use: risks and risk factors.” Semin Vasc Med 3 (2003): 69-84.
7. Rosendaal FR, Helmerhorst FM, and Vandenbroucke JP. “Oral contraceptives,
hormone replacement therapy and thrombosis.” Thromb Haemost 86 (2001): 112-
23.
8. Dentali F, Crowther M, and Ageno W. “Thrombophilic abnormalities, oral
contraceptives, and risk of cerebral vein thrombosis: a meta-analysis.” Blood 107
(2006): 2766-73.
9. Kemmeren J, Tanis B, Maurice AAJ, et al. “Risk of Arterial Thrombosis in
Relation to Oral Contraceptives (RATIO) Study. Oral Contraceptives and the
Risk of Ischemic Stroke.” Stroke 33 (2002): 1202–1208. *
Third-generation oral contraceptives (containing desogestrel or gestodene) confer the
same risk of first ischemic stroke as second-generation oral contraceptives (containing
levonorgestrel).