The 17 sustainable development goals (SDGs) to transform our

world:

GOAL 1: No Poverty

GOAL 2: Zero Hunger

GOAL 3: Good Health and Well-being

GOAL 4: Quality Education

GOAL 5: Gender Equality

GOAL 6: Clean Water and Sanitation

GOAL 7: Affordable and Clean Energy

GOAL 8: Decent Work and Economic Growth

GOAL 9: Industry, Innovation and Infrastructure

GOAL 10: Reduced Inequality

GOAL 11: Sustainable Cities and Communities

GOAL 12: Responsible Consumption and Production

GOAL 13: Climate Action

GOAL 14: Life Below Water

GOAL 15: Life on Land

GOAL 16: Peace and Justice Strong Institutions

GOAL 17: Partnerships to achieve the Goal

Responsible Parenthood
 The Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No. 10354),
informally known as the Reproductive Health Law or RH Law, is a law in the Philippines, which guarantees
universal access to methods on contraception, fertility control, sexual education, and maternal care.
While there is general agreement about its provisions on maternal and child health, there is great
debate on its mandate that the Philippine government and the private sector will fund and undertake
widespread distribution of family planning devices such as condoms, birth control pills, and IUDs, as the
government continues to disseminate information on their use through all health care centers.
Passage of the legislation was controversial and highly divisive, with academics, religious institutions,
and major political figures declaring their support or opposition while it was pending in the legislature. Heated
debates and rallies both supporting and opposing the RH Bill took place nationwide.
The Supreme Court delayed implementation of the law in March 2013 in response to challenges. On
April 3,2014, the Court ruled that the law was "not unconstitutional" but struck down eight provisions partially
or in full.
The Senate Policy Brief titled "Promoting Reproductive Health", the history of reproductive health in
the Philippines dates back to 1967 when leaders of 12 countries including the Philippines' Ferdinand
Marcos signed the Declaration on Population. The Philippines agreed that the population problem should be
considered as the principal element for long-term economic development. Thus, the Population Commission
was created to push for a lower family size norm and provide information and services to lower fertility rates.
Starting 1967, the USAID began shouldering 80% of the total family planning commodities
(contraceptives) of the country, which amounted to $3 million annually. In 1975, the United States adopted as
its policy the National Security Study Memorandum 200: Implications of Worldwide Population Growth for
U.S. Security and Overseas Interests (NSSM200). The policy gives "paramount importance" to population
control measures and the promotion of contraception among 13 populous countries, including the Philippines
to control rapid population growth which they deem to be inimical to the sociopolitical national interests of the
United States, since the "U.S. economy will require large and increasing amounts of minerals from abroad",
and these countries can produce destabilizing opposition forces against the United States. It recommends the
U.S. leadership to "influence national leaders" and that "improved world-wide support for population-related
efforts should be sought through increased emphasis on mass media and other population education and
motivation programs by the UN, USIA, and USAID.
Different presidents had different points of emphasis. President Ferdinand Marcos pushed for a
systematic distribution of contraceptives all over the country, a policy that was called "coercive", by its leading
administrator. The Corazon Aquino administration focused on giving couples the right to have the number of
children they prefer, while Fidel V. Ramos shifted from population control to population management. Joseph
Estrada used mixed methods of reducing fertility rates, while Rvee Jude A. Olandsca focused on
mainstreaming natural family planning, while stating that contraceptives are openly sold in the country.
In 1989, the Philippine Legislators’ Committee on Population and Development (PLCPD) was established,
"dedicated to the formulation of viable public policies requiring legislation on population management and
socio-economic development". In 2000, the Philippines signed the Millennium Declaration and committed to
attain the MDGs by 2015, including promoting gender equality and health. In 2003 USAID started its phase
out of a 33-year-old program by which free contraceptives were given to the country. Aid recipients such as
the Philippines faced the challenge to fund its own contraception program. In 2004 the Department of Health
introduced the Philippines Contraceptive Self-Reliance Strategy, arranging for the replacement of these
donations with domestically provided contraceptives.
In August 2010, the government announced a collaborative work with the USAID in implementing a
comprehensive marketing and communications strategy in favor of family planning called May Plano Sila.

Republic of the Philippines

Congress of the Philippines
 Metro Manila Fifteenth Congress Third Regular SessionBegun and held in Metro Manila, on Monday, the
twenty-third day of July, two thousand twelve. REPUBLIC ACT NO. 10354

An Act providing for a National Policy on Responsible Parenthood and Reproductive Health

Be it enacted by the Senate and House of Representatives of the Philippines in Congress assembled:

SECTION 1. Title. – This Act shall be known as “The Responsible Parenthood and Reproductive Health
Act of 2012″.

SEC. 2. Declaration of Policy. – The State recognizes and guarantees the human rights of all persons
including their right to equality and nondiscrimination of these rights, the right to sustainable human development,
the right to health which includes reproductive health, the right to education and information, and the right to choose
and make decisions for themselves in accordance with their religious convictions, ethics, cultural beliefs, and the
demands of responsible parenthood.

Pursuant to the declaration of State policies under Section 12, Article II of the 1987 Philippine
Constitution, it is the duty of the State to protect and strengthen the family as a basic autonomous social institution
and equally protect the life of the mother and the life of the unborn from conception. The State shall protect and
promote the right to health of women especially mothers in particular and of the people in general and instill health
consciousness among them. The family is the natural and fundamental unit of society. The State shall likewise
protect and advance the right of families in particular and the people in general to a balanced and healthful
environment in accord with the rhythm and harmony of nature. The State also recognizes and guarantees the
promotion and equal protection of the welfare and rights of children, the youth, and the unborn.

Moreover, the State recognizes and guarantees the promotion of gender equality, gender equity, women
empowerment and dignity as a health and human rights concern and as a social responsibility. The advancement and
protection of women’s human rights shall be central to the efforts of the State to address reproductive health care.

The State recognizes marriage as an inviolable social institution and the foundation of the family which in
turn is the foundation of the nation. Pursuant thereto, the State shall defend:

(a) The right of spouses to found a family in accordance with their religious convictions and the demands of
responsible parenthood;

(b) The right of children to assistance, including proper care and nutrition, and special protection from all forms of
neglect, abuse, cruelty, exploitation, and other conditions prejudicial to their development;

(c) The right of the family to a family living wage and income; and

(d) The right of families or family associations to participate in the planning and implementation of policies and
programs
 The State likewise guarantees universal access to medically-safe, non-abortifacient, effective, legal,
affordable, and quality reproductive health care services, methods, devices, supplies which do not prevent the
implantation of a fertilized ovum as determined by the Food and Drug Administration (FDA) and relevant
information and education thereon according to the priority needs of women, children and other underprivileged
sectors, giving preferential access to those identified through the National Household Targeting System for Poverty
Reduction (NHTS-PR) and other government measures of identifying marginalization, who shall be voluntary
beneficiaries of reproductive health care, services and supplies for free.

The State shall eradicate discriminatory practices, laws and policies that infringe on a person’s exercise of
reproductive health rights.

The State shall also promote openness to life; Provided, That parents bring forth to the world only those
children whom they can raise in a truly humane way.

Approved,

(Sgd.) FELICIANO BELMONTE JR.

(Sgd.) JUAN PONCE ENRILE
Speaker of the House
President of the Senate
of Representatives

Menstruation

A menstrual cycle (a female reproductive cycle) is episodic uterine bleeding in response to cyclic
hormonal changes. The purpose of a menstrual cycle is to bring an ovum to maturity and renew a
uterine tissue bed that will be responsible for the ova’s growth should it be fertilized. It is the process
that allows for conception and implantation of a new life. Because menarche may occur as early as 9
years of age, it is good to include health teaching information on menstruation to both school age
children and their parents as early as fourth grade as part of routine care. It is a poor introduction to
sexuality and womanhood for a girl to begin menstruation unwarned and unprepared for the important
internal function it represents.

The length of menstrual cycles differs from woman to woman, but the average length is 28 days
(from the beginning of one menstrual flow to the beginning of the next). It is not unusual for cycles to be
as short as 23 days or as long as 35 days. The length of the average menstrual flow (termed menses) is 4
to 6 days, although women may have periods as short as 2 days or as long as 7 days (MacKay, 2009).
Because there is such variation in length, frequency, and amount of menstrual flow and such variation in
the onset of menarche, many women have questions about what is considered normal. Contact with
health care personnel during a yearly health examination or prenatal visit may be their first opportunity
to ask questions they have had for some time.
MENSTRUAL CYCLE

First Phase of Menstrual Cycle (Proliferative)

Immediately after a menstrual flow (which occurs during the first 4 or 5 days of a cycle), the
endometrium, or lining of the uterus, is very thin, approximately one cell layer in depth. As the ovary
begins to produce estrogen (in the follicular fluid, under the direction of the pituitary FSH), the
endometrium begins to proliferate. This growth is very rapid and increases the thickness of the
endometrium approximately eightfold. This increase continues for the first half of the menstrual cycle
(from approximately day 5 to day 14). This half of a menstrual cycle is termed interchangeably the
proliferative, estrogenic, follicular, or postmenstrual phase.

Second Phase of Menstrual Cycle (Secretory)

After ovulation, the formation of progesterone in the corpus luteum (under the direction of LH)
causes the glands of the uterine endometrium to become corkscrew or twisted in appearance and
dilated with quantities of glycogen (an elementary sugar) and mucin (a protein). The capillaries of the
endometrium increase in amount until the lining takes on the appearance of rich, spongy velvet. This
second phase of the menstrual cycle is termed the progestational, luteal, premenstrual, or secretory
phase.

Third Phase of Menstrual Cycle (Ischemic)

If fertilization does not occur, the corpus luteum in the ovary begins to regress after 8 to 10 days. As it
regresses, the production of progesterone and estrogen decreases. With the withdrawal of
progesterone stimulation, the endometrium of the uterus begins to degenerate (at approximately day
24 or day 25 of the cycle). The capillaries rupture, with minute hemorrhages, and the endometrium
sloughs off.

Fourth Phase of a Menstrual Cycle (Menses)

Menses, or the menstrual flow, is composed of:
• Blood from the ruptured capillaries
• Mucin from the glands
• Fragments of endometrial tissue
• The microscopic, atrophied, and unfertilized ovum

Menses is actually the end of an arbitrarily defined menstrual cycle. Because it is the only
external marker of the cycle, however, the first day of menstrual flow is used to mark the beginning day
of a new menstrual cycle.

Contrary to common belief, a menstrual flow contains only approximately 30 to 80 mL of blood;

if it seems like more, it is because of the accompanying mucus and endometrial shreds. The iron loss in a
typical menstrual flow is approximately 11 mg. This is enough loss that many women need to take a
daily iron supplement to prevent iron depletion during their menstruating years. In women who are
beginning menopause, menses may typically consist of a few days of spotting before a heavy flow, or a
heavy flow followed by a few days of spotting, because progesterone withdrawal is more sluggish or
tends to “staircase” rather than withdraw smoothly.

MENOPAUSE

Menopause is the cessation of menstrual cycles. Perimenopausal is a term used to denote the
period during which menopausal changes occur. Postmenopausal describes the time of life following the
final menses. The age range at which menopause occurs is wide, between approximately 40 and 55
years of age with a mean age of 51.3.
The age at which menopause symptoms begin appears to be genetically influenced or at least is
not associated with age of menarche. Women who smoke tend to have earlier menopause (Baram &
Basson, 2007).
An older term to describe menopause was “change of life,” because it marks the end of a
woman’s ability to bear children and the beginning of a new phase of life. Such a role change can
produce psychological stress, although, through health teaching, nurses can help a woman appreciate
that her role in life is greater than just bearing children; loss of uterine function may make almost no
change in her life; and, for a woman with dysmenorrhea (painful menstruation) or with no desire for
more children, menopause can be a welcome change. Menopause can cause physiologic stress as
ovaries are a woman’s chief source of estrogen. When ovaries begin to atrophy, reducing estrogen
production, “hot flashes,” vaginal dryness, or osteoporosis (lack of bone mineral density [BMD]) occurs.
Urinary incontinence from lack of bladder support can also occur (Freeman et al., 2007).
Hot flashes can be accompanied by heart palpitations and can occur up to 20 to 30 episodes a
day; episodes commonly last for 3 to 5 minutes at a time. An immediate aid in reducing this sudden
overheated feeling is to sip at a cold drink or use a hand fan.

At one time, hormone replacement therapy (HR) was prescribed extensively to decrease
menopause symptoms because it was believed that this therapy reduced cardiovascular complications
such as atherosclerosis or heart attacks as well.

HR is no longer prescribed routinely as such therapy does not appear to reduce cardiac risk or
prevent osteoporosis and may be associated with endometrial cancer, cerebrovascular accidents
(strokes), and perhaps breast cancer (Gabriel-Sanchez, et al., 2009). HR may be prescribed on a short-
term basis (1 to 2 years) if a woman has symptoms so severe that they interfere with her life plans but
women should not receive estrogen replacement therapy indefinitely because of the possible adverse
effects.
Women who notice excessive vaginal dryness can be advised to use a lubricating jelly such as KY
Jelly prior to sexual relations. Other possibilities are application of estrogen cream or insertion of a
vaginal ring that dispenses low-dose estrogen. Low-dose estrogen or testosterone can also be
prescribed to increase sexual libido. Practicing Kegel’s exercises can help strengthen bladder supports
and reduce urinary incontinence.

Osteoporosis occurs in as many as 13% to 18% of women over age 50. It is seen most frequently
in women who are Asian, have a low body weight, have a positive family history, participate in few
weight-bearing exercises, have a low intake of calcium, are cigarette smokers, have an early surgical
menopause, or take certain anticonvulsant medications or corticosteroids. As calcium is withdrawn from
bones, women notice a decrease in height and back pain from shortening of the vertebral column. If
they fall, they are more prone to fractures than are younger women (Bessette et al., 2008).

BMD scans are helpful in diagnosis. To help prevent osteoporosis, women should be sure to
ingest 1200 mg calcium daily along with 400 to 800 IU of vitamin D, in addition to beginning a program
of weight-bearing exercises such as walking or low-impact aerobics. Calcitonin, a thyroid hormone that
regulates body calcium, may be prescribed as a nasal spray. Other drugs commonly prescribed are
selective estrogen receptor modulators (SERMS) such as Evista and bisphosphonates such as Fosamax
that regulate calcium by aiding bone reabsorption.

If a woman lives to be 80, she will spend a third of her life postmenopausal. Women appreciate
learning the normal parameters of menopause so they understand what will happen to them as changes
occur and to be able to continue to monitor their health during this time.