Implementing Rules and Regulations of Republic Act No. 10354 (2012) PDF

## Implementing Rules and Regulations of Republic Act No. 10354 (The Responsible Parenthood and Reproductive Health Act of 2012) **WHEREAS**, Having taken effect on January 17, 2013 in large part due to the strong advocacy of stakeholders and the commitment of Government, Republic Act No. 10354 or...

## Implementing Rules and Regulations of Republic Act No. 10354 (The Responsible Parenthood and Reproductive Health Act of 2012) **WHEREAS**, Having taken effect on January 17, 2013 in large part due to the strong advocacy of stakeholders and the commitment of Government, Republic Act No. 10354 or "The Responsible Parenthood and Reproductive Health Act of 2012" (RPRH Act) has become the focal point for convergence of multi-sectoral efforts toward the improvement of health outcomes; **WHEREAS**, Partnership with local governments as lead implementers of basic health services is central to the success of the RPRH Act, hence the active participation in the process of implementing rules and regulations (IRR) drafting and commitment to implementation thereof by the League of Provinces of the Philippines; the League of Cities of the Philippines; and the League of Municipalities of the Philippines; **WHEREAS**, Delivery of responsible parenthood and reproductive health services and information is at the core of implementation of the mandate given by the RPRH Act, hence the active participation in IRR drafting and commitment to implementation thereof by Civil Society Organizations (CSOs) such as Likhaan Center for Women's Health; Reproductive Health, Rights, and Ethics Center for Studies and Training; Women's Health Care Foundation; Philippine Medical Association; Philippine Obstetrical and Gynecological Society; Alliance of Young Nurse Leaders and Advocates International; and Bishops-Businessmen's Conference for Human Development in collaboration with national government agencies such as the Department of Health, Department of Education, Department of Social Welfare and Development; Department of the Interior and Local Government; National Economic and Development Authority; Philippine Health Insurance Corporation; and the Philippine Commission on Women; **WHEREAS**, Pursuant to Section 26 of the RPRH Act, the Drafting Committee was convened on January 22, 2013 and completed its work on March 15, 2013; **NOW, THEREFORE**, the following rules and regulations are hereby promulgated as the Implementing Rules and Regulations of Republic Act No. 10354: ### CHAPTER 1 – General Provisions #### RULE 1 - Preliminary Provisions - **Section 1.01 Title**. These Rules shall be known and cited as the Implementing Rules and Regulations of Republic Act No. 10354, otherwise known as "The Responsible Parenthood and Reproductive Health Act of 2012" or the RPRH Act. - **Section 1.02 Purpose**. These Rules are hereby promulgated to prescribe the procedures and guidelines for the implementation of the RPRH Act in order to facilitate compliance therewith and to achieve the objectives thereof. - **Section 1.03 Interpretation Clause**. These Rules shall be liberally construed to ensure the provision, delivery and access to reproductive health care services, and to promote, protect and fulfill women's reproductive health and rights. - **Section 1.04 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. - **Section 1.05 Declaration of Policy** 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 that affect them. - **Section 1.06 Declaration of Policy** 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. - **Section 1. 07 Declaration of Policy** The State shall eradicate discriminatory practices, laws and policies that infringe on a person's exercise of reproductive health rights. - **Section 1.08 Declaration of Policy** 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. #### RULE 2 - Guiding Principles for Implementation - **Section 2.01** These Rules declare the following as guiding principles: - a) The right to make free and informed decisions, which is central to the exercise of any right, shall not be subjected to any form of coercion and must be fully guaranteed by the State, like the right itself; - b) Respect for protection and fulfillment of reproductive health and rights which seek to promote the rights and welfare of every person particularly couples, adult individuals, women and adolescents; - c) The right of unmarried individuals, who are capacitated to marry, to found a family in accordance with their religious convictions and the demands of responsible parenthood; - d) Informed choice and voluntarism shall be promoted by all public and private health care providers rendering reproductive health care. Clients shall not be denied any right or benefit (including the right to avail of any program of general welfare or health care) as a consequence of any decision regarding reproductive health care; neither shall they be coerced nor induced to avail of any particular service or health product; - e) The provision of reproductive health care shall not discriminate between married or unmarried individuals, for all individuals regardless of their civil status have reproductive health concerns; - f) Since human resource is among the principal assets of the country, effective and quality reproductive health care services must be given primacy to ensure maternal and child health, the health of the unborn, safe delivery and birth of healthy children, and sound replacement rate, in line with the State's duty to promote the right to health, responsible parenthood, social justice and full human development; - g) The provision of ethical and medically safe, legal, accessible, affordable, non-abortifacient, effective and quality reproductive health care services and supplies is essential in the promotion of people's right to health, especially those of women, the poor, and the marginalized, and shall be incorporated as a component of basic health care; - h) The State shall promote and provide information and access, without bias, to all modern methods of family planning, whether natural or artificial, which have been proven medically safe, legal, non-abortifacient, and effective in accordance with scientific and evidence-based medical research standards such as those registered and approved by the FDA for the poor and marginalized as identified through the NHTS-PR and other government measures of identifying marginalization: Provided, That the State shall also provide funding support to promote all modern natural methods of family planning, especially the Billings Ovulation Method, consistent with the needs of acceptors and their religious convictions; - i) The State shall promote programs that (1) enable individuals and couples to have the number of children they desire with due consideration to the health, particularly of women, and the resources available and affordable to them and in accordance with existing laws, public morals and their religious convictions: Provided, That no one shall be deprived, for economic reasons, of the rights to have children; (2) achieve equitable allocation and utilization of resources; (3) ensure effective partnership among national government, local government units (LGUs) and the private sector in the design, implementation, coordination, integration, monitoring and evaluation of people-centered programs to enhance the quality of life and environmental protection; (4) conduct studies to analyze demographic trends including demographic dividends from sound population policies towards sustainable human development in keeping with the principles of gender equality, protection of mothers and children, born and unborn and the promotion and protection of women's reproductive rights and health; and (5) conduct scientific studies to determine the safety and efficacy of alternative medicines and methods for reproductive health care development; - j) The provision of reproductive health care, information and supplies giving priority to poor beneficiaries as identified through the NHTS-PR and other government measures of identifying marginalization must be the primary responsibility of the national government in collaboration with the LGUs consistent with its obligation to respect, protect and promote the right to health and the right to life; - k) While the provision states that reproductive health supplies and health products for the poor shall be the primary responsibility of the national government, LGUs shall endeavor to provide information, services and supplies to poor and non-poor families; - 1) The State shall respect individuals' preferences and choice of family planning methods that are in accordance with their religious convictions and cultural beliefs, taking into consideration the State's obligations under various human rights instruments; - m) Active participation by nongovernment organizations (NGOs), women's and people's organizations, civil society, faith-based organizations, the religious sector, private sector, and communities is crucial to ensure that reproductive health and population and development policies, plans, and programs will address the priority needs of women, the poor, and the marginalized; - n) While these Rules recognize that abortion is illegal and punishable by law, the government shall ensure that all women needing care for post-abortive complications and all other complications arising from pregnancy, labor and delivery and related issues shall be treated and counseled in a humane, nonjudgmental and compassionate manner in accordance with law and medical ethics; - o) Each family shall have the right to determine its ideal family size: Provided, however, That the State shall equip each parent with the necessary information on all aspects of family life, including reproductive health and responsible parenthood, in order to make that determination; - p) There shall be no demographic or population targets and the mitigation, promotion and/or stabilization of the population growth rate is incidental to the advancement of reproductive health; - q) Gender equality and women empowerment are central elements of reproductive health and population and development; - r) The resources of the country must be made to serve the entire population, especially the poor, and allocations thereof must be adequate and effective: Provided, That the life of the unborn is protected; - s) Development is a multi-faceted process that calls for the harmonization and integration of policies, plans, programs and projects that seek to uplift the quality of life of the people, more particularly the poor, the needy and the marginalized; and - t) That a comprehensive reproductive health program addresses the needs of people throughout their life cycle. #### RULE 3-Definition of Terms - **Section 3. 01** For purposes of these Rules, the terms shall be defined as follows: - a) **Abortifacient** refers to any drug or device that primarily induces abortion or the destruction of a fetus inside the mother's womb or the prevention of the fertilized ovum to reach and be implanted in the mother's womb upon determination of the Food and Drug Administration (FDA). - b) **Accredited public health facilities** refer to public health facilities that are of sufficient capability and competence to deliver quality health services, without prejudice to accreditation as may be carried out by the Philippine Health Insurance Corporation (PHIC). - c) **Adolescent** refers to young people between the ages of ten (10) to nineteen (19) years who are in transition from childhood to adulthood. - d) **Basic Emergency Obstetric and Newborn Care (BEmONC)** refers to lifesaving services for emergency maternal and newborn conditions/complications being provided by a health facility or professional to include the following services: administration of parenteral oxytocic drugs, administration of loading dose of parenteral anticonvulsants, administration of parenteral antibiotics, antenatal administration of steroids in threatened premature delivery, performance of assisted vaginal deliveries, removal of retained placental products, and manual removal of retained placenta. It also includes neonatal interventions which include at the minimum: newborn resuscitation, provision of warmth, and referral, blood transfusion where possible. These services must be made available twenty-four hours a day, seven days a week in a single facility or in a network of facilities. - e) **Basic Sectors** refer to the disadvantaged sectors of Philippine society, namely: farmer-peasant, artisanal fisherfolk, workers in the formal sector and migrant workers, workers in the informal sector, indigenous peoples and cultural communities, women, differently-abled persons, senior citizens, victims of calamities and disaster, youth and students, children, and urban poor. - f) **Civil Society Organizations (CSOs)** refer to nongovernment organizations (NGOs), People's Organizations (POs), cooperatives, trade unions, professional associations, faith-based organizations, media groups, indigenous peoples movements, foundations, and other citizen's groups which are non-profit and formed primarily for social and economic development to plan and monitor government programs and projects, engage in policy discussions, and actively participate in collaborative activities with the government. - g) **Client** refers to the patient or beneficiary of reproductive health care. - h) **Comprehensive Emergency Obstetric and Newborn Care (CEMONC)** refers to lifesaving services for emergency maternal and newborn conditions/complications as in Basic Emergency Obstetric and Newborn Care plus the provision of surgical delivery (caesarian section) and blood bank services, and other highly specialized obstetric interventions. It also includes emergency neonatal care that includes at the minimum: newborn resuscitation, treatment of neonatal sepsis infection, oxygen support, and antenatal administration of steroids in threatened premature delivery. These services may be delivered in a single facility or in a network of facilities. - i) **Conscientious objector** refers to a practicing skilled health professional who refuses to provide legal and medically safe reproductive health care within the scope of his or her professional competence, on the grounds that doing so is against his or her ethical or religious convictions. - j) **Contraceptive** refers to any safe, legal, effective, and scientifically proven modern family planning method, device, or health product, whether natural or artificial, that prevents pregnancy but does not primarily destroy a fertilized ovum or prevent a fertilized ovum from being implanted in the mother's womb in doses of its approved indication as determined by the Food and Drug Administration (FDA). - k) **Emergency** refers to a condition or state of a patient wherein based on the objective findings of a prudent medical officer on duty for the day there is immediate danger and where delay in initial support and treatment may cause loss of life or cause permanent disability to the patient. - 1) **Emergency Contraceptive Pills**, also known as **Postcoital Pills** refers to methods of contraception that can be used to prevent pregnancy in the first few days after intercourse intended for emergency use following unprotected intercourse, contraceptive failure or misuse, rape or coerced sex. These are effective only in the first few days following intercourse, before the ovum is released from the ovary and before the sperm fertilizes the ovum; furthermore, these cannot interrupt an established pregnancy or harm a developing embryo. - m) **Family Planning (FP)** refers to a program which enables couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to do so, and to have access to a full range of safe, affordable, effective, non-abortifacient modern natural and artificial methods of planning pregnancy. - n) **Fetal and infant death review** refers to a qualitative and in-depth study of the causes of fetal and infant death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies. - o) **Fetal death** refers to the death of a fetus prior to the complete expulsion or extraction from the womb, irrespective of the duration of pregnancy, indicated by the fact that after such separation, the fetus does not breathe or show any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles. - p) **Formal education** refers to the systematic and deliberate process of hierarchically structured and sequential learning corresponding to the general concept of schooling. At the end of each level, the learner needs a certification in order to enter or advance to the next level. - q) **Gender equality** refers to the principle of equality between women and men and equal rights to enjoy conditions in realizing their full human potentials to contribute to, and benefit from, the results of development, with the State recognizing that all human beings are free and equal in dignity and rights. It entails equality in opportunities, in the allocation of resources or benefits, or in access to services in furtherance of the rights to health and sustainable human development among others, without discrimination. - r) **Gender equity** refers to the policies, instruments, programs and actions that address the disadvantaged position of women in society by providing preferential treatment and affirmative action. It entails fairness and justice in the distribution of benefits and responsibilities between women and men, and often requires women-specific projects and programs to end existing inequalities. This concept recognizes that while reproductive health involves women and men, it is more critical for women's health. - s) **Geographically Isolated and Depressed Area (GIDA)** refers to communities with marginalized population physically and socio-economically separated from the mainstream society such as island municipalities, upland communities, hard-to-reach areas, and conflict-affected areas. - t) **Health care provider** refers to: - 1. A health care institution, which is duly licensed by the Department of Health (DOH) devoted primarily to the maintenance and operation of facilities for health promotion, prevention, diagnosis, treatment, and care of individuals suffering from illness, disease, injury, disability, or deformity, or in need of obstetrical or other medical and nursing care. It shall also be construed as any institution, building, or place where there are installed beds, cribs, or bassinets for twenty-four hour use or longer by patients in the treatment of diseases, injuries, deformities, or abnormal physical and mental states, maternity cases or sanitarial care; or infirmaries, nurseries, dispensaries, and such other similar names by which they may be designated; or - 2. A skilled health professional, as defined in these Rules; or - 3. A health maintenance organization, which is an entity that provides, offers, or arranges for coverage of designated health services needed by plan members for a fixed prepaid premium; or - 4. A community-based health care organization, which is an association of indigenous member of the community organized for the purpose of improving the health status of that community through preventive, promotive and curative health services. - u) **Infant mortality** refers to the death of a child before his or her first birthday. - v) **Informal education** refers to a lifelong process of learning by which every person acquires and accumulates knowledge, skills, attitudes and insights from daily experiences at home, at work, at play and from life itself. - w) **Informed choice and voluntarism** means effective access to information that allows individuals to freely make their own decision, upon the exercise of free choice and not obtained by any special inducements or forms of coercion or misinterpretation, based on accurate and complete information on a broad range of reproductive health services. - x) **Interpersonal communication and counseling (IPCC)** refers to a face-to-face, verbal and non-verbal exchange of information. Effective IPCC between health care provider and client is one of the most important elements for improving client satisfaction, compliance and health outcomes. - y) **Life-saving drugs** are drugs such as oxytocin, magnesium sulfate, antenatal steroids, and antibiotics, among other medicines used to prevent and manage pregnancy-related complications. - z) **Male responsibility** refers to the involvement, commitment, accountability and responsibility of males in all areas of sexual health and reproductive health, as well as the care of reproductive health concerns specific to men. - aa) **Management of abortion complications** refers to an initial assessment confirming the presence of complications, medical evaluations, counseling of the patient regarding medical condition and treatment plan, prompt referral and transfer if the patient requires treatment beyond the capability of the facility, stabilization of emergency conditions and treatment of any complications (both complications present before treatment and complications that occur during or after the treatment procedure), conduct of appropriate procedures, health education, and counseling on family planning, responsible parenthood, and prevention of future abortions, among others. - bb) **Marginalized** refers to the basic, disadvantaged, or vulnerable persons or groups who are mostly living in poverty and have little or no access to land and other resources, basic social and economic services such as health care, education, water and sanitation, employment and livelihood opportunities, housing, social security, physical infrastructure, and the justice system. - cc) **Maternal death** refers to the death of a woman while pregnant or within forty two (42) days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. - dd) **Maternal death review** refers to a qualitative and in-depth study of the medical and social causes of maternal death with the primary purpose of preventing future deaths through changes or additions to programs, plans and policies. - ee) **Maternal health** refers to the health of a woman of reproductive age including, but not limited to, during pregnancy, childbirth and the postpartum period. - ff) **Maternal health services** refer to a range of services that covers care during the periods that include, but are not limited to, antenatal, delivery, and postpartum periods. - gg) **Miscarriage** means any loss of pregnancy. - hh) **Modern methods of Family Planning (MFP)** refer to safe, effective, non-abortifacient and legal methods or health products, whether natural or artificial, that are registered with the Food and Drug Administration (as applicable) to plan pregnancy. Modern natural methods include Billings Ovulation or Cervical Mucus Method, Basal Body Temperature, Symptothermal Method, Standard Days Method, Lactational Amenorrhea Method, and any other method deemed to be safe, effective, and natural by the Department of Health (DOH). Modern artificial methods and/or health products include oral contraceptive pills, condoms, injectables, intrauterine devices (IUDs), No Scalpel Vasectomy (NSV), Bilateral Tubal Ligation (BTL), sub-dermal implants, and any other method deemed to be safe, and effective by the DOH. - ii) **National Household Targeting System for Poverty Reduction (NHTS-PR)** refers to an information management system that identifies who and where the poor are, with its implementation being spearheaded by the Department of Social Welfare and Development (DSWD). - jj) **Natural Family Planning (NFP)** refers to a variety of modern methods used to plan or prevent pregnancy based on identifying the woman's fertility cycle. - kk) **Natural Family Planning (NFP) Provider** refers to a person (skilled health professional or otherwise) trained to explain NFP and to coach/supervise NFP acceptors and users. The NFP provider should have successfully used the method herself/himself and should have had experience in supervising NFP acceptors and users. - 11) **No balance billing (NBB)** refers to a policy wherein no other out-of-pocket fees or expenses shall be charged to or paid by a PhilHealth-eligible individual/patient above and beyond prescribed PhilHealth benefit package rates. - mm) **Persons with Disabilities (PWDs)** refers to those who are suffering from restriction or different abilities, as a result of a mental, physical, or sensory impairment, to perform an activity in the manner or within the range considered normal for a human being as defined in Republic Act (RA) No. 7277 as amended by RA 9442, otherwise known as the "Magna Carta for Disabled Persons". - nn) **Poor** refers to members of households identified as poor through the NHTS-PR by the Department of Social Welfare and Development (DSWD) or any subsequent system used by the national government in identifying the poor. - 00) **Private Sector** refers to the key actor in the realm of the economy where the central social concern and process are the mutually beneficial production and distribution of goods and services to meet the physical needs of human beings. The private sector comprises private corporations, households, and non-profit institutions serving households. - pp) **Proscription of abortion** refers to the prohibition of the crime of abortion as defined in Articles 256, 257, 258 and 259 of the Revised Penal Code. - qq) **Public health care service provider** refers to: (1) public health care institution, which is duly licensed and accredited and devoted primarily to the maintenance and operation of facilities for health promotion, disease prevention, diagnosis, treatment and care of individuals suffering from illness, disease, injury, disability or deformity, or in need of obstetrical or other medical and nursing care; (2) public health care professional, who is a doctor of medicine, a nurse or a midwife; (3) public health worker engaged in the delivery of health care services; or (4) barangay health worker who has undergone training programs under any accredited government and NGO and who voluntarily renders primarily health care services in the community after having been accredited to function as such by the local health board in accordance with the guidelines promulgated by the Department of Health (DOH). - rr) **Reproductive Health (RH)** refers to the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. This implies that people are able to have a responsible, safe, consensual and satisfying sex life, that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. This further implies that women and men attain equal relationships in matters related to sexual relations and reproduction. - ss) **Reproductive health care** refers to the access to a full range of methods, facilities, services and supplies that contribute to reproductive health and well-being by addressing reproductive health-related problems. It also includes sexual health, the purpose of which is the enhancement of life and personal relations. The elements of reproductive health care include the following: - 1. Family planning information and services which shall include as a first priority making women of reproductive age fully aware of their respective cycles to make them aware of when fertilization is highly probable, as well as highly improbable. The provision of information on fertility cycles includes information on the full range of modern family planning methods; - 2. Maternal, infant and child health and nutrition, including breastfeeding; - 3. Proscription of abortion, and management of abortion complications; - 4. Adolescent and youth reproductive health guidance and counseling at the point of care; - 5. Prevention, treatment and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections (STIs); - 6. Elimination of violence against women and children and other forms of sexual and gender-based violence; - 7. Age- and development-appropriate education and counseling on sexuality and reproductive health; - 8. Treatment of breast and reproductive tract cancers and other gynecological conditions and disorders; - 9. Male responsibility and involvement and men's reproductive health; - 10. Prevention, treatment and management of infertility and sexual dysfunction; - 11. Age- and development- appropriate reproductive health education for adolescents in formal and non-formal educational settings; and - 12. Mental health aspect of reproductive health care. - tt) **Reproductive health care program** refers to the systematic and integrated provision of reproductive health care to all citizens prioritizing women, the poor, marginalized and those in vulnerable or crisis situations. - uu) **Reproductive health and sexuality education** refers to a lifelong learning process of providing and acquiring complete, accurate and relevant age- and development-appropriate information and education on reproductive health and sexuality through life skills education and other approaches. - vv) **Reproductive health rights** refers to the rights of individuals and couples, to decide freely and responsibly whether or not to have children; the number, spacing and timing of their children; to make other decisions concerning reproduction, free of discrimination, coercion and violence; to have the information and means to do so; and to attain the highest standard of sexual health and reproductive health: Provided, however, That reproductive health rights do not include abortion, and access to abortifacients. - ww) **Reproductive Tract Infection (RTI)** refers to sexually transmitted infections (STIs), and other types of infections affecting the reproductive system. - xx) **Responsible parenthood (RP)** refers to the will and ability of a parent to respond to the needs and aspirations of the family and children. It is likewise a shared responsibility between parents to determine and achieve the desired number of children, spacing and timing of their children according to their own family life aspirations, taking into account psychological preparedness, health status, sociocultural and economic concerns consistent with their religious convictions. - yy) **Serious case** refers to a condition of a patient characterized by gravity or danger wherein based on the objective findings of a prudent medical officer on duty for the day when left unattended to, may cause loss of life or cause permanent disability to the patient. - zz) **Service delivery network (SDN)** refers to the network of health facilities and providers within the province- or city-wide health systems, offering a core package of health care services in an integrated and coordinated manner. This is similar to the local health referral system as identified in the Local Government Code. - aaa) **Sexual health** refers to a state of physical, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrimination and violence. - bbb) **Sexually Transmitted Infection (STI)** refers to any infection that may be acquired or passed on through sexual contact. This type of infection may also be transmitted through the use of IV (sharing of intravenous drug needles, contaminated blood transfusions, among others), or vertically during childbirth and breastfeeding. - ccc) **Skilled birth attendance** refers to childbirth managed by a skilled health professional including the enabling conditions of necessary equipment and support of a functioning health system, including transport and referral facilities for emergency obstetric care. - ddd) **Skilled health professional** refers to a midwife, doctor, or nurse who has been educated and trained in the skills needed to manage normal and complicated pregnancies, childbirth and the immediate postnatal period, and in the identification, management, and referral of complications in women and newborns. - eee) **Social and Behavioral Change Communication (SBCC)** refers to an approach that looks at the role of communication in bringing about social change, including individual behaviors and social norms. SBCC utilizes a strategic mix of communication interventions using audience-appropriate interpersonal and mass media communication channels to engage individuals, families and communities to promote, stimulate, and sustain behavior change. - fff) **Stabilize** refers to the provision of necessary care until such time that the patient may be discharged or transferred to another hospital or clinic with a reasonable probability that no physical deterioration would result from or occur during such discharge or transfer. - ggg) **Sustainable human development** refers to bringing people, particularly the poor and vulnerable, to the center of development process, the central purpose of which is the creation of an enabling environment in which all can enjoy long, healthy and productive lives, done in the manner that promotes their rights and protects the life opportunities of future generations and the natural ecosystem on which all life depends. - hhh) **Unmet need for modern family planning** refers to the number of women who are fecund and sexually active but are not using any modern method of contraception, and report not wanting any more children or wanting to delay the birth of their next child. - iii) **Violence Against Women (VAW) or Gender-Based Violence (GBV)** refers to all forms of violence inflicted on women on account of their gender. In the broadest sense, it is a violation of a woman's personhood, mental or physical integrity or freedom of movement. More specifically, it refers to any act of gender-based violence that results, or is likely to result, in physical, sexual, or psychological harm or suffering to women including threats of such acts, coercion, or arbitrary deprivation of liberty, whether occurring in public or private life. - jjj) **Vulnerable** refers to households confronted by prospective risk that if currently non-poor, will fall below the poverty line, or if currently poor, will remain in poverty. It is also defined in terms of exposure to adverse shocks to welfare and not just in terms of exposure to poverty. - kkk) **Women And Children Protection Unit (WCPU)** refers to a unit composed of multi-disciplinary team of trained physicians, social workers, mental health professionals, and police providing comprehensive medical and psychological services to women and children who are victims of violence. ### CHAPTER 2 – Provision and Financing of Care #### RULE 4 - Service Delivery Standards - **Section 4.01 Service Delivery Standards**. This Rule shall describe the provision of information and services related to responsible parenthood and reproductive health. Existing DOH guidelines and program standards shall be reviewed and updated to be consistent with the RPRH Act and these Rules shall continue to be in effect. - **Section 4. 02 LGUs to Ensure Provision of Responsible Parenthood and Reproductive Health Care Services**. The LGUs, with assistance from the DOH, shall ensure the provision, at the appropriate level of care, of the full range of responsible parenthood and reproductive health care services, according to the definitions in Sections 3.01 (xx) and 3.01 (ss), respectively. - **Section 4.03 Availability of Information and Services in General**. All public health facilities shall provide full, age- and development-appropriate information on responsible parenthood and reproductive health care to all clients, regardless of age, sex, disability, marital status, or background. - **Section 4.04 Informed Choice and Voluntarism**. To ensure adherence to the principles of the RPRH Act and the delivery of quality reproductive health care services to voluntary recipients, the applicable provisions of DOH guidelines on Informed Choice and Voluntarism shall form part of these Rules. - **Section 4.05 Access to Family Planning**. All accredited public health facilities shall provide a full range of modern family planning methods, which shall also include medical consultations, supplies and necessary and reasonable procedures for poor and marginalized couples having infertility issues who desire to have children. - **Section 4.06 Access to Family Planning Information and Services**. No person shall be denied information and access to family planning services, whether natural or artificial: Provided, That minors will not be allowed access to modern methods of family planning without written consent from their parents or guardian/s except when the minor is already a parent or has had a miscarriage. - **Section 4.07 Access of Minors to Family Planning Services.**Any minor who consults at health care facilities shall be given age-appropriate counseling on responsible parenthood and reproductive health. Health care facilities shall dispense health products and perform procedures for family planning: Provided, That in public health facilities, any of the following conditions are met: - a) The minor presents written consent from a parent or guardian; or - b) The minor has had a previous pregnancy or is already a parent as proven by any one of the following circumstances, among others: - 1. Written documentation from a skilled health professional; - 2. Documentation through ancillary examinations such as ultrasound; - 3. Written manifestation from a guardian, local social welfare and development officer, local government official or local health volunteer; or - 4. Accompanied personally by a parent, grandparent, or guardian. - **Section 4.08 Care for Victim-Survivors of Gender-Based Violence.**Within sixty (60) days from the effectivity of these Rules, the DOH, in coordination with the DSWD, shall review and implement guidelines and standards for the care of victim-survivors of gender-based violence. - **Section 4.09 Sexual and Reproductive Health Programs for Persons with Disabilities (PWDs)**. The cities and municipalities shall ensure that barriers to reproductive health services for PWDs are obliterated by the following: - a) Providing physical access, and resolving transportation and proximity issues to clinics, hospitals and places where public health education is provided, contraceptives are sold or distributed or other places where reproductive health services are provided, pursuant to the standards