By Perla Aragon-Choudhury, Womens Feature Service
Mina was too poor to buy pills and too powerless to say no to her husband whenever he came home drunk. “I would always give in,” she said. “Otherwise, he might have created a scene and disturbed my employer, Ate Cris, who took us all in, including my son, when I applied as her helper.”
Mina eventually became pregnant but prioritised the schooling of her son over prenatal care. She got access to health care only in her seventh month and only when a neighbour referred her to the nearby Community Health Care Clinic of the Family Planning Organization of the Philippines. “The medical personnel there were really alarmed when they saw me,” recalled Mina.
When her time came, Mina was rushed to a nearby birthing clinic and she remembered that her employer had to pay for everything. But even before Mina could celebrate her daughter’s second birthday, she became pregnant again. The pregnancy forced her to quit her job and return to her hometown. She gave birth to her third child in the public ward of the district hospital.
Mina is just one of the poorest 35 per cent of Filipinas who make up 53 per cent of the unmet need for contraception, says Josefina Cabigon, Ph.D. of the University of the Philippines Population Institute (UPPI). A demographer, Cabigon collaborated in a research study with the Guttmacher Institute, a US-based organisation advancing sexual and reproductive health worldwide through research, policy analysis and public education.
For their research, the team used the Philippine 2000 census data; referred to the 2003 National Demographic and Health Survey (NDHS) as well as the costings from the Philippines Health Insurance Corporation for various years but mainly for 2008. Data from the Department of Health in the form of hospital reports on discharges for 1997-2002 was consulted to establish trends. A survey of health professionals, including those from non-government organisations was also undertaken.
Details of the study, entitled ‘Meeting Women’s Contraceptive Needs in the Philippines’, were presented earlier this year. According to Cabigon it revealed that in 2008 there were 3.4 million pregnancies in the Philippines, of which 1.8 million, or 54 per cent, were unintended. Of such unintended births, 1.2 million were mistimed or unwanted, and 560,000 were induced abortions. She also noted that in most regions, unmet need is concentrated among poor women and that it is highest (87 per cent) in the Autonomous Region of Muslim Mindanao (ARMM), which includes Basilan. In Eastern Visayas, which includes Eastern Samar, it is 78 per cent and in the National Capital Region, which includes Manila, it is 18 per cent.
At the Forum, Dr Junice Melgar, executive director of the women and health group Likhaan – one of the partner organisations of Guttmacher Institute in the study – spoke about the experiences of poor women from these places.
Not very far from Mina’s former place of employment – Quezon City – is Manila, where Mayor Alfredo Lim has not revoked an executive order of his predecessor that favoured natural family planning over artificial methods. Melgar cited a case from a study by Likhaan on the social impact of former Mayor Jose Atienza’s executive order: T.R., 39, has never used contraceptives and got pregnant. She and her baby almost died because of obstetric complications. She faced barriers to family planning in terms of poverty and the twin lack of a government programme and of funding for family planning.
Another resident interviewed by Likhaan for the study explained, “I want to use family planning to limit the number of my children. A mother is the one who has to search for food, school allowance and everything else, on top of doing the household chores. I feel sorry for my kids, I’m full of pity and can’t help crying when one of my children is sick and I can’t buy medicines.”
A third interviewee talked about domestic violence. “My husband and I would quarrel when I refused to have sex for fear of getting pregnant. He suspected me of having an affair and would hit me on the thighs. Then he left and didn’t communicate for a year. I went to my sister’s with my six children and supported them and myself by working as a laundrywoman,” narrated the young mother.
In Eastern Samar, Likhaan had a study on maternal health, which documented how B.L., 38, died of bleeding when she gave birth to her ninth living child, who had to be adopted by a neighbour when her husband could not take care of child.
“B.L was too poor to buy pills after getting an initial pack,” recalled Melgar. “Her family survives on slash-and-burn farming and lives an hour away from the barrio (village). The outreach of health services is poor where she lives.”
In a similar study in Mindanao, Likhaan saw obstetric complications in four women from Basilan, on an island 30 minutes away by boat from the nearest health centre. “Three are on-off users of contraceptives and one is a non-user,” said Melgar. “They have one to 12 children, what with inadequate supply of contraceptives. They have had ‘near-misses’ while giving birth. One had an inverted uterus, another had eclampsia and profuse bleeding, and the third had prolonged labour,” she revealed.
Study authors Jacqueline Darroch, Susheela Singh and Haley Ball – all of them attached to Guttmacher Institute – and Cabigon have calculated the funding required to provide modern contraception to all women who are at risk from unintended pregnancies in the country. They argue that the annual budget for family planning needs to increase from PhP 1.9 billion (US$1= PhP 48.13) to PhP 4 billion.
According to Cabigon, the amount is not prohibitive. She explained, “The medical costs linked with unintended pregnancy would fall from PhP 3.5 billion to PhP 600 million. Increasing investments in contraceptive supplies and services is especially critical to improving the health of poor women, who face the greatest barriers in achieving the family size they desire. Ensuring contraceptive access is not only wise fiscal policy but also has a profound effect in improving public health.”
Poor women will gain if donors and the Philippines government fund contraception concluded, the study argues. Sharon Camp, Ph.D., president and CEO of Guttmacher Institute, said, “The initial investment in contraceptive services of PhP 4 billion may seem great but there is a much higher cost associated with unintended pregnancies, including treating the consequences of unsafe abortion.”
People in the Philippines no longer get free or affordable contraceptives. It is to change this situation that councillors like Joseph Juico of Quezon City, who has braved threats of excommunication from the church, have pushed for the full range of contraception. Lawmakers like Edcel Lagman of Albay are also fighting for a national policy on reproductive health.
Concluded Melgar, “Why should government spend PhP4 billion for contraception? Because contraceptives prevent 20-35 per cent of maternal deaths (UNFPA). Because of social-economic benefits. Because it will take only 0.28 per cent of the PhP 1.4 trillion budget for 2009. Because it is the moral and ethical thing to do.”