MANILA, Philippines – “I want to be a scientist…” says Laura Jane Duran. Like most 15-year-olds, Duran dreams about what she would like to be when she grows up.

But Duran had to stop schooling when she got pregnant last year. Now, she lives with her husband, Jason, and his family in a shanty in Baseco, Tondo, Manila.

“I don’t know if I can still go back to school,” she says.

According to the National Demographic and Health Survey of 2008, in the Philippines, 10% of girls like Duran who are between the ages of 15-19, become pregnant with their first child.

Teen pregnancy rate is 53 births per 1,000 women between the ages of 15-19, the United Nations Population Fund (UNFPA) says in its 2011 annual report. 

The Philippines has the highest rate of teenage pregnancies among its neighbors and is well above the Asia Pacific average of 34 births per 1,000 women between the ages of 15-19.

Little or no knowledge

Prior to getting pregnant, Duran says she did not know anything about birth control.

Today, when it comes to birth spacing and family planning options, she defers to her husband. “He said I should just go on the pill,” she says.

When asked which birth control method she preferred, she was surprised by the question and the option it offered her. She had to think for a moment before answering, “I want to get injectables because they said that it’s easy and will last for months.”

It may not be easy for Duran and her husband to get injectables though.

In the city of Manila, they are not available for free and with Jason’s inconsistent employment as a laborer, injectables, which cost an average of P100 or more, would not be affordable to the couple.

According to the Guttmacher Institute, a US-based reproductive health research organization, contraceptive use has hardly increased in the Philippines over the past decade.

And as a result, women are having, on average, about one more child than they would like.  

According to the 2010 Guttmacher report, “Facts on Barriers to Contraceptive Use in the Philippines,”  the US Agency for International Development (USAID) was the largest contributor to Philippine public contraceptive services for several decades.

In a bid for contraceptive self-reliance, USAID began to phase out support in 2004 and ended in 2008. The withdrawal of all of USAID’s contraceptive support has forced women to buy contraceptives at local pharmacies and bear the cost themselves.

The higher cost is equated with reduced or zero access, especially among young women like Duran.  

No national legislation

In the absence of a national law to standardize and create universal access to reproductive health care services and appropriate budgets, local government units have drafted and implemented their own local policies.

In Manila, where Duran lives, an executive order banning contraceptives in the city of Manila was passed in 2000 by then Mayor Lito Atienza.

Atienza is also the former president of Pro-Life Philippines, a non-profit organization that promotes the exclusive use of natural birth control methods such as the rhythm method for family planning purposes.

The ordinance has long been a sore spot between the city of Manila and women’s and human rights groups who filed but lost a civil case versus Atienza. In addition, they have held dialogues with the Manila City Health Office and Lim, who succeeded Atienza.  

Last November 2011, there seemed to be a reprieve when the Manila City Health Office signed EO 30 entitled, “Further Strengthening Family Planning Services,” a copy of which was obtained by Rappler (see ordinance below).

It clearly says that birth control choices are left up to the couple, as responsible parents.

Reading from the ordinance, Dr Rolinda Gante, chief of reproductive health of the Manila City Health Department, says, “Family planning [FP] is left to be the choice of the couple and our doctors are allowed to counsel and give advice on all FP methods.”

“But we will not be able to give patients supplies [condoms, pills] because the City will not use its funds to procure these,” Gante explains.

However, the city will be open to receiving donations from the Department of Health (DOH) and other NGOs.

This, says Gante, is already an improvement from the previous administration.

“At least now we can accept donations. Under Atienza, everything [regarding modern contraception] was forbidden,” she says.

Support without funds

The ordinance has not satisified women’s rights groups.

“The repeal of Atienza’s EO 003 was the hope and the expectation. We were hoping for funding, for support and collaboration with the city government,” says Dr Junice Melgar, executive order of Likhaan Women’s Health.

“The cudgels of providing for RH services will again fall on the NGOs when it should also be the responsibility of the local government to fund these initiatives. How can you say you support something, but are not willing to fund it?” asks Melgar.

Gante admits that while the ordinance is already more lenient, it does poses limitations.

“Even if we will allow counseling on modern contraception and can give out condoms and pills—provided that they were not bought using city funds—currently, we don’t have supplies. There have been no donations yet,” says Gante.

Services like vasectomies and tubal ligation will also be difficult for Manila residents to avail of. According to Gante, the doctors who were trained to perform vasectomy are all set to retire. No new doctors were trained during the 9-year term of Atienza (1998-2007).

The same is true for tubal ligations. The procedure requires mini-labs as a sterile location. These mini-labs were closed during Atienza’s administration.

Other health services that Manila offers its constituents are for free, says Gante.

“We offer free hospitalization and birthing services in all 6 of our district hospitals. We offer free medicine at all of our health centers. The price of pills and condoms is minimal compared to that,” she explains.

Better than nothing

“It’s a start,” says Commission on Human Rights (CHR) chairperson Etta Rosales, who sees the new ordinance as positive.

“This new ordinance shows that Mayor Lim allowed the rectification of EO 003. From here, we can introduce rights-based approaches to primary health care and RH,” Rosales says.

“Once they [Manila City government] see that these services are beneficial to their constituents, then they may become more receptive to other RH programs,” says Rosales.

During dialogues between CHR, a reproductive rights and health organization based in the University of the Philippines in Manila, women’s groups and the Manila City Health officials and Lim, CHR and ReproCen submitted proposed amendments to the prohibitive EO 003.

Admitting that the new executive order is not exactly what they had proposed during their discussions, Beth Pangalangan of ReproCen says, “It has fallen short of our expectations, but it’s better than nothing.”

But Pangalangan is quick to point out that the new ordinance doesn’t mean that the civil case of Lourdes Osil, et al. vs Mayor of Manila, is now all but forgotten.

Pursue the case

On the contrary, the civil case filed by 20 respondents in 2008 contesting the constitutionality of EO 003 will still be pursued, albeit in another court. 

“The rights of our litigants were still violated. We have exhausted all domestic remedies,” says Pangalangan, referring to the appeal filed before the Supreme Court, which was dismissed in 2008.

“We will file the motion at CEDAW [Committee on the Elimination of Discrimination Against Women] International Tribunal. While there is no retribution to be expected, there will be a lot of international pressure on our government to see EO 003 as a clear violation of the international treaties that the Philippines is a signatory of.”

“We hope this action will also stress the importance of the RH Bill. If passed into law, it would provide for national legislation that would override inconsistencies in implementation of RH and family planning ordinances at the municipality level,” Pangalangan says.

Addressing inconsistencies in RH policies just might spell the difference between Laura Jane Duran and her neighbor, Rosalie Cabinyan, who, similar to Duran, had her first child at 16.

Cabinyan ended up having 22 children, when she wanted only 3. – Rappler.com