‘GMA used pills but bucks birth control’

( First of a series )

Two weeks ago, President Arroyo shocked pro-family planning legislators when she admitted to them that she had used contraceptives as a young mother.

The President, after all, is known as a devout Catholic who has defended the Catholic hierarchy’s position against artificial birth control. During the luncheon at Malacañang on Feb. 28, Mrs. Arroyo revealed that she went to confession after taking birth control pills, but the priest who heard her merely said, "It’s okay."

A member of Congress who was at the meeting recounted that the President told the story to make the point that legislators who were drafting a reproductive health bill that would make contraceptives available in government clinics had allies among the liberal clergy. But Mrs. Arroyo stopped short of endorsing artificial birth control and instead pushed for natural family planning, which is the method sanctioned by the Church.

"I guess at the back of our mind we were all thinking, ‘if you did it yourself, then why are you depriving women from having the same choices that you had’" said a legislator who was present at the luncheon.

Worried demographers and business groups blame precisely this inconsistency for the population time bomb that is the Philippines. They say the lack of a clear and consistent government policy lies at the root of our population woes.

Since the 1970s, high officials have chosen to follow the dictates of the Church on contraceptives, either because they could not resist the pressure or because of their own personal beliefs.

Mrs. Arroyo herself personifies this ambiguity: As an economist she knows that an exploding population puts undue stress on a weak economy, but as a Catholic whose rise to power was due in part to Church support, she is torn.

The result is that, unlike in other Southeast Asian countries, there is no coordinated government family planning program and today, not a single centavo of public funds is spent on artificial birth control.

Demographers and economists say that such a weak population policy has helped create a country with a big and permanent underclass. The World Bank estimates that of the 80 million Filipinos today, 40 percent are living on less than $1 a day.

Three years ago, the government’s own Population Commission (Popcom) had already warned, "Larger families among the poor make it more difficult for them to break out of poverty."

Demographers say more births are occurring in places that can afford them the least – in poor, rural areas and in communities like Paradise in the innards of Malabon, a teeming city in Metro Manila’s northern fringe.

Magdalena Bacalando, a resident of Paradise since 1986 and an 11-year veteran health worker at Mothers, an NGO providing birth control and counseling, has seen it all – from teenage mothers to women who have given birth to more than a dozen children each, not counting several miscarriages.

Bacalando recalls the case of Claudia, who wept when told at the clinic last month that she was expecting another child. Already a mother of a four-month-old boy, Claudia (not her real name) had intended to get started on birth control pills when she visited the Mothers clinic in a cramped urban poor community in Tonsuya, Malabon.

Her live-in partner had frowned on her taking any contraceptives, but she had lied to him, telling him their son was due for a check-up, so that she could go to the clinic.

Claudia had talked of going back to school. She was, after all, only 14. She was 13 and still in fifth grade when she had to stop studying to become mother to her first child and common-law wife to a 22-year-old junkyard worker. But now she was pregnant again, and her education would have to take the backseat once more. If she and her partner fail to break the pattern set by most families in Paradise, where the average number of children per family is five to six, Claudia may never go back to school.

Claudia, of course, is hardly the first woman to be in such a dilemma. In this 14th most populous country in the world, a myriad of socio-economic and cultural factors has ensured that each year, hundreds of thousands of women bear children they had not planned for and are most probably not ready to raise.

According to the United States Agency for International Development (USAID), 45 percent of all pregnancies in the Philippines are "unwanted or mistimed." This is manifested, says the USAID, in the country’s high abortion rate of more than 400,000 each year or about 16 per 100 pregnancies. Most of these clandestine abortions occur in large, poor households and involve 20- to 29-year-old women.

The 1998 National Demographic and Health Survey (NDHS), meanwhile, said that about 20 percent of married Filipino women "do not want any more children or want to wait at least until two years before having another child." At the time of the survey, however, these same women were not using any family planning method. Said the NDHS: "(This) translates to about 1.9 million women who have an unmet need for family planning. They have one more child than they intended to have."

But the Catholic Church and some religious groups do not subscribe to the idea of an "unmet need" and instead blame moral decay and the "proliferation of contraceptives" for promiscuity, abortions and illegitimate births. They also say that injustice and inequality rather than population are responsible for hunger in larger, poor families.

Old rhythm

According to Catholic doctrine, the sexual act should always be for the purpose of procreation and should take place only in the context of marriage. For those who need to keep family size small, the Church recommends only one method: natural family planning (NFP), because it "recognizes the sanctity of marriage and respect of life."

Moreover, say Catholic and pro-life groups, NFP helps couples develop such traits as patience, self-control and responsibility.

NFP requires a woman to tell when she is fertile. She does this by recording her body temperature when she wakes up, how long her menstrual cycle lasts and her cervical secretions. For the NFP to work, both partners must follow the recording process religiously and avoid intercourse during the woman’s fertile period.

Health experts say the NFP has the following advantages: No chemical agents or physical devices are used, there are no physical side effects, women become more aware of their fertility and use this awareness to either plan or avoid a pregnancy, it involves no expense on the part of couples, and it is acceptable to all faiths. It also has an effectiveness rate of 98 to 99 percent.

Even the USAID says that it is an attractive option. But Jed Meline, deputy chief of the USAID’s office of Population, Health and Nutrition, also says, "It is not an easy method to teach."

Meline says it takes a lot of discipline for couples who will need to control their sexual urges – for as long as 11 straight days in 23-day cycle. Health experts note as well its other disadvantages, which include the keeping of daily records, the length of time to learn it effectively (three to six cycles), and its inability to protect partners against sexually transmitted diseases.

Dr. Alberto Romualdez, who was health secretary in the Estrada administration, and Popcom executive director Tomas Osias both say that a population policy that is dependent on the NFP is not practical in a poor country like the Philippine because it is costly. Says Osias: "It’s all direct communication and training."

Romualdez adds that the NFP often fails with the poor because "they don’t have the luxury of planning the satisfaction of their biological need." Besides, he says, "you have many other things to do besides record your fertility. You have to think about food and so forth. Pag-aawayan mo pa ba ’yan (Are you still going to fight about that).’"

To Romualdez and population experts, the Philippines needs a population program that offers contraceptives. Gripes Romualdez: "You just can’t exclude contraceptives because the Church says so. That’s the worst part, being dictated by people who were never elected, never had the experience. They’re incompetent to make that decision."

Yet a study on Philippine population policies from 1969 to 2002 shows that is what has happened for most of the last three decades. According to the study’s author, Professor Alex Herrin of the UP School of Economics, the "persistent and consistent opposition of the Catholic Church hierarchy to the government population policy of reducing population growth as well as the promotion of artificial family planning methods" is the "single most important factor influencing population policy-making" in the last three decades."

In 1969, then President Ferdinand Marcos embarked on a policy to regulate population growth and reduce fertility rate with the goal of achieving economic development. A "clinic-based and contraceptive-oriented approach" was used. But even then, says Herrin, the program had its ups and downs as officials grappled with their Catholic consciences.

Marcos created the Popcom and appointed his National Economic and Development Authority (NEDA) chief Gerardo Sicat to head it. But Sicat was eventually replaced by Placido Mapa, who was a member of the ultraconservative Catholic group Opus Dei.

"During the brief period of time that Mapa was chairman of Popcom and theoretically in charge of population, support for the family planning program waned," says Romualdez. "His conscience did not allow him to advocate a government policy that would include the distribution of supplies for birth control."

Later, leadership of Popcom sifted to the Department of Social Welfare and Development, then headed by Sylvia Montes, who maintained a moderate family planning program.

When Corazon Aquino became president, her pro-Church stance on family planning was reflected in her choice of Dr. Mita Pardo de Tavera, a devout Catholic, as the DSWD secretary and Popcom head.

Herrin also observes, "In response to criticism – coming mainly from the Church – that the program was preoccupied with demographic targets, the government shifted emphasis to family welfare and development. While there was a strong fertility reduction objective during the Marcos era, there was none during the Aquino administration."

The policy shift was reflected in the Aquino government’s budget. From P120 million in 1983, the Popcom budget plunged to P56.8 million by the time Aquino left Malacañang in 1992. That budget went mainly to employees’ salaries. Herrin says that from 1986 to 1988, there was a "de facto squeeze on public spending on family planning services."

Romualdez says that then health secretary Alfredo Bengzon tried to re-establish a strong family program in 1989 but under tight time constraints. By then, Bengzon had less than two years left to his term and was also very busy with the RP-US bases talks.

The population program under the Ramos administration fared a little better despite the strong opposition of the Church. Herrin says the program even underwent a "redefinition from population control to population management."

Fidel Ramos, a Protestant, appointed Dr. Juan Flavier, a family planning advocate, to the Department of Health (DOH). Flavier managed to set aside some money for the purchase of birth control pills and other contraceptives. He even launched an anti-AIDS campaign that heavily featured condoms, which had Church leaders up in arms.

Ramos, however, "didn’t make any strong pronouncements (on family planning)," says Romualdez. "He didn’t go out of his way to antagonize the Church. He basically relied on his Cabinet to shield him from controversy."

Joseph Estrada apparently adopted the same "hands-off" tactic when he succeeded Ramos in July 1998, having no desire as well to upset the Church. But by leaving it up to his Cabinet secretaries to craft policies, Estrada almost became the first president to allocate a big amount for contraceptives.

Aborted purchase

Romualdez says that shortly before it was ousted in January 2001, the Estrada government had made a commitment to purchase P70 million worth of contraceptives in response to the USAID’s decision to scale down and eventually end its contraceptives donations. At the time, Romualdez says, "we were targeting reducing fertility rate from 3.7 to 2.1 by 2004" – a rate demographers had recommended to achieve zero population growth. Such a target could be met only by increasing contraceptive use.

But Estrada was ousted before the contract was signed. Current Health Secretary Manuel Dayrit says that the Arroyo government decided not to go through with the purchase because the President "did not want her administration to be identified with contraceptives."

He confirms that the government has no intention to buy contraceptives since, he reasons, there is "no shortage" because "the USAID will continue to donate." Dayrit also says this is why the government did not use the P100-million congressional insertion requested by Flavier in last year‘s budget for the purchase of contraceptives.

Yet Dayrit denies that the Arroyo administration has pushed the NFP to the detriment of other birth control choices. He says that the President has even risked the Church’s ire by using the terms "responsible parenthood" and "informed choices."

"When you say responsible parenthood, that is really aspirational," says Dayrit. "It says think about your family, the number of children you can afford to bring into this world, the quality of life and practice it." But, he also says, "it is silent on artificial contraceptives."

Last week, Dayrit announced that the government was discontinuing the promotion of the IUD, which it has classified as an abortifacient. (To be continued)