Social consensus needed to reduce RP’s population growth

(Third of a series)

PARADISE, Malabon — Fourteen-year-old Claudia said she had urged her common-law husband to use condoms, but he refused, arguing that it was just going to get torn anyway. Instead, she told health worker Magdalena Bacalando, they used toothpaste, which the couple mistakenly believed would work as a spermicide. Now Claudia is three months pregnant with her second child and seems confused what to do next.

Some women’s rights groups agree with religious organizations that "family planning is not about flooding the market with contraceptives" but also entails an education process and efforts to bring about changes in attitude. These in turn mean a multisectoral approach — which, along with clear direction, seems to be lacking in the Arroyo government’s population policy.

Last Saturday, the President launched her family planning slogan, "Birth Spacing through Billings, Body Signs and Basal Temperature," or "BBBB," which only confirms that her administration is making natural family planning the cornerstone of its population program.

But economist and population expert Alex Herrin describes Mrs. Arroyo’s population policy as "ambiguous" at best, since she seems to equate the official push for natural family planning with "informed choice."

He also points out that Mrs. Arroyo has previously issued conflicting statements on population — first adopting the Roman Catholic Church’s position that population was not a problem and then stating earlier this year that there is a link between poverty and population.

Herrin notes that the present administration’s family planning approach is similar to that of the Aquino government, which saw the issue primarily as a health intervention and as a means to help couples achieve their fertility preference.

"This," he says, "does not necessarily reduce population growth."

Population growth in the Philippines has declined from 2.7 percent in the 1970s to 2.3 percent. But experts say that is nothing to crow about, especially when compared to Thailand, which had almost the same population growth rate in the 1970s, yet is now averaging an annual rise of less than one percent.

Come together

Experts agree that while solutions to population challenges are unique to each country, the ability of key sectors in society to come together is a crucial factor in the success of a population program.

A 2002 study on the changing Asian population, by the Hawaii-based East-West Center, cites the common factors that made the population programs of Thailand and Indonesia work.

One was that key political and religious leaders all agreed on the importance of slowing population growth. "Neither religious leaders nor other politically powerful groups mounted a strong opposition to the programs," notes the study. "Even in Indonesia, the largest Islamic nation in the world, religious leaders did not actively oppose President Suharto’s decision to promote family planning."

Both governments also adopted national development plans with specific growth reduction rates. Another factor was that "they initiated public campaigns to persuade couples of the benefits of small families and started education programs in communities and schools to inform the citizens about modern contraceptive methods."

Also, says the study, "family planning clinics and distribution systems, many heavily subsidized, were established to increase the availability of contraceptive methods and services."

The last two factors are present in the Philippines but only on a small scale. This is because much of the work is being done by civil society rather than by the government itself.

The 1994 Local Government Code devolved many of the national government’s roles, including the delivery of family planning and reproductive health services to local governments. This has worked both for and against family planning.

Devolution allows local governments to purchase contraceptives if they wish and to run any family planning program they want to as long as it is legally and socially acceptable, points out Health Secretary Manuel Dayrit.

But devolution has also allowed some local governments, like those of Manila and Bukidnon, to adopt a no-contraceptive policy. Women’s rights groups have denounced this move as unconstitutional but Population Commission (Popcom) executive director Tomas Osias says this is a gray area.

In any case, the clientele of government health centers — the poor — seem to prefer going to those run by NGOs anyway.

NGO workers, however, can only do so much. NGOs like Mothers also rely heavily on free contraceptives that they get from the government health centers — which for now are getting them as donations from the United States Agency for International Development (USAID).

At present, the Mothers clinic is still receiving an allocation of 200 pills of Logentrol per month. But the USAID is scaling down its donation of contraceptives beginning this year, and Bacalando is already worrying that their supply will run out.

The Mothers clinic sells Trust pills as an alternative to Logentrol. Bacalando, however, says few can afford to buy these. After all, she notes, the cost of P17 per cycle is equivalent to a kilo of rice.

Sterilization is not a desired option for the poor because of the cost — clinics do not perform them and clients are referred to the provincial or city hospital where the cost is at a prohibitive P300.

Although Philhealth, the government insurance system, covers sterilization, this medical insurance is often not available to the poorest of the poor.

Bacalando, however, says that aside from pills, injectibles are also popular even if they cost P30 at the clinic because they are good for three months and can be administered to wives without their husbands’ knowledge. (To be continued)