Church’s gain in population policy is women’s loss

(Last of Two Parts)

DATU PAGLAS, Maguindanao – Prayers echo from the minaret of a mosque through a vast banana plantation. Owned by a company called La Frutera, the 1,000-hectare land used to be a “killing field.” At the time, men in the area wound up either as members of secessionist groups or in the middle of a “rido” or clan war.

But since 1997, when La Frutera set up shop in this town, men have ditched their guns to help grow the Cavendish bananas the firm exports. Benefiting from the peace that has taken over the land, many of them now own houses, and most of those houses have TV sets. Those among the men who are married also practice family planning.

“Parang tao rin ang saging, pag masyadong marami, maliliit lang ang bunga (Bananas are like people, when there’s too much, the fruits are tiny),” says a farm supervisor, in explaining why they limit the number of “hands” in each plant.

La Frutera runs a family planning-education program for its 2,000 employees, 95 percent of whom are Muslim men. As a result, the community it calls home has become a pocket of hope in Maguindanao, which is one of the country’s poorest provinces and where many girls are still being married off at an early age and giving birth at home. In 2005, the United Nations Children’s Fund (UNICEF) placed the province’s maternal mortality rate at 300 per 100,000 births.

In Muslim Mindanao, family planning was endorsed by the Assembly of Darul Iftah (Religious Leaders Assembly) on Nov. 23, 2003. The assembly produced a document that said, “Islam has encouraged its people to increase and populate the earth with the proviso that their quality should not be compromised.” Stressing the principle of non-coercion, responsible parenthood, and informed choice, the assembly adopted family planning as a method to birth spacing. It also endorsed all methods of contraception.

Muslims make up five to nine percent of the Philippines’ population of about 88.7 million people, who are all covered by a Constitution that guarantees freedom of faith and the separation of church and state, among other things. But since 2002, Filipinos of all faiths have been subjected to a national family planning policy that pushes only natural methods – a policy that echoes the beliefs espoused by the Roman Catholic Church, which claims some 80 percent of the country’s population as its followers.

The government, of course, stresses that those who want to use artificial contraceptives are free to do so. Health Secretary Francisco Duque says, though, that it is up to local government units to procure such supplies for their constituents. Those who are short on funds “can go to the USAID (US Agency for International Development),” which, he says, has a supply that is “good up to the end of 2008.”

The USAID has been providing contraceptive supplies to the Philippines since the 1970s. But it has been scaling down its donation in recent years; and by the end of next year, it will shut down the program completely. A recent study by the United Nations Population Fund (UNFPA) estimates that the country needs at least $2 million a year to fund its contraceptives requirement to plug the vacuum the USAID would leave behind.

For sure, some local government officials, especially those in the poorest regions, know they need to provide their constituents a good range of family planning methods. But many of them apparently do not have enough resources. Dr. Junice Melgar, head of the non-governmental organization (NGO) Linangan ng Kababaihan or Likhaan, says that in one forum, a provincial governor complained about the DOH’s lack of support in this arena. The DOH officials present, however, could only repeat Malacañang’s line of giving natural family planning a chance.

This, say observers, has been a tremendous setback for the poorest provinces mostly in the Autonomous Region in Muslim Mindanao, where the highest “unmet needs” in family planning have been recorded.

Mary Catherine Sumapal, who mans La Frutera’s health clinic, recalls that when Datu Paglas was a killing field, girls would usually be married off by the time they were 13. They would then proceed to have children almost every year. “It was common then to see ‘do-re-mi’ children,” she says.

But now Sumapal says that with the Muslim religious leaders’ edict and La Frutera’s family planning program, which was launched early this year, there is at least a bigger chance for their workers to have planned pregnancies. In fact, the program’s first year supply of contraceptives worth P200,000 is now in the pipeline.

Rose Sira, La Frutera’s personnel department head, says the family planning program will help ensure that each farm worker’s child has health coverage. The company’s health service covers a maximum number of four children per worker. Sira adds, “The workers know that if they just keep on having wives or children, and they get sick, they spend a lot of time away from work, and they lose income.” 

In a sense, La Frutera itself is already the most effective family planning tool in the province. As more heads of the family and young people begin to have financial independence, many are reluctant to be weighed down by raising a big family; young people delay marriage in favor of an education and a career.

Nevertheless, Ustadz Abdulwahid Sumaoang still counsels farm workers on family planning, especially the men, who have grown accustomed to a culture of having more than two or three wives, with their number of children often unplanned. He often tells them, “If you are God-fearing, you will plan your family.”

A Muslim professor, Sumaoang has been La Frutera’s values consultant since 2003. He says that he often had to mediate in couples’ fights, mostly because the men did not secure their wives’ permission before getting a second or third wife, as stated in the Holy Qur’an. Some also strayed from the Islamic ideals of choosing “widows and orphans” as second or third wife. “They have forgotten that it is a responsibility, an effort to provide sustenance to a disadvantaged woman,” he says.

Sumaoang says that Muslims also place emphasis on natural family planning. But he says that since this method is not 100-percent foolproof, they have made artificial contraceptives available should couples have the need for it.

La Frutera clinic’s records show that two percent of its clients have chosen natural family planning. The rest rely on artificial methods.

Attitude planning

This may well reflect the general attitude toward family planning nationwide. In a Pulse Asia survey conducted just before the May 14 polls, 92 percent of the respondents said it is important to control and plan one’s family. Nearly nine in 10 also said the government should allocate funds for family planning measures other than natural methods.

But advocates of natural family planning have become stronger in recent years, having clinched seats in various levels in government since Gloria Macapagal Arroyo became president. Recently, their influence has been felt even in schools like the Ateneo de Manila University, which is run by the Jesuits, who are considered to be mavericks among the Catholic orders. 

This year, the Ateneo would have offered an MBA in Health, with emphasis on strategic population research management. But pro-life and several similarly aligned groups protested, saying that “as a Catholic university, the Ateneo should not be receiving funding support from an organization that openly espouses abortion, population control, and reproductive health.” Ateneo has dropped the course.

Dr. Napoleon Juanillo, program director of Ateneo’s Leadership and Managerial Excellence in Health Systems, says that being a “transplant” from Cornell University, he was surprised at the level of discourse on the issue of population in the country. “It’s pushing us back to the medieval period,” he says. “It is an affront to science, and on the rights of women.”

He says the course, which was to receive a $250,000 funding from the David and Lucile Packard Foundation, would have elevated the discourse on population management to a “more intelligent, scientific level.” Yet while he expresses disappointment over the scrapping of the course, Juanillo says he takes his hat off to the Catholic Church and pro-life groups like the Alliance for the Family Foundation Inc. (ALFI) for having “a good war tactic.”

ALFI wrote letters to Ateneo officials and demanded that the course be pulled out. Says Juanillo: “They merely did what they had to do, since it is part of their advocacy.”

He admits that the university was unprepared for the negative reaction to the course. In the end, he says, the university was left all alone carrying the flag. He says NGOs should have backed the school, adding, “This is a wake-up call to the RH (reproductive health) groups. They should fight and join the sphere. The NGOs did not do their job.”

Pro-life Manila

That may be because they were busy trying to convince local and national officials to fund family planning measures other than the natural methods. As some NGO workers tell it, they would rather not have a repeat of what happened to Manila under Mayor Joselito “Lito” Atienza, who ended a nine-year run in City Hall just recently and is now the environment secretary.

Atienza banned contraceptives in Manila from 2000 to May 2007. Women interviewed earlier this year by Likhaan, the Reproductive Health, Rights and Ethics Center for Studies and Training (ReproCen), and Center for Reproductive Rights told tales of financial, physical, and emotional difficulties when contraceptives totally disappeared from Manila’s health centers. 

Some of the 67 women interviewed for the NGOs’ study said they wanted to have two to three children, but ended up with more than double their ideal number of offspring when contraceptives and ligation at government-funded facilities were banned. All of them belonged to the poorest bracket of society, where a P35 packet of pills is an unbearable monthly burden.

One 32-year-old mother of seven said she had wanted just three children. She wanted to be ligated after her fifth pregnancy. But the public hospital she went to would not perform the procedure, citing Atienza’s Executive Order 003, which was already in effect. In language, that EO pushed for natural family planning, but in practice, it worked against any artificial method.

Then there was a 36-year-old mother of eight who had dreamed of having only two children. She said that she was unable to get her regular supply of pills. She wanted to undergo tubal ligation after her fourth child, but the public hospital near her home no longer offered the service. By then, she said, her family’s daily meals were already consisting of just three sachets of coffee and a few pieces of pan de sal for breakfast, rice and soy sauce for lunch, and bread for dinner.

Officials of the Dr. Jose Fabella Memorial Hospital also observed many high-risk cases among women patients, because of “anemia, too-frequent deliveries, very short spacing, and sometimes no spacing at all,” said the NGOs’ study.

An official at another government hospital told the NGO interviewers that the ban resulted in many unwanted pregnancies, prompting a greater “tendency to have an abortion.” One hospital director, in fact, said that abortion complications, including deaths, were “the second largest cause of admissions in his hospital, and a leading cause (of admission) in most hospitals.”

Other women interviewed post-Atienza told of marital spats, physical and verbal abuse, and being abandoned by their partner because of their refusal to have sex to avoid getting pregnant.

Government health workers agree with those from NGOs that Atienza’s EO 003 should be revoked. But they say that with the national government policy on family planning similar to Atienza’s, a legal victory is unlikely.

Indeed, Jose Sandejas, President Arroyo’s consultant on family matters, downplays the report by Likhaan and company. “There are studies by people who have an agenda to push,” he says, “so you really have to look at who funded it.”

He adds that there are groups in Manila’s slums promoting natural family planning “and they will be the ones to tell you most men are responsible, even in the slums.” He argues that the urban population growth will go down even without contraception. Urbanization, he says, will leave couples naturally wanting smaller families because of the higher cost of living, as compared to living in the provinces. 

Sandejas, however, would rather focus on the positive effects of keeping the population growth robust even though 2006 figures show this may be causing a downtrend in major education indicators like elementary enrollment and survival rate in schools.

“Even if you are not able to educate them as well you would like,” he says, “in the end their capability to quickly learn skills in the health services, in construction, as seamen, is going to save the Philippines.” Sandejas says that even the current generation, “where we have low levels of education, our overseas Filipino workers are saving us at this time.”

It’s a line that could well upset people like medical anthropologist Michael Tan, who writes a column for the Philippine Daily Inquirer. In a 2003 column on Arroyo’s policies, he observed the president, being an economist, should know better than “arguing that a large population is good for the economy because it means more consumers, more business, even more workers to export.”

“There is just no way government or the private sector can cope with the demands for jobs, housing, health, education and other social services, not with the present rate of population growth,” Tan added. “As for exporting Filipinos as caregivers to the world, I find it terribly immoral that we can think of producing children mainly because we see them as possible exports to bring in dollars later, even as we export their parents today.”

Interestingly, Arroyo’s stance is nowhere near that of Ed Panlilio, a Catholic priest who is the new governor of the president’s home province, Pampanga. According to Panlilio, he will pursue the family planning program already in place at the capitol, and that includes providing artificial contraceptives to those who ask for it.

“As governor and a public official,” he says, “the reality is I cannot impose my Catholic stand on the issue. Otherwise, I will be violating the human rights of my constituents.”

Panlilio says he will ask health workers to offer the whole range of family planning options to couples so they can practice a method based on the dictates of their conscience. He admits this may make him a target of attacks by Catholic hardliners. But he says he is confident Church leaders will understand the position he has taken.

“Nobody should dictate the choices couples should take,” says Panlilio, “not even the Pope, not even the president.”