Manila women to fight ban on contraceptives

Lourdes Esplana-Osil has seven children, all born within a space of 12 years. Warned by her doctor of complications from repeated pregnancies, she started using injectable contraceptives provided free at a local government health center. But in 1998, the center stopped providing contraceptives. Since she could not afford to buy them -- her husband, a pedicab (a bicycle rickshaw) driver, earns very little -- and because natural family planning methods failed, she had several unwanted pregnancies before she found a non-government organization (NGO) that gave her free contraceptives. Osil is just one of the many women residents of Manila who were deprived of access to artificial contraceptive methods when Joselito Atienza became city mayor in 1998. In line with his Roman Catholic beliefs, Atienza issued an executive order promoting "responsible parenthood" and upholding natural family planning methods, while discouraging artificial contraceptive methods like condoms, pills, intrauterine devices and surgical sterilization. Atienza was mayor for nine consecutive years until he reached his term limit last June. His executive order, signed in 2000, is still in effect. According to a study, Atienza's order, which was adopted by all health centers and hospitals run by the city government, contributed to high rates of unplanned pregnancies, with their attendant socio-economic and health consequences. Its vague wording also led some health facilities and providers to withhold information on where women could get artificial contraceptives. Some NGOs and private providers of family planning services "felt the chilling effects" of the policy and were even harassed, said the study 'Imposing Misery: The Impact of Manila's Contraception Ban on Women and Families', released by the voluntary agencies Likhaan, ReproCen and the Center for Reproductive Rights. Dr. Junice Melgar of Likhaan (Linangan ng Kababaihan Inc or Centre for Women's Development) said a group of at least 10 women like Osil is contemplating filing a civil case against Atienza for emotional and health damages inflicted on them through the executive order. Melgar said there is also a plan to challenge the legality of the order. She explained that efforts to file a legal case started as early as 2004, but the complainants were hesitant to come forward because they were "awfully scared" of the consequences. She said the women were afraid Atienza might take away their housing. She said the incumbent mayor, Alfredo Lim, has indicated his willingness to make available artificial family planning methods in city-run health centers and hospitals. She said that in a dialogue last August reproductive health advocates also asked Lim to revoke Atienza's executive order. The problem, however, is that while Lim is more open-minded to artificial contraceptive methods, it will take some time before the city can actually provide the services. Melgar said there are no contraceptives in health centers in the city because no budget had been provided for them when Atienza was mayor. There is also a need to train health workers again who have not practiced family planning counseling and advocacy for nine years. Dr. Jonathan Flavier of the Cooperative Movement for Encouraging NSV (no-scalpel vasectomy) estimated that it would cost the city about one million pesos (22,000 US dollars) per quarter to restore the supply of contraceptives and to train service providers. He said the funds could be sourced from NGOs in the meantime while the city government sorts out the necessary changes in its budget. Flavier did a comparative study of live births and maternal deaths in Manila and Quezon City to see the effects of Atienza's ban on artificial contraception. The two cities are quite similar economically, but both artificial and natural family planning methods are allowed in Quezon City. Flavier compared data from 1996 to 2006 and found that there was an increase in maternal deaths in Manila. This backs the observation in the 'Imposing Misery' study that women in Manila are at an increased risk of maternal mortality because they have limited access to affordable reproductive health services, and thus have unintended pregnancies and are also susceptible to induced illegal and unsafe abortions. Flavier also looked at admissions at local government-run hospitals in Manila and Quezon City and, based on anecdotal reports, found that there seemed to be an increase in abortion cases in Manila. The Philippine population -- 84 million, according to government figures -- is one of the fastest growing in the world. About 70 percent of the people rely on the government for family planning services, but some public officials like President Gloria Arroyo and Atienza have made it clear that their priority is the promotion of natural family planning methods acceptable to the Roman Catholic Church. For the women of Manila, many of whom live in poverty, going to a private family planning service provider or buying their own contraceptives to fill the gap is out of the question. "The financial burden would just be too much," said Melgar of the women who were affected by Atienza's policy. "It's like asking them to sacrifice the rice their family has to eat for the contraceptives they have to buy." One woman who was interviewed for the Imposing Misery study said she could barely afford to fork out 35 pesos (77 cents) for her monthly pack of contraceptive pills. "I try to save whenever I have extra money. Sometimes when I don't have extra money, I would go around and borrow 10 pesos from each neighbor until I come up with the amount needed to buy the pills," she said. Dr. Alberto Romualdez, a former health secretary, finds the situation unacceptable. "This is something that should not happen again," he said, pointing out that it was the women who suffered the most. "Withholding (family planning) services is not only neglect, it is criminal,'' said Romualdez. "The failure to give (family planning) advice and service is a form of coercion."