Arroyo’s legacy may include more mothers put at risk

First of two parts

UBAY, BOHOL — Antonia Quirino sits with a dazed look on top of the stairs of her bamboo house amid a large swath of cornfield. She speaks laconically, as if every word is a labor. Filth surrounds her; debris of past meals remain on the dirty kitchen and table, the clotheslines display tiny clothes too grimy and stained to be considered ready for wear. Nearby, a few of her children sleep the day away.

At 40, Quirino is a mother of 10 children, and is four months away from giving birth to her 11th. She delivers at home and has known no prenatal or postnatal care, yet her nipa hut is just a few meters off the main road that leads to Bohol’s tourist-drawing resorts. She is a mother at risk, but she is below the radar of the government, which has sworn off providing free contraceptives, and which does not encourage information about their use.

About a 90-minute plane ride away, in Malacañang, sits a woman whose family planning policy, many say, has directly or indirectly consigned Quirino to her fate.

IT’S rice porridge for lunch for Antonia Quirino and
her young brood.
[photo by Jaileen Jimeno]

When she first took power in 2001, President Gloria Macapagal Arroyo initially issued confusing statements on her family planning policy. She once admitted using pills in her early years as a mother and wife, but said that as a Roman Catholic, it made her go to confession. In 2002, in an apparent effort to woo the Church, which supported her predecessor’s ouster, she ruled out the purchase of contraceptive materials and tossed the responsibility of buying these supplies to local governments. She has since fortified that policy to placate the Church as her government battled numerous threats to its survival. It has also resulted to the undue delegation of official power and handing over of state funds to a private group allied with the Church.

Government health workers and nongovernmental organizations (NGOs) exposed to the realities in the field say Arroyo’s position has deadly effects on numerous fronts. They say it keeps the poorest women uninformed of all the options available to them to limit or space their children. It deprives women of the free contraceptive materials previously available to them in barangay health centers. Worse, private groups like Couples for Christ (CFC), using government funds, preached against artificial contraception. This has prompted a longtime government health expert, who spoke on condition of anonymity, to warn of a rise in abortion rates because of the dearth of contraceptives, formerly available but now absent, in health centers.

“When the census numbers are out next year, this government will be shocked by the high incidence of abortion,” says the government health official. The same official is aghast at how women’s health is being regarded as just another political issue.

Dr. Junice Melgar, head of the NGO Linangan ng Kababaihan or Likhaan, also says that women’s health is now being sacrificed for political expediency. “This is her legacy,” she says, referring to President Arroyo. “Women will remember her harshly for this. This is a woman who has been very unkind. She is pushing women into unsafe pregnancies, and probably even death.”

In a paper that reported the effects of the contraceptive ban in the city of Manila, Likhaan noted that Arroyo “is the first president since 1969 to weld its policies not to medical standards, but to the moral standards of the (Roman) Catholic Church.” (See sidebar) Melgar also asserts, “The major battle is the president herself. It’s not just the Church, but the president’s own attitude toward women.”

Rise in unintended pregnancies

A 2006 study done by Josefina Cabigon of the University of the Philippines Population Institute (UPPI) and five other experts at the Alan Guttmacher Institute, an international NGO that focuses on sexual and reproductive rights worldwide, says that six in 10 Filipino women had an unintended pregnancy at some point in their lives because of lack of access to and knowledge of modern contraceptives. That fraction, says the study, translates to some 1.43 million unintended pregnancies each year, a third of which end in abortion.

It also says that while the women who had abortion come from all classes, the majority are “married, poor, and Catholic.” The study adds that poor women tend to use unsafe methods because they cannot afford safe procedures by trained providers. These unsafe methods include massage, insertion of a catheter, and the use of Misoprostol, which is prescribed by doctors to treat gastric ulcers. Eight of 10 of the women who use such methods suffer complications, says the study.

A July 2007 World Bank report on population issues also says that the main reason women in developing countries like the Philippines seek abortion is “often due to difficulties in obtaining access to an appropriate method of contraception, incorrect or inconsistent use of contraceptive methods, and contraceptive method failure.”

Meanwhile, the Department of Health (DOH) says it has reduced maternal deaths from 172 per 100,000 births in 1998 to 162 per 100,000 in 2006. But that still means 10 to 12 women die everyday, or around 3,650 to 4,380 every year, because of pregnancy and related cases. Originally, too, DOH had aimed to reduce the maternal mortality rate to 100 per 100,000 births by 2004.

Tomas Osias, head of the Commission on Population (Popcom), the state agency that determines the direction and implementation of the government’s family-planning programs, traces the maternal death rate to women being “too young (less than 18 years old), too old (over 34 years old), or having babies too close or unspaced (less than two years).”

Suneeta Mukherjee of the United Nations Population Fund (UNFPA) has also said that 99 percent of maternal deaths are preventable, adding that promoting family planning in places with high birth rates could help cut the maternal mortality rate by as much as 35 percent. Media reports last March also quoted her as saying that it is unlikely that the Philippines will meet its target of reducing the maternal mortality rate to 52 per 100,000 births by 2015 without “political will.”

As it is, NGOs even doubt the data on maternal health now in use by the DOH. Melgar explains that the maternal mortality rate of 162 per 100,000 is not the result of the regular census conducted every five years. She says it is the result of a survey, which has an error margin of plus or minus 30. This is because the president, whose much-vaunted field of expertise is economics, was not able to fund a census in 2005, because the budget was again re-enacted. A census is a basic requirement in economic planning, as well as in goal- and policy-setting.

Melgar says that veteran health department officials know it is critical to provide family-planning materials to women who want to plan how many children they will have and when, but who are unable to afford these materials on a regular basis. But Melgar asks, “How can you do that, (provide supplies) if your boss does not allow it?”

A YOUNG mother and her new-born wait for their number to be called at their community health center. [photo by Jaileen Jimeno]

No buying of artificial contraceptives

Last year, in fact, Albay Representative Edcel Lagman was able to insert a P180-million budget for contraceptives for 2007. But that money remains unspent, and Health Secretary Francisco Duque says it certainly will not be used for artificial contraceptives.

“We are not buying,” he told PCIJ recently. According to Duque, DOH’s policy against government spending on contraceptives will remain, and that his department aims to just “strengthen the scientific, natural family planning methods” it has espoused under the Arroyo administration.

In 2004, DOH even awarded P50 million to the religious group Couples for Christ to fund a government program called Responsible Parenthood-Natural Family Planning (RP-NFP). According to its own website, the CFC considers sex education, contraception, sterilization, in vitro fertilization, and population control as “anti-life.”

Couples for Christ was one of the first groups to mobilize its members during Edsa II, which resulted in the ouster of then President Joseph Estrada and Arroyo’s ascension to power. In a June 2004 report to then Health Secretary Manuel Dayrit to cover the first tranche of the money, CFC said it used the fund to conduct almost a hundred lectures on natural family planning, “chastity education” campus tours, and media and public relations expenses.

Lawyer Rhodora Roy Raterta, executive director of the Family Planning Organization of the Philippines (FPOP), says the deal violated the principle of separation of church and state, “as the CFC is known to have links with the Catholic Church.” But what made it worse, she says, were reports that CFC also used its trainings to denounce artificial contraception.

“The bottom line is, it’s wrong,” says Raterta. She also says that funding natural family planning alone violates the Constitutional provision that says the government will protect the right of spouses to found a family in accordance with their personal religious convictions.

Then Senator Luisa Ejercito, Estrada’s wife, was so incensed by the agreement between the DOH and the CFC that she filed a resolution demanding an investigation into its legality. She said the P50-million deal should have gone through bidding, like all other government contracts.

But health experts are also unhappy over CFC’s claims regarding the efficacy of natural family planning (NFP). Melgar says CFC does not tell its clients that “going natural” has a high failure rate of seven per 100 cases.

In a 1995 study by four experts led by Haishan Fu for the Alan Guttmacher Institute, abstinence, the core of natural family planning, was found to have a 22-percent failure rate while withdrawal had 26 percent. (The Standard Days Method, which the Church promotes, requires abstinence of up to 12 days.)

In comparison, says the study, implant and injectables have the lowest failure rates (two to four percent), followed by the pill (nine percent), the diaphragm and the cervical cap (13 percent), and the male condom (15 percent).

“It’s okay if women choose natural family planning methods,” says Melgar, who is Catholic. “But they should be advised that they could get pregnant, that it has a very high failure rate.”

Yet the CFC, in a letter to its members in October 2004 stated, “NFP is the most reliable, with 99-percent efficacy rate, proven in more than 100 countries and no side effects, except greater marital love and joy.”

Strategic appointments

Last year, Geraldine Padilla, wife of CFC director Frank Padilla, was appointed to the Popcom board, which is made up of 10 Cabinet members led by the health secretary, the UPPI director, and three private-sector representatives.

PRESIDENTIAL adviser on family matters Dr. Jose Sandejas believes despite the dismal chances at higher education of children belonging to big
families, they will save the country as the next generation of overseas Filipino workers.
[photo by Jaileen Jimeno]

As a state agency with almost four decades of experience, Popcom has built a strong network in all provinces, which could effectively reach all households, given enough funding and support. But Popcom has found itself unable to provide the whole array of options it used to offer women. In keeping with Arroyo’s ban on modern methods, its trainings are now limited to explaining women’s fertile periods and the natural methods of contraception. No lessons on artificial means are taught; should a woman ask for these, she is “referred to health centers,” says Popcom chief Osias.

What frustrates women’s rights advocates is the lack of a written, official government policy directive on the ban on contraceptives. This would have afforded them the right to question the policy in the courts. “Our problem is that our hands are tied,” says Likhaan’s Melgar. “There’s no executive order and it’s all verbal. GMA says ‘I am not funding,’ and it becomes the law.”

In 2002, however, the DOH did issue Administrative Order 125, which mandates government health workers to promote natural family planning as “the only acceptable mode of birth control.” It promotes the program under the battle cry of “responsible parenthood.”

Arroyo’s political accommodations in favor of the Catholic Church are also clear and out in the open, leaving even career government officials in fear of losing their jobs should they go against the anti-contraceptives policy.

Thus, they have kept their mouths shut even as the likes of Padilla were named to the Popcom. Padilla is also one of the commissioners of the National Commission on the Role of Filipino Women (NCRFW). (Weeks of efforts to interview her for this piece proved difficult, however, as no one at CFC, Popcom, and NCRFW seemed to know how to get in touch with her.)

Five years ago, Arroyo also appointed Jose Sandejas, who has a doctorate in materials engineering, as presidential adviser on family matters. Sandejas, aside from being a close adviser of Archbishop Paciano Aniceto of Pampanga, has been a trustee of Pro-Life Philippines since 1987. In 2006, he was also named commissioner of Popcom.

Sandejas says that for 37 years, the country pushed artificial contraception, which he says only benefited big pharmaceutical companies. He says that by promoting just the natural methods, the Arroyo government is merely trying to balance the equation. “The pharmaceutical companies make a lot of profit,” he says, “let them push it (artificial contraceptives).”

“It’s really the work of the devil,” he says of artificial contraceptives. “The devil’s main strategy is to create divorce, contraception, homosexuality. The enemy is really winning out so much.”

Rich and poor realities

Sandejas dismisses the notion that men tend to leave the responsibility of contraception to women, and that men find it difficult to comply with the abstention required of couples who opt for natural contraception. “I think the men would resent the accusation that they are like animals,” he says. He says most men are responsible, “even those who live in the slums, even the uneducated.”

Sandejas warns of a “demographic winter,” of a graying society with no young blood, of the “human race becoming extinct,” should all countries aggressively try to limit their population. With sadness in his voice, he notes that 50 years ago, Filipino families had an average of seven children; now the average is inching closer to just two children per family.

But experts say that average does not capture the reality of poorer households having more children than higher-income families. While the poorest 20 percent of Filipino women have an average of six to seven children, the richest 20 percent have an average of two.

The 2007 World Bank report on population issues also highlights the correlation between the number of children a woman gives birth to and her capacity to earn. “In the Philippines, the average income growth for women with one to three pregnancies was twice that of women who had undergone more than seven pregnancies,” it says. “Accordingly, the number of children a woman gives birth to affects her subsequent employment and income prospects, with the risk of further driving gender inequalities and perpetuating poverty.”

The report says that since a large family is unable to adequately invest in education, the setback “can create inequities in education and perpetuate poverty.”

With the odds stacked against women who belong to the poorest of the poor, the World Bank report calls on policymakers and development agencies to address inequities in the area of reproductive health.