Population growth drops when women are free to choose

An NGO health worker discussing artificial family planning methods with residents of an urban community. [PCIJ file photo]

LINGAYEN, Pangasinan — Since 1975, the year Pangasinan’s population office was created by then Gov. Aguedo Agbayani, Luz Muego’s life has been governed by numbers. At the time, Muego was a researcher at the office. Now she is the province’s population officer, but she is still preoccupied with all sorts of figures.

Today Muego, who has a degree in nursing, is pondering over these: 2.4 million, the province’s total population; 23 percent of the province’s women want to plan their family but are unable to do so; 33 percent of the population lives below the poverty line.

Pangasinan is the country’s most populous province. But another number has helped make it one of the Philippines’ role models in family planning: a population growth rate of 1.9 percent, which is phenomenal compared to the national figure of 2.3 percent, and considering the increasing strength of religious conservatives in the crafting of population-control policies.

In fact, Muego, now 59 years old, and current Governor Victor Agbayani — Aguedo’s son — are reluctant to draw attention to their accomplishment for fear of attracting the ire of these conservatives. Already, Muego says, a mayor who is part of the province’s contraceptives-reliance program has been approached by a “convert” of the group Pro-Life Philippines, asking him to “do an Atienza” in his town.

The “convert” is an employee of the Department of Health. “Doing an Atienza” is a reference to Manila Mayor Lito Atienza’s imposition of an anti-artificial contraceptive policy on his entire city. Atienza also happens to be the chairman of Pro-Life, whose founder is a Roman Catholic nun with ultraconservative views about birth control.

In large part, Pangasinan’s success has been due to the provincial government ensuring that couples are free to choose which family planning method they want to use. But part of it is also due to a deal struck four years ago by Agbayani and the population office with local Church leaders to promote natural family planning methods.

Even now, it still seems unthinkable, and the effort did fizzle out after a couple of years or so. But not before the project was able to train 37 laymen in three towns on the rudiments of family planning.

While it lasted, the memorandum of agreement demonstrated that a population program need not necessarily mean anti-Church. The agreement, after all, did not in any way promote artificial contraception. But it did widen the province’s reach in disseminating information about family planning.

The provincial government allocated P300,000 for the beads used in tracking a woman’s cycle — crucial in natural birth control. Part of the fund for the training of trainors, meanwhile, came from the budget of local officials. Says Agbayani: “The collaboration meant our people will train their people on the use of natural family planning methods so they can have trainors.”

But Agbayani says he had wanted to keep the MOA “below the radar,” and for good reason. the Catholic Bishops’ Conference was viewing it with concern. In the end, some priests in Pangasinan chose not to implement it, fearing that jueteng money earned by some local officials were used to fund the training.

If Pangasinan officials remain wary of catching the eye of organizations such as Pro-Life, it is because population experts and health workers alike say that when it comes to population control, support from the national government is sorely lacking. They also say that President Gloria Macapagal-Arroyo is even perceived as endorsing only natural family planning, of which she is a staunch advocate.

In fact, there is no national population policy at the moment, something that has left Senator Juan Flavier very frustrated. As health secretary during the Ramos administration, population control had been one of Flavier’s flagship programs. He came up with the “Kung Sila’y Mahal Niyo, Magplano (Plan Your Family if You Love Them)” campaign. He also helped reduce the stigma of condom use by employing various media gimmicks, “for which,” he once said, “I was condomed without trial.”

Now, Flavier says, “kanya-kanyang style to do their best to block it (population control).”

Dr. Junice Melgar, head of the Reproductive Health Advocacy Network (RHAN), blames the weakening of the country’s family planning program on the government’s disregard of women’s rights. “Women’s needs are always at the bottom of the priority list,” she says. Yet women are often made to take the entire burden of family planning-even as they are denied the full range of birth control methods.

Melgar says this is why RHAN can only critically support Albay Rep. Edcel Lagman’s House Bill 3773, which aims to “encourage the limitation of the number of children to an affordable level of two children per family.” According to Melgar, the arguments should focus not on economics, but on the right of women to make their own decisions.

She says government’s neglect of women’s rights to family planning has led to the unusual strength of groups like Pro-Life Philippines. “In other countries, they are on the fringes, here they are mainstream,” she says.

But Ramon San Pascual, executive director of the Philippine Legislators Committee on Population and Development, says HB 3773, will at least force Malacañang to abandon its “escapist” stand of allowing local government officials to implement family planning as they see fit. While he concedes that the bill has provoked strong reactions from anti-contraception groups, he also says that floor discussions on it at least present a good “educational” opportunity for the whole population.

Indeed, with various sides and arguments clashing on the issue, some cooler heads have seen the need for a rational discussion. At the Bishops-Businessmen’s Conference for Human Development in Makati last March, Fr. John J. Carroll, S.J., called on the Church, the government and other sectors to hold a dialogue on the issue “from the points of view of women and the poor.”

He observed that the Church had always flexed its muscle on the political level when it came to contraception, but lacked in efforts to educate its people on the advantages of family planning. The Church was a member of the Population Commission until it pulled out in 1970 due to its stand against artificial contraception.

Carroll warned that 27 percent of women in the poorest fifth of the population “want to limit their families, but are not taking steps to do so.” He said the Church should have an “openness (to) receiving government assistance for its program of natural family planning,” admitting that “the Church lacks the resources to meet the need by itself.”

The likes of Manila’s Atienza, however, may not be willing to participate in any kind of dialogue on birth control. The Manila mayor has already made up his mind, and has gone to the extent of arguing that the Constitution is pro-life and that it contains no provision mandating government officials like him to provide birth control materials to couples.

In his view, the government is even violating the law when it uses taxpayer’s money for birth control. “Population control and the distribution of contraceptive materials in government facilities is a continuing illegal act,” argues Atienza.

Pangasinan’s Agbayani obviously does not agree with this view. Still, he emphasizes that his government is not pro-abortion. “We are pro-quality of life,” he clarifies. “If we do not manage our population, we negate our gains in economic development.”

Like Muego, Agbayani, a civil engineer with a Master’s degree in business administration, pays close attention to numbers. “Our budgetary resources are not enough to provide the basic services of our people,” he says. The province has built some 400 school rooms the past years, but it is not enough to meet the new entrants every year. While the province has 100,000 hectares of irrigated land, it cannot support a runaway population growth rate.

Agbayani says that based on their studies, a family spends every year as much as P3,300 to educate one child if there are two children. This amount dwindles to P2,500 for a family with three to four children, and to P800 for a family with nine.

The governor says their target is to reduce the population growth rate by point one percent per year until it reaches 1.5. He says this will give the province enough time to cope with the demands of the current population. But the provincial office also aims to bring down the number of women with unmet contraception needs by one percent per year.

Agbayani notes with amusement that while his father pioneered population management in Pangasinan, the late governor had nine children. Victor Agbayani has only three children, aged 13, eight and five. He and his wife never used contraceptives, relying only on natural family planning, an area he leaves up to his wife, a doctor.

Experts like Corazon Raymundo of the University of the Philippines Population Institute have noted that while natural family planning is “97 percent effective, it has a lot of dropouts.” This is because the natural method calls for things like the constant monitoring of a woman’s fertility cycle and the taking of temperatures, which many couples may have neither the time nor patience for.

Manila Mayor Atienza himself admits that the number of women actively using natural family planning in his city is dismal. But he says this is proof that the “contraceptive mentality has been somehow effective in brainwashing the young generation to believe that the solution to poverty is not having or avoiding children.”

According to the 2004 report of Manila’s city health department, the most widely accepted form of natural family planning method is the Lactation Amenorrhea Method or LAM, with 22,148 users. But LAM is effective only for a maximum period of six months, and mothers have to breastfeed constantly for it to work. It says as of 2004, 1,401 people have accepted the Billings method, in which women chart their fertile and infertile periods.

National Statistics Office data show that in 2000, Manila had 471,307 women of childbearing age, or those aged between 15 and 49.

The city of Manila, which had a total population of more than 1.5 million in 2000, allocated a total of P470,920 for natural family planning last year.

Here in Pangasinan, the capitol this year set aside P14 million for the province’s population control program. In 2004, the province had a total of 120,822 family planning “acceptors,” or those who are employing means of birth control, natural or otherwise.

The province’s population management efforts have had major setbacks in the past. In 1987, with fertility reduction missing from the agenda of the administration of then President Corazon Aquino, Pangasinan’s population program was abolished due to lack of funding.

Instead, family planning campaigns were left solely in the hands of the Department of Health. The result: the province’s population growth rate of 1.8 percent jumped to 2.1 percent. It was pulled back to 1.9 percent beginning 1992, when the program was revived under then President Fidel Ramos.

These days, among the problems Agbayani and Muego are looking at is the U.S. Agency for International Development (USAID) scheduled phaseout of its materials support for family planning in 2007. Already, the province is reeling from the 20-percent reduction in contraceptive supplies from USAID. By next month, the drop will reach 40 percent.

As usual, Agbayani and Muego are solving the problem by doing their math. The numbers have told them that close to half of commodity users can afford to buy their supply. But only 14 percent buy their own, with the rest relying on government.

Realizing this, the capitol launched a contraceptives self-reliance program to make individuals and town mayors share the burden. Indigent clients will be given an ID entitling them to free materials or a subsidy. The provincial government has identified nine towns where the program will be tested. Agbayani has also wooed pharmaceutical companies to provide cheaper contraceptives to the province.

Although Pangasinan has tried to keep a low profile when it comes to its population control efforts, these have been just too good to escape notice by various groups. In 2003, Agbayani received the Rafael Salas Population and Development Award. Muego and her office, meanwhile, have garnered several awards from the Population Commission and other agencies for their effective population management program.

The Population Institute’s Raymundo remarks, “Pangasinan’s program is ideal because it comes from the highest policy-making body, the governor. There’s support, there are no barriers, and the population units are very strong, with lots of activities. Most importantly, the people are free to choose.”