From Marcos to Duterte: An ever-changing Philippine population policy

Karen Reginio, 39, originally wanted just 3 children with her husband Rogelio. Instead, they have 9.

She said she tried birth control but the contraceptives made her irritable, hypertensive and prone to bloating.

“Nag-pills po ako pero pag dumarating yung kalagitnaan ng pag-take ko, naititigil ko, nabubuntis ako. May masamang epekto kasi eh, mainitin ‘ang ulo ko, tumataba ako, di ako makahinga. Iba-iba ang epekto, nahihinto ko kaya dumarami sila,” she said.

Richelle Alanan is in a similar predicament. She said she wished to have only 3 or 4 kids, but her husband wanted a large family so they also ended up with 9 kids.

“Kung ako lang sana siguro mga 3 o 4 lang,” Alanan said.

Family planning methods were available to them in the health centers in Iloilo but their desire to have several children overpowered the discipline to follow proper family planning methods.

Alanan finally stopped childbearing when she left for Manila to work as a maid, leaving behind her husband to take care of their children and their farm.

Thirteen years after she left, her son, Rey, believes his mother knows her wards more than her own kids.

“Hindi na po ako nasanay kay Nanay. Parang mas kilala na po nila siya kasi maliit pa po ako nung umalis si Nanay eh,” Rey said.

POPULATION BLOAT, SCARCE RESOURCES

According to former Health Secretary Esperanza Cabral, the Philippines is currently at a crossroad where the nation’s resources cannot keep up with the demands of the growing population.

With a current population of 107.9 million, the Philippines is ranked 13th among the most populated nations in the world. The Commission on Population projects the country might hit 109 million by the end of 2019, with 3 babies born per minute in the Philippines.

Cabral said results of the last National Demographic and Health survey say that on average, Filipino women only want 2 children. Many families, however, have more than that.

“They don’t have education. They don’t know what to do. They don’t have the money to buy the contraceptives so they are the ones who need to be helped. Helping the poor exercise their reproductive health rights by giving them education so that they can make informed choices about their family size and then giving them the means to access health services that they need or want,” she said.

Nimfa Ogena, a professor at the University of the Philippines Population Institute, said there is an unmet need for mothers who want to keep their family sizes small.

“They want to limit the number of children or they want to delay child bearing pero hindi sila gumagamit ng any method para doon sa goal nila na ‘yun. Hindi sila informed,” Ogena said.

BELIEF AND BABIES

One problem the Philippines faces is the shifting population policy of its leaders.

During his term, President Ferdinand Marcos formed the Commission on Population, a government agency that focused on population management and intervention. At the time, the country’s population was at 37.8 million, with 6.8 average family size.

The PopCom introduced family planning methods to enable families to understand the wisdom behind controlling family growth. USAID also provided artificial contraceptives, which had a higher effectivity rate compared to the natural calendar method.

Bhoyet Tacardon, Deputy Executive Director of the Commission on Population, said it was a time when the family planning program was branded as “population control.”

This changed when Marcos was deposed in 1986 and Corazon Aquino, backed by the Catholic Church, took over as president.

Having strong affiliations with the Catholic leadership, Aquino had a more conservative approach to things and family planning was considered a health intervention. Instead of PopCom, the Department of Health took over the task of implementing, planning and coordinating family planning.

It was also during Aquino’s term that a shift happened in people’s mindsets: at least 50 percent of the population favored smaller families. “1990s tumaas na yung rate na gusto na konti ang number of children but nag-umpisa na rin bumaba ang supply ng contraceptives from abroad nung time ni Arroyo kasi very vocal siya na against it,” Ogena said.

In 1992, President Fidel Ramos, a Protestant, took over and emphasized reproductive health and human rights as a policy framework for the implementation of family planning programs. More emphasis was given on informed choice to couples to exercise their right to have babies at their perceived ‘right time’.

The health secretary at that time, Dr. Juan Flavier, had the slogan “Kung sila ay mahal niyo, magplano.” (If you love them, plan the size of your family.) He intensified family planning and recognized it as a population and development strategy, which the president preferred.

Former President Joseph Estrada was low key with the implementation of family planning since his belief was more inclined to responsible parenthood. Although he was supportive of family planning, he focused more on the implementation and equipping couples for responsible parenthood.

“He focused on pagiging responsable ng mga magulang and pagpaplano ng pamilya,” Tacardon said.

CLASHING WITH THE PRESIDENT

After former President Gloria Macapagal Arroyo came to power in 2001 with the support of the Catholic Church, she explicitly rejected artificial family planning.

This, despite the advice of her health secretary, Esperanza Cabral, that the government could not keep up with the demands for social services any longer.

Cabral said Arroyo recognized the need to manage the population and families should have some access to family planning methods “but because of her faith, her kind of family planning method is the natural family planning method which was really not as effective as the modern means of contraception.”

“The family planning program did not grow as much as it should have. Women did not have that much access to modern family planning methods. In public health facilities, very little modern contraceptive methods were provided,” she said.

As a result, the national government emphasized natural family planning methods and would not provide a budget for modern contraceptive methods.

It was a moment when the President and her health secretary did not see eye-to-eye.

“It was difficult because as I told you, there was a disagreement between the President and myself. Fortunately, I guess she respected my stand even so she allowed me to do whatever I could with the money that was provided to the DOH [Department of Health] to provide services that I felt were necessary,” Cabral said.

Cabral continued on sourcing out contraceptives from organizations that gave them for free and provide them to the local government units.

Not all the disagreements were at the national level.

After his election in 2010, President Benigno Aquino III signed into law the reproductive health (RH) bill and population management started to pick up again. By this time, the population of the Philippines was already at 101.7 million. In 46 years, the population of the Philippines had an addition of 63.9 million.

Though there was a push for the enactment of RH law, the implementation was not standardized. Tacardon said local government units still implemented their own programs based on their own religious beliefs instead of following the national policy on family planning.

“Hindi katulad sa national level, yung mga LGUs [Local Government Units] natin ay nagdidikta kung paano i-implement ‘yung programa based on religious beliefs din, kaya naaapektuhan. So ‘yung mga LGUs ay masyadong conservative and religious just like ‘yung kay [Manila Mayor Lito] Atienza for example, talagang pinigilan niya ‘yung implementation ng family planning sa Manila,” he said.

The RH law provided the procurement and distribution of family planning commodities centralized by the health department. The LGUs had to augment the need to achieve universal coverage based on their existing beneficiaries.

“Ang kwento ng family planning is dependent kung sino ang nandiyan at nakaupo and it has been affected by their belief. Ano ang personal belief ng President or current administration had an impact on family planning,” Tacardon said.

“It depended on the leadership. Kung ano 'yung palagay ng presidente na gusto niya as far as the population management is concerned, yun ang nangyayari. So leaders who were more progressive, more liberal, would provide modern contraceptive methods. They would not stop their cabinet secretaries, for example, or the local chief executives from doing that, in fact, encourage them. But people who were more conservative would say ‘oh this is what we're going to emphasize’,” Cabral said.

2 MILLION BIRTHS PER YEAR

Based on the National Quickstat released by the Philippine Statistics Authority in April 5 of this year, there are almost 2 million births per year in the country, discounting unregistered births.

Births (based on civil registration)

2015
Male 910,877
Female 833,890
Total: 1,744,767

2016
Male 903,694
Female 827,595
Total: 1,731,289

2017
Male 851,531
Female 779,084
Total: 1,630,615

Just half of couples are using family planning in the latest data.

Family planning, 2017 (in percentage)
(Number of women: 15,016)

Any method 54.3 %
Any modern method 40.4%
Any traditional method 13.9%
Not currently using 45.7%

[Source: https://psa.gov.ph/statistics/quickstat/national-quickstat/all/*]

Based on the 2017 demographic health survey, the total fertility rate of women ages 15 to 49 years who are in the reproductive bearing age is at an average of 2.7 children from 3.6 in early 2000. For women in the marginalized sector, it remains at an average of 4 kids.

There is a decline in population growth from 1.65 percent in 2015 to 1.15 percent in 2019. Though this means that the growth in numbers is moving slow, the Philippine population already has a very big base to begin with, Commission on Population said.

“It doesn’t mean na nababawasan kayo because ‘yung population growth rate na ‘yun is just saying that bumagal tayo in terms of pag laki pero since malaki na ‘yung population base natin by which we compute ‘yung growth rate natin, it translates to about 2 million parin ‘yan ‘yung ating addition every year,” Tacardon said.

THE SOLUTION

Cabral said easing the country’s population growth rate requires more than just the action of one group. She noted the government should be able to stand alone, independent of their faith and beliefs.

“If the government allows itself to be influenced by any group, not just the Catholic Church but any group into doing or not doing something that should be done or not done for the population, it is on the government, not on the Catholic Church,” she said.

With the RH Law in place and the present administration of Rodrigo Duterte who is supportive of family planning, PopCom said, the widest range possible of family planning methods will be offered to Filipino women for free in public health facilities. They have also mobilized plans of going to the workplace to reach women.

“Mga belonging to informal sectors na hindi rin nakakapunta sa health centers dahil nag hahanapbuhay sila. Instead na sila na ang pupunta sa facility, we’re thinking of giving them like in their workplace, ‘yung services para sila naman ay mabigyan ng serbisyo,” Tracardon said.

PopCom is requesting for augmentation in their current P400-million budget to P500 million to cover mostly for the demand generation. In the projected aggressive information campaign of PopCom in marginalized sectors, the demand might bloat and they want to be prepared for it.

The target of the commission is that by 2022, the rate of women using contraception would be at 65%.

But the biggest challenge facing the population crisis is the belief of women that contraception will have adverse effects, such as abortion and other medical side effects.

“So, ito ang ina-address din natin. That’s why we are training itong mga barangay volunteers to really provide information and even mobilizing ‘yung mga satisfied users or ‘yung mga nakagamit na para sila mismo magsabi sa kanilang peers na effective ito,” he said.

Tacardon said the inconsistency of national policy when it comes to population has led the Philippines to its present state. Had there been a consistent implementation of family planning since the Marcos era, when the Commission on Population was born, the Philippines could have controlled its population growth rate and even helped create a “quality” labor force.

“Malaking bagay sana. Magkakaroon tayo ng quality labor force na magko-contribute more productively to the economy and kung sila ay productive na nae-employ, reduced din sana yung poverty. So wala sana tayong malaking problema ngayon para sa kakayahan ng mga pamilya na maka-access ng different services na ito,” he said.

“Masu-supply-an natin agad ‘yung more than 100 million na mga kailangan ng mga Filipinos,” he added. -- Edited by Dave Dizon, ABS-CBN News