At the weekly Friday meeting of the young parents group, a dozen or so girls sit around a table at the Eversley Childs Sanitarium and General Hospital, about 40 minutes outside downtown Cebu City, one of the Philippines’ major urban areas. Two of them are with their boyfriends, one with her mother, and another with her sister. The rest are alone. Most are visibly pregnant. An infant boy sleeps quietly in the arms of one girl.
A few of them share their stories. Rhea May, 18, had given birth two weeks earlier. Her boyfriend left her when he found out that she was pregnant. She had to go back to her job as a sales clerk shortly after giving birth to help support her family, and had taken the morning off work to attend the meeting. (Since our visit in March she has had to stop working altogether as her baby is very sick, so her father, a carpenter, is supporting her.)
Syke Rose, 18, is about to move in with her boyfriend Joseph, 19, who works in a bakery. She says her parents are not supportive, so she and Joseph will try to find a way to make things work on their own. Tears accompany all the stories.
We ask them if they have any questions. They do, but it’s basically the same one: “How can I go back to school and complete my education?” The girls are worried their futures are over; that this unplanned pregnancy means the end of their hopes and dreams of a college education and a career of their choice. Our main message to them is not to give up on their dreams, and to keep their hopes alive. And though it may not seem so, these girls are fortunate – they’re receiving prenatal care from qualified staff, and they’re learning about safe motherhood, breast-feeding and family planning.
This is the front line of reproductive health in the Philippines. This country of 100 million people has one of the fastest growing economies in the region, registering economic growth of 5.8 percent in 2015, and forecast at 6 percent in 2016. Yet behind those robust numbers, other data are less promising.
Poverty is widespread, with over 25 million people living on incomes of less than $1.25 a day, and 7 million of those living in “ultra poverty” – on less than $0.50 a day Youth unemployment is high, with one in four young people neither working nor in training.
The national fertility rate is 3.06, which is a big drop from 7.2 back in 1960, and consistent with regional and global trends. But it’s still high compared to the rest of the region. Also high is the maternal mortality rate, which is 86 per 100,000 live births. The Philippines failed to reach its target of reducing maternal mortality to about 50 per 100,000 live births by 2015.
The contraceptive prevalence rate, a measure of women reporting current use of any method of contraception, is 55.1 percent, which is considered low on a global scale.
The Philippines has the opportunity to reap huge benefits from the so-called “demographic dividend,” whereby a falling fertility rate results in smaller families, with better-educated children who contribute more to the economy as adults. But religious and cultural norms are holding back progress.
After a 15-year battle through Congress, the national government passed the Responsible Parenthood and Reproductive Health Act in 2012. Under the law, the government must provide universal access to all kinds of family planning, improve maternal health, reduce the rate of sexually transmitted diseases and include sex education in schools. The government has been making progress in building the infrastructure to put the laws into action, by supporting training, constructing facilities and including family planning in national health insurance coverage.
The Roman Catholic Church fought against the legislation, before and after its passing. The Church argues that it goes against the right to life, and that it encourages young people to be promiscuous. It is still fighting today; as a result of its legal challenges, subdermal implants, one of the most effective and popular long-acting methods of contraception, have been temporarily banned since June 2015.
The religious and cultural environment poses huge challenges. Eight out of 10 Filipinos are devout Catholics, and some say they will accept as many children as God gives them, regardless of whether they have the means to support them.
And while the responsible parenthood law now exists, it’s far from perfect. Dr. José Rodriguez, country director of EngenderHealth Philippines, explains how the measures fall short in addressing the issue of teenage pregnancy: “To a certain extent the law is very conservative in addressing the needs of adolescents. There are some provisions of the law that still require parental consent, even for teenagers who already have children. To me, those are challenges that implementers of the reproductive health law are facing.”
Teenage pregnancy is a huge problem. At Eversley Childs Sanitarium, of the nearly 3,500 deliveries in 2015, 13 percent were to teen mothers. According to a national Demographic and Health survey by the Philippines Statistics Authority, as of 2013 one in 10 young women between the ages of 15 and 19 is already a mother or pregnant with her first child. Most of them are poor and have a low level of education.
The same survey showed 19 percent of young adult Filipino women initiate sexual activity before the age of 18.
And a recent report from the United Nations Population Fund showed that adolescent fertility rates in the Asia-Pacific have declined in the past two decades “with the exception of the Philippines, where there has been little change.”
Post-abortion care is also a prickly issue. Abortion is still illegal in the Philippines, so women are forced to go to underground providers or self-abort, sometimes leading to complications and even death.
Another challenge is implementation. Spanning the 2,000 inhabited islands (of more than 7,100 islands in total), the health system in the Philippines is highly decentralized, and the success of national policies depends on how local governments implement them. Local mayors are very influential in their communities, and some have declared themselves to be pro-life. This means that in those areas, public health workers trying to offer services will not get local support, and will sometimes be obstructed from doing their jobs. Conversely, where support is strong, services are likely to withstand political changes or pressure at the national level.
An hour’s ferry ride from the port of Cebu is the island of Bohol, most famous for its Chocolate Hills. These are thousands of limestone mounds that dot the landscape in the center of the island, covered in vegetation that turns a chocolate brown in the dry season.
The hills lie in the municipality of Carmen, which has a population of almost 44,000 people living among 29 barangays, or villages. In 2013, a magnitude 7.2 earthquake struck, its epicenter within Carmen. The rural health unit was totally destroyed and still hasn’t been rebuilt.
The temporary clinic and birthing center is a small facility, with some makeshift doors and walls designed to give privacy to women in labor and a clean delivery room. The clinic offers prenatal care, and contraceptive counseling and services such as family health days for men and women, as well as training for health staff.
Dr. Josephine Jabonillo is the municipal health officer who runs the facility. She is a bundle of smiling energy – inspired rather than daunted by the challenges.
Dr. Josephine knows how to make a little go a long way, and is a vocal advocate for more training, more collaboration and more creativity. Fortunately, the municipal mayor is very supportive, which has allowed the rural health unit to thrive in providing family planning services to the community.
While families are well served, teenagers present a problem in Carmen. Some teens are living with grandparents or other relatives while their own parents are working overseas. They don’t want to spend time at home, where they might be bored, or get scolded, so they go out at night and spend time with their friends. This is when they start partnering up and experimenting with sex. Cultural norms make openly talking about sex taboo, so they talk to their friends and go where every teen these days goes for information and socialization – the internet. Facebook, WhatsApp and texting are very popular in the Philippines, and one problem is that teenagers share a lot of false and inaccurate information.
But the internet may also be a partial solution to the problem. Health providers are gradually realizing that to reach teens, you have to be where they are – online, as well as in the real world. Dr. Rodriguez acknowledges this. “Probably the answer can be found in the modern communications technology that’s currently available. I think social networking and mobile technology provide a great opportunity and platform for reaching out, especially to these high-risk teenagers.”
Having waited so long for a reproductive health law, the country can’t afford to wait much longer to address its teenage baby boom. Without further action, it will grow up to become a baby burden.
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Women and Girls Deeply.