by MARITES N. SISON

PARADISE, Malabon — Fourteen-year-old Claudia said she had urged her common-law husband to use condoms, but he refused, arguing that it was just going to get torn anyway. Instead, she told health worker Magdalena Bacalando, they used toothpaste, which the couple mistakenly believed would work as a spermicide. Now Claudia is three months pregnant with her second child and seems confused what to do next.

Some women’s rights groups agree with religious organizations that “family planning is not about flooding the market with contraceptives” but also entails an education process and efforts to bring about changes in attitude. These in turn mean a multisectoral approach which, along with clear direction, seems to be lacking in the Arroyo government’s population policy.

Last Saturday, the president launched her family planning slogan, “Birth Spacing through Billings, Body Signs and Basal Temperature,” or “BBBB,” which only confirms that her administration is making natural family planning the cornerstone of its population program.

But economist and population expert Alex Herrin describes Arroyo’s population policy as “ambiguous” at best, since she seems to equate the official push for natural family planning with “informed choice,” much to the consternation of pro-family planning groups that say the term means providing couples with all options including contraceptives.

He also points out that Arroyo has previously issued conflicting statements on population first adopting the Roman Catholic Church’s position that population was not a problem and then stating earlier this year that there is a link between poverty and population.

Herrin does note, though, that the present administration’s family planning approach is similar to that of the Aquino government, which saw the issue primarily as a health intervention and as a means to help couples achieve their fertility preference.

“This,” he says, “does not necessarily reduce population growth.”

Population growth in the Philippines has declined from 2.7 percent in the 1970s to 2.3 percent. But experts say that is nothing to crow about, especially when compared to Thailand, which had almost the same population growth rate in the 1970s, yet is now averaging an annual rise of less than one percent.

Experts agree that while solutions to population challenges are unique to each country, the ability of key sectors in society to come together is a crucial factor in the success of a population program.

A 2002 study on the changing Asian population, by the Hawaii-based East-West Center, cites the common factors that made the population programs of Thailand and Indonesia work.

One was that key political and religious leaders all agreed on the importance of slowing population growth. “Neither religious leaders nor other politically powerful groups mounted a strong opposition to the programs,” notes the study. “Even in Indonesia, the largest Islamic nation in the world, religious leaders did not actively oppose President Suharto’s decision to promote family planning.”

Both governments also adopted national development plans with specific growth reduction rates. Another factor was that “they initiated public campaigns to persuade couples of the benefits of small families and started education programs in communities and schools to inform the citizens about modern contraceptive methods.”

Also, says the study, “family planning clinics and distribution systems, many heavily subsidized, were established to increase the availability of contraceptive methods and services.”

The last two factors are present in the Philippines but only on a small scale. This is because much of the work is being done by civil society rather than by the government itself.

The 1994 Local Government Code devolved many of the national government’s roles, including the delivery of family planning and reproductive health services to local governments. This has worked both for and against family planning.

Devolution allows local governments to purchase contraceptives if they wish and to run any family planning program they want to as long as it is legally and socially acceptable, points out Health Secretary Manuel Dayrit. This means that except for abortion, which is prohibited by law, local governments can actually have a more aggressive contraceptive policy than the national government.

But devolution has also allowed some local governments, like those of Manila and Bukidnon, to adopt a no-contraceptive policy. Women’s rights groups have denounced this move as unconstitutional but Population Commission Executive Director Tomas Osias says this is a gray area. It may also well be that Manila and Bukidnon were merely taking the cue from Malacañang, which has said it will not spend a single centavo on contraceptives.

In any case, the clientele of government health centers the poor seem to prefer going to those run by NGOs anyway. Rosita, for example, would rather take a tricycle to the Mothers clinic here in Paradise, a slum in Tonsuya, Malabon, rather than visit the Tonsuya health center much closer to her home. According to Rosita, the people at Mothers “listen and give advice” while those at the government clinic “give us the runaround.” Numerous studies have also shown that women are reluctant to consult government health workers regarding family planning for fear of being shamed and ridiculed.

NGO workers, however, can only do so much. Bacalando, for instance, is wracked with guilt over Claudia’s latest pregnancy. The Mothers health worker had planned to personally monitor the teenager, but had been inundated with the constant deluge of clients at the clinic to make a house call.

But then Bacalando was not exactly welcome at Claudia’s house; the girl’s mother and common-law husband had been hostile to her ever since she found out that they had tried to get rid of Claudia’s first child through hilot or what health workers have taken to calling a “deep abdominal manipulation.”

NGOs like Mothers also rely heavily on free contraceptives that they get from the government health centers which for now are getting them as donations from the United States Agency for International Development (USAID). At present, the Mothers clinic is still receiving an allocation of 200 pills of Logentrol per month. But the USAID is scaling down its donation of contraceptives beginning this year, and Bacalando is already worrying that their supply will run out.

The Mothers clinic sells Trust pills as an alternative to Logentrol. Bacalando, however, says few can afford to buy these. After all, she notes, the cost of P17 per cycle is equivalent to a kilo of rice.

Sterilization is not a desired option for the poor because of the cost clinics do not perform them and clients are referred to the provincial or city hospital where the cost is at a prohibitive P300. Although Philhealth, the government insurance system, covers sterilization, this medical insurance is often not available to the poorest of the poor. Another factor is time; a day’s off from work is enough to make a family hungry.

Bacalando, however, says that aside from pills, injectibles are also popular even if they cost P30 at the clinic because they are good for three months and can be administered to wives without their husbands’ knowledge.

Several studies have shown that Filipino husbands often dictate what their wives can and cannot do with their bodies. And more often than not, they do not want their wives to resort to artificial birth control. In a 2000 report, the Population Commission (Popcom) says, “Husbands tend to view contraceptive as socially unacceptable and potentially damaging to women’s health. They believe use of contraceptives pose more hazards to women than do pregnancies.”

It adds that Filipino men are adverse even to natural family planning (NFP) because they want more children. “The pressure to have children is greater on the husband than on the wife,” says the Popcom. “Children are viewed as proof of their virility. Men also hold custody of their lineage.”

The Commission says that in the Philippines, “women have limited power to refuse sexual relations with husbands,” some of whom become violent when denied their “marital rights.”

Bacalando says that this is one of the reasons why NFP has not been popular in Paradise. She says, “There are many who try it, but what husband would really wait (for days on end)? Many people also believe a wife is the husband’s property. And there are so many men coming home drunk and forcing themselves on their wives.”

The implication therefore is that artificial contraceptives should be an integral part of any government population policy. Yet while there may never be a meeting of minds on the matter between the Catholic Church and population experts, Herrin says teamwork is still possible.

He says the government obviously “cannot expect the Church hierarchy to promote the use of artificial contraception,” but that there can be cooperation in support of “socioeconomic policies that have fertility and family welfare impacts.”

He cites the “principled cooperation” stance adopted by Bishop Antonio J. Ledesma, who has tapped government resources to promote NFP in Ipil, Zamboanga. The Lingayen-Dagupan archdiocese of Pangasinan, which is one of the most heavily populated areas of the country, has also entered into a “collaborative partnership” with the local government to provide Catholic couples with viable alternatives to artificial contraceptives.

Herrin adds that the Church’s position that issues of inequality, corruption and injustice must be addressed to solve poverty should not be ignored. “We’re not saying that population control will solve everything,” he says. “Having a big population just makes issues like poverty harder to solve. What we’re saying is a slowdown in growth coupled with sound economic policies will help facilitate economic development.”

Other experts meanwhile say the business sector, which has been harping on how the country’s population growth rate is impinging on the economy, must be made to shoulder some responsibility for the problem as well. In its 2000 report, the Popcom had also said, “The potential of industry-based clinics is immense. With moderate local and foreign donor funding for public sector reproductive health services, the participation of profit-oriented organizations is encouraged as a way of meeting growing demand.”

Experts, however, stress that the government must once and for all articulate a clear, consistent, and holistic policy on family planning. As it is, current family planning services have yet to fully take into account the issue of adolescent sexuality.

Studies have shown that more and more of the country’s youth are engaging in various types of sexual risk-taking. The East West Center study says about 87 percent of Filipinos ages 15-24 had their first sexual experience outside of marriage. National data also show that more than one-third or 36 percent of young Filipino women ages 15 to 24 conceive before marriage. Young mothers account for 17 percent of induced abortion cases; six percent of spontaneous abortions and 74 percent of illegitimate births.

“Teenage pregnancies often hinder and in some cases end a young mother’s education,” says the Popcom 2000 report. “The direct link between girls’ education and women’s ability to escape poverty are well-understood. Education enables women to respond to opportunities, challenge their traditional roles and change their life circumstances.”

The Popcom adds that the only way adolescents can be encouraged to delay marriage and child-bearing is by providing them with “appropriate, accurate sexual and reproductive health education, helping them make informed decisions about their sexuality and stressing the prevention of unplanned pregnancy, induced abortion and sexually-transmitted diseases.”

Experts emphasize that such education can begin at home, where parents and older relatives are able to have informed and healthy discussions on sexuality issues with their children so that they do not feel the need to experiment or rely on their peers for information.

Claudia said her mother knew she had a 22-year-old boyfriend but never warned her of the dangers of intimacy. The young mother has told the personnel at Mothers that she will keep the child now growing inside her womb. Bacalando says they are trying to give her guidance because Claudia “keeps changing her mind.” The only certainty for now is that this child bearing a child still sleeps beside her mother at night in their shanty in the community called Paradise.