A health worker gives out medical advice and birth control pills to women in Tondo during their regular visits to the Manila neighborhood
It's lunchtime in Vitas, the sprawling slum built on the City of Manila's garbage dump. Flies swarm as Bing, a 34-year-old mother of five, prepares a meal of salted rice for her children. While she feeds them, her husband sifts through the mounds of grease-stained cardboard boxes, plastic bags, and broken glass that crowd their home. He'll sell his rotten harvest for about $3.50. For their family of seven, that’s 50 cents per person, per day. The arithmetic is simple, Bing says. "With every child I have, there is less rice each. I can’t give them all a good life."
Bing planned on having one child, but birth control was never an option. For much of the last decade, the City of Manila, one of Metro Manila's semi-autonomous municipalities, has engaged in a campaign against modern contraception. In 2000, Mayor Lito Atienza issued an order effectively banning birth control from city-funded clinics. Eight years and a new mayor later, the ban persists. The city's affluent minority buys birth control from private clinics or procures condoms on the sly, but poor women, like Bing, go without.
She's hoping that will change. Backed by local women's groups and the Center for Reproductive Rights, Bing and a group of 19 of Manila’s poorest residents have taken the city to court. Their potentially precedent-setting lawsuit contends that the ban damages women’s health and violates their rights. They've marshaled compelling evidence: a relative increase in maternal deaths, reports of botched back-alley abortions, and children born into families that can't afford to raise them. "The consequences are far-reaching," says Aya Fujimura-Fanselow, a legal adviser to the Center for Reproductive Rights. "In the 15 years we've been involved in legal reform for reproductive rights, this is one of the most devastating bans we’ve ever seen."
Unlike most countries in Asia—and most countries around the world—this majority Catholic nation of some 90 million has moved away from birth control. National funds aren't used to buy condoms or pills, and, though local governments are technically free to buy them, many like the City of Manila won't. For years, international organizations filled the void. But that's changing. USAID, once a leading supplier of condoms in the Philippines, is phasing out their contraception program, and some worry other groups will follow. "They are saying that contraceptives should be sold, not distributed for free," says Suneeta Mukherjee, a representative for the the United Nations Population Fund. “This is fine, but there is no safety net for the poor."
In lieu of condoms or pills, government and church authorities promote what they call "natural" family planning. Women are advised to purchase a thermometer, monitor their cycle, and abstain from sex on all but their least-fertile days. But abstinence is a tough sell and people, it seems, aren’t buying it. The country's population is growing at a rate of about 2.3% per year, outpacing increases in agricultural production and economics gains. Poor families, like Bing's, are growing fastest. The country's poorest residents have an average of six children. The richest, meanwhile, have two. And it's not simply a matter of choice. Asked how many children they'd like to have, Philippine women, rich and poor, say they'd like two. Bing's neighbor, Sheryl, was one of those women, but, at 25, she's already had five. Three survived infancy. "What we earn here is not enough for children," she says.
The architects of the ban deny a link between population and poverty. "I reject the notion that we are poor because we are plenty," says former mayor Atienza. "Poverty is caused by mismanagement, not by the number of people." He’s partly right, of course. Endemic corruption and sluggish agricultural production helps keep the Philippines poor. But government statistics and a host of studies show that population is part of the problem. Access to nutrition, education and employment decreases dramatically when a family outgrows its means.
But the Philippines' birth control debate doesn’t turn on economics, which often makes it difficult for human rights activists and policymakers to find common ground. Government and church leaders frame the discussion in Manichean religious terms, as a battle either for or against human life. Archbishop Paciano Aniceto, who chairs the influential Commission on Family and Life for the Catholic Bishop's Conference in the Philippines, calls birth control advocates "propagandists of a culture of death." Sex, he says, is a privilege and should always be open to the transmission of life. Former mayor Atienza agrees. Family planning advocates have been "brainwashed" by the West, he says. His ban succeeded, he adds, by teaching Manila's "innocent and ignorant" women "true" Filipino values.
This attitude riles advocates for modern contraception, who maintain there is nothing anti-Filipino about birth control. Indeed, a survey commissioned by the Philippine Legislators' Committee for Population and Development found the majority of Filipinos are actually in favor of it. In their 2007 study, 90% of respondents said they'd vote for a political candidate who supported the use of modern contraception. And many women don’t see birth control as anti-Catholic, either. Lourdes Osil, a mother of seven who joined the lawsuit, says family planning does not violate her Catholic beliefs. "I don’t think it's a sin," she says. "It's different than abortion." For her, this is a matter of rights, not religion.
Since they filed suit in January, the petitioners say they've seen small signs of change. Outreach workers say it's getting easier for them to provide family planning services independently. And, though he's yet to speak out against the ban, Manila's new mayor, Alfredo Lim, has met with pro-family planning groups and expressed some willingness to collaborate with NGOs. Roberto Ador, executive director of the Family Planning Organization of the Philippines, says the suit comes at an opportune time. He sees it as part of a nascent nationwide push for reproductive rights. "We're hoping this will create a bandwagon effect," he says, "We think this could be noticed by executives at the highest levels of government and church." For Manila's poorest families, that change can't come soon enough.