|
Maria
Susana Espinoza wanted only two children. But it was not
until after the birth of her fourth child in six years
that she learned any details about birth control.
“I knew it
existed, but I didn’t know how it works,” said Espinoza,
who lives with her husband and children in a squatter’s
hut in a vast, stinking garbage dump by the
Manila Bay.
She and
her family belong to the fastest-growing segment of the
Philippine population: very poor people with large
families. There are many reasons why this country is poor,
including feudal patterns of land ownership and corrupt
government. But there is a compelling link between family
size and poverty. It increases in lock step with the
number of children, as nutrition, health, education and
job prospects all decline, government statistics and many
studies show.
A HOMELESS girl gets a little
help from her elder relative as she eats her lunch on a
street in Quezon City. Birth and poverty rates in the
country are among the highest in Asia. And the
Philippines, where four out of five of the country’s 91
million people are Roman Catholic, also stands out in Asia
for its government’s rejection of modern contraception as
part of family planning.
--AP PHOTO/BULLIT MARQUEZ
Birth and
poverty rates here are among the highest in Asia. And the
Philippines, where four out of five of the country’s 91
million people are Roman Catholic, also stands out in Asia
for its government’s rejection of modern contraception as
part of family planning.
Acceding
to Catholic doctrine, the government for the past five
years has supported only what it calls “natural” family
planning. No national government funds can be used to buy
contraceptives for the poor, although anyone who can
afford them is permitted to buy them. Local governments
can also buy and distribute contraceptives, but many lack
the money.
Distribution of donated contraceptives in the government’s
nationwide network of clinics ends this year, as does a
contraception-commodities program paid for by the US
Agency for International Development (USAID). For years it
has supplied most of the condoms, pills and intrauterine
devices (IUD) used by poor Filipinos.
“Family
planning helps reduce poverty,” President Gloria Macapagal-Arroyo
said in a 2003 speech that detailed her approach to birth
control. But she said then and has since insisted that the
government would support only family-planning methods
acceptable to the Catholic Church.
Women not
wanting to get pregnant, Arroyo advised, should buy a
thermometer and recording charts and abstain from sex when
they are outside the “infertile phases of the monthly
cycle.”
Arroyo, 61
and a grandmother with three grown children, said in 2003
that when she was a young mother, she took birth-control
pills. She said that she later confessed to a priest.
At the
Manila garbage dump, Espinoza said she has been lucky.
A
nongovernment organization with health workers who
regularly visit the dump told her that an intrauterine
device could prevent her from having another baby. She
plans to visit a clinic this month to get an IUD.
The
organization that is helping Espinoza agreed to introduce
this reporter to her on condition that it not be named.
The group’s health workers said they fear retaliation and
harassment from officials in the national and city
government, as well as from the Catholic Church.
In 2005
Catholic bishops in the
Southern Philippines
announced that they would refuse communion to government
health workers who distributed birth-control devices.
In the
past two weeks, the Catholic Bishops’ Conference of the
Philippines declined repeated requests for comment on its
family-planning policies. The Church leadership made its
last major statement on birth control last fall.
“Chemical
agents and mechanical gadgets that make up the cluttered
display of contraceptive methods of birth control have
caused serious damage in family relationships, disrupting
the unity and openness that build family life by the
effects that accompany the contraceptive culture which
include extramarital relationships, adolescent
pregnancies, and even the hideous murderous act of
abortion,” said Archbishop Paciano Aniceto, chairman of a
bishops’ commission on family life.
In recent
weeks, public alarm in the Philippines over the soaring
price of rice has focused attention on the fast-growing
population and its dependence on rice imports.
Despite
steadily increasing rice harvests, farmers here have been
unable to keep pace with domestic demand. Economists here
have calculated, though, that the Philippines would not
need imported rice if it had managed to control population
growth—like its neighbor Thailand.
In 1970
the population of each country was about 36 million people
and growing at about 3 percent a year. But with an
aggressive family-planning program that provides the poor
with free contraceptives, Thailand has since reduced its
population growth rate to 0.9 percent. In the Philippines
the rate has declined sluggishly to about 2.1 percent.
There are
now about 26 million more people in the Philippines than
in Thailand.
“It’s a
no-brainer,” said Ernesto M. Pernia, professor of
economics at the University of the
Philippines.
The
Philippines now produces 16 million metric tons (MT) of
rice a year—and needs to import 2 million tons more to
meet local demand.
“If the
Philippines had pursued what Thailand has done, the
Philippines would be only consuming 13 MT of rice per
annum,” Pernia said. “We could be a net exporter of 3
million MT.”
Besides
increased food security, the Philippines could have lifted
3.6 million more people out of poverty if it had followed
Thailand’s population-growth trajectory, according to
Pernia’s analysis.
“Even when
there is widespread corruption, insurgent violence and
other powerful reasons for poverty, the evidence from
across
Asia is that good population policy by itself contributes to
significant poverty reduction,” he said.
There
appears to be widespread public support in the Philippines
for modern contraceptives.
Public-opinion surveys in recent years have consistently
found that about 90 percent of respondents supported
government funding of contraceptives for people who cannot
afford them.
Surveys by
the government also show that poor families have
significantly more unwanted pregnancies than richer
families—and much more difficulty finding affordable
contraceptives.
The
problems the poor face in finding contraception products
will increase sharply this year as the Philippine
government and USAID end the distribution of donated
contraceptives, according to Suneeta Mukherjee, country
representative for the UN Population Fund. “The poor
cannot afford to go somewhere and buy contraceptives,” she
said. “Many cannot even afford the transportation. By the
time they go, they are already pregnant.”
The
government’s plan for “contraceptive self-reliance”
anticipates that market forces will make condoms and other
products available in shops or that they will be given to
the poor by local governments.
But
Mukherjee predicted that these new sources will not keep
up with demand. “Access to contraceptives will be
restricted for most of those who cannot pay and for many
who might be willing to pay,” she wrote in a February
report.
A
reduction in the use of contraception—which is now about
33 percent among women of childbearing age—will lead to an
increase in abortions, Mukherjee predicts.
Abortion
is illegal here, but a 2006 study found that there were
about 473,000 a year, which accounts for about a third of
women with unwanted pregnancies. The study also found that
80 percent of abortions had complications requiring
medical treatment.
As for the
efficacy of “natural” methods to control population
growth, Mukherjee said “it does not work.”
At the US
Embassy in
Manila, an official confirmed that USAID would soon end all
donations of contraceptives, after having phased out the
program over several years.
But this
does not mean less US money for family planning. The
official said that USAID has increased its budget, from
about $12 million to about $15 million a year, to provide
technical assistance to 700 local governments and “to help
the private sector to grow the market” for contraceptives.
“We are
working in a devolved setting,” said the official, who
spoke on condition of anonymity. “I am not saying it is a
perfect situation.”
In the
garbage dump on
Manila Bay,
Espinoza said she is nervous about getting an IUD. But she
sees no alternative. “I already have so many kids, I have
trouble looking after them,” she said.
Until her
fourth child was born in October, Espinoza, 26, had time
to work as a scavenger in the dump, collecting plastic
bottles. On a good 10-hour day, she said, she could
collect enough bottles to earn $1. Her husband sells salt
and sometimes makes $4 a day.
Espinoza
is the oldest of nine children and left school after fifth
grade. She grew up in another Manila garbage dump, where
her parents also worked as scavengers.
“I don’t
want any more children,” she said. “Life is hard. Rice is
expensive.” |
