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Lourdes Osil, 33, is a resident of San Andres Bukid, Manila. Her husband, Jessy, is a tricycle driver who earns about Php100 (USD2) a day.

Osil,  Jessy  and their seven children live in a small shanty with her parents and her sister’s children. All in all, there are about twenty one people living in their tiny home.

According to a report made by the Reproductive Health, Rights, and Ethics Center for Studies and Training (ReproCen), Osil only wanted to have four children. After her third child, she wanted to wait before getting pregnant again and went to the public health center to get injectables. She was informed that such methods of contraception were banned by then Mayor Lito Atienza under Executive Order 003 filed in 2000.

The city ordinance states, “the City [of Manila] promotes responsible parenthood and upholds natural family planning not just as a method but as a way of self-awareness in promoting the culture of life while discouraging the use of artificial methods of contraception like condoms, pills, intrauterine devices, surgical sterilization, and other.”

Manila, a city of more than 1.5 million, has the highest population density of any major city in the world. Of this number, there are more than half a million women of childbearing age. That’s half a million women who have limited access to modern forms of contraception and are rendered powerless over their own bodies; over their own lives.

In 2008, Osil and her husband along with 18 other residents of Manila filed a case challenging the constitutionality of Executive Order 003.

Atty. Elizabeth Pangalangan of the UP College of Law and also a member of ReproCen, is representing Osil and the petitioners. “EO 003 is a violation of a couple’s right to privacy and health. It is not for the state to determine how couples should plan their families,” Pangalangan said.

“All the petitioners are of legal age, married or in long-term relationships. They are not promiscuous or engaged in the sex trade industry,” she added.

The Court of Appeals dismissed the Osil vs. City of Manila case on a technicality.  The petitioners were orderd to file the case before the Regional Trial Court of Manila. This was filed in April 2009, and more than one year and a half later, the case remains unresolved.

Meanwhile the women of Manila continue to suffer and remain helpless as they continue to have more children than they want or can afford.

Imposing Misery

The stories of these women,  which are very much similar to that of Osil’s are documented in, “Imposing Misery: The Impact of Manila’s Ban on Contraception”, a study done by Linangan ng Kababaihan, Inc. (Likhaan), Reproductive Health, Rights and Ethics Center for Studies and Training (ReproCen) and the US-based Center for Reproductive Rights.

Interviews with more than 67 different individuals ranging from Manila and city health officials were conducted from November 2006 – January 2007.

The study revealed that EO 003 compounded the respondents’ already hard-pressed hand to mouth existence and affected maternal and new born health. In some cases, marital relations were strained as women had no other recourse than to avoid sex altogether with their husbands. Some women were accused of infidelity as the reason for refusing sex with their husbands and beaten.

One woman who has eight children was advised by her doctor not to get pregnant after her fourth child because of her poor health:

“The doctor at OM [Ospital ng Maynila] advised me not to get pregnant anymore because of my rheumatic heart condition. I wanted to have ligation but OM hasn’t been providing FP [family planning] services. I was referred to Fabella Hospital but I couldn’t afford the 2,000 peso fee.”

Another woman with eight children was worried about getting pregnant again because of her health and financial problems, but could not afford contraception now that free supplies were no  longer available at her health center and hospital. Most of the time, she refused sex with her husband as a way of avoiding pregnancy. Her husband became abusive and violent towards her:

“My husband and I would quarrel when I refused to have sex for fear of getting pregnant. He suspected me of having an extramarital affair. He would hit me on the thighs. He left us for the province and didn’t communicate. I went to my sister’s place with my six children and worked as a laundry woman to support myself and my children. We were separated for one year.”

Some women simply succumbed to their husbands to avoid confrontation and abuse:

We used to fight, shout at each other when I refused to have sex. My husband would get mad when I refused and grab me. Because of these problems, we separated for three months during which time I lived with my mother. I feel embarrassed if people learn that we fight because of sex so now I just give in to my husband’s sexual needs, all the time. Ako na lang maghahanap ng paraan para di mabuntis. [I take it upon myself to look for ways not to get pregnant.]

Contrasting two cities: maternal death

In direct contrast to the City of Manila, Quezon City, has been supporting family planning programs since the term of Mayor Sonny Belmonte. In 2008, Quezon City took a step further by passing a Family Planning Ordinance that would insitutionalize availability of services and budget allocation.

Councilor Joseph Juico of the First District of Quezon City gave a background on the rationale for passing the city’s Family Planning Ordinance in 2008.  “This actually came from a recommendation from our Anti-Poverty Task Force. They conducted a study and [among their findings], it showed that maternal death and infant death were both high. The population growth rate of Quezon City was at 2.4% which is way above the normal 1.3%. When this ordinance was passed, we allocated a budget Php12M for family planning services; from the previous Php2-Php3M.”

The City of Manila does not allocate budgets to provide information on family planning methods, apart from natural family planning. Mayor Lito Atienza, with the passage of EO 003, instead rewarded families with many children by giving them sacks of rice.

Health NGO Cooperative Movement for Encouraging Non-scalpel vasectomy (CMEN) collected data from the Department of Health Field Service Information System and compared the maternal death and infant death in Quezon City and the City of Manila over the 10-year period from 1996 to 2006.

The report entitled, “Contrasting Two Cities” showed that the maternal mortality rate (MMR) declined in Quezon City, from a high of 14 deaths per 100,000 live births in 1997 to about three per 100,000 in 2006; while in Manila, it declined from a peak of about 12 deaths per 100,000 in 2005 to about seven per 100,000 in 2006.

Comparison of maternal deaths in Quezon City and Manila. Graph courtesy of CMEN.

Furthermore, the study stated: “This gives an indication of what is better for women, couples, and their children. Supporting family planning reduces the deaths of women that are caused by getting pregnant too often or too many times, getting pregnant at very young or very old ages, and when the woman is too sick or unable to nurture more children. We believe that part of the decreasing maternal deaths in Quezon City is due to their encouragement of FP and reduced births per woman. In contrast, it is also possible that the increasing maternal deaths in the City of Manila are due to the policies against family planning there.”

According to the  2009 UN Children’s Fund report, The State of the World’s Children, the Philippines has an MMR average of 230 per 100,000 live births. Health officials predict the 2015 Millennium Development Goal of 55-60 per 100,000 live births will not be met.

Manila City Health Officer, Dr. Gina Pardilla was asked about these studies and said, “These studies are only meant to give indications. There are only 6 public hospitals (in Manila). All the rest are privately owned, but we look at maternal deaths that happen in a certain place. What about those who come from other provinces and just stay in Manila?”

Pardilla added, “The ordinance doesn’t ban anything. It only discourages artificial forms of family planning.”

Beth Angsioco, chairperson of the Democratic Socialist Women of the Philippines (DSWP), said, “They really cannot ban it [modern contraception], because it would be against the law to do so, but in reality, that is what is happening.”

“In the City of Manila, it’s very very tragic indeed.”, said Ben de Leon, president of Forum for Family Planning. “Executive Order 003 of the former Mayor Lito Atienza has really given so much disadvantage to the women who are clamoring for information and services. Under the present leadership of Mayor Lim, while it seems as if he is neutral, my take is that he is also not in favor of family planning in the city of Manila.”

Lack of support from the national government

The previous Arroyo government was known to be an avid supporter of natural family planning. According to a report cited by the UN Human Rights Watch”

“In late 2003, President Arroyo was praised by religious conservatives for taking Pesos (P)50 million (U.S.$888,000) from a fund allocated to contraceptive programs under former President Joseph Estrada and awarding the sum to a nongovernmental organization (NGO), Couples for Christ, to teach natural family planning methods.”

Dr. Alberto Romualdez, former DOH Secretary further added, “This is the direct result of the previous government’s policy of being anti-RH and saying that the national government will no longer provide the information and services, because this responsibility has been delegated to local government. This is one of the major failures of the Arroyo government by not supporting the national family planning program.”

“Manila is a very good example of what happens when national government denies their responsibility. This is one reason why we should  have a RH bill legislated.”, Romualdez concluded.

What difference can the Reproductive Health Bill make in the lives of women? The conclusion of this three part series aims to answer that question.

This three part series is produced under a media fellowship grant awarded to Sex and Sensibilities.com by the Probe Media Foundation.