Filipinos
want birth
control, priests don't
In
the Philippines, access to contraceptives is limited for the most part to those
with the means to pay. The Catholic Church has fought a "reproductive
health bill" in the legislature that would change that.
Shortly after sunrise, a woman with soulful eyes and short-cropped black hair
hurried down a narrow alley in flip-flops, picking her way around clusters of
squatting children, piles of trash and chunks of concrete in Manila.
Yolanda
Naz's daily scramble had begun. Peddling small shampoo packets in the
shantytown of San Andres, she raced to earn enough money to feed her eight
children.
She
went door to door in the sweltering heat, charming and cajoling neighbors into
parting with a few pesos. After several hours, she had scrounged enough to buy
a kilo of rice, a few eggs and a cup of tiny shrimp.
"My
husband and I skip lunch if there is no money," Naz said as she dished
rice and shrimp sauce into eight plastic bowls in the 10-by-12-foot room where
the family eats and sleeps.
This
was not the life Naz wanted. She and her husband, who sells coconut drinks from
a pushcart, agreed early in their marriage to stop at three children. Though a
devout Catholic, she took birth control pills in defiance of priests'
instructions at Sunday Mass.
But
after her third child was born, the mayor of Manila — with the blessing of
Roman Catholic bishops — halted the distribution of contraceptives at public
clinics to promote "a culture of life." The order put birth control
pills and other contraceptives out of reach for millions of poor Filipinos, who
could not afford to buy them at private pharmacies.
"For
us, the banning of the pills was ugly," Naz said. "We were the ones
who suffered."
At
36, she had more children than teeth, common for poor women after repeated
pregnancies and breast-feeding.
Undernourished
and living in close quarters, her children were often sick. Measles was
sweeping through the shantytown, afflicting two of Naz's sons and her
3-year-old daughter, Jasmine, who hung like a rag doll from her mother's arms.
"I
pray to God. I pray really, really hard," she said. "Should God
decide to take my kids, just don't let them suffer."
In
the Philippines, a country of 96 million people, access to birth control is
mostly limited to those with the means to buy it. A "reproductive health
bill" in the national legislature seeks to change that: It calls for
public education about contraceptives and government subsidies to make them
available to everyone.
The
church and like-minded opponents have stalled the legislation for 14 years.
Following Vatican dictates, Philippine bishops oppose any
"artificial" measures to prevent pregnancy, sanctioning only natural
means such as periodic abstention from sex.
It's
one example of how religious and political forces affect women's control over
childbearing and, as a result, the trajectory of population growth in the
developing world.
The
church's stance puts it at odds with many of its followers in the Philippines.
Eight out of 10 Filipinos are Catholic. Even for weekday Mass, popular churches
draw huge crowds that tie up Manila traffic.
Polls
show, however, that 70% of the population supports the reproductive health
bill, which also calls for sex education in schools.
Birth
control is a source of political dispute in many societies, including the
United States. In the Philippines, however, the battle has been particularly
acrimonious because of the church's wide reach and influence.
Priests
denounce the reproductive health bill during Mass. Some churches post
billboards with gruesome images of aborted fetuses and the message "NO to
Reproductive Health Bill — YES to the Gospel of Life."
Lawmakers
say the church threatens to deny them Communion if they vote for the
legislation.
In
2010, Benigno Aquino III was elected president after pledging to sign the bill.
Bishop Nereo Odchimar, then president of the Catholic Bishops Conference of the
Philippines, suggested Aquino might be excommunicated if he followed through on
the commitment.
Neither
man's resolve has been tested: After years of debate, a consensus version of
the law has yet to emerge from the Philippine Congress and reach the
president's desk.
For
nearly four decades, the U.S. Agency for International Development was the
major donor of contraceptives to the Philippines, spending about $400 million
total. The administration of George W. Bush phased out the program in 2008,
saying it was time for the Philippine government to take full responsibility.
Then-President
Gloria Macapagal Arroyo refused, deferring to bishops who had supported her
election. She acknowledged taking birth control pills as a young mother but
said she had since sought forgiveness from a priest.
"The
contraceptive pills do not only prevent conception, they even destroy
conception once it is already there," retired Archbishop Oscar V. Cruz
said in an interview. "That is abortion."
Since
U.S. funding ended, affordable contraceptives have become scarce, particularly
in Manila. A patchwork of programs funded mainly by foreign donors provides
limited access for the poor.
According
to a 2008 government survey, 39% of married Philippine women in their
childbearing years said they wanted to avoid or postpone pregnancy but were not
using modern contraceptives. By far, the most commonly cited reason was fear of
side effects. Other reasons included a husband's opposition, cost and lack of
availability.
Half
of all pregnancies in the Philippines are unintended, the survey found.
A
similar pattern holds across the developing world, where an estimated 222
million women want to avoid pregnancy but do not use modern birth control.
If
they did, unplanned births in those countries would fall by two-thirds, as
would the number of abortions, according to an analysis by the U.N. Population
Fund and the Guttmacher Institute, a New York think tank that supports access
to contraception and safe abortion.
Under
that scenario, the global population would keep rising but more slowly.
The
Philippines has one of the fastest-growing populations in Asia. It is on track
to increase by more than half, to 155 million, by 2050.
Greater
Manila is one of the most densely populated places on Earth. About a third of
its 12 million inhabitants live in poverty, many in teeming shantytowns that
sprawl across trash dumps and cemeteries.
Still,
former Manila Mayor Jose "Lito" Atienza, who ordered the removal of
contraceptives from public clinics a dozen years ago, said he sees economic
potential in a growing population.
"Our
people are so talented and so skilled and brilliant and bright," he said,
citing Manila's entrepreneurial street vendors and the 10 million Filipinos
working overseas who boost the economy by sending money home.
"When
you have more people, you have a bigger labor force. You have a bigger social
security base. You have more productivity. You have more consumption. More
production. The whole cycle of the economy moves faster."
Atienza
said he also opposes birth control because he believes it "weakens the
family" and is in conflict with the Filipino Constitution's protection of
the unborn.
"Government
should not spend government funds for this purpose," he said.
Erlinda
A. Casitas presses her thick thumbs into her thigh to demonstrate how she
dislodges a fetus and massages it out of the womb.
"I
usually feel for the baby, for the swelling, and then I apply pressure
gradually downwards," said Casitas, a middle-aged woman with wide-set
eyes. "I'm very careful. If I apply too much pressure, the patient will
experience shock or the woman will get bruises."
Abortion
is a crime in the Philippines, unless a board of medical professionals deems it
necessary to save the mother's life.
Casitas
is a hilot, one of the massage abortionists who perform a large share of the
estimated 475,000 illegal abortions in the country every year. Before she gives
the aggressive massage, Casitas has her clients take three tablets of Cytotec,
an ulcer medication sold on the black market and used to bring on uterine
contractions.
Many
women seeking abortions go to the area around Quiapo Church, in old downtown,
where street vendors sell crucifixes and statues of the Virgin Mary, alongside
bitter herbal brews such as "Pampa Regla" (which means "induce menstruation"
in Tagalog) to end pregnancy. Cytotec is on sale, too, but kept out of sight.
"Everyone
knows about Quiapo," Casitas said.
Among
her clients, she said, are "mothers who have many kids, who can no longer
afford to have more children," and mothers with children under a year old
who want "birth spacing."
Casitas
said she doesn't have a fixed fee. She often asks patients for a $20 donation,
less if they are very poor.
"First
what I do is to pray to God and ask for forgiveness," said Casitas, a
practicing Catholic who wears a small silver crucifix around her neck.
"I'm telling God I'm not charging a big amount…. It's just like helping
the patient with her problem."
"I
think God hears my prayers because so far I haven't had any patient who
suffered any hemorrhage and has to be rushed to the hospital."
Casitas
said she quizzes clients on why they got pregnant. "I advise the women to
use pills, injectables (hormones) or
IUDs."
She
knows many will not follow her advice, or cannot afford to. But she said she
has a strict rule: "I only allow myself to help a woman twice. So when she
comes to me to abort her first pregnancy, I do it. If she comes back to me a
second time, I do it. The third time, I refuse."
When
illegal abortions go awry, the patients often end up at Dr. Jose Fabella
Memorial Hospital in Manila, the largest women's hospital in the Philippines.
On a
spring day in one ward, injured women lay on cots, one beside the other. One
patient was moaning and barely conscious, her blood splattered at the base of
the bed. She'd been rushed there, delirious from fever and infection. Her skin
was ashen from losing a third of her blood.
She
was 28, an upholsterer's wife with four children. Pregnant again, she was three
months along when she tried to abort the fetus by drinking a bitter herbal
brew.
Some
hospitals in the Philippines refuse treatment in such cases and call the police
because staff members see the women as criminals and sinners, according to
doctors and nurses at Jose Fabella.
Here,
doctors say they ask few questions and treat the injured. Cleaning up botched
abortions, however, is the second order of business at Jose Fabella.
No.
1 is childbirth and keeping children alive.
More
than 17,000 babies a year are born at the hospital — the nation's busiest —
inspiring its nickname, "Baby Factory."
In
the delivery room that day, teams of doctors and nurses had their hands full
with two births in progress. A half-dozen women in various stages of labor
waited on gurneys.
In
the hallway, wheels clacked across the white tile floor. A gurney burst into
the delivery room led by a nurse holding a newborn in outstretched hands. A
coiled umbilical cord connected the blue-tinged baby to a woman lying on her
back, hair matted.
She
had just arrived by cab. The newborn girl couldn't wait.
Dr.
Maria Lu Andal moved in to clear the baby's airways and snip the cord. The baby
began to cry, turning bright pink as a crew of assistants swarmed mother and
child, swabbing, draping, measuring and tagging.
In a
room nearby, newborns lay shoulder to shoulder on tables for nurses to weigh
and measure. Oversize recovery rooms contained rows of worn metal beds, each
shared by two mothers and their newborns.
In
the neonatal unit, 68 babies lay in incubators, many of them dangerously
premature. On average, about a third die, doctors said.
Andal,
in dark green scrubs, a hairnet and mask, recalled that she once delivered 36
babies in a four-hour shift.
"It's
like an assembly line," said Dr. Ruben Flores, who directs the hospital
and its 1,200 employees. "It never stops."
This
was the quiet season. Only 63 babies were delivered this day, about half the
hospital's capacity.
"That's
what they say: It's a baby factory," Flores said. "But I say, we
didn't produce the babies. We just deliver them. These babies were produced at
home."
The
Naz family gathers for a meal, in the same room where everyone sleeps. When
food is especially scarce, only the children eat. About a third of Manila's
residents live in poverty. (Rick Loomis / Los Angeles Times) More photos
Yolanda
Naz began to stack up the plastic bowls and plates from the midday meal. Her
family had devoured every morsel.
A
boy came to the door with an orange garden hose. For a few pesos, Naz can fill
a plastic barrel with water for cooking, cleaning and bathing.
Naz
picked through the remaining coins from her shampoo sales to see if there was
enough for the next meal.
On a
good day, her husband, Noel, earned about $5 selling coconut drinks from his
cart. That was enough to pay for rice, instant noodles, some eggs, vegetables,
even some milk and a diaper for the baby. But Noel is afflicted with a racking
cough that often keeps him from working.
Naz
sometimes buries her pride and asks neighbors for a loan of 10 cents or a bit
of food.
A
few years ago, one of her neighbors asked her to join a lawsuit by women's
rights groups seeking to overturn Manila's ban on contraceptives at public
clinics. She became a plaintiff, along with 19 other poor residents of the
capital.
These
women and a few of their husbands are asking the court to grant them access to
birth control pills, condoms and IUDs, a rare challenge to church authority.
The
case has been thrown out twice, once by the Philippine Supreme Court because it
lacked a signature from one of the 20 plaintiffs. It was refiled in a lower
court, where it has been essentially frozen for three years.
Naz
said she'll always be a Catholic. That doesn't mean she agrees with the priests
on everything.
"When
I go to Mass, I hear the priest give sermons saying that pills are bad,"
Naz said. "But whenever I hear that, I just say to myself that for me,
it's not evil, it's not bad or it's not sinful.
"What
is more sinful is to have more children than I can afford to feed." (Kenneth R. Weiss, Los Angeles Times)
