Vulnerable. The 13-year old was admitted to the Southern Philippines Medical Center (SPMC) in Davao City not for complicated mumps or gastroenteritis or even severe acne. She was there to give birth.
It happened all too often, that unfortunate story of a girl-boy sexual situation that resulted in a kid having a kid, says Freyza Muana, midwife and health provider of the SPMC’s Center for Teens. In her daily rounds through the OB Ward, Muana identifies an average of 6 to 7 girls-turned-mommies and schedules them for counselling at the Center.
Based on the Center’s records, SPMC has a total of 1,296 deliveries of girls all under 19 years old from November 2015 to June 2016. Although SPMC requires that all post-partum teens go through counselling prior to discharge, not all of them do.
Unprotected. She has seen returnees, says Muana, and around one or two girls rushed to SPMC in a month for obviously botched abortions and complications. It is the family’s responsibility to protect these girls, she said, as everything starts there. But in a focus group discussion with five of the girls who gave birth at SPMC, the parental warnings were aplenty, and they, in fact, knew the consequences: “matitigil ang pag-aaral,” (our schooling will stop) “masisira ang pangarap,” (our dreams will be broken) “maghihirap ang buhay” (our lives will not get better) but still they had unprotected sex. The reasons for sexual intimacies varied. But all of them admitted that they did not know when and how they could be pregnant and most telling of all, nobody ever told them that there were ways to protect themselves.
More vulnerable. More unprotected. Having teen centers is crucial in counseling the girls who have given birth, and referring those who opt for contraceptives to the OB departments. But many health providers are jittery that even if they provide counseling, the contraceptive supplies that the girls badly need may run out leaving them more vulnerable and more unprotected.
Legal manueverings and the threats to contraceptive supplies
Media has largely reported about how the Alliance for the Family Planning Foundation of the Philippines (ALFI) maneuvered for the Supreme Court to issue a Temporary Restraining Order (TRO) in June 2015 enjoining the Department of Health (DOH) and Food and Drug Administration (FDA) from procuring or administering the hormonal contraceptive, “Implanon” and “Implanon NXT.”
It was, however, way more than that. What was not made as widely known in the TRO was that the Supreme Court also barred the FDA from “granting any and all pending application for registration and/or re-certification of reproductive products and supplies, including contraceptive drugs and devices.” Despite the FDA’s regulatory processes and tests, it was still directed to follow due process (i.e., publication, notice and hearing) on every application and renewal of registration of all contraceptives.
ALFI, a conservative group touting “family protection,” has oppositions for 77 modern family planning commodities for being allegedly abortifacients. As a consequence, the TRO bound FDA to hear all oppositions for the 77 commodities even if the agency is already tasked by law to conduct tests on all drugs and health products for safety, efficacy, purity and quality before they are made publicly available. Curiously, many of the contraceptives opposed by ALFI had been commercially available for more than 20 years, the registration of which had been renewed by FDA several times.
READ MORE: G.R. No. 217872 (Alliance For The Family Foundation Philippines,l nc. [ALFI] and Atty. Maria ConcepcionS . Noche,i n her own behalf and as President of ALFI, et al. vs. Dr. Janette L. Garin, Secretary-Designate of the Department of Health, et al.)
This is a health crisis!” said Chi Laigo Vallido, Director for Programs and Advocacy of the Forum for Family Planning and Development. As a consequence of the ruling, Vallido said around 40% of contraceptives with expiring certifications this year may not have their registrations renewed to ensure their continued availability in the Philippine market.
By 2019, she said, there will be no more safe and legal contraceptives available and 750,000 women who need them will have to buy outside of the country or resort to the black market.
According to the Population Commission (POPCOM), the Certificates of Product Registration (CPR) of 15 contraceptives have expired in December 2016. And by 2018, the CPRs of 90% of family planning commodities will expire. Despite this, the Supreme Court denied the motion of the DOH, through the Office of the Solicitor General (OSG) to lift the TRO unless the FDA follows due process particularly the conduct of public hearings.
In November 2016, four NGOs have questioned the necessity and propriety of conducting hearings particularly when ALFI’s main contention for due process was contraceptives’ alleged abortifacient qualities. The NGOs — the Filipino Catholic Voices for Reproductive Health (C4RH), Philippine NGO Council on Population Health and Welfare (PNGOC), Philippine Center for Population and Development (PCPD), and Philippine Legislators’ Committee on Population and Development Foundation, Inc. (PLCPD) — filed a “Motion for Leave to Intervene and to Admit Intervenors’ Omnibus Motion.”
The FDA’s certification process, according to the NGOs’ motion, is not the venue to discuss whether a drug or device is abortifacient. “Scientific and/or medical analysis and demonstrations are clearly more credible, efficient and appropriate, than the notice and hearing requirements applied in legal or judicial proceedings,” the NGOs wrote in their motion.
Government pushes for implementation of Reproductive Health Law
President Rodrigo Duterte signed Executive Order (E.O.) on 9 January 2017 directing government agencies and local government units to make sure women who need family planning are provided with information and services.
The irony is as obvious as it is sad. “Now who is really pro-life?” sighs Dr. Wes Dulawan, a public health practitioner, in reference to ALFI which on its website, professes to “protect life in all stages of development” but whose actions to restrict contraceptive access put the lives of women in more danger, and President Duterte whose drug war has been criticized by human rights advocates.
According to Phelim Kine, Deputy Director of the Asian Division of Human Rights Watch, the death toll of Filipinos killed as part of President Duterte’s drug war has surpassed the 7,000 mark. Based on the Philippine Statistics Authority, adolescent pregnancy is increasing with the birth rate of 15-19 year olds at 57 per 1,000 live births. The UNFPA has continuously warned that the consequences of pregnancy before age 18 threaten not just the girls’ education, health or other opportunities but their very lives.
The Threat to Girls
“I have talked with 12-year olds, 13-years olds, 14-year olds, all pregnant girls. Some have just given birth,” sighs Dr. Dulawan, who had assessed an NGO’s adolescent reproductive health program in Mindanao last year. “If not for the midwives and nurses in teen centers, hospitals and health centers who counselled the girls and provided family planning options, what do you think would have happened to these kids? Do you think they would have gone back to school and had better lives? Of course not.”
According to the 2013 Functional Literacy, Education and Mass Media Survey, the top reason why kids ages 16-24 stop attending schools is union or marriage (22.9%), particularly for girls (36.2%). Insufficiency of income comes in only as second reason for stopping schooling (19.2%).
Dulawan says, “The kids said they would have simply dropped out of school, gotten married, had more kids. Their peers, other girls, are already into vices. And then what?”
Freyza Muana says the 1 to 2 girls she sees monthly rushed to SPMC with post-abortions complications have been reduced. There were more abortion cases before but with intensified adolescent reproductive health efforts to reach the girls in the OB wards, they hoped to save more lives and futures. With an FP crisis in contraceptive supplies if the TRO is not lifted, Muana may see more than the 1 to 2 kids desperate not to have kids, more than the 6 to 7 kids already having kids. And then what.
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