When Cyrene Villar, 24, gave birth to her son Amir, now one-year-old, she wanted to recover from her difficult pregnancy and hopefully not be pregnant again.  Not that she did not cherish the blissful moments of expecting a child, because to her, the promise of a baby was momentous and unalterable.

“I want to concentrate on taking care of Amir. His needs are too much to put up with on a daily basis,” she said. So she asked the health worker in her barangay to administer a sub-dermal implant on her forearm. She now enjoys the freedom of not fearing another pregnancy in the next three years. Her husband did not want to approve at first as they have an only child, but he agreed later when told that the three-year spacing is helpful to Cyrene and Amir’s health.

Villar, a resident of barangay Santo Cristo in Tabaco City, Albay, attended a session with other young mothers in the barangay health center when interviewed for this story. The session is a regular gathering where the village’s women of reproductive ages are invited to listen to health workers explain the use of family planning methods, learn about child rearing and family health care, and to socialize.

For Mary Ann Matilla, 23, the choice is having the intrauterine device (IUD), which at first frightened her because of the fact that it will be inside her for 10 to 12 years. But she conquered her fear and decided that it is the best family planning method to prevent another pregnancy, as she already has two children now aged five and two. “It’s a no-fuss, no-worry method,” she said of the IUD that was inserted in her uterus in July 2018.

Prior to the IUD, she was offered an implant, which she refused, and an injectable, which works for about three months at a time and women have to have one shot four times a year to prevent ovulation and, subsequently, pregnancy. She said her live-in partner respects her choice. “I am thankful that he understands my situation. Not many women have a partner like mine,” she said.

Throughout the country’s more than 40,000 barangays, sessions like this in Santo Cristo, Tabaco City’s version of Tondo, Manila’s underprivileged population, occur on a regular basis for as long as there are women needing reproductive health services. The meetings are conducted in such forms as family planning motivational seminars, one-on-one family planning counseling and buntis (pregnant) class. Depending on the demographic grouping, there are also parent talk and teen talk sessions.  But in most of these village activities, the clients are women.

Mary Ann Matilla (2nd from left) and barangay health workers
Mary Ann Matilla (2nd from left) and Barangay Health Workers

Hazel Cardona, population program officer of the Albay Provincial Health Office, said women, not the men, are still the ones expected to practice family planning and use their preferred contraceptive. In most cases, this is with the consent of their husbands or male partners. The decades-old situation where a woman’s decision to stop, limit or space her pregnancies and to choose a method has to get approval from her male partner is still happening, but she said things are slowly changing.

″Many women are getting ahead with their decisions,″ she said. ″When a woman asks me for an implant or a shot of the injectable contraceptive, I grant her request immediately. It will be good for her, it will save her,″ she said.  Herself a nurse and a mother of two.  Cardona said a lot of women are now making their reproductive health choices and decisions without or with little participation from their male partners.

She said, however, that there is yet no equal roles for men and women when it comes to planning the number of children that they want and in how to do it. For their part, men have limited number of choices. First is the condom, also called the barrier method to prevent pregnancy on his female partner and sexually transmitted infection. Second is  the no-scalpel vasectomy (NSV), also called the male sterilization method that is a non-invasive procedure requiring only a small puncture made on the scrotum to access and cut the vas deferens that transports the sperm. The NSV can take only about 20 minutes or less and is the improved version of traditional vasectomy that requires the use of scalpel to make a cut in the scrotum.

Apart from engaging the women to the counselling session, Cardona also invited them and their male partners to free NSV and bilateral tubal ligation (BTL) procedures at Tabaco City’s Ziga Memorial Hospital in mid-March in a campaign of the Commission on Population (Popcom), an attached agency of the National Economic Development Authority, and the local government of Tabaco City where Popcom re-launched the government’s  National Program for Population and Family Planning.

Hazel Cardona explains family planning to young mothers
Hazel Cardona explains Family Planning to young mothers

BTL, which is a surgical method of family planning, entails tying or clamping a woman’s fallopian tubes to prevent her eggs from going to the uterus for implantation.

Both NSV and BTL are permanent surgical family planning procedures. In the Popcom campaign in Ziga Memorial Hospital, there were 30 women family planning ″acceptors″ who turned up for BTL and only four men underwent NSV.

One of the women, Salve Maranan, 25, emerged from the operating room clutching pain relievers and other medicines prescribed for her recovery. ″Mabilis lang po ako mga 15 minutes (It was fast; I was done in 15 minutes),she said, although she was limping from apparent discomfort. She was given a Jollibee packed snack while in the recovery room.

Maranan, who has two children, said she asked her husband to accompany her and perhaps also consider NSV, but he had to work. They haven’t discussed her undergoing BTL but even without a final decision, she said she had to do it. ″I don’t want to linger and wait for him. I might even get pregnant again while waiting for him to decide. He’s not the one who bears babies anyway.″

Women listen to a medical worker of Ziga Memorial Hospital prior to ligation
Women listen to a medical worker of Ziga Memorial Hospital

Socioeconomic Planning Undersecretary Dr. Juan Antonio Perez, who is also Popcom executive director who led the family planning program launch, caravan and campaign, said the low uptake among men in contraception, even with NSV which can take a few minutes only and is very convenient, is the biggest challenge to government.

He said the 2017 National Demographic and Health Survey (NDHS) found that two million women want to undergo BTL as they have achieved their desired number of children and do not want more, so they want to stop having children altogether. ″This would mean that we should perform two million ligations in the next four years, which is difficult given the limited medical manpower,″ he said.

Challenging the men

The crucial thing to do now, he said, is to turn to the two million husbands and male partners of these women and ask them to share in the responsibility. He said this goal will clash head on with the machismo of Filipino males.  ″We want to challenge them,″ he said.

As not all men turn up to be like the more considerate husband and partner of Cyrene and Mary Ann, Undersecretary Perez said the family planning program, which was re-launched after undergoing revisions to cover a more expanded government and civil society partnership, will turn on a very special attention to the men.

Based on the 2017 NDHS, Perez said only less than 1 percent of males have availed themselves of male sterilization, which is NSV, and only 2 percent have used condoms as family planning methods.

The survey, which is conducted every five years or depending on government budget and usually with foreign support, provides indicators on fertility, family planning practices, childhood and maternal mortality, HIV and AIDS awareness, and violence against women that are  crucial in policy-making and planning health programs. The 2017 survey covered over 31,000 households and more than 25,000 women age 15-49.

“Health volunteers in local governments have started educating men about family planning. Their response to it may be slow and gradual but we are making progress,” he said.