“I didn’t know I would end up pregnant. He said everything will be okay,” Johaina Rahman, 17 and six months pregnant, recalls the night she thinks her boyfriend knocked her up. For Emalyn Sabtal, 27, “it was the night he didn’t pull out on time,” or when her husband’s use of “withdrawal” to prevent pregnancy failed, resulting in her third childbirth even if they planned to stop after their second.

In a country reeling from a spike of early and unplanned pregnancies, Johaina and Emalyn are just two faces of that statistic which development planners are terrified to see crawling up the demographic charts every year. But the number of women who give birth every year, recorded in the National Demographic and Health Survey (NDHS) in 2017 at 1.7 million — is worrisome in absolute numbers: 194 babies per hour or three babies born per minute.

Women in Emalyn’s age group are responsible for having  three babies born per minute in the country, many of them also unintended and unplanned. Johaina’s 10-19 age group who make up 10% of the total population of females shares a chunk of the figure. When broken down, the 2017 NDHS recorded nearly 200,000 girls aged 15-19 who get pregnant each year: 500 babies born each day or 24 babies per hour. It is more dismal that 1 in 10 girls aged 15-19 have begun childbearing: 8% were already mothers and 2% were already pregnant with their first child.

Read related article: Midway and pending: the Philippines’ demographic dream

Interviewed during the World Contraception Day activity in Zamboanga City in September 2019, Emalyn, who brought her eight-month-old son Alwahid, joined an audience as government and civil society advocates talked about family planning. “My husband should be here,” she said of her spouse, a tricycle driver, who had to work but will just pick them up after the event.

Johaina, the only pregnant girl in a roomful of girls and boys who participated in a parent-teen talk on sexuality and reproductive health, listened to an adult expert talk about understanding changes in the body and postponing sexual contact, something she said she was hearing for the first time. She hears grown-ups tell sex jokes and sees stuff online, but that’s it.

“If only there was someone who told me about all these,” she said. She sees girls her age married off early, but she didn’t want that because she had a dream. “I wanted to be in college, work overseas, then think about marriage when I have my own money.”

Emalyn blames both herself and her husband for their unsuccessful plan to having just two kids, “but more on him because he doesn’t use condoms and doesn’t listen when I tell him I forgot to take my pills so sex is risky.”

Teens listen to a talk about sexual behavior
Teens listen to a talk about sexual behavior

The faults in macho men

While Johaina and Emalyn would blame themselves for getting pregnant, their male partners were equally responsible. Decisions about sexual activity, preventing pregnancies, and parenthood requires male responsibility and participation.

“They feel they are less of a man when they are asked to be involved,” said Socioeconomic Planning Undersecretary Dr. Juan Antonio Perez, who is also the executive director of the Commission on Population (Popcom). “We work to make men aware that what they think and do affect their lives and the future of their female partners and their children,” he said. “We want to demonstrate that the culture and tool of machismo has no role in human development.”

He admitted that this is easier said. The challenge of changing male behavior is difficult because of patriarchy and male entitlement into which many Filipino boys grow up. Exposed to the normative and cultural dictates of masculinity, boys model behaviors that display their strength including having a strong sexual drive and its tangible showcase, children.

Perez disclosed that most women want bilateral tubal ligation (BTL), a permanent family planning method that stops the travel of eggs from the ovaries to the fallopian tubes, which are cut and tied up, preventing pregnancy after sexual contact.

“These women who want to stop childbearing because they have achieved their desired number; which is 2 children, at most 3, while the men want 4 kids or more,” Perez said. “Men want many children but they leave the responsibility of pregnancy and birth spacing to their female partners. Why should it always be the women who take responsibility?”

Popcom and its government and civil society partners enjoin the males to take an active role in family planning through no-scalpel vasectomy (NSV), a procedure that cuts and ties up the vas deferens, the tube in the male reproductive system that carries sperm, to stop the sperm from entering the urethra to prevent fertilization during sex. This male sterilization method has its attendant myths, but Perez said men must be aware that vasectomy does not emasculate but instead frees them from worrying about pregnancies while enjoying a healthy sex life.

Male responsibility

PopCom also carries out Katropa program, or Kalalakihang tapat sa responsibilidad at obligasyon sa pamilya. “Tropa is a military term that appeals to men, referring to a group organized formally or informally; just like kakosa, also a term meaning friend or buddy,” Perez said. Popcom says Katropa is an innovative aspiration that supports men to be responsible individuals, parents and partners on family planning and healthy and safe pregnancy for their partners. There is also MR. GAD or Male Responsibility in Gender and Development, a program for attitude and behavior change among men.

In March 2019, President Rodrigo Duterte tasked PopCom and the Department of Health to intensify the National Program for Population and Family Planning (NPPFP) in the next four years by doubling the number of men and women who practice family planning from 6.5 million to 11.3 million, or a modern contraceptive prevalence rate of 65% by 2022.

Apart from the pill and condom, modern contraceptives include subdermal implants which are tiny, thin plastic rods or capsules inserted under a woman’s arm that prevent ovulation and pregnancy for three years; the copper-bearing intrauterine device (IUD), a small, flexible plastic frame with copper wires inserted into a woman’s uterus through her vagina and cervix and works by causing a chemical change that damages sperm and egg before they meet; and injectables depot medroxyprogesterone acetate (DMPA) and norethisterone enanthate (NET-EN) that contain two hormones—a progestin and an estrogen, which prevent ovulation.

Dr. Juan Antonio Perez talks to women about to undergo bilateral tubal ligation at Ziga Memorial Hospital in Tabaco City, Albay in March 2019
Dr. Juan Antonio Perez talks to women about to undergo bilateral tubal ligation at Ziga Memorial Hospital in Tabaco City, Albay in March 2019

Mobilizing the troops

With heightened focus on males, Perez said he has reached out to Interior Secretary Eduardo Año and leaders of the Philippine National Police, Department of National Defense and Armed Forces of the Philippines to encourage police officers and military men to undergo NSV. Popcom is also approaching firemen, barangay councilmen and other male groups.

“We are starting with the tropa mentality of men. Soldiers, police, barangay tanod, and even the TODAs (tricycle operators and drivers associations) are easy to mobilize,” he said. “Men are more comfortable interacting with each other around shared interests, such as sports and drinking. They are socialized to compete in structured ways and they do not show too much affection,” he said, but he expected that “once a strong connection is established, individual men will come in.”

Perez cited soldiers as needing family planning services. When a soldier comes home from assignment, he should seek services to help him and his wife plan their families and avoid unintended pregnancies.”We always say mga lalaki yan eh, but we forget that their expressions of masculinity have faulty consequences if not addressed responsibly.”

No-scalpel vasectomy

Popcom launched the NPPFP in Tabaco City, Albay in March this year. The city, while having the highest teen pregnancies in Albay, was chosen for starting a program among more than 100 padyak (pedicab) drivers.

Tabaco City Mayor Krisel Lagman-Luistro cited “usapang macho” that entails counseling and discussions, most of it to convince men who have attained their ideal number of children to undergo NSV. “We tell the men and their wives that NSV is so convenient they can have the procedure and go back to their padyak after,” she said.

In the Tabaco City event that offered free, voluntary services, only 4 men showed up for NSV while 30 women underwent BTL. One of the men, padyak driver Richard Bacarra, 24, who has 4 children with his 20-year-old wife, celebrated his birthday by undergoing surgery. “It took only 5 minutes,” he said of the procedure. “We think we can only provide for 4 children so we have to stop.”

Recourse from broken dreams

For Emalyn and Johaina of Zamboanga City, the option was to learn and live. They went home with information materials, condoms, lubricants and information from the sessions they attended. “I will go to the health center and seek advice,” said Emalyn, herself thinking about tubal ligation.

While her new knowledge about responsible teen sexual behavior came too late, Johaina promised to go to her first pre-natal visit. “I didn’t know a pregnant woman has to have four pre-natal checkups.”