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Thursday, August 30, 2007

MDG Music Video (Tayo-Tayo Rin)

With the recent MDG Midterm Review showing the Philippines lagging behind in achieving the said targets, intensified advocacy campaigns to meet them are in order. In view thereof, I am posting here the Music Video of the MDG song performed by well-known Filipino artists.

It must be noted that said Music Video was awarded BEST MTV in last year's Catholic Mass Media Awards (CMMA). Consequently, the various artists featured in this video rendered their services pro-bono.

Special mention to Dino Subingsubing of UNFPA who uploaded this file in the YouTube. =)And to Dr. Zahidul Huque [UNFPA Representative in the Philippines at that time] who was the Head of the UN Team which made this video a possibility.

Monday, August 27, 2007

Reproductive health bill tries to address Church concerns

To RH/PopDev ADvocates, it seems policy advocacy efforts and initiatives are bearing fruit. Hopefully, this congress makes the difference!!!


RH Bill tries to address Church concerns

By Christian V. Esguerra
Inquirer
Last updated 11:20pm (Mla time) 08/26/2007

MANILA, Philippines
--There’s some bad news and good news for the Catholic Church and pro-life advocates.

An administration lawmaker has resurrected a piece of a legislation previously criticized for allegedly trying to control population growth in the country.

Mindful of the dispproving views of the Catholic hierarchy, Iloilo Rep. Janette Garin said her Reproductive Health Care Act, omitted contentious issues that led to the demise of similar bills in the 13th Congress.

Gone was the provision which encouraged couples to stop at two children in exchange for a government scholarship and other benefits, according to the lawmaker.

Garin’s bill made optional sex education and the provision of artificial family planning methods such as the use of pills, intrauterine devices (IUDs), and Depo Provera injectables. Many of these techniques were described as abortifacients by pro-life advocates.

“I hope this (new bill) will now be acceptable to the Church,” Garin told the Philippine Daily Inquirer (parent company of INQUIRER.net) in an interview. “We excluded the contentious provisions so there should be no problems.”

Garin, a physician, said her bill was centered on educating the public on reproductive health and allowing couples to choose between natural and artificial family planning methods.

“The point here is to educate people on what method is most suitable for them,” she said.

The information-dissemination approach was not exactly new in the protracted debate between pro-life and pro-choice advocates.

In the government’s previous “Ligtas Buntis” program, the Department of Health went around the country to educate the public on reproductive health. But government health workers were criticized for allegedly selling only the idea of artificial methods.

“That’s because they’re easier to teach than the natural method,” one former health worker told the Inquirer newspaper.

Garin initiated the debate on an effective reproductive health measure by delivering a five-page privilege speech.

“My dear colleagues, I am very much aware of the differing views on reproductive health,” she said. “However, I believe it is the responsibility of Congress to discuss and debate the matter in plenary. Only through a comprehensive and deliberate discussion can we determine the truth, and achieve a consensus on such an urgent matter for our people.”

The lawmaker cited several studies which drew a correlation between poverty and family size, an old formula consistently debunked by the Church and pro-life advocates.

During interpellation, one male lawmaker suggested that Congress do some “preparatory work” to deal with “stumbling blocks” to the new measure. He proposed a series of dialogues with the Catholic Church and President Macapagal-Arroyo to ensure that the bill would be passed this time.

He expressed fears that Ms Arroyo, an avowedly devout Catholic, would eventually succumb to pressure from the Church.

Garin shot down the proposal, maintaining that the House of Representatives was independent from the executive branch.

Sex, Lies and the Catholic Church

REBEL WITHOUT A CLUE
Sex, lies and the Catholic Church

By Patricia Evangelista
Inquirer
Last updated 02:35am (Mla time) 08/26/2007

MANILA, Philippines -- There was an old woman of great virtue, she had 26 children and didn’t know what to do. She dressed them and schooled them and fed them their bread, bellowed at them soundly and put them to bed.

In a newspaper article, Christine Herrera reported that Gloria Junio first gave birth at 15 and popped out a bouncing Junio baby little more than once a year. She was, between births, pregnant for the majority of 20 years, alongside some of her daughters. Three children died young, one child after falling off the dinner table. She has forgotten some names, is uncertain who is still living, and now has a grand total of 96 known grandchildren and great-grandchildren.

This year, the country’s population hit the astounding total of 88 million, and is expected to reach 94 million in 2010. Gloria Junio’s story is just one of many. Population estimates from the Philippine Minimum National Social Data show that this country’s population is a population of young people. With an unemployment rate of 7.4 percent, the ballooning birthrate renders null any of the much-trumpeted economic gains claimed by the government. The need to address the issue of overpopulation seems ridiculously obvious.

Just recently, in Olongapo City, councilor John Carlos de los Reyes was disturbed by the Reproductive Health Code’s policy statement, a portion of which reads that “Unmet family planning needs due to shortage of supplies may contribute to the looming surge in the city’s population in the near future.” He claims that “We are poor not because we are many, but because only a few wittingly or unwittingly deprive our kababayan of opportunities to prosper,” as if a few million more mouths to feed will make it easier to spread around “opportunities to prosper.”

In 2003, the Catholic Bishops’ Conference of the Philippines successfully blocked legislation that would have authorized the use of national funds for condoms and other contraceptive supplies. In 2006, the government backed off from its trial run of a sex education program in two areas of Metro Manila. The bishops objected that the introduction of sex education into public schools would encourage teenagers to try premarital sex rather than remain abstinent.

The argument is interesting. A teenager’s choice to have sex is not made because a teacher dangles a condom in front of students and runs down the colorful menu of possible sexually transmitted diseases (STDs). Blame it on raging hormones, on television, on the alignment of the stars, or simply on choice. At the risk of excommunication, it has to be said: People do have sex before marriage, and have done so long before MTV and the World Wide Web. They will continue to do so long after this generation goes geriatric. To preach abstinence in a vacuum is not only ineffective, it is irresponsible.

The 2003 National and Demographic and Health Survey shows that the problem revolves around lack of information and access to family planning services. Sex education is not sexy; when done correctly, it is clinical, scientific and brutally honest. It explains what can happen after the wham, bam, and thank you ma’am, and what to do to prevent repercussions if the choice is to be made. Sources also say that nurses in government health clinics in Manila teach that condoms have holes in them, a myth that has also been articulated by Vatican spokesmen.

It would be wonderful if all conversations about birds and bees and what happens when watering pots meet flowers can happen between parents and children. That is rarely the case in a country where most of the parents, themselves poor and without access to correct sex education, cannot reliably transmit information. Information about sex comes from whispered conversations between friends, and it is easier to say yes to the boy who promises eternal love if there is no mention of STDs or condoms. Even with media taking up the responsibility of educating the public, the average Pinoy teenager cannot afford to buy condoms, much less the latest issue of Cosmopolitan.

Studies conducted by the UP Population Institute and the Alan Guttmacher Institute states that 473,400 cases of induced abortion were recorded in 2000. The Department of Health has put complications related to abortion as the fourth leading cause of maternal deaths in the country. Ninety-one percent of the recorded cases are of married women, and it is reasonable to assume that there are thousands more cases of young girls who bleed in dark rooms because of fear and ignorance, and more cases of fetuses found in the college toilets. Perhaps with better education programs, and greater access to contraception, none of these would have been necessary.

A bill (introduced in the 13th Congress) “providing for reproductive health care structures and appropriating funds” still sits in the back burner. According to Rep. Fergenel Biron of the fourth district of Iloilo, many of the representatives who initially supported the bill pulled out in fear of a Catholic backlash.

There are several concessions that must be made by a modern democratic country. Foremost is the right of an individual to choices he believes are beneficial to himself. It is that right that protects a leftist from being tortured because of his ideology, the same right that enshrines the value of the ballot box, and the same right that permits the publication of this column today. For the Catholic Church to claim it is immoral for a gay man to copulate with another is fair, but when the government tosses a homosexual man into jail because of that claim is to violate the principle of pluralism by which the government stands. The same goes for a man’s, or, in most cases, a woman’s, sovereignty over her body—it is her temple, not the Church’s.

That the Church continues to campaign against contraception should not be held against the priests, it is their right. It is the government that must take responsibility for allowing that Catholic lobby to decide against the welfare of the people. At the moment, the DOH has put reproductive health and population issues at “low priority,” while a P180-million budget for artificial family planning is still being delayed.

The saying goes that in a democracy, the voice of the people is the voice of God. Vox Populi, Vox Dei. According to a United Nations survey, in the Philippines, two out of five women who want to use contraceptives don’t have access. The 2006 Family Planning Survey reveals that the unmet needs for contraception remain high, with one in six women wanting but not able to practice family planning. The 2003 National Demographic and Health Survey shows that the problem of overpopulation revolves around lack of information and access to family planning services.

In a situation where the voice from above clashes against the voice of the people, even God has to learn how to compromise.

Saturday, August 25, 2007

Ethnic groups fear not being counted properly in census

By Ma. Cecilia Rodriguez, Nash Maulana
Mindanao Bureau
Last updated 05:50pm (Mla time) 08/24/2007


CAGAYAN DE ORO CITY, Philippines -- A tribal group based in Bukidnon has expressed dismay over the alleged failure of the National Statistics Office to accurately count them in this year's population census.

"How can they count us properly when they don't go to our areas? They only go to the sitio (sub-village) proper," said Bai Carmen Tigbabao Lopez in the vernacular.

Lopez is an official of the Maramag-Manobo Tribal Association of San Miguel in Bukidnon.

Earlier, Muslim leaders in the Autonomous Region in Muslim Mindanao also made the same observation.

Physician Tahir Sulaik, ARMM health secretary, said by national and regional health department figures, the Muslim population grew at the rate of 3.2 percent in the last four years, faster than the national growth rate of 2.7 percent.

But the ARMM population has remained unchanged at 2,744,987 in the 1997 and 2000 population and poverty incidence figures of the United Nations Development Program's most recent edition of Philippine Human Development Report (PHDR).

Muslim scholar Datu Michael Mastura said Philippine Muslim population, often reported at three million, has hardly changed since the first census was conducted in 1903, when Muslim-Christian population ratio then was placed at 2:1 in Mindanao.

Like Lopez, Mastura said enumerators only concentrate their work in town centers.

Tommie Labaon, director of the National Commission on the Indigenous People (NCIP) for Northern Mindanao, echoed Lopez's observation.

"For this year's census, we will not be counted (properly)," said Labaon, a Higaonon.

Labaon said getting an accurate count of the indigenous peoples in the country has been a perennial problem.

"In 2002, there was a move by the NCIP central office with the NSO that there should be a separate counting or there should be another questionnaire so that the lumads or indigenous peoples nationwide would be counted. But it was very expensive and the NCIP could not afford it. So as talks went on for this August census, the IPs cannot still be counted," he said.

Labaon said the NSO only promised to count as many members of the indigenous communities and also pledged to hire enumerators that are from the tribal groups.
But that would be in 2010 yet.

"[NCIP secretary] Grace Pascua initiated a series of consultations with the NSO to formulate a separate system to count the lumads. [NSO secretary] Africa said that they will do that in 2010," explained Labaon.

As for Lopez, she said she made sure that all members of her clan will be counted.

"It was easy for us to be counted because we live near town. For those who lived farther in the mountains, I don't think they were counted," she said.

Labaon estimated that only 25% of the members of the indigenous communities in the region have been properly accounted for.

He said that based on a 1986 study, Region 10 has the second largest IP population in Mindanao at more than a million.

"But this was also based on estimates, no accurate counting was ever done," Labaon said.

"There are big lumad barangays in Region 10. Most have eight to 10 sitios. What the enumerators usually do is to stay in the sitio proper and merely ask the barangay officials for an estimate of the population living in the other sitios. That means the rest of the people are not included in the census" he said.

Labaon said the census also appears to be very dependent on public transportation.

"There are places where public transportation is only available until 1:00 p.m. so what the enumerators do is to rush up their interview so they can catch the last trip," he said.

Another reason, he said, could be the fact that communist rebels operate in many lumad areas.

"Around 97% of our ancestral domains are NPA-infested," he said, noting that census takers do not go there for fear of their lives.

Luis Alquiza, NSO regional information officer, confirmed that it was very difficult for them to take a census in areas where NPA’s are known to operate.

"In extreme cases where the area has an ongoing 'rido' (clan feuds) or tribal conflict, we consult with the imams (religious leaders) or the Council of Elders," he said.

As early as June this year, NSO has begun recruiting and training enumerators for the census.

Arquiza said all enumerators were properly trained on how to interview IPs and Muslims.

"They all go through intensive training. We teach them techniques on how to ask the questions indicated in the questionnaire," he said.

Arquiza admitted, however, that language barrier could be a problem. "If the enumerator does not speak their language, they shy away," he said of the lumads' attitude. "We are fortunate here in the region because most of the IPs are already more 'civilized'."

Labaon also noted that the NSO questionnaire did not reflect the tribal origin or the ethno-linguistic groupings of a respondent.

"So whether a Bisaya, an Ilonggo or a tribal member, the set of questions is the same. Most likely if the conduct of the interview is in the Cebuano dialect, all the [respondents] are Cebuano," he said.

DepEd pushes madrasah program

Here's a positive news on Education in Mindanao...

DepEd pushes "madrasah" program

By Jerry E. Esplanada
Inquirer
Last updated 06:03pm (Mla time) 08/24/2007

MANILA, Philippines -- The Department of Education (DepEd) is stepping up its efforts to provide high-quality education in Muslim public schools through the madrasah program.

The program, which includes the implementation of a Muslim-friendly school curriculum, will require at least P2 billion in the next four years, according to a DepEd report furnished the Philippine Daily Inquirer.

The Libyan government has pledged at least P200 million worth of textbooks for the DepEd initiative.

Madrasah, the Arabic word for school, aims to "positively contribute to the ongoing peace process, make the public education system more intensive and seek to improve the quality of life of Muslim school children through education," Education Secretary Jesli Lapus said.

The program is part of the department's ambitious Muslim Basic Education Road Map "in line with the government's Medium-Term Development Plan and its peace agreement with the secessionist Moro National Liberation Front."

"This is the department's modest yet significant contribution to the peace-building efforts by government and non-government agencies," Lapus said.

Lapus said the department recognizes the critical role of education in peace-building. "The school is where minds are formed and values are enhanced."

Three years ago, the DepEd started implementing a Muslim-friendly curriculum in selected public schools serving Muslim communities in Metro Manila.

In addition to Filipino, English, mathematics, science and makabayan, (nationalism) the Arabic language and Islamic values have been added to the elementary school curriculum.

According to Manaros Boransing, DepEd Undersecretary for Muslim Affairs, "this is to prove the sincerity of the department in providing free, quality education to all public school children regardless of ethnicity or religious affiliation."

The DepEd also plans to put up what it calls "Fund for Assistance to Muslim Education" or FAME. The project will require at least P500 million in seed money from the government.

The initiative, another component of the seven-point road map for upgrading basic education of Muslim Filipinos, will be created "by an Act of Congress," said Boransing.

FAME is similar to the existing Fund for Assistance to Private Education or FAPE.

Under the program, the government will solicit "matching donations" from Malaysia and Brunei, its "partners in Southeast Asia for improving the quality of Muslim education in the country."

Other road map components are: upgrading secular education in elementary and secondary schools serving Muslims; development of livelihood-skills education for Muslim out-of-school youth; provision of quality education for Muslim pre-school children; improvement of the health and nutritional status of Muslim students, especially those in public elementary schools; and development of a special alternative learning system Muslim out-of-school youth and adults.

This year, the DepEd has allocated P100 million for the alternative learning system for out-of-school youth, said Boransing. "They are the product of extreme poverty and the continuing armed conflict in Mindanao. Their problems are the most urgent."

The program's main objectives are "to be able to positively contribute to the peace process between the government and our Muslim brothers and improve the quality of their life through education," he said.

Compared to the whole of Mindanao, the Autonomous Region in Muslim Mindanao or ARMM registers the highest incidence of poor families and malnutrition, as well as maternal and child mortality rates.

A Congressional Planning and Budget Department report disclosed that the region has a "very low percentage of students in primary and secondary schools."

"Certainly, the region has the lowest level of human development in the country... More than 60 percent of the children younger than seven and up to 16 years old live in poor households," the report said.

Boransing said that the conflict in Mindanao has driven Muslims to other parts of the country where Muslim children have no access to the state-run education system.

According to him, the alternative learning program will first target Muslim out of school children in urban areas because in five to 10 years, they may become part of the peace and order problem.

The Libyan government has pledged at least P200 million worth of textbooks, all to be supplied by local publishers.

In 2004, DepEd Order No. 51 formally integrated the madrasah into the mainstream education system.

The DepEd currently has 459 public schools nationwide implementing the madrasah program, "excluding those in the ARMM," which is supposedly autonomous, said Boransing.

Like many of the other public schools, Muslim schools have apparently failed to deliver quality education "because of insufficient or irrelevant textbooks and instructional materials, lack of academically qualified teachers and lack of funds," said a DepEd report in the early 1990s (titled Making Education Work: An Agenda for Reform).

Boransing said "it's only during the Arroyo administration where the DepEd came up with an Islamic-friendly school curriculum for local Muslims. For public schools, we now have Arabic language and values education being taught alongside English, Filipino, Science and Makabayan subjects. For Muslim private schools, the Koran and two other Islamic religion subjects have been added. So they are now similar to Christian schools."

The DepEd started implementing these initiatives in school year 2005-2006.

The department has proposed to Congress a P260 million budget for this year's alternative learning and madrasah program "but we're only given P100 million."

"But we're working within the department that certain items will be realigned so we can get the budget we asked for. For 2008, we're asking for P520 million. For 2009, it's P700 million and for 2010, P967 million," Boransing added.

Friday, August 24, 2007

MDG Midterm Review: Missing the target

This is a "wake-up" call kind of an article. Read on... up to the last sentence.

MDG Midterm Review: Missing the target

By Ma. Ceres P. Doyo
Inquirer
Last updated 02:05am (Mla time) 08/23/2007

The Philippines is “off the track,” it’s too soon to celebrate and there is a lot of work that needs to be done to achieve the Millennium Development Goals (MDGs).

The year 2007 is midway through the 15-year-long process of achieving the so-called MDGs targeted by the United Nations, but the Philippines is still way off the expected results.

Social Watch Philippines gathered civil society groups last Aug. 15 and 16 to do a mid-term review of the MDGs and came up with conclusions and suggestions. Among them: Government is “missing and messing up the MDG targets” and citizens should therefore help monitor government performance and push for an alternative budget for the MDGs.

The Philippines is one of 189 countries that signed in 2000 the Millennium Declaration and covenant to attain the MDGs by 2015. The MDGs refer to the eight goals and 18 targets that the international community committed to attain in 15 years.

The eight goals are: (1) eradicate extreme poverty and hunger; (2) achieve universal primary education; (3) promote gender equality; (4) reduce child mortality; (5) improve maternal health; (6) combat HIV/AIDS, malaria and other diseases; (7) ensure environmental sustainability; and (8) develop a global partnership for development.

After presentations by civil society groups working in different regions, Social Watch challenged government pronouncements that the Philippines is on track with majority of the MDGs. The government, Social Watch said, had admitted that the goals with low probability of being achieved are: universal primary education for both participation and survival, maternal mortality ratio (MMR) and access to reproductive health. The government also admitted problems in financing, regional disparities, advocacy, localization and monitoring.

Social Watch concluded that with the way things are, and judging from MDG performance in the last seven years, most of the goals will not be fully met. It cited the 2006 report of UN-ESCAP, UNDP and the Asian Development Banks that showed that the Philippines was “failing further behind” in relation to countries in Asia and the Pacific.

Social Watch International ranks the Philippines as “very low” in the Basic Capabilities Index (BCI) on a global scale. BCI is based on three indicators: percent of children reaching Grade 5, under-5 mortality, and percentage of birth attended by health personnel.

Minar Pimple, deputy director of the UN’s Asia Millennium Campaign, said that globally poverty has been reduced. The number of very poor, which used to be 1.25 billion, has been reduced to 980 million. Pimple came to attend the Social Watch convention where civil society groups from different regions shared how the MDGs are faring on the ground.

Social Watch convener Leonor Briones raised questions on the reliability of data presented by the government. Briones, who once headed the Bureau of Treasury, pointed out that national data do not reflect the situation in the regions. “There is disparity between national data and regional data,” she said. “Averages are a poor measure.” She cited the example of Makati City which could pull up the averages even while the ethnic minorities remain very poor.

Citing key indicators in education such as “participation rate and cohort survival rate,” Social Watch noted that these are going down in the elementary and secondary levels. Drop-out rates are rising and the number of out-of-school youth is among the highest in Asia, higher than in Indonesia and Vietnam. The Philippines, Social Watch added, rates very poorly in performance scores in math when compared with other countries.

Inequality is more serious than mere poverty, Social Watch pointed out. The claims that poverty has been reduced in the Philippines, Briones said, are only in terms of national totals, which do not reflect reality. National totals are pulled up by the few relatively rich regions.

The Gini Coefficient, which is used to measure inequality, shows that inequality in the Philippines remains high. Social Watch cited the 2003 Family Income and Expenditure Survey that showed that only 2 percent of the total number of families earn more than P500,000 a year, and only 10 families control 52.5 percent of the total market capitalization.

While the Philippines is supposed to have a sound environmental policy, translating these policies into actual programs and allocating the needed resources have been problematic. Social Watch noted inconsistencies in governance, characterized by a high turnover of environment secretaries.

Briones said that among the MDG goals, environmental sustainability remained the least funded at less than one percent of the total budget.

Social Watch criticized the government’s overemphasis on the so-called “super regions,” which was evident in President Macapagal-Arroyo’s recent State of the Nation Address.

“For the past seven years,” Social Watch said, “the Sonas which are the bases for budget priorities, hardly noticed the MDGs. Attention has been focused on the super regions these past two years, while the poor are lagging behind in the ‘un-super’ regions.”

Seven years to go and there is still hope for the Philippines to get near the targets. There is need for more civil society groups (forget the incorrigible politicians) to get involved on the ground. There are NGOs that spend so much time, effort and money on political protests and propaganda while the poor they claim to defend continue to languish.

This I need to say out loud: Time also for some of these civil society groups to look into themselves and how they spend the funds entrusted to them by their funders.

Wednesday, August 22, 2007

More articles on population issues and concerns


Gov't urged to address RP's growing population
Manila Bulletin / 22 August

Sen. Pilar Juliana "Pia" S. Cayetano, chairwoman of the Senate Health and Demography Committee, said yesterday that the national government cannot just shut its eyes to the increasing population problem after the Department of Health (DoH) decided to place family planning at the bottom of its priorities.

Cayetano issued the statement after Health Secretary Francisco T. Duque III said that the DoH would be prioritizing maternal health care, while pushing for family planning merely as a "complementary strategy" for the segment of women who need it.

She pointed out that the Philippines faces a burgeoning population of 88.7 million, up from 76.8 million seven years ago when the last census was conducted.

Seven years from now, there would be 100 million Filipinos at an explosive growth rate of 2.36 percent annually, she said. (Mario B. Casayuran)

Birth control fund makes Lagman worry
Manila Standard Today / 20 August

ALBAY Rep. Edcel Lagman has asked the Department of Health to explain the delay in the use of the P180-million fund allocated for the government’s artificial birth control program.

In a letter to Health Secretary Francisco Duque, Lagman asked for the guidelines on the use of the fund. “It is already in the middle of the third quarter and many LGUs [local government units] would have liked to procure the much-needed health commodities and to conduct family planning seminars for their constituents.”

Lagman also asked for clarification on reports that before the LGUs could avail themselves of the fund, they were required to meet the minimum standards on local availability and access to the national family planning program.

He stressed that the access of LGUs to the said fund should not be dependent on any program relating to the NFP. “The congressional allocation was for artificial family planning, and therefore, its access by LGUs should not be made dependent on any program relating to the NFP.”

“In the same manner that access to NFP must not depend on the beneficiary’s existing programs on artificial family planning,” Lagman wrote in his letter.

Lagman together with then Rep. Rodante Marcoleta pushed for the inclusion of the artificial family planning fund in the health department’s budget for this year.

He pointed out that even President Gloria Macapagal Arroyo did not veto the fund. The President only required the issuance of guidelines and the execution of a memorandum of agreement between the local government unit concerned and the health department, Lagman said.

“I am deeply concerned that the long delay in the approval and issuance of the guidelines immobilizes precious funds for reproductive health,” said the Bicolano lawmaker. Macon Ramos Araneta

Opinion / Health News and View

Dr. A.G. Romualdez / Malaya / 21 August

No one (except possibly the Palace occupant) is happy about the situation

Last week, Dometilo Redulla, M.D., former Pro-vincial Health Officer of Leyte, passed away in his home province. Not very many people even in the field of health are aware of the vital role played by Doming (as he was fondly called by his friends) in shaping health system concepts not only in the Philippines but also globally.

Dr. Redulla was the chief of the Carigara Emergency Hospital (CEH) in the late 70s and early 80s when two major innovations in health service delivery were in the initial stages of development. One was the establishment of the "ladder-curriculum" for health care professionals (midwives, nurses, doctors) at the University of the Philippines Institute of Health Sciences (now known as the School of Health Sciences). Upon the advice of the World Health Organization’s Regional Adviser for Primary Health Care, the University linked development of the new curriculum to a community and health research program to be carried out in the towns constituting the catchment area of the hospital in Carigara. The idea was to base the training courses on evidence-based community needs.

The other development was the plan, spearheaded by then Health deputy minister Jesus Azurin, to integrate hospital and public health services at a level as close as possible to delivery points. At that time, public health programs were vertically implemented with lines of control all the way through regional offices and the national office under a deputy minister. Likewise the line of control for hospitals was a single vertical line directly managed by another deputy minister. As a result, delivery of services at the frontline level was seen as fragmented and inefficient. The Carigara catchment area was one of the trials of integration at the "district" level.

As chief of the catchment area hospital, Doming Redulla was instrumental in securing the cooperation of the municipal health officers in the towns of Carigara, Barugo, Jaro, Capoocan, and San Miguel. Together, these six doctors constituted the Carigara Research and Development Team.

With help from staff of the U.P. College of Medicine as well as WHO and other UN agencies, the team put together the information that led to what is still considered the most relevant curriculum in the country for the training of health workers for rural poor communities.

The successful integration of hospital and public health services at Carigara led to the development of the District Health Services concept. The concept was executed with the implementation of integration of health functions when Dr. Azurin became health minister in 1981. Some of the information from Carigara also found their way into the formulation of a manual for district hospitals published by the WHO Regional Office for the Western Pacific in 1990.

Unfortunately, integrated health services suffered a major set-back with the passage of the Local Government Code in 1991. Localization of services once again separated hospitals from public health as provincial governors took control of the former while the latter was given over to municipal mayors.

The effort to reintegrate health services was initiated with the Estrada administration’s health sector reform agenda. The idea of inter-local health zones revived the concept of towns within catchment areas of district hospitals working together as integrated health service units. This idea owes much to unsung heroes like Dr. Dometilo Redulla and the group of municipal health officers in the catchment area of the Carigara District Hospital.

***

During the last Congress, ALAGAD party list representative Rodante Marcoleta (the same politician who prominently participated in Malacañang’s successful maneuvers to foil the opposition’s impeachment attempts) managed to insert in the General Appropriations Act an allocation of 180 million pesos specifically for "artificial family planning". What followed is a classic example of the Palace’s transactional politics that ties itself up in Gordian knots so complicated that divine intervention is required to unravel them.

As a favor to the helpful congressman, Malacañang declined to invoke its line item veto power so eagerly anticipated by the much-feared conservative wing of the Catholic Church. Nevertheless, during the signing of R. A. 9401, verbal instructions were given to the Department of Health that the item was not to be used. In the subsequent transmittal letters to executing agencies, use of the line item for "artificial family planning" was severely restricted by a conditionality requiring the DOH to draft "strict budget execution guidelines for programs and activities under item III, Section C, No. 2.j of the DOH budget."

The DOH is now under severe pressure by the population management community to seek approval for a set of guidelines to enable the release of funds under Marcoleta’s line item. So far, the guidelines, already so complicated that the budget year will expire before they can be complied with, are still under study by the DOH. At this stage, it is doubtful if even Malacañang itself knows whether or when these will ever be approved.

As may be expected no one (except possibly the Palace occupant) is happy about the situation. Conservative religious groups are on edge because there is still a possibility that the funds would be released. Population and development supporters are distressed because the supply of contraceptives from USAID is really running out.

But of course the birds and the bees are delighted because they can continue to do their thing.


Opinion /Manila Bulletin


Life Expectancy and Population Growth

Francis N. Tolentino/August 22

LAST week we shared with our readers how uncontrolled population growth greatly affects the people’s lives. Everyone, especially young people, is deprived of many of the basic social services that the government ought to provide them because the latter’s resources are extremely lacking. A study quoted in our article last week claimed that population growth is bound to decrease through time, but the rate at which this happens is much too slow. Our resources deplete perhaps twice as fast as our population grows. A serious and clearly defined population management program (or a strengthening of existing ones) is thus an urgent business that the national government would need to attend to.


But while we continue to grapple with booming demographics, we are also being confronted with people living longer and continuing to take their share of our scarce resources. In 2003, life expectancy at birth for both sexes in the Philippines was recorded at 68 years old. Today, our life expectancy, according to the 2006 revision of the United Nations World Population Prospect Report for the period 2005-2010, is at 71.7 years old. As our young people’s need for education rises, so is our elderly’s need for health care and retirement benefits. With very limited resources, we wonder how society will be able to strike a balance on this.

World average life expectancy (at birth) is presently at 67.2 years. Japan ranks first in the world with the highest life expectancy at 82.6 years, followed by Hong Kong with 82.2 and Iceland with 81.8. The United States ranked 38th with a life expectancy of 78.2 years. The Philippines ranked 100th in this list. The shortest life span, according to the same report is at 39.2 years in Swaziland. (United Nations World Population Prospect, 2006 Revision)

Higher life expectancy and an unchecked population growth both hasten resource depletion. "Concerns over dramatic changes in the nature of global human population, estimated at over 6.7 billion in 2006, primarily take two different tracks: Environmental threats from rapidly encroaching human populations and economic demands born from an increasingly aging citizenship. While very different in principle, both trends are harmful… Environmental impacts include threats to sustainability and biodiversity, and economic impact studies show troubling projections.’’ (Earth’s Population Growth is Unsustainable, 2007).

Higher life expectancy is most commonly attributed to breakthroughs in the fields of health, nutrition and medicine. Improvements in these fields, coupled with increased welfare programs for the elderly enabled them to add a few more years to life. Moreover, ". . . more developed regions of the world generally have higher life expectancies than less developed regions. . .’’ obviously because of the disparity in available resources and the people’s living conditions.

Peter G. Peterson, former chairman of the Federal Reserve Bank of New York, had argued that "while extended lifespan and lower populations may initially seem positive, they carry with them potential economic hardships. For example, as the population ages, the elderly accumulate a significant financial cost from increased medical expenses and lower economic productivity. . . how will young and old live happily together if they see themselves as competitors of scarce resources?’’ Such is very true for the Philippines right now. The government would need to slice up part of the budget for education (intended for the younger members of the population) and divert it to added appropriations for health care and other social services for old people. Should this trend persist in the next few years, we might expect even worse than what the national government provides today.

Existing population management programs of the government need to be evaluated if we are at all to take our population problem seriously. These programs may need restructuring in order to fit into the changing needs of the population. Population Education, especially among our young people, would need to be strengthened in order to make them understand how the increase in the number of people affects the quality of their living conditions. For after all, a controlled population is in so many ways beneficial for both young and old people.


And things heat up!

Keep the flame burning!!!


From Dino Subingsubing, Information Coordination Officer of UNFPA:


Folks,

Legislators and Media are picking up our call to national government to ensure contraceptive security as a link to maternal health. Meanwhile, the opposition can do nothing but react angrily to PCIJ's hard-hitting article on maternal health (published two weeks ago).

Read on.

DOH asked about P180-M fund for artificial birth control

First posted 15:37:15 (Mla time) August 16, 2007
Maila Ager / INQUIRER.net

MANILA, Philippines -- The Department of Health should explain why it has been delayed in using a P180-million fund for the government's program on artificial family planning, a lawmaker at the House of Representatives said.

Albay Representative Edcel Lagman wrote a letter to Health Secretary Francisco Duque on Wednesday inquiring about the status of the fund, which he and then Congressman Rodante Marcoleta, had initiated for inclusion in the DoH's budget for this year.

Lagman noted a special provision in the budget, which clearly stated that the fund should be used for the purchase of reproductive health commodities and the conduct of family planning seminars in local communities.

"In this regard, may I know the status of the guidelines on the utilization of the subject fund considering that it is already in the middle of the third quarter and many LGUs [local government units] would have liked to immediately procure the much needed health commodities and to conduct family planning seminars for their constituents," Lagman said in his letter, a copy of which was obtained Thursday.

Lagman also sought a clarification to reports that before the LGUs could avail of the fund, they were required to meet the minimum standards on local availability and access to the national family planning program (NFP).

Lagman pointed out that the congressional allocation was for artificial family planning, and therefore, its access by LGUs should not be made dependent on any program relating to the NFP.

"In the same manner that access to NFP must not depend on the beneficiary's existing programs on artificial family planning," he said.

Even President Gloria Macapagal-Arroyo did not impose a direct item veto on the fund as she only required the issuance of guidelines and the execution of a memorandum of agreement between the local government unit concerned and the DoH, he said.

"I am deeply concerned that the long delay in the approval and issuance of the guidelines immobilizes precious funds for reproductive health," Lagman said.

Solon asks: Where's money for family planning program?

By BEN R. ROSARIO / Manila Bulletin / 18 August 2007

Bureaucratic red tape has reportedly endangered the implementation of the artificial family planning program of the government which requires the release of P180 million this year.

A letter sent by Albay Rep. Edcel Lagman to the Department of Health showed that local government units which were supposed to implement reproductive health programs have failed to carry out this mandate due to the non-release of the budget.

Lagman asked Health Secretary Francisco T. Duque for an explanation about the unreleased fund even as he reminded the Cabinet official that the allocation in the 2007 national budget of P180 million for artificial family planning was never vetoed by President Gloria Macapagal Arroyo.

He pointed out that under the General Appropriations Act the budget for artifical family planning was supposed to be sub-allotted by the DoH to LGUs to purchase "reproductive health commodities and conduct family planning seminars in local communities."

The Albay lawmaker said there was no direct item veto made by Arroyo on the fund.

"She merely required the issuance of guidelines and the execution of a Memorandum of Agreement between the local government unit concerned and the DoH," Lagman said.

The DoH has reportedly withheld release of the fund to the LGUs because guidelines on how the money will be spent have yet to be completed.

Lagman noted that the DoH has imposed a strict criteria in the availment of the funds by the LGUs which were not contemplated in the budget law.

According to Lagman the congressional allocation's objective is to fund "artificial family planning" program, adding that access to the fund "should not be dependent on any program to NFP."

Lagman said the "long delay in the approval and issuance of the guidelines immobilizes precious funds for reproductive health," stressing that the fiscal year is now in the middle of its third quarter.


By Christina Mendez / Saturday, August 18, 2007 / Philippine Star

Sen. Pia Cayetano urged the Department of Health (DOH) yesterday to reconsider a policy that keeps the family planning program on its "least priority" list.

Cayetano pointed out family planning should be part of the government's priorities to address the alarming increase in population.

Cayetano, chairman of the Senate committee on health and demography, made the call to Health Secretary Francisco Duque who said the government's "overwhelming priority" at the moment is to improve health care to curb the high maternal mortality rate.

Duque said the DOH will pursue family planning methods for women "who want to control their fertility."

"With all due respect to the health secretary, I don't think a conflict should exist at all between maternal health and family planning. Both are intrinsically related and fall within the ambit of reproductive health," Cayetano said.

Cayetano slammed the DOH's plan to place family planning at the bottom of its priorities, saying the government cannot just shut its eyes to the population problem.

"The country has reason to be seriously alarmed if 1.8 million are added to the Philippine population every year, and their chances of being fed, clothed and educated are slim," she said.

Other articles:

PCIJ: Fund for contraceptives lies idle as LGUs await guidelines
Bishops vs couple's informed conscience
==============================

And here are the "violent reactions":

Opinion

Notable reactions: The fallacy of population control
AS I WRECK THIS CHAIR

By William M. Esposo / Thursday, August 16, 2007 / Philippine Star

Proposals to curb birth rates as a solution to easing poverty have always triggered impassioned debates. I would like to share two of the reactions to my "Who has the right to life?" column where I had debunked the fallacy of population control as a means of solving poverty. One reactor is a political player and the other is a Jesuit priest.

My friend Roland Redoble, who is now based in Cebu but has lived in Mindanao, wrote this reaction.

"In the towns of my youth in Ipil, Zamboanga Sebuguey and Moalboal, Cebu, everybody is poor. But nobody gets hungry or dies of famine. Let the economists explain that. On the contrary, there was and still is an upward mobile trend in the life of the same people I know in the last 40 years.

The Malthusian theory of unlimited want and limited supply of resources as the governing dictum of societal life has long been proven wrong. It is only true in the sense that it pushes the human spirit to be more creative and be more innovative. But it was and is wrong if taken as a warning to any society that it will collapse if its population growth is left unchecked.

Decongestion of population centers through creative government intervention is the best solution to excessive centers of poverty.

Imagine this: to the East of Metro Manila, in between Antipolo and the Pacific Seaboard, are endless hectares of government property. This straddles along the most scenic slopes anyone can see in Luzon. The only thing lacking is a mass transit system from there that goes direct to Quezon City, Ortigas, and Makati.

From the Pacific seaboard it will only take approximately 1 hour and 30 minutes of travel time. If such a mass transit system can accommodate 2,000,000 a day from 7 a.m. to 8 p.m. — then that means government can move 1,000,000 families away from Metro Manila.

Do the same in the Western seaboard of Metro Manila up to the banks of Hermosa, Bataan passing along the Bulacan marshes and the same decongestion can be accomplished.

In the Eastern seaboard of Metro Manila, the land will cost nothing at all since it is owned by the government. These are the blue mountains one will see beyond the hills of Antipolo.

Doing it will be very good for the economy.

By the way, this area is still forested by secondary growth trees so water is not a problem at all.

India and China are powerful because of their population. Indonesia is the most influential in ASEAN because of its population.

On the opposite end is Europe. It is declining, especially France, because of its more than a decade negative population growth. Migration is saving it but with such a very strong cultural upheaval.

Closer to home, Singapore wanted to imitate the First World countries by imposing zero population growth more than a decade ago. It had to reverse the policy when they realized it will destroy them eventually.

So, being born is really a gift to society more than such life being the gift to the person being born. It is the maximum demand of justice for such Society to make sure that the person born will live a fruitful nurturing life...ALL FOR SOCIETY'S SAKE!"

I shared Roland Redoble's reactions with Fr. Vicente Marasigan, SJ (or Fr. V as we fondly call him). Fr. V and I regularly exchange views via email.

Fr. V is particularly enthused with my espousal of the vision and activities of Gawad Kalinga and the Focolare Movement's Economy of Communion which offers to bridge our wealth gap problem. He frowns at my severe and unforgiving criticisms of the abuses of people vested with the highest power and authority in the land.

I must admit that I have yet to internalize the Christian way of loving our enemies and turning them the other cheek when they violate us. I fear that our enemies from within will rob us blind if we blink and forgive. Shouldn't justice first prevail before forgiveness?

Fr. V condemns factors in media who promote the anti-Life position and takes many of them to task for accepting incentives from foreign financiers in exchange for promoting population control.

"Four cheers for the Chair Wrecker! Who has the right to live? Certainly not those columnists and spin-weavers in media who are salivating for the funds of the UNFPA and other UN infiltrators and noisily proclaiming their concern for promoting reproductive health. They are forfeiting their right to eternal life." Fr. V wrote.

"I put the blame on media spin for hardening public opinion towards seeing reproduction as a disease. It is NOT a disease. It is a gift of God. Like all God's gifts, reproduction can be used RESPONSIBLY," he added.

It's very comforting to know that there are Filipinos who can think straight and arrive at real solutions that assure an eradication of the causes of problems, rather than their victims.

-----------------------------------------------------------------------------------
Opinion

Lessons unlearned
A LAW EACH DAY (KEEPS TROUBLE AWAY)
By Jose C. Sison
Friday, August 17, 2007 / Philippine Star

The two-part series of write up by Jaileen Jimeno of the Philippine Center for Investigative Journalism (PCIJ) in this week's Philippine STAR (Monday and Tuesday) captioned, "GMA's legacy may include more mothers put at risk" and "Church gain in population policy is women's loss", are quite appalling. They re-enforce my long held belief that foreign governments and interest groups are still aggressively pursuing their agenda to impose their population control program in this country. I am particularly referring to the US Agency for International Development (USAID) and the United Nations Fund for Population Activities (UNFPA) that have been intruding into the Philippine Population Control Program from its inception in the late 60's up to the present. Lately, even big US private foundations like the David and Lucile Packard Foundation have entered the picture. As the PCIJ reported, this foundation tried but failed to inject $250,000 fund into the Ateneo University for its MBA on health with emphasis on the strategic population research management.

My belief is based on the report's contents and thrusts. It concentrates its criticisms on the persons and institutions opposing and putting obstacles to the population control program of America through USAID and UNFPA. It is quite perceptible that blame is being heaped on the President and the Catholic Church for the alleged existing miserable life of Filipino women and their families. More striking is its attack and emphasis on the alleged weaknesses and adverse effects of the alternative method that the government and the Church are advocating particularly the natural family planning.

I am really disturbed and puzzled how these foreign interest groups can openly operate and manipulate people in and out of government to impose their program of depopulation. Up to now they think that the Philippines, as a third world country, can still be effectively controlled by wielding their financial power channeled through soft loans, grants and packages. They should know that we already know that this is the calculated aim of the NSSM 200 report of Henry Kissinger way back in the late 70's for the depopulation of third world countries like ours so they could maintain access to strategic resources in these countries. Since they cannot convince our President to adopt their program and they are stymied in their efforts to get Congress approval of their population policies and programs, they turned their sights on the more vulnerable local government units. Meantime they are now likewise trying to use media to exert pressure on the national government and to promote their population control methods.

Amidst the din of the debate on the pros and cons of our country's need to have a population control program, I would say that the more urgent and annoying issue we should address is this intrusion into our national sovereignty particularly in matters of health and the very integrity of the Filipino people. I simply cannot reconcile myself to the proposition that foreigners can, with impunity, try to work their way into the various government agencies to promote their depopulation program that intrude into such intimate aspects of our life like sex and reproductive functions, conjugal and family relations pertaining to birth spacing and family size and even on child and youth education. At present UNPFA has even asked the DepEd to adopt its sex education modules in all levels of our public schools. This is really outrageous.

More outrageous is the deception employed to soften the resistance to the population control methods espoused by these foreign financiers. In the PCIJ report, the emphasis is on the health and welfare of the women and children. It cited the example of a mother in Bohol who has ten children with the 11th coming out in 5 months wallowing in filth and suffering hunger because of lack of access and information about all options available to her in limiting the children particularly artificial contraceptives.

The report also heaped the blame on the president's natural family planning policy. Then it cited the maternal mortality rate due to this natural method as well as its high failure rate that invariably ends up in more women resorting to clandestine abortion. While it cited figures, there seems to be a contradiction between its example of a woman having 10 to 11 children and the abortion rate. The typical Filipino women bearing more children personified by the Bohol mother are simply incompatible with the claim of high abortion rate among them due to failed natural family planning. The report also did not say that natural family planning was included among the list of population control methods only in 1995 whereas the artificial contraceptives of these foreign intruders have been made available since the inception of the depopulation program in the late 60's. Hence the cited high mortality rate may really be due to these contraceptives rather than natural family planning.

The PCIJ also kept on hammering at the damaging effects of the natural family planning method while it is conspicuously silent on the more damaging effects of the population control methods advocated by the foreign interest groups. The report did not say whether the women of Datu Paglas to whom the entire range of contraceptive methods and devices including voluntary surgical sterilization VSS (vasectomy and tubal ligation) have been made available and applied, were informed that the pills and IUDs cause abortion and have side effects like peritonitis, psychological depression, social aberrations due to broken families, divorces and pre-marital sex, not to mention the health and sanitation problems connected with the mass VSS.

Again the report came up with the flawed reasoning that the main cause of poverty is overpopulation because the growth rate has outpaced development such that the population already exceeds the available resources. Such reasoning is quite deceptive as it conveniently overlooks the wrong economic policy of enabling only a few to enjoy and own the country's resources which is the main cause of poverty.

It seems that we never learn about the truth that God's power and wisdom is manifested in his creations more especially a human being endowed with a reproductive system as a means of sharing in His power of procreation. If we disrupt that system with our scientific methods we are substituting God's infinite wisdom with our finite minds. The disastrous consequences of this lesson unlearned can be clearly seen in the ecological disasters now happening all over the globe.

Monday, August 20, 2007

The Trouble with Mindanao

Here's a very good article about Mindanao. What he wrote isn't a mystery but perhaps people who are supposed to make the difference should start doing something about it.

The Trouble With Mindanao
By Fernando Fajardo
Cebu Daily News
Last updated 01:31pm (Mla time) 08/17/2007



Marcos reorganized the National Economic Council (NEC) to become the super economic planning body after abolishing, or relegating to supporting role, the other agencies that competed with it in coming up with economic plans and giving advice to the President on development matters.

Changing its named to National Economic and Development Authority (NEDA), Marcos mandated the revitalized government planning office to include the regions in its planning work to lessen the degree of regional imbalance in the country’s development. This required its presence in the different regions of the country. The new opening gave me the chance to land a new job at NEDA Region X based in Cagayan de Oro City. That came in 1974 and there began my education on Mindanao.

Although based in Cagayan de Oro, I had the chance to see not only the ten provinces that comprised Region X or Northern Mindanao at that time, but also the rest of the island during the course of my work, which sometimes required me to go to Davao, Cotabato, and Zamboanga for conferences, including a side trip to Basilan to observe its plantation economy.

At that time I was not worried about the secessionist movement in Mindanao, which I thought was very much under control by Marcos with martial law. I saw no problem in Cagayan de Oro and Northern Mindanao in general. Even Lanao del Sur looked serene to me, especially that then-Mayor Omar Dianalan of Marawi City was very supportive of our work at NEDA.

While in Cagayan de Oro, I saw for myself the start and completion of many programs and projects that made Cagayan de Oro into one of the most progressive cities in Mindanao today. One of these was the decision of Marcos of develop a 3,000-hectare industrial-estate nearby, in Tagoloan and Villanueva, Misamis Oriental, to convince Kawasaki of Japan to put up its new iron sintering plant in the country.

Another was the inclusion of the city in the Regional Cities Development Project, which allowed it to improve its road network and other basic facilities required of a regional capital. The newly organized water district was amply funded, a new port was developed, and the airport was improved. Meanwhile, the concreting of Butuan-Cagayan de Oro-Iligan Road was started, which included a four-lane highway within the city proper. This was followed by the improvement of the Sayre Highway to Bukidnon. In rural electrification, Misamis Oriental became the pilot project using hydropower from Maria Cristina Falls in Iligan.

One day in 1975, I was told to go to Cotabato City to help set up the new NEDA regional office there after the creation of the Central Mindanao Region or Region XII, the first of the five new regions added to the original eleven, or twelve, if Metro Manila or NCR is included. My temporary posting in Cotabato City came with a chance for me to become chief of either of the two technical divisions in the new office. Did I take the chance? No, sir, because after few weeks of familiarizing myself with the city and the new region, I immediately sensed that something was wrong there.

At that time, no day would pass without some shootings or bombings somewhere in the city or nearby towns. From Cotabato City, one had to be careful in going to Davao City or General Santos City or to any of the provinces in Central Mindanao because of the danger of being ambushed along the way. And going home to Cagayan de Oro via Bukidnon was out of the question. I figured that the only safe way out of Cotabato City was by plane because of its heavily guarded airport, but in case of a real trouble, how many planes would be there to take us out? After a few months, I decided to return to Cagayan de Oro without the promotion and stayed there until Edsa I happened.

After Edsa I, I asked to be transferred here in Cebu, where I also got promoted two years later. Finally, after 20 years in 1994, I left NEDA. Even while here, though, my assignments as lecturer on planning and development allowed me to visit the major cities in Mindanao. As an outsider this time, I could now easily sense the discrepancy in the island’s growth and development: fast in most of the Christian areas and slow or almost nil in Muslim areas.

That is the trouble with Mindanao. I would not say that the problem is mainly economic. Surely, culture and religion have much to do with the underdevelopment of the Muslim areas. Different cultures and religions motivate people to behave in different ways. We know that, but if so, what have we done about it? Did we even teach ourselves to learn the language of our Muslim brothers in Mindanao to better understand and interact with them? How is life in a Muslim home or community, do we know? What about our western-style government? If it suits us, Christians, do our Muslim brothers and sisters feel comfortable with it?

If until today there is mistrust on the part of the Muslims against Christians, I blame that not so much on their great feeling of deprivation compared to us. It could be an aggravating factor, but the main reason I believe is our lack of understanding of their culture and religion and our inability to integrate with them or they with us. Until we change that, no amount of brave posturing by Malacañang, whenever our men in uniform is challenged in Mindanao, will bring us any closer to end the trouble there.

Thursday, August 16, 2007

Rise in births in RP feared with phase-out of US program

Associated Press
Last updated 00:15am (Mla time) 08/15/2007


MANILA, Philippines -- The Philippine government is unprepared for the phase-out of a contraceptive donation program by the United States, which could mean high population growth, maternal deaths, and abortion, family planning advocates said Tuesday.

The US Agency for International Development began phasing out its 30-year program to donate condoms and birth control in 2003 and will complete it next year.

The government of President Gloria Macapagal-Arroyo promotes natural family planning in line with the stand of the dominant Catholic Church, officials said.

The Philippine Congress has allocated 1P80 million (US$3.9 million) for family planning this year, but guidelines for the funds' release to local governments have not yet been approved, private groups said.

Benjamin de Leon, head of The Forum for Family Planning and Development, Inc., said the money was needed to bring down infant and maternal mortality.

About 473,000 abortions, or a third of 1.4 million unplanned pregnancies, occur in the country yearly, said Rena Dona, a UN Population Fund official.

Two out of five women who want to use contraceptives don't have access to them, Dona told a forum on family planning.

A UN study showed the country needs about US$2 million for contraceptives yearly from 2007 to 2010 to provide them free or at subsidized prices to the poor.

Alberto Romualdez, a former health secretary, doubts the budget for family planning would be available anytime soon, and fears a rise in population.

"The problem is that the conservative elements of the church hierarchy seem to have the upper hand in getting access to the President's ear, that is why her policies reflect the extreme conservatism of those who oppose any kind of family planning," he added.

The government estimates the Philippine population has topped 88 million, with a growth rate of slightly less than two percent.

Wednesday, August 15, 2007

GMA Legacy May Include More Mothers At Risk

Feature Story / Philippine Center for Investigative Journalism

Jaileen Jimeno, PCIJ / FIRST OF TWO PARTS

UBAY, BOHOL — Antonia Quirino sits with a dazed look on top of the stairs of her bamboo house amid a large swath of cornfield. She speaks laconically, as if every word is a labor. Filth surrounds her; debris of past meals remain on the dirty kitchen and table, the clotheslines display tiny clothes too grimy and stained to be considered ready for wear. Nearby, a few of her children sleep the day away.

At 40, Quirino is a mother of 10 children, and is four months away from giving birth to her 11th. She delivers at home and has known no prenatal or postnatal care, yet her nipa hut is just a few meters off the main road that leads to Bohol’s tourist-drawing resorts. She is a mother at risk, but she is below the radar of the government, which has sworn off providing free contraceptives, and which does not encourage information about their use.

About a 90-minute plane ride away, in Malacañang, sits a woman whose family planning policy, many say, has directly or indirectly consigned Quirino to her fate.


When she first took power in 2001, President Gloria Macapagal Arroyo initially issued confusing statements on her family planning policy. She once admitted using pills in her early years as a mother and wife, but said that as a Roman Catholic, it made her go to confession. In 2002, in an apparent effort to woo the Church, which supported her predecessor’s ouster, she ruled out the purchase of contraceptive materials and tossed the responsibility of buying these supplies to local governments. She has since fortified that policy to placate the Church as her government battled numerous threats to its survival. It has also resulted to the undue delegation of official power and handing over of state funds to a private group allied with the Church.

Government health workers and nongovernmental organizations (NGOs) exposed to the realities in the field say Arroyo’s position has deadly effects on numerous fronts. They say it keeps the poorest women uninformed of all the options available to them to limit or space their children. It deprives women of the free contraceptive materials previously available to them in barangay health centers. Worse, private groups like Couples for Christ (CFC), using government funds, preached against artificial contraception. This has prompted a longtime government health expert, who spoke on condition of anonymity, to warn of a rise in abortion rates because of the dearth of contraceptives, formerly available but now absent, in health centers.

“When the census numbers are out next year, this government will be shocked by the high incidence of abortion,” says the government health official. The same official is aghast at how women’s health is being regarded as just another political issue.

Dr. Junice Melgar, head of the NGO Linangan ng Kababaihan or Likhaan, also says that women’s health is now being sacrificed for political expediency. “This is her legacy,” she says, referring to President Arroyo. “Women will remember her harshly for this. This is a woman who has been very unkind. She is pushing women into unsafe pregnancies, and probably even death.”

In a paper that reported the effects of the contraceptive ban in the city of Manila, Likhaan noted that Arroyo “is the first president since 1969 to weld its policies not to medical standards, but to the moral standards of the (Roman) Catholic Church.” (See sidebar) Melgar also asserts, “The major battle is the president herself. It’s not just the Church, but the president’s own attitude toward women.”

Rise in Unintended Pregnancies

It was particularly the memory of youngest sister Elisa who died at seven years old from peritonitis, an abdominal infection, that firmed up her resolve to become a doctor. “She kept a little notebook where she wrote that she wanted to take up medicine,” recalls del Mundo. “When she died, I decided to take her place.”

A 2006 study done by Josefina Cabigon of the University of the Philippines Population Institute (UPPI) and five other experts at the Alan Guttmacher Institute, an international NGO that focuses on sexual and reproductive rights worldwide, says that six in 10 Filipino women had an unintended pregnancy at some point in their lives because of lack of access to and knowledge of modern contraceptives. That fraction, says the study, translates to some 1.43 million unintended pregnancies each year, a third of which end in abortion.

It also says that while the women who had abortion come from all classes, the majority are “married, poor, and Catholic.” The study adds that poor women tend to use unsafe methods because they cannot afford safe procedures by trained providers. These unsafe methods include massage, insertion of a catheter, and the use of Misoprostol, which is prescribed by doctors to treat gastric ulcers. Eight of 10 of the women who use such methods suffer complications, says the study.

A July 2007 World Bank report on population issues also says that the main reason women in developing countries like the Philippines seek abortion is “often due to difficulties in obtaining access to an appropriate method of contraception, incorrect or inconsistent use of contraceptive methods, and contraceptive method failure.”

Meanwhile, the Department of Health (DOH) says it has reduced maternal deaths from 172 per 100,000 births in 1998 to 162 per 100,000 in 2006. But that still means 10 to 12 women die everyday, or around 3,650 to 4,380 every year, because of pregnancy and related cases. Originally, too, DOH had aimed to reduce the maternal mortality rate to 100 per 100,000 births by 2004.

Tomas Osias, head of the Commission on Population (Popcom), the state agency that determines the direction and implementation of the government’s family-planning programs, traces the maternal death rate to women being “too young (less than 18 years old), too old (over 34 years old), or having babies too close or unspaced (less than two years).”

Suneeta Mukherjee of the United Nations Population Fund (UNFPA) has also said that 99 percent of maternal deaths are preventable, adding that promoting family planning in places with high birth rates could help cut the maternal mortality rate by as much as 35 percent. Media reports last March also quoted her as saying that it is unlikely that the Philippines will meet its target of reducing the maternal mortality rate to 52 per 100,000 births by 2015 without “political will.”

As it is, NGOs even doubt the data on maternal health now in use by the DOH. Melgar explains that the maternal mortality rate of 162 per 100,000 is not the result of the regular census conducted every five years. She says it is the result of a survey, which has an error margin of plus or minus 30. This is because the president, whose much-vaunted field of expertise is economics, was not able to fund a census in 2005, because the budget was again re-enacted. A census is a basic requirement in economic planning, as well as in goal- and policy-setting.

Melgar says that veteran health department officials know it is critical to provide family-planning materials to women who want to plan how many children they will have and when, but who are unable to afford these materials on a regular basis. But Melgar asks, “How can you do that, (provide supplies) if your boss does not allow it?”

No Buying of Artificial Contraceptives

Last year, in fact, Albay Representative Edcel Lagman was able to insert a P180-million budget for contraceptives for 2007. But that money remains unspent, and Health Secretary Francisco Duque says it certainly will not be used for artificial contraceptives.

“We are not buying,” he told PCIJ recently. According to Duque, DOH’s policy against government spending on contraceptives will remain, and that his department aims to just “strengthen the scientific, natural family planning methods” it has espoused under the Arroyo administration.

In 2004, DOH even awarded P50 million to the religious group Couples for Christ to fund a government program called Responsible Parenthood-Natural Family Planning (RP-NFP). According to its own website, the CFC considers sex education, contraception, sterilization, in vitro fertilization, and population control as “anti-life.”

Couples for Christ was one of the first groups to mobilize its members during Edsa II, which resulted in the ouster of then President Joseph Estrada and Arroyo’s ascension to power. In a June 2004 report to then Health Secretary Manuel Dayrit to cover the first tranche of the money, CFC said it used the fund to conduct almost a hundred lectures on natural family planning, “chastity education” campus tours, and media and public relations expenses.

Lawyer Rhodora Roy Raterta, executive director of the Family Planning Organization of the Philippines (FPOP), says the deal violated the principle of separation of church and state, “as the CFC is known to have links with the Catholic Church.” But what made it worse, she says, were reports that CFC also used its trainings to denounce artificial contraception.

“The bottom line is, it’s wrong,” says Raterta. She also says that funding natural family planning alone violates the Constitutional provision that says the government will protect the right of spouses to found a family in accordance with their personal religious convictions.

Then Senator Luisa Ejercito, Estrada’s wife, was so incensed by the agreement between the DOH and the CFC that she filed a resolution demanding an investigation into its legality. She said the P50-million deal should have gone through bidding, like all other government contracts.

But health experts are also unhappy over CFC’s claims regarding the efficacy of natural family planning (NFP). Melgar says CFC does not tell its clients that “going natural” has a high failure rate of seven per 100 cases.

In a 1995 study by four experts led by Haishan Fu for the Alan Guttmacher Institute, abstinence, the core of natural family planning, was found to have a 22-percent failure rate while withdrawal had 26 percent. (The Standard Days Method, which the Church promotes, requires abstinence of up to 12 days.)

In comparison, says the study, implant and injectables have the lowest failure rates (two to four percent), followed by the pill (nine percent), the diaphragm and the cervical cap (13 percent), and the male condom (15 percent).

“It’s okay if women choose natural family planning methods,” says Melgar, who is Catholic. “But they should be advised that they could get pregnant, that it has a very high failure rate.”

Yet the CFC, in a letter to its members in October 2004 stated, “NFP is the most reliable, with 99-percent efficacy rate, proven in more than 100 countries and no side effects, except greater marital love and joy.”

Strategic Appointments

Last year, Geraldine Padilla, wife of CFC director Frank Padilla, was appointed to the Popcom board, which is made up of 10 Cabinet members led by the health secretary, the UPPI director, and three private-sector representatives.

As a state agency with almost four decades of experience, Popcom has built a strong network in all provinces, which could effectively reach all households, given enough funding and support. But Popcom has found itself unable to provide the whole array of options it used to offer women. In keeping with Arroyo’s ban on modern methods, its trainings are now limited to explaining women’s fertile periods and the natural methods of contraception. No lessons on artificial means are taught; should a woman ask for these, she is “referred to health centers,” says Popcom chief Osias.

What frustrates women’s rights advocates is the lack of a written, official government policy directive on the ban on contraceptives. This would have afforded them the right to question the policy in the courts. “Our problem is that our hands are tied,” says Likhaan’s Melgar. “There’s no executive order and it’s all verbal. GMA says ‘I am not funding,’ and it becomes the law.”

In 2002, however, the DOH did issue Administrative Order 125, which mandates government health workers to promote natural family planning as “the only acceptable mode of birth control.” It promotes the program under the battle cry of “responsible parenthood.”

Arroyo’s political accommodations in favor of the Catholic Church are also clear and out in the open, leaving even career government officials in fear of losing their jobs should they go against the anti-contraceptives policy.

Thus, they have kept their mouths shut even as the likes of Padilla were named to the Popcom. Padilla is also one of the commissioners of the National Commission on the Role of Filipino Women (NCRFW). (Weeks of efforts to interview her for this piece proved difficult, however, as no one at CFC, Popcom, and NCRFW seemed to know how to get in touch with her.)

Five years ago, Arroyo also appointed Jose Sandejas, who has a doctorate in materials engineering, as presidential adviser on family matters. Sandejas, aside from being a close adviser of Archbishop Paciano Aniceto of Pampanga, has been a trustee of Pro-Life Philippines since 1987. In 2006, he was also named commissioner of Popcom.

Sandejas says that for 37 years, the country pushed artificial contraception, which he says only benefited big pharmaceutical companies. He says that by promoting just the natural methods, the Arroyo government is merely trying to balance the equation. “The pharmaceutical companies make a lot of profit,” he says, “let them push it (artificial contraceptives).”

“It’s really the work of the devil,” he says of artificial contraceptives. “The devil’s main strategy is to create divorce, contraception, homosexuality. The enemy is really winning out so much.”

Rich and Poor Realities

Sandejas dismisses the notion that men tend to leave the responsibility of contraception to women, and that men find it difficult to comply with the abstention required of couples who opt for natural contraception. “I think the men would resent the accusation that they are like animals,” he says. He says most men are responsible, “even those who live in the slums, even the uneducated.”

Sandejas warns of a “demographic winter,” of a graying society with no young blood, of the “human race becoming extinct,” should all countries aggressively try to limit their population. With sadness in his voice, he notes that 50 years ago, Filipino families had an average of seven children; now the average is inching closer to just two children per family.

But experts say that average does not capture the reality of poorer households having more children than higher-income families. While the poorest 20 percent of Filipino women have an average of six to seven children, the richest 20 percent have an average of two.

The 2007 World Bank report on population issues also highlights the correlation between the number of children a woman gives birth to and her capacity to earn. “In the Philippines, the average income growth for women with one to three pregnancies was twice that of women who had undergone more than seven pregnancies,” it says. “Accordingly, the number of children a woman gives birth to affects her subsequent employment and income prospects, with the risk of further driving gender inequalities and perpetuating poverty.”

The report says that since a large family is unable to adequately invest in education, the setback “can create inequities in education and perpetuate poverty.”

With the odds stacked against women who belong to the poorest of the poor, the World Bank report calls on policymakers and development agencies to address inequities in the area of reproductive health.


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CHURCH'S GAIN IN POPULATION POLICY IS WOMEN'S LOSS

Jaileen Jimeno, PCIJ / LAST OF TWO PARTS

DATU PAGLAS, MAGUINDANAO — Prayers echo from the minaret of a mosque through a vast banana plantation. Owned by a company called La Frutera, the 1,000-hectare land used to be a “killing field.” At the time, men in the area wound up either as members of secessionist groups or in the middle of a “rido” or clan war.

But since 1997, when La Frutera set up shop in this town, men have ditched their guns to help grow the Cavendish bananas the firm exports. Benefiting from the peace that has taken over the land, many of them now own houses, and most of those houses have TV sets. Those among the men who are married also practice family planning.

“Parang tao rin ang saging, pag masyadong marami, maliliit lang ang bunga (Bananas are like people, when there’s too much, the fruits are tiny),” says a farm supervisor, in explaining why they limit the number of “hands” in each plant.

La Frutera runs a family planning-education program for its 2,000 employees, 95 percent of whom are Muslim men. As a result, the community it calls home has become a pocket of hope in Maguindanao, which is one of the country’s poorest provinces and where many girls are still being married off at an early age and giving birth at home. In 2005, the United Nations Children’s Fund (UNICEF) placed the province’s maternal mortality rate at 300 per 100,000 births.

In Muslim Mindanao, family planning was endorsed by the Assembly of Darul Iftah (Religious Leaders Assembly) on November 23, 2003. The assembly produced a document that said, “Islam has encouraged its people to increase and populate the earth with the proviso that their quality should not be compromised.” Stressing the principle of non-coercion, responsible parenthood, and informed choice, the assembly adopted family planning as a method to birth spacing. It also endorsed all methods of contraception.

Muslims make up five to nine percent of the Philippines’ population of about 88.7 million people, who are all covered by a Constitution that guarantees freedom of faith and the separation of church and state, among other things. But since 2002, Filipinos of all faiths have been subjected to a national family planning policy that pushes only natural methods — a policy that echoes the beliefs espoused by the Roman Catholic Church, which claims some 80 percent of the country’s population as its followers.

The government, of course, stresses that those who want to use artificial contraceptives are free to do so. Health Secretary Francisco Duque says, though, that it is up to local government units to procure such supplies for their constituents. Those who are short on funds “can go to the USAID (US Agency for International Development),” which, he says, has a supply that is “good up to the end of 2008.”

The USAID has been providing contraceptive supplies to the Philippines since the 1970s. But it has been scaling down its donation in recent years; by the end of next year, it will shut down the program completely. A recent study by the United Nations Population Fund (UNFPA) estimates that the country needs at least $2 million a year to fund its contraceptives requirement to plug the vacuum the USAID would leave behind.

Cash - Strapped Local Governments

For sure, some local government officials, especially those in the poorest regions, know they need to provide their constituents a good range of family planning methods. But many of them apparently do not have enough resources. Dr. Junice Melgar, head of the nongovernmental organization (NGO) Linangan ng Kababaihan or Likhaan, says that in one forum, a provincial governor complained about the DOH’s lack of support in this arena. The DOH officials present, however, could only repeat Malacañang’s line of giving natural family planning a chance.

This, say observers, has been a tremendous setback for the poorest provinces mostly in the Autonomous Region in Muslim Mindanao, where the highest “unmet needs” in family planning have been recorded.

Mary Catherine Sumapal, who mans La Frutera’s health clinic, recalls that when Datu Paglas was a killing field, girls would usually be married off by the time they were 13. They would then proceed to have children almost every year. “It was common then to see ‘do-re-mi’ children,” she says.

But now Sumapal says that with the Muslim religious leaders’ edict and La Frutera’s family planning program, which was launched early this year, there is at least a bigger chance for their workers to have planned pregnancies. In fact, the program’s first year supply of contraceptives worth P200,000 is now in the pipeline.

Rose Sira, La Frutera’s personnel department head, says the family planning program will help ensure that each farm worker’s child has health coverage. The company’s health service covers a maximum number of four children per worker. Sira adds, “The workers know that if they just keep on having wives or children, and they get sick, they spend a lot of time away from work, and they lose income.”

In a sense, La Frutera itself is already the most effective family planning tool in the province. As more heads of the family and young people begin to have financial independence, many are reluctant to be weighed in by raising a big family; young people delay marriage in favor of an education and a career.

Nevertheless, Ustadz Abdulwahid Sumaoang still counsels farm workers on family planning, especially the men, who have grown accustomed to a culture of having more than two or three wives, with their number of children often unplanned. He often tells them, “If you are God-fearing, you will plan your family.”

A Muslim professor, Sumaoang has been La Frutera’s values consultant since 2003. He says that he often had to mediate in couples’ fights, mostly because the men did not secure their wives’ permission before getting a second or third wife, as stated in the Holy Qur’an. Some also strayed from the Islamic ideals of choosing “widows and orphans” as second or third wife. “They have forgotten that it is a responsibility, an effort to provide sustenance to a disadvantaged woman,” he says.

Sumaoang says that Muslims also place emphasis on natural family planning. But he says that since this method is not 100-percent foolproof, they have made artificial contraceptives available should couples have the need for it.

La Frutera clinic’s records show that two percent of its clients have chosen natural family planning. The rest rely on artificial methods.

This may well reflect the general attitude toward family planning nationwide. In a Pulse Asia survey conducted just before the May 14 polls, 92 percent of the respondents said it is important to control and plan one’s family. Nearly nine in 10 also said the government should allocate funds for family planning measures other than natural methods.

Ateneo Drops Population Management Course

But advocates of natural family planning have become stronger in recent years, having clinched seats in various levels in government since Gloria Macapagal Arroyo became president. Recently, their influence has been felt even in schools like the Ateneo de Manila University, which is run by the Jesuits, who are considered to be mavericks among the Catholic orders.

This year, the Ateneo would have offered an MBA in Health, with emphasis on strategic population research management. But pro-life and several similarly aligned groups protested, saying that “as a Catholic university, the Ateneo should not be receiving funding support from an organization that openly espouses abortion, population control, and reproductive health.” Ateneo has dropped the course.

Dr. Napoleon Juanillo, program director of Ateneo’s Leadership and Managerial Excellence in Health Systems, says that being a “transplant” from Cornell University, he was surprised at the level of discourse on the issue of population in the country. “It’s pushing us back to the medieval period,” he says. “It is an affront to science, on the rights of women.”

He says the course, which was to receive a $250,000 funding from the David and Lucile Packard Foundation, would have elevated the discourse on population management to a “more intelligent, scientific level.” Yet while he expresses disappointment over the scrapping of the course, Juanillo says he takes his hat off to the Catholic Church and pro-life groups like the Alliance for the Family Foundation Inc. (ALFI) for having “a good war tactic.”

ALFI wrote letters to Ateneo officials and demanded that the course be pulled out. Says Juanillo: “They merely did what they had to do, since it is part of their advocacy.”

He admits that the university was unprepared for the negative reaction to the course. In the end, he says, the university was left all alone carrying the flag. He says NGOs should have backed the school, adding, “This is a wake-up call to the RH (reproductive health) groups. They should fight and join the sphere. The NGOs did not do their job.”

That may be because they were busy trying to convince local and national officials to fund family planning measures other than the natural methods. As some NGO workers tell it, they would rather not have a repeat of what happened to Manila under Mayor Joselito ‘Lito’ Atienza, who ended a nine-year run in City Hall just recently and is now the environment secretary.

Atienza banned contraceptives in Manila from 2000 to May 2007. Women interviewed earlier this year by Likhaan, the Reproductive Health, Rights and Ethics Center for Studies and Training (ReproCen), and Center for Reproductive Rights told tales of financial, physical, and emotional difficulties when contraceptives totally disappeared from Manila’s health centers.

Some of the 67 women interviewed for the NGOs’ study said they wanted to have two to three children, but ended up with more than double their ideal number of offspring when contraceptives and ligation at government-funded facilities were banned. All of them belonged to the poorest bracket of society, where a P35 packet of pills is an unbearable monthly burden.

Women, Doctors Tell Tales of Woe

One 32-year-old mother of seven said she had wanted just three children. She wanted to be ligated after her fifth pregnancy. But the public hospital she went to would not perform the procedure, citing Atienza’s Executive Order 003, which was already in effect. In language, that EO pushed for natural family planning, but in practice, it worked against any artificial method.

Then there was a 36-year-old mother of eight who had dreamed of having only two children. She said that she was unable to get her regular supply of pills. She wanted to undergo tubal ligation after her fourth child, but the public hospital near her home no longer offered the service. By then, she said, her family’s daily meals were already consisting of just three sachets of coffee and a few pieces of pandesal for breakfast, rice and soy sauce for lunch, and bread for dinner.

Officials of the Dr. Jose Fabella Memorial Hospital also observed many high-risk cases among women patients, because of “anemia, too-frequent deliveries, very short spacing, and sometimes no spacing at all,” said the NGOs’ study.

An official at another government hospital told the NGO interviewers that the ban resulted in many unwanted pregnancies, prompting a greater “tendency to have an abortion.” One hospital director, in fact, said that abortion complications, including deaths, were “the second largest cause of admissions in his hospital, and a leading cause (of admission) in most hospitals.”

Other women interviewed post-Atienza told of marital spats, physical and verbal abuse, and being abandoned by their partner because of their refusal to have sex to avoid getting pregnant.

Government health workers agree with those from NGOs that Atienza’s EO 003 should be revoked. But they say that with the national government policy on family planning similar to Atienza’s, a legal victory is unlikely.

Big Population an Economic Plus?

Indeed, Jose Sandejas, President Arroyo’s consultant on family matters, downplays the report by Likhaan and company. “There are studies by people who have an agenda to push,” he says, “so you really have to look at who funded it.”

He adds that there are groups in Manila’s slums promoting natural family planning “and they will be the ones to tell you most men are responsible, even in the slums.” He argues that the urban population growth will go down even without contraception. Urbanization, he says, will leave couples naturally wanting smaller families because of the higher cost of living, as compared to living in the provinces.

Sandejas, however, would rather focus on the positive effects of keeping the population growth robust even though 2006 figures show this may be causing a downtrend in major education indicators like elementary enrolment and survival rate in schools.

“Even if you are not able to educate them as well you would like,” he says, “in the end their capability to quickly learn skills in the health services, in construction, as seamen, is going to save the Philippines.” Sandejas says that even the current generation, “where we have low levels of education, our overseas Filipino workers are saving us at this time.”

It’s a line that could well upset people like medical anthropologist Michael L. Tan, who writes a popular column for the Philippine Daily Inquirer. In a 2003 column on Arroyo’s policies, he observed the president, being an economist, should know better than “arguing that a large population is good for the economy because it means more consumers, more business, even more workers to export.”

“There is just no way government or the private sector can cope with the demands for jobs, housing, health, education and other social services, not with the present rate of population growth,” Tan added. “As for exporting Filipinos as caregivers to the world, I find it terribly immoral that we can think of producing children mainly because we see them as possible exports to bring in dollars later, even as we export their parents today.”

Interestingly, Arroyo’s stance is nowhere near that of Ed Panlilio, a Catholic priest who is the new governor of the president’s home province, Pampanga. According to Panlilio, he will pursue the family planning program already in place at the capitol, and that includes providing artificial contraceptives to those who ask for it.

“As governor and a public official,” he says, “the reality is I cannot impose my Catholic stand on the issue. Otherwise, I will be violating the human rights of my constituents.”

Panlilio says he will ask health workers to offer the whole range of family planning options to couples so they can practice a method based on the dictates of their conscience. He admits this may make him a target of attacks by Catholic hardliners. But he says he is confident Church leaders will understand the position he has taken.

“Nobody should dictate the choices couples should take,” says Panlilio, “not even the Pope, not even the president.”