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Thursday, November 13, 2008


Date: Tuesday, November 11, 2008
Source: Philippine Daily Inquirer (Philippines)
Author: Rina Jimenez-David

MEXICO -- ENVY IS A PREVALENT FEELING among us Filipino reproductive health advocates on this study tour. With funding from the David and Lucille Packard Foundation, and managed by the Health Action Information Network (Hain) and the Leadership Development for Mobilizing Reproductive Health (LDM) program of the Institute for International Education, the study tour was planned to acquaint us with the various players in Mexicos reproductive health movement. More specifically, were looking at how policymakers, implementers, civil society and even young people work together to get the program going despite challenges raised by a conservative government and an increasingly strident Catholic opposition.

There is much the Philippines and Mexico have in common. Most obvious is the Catholicism of the majority of the population, as well as a history of colonialism (in fact, the Philippines was governed largely by the colonial administration of Mexico). We also have a history of anti-clericalism, although in Mexico this tradition was expressed more formally and forcefully in its laws. We are also both countries of stark contrasts. Although Mexico has been classified as a middle-income country, some parts of it have health, social and economic indicators rivaling that of poor Third World countries.

A glaring difference is the status of our national family planning and reproductive health programs. In the Philippines, reproductive health has not only been neglected, the term itself is looked on with hostility by President Macapagal-Arroyo. The family planning program has been reduced to the promotion of a single, unreliable methodthe so-called natural family planning which so far, despite the millions spent on its promotion, is still largely rejected by couples and women. And in Congress, a reproductive health bill is facing stiff opposition from religious conservatives, although a growing number of legislators have been supportive.


IN CONTRAST, the family planning program of Mexico has been, said Dr. Marco Antonio Olaya Vargas, head of the program at the Ministry of Health, one of the programs with the most experience in the country, having been established in the 1970s.

Today, Mexico boasts of 70.9 percent contraceptive coverage for women of reproductive age (compared to about 45 percent in the Philippines). Twenty years ago, said Olaya Vargas, the average fertility rate in Mexico was seven children, and the population growth rate (PGR) was 3 to 4 percent. Today, the fertility rate has fallen to 2.1 per woman, and the PGR is down to 1.9 percent.

Family planning is a national policy and therefore it is mandatory and must be enforced in all the states (Mexico follows the federal system), replied Olaya Vargas when asked about the possibility of conservatives in state governments simply refusing to implement the program in their areas. In cases where a local leader imposes his own personal beliefs in the implementation of the program, we will have to go to that state and investigate, ask them what the problems are and how we can work to solve these problems. But so far, said Olaya Vargas, no state has openly said no to family planning.

THE INFLUENCE of the Catholic Church, the health official said, hasn't been an obstacle. He reminded us that there is separation of church and state in Mexico, and that means the church cannot interfere in national government policies.

A bigger problem for the program is the disparities in access and availability of supplies and services across Mexico.

Olaya Vargas said the governments policy is to ensure that services get to all the people, and that is why our services are given free. While the national rate for unmet need (the percentage of women and couples who want to use family planning but cannot avail of the services) is a mere 12 percent (compared to around 20 percent in the Philippines), he says he is aware that the rate is twice or thrice among the rural population and adolescents.

For teens, he said, the problem seems to be their reluctance to access reproductive health services, including protection from sexually transmitted infections, through official government health enters. Instead, they have found that as much as 80 percent of Mexican teens go to drugstores and pay for their contraceptives even if we have free family planning services. One solution to this is the creation of what he calls youth-friendly services in health centers, with no questions asked regarding the young clients sexuality.


MEXICO, said Olaya Vargas, is a diverse country, with different characteristics and socio-cultural traits and ethnicity. Mexico is a varied mosaic.

Health-wise, he says while there is good health coverage in the north and central areas of the country, in the southeast, which has the biggest number of indigenous and rural people, with populations more spread out, there is low coverage and it is not so easy to gain access to services.

In its bid to reduce maternal mortality, the ministry has also launched an initiative called an equal start in life, with the objective of lowering maternal and newborn mortality, preventing breast and cervical cancer, and preventing family violence. They are organizing government bodies at the local level, holding censuses to identify where pregnant women live and arranging for ways of transporting these women when the time comes for their delivery. And when pregnant women come to health centers for pre-natal consultations, there is already a plan to counsel them on post-delivery contraception, with caregivers advising them to space the next pregnancy for at least two years.

Now that’s an integrated plan.