Standing in line under the blazing sun with dozens of other young women at a makeshift prenatal clinic in a Manila slum, 14-year-old Jasmin Balute says she is too young to have a child. “It’s too late now,” she reflects, “but I realise girls my age should be in school, playing around – not taking care of a baby. I have never used birth control; I don’t know about it.”
Marycris Fajardo says she had sex “without knowing what could happen”. Fajardo, 16, comes from a large family without enough money for everyone to finish primary school; she equates pregnancy with giving up her hopes of escaping poverty. “I wish I hadn’t got pregnant so I could go back to school,” she says. “I would have liked to wait a while before having a child. If I had known about contraceptives, I would have used them.”
Such sentiments are common in the Philippines, a country of 96 million people and with the second highest teenage pregnancy rate in south-east Asia. Government statistics show that, in the past five years, the number of babies born to teenage mothers has risen from 39 to 54 for every 1,000 births.
A controversial reproductive health bill, now before the Philippine Congress, takes aim at these figures. Under the bill, free contraceptives and information on family planning will be available through government health centres, and comprehensive reproductive health classes will be held in schools.
The majority of the population either doesn’t have access to or can’t afford artificial birth control. This landmark legislation would offer Filipino women a choice they have not previously had.
However, the bill has faced fierce opposition. More than 80% of Filipinos are devout Catholics and the Roman Catholic church, which has significant political influence, has accused the bill’s supporters of condoning abortion, which is illegal.
Father Melvin Castro, executive secretary of the Catholic bishops’ conference of the Philippines episcopal commission on family and life, says educating young people about reproductive health and “distributing contraceptives to anyone who wants them” will hurt rather than help society.
But proponents of the bill say it is about giving women the basic right to choose how many children they want to have, and when they want to have them.
Ugochi Florence Daniels, Philippine representative to the UN Population Fund, says young people are being failed by the lack of services and information. “There’s no sexuality education in school, and there’s no policy. So for a poor young person in the Philippines, what are your options? None. They get pregnant.”
When this happens, a young woman’s priority is then providing for her child, not finishing school, says Elizabeth Angsioco, national chairperson of the Democratic Socialist Women of the Philippines. “The direction of her life immediately changes and opportunities for her to escape poverty become limited because she lacks education. She may eventually learn about birth control but be too poor to use it, and have more children.”
The bill’s authors say it’s concerned with preventing not just unwanted pregnancies but maternal deaths. At the June launch of the national statistics office’s 2011 family health survey, the Philippine health secretary, Enrique Ona, said the number of women dying from complications arising from childbirth increased from 162 to 221 for every 100,000 live births between 2006 and 2010. “This translates to 11 women dying a day [rising] to 14 or 15,” says Daniels.
Amina Evangelista Swanepoel, executive director of Roots of Health, amaternal health organisation working with impoverished communities, says many poor women are dying because of a lack of emergency and special care. Young women have multiple births in rapid succession. “If you are 23 and on your seventh pregnancy, it [creates a] risk of complications during pregnancy or birth.”
According to Dr Alberto Romualdez, former health secretary and now vice-president of the Forum for Family Planning and Development, the inequity in the reproductive health system is one of the biggest problems facing the country.
“Rich women will say they want two children and they have two,” says Romualdez. “In a poor area, you will see the average desired fertility is three children, yet women are having six … because they don’t have access to family planning supplies and information.”
Although it has been a 14-year battle to get the bill on to the legislative floor, national surveys show 65% to 70% of Filipinos support it. The country’s president, Benigno Aquino, is also behind it, and urged lawmakers to take it forward in his annual state address in July.
But it will not be an easy ride. Church officials have been visiting politicians to convince them to strengthen their positions, and priests have spoken out against the bill from the pulpit. At a recent senate meeting, one politician railing against the bill declared that his son had died soon after birth because his wife had taken contraceptive pills.
However, there are signs that lawmakers might be willing to negotiate a compromise on the bill’s most salient points. The bill’s co-author, Edcel Lagman, recently said that amendments to emphasise that reproductive health services would be geared to the “poorest and most marginalised households” were being discussed.
Debates on the bill are expected to resume within the next few weeks. Supporters will want to see it passed before campaigning for the next congressional elections starts in October. Meanwhile, teenage girls such as Jasmin Balute will continue to have children before they are ready.