(March 2004) Continued ambivalence and resistance at the national level on the merits, the morals, and the means of birth control have prompted business executives in the Philippines to call for a national campaign on family planning. The business leaders cite the need to check rapid growth of the Philippine population to stimulate further economic growth, create more jobs, reduce poverty, and improve health. They say they must act because political leaders have vacillated under pressure from the Catholic Church to limit the availability of modern methods and because the United States has begun phasing out contraceptive commodity assistance to invest those funds in other family planning activities.
Donald Dee, past president of the Employers Confederation of the Philippines (ECOP), explained the private sector’s interest. “Business leaders used to equate a growing population with an expanding market. Now they see declining purchasing power,” he said.
The numbers bear him out. Although the economy is growing, poverty in the Philippines is high. While the gross domestic product grew by 4.6 percent in 2002, the Philippine poverty rate is 40 percent, affecting nearly 33 million people. And the Philippine labor force grows by more than 1 million workers per year due to an annual population growth rate of 2.4 percent. The creation of new jobs lags, and unemployment grows (see figure).
Growing Unemployment, Philippines, 1995-2003
Source: National Statistics Office of the Philippines.
Lack of Political Leadership
Businesses are not alone in recognizing the need for population programs. In 1971 President Ferdinand Marcos issued an executive order establishing a national population program that would provide family planning information and services and conduct advocacy for a small family norm. But presidents since Marcos — Corazon Corazon Aquino, Fidel Ramos, Joseph Estrada, and Gloria Arroyo — have all treated the topic of population differently. According to Alejandro Herrin, professor of economics at the University of the Philippines, presidents have emphasized a range of policy goals, from achieving the desired family size to protecting maternal and child health to limiting population growth and back to promoting health, all in keeping with the 1987 constitutional mandate of “responsible parenthood” and most in keeping with the wishes of the Catholic Church. President Arroyo announced in 2002 that her government would promote responsible parenthood by funding only natural family planning (see box below), which the Catholic Church endorses.
Businesses, in contrast, are not shy about dispensing contraceptives and some already deliver such health care services. Under Article 134 of the labor law, businesses that employ 200 or more people are obligated to provide employees with family planning, health, and dental services and emergency clinics. ECOP, an umbrella group of more than 400 businesses, advocates expanding the clinic offerings to include reproductive health services. In May of last year, ECOP passed a resolution at the 24th National Conference of Employers to fund such programs; businesses will devote a portion of their revenues to cover this. “The challenge now,” said Dee, “is to have small firms buy into it.” Small businesses, he said, make up 97 percent of the country’s enterprises.
Having businesses provide contraceptives may fill an important gap that is emerging as USAID, after more than 30 years of continuous commodity support, ceases its provision of contraceptive supplies and shifts to other forms of family planning assistance. By September, no more USAID-supplied pills will be left in government clinics, according to media accounts. USAID says that the phase-down is “in consonance with the Philippine government’s goal of eventual contraceptive self-reliance,” and the agency is working through its Commercial Marketing Strategies (CMS) Project to encourage private sector provision of contraceptives. However, given the government’s exclusive support for natural family planning, employers may be one of a very few options for poor people who want modern methods.
Besides passing the resolution on population management at the National Conference of Employers last May, ECOP has established a family welfare committee under the ECOP Corporate Social Responsibility Division and has met with candidates who will challenge Arroyo in May 2004 for the presidency. “We made sure that population is part of their [all the candidates’] platform,” said Dee. “We expect that we will have a more relevant population policy in place next year.”
The Women’s Reproductive Health Care Act, legislation that cleared a House committee in October of last year after languishing for many months, could lay the groundwork for a “relevant” population policy. The act is supported by the Philippine Legislators’ Committee on Population and Development and numerous nongovernmental organizations, groups that Dee credits with giving ECOP the idea of becoming involved in the push for family planning. The act would provide universal access to and ensure steady financing for safe, affordable, and quality reproductive health services and education — including post-abortion care (abortion is illegal in the Philippines) and services for adolescents.
Future ECOP activities will include establishing a Population Management Action Center for advocacy (this in conjunction with Responsible Parenthood and Maternal and Child Health Association of the Philippines Inc., another organization of companies implementing industry-based family planning and health services); urging even small and medium-size enterprises to provide family planning to their workers through a facility whose costs and staff the small businesses would share; and getting worksite health centers involved in HIV/AIDS prevention and substance abuse prevention.
Asked about such an expansive role for the business sector, Dee replied: “We want our government to have a stronger policy, but it’s not forthcoming. So we’re taking the initiative. The workplace should be where we implement these programs. We are involved because we want to see our country not divided between poor and nonpoor.”
Natural Family Planning
Natural family planning (NFP) is any of several methods that do not involve sterilization or contraceptive devices or drugs; it involves avoiding sexual intercourse during the fertile time of a woman’s menstrual cycle. The fertile time is ascertained by calendar (cycle length), by body temperature, by cervical mucus, or by a combination of these indicators. However it is done, gauging the fertile period requires men and women to have a fairly sophisticated knowledge of the woman’s body.
Although natural family planning costs virtually nothing and frees women who practice it from having to refill prescriptions and/or restock supplies, the method’s reliability is uncertain. Top effectiveness (a failure rate of 2 percent to 20 percent) is achieved when women whose menstrual cycles are regular practice the method perfectly. But most do not practice it perfectly — the participation of males is an integral and difficult part — leading to a failure rate as high as 24 percent. And up to half the women who seek to practice family planning do not have sufficiently regular menstrual cycles to rely on NFP, report many Filipino gynecologists.
A further criticism, which has appeared in Philippine newspapers such as the Manila Standard, is that the “natural” method is unnatural. It disregards sexuality — and not only men’s. Female sexual desire is greatest, the critics point out, during the fertile period.
Philippines — Demographic Basics
|Annual population growth||2.4%|
|Family planning use||49%|
|Modern method use||35%|
|Total fertility rate||3.5|
|Unmet need for contraceptives||19.8%; high rates of abortion and teen pregnancy|
|Source of contraceptives||USAID (for 75% of users)|
Sources: C. Haub, 2003 World Population Data Sheet; ORC Macro, Philippines National Demographic and Health Survey 1998; W. Winfrey et al., The Potential Market for Expanded Private-Sector Family Planning in the Philippines, 2003.
Allison Tarmann is a senior editor at PRB.
Commercial Marketing Strategies Project Website: www.cmsproject.com.
Rina Jimenez David, “Living With Sin — The Catholic Hierarchy and Reproductive Rights in the Philippines,” Conscience 24, no. 2 (Summer 2003).
William Winfrey et al., The Potential Market for Expanded Private-Sector Family Planning in the Philippines, Country Research Series No. 10 (Washington, DC: USAID/Commercial Marketing Strategies Project, 2003).