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Afterthoughts

A tale of two countries: Family planning in the Philippines and Thailand

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Whenever students ask him if family planning is really essential in curbing population growth, Dr. Nibhon Debavalya, Thailand’s leading population expert, responds with a parable about Thailand and the Philippines. Interestingly, Meechai Viravaidya,  the family planning and HIV-AIDS activist who received the Ramon Magsaysay Award in 1994, answers the same question with the same story.

Same starting point, different outcomes

Essentially, the tale is how, starting from the same point in the early seventies, Thailand and the Philippines took separate routes, with contrasting results. Currently, Thailand has a much smaller population, a much bigger economy, fewer people living in poverty, and a better quality of life for the general population. What accounted for the difference?  “Thailand,” says Nibhon, “took family planning seriously.”

Thailand had a slightly smaller GDP than the Philippines in 1975, but it had roughly the same population size, a high population growth rate, a high fertility rate, and a high proportion of people living under the poverty line.

Comparing the performance of Thailand and the Philippines over the last four decades, the following contrasts emerge: Thailand was able to radically reduce its population growth rate to 0.6 per cent while the Philippines inched down to 2.04 per cent in the period 1970 -2010.

During the period 1970-2008, Thailand’s GDP per capita grew by 4.4 per cent, while the Philippines’ grew by 1.4 per cent. By 2008, Thailand’s total GDP was US$273 billion while the Philippines’ was $167 billion.

By 2010, there were 93.6 million Filipinos, or over 20 million more than the 68.1 million Thais. This gap of 25.5 million is the demographic advantage enjoyed by Thailand—one that has made a vast difference in the economic performance and the quality of life of the people in the two countries.  By 2008, owing partly to its demographic performance, Thailand’s GDP per capita was US$4,043 or more than twice that of the Philippines, which stood at $1,847.  By 2010, only 9.6 per cent of Thais lived under the national poverty line while 26.4 per cent of Filipinos did.

Why family planning mattered

Governance certainly played some role in the contrasting outcomes, but then Thailand was known to be equally as corrupt as the Philippines, both ranking high in various indices of corruption.  For instance, in 2010, Thailand and the Philippines ranked 12th and 13th on the most corrupt scale of 16 Asia-Pacific countries evaluated by the political risk analysis group PERC.

Economic policies also mattered, but then again, both countries followed export-oriented macroeconomic strategies and were subjected to market-oriented structural adjustment, though the program was milder in Thailand.

In terms of social programs, asset redistribution measures were weak in both countries, and in the case of agrarian reform, practically nonexistent in Thailand while it plodded on in the Philippines.

So Meechai and Nibhon are right: while not denying the influence of other factors, one cannot deny that the rapid reduction of population growth and fertility in Thailand and its slow decline in the Philippines played a very major role in explaining the difference in the post-1970’s economic and social performance of the two countries.

Reasons for family planning’s success

Why was family planning successful in Thailand?  Why was it, in fact, so successful that the Total Fertility Rate (TFR)–meaning the average number of children of sexually active women of reproductive age–fell from 5.5 to 2.2 in only 20 years, which was the swiftest rate over the period among all countries in Southeast Asia?

Nibhon identifies four major factors.

First of all, economic change, the fall in the death rate owing to better health services, and the rising cost of education that Thais saw as the main vehicle for social mobility combined to make people realize the economic cost associated with having more babies, especially the rising cost of obtaining quality education for one’s offspring.

Second, cultural factors like the high level of female autonomy in the family and religion.  The religious dimension, he felt, was central in explaining the difference between Thailand and the Philippines’ family planning performance.  “Unlike Catholicism, Buddhism does not have anything against family planning, except abortion,” he said.

A third factor was discovered in surveys designed to test the population’s possible response to family planning that were conducted in the late sixties. This was a “latent demand” for smaller families which could not be filled owing to lack of knowledge of and access to effective methods.

A final decisive factor was the national government’s durable commitment to a comprehensive program that systematically provided information and contraceptives, especially to the poor and in rural areas. While NGOs, such as Meechai’s Population and Community Development Association (PDA), were important in educating rural Thais on the different methods of family planning, it was the government that provided access to contraceptives in the grassroots.

In short, what appeared to have happened was something like the following:  Without significant cultural obstacles, a latent demand for family planning caused by, among other things, an increasing awareness of the negative consequences of large families at a time of rapid economic change translated into a widespread acceptance of the government’s family planning program.  This was the synergy that accounted for the decline in fertility from 3 per cent in 1970 to 2.2 per cent by 1984 – “a 30 per cent decline in 14 years, which is one of the most significant declines ever observed in any developing country,” according to Nibhon.

What this rapid decline in the population growth rate and fertility meant was that demographically, Thailand was well positioned when Japanese capital flowed into the country during the “Golden Age” of economic growth from 1985 to 1995.  Instead of the fruits of economic growth being eaten up by the need to feed larger and larger families, the “reproductive revolution” led to smaller families, triggered a higher savings and investment rate, and enabled the government to divert more and more funds from expanding primary education facilities to investing more in high school and college education to improve the quality of the work force.  Thailand grew by sizzling 8 to 10 per cent per annum from 1985 to 1995, earning it the sobriquet of Asia’s “fifth tiger,” after South Korea, Taiwan, Hong Kong, and Singapore.  Meanwhile, the Philippines posted a one per cent annual GDP growth rate, with its takeoff aborted by the high 2.5 per cent population growth rate during that period.

Success in the anti-HIV-AIDS front

Alongside the success in family planning and poverty reduction, Thailand also registered advances in curbing the HIV-AIDs epidemic, which posed a grave threat to reproductive and sexual health beginning in the early 1980’s. The lowly condom, derided as a contraceptive, became the key weapon in the government campaign to contain AIDS.  Meechai, who had played a key role in family planning, also took a high profile role in promoting the condom to stop the spread of AIDS, taking his campaign so aggressively to sex workers that the condom came to be known as “meechai” in Thailand. Civil society groups and the government promoted the “100-Per-Cent-Condom-Use-Campaign,” which a Ministry of Public Health publication described as aiming “to empower sex workers to refuse sex service when customers did not agree to use a condom.  No condom, no sex.”

By all accounts, the campaign, which was initiated in 1991, has been a huge success. New HIV cases dropped from 150,000 in 1991 to less than 14,000 in 2008.  HIV prevalence among sex workers working out of brothels in Bangkok was 2.5 per cent.  As Meechai jokingly told me, “Our sex workers know they are in the frontline of the war against AIDS, and when they do battle, they put on their helmets. Our sex workers are very, very safe, though I am not recommending that you go out right now to find that out.”

Too successful?

This article would be remiss, however, if it did not mention that owing to the success of the government’s efforts to reduce fertility and people living longer, Thailand now has a higher proportion of elderly people in the population than a few years ago.  Few are alarmed by this prospect, however.  For with economic development, labor productivity has risen, meaning fewer workers are needed to produce the same output. With so many resources freed that would otherwise go to educating large numbers of children entering early education, more investments can be made to upgrade the quality of post-elementary education and the productivity of the working age population that is growing more slowly in absolute numbers.  Meanwhile, much manual and service work is rapidly being filled by migrant workers, especially from Burma, and this produces benefits for both Thai society and the migrants, who do not have decent-paying jobs in their countries of origin.

Thailand’s lessons for the Philippines

What lessons does the Thai experience have for the Philippines?

First of all, as in the case of Indonesia, the family planning program must not be an on-and-off affair, but must enjoy the sustained support of the government through time. What is impressive about Thailand is the way all the five-year national development plans from 1970 to the late 1990’s placed family planning at the top of the national priorities.

Another lesson is the importance of a latent need for family planning.  As noted earlier, the program took off rapidly in Thailand owing to a felt need among the population for family planning that could not be satisfied owing to lack of knowledge or access to birth control methods. Survey after survey has shown a very widespread unmet need for family planning in the Philippines.  This could indicate that were the RH Bill to be approved, the effects in terms of a decline in the fertility rate and birth rate could be just as swift as in Thailand, despite the objections of the Catholic Church hierarchy.

Working towards the same effect is the high degree of female autonomy in the Philippines.  The only area of family life where there is a relative absence of female control is reproduction, and here it is not male macho that appears to be the problem but lack of knowledge or access to contraceptives.   Nevertheless, male coercion is not absent, though it assumes the form of an ideological and political obstruction posed by the Catholic hierarchy’s opposition to state-sponsored family planning.   The passage of the Reproductive Health, Family Planning, and Population and Development Bill (RH Bill) would severely weaken this patriarchal barrier to women’s reproductive control.

Finally, the effective use of condoms to stop the spread of AIDS is one of the aims of RH bill, and Thailand’s successful campaign is something that the government can emulate.  In fact, we have no choice:  RH or no RH, there must be an aggressive move to distribute condoms along with public information campaign on their use to stem the rapid spread of AIDS, whatever are the doctrinal apprehensions of the Catholic Church hierarchy.

Asked to comment on how the Philippines could get a really effective family planning program going, Meechai answered, “Maybe you should get the bishops to take care of the babies being added to the population each year.”

I could not tell if he was kidding.

*INQUIRER.net columnist Walden Bello is a member of the House of Representatives representing Akbayan (Citizens’ Action Party) and a senior analyst at the Bangkok-based research institute Focus on the Global South.


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  • http://twitter.com/phillipgeorge1 philip george

    Good article.

  • http://pulse.yahoo.com/_OHOD5EA75DBBUH53UKLRXRK764 Mang Teban

    Only a tale..a myth…a folk legend…a useless piece of crap….a desperate attempt to get noticed…a pitiful argument…
    Hey, editors…..it is a reprint….so boring that you must have forgotten it is the same piece of junk!

    • Vince B

      this is desperate? i’ve read the prolife articles. nothing your side make sense. hard to tell if the articles made are serious or its a sick joke.

  • Anonymous

    Thailand and the Philippines both saw their first cases of HIV in 1984.
    Thailand adopted a 100% condom use policy while the Philippines promoted Abstinence and Be faithful.
    Twenty seven year later, Thailand has 650,000 AIDS cases while the the Philippines has 7,000
    One in 70 Thai adults are infected with HIV/AIDS– a rate 100 times higher than the Philippines HIV/AIDS rate.
    620,000 Thais have died from AIDS compared to less than 1,000 in the Philippines
     
    And have you noticed that the Philippine AIDS Rate has doubled recently coinciding with increased promotion of condom use?

    • http://www.facebook.com/angelus.martinez Angelus Martinez

      remember that the 7,000 cases you are claiming are the “known” cases… THERE ARE A LOT OF UNDIAGNOSED CASES IN THE PHILIPPINES… and the Phil AIRDS Rate that you claimed have doubled is not due to the proliferation of condom used but the ability to diagnosed a case… 

      • http://www.facebook.com/profile.php?id=1785095901 Mark Angelo Virly Ching

        643,000 unknown AIDS cases. Right. Coooool story bro.

    • sked482

      More than 80% of the 650,000 HIV cases in Thailand happened before the aggressive government promotion of condoms in the early 90s. It was caused by something else not by condoms. When the government started promoting condom use, their number of annual HIV cases dropped. by 90% and sometime in 2000, then prime minister acknowledged Thailand’s condom program as the cause of the HIV decline.

      Get your facts straight.

      • Anonymous

        Ayon po sa UNAIDS Case Study nag-start ang 100% condom policy sa sex workers noong 1989 at naging national policy noong 1991.  Reported AIDS cases per year was 14 in 1989 and 24,902 in 1996, five years after the start of the 100% condom policy. Thailand averages 60,000 deaths per year from 2001-2008, ten years after the start of the 100% condom policy.

        Hindi nga po condoms ang cause of HIV/AIDS kundi yung lifestyle of having multiple sex partners.  What condom promotion does is to lull the user to a false sense of security and thus indirectly promote that kind of lifestyle.  Condoms failure occurs 15% of the time on typical use. That is one out of six times people use condoms.  What the WHO and condom manufacturers advertise is data on perfect use, based on laboratory results.

        So if a person is sexually active with multiple partners, it is quite reasonable to say that after two years his chance of contracting HIV/STD is the same as the next guy who does not use condoms at all.

      • sked482

        Sorry but the facts say otherwise. If you have access to the UN table of HIV cases you will see that the majority of the HIV cases in Thailand occurred before 1991. This was not caused by the condom policy, which in fact has caused significant declines in new HIV cases. I would suppose that it is in fact caused by a rather large and vibrant tourism industry (Thailand receives a lot more foreigners than we do, and a good percentage of this goes for the sex trade). It is typical of anti-RH advocates to twist the facts by making it look like a 100% condom use policy caused the high number of cases when in reality it was the policy that caused the decline.

        —————–
        From a 2004 UNDP report on Thailand:

        Thailand’s response to
        HIV/AIDS is a story of impressive achievements. Since 1991, yearly new
        infections have fallen dramatically and millions of lives have been
        spared. Thailand is one of the very first countries to have achieved the
        sixth Millennium Development goal, to begin to reverse the spread of
        HIV/AIDS by 2015, well in advance of the target date.

        This success of Thailand must first and foremost be attributed to courageous and visionary top-level leadership displayed at a relatively early stage of the epidemic. This strong commitment created the political and institutional environment necessary for a broad-based response. Public health agencies, government ministries, the military, non-governmental organizations, communities and the media all joined together in the campaign to confront the growing epidemic. Most striking of all was the pragmatism that guided the Thailand’s response. This allowed for an open dialogue about safe sex and condom promotion and a no-nonsense approach to preventing HIV transmission among sex workers and their clients.

        ————————————-
        Quoted from a Thai newspaper (the news article is in 2001, 10 years after the national condom policy was instituted)

        At the 7th Association of Southeast Asian Nations (ASEAN) Leaders Summit
        in Brunei on Monday, Thai Prime Minister Thaksin Shinawatra said the
        most significant strategy in Thailand’s AIDS prevention program was its
        policy of 100 percent condom use in sex establishments. The policy,
        adopted in 1991, “prevents customers from purchasing sexual services
        unless they use a condom,” he said in a statement during a special
        session on HIV/AIDS. As a result, the incidence of STDs dropped from
        more than 400,000 cases per year before 1991 to fewer than 14,000 cases
        per year since 2000.

      • Anonymous

        I presented statistics as evidence while you present press releases.

      • sked482

        The UNDP Report is not a press release and is based on statistics. And what’s wrong with a news item? The news item was still based on statistics and adds real interpretation to these statistics, and like many news items, are verifiable. I find it much more credible than your own interpretation of the stats.

        Just as an addendum: All available public sources of HIV data in Thailand points out to a rapid decline in HIV cases during the 1990s. Those who are pointing out the rise in reported AIDS cases in the 1990s should take note that HIV is the precursor to AIDS, and that in the absence of antiretroviral therapy, the median time of progression from HIV infection to AIDS is nine to ten years, and the median survival time after developing AIDS is only 9.2 months. It is therefore not conclusive that the rise in AIDS cases and deaths in the 1990s was due to the failure of the condom program. It is more reasonable to believe that these AIDS cases stemmed from HIV cases well before the 1990s. And in any case, if one looks at the whole picture up to 2010, the number of AIDS cases are dropping steadily.

        UN Agencies such as the WHO, UNDP, UNICEF and UNAIDS, as well as various NGOs and government aid agencies have all hailed the Thai condom program of 1991 in effectively reducing the number of HIV, and therefore future AIDS cases. To now portray this same program as causing the rise in AIDS cases, when it fact it has done the opposite, is a blatant distortion of facts.

  • http://pulse.yahoo.com/_OHOD5EA75DBBUH53UKLRXRK764 Mang Teban

    Did Rep.Walden Bello pay Philippine Daily Inquirer to keep this hogwash of an article posted for more than two weeks now? What happened to the previous comments? Why was there a reprint?

    Are the RH bill legislators paying for this out of people’s money called “pork barrel”? Desperado na ba talaga itong mga utak contraception?

    • Vince B

      are the antiRH legislators also paid by the cbcp to promote lies? fear the number four, preach condoms cause cancer, scream genocide and call everyone who disagrees anti-life, murderers and abortionists?

      screaming condoms causing cancer, contraception is genocide to the RC also blaming the sex abuse during the 60s and 70s on the hippies -there was an actual study worth $1mil. all that was presented to the world with a straight face. they are baffled why the world is laughing at them

      thats how absurd your side’s articles are. are the anti-choicers and pedo worshiper that desperate?

  • http://pulse.yahoo.com/_IJPEMCYBKVFALDPL6WSUIZJZTA Romy

    this article is not a myth or useless piece of crap or reprint or not about contraception or whatsoever…..it is a fact…just think deeper and see what is happening sa Pinas?..we are left behind by our neighbors.. maybe because of our own attitudes as well..

  • Anonymous

    This reprint is outrageous: it repeats the same lies and ignores the facts behind his wrong statistics just in order to be noticed. More people in Thailand die of HIV-AIDS many times over due to and in spite of legalization of condom use.  The economic miracle of Thailand is not due to the legalization of artificial contraception methods.  I am very sure that when big transnational companies decided to put their investments there, their manufacturing plants and businesses, instead of in the Philippines, farthest from their minds was that a contraception culture prevailed in Thailand.  To attribute our slower economic progress compared to Thailand because of this alone is to divert attention from the real issues and, as the author of this article hoped (Bello is one of the proponents in Congress for the passage of the rh bill) will somehow promote his advocacy and the passage of the bill despite its controversial provisions.  Legislators and the public are warned of the hidden agendas in the bill, among which is the raid of taxpayers money and the evil consequences advocates of the bill do not want us to see: the gradual lossening of the moral fiber of this nation and the continued falling into a culture of death (the unborn and the aged), same sex marriages, divorce, free sex and sexual promiscuity.  Our cultural values and traditions, mores and laws will erode without an objective, unchanging metric for righteousness that is neither in excess or deficient, but balanced and virtuous, i.e., in conformity with moral, positive divine laws, eternal law and Natural Law.

    We need to utilize wisely our scarce resources, spending them only for the right reasons and for them alone, not to line the pockets of multinational contraceptive drug companies and congressmen who see in enacting a new law peso and dollar signs and not the proper respect for women as they should be loved and respected, as they perpetuate the exploitation of women as sex toys and expose them to medical side effects for long periods, some of them fatal. Progress should not be bought with human degradation and the sacrifice of morality for a few pesos more.  One of these precious resources is our HUMAN CAPITAL who can be trained, employed, provided with livelihood and enduring opportunities to improve the quality of life.  It is not done by killing the unborn but by giving the living the proper tools for PRODUCTIVITY so that he and his family can live in peace and harmony with decent shelter, food on the table, more shirt on their backs, in short, become productive members of society.  Womenfolk , for example, can be trained to produce competitive, quality home products and thus develop our cottage for export and in this way, fight poverty.  Surprise of surprises, with such opportunities supported by public and private initiatives, less attention would be paid by couples on their bodies than production for their families.  Thailand has plenty of native products that tourists feast on; tourism and related industries grow because of government direction, and Thailand’s progress can give us lessons, yes!  But, please spare us the “non sequiturs” Congressman Bello,  NO TO THE RH BILL!

  • http://www.facebook.com/notes/robert-de-castro/sidewalk-para-paradahan-ng-sasakyan-kaysa-para-sa-seguridad-ng-mga-pilipino/224324747603543 Robert P. de Castro

    Robert De Castro In
    a family, the Parent usually SCARES their children of the consequences
    of something they will be doing rather than telling them the solution.
    For if the children would know the solution to the consequences of their
    wrong doings, they will be braver in
    doing so. And that in the long run, they are prone to commit an error.
    Whereby the consequences to their wrong doings would not be prevented.
    But if the children would be SCARED of the consequences of their wrong
    doings while they are young. They will develop FULL CONTROL by merely
    NOT THINKING OF DOING THE WRONG DOINGS THAT WILL COME INTO THEIR MINDS
    and also GAINING THE BLESSINGS OF GOD which is not only in terms of
    CASH,FOOD and LUXURY but HAPPINESS AND HARMONY WITH OTHERS. For we all
    know that TOO much CASH and LUXURY would lead to sin and TOO much FOOD
    will lead to SICKNESS. But to FOLLOW GODS’ COMMANDMENT WOULD LEAD TO
    RECIEVING GODS’ BLESSINGS W/O ANY SIDE EFFECTS, for GOD KNOWS WHAT IS
    BEST FOR US. Also, it is proven that the ways and knowledges of a child
    while growing is what the child will do in his/her adult life. Thus, its
    better to PLANT / ENGRAVE “SCARE” INTO A CHILD OF THE CONSEQUENCES OF
    THEIR WRONG DOINGS so as FOR THEM NOT TO THINK OR BE TEMPTED TO DO SO
    for they will NOT BE INTERESTED TO DO SO. Thus will FORGET THE TOPIC and
    just do what is righteous. Compared to GIVING THEM THE SOLUTIONS to
    EVERY CONSEQUENCES OF THEIR WRONG DOINGS that THEY MIGHT COMMIT AN
    ERROR IN DOING SO IN THE FUTURE. TO FORGET TO DO SUCH WRONG DOINGS/ACTS
    IS BETTER RATHER THAN REMEMBERING SUCH WRONG DOINGS/ACTS THROUGH THE
    SOLUTIONS AT HAND (CONDOMS ETC.) THAT WILL ONLY TEMPT THE INDIVIDUAL TO
    ENGAGE IN THE WRONG DOING/ACT.23 hours ago · Like · 2 people

  • http://www.facebook.com/notes/robert-de-castro/sidewalk-para-paradahan-ng-sasakyan-kaysa-para-sa-seguridad-ng-mga-pilipino/224324747603543 Robert P. de Castro

    Robert De Castro In
    a family, the Parent usually SCARES their children of the consequences
    of something they will be doing rather than telling them the solution.
    For if the children would know the solution to the consequences of their
    wrong doings, they will be braver in
    doing so. And that in the long run, they are prone to commit an error.
    Whereby the consequences to their wrong doings would not be prevented.
    But if the children would be SCARED of the consequences of their wrong
    doings while they are young. They will develop FULL CONTROL by merely
    NOT THINKING OF DOING THE WRONG DOINGS THAT WILL COME INTO THEIR MINDS
    and also GAINING THE BLESSINGS OF GOD which is not only in terms of
    CASH,FOOD and LUXURY but HAPPINESS AND HARMONY WITH OTHERS. For we all
    know that TOO much CASH and LUXURY would lead to sin and TOO much FOOD
    will lead to SICKNESS. But to FOLLOW GODS’ COMMANDMENT WOULD LEAD TO
    RECIEVING GODS’ BLESSINGS W/O ANY SIDE EFFECTS, for GOD KNOWS WHAT IS
    BEST FOR US. Also, it is proven that the ways and knowledges of a child
    while growing is what the child will do in his/her adult life. Thus, its
    better to PLANT / ENGRAVE “SCARE” INTO A CHILD OF THE CONSEQUENCES OF
    THEIR WRONG DOINGS so as FOR THEM NOT TO THINK OR BE TEMPTED TO DO SO
    for they will NOT BE INTERESTED TO DO SO. Thus will FORGET THE TOPIC and
    just do what is righteous. Compared to GIVING THEM THE SOLUTIONS to
    EVERY CONSEQUENCES OF THEIR WRONG DOINGS that THEY MIGHT COMMIT AN
    ERROR IN DOING SO IN THE FUTURE. TO FORGET TO DO SUCH WRONG DOINGS/ACTS
    IS BETTER RATHER THAN REMEMBERING SUCH WRONG DOINGS/ACTS THROUGH THE
    SOLUTIONS AT HAND (CONDOMS ETC.) THAT WILL ONLY TEMPT THE INDIVIDUAL TO
    ENGAGE IN THE WRONG DOING/ACT.23 hours ago · Like · 2 people

  • Vince B

    sorry not everyone believes in the vatican, the pope is not infallible and the bible is not a biology book



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