‘Fear of the knife’ as family planning method

He may have said it as a joke, but President Duterte has put the fear of God (and of the knife) in the hearts not just of drug lords and their cop protectors, but of all Filipino men.

In a speech in Davao City before his inauguration, he threatened to have “the penises of defiant men chopped off” if they continued to persist in siring more children than they could afford to decently raise.

Having too many children, he said, has driven families deeper into poverty. He reiterated his call for smaller families, three children at the most as he suggested, even if he himself has four, at least among those he has publicly acknowledged.

But a friend active in the reproductive health movement reacted to this presidential declaration, widely perceived as a broadside against the Catholic Church, with the following observations. Among them, the “aggressive” promotion of modern contraceptives “will not violate the guiding principles of the RPRH Law and the Magna Carta of Women,” that is: free, informed choice, nondiscriminatory, providing access to the full range of methods, setting no “ideal” size of family, promoting equity and equality, observing human rights.

The President’s three-children-per-family recommendation, she said, should remain a personal view and not be translated into a national policy.

He should also be aware that in addition to the Catholic hierarchy, he risks colliding with a number of anti-RH groups and individuals, including so-called “prolife” groups and party lists, and personalities like Sen. Tito Sotto and Rep. Lito Atienza. He must likewise confront local government officials like Sorsogon City Mayor Sally Lee (soon to face a lawsuit to be filed by the Department of Health), who imposed a ban on contraceptives in the city, and others “who do not allocate requisite funds for or implement a family planning/reproductive health program” in their own areas.

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In addition to reiterating his support for an RH program, Mr. Duterte should also exert influence on Congress to “amend the RH Law so that [local government units] will share equal responsibility in implementing RH programs and services at the local  level including fund allocations, hire trained health personnel, provide mobile health clinics, etc.” In short, reinstate in the law “provisions that Sen. Ralph Recto and company removed” during deliberations on the draft bill.

Even better, says the observer, if Mr. Duterte could initiate the “reintegration” of public health programs, services, personnel (which had been devolved) at the national level under the DOH. And if the RH Law undergoes amendment, then legislators should work as well for the removal of barriers against access to contraceptives and RH services, including so-called third-party authorization, such as spousal or parental consent.

In relation to this, Malacañang should “encourage” the Supreme Court to decide as soon as possible against pending anti-RH petitions, including lifting the temporary restraining order on the provision of subdermal implants by the government, and rule on the legality of modern contraceptives “with finality.”

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I’d written previously on the looming danger of women and men in the Philippines—regardless of economic or social status—losing ALL access to modern contraceptives if the TRO on implants and contraceptives is not lifted soon by the Supreme Court.

As it is, wealthy women in this country already enjoy fertility levels at par with women in developed economies, even as women at the bottom levels of society are having two or three more children than they desire.

Part of the reason for this is that “in general across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods of contraception rather than shorter-acting methods.”

A study by the Guttmacher Institute acknowledged that economics provides a ready explanation: The up-front costs of a permanent method like ligation are generally higher (about P2,000, if I’m not mistaken) than for shorter-acting methods.

But the same study points out that in countries like Bangladesh and India, “poorer women were more likely than wealthier women to use a permanent method,” including long-acting reversible methods such as IUDs and implants. The difference, the study found, “could have something to do with the policy environment in those countries, which could involve subsidies or incentives.”

In other countries, the study found no relationship between wealth and use of permanent methods, since the choice of contraceptive for one’s personal use “depends on many things, and one of them is which contraceptives are available.” With the Supreme Court against implants, for instance, the choices available to women, especially poor women, are extremely limited.

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Indeed, “choice” when it comes to discussions of women’s reproductive health seems to be a highly complicated matter.

Another study finds that women who wish to avoid pregnancy but are not using any contraceptive method (unmet need) most commonly cite as a reason “concerns about side effects and health risks,” as well as the belief that “they have sex too infrequently to warrant use.” Others say that they are breastfeeding or have not resumed menstruation after giving birth (even if protection from accidental pregnancy is guaranteed only up to six months after delivery).

Lack of access to contraceptives is a relatively uncommon reason for nonuse, the study found.

Clearly then, while broadening services and access is imperative, even more important is improving the quality of counseling and public education on matters related to reproductive health, to counter popular misconceptions and myths that still dominate discussions about sex and reproduction.