On April 8, the Philippine Supreme Court upheld a controversial new law that, among other things, would provide free contraceptives to poor women. The ruling is seen as a significant blow to the Catholic Church, which fought hard against the legislation for 15 years. Officially known as the Responsible Parenthood and Reproductive Health Act, this legislation guarantees universal access to modern contraception methods, sex education, and maternal care.
President Benigno Aquino III defied the powerful Catholic Bishops' Conference of the Philippines and ignored threats of excommunication when he signed the law in December 2012. But before it could take effect, church-backed opponents filed a legal challenge, arguing that most forms of contraception other than church-approved "natural" methods or abstinence are tantamount to abortion, which is forbidden by the Constitution in this overwhelmingly Catholic country.
This week, after deliberating for more than a year, the judges ruled unanimously that the RH Law, as it is called in the Philippines, is "not unconstitutional."
The unanimous verdict was a surprise. All indications were of a closely and bitterly divided court. But recognizing the profound importance of the case in the Philippines, the 15 justices, it appears, may have reached their own compromise by agreeing to a unanimous decision, but rejecting some parts of the law that most offended the church. (The court tossed out several provisions imposing criminal sanctions against individuals and groups that refused to provide family planning services on religious grounds as well as nullified a provision that would have given minors access to contraceptives without parental consent.)
The Bishops' Conference, which is accustomed to wielding great influence in most spheres of public life, made the best of what was clearly a disappointment, saying the court had "watered down" the RH Law. But people on the frontlines of the struggle against poverty in the Philippines were elated by the court’s decision.
"I think it is a total victory for the Filipino people. The elimination of certain provisions, we can live with," said Esperanza Cabral, former secretary of the Department of Health and an advocate of the law.
The immediate beneficiaries of the court's ruling are the country's women -- especially women living in places like Tondo, a Manila slum district best known for the vast shantytown built on the perimeter of the city's overflowing municipal dump. Many of the district's half-million inhabitants live in shacks cobbled together from a hodgepodge of scavenged building materials. Toilets and water are communal. Electricity is scarce and sporadic. When it rains, the roofs leak, and the streets, paved with garbage and animal droppings, become slippery swamps of smelly gray goo.
I visited Tondo in May 2013 and again in November to talk with women about their attitudes toward contraception and the Catholic Church's teaching on the subject. Almost everyone I spoke to proudly professed to being a practicing Catholic, an indication of just how deeply the church's teachings are woven into the fabric of daily life in the Philippines, especially among the poor. The church, of course, is strongly opposed to any form of artificial contraception, but for most women here, modern birth control is a luxury they could never afford on their own. The result is a lot of children.
As recently as seven years ago, in 2007, when the staunchly pro-life mayor of Manila was able to effectively ban contraceptives in the city, almost no women in Tondo were using contraceptives. Today, as a result of the efforts of various NGOs, it is estimated that close to 70 percent of women of childbearing age are using some form of modern birth control.
During the years when women's rights advocates and the Catholic bishops were fighting over the Reproductive Health Act, Tondo became an ideological battlefield. Volunteers from conservative Catholic groups made the rounds here, providing families with money for schoolbooks, school uniforms, and tuition in exchange for a commitment to adhere to the church's teaching on contraception. They also instilled fear about the possible dangerous side effects of some contraceptives. Several women told me they had heard that oral contraceptives cause cancer or that injectable contraceptives are part of a medical "experiment." At the same time, a local women's reproductive health group called Likhaan set up a neighborhood clinic and sent its workers into the streets to preach the gospel of family planning.
Most of the women with whom I spoke welcomed the new law that would give them easier access to modern contraceptives. All of them wanted a safe, reliable way to limit the size of their families. Here they are in their own words.
The Mothers (and Father) of Tondo
Maricar Macalino is 21 and has three children — one each year after meeting her husband when she was 18. She and her husband, who drives a jeepney, the shaky contraptions that serve as public transportation in Manila, agree that three children is enough. She is using an oral contraceptive.
Macalino says she goes to Mass every Sunday and is active in her church, but disagrees with its teaching on contraception. "I listen to them, but I don't accept what they say about family planning. They say artificial contraception is not good, but it is good for us. It has helped with our marriage."
The couple tried the church-approved method of natural family planning after their first child, but it didn't work. "The priest says it's good to have many children, but I don't think so, not if you are poor." Would she consider an abortion if she became pregnant again? "No, never. For me it's a real sin. Better to use contraceptives."
Christina Jimenez is 19, but has a childlike softness that makes her appear younger. She met her husband when she was 13 and became pregnant with the first of their three children a year later. Jimenez gave birth at home, with the help of a midwife.
Her husband, who is 26, makes his living driving a truck, delivering coconuts and bananas to a wholesale produce market. Jimenez sometimes helps him. Last year, she became pregnant for the fourth time — this time with twins — but suffered a miscarriage. As soon as she recovered from the miscarriage, she decided it was time to look into family planning. Her husband objected. "He wanted four children," she said.
All Jimenez knew about birth control was what she had heard "from the mouths of others" — that it could cause cancer or have other dangerous side effects. But she decided to visit the Likhaan clinic (the only one of its kind in Tondo) anyway, without her husband's knowledge. She was fitted with an IUD, but it has been giving her problems so she is going to try an injectable contraceptive. Her husband, who knows that she is using birth control, has come around and agrees that three children is enough.
Jimenez takes her children to Mass every Sunday, but says she has no use for the church's teaching on contraception. "The priests tell us to use natural family planning. Sure. We'll use it — if you agree to help support our children," she says.
Helen Memis, 34, works as a street sweeper. She also earns money helping the owner of a standpipe sell water to other Tondo residents. One peso for a bucket. She has three children; a fourth died at age 3. The man she lives with is a welder.
"Yes, I'm a Catholic. I go to church, but I don't agree with what they say about family planning," she told me. "If I agreed with them, I will only suffer and the children will suffer." She has been using injectable contraceptives for the last five years.
Risa Hernandez, 25, is the mother of a 2-year-old boy. She and her husband, a delivery man, want only one child because, she says, "life is difficult." But the only form of birth control they practice is withdrawal.
"There's a lot of bad side effects [from contraceptives] like headaches. My sister had very bad headaches and sometimes she was moody. I also heard that injectables cause cancer," she explained. "I won't be comfortable using a condom. It's slimy," she giggles. "And he won't enjoy it."
Hernandez says she agrees with the church's teaching on contraception. "Natural family planning is good," she said.
Jean Ariola is 35 and has never used any form of contraceptive. She and her first husband produced three children, the youngest of whom is now 10 years old. She has since remarried and would like to have a child with her new husband, but she has not been able to get pregnant. Ariola has been diagnosed with ovarian cysts, and she believes this is the reason she has been unable to conceive.
She has been told that she should have surgery to remove the cysts, but she has also been told that the operation would cost at least 15,000 pesos (about $340), a daunting sum for anyone living in Tondo.
"I hope that if someday we have the RH bill, it will be free," Ariola said. Meanwhile, a Catholic volunteer group has knocked on her door and urged her to try natural family planning. She has agreed to go along because the group has offered to pay for her children's school supplies.
Jocelyn Mallari and her husband work as scavengers in the Tondo dump, earning maybe $10 on a good day, nothing on a bad day. They have five children. Mallari and her husband are practicing a challenging but far-from-foolproof method of family planning: "We are avoiding sex; we have sex just once a year."
Mallari was using an oral contraceptive up until a year ago, but stopped when she went back to her home province for family reasons. When she returned to Tondo, she did not resume taking the pill "because I am shy."
I asked her what she meant, and she explained that because she had stopped taking the pill and had not been going for required checkups at the Likhaan clinic, she felt embarrassed. She also told me that she would like to have a tubal ligation -- a procedure that Likhaan, an NGO, would pay for -- but was afraid that because she couldn't afford to take time off from working in the dump she would be exposed to infection after the surgery.
William Geronimo, a 39-year-old taxi driver who earns about $15 a day, told me that he had scheduled his vasectomy.
"I have three kids and I am worried that if I have anymore I won't be able to give them a life," he explained.
Normally, the procedure would cost 3,000 pesos (about $70), but Geronimo is getting it free through Likhaan. Initially, his biggest concern was that if he had the operation, he would need a month or two to recuperate. When he was told that he would be back on his feet after only a day, he was sold.
"I will ignore what the priests say, but I will go to church to pray before the operation," he said.
Lorena Calinao, 38, who was battered and abandoned by her first husband, works as a scavenger in the Tondo dump to support her two daughters, ages 7 and 8. A month after she had her youngest daughter, Calinao was pregnant again, but that pregnancy ended in a miscarriage.
"I had some knowledge of family planning, but I could not afford it. The pills cost 600 pesos [about $13] a month," she said.
She heard about the free services offered by Likhaan and visited one of its clinics — a long trip that required three buses. Calinao started with an IUD, but now uses an injectable contraceptive that lasts for an entire year.
She is not planning on having anymore children. "Two is enough," she said. "With these two it sometimes feels like I'm looking after 10," she said.
Mary Ann Santateresa, 26, was married when she was 15. She had her first child when she was 16 — and had one child each year for the next six years.
"We planned to have three kids, but the first three were girls and my husband wanted a boy," she said. The next four were boys. She and her husband tried "abstinence," but it didn't work, she said.
"I knew about family planning in the past, but I could not afford it. I didn't know I could get it for free," Santateresa told me as she waited outside the hospital for her turn for a contraceptive implant.
Lena Bacalando has been a health worker and community organizer for Likhaan since 1995. She says that she often finds herself competing with conservative Catholic groups for the hearts and minds of Tondo's impoverished women.
"The church's moral teaching is not a factor. These women know the church is not doing anything to help their families out of their poverty." The bigger problem, Bacalando explained, is the church's campaign to instill fear about possible side effects of contraceptives. "It's difficult to convince the women it's safe," she said.
Bacalando told me the story of one client, a woman who had 13 children: "We convinced her to start on pills, but she complained that the pills made it hard to breath, so she stopped. We tried with an IUD, but again she said she had difficulty breathing, so she stopped again."
The woman is now pregnant with No. 14.
But on this day Bacalando is savoring a sweet success. She has arranged for two minibuses to transport 46 women to Philippine General Hospital, several miles away, where they will get free contraceptive implants that will last for three years. Normally the implants would cost $400 apiece, but they are being provided at no cost thanks to funding from the UNFPA, the U.N.'s population fund.
Donna Estrada, 28, is a nurse who volunteers her time to Likhaan. She is also the mother of two young boys, ages 4 and 1.
We chatted in the courtyard outside Philippine General Hospital where Estrada, who works with Bacalando, is waiting for her turn to receive free contraceptive implants along with the 46 other women there. The women have been given numbers — Estrada is No. 17 — and implant packages.
"Some of the women thought it was an experiment because [the implant] was for free. A lot of them didn't know what an implant is — so that's why they were afraid," she said. "But I convinced them. I told them I will use an implant too. That's why they agreed to come."