What do you think are the reasons for the high unmet need of FP in the Philippines?
Religion-based opposition to contraception. In the Philippines, 90% of the people are Roman Catholics. There is an unmet need for family planning due to the implication by the Church that birth control is the equivalent of abortion and that it defies God’s will of procreation (Guardian News, 2011). The Sacred Heart of Jesus Catholic Church (n.d.) even added that when married couples deliberately act to suppress fertility through the use of contraception, making love is much less intimate and powerful, that it is no longer a fully marital intercourse and just something casual. It also denies the inherent meaning of married sexuality, they say, and does harm the couple’s unity (Sacred Heart of Jesus Catholic Church, n.d.).
Expensive cost of contraceptives. The Philippines is a low-income country. Despite the accessibility of contraceptives in terms of areas where you can find them, most still opt not to get one because of their cost. Despite provisions of laws that supports affordable and safe reproductive health services like various contraceptives, it is still not enough to sustain the needs of most sexually-active Filipinos.
Health concerns about contraceptive methods, including fear of side effects. People who are in fear of using contraceptives most likely do not have the sufficient and right education about the varying types of contraceptives. This is where health education comes into play. Patients must be educated that there are family planning methods, for one, natural/traditional or Fertility awareness-based methods (FAB) that has zero side effects. This include the Cervical Mucus/ Billings Ovulation Method (CMM/BOM) which may also be called the “two-day method” and “Two Day Mucus-Based Method Rule”, Basal Body Temperature (BBT), Standard Days Method (SDM), Sympto-thermal Method (STM), and Lactation Amenorrhea Method (LAM). These methods ensures no physical effects with additional advantages of inexpensiveness, no follow-up medical appointments required, no prescription needed, having better understanding of the couple about their sexual physiology and reproductive functions, and many more. It also only requires consistent and accurate record keeping with close attention to body changes; and adherence to daily routine of waking up at a fixed time.
Women's perception that they are at low risk of conception. In a report by Likhaan Center for Women’s Health Inc. (2010), there were 41% of women who believes that they are not that prone to conceiving because of having sex infrequently, experiencing lactational amenorrhea (temporary infertility while nursing) and being less fecund than normal. However, it is important to understand that we cannot definitely tell we are at low risk of conception unless we visit our obstetrician/gynecologists and FP counselors. This is where health education about family planning is very important to be taught as well. Natural/traditional family planning methods allow a woman to have knowledge about her own physiologic changes to identify her fertile and infertile days. Obtaining knowledge about these concepts will allow a client to identify the days within a month where she is truly and accurately at low risk of conception. At the same time, it will also give them the opportunity to identify the days where the client is most fertile, to avoid sexual intercourse during such days and avoid pregnancy.
References:
Likhaan Center for Women’s Health Inc. (2010). Facts on barriers to contraceptive use in the Philippines. https://www.guttmacher.org/sites/default/files/factsheet/fb-contraceptives-philippines.pdf
Guardian News. (2011). Philippines birth control legislation opposed by church. https://www.theguardian.com/world/2011/jun/08/philippines-birth-control-legislation-church
What are ways you can suggest to increase the practice of FP in the country? Give at least 1-2 suggestions.
Stronger implementation of the National Family Planning (FP) Program by the DOH. While there are laws about family planning here in the Philippines, it still requires stronger implementation to be fully maximized by the Filipinos. For one, the government can enhance partnerships with Barangays, Local Government Units (LGUs), Non-Government Organizations (NGOs), private sectors, and development partners to better reach the masses especially since these programs have really good components that shouldn’t be put to waste. Particularly, the program includes the provision of free family planning commodities that are legal, non-abortifacient, safe, and culturally acceptable to all in need of the FP service. It also includes the development of a community-based management information system that identifies and profiles the current FP users, potential FP clients, and the clients with unmet needs for FP here in the Philippines. The program also covers the establishment of FP service packages in hospitals and the organization of outreach missions related to FP. It also comprises the expansion of PhilHealth benefits packages to include FP services. The program is truly beneficial to every Filipino starting a family. Therefore, programs like these should be socially advocated, mobilized, and strongly implemented.
Promotion of a non-judgmental attitude towards contraceptive users. In a highly religious country like the Philippines, the concept of sex and contraceptive use is still a taboo. Males buying condoms in convenience stores like 7/11 or Alfamart are probably buying only when there are no people around, when the cashier is a male, or for all other reasons that wouldn’t tell they engage in sex. This notion should be completely eradicated. It is important to understand that family planning through utilization of contraceptive methods/forms offers more benefits than harm to its users. When a person uses contraceptives, it should imply that he/she is knowledgeable and educated and that he/she practices family planning, not anything else.
Promotion and Implementation of sexual health education in schools. Sexual health education (SHE) is an important strategy for promoting well-informed sexual decision-making and preventing unintended pregnancies and sexually transmitted infections (STIs) among adolescents. Schools and universities should start to incorporate sexual health education that is age-appropriate, comprehensive, medically accurate, and that gives emphasis on abstinence without the exclusion of information about the traditional/natural or modern contraceptive methods. For one, the non-governmental organization, Roots for Health, provides sex education to women in Palawan and Puerto Princesa (Nichols, n.d.). Started in 2009, the founders, Dr. Susan Evangelista and Amina Evangelista Swanepoel, initially provided reproductive health classes at Palawan State University in Puerto Princesa and have since expanded into free clinical services for young women. The Roots of Health provides services that assist with birth, reproductive healthcare, contraceptives, prenatal and postpartum check-ups, and ultrasounds. By 2018, they served 20,000 women and adolescents in the Palawan and Puerto Princesa communities, demonstrating that there is a growing grassroots movement towards reframing reproductive health in the Philippines (Nichols, n.d.).
As a student nurse, educate. Sexual health and family planning education will remain a controversial subject here in the Philippines. Nonetheless, it is a developing matter that is expected to evolve with continued conversations even just between the people around us. Now that I have become more knowledgeable about the topic through learning maternal and child health nursing, I can educate my friends, family, and relatives about it. Personally, I have cousins who got pregnant during their teenage years. I believe that this can also help in making a change, even in the smallest way.
References:
Department of Health. (n.d.) National family planning program. https://doh.gov.ph/family-planning
Fagen, M.C., Stacks, J.S., Hutter, E., & Syster, L. (2010). Promoting implementation of a school district sexual health education policy through an academic-community partnership. Public Health Reports, 125(2): 352–358. doi: 10.1177/003335491012500227
Nichols, Z. (n.d.). Sex education in the Philippines. The Borgen project. https://borgenproject.org/sex-education-in-the-philippines/