Birth Control Tourism: Manila Residents Leave Town for Contraception

Nine years into former Manila Mayor Lito Atienza's total ban contraceptives, which purported to "discourage" modern family planning methods, the city has yet to reverse the policy and practice. While the city of Manila keeps contraception inaccessible, how are Manila's residents getting the family planning services they need? Are Manila's residents obtaining birth control from nearby cities?

According to a "quick survey" of Family Planning Needs in the City of Manila conducted by the Manila Health Department in August 2007, 72.10% percent of Manilans use modern contraceptives, despite the lack of complete family planning services in the City. Indeed, the rate is unusually high given that the national average is 49%, and even in neighboring Quezon City, which provides family planning services to its residents, modern contraceptive use is at 66%.

Because of limitations of both funding and time, the quick survey's sample and methodology had clear problems. Respondents were mostly those who accessed the clinics specifically to get the service. This could explain why the rate is significantly higher than in nearby cities and the national average. Dr. Zelda Zablan of the Demographic Research and Development Foundation (DRDF) also pointed out that any study on "unmet needs" in family planning has to include currently pregnant women as well as lactating women since they also need to be asked the obvious questions: "Were they practicing family planning at the time of pregnancy? Was the pregnancy planned?"

UNFPA has also noted the gaps in the data and recommended a more detailed household survey. In coordination with the Cooperative Movement for Encouraging NSV (Non-scalpel vasectomy), UNFPA looked into the situation of the two most depressed districts in the city of Manila and confirmed that the demand for family planning services remains quite high, with women desiring family planning both for spacing births and the number of births.

According to Manila residents, there are still very few community health centers able to offer family planning and in some cases, only Depo Provera is offered. Unlike his predecessor, the incumbent Mayor, former Senator Alfredo Lim, has stated that he supports the choice of couples in family planning and has no problem including modern methods alongside natural family planning methods in the city's program.

This year, however, Manila residents can't expect a lot to change. The year's budget still does not allocate funds for universal family planning methods or any expansion of reproductive health care services. The Mayor has not revoked his predecessor's Executive Order.

Early this year, Manila residents filed a case to nullify Atienza's Executive Order. But because the incumbent Mayor was already former Senator Lim at the time of filing, his office was named respondent. The current Mayor is, after all, in the best position to make the changes the petitioners required: the revocation of the order discouraging modern family planning, and the provision of reproductive health care in Manila.

Through his policy, Atienza also kept the Department of Health (DOH) from allocating available supplies of contraceptives and conducting their programs in Manila. In 2005, the DOH program "ligtas buntis" (safe pregnancy) was opposed by both Atienza and the conservative members of the Catholic hierarchy. When the program was launched by the DOH, it did not include Manila.

A study conducted by the Center for Reproductive Rights and its local partners in Manila in 2007 confirmed that women who bore the brunt of the former Mayor's policy against contraceptives were still exposed to the health risks and dire choices arising from unplanned pregnancies, long after Atienza ended his term. The CRR study also reported that women who could not access family planning in Manila were already resorting to visiting nearby cities such as Quezon City while others sought services from private clinics run by non-government organizations. The resourcefulness of Manila residents in the face of adversity is laudable -- but Manila's current administration needs to get its act together.