The government of the Philippines is aiming to save its “failed” national family planning programme and drastically cut maternal deaths by spending 500 million pesos (almost US$12 million) on contraceptives in 2012, a move bitterly opposed by the influential Roman Catholic Church.
The Department of Health has said it will use the money to purchase "family planning commodities and supplies” - an official euphemism for condoms, intra-uterine devices (IUDs), birth control pills and other contraceptives - and distribute them on a large scale for the first time in largely underfunded community centres across the country.
It is a controversial decision that even public health officials and family planning advocates admit may not be carried out by local officials wary of angering the Church or losing the votes of Catholic supporters.
The Church frowns on contraceptives and discourages Filipinos from using them, so government support for family planning programmes has usually been limited. Earlier attempts to boost family planning services failed when strict congressional vetting scrapped any programme that involved paying for and distributing contraceptives.
The money for the new family planning initiative will have to come from 2012 general budget allocations of $990 million. Health department officials say the move is aimed at cutting maternal mortality rates, which went from just 162 deaths per 100,000 live births in 2006 to 221 in 2011 - a rise of 35 percent - according to the government’s 2011 Family Health Survey.
Health officials say at this pace the Philippines will likely miss the UN Millennium Development Goal (MDG) of reducing the 1990 maternal mortality ratio (MMR) by three-quarters by 2015.
"The Philippines started its family planning programme in the 1970s, when we had a similar population to Thailand of around 40 million. But now our population is roughly 95 million, while Thailand only has 65 million,” said Esmeraldo Ilem, head of the Jose Fabella Memorial Hospital, the national maternity facility in the capital, Manila.
“This difference… is attributed to Thailand's very successful [family planning] programme," he said. "In other words, ours has been unsuccessful." The hospital’s dark hallways and perpetually overcrowded maternity wards could symbolize the country's inadequate health sector management.
A reproductive health bill that includes allocating funds for contraceptives and introducing sex education for primary school children has been bitterly debated in Congress for the past two years, but there is little sign of it being passed anytime soon.
Foreign governments and NGOs have so far filled the gap, but the global financial crisis and changing geopolitical priorities have forced them to cut back on aid, say Philippine government officials. In 2005 donors provided $4.4 million for contraceptives, with the US government contributing most of the money, according to the public-private Reproductive Health Supplies Coalition, which tracks shipments of reproductive health supplies.
Funding for contraception was half that amount in 2011. The International Planned Parenthood Federation, Marie Stopes International - a global reproductive health NGO - and the UN Population Fund (UNFPA) together provided $2.2 million for contraceptives, with $836,000 coming from UNFPA.
As a result, some six million Filipina women reported an "unmet need" for modern family planning services, according to the health department.
"These are women who are too old or too young to give birth, or those who already have too many [children], yet still come here and bear babies because they do not have proper access to health services,” Ilem said as he made the rounds in Fabella's crowded wards.
The city government of Manila hosts the national headquarters of the Catholic Church in a country where more than 80 percent of the people identify themselves as members.
"In Manila, there is no health centre where you can find free contraceptives." The city banned contraceptives in government health centres about a decade ago.
President Benigno Aquino, elected in 2010 on a promise to end poverty, initially voiced support for the reproductive health bill, but intense lobbying by Church officials, whose views on key issues often shape public opinion, has softened that position.
"We will not meet the MDG [Millennium Development Goal] on maternal health," Ilem said. "But at the very least the purpose of this spending is to help save our family planning programme by… mak[ing] contraceptives available to the public."
The statistics and acronyms mean little to women like Irish Gili, 31, a mother of eight who had just delivered her latest baby at Fabella. She has never had access to family planning advice, much less free contraceptives. She nearly died while delivering her seventh child, but found herself pregnant again, barely a month after giving birth.
"I have been advised to have a [tubal] ligation already," she said. "I suppose I need to that now. I have so many mouths to feed, and my body can no longer handle another childbirth."