Aya, you were one of the researchers on a new Center for Reproductive Rights report. Can you give us a little background and tell us about your findings?
Our new report, "Imposing Misery," documents the impact of Manila's contraception ban on women and their families. It was a joint effort between three groups: the International Legal Program here at the Center for Reproductive Rights; Likhaan, a women's health organization based in Quezon City, Philippines; and ReproCen, a reproductive rights and health organization based at the University of the Philippines in Manila.
In 2000, Manila mayor Jose "Lito" Atienza issued an executive order that, in practice, banned city health centers and hospitals from providing contraception. Essential family planning information, services, and supplies, including condoms and birth control pills, have disappeared from city health facilities. And doctors—silenced into compliance—are unable to exercise their best medical judgment, endangering women's lives and health.
We interviewed women affected by the ban, government and health officials, and nongovernmental organizations and found that the policy has harmed women and their families, depriving them of basic human rights. The ban has had a particularly detrimental effect on the poorest women, who rely heavily on city health centers and hospitals.
For example, women who are barely able to provide their families with even the most basic necessities are becoming pregnant for the seventh or eighth time. One woman with eight children wanted to have a tubal ligation (a form of female sterilization) after her fourth pregnancy, but was unable to because the local hospital couldn't offer the service as a result of the ban. Her family's daily income of 150 pesos (3.28 USD/2.40 EUR) means that meals often consist of soy sauce or salt when they can't afford vegetables or fish. Her children are malnourished, often having to miss meals, and not all of her children are able to attend school.
Women who have been advised by their doctors that further pregnancies would threaten their health or lives have also not been able to get a tubal ligation. And when some women tried to refuse sex with their partners, their partners became abusive and violent, abandoning them in some cases.
Is this policy limited to Manila?
The ban in Manila is an example of ideology taking precedence over respect for public health and people's lives—a phenomenon that we see in different forms elsewhere in the Philippines and throughout the world. The mayor of Puerto Princesa issued a similar policy in 2001; the province of Laguna has a similar policy. In the legislative realm, there have been attempts to pass contraceptive bans since the 1990s.
In 2001, the national Department of Health banned the emergency contraceptive Postinor in response to allegations from a conservative Catholic group that it is an abortifacient. Similarly, the administration of President Arroyo, in focusing solely on "natural family planning" methods, has wedded its policies to the moral standards of the Catholic Church.
Elsewhere in the world, we see that in Latin American countries conservative groups are attempting to ban emergency contraception. Even in the United States, despite volumes of medical research and scientific recommendations, the FDA has limited teenagers' ability to get emergency contraception.
Have disease and maternal health problems increased since the ban?
One of the hospital directors in Manila reported that the ban contributes to pregnancy complications and maternal mortality and morbidity. Many of the women affected by the ban have poor health to begin with, as a result of malnourishment or anemia, because they are so impoverished. And their lack of access to contraception results in short spacing between children, which contributes to high-risk pregnancies.
Similarly, hospital officials observed that abortion complications are common or increasing, including deaths from unsafe abortions due to the legal restrictions. Because the proportion of unintended pregnancies that end in abortion is the highest in Metro Manila, as compared to the rest of the Philippines, the ban's potential for impacting unsafe abortion rates is particularly worrisome.
In addition, although the AIDS rate in the Philippines is generally low, the prevalence of HIV/STI (sexually transmitted infections) risk behavior is high, as is the prevalence of STIs among sex workers. While it is argued that monogamy protects women from HIV/AIDS, this ignores the reality that while one partner might be monogamous there is no guarantee that the other partner will be. Without access to condoms, people lose a line of defense against HIV/AIDS.
How does the ban conform with international norms and laws?
The Philippines has ratified international human rights treaties, including the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and other covenants. The contraception ban violates provisions of all these treaties. For example, the Philippines is obligated to provide access to family planning services and information. It must also ensure that men and women have the right to decide on the number and spacing of their children and have access to the information, education and means to do so.
The ban violates national law as well. The Philippine Constitution guarantees the right to health, equality, and various rights relating to family. In the event that the ban is not overturned on the city level, we would pursue litigation on these domestic and international levels.
Have other health groups stepped into the vacuum?
While the ban technically applies to city health centers and hospitals, it has had a chilling effect on the provision of services by other facilities. NGOs, private clinics, and pharmacies have all been affected by the ban. NGO workers have been harassed. A government doctor who merely provided referrals to his patients was fired. Even a private clinic that provided family planning services was shut down. And some drugstores have stopped carrying certain forms of contraception.
What is disturbing is that city health workers who disagree with the policy have gone along with it.
Aside from the chilling effect, the vague wording of the ban and the lack of clear policy guidance from the government of Manila has resulted in health facilities not providing information or counseling services. Referrals have dropped off, and even "natural family planning" (methods that involve, for example, abstinence during periods of fertility) is not being promoted.
I just returned from a conference in Manila at which we launched the report. One of the women we had interviewed had a chance to tell her story to the press directly. A former Philippine Secretary of Health was also in attendance and he acknowledged the grave health effects of the ban and its impact on human rights.
We are hopeful that this report will serve as an advocacy tool with which to encourage the new mayor of Manila—Mayor Lim, who took office in July—to revoke the ban and ensure that women in Manila have access to a full range of health and contraceptive services.