Amid population explosion, birth control access roils the Philippines
MARK LITKE: It's 8 a.m. at the Jose Favella hospital in the Philippine capital, Manila. In the past 12 hours there have been about 40 births, a fairly average night for one of the world's busiest maternity wards.
DR. SYLVIA DE LA PAZ: As you can see, there's more patients than there are resources for them.
MARK LITKE: Dr. Silvia de la Paz, the chief obstetrician here, says they manage the crush as best they can. Often putting two beds together as a tandem bed for four mothers and four newborns.
And from these overcrowded hospital wards, out into the teeming slums of the city, it's easy to see this country is in the midst of a population explosion, what some are calling a crisis. The Philippines today has one of the highest birth rates in Asia with a population that has more than doubled over the last three decades from 45 million to 100 million.
Once the mothers and their newborns leave the maternity hospital, many are going to return to places like, Tondo — this gritty neighborhood right on the edge of Manila. It's a place where families struggle to get by on $1 or $2 a day at best. Here, very young children scavenge through garbage in search of something to sell for a few dollars to help support their families.
Families in Asia's most Catholic country that have had little or no access to contraception or family planning advice. Families that often get larger by the year.
Vilma Lopez has ten children, ages 1 to 20. She had her first child at 19.
VILMA LOPEZ: We didn't plan it, it just happened every year. It's just easy for me to get pregnant.
MARK LITKE: Manila is now one of the most densely populated urban area on earth, so congested some are forced to seek refuge in local cemeteries, where they eat and sleep on tombs and mausoleums.
ESPERANZA CABRAL: In the Philippines, there is family planning, but it is available only to the rich, to those who are able to afford to go see doctors, to buy pills.
MARK LITKE: Esperanza Cabral, a former Health Secretary of the Philippines, has been sounding the alarm on the population crisis here, a population growing fastest among the poorest Filipinos — those whose need for birth control is the greatest.
ESPERANZA CABRAL: For the poor among us, it is often an aspiration, something we want to do but are not able to do.
MARK LITKE: Dr. Silvia de La Paz says teen pregnancies are at an all-time high.
DR SYLVIA DE LA PAZ: With the lack of contraceptives, so what else will they do? Have babies– more and more babies, you know. So it's– it's a sad picture.
MARK LITKE: For years the UN has urged the Philippine government to take action, to provide free contraception and family planning for the poor. Recent surveys indicate eight in 10 Filipinos now agree.
But the Philippines most powerful institution, the Roman Catholic Church, has fought family planning policies every time they are raised. In a country where more than 80 percent are practicing Catholics, the church has dominated nearly every aspect of life in the Philippines for more than 400 years — it's moral authority and political power rarely challenged, especially when it comes to reproduction.
Abortion here is strictly illegal, although rare exceptions are made if the health of the mother is at risk. Outside the Vatican it is the only country in the world where divorce is still not allowed. And while the Philippine church says it is not opposed to natural family planning — avoiding intercourse when a woman is most fertile — it remains opposed to all forms of artificial contraception.
Retired Archbishop Oscar Cruz:
MARK LITKE: Contraception in the eyes of the church is still immoral?
ARCHBISHOP OSCAR CRUZ: Yes.
MARK LITKE: You do believe it leads to promiscuity among other things?
ARCHBISHOP OSCAR CRUZ: Yes.
MARK LITKE: If the people of the Philippines are in support of– of population control and contraception, and they want their children to learn– in school– proper family planning education, why would the church oppose any of that?
ARCHBISHOP: The church promotes parenthood. Only let it be responsible parenthood. The church has never said, "Go ahead, multiply as– as much as you like or that– and let the good lord provide." No, no, no, no, no. The church preaches responsible parenthood through natural family planning.
MARK LITKE: But changes are now underway in the Philippines that could help slow the population boom. This past spring, after a 15-year battle that went all the way to the Filipino Supreme Court, a new reproductive health care law took effect. It requires the Philippine government to fund family planning health clinics, provide affordable contraception, and launch comprehensive sex education in schools.
Former Health Secretary Cabral, one of the most prominent supporters of the new law, says it's about time.
ESPARANZA CABRAL: It's a victory for all Filipinos, especially women and children. The law can make a very big dent in our problem with poverty and population.
MARK LITKE: So is this a defeat for the Catholic Church?
ESPARANZA CABRAL: I think so.
MARK LITKE: The fight went on for 15 years and with all due respect, Archbishop, the church lost.
ARCHBISHOP CRUZ: Yes, yes, what's new? The church teaches, the world does not listen. If the church teaches and the world listens that would be a first-class miracle.
MARK LITKE: But before the bill was implemented, the church and it supporters won some major concessions from the Supreme Court, effectively diluting the law: private hospitals owned by religious institutions will not have to provide family planning options or even refer patients to hospitals that will provide the services. Minors seeking birth control pills or condoms will require parental consent. And married women will have to have their husbands consent if they want to undergo a fertility procedure like inserting an IUD.
KLAUS BECK: Our main concern is that we're looking at women and– and young– girls have the right to choose, you know, freely and responsibly the number of children they want and when they want them.
MARK LITKE: Klaus Beck is the head of the United Nations Population Fund in the Philippines. While he cheers the passage of the reproductive health care law here, he says that for the law to be effective it must empower women to make their own choices, which the current law now limits.
Without those choices many women may still feel the need to seek out abortions. Here in Manila, that means a visit to what could be described as an abortion black market, right outside the 400-year-old church of the Black Nazerene, right alongside the rosary beads and statues of saints, shopkeepers openly offer a variety of herbs and potions, promising to induce menstruation as a way to end unwanted pregnancies.
For the equivalent of $5, we were able to buy this concoction, what the vendor described as an herbal remedy, a brew that's supposed induce miscarriages in the first trimester of pregnancy.
Others may find it necessary to find someone in these back alleys to perform an abortion. We met up with a woman called Rose, who did not want to be identified on camera. Rose says she has assisted doctors performing hundreds of abortions.
ROSE: Every day we had three to five patients, because it would only take 15 minutes for each procedure.
MARK LITKE: According to the Center for Reproductive Rights, there are more than 500,000 illegal abortions in the Philippines every year; an estimated 1,000 women die every year of complications from those procedures. While the limitations of the new Reproductive Health Care Law are clear, former Health Secretary Cabral is optimistic that it will eventually lower the number of unwanted pregnancies and eventually slow the population growth.
ESPERANZA CABRAL: Even though the pragmatic purpose of the bill is not population control, as we know from other countries, if you give mothers a chance, what actually happens is the population rates go down.
MARK LITKE: For Cabral and many others in the Philippines failure is not an option. The need to control this country's population growth is becoming a matter of survival for Filipinos today.
A matter of survival from the cradle to those graveyards, where people are now living as squatters, because they have nowhere else to live.