Amid coronavirus lockdown, Philippines sees pregnancy boom and little progress in family planning

In March, Melody Fernandez only had one thing to look forward to for the month: taking a break from her full-time job as a fast-food worker at a chain restaurant. So she took an eight-hour bus drive from Manila, where she works, to Camarines Sur, the province her sister lives in, for a quick holiday. And then the country was put in lockdown.

"I was only supposed to take a holiday," the 22-year-old said. "Now, I'm having a baby."

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Fernandez, who will become a mother for the first time, is one of the millions of Filipino women expected to give birth this year and next. According to the University of the Philippine Population Institute (UPPI) and the United Nations Population Fund (UNFPA), 2.5 million unplanned pregnancies are expected to be recorded in the country by the end of the year - a 42 per cent increase compared with last year.

"These numbers are an epidemic in and of itself," Aimee Santos, the UNFPA chief of gender in the Philippines, told a Senate committee hearing in September.

Even before the pandemic, the Philippine government was already trying to temper its population numbers. At the turn of the millennium, the country had a population of 76 million, but by 2015 it had grown almost one-quarter to 100 million, representing average annual population growth of 1.6 per cent - the highest in Southeast Asia.

The landmark passage in 2012 of the Reproductive Health Law, which introduced a more comprehensive national family planning programme, was aimed at slowing the birth rate. A year after the law was passed, the modern contraceptive prevalence rate was at 38 per cent, up from 34 per cent in 2008, and by 2017 - the last year for which statistics are available - the rate had only slightly improved to 40 per cent. The National Economic and Development Authority had in 2017 set a five-year goal of increasing the modern contraceptive prevalence rate to 65 per cent.

REVERSAL OF FORTUNES

Now, however, the extended lockdown measures are reversing the small strides the country has made. Aside from an increase in unintended pregnancies, the UPPI and UNFPA foresee a 67 per cent jump in unmet needs for family planning services, resulting in 5.2 million women being left without access to birth control by December.

"Just because we're in quarantine does not mean we will stop being sexual beings," Mike Singh, the UNFPA's chief of health, told This Week in Asia. "We have to acknowledge that while [combating] Covid-19 is a top priority, the continuity of other essential health services, like family planning, should be ensured too."

As the country's struggling health care system was confronting the virus in mid-March, health care workers from different sectors were called to serve on the front lines. This meant that nurses who were supposed to serve in family planning clinics were called to provide Covid-19 care instead.

Risa Hontiveros, a lawmaker who is pushing for the passage of the Prevention of Adolescent Pregnancy Act, called this phenomenon a "Covid-isation of the health care system".

And yet, the Philippines still had the highest number of Covid-19 infections in Southeast Asia seven months into the pandemic. It now has over 350,000 recorded cases, with more than 6,000 deaths.

Lockdown restrictions across the country have also resulted in limited access to family planning services. Likhaan, a non-governmental organisation that provides free family planning services to women in marginalised communities, saw its patient load decrease almost 50 per cent at the height of the lockdown. A troubling statistic considering that its clinics offered family planning services to at least 20,000 patients last year, with about 20 per cent of its clientele comprising girls and young women aged 10 to 19.

At Fabella Memorial Hospital, the country's busiest and largest government-run maternal hospital, most mothers-to-be visit for the first time when they are ready to give birth, with many failing to visit their doctors for prenatal care because of travel restrictions.

RECALIBRATING FAMILY PLANNING

While social-distancing measures have somewhat eased in most parts of the country, improving access to family planning health facilities, public health experts and stakeholders are calling for the implementation of more efficient and better organised family planning services to slow the baby boom that has sprang from the lockdown.

Like many industries, the sector is looking at technology to improve its services, with a primary solution of telemedicine being touted.

Dr Diana Cajipe, public information officer at the government-run Fabella Memorial Hospital, said it and other government-run hospitals are now in the process of introducing a telemedicine solution for family planning services, which includes the provision of prenatal and postnatal care over the phone. "At the moment, some of our patients actually contact their [obstetrician-gynecologists] through phone or video calls ... especially when they just need to have test results checked, for example," she said. "But we are looking at optimising that so more can tap the service."

Likhaan has likewise turned to this solution, going as far as providing free delivery of contraceptive pills for some of its patients. The Family Planning Organisation of the Philippines, which has 16 clinics nationwide, has also launched a mobile clinic that visits far-flung areas to distribute contraceptives.

Singh said the country's National Programme on Population and Family Planning is also undergoing a rethink, with more informed guidelines based on the exigencies of the pandemic. A stronger communications plan is also in the works to better address misinformation on family planning tools and services, he said.

ECONOMIC IMPACT

How the country addresses its new baby boom will affect not only the health of young girls and mothers but the overall economy of the country as well. When the National Economic and Development Authority in 2017 set out its five-year goal of increasing the modern contraceptive prevalence rate to 65 per cent, its intention was to see a "demographic window" created where the "majority of the population is young and in good health, and has the right skill set to be highly productive".  

Meanwhile, neighbouring countries like Singapore and Japan are taking the opposite tack to increase productivity - offering monetary rewards to couples who have children. In September, The Japan Times reported that the Japanese government was working on a programme to provide 600,000 yen (US$5,600) to support couples in the early years of their married lives. In October, Singapore also announced it would offer monetary support for aspiring parents who may have postponed having children because of the pandemic.

While the Philippines can someday hope to have the same "problems" as its wealthier neighbours, for now its high rate of unintended pregnancies leaves it mired in a cycle of poverty.

"These considerable negative effects on reproductive health and access to care will undoubtedly be carried on to the next generation," said Hontiveros, the lawmaker. "It is dismaying that a lack of essential knowledge and services that could have been provided early may snowball into creating wider gaps of inequality, leading to an intergenerational cycle of poverty. That is unfair to our children."

As for Fernandez, who is due to give birth by March, a year after the lockdown started, her hopes are only for the safe delivery of her baby, for now.

"I know the delivery will be difficult, but I hope I endure it," she said. "I just want my baby to be safe and healthy."

This article originally appeared on the South China Morning Post (SCMP).

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