Filipino women struggle for birth control

In January, Philippine President Rodrigo Duterte issued an executive order calling for the full implementation of the so-called Reproductive Health Law that would give an estimated 6 million women in need access to birth control. According to government data, an estimated 2 million of those women are poor and require government assistance to access contraceptives.

But unless the Supreme Court lifts its temporary restraining order (TRO) on the registration of contraceptives, the Philippines may run out by 2020.

“Of course, we welcome the president’s support, but it is not enough,” Romeo Dongeto, head of advocacy group Philippine Legislators’ Committee on Population and Development (PLCPD), told DW.

In 2015, the Philippine Supreme Court issued the TRO preventing the Department of Health (DOH) from procuring, selling and distributing the contraceptive implant, Implanon. The order was issued in response to a petition filed by anti-abortion groups that claimed it caused abortions.

When the DOH appealed for the lifting of the order, the Supreme Court rejected the motion and in August 2016 effectively expanded its effect when it put the renewal of licenses on hold for other contraceptives.

“To date, the most serious challenge to the implementation of the Reproductive Health Law is the Supreme Court’s temporary restraining order, which would result in contraceptive stock-out in the country if it remains unsolved, affecting more than 13 million Filipino women,” said Dongeto.

A presidential executive order cannot overturn the Supreme Court order as the executive and judicial are equal branches of government.

Public health emergency

The imposition of the TRO for more than 18 months has had a drastic effect on reproductive health and government health officials warned that if it remains in force, the increasing number of unplanned pregnancies and maternal deaths could reach the scale of a public health emergency.

“Since 2015, when the TRO was first imposed, we estimate that half a million unintended pregnancies have occured,” Juan Antonio Perez, executive director of the Commission on Population (POPCOM), said at a press conference.

Based on the Philippines’ current maternal mortality ratios, POPCOM projects that these pregnancies will result in 1,000 maternal deaths every year.

“That is the equivalent of three jumbo jets of pregnant women dying every year,” said Perez.”It would be equivalent to a public health emergency if the Supreme Court does not lift its TRO.”

According to a United Nations report, the Philippines topped the regional list of Asian countries with high numbers of teen pregnancies. Globally, teen pregnancy rates have declined over the past two decades, except in the Philippines.

Gradual decrease in supply

Another concern is the gradual elimination of contraceptives from the market. Under the TRO, product registrations expire that would allow for the sale and distribution of contraceptives. The total effect is the gradual phasing out of contraceptives from government clinics and pharmacy shelves.

According to data provided by POPCOM, about 31 percent or about 15 brands of contraceptive certifications, expired as of December 2016. Currently there are 48 contraceptive brands in the Philippines. To date, there are a total of 20 contraceptive brands whose product registrations have already expired.

“What we are seeing now in the market, are just existing stocks that will eventually run out. By 2018, there will hardly be any more brands left and by 2020, there will be no more contraceptive brands available unless the Supreme Court lifts its TRO,” added Perez.

The TRO affects oral contraceptive pills, injectables and intra-uterine devices. While condoms are not affected by the TRO, the Department of Health said offering only condoms would not address the need to have choices.

After more than a decade of fierce lobbying, the Reproductive Health Law was passed in December 2012. But in the years since then, the controversial law, which promises access to family planning commodities and information, has continued to divide the deeply Catholic country of more than 100 million.

Immediately after it was passed, pro-life groups contested its constitutionality causing the Supreme Court to temporarily halt its implementation. In 2014, the High Court upheld the constitutionality of the law. In 2016, the health department’s $21 million contraceptive budget was cut.

But this confrontation with the Supreme Court will be its toughest battle yet. Considering that the Supreme Court is the court of last resort, if it decides to uphold the TRO, access to contraception could become a major public health issue in the Philippines.

“I don’t want to even imagine that,” DOH Undersecretary Gerardo Bayugo, told DW. “I want to believe that we will continue to be allowed to provide the family planning products requested by our people.”