Family planning

Use of contraceptives but responsibility for family planning still falls primarily on women

MANILA, Philippines – In April 2021, the Commission on Population and Development (PopCom) recorded that more than 8 million Filipinos used family planning methods during the pandemic, a 6% increase from 2019.

Husband and wife Saldo Aquino and Leslie Paunil were among those who decided to use contraceptives due to the financial burden caused by the spread of COVID-19.

Aquino works as an informal laborer, earning 2,000 pesos to work four days a week. Like many other daily workers, his family loses an income equivalent to surviving for two weeks when the closures are declared.

Dr. Juan Antonio Perez III, executive director of Popcom, said more people were using contraception because families worried about pregnancy during the pandemic.

It also helped health workers scale up home delivery of modern contraceptives.

Leslie Paunil shows the implant inserted in her left arm.

For women like Paunil, birth control methods were accessible because she lives near a clinic at the Likhaan Center for Women’s Health.

The Likhaan Center for Women’s Health is a nonprofit organization that provides free access to a wide variety of contraceptives and sexual and reproductive health services.

“I decided to get implanted because there was no way to survive [if we have] another child,” Paunil said. A contraceptive implant is about the size of a match. It is inserted inside a woman’s arm and releases hormones to prevent women from getting pregnant.

Paunil previously used birth control pills to prevent pregnancy, but the problem with using pills is that she sometimes forgets to take them. Compared to pills, implants guarantee women that they would be protected from pregnancy for three years as long as they are attached to their arms.

“I did not hesitate to use contraceptives as I attended educational workshops from Likhaan which informed my decision,” the mother-of-two said.

As they both expected, Paunil and her husband were spending more time together as they were locked up at home. They said it helped that there was a clinic nearby to consult on family planning.

Changing mindset about contraceptives

Free contraceptives (implants, condoms, copper IUDs, injectables, and pills) available at Likhaan Center for Women’s Health clinics

Dr Junice Melgar. executive director of the Likhaan Center for Women’s Health, said women are aware of their need for sexual and reproductive health services and there has always been a demand for contraceptives, contrary to what most people assume About them.

Likhaan has established clinics in several poor urban communities to connect women to health services and meet this need, but closures and limited transportation options have made it difficult to access them.

“Women traveled miles just to reach our family planning service centers because they knew how difficult it would be to get pregnant under these circumstances,” Melgar said.

More Filipino women wanted to get implants during the pandemic, but supply was limited due to international supply chain disruption issues, according to Data of the United Nations Population Fund.

“The mindset has changed and the demand is greater, and now we have to meet the growing demands of women,” Melgar said.

“At this point it is not true that women worry about side effects, of course there have been a few, but that could easily be explained by quality family planning advice,” she added.

Family planning in a patriarchal society

A woman receiving an injectable at the satellite clinic in Likhaan. Injectables are a form of hormonal birth control for women that is done every three months.

Although there is progress in the use of contraceptive methods, much of the responsibility still lies with women.

According to “Contraceptive Justice: Why We Need a Male Pill”, women bear the financial and health burden of contraception. They are also the ones who spend the most time accessing services and consulting health professionals.

According to the 2012 study, women have a total of 11 birth control methods to choose from, while men’s options are limited to just two – male condoms and vasectomy.

Women’s birth control methods affect their hormones, unlike men’s options. Based on interviews at the health center, women reported gaining weight, feeling nauseous and spotting when they started contraception. However, these side effects are normal and temporary.

“I took the initiative to get implanted because my husband doesn’t like using condoms,” Paunil said.

“If I don’t adjust to him, it will just be harder for me if I carry the child. I was also aware that the hormonal changes were temporary, and it’s normal to be on birth control.” , she added.

Saldo Aquino and Leslie Paunil at home

At home, the distribution of tasks between Aquino and Paunil remains traditional.

Aquino, who works long hours as a laborer, is the one in charge of earning money. Paunil, unemployed, is responsible for maintaining the house, caring for their children and budgeting their expenses.

Neither saw any issues with their dynamics and carried out their roles according to the standards of their community. They also said they were unfamiliar with gender role concepts.

Aquino is unfamiliar with the term “gender equality”, although he acknowledges that he and his wife are “partners” with different contributions to the household.

He still believes in common misconceptions about women’s physical abilities, but his experience tells him that running the household would be impossible without his wife.

“I think my wife and I are the same. There are things she can’t do and there are things I can do, and as partners we help each other out,” Aquino said.

Addressing Gender Inequalities to Break Systemic Inequalities

Lina Bacalando with other Women Mobilizers at the Likhaan Satellite Clinic in Malabon

Lina Bacalando, a community health worker and one of the oldest community leaders in Likhaan, highlighted the organization’s role in empowering women, as a product of the organization itself at the grassroots.

Bacalando recalled that in the 1990s she was one of the most persistent participants in Likhaan workshops in the poor urban community in which she lives.

“I attended their workshops because I was very interested in learning more about child mortality prevention, maternal care and medication alternatives,” said the 59-year-old community mobilizer.

Because Bacalando learned from Likhaan’s workshops and training, her neighbors ran to her for consultation on sexual and reproductive health care.

“I was hesitant to be a mobilizer at first because I always thought that the type of work Likhaan does is only for people who have completed their education. But because I saw the need in my neighbors and because that they trusted me, that made it reasonable for me to help them with their concerns,” Bacalando said.

In addition to learning about maternal care, attending educational seminars also informed Bacalando about women’s and peoples’ rights. She became aware of the inequalities in society and realized that the gender roles she had learned in the past were not always correct and were not set in stone.

“I live in a poor urban community and through workshops I learned that demolition, health and gender issues are intersectional,” she said.

But spending more time in the organization and being an active mobilizer upset her husband.

“You never know when a pregnant woman needs your help, so I was always away. The longer I was awake, the less I stayed at home, and of course that disappointed him,” Bacalando said.

She began breaking traditional patterns in their household, which led to fights and changed their relationship. But, by dint of tireless explanations, her husband ends up understanding. Today, she and her husband are still together.

Meanwhile, back at Aquino and Paunil’s, Leslie is caught between finding a job to bring extra income to their household and staying with their children.

Her only option is to work night shifts in a factory, and as in their case with contraceptives, Paunil would be the one to make the most adjustments.

“Because my husband works during the day and I have to take care of the children when he is away, I can only work at night. I will just have to adapt again, but given our current worries, this is not a big deal,” she said.

Bacalando said it may have taken her years for her husband to understand her choice and the change in their household dynamics, but she remains hopeful that more women, when informed and empowered, can do the same.

“If I was able to change the cycle in our family because I was empowered by my community, I believe other women can do the same too,” Bacalando said.

This story was produced with the support of Oxfam Philippines.