Tiago Villanueva: Time for an overhaul of reproductive health in the Philippines

Tiago_VillanuevaPopulation control in the developing world is a major public health issue, as large families and overcrowding perpetuate cycles of poverty. The dire situation in the Philippines is considerably overlooked, even though it is extremely serious and the country has one of the highest birth rates outside Africa. The Philippines is the 12th most populated country in the world even though it is just 73rd  on the ranking of countries by surface area. The national capital region of Metropolitan Manila hosts around 12 million people in a surface area just over a third of the surface area of Greater London, whereas the population of Greater London is estimated to be 8.1 million. This year, the Philippine’s population is estimated to reach nearly 98 million, up from 86 million in 2006.

The exponential growth rate of the population is partly to do with reasons that are less common in the rest of Southeast Asia. It was formerly a Spanish colony, so the majority of the population is devoutly Catholic. The Catholic church in the Philippines is one of the most conservative in the world and firmly opposes family planning and widespread use of contraception methods. Population wide adherence to family planning services is therefore patchy. This is not only due to the influence of the church, but also due to the lack of access to contraceptive methods. Even though they are available on the market, they are too expensive for many people.

During a recent trip to the Philippines, I realised that many women, particularly in remote areas, lack access to prenatal care, which helps explain why the country’s maternal mortality rates are so high. In 2010, it was 221 deaths per 100 000 live births, up from 162 in 2006, according to the 2011 family health survey. This is one of the highest rates in Southeast Asia. A recent BBC report showed that the same bed in an overstretched Manila maternity hospital is often shared by two or even three women. The source of greatest hope for the country lies in the passage of the reproductive health bill, which has been pending for years and is due to be voted on in the Congress of the Philippines. The bill would make the government improve access to contraceptive methods and to reproductive health information, as well as introduce classes on reproductive health in school.

On 6 August, the House of Representatives decided to conclude the debate and start working on the amendments to the aforementioned legislation. I was happy to find out that a group of European legislators visited Manila recently, and raised awareness about the need to contain population growth. As expected, they were appalled at what they saw in Manila’s sprawling slums, where there are even couples struggling with 16 children. A Portuguese member of the visiting group mentioned that “Thirty years ago in Portugal, we had very similar health indicators as you have now. We had high maternal death rates and extremely high newborn death rates.” But he also added that he considered that Portugal’s Catholic church was more modern in its views, and that “the church is actually an ally in providing good health. They disagree with some laws, but they do not try to block it. They give their faithful the freedom to choose.”

Most of us are limited to raising awareness and to hope for a good outcome to the vote on the bill. No one seems to know exactly when it will happen, but there are accounts that it could happen in a matter of weeks.

For a country which overcame dictatorship not so long ago and constantly endures the effects of corruption, violence, terrorism, and natural disasters, it is now time for a small revolution in reproductive health. The future of the Philippine’s economy is bright, with the country being hailed as the next “Asian tiger.” But the question at play here is whether we want the next generations’ futures to be bright as well.

Tiago Villanueva is a GP based in Portugal and a former BMJ Clegg Scholar and student editor of the Student BMJ. His mother and most of his family are from the Philippines.