Family Planning in Asia and the Pacific - International Council on ...

BackgroundThe Philipp<strong>in</strong>es is an archipelago of 7,107 isl<strong>and</strong>s – some4,000 of which are named <strong>and</strong> 1,000 <strong>in</strong>habited – located off<strong>the</strong> south-eastern coast of ma<strong>in</strong>l<strong>and</strong> <strong>Asia</strong>. The country hasa total l<strong>and</strong> area of some 300,000 square kilometres. Thedispersed character of <strong>the</strong> country is fur<strong>the</strong>r heightenedby its diverse <strong>and</strong> difficult terra<strong>in</strong>: numerous mounta<strong>in</strong>s,volcanoes <strong>and</strong> plateaus broken up by pla<strong>in</strong>s, valleys, rivers<strong>and</strong> lakes 1 .The country’s population was estimated 2 to beapproximately 94 million <strong>in</strong> 2010; 171 languages arespoken <strong>in</strong> <strong>the</strong> country, <strong>the</strong> top 15 of which are <strong>in</strong> use by500,000 or more people each 3 . The official languages areEnglish <strong>and</strong> Filip<strong>in</strong>o (a l<strong>in</strong>gua franca m<strong>and</strong>ated by <strong>the</strong>1987 constitution). Filip<strong>in</strong>os value education as a way ofescap<strong>in</strong>g poverty; hence, <strong>the</strong> country has a relatively highfunctional literacy rate (86%), with females enjoy<strong>in</strong>g a 4.5percentage po<strong>in</strong>t advantage over males 4 .The country had a gross national <strong>in</strong>come per capita of US$1,890 <strong>in</strong> 2008, slightly below <strong>the</strong> average of US$ 2,078 forlower middle-<strong>in</strong>come countries accord<strong>in</strong>g to <strong>the</strong> WorldBank classification, <strong>and</strong> 28 per cent beh<strong>in</strong>d <strong>the</strong> average for<strong>the</strong> East <strong>Asia</strong>n <strong>and</strong> <strong>Pacific</strong> region: US$ 2,631 5 .The Philipp<strong>in</strong>es has an urban population that <strong>in</strong>creasedfrom 27 per cent of <strong>the</strong> total population <strong>in</strong> 1950 to 48 percent <strong>in</strong> 2000, <strong>and</strong> is predicted to cont<strong>in</strong>ue ris<strong>in</strong>g to about65 per cent of <strong>the</strong> total by 2020. Consistent with thisurbaniz<strong>in</strong>g trend, <strong>the</strong> proportion of persons employed <strong>in</strong>agriculture, forestry <strong>and</strong> fisheries has gone down from 45per cent <strong>in</strong> 1989 7 to 34 per cent <strong>in</strong> 2009 8 .About 83 per cent of <strong>the</strong> people identify <strong>the</strong>mselves asCatholics, 5 per cent as Muslims <strong>and</strong> <strong>the</strong> rest variouso<strong>the</strong>r Christian faiths. 9 Catholicism was <strong>in</strong>troduced bySpanish colonists; <strong>the</strong> colonial period lasted for more than300 years, from <strong>the</strong> mid-1500s to 1898. The operation ofCatholic hospitals <strong>and</strong> medical schools that began <strong>in</strong> <strong>the</strong>1800s cont<strong>in</strong>ues until today <strong>and</strong> plays an important role<strong>in</strong> <strong>the</strong> provision of health-care services <strong>and</strong> – throughgraduates that enter <strong>the</strong> Department of Health <strong>and</strong> o<strong>the</strong>rgovernment agencies – <strong>the</strong> craft<strong>in</strong>g of health policies.Catholicism <strong>and</strong> <strong>the</strong> church hierarchy play a critical role <strong>in</strong>respect of family plann<strong>in</strong>g policies.The Philipp<strong>in</strong>es has a unitary presidential form ofgovernment with universal suffrage. State powers aredivided among three coequal <strong>and</strong> separate branches – <strong>the</strong>executive, legislative <strong>and</strong> judicial – patterned after <strong>the</strong>United States of America, which took over from Spa<strong>in</strong>as <strong>the</strong> colonial power <strong>in</strong> <strong>the</strong> early 1900s. Election-based,autonomous governance <strong>in</strong> localities was thoroughlydeveloped dur<strong>in</strong>g <strong>the</strong> American colonial period 10 .Currently, tens of thous<strong>and</strong>s of local government officials –all elected every three years – wield extensive executive <strong>and</strong>legislative powers <strong>in</strong> numerous <strong>and</strong> complex layers of localgovernment units (LGUs), mirror<strong>in</strong>g <strong>the</strong> geographically<strong>and</strong> l<strong>in</strong>guistically fragmented character of <strong>the</strong> country.From highest to lowest level, LGUs are composed of 80prov<strong>in</strong>ces, 138 cities, 1,496 municipalities <strong>and</strong> 42,025barangays (villages) 11 .Nodal po<strong>in</strong>ts <strong>in</strong> <strong>the</strong> familyplann<strong>in</strong>g programmeThe official Philipp<strong>in</strong>e <strong>Family</strong> <strong>Plann<strong>in</strong>g</strong> Program wascreated by <strong>the</strong> Population Act (Republic Act 6365), a lawpassed <strong>in</strong> 1971. From 1988 to <strong>the</strong> present, <strong>the</strong> programmehas been led by <strong>the</strong> Department of Health <strong>and</strong> framed asa public health programme with a desirable demographicimpact. With<strong>in</strong> this broad framework, major variationsoccurred as a result of three ma<strong>in</strong> factors: <strong>the</strong> position of<strong>the</strong> President with regard to artificial contraception, anissue that has been elevated to <strong>the</strong> highest office ow<strong>in</strong>g to<strong>the</strong> strong opposition of <strong>the</strong> Catholic hierarchy; devolutionof health personnel, facilities, budget <strong>and</strong> decision-mak<strong>in</strong>gto local government units (LGUs); <strong>and</strong> <strong>the</strong> reproductivehealth framework <strong>and</strong> <strong>in</strong>ternational commitments madeat <strong>the</strong> <strong>International</strong> Conference on Population <strong>and</strong>Development (ICPD) <strong>in</strong> Cairo <strong>in</strong> 1994.The first period (1988-1991)was a transition phase <strong>in</strong> many ways: <strong>the</strong> wholegovernment was rebuild<strong>in</strong>g old <strong>and</strong> new <strong>in</strong>stitutions <strong>and</strong>processes after 14 years of authoritarian rule*, <strong>and</strong> a lawthat would radically change <strong>the</strong> health sector throughdevolution was proposed <strong>and</strong> ultimately passed <strong>in</strong>1991. The constitutionality of <strong>and</strong> <strong>the</strong> need for a familyplann<strong>in</strong>g programme were debated 12 at <strong>the</strong> highest levelof government. From a population programme under <strong>the</strong>Commission on Population (POPCOM), family plann<strong>in</strong>gsurvived <strong>and</strong> was redef<strong>in</strong>ed as a health programme under<strong>the</strong> Department of Health.The second period (1992-2000)was dom<strong>in</strong>ated by health devolution <strong>and</strong> ICPD. Theactual transfer of health personnel, facilities <strong>and</strong> resourcesoccurred from 1993 to 1994; legal efforts <strong>and</strong> masscampaigns by public health workers <strong>and</strong> some governmentofficials to renationalize <strong>the</strong> sector cont<strong>in</strong>ued until <strong>the</strong> late1990s; <strong>and</strong> a new health sector strategy to “make devolutionwork” was released <strong>in</strong> 2000. 13 High-level commitments<strong>and</strong> efforts to promote family plann<strong>in</strong>g <strong>and</strong> reproductivehealth were slowed down by <strong>the</strong> very new <strong>and</strong> fragmentedstructure of <strong>the</strong> health sector.295