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

Figure 11 summarizes <strong>the</strong> explanations*2 provided bywomen when asked for one ma<strong>in</strong> reason why <strong>the</strong>y did not<strong>in</strong>tend to use any method of contraception <strong>in</strong> four surveysdone from 1993 to 2008. About one third did not <strong>in</strong>tend touse a method simply because <strong>the</strong>y wanted to get pregnantor <strong>the</strong>y could not get pregnant anymore due to menopauseor hysterectomy. The rema<strong>in</strong><strong>in</strong>g two thirds gave o<strong>the</strong>rreasons, which <strong>in</strong>dicate that <strong>the</strong>y had an unmet need, <strong>and</strong>would cont<strong>in</strong>ue to have an unmet need unless barriers touse are successfully addressedSafety concernsThe top concern is about safety, cited by half of thosewith an unmet need. The issues with<strong>in</strong> this group revolvearound doubts about <strong>the</strong> <strong>in</strong>tr<strong>in</strong>sic safety of contraceptiveproducts or <strong>the</strong>ir suitability or fit (hiyang <strong>in</strong> Filip<strong>in</strong>o)to <strong>the</strong> user. Focus group discussions typically open upconcerns about cancer, weight loss, dangerous levels ofchemical build-up due to prolonged use, excessive bleed<strong>in</strong>g,<strong>the</strong> build-up of unclean blood if menstruation stops, lossof physical strength which leads to <strong>in</strong>ability to work,debilitat<strong>in</strong>g headaches or stomach aches, devices that getlost or entangled <strong>in</strong>side, among many more such concerns.A study39 done <strong>in</strong> 2003 has documented many of <strong>the</strong>sefears (see Table B).Filip<strong>in</strong>o women have relatively high levels of formaleducation: 71 per cent of women not us<strong>in</strong>g any method <strong>in</strong><strong>the</strong> 2008 NDHS had a high school or college/universityeducation. However, contraception is not a st<strong>and</strong>ard partof <strong>the</strong> curriculum. The Department of Education hada much publicized attempt to pilot-test <strong>the</strong> <strong>in</strong>clusion ofsexuality <strong>and</strong> family plann<strong>in</strong>g topics <strong>in</strong> some public highschools <strong>in</strong> <strong>the</strong> last few months of <strong>the</strong> previous government,but this effort was blocked by lobby<strong>in</strong>g conducted byCatholic bishops <strong>and</strong> clergy. A policy of <strong>in</strong>tegrat<strong>in</strong>g ageappropriatereproductive health <strong>and</strong> sexuality education<strong>in</strong>to <strong>the</strong> formal school system is also part of numerousreproductive health bills filed <strong>in</strong> Congress s<strong>in</strong>ce 2001, butall such attempts have been successfully blocked by <strong>in</strong>tense<strong>and</strong> widespread lobby<strong>in</strong>g by <strong>the</strong> Catholic hierarchy.Ano<strong>the</strong>r factor for <strong>the</strong> prom<strong>in</strong>ence of safety questions is<strong>the</strong> open <strong>and</strong> cont<strong>in</strong>u<strong>in</strong>g campaign by Catholic bishops, laygroups, some Catholic medical practitioners <strong>and</strong> politiciansto raise doubts about <strong>the</strong> safety of contraceptives. 40 Some of<strong>the</strong> worst documented cases occurred <strong>in</strong> <strong>the</strong> city of Manila(population 1.7 million). In a 2006 video documentary 41 ,<strong>the</strong> city mayor justified his ban of contraceptives with <strong>the</strong>follow<strong>in</strong>g assertion: “Contraceptive materials actually arepoison to <strong>the</strong> woman's body. You look at <strong>the</strong> <strong>in</strong>ternet, it'seven described as a pesticide. Why should I be teach<strong>in</strong>gpeople how to take pesticide?” In 2007, medical doctorsemployed by <strong>the</strong> city government admitted <strong>in</strong> <strong>in</strong>terviewsabout <strong>the</strong> contraceptive ban <strong>in</strong> <strong>the</strong> city that <strong>the</strong>y teachpeople that contraceptives are unsafe or <strong>in</strong>effective, thatoral pills conta<strong>in</strong> pesticides <strong>and</strong> cause cancer, <strong>and</strong> thatcondoms are not effective <strong>in</strong> prevent<strong>in</strong>g HIV because <strong>the</strong>virus is smaller than <strong>the</strong> condom’s pores <strong>and</strong> can penetratethrough. 42In a focus group discussion by one of <strong>the</strong>authors with long-time community healthworkers, some of <strong>the</strong>m tried four modernmethods – usually pills, DMPA, condom,breastfeed<strong>in</strong>g <strong>and</strong> IUD – <strong>in</strong> differentorders, before <strong>the</strong>y settled on a methodthat was most comfortable for <strong>the</strong>m. A fewused a comb<strong>in</strong>ation of modern methods<strong>and</strong> herbal “menstrual regulators”, such asroots of achuete, makahiya, makabuhay<strong>and</strong> marabilos. The shift to differentmethods is triggered by side effects, suchas headaches, ligh<strong>the</strong>adedness, gastritis;unexpected effects, such as cessationof menses with pills <strong>and</strong> IUD; <strong>and</strong>cont<strong>in</strong>uous method failure, usually withpills <strong>and</strong> DMPA; <strong>and</strong> heavy bleed<strong>in</strong>gwith DMPA. A few used withdrawal.Despite <strong>the</strong> difficulties, women persist <strong>in</strong>us<strong>in</strong>g <strong>the</strong>se methods for many reasons.In <strong>the</strong>ir experience, clients who havedifficulty susta<strong>in</strong><strong>in</strong>g use are those whoexperience side effects, some of whichare contrary to <strong>the</strong> postulated effects ofmethods – amenorrhoea with IUD <strong>and</strong>pills, monthly bleed<strong>in</strong>g with <strong>in</strong>jectables– or symptoms which are not logicallyrelated to <strong>the</strong> methods, such as chestpa<strong>in</strong>, mass <strong>and</strong> asthma. There are thosewho fear experienc<strong>in</strong>g pa<strong>in</strong> on gett<strong>in</strong>gan IUD because <strong>the</strong>y th<strong>in</strong>k it is asurgical procedure, or because of previousexperiences with pa<strong>in</strong>ful <strong>in</strong>sertion,<strong>in</strong>fection <strong>and</strong> abscess formation, <strong>and</strong>perforation.308