Contraceptive use exhausted, but responsibility for family planning still predominates among women

MANILA, Philippines — In April 2021, the Population and Development Commission (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 chose to use contraception due to the financial drain of the spread of COVID-19.

Aquino works as an informal worker and earns P2,000 four days a week. Like many other day laborers, his family loses its survival for two weeks when curfews are imposed.

dr Juan Antonio Perez III, Popcom’s executive director, said more people were using birth control as families worried about pregnancy during the pandemic.

It also helped that health workers stepped up door-to-door delivery of modern contraceptives.

Leslie Paunil shows the implant placed in her left arm.

Contraceptive methods were accessible to women like Paunil 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 variety of contraceptives and sexual and reproductive health services.

“I chose an implant because there was no way we would survive [if we have] another child,” Paunil said. A birth control implant is about the size of a matchstick. It’s placed in a woman’s upper arm and releases hormones to help prevent women from becoming pregnant.

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

“I didn’t hesitate to use birth control because I attended Likhaan’s educational workshops, which influenced my decision,” said the mother-of-two.

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

Rethinking contraceptives

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

dr Junice Melgar. The 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 set up clinics in several urban slums to connect women to health services and meet those needs, but lockdowns and limited transportation made access to them difficult.

“Women would walk miles just to reach our family planning services centers because they knew how difficult it would be to conceive in those circumstances,” Melgar said.

More Filipino women wanted to get implants during the pandemic, but supplies were limited due to disrupted international supply chain issues, according to United Nations Population Fund data.

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

“At this point it’s not true that women are worried about side effects, of course there have been some, but that could easily be explained by quality family planning counseling,” she added.

Family planning in a patriarchal society

A woman receiving an injection at the Likhaan Satellite Clinic. Injections are a form of hormonal contraception for women that is performed every three months.

Although there have been advances in the use of contraceptive methods, much of the responsibility still rests with women.

According to Contraceptive Justice: Why We Need a Male Pill, women bear the financial and health burdens of contraception. They are also the ones who spend more time accessing services and visiting healthcare 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, while men’s options do not. Based on interviews at the health center, the women said they gained weight, felt nauseous and encountered spotting when they started using birth control. However, these side effects are normal and temporary.

“I took the initiative to get an implant because my husband doesn’t use condoms,” Paunil said.

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

Saldo Aquino and Leslie Paunil at their home

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

Aquino, who works long hours as a laborer, is the one in charge of making money. Paunil, who is unemployed, is responsible for maintaining the house, looking after her children and planning her expenses.

None of them saw problems with their dynamic and took their roles according to the norms 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 without his wife would be impossible.

“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,” Aquino said.

Address gender inequalities to overcome systemic inequalities

Lina Bacalando with other mobilizers at the Likhaan Satellite Clinic in Malabon

Lina Bacalando, a community health worker and one of Likhaan’s longest-serving community leaders, emphasized the role of organizing in women’s empowerment as a product of grassroots self-organization.

Bacalando recalled being one of the most consistent participants in Likhaan’s workshops in the urban impoverished community where she lives in the 1990s.

“I attended her workshops because I was very interested in learning about preventing infant deaths, providing maternal care and medical alternatives,” said the 59-year-old community mobilizer.

Because Bacalando has learned workshops and training from Likhaan’s, her neighbors rush to her for advice on sexual and reproductive health issues.

“I was initially hesitant to be a mobilizer because I always thought the kind of work Likhaan does is only for people who have graduated. But because I saw the plight of my neighbors and because they trusted me, it made sense that I could help them with their concerns,” Bacalando said.

Attending educational seminars not only informed Bacalando about caring for mothers, but also about women’s and people’s rights. She became aware of the inequalities in society and realized that the gender roles learned in the past were not always correct and not set in stone.

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

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

“You never know when a pregnant woman will need your help, so I’ve always been away. The more awake I became, the less I stayed 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 through tireless explanations, her husband finally understood. Today she and her husband are still together.

Meanwhile, back at Aquino and Paunil’s home, Leslie is caught between looking for a job to contribute extra income to her household and staying with her children.

Her only option is the night shift at a factory, and similar to the contraceptives, Paunil would be the one making the most adjustments.

“Because my husband works during the day and I have to look after the children when he’s gone, I can only do the night shift. I just need to adjust again, but with our current worries, that’s not much.” She said.

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

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

This story was produced with support from Oxfam Philippines.

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