A tropical storm rages outside while Ruzel Delovino gathers her family into their dimly lit one-room home. A light bulb flickers as she cooks a small pot of rice, shared among her four youngest children, her husband and herself.
Water drips into the ramshackle apartments, stacked one on top of another in Manila’s most populated slum, Tondo. Below, rising floodwater — a mix of sewage, mud, and debris — flows through the narrow, crowded alleyways. The rain shows no sign of letting up.
School has been cancelled across Manila today, and even if school were in session, Delovino’s kids would likely still be at home. That’s because she refuses to send them to school hungry.
“My husband can sometimes get construction work, but if there’s no work, then we don’t eat,” she says. “That’s when my kids don’t get to eat three times a day. They cry and beg me for food, but I don’t have any food to give them.”
By age 31, Delovino was the mother of seven children, all born in the span of about a decade. She couldn’t afford to raise them all, so she sent her three oldest to live with other relatives. Delovino, like many other impoverished women in Manila, has had little or no access to birth control.
Half of all pregnancies in the predominantly Catholic Philippines are unintended, according to a recent study by the Guttmacher Institute, a US-based think tank that promotes reproductive health. Of those unintended pregnancies, 90 percent are due to a lack of modern methods of contraception. Unlike in some other developing nations, the Philippines’ government has not provided free contraception.
In the year 2000, the former mayor of Manila banned the distribution of contraceptives in all city-funded health centers, and the ban lasted for almost a decade. On top of that, the US Agency for International Development phased out family planning services in the country in 2008.
But the unmet need for birth control may become a thing of the past as the Philippines begins to roll out free contraception under its new reproductive health law. The groundbreaking legislation will require government health centers to distribute free contraceptives, including birth control pills and condoms, no matter the beliefs of the politicians in power. The law also aims to educate Filipino youth about family planning by integrating sex education into school curricula.
The path to free family planning services for the poor wasn’t an easy one. Fierce opposition from influential Catholic Church leaders, who have long played a major role in politics, resulted in a bitter 14-year battle in Congress.
Even after lawmakers passed the bill in 2012, church groups filed petitions questioning the measure's constitutionality, sending the debate to the Supreme Court. Last year, the Supreme Court upheld the legislation and the bill became law.
The Catholic Church still opposes it.
Pope Francis visited the Philippines this week and reiterated the church’s stance on birth control in a press conference on the flight back to Rome. He emphasized the church’s rejection of artificial birth control, but also said that Catholics should use natural family planning methods. He spoke about a woman he met who had seven children and was pregnant again, which he called irresponsible.
“Some think, excuse me if I use the word, that in order to be good Catholics, we have to be like rabbits — but no,” he said.
Politicians who opposed the reproductive health bill have demanded proof that each contraceptive on the market is not an abortifacient, meaning it doesn’t terminate a pregnancy, and has full approval from the Food and Drug Administration of the Philippines.
Former mayor of Manila Lito Atienza — now a congressman — says his Catholic faith dictates his views on the issue.
“Valuing life is a golden value of the Filipino mindset. The contraceptive mentality is not correct. The life that is conceived in a woman’s womb is a creation of the Almighty,” he said. “Allow your reproductive system to function naturally and don’t meddle with it, and you’ll have good health, as a woman and as a mother.”
Atienza’s policy when he was mayor made it impossible for poor families to get contraception at public health facilities in Manila. He and Catholic archbishops say a reproductive health law will lead the country down an immoral path.
The bill’s authors disagree.
“Each woman and each couple has the right to say, ‘are we going to have children? and if so, ‘how many years between each child?’” said Risa Hontiveros, a former congresswoman who co-authored the reproductive health bill, “’so that we can plan for, and actually provide a humane quality of life for each member of this family.’”
Senator Pia Cayetano, another author of the bill, pointed to the fact upper- and middle-class women in the Philippines have long been able to access contraception, since they can afford to pay for it. “The law recognizes the poor need assistance,” she said. “A mother has to make a choice of which of her kids are going to eat a meal today. This law will change their lives so drastically.”
Delovino, the mother of seven, said she would have only had three children if she had access to free birth control. However, the cost of the pills, 50 pesos ($1.25) per month, is just too much for her.
“I’d rather put it towards food so the kids can eat,” Delovino said.
The lack of free contraception has taken a toll on maternal health, according to experts. The Philippines isn’t on track to meet the UN’s Millennium Development Goal of reducing maternal deaths from 162 per 100,000 in 2006 to just 52 deaths per 100,000 women by this year. The UN Population Fund’s director for the Philippines, Klaus Beck, is hopeful the new law will change things.
“Each family would have fewer children and more space in between them, so women will be healthier,” he said. “As they have fewer pregnancies, they are less likely to become sick from that, and fewer women will die in pregnancy as well.”
Many maternal deaths in the Philippines are due to unsafe, underground abortions — the country has one of the strictest abortion laws in the world. It’s illegal under all circumstances, including rape, and there’s no clear exception even when the pregnancy jeopardizes the woman's health.
A lack of subsidized contraception has drastically increased abortion rates. There were an estimated 610,000 abortions in the Philippines in 2012, an increase of 50,000 from four years earlier.
Outside Manila’s crowded Quiapo Church, women can walk through alleyways to find traditional healers who sell bottles of colorful herbal liquids and use painful massage to induce abortion. These methods can cause life-threatening hemorrhage or other dangerous health problems.
With limited post-abortion care and a stigma surrounding abortion, many women have nowhere to turn after complications, and they are often ridiculed or shamed when they seek medical help. But the new law stipulates that women needing post-abortion care will receive proper treatment and counseling.
When Ruzel Delovino became pregnant for the fifth time, she didn’t know how she could possibly feed another child.
“It came to a point where the babies were coming one after another. I wanted an abortion, because I was thinking, would I be able to take care of the baby?”
A devout Catholic, she went to church to pray, and she talked to a priest. He advised her against the abortion.
“Because I was so afraid that it’s a sin to kill an innocent unborn child, I just went through with it, even though I was already struggling,” she said. “I chose to keep the baby.”
After Delovino had her seventh child three years ago, a community health worker from a local NGO’s clinic happened to visit her home. The clinic had a limited supply of free contraceptives, and Delovino was able to get an intrauterine device (IUD), which prevents pregnancy for several years.
Though she’s not worried about getting pregnant anymore, her daily struggle to get enough rice for her kids doesn’t end.