Contraceptive use of young people in select urban - Youth Sextion

Contraceptive Use
of Young People
in Select Urban Poor
Metro Manila Communities
Elizabeth Aguiling-Pangalangan
Ma. Lourdes Acosta-Alba
Reproductive Health, Rights, and Ethics
Center for Studies and Training (ReproCen)
Social Medicine Unit, College of Medicine
University of the Philippines Manila
2009
i

iii Contents
Foreword by Alberto G. Romualdez, M.D. v
Foreword by Alvin B. Caballes, M.D. vii
1 4
I II
Introduction Research Problem/
Objectives
6 8
III IV
Participants Methodology
in the Study
11 16
V VI
The Research Presentation
Areas of Data
28 47
VII VIII
Discussion Recommendations
About the Authors and Acknowledgement
iii

FOREWORD
This monograph is an important piece of work for
three reasons: 1) it highlights a major blind spot in the
social services delivery system of the Philippines; 2) it
documents the areas of need of a major but neglected
segment of the Philippine population, and; 3) it points
the way forward in learning more about and finding
solutions to a significant problem.
Health inequity – defined as inequalities in health
resulting from unfair and unjust differences in access
to health services between population groups – is well
documented in the Philippines. In reproductive health
the disparities in fertility rates between rich women
and those from the poor majority have not diminished
over the last three or four national surveys. Health
inequity is in fact the most serious health problem in
the Philippines today as it has been for most of the last
century.
The present study reveals another significant gap
in the country’s social services delivery system. It
shows that a very important group – the youth – is not
adequately provided with the social services (health
and education) they need to lead healthy and
responsible reproductive lives at a time when they
need it most. The lack of reproductive health content
in social services for disadvantaged groups reported
v

here is yet another area of concern that requires
urgent attention.
The study also singles out a large and important
segment of the population – the youth – that has a
number of unmet needs. This segment of the
population is of major importance not only because it
is large and growing but also because they comprise
the future generation of Filipinos.
While the survey limited itself to looking at urban
youth, the findings will be extremely useful in
developing tools to study the needs of young people in
the rest of the country. If universal health care is to be
made a reality for the Philippines, it will be necessary
to develop targeted health service packages designed
specifically for this, arguably the most important,
segment of Philippine society.
Alberto G. Romualdez, M.D.
Vice President, The Forum on
Family Planning and
Development;
Former Secretary, Department of
Health
vi

FOREWORD
The reproductive health of the youth is important
for several reasons. In a developing country such
as the Philippines, the youth comprises a large
portion of the population. Changing social and
cultural norms – facilitated by the pervasive
effects of globalization – translates to increasing
sexual activity for the “youth bulge”. Whether the
latter can be looked upon as a positive
advancement (e.g., a more liberal acceptance of
essentially natural interactions) or a negative
development (e.g., a diminution of social mores)
will remain a contentious issue. From a macro
perspective nonetheless, such a demographic
phenomenon, coupled with the widely perceived
falling age of menarche, can potentially translate
to higher over-all fertility rates.
Higher fertility will necessarily require the
investment of more resources if only to provide for
the basic needs of a growing population. Certainly,
larger outlays will be needed if more enhanced
resources are to be required (e.g., higher
education). In the context of the limited resource
capacities of most developing countries, the higher
fertility rates that may come about with greater
sexual activity among the youth – whether by
earlier onset or longer duration of childbearing –
can be a considerable strain particularly for public
vii

administration.
However, it is not only the bigger picture
which is worth considering. What may be more
consequential would be the difficulties that may
arise on a personal level. The earlier engagement
in sexual activities will also heighten the attendant
reproductive health risks, such as unplanned
pregnancies, induced abortions, disease
transmission, violence, and others.
Likewise, the same social environment that has
apparently encouraged earlier sexual engagement
remains unsupportive of the possible mitigating
mechanisms (e.g., sex education) and even
outcomes (e.g., schooling opportunities for
pregnant teens). Some of the consequences are
equally tragic from both the personal and societal
perspectives (e.g., sexual violence, higher infant
mortality rates in teen pregnancies, etc.).
For the young, and especially the poor, the adverse
effects are all the more accentuated. Having less
access to society’s opportunities to begin with,
they are made more vulnerable to the alluded ill
effects of what society itself has ironically actually
initiated them into. Such reproductive health
issues, being of both personal and communal
interest, can only be decisively dealt with by
effective public policy. This is particularly true for
states that have inadequate means to address the
untoward toll on its populace. The succeeding
article of Aguiling-Pangalangan and Acosta-Alba
viii

I
INTRODUCTION
The Philippines is the thirteenth most populated
country in the world with 97,976,603 people 1 .
Manila, the country's capital, has a population of
11,553,427 2 in an area of only 636 square
kilometers. However, the greater urban area of
Metro Manila, which includes Manila, puts the
population at around 20,075,000 3 people.
Population is growing rapidly at 3 births per
minute. Half of the Philippine population is
below the age of 21, thus we have what is referred
to as a “youth bulge,” that will continue into the
1 CENTRAL INTELLIGENCE AGENCY. 2009. CIA: The World Factbook.
Online. Central Intelligence Agency: USA. Available from:
https://www.cia.gov/library/publications/the-world-factbook/geos/rp.html. [05
Oct 2009]
Rates by Region, Province and City/Municipality: 1995,2000, 20007. Online.
2 NATIONAL STATISTICS OFFICE. 2007. Population and Annual Growth
National Statistics Office: Philippines. Available from:
http://www.census.gov.ph/data/sectordata/2007/municipality.pdf. [05 Oct
2009]
3 _______. 2009. “Demographia World Urban Areas and Population
Projections. Demographia: ____.” Available at:
05 Oct 2009.
1

year 2025 because of our weak family planning
programs. Consider further that on the average,
23% of the youth have premarital sex. 4
Almost half of all pregnancies in the country or
almost 800,000 births annually are unplanned.
Thirty-six percent of young Filipino women aged
15-24 conceive before marriage, and more than
half of illegitimate births are from young
mothers. The Philippines has a low contraceptive
prevalence rate and a high 20% unmet need
problem 5 .
Eighty-five percent of the population is nominally
Catholic, with Protestants and Muslims each with
adherents coming from five percent of the
population and another five percent from homegrown
religions like the Iglesia ni Kristo and the
Philippine Independent Church, also known as
the Aglipayan. 6 Given that the Philippines is a
4 UP POPULATION INSTITUTE AND THE DEMOGRAPHIC
RESEARCH AND DEVELOPMENT FOUNDATION INC. 2004. Youth, Sex
and Risk Behaviors in the Philippines: A Report on a Nationwide Study: 2002
Young Adult Fertility and Sexuality Study (YAFS3). Philippines: UP
Population Institute.
5 POLICY PROJECT. 2003. Adolescent and Youth Reproductive Health in
the Philippines: Status, Issues, Policies and Programs. Online. Policy Project:
USA. Available from:
http://www.policyproject.com/pubs/countryreports/ARH_Philippines.pdf. [09
Dec 2009]. This refers to the number of women who do not use any family
planning method despite their express desire to limit the number of children.
6
DEPARTMENT OF TOURISM. 2009. Religion. Online. Wow Philippines:
Philippines. Available from [October 5, 2009]
2

predominantly Catholic country, its strong and
influential Catholic clergy has been a major
hindrance in the passage of laws and policies that
recognize and protect the reproductive health
rights of Filipinos. This has translated into
inadequate, and in some areas, totally
nonexistent reproductive health information,
services and supplies.
3

II
RESEARCH PROBLEM /
OBJECTIVES
Poor contraceptive use among young people
stems from situational factors such as social
proscriptions against young people engaging in
sex, the sporadic, unplanned nature of sexual
encounters among them (especially teenagers),
lack of knowledge during the first sexual
encounter, and limited mobility and access to
contraception. These can be explained partially
by significant national and local policies that
reflect the Catholic teachings of confining sex
within marriage and regarding procreation as the
sole reason for engaging in sexual intercourse.
Thus, the right of young people to sexual and
reproductive health is barely acknowledged and
has given rise to problems of availability and
accessibility to information and services relating
to traditional and modern contraception. It has
likewise placed health care providers in a
quandary over providing RH counseling and
keeping such consultations confidential, which
they fear might contravene the right of parents to
exercise authority over their children.
4

This study looks into the reasons for the low level
of contraceptive use among sexually active youth
in select urban poor communities in Metro
Manila, with a focus on the accessibility of young
people to family planning information, services
and supplies and their knowledge about
contraception. It explores the accessibility of
contraceptive information and services in terms
of awareness or knowledge of sources of family
planning information and other services,
proximity or distance to one or more sources of
such services, and cost of contraception.
The second part of the study seeks to present the
policy and legal situation vis-a-vis raising
awareness about young people‟s sexual and
reproductive health and rights. It aims to
describe how their right to access safe, effective
and affordable family planning (FP) methods
have been expressed in national health and
population policies. The study seeks to establish
that lack of effective access to FP information and
services, and significant unmet need for
contraception among Filipinos in general and
young people, in particular are due mainly to the
absence of a government policy to provide the full
range of medically safe and legally acceptable
family planning methods.
5

III
PARTICIPANTS
IN THE STUDY
Young people are the target of the study although
it is a group, which has no categorical designation
in any Philippine law.
PD 603, otherwise called the Child and Youth
Welfare Code 7 and EO 209, known as The Family
Code 8 both use the term “child” and define it as a
person below the age of majority. 9 The word is
used interchangeably with terms “minor” and
“youth.” On the other hand, the Anti-Child
Abuse Law 10 is broader in scope in that it
includes those over 18 years of age but are unable
to fully take care of themselves or protect
themselves from abuse, neglect exploitation,
cruelty or discrimination while RA 8044, Act
Creating the National Youth Commission extends
7 Article 2 of Presidential. Decree No. 603 was enacted on December 10,
1974.
8 Executive Order 209 took effect on Aug. 3, 1988/
9 Rep. Act No. 6809 waspassed on December 13, 1989. It lowered the age of
majority from 21 to 18 yrs. of age.
10 Rep. Act No. 7610 was passed on June 17, 1992.
6

the category “youth” to persons from 15-30 yrs.
old.
In contrast, the United Nations uses the term
“adolescent” to refer to persons between 10-19
years of age and “youth” to those between 15-24
years old. Although there is no legal definition of
“young people” it has been empirically described
as males and females from 10-24 and thus covers
both adolescents and youth. 11 According to the
World Health Organization, this age group
comprises a little over 30% (or roughly 26
million) of the Philippine population. 12
The participants in our study ranged from ages
12- 21 who therefore fall under the class of
“young people.”
11 UNITED NATIONS POPULATION FUND. 2007 Supporting Adolescents
and Youth. Available at:

IV
METHODOLOGY
Data was gathered through a survey administered
to more than 308 young people (134 males, and
170 females, and four who did not specify their
gender), with an average age of 18 years and
additionally, through focus group discussions
(FGD) conducted among 45 respondents from
the same Metro Manila communities.
PRIMARY DATA ANALYSIS
Survey
Survey questions were developed to elicit the
information necessary to prove the hypothesis of
the study. These survey questions were
distributed to key, urban poor areas in Metro
Manila through health workers or NGO workers
we had previously worked with in the selected
communities. In some areas, the questionnaires
were left in the barangay health center, which is
one of the key areas frequented by young people
with reproductive health care concerns.
8

As some of the questions did not limit the
responses to a pre- identified selection of answers
and instead required the respondents to answer
them individually, several focus group
discussions were held to follow up on the
concerns that were raised in the surveys.
Focus Group Discussions
The survey questions were the starting point of
the FGDs. In some instances, the original
respondents to the survey could not be tracked,
or were no longer available since most of the
communities covered a big area and were densely
populated. Some were run by notorious youth
gangs, which made it particularly difficult to
organize meetings in areas not considered
“neutral”.
The FGD aided the researchers in observing and
discussing informal observations pertaining to
language, trends and other intangibles (values,
etc.) with the participants as well as providing the
participants an occasion to sort out their
thoughts about sexual and reproductive health.
The tabulations that are mentioned in this study
only refer to results of the survey. Unless
otherwise specified, “the number of respondents”
refers to the number of individuals who took the
survey. Although the FGD results were also
9

tabulated as far as practicable, the inherent
differences in the two methods did not permit
considering the two results as one.
10

V
THE RESEARCH
AREAS
The views of the young people involved in the
study are better understood when placed in the
context of their community surroundings. The
first challenge we met in identifying our research
areas was the sensitivity of the topic. Since the
intrusive nature of the questions would affect the
readiness and openness of respondents to give
honest answers, we chose communities
considered urban poor according to
official government classification in which we
already had youth partners. What follows is a
short description of the selected urban
communities or barangays in Metro Manila
based on a WHCF Baseline Study conducted in
2000. 13
A. Barangay 176, Caloocan City
Barangay Bagong Silang (also known as Barangay
176) covers a total land area of 598 hectares and
13
WOMEN’S HEALTH CARE FOUNDATION. 2001. Baseline Study for
the project Addressing the Unmet Reproductive Health Needs of Adolescents
and Women in Metro Manila.
11

is subdivided into 10 Phases. It is classified as a
less developed area of Caloocan City. Bagong
Silang became an independent barangay when
several hectares of the Tala Estate were allocated
as a resettlement site. From February 1982 to
November 1983, a series of resolutions were
passed to develop the area and formalize
ownership of lots for the relocated squatter
families coming from nearby areas in Metro
Manila.
Bagong Silang‟s estimated total population of
500,000 composed of 83,000 households (as of
2000) made it the most populated barangay
throughout the country.
B. Barangay 178, Camarin, Caloocan
City
Barangay 178, now called Caloocan City North, is
also located in Caloocan City. Some portions of
Camarin are now occupied by migrant dwellers
from Metro Manila.
Barangay 178, which is both a residential area
and a small business community is about 549.12
hectares. Its total population (based on the 2000
National Statistics Census) is 64,148 with 13,369
households or families. Some families operate
convenience stores commonly managed by
women in the family, while repair shops are
12

managed by male family members.
C. Barangay 649, Baseco, Manila City
Baseco (or Barangay 649, Zone 68, District V) is a
reclaimed area under the Philippine Ports
Authority at the Port Area, Manila. Most houses
are built on stilts, commonly about 2 meters
above seawater. The makeshift houses are within
the premises of the port.
Recent survey conducted by the Office of the
Barangay Chairwoman shows a total population
of 45,017 with a total number of households at
3,499. Unemployment rate is high at 40% a year
with labor population growing at steady rate of
60% a year. Barangay Profile 2001 list common
occupations such as laborer, carpenter,
stevedore, fishermen, and land and water
transport worker, retailer/vendor and some blue
collared employee or working professional.
The barangay has a history of gang riots between
migrant Moslem groups and Christian groups.
Barangay Chairman Generoso Hispano Jr. when
elected in 1997 was able to keep peace among
warring groups but he was killed in an ambush in
2000.
D. Barangay 144, Pasay City
13

Barangay 144 has a total land area of 4.2 hectares
where settlements made of semi-concrete (30%)
and wood makeshifts (70%) are closely
constructed. On the average, residential
structures are occupied by three households.
Barangay 144 had a total population of about
3,404 with a total of 345 households back in
2000. It is estimated that about 50% of the
population is transient such that there is some
difficulty in establishing the community profile in
some aspects. Residents of Barangay 144 eke out
a living through vending and self-employment
that is small-scale and unstable. Those who are
employed are in jobs that pay below the
minimum wage.
E. Barangay Gulod, Novaliches, Quezon
City
Barangay Gulod was established in 1962. Gulod is
about 98.61 hectares. There are four depressed
areas that form part of this barangay, namely:
Joan of Arc, Margarita, Sta. Barbara area, San
Nicacio Bayabasan area and San Martin (dulo). 14
Areas that are frequently flooded are Margarita
St., San Ignacio, San Nicasio, Sta. Barbara and
14 _____. 2009. Quezonian Newsletter - QC Barangay Profiles. Online.
Available at http://www.qcpubliclibrary.org/
brgyprofile.php#novalichesproper. [09 Dec 2009]
14

Bayabasan.
In 1997, the total population of Barangay Gulod
was about 140,000 and the total number of
households reached 22,000. 15
15
There are also four major subdivisions within the barangay: the Forest Hills
Subdivision, Villaflor Village, Sta. Monica Village and Menrey Subdivision
where the affluent families reside.
15

VI
PRESENTATION
OF DATA
SEXUAL ACTIVITY OF RESPONDENTS
Sexual initiation
Sexual initiation occurred between the ages of 16-
18 years for 70% of 308 respondents followed by
13-15 years for 26% of the respondents. The age
of first sexual intercourse for 2% of the
respondents was 12 and below. For 1% of the
respondents, it was 19 years and above.
As for the number of sexual partners since first
sexual experience for 308 respondents, 66% of
132 male respondents have had only one partner,
5% have had two and 29% have had three or
more(“marami na”). Among 129 female
respondents, 83% have had only one partner, 5%
have had two partners, and 12% had three or
more.
16

Non-use of Contraceptives
A significant number of the youth constituting
73% of respondents (48% of which are males and
51% of which are females) do not use
contraceptives. Among 167 non-users, 47% are
single, 26% are married and 23% are in a
domestic partnership (living in with a permanent
partner but not legally married). Only 137 nonusers
indicated whether or not they had children
or how many. Forty-nine percent have no
children, 9% are pregnant, 36% have one child,
4% have two children, and 1.3% have three
children.
Reasons for Non-use of Contraceptives
The respondents were allowed to check more
than one reason for non-use. Lack of information
about contraception was indicated by 32% of the
291 responses to this question, as the reason they
were not using contraceptives. Concern about
contraceptive side effects was a primary reason
for 19% of the responses. Considering that the
study was conducted in urban poor communities,
13% of the responses attributed the cost of
contraceptives (or having no money to buy
contraceptives) as the reason behind their nonuse,
while distance to one or more sources
of contraceptives/FP information and services
(e.g., distance of health centers or clinics) was the
17

main reason for 6% of the responses. Non-use
was motivated by wanting to have children (8%)
and an equal number cited partners‟/spouses‟
disapproval of contraceptives (8%) as a reason.
Three percent said using contraceptives would
make sex “less thrilling”. Only 2% of the
respondents point to religion as a basis for nonuse.
Three male FGD participants gave other reasons
for not using contraceptives among which was
that he plans to undergo a vasectomy, one limited
himself to having “quickie sex”, which he believed
would not result in pregnancy, while the last did
not want to waste his sperm.
Reasons for Unplanned First Pregnancy
One hundred thirty respondents said that their
first pregnancy was unplanned. Sixty-five percent
(65%) of them attribute their non-use of
contraceptives as the reason for their unplanned
first pregnancy while 7% nine cited ineffective
use of contraceptives (i.e., chosen contraceptive
failed.) Other reasons cited by 11 respondents
included lack of experience, drunkenness and
premature ejaculation.
Contraceptive Use
Only 74 out of 308 respondents (24%) reported
18

that they were using contraceptives at the time of
the study. Most young people using contraception
were women (70%) who had gone to (or had
completed) high school, and are married with a
child. Out of the contraceptive users, 42% are
married, 30% are in a domestic partnership, and
26% are single. Sixty percent have reached high
school, 30% have been to college, 4% have taken
vocational courses, and 6% have gone to the
elementary level.
As to what contraceptives they use, the
respondents were allowed to indicate more than
one method. Out of the 174 responses that were
generated, the withdrawal method was indicated
by 65 responses (38%) followed by the condom
with 27% and the pill (17%). Thirteen responses
pointed to the calendar method (8%) while 6
responses specified the use of injectables (3%),
and 3 responses (2%) cited the IUD. Other
19

methods such as breastfeeding, and ingesting a
soft drink mixed with Cortal (a paracetamol
tablet) were indicated by 8 responses (5%).
Sources of Contraceptives
Respondents were allowed to check more than
one source of contraceptives. Out of 117 survey
responses, the most common source of
contraceptives is the drugstore as indicated by 44
responses (38%). The community health
center/clinic was indicated by 32 responses
(27%), while 26 responses (22%) pointed to other
sources such as peers/barkada, stores (like 7-11,
SM and Divisoria), and a club. Only 5
20

esponses cited government hospital (4%) while
less than 5 responses each pointed to the
following sources: private hospital (4), barangay
health workers (2), private doctor (2) and NGOs
(2).
Sources of Information on Contraceptives
Respondents were allowed to check more than
one source of contraceptives. Out of 346 survey
responses, friends/peers ranked highest as the
most common source of information about
contraceptives as indicated by 147 responses
(42%). This was followed by advertisements
21

(17%), barangay/community health clinics O
(11%), relatives or household members (10%),
health providers such as barangay health
workers, nurse/midwife, and private doctor (8%),
and partners (7%). Other sources that were
indicated by 16 responses (5%) include school,
youth organizations and NGOs. Six FGD
respondents said they had no source.
22

Frequency of Contraceptive Use and
Preferred Contraceptive
When asked how often they use contraceptives,
36 respondents revealed that they use
contraceptives such as the condom (15),
injectables and the pill (each of which was cited
by 6 respondents), withdrawal (4), and the
calendar method (2) on a monthly basis. Thirtythree
respondents said they use contraceptives
(mostly condoms) before intercourse.
The respondents were allowed to indicate more
than one option as regards their preferred
contraceptive. Among 333 responses 114
responses cited condoms as the most preferred
contraceptive (34%) followed by the pill (31%),
injectables (10%) and withdrawal (10%), the
calendar method (7%) and IUD (5%). Their
preferred method starkly differs from the
contraceptive method actually used by
respondents.
23

Need for Contraceptive Use
Sixty-two percent of all survey respondents think
they need to use contraceptives while 38% think
they do not need contraceptives. Among 170
respondents with a perceived need for
contraceptives, 64% are female and 36% are
male. Among 105 respondents without a
perceived need for contraceptives men
significantly outnumber women (79% to 21%).
Among the 32 FGD respondents eight males said
that they do not need contraceptives, three males
simply did not want to use contraceptives,
another three said they could control themselves
24

anyway and one said he did not know anything
about contraceptives. The rest (17 females and 6
males) deemed it important to use contraceptives
mainly because of economic considerations,
specifically since having many children is costly
or not desirable during hard times especially
when one is unemployed. Other reasons
mentioned are the importance of having a
planned pregnancy and limiting family size,
having no desire for another pregnancy after four
children and lack of preparedness to build a
family especially at a young age.
Desired Changes
As for the changes desired relative to the
purchase and procurement of contraceptives, as
indicated by 464 responses, 137 survey responses
(30%) cited more affordable contraceptives while
76 responses (16%) pointed to guidance by health
care providers as an area that had to be
improved. Sixty-two responses (13%) believed
contraceptives should be made accessible (i.e.,
available in different places). Fifty-eight
responses (13%) verbalized the need for more
information on family planning methods while 52
(11%) expressed their hope that the stigma
attached to the purchase or procurement of
contraceptives be addressed and done away with.
25

FGD participants gave the following suggestions
to improve access to contraceptive/FP
information and services:
1. Health center workers should have
adequate knowledge and provide
complete and accurate information on all
family planning (FP) methods;
2. BHWs should promote family planning
through house-to-house visits and
seminars conducted in the community and
sex education;
3. Contraceptives should be given out for free
(especially in health centers) for those who
26

cannot afford to purchase and be readily
available (with special mention of making
condoms accessible). One respondent
however cautioned that contraceptives
should not be sold just anywhere;
4. Parental guidance on FP should be
encouraged;
5. Reading materials on FP written in Tagalog
should be popularized
6. Young people should be able to avail of a
free check-up and counseling during
consultation with a doctor;
7. Service providers should not scold or
moralize (e.g., as regards their being
sexually active or promiscuous at a young
age);
8. Government should be serious with their
responsibility to provide these kinds of
services; and
9. Because life is hard, contraceptives should
be made legal so more people can use
them. A respondent explained that
contraceptives will help women stay
beautiful.
27

VII
DISCUSSION
This study recognizes that the rights of young
people are important in as much as many
participants belong to two significant sectors of
Philippine society which the Constitution vows to
protect: women 16 and youth 17 .
In general, young people lack sufficient
knowledge to protect themselves from the
consequences of sexual behavior. The lack of
effective access to FP information
(contraceptives) and services and significantly
large unmet need for contraception are due
mainly to the absence of a government policy to
provide a sound family planning program to
young people who are sexually active. In the State
16 1987 Constitution, Article 2, Section 14 (Philippines) provides that: “The
State recognizes the role of women in nation-building, and shall ensure the
fundamental equality before the law of women and men.”
17 1987 Constitution, Article 2, Section 13 (Philippines) provides that: “The
State recognizes the vital role of the youth in nation-building and shall
promote and protect their physical, moral, spiritual, intellectual, and social
well-being. It shall inculcate in the youth patriotism and nationalism, and
encourage their involvement in public and civic affairs.”
28

of the Philippine Population Report 2000, family
planning is defined as the “fundamental right of
couples and individuals to choose the number
and spacing of their children, taking into account
their responsibilities to their communities and
the country.” We submit that reproductive and
sexual health are part of the state‟s duty “to
promote the right to health of the people and
instill health consciousness among them.” 18
Our study shows that for 70% of the participants,
sexual initiation occurred between the ages of 16-
18 years. The 2002 Young Adult Fertility Survey
(YAFS 3) national survey, established this
pattern, too and revealed no significant
differential in the probability sex was initiated
based on the economic status of the survey
respondents. This means that whether young
people belong to the poorest or wealthiest group,
the majority of them had their first sexual
encounter while in this age range. A possible
explanation to this is the biological or
physiological changes that all persons undergo at
this stage of life that remains constant despite
their economic station in life. Our study likewise
demonstrates that engaging in non-marital sex is
not evidence of promiscuity given that 66% of
male respondents and 83% of female
18
1987 Constitution, Article 2, Section 15 (Philippines) provides that: “The
State shall protect and promote the right to health of the people and instill
health consciousness among them.”
29

espondents reported having had only one
partner since they became sexually active.
Seventy-three percent of the respondents do not
use contraception. Our study reveals that lack of
information about contraception is the
overwhelming reason given for non-use of
contraceptives among young people in poor
Metro Manila communities. Compared, however,
to the findings of the YAFS3, this reason is only a
far second to “didn’t expect to have sex”, the
reason most cited by the poorest 20% of the
YAFS‟ nationwide Filipino youth sample.
“Didn’t expect to have sex” was not among the
multiple-choice items under the question nor did
it come out as „”other reasons” reasons. The
question we posed in the survey questionnaire
that was administered to the respondents was, „If
you are not using contraceptives what do you
think is/are the reason/s for this?‟ “Lack of
information about contraception” can, however,
be seen as a precursor of a “didn’t-expect-tohave-sex”
attitude since lack of information about
contraception can and does affect or shape
attitudes toward sex, pregnancy and
contraception, and attitudes toward
contraception have a potentially strong impact on
contraceptive use.
Another variable regarding young people‟s nonuse
of contraceptives on which this study and the
30

YAFS3 have contrary findings is the role played
by religion in the decision making process of
young people. While this study shows that
religion is not a significant factor, it was a
common reason cited by participants in the
YAFS3 for non-use of contraceptives. This
contradiction could lie in the size and definition
of this study‟s sample.
Nonetheless, the ReproCen study where only 2%
of the respondents cite religion as the reason for
no-use of contraceptives is consistent with
nation-wide reports that “85 million Catholics
have endorsed the Reproductive Health Bill 19 as a
means of family planning”, giving rise to the
conclusion that there is no Catholic vote. 20 The
bill‟s principal author further said that the
“Pulse Asia survey in 2007 indicated that 93
percent of Catholics „considered it important to
have the ability to control their fertility and plan
their families.”
Many of our youth get little or no information
from government services or schools, which
19 House Bill 5043 entitled An Act Providing for a National Policy on
Reproductive Health, Responsible Parenthood and Population Development,
and for Other Purposes.
20 PORCALLA, D. 2008. 85 Million Catholics Endorse Reproductive Health
Bill – Lagman. Online. Available from
www.newsflash.org/2004/02/hl/hl107942.htm. [09 Dec 2009]
31

would otherwise ensure that accurate and
responsible reproductive and sexual heath
information reaches the youth. Participants
pointed out that in the event that SRHR is
discussed in guidance counseling it is oftentimes
founded on moralistic perceptions. This may be a
reaction to the concern of some adults, most
especially parents that discussing sex is taboo
and thus, counseling as well as sex education
classes are likely to encourage young Filipinos to
engage in sex and would promote promiscuity.
However, the results of a study analyzing 23
school-based condom availability programs in the
US 21 indicate that such programs do not hasten
the onset of intercourse among students or
increase its frequency. Likewise, in the
Philippines, public school children who were
interviewed after the Department of Education
Sex Education Modules 22 were tested said that
they were discouraged, rather than encouraged to
21 KIRBY. D. 1994. School-Based Programs to reduce Sexuality Risk-Taking
Behaviors: Sexuality and HIV/AIDS Education Health Clinics, and Condom
Availability Programs. Online. Washington DC: merican Enterprise Inst. for
Public Policy Research. Available from:
http://www.eric.ed.gov/ERICWebPortal/custom/portlets/recordDetails/detail
mini.jsp?_nfpb=true&_&ERICExtSearch_SearchValue_0=ED434103&ERIC
ExtSearch_SearchType_0=no&accno=ED434103. [09 Dec.
22 GRAFILO, J. 2006. Philippines: Acrimonious Debate over Sex Education
in the Philippines. Online. Deutsche Presse-Agentur. Available from
http://www.aegis.com/news/ads/2006/AD061232.html. [09 Dec 2009]
32

engage in early sexual activity. Nevertheless, the
government pulled out the modules due to
opposition from the Catholic Bishop Conference
of the Philippines. A crucial argument for this
opposition is that sex education is a right
reserved to parents. However, Professor Corazon
Raymundo, former director of the University of
the Philippines' Population Institute (UPPI),
counters that “sex education in schools is
necessary because it is not in the nation's culture
for parents to discuss sex with their children.” 23
Considering this, a national ASRHR program is
necessary where services are not limited to
information, education and communications
(IEC) and but likewise teach both “resistance
skills” to delay the onset of sexual activity as well
as contraceptive skills to prevent teenage
pregnancy. Limiting instructions to young people
with slogans such as “chastity in singleness” and
“just say no” is to abdicate our moral
responsibility to them.
We reiterate that teaching sex education in
schools or counseling by health workers on one
hand and sex education by parents are not
mutually exclusive. The young people who
participated in the study articulated their
preference for parental guidance on family
planning among the changes they hoped to see.
23 Id..
33

The reality though is that at present out of 346
survey responses, friends/peers ranked highest as
the most common source of information about
contraceptives as indicated by 147 responses
(42%), while relatives or household members was
merely the fourth source and accounted for only
10%. Likewise, the YAFS 3 study showed that
among the poorest 20% and wealthiest 20% of
their respondents, the drugstore ranked the first,
friends the second and community health center
the third source of information on contraceptives.
Since parents are not in fact active in educating
their children on sexual matters, the absence of
well designed sexuality education programs
taught by responsible adults would leave our
young people to seek reproductive and sexual
health information from their friends who are as
unprepared and ignorant or from media and the
internet, over which parents have little control.
The Reproductive Health Bill 24 now pending in
Congress squarely addresses this issue. It says:
“SEC. 12. Mandatory Age-
Appropriate Reproductive Health
Education. - Recognizing the
importance of reproductive health rights
24
The full title of Houe Bill No.5043 is “An Act Providing for a national
Policy on Reproductive Health, Responsible parenthood and Population
Development, and for other Purposes”.
34

in empowering the youth and developing
them into responsible adults.
Reproductive Health Education in an ageappropriate
manner shall be taught by
adequately trained teachers starting from
Grade 5 up to Fourth Year High School. In
order to assure the prior training of
teachers on reproductive health, the
Implementation of Reproductive Health
Education shall commence at the start of
the school year one year following the
effectivity of this Act. The POPCOM, in
coordination with the Department of
Education, shall formulate the
Reproductive Health Education
curriculum, which shall be common to
both public and private schools and shall
include related population and
development concepts in addition to the
following subjects and standards:
a. Reproductive health and sexual rights;
b. Reproductive health care and services;
c. Attitudes, beliefs and values on sexual
development, sexual behavior and sexual
health;
d. Proscription and hazards of abortion and
management of post-abortion
complications;
e. Responsible parenthood;
f. Use and application of natural and modern
35

family planning methods to promote
reproductive health, achieve desired family
size and prevent unwanted, unplanned and
mistimed pregnancies;
g. Abstinence before marriage;
h. Prevention and treatment of HIV/AIDS
and other STIs/STDs, prostate cancer,
breast cancer, cervical cancer and other
gynecological disorders;
i. Responsible sexuality; and
j. Maternal, peri-natal and post-natal
education, care and services.
In support of the natural and primary right of
parents in the rearing of the youth, the
POPCOM shall provide concerned parents
with adequate and relevant scientific
materials on the age-appropriate topics and
manner of teaching reproductive health
education to their children.
In the elementary level, reproductive health
education shall focus, among others, on
values formation.
Non-formal education programs shall
likewise include the abovementioned
Reproductive Health Education.”
The Bill is comprehensive in that it ensures that
sex education materials are adequate, relevant
36

and age-appropriate and that these are made
available to young people who are in and out of
schools. It underscores the primary right of
parents to rear their children and encourages
their involvement in the process of educating
their children on reproductive health and
sexuality.
When asked what changes the research
participants wanted to see, our survey showed
that 16.4% of the young people wanted more
guidance by health care provider, 12.5%
verbalized the need for more information on
family planning methods while 11.2% stated that
the stigma attached to obtaining contraceptives
should be eliminated. In the focus group
discussions, the main suggestion made by
participants to improve access to
contraceptive/FP information and services was
for health center workers to have adequate
knowledge and provide complete and accurate
information on all family planning (FP) methods.
These point to the pivotal role played by health
providers in providing adequate information and
efficient service given in a humane manner.
Health workers lack training on how to
understand youth issues and the special
(reproductive/sexual health) needs of young
people. This calls for them to not only brush up
on their knowledge of young people‟s SRHR but
37

to learn new counseling and communication
skills. More importantly, there is the need for
professionalizing health care service so that
providers understand that they are consulted not
as religious leaders but as secular persons who
have acquired a level of proficiency in SRHR.
The Convention on the Rights of the Child 25 is an
important document to lay the basis for the right
of young people to reproductive and sexual health
care in the light of the child‟s “evolving
capacities.” States who signed the convention
commit to “take appropriate measures to develop
preventive health care, guidance for parents and
family planning education and services.” This has
been interpreted to mean that state parties
should ensure that health care personnel will
fully respect the rights of a children to non
discrimination in offering them access to HIV
related information including “confidential
sexual and reproductive health services, and free
or low cost contraceptive methods and services.”
The interest of young people, including minors,
in access to contraceptives, like the interest of
adults, is vital given the high incidence of sexual
activity, unplanned pregnancy and sexually
transmitted diseases. Although it has been
25 UNITED NATIONS GENERAL RESOLUTION. 1989. Convention on the
Rights of the Child. Online. Available from:
http://www.un.org/documents/ga/res/44/a44r025.htm. [09 Dec 2009]
38

argued that government interest in barring access
by minors to contraceptives is in the child‟s best
interest it is not clear how denying information
and services furthers the child‟s interests.
Another justification given is the state‟s concern
to foster a particular moral climate. It has
however not established that depriving minors of
contraceptives has served as a deterrent to
engage in sexual activity or alterred their sexual
attitudes.
The Reproductive Health Bill 26 addresses these
issues by mandating that “community-based
volunteer workers, like but not limited to,
Barangay Health Workers, shall undergo
additional and updated training on the delivery of
reproductive health care services and shall
receive not less than 10% increase in honoraria
upon successful completion of training.”
Furthermore, section 21 thereof penalizes any
public or private health care service provider,
who shall “knowingly withhold information or
impede the dissemination thereof, and/or
intentionally provide incorrect information
regarding programs and services on reproductive
health including the right to informed choice and
access to a full range of legal, medically-safe and
effective family planning methods.”
26 Section 15 of House Bill 5043
39

The study showed that young people yearn for
more TV infomercials on family planning and
contraceptive methods and expected government
to be serious in their responsibility to provide
these services.
One respondent said that contraceptives should
be used because life is hard and that it should be
made legal so that it can be accessed easily, which
reveals the misimpression that contraceptives are
illegal, just like abortion. Perhaps the difficulty of
accessing contraceptives has given rise to this.
One respondent cautioned, and properly so, that
contraceptives should be available but not sold
everywhere.
Among 105 respondents there were more men
than women who did not perceive a need for
contraceptives (79% to 21%). There were
responses from male participants in the study
that since the use of condom decreases their
enjoyment of sex, it is their partner‟s
responsibility to use contraceptives to prevent
pregnancy. Here we see the importance of
drawing the connection between traditional
gender roles and harmful sexual health practices.
This calls for re- thinking of conventional notions
of what it is to be a man or to be “manly.” The
narrow definition of masculinity gives rise to
questions of whether it is any one‟s sole burden to
say “no” and take responsibility to protect against
40

pregnancy or sexually transmissible diseases.
Counseling should thus include lessons that will
bolster the decision-making capacity of young
women, which is crucial to the exercise of SRHR.
A prevalent belief that avoiding pregnancy is a
woman‟s responsibility reflects little knowledge
of sexual health and safe sexual practices as well
as absence of respect for the female partner. In
the context of Philippine culture and laws that
continue to give premium to decisions made by
males, this is a double burden (the disparate
impact of pregnancy on women and the
responsibility to avoid it) that is unjustly placed
on women.
Under the present administration, the basic
policies of President Arroyo‟s family planning
(FP) program are responsible parenthood,
respect for life, birth spacing and informed
consent but her FP program promotes Natural
Family Planning in keeping with the demands of
the Catholic Church. In her 2008 State of the
Nation Address, Arroyo categorically announced
her rejection of the reproductive rights. The lack
of government action to provide the full range of
family planning methods is more apparent in
poor communities. When respondents were
asked about their source of information on
contraceptives, only 18% reported having
received such from community health clinics and
health professionals while 41% got information
41

from friends and peers. Further, only less than
15% identified government hospitals, barangay
health workers, private doctors, or NGOs as
source of contraceptive supplies.
An apt illustration is the City of Manila which
passed EO 003 in 2000 and which has not been
repealed until today. It has caused the cessation
of contraceptive supply in city health centers and
public hospitals. Under its former mayor, Lito
Atienza, even medical missions that offered these
services, clinics supported by private and NGO
sectors were shut down, and their health care
workers providing access to family planning
information harassed. It is not enough that now
under Mayor Alfredo Lim NGOs are allowed to
provide these services considering that the State
itself is obligated to follow the law and comply
with its domestic and international law
obligations.
A restrictive and oppressive law effectively
banning contraceptive information, services and
supplies contravenes the individual‟s right to
liberty 27 to decide matters that are private and
intimate in nature. 28 The Constitution, under
27 1987 Constitution, Article 3, Section 1 (Philippines) provides that: “No
person shall be deprived of life, liberty, or property without due process of
law, nor shall any person be denied the equal protection of the laws.”
CONST. art III sec. 1.
42

Article XV Section 3(1) likewise, affords spouses
the right “to found a family in accordance with
their religious convictions and the demands of
responsible parenthood.” 29
This violates international human rights
instruments, which the Philippines has signed.
The modern human rights movement was created
in the aftermath of World War II and focused on
key abuses identified at the root of that conflict.
The key human rights document is the Universal
Declaration of Human Rights (UDHR). 30 It is not
a legally binding document but it represents the
shared aspirations of governments about what
rights are, and why they should exist for all
people everywhere.
The two covenants, the International Covenant
on Economic, Social and Cultural Rights
(ICESCR) and the International Covenant on
Civil and Political Rights (ICCPR) further clarify
the rights set out in the UDHR. Unlike the
UDHR, they are legally binding on those
28 1987 Constitution, Article 2, Section 11 (Philippines) provides that: “The
State values the dignity of every human person and guarantees full respect for
human rights.”
29 1987 Constitution, Article 15, Section 3(1) (Philippines) provides that:
“The State shall defend (t)he right of spouses to found a family in accordance
with their religious convictions and the demands of responsible parenthood.”
30
UNITED NATIONS GENERAL ASSEMBLY. 1948. The Universal
Declaration of Human Rights. Online. Available from:
http://www.un.org/en/documents/udhr/. [09 Dec 2009.
43

countries that ratify them. The Philippines has
ratified both these documents. These three
documents together are often called the
International Bill of Human Rights.
Equality of rights for women is a basic principle
of the United Nations. The preamble to the
Charter of the United Nations sets as one of its
central goals the reaffirmation of “faith in
fundamental human rights, in the dignity and
worth of the human person, in the equal rights of
men and women.” The Charter is the first
international instrument to specifically refer to
human rights and to the equal rights of men and
women. By its terms, all members of the United
Nations are legally bound to strive towards the
full realization of all human rights and
fundamental freedoms.
The International Bill of Human Rights
strengthens and extends this emphasis on the
human rights of women. It proclaims that
everyone is entitled to equality before the law and
to the enjoyment of human rights and
fundamental freedoms without distinction as to
any kind, including sex. The Philippines is also a
state party to the UN Convention on the
Elimination of all Forms of Discrimination
Against Women (CEDAW), which obligates states
to “ensure access to specific educational
information to help to ensure the health and well
44

eing of families, including information and
advice on family planning,” The Millennium
Development Goals (MDGs) stemmed from the
Millennium Declaration that seeks to advance “a
shared vision of a much improved world by 2015,
where extreme poverty is cut in half, child
mortality is greatly reduced, gender disparities
in primary and secondary education are
eliminated, women are more empowered, and
health and environment indicators improve
within a global partnership for development.”
This Declaration was signed by 189 Member
States in September 2000, ensuring their
commitment to “promote gender equality and the
empowerment of women, as effective ways to
combat global poverty, hunger and disease and to
stimulate development that is truly
sustainable.” 31 In 2001, UN Secretary Kofi Annan
announced the development of eight MDGs with
18 time- bound global targets. As a signatory to
this international declaration, the Philippines is
committed to pursue these goals, one of which is
the promotion of gender equality and
empowerment of women, within the 1990 – 2015
time frame.
31 UNITED NATIONS GENERAL ASSEMBLY. 2000. United Nations
Millennium Declaration. Online. Available from:
http://www.un.org/millennium/declaration/ares552e.htm. [09 Dec 2009]
45

The MDG recognizes the equality and
empowerment of women and girls as among the
most effective ways of fighting poverty and
disease and fuel progress that is sustainable.
Government must undertake all measures to
remove all manifestations of gender inequality.
Lack of access to and availability of information
and services on the full range of legally allowed
and scientifically safe family planning methods
fosters gender inequality given that it is only
females who get pregnant. Thus, if women do not
have the information and means to control their
own fertility it is highly unrealistic that they will
have a way to chart their own destinies.
46

VIII
RECOMMENDATIONS
Vis-à-vis young people, there are rights to plan
one‟s family, to health, to privacy, to information
and education. A component of these is access to
sexual and reproductive health information and
services, which ought to be increased through the
use of multiple entry points (education, work,
sports or other social activities) and settings
(home, community, workplace, school,
clinic/health center) in order to address the
knowledge gap on family planning and
contraception. Information must translate to an
understanding of contraceptives adequate to lead
to contraceptive use if such is the choice of the
individuals concerned. Here we see the role that a
more involved private sector can play thru media
and other less formal communications (including
TV commercials) to raise awareness and
acceptance of SRHR. The various forms of mass
media are powerful instruments in perpetuating
knowledge and awareness. There have been
positive changes brought about by the initiatives
and advocacies of women NGOs working in
media, the institutions can do much more. The
47

Philippine NGO Beijing + 10 Report on Women
and Media pointed out that women are still
“portrayed in a very limited, sexist and
stereotyped roles” essaying roles of passivity and
domestication. This calls for a conceptual
overhaul but since media itself has been
immersed in patriarchal thinking and values, it
may not even see that there is something that
ought to be corrected. Government must monitor
and ensure that mass media follows gender
neutral policies and sends out the right message
to young people whose values are shaped partly
by mass media.
Continued support should be given the
comprehensive Reproductive Health and
Population Development bill now pending in
Congress that will lay down an unequivocal
national policy respecting and protecting the
right to reproductive and sexual health of all
including youth and disregarding marital status
as a requirement for availing of reproductive
health services. In the absence of a national law,
local legislative councils should pass ordinances
explicitly making available information on the
full range of family planning methods.
Interestingly, only 2% of the respondents cite
religion as a reason for not availing of
contraceptives. Given that religion does not hold
sway in making decisions on family planning
48

then legislators who advance reproductive rights
should be convinced that doing so would not
jeopardize their “winnability.”
Pending the passage of an RH law, we also
recommend that FP and sex education classes
and seminars be conducted in communities thru
NGO-led activities but in partnership with
government entities. Parental involvement
should be encouraged but refusal of parents to
participate should not hinder these seminars.
An aggressive information drive will be aided
greatly with the development of accurate, ageappropriate
and user-friendly informative
brochures about sexuality, reproduction,
contraception, and life skills. These should be
written in the local dialect for distribution in
urban poor communities.
Furthermore, government-supported training of
health workers on the substantive aspects of both
modern and traditional family planning as well as
counseling and communication skills is crucial.
Government must provide accurate and
evidence-based information relayed in a manner
understandable to young people in order to
correct misconceptions about contraceptive side
effects, among others and help them develop the
ability to make informed and intelligent choices
and practice healthy behaviors.
49

ABOUT THE AUTHORS
Elizabeth Aguiling-Pangalangan is a Professor of
the College of Law, University of the Philippines
(U.P.) and heads ReproCen. She obtained her
Bachelor of Arts and Bachelor of Law degrees
from the University of the Philippines. She did
her Master of Laws at Harvard Law School
in1989, where she was later appointed Visiting
Scholar in 1998-99 and Research Fellow in 2007.
She enjoyed a Packard-Gates fellowship with the
International Family Planning Leadership
Program in Sta. Cruz, CA, USA. She is lead
counsel in the case filed on behalf of 20 indigent
residents of the City of Manila questioning the
constitutionality of Executive Order 003 and is a
member of the Magna Carta of Women
Implementing Rules and Regulations Technical
Drafting Committee.
Ma. Lourdes Acosta-Alba is ReproCen‟s Program
Officer. She holds a BS in Psychology (UP
Diliman) and an M.A. in Sociology from the
Indiana University (where she was also a
graduate assistant with the Women‟s Studies
Program). She has also completed the
coursework under the masters program of the
Department of Women and Development Studies
at the U.P. College of Social Work and
Community Development. She participated in a
50

short graduate course on feminism under the
International Women‟s University project at the
University of Hannover, Germany.
ACKNOWLEDGEMENT
The authors thank the Asia-Pacific Research and
Resource Center for Women (ARROW) for its
support of ReproCen‟s research, publication and
advocacy efforts.
REPROCEN PROJECT TEAM
Elizabeth Aguiling-Pangalangan Researcher/Writer
Ma. Lourdes Acosta-Alba Researcher/Writer
Marita T. Reyes, M.D. Reviewer
Valerie Buenaventura Research Assistant
Arturo C. Tiro, Jr. Research Assistant
Krizelle Marie Poblacion Editorial Assistant
Chloe Gim Editorial Assistant
Elizabeth Sy-Pamplona Lay-out Artist
Ashley Kim Cover Design
Benjamin D. David Jr. Admin. Assistant
51

dwells into a specific concern, that of
contraceptive use among the urban poor youth.
The paper not only looks into the prevailing
situation for this specific segment of Philippine
society, but also examines how the situation has
been exacerbated by existing social and political
structures. In the end, the solution still lies in
greater, and unwavering, public engagement and
support. Government needs to take the lead in
advocacy, information dissemination, and
ensuring service provision. Government should
not abrogate on its responsibility to the youth.
Alvin B. Caballes, M.D.
Chief, Social Medicine Unit
College of Medicine
University of the Philippines Manila
ix