MANILA: Ms Blessy Chio, a 23-year-old Filipina student, recently underwent a medical procedure that took less than five minutes.

But the effects of a contraceptive implant on her body are long-term, as it will prevent her from getting pregnant for three years.



The distribution of free implants is the latest contraceptive measure in the Philippines allowed by its Supreme Court.

In November 2017, the court lifted a temporary restraining order (TRO) against the procurement and distribution of the implants Implanon and Implanon NXT, after the country's Food and Drug Administration certified that they were not abortifacients - something that can induce abortion.

The implant – a plastic rod inserted in the arm – prevents pregnancy by producing progestin, a hormone that thickens a woman's cervical mucus, preventing sperm from reaching an egg cell.

The lifting of the TRO saw women like Ms Chio flocking to health centres to get the implant.



“It’s just for me primarily. I'm doing it for myself because I don’t want to have children,” she said.

Ms Chio, who studies in the province of Los Banos, travelled for two hours to Pasay city to get an implant from the Apelo Women’s Health Association (AWHA), a partner of non-governmental organisation Likhaan, which provides direct health services to Filipinas.

She was not alone, as the centre on this occasion was filled with other women who had come from other provinces.

Some of them, like Ms Chio, were in their 20s, while others were older; some were married, while others were not. All wanted to have contraceptives in various forms, with most of them asking for implants.

“When the TRO was lifted, we saw an increase in the number of women asking for contraceptive implants,” said Ms Gemma Conde, president of AWHA.

“They flock to our clinics," she said. "In our biggest clinic in Tondo, we need to implement a cut-off because of the swelling number of patients. Most of them really want the implants.”

"STUDIES FIRST"

The resolve to secure long-term contraceptive methods among some women suggests there could be a reduction in the number of unplanned pregnancies.

The United Nations Population Fund said in 2016 that the Philippines was the only country in the Asia-Pacific region which saw an increase in the rate of teen pregnancy over the last 20 years.

The maternal mortality rate is also high, with World Health Organisation data revealing 114 deaths per 100,000 live births in the country in 2015. This is much bigger than the rates in other Southeast Asian countries where the rate is below 100. In Singapore is it is 10 maternal deaths per 100,000 live births, in Thailand it is 20 and 40 in Malaysia.

Advocates of the Republic Act 10354, or the Responsible Parenthood and Reproductive Health Act of 2012 (RH law), believe that making all methods of family planning – both modern and natural – accessible to the public can help reduce these statistics.

Since the RH law was implemented in 2014, women have had the opportunity to choose modern family planning methods - a significant change in a predominantly Catholic country whose views about reproductive rights have been influenced by the church for centuries.

According to the country's Department of Health, there has been an increase in the use of modern family planning methods among Filipinos – from 41.14 per cent in 2014 to 43.8 per cent in 2015.

Those who often go to Likhaan's health centres include mothers who take their daughters to the centre to prevent them from getting pregnant at a young age, as well as students like Ms Chio, said Ms Chona Lobitana from Likhaan.

“Many are like Blessy. That’s why I’m glad, because young people, in their desire to first finish their studies, have now learned how to prevent unwanted pregnancy. They themselves go here so they will not get pregnant at a young age,” she said.

Chona Lobitana from non-governmental organiation Likhaan said they're encouraging women to opt for long-term contraceptive methods such as implants. (Photo: Purple Romero)

WHY PILLS ARE NOT ENOUGH

However the main method among Filipinos when it comes to contraceptives is still birth control pills, with 1,952,190 women recorded to have taken them in 2015. But there are those who have started to shift to long-term contraceptive methods such as implants.

Ms Beverly Sarmiento is one of those who first opted to go for pills, but switched to implants.

“I often forget to take them. That’s how I got pregnant with my second child,” she said.

Upon learning about implants from a neighbour, the 27-year-old mother decided to get one in 2014, just before the High Court barred the Department of Health from providing the implants.

Ms Conde said AWHA has intensified its campaign for women to consider implants, precisely to address the lapses resulting from cases similar to Ms Sarmiento's.

“In 2015, that’s when we really ramped up the campaign for implants because we noticed that many will initially go back to our clinic for pills, but then they will stop doing so after a few months," she said.

"This is because they have many things to attend to and they don’t have the time to go to the clinic. That’s when we decided we have to highlight the long-term methods."



Ms Chio, who studies in the province of Los Banos, travelled for two hours to Pasay city to get an implant. (Photo: Purple Romero)

GOODBYE TO IMPLANTS AGAIN?

In 2015, in spite of the implant ban, about 100,000 women in the Philippines still got them, though they had to be purchased – with one costing about US$100. Now that the TRO has been lifted, women can get the implants more easily.

Ms Conde said out of the 60 to 80 young girls and women who go to AWHA on a bi-weekly basis, 30 of them ask for implants. The youngest of these, according to Ms Conde, is 16 years old.

While AWHA and Likhaan still go out of their way to reach poor communities and educate women – and men – about contraceptives, those who go to their centre represent a mixture of young girls and women from different socioeconomic classes.

Ms Lobitana said there are young professionals who go to their centre through the recommendation of friends and peers, while teenagers find them via Reddit, a social news aggregation site and Facebook.

OPPOSITION INTENSIFIES

However, the Department of Health could again be stopped from providing implants to the public, after the Alliance for the Family Foundation Philippines Inc (ALFI) - the same group which lobbied against the passage and implementation of the Republic Act 10354 or the Responsible Parenthood and Reproductive Health Act of 2012 - appealed against the lifting of the TRO.

ALFI is a multisectoral organisation that lobbies against what it calls "anti-life" legislative measures, such as pending bills on divorce and anti-discrimination against the LGBT community. The Reproductive Health law fall under such anti-life laws, as ALFI believes such legislation runs counter to Christian teachings and values on the sanctity of life, family and sexuality.



“We’ve filed cases in appropriate courts. The original proposition with the TRO, they ordered the FDA to follow due process and due process has very specific steps and they did not do that,” ALFI president Tim Laws said.

Dr Ryan Capitulo and Tim Laws from the Alliance for the Family Foundation Philippines insist implants are abortifactients. (Photo: Purple Romero)

Mr Laws was referring to the public hearings conducted by the FDA late last year to determine if implants were abortifacients or not. He claimed that the FDA did not inform them about the meeting, depriving them of the opportunity to defend their views.

“We are saying we were not given due process,” he said. “We were not given due opportunity to present our evidence and refute the evidence they presented during that hearing.”

Dr Ryan Capitulo, an obstetrician-gynecologist who is also a member of ALFI, said that he also believes the FDA erred in saying implants are non-abortifacients because they thin out the endometrial lining, preventing a fertilised egg from penetrating the uterus.

“That for me as a doctor, as a medical person, is an abortifacient action,” he said.

ALFI is now awaiting the decision of the Supreme Court. If the High Court decides in its favour, the Department of Health may have to pull free implants from health centres again.

For women like Ms Chio, however, getting implants is a personal decision that only the woman involved can make.

“It’s our choice as a woman," she said. "If you know you don’t want to have children or you just want to be safe because people can be sexually active at an early age (you can get contraceptive implants). It’s a journey to self-discovery.”