“When I had my third child, I swore to myself that I will never get pregnant again because I know we could not afford to have another one,” Ms. Judilla said in a recent interview at her home in Pasig City, on the eastern outskirts of Manila.

Abortion is illegal in the Philippines. Birth control and related health services have long been available to those who can afford to pay for them through the private medical system, but 70 percent of the population is too poor and depends on heavily subsidized care. In 1991, prime responsibility for delivering public health services shifted from the central government to the local authorities, who have broad discretion over which services are dispensed.

Many communities responded by making birth control unavailable.

More recently, however, family planning advocates have been making headway in their campaign to change that. Legislation before the Philippine Congress, called the Reproductive Health and Population Development Act, would require governments down to the local level to provide free or low-cost reproductive health services, including condoms, birth control pills, tubal ligations and vasectomies. It would also mandate sex education in all schools, public and private, from fifth grade through high school.

Supporters of the bill cite urgent public health needs. A 2006 government survey, which interviewed 46,000 women, found that between 2000 and 2006, only half of Filipino women of reproductive age used birth control of any kind. According to the Guttmacher Institute, a nonprofit organization based in the United States that researches reproductive health policy, 54 percent of the 3.4 million pregnancies in the Philippines in 2008 were unintended.

Most of those unintended pregnancies  92 percent  resulted from not using birth control, the institute said, and the rest from birth control that failed. Those unintended pregnancies, the institute says, contributed to an estimated half-million abortions that year, despite a ban on the procedure. Most of the abortions are done clandestinely and in unsanitary conditions. Many women resort to crude methods like those Ms. Judilla tried.