MANILA – Lelet Labarette was 31 when she had her sixth child. She and her family lived in a shanty made of thin wooden boards and scraps, electricity was intermittent, money more so. Her husband made about $3 a day driving a pedicab – they had neither the space nor the money for another child.

Labarette needed a birth control method that would serve her better than the pill that she sometimes forgot to take, the condom that she and her husband did not like or the injectable that she couldn’t quite keep track of.

In 2014, the Likaan Women’s Health Center in Manila introduced Labarette to contraceptive implants, matchstick-like rods that are inserted subdermally into a woman’s upper arm and provide three years of contraceptive protection.

Now 36 and with her youngest child at the age of five, Labarette says she has reacquainted herself with simple luxuries. “I now have time to comb my hair,” she laughs.

Labarette loves her implants so much that when her niece, Eileen Bayawanon, gave birth in 2015, Labarette urged her to get implants, too.

But there was one problem. The Supreme Court had earlier that year issued a temporary restraining order (TRO) on contraceptive implants, banning the Department of Health (DOH) and all public hospitals and health centers under it from procuring, distributing or administering the two hormonal implant brands available in the Philippines, Implanon and Implanon XT.

The TRO was in response to a complaint raised by a pro-life group that claimed that implants cause abortions.

An estimated 100,000 women had signed up to get implants by the end of 2015 after they were first made available. With help from a subsidy from the Bill and Melinda Gates Foundation, the DOH had procured 500,000 units to cater for the expected demand.

When the Supreme Court issued its TRO, all implant stocks from DOH service networks were recalled. For anyone who couldn’t afford to pay $150-$300 to get implants through private healthcare, non-governmental organizations and civil society groups were left to fill in the gap.

Although Bayawanon, Labarette’s niece, could not get implants from the government hospital where she gave birth, she was still able to get them for free through Likhaan. But the Supreme Court TRO had a chilling effect. Varied interpretations of the TRO caused fear and anxiety, and even some service providers not covered by the TRO chose to obey it to be on the safe side.

“The TRO makes implants appear to be illegal, as if it is contraband,” says Dr. Junice Melgar, executive director of Likhaan.

Myths about implants causing disease or blindness – myths that activists say the TRO appeared to legitimize – prompted many women to have theirs removed. Others desperate for a convenient, long-term and reliable form of birth control traveled miles to get implants. “We had some women traveling for 2-3 hours by bus to come to our clinic because they could not get implants in their village,” says Likhaan staff member Mary Jane Judilla.

And getting hold of contraceptives was about to get much harder.

When the DOH appealed for the lifting of the TRO, the Supreme Court rejected the motion in August 2016 and instead effectively expanded its coverage when it put the renewal and application of product licenses on hold for other contraceptives.

Under this broader TRO, when product registrations that allow for the sale and distribution of existing contraceptives lapse, they can’t be renewed, and product registrations for both new and existing and contraceptive brands can’t be issued. The effect is the gradual phasing out of contraceptives from government clinics and pharmacy shelves.

According to data provided by the Commission on Population (POPCOM), there are 48 contraceptive brands in the Philippines. To date, the product registrations for 20 of those brands have already lapsed.

“What we are seeing now [in the market] are existing stock that will eventually run out. By 2018, there will hardly be any more brands left, and by 2020, there will be no more contraceptive brands available, unless the Supreme Court lifts its TRO,” says Juan Antonio Perez, executive director of POPCOMM.

Public Health Emergency

After more than a decade of lobbying by women’s groups and reproductive rights activists, the Philippines passed its Reproductive Health (RH) Law in December 2012, promising the country’s poorest free access to family planning resources and information. But in the years since, the controversial law continues to divide the deeply Catholic country of more than 100 million.

Immediately after it was passed, pro-life groups contested the constitutionality of certain provisions, causing the Supreme Court to temporarily halt the law’s implementation. In 2014, the High Court upheld the constitutionality of the law, but before the law was fully implemented, in 2016, the health department’s $21 million contraceptive budget was cut.

Now, advocates say, the TRO presents the biggest risk yet to the reproductive health law.

“To date, the most serious challenge to the implementation of the RH Law is the Supreme Court TRO, which would result in contraceptive stockout in the country,” says Romeo Dongeto, head of advocacy group Philippine Legislators’ Committee on Population and Development (PLCPD). “More than 13 million Filipino women will be affected.”

An executive order signed by President Rodrigo Duterte in January 2017 calling for the full implementation of the RH law offered a brief spark of hope to advocates.

“Of course, we welcomed the president’s support, but it is not enough,” says Dongeto. In the Philippines, the executive and judicial branches of government are equal, meaning the president’s executive order can’t overturn the TRO.

Resistance is also building up at the local level. According to Dongeto, with citizens clamoring for access to family planning, local government officials in some provinces are filing resolutions calling for the lifting of the TRO.

Life Without Choice

On a hot Sunday afternoon, Labarette and Bayawanon sit with three other women, sipping soft drinks underneath a tarpaulin to shield them from the sun. All of the women, who are aged between 19 and 36, have contraceptive implants and are talking about the difference it has made in their lives.

“I’m more confident about initiating sex,” says Irene Espares, 21. When ribbed by the other women, she defends herself: “Why does it have to be him all the time? I want it, too!”

When the looming contraceptive stockout is explained to them, they fall silent. They had heard about the TRO, but didn’t quite understand its full implications.

“As in, no more implants? What about pills? Injectables? IUDS?” the women ask, their eyes widening with every answer of “No more.” Only condoms, natural family planning and procedures like vasectomy and tubal ligation would be left.

The coping scenarios they try to imagine all end with them helplessly getting pregnant over and over again.

“This is all we have,” says 19-year-old Angelina Francisco. “We hope the government doesn’t take it away.” The other women echo her sentiments.

When asked to explain what they mean by “it”, the women have a hard time finding the right word.

In the end, they settle for “happiness.”

Listen to Ana P. Santos discuss this story on WNYC’s The Takeaway.