Jovilyn Bartolome first became a mother when she was 16. It was a particularly difficult pregnancy. She developed an infection and lost so much blood during the delivery that, for a while, her family wasn’t sure she would make it.
Now at 20, Bartolome is a mother of three.
“I only wanted one child … but they just multiplied,” she says, with her 8-month-old son sitting on her lap, occasionally pulling and chewing on Bartolome’s long black hair.
According to the United Nations Population Fund (UNFPA), one in 10 young Filipino women have their first child between the ages of 15 and 19, earning the Philippines the highest teen pregnancy rate in Asia. And while most of the rest of the world is seeing a decrease in early pregnancy, from 2000-2010, teen pregnancy rates in the Philippines increased by 65 percent.
The country has long been battling a teen pregnancy crisis and its Supreme Court is not helping, say health advocates. In 2015, in response to claims by a pro-life group that contraceptive implants cause abortions, the court issued a temporary restraining order (TRO) banning the Department of Health from procuring and distributing sub-dermal implants.
The following year, when the Department of Health appealed the decision, the Supreme Court instead broadened the TRO, suspending the renewal and application of product licenses for most of the other available contraceptives. Now, when the license for selling and distributing a contraceptive brand expires, a new one can’t be issued and existing licenses can’t be renewed. As a result, the Philippines is quickly running out of birth control.
“By 2020, only 2 percent of [product licenses] will be valid,” said Dr. Juan Antonio Perez, executive director of the Department of Health’s Commission on Population (POPCOM), at a press conference in March.
For those working to curb the Philippines’ staggering teen pregnancy rate, the Supreme Court’s rulings are nothing short of a disaster. “The TRO spells double jeopardy for teens,” says Perci Cendana, commissioner of the government-affiliated National Youth Commission.
The country’s existing reproductive health (RH) laws prohibit minors from accessing reproductive health services in government clinics without parental consent. Often, public health providers try to teach teen mothers about birth control after they have had their first child – which is already too late.
“The TRO exacerbates the access problem teens have when it comes to reproductive health services. They [the Supreme Court] are just playing with the lives of young people,” says Cendana. “Judges are not medical experts or scientists. How can they decide on this?”
The government estimates that since 2015, when the TRO was first imposed, there have been an additional half a million unintended pregnancies. Based on the Philippines’ current maternal mortality rate of 114 deaths per 100,000 live births, POPCOM estimates that there have been an additional 1,000 maternal deaths as a result of these unintended pregnancies.
“That is the equivalent of three jumbo jets of pregnant women dying every year. It would be equivalent to a public health emergency if the Supreme Court does not lift its TRO,” said POPCOM’s Perez in March.
Worst case scenarios
In an attempt to get the Supreme Court to drop the TRO, President Rodrigo Duterte signed an executive order in January calling for the full implementation of the country’s RH law, which includes making free birth control available to the poorest communities. The executive order says 6 million women in the country – an estimated 2 million of whom live below the poverty line – currently have an unmet need for contraception.
But since the Philippine government gives equal standing to the executive and judicial branches, the president’s executive order can’t overturn the TRO.
“The president needs to put his full political capital behind this to exert pressure on the Supreme Court to lift the TRO,” says Romeo Dongeto, head of advocacy group Philippine Legislators’ Committee on Population and Development.
The Supreme Court’s response to Duterte’s executive order was to note that the TRO doesn’t apply to the RH law, meaning the government is free to implement the law as and when it wants.
But public health advocates and women’s groups say that the very essence of the RH law is access to birth control options. Without this access, the law is essentially rendered useless. “While there is no direct injunction against the implementation of the RH law, the Supreme Court has pierced the heart and soul of the RH law by making the certification, procurement and access to contraceptives more difficult and cumbersome,” said congressman Edcel Lagman, one of the principal authors of the RH law, in a statement.
Many experts foresee a worst- case scenario where dwindling contraceptive supplies will give rise to a black market, with desperate buyers forced to risk using counterfeit contraceptives. Those with resources will have to secure their supplies from overseas. Those without will get caught in a cycle of unintended pregnancies, leading to a rise in unsafe abortions and maternal deaths.
“It will be a dire, dire situation for women,” says Dr. Junice Melgar, executive director of the Likhaan Women’s Health Center in Manila.
To try to cope with the consequences of the TRO, the Department of Health has refocused it strategies toward promoting the birth control methods that remain available and accessible: condoms, natural family planning and surgical procedures like vasectomy.
Department of Health Director Dr. Eric Tayag says that, at this point, repairing the effects of the TRO will take more than the Supreme Court simply repealing it.
“We don’t know if we can reverse the impact of the TRO. A precedent has been set. What is to stop the pro-life groups from filing another complaint to question another provision of the RH law as soon the TRO is lifted?” says Tayag.
“The impetus to manage the population through responsible family planning has been reset. It will take a lot more than lifting the TRO to fix that.”