COVER STORY

This might be your last year to access birth control

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Manila (CNN Philippines Life) — Joy Cabeñan has a problem.

Her bedridden mother, for one, has bone cancer. Rosalie Cabeñan was the subject of the award-winning GMA News TV documentary “Bente Dos,” named for the number of her children.

Joy, the sixteenth of 18 surviving children, was around 13 when the documentary aired in 2012. That same year, Joy Cabeñan swore she would not get married early.

Five years later, at the tender age of 18, she has been married for three years, with two children: a three-year-old named Angelo and an infant reaching three months. Her parents have around 12 grandchildren, the same number of people left in the household since some of her siblings left. Motherhood has aged her, as it did her mother.

And despite the media mileage that being part of a 24-member nuclear family can bring, they still live here: at a two-storey cement house in Baseco, Tondo, one of the densest and poorest communities in Metro Manila.

Ayoko na talaga masundan. Kasi sa bunso ko, muntikan na akong mamatay diyan,” said Cabeñan. She recalled that she broke blood instead of water prior to delivering both her children.

“Nung hindi pa ako nasusundan sa bunso ko, nag-usap ako sa asawa ko. Sabi ko, gusto ko magpa-family planning,” she said. “Sabi ng asawa ko, ‘Huwag kang mag-family planning, gagawin pa natin lima yan!’ [Sabi ko,] ‘Ang kapal ng mukha mo, hindi mo nga kaya buhayin yung isa mo tapos dadagdagan mo pa!’”

Her husband earns roughly ₱600 a week, which they use to buy milk, rice, and a fraction of the medicines for her mother, which cost ₱25 a tablet, needed three times a day.

But Cabeñan is safe for now. After that conversation with her husband, she sneaked out and got an injectable — a contraceptive that kept her from conceiving for three months. After Angelica was born, she went and got an implant. It’s supposed to last for three years.

For now, these are Joy Cabeñan’s problems: how to pay for her mother’s meds, how to feed the baby, how to put food on the table. She has another problem, but she doesn’t know it yet.

By the time her implant expires, there may be no more contraceptives available for her.

You have the same problem as Joy Cabeñan. The problem is a quiet, sneaky one — one that will spill out of Baseco, Tondo and onto your streets, from the slums to gated subdivisions.

As early as next year, government and non-government organizations alike may be forced to halt the distribution of family planning resources. The reason is simple: There is a looming possibility that it will no longer be on the market. Not even over the counter.

By 2018, it might be possible that no Filipino woman — not Joy Cabeñan or you, whether you are a well-to-do mom with enough-kids-for-now or a career woman who wants to put childbearing off — will be able to avail of contraceptives for women.

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On June 2015, the Supreme Court released a temporary restraining order halting the distribution of contraceptive implants and prohibiting the Food and Drug Administration (FDA) from “granting any and all pending applications for registration and/or recertification for reproductive products and supplies, including contraceptive drugs and devices.”

Alliance for the Family and Foundation (ALFI) declared its opposition to a total of 77 contraceptives, taking its case to court, arguing that contraceptives had abortifacient qualities.

“Sabi ng asawa ko, ‘Huwag kang mag-family planning, gagawin pa natin lima yan!’ [Sabi ko,] ‘Ang kapal ng mukha mo, hindi mo nga kaya buhayin yung isa mo tapos dadagdagan mo pa!’”

The Supreme Court denied a petition to lift the TRO in 2016, directing FDA to conduct a hearing that would allow ALFI to air its grievances and present its evidence. It also ordered that the FDA and the Department of Health (DOH) come up with specific guidelines to prove these contraceptives were non-abortifacient and allow “interested parties... to intervene.”

All this is on top of the Responsible Parenthood and Reproductive Health Law — which provides that these contraceptives be made distributable — being disputed in court.

For its part, the executive department, through President Rodrigo Duterte — keeping to an earlier promise — has signed Executive Order No. 12, which hopes to accelerate the implementation of the Reproductive Health Law (at least, by providing for collaborations between civil society and the private sector), even as access through public agencies faces a conundrum in the judiciary.

Still, the EO may not be enough. “The issue will be that no one will be allowed to provide any family planning methods ... whether it’s the government or the private sector or a UN agency doesn’t matter, because it’s the product registration that would be not in place,” explained Klaus Beck, United Nations Population Fund (UNFPA) Philippine Country Representative.

Beck describes two ways the TRO affects the public. First, although it only targets one form of contraception — the implant — it targets the go-to method for women in rural communities.

“The implants have increasingly become the method of choice for many women because it's very convenient,” Beck says. “That's particularly important if you're living very far away from health facilities, you have limited access to health services and health supplies.”

“Secondly, by having this TRO in place, it has sown a lot of confusion among people about what is and what is not allowed, which has meant that many healthcare providers, government units have been confused about what is covered [and what isn’t],” Beck continues.

Klaus Beck, United Nations Population Fund Philippine country representative. Photo by JL JAVIER

Commission on Population Executive Director Juan Perez III estimated that by next year, only four out of the 48 available contraceptives would be on the market, in an interview in Esquire Philippines. The same report estimated that by 2020, condoms would be the only contraceptive available.

But Dr. Junice Melgar, founder of the Likhaan Center for Women’s Health, estimated that it would be as early as next year. Although these date estimations vary among sources, they all agree — to quote Melgar — that “there will come a time when not one contraceptive will be allowed and all women, whether rich or poor, will not have access to contraceptives.”

It’s unclear whether an actual move for a public hearing is in the works. Just this month, Perez and former Department of Health Secretary Esperanza Cabral called on the SC to lift the TRO again.

We tried to reach Supreme Court for comment on the subject.

Their spokesperson, Atty. Theodore Te, answered: “It’s a pending case so I cannot comment on it.”

But would there at least be a time that the SC is looking at for ruling on the case?

“The resolution of the SC pretty clearly states who has the burden in terms of time frame,” Te wrote back. “and it’s not the SC. The DOH should know that if it read the resolution.”

Sir, the TRO asked DOH and FDA to come up with detailed guidelines and allow ALFI to air their objections. Were they able to provide these to the SC already?

Te replied, “Please ask them, not us.”

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“That will delay the process. Parang tinanggalan mo 'yung FDA ng mandato ... Kaya nga sila Food and Drug Administration eh,” says Dr. Eric Tayag, spokesperson of the Department of Health (DOH). He was referring to subjecting contraceptives to a public hearing. “Ibig ba sabihin lahat ng gamot na ice-certify, parang bakuna, gagawin mo nang ganung proseso?”

He said this at the DOH office in Manila, two weeks before we contacted the Supreme Court. This was in response to an update on the TRO.