Part one discussed the way the Philippines went along with American pressure to pass a US style family planning program whose aim (denied by the president) is to limit population control.

Reality check: every “discussion” of the bill by the Manila elites includes lamentations about the high population growth, and even a few politicians have been quoted as supporting a mandatory “two child” policy to copy China.

From the PhilStar editorial pages:

2. Halt the population explosion. Do what the Chinese are doing and institute a strict one-child policy nationwide. The country’s natural resources is rapidly being depleted. And for every step forward the country takes—be it in improved farming methods or a cleaner environment—the exploding population instead pushes it two or three steps backwards.

Never mind that the resource depletion is because a small gift to the right politician/government official will let you mine without cleaning up or remove all the trees from the mountain without replanting any to stop landslides.

Luckily, the easy going Philippines would balk at such a policy. Yet repeated reports of coercive sterilization of the poor, from places as diverse as the US Indian reservations to India to Peru (not to mention China and Viet Nam) do suggest that governments too eager to stop poor people from having babies often resort to forcing them to do it.

So is there an alternative?

Well, allowing birth control pills as one of several “free” medicines in clinics might be an alternative. I mean, why allow “free” birth control, but not free antibiotics, protein supplements for malnourished children, or free medicine to control high blood pressure, a major cause of stroke related disability here in rural areas.

And why not promote free birth control at the grass roots level?

From the UK Economist, discussing the successful program of family planning run in Bengladesh, a conservative Muslim country.

At independence, its leaders decided that they had to restrain further population growth (China’s one-child policy and India’s forced sterilisation both date from roughly the same time).

Fortunately, Bangladesh’s new government lacked the power to be coercive. Instead, birth control was made free and government workers and volunteers fanned out across the country to distribute pills and advice.

In 1975, 8% of women of child-bearing age were using contraception (or had partners who were); in 2010 the number was over 60% (see chart 2). In 1975 the total fertility rate (the average number of children a woman can expect to have during her lifetime) was 6.3. In 1993 it was 3.4. After stalling, it resumed its fall in 2000.

After one of the steepest declines in history the fertility rate is now just 2.3, slightly above the “replacement level” at which the population stabilises in the long term.

I saw a similar success story when I worked in Africa.

Our Catholic hospital pushed prolonged breast feeding and natural family planning, but was not required to push birth control even though the government helped fund the hospital.

However, there were private funded village pill ladies in nearly every village who could supply free pills to any woman who asked for them.

Most of these women were teachers, teacher’s wives, or business women who welcomed it as a way to get extra income.

Yet even in Africa, the fact that the pill, but not clean water, was available in poor villages seems a bit absurd.  Yes, village women might have to travel two miles to the water hole in the dry season (before our hospital funded a well digging project), but the pill was as close as your child’s school.

Yet, if the aim is population control, a such grass roots program that works with the culture will work best.

So why not implement a similar program in the Philippines?

At the same time, it is a bit absurd to fund free birth control pills when a lot of women don’t have access to prenatal care.

True, the Philippines has a program to place trained midwives in every village and poor neighborhood.

But it is well known that the high maternal mortality here is mainly because only 62 percent of births have a trained birth attendant.

The main reason for this is that there often is no trained midwife in poor isolated villages, so local “hilots”, traditional birth attendants, are used.  A lot of babies are delivered at home, (44% of births are “non institutional deliveries). and although some hilots have been trained in modern birthing techniques by the government, but not all of them are well trained.

Another reason the poor might not seek a midwife is the cost and distance to travel to the local town to deliver at a birth center or hospital.

Even having a trained midwife at your home birth can cost a lot of money if you are a subsistence farmer and the only trained midwife nearby is in private practice: she might only be called if the hilot runs into problems, and then, sometimes, it is too late (which is why we lost one local farmer’s wife from eclampsia related seizures two years ago).

The government is trying to place “free” midwives in all villages and neighborhoods, but that goal has not yet been reached.

Another problem, not well documented and rarely discussed in public, is that some “free” government health care workers expect a gift for caring for you. Better pay might discourage this “custom”.

Which brings us to a question nobody seems to be asking: If the highest risk ladies don’t go to government clinics to give birth, or use a “free” government midwife, why do you think they will go to government clinics for free birth control pills?

Finally, there is another problem: corruption.

Will the pills be bought from a big American or European drug company (who will make a huge profit) or will they be generic (from China or India), so that the counterfeit drug companies can copy the design of the pills and get rich supplying fake and substandard pills for the real thing?

Of course, I suspect what will happen is that a lot of the “free birth control” pills and condoms given out will get diverted into the palenkes (local open air markets) to be sold for a profit, or diverted to other uses, as this story on India’s condom give away program shows.

UNUSUAL USES FOR CONDOMS

Villagers use them to carry water when working in fields

For waterproofing ceilings: condoms are spread under the cement-concrete mortar

Can be mixed with tar and concrete to give a smooth finish to roads

Can be placed over the ends of guns to protect them in desert sandstorms

Drugs ‘mules’ swallow condoms filled with drugs to smuggle them across borders

I’m also taking bets on how quickly the politicians etc. will manage to figure a way to get rich off of the program…

Ah, welcome to the Philippines, where the bribes are given “over the table, under the table and with the table”.

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Nancy Reyes is a retired physician working in the rural Philippines. And yes: I’ve worked with Family planning as part of a comprehensive maternal child health program both in the US and in Africa, which means I support the funding of chemical contraceptives, but not the coercive nature of the bill.

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The danger of “government” programs

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