The Pill’s Stealthy Journey Through a Conservative City

Manila | 01/31/2013 8:19am
Purple Romero | Informal City Dialogues

Stigma around the use of contraception in Manila means some women are more comfortable accessing it informally. Photo credit: Purple Romero

Soledad Villanueva, a 59-year-old mother of four, is not a doctor or a nurse, and the people she sees on a daily basis aren’t sick. Still, she calls them her patients.

On the day I visited her house in Commonwealth — one of the biggest barangays in Quezon City, one of Metro Manila’s municipalities, where families both rich and poor reside — she was off to see two of her patients. One was a 39-year-old mother of two, the other, a 24-year-old mother of one.

She was here to make sure they don’t become pregnant again.

In this predominantly Catholic country, artificial contraception, like sex itself, is something not often discussed openly. The Catholic Bishops’ Conference of the Philippines vehemently opposes the use of birth control, and the nation is sharply divided over the issue of allowing the government to promote modern family planning. In December, President Benigno Aquino III signed into law the Responsible Parenthood and Reproductive Health Act of 2012 (known as the RH law) which mandates that the state provide access to artificial contraception. But this did not end the debate, nor did it lead to the immediate provision of artificial contraception to mothers in every community. The legality of the law is currently being challenged before the Supreme Court.

Villanueva is well aware of the controversy. She sees the posters slamming the RH law as pro-abortion, hears the fiery exchange of viewpoints on the radio and TV, and even hears priests calling the use of artificial contraception a sin in her own community. Despite this, Villanueva has been working as an informal family planner since the 1970s, distributing birth control systematically to the women who need it.

Clinics like this one are where Villanueva gets the pills she distributes in her neighborhood. Photo credit: Purple Romero

She calls these women her patients because giving them “medicine” is less likely to attract attention. Some of the women, she says, refer to the birth-control pills she distributes as “vitamins.” Each day, she walks the narrow, dusty streets of Barangay Commonwealth to visit them. Today, her first stop is the house of Mona Ehage, a 39-year-old mother. Ehage lives in a two-story home and has her own small store where she sells food and other items. She has only two children — the eldest is eight years old, and the youngest is six. Ehage has been taking birth control pills for six years.

“Many families can’t afford to put food on their table,” she said. “We don’t want that to happen to us.”

She learned about how to use birth control pills from her obstetrician, but chooses to get her pills from Villanueva because they’re neighbors and they belong to the same religious sect. Villanueva gives her $2 worth of pills, enough to last 28 days.

Second stop is the home of Heidi Resnera, a 24-year-old mother of one. Ehage had recently checked in on her to see if she had enough pills. Ehage lives in a relocation site in Commonwealth, in a small room in a building whose green walls have been muddled by dirt. Resnera’s mother-in-law knows Villanueva and Villanueva was one of the godmothers in Resnera’s wedding. Resnera might not be willing to get her pills from a doctor, but she’ll take them from Villanueva.

The personal ties woven throughout this distribution system are what make it work. There are no formal sessions or workshops, and the professional medical community is largely invisible. Instead of scheduled appointments, Villanueva reaches out to the women in her neighborhood during the afternoon siesta. She sits outside their homes, asking them how many kids they have and if they plan on having more, interspersing her questions about condoms and pills with chit-chat about local entertainment, money and parenting.

Her work isn’t borne of a political agenda. When she was 17, Villanueva gave birth to her first child. “It was testing to take care of a child. Then when she reached two years old, I found myself pregnant again.” She told her husband she wanted to try birth control pills. He was lukewarm to the idea, but she took them anyway, and her next pregnancy was planned, four years later. It was around then that she heard that the mothers in their neighborhood in the city of Muntinlupa didn’t know how or where to get birth control pills. She led them to the community health center, the beginning of work she would carry on under six presidents and dozens of local officials.

In the 1970s and ’80s, under President Ferdinand Marcos, Villanueva could get birth control pills for free in government-supported health centers. But when Marcos was ousted in 1986, the centers stopped offering them. The Catholic Bishops’ Conference of the Philippines had become a force to be reckoned with, and Villanueva had to find other ways to access the pills. By this time she had moved to Quezon City where she found the Maligaya community clinic, which was funded by a faith-based organization. Here, she learned about modern family-planning methods like intrauterine devices and ligation.

Villanueva began distributing birth control pills from the clinic to the mothers in her community, and the clinic allowed her to keep P20 (less than $1 USD) for every pill she sold. When it shut down due to lack of funds, she ended up at the Family Planning Organization of the Philippines, a group that has been at the forefront of providing health care to Filipinas for the past 40 years. FPOP works through volunteers like Villanueva in 25 provinces nationwide and operates clinics with funding from various private donors.

In 2004, some local government officials stopped the community clinics from providing contraception entirely. That was under the term of President Gloria Macapagal Arroyo, who supported the use of natural family planning methods over all other options. It was volunteers from FPOP like Villanueva who provided the birth control pills to women by going to their homes.

Villanueva saw how Arroyo’s policy affected her own family, as her sister could not get birth control pills from the health center in Manila. Villanueva provided her with what she got as a volunteer. Today, when Villanueva is not available, her “patients” in Commonwealth go to her children. They sit in a corner and talk about getting the contraceptives they need, while the rest of the nation goes on its noisy debate over reproductive health.