ALMOST HALFWAY. The poorest families in remote Ifugao towns have as many as 12 children. [photo by Ricardo Reyes]
THERE ARE about four television sets in Tinoc, a remote town in Ifugao Province at the eastern foot of Mt. Pulag. The TVs are powered by solar panels. But there is no TV or even radio signals in the area. The TV sets are used in conjunction with DVD players.
One would think that Tinoc would have a long list of wants and needs. But last December 1 saw the inauguration of a local law that is expected to change profoundly the lives of the people of Tinoc and the rest of the province: the Ifugao Reproductive Health Code.
Ifugao Province has some 161,123 people living on 251,778 hectares of land, much of which cannot be tilled. Of its 11 towns, only two can be considered urban areas. The average family size in the province hews close to the national figure of five to six members, but in towns like Tinoc, the poorest families can have as many as a dozen children.
In 2000, the National Statistical Coordination Board said that Tinoc was the 23rd poorest municipality in the country, with 76.4 percent of its population considered poor. Most of those on the list were located in the Autonomous Region in Muslim Mindanao (ARMM). Bulalacao in Oriental Mindoro (2nd), Tineg in Abra (9th), San Francisco (10th) and San Andres (20th) in Quezon, and Siayan in Zamboanga del Norte (17th), were the only non-ARMM towns rating lower than Tinoc.
Ifugao was also among the 10 poorest provinces in the country at that time, which is why it was included among the pilot areas in the Sixth Country Programme of the United Nations Population Fund (UNFPA) in 2005.
Until 2009, UNFPA is supposed to focus on those 10 poorest provinces and try to improve their reproductive-health status through better population management and sustainable human development. The programme (as the UNFPA insists on spelling it) is based on the identified priority areas of the United Nations Development Assistance Framework (UNDAF) namely: macroeconomic stability and broad-based and equitable development; basic social services; good governance; and environmental sustainability. (The fifth UNDAF priority, conflict prevention and peace building, will be integrated in five Mindanao provinces.)
In Ifugao, the programme singled out Tinoc, Lagawe, and Asipulo, the province’s newest municipality. The UNFPA believes that quality reproductive health care, of which family planning is just one of ten aspects, can help alleviate poverty.
The other elements of reproductive health care are maternal and child health; men’s involvement in reproductive health; elimination of violence against women; adolescent reproductive health; elimination of breast and reproductive tract cancers and other gynecological conditions; prevention of sexually transmitted infections and HIV/AIDS; prevention and management of abortion complications; and prevention of infertility and sexual dysfunction.
Location map of Tinoc, Ifugao Province courtesy of Wikipedia
IT MAY not be immediately obvious why a reproductive-health code would be so important in places like Tinoc, which has been in isolation for so long that identifying it as a fifth-class municipality would be putting it kindly. The town has native Kalanguya and Ifugao as residents, and almost all of them work as farmers. Yet even though the families each earn only about P2,000 to P3,000 a month, they are able to meet all their basic needs.
Well, almost all their needs. After all, this sense of self-sustainability can only go so far. According to Rowena Comilang, program director of Baguio Center for Young Adults (BCYA), in a wealth-ranking survey made in the three UNFPA pilot villages two years ago, only 58 families said that they had “enough.” More than 330 families considered themselves poor and 148 families said they were among the kabitegan or the very poor.
Many of the poorer families have 10 to 13 children. Comilang also says that alcoholism is a very common problem there (perhaps an indication that the people of Tinoc are in dire need of more DVD shows to while away their nights).
She adds that teenage pregnancy and arranged marriages are still common practices. This may be the reason why Tinoc has one of the highest dropout rates in the country, according to education department statistics, with 13.84 percent of its high school students never graduating. Some 3.76 percent of Tinoc’s elementary students eventually stop going to their classes as well.
But it’s not as if people in Tinoc are complacent about family planning. Like the rest of the people of Ifugao Province, they are all too aware that having too many children could be a problem. In Tinoc, Lagawe, and Asipulo, the BCYA reported that the ideal number of children wanted by both parents is four, although the actual average per household in these towns is five to eight children. (At the national level, the desired number of children per household is three and the actual number is four.)
The favored contraceptives among Ifugao women are pills and injectables. Male involvement in family planning, however, is almost nil, with no takers at all for nonsurgical vasectomy, while condom use is very low.
Still, there may be another reason for the supposedly weak popularity of prophylactics. Roy Dimayuga, the UNFPA coordinator for Ifugao, says that one December night in 2005, the Tinoc Rural Health Unit was burglarized. The only items stolen, however, were 50 pieces of strawberry-flavored condoms and two packets of contraceptive pills. These were taken from the DKT Pop Shop inside the office.
“We roared in laughter, but in a deeper sense, that incident reminded us of the importance of addressing not only people’s RH concerns, but also their economic concerns,” Dimayuga says.
Ifugao was one of the last provinces to be given free contraceptives by the United States Agency for International Development (USAID), and that supply ran out in 2005. The local health unit thereafter began selling condoms and other contraceptives in DKT Pop Shops. (See sidebar)
The Ifugao towns are too poor to shoulder the reproductive-health needs of their people. The Tinoc Municipal Health Office, for example, had a budget in 2005 of only P1,641,621. Of this, P1,459,940 was for personnel cost. That meant only a little more than P10 for each resident of Tinoc for their health needs. That is equivalent to only two movie showings using their solar-powered DVD players.
ADVOCATES OF reproductive health care had been putting up a vigorous fight in Congress to pass a reproductive-health code to help poor provinces like Ifugao. But HB 4110 (Reproductive Health Care Act of 2002) at the previous House did not even muster a second reading; in the current House, HB 3773 (The Responsible Parenthood and Population Management Act of 2005) made it a bit farther, but in the end it drowned in the legislative quagmire.
TATAY KONG NANAY. An enlightened man of the mountains. [photo by Ricardo Reyes]
It’s no help that the administration of President Gloria Macapagal Arroyo toes the line of the Roman Catholic Church. The government’s family-planning budget has been severely slashed, and the administration is giving emphasis only to the church-approved natural family planning, which is based on the premise that the woman’s menstruation cycle is regular and that partners are cooperative enough not to have sex on certain days.
Not surprisingly, some local governments are taking matters into their own hands. When HB 4110′s main sponsor, then Aurora Rep. Bellaflor Angara-Castillo, ran for governor of her province and won, one of her first moves was to sign Provincial Ordinance No. 125, providing for the Aurora Reproductive Health Care Code of 2005.
Castillo deputized the barangay health workers to do door-to-door family-planning consultations and surveys. The result is a code that assures Aurora youths that they will be provided reproductive health and sexuality education. Everyone else — like unwed mothers, government officials, overseas Filipino workers, and even those couples separated by jail bars — is required to undergo responsible parenthood counseling.
Aurora’s code also earmarked a minimum amount of P500,000 for the program’s implementation, even as it had towns and barangays augment the province’s reproductive-health program financially.
Ifugao must have heard the call from the other side of the mountain. Then Ifugao Vice Governor Glenn Prudenciano, who had been attending health symposia all over the country, started the groundwork for a similar bill. When Governor Benjamin Cappleman succumbed to cancer last October, Prudenciano became the province’s chief executive, but he kept on working on the reproductive-health bill.
In consultation with UNFPA, Prudenciano devised a scheme so that the cash-strapped Ifugao provincial government would not have to shell out the bulk of the money needed for its Reproductive Health Code. So now Section 22 of the Code states that “a minimum amount which is equivalent to ten percent of the benefit payment from the Philippine Health Insurance Corporation of the Ifugao Provincial Hospital and District Hospitals in the province shall be automatically appropriated for this purpose.”
“There was no opposition from the board because the IRA (internal revenue allotment) would not be touched,” says Dimayuga. He also observes, “The beauty of this code is that the financing and the roles of every organization had been clearly defined so that the sustainability of the program is set.”
Similar to Aurora’s version, the Ifugao Code looks to the barangay health workers as the backbone of its program. One of the barangay health workers’ tasks is to coordinate with the Sangguniang Kabataan of each village to establish a peer-counseling network particularly for out-of-school youths.
At the same time, public and private schools from Grade 5 up would have a common curriculum to inform them about reproductive and sexual health and family planning, with emphasis on modern contraceptive methods, abstinence before marriage and prevention of sexually transmitted diseases. Religious organizations, meanwhile, are expected to provide education and counseling on sexuality and network with other members of the civil society.
DR. EDEN Divinagracia, executive director of the nongovernmental organization Council for Population, Health and Welfare, which is one of those calling for local RH advocacy, says Ifugao Province’s new Code is a victory for the people. She has predicted that other provinces would follow suit with their own reproductive-health code even if the national government is “trying to act blind.”
True enough, Governor Maximo Dalog of neighboring Mountain Province said in his state of the province address last January 16 that his top priority this year would be the passage of his province’s very own reproductive-health code.
Yet it remains to be seen how Tinoc will take to the new Code. Culture can be a hindrance to quality reproductive health care, even when there are laws that mandate the latter. For instance, Comilang notes of the sexual-abuse cases in Ifugao: “The traditional way of justice…prevails over the aggrieved party’s desire to got to court.”
Indeed, even with the interference of UNFPA in the area, Tinoc still had 13 cases of verbal and physical abuse, and rape and incest cases, documented by the municipal social services office in 2004 and 2005.
The practice of kalon where the older men court a girl in behalf of a boy, along with kaihing or a’apuh or arranged marriages, are still prevalent in remote Ifugao towns. Sexually transmitted diseases and abortion remain taboo conversation topics. Yet the Ifugao Provincial Health Office recorded 104 cases of abortion in 2004 and 112 in 2005.
Even the use of family planning is shadowed by cultural bias. There is the traditional notion that children are the source of wealth, which means the more, the better. It is also believed that Maknongan (supreme deity of the Ifugao) controls the number of children a family can have.
Then again, the theft of the strawberry condoms in Tinoc could be an indication that some townfolk now think Maknongan has better things to do than count babies.