Plan now, baby later

In a recent talk, former NEDA secretary Cielito Habito mentioned that while most Asian countries have been experiencing a decline in population, the Philippines has been experiencing the opposite. Sadly, however, even as our population continues to rise, the state of our people’s health and nutrition keeps worsening. 

With this in mind, we devoted an Okay, Doc edition of #PamilyaTalk to one of the advocacies that I hold near and dear: family planning. And because that spirited discussion centered mostly around the medical aspects of family planning, I thought it best to delve a little bit deeper into the issue in this week’s Broad Cast.

What is family planning?

The Department of Health defines family planning as “having the desired number of children and when you want to have them by using safe and effective modern methods. Proper birth spacing is having children 3 to 5 years apart, which is best for the health of the mother, her child, and the family.”

Therefore, in a nutshell, family planning is synonymous with responsible parenthood. It takes into account the entire family’s well-being, including the parents’ readiness to provide for the financial, physical, emotional, and other developmental needs of each member of the family.

Why is family planning necessary?

Too many people, too small a world

According to the Commission on Population and Development, an average of 4,177 babies are born in the Philippines each day. That’s equivalent to 174 babies born every hour or three babies every minute. And that’s on top of the total population of 109M Filipinos reported by the Philippine Statistics Authority in 2021.

What does this mean? The Philippines currently accounts for 1% of the daily population growth of the entire world. 

In fact, according to the World Population Prospects 2022, a report by the United Nations, “More than half of the projected increase in global population up to 2050 will be concentrated in just eight countries: the Democratic Republic of Congo, Egypt, Ethiopia, India, Nigeria, Pakistan, the Philippines and the United Republic of Tanzania.” 

For such a small country, that’s how much impact we’re expected to make in the next few years. And sadly, not for the better. 

At this point, the world is already facing food insecurity, water scarcity, and climate change, among many other global problems that threaten our survival as a species. But it’s not too late to change that. With proper family planning, the Philippines doesn’t have to put that much strain on our small planet’s finite and quickly diminishing resources. 

Family planning is the sensible, responsible way to move forward as a nation. To do otherwise is reckless.

But if national and global sustainability may seem too abstract to justify the need for family planning for some, then let’s look at the issue on a more personal level.

Closer to home

It all goes back to responsible parenthood.

Though each child is a blessing, having more children than you can provide for ends up being a curse on them. When parents have more children than they can adequately feed, clothe, educate, and give attention to, it diminishes the quality of life of the entire family.

Aside from denying children their right to be fully nurtured, nourished, secured, and loved, It also puts an added strain on the parents who have to work double time to pay the bills and put food on the table. They become too busy making a living that they end up missing out on life.

Therefore, responsible parents are the most loving kind of parents. They ensure that their offspring—be they many, few, or even just one—have the best opportunities to thrive. They also ensure that they have the time, resources, and presence to give to their spouse and children. 

Moreover, multiple pregnancies and childbirths can put a mother’s life at greater risk. Maternal and infant mortality and morbidity tend to increase proportionately with the increase in population. Proper child spacing greatly reduces the risk of losing the baby and/or tragically leaving other children orphaned.

What does family planning entail?

Mutual Commitment. The most crucial ingredient of family planning is full cooperation. Both spouses have to be in it for the long haul. Family planning shouldn’t be the responsibility of just one or the other.

Doctor’s Advice. Under a doctor’s regular guidance, a couple can determine which methods will be best suited for them.

An Open Mind. In this way, a couple will understand that family planning is needlessly controversial. That’s because it’s neither anti-religion nor pro-promiscuity. 

There are methods that won’t violate a couple’s religious convictions. Numerous studies have shown that awareness, proper education, and the availability of safe and reliable contraceptive methods do not encourage sexual experimentation, especially in the youth. Instead, the incidence of unwanted pregnancies and sexually transmitted diseases are lower.  

Which methods work best?

Traditional or natural methods for couples  

According to obstetrician, gynecologist, and sonologist Dr. Sharon Mendoza, the answer will vary from person to person, especially based on their views and their body’s unique response. It is also important to keep in mind that, as with most things, there are no 100% guarantees. Contraceptive methods are effective only up to 99% of the time.

Those with religious restrictions against contraceptive devices can opt for traditional birth control methods. These include the calendar and rhythm methods that require sexual abstinence when a woman is fertile. This is done by tracking the menstrual cycle via pen and paper or even a mobile app. It is effective only when a woman’s menstrual cycle is regular. If her period isn’t predictable, then these natural methods are likely to fail. 

The withdrawal method may also be practiced, however, it is only around 70% effective. This means that this method can result in pregnancy 3 out of 10 times.

New mommies may opt to use the Lactational Amenorrhea Method or LAM. However, this is applicable only to those who have been straight breastfeeding without feeding the baby any replacements such as water or formula. Doing so, especially within the first six months of childbirth, sends signals to the brain that prevent the body from releasing a viable egg cell. Thus, the woman remains infertile for the duration. But as soon as her period starts again, she will require additional birth control methods.

Female contraceptives

Pills, according to Dr. Mendoza, need to be taken consistently to be up to 99% effective. But with the hundreds of brands available, it may take some trial and error to find the brand that works best for each individual. Common complaints versus the pill include weight gain or loss and an upset stomach may require the user to try out other formulations until the right hormonal component for their system can be found. 

In lieu of pills, women may opt for injectables that last longer. Some last for a month while others last up to three months.   

An intrauterine device or IUD is another option. This small, T-shaped device is inserted by a medical professional into a woman’s uterus. It then releases copper that prevents pregnancy for up to 12 years.

The subdermal implant that, as its name suggests, is a small device inserted in the arm just under the skin. Dr. Mendoza stresses the importance of having this administered by a duly trained and certified health care provider (ex. OB GYNE, family physician, midwife). Though bruising may occur after the implantation, this side effect should last no more than a week. The implant is effective for up to three years. 

Then there’s tubal ligation, a major surgical procedure that involves the snipping, tying or blocking of the fallopian tubes. Ligation prevents the egg from traveling from the ovaries to the uterus. It also blocks sperm from reaching the egg but doesn’t affect a woman’s menstrual cycle. This procedure is reversible.

Male contraceptives

Urologist Dr. Frances Monette Bragais emphasizes that women shouldn’t be burdened with preventing pregnancy all on their own. Especially not when there are male contraceptives that are just as effective and less invasive. 

Aside from the withdrawal method, men can simply use a condom. For maximum efficacy, she recommends using them long before their expiration date. Dr. Bragais also warned against exposing the wrapped condom to heat and against using oil-based lubricants, both of which can degrade the latex and render the condom useless. 

A vasectomy is a long-term and reversible option that is now less invasive than ever before. This entails snipping the vas deferens, a small tube in the scrotum that serves as the passageway for sperm to flow into the semen. 

This is a minimally invasive outpatient procedure that typically takes 30 minutes and only requires local anesthesia. The incision is so small it only requires a small band-aid and no stitches. 

Patients can be up and about within minutes of the procedure. Any discomfort can be remedied by the application of a cold pack to the area. But the patient will need to use other forms of contraception for the next three months to ensure that all the remaining sperm in the vas deferens has been flushed out. A semen analysis can easily confirm this.

Dr. Bragais assures that vasectomies are easier and safer to perform on men than tubal ligation on women. The latter is more invasive as it deals with the inside of the body. And since vasectomies are reversible and don’t affect the testosterone level of men, Dr. Bragais says that the fear of losing sexual pleasure, libido, manhood, and future fertility are all misconceptions. In fact, the procedure can be safely undergone by older, more senior men

Responsible parenthood: It takes two 

Whether a couple opts for more traditional or more modern and gender-specific contraception, family planning requires the commitment of both partners to reach their desired number of children. 

In the long run, the sacrifices and inconveniences of family planning are well worth achieving the right-sized family that you can support, and even spoil, within your means.

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