Bulusan, Philippines – Echoing through the small mountainous community, or barangay, of San Antonio is the high-pitched cry of a nine-month-old infant. The sound can be traced to a thatched-roof shanty that the infant shares with his two-year-old brother and his parents, Arlene and Anthony Gambas, along with two other families.
Arlene, 19, admits she wasn’t ready to have a child when she first met her husband in a short-term cooking course run by the local government: “I did not want to get pregnant, but he [Anthony] really insisted. He wanted to have a child while I was still in school, Grade 11 at that time.”
First came her son, and then a brother. But through the Sexual Health and Empowerment (SHE) project and a caring midwife who received training from Jhpiego on health issues specific to adolescents, Arlene has been able to choose when, and if, to increase her family. Given a choice of voluntary family planning methods, Arlene opted for an injectable contraceptive following the birth of her second child—a decision, supported by Anthony, that will give her time and energy to care for her two small sons and finish high school while her husband works as a gas pump operator to provide for his family.
It is not unusual for women in the Philippines to have limited control over their reproductive health. The 2017 Philippines National Demographic and Health Survey reported that only 47% of married women aged 15–49 are the primary decision-makers when it comes to their own health care. And, with 47 births per 1,000 women aged 15–19 years old per year, the adolescent birth rate in the Philippines is one of the highest in Southeast Asia, and higher than the global average of 44.
The Global Affairs Canada-funded SHE project, implemented by Oxfam with technical assistance from Jhpiego, works to transform discriminatory social norms, attitudes, behaviors and other factors hindering sexual and reproductive health and rights in 13 provinces across six regions in the Philippines. In partnership with the government, SHE provides high-quality, rights-based, comprehensive sexual and reproductive health information and services to women, from adolescents to mothers and those who wish to delay pregnancy. Their work includes expanding access to contraceptives and post-abortion care, and educating clients on gender-based violence prevention and support through awareness-raising and mobilization activities.
Elsa Geva, a rural health midwife who has been caring for adolescent girls and young women in the Bulusan rural health unit (RHU) for 29 years, attests to the benefits of the Jhpiego-led learning and mentoring workshops and community engagement provided by Mayon Integrated Development Alternatives and Services (MIDAS), a local civil society organization and partner to the SHE project.
Before the training, she says, she typically treated adolescent clients just like any other age group. Jhpiego’s training helped her recognize the unique health-related needs and concerns of adolescents—an understanding that not only improved the care she provides, but also had clear benefits for the community: “We noticed that many people are now visiting the RHU for consultations on family planning services as a result of our outreach activities, which I think is also a factor why teenage pregnancy decreased.”
Geva was able to put the training into practice when Arlene came to the health center. “Whenever I visited the RHU during my pregnancy, Ms. Elsa would provide me with utmost care,” Arlene said.
I really felt the concern and care she provided me throughout my pregnancy. I did not sense any negative forms of judgment, which made me more confident to seek health services in our facility.”Arlene Gambas
Midwife Geva also took part in a Jhpiego-supported community outreach activity in Bulusan. The activity aimed to increase voluntary family planning use by allowing women to choose the method that best meets their needs for delaying, spacing or limiting pregnancy. She, in turn, facilitated training sessions for barangay health workers to share family planning information and address the proliferation of false information and unfounded claims in the community.
SHE aims to benefit almost 350,000 people. For providers like Midwife Geva, Jhpiego’s SHE interventions are transforming how they deliver health care services. And for Arlene and other young women, SHE is providing the building blocks to increase uptake of health care services and improve health-seeking behavior. With greater knowledge and awareness of their sexual and reproductive health and rights, adolescent girls and young women can claim their decision-making power—free from discrimination, coercion and violence.
“It is very difficult to be a teenage mom, but through the SHE Project young women are able to rise from the stigma and discrimination from the community, with the correct information and support system,” said Commissioner Cristita Cervantes-Triunfante, of MIDAS.
Cressida Reyes was a regional coordinator for family planning and reproductive health for Jhpiego’s Philippines office. Joan Taylor is an editor at Jhpiego. Jeremiah Eleazer Sotto, Monitoring and Evaluation Officer in Jhpiego’s Philippines office, also contributed to this story.