In line with the Philippines commitment to the Millennium Development Goals to reduce maternal mortality ratio (MMR) by 2015 and meet the demand of around 2 million women or couples of reproductive age for family planning (FP) with around 1 million need for limiting family size, policy makers should come up with measures to provide assistance and support for family planning health care services.
At the 11th Usapang PopDev (Population and Development), The Forum for Family Planning and Development said there should be some subsidy or financing support from the government in order for the poor to have better access to initially expensive but more reliable and cost effective methods like Voluntary Surgical Contraception (VSC) like bilateral tubal ligation (BTL) for women and no-scalpel vasectomy (NSV) for men to allow them to maintain their preferred number of children and prevent maternal and child mortality.
Benjamin de Leon, President, The Forum said in order to address the family planning service gap, we urge the government to provide public information on VSC, identify couples with unmet need for limiting family size and encourage men to assume some of the contraceptive responsibility that majority of women bear.
The Philippines is committed to the Millennium Development Goals including the reduction of MMR to 52 in the year 2015 from 172 in 1998 (DOH 2007). Based on estimates from the FP Survey of 2006, we have only reduced MMR to 162 maternal deaths per 100,000 live births or a mere 22% reduction. We still have to complete a big part of the promised 75% reduction with only 8-years left for concrete action (NSO 2007).
According to Dr. Jonathan Flavier, Chairman, Cooperative of Men Encouraging No-Scalpel Vasectomy and Member, The Forum Board of Trustee, the Department of Health over the years has their focus on the use of pills and injectables and other contraceptives. There is a need to fill the gap in demand for VSC to fully address fertility preference. Family planning methods like the use of the contraceptive pills, injectables, and condoms are essentially available in most Barangay Health Stations and Municipal Health Offices but not NSV or BTL.
He furthered, currently, preference for more effective method imply a need for VSC. There is a high rate of discontinuation of temporary FP methods due to method failure, dissatisfaction with current choice, misinformation on their proper use and non-availability of services due to our less privilege countrymen especially in the provinces, and even in citied like Manila where methods other than natural family planning is a big no-no.
Over the last decade, there have been more men accepting no-scalpel vasectomy. But even with more than a 7-fold increase to 4,634 NSVs during this period and an average of around 2,200 NSVs per year “this is a far cry from the 1 million or so women and couples who have a need for longer term methods of FP” Flavier added.
There have been a consistently low percentage of acceptors in the Philippines who use vasectomy as a contraceptive method. NSV share of method mix has been hovering around 0.2% of method mix over the last decade. In 1977, only 6,600 men of a total of 200,000 under contraception have used vasectomy. In comparison, 90% of the 66,400 women who opted for surgical contraception chose tubal ligation.
De Leon stressed, resistance to vasectomy could be traced to cultural values and misconceptions about the method. In the Philippines with a wide agricultural setting, people often equate vasectomy with castration. Even with simplified and improved operative techniques for vasectomy, the program needs to emphasize more education about the method. Just like other methods, there could be risk but it is manageable given the more advance technology now in medicine.
A local study by Magbanua and Morcillo (2004) reported that NSV does not result in any significant effect on sex-drive and frequency of erection among the post-vasectomy males they interviewed. Neither was there any change in stamina, masculinity, and self-perception of these respondents.
In contrast, among the men who had an NSV; 63% had stronger and 54% longer erections, 60% reported a stronger sex drive, and 75% had more frequent sexual intercourse. Among women who underwent BTL there was an 80% chance of having no change in sexual interest and an 81.7% of having no change in sexual pleasure. Among those who reported a change in their sexual pattern, most had experienced better sexual effects. Decrease in sexual interest or pleasure was mostly observed among women who had a change of mind and regretted that they had a BTL. (Costello et al. 2002).