“Family planning is a critical part of addressing social determinants of health, like educational level and employment, and actually answering the complex problems that health systems are facing.”
This tenet drives Dr. Jan Villamor Llevado’s work as the Program Manager for Family Planning (FP) under the Department of Health (DOH) in the Philippines. She has devoted her career to improving maternal and child health by ensuring women and girls have access to information and resources to make informed decisions about their reproductive and sexual health. Since joining the DOH in 2019, this 33-year-old mother of two has had the gargantuan task of steering the country in the right direction in terms of FP.
As the second most populous country in Southeast Asia, the Philippines ranks high in terms of unmet need for FP: 17% of married women and 49% of unmarried women who want to delay childbearing are not using any method of contraception. The country also ranks second in Southeast Asia for teenage pregnancy, with over 500 teenage girls getting pregnant every day, a number that has not dropped below 500 since 2010, according to the Philippine Commission on Population and Development (POPCOM) under the National Economic and Development Authority (NEDA).
When adolescent girls get pregnant, this can hinder their ability to continue their education, and have implications for their future wages. In fact, according to the United Nations Population Fund, teen pregnancies can lead to cumulative losses between 24 to 47 billion Philippine pesos — a big loss for young families. This has recently prompted the NEDA, the main economic agency in the Philippines, to declare teenage pregnancy as a “national social crisis” that is affecting the country’s economic growth.
Dr. Llevado is one of the reproductive health advocates working tirelessly to empower Filipino women and their families with access to contraception and FP resources.
Her passion and advocacy started when she was serving as a doctor in the barrios (small towns in the countryside) in 2012. She was deployed to a Geographically Isolated and Disadvantaged Area (GIDA) after getting her medical degree, choosing to serve in one of the poorest island municipalities in the Philippines, with a very high birth rate and where many mothers and infants were in dire need of maternal and neonatal care. Some mothers had 17 children each and Dr. Llevado said it was eye opening to see how lack of access to FP had affected their economic situations, to the point where families would dry fish bones in the sun for food. In other areas, she noted that women resorted to risky abortions for unwanted pregnancies.
“It was shocking for me to hear, in this modern era, coming from the mouths of these women that they had to resort to forced abortions using whatever they had at their disposal, like gas, bamboo sticks, and clothes hangers,” Dr. Llevado recalls.
At first, she was shocked by what she encountered in the barrios, and didn’t understand how these women could resort to such drastic measures. “Masungit ako noon eh (I was short tempered back then),” she laughs at herself. But she started to understand that much of what she was encountering was due to poor health literacy and the health system failing these women.
Armed with a new perspective after her experience in the barrios, she took a job at the Health Policy Development Program with the United States Agency for International Development (USAID), which focused on improving health care policies with FP as the focus. Since then, FP has continued to be the focus of her career.
Today, her top three priorities for the FP program she leads at the DOH are to reinvigorate the national family planning program strategy, get rid of barriers by strengthening health systems, and address the high rate of teen pregnancies.
This work is done in close partnership with other government agencies, non-governmental organizations, and development partners like USAID.
For example, the USAID ReachHealth project, implemented by RTI International, is supporting Philippine counterparts — primarily the DOH, POPCOM, Philippine Health Insurance Corporation (PhilHealth), civil society, and the private sector — to reduce unmet need for FP services and decrease teen pregnancy and newborn morbidity and mortality across 11 regions by identifying and responding to root causes of poor FP outcomes, with a concerted focus on disadvantaged women, adolescents, and the most underserved.
Dr. Llevado believes the Philippines has good laws and policies for family planning but encounters challenges in implementing those policies. FP is increasingly being incorporated into laws, such as the Kalusugan at Nutrisyon ng Mag-Nanay Act, which focuses on improving nutrition during the first 1,000 days of life, and the Universal Health Care Act that was signed into law in February 2019.
When it comes to being able to continuously implement these laws, she cautions, “I still see family planning as politically driven in the country. Without good and sensible politicians, we are going to have barriers along the way.” For this reason, Dr. Llevado continues to push for advocacy activities that educate legislators on the importance of family planning, including supporting the POPCOM’s plan of hosting lectures on FP for the staff of legislators.
Dr. Llevado also acknowledges the role of the civil society organizations that are at the forefront of reproductive health advocacy in the country.
“Without [other agencies, development partners and civil society organizations] pushing for FP as well I don’t think we [the Department of Health] would be strong enough to implement family planning policies.”
With such a huge task of orchestrating goals, plans and activities at the national level, Dr. Llevado reminisces with nostalgia about her time working in the barrios: “I sometimes think I would want to go back to the Regional Health Unit and work as a municipal health officer. Because it’s easy to get a win-win situation there and you’re nearer to the people you’re servicing.”
But she also acknowledges that in her current role as head of the national program, she will be able to help more women have an informed choice for family planning, and thus touch the lives of more Filipino families.
When asked what future she wants to see, she says with hope in her eyes, “I aspire in the future that my kids can use contraceptives without stigma and not have unplanned pregnancies because we are in a society where we are open in discussing family planning or sexual health with them.”
For more information on RTI’s work in global health, please visit http://www.rti.org/globalhealth.
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