Every woman deserves the right contraceptive

I met Angie (not her real name) at a health center in a remote barangay in Samar in 2025. She stood out in a waiting room full of teenagers and young mothers. At 43, she was expecting her seventh child.

The pregnancy was unplanned. She no longer wanted more children, and learning that the pregnancy was high risk only deepened her anxiety.

I asked whether she had ever used contraception. She smiled and nodded.

She had tried pills but often forgot to take them. She switched to injectables but could not tolerate the side effects. By her fourth pregnancy, she had decided she did not want to become pregnant again because of health and financial concerns. She requested sterilization after giving birth, but the facility did not offer it. The provincial hospital did, but it was too far away.

The Philippines has made significant progress in family planning. Access to services has expanded, more Filipino women are using modern contraception, and fertility has fallen to 1.7 children per woman in 2025, the lowest on record. These are achievements worth recognizing on World Contraception Day.

But national averages can hide important gaps.

The 2025 National Demographic and Health Survey shows wide geographic differences in modern contraceptive use, from only 20 percent in the Bangsamoro Autonomous Region in Muslim Mindanao to 58 percent in the Davao region. It also shows a mismatch between what many women want and the methods they use. Nearly half of married women say they do not want any more children, yet only about 15 percent use a permanent or long-acting contraceptive method.

For years, our family planning program has rightly focused on expanding access. That work is far from finished. But access should mean more than having some contraceptive available at the health center. A woman should be able to choose a method that is appropriate for her health, preferences, reproductive intentions, and circumstances.

In Filipino, we might simply call it hiyang. What works for one woman may not work for another. Some women may prefer pills or injectables. Others who want to delay pregnancy for several years may prefer an implant or intrauterine device. Those who are certain they do not want more children should be able to consider permanent contraception. A woman should receive accurate information about these options, decide what is right for her, and actually be able to obtain the method she chooses.

Too often, that last part is where our system fails.

Many public health facilities still cannot provide the full range of contraceptive methods because of shortages in commodities, supplies, or trained providers. Even basic methods such as pills and condoms can become unavailable because of recurring stockouts. Meanwhile, contraceptive commodities have expired in government warehouses before reaching the communities that need them.

If we are serious about contraceptive choice, three things need greater attention.

First, we need to examine whether the range of methods routinely available in public facilities is enough to meet women’s different needs. Where appropriate, the country should accelerate the introduction of additional contraceptive technologies already being used elsewhere, including self-administered injectables and longer-acting options.

Second, we need to fix persistent weaknesses in the family planning supply chain. Filipinos can track a parcel from a warehouse to their doorstep in real time. We should expect at least the same level of visibility for essential health commodities. Better forecasting, integrated digital logistics systems, timely distribution, and clear accountability are needed so that contraceptives reach facilities before stocks run out or products expire.

Third, women need to know what family planning services PhilHealth actually covers and what, if anything, they are expected to pay. Fear of unexpected expenses can itself become a barrier to care. Coverage on paper is not enough if patients remain uncertain about what is covered or are still asked to pay for medicines, supplies, or other costs they cannot afford.

None of these changes means telling women which contraceptive they should use. The point is precisely the opposite. Family planning should give women meaningful choices and support them in making their own decisions.

I still think about Angie, not because her story is unusual, but because it is not. She had tried different methods. She knew she did not want another pregnancy. She sought a permanent method. Yet the option she wanted remained beyond her reach.

Her story reminds us that the success of family planning cannot be measured only by how many women use contraception. We should also ask whether women are getting the method they actually want and need.

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Jaime D. Bonifacio Jr. is a Filipino public health professional who has worked across the Philippine health care system on family planning, maternal and child health, quality improvement, and health systems strengthening. He is currently pursuing a Doctor of Public Health degree at Harvard University.