THE PROBLEM: TO GENERATE INTEREST IN FAMILY PLANNING

First of all, I decided I would find out what was the problem. And very quickly I found out the problem was that the whole program was in shambles. Why? Because -- without making a judgement of the previous regime -- the influence of the Catholic Church was just so strong, and the past President was such a devout Catholic, that, you know, through plain attrition and turnover, we found out that we only had 200 workers in the field. And that is why I knew I was in trouble.

But I said: "How do we get awareness?" And we developed it very quickly -- by quarrelling. And I found out very quickly also that when you are only 4'11", they don't really hurt you. Because, you know, when you're taller in the Philippines and you hit a boy, that's no achievement. So, I became rather bold. What I really wanted to say was that we just had to create the excitement because there was none.

THE PROBLEM: THE PHILIPPINE GOVERNMENT

But I found out that I was very vulnerable because I was in government. All the senators and all the congressmen, in one snap of the finger, can cut my budget and I am nowhere to be found. So what did I do? Something that you must realize is the power of the NGO.

THE SOLUTION: NGOs

I decided [that] I'm gonna do it through the NGO and that's exactly what I did, up to today. Why? Because when I do it, they shoot me, but when you do it, they can't talk. Why? They can't abolish you. Not only that. You are the electorate! -- at least, you "pretend" to be the electorate. There is why.

FIVE AREAS OF OPERATION

So, what did I do? I said, "Let's do it systematically". I said, "There are five areas -- we're gonna get the NGOs to do it:

(1) ADVOCACY;
(2) INFORMATION, EDUCATION, & COMMUNICATION;
(3) TRAINING;
(4) SUPPLIES -- contraceptives; and
(5) would be the CLINICS. And what I did was to get NGOs for each one of them. And by underground ... [Are there spies around here? You're all my friends, ha? No, its an open secret. That's why they're all so sore! ] because while I was fighting on top, all these was happening below -- quietly. Because once it was installed, there was no way it can be removed. And what we did was we got a lead agency -- NGO -- for each one of them.

1) Contraceptive Distribution: C.A.R.E.

I'll give you a good example. I found out that to distribute the contraceptive supplies in an island structure like the Philippines, [where] we have 7,107 islands, when it is high tide; when it is low tide, a few more -- how do you distribute all of these condoms, pills and IUDs all over the country? I found out that C.A.R.E. -- you know -- Cooperative American Relief Everywhere? They are the world's expert in distributing food all over. They know the system -- they've been doing it for 45 years. So I said, "That's the group!" They're gonna bring the food and together with the food will be condoms, pills and IUDs. And it worked! So we had a contract with them. So the people were saying, "Why is it all over the place?" I said, "I don't know".

You have to know how to play the game. And then what? Today, it's all over the place. And they cannot drive C.A.R.E. away because there is an agreement between the government and C.A.R.E. to be there! And they are there. And they just add on the boxes, and the boxes are all over the Philippines. So when they complain why IUD, and condoms and pills are all over -- including villages -- it's because of that one.

Now, I could also honestly say that I'm not spending money of the government for the supply -- yet. But once the demand is there, then we can begin to shift, but the point is that that one will stand.

2) I.E.C.: Johns Hopkins Center for Communication

Same with IEC. I didn't do it. I got a group -- which is an NGO called Johns Hopkins Center for Communication. Why them? Because I graduated from that school, y'know. It's a good school. And there it was! They're good! They know their business! And what happens is [that] if there's need for IEC, I don't do it. That group does it; not only that it produces them. Anybody [who] wants materials -- just go to them. You don't even have to pass through the government.

You know what's the beauty? You also cut the red tape. The most complicated things that are done are done in government. When you remove the government, then you get it efficient, because it is run like the NGO which is what all of you are. OK? [You're supposed to clap when I say that! ] And there it was!

(3) Training: Educational Development Foundation

And then for the training we deal with a group called Educational Development Foundation. And the beauty was this: you can structure your training. You tell them how many [persons], how many days, where it will be -- and on the beginning of the first day, first hour of the training, they give you the check! How efficient can you get! If you do that with government, forget it. It will take you six months to get your refund -- if you ever do.

And that's why it intrigued me and made me even more excited, and down the line we did this for every segment -- point one.

(4) Family Planning Clinics: Government Hospital System

Point two. We were also very specific in terms of what groups to work with. What were they? One, I found out that I was in control of all the hospitals. "Wow!", I said to myself. I can do it "gently". What does that mean? "Gentle persuasion": if they don't follow, I don't give them the license!

I never used it, but it was the facilities that were available. It was already there! [Did I say something wrong? Do you belong to the government? It's alright. Even better -- women replacements. I'll take women anytime. The best men are women! ]

And these hospitals, up to now, still provide for 70% of all the family planning services. So, even where I want the NGOs to come in, it has not yet been that practical because we don't have the facilities in the NGO world to really take over -- not yet, anyway. So that's something that I'm trying to facilitate and make grow so they can eventually come in.

(5) Linkages with Other Government Departments

Two, I made sure that the other departments of the government were in the stream of things. Because, I'm in the Department of Health -- we're natural for family planning. But if we don't use all the other departments -- labor, defense, education, environment -- we've missed the point. Why? Each one of them have their own clientele that are really "made to order". What do I mean?

Environment. They have all the foresters that are working with people who are now encroaching on the mountains because of sheer population explosion on the plains. And so they're very eager to work with us.

Military. Oh, what a wonderful group to work with! Why? They also have "gentle persuasion". When they are told to use condoms and they don't, they shoot them. Wow! So we're in business! -- education and down the line.

NGOs. Three, are the NGOs that I already annotated.

Local Governments. And of course, the number four, really, is a track that we are still developing, and that is what we call the "Local Governments". Because we've just been devolved. There's a new law that effectively devolved the provincial -- that would be equivalent to the states in the United States and districts in some areas. But anyway, they are now independent so we're working through them through a system of "lateral persuasion".

What does that mean? Very simple. I tell them: "If you have a population officer, you get one point; if you have your contraceptive system in place, one point; if you have a training system, one point; if you have IEC, one point; if you have clinics in the place, one point; if your prevalence rate of contraceptive use is so much, you've get one point. If you get six points, I give you a car!" Verrry persuasive! [ Now, where to get the car is somewhere else ...]

GENERATED INTEREST: 98%

It's very, very interesting because there is a lot of interest being generated. So why don't we just stop at that as the appetizer and I will be happy to answer questions from the panel whatever [questions] you want. But this is what we have done.

Meanwhile, I'm in trouble with the Church but that's alright because 98% of the Filipinos said that they want the government to provide family planning services. The two percent? We'll just kill them.

OPEN FORUM

Use of Humor to Anger and "Disarm"

I just want to annotate the point of Ms. Lindsay (?) mentioned about the use of humor.

If you want to anger the Church, make fun of it. And I did it without meaning to. But when I found out that they were getting angry, I used more of it.

For example, they were all so heated up about the condom, [so] I invented a luminous condom for the older priests. And they said, "Why luminous?" I said, "At their age, they need to know where it is!"

Then there were those who are called "Ilocanos" in our country. They are very thrifty. They would be the equivalent of the Scots. They're very tight about it. And I invented what is known as the Ilocano or the Scotch condom. And everybody was saying, what is it? I said, it's a kind of condom that has five characteristics: (1) it is reusable; (2) it is washable; (3) it is invertible; (4) like the tire, it is recappable; and (5) when it develops a hole, it is vulcanizable. Overnight everybody was talking about it!

Then, when they started hitting me personally -- they were saying that I was promoting promiscuity, lechery, incest and all that, I said, "What? Me? I can't even spell those words, you know."

And then they called me the agent of the devil, and the agent of Satan, so instead of answering, I said, "Look at this face. So angelic and so cherubic! How can I be able to do those things?"

And I found out it angered them. And it was very effective because it was the best way to disarm. First of all, the people find what they are saying [to be] offensive, and not what I'm saying.

For example, Cardinal called me a liar. What do you do? And they're angry that I do not take them seriously! In the village where I come from, when they call you a liar and you take it seriously, there's gonna be a killing! So, I took them lightly, and it just so happens that the name of our Cardinal is "Sin". So when I was asked by the media about the fact that he called me a liar, I just very, very cutely said, "It's a sin to tell a lie." And it angered him. But that humorous approach to the whole thing really created all the excitement that we need.

"Excitement" Leads to AIDS Awareness

Ergo, now -- even for AIDS. The awareness for AIDS when I first became minister two years ago was 12%. Now, it is 92%. That's the good news. Now, the bad news is that people still don't know how you get it and how to prevent it. So, there is still a lot to do.

"Excitement" Leads to Family Planning Awareness

But in family planning, awareness is so high that I ended a while ago with a figure that's even staggered me: 98% of all Filipino men and women are saying the government must provide family planning services and that's just a wonderful place to start with. That's the good news. The bad news is that only 50% of all the needs are being met. So, there's a lot to do. But having -- you know -- stirred up this kind of excitement, I think when I go back we'll really go to work, and we'll be in business.

QUESTION 1: How to Influence Funding Organizations. [ Yes, I'll speak louder. ] When you talk about influencing policy decision makers, we are not just talking about the governments. We are talking also about the funders, who fund our NGO's. And too often, funders come in with certain strings and certain accountabilities that becomes so foreign to the FPAs or the NGOs at the grassroot level. Now, how did you influence these funders who hold the purse, and, so that they do not control through the money that they channel to us, what we do at the grassroot?

FLAVIER: I just want to bring up one point. You may think I am very immodest. I'm really very very humble. I am very proud of my humility.

I found -- at least just now -- that the trick is to become famous. At least, become known. Then they'll come knocking at your door. I've become famous -- maybe the word is notorious -- so, if you're not working with Dr. Flavier, you don't count! So, that's when you begin to have clout. [ Is that the term you use in America -- "clout"? I like that word, "CLOUT"! ] And then your funders will come. Why? Their business is to give money. If they cannot give it, they're nobody! So they have to give, but they also want to give to those that are known. And that is why, you know, when they say, "Are you dealing with Dr. Flavier?" and you say "No", then you don't count!

And how do we achieve that? Through the things that we were talking about -- by being known and, of course, track record. Because ultimately, it can't be all hype. There's got to be results. And when you have that, my experience is that even the funder is more likely to be flexible.

QUESTION 2: Apparent Slowness of Government to Employ NGOs. NGOs have always been known to do innovative, pioneering work which the governments are hesitant to go into. My question is: Even if NGO's have demonstrated the value of a particular area of work -- let's say, sex education for adolescents -- my observation is that the government is very slow to pick up this particular innovative program. They have all the resources to be able to expand and replicate the program on a bigger scale but they don't do it. What is your comment?

FLAVIER: Under ideal circumstances, they should be tapped. Unfortunately, there are also problems. For example, in an actual case that I am grappling with now, I find that it is possible when done small-scale by a small NGO. But when you begin to talk about big scale of nationwide, it becomes a different problem.

QUESTION 3: Prospects of NFP in the Philippines. The Catholic Church talks a lot about natural family planning but doesn't seem to do very much to promote it. Do you think there are prospects for them doing more in the Philippines?

FLAVIER: I think there is a very basic problem of mistrust going on. Because, at one point in time, I made an invitation to the Catholic Church. I said, "Help me establish natural family planning centers in every church and in every diocese. I will also help you with funding and training and equipments." I'm surprised there was no response. Later, I found out that the problem was that if they responded to me, then I would have put one over them. And so I said, "Look, is it going to be that personal? This is for the people, not for me."

But when I heard that, what I did was I went down. So what I've done was to work with communities, and we now have 244 natural family planning clinics in the field. But two weeks before I came, I also inaugurated the first natural family planning center in a diocese where the archbishop was enlightened enough to work with me. And of course, I loaded it up and gave them all the equipments. So everybody wants it now. So when I go back, I'll have no equipments, but I'll still have this center.

So, I think there are prospects, especially because, I keep telling them, "If you're a Catholic and that's all you want, we'll help you." And we have already introduced the lactational amenorrhea method -- which was a hit because very few people knew that by consistently breast-feeding in the [first] six months, it is really a form of family planning.

So, in the eight methods -- except abortion -- two are what I now call the natural: the sympto-thermo (sic) method (the Billings and the thermometer system), and then the lactational. Then, the six are the usual artificial, where it's going to be somewhat really ... we just have to agree to disagree on this particular point.

"I won the media battle!" -- The Creation of "Unmet Needs".

But 75% of all contraceptive users are Catholics, and 98% are saying the government should provide it. So there's no way we can skirt that. It's going to be there. BUT, the lesson is this: I won the media battle.

So now, I should stop there and really just go to the field -- where the need is. And just by capitalizing on the "unmet needs", defined as what? Sixty percent of all the women say they don't want any more children -- these are of reproductive ages. Twenty percent say, they want it but not within two years. Sixty plus twenty is 80% and only half of them are practicing. And therefore, just by taking care of half of those -- which is equivalent to about 3 million women -- we have a lot to do. And yet, the beauty is that they are asking for it now. So we will just provide that and then be there.

Concentrating on "Risk Groups"

And just one last point is that we are concentrating on the "Risk Groups", defined as:

·  too young, meaning below 18;
·  too old, above 35;
·  too soon, shorter than 2 years; and then
·  too many, defined as four [children] and above; and
·  too sick.

So: too young, too old, too soon, too many, and too sick. If you do that, then you've got the people with a risk factor. It's a health problem as far as I am concerned. Why? For example, if we only succeed to get all the women to have their births two years apart, automatically -- don't do anything else -- you'll put down the infant and maternal mortality rate by 25%. What a tremendous achievement if we can only do that. So this is how we're doing it.

NFP as "first line of defense" against pregnancy

The natural family planning is the first line of defense. Don't tell my enemies because, I know that when it fails, they want a more effective method anyway. So the network is there.

But where they honestly want the natural family planning, we'll give it a good chance. We are now training them and we're trying to get them to be better and better. By combining the thermometer and the Billings, our experience is that they are more likely to succeed -- except on one situation that is very serious, either urban or rural. When the man comes home drunk, and imposes himself on the woman, forget it. It just won't work. And that is the reason why sometime along the line, if this is the situation, we just have to go to the artificial method. So that's the score.

QUESTION 4: Role of NGOs in Promotion of NFP. [ My question is on ] promoting the natural way of birth control. In a press conference I attended just yesterday, I heard that everybody is for the natural way and that they call it the "ovulation method", and they said that it is very healthy and doesn't have side effects for the women. And so, I just wondered what is the role of NGOs concerning this way, in promoting the natural way of birth control.

FLAVIER: In the Philippine context, the 244 were set up with the NGOs. It was the NGOs that really did it. And one that I inaugurated two weeks ago was with a diocese -- meaning the church, a Catholic Church group, also for practical purposes, an NGO. So, [it's] very strong.

However, in the 10,000 clinics that I am running in the Philippines -- 2,000 are run by the NGOs -- in the 10,000, I made sure the natural family planning is one of the eight that is taught. However, not everybody is good at teaching it. And also -- I'll be honest with you -- it is also harder to teach. And therefore, from the point of view of the motivation of the family planning worker, he or she is more likely to be emphasizing the others. Therefore, we need to retrain them and really, in good faith, I say, let's give it a good chance. If the woman really wants that, let's do it.

But also, as a final point, our experience is that if the man and woman are involved in the teaching of the natural family planning, it is more likely to succeed.

< END OF TRANSCRIPT >

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Other articles on population activities and de-population of the Philippines ~
    l Underlying motives of the Population Control Movement
    l The Second Contraceptive Revolution
    l US Demographic Warfare in the Philippines [ "NSSM 200" ]
    l Three Levels of De-Population Activities
    l De-Population Activities in the Philippines
    l Americans export chemical sterilization to the Third World
    l Directory of UNFPA-supported contractors
    l Directory of USAID donors & contractors