For decades, Manila’s access to family planning was shaped by restrictive policies. In 2000, an executive order effectively banned artificial contraceptives in the city. Although later lifted, it was replaced by a new executive order in 2008, which barred city funding for contraceptives like pills, condoms, IUDs, and sterilization. Even after repeal, little political will existed to rebuild services. It wasn’t until 2019 that family planning was formally prioritized, but the damage had already taken root.
In 2020, Manila’s modern contraceptive prevalence rate (mCPR) was just 6%, one of the lowest in Metro Manila. Adolescent births were at 50%, 20% above the national average. These figures reflected a broader failure to provide access to contraception and other youth-friendly services.
Rising to the Challenge
In 2023, Manila joined The Challenge Initiative (TCI) and committed to reversing stalled progress. A data-driven roadmap was created to restore public trust and rebuild the reproductive health system. Mayor Dra. Maria Sheilah “Honey” Lacuna-Pangan led the formation of a City Leadership Team, a multisectoral body tasked with coordinating reforms.
Early assessments revealed deep-rooted issues: fragmented services, outdated protocols, weak youth engagement, and limited data sharing. Family planning information remained inaccessible, especially in low-income communities. Health providers often favored natural methods and lacked training on long-acting options like the Progestin-only Subdermal Implant (PSI). Adolescent and Youth Sexual and Reproductive Health (AYSRH) services were inconsistent, with limited infrastructure and staff capacity.
As Dr. Evelyn Rimando, Family Planning Coordinator, asked:
How can we reach those in need of family planning if there is a shortage of trained staff, few people know that such services exist, and misconceptions about it are widespread?”
Despite these challenges, the city committed to equitable access for all, with a focus on underserved populations. The goal was a trained, youth-friendly workforce, strong leadership, and integrated coordination across sectors.
From Policy Paralysis to Grassroots Power
The Bayanihan Outreach Program was one of Manila’s first efforts after partnering with TCI. The city mobilized a small pool of trained doctors and midwives to bring services directly to households in underserved areas. In line with the Filipino value of bayanihan (community effort), teams visited homes offering pills, injectables, implants, and condoms.
Initially launched in ten areas, the program saw overwhelming community acceptance. Dr. Rimando noted that doorstep services helped dispel fear, correct misinformation, and foster trust. This success scaled the outreach citywide, with active teams in every district.
Training the Frontlines
Manila’s efforts extended beyond access. With TCI’s support, it prioritized building provider capacity through Family Planning Competency-Based Trainings (FPCBT). Twenty midwives completed Level 1 training, while another 20 were certified to administer PSI. To sustain momentum, the city developed its own trainers: 30 health workers were certified to coach peers in PSI and IUD services. These trainers helped capacitate 38 more providers, positioning Manila as a local training hub.
To boost demand for services, the city introduced the Usapan series – structured group discussions led by trained midwives to address myths and promote informed decision-making in clinics.
Reaching Adolescents
The city also confronted barriers in adolescent care. Many providers lacked the tools and training to address youth-specific needs. On March 19, 2025, the Manila Health Department (MHD) held a workshop focused on the Adolescent Sexuality and Reproductive Health–Family Planning Module.
Central to this training was the globally endorsed HEEADSSS framework, which supports holistic adolescent assessments across areas like home, education, and sexuality. Providers were also trained to document data in the Wireless Access for Health Electronic Medical Record (WAH EMR) system.
The training introduced the Adolescent Job Aid 2.0 (AJA), aligned with the Department of Health’s Omnibus Guidelines. AJA equips providers to address mental health, abuse, nutrition, and sexual health with developmentally appropriate, respectful care.
However, gaps remained. Only four of Manila’s more than 50 public doctors had received AJA training. This capacity shortfall extended across Metro Manila. With just two trainers planned per city under the Department of Health–NCR rollout, Manila began exploring ways to localize and scale training, deepen mentorship, and strengthen partnerships
As Dr. Anthony R.G. Faraon, Chief of Party for TCI Philippines, emphasized:
Adolescent health training is essential, not optional.”
As adolescents face rapid physical, emotional, and social transitions, they deserve care that is developmentally appropriate and grounded in respect. For Manila, empowering a workforce that understands and advocates for young people is not just a strategic goal; it’s imperative. It’s key to protecting recent gains in reproductive health and to finally breaking the cycle of neglect that has long silenced adolescent voices.
Assistant City Health Officer Dr. Gina Pardilla once again echoed the importance of the partnership with WAH:
This partnership empowers us to design interventions that truly respond to the evolving realities of families and young people. It is about meeting them where they are.”
Systemic Reform from the Ground Up
Alongside outreach and training, Manila tackled structural reforms. The city improved access to reproductive health information, upgraded health facilities, and strengthened AYSRH services.
To ensure coordination, Manila adopted new data-sharing policies and formalized interagency agreements. City Ordinance No. 9054 institutionalized the Key Assistance for Developing Adolescents program, which outlined protocols for referrals, data use, and continuity of care.
A City Transformed
Manila’s transformation stands as a powerful example of what can be achieved when strong leadership, active community engagement, and evidence-based health interventions come together.
From a modern contraceptive prevalence rate of just 6% in 2020, the city achieved a dramatic increase to 35% by 2024. Likewise, the adolescent birth rate dropped significantly from 50% to 15% over the same period.
Adolescent birth rate (ABR) in Manila, by year.
These gains led to Manila receiving a Global Self-Reliant City in Family Planning and Adolescent Sexual and Reproductive Health award from TCI, reflecting the city’s steady and determined progress in expanding access to reproductive health services, especially for those who had long been underserved. Manila officially graduated from TCI in 2025, an acknowledgment of the city’s ability to independently sustain and scale its family planning and AYSRH efforts.
Now with these strides, Dr. Pardilla urges the city to consider ways to do more. She shared that if Manila is to sustain and expand these hard-won gains, the commitment must go beyond training or funding. Local health systems must own and drive these reforms, supported by national agencies that commit to long-term investment in people.
Increase in Manila’s local government commitment to AYSRH and FP from 2023 to 2025.
Where outdated policy once stifled progress, a spirit of bayanihan has now empowered communities. Families, adolescents, and health providers are no longer passive recipients of care but active participants in shaping a healthier, more equitable Manila.
The city’s journey offers a powerful lesson: even the most entrenched public health challenges can be overcome, one trained provider, one doorstep visit, and one informed choice at a time.
