By Philippa Fogarty
Twenty of Manila's poorest residents have filed a legal challenge against what they say is a ban on contraception.
The Roman Catholic Church is very influential in the Philippines
The group - 16 women and four of their husbands - are fighting a policy which they say denies them access to condoms, to the pill and other effective forms of family planning.
This has had a devastating effect on their lives, they argue, causing unwanted pregnancies, pushing them further into poverty and harming their health and wellbeing.
The case has sparked debate in the Philippines where, says Professor Michael Tan, chair of the anthropology department at the University of the Philippines, there is no national policy on family planning.
More than 80% of Filipinos are Roman Catholics and the Church is hugely influential. Abortion is banned and President Gloria Arroyo openly backs the Church's anti-contraception stance.
Previous attempts to pass laws requiring government funding for services like family planning and Aids prevention have been blocked by conservatives, Mr Tan says.
This has left crucial decisions in the hands of local officials and resulted in a very mixed picture nationwide - so this case is very significant.
"People recognise that the courts must decide once and for all whether local government officials can unilaterally ban family planning services," he said.
'Culture of life
The policy at the centre of the controversy was introduced in February 2000 by the then Manila City Mayor Jose Atienza, a staunch Catholic.
He backed "natural" family planning - a less reliable method which involves couples not having sex when the woman is at her most fertile - and called the use of alternative contraceptives "a very, very destructive practice which ruins Filipino values".
Mr Atienza passed Executive Order 003, which "upholds natural family planning not just as a method but as a way of self-awareness in promoting the culture of life while discouraging the use of artificial methods of contraception".
Although carefully worded to avoid an outright prohibition on "artificial" contraception, it was interpreted as such by city health officials, campaigners say.
Condoms and pills - which had been free - disappeared from local health centres. Hospitals turned down requests for sterilization operations. Many health workers stopped providing any information whatsoever on contraception.
Some family planning services did remain available at government-run hospitals or in other districts of the sprawling capital which did not fall under Mr Atienza.
But these services came at a price, people had to travel to get them and many simply did not know where to go. NGOs who tried to fill the gap reported harassment by city officials.
Lawyers for the group - from Philippine-based rights organisations LIKHAAN and Reprocen, and the US-based Center for Reproductive Rights (CRR) - argue that EO 003 has caused "serious and lingering damage" to residents.
The policy has hit poorest people the hardest, they say, forcing people to choose between a packet of pills or food for their families.
President Arroyo says that natural family planning is best for Filipinos
Several of the petitioners have had many more children than they wanted - some at the expense of their health - because they could not afford to pay for contraception.
The policy also exposed women to violence from husbands who did not want to abstain from sex, the rights groups found in an earlier report, and meant more women were resorting to illegal and unsafe abortions.
Mr Atienza is no longer mayor - he is now secretary for the Department of Environment - and his replacement Alfredo Lim is currently looking at the issue.
But EO 003 remains in place and there are no plans to start providing free contraceptives again - not even condoms for sex workers.
"The city will not use funds for the procurement of contraceptives - not when we have a budget deficit of more than 1bn pesos," said Dr Gina Pardilla of Manila City health department.
"We need the money for other social and health needs."
The plaintiffs argue that EO 003 violates the constitution - which gives couples the right to plan a family in accordance with their beliefs - as well as several international conventions to which the Philippines is a signatory.
Similar orders have been enacted in two other areas, which is why Elizabeth Pangalangan, Reprocen director and a lawyer for the petitioners, says it is important that the case sets a legal precedent.
"We want to say that this cannot be done in Manila or anywhere else," she said.
The group will take their case to international courts if necessary.
Success in the courts would be welcomed by a silent majority, Professor Tan said, citing surveys which show most Filipinos want access to family planning.
"Demand is very clear, but the problem is that the Catholic Church works on the supply side, getting to politicians like Mayor Atienza and threatening them with the so-called Catholic vote."
A court decision might also embolden government officials to implement nationwide policies, he said.
"The Department of Health is currently held hostage to the views of Arroyo - officials fear that they will lose their jobs if they promote family planning."
"A court decision would free people by taking away the Sword of Damocles hanging over them."