Sowing the Seeds of Sexual Health in the Philippines

Amina Evangelista Swanepoel and her team at Roots of Health are combating the stigma surrounding sexual health and providing crucial reproductive health services in the Philippines. Their hard work has paid off: teenage pregnancies in Palawan’s capital of Puerto Princesa have decreased by a third.  

Amina Evangelista Swanepoel, Executive Director of Roots of Health

Palawan, Philippines

Amina Evangelista Swanepoel is leading a sexual health revolution in Palawan in the Philippines. Photo by Ashoka

Amina Evangelista Swanepoel’s upbringing in Palawan in the Philippines was uniquely liberal in a country whose conservative social norms are heavily governed by the Catholic Church. Her American mother and Filipino father both worked as professors and her childhood home was constantly hosting guests and visiting scholars from around the world. Inspired by global issues, Amina pursued masters’ degrees in international affairs and public health in the United States. But, as Amina learned about global health issues, she realized her home country was in much need of a public health overhaul—specifically pertaining to sexual health. 

In the Philippines, the Catholic Church’s influence extends into Filipino legislation, resulting in the Philippines being the only country, barring the Vatican, where divorce is illegal. Additionally, abortion remains a criminal offense, dispensation of contraceptives faces funding challenges across the archipelago, and sexual health education in schools is essentially nonexistent. 

Thus, sexual and reproductive health is shrouded in stigma and has resulted in the Philippines having a very high number of unplanned pregnancies, especially among young people aged 15-19. According to UNFPA, more than 500 adolescents become pregnant and give birth in the Philippines every day.

Amina decided to change this reality, beginning with women and girls in her adopted province of Palawan. In 2009, she moved to Palawan and joined forces with her mother, Dr. Susan Evangelista who worked as a university professor. Dr. Evangelista had been increasingly disturbed by the growing numbers of her female students dropping out due to unplanned pregnancies.  

Together, they founded Roots of Health, a reproductive health organization that offers a comprehensive sexual education program and sexual health services to improve the awareness and circumstances of women and girls by focusing on the basics – how pregnancies happen and how contraception works, all while making contraceptives easily accessible.  

Since its inception in 2009, Roots of Health (ROH) has transformed the sexual health system in Palawan, teaching more than 85,000 young people comprehensive sex education through their in-school programs. Additionally, ROH’s clinic and outreach program have dispensed over 86,000 units of modern method contraceptives (pills, injectables, implants, and IUDs) to nearly 66,000 women and girls. They also have cared for over 3,400 pregnant women and girls to ensure better pregnancy and childbirth outcomes (Roots of Health Impact Report). 12 years later, ROH continues to be the only reproductive health organization in Palawan and is filling an enormous gap in reproductive healthcare by providing the majority of services on the island. 

Roots of Health Staff member provides contraceptive counseling at an ROH clinic. Photo by Roots of Health

Scaling Deep: Combating Stigma

Amina and her team at Roots of Health are using education and service delivery to tackle the ubiquitous stigma surrounding sexual health and the misinformation that follows. At Ashoka’s Women’s Initiative for Social Entrepreneurship (WISE), this form of impact is known as “scaling deep,” changing dominant mindsets, attitudes, and behaviors. Roots of Health’s strategy is working – over the past ten years, teenage pregnancies in Palawan have continued a downward trend, and have decreased by a third in the capital city of Puerto Princesa.   

For example, Amina explained that the shame surrounding pre-marital sex is so pervasive that most women don’t want to admit, even to themselves, that they might have sex before marriage—until they suddenly do.  

“There’s a huge portion of the population that believes contraception is the same as abortion. There are a lot of problems because so many people don’t have the correct knowledge and information about their bodies, sexuality, how pregnancy happens, and how contraception works,” Amina explained.  

Educational session for high school students led by Ivann, a staff member for Roots of Health staff. Photo by Roots of Health.

ROH’s massive, comprehensive sexual education campaign and distribution of sexual health services are bringing this critical issue to the forefront. For the first time, these issues are being discussed in classrooms and community centers across Palawan, equipping young people with the correct information and tools about sexual health to make better-informed decisions. 

Their school-based program, modules, and teacher trainings educate 15,000-20,000 students annually about sexual and reproductive health. After teachers assess the community’s specific needs, they approach these sensitive topics with both facts and empathy. Besides ROH educators, the organization has also trained local teachers and school heads throughout Palawan, providing them with modules that can be easily incorporated into their lesson plans. 

ROH also focuses on building a network of peer educators who provide fellow young people with information around these topics, as many Filipino youth find it difficult to discuss sex and sexual health with the adults in their lives. 

Scaling Up: Enforcing the Law

In 2012, the Philippines passed a landmark act, the Responsible Parenthood and Reproductive Health Act (RH), which is supposed to guarantee universal access to various contraceptive methods, fertility control, sexual education, and maternal care. Still, HIV rates and teen pregnancies have continued to rise. One major reason that these guarantees have not come to fruition is that towns in the Philippines are figuratively and literally islands, so the responsibility of implementation largely falls on fragmented local leadership. 

Amina remarked, “The Philippines has a ton of really great and progressive laws – the problem is always with their implementation.”   To tackle the gap in enforcement, ROH created Municipal Implementation Teams, which are involved in local-level legislation discussions to ensure that existing reproductive health programs are enforced. These teams identify and engage local government stakeholders including health boards, departments of education, and elected officials by offering them training on adolescent health issues. The learnings from these trainings can then be disseminated to healthcare staff and teachers or considered in new budgets and policies. 

As the only reproductive health organization in Palawan, ROH institutionalizes sexual health education and services through a mix of legislative support, training, and mentoring for stakeholders across communities. Roots of Health’s pillars of education, services, and systems collude to tackle the visible and invisible effects of misinformation and stigma surrounding sexual and reproductive health. 

Strengthening Systems of Sexual Health

Roots of Health’s success relies on its relationships and partnerships with stakeholders from individual provinces, so Amina is positioning ROH to become a training center to scale this work. This would enable any other provincial government or organization to replicate ROH’s work in their own provinces and hire Roots of Health to train them on how to conduct programs and services and build from their own communities.  

In 2020 alone, ROH’s clinic and outreach programs dispensed contraceptives to 18,282 women. Due to the high number of small, rural, and hard-to-reach communities in Palawan, not everyone can access their clinic. So, Roots of Health comes to them on contraceptive missions, administering long-lasting but reversible contraceptive methods like implants and IUDs.    

“We have always been very open and collaborative, always sharing our training modules and materials. Our hope is to become more well-known so more people hear about our work and see the data and impact we have had. Then hopefully other provinces will notice and decide that they want that as well,” Amina said. 

What began as an effort to keep women in university twelve years ago has grown into a sexual health revolution in the province of Palawan, changing thousands of women’s lives by giving them the knowledge to make life-altering decisions when they are ready. Amina and her team at ROH continue to be the only organization of its kind in Palawan and currently have the biggest team since its inception in 2009. They are committed now more than ever to ensuring that everyone on the island can lead healthy reproductive lives.  

By Audrey Lodes