For decades, access to reproductive health services in Manila was restricted by policy. Executive Order 003, enacted in 2000, effectively banned modern contraceptives in the city. Though it was eventually repealed, its replacement—EO 030 in 2008—prohibited the use of public funds for contraceptives such as pills, condoms, intrauterine devices (IUDs), and sterilization. These policies were only formally reversed in 2019. 

In 2020, City reports show that Manila’s modern contraceptive prevalence rate (mCPR) was just 6%—30 percentage points below the national target and among the lowest in Metro Manila. The adolescent birth rate (ABR) stood at 50 per 1,000 girls aged 15–19, 20 points higher than the national average of 30.

 

Rising to the Challenge

In 2023, the City Government of Manila joined The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation and the Bill and Melinda Gates Institute for Population and Reproductive Health. A structured roadmap was developed to address systemic issues and restore public confidence in reproductive health services.

Spearheading this transformation was Mayor Honey Lacuna-Pangan, who convened a City Leadership Team (CLT) to institutionalize reforms. The CLT addressed issues such as fragmented service delivery, outdated clinical protocols, weak data systems, low youth engagement, and lingering biases among providers.

Dr. Evelyn Rimando, Family Planning Coordinator at the Manila Health Department, captured the core of the problem: “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?”

From Policy Paralysis to Grassroots Power

To overcome these barriers, the city launched the Bayanihan Outreach Program, modeled after the Filipino tradition of collective community effort. Small teams composed of trained midwives, supervisors, and barangay health workers conducted daily door-to-door visits in low-income communities, providing pills, implants, injectables, and condoms.

Dr. Rimando noted, “The response was overwhelming. For many, this was their first time accessing family planning services. Being met by someone they trust, right at their doorstep, changed everything.”

What began in just ten communities quickly expanded citywide.

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Training the Frontlines, Transforming the System

In parallel, the city invested in training to boost the quality and reach of reproductive health services. Through Family Planning Competency-Based Trainings (FPCBT):

• 20 midwives were trained in FPCBT Level 1
• 20 more learned to administer progestin-only subdermal implants (PSI)
• 15 health workers were certified as IUD trainers
• Another 15 became PSI mentors

These trainers helped capacitate 38 additional providers, helping Manila build a self-sustaining training network.

To boost demand for services, the Usapan series—structured group discussions—were rolled out in clinics. Midwives were trained to lead these sessions, tackling misinformation, and fostering informed choices.

Supporting Adolescents

Youth-specific interventions were introduced in 2025, starting with a training focused on the Adolescent Sexuality and Reproductive Health – Family Planning Module, grounded in the HEEADSSS or the Home, Education, Eating, Activities, Drugs, Sexuality, Suicidal Ideation, and Safety assessment framework. This globally recognized tool guides providers in addressing adolescents’ psychosocial and reproductive health needs holistically.

The training also featured the Adolescent Job Aid 2.0 (AJA), aligned with the Department of Health’s Omnibus Guidelines. However, a gap surfaced: out of over 50 public doctors in Manila, only four had prior AJA training.

Dr. Anthony Faraon, Chief of Party for TCI-Philippines, stressed, “Adolescent health training is essential, not optional.” He added that care for young people must be developmentally appropriate, respectful, and consistent.

To address training shortfalls, Manila is now seeking to scale adolescent health training locally and strengthen mentorship with ZFF-TCI and partners.

Systemic Reform from the Ground Up

Manila also tackled system-level bottlenecks:

• AYSRH services were made more youth-friendly
• Data-sharing agreements were formalized
• City Ordinance No. 9054 institutionalized the Key Assistance for Developing Adolescents (KADA) program, enabling stronger coordination across departments

The city’s long-neglected reproductive health infrastructure is now being rebuilt with intention and inclusivity.

A City Transformed

From a modern contraceptive prevalence rate of 6% in 2020, Manila surged to 35% in 2024. The adolescent birth rate fell from 50 to 15 per 1,000 in the same period. In recognition of these achievements, Manila was named a Global Self-Reliant City in family planning and adolescent health by ZFF-TCI. During the turnover, Assistant City Health Officer Dr. Gina Pardilla said, “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.”

Still, the work is far from over. Dr. Pardilla reflected, “If we are to sustain these gains, the commitment must go beyond training or funding. Our local systems must take ownership of reform, backed by national support.”

Where outdated policy once stifled progress, a spirit of bayanihan now fuels Manila’s drive toward equitable reproductive health. Families, adolescents, and providers are no longer sidelined—they are leading the change. This is Manila’s lesson: even the most entrenched public health challenges can be broken—one provider trained, one visit made, and one choice empowered at a time.

Naga City, the ‘Heart of Bicol’, is known for its rich history, deep religious heritage, and a strong sense of community. With a population of 209,170 as of the 2020 Census of Population and Health, it stands as the second most populous city in the Bicol Region. However, like many growing cities in the Philippines, it grapples with significant social challenges, including the rising concern of adolescent pregnancy, which continues to impact the youth and local development efforts.

Based on city reports, Naga’s adolescent birth rate (ABR) surged dramatically in recent years, climbing from 21 per 1,000 live births in 2020 to 106 in 2021, and even higher in 2022 at 110. This prompted local officials to rethink how they addressed adolescent reproductive health. Mayor Nelson Legacion recognized the urgency of the situation, particularly as young people struggled with limited access to reproductive health services and faced social stigma. The COVID-19 pandemic only made things worse by disrupting outreach programs and services.

 

A Strategic Partnership to Drive Change

In 2021, Naga City partnered with The Challenge Initiative (TCI)-Philippines, co-managed by the Zuellig Family Foundation (ZFF) and the Bill and Melinda Gates Institute for Population and Reproductive Health. This partnership led to the creation of a City Leadership Team (CLT), which helped harmonize and scale up family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) efforts.

“We’ve had adolescent-focused initiatives in the past, but they were not well-coordinated or harmonized,” said Joy Macaraig, Assistant Department Head of the City Population and Nutrition Office (CPNO). With 26 years in public service, she explained how the integration of FP and AYSRH under the CPNO helped streamline both outreach and service delivery. The CLT further empowered various departments to incorporate adolescent health into their work.

The results were striking: by 2023, Naga’s ABR had dropped to 71, and by 2024, it had plummeted to 20—well below the national target of 37 .

From Pilot to Full Coverage: Empowering Barangays

Originally launched in three barangays, TCI’s model was soon expanded to six through the mayor’s initiative, and later to all 27 barangays in the city. The backbone of this local effort was the Barangay Service Point Officers (BSPOs), who not only tracked adolescent mothers but also ensured these young families received critical health and nutrition services.

Healthcare workers were also equipped through TCI University, an online platform offering practical tools and real-world examples. Janet Beloro, a midwife at the City Health Office, noted the improvement in her service delivery. “When clients return and tell me they will practice family planning, that’s when I realize I’ve made a difference—that I’ve been an effective provider. I see their health literacy improving, and for young people especially, I notice their growing awareness.”

Institutionalizing the Vision: Naga’s AYSRH Ordinance

In 2023, Naga passed City Ordinance No. 2023-025, also known as the AYSRH Ordinance. Authored by Councilor Gayle Abonal-Gomez, a member of the CLT, the ordinance institutionalized adolescent health initiatives and created a dedicated local budget to fund them.

One key result was the establishment of an Integrated Service Delivery Network (ISDN), which strengthened referral pathways among barangay health stations, hospitals, schools, and NGOs. This made it easier for adolescents to access the care they need, when and where they need it.

Creating Safe Spaces for Teens

Another major achievement of the ordinance was the rollout of teen hubs in schools and barangays. These safe spaces provide young people—including out-of-school youth—with information, counseling, and support.

At Concepcion Pequena National High School, teacher Dessa Bermejo helps manage their school’s Teen Hub. “With teenage pregnancy remaining a pressing concern, young people need a safe space where they can confide in someone they trust—someone who will listen without judgment and provide the guidance and support they need,” she shared.

Teen hubs have already been set up in Barangays Balatas and Calauag, and the goal is to bring these hubs to every school in the city.

Empowering Youth Through Communication

To support a more holistic approach to adolescent well-being, the Commission on Population and Development Region V launched the ‘Hearts and Minds’ campaign, under Director Joyce Dela Paz-Hilvano. This pre-orientation program focuses on emotional well-being and self-awareness, laying the foundation for more informed decision-making in adolescence.

The result? Naga’s modern contraceptive prevalence rate (mCPR) has remained above national targets, signaling sustained progress in FP and AYSRH initiatives.

Funding the Future

Since joining TCI, Naga has grown its investment in AYSRH from Php 2.2 million in 2023 to Php 5.1 million in 2024. This increase supports teen hubs, healthcare worker training, and the continuous delivery of reproductive health services.

Importantly, the city’s general fund and annual investment plan now include AYSRH—securing financial sustainability beyond political cycles.

Naga City’s experience shows that tackling adolescent pregnancy demands leadership, coordination, and sustained investment. Its journey offers a clear message to other local governments: meaningful change is possible when adolescents are placed at the center of public health and development efforts.

Related articles:

• Eight Cities Share Success in Family Planning and Adolescent Health
• Cities Lead the Way in Family Planning and Adolescent Health—Webinar Series to Spotlight Local Innovations

The Zuellig Family Foundation (ZFF), through The Challenge Initiative (TCI)-Philippines, proudly celebrates the graduation of five cities from the TCI program.

On November 28, 2024, during the TCI Graduation Colloquium, Cagayan de Oro, Dipolog, Puerto Princesa (Batch 1), Baguio, and San Jose (Batch 2) shared their success stories, innovations, and lessons learned in addressing challenges related to adolescent health and family planning.

Since 2020, these cities have collaborated with TCI-Philippines, co-managed by the William S. Gates Sr. Institute for Population and Reproductive Health and ZFF, along with the Department of Health and Commission on Population Development. Together, they have worked to create adolescent and youth-friendly communities by empowering local leaders, city teams, master coaches, and youth leaders in bridging leadership and governance. Here’s to their continued success in transforming communities!

READ MORE:

Five Cities Celebrate Milestone in Adolescent Health and Family Planning Efforts

Baguio City: Towards Zero Adolescent Pregnancy