Joan Garcia became pregnant at 14 and gave birth at 15. She and her child travel by raft between the two shacks where they live in Navotas fish port on Manila Bay. 1 in 10 Filipino girls between the ages of 15 and 19 is either pregnant or a mother.

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Joan Garcia became pregnant at 14 and gave birth at 15. She and her child travel by raft between the two shacks where they live in Navotas fish port on Manila Bay. 1 in 10 Filipino girls between the ages of 15 and 19 is either pregnant or a mother.

Hannah Reyes Morales for NPR

Editor’s note: Hannah Reyes Morales began photographing teen moms in 2017. Aurora Almendral reported this story in October and November 2019 and updated the text in light of the pandemic.

At 12 years old, Joan Garcia liked leaping into the sea and racing the boys to the nearest pylon. She liked playing tag. When she started having sex at 13, she thought it was just another game. Joan was skipping across the pavement, playing a game with friends, when an older neighbor noticed her rounding belly.

Her daughter, Angela, is now a year old. Joan crouched on the floor, folding up her lanky teenage limbs, and fed Angela fingers-full of steamed rice, crimped strands of instant noodles and fermented anchovies from the family’s small communal bowl.

Sisters Joan (center) and Jossa Garcia (left), both teen mothers, hang out in a boat with their children and their younger sister. Joan dropped out of school after becoming pregnant at 14.

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Sisters Joan (center) and Jossa Garcia (left), both teen mothers, hang out in a boat with their children and their younger sister. Joan dropped out of school after becoming pregnant at 14.

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Joan, now 16 years old, said since she became a mother, she’s embarrassed to play kids’ games, then paused for a moment. “Sometimes I still play tag in the water with my brothers,” she admitted.

Each year, 1.2 million Filipina girls between the ages of 10 and 19 have a child. That’s a rate of 24 babies per hour.

And the rate of teenage pregnancy is rising. According to the most recent data, collected every ten years, in 2002, 6.3 percent of teenagers were pregnant; by 2013 it had gone up to 13.6 percent.

Last August, the Philippines’ economic development agency declared the number of teenage pregnancies a “national social emergency.”

Joan Garcia (right) and her baby take a boat ride home. Garcia says she’s embarrassed to play kids’ games now that she’s a mother — but admits “sometimes I still play tag in the water with my brothers.”

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The pandemic has made the situation worse. With Manila under a strict lockdown — including limited access to medical facilities, no public transportation and harshly-enforced rules on not going out — access to birth control has been severely curtailed, particularly for teenagers, said Hope Basiao-Abella, adolescent reproductive health project coordinator for Likhaan, a non-governmental organization that works on women’s health and access to contraception.

The University of the Philippines Population Institute is predicting a baby boom in 2021 — an estimated 751,000 additional unplanned pregnancies due to conditions created by the pandemic.

Access to birth control

The main reasons for the high rate of teenage pregnancies are inadequate sex education (some girls do not know that having sex can result in pregnancy or having fully considered the responsibility of having a children) and a lack of access to birth control.

Contraceptive access has long been a complicated, divisive issue in the Philippines. Despite a constitutional separation of church and state, Catholic morals dominate Philippine law. For more than a decade, reproductive health activists and legislators fought a bitter battle with the Catholic Church and conservative politicians to pass a law that would allow the government to distribute contraceptives to those who could not afford them and require comprehensive sex education in public schools.

Vendors outside the Quiapo Church in Manila. Some sell herbs, roots and bottled pills used to induce abortion — which is illegal in all circumstances in the majority Catholic country.

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The Philippine Catholic church has long opposed birth control in the Philippines, where about 80% of people are Catholics. In the past, the Catholic Bishops Council of the Philippines preached — in public statements, on the pulpit and through allied lawmakers — against a bill to widen access to birth control on moral grounds, calling it “anti-life” and “a major attack on authentic human values and on Filipino cultural values.”

The Philippines passed a reproductive health bill into law in 2012. But years of Supreme Court challenges and delays in implementation continue to this day. Among the concessions to conservatives was a provision requiring parental consent for minors to buy contraceptives or receive them for free.

The Jose Fabella Memorial Hospital serves low-income communities in Manila, where the rates of teen pregnancy are high. Locals call it the “baby factory” — and the maternity ward is typically very busy.

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“It was one step back [for] adolescent health,” said Dr. Juan Perez III, executive director for the Philippine Commission on Population. The law improved access to birth control for women, but it became harder for teenagers to get birth control.

To address the resulting uptick in adolescent pregnancies, lawmakers have introduced bills improving access to contraception, supporting sex education and making it illegal to expel girls from school should they become pregnant. None have become law so far.

Dr. Perez said that a teenage pregnancy has a significant impact on perpetuating poverty. “They cannot recover from being a child mother,” he said.

That was the finding of a 2016 study by the United Nations Population Fund. By age 20, a teenage girl in the Philippines who gets pregnant and drops out of school earns 87 percent of the average 20-year-old woman’s pay. Perez says the lower income continues into adulthood.

Life on a raft

Joan lives with 16 relatives on a small raft of bamboo poles and scavenged wood, tied to a broken cement pylon, bobbing behind a row of steel shipping vessels docked in Manila’s fish port — a patchwork of spaces no larger than two king-sized mattresses. Two of her sisters’ babies and a kitten nap on a pile of rumpled sheets against a particle board barrier to keep them from falling into the murky, gray water.

Sisters Joan (left) and Jossa Garcia (right), both teen mothers, are seen in their home in the Navotas fish port with their children Angela (second from left) and JM (second from right). Joan got pregnant after she dropped out of school.

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Sisters Joan (left) and Jossa Garcia (right), both teen mothers, are seen in their home in the Navotas fish port with their children Angela (second from left) and JM (second from right). Joan got pregnant after she dropped out of school.

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Like Joan, her older sisters also had babies when they were young and left school before they graduated. No woman close to her has ever had a good job. Her mother occasionally finds a day of work cleaning mussels on the cement floor of the fish port. Her father brings in some money doing odd jobs at the port. The family is often hungry and thirsty, and survives by begging sailors for food and water.

Joan can’t imagine a different kind of life.

Yet the current government wants to see changes. “We made a decision in this country that population is a problem,” says Perez. The government now believes that the country’s birth rate of 2.92 births per woman — among the highest in Asia — is holding back economic development. So after decades of policies that limited access to contraception informed by a Catholic ethos to procreate, government agencies are now acting with a new urgency to bring the birth rate down.

If households have fewer children, Perez says, it will improve their chances of getting out of the mire of poverty.

Yet the reproductive health laws in the Philippines — aimed at stemming population growth — have not had the impact hoped for by the government. And the people who suffer are the urban poor. Risa Hontiveros, the senator, knows the limits of the laws, the complexity of the issue and the danger of losing hope.

The work of improving access to birth control, Hontiveros said, “were passed on to us by those who came before us, they struggled, and they fought. They won some, and they lost probably more, but they passed on to us better situations that they started out with,” she said. “So the least we can do — the least I can do — is to keep fighting.”

Joy: ‘He really wanted a baby’

Joy Villanueva dropped out of high school when she got pregnant at 14, in 7th grade. Her boyfriend, four years older, wooed her with afternoons out, buying her fried quail eggs on a stick and paying for rounds on the karaoke machine at a local hangout.

15-year-old Joy Villanueva (right) is seen with her baby after the slums where they lived burned down. She and her relatives hope to build a new shack to replace the home they lost.

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15-year-old Joy Villanueva (right) is seen with her baby after the slums where they lived burned down. She and her relatives hope to build a new shack to replace the home they lost.

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He was tall and handsome, and she liked that he did chores around the house and washed the dishes for his mother. Soon she was living with him. “He really wanted a baby,” Joy said, “so no one else would court me.”

For her boyfriend, getting Joy pregnant was a mark of ownership. Joy resisted, but he convinced her to have sex. By the time she gave birth, he was in jail for theft, and she was raising the baby with help from his mother. The day we met, the three of them were living together in a makeshift home of little more than a tarp supported by planks of wood — they’d set it up after their slum had burned down a week before.

At 15, Joy dreamed of finishing high school, going to college and becoming a police officer. That was what her late father wanted for her when she was a little girl. She said any day now, she’ll move in with her mother, who will take care of the baby while she goes to class.

Joy Villanueva said she hopes to fulfill her father’s dream for her and becoming a police officer —but later admitted that’s an impossible dream for a poor teenage mom.

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Joy Villanueva said she hopes to fulfill her father’s dream for her and becoming a police officer —but later admitted that’s an impossible dream for a poor teenage mom.

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If Joy is able to complete her schooling, she said she wants to own a big house made of cement with air conditioning and glass windows. She wants to have a nanny to take care of her kids so she can wake up every morning, check her uniform in the mirror and go to work.

For 20 minutes she told me about her plans for the future. But when I said a word of encouragement, Joy went silent, looked away and shook her head. Hindi na, she said. I can’t anymore. It was a game of pretend. She shifted Ashley in her arms. At age 15, no more than four and a half feet tall, she is just old enough to know what can no longer be real for her.

Joy confessed that her mother disowned her. So she can’t go to live with her. Her husband’s mother earns just enough to feed her and the baby. There’s no money for notebooks or uniforms or college. They’re trying to gather enough materials to build a shack so they don’t have to continue living under a tarp.

Girls like Joy are classified among the poor, a vast category that encompasses 20 percent of Filipinos. Among teenage mothers of all income brackets, the poorest girls are the least likely to be able to finish their high school education after having their first child.

“It’s only difficult,” Joy said about motherhood. “There’s no happiness.” Maybe next month, she said, she’ll get birth control implants.

Laughter in sex ed

Likhaan’s clinic is a mile and a half down the road from where Joy lives. The organization advocates for reproductive health and fills the gap in services the government does not provide, like formal sex education, ready access to free contraception like IUDs and birth control implants.

Diane Vere, a community coordinator, leads workshops for teenagers from the surrounding slums. The topic is sex.

Inevitably, when Vere turns to the page in the photo workbook that shows an array of penis sizes and shapes, the teenagers break into peals of laughter. They cover their eyes and hide behind each other. Vere fields their questions: Why are some bigger than others? Why is that one crooked?

She shows them an uncircumcised penis and tries to dispel the myth that a boy in this condition is dirty or incapable of impregnating women.

Before the reproductive health law, there was no formal sex education in the Philippines, and to this day the roll-out remains patchy, fraught and very limited. Teenagers cobble together information based on what their parents ventured to tell them, sermons from priests and whispers from each other, often gleaned from the internet or old wives’ tales.

Was it true, the girls at the clinic class asked, that if you wash your face with a girl’s first menstruation it prevents pimples? If a girl jumps from the third step of a ladder, would her period only last three days? Does masturbating make boys taller? Can you get pregnant if you have sex only once?

While the teenagers were fascinated with the practicalities and hygiene of sex and puberty, they struggled to discuss the process of conception. Bring up the difficulties and cost of raising a child, Vere said, and the teenagers would shut down or quickly change the subject.

Teachers often did not fare better. Some teachers had to be excused from a recent training because they couldn’t control their laughter when frank discussions about sexual organs came up. Every acceptable word in Tagalog to describe sex or private parts is a euphemism: peanut, flower, junior, eggplant. Teachers complain that every proper noun in this category is too vulgar to say out loud. With this combination of discomfort and lack of formal training on teaching sex, it is not surprising that 59 percent of Philippine educators said they had difficulty naming body parts, according to a 2018 survey by the United Nations Population Fund.

“We can’t even discuss it,” said Hope Basiao-Abella of Likhaan.

In previous years, sex educators in schools preached abstinence, and anything beyond abstinence was limited to what the teachers knew. Often it didn’t extend beyond basic science and was heavily inflected with religious and personal beliefs. Basiao-Abella said one teacher told her students that condoms were murderers because they killed sperm. She said a pastor told congregants that condoms spread AIDS, a mistaken belief reiterated by a sitting senator as recently as 2017. “For their information, the HIV virus is smaller than the pores of condoms which can only prevent pregnancy. Scientifically proven,” senator Vicente Sotto III erroneously stated during a public argument with another politician.

To address gaps in knowledge and uneven information, the Philippine education department is developing a comprehensive sexual education curriculum, which they had begun to roll out in the public school system — before schools were closed due to the pandemic lockdown.

Much like 2012’s reproductive health law, the process of developing the curriculum has been embattled.

“There was a big fight about whether [the curriculum] could use the word ‘condom’,” Basiao-Abella said. “We have to change centuries of religion and culture.”

The supporters of the reproductive health law say that progress is coming, even if in fits and starts. Senator Risa Hontiveros, who sponsored one of the bills to prevent adolescent pregnancy and was at the forefront of the decade-long battle for the law, says the Catholic hierarchy continues to oppose legislation counter to their teaching but with “less of the stridency and less of the hostility than previously demonstrated.”

The midwife who breaks the abortion law

In one of Manila’s poor neighborhoods, a midwife prays to her saint, Ina ng Awa, the mother of pity or compassion. The carved wood statue hanging on the wall of her home is oily and chipped from age. A string of dried-out jasmine flowers hang from one outstretched hand, and on the other, the saint cradles a baby. The midwife believes Ina ng Awa is the patron saint for the women who come to her asking for abortions.

In the Philippines, abortions are illegal in all cases. Perhaps more powerfully, it’s considered a sin. The midwife understands all this yet will offer abortions. She asked that her name not be used for fear of arrest or reprisal.

The women who come to her are too poor to raise another child or unwed and ashamed or so young, she said. “They still think like children.” The midwife, who has delivered more babies than she can count, believes abortions are wrong, but she pities the women.

For an abortion, she charges her clients on a sliding scale, usually 100 pesos, or about $2. If the woman has a bit more money, the midwife might charge $10, but more often women in her neighborhood are poor, and she’ll accept a cigarette or a 10-cent cup of instant coffee as payment.

She demonstrates her technique for massaging a woman’s womb: a scooping motion to lift the uterus, then she grinds down with her fingers to crush the fetus, pressing into a woman’s belly until her hands start to cramp. She gathers bitter melon leaves from her garden, which she steeps into an acrid tea and tells the woman to drink. She says these methods usually will end a pregnancy.

A Filipino abortionist holds up the flowers of the bitter gourd. Abortions are against the law in the Philippines, but some midwives and others will use bitter gourd — believed to cause a miscarriage when ingested — and other methods to terminate a pregnancy.

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If the woman was a few months pregnant, they bury the blood from the aborted fetus in the dirt. If she was five or six months along, they put the fetus in a box and bury it like a child.

And before the midwife goes to bed, she asks Ina ng Awa for forgiveness.

One 16-year-old girl, who asked not to be named because of the stigma of abortion, took a handful of pills her mother bought from one of the illicit nighttime markets under the bridges and in the backlots of Manila. Her mother was told it was cytotec, the abortion pill. When the girl started bleeding in clots, her mother rushed her to the hospital. She spent a week in the recovery ward, where she mostly slept and imagined herself “flying in the sky,” unable to think about what she’d done.

But three months later, she was grateful. Her boyfriend was her first love, until he started beating her. He locked her in his house to keep her from running away and yanked her back in when she tried to escape. Her mother had to rescue her. “He’s a demon,” the 16-year-old said. If she had the baby, she would never be rid of him.

Walking through her crowded slum, she passes small children playing on mounds of torn plastic stained with leachate, the black sludge that seeps from the neighborhood’s cottage industry of sorting through the city’s trash. She points out to one girl and says she’s one of many people who have had an abortion. But it’s the pregnant girls, thin and tilting back against the weight of their growing bellies, that brings her voice to a whisper. Their lives will be painful, she said.

She herself doesn’t want a family: “I just want to work hard.”

Blaming herself

Ralyn Ramirez, 19, had her daughter when she was 16 years old. She and her boyfriend, John Michael Torre, 19, looked at other girls holding babies and longed for their own. “I was jealous, and I thought I was ready,” Ralyn said. “But it turns out I wasn’t.”

In this photo taken in 2017 (left), Ralyn Ramirez, then 17, had just given birth to her first child, a baby girl. She’d tell other teenagers that becoming a teen mom was not wonderful. But in 2019, Ramirez became pregnant a second time (photo at right).

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In this photo taken in 2017 (left), Ralyn Ramirez, then 17, had just given birth to her first child, a baby girl. She’d tell other teenagers that becoming a teen mom was not wonderful. But in 2019, Ramirez became pregnant a second time (photo at right).

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She says she blames herself for not finishing high school and for having a baby so young. “Sometimes I cry just thinking about it,” Ralyn said. When other girls ask her if it’s wonderful to have a baby, she tells them “no.”

Ralyn Ramirez, 17 at the time, is seen in her home with her partner weeks after their first child was born in 2017. The couple stays in a mausoleum at the Manila North Cemetery, where several thousand people live.

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Ralyn Ramirez, 17 at the time, is seen in her home with her partner weeks after their first child was born in 2017. The couple stays in a mausoleum at the Manila North Cemetery, where several thousand people live.

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“But they don’t listen. Next time I see them, they’re already pregnant,” Ralyn said.

Ralyn Ramirez, 18 at the time, is seen after giving birth to her second child, a boy, in November 2019.

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Ralyn Ramirez, 18 at the time, is seen after giving birth to her second child, a boy, in November 2019.

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Sitting at small sundries shop in Manila North Cemetery, where she lives (as thousands of people do) in one of the mausoleums, Ralyn chats with Margie, a 15-year-old who is seven months pregnant. In front of the shop, another young girl sits on a bench, her dress stretched over her belly. Ralyn points out a teenager walking down the path and says she was a child mother too. Margie says she knows an even younger girl who gave birth when she was just 12 years old.

Ralyn Ramirez (left) is seen with her family days after giving birth to her second child, a boy named Ruish. Ralyn became pregnant with her first child when she was 16.

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Ralyn Ramirez (left) is seen with her family days after giving birth to her second child, a boy named Ruish. Ralyn became pregnant with her first child when she was 16.

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“Child mothers are everywhere here,” Ralyn said. And in the end, she didn’t listen to her own advice. We spoke in November. Her son was born later that month.

Let us know what you think of this story. Email goatsandsoda@npr.org with your feedback, with the subject line “Teen Moms.”

Aurora Almendral is an American journalist based in Southeast Asia with an interest in politics, climate change, migration and economics. Her work has been recognized with multiple awards, including from the Overseas Press Club of America and a regional Edward R. Murrow Award.

Hannah Reyes Morales is a Filipino photographer based in Manila. She has been photographing teen moms since 2017.