PMC Manual

Table of Contents

Acronyms Foreword Message of Dr. Espereranza I. Cabral, Secretary of DOH Message of Mr. Tomas Osias, Executive Director of POPCOM Acknowledgments Pre-Marriage Counseling Nurturing the Marriage and Family - A Content Guide Introductions

1

Part I

About the Pre-Marriage Counseling Manual

5

Part II

Setting the Tone

9

Part III Essential Topics for the Pre-Marriage Counseling Session

13

A. Marriage and Relationships

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1. What God Says About Marital Union

2. What the Law Says About Marriage a. Universal Declaration of Human Rights (UDHR) b. New Family Code of the Philippines (EO 209, 1987) 1) Definition of Marriage 2) Requisites of Marriage

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3. Purpose of Marriage

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4. Elements of a good marriage

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5. Roles and Relationships a. As husband and wife b. As in-laws c. As Parents

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15

6. Other Supportive Laws 19 a. RA 9262 - Anti-Violence Against Women and their Chilren Act of 2004 b. RA 9710 Magna Carta of Women (2009) c. Presidential Decree 603 - The Child and Youth Welfare Code d. Republic Act 7610 - “Special Protection of Children Against Abuse, Exploitation and Discrimination Act.” e. Convention on the Rights of the Child B. Building the Family 1. Human Sexuality

21 21

a. What makes a man and a woman? b. Five Major Components of Human Sexuality c. Importance of Human Sexuality for Married Couples 2. Maternal, Neo Natal, Child Health and Nutrition (MNCHN) a. Dynamics of Fertility 1) Male Fertility 2) Threats to Male Fertility 3) Female Reproductive System 4) Female Fertility 5) The Menstrual Cycle 6) Combined/Joint Fertility b. c. d. e.

Early Signs of Pregnancy Pre-Natal Care Services Provided to Pregnant Women Caring for the Baby 1) Newborn Screening 2) Breastfeeding 3) Other Baby Care • Immunization • Growth Monitoring

25 25

35 36 37 38

C. Planning the Family 1. Importance and Benefits of Family Planning

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2. Family Planning Methods a. Temporary Methods 1) Fertility Awareness Based Methods 2) Pills 3) Intra-Uterine Device 4) Injectables 5) Condoms b. Permanent Methods 1) Bilateral Tubal Ligation 2) Vasectomy

44 44

3. Making choices for FP and services available in the Health Center

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46

4. Sexually Transmitted Infections, HIV and AIDS a. Modes of Transmission b. Ways to Prevent STIs and HIV Infection

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*Learning Points/Key Messages/Closing Statements

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D. Caring For and Managing the Family and the Home - A Shared Responsibility

42

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1. Responsible Parenthood

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2. Duties and Responsibilities of Parents

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3. Childless Couples

51

4. Rights of the Child (supportive laws in the country that provides protection to the child)

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5. Responsibilities of Children

54

6. Dealing with Children

54

7. Managing the Home

55

*Learning Points/Key Messages

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Part IV

Ending the Pre Marriage Counseling Session

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Pre-Marriage Counseling Nurturing the Marriage and Family - A Process Guide Purpose of the Pre Marriage Counseling Process Guide Pre-Marriage Counseling Session Design Preparing for the Pre-Marriage Counseling Session Welcoming and Building Rapport with the PMC participants Principles of Adult Learning Principles of Learning What is Facilitation Tips and Good Practices in Facilitation More Tips ... Keeping the Audience Engaged Running the Actual Pre-Marriage Counseling Session Marriage and Relationships Building the Family Caring for and Managing the Home - A shared responsibility Ending the Pre-Marriage Counseling Session Sample Energizers

67 68 74 75 76 76 77 78 79 80 82 85 90 92 94

Annexes 1 - Recommended Selected Readings for Pre Marriage Counselors and Trainers

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2 - Revised Implementing Guidelines, Series No.1 2009

102

3 - References

109

Acronyms

AIDS Acquired Immuno Deficiency Syndrome BBT Body Basal Temperature BOM Billings Ovulation Method BTL Bilateral Tubal Ligation CRC Convention on the Rights of the Child DOH Department of Health DSWD Department of Social Welfare and Development EO Executive Order FAB Fertility Awareness Based HIV Human Immuno Virus IUD Intra-uterine Device MCC Marriage Crisis Counseling NFP Natural Family Planning NSV Non Scalpel Vasectomy PD Presidential Decree PMC Pre-Marriage Counseling PNGOC Philippine NGO Council on Population, Health and Welfare, Inc. POPCOM Commission on Population SDM Standard Days Method STI Sexually Transmitted Infections STM Sympto Thermal Method UDHR Universal Declaration of Human Rights

Foreword

The Pre-Marriage Program is a flagship endeavor of the government designed to help engaged couples understand their roles, rights and obligations as married partners and would-be parents.

The program has been on-going since the late 1970s. There have been two Pre-Marriage Counseling (PMC) manuals produced since then. However, many developments have happened in terms of new laws, new trends, and new leaderships.

Despite all these, many Pre-Marriage Counselors have not been given refresher training on PMC updates while some new ones have not undergone any training at all.

In mid-2009, the Board of Commissioners of the Commission on Population directed the conduct of an assessment of the PMC Program the results of which will serve as guidelines for the revision of the 1996 PMC manual and the 2002 PMC Implementing Guidelines.

This Pre-Marriage Counseling Manual: Nurturing the Marriage and Family – A Content Guide and the accompanying Process Guide are the results of that assessment.

While the development of the manuals took place during a short period – from August to December 2009 – care and special attention to details have been poured into their crafting to ensure overall technical accuracy, usability and appropriateness of the subject matter to the counselors and their audience – the engaged couples.

Several consultations at the national, regional and even city levels, two pretests and four field tests were conducted in order to facilitate the crafting of these manuals.

Message

Marriage is not only a life-long legal, moral and spiritual commitment between two individuals, it is also an inviolable social institution that the State is bound to protect and strengthen.

It is thus incumbent on the government to ensure ‘that this obligation is fulfilled, including through proper counseling of people before they enter into this special union.

This manual represents a milestone in our continuing efforts to help couples about to get married to understand their roles, rights and obligations as partners, future parents and pillars of the basic social unit of the family. It will be an integral tool for our pre-marriage counselors by enhancing their knowledge of the intricacies of marriage and relationships, family, maternal, neonatal and child health, and the proper ways of caring for and nurturing the family.

I extend my warmest congratulations to the Commission on Population (POPCOM) for spearheading this multi-sectoral, multi-agency undertaking. I am confident that this manual will be a valuable contribution in our efforts to uphold the sanctity of marriage and the family, which are the foundations upon which a strong Filipino society is built.

Mabuhay kayong lahat!

DR. ESPERANZA I. CABRAL Secretary Department of Health Chair, Board of Commissioners Commission on Population

Message

The completion of this Pre-marriage Counseling Manual, and the accompanying process guide, comes with a feeling of pride and gratitude in the participation of so many stakeholderorganizations who dedicatedly participated in the tedious task of assembling new data and updating previously published information on a wide array of subjects in counseling couples about to get married.

Between the period August to December 2009, several workshops were held to gather inputs from these stakeholders and determine the appropriateness, accuracy, usability and timeliness of information in such diverse subjects as marriage and relationships, supportive laws, human sexuality, maternal, neonatal, child health and nutrition, family planning, responsible parenthood and even home management and budgeting.

Let me therefore express my sincerest gratitude to stakeholders from the Commission on Population, Department of Health, Department of Social Welfare and Development, Department of Agrarian Reform, National Economic Development Authority and National Statistics Office, particularly their various officials and staff in the National Capital Region (NCR), Cagayan Valley (Region 2), Western Visayas (Region 6) and Western Mindanao (Region 9).

By the very composition of the stakeholder-agencies involved, it can be gleaned that this manual is a product of team effort on a grand scale. The learning points and key messages highlighted in the manual are products of experts in relationships, laws and rights, human sexuality and the shared responsibility of bringing forth life and raising a healthy family.

Their collective contributions are enshrined in this manual, so to speak, and will go a long way in leading engaged couples to better understand the union they are committing themselves to, and the responsibilities that go with it.

To all the stakeholders, Mabuhay!

TOMAS M. OSIAS Executive Director Commission on Population

Acknowledgments

Many minds and time were involved in the development of this manual, but special recognition is due the following: The partner organizations, both the central and regional offices– Department of Health, Department of Social Welfare and Development, Department of Agriculture, Department of Agrarian Reform, National Statistics Office; The City Population Offices and City Health Offices of Iloilo City, San Juan, Metro Manila, Amulung, Cagayan, Bacolod City, Cadiz City and Zamboanga City; The regional offices 2, 6, 9 and NCR of the Commission on Population; The Philippine NGO Council on Population, Health and Welfare, Inc (PNGOC) Pre-Marriage Program Manual Revision Team; and Most especially to the Pre-Marriage Counselors of the cities of Cadiz, Zamboanga, Iloilo and Bacolod.

The complete listing of those who were involved, one way or another, can be found on the last pages of this manual.

A profound THANK YOU to all!

CONTENT GUIDE

Pre-Marriage Counseling Nurturing the Marriage and Family

- A Content Guide

Commission on Population December 2009

Introductions

The Pre-Marriage Counseling Manual: Nurturing the Marriage and Family–A Content Guide is a modified version of the 1996 Pre-Marriage Counseling (PMC) Training Manual. It is the outcome of the assessment study of the Pre-Marriage Counseling Program conducted in June-August 2009.

Evidence obtained from the assessment called for the need to revise and update the 1996 PMC training manual and to reduce the required number of PMC sessions from eight to four hours.

The program implementers however noted that the abbreviated PMC sessions that they have conducted mainly provided engaged couples with information about marriage and relationships, responsible parenthood, maternal and child health, family planning and home management.

While the engaged couple should ideally gain a lot of knowledge on how to make the marriage successful and how to nurture the family, it is neither practical nor wise to give all these in a four-hour session.

Follow up services should be provided to them later. This revised version of the manual therefore should only be one of resource materials that implementers can use to enhance the PMC sessions.

Engaged couples are required to participate in the PMC session before they are issued the certificate that enable them to obtain the marriage license from the Local Civil Registrar Office (LCRO).

The Marriage-Continuum Framework The Marriage Continuum Framework (refer to the diagram, next page) shows two types of services that are provided by the State: The Pre-Marriage Counseling (PMC), which is required of all engaged couples.

The law requires engaged couples to attend a PMC session before they are issued a marriage license. (PD 965)

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The Marriage Crisis Counseling services, on the other hand, is extended to married couples with problems in their relationship and are voluntarily seeking assistance from the state through the Department of Social Welfare and Development. This service is provided by DSWD-accredited marriage counselors.

Certified counselors who have gone through training in the application of the revised PMC manual by the Commission on Population, the Department of Health, and the Department of Social Welfare provide the PMC. The Commission on Population, the PMC’s lead government agency, signs the trained counselors’ certificates.

The signatory of the PMC certificate given to engaged couples is one or all members of the three involved government agencies.

The diagram below illustrates the relationship between Pre-Marriage Counseling and Marriage Crisis Counseling.

Service

Content

In-Charge/ Provider When Provided

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Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

About the Pre-Marriage Counseling Manual

Part I: About the Pre-Marriage Counseling Manual

Part I: About the Pre-Marriage Counseling Manual Purpose of the Pre Marriage Counseling Manual The revised Pre Marriage Counseling (PMC) Manual is a content guide for a fourhour session with couples engaged to be married. It contains updated information about social and legal changes related to the institution of marriage and the family in Philippine society.

It provides vital information to engaged couples about marriage, marital obligations, and how they could live in harmony with in-laws. It also covers information about male and female sexuality, spacing of pregnancy, caring for the family and children’s health and tips on home management.

How to Use the Manual This training manual covers essential topics that need to be discussed with engaged couples within the prescribed four-hour session. The PM counselors are required to master the manual’s contents. However, they are encouraged to use other suggested references listed on the last section of this manual for additional information and for their personal growth.

This manual also comes with an accompanying Process Guide to assist the PM counselors in conducting the PMC session.

About the Pre-Marriage Counselors Role of Pre-Marriage Counselors The pre-marriage counselors guide engaged couples in learning about marriage. They discuss topics on the challenges of marriage such as couples’ rights and obligations, and how to nurture the union and the family that they will build.

To be effective PM counselors and resource persons, they should be good communicators. They should not impose their own values on the participants. They are knowledgeable, objective, pleasant, and nonjudgmental.

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Qualities and Qualifications of Pre-Marriage Counselors and Trainers • He/she should have been trained and certified as a PM counselor by the Commission on Population, (please refer to Implementing Guidelines – December, 2009); • With ability to deal with and adjust to various types of people; • Open to new ideas and ideas of others; • Must be gender-sensitive; and • Able to work in and with a team

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Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

Setting the Tone and Perspective of the Pre-Marriage Counseling Session

Part II: Setting the Tone and Perspective of the Pre-Marriage Counseling Session

Part II: Setting the Tone and Perspective of the Pre-Marriage Counseling Session Purpose of Pre Marriage Counseling Applicants for marriage license are required by the government to attend the PreMarriage Counseling to provide them with essential information and help them prepare for married life. This pre-requisite to obtaining a marriage license is governed by two laws, namely: • Presidential Decree 965 which was issued on July 20, 1976. It requires that all marriage license applicants must receive instructions about family planning and responsible parenthood; and • Article 16 of the New Family Code promulgated in 1987 provides that applicants for marriage license who need parental consent (18 years old for females, 21 for males), and parental advice (those aged 21-25 for both males and females) shall attach a certification of marriage counseling to their applications for marriage license.

Marriage is a crucial step for a man and a woman who agree to live together, commit themselves and vow to love and cherish each other until death. Marriage also signals the couple’s entry into a new world where they will assume new roles and responsibilities.

Families are the building blocks of a country and marriage is the initial step in the formation of families. The family is the basic unit of society. A stable family helps make a stable community and country.

Marriage is a lifetime career and vocation. Unlike other vocations for which individuals can study and prepare for, there is no course that teaches couples the how to’s of married life. Couples are expected instead to learn from their marital experiences on a trial-and-error manner or at least, with some guidance and advice from other caring people.

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Through the Pre-Marriage Counseling, it is hoped that engaged couples will: • Become aware of the different rights and privileges as well as the duties and responsibilities of married couples in their various roles— as husbands and wives, as responsible parents, as children of their parents, as in-laws, and as responsible members of society; • Acquire key information about marriage and relationship, maternal and child health, family planning, responsible parenthood and home management — which would be critical tools in making crucial decisions as they try to attain quality life for their families.

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Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

Part III: Essential Topics for the Pre-Marriage Counseling Session

Essential Topics for the Pre-Marriage Counseling Session

Part III: Essential Topics for the Pre-Marriage Counseling Session The topics discussed in the succeeding pages are the essential subject matter that engaged couples should know. These topics should be covered during the four-hour Pre Marriage Counseling session.

The Pre-Marriage Counseling Team or educators are encouraged to read more about the subsequent topics beyond what is written in this manual to enhance and update their knowledge on these matters.

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A. MARRIAGE AND RELATIONSHIPS 1. What God Says About Marital Union God designed marriage to be the most intimate of all human relationships, where couples share intellectual, social, emotional, spiritual, and physical relationships.

• Intellectual intimacy—This is not about discussing highly intellectual ideas. The important thing is discussing your thoughts. These may be thoughts about food, finances, health, crime, work and politics. They reveal something of what’s going on in your mind throughout the day.

• Social intimacy—This has to do with spending time around the events of life.

Some of these events are experienced together; others happen while they are apart and are shared through open communication. Much of life involves doing.

When we do things together, we not only develop a sense of teamwork, we also enhance our sense of intimacy.

• Emotional intimacy— Feelings are our spontaneous, emotional responses to what we encounter through the five senses. When we share emotions, we build emotional intimacy.

• Spiritual intimacy— Often the least explored of all the foundations of marital intimacy. Yet this has a significant impact on others. It is discussing our thoughts about spiritual realities.

The charter of marriage is Genesis 2:24, reproduced by our Lord with greater distinctness in Matthew 19:4-5; “He which made them at the beginning made them male and female, and said, For this cause shall a man leave father and mother, and 1 shall cleave to his wife: and they twain, shall be one flesh.” 1 The Quran specifically refers to marriage as “mithaqun Ghalithun,”. Which means “a strong covenant”.22 Marriage is “mithaq” - a solemn covenant (agreement). It is not a matter which can be taken lightly. It should be entered into with total commitment and full knowledge of what it involves.33

1 http://www.bible-history.com/faussets/M/Marriage/ 2 http://www.soundvision.com/Info/Islam/marriage.purpose.asp 3 http://www.jannah.org/sisters/marr.html

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2. What the Law Says About Marriage a. Universal Declaration of Human Rights (UDHR) - is a declaration adopted by the United Nations General Assembly Article 16 of which guarantees that • Men and women of full age, without any limitation due to race, nationality or religion, have the right to marry and to found a family. They are entitled to equal rights as to marriage, during marriage and at its dissolution; • Marriage shall be entered into only with the free and full consent of the intending spouses.

• The family is the natural and fundamental group unit of society and is entitled to protection by society and the State. b. New Family Code of the Philippines (Executive Order 209, 1987)

1) Definition of Marriage Marriage is a special contract of a permanent union between a man and a woman entered into in accordance with law for the establishment of conjugal and family life. It is the foundation of the family and an inviolable social institution whose nature, consequences, and incidents are governed by law and not subject to stipulation, except that marriage settlements may fix the property relations during the marriage within the limits provided by this Code. (52a)

2) Requisites of Marriage

No marriage shall be valid, unless these essential requisites are present: • Legal capacity of the contracting parties who must be a male and a female; (any male or female of the age of eighteen years or upwards not under any of the impediments mentioned in Articles 37 and 38, may contract marriage); and • Consent freely given in the presence of the solemnizing officer. (53a) In Article 3 of the Family Code of the Philippines, the formal requisites of marriage are:

(1) Authority of the solemnizing officer;

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(2) A valid marriage license except in the cases provided for in Chapter 2 of the Family Code of the Philippines;44 (3) A marriage ceremony which takes place with the appearance of the contracting parties before the solemnizing officer and their personal declaration that they take each other as husband and wife in the presence of no less than two witnesses of legal age.(53a, 55a) The absence of any of the essential or formal requisites shall render the marriage void ab initio (from the very beginning), except as stated in Article 35 (2). A defect in any of the essential requisites shall not affect the validity of the marriage but the party or parties responsible for the irregularity shall be civilly, criminally and administratively liable. (n) 3. Purpose of Marriage The purpose of marriage is to spiritually, emotionally and physically unite a man and woman together, as husband and wife, in a covenantal (agreement or contract) relationship between themselves and their Creator.

In the Bible there are essentially two sets of reasons for marriage on earth. One of these is of course to provide for the physical needs for human love, intimacy and procreation.55

4 Exemptions to the requirement of a valid marriage license are: In case either or both of the contracting parties are at the point of death; if the residence of either party is so located that there is no means of transportation to enable such party to appear personally before the local civil registrar; marriages among Muslims or among members of the ethnic cultural communities may be performed validly without the necessity of marriage license, provided they are solemnized in accordance with their customs, rites or practices; and the marriage of a man and a woman who have lived together as husband and wife for at least five years and without any legal impediment to marry each other.

5 http://bible.geek.nz/post/2007/04/08/The-purpose-of-marriage-part-1.aspx

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Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

The Qur’an states that the purposes of marriage are: 1) To ensure preservation of the human species and continuation of the human race. “O mankind! Be careful of your duty to your Lord, Who created you from a single soul and from it created its mate and from them has spread abroad a multitude of men and women” (Quran: 4:1) 2) To provide the spiritual and legal foundation of the family. “And of His signs is this: He created for you mates from yourself that you might find rest in them, and He ordained between you love and mercy. Lo, therein indeed are portents for folk who reflect”. (Quran 30:21) Through Marriage, the conjugal relationship between a man and a woman becomes lawful. It provides a legitimate outlet for recreation as well as procreation. Islam regards sex as natural and good, but restricts it to the partners of marriage so as to ensure the responsibility for its consequences.

4. Elements of a good marriage A good marriage often has the following ingredients—mutual understanding and commitment, love, respect, trust, loyalty, commitment, shared beliefs and ideas, open communication, financial stability, good health, and continued personal growth and development.

5. Roles and Relationships

a.As Husband and Wife The rights and obligations of the husband and wife are defined and protected by the New Family Code particularly in the following provisions: Art. 68 – The husband and wife are obliged to live together, observe mutual love, respect and fidelity, and render mutual help and support.

Art. 69 – The husband and wife will fix the family domicile. In case of disagreement, the court shall decide.

Art. 70- The spouses are jointly responsible for the support of the family. The expenses of such support and other conjugal obligations shall be paid from the community property and, in the absence thereof, from the income or fruits of their separate properties. In case of insufficiency or absence of said income or fruits, such obligations shall be satisfied from their separate properties.

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Art. 71 – The management of the household shall be the right and duty of both spouses. The expenses for such management shall be paid in accordance with the provision of Article 70.

Art. 72 – When one of the spouses neglects his or her duties to the conjugal union or commits acts which tend to bring danger, dishonor or injury to the other or to the family, the aggrieved party may apply to the court for relief.

Art. 73 – Either spouse may exercise any legitimate profession, occupation, business or activity without the consent of the other. The latter may object only for valid, serious or moral grounds. In case of disagreement, the court shall decide whether or not: (1) the objection is proper; and (2) benefit has accrued to the family prior to the objection or thereafter. If the benefit has accrued prior to the objection, the resulting obligation shall be enforced against the separate property of the spouses who has not obtained consent.

The husband and wife should live in mutual love, respect and harmony, should always strive to resolve conflicts peacefully and amicably. There is no place for violence in the home. b. As In- Laws In the Filipino culture, when persons marry, they automatically become members of their spouses’ families. In-laws have a big part in the success or failure of marriage, hence maintaining good relationship with in-laws is very important.

• Treat your in-laws as you would your parents • Be fair. Give as much respect and time to your in-laws as you would to your own parents • Do not criticize your spouse’s parents • Do not compare your in-laws with your parents and vice versa • Let your in-laws enjoy your kids as much as you let your own parents However, the couple should not let negative interference from in-laws prevail. The couple should conduct a rational discussion of the problem when such a situation would occur.

c. As Parents

The couple should be able to care for and relate well with their children as members of the family increases.(This topic is discussed lengthily in page 49 section D of this guide ) 18

Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

6. Other supportive laws There are other protective laws in the Philippines that can be resorted to in case of violence/abuse in the home. These are: a. RA 9262 –Anti-Violence Against Women and their Children Act of 2004 (Promulgated March 08, 2004) “Violence against women and their children” refers to any act or a series of acts committed by any person against a woman who is his wife, former wife, or against a woman with whom the person has or had a sexual or dating relationship, or with whom he has a common child, or against her child whether legitimate or illegitimate, within or without the family abode, which result in or is likely to result in physical, sexual, psychological harm or suffering, or economic abuse including threats of such acts, battery, assault, coercion, harassment or arbitrary deprivation of liberty.

The State recognizes the need to protect the family and its members particularly women and children, from violence and threats to their personal safety and security. b. Republic Act 9710 Magna Carta of Women (2009)61 The newly signed Magna Carta of Women provides for women’s: Protection from all forms of violence, including those committed by the State and defense of women against gender-based violence (including domestic violence); Equal rights in all matters relating to marriage and family relations. The state shall ensure the same rights for women and men to: enter into and leave marriages, freely choose a spouse, decide on the number and spacing of their children, enjoy personal rights including the choice of a profession, own, acquire, and administer their property, and acquire, change, or retain their nationality. It also states that the betrothal and marriage of a child shall have no legal effect.

61 The Magna Carta of Women is a comprehensive women’s human rights law that seeks to eliminate discrimination against women by recognizing, protecting, fulfilling and promoting the rights of Filipino women, especially those in the marginalized sectors.

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c. Presidential Decree 603 – The Child and Youth Welfare Code This Code applies to persons below 21 years of age except those emancipated in accordance with law. “Child” or “minor” or “youth”as defined in the Code. It promotes the rights of children and youth and defines the role of the Department of Social Welfare and Development (DSWD) in caring for and protecting the children and youth. d. Republic Act 7610 - “Special Protection of Children Against Abuse, Exploitation and Discrimination Act.” This law declares that it is the policy of the State to provide special protection to children from all forms of abuse, neglect, cruelty exploitation and discrimination and other conditions, prejudicial to their development; provide sanctions for their commission and carry out a program for prevention and deterrence of and crisis intervention in situations of child abuse, exploitation and discrimination.

The State shall intervene on behalf of the child when the parent, guardian, teacher or person having care or custody of the child fails or is unable to protect the child against abuse, exploitation and discrimination or when such acts against the child are committed by the said parent, guardian, teacher or person having care and custody of the same.

It shall be the policy of the State to protect and rehabilitate children gravely threatened or endangered by circumstances which affect or will affect their survival and normal development and over which they have no control. e. Convention on the Rights of the Child The rights of children are guaranteed under the internationally ratified document called the Convention on the Rights of the Child (CRC). This is discussed lengthily in page 52 Section D – Caring For and Managing the Family and the Home.

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B. BUILDING THE FAMILY The couple may decide to build their family. A first step to a couple’s fulfilling partnership is the understanding of their sexuality, their reproductive functions and their combined fertility.

Human sexuality is a product of what we are born with. It is our own unique life experiences that have shaped our attitudes, feelings, and values toward ourselves and other people. Sexuality includes all kinds of relationships - with one’s parents, siblings or other people. This complex phenomenon covers many aspects. Biologically, sexuality refers to the reproductive mechanism as well as the basic drive that exists in all species and can encompass reproductive processes like sexual intercourse and childbearing.

There are also emotional or physical aspect of sexuality, which refers to the bond that exists between individuals, which may be expressed through profound feelings or emotions, and which may be manifested in physical or medical concerns about the physiological or even psychological aspects of sexual behavior. Sociologically, it can cover the cultural, political, and legal aspects; and philosophically, it can span the moral, ethical, theological, spiritual or religious aspects (from Wikipedia, the Free Encyclopedia)

a. What makes a man and a woman?

The following are the basic differences between a man and a woman. It is important to know these differences to understand why we behave, act, and relate differently.

Aspects

Physical

Differences Male (Man) Female (Woman) • Hair on face or mustache/beard on an unshaven face • Has Adam’s apple • Broad shoulders • Breasts not enlarged • Narrow hips

Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

• Narrow shoulder • Narrow waist • Breasts markedly enlarged • Broad hips

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Aspects

Differences Male (Man) Female (Woman)

Biological

• Reproductive function starts during puberty and continue to late 60s and 70s.

• Reproductive function starts at puberty and continues till late 40s to early 50s.

Sexual

• Easily aroused (smell, sight, imagination, not necessarily by direct stimulation) reaches sexual satisfaction in shorter time, his feelings settle down in much shorter time.

• Easier for a man to deal with sexual frustrations, it is more localized and can easily be forgotten.

• Sexual desire reaches its peak in late teens to late twenties then it goes downhill and slightly goes up to mid 40s and 50s.

• Sex and love can exist independently of the other.

• Uses sex as means of satisfying a great physical hunger- a physical need that can exist even without love.

• Longer time to get sexually aroused more by direct stimulation on erotic parts, longer time for her to reach sexual peak and for her feelings to subdue.

• Repeated sexual frustrations are difficult for a woman.

• Average woman does not achieve sexual peak till she is in her 30s and retain this ability into her 60s.

• Looks and expects more beyond just the sexual relationship alone.

• Thinks of sex in terms more of love, care, and security and not just a means to physical satisfaction.

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Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

b. Five Major Components of Human Sexuality 1). Biological sex - pertains to being a male or female, and includes reproductive anatomy and physiology.  There are two sexes- male and female  Men’s sperm has two types of chromosomes (X and Y) that determine the sex of the baby.

2). Sexual orientation - preference of an individual concerning the sex of a person he/she is attracted to, or the sex of his or her partner in a sexual relationship.  Many scientists share the view that sexual orientation is shaped for most people at an early age through complex interactions of biological, psychological and social factors.

3). Sexual Identity (body Image) – a person’s feelings about his/ her body in relation to others which includes relationships and intimacy, sexual response, sexual awakening, and other sexual concerns, such as frigidity and impotence.  Our body is a gift from God. It is something to be appreciated and not to be ashamed of. Understanding and appreciating our sexuality is important to be able to make responsible decisions is a way of harnessing that gift.

4). Gender Identity- the psychological sense of being male or female, and the personal and social norms for feminine or masculine behavior.  Gender identity is about an individual’s sex role. The most significant influence to sexuality comes from prescribed gender roles- the social norms and values that develop the relative power, responsibilities, and behavior or men and women.

Prescribed gender roles, however, can be influenced and changed. Learning, listening, and talking about sexuality are just some of the important ways by which individuals can change their perceptions of themselves.

5). Values and attitudes, feelings and emotions – the psyche of the person that was shaped by life and love experiences and by the people his/her life has touched.

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c. Importance of Human Sexuality for Married Couples 1) Understanding a man’s and woman’s basic characteristics and differences is necessary to achieve sexual harmony that make and keep a successful marriage. Sexual harmony happens when husband and wife recognize and appreciate each other’s sexual needs, desires, and preferences. It also means the ability to give and receive sexual satisfaction from each other.

2) Makes couples aware of their reproductive capacity and to control and regulate it as guided by their sense of responsibility.

3) Makes couples realize their respective roles as husband and wife and as children of their parents and as parents to their children.

4) Provides a sense of well being, enhancement of life and feelings of oneself towards greater fulfillment in relationship with others.

One’s power to express sexually lasts a lifetime—whether or not a person is in a sexual relationship with a loved one, or feels good about his or her body, or appreciates sensual pleasure that is given or taken.

Couples can enjoy a wide range of intimate sexual expressions— from holding hands, hugging, kissing, massaging, dancing or doing the sex act. People touch people to express simple expression, to communicate and to give sexual gratification.

A sexual relationship is for the mutual satisfaction of both partners. The sex act is the most intimate and spiritual form of communication between human beings. It is one of the means of strengthening the couple’s relationship and their commitment to the welfare of their family. As such the couple must always consider the well-being of the partner.

Every sexual act therefore, should be with mutual consent of the partners.

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2. Maternal, Neonatal, Child Health and Nutrition (MNCHN) a. Dynamics of Fertility: Male Reproductive System

- Sperms are produced in the testicles.

- The sperm cells travel to and mature in the Epididymis, a long coiled tube at the upper part of the testes.

- They are then transported/propelled from the epididymis through a long, muscular tube called the Vas Deferens.

- Nourishing protective fluid containing glucose is released from the Seminal Vesicles.

- Alkaline secretions are provided by the Prostate Gland.

- Cowper’s Gland secretes a clear lubricating fluid into the urethra that cleanses and neutralizes the acidity of the passage.

- The pre-ejaculatory fluid nourishes and assists in the movement of sperms and prepares the Urethra for sperm transport outside the penis through ejaculation.

- Semen is the viscid fluid, which is composed of the sperm, and the fluids from the Cowper’s gland, prostate gland and seminal vesicle.

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1) Male Fertility

 Men are always fertile: • Nature awakens the boy to his fertility with his first wet dreams.

• A normally healthy man continues to produce sperm cells throughout his entire life.  Men’s reproductive components is in abundant supply: • Approximately 50,000 new sperm cells are produced each minute with as many as 100 million produced each day. There are between 300 to 500 million sperm cells in a normal ejaculation.

• Sperm cells outside the man’s body can survive as long as 3-5 days in a favorable environment such as the woman’s fertile cervical mucus otherwise they will die almost immediately.

2) Threats to Male Fertility: • Substance abuse include smoking, using prohibited drugs and alcohol • Overly intense exercise • Chemicals, pesticides, fertilizers, radiation • Infections of reproductive system such as prostatitis, epididymitis, orchitis • Trauma or injury to the testes • Certain jobs or work which exposes the scrotum to intense heat • Systematic diseases like diabetes mellitus, thyroid dysfunction • Certain prescription drugs may cause erectile dysfunction like beta blocker 26

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3) Female Reproductive System

The External Female Reproductive Anatomy: Vaginal opening— entrance to the vaginal canal. During sexual excitement, it widens to allow the entrance of the penis. During childbirth, it widens to allow the delivery of the baby.

Labia majora – the outer lips that protect the vaginal opening. This is covered with pubic hair starting from puberty.

Labia minora– the inner lips that protect the vaginal opening which are not covered with hair.

Urinary opening—located above the vaginal opening. It is the entrance to the urethra, the tube to which urine leaves the body.

Clitoris— the peanut-sized organ above the urinary opening and is a major area of sexual arousal for many women.

Mons Pubis– the pad of fatty tissue that covers the pubic bone. It helps protect the internal reproductive organs and cushions the impart during sexual intercourse. This is covered with pubic hair starting from puberty.

Vulva– refers to all the outer parts described above

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INTERNAL FEMALE REPRODUCTIVE ANATOMY: Uterus – a hollow, muscular organ about the size of a close fist. It serves as incubator where the fertilized egg is nurtured and grows to become a baby.

Cervix – looks like a small, round ball. It has an opening that allows the sperms to swim into the uterus and widens to allow the passage of the baby to the vagina.

Vaginal canal– located at the front of the cervix. It expands during sexual intercourse and during childbirth.

Ovaries – the primary sex glands of a woman; considered as the storehouse of a woman’s eggs. They are two very small organs attached to the uterus. During a woman’s fertile time, one egg matures and leaves the ovary.

Fallopian tubes – are tubular structures that are attached to the sides of the body of the uterus. The mature egg enters the fallopian tubes and waits for the sperm.

Fertilization could happen if the meeting of the sperm and egg takes place.

Fimbriae– finger-like tissues (label in the illustration).

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4) Female Fertility

 Women of reproductive age are at most times infertile between puberty and menopause. A woman is only fertile for just a few days at a time during each menstrual cycle, when her body releases an egg. The egg (ovum) matures and lives for about 12-24 hours.  Girls achieve reproductive capability earlier than boys, on the average around the age of 12.  Woman’s fertility starts at puberty, with her first menstrual period and ends at menopause.  When a baby girl is born, her young ovaries already contain approximately 400,000 immature eggs and follicles, however, only around 400 of these will ever mature.  A woman has times of dryness and wetness, in each cycle: • Dry times are infertile times • Wet times are fertile times • The time when the woman feels dry but is still wet, is a fertile time • Most of the time, the cervix produces thick mucus, which effectively seals the uterus from any outside contamination, thus, the woman observes dryness or no mucus discharge.

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Threats to Female Fertility

Threats

Effects

How to Deal with Threats

Teenage pregnancy

• High risk pregnancy • Abortion • Sexually transmitted diseases

Avoid pre - marital sex

Unsafe/several abortions

• • • •

Submit to medical consultation

Infection of the reproductive tract ( e.g. gonorrhea, chlamydia) • infection of the vagina • cervical infection • chronic pelvic inflammatory disease

• Too acidic vaginal secretion which weakens the sperm • Too thickened cervical mucus limiting passage of the sperm to the uterus • Scarring of the fallopian tubesobstructing the transport of the egg

Illnesses ( e.g. tuberculosis, goiter, tumor of the ovary)

Menstrual irregularities

Damaged cervix Infections Hemorrhages / bleeding Death

• Avoid premarital sex • Submit to early medical consultation and treatment

Seek early medical consultation and treatment

Stress Decrease body fat ratio (e.g. extremely thin) Chronic or excessive exposure to x-rays or radio active substances 30

Menstrual irregularities

Healthy lifestyle / stress management Avoid unnecessary exposure to radio active substances

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To understand childbearing, the couple should understand the woman’s menstrual cycle. The onset of Menarche (first menstruation) among girls at the age of puberty signals their ability to become pregnant.

5) Menstrual Cycle Menstrual Cycle –refers to the period between the first day of menstruation until the day before the next menstrual flow.  Begins on the first day of menstrual flow and ends the day before the next menstrual flow occurs.  The menstrual cycle is made possible by substance called hormones produced by the different organs of the body.  When the egg matures, it is released from the ovary. This is called ovulation. The “fimbrae” catches the egg as it comes out of the ovary and travels along the fallopian tube and to the uterus.  If the egg fails to meet a sperm within 24 hours, no fertilization takes place. The levels of hormones will then fall and the uterine lining will shed off. This flows out of the vagina as menstruation.  If the couple made love at the time when the egg is still alive, there is great possibility that the woman’s egg will meet and unite with a sperm from the man and fertilization takes place.

The production of the hormones to sustain the fertilized egg continues.

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a) Phases of the Menstrual Cycle:

Menstruation is the blood flow from a woman’s vagina that occurs every 28 days. The number of days varies among women anywhere from 23 to 35 days. A woman usually starts to menstruate during puberty, about 9 or 12 years of age until she is about 40 or 50 years old.

What happens during the phases in the menstrual cycle? i.

Starts on first day of menses • If the egg is not fertilized, the thickened uterine lining will be shed off.

• Woman observes bleeding which indicates that there is no pregnancy.

• This is the first day of the menstrual bleeding.

• The phase includes all days of menstrual bleeding which usually last 3-5 days.

ii.

Pre-ovulatory phase • Bleeding has stopped.

• Egg cells begin to develop.

• Lining of the uterus starts to thicken.

• Mucus forms a plug. This mucus prevents entry of sperms.

• A woman experiences dry feeling and no mucus.

• The pre-ovulatory is the infertile phase which includes all dry days after the menstrual bleeding stops.

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iii.

Ovulatory phase - This is the highlight of a woman’s fertility.

• One mature egg is released and stays in the fallopian tube for about 24 hours.

• The uterine lining continues to thicken.

• The mucus plug disappears.

• The mucus becomes very watery, stretchy, slippery, and clear. This helps sperm swim to the egg.

• Mucus nourishes the sperms.

• The ovulatory phase is the fertile phase. A woman experiences wet feeling with watery, slippery, stretchy, and clear mucus

iv.

Post-ovulatory phase • No egg is present. If there is no meeting of egg and sperm, the cell deteriorates and is absorbed.

• Lining of the uterus has thickened.

• The mucus forms a plug again to prevent entry of sperms.

• Women experience dry feeling with no mucus at all. If mucus is present, it is sticky, cloudy, crumbly, or pasty.

• Because there is no pregnancy, the woman will experience menstruation and another cycle begins.

• The post-ovulatory phase is absolutely the infertile phase which covers about 10-16 days.

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6) Combined /Joint Fertility

Joint or combined Fertility means:  The equal contribution of the male and female in the decision and capability to have a child.  The sex life of the husband and wife is integrated with their periods of fertility and infertility. A male is always fertile while the woman is fertile only for just a few days at a time during each menstrual cycle, when her body releases an egg.  It involves the contribution of sperm cells by the husband and the egg cell by the wife, but more importantly, the joint decision and the ability of the married couple to have a child.  A male sperm and a female egg are needed for fertilization to occur. The sperm cell and egg cell each contain 23 chromosomes, which carry with them the characteristics of the father and mother that would be inherited by the baby.

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Some couples may take sometime to have a child. It is recommended that they have themselves checked up by the physician to determine the cause.

Some couples go through a fertility work up where they are professionally assisted to have children. However, it is expensive and may not always be successful.

What happens if fertilization occurs?  The fertilized egg produces Human Chorionic Gonadotropin hormone ( HCG)  What happens due to HCG: o corpus luteum is maintained o estrogen and progesterone is sustained o no shedding of the endometrium o no menstruation o pregnancy test is positive  After getting fertilized somewhere in the fallopian tube, which is the meeting place of the egg and sperm, the zygote (the fertilized egg) begins to divide and grow as it continues to travel to the uterus.  It takes about a week or two for the fertilized egg to reach the uterus where it will attach to the soft and spongy lining, specially prepared for it. The process of getting attached to the uterine wall is called implantation. b. Early Signs of Pregnancy • absence of menstruation or amenorrhea • nausea and vomiting ( commonly known as morning sickness) • increased frequency of urination and breast changes characterized by enlargement and discoloration of nipples and areola.

• The enlargement of the uterus may not be visible until the 3rd or 4th month of pregnancy.

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As soon as a woman suspects or feels she is pregnant, she should immediately visit a health facility to confirm her pregnancy. It is during the first months when the different parts of the baby develop. Care must be taken to ensure the normal and healthy development of the baby inside the womb.

c. Prenatal Care It is essential for the woman to go for prenatal care for a safe pregnancy for the following reasons: • • • •

Care for the woman and the fetus during pregnancy before childbirth.

Promotes safe pregnancy and delivery of a healthy baby.

Provides pregnant woman and family with needed information.

Identifies and monitors pregnant women at risk of the future complications and facilities referral for proper action.

Prenatal check-ups should be done at least once a month for the first seven months, every two weeks on the 8th month and every week on the 9th month. More frequent check-ups may be necessary in special cases.

Schedule of Prenatal Check-ups

1st trimester

1-3 months

2nd trimester

4-6 months

3rd trimester

7th month 8th month 9th month

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once a month once a month once a month twice a month 4 X a month

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Steps to Follow in Prenatal Care Tetanus Toxoid Immunization Schedule Vaccine

TT1

TT2

TT3

TT4

TT5

Minimum Interval At first contact with woman 1549 years or at first ANC visit

At least 4 weeks after TT1

At least 6 months after TT2

At least 1 year after TT3

At least after 1 year TT4

Duration of Protection

NIL – no protection • Infants born to the mother will be protected from neonatal tetanus • 3 years protection for the mother • Infants born to the mother will be protected from neonatal tetanus.

• 5 years protection for the mother • Infants born to the mother will be protected from neonatal tetanus • 10 years protection for the mother • Infants born to the mother will be protected from neonatal tetanus • Lifetime protection for the mother

d. Services Provided to Pregnant Women:  Assessment of pregnancy – initial and periodic assessment of pregnancy including the health and nutritional status of the mother and the growth of the fetus. This consists of thorough physical, breast and laboratory examination.

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 Early detection of problem related to pregnancy – early signs of problems that may arise in order to provide timely and appropriate intervention.  Education – focuses on proper nutrition, dental care, importance of TT immunization, and preparation for safe delivery.  Advice of proper breastfeeding – training prior to delivery, including the promotion of prompt initiation of breastfeeding soon after delivery; proper positioning and procedures.  Nutritional supplementation and counseling – correction of common nutritional deficiencies through counseling and supplementation.  Tetanus Toxoid Immunization Every pregnant woman should have a Birth Plan, a document prepared during the prenatal care which states the woman’s conditions during pregnancy; her preferred place of delivery and choice of birth attendant; resources available for her childbirth and newborn baby; and importantly, preparation needed should an emergency situation arise during pregnancy, childbirth and postpartum.

e. Caring for the Baby The couple should prepare for the birth of the baby. They should plan where the wife will give birth – at home or at the health facility. They should also prepare the baby’s clothes and birth paraphernalia. A newborn child is one of the most helpless creatures on earth. The quality of care given to children during the first year of their life is most crucial not only for their survival but also for determining their health for the rest of their lives.

The health centers in the city or municipality provide an array of services for baby and children’s care.

1) Newborn Screening A newborn baby goes through newborn screening – a simple procedure to find out if a baby has a congenital metabolic disorder that may lead to mental retardation or even death if left untreated.

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Why is it important to have newborn screening?  Most babies with metabolic disorder look normal at birth.  One will never know that the baby has the disorder until the signs and symptoms are manifested. By this time, irreversible consequences are already present.

When is newborn screening done?  Ideally done on the 48th to 72nd hour of life (first 2-3 days of life)  May also be done 24 hours from birth since some disorders are not detected if the test is done earlier than 24 hours from birth.

2) Breastfeeding Breast milk is the best food for the baby. Through her breast milk, a well-nourished mother can provide all the nutrients and fluids an infant needs. Encourage breastfeeding on demand, day and night, as long as the baby wants it.

• A baby should be breastfed immediately upon birth to enable him/ her to receive the colostrum, which contains antibodies that will protect the baby from common illness.

• A baby needs to be fed day and night, 8 or more times in 24 hours from birth. Only on the first day may a full-term baby sleep many hours after a good feed.

• A small baby should be encouraged to feed, day and night, at least 8 times in 24 hours from birth.

• For the first six (6) months of life, the baby needs breast milk alone or exclusive breastfeeding.

Benefits of Breastfeeding o Breastfeeding provides optimum nutrition. Breastfed babies are less likely to be malnourished than other babies o Breastfeeding enhances the mother’s health.  Immediately after delivery, suckling of the breast reduces the risk of postpartum hemorrhage. Suckling stimulates releases of hormones or substances which help milk flow and cause contraction of the uterus.

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o Breastfeeding lowers the danger of at least two kinds of cancer: ovarian and breast cancer. o Breastfeeding promotes child spacing because it delays ovulation and menstruation if the following criteria are met:  No menstruation (amenorrhea)  Fully exclusive breastfeeding; and  Child is less than six (6) months old o Breastfeeding establishes bonding or closer relationship between mother and child. o Breastfeeding protects baby from illness.  Antibodies in the milk protect the baby from certain illnesses.  Since the milk in the mother’s breast is not contaminated compared to the possible contamination during the preparation of bottled milk, more bottle-fed babies experience bouts of diarrhea than breast-fed babies. o Breastfeeding saves money. Breastfeeding offers important economic advantages to families ( breast milk substitute are expensive, bottle feeding requires purchase of special equipment, it cost more to use milk formula than to give food supplements to the mother) 3) Other Baby Care 1) Immunization Another important area of child health care is the administration of vaccines against the preventable childhood killer diseases.

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Immunization Schedule: Age

Vaccine

6 weeks

Birth BCG

10 Weeks

14 weeks

15-23 months

X (1st dose)

X (2nd dose)

X

Oral Polio

X

X

X

DPT

X

X

X

X (If the vaccine was not given at birth or within 7 days) (1st dose)

X (2nd dose)

Hepatitis B

9 months

X Option A – given within 24 hours after birth up to 7 days (1st dose)

Measles

X 3rd dose)

2) Growth Monitoring The child’s growth is monitored and recorded using the Growth Monitoring Chart which is given to the mother as soon as the newborn child is registered. This card shows the progress of the child’s growth and other information about the child such as illness, immunization, supplemental feeding, vitamins, supplementation, etc.

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C. PLANNING THE FAMILY The 1987 Constitution of the Republic of the Philippines affirms the State policies on the equal protection of “the life of the mother and the life of the unborn from conception” (Section 12, Article II); the “Filipino family as the foundation of the nation” (Article XV, Section 1). Abortion, therefore is NOT an option in family planning. Abortion is illegal in the Philippines.

Family planning (FP) is the voluntary and positive act of couples to plan and decide: • • • •

The number of children a married couple wants When to have the next baby To use responsible means to achieve the couples desired number of children To seek help so the childless couple will have children

Family planning does not refer to the pill or IUD nor to any of the contraceptive methods alone. Rather, it refers to the concept of spacing children and having only the number of children that the couple can take care of.

1. Importance and Benefits of Family Planning Family planning is a way of helping the couple to build a happy and well-provided family. A planned family allows members more opportunities to enjoy each other’s company with love and affection. It enables the family to build savings for the improvement of living standards and for use during emergencies. The benefits of family planning to the family’s individual members are numerous.

Benefits of Family Planning to the Mother

• Enables the mother to regain her health after recovery. It takes two to three years to fully recover her health after childbirth.

• Prevents young mothers (below 18 years old) and old mothers (over 35 years old) from getting pregnant because it is dangerous for them to bear children at their age. o Teenage mothers have high tendency to have anemia, toxemia and prolonged labor. o Old mothers are more likely to suffer hemorrhage because failure of the uterus to contract and uterine rapture. Also they have high tendency to develop hypertension.

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• Provides the mother who may be suffering from chronic illnesses such as tuberculosis, diabetes, heart disease, and anemia, enough time for treatment and recovery without fear of getting pregnant.

• Gives the mother enough time and opportunity to care and provide attention to herself, her husband and children.

• Gives the mother time for personal advancement or development.

Benefits of Family Planning to the Father • Provides fathers who are suffering from chronic illnesses such as tuberculosis, diabetes, anemia, etc, enough time for treatment and recovery.

• Lightens his burden and responsibility in supporting his family since he will be providing only for few children he can afford to support.

• Enables him to give his children a good home, good education and a better future.

• Gives him time for his own personal advancement • Gives him a feeling of fulfillment and pride in the family for having a wife who can attend to their children and home chores, and develop herself as a woman/wife.

• Provides fathers with extra resources and enough time to actively participate in community programs/projects.

• Frees a jobless father from worry of having an additional child to support.

The Practice of Family Planning will make the Children • Healthy – a healthy mother can produce healthy children.

• Happy – the children will be brought up in a happy home where they are given all the love and attention they deserve.

• Wanted and satisfied – well spaced children in the family will allow time and opportunity for mothers and fathers to attend to their growth and development.

• Secure – well spaced children in the family will provide more opportunities for adequate food, clothing, good education and other needs.

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2. Family Planning Methods A couple can practice family planning in various ways depending on their family planning goal – spacing of children, completing the number of children or aspiring to have more children. These are: a. Temporary Methods 1) Natural Family Planning (NFP) or Fertility-Awareness–based (FAB) methods is a collection of practices that help a woman know which days of the month she is most likely to get pregnant. A woman can learn when ovulation is coming by observing her own body and charting physical changes. She can then use this information to avoid or encourage pregnancy. The methods’ effectiveness depend on the couple’s ability to identify fertile and infertile periods and motivation to practice abstinence when required.

The different NFP or FAB Methods are: a) Billings Ovulation Method (BOM) – is based on the daily observation of what a woman sees and feels at the vaginal area throughout the day. Cervical mucus changes indicate whether days are fertile or infertile and can be used to avoid or achieve pregnancy. With correct use, this method is 97% effective. However, with typical use, it is 80% effective. b) Basal Body Temperature (BBT) – is based on a woman’s resting temperature (i.e. body temperature after 3 hours of continuous sleep), which is lower before ovulation until it rises to a higher level beginning around the time of ovulation. Her infertile days begin from the third day of the high temperature reading to the last day of the cycle. All days from the start of the menstrual cycle up to the third high temperature reading are considered fertile days. With perfect use, this method is 99% effective while with typical use, its effectiveness is 80%. c) Symptothermal Method (STM) is based on the combined technology of the Basal Body Temperature and the Billing Ovulation Method, i.e., the resting body temperature and on the observation of mucus changes at the vaginal area through the day together with other signs (e.g. breast enlargement, unilateral lower abdominal pain) which indicate that the woman is fertile or infertile. This method is 98% effective as correctly used.

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d) Standard Days Method (SDM) is based on a calculated fertile and infertile period for menstrual cycle lengths that are 26-32 days.

Women who are qualified (i.e. with 26 to 32 days menstrual cycles) to use this method are counseled to abstain from sexual intercourse on days 8-19 to avoid pregnancy. Couples on this method use a devise, the color-coded “cycle beads” to mark the fertile and infertile days of the menstrual cycle.

2) Pills contain hormones, in different proportion; comes in 21 or 28 pill packs taken daily. The pill prevents ovulation and thickens the cervical mucus, which prevents the sperm from entering the uterus.

3) Intra-uterine device (IUD) - is a small device that is inserted into the uterus through the vagina. The IUD prevents sperm from meeting the egg.

4) Injectable – is injected in the arm or in the buttocks. It may be administered every 3 months or monthly depending on the preparation. The injectable thickens the cervical mucus which prevents sperm from entering the uterus, stops ovulation and causes changes in the uterus and fallopian tubes, which prevents fertilization.

5) Condoms – rubber sheath worn over the penis during sexual intercourse thus preventing the sperm from entering the vagina. b. Permanent Methods These are methods more appropriate for couples that have decided to complete their number of children and cease further pregnancies of the wife.

1) Bilateral Tubal Ligation (BTL) or female sterilization – a small incision is made in the abdomen to gain access to the fallopian tubes, which are then cut and tied; requires local anesthesia.

2) Vasectomy (Non Scalpel Vasectomy or NSV) – where a small puncture is made on the scrotum to expose the vas deferens which is then cut and tied; requires local anesthesia.

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3. Making Choices for FP and services available in the Health Center Family planning is the voluntary and positive action of couples to plan and decide the number of children they want and when to have them.

It is important for the couple to make an informed choice on which method they can practice to plan the family, according to their situation.

They can ask the help of health service providers in the Health Center where the following services are available: • • • • •

Family planning commodities Family Planning Counseling Infertility Management Management of Minor Gynecological Conditions Laboratory examination such as Paps smear and pregnancy test.

4. Sexually Transmitted Infections and HIV and AIDS (Human Immuno Deficiency Virus and Acquired Immuno Deficiency Syndrome Sexually transmitted Infections or STIs are caused by bacteria and viruses spread through sexual contact. Infections can be found in body fluids such as semen, on the skin of the genitals and areas around them, and some also in the mouth, throat, and rectum. STIs spread in a community because an infected person has sex with an uninfected person. The more sexual partners a person has, the greater his or her risk of either becoming infected with STIs or transmitting STIs.7 91 STIs are infections that may be contracted through any of the following ways:

• • • •

sexual intercourse without condoms (vaginal, anal and oral ways), blood transfusion from infected blood; sharing of contaminated needles and syringes; and mother-to-child transmission

777 Family Planning -A Global Handbook for Providers. World Health Organization. 2008. p. 271

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Some STIs cause no symptoms but all STIs can be life-threatening. If not treated, it can cause pelvic inflammatory disease, chronic pelvic pain, infertility, miscarriage, ectopic pregnancy and cervical cancer. STIs can also cause sterility and impotency in men. Some STIs can also greatly increase the chance of becoming infected with HIV. The common signs and symptoms of STIs are: pain on urination, itching in the genital area, foul-smelling genital discharge and genital sores.

However, most women do not usually experience symptoms, although the bacteria or the virus stays within the body and silently cause harm.

The health centers provide STI diagnosis and treatment services.

One must immediately consult a doctor if and when symptoms are experienced.

HIV and AIDS Since 1984, the Human Immuno Virus (HIV) infection that leads to AIDS (Acquired Immuno Deficiency Syndrome) has been found in the Philippines.

HIV and AIDS are incurable. HIV and AIDS is a worldwide epidemic and the number of people getting infected with HIV is increasing in the Philippines. HIV infection has no signs and symptoms during the early stages. Anyone can be infected but the good news is HIV and AIDS is preventable. Knowing about HIV and AIDS and avoiding behaviors that will put one at risk of HIV is the best way to protect one’s self and his or her loved ones from the infection.

Modes of Transmission of HIV/AIDS: • Penetrative sexual intercourse with someone who has the virus.

• Transfusion of infected blood • Injection using contaminated syringe/needles or cut by contaminated instruments.

• From the infected mother to her fetus or infants before, during or shortly after birth or through breastfeeding Ways to Prevent STIs and HIV Infection • Abstinence from sexual intercourse • Be mutually faithful to one’s spouse or partner • Avoid use of drugs Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

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Learning Points/Key Messages/Closing Statements  Men and women complement each other. Knowledge of the basic differences between a man and a woman will enable them to better adjust to achieve and maintain a successful marriage.  Men and women are provided with gifts – the ability to make love and find satisfaction in doing it. Yet this ability should always be coupled with the responsibility because through it, they bring forth into this world human beings who need to be taken care of, nurtured and nourished.  Sexual relationship is for the mutual satisfaction of both partners. Every sexual act therefore should be with mutual consent of partners.  Family planning saves lives, promotes family health and happiness and work life balance  All couples have the right to full information and services on family planning.  As soon as a woman suspects or feels she is pregnant, she should immediately visit a health facility to confirm her pregnancy.  Prenatal care promotes safe pregnancy and delivery of healthy baby.  Every pregnant woman should have a Birth Plan, which states the woman’s conditions during pregnancy; her preferred place of delivery and choice of birth attendant; resources available for her childbirth and newborn baby; and importantly, preparation for an emergency situation arise during pregnancy, childbirth and postpartum.  Breast milk provides optimum nutrition, protects the baby from illnesses.  Breastfeeding promotes the mother’s health, enhances bonding or closer relationship between mother and child  HIV infection and AIDS are incurable, but preventable. Protect yourself, your spouse and future children against HIV AIDS  The health centers provide a variety of services, which include family planning, pre and post natal care, child care and counseling. Every city and municipality in the country has a health center.

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D. CARING FOR AND MANAGING THE FAMILY AND THE HOME – A SHARED RESPONSIBILITY Art. 149 (216a, 218a) of the Family Code of the Philippines states: The family as being the foundation of the nation is a basic social institution which public policy cherishes and protects. Consequently, family relations are governed by law and no custom, practice or agreement destructive of the family shall be recognized or given effect.

Likewise, Art. 50. Of the Family Code defines “Family Relations as including those: (1) Between husband and wife; (2) Between parents and children; (3) Among brothers and sisters, whether of the full or half-blood.”

The couple that founds the family therefore carries an awesome privilege and a tremendous responsibility. The married couple as parents is co-creators of human life with God the Creator. As parents, the married couple thus becomes integral agents of the cycles of eternity from generation to generation.

1. RESPONSIBLE PARENTHOOD Responsible Parenthood – is the will and ability to respond to the needs and aspirations of the family and children. It is a shared responsibility between husband and wife to determine and achieve the desired number and spacing of their children according to their own family life aspirations, taking into account psychological preparedness, health status, socio-cultural and economic concerns (PPMP DP 2005-2010).

It is the primary right and responsibility of parents to get actively involved in the promotion of their children’s well-being through the provision of adequate care, attention and affection (Training Manual on PMC, DOH 1996) 2. DUTIES AND RESPONSIBILITIES OF PARENTS a) Provision of physical care and love. The physical, emotional and mental health of the child depends on the quality of parental care he gets as he/she grows.

Parents should provide their children with the minimum basic needs like: • Clothing that is appropriate for every occasion • Nutritious food that are not necessarily expensive • Health care • A happy home and family environment

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b) Inculcating discipline. As early as the first year, children should be trained to think and reason out for themselves and be able to distinguish between right and wrong. They should learn to accept limitations, value freedom with responsibility and understand the requirements of living happily and peacefully with other people.

Inculcating discipline can be done with care and love. Excessive punishment becomes child battering and often has more negative than positive effects. c) Developing social competence. The socially-competent child is described as friendly, happy, self-confident, responsible, imaginative, alert and energetic. He/she enjoys work, has good communication skills and is a good sport. Allowing children to do things on their own, think for themselves and make decisions in accordance with their level of development, heightens their self-esteem and develops their social competence. Praising children for their efforts and congratulating them for their successes develops their self-confidence. If they fail, encourage them to try again. Scolding and shaming them as a reaction can do more harm than good. d) Education. Parents are the child’s first teacher and the home, the first school.

Suitable learning experiences must be provided in the home to hasten the child mental development as early as infancy. Parents are also duty-bound to discover and help develop their children’s innate abilities to the fullest extent possible.

Every child has the right to education. Parents are required to send and provide for their children’s schooling. e) Citizenship training. It is necessary to teach the child a sense of nationhood and develop his commitment to his/her country. He/She is to be taught the value of order, cooperation, tolerance, sportsmanship, self-discipline and self-reliance in his/her home and play experiences, aside from those learned in school.

Citizenship training is important for the child to acquire a perspective larger than his family. It is important to inculcate a sense of nationhood and national purpose in the young. f) Educating children in age-appropriate aspects of human sexuality. Parents should provide correct information on human and responsible sexuality to their children. It has been proven that children who are appropriately sexuality aware are able to protect themselves more and become well-adjusted and responsible adults. g) Wise use of money. A child should be taught the value of money, thrift and selfreliance. When the child starts schooling, he/she is given a reasonable allowance, which he himself budgets. He/she could be provided with the opportunity to buy things such as school materials and supplies. As much as possible, the child should be made aware of his share in the family’s budget. To encourage wise 50

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spending, the child should be reprimanded for excessive buying or indulgence in expensive things. Likewise, he or she should be praised for wisely spending his/her money. On top of these, the child should see his own parents as wise spenders to be his role models.

3.

CHILDLESS COUPLES

Some couples, may not be able to have biological children. It does not mean, however, that they cannot have them. The usual way is by adoption. The law protects this right.

Article183 of the Family Code of the Philippines states that a person of age and in possession of full civil capacity and legal rights may adopt, provided he is in a position to support and care for his children, legitimate or illegitimate, in keeping with the means of the family. Only minors may be adopted, except in the cases when the adoption of a person of majority age is allowed in this Title.

In addition, the adopter must be at least sixteen years older than the person to be adopted, unless the adopter is the parent by nature of the adopted, or is the spouse of the legitimate parent of the person to be adopted. (27a, E. O. 91 and PD 603) Article184 further provides: The following persons may not adopt: (1) The guardian with respect to the ward prior to the approval of the final accounts rendered upon the termination of their guardianship relation; (2) Any person who has been convicted of a crime involving moral turpitude; (3) An alien, except: (a) A former Filipino citizen who seeks to adopt a relative by consanguinity; (b) One who seeks to adopt the legitimate child of his or her Filipino spouse; (c) One who is married to a Filipino citizen and seeks to adopt jointly with his or her spouse a relative by consanguinity of the latter.

Aliens not included in the foregoing exceptions may adopt Filipino children in accordance with the rules on inter-country adoptions as may be provided by law.

(28a, E. O. 91 and PD 603) Art. 185. Husband and wife must jointly adopt, except in the following cases: (1) When one spouse seeks to adopt his own illegitimate child; or (2) When one spouse seeks to adopt the legitimate child of the other.

(29a, E. O. 91 and PD 603) Art. 186. In case husband and wife jointly adopt or one spouse adopts the legitimate child of the other, joint parental authority shall be exercised by the spouses in accordance with this Code. (29a, E.O.) Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

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Adopted children enjoy all the rights and privileges and render all the duties and responsibilities of natural children.

Children are blessings in life and assets of the nation. As the future generation, every effort should be exerted to promote their welfare and enhance their opportunities for a useful and happy life. Children therefore, should not be seen as security of parents in their old age. (Video on the Rights of the Child c/o UNICEF).

4.

RIGHTS OF THE CHILD

Not only does the child have a right to basic necessities such as food, shelter and clothing; the child also needs to be provided with full and harmonious development of his or her personality, (and) should grow up in a family environment, in an atmosphere of happiness, love and understanding. With the support and protection of both human and divine law, parents are to be responsible in fulfilling the rights of their child - in his/her material, psycho-emotional, educational and moral-spiritual needs. (Marina Benipayo, Philippine Daily Inquirer; September 2, 2009).

To ensure that the rights of the child are not taken for granted nor forgotten, the Convention on the Rights of the Child (CRC) was ratified by the United Nations in 1990 and by member countries. The rights of the child can be clustered into four broad categories and summarized as follows: Survival and Development Rights These are rights to the resources, skills and contributions necessary for the survival and full development of the child. They include rights to adequate food, shelter, clean water, formal education, primary health care, leisure and recreation, cultural activities and information about their rights. These rights require not only the existence of the means to fulfill the rights but also access to them. Specific articles address the needs of child refugees, children with disabilities and children of minority or indigenous groups.8 101 a) Survival • The right to be born, to have a name and a nationality.

• To have enough food, clothing and shelter.

• To have a healthy and active body.

8108 UNICEF Convention on Rights of the Child Rights under the Convention on the Rights of the Child.web archive 52

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b) Development • • • • •

The right to have a family to take care of him or her.

To have a good education.

To develop his or her full potential.

To learn good manners and good conduct.

To be given the opportunity to play and have leisure.

Protection Rights These rights include protection from all forms of child abuse, neglect, exploitation and cruelty, including the right to special protection in times of war and protection from abuse in the criminal justice system.9112

c) Protection • To be given protection against all forms of abuse, neglect, danger and violence.

• To live in a peaceful community.

• To be defended and assisted by the government.

Participation Rights Children are entitled to the freedom to express opinions and to have a say in matters affecting their social, economic, religious, cultural and political life.

Participation rights include the right to express opinions and be heard, the right to information and freedom of association. Engaging these rights as they mature helps children bring about the realization of all their rights and prepares them for an active role in society.10123 d) Participation • To be able to express his or her views.

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5.

RESPONSIBILITIES OF CHILDREN

If children have rights, so do they have responsibilities. The Family Code of the Philippines is also clear on that. “Children shall always observe respect and reverence towards their parents and are obliged to obey them as long as the children are under parental authority”. (311a) Chan Robles virtual law library) 6.

DEALING WITH CHILDREN

Children should develop in an environment of love, understanding and respect.

Children imbibe what they see and hear, thus it is imperative that parents provide them good models of behavior. Parents should strive to make the home a haven of love, harmony and security.

There are techniques to encourage good behavior in children. These are: • Express affection to the child.

• Praise the child for good deeds.

• Give occasional rewards for accomplishments at home or in school.

Children misbehave and this may be due to the following reasons: This may be related to their need for attention and feelings of inadequacy. Parents should try to understand the situation the child is in.

Examples of misconduct are lying, throwing tantrums, destroying things and other destructive behavior. There are several techniques in managing young children’s misconduct: • Probe the reason for the misconduct.

• Ask them to stay in a corner.

• Take away privileges (e.g. No TV viewing, no playing, taking away toys for a time).

• Give them extra chores.

The following are basic behaviors that will help children grow as well-adjusted individuals:

• Should never use language, make suggestions or offer advice that is inappropriate, offensive or abusive.

• Never behave physically in a manner that is inappropriate or sexually provocative.

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• Never do things for children of a personal nature that they can do for themselves.

• Never condone, or participate in, behavior of children, which is illegal, unsafe or abusive.

• Never act in ways intended to shame, humiliate, belittle or degrade children, or otherwise perpetrate any form or emotional abuse.

• Never hit or otherwise physically assault or physically abuse children.

• Never develop physical/sexual relations with children.

• Never develop relationships with children that could in any way be deemed exploitative or abusive.

7.

MANAGING THE HOME

The couple not only shares the responsibility for managing and nurturing the family but the home and household as well. Among the things the husband and wife must attend to are: • • • •

Balancing income against expenses through budgeting Building savings and investments Maintaining hygiene and sanitation in the house and its surroundings Maintaining a healthy lifestyle for the family

Home Management is the process of planning, controlling and evaluating family resources to achieve family goals. Home management is a decision-making activity shared by the couple. It helps families and couples make maximum use of what they have to attain their goals and aspirations. Proper and wise management of time, energy and family finances are the key elements to effective home management.

Family Resources include time, energy, money, material goods, knowledge and skills of all the members of the family.

Family Goals are based on concrete human needs, and pertain mainly to the provision of basic needs, which are food, clothing and shelter. Beyond these basic needs, family goals may include the maintenance of health, education of children, security for the future and the full development of each member’s potentials.

The basic needs that a family has to provide for its members include food, housing, transportation, recreation, clothing, medical and dental needs, education, utilities like water, electricity, cooking fuel, etc. Family needs are numerous but family resources are often limited. Another fact that a family has to recognize early, in order to prepare for it as much as possible, is that financial demands vary at different stages of family life. For example, it is expected that when the children start going to school a bigger dent on family funds will be incurred than when they were just preschoolers. It is also Pre - Marriage Counseling Nurturing the Marriage and Family - A Content Guide

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expected that when the children go to college, a bigger portion of the family income will go to their education.

The family should also avail of PhilHealth, a health insurance service administered by the government for employed individuals and provided free indigent families. Free PhilHealth enrolment can be availed from the local government unit subject to certain inclusion criteria.

A common complaint among married couples is that, whatever they do, their money seems to be always lacking. It seems they are never able to earn enough for their needs. A prevailing current reality is that many young married couples start out without their own place and have to live with their parents. These couples will have to consider how to contribute to the resources of the household they live with. Moreover, there are couples that have no income. How will these couples derive their income?

There are many ways a family can cope with its needs. These are: • • • •

Allowing the wife to work or do part time work.

Having few children.

Following some simple rules in budgeting.

Learning to save.

No matter what income level it falls under, a family must have a budget.

Budget is a plan by which the important needs of a family are met in a satisfactory way through a well-thought out system of priorities.

Budgeting should be a joint decision-making between husband and wife. This will provide a constant consultation and communication regarding matters that will affect them. Money matters have to be handled carefully to prevent it from becoming a source of marital conflict.

Tips in budgeting: • Estimate the total income, which may come in the following forms: o Wages or salaries o Extra earnings or sidelines o Sale from home products or fruits/vegetables (backyard garden) o Additional amount from gifts or other sources 56

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• List down all items that the couple or the family has to spend on including estimates on each item.

• Subtract fixed expenses such as rental (house/room/apartment), utilities (water, electricity, etc), tuition, and other similar expenditures.

• The balance is divided for daily needs, such as food, clothing, transportation, health and recreation expenses, etc.

• As much as possible set aside 5% to 10% of the balance for saving.

This is important for emergency use as sickness, or for earning additional income like investments, or capital for a small business.

Another technique to stretch your money is to buy wisely.

Wise Buying is the art of getting goods that satisfy your needs at a minimum amount of time, energy and money. It is getting the most out of limited resources.

Tips in Wise Buying • Buy food that is cheap but nutritious. Take advantage of fruits and vegetables in season.

• Always check the expiry date of the food item bought.

• Buy clothes that can serve many purposes and can be worn on many occasions.

• Buy household equipment that is within your means.

• Buy on sound credit terms. Large down payments pay off quickly.

Advertising claims such as “No Down Payment” and “Long time to pay” mean greater costs.

• Avoid/limit the use of credit cards.

SAVING

Tips on saving: • Buy wisely.

• Learn to say “no” to salespeople who encourage “hulugan”. Establish priorities and resort to hulugan only for very important items.

• Avoid smoking/drinking liquor /gambling/junk foods. Aside from helping you to keep healthy, you can also save some amount.

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• Learn to recycle food, clothing, and other items. We are challenged to be creative in cooking, in learning to sew and other means of reusing items at home.

• Walk instead of taking a ride when your destination is only a short distance away. Aside from saving, the walk will provide exercise, which is good for your health.

• Plant vegetables in your backyard/pots. Your vegetables will always be fresh and you can sell the excess for extra money.

• Include savings in your budget items.

• Conserve energy and water.

• If you have a baby, breastfeed him/her. This is good for the baby’s health and for closer bonding between you and the baby.

• Learn to live within your means.

• Don’t overcook food. It is a waste on fuel.

• In case of illness, get medical care on time to prevent complications.

Complications mean greater expense.

• A fiesta, birthday or family reunion as an established tradition may be celebrated but not lavishly. Simple but attractive meals may be served.

Stress Management in the Home Some situations at home could create stress or anxiety to the couple. Common causes of stress at home include: • • • • • • • •

Lack of money, food and other resources Lack of communication Conflict in relationships Lack of clear rules and agreement Neglect in performance of roles and responsibilities, Too high expectation among family members and in-laws Too much dependency on one’s spouse Lack of skills in parental responsibilities

It is important to manage stress to maintain harmony and peace in the home. The couple should communicate, set family rules, agree on expectations of each other, perform their respective roles and responsibilities and hone their skills in parenting.

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Healthy Lifestyle for the Family Early on in the marriage, it is good to practice a healthy lifestyle. It is also good training for the children to come. Here are some tips for a healthy lifestyle: • Prepare and eat a well-balanced diet of nutritious foods, which may not necessarily be expensive • Avoid vices like smoking, drinking and staying late • Avoid stress by exercising, listening to pleasant music, reading and similar hobbies • Maintain cleanliness and sanitation in the home and surroundings • Avoid excess of any kind- in eating, drinking, playing, etc • Have a happy disposition.

Learning Points and Key Messages  It is the duty and responsibility of parents to develop their children to become useful and productive Filipino citizens.  Children have rights and parents must respect and observe these rights.  Adopted children enjoy all the rights and privileges and render all the duties and responsibilities of natural children.  It takes two to manage a home: “ One plus One = One”  It takes a couple to raise a family.  It takes a family to build a home  Home management promotes successful marriage and relationships.  Small family size facilitates budgeting, saving and living within one’s means  “Kung may isinuksok may dudukutin”  The family that prays together stays together.

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Part IV: Ending the Pre-Marriage Counseling Session

Synthesizing the Session

Ending the Pre-Marriage Counseling Session Synthesizing the Session

Part IV: Ending the Pre-Marriage Counseling Session

Synthesizing the Session

At this juncture, the Counselor should be able to conduct an open forum and then synthesize the whole session. Here is a summary of messages to leave the premarriage orientation participants:  Marriage is a life-long legal, moral and spiritual commitment between two people who love each other and voluntarily entered into the union. The establishment, management and nurture of the family and the home and the relationships within the family and home and outside of them is a joint and shared responsibility of the couple.  Men and women are different physically, physiologically and emotionally, but they complement each other. Learn to adjust to these differences between the sexes so you will better understand and live happily with each other.  There is no place for domestic violence in the home.  The couple should at all times strive for harmony in the home, discuss and resolve marital and family crises, and remain faithful to and respectful of each other. A well-managed home should be free of stress  Have only the number of children you can afford and able to give the best that you can give.  Children are blessings and the couple should treasure those blessings by showering them with love and care, which can be demonstrated by parents by giving their children the best shelter, education, and observing their rights so they will become good human beings and useful and productive citizens.  Know the services provided by the government through various offices in the city or municipality where you reside like health centers, barangay councils for the protection of women and children, social welfare and development, agriculture, and other offices.  Remember the elements of a successful marriage and you, as couples cannot go wrong.

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Pre-Marriage Counseling Nurturing the Marriage and Family

- A Process Guide

PROCESS GUIDE

Purpose of the Pre Marriage Counseling Process Guide The Pre Marriage Counseling (PMC) Manual Process Guide is a tool for PreMarriage Counselors in running a four-hour session with engaged couples.

This Process Guide is a companion manual to the Pre-Marriage Counseling ManualA Content Guide.

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Pre-Marriage Counseling Session Design Time Alloted 30 minutes

Session Objective To set the tone of the Pre-Marriage Counseling Session

Topic for Discussion Setting the Tone of the Session • Welcome and Introductions • Purpose of the Pre Marriage Counseling Session – PD 965 • Objectives of the PMC

40 minutes

To enable engaged Marriage and couple-participants to Relationships learn about Marriage and Relationships Definition of Marriage:

Tools and/or Materials Needed PMC Manual – A Content Guide (Part II – Setting the Tone) Let couples introduce themselves Audio Visual Aid/ Visual Aid Laptop and LCD (if available) PMC Manual – A Content Guide (Part III – A. Marriage and Relationships)

Audio Visual Aid/ Visual • What God says Aid about marital union Laptop and LCD (if available) • What the law says about Marriage (New Family Code)

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Time Alloted

Session Objective

Topic for Discussion Purpose of Marriage

Tools and/or Materials Needed

• Elements of a Good Marriage • Roles and Relationships 1. As Husband and Wife 2. As In-Laws 3. As Parents Other Supportive Laws • RA 9262 – Anti-Violence Against Women and their Children Act of 2004 • RA 9710 Magna Carta of Women (2009 • Presidential Decree 603 – The Child and Youth Welfare Code • Republic Act 7610 - “Special Protection of Children AgainstAbuse, Exploitation and Discrimination Act.” Pre - Marriage Counseling Nurturing the Marriage and Family - A Process Guide

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Time Alloted

Session Objective

Topic for Discussion • P.D. No. 965 (1976) – Requiring marriage applicants to receive instructions in family planning and responsible parenthood • P.D. No. 1202 (1974) – Reduction of four of paid maternity leaves • Republic Act 8187 (1996) – An Act Granting Paternity Leave of Seven Days with Full Pay to All Married Male Employees in the Private and Public Sectors for the First Four Deliveries of the Legitimate Spouse with Whom He is Cohabitating and for other Purposes

Tools and/or Materials Needed

Key Learning Points and Messages

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Time Alloted 1.75 hours divided into: 20 minutes for Human Sexuality; 40 minutes for MNCHN; 30 minutes for FP 15 minutes for STIs and HIV; 5 minutes for Key Learning Points

Topic for Discussion To enable engaged Building the couple-participants to Family learn about concepts and practical matters Human Sexuality about Building the • Male and family Female Differences • Importance of Human Sexuality to Married Couples • Sexual Relationship Session Objective

Tools and/or Materials Needed PMC Manual – A Content Guide (Part III – B. Building the Family) Audio Visual Aid/ Visual Aid

Laptop and LCD (if available)

Maternal, Neonatal, Child Health and Nutrition (MNCHN) • Dynamics of Fertility- Male and Female Reproductive Systems and Fertility; • Joint Fertility • Pregnancy • Pre Natal Care • Caring for the Baby (Newborn screening, breastfeeding, immunization, growth monitoring)

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Participatory Learning Activity – Ask participants to identify the parts of the male and female reproductive systems

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Time Alloted

Session Objective

Topic for Discu • Planning the Family • What isFP • Importance and Benefits of FP • FP Methods • Making Choices for FP

Tools and/or Materials Needed Samples of FP methods (BBT, SDM necklace, IUD, Pills, Condom, Injectable, etc)

• Sexually Transmitted Infections and HIV and their Prevention • Key Learning Points and Messages

40 minutes

To enable engaged couple-participants to learn about concepts and practical matters about shared responsibility in caring for the home and family.

Caring for and Managing the Home-A Shared Responsibility

PMC Manual – A Content Guide (Part III – D. Caring For and Managing the Family and the Home – A Shared Responsibility)

• Responsible Parenthood • Duties and responsibilties of parents Audio Visual Aid/ • Childless couples Visual Aid • Rights of the Child • Dealing with Children Laptop and LCD (if available) • Managing the Home • Tips in Budgeting, Wise Buying and Saving

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Time Alloted

Session Objective

Topic for Discu

Tools and/or Materials Needed

• Healthy Lifestyle for the Family • Key Learning Points and Messages Synthesizing the PMC Session • Open Forum • Summarizing Key Learning Points and Messages • Distribution of IEC Materials 20 minutes

Synthesizing the PMC Session • Open Forum • Summarizing Key Learning Points and Messages • Distribution of IEC Materials

PMC Manual – A Content Guide (Part IV – Ending the Pre-Marriage Counseling Session) Laptop and LCD (if available) IEC materials

Total number of minutes – 240 = 4 hours

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Preparing for the Pre-Marriage Counseling Session The Pre-Marriage Counseling (PMC) session is a learning activity designed for engaged couples as a requirement for getting their marriage license. To ensure that the four-hour session achieve its objectives, it is important to consider several factors that will make the learning exercise productive. These are: 1.

Physical Arrangement and Privacy of the Venue

As much as possible, the seating arrangement should be conducive to optimum interaction between and among the PM counselors and the PMC participants. It is best to seat the participants in a semi-circular arrangement where they can adequately view the whiteboard or the visual aids. Ideally, the room should be clean, comfortable, well lighted, private and free from outside noise.

2.

Completeness of the Equipment and Materials to be used during the session

The PMC team should ensure that all the equipment and materials (examples: whiteboard and markers, audio/visual materials, sound system, IEC materials, Identification cards, participant profile sheet, attendance sheet, music) are complete and placed where they can be easily retrieved for use.

Be ready with energizing activities to break the monotony of the session. Examples of the icebreakers are provided in this process guide.

3.

Personal Grooming of the Pre-Marriage Counselors

The members of the PMC team are professionals and respected in the community.

They should always present themselves in the session in appropriate attire and appearance.

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Welcoming and Building Rapport with the PMC participants • It is recommended that the PMC Team assign a member to greet the participants as they come and ask them to fill in the participant profile sheet and the attendance sheet.

• Then give each an identification card as they register.

• Take advantage of this phase also to let the participants write their expectation of the PMC session in a meta card.

• Use this opportunity to begin establishing rapport with the participants through small talk, if you have the time.

• Provide a nametag for each participant. This will help the educator to call every participant by his or her first name.

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Principles of Adult Learning Adults learn differently from children. Knowing the principles of adult learning will help the PM counselors adjust their style and manner of instruction. These principles are: 1. Adults will commit to learn when their goals and objectives are important to them.

2. Adults want to be the origin of their own learning. Adults want control over what, who, why, when and where of their learning.

3. Adult learners need concrete experiences.

4. Adults will commit to learn when their goals and objectives are important to them.

5. Adults want to be the origin of their own learning. Adults want control over what, who, why, when and where of their learning.

6. Adult learners need concrete experiences.

7. Adults need to participate to reflect, share and generalize their learning experiences.

8. Adults are self-directed. They have interests and competencies.

9. Transfer of learning for adults is not automatic and must be facilitated.

Principles of Learning 1.

2.

3.

4.

5.

6.

We learn by doing.

We learn to do what we do and not something else.

Without motivation, there can be no learning at all.

For effective learning, responses must be immediately reinforced Meaningful content is better learned and longer retained.

For the greatest amount of transfer, learning responses should be learned in the way they are going to be used.

7. One’s response will vary according to hoe one perceives the situation.

8. An individual’s responses will vary according to the learning atmosphere.

9. One does the only thing one can do given the physical, background and present acting forces.

10. Learning transfer does not happen automatically unless reinforced by action 11. Experts say that people retain:

10% of what you read

20% of what you hear

30% of what you see

50% of what you see and hear

70% of what you say

90% of what you say as you do or what the learners does 76

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What is Facilitation?

The Pre-Marriage Counseling session should be as interactive as possible to ensure optimum learning experience for the engaged couples. To achieve this, the PM counselors should also be good facilitators. Facilitation is helping people achieve objectives by deliberately intervening in the process. It is the process of drawing out from the learners on how to relate information to experiences and learning objectives.

Since the PMC counselor is facilitating a group learning activity, he/she should: • Describe the purpose or desired outcome (What’s in it for me?)

• Ensure the task is clear and acceptable.

• Provide information.

• Structure the discussion.

• Ask questions.

• Clarify individual contributions.

• Summarize the discussion.

• Manage the interaction.

• Provide direction.

• Provide feedback.

• Confront the challenges.

• Provide support and affirmation.

• Keep a record.

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Tips and Good Practices in Facilitation 1. Personal grooming is necessary. Maintain a pleasant voice and tone, gestures and facial expression.

2. Keep an upbeat stance throughout the duration of the session. Create a fun environment.

3. Strategically use various forms of energizers at different points of the session to sustain the attention of the participants 4. Mastery of the subject matter is key to a good sharing session 5. Use introductory techniques for topics – examples: • asking questions or opinions of the participants on the topic on hand • distributing “question cards” to participants, requesting them to read these aloud and answering them • distributing “statement cards to participants, requesting them to read these aloud and asking whether they agree with the statement and why 6. Make the session an interactive and self-discovery based exercise. Encourage the participants to ask questions or give opinions 7. Respect your learners.

8. Make your presentation interesting by: • Using visual aids • Asking probing questions • Being personable • Sticking to the time • Speaking clearly and loud enough to be heard • Showing enthusiasm and interest 9. Don’t force in your values and viewpoints 10. Refrain from talking about yourself and your experiences 11. Link/weave the preceding topic with the succeeding topic 12. Always thank the previous speaker and introduce yourself to the participants before discussing your assigned topic.

13. Regularly check if the attention of the participants is still engaged.

14. From time to time, a good technique to raise the energy of the participants is to ask them to read together loudly key learning points.

15. Act as a team and ensure the members of the PMC Team know his/her specific roles and assignment.

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More Tips… Keeping the Audience Engaged One way of sustaining the interest the participants is by stimulating their minds through questions. There are several ways of asking questions. Examples are: Conceptual clarification questions

Probing implications and consequences

Why are you saying that?

What exactly that this mean?

How does this relate to?

What do we already know about this?

Can you give me an example?

Can you rephrase that please?

Then what would happen?

What are the consequences?

How could … be used to...?

How does … affect...?

Why is ... important?

What is the best ...? Why?

Probing rationale, reasons and evidence

Questions about questions

Why do you think I asked the question?

Why is this happening?

What was the point of asking the question?

Can you show me…?

What does that mean?

What do you think are the causes?

What evidence is there to support what you are saying?

Are these reasons good enough?

Questioning viewpoints and perspectives Why is it necessary?

Another way of looking at this is…

What is the difference between..and...?

What if...?

Who benefits from this?

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Running the Actual Pre-Marriage Counseling Session Setting the Tone of the Pre-Marriage Counseling – 20 minutes Objective: To set the tone of the Pre-Marriage Counseling Session, build rapport and to encourage a lively interaction between the PM counselor and among the participants Topic/Activity Welcome and Introductions Maximum of 15 minutes

Process and Tools In order to establish rapport with the participants from the very beginning, the Pre-Marriage Counseling Team Leader or PM counselor welcomes the participants to the session and introduces him/herself to the participants, then ask each couple to introduce themselves in the following manner: Please stand up and face the audience and state your: 1.

2.

3.

4.

Names Place of origin(s) Occupation(s); and How long they have been in the relationship 5. Their personal expectation of the PMC Then relate the expectation of the participants to the overview of the PMC session.

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Topic/Activity

Process and Tools Establish the house rules namely: 1. No wrong answers 2. Listen 3. Confidentiality The PM counselor wraps up the introduction sessions in an upbeat manner.

Introducing the PMC Session • Purpose of the Pre Marriage Counseling Session – PD 965 • Objectives of the PMC Maximum of 15 minutes

Begin this topic by asking the participants if they know why they are attending the PMC session. Then use the responses as springboard for discussion.

Then give the inputs on: • Purpose of the Pre Marriage Counseling Session – PD 965 • Objectives of the PMC Flash the PowerPoint presentation if available or a flipchart or any visual aid.

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Marriage and Relationships – 40 minutes Objective: To enable engaged couple-participants to learn about Marriage and Relationships Topic/Activity Definition of Marriage: • What God says about marital union • What the law says about Marriage (New Family Code) • Purpose of Marriage Maximum of 10 minutes

Process and Tools To initiate the discussion on the topic, ask volunteers to define marriage. Then use the responses as springboard for discussion.

Then give the inputs on: • What God says about marital union • What the law says about Marriage (New Family Code) –definition, and requisites of marriage Then summarize by stating the Purpose of Marriage Flash the PowerPoint presentation if available or a flipchart or any visual aid.

Elements of a Good Marriage Maximum of 5 minutes

Continue engaging the participants by asking: In your opinion, what makes a good marriage? Then use the responses as springboard for discussion.

Then affirm and add on the responses of the participants.

Flash the PowerPoint presentation if available or a flipchart or any visual aid.

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Topic/Activity Roles and Relationships • As Husband and Wife • As In-Laws • As Parents Maximum of 5 minutes

Process and Tools Discuss with the participants that getting married brings one to enter various relationships where one also assumes different roles depending on the kind of relationship.

Give inputs on being: • A husband or wife (citing the provisions of the New Family Code) • An in-law; • As a parent (just introduce briefly and say that this particular topic will be discussed more lengthily in the latter part of the session.)

Flash the PowerPoint presentation if available or a flipchart or any visual aid.

Other Supportive Laws • RA 9262 –Anti-Violence Against Women and their Children Act of 2004 • Magna Carta of Women (2009) • Presidential Decree 603 – The Child and Youth Welfare Code • Republic Act 7610 - “Special Protection of Children Against Abuse, • Exploitation and Discrimination Act.” Maximum of 10 minutes

Introduce that aside from the New Family Code, there are other laws that protect wives and children from domestic violence and other forms of abuse.

Then provide inputs on these laws in as simple a manner you can make on the following: • RA 9262 –Anti-Violence Against Women and their Children Act of 2004 • RA 9710 Magna Carta of Women (2009) Presidential Decree 603 – The Child and Youth Welfare Code • Republic Act 7610 - “Special Protection of Children Against Abuse, • Exploitation and Discrimination Act You can cite practical examples of the violence of these laws.

Flash the PowerPoint presentation available or a flipchart or any visual aid

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if

Topic/Activity Process and Tools Key Learning Points and Messages Summarize the session by repeating the key learning points.

Maximum of 5 minutes • Marriage is a life-long partnership between a man and a woman- two different individuals who love, understand, respect and care for each other. It is an active relationship in which both partners grow and develop their best qualities as persons, within the protection of laws.

• The husband and wife enjoy equal rights in all matters relating to marriage and family relations.

• There are laws that provide protection against all forms of domestic and gender-based violence.

Being aware of these laws may prevent the occurrence of domestic violence.

• The in-laws are the couple’s extended family. The couple should strive to get along well with their in-laws without jeopardizing the welfare of their nuclear family.

Flash the PowerPoint presentation available or a flipchart or any visual aid

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Building the Family – 120 minutes or 2 hours Objective: To enable engaged couple-participants to learn about concepts and practical matters about building the family.

Topic/Activity Human Sexuality • Male and Female Differences • Importance of Human Sexuality to Married Couples • Sexual Relationship Maximum of 20 minutes

Process and Tools Introduce the topic through a participatory learning activity.

Ask the participants to stand up and form two lines – a female line and a male line.

Swiftly, ask the women to enumerate the sexual characteristics (physical and biological,) of males and likewise, ask the men to enumerate the same of females.

Process the responses and validate by discussing the Male and Female Differences.

Discuss the following: • Importance of Human Sexuality to Married Couples • Sexual Relationship Flash the PowerPoint presentation if available or a flipchart or any visual aid.

Entertain a few questions from the audience at this time.

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Topic/Activity Maternal, Neonatal, Child Health and Nutrition (MNCHN)

Process and Tools Define Fertility and explain the dynamics of fertility.

• Dynamics of Fertility- Male and Female Reproductive Systems and Fertility; • Combined or Joint Fertility • Pregnancy • Pre Natal Care • Caring for the Baby (Newborn screening, breastfeeding, immunization, growth monitoring)

Ask participants to identify the parts of the male and female reproductive systems.

Maximum of 40 minutes

This activity usually elicits embarrassment and laughter among the participants. The PM counselor should endeavor to make the participants realize that talking about sex should be a natural and wholesome exercise.

Discuss the following in a comprehensible manner: • Dynamics of Fertility • Male and Female Reproductive Systems/ Threats to Male and Female Fertility • Combined or Joint Fertility Relate the following topic – Pregnancy to the previous topic (Fertility). Mention also that the couple should as much as possible plan the pregnancy to insure their mental, physical and financial readiness for the pregnancy and caring for a child.

Then provide inputs on: • Pregnancy • Pre Natal Care • Caring for the Baby (Newborn screening, breastfeeding, immunization, growth monitoring) Flash the PowerPoint presentation if available or a flipchart or any visual aid.

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Topic/Activity Planning the Family • • • •

What is FP Importance and Benefits of FP FP Methods Making Choices for FP

Maximum of 30 minutes

Process and Tools Discuss that one way of ensuring a comfortable life is through the practice of family planning.

Provide inputs on • What is FP • Importance and Benefits of FP • FP Methods • Making Choices for FP Show samples of the FP method as they are introduced (BBT, SDM necklace, IUD, Pills, Condom, Injectable, etc) Flash the PowerPoint presentation if available or a flipchart or any visual aid.

Sexually Transmitted Infections and Say that one way of showing love for one’s HIV and their Prevention spouse is ensuring that he or she is safe from health risks like sexually transmitted • STIs diseases.

• HIV and AIDS Then discuss: Maximum of 15 minutes • Sexually Transmitted Infections and HIV and their Prevention • STIs • HIV and AIDS Briefly show the different STIs and HIV and explain what these visuals are.

Flash the PowerPoint presentation if available or a flipchart or any visual aid.

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Topic/Activity Process and Tools Key Learning Points and Messages Summarize the session by repeating the key learning points: Maximum of 3 minutes • Men and women complement each other. Understanding and respecting each other’s differences, can help achieve and maintain the marriage.

• Sexual relationship is for the mutual satisfaction of both partners. Every sexual act therefore should be with mutual consent of partners.

• Family planning saves lives, promotes family health and happiness and work life balance • Abortion is not a family planning method. It is illegal in the Philippines.

• All couples have the right to full information and services on family planning • A woman should immediately visit a health facility as soon as she suspects or feels she is pregnant.

Care must be taken to ensure her health and safety and the normal and healthy development of the baby.

• Prenatal care promotes safe pregnancy and delivery of healthy baby.

• Every pregnant woman should have a Birth Plan, a document prepared during the prenatal care which states the woman’s conditions during pregnancy; her preferred place of delivery and choice of birth attendant; resources available for her childbirth and newborn baby; and importantly, preparation needed should an emergency situation arise during pregnancy, childbirth and postpartum.

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Topic/Activity • • • •

•

Process and Tools Breast milk provides optimum nutrition, protects the baby from illnesses.

Breastfeeding promotes the mother’s health and enhances bonding between mother and child Have the children immunized against diseases HIV infection and AIDS incurable, but preventable. Protect yourself, your spouse and future children against HIV and AIDS The health centers provide a variety of services, which include family planning, pre and postnatal care, childcare and counseling. Every city and municipality in the country has a health center.

Flash the PowerPoint presentation available or a flipchart or any visual aid

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if

Caring for and Managing the HomeA Shared Responsibility- 40 minutes Objective: To enable engaged couple-participants to learn about concepts and practical matters about shared responsibility in caring for the family and managing the home.

Topic/Activity Responsible Parenthood • Duties and Responsibilities of Parents • Childless Couples • Rights of the Child • Dealing with Children Maximum of 15 minutes

Process and Tools Introduce the topic by asking the participants their opinion of how to show that one is a responsible parent. Use the responses as springboard for discussion.

Then provide inputs on the following: • Duties and Responsibilities of Parents • Childless Couples • Rights of the Child • Dealing with Children Flash the PowerPoint presentation if available or a flipchart or any visual aid

Managing the Home • Tips in Budgeting, Wise Buying and Saving

Give tips on: • Budgeting • Wise buying • Building savings

Maximum of 10 minutes

Flash the PowerPoint presentation if available or a flipchart or any visual aid

Healthy Lifestyle for the Family

Briefly describe different aspects of a healthy lifestyle with some practical examples.

Maximum of 10 minutes

Flash the PowerPoint presentation if available or a flipchart or any visual aid

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Topic/Activity Process and Tools Key Learning Points and Messages Summarize the session by repeating the key learning points: Maximum of 5 minutes • It is the duty and responsibility of parents to develop their children to become useful and productive Filipino citizens.

• Children have rights and parents must respect and observe these rights.

• Adopted children enjoy all the rights and privileges and render all the duties and responsibilities of natural children.

• It takes two to manage a home: “ One plus One = One” • It takes a couple to raise a family.

• It takes a family to build a home • Home management promotes successful marriage and relationships.

• Small family size facilitates budgeting, saving and living within one’s means • “ Kung may isinuksok may dudukutin” • The family that prays together stays together.

Flash the PowerPoint presentation if available or a flipchart or any visual aid.

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Ending the Pre-Marriage Counseling Session - 20 minutes Objective: To summarize the entire session and enable the participants to remember key learning points.

Topic/Activity Ending the Pre-Marriage Counseling Session Maximum of 20 minutes

Process and Tools Synthesizing the PMC Session At this point, the PM counselor should be able to conduct an open forum and then synthesize the whole session.

During the Open Forum, be sure to traffic the flow of discussion. Ensure that the answers given to the participants during the open forum are accurate and clear. Always ask the “questioner” if he or she is satisfied with the answer.

Then summarize the Key Learning Points and Messages •

•

• •

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Marriage is a life-long legal, moral and spiritual commitment between a man and a woman who love each other and voluntarily entered into the union.

Men and women are different physically, physiologically and emotionally, but they complement each other. Understanding and adjusting to these differences will make for a good marriage.

There is no place for domestic violence in the home.

The couple should at all times strive for harmony in the home, discuss and resolve marital and family crises, and remain faithful to and respectful of each other.

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Topic/Activity

Process and Tools • • • • •

Have only the number of children you can afford and able to give the best that you can give.

Shower your children with love and care. Give them the best shelter and education.

Respect and observe their rights so they will become good human beings and useful and productive citizens.

Strive for harmony in the family and the home. Work hard; build savings to realize financial stability.

Know the services provided by the government through various offices in the city or municipality where you reside like health centers, barangay councils for the protection of women and children, social welfare and development, agriculture, and other offices.

Remind the participants of the next steps in processing their application for marriage license.

Award/distribute the certificates of completion of the Pre-Marriage Counseling.

End the session in an upbeat manner by doing a last activity with the PMC participants like community singing or asking for feedback from them.

Flash the PowerPoint presentation if available or a flipchart or any visual aid.

Distribute IEC Materials

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Sample Energizers 1. Getting to Know You Exercises/Grouping Goals • • • • •

Group yourselves according to the birth month Group yourselves according to year in school Group yourselves according to birth place Group yourselves according to age Group yourselves according to the shapes you have; or according to color; (lottery and shapes in color)

2. Friend, what are you doing?

Let the participants stand in a circle. The first person does an action and the person next to her asks: “Friend, what are you doing?” The answer is for instance: “eating”. The person asking then mimes the action of eating. Then the next person asks: “Friend, what are you doing?” and the answer comes: “I am cooking”. The next person mimes cooking… and so on until everyone gets to mimic.

3. Pamilya Animalia Sa isang kagubatan, tumawag ng meeting ang leon. Tinawag niya ang mga palaka, agila, ahas, unggoy, bibe.

“Duon po sa amin may nagpulong Mga hayop sa gubat, pinaghahanap ng leon Ang sabi ng palaka, etc. (animal respond with respective sounds and movements)” 4. Mirroring Group the participants in pairs - one is the mirror, and the other is the looker. The looker will make faces or actions, which the mirror must then copy as if the person were looking in a mirror. Then switch roles.

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Annexes

Recommended Selected Readings for Pre-Marriage Counselors

Republic Act 9710 Magna Carta of Women (2009) Different family-related laws: P.D. No. 1202 (1974) – Reduction to four of paid maternity leaves P.D. No. 965 (1976) – Requiring marriage applicants to receive instructions on family planning and responsible parenthood New Family Code of the Philippines (Executive Order 209, 1987) Republic Act No. 7610, June 17, 1992. An Act Providing For Stronger Deterrence and Special Protection Against Child Abuse, Exploitation and Discrimination, and For Other Purposes Republic Act 8187 (1996) – An Act granting Paternity Leave of Seven Days with Full Pay To All Married Male Employees in the Private and Public Sectors for the First Four Deliveries of the Legitimate Spouse with Whom He is Cohabitating and for Other Purposes Republic Act 8504 - Philippines AIDS Prevention and Control Act of 1998 Republic Act 9262 –Anti-Violence Against Women and their Children Act of 2004

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Amendments to the Revised Pre-Marriage Counseling (PMC) Implementing Guidelines of 2002 I. Background and Rationale The requirement to provide all engaged couples instructions on family planning (FP) and responsible parenthood (RP) emanated from the issuance of the 1976 Presidential Decree (PD) No. 965 by the late President Ferdinand Marcos. The PD designated the Commission on Population (PopCom), the coordinating agency of the country’s population program, to issue implementing guidelines and accredit public health officers and non-state entities and actors to conduct pre-marriage counseling (PMC) for Family Planning and Responsible Parenting (FP-RP). A PMC training manual was developed for pre-marriage counselors at this time.

In 1989, PopCom’s FP Program including the coordination of the PMC was transferred to the Department of Health. With the passage of the 1988 Family Code, a new provision stipulated that if the engaged couple-applicants for a marriage license are below 25 years old, they should attach a certificate that a solemnizing officer or a duly-certified marriage counselor, implying that they have undergone marriage counseling. The Department of Social Welfare and Development was designated as the government agency that will provide marriage counseling, issue guidelines and standards, and accredit counselors.

The enactment of the 1991 Local Government Code led to the devolution of the national government agencies’ functions to local government units including the pre-marriage counseling services. The PMC manual was subsequently revised in 1996 and it served as the main reference and training tool for PMC counselors.

On March 6, 1998, the POPCOM Board of Commissioners approved the issuance of Implementing Guidelines to the local government units. A Joint Memo Circular on PMC Implementing Guideline was subsequently issued by DOH, DSWD, DILG and POPCOM and disseminated to the LGUs. The guidelines define the roles of LGUs, national agencies, individuals and other entities in the efficient and effective delivery of PMC services. The guidelines enjoined LGUs to convene a PMC Team and implement a PMC program using the guidelines.

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The PMC Joint Memo Circular issued in 1998 was revised in 2002. The revised circular was disseminated to the LGUs through a Memo Circular issued by the Department of the Interior and Local Government to its regional offices. This joint circular 2002 stipulated the composition, eligibility requirements, and functions of the PMC team, the roles of the implementing agencies, the PMC service protocol, the training of PMC counselors, and funding mechanisms (see appendix). It specified that the three (3) agencies should be mandatory members of the PMC team particularly the local Health Office, DSWD, and the Commission on Population. “At least one (1) member is a DSWD-accredited marriage counselor for couples less than 25 years old.� The total number of hours for the PMC session is eight and this can be conducted in one day or two half-day sessions.

After almost seven (7) years since its issuance, there is a need again to review the existing guidelines to address issues and emerging concerns coming both from the national and field levels. Observations and feedback about the LGU implementation from the partner agencies called for the need to conduct a qualitative assessment study in mid-2009 to make appropriate revisions of the 1996 PMC manual and the 2002 PMC Implementing Guidelines. The major research findings showed, among others, that the PMC sessions were conducted by the PMC teams for four and less hours, that the training manual was useful but it needed updating and revision, that there is a need for annual LGU allocation.

While the implementation of the PMC program is a devolved function under the law, the LGUs, however, continued to rely on guidelines and standards formulated by the national agencies. Thus, these Amendments to the Revised PMC Implementing Guidelines of 2002 and the 1996 PMC Manual.

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Department of Interior and Local Government Department of Health Department of Social Welfare and Development Commission on Population Joint Memorandum Circular No. ____ Series of _____ To :

All Provincial Governors, City/Municipal Mayors, Civil Registrars, Pre-Marriage Counselors and Parties to Intended Marriages

Subject: Amendments to the Revised Pre-Marriage Counseling (PMC) Program Implementing Guidelines of 2002 Recognizing the significant role of parents in shaping the future of Filipino children, a revised Pre-Marriage Counseling Manual has been developed as a vital tool in disseminating accurate and important information about marriage and relationships, human sexuality, maternal, child, and neonatal health, family planning, STIs including HIV/AIDS, responsible parenthood and home management to engaged couples.

Pursuant to PD 965, the new Family Code, and the Local Government Code and for the efficient and effective delivery of the Pre-Marriage Counseling Program services, all cities/municipalities are enjoined to organize Pre-Marriage Counseling teams and implement the PMC Program using the following guidelines.

I. The PMC Team The city/municipal mayors shall organize the PMC team composed of the following: A. Composition Team Leader : Appointed Population Officer or the Designated Population Officer by the Local Chief Executive (LCE) Members : Pre-Marriage Counselors from the following government agencies and civil society and faith-based organizations Government agencies  City/Municipal Health and Nutrition Office  City/Municipal Social Welfare Development Office  City/Municipal Population and Development Office 102

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City/Municipal Agriculture Office Department of Education City/Municipal District Office The PMC team shall comprise of a minimum of three (3) and maximum of five (5) members depending on the availability of the counselors from the foregoing organizations. The selected counselors from the government agencies in Health and Nutrition, Social Welfare and Development, and Population are mandatory members. Those from Education, Agriculture, Civil Society Organization (CSO) and Faith-based organizations are optional members. The PMC team member from Education should be a guidance counselor of a local public school. The PMC team member from Agriculture should be a local extension worker. It is mandatory for PMC team to invite non-government organizations (NGOs) and faithbased organizations (FBOs). Having team members from NGOs could provide the perspectives of non-state community-based actors while those from faithbased organizations could give the spiritual dimension for the PMC program.

The city/municipal mayor has the option to increase the team membership.

He/she should ensure the timely replacement or renewal of mandated team members upon the expiration of their terms of office as counselors.

B. Eligibility requirements Members of the PMC team should have undergone the training using the 2009 PMC Manual Content and Process Guides and trained/certified by the Commission on Population. At least one member of the PMC team is a Department of Social Welfare & Development-accredited marriage counselor for engaged couple applicants below 25 years old.

C. Functions The PMC team is expected to discharge the following: 1. Develop and maintain a responsive mechanism to effectively implement the PMC program in the city/municipality.

2. Advocate for the effective implementation of the PMC Program to ensure continued awareness and support for the program.

3. Undertake preparatory activities for the PMC sessions by a. Disseminating information about the PMC program through the radio, community assemblies, barangay meetings, and other media outlets.

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b. Posting schedules of PMC sessions in the offices of the Local Civil Registrar Office, offices of the mandatory members of the PMC team, and other noticeable places in the city/municipal hall. c. Ensuring appropriateness, readiness and availability of a venue for PMC sessions. d. Preparing schedules of PMC sessions for mandatory team members to enable them to plan these activities. e. Ensuring the availability of PMC supplies and materials.

4. Conduct a PMC session to not more than 15 couples at a time.

5. Issue PMC certificates which are signed by accredited mandatory PMC team members to engaged couples who have completed the PMC session.

II. Roles of Local bodies A. City and Municipal Level 1. City/Municipal Mayor a. Effect the implementation of the PMC Program particularly the issuance of circular/directives for an effective and responsive PMC Program implementation including the provision of an annual budget for the PMC team and the effective conduct of PMC sessions. b. The provision of support for PMC implementation including the (1) venue for the sessions; (2) supplies and materials; (3) Basic and refresher training of the PMC team; and 4) meals, transportation and allowances of the PMC Team. c. Supervise the PMC implementation, monitoring, and evaluation.

2. Sanguniang Panglunsod/Pambayan Pass/adopt ordinances in support of the PMC Program to include recurrent annual budgets for the PMC team and their clients.

3. City/Municipal Population Office or designated office a. Serve as the focal office/secretariat of the PMC team b. Prepare a quarterly report and submit to PopCom Regional Population Office furnish copies to Department of Health-Center for Health Development (DOHCHD) and Department of Social Welfare and Development-Field Office (DSWDFO) and the city/municipal mayor’s office. c. Organize and conduct training of PMC team members.

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d. Ensure that the PMC session is conducted as a team effort. e. Maintain records and files of the PMC Program.

4. City/Municipal Health Office a. Serve as member of PMC Team b. Conduct PMC sessions together with other mandatory agencies c. Collaborate with the mandated agencies in ensuring that the PMC Program is implemented efficiently and effectively 5. City/Municipal Social Welfare and Development Office a. Serve as member of PMC Team b. Conduct PMC sessions together with other mandatory agencies c. Collaborate with the mandated agencies in ensuring that the PMC Program is implemented efficiently and effectively 6. Local Civil Registrar Office Release the marriage license upon presentation of the duly signed PMC certificate.

B. Provincial Level 1. Provincial Governor Issue an Executive Order to all city/municipal mayors directing them to implement an effective and efficient PMC Program in their respective localities.

2. Sanguniang Panlalawigan Pass/adopt an ordinance in support of the PMC Program implementation.

3. Provincial Health Office Collaborate with the other two agencies with mandatory team members in the training of the city/municipal PMC team.

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4. Provincial Social Welfare and Development Office Collaborate with the other two agencies with mandatory team members in the training of the city/municipal PMC teams.

5. Provincial Population Office a. Lead the training of trainers for PMC at the provincial level b. Collaborate with the and PSWD in the training of the city/municipal PMC teams.

III. Roles of National and Regional Coordinating Agencies 1. Department of Interior and Local Government (DILG) a. Issue a Memorandum Circular to all LGUs regarding the PMC implementation based on the PopCom Board Resolution. b. Monitor compliance to the Memorandum through the regional Department of the Interior and Local Government.

2. Department of Health (DOH) Central Office a. Provide financial and technical assistance to CHDs/LGUs. b. Advocate for the effective implementation of the PMC Program.

The Centers for Health Development (CHD) a. Provide financial and technical assistance to LGUs concerning the PMC Program. b. Advocate for the effective implementation of the PMC Program. c. Coordinate with PopCom and DSWD in monitoring the PMC Program 3. Commission on Population (PopCom) PopCom Board of Commissioners a. Issue a resolution encouraging LGUs to provide PMC Program as a basic service in consonance with the Local Government Code

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PopCom Central Office a. Design and conduct TOT of the PMC program for the RPOs. b. Consolidate and analyze reports from RPOs and provide quarterly feedback to the RPOs and other mandatory agencies. c. Conduct annual assessment of the PMC Program d. Advocate for the effective implementation of the PMC program.

PopCom Regional Office a. Collaborate with the mandatory agencies in the training of PMC teams. b. Consolidate and analyze the LGU report and provide a report the POPCOM Central Office and quarterly feedback to the LGUs c. Monitor, assess and evaluate the PMC implementation d. Undertake researches as input to the PMC policy development tools. e. Install and maintain a data bank for the PMC Regional Program f. Conduct advocacy activities for the effective PMC implementation. g. Lead agency in the conduct of PMC training of trainers for provincial/city/municipal Pre-Marriage Counselors in partnership with CHD and DSWD, h. Issue the certification of PMC counselors with mandatory agencies as qualified implementers.

4. Department of Social Welfare and Development (DSWD) a. Advocate for the effective PMC and Marriage Counseling Service (MCS) Program implementation. b. Provide technical assistance to LGUs and to the PMC teams. c. Accredit the Pre-Marriage counselor of the PMC teams and Marriage Counselors. d. Assist in developing the PMC training design. e. Enable the DSWD-Field Office to assist in the training of the PMC teams.

IV. PMC Service Protocol The following are the procedures to avail of the PMC Program services: 1. All engaged couples must first apply for a marriage license at the Local Civil Registrar Office (LCRO).

2. The LCRO subsequently refers the engaged couple applicant to the PMC focal office.

3. The engaged couple applicant will personally register for the PMC and must accomplish the Marriage Expectation Inventory Form (MEIF)

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4. All engaged couple applicants must attend the four-hour PMC session to be conducted by the PMC Team on the designated schedule.

5. Certificate of Pre-Marriage Counseling for would-be couples 25 years old and above shall be signed by all accredited PMC Team members while those 25 years old and below shall be signed by at least one accredited team member 6. The engaged couple applicant will return to the LCRO and must present the signed PMC certificate to obtain the marriage license.

V. Training of PMC Team 1. The PMC teams’ live-in training course shall be conducted for four days with a maximum number of 25 participants using the 2009 PMC Manual Content and Process Guides developed by POPCOM. 2. A maximum of five (5) participants per LGU comprising of PMC counselors from the mandatory agencies ( Health, SWD, and City/Municipal Population offices) and from other government agencies as well as non-state actors including faithbased groups, shall participate in the training course.

3. PMC counselors will be selected using the following minimum criteria: a. Willingness to participate in the four-day live-in training course b. Willingness to serve as PMC counselor for a specific duration c. Good moral reputation/character d. Good communication skills 4. Three (3) regional trainers from the participating mandatory agencies shall be invited as facilitators to the training of trainers (TOT) for the PMC Program. Alternate provincial/city/municipal trainers may be tapped if they would have the needed expertise.

5. A certificate of training shall be issued by the POPCOM to the PMC counselors.

Being certified by POPCOM as a PMC counselor, is a first step for PMC Team member who wish to be accredited as marriage counselor by DSWD. 6. The present PMC counselors who went through previous PMC training and who shall join the PMC training course will be certified by POPCOM. This new training will be considered as a refresher course.

7. The PMC counselor must go through a refresher course every three years.

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REFERENCES

Bautista, Paulina F. A Manual on How to Provide Pre- Marriage Information. Quezon City: University of the Philippines.1992.

Blumenthal, Erik. Peace With Your Partner. 1992.

Congress of the Philippines. Republic Act 9710: Magna Carta of Women. 2009 Congress of the Philippines. The Family Code of the Philippines, Department of Reproductive Health and Research. Family Planning -A Global Handbook for Providers. World Health Organization Bloomberg School of Public Health Johns Hopkins Center for Communication Programs INFO Project. 2008 Department of Social Services and Development. A Handbook on Parent Effectiveness Service. 1991 Enhanced Pre Marriage Counseling Manual (unpublished). Department of HealthCenter for Health Development IX. 2009 Family Planning Service. An Operations Manual for Community Volunteers Health Workers. Manila: Department of Health. 1994.

Family Planning Service. Training Handouts on Basic/Comprehensive Course in Family Planning for Physicians, Nurses and Midwives. Manila. Department of Health.

1993.

Fertility Awareness: Making a Difference in the Philippine Family Planning Program: Department of Health, San Lazaro Compound, Manila, Philippines, 2002.

Hatcher, Robert A. Contraceptive Technology, 16th Revised Edition. New York: Irvington Publisher, Inc. 1994.

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109

Health Workers Manual on Family Planning Operations: Western Pacific Education in Action, Series No.7.

National Family Planning Office. Pre- marital Guidance and Counseling. Manila: Ministry of Health. 1982.

Pre-Marriage Counseling Manual. Manila. Department of Health. 1996 Responsible Parenting and Natural Family Planning Facilitators Manual: Commission on Population.

Stewart, Felisa et. al. Understanding Your Body. London:Bantam Books. 1975.

Training Modules on PMC. Tacloban City: Region VIII Offices of the Department of Social Welfare and Development, Department of Health, Commission on Population.

United Nations. Convention on the Rights of the Child.

On Line Sources http://www.bible-history.com/faussets/M/Marriage/ http://www.soundvision.com/Info/Islam/marriage.purpose.asp http://www.jannah.org/sisters/marr.html http://bible.geek.nz/post/2007/04/08/The-purpose-of-marriage-part-1.aspx

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The Commission on Population (POPCOM) and the Philippine NGO Council on Health, Population and Welfare (PNGOC) wish to acknowledge the assistance of the following representatives from the Pre-Marriage Program stakeholderorganizations: Central Offices of National Organizations and Agencies Commission on Population Jose S. Sandejas

- Member, Board of Commissioners

Tomas M. Osias Mia C. Ventura Avelino T. Marallag Rosalinda D. Marcelino Susan B. Tejada Zenaida M. Opiniano

- Executive Director - Deputy Executive Director - Regional Director, Region 2 - Regional Director, National Capital Region - Officer-in-Charge, Region 9 - Chief, Policy Analysis and Development Division (PADD) - Chief, Planning and Monitoring Division - Project Evaluation Officer IV, PADD - Project Evaluation Officer II, PADD - Project Evaluation Officer II, PADD - Administrative Assistant VI, PADD

Victoria D. Corpuz Jackylin D. Robel Resurreccion B. Alegria Lilibeth S. Jacinto Margarita K. Guilas Department of Health Norma A. Escobido

- Supervising Health Program Officer National Center for Disease Prevention and Control Department of Health

Department of Social Welfare and Development Ma. Alicia S. Bonoan Cynthia V. Ilano Hannibal A. Galang

- Director IV, Standards Bureau - Social Welfare Officer V - Social Welfare Officer IV

Department of Agrarian Reform Fraulien M. Villa

- Annexes

- Senior Agrarian Reform Program Officer

111

National Economic Development Authority Lianelle G. Tandoc Desiree D. Guevarra

- Senior Economic Development Specialist - Administrave Officer I

National Statistics Office (NSO) Albert A. Acosta

- Registration Officer I

Union of Local Authorities in the Philippines (ULAP) Atty. Monina Camacho

- Executive Director

National Capital Region Eleanor M. Cura Maridol R. Licerio

Annabelle Fajardo

- Planning Officer IV, POPCOM-NCR - Social Welfare Officer III OIC, Standards Bureau, DSWD-NCR - City Population Officer, Valenzuela City

San Juan, Metro Manila – PMC Team Ruben Quimosing, M.D. Celestina Chua Michelle Cipriano Jessica Quitor Rocel Camagas Marian Guevarra Leonida Cipriano

-

Asst. Department Head II, POPDEV SUC Population Program Officer IV Population Program Officer I Chief, City Social Welfare Development Office City Social Welfare Development Office Public Health Nurse, City Health Office II Midwife III, City Health Office II

Region 2 – Cagayan Valley Herita O. Macarubbo

Susana C. Tupas Felicitas M. Mendoza Rosemarie O. Martin

112

- Project Evaluation Officer II/OIC Technical Division, POPCOM-RPO 2 - Information Officer II, POPCOM-RPO 2 - City Population Officer, Cauayan City - Supervising Agriculturist and Chief- Institutional

Development Section, Department of Agriculture, Region II

- Annexes

Municipality of Amulung Nerlita Barcellano Ma. Jesusa Catolico Myrna Matias

Tuguegarao City

- Municipal Population Officer/Rural Health Midwife - Public Health Nurse - Municipal Social Welfare and Development Officer

James C. Guzman, M.D. Amalia A. Calubaquib Elsie P. Daravay Lucena Quilang Virginia Calimay Ediltrudes C. Tuddao Joel D. Salvador Edmund M. Liquigan Bambi B. Castillo

-

City Health Officer Nutritionist-Dietitian/City Population Officer Nurse II Staff, City Social Welfare and Development Office Staff, Office of Local Civil Registrar Municipal Population Officer/Nurse II, Enrile, Cagayan Municipal Population Officer, Lallo, Cagayan Municipal Population Officer, Solana, Cagayan Municipal Population Officer, Tuao, Cagayan

Region VI – Western Visayas Regional Agencies (POPCOM/DSWD/DOH) Medalla T. Balandra Pilar G. Lamanosa Judith S. Marte

- Nurse V, Center for Health Development-DOH Region VI - Project Evaluation Officer I, POPCOM Region VI - Social Welfare Officer III, DSWD Region VI

PMC Team, Iloilo City Edna B. Querubin Mary Ann Ramos Yazmin Noble Gene Garingalao Elna de la Cruz Elna T. Lagos Jona S. Senarellos Ruby S. Lopez Arlene C. Boteros Ruth D. Rodrigues Cecile Guillergan Florence F. Galanto Geraldine Hautea Monaliza Diones

- Annexes

-

City Population Officer, Action Officer for PMC Program Population Program Officer III, CPO Health Education and Promotions Officer III, CHO Asst. Department Head, CSWDO Population Program Officer II, CPO Midwife V, CHO Social Welfare Officer III, CSWDO Social Welfare Officer III, CSWDO Population Program Officer II, CPO Population Program Officer II, CPO Population Program Officer II, CPO Population Program Officer II, CPO Supervising Agriculturist, City Agriculture Office Chapter Operations Manager, FPOP

113

PMC Team, Bacolod City Mary Ann M. Alisbo Elizabeth V. Caumban Harriet F. Alcantara Gina F. Castro Susan R. Ramos

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Population Program Worker II, CPO Social Welfare Officer II, CSWDO Social Welfare Officer I, CSWDO Social Welfare Officer II, CSWDO Public Health Nurse II, CHO

PMC Team, Cadiz City Lydia P. Delina - Population Program Officer III, CPO Mila B. Ong - Social Welfare Officer III, CSWDO Ana Marie A. Rosal - Public Health Nurse III, CHO Liberty J. Fernandez - Midwife IV, CHO

Region 9 – Western Mindanao Regional Agencies (POPCOM/DSWD/DOH/DA) Cynthia Dionio, M.D. Maria Rosalinda Fernando Susan P. Arevalo Evelyn del Mar Pilar F. Francisco

Ma. Socorro S. Mocaso

Medical Specialist IV, Center for Health Development, DOH

Information Officer II, Commission on Population Planning Officer I, Commission on Population Department of Agriculture Social Welfare Officer IV, Department of Social Welfare and Development Social Welfare Officer IV, Department of Social Welfare and Development

City Government of Zamboanga Lourdes Carabana, M.D. Ma. Rosalie M. Mendoza Mila Ma. Abayon Anabelle F. Leyran Lois O. Tigero Belinda Tagbar

114

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Asst. City Health Officer, City Health Office Nurse III, City Health Office Nurse III, City Health Office Midwife III, City Health Office Social Welfare Officer I, CSWDO Social Welfare Officer I, CSWDO

- Annexes

City Population Office Christina P. Arevalo Susan L. Flores Leonida T. Bayan, M.D.

Dolores N. Cabarrubias Cielita G. Quisel Romana Limen Adorada S. Eroy Celia M. Iturralde Elinor M. Adora Julliene Joy E. Garcia Jessica E. Rivera Irene C. Las Marias Ma. Victoria A. Francisco Priscilla A. Ararao

- Population Program Officer IV, CSWDO - Population Program Officer I, CSWDO - Asst. City Social Welfare and Development Officer, CSWDO - Population Program Officer II, CSWDO - Population Program Worker II, CSWDO - Population Program Worker I, CSWDO - Population Program Worker I, CSWDO - Population Program Worker II, CSWDO - Population Program Worker I, CSWDO - Population Program Worker I, CSWDO - Population Program Worker I, CSWDO - Population Program Worker I, CSWDO - Population Program Worker I, CSWDO - Population Program Worker II, CSWDO

Local Civil Registrar’s Office Atty. Alexander Eric F. Elias- City Civil Registration Officer Rosabel C. de los Reyes - Local Civil Registrar’s Office Pre-Marriage Program Assessment and PMC Manual Revision Team – Philippine NGO Council on Health, Population and Welfare (PNGOC) Eden R. Divingracia - Project Director Ruthy D. Libatique - Project Manager and Technical Writer Pilar Ramos-Jimenez - Consultant Jenny Oblema - Project Assistant Naty Pagayonan - Finance Manager Jacobe Villareal - Documenter Roberto C. Navarro - Style Editor Paolo Antonio G.Fernando - Layout Artist

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115

Project Team: Commission on Population Tomas M. Osias Executive Director Mia C. Ventura Deputy Executive Director

Policy Analysis and Development Division (PADD)

Zenaida M. Opiniano Division Chief Jackylin D. Robel Project Evaluation Officer IV Resurrecion B. Alegria Project Evaluation Officer II Lilibeth S. Jacinto Project Evaluation Officer II Margarita K. Guilas Administrative Assistant VI

Tel +632 531-7192 (PADD) www.popcom.gov.ph