I struggle to open my eyes as I feel my son’s hot arms tangled up beside me. Without taking out a thermometer, I can feel his fever and know I need to get up to get him medicine. My husband is a very engaged and hands-on father, but when the kids are sick, I can’t sleep well anyway worrying about them, so I become the de facto night nurse who sleeps with them and gets up in the night to check temperatures and give medicine.

It’s the second night of my son’s current illness and I’m exhausted from two nights in a row of too-little sleep. Despite being exhausted, I can’t fall back asleep after giving my son medicine. My mind is alert despite my body being so tired.

My mind drifts to work and I recall the photo my colleagues sent me from a mission trip they conducted in Aklan. It was of a 38-year old woman named Elsa. Elsa just delivered her 11th baby a few days before my colleagues arrived, and she asked them for a contraceptive implant to protect against pregnancy for the next three years. She wanted to be sure there wouldn’t be a 12th pregnancy. My colleagues obliged and gave her an implant. She is using contraceptives now for the very first time in her life.

I struggle to imagine how someone cares for 11 kids. Even when no one is sick, I often feel like I don’t have enough energy to keep up with my two kids, plus my husband and my parents and my friends and all my responsibilities at work.

I wonder if Elsa’s partner is supportive and helps her out with all their kids. I imagine that the older kids must help out. I wonder if all of them are going to school, and how healthy they are. I wonder what Elsa does when one or more of them are sick.

It is so hard for me to imagine how difficult it must be. I don’t doubt for one second that she has enough love for all her children. But I doubt she has all the energy and time and resources she needs to fully care for every single child.

Millions of Filipinos live in poverty, and struggle to make ends meet, struggle to care for all their kids, struggle to survive. They do what they can, and face each day as it comes, hoping there will be enough money for food, hoping that no one will meet an accident or get sick.

And while one can argue the merits of big families over small, there is no denying that the fewer children a couple has, the more resources they can devote to their kids. And when resources are scarce, there is a huge difference in quality of life for children if there are two or three of them in a family, versus 11 or 12.

I marvel at the fact that Elsa is 38 with 11 kids and has never before used contraception. I wonder if she and or her partner object to contraception because of their faith, or if her partner always wanted her to be pregnant to prove his masculinity, or if she couldn’t afford any method, or if she simply never had the chance before to learn about contraception and how it works. I wonder how old Elsa was when she had her first child, and if that first pregnancy made her dropout of school. It is women like Elsa who motivate our staff to keep going, and to travel to distant, isolated places to make sure that women have a choice about whether or when to have another baby. Because we want to make sure that all babies are wanted and all babies are planned, and that all children can grow up with the best opportunities possible to have beautiful futures. Para sa magandang kinabukasan.