Facts and Barriers to Family Planning in the Philippines


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A comprehensive set of facts and research on the unmet needs of family planning and reproductive health in the Philippines.

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Facts and Barriers to Family Planning in the Philippines

  1. 1. In BriefFacts on Barriers to Contraceptive UseIn the PhilippinesOverview The Need for Contraception approved by the Catholic Church—not• Contraceptive use has hardly increased • Women in the Philippines increasingly to support modern “artificial” contracep-in the Philippines over the past decade. want smaller families. According to na- tives, such as pills, injectables, IUDs andYet women are having, on average, about tional surveys, women aged 15–49 want condoms.one more child than they would like. 2.4 children but have an average of 3.3. • The Philippine health system is com-More than one-fifth of married women • The poorest women (those whose plex, with the national government anddo not want to have a child soon or at households fall into the lowest wealth about 1,700 autonomous local govern-all but are not using a contraceptive quintile) have about two more children ment units (LGUs) sharing responsibil-method. than they want, while those in the richest ity for providing health care. The LGUs• Cutbacks in publicly funded contracep- quintile have only 0.3 more children than are free to decide how much they willtive services and supplies since 2004 they want—evidence of serious health allocate to family planning services andhave reduced women’s and couples’ ac- and social inequities. Only 41% of the which methods they will support.cess to contraceptives. National surveys poorest women use contraceptives, com- • Manila (with a population of 1.7from 1998 to 2008 show that women pared with 50% of the wealthiest. Most million) effectively banned public andhave relied increasingly on pharmacies of this difference is due to lower use of private provision of contraceptives infor contraceptive services. This switch sterilization among poor women. 2000, following the election of a “pro-to private-sector suppliers is likely to • Premarital sexual activity is increasing, life” mayor. Under pressure from churchinvolve higher costs and lead to reduced creating a greater need for contraceptives officials, the current mayor has continuedaccess, particularly for low-income among young women and men. Among the ban on public provision of contracep-women and couples. all young adults aged 15–24, premarital tives. According to recent reports, similar• Fulfilling demand for contraceptives sexual activity increased from 18% in bans are in effect in Northern Samar andwould be especially beneficial to disad- 1994 to 23% in 2002 (from 26% to 31% Antipolo City.vantaged women, who use contracep- among young men and from 10% to 16% • The U.S. Agency for Internationaltives less and experience unintended among young women).1 Development (USAID) was the largestpregnancy more than their better-off The Policy Context contributor to Philippine public contra-counterparts. Poor women face barriers to • Poverty and reproductive health are ceptive services for several decades, butcontraceptive use such as costs, poor- headline issues in the Philippines and phased out support between 2004 andquality services, lack of awareness of or were especially prevalent in the May 2008. The withdrawal of USAID’s fundingaccess to a source of contraceptive care, 2010 elections. Candidates often talked placed a new and critical constraint onand lack of awareness of methods. How- about what they will do for the poor, but the ability of the government, particular-ever, all groups of women report barriers expanding access to contraceptives has ly poor municipalities, to meet contra-to using contraceptives that must garnered limited political support, ceptive needs.be addressed through improved policies despite the interrelationship betweenand programs. • PhilHealth, the national health insur- poor reproductive health and poverty. ance program, provides little coverage for • The Arroyo government uses the contraceptive services. It covers tubal li-*Includes the mucus or Billings Ovulation, Standard gation, vasectomy and IUD insertion, butDays, symptothermal, basal body temperature and national budget to support only mod-lactational amenorrhea methods. ern natural family planning,* which is no other services or methods. PhilHealth
  2. 2. Figure 1Contraceptive Use in the Philippines Unmet Need for Barriers to Using Contraception ContraceptivesThe proportion of married women using a contraceptive method hardlychanged over the last decade. • Twenty-two percent of mar- • The most common reasons ried women are able to become why women with unmet need in 100 pregnant, but do not want to the Philippines do not prac- 90 have a child in the next two tice contraception are health % of married women aged 15–49 80 years or at all and are not us- concerns about contraceptive 70 ing any contraceptive method. methods, including a fear of 60 49 51 These women are defined as side effects. Forty-four percent 50 47 40 having an unmet need for reported these reasons in 2008, 40 16 17 18 contraception. An additional as did 41% in 2003. 30 15 17% of married women use 20 33 34 • The second largest category 25 28 traditional methods and are in 10 of reasons why women with need of more effective, modern 0 unmet need do not use contra- 1993 1998 2003 2008 contraceptives to have the best ceptives is that many believe Demographic and Health Survey year possible chance of preventing they are unlikely to become Modern methods Traditional methods unintended pregnancy. pregnant—41% in 2008, up • Unmet need is highest among from 26% in 2003. Their spe- the poorest quintile of mar- cific reasons include having sexcoverage is also skewed toward • The use of modern contracep- ried women (28%) and lowest infrequently, experiencing lac-better-off citizens—mainly tives* among married women among the top two quintiles of tational amenorrhea (temporaryemployees of the government did not increase in recent years, married women (around 20%). infertility while nursing) andand midsize to large companies. remaining at 33–34% in 2003– being less fecund than normal. • Twenty-four percent of un-Poor people without regular 2008. The use of traditional married sexually active women • The cost of contraceptiveemployment, the self-employed methods—mainly periodic ab- aged 15­ 29 have an unmet – supplies has become a moreand most of the rural poor stinence and withdrawal—also need for contraception. An common reason for nonuse inmust enroll on their own or be remained steady, at 16–17%, additional 21% of these young recent years. It was cited byenrolled as indigents by their during the same period. women are using traditional 15% of married women withLGUs. Fewer than one-third of • Several factors may explain methods and have a need for unmet need in 2008, comparedpoor women (those in the poor- the leveling off of modern con- modern contraceptives. with 8% in 2003. Cost is anest two quintiles) are covered traceptive use among married even greater barrier amongby any type of health insurance. women: the phasing out of con-Trends in traceptive supplies from USAID, Figure 2Contraceptive Use the national government’s focus Sources for Modern Contraceptives• Contraceptive use among on natural family planning, the Many women using modern methods switched from public facilities tomarried women has increased ban on public provision of mod- private pharmacies between 2003 and 2008.very slowly in the past 10 years, ern contraceptives in Manilafrom 47% in 1998 to 51% in and other parts of the country,2008—an average increase of and policymakers’ poor atten- 14 15 20only about 1% per year (Figure tion to quality of care. 251). By contrast, contraceptive 17 12use increased more rapidly in • In addition, there are many 40 local barriers to increasing 20the early 1990s, from 40% in 23 141993 to 47% in 1998. contraceptive use throughout the Philippines: geographic isolation, poverty, shortages of 2003 2008*Refers to male and female sterilization contraceptive supplies, LGUs’and the IUD, injectable, pill and con-dom, as well as modern natural family inability to procure and allocate Government hospital Pharmacyplanning. contraceptive supplies, and a Government health center Other private-sector source†This total differs slightly from the lack of male involvement inpercentages in Figure 2 because of Barangay health stationrounding. family planning.2Barriers to Contraceptive Use in the Philippines 2 Guttmacher Institute M Modern method Tr Traditional method
  3. 3. Figure 3those who are single and sexu- private pharmacies in that Public-Sector Supply of Modern Methodsally experienced: According to five-year period. The proportion of poor women obtaining contraceptives from thea 2004 national survey, 42% public sector dropped dramatically between 2003 and 2008. • Among modern method us-mentioned this as a reason for ers, increased reliance on the 100not using contraceptives.3 private sector has been greatest 90 % of modern method users aged 15–49 84• Opposition to family planning among poor women, who have 80 78 72by women, their partners or the most difficulty paying for 70 64their families is a decreasingly contraceptive services. While 60 58 53 50important factor in the Philip- the proportion of the wealthiest 50 44 42pines. Personal or religious women using a public source 40 31opposition was reported by 10% decreased 13 percentage points 30of women with unmet need in from 2003 to 2008, the propor- 20 33 34 25 282008, down from 18% in 2003. tion of women in the poorest 10 two quintiles using a public 0 Poorest Poorer Middle Richer Richest• Only 5% of women with source dropped by 25­ 26 per- –unmet need cited opposition Wealth quintiles centage points (Figure 3).by their partners or families as 2003 2008their reason for not practicing Public-Sector Failurecontraception. Still, more poor to Increase Accesswomen than better-off women • The Philippine Departmentreported such opposition: 9% of Health maintains that the viable public program. Thus, ac- • The government has notamong the poorest quintile, primary responsibility for pro- cess to contraceptives for poor acknowledged that the ces-compared with 3% among the viding family planning services women now depends largely on sation of USAID funding haswealthiest quintile. lies with the LGUs. Yet local the ability and willingness of reduced access to modern governments do not receive suf- LGUs to take over the program. contraception. Rather, it claimsPublic-Sector Supply ficient funds under the revenue- Within the limits of their fund- that the new focus on naturalof Contraceptives ing, LGUs can purchase con- family planning has been a sharing scheme to fully meet• The proportion of modern traceptives and include family success. According to the 2008 this responsibility. The Depart-method users who obtain their planning services as part of Demographic and Health Survey, ment of Health, which procuressupplies from the public sector their public health functions, however, the natural family drugs and supplies for tubercu-has declined sharply, from 67%† but many have devoted too planning program fell far short losis control, immunization andin 2003 to 46% in 2008 (Figure few resources to meet women’s of its target of raising the use malaria, could also purchase2). Correspondingly, more users needs. of such methods to 20%: The contraceptive supplies, if ithave obtained contraceptives proportion of currently married gave priority to family planning • The Department of Healthfrom the private sector, particu- women using modern natural services. issued an administrative orderlarly from pharmacies. family planning methods is • PhilHealth is also failing to (AO 158) in 2004 calling on the• All categories of public-sector 0.5%. improve access to health care, government to act as a “guaran-facilities saw declines in the tor of last resort” by ensuring • Two reproductive health bills including contraceptive servic-proportion of contraceptive es, for the poor. The PhilHealth that contraceptives remain that are stalled in the Houseusers they serve. Declines were report for the first six months of available for current users who and Senate as of May 2010 con-smaller in hospitals, however, depend on donated supplies. tain various measures regarding 2009 showed that the poorestthan in government health The order gives LGUs frontline funding for and access to family sector (“sponsored” members)centers and Barangay health responsibility for distributing planning services. If enacted, made up 24% of membershipstations. free contraceptives to users all national and local hospi- but received only 14% of ben-• In the private sector, only efits, while those employed in without the means to pay. How- tals would be required to offerpharmacies experienced a major the private sector accounted for ever, the strategy has failed: family planning services andchange in the share of users 35% of membership, paid 62% The public sector has not filled to provide them free of chargethey serve; they served 17% of of collections and received 84% gaps in services; instead, it has to poor patients. PhilHealthusers in 2003 and 40% in 2008. of benefits. declined greatly as a source of would be required to cover theThis means that about 23% of contraceptive supplies and full cost of family planning for • The government has not services, especially for the poor. three years after the use of anycontraceptive users switched replaced the USAID-funded pregnancy-related benefit, andfrom a public-sector source to family planning program with a contraceptives would be de-Guttmacher Institute 3 Barriers to Contraceptive Use in the Philippines
  4. 4. clared essential medicines to be Recommendations Except where otherwise noted,purchased by national and local • Changes must be made in the data are from Demographichealth units. In addition, the government policies, programs and Health Surveys.Senate bill contains a provision and health insurance coveragefor a national procurement and references if the existing need for contra- 1. Natividad JN and Marquez MP,distribution program for family ceptive care is to be met. These Sexual risk behaviors, in: Raymundoplanning supplies and explicitly changes are especially neces- CM and Cruz GT, eds., Youth Sex andprohibits local bans on contra- sary to reduce barriers for poor Risk Behaviors in the Philippines: Aception. Report on a Nationwide Study 2002 and low-income women and Young Adult Fertility and Sexuality couples, to enable them to ob-Benefits of Meeting the Survey (YAFS 3), Quezon City,Need for Modern Methods tain the contraceptive services Philippines: Demographic Research• Government action to they need to reduce unintended and Development Foundation, pregnancy, unplanned child- University of the Philippines increase access to modern Population Institute (UPPI), 2004.contraceptives is urgently bearing and unsafe abortion. 2. Ron I et al., Local-Level Contra-needed, given the high rate of • The national Department of ceptive Prevalence Rate Performanceunintended pregnancies, which Health and PhilHealth should Analysis in the Philippines: Selectedaccounted for more than half Main Findings vis-à-vis Study Objec- make improved family planningof pregnancies in 2008.4 Un- tives, Manila, Philippines: ABT-PSP- a major public health prior- One and UPPI, 2010.planned pregnancies and births ity and ensure that funding is 3. Special tabulations of data fromplace a large and costly health provided seamlessly from the the 2004 Philippines Community-burden on women, their families national to the local levels, as Based Survey of Women, Guttmacherand the health system. it is for the national immuniza- Institute and UPPI. tion program. The government 4. Darroch JE et al., Meeting• In 2008, there were approxi- women’s contraceptive needs in themately 4,700 maternal deaths, should fulfill its role as guaran- Philippines, In Brief, 2009, Newmore than half of which were tor of supplies and services for York: Guttmacher Institute, No. 1.among women who had had the poor.unintended pregnancies. One • The national government and This publication was supportedthousand of these deaths were the relevant departments— by a grant from the Australiandue to unsafe abortion. especially the Department of Agency for International Health and the Office of the Development.• If all women who wanted toavoid pregnancy used mod- President—should fully exercise 88 Times Street, West Triangle Homes their standard-setting and Quezon City 1104 Philippinesern methods, there would be Tel: 63 2.926.62301.6 million fewer pregnancies regulatory powers over LGUs to office@likhaan.orgeach year in the Philippines. prevent contraceptive bans and reverse them where they exist. www.likhaan.orgUnintended births woulddrop by 800,000, abortions • The Department of Health andwould decline by 500,000 and LGUs must improve the qualitymiscarriages would decline by of family planning services by200,000. complying with standards that• Expanding modern contracep- include providing a wide choicetive use to all women at risk for of methods and responding tounintended pregnancy would clients’ actual and perceivedprevent 2,100 maternal deaths health concerns. Advancing sexual andeach year. It would also reap reproductive health worldwidesavings on medical care for through research, policy analysispregnant women and newborns and public educationthat would more than offset the 125 Maiden Laneadditional spending on modern New York, NY 10038 USAcontraception.4 Tel: 212.248.1111 info@guttmacher.org www.guttmacher.org May 2010