When one looks more closely into the method and the level of method use, one sees that the poorest women actually use some modern methods –notably pills, IUD, injectables - more than the richest. But the modern method where they lag behind the most is in ligation. This gap is most likely the result of access problems rather than preference.
Of the 10.2M women at risk for unintended pregnancy, >49% were using modern methods of contraception, >22% were using traditional methods, >and 29% were not using any method. These levels of use corresponded with the 1.9M unintended pregnancies for the same period in the following way: >68% were from women not using contraceptives, >24% were from women using traditional methods >and 8% were from women using modern methods. Among modern those using modern methods, the highest pregnancy rates are from those using NFP followed by condom.
These chart shows the different pregnancy outcomes following the different contraceptive use models. The baseline for 2008 shows a total of 3.4M pregnancies, 1.5M of which are intended,1.3M unintended, with about 600,000 induced abortions. Since the number of intended pregnancies is constant – i.e 1.5M – only the number of unintended pregnancies and induced abortion change with different contraceptive scenarios. 100% use of NFP brings down the unintended pregnancies by .2M, but the number of induce abortion is unchanged. 100% use of the current method mix brings down unintended pregnancies by .8M and induced abortion by .3M. The best results are with 100% use of all modern methods, which brings down unintended pregnancies by 1.1M and induced abortion by .5M
In terms of the impact of contraceptive use on maternal death, the current level and method mix results in about 4,600 deaths, 3,600 from unplanned births and miscarriages and 1,000 from abortion. 100% NFP use brings down maternal deaths to 4, 400, 100% use of the current method mix brings it down to 3,000 and 100% use of modern methods, brings it down to only 2,500.
Dr. j melgar fp use in the phil presentation
Family Planning in the Philippines: Levels, Implications, Issues Junice L. Demeterio-Melgar, MD Training of Medical Educators on Family Planning Silliman University,May 2010
50.7% married women used FP in 2008 34.0% Mod 16.7% Tradl Use of Contraception Among Currently Married Women Age 15-49, NDHS 2008 Fig. 5.1
Trends in Contraceptive Use 1968-2008, NDHS 2008 Fig. 5.2 Modern Methods use tapered 2003-2008
22.3%: unmet need for FP in 2008 Need and Demand for FP Among Currently Married Women, NDHS 2008 Table 7.4
Poorest women with highest Unmet Need 28% compared with Richest Women Unmet Need for FP Across wealth Quintiles, NDHS 2008 Table 7.4
Widest gap in method use between poorest & richest women with Fem Sterilization % distribution of currently married women by contraceptive method used, NDHS 2008 Table 5.5
Adolescent Women with highest Unmet Need 36% compared with Oldest Women Unmet Need for FP Across wealth Quintiles, NDHS 2008 Table 7.4
Phil. FP Use vs. select SEA & Cent. Am 2005-08 81.1 61.4 79.0 40 51 72.7 70.9 65.2 72.5
Using no FP or trad’l method carries high risk of unintended pregnancy <ul><li>Women at risk </li></ul><ul><li>All women </li></ul><ul><li>Fecund </li></ul><ul><li>Sexually active </li></ul><ul><li>Not intending </li></ul><ul><li>to be pregnant </li></ul>(Guttmacher Institute, Investing in Women’s Contraceptive Use in the Philippines , 2009)
Inadequate FP caused 54% of all pregnancies to be unintended in 2008 (Guttmacher Institute, Investing in Women’s Contraceptive Use in the Philippines , 2009) Unintended Pregnancies Intended Pregnancies 54% 46% (Guttmacher Institute, Investing in Women’s Contraception in the Philippines , 2009) Miscarriage Intended births Mistimed births Unwanted births Induced abortions Miscarriage
Estimated impact of 3.4 M unintended pregnancy in 2008 <ul><li>1.3M unintended births/miscarrige </li></ul><ul><ul><li>185T Maternal complications (*15% of pregnancies) </li></ul></ul><ul><ul><li>3.6T deaths </li></ul></ul><ul><li>Almost 600 T abortions </li></ul><ul><ul><li>90T post-abortion complications </li></ul></ul><ul><ul><li>Close to 1T abortion-related deaths </li></ul></ul>(Guttmacher Institute, Investing in Women’s Contraception Use in the Philippines , 2009) *WHO (estimate of proportion of pregnancies encountering life-threatening obstetric complications), World Health Report 2005
Postulated decrease in pregnancy & abortion: using current FP method mix & using only modern methods (Millions of pregnancies) (Guttmacher Institute, Investing in Women’s Contraception in the Philippines , 2009) 3.4 2.3 1.8
(Thousands of maternal deaths) Postulated decrease in maternal death: using current FP method mix & using only modern methods (Guttmacher Institute, Investing in Women’s Contraception in the Philippines , 2009)
Barriers to FP No government supplies Concerns about effects/side-effects Contraception ban Weak FP policies Catholic groups’ opposition Misconceptions about fertility http://www.accelerated-personal-development.com/barriers-to-personal-growth.html
USAID “phasedown” (2003-2008) <ul><li>USAID provided 80% of contraceptive supplies amounting to $3 million yearly </li></ul><ul><li>March 2003: last shipment of condoms </li></ul><ul><li>2004-2007 : pills </li></ul><ul><li>2005-2008 : injectables </li></ul><ul><li>later : IUD </li></ul>PopCom, CSR+ Initiatives, [email_address]
RH Program 1998-2000 <ul><li>FP </li></ul><ul><li>MCH & Nutrition </li></ul><ul><li>Prevention and Management of Abortion </li></ul><ul><li>Prevention & Treatment of RTIs, inc. STDs, Hiv & AIDS </li></ul><ul><li>Education & Counseling on Sexuality & Sexual Health </li></ul><ul><li>Breast & Repro Tract Cancers & other Gyne conditions </li></ul><ul><li>Men’s RH </li></ul><ul><li>Adolescent RH </li></ul><ul><li>Violence Against Women </li></ul><ul><li>Prevention & Treatment of Infertility and Sexual Disorders </li></ul>DOH Admin Order 1-A, s 1998
PopCom’s NFP & Resp. Parenthood Prog <ul><li>10-10-2006: PGMA issued order promoting NFP, 3-yr spacing & breastfeeding as part of hunger mitigation program </li></ul><ul><li>PhP5M to LGUs for advocacy and training </li></ul><ul><li>Couples trained in 6 NFP methods </li></ul><ul><ul><li>LAM, BOM, Mercedes Wilson, 2-day method, BBT, sympto-thermal, Standard Days </li></ul></ul><ul><li>& Barangay RP Teams formed </li></ul><ul><li>As of 4-25-2010: </li></ul><ul><ul><li>508,245 couples reached in 82 provinces </li></ul></ul><ul><ul><li>Total NFP continuing users: 4,763 </li></ul></ul><ul><ul><li>NFP users reported by RHO.CHO: 0 </li></ul></ul><ul><li>*Estimated cost per couple: PhP283. * (Gutmacher, 209 </li></ul>News realeases citing PopCom in Freeman/Philstar.com, PopCom NFP report 2010
What the bishops say The Christian ideal of human sexuality and responsible parenthood is a sacred sharing in the creative power of God that requires the fusion of parental love and a sincere gift of self in transmitting and nurturing life. Responsible parenthood means respect for one’s generative functions....Responsible parenthood makes parents “free and responsible collaborators of God, the Creator. Population growth is not the cause of poverty…Population control is like saying that in order to eliminate poverty, we must reduce human resources Conception takes place at fertilization. Prevention of implantation of fertilized ovum is abortion. Pills, injectables, implant and IUD are abortifacient. Contraceptives are intrinsically evil. Sterilization and vasectomy are immoral.
Families driven to extreme poverty Harm & risks to women’s health Strain in intimate relationships Erasure of FP Harrassment of providers Ethical Conflict in providers Tolerance of injustice CRR, ReproCen, Likhaan: Imposing Misery,2007 Republic of the Philippines OFFICE OF THE MAYOR Manila, Philippines Executive Order No. 003 Series of 2000 Declaring Total Commitment and Support to the Responsible Parenthood Movement in the City of Manila and Enunciating Policy Declarations in Pursuit Thereof WHEREAS, the City of Manila recognizes its vital role as catalyst for change in the attainment of its goal and policies; WHEREAS, the City believes that the family, being the basic unit of society, has an important role in the comprehensive development of its citizenry; WHEREAS, the City firmly believes in the sanctity of life and supports the Constitution in the protection of life of the mother and the unborn; WHEREAS, the City is aware of its duty in molding the children to become effective citizens; WHEREAS, the City takes an affirmative stand on pro-life issues and responsible parenthood; WHEREAS, the City condemns criminal abortion, euthanasia, divorce and same sex intermarriages as amoral and deplorable practices that weaken the basic unit of family and society; WHEREAS, the City promotes responsible parenthood and upholds natural family planning not just as a method but as a way of self-awareness in promoting the culture of life while discouraging the use of artificial methods of contraception like condoms, pills, intrauterine devices, surgical sterilization, and other; NOW, THEREFORE, I, JOSE L. ATIENZA, JR., Mayor of the City of Manila, by virtue of the power vested upon by law, do hereby declare total commitment and support to the Responsible Parenthood Movement in the City of Manila and in pursuit thereof, enunciate the following policy declarations: 1. That all health and social services shall promote responsible parenthood by providing the youth with adequate modes of support to develop as model parents in their own time; 2. That the City shall advocate active citizen participation in implementing policies and programs in collaboration with various non-government, religious and other civic organizations; 3. That the City shall establish programs and activities in City Health Department and its health centers, Ospital ng Maynila Medical Center, Gat Andres Bonifacio Memorial Medical Center, Ospital ng Tondo, Ospital ng Sampaloc as well as the Department of Social Welfare which promote and offer as integral part of their functions counseling facilities for natural family planning and responsible parenthood; 4. That the various activities geared on moral rejuvenation shall be encouraged to equip its people against amoral influences brought about by the excesses of modernization; 5. That City and its citizenry shall acknowledge that this noble endeavor requires great conviction, unceasing advocacy, unflagging patience, perseverance and persistence. Let the herein-enunciated policy declarations form as integral part of the policies and programs of the present City Administration in the delivery of basic health and welfare services to Manileños in the interest of public service and welfare. Done this 29th day of February 2000 in the City of Manila, Philippines. JOSE L. ATIENZA, JR. CITY MAYOR Atienza’s EO 003 and its Impact on Women
Top reasons why women do not intend to use FP (%) <ul><li>Health concerns 20.9 </li></ul><ul><li>Want to have as many children 15.5 </li></ul><ul><li>Fear of side effects 13.9 </li></ul><ul><li>Infrequent/or no sex 9.8 </li></ul><ul><li>Infecund 9.8 </li></ul>Opposition to use, lack of knowledge of method or source, lack of access/too far - uncommon NDHS 2008 Table 5.15: Reason for not intending to use contraception in the future
Women’s misconceptions about fertility Infrequent sex is safe Some women are prone to pregnancy, some are not If you don’t enjoy sex, you will not get pregnant Standing up, jumping up and down and douching with water after sex can prevent pregnancy Uterine manuver (hilot) can prevent pregnancy If one’s children are grown, one does nor get pregnant. If one’s period is breastfeeding, one will not get pregnant. If one has irregular period, one will not get pregnant Likhaan, Identifying barriers to accessting safe motherhood services, unpub, 2009
FP in RH Bills in 14 th Congress GAA Appropriation: GAA Provider, public official, employer, any who disnforms Prohibited acts: same except does not include disinformation PopCom Implementor: DoH - same Employers’ responsibilities - Same different wording Mandatory age approp education ---- Procurement & distrib of FP supplies -same Contraceptives as essential meds - same Surgical FP Responsible parenthood, population management FP as a right, for health and dev HB 5403 SB 3122