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

1. In Brief
Facts on Barriers to Contraceptive Use
In the Philippines
Overview 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 and
Yet 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 and
do 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 will
tive services and supplies since 2004 they want—evidence of serious health allocate to family planning services and
have 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 1.7
from 1998 to 2008 show that women pared with 50% of the wealthiest. Most
million) effectively banned public and
have relied increasingly on pharmacies of this difference is due to lower use of
private provision of contraceptives in
for 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 church
involve higher costs and lead to reduced
creating a greater need for contraceptives officials, the current mayor has continued
access, 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 and
would 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 International
tives less and experience unintended among young women).1
Development (USAID) was the largest
pregnancy 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, but
contraceptive use such as costs, poor-
headline issues in the Philippines and phased out support between 2004 and
quality services, lack of awareness of or
were especially prevalent in the May 2008. The withdrawal of USAID’s funding
access to a source of contraceptive care,
2010 elections. Candidates often talked placed a new and critical constraint on
and 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 between
and 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, but
Days, 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. Figure 1
Contraceptive Use in the Philippines Unmet Need for Barriers to Using
Contraception Contraceptives
The proportion of married women using a contraceptive method hardly
changed 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 sex
coverage 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 (temporary
employees of the government did not increase in recent years, married women (around 20%). infertility while nursing) and
and 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 contraceptive
employment, the self-employed methods—mainly periodic ab-
aged 15­ 29 have an unmet
– supplies has become a more
and most of the rural poor stinence and withdrawal—also
need for contraception. An common reason for nonuse in
must enroll on their own or be remained steady, at 16–17%,
additional 21% of these young recent years. It was cited by
enrolled as indigents by their during the same period.
women are using traditional 15% of married women with
LGUs. Fewer than one-third of
• Several factors may explain methods and have a need for unmet need in 2008, compared
poor women (those in the poor-
the leveling off of modern con- modern contraceptives. with 8% in 2003. Cost is an
est two quintiles) are covered
traceptive use among married even greater barrier among
by any type of health insurance.
women: the phasing out of con-
Trends in traceptive supplies from USAID, Figure 2
Contraceptive 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 to
married 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 Manila
from 47% in 1998 to 51% in and other parts of the country,
2008—an average increase of and policymakers’ poor atten- 14
15
20
only about 1% per year (Figure tion to quality of care. 25
1). By contrast, contraceptive 17
12
use increased more rapidly in • In addition, there are many 40
local barriers to increasing 20
the early 1990s, from 40% in 23 14
1993 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 Pharmacy
planning. contraceptive supplies, and a Government health center Other private-sector source
†This total differs slightly from the lack of male involvement in
percentages in Figure 2 because of Barangay health station
rounding. family planning.2
Barriers to Contraceptive Use in the Philippines 2 Guttmacher Institute
M
Modern method
Tr
Traditional method

3. Figure 3
those who are single and sexu- private pharmacies in that Public-Sector Supply of Modern Methods
ally experienced: According to five-year period. The proportion of poor women obtaining contraceptives from the
a 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 100
not 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
72
by women, their partners or the most difficulty paying for 70
64
their families is a decreasingly contraceptive services. While 60 58
53 50
important factor in the Philip- the proportion of the wealthiest 50
44
42
pines. Personal or religious women using a public source 40
31
opposition was reported by 10% decreased 13 percentage points 30
of women with unmet need in from 2003 to 2008, the propor- 20 33 34
25 28
2008, 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 2008
their reason for not practicing Public-Sector Failure
contraception. Still, more poor to Increase Access
women than better-off women • The Philippine Department
reported such opposition: 9% of Health maintains that the viable public program. Thus, ac- • The government has not
among 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 has
wealthiest 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 claims
Public-Sector Supply ficient funds under the revenue- Within the limits of their fund- that the new focus on natural
of 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 procures
supplies 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 and
in 2003 to 46% in 2008 (Figure few resources to meet women’s of its target of raising the use
malaria, could also purchase
2). Correspondingly, more users needs. of such methods to 20%: The
contraceptive supplies, if it
have obtained contraceptives proportion of currently married
gave priority to family planning • The Department of Health
from the private sector, particu- women using modern natural
services. issued an administrative order
larly 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 House
users 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 poorest
than 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 membership
stations. 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 offer
pharmacies experienced a major the private sector accounted for ever, the strategy has failed: family planning services and
change in the share of users 35% of membership, paid 62% The public sector has not filled to provide them free of charge
they serve; they served 17% of of collections and received 84% gaps in services; instead, it has to poor patients. PhilHealth
users in 2003 and 40% in 2008. of benefits. declined greatly as a source of would be required to cover the
This 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 any
contraceptive users switched
replaced the USAID-funded pregnancy-related benefit, and
from 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. clared essential medicines to be Recommendations Except where otherwise noted,
purchased by national and local • Changes must be made in the data are from Demographic
health units. In addition, the government policies, programs and Health Surveys.
Senate bill contains a provision and health insurance coverage
for 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: Raymundo
planning supplies and explicitly changes are especially neces- CM and Cruz GT, eds., Youth Sex and
prohibits local bans on contra- sary to reduce barriers for poor Risk Behaviors in the Philippines: A
ception. 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 Performance
unintended pregnancies, which Health and PhilHealth should Analysis in the Philippines: Selected
accounted for more than half Main Findings vis-à-vis Study Objec-
make improved family planning
of 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 from
place 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, Guttmacher
and 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 the
mately 4,700 maternal deaths, should fulfill its role as guaran-
Philippines, In Brief, 2009, New
more 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 supported
thousand of these deaths were the relevant departments— by a grant from the Australian
due to unsafe abortion. especially the Department of Agency for International
Health and the Office of the Development.
• If all women who wanted to
avoid pregnancy used mod- President—should fully exercise 88 Times Street, West Triangle Homes
their standard-setting and Quezon City 1104 Philippines
ern methods, there would be Tel: 63 2.926.6230
1.6 million fewer pregnancies regulatory powers over LGUs to office@likhaan.org
each year in the Philippines. prevent contraceptive bans and
reverse them where they exist. www.likhaan.org
Unintended births would
drop by 800,000, abortions • The Department of Health and
would decline by 500,000 and LGUs must improve the quality
miscarriages would decline by of family planning services by
200,000. complying with standards that
• Expanding modern contracep- include providing a wide choice
tive use to all women at risk for of methods and responding to
unintended pregnancy would clients’ actual and perceived
prevent 2,100 maternal deaths health concerns.
Advancing sexual and
each year. It would also reap reproductive health worldwide
savings on medical care for through research, policy analysis
pregnant women and newborns and public education
that would more than offset the 125 Maiden Lane
additional spending on modern New York, NY 10038 USA
contraception.4 Tel: 212.248.1111
info@guttmacher.org
www.guttmacher.org
May 2010