Philippines - Demographic and Health Survey - 1994

Publication date: 1994

Philippines National Demographic Survey 1993 ® National Statistics Office ®DHS Demographic and Health Surveys Macro International Inc. REPUBLIC OF THE PHILIPPINES National Demographic Survey 1993 National Statistics Office Manila, Philippines Macro InteYnational Inc. Catverton, Maryland USA May 1994 This report summarizes the findings of the 1993 National Demographic Survey (NDS) undertaken by the Na- tional Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other concerned agencies in the Philippine government. Funding for the 1993 NDS was provided by the U.S. Agency for International Development. The 1993 NDS is part of the worldwide Demographic and Health Surveys (DHS) program, which is designed to collect, analyze, and disseminate demographic data on fertility, family planning, and maternal and child health. Additional information on the 1993 NDS may be obtained from the National Statistics Office, Solicarel Building,Ramon Magsaysay Boulevard, Santa Mesa, Manila, Philippines. Additional information about the DHS program may be obtained by writing to: Macro International Inc., 11785 Beltsville Drive, Calverton, MD 20705-3119, US A (Telephone 301-572-0200, Fax 301-572-0999). Recommended citation: National Statistics Office (NSO) [Philippines] and Macro International Inc. (MI). 1994. National Demographic Survey 1993. Calverton, Maryland: NSO and MI. CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary and Recommendat ions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii i CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 1.10 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Geography, history, and economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I Population growth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Population polices and programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Health plan and programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Objectives and organization of the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Sample design and implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Training and fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . g Data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Response rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 CHAPTER2 2.1 2.2 2.3 BACKGROUND CHARACTERIST ICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Population composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 CHAPTER3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 FERT IL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fertility trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Teenage fertility . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 CHAPTER 4 4.1 4.2 FAMILY PLANNING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Knowledge of family planning methods and their sources . . . . . . . . . . . . . . . . . . . . . . 39 Ever use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 iii 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 Page Current use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Problems with current method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 T iming of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Source of supply of modem contraceptive methods currently used . . . . . . . . . . . . . . . 49 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Intentions for future family planning use among nonusers . . . . . . . . . . . . . . . . . . . . . . 52 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 CHAPTER 5 5,1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 OTHER PROXIMATE DETERMINANTS OF FERT IL ITY . . . . . . . . . . . . . . . . 59 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 66 Median duration of postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . 67 Termination of exposure to pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 CHAPTER6 6.1 6.2 6.3 6.4 FERT IL ITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Desire for more children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Demand for family plarming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Unplanned and unwanted fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 CHAPTER 7 7.1 7.2 7.3 7.4 7.5 INFANT AND CHILD MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Levels and trends in infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Infant and child mortality differentials by socioeconomic characteristics . . . . . . . . . . 84 Infant and child mortality differentials by demographic and health-related characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 CHAPTER 8 8.1 8.2 8.3 8.4 MATERNAL AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Tetanus immunization of pregnant women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Delivery assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Immunization of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 iv 8.5 8.6 8.7 Page Prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Diarrheal disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 CHAPTER 9 9.1 9.2 INFANT FEEDING AND SUPPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . 111 Prevalence of breastfeeding and supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 CHAPTERIO 10.1 10.2 10.3 10.4 10.5 MATERNAL MORTAL ITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Data collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Assessment of data quality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Direct estimates of adult mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Direct estimates of maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 CHAPTER 11 I1.1 11.2 LOCAL AVAILABIL ITY OF FAMILY PLANNING AND HEALTH SERVICES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Distance and time to nearest family planning services . . . . . . . . . . . . . . . . . . . . . . . . 121 Distance to nearest maternal and child health services . . . . . . . . . . . . . . . . . . . . . . . . 125 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 APPENDIX B EST IMATES OF SAMPL ING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 APPENDIX C QUAL ITY OF THE DATA: NONSAMPL ING ERRORS . . . . . . . . . . . . . . . . . . 159 APPENDIX D PERSONS INVOLVED IN THE 1993 NAT IONAL DEMOGRAPHIC SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 APPENDIX E SURVEY QUEST IONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 V TABLES Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.5 Table 2.6 Table 2.7 Table 2.8.1 Table 2.8.2 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 3.11 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Page Demographic indicators, Philippines 1970-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . 16 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Fertility trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Age-specif ic fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . 40 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . 41 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Trends in contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 vii Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4. I 1 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 6.1 Table 6.2 Table 6.3 Table 6A Table 6.5 Table 6.6 Table 6.7 Table 6.8 Page Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 46 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Problems with current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 T iming of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 50 T ime to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . 50 First-year discontinuation rates for contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Reasons for discontinuation of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Marital exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Postpartum amenorrhea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 66 Median duration of postpartum insusceptibility by background characteristics . . . . . . 68 Indicators of termination of exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Fertility preferences by number of l iving children . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Desire to fimit (stop) childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Mean ideal number of children by background characteristics. . . . . . . . . . . . . . . . . . . 78 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 viii Table 7.1 Table 7.2 Table 7.3 Table 7.4 Table 7.5 Table 8.1 Table 8.2 Table 8.3 Table 8.4 Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 8.15 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 10.1 Table 10.2 Table 10.3 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table 11.5 Table 11.6 Page Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Trend in infant mortality rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Infant and child mortality by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . 85 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 87 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . 93 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 "Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . 105 Prevalence of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Treatment of diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Feeding practices during diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Breastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Data on siblings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Estimates of age-specific adult mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Maternal mortality rates by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Distance to nearest health or family planning services . . . . . . . . . . . . . . . . . . . . . . . . 121 Distance to nearest health or family planning services . . . . . . . . . . . . . . . . . . . . . . . . 122 Distance to nearest family planning service by use of family planning . . . . . . . . . . . 122 Distance to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . 123 T ime to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . . . . 124 Distance to nearest maternal and child health services by type of care received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 ix Table A. 1 Table A.2 Table B. 1 Table B.2.1 Table B.2.2 Table B.2.3 Table B.2.4 Table B.2.5 Table B.2.6 Table B.2.7 Table B.2.8 Table B.2.9 Table B.2.10 Table B.2.11 Table B.2.12 Table B.2.13 Table B.2.14 Table B.2.15 Table B.2.16 Table B.2.17 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Page Sample implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Distribution of sample PSUs, households and women . . . . . . . . . . . . . . . . . . . . . . . . 135 List of selected variables for sampling errors, Philippines, 1993 . . . . . . . . . . . . . . . . 141 Sampling errors: Entire sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Sampling errors: Urban sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Sampling errors: Rural sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Sampling errors: Metropolitan Manila sample, Philippines, 1993 . . . . . . . . . . . . . . . 145 Sampling errors: Cordillera Administrative Region sample, Philippines, 1993 . . . . . 146 Sampling errors: Ilocos sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Sampling errors: Cagayan Valley sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . 148 Sampling errors: Central Luzon sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . 149 Sampling errors: Southem Tagalog sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . 150 Sampling errors: Bicol sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Sampling errors: Western Visayas sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . 152 Sampling errors: Central Visayas sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . 153 Sampling errors: Eastern Visayas sample, Philippines, 1993 . . . . . . . . . . . . . . . . . . . 154 Sampling errors: Western Mindanao sample, Philippines, 1993 . . . . . . . . . . . . . . . . . 155 Sampling errors: Northern Mindanao sample, Philippines, 1993 . . . . . . . . . . . . . . . . 156 Sampling errors: Southem Mindanao sample, Philippines, 1993 . . . . . . . . . . . . . . . . 157 Sampling errors: Central Mindanao sample, Philippines, 1993 . . . . . . . . . . . . . . . . . 158 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Percent distribution of respondents and siblings by year, Philippines, 1993 . . . . . . . . 167 Mean sibsbip size and sex ratio of births, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . 167 X Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 5.1 Figure 6.1 Figure 6.2 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure 9.1 FIGURES Page Single-year distribution by sex, Philippines ,1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Population pyramid, Philippines, 1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Housing characteristics by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Age-specific fertility rates by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Total fertility rate among women 15-49 by residence and education . . . . . . . . . . . . . . 28 Total fertility rates, Philippines, 1970-1991 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Percentage of teenagers who have begun childbearing . . . . . . . . . . . . . . . . . . . . . . . . . 37 Knowledge of contraception married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Use of contraception, married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Trend in contraception use, Philippines, 1968-1993 . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Contraceptive Discontinuation rates for first year of use . . . . . . . . . . . . . . . . . . . . . . . 52 Percentage of births whose mothers are amenorrheic, abstaining and insusceptible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Fertility preferences, married women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Percentage of married women who want no more children by residence and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Deaths among children under two years for three 5-year periods preceding the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Trends in infant mortality, Philippines, 1971-1990 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Infant mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Number of antenatal care visits anti stage of pregnancy at first visit . . . . . . . . . . . . . . 93 Delivery characteristics of births in the five years preceding the survey . . . . . . . . . . . 99 Vaccination coverage among children 12-23 months . . . . . . . . . . . . . . . . . . . . . . . . . 102 Feeding practices among children under five with diarrhea . . . . . . . . . . . . . . . . . . . . 109 Distribution of children by breastfeeding (BF) status, according to age . . . . . . . . . . . 113 xi To the women respondents whose cooperation made this survey possible. Finally, to those who helped in one way or another but who were not mentioned here. TOMAS P. AFRICA Administrator Manila, Philippines February 1994 xiv SUMMARY OF FINDINGS The 1993 National Demographic Survey (NDS) is a nationally representative sample survey of women age 15-49 designed to collect information on fertility; family planning; infant, child and maternal mortality; and maternal and child health. The survey was conducted between April and June 1993. The 1993 NDS was carried out by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines Population Institute, and other agencies concerned with population, health and family planning issues. Funding for the 1993 NDS was provided by the U.S. Agency for International Development through the Demographic and Health Surveys Program. Close to 13,000 households throughout the country were visited during the survey and more than 15,000 women age 15-49 were interviewed. The results show that fertility in the Philippines continues its gradual decline. At current levels, Filipino women will give birth on average to 4.1 children during their reproductive years, 0.2 children less than that recorded in 1988. However, the total fertility rate in the Philippines remains high in comparison to the level achieved in the neighboring Southeast Asian countries. Fertility varies significantly by region and socioeconomic characteristics. Urban women have on average 1.3 children less than rural women, and uneducated women have one child more than women with college education. Women in Bicol have on average 3 more children than women living in Metropolitan Manila. Virtually all women know of a family planning method; the pill, female sterilization, IUD and condom are known to over 90 percent of women. Four in 10 married women are currently using contraception. The most popular method is female sterilization ( 12 percent), followed by the piU (9 percent), and natural family planning and withdrawal, both used by 7 percent of married women. Contraceptive use is highest in Northern Mindanao, Central Visayas and Southern Mindanao, in urban areas, and among women with higher than secondary education. The contraceptive prevalence rate in the Philippines is markedly lower than in the neighboring Southeast Asian countries; the percentage of married women who were using family planning in Thailand was 66 percent in 1987, and 50 percent in Indonesia in 199l. The majority of contraceptive users obtain their methods from a public service provider (70 percent). Government health facilities mainly provide permanent methods, while barangay health stations or health centers are the main sources for the pill, IUD and condom. Although Filipino women already marry at a relatively higher age, they continue to delay the age at which they first married. Half of Filipino women marry at age 21.6. Most women have their first sexual intercourse after marriage. Half of married women say that they want no more children, and 12 percent have been sterilized. An additional 19 percent want to wait at least two years before having another child. Almost two thirds of women in the Philippines express a preference for having 3 or less children. Results from the survey indicate that if all unwanted births were avoided, the total fertility rate would be 2.9 children, which is almost 30 percent less than the observed rate, More than one quarter of married women in the Philippines are not using any contraceptive method, but want to delay their next birth for two years or more (12 percent), or want to stop childbearing (14 percent). If the potential demand for family planning is satisfied, the contraceptive prevalence rate could XV increase to 69 percent. The demand for stopping childbearing is about twice the level for spacing (45 and 23 percent, respectively). Information on various aspects of maternal and child health---antenatal care, vaccination, breastfeeding and food supplementation, and illness was collected in the 1993 NDS on births in the five years preceding the survey. The findings show that 8 in 10 children under five were bom to mothers who received antenatal care from either midwives or nurses (45 percent) or doctors (38 percent). Delivery by a medical personnel is received by more than half of children born in the five years preceding the survey. However, the majority of deliveries occurred at home. Tetanus, a leading cause of infant deaths, can be prevented by immunization of the mother during pregnancy. In the Philippines, two thirds of bitlhs in the five years preceding the survey were to mothers who received a tetanus toxoid injection during pregnancy. Based on reports of mothers and information obtained from health cards, 90 percent of children aged 12-23 months have received shots of the BCG as well as the first doses of DPT and polio, and 81 percent have received immunization from measles. Immunization coverage declines with doses; the drop out rate is 3 to 5 percent for children receiving the full dose series of DPT and polio. Overall, 7 in 10 children age 12-23 months have received immunization against the six principal childhood diseases---polio, diphtheria, ~rtussis, tetanus, measles and tuberculosis. During the two weeks preceding the survey, 1 in 10 children under 5 had diarrhea. Four in ten of these children were not treated. Among those who were treated, 27 percent were given oral rehydration salts, 36 percent were given recommended home solution or increased fluids. Breasffeeding is less common in the Philippines than in many other developing countries. Overall, a total of 13 percent of children born in the 5 years preceding the survey were not breastfed at all. On the other hand, bottle feeding, a widely discouraged practice, is relatively common in the Philippines. Children are weaned at an early age; one in four children age 2-3 months were exclusively breastfed, and the mean duration of breastfeeding is less than 3 months. Infant and child mortality in the Philippines have declined significantly in the past two decades. For every 1,000 live births, 34 infants died before their first birthday. Childhood mortality varies significantly by mother's residence and education. The mortality of urban infants is about 40 percent lower than that of rural infants. The probability of dying among infants whose mother had no formal schooling is twice as high as infants whose mother have secondary or higher education. Children of mothers who are too young or too old when they give birth, have too many prior births, or give birth at short intervals have an elevated mortality risk. Mortality risk is highest for children born to mothers under age 19. The 1993 NDS also collected information necessary for the calculation of adult and maternal mortality using the sisterhood method. For both males and females, at all ages, male mortality is higher than that of females. Matemal mortality ratio for the 1980-1986 is estimated at 213 per 100,000 births, and for the 1987-1993 period 209 per 100,000 births. However, due to the small number of sibling deaths reported in the survey, age-specific rates should be used with caution. Information on health and family planning services available to the residents of the 1993 NDS barangay was collected from a group of respondents in each location. Distance and time to reach a family planning service provider has insignificant association with whether a woman uses contraception or the choice of contraception being used. On the other hand, being close to a hospital increases the likelihood that antenatal care and births are to respondents who receive ANC and are delivered by a medical personnel or delivered in a health facility. xvi PHILIPPINES CORDILLERA ADMINISTRATIVE '~ REGION (CAR)\ ~ ILOCOS REGION II CAGAYAN VALLEY China Sea Pacific Ocean REGION 111~ CENTRAL LUZON NATIONAL CAPITAL / REGION (NCR) REGION IV SOUTHERN TAGALOG i # qt REGION VI WESTERN VISAYAS REGION VIV \ CENTRAL VISAYAS REGION V REGION VIII EASTERN VISAYAS % • REGION X NORTHERN MINDANAO WESTERN MINDANAO ~1~,~ ".~ ~' REGION Xll CENTRAL MINDANAO Celebes Sea ,b REGION XI SOUTHERN MINDANAO xviii CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy The Philippine archipelago lies strategically within the arc of nations that sweeps southeastward from mainland Asia to Australia, spanning 1,094 kilometers from west to east. The archipelago is composed of about 7,100 islands, many of which are still uninhabited. Ithas a total area of 300,000 square kilometers, 92 percent of which is found in the 11 largest islands. There are three major island groups: Luzon, the largest island situated in the north accounts for 47 percent of the land area; Mindanao in the south has 34 percent of the total land area; and the Visayas, a group of smaller islands between Luzon and Mindanao, which constitute the remaining 19 percent of land area. Administratively, the Philippines is divided into 15 regions as follows: LUZON National Capital Region (NCR) Cordillera Autonomous Region (CAR) Region 1 - llocos Region Region 2 - Cagayan Valley Region 3 - Central Luzon Region 4 - Southern Tagalog Region 5 - Bicol VISAYAS Region 6 - Region 7 - Region 8 - Westem Visayas Central Visayas Eastern Visayas MINDANAO Region 9 - Westeru Mindanao Region 10 - Northern Mindanao Region 11 - Southern Mindanao Region 12 - Central Mindanao Autonomous Region in Muslim Mindanao - ARMM The next lower administrative units are provinces/subprovinces, cities, and municipalities, and barangays. Barangays are the smallest political subdivisions in the country. In 1990, there were 73 provinces, 2 subprovinces, 60 cities, 1,537 municipalities and some 41,000 barangays. Classification of urban and rural areas is made at the barangay level using the 1970 Census urban-rural definitions. The Philippines has the longest discontinuous coastline in the world. It has 61 natural harbors, 31 of which are developed and could accommodate large vessels. Manila Bay, the finest natural harbor in the Far East, is an asset which has given Metropolitan Manila a locational advantage for rapid industrial development. The archipelago has a diverse topography and climate. The mountain ranges which traverse the major islands are contrasted sharply by adjacent valleys and plateaus. Because of their topography and geographic location, the provinces are exposed to varying climatic conditions and degree of weather disturbances. The northeastern parts of Luzon and the Bicol Region are generally wet and more vulnerable to typhoons. On the whole, the Visayas have more rainy days than Luzon and Mindanao. Mindanao is almost free from typhoons, which makes agriculture a very valuable industry in that island. The Philippines became a republic in 1946. Since the latter part of the 1960s, the government faced several political and social problems caused by ideological and ethnic differences. Threat of communist takeover and student unrest precipitated the declaration of Martial Law by former President Marcos in 1972. Rebellions led by Muslim leftists exacerbated the political and economic situation. Under the shroud of Martial Law, Marcos extended his dictatorial leadership for two decades. The ouster of Marcos in 1986 brought new hope for political stability and economic recovery. Several attempts to topple the new government failed. Sporadic encounters of govemment forces with both the leftist and rightist groups are no longer considered threats as the Ramos administration gears itself toward the attainment of a Newly Industrialized Country status by the year 2000. The 1970s witnessed a substantial growth in the Philippine economy, with a growth rate higher than the world average for developing countries. Real GNP increased at an average rate of 6.2 percent annually during the period 1972-80. While the country experienced substantial growth in the 1970s, the income distribution structure improved only very slightly during the period 1961 to 1988. A large percentage of the nation's wealth remained concentrated in the hands of a few families. The income share of the lowest 50 percent reached its highest level at only 20.5 percentin 1975, from 17.6 percent in 1961. The corresponding proportion in 1988 and 1991 is 20.3 percent and 18.9 percent, respectively. The worldwide recession in the 1980s, however, affected the top 20 percent income group. This is reflected in the continued decline of its share from 56.5 percent in 1961 to 51.8 percent in 1988. The income share of the top 20 percent improved slightly in 1990 (53.9 percent), which is comparable to that in the early 1970s. This is because international markets for Philippine exports became weak, which adversely affected the trade and industrial sectors. Balance of payment deficit widened as a result of accelerated outflow of short-term capital and the unwillingness of some creditors to extend new credit lines. The debt servicing capacity of the country underwent stresses and strains from both the high cost of borrowing and the difficulty ofeamlng foreignexchange, ltwas agriculture whichpropelledeconomicgrowthinthe 1980s, butitsoutput was affected by the eight-month drought which struck the country in the late 1982. The worsening employment situation was partly offset by the overseas deployment of workers and the implementation of the national livelihood program. After President Aquino came into power in 1986, the government underwent political and economic reform. The 1984-1987 Development Plan was updated, with the commitment to strengthen the national will and capability for self-reliant development through a conscious effort to raise productivity and attain self- sufficiency. Its fundamental goals are to increase productivity for sustainable development, more equitable distribution of the fruits of development, and total human development. Over the years, development has not been distributed equitably among regions and provinces within a region. Infrastructure and development eflbrts have been concentrated in Metropolitan Manila and its environs, and selected cities. Because of the locational advantage of Metropolitan Manila, economic and social policies in the past administrations have been biased, resulting in the rapid industrialization of Metropolitan Manila. Later, an overspill of economic development was seen in the neighboring provinces. Uneven development and perceived economic opportunities in urban centers stimulated rural-urban migration and the continued influx of migrants has exerted pressure on the urban resources and environment. 2 In 1991, the Philippine economy suffered from disturbances caused by the Gulf War which disrupted employment in the Middle East where many Filipinos work. Millions of US dollars were lost, not only from overseas remittances but also from the damage caused by the continued eruption of Mt. Pinatubo and the flash floods in Ormoc City. The economic slowdown was manifested in all the major sectors, posting lower growth rates over the previous year. As with economic development, social development has not been distributed equitably among geographic units of the country. Although the national level of literacy has improved from 83 percent for persons aged 10 and over in 1970 to 94 percent in 1990, pockets of illiteracy are still prevalent in remote barangays of nearly all provinces. The present government policy on this issue is aimed at eradicating illiteracy by the year 2000 by providing education for all. There are wide differences in the economic participation between males and females. Sex differentials in education, however, are minimal. In fact, in terms of higher educational attainment, females have an advantage over males. The differential impact of development on women has been integrated in the development plan for 1989-92 by providing women equal opportunities in the economic, political, and social activities of the country. In 1982, the Filipino diet was found to be adequate in protein but inadequate in energy and micronutrients, except niacin. Nutrient intake was generally higher among those with higher education and income, in urban than in rural areas, with Metro Manila being worse off than other urban and rural areas. Breastfeeding practices and duration have been slowly declining but a reversal in trend was observed among urban and more educated women. A declining trend persists among the disadvantaged women where the benefits of breastfeeding are most needed. 1.2 Population Growth The 1990 Census of Population reported a total population of 60.7 million, up by 12.6 million persons over the previous decade. About 30 million or 49 percent of the population lived in urban areas, an increase of 11 percentage points from 1980 (see Table 1.1.). The population growth rate has been declining at a slow pace. The average annual growth rate decreased by 0.4 percentage points, from 2.75 percent during the intercensal period 1970-80 to 2.35 percent in 1980-1990. The Philippine population is unevenly distributed over the 15 regions. In 1990, the National Capital Region (NCR), which accounted for only 0.2 percent of the total land area, had 13 percent of the total population, surpassed only by Southern Tagalog which registered 14 percent of the population. These two regions, together with Central Luzon, accounted for more than a third of the country's population. The six least populated regions are Cordillera Administrative Region (CAR), Cagayan Valley, Bicol, Eastern Visayas, Western Mindanao and Central Mindanao, which are at the same time the least developed regions, as well as experiencing a relatively high level of civil unrest. The overall population density increased from 122 persons per square kilometer in 1970 to 160 in 1980, and 202 in 1990. The average density in 1990 ranged from 12,498 persons per square kilometer in Metro Manila to 30 in Kalinga-Apayao in CAR. The slow decline in population growth has partly been brought about by a decline in both the fertility and mortality levels. In 1970, the crude birth rate was estimated at 39 births per 1,000 population, dropping slightly to 36 in 1980 and 29 in 1990. The total fertility rate for women 15-49 years dropped by about one child in two decades, from an estimated level of 5.1 children in 1970, to 4.7 in 1980 and 4.1 in 1990. 3 Table I. l Demographic indicators, Philippines 1970-1990 Indicator 1970 1980 1990 Population (millions)" 36.7 48.1 60.7 Density (Pop./sq. km.~ 122 160 202 Urban population (percen0 m 31.8 37.3 48.7 Rate of annual increase (percent)" 3.08 2.74 2.35 Population doubling time (years) 23 26 30 Crude birth rate (per 1,000 pop.) b 39 36 29 Crude death rate (per 1,000 pop.) b 10 9 7 Total fertility rate 5.1 4.7 4.1 Infant mortality rate 63 c 63 d 570 Life expectancy at birth, both sexes (years) 55.9 e 61.6 b 64.8 ~ Soui-ce$: s1990 Census of Population and Housing. Report no.3. b1980-based projection eFlieger.n.d. C~Task Force on Infant Mortality Rate *University of the Philippines Population Institute. Baseline Estimation Project. While the overall mortality rate showed a decline during the period from 1948-1960, the pace has slowed down since 1960. The crude death rate was estimated at 10 deaths per 1,000 population in 1970, declining to 6 in 1990. Likewise, infant mortality rates hovered around 63 per 1,000 live births during the period 1977-1986, and was estimated at 57 in 1990. Life expectancy at birth which slowed in the 1970s resumed a more rapid increase in the 1980s, rising by 3 years, from 61.6 in 1980 to 64.8 in 1990. 1.3 Population Policies and Programs The family planning movement in the Philippines was initiated by the private sector in the 1960s. The government's commitment to family planning was manifested with the issuance of Executive Order No. 171 in 1969 to establish the Commission on Population (POPCOM) to undertake studies on all aspects of the population and to formulate policy and program recommendations on population as it relates to economic and social development. Executive Order No. 233 of 1970 empowers the POPCOM to conduct and direct the national population program as an integral part of the national development strategy. When the Population Act was passed in 1971, family planning became an integral part of the national development plan. Reduction of the population growth rate was embodied as a goal in the country's five-year and ten- year development plans. Specifically, the goal was to reduce the growth rate from 2.5 percent in 1978 to 2.1 percent in 1987. The target was to achieve a contraceptive prevalence rate of 40 percent in 1982 and 50 percent in 1987. Cognizant of the close interrelationship between population, resources and environment, the population policy of 1987 broadens the scope of population concerns beyond fertility reduction, to include family formation, the status of women, matemal and child health, child survival, morbidity and mortality, population distribution and urbanization, internal and international migration and population structure. In 4 the 1987-92 Population Development (POPDEV) Program, rapid population growth which remains an important national development issue, took on a more complex dimension as it is linked to welfare and sustainable development. The policy places emphasis on the following objectives (DOH, 1990): 1. To pursue and promote policies and measures that will ensure the attainment of rational population size, growth, composition and balanced distribution; 2. To promote and ensure explicit, full and conscious consideration of population and sustainable development interrelationships in policy formulation, development planning and decision-making; 3. To strengthen, institutionalize and ensure greater political support of the local government units in the coordination and implementation of the local population program; 4. TO promote the values of responsible parenthood, delayed marriage, birth spacing and a small family norm; and 5. To ensure maximum participation of govemment and non-government organizations as well as population organizations in the implementation of population and population-related programs, projects and activities. Under the Aquino administration (1986 to 1992), the family planning program suffered from a vacillating political and financial support because of the strong influence of the Catholic Church. The program was transferred from POPCOM to the Department of Health. It became mainly a health program with the primary goal of improving the health of the mother and the child, with fertility reduction as only a consequence. The integration of population and development (POPDEV) which considers the interaction of socioeconomic and demographic variables in development planning has laid down the foundation for the application of POPDEV approaches and concepts through advocacy, research, training and technology dissemination and adoption. Although a few sectors have attempted to operationalize POPDEV in their development efforts, the program has failed to develop a unified framework and a more vigorous strategy for integration of population in various development concerns. A more recent population program is currently being updated for the 1993-1998 period. 1.4 Health Plan and Programs The Health Plan of 1987-1992 aimed at health, nutrition and family planning as the foundation of the sector's contribution to the development of healthy and productive citizens and to their participation in the socioeconomic development of the country. a) b) e) The main objectives were: to improve the health and nutritional status of the population; to contribute to the achievement of Health for All by the year 2000 through primary health care; and to promote family planning as a means to improve family well-being. The Plan alms to improve the accessibility of high quality health services particularly to the poor, unserved, underserved and high risk groups. It focuses on the integration and promotion of individual and collective responsibility for health, self-reliance, preventive actions, the status of women, environmental sanitation and workers' safety. It relies heavily on the primary health care to further the establishment of a network to meet the health needs of the people. Another strategy is to involve the private sector in the provision of preventive and creative health services and to more actively participate in the implementation of the Plan. The priority health programs include, among others, the following: . Expanded Program on Immunization. The goal of this program is to protect children from the six immunizable diseases by providing specific protection through the use of effective vaccine against TB, diphtheria, pertussis, tetanus, measles and poliomyelitis, and protect newborns from tetanus by immunizing pregnant mothers; . Maternal and Child Health. This program is designed to improve the well-being of mothers and children through a comprehensive approach of providing preventive, promotive, and curative health care. The specific objective is to reduce matemal, infant and child mortality; the target populations are women of reproductive age (15-49 years); infants (under 1 year); and children (1-6 years). The major activities undertaken are increased coverage of pregnant women given antenatal, natal, and postnatal care and immunization of pregnant mothers against tetanus; and establishment of under-six clinics in all government facilities to monitor the growth and health status of infants and children. The program components of the maternal and child health program are as follows: Maternal Care, Immunization of Pregnant Mothers, Under-Six Clinic, and Breastfeeding Promotion; . Nutrition Program. The program alms to improve the nutritional status of pre-schoolers, pregnant women and lactating mothers. It is directed towards the prevention and reduction of the prevalence of protein-energy malnutrition, Vitamin A de ficiency disorders through effective growth monitoring, nutrition education, food and micronutrients supplementation, and rehabilitation of malnourished children. . Family Planning Program. This program is a delivery program systematically aimed to provide information and services necessary for couples of reproductive age to plan their families according to their beliefs and circumstances. It gives couples the choice of when to start having children, how many to have, how far apart, when to have them and when to stop, at the least risk to the health of the mother and best chance of survival for the child. . Dental Health Program. The objective of this program is to reduce the incidence and prevalence of dental caries including reduction of periodontal diseases, particularly among pregnant women and children. . Acquired Immuno-Deficiency Syndrome. The program aims to control the spread of AIDS in the country winch is considered to be in the early stage of AIDS epidemic. The central measures undertaken are generally preventive such as surveillance of high-risk populations including monitoring blood banks, health education, and development of capabilities for dealing with the disease. 6 1.5 Objectives and Organization of the Survey The 1993 Philippine National Demographic Survey (1993 NDS) is a nationwide sample survey designed to collect information on fertility, family planning, maternal and child health and child survival. It is the sixth of the series of demographic surveys taken at five-year intervals since 1968. The 1993 NDS was undertaken as part of the worldwide program known as the Demographic and Health Survey (DHS). It was conducted by the National Statistics Office in collaboration with Department of Health (DOH), the University of the Philippines Population Institute, and other concerned agencies of the Philippine government. Macro International, Inc., which is based in Calverton, Maryland (USA), provided funding and technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). The primary objective of the 1993 NDS is to provide up-to-date inform ation on fertility and mortality levels; nuptiality; fertility preferences; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policymakers and administrators in evaluating and designing programs and strategies for improving health and family planning services in 'the country. 1.6 Sample Design and Implementation The main objective of the 1993 NDS sample is to allow analysis to be carried out for urban and rural areas separately, for 14 of the 15 regions in the country, and to provide estimates with an acceptable precision for sociodemographic characteristics, like fertility, family planning, health and mortality variables. Due to the recent formation of the 15th region, Autonomous Region in Muslim Mindanao (ARMM), the sample did not allow for a separate estimate for this region. Detailed discussion of the 1993 NDS is presented in Appendix A, and sampling errors for selected variables can be found in Appendix B. The Integrated Survey of Households (ISH) was used as a frame, to generate a nationally repre- sentative sample of women aged 15 to 4-9 years. The ISH was developed in 1980 to collect information on employment and other socioeconomic characteristics of households. It consists of 2,100 samples of primary sampling units (PSUs) systematically selected, with a probability proportional to size, in each of the 14 regions. The PSUs were again selected in 1991, using the 1990 Population Census data on population size, but retaining the maximum number of PSUs selected in 1980. The sample is sel f-weighted in each of the 14 regions, but not at the national level. The selection was done separately for the urban and the rural areas, using a two-stage sample design. The first stage is the se•ecti•n•fbarangays•andthesec•ndisthese•ecti•n•fh•useh••dsinthesamp•edbarangays. Of the 2,100 PSUs in the ISH, 750 were selected for the 1993 NDS. Individual households were selected with a probability of selection inversely proportional to the barangay's size to maintain a fixed overall sampling fraction within each region. Eligible respondents for the individual interview were all females age 15-49 years, who are members of the sample household or visitors present at the time of interview and had slept in the sample households the night prior to the time of interview, regardless of marital status. 1.7 Questionnaires Three types of questionnaires were used for the 1993 NDS: the Household Questionnaire, the Individual Woman's Questionnaire and the Service Availability Questionnaire. The contents of the first two questionnaires were based on the DHS Model Questionnaire, which was designed for use in countries with high levels of contraceptive use. Additions and modifications to the model questionnaires were made after consultation with members of a Technical Working Group convened for the purpose of providing technical assistance to the NSO in the implementation of the survey. The questionnaires used in the 1993 NDS are presented in Appendix E. The household and individual questionnaires were developed in English and then translated into and printed in six of the most widely spoken languages in the Philippines, namely: Tagalog, Cebuano, Ilocano, Hiligaynon, Bicol and Waray. The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women who were eligible for individual interview. In addition, information was collected about the dwelling, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various consumer goods. The Individual Woman's Questionnaire was used to collect information from women aged 15-49. An important change from the past practice in large-scale demographic surveys in the Philippines is that the 1993 NDS covered all women 15-49 instead of limiting the interview to ever-married women. In keeping with past practice, the questionnaire contained a pregnancy history instead of the usual DHS birth history. Women were asked questions on the following topics: Background characteristics (education, religion, etc.) Reproductive behavior and intentions Knowledge and use of contraception Availability of family planning supplies and services Breastfeeding and child health Maternal mortality The Health Service Availability Questionnaire was designed to collect information about health and family planning services available to the individual women respondents. This questionnaire was administered at the cluster level, that is, one questionnaire was filled for each of the 750 sample points. Combined with information collected in the main survey, data from the two surveys can identify subgroups of women who are underserved by the health and family planning providers. 1.8 Tra in ing and F ie ldwork The 1993 NDS questionnaires were pretested in December 1992. Three pretest areas were selected; namely, the barangays of Malolos and Calumpit, Bulacan Province, and Barangay Tatalon in Metropolitan Manila. Fifteen female interviewers were recruited. Three NSO employees were assigned as field editors, and three statisticians from the NSO were assigned to supervise the fieldwork. About 180 interviews of women 15-49 were completed in the pretest. The pretest results were used as basis for revising the questionnaires and the translations into the six dialects. They also provided a basis for firming up survey operational procedures. Training of field staff for the main survey was conducted in the following designated training sites: Baguio City, Manila, Cebu City and Davao City. The training course consisted of instructions in general interviewing techniques, field procedures, a detailed review of items on the questionnaires, mock interviews between participants in the classroom, and practice interviews in the field. Trainees who performed satisfactorily in the training program were selected as interviewers, while those whose performance was rated as superior were selected as field editors. The fieldwork for the Philippine NDS was carried out by 31 interviewing teams. Each team consisted of one team supervisor, one field editor, and an average of five interviewers. The Regional Administrators of NSO served as field coordinators during the data collection phase of the survey. During the first two weeks of the field work, statisticians from the Central Office, who served as trainers during the training of interviewers, went on field trips to observe and guide the teams in their initial interviews. 1.9 Data Processing Editing of the questionnaires was an integral part of the field data collection in the sense that questionnaires based on successful interviews were immediately edited by field editors. Further review and coding of some variables were done at the NSO central office. Machine processing was also done at the central office. Processing of the NDS data was done with the use of the DHS computer program ISSA (Integrated System for Survey Analysis), from data entry to tabulation. Seven microcomputers were made available by NSO for data entry while Macro International provided four microcomputers for data management as well as for running edit and tabulation programs. Initial tabulations were generated by the end of August 1993, and a preliminary report was released in October 1993. 1.10 Response Rate Table 1.2 gives a summary of the response rates for the survey. A total of 13,728 households was selected for the survey, of which 12,995 were successfully interviewed. The difference was due to one of the following reasons: some selected households had moved out or could not be located by the NDS team; there were no eligible respondents found for the selected household during the NDS team's visit; or the household simply refused to be interviewed. (See Appendix Table A.1 for details.) The household interviews identified 15,332 eligible women. Of these, 15,029 were successfully interviewed, giving a response rate of 98 percent. The principal reason for nonresponse among eligible women was the failure of interviewers to find them at home despite repeated visits to the household. Refusals were few in number (less than one percent). Table 1.2 Results of the household and individual interviews Number of households, number of interviews and response rates, according to urban-rural residence, Philippines 1993 Residence Result Urban Rural Total Household Interviews Households sampled 6542 7186 13728 Households found 6201 6901 13102 Households interviewed 6131 6864 12995 Household response rate 98.9 99.5 99.2 Individual Interviews Number of eligible women 8056 7276 15332 Number of eligible women interviewed 7908 7121 15029 Eligible woman response rate 98.2 97.9 98.0 9 CHAPTER 2 BACKGROUND CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Presented in this chapter are the background characteristics of the sample households and the respondents to the survey. Information on the characteristics of the households and respondents is deemed important in the interpretation of the survey results. The behavior of women concerning demographic phenomena is known to be influenced by their characteristics and their environment. Also, analysis of the reported characteristics of the sample households and the respondents can serve to indicate the representativeness and quality of the data collected in the survey. The chapter is divided into three parts. The first part deals with the characteristics of the household population in terms of age-sex composition, household size and distribution, and educational background. The second part describes the housing environment in which the respondents live. The characteristics of the individual women respondents to the survey are discussed in the third part of this chapter. 2.1 Population Composition The household questionnaire used in the 1993 National Demographic Survey (NDS) collected data on the demographic and social characteristics of the members and visitors of each sample household. A household, as defined in the survey, refers to a person or group of persons who usually sleep in the same housing unit and have a common arrangement for the preparation and consumption of food. A visitor, on the other band, is someone who is not a usual resident of the household but had slept in the household the night prior to the time of interview and is still present in the household during the time of interview. In this report, except in Table 2.2, the population is presented according to the place where they spent the night before the interview (de facto). Age-Sex Composition Age reporting in the Philippines is relatively accurate. The present generation of residents, including those living in the rural areas, seem to be conscious of calendar dates especially those relating to important events in their personal lives such as birthdays. The distribution of the sampled population by single year of age and by sex is presented in Figure 2.1 and in Appendix Table C.1. Examination of the data and the graph reveals only a slight preference for digits ending in 0 and 5 when reporting ages. It will be noted, however, that the number of women age 15 and age 49 relative to those age 14 and 50, respectively, is conspicuously small. This seems to indicate that there was intentional displacement of women from age 15 to age 14 and from age49 to 50. Since the respondents for the main questionnaire are women age 15 to 49 years, this was probably done intentionally by the interviewers, to reduce their assigned workload. For each sex, the proportions below 15 years are larger in rural than in urban areas, indicating a younger age structure of the rural population (Table 2.1). Within the urban areas, the proportion is, however, larger for males than for females but it does not differ much between the sexes in rural areas. On the whole, it can be said that the composition of the Philippine population by age and sex depicts a population pyramid (Figure 2.2) with a wide base and narrow top, a pattcm that is typical of high fertility societies. II Figure 2.1 Single-year Age Distribution by Sex Philippines, 1993 Number of Persons 1,000, 800 600 4OO 200 0 I I I I t I I I I I I I I 0 5 10 15 20 25 30 35 40 45 50 55 60 65 Age 1993 NDS Table 2.1 Household population by age~ residence and sex Percent distribution of the de facto household poptdation by five-year age group, according to urban-rural residence mad sex, Philippines 1993 Urban Rural Total Age group Male Female Total Male Female Total Male Female Total 0-4 14.0 12.3 13.2 14.8 14.7 14.7 14.4 13.5 13.9 5-9 13.0 11.5 12.2 15.0 14.6 14.8 14.0 13.0 13.5 10-14 12.0 12.2 12.1 13.8 14.1 13.9 12.9 13.1 13.0 15-19 10.9 11.3 11.1 10.7 8.7 9.7 10.8 10.0 10.4 20-24 9.7 9.3 9.5 7.7 7.2 7.4 8.7 8.3 8.5 25-29 8.0 8.5 8.3 6.6 6.8 6.7 7.3 7.7 7.5 30-34 6.5 7.4 6.9 6.0 6.2 6.1 6.3 6.8 6.5 35-39 6.1 6.0 6.1 5.5 5.8 5.6 5.8 5.9 5.9 40-44 5.1 5.0 5.0 4.4 4.8 4.6 4.7 4.9 4.8 45-49 3.8 3,7 3.8 3.6 3.5 3.5 3.7 3.6 3.7 50-54 2.9 3.6 3.2 3.2 4.0 3.6 3.0 3.8 3.4 55-59 2.5 2.9 2.7 2.8 2.9 2.8 2.6 2,9 2.8 60-64 2.1 2.2 2.1 2.2 2.3 2.2 2.1 2.2 2.2 65-69 1.3 1.7 1.5 1.4 1.7 1.6 1.4 1.7 1.5 70-74 1.0 1.2 1.1 1.0 1.3 1.1 1.0 1.2 1.1 75-79 0.5 0.6 0.5 0.6 0.8 0.7 0.6 0.7 0.6 80 + 0.6 0.7 0.6 0.6 0.8 0.7 0.6 0.7 0.7 Missing/Don't know 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number I 16734 17376 34117 16585 15907 32491 33319 33283 66608 qncludes 8 cases with missing information on sex. 12 Age 80+ 75-79 70-74 65-69 6O-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 Figure 2.2 Population Pyramid Philippines, 1993 0-4 8 6 4 2 0 2 4 6 8 Percent 1993 NDS In Table 2.2, the percent distributions of the population by broad age groups, according to the 1970, 1980, and 1990 Censuses of Population and the 1993 NDS are presented. There appears to be a progressive decline since 1970 in the proportion of the young population and, concomitantly, an increasing value of the median age. The growing proportion in the 15-64 group results in declining dependency ratio, defined as the ratio of persons in the "dependem" ages (under 15 and 65 and over) to those in the "economically active" ages (15-64). This slight ageing of the population has taken place in the recent past as a result of a continuous, albeit slow decline in fertility levels. The 1993 NDS data and 1990 census show fairly similar distributions by age which supports the representativeness of the survey population. Table 2.2 Population by age from selected sources Percent distribution of the de jure population by age group, selected sources, Philippines 1970 1980 1990 1993 Age group Census Census Census NDS Less than 15 45.7 42.0 39.5 39.3 15-64 51.4 54.6 57.1 56.8 65+ 2.9 3.4 3.4 3.9 Total 100.0 100.0 100.0 100.0 Median age 16 18 19 20.1 Dependency ratio 94.6 83.2 75.1 76.1 13 Househo ld Compos i t ion Information on the size and composition of the sample households by urban-rural residence is presented in Table 2.3. About 14 percent of the households are headed by women. As expected, a higher proportion of female-headed households is noted in the urban areas (16 percent) than in the rural areas (12 percent). On average, a household is composed of 5.3 persons. A negligible difference in average household size is observed between the urban and rural areas. Taking into consideration the adult composition of the household population, about half of the households contain 3 or more related adults, while 39 percent consist of two adults of opposite sex. About f ive percent of the households have one adult member, while households with two related adults of the same sex are very rare (2 percent). About one-tenth of the households had foster children, that is, children below 15 years whose natural mother or father is not a member of the household. Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, kinship structure, and presence of foster children, according to urban-rural residence, Philippines 1993 Resideaee Characteristic Urbaaa Rural Total Household headship Male 84.2 87.8 86.0 Female 15.8 12.2 14.0 Total 100.0 100.0 100.0 Number of usual members 1 2.6 3.0 2.8 2 7.0 7.9 7.4 3 12.0 13.0 12.5 4 17.6 16.2 16.9 5 17.5 17.5 17.5 6 15.2 15.0 15.1 7 11.2 11.7 11.4 8 6.8 6.7 6.7 9+ 10.1 9.1 9.6 Total 100.0 100.0 100.0 Mean size 5.4 5.3 5.3 Relationship structure One adult 4.0 5.1 4.5 Two related adults: Of opposite sex 35.1 42.4 38.7 Of same sex 1.6 1.9 1.8 Three or more related adults 50.7 48.4 49.6 Other 8.6 2.1 5.4 Total 100.0 100.0 100.0 With foster children I 9.1 10.2 9.7 1Foster children are those under age 15 living in households with neither their natural mother nor father. 14 Education Tables 2.4.1 and 2.4.2 present information on the highest educational level attained by the population classified by sex, age, residence, and region. The value of education is highly regarded by Filipino families. The constitution of the country respects this and states that education, at least up to high school level, is a basic right of all Filipino children. The results of the survey indicate that the vast majority of the population do have some formal education. Among the population age 5 and over, only 8 percent have no formal education, and no more than 4 percent among those between the ages of 10 and 50 never went to school. Of both men and women, around half attended primary school, one in four attended high school, and one in six attended higher education. Table 2.4.1 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, according to selected background characteristics, Philippines 1993 College Median Background High or Don't know/ number characteristic None Elementary school higher missing Total Number of years Age 1 6-9 37.9 58.9 0.4 0.0 2.8 100.0 3660 1.4 10-14 2.4 80.5 16.9 0.0 0,1 100.0 4306 5.2 15-19 1,1 27.3 58.3 13.1 0.1 100.0 3602 9.0 20-24 1.6 27.7 41.1 29.5 0.0 100.0 2896 10.2 25-29 1.9 29.3 40.6 28.1 0.1 100.0 2437 10.2 30-34 2.3 34.7 35.7 27.2 0.1 100.0 2085 10.0 35-39 2.3 41.7 32.9 22.8 0.3 100.0 1929 8.6 40-44 2.3 44.2 30.3 23.1 0.0 100.0 1571 8.1 4549 2.6 51.8 24.9 20.6 0.2 100.0 1244 6.8 50-54 4.3 56.6 22.1 16.8 0.2 100.0 1015 6.6 55-59 5.8 56.5 23.3 14.1 0.3 100.0 881 6.5 60-64 9.5 53.6 21.1 15.2 0.6 100.0 710 6.4 65+ 16.9 58.5 13.5 10.9 0.I 100.0 1181 4.9 Residence Urban 6.0 38.8 32.7 22.0 0.5 100.0 13942 8.1 Rural 9.7 56.9 24.8 8.1 0.6 100.0 13583 6.1 Region Metro. Manila 4.2 26.0 38.6 30.8 0.4 lll0.0 3732 10.2 Cordillera Admin. 6.4 44.1 29.5 19.9 0.2 100.0 479 6.9 llocos 7.0 45.9 33.3 13.5 0.2 100.0 1631 6.8 Caga)an Valley 6.4 53.1 28.7 10.7 1.1 100.0 1060 6,5 C-Luzon 4.6 48.1 33.7 13.2 0.4 100.0 2799 6.9 S-Tagalo 8 6.4 47,7 31.8 13.8 0.3 100,0 3612 6.8 Bicol 9.3 55.4 25.0 9.6 0.7 100.0 1729 6.3 W-Visayas 8.1 50,7 25.9 15.3 0.0 1120.0 2463 6.4 C-Visa)as 8.8 53.2 22.8 14.1 1.2 100.0 2142 6.1 E-Visa)as 8.5 57.6 22.2 11.5 0.2 100.0 1366 6.0 W-Mindanao 12.2 54.3 20.0 11.3 2.1 100.0 1467 5.5 N-Mindanao 7.3 56.1 25.0 10.8 0.8 100.0 1581 6.2 S-Mindanao 11.8 52.5 24.1 11.5 0.0 100.0 2018 6.1 C-Mindanao 15.6 48.1 25.4 10.5 0.4 100.0 1447 6.0 Total 7.8 47.7 28.8 15.2 0.5 100.0 27525 6.6 IExcludes 9 people with age information missing. 15 Table 2.4.2 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, according to selected backgrotmd characteristics. Philippines 1993 College Median Background High or Don't know/ number characteristic None Elemmtary school higher missing Total Number of years Age 1 6-9 35.7 61.6 0.2 0,0 2.5 100.0 3448 1.5 10-14 1,7 75.0 23.2 0.0 0.1 100.0 4351 5,6 15-19 1.1 18.6 63.9 16.3 0.1 100.0 3333 9.6 20-24 1,8 21.7 39.6 36.9 0.1 100,0 2762 10.5 25-29 2.4 25.2 38.6 33.6 0.2 100.0 2552 10.3 30-34 2,3 34,5 32.0 31.3 0.0 100.0 2262 10,1 35-39 2.7 42.0 31.0 24.2 0.1 100.0 1979 8.3 40-44 2.7 47,1 26.9 23,2 0,2 1(30.0 1636 7.0 45-49 3.8 56.0 20.4 19.7 0.1 100.0 1192 6.7 50-54 6.2 59.3 19.2 15.0 0.2 100.0 1255 6.5 55-59 8,1 60.5 18.6 12.4 0.4 100.0 959 6.3 60-64 11.2 58.7 18,2 11.1 0.9 100.0 740 6.0 65+ 22.5 61.3 7.6 7.7 0.9 100.0 1441 4.4 Residence Urban 5.9 38.5 31.9 23.2 0.5 100.0 14819 8.1 Rural 10,2 55.2 24.2 9.8 0.5 100.0 13104 6.2 Region Metro. Manila 3.0 28,6 36,9 30.8 0.7 100.0 4268 10.1 Cordillera Admin, 10.4 40,2 26.9 22.4 0.1 100.0 474 6.9 llccos 7.9 46.5 29.9 15.4 0,3 100.0 1723 6.8 Cagayan Valley 7.4 52.3 25,2 14,2 0.8 100.0 945 6,5 C-Luzon 5.8 48.5 31.0 14,5 0.2 100.0 2870 6.8 S-Tagalog 6.3 48.8 28.7 16.1 0.I I00.0 3873 6.7 Biool 6,9 59.5 22,6 10.0 0.9 1OO.0 1658 6.3 W-Visayas 7.2 48.1 26.9 17.6 0.2 100.0 2388 6.7 C-Visayas 9.1 52.6 22.9 14.5 1.0 100.0 208I 6.3 E-Visayas 8.8 53.4 25.2 12.4 0.2 100.0 1366 6.3 W-Mindanao 15.2 50.1 20.7 12.1 2,0 100.0 1435 5.7 N-Mindanao 6.6 5111 28,6 13,1 0.7 100.0 1501 6.6 S-Mindanao 11.5 45.7 29.3 13.4 0.1 100.0 1961 6.5 C-Mindanao 20.4 43,9 22.7 12.6 0,4 100.0 1380 5,8 Total 7.9 46.3 28.3 16.9 0.5 100.0 27923 6.7 tExc, ludes 13 people with age information missing, No profound gender difference may be observed as far as education is concemed. However, a significant difference is noted in the educational level between the urban and rural population. The educational system obviously favors residents of the urban areas. The distribution of the population by highest level of education attended differs greatly among the regions of the country. Metropolitan Manila has a much better educated population compared to the rest of the country; the median duration of schooling in this region is 10 years, compared to 6 or 7 for the other regions. Residents of Western Mindanao and Central Mindanao have the lowest median duration of schooling. 16 School Enrollment Table 2.5 shows the percent distribution of the household population 6-24 years of age enrolled in school by age, sex and urban-rural residence. Close to four-fifths of persons age 6 to 10 and 88 percent of those age 11-15 are attending school. Between the ages of 16 and 20, when most everybody is still supposed to be in school, the proportion of those actually enrolled diminishes significantly. Economic reasons possibly pull the youth of the country from the school system into the job market. The probability of being in school is fairly equal for the male and female populations in the urban areas except at ages 16-24, where men are more likely to be enrolled than women. In the rural areas, however, the female population seems to get the advantage as far as schooling is concerned. This is possibly due to the fact that male children are more needed to help on the farm. Table 2.5 School enrollment Percentage of the de facto household population age 6-24 years ettrolled in school by age group, sex, and urban-rural residence, Philippines 1993 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-10 80.4 73.8 76.9 81.4 77.0 79.0 80.8 75.3 77.9 11-15 91.0 83.2 86.9 91.8 87.2 89.5 91.4 85.2 88.2 6-15 85.4 78.3 81.6 86.6 81.8 84.2 86.0 80.0 82.9 16-20 56.3 41.4 48.9 50.3 47.3 49.1 53.1 44.0 49.0 21-24 18.0 10.7 14.9 12.8 8.8 11.2 15.5 9.8 13.1 2.2 Housing Characteristics Table 2.6 shows the distribution of households with selected housing characteristics by urban-rural residence. The information on the source of water, type of sanitary facility, type of floor material and number of persons per sleeping room are indicators of the health and socioeconomic condition of households which, in turn, are associated with demographic behavior. About two thirds of the households have electricity. However, a significant difference was noted between the urban and rural areas; 84 percent of urban households have electricity, compared to less than half (46 percent) of rural households (Figure 2.3). One in 3 households has piped water (37 percent) and 28 percent have water piped into the residence. Again, a significant difference is noted between the urban and rural areas. In the urban areas, more than half (54 percent) of the households have water piped into the residence, compared to only 21 percent in the rural areas. Open dug well and developed spring are among the main sources of water in the rural areas, but only a few households in the urban areas get their water from these sources. 17 Table 2.6 Houshi~ charactenstics. Percent distribution of households by housing characteristics, according to urhan-raral residence, philippines 1993 Residence Housing characteristic Urban Rural Total Electricity Yes 83.7 46.4 65.4 No 16.1 53.3 34.4 Missing 0.2 0.3 0.2 To¢~[ 100.0 I00.0 100.0 Source of drinking water Piped into residence 44.1 12.0 28.3 Public tap 9.4 8.6 9.0 Tubed~iped well/improved dug well within residence 13.7 20.2 16.9 Tubed/piped well/unproved dug well outside residence 6.0 10.4 8.2 Private weU 5.9 4.3 5.2 Public well 10.8 11.9 11.3 Open dug well 3.8 15.8 9.7 Developed spring 2.1 12.3 7.1 Rainwater 0.5 l. 1 0. 8 Other 3.4 3.2 3.3 Missing/Don't know 0.2 0.3 0.3 Total 100.0 100.0 1(30.0 Sanitation facility Own flush toilet 62.8 43.5 53.3 Shared flush toilet 13.0 6.9 10.0 Trad. own pit toilet 8.7 12.0 10,3 Trad. shared pit toilet 3.6 3.3 3.5 Open p6vy 3.8 10.0 6.8 Drop/overhang type 2.0 3.9 2.9 No facilities 5.8 20.1 12.8 Other 0.2 0.0 0.1 Missing/Don't know 0.2 0.2 0.2 Total 100.0 100.0 100.0 Flooring Eaah/sand 5.1 7.9 6.5 Wood planks 20.3 20.9 20.6 Palm/bamboo 14.3 36.4 25.2 Parquet/polished wood 0.8 0.5 0.7 Viny//asphalt strips 1.3 0.2 0.8 Ceramic tiles 2.7 0.9 1.8 Cement 50.4 31.9 41.3 Marble 3.0 0.5 1.8 Other 1.7 0.6 1.2 Missing/Don't know 0.3 0.2 0.3 Tc~al I00.0 100.0 100.0 Persons per sleeping room 1-2 47.3 41.4 44.4 3-4 33.0 35.1 34.0 5-6 12.8 14.7 13.7 7 + 5.3 7.5 6.4 MJ ssing/Don 't know 1.6 1.3 1.4 Total 100.0 100.0 100.0 Mean persons per room 3.2 3.4 3.3 Number of households 6613 6382 12995 18 Figure 2.3 Housing Characteristics by Residence Percent of Households 100 80 60 40 20 Electricity Piped Water Flush Toilet Note: Piped water includes public tap. 1993 NDS The majority of the households (64 percent) have their own toilet facility. The proportion is much higher in urban (72 percent) than in rural areas (56 percent). A large proportion (20 percent) of rural households have no toilet facility. As to the type of flooring material, 41 percent of the households have cement floors, and one in four have palm or bamboo floors. Urban households are more likely to use cement than rural households (50 and 32 percent, respectively). One fifth of the households in both the urban and rural areas have wood plank floors. In the NDS, a question was asked about the number of rooms the household used for sleeping. The purpose was to get a measure of household crowding. On average, there were 3 persons per sleeping room. No significant difference was noted between the urban and rural areas in this respect. Durable Consumer Goods The percentage ofbeuseholds owning specific durable consumer goods by urban- rural residence is presented in Table 2.7. Among the durable consumer goods, tele- vision is available in 43 percent of the house- holds, followed by refrigerator (28 percent). Table 2.7 Household durable goods Percentage of households possessing specific durable consumer goods, by urban-rural residence, Philippines 1993 Residence Durable goods Urbma Rural Total Oas/electaic range 21.1 8.0 14.6 Television 61.5 23.8 43.0 Refrigerator 41.9 13.0 27.7 Bicycle 24.1 18.5 21.4 Momrcycle 7.3 4.7 6.0 PrivaLe cer 9.9 2.1 6.1 Number of households 6613 6382 12995 19 The proportion of households with such appliances varies greatly between the urban and rural areas; 62 percent of urban households reported having a television, compared to only 24 percent of rural households, and 42 percent of urban households have a refrigerator, compared to 13 percent of rural households. Twenty- one percent of urban households have either an electric or a gas range, compared to only 8 percent of rural households. Urban households are more likely than rural households to own some means of transportation (either a bicycle, motor cycle or private car). 2.3 Characteristics of Respondents In the household questionnaire, a total of 15,332 women were identified as eligible for interview for the NDS individual ques- tionnaire. Of these women, 15,029 or 98 per- cent were successfully interviewed. In each age group, the proportion of women inter- viewed was about the same. General Characteristics Table 2.8.1 shows the distribution of women in the NDS sample by selected back- ground characteristics. More than half (55 percent) of the women interviewed in the sur- vey are under age 30. Married women com- prise 54 percent of the total women inter- viewed, while never-married women consti- tute just over one third. Almost all of the women who were interviewed have had some formal education. More than one fourth are in college or are college graduates, and a large proportion (40 percent) have attended high school. Roman Catholic is the most predomi- nant religion (83 percent). With respect to ethnicity, Tagalog and Cebuano groups com- prise more than half of the respondents. Table 2.8.2 shows that there are slightly more respondents from the urban areas than from the rural areas. Almost one in five respondents (18 percent) were from the Metropolitan Manila area, 10 percent were found in the Northern provinces (comprising Ilocos, Cagayan Valley, and Cordillera Administrative Region), while the rest of Luzon has about 30 percent of the respon- dents. Visayas and Mindanao have 20 and 22 percent of the respondents, respectively. Table 2.8.1 Background characteristics of respondents Percem distribution of women by selected background characteristics, Philippines 1993 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 21.0 3158 3139 20-24 17.6 2649 2602 25-29 16.2 2430 2412 30-34 14.6 2196 2228 35-39 12.6 1889 1907 40-44 10.5 1571 1597 45-49 7.6 1137 1144 Marital status Never married 36.7 5518 5343 Married 54.4 8180 8372 Living together 5.2 781 773 Widowed 1.8 273 276 Divorced 0.2 29 31 Separated 1.6 248 234 Education No education 2.1 320 382 Elementary 31.2 4690 4863 High school 39.7 5967 5868 College or higher 26.9 4049 3913 Don't know~missing 0.0 3 3 Religion Catholic 83.2 12507 12246 Protestant 2.8 426 454 Iglesia ni Kristo 2.8 414 403 Aglipay 1.5 228 241 Islam 3.5 521 671 Other 6.0 908 989 None 0.1 13 14 Missing 0.1 11 11 Ethnlclty Tagalog 28.2 4237 3256 Cobuuno 26.0 3907 4345 Iloca~o 10.4 1556 1773 nonggo 11.1 1670 1659 Ricolano 6.2 926 902 Waray 4.0 597 638 Other 14.1 2117 2437 Missing 0.1 19 19 Total 100.0 15029 15029 20 Table 2.8.2 Background characteristics of respondents Percem distribution of women by type of residence and region, Philippines 1993 Number of women Background Weighted Un- characteristic percent Weighted weighted Residence Urban 56.6 8501 7908 Rural 43.4 6528 7121 Region Metro. Manila 18.2 2733 1882 Cordillera Admin. 1.6 241 473 Ilocos 5.5 832 967 Cagayan Valley 3.2 486 689 C-Luzon 10.6 1599 1391 S-Tagalog 13.5 2025 1516 Bicol 5.4 805 849 W-Visayas 8.1 1216 1206 C-Visayas 7.5 1121 1165 E-Visayas 4.3 645 802 W-Mindanao 4.8 729 945 N-Mindanao 5.3 794 996 S-Mindanao 7.3 1095 1205 C-Mindanan 4.7 707 943 Education by Age, Urban-Rural Residence and Region Table 2.9 presents the percent distribution of the respondents by the highest level of education attended, according to age, urban-rural residence and region. The data show that younger women have higher educational attainment than older women. About 80 percent of women 15-24 have attended at least secondary level of education, compared to less than half of women age 40 and older. As expected, women in the urban areas are better educated than women in the rural areas. About three fourths of urban women have attended at least secondary school compared to only 54 percent of rural women. Women in Metropolitan Manila, Ilocos and the Cordillera Administrative Region (CAR) are better educated than in other regions. On the other hand, Bicol, Western Mindanao and Central Mindanao had the lowest proportion of women with secondary or higher level of education. Exposure to Mass Media Presented in Table 2.10 is the percentage of the respondents who were exposed to different types of mass media by age, educational level, urban-rural residence and by region. The table shows that about 90 percent of the women listen to the radio at least once a week while 72 percent or more watch television and read newspapers. Younger women are more likely to have been exposed to mass media than older women. A positive relationship is noted between exposure to mass media and educational attainment. Women with higher educational level are more likely to have been exposed to mass media. Between urban and rural areas, the proportion differs greatly for those who read newspapers and watch television but not for those who listen to the radio. 21 Table 2.9 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Philippines 1993 Level of education College Background High or characteristic None Elementary school higher Total Number Age 15-19 1.2 17.9 64.6 16.4 100.0 3158 20-24 1.7 21.1 40.2 37.1 100.0 2649 25-29 2.3 25.5 38.4 33.8 100.0 2430 30-34 2.1 34.6 31.9 31,4 100.0 2196 35-39 2.8 42.7 30.5 24,0 100.0 1889 40~4 2.8 47.3 26.8 23.1 100.0 1571 45-49 3.7 56.0 20.7 19.6 100.0 1137 Residence Urban 1.3 22.6 41.9 34.2 100.0 8501 Rural 3.2 42.5 36.8 17.5 100.0 6528 Region Metro. Manila 0.5 14.4 44.8 40.2 100.0 2733 Cordillera Admin. 1.1 23.5 37.0 38.5 100.0 241 Ilocos 0.4 29.5 43,2 26,9 100.0 832 Cagayan Valley 1.6 38.5 35.4 24.5 I00.0 486 C-Luzon 0.4 34.9 41.9 22.8 100.0 1599 S-Tagalog 0.8 31.7 40.6 26.9 100.0 2026 Bicol 0.2 45.0 37.0 17.8 100.0 805 W-Visayas 0.9 32.5 38.1 28,4 100.0 1216 C-Visayas 2.1 42.7 32.4 22.7 100.0 1121 E-Visayas 1.1 38.2 39.8 20.9 109.0 645 W-Mindanao 10.9 38.5 28.9 21.7 100.0 729 N-Mindanao 0.9 35.2 41.9 21.9 100.0 794 S-Mindanao 4.1 31.9 42,9 21.2 100.0 1095 C-Mindanao - 13.6 30.6 32,9 22.8 100.0 707 Total 1 2.1 31.2 39,7 26.9 100.0 15029 alncludes 3 women with no information on level of education. 22 Table 2.10 Exposure to mass media Percentage of women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week. by selected background characteristics, Philippines 1993 Read Watch Listen to Number Background newspaper tele-~islon radio of characteristic weekly weekly weekly women Age 15-19 80.9 81.1 93.2 3158 20-24 77.0 74.7 91.1 2649 25-29 74.6 71.2 89.8 2430 30-34 70.0 67.0 88.4 2196 35-39 67.9 66.5 87.5 1889 40M4 64.6 67.5 88.9 1571 45-49 61.8 67.1 88.9 1137 Education No education 6,7 17.7 51.5 320 Elementary 50.2 53.0 84.6 4690 High school 79,9 77.6 92.7 5967 College or higher 93.7 90.0 95.7 4049 Residence Urban 81.8 85.4 92.2 8501 Rural 61,1 54.5 87.3 6528 Region Metro. Manila 94.7 97,8 93.8 2733 Cordillera Adrnin. 71.9 44.6 89.4 241 IIocos 78.6 83.5 92.5 832 Cagayen Valley 62.0 43.1 93.3 486 C-Luzon 84.1 90.5 91,I 1599 S-Tagalog 80.7 82.1 93.1 2026 Bicol 65.0 43.7 85.6 805 W-Visayas 72.0 69.7 93.1 1216 C-Visayas 45.4 61.8 90.2 1121 E-Visayas 77.4 58.1 91.4 645 W-Mindanao 46.9 41.1 72.6 729 N-Mindenao 49.5 54.0 84.9 794 S-Mindmaao 63.7 66.0 90.1 1095 C-Mindenao 57.4 43.9 82.6 707 Total 1 72.8 72.0 llaxcludes 3 women with no information on lave| of education. 90.1 15029 23 CHAPTER 3 FERTILITY In line with the objective of measuring fertility levels, trends, and differentials, spocial care was given to administer a set of carefully worded questions to obtain accurate and reliable data on fertility. Data on fertility come from a full pregnancy history asked of all women aged 15-49 at the time of survey. The sequence of questions was intended to derive information on all pregnancies which resulted in either a live birth or a miscarriage or still birth. For live births, the women were asked questions about children stitl living at home, those living elsewhere, and those who had died. Since pregnancies were listed in the order of occurrence, it was possible to probe cases where any lengthy or too brief time gap between pregnancies was reported. For pregnancies not ending in a live birth, the women were asked the month and year of pregnancy termination as well as the duration of the pregnancy. For pregnancies that were lost before full term, the women were asked whether a doctor or anyone else did something to end the pregnancy. This approach maximizes recall of all pregnancies and provides a richer data set for fertility analysis than a full birth history. The analysis in this chapter revolves around females who were 10om in a given time period (birth cohorts) and on those who married during a given time period (marriage cohorts). The fertility measures presented here are derived directly from the pregnancy history. The total fertility rate (TFR) is calculated by summing the age-specific fertility rates, and can be interpreted as the average number of births a hypothetical group of women would have at the end of their reproductive lives if they were subject to the currently prevailing age-specific rates from age 15 to 49. The'l VI< remains the most significant demographic indicator in the analysis of the impact of national population programs, in particular, family planning programs, on individual or group reproductive behavior. A three-year "l'l~R was computed to provide the most recent estimates of current levels of fertility to reduce sampling error and to avoid problems of displacements of births reported from 5 to 6 years prior to survey. ~ 3.1 Current Fertility Reproductive behavior in the.Philippines around 1993 remains at a level not substantially different from what prevailed in 1988, as measured by TFR. Data in Table 3.1 show that for the country as a whole, TFR was estimated at 4.09 children per woman. This is indicative of a slight decline from 4.26 children per woman in 1988. The age-specific fertility rates show an age pattern that peaks at ages 25-29 and tapers off at the older ages. Table 3.1 also shows a general fertility rate (GFR) of 138 live births per 1,000 women age 15M4 years and a crude birth rate (CBR) of 29.7 births per 1,000 population. By all indicators, the current fertility level in the Philippines remains relatively high when compared with its Southeast Asian neighbors. In addition to the slow pace of decline from the most recent survey prior to 1993, another notable feature of current fertility is the lower fertility of urban women in the country. The "FUR for urban areas is 3.5 births per woman, 1.3 less than the rural TFR. Lower urban fertility is observed across all age groups (Figure 3.1). ~The distribution of all children by calendar year of birth shows a slight heaping of births in 1989 and 1990 and a deficit in the year prior to and after those years (see Table C.4). The transference of births out of 1988 was apparent for living children. This pattern has been observed in other DHS surveys; it is believed to be the result of transference of births by interviewers out of the period for which the health and calendar data were collected (January 1988 through the date of the survey). 25 Table 3.1 Current fertilh~' Age-specific and cumulative fertility rates and the crude birth rate for the thr~c years preceding the sur~cy, by urban- rural realdenc~, Philippines 1993 Residence Age group Urban Rural Total 15-19 36 72 50 20-24 157 239 190 25-29 203 236 217 30-34 161 205 181 35-39 102 140 120 40~4 42 62 51 45-49 5 12 8 TFR 15-49 3.53 4.82 4.09 TFR 15-44 3.50 4.77 4.05 GFR 119 163 138 CBR 28.5 30.9 29.7 Not*: Rates are for the period 1-36 months preceding the survey. Ratss for age group 45-49 may be slighfy biased due to truncadon. TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of womcn 15-44), expressed per 1,000 women CBR: Crude bitlh rate, expressed per 1,000 populatinn 250 2O0 150 Figure 3.1 Age-Specific Fertility Rates by Residence Births per 1,000 Women / / / / / / y I I [ I I 15-19 20-24 25-29 30-34 35-39 40-44 Age 45-49 1993 NDS 26 3.2 Fertility by Background Characteristics Variations in fertility are evident from the data on current and cumulative fertility shown in Table 3.2. The mean number of children ever born (CEB) to the oldest women (40-49 years of age) is an indicator of completed fertility for it reflects the fertility per- formance of older women who are nearing the end of their reproductive life span. If fertility has remained stable over time, the two fertility measures, TFR and CEB, would be equal or similar. Although a comparison of completed fertility among women aged 40-49 years with the total fertility rate provides an indication of fertility change, this approach may be somewhat biased due to understatement of parity reported by older wom- en. Nevertheless, consistency in the two measures with respect to urban-rural differentials and educational attainment is observed. As noted earlier, urban women are inclined to have fewer children than their rural counterparts. On average, urban women have at least one child less than rural women have. This may be interpreted as arising from differences in levels of development between the urban and rural areas (Figure 3.2). Such differences are also substantiated by the regional variation in fertility. Note that Metropolitan Manila, the most developed region, exhibits the lowest I 'FR of 2.76 children per woman, and the lowest mean number of children ever bom of 3.46 children per wom- an. By contrast, Bicol, the least developed region in the country, shows the highest TFR of 5.87 and mean CEB of 6.14 children per woman. The difference in fertility between the two contrasting regions is at least 3 chil- dren. The widely accepted nonlinear negative effect of education on fertility is clearly bome out by the data. The depressing effect of education on fertility is best indicated by the difference in fertility rate between those with an elementary education estimated at 5.5 children Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40-49. by selected background characteristics. Philippines 1993 Mean number of children Total ever born Background fertility to women characteristic rate I age 40-49 Residence Urban 3.53 4.34 Rural 4.82 5.65 Region Metro. Manila 2.76 3.46 Cordillera Admin. 5.05 4.44 llocos 4.25 5.12 Cagayan Valley 4.20 4.60 C-Luzon 3.87 4.58 S-Tagalog 3.86 4.81 Bicol 5.87 6.14 W-Visayas 4.24 5.17 C-Visayas 4.38 5.04 E-Visayas 4.86 5.70 W-Mindanao 4.46 5.46 N-Mindanao 4.81 5.79 S-Mindanao 4.23 5.43 C-Mindanao 4.81 6.09 Education No education 4.93 6.07 Elementary 5.51 5.93 High school 3.93 4.40 College or higher 2.82 3.10 Total 4.09 4.95 IRate for women age 15.49 years per woman and those with higher education estimated at 2.8 children per woman. Thus, a Filipino woman without education can be expected to have almost twice as many children as a highly educated woman. The data suggest that a good, perhaps the best mechanism, for fertility reduction is to improve education of women. This would free women to spend more time on economic and other pursuits rather than childbearing which in turn would aid the family as a whole. 27 Figure 3.2 Total Fertility Rate among Women 15-49 by Residence and Education Total Fertility Rate 6 5 4 3 2 1 0 Urban Rural No Elemen- High Collge Education tary School or Higher RESIDENCE EDUCATION Note: Rates are for the period 0-3 years preceding preceding the survey, 1993 NDS 3.3 Fertility Trends To validate the data obtained from the 1993 NDS, age-specific fertility rates are compared with corresponding rates from periodic national demographic surveys from 1973 to 1993. Discrepancies will reflect a combination of real change, of differences in geographic coverage, of change in data collection procedures, and of estimation techniques in one or in all surveys. Nonetheless, they serve the purpose of reflecting recent change in fertility trends in the Philippines. Data inTable 3.3 for the 20-year period preceding the survey are fertility rates reflecting a three-year rate from the 1993 survey and five-year averages centered on mid-period years as calculated from the 1973, 1978, 1983, and 1988 surveys, respectively. In general, however, the TPR declined from 6.0 children per woman in 1970 to 4.1 in 1991 or a decrease of 2.0 births per woman during the 20-year period. The pace of decline in fertility over time is varied. During the period roughly 1970-1975, the "l't'R declined by 2.4 percent annually. This was followed by a smaller decline of 0.6 percent during the succeeding five-year period. The largest decline was during the first half of the eighties estimated at 3.2 percent annually. The latter half of the eighties once again revealed a slide back in the progress of fertility reduction with just 1.2 percent annual decline during the period 1985-1991 (see Figure 3.3). Through most of the 20 years, the female mean age at marriage has remained high and relatively stable, averaging about 23 years for the past two decades. The observed decline in fertility can be attributed primarily to changes in family planning practices (see Chapter 4). 28 Table 3.3 Fertility trends Age-specific and total fertility rates from various surveys, Phliipp'mes 1973-1993 Age 1973 1978 1983 1986 1993 NDS RPFS NDS CPS NDS (1970) (1975) (1980) (1984) (1991) 15-19 56 50 55 48 50 20-24 228 212 220 192 190 25-29 302 251 258 229 217 30-34 268 240 221 198 181 35-39 212 179 165 140 120 40-44 100 89 78 62 51 45-49 28 27 20 15 8 TFR 5.97 5.24 5.08 4.42 4.09 Note: Rates for 1970-1980 are five-year averages, and 1984 and 1991 are three- year averages centered on the years in parentheses. Source: Concepcidn, 1991, Table 4.10 Births per Woman Figure 3.3 Total Fertility Rates Philippines, 1970-1991 7,0 6.0 5.0 4.0 3.0 2.0 1,0 0.0 1973 NDS 1978 RPFS Note: Rates are based on 5-year averages except for the 1993 NDS, which is based on a 3-year average, 1983 NDS 1986 CPS 1993 NDS 29 Retrospective data from a single survey can also be used to establish fertility trends overtime. Age- specific fertility rates (ASFRs) from the 1993 NDS for the last 20 years by five-year periods are shown in Table 3.4. The ASFRs therefore are progressively truncated with increasing number of years from time of survey. Due to truncation, changes over the past 20 years are observed for women up to age 29 years. Table 3.4 Age-specific fertili~ rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age, Philippines 1993 Number of years preceding the survey Mother's age 0-4 5-9 10-14 15-19 15-19 52 62 70 75 20-24 190 216 238 239 25-29 216 232 263 277 30-34 175 192 216 [250] 35-39 123 133 [167] 40-44 56 [76] 45-49 [10] Note: Age-specific ferdfity rates are per 1,000 women. Estimates enclosed in brackets are truncated. In terms of intemal consistency, the data substantiate a fertility decline, as the ASFRs are higher in the distant past than in the more recent past. The minimal decline of fertility among women age 20-24 as shown by ASFRs 15-19 and 10-14 years from the survey is similar to the trend observed in previous surveys and, therefore, does not necessarily suggest recall or omission of problems by older women in the survey. Overall, fertility decline during the past 20 years has been moderate. For women aged 15-29, the "I'FR declined from 3.0 in 15-19 years before the survey to 2.3 in 0-4 years before the survey. The data also show variation across age groups. A closer look at the more recent fertility change by comparing the ASFRs between 0-4 years and 5-9 years prior to survey reveal that the reduction is largest for those under 20 years. 3.4 Fertility by Marital Duration Table 3.5 presents fertility rates for ever-m arried women by duration since first marriage for five-year periods preceding the survey. These rates are similar to the ones presented in Table 3.4 and are subject to similar problems of truncation. Declines are observed in all marital durations; for all five-year periods marital fertility is larger in the more distant past than in the recent past. 3.5 Children Ever Born and Living A basic measure of fertility is the number of children ever bom (CEB) or current parity. This measure is based on a cross-sectional view at the time of survey and does not refer directly to the timing of fertility of the individual respondents but is a measure of her completed fertility. The number of CEB by age of women for all women and currently married women and the corresponding mean CEB as well as mean number of living children is presented in Table 3.6. Among all women, at least 2 in 5 do not have children. 30 Table 3.5 Fertility by marital duration Fertility rates for ever-married women by duration since f'trst marr iage in years, for five-year periods preceding the survey, Phil ippines 1993 Marr iage duration at birth Number of yeats preceding the survey 0-4 5-9 10-14 15-19 04 384 392 411 425 5-9 235 258 291 325 10-14 165 183 234 274 15-19 114 151 187 [261] 20-24 76 106 [156] [312] 25-29 33 [83] Note: Fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. Table 3.6 Chi ldren ever born and living Percent distribution of all women and of currently married women by number of chi ldren ever born (CEB) and mean number ever born and living, according to five-year age groups. Philippines 1993 Mean Mean Number of children ever born (CEB) Number number number Age of of of livang group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN 15-19 94.7 4.1 1.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3158 0.07 0.06 20-24 59.9 17.7 13.8 6.3 1.9 0.4 0.0 0.1 0.0 0.0 0.0 100.0 2649 0.74 0.71 25-29 29.2 14.8 20.6 17.0 11.1 4.7 2.0 0.4 0.1 0.1 0.0 100.0 2430 1.92 1.81 30-34 14.9 11.1 16,0 17.8 15.7 10.1 7.3 4.1 1.9 0.8 0.2 100.0 2196 3.08 2.86 35-39 9.2 7.7 12.2 16.6 15.4 12.5 9.9 6.6 4.5 3.0 2.4 100.0 1889 4.01 3.71 40~14 8.0 4.7 8.7 14.1 17.5 12.2 9.1 7.3 6.6 5.3 6.4 100.0 1571 4.73 4.33 45-49 8.5 3.9 7.2 11.7 12.9 12.5 9.7 8.6 8.2 5.9 10.9 100.0 1137 5.26 4.76 Total 40.0 9.8 11.3 10.9 9.2 6.1 4.3 2.9 2.2 1.5 1.8 100.0 15029 2.30 2.13 CURRENTLY MARRIED WOMEN 15-19 33.8 50.3 14.4 1.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 234 0.83 0.80 20-24 13.5 37.0 30.5 13.8 4.2 0.8 0.l 0.1 0.0 0.0 0.0 100.0 1174 1.62 1.55 25-29 6.0 18.6 27.5 22.7 15.2 6.5 2.7 0.5 0.2 0.1 0.0 100.0 1763 2.58 2.44 30-34 4.1 10.7 17.7 20.4 18.2 11.9 8.6 4.9 2.3 0.9 0.3 100.0 1838 3.55 3.30 35-39 2.8 6.7 12.1 18.0 16.9 13.7 11.1 7.5 5.1 3.4 2.8 100.0 1652 4.40 4.07 40-44 2.9 3.8 8.6 15.1 18.5 13.1 10.0 8.1 6.9 6.0 6.9 100.0 1358 5.09 4.66 45-49 3.1 2.9 7.5 13.1 13.3 13.2 10.5 8.7 9.1 6.6 12.0 100.0 942 5.67 5.13 Total 6 0 14.1 17.7 17.5 14.6 9.7 7.0 4.6 3.5 2.4 2.9 100.0 8961 3.65 3.38 31 By contrast, only 6 percent of married women do not have children. The table shows marked differences in the proportion without any children at younger ages and between married women and all women. This is due to the fact that many women remain unmarried in their twenties. Considering that most of the births still occur within marriage despite sweeping social changes in the country, this rather small proportion of childlessness suggests that the potential for high fertility is great in Philippine society. The figures for childlessness may also be used to estimate primary sterility. On the other hand, 3 percent of married women age 45-49 are childless, the corresponding proportion without children among all women 45-49 is higher, at 9 percent. The differences at older ages reflect the combined impact of marital dissolution, infertility, and celibacy. It is worth stressing that while 1 in 12 Filipino women 45-49 remains childless, over 10 percent have 10 or more births. Table 3.6 also shows that while the proportion of women with no children or zero parity decreases with age, the proportion of women at higher parity increases with age, reflecting the process of family formation over time. Also, the mean CEB for both groups of women become larger with increasing age of the women indicating that the data were free from gross recall bias. The mean parity for the whole sample of women was 2.3 children; for the married women, it was 3.7 children. It is interesting to note that for women completing their childbearing at age 45-49, mean CEB was 5.3 children among all women and 5.7 children among married women. Besides describing average family size, information on number of living children at the time of interview reported by a respondent or the current family size derived from the pregnancy history can give some indications of infant and child mortality. The data show that on average, all women had 2.1 children still living and those married report 3.4 living children. It is notable that the mean number of CEB and children still living are not substantially different. On average, both groups of women had a loss of 7 percent of all live births. 3.6 Birth Intervals The timing of births has significant influence on both fertility and mortality. There has been evidence that women with closely spaced births have higher fertility than women with longer birth intervals. Similarly, studies in diverse settings consistently show that shorter birth intervals increase the incidence of infant and child mortality. Table 3.7 shows the percent distribution of births in the five years preceding the survey by length of interval since the previous birth, classified by some demographic and background characteristics of the women. In general, the median length of birth interval is slightly over 2 years, estimated at 28 months; about 1 in 5 births occurs four or more years after a previous birth, and more than one third of the births occur within two years of a previous birth. This finding is cause for concem as it has implications for maternal and child health and survival. It has been shown that short birth intervals, particularly those less than two years, elevate risks of death for both mother and child (see Chapter 7). Data on median birth interval by demographic and background characteristics reveal interesting differentials. Younger women who are just beginning tbeir reproductive years exhibit shorter median birth intervals; they are estimated at 19 and 25 months for women under 20 and 20-29 years old, respectively. By contrast, those 30-39 years old report a median birth interval of 31 months, and those 40 years and older report 36 months, an interval nearly twice as lung as that of women aged 15-19. 32 Table 3.7 Birth intervals Percent dis~ibudon of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic chm-acterisdcs, Philippines 1993 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Total Median number of Number months since of previous birth births Age of mother 15-19 36.0 32.5 31.5 0.0 0.0 I00.0 19.3 40 20-29 21.8 26.0 32.0 11.7 8.6 100.0 24.6 2779 30-39 13.7 16.3 30.5 15.5 24.1 100.0 30.9 3175 40 + 10.0 12.4 26.8 15.1 35.8 100.0 36.4 846 Birth order 2-3 19.8 21.8 28.1 12.8 17.6 100.0 26.6 3192 4-6 13.4 17.7 32,2 14.8 22.0 100.0 29.9 2460 7 + 14.9 19.4 34.5 14.4 16.9 100.0 28.3 1188 Sex of prior birth Male 17.4 19,4 29.9 13,5 19.8 100.0 28.3 3570 Female 15.8 20.4 31.5 14.0 18.3 100.0 27.9 3269 Survival or prior birth Living 15.6 20.1 30.9 14.0 19.4 100.0 28.4 6439 Dead 33.0 16.3 27.2 10.3 13.1 100.0 24.2 400 Residence Urban 18.1 19.9 28.4 12.4 21.1 100.0 27.8 3187 Rural 15.3 19.8 32.6 15.0 17.3 100.0 28.3 3652 Region Metro. Manila 23.2 17.0 25.5 11.9 22.4 100.0 27.2 719 Cordillera Admin. 19.4 21.2 33,8 11.9 13.7 100.0 26.7 142 llocos 17.2 19.5 30.7 14.2 18.5 100.0 27.7 376 Cagayaa Valley 15.2 15.2 33.0 14.3 22.3 100.0 29.7 249 C-Luzon 17.9 16.4 29.3 14.6 21.8 100.0 30.3 686 S-Tagalog 13.8 18.2 31.9 14.8 21.2 100.0 29.6 820 Bicol 16.6 20.1 34.7 12.0 16.6 100.0 27.5 560 W-Visaya.s 13.9 20.4 34.0 14.4 17.2 100.0 28.1 587 C-Visayas 16.1 22.9 28.4 14.6 17.9 100.0 27.2 579 E-Visayas 15.2 24.5 28.4 14.8 17.0 100.0 27.6 354 W-Mindanao 15.5 20.0 32.8 12.2 19.5 100.0 28.2 404 N-Mindanao 15.6 23.8 26.7 15.1 18.9 100.0 27.6 439 S-Mindanao 16.6 21.2 33.3 12.4 16.5 100.0 27.2 519 C- Mindanao 16.0 21.2 30.6 14.9 17.3 100.0 28.1 407 Ed uca~ol'l No education 18.4 16.5 3].8 16.6 16.8 100.0 28.0 209 Elementary 14.1 19.7 33,7 13.9 18.6 100.0 28.8 3140 High school 17.2 2L1 30.3 14.0 17.4 100.0 27.2 2307 College or higher 21.9 18.4 23.2 12.5 24.0 100.0 27.8 1184 Total 16.6 19.9 30.7 13.8 19.1 100.0 28.1 6839 Note: First-order births are exchided.The interval for multiple births is the number of months since the preceding pregnancy that ended in a l ive birth. 33 Birth order exhibits a generally curvilinear relationship with median birth interval, increasing from a minimum of 27 months for second to third birth orders, to a peak at 30 months for the fourth through the sixth order births, then declining to 28 months for the seventh or higher order births. It is apparent from these data that the interval between births is greater after the third child. The data in Table 3.7 show that birth interval does not vary by the sex of the previous child. The survival status of the previous birth influences the timing of the next birth. For women whose previous birth is still living, the next birth occurred after 28 months. For those whose previous births did not survive, the corresponding birth interval was shorter by 4.2 months. This finding raises interesting questions on the different mechanisms through which infant and child mortality influences birth intervals and fertility, particularly the question of whether mothers seek to replace deceased children as soon as possible. Urban-rural residence and mother's education do not seem to exert an effect on length of birth interval. The insignificant difference in median birth interval between those with no schooling and those with college education does not stand up to the usual expectation that better educated women would space their births more widely than uneducated women. The absence of any significant differential in spacing behavior is also evident when urban-rural residence of mother are examined. 3.7 Age at FirstBirth Onset of childbearing is an important fertility indicator. Postponing the first birth and lengthening the interval between subsequent births can contribute to fertility reductions. As can be seen in Table 3.8, early childbearing in the Philippines is not commonplace. Among women age 45-49, only 2 percent had their first birth below age 15. This proportion has diminished among women 15-19. Even among women 20-24, the proportion who had their first birth before reaching age 15 is less than 1 percent. The reduction in the proportions giving birth in the early teens could be attributed to the rise in age at first marriage which has been sustained during the past two decades. Even if reported age at first birth by older women may be subject to omission or misdating of early births, information gathered among women age 45-49 still give some indications of the timing of first birth and the tempo of fertility. Four in 10 of women in the oldest age group had their first birth during their early Table 3.8 Age at first birth Percent distribution of women 15~.9 by age at first birth, according to current age, Phil ippines 1993 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-2I 22-24 25+ Total women birth 15-19 94.7 0.1 3.3 1.9 NA NA NA 100.0 3158 a 20-24 59.9 0.5 7.4 13.6 12.0 6.6 NA 100.0 2649 a 25-29 29.2 0.9 8.3 14.6 17.4 19.5 10.0 100.0 2430 23.1 30-34 14.9 0.5 9.3 16.5 16.7 20.3 21.8 100.0 2196 22.9 35-39 9.2 0.7 10.3 16.4 18.9 20.6 24.0 100.0 1889 22.4 40-44 8.0 1.1 8.8 15.8 17.7 22.0 26.6 100.0 1571 22.9 45-49 8.5 1.5 9.8 17.0 17.2 20.0 25.9 100.0 1137 22.6 NA = Not applicable aLess than 50 percent of the women in the age group x to x-~4 have had a birth by age x 34 twenties (37 percent), and one in four (26 percent) after age 25. A similar pattern is found for younger women, with a larger proportion of women 30-34 having their first birth at age 20-24 than after age 25 (37 and 22 percent, respectively). Clearly, most Filipino women had their first birth during their early twenties rather than in their teens. The median age at first birth shows a slight increase from 22.6 years among women age 45-49 to 23.1 years among women age 25-29. Differentials in age at first birth by selected background characteristics of the women are presented in Table 3.9. The median age at first birth among women age 25-49 is 22.8 years. This figure compares well with that of Thai women, and is almost three years higher than that of Indonesian women and 1.5 years higher than that of Pakistani women (Central Bureau of Statistics, 1992; Chavoyan et al., 1988; and National Institute for Population Studies, 1992). Table 3.9 Median age at first birth Median age at first birth among women age 25-49 years, by current age and selected background characteristics, Philippines 1993 Current age Background Ages chm-acteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 24.3 23.8 23.0 23.5 23.6 23.7 Rural 22.0 21.9 21.7 22.1 21.5 21.9 Region Metro. Manila a 26.1 23.5 24.6 24.5 a Cordillera Admin. 22.7 22.6 23.9 23.6 23.2 23.2 Iloces 23.7 22.6 23.2 22.6 22.8 23.0 Cagayan Valley 21.7 22.0 21.3 22.3 19.9 21.7 C-Luzon 22.7 22.4 22.5 23.7 22.8 22.7 S-TagaIog 22.9 22.7 22.1 22.8 22.8 22.7 Bicol 22.5 22.1 21.6 21.8 21.0 21.9 W-Visayas 23.5 23.6 23.4 22.8 23.3 23.3 C-Visayas 22.9 22.8 23.5 22.7 22.4 22.9 E-Visayas 21.9 21.9 21.9 22.2 20.7 21.8 W-Mindanao 21.5 21.3 22.1 22.1 21.5 21.7 N-Mindanao 21.8 22.8 21.4 20.8 22.5 21.8 S-Mindanao 22.1 21.9 21.4 22.9 22.4 22.0 C-Mindanao 21.2 21.3 22.3 21.6 21.6 21.6 Education No education 19.8 21.5 20.9 20.2 23.1 20.9 Elementary 20.8 20.7 21.0 21.4 21.1 21.0 High school 22.4 22.1 22.4 22.7 23.1 22.4 College or higher 26.9 26.5 25.9 26.4 26.9 26.6 Total 23.1 22.9 22.4 22.9 22.6 22.8 Note: The medians for the 15-19 cohort and for the 20-24 cohort could not be determined because half the women have not yet had a birth, aMedians were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 35 Filipino women in the urban areas are 1.8 years older than their rural counterparts when they first enter motherhood. Regional variation is not as distinct, but four regions (llocos, Western and Central Visayas, and the Cordillera Administrative Region) have median ages at first birth exceeding that of the country as a whole. Sharp educational differentials, however, are observed. Women with higher education exhibit a median age at first birth 5.7 years more than that of the unschooled women. The direct correlation between the median age at first birth and education indicates the postponement of marriage and eventual first birth among women who stay longer in school. 3.8 Teenage Ferti l i ty As noted earlier, early childbearing, and in particular births occurring before age 20, affects a small segment of the population. However, this does not necessarily mean that the insignificant level of teenage childbearing and motherhood does not pose social and health threats to society. Table 3.10 present data on fertility among teenagers age 15-19 at the time of the survey. Of the total women in these ages, only 7 percent have begun childbearing, five percent are already mothers and one percent being pregnant for the first time at the time of survey. Table 3.10 Te~a/~e pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by seleeled background charaOzrisdes, Philippines 1993 Percentage who are: Percentage who have Pregnant ba/~un Number Background with rLrst child- of characteristic Mothers child bear ing teenagers Ag~ 15 0.4 0.1 0.5 662 16 0.6 0.7 1.3 681 17 2.9 0.7 3.6 650 18 8.3 2.0 10.3 600 19 16.1 2.9 19.0 565 Residence Urban 4.1 0.8 4.8 1868 Rural 7.0 1.8 8.9 1290 Region Metro. Manila 3.7 0.7 4.4 595 Cordillera Admin. 3.8 1.0 4.8 54 Iloeos 5.3 1.9 7.2 179 Cagayan Valley 7.3 1.8 9.2 77 C-Luzon 3.7 1.0 4.7 339 S-Tagnlog 6.0 0.9 6.9 444 aicol 3.4 2.1 5.5 138 W-Visayas 5.4 1.1 6.5 263 C-Visayas 7.7 2.3 9.9 214 E-Visayas 7.7 0.0 7.7 147 W-Mindanao 9.7 2.8 12.5 136 N-Mindanao 5.5 0.9 6.5 173 S-Mmdanao 5.2 1.1 6.3 245 C-Mindemao 4.4 1.0 5.4 154 Edu~thin No education 15.2 0.0 15.2 36 Elementary 11.7 1.8 13.5 566 High school 4.3 1.2 5.5 2039 CoLIegn or higher 1.3 0.4 l.g 517 Total 5.3 1.2 6.5 3158 36 Differences between subgroups of these women are evident. As expected, the proportion of women who have begun childbearing increases linearly with age, from less than one percent among those age 15 years to 19 percent among those age 19 years. Rural teenagers are almost twice as likely (9 percent) to experience teenage pregnancy as their urban counterparts (5 percent) (see Figure 3.4). Consistent with the urban-rural differentials, regional variations show that the less urbanized regions of Western Mindanao, Central Visayas, and Cagayan Valley all share higher proportions of teenage fertility relative to other regions of the country. This is particularly true for Western Mindanao where cultural factors impinging on women's roles and status could partially explain the highest proportion of teenagers with early childbearing ( 13 percent). Compare this to that in Metropolitan Manila which has the lowest proportinn of teenagers having begun childbearing (4 percent). One could infer from the data that teenagers in urban areas where educational facilities are concentrated, particularly in Metropolitan Manila, have other alternatives in life than early childbearing. Another interpretation is that teenagers in urban areas and more urbanized regions and those in school have greater access to information and could therefore be more knowledgeable on matters of safe sex. The preventive effect of education on early childbearing is borne out by the data. There is a gradual decrease in the proportions having begun childbearing from 15 percent among women who had never been to school to 2 percent among those with higher education. Percent Figure 3.4 Percentage of Teenagers Who Have Begun Childbearing Total Urban Rural No Elemen- High Colleg~ Education tan/ Sohool or Higher RES IDENCE EDUCATION 1993 N DS 37 3.9 Children Born To Teenagers A major concern about teenage pregnancy is its impact on the overall health and well-being of the mother and the child as women of reproductive age under 20 years old are considered at high risk of pregnancy-related illness and death. Table 3.11 shows that three of four teenagers who have started childbearing have one child, and the remaining 20 percent have two or more children. In both instances, the contribution of older teenagers to teenage motherhood is much more substantial than that of the younger teenagers. The overall level of teenage pregnancy in the country is low but this does not necessarily imply that efforts at curbing the incidence of pregnancy among adolescents should be decelerated. It should be borne in mind that as of 1990, about 5.5 percent of the country's total population--some 3.3 mill ion are girls aged 15-19. Table 3.11 Children bern to teenagers Percent distribution of teenagers 15-19 by number of children ever born (CEB), according to age, Philippines 1993 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 99.6 0.4 0.0 100.0 0.00 662 16 99.4 0.6 0.0 100.0 0.01 681 17 97.1 2.7 0.3 100.0 0.03 650 18 91.7 7.6 0.8 100.0 0.09 600 19 83.9 10.7 5.4 100.0 0.22 565 Total 94.7 4.1 1.2 100.0 0.07 3158 38 CHAPTER 4 FAMILY PLANNING 4.1 Knowledge of Family Planning Methods and Their Sources Lack of knowledge of family planning methods and their sources is obviously a major obstacle to the use of contraception. As in other DHS surveys, information about knowledge of family planning methods and of the places where they can be obtained was generated by asking the respondent to name the ways or method that a couple can use to delay or avoid a pregnancy. If the respondent did not spontaneously mention a particular method, the interviewer described that method and asked the respondent if she recognized it. There were nine methods (pill, IUD, injection, diaphragm--together with foam and jelly--condom, female sterilization, male sterilization, natural family planning/rhythm method/period abstinence and withdrawal) described in the questiormaire. Other methods not provided in the questionnaire but mentioned spontaneously by the respondent were also recorded. For all methods mentioned or recognized, the respondent was asked if she knew where a person could obtain the method or, in the case of natural family planning, advice on how to use natural family planning. In this report, the term natural family planning is used for rhythm and periodic abstinence. Virtually all currently married women as well as all women know of one or more family planning method or a modem method (97 percent and 96 percent, respectively) (Figure 4.1 and Table 4.1). This high level of general contraceptive awareness has been observed in previous surveys, including the 1983 and 1988 National Demographic Surveys and 1986 Contraceptive Prevalence Survey (e.g., Concepci6n, 1991). Knowledge of traditional methods is only slightly less common than that of modem methods. Figure 4.1 Knowledge of Contraception Currently Married Women 15-49 Pill IUD Injection Diaphragm/Foam/Jelly Condom Female Sterilization Male Sterilization Natural Family Planning Withdrawal Note: Natural family planning refers to periodic abstinence or rhythm. ~ 9 6 54 92 . . . - 8 9 20 40 60 80 1 O0 Percent 1993 N DS 39 Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women and currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Philippines 1993 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 95.9 97.2 88.8 93.3 Modern method 95.7 96.9 88.8 93.3 Pill 94.3 96.0 85.0 90.8 IUD 85.4 90.9 73.8 82.1 Injection 47.6 53.5 38.1 43.6 Diaphragm/foam/jelly 30.0 31.0 22.9 24.0 Condom 91.8 93.7 81.3 86.5 Female sterilization 87.4 92.2 75.4 82.9 Male sterilization 74.4 81.7 62.7 71.0 Any traditional method 85.1 92.5 NA NA Natural family planning 79.3 86.4 NA NA Withdrawal 77.5 88.7 NA NA Other traditional methods 6.2 8.1 NA NA Number of women 15029 8961 15029 8961 NA = Not applicable The more widely known modem methods are the pill, condom, female and male sterilization, and IUD. It is important to note that the low knowledge of injection is likely related to the fact that the method has not been cleared for widespread distribution (World Bank, 1991). The least known modem methods include the diaphragm together with foam and jelly and injections. Four of 5 women and slightly less than 90 percent of married women are aware of natural family planning and withdrawal. Not all who claim to know a family planning method know where they can obtain it; however, the gap between knowledge of contraceptive methods and knowledge of their sources among married women is very small. Over 90 percent know a source for the pill, 80 percent for the IUD, condom and female sterilization, and 70 percent for male sterilization. It is not surprising that less than 50 percent of women know a place where one can obtain injections and less than 25 percent of women know the source for diaphragm, foam and jelly because they are not well known contraceptive methods. Knowledge of any method, modem methods and sources for modem methods does not vary greatly by age, with the exception of the youngest age group, showing a lower level than older counterparts (Table 4.2). There is also little difference in levels of knowledge by urban-rural residence, where the urban level is higher by only 3 percentage points than the rural level. 40 Table 4.2 Knowledge of modem contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected background characteristics, Philippines 1993 Know a Know Know source for Number Background any a modem modem of characteristic method method 1 method women Age 15-19 89.6 89.3 83.6 234 20-24 97.3 97.1 91.7 1174 25-29 96.9 96.7 94.5 1763 30-34 97.8 97.7 94.4 1838 35-39 96.9 96.7 93.3 1652 40-44 98.0 97.7 94.2 1358 45-49 97.1 97.0 92.2 942 Res|dence Urban 98.6 98.6 95.1 4638 Rural 95.6 95.2 91.4 4323 Region Metro. Manila 99.9 99.9 97.5 1272 Cordillera Admin. 99.3 99.3 98.6 148 Iincos 98.8 98.8 97.6 503 Cagayan Valley 98.1 97.9 94.2 340 C-Luzon 99.8 99.8 97.5 977 S-Tagalog 98.4 98.2 96.8 1218 Bicol 99.0 98.8 95.2 553 W-Visayas 99.1 99.1 97.7 706 C-Visayas 99.7 99.6 95.9 701 E-Visayas 95.8 95.4 81.6 403 W-Mindanan 80.3 79.2 67.7 485 N-Mindanan 99.8 99.8 94.6 506 S-Mindanac 97.3 96.5 92.3 677 C-Mindanao 84.6 83.9 81.1 471 Education No education 49.5 46.7 36.0 239 Elementary 96.9 96.7 91.9 3564 High school 99.3 99.2 96.4 3072 College or higher 99.8 99.8 97.7 2085 Missing 100.0 100.0 100.0 1.0 Total 97.2 96.9 93.3 8961 qncludes pill, 1UD, injection, vaginal methods (foaming tablets/diap~agm/ foam/jelly), condom, female sterilization, and male sterillzafion. 41 When it comes to regional variations, only Western Mindanao and Central Mindanao deviate from the practically universal knowledge of any method and any modem method. It is in the level of knowledge of a place to obtain a modem method that large regional differentials exist. Women in the Cordillera Administrative Region, Ilocos, Central Luzon and Western Visayas show the highest levels of knowledge of a source for a modem method (at least 97 percent); Eastem Visayas, Western Mindanao and Central Mindanao show the lowest levels (82, 68 and 81 percent, respectively). Excluding women with no education, there are no substantial differentials in the proportion knowing at least one contraceptive method and source for a modem method by women's education. Women with no education are much less likely to know about methods or their sources. 4.2 Ever Use of Family Planning Methods For each method mentioned spontaneously or recognized, the respondent was asked if she had ever used it. While the information is available for all women and married women, the analysis primarily focuses on the latter who are at the greatest risk of pregnancy (Table 4.3). Around 61 percent of married women have ever used a family planning method; 45 percent have used a modem method and 35 percent have ever used a traditional method. The most popular modem method is the pill (30 percent) followed by female sterilization (12 percent), the condom (10 percent) and the IUD (8 percent). The remaining modem methods have small proportions of ever users. Among the traditional methods, withdrawal is the most popular (23 percent), followed by natural family planning methods (19 percent). Table 4.3 Ever use of contraception Among all women and currently married women, the percentage who have ever used a contraceptive method, by specific method and age, philippines 1993 Modem methods Traditional methods Dia- Natural Any phragm/ Female Male Any family Number Any modem In~ec- foam/ Con- sterili- steri- trad. plan- With- of Age method method Pill IUD taoa jelly dora zailon lization method ning drawal Other women ALL WOMEN 15-19 1.9 1.2 0.9 0.2 0.0 0.0 0. I 0.0 0.0 1.0 0.4 0.7 0. I 3158 20-24 21.9 14.0 11.1 2.5 0.1 0.0 1.7 0.4 0.0 12.0 5.2 8.7 0.8 2649 25-29 46.0 33.0 25.8 5.3 0.6 0.2 4.6 4.0 0.1 25.4 13.0 17.7 1.6 2430 30-34 57.5 42.5 29.5 7.8 1.4 0.3 9.4 10.2 0.7 32.7 18.9 21.8 1.8 2196 35-39 62.9 47.7 29.4 7.7 1.6 1.0 12.7 16.9 0.5 37.7 22.5 25.4 2.0 1889 40-44 59.5 43.8 25.1 7.9 1.5 1.0 11.4 18.6 0.4 33.0 20.0 21.1 1.7 1571 4549 49.7 37.8 21.1 7.5 1.0 0.6 10.3 14.3 0.7 26.6 14.8 16.9 1.6 1137 Total 38.0 27.7 18.6 4.8 0,8 0.3 6.0 7.3 0.3 21.4 11.9 14.4 1.2 15029 CURRENTLY MARRIED WOMEN 15-19 25.1 16.1 12.2 3.1 0.0 0.0 1.3 0.0 0.0 I3.4 5.1 10.1 1.4 234 20-24 48.3 31.1 24.7 5.7 0.3 0.0 3.7 0.8 0.0 26.4 11.5 19.0 1.8 1174 25-29 62.4 44.8 34.9 7.2 0.8 0.2 6.2 5.4 0.2 34.6 17.8 24.0 2.2 1763 30-34 66.6 49.4 34.4 9.0 1.5 0.4 10.8 12.0 0.8 38.0 22.0 25.3 2.0 1838 35-39 68.9 52.1 31.7 8.5 1.6 0.9 13.7 18.6 0.6 41.8 25.4 28.0 2.3 1652 40-44 64.6 47.7 27.2 8.6 1.6 1.0 12.6 20.5 0.4 35.9 21.8 22.9 1.9 1358 45~19 54.5 41.4 23.0 7.7 1.2 0.5 11.6 16.1 0.8 29.6 16.3 18.9 1.8 942 Total 61.1 44.6 29.9 7.8 1.2 0.5 9.6 11.9 0.5 34.7 19.4 23.3 2.0 8961 42 In general, the level of ever used increases with age up to age 35-39, and then declines thereafter. However, the pattem varies for specific modem methods; pill ever-used peaks at age 25-34, IUD at age 30- 34, and female sterilization at age 40-44. 4.3 Current Use of Family Planning Methods The level ofcurrcnt use of contraception is the most widely used and valuable measure of the success of the Philippine Family Planning Program (PFPP). As with ever use, the information on current use is available for all women and currently married women but the analysis focuses on the latter (Table 4.4). Thus, contraceptive prevalence is defined as the proportion of married women age 15-49 years who were using some method of family planning at the survey date. Table 4.4 Current use of contraception by age Percent dJs~ibution of all women and currently marr ied women by contraceptive method currently used, according to age, Phil ippines 1993 Age Modern methods Traditional methods Any Dta- Feanale Male Any Natural Not Any modem phragnd steri- stefi- tradi- family With- Other cur- Number meth- meth- Injc¢- foam/ Con- liza- llzl- don- plan- draw- meth- reaatly of od od Pill ILID fion jeUy dora don tlon al nlng al od~ using Total womc/z ALL WOMEN 15-19 1.3 0.7 0.5 0.2 0.0 0.0 0.0 0.0 0.0 0.6 0.1 0.4 0.1 98.7 100.0 3158 20-24 14.2 8.4 5.9 1.8 0.0 0.0 0.3 0.4 0.0 5.8 2.2 3.4 0.2 85.8 100.0 2649 25-29 28.4 17.1 9.7 2.4 0.0 0.0 1.0 4.0 0.0 11.4 5.1 5.8 0.4 71.6 100.0 2430 30-34 38.6 24.6 9.2 3.1 0.1 0.0 1.4 10.2 0.5 14.0 7.6 6.3 0.2 61.4 100.0 2196 35-39 42.8 26.3 5.3 2.7 0,1 0.0 0.8 16.9 0.5 16,4 8.0 8.2 0.3 57.2 100.0 1889 40-44 38.3 24.2 3.0 1.7 0.0 0.0 0.6 18.6 0,3 14.0 7.6 6.2 0.2 61.7 100.0 1571 4549 23.6 17.1 0.5 1.3 0.0 O.0 0.3 14.3 0.7 6.5 3.0 3.2 0.2 76.4 1(10.0 1137 Total 24.2 15.1 5.1 1.8 0.0 0.0 0.6 %3 0.2 9.0 4.4 4.4 0.2 75.8 100.0 15029 CURRENTLY MARRIED WOMFAq 15-19 17.2 9.6 7.0 2.7 0.0 0.0 0.0 0.0 0.0 7.6 2.0 4.9 0.7 82.8 100.0 234 20-24 31.9 18.9 13.3 4.1 0.1 0.0 0.6 0.8 0.0 12.9 4.9 7.5 0.5 68.1 I00.0 1174 25-29 39.1 23.5 13.3 3.3 0.0 0.1 1.4 5.4 0.0 15.6 7.1 7.9 0.6 60.9 100.0 1763 30-34 45.8 29.0 10.9 3.8 0.1 0.0 1.6 12.0 0.6 16.7 9.0 7.5 0.2 54.2 100.0 1838 35-39 48.2 29.4 6.1 3.1 0.1 0.1 0.9 18.6 0.6 18.8 9.1 9.4 0.3 51.8 100.0 1652 40-44 43.1 27.0 3.5 1.9 0.0 0.0 0.7 20.5 0.4 16.2 8.8 7.1 0.3 56.9 100.0 1358 45-49 27.2 19.4 0.7 1.5 0.0 0.0 0.4 16.1 0.8 7.9 3.7 3.9 0.3 72.8 100.0 942 Total 40.0 24.9 8.5 3.0 0.1 0.0 1.0 11.9 0.4 15.1 7.3 7.4 0.4 60.0 100.0 8961 The contraceptive prevalence rate is 40 percent; 25 percent arc using modem methods and 15 percent traditional methods. Female sterilization ranks first (12 percent), the pill second (9 percent), withdrawal and natural family planning third (7 percent each), and IUD fourth (3 percent). The remaining methods have fewer users, each being used by one percent or less by married women (see Figure 4.2). 43 Figure 4.2 Use of Contraception Currently Married Women 15-49 Withdrawal 7% Other Methc Natural Family Planning 7% Female ¢~÷=rili7~fi~n 12% ndom 1% JD 3% Pill 9% Not Using 60% Note: Natural family planning refers to periodic abstinence or rhythm. 1993 N DS A review of the previous survey results in the past two decades reveals that the percentage using contraceptives at the time of interview among women 15-44 years increased from 15 percent in 1968 to 36 percent in 1988. The use of modem contraception increased steadily from 3 percent to 22 percent. The increase is mainly due to significant rise in the percentage of sterilized women from less than 1 percent in 1968 to 11 percent in 1988, making it the most prevalent method in the country. On the other hand, the use of traditional methods increased from 6 percent in 1973, reaching its peak at 22 percent in 1978 and subsequently declining to its level of 15 percent in 1993 (see Table 4.5 and Figure 4.3). An inverted-U pattern of prevalence by age was observed which is typical of patterns in most countries. A peak in use occurs at age 35-39 for any method, any modem method or any traditional method (Table 4.4). However, as with the data on ever use, the peak occurs in different age groups for specific modem methods. As expected, permanent methods such as female sterilization are popular among older women who are more likely to have completed their families and want to stop childbearing altogether. In contrast, the pill is popular among the younger women who are still in their early stages of family building, peaking with use at age 20-29 years. Current use of natural family planning is highest among married women age 30-39 years. Among women under age 30, withdrawal is the second most widely used method. 44 Table 4.5 Trends in contraceptive use Percentage of currently married women 15-44 using modem contraceptive methods mad traditional methods, Philippines, 1968-1993 Modern Traditional Survey methods methods Total 1968 National Demographic Survey 2.9 11.5 15.4 1973 National Demographic Survey 10.7 6.7 17.4 1978 Republic of the Philippines Fertility Su~ey 17.2 21.3 38.5 1983 National Demographic Survey 18.9 13.1 32.0 1988 National Demographic Survey 21.6 14.5 36.1 1993 National Demographic Survey x 24.9 15.1 40.0 Source: World Bank, 1991. Table 1.3 and 1993 NDS IBased on currently married women 15-49 Percent 80 4o 30 20 10 1968 NDS Figure 4.3 Trend in Contraceptive Use Philippines, 1968-1993 1973 NDS 1978 RPFS 1983 NDS 1988 NDS 1993 NDS IlModern Methods []Traditional Methods / With regard to specific methods, the most notable difference is observed for female sterilization, which tends to be urban biased (Table 4.6). Use of any contraceptive method is highest in Northern Mindanao, Central Visayas and Southern Mindanao (49, 46 and 46 percent, respectively), while Western Mindanao manifests the lowest use (29 percent). However, when current use of any modem method is examined, Cagayan Valley ranks first (32 percent), followed by Northern Mindanao and Central Luzon (31 percent). Bicol and Western Mindanao register the lowest level of current use of modem methods (16 and 45 Table 4.6 Current use of contraception by background characteristics Percent distribution of currently marr ied women by contlacepdve method cuffently used, according to selected background charactorisdcs, Phi l ippines 1993 Modem methods Traditional methods Any Dia- Fcraath Male Any Natural Not Any modem pbxngm/ stefi- stefi- tradi- farmly With- Othe~ cur- Number Background meth- mefn- Inj~> fman/ Con- ~za- llza- fton- plan- draw- mtth- rlmtly of characteristic od od Pill IUD tion jelly dora tion tion al nthg at ods using Total women Residence Urban 43.0 27.6 9.0 2.9 0.1 0.0 1.3 13.9 0.4 15.4 7.8 7.3 0.2 57.0 100.0 4638 Rural 36.8 21.9 8.0 3.2 0.1 0.0 0.6 9.6 0.3 14.9 6.8 7.5 0.5 63.2 100.0 4323 Region Metro. Manila 41.9 27.3 9.4 1.6 0.1 0.0 1.1 14.8 0.2 14.6 7.1 7.5 0.0 58.1 100.0 1272 Cordillera Admin. 38.6 23.1 3.4 2.1 0.0 0.0 1.7 15.9 0.0 15.5 7.6 7.9 0.0 61.4 100.0 148 llccos 38.8 21.9 6.8 0.9 0.0 0.2 1.2 12.8 0.0 16.9 5.5 10.9 0.5 61.2 100.0 503 Cagayan Valley 41.1 32.2 14.9 2.9 0.0 0.0 0.8 13.3 0.2 8.9 2.9 6.0 0.0 58.9 1GO.0 340 C-Luzon 43.8 30.9 9.4 1.1 0.1 0.0 1.3 19.1 0.0 12.8 3.2 9.6 0.0 56.2 100.0 977 S-Tagalog 35.2 22.6 5.8 3.4 0.0 0.0 0.9 12.5 0.0 I2.6 4.5 7.9 0.2 64.8 100.0 1218 Bicol 36.4 16.1 6.5 1.0 0.3 0.0 0.9 6.9 0.5 20.2 7.5 12.3 0.3 63.6 100.0 553 W-Visayas 39.7 23.4 9.7 1.6 0.0 0.0 1.0 9.9 1.3 16.3 10.1 6.0 0.1 60.3 100.0 706 C-Visayas 46.1 28.8 9.6 4.7 0.0 0.1 1.6 11.5 1.2 17.3 8.8 8.4 0.1 53.9 100.0 701 E-Visayas 35.9 18.2 6.0 1.8 0.0 0.0 0.2 10.2 0.0 17.8 9.8 6.6 1.4 64.1 100.0 403 W-Mindanao 28.5 16.7 8.7 1.7 0.0 0.0 0.2 5.9 0.2 11.8 7.3 3.3 t . l 71.5 100.0 485 N-Mindanao 49.3 31.3 12.3 9.1 0.2 0.0 1.4 8.2 0.2 18.0 13.2 4.3 0.5 50.7 100.0 506 S-Mindanao 45.9 27.1 8.5 5.5 0.0 0.0 1.2 11.0 0.9 18.8 11.3 6.6 0.9 54.1 100.0 677 C-Mindanao 32.5 20.4 6.7 7.3 0.0 0.0 0.0 6,2 0.2 12.1 8.4 2.9 0.8 67.5 I(30.0 471 FMucailon No education 10.8 7.2 1.6 1.4 0.0 0.0 0.0 3.8 0.4 3.6 2.1 1.1 0.3 89.2 100.0 239 Elementary 34.5 21.5 7.0 2.6 0.0 0.0 0.4 11.1 0.4 13.0 5.2 7.3 0.4 65.5 100.0 3564 High school 43.8 27.6 10,1 3.5 0.1 0.0 1.2 12.3 0.4 16.1 7.6 8.1 0.5 56.2 100.0 3072 College or higher 47A 28.5 9.4 3,3 0.l 0.0 1.9 13.5 0.2 18.6 11.1 7.4 0.1 52.9 1000 2085 Number of children None 1.9 0.6 0.6 0.0 0.0 0.0 0.0 0.0 0.0 1.3 0.7 0.6 0.0 98.1 100.0 558 1 26.7 13.9 9.7 2.5 0.0 0.0 1.0 0.7 0.1 12.7 5.9 6.5 0.4 73.3 1(30.0 1319 2 44.0 25.4 13.1 4.3 0.1 0.1 1.4 6.3 0.2 18.5 9.9 8.0 0.6 56.0 100.0 1745 3 51.5 35.5 10.I 4.0 0.0 0.1 1.2 19.5 0.6 16.1 7.7 8.0 0.4 48.5 100.0 1657 4+ 43.4 27.4 6.3 2.7 0.1 0.0 0.9 16.9 0.5 16.0 7.5 8.2 0.3 56.6 100.0 3682 Total 40.0 24.9 8.5 3.0 0.1 0.0 1.0 11.9 0.4 15.1 7.3 7.4 0.4 60.0 1000 8961 17 percent, respectively). The ranking changes with the current use of any traditional method with Bicol showing the highest level (20 percent) and Cagayan Valley the lowest (9 percent). The top ranking regions when pill use is considered are Cagayan Valley (15 percent) and Northem Mindanao (12 percent), and for female sterilization are Central Luzon (19 percent), Cordillera Administrative Region (16 percent) and Metropolitan Manila (15 percent). The higher the educational attainment, the higher the current use of any method, any modem method and any traditional method. This pattern holds true with specific methods such as female sterilization, condom, and natural family planning. For pill and IUD, the pattern is one of increasing current use with education up to secondary education with a slight decline among those with college education. 46 Contraceptive use of any method, any modem method and female sterilization also increases with the number of children a woman has, up to three children, then declines thereafter. An earlier peak at two children is observed for the pill, IUD, condom, natural family planning and withdrawal. 4.4 Number of Children at First Use of Family Planning In many cultures, family planning is used only when couples have already had as many children as they want. However, as the concept of family planning gains acceptance, the motivation to use family planning may either be to space births or to limit family size. Table 4.7 shows the percent distribution of ever-married women by the number of living children at the time of first use by the respondent's age at the time of interview. The results indicate that Filipino women are adopting family planning fairly early in the family building process although only 2 percent of ever-users began using immediately after marriage or before the first birth. Overall, one in five women began using family planning after they had the first child and one in four started using after they had two children. Table 4.7 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Philippines 1993 Number of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4+ Missing Total women 15-19 76.0 6.0 15.0 2.6 0.4 0.0 0.0 100.0 245 20-24 52.2 4.7 26.6 13.1 2.7 0.8 0.0 100.0 1203 25-29 38.7 3.5 26.2 17.2 9.5 4.9 0.0 100.0 1820 30-34 34.9 1.6 23.0 17.3 12.1 11.2 0.0 100.0 1929 35-39 32.7 1.6 19.4 14.7 12.2 19.2 0.1 100.0 1763 40~IA 37.1 1.3 13.1 14.6 12.4 21.3 0.2 100.0 1487 45-49 47.0 0.7 8.9 9.7 12.5 21.3 0.0 100.0 1065 Total 40.2 2.3 20.1 14.6 10.2 12.6 0.1 100.0 9511 The timing of first contraceptive use in terms of the number of living children varies among the different age cohorts ofwomen. A particularly striking difference is observed between women age 20-24 and 45-49 years. About half of the women in both age groups of women have ever used a method. Of those half, slightly less than half of those age 45-49 started after having four children while among those age 20-24, slightly more than half started when they had only one child. 4.5 Problems with Current Method Identifying problems with the use of specific methods has practical implications for future educational and publicity campaigns. Therefore, the 1993 NDS included a question for all current users as to whether they had experienced any problems with the method they were using and if so, what the main problem was. The results are shown in Table 4.8. Ninety percent or more of current users of the pill, IUD, condom, female sterilization, natural family planning and withdrawal reported having no problems with the method they were currently using. Of those who have had problems with their methods, side effects were generally cited as the most common problem, however, for condom users, the most common problem is that it is inconvenient. It should be mentioned that this question which asks about problems with current method may not have elicit a full reporting of problems. Women who had serious problems are likely to have discontinued the method. 47 Table 4.8 Problems with current method of contraception Percent distribution of contraceptive users by the main problem with current method, according to specific methods, Philippines 1993 Natural Female Male family Con- sterili- sterili- plan- With- Main problem Pill IUD dom zation zation ning drawal Other No problem 89.4 93.6 87,5 91.2 (83.6) 97.0 89.4 (97.7) Husband disapproves 0.2 0.2 0.0 0.1 (0.0) 0.4 0.4 (0.0) Side effects 5.9 4,1 1.0 5.9 (5.3) 0.8 3.7 (2.3) Health concerns 2.7 1.6 1.0 2.6 (0.0) 0.4 3.4 (0.0) Access/availability 0.l 0,0 0.0 0.0 (0.0) 0.0 0.0 (0,0) Cost 0.2 0.0 0.0 0.0 (0.0) 0.0 0.1 (0,0) Inconvenient to use 0,6 0.5 9.4 0.0 (0.0) 0.6 1,7 (0.0) Sterilized/want children 0.0 0.0 0.0 0.1 (2.8) 0,0 0.0 (0.0) Other 0.1 0.0 0.0 0.1 (5.6) 0.3 0.5 (0.0) Missing 0.8 0.0 1.1 0.1 (2.7) 0A 0.8 (0.0) Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women t 764 273 90 1104 34 658 669 33 ITotal includes 5 users of injection and 2 users of vaginal methods. ( ) Figures in parentheses are based on 25-49 cases 4.6 Knowledge of Fertile Period An elementary knowledge of reproductive physiology is useful for successful practice of coitus- associated methods, such as withdrawal, condom and vaginal methods. Such knowledge is particularly critical in the practice of natural family planning. In the 1993 NDS, women were asked during which days of a wom- an's menstrual cycle does a woman have the greatest chance of becoming pregnant. A fifth of all women in- terviewed said they did not know when they are fertile during their ovulatory cycle (Table 4.9). In contrast, only 6 percent of those who have used natural family planning did not know when a woman is most likely to get pregnant. Only 24 percent of all women and 34 per- cent of ever-users of natural family planning gave the "correct" response, that a woman's fertile period occurs in the middle of her cycle. Thirty percent of all women and 38 percent of ever-users of natural family planning said that a woman is most likely to conceive right after her period has ended. Much smaller proportions report- ed the least safe period as that right after a woman's period begins. A sizable proportion of all women and ever users of natural family planning (23 percent and 18 Table 4.9 Knowledge of fertile period Percent distribution of all women and of women who have ever used natural family planning by knowledge of the fertile period during the ovulatory cycle, Philippines 1993 Ever users of natural Perceived All family fertile period women planning During menstrual period 0.8 0.8 Right after period has ended 30.4 37.9 In the middle of the cycle 23.5 33.7 Just before period begins 2.3 2.8 Other 0.1 0.6 No particular time 22.6 17.8 Don't know 20.1 6.3 Missing 0.2 0.1 Total percent 100.0 100.0 Number of women 15029 1790 48 percent, respectively) reported no particular time. These proportions indicate the need to further educate the potential and actual users of natural family planning on the ovulatory process. 4.7 Timing of Sterilization In the Philippines where female sterilization is the most prevalent method, information about the trend in age at adoption of sterilization is very useful. To minimize problems of censoring, the median age at the time of operation is calculated for women sterilized at less than 40 years of age. Data shown in Table 4.10 indicate that 7 in 10 women who are sterilized had their operation at age 25-34, and 12 percent are sterilized before reaching their 25th birthday. There is evidence that, over time, women are having their sterilization operation at older ages; the median age at sterilization is 29.9 for women sterilized 8-9 years ago, and 30.9 for women who had the operation less than 2 years ago. Table 4.10 Timing of sterilization Percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation, Philippines 1993 Age at time of sterilization Number Years since of Median operation <25 25-29 30-34 35-39 40-44 45-49 Total women age" <2 5.1 37.2 29.1 23.2 5.4 0.0 100.0 127 30,9 2-3 10.0 26.7 36.2 18.9 7.6 0.5 100.0 t59 30.7 4-5 10.0 39.6 24.1 20.7 5.6 0.0 100.0 137 29.8 6-7 17.3 33.6 30,5 16.0 2.7 0.0 100.0 152 29.8 8-9 13.2 36.7 32.6 15.9 1.5 0.0 100.0 153 29.9 10+ 12.5 47.3 32.9 7.2 0.0 0.0 100.0 376 b Total 11.8 38.9 31.5 14.8 3.0 0.1 100.0 1104 29.7 "Median age was calculated only for women less than 40 years of age to avoid problems of censoring t~Not calculated due to censoring 4.8 Source of Supply of Modern Contraceptive Methods Currently Used Information on sources of modem contraceptives currently used is useful for family planning program managers and implementors. The public sector (Table 4.11) emerges as the main source for a large majority of current users (71 percent) of modem contraceptives. In fact, almost three-quarters of users of the pill, IUD and female sterilization obtained their methods from government sources, as do over half of condom and male sterilization users. While the g°vemment h°spitals are the main s°urces °f the permanent meth°ds' barangay health stations or health centers are the main sources for the pill, IUD and condom. Pharmacies are an important source of pills and condoms. Aside from the type of source, information on the length of time needed to reach the source from home was obtained for women who are currently using a modem contraceptive method. Nonusers were also asked if they knew a place to obtain a method and, if so, where and how long it takes to get there. Table 4.12 shows the relevant information by urban-rural residence for three types of women: current users of modem contraceptives, nonusers of modem contraceptives and all women knowing a method. Among current users 49 Table4.11 Source of supply for modern contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Philippines 1993 Female Male Con- stefili- sterili- All So~ce of supply Pill IUD dom zation zadon methods Pubne seclor 73.4 78.8 55,6 70.4 (56.6) 71,4 Government hospital 2,7 17.7 4.0 59.2 (41.4) 32.6 Barangay health station 53.9 30,7 34.9 3.3 (12,4) 25.0 Barangay supply office 2.6 2.4 2.2 0.4 (0.0) 1.5 Puerleulture center 14.2 28.0 14,5 7.5 (2.8) 12.4 Medical private 23.4 19.5 40.6 28.5 (29.7) 26,3 Private hospital/clinic 3.6 12.8 3.8 26.8 (21.0) 16.4 pharmacy 17,4 0.0 36.0 0.0 (0.0) 7.3 Private doctor 2.4 6.7 0.8 1.7 (8.7) 2,6 Other private 2.2 0.6 2.7 0,8 (5.5) 1.4 Store 0.2 0,0 1.9 0.0 (0.0) 0,2 Church 0.0 0.0 0.0 0.8 (5,5) 0.5 Friends/~elatives 2.0 0,6 0,8 0.0 (0.0) 0,8 Other 0.4 0.7 0.0 0,3 (0.0) 0.4 Don't know 0.0 0,0 0.0 0.0 (5.5) 0.1 Missing 0.7 0.4 1.1 0.0 (2.7) 0.4 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 Number of women I 764 273 90 1 I04 34 2272 ITotal includes 5 users of injection and 2 users of diaphragm/foam/jelly, ( ) Figures in parentheses ave based on 25-49 cases Table 4.12 Time to source of supply for modern contraceptive methods Percent distribution of women who are currently using a modem contraceptive method, of women who are not using a modern method, mad of women who know a method, by time to reach a source of supply, according to urban-rural residence, Philippines 1993 Women who are currently using a modem method Women who are not using a modem method Women who know a contraceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total Other private sector 1,9 2,8 2,3 2,6 2,6 2.6 2,5 2.7 2.6 0-14 30.7 25.5 28.5 42.3 33.9 38.6 41.5 34.3 38.5 15-29 18.0 16.9 17.5 15.3 15.7 15.5 16.1 16.8 16.4 30-59 27,3 25.9 26.7 9.2 15.8 12.1 12.3 18.2 14.8 60+ 20.8 27.7 23.7 3.4 9.7 6.1 6.2 12,8 9.0 Don't know time 0.6 0.2 0.4 0.4 0.1 0.3 0.4 0,1 0.3 Don't know source 0.0 0.0 0.0 26,3 21.7 24.3 20,3 14,3 17.8 Not stated 0.8 1.0 0.9 0.6 0.5 0.6 0.6 0.6 0.6 Total percentage 100,0 100.0 100,0 100,0 100,0 100,0 100,0 100,0 100.0 Median time to source 25.8 30.3 30.1 10.5 15.4 10.8 10.8 15.7 15.1 Number of women 1319 953 2272 7182 5575 12757 8261 6148 14408 50 of modem contraceptives, the median time to reach a source is 30 minutes. The same length of time holds true for rural users, while urban users need about 26 minutes. Among nonusers of modem contraceptives, the median time is about 11 minutes in urban areas and about 15 minutes in rural areas. While it appears that women who are not using a modem contraception are closer to a known source than users of modem contraceptive method, note however, that about one in four nonusers did not know a source, which may be a cause for nonuse. Among all women who know a method, the median time is about 15 minutes; rural women state an average of 16 minutes, 5 minutes longer than the average travel time of urban women. In the 1993 NDS, users of modem contraceptive methods were asked if they had obtained the method they were currently using from the same place as previously. Questions on the first source of service and the reason for switching sources were asked to women who reported using a different source. This information is important in the evaluation of family plarming programs, particularly those related to the provision of methods and services. These data are not presented in this report due to the small number of women (88) who reported a change in source for the same method in the last segment of use. 4.9 Contraceptive Discontinuation Rates Population program managers are greatly interested in fostering improvements in the quality of contraceptive practice. One means of assessing the quality of contraceptive practice is to look at the contraceptive discontinuation rates which represent the proportion of users who discontinued the use of a method within 12 months after the start of use (for a technical discussion on the methodology of calculating this measure, see Macro International, 1992). Table 4.13 shows the contraceptive discontinuation rates due to various reasons for selected contraceptive methods. The results show that overall, one in three users discontinues during the first year of use. Discontinuation rates are highest for the condom (59 percent), followed by withdrawal (41 percen0 and the pill (40 percent). IUD has the lowest discontinuation rate--22 percent (see Figure 4.4). Withdrawal, natural family planning and condoms show high failure rates; one of five withdrawal users and around one in seven users of the condom and natural family planning becomes pregnant within a year of starting the method. Side effects/health reasons are cited as the main causes for discontinuing use of the pill. Table 4.13 First-year discontinuation rates for contraception Proportion of contraceptive users who discontinued use of a method by 12 months after beginning the method, due to method failure, desire to become pregnant, or other reason, according to specific methods, Philippines 1993 Reason for discontinuing contraceptive method Side Desire effects/ All Method to become Health other All Method failure pregnant concerns reasons reasons Pill 5.1 6.6 13.9 14.4 40.1 IUD 2.5 2.1 7.6 10.2 22.4 Condom 15.1 5.7 3.9 34.5 59.2 Natural family planning 15.6 4.8 1.0 9.8 31.3 Withdrawal 20.6 3.7 3.5 12.9 40.7 All methods 11.6 4.6 6.4 12.8 35.4 Note: Figures are based on life-table calculations. 51 Percent Figure 4.4 Contraceptive Discontinuation Rates for First Year of Use 60 40 20 0 Pill IUD Condom Natural Family Withdrawal Planning Note: Natural family planning refers to to periodic abstinence or rhythm. 1993 N DS "Other reasons" is an important category for the pill, IUD and condom. They include method-related reasons such as desire for a more effective method, inaccessibility or inconvenience, and the method costs too much and attitudinal, such as disapproval of the respondent's husband, or fatalistic feeling on the part of the respondent. Table 4.14 presents reasons for discontinuation among ever users who have discontinued use of a method during the five years preceding the survey. Considering all methods, accidental pregnancy stands out as the most important reason of stopping use. Desire for pregnancy and side effects rank second and third, respectively. Manipulable program variables, such as access/availability and cost of methods, are minor reasons for discontinuing use of any method. Looking at specific methods with the number of respondents in question greater than 50 women, the most common reason for discontinuing use the pill and IUD is side effects, while method failure is reported by users of condom, natural family planning and IUD. Method failure accounts for about half of the discontinuations of traditional methods. 4.10 Intentions for Future Family Planning Use among Nonusers Intention to use contraception in the future provides a forecast of potential demand for services, and acts as a convenient summary indicator of disposition towards contraception among current nonusers. Intention not to use contraception in the future is useful in identifying "hard core" targets for program managers and implementors. Among currently married nonusers, 64 percent do not intend to use a family planning method in the future (Table 4.15). Three in ten nonusers indicated their intent to use a contraceptive method in the future; 80 percent of these women said they were going to use it within the next 12 months. The past experience of nonusers also is taken into account in looking at future intentions in Table 4.15. Overall, 7 in 10 nonusers are never users. The intent to use a contraceptive in the next 12 months is more common among previous users than never users. 52 Table 4.14 Reasons for discontinuation of contraception Percent distribution of discontinuation of contraceptive methods in the five years preceding the survey by main reason for discontinuation, according to specific methods, Phil ippines 1993 Modem method Traditional method discontinued discontinued Natural Reason for Injec- Con- family With- discontinuation Pill IUD don dom planning drawal Other Total Became pregnant 14.5 9.0 (5.7) 26.1 47.5 52.6 40.6 34.0 To become pregnant 20.9 17.3 (5.3) 16.7 21.0 14.1 11.0 18.1 Husband disapproved 2.1 2.4 (0.0) 11.6 3.4 4.8 0.0 3.6 Side effects 24.3 24.5 (20.6) 2.9 1.6 4.4 6.0 11.9 Health concerns 6.3 7.5 (6.5) 2.8 1.4 1.2 1.9 3.5 Access/availability 2.0 2.2 (0.(3) 3.2 0.3 0.0 0.0 1.1 More effective method 1.1 2.8 (14.6) 4.7 4.1 3.0 1.0 2.7 ]namvenimt to use 2.0 8.8 (3.0) 17.7 2.1 3.0 7.5 3.5 lrtfrequent sex 7.8 1.1 (0.0) 1.3 3.7 2.8 6,0 4.6 Cost 0.6 0.0 (12.0) 0.6 0.0 0.0 0.0 0.4 Fatalistic 0.0 0.0 (0.0) 0.0 0.1 0.1 0.0 0.1 Menopause 0.2 1.4 (0.0 0.6 0.4 0.0 1.7 0.3 Marital dissolution 0.4 0.0 (0.0) 0.5 0.3 0.2 0.0 0.3 Other 2.3 3.1 (3.6) 0.9 0.9 0.9 3.0 1.6 Don't know 0.0 0.0 (0.0) 0.0 0.0 0.0 1.9 0.0 Missing 15.5 20.0 (28.8) 10.5 13.1 12.9 19.4 14.4 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women I 1196 153 25 169 708 1036 53 3354 lincludcs users o f diaphragm/foam/j elly, female sterilization, male stenlizatlotl. ( ) Figures in parentheses are based on 25-49 cases. 53 Table 4.15 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Philippines 1993 Past experience with contraception and future intentions Number of living children I 0 1 2 3 4+ Total Never used contraception Intends to use in next 12 months 2.6 21,2 15.3 13.4 8,9 12,5 Intends to use later 10.0 6.5 3,4 1,4 1.4 3.2 Unsure as to timing 0.7 0.8 0.6 0,7 0.4 0.5 Unsure as to intention 4.1 5.9 2.6 2.3 1.6 2.8 Does not intend to use 77.7 48.9 39.9 38.6 44.0 45.6 Missing 0.3 0.0 0,0 0.1 0,0 0,0 Previously used contraception Intends to use in next 12 months 0.5 3.6 15,2 15.2 15.3 12.2 Intends to use later 0.2 2.3 2,8 3.7 2.0 2.3 Unsure as to timing 0,0 0.2 0.5 0.4 0.3 0.3 Unsure as to intention 0,0 0.5 1.2 1,8 1.2 1.1 Does not intend to use 3.9 10.0 17.6 21.1 23.4 18,3 Missing 0,0 0.2 1.0 1.3 1.5 1.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 All currently married nonusers Intends to use in next 12 months 3.1 24,8 30,5 28.6 24.2 24,7 Intends to use later 10.3 8.7 6.1 5,1 3,4 5.6 Unsure as to timing 0.7 1.0 1,I 1,1 0.7 0.9 Unsure as to intention 4.1 6.4 3,8 4.1 2.8 3,9 Does not intend to use 81.6 58.9 57.5 59,7 67.4 63.8 Missing 0,3 0.2 1.0 1.4 1.5 1.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 373 927 1007 876 2196 5379 llnclodes current pregnancy More than one fifth of married nonusers who say they do not intend to use family planning cited side effects as the main mason for not using a method. A similar percentage say that they want more children (Table 4.16). Other often cited reasons are "older age, difficulty in becoming pregnant, infrequent sex and husband away" (19 percent), "menopausal and had hysterectomy" (11 percent), and health concerns (10 percent). Small proportions (less than 5 percent) of nonusers are opposed to family planning or cited religion as a reason for not using contraception. Women under age 30 are twice as likely as older women not to use family planning because they want children. Side effects and health concerns are reported more often by women under 30 than older women as the reason for not using contraception. 54 Table 4.16 Reasons for not using contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Philippines 1993 Age Reason for not using contraception 15-29 3049 Total Wants children 32.2 15.6 20.1 Lack of knowledge 9.4 4.7 6.0 Opposed to family planning 3.0 3.3 3.2 Religion 5.6 4.5 4.8 Costs too much 0.6 0.4 0.4 Hard to get methods 0.4 0.4 0.4 Side effects 27.4 19.5 21.6 Inconvenient 2.2 2.1 2.1 Health concerns 11.3 9.5 10.0 Fatalistic 0.3 0.5 0.4 Old/difficult to get pregnant/ infrequent sex/husband away 5.4 23.5 18.6 Menopausal/had hysterectomy 0.4 14.6 10.7 Not married 0.4 0.2 0.3 Other 0.9 0.9 0.9 Don't know 0.4 0.4 0.4 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number 929 2505 3433 Presented in Table 4.17 is the distribution of married nonusers who intend to use in the future by their preferred method. Half of nonusers who intend to use family planning in the future prefer to use the pill, 14 percent want to use natural family planning and 13 percent, female sterilization. It is interesting to note that the intent to use female sterilization is twice as common among nonusers planning to adopt in the next 12 months as among those who plan to use later. In contrast, a larger percentage of women who intend to use contraception later preferred to use the pill and natural family planning than those who wanted to use within the next 12 months. 55 Table 4.17 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Philippines 1993 Intend to use In next After Unsure Preferred method 12 12 as to of contraception , months months timing Total Pill 45.3 48.1 43.9 45.7 IUD 10.5 7.6 11.3 9.9 Injection 1.5 1.1 2.4 1.4 Diaphragm/foam/jelly 0.0 0.5 0.0 0.1 Condom 2.8 2.2 2.8 2.6 Female sterilization 14.0 7.7 8.1 12.7 Male sterilization 0.1 0.0 0.0 0.1 Natural family planning 13.8 16.8 11.5 14.2 Withdrawal 5.9 8.7 7.6 6.4 Other 1.2 0.3 2.0 1.1 Missing 4.9 7.1 10.4 5.7 Total percent 100.0 100.0 100.0 100.0 Number of women t 1330 300 47 1683 1Includes 6 cases with missing information on timing of future use 4.11 Family Planning Messages on Radio and Television In the Philippine Family Planning Program, the Department of Health and Commission on Population are working hand in hand with other govemment and private agencies in implementing the Information, Education, Communication and Motivation (IECM) component. For example, given the high level of awareness about family planning, the focus of the Department of Health's efforts in IECM are (Department of Health, 1990): . 2. . 4. correcting misinformation about the Program emanating from various sources; reiterating and specifying the health bcnefits of family planning and the link of family planning services with other health services; providing the informational basis for expanded choice; and supporting any selection among legally and medically accepted choices with necessary information (as part of the service to assist that choice). One of the channels of IECM relates to the mass media which includes radio and television. About half of respondents in the 1993 NDS reported that they had not heard or seen a family planning message on either the radio or television during the one month prior to interview (Table 4.18). Of those who had, more than half heard messages on both the radio and television, one in three heard a message on the radio only, and one in six heard from the television only. Women in urban areas are more likely to have heard a message from a television or both television and radio while women in rural areas, heard the message from only the radio. 56 Table 4.18 Family planning messages on radio and television Percent distribution of all women by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristics, Philippines 1993 Heard family planning message on radio or on television Number Background Radio Television of characteristic Neither only only Both Missing Total women Residence Urban 44.6 12.5 11.7 31.0 0.2 100.0 8501 Rural 55.9 21.4 3.1 19.2 0.3 100.0 6528 Region Metro. Manila 38.8 6.2 22.3 32.7 0.0 100.0 2733 Cordillera Admin. 15.2 43.6 1.1 40.2 0.0 100.0 241 llocos 46.6 7.0 4.9 41.5 0.0 I00.0 832 Cagayan Valley 51.1 36.1 1.5 11.0 0.3 100.0 486 C-Luzon 28.9 20.1 7.8 43.2 0.0 100.0 1599 S-Tagalog 50.1 15.0 9.3 25.5 0.1 100.0 2025 Bicol 61.0 23.2 4.2 11.3 0.2 100.0 805 W-Visay~s 64.0 15.5 1.4 19.1 0.0 100.0 1216 C-Visayas 58.5 17.3 5.1 18.7 0.5 100.0 1121 E-Visayas 57.6 20.9 2.1 18.6 0.7 100.0 645 W-Mindanao 59.0 22.8 2.1 15.6 0.5 100.0 729 N-Mindanao 61.1 16.4 2.2 20.1 0.2 t00.0 794 S-Mindanao 56.7 15.1 4.7 22.5 1.0 100.0 1095 C-Mindanao 56.8 23.4 2.4 17.1 0.2 100.0 707 Education No education 85.9 6.6 1.7 5.3 0.5 t00.0 320 Elementary 59.5 20.4 4.0 15.8 0.3 100.0 4690 High school 48.9 16.8 8.5 25.6 0.2 100.0 5967 College or higher 36,0 11.9 12.2 39.6 0.3 100.0 4049 Total I 49.5 16.4 8.0 25.9 0.2 100.0 15029 tlncledes 3 women with missing information on level of education The role of mass media as a channel for communicating family planning to the public varies by region. It is generally more important in Luzon than in other island groups; while only 15 percent of women in Cordillera Administrative Region said that they had not heard family planning messages on radio or television, in Visayas and Mindanao this proportion is more than 56 percent. Surprisingly, being the seat of the government, the level of family planning communication through radio and television in Metropolitan Manila is not the highest. With radio only as the source of family planning messages, Cordillera again tops the list, Cagayan Valley ranks second, and Bicol, Westem Mindanao and Central Mindanao together ranking third. The higher the education, the higher the proportion stating they have heard family planning messages from radio and television. Over half of women with some college education had heard a family planning message on the radio in the month before the survey, compared to only 12 percent of uneducated women. To determine the level of acceptance for family planning information dissemination among Filipino women, NDS asked the women respondents whether they consider it acceptable to provide family planning information over the radio or television. The results show that most of the women respondents consider it acceptable to air family planning messages over the radio or television (86 percent). There is very little 57 variation by women's current age. Urban women are somewhat more likely to accept family planning messages on radio or television than rural women. Women living in Metropolitan Manila, Southern Tagalog and Northern Mindanao are more likely to accept family planning messages over radio or television (92 percent or higher) in contrast to their counterparts residing in Western Mindanao and Central Mindanao (63 and 68 percent, respectively). Again, more educated women are more likely to accept family planning messages on radio or television (Table 4.19). Table 4.19 Acceptability of the use of mass media for disseminating family planning messages Percentage of women who believe that it is acceptable to have messages about family planning on radio or television, by selected background characteristics, Philippines 1993 Not Background Accept- accept- Don't know/ characteristic able able missing Total Number Age 15-19 80.8 5.6 13.7 100.0 3158 20-24 87.4 4.9 7.7 100.0 2649 25-29 88.1 5.4 6.5 100.0 2430 30-34 88.4 5.2 6.3 100.0 2196 35-39 87.3 6.1 6.6 100.0 1889 40-44 86.4 6.9 6.7 100.0 1571 45-49 85.9 6.4 7.7 100.0 1137 Residence Urban 88.5 4.6 6.9 100.0 8501 Rural 82.8 7.0 10.2 100.0 6528 Region Metro. M a,rtila 92.5 3.7 3.9 100.0 2733 Cordillera Admin. 85.4 2.1 12.5 100.0 241 Ilocos 80.5 6.6 12.9 100.0 832 Cagayar~ Valley 76.5 1.3 22.2 100.0 486 C-Luzon 88.3 3.5 8.2 100.0 1599 S-Tagalog 92.8 2.2 4.9 100.0 2025 Bicol 86.6 4.6 8.8 100.0 805 W-Visayas 82.8 6.3 10.9 100.0 1216 C-Visayas 89.6 5.3 5.1 100.0 1121 E-Visayas 86.4 5.1 8.5 I00.0 645 W-Mindanao 62.8 21.7 15.6 100.0 729 N-Mirtdanao 95.1 2.8 2.1 100.0 794 S-Mindanao 82.9 7.7 9.4 100.0 1095 C-Mindanao 67.7 15.5 16.9 100.0 707 Education No education 32.5 30.9 36.6 100.0 320 Elementary 82.2 7.1 10.7 100.0 4690 High school 87.1 4.6 8.2 100.0 5967 College or higher 93.1 3.5 3.4 100.0 4049 Total I 86.0 5.7 8.3 100.0 15029 lIncludes 3 women with missing iaformatlon on level of education 58 CHAPTER 5 OTHER PROXIMATE DETERMINANTS OF FERTILITY Addressed in this chapter are the principal factors, other than contraception, which affect a woman's risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhea and abstinence from sexual relations, and secondary infertility. Marriage is a primary indicator of the exposure of women to the risk of pregnancy and, therefore, is important for the understanding of fertility. Populations in which age at marriage is low tend 10 be populations with early childbearing and high fertility. Trends in the age at which women marry as well as in the proportions remaining single can help explain trends in fertility. Included also in this chapter is information on more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of several other proximate determinants of fertility which, like marriage and sexual intercourse, influence exposure to risk are also presented. These are the durations of postpartum amenorrhea and postpartum abstinence, and secondary infertility. 5.1 Current Marital Status Table 5.1 shows the marital status of women at the time of the survey by age. Overall, 37 percent of women have never married, 54 percent are married, 5 percent are living together with a partner, and about 4 percent are not living with a husband or a partner. Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Philippines 1993 Marital status Number Never Living Not living of Age married Married together Widowed Divorced together Total women 15-19 92.2 4.7 2.7 0.0 0.0 0.3 100.0 3158 20-24 54.6 38.4 6.0 0.3 0.0 0.8 100.0 2649 25-29 25.1 66.3 6.3 0.7 0.1 1.6 100.0 2430 30-34 12.2 77.9 5.8 1.4 0.3 2.5 100.0 2196 35-39 6.7 81.6 5.9 2.7 0.2 2.9 100.0 1889 40J,4 5.3 81.0 5.4 5.1 0.6 2.5 100.0 1571 45-49 6.3 77.3 5.6 7.6 0.6 2.6 100.0 1137 Total 36.7 54.4 5.2 1.8 0.2 1.6 100.0 15029 The proportion never married decreases rapidly from 92 percent among teenagers to 55 percent among women in their early twenties to 25 percent among women in their late twenties. The proportions in both formal and informal unions start well below 10 percent among teenagers, increasing rapidly to 44 percent among women 20-24 years of age, and 73 percent among women 25°29 years. This proportion reaches its peak at 88 percent among women 35-39 years and slightly declines thereafter more as a result of marital dissolution (primarily through widowhood) than by nonmarriage. 59 5.2 Marital Exposure Table 5.2 is intended to show variations in exposure to marriage for a recent period by age and background characteristics of all women. The table is calculated using information collected in the calendar and shows the percentage of months in the five years prior to the survey spent married. Since the table is based on all women, never-married woman are included in the denominator by adding 60 months for each. The percentage of months spent in married state incorporates the effects of age at first marriage, marital dissolution, and remarriage. Table 5.2 Marital exposure Percentage of months spent in marital union in the five years preceding the sta'vey, by age and selected background characteristics, Philippines 1993 Age at time of survey Background characterisfc 15-19 20-24 25-29 30-34 35-39 40~14 45-,19 Total Residence Urban 2.0 24.2 58.2 76.4 83.7 87.2 79.7 49.7 Rural 4.0 38.4 72.7 86.6 90.6 87.5 88.9 60.8 Region Me~a'o. Matfda 2.1 17.0 46.3 66.3 78.4 85.6 68.0 41.3 Cordillera Admin. 1.7 28.3 69.7 88.2 94.6 86.3 90.0 57.7 llocos 2.9 27.6 65.1 80.3 85.5 84.4 86.1 54.3 Cagayan Valley 3.5 37.4 75.9 86.4 89.3 91.1 83.7 63.0 C-Luzon 1.8 37.5 68.8 85.5 85.5 83.4 85.4 55.9 S-Tagalog 3.0 27.0 65.7 79.2 90.0 89.3 88.3 54.7 Bicol 2.3 39.8 72.2 84.8 91.2 86.1 89.9 63.3 W-Visayaz 3.3 27.2 61.9 83.1 84.0 87.2 87.5 54.3 C-Visayas 3.5 33.1 65.2 78.9 86.1 87.2 85.6 57.9 E-Visayas 3.8 34.0 66.6 87.4 92.0 86.6 82.8 56.9 W-Mindanao 5.3 37.3 73.4 88.1 88.5 90.0 84.5 62.3 N-Mindanao 2.8 38.4 71.1 88.1 90.2 88.1 87.4 58.4 S-Mindanao 2.9 36.6 73.7 84.6 90.8 89.6 88.4 56.9 C-Mindanao 2.5 42.3 76.9 90.0 91.5 92.5 91.4 62.3 EducaHoB No education 5.2 53.9 82.5 82.8 91.6 87.8 87.2 72.6 Elementary 7.3 49.0 79.6 87.9 89.5 88.4 86.3 72.6 High school 2.1 35.5 69.7 82.9 87.8 87.3 81.8 45.5 College or higher 0.6 12.3 45.6 70.8 80.9 85.2 78.8 45.4 Total 2.8 30.1 64.3 80.9 87.0 87.3 84.0 54.5 The percentage of months spent married, as expected, increases with age, reaching a peak of 87 percent at ages 35-39, with a plateau of 87 percent at ages 40-44, and declining only slightly to 84 percent at ages 45-49 years. Undoubtedly, this pattern reflects the pace of entry into marriage among young women as well as the increasing incidence of widowhood among women aged 40 to 49 and the substantial proportion of older women living apart from their husbands. The most revealing aspect of the data in Table 5.2 is the low level of marital exposure among Philippine women. Only 55 percent of the 5 years preceding the survey was spent in marital exposure. The low level of marital exposure for those below age 25 arises from the fact that 55 percent are still single. 60 There are wide variations in marital exposure by level of education. In general, women with at most a primary education spent 73 percent of the last 5 years in marriage while those with secondary or higher education spent only 45 percent in marital union. This pattern most likely reflects the higher age at marriage among the more educated women. Regional variations in marital exposure depict larger than average marital exposure in less developed regions (Cagayan, Bicol, Westem Mindanao and Central Mindanao) with the most developed region (Metropolitan Manila) depicting the lowest marital exposure of 41 percent. The rest of the regions hover around the national marital exposure figure of 55 percent. The larger than average marital exposure values observed in the less developed regions reflects the effects of early age at marriage and of marital dissolution, while the low value for the country's primer region arises from the effects of older age at marriage and marital dissolution, particularly those not living with their husbands. In general, women in urban areas show slightly lower than average marital exposure of 50 percent while rural women show slightly higher than average marital exposure of 61 percent. 5.3 Age at FirstMarriage Table 5.3 presents the percentage of women who first married at selected ages and the median age at first marriage, according to current age. The table clearly shows an increase in age at marriage across cohorts. Among women aged 35 or older, approximately 40 percent were married by age 20, while 37 percent of women age 30-34 and only 29 percent of women aged 20-24 did so. The median age at first marriage increased only slightly from 21.3 years among women 45-49 years to 22.0 years among women 25- 29 years. This reflects a long-standing late age at marriage among Filipino women, evidenced by the fact that around one in three women 25-49 was still single at age 25. Table 5.3 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to current age, Philippines 1993 Percentage of women who were first married by exact age: Current age 15 18 20 22 Percentage Median who had Number age at never of F~st 25 married women marriage 15-19 0,7 NA NA NA NA 92.2 3158 a 20-24 1.9 14.2 29.3 NA NA 54.6 2649 a 25-29 2.4 16.7 34.0 49.8 66.9 25.1 2430 22.0 30-34 2.4 18.3 36.6 52.6 69.0 12.2 2196 21.7 35-39 2.9 20.1 39.0 54.5 73.5 6.7 1889 21.4 40~14 3.3 20.9 38.3 53.7 72.3 5.3 1571 21.5 45-49 4.2 22.7 40.4 55.3 72.3 6.3 i137 21.3 20-~9 2.7 18.1 35.4 50.0 64.8 21.9 11871 b 25-49 2.9 19.2 37.2 52.8 70,3 12.6 9222 21.6 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x t'Not calculated due to censoring 61 5.4 Median Age at First Marriage Urban women marry at a somewhat later age than rural women; the median age at first marriage for urban women is 22.3 years while that for rural women is 20.7 years. Sizeable differences in age at marriage exist by regions (Table 5.4). The median age at first marriage in Metropolitan Manila is 24 years. There is no distinct pattern in age at first marriage by island groups; however, the less developed areas show lower median values (ranging from 20.4 to 21.4 years) than other areas. There is a positive relationship between age at first marriage and educational attainment. The median value for women with no education is 19 years while those who reached high school show a median value of 21 years. Table 5.4 Median age at first marriage Median age at first marriage among women age 25-49 years, by current age and selected background characteristics, Philippines 1993 Current age Women Background age characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 22.7 22.3 22.1 22.1 22.2 22.3 Rural 20.9 20.7 20,6 20.7 20,3 20.7 Region Metro. Manila a 25.0 22.6 23.3 22.8 24.0 Cordillera Admin, (22.4) 22.1 23.1 (21.2) (21.8) 22.3 Ilocos 22.8 21.8 22,3 22,1 21.5 22.2 Cagayan Valley 20,7 20.4 20.0 20.6 (19.6) 20,4 C-Luzon 20.9 21.4 21.6 22.6 21.2 21.5 S-Tagalog 21.8 21.3 20.9 21.4 21.7 21.4 Bicol 21.3 21.0 20.5 20.4 19.9 20.8 W-Visayas 22.2 22.6 22.4 22.0 22.1 22.3 C-Visayas 22. l 21.8 22.0 21.3 20.2 21.7 E-Visayas 21.1 21.3 20.7 21.1 19.7 20.9 W-Mindanao 20.6 20.0 20.7 20.3 20.6 20.4 N-Mindanao 20.9 21.3 19.9 18.9 21.1 20.6 S-Mindanao 20,9 20.5 20.5 21.6 21.2 20.9 C-Mindanao 20. l 20.2 21.0 20.0 20.7 20.4 Education No education 18.3 19.0 19.2 18.8 20,2 18.9 Elementary 19.7 19.4 19,5 19.8 19.8 19.6 High school 21,0 20,8 21.4 21.2 21.6 21.1 College or higher a 25.2 24.8 25.0 25.8 a Total 21.8 21.5 21.3 21.4 21,1 21.4 Note: Medians are not shown for women 20-24 because less than 50 percent have married by age 20 in almost all subgroups shown in the table. aOmitted because less than 50 percent of the women in the age group were first married by age 25. ( ) Figures in parentheses are based on 25-49 cases 62 5.5 Age at First Sexual Intercourse Like the age at first marriage, the age at first sexual intercourse is a proxy measure for the beginning of a woman's exposure to the risk of pregnancy. Table 5.5 presents information on age at first sex for all women. Overall, half of the women aged 25-49 started to be sexually active at age 21.5 years. Only 3 percent of the women aged 25-49 years had their first intercourse by age 15 and 38 percent by age 20. By age 25, 7 in 10 women have had sexual intercourse. The table shows that the onset of sexual activity has not changed remarkably over time. Table 5.5 Age at fLrst sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at f'trst intercourse, according to current age, Philippines 1993 Current age 15 18 20 22 Percentage of women who had Percentage Median first intercourse by exact age: who Number age at never had of f'tr st 25 intercourse women intercourse 15-19 0.8 NA NA NA NA 91.9 3158 a 20-24 2.0 14.7 30.3 NA NA 53.4 2649 a 25-29 2.5 17.9 35.3 50.8 67.4 24.4 2430 21.9 30-34 2.4 19.1 37.8 53.5 70.1 11.3 2196 21.5 35-39 3.2 21.4 41.0 56.0 74.4 6.4 1889 21.1 4044 3.3 21.1 38.8 54.6 72.8 5.1 1571 21.4 45-49 4.5 23.0 41.5 56.4 73.0 5.9 1137 21.1 20-49 2.8 18.9 36.6 51.1 65.6 21.3 11871 a 25~19 3.0 20.1 38.4 53.8 71.1 12.0 9222 21.5 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 bad had intercourse by age x. Comparing the information in Table 5.5 with the information on age at first marriage in Table 5.4, it is clear that the majority of Filipino women have first sexual intercourse when they marry; there is only a one month difference between the median ages at first intercourse (21.5) and first marriage among women aged 25-49 (21.6 year). Differentials in the median age at first intercourse also parallel those observed in the median age at first marriage (see Table 5.6). 5.6 Recent Sexual Activity In the absence of contraception, the probability of pregnancy is related to the participation in sexual intercourse. Thus, information on intercourse is important for refinement of the measurement of exposure to pregnancy. An indicator of the percentage of women who are abstaining from sex in any given month, due to such factors as a recent birth, spousal separation, illness, etc. is given by the percent who were not sexually active in the last four weeks. There were several questions in the 1993 NDS on the topic of recent sexual activity. All women were asked how long ago they had last had sexual intercourse, how many times they had sex in the last four weeks, and how many times they usually have sex in a month. 63 Table 5.6 Median age at first intercourse Median age at first sexual intercourse among women age 25-49 years, by current age and selected background characteristics, Philippines 1993 Current age Women Background age characteristic 25-29 30-34 35-39 40-44 45~19 2549 Residence Urbaaa 22.8 22,5 22,0 22,0 22,t 22,3 Rural 20.8 20.6 20.4 20.7 20.2 20.6 Region Metro. Manila 24.8 24.6 22.4 23.1 22.7 23.7 Cordillera Admin. (22.2) (21.8) (22.9) * * 22.1 llocos 22.8 21.8 22.2 22.2 20.6 22.2 Cagayan Valley 20.7 20.4 20.2 20.8 19.4 20.4 C-Luzon 20.9 21.4 21.4 22.2 21.1 21.4 S-Tagalog 21.9 21.3 20.9 21.3 22.0 21.4 Bicol 21.3 21.1 20.4 20.5 19.8 20.8 W-Visayas 22.2 22.5 22.2 21.6 21.9 22.1 C-Visayas 21.9 21.4 21.5 21.0 19.7 21.3 E-Visayas 20.8 21.0 20.8 21.1 19.7 20.7 W-Mindanao 20.7 19.9 20.5 20.5 20.5 20.4 N-Mindanao 20.8 21.2 19.9 18.9 20.8 20.5 S-Mindanao 20.6 20.2 20,1 21.6 21.1 20.6 C-Mindanao 19.9 20.3 20.8 20.0 20.5 20.3 Education No education (18.3) (19.1) (18.9) (18.8) (19.6) (18.8) Elementary 19.6 19.4 19.5 19.9 19.8 19.6 High school 21.0 20.8 21.1 21.3 21.6 21.1 College or higher a 25.2 24.6 24.9 25.8 a Total 21.9 21.5 21.1 21.4 21.1 21.5 Note: Medians were not shown for women 20-24 because less than 50 percent had had intercourse by age 20 in almost all subgroups shown in the table. 'Omitted because less than 50 percent of the women in age group x to x+4 had bad intercourse by age x. * Less than 25 u~aweighted eases ( ) Figures in parentheses are based on 25-49 unweighted cases. Table 5.7 is based on the question of time since last intercourse and allows an assessment of the overall level of sexual activity according to age, marital duration, and other background characteristics. In general, 77 percent of all women were sexually active in the month preceding the survey, 5 percent were postpartum abstaining, and 18 percent were not sexually active for reasons other than a recent birth (e.g., spousal separation, illness). The proportion postpartum abstaining declines as age and duration of marriage increase. At the same time, the proportion not sexually active for other reasons increases with increasing age and marriage duration. 64 Table 5.7 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Philippines 1993 Not sexually active in last 4 weeks Sexually Abstaining Abstaining active (postpartum) (not postpartum) Number Background in last of characteristic 4 weeks 0-1 years 2+ years 0-1 years 2+ years Missing Total women Age of mother 15-19 72.0 15.9 1.7 9.5 0.5 0.3 100.0 255 20-24 79.1 8.4 0.7 10.8 0.6 0.4 100.0 1233 25-29 79.7 5.5 0.5 11.7 2.6 0.0 100.0 1837 30-34 78.5 4.6 1.2 11.5 4.1 0.1 100.0 1948 35-39 77.7 3.4 0.7 12.7 5.3 0.1 100.0 1769 40-44 76.6 1.5 0.7 12.0 9.1 0.1 100.0 1490 45-49 69.2 0.3 0.2 16.6 13.3 0.5 100.0 1069 Duration of union 0-4 76.3 9.2 0.8 12.7 0.9 0.1 100.0 1858 5-9 79.4 4.7 1.0 11.7 3.0 0.1 100.0 2045 10-14 81.4 3.2 0.6 10.6 4.2 0.0 100.0 1851 15-19 79.1 3.1 0.3 11.1 6.1 0.2 100.0 1604 20-24 75.9 1.1 0.4 13.8 8.5 0.3 100.0 1217 25+ 69.3 0.4 0.5 16.1 13.5 0.2 100.0 937 Never in union 21.3 28.3 11.3 9.7 24.2 5.3 100.0 91 Residence Urban 73.5 4.3 0.9 14.7 6.4 0.2 100.0 5025 Rural 81.2 4.5 0.6 9.6 4.0 0.1 100.0 4577 Region Metro. Manila 66.7 5.3 0.7 17.5 9.5 0.3 100.0 1425 Cordillera Admin. 79.6 2.9 1.0 11.3 4.9 0.3 100.0 158 llocos 77.1 5.5 0.8 11.8 4.5 0.3 100.0 532 Cagayan Valley 85.1 4.2 0.2 6.2 4.0 0.4 100.0 356 C-Luzon 73.8 4.3 0.9 14.8 6.2 0.0 100.0 1038 S-Tagalog 73.6 5.2 0.6 15.3 5.3 0.0 100.0 1289 Bicol 79.7 6.6 0.5 9.7 3.1 0.5 100.0 588 W-Visayas 78.7 3.7 0.7 12.2 4.7 0.0 100.0 753 C-Visayas 79.6 4.4 0.9 10.3 4.3 0.5 100.0 765 E-Visayas 75.6 6.7 0.7 12.9 4.1 0.0 100.0 435 W-Mindmaao 85.5 2.5 1.0 6.9 3.9 0.1 100.0 514 N-Mindartao 86.4 2.1 0.9 7.7 3.0 0.0 100.0 540 S-Mindanao 82.0 2.9 1.0 10.4 3.6 0.1 100.0 715 C-Mindanao 83.8 2.1 0.6 7.7 5.6 0.2 100.0 494 Education No education 80.6 3.0 1.1 8.7 6.1 0.6 100.0 263 Elementary 79.2 4.3 0.6 10.5 5.2 0.2 100.0 3823 High school 76.1 4.9 0.8 13.4 4.5 0.2 100.0 3277 College or higher 74.6 3.8 0.9 14.0 6.4 0.1 100.0 2239 Current contraceptive No method 68.8 6.8 1.2 15.5 7.5 0.3 100.0 5971 Pill 95.0 0.2 0.0 4.6 0.1 0.0 100.0 764 IUD 94.9 0.0 0.0 4.3 0.8 0.0 100.0 273 Sterilization 82.8 0.7 0.1 11.5 4.8 0.1 100.0 1138 Periodic abstinence 94.0 0.9 0.0 5.0 0.1 0.0 100.0 658 Other 94.6 0.2 0.0 5.2 0.0 0.0 100.0 798 Total 77.1 4.4 0.8 12.3 5.3 0.2 100.0 9602 65 The percentage of women who were sexually active in the month preceding the sur- vey declines gradually with increasing level of education. More rural than urban women were sexually active in the month preceding the sur- vey. Women living in Metropolitan Manila showed the lowest proportion (67 percent) who were sexually active in the month before the survey. The comparatively large proportion ab- staining among Metropolitan Manila women was mainly due to factors other than a recent birth. The proportions sexually active among contraceptive users were far higher than for nonusers (95 percent compared to 69 percent), except for sterilization users, 16 percent of whom were abstaining for reasons other than a recent birth. 5.7 Postpartum Amenorrhea, Abstinence, and Insusceptibility Among women who are not using con- traception, exposure to the risk of pregnancy in the period following a birth is influenced by two factors: brcastfeeding and sexual absti- nence. Postpartum protection from conception can be prolonged by breastfceding, which can lengthen the time to onset of ovulation, and by delaying the resumption of sexual relations. Table 5.8 Postpartum amenorrhea~ abstinence and insusceptibility Percentage of births whose mothers are postpartum arnenorrheic. abstaining and insusceptible, by number of months since birth, and median and mean durations, Philippines 1993 Number Months Amenor- Insus- of since birth rbeie Abstaining ceptible births < 2 94.0 86.7 97.6 196 2-3 68.4 47.2 77.6 293 4-5 56.0 15.5 61.0 329 6-7 44.5 l 1.2 50.0 326 8-9 31.7 7.0 36.3 323 10-11 26.5 5.8 30.8 272 12-13 18.5 4.0 21.4 289 14-15 14.4 3.8 17.3 288 16-17 6.5 5.2 11.4 314 18-19 2.7 3.7 6.3 332 20-21 1.2 2.8 3.3 301 22-23 2.2 2.4 4.3 265 24-25 0.5 2.8 3.4 285 26-27 0.6 1.5 2.1 274 28-29 0.8 1.1 1.9 337 30-31 0.0 0.7 0.7 321 32-33 0.3 1.1 1.4 317 34-35 0.0 2.2 2.2 293 Total 19.2 9.9 22.6 5356 Median 5.5 2.3 6.4 NA Mean 7.7 4.4 8.8 NA Prevalence/ Incidence mean 6.8 3.5 8.0 NA Note: Means and medians are based on the current-status proportions in each two-month age interval (smoothed) NA = Not applicable Estimation of the mean durations was done using the current status proportions. The preva- lence/incidence (P/I) mean is borrowed from epidemiology, and is provided to enable intemational com- parison. Table 5.8 shows the percentage of births whose mothers are postpartum amenorrheic, abstaining, and postpartum insusceptible by the number of months since the birth, Women who are insusceptible are defined as those who are either amenorrheic or abstaining following a birth and, thus, are not exposed to the risk of pregnancy. The estimates shown in Table 5.8 are based on current status data, that is, they refer to the proportion of births occurring x months before the survey for which mothers are still amenorrheic or abstaining at the time of the survey. All live births occurring during the three years prior to the survey are included. To reduce fluctuations in the estimates, the births are grouped in two-month intervals. Among births 2 to 3 months prior to interview, 68 percent of the mothers are still amenorrheic. The proportion amenorrheic 6 to 7 months after the birth is 45 percent and 12 to 13 months after the birth, declined to 19 percent. The duration of postpartum abstinence is shorter than the duration of amenorrhea (see Figure 5.1). Forty-seven percent of mothers are still abstaining from sexual relations 2 to 3 months following a birth, but only 4 percent arc still abstaining after a year. Overall, half of all mothers are susceptible to the risk of pregnancy 6 months after a birth (not taking into account contraceptive use). 66 10(: 8C 60 40 20 0 Figure 5.1 Percentage of Births Whose Mothers Are Amenorrheic, Abstaining and Insusceptible Percent 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 Months since Birth 1993 NDS 5.8 Med ian Durat ion of Pos tpar tum Amenorrhea , Abstinence and Insuscept ib i l i ty Presented in Table 5.9 is the median duration of postpartum amenorrhea, abstinence, and insusceptibility by various background characteristics of women. As for Table 5.8, this table is based on current status data on all live births occurring in the three years prior to the survey. On average, women in the Philippines are amenorrheic for 5.5 months following a birth, abstain for 2.3 months, and are insusceptible to the risk of pregnancy for 6.4 months. The duration of postpartum amenorrhea is practically identical among women under 30 years of age and those 30 years or older. Urban women are amenorrheic for a shorter period of time than rural women perhaps due to their breastfeeding practices. As expected, the median duration of amenorrhea is shortest in Metropolitan Manila (3 months), average for the more developed regions (4-5 months) and longest for the less developed regions of the country (6-9 months). Education is inversely related with the duration of postpartum amenorrhea. Women with no education are amenorrheic for twice as long (9.8 months) as women with high school or higher education (4.8 months). Subgroup differences in the duration of abstinence tend to be less pronounced due to the brevity of this practice among Philippine couples. The most remarkable differences are observed among regions in Mindanao showing durations of less than 2 months compared to regions in Visayas or Luzon with abstinence duration of 2 to 3 months. In addition, women with no education showed a duration of abstinence of 1.5 months while for those with formal education, this is 0.5 month longer. 67 The combined effect of amenorrhea and abstinence is reflected in the median duration of insusceptibility shown in Table 5.9. Rural women are insusceptible for longer periods (7.9 months) than urban women (5.2 months); this difference is due largely to longer durations of postpartum amenorrhea among rural women. Education is inversely associated with duration of insusceptibility to the risk of pregnancy following a birth. Regional differences in the duration of insusceptibility generally replicate the differences in the duration of amenorrbea. Table 5.9 Median duration of postpartum insusceptibility by background charac

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