Philippines - Demographic and Health Survey - 1999

Publication date: 1999

National Demographic and Health Survey 1998 National Statistics Office ® Department of Health ~DHS / Demographic and Health Surveys Macro International Inc. REPUBLIC OF THE PHILIPPINES National Demographic and Health Survey 1998 National Statistics Office Manila, Philippines Department of Health Manila, Philippines Macro International Inc. Calverton, Maryland January 1999 This report summarizes the findings of the 1998 National Demographic and Health Survey (NDHS) undertaken by the National Statistics Office in collaboration with the Department of Health (DOH), the University of the Philippines Population Institute, and other concerned agencies in the Philippine government. Funding for the 1998 NDHS was provided by the U.S. Agency for Ituemational Development and the DOH. The 1998 NDHS 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 1998 NDHS 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, USA (Telephone 301-572-0200, Fax 301-572-0999). Recommended citation: National Statistics Office (NSO)], Department of Health (DOH) [Philippines] and Macro International Inc. (MI). 1999. National Demographic and Health Survey 1998. Manila: NSO and MI. ISSN 0119-3252 CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Summary of findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Map o f Philippines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xx iv CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Objectives of the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Sample design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Questionnaires . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Training and fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Data processing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Response rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 CHAPTER 2 BACKGROUND CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.1 Age-sex composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2.2 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.4 Education level of the household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.5 School enrolrnent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.6 Housing conveniences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.7 Presence of durable goods in the household . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.8 Background character i s t i cs of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 2.9 Education level of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.10 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 2.11 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.12 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 2.13 Earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 2.14 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 iii CHAPTER3 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 CHAPTER4 Page FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 l Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fertility trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Teenage fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 FAMILY PLANNING 4.1 Knowledge of family planning methods and their sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.2 Ever use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.3 Current use of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 4.4 Number of children at first use of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.5 Problems with current method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 4.6 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 4.7 Timing of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 4.8 Willingness to pay for contraceptive method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 4.9 Source of supply of modem contraceptive methods currently used . . . . . . . . . . . . . . . . . 63 4.10 Contraceptive discontinuation rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 4.11 Intentions for future family planning use among nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 4.12 Family planning messages in the mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 CHAPTER5 5.I 5.2 5.3 5.4 5.5 5.6 OTHER PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . 75 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 iv 5.7 5.8 CHAPTER 6 6.1 6.2 6.3 6,4 6.5 CHAPTER7 7.1 7.2 7.3 7.4 7.5 CHAPTER8 Page Median duration of postpartum amenorrhea, abstinence, and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Desire for more children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Deinand for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Unplanned and unwanted fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Family size desires of c0uples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 INFANT AND CHILD MORTALITY . 103 Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Levels and trends in infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Infant and child mortality differentials by socioeconomic characteristics . 107 Infant and child mortality differentials by demographic and health characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 MATERNAL AND CHILD HEALTH . 113 8.1 Prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 8.2 Tetanus immunization of pregnant women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 8.3 Iron and iodine supplementation during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 19 8.4 Delivery assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 8.5 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 8.6 Maternal mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . t28 8.7 Immunization of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 8.8 Prevalence of acute respiratory infection and fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 8.9 Diarrheal diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 8.10 Treatment of diarrhea with oral rehydration therapy . 134 V Page CHAPTER 9 INFANT FEEDING AND SUPPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 9.1 9.2 Prevalence of breastfeeding and supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 CHAPTER 10 GENERAL HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 10.1 Communicable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Dengue fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Rabies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Leprosy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 10.2 Non-communicable diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Healthy lifestyle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 10.3 Environmental health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Garbage disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Use ofpre-cooked foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 10.4 Health care financing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 10.5 Traditional medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 10.6 Health facility utilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 APPENDIX A SAMPLE DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX B EST IMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX C QUAL ITY OF THE DATA: NONSAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . 195 APPENDIX D PERSONS INVOLVED IN THE 1998 NATIONAL DEMOGRAPI~C AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 APPENDIXE SURVEY QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 vi 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. l0 Table 2.11 Table 2.12 Table 2.13 Table 2.14 Table 2.15 Table 2.16 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 4.1 Table 4.2 Table 4.3 Table 4.4 TABLES Page Household population by age, residence, and sex . 8 Median and dependency ratio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Housing conveniences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Background characteristics of respondents by residence and region . . . . . . . . . . . . . . 20 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Exposure to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Employment status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Type of employer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26' Person who decides on use of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Child care while working . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Child care while working by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Current feritility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Fertility by background character i s t i cs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Fertility trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Children ever-born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of contraceptive methods and a source for methods . 48 Knowledge of modem contraceptive methods and source for methods . 50 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 vii Table 4.5 Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4. I5 Table 4.16 Table 4.17 Table 4.18 Table 4.19 Table 4.20 Table 4.21 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 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Page Trends in contraceptive use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Current use of contraception by background charateristics . . . . . . . . . . . . . . . . . . . . . . . . . 57 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Problems with current method of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Timing of sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Willingness to pay for contraceptive method used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Source of supply for modem contraceptive methods . 63 Time to source of supply for modern contraceptive method used . 64 First year discontinuation rates for contraception . 65 Reason for discontinuing of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Exposure to family planning messages in the mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Acceptability of the use of mass media for disseminating family planning message . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Exposure to family planning slogan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Median age at first intercourse . L . 80 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Postpartum amenorrhea, abstinence, and insusceptibility . 83 Median duration of postpartum insusceptibility by background characteristics . 86 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Desire to limit (stop) childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . . 97 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 viii Table 6.8 Table 6.9 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 8.9a Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 8.15 Table 8.16 Table 8.17 Table 8.18 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 10.1 Table 10.2 Table 10.3 Page Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Couple's consensus on family size . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Trend in infant mortality rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Infant and child mortality by socio-economic characteristics . 107 Infant and child mortality by demographic characteristics . 109 High-risk fertility behavior . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . I 11 Prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Information about danger signs of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Iron and iodine supplementation during pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Del ivery character i s t i cs : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Reasons for caesarian section . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Timing of postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Postnatal care services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Vaccination by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Vaccination by background characteristics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Reasons for non-immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Prevalence of acute respiratory tnfection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Diarrhea prevalence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Knowledge of diarrhea care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Diarrhea treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Treatment with vitamin A and Iron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Breasfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Type of foods received by breastfeeding children in the preceding 24 hours . 145 Median duration aiad frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Dengue fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 Responsibility of dog owners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Treatment of dog bites . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 ix Page Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Table 10.9 Table 10.10 Table 10. I 1 Table 10.I2 Table 10.13 Table 10.14 Table 10.15 Table 10.16 Table A. I Table B. 1 Table B. 1.1 Table B. 1.2 Table B. 1.3 Table B. 1.4 Table B.1.5 Table B. 1.6 Table B. 1.7 Table B. 1.8 Table B. 1.9 Table B.I.10 Table B. 1.11 Table B.I.12 Table B.l.13 Table B. 1.14 Table B. 1.15 Table B. 1.16 Table B.1.17 Table B. 1.18 Perceived transmission of leprosy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Curability of leprosy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Causes of tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Length of TB treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Ways to keep healthy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Effects of smoking on health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I55 Signs and symptoms of cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Use ofpre-cooked food . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Health care financing membership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 Type of insurance plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I58 Familiarity with herbal medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Utilization of health facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16i Utilization of health facilities by type of service accessed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Sample Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 List of variables for sampling errors, Philippines 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174 Sampling errors: Entire sample, Philippines, I998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 Sampling errors: Urban sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I76 Sampling errors: Rural sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 Sampling errors: National Capital Region sample, Philippines, 1998 . 178 Sampling errors: Cordillera Administrative Region sample, Philippines, 1998 . 179 Sampling errors: Ilocos sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180 Sampling errors: Cagayan Valley sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . 181 Sampling errors: Central Luzon sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . 182 Sampling errors: Southern Tagalog sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . 183 Sampling errors: Bicol sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184 Sampling errors: Western Visayas sample, Philippines, 1998 . 185 Sampling errors: Central Visayas sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . 186 Sampling errors: Eastern Visayas sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . 187 Sampling errors: Western Mindanao sample, Philippines, 1998 . 188 Sampling errors: Northern Mindanao sample, Philippines, 1998 . . . . . . . . . . . . . . . . . 189 Sampling errors: Southern Mindanao sample, Philippines, 1998 . . . . . . . . . . . . . . . . . 190 Sampling errors: Central Mindanao sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . 191 Sampling errors: Autonomous Region of Muslim Mindanao sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192 X Table B.l.19 Table C. 1 Table C.2 Table C.3 Table CA Tal:le C.5 "I able C.6 Page Sampling errors: Caraga sample, Philippines, 1998 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 xi FIGURES Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 3.7 Figure 3.8 Figure 4.1 Figure 4.2 Figure 4.3 Figure 4.4 Figure 5.1 Figure 5.2 Figure 5.3 Page Single-year age distribution of the household population, by sex . . . . . . . . . . . . . . . . 8 Distribution of the household population by age and sex . . . . . . . . . . . . . . . . . . . . . . 9 Median years of schooling by sex and region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Housing conveniences by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Distribution of respondents by religion and ethnieity . . . . . . . . . . . . . . . . . . . . . . . . . 20 Total fertility rates in selected countries in Southeast Asia . . . . . . . . . . . . . . . . . . . . 32 Age-specific fertility rates by residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Total fertility rate among women age 15-49 by residence and education . . . . . . . . . 34 Total fertility rate, Philippines 1970-1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Mean number of children ever born among women age 15-49 by age group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Median number of months since previous birth by age of mother and birth order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Percentage of women age 15-19 (teenagers) who have begun childbearing by residence and education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Percentage of women age 15-19 (teenagers) who have begun childbearing by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Knowledge of contraception among currently married women age 15-49 . . . . . . . . . 49 Use of contraception among currently married women 15-19 . . . . . . . . . . . . . . . . . . 53 Trends in contraceptive use, Philippines 1968-1998 . . . . . . . . . . . . . . . . . . . . . . . . . 56 Contraceptive discontinuation rates for first year of life . . . . . . . . . . . . . . . . . . . . . . 66 Median age at first marriage by residence and education . . . . . . . . . . . . . . . . . . . . . . 78 median ge at first marriage by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Percentage of births for which mothers are postpartum amenorrheic, abstaining and insusceptible . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 xiii Figure 6.1 Figure 6.2 Figure 6.3 Figure 6.4 Figure 6.5 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8. I Figure 8.2 Figure 8.3 Figure 8.4 Fignre 8.5 Figure 8.6 Figure 9.1 Figure 10.1 Figure 10.2 Page Fertility preferences among currently married women age 15-49 . . . . . . . . . . . . . . . 91 Percentage of currently married women who want no more children by residence and region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Mean ideal number of children for all women by region . . . . . . . . . . . . . . . . . . . . . . 98 Currently married women by perceived consensus with husband regarding the number of children desired . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Currently ma~ied women whose desired number of children is the same as that perceived as desired by their husband . . . . . . . . . . . . . . . . . . . . . . . . . 102 Deaths among children under two years for three 5-year periods preceding the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Trends in infant mortality in the Philippines, various sources, 1970-1995 . . . . . . . 106 Infant mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Number of prenatal care visits and stage of pregnancy at first visit . . . . . . . . . . . . . 115 Knowledge of dangerous signs and symptoms during pregnancy among women who received prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Percentage of live births with complications during pregnancy . . . . . . . . . . . . . . . . 123 Distribution of live births by source of postnatal care . . . . . . . . . . . . . . . . . . . . . . . 127 Vaccination coverage among children 12-23 months . . . . . . . . . . . . . . . . . . . . . . . . 130 Feeding practices among children under five with diarrhea . . . . . . . . . . . . . . . . . . . 138 Distribution of children by breastfeeding (BF) status according to age . . . . . . . . . . 144 Sources of Anti-TB medicines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Percentage of households that utilized health facilities in the 6 months preceding the survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 xiv PREFACE The National Statistics Office (NSO) is pleased to present this final report on the 1998 National Demographic and Health Survey (NDHS). The survey is the seventh in a series of surveys conducted every five years since 1968 to measure trends in demographic and family planning indicators. It was implemented by the NSO in collaboration with the Department of Health. Fieldwork for the NDHS took place from early March to early May and covered a sample of over 12,000 households and 14,000 women of childbearing age. The successful completion of the 1998 NDHS was made possible by the joint efforts of a number of organizations and individuals whose pa~ieipation I would like to acknowledge with gratitude. First is the U.S. Agency for International Development (USAID)/Philippines which initiated planning for the survey and provided substantial financial assistance for the implementation of the sampling and data collection. The Department of Health (DOH), University of the Philippines Population Institute, Commission on Population and Food and Nutrition Research Institute collaborated on all stages of the survey, assisting in the design, field staff training, and fieldwork. DOH also provided financial assistance and participated in the analysis and production of this report. We would also like to thank the Demographic and Health Surveys program of Macro International Inc. in Maryland U.S.A. for providing technical assistance in all phases of the project. As part of its ongoing assistance to NSO in the design and implementation of a new master sample, the U.S. Bureau of the Census provided invaluable assistance in the design and selection of the NDHS sub-sample. The survey would not have gotten offthe ground without the exemplary, untiring efforts of the staff at the Household Statistics Department and at the NSO regional and provincial offices. They spent many long days, nights and weekends of overtime work to make this survey a success. Finally we are ever mindful of the generosity of our respondents in contributing their time and information to enable us to gather crucial data for our country's future planning. Manila, Philippines January 1999 TqMA ~ P. ~,FRICA Adm'l~istr~or National StatiStics Office XV PREFACE The Department of Health is proud to have been involved in the implementation of the 1998 National Demographic and Health Survey. The survey has provided much needed information that will be used in evaluating DOH programs and in planning future directions. In fact, there are few survey findings that do not have direct relevance to DOH programs. Data from the households interviewed concerning source of drinking water, type of toilet facility, and use of iodized salt are basic indicators of the home health environment. Data collected from individual women such as levels of contraceptive use, fertility and child mortality rates, and the extent of coverage of various reproductive health services will be used to assess progress in the relevant DOH programs. Regional-level indicators will point to the areas where more concentrated efforts are needed. Finally, the special health module that was added to the survey at the request of the DOH provides results of particular interest to DOH concerning health facility utilization, knowledge of the causes of various diseases, knowledge and use of traditional medicines, and health insurance coverage. I would like to thank the National Statistics Office for taking the lead in implementing the 1998 NDHS. I heartily support such collaborative efforts between government agencies because they result in a better product at lower cost. Perhaps more importantly, collaboration encourages a wider sense of ownership of the data and ensures its broader use. I hope that the future will hold more examples of such fruitful joint efforts. Manila, Philippines January 1999 A L B E R ~ J R . , M.D. Secretary Department of Health xvii SUMMARY OF FINDINGS The 1998 Philippines National Demographic and Health Survey (NDHS). is a nationally- representative survey of 13,983 women age 15-49. The NDHS was designed to provide information on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and maternal and child health. It was implemented by the National Statistics Office in collaboration with the Department of Health (DOH). Macro International Inc. of Calverton, Maryland provided technical assistance to the project, while financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. Fieldwork for the NDHS took place from early March to early May 1998. Survey data generally confirm patterns observed in the 1993 National Demographic Survey (NDS), showing increasing contraceptive use and declining fertility. FERT IL ITY Fertility Decline. The NDHS data indicate that fertility continues to decline gradually but steadily. At current levels, women will give birth an average of 3.7 children per woman during their reproductive years, a decline from the level of 4.1 recorded in the 1993 NDS. A total fertility rate of 3.7, however, is still considerably higher than the rates prevailing in neighboring Southeast Asian countries. Fertility Differentials. Survey data show that the large differential between urban and rural fertility levels is widening even further. While the total fertility rate in urban areas declined by about 15 percent over the last five years (from 3.5 to 3.0), the rate among rural women barely declined at all (from 4.8 to 4.7). Consequently, rural women give birth to almost two children more than urban women. Significant differences in fertility levels by region still exist. For example, fertility is more than twice as high in Eastern Visayas and Bicol Regions (with total fertility rates well over 5 births per woman) than in Metro Manila (with a rate of 2.5 births per woman). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 5.0 children in their lifetime, compared to 2.9 for women with at least some college education. Women with either elementary or high school education have intermediate fertility rates. Family Size Norms. One reason that fertility has not fallen more rapidly is that women in the Philippines still want moderately large families. Only one-third of women say they would ideally like to have one or two children, while another third state a desire for three children. The remaining third say they would choose four or more children. Overall, the mean ideal family size among all women is 3.2 children, identical to the mean found in 1993. Unplanned Fertility. Another reason for the relatively high fertility level is that unplanned pregnancies are still common in the Philippines. Overall, 45 percent of births in the five years prior to the survey were reported to be unplanned; 27 percent were mistimed (wanted later) and 18 percent were unwanted. If unwanted births could be eliminated altogether, the total fertility rate in the Philippines would be 2.7 births per woman instead of the actual level of 3.7. xix Age at First Birth. Fertility rates would be even higher if Filipino women did not have a pattem of late childbearing. The median age at first birth is 23 years in the Philippines, considerably higher than in most other countries. Another factor that holds down the overall level of fertility is the fact that about 9 or 10 percent of women never give birth, higher than the level of 3-4 percent found in most developing countries. FAMILY PLANNING Increasing Use of Contraception. A major cause of declining fertility in the Philippines has been the gradual but fairly steady increase in contraceptive use over the last three decades. The contraceptive prevalence rate has tripled since 1968, from 15 to 47 percent of married women. Although contraceptive use has increased since the 1993 NDS (from 40 to 47 percent of married women), comparison with the series of nationally representative Family Planning Surveys indicates that there has been a levelling-off in family planning use in recent years. Method Mix. Use of traditional methods of family planning has always accounted for a relatively high proportion of overall use in the Philippines, and data from the 1998 NDHS show the proportion holding steady at about 40 percent. The dominant changes in the "method mix" since 1993 have been an increase in use of injectables and traditional methods such as calendar rhythm and withdrawal and a decline in the proportions using female sterilization. Despite the decline in the latter, female sterilization still is the most widely used method, followed by the pill. Differentials in Family Planning Use. Differentials in current use of family planning in the 16 administrative regions of the country are large, ranging from 16 percent of married women in ARMM to 55 percent of those in Southern Mindanao and Central Luzon. Contraceptive use varies considerably by education of women. Only 15 percent of married women with no formal education are using a method, compared to half of those with some secondary school. The urban-rural gap in contraceptive use is moderate (51 vs. 42 percent, respectively). Knowledge of Contraception. Knowledge of contraceptive methods and supply sources has been almost universal in the Philippines for some time and the NDHS results indicate that 99 percent of currently married women age 15-49 have heard of at least one method of family planning. More than 9 in 10 married women know the pill, IUD, condom, and female sterilization, while about 8 in 10 have heard of injectables, male sterilization, rhythm, and withdrawal. Knowledge of injectables has increased far more than any other method, from 54 percent of married women in 1993 to 89 percent in 1998. Unmet Need for Family Planning. Unmet need for family planning services has declined since I993. Data from the 1993 NDS show that 26 percent of currently married women were in need of services, compared with 20 percent in the 1998 NDHS. A little under half of the unmet need is comprised of women who want to space their next birth, while just over half is for women who do not want any more children (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 47 percent to 70 percent of married women. Currently, about three-quarters of this "total demand" for family planning is being met. XX Discontinuation Rates. One challenge for the family planning program is to reduce the high levels of contraceptive discontinuation. NDHS data indicate that about 40 percent of contraceptive users in the Philippines stop using within 12 months of starting, almost one-third of whom stop because of an unwanted pregnancy (i.e., contraceptive failure). Discontinuation rates vary by method. Not surprisingly, the rates for the condom (60 percent), withdrawal (46 percent), and the pill (44 percent) are considerably higher than for the 1UD (14 percent). However, discontinuation rates for injectables are relatively high, considering that one dose is usually effective for three months. Fifty-two percent of injection users discontinue within one year of starting, a rate that is higher than for the pill. MATERNAL AND CHILD HEALTH Childhood Mortality. Survey results show that although the infant mortality rate remains unchanged, overall mortality of children under five has declined somewhat in recent years. Under-five mortality declined from 54 deaths per 1,000 births in 1988-92 to 48 for the period 1993-97. The infant mortality rate remained stable at about 35 per 1,000 births. Childhood Vaccination Coverage. The 1998 NDHS results show that 73 percent of children 12- 23 months are fully vaccinated by the date of the interview, almost identical to the level of 72 percent recorded in the 1993 NDS. When the data are restricted to vaccines received before the child's first birthday, however, only 65 percent of children age 12-23 months can be considered to be fully vaccinated. Childhood Health. The NDHS provides some data on childhood illness and treatment. Approximately one in four children under age five had a fever and 13 percent had respiratory illness in the two weeks before the survey. Of these, 58 percent were taken to a health facility for treatment. Seven percent of children under five were reported to have had diarrhea in the two weeks preceeding the survey. The fact that four-fifths of children with diarrhea received some type of oral rehydration therapy (fluid made from an ORS packet, recommended homemade fluid, or increased fluids) is encouraging. Breastfeeding Practices. Almost all Filipino babies (88 percent) are breastfed for some time, with a median duration of breastfeeding of 13 months. Although breastfeeding has beneficial effects on both the child and the mother, NDHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in the Philippines. For example, among newborns less than two months of age, 19 percent were already receiving supplemental foods or liquids other than water. Maternal Health Care. NDHS data point to several areas regarding maternal health care in which improvements could be made. Although most Filipino mothers (86 percent) receive prenatal care from a doctor, nurse, or midwife, tetanus toxoid coverage is far from universal and has been declining somewhat. The proportion of recent births for which the mother reported receiving two or more tetanus toxoid vaccinations during pregnancy declined from 42 in 1993 to 38 percent. Moreover, two-thirds of births in the Philippines are delivered at home; consequently only 56 percent receive asistance at delivery from a doctor, nurse, or midwife and 41 percent are assisted by traditional birth attendants. Proper medical attention during pregnancy and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the newborn. Somewhat more encouraging is the fact that for 75 percent of recent births, mothers reported having received iron tablets during pregnancy and in 57 percent of cases, they received iodine tablets during pregnancy. Maternal mortality has remained low at approximately 200 maternal deaths per 100,000 live births. xxi HOUSEHOLD HEALTH ISSUES Health Care ~inaneing. NDHS data indicate that in 40 percent of households, at least one member of the household belongs to a health care financing scheme or an insurance plan. Over 90 percent of such households belong to Medicare. Knowledge of Herbal Medieines. The Depar~nent of Health has endorsed 10 herbal medicines as being scientifically proven effective for treatment of specific illnesses and conditions. NDHS data show that although awareness of some of these herbs is widespread, knowledge about the specific uses of the herbs is quite limited. For example, although 81 percent of household respondents recognized ampalaya, only one in 20 know that it is useful in treating diabetes and only 6 percent of the 75 percent of respondents who are familiar with sambong correctly said that it is used as a diuretic. However, knowledge of bayabas is high; 97 percent of household respondents had heard of it and 81 percent know that it is used to clean wounds. Knowledge of Healthy Lifestyle. NDHS data indicate quite high general awareness regarding health issues. For example, most household respondents say that they watch their nutrition or exercise to stay healthy. Similarly, a majority of household respondents are aware that smoking causes lung diseases such as cancer. Over 90 percent of respondents have heard of dengue fever and two-thirds of them say that dengue can be prevented by destroying the breeding sites of mosquitos. However, misconceptions about leprosy and tuberculosis abound, with 21 percent of respondents knowing that leprosy is transmitted by skin and 11 percent by airborne droplets, and only one in six respondents knowing that tuberculosis is caused by a germ or bacteria. xxii PHIL IPP INES ,¢ .# CORDILLERA ADMINISTRATIVE I i REGION (OAR)\ CHINA SEA REGION I ILOCOS OAGAYAN VALLEY PACIFIC OCEAN REGIONIII CENTRAL LUZON REGION V REGION(NCR) SOUTHERN TAGALOG t f • ",o REGION VI WESTERN VISAYAS I OENTRAL VISAYAS It EASTERN VlSAYAS REGION O REGIONIX- WESTERN MINOANAO REGION Xll- OENTRAL, MINDANAO 6". / ~.~ o ; ~ AUTONOMOUS REGION • OF MUSLIM MINDANAO CELEBES SEA REGION XI SOUTHERN MINDANAO NORTHERN MINOANAO CHAPTER 1 INTRODUCTION 1.1 Background Demographic surveys are the primary source of data used in monitoring the progress and evaluating the impact of the population program of the country. The Philippine Population Program was officially launched in 1970. Since then, it has undergone many changes in its policy and program directions. In the beginning, the program was centered on fertility reduction and contraceptive distribution, using a clinic-based approach. In the 1970s, the family planning program shifted to a family welfare approach, adopting a combined clinic and community-based delivery approach. In the 1980s, the population policy was re-stated, calling for the broadening of population concerns beyond fertility reduction to cover family formation, the status of women, maternal and child health, morbidity and mortality, population distribution and urbanization, internal and international migration and population structure (POPCOM, 1997: p.1). The Philippine Population Management Program (PPMP) was developed in 1993 to supplant the Philippine Population Program (PNGOC, 1998: p 25.). The PPMP adopts the population, resources and environment (PRE) framework which defines the connection between population and sustainable development. Its overall goal is the improvement of quality of life by creating a favorable environment for achieving rational growth and distribution of population, defined in relation to resources and environment. In the years 1998 to 2003, the program aims at promoting the reproductive health approach in the implementation of population policies and programs. Specifically, the Philippine Family Planning Program (PFPP) will promote family planning within a comprehensive package of reproductive health services (POPCOM, 1997: p.17). The action agenda includes: 1) reducing unmet need for family planning services, 2) reducing incidence of high-risk pregnancies, 3) making available high-quality family planning serviees, 4) reducing abortion, and 5) increasing the participation and sharing of responsibility of men in the practice of family planning (POPCOM, 1997: p.19). The Department of Health (DOH) is the lead agency for the reproductive health and family planning component of the PPMP. The Commission on Population (POPCOM) is the coordinating body of the PPMP (POPCOM, 1997: p. 5-6). The 1998 National Demographic and Health Survey (NDHS) is the seventh in a series of demographic surveys taken at five-year intervals since 1968. It is a nationwide sample survey designed to collect information on fertility, family planning, and health in the Philippines. The 1998 NDHS was undertaken as part of the worldwide Demographic and Health Survey (DHS) program. "It was conducted by the National Statistics Office (NSO), in collaboration with the Department of Health (DOH). Macro International, Inc., which is based in Calverton, Maryland (USA), provided technical assistance to the project. The University of the Philippine Population Institute (UPPI), The Population Commission (POPCOM), the Food and Nutrition Research Institute (FNR1) and the DOH also provided technical inputs during the preparatory phase of the survey. Financial assistance was provided by the U.S. Agency for International Development (USAID) and the DOH. This report presents the findings from the 1998 NDHS regarding the principal topics covered in the survey, namely, fertility, family planning, infant and child mortality, infant feeding practices, maternal and child health, as well as general health. The NDHS data can be useful inputs for the implementation of some major program tasks of the government under the Philippine Population Management Program (PPMP). These data can be utilized for research activities aimed at improving program strategies. Together with data from previous demographic surveys, the survey ean serve as an instrument to monitor the progress and evaluate the impact of the PPMP. 1.2 Objectives of the Survey The primary objective of the NDHS is to PrOvide up-to-date information on fertility levels; determinants of fertility; fertility preferences; infant and childhood mortality levels; awareness, approval, and use of family planning methods; breastfeeding practices; and maternal and child health. This information is intended to assist policy makers and program managers in evaluating and designing programs and strategies for improving health and family planning services in the country. 1.3 Sample Design The 1998 NDHS aims at providing estimates for each of the sixteen regions of the country with an acceptable precision for socio-demographic characteristics like fertility, family planning use, and health and mortality indicators. The NDHS sample design consisted of selecting some 12,500 households in 755 enumeration areas (EAs) which was expected to produce completed interviews with approximately 15,000 women age 15-49. The sample was first allocated to each of the regions. Within each region, a self-weighting sampling scheme was adopted; however, due to the non-proportional allocation of the sample to the regions, the NDHS sample is not self-weighting at the national level and weighting factors have been applied to the data. The 1998 NDHS sample is a sub-sample of the new master sample of the Integrated Survey of Households (ISH) of the NSO. The expanded sample of ISH consists of 3,416 enumeration areas selected from the 1995 census frame with a sophisticated design that allows for regional estimates with periodic rotation of panels. The ISH expanded sample was drawn by first, selecting barangays systematically with probability proportional to size. In barangays that consist of more than one EA, a subsequent step consisted of selecting the sample Elk systematically with probability proportional to size. Because the primary sampling units in the ISH were selected with probability proportional to size, the EAs for the NDHS were sub-selected from the ISH with equal probability to make the NDHS selection equivalent to selection with probability proportional to size. A total of 755 primary sampling units were utilized for the NDHS. Fieldwork in three sample EA was not possible, so a total of 752 EAs Were covered. The list of households based on the household listing operation conducted in all the NDHS sample points in November 1997 served as the frame for the selection of the NDHS sample households. A different scheme for selecting sample households was applied to urban and rural areas. A systematic sampling of households was carried out in urban areas in order to spread the NDHS sample throughout the sampled EA, while compact clustering was employed in rural areas in order to facilitate field operations. This was accomplished by taking a specified number of consecutive households starting with a household selected at random. Detailed discussion of the 1998 NDHS sampling design is presented in Appendix A. Sampling errors can be found in Appendix B. 1.4 Questionnaires There were three types of questionnaires used for the 1998 NDHS: the Household Questionnaire 0xrDHS Form 1), the Individual Questionnaire (NDHS Form 2), and the Health Module (NDHS Form 3). The contents of the first two questionnaires were based on the DHS Model A Questionnaire, which is designed for use in countries with relatively high levels of contraceptive use. These model questionnaires were adapted for use in the Philippines during a series of meetings with representatives from the DOH, UPPI, POPCOM, FNRI, USAID/Philippines, and Macro International Inc. Draft questionnaires were then circulated to other interested groups. These questionnaires were developed in English (see Appendix E) and were translated into six of the most common dialects, namely, Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray. The Household (HH) Questionnaire was used to list all the usual members of the sample household, and visitors who slept in the sample household the night prior to the date of interview and some of their characteristics such as name, age, sex, education, relationship to household head, and usual residence. Information on age and sex from the HH Questionnaire was used to identify eligible women for interview using the Individual Questionnaire. Questions about the dwelling such as the source of drinking water, type of toilet facilities, ownership of various consumer goods and use of iodized were also included in the Household Questionnaire. The Individual Questionnaire was used to collect information on the following top!cs: • Background characteristics (age, education, religion, etc.) • Reproductive history and fertility preferences • Knowledge and use of contraception • Availability of family planning supplies and services • Breastfeeding and child health • Maternal mortality The Health Questionnaire was developed in close collaboration with the DOH in partial substitution for the cancelled National Health Survey, It included questions on health practice s of the household, awareness about selected communicable ~ind non-communicable diseases, utilization of and satisfaction with various types of health facilities, knowledge concerning traditional medicines, and health care financing. 1.5 Training and Fieldwork The NDHS questionnaires were pretested in October 1997. Female interviewers were trained at the NSO central office in Manila, after which they conducted interviews in various locations in the field under the observation of staff from NSO central office. Altogether, approximately 160 Household, Woman's and Health Questionnaires were completed. Based on observations in the field and suggestions made by the pretest field teams, revisions were made in the wording and translations of the questionnaires. Training for the main survey took place in two phases. In the first phase, approximately 35 trainers from NSO, DOH, UPPI, and POPCOM gathered for two weeks in late January at a training center near the NSO central office in Manila. They received thorough training in how to fill and edit the questionnaires, how to supervise fieldwork, and how to train field staff in their respective training sites. These trainers then dispersed to the six training sites (Agoo, Malolos, Lucena City, Cebu City, Iloilo City, and Davao City) where they trained some 261 interviewers, 44 supervisors, and 43 field editors for three weeks (February 9-27, 1998). Initially, training consisted of lectures on how to complete the questionnaires, with mock interviews between participants to gain practice in asking questions. Towards the end of the training course, the participants spent several days in practice interviewing in households near the training sites. Fieldwork for the NDHS was carried out by 44 interviewing teams. Each team, except that which covered Palawan, Lanao del Sur and Maguindanao, consisted of 1 supervisor, 1 field editor, and 3-7 female interviewers, for a total of 348 field staff. Fieldwork commenced on 3 March 1998 and was completed in the first week of May 1998. Periodic field monitoring of the NDHS operations was done by the NSO regional and provincial officials, NDHS regional supervisors and selected NSO central office staff. 1.6 Data Processing Review and editing of NDHS questionnaires was done by the field editors while they were in the enumeration areas to facilitate the verification of the forms. The editors were expected to review questionnaires of at least 8 households per day. The supervisors of teams with more than four interviewers assisted the editors in reviewing the questionnaires. Folioing of forms was done by the team supervisors before submission to the Provincial Office. The Provincial Statistics Officers were responsible for the transmittal of these forms to the Central Office. On March 16, 1998, eighteen hired NDHS data processors started the data processing at the Central Office. Office editing, data entry, key verification (100%), and machine processing were done simultaneously. There were two stages involved in the machine processing. In the first stage, keyed-in data were checked for completeness and were matched with the verification data. In the second stage, inconsistencies in the data were noted and checked. All the data processing activities were completed on June 30, 1998. 4 1.7 Response Rate Table 1 shows the response rates for the survey and reasons for non-response. A total of 13,708 households were selected for the sample, of which 12,567 were occupied. Of these households occupied, 99 percent or 12,407 were successfully interviewed. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants had le~ for an extended period at the time they were visited by the interviewing teams (see Appendix Table A.1 for details.) In the households interviewed, 14,390 women were identified as eligible for the individual interview (i.e. age 15-49) and interviews were completed for 13,983 or 97 percent of them. The principal reason for non-response among eligible women was the failure to find them at home despite repeated visits to the household. The refusal rate was low. Table 1 Sample results Number of households, number of interviews and response rates, Philippines 1998 Result Number Percent Households selected 13,708 100.0 Households occupied 12,567 91.6 Households absent for extended 202 1.5 period Dwelling vaeanffdestroyed 853 6.2 Householdsoceupied 12,567 100.0 Households interviewed 12,407 98.7 Households not interviewed 160 1.3 Eligible women 14,390 100.0 Women interviewed 13,983 97.2 Women not interviewed 407 2.8 Source: NSO, DOH and MI, 1998 NDHS 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 indicate the quality of the information collected and whether or not it is representtive of the population. 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 Age.Sex Composition The household questionnaire used in the 1998 National Demographic and Health Survey (NDHS) collected data on the demographic and social characteristics of the members and visitors in 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 hand, is someone who is not a usual resident of the household but slept in the household the night prior to the interview. In this report, except in Table 2.2 census figures, data are based on the population according to the place where they spent the night before the interview (de facto). Age reporting in the Philippines is relatively accurate. The present generation of residents, including those living in the rural areas, seems 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. Another indication of the quality of age reporting is the number of women age 15 and age 49 relative to those age 14 and 50. In some surveys, including the 1993 NDS, there was displacement of women from age 15 to age 14 and from age 49 to 50, probably done intentionally by the interviewers to reduce their assigned workload. The data in Table C.1 indicate that this was not a problem in the 1998 NDHS. The proportion of the population below 15 years is larger in rural than in urban areas, indicating a younger age structure of the rural population (Table 2.1). In urban areas, the proportion is, however, larger for males than for females but it differs little 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 pattern that is typical of high fertility societies. 7 900 800 700 600 500 400 300 200 t00 Figure 2.1 Single-year Age Distribution of the Household Population, by Sex, Philippines Number of Persons I I I I I I I l l I I I I 5 10 15 20 25 30 35 40 45 50 55 60 65 70 Age I--Male +Female ] 1998 NDH$ Table 2.1 Household votmlation by a~e. residence and sex Percent distribution of the de facto household population by five-year age groups, according to urban-rural residence and sex, Philippines 1998 Age Urban Rural Total group Male Female Total Male Fema!e Total Male Female Total. 0-4 13.1 10.8 11.9 14.9 13.9 14.4 14.0 12.3 13.2 5-9 12.1 11.1 11.6 15.0 15.0 15.0 13.6 13.0 13.3 10-14 11.2 10.4 10.8 13.2 13.1 13.2 12.2 11.7 12.0 15-19 11.2 11.6 11.4 10.1 8.9 9.5 10.7 10.3 10.5 20-24 9.7 9.3 9.5 6.8 6.7 6.7 8.2 8.0 8.1 25-29 8.6 8.8 8.7 6.6 6.7 6.7 7.6 7.8 7.7 30-34 7.4 7.8 7.6 6.5 6.5 6.5 6.9 7.2 7.0 35-39 6.4 6.6 6.5 5.8 6.1 5.9 6.1 6.4 6.2 40-.44 5.1 5.6 5.4 4.6 4.7 4.6 4.8 5,2 5.0 45.49 4.3 4.2 4.3 4.0 3.9 4.0 4.2 4.1 4.1 50-54 3.2 3.7 3.5 3.2 3.6 3.4 3.2 3.7 3.4 55-59 2.5 3.0 2.8 2.7 3.1 2.9 2.6 3.1 2.8 60-64 2.0 2.2 2.1 2.3 2.7 2.5 2.2 2.4 2.3 65-69 1.2 1.7 1.5 1.5 1.8 1.7 1.4 1.7 1,6 70-74 0.9 1.2 1.0 1.3 1.4 1.3 1.1 1.3 1.2 75-79 0.5 0,9 0,7 0,7 1,0 0,9 0.6 1.0 0.8 80+ 0.4 0.9 0.7 0.7 0.8 0.8 0.6 0.9 0.7 Missing/ 0.1 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Don't know Total 10O.0 100.0 100.0 100.0 100.0 100.0 100.0 100,0 100.0 Number ~ 14,707 15,585 30,300 15,273 14,784 30,057 29,980 30,369 60,357 lIncludes 8 cases with missing information on sex. 8 Age 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 Figure 2.2 Distribution of the Household Population by Age and Sex, Philippines 1998 El im Male ~ I ~ n ~ n :S i {i i i!I:iliI ~ }i i i!" ;!i!~ilI I i~!~ Yi ii!i iI Ii! ~:4i"ii'!~::!4 ' I I i, I 6 4 2 Percent Female I I I 2 4 6 8 1998 NDHS 2.2 Population by Age from Selected Sources In Table 2.2, the percent distribution of the population by broad age groups, according to the 1970, 1980, 1990 and 1995 Census of Population and the 1993 NDS and 1998 NDHS are presented. There appears to be a progressive decline since 1970 in the proportion Of the population under 15 and, concomitantly, an increase in the median age. The growing proportion in the 15-64 group results in a declining dependency ratio, defined as the ratio of persons in the "dependent" ages (under 15 and 65 and over) to those in the "economically active" ages (15-64). This slight aging 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 and 1998 NDHS data show fairly similar distributions by age, which supports the representativeness of the survey population. 2.3 Household Composition Information on the size and composition of the sample households by urban-rural residence is presented in Table 2.3. Women head about 15 percent of the households. As expected, a higher proportion of female-headed households is noted in urban areas (17 percent) than in rural areas (12 percent). On average, a household is composed of 5.1 persons, A negligible difference in average household size is observed between urban and rural areas. 9 Table 2.2 Median a~e and de~ndanev ratio Percent distribution of the household population by broad age groups for various census years and the NDHS. Philippines 1998 1970 1980 1990 1993 1995 1998 Ago group Census Census Census NDS Census NDHS Less than 15 45.7 42.0 39.5 39.3 38.4 38.5 15.,64 51.4 54.6 57.1 56.8 58.1 57.3 65+ 2.9 3.4 3.4 3.9 3.5 4.2 Total I00.0 100.0 100.0 10O.0 100.0 100.0 Median age 16 18 19 20.1 20 20.6 Dependency ratio 94.6 83.2 75.1 76.1 72.2 74.5 Table 2.3 Household comvosition Percent distribution of households by sex of head of household and household size. according to urban-rural residence. Philippines 1998 Residence Characteristic Urban Rural Total Household headship Male 83.1 87.9 85.5 Female 16.9 12.1 14.5 Total 100.0 100.0 100.0 Number~usual membe~ 1 3.8 4.3 4.1 2 8.0 9.1 8.6 3 12.6 13.8 13.2 4 18.1 16.6 17.3 5 19.6 17.7 18.6 6 14.3 14.3 14.3 7 9.4 10.3 9.9 8 6.0 6.1 6.0 9+ 8.3 7.7 8.0 Total 1~.0 100.0 100.0 Mean size of household 5.1 5.0 5.1 10 Figure 2.3 Median Years of Schooling by Sex and Region, Philippines 1998 Median Number Years 10 8 6 4 2 0 Region 1998 NDHS 2.4 Education Level of the Household Population Tables 2.4.1 and 2.4.2 present information on the highest level of education attended by the population according to sex, age, residence, and region. Education is highly valued by Filipino families. The constitution of the country reflects 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 does have some formal education. Among the population age 6 and over, only 4 percent have no formal education, and no more than 3 percent among those between the ages of 10 and 50 never attended school. Of both men and women, around half reached only as far as primary school, more than one in four attended high school, and one in five attended higher education. ~ No major gender differences are observed as far as education is concerned. However, a significant difference is noted in the educational level between urban and rural areas. The educational system appears to favor residents of urban areas. The distribution of the population by highest level of education attended differs greatly among the regions of the country (Figure 2.3). Metropolitan Manila has a much better educated population compared with the rest of the country; the median duration of schooling in this region is 9 years, compared with 5 or 6 years for the other regions. Residents of Autonomous Region in Muslim Mindanao have the lowest median duration of schooling. 1Comparisons with the 1993 NDS data are complicated slightly by the fact that the 1993 survey questions make it difficult to distinguish those who never attended school from those who attended but did not complete any grade. In practice, this affects only children who were currently in first grade. In 1993, such children were considered to have no education, while in 1998, they were categorized in elementary school. This accounts for the seemingly large decline between the two surveys in the proportion of 6-9 year olds with no education. 11 Table 2.4.1 Educational level of the male household oooulation 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 1998 Level of education Median College Don't Number number of Background Elemen- High or know/ of years of characteristic None tar/ school hig~her missin s Total males schooling Age l 6-9 16.3 83.0 0.0 0.0 0.6 100.0 3,247 0.1 10-14 1.6 84.2 13.9 0.1 0.2 100.0 3,670 3.8 15-19 1.1 27.2 60.2 11.4 0.1 10O.0 3,197 7.7 20-24 1,3 23,4 38,7 36,5 0,1 100.0 2,464 9,5 25-29 1.3 28.8 36.2 33.5 0.2 100.0 2,275 9.3 30-34 1.3 30.1 36.2 32.3 0.1 100.0 2,076 9.3 35-39 1.7 33.7 34.3 30.3 0.1 100.0 1,833 9.1 40-44 2.0 37.7 33.4 26.8 0.1 I00.0 1.444 8.6 45-49 3.0 43.2 30.1 23.8 0.0 100.0 1,255 7.2 50-54 3.3 52.2 21.5 22.8 0.2 100.0 957 5.8 55-59 4.5 57.0 19.2 18.7 0.5 100.0 778 5.5 60-64 5.2 57.1 22.7 15.0 0.1 I00.0 655 5.5 65+ 11.6 59.8 14.5 13.7 0.4 100.0 1,096 4.5 Residence Urban 2.3 37.4 32.9 27.2 0.2 100.0 12,444 8.0 Rural 6.0 60.2 24.2 9.3 0.3 100.0 12,512 5.1 Region Metro Manila 1.4 27.6 35.0 35.7 0.4 I00.0 3,760 9.4 Cordillera Admin. 6.6 51.9 24.6 16.5 0.4 100.0 436 5.3 Ilocos 4.3 44.6 34.2 16.6 0.3 100.0 1,385 6.3 Cagayan Valley 4.8 54.2 25.9 14.9 0.2 100.0 966 5.5 C. Luzon 2.7 45.1 35.6 16.5 0.1 100.0 2,553 6.5 S. Tagalog 2.8 47.2 30.0 19.7 0.3 100.0 3,468 6.0 Bieol 3.0 61.2 25.2 10.4 0.2 100.0 1,481 5.4 W. Visayas 3.4 55.8 24.3 16.4 0.1 100.0 2,013 5.3 C. Visayas 4.0 57.3 24.0 14.6 0.2 100.0 1,899 5.3 E. Visayas 6.0 65.4 19.3 9.0 0.3 100.0 1,242 4.1 W. Mindanao 9.0 54.1 21.3 15.5 0.1 100.0 995 5.0 N. Mindanao 3.7 56.1 26.6 13.4 0.1 100.0 882 5.3 S. Mindanao 4.4 50.9 30.3 14.4 0.0 100.0 1,662 5.6 C. Mindanao 4.2 55.4 24.9 15.1 0.4 100.0 854 5.4 ARMM 25.3 46.4 16.6 10.6 1.0 100.0 707 2.8 Caraga 2.3 58.7 27.6 11.2 0.3 100.0 653 5.2 Total 4.2 48.8 28.5 18.2 0.2 100.0 24r956 5.8 ~Excludes 9 men with missing age. 12 Table 2.4.2 Educational level of the female household aooulatigll Percent distribution of the de facto female household population age six and over by highest level of education attended, according to selected background characteristics, Philippines 1998 Level of education Median College Don't Number number of Background Elemen- High or know/ of years of characteristic None tary school hig~her missin~ Total females schooling Age 1 6-9 12.8 86.2 0.2 0.0 0.7 100.0 3,128 0.3 10-14 1.1 81.3 17.4 0.0 0.2 100.0 3,563 4.3 15-19 0.9 16.7 65.9 16.4 0.1 100.0 3,113 8.4 20-24 1.3 17.3 40.5 40.7 0.1 100.0 2,440 9.7 25-29 2.0 21.8 40.0 36.1 0.0 100.0 2,375 9.5 30-34 1.6 27.3 36.5 34.4 0.2 1120.0 2,177 9.3 35-39 2.1 33.7 32.2 31.8 0.2 100.0 1,933 9.1 40-44 2.8 37.8 30.5 28.8 0.0 100.0 1,568 7.9 45-49 3.1 45.8 24.7 26.4 0.0 100.0 1,240 6.5 50-54 5.5 55.1 17.5 21.7 0.2 100.0 1,120 5.7 55-59 5.4 60.0 18.9 15.5 0.1 100.0 931 5.5 60-64 8.0 61.6 19.8 10.2 0.4 100.0 739 5.2 65+ 15.9 63.4 10.0 10.1 0.5 100.0 1,460 3.7 Residence Urban 2.3 37.1 32.6 27.8 0.2 100.0 13,541 8.0 Rural 6.5 57.1 25.1 11.1 0.3 100.0 12,255 5.3 Region Metro Manila 0.9 29.2 36.8 32.5 0.5 100.0 4,386 9.2 Cordillera Admin. 9.1 48.2 25.7 16.7 0.2 100.0 412 5.5 linens 3.8 46.4 30.7 18.9 0.1 100.0 1,356 6.1 Cagayan Valley 4,5 54,1 23,9 17,4 0,1 100,0 926 5,6 C. Luzon 2.3 47.1 31.4 19.1 0.1 100.0 2,582 6.2 S. Tagalog 2.7 47.5 29.0 20.6 0.1 100.0 3,609 6.0 Bicol 3.5 58.6 24.8 12.8 0.2 100.0 1,477 5.5 W. Visayas 3.7 50.2 26.5 19.4 0.1 100.0 2,060 5.8 C. Visayas 3.9 52.4 28.0 15.6 0.2 100.0 2,050 5.6 E. Visayas 6.7 61.7 20.6 10.7 0.3 100.0 1,211 5.0 W. Mindanao 9.7 49.6 24.9 15.3 0.4 100.0 979 5.3 N. Mindanao 3.5 51.9 28.6 15.9 0.1 100.0 907 5.7 S. Mindanao 4.8 46.0 30.3 18.9 0.1 100.0 1,651 6.0 C. Miedanan 6.4 45.4 29.6 18.4 0.3 100.0 825 5.9 ARMM 30.4 41.4 16.2 10.8 1.2 100.0 715 2.5 Caraga 2.8 56.5 26.1 14.3 0.3 100.0 649 5.5 Total 4.3 46.6 29.0 19.8 0.2 100.0 25r796 6.0 1Excludes 8 women with age missing. 13 2.5 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. More than eight out of ten person's age 6 to 10 and age 11 to 15 are attending school. Between the ages of 16 and 20, the proportion of those actually enrolled diminishes significantly. Economic reasons possibly pull youth from the school system into the job market. The probability of being in school is fairly equal for the male and female populations in urban areas except at ages 21 to 24, when men are more likely to be enrolled than women. In 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 needed more to help on the farm. Table 2.5 School enrollment Percentage of the de facto household population age 6-24 years enrolled in school by age group, sex, and urban-rural residence, Philippines 1998 Male Female Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 6-10 86.8 76.4 81.0 90.2 80.4 84.7 88.5 78,3 82.8 11-15 89.5 78.7 83.6 90.7 88.7 89.7 90.1 83,6 86.6 6-15 88.1 77.5 82.2 90.5 84.2 87.0 89.3 80.8 84.6 16-20 57.2 41.4 49.9 55.1 49.7 52.9 56.1 45.1 51.4 21-24 18.1 10.1 14.8 12.0 9.8 11.1 15.1 10.0 13.0 2.6 Housing Conveniences Table 2.6 and Figure 2.4 show the distribution of households with selected housing conveniences by urban-rural residence. The information on the source of water, type of sanitation 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. Seven out of ten households have electricity. However, a significant difference was noted between urban and rural areas; 91 percent of urban households have electricity compared with only half (51 percent) of rural households (Figure 2.4). Almost half of the households have piped water (48 percent) and most of these have water piped into the residence (piped into dwelling or yard/plot). Again, a significant difference is noted between urban and rural areas. In urban areas, two out of three households have piped water, compared with only one out three households in rural areas. Wells and springs are among the main sources of water in rural areas; far fewer households in urban areas get their water from these sources. The vast majority of urban and rural households live within 15 minutes of a source of water. 14 Table 2.6 Housinz conveniences Percent distribution of households by housing eonvefftance, according to urban.rural rcs'tdene¢, Philippines 1998 Housing Residence characteristic Urban Rural Total Electricity Yes 91.1 51.9 71.3 No 8.8 47.9 28.5 Missing 0.1 0.2 0.1 Total 100.0 100.0 I00.0 Source of drinking water Piped into dwelling 46.6 14.0 30.2 Piped into yard/plot 7.8 5.4 6.6 Piped into public yard l 1.4 11.7 11.6 Protected well 24.8 40.0 32.5 Unprotected well 1.9 11.2 6.6 Developed/undeveloped spring 1.9 15.0 8.5 River/stream/Fond/lake~rainwater 0.5 1.5 1.1 Tanker truck/peddler 3.3 0.9 2.1 Bottled water 1.6 0.0 0.8 Other 0.1 0.1 0.1 Total 100.0 1130.0 100,0 Time to get to water source Within 15 minutes 92.7 79.8 86.2 Median time (minutes) 0.0 2.9 0.0 Sanitation facility Own flush toilet 71.1 48.1 59.5 Shared flush toilet 16.3 12.1 14.2 Closed pit latrine 4,9 9.6 7.3 Open pit latrine 2.4 9.7 6.1 No facilities/field 3.6 17.0 10,3 Drop/overhang 1.4 2.9 2.1 Other 0.0 0.1 0.1 Missing 0.4 0.5 0.4 Total 100.0 100.0 100.0 Flooring Earth/sand 4.3 12.8 8,6 Wood planks 13.2 16.4 14.8 Palnv'bamboo 8.7 29.8 19.3 Parquet/polished wood 1.1 1.2 1.1 Vinyl/asphalt strips 1.7 0.3 1.0 Ceramic tiles 4.8 0.9 2.8 Cement 61.0 37.5 49.1 Marble 4.9 0.9 2.9 Missing 0.3 0.2 0.2 Total 100.0 100.0 100.0 Persons per sleeping room 1-2 57.9 48.0 52.9 3-4 29.1 32.7 30.9 5-6 9.6 12.9 11.3 7+ 3.0 6.0 4.5 Missing/Don't know 0.4 0.3 0.4 Total 100.0 100.0 100.0 Mean persons per room 2.8 3.2 3.0 Iodized salt Iodized 15.4 6.4 10.9 Not iodized 77.5 86.7 82.2 Missing 7.1 6.9 7.0 Total 100.0 100.0 100.0 Number of households 6,151 6,256 12,407 15 The majority of households (81 percent) have either a flush toilet or a closed pit latrine. The proportion is much higher in urban (92 percent) than in rural areas (70 percent). A large proportion (17 percent) of rural households have no toilet facility. As to the type of flooring material, half of the households have cement floors and one in five have palm or bamboo floors. Urban households are more likely to use cement than rural households (61 and 38 percent, respectively). About 15 percent of households in both urban and rural areas have wood plank floors. 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 urban and rural households in this respect. Lack of a sufficient amount of iodine in the diet can lead to serious nutritional deficiencies such as goiter, nutritional stunting, mental retardation, and cretinism. To prevent these health problems, iodine is routinely added to salt in many countries. In order to evaluate the extent of use of iodized salt in the Philippines, NDHS interviewers tested samples of salt used in the households surveyed. The test involved placing a drop of a special solution on to a small amount of salt supplied by the household respondent. The test indicates the presence of iodine in the salt, but not its quality, which is subject to degradation. Test kits were supplied by UNICEF/Philippines. Results show that only about 10 percent of households in the Philippines utilize iodized salt. Use of iodized salt is higher among urban than rural households. Percent Figure 2.4 Housing Conveniences by Residence, Philippines 1998 100 80 60 40 20 0 E(ectdcity Water piped into dwelling/yard for drinking Own/shared flush toUet I IUrban mRural ~Total I Cement flooring 1998 NDHS 16 2.7 Presence of Durable Goods in the Household The percentage of households owning specific consumer durable goods by urban-rural residence is presented in Table 2.7. Among the durable consumer goods, radio and television are available in 80 percent and 56 percent of households, respectively. Two out of five households own a refrigerator while one out of four report owning a bicycle. Table 2.7 Household durable ~oods Percentage of households possessing residence, Philippines 1998 specific durable consumer goods, by urban-rural Residence Durable ~oods Urban Rural Total Radio 86.0 73.8 79.8 Television 77.2 35.8 56.3 Telephone 28.7 3.1 15.8 Refr/geraCor 56.8 19.5 38.0 Bicycle 27.0 21.2 24.1 Motorcycle 13.1 8.8 10.9 Private car 17.6 3.7 10.6 Boat 2.2 3.7 2.9 Tractor 0.9 1.8 1.4 None of the above 7.3 20.2 13.8 Number of households 6,151 6,256 12,407 The proportion of households with such appliances varies greatly between urban and rural areas. Almost nine out of ten urban households report having a radio, compared to three out of four rural households. About 77 percent of urban households report having a television, compared to only 36 percent of rural households. A majority of urban households have a refrigerator, compared to only one out of five rural households. Urban households are more likely than rural households to own some means of transportation (a bicycle, motorcycle, or private car). There has been an increase since 1993 in the ownership of durable goods. For example, the proportion of households with a television increased from 43 percent in 1993 to 56 percent in 1998. Over the same period, the proportion of households owning a refrigerator increased from 28 to 38 percent NSO and MI, 1994: 19). 2.8 Background Characteristics of Respondents In the household questionnaire, a total of 14,390 women were identified as eligible for interview with the NDHS individual questionnaire. Of these women, 13,983 or 97 percent were successfully interviewed. In each age group, the proportion of women interviewed was about the same. Table 2.8.1 shows the distribution of women in the NDHS sample by selected background characteristics. More than half (53 percent) of the women interviewed in the survey are under age 30. Married women comprise 53 percent of the total women interviewed, while never-married women 17 constitute just over one-third. An additional 6 percent of women are living with a manJ Almost all of the women who were interviewed have had some formal education. Almost three out of ten women interviewed are in college or are college graduates, and a large proportion (42 percent) have attended high school. Roman Catholicism is the predominant religion (82 percent). With respect to ethnicity, Tagalog and Cebuano groups combined comprise more than half of the respondents. Table 2.8.2 shows that there are more respondents from urban areas than from rural areas. One out of five respondents (20 percent) is from the Metropolitan Manila area, I0 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 respondents. Visayas and Mindanao (including ARMM and Caraga) have 19 and 22 percent of the respondents, respectively. 2.9 Education Level of Respondents 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 do. About 80 percent of women age 15 to 24 years have attended at least secondary level of education, compared with less than 60 percent of women age 40 and older. As expected, women in urban areas are better educated than women in rural areas. Over 80 percent of urban women have attended at least secondary school compared to only 60 percent of mral women. Women in Metropolitan Manila, Ilocos, Central Luzon, Southem Mindanao, Western Visayas, Central Mindanao and Southern Tagalog are better educated than in other regions. More than 70 percent of the women in these regions have secondary or higher education. On the other hand, ARMM and Eastern Visayas have the lowest proportion of women with secondary or higher education at 44 and 53 percent, respectively. 2.10 Exposure to Mass Media Presented in Table 2.10 is the percentage of respondents who were exposed to different types of mass media by age, education level, urban-rural residence and region. The table shows that eight out of ten women listen to the radio every day. A similar number watch television at least once a week, while almost two in three women read newspapers at least once a week. 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 education are more likely to have been exposed to mass media. Between urban and rural areas, the proportion differs for those who read newspapers and watch television but not for those who listen to the radio. lIn this report, women who are living together with a man are considered as currently married. 18 Table 2.8.1 Baekm'ound characteristics of resnondents Percent distribution of women by selected background characteristics, Philippines 1998 Number of women Background Weighted Weighted Unweighted characteristic percent number number Age 15-19 20.9 2,924 2,949 20-24 16,4 2,299 2,241 25-29 15.8 2,209 2,166 30-34 14.7 2,058 2,058 35-39 13,2 1,842 1,876 40-44 10,6 1,480 1,478 45-49 8,4 1,170 1,215 Marital status Never married 36.4 5,087 4,822 Married 53.4 7,467 7,824 Living together 6.2 869 810 Widowed 1,7 241 242 Divorced 0,0 4 8 Separated 2.3 315 277 Education No education 1,5 217 366 Elementary 26,2 3,664 4,010 High school 42.3 5,916 5,718 College or higher 29.9 4,186 3,889 Religion Catholic 82.0 11,465 10,857 Protestant 6.7 942 1,023 lglesia ni Kristo 3.0 413 355 Aglipay 1,3 186 206 Islam 4,1 572 1,073 Other 2.8 391 446 None 0,0 5 9 Missing 0,1 10 14 Ethnicity Tagalog 29.8 4,164 2,596 Cebuano 24.0 3,358 4,092 Ilocaao 9.0 1,259 1,444 llonggo 10.1 1,408 1,273 Bicolano 5,8 814 739 Waray 3.7 513 577 Kapampangan 3.2 447 297 Other 14.4 2,014 2,954 Missing 0.0 6 11 Total 100.0 13,983 13,983 19 Table 2.8.2 Background characteristics of respondents: residence and region Percent distribution of women by residence and region, Philippines 1998 Number of women Background Weighted Weighted Unweighted characteristic percent number number Residence Urban 56.6 7,911 6,730 Rural 43.4 6,072 7,253 Region Metro Manila 20.2 2,818 1.490 Cordillera Admin. 1.5 207 589 llocos 4.9 689 709 Cagayan Valley 3.4 474 717 C. Luzon 10,1 1,414 953 S. Tagalog 13.7 1,917 1,181 Bicol 5.0 703 745 W. Visayas 7.5 1,045 882 C. Visayas 7.8 1,093 993 E. Visayas 4.0 553 770 W. Mindanao 3.8 530 973 N. Mindanao 3.4 482 781 S. Mindanao 6.6 925 985 C. Mindanao 3.0 425 682 ARMM 2.8 385 810 Caraga 2.3 323 723 Total 100.0 13,983 13,983 Figure 2.5 Distribution of Respondents by Religion and Ethnicity Protestant Agilpay Islam Igles~an~ Other 7% 1% 4% Kristo Catholic 82% RELIGION 3u% Ilocano Other 9% 4Ao, beouano 24% ETHNICITY ~ampangan 3% Ilonggo 10% Waray 4% 1998 NDHS 20 Table 2.9 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Philippines 1998 Level ofeducation Background No High College or Number characteristic education Elementary school higher Total of women Age 15-19 0,5 16.1 67,1 16,3 100.0 2,924 20.24 0.8 17.4 41.2 40.6 I00,0 2,299 25-29 1.9 21.9 40.5 35.8 100.0 2,209 30-34 1.4 27.4 37.5 33.8 100,0 2,058 35-39 2.0 33.9 32.8 31.3 100,0 1,842 40.44 2.7 38.5 30.6 28.2 100.0 1,480 45,-49 3.0 47.2 24.4 25.4 100,0 1,170 Residence Urban 0.6 17.5 43.7 38.3 100,0 7,911 Rural 2.8 37.6 40.5 19.1 100,0 6,072 Region Metro Manila 0.4 13.2 46.5 39.9 100,0 2,818 Cordillera Admin. 3.1 28.7 39.7 28.5 100,0 207 Ilocos 0.1 22.8 46.3 30.7 100.0 689 Cagayan Valley 1.4 33.9 36.0 28.7 100,0 474 C. Luzon 0.2 24.6 45.0 30.2 I00,0 1,414 S. Tagalog 0.5 25.3 42.1 32.1 100.0 1,917 Bicol 0.5 36.9 40.7 21.9 100.0 703 W. Visayas 0.3 29.4 40.7 29.6 100,0 1,045 C. Visayas 0.8 33.2 42.0 24.0 100,0 1,093 E. Visayas 0.8 46.0 35.1 18.2 100.0 553 W. Mindanao 5.8 33.5 36.3 24.5 100,0 530 N. Mindanao 0.3 33.7 41.1 25.0 I00,0 482 S. Mindanao 1.8 25.1 44.2 28.9 100,0 925 C. Mindanao 2.3 22.6 45.6 29.5 100,0 425 ARMM 25.6 30.6 26.0 17.8 100,0 385 Caraga 0.4 34.6 41.4 23.7 100,0 323 Total 1.5 26.2 42.3 29.9 100.0 13,983 21 Table 2.10 Exuosure to mass media Percent distribution of women who usually read a newspaper once a week, watch television once a week, or listen to a radio dally, by background characteristics, Philippines 1998 Read Watch Listen to Background No mass newspaper television radio All three Number characteristic media weekly weekly dally media of women Age 15-19 2,9 70.8 85.8 83.1 57.0 2,924 20-24 3,5 69.0 82.4 81.8 54,1 2,299 25-29 4.5 63.2 78.7 80.0 47.5 2,209 30-34 6.0 58.2 78.8 76.8 43.4 2,058 35-39 6.9 57.5 75.5 77.5 43.4 1,842 40-44 6.3 58.5 76.5 76.9 45.0 1,480 45-49 6.6 53.9 74.2 76.9 40.1 1,170 Residence Urban 1,9 72.9 91.6 80.3 58.9 7,911 Rural 8.9 50.1 64.3 78.5 35.0 6,072 Region Metro Manila 0.7 82.1 95.8 78.9 66.0 2,818 Cordillera Adrnin. 15.4 49.9 50.1 74.0 32.8 207 nocos 2.8 70.7 86.5 91.8 65.0 689 Cagayan Valley 7.4 59.1 64.3 79.4 39.3 474 C. Luzon 1,2 66.9 92.9 80.5 53.3 1,414 S. Tagalog 3.0 67.2 84.6 80.2 52.4 1,917 Bicol 8.1 45.0 60.1 79.5 29.0 703 W. Visayas 2.3 69.3 82.3 86.1 54.9 1,045 C. Visayas 5.6 49.4 71.7 78.1 34.5 1,093 E, Visayas 7,3 49.5 65.8 79,1 36.0 553 W. Mindanao 13.8 52.2 58.1 79.7 38.2 530 N. Mindanao 10.8 43.9 67.6 73.6 31.8 482 S. Mindanao 4.2 50.8 83.0 74.9 37.4 925 C. Mindanao 4.0 63.8 77.7 84.0 49.7 425 ARMM 31.5 34.4 28.4 60.6 18.0 385 Caraga 5.9 53.8 75.8 78.7 40.4 323 EdueaUon No education 42.6 2.6 20.1 53.6 1.8 217 Elementary 10.4 39.1 61.7 73.3 25.1 3,664 High school 2.9 64.9 84.3 81.2 50.5 5,916 College or higher 1.0 84.4 92.2 84.0 68.8 4,186 Total 4.9 63.0 79.8 79.6 48.5 13,983 22 2.11 Employment In the 1998 NDHS, respondents were asked if they worked, aside from doing their housework, regardless of whether they were paid or not. Table 2.11 shows that a majority of women (55 percent) were engaged in an economic activity in the last 12 months. Older women, women in urban areas and women with some college education or college degree are more likely to have been employed. For example, the proportion of women 30 years old and older who worked in the last year is about 65 percent, while for women in their 20s the proportion is 56 percent or lower. The smaller proportion of young women who work, especially those below 20 years, may be related to the practice of letting college-age children study full-time. By residence, six out of ten women in urban areas were engaged in an economic activity in the last 12 months compared with only one-half of rural women. Across regions, more than 60 percent of women in Western Visayas, Southern Mindanao and Metro Manila were engaged in an economic activity in the 12 months preceding the survey. Only one out of 3 women worked in ARMM. Table 2.12 shows that three out of five employed women are self-employed. It is interesting to note that self-employed women tend to be younger, live in the urban areas, and have higher educational attainment. In all regions except Ilocos, Eastern Visayas, Northern Mindanao, Central Mindanao, CAR and ARMM, self-employed women comprise a majority of the employed women. Almost one out of three employed women work for others. Ninety-five percent of working women earn cash for their work (data not shown). 2.12 Occupation Table 2.13 presents the percent distribution of currently employed women by occupation, according to selected background characteristics. The majority of the women work in sales and services (53 percent). One out of five women who work are in professional and technical occupations. Only about 11 percent of women work in agriculture. Sales and service occupations are the most popular among all groups, except those with no education who are more likely to be working in agriculture and those with college, who tend to be employed in professional occupations. The regional differentials show that in most regions, about half of employed women work in sales and services occupations. In Cagayan Valley, CAR and ARMM, at least one-third of working women are engaged in agricultural occupations. Central Luzon, Southern Tagalog and Central Visayas have more than 20 percent of its employed women in skilled manual occupations. 23 Table 2.11 Emdiovment status Percent distribution of women by employment status in the last 12 months, according to background characteristics, Philippines 1998 Not currently employed Currently employed Did not work in Worked Number Background last 12 in last 12 Season- Occasion- of characteristic months months All year all}' ally Missing Total women Age 15-19 69,2 7.5 12.1 9.1 2.0 0.2 100.0 2,924 20-24 44.3 12.1 30.6 11.0 1.9 0.1 100.0 2.299 25-29 43,5 10.4 35.9 7.1 3.0 0.1 100.0 2,209 30-34 37,5 8.0 41.3 9.8 3.3 0.1 100.0 2,058 35-39 35,7 7.4 ,:14.0 8.9 3.8 0.3 100.0 1,842 40-44 34.6 5.6 47.4 8.3 3.9 0.2 100.0 1.480 45-49 34,4 5.1 48.5 8.6 3.5 0.0 100,0 1,170 Residence Urban 40,4 7.3 40.7 9.0 2.4 0.1 100.0 7.911 Rural 51,8 9.7 25.7 9.1 3.5 0.2 100.0 6,072 Region Metro Manila 36,4 6.9 43.0 11.4 2.1 0.1 100.0 2,818 Cordillera Admin. 44.5 7.3 31.9 9.7 6.6 0.0 100.0 207 llocos 50,5 9.4 29.1 8.0 2.4 0.6 100.0 689 Cagayan Valley 53,7 5.7 24.4 11.4 4.6 0.1 100.0 474 C. Luzon 50.6 7.0 34.7 5.1 2.3 0.3 100.0 1.414 S. Tagalog 45,6 7.0 37.2 7.2 3.0 0.1 100.0 1,917 Bieol 58,7 10.9 19.6 6.7 4.2 0.0 100.0 703 W. Visayas 38,8 15.1 31.4 10.4 4.3 0.0 100.0 1.045 C. Visayas 42.8 7.2 38.9 9.0 1.8 0.3 100.0 1,093 E. Visayas 44,7 12.5 30.0 8.1 4.8 0.0 100.0 553 W. Mindanao 63,4 5.9 22.7 6.3 1.6 0.1 100.0 530 N. Mindanao 44~3 8.6 33.7 10,8 2.6 0.1 100.0 482 S. Mindanao 36,3 11.4 35.7 13.4 3.1 0.1 100.0 925 C. Mindanao 50,6 6.9 28.5 10.0 3.8 0.1 100.0 425 ARMM 66.8 3.7 22.4 5.7 1.1 0.4 100.0 385 Caraga 45,2 10.I 32.4 9.1 3.2 0.0 100.0 323 Education No education 58.9 5.7 22.2 9.9 3.4 0.0 100.0 217 Elementary 43.0 8.3 32.1 12.1 4.5 0.1 100.0 3,664 High school 51.7 9.1 27.2 9.0 2.9 0,2 100.0 5,916 College or higher 37.9 7.6 46.3 6.4 1.4 0.2 100.0 4,186 Total 45,4 8.4 34.2 9.0 2.9 0.1 1130.0 13,983 24 Table 2.12 Tvne of emolover Percent distribution of currently employed women by employer, according to background characteristics, Philippines 1998 Employer Number Background Self- Works for Works for of characteristic employed others relative Missing Total women Age 15-19 79.0 8.1 12.6 0.3 100.0 679 20-24 77.3 14.6 7.2 0.9 100.0 999 25-29 62.0 29.7 7.9 0.3 100.0 1,016 30-34 52.2 39.0 8.4 0.4 100.0 1,118 35-39 52.9 39.3 7.5 0.2 100.0 1,045 40-44 48.5 43.5 7.8 0.2 100.0 882 45-49 42.4 49.1 8.5 0.0 100.0 708 Residence Urban 66.2 26.2 7.2 0.3 100.0 4,127 Rural 46.2 43.1 10.3 0.4 100.0 2,322 Region Metro Manila 74.1 18.5 7.0 0.4 100.0 1,595 Cordillera Adrniu. 42.9 47.9 9.2 0.0 100.0 100 Ilucus 47.3 41.3 11.0 0.4 100.0 273 Cagayan Valley 55.5 25.5 18.9 0.0 100.0 192 C. Luzon 56.6 34.9 7.4 1.0 100.0 595 S. Tagalog 62.1 29.4 8.3 0.4 100.0 907 Eicol 51.1 40.6 7.9 0.4 100.0 214 W. Visayas 56.5 35.4 8.2 0.0 I00.0 482 C. Visayas 61,0 34.3 4.4 0.2 100.0 545 E. Visayas 41.8 50.3 7,5 0~3 100.0 237 W. Mindanao 54.4 38.9 6.7 0.0 100.0 162 N. Mindanao 45.2 45.2 9.3 0.3 100.0 227 S. Mindanao 53.5 37.9 8.3 0.2 100.0 483 C. Mindanao 46.0 35.0 19.1 0.0 100.0 180 ARMM 22.3 59.1 18.2 0.4 100.0 113 Caraga 50.1 43.3 5.3 1.2 100.0 144 Education No education 26.9 54.6 18.5 0.0 100.0 77 Elementary 49.7 40.5 9.5 0.3 100.0 1,786 High school 57.0 34.6 8.0 0.5 100.0 2,314 College or higher 69A 22.9 7,6 0,3 100.0 2,271 Total 59.0 32.3 8.4 0.3 I00.0 6,448 25 Table 2.13 Occuoation Percent distribution of currently employed women by occupation and type of agricultural land worked or type of non-agricultural employment, according to background characteristics, Philippines 1998 Agricultural Non-agricultural Background Own Family Rented Other's Prof., Sales, Skilled Don't Number characteristic land land land land Tech. services manual know Total of women Age 15-19 0.5 1.8 0.2 4.5 5.5 75.4 10.9 1.1 100.0 679 20-24 1.0 1.3 0.3 2.8 26.7 51.7 15.7 0.6 100.0 999 25-29 1.9 1.8 0.4 4.0 30.3 49.l 11.8 0.6 100.0 1,016 30-34 2.7 2.1 0.6 6.6 23.8 50.1 13.3 0.9 100.0 1, I 18 35-39 2.0 2.2 0.5 8.5 23.8 48.2 13.9 0.8 100.0 1,045 40M4 2.7 2.7 0.7 7.3 20.8 53.3 11.2 1.2 100.0 882 45-49 3.9 2.7 1.4 10.9 17.8 50.4 11.9 1.0 I00.0 708 Residence Urban 0.3 0.5 0.I 1.9 26.4 57.7 12.3 0.7 100.0 4,127 Rural 5.2 4.8 1.5 14.0 15.1 44.7 13.7 1.0 100.0 2,322 Region Metro Manila 0.0 0.0 0.0 0.2 27.8 61.8 10.0 0.2 100.0 1,595 Cordillera Admin. 10.9 7.0 1.4 14.1 13.7 38.7 13.0 1.1 100.0 100 nocos 2.1 3.9 1.8 13.2 19.2 48.0 11.4 0.4 100.0 273 Cagayan Valley 12.8 6.2 0.7 16.2 20.7 41.4 1.4 0.7 100.0 192 C. Luzon 0.7 0.2 0.0 6.5 20.0 48.6 23.9 0.0 100.0 595 S. Tagalog 1.4 1.1 0.0 4.3 23.8 47.6 21.1 0.7 100.0 907 Bicol 1.8 1.8 0.0 5.7 17.6 54.6 16.7 1.8 100.0 214 W. Visayas 1.7 2.5 0.7 11.8 18.7 53.8 6.9 3.9 100.0 482 C. Visayas 1.6 1.6 0.0 3.8 20.6 49.1 22.8 0.4 100.0 545 E. Visayas 4.2 4.5 4.5 9.1 17.0 53.6 7.0 0.0 I00.0 237 W. Mindanao 4.7 5.0 0.0 3.4 26.2 55.0 5.4 0.3 100.0 162 N. Mindanao 6.8 4.6 1.4 10.1 17.4 54.8 4.6 0.3 100.0 227 S. Mindanao 1.4 2.5 0.4 10.5 21.6 54.7 7.0 1.9 100.0 483 C. Mindanao 2.8 4.8 3.8 6.9 21.8 51.9 6.9 1.0 100.0 180 ARMM 6.8 11.8 0.8 19.0 19.4 32.9 6.3 3.0 100.0 113 Caraga 1.9 1.9 1.5 12.I 19.2 58.8 4.3 0.3 100.0 144 Education No education 10.0 18.2 1.8 28.2 0.0 27.4 13.1 1.2 100.0 77 Elementary 4.6 4.2 1.6 14.9 1.6 57.9 14.0 1.3 I00.0 1,786 High school 1.5 1.4 0.3 4.4 6.2 66.6 18.8 0.7 100.0 2,314 College or higher 0.4 0.5 0.0 0.6 55.8 36.2 5.9 0.7 100.0 2,27 l Total 2.1 2.0 0.6 6.3 22.3 53.0 12.8 0.8 100.0 6,448 26 2.13 Earnings Data on who decides how to spend the money earned by employed women is shown in Table 2.14. Two out of three respondents reported that they alone decide how to spend the money they earn. About 14 percent said that their partner decides, while 18 percent jointly decide with their partner. In all age groups, a large majority of respondents say they alone decide on how to spend their cash earnings. However, among those 35 years old and older, about one out of every four women receiving cash said that the decision to spend their earnings is made jointly with their partner. Two out of three urban residents said that they decide how to spend their money. Although in most regions, a majority of the respondents said that they decide for themselves how to spend their money, in some regions--notably Cagayan Valley, Caraga, Northern Mindanao, and Western Visayas--one-third or more of working women say they decide with their husband how to spend their earnings. 2.14 Child Care While Working The welfare of children under six years whose mothers are employed is the focus of Tables 2.15.1 and 2.15.2. Overall, one out of three women who works has one or more children under six years old. This proportion varies by background characteristic. Rural women, less educated women, and women working for someone else or in agriculture are more likely to have a child under six. As a reflection of regional differentials in fertility, women in Bicol, Western Visayas, Eastern Visayas, Northern Mindanao, Central Mindanao and CAR are more likely to have one or more children under six years of age. Among working women, three out of ten take care of their children under six years while they work. Relatives are also common caretakers for children of working women (28 percent). In 12 percent of cases, husbands/partners take care of children while their wife works and in 11 percent of cases, female siblings care for the children. The role of female siblings in child care is more pronounced in the rural than in the urban areas. Children whose mothers have attended some college or acquired a college degree are more likely to leave their children with servants/hired help (24 percent) or other relatives (37 percent). Children whose mothers have no education or are engaged in agricultural occupations are most likely to be cared for by their sisters. Across regions, mothers and relatives, including female siblings, are the most important caregivers while the mother is working. Hired help or servants are common in Metro Manila. Children in Eastern Visayas and CAR are likely to be cared for by their female siblings while their mother is at work (21 percent and 20 percent, respectively). 27 Table 2.14 Person who deoides on use of earnings Percent distribution of women receiving cash earnings by person who decides on use of earnings, according to background characteristics, Philippines 1998 Person who decides how earnings are used Jointly with Jointly Number Background Respondent Husband/ husband/ Someone with of characteristic only partner partner else someone Missing Total women Age 15-19 80.6 1.2 1.8 11.4 4.0 1.0 100.0 636 20-24 79.6 6.0 8.6 2.5 2.5 0.9 100.0 964 25-29 65.6 14.6 17.1 1.1 1.3 0.4 100.0 982 30-34 57.1 16.9 23.7 0.7 0.4 1.2 100.0 1,064 35-39 54.8 18.6 24.9 0.5 0.6 0.7 100.0 1,008 40-44 56.1 19.3 23.0 0.6 0.3 0.6 100.0 839 45-49 57.7 15.5 25.2 0.4 0.6 0.5 100.0 664 Residence Urban 68.6 12.0 15.2 2.2 1.4 0.7 100.0 4,049 Rural 55.1 16.8 24.3 1.8 1.1 0.8 100.0 2,108 Region Metro Manila 74.1 10.9 11.5 0.8 1.7 1.0 100.0 1,579 Cordillera Admin. 49.1 15.0 27.4 4.0 1.3 3.1 100.0 79 Ilocos 61.6 20.0 16.1 0.0 0.4 2.0 100.0 248 Cagayan Valley 43.4 11.8 39.5 0.4 0.9 3.9 100.0 151 C. Luzon 66.9 15.6 13.3 2.3 1.3 0.5 100.0 579 S. Tagalog 61.5 16.7 19.3 1.8 0.5 0.2 100.0 893 Bicol 61.4 18.1 16.3 2.3 1.9 0.0 100.0 203 W. Visayas 46.9 12.1 31.5 6.4 2.6 0.5 100.0 462 C. Visayas 73.2 14.1 8.7 2.3 1.7 0.0 I00.0 531 E. Visayas 54.8 13.4 25.8 4.0 1.0 1.0 100.0 215 W. Mindanao 59.9 22.6 12.2 1.7 1.4 2.1 100.0 156 N. Mindanao 56.3 8.1 33.4 0.6 0.9 0.6 100.0 205 S. Mindanao 63.8 9.6 22.6 3.4 0.4 0.2 100.0 470 C. Mindanao 62.4 19.2 15.5 2.0 0.0 0.8 100.0 153 ARMM 50.0 15.3 28.7 0.5 3.0 2.5 100.0 96 Caraga 53,9 9.4 35.2 0.6 0.6 0.3 100.0 138 Education No education 55.5 15.4 22.8 0.9 2.1 3.3 100.0 62 Elementary 62.1 13.0 20.7 2.1 1.3 0.9 100.0 1,646 High school 67.2 12.4 15.2 3.0 1.6 0.6 100.0 2,218 College or higher 62.4 15.3 19.4 1.0 1.0 0.8 100.0 2,232 Total 64.0 13.7 18.3 2.0 1.3 0.8 100.0 6,157 28 Table 2.15.1 Child care while working Percent distribution of employed women by whether they have a child under five years of age and percent distribution of employed mothers who have a child under five by person who cares for child while mother is at work, according to background characteristics, Philippines 1998 to Employed women Child's caretaker, among employed mothers who have children <5 Residence Urban 72.3 27.7 27.5 10.3 32.9 1.0 15.0 0.3 7.6 2.0 3.4 100.0 4,127 Rural 56.0 44.0 34.3 12.7 22.8 1.4 3.2 0.1 15.1 4.7 5.7 100.0 2,322 Edu~on No education 58.6 41.4 31.3 5.1 8.9 1.1 0.0 0.0 43.0 7.7 3.0 100.0 77 Elementary 63.5 36.5 32.2 11.6 21.1 0.8 0.1 0.2 22.3 5.9 5.8 100.0 1,786 High school 69.3 30.7 38.9 13.7 26.5 2.0 2.7 0.0 8.4 2.9 4.9 100.0 2,314 College or higher 66.1 33.9 21.8 9.5 36.5 0.7 23.9 0.5 2.9 1.2 3.0 I00.0 2,271 Type of employer Work for family 67.7 32.3 27.4 3.4 29.9 0.9 9.6 0.0 16.6 6.7 5.5 100.0 539 Work for someone else 53.5 46.5 50.5 10.3 14.1 1.1 5.3 0.2 10.8 3.7 4.0 100.0 2,083 Self-employed 73.2 26.8 12.3 14.0 41.2 1.2 13.3 0.3 10.5 2.3 4.6 100.0 3,804 Occupation Agricultursl 51.1 48.9 22.5 5.8 26.1 1.0 0.7 0.0 27.2 9.2 6.6 100.0 707 Non-agricultural 68.3 31.7 32.0 12.6 28.7 1.2 11.2 0.3 8.1 2.1 3.7 I00.0 5,697 Employment status All year, full time 68.7 31.3 30.7 10.8 30.3 1.1 13.8 0.3 7.5 2.4 3.0 100.0 4,291 All year, part-time 59.1 40.9 24.8 17.4 21.0 1.9 4.1 0.4 21.4 5.4 3.6 100.0 488 Seasonal 66.0 34.0 32.3 10.6 29.2 1.4 1.9 0.0 15.0 4.1 5.1 I00.0 1,263 Occasional 53.1 46.9 33.3 12.2 17.8 0.0 1.0 0.0 17.0 5.6 12.1 100.0 404 Total 66.4 33.6 30.7 11.5 28.1 1.2 9.4 0.2 11.1 3.3 4.2 100.0 6,448 One or more Other Other Number Background No child children Husband/ Other Neighbor/ Hired School/inst'l female male Other, of characl/~ristic <5 <5 Respondent partner relative friend help care/other child child Missing Total women o Table 2.15.2 Child care while working: region Percent distribution of employed women by whether they have a child under five years of age and percent distribution of employed mothers who have a child under five by person who cares for child while mother is at work, according to region, Philippines I998 Employed women Child's caretaker among employed mothers who have children <5 Metro Manila 77.9 22.1 22.0 9.7 36.6 1.1 18.8 0.0 7.5 1.6 2.7 100.0 1595 Cordinera Admin. 53.9 46.1 19.1 13.7 26.7 2.3 3.1 0.0 19.8 7.6 7.6 100.0 1130 Ilocos 64.1 35.9 31.7 11.9 31.7 1.0 6.9 0.0 10.9 3.0 3.0 100.0 273 Cagayan Valley 63.1 36.9 28.0 6.5 30.8 3.7 5.6 0.0 t5.0 6.5 3.7 100.0 192 C. Luzon 67.3 32.7 36.6 9.9 32.8 0.8 4.6 0.0 7.6 3.1 4.6 100.0 595 S. Tagalog 64.4 35.6 29.6 9.5 31.2 1.5 11.1 0.0 7.5 4.0 5.5 i00.0 907 Bicol 55.1 44.9 50.0 8.8 13.7 1.0 3.9 1.0 13.7 2.9 4.9 100.0 214 W. Visayas 59.0 41.0 29.3 19.2 27.5 1.8 6.6 0.0 9.6 1.8 4.2 100.0 482 C. Visayas 69.3 30.7 33.6 16.4 24.3 0.7 11.2 0.0 8.6 1.3 3.9 100.0 545 E. Visayas 53.6 46.4 32.7 13.1 16.3 0.7 2.0 2.0 20.9 7.2 5.2 100.0 237 W. Mindanao 63.4 36.6 29.4 8.3 33.9 0.0 8.3 1.8 13.8 0.9 3.7 I00.0 162 N. Mindanao 56.7 43.3 37.1 7,5 16.4 1.3 10.I 0.0 17.0 5.0 5.7 100.0 227 S. Mindanao 65.4 34.6 27.5 14,0 24.2 0.0 8.4 0.0 14.6 4.5 6.8 100.0 483 C. Mindanao 54.7 45.3 27.5 11.5 27.5 2.3 8.4 2.3 16.0 2.3 3.8 100.0 180 ARMM 59.1 40.9 47.4 7.2 21.6 0.0 3.1 0.0 14.4 3.1 3.1 100.0 113 Caraga 60.7 39.3 31.5 7,9 27.6 1.6 11.0 0.0 tl.0 3.9 5.5 I00.0 144 Total 66A 33.6 30.7 11,5 28.1 1.2 9.4 0.2 11.1 3.3 4.5 100.0 6,448 One or more Other Other Number No child children Husband/ Other Neighbor/ Hired School/inst'l female male Other, of Region <5 <5 Respondent partner relative Friend help care/other child child missing Total women CHAPTER 3 FERTILITY In line with the objective of measuring fertility levels, trends, and differentials, special care was given to administer a set of carefully worded questions to obtain accurate and reliable data on fertility. Data on fertility came from a full pregnancy history asked of all women aged 15-49 at the time of the survey. The sequence of questions was intended to derive information on all pregnancies that resulted in either a live birth or a miscarriage or still birth. For live births, women were asked questions about children still living at home, those living elsewhere, and those who had died. Since pregnancies were listed in order of occurrence, it was possible to probe cases in which the interval between pregnancies seemed too short or too long. For pregnancies not ending in a live birth, women were asked the month and year of the pregnancy termination as well as the duration of the pregnancy. For pregnancies that were lost before full term, 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 history of live births only. The analysis in this chapter revolves around females who were born in a given time period (birth cohort) and on those who married during a given time period (marriage cohort). 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 woman would have at the end of her reproductive life if she were subject to the currently prevailing age-specific rates from age 15 to 49. The TFR remains the most significant demographic indicator in the analysis of the impact of national population programs, particularly family planning programs, on individual or group reproductive behavior. A three-year TFR was computedtu provide the most recent estimates of current levels of fertility. The three-year rate also helps reduce sampling errors and avoid problems of displacement of births reported from 5 to 6 years prior to the survey? 3.1 Cur rent Fert i l i ty Fertility levels in the Philippines between 1995 and early 1998, as measured by the TFR, have declined from the levels in 1990-1993. Data in Table 3.1 indicate that for the country as a whole, the TFR is estimated at 3.7 ehildren per woman. This represents a decline from 4.1 children per woman in 1990-1993. The age-specific fertility rates show a 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 126 live births per 1,000 women age 15- 44 years and a crude birth rate (CBR) of 28 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 (Figure 3.1). Another notable feature of current fertility !s the lower fertility of urban women in the country. The TFR for urban area is 3~0 births per woman, 1.7 less than the rural TFR. Lower urban fertility is observed across all age groups (Figure 3.2). IThe distribution of all children by calendar year of birth shows that there is only very slight heaping of births for 1992 with small associated deficits in the years prior to and following those years (see Table C.4). The pattern of transference of births has been observed in other DHS surveys and is believed to be due to transference of births by interviewe£~ out of the period for which the health and calendar data were collected. 31 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the cmde birth rate for the three years preceding the survey, by urban-rural residence, Philippines 1998 Residence Age group Urban Rural Total 15-19 30 69 46 20-24 137 233 177 25-29 182 247 210 30-34 133 183 155 35-39 84 142 111 40-44 32 50 40 45-49 4 10 7 TFR 15-49 3.01 4.67 3.73 TFR 15-44 2.99 4.63 3.70 GFR 101 159 I26 CBR 25.8 30.1 28.0 Note: Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44), expressed per 1,000 women Figure 3.1 Total Fertility Rates in Selected Countries in Southeast Asia Births per Woman 4,0 3.5 3.0 2.5 2,0 1.5 1.0 0,5 0.0 1.7 m 2.0 2.3 2.8 3.2 Singapore Thailand Vietnam Indonesia Malaysia Philippines Sources: Indonesia: 1997 Indonesia DHS; Philippines: 1998 NDHS Other:, Population Reference Bureau, 1998 Wodd Population Data Sheet 32 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 performance of older women who are nearing the end of their reproductive years. 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 omission of births by older women. Nevertheless, consistency in the two measures with respect to urban-rural differentials and educational attainment is observed. As noted earlier, urban women have fewer children than their rural counterparts. On average, urban women have at least one and a half children less than rural women have. This may be interpreted as arising from differences in levels of development between urban and rural areas (Figure 3.3). Such differences are also substantiated by regional variations in fertility. Metropolitan Manila, the most developed region, exhibits the lowest TFR (2.5 children per woman) and the lowest mean number of children ever born (3 children per woman). In contrast, Eastern Visayas, one of the least developed regions in the country, shows the highest TFR (5.9) and a mean CEB of 6.2 children per woman. The difference in fertility between the two regions is more than 3 children. The widely accepted negative effect of education on fertility is clearly borne out by the data. The depressing effect of education on fertility is best indicated by the difference in fertility rates between Table 3.2 Fertiliw by background characteristics Total fertility rates for the three years preceding the survey and mean number of children ever born to women age 40-49, by selected background characteristias, Philippines 1998 Mean number of children Total ever born Background fertility to women characteristic rate ~ age 40-49 Residence Urban 3.0i 3.70 Rural 4.67 5.28 Region Metro Manila 2.49 2.95 Cordillera Admin. 4.79 5.71 llocos 3.43 4.99 Cagayan Valley 3.56 4.30 C. Luzon 3.52 4.15 S. Tagalog 3.69 4.09 Bicol 5.45 5.39 W. Visayas 4.02 4.48 C. Visayas 3.70 4.35 E. Visayas 5.91 6.19 W. Mindanao 3.90 4.97 N. Mindanao 4.75 5.50 S. Mindanao 3.67 4.63 C. Mindanao 4.22 5.17 ARMM 4.61 5.10 CARAGA 4.65 5.65 Education No education 5.01 5,42 Elementary 5.00 5.46 High school 3.64 4.24 College or higher 2.90 2.86 Total 3.73 4.42 Rate for women age 15-49 years women with no education (5.0 children per woman) and those with higher education (2.9 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 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. 33 Figure 3.2 Age-Specific Fertility Rates by Residence 300 250 200 150 100 50 0 Births per 1,000 Women I I I I I 15-19 20-24 25-29 30-34 35-39 40-44 Age [÷Uban "B'Rural "8Total] 45-49 1998 NDHS Figure 3.3 Total Fertility Rate among Women Age 15-49 by Residence and Education Total Fertility Rate 6.0 5.0 4.0 3.0 2.0 1.0 0.0 Urban 4,7 Rural RESIDENCE 5.0 5.0 No Elemen- H igh College education tary school or higher EDUCATION 34 1998NDHS 3.3 Fertility Trends To validate the data obtained from the 1998 NDHS, age-specific fertility rates can be 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 eoverage, 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. Table 3.3 and Figure 3.4 shows fertility rates for the 25-year period preceding the survey. The rates reflect a five-year average centered on mid-period years for the 1973, 1978 and 1983 surveys and a three-year rate for the 1986, 1993 and 1998 surveys. In general, the TFR declines from 6.0 children per woman in 1970 to 3.7 in 1996, or a decrease of 2.3 births per woman during the 25-year period. The pace of decline in fertility over time varies. During roughly the period 1970-1975, the TFR 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 1980s and was estimated at 3.2 percent annually. The latter half of the 1980s once again revealed a slide back in the progress of fertility reduction with just 1.1 per6ent annual decline during the period 1984-1991. Between 1991 and 1996, the TFR decreased annually by 1.8 percent. Through most of the 25 years, the mean age marriage for women has remained high and relatively stable, at about 22 or 23 years. The observed decline in fertility can be attributed to changes in family planning practices. Retrospective data from a single survey can also be used to establish fertility trends over time. Using the 1998 NDHS age-specific fertility rates (ASFR) for the last 20 years are presented in Table 3.4 by five-year periods. The ASFRs are progressively truncated with increasing number of years from the time of the survey. Due to truncation, changes over the past 20 years are observed only for women up to age 29. In terms of internal 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 20-29 shown for periods 5-9 and 10-14 years before the survey is similar to the trend observed in previous surveys and, therefore, does not necessarily suggest recall problems or omission of births by older women. Overall, fertility decline during the past 20 years has been moderate. For women aged 15-29, the TFR declined from 2.7 (15-19 years before the survey) to 2.2 (0-4 years before the survey). A closer look at more recent fertility change by comparing ASFRs between 0-4 years and 5-9 years prior to the survey reveals that the relative reduction is largest for women under 20 years and those above age 35. 3.4 Fertility by Marital Duration Table 3.5 presents fertility rates for ever-married 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 higher in the more distant past than in the recent past. 35 Table 3.3 Fertility trends Age-specific and total fertility rates from various surveys, Philippines 1973-1998 1973 1978 1983 1986 1993 1998 NDS RPFS NDS CPS NDS NDHS Age (1970) (1975) (1980) !1984) (I991) (1996) 15-19 56 50 55 48 50 46 20-24 228 212 220 192 190 I77 25-29 302 251 258 229 217 210 30-34 268 240 221 198 181 155 35-39 212 179 165 140 120 111 40-44 100 89 78 62 51 40 45-49 28 27 20 15 8 7 TFR 5.97 5.24 5.08 4.42 4.09 3.73 Note: Rates for 1970 to 1980 are five-year averages and 1984 to I996, three-year averages centered on the year in parentheses. Sources: 1970to 1984-Concepcion, 1991,Table4.10 1991 - NSO and Macro International Ine, 1994, Table 3.3 Figure 3.4 Total Fertility Rate Philippines 1970-1996 Births per Woman 1973 NDS 1978 RPFS 1983 NDS 1986 CPS 1999 NDS 1998 NDHS Sources: Concepcion, 1991; NSO and MI, 1994 36 Table 3.4 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Philippines 1998 Mother's ageat time ofbi~h Number of years preceding the survey 0-4 5-9 10-14 15-19 15-19 50 57 64 63 20-24 177 199 207 223 25-29 210 224 226 251 30-34 161 181 189 [221] 35-39 106 124 [138] 40-44 43 [69] 45-49 [8] Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. 3.5 Children Ever Born and Living A basic measure of fertility is the number of children ever born (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 individual respondents but is a measure of 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, two out of five do not have any children. By contrast, only 6 percent of married women do not have any children. Table 3.5 Fertility by marital duration Fertility rates for ever-married women by duration (years) since first marriage, for five-year periods preceding the survey, Philippines 1998 Marriage Number of years preceding the survey duration at birth 0-4 5-9 10-14 15-19 0-4 370 393 404 397 5-9 221 249 247 289 10-14 143 164 205 252 15-19 93 132 158 [219] 20-24 62 117 [153] 25-29 27 [39] Note: Fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated. 37 Table 3.6 shows marked differences between married women and all women in the proportion without any children at younger ages. This is due to the fact that many women remain unmarried in their late teens and early twenties. Assuming that voluntary childlessness within marriage is rare, this figure 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 should be noted that while 1 out of 11 Filipino women 45-49 remains childless, about 8 percent have 10 or more births. Table 3.6 also shows that while the proportion of women with no children decreases with age, the proportion of Women at higher parities increases with age, reflecting the process of family formation over time. Also, the mean CEB for all women and currently married women increases with increasing age indicating that the data are free from gross recall bias (Figure 3.5). The mean CEB for the whole sample of women is 2.2 children, while for married women, it is 3.4 children. It is interesting to note that for women completing their childbearing (age 45-49), the mean CEB is 4.7 children among all women and 5.1 children among married women. Table 3.6 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number of children ever barn and living, according to five-year age groups, Philippines 1998 Mean Mean Number of children ever born (CEB) Number number number Age of of of living group 0 1 2 3 4 5 -6 7 8 9 10 Total women CEB children ALL WOMEN 15-19 94.5 3.9 1.4 0.I 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,924 0.07 0.07 20-24 61.5 19.4 11.9 5.0 1.7 0.5 0.I 0.0 0.0 0.0 0.0 100.0 2,299 0.68 0.65 25-29 29.8 19.2 19.5 16.6 9.1 3.8 1.3 0.4 0.1 0.0 0.0 100.0 2,209 1.75 1.67 30-34 15.5 I1.0 18.1 20.8 14.4 9.3 6.1 2.8 1.3 0.4 0.2 100.0 2,058 2.86 2.69 35-39 9.4 8.0 I4.7 18.2 16.1 12.4 8.1 5.1 3.8 1.7 2.3 100.0 1,842 3.75 3.47 40-44 9.7 7.4 10.1 17.7 15.5 12.9 8.6 6.1 4.2 3.1 4.8 I00.0 1,480 4.16 3.81 45-49 8.7 5.9 10.5 12.7 13.8 9.8 10.4 10.5 5.4 4.8 7.6 100.0 1,170 4.74 4.28 Total 39.9 11.0 11.9 11.9 8.7 5.9 4.0 2.7 1.6 1.0 1.5 100.0 13,983 2.16 2.00 CURRENTLY MARRIED WOMEN 15-19 40.5 41.2 16.5 1.7 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 224 0.79 0.74 20-24 14.3 41.7 27.1 II.6 3.9 1.1 0.2 0.0 0.0 0.0 0.0 100.0 967 1.53 1.49 25-29 7.5 24.0 25.8 22.7 12.5 4.9 1.9 0.6 0.1 0.0 0.0 100.0 1,585 2.35 2.24 30-34 5.0 11.1 20.5 24.I 16.2 10.5 7.2 3.1 1.6 0.4 0.2 100.0 1,730 3.25 3.06 35-39 2.3 7.9 15.3 19.9 17.4 13.6 8.8 5.7 4.4 2.0 2.7 I00.0 1,602 4.11 3.81 40-44 2.6 6.6 11.1 18.8 I6.9 14.1 9.4 6.5 4.9 3.7 5.5 100.0 1,243 4.58 4.I8 45-49 2.6 4.9 II.0 13.8 14.3 10.8 12.2 11.3 5.8 5.0 8.4 100.0 965 5.14 4.65 Total 6.4 16.0 18.7 18.9 13.7 9.2 6.4 4.1 2.6 1.6 2.3 100.0 8,336 3.39 3.15 Besides describing average family size, information on the number of living children at the time of interview (reported by the respondent) or the current family size (derived from the pregnancy history) can give some indication of infant and child mortality. The data show that on the average, all women have a mean of 2 children still living and currently married women have a mean of 3.2 living children. It 38 is notable that the mean number of CEB and of children still living are not substantially different. On the average, both groups of women had a loss of 7 percent of all live births. Figure 3.5 Mean Number of Children Ever Born among Women Age 15-49 by Age Group Number of Children Ever Born 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2.2 / 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Age Group 1998 NDHS 3.6 Birth Intervals The timing of births has significant influence on both fertility and mortality. There is 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 deaths. Table 3.7 shows the percent distribution of births in the five years preceding the survey by the length of the interval since the previous birth, classified by selected demographic and background characteristics of women. In general, the median length of the birth interval is slightly over 2 years, or 28 months. About 1 out of 5 births occurs four or more years after a previous birth. More than one-third of births occur within two years of a previous birth. This finding is cause for concern 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 in length, elevate the risk of death for 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 their reproductive years exhibit shorter median birth intervals. These are estimated at 19 and 25 months for women under 20 and those 20-29, respectively. By contrast, women who are 40 or older report a median birth interval of 39 months, an interval more than twice as long as that of women aged 15-19 (Figure 3.6). 39 Median birth interval exhibits a generally curvilinear relationship with birth order, increasing from 27 months for second to third births, to a peak of 30 months for fourth through the sixth births, then declining to 29 months for seventh or higher births. The data in Table 3,7 show that the birth interval does not vary by 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 occurs after 29 months. For those whose previous birth did not survive, the corresponding birth interval is shorter by 3.8 months. This finding raises interesting questions on the mechanism where by 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 seem to exert some effect on the length of birth intervals. For women who live in urban areas, the median birth interval is 29.3 months, 1.5 months longer than for women who live in rural areas. As expected, better educated women space births more widely than uneducated women. Women with college education or higher have a median birth interval 4 months longer than women without schooling. Figure 3.6 Median Number of Months Since Previous Birth by Age of Mother and Birth Order Median Number of Months 45 40 35 30 25 20 15 10 5 0 30 15-19 20-29 80-39 40+ 2-3 4-6 Age ol Mother Birth Order 7+ 1998 NDHS 40 Table 3.7 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Philippines 1998 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-47 48+ Median number of Number months since of Total previous birth births Age of mother 15-19 47.9 20.3 31.1 0.7 0.0 100.0 18.7 49 20-29 2],7 25.1 33,2 10.6 9.4 100,0 24.7 2,182 30-39 14.2 15.5 29.5 14.5 26.2 100.0 31.0 2,815 40+ 8.7 11.0 24.0 17.9 38.4 100.0 39.1 605 Birth order 2-3 20.0 20.2 28.0 11.7 20.2 100.0 26.7 2,855 4-6 13.3 17.2 31.7 14.7 23.1 100.0 30.2 1,993 7+ 14.4 17.7 35.3 15.1 17.5 100.0 28.6 803 Sex of prior birth Male 16.5 17.8 30.8 13.8 21.0 100.0 28.7 2,917 Female 17.2 19.8 29.8 12.6 20.6 I00.0 27.8 2,734 Survival of prior birth Living 15.8 19,0 30.8 13.4 21.0 100,0 28.5 5,327 Dead 33.8 15.5 23.6 9.6 17.4 100.0 24.7 324 Residence Urban 18.2 16.7 27.1 13.5 24.5 100,0 29.3 2,439 Rural 15.8 20.4 32.8 13.0 18.0 100.0 27.8 3,212 Region Metro Manila 17.9 13.4 28.3 13.4 27.0 100.0 30.3 707 Cordillera Admin, 16.7 21,6 33,0 13.8 14.9 100.0 28,0 122 Ilocos 14.1 20.0 36.1 11.8 18.0 100.0 28.6 248 Cagayan Valley 13.8 16.4 29.7 16.0 24.2 100.0 31.4 178 C. Luzon 17.5 19.6 21.6 11.4 29.8 100.0 29.2 507 S. Tagalog 17,7 19.3 28.9 13.4 20.8 100.0 28.9 826 Bieol 17,0 20.1 35.9 13,6 13.4 100.0 27.1 423 W, Visayas 17.4 19.3 30.4 13.8 19.1 100.0 27.6 429 C. Visayas 13.6 18.2 38.5 11.5 18.2 100.0 28.1 429 E. Visayas 17.6 20.2 31.0 14.0 17.2 100.0 27.7 370 W, Mindanao 15,5 18.1 29.9 16.2 20.2 100.0 28.7 231 N. Mindanao 15.8 21.5 31,5 14.1 17.2 I00.0 26.7 259 S. Mindanao 17.0 21.4 24.4 13.2 24.1 100.0 28.3 343 C. Mindanao 18.4 17.5 31.3 13.6 19.3 100.0 28.1 207 ARMM 18.1 21.4 32.2 13.1 15.3 I00.0 26.5 218 Caraga 17.5 19.3 33.9 10.5 18.7 100.0 26.9 153 Education No education 18.9 21.8 27.7 14.7 16.9 100.0 26,2 ]51 Elementary 14.3 19.9 35.0 13.6 17.2 100.0 28.2 2,191 High school 17.6 19.5 29.9 11.9 21.2 100.0 27.9 2,092 College or higher 19.9 15.3 23.1 14.6 27.1 100.0 30.2 1,216 Total 16.8 18.8 30.3 13.2 20.8 100.0 28.3 5,651 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 41 3.7 Age at F i r s tB i r th 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 1 percent had their first birth at less than 15 years of age. This proportion diminishes among younger women. The reduction in the proportion giving birth in their early teens is associated with the rise in age at first marriage, which has been sustained during the past 25 years. Even if age at first birth as reported by older women is subject to omission or misdating of early births, information gathered among women age 45-49 still gives some indication of the timing of first births and the tempo of fertility. Four out of 10 women in the oldest age group had their first birth during their early twenties (38 percent) and three out often (29 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 23 percent, respectively). Clearly, most Filipino women have their first birth during their early twenties rather than in their teens. The median age at first birth shows a slight increase from 23 years among older women to 24 years among women age 25-29. Differentials in age at first birth by selected background characteristics are presented in Table 3.9. The median age at first birth among women age 25-49 is 23.3 years. Filipino women in urban areas are about two years older than their rural counterparts when they first enter motherhood. Regional variations are less distinct but median age at first birth exceeds that of the country as a whole in two regions--Western Visayas and Central Visayas. Sharp education differentials, however, are observed. Women with higher education exhibit a median age at first birth higher than that of the unschooled women. The direct correlation between median age at first birth and education indicates the postponement of marriage and eventual first birth among women who stay longer in school. Table 3.8 Age at first birth Percent distribution of women age 15-49 years by age at first birth, according to current age, Philippines 1998 Median Women Age at first birth Number age at Current with of first age no births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 94.5 0.2 3.4 1.9 NA NA NA 100.0 2,924 a 20-24 61.5 0.5 6.6 13.4 11.5 6.5 NA I00.0 2,299 a 25-29 29.8 0.7 6.4 13.0 16.5 20.6 13.0 100.0 27209 23.9 30-34 I5.5 1.0 8.1 15.2 15.5 21.5 23.2 100.0 2,058 23.4 35-39 9.4 0.6 8.7 13.3 18.2 21.4 28.5 100.0 1,842 23.1 40-44 9.7 0.9 9.7 15.8 15.9 21.6 26.3 100.0 1,480 22.9 45-49 8.7 1.0 8.8 14.3 16.6 21.4 29.1 I00.0 1,170 23.1 NA = Not applicable ~Less than 50 percent of the women in the age group x to x+4 had a birth by age x 42 3.8 Teenage Fertility As noted earlier, early childbearing, particularly births occurring before age 20, affects only a small segment of the population. However, this does not mean that the level of teenage childbearing and motherhood does not pose social and health threats to society. Table 3.10 presents data on fertility among women age 15-19 (teenagers) at the time of the survey. Of the women in this age group, 7percent have begun childbearing (6 percent are already mothers and 2 percent are pregnant with their first child). 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 21 percent among those age 19 years. Rural teenagers are almost twice as likely (11 percent) to experience teenage pregnancy as their urban counterparts (5 percent) (see Figure 3.7). Consistent with urban-rural and regional differentials, the less urbanized regions of ARMM, Western Mindanao, Eastern Visayas, and Cagayan Valley all share higher proportions of teenage fertility relative to other regions of the country (Figure 3.8). This is particularly true for ARMM, a predominantly Muslim region, where cultural factors impinging on women's roles and status may partially explain the high proportion of teenagers who begun childbearing early (13 percent). In comparison, Metropolitan Manila, the premier region of the country, has the lowest proportion of teenagers who have begun childbearing (4 percent). It may be inferred 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 may 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 proportion who having begun childbearing from 17 percent among teens who had never been to school to 5 percent among those with higher education. 43 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 1998 Background Current age Ages characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 25.3 24.3 23.9 23.7 24.1 24.3 Rural 22,3 22,3 22,3 22.0 22.2 22,2 Region Metro Manila a 25.7 24,7 24.3 25.1 a Cordillera Admin. 21.7 22.5 21.9 20.7 22.3 21.8 Ilocos 24.3 23.3 22.6 24.5 21.6 23.2 Cagayan Valley 21.6 21.2 21.7 22,2 22.0 21.7 C. Luzon 23.5 23.3 23.7 22.9 23.3 23.3 S. Tagalog 23.4 22.9 23.6 23.1 23.0 23.2 Bieol 22.7 22.7 23.1 22.2 22.3 22.6 W. Visayas 24.8 23.8 22.8 24.0 24.8 24.0 C. Visayas 24.0 22.9 23.5 22.7 24.0 23.5 E. Visayas 22,9 21.3 21.3 20.8 21.9 21,6 W. Mindanao 22.8 22.2 22.4 21.3 22.8 22.3 N. Mindanao 23.5 22.9 22.4 21.0 21.9 22.6 S. Mindanao 23.3 22.9 22.9 22.1 22.6 22,7 C. Mindanao 22.0 23.1 23.8 21.6 21.7 22.7 ARMM 21.7 20.8 21.3 22.3 23.6 21.8 Caraga 23.4 23.2 21.6 20,9 22.1 22.3 F~lueation No education 19,9 20.0 20,4 20,4 21.8 20.5 Elementary 20.9 20.8 21.2 21.0 21.4 21.1 High school 23.0 22.7 22.6 22.4 22.9 22.7 College or higher a 26.0 26.6 26,3 27.1 a Total 23.9 23.4 23.1 22.9 23. I 23.3 Note: Themedians for the 15-19 cohort and for the20-24 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 agex. 44 Table 3.10 Teenage pregnancy and motherhood Percentage of teenagers age 15-19 years who are mothers or pregnant with their first child, by selected background characteristics, Philippines 1998 Percentage Percentage who are: who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing teenagers Age 15 0.3 0.2 0.5 624 16 0.8 0.8 1.6 613 17 3.6 1.4 5.0 589 18 7.8 2.6 10.5 602 19 17.0 4.2 21.3 497 Residence Urban 3.4 1.3 4.7 1,701 Rural 8.3 2.4 10.8 1,223 Region Metro Manila 2.8 0.9 3.7 605 Cordillera Admin. 2.3 2.3 4.6 46 Ilocos 3.3 1.3 4.6 147 Cagayan Valley 5.0 5.6 i0.6 106 C. Luzon 5.1 1.0 6.2 289 g. Tagalog 7.2 2.7 9.9 360 Bieol 8.4 1.4 9.8 135 W. Visayas 4.6 1.0 5.6 233 C. Visayas 4.3 1.0 5.3 228 E. Visayas 8.5 3.5 12.0 102 W. Mindanao 8.3 4.4 12.6 112 N. Mindanao 7.0 1.2 8.2 106 S. Mindanao 6.4 2.3 8.7 206 C. Mindanan 5.7 1.3 7.0 98 ARMM 11.4 1.7 13.1 83 Caraga 7.8 1.3 9.2 68 Education No education i 7.3 0.0 17.3 15 Elementary 11.5 4.4 15.9 471 High school 4.5 1.2 5.7 1,962 College or higher 3.0 1.5 4.5 476 Total 5.5 1.8 7.2 2,924 45 20 15 10 5 0 Figure 3.7 Percentage of Women Age 15-19 (Teenagers) Who Have Begun Childbearing by Residence and Education Percent 10.8 17.3 Urban Rural No Elemen- High College education tary school or higher RESIDENCE EDUCATION 1998 NDHS Figure 3.8 Percentage of Women Age 15-19 (Teenagers) Who Have Begun Childbearing by Region Metro Manila Cordillera Admin. Ilicos Cagayan Valley C. Luzon S. Tagalog I Bicol W. Vlsayas C. Vlsayas E. Visayas W. Mindanao N. Mindanao S. Mindanao C. Mindanao ARMM Caraga 0 2 10.6 6.2 I :9.9 :9.6 I :s.6 r i .12.0 12.6 4 6 8 10 12 14 Percent 46 1998 NDHS 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 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 methods 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. Thirteen methods (pill, IUD, injection, condom, ligation or female sterilization, vasectomy or male sterilization, calendar/rhythm method/periodic abstinence, mucus/Billings/ovulation, basal body temperature, symptothermal, lactational amenorrhea method or LAM, breastfeeding, and withdrawal) were described in the questionnaire. 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 had ever used the method and 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, t Among currently married women as well as all women, virtually all respondents know of one or more family planning methods (99 percent and 98 percent, respectively) or a modem method (98 percent and 97 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, 1988, and 1993 National Demographic Surveys and the 1986 Contraceptive Prevalence Survey (Concepcion, 1991). Knowledge of traditional methods is only slightly less common than knowledge of modem methods. The more widely known modem methods are the pill, condom, female sterilization, IUD, and injection. The least known modem methods include lactationai amenorrhea method (LAM) and symptothermal method. Slightly less than 90 percent of married women are aware of the calendar/rhythm method 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. Ninety-five percent know a source for the pill, 91 percent for condom, 87 percent for female sterilization, 86 percent for the IUD, 83 percent for injections, and 72 percent for male sterilization. It is not surprising that a smaller percentage of currently married women know a place where one can obtain advice on how to use the mucus/Billings/ovulation (22 percent), basal body temperature (20 percent), LAM (13 percent), and symptothermal methods (9 percent), which are not well known contraceptive methods. lln this report, the term natural family planning refers to mucus/Billings/ovulation, basal body temperature and symptothermal methods. In the 1993 NDS, questions did not differentiate between the various methods of periodic abstinence and the term includes both rhythm and periodic abstinence. 47 Table 4.1 Knowledge of contraceptive methods and a 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 1998 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 97,6 98.6 93.8 96.4 Modern method 97.0 98.0 93.7 96.4 Pill 95.9 97.3 90.8 94.6 IUD 86,7 91.8 78.4 85.5 Injection 82,8 89.1 75.8 83.3 Condom 93,4 95.4 86.7 90.7 Female sterilization 87.8 92.2 81.4 87.2 Male sterilization 69.4 78.4 63.2 71.8 Mucus, Billings, ovulation 20;8 23.8 18.6 21.6 Basal body temperature 20.7 22.6 18.2 20.0 Symptothermal 9.5 10.4 8.5 9.3 Lactational amenorrhea 13.4 15.0 11.9 13.4 Traditional method 88.2 94.1 71.0 80.1 Calendar, rhythm 78.6 87.1 71.0 80.1 Breastfeeding 54.9 62.2 NA NA Withdrawal 75.9 87.3 NA NA Other traditional methods 6.5 8.0 NA NA Total 13,983 8,336 13,983 8,336 NA -- Not applicable 48 Figure 4.1 Knowledge of Contraception among Currently Married Women Age 15-49 Pill IUD Injection Condom Female sterilization Male sterilization Mucus, Billings, ovulation Basal body temperature Symptothermal Lactational amenorrhoa Calendar, rhythm Breastfeeding Withdrawal 97 BBlo m l . = 10 20 30 40 50 60 70 80 90 100 Percent 1998NDHS Except for women in the age group 15-19, the level of knowledge of any method, modem methods, and sources for modem methods does not vary greatly by age. The age group 15-19 shows the lowest proportion having knowledge of methods and their sources (Table 4.2). There is also little difference in levels of knowledge by urban-rural residence, where the urban level is higher by only about two percentage points than the rural level. 49 Table 4.2 Knowledue of modem contracentive 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 1998 Know a Know Know source for Number Background any a modem modem of characteristic method method I method women Age 15-19 96.5 96.0 90.6 244 20-24 98.7 98.2 96.2 967 25-29 98.7 98.0 96.7 1,585 30-34 99.0 98.3 96.7 1,730 35-39 98.8 98.0 96.9 1,602 40-44 98.5 98.1 96.7 1,243 45-49 97.9 97.3 95.6 965 Residence Urban 99.3 99.0 97.9 4,222 Rural 97.8 96.8 94.8 4,114 Region Metro Manila 99.7 99.6 98.1 1,298 Cordillera Admin. 99.2 99.0 95.1 136 I1ocos 100.0 100.0 99.3 414 Cagayan Valley 99.0 98.4 96.5 322 C. Luzon 99.3 99.3 98.3 883 S. Tagalog 99.7 99.6 97.1 1,219 Bicol 99.6 99.4 97.8 481 W. Visayas 100.0 100.0 98.5 627 C. Visayas 99.6 99.6 98.8 620 E. Visayas 99.5 99.1 96.7 395 W. Mindanan 91.0 90.3 89.5 343 N. Mindanan 100.0 100.0 99.2 295 S. Mindanao 99.3 99.2 98.4 572 C. Miudanao 98.4 98.4 96.3 273 ARMM 77.9 61.9 57.5 252 Caraga 100.0 99.8 99.1 208 Education No education 64.9 51.1 44.0 169 Elementary 98.6 97.7 95.0 2,756 High school 99.5 99.3 98.3 3,050 College or higher 99.8 99.8 99.2 2,361 Total. 98.6 98.0 96.4 8,336 llncludes pill, IUD, injection, condom, female stefilizaton, male sterilization, mucus/Billings/ovulation, basal body temperature, symptothermal method and lactational amanorrhea method (LAM). 50 When it comes to regional variations, only ARMM deviates 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 larger regional differentials exist. Women in Ilocos Region, Central Visayas, Northern Mindanao and Caraga have the highest levels of knowledge of a source for a modem method (at least 99 percent). ARMM shows the lowest level (58 percent). Excluding women with no education, them are no substantial differentials in the proportion knowing at least one contraceptive method and a source for a modem method by level of 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 after probing, 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 married women who are at the greatest risk of pregnancy (Table 4.3). Seven in 10 married women have used a family planning method at some time; 53 percent have used a modem method and 44 percent have used a traditional method. The most popular modem method is the pill (36 percent) followed by the condom (14 percent), female sterilization (10 percent), and the IUD (9 percent). The remaining modem methods have small proportions of ever users. Among the traditional methods, withdrawal is the most popular (33 percent), followed by the calendar/rhythm method (24 percent). In general, the level of ever use increases with age up to age 35-39, and then declines. However, the pattern varies for specific modem methods; ever use of the pill peaks at age 30-34, IUD use at age 35- 39, and female sterilization use at age 40-44. 51 t.~tt to 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 1998 Modem methods Traditional methods Mucus, Basal Lac- Any Any Female Male Bill'mgs, body tational tradi- Calen- Other Number Any modem In jet- Con- stedli- sterili- ovula- temper- Sympto- amenor- fional dar, With- meth- of Age method method Pill IUD tion dora zafion zation tion ature thermal rhea method rhythm drawal ods women ALL WOMEN 15-19 2.6 1.8 1,3 0,3 0.4 0.3 0.0 0,0 0.0 0,0 0.0 0,0 1.4 0,4 1.2 0,0 2,924 20-24 25.3 17.8 13.4 2.5 3.2 3.4 0.l 0.0 0.2 0.1 0.0 0.1 14.3 5.7 11.4 0.9 2,299 25-29 52.1 37.9 28.1 6.2 6.8 8.1 2.5 0.0 0.6 0.3 0.0 0.5 32.4 14.7 25.3 1.5 2,209 30-34 66.2 52.0 36.5 8.5 6.5 13.8 7.5 0.0 1.1 0.5 0.0 0.3 42.6 23.4 32.6 2.8 2,058 35-39 69.9 54.1 35.9 9.3 5.8 13.9 13.6 0.1 1.5 0.3 0.1 0.5 44.2 28.1 30.2 3.4 1,842 40-44 63.8 49.3 30.6 7.5 4.5 16.8 17.3 0.3 1.3 0.9 0.5 0.7 40.6 26.2 28.8 3.2 1,480 45-49 56.8 42.4 25.3 7.2 2.0 15.7 15.3 0.7 0.9 0.8 0.0 0.3 36.5 22.7 26.0 3.8 1,170 Total 43A 32.8 22.4 5.3 4.0 8.8 6.4 0.1 0.7 0.3 0.1 0.3 27.2 15.2 20.1 1.9 13,983 CURRENTLY MARRIED WOMEN 15-19 28.6 19.5 14.5 2.9 4.0 2.1 0.0 0.0 0.3 0.0 0.0 0.3 16.3 4.4 14.1 0.6 244 20-24 57.7 40.6 30.9 5.9 7.1 7.2 0.2 0.0 0.3 0.3 0.1 0.2 32.5 12.9 25.9 1.6 967 25-29 70.2 50.9 37.6 8.6 9.3 11.1 3.3 0.0 0.7 0.5 0.1 0.7 44.4 20.1 34.9 2.1 1,585 30-34 75.7 59.7 41.5 9.7 7.5 15.9 8.8 0.0 1.3 0.6 0.0 0.4 49.2 27.1 37.5 3.2 1,730 35-39 76.6 59.6 39.8 10.3 6.4 15.3 14.7 0.1 1.7 0.3 0.1 0.6 48.8 30.7 33.2 3.8 1,602 40-44 71.2 54.4 33.9 8.2 5.2 18.7 19.9 0.4 1.6 1.0 0.6 0.8 46.3 29.8 33.1 3.8 1,243 45-49 64.0 48.3 28.4 g.5 2.3 18.4 17.5 0.8 1.1 1.(3 0.0 0.4 41.2 25.9 29.6 4.2 965 Total 69.4 52.5 35.8 8.6 6.5 14.2 10.3 0.2 I.I 0.6 0.I 0.5 44.0 24.4 32.6 3.0 8,336 52 4.3 Current Use of Family Planning Methods The level of current 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. An inverted U-shaped pattern of prevalence by age is observed, which is typical of most countries. Among currently married women, a peak in use occurs at age 35-39 for any method or any traditional method and at age 30-34 years for any modern 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 use of pill is popular among the younger women who are still in their early stages of family building, peaking at age 20-29 years. Current use of calendar/rhythm/periodic abstinence is highest among married women age 35-39 years, while withdrawal is highest among those age 25-29 years. The contraceptive prevalence rate is 47 percent; 28 percent are using modern methods and 18 percent traditional methods. Female sterilization and the pill are the most preferred methods (10 percent each). Withdrawal and calendar/rhythm rank next (9 percent each), IUD fifth (4 percent), followed by injection and condom (2 percent each). The remaining methods have fewer users, each being used by one percent or less of married women (see Figure 4.2). P 10 Other methods 1% Figure 4.2 Use of Contraception among Currently Married Women 15-49 Withdrawal IUD Condom 9% 4% Female ection 2% Calendar/ rhythm 9% Not using 53% 1998 NDHS 53 Table 4.4 Current use of contraception by age Percent distribution of all women and currently married women by contraceptive method currently used, according to age, Philippines 1998 Modem methods Traditional methods Mucus, Lac- Any Not Any Any Female Male Billings, tational tradi- Calen Other cur- Number meth- modem Injec- Con- stcrili- sterili- ovula- amenor- tional dar, Breast- With- meth- rently of Age od method Pill IUD tion dora zation zation tion rhea method rhythm feeding I drawal ods using Total women ALL WOMEN 15-19 1.5 1.0 0.5 0.2 0.2 0,0 0,0 0.0 0.0 0.0 0.6 0.1 0,0 0.4 0.0 98.5 100.0 2,924 20-24 16.2 10.1 6.6 1.4 1.3 0,6 0.1 0.0 0.0 0.0 6.1 1.6 0.3 4.3 0.0 83.8 1(30.0 2,299 25-29 35.1 21.2 11.3 3.3 2.6 1.3 2,5 0.0 0.2 0.1 13.9 4.8 0.5 8.4 0.2 64.9 100.0 2,209 30-34 44,l 27.6 11.8 4.1 2,5 1.6 7.5 0.0 0.0 0,1 16.5 8.1 0.5 7.5 0.4 55.9 100.0 2,058 35-39 48.1 28.3 7.3 3.9 1.5 1.8 13.6 0,1 0.1 0.0 19.8 10.9 0.5 7.9 0.4 51.9 100.0 1,842 40-44 41.4 24,8 2.1 2.0 1.5 1.3 17.3 0.3 0.4 0.0 16,6 10.2 0.1 6.0 0.3 58.6 100.0 1,480 45-49 29.1 18.5 0.7 1.0 0.3 0,8 15.3 0.4 0.0 0.0 10.5 5.4 0.0 4.9 0.2 70.9 100.0 1,170 Total 28.2 17.2 5,9 2.2 1.4 1.0 6.4 0.1 0.1 -- 11.0 5,2 0.3 5.3 0.2 71.8 1130.0 13,983 CURRENTLY MARRIED WOMEN 15-19 18.3 11.4 6.2 2.3 2,5 0,0 0.0 0.0 0.0 0.3 6.9 1.6 0.0 5,3 0.0 81,7 100.0 244 20-24 37.4 23.5 15.6 3.4 3.2 L0 0,2 0,0 0,1 0.0 13.9 3.4 0.4 10.0 0,1 62.6 100,0 967 25-29 48.6 29.3 15.7 4.6 3.5 1.8 3.3 0.0 0.2 0.1 19.3 6.7 0.7 11.7 0.2 51.4 100.0 1,585 30-34 52.1 32.5 13.9 4.8 3.0 1,9 8.8 0.0 0.0 0.I 19,6 9.6 0.6 8.9 0.4 47.9 100.0 1,730 35-39 54.1 31.6 8A 4.5 1.7 2,1 14.7 0.1 0.1 0.0 22,5 12.4 0.6 9.0 0.5 45.9 100.0 1,602 40-44 48.6 28.8 2.4 2.3 1.7 1.6 19.9 0.3 0.5 0.0 19,8 12,1 0.I 7.1 0.4 51.4 I00.0 1,243 45-49 34.3 21.5 0.8 1.3 0.4 0,9 17.5 0,5 0.0 0.0 12,8 6.6 0.0 5.9 0.3 65.7 100.0 965 Total 46.5 28.2 9.9 3.7 2.4 1,6 10,3 0.1 0.2 -- 18,3 8,7 0.5 8.9 0.3 53.5 100.0 8,336 lIncludes only those women who spontaneously mentioned breasffeeding as a method of family planning and said they are currently using it as a method. -- = Less than 0.05 percent A review of survey results over the past three decades reveals that the percentage using contraceptives at the time of the interview among women of childbearing age increased from 15 percent in 1968 to 48 percent in 1996. In 1997, it declined slightly to 47 percent and remained at this level until 1998 (see Table 4.5 and Figure 4.3). The use of modem contraception increased steadily from 3 percent in 1968 to 22 percent in 1988, and further to 31 percent in 1997, before declining slightly to 28 percent in 1998. The increase between 1968 and 1988 is mainly due to a significant rise in the percentage of sterilized women from less than 1 percent in 1968 to 11 percent in 1988. On the other hand, the use of traditional methods increased from 7 percent in 1973 to its peak at 21 percent in 1978. It subsequently declined to 15 percent in 1993, and then rose to a level of 18 percent in 1998. Table 4.5 Trends in contracentive use Percentage of currently married women 15-44 using modern contraceptive methods and traditional methods, Philippines, 1968-1998 Modem 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 Survey 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 i 24.9 15.1 40.0 1996 Family Planning Survey I 30.2 17.9 48.1 1997 Family Planning Survey J 30.9 16.1 47.0 1998 National Demographic and Health Survey t 28.2 18.3 46.5 Sources: World Bank, 1991; NSO, 1996; NSO, 1997; NSO and Macro International, 1994 1Based on currently married women 15-49 55 Figure 4.3 Trends in Contraceptive Use Philippines 1968-1998 60 50 40 30 20 10 0 Percent 1968 NDS 1973NDS 1978 RPFS 1983NDS 1988 NDS 1993NDS 1998 NDHS It~Modern methods DTraditional methods] The level of current contraceptive use is higher in urban areas (51 percent) than in rural areas (42 percent). Among urban women, female sterilization (13 percent) is the most popular method, followed by the pill (11 percent), whereas among rural women, the most commonly used methods are the pill (9 percent), withdrawal (8 percent), and calendar/rhythm/periodic abstinence (8 percent) (Table 4.6). Differentials in current contraceptive use among the 16 administrative regions of the country are large. The use of any contraceptive method is highest in Central Luzon (55 percent), Southern Mindanao (55 percent) and Northern Mindanao (54 percent), while Autonomous Region of Muslim Mindanao (ARMM) manifests the lowest use (16 percent). However, when current use of any modem method is examined, Cagayan Valley ranks first (39 percent), followed by Southern Mindanao (36 percent) and Central Luzon (35 percent). ARMM registers the lowest level of current use of modem methods (9 percent). The ranking changes with the current use of any tradit'tonal method with Central Visayas showing the highest level (23 percent) and ARMM the lowest (7 percent). The top ranking regions when pill use is considered are Cagayan Valley and Western Mindanao (16 percent each), and for female sterilization they are Central Luzon (19 percent) and Cordillera Administrative Region (15 percent). 56 Table 4.6 Cmxent use of egntraeeption by baek~ound characteristics Percent distribution of currently marciod women by contraceptive method currently used, according to selected background characteristics, Philippines 1998 Modem methods Traditional methods Lacta- Male Mucus, • tional Any Not Any Female steri- Billings, amen- ttadi- - cur- Number Background Any modem Injee- Con- sterili- liza- ovula- or- tlonal- Calendar Breast- With- Other- rently of characteristic method method Pill IUD lion dora zafion tion llon rhea method hythm feeding ~ dmwal methods using Total women Residence Urban 50.7 31.3 10.7 3.4 2.3 1.9 12.6 0.1 0.2 0.1 19.4 Rural 42.2 25.0 9.1 4.0 2.4 1.3 7.9 0.2 0.1 0.0 17.2 9.3 0.5 9.3 0.2 49.3 100.0 4,222 8.0 0.4 8.4 0.4 57.8 100.0 4.114 Region Metro Manila 49.4 28.7 10.6 1.7 0.6 3.1 12.4 0.0 0.1 0.1 20.7 10.1 Cordillera Admin. 42.0 30.6 7.0 2.3 3.9 2.3 14.8 0.3 0.0 0.0 11.4 4.4 lloeos 43.2 28.6 10.1 1.4 2.6 0.9 13.4 0.2 0.0 0.0 14.6 3.3 Cagayan Valley 48.3 38.8 16.4 5.1 4.5 0.0 12.3 0.2 0.0 0.2 9.4 3.1 C. L~zoa 54,8 35.1 12.1 0.7 2.0 1.0 19.3 0.0 0.0 0.0 19.7 6.4 S. Tagalog 45.0 26.6 7.9 2.9 2.5 1.3 11.9 0.0 0.1 0.0 18.4 5.6 Bieol 36.3 19.3 8.1 2.8 1.0 1.2 5.5 0.2 0.6 0.0 17.1 6.3 W. Visayas 45.0 25.5 8.5 2.6 3.0 1.5 8.7 0.6 0.4 0.2 19.5 11.7 C. Visayas 51.5 28,1 7.6 6.7 3.2 3.2 6.7 0.5 0.0 0.0 23.4 14.9 E. ~FLsayas 37.5 16.7 4.4 1.8 1.8 1.1 7.3 0.2 0.2 0.0 20.7 10.4 W. Mindanao 43.8 30.0 15.7 6.0 2.1 1.7 4.1 0.0 0.3 0.0 13.8 9.7 N. Mindanao 54.0 33.9 13.8 10.0 3.1 1.3 5.2 0.0 0.4 0.0 20.1 12.6 S. Mindanao 55.2 35.8 14.4 9.4 3.4 1.5 6.9 0.0 0.2 0.0 19.4 12.6 C. Mindanao 45.2 28.5 8.0 7.3 3.4 0.9 8.7 0.2 0.0 0.0 16.7 10.3 ARMM 15.8 8.7 3.6 0.2 1.9 0.0 3.0 0.0 0.0 0.0 7.2 1.7 Camga 48.8 28.7 8.8 6.9 4.1 1.3 7.5 0.2 0.0 0.0 20.1 12.4 Education No odueation 15.3 9.3 1.3 0.7 2.1 0.9 4.3 0.0 0.0 0.0 6.0 1.9 Elementary 41.1 25.4 8.6 2.9 2.3 1.1 10,2 0.3 0.1 0.0 15.7 6.1 High school 50.2 30.5 11.7 4.5 2.7 1.5 9.8 0.1 0.1 0.1 19.7 8.4 Callege or higher 50.3 29.9 9.8 3.8 2.0 2.4 11.5 0.1 0,3 0.1 20.4 12.5 Number of children None 3.1 0.9 0.6 0.0 0.2 0.2 0.0 0.0 0.0 0.0 2.2 0.7 1 35.5 18.2 11.7 3.4 1.4 0.8 0.9 0.0 0.1 0.0 17.2 7.2 2 52.1 30.3 14.1 4.3 3.7 1.9 6.0 0.2 0,2 0.0 21,8 10.0 8 59.0 40.1 12.5 4.3 2.2 2.5 18.4 0.2 0.0 0.1 18.8 8.7 4+ 49.8 30.2 7.2 3.8 2.6 1.6 14.5 0.1 0.3 0.1 19.6 10.1 Total 46.5 28.2 9.9 3.7 2.4 1.6 10.3 0.1 0.2 0.0 18.3 8.7 0.9 9.6 0.1 50.6 100.0 1,298 0.0 6.7 0.3 58.0 100.0 136 0.2 11.0 0.0 56.8 100.0 414 0.4 6.0 0.0 51.7 100.0 322 0.0 13.1 0.2 45.2 100.0 883 0A 12.4 0.0 55.0 100.0 1.219 0.6 9.0 1.2 63.7 100.0 481 0,6 7.0 0.2 55.0 100.0 627 0.7 7.8 0.0 48.5 100.0 620 0.0 9.8 0.5 62,5 100.0 395 0.5 3.2 0.5 56.2 100.0 343 0.0 7.5 0.0 46.0 100.0 295 0.0 6.2 0.5 44.8 100.0 572 0.0 5.7 0.7 54.8 100.0 273 1.9 0.8 2.8 84.2 100.0 252 1.1 6.2 0.4 51.2 100.0 208 0.6 2.2 1.4 84.7 100.0 169 0.5 8.6 0.4 58.9 100.0 2,756 0.6 10.5 0.3 49.8 100.0 3,050 0.2 7.6 0.2 49.7 100.0 2,361 0.0 1.5 0.0 96.9 100.0 560 0.3 9.7 0.1 64,5 100.0 1.406 0.3 11.2 0.3 47.9 100.0 1,652 0.6 9.1 0.4 41.0 100.0 1,666 0.6 8.4 0.5 50.2 100.0 3,052 0.5 8.9 0.3 53.5 I00.0 8,336 ~Inchides only those women who spontaneously mentioned breasffeeding as a method of family planning and said they are currently using it as a method. 57 Current contraceptive use differs by level of education. Only 15 percent of married women with no formal education are currently using a method, compared with 41 percent of women with at most some elementary education, and 50 percent of those with at least some secondary education or higher. Among women with no education or only some elementary schooling, female sterilization is the most widely used method, followed by withdrawal. Among women with some secondary schooling, the pill is the most widely used method, followed by withdrawal. It is interesting to note that among women who have at least some college education or higher, calendar/rhythm is the most commonly used method, followed by female sterilization. The level of contraceptive use is also strongly related to the number of children a woman has. Only 3 percent of married women with no children are currently using a family planning method. After the first child, contraceptive use increases sharply with the number of living children, peaking at 59 percent among women with 3 children, after which it declines. 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 the interview. The results indicate that Filipino women are adopting family planning fairly early in the family building process although only 4 percent of ever-users began using immediately after marriage or before the first birth. Overall, about one in three women began using family planning after the first child and about one in six started using after two children. Table 4.7 Number of children at first use of contracention Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Philippines 1998 Number of living children at time of first use of contraceptive Number Current Never used Miss- of age contraception 0 1 2 3 4+ ing Total women 15-19 68.7 6.5 21.0 3.3 0,3 0.0 0.2 100.0 248 20-24 40.1 7.0 39.5 9.8 2,5 1,0 0.0 100,0 1,004 25-29 28.2 4.7 38.5 17.1 7,2 4,2 0.1 I00,0 1,657 30-34 23.4 3.2 35.2 15.9 11.8 10,4 0.1 100.0 1,820 35-39 22.3 2.8 31.5 17.4 13.5 12.5 0.1 100,0 1,703 40-44 29.4 2.6 25.4 15.4 12,1 15,0 0.1 100,0 1,371 45-49 35.5 1.7 21.1 15.1 10,9 15,5 0.1 100.0 1,093 Total 29.7 3.6 32.0 15.2 9.8 9,6 0.1 100,0 8,896 58 The timing of first contraceptive use in terms of the number of living children varies among the different age cohorts of women. A higher percentage of younger women compared with older women started using contraception after having one child. For instance, two out of five women aged 20-24 years first used contraception after having one child, compared with one out of five women aged 45-49 years. The two age cohorts are worth noting as the 45-49 cohort has a slightly higher percentage of ever-users of contraception compared to the 20-24 cohort (64 percent versus 60 percent). 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 1998 NDHS 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 condom, female sterilization, withdrawal, and the KID reported having no problems with the method they were currently using. A slightly lower percentage of current users of the pill (86 pereen0 reported the same. Of those who have had problems with their methods, side effects were generally cited as the most common problem. Health concerns were reported by a little more than one percent of the current users of the pill, IUD, female sterilization and withdrawal. It should be mentioned that this question, which asks about problems with current method, may not have elicited a full reporting of problems. Women who had serious problems are likely to have discontinued the method. 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 1998 Female sterili- With- Main problem Pill IUD Condom zation drawal No problem 85.9 89.4 95.3 89.9 89.8 Husband disapproves 0.0 0.2 0.0 0.0 0.0 Side effects 12.1 7.9 2.1 8.1 8.1 Health concerns 1.2 0.8 1.4 1.4 1.5 Access/availability 0.0 0.2 0.0 0.0 0.0 Cost 0.1 0.0 0.0 0.0 0.0 Inconvenient to use 0.7 0.7 1.2 0.0 0.2 Other 0.0 0.2 0.0 0.5 0.1 Missing 0.0 0.6 0.0 0.1 0.3 Total 100.0 100.0 100.0 100.0 100.0 Number of women 831 310 138 898 742 59 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 calendar/rhythm method and natural family planning methods such as mucus/Billings/ovulation, basal body temperature, and symptothermal method. In the 1998 NDHS, women were asked during which days of a woman's menstrual cycle a woman has the greatest chance of becoming pregnant. A fifth of all women interviewed said they did not know when they are fertile during their ovulatory cycle (Table 4.9). In contrast, only a small proportion of those who have used calendar/rhythm (7 percent) did not know when a woman is most likely to get pregnant. However, only 14 percent of all women and 26 percent of ever-users of calendar/rhythm gave the "correct" response, that is, a woman's fertile period occurs in the middle of her cycle. About 33 percent of all women and 35 percent of ever-users of calendar/rhythm method said that a woman is most likely to conceive right after her period has ended. Smaller proportions reported that the least safe period is just before a woman's period begins. One-fifth of all women and 16 percent of users of calendar/rhythm reported that there is no particular time when women are at greater risk of conceiving. The findings indicate a need to further educate potential and actual users of natural family planning on the ovulatory process. Table 4.9 Knowledge of fertile period Percent distribution of all women and of women who have ever used calendar/rhythm by knowledge of the fertile period during the ovulatory cycle, Philippines 1998 Ever-users of Perceived calendar/ All fertile period rhythm women During menstrual period 0.4 0.9 Right after period has ended 34.5 33.2 ! In the middle of the cycle 25.7 13.8 Just before period begins 3.8 5.6 Other 13.1 6.8 No particular time 15.7 19.6 Don't know 6.5 20.1 Missing 0.1 0.1 Total 100.0 100.0 Number of women 728 13,983 60 4.7 Timing of Sterilization In the Philippines where female sterilization is one of the most widely used methods of contraception, 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 the operation is calculated for women sterilized at less than 40 years of age. Data shown in Table 4.10 indicate that 73 percent of sterilized women had their operation at age 25-34, and 12 percent were sterilized before age 25. There is evidence that, over time, women are having the operation at older ages; the median age at sterilization is 29 for women sterilized 8-9 years ago, and 32 for women who had the operation less than 2 years ago. Overall, the median age is 30 years. Table 4.10 Timin~ of sterilization Percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation, Philippines 1998 Age at time of sterilization Number Years since of Median operation <25 25.29 30-34 35-39 40-44 45-49 Total women ago <2 4.1 30.8 33.6 24.0 7.0 0.5 100.0 103 31.9 2-3 4.6 41.1 29.4 16.8 6.2 1.9 100.0 85 30.1 4-5 6.7 23.8 49.8 11.8 7.9 0.0 100.0 88 3t.5 6-7 7.3 33.9 32.3 24.0 2.5 0.0 100.0 121 31.2 8-9 11.8 44.2 29.8 14.3 0.0 0.0 I00.0 84 28.9 10+ 18.1 45.6 31.6 4.7 0.0 0.0 100.0 417 b Total 12.1 39.6 33.3 12.3 2.5 0.2 100.0 898 29.6 a Median age was calculated only for women less than 40 years of age to avoid problems of censoring. b Not calculated due to censonng 4.8 Willingness to Pay for Contraceptive Method Used Slightly more than one-third (35 percent) of current users of pills obtain these free of charge (Table 4.11). Three out of ten purchase a packet of pills at less than 10 pesos, 15 percent, at 10 to 24 pesos and another 14 percent at 25 to 99 pesos. When asked how much they are willing to pay for the pills, more than half (55 percent) of pill users expressed willingness to pay between 10 and 50 pesos per packet. Around one-fifth would still purchase it at more than 50 pesos but not to exceed 99 pesos. Of the users of injection, one-third obtain it for free, while around three-fifths pay less than 100 pesos per injection. Less than 5 percent pay 100 pesos or more. However, almost three out of ten are willing to pay 100 pesos or more per injection, one-quarter from 50 to 99 pesos, and 48 percent would rather pay less than 50 pesos. Almost three out of ten IUD users do not pay for the method, while more than half (53 percent) pay less than 100 pesos. Surprisingly, four out of ten IUD users expressed willingness to pay for the method at 100 pesos or more. Almost half of condom users are willing to pay less than 20 pesos for a packet of condoms. This is to be expected since 28 percent obtain the method for free, while another 39 percent pay less than 10 pesos per packet. 61 Table 4.11 Willingness to pay for contraceptive method used Percent distribution of current users of pill, injection, IUD; and condom, by cost of method and by amount willing to pay for method, Philippines 1998 Pill users Injection users IUD users Condom users Amount Amount Current willing Current willing Cost cost to pay Cost cost to pay Cost Amount Current willing cost to pay Cost Amount Current willing cost to pay Free 35.4 Free 33.2 Free 27.1 < 10 pesos 30.2 7.4 < 10 pesos 13.4 3.2 < 10 pesos 6.1 10 - 24 pesos 14.7 29.5 10 - 19 pesos 17.5 13.0 10- 19 pesos 8.3 25- 49 pesos 3.8 25.1 20- 29 pesos 10.2 17.4 20- 29 pesos 12.1 50 - 74 pesos 5.0 11.5 30 - 49 pesos 7.5 14.1 30 - 49 pesos 6.5 75 - 99 pesos 5.4 9.8 50 - 99 pesos 13.8 23.2 50- 99 pesos 19.9 100- 149 pesos 4.2 8.3 100 - 249 pesos 2.5 14.3 100 - 249 pesos 12.4 150- 199 pesos 0.0 1.7 250 - 499 pesos 1.3 11.1 250 - 499 pesos 4.3 200 - 299 pesos 0.4 1.2 500 - 749 pesos 0.2 2.5 500 - 749 pesos 1.1 300 pesos 0.1 2.3 750 - 999 pesos 0.5 0.7 750 - 999 pesos 1.1 >300 pesos 0.4 3.0 1,000 pesos 0.0 0.5 1,000 pesos 0.0 Don't know/ 0.5 0.2 Don't know/ 0.0 0.0 Don't know/ 1.2 missing missing missing Total 100.0 100.0 Total 100.0 100.0 Total 100.0 Mean 19.6 51.5 Mean 28.0 85.1 Mean 65.8 No. ofusers 831 831 No. ofusers 198 198 No. ofusers 310 Free 0.6 < 10 pesos 7.6 10- 19 pesos 10.7 20- 29 pesos 9.4 30- 49 pesos 29.1 50 - 99 pesos 18.7 100- 249 pesos l 3.3 250- 499 pesos 4.9 1.3 3.9 0.6 Don't know/ missing 28.3 38.6 15.5 18.1 32.3 2.7 20.4 2.2 12.8 1.5 6.9 0.8 8.4 1.4 3.7 6.4 0.0 100.0 Total 100.0 146.1 Mean 13.0 Note: Cost refers to the cost per packet of pills, per injection, and per packet of condoms; IUD cost includes cost of insertion. 310 No. of users 138 I00.0 32.3 138 4.9 Source of Supply of Modern Contracept ive Methods Current ly Used Information on sources of modem contraceptives currently used is useful for family planning program managers and implementors. The public sector (Table 4.12) emerges as the main source for a large majority of current users (72 percent) of modem contraceptives. In fact, about nine in I0 users of injection, four in five users of IUD, and three in four users of the pill obtained their methods from government sources. While government hospitals are the main source of female sterilization, barangay health stations and urbardmral health centers are the main sources for the pill, IUD, and injection. Pharmacies are an important source of pills and condoms. Table 4.12 Source of supply for modern contraceetive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply, according to specific methods, Philippines 1998 Female Source of supply Pill IUD Injection Condom sterilization Total Public sector 76.4 82.4 92.0 41.4 65.6 72.0 Government hospital 1.8 10.4 3.5 0.0 54.1 22.7 Rural/urban health station 31.3 41.4 33.7 17.4 7.1 22.7 Barangay health station 38.6 28.3 53.0 21.9 3.3 23.9 Barangay supply office 4.3 0.6 1.3 1.0 0.3 1.9 Other public 0.4 1.7 0.4 1.0 0.9 0.8 Medical private 22.7 15.8 7.5 54.1 32.7 26.3 Private hospital/clinic 3.2 13.4 5.7 3.0 30.8 15.4 Private doctor 2.6 1.8 1.3 0.0 1.6 1.9 Private nurse/midwife 0.4 0.4 0.5 0.0 0.1 0.3 Pharmacy 15.5 0.2 0.0 47.2 0.0 8.1 Store 0.6 0.0 0.0 2.4 0.0 0.4 NGO 0.1 0.0 0.0 0.0 0.0 0.1 Industry based clinic 0.3 0.0 0.0 1.4 0.0 0.2 Other private 0.9 1.2 0.5 4.5 1.1 1.4 Puericulture center 0.1 1.2 0.0 0.0 0.4 0.3 Church 0.0 0.0 0.0 0.0 0.6 0.3 Friends/relatives 0.8 0.0 0.5 3.8 0.1 0.7 Other 0.0 0.0 0.0 0.7 0.1 0.1 Don't know 0.0 0.0 0.0 0.0 0.3 0.1 Missing 0.0 0.6 0.0 0.0 0.2 0.2 Total 100.0 100.0 100.0 100.0 I00.0 100.0 Number of women 831 310 198 138 898 2,403 Note: Total includes 12 users of male sterilization, 13 users of mucus/Billings/ovulation method and 4 LAM users. 63 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. Table 4.13 shows the relevant information by urban-rural residence for current users of modem contraceptives. Among current users 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 20 minutes, on average. Table 4.13 Time to source of suonlv for modem contracentive methods Percent distribution of women who are currently using a modem contraceptive method by time (minutes) to reach a source of supply, according to urban-rural residence, Philippines 1998 T ime (minutes) tO source Women who are currently using a modem method Urban Rural Total 0-14 37.4 26.4 32.7 15-29 17.3 15.2 16.4 30-59 22.9 25.1 23.8 60+ 21.5 32.8 26.4 Don't know time 0.4 0.3 0.4 Don't know source 0.2 0.0 0.1 Not stated 0.2 0.2 0.2 Total 100.0 100.0 100.0 Median time to source 20.2 30.4 30.0 Number of women 1,363 1,040 2,403 64 4.10 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 4.14 shows the contraceptive discontinuation rates due to various reasons for selected contraceptive methods. The results show that overall, two in five users discontinue during the first year of use. The discontinuation rate is highest for condom (60 percent), followed by injection (52 percent), withdrawal (46 percent), and the pill (44 percent). The IUD has the lowest discontinuation rate---14 percent (see Figure 4.4). Withdrawal and calendar/rhythm show higher failure rates than the other methods; 22 percent of withdrawal users and 18 percent of the users of calendar/rhythm become pregnant within a year after starting the method. Side effects/health reasons are cited as the main causes for discontinuing use of injections (32 percent) and the pill (18 percent). "Other reasons" is an important category for condom. These include method-related reasons such as desire for a more effective method, inconvenience and disapproval of the respondent's husband. Table 4.14 First-year discontinuation rates for contracet~tion 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 1998 Reason for discontinuing contraceptive method Side Desire effects/ All Method to become Health other All Method failure pregnant concerns reasons reasons Pill 5.4 4.5 17.7 16.2 43.8 IUD 1.1 0.6 7.8 4.8 14.3 Injection 1.9 2.2 31.8 15.9 51.8 Condom 8.5 2.4 5.5 43.7 60.1 Calendar, rhythm 18.4 4.9 1.2 11.3 35.9 i Withdrawal 22.4 5,0 4,5 13.8 45,7 All methods 12.0 4.1 9.8 15.2 41.1 Note: Figures are based on life-table calculations. 65 Figure 4.4 Contraceptive Discontinuation Rates for First Year of Use Percent 70 60 5O 40 3O 2O 10 0 Pill IUD Injection Condom Calendar/ With- rhythm drawa{ 1998 NDHS Table 4.15 presents reasons for discontinuation among ever users who have discontinued use of a mt:!hod during the five years preceding the survey. Considering all methods, accidental pregnancy stands ,ut as the most important reason of stopping use of contraception. Side effects ranks second (16 percent) md desire for pregnancy is third (15 percent). Manipulable program variables, such as access/availability md cosl of methods, are minor reasons for discontinuing use of any method. Looking at specific methods, the most common reason for discontinuing use of the pill, IUD and injection is side effects, ~ hile method failure is reported by users of withdrawal and calendar/rhythm. Method failure accounts t,,, :d, onl half of the discontinuations of traditional methods. More users of condom discontinue use due + ' i~1~ onvellience than for any other reason. 66 Table 4.15 Reasons for discontinuing of contraception Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason for discontinuation, according to specific methods, Philippines 1998 Modern method discontinued Traditional method discontinued Reason for Calendar discontinuation Pill IUD Injection Condom rhythm Withdrawal Other Total Became pregnant 13.0 6.4 2.4 16.7 50.7 52.5 28.1 31.4 To become pregnant 17.0 20.3 5.9 8.1 19.4 12.4 17.3 15.1 Husband disapproved 0.8 0.9 3.0 9.8 1.9 3.3 2.2 2.5 Side effects 28.1 36.0 44.6 6.6 1.0 5.3 3.2 15.5 Health concerns 8.6 13.7 14.8 3.0 1.6 2.6 4.5 5.6 Access/availability 1.6 0.2 2.7 1.1 0.2 0.0 1.7 0.8 More effective method 2.0 4.8 3.4 6.3 7.9 8.1 9.7 5.6 Inconvenient to use 2.6 5.8 1.9 27.3 2.5 2.3 3.7 4.3 Infrequent sex 11.3 1.4 4.1 8.1 3.4 3.1 0.9 6.0 Cost 0.3 0.0 1.4 0.4 0.0 0.0 2.6 0.3 Fatalistic 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 Menopause 0.2 0.3 0.0 0.7 1.0 0.4 2.2 0.5 Marital dissolution 0.5 0.9 0.1 1.0 0.4 0.3 0.0 0.4 Other 8.2 5.6 6.7 5.2 3.5 2.3 14.1 5.4 Don't know 0.7 0.5 0.9 0.3 0.7 0.2 2.1 0.6 Missing 5.3 3.1 7.8 5.6 5.7 7.1 7.6 6.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 1,295 179 275 287 876 1,130 110 4,152 4.11 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, 54 percent do not intend to use a family planning method in the future (Table 4.16). One in three nonusers indicated their intent to use a contraceptive method in the next 12 months, while 8 percent said they will use it later. Among currently married nonusers with no living children, a much lower percentage (13 percent) intend to use a method in the next 12 months but 24 percent of them said they will use it later. 67 Table 4.16 Future use of eontraeention Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Philippines 1998 Number of living children I Fhtut¢ intention 0 I 2 3 4+ Total Intends to use in next 12 months 12.5 31.3 39.0 37.0 33.1 32.8 Intends to use later 23.5 13.3 7.3 6.6 2.6 8.0 Unsure as to timing 0.9 0.9 0.6 0.7 1.0 0.8 Unsure as to intention 6.4 5.0 4.2 3.3 2.8 3.9 Does not intend touse 56.8 48,9 48.4 52.0 59.7 53.9 Missing 0.0 0.6 0.6 0.3 0.9 0,6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 361 877 829 695 1,588 4,351 IIneindes current pregnancy One-fifth of married nonusers who say they do not intend to use family planning cited desire for pregnancy as the main reason for not using a method. A slightly lower percentage (18 percent) say that they fear side effects (Table 4.17). Other often cited reasons are "menopausal/ had hysterectomy" (14 percent) and health con- cerns (14 percent). Small proportions (6 percent or less) of nonusers cited "husband opposed" (6 per- cent), "opposed to family planning" (5 percent), religion (5 percent) and "older age, difficulty in becoming pregnant, infrequent sex and husband away" (5 percent) as reasons for not using contra- ception. Desire for more children, side effects and health concerns are reported more often by women under 30 than older women as the reason for not using contraception. Presented in Table 4.18 is the distribution of married nonusers who intend to use in the future by their preferred method. Two out of five nonusers who intend to use family planning in the future prefer to use the pill, 13 percent want to use calendar/rhythm/periodic abstinence, 12 percent want to use injection, 9 percent prefer to use IUD and another 9 percent, female sterilization. A larger percentage of women who intend to use contraception within the next 12 months prefer to use the IUD, injection, and female sterilization than those who want to use contraception after 12 months. Table 4.17 Reasons for not usine contracentlon Percent dis~butlon 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, Philip- pines 1998 Age Reason for not using Contraception <30 30+ Total Wants more children Respondent opposed Husband opposed Others opposed Religion Knows.no method Knows no source Costs too much Side effects Lack of access Inconvenient Interfere with body Health concerns Old/difficuli to get pregnant/ infrequent sex/husband away Menopausal/had hysterectomy Subfecund, infecuod Other Don't know/missing Total Number of women 26.7 18.8 ~.4 4.0 5.0 ~8 8,8 4.6 5.5 0.4 0.2 0.2 6.1 4.4 4.8 2,4 1.0 1.3 0,I 0.2 0.2 0.1 0.4 0.4 25.3 15.6 17.5 0.7 0.1 0.2 1.1 L0 1.0 0.8 1.0 1.0 15.3 13.4 13.8 3,0 5.3 4.8 0,5 17.9 14.4 0.6 4.0 3.4 2.2 6.6 5.8 1.8 0.4 0.7 100.0 100.0 100,0 468 1,877 2,345 68 Table 4.18 Preferred method of contraceotion for thture 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 1998 Intend to use In next After Preferred method 12 12 of contraception months months Total Pill 39.0 44.2 40.0 IUD 10.6 5.0 9.3 Injection 12.2 8.3 11.7 Condom 2.2 6.5 3.0 Female sterilization 9.4 5.7 8.7 Male sterilization 0.1 0.0 0.1 Calendar/rhythm/periodic abstinence 11.9 16.0 12.8 Mucus/Billings/ovulation 0.1 0.1 0.1 Basal body temperature 0.1 0.5 0.2 Symptothermal 0.1 0.2 0.1 Lactational amenorrhea 0.3 0.0 0.2 Breastfeeding 0.4 0.7 0.6 Withdrawal 7.2 7.5 7.1 Other 2.4 1.2 2.1 Unsure 4.1 3.8 4.0 Total 100.0 100.0 100.0 Number of women 1,426 349 1,811 Note: Total includes 36 women unsure as to timing of intended use. 69 4.12 Family Planning Messages in the Mass Media In the Philippine Family Planning Program, the Department of Health and Commission on Population are working hand in hand with other government 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 focuses 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; reiteration and specifying the health benefits 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, television, news- paper/magazine, posters and leaflets/brochures. During the few months prior to the survey, 67 percent of all women had heard about family planning on the radio, while 71 percent had seen it on television (Table 4.19). Less than half had read about family planning in a newspaper/magazine (44 percent), a poster (44 percent), or leaflet/brochure (34 percent). Women, irrespective of age and residence mainly hear about family planning from a radio or a television. A higher percentage of younger women than older women and of urban women compared with rural women had seen a family planning message on television. Moreover, urban women are more likely to see a message in a newspaper/magazine, poster and leaf- let/brochure compared with women in rural areas. The role of mass media as a channel for communicating family planning to the public is least important in the Autonomous Region of Muslim Mindanao (ARMM). Metropolitan Manila leads all regions in the level of family planning communication through television, newspaper/magazine and leaflet/brochure while Southern Mindanao leads in communications through posters. With radio as the source of family planning messages, Caraga tops the list (79 percent), and Ilocos, Northern Mindanao, Central Mindanao, and Western Mindanao rank second, third, fourth and fifth, respectively. Generally, more highly educated women are more likely to hear or see family planning messages from the different media of communication. Five in s

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