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Fact Sheet - Barriers to Contraceptive Use in the Philippines

Fact Sheet - Barriers to Contraceptive Use in the Philippines

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Contraceptive use has hardly increased in the Philippines over the past decade. Yet women are having, on average, about one more child than they would like. More than one-fifth of married women do not want to have a child soon or at all but are not using a contraceptive method.
Contraceptive use has hardly increased in the Philippines over the past decade. Yet women are having, on average, about one more child than they would like. More than one-fifth of married women do not want to have a child soon or at all but are not using a contraceptive method.

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Published by: BlogWatch.ph on Feb 15, 2011
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08/03/2012

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Ovrviw
•ContraceptiveusehashardlyincreasedinthePhilippinesoverthepastdecade.Yetwomenarehaving,onaverage,aboutonemorechildthantheywouldlike.Morethanone-fthomarriedwomendonotwanttohaveachildsoonoratallbutarenotusingacontraceptivemethod.•Cutbacksinpubliclyundedcontracep-tiveservicesandsuppliessince2004havereducedwomen’sandcouples’ac-cesstocontraceptives.Nationalsurveysrom1998to2008showthatwomenhavereliedincreasinglyonpharmaciesorcontraceptiveservices.Thisswitchtoprivate-sectorsuppliersislikelytoinvolvehighercostsandleadtoreducedaccess,particularlyorlow-incomewomenandcouples.•Fulfllingdemandorcontraceptiveswouldbeespeciallybenefcialtodisad-vantagedwomen,whousecontracep-tiveslessandexperienceunintendedpregnancymorethantheirbetter-ocounterparts.Poorwomenacebarrierstocontraceptiveusesuchascosts,poor-qualityservices,lackoawarenessooraccesstoasourceocontraceptivecare,andlackoawarenessomethods.How-ever,allgroupsowomenreportbarrierstousingcontraceptivesthatmustbeaddressedthroughimprovedpoliciesandprograms.
T Nd fOr CONTrCpTiON
•WomeninthePhilippinesincreasinglywantsmalleramilies.Accordingtona-tionalsurveys,womenaged15–49want2.4childrenbuthaveanaverageo3.3.•Thepoorestwomen(thosewhosehouseholdsallintothelowestwealthquintile)haveabouttwomorechildrenthantheywant,whilethoseintherichestquintilehaveonly0.3morechildrenthantheywant—evidenceoserioushealthandsocialinequities.Only41%othepoorestwomenusecontraceptives,com-paredwith50%othewealthiest.Mostothisdierenceisduetoloweruseosterilizationamongpoorwomen.•Premaritalsexualactivityisincreasing,creatingagreaterneedorcontraceptivesamongyoungwomenandmen.Amongallyoungadultsaged15–24,premaritalsexualactivityincreasedrom18%in1994to23%in2002(rom26%to31%amongyoungmenandrom10%to16%amongyoungwomen).
1
T pOliCy CONTxT 
•PovertyandreproductivehealthareheadlineissuesinthePhilippinesandwereespeciallyprevalentintheMay2010elections.Candidatesotentalkedaboutwhattheywilldoorthepoor,butexpandingaccesstocontraceptiveshasgarneredlimitedpoliticalsupport,despitetheinterrelationshipbetweenpoorreproductivehealthandpoverty.
 
•TheArroyogovernmentusesthenationalbudgettosupportonlymod-ernnaturalamilyplanning,*whichisapprovedbytheCatholicChurch—nottosupportmodern“artifcial”contracep-tives,suchaspills,injectables,IUDsandcondoms.•ThePhilippinehealthsystemiscom-plex,withthenationalgovernmentandabout1,700autonomouslocalgovern-mentunits(LGUs)sharingresponsibil-ityorprovidinghealthcare.TheLGUsarereetodecidehowmuchtheywillallocatetoamilyplanningservicesandwhichmethodstheywillsupport.•Manila(withapopulationo1.7million)eectivelybannedpublicandprivateprovisionocontraceptivesin2000,ollowingtheelectionoa“pro-lie”mayor.Underpressureromchurchofcials,thecurrentmayorhascontinuedthebanonpublicprovisionocontracep-tives.Accordingtorecentreports,similarbansareineectinNorthernSamarandAntipoloCity.•TheU.S.AgencyorInternationalDevelopment(USAID)wasthelargestcontributortoPhilippinepubliccontra-ceptiveservicesorseveraldecades,butphasedoutsupportbetween2004and2008.ThewithdrawaloUSAID’sundingplacedanewandcriticalconstraintontheabilityothegovernment,particular-lypoormunicipalities,tomeetcontra-ceptiveneeds.•PhilHealth,thenationalhealthinsur-anceprogram,provideslittlecoverageorcontraceptiveservices.Itcoverstuballi-gation,vasectomyandIUDinsertion,butnootherservicesormethods.PhilHealth
In Brief
*IncludesthemucusorBillingsOvulation,StandardDays,symptothermal,basalbodytemperatureandlactationalamenorrheamethods.
Facts on Barriers to Contraceptive UseIn the Philippines
 
Brrirs TO UsiNgCONTrCpTivs
•ThemostcommonreasonswhywomenwithunmetneedinthePhilippinesdonotprac-ticecontraceptionarehealthconcernsaboutcontraceptivemethods,includingaearosideeects.Forty-ourpercentreportedthesereasonsin2008,asdid41%in2003.•Thesecondlargestcategoryoreasonswhywomenwithunmetneeddonotusecontra-ceptivesisthatmanybelievetheyareunlikelytobecomepregnant—41%in2008,uprom26%in2003.Theirspe-cifcreasonsincludehavingsexinrequently,experiencinglac-tationalamenorrhea(temporaryinertilitywhilenursing)andbeinglessecundthannormal.•Thecostocontraceptivesupplieshasbecomeamorecommonreasonornonuseinrecentyears.Itwascitedby15%omarriedwomenwithunmetneedin2008,comparedwith8%in2003.Costisanevengreaterbarrieramong
UNT Nd fOrCONTrCpTiON
•Twenty-twopercentomar-riedwomenareabletobecomepregnant,butdonotwanttohaveachildinthenexttwoyearsoratallandarenotus-inganycontraceptivemethod.Thesewomenaredefnedashavinganunmetneedorcontraception.Anadditional17%omarriedwomenusetraditionalmethodsandareinneedomoreeective,moderncontraceptivestohavethebestpossiblechanceopreventingunintendedpregnancy.•Unmetneedishighestamongthepoorestquintileomar-riedwomen(28%)andlowestamongthetoptwoquintilesomarriedwomen(around20%).•Twenty-ourpercentoun-marriedsexuallyactivewomenaged15–29haveanunmetneedorcontraception.Anadditional21%otheseyoungwomenareusingtraditionalmethodsandhaveaneedormoderncontraceptives.•Theuseomoderncontracep-tives*amongmarriedwomendidnotincreaseinrecentyears,remainingat33–34%in2003–2008.Theuseotraditionalmethods—mainlyperiodicab-stinenceandwithdrawal—alsoremainedsteady,at16–17%,duringthesameperiod.•Severalactorsmayexplainthelevelingoomoderncon-traceptiveuseamongmarriedwomen:thephasingoutocon-traceptivesuppliesromUSAID,thenationalgovernment’socusonnaturalamilyplanning,thebanonpublicprovisionomod-erncontraceptivesinManilaandotherpartsothecountry,andpolicymakers’pooratten-tiontoqualityocare.•Inaddition,therearemanylocalbarrierstoincreasingcontraceptiveusethroughoutthePhilippines:geographicisolation,poverty,shortagesocontraceptivesupplies,LGUs’inabilitytoprocureandallocatecontraceptivesupplies,andalackomaleinvolvementinamilyplanning.
2
coverageisalsoskewedtowardbetter-ocitizens—mainlyemployeesothegovernmentandmidsizetolargecompanies.Poorpeoplewithoutregularemployment,thesel-employedandmostotheruralpoormustenrollontheirownorbeenrolledasindigentsbytheirLGUs.Fewerthanone-thirdopoorwomen(thoseinthepoor-esttwoquintiles)arecoveredbyanytypeohealthinsurance.
TrNds iNCONTrCpTiv Us
•Contraceptiveuseamongmarriedwomenhasincreasedveryslowlyinthepast10years,rom47%in1998to51%in2008—anaverageincreaseoonlyabout1%peryear(Figure1).Bycontrast,contraceptiveuseincreasedmorerapidlyintheearly1990s,rom40%in1993to47%in1998.
BarrierstoContraceptiveUseinthePhilippines
2
guttmache inttute
Contacete Ue n the phne
The ooton o mae omen un a contacete metho hachane oe the at ecae.
15252833341816170102030404049515060708090100Modern methods Traditional methods19981993 2003 2008
    %    o    f   m   a   r   r    i   e    d   w   o   m   e   n   a   g   e    d    1    5  –    4    9
47
Demographic and Health Survey year
souce o oen Contacete
an omen un moen metho tche om ubc acte toate hamace beteen 2003 an 2008.
 
Government hospital
20032008
Government health centerBarangay health stationPharmacyOther private-sector source25201423201217151440
Figure 2Figure 1
*ReerstomaleandemalesterilizationandtheIUD,injectable,pillandcon-dom,aswellasmodernnaturalamilyplanning.†ThistotaldiersslightlyromthepercentagesinFigure2becauseorounding.
 
•Thegovernmenthasnotacknowledgedthattheces-sationoUSAIDundinghasreducedaccesstomoderncontraception.Rather,itclaimsthatthenewocusonnaturalamilyplanninghasbeenasuccess.Accordingtothe2008DemographicandHealthSurvey,however,thenaturalamilyplanningprogramellarshortoitstargetoraisingtheuseosuchmethodsto20%:Theproportionocurrentlymarriedwomenusingmodernnaturalamilyplanningmethodsis0.5%.•TworeproductivehealthbillsthatarestalledintheHouseandSenateasoMay2010con-tainvariousmeasuresregardingundingorandaccesstoamilyplanningservices.Ienacted,allnationalandlocalhospi-talswouldberequiredtooeramilyplanningservicesandtoprovidethemreeochargetopoorpatients.PhilHealthwouldberequiredtocovertheullcostoamilyplanningorthreeyearsatertheuseoanypregnancy-relatedbeneft,andcontraceptiveswouldbede-viablepublicprogram.Thus,ac-cesstocontraceptivesorpoorwomennowdependslargelyontheabilityandwillingnessoLGUstotakeovertheprogram.Withinthelimitsotheirund-ing,LGUscanpurchasecon-traceptivesandincludeamilyplanningservicesaspartotheirpublichealthunctions,butmanyhavedevotedtooewresourcestomeetwomen’sneeds.•TheDepartmentoHealthissuedanadministrativeorder(AO158)in2004callingonthegovernmenttoactasa“guaran-torolastresort”byensuringthatcontraceptivesremainavailableorcurrentuserswhodependondonatedsupplies.TheordergivesLGUsrontlineresponsibilityordistributingreecontraceptivestouserswithoutthemeanstopay.How-ever,thestrategyhasailed:Thepublicsectorhasnotflledgapsinservices;instead,ithasdeclinedgreatlyasasourceocontraceptivesuppliesandservices,especiallyorthepoor.privatepharmaciesinthatfve-yearperiod.•Amongmodernmethodus-ers,increasedrelianceontheprivatesectorhasbeengreatestamongpoorwomen,whohavethemostdifcultypayingorcontraceptiveservices.Whiletheproportionothewealthiestwomenusingapublicsourcedecreased13percentagepointsrom2003to2008,thepropor-tionowomeninthepooresttwoquintilesusingapublicsourcedroppedby25–26per-centagepoints(Figure3).
pUBliC-sCTOr filUrTO iNCrs CCss
•ThePhilippineDepartmentoHealthmaintainsthattheprimaryresponsibilityorpro-vidingamilyplanningserviceslieswiththeLGUs.Yetlocalgovernmentsdonotreceivesu-fcientundsundertherevenue-sharingschemetoullymeetthisresponsibility.TheDepart-mentoHealth,whichprocuresdrugsandsuppliesortubercu-losiscontrol,immunizationandmalaria,couldalsopurchasecontraceptivesupplies,iitgaveprioritytoamilyplanningservices.•PhilHealthisalsoailingtoimproveaccesstohealthcare,includingcontraceptiveservic-es,orthepoor.ThePhilHealthreportorthefrstsixmonthso2009showedthatthepoorestsector(“sponsored”members)madeup24%omembershipbutreceivedonly14%oben-efts,whilethoseemployedintheprivatesectoraccountedor35%omembership,paid62%ocollectionsandreceived84%obenefts.•ThegovernmenthasnotreplacedtheUSAID-undedamilyplanningprogramwithathosewhoaresingleandsexu-allyexperienced:Accordingtoa2004nationalsurvey,42%mentionedthisasareasonornotusingcontraceptives.
3
•Oppositiontoamilyplanningbywomen,theirpartnersortheiramiliesisadecreasinglyimportantactorinthePhilip-pines.Personalorreligiousoppositionwasreportedby10%owomenwithunmetneedin2008,downrom18%in2003.•Only5%owomenwithunmetneedcitedoppositionbytheirpartnersoramiliesastheirreasonornotpracticingcontraception.Still,morepoorwomenthanbetter-owomenreportedsuchopposition:9%amongthepoorestquintile,comparedwith3%amongthewealthiestquintile.
pUBliC-sCTOr sUpplyOf CONTrCpTivs
•Theproportionomodernmethoduserswhoobtaintheirsuppliesromthepublicsectorhasdeclinedsharply,rom67%
in2003to46%in2008(Figure2).Correspondingly,moreusershaveobtainedcontraceptivesromtheprivatesector,particu-larlyrompharmacies.•Allcategoriesopublic-sectoracilitiessawdeclinesintheproportionocontraceptiveuserstheyserve.Declinesweresmallerinhospitals,however,thaningovernmenthealthcentersandBarangayhealthstations.•Intheprivatesector,onlypharmaciesexperiencedamajorchangeintheshareouserstheyserve;theyserved17%ousersin2003and40%in2008.Thismeansthatabout23%ocontraceptiveusersswitchedromapublic-sectorsourceto
pubc-secto su o oen etho
The ooton o oo omen obtann contacete om theubc ecto oe amatca beteen 2003 an 2008.
252833340102030405060708090100847853725064424431582003 2008PoorerPoorest Middle Richer Richest
    %    o    f   m   o    d   e   r   n   m   e   t    h   o    d   u   s   e   r   s   a   g   e    d    1    5  –    4    9
Wealth quintiles
Figure 3
guttmache inttute
3
BarrierstoContraceptiveUseinthePhilippines

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Johnrob Bantang added this note
5. Premarital sexual activity is THE problem, not just its consequences. Why just treat a band-aide when the wound is left untreated? What about the issue of STDs and STIs, clearly contraceptive chemicals cannot handle this (except probably condom, but still arguably not in the long run).
Johnrob Bantang added this note
4. Obviously, inequitable distribution of wealth and opportunity to education are the root causes of "sterilization" problem. On the second point, why use "sterilization" for the poor while "contraception" for the rich? One feels that poor are not worthy to live this planet -- sounds like Hitler to me.
Johnrob Bantang added this note
3. Wanting only 2.4 children (on the average for the whole country) is a very rough measure. Why would a law needed just to cover that "want"? What is really the best number of children for the economy and true welfare of the population in the future? Should the entire populace be burdened just because of the average survey?
Johnrob Bantang added this note
2. If the target is more accessible (and cheaper) (artificial) contraceptive methods, then why not the government just force the producing Companies to lower their prices? How about lowering their taxes if the State really want to make this happen?
Johnrob Bantang added this note
1. When only 20% of the women want to reduce their number of children AND are not using contraception, the problem is promotion, not law. On the second place, should there be a law at all when only 20% of the populace need it?

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