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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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