MODULE 1

The Philippine Family

Planning Program
 Module Overview
• The module provides information on the Philippine
Family Planning Program as a health intervention
and its contribution to reduction of maternal and
child mortality.
• Overview of the program in terms of its evolution, FP
coverage, policies, strategies and its benchmarks
• Integration of FP with other elements of RH

• Health benefits of FP and risk factors that affect

maternal health
Module Objectives

At the end of the module, the participants

will be able to:
 Explain the Philippine Family Planning
Program (PFPP) as an intervention to
improve the health of all Filipinos with
special attention to women and children.
 Relate Family Planning to reduction of
Maternal & Child Mortality.
Module Sessions

Session 1 – Overview of the Philippine Family

Planning Program
Session 2 – Family Planning & Reproductive
Health
Session 3 – Health Benefits of Family Planning
Session 4 – Maternal High Risk Factors
 SESSION 1
Overview of the Philippine
Family Planning Program
Learning Objectives:
At the end of the session, the participants will be able to:
 Explain the evolution of the Philippine FP program.
 Describe the PFPP in terms of its vision, mission, goal,
and objectives.
 Explain the 4 pillars of the PFPP.
 Explain the implementing guidelines and policies of
the PFPP as stipulated in A.O. 50-A, s. 2001,
otherwise known as the National FP Policy.
 Enumerate the FP program methods.
Learning Objectives:

 Enumerate benchmarks on the implementation of

a FP program.
 Explain the health status and FP situation as it
relates to the attainment of the MDGs on:
maternal mortality, under 5 mortality, population
growth rate, total fertility rate, FP unmet need,
and the contraceptive prevalence rate.
 Identify activities towards the improvement and
attainment of program benchmarks.
1970’s – mid 1980’s

National Population Program

 Coordinating body was the POPCOM
 FP service delivery implemented by the
DOH, NGAs, NGOs, and the private sector
 Aim was to achieve population control
through a contraceptive-oriented approach
1986-1992

Philippine Family Planning Program

 Reorientation of the program from a population
control to a health intervention for improvement of
the health of mothers and children.
 FP program component transferred from the
POPCOM to the DOH.
 FP service delivery devolved to the LGUs.
 DOH responsible for policy formulation,
standards/guidelines setting, technical assistance
provision, licensing and regulation.
1995-1998

 ICPD Plan of Action

 Philippines was one of the 179 country
signatories
 Commitment to ensuring universal access to
reproductive health services, including FP, and
equality for men and women.
 DOH developed the RH Policy with FP as the
core element of RH and integration of FP to the
other RH services
2000 - present

 AO no. 50-A , s. 2001: The National FP Policy

 Prescribes
the key policies for FP services focused
on modern FP methods, including natural family
planning.
 Stipulates
the guiding principles (4 pillars)of
program implementation
2000 - present (continuation)

 Millennium Development Goals (MDG)

Summit
 Philippinesis signatory to the commitment of
achieving the goals
 Health goals:
 Improvement of maternal health and reduction of
maternal deaths
 Reduction of child mortality
 Combating AIDS, malaria, and other emerging
diseases
2000-present (continuation)

 Philippine
Government decided to become
contraceptive self–reliant.
 Maternal, Newborn, Child Health and Nutrition
(MNCHN) strategy was introduced to address the
need to reduce both maternal and infant
mortality.
Vision

To empower women and men to live healthy,

productive, and fulfilling lives with the right to
achieve their desired family size through
quality, medically sound, and legally
permissible FP methods.
Mission

The DOH, in partnership with the LGUs, NGOs,

private sector, and communities shall ensure the
availability of FP information and services to all
men and women of reproductive age who need
them.
Goal

To provide universal access to FP information and

services whenever and wherever these are needed.
Objectives

1. To help couples and individuals achieve

their desired family size within the context
of responsible parenthood and improve
their RH to attain sustainable development.
2. To ensure quality FP services are available
in DOH-retained hospitals, LGU-managed
health facilities, NGOs, and the private
sector.
 Four Pillars/ Guiding Principles of
the FP Program

1. Responsible Parenthood

2. Respect for life

3. Birth Spacing (at least 3 years)

4. Informed Choice
Four Pillars/ Guiding Principles of the
FP Program

1. Responsible Parenthood
• Is the will and ability to respond to the needs
and aspirations of the family.
• Promotes the freedom of responsible parents to
decide on the timing and size of their families
in pursuit of a better life.
Four Pillars/ Guiding Principles of
the FP Program

2. Respect for life

• The 1987 Constitution protects the life of the
unborn from the moment of conception
• FP aims to prevent abortions thereby saving
lives of both mothers/women and children.
Four Pillars/ Guiding Principles of
the FP Program

3. Birth spacing

• Proper spacing of 3 to 5 years from recent

pregnancy enables women to recover from
pregnancy and to improve their well-being, the
health of the child, and the relationship between
husband and wife, and between parents and
children.
 Four Pillars/ Guiding Principles
of the FP Program
4. Informed choice
• Couples and individuals are fully informed on the
different modern FP methods: its mechanisms of
action, advantages, disadvantages and possible
side effects.
• To decide and choose the method that they will
use to exercise responsible parenthood in
accordance with their religious and ethical values
and cultural background, subject to conformity
with universally recognized international human
rights.
Policies
• FP is a health intervention.
• FP information and service provision be based on
voluntary and informed choice regardless of age,
sex, number of children, marital status, religious
beliefs, and cultural values.
• Only medically safe and legally acceptable FP
methods be made available in all public and private
health facilities.
• Quality of care be ensured in providing FP services.
Privacy and confidentiality be observed at all times.
Policies

• Every client oriented on fertility awareness to fully

understand and appreciate FP.
• Integrate FP services in other RH programs (one
stop shop health care delivery).
• Multiagency participation encouraged at all levels
of operations
• Sustainability of FP services and commodities
promoted through localization and adoption of the
Contraceptive Self-Reliance (CSR) strategy.
Strategies
 Focus service delivery to the urban and rural poor
 Re-establish the FP outreach program
 Strengthen FP provision in regions with high unmet
need
 Promote frontline participation of hospitals
 Mainstream modern natural FP
 Promote and implement CSR strategy
 Integration of FP with other RH elements
 Ensure quality of care through compliance to
Informed Choice and Voluntarism (ICV) principles
 Capacitate high volume service providers
Components
 Service Delivery
 Training
 Logistics Management
 IEC and Advocacy
 Monitoring and Evaluation
 Research and Development
 Management Information System
The FP Program Methods

Modern methods
 Permanent methods
Female sterilization
Male sterilization
 Supply methods
Pills
IUD
Injectable
Male condom
The FP Program Methods

 Fertility Awareness Based Method (FAB)

• Billings Ovulation/ Cervical Mucus Method
• Basal Body Temperature
• Sympto-thermal Method
• Standard Days Method
• LAM
FP Benchmarks (2003-2010)

• Reduced population growth rate (PGR )

from 2.3 to 1.9
• Reduced total fertility rate (number of
children) that a woman could have during
her reproductive period) from 3.5 to 2.1
FP Benchmarks (2003-2010)

• Increased CPR from 48.9% to 80%

• Increased modern FP methods use from
33.4% to 60%
• Reduced FP unmet need from 17.3% to
8.6%
 SESSION 2
FAMILY PLANNING AND
REPRODUCTIVE
HEALTH
Learning Objectives

At the end of the session, the participants

will be able to:
 Explain the Administrative Order (AO) for
Reproductive Health (RH).
 Define Reproductive Health.
 Enumerate the 10 elements of RH.
 Explain how FP could be integrated with the
other RH elements.
 Explain the MNCHN strategy.
The Philippine RH Program &
Policy

 In 1998, DOH issued AO 1-A establishing

the Philippine RH Program, which
defined the RH service package
consisting of 10 elements to include FP.
 AO 43, s 1999 adopting the RH Policy to
integrate RH services in all health
facilities as part of basic package of
health services.
Definition

The state of complete physical, mental and

social well- being and not merely the
absence of disease or infirmity, in all matters
relating to the reproductive system and to its
functions and processes.
Ten Elements
1. Family Planning
2. Maternal and Child Health and Nutrition
(MCHN)
3. Prevention and Management of
Reproductive Tract Infections (RTIs)
including Sexually Transmitted Infections
(STIs), and HIV and AIDS
4. Adolescent Reproductive Health (ARH)
5. Prevention and Management of Abortion
and its complications (PMAC)
Ten Elements
6. Prevention and Management of Breast and
Reproductive Tract Cancers and other
gynecological conditions
7. Education and counseling on sexuality and
sexual health
8. Men’s reproductive health (MRH) and
involvement
9. Violence against women and children
(VAWC); and
10. Prevention and management of infertility
and sexual dysfunction
1. Maternal and Child Health and
Nutrition

Central to the attainment of optimum MCHN is

proper birth spacing of at least 3 years to
give ample time for the mother to regain their
health and to properly care for her newborn.
Through the use of safe and effective FP
methods, the risks of pregnancy among “too
young, too old, too frequent and too many”
can be avoided.
1. Maternal and Child Health and
Nutrition

 Pregnant women and most mothers are

sexually active and may have unmet need for
FP.
 They should be reminded of available FP
services so that they know when and where to
consult.
 Breastfeeding mothers have specific needs for
FP that should consider the quality and quantity
of breast milk for health of the infant.
2. Prevention and Management of
RTIs, including STIs like HIV

• Individuals with FP needs are sexually active which

makes them at risk for sexually transmitted infections
(STIs) like HIV.
• Clients who are at risk of contracting STIs need dual
protection through the use of FP method such as
condoms that also provide protection from pregnancy.
• Risk assessment for STIs is part of determining the
client’s eligibility for IUD use (both for initial and
continuing use)
3. Prevention and Management of
Abortion and its Complications
 Abortions are the result of unplanned pregnancies.
 One of the major causes of maternal deaths is due to
the complications of unsafe abortion.
 Women who resort to abortion have unmet needs for
FP.
 FP provides men and women with options for
preventing unplanned pregnancies which may result
to abortion.
 Proper management of complications consists of
medical treatment and provision of FP counseling
and services.
4. Prevention and Management of
Breast and Reproductive Tract
Cancers and Other Gynecological
Conditions

 Provision of FP services presents an

opportunity for screening and early detection
of breast and reproductive tract cancers.
 Combined oral contraceptives are proven to
reduce the risk of ovarian and endometrial
cancers.
5. Education and Counseling on
Sexuality and Sexual Health
 An understanding of basic concepts on fertility
deepens the appreciation of gender roles and their
differences and enhances the relationship between
sexual partners.
 Fertility management is an essential part of sexual
health
 Sexuality education is a basic component of the FP
program.
 FP counseling and providing correct information on
sexuality will help reduce unplanned pregnancies
6. Men’s Reproductive Health and
Involvement
 Men are crucial halves in the attainment of a couple’s
reproductive intentions and should be involved in FP.
 Male involvement is critical to acceptance and
continuous use of FP. This can be in the form of
supporting their partners’ use of FP, or by being
acceptors themselves and in performing family
obligations and other shared responsibilities such as
child rearing.
 Men have their own specific health needs for FP that a
comprehensive RH service should provide for
7. Adolescent and Youth Health

 Adolescents have the potential to be sexually

active and need to be advised and counseled
about safe and responsible sexual practices,
including FP.
 Orientation
on fertility awareness and
counseling are basic services which will
help promote responsible sexuality among
adolescents. Responsible sexuality will help
reduce unplanned pregnancies and RTIs.
 8. Prevention and Management of
Infertility and Sexual Dysfunctions

 Fertilityawareness during FP counseling

may provide the opportunity to discuss
infertility and sexual dysfunction problems,
which are normally difficult topics to bring
out in the open.
 FPis not only for delaying pregnancies but
also for achieving fertility through fertility
awareness orientation, counseling and
referral to appropriate facilities.
9. Violence against women and
children
 FPuse may be a sensitive issue in a family affected
by a gender-related violence (i.e women who are
beaten up because they do not want to get pregnant).
Health providers need to be tactful while ensuring
that clients’ needs are met.
 Domestic violence, mostly with women as the
victims, is now recognized as an important public
health issue.
 Sexualviolence is one of the most common forms.
This provides an opportunity to discuss and promote
FP
MNCHN Strategy
Ensures that:
• Every pregnancy is wanted, planned and supported

• Every pregnancy is adequately managed throughout

its course
• Every delivery is facility-based and managed by
skilled birth attendants; and
• Every mother and newborn pair secures proper
postpartum and postnatal care with smooth
transitions to the women’s health care package for
the mother and child survival package for the
newborn
 SESSION 3

HEALTH BENEFITS OF
FAMILY PLANNING
 Learning Objective

At the end of the session, the participants

will be able to:
Identify the health benefits of family planning
to mothers, children, and fathers.
 Benefits to Mothers
Reduction in Maternal Mortality and
Morbidity
 Prevention of high risk pregnancies among
women who are too young, too old, too
many or too ill to bear children safely
 Unplanned pregnancies are avoided and
pregnancies are spaced by at least three
years
 Prevention of closely spaced pregnancies
that leads to and worsen such conditions as
anemia and maternal malnutrition

64
Benefits to Mothers
 Non-contraceptive health benefits of COCs-
prevents:
Ectopic pregnancy Benign breast disease
Ovarian cancer/cysts Endometrial cancer
Excessive menstrual bleeding Menstrual cramping,
and associated anemia pain, and discomfort

 All FP methods help women with HIV to avoid

pregnancy and thus avoid bearing HIV-infected
children
 Benefits to Infant and Child

Reduction in Infant and Child Mortality and Morbidity

 Globally, an estimated 14.5 million infants and children
under age five die every year, mainly from respiratory
and diarrheal diseases complicated by malnutrition
 Recent studies indicate that the lowest risks for fetal
death, pre-term delivery, small for gestational age,
neonatal death, and low birth weight occur when births
are spaced from three to five years. (Demographic and
Health Surveys, 2002)
Benefits to Infant and Child

 Reduction in Infant and Child Mortality and

Morbidity
 Properly spaced children at least 3 years will be given
the love, attention, care and time from mothers and
fathers to attend to their growth and development.
 Fewer children in the family will be provided more
opportunities for adequate food, clothing, good
education and good health.
 Breastfeeding protects infants against diarrheal and
other infectious disease as well as protects mothers
from postpartum hemorrhage
Benefits to the Fathers
 Provides fathers who are suffering from chronic illnesses
(eg. Diabetes, Hypertension) enough time for treatment and
recovery from those illnesses
 Lightens his burdens and responsibilities in supporting his
family since he will only be providing for the number of
children he can afford to support
 Enables him to give his children good home, good
education and better future
 Gives time for his own personal achievement

 Enables him to have time and opportunity to relate with his

wife and play with his children
 Will have extra resources and enough time to actively
participate in community program and projects.

Module 1: The Philippine Family Planning Program

 SESSION 4
Maternal High-Risk
Factors
Learning Objectives

At the end of the session, the

participants will be able to:
Discuss the maternal high risk factors in
pregnancy and childbirth, its
complications to the mothers and infants.
Maternal High-Risk Factors
1. Too Young
 Pregnancy complications of mothers who are at young
age (below 18 years old) include the following:
• Hemorrhage
• Iron deficiency anemia
• Toxemia of pregnancies
• Miscarriage
• Prolonged labor
 Infants of mothers who are too young are in danger of:
• Low birth weight
• Birth-related defects
• Prematurity
• High incidence of fetal deaths and morbidity
Maternal High-Risk Factors

2. Too Old
 Pregnancy complications of mothers who are at
advanced age (35 years old and above) includes :
 Hemorrhage
 Prolonged labor
 Toxemia of pregnancies

 Infants born to older women also have a much greater

risk of having the following birth defects:
 Heart defects
 Birth defects (e.g cleft palate and lip )
 Down’s syndrome
 Higher incidence of stillbirths and fetal deaths
Maternal High-Risk Factors

3. Birth Number (Too Many)

• Four or more deliveries are more likely to
experience problems during pregnancy and
labor and to require caesarean section
• Has a significantly higher risk of
miscarriage and perinatal morbidity and
mortality than women undergoing their
second or third delivery.
Maternal High-Risk Factor

4. Birth Interval ("Too Close")

 Complication to mothers of birth interval of
less than three years :
• anemia and malnutrition
• more vulnerable to illnesses
• mothers are physically stressed and
burdened by pregnancy, needs at least
three years to regain her nutritional status
Maternal High-Risk Factor
 Babies born less than three years will result
to :
 the early weaning of the child from the mother
often times will result to child’s diarrheal disease
and malnutrition
 low birth weight
 high infant deaths (1-1.5x more likely to happen)
 lower resistance to communicable diseases
Maternal High-Risk Factors
5. Too ill or Unhealthy or with Medical Conditions
Women with chronic medical conditions ( eg.TB, cardiac
disease , mental health condition, cancer) require
treatment and therefore needs to postpone or limit
pregnancy through family planning.
 Pregnancy complicates physiological processes of
treatment and rehabilitation
 Pregnancy adds burden to a body already burdened
by disease
Danger to infants
• Adverse effects caused by medicines used to treat
the disease (eg. Congenital malformations,
stillbirths)
Key Messages
1. FP as a health intervention that contributes
to the reduction of maternal and child
mortality
2. FP is anchored on the 4 Pillars namely:
- Birth Spacing (at least 3 years)
- Informed Choice
- Responsible Parenthood and
- Respect for Life
3. FP saves lives and is pro quality life