Filipino Women Who Use a Modern Method Prefer the Pill or Tubal Sterilization
Women in the Philippines can expect to have 3.7 children over the course of their reproductive years, if current fertility rates remain constant. According to the 1998 Philippines National Demographic and Health Survey (PNDHS), 47% of married women currently practice contraception.1 The pill and female sterilization are the most widely used methods (each used by 10% of married women who practice contraception), followed by withdrawal and natural family planning (9% each).
The sample for the 1998 PNDHS included 13,983 women aged 15-49. The majority of respondents were married at the time of the survey (53%), had attended at least elementary school (98%) and were Catholic (82%).
The median age at first marriage among Filipino women aged 25-49 was 22.1 in 1998. Age at first marriage rose from 18.7 among women with no schooling to 21.5 among women who had attended high school. Fewer than 50% of women with at least some college education had married by age 25. Women in urban areas married, on average, two years later than those in rural areas (23.0 vs. 21.0).
At the time of the survey, 53% of women aged 15-49 were married and 36% had never been married. The remainder were either cohabiting, widowed or separated.
Women aged 25-49 had first had intercourse at a median age of 22.1 years, the same as that at which women first married. Age at first intercourse appears to be rising: Women aged 25-29 had started having sex at a median age of 22.8, compared with 21.7 among women aged 45-49. Like age at first marriage, the median age at first intercourse rose with level of education: Women with no education had started having sex at age 19.3, while women who had attended high school had first had intercourse at age 21.5.
Fertility and Fertility Preferences
The total fertility rate (TFR) for Filipino women aged 15-49, based on the three years preceding the survey, was 3.7 lifetime births per woman. Women who lived in rural areas could expect to have almost two more lifetime births than women in urban areas (4.7 vs. 3.0). Women with no education or with an elementary school education had a much higher TFR than women with at least some college education (5.0 vs. 2.9 births).
Women aged 25-49 had had their first birth at a median age of 23.3. Women in urban areas had begun childbearing two years later than women in rural areas (24.3 vs. 22.2), and women's age at first birth rose from 20.5 among women with no education to 22.7 among women with a high school education.
Overall, 7% of women aged 15-19 had had a birth or were pregnant with their first child at the time of the survey. Adolescents living in rural areas were more than twice as likely as those in urban areas to have begun childbearing (11% vs. 5%). Further, the likelihood that a young woman had begun childbearing declined as her level of education rose, from 17% of 15-19-year-olds with no education to 5% of women with at least some college education.
Women in the Philippines, on average, considered 3.2 children ideal. Younger women wanted smaller families than older women. For example, women aged 15-19 wanted 2.8 children, while women aged 45-49 considered 3.8 children ideal. Further, women with no education wanted larger families than women who had had at least some education (5.1 vs. 3.0-3.5 children). Desired family size varied little by area of residence.
The majority of women (62%) reported wanting no more children. Women with an elementary school education were more likely than those with more education or with none at all to want no more children (72% vs. 43-60%). Further, the desire to end childbearing rose sharply with the number of living children, from 17% of women with one child to 53% of those with two children and 75% of those with three; 89% of women with six or more children wanted no more.
The wanted fertility rate--a composite index calculated in the same way as the TFR, but omitting births exceeding the number women considered ideal--was one birth lower than the TFR (2.7 vs. 3.7). Women in urban areas had a wanted fertility rate that was considerably lower than that of rural women (2.3 vs. 3.3). Women with no schooling had a fertility rate substantially greater than that of women with at least some college education (3.9 vs. 2.5).
Overall, 20% of Filipino women were considered to have an unmet need for family planning services--9% for means of spacing births and 11% for means of ending childbearing. An unmet need for family planning was more common among rural than among urban residents (23% vs. 16%). Teenagers and women aged 20-24 were the age-groups most likely to have an unmet need for means of spacing births (27% and 21%, respectively). In terms of schooling, a need for means of spacing births was greatest among women with no education (14% vs. 8-9% among other women), and women with no education or elementary schooling were more likely than women with higher levels of education to have an unmet need for means of ending childbearing (15-16% vs. 8-10%).
Contraceptive Knowledge and Use
Knowledge of family planning is almost universal in the Philippines: At the time of the survey, 98% of currently married women knew of at least one modern method and 94% knew of at least one traditional method. The most widely known methods were the pill (mentioned by 97% of currently married women), followed by the condom (95%), the IUD and female sterilization (92% each), and the injectable (89%).
A total of 69% of married women had ever practiced contraception; the pill and the condom were the methods reported by the largest proportions of women (36% and 14%, respectively). At the time of the survey, 28% of women were using a modern method and 18% were using a traditional one. The most widely used methods were female sterilization and the pill (each mentioned by 10% of women), followed by withdrawal and natural family planning (9% each). No other method was relied on by more than 4% of women.
Use of modern methods was higher among women in urban areas than among rural inhabitants (31% vs. 25%). Further, women with at least some education were much more likely than women with no formal schooling to rely on such methods (25-31% vs. 9%). When family size was considered, contraceptive prevalence was highest among women with three children (40%) and lowest among women with none (1%).
Most women who used a modern contraceptive method obtained their contraceptive from a public source (72%), such as a barangay or community health station (24%), a government hospital or a local health station (23% each). However, the majority of women who used condoms obtained them from a private medical source (54%), such as a pharmacy (47%). Overall, 41% of women practicing contraception discontinued use of their method within the first 12 months. Users of condoms, the injectable, withdrawal and the pill were the most likely to discontinue use (60%, 52%, 46% and 44%, respectively). Of those who discontinued, 31% cited method failure, 16% side effects and 15% a desire to become pregnant. Users of the injectable were most likely to report side effects (32%); users of withdrawal were most likely to cite method failure (22%).
Among women not currently practicing contraception, 33% intended to use a method in the next 12 months and 8% planned to use a method later. The pill was the preferred method of 40% of women intending to practice contraception at some time in the future.
Fifty-four percent of nonusers did not intend to practice contraception in the future. The reasons most often cited for nonuse among women younger than 30 were a desire for more children (27%), side effects (25%) and health concerns (15%). Among women aged 30 or older, the most common reasons given for nonuse were a desire for more children (19%), menopause or hysterectomy (18%), side effects (16%) and health concerns (13%).
The majority of women in the Philippines had heard family planning messages on the radio or on television (67% and 71%, respectively). In addition, 44% each had seen such messages in a newspaper or on a poster, and 34% had acquired a family planning brochure. Women's exposure to family planning messages through the media increased with level of education: Exposure to family planning messages on television rose from 16% of women with no education to 84% of women with at least some college education. Most women (87-88%) said it was acceptable to use the media to disseminate family planning information.
Maternal and Child Health
The mothers of 86% of infants born in the five years preceding the survey had obtained prenatal care from a medical professional, usually a nurse-midwife (47%). Of births to women who received prenatal care, 48% were to women who made their initial visit within the first three months of pregnancy, and most (77%) were to women who had had three or more prenatal visits. The majority of births took place in the woman's home (66%); the remainder occurred at a health facility.
The majority of children born in the five years preceding the survey were breastfed (88%); the median duration of breastfeeding was 12.8 months. Female infants were breastfed for longer than male infants (13.5 vs. 11.6 months). The duration of breastfeeding declined as level of education rose, from 15.4 months among women with no schooling to 4.6 months among women with at least some college education. Further, women in rural areas breastfed their children for more than twice as long as women in urban areas did(15.5 vs. 5.6 months).
Infant and child mortality rates have declined in the Philippines over the past 15 years. In the period 10-14 years before the survey, 46 of every 1,000 infants died before their first birthday, compared with 35 deaths per 1,000 in the five years preceding the PNDHS. Over the same period, mortality before age five dropped from 72 deaths per 1,000 births to 48 deaths per 1,000.
Overall, mortality rates for the 10 years preceding the survey were higher in rural than in urban areas. For instance, 40 of every 1,000 infants living in rural areas died before their first birthday, compared with 31 of every 1,000 infants in urban areas. Further, 63 of every 1,000 rural children died before their fifth birthday, compared with 46 of every 1,000 urban children. Mortality levels also varied with the mother's level of education, dropping from 136 deaths per 1,000 children younger than five whose mothers had no education to 28 deaths per 1,000 children born to mothers with at least some college education. In addition, infants and children born to women who received no prenatal care were more likely to die than were those born to mothers who had received prenatal and delivery care. For instance, 111 of every 1,000 children born to mothers who had no prenatal or medically trained delivery assistance care died before age five, compared with 30 of every 1,000 whose mothers received care both prenatally and at delivery.
According to direct estimates of mortality based on the surviving sister method, in which respondents are asked about the survival of all of their siblings, 172 Filipino women died of maternal causes for every 100,000 live births between 1991 and 1997. Maternal deaths accounted for approximately 14% of all deaths to women aged 15-49.--I. Olenick
1. Philippines National Statistics Office (NSO), Department of Health and Macro International Inc., Philippines National Demographic and Health Survey 1998, Manila: NSO and Macro International, 1999.