A sharp decline in publicly funded contraceptive services and supplies in the Philippines since 2004 has created severe barriers to women's contraceptive use, according to a new analysis conducted by the New York–based Guttmacher Institute. The proportion of modern method users who obtain their supplies from the public sector declined from 67% in 2003 to 46% in 2008. Thus, more women are now relying on the private sector to obtain modern contraceptives, which means higher costs and reduced access, particularly for poor and low-income women.
This decline is due largely to the United States Agency for International Development's ending its provision of free family planning supplies to the government and the Arroyo administration's reluctance to replace it with a viable national public program. Access to contraceptives for poor women now depends mostly on the ability and willingness of local government offices to support these services. Local governments can purchase contraceptives and include family planning services at their discretion as part of their public health functions if and when their limited budgets allow for such spending. To date, few have done so.
Facts on Barriers to Contraceptive Use in the Philippines, released today by the women's health advocacy group Likhaan, in Quezon City, the Philippines, and the Guttmacher Institute, presents an analysis of new national data examining barriers to contraceptive use among women who have an unmet need for contraception. A woman is defined as having an unmet need if she can become pregnant, but does not want a child in the next two years, or at all, and is not using any contraceptive method.
The analysis found that cost has become an increasingly common reason for nonuse of contraceptives in recent years: Fifteen percent of married women with unmet need cited this reason in 2008, compared with 8% in 2003. Cost is a particularly severe barrier for unmarried women: Forty-two percent of sexually experienced single women cited cost as a reason for not using a method, according to a 2004 national survey.
Funding shortages also mean that information and education about contraception are inadequate. Health concerns and fear of side effects were the most commonly cited reasons women gave for not using contraceptives. The persistence of these issues underscores the need to provide contraceptive counseling and education that informs women about pregnancy risk and possible side effects and that enables those who experience problems with one method to choose another.
"Family planning services should be a major public health priority for the incoming administration," said Junice Melgar, executive director of Likhaan. "The government must ensure that the rapid fall in access to contraception, especially among poor women, is halted. Family planning services must be restored as a key strategy to help reduce maternal deaths and pregnancy complications."
On the basis of national surveys, the analysis found that overall contraceptive use among married women has increased very slowly in the past 10 years, from 47% in 1998 to 51% in 2008. Modern contraceptive use has not increased in recent years; it remained at 33–34% between 2003 and 2008. Meanwhile, women are having, on average, one more child than they want.
As a result, 22% of married women have an unmet need for contraception. The proportion is higher among the poorest married women (28%) and among sexually active unmarried women aged 15–29 (24%), and lowest among the richest married women (20%).
"Meeting the need for contraception will be particularly helpful for disadvantaged women, who tend to have relatively little access to supplies and services, and relatively high levels of unintended pregnancy," noted Sharon Camp, president and CEO of the Guttmacher Institute.