The 1998 Philippines NDHS shows an urban TFR of 3.0, that is, even in the segment of the population that I hypothesize would be more inclined towards small families, fertility remains substantially above replacement. As well, rural TFR’s in the 1990’s appear to be relatively stagnant at a high level (4.7). Moreover, desired fertility remains some distance from replacement level: the wanted fertility rate in 1998 was 3.3, exactly the same rate as in 1993.
As in many countries, there are significant differences in fertility levels by region. For example, fertility is more than twice as high in Eastern Visayas and the Bicol regions, both with relatively low levels of development (with TFR’s well over 5 births per women) than in Metro Manila (with a TFR of 2.5 births per women).
Desired Fertility
It is improbable that fertility in the Philippines would fall to replacement level unless desired fertility reached levels close to replacement level. According to the 1998 NDHS, the wanted fertility for the country as a whole was 2.7 children per women, more than one-half child above replacement. Even in the urban areas, where about one-half of the currently married women were using a contraceptive method, the wanted fertility rate was slightly higher (2.3) than replacement, but somewhat lower than in 1993 (2.6). This rate for college educated women was estimated at 2.5 in 1998 and in 1993, it was 2.4. It is alarming to note that the wanted fertility of neither urban nor college educated Filipinos has fallen to replacement level.
Economy
Income, inequality, unemployment and underemployment, urban-rural and regional differences in economic opportunities, have all led to the persistence of widespread poverty. These economic conditions, in my opinion, help explain the unchanged preference for an average of 3 children among rural women during the 1990s. This is due to the expectation of children as a means of financial assistance. Children are valued for their assistance in household chores, their contribution to family income (e.g. working on the farm), and as a source of financial security for parents in old age. Unless the Philippines economy offers substantially more opportunity and security, certain cohorts of the population will continue to desire, on average, more than two children.
Culture, Values and Ideas
Religion does not exercise a strong direct influence on fertility desires, but it acts as a major factor in preventing the government - both national and local – from committing funds to population programs. This in turn helps create a social climate that works against an acceptance of a two child norm. At present, there is no widespread belief that limiting childbearing to 2 or fewer children is a prerequisite for the achievement of a range of household needs (ex. financial) and for a better individual standard of living.
Institutional Factors and Policy Instruments
What do not exist are institutions that would encourage couples to desire just two children. Few disincentives for childbearing exist in the Philippines, and many of these are rather weak and hardly felt by couples. One that might be mentioned is the increase in the legal age of marriage without parental approval to age 21, which could exert downward pressure on fertility. Conversely, policies exist that provide incentives for large families, including maternity and paternity benefits for those in the formal sector, free elementary and high school education, and housing programs.
Unwanted Fertility
The fraction of births that were unwanted increased during the 1990s, from 15.9 percent in 1993 to 18.2 percent in 1998. Unless this substantial amount of unwanted fertility is largely eliminated, it is difficult to imagine how fertility in the Philippines could fall to replacement level during the next few decades.
Conclusion
For replacement level to occur, the next two decades must witness two crucial changes in the Filipino reproductive attitude and behavior: first, the emergence of a firmly held two child norm; and second, the attainment of fertility preferences through effective contraceptive practice.
Mortality
As of 1997
Source: http://www.wpro.who.int/chips/chip02/phl.htm
The infant mortality rate in the Philippines declined to 29 deaths among children below 1 year old per 1000 live births during the period 1998-2002. In the decades prior to this, the rate had remained largely unchanged at roughly 35 deaths per 1000. The mortality rate among children below 5 years old also declined to 40 deaths per 1000 live births during the period 1998-2004 from 48 deaths per 1000 live births for the period 1993-97, according to the NDHS. Moreover, during the period 1988-92 the rate was 54 deaths per 1000 births .The decrease in infant and under five mortality may be attributed to improved maternal health care received by most Filipino mothers. In the 2003 NDHS, 88 percent of women with children under 5 years received parental care from a doctor, midwife or nurse during their pregnancy with their youngest child. In the 1998 NDHS, it was around 86 percent. There was also an increase in the percentage of births delivered in health facilities, such as hospitals, clinics, and health centers. Consequently, in the 2003 NDHS, 38 percent of children below 5 years old were reportedly born in health facilities compared with 34 percent in the 1998 NDHS. The 2003 NDHS also revealed a slight improvement in tetanus toxoid coverage. Survey results showed that 71 percent of women with children below 5 years old received at least one tetanus toxoid injection during pregnancy with their youngest child. The 1998 NDHS figure is approximately 69 percent, and in 1993 it was 42 percent. Child health, though, seems to be an area of concern, as the percentage of children aged 12-23 months who were fully immunized before reaching the age 1 sloped downward from 65 percent in 1998 to only 60 percent in 2003. Moreover, during the period between 1993 and 1998 the percentage only slightly improved from 72 to 73. Statistics on breastfeeding practices of Filipino mothers is also on the downtrend as the percentage of children under two months old who were exclusively breastfed was only 53 percent in the 2003 NDHS. The figure was lower than what was recorded in 1998, which was at 58 percent.
The relationship of a mothers level of education to the health and well being of her child is evident in that the probability of dying among infants whose mother received no formal schooling (79 deaths per 1000 live births) is two and half times higher than that for infants whose mother has had some high school education (31 deaths per 1000). A final positive is that maternal mortality has remained constant at approximately 200 maternal deaths per 1000 live births for the period 1998-2003.
Population Growth
In 2002 the population growth rate was 2.2 percent and the population was roughly 79 million. In 2000 the growth rate was 2 percent. By 2005 the government wants to decrease the growth rate to 1.87 percent, just above the average world rate of 1.54 percent. In the Philippines, the growth rate was the third highest among the most populous countries in the world. The Philippines population in the early 1990s continued to grow at a rapid, although somewhat reduced rate from what had prevailed in the preceding decades. In 1990, the Philippine population was more than 66 million, up from 48 million in 1980. This figure represents an annual growth rate of 2.5 percent, down from 2.6 percent in 1980 and from more than 3 percent in the 1960s. Even at the lower growth rate, the Philippine population had increased to roughly 77 million in the year 2000. Also, in 1990 the population was still a youthful one, with 57 percent under the age of twenty, as well, population density increased from 160 per square kilometer in 1980 to 220 in 1990.
Popcom was the government agency with the primary responsibility for controlling population growth. In 1985 Popcom set a target for reducing the growth rate to 1 percent by 2000. To reach that goal in the 1990s, Popcom recommended that families have a maximum of 2 children, they space the birth of children at three year intervals, and that women delay marriage to age 23 and men to age 25.
Family Planning
B) Which attempts have been made to bring fertility down?
This is a population that is familiar with family planning. According to 1993 DHS estimates, 97 percent of currently married women and 96 percent of all women in the Philippines know of one or more family planning method or modern method. In light of the near universal awareness in the Philippines of contraceptives and where to obtain them, these two informational barriers cannot account for the substantial fraction of women who do not practice contraception.
33 Percent of married women aged 15 to 49 years in rural areas are using modern family planning methods according to the 2003 NDHS. This figure is higher than what was recorded in the 1998 NDHS of only 25 percent. The pill remained as the most commonly used contraceptive method by rural women, registering a prevalence rate of 14 percent in 2003, up from the 1998 figure of 9 percent. In urban areas, on the other hand, the prevalence rate for modern family planning methods increased only slightly, from 31 percent in 1998 to 34 percent in 2003.
At the national level, the prevalence in the use of modern contraceptives increased by only 4 percent from 21 to 25 from 1986 to 1993. However, since then, there has been a significant improvement in the use of modern methods of family planning as it is up by 5 percent, from 28 in 1998 to 33 in 2003. Also nationally, the use of the pill increased from 10 percent to 13 percent during the period 1998-2003. Meanwhile, the use of female sterilization, IUD, and the condom remained at their 1998 levels of 10 percent, 4 percent and 2 percent respectively.
Knowledge, Attitude, and Practice of Family Planning
To familiarize people with methods of birth control and to create a positive attitude toward these methods are necessary prerequisites if family planning programs, adopted by the government, are to succeed. The widespread knowledge of contraceptive techniques and the known introduction of modern contraceptives - largely due to government initiatives over the last few decades - found in all the surveys, regardless of whether the populations involved were rural or urban, may be surprising in view of the aforementioned high fertility levels. However, knowledge sharing and programs designed by government agencies will only be effective when accompanied by actions to transform this knowledge into practice. The large gap that exists between knowledge and approval of birth control on the one hand, and actual practice on the other, is made abundantly clear by the statistics. They cannot do anything but dampen the optimism created by the high levels of knowledge from widespread state initiatives. The Philippines General Hospital provides family planning counseling to its regular obstetrical patients, many of whom later make use of the hospital’s family planning clinic. These clinics also accept patients referred from other sources, or who simply hear about the service by word of mouth. As previously mentioned, since the 1970’s family planning clinics have opened across the country, contraceptive distribution initiatives have taken place, and campaigns against unwanted fertility and a two child norm have been launched. Lastly, both government and non-government agencies have attempted to spread the notion that contraception is both socially acceptable and, when used properly, is not accompanied by harmful side effects.
C) How has the lack of anti-natalist population policy been motivated?
I interpret this question as “Why haven’t the government initiatives for anti-natalist population policy been effective for the population? Or, “Why hasn’t the anit-natalist population policy been successful?” Here, I will examine some of the reasons.
Unmet need for family planning refers to a discrepancy between expressed fertility goals and contraceptive practice. The most fundamental discrepancy is between an expressed preference to limit or space births and the absence of contraceptive behavior. Women who were not using contraceptives and who expressed a desire to avoid pregnancy were asked their reasons for not using. In the Philippines, lack of knowledge, fear of side effects to health, and social and familial disapproval (especially the husband’s) were the principal reasons for non use among those who were otherwise motivated. Nonusers who expressed a desire to avoid pregnancy but no intention to use contraceptives in the future were also asked why they did not intent to use birth control. Lack of information about contraception, opposition to family planning, and ambivalence about future childbearing were listed as the principal reasons.
A Framework for Explaining Unmet Need
Attitude-behavior consistency is shaped by motivation and by the opportunities and resources available to carry out behaviors implied by the attitudes. Many factors serve as disincentives or obstacles to the use of contraceptives for women who apparently should be using them in order to reach their reproductive goals: weakly held fertility preferences (less desperate to avoid having 3+ children; little perceived risk of conceiving; lack of knowledge in avoiding pregnancy, including modern contraception; perceptions that practicing contraception is socially and culturally unacceptable; fear of contraceptive effects on health; inadequate family planning services (inaccessible or poor quality); and opposition from husband, other kin, and other community members all rank as important. Many of these factors can be collected under the term “costs of contraception,” broadly defined to include economic, social, cultural, and health costs. Finally, among those women who are sufficiently motivated to use contraceptives and informed about methods, various obstacles (social, economic, cultural) may prevent their adopting and continuing use of contraception.
The data suggest that many husbands are more pro-natalist than their wives, and that this is substantially more true of nonusers than of users. Most women describe husbands with strong and definite views on fertility and contraception, but the women with an unmet need are more likely to describe their husbands as controlling decisions about fertility and contraception. The pro-natalist desires of husbands, combined with their greater influence in decisions about sex and reproduction, make a major contribution to unmet need in the Philippines.
These findings have clear implications for the training of family planning workers and the design of information, education, and communication efforts.
D) Opinion on the Philippines policy, implementation, and motivation
Unfortunately, a review of the past three decades shows that, when the government policy has included explicit goals, the amount of fertility decline has consistently fallen short of those goals. However, it is my belief that it is not the fault of the government. Ever since population control and family planning services became government policy, they have maintained adequate programs. Look no further than the fact that over 90 percent of the population is aware of contraceptives, and their use, and that the hospitals provide family planning services to each obstetrical patient. This, in my opinion, is a clear indication that the government is fulfilling its role.
On the other hand, I did read that the dominating Catholic religion in the Philippines does not act as a direct obstacle, but has succeeded in preventing the necessary amount of funding from being allocated to family planning programs and contraceptive initiatives.
There is not one answer as to why the informed Filipino population is not taking advantage of the programs and availability of these services. Each research paper is able to focus on a different reason as the dominating factor the for lack of use of the government offered programs and services.
3) Member of the Philippine Delegation to the 36th Session of the Commission on Population and Development (A Presentation to the UN based on extensive research conducted by the Philippine Government)
The impact of education on population dynamics is quite evident when examining the case and experience of the Philippines, as revealed by recent surveys. The 1998 National Demographic and Health Survey (NDHS) showed that women with higher levels of education have lower total fertility rates. Likewise, more educated women, with college or higher education, have lower total wanted fertility than those with no education and those with elementary education. Moreover, results of the 1999 Family Planning Survey (FPS) also revealed that generally, women with more education were more likely to use contraception than those with less education or no education at all. Moreover, in the Philippines, infant mortality has decreased most in the highest educational group and has increased in the lowest educational group. The report then outlines why infant mortality is one of the best indicators in order to derive statistics that could help to determine the number of women who are considered educated and the level of education they have attained. While education does not work in isolation of other variables influencing population dynamics, its direct effect on knowledge, on family planning programs and on the importance of maintaining a fertility level that suits one’s socioeconomic level cannot be discounted. Educational levels influence desired family sizes, family planning practices and living standards. Education clearly deters early marriage and childbearing most likely because it opens other opportunities to women. It is also associated with higher levels of income and the capability to participate in economically productive opportunities. Thus, this will allow women the opportunity to provide their families and their children with more comfortable conditions in life, better nutritional habits, health care and an overall greater standard of living. Apart from these, education enables women to gain greater information, knowledge and access to services within the realm of contraceptives. Lastly, aside from the direct effects of education on maternal, infant and child mortality, indirect effects also contribute to certain important aspects for the overall health and well-being of the future population.
This report also outlines the importance of socioeconomic status (I would include education in socioeconomic status) and how it influenced the health of children. As expected there was a low birth weight among the children of less-educated mothers than among children of more-educated mothers. The results from the survey included in the report showed infants born to mothers who did not finish high school were about 50 percent more likely to be of low birth weight than infants whose mothers finished college.
The Philippines is committed to education. They will continue to promote greater access to education, especially to the poor, and will continue to improve the overall quality of education. The government pledges to continue financial support for education and skill-building programs, especially for the poor and the underprivileged sectors. Furthermore, there is the intention in the Philippines to expand the Population Education Program so that the young will appreciate the relationship between responsible parenthood and family planning. The Philippines will continue to stress the importance of understanding the consequences of population growth, and will maintain their efforts to make the public aware of its potentially dangerous consequences – an element that could not be understood without some level of education.
Maternal Education and the Utilization of Maternal and Child Health Services
(The Statistics used in this report were from a study carried out in India; however, I believe that the majority of the report discussed educational mortality differentials more generally.)
It is evident that a higher level of maternal education results in improved child survival because health services that effectively prevent fatal childhood diseases are used to a greater extent by mothers with a higher education than by those with little or no education.
World Fertility Survey and the DHS’s, have shown that education in general and female education in particular have a very strong influence in reducing child morbidity and mortality. Educated women are better able to break away from traditional norms in order to utilize modern means of safeguarding their own health and that of their children; educated women are better able to utilize what is available in the community to their advantage; educated women may be able gain greater autonomy regarding their own and their children’s health thus leading to greater utilization of modern health facilities. The relationship between maternal schooling and factors known to reduce the risks of maternal and child mortality – utilization of antenatal and delivery care services, utilization of child immunization services, and treatment of childhood diseases – were examined. The results affirm the assumptions. The TFR for illiterate women is 3.6 births or higher, and it is 2.9 or lower for those who are literate. Despite the rapid overall decline in infant mortality, 1 in every 10 children born to an illiterate mother, died within the first year of life, and 1 in every 7 children died before reaching age five. Conversely, for literate women, it was 1 in 15 and 1 in 12, for infant and under 5 mortality, respectively.
A consistently strong and positive relationship between maternal-care utilization and mother’s education continues to show the impact of education. Only half of births to illiterate women received antenatal care, compared with 79 percent of births to literate women with less than middle school education and more than 90 percent of births to women with at least middle school education. Similar differentials by maternal education are observed for tetanus toxoid injections and iron/folic-acid tablets. Only 12 percent of births to illiterate women are delivered in institutions compared with 67 percent of births to women with at least a middle school education. Similarly, only one fifth of births to illiterate women are attended by a health professional, compared with three fourths of births to women who have completed middle school.
The belief that education and infant and child mortality is merely a reflection of the fact that educated mothers come from wealthier homes, live in urban settings where health care is more accessible, and are married into households that have a good source of income and therefore are better able to care for their young children through utilization of health services is also examined. The study controls for the possible impact of other socioeconomic variables to determine if the positive impact of mother’s education on utilization of health-care services is real. Multivariate analysis confirms the positive and significant influence of mothers schooling on maternal care utilization. Education emerges as the single most important determinant of maternal health care utilization when the influence of other intervening factors is controlled. Education by itself has the strongest impact on maternal health care utilization.
It is plausible that the more educated mothers are more likely to recognize and report symptoms of the most common contributors to child mortality than less educated mothers. Educated mothers are also generally more likely to take their children to a health facility than their counterparts. Mother’s education is positively related to utilization of child health care services, and this relationship is consistent for all four types of child health care analyzed. Educational differences are particularly pronounced when comparing the percentage of children fully immunized. For example, children of mothers with middle school education are 173 percent more likely to be fully vaccinated than children of mothers who are illiterate.
Continued investment in female education is indispensable for achieving reduced infant mortality and morbidity and could possibly have an impact on factors that reduce maternal mortality
3) Part B
As I have previously discussed many of the relationships between education, mortality and fertility in this report, it is difficult to find many more things to say, without having to repeat myself.
Firstly, and most importantly, as we have learned from the study by Mosely and Chen (1986), education plays a major factor in the mother’s age at the time of birth and in the intervals, or spacing of each birth. In turn, the later a mother gives birth to her first child, the less likely it is she will have unwanted births, and with more education, it is likely that a mother will understand the positive health aspects derived from appropriate birth spacing.
Secondly, education helps prevent infant mortality because, even with as minimal as middle school education, a mother is much more likely to take active measures in preventing her child from developing common childhood diseases, and will actively seek treatment if the mother suspects a problem. That is to say she will seek full immunization and other preventable measures. Not only was this evident in the study I found on the general benefits from education in preventing child mortality, but it is also highlighted by the study conducted by Bloom et al (2001) “Dimensions of women’s autonomy and the influence on maternal health care utilization in a North India city.” Perhaps this is hypothesizing, but an educated woman in India, will have a higher degree of autonomy, and thus, be able to take advantage of the Safe Motherhood Program, as compared to her uneducated counterparts. Indeed, the uneducated may be blocked by the influence of the husband and the surrounding family, but could it not also be said that a women with a higher degree of education would be able to break away from these societal norms, achieve a higher degree of autonomy, and consequently, take advantage of such programs. I believe so.
From the research I have conducted, the studies I have read and the lectures I have attended, it seems to me that education is one of the most vital factors in preventing infant mortality, and in controlling unwanted population growth. In some parts of the world, the subordinate position of women, and/or religious beliefs may still act as a roadblock in achieving higher levels of education, but from the studies I have read concerning Iran, Bangladesh, India and the Philippines, it seems as though religion is not the major obstacle. Socioeconomic position does influence factors that contribute to a certain level of education, but in the study that I found, even when this wide ranging factor was controlled for in the regression analysis, education still proved to be the single most important determinant in child survival.
Educated women will help control the population by taking advantage of modern contraceptives because they understand the benefits. They will have a higher degree of knowledge concerning these contraceptive methods and they will decrease the unmet need for fertility. They greatly understand how to care for children, and how to prevent infant mortality, and they understand the all around negatives associated with an undesired amount of children.
I share that same opinion as Caldwell. A certain degree of education is the most effective way to combat unwanted population growth (a two child norm), unwanted fertility and mortality.
Bibliography:
1. Country, Situation and Trends
Geography, Demographic Statistics
2. Studies of Fertility and Fertility Planning in the Philippines
By: Mercedes B. Concepcion; Wilhelm Flifger
From: Demography
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By: John B. Casterline; Aurora E. Perez; Anne E. Biddlecom
From: Studies in Family Planning
4. Maternal Education and the Utilization of Maternal and Child Health Services
By: Pavalavalli Govindasamy; B.M Ramesh
From: International Institute for Population Sciences
5. Member of the Philippine Delegation to the 36th Session of the Commission on Population and Development
1 April 2003, New York
From: Permanent Mission of the Republic of the Philippines to the United Nations
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By: Marilou P. Costello; John B. Casterline
7. INFANT MORTALITY RATE DOWN TO 29 DEATHS PER 1,000 BIRTHS
(Preliminary Results from the 2003 National Demographic and Health Survey)
From: National Statistics Office, Republic of the Philippines
8. USE OF MODERN FAMILY PLANNING METHODS UP IN RURAL AREAS
(Preliminary Results from the 2003 National Demographic and Health Survey)
From: National Statistics Office, Republic of the Philippines
9. Infant Mortality Rate in the Philippines Remains Unchanged at About 25 deaths per 1, 000 Births
From: National Statistics Office, Republic of the Philippines
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Population Control
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Population Control
