Philippines -Demographic and Health Survey - 2004

Publication date: 2004

World Summit for Children Indicators, Philippines 2003 Childhood mortality Clean water supply Sanitary excreta disposal Basic education Family planning Antenatal care Delivery care Low birth weight Vitamin A supplements Night blindness Exclusive breastfeeding Continued breastfeeding Timely complementary feeding Vaccinations Oral rehydration therapy (ORT) Home management of diarrhea Treatment of ARI Malaria treatment HIV/AIDS Infant mortality rate (per 1,000 live births) Under-five mortality rate (per 1,000 live births) Percent of households with safe water supply1 Percent of households with flush toilets, pit toilet/latrine Proportion of children reaching grade 52 Net primary school attendance rate2 Proportion of children entering primary school2 Contraceptive prevalence rate (any method, currently married women) Contraceptive prevalence rate (any method, all women) Percent of women who received antenatal care from a health professional3 Percent of births in the 5 years preceding the survey attended by a health professional Percent of births in the 5 years preceding the survey at low birth weight4 Percent of children age 6-59 months who received a vitamin A dose in the 6 months preceding the survey Percent of women age 15-49 who received a vitamin A dose in the 2 months after delivery3 Percent of women 15-49 who suffered from night blindness during pregnancy3 Percent of youngest children under 6 months who are exclusively breastfed Percent of children age 12-15 months still breastfeeding Percent of children age 20-23 months still breastfeeding Percent of youngest children age 6-9 months receiving breast milk and complementary foods Percent of children age 12-23 months with tuberculosis vaccination Percent of children age 12-23 months with at least 3 DPT vaccinations Percent of children age 12-23 months with at least 3 polio vaccinations Percent of children age 12-23 months with measles vaccination Percent of mothers who received at least 2 tetanus toxoid vaccinations during pregnancy3 Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the survey who received oral rehydration salts (ORS) or recommended home fluids (RHF) Percent of children age 0-59 months with diarrhea in the 2 weeks preceding the interview who took more fluids than usual and continued eating somewhat less, the same or more food Percent of children age 0-59 months with acute respiratory infection (ARI) in the 2 weeks preceding the survey who were taken to a health provider Percent of children age 0-59 months with a fever in the 2 weeks preceding the survey who were treated with an anti-malarial drug Percent of women age 15-49 who correctly stated 2 ways of avoiding HIV infection5 Percent of women age 15-49 who correctly identified 2 misconceptions about HIV/AIDS6 Percent of women age 15-49 who believe that AIDS can be transmitted from mother to child during breastfeeding Percent of women age 15-49 who believe that the risk of AIDS transmission from mother to child can be reduced by mother taking drugs in pregnancy Percent of women age 15-49 who believe that a female teacher with the AIDS virus should not be allowed to continue teaching in the school Percent of men age 15-54 who correctly stated 2 ways of avoiding HIV infection5 Percent of men age 15-54 who correctly identified 2 misconceptions about HIV/AIDS6 Percent of men age 15-54 who believe that AIDS can be transmitted from mother to child during breastfeeding Percent of men age 15-54 who believe that the risk of AIDS transmission from mother to child can be reduced by mother taking drugs in pregnancy Percent of men age 15-54 who believe that a female teacher with the AIDS virus should not be allowed to continue teaching in the school Percent of men age 15-54 who have been tested for the AIDS virus 29 per 1,000 40 per 1,000 79.7 75.3 92.5 85.5 55.3 48.9 31.6 87.6 59.8 20.3 76.0 44.6 7.9 33.5 54.2 26.9 57.9 90.8 78.9 79.8 79.7 37.3 57.6 2.2 54.8 0.2 45 36 65 20 14 56 30 60 21 11 4 1 Piped water or protected well water 2 Based on de jure children 3 For the last live birth in the five years preceding the survey 4 For children without a reported birth weight, the proportion with low birth weight is assumed to be the same as the proportion with low birth weight in each birth size category among children who have a reported birth weight. 5 Having sex with only one partner who has no other partners and using a condom every time they have sex 6 They say that AIDS cannot be transmitted through mosquito bites and by supernatural means. Philippines National Demographic and Health Survey 2003 National Statistics Office Manila, Philippines ORC Macro Calverton, Maryland, USA October 2004 National Statistics Office Manila, Philippines ORC Macro Calverton, Maryland This report summarizes the findings of the 2003 National Demographic and Health Survey (NDHS) carried out by National Statistics Office. ORC Macro provided financial and technical assistance for the survey through the USAID-funded MEASURE DHS+ program, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the donor organizations. Additional information about the survey may be obtained from National Statistics Office (NSO), Solicarel Building, Ramon Magsaysay Boulevard., P.O. Box 779, Santa Mesa, Manila, Philippines (Telephone: (632) 716-9368 or 713-7081; Fax: 713-7074 or 714-1715; Email: info@.census.gov.ph; Internet: http://www.census.gov.ph). Additional information about the DHS program may be obtained from MEASURE DHS+, ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A. (Telephone: 301-572-0200; Fax: 301-572-0999; Email: reports@orcmacro.com). Recommended citation: National Statistics Office (NSO) [Philippines], and ORC Macro. 2004. National Demographic and Health Survey 2003. Calverton, Maryland: NSO and ORC Macro. Contents | iii CONTENTS Page Tables and Figures . ix Preface . xv Final Report Writers. xvi Summary of Findings . xvii Map of Philippines. xxiv CHAPTER 1 INTRODUCTION 1.1 Background .1 1.2 Objectives of the Survey .2 1.3 Organization of the Survey .2 1.4 Questionnaires .2 1.5 Pretest .5 1.6 Training and Fieldwork .4 1.7 Data Processing .4 1.8 Sample Design and Implementation .5 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Age and Sex Composition of the Household Population .7 2.2 Age Distribution from Selected Sources .9 2.3 Household Composition .9 2.4 Education of Household Population.10 2.4.1 Education Level of the Household Population.10 2.4.2 School Attendance Ratios .12 2.5 Repetition and Dropout Rates.14 2.6 Housing Characteristics.16 2.7 Household Durable Goods .17 2.8 Availability of Drinking Water and Ways to Make Drinking Water Safe .18 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3.1 Background Characteristics of Respondents .21 3.1.1 Mobility.21 3.2 Educational Attainment.23 3.3 Exposure to Mass Media .25 3.4 Employment .27 iv | Contents 3.4.1 Employment Status .27 3.4.2 Occupation .30 3.5 Characteristics of Women’s Employment .33 3.6 Control Over Women’s Earnings and Contribution of Women’s Earnings to Household Expenditures.34 3.7 Women’s Empowerment .37 3.7.1 Women’s Participation in Decisionmaking.37 3.7.2 Women’s Attitude toward Wife Beating and Refusing Sex with Husband .40 CHAPTER 4 FERTILITY 4.1 Current Fertility .41 4.2 Fertility by Background Characteristics .42 4.3 Fertility Trends.44 4.4 Children Ever Born and Living .45 4.5 Birth Intervals .47 4.6 Age at First Birth .49 4.7 Adolescent Fertility .51 4.8 Male Fertility .52 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Family Planning .55 5.2 Ever Use of Family Planning Methods .58 5.3 Current Use of Family Planning Methods .59 5.3.1 Trends in Contraceptive Use.60 5.3.2 Differentials in Contraceptive Use.61 5.3.3 Current Use by Woman’s Status .63 5.4 Number of Children at First Use of Family Planning .64 5.5 Knowledge of the Fertile Period.65 5.6 Timing of Sterilization .66 5.7 Source of Supply of Modern Contraceptive Methods .66 5.8 Informed Choice .67 5.9 Contraceptive Discontinuation Rates .70 5.10 Intentions for Family Planning Use among Nonusers .73 5.11 Family Planning Messages in the Mass Media.75 5.12 Contact Communication between Nonusers and Family Planning/Health Service Providers .77 CHAPTER 6 DETERMINANTS OF FERTILITY 6.1 Current Marital Status .79 6.2 Age at First Marriage .80 Contents | v 6.2.1 Median Age at First Marriage .80 6.3 Age at First Menstruation .82 6.4 Age at First Sexual Intercourse .82 6.5 Recent Sexual Activity.84 6.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility .86 6.6.1 Median Duration of Postpartum Amenorrhea, Abstinence, and Insusceptibility.87 6.6.2 Median Duration of Postpartum Amenorrheic Period for Breastfeeding Duration.88 6.7 Menopause .89 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for Additional Children .91 7.2 Demand for Family Planning .94 7.3 Ideal Number of Children.97 7.4 Unplanned and Unwanted Fertility. 100 7.5 Ideal Number of Children and Unmet Need by Women’s Status . 102 7.6 Family Size Desires of Couples. 104 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definitions and Assessment of Data Quality . 107 8.2 Levels and Trends in Infant, Child, and Under-Five Mortality . 108 8.3 Socioeconomic Differentials in Childhood Mortality . 109 8.4 Biodemographic Differentials in Childhood Mortality. 110 8.5 Differentials in Childhood Mortality By Women’s Status . 111 8.6 Perinatal Mortality . 113 8.7 High-Risk Fertility Behavior. 114 CHAPTER 9 MATERNAL AND CHILD HEALTH 9.1 Antenatal Care. 117 9.1.1 Antenatal Care Coverage . 117 9.1.2 Components of Antenatal Care Services . 119 9.1.3 Information about Pregnancy Complications. 121 9.1.4 Tetanus Toxoid Injections . 124 9.2 Delivery Care . 125 9.2.1 Place of Delivery . 125 9.2.2 Delivery Assistance . 126 9.2.3 Delivery Characteristics . 128 9.3 Postnatal Care . 130 vi | Contents 9.3.1 Postnatal Care Coverage. 130 9.3.2 Place of First Postnatal Checkup . 132 9.3.3 Type of Postnatal Checkup . 134 9.4 Reproductive Health Care by Woman’s Status . 134 9.5 Immunization of Children. 135 9.6 Acute Respiratory Infection. 138 9.7 Diarrheal Disease and Related Findings . 140 9.7.1 Disposal of Children’s Stools. 140 9.7.2 Prevalence of Diarrhea . 141 9.7.3 Knowledge of ORS Packets. 143 9.7.4 Diarrhea Treatment . 143 9.7.5 Feeding Practices during Diarrhea . 145 9.8 Children’s Health Care by Women’s Status. 145 9.9 Problems in Accessing Health Care . 146 CHAPTER 10 INFANT FEEDING AND SUPPLEMENTATION 10.1 Prevalence of Breastfeeding and Prelacteal Feeding . 149 10.2 Median Duration and Frequency of Breastfeeding . 153 10.3 Reasons for Not Breastfeeding and Reasons for Stopping Breastfeeding. 155 10.4 Type of Foods and Frequency of Feeding . 156 10.5 Micronutrient Intake among Children and Women. 158 CHAPTER 11 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11.1 Knowledge of HIV/AIDS/STIs . 163 11.2 Knowledge of Ways to Avoid HIV/AIDS/STIs . 165 11.3 Beliefs about AIDS. 167 11.4 Stigma and Discrimination Associated with HIV/AIDS . 170 11.5 Knowledge of Prevention of Mother-to-Child Transmission . 173 11.6 HIV Testing. 176 11.7 Attitudes toward Negotiating Safer Sex . 176 11.8 Sexual Behavior among Young Women and Men . 179 11.9 Self-reporting of Sexually Transmitted Infections (STIs) . 183 11.10 Sti Treatment-seeking Behavior. 185 11.11 Payment for Sexual Relations . 185 11.12 Men Having Sex with Men . 187 CHAPTER 12 TUBERCULOSIS 12.1 Background on TB. 189 12.2 Respondents’ Knowledge of TB . 190 12.3 Self-Reported Diagnosis, Symptoms, and Treatment . 194 12.4 Willingness to Work with Someone Who Has Previously been Treated for Tuberculosis . 200 Contents | vii 12.5 Awareness of the DOTS Chemotherapy Program. 202 12.6 Summary and Conclusion . 203 CHAPTER 13 GENERAL HEALTH 13.1 Communicable Diseases. 203 13.1.1 Dengue Fever. 203 13.1.2 Leprosy . 203 13.1.3 Malaria . 205 13.2 Noncommunicable Diseases. 206 13.2.1 Cancer . 206 13.2.2 Diabetes. 207 13.3 Health Care Financing . 208 13.4 Traditional Medicines . 209 13.5 Health Facility Utilization. 211 13.6 Alternative Health Care . 212 REFERENCES . 215 APPENDIX A SURVEY DESIGN . 217 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 223 APPENDIX C DATA QUALITY TABLES. 247 APPENDIX D PERSONS INVOLVED IN THE 2003 PHILIPPINES DEMOGRAPHIC AND HEALTH SURVEY . 253 APPENDIX E QUESTIONNAIRES . 263 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 5 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 8 Table 2.2 Median age and dependency ratio . 9 Table 2.3 Household composition. 9 Table 2.4.1 Educational attainment of female household population. 10 Table 2.4.2 Educational attainment of male household population. 11 Table 2.5.1 School attendance ratios: primary school. 13 Table 2.5.2 School attendance ratios: secondary school . 14 Table 2.6 Grade repetition and dropout rates. 15 Table 2.7 Household characteristics . 16 Table 2.8 Household durable goods. 18 Table 2.9 Availability of drinking water. 18 Table 2.10 Safe drinking water . 19 Figure 2.1 Distribution of the de facto household population by single year of age and sex. 7 Figure 2.2 Population pyramid . 8 Figure 2.3 Median years of schooling by sex and regon . 12 Figure 2.4 Housing conveniences by residence . 17 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS Table 3.1 Background characteristics of respondents . 22 Table 3.2 Childhood residence and mobility . 23 Table 3.3.1 Educational attainment by background characteristics: women. 24 Table 3.3.2 Educational attainment by background characteristics: men. 25 Table 3.4.1 Exposure to mass media: women. 26 Table 3.4.2 Exposure to mass media: men . 27 Table 3.5.1 Employment status: women. 28 Table 3.5.2 Employment status: men . 29 Table 3.6.1 Occupation: women. 31 Table 3.6.2 Occupation: men . 32 Table 3.7 Type of employment: women. 33 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures. 35 Table 3.9 Women’s control over earnings . 37 Table 3.10 Women’s participation in decisionmaking by background characteristics . 38 x | Tables and Figures Table 3.11 Women’s participation in decisionomaking . 39 Table 3.12 Women’s attitude toward wife beating and refusing sex with husband. 40 Figure 3.1 Decisionmaker on how women’s earnings are used . 36 Figure 3.2 Proportion of household expenditures met by women’s earnings. 36 CHAPTER 4 FERTILITY Table 4.1 Current fertility . 41 Table 4.2 Fertility by background characteristics. 43 Table 4.3 Fertility trends. 44 Table 4.4 Age-specific fertility rates . 45 Table 4.5 Children ever born and living. 46 Table 4.6 Birth intervals. 48 Table 4.7 Age at first birth . 49 Table 4.8 Median age at first birth by background characteristics. 50 Table 4.9 Pregnancy and motherhood among young women . 51 Table 4.10 Male fertility and fatherhood . 52 Table 4.11 Mean number of children . 53 Figure 4.1 Age-specific fertility rates, by residence. 42 Figure 4.2 Total fertility rate by residence and education. 44 Figure 4.3 Trends in the total fertility rate . 45 Figure 4.4 Mean number of children ever born among women 15-49. 46 Figure 4.5 Median number of months since previous birth . 49 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods . 55 Table 5.2 Knowledge of contraceptive methods by background characteristics. 57 Table 5.3 Ever use of contraception . 58 Table 5.4 Current use of contraception . 59 Table 5.5 Trends in contraceptive use . 61 Table 5.6 Current use of contraception by background characteristics . 62 Table 5.7 Current use of contraception by regions. 63 Table 5.8 Curret use of contraception by women’s status . 64 Table 5.9 Number of children at first use of contraception . 65 Table 5.10 Knowledge of fertile period. 65 Table 5.11 Timing of sterilization . 66 Table 5.12 Source of contraception. 67 Table 5.13 Informed choice by method/source . 68 Table 5.14 Informed choice by source . 69 Table 5.15 Informed choice by background characteristics. 70 Table 5.16 First-year contraceptive discontinuation rate . 71 Table 5.17 Reasons for discontinuation . 72 Table 5.18 Future use of contraception . 73 Table 5.19 Reason for not intending to use contraception . 74 Table 5.20 Preferred method of contraception for future use . 75 Table 5.21 Exposure to family planning messages. 76 Table 5.22 Contact of nonusers with family planning providers . 78 Tables and Figures | xi Figure 5.1 Knowledge of contraception among currently married women age 15-49 . 56 Figure 5.2 Use of contraception among currently married women age 15-49 . 60 Figure 5.3 Trends in contraceptive use, Philippines 1968-2003 . 61 CHAPTER 6 DETERMINANTS OF FERTILITY Table 6.1 Current marital status. 79 Table 6.2 Age at first marriage . 80 Table 6.3 Median age at first marriage. 81 Table 6.4 Age at menarche . 82 Table 6.5 Age at first sexual intercourse. 82 Table 6.6 Median age at first intercourse . 83 Table 6.7 Recent sexual activity. 85 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility . 86 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 87 Table 6.10 Median duration of postpartum amenorrheic period for breastfeeding duration. 88 Table 6.11 Menopause . 89 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children. 92 Table 7.2 Fertility preferences by age . 92 Table 7.3 Desire to limit childbearing. 93 Table 7.4 Need for family planning . 95 Table 7.5 Preferred future method of family planning among women with unmet need. 96 Table 7.6 Willingness to pay for contraceptive method. 97 Table 7.7 Ideal number of children . 98 Table 7.8 Mean ideal number of children by background characteristics . 99 Table 7.9 Fertility planning status . 101 Table 7.10 Wanted fertility rates . 102 Table 7.11 Ideal number of children and unmet need by women’s status. 103 Table 7.12 Couples consensus on family size. 104 Figure 7.1 Fertility preferences among currently married women age 15-49 . 91 Figure 7.2 Percentage of currently married women who want nomore children by residence, education, and wealth index quintile . 94 Figure 7.3 Mean ideal number of children for all women by region. 100 Figure 7.4 Currently married women by perceived consensus with husband regarding the number of children desired . 105 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates. 108 Table 8.2 Early childhood mortality rates by socioeconomic characteristics and region . 109 Table 8.3 Early childhood mortality rates by demographic characteristics . 110 Table 8.4 Early childhood mortality rates by women’s status. 112 Table 8.5 Perinatal mortality . 113 Table 8.6 High-risk fertility behavior. 115 xii | Tables and Figures Figure 8.1 Under-five mortality rates by background characteristics. 111 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care . 118 Table 9.2 Number of antenatal care visits and timing of first visit . 119 Table 9.3 Components of antenatal care . 120 Table 9.4 Information about danger signs of pregnancy . 122 Table 9.5 Places to go in case of pregnancy complications . 123 Table 9.6 Tetanus toxoid injections . 124 Table 9.7 Place of delivery . 125 Table 9.8 Assistance during delivery . 127 Table 9.9 Place and assistance during delivery. 128 Table 9.10 Delivery characteristics . 129 Table 9.11 Reason for caesarean operation . 130 Table 9.12 Postnatal care by background characteristics. 131 Table 9.13 Place of postnatal care . 133 Table 9.14 Postnatal care services . 134 Table 9.15 Reproductive health care by women’s status. 135 Table 9.16 Vaccinations by source of information . 136 Table 9.17 Vaccinations by background characteristics. 137 Table 9.18 Prevalence and treatment of symptoms of ARI and fever. 139 Table 9.19 Drugs taken for fever . 140 Table 9.20 Disposal of children’s stools . 141 Table 9.21 Prevalence of diarrhea . 142 Table 9.22 Knowledge of ORS packets . 143 Table 9.23 Diarrhea treatment . 144 Table 9.24 Children’s health care by women’s status. 146 Table 9.25 Problems in accessing health care . 147 Figure 9.1 Feeding practices during diarrhea . 145 CHAPTER 10 INFANT FEEDING AND SUPPLEMENTATION Table 10.1 Initial breastfeeding . 150 Table 10.2 Breastfeeding status by age . 152 Table 10.3 Median duration and frequency of breastfeeding. 154 Table 10.4 Reasons for stopping breastfeeding . 156 Table 10.5 Foods consumed by children in the day or night preceding the interview . 157 Table 10.6 Frequency of foods consumed by children in the day or night preceding the interview . 158 Table 10.7 Micronutrient intake among children . 159 Table 10.8 Treatment with iron. 160 Table 10.9 Micronutrient intake among mothers . 161 Figure 10.1 Reasons for never breastfeeding. 155 CHAPTER 11 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Table 11.1 Knowledge of AIDS. 164 Table 11.2 Knowledge of HIV prevention methods . 166 Tables and Figures | xiii Table 11.3.1 Beliefs about AIDS: women . 168 Table 11.3.2 Beliefs about AIDS: men. 169 Table 11.4.1 Accepting attitudes toward those living with HIV: women. 171 Table 11.4.2 Accepting attitudes toward those living with HIV: men . 172 Table 11.5.1 Knowledge of prevention of mother-to child transmission of HIV: women. 174 Table 11.5.2 Knowledge of prevention of mother-to child transmission of HIV: men. 175 Table 11.6 HIV testing status of men . 177 Table 11.7 Attitudes toward negotiating safer sex with husband . 178 Table 11.8 Knowledge of a source for condoms among young people. 180 Table 11.9 Premarital sex and use of condoms among young women and men. 181 Table 11.10 Multiple sex partners among young men. 182 Table 11.11 Condom use at first sex among young men. 183 Table 11.12 Self-reporting of sexually transmitted infection (STI) and STI symptoms . 184 Table 11.13 Men seeking treatment for STIs. 185 Table 11.14 Payment for sex . 186 Table 11.15 Men having sex with men. 187 Figure 11.1 Percentage of men and women who have heard of AIDS and who believe there is a way to avoid HIV/AIDS. 165 Figure 11.2 Percentage of men and women who know of two specific ways to avoid HIV/AIDS . 167 Figure 11.3 Beliefs about AIDS. 170 CHAPTER 12 TUBERCULOSIS Table 12.1 Knowledge of tuberculosis . 190 Table 12.2 Knowledge of specific symptoms of tuberculosis . 191 Table 12.3 Knowledge of the cause of tuberculosis. 191 Table 12.4 Knowledge of the modes of transmission of tuberculosis . 192 Table 12.5 Knowledge of TB causes and transmission modes by background characteristics . 193 Table 12.6 Diagnosis of tuberculosis. 194 Table 12.7 Source of TB treatment. 195 Table 12.8.1 Experience of symptoms of tuberculosis: women . 196 Table 12.8.2 Experience of symptoms of tuberculosis: men. 197 Table 12.9.1 Reasons for not seeking treatment for symptoms of tuberculosis: women. 198 Table 12.9.2 Reasons for not seeking treatment for symptoms of tuberculosis: men . 199 Table 12.10 Reasons for choosing source of treatment for symptoms of TB . 200 Table 12.11 Positive attitudes towardsthose with TB. 201 Table 12.12 Awareness of DOTS. 202 Figure 12.1 Percentage of women and men who ever had symptoms of tuberculosis . 195 CHAPTER 13 GENERAL HEALTH Table 13.1 Dengue fever prevention . 204 Table 13.2 Perceived mode of transmission of leprosy. 204 Table 13.3 Perceived transmission of malaria . 206 Table 13.4 Signs and symptoms of cancer . 207 Table 13.5 Awareness of diabetes . 208 Table 13.6 Profile of PhilHealth members . 209 xiv | Tables and Figures Table 13.7 Familiarity with herbal medicines. 210 Table 13.8 Usage of herbal medicines. 211 Table 13.9 Utilization of health facilities. 212 Table 13.10 Alternative health care modalities . 213 Figure 13.1 Percent distribution of household respondents by whether they think leprosy is curable . 205 APPENDIX A SAMPLE IMPLEMENTATION Table A.1.1 Sample implementation: results of the household interview: women. 218 Table A.1.2 Sample implementation: results of the individual interview: women. 219 Table A.2.1 Sample implementation: results of the household interview: men. 220 Table A.2.2 Sample implementation: results of the individual interview: men. 221 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 226 Table B.2 Sampling errors for national sample . 227 Table B.3 Sampling errors for urban sample. 228 Table B.4 Sampling errors for rural sample. 229 Table B.5 Sampling errors for National Capital Region sample . 230 Table B.6 Sampling errors for Cordillera Administrative Region sample. 231 Table B.7 Sampling errors for I - Ilocos sample . 232 Table B.8 Sampling errors for II - Cagayan Valley sample . 233 Table B.9 Sampling errors for III - Central Luzon sample. 234 Table B.10 Sampling errors for IVA - CALABARZON sample . 235 Table B.11 Sampling errors for IVB - MIMAROPA sample. 236 Table B.12 Sampling errors for V - Bicol sample . 237 Table B.13 Sampling errors for VI - Western Visayas sample . 238 Table B.14 Sampling errors for VII - Central Visayas sample. 239 Table B.15 Sampling errors for VIII - Eastern Visayas sample . 240 Table B.16 Sampling errors for IX - Zamboanga Peninsula sample . 241 Table B.17 Sampling errors for X - Northern Mindanao sample. 242 Table B.18 Sampling errors for XI - Davao sample . 243 Table B.19 Sampling errors for XII - SOCCSKSARGEN sample . 244 Table B.20 Sampling errors for XIII - Caraga sample. 245 Table B.21 Sampling errors for Autonomous Region in Muslim Mindanao (ARMM) sample. 246 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution. 247 Table C.2.1 Age distribution of eligible and interviewed women. 248 Table C.2.2 Age distribution of eligible and interviewed men . 248 Table C.3 Completeness of reporting . 249 Table C.4 Births by calendar years . 249 Table C.5 Reporting of age at death in days . 250 Table C.6 Reporting of age at death in months . 251 Preface | xv PREFACE The National Statistics Office (NSO) is pleased to present the final report on the 2003 National Demographic and Health Survey (NDHS). The 2003 NDHS is the eighth in a series of surveys conducted every five years since 1968 that mainly aim to measure levels and trends in demographic and family planning indicators. Fieldwork for the 2003 NDHS was carried out from June 16 to September 3, 2003 covering a national sample of approximately 13,000 households, 14,000 women aged 15 to 49 years and 5,000 men aged 15 to 54 years. The successful completion of the 2003 NDHS was made possible by the collaborative efforts of a number of organizations and individuals, whose participation we would like to acknowledge with grati- tude. The United States Agency for International Development (USAID)/Philippines provided substantial financial assistance for the implementation of the data collection. Dr. Mercedes Concepcion, the Depart- ment of Health (DOH), the University of the Philippines Population Institute (UPPI), Population Com- mission (POPCOM), the Food and Nutrition Research Institute (FNRI), the United Nations Children’s Fund (UNICEF), the National Economic and Development Authority (NEDA), the National Statistical Coordination Board (NSCB) and PhilHealth provided inputs during the development of the question- naires. The DOH and UPPI likewise assisted in the training of trainers and regional supervisors for the survey, and in writing this report. Dr. Elizabeth Go, who formerly worked with the NSO, also assisted in writing the report. ORC Macro, through the MEASURE DHS+ program, provided technical assistance at various stages of the project. As part of its technical assistance to the NSO in the design and implementa- tion of a new master sample for household-based surveys, the Asian Development Bank through its con- sultants, Dr. Graham Kalton and Dr. Arturo Pacificador, Jr., provided invaluable assistance in the design and selection of the NDHS sub-sample. The survey would not have gotten off the ground without the untiring efforts and dedication of the staff of the Demographic and Social Statistics Division (DSSD) of the Household Statistics Depart- ment, selected personnel of the Information Resources Department, employees in the regional and pro- vincial offices, the trainers and regional supervisors, and the 44 interviewing teams composed of team supervisors, field editors and interviewers. Our gratitude also goes to the data processors who patiently worked for long hours during weekdays and weekends in order to meet the target date of completion of data entry and machine editing. Finally, we are ever indebted to the survey respondents who generously shared their time and in- formation to enable us to gather crucial data for our country’s future planning. CARMELITA N. ERICTA Administrator Manila, Philippines October 2004 xvi | Final Report Writers FINAL REPORT WRITERS Macro International. Inc. Dr. Jeremiah Sullivan National Statistics Office Paula Monina G. Collado (Deputy Administrator) Dr. Socorro D. Abejo Benedicta A. Yabut Aurora T. Reolalas Apolinar F. Oblea Erma Y. Aquino Glenn B. Barcenas University of the Philippines Population Institute Dr. Nimfa B. Ogena Dr. Zelda C. Zablan Dr. Josefina V. Cabigon Department of Health Dr. Aura C. Corpuz Free-lance Researcher Dr. Elizabeth M. Go NSO Technical Assistants Luzviminda G. Buensalida Maritess Q. Tan Summary of Findings | xvii SUMMARY OF FINDINGS The 2003 National Demographic and Health Survey (NDHS) is a nationally representative sur- vey of 13,945 women age 15-49 and 5,009 men age 15-54. The main purpose of the 2003 NDHS is to provide policymakers and program managers with detailed information on fertility, family plan- ning, childhood and adult mortality, maternal and child health, and knowledge and attitudes related to HIV/AIDS and other sexually transmitted in- fections. The 2003 NDHS also collects high qual- ity data on family health: immunizations, preva- lence and treatment of diarrhea and other diseases among children under five, antenatal visits, assis- tance at delivery and breastfeeding. The 2003 NDHS is the third national sample survey undertaken in Philippines under the aus- pices of the worldwide Demographic and Health Surveys program. CURRENT STATUS AND PROGRESS FERTILITY The 2003 NDHS indicates that there has been a steady decline in fertility in the Philippines in the past three decades from 6.0 children per woman in 1970 to 3.5 children per woman in 2001. However, compared with current fertility levels in Southeast Asia, fertility in the Philip- pines is relatively high. Only Laos (4.7 children per woman) and Cambodia (4.0 children per woman) are higher. Fertility varies substantially across sub- groups of women. Urban women have, on aver- age, 1.3 children fewer than rural women (3.0 and 4.3 children per woman, respectively). The differ- ences are also substantial across regions. The Na- tional Capital Region (NCR) has the lowest fertil- ity rate (2.8 children per woman) while MIMA- ROPA has the highest (5.0 children per woman). Fertility level has a negative relationship with education. The fertility rate of women with college or higher education (2.7 children per woman) is about half that of women with no edu- cation (5.3 children). Fertility is also negatively asso- ciated with wealth index quintile: women in wealthier households have fewer children than those in poorer households. WHY DID FERTILITY DECLINE? The decline in fertility is brought about by, among other things, longer birth intervals, and desire for fewer children. Longer birth intervals. Fertility decline in the Philippines can be attributed to longer intervals be- tween births. Results of the 2003 NDHS indicate that half of births occur 30.5 months after the previous birth, which is longer than the median birth interval reported in the 1998 NDHS (28 months). Gap between wanted fertility and actual fertil- ity rates. Despite increasing use of contraception, the survey data indicate that one in four pregnancies is mistimed and one in five is not wanted at all. If un- wanted births could be prevented, the total fertility rate in the Philippines would be 2.5 births per woman instead of the actual level of 3.5. This gap between wanted fertility and actual fertility is the same as that observed in the 1998 survey, but the fertility levels in 2003 are lower than in 1998 (2.7 and 3.7 births per woman, respectively). Increased use of contraception. Contraceptive use among currently married women in the Philip- pines over the past 35 years has more than tripled, from 15 percent in 1968 to 49 percent in 2003. Most of the rise in contraceptive prevalence is due to the increase in use of modern contraceptive methods, from 25 percent in 1993 to 33 percent in 2003. USE OF CONTRACEPTION Method mix. Not only has the contraceptive prevalence rate in the Philippines increased, the pro- portion of married women who use modern contracep- tive methods has increased from 28 percent in 1998 to 33 percent in 2003, while use of traditional methods has decreased from 18 percent in 1998 to 16 percent in 2003. xviii | Summary of Findings Large differentials in use of contraception. There are large differences in the use of modern contraceptive methods across subgroups of mar- ried women. More than half of women with at least a high school education are current users of contraception compared with less than one in five women with no formal education. Use of any method of family planning also increases with wealth status. Contraceptive preva- lence is 37 percent among women in the lowest wealth quintile, 54 percent for those in the fourth quintile, and 51 percent for women in the highest wealth quintile. Contraceptive use shows an inverted U- shaped relationship with the number of living children. Use of any method ranges from 6 per- cent among women with no living children to 61 percent for women with three to four children, after which it declines to 46 percent for women with five or more children. Contraceptive prevalence among married women by region ranges from 19 percent in ARMM to 59 percent in Davao Peninsula. How- ever, use of modern methods shows a different pattern. The proportion of currently married women who use modern methods of contraception is 40 percent or more in Central Luzon, Davao, and Cagayan Valley, and only 12 percent in ARMM. Traditional methods are most popular in Bicol Region (24 percent) and least popular in Cagayan Valley (4 percent). Source of supply. Over two-thirds of current users of modern methods obtain their contracep- tive supplies and services from a public source (67 percent), 29 percent from a private medical source, and 3 percent from other sources. Com- pared with data from the 1998 NDHS, there has been a decrease in reliance to the public sector (from 72 percent) and an increase in use of private sector (from 26 percent). Unmet need for family planning. Unmet need for family planning is defined as the percent- age of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2003 NDHS data show that the total unmet need for family planning in the Philippines is 17 percent, of which 8 per- cent is for limiting and 9 percent is for spacing. The level of unmet need has declined from 20 percent in 1998. Overall, the total demand for family planning in the Philippines is 69 percent, of which 75 percent has been satisfied. If all of this need were satisfied, a con- traceptive prevalence rate of about 69 percent could, theoretically, be expected. Comparison with the 1998 NDHS indicates that the percentage of demand satis- fied has increased only slightly from 72 percent. REPRODUCTIVE HEALTH Antenatal care. Nine in ten mothers received care from a medical professional during their preg- nancy; 50 percent received care from a nurse or a midwife and 38 percent from a doctor. Traditional birth attendants provide antenatal care to 7 percent of women. Six percent of pregnant women received no antenatal care. These figures show little change from those recorded in the 1998 NDHS. The Philippines Department of Health (DOH) recommends that all pregnant women have at least four antenatal care visits during each pregnancy. The 2003 NDHS data show that seven in ten women with a live birth in the five years before the survey had the recommended number of antenatal care visits during the pregnancy for the last live birth. The DOH further recommends that for early de- tection of pregnancy-related health problems, the first antenatal check up should occur in the first trimester of the pregnancy. More than half (53 percent) of women who had at least one live birth in the five years before the survey adopt this recommendation. For three in 10 women, the first visit was made when their pregnancy was 4-5 months, while one in 10 had the first antenatal care when they were 6-7 months preg- nant. Information about the danger signs of preg- nancy. Five in ten women with a live birth in the five years preceding the survey were informed about the danger signs of pregnancy complications. This is an increase from 33 percent in 1998. Tetanus toxoid injections. The DOH also rec- ommends that women receive at least two tetanus toxoid (TT) injections during their first pregnancy. The 2003 NDHS shows that 37 percent of women who had a live birth in the five years before the survey met this recommendation. TT coverage in 2003 is Summary of Findings | xix similar to that recorded in the 1998 NDHS (38 percent). Delivery care. Thirty-eight percent of live births in the five years before the survey were de- livered in a health facility and 61 percent were born at home. These figures show an increase in the proportion of births occurring in a health facil- ity from 34 percent in 1998 and a decline in the percentage of births delivered at home (66 percent in 1998). Assistance during delivery. Six in ten births in the five years before the survey were assisted by health professionals; 34 percent by a doctor and 26 percent by a midwife or a nurse. While coverage of births attended by a health profes- sional has increased in the last five years from 56 percent in 1998, it remains lower than the target set by DOH (80 percent by 2004). Postnatal care. The DOH recommends that mothers receive a postpartum checkup within two days of delivery. Women who delivered in a health facility are assumed to receive postnatal care. One in three women who delivered outside a health facility had their first postnatal checkup within two days of delivery. With another 17 per- cent of the women receiving their first postnatal checkup from 3 to 6 days after delivery, 51 per- cent of women received a postnatal checkup within six days of delivery. Combined with 38 percent of women delivering their last birth in a health facility, a total of 89 percent of women re- ceived postnatal care in the 6 days after delivery. This percentage is higher than the target set by the DOH (80 percent). CHILD HEALTH Childhood immunization. Information from health cards and mothers’ reports (combined) shows that 60 percent of children 12-23 months have been immunized with vaccines against the six preventable childhood diseases—tuberculosis, diphtheria, pertussis, tetanus, polio, and mea- sles—before one year of age. Seventy percent of children age 12-23 months have received the vac- cines. This rate is higher than in the 1998 NDHS (65 percent). The proportion of children age 12 to 23 months who have received no vaccination (7 percent) is similar to that in the 1998 NDHS (8 percent). Childhood illnesses. Acute respiratory infections (ARI), diarrhea, and malaria are common causes of childhood illness and death. In the 2003 NDHS, acute respiratory infection was identified by mother’s re- ports on the prevalence of symptoms of ARI—cough accompanied by short, rapid breathing—in the two weeks preceding the survey. One in 10 children under age five had symptoms of ARI. Eleven percent of children under age five were reported to have diarrhea during the two-week period before the survey, which indicates a slight increase from the 7 percent level in the 1998 NDHS. Thirty-two percent of children who were reported to have had diarrhea were taken to a health facility for treatment. Fifty-nine percent of children with diarrhea were treated with ORT, either ORS packets (42 per- cent), recommended homemade fluids (RHF) (24 per- cent), or increased fluids (2 percent). Other treatments for diarrhea were pills or syrup (30 percent), a home remedy (18 percent), injection (1 percent), or intrave- nous solution (1 percent). Breastfeeding. The prevalence of breastfeeding in the Philippines has remained the same, at least since the 1993 survey. Eighty-seven percent of chil- dren born in the five years preceding the 2003 NDHS were breastfed. There has been no change in this prac- tice since 1993 (87 percent in 1993 and 88 percent in 1998). Overall, the most common reason given by mothers for not breastfeeding their babies is that they do not have enough milk (20 percent), that they have nipple or breast problems, or that they are working (5 percent and 13 percent, respectively). Twelve percent of mothers reported that the child refused to breast- feed. The median duration of any breastfeeding in- creased from 12.8 months in 1998 to 14.1 months in 2003. However, the median duration of exclusive breastfeeding declined slightly from 1.4 months in 1998 to 0.8 months in 2003. Perceived problems in accessing health care. In the 2003 NDHS, women were asked whether they have problems seeking medical advice or treatment for themselves. Getting money for treatment is the problem most often cited (67 percent). Other problems include not wanting to go alone (28 percent), access to the health facility because of the distance (27 percent), and because they have to take transport to go to the health facility (26 percent). xx | Summary of Findings AWARENESS OF HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS Knowledge of HIV/AIDS and ways to avoid HIV/AIDS. While the vast majority of the 2003 NDHS respondents have heard of AIDS (95- 96 percent), knowledge of the three principal ways to reduce HIV transmission—abstinence, use of condoms, and reducing the number of part- ners—is not widespread. Less than half of women and 62 percent of men know that HIV can be pre- vented by using condom, 77 percent or women and men say that limiting sex to one uninfected partner can reduce the risk of getting HIV. Forty- five percent of women and 56 percent of men know that the combination of the two preventive measures can reduce the risk of HIV infection. Misconceptions about the transmission of AIDS are high in the Philippines; only 36 percent of women and 30 percent of men reject the two most common misconceptions about AIDS in the Philippines (i.e., AIDS can be transmitted by mosquito bites and by sharing food with a person who has AIDS). Knowledge of mother-to-child transmis- sion (MTCT). In the 2003 NDHS, respondents were asked if the virus that causes AIDS can be transmitted from a mother to a child. The general knowledge about HIV transmission during preg- nancy, delivery, and breastfeeding is relatively high (63 to 73 percent among women and 60 to 68 percent among men). However, few women and men (20 to 21 percent) know that the risk of MTCT can be reduced if a mother takes special drugs during pregnancy. This knowledge varies widely across subgroups of women and men. Ur- ban residence, education, and household eco- nomic status have a positive impact on the re- spondent’s knowledge of MTCT. Stigma and Discrimination Associated with HIV/AIDS. The majority of respondents (76 percent of women and 79 percent of men) feel that HIV-positive status should not be kept confiden- tial. When asked if they would be willing to care for a relative who became sick with AIDS in his/her own household, 34 percent of women and 29 percent of men gave a positive response. To assess whether there is a discrimination against persons with AIDS in the workplace, the respon- dents were asked if they believe that an HIV- infected female teacher should be allowed to con- tinue teaching. Only a small percentage of respon- dents (14 percent of women and 11 percent of men) agreed with the question. Self-reporting of sexually transmitted infec- tions (STIs). Less than 2 percent of men reported hav- ing had an STI and/or symptoms of an STI in the 12 months preceding the survey. However, less than half of the men sought care (46 percent) for the infection. Men having sex with men. Among men who have ever had sex, 5 percent reported ever having had sexual relations with a man; less than 1 percent re- ported having sex with a man in the 12 months pre- ceding the survey. Nonmarried men and men with high school education are more likely to engage in homosexual relations than other men. TUBERCULOSIS Knowledge of tuberculosis (TB). Almost all of the women and men surveyed (97 percent of women and 96 percent of men) have heard of TB. However, the percentage of respondents who believe that TB can be cured is a little lower (92 percent for women and 89 percent for men). About half of the respon- dents know that TB is transmitted through the air when coughing (52 percent for women and 46 percent for men). Self-reporting TB infection. Less than 1 per- cent of women and 1 percent of men reported that they had been told by a doctor or a health professional that they had TB in the five years preceding the sur- vey. Differentials across subgroups of respondents were small. Stigma and Discrimination Associated with TB. Six in ten women and men who have heard of TB say they are willing to work with someone who has previously been treated for TB. GENERAL HEALTH In the 2003 NDHS, household respondents were interviewed on their knowledge, practice, and atti- tudes toward health. Communicable Diseases Knowledge of dengue fever. Results of the 2003 NDHS show that effective ways to prevent dengue fever are well known in the Philippines. More than Summary of Findings | xxi two-thirds of household respondents reported that removing mosquito breeding places is a way to avoid dengue. Knowledge of leprosy. About three in four household respondents (76 percent) have heard of leprosy. However, knowledge of the mode of transmission, contact with leprosy patient and skin-to-skin transmission, were correctly identi- fied by only 31 and 28 percent of household re- spondents, respectively. A considerable propor- tion (26 percent) of respondents did not know how leprosy spreads from one person to another. Knowledge of malaria. Nine in ten house- hold respondents have heard of malaria, and 61 percent of them are right in saying that a mosquito bite is the major means of transmission. Noncommunicable Diseases Knowledge of cancer. Survey results show that 94 percent of the household respondents are aware of cancer. Of those, 35 percent mentioned that the most obvious symptom of cancer is the presence of a lump or mass in any part of a per- son’s body. Diabetes. Almost all Filipino households (95 percent) have heard of diabetes. Awareness of this disease is high in all regions (86 percent in CAR to 98 percent in Western Visayas). Health Care Financing In the 2003 NDHS, household respon- dents were asked whether they or anyone in the household were members of Philippine Health Insurance Corporation (PhilHealth) and, if so, what type of members they were. Thirty percent of household respondents in the 2003 NDHS re- ported having at least one member in their house- hold with PhilHealth membership. The largest proportion (43 percent) of PhilHealth members are employed in privately owned businesses or establishments, followed by government employ- ees (27 percent). Individual/voluntary payers and indigents compose smaller percentages (15 and 11 percent, respectively), while overseas Filipino workers (OFW) and nonpaying members compose the smallest percentages (2 percent each). Traditional Medicines DOH continues to promote locally produced herbs with scientifically proven medicinal uses through its Traditional Medicine Program. The 2003 NDHS investigated the familiarity of Filipino house- holds with these herbal medicines and their medicinal uses. The most popular herbal medicines are bayabas (guava, 98 percent), bawang (garlic, 92 percent), and ampalaya (bitter gourd, 88 percent). Health Facility Utilization In the 2003 NDHS, respondents were asked if a member of their household visited any health facility in the six months preceding the survey. More than half (57 percent) of the households utilized a health facil- ity. Barangay health stations, which are public health facilities operating at the grassroots level, are the most utilized health facilities (22 percent each). MORTALITY Childhood Mortality. The infant mortality rate in the Philippines has declined from 34 deaths per 1,000 live births in 1990 to 29 deaths in 2000. At cur- rent mortality levels, 40 of every 1,000 children born in the Philippines die before the fifth birthday. Mortality levels in urban areas are much lower than those in rural areas (24 deaths per 1,000 live births compared with 36 deaths per 1,000 live births). Childhood mortality is inversely related to the mother’s education level and wealth status. The IMR for children whose mother have no education is 65 deaths per 1,000 live births compared with 15 deaths per 1,000 live births for children whose mother have college or higher education. The IMR is higher than the national average in seven regions: MIMAROPA, Western Visayas, Eastern Visayas, Northern Min- danao, Davao, Caraga, and ARMM. CONTINUING CHALLENGES • Despite increased use of family planning, in- creased age at first birth, and the continued decline in fertility, the 2003 NDHS reveals continuing chal- lenges. Twenty-four percent of births in the five years preceding the survey were wanted, but at a later time, and 20 percent were not wanted at all. While the pro- portion of mistimed births declined from 27 percent in xxii | Summary of Findings 1998 to 24 percent in 2003, the proportion of un- wanted births increased from 18 percent in 1998 to 20 percent in 2003. • As use of family planning has increased over time, there has been greater reliance on mod- ern contraceptive methods. The largest increase in use of modern methods involves supply meth- ods—the pill, and injectables. Greater program emphasis needs to be placed on long-term meth- ods such as the IUD and sterilization. • In the maternal health sector, while se- lected health indicators have shown improvement, others show deterioration. The Department of Health recommends that all pregnant women have at least four antenatal care visits during each pregnancy, but only seven in ten women had the recommended number of antenatal care visits dur- ing the last pregnancy resulting in a live birth. • In the area of child health, while coverage of childhood immunizations against the six major dis- eases increased from 65 percent in 1998 to 70 percent in 2003, the percentage of women who have been immunized against neonatal tetanus has stayed at about 37 percent. • Although childhood mortality continues to decline, 54 percent of births in the Philippines have an elevated mortality risk that is avoidable. These include births in which the mother is too young (under age 18) or too old (age 35 or older), the birth interval is too short (less than two years), or the mother has had too many prior births (more than three). • While 95 to 96 percent the 2003 NDHS re- spondents have heard of AIDS, knowledge of ways to reduce the transmission of HIV is limited, and mis- conceptions about AIDS transmission are high. There is need for better information on the modes of trans- mission and ways to prevent HIV/AIDS. BATAN ES MOUNTAIN PROVINCE IFUGAO CAGAYAN ISABELA QUIRINONUEVA VIZCAYA ILOCOS NORTE ABRA ILOCOS SUR LA UNION PANGASINAN ZAMBALES TARLAC NUEVA ECIJA PAMPANGA BULACAN NORTHERN SAMAR WESTERN SAMAR EASTERN SAMAR LEYTE SOUTHER N LEYTE CEBU BOHOL SIQUIJOR CAMIGUIN ZAMBOANGA DEL NORTE MISAMIS OCCIDENTAL ZAMBOANGA SIBUGAY ZAMBOANGA DEL SUR MISAMIS ORIENTAL BUKIDNON AGUSAN DEL NORTE AGUSAN DEL SUR BASILAN SULU TAWI -TAWI SURIGAO DEL NORTE SURIGAO DEL SUR Republic of the Philippines NATIONAL STATISTICS OFFICE Manila Philippine Map N Region I ILOCOS Region II CAGAYAN VALLEY Cordillera Administrative Region (CAR) Region III CENTRAL LUZON National Capital Region (NCR) Region IV-B MIMAROPA Region VI WESTERN VISAYAS Region IX ZAMBOANGA PENINSULA Autonomous Region in Muslim Mindanao (ARMM) Region X NORTHERN MINDANAO Region XIII CARAGA Region VIII EASTERN VISAYAS Region V BICOL P H ILIP P IN E S EA S O U T H C H IN A S E A LU ZO N S EA L U Z O N S T R A I T PALAWAN Region VII CENTRAL VISAYAS ALBAY CAMARINES NORTE CAMARINES SUR MASBATE SORSOGON CATANDUANES RIZAL CAVITE BATANGAS LAGUNA QUEZON ROMBLON NEGROS ORIENTAL Region XI DAVAO Region XII SOCCSKSARGEN Zamboanga City BILIRAN SIBUYAN SEA VISAYAN SEA CAMOTES SEA S U L U S E A BOHOL SEA M O R O G U L F GUIMARAS BABUYAN CHANNEL BENGUET KALINGA APAYAO BATAAN AURORA SULTAN KUDARAT SARANGANI SOUTH COTABATO COTABATO D A V A O GULF DAVAO DEL SUR DAVAO DEL NORTE DAVAO ORIENTAL. COMPOSTELA VALLEY LANAO DEL NORTE MAGUINDANAO LANAO DEL SUR NEGROS OCCIDENTAL AKLAN ILOILO CAPIZ ANTIQUE OCCIDENTAL MINDORO ORIENTAL MINDORO MARINDUQUE Region IV-A CALABARZON xxiv l Map of Philippines Introduction | 1 INTRODUCTION 1 1.1 BACKGROUND In the absence of comprehensive registration of population and vital statistics, demographic surveys are the primary source of data used in monitoring the progress and evaluating the impact of the population program of the country. The Philippine Population Program was officially launched in 1970. Since then, it has undergone many changes in its policy and program directions. In the beginning, the program was centered on fertility reduction and contraceptive distribution, using a clinic-based approach. In the 1970s, the family planning program shifted to a family welfare approach, adopting a combined clinic and community-based delivery approach. In the 1980s, the population policy was restated, calling for the broadening of population concerns beyond fertility reduction to cover family formation, the status of women, maternal and child health, morbidity and mortality, population distribution and urbanization, internal and international migration, and population structure (Commission on Population, 1997: 1). The Philippine Population Management Program (PPMP) was developed in 1993 to supplant the Philippine Population Program (Philippine NGO Council on Population, Health and Welfare, Inc., 1998: 25). The PPMP adopted the population, resources and environment (PRE) framework, which defines the connection between population and sustainable development. Its overall goal is the improvement of quality of life by creating a favorable environment for achieving rational growth and distribution of population, defined in relation to resources and environment. Since 1998, the program has aimed to promote the reproductive health approach in the implementation of population policies and programs. Specifically, the Philippine Family Planning Program promotes family planning within a comprehensive package of reproductive health services (Commission on Population, 1997: 17). The action agenda includes the following (Commission on Population, 1997: 19): 1) Reducing unmet need for family planning services 2) Reducing incidence of high-risk pregnancies 3) Making available high-quality family planning services 4) Reducing abortion 5) Increasing the participation and sharing of responsibility of men in the practice of family planning. The Department of Health (DOH) is the lead agency for the reproductive health and family planning component of the PPMP. The Commission on Population (POPCOM) is the coordinating body of the PPMP (Commission on Population, 1997: 5-6). The PPMP Directional Plan for 2001-2004 aimed to continue pursuing responsible parenthood within the context of sustainable development, with emphasis on the health rationale of family planning and on the exercise of reproductive health and sexual rights. The Directional Plan aimed to reduce or eliminate the unmet need for family planning and ultimately achieve replacement-level fertility, that is about 2 children per couple in the year 2004 (POPCOM, 2000). The PPMP Directional Plan was updated during the administration of President Gloria-Macapagal- Arroyo through the development of Strategic Operational Plan (SOP). The PPMP SOP will focus on Introduction | 2 addressing the unmet need for family planning among poor couples, and the sexuality and fertility information needs of the adolescents and youth, especially among those who are poor (POPCOM, 2002). The strategic actions areas are: 1) service delivery, 2) IEC/advocacy, and 3) capacity building. POPCOM, in coordination with the DOH, will advocate for the promotion of the Family Planning/Reproductive Health (FP/RF) services. The DOH will implement the clinic-based delivery of FP/RH services. 1.2 OBJECTIVES OF THE SURVEY The 2003 Philippines National Demographic and Health Survey (NDHS) is designed to provide up- to-date information on population, family planning, and health to assist policymakers and program managers in evaluating and designing strategies for improving health and family planning services in the country. In particular, the 2003 NDHS has the following objectives: • Collect data at the national level, which will allow the calculation of demographic rates and, particularly, fertility and under-five mortality rates. • Analyze the direct and indirect factors that determine the level and trends of fertility. Indicators related to fertility will serve to inform plans for social and economic development. • Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. • Collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use. • Collect high-quality data on family health, including immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding. 1.3 ORGANIZATION OF THE SURVEY The 2003 NDHS was implemented by the Philippines National Statistics Office (NSO) from June 16 to September 3, 2003. Financial support for the local costs of the survey was provided by the United States Agency for International Development (USAID). ORC Macro provided technical assistance to the project through the MEASURE DHS+ program. The 2003 NDHS is the eighth in a series of demographic surveys in the Philippines taken at five- year intervals since 1968. It is the third survey conducted under the auspices of the Demographic and Health Surveys program. Thus, the data collected in the 2003 NDHS provide updated estimates of basic demographic and health indicators covered in previous NDHS surveys. 1.4 QUESTIONNAIRES The 2003 NDHS used four questionnaires: Household Questionnaire, Health Module, Women’s Questionnaire, and Men’s Questionnaire. The content of the Women’s Questionnaire was based on the MEASURE DHS+ Model “A” Questionnaire, which was developed for use in countries with high levels of contraceptive use. To modify the questionnaire to reflect relevant family planning and health issues in the Philippines, program input was solicited from Department of Health (DOH), Commission on Population (POPCOM), the University of the Philippines Population Institute (UPPI), the Food and Nutrition Research Introduction | 3 Institute (FNRI), the Philippine Health Insurance Corporation (PhilHealth), USAID, the National Statistics Coordination Board (NSCB), the National Economic and Development Authority (NEDA), the United Nations Children’s Fund (UNICEF), and Dr. Mercedes B. Concepcion, professor emeritus at the University of the Philippines, as well as managers of USAID-sponsored projects in the Philippines. The questionnaires were translated from English into six major languages: Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray. The Household Questionnaire was used to list all of the usual members and visitors in the selected households. Basic information collected for each person listed includes age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various durable goods, was also recorded in the Household Questionnaire. These items are indicators of the household’s socioeconomic status. The Health Module was aimed at apprising concerned agencies on the health status, practices, and attitude of the population. The module included the following topics: - Health facility utilization - Noncommunicable diseases - Infectious diseases - Traditional medicines, healing practices, and alternative health care modalities - Health care financing - Environmental health. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: - Background characteristics (e.g., education, media exposure) - Reproductive history - Knowledge and use of family planning methods - Fertility preferences - Antenatal, delivery, and postnatal care - Breastfeeding and infant feeding practices - Vaccinations and childhood illnesses - Marriage and sexual activity - Woman’s work and husband’s background characteristics - Infant’s and children’s feeding practices - Childhood mortality - Awareness and behavior regarding AIDS and other sexually transmitted infections - Awareness and behavior regarding tuberculosis. The Men’s Questionnaire was administered to all men age 15-54 living in every third household in the NDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire but was shorter because it did not contain questions on reproductive history, maternal and child health, and nutrition. Instead, men were asked about their knowledge and participation in health-seeking practices for their children. Introduction | 4 1.5 PRETEST Three pretests were conducted prior to finalizing the survey instruments. The first pretest was conducted on January 6 through 10, 2003, in Caloocan City and Marikina City, both located in the National Capital Region (NCR). It was aimed at checking the flow of questions and the practicability of administering the Men’s Questionnaire, which was used for the first time in the Philippines NDHS. The second pretest was carried out in Bulacan Province. The aim was to test the Tagalog translation of the questionnaires and also the field operation procedures. Training for the pretest field staff took place in the NSO Central Office in Manila from February 24 through March 7, 2003, with fieldwork on March 10 through 22, 2003. The NDHS questionnaires were later translated into other dialects—Cebuano, Ilocano, Bicol, Hiligaynon, and Waray—with assistance from staff of the Regional Statistics Offices (RSOs). The third pretest was mainly carried out to check the translation of the questionnaires. It was conducted on April 2 through 9, 2003, in the NSO Central Office, with personnel assigned at the Household Statistics Department and the NSO NCR office who spoke any of the five dialects acting as the interviewers. Selected male and female employees from different departments of NSO who spoke the dialects were interviewed with the translated questionnaires. Some of the third pretest interviewers administered the translated questionnaires to their neighbors and relatives who spoke the dialects. 1.6 TRAINING AND FIELDWORK Training of the field staff was conducted in two phases. The first was the Task Force training (instructors and regional coordinators), followed by training of the interviewing teams. The Task Force training was conducted in Manila from April 28 through May 17, 2003. Thirty-six persons participated as trainees: 17 from RSOs and 19 from the NSO Central Office. The trainers were staff of the Demographic and Social Statistics Division (DSSD) at NSO and professors from UPPI. Staff from DOH and PhilHealth served as resource persons in the training. The second-level training took place from May 21 through June 6, 2003, in eight training centers: Antipolo, Rizal; San Fernando, La Union; Legazpi City; Iloilo City; Cebu City; Zamboanga City; Cagayan de Oro City; and Davao City. Instructors in this training were members of the Task Force who were trained in the first-level training. Data collection was carried out from June 16 to September 3, 2003, by 44 interviewing teams. Each team consisted of a team supervisor, a field editor, three or four female interviewers, and one male interviewer. 1.7 DATA PROCESSING All completed questionnaires and the control forms were returned to the NSO Central Office in Manila for data processing, which consisted of manual editing, data entry and verification, and editing of computer-identified errors. An ad hoc group of seven regular employees of DSSD was created to work full time in the NDHS Data Processing Center. This group was responsible for the different aspects of NDHS data processing. There were 10 manual processors and 25 data encoders hired to process the data. Manual editing started on July 15, 2003, and data entry started on July 21, 2003. The computer package program called CSPro (Census and Survey Processing System) was used for data entry, editing, and tabulation. To prepare the data entry programs, two NSO staff members spent three weeks in ORC Macro offices in Calverton, Maryland, in April and May 2003. Data processing was completed in October 29, 2003. Introduction | 5 1.8 SAMPLE DESIGN AND IMPLEMENTATION The 2003 NDHS is the first survey that used the new master sample created for household surveys on the basis of the 2000 Census of Population and Housing. The 2003 NDHS used one of the four replicates of the master sample. The sample was designed to represent the country as a whole, urban and rural areas, and each of the 17 administrative regions. In each region, a stratified, three-stage cluster sampling design was employed. In the first stage, 819 primary sampling units (PSUs) were selected with probability proportional to the number of households in the 2000 census. PSUs consisted of a barangay or a group of contiguous barangays. In the second stage, in each PSU, enumeration areas (EAs) were selected with probability proportional to the number of EAs. An EA is defined as an area with discernable boundaries consisting of about 150 contiguous households. All households in the selected EAs were listed in a separate field operation conducted May 7 through 21, 2003. In the third stage, from each EA, an average of 17 households was selected using systematic sampling. For the 2003 NDHS sample, 13,914 households were selected, of which 12,694 were occupied (Table 1.1). Of these households, 12,586 were successfully interviewed, yielding a household response rate of 99 percent. Household response rates are similar in rural areas and in urban areas (99 percent). Among the households interviewed, 13,945 women were identified as eligible respondents, and interviews were completed for 13,633 women, yielding a response rate of 98 percent. In a subsample of every third household, 5,009 men were identified to be eligible for individual interview. Of these, 4,766 were successfully interviewed, yielding a response rate of 95 percent. The principal reason for nonresponse among women and men was the failure to find individuals at home, despite interviewers’ repeated visits to the household. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Result Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household interviews Households selected 6,878 7,036 13,914 Households occupied 6,247 6,447 12,694 Households interviewed 6,183 6,403 12,586 Household response rate 99.0 99.3 99.1 Interviews with women Number of eligible women 7,610 6,335 13,945 Number of eligible women interviewed 7,436 6,197 13,633 Eligible woman response rate 97.7 97.8 97.8 Interviews with men Number of eligible men 2,526 2,483 5,009 Number of eligible men interviewed 2,379 2,387 4,766 Eligible man response rate 94.2 96.1 95.1 Household Population and Housing Characteristics | 7 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter provides a summary of the demographic and socioeconomic characteristics of the household population in the 2003 National Demographic and Health Survey (NDHS). It provides valu- able input for social and economic development planning and is also useful for understanding and identi- fying the major factors that determine or influence the basic demographic indicators of the population. The Household Questionnaire used in the 2003 NDHS collected data on the demographic and so- cial characteristics of the members and visitors in each sample household. A household, as defined in the survey, refers to a person or group of persons who usually sleep in the same housing unit and have a common arrangement for the preparation and consumption of food. A visitor is someone who is not a usual resident of the household but had slept in the household the night prior to the interview. In the 2003 NDHS, information was collected on each household’s ownership of a number of consumer items, such as radio, television, or car, as well as on dwelling characteristics and sanitation fa- cilities. A wealth index was constructed by assigning a weight or factor score to each household asset through principal components analysis. These scores were summed by household, and individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles—five groups with the same number of individuals each. 2.1 AGE AND SEX COMPOSITION OF THE HOUSEHOLD POPULATION Age and sex are important demographic variables and are the primary basis of demographic clas- sification in vital statistics, censuses, and surveys. They are also important variables in the study of mor- tality, fertility, and nuptiality. In general, the presentation of indicators according to sex is a useful analy- sis. An examination of the quality of data indicates that age reporting in the Philippines is fairly accu- rate. Slight heaping is notable in selected ages (Figure 2.1). Figure 2.1 Distribution of the De Facto Household Population by Single Year of Age and Sex 0 10 20 30 40 50 60 70 Age 0 0.5 1 1.5 2 2.5 3 Percent Male Female NDHS 2003 8 | Household Population and Housing Characteristics The 2003 NDHS enumerated a total of 58,449 persons, almost equally divided between males and females. The overall sex ratio, the number of males per 100 females, is 101. The sex ratio differs by resi- dence; it is lower in urban areas than in rural areas (97 and 106, respectively). The proportion of popula- tion below age 15 years is larger in rural than in urban areas (41 and 35 percent, respectively), indicating a younger age structure of the rural population (Table 2.1 and Figure 2.2). Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and resi- dence, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban Rural Total ––––––––––––––––––––––– –––––––––––––––––––––– ––––––––––––––––––––––– Age Male Female Total Male Female Total Male Female Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <5 12.2 11.3 11.7 13.0 13.3 13.2 12.6 12.2 12.4 5-9 12.4 10.8 11.6 14.1 13.9 14.0 13.3 12.3 12.8 10-14 11.8 11.6 11.7 13.9 14.1 14.0 12.8 12.8 12.8 15-19 10.4 10.3 10.4 10.3 8.4 9.4 10.4 9.4 9.9 20-24 9.9 9.5 9.7 7.3 6.2 6.7 8.6 8.0 8.3 25-29 8.0 7.9 8.0 6.4 6.5 6.5 7.2 7.2 7.2 30-34 7.2 7.3 7.2 6.2 6.4 6.3 6.7 6.9 6.8 35-39 6.3 6.9 6.6 6.1 6.3 6.2 6.2 6.6 6.4 40-44 5.8 5.7 5.7 5.2 5.4 5.3 5.5 5.6 5.5 45-49 4.8 5.0 4.9 4.5 4.4 4.5 4.6 4.7 4.7 50-54 3.5 4.3 3.9 3.7 4.2 3.9 3.6 4.3 3.9 55-59 2.7 2.8 2.7 2.7 2.9 2.8 2.7 2.9 2.8 60-64 1.9 2.2 2.1 2.4 2.6 2.5 2.2 2.4 2.3 65-69 1.3 1.5 1.4 1.6 2.1 1.9 1.4 1.8 1.6 70-74 0.9 1.2 1.1 1.1 1.4 1.3 1.0 1.3 1.2 75-79 0.5 0.7 0.6 0.6 1.0 0.8 0.6 0.8 0.7 80+ 0.5 0.9 0.7 0.8 0.9 0.8 0.6 0.9 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 14,910 15,428 30,337 14,490 13,622 28,112 29,399 29,050 58,449 Figure 2.2 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 NDHS 2003 Age Male Percent Female Household Population and Housing Characteristics | 9 Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––– Characteristic Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––– Sex of head of household Male 81.9 87.6 84.6 Female 18.1 12.4 15.4 Total 100.0 100.0 100.0 Number of usual members 1 4.1 4.2 4.1 2 9.8 10.5 10.1 3 15.9 14.9 15.4 4 19.9 17.8 18.9 5 17.9 17.8 17.8 6 13.5 12.7 13.1 7 8.4 9.2 8.8 8 4.6 6.3 5.4 9+ 5.9 6.5 6.2 Total 100.0 100.0 100.0 Number of households 6,583 6,003 12,586 Mean size 4.8 4.9 4.8 –––––––––––––––––––––––––––––––––––––––––––––––––– Note: Table is based on de jure members, i.e., usual residents. 2.2 AGE DISTRIBUTION FROM SELECTED SOURCES The percent distributions of population by broad age groups, according to the 1970, 1980, 1990, 1995, and 2000 census of population and the 1993, 1998, and 2003 NDHS are presented in Table 2.2. There appears to be a progressive decline in the proportion of population under 15 and, concomitantly, an increase in the median age since 1970. The growing proportion of population age 15-64 results in a de- clining dependency ratio, defined as the ratio of persons in the “dependent ages” (under 15 and 65 and over) to those in the “economically active” ages (15-64). This slight aging of the population has taken place in the recent past as a result of continuous, albeit slow, decline in fertility levels. The 1993, 1998, and 2003 NDHS data show fairly similar distributions by age, which lends support to the representative- ness of the survey population. 2.3 HOUSEHOLD COMPOSITION Information on the distribution of house- holds by selected background characteristics is useful for several reasons. For example, female- headed households are often found to be poorer than male-headed households. The size and compo- sition of the household influence the allocation of limited resources and affect the living conditions of individuals in the household. Information on the size and composition of the sample households by urban-rural residence is presented in Table 2.3. Fifteen percent of households are headed by women. This proportion is higher in urban areas than in rural areas (18 and 12 percent, respec- tively). On average, a household is composed of 4.8 persons, with a negligible difference in average household size between urban and rural areas. Table 2.2 Median age and dependency ratio Percent distribution of the household population by broad age groups for various census years and the NDHS, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1970 1980 1990 1993 1995 1998 2000 2003 Age group census census census NDHS census NDHS census NDHS ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Less than 15 45.7 42.0 39.5 39.3 38.4 38.5 37.0 38.0 15-64 51.4 54.6 57.1 56.8 58.1 57.3 59.2 57.8 65+ 2.9 3.4 3.4 3.9 3.5 4.2 3.8 4.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median age 16.0 18.0 19.0 20.1 20.0 20.6 21.4 21.3 Dependency ratio 94.6 83.2 75.1 76.1 72.2 74.5 69.0 73.0 10 | Household Population and Housing Characteristics 2.4 EDUCATION OF HOUSEHOLD POPULATION Studies show that education is one of the major socioeconomic factors that influence a person’s behavior and attitudes. In general, better-educated women are more knowledgeable about the use of health facilities, family planning methods, and the health of their children. Education is highly valued by Filipino families. This is reflected in the country’s constitution, which states that education up to high school level is a basic right of all Filipino children. Furthermore, in September 2000, the United Nations General Assembly encouraged all member countries to achieve the Millennium Development Goals, spe- cifically goal 2, which is aimed to achieve universal primary education and gender equity by 2015. 2.4.1 Education Level of the Household Population Information on the highest level of education attended by the population, according to selected background characteristics, is presented in Tables 2.4.1 and 2.4.2 for females and males, respectively. Table 2.4.1 Educational attainment of female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Don’t Median Background No High College or know/ number characteristic education Elementary school higher missing Total Number of years ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 39.8 60.0 0.1 0.0 0.1 100.0 2,829 0.4 10-14 1.8 72.7 25.3 0.0 0.1 100.0 3,707 4.7 15-19 0.9 13.4 69.7 16.0 0.0 100.0 2,734 8.6 20-24 1.0 14.5 43.0 41.5 0.0 100.0 2,311 9.7 25-29 1.6 18.0 42.5 37.9 0.0 100.0 2,099 9.6 30-34 1.4 24.4 38.7 35.5 0.0 100.0 1,995 9.4 35-39 2.5 27.6 37.0 32.9 0.0 100.0 1,926 9.2 40-44 2.5 36.0 32.1 29.4 0.0 100.0 1,614 8.7 45-49 2.7 41.2 31.4 24.5 0.2 100.0 1,376 7.3 50-54 4.9 46.8 23.7 24.4 0.2 100.0 1,240 5.9 55-59 4.8 52.3 21.8 21.1 0.0 100.0 831 5.7 60-64 8.9 59.8 17.3 13.6 0.4 100.0 703 5.3 65+ 14.4 61.5 13.6 9.9 0.6 100.0 1,400 4.3 Residence Urban 5.3 31.7 34.9 28.0 0.1 100.0 13,340 8.3 Rural 9.6 49.9 28.8 11.6 0.1 100.0 11,428 5.4 Region National Capital Region 4.5 25.9 36.7 32.8 0.1 100.0 3,832 9.2 Cordillera Admin Region 9.8 35.0 26.8 28.1 0.2 100.0 381 6.9 I - Ilocos 5.3 39.4 36.1 19.2 0.0 100.0 1,244 7.0 II - Cagayan Valley 7.8 45.3 28.8 17.9 0.2 100.0 810 5.8 III - Central Luzon 6.1 39.8 35.6 18.3 0.2 100.0 2,601 6.7 IVA - CALABARZON 4.8 34.6 36.6 23.9 0.1 100.0 3,242 7.9 IVB - MIMAROPA 10.0 49.6 28.5 11.9 0.0 100.0 672 5.5 V - Bicol 7.1 47.2 29.9 15.8 0.0 100.0 1,419 5.8 VI - Western Visayas 8.5 44.7 29.1 17.4 0.3 100.0 1,859 5.8 VII - Central Visayas 6.7 45.3 30.2 17.9 0.0 100.0 1,965 5.9 VIII - Eastern Visayas 8.0 53.5 24.8 13.7 0.0 100.0 1,133 5.4 IX - Zamboanga Peninsula 9.7 49.6 25.1 15.3 0.3 100.0 904 5.4 X - Northern Mindanao 6.8 43.5 31.0 18.7 0.0 100.0 1,077 6.0 XI - Davao 7.9 41.7 31.0 19.1 0.3 100.0 1,154 6.0 XII - SOCCSKSARGEN 11.0 41.5 31.8 15.6 0.0 100.0 986 5.8 XIII - Caraga 6.0 46.0 30.1 17.9 0.0 100.0 648 5.9 ARMM 23.1 42.7 23.0 11.2 0.0 100.0 842 4.5 Wealth index quintile Lowest 16.7 60.3 20.2 2.6 0.1 100.0 4,407 3.9 Second 8.2 50.9 33.0 7.8 0.1 100.0 4,670 5.5 Middle 5.7 41.6 38.0 14.6 0.1 100.0 4,894 6.4 Fourth 4.0 32.1 37.4 26.3 0.2 100.0 5,147 8.3 Highest 3.4 21.5 30.7 44.3 0.1 100.0 5,651 9.7 Total 7.2 40.1 32.1 20.4 0.1 100.0 24,769 6.5 Household Population and Housing Characteristics | 11 The results of the 2003 NDHS indicate that the vast majority of the population has some formal educa- tion. Among women age 6 and over, only 7 percent have had no formal education. For men and women, two in five had elementary school only, three in ten attended high school only, and one in five attended higher education. No major gender differences are observed for education. However, a significant difference is noted between urban and rural areas; the educational system favors residents of urban areas. Table 2.4.2 Educational attainment of male household population Percent distribution of the de facto male household population age six and over by highest level of education attended or com- pleted, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Don’t Median Background No High College or know/ number characteristic education Elementary1 school2 higher3 missing Total Number of years ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 6-9 44.5 55.2 0.2 0.0 0.2 100.0 3,091 0.2 10-14 3.2 79.3 17.5 0.0 0.0 100.0 3,778 4.2 15-19 1.9 26.1 61.0 10.9 0.1 100.0 3,056 7.8 20-24 1.1 21.7 42.7 34.5 0.0 100.0 2,527 9.4 25-29 1.6 24.5 39.7 34.1 0.1 100.0 2,130 9.4 30-34 1.9 30.7 37.6 29.8 0.0 100.0 1,964 9.1 35-39 2.1 31.3 37.5 29.1 0.0 100.0 1,823 9.1 40-44 2.8 36.2 34.4 26.5 0.0 100.0 1,620 8.5 45-49 1.7 40.4 30.2 27.5 0.1 100.0 1,364 7.8 50-54 2.5 47.2 29.4 20.7 0.2 100.0 1,062 6.0 55-59 4.7 52.1 23.2 19.7 0.4 100.0 781 5.7 60-64 6.2 55.9 20.9 16.6 0.4 100.0 632 5.5 65+ 12.5 56.8 19.0 11.3 0.3 100.0 1,063 5.1 Residence Urban 6.1 33.0 35.0 25.7 0.1 100.0 12,697 7.9 Rural 10.0 53.7 26.5 9.7 0.1 100.0 12,194 5.2 Region National Capital Region 5.3 26.2 36.6 31.8 0.1 100.0 3,509 9.1 Cordillera Admin Region 9.5 42.6 27.6 20.1 0.2 100.0 385 5.8 I - Ilocos 5.3 41.5 36.4 16.9 0.0 100.0 1,324 6.5 II - Cagayan Valley 7.8 47.4 28.8 15.8 0.2 100.0 816 5.7 III - Central Luzon 6.2 40.4 35.3 17.8 0.3 100.0 2,581 6.7 IVA - CALABARZON 6.0 33.8 37.5 22.6 0.1 100.0 3,127 7.8 IVB - MIMAROPA 9.1 55.4 26.2 9.2 0.1 100.0 697 5.1 V - Bicol 7.7 49.6 30.1 12.4 0.2 100.0 1,493 5.6 VI - Western Visayas 9.5 50.1 27.3 13.1 0.1 100.0 1,900 5.4 VII - Central Visayas 8.4 46.4 27.0 18.1 0.1 100.0 1,958 5.6 VIII - Eastern Visayas 9.9 59.3 21.1 9.6 0.0 100.0 1,227 4.6 IX - Zamboanga Peninsula 9.8 55.4 22.0 12.8 0.0 100.0 1,003 5.0 X - Northern Mindanao 8.8 50.3 27.8 13.2 0.0 100.0 1,074 5.4 XI - Davao 10.0 46.1 28.7 15.0 0.2 100.0 1,208 5.5 XII - SOCCSKSARGEN 10.5 48.3 28.6 12.5 0.1 100.0 1,075 5.3 XIII - Caraga 9.0 49.2 26.3 15.5 0.0 100.0 680 5.4 ARMM 19.2 47.9 22.6 10.0 0.3 100.0 835 4.3 Wealth index quintile Lowest 16.5 65.2 16.5 1.8 0.0 100.0 4,933 3.4 Second 8.6 54.8 30.3 6.0 0.2 100.0 5,073 5.3 Middle 6.4 41.8 38.3 13.4 0.0 100.0 5,080 6.3 Fourth 4.7 31.3 39.7 24.2 0.1 100.0 5,080 8.4 Highest 3.8 21.9 28.7 45.5 0.2 100.0 4,725 9.7 Total 8.0 43.2 30.8 17.9 0.1 100.0 24,891 5.9 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Completed grade 6 at the primary level 2 Completed grade 4 at the secondary level 3 Have attended college 12 | Household Population and Housing Characteristics The distribution of population by highest level of education attended differs greatly among the regions of the country (Figure 2.3). The National Capital Region (NCR) and CALABARZON have a much better educated population compared to the rest of the country; the median duration of schooling in these regions is nine and eight years, respectively, compared with four to seven years in the other regions. On the other hand, residents of Autonomous Region in Muslim Mindanao (ARMM) have the lowest me- dian duration of schooling (4.5 years for women and 4.3 years for men). 2.4.2 School Attendance Ratios The net attendance ratio (NAR) in primary school is the proportion of population age 6-11 who are enrolled in primary school, and the NAR in secondary school is the proportion of population age 12- 17 who are enrolled in secondary school. The gross attendance ratio (GAR) is the proportion of students expressed “as official school age” at each level of schooling. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level. A NAR of 100 percent indicates that all children in the official age range of a particular education level are attending that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. Tables 2.5.1 and 2.5.2 present information on primary and secondary school attendance, respectively, in terms of NARs and GARs for the de jure household population by level of schooling and sex. For primary school, the NAR is 83 percent and the GAR is 99 percent (Table 2.5.1). The NAR is higher in urban areas and among females, compared with other populations. For instance, the NAR for females is 85 percent, compared with 81 percent for males. Among regions, the NAR is highest in Cordil- lera Administrative Region (CAR) (91 percent) and lowest in ARMM (70 percent). There are negligible variations in GAR by urban-rural residence and gender. Among regions, CAR and ARMM also show the highest and lowest GAR in the country, respectively (113 percent in CAR and 93 percent in ARMM). Figure 2.3 Median Years of Schooling by Sex and Region Na tio na l C ap ita l R eg ion Co rd ille ra Ad mi n R eg ion I - Ilo co s II - C ag ay an V all ey III - C en tra l L uz on IV A - C AL AB AR ZO N IV B - M IM AR OP A V - B ico l VI - W est ern V isa ya s VI I - C en tra l V isa ya s VI II - Ea ste rn Vis ay as IX - Z am bo an ga Pe nin su la X - N ort he rn Mi nd an ao XI - D av ao XII - SO CC SK SA RG EN XII I - Ca rag a AR MM Region 0 2 4 6 8 10 Median years of schooling Female Male NDHS 2003 Household Population and Housing Characteristics | 13 The last column in Table 2.5.1 presents the gender parity index. The overall index is 1.01, which indicates that in the Philippines, women are slightly more advantaged than men in terms of education. There are no differences by urban-rural residence and small differences by region. The largest deviation from 1.00 (no gender difference) is in Caraga (1.06), and the smallest difference (0.01) is observed in Ilocos, Central Luzon, MIMAROPA, Central Visayas, Eastern Visayas, and Northern Mindanao. The NAR and GAR by wealth quintile index show an increasing pattern; respondents from the poorest households have the lowest NAR and GAR, while those in the highest quintile have the highest NAR and second-highest GAR. Table 2.5.2 shows that for secondary school, the NAR is 49 percent and the GAR is 53 percent. As in the case of primary education, the NAR is higher in urban areas and for females. Among regions, the NAR is highest in Ilocos Region (59 percent) and lowest in ARMM (32 percent). The GAR is highest in CALABARZON (62 percent) and lowest in ARMM (37 percent). Table 2.5.1 School attendance ratios: primary school Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de jure household population by level of schooling and sex, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Net attendance ratio1 Gross attendance ratio2 Gender Background –––––––––––––––––––––––––– ––––––––––––––––––––––––– parity characteristic Male Female Total Male Female Total index3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 83.8 87.9 85.7 99.3 101.7 100.4 1.02 Rural 78.6 83.2 80.9 98.1 97.7 97.9 1.00 Region National Capital Region 82.4 88.1 85.1 96.5 100.6 98.5 1.04 Cordillera Admin Region 89.5 93.4 91.3 110.6 115.5 112.9 1.04 I - Ilocos 84.5 89.1 86.4 97.7 98.9 98.2 1.01 II - Cagayan Valley 84.0 87.8 86.0 98.9 96.5 97.7 0.98 III - Central Luzon 85.9 85.9 85.9 100.6 99.2 99.9 0.99 IVA - CALABARZON 85.6 89.7 87.6 97.8 101.4 99.6 1.04 IVB - MIMAROPA 82.2 85.6 83.8 100.5 97.4 99.1 0.97 V - Bicol 82.6 84.6 83.5 98.5 99.4 99.0 1.01 VI - Western Visayas 79.0 84.7 81.8 97.7 100.4 99.0 1.03 VII - Central Visayas 82.4 86.3 84.2 101.9 100.7 101.3 0.99 VIII - Eastern Visayas 74.8 82.1 78.4 98.6 99.3 98.9 1.01 IX - Zamboanga Peninsula 76.5 82.4 79.4 102.5 96.0 99.3 0.94 X – Northern Mindanao 79.6 85.2 82.3 102.8 101.3 102.1 0.99 XI - Davao 78.2 81.8 80.0 98.3 96.2 97.2 0.98 XII - SOCCSKSARGEN 76.5 82.8 79.5 96.3 99.0 97.6 1.03 XIII - Caraga 76.6 83.2 79.8 94.0 99.9 96.8 1.06 ARMM 67.4 71.8 69.6 90.8 94.2 92.5 1.04 Wealth index quintile Lowest 68.6 75.4 71.9 90.6 92.5 91.5 1.02 Second 79.1 84.7 81.8 100.6 100.8 100.7 1.00 Middle 84.8 90.3 87.4 99.7 102.5 101.0 1.03 Fourth 89.2 90.4 89.8 105.7 101.4 103.6 0.96 Highest 89.8 90.7 90.2 99.6 103.4 101.4 1.04 Total 81.0 85.3 83.1 98.7 99.5 99.1 1.01 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 The NAR for primary school is the percentage of the primary-school-age (7-12 years) population that is attending primary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the offi- cial primary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for primary school is the ratio of the primary school GAR for females to the GAR for males. 14 | Household Population and Housing Characteristics The NAR and GAR in secondary education have even stronger associations by wealth quintile index, as compared with those in primary education. They are lowest for students in the poorest house- holds and highest for those in households with higher wealth quintiles. 2.5 REPETITION AND DROPOUT RATES By asking about the grade that children were attending during the previous and the current school year, it is possible to calculate dropout and repetition rates. The repetition rate is the percentage of stu- dents in a given grade the previous school year who repeat that grade in the current school year. The dropout rate is the percentage of students in a given grade in the previous school year who are not cur- rently attending school. Table 2.6 shows the repetition and dropout rates for the de jure household population age 5-24 years by school grade. In general, repetition rates are highest in grade 1 (8 percent). Male students, those Table 2.5.2 School attendance ratios: secondary school Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de jure household population by level of schooling and sex, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Net attendance ratio1 Gross attendance ratio2 Gender Background –––––––––––––––––––––––––– ––––––––––––––––––––––––– parity characteristic Male Female Total Male Female Total index3 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Urban 50.4 54.9 52.7 56.6 58.6 57.6 1.03 Rural 37.8 52.8 44.8 42.3 56.0 48.7 1.32 Region National Capital Region 51.3 52.4 51.9 57.8 56.0 56.9 0.97 Cordillera Admin Region 47.8 52.6 50.2 51.6 57.5 54.5 1.12 I - Ilocos 57.2 60.0 58.6 60.0 61.9 61.0 1.03 II - Cagayan Valley 48.7 55.9 52.3 51.6 59.4 55.5 1.15 III - Central Luzon 41.7 56.8 49.7 47.5 59.9 54.0 1.26 IVA - CALABARZON 53.5 60.5 57.1 58.5 65.4 62.1 1.12 IVB - MIMAROPA 43.2 55.6 48.8 45.4 58.2 51.2 1.28 V - Bicol 45.6 55.8 50.4 51.1 58.1 54.4 1.14 VI - Western Visayas 40.5 54.0 47.0 45.8 56.3 50.9 1.23 VII - Central Visayas 43.1 51.0 47.1 51.3 54.7 53.0 1.07 VIII - Eastern Visayas 37.3 48.7 42.2 40.8 54.9 46.9 1.34 IX - Zamboanga Peninsula 32.6 51.0 40.4 38.0 53.6 44.6 1.41 X - Northern Mindanao 34.8 57.0 45.5 39.6 59.4 49.2 1.50 XI - Davao 40.1 50.3 45.3 46.2 52.9 49.6 1.15 XII - SOCCSKSARGEN 36.2 50.8 42.9 42.8 54.1 47.9 1.26 XIII - Caraga 44.4 51.1 47.6 50.5 52.2 51.3 1.04 ARMM 29.3 35.6 32.2 34.2 41.2 37.4 1.21 Wealth index quintile Lowest 21.6 33.8 26.9 24.0 36.3 29.3 1.51 Second 32.3 52.1 41.4 37.8 55.0 45.7 1.46 Middle 49.2 59.3 54.2 55.8 62.1 58.9 1.11 Fourth 56.9 65.4 61.1 61.7 69.8 65.7 1.13 Highest 63.8 55.0 58.8 71.7 59.1 64.5 0.82 Total 43.9 54.0 48.9 49.3 57.4 53.2 1.16 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 The NAR for secondary school is the percentage of the secondary-school-age (13-16 years) population that is at- tending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. Household Population and Housing Characteristics | 15 who live in rural areas, and those from the poorest households are most likely to repeat in grade 1. The rates vary greatly across regions, ranging from 3 percent or less in NCR, CALABARZON, Central Visayas, and ARMM to 18 percent in Northern Mindanao. Repetition rates in grade 1 are 12 percent or higher in Western Visayas, Davao, Bicol, and Northern Mindanao. Repetition rates in higher grades are much lower than those in grade 1. Bicol has the highest repetition rates in grades 1, 2, and 4. Dropout rates show a different pattern: They increase with grade, ranging from 1 percent in grade 1 to 8 percent in grade 6. Again, rural and poor students are most likely to drop out in grade 6. Male students in general have higher dropout rates than female students. Across regions, the dropout rate in grade 6 is 12 percent or higher in Central Visayas, Eastern Visayas, Zamboanga Peninsula, Northern Mindanao, and SOCCSKSARGEN. Table 2.6 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background charac- teristics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Repetition rate1 Dropout rate2 Background ––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––– characteristic 1 2 3 4 5 6 1 2 3 4 5 6 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Sex Male 8.3 3.9 2.9 2.6 0.9 2.5 0.8 2.6 2.9 2.5 4.4 8.6 Female 6.8 0.9 0.8 1.4 0.5 1.3 1.4 1.4 1.3 1.8 1.0 7.5 Residence Urban 5.1 1.9 1.6 1.8 0.4 2.1 1.6 1.0 1.7 0.9 1.3 5.5 Rural 9.4 3.0 2.1 2.2 0.9 1.7 0.7 2.9 2.5 3.3 4.0 10.6 Region National Capital Region 3.0 1.7 1.9 1.5 0.5 5.5 2.3 0.0 2.4 0.2 0.4 2.9 Cordillera Admin Region 5.3 3.8 1.8 1.5 2.0 4.7 0.0 2.5 1.7 0.0 6.4 1.9 I - Ilocos 4.5 2.5 0.0 0.0 0.0 1.3 1.5 1.3 0.0 2.8 1.6 0.0 II - Cagayan Valley 8.2 1.5 3.2 0.0 2.0 0.0 0.0 0.0 0.0 1.7 0.0 4.6 III - Central Luzon 8.0 1.7 0.9 3.6 0.9 2.4 0.0 3.0 1.7 0.0 1.9 7.8 IVA - CALABARZON 2.2 2.0 2.6 0.9 0.0 1.6 0.3 0.0 0.0 1.5 2.5 4.4 IVB - MIMAROPA 4.6 0.0 3.8 3.1 0.0 3.1 0.0 1.4 1.2 1.7 3.4 9.2 V - Bicol 16.3 8.3 4.1 4.9 0.0 1.7 2.2 6.4 3.3 2.9 6.1 9.6 VI - Western Visayas 12.1 4.4 0.9 2.6 0.0 1.1 0.0 2.2 1.5 3.5 2.3 10.3 VII - Central Visayas 2.6 0.0 0.9 0.0 0.0 0.0 2.6 2.1 2.7 3.1 2.4 12.8 VIII - Eastern Visayas 5.4 0.9 2.1 1.2 1.3 1.0 2.7 1.8 2.2 2.2 4.0 13.3 IX - Zamboanga Peninsula 11.6 3.7 0.0 1.2 2.6 0.0 1.0 3.6 3.8 3.5 6.4 12.3 X - Northern Mindanao 18.1 3.5 4.8 4.1 1.8 0.0 0.9 4.2 4.9 4.0 1.7 13.7 XI - Davao 12.9 1.1 0.0 4.7 1.4 2.9 3.2 2.2 5.6 3.4 1.5 10.4 XII - SOCCSKSARGEN 5.7 1.2 2.2 0.0 0.0 0.0 0.0 2.4 2.2 3.1 6.1 13.8 XIII - Caraga 6.1 5.5 2.3 2.9 0.0 0.0 0.0 1.4 3.5 5.6 5.6 11.6 ARMM 1.9 2.6 0.0 0.0 2.9 4.3 0.0 0.0 0.0 0.6 0.0 4.4 Wealth index quintile Lowest 11.8 2.7 1.5 1.6 0.7 1.5 1.6 5.3 3.9 5.1 6.6 17.7 Second 9.8 2.3 2.6 3.3 0.9 2.1 1.7 2.1 2.9 3.5 4.0 12.2 Middle 4.7 3.2 2.9 2.3 0.6 1.9 1.0 0.0 1.6 0.6 1.4 3.6 Fourth 3.9 3.4 1.5 1.6 0.6 2.2 0.2 0.6 0.9 0.2 0.0 4.5 Highest 2.1 0.3 0.4 0.6 0.6 1.8 0.0 0.0 0.4 0.0 1.2 4.0 Total 7.6 2.5 1.8 2.0 0.7 1.9 1.1 2.0 2.1 2.2 2.7 8.0 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. 16 | Household Population and Housing Characteristics Table 2.7 Household characteristics Percent distribution of households by household characteristics, according to residence, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence Household ––––––––––––– characteristic Urban Rural Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Electricity Yes 92.0 59.8 76.6 No 7.9 40.2 23.3 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 50.9 16.0 34.3 Piped into yard/plot 4.8 5.9 5.3 Public tap 11.1 15.2 13.1 Open dug well 0.7 8.7 4.5 Protected well 18.6 35.3 26.6 Developed spring 0.9 8.1 4.3 Undeveloped spring 0.6 6.1 3.2 River/stream/pond/lake/dam 0.2 1.6 0.9 Rainwater 0.1 0.8 0.4 Tanker truck/peddler 2.2 0.8 1.5 Bottled water/refilling station 9.8 1.3 5.7 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 92.5 80.9 87.0 Median time to source 0.0 2.4 0.0 Sanitation facility Flush toilet: own 76.7 53.6 65.7 Flush toilet: shared 15.9 10.7 13.4 Close pit 1.5 10.7 5.9 Open pit 0.8 6.8 3.7 Drop/overhang 1.1 2.8 1.9 No toilet/field/bush 3.9 15.4 9.3 Other 0.1 0.1 0.1 Total 100.0 100.0 100.0 Flooring material Earth, sand 8.9 16.9 12.7 Wood planks 11.2 14.1 12.6 Palm, bamboo 5.8 23.0 14.0 Parquet, polished wood 0.8 0.5 0.7 Vinyl, asphalt strips 1.3 0.2 0.8 Ceramic tiles 6.8 1.8 4.4 Cement 62.5 43.2 53.3 Marble 2.6 0.3 1.5 Main material of outer walls Concrete/brick/stone 52.4 27.3 40.5 Wood 16.8 22.1 19.3 Half concrete/brick/stone/and half wood 20.0 14.4 17.3 Galvanized iron/aluminum 0.9 1.0 0.9 Bamboo/sawali/cogon/nipa 8.7 34.6 21.0 Makeshift/salvaged/improvised materials 0.9 0.5 0.7 No walls 0.1 0.1 0.1 Total 100.0 100.0 100.0 Tenure status of lot Owned/being amortized 53.0 54.6 53.8 Rented 21.3 6.5 14.2 Rent-free with consent of owner 23.0 36.5 29.4 Rent-free without consent of owner 2.6 2.1 2.3 Total 100.0 100.0 100.0 Number of households 6,583 6,003 12,586 2.6 HOUSING CHARACTERISTICS The physical characteristics of households are important indicators of health and of the general socioeconomic condition of the population. In the 2003 NDHS, respondents were asked about access to electricity; sources of drinking water and time taken to reach the nearest source; type of toilet facility; main material of the floor and walls; and tenure status. The percent distribution of households by their housing character- istics according to urban-rural residence is shown in Table 2.7. Table 2.7 and Figure 2.4 shows that eight in ten households have electricity, with a significant difference between urban and rural areas: 92 per- cent in urban areas, compared with 60 percent in rural areas. Safe drinking water is important for health and sanitation. Two out of five households (40 percent) have piped water into dwelling/yard/plot as their main source of drinking water. The main source of drinking water in rural areas is protected wells (35 percent), while in urban areas the main source is piped water (56 percent). The majority of the households live within 15 minutes from the source of water (87 percent). Two in three households have a private flush toilet. This type of sanitation facility is much more common in urban areas than in rural areas (77 and 54 percent, respectively). Furthermore, 15 percent of households in rural areas have no toilet facility, compared with only 4 percent in urban areas. More than half of all households (53 percent) have cement flooring. Urban households are more likely to have cement floors than rural households (63 and 43 percent, respectively). Palm and bamboo are used as flooring materials in 23 percent of households in the rural areas. Household Population and Housing Characteristics | 17 The most common material of the outer walls is concrete, brick, and stone, used by two in five households. However, there are urban-rural differentials; urban households are more likely to use con- crete, brick, and stone (52 percent), while the rural households are more likely to use bamboo, sawali, cogon, or nipa for the outer walls (35 percent). The 2003 NDHS also collected information on the tenure status of the lot in which the household resides. More than half of the households (54 percent) own or amortize their lot, 14 percent are renting, and 29 percent of households occupy the lot rent-free with the consent of the owner. Urban and rural households are equally likely to own or amortize their lot. However, urban households are more likely than rural households to rent (21 and 7 percent, respectively). Rural households, on the other hand, tend to use the lot rent-free with consent of the owner (37 percent). Two percent of households occupy the lot without paying rent to the owner; this is true in urban and rural areas. 2.7 HOUSEHOLD DURABLE GOODS In the 2003 NDHS, information on the possession of selected durable consumer goods was also collected at the household level. The percentages of households possessing various durable consumer goods are shown in Table 2.8. There is a vast difference between urban and rural households, with urban households much more likely to own these durable consumer items than rural households. The urban- rural difference is especially pronounced for ownership of modern conveniences such as television, tele- phone, washing machine, refrigerator/freezer, CD/VCD/DVD player, component or karaoke player, and personal computer. Thirteen percent of the total households do not possess any of the durable consumer goods listed. Rural households are much more likely than urban households not to have any of these consumer goods. Figure 2.4 Housing Conveniences by Residence Electricity Water piped into dwelling/yard/plot Own/share flush toilet Cement flooring 0 20 40 60 80 100 Percent Urban Rural Total NDHS 2003 18 | Household Population and Housing Characteristics Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence ––––––––––––––––– Durable consumer goods Urban Rural Total –––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Radio/radio cassette 75.8 66.3 71.3 Television 80.6 43.9 63.1 Landline telephone 20.9 2.3 12.0 Cellular telephone 50.9 19.7 36.0 Washing machine 43.9 12.8 29.1 Refrigerator/freezer 52.3 22.0 37.8 CD/VCD/DVD player 48.7 19.3 34.7 Component/karaoke 36.9 17.0 27.4 Personal computer 11.1 1.6 6.6 Tractor 1.0 2.9 1.9 Motorized banca/boat 2.2 7.2 4.6 Car/jeep/van 14.3 4.2 9.5 Motorcycle/tricycle 13.7 11.0 12.4 Bicycle/pedicab 22.0 17.2 19.7 None of the above 7.0 20.4 13.4 Number of households 6,583 6,003 12,586 2.8 AVAILABILITY OF DRINKING WATER AND WAYS TO MAKE DRINKING WATER SAFE Information on the availability of drinking water sources and ways to make drinking water safe are shown in Tables 2.9 and 2.10, respectively. Table 2.9 shows that drinking water is reported to be regu- lar in 90 percent of households, available several hours a day in 8 percent of households, and only once or twice a week in 2 percent of households. Water is reported to be usually always available in 97 percent of households in which the source of drinking water is surface water (river, stream, pond, lake, or dam) and in 96 percent of households using protected wells. On the other hand, as expected, water is the least regu- lar when the source is rainwater (34 percent). Table 2.9 Availability of drinking water Percent distribution of households by availability of drinking water, according to source, Philippines 2003 Water availability last month Source of drinking water Usually always Several hours per day Once or twice a week Infrequently Missing Total Number Piped into dwelling 87.7 10.5 1.0 0.6 0.1 100.0 4,314 Piped into yard/plot 84.7 12.3 1.1 1.9 0.0 100.0 670 Public tap 82.6 14.5 2.0 0.4 0.4 100.0 1,647 Open dug well 93.6 2.5 0.6 2.7 0.6 100.0 569 Protected well 96.3 2.2 0.4 0.4 0.9 100.0 3,344 Developed spring 91.7 6.5 1.5 0.2 0.2 100.0 542 Undeveloped spring 94.1 3.2 0.9 0.7 1.1 100.0 404 River/stream/pond/lake/dam 96.9 0.7 2.5 0.0 0.0 100.0 115 Rainwater 34.4 1.3 8.1 54.0 2.2 100.0 52 Tanker truck/peddler 73.9 12.7 12.9 0.5 0.0 100.0 193 Bottled water/refilling station 90.7 2.7 6.4 0.1 0.1 100.0 723 Other/missing 61.2 5.0 0.0 0.0 33.8 100.0 12 Total 89.6 7.6 1.5 0.9 0.4 100.0 12,586 Household Population and Housing Characteristics | 19 Fifty-eight percent of households do nothing to make their drinking water safer, 27 percent boil the water, and 11 percent use an improvised filter (Table 2.10). Boiling water to make it safe for drinking is most common among households that have water piped into the dwelling, obtain water from a public tap, use surface water, or get the water from a tanker truck or a peddler (30 percent or higher). House- holds that collect rainwater for their drinking water are the most likely to use an improvised filter (43 per- cent). Filter equipment is used in 11 percent of households in which drinking water is piped into the house. Table 2.10 Safe drinking water Percent of households that employ specific procedures to make drinking water safe by source of water, Philippines 2003 Procedures to make water safe Source of drinking water Nothing Boiling Chlori- nation Filter equipment Improvised filter Other Number Piped into dwelling 49.9 31.8 1.9 11.3 9.7 0.3 4,314 Piped into yard/plot 63.7 25.7 1.2 3.1 9.3 0.2 670 Public tap 60.2 30.7 1.2 1.9 9.0 0.4 1,647 Open dug well 48.7 29.9 1.8 1.4 23.9 0.0 569 Protected well 61.8 24.5 2.3 2.8 10.9 0.5 3,344 Developed spring 66.5 18.9 1.0 1.9 15.0 0.0 542 Undeveloped spring 64.1 17.9 0.5 1.0 18.4 0.3 404 River/stream/pond/lake/dam 48.9 32.3 0.8 4.0 21.4 0.8 115 Rainwater 27.1 27.9 3.5 1.8 42.7 1.8 52 Tanker truck/peddler 61.2 30.2 2.1 1.5 7.5 0.7 193 Bottled water/refilling station 77.2 9.6 0.4 7.7 5.7 1.2 723 Other/missing 43.6 11.3 5.6 0.0 5.7 0.0 12 Total 57.9 27.0 1.7 5.7 11.0 0.4 12,586 Characteristics of Respondents and Women’s Status | 21 CHARACTERISTICS OF RESPONDENTS AND WOMEN’S STATUS 3 This chapter highlights the basic characteristics of women and men who were interviewed in the 2003 National Demographic and Health Survey (NDHS). This information is essential for the interpreta- tion of findings presented later in the report. The chapter begins by describing background characteristics, such as age, marital status, educational level, and residential characteristics. More detailed information on education, literacy, and exposure to mass media is then discussed. This is followed by data on the em- ployment and earnings of women, decisionmaking in the household, and attitudes on women’s position in relation to others in the household. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS The distribution of women and men interviewed by selected background characteristics is shown in Table 3.1. About half of the women and men in the survey are under age 30. Three in ten women and four in ten men have never married, while 64 percent of women and 58 percent of men are married or are living together. More than half of the respondents live in urban areas (58 percent of women and 54 per- cent of men). Education in the Philippines is almost universal; less than 2 percent of women and men have no formal education, while 31 percent of women and 25 percent of men have some college education. The majority of the respondents are Roman Catholic (82 percent of women and 83 percent of men). Other re- ligions with notable proportions are Protestant and Islam (4 to 6 percent each). Three in five respondents (59 percent) are from Luzon, the largest major island in the country, with 18 percent of women coming from the National Capital Region (NCR), 9 percent from the northern regions (Ilocos, Cagayan Valley, and Cordillera Administrative Region [CAR]), and 32 percent from the rest of Luzon. The remaining 41 percent are from the two other major islands: 22 percent from Mindanao and 19 percent from Visayas. 3.1.1 Mobility The questions on childhood residence and mobility are intended to provide a basis for developing an index of rural to urban migration, which has been shown to be a better predictor of contraceptive use and fertility than either childhood or current residence alone (ORC Macro, 2001). The question on previ- ous residence is asked of respondents who have moved from their place of birth and respondents who are visitors in the interviewed households. Table 3.2 presents the distribution of women and men by residence until they are 12 years old and by residence prior to current residence. The majority of women and men (63 percent each) spent their childhood in a barrio, 19 to 20 percent lived in a town, and 17 to 18 percent lived in a city. Less than 1 percent of the respondents are visitors. Thirty-seven percent of women and 45 percent of men have never moved from the area where they were born. Thirty percent of women and 26 percent of men report that they previously resided in a barrio, while 20 percent of women and 16 percent of men say that they moved from a city. 22 | Characteristics of Respondents and Women’s Status Table 3.1 Background characteristics of respondents Percent distribution of women and men by background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of women Number of men ––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––– Background Weighted Weighted characteristic percent Weighted Unweighted percent Weighted Unweighted ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 19.4 2,648 2,646 19.3 918 920 20-24 16.2 2,209 2,214 16.5 785 765 25-29 14.9 2,034 2,048 13.6 647 653 30-34 14.3 1,954 1,949 12.4 593 611 35-39 13.7 1,873 1,892 12.3 586 579 40-44 11.5 1,564 1,541 10.1 483 481 45-49 9.9 1,351 1,343 8.7 416 415 50-54 na na na 7.1 338 342 Marital status Never married 32.2 4,388 4,309 40.2 1,914 1,889 Married/living together 63.6 8,671 8,764 57.6 2,746 2,766 Divorced/not living together 2.7 373 355 1.9 88 93 Widowed 1.5 201 205 0.4 17 18 Residence Urban 57.8 7,877 7,436 53.6 2,553 2,379 Rural 42.2 5,756 6,197 46.4 2,213 2,387 Region National Capital Region 17.5 2,387 2,168 15.5 740 676 Cordillera Admin Region 1.6 216 482 1.5 72 154 I - Ilocos 4.7 642 633 4.9 232 231 II - Cagayan Valley 3.1 426 531 3.4 163 202 III - Central Luzon 10.7 1,459 1,079 10.9 520 385 IVA - CALABARZON 13.9 1,890 1,425 13.7 652 483 IVB - MIMAROPA 2.5 340 481 2.5 119 168 V - Bicol 5.2 713 724 5.0 236 238 VI - Western Visayas 6.7 910 784 6.7 322 276 VII - Central Visayas 7.8 1,070 927 7.8 373 320 VIII - Eastern Visayas 4.1 555 647 4.8 229 268 IX - Zamboanga Peninsula 3.4 465 552 4.0 189 224 X - Northern Mindanao 4.1 565 592 4.2 202 216 XI - Davao 4.8 654 725 4.5 212 225 XII - SOCCSKSARGEN 3.8 524 655 4.5 216 255 XIII - Caraga 2.4 327 545 2.6 125 206 ARMM 3.6 489 683 3.5 166 239 Education No education 1.4 186 231 1.8 84 102 Elementary 23.1 3,146 3,241 30.2 1,441 1,499 High school 44.8 6,109 6,035 43.0 2,048 1,991 College or higher 30.7 4,192 4,126 25.0 1,193 1,174 Religion Roman Catholic 81.5 11,116 10,818 83.0 3,957 3,854 Protestant 5.5 749 850 4.1 194 226 Iglesia Ni Kristo 2.9 393 383 2.8 134 130 Aglipay 1.3 181 189 1.8 85 84 Islam 4.2 579 748 4.0 189 253 None 0.1 9 10 0.2 11 13 Others 2.2 293 324 2.3 109 119 Born-again/Jehovah's Witness/SDA 2.2 304 302 1.8 84 85 Missing 0.1 9 9 0.1 3 2 Total 100.0 13,633 13,633 100.0 4,766 4,766 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable; SDA = Seventh-Day Adventist Characteristics of Respondents and Women’s Status | 23 3.2 EDUCATIONAL ATTAINMENT Tables 3.3.1 and 3.3.2 present the percent distribution of women and men, respectively, by high- est level of schooling attained or completed according to their background characteristics. Young women and men are more likely to have attended school than the older respondents; the proportion of respondents who have never attended school rises with increasing age for both men and women. For example, 86 per- cent of women age 15-19 have attained secondary education, compared with 56 percent of women age 45-49. Urban women are as likely as rural women to have reached only secondary school (45 percent). However, rural women are less likely to continue to college or higher levels of education than urban women (20 and 39 percent, respectively). Women in NCR, CAR, Ilocos, and CALABARZON have higher educational attainment than women in other parts of the country. In these regions, about 80 percent of women have secondary or higher education. On the other hand, 15 percent of women in Autonomous Region in Muslim Mindanao (ARMM) have no education, and only half (52 percent) have secondary or higher education. As expected, women in the wealthier quintiles are more likely to be better educated than those in the poorer quintiles. While 93 percent of women in the wealthiest quintile have secondary or higher education, the corresponding proportion for women in the poorest group is 41 percent. The variations in educational attainment among men are similar to those for women. Younger, urban, and richer men are more likely to be better educated than other men (Table 3.3.2). Men in NCR and CALABARZON have the highest percentages for high school education or higher (86 and 79 percent, respectively). On the other hand, less than 50 percent of men in ARMM, Eastern Visayas, and Zambo- anga Peninsula have attended high school or higher education. Across all background characteristics, women consistently have more years of schooling than men. For age 15-19, the median years of schooling for women is 0.6 years more than men. In rural areas, the median years of schooling for women is 1.6 years more than for men. Especially striking are gender differences across regions; they range from 0.2 median years in NCR and Central Luzon to 2.1 median years in Eastern Visayas. Table 3.2 Childhood residence and mobility Percent distribution of women and men by residence until age 12 and previous residence, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of women Number of men –––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––– Weighted Weighted Residence percent Weighted Unweighted percent Weighted Unweighted –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Residence until age 12 years City 17.7 2,416 2,311 16.8 802 761 Town 19.0 2,597 2,594 19.5 929 873 Barrio 63.0 8,588 8,697 63.4 3,023 3,119 Previous residence Live in current residence since birth 36.6 4,995 5,002 45.4 2,163 2,181 Moved from City 19.8 2,699 2,631 16.4 780 742 Town 11.9 1,627 1,653 10.8 515 494 Barrio 29.8 4,065 4,090 26.3 1,254 1,291 Visitor 0.8 110 122 0.8 37 40 Total 100.0 13,633 13,633 100.0 4,766 4,766 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women and men with missing information on residence. 24 | Characteristics of Respondents and Women’s Status Table 3.3.1 Educational attainment by background characteristics: women Percent distribution of women by highest level of schooling attended or completed, and median number of years of schooling, according to back- ground characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Education ––––––––––––––––––––––––––––––––––––––––––––––– Number Median Background No High College of years of characteristic education Elementary school or higher Total women schooling ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 0.6 13.2 70.1 16.2 100.0 2,648 8.6 20-24 0.5 14.3 43.8 41.4 100.0 2,209 9.7 25-29 1.3 17.7 43.3 37.7 100.0 2,034 9.6 30-34 1.1 24.5 39.2 35.2 100.0 1,954 9.4 35-39 2.3 27.7 37.5 32.4 100.0 1,873 9.2 40-44 2.2 36.0 32.8 29.0 100.0 1,564 8.7 45-49 2.5 41.5 31.4 24.6 100.0 1,351 7.3 Residence Urban 0.6 15.7 44.9 38.8 100.0 7,877 9.6 Rural 2.4 33.2 44.7 19.7 100.0 5,756 8.0 Region National Capital Region 0.2 11.5 45.8 42.5 100.0 2,387 9.8 Cordillera Admin Region 2.2 17.4 36.2 44.2 100.0 216 9.7 I - Ilocos 0.8 16.7 50.8 31.6 100.0 642 9.4 II - Cagayan Valley 1.3 28.2 42.7 27.8 100.0 426 9.0 III - Central Luzon 0.3 22.0 48.9 28.8 100.0 1,459 9.3 IVA - CALABARZON 0.2 17.5 48.6 33.7 100.0 1,890 9.5 IVB - MIMAROPA 3.3 33.2 43.1 20.4 100.0 340 8.0 V - Bicol 0.3 27.6 45.2 26.9 100.0 713 8.7 VI - Western Visayas 1.8 27.0 44.0 27.2 100.0 910 9.1 VII - Central Visayas 1.3 29.8 42.7 26.2 100.0 1,070 8.7 VIII - Eastern Visayas 0.6 37.1 38.8 23.4 100.0 555 7.8 IX - Zamboanga Peninsula 1.1 36.1 38.4 24.4 100.0 465 7.8 X - Northern Mindanao 0.3 26.9 43.9 28.9 100.0 565 8.8 XI - Davao 1.0 26.7 42.3 30.0 100.0 654 9.1 XII - SOCCSKARGEN 4.0 25.3 46.7 24.0 100.0 524 8.5 XIII - Caraga 0.9 26.4 43.2 29.5 100.0 327 9.0 ARMM 15.0 33.2 33.9 18.0 100.0 489 6.4 Wealth index quintile Lowest 6.3 53.1 35.4 5.2 100.0 2,161 5.6 Second 1.1 33.5 51.8 13.6 100.0 2,412 7.8 Middle 0.5 21.6 54.4 23.4 100.0 2,682 9.1 Fourth 0.2 12.8 48.6 38.4 100.0 2,940 9.6 Highest 0.1 6.8 35.0 58.0 100.0 3,438 11.1 Total 1.4 23.1 44.8 30.7 100.0 13,633 9.2 Characteristics of Respondents and Women’s Status | 25 3.3 EXPOSURE TO MASS MEDIA The 2003 NDHS collected information on the exposure of respondents to the various mass media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television. This information is useful in determining the media channels to use in disseminating health and other in- formation to target audiences. Furthermore, it is important for knowing the likelihood of reaching the re- spondents by media. Tables 3.4.1 and 3.4.2 show that television is the most popular mass media among women and men (80 and 82 percent, respectively), followed by radio, with 78 percent of women and 82 percent of men listening to the radio weekly. Newspaper and magazine reading is not as popular as the other two media: 44 percent of women and 47 percent of men read the newspaper or magazine weekly. Overall, about four in ten women and men are exposed to all three media, and less than 8 percent are not exposed to any of these media. Table 3.3.2 Educational attainment by background characteristics: men Percent distribution of men by highest level of schooling attended or completed, and median number of years of schooling, according to back- ground characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Education ––––––––––––––––––––––––––––––––––––––––––––––– Number Median Background No High College of years of characteristic education Elementary school or higher Total men schooling ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.8 24.2 62.6 11.5 100.0 918 8.0 20-24 0.4 21.2 44.4 34.0 100.0 785 9.4 25-29 1.5 24.4 43.9 30.2 100.0 647 9.3 30-34 1.9 33.2 37.3 27.6 100.0 593 9.0 35-39 2.4 31.4 39.2 27.0 100.0 586 9.0 40-44 2.3 35.1 36.5 26.1 100.0 483 8.3 45-49 2.0 42.4 29.3 26.2 100.0 416 7.0 50-54 2.9 49.6 27.1 20.4 100.0 338 5.9 Residence Urban 0.8 17.8 47.4 34.0 100.0 2,553 9.4 Rural 2.9 44.6 37.8 14.8 100.0 2,213 6.4 Region National Capital Region 0.2 13.6 46.1 40.1 100.0 740 9.6 Cordillera Admin Region 2.9 23.5 37.9 35.8 100.0 72 9.2 I - Ilocos 0.5 29.8 49.5 20.3 100.0 232 8.5 II - Cagayan Valley 1.0 37.0 36.8 25.2 100.0 163 8.2 III - Central Luzon 0.8 27.7 44.6 26.9 100.0 520 9.1 IVA - CALABARZON 0.5 20.2 53.5 25.8 100.0 652 9.2 IVB - MIMAROPA 4.3 39.8 35.3 20.5 100.0 119 6.8 V - Bicol 0.9 34.9 43.5 20.7 100.0 236 8.0 VI - Western Visayas 3.3 34.6 44.2 17.9 100.0 322 7.7 VII - Central Visayas 2.2 32.0 42.0 23.9 100.0 373 8.3 VIII - Eastern Visayas 1.9 54.2 31.0 12.9 100.0 229 5.7 IX - Zamboanga Peninsula 1.8 49.5 30.4 18.3 100.0 189 5.9 X - Northern Mindanao 0.9 36.7 40.4 22.1 100.0 202 7.3 XI - Davao 1.5 34.1 41.6 22.8 100.0 212 8.2 XII - SOCCSKSARGEN 1.1 37.6 41.5 19.8 100.0 216 7.2 XIII - Caraga 2.5 34.6 36.8 26.1 100.0 125 7.9 ARMM 15.5 42.2 28.7 13.6 100.0 166 5.6 Wealth index quintile Lowest 7.1 63.7 25.8 3.4 100.0 884 5.0 Second 1.4 43.2 45.0 10.4 100.0 937 6.6 Middle 0.6 25.4 54.0 20.0 100.0 992 8.7 Fourth 0.0 16.0 52.5 31.5 100.0 957 9.4 Highest 0.2 6.8 36.2 56.8 100.0 996 10.8 Total 1.8 30.2 43.0 25.0 100.0 4,766 8.6 26 | Characteristics of Respondents and Women’s Status Tables 3.4.1 and 3.4.2 also show that younger, urban, better-educated, and wealthier respondents are more likely to be exposed to mass media than other respondents. There are large variations in the ex- posure to mass media across regions. While more than 90 percent of women in NCR and in Central Lu- zon watch television at least once a week, the corresponding proportion in ARMM is only 33 percent. Moreover, 64 percent of women in NCR have access to all three media, while only 10 percent of women in ARMM do. This pattern of regionally disparate access to mass media also holds for men. Table 3.4.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Reads a Watches Listens to newspaper television the radio at least at least at least Number Background once once once All three No of characteristic a week a week a week media media women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 49.6 86.3 83.3 43.6 5.1 2,648 20-24 48.1 83.0 79.6 41.6 6.8 2,209 25-29 44.3 79.7 77.4 36.6 7.0 2,034 30-34 42.8 79.0 75.4 34.4 8.6 1,954 35-39 42.0 77.5 75.1 34.8 10.2 1,873 40-44 37.7 76.4 76.3 31.3 8.5 1,564 45-49 34.4 75.8 74.3 28.6 9.0 1,351 Residence Urban 55.3 91.1 81.1 48.2 3.3 7,877 Rural 27.7 65.7 73.5 21.2 13.5 5,756 Region National Capital Region 72.2 95.8 84.8 63.6 1.2 2,387 Cordillera Admin Region 46.9 67.1 75.0 33.7 11.8 216 I - Ilocos 49.2 86.6 85.3 43.6 4.0 642 II - Cagayan Valley 45.0 72.4 81.0 37.2 9.4 426 III - Central Luzon 49.1 92.1 73.0 40.8 2.8 1,459 IVA - CALABARZON 49.9 89.9 77.3 43.2 5.0 1,890 IVB - MIMAROPA 23.1 54.7 64.3 15.1 18.3 340 V - Bicol 31.0 75.4 82.5 25.0 7.9 713 VI - Western Visayas 29.3 76.6 80.3 24.7 7.8 910 VII - Central Visayas 42.9 81.3 81.3 37.1 5.2 1,070 VIII - Eastern Visayas 28.3 63.0 68.2 24.3 19.7 555 IX - Zamboanga Peninsula 28.8 53.1 68.4 19.3 18.9 465 X - Northern Mindanao 26.0 73.4 74.4 20.4 10.5 565 XI - Davao 32.3 79.7 80.1 26.8 5.3 654 XII - SOCCSKSARGEN 23.4 70.3 76.9 19.4 12.8 524 XIII - Caraga 21.0 79.7 83.2 18.9 7.6 327 ARMM 19.4 32.8 58.7 9.7 32.6 489 Education No education 0.4 27.8 48.3 0.0 43.3 186 Elementary 18.7 59.6 67.0 13.2 17.6 3,146 High school 42.2 83.8 79.4 35.3 5.4 6,109 College or higher 66.5 93.3 85.1 58.3 1.8 4,192 Wealth index quintile Lowest 13.9 34.5 59.4 7.1 30.0 2,161 Second 28.2 69.3 75.8 20.5 9.2 2,412 Middle 41.6 89.2 78.1 34.5 3.7 2,682 Fourth 53.0 95.3 82.7 46.4 1.5 2,940 Highest 66.9 97.2 86.6 60.5 0.9 3,438 Total 43.7 80.4 77.9 36.8 7.6 13,633 Characteristics of Respondents and Women’s Status | 27 3.4 EMPLOYMENT 3.4.1 Employment Status Women and men interviewed in the 2003 NDHS were asked if they were engaged in any eco- nomic activity in the 12 months preceding the survey, regardless of whether they were paid or not. Table 3.5.1 shows that more than half of the women interviewed (52 percent) were employed in the 12 months preceding the survey. Older women, women who have more living children, those who live in urban ar- eas, and those who fall in the wealthier quintiles are more likely to be engaged in an economic activity. Women who are no longer married are more likely than those who never married and are currently mar- ried to be employed in the 12 months preceding the survey. Women with no education and those with col- lege or higher education are more likely to be employed than other women. Women’s economic activity varies significantly by region, ranging from 66 percent in Davao to 38 percent in ARMM. Table 3.4.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Reads a Watches Listens to newspaper television the radio at least at least at least Number Background once once once All three No of characteristic a week a week a week media media men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 40.4 85.8 84.3 36.0 5.5 918 20-24 52.3 87.5 86.7 46.1 4.1 785 25-29 52.1 82.9 81.7 44.9 6.1 647 30-34 48.0 79.3 81.9 40.9 6.5 593 35-39 50.1 79.8 82.4 42.4 6.2 586 40-44 45.9 78.4 76.5 37.9 9.9 483 45-49 47.0 79.4 79.6 37.9 6.0 416 50-54 39.7 76.0 76.6 32.2 7.5 338 Residence Urban 59.8 91.5 83.5 51.8 3.0 2,553 Rural 32.7 71.2 80.4 27.1 9.9 2,213 Region National Capital Region 77.4 95.5 87.1 69.2 0.7 740 Cordillera Admin Region 46.4 73.2 76.6 36.7 11.1 72 I - Ilocos 55.0 85.8 84.4 45.5 1.7 232 II - Cagayan Valley 42.8 76.8 84.9 35.1 2.9 163 III - Central Luzon 68.1 89.3 82.0 59.4 5.4 520 IVA - CALABARZON 41.5 90.8 76.0 31.8 4.0 652 IVB - MIMAROPA 28.7 69.6 68.8 23.5 12.7 119 V - Bicol 42.9 83.7 96.4 38.2 0.7 236 VI - Western Visayas 36.0 79.0 83.1 30.5 6.4 322 VII - Central Visayas 52.2 84.6 86.2 44.7 4.7 373 VIII - Eastern Visayas 16.4 65.6 67.9 13.0 19.1 229 IX - Zamboanga Peninsula 22.2 57.1 82.6 17.2 12.8 189 X - Northern Mindanao 28.1 77.6 90.9 26.3 5.9 202 XI - Davao 36.7 78.8 82.4 30.8 2.8 212 XII - SOCCSKSARGEN 30.0 73.3 81.4 24.5 7.1 216 XIII - Caraga 34.5 87.6 88.7 33.0 4.5 125 ARMM 31.9 44.8 61.0 29.0 35.7 166 Education No education 0.0 27.5 55.3 0.0 39.6 84 Elementary 23.4 64.7 75.0 17.8 12.6 1,441 High school 49.3 88.6 85.4 43.5 3.6 2,048 College or higher 75.5 95.8 86.8 65.1 0.6 1,193 Wealth index quintile Lowest 19.4 45.7 70.5 14.1 21.7 884 Second 35.5 76.3 80.7 28.4 6.8 937 Middle 52.1 92.5 84.7 44.2 1.8 992 Fourth 57.7 95.9 85.7 51.3 1.2 957 Highest 67.9 96.4 87.5 60.5 1.0 996 Total 47.2 82.1 82.1 40.4 6.2 4,766 28 | Characteristics of Respondents and Women’s Status Eight in ten men were employed in the 12 months preceding the survey (Table 3.5.2). Men over the age of 30, men who have ever been married, those with living children, those in rural areas, and those who fall into the poorer quintiles are more likely to be employed. The data also show that the employment status of men has a negative relationship with their educational attainment: Better-educated men are less likely to be employed. Across regions, the proportions of men employed in the 12 months preceding the survey range from 75 percent in NCR to 90 percent in Cagayan Valley. Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months Not preceding the survey employed ––––––––––––––––––– in the Not 12 months Number Background Currently currently preceding of characteristic employed employed the survey Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 20.4 5.5 74.2 100.0 2,648 20-24 39.0 10.3 50.6 100.0 2,209 25-29 45.8 7.9 46.2 100.0 2,034 30-34 52.2 6.2 41.6 100.0 1,954 35-39 56.6 4.4 39.0 100.0 1,873 40-44 60.9 3.3 35.8 100.0 1,564 45-49 62.1 3.7 34.2 100.0 1,351 Marital status Never married 37.7 6.6 55.7 100.0 4,388 Married/living together 47.9 5.8 46.3 100.0 8,671 Divorced/not living together 66.8 8.6 24.6 100.0 373 Widowed 74.8 5.5 19.7 100.0 201 Number of living children 0 38.6 7.7 53.7 100.0 5,012 1-2 45.0 6.4 48.5 100.0 3,747 3-4 51.4 4.5 44.2 100.0 2,961 5+ 55.6 4.1 40.3 100.0 1,912 Residence Urban 47.2 6.2 46.7 100.0 7,877 Rural 43.3 6.1 50.6 100.0 5,756 Region National Capital Region 47.9 6.5 45.6 100.0 2,387 Cordillera Admin Region 54.3 6.6 39.1 100.0 216 I - Ilocos 39.5 4.3 56.2 100.0 642 II - Cagayan Valley 40.8 4.0 55.1 100.0 426 III - Central Luzon 37.0 6.8 56.0 100.0 1,459 IVA - CALABARZON 43.5 5.5 51.0 100.0 1,890 IVB - MIMAROPA 38.2 6.1 55.7 100.0 340 V - Bicol 46.9 7.8 45.3 100.0 713 VI - Western Visayas 49.9 6.1 43.9 100.0 910 VII - Central Visayas 48.1 6.0 45.9 100.0 1,070 VIII - Eastern Visayas 46.7 6.2 47.1 100.0 555 IX - Zamboanga Peninsula 43.7 1.9 54.4 100.0 465 X - Northern Mindanao 50.6 7.8 41.5 100.0 565 XI - Davao 55.3 11.0 33.6 100.0 654 XII - SOCCSKSARGEN 51.4 5.0 43.6 100.0 524 XIII - Caraga 50.5 8.5 41.0 100.0 327 ARMM 36.1 2.2 61.7 100.0 489 Education No education 53.4 3.3 43.3 100.0 186 Elementary 49.6 5.5 44.9 100.0 3,146 High school 37.6 6.4 56.0 100.0 6,109 College or higher 53.7 6.4 39.9 100.0 4,192 Wealth index quintile Lowest 42.5 6.0 51.5 100.0 2,161 Second 40.7 7.7 51.6 100.0 2,412 Middle 42.0 6.6 51.4 100.0 2,682 Fourth 44.2 6.3 49.4 100.0 2,940 Highest 54.7 4.6 40.7 100.0 3,438 Total 45.5 6.1 48.3 100.0 13,633 Characteristics of Respondents and Women’s Status | 29 Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in the 12 months Not preceding the survey employed ––––––––––––––––––– in the Not 12 months Don’t Number Background Currently currently preceding know/ of characteristic employed employed the survey missing Total men ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 25.8 11.5 61.8 0.8 100.0 918 20-24 57.5 15.8 26.0 0.7 100.0 785 25-29 80.9 12.1 6.9 0.1 100.0 647 30-34 85.5 9.1 5.4 0.0 100.0 593 35-39 88.8 7.6 3.6 0.0 100.0 586 40-44 90.5 5.7 3.9 0.0 100.0 483 45-49 91.3 4.8 3.9 0.0 100.0 416 50-54 85.6 5.5 8.7 0.2 100.0 338 Marital status Never married 42.8 13.8 42.7 0.6 100.0 1,914 Married/living together 89.2 6.8 3.9 0.1 100.0 2,746 Divorced/not living together 71.5 20.7 7.7 0.0 100.0 88 Widowed * * * * * 17 Number of living children 0 46.8 14.0 38.5 0.6 100.0 2,154 1-2 87.3 8.5 4.2 0.0 100.0 1,092 3-4 90.3 6.0 3.8 0.0 100.0 923 5+ 92.3 3.9 3.7 0.0 100.0 596 Residence Urban 65.2 11.4 23.2 0.2 100.0 2,553 Rural 76.0 8.2 15.4 0.4 100.0 2,213 Region National Capital Region 63.1 12.1 24.8 0.0 100.0 740 Cordillera Admin Region 67.4 13.1 18.6 0.8 100.0 72 I - Ilocos 77.3 10.0 12.7 0.0 100.0 232 II - Cagayan Valley 85.1 4.6 10.3 0.0 100.0 163 III - Central Luzon 68.7 11.9 19.4 0.0 100.0 520 IVA - CALABARZON 64.3 12.5 22.9 0.2 100.0 652 IVB - MIMAROPA 77.1 8.9 14.0 0.0 100.0 119 V - Bicol 70.8 6.1 21.2 1.9 100.0 236 VI - Western Visayas 77.1 8.3 14.6 0.0 100.0 322 VII - Central Visayas 66.8 10.8 21.7 0.7 100.0 373 VIII - Eastern Visayas 68.3 13.7 17.6 0.4 100.0 229 IX - Zamboanga Peninsula 76.7 4.1 19.2 0.0 100.0 189 X - Northern Mindanao 70.5 11.2 18.2 0.0 100.0 202 XI - Davao 73.6 7.3 18.4 0.7 100.0 212 XII - SOCCSKSARGEN 73.8 6.6 19.6 0.0 100.0 216 XIII - Caraga 68.9 8.5 21.2 1.4 100.0 125 ARMM 81.8 3.1 14.3 0.8 100.0 166 Education No education 93.2 2.0 4.8 0.0 100.0 84 Elementary 84.3 7.6 7.8 0.3 100.0 1,441 High school 61.9 11.9 25.9 0.3 100.0 2,048 College or higher 65.9 9.9 24.0 0.3 100.0 1,193 Wealth index quintile Lowest 82.3 7.6 9.8 0.3 100.0 884 Second 78.1 9.3 12.1 0.4 100.0 937 Middle 68.9 12.3 18.6 0.3 100.0 992 Fourth 63.8 10.8 24.8 0.6 100.0 957 Highest 59.6 9.3 31.2 0.0 100.0 996 Total 70.2 9.9 19.6 0.3 100.0 4,766 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 30 | Characteristics of Respondents and Women’s Status 3.4.2 Occupation The distributions of currently employed women and men by occupation and selected background characteristics are presented in Tables 3.6.1 and 3.6.2, respectively. Eighty-six percent of women and 63 percent of men work in nonagricultural jobs. Residence determined the type of occupation: 96 percent of women and 85 percent of men in urban areas are employed in nonagricultural jobs. Occupation also var- ies widely by background characteristics: Respondents who are no longer married, those with a larger number of living children, those with less education, and those who fall in the poorest quintiles tend to work in agriculture. Among men who work in agriculture, those in the youngest group are the most likely to work on someone else’s land (31 percent). Women and men in NCR, CALABARZON, and Central Visayas are more likely to be engaged in nonagricultural jobs than those in other regions. Women and men in ARMM are more likely to do agri- cultural work. Sales and services and professional, technical, or managerial occupations are the most common jobs for working women in all groups, although those with no education are generally engaged in agricul- ture, working on their own land or someone else’s land. Employed men generally do unskilled manual work or agricultural work on someone else’s land. Characteristics of Respondents and Women’s Status | 31 Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Nonagricultural ––––––––––––––––––––––––––––––––––––––––––––––– Agricultural Profes- –––––––––––––––––––––––––––––––––––––– sional/ Some- tech- one nical/ Sales Un- Number Background Own Family else’s Rented mana- and Skilled skilled of characteristic land land land land Missing gerial Clerical services manual manual Missing Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 1.4 2.4 3.8 0.4 0.2 4.9 4.6 71.4 4.8 4.6 1.4 100.0 684 20-24 1.9 1.2 3.1 0.4 0.5 18.6 13.4 45.6 6.4 7.0 1.9 100.0 1,090 25-29 3.1 1.6 4.7 0.8 0.5 26.5 14.3 35.6 7.2 4.6 1.1 100.0 1,093 30-34 4.1 1.7 6.9 0.9 0.7 30.9 11.0 35.5 5.9 1.6 0.9 100.0 1,140 35-39 5.1 2.5 7.0 1.1 1.0 28.3 9.0 36.8 6.7 1.9 0.6 100.0 1,142 40-44 5.9 2.5 8.9 1.2 0.8 28.6 8.3 33.4 7.8 1.9 0.7 100.0 1,004 45-49 6.7 2.1 9.9 1.1 0.8 28.2 5.4 37.6 6.0 1.0 1.3 100.0 889 Marital status Never married 1.1 0.9 2.3 0.1 0.2 18.9 12.6 51.4 6.0 5.4 1.1 100.0 1,944 Married/living together 5.4 2.3 8.1 1.2 0.9 27.3 8.8 36.0 6.5 2.4 1.0 100.0 4,656 Divorced/not living together 2.4 1.9 4.2 0.0 0.3 25.1 9.0 44.6 7.8 2.2 2.4 100.0 281 Widowed 6.5 3.6 10.0 0.0 0.5 19.9 8.4 40.9 8.3 1.1 0.8 100.0 162 Number of living children 0 1.4 1.0 2.4 0.3 0.3 21.1 12.2 48.1 6.5 5.4 1.2 100.0 2,320 1-2 3.5 1.4 4.7 0.7 0.4 31.7 13.0 33.5 6.5 3.3 1.2 100.0 1,927 3-4 4.7 2.9 7.8 1.0 0.9 28.4 7.6 38.7 5.5 1.5 0.9 100.0 1,653 5+ 9.7 3.4 15.1 2.1 1.3 14.9 3.0 41.1 7.9 0.9 0.8 100.0 1,142 Residence Urban 1.1 0.4 1.6 0.2 0.4 27.5 12.3 44.4 6.7 4.2 1.1 100.0 4,201 Rural 8.5 4.2 13.4 1.8 1.0 20.6 6.2 35.3 6.2 1.7 1.0 100.0 2,842 Region National Capital Region 0.2 0.0 0.1 0.0 0.1 26.2 15.8 47.2 5.5 2.7 2.2 100.0 1,298 Cordillera Admin Region 16.2 3.8 11.4 3.4 0.3 25.3 9.3 28.3 1.0 0.7 0.3 100.0 131 I - Ilocos 5.3 1.8 13.4 0.7 1.1 19.3 3.9 46.6 4.3 2.8 0.7 100.0 281 II - Cagayan Valley 11.1 2.5 21.5 1.7 1.3 34.3 6.8 20.0 0.0 0.0 0.8 100.0 191 III - Central Luzon 1.2 1.2 4.7 0.2 2.3 24.8 8.4 43.7 9.8 3.1 0.6 100.0 639 IVA - CALABARZON 0.7 0.2 2.3 0.1 0.4 28.7 12.2 32.2 13.3 9.3 0.6 100.0 926 IVB - MIMAROPA 7.7 2.9 8.3 0.5 0.0 19.7 9.7 43.4 5.2 1.0 1.6 100.0 150 V - Bicol 2.3 2.3 4.2 1.5 1.5 19.4 9.2 50.1 7.7 1.8 0.0 100.0 391 VI - Western Visayas 5.6 1.4 12.0 0.7 0.0 17.5 8.8 44.7 6.9 2.3 0.2 100.0 510 VII - Central Visayas 1.8 1.6 4.3 0.6 0.4 18.8 7.9 50.4 9.3 4.7 0.2 100.0 579 VIII - Eastern Visayas 4.6 2.7 7.9 0.3 0.0 27.5 6.7 42.1 7.3 0.6 0.3 100.0 294 IX - Zamboanga Peninsula 11.2 10.2 9.8 1.6 2.2 29.5 6.1 19.3 0.4 1.8 7.8 100.0 212 X - Northern Mindanao 5.6 5.1 7.5 0.8 0.3 29.7 6.5 42.8 0.8 0.8 0.0 100.0 331 XI - Davao 6.0 2.2 6.3 0.6 0.6 24.4 11.2 42.1 4.2 1.9 0.4 100.0 434 XII - SOCCSKSARGEN 7.8 5.0 11.8 5.7 0.4 23.7 5.8 33.5 2.9 2.5 0.8 100.0 296 XIII - Caraga 8.4 3.4 9.3 1.8 0.3 27.0 7.9 35.3 3.7 2.2 0.6 100.0 193 ARMM 18.0 4.1 20.3 2.3 0.8 26.8 4.7 19.5 0.0 0.0 3.6 100.0 187 Education No education 27.9 4.5 26.0 4.8 0.0 9.8 0.7 22.6 2.7 1.1 0.0 100.0 106 Elementary 9.0 3.8 15.5 1.7 1.4 9.5 1.6 47.8 7.0 1.7 1.1 100.0 1,734 High school 3.0 2.1 4.9 0.8 0.7 14.9 5.0 53.7 9.5 4.5 0.8 100.0 2,685 College or higher 0.9 0.4 0.8 0.2 0.1 46.2 21.1 22.8 3.1 3.0 1.4 100.0 2,518 Wealth index quintile Lowest 15.3 8.0 22.1 2.2 0.7 8.0 2.0 32.8 6.3 1.3 1.3 100.0 1,049 Second 5.8 2.0 11.5 1.9 0.9 14.2 4.4 46.8 7.9 3.7 1.0 100.0 1,166 Middle 2.7 1.6 4.0 0.9 1.1 20.7 9.8 43.9 9.1 5.4 0.9 100.0 1,304 Fourth 1.4 0.7 1.9 0.1 0.5 28.7 13.9 40.1 8.0 4.0 0.7 100.0 1,485 Highest 0.3 0.0 0.1 0.0 0.3 39.0 14.1 39.9 3.0 1.9 1.5 100.0 2,039 Total 4.1 2.0 6.4 0.9 0.6 24.7 9.8 40.7 6.5 3.2 1.1 100.0 7,043 32 | Characteristics of Respondents and Women’s Status Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Non-agricultural ––––––––––––––––––––––––––––––––––––––––––––––– Agricultural Profes- –––––––––––––––––––––––––––––––––––––– sional/ Some- tech- one nical/ Sales Un- Number Background Own Family else’s Rented mana- and Skilled skilled of characteristic land land land land Missing gerial Clerical services manual manual Missing Total men –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 3.8 7.9 30.9 2.3 1.3 1.8 1.0 21.4 10.4 13.5 5.6 100.0 343 20-24 5.2 5.1 16.3 2.7 3.4 6.7 3.6 19.5 13.0 23.0 1.5 100.0 575 25-29 5.1 4.5 15.8 3.9 1.4 10.3 2.7 18.1 12.2 25.1 1.0 100.0 602 30-34 10.2 7.1 14.1 3.4 2.9 12.0 1.1 15.1 11.6 21.7 0.9 100.0 561 35-39 9.5 3.1 14.8 4.8 2.2 12.5 2.3 12.3 13.8 23.4 1.3 100.0 565 40-44 9.1 4.9 16.8 3.7 0.6 13.0 1.8 14.7 11.7 22.6 0.9 100.0 464 45-49 10.4 3.6 19.7 3.8 1.7 14.1 2.5 11.2 13.6 18.8 0.7 100.0 400 50-54 14.4 5.2 18.3 4.7 2.8 13.0 2.0 13.3 12.1 13.0 1.0 100.0 308 Marital status Never married 5.7 5.5 19.9 3.3 2.4 8.0 2.9 20.5 10.7 18.5 2.5 100.0 1,084 Married/living together 9.2 4.8 16.5 3.8 1.9 11.7 1.9 13.7 12.9 22.4 1.1 100.0 2,636 Divorced/not living together 7.8 8.7 19.2 4.8 2.8 4.1 2.5 19.8 18.7 11.5 0.0 100.0 81 Widowed * * * * * * * * * * * * 17 Number of living children 0 6.1 5.7 19.2 3.5 2.1 7.8 2.7 19.9 11.2 19.5 2.3 100.0 1,310 1-2 7.0 4.9 13.5 2.9 1.6 13.2 2.7 16.3 12.0 24.5 1.4 100.0 1,046 3-4 10.6 3.8 15.4 3.4 2.1 13.4 1.7 12.9 13.5 22.1 1.0 100.0 888 5+ 11.4 6.1 24.5 5.9 2.9 7.2 1.0 9.8 14.2 16.6 0.5 100.0 574 Residence Urban 3.0 1.3 7.1 1.3 1.8 15.0 3.4 21.1 15.9 28.4 1.6 100.0 1,954 Rural 13.6 9.1 28.5 6.2 2.4 5.8 1.0 10.2 8.6 13.3 1.3 100.0 1,864 Region National Capital Region 0.6 0.3 1.5 0.0 0.3 20.0 3.4 27.9 15.3 28.6 2.1 100.0 556 Cordillera Admin Region 15.5 5.9 19.0 4.0 0.8 14.5 1.5 10.6 11.6 16.7 0.0 100.0 58 I - Ilocos 13.7 2.1 18.0 13.3 2.5 8.4 2.0 6.5 15.2 16.9 1.5 100.0 202 II - Cagayan Valley 24.2 8.0 28.9 0.5 1.1 6.9 0.6 7.3 8.4 14.2 0.0 100.0 146 III - Central Luzon 6.4 1.6 9.9 7.6 3.0 7.7 2.3 13.0 15.1 31.4 1.9 100.0 419 IVA - CALABARZON 2.7 1.9 11.4 0.0 0.8 11.3 3.0 19.0 16.5 31.8 1.4 100.0 501 IVB - MIMAROPA 19.9 6.2 36.6 4.1 1.4 4.1 3.4 7.1 8.3 8.9 0.0 100.0 102 V - Bicol 9.1 5.4 17.4 4.4 14.3 7.4 1.1 17.0 6.7 16.9 0.3 100.0 182 VI - Western Visayas 7.5 5.1 33.5 3.4 0.9 7.1 1.6 13.5 10.9 16.0 0.4 100.0 275 VII - Central Visayas 4.5 4.5 12.0 4.5 2.0 8.4 1.9 20.3 16.3 24.9 0.8 100.0 289 VIII - Eastern Visayas 15.3 11.4 34.4 2.3 0.0 4.5 1.3 14.5 9.0 7.3 0.0 100.0 188 IX - Zamboanga Peninsula 14.6 12.5 19.0 7.3 1.1 16.9 1.7 5.6 5.1 9.6 6.6 100.0 153 X - Northern Mindanao 4.3 11.0 25.7 2.2 2.2 8.0 1.6 19.8 13.3 11.8 0.0 100.0 165 XI - Davao 5.9 10.2 24.8 1.2 2.0 9.6 2.2 16.3 7.3 20.1 0.5 100.0 172 XII - SOCCSKSARGEN 7.4 7.3 24.4 7.3 3.9 9.0 2.0 11.6 11.1 15.4 0.5 100.0 174 XIII - Caraga 11.1 10.5 12.2 7.0 0.0 7.9 4.0 12.4 13.7 19.8 1.2 100.0 97 ARMM 24.7 10.5 32.5 2.6 1.5 11.9 0.0 4.0 1.7 3.7 7.1 100.0 141 Education No education 20.5 4.2 51.0 4.0 1.5 3.9 0.0 4.6 5.5 4.3 0.4 100.0 80 Elementary 11.4 8.6 30.2 6.3 3.3 1.9 0.4 10.6 9.9 16.2 1.0 100.0 1,324 High school 7.0 3.6 13.8 2.8 1.7 5.6 1.6 18.8 16.2 27.1 1.7 100.0 1,511 College or higher 4.5 2.4 2.3 1.2 0.9 31.8 6.0 19.3 10.2 19.4 2.0 100.0 904 Wealth index quintile Lowest 15.9 10.8 40.7 4.6 4.1 2.7 0.3 6.7 6.2 7.1 0.9 100.0 795 Second 8.8 6.6 24.6 6.4 2.2 3.6 0.5 12.4 13.6 19.8 1.5 100.0 820 Middle 6.9 3.9 10.9 3.8 2.0 6.2 2.9 18.4 17.3 26.4 1.1 100.0 805 Fourth 5.4 2.1 6.9 2.4 1.6 11.7 3.1 21.0 14.1 29.8 2.0 100.0 713 Highest 3.0 1.2 1.2 0.4 0.0 31.7 4.7 21.9 10.6 23.4 2.1 100.0 686 Total 8.2 5.1 17.6 3.7 2.1 10.5 2.2 15.8 12.4 21.0 1.5 100.0 3,819 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: An sterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Characteristics of Respondents and Women’s Status | 33 Table 3.7 Type of employment: women Percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employment Agricultural Nonagricultural characteristic work work Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Type of earnings Cash only 29.0 74.8 71.5 Cash and in-kind 25.5 12.0 13.0 In-kind only 8.2 1.0 1.6 Not paid 37.1 12.1 13.9 Missing 0.2 0.0 0.1 Total 100.0 100.0 100.0 Type of employer Employed by family member 46.9 15.3 17.6 Employed by nonfamily member 31.8 58.4 56.5 Self-employed 20.5 26.2 25.7 Missing 0.7 0.1 0.2 Total 100.0 100.0 100.0 Continuity of employment All year 55.5 65.6 64.8 Seasonal 39.2 26.1 27.1 Occasional 5.1 8.2 7.9 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number of women 510 6,456 7,043 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women with missing information on type of employ- ment who are not shown separately. 3.5 CHARACTERISTICS OF WOMEN’S EMPLOYMENT Table 3.7 presents the percent distribution of women who were employed in the 12 months pre- ceding the survey by type of earnings, type of employer, and whether they work all year or not, according to agricultural and nonagricultural occupations. Overall, 72 percent of women receive cash payment. This proportion varies by the type of occupation: While 75 percent of women working in nonagricultural jobs are paid in cash, the corresponding proportion for women in agricultural occupations is 29 percent. Whereas 37 percent of women who work in agriculture receive no payment, only 12 percent of women who work in the nonagricultural sector receive no payment. Overall, 18 percent of women are employed by a family member, 57 percent are employed by a nonfamily member, and 26 percent are self-employed. Women who work in agriculture are much more likely to be employed by a family member than those who are employed in nonagricultural jobs. For ex- ample, whereas 47 percent of women working in the agricultural sector are employed by a family mem- ber, the corresponding proportion for women in nonagricultural jobs is 15 percent. Women who work in the nonagricultural sector are more likely to be self-employed than those in agriculture (26 and 20 per- cent, respectively). Regardless of the type of occupation, the majority of women work all year long (56 percent in ag- riculture and 66 percent in nonagriculture). 34 | Characteristics of Respondents and Women’s Status 3.6 CONTROL OVER WOMEN’S EARNINGS AND CONTRIBUTION OF WOMEN’S EARNINGS TO HOUSEHOLD EXPENDITURES In the 2003 NDHS, employed women who earn cash for their work were asked about the primary decisionmaker with regard to the use of their earnings. This information allows the assessment of women’s control over their own earnings. In addition, they were asked about the proportion of household expenditures met by their earnings. This information allows an evaluation of the relative importance of women’s earnings in the household economy, which may have bearing on women’s empowerment. Em- ployment and earnings are expected to empower women if they perceive their earnings as important for meeting the needs of their households. Table 3.8 and Figure 3.1 show how respondent’s degree of control over the use of their earnings and the extent to which the earnings of women meet household expenditures vary by background charac- teristics. Seven in ten women report that they alone decide how their earnings are to be spent, and 23 per- cent decide jointly with someone else. Five percent of women report that someone else makes the deci- sion on how their earnings are used. Table 3.8 also shows that the respondent’s degree of control over the use of their earnings varies by background characteristics. Women who are married tend to make decisions jointly, while women who are not married (either never married or no longer married) are significantly more likely than women who are married to decide alone how their earnings are used (90 percent or higher and 60 percent, respec- tively). In general, younger women, women with no children, those who live in urban areas, those with high school education, and those in wealthier quintiles are more likely than other women to make house- hold decisions on their own. The proportion of women who decide how their earnings are used varies across regions: While 80 percent or more of women in NCR, Western Visayas, and Davao say that they themselves decide how their earnings are used, the corresponding proportion in ARMM is only 36 percent. When asked about the proportion of household expenditures that are met by their earnings, 24 percent of women reported that their earnings support all of the household expenditures, and 45 percent reported that their earnings support half or more (Figure 3.2). Across subgroups, the data show that older women; those who are widowed, separated, or divorced; rural women; and those who are less educated are more likely to meet all of their household’s expenditures (Table 3.8). The proportion of household expenditures that are met by the women’s earnings varies widely across regions. While 40 percent of women in Central Luzon and Caraga support all of the household ex- penditures, the corresponding proportion in SOCCSKSARGEN is less than 10 percent. The proportion of women who reported that they are responsible for all the household expendi- tures decreases with increasing wealth status. While 34 percent of women in the poorest households sup- port all of the household expenses, only 15 percent of women in the wealthiest households do. Characteristics of Respondents and Women’s Status | 35 Table 3.8 Decision on use of earnings and contribution of earnings to household expenditures Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Person who decides Proportion of household how earnings are used expenditures met by earnings –––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––– Someone Almost Less Number Background Self else none/ than Over of characteristic only Jointly1 only2 Total none half half All Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 80.4 9.1 10.6 100.0 22.3 23.4 48.6 5.7 100.0 616 20-24 80.2 15.2 4.6 100.0 19.0 26.7 45.0 9.2 100.0 1,002 25-29 72.6 22.9 4.5 100.0 9.4 27.2 46.2 17.2 100.0 949 30-34 64.6 29.8 5.3 100.0 7.0 16.8 46.6 29.4 100.0 941 35-39 68.6 26.0 5.2 100.0 6.8 18.1 45.1 29.9 100.0 941 40-44 68.5 27.9 3.4 100.0 5.9 14.7 41.4 37.7 100.0 792 45-49 68.8 25.6 5.1 100.0 5.6 15.6 43.0 35.3 100.0 711 Marital status Never married 89.9 4.7 5.3 100.0 19.5 28.3 46.6 5.6 100.0 1,811 Married/living together 60.4 33.6 5.8 100.0 6.8 17.7 45.3 30.0 100.0 3,763 Divorced/not living together 97.7 0.8 1.2 100.0 6.2 16.9 36.1 40.7 100.0 242 Widowed 99.4 0.6 0.0 100.0 5.9 5.8 37.7 50.6 100.0 136 Number of living children 0 85.1 9.2 5.7 100.0 17.9 27.3 47.4 7.3 100.0 2,140 1-2 65.5 29.3 5.1 100.0 8.3 18.9 48.2 24.6 100.0 1,657 3-4 64.5 30.1 5.1 100.0 5.6 15.9 42.4 35.9 100.0 1,307 5+ 61.8 32.8 5.0 100.0 4.7 14.3 37.6 43.1 100.0 847 Residence Urban 75.3 19.2 5.3 100.0 11.9 21.8 45.4 20.6 100.0 3,800 Rural 65.6 29.0 5.3 100.0 8.4 18.5 44.6 28.5 100.0 2,152 Region National Capital Region 80.1 14.5 5.2 100.0 16.5 28.4 42.8 12.3 100.0 1,256 Cordillera Admin Region 69.5 20.6 9.9 100.0 9.9 19.7 46.0 24.4 100.0 85 I - Ilocos 70.7 22.7 6.5 100.0 7.7 13.9 43.5 35.0 100.0 248 II - Cagayan Valley 56.9 36.6 6.5 100.0 6.0 15.1 47.4 31.5 100.0 177 III - Central Luzon 66.7 28.1 4.9 100.0 6.3 15.2 38.7 39.6 100.0 597 IVA - CALABARZON 69.3 25.8 4.9 100.0 10.8 17.5 42.9 28.8 100.0 847 IVB - MIMAROPA 64.2 30.9 5.0 100.0 14.0 17.0 33.0 35.3 100.0 114 V - Bicol 77.9 17.6 4.6 100.0 8.8 16.1 46.4 28.6 100.0 301 VI - Western Visayas 80.0 12.3 7.7 100.0 6.0 33.3 43.2 17.4 100.0 464 VII - Central Visayas 77.1 17.3 5.6 100.0 7.2 14.0 55.6 23.2 100.0 399 VIII - Eastern Visayas 74.8 19.7 5.5 100.0 6.0 16.9 52.0 25.1 100.0 188 IX – Zamboanga Peninsula 76.8 20.2 3.0 100.0 12.4 9.7 52.8 25.1 100.0 147 X – Northern Mindanao 68.5 26.9 3.7 100.0 21.0 25.2 40.7 12.2 100.0 296 XI - Davao 81.7 15.3 3.0 100.0 11.8 18.3 50.6 19.3 100.0 246 XII - SOCCSKSARGEN 55.3 38.2 6.6 100.0 5.9 23.3 62.0 8.9 100.0 250 XIII -Caraga 61.6 33.0 3.3 100.0 8.9 16.9 32.2 39.9 100.0 169 ARMM 36.3 57.2 6.5 100.0 5.6 13.0 55.4 26.1 100.0 169 Education No education 49.6 42.4 7.0 100.0 4.9 7.9 51.0 35.3 100.0 79 Elementary 67.1 25.9 6.7 100.0 8.5 14.4 42.4 34.4 100.0 1,295 High school 73.4 21.0 5.6 100.0 11.4 20.5 44.8 23.2 100.0 2,289 College or higher 73.6 22.1 4.2 100.0 11.3 24.6 46.8 17.2 100.0 2,289 Wealth index quintile Lowest 60.9 33.3 5.7 100.0 5.5 15.9 44.4 34.1 100.0 720 Second 68.0 25.5 6.3 100.0 7.0 18.2 44.8 29.7 100.0 954 Middle 70.5 23.0 6.3 100.0 9.4 19.4 42.2 28.8 100.0 1,091 Fourth 71.4 22.4 6.0 100.0 10.6 20.8 46.7 21.6 100.0 1,302 Highest 78.9 17.4 3.6 100.0 15.2 24.2 46.1 14.5 100.0 1,886 Total 71.8 22.7 5.3 100.0 10.6 20.6 45.1 23.5 100.0 5,952 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women with missing information. 1 With husband or someone else 2 Includes husband 36 | Characteristics of Respondents and Women’s Status Figure 3.1 Decisionmaker on How Women’s Earnings Are Used 1 2 1 Includes husband 2 With husband or someone else NDHS 2003 Self only 72% Someone else only 5% Jointly 23% Figure 3.2 Proportion of Household Expenditures Met by Women’s Earnings NDHS 2003 Over half 49% Less than half 21% Almost none/none 11% All 24% Characteristics of Respondents and Women’s Status | 37 Table 3.9 shows the percent distribution of women by the decisionmaker in how the women’s earnings are used and the proportion of household expenditures that are met by their earnings. The data are presented to gauge whether women’s contribution to household expenditures empower them in mak- ing decisions on how to use their income. Figures in the table show that women’s contribution to house- hold expenditures has no association with who makes the decision on how their income is used. While 63 percent of married women whose earnings support all of the household expenses make the decision alone, the corresponding proportion of women who make no contribution to household expenditures is 69 per- cent. The absence of association between women’s contribution to household expenditures and who makes the decision on how their income is used is also true for nonmarried women. While 93 percent of women whose earnings support all of the household expenses make the decision alone, the corresponding proportion of women who make no contribution to household expenditures is 96 percent. 3.7 WOMEN’S EMPOWERMENT 3.7.1 Women’s Participation in Decisionmaking To assess women’s decisionmaking autonomy, the 2003 NDHS collects information on women’s participation in five different types of decisions: on the respondent’s own health care, on making large household purchases, on making household purchases for daily needs, on visits to family or relatives, and on what food should be cooked each day. Table 3.10 shows the percent distribution of women according to who in the household usually has the final say on each one of specified decisions, by background char- acteristics. In general, the majority of women (60 percent or higher), alone or jointly, have a say in at least one of the five specified areas of decisionmaking. The proportions range from 88 percent for decisions regarding their own health care to 60 percent for making large purchases. Table 3.9 Women’s control over earnings Percent distribution of women who received cash earnings for work in the 12 months preceding the survey, by person who decides how earnings are used, according to marital status, and the proportion of household expenditures met by earnings, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married1 –––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––––––––––– Jointly Jointly Some- Jointly Some- Contribution with with Hus- one Number with one Number to household Self hus- someone band else of Self someone else of expenditures only band else2 only only3 Total women only else only Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Almost none/none 68.9 24.7 1.6 3.6 1.1 100.0 257 95.6 1.7 2.4 100.0 377 Less than half 66.4 26.8 0.0 6.5 0.2 100.0 666 93.1 2.9 4.1 100.0 561 Half or more 55.7 37.5 0.5 6.1 0.2 100.0 1,704 88.5 5.7 5.8 100.0 982 All 62.5 32.3 0.5 4.7 0.0 100.0 1,129 92.6 3.5 4.0 100.0 268 Total 60.4 33.1 0.5 5.6 0.2 100.0 3,763 91.4 4.0 4.5 100.0 2,189 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women with missing information on contribution to household expenditures 1 Never married, divorced, separated or widowed women 2 With husband or someone else 3 Includes husband 38 | Characteristics of Respondents and Women’s Status Table 3.10 Women’s participation in decisionmaking by background characteristics Percentage of women who say that they alone or jointly have the final say in specific decisions, by background characteris- tics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Alone or jointly have final say in –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– What None Own Making Making Visits to food All of the Number Background health large daily family or to cook specified specified of characteristic care purchases purchases relatives each day decisions decisions women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age 15-19 67.0 15.9 18.5 33.3 22.3 11.3 26.3 2,648 20-24 86.0 45.2 50.3 63.7 53.6 33.2 7.5 2,209 25-29 92.4 66.8 74.8 79.7 76.5 54.5 2.4 2,034 30-34 94.9 75.0 83.5 83.6 85.6 62.8 1.3 1,954 35-39 94.8 81.2 88.6 87.7 90.7 70.0 1.0 1,873 40-44 95.9 84.1 90.8 90.4 90.8 74.0 0.7 1,564 45-49 94.3 81.1 88.9 89.5 92.1 71.7 1.1 1,351 Marital status Never married 74.3 22.0 23.7 40.3 26.3 14.7 19.9 4,388 Married/living together 94.1 78.0 86.9 87.0 89.3 66.5 1.1 8,671 Divorced/not living together 93.2 73.9 74.9 83.1 75.6 62.6 3.8 373 Widowed 96.4 85.8 90.3 92.8 89.4 82.0 1.4 201 Number of living children 0 76.5 28.5 31.1 45.9 33.3 20.3 17.5 5,012 1-2 93.6 74.7 82.9 85.2 84.6 62.6 1.9 3,747 3-4 94.9 80.1 89.9 88.5 92.0 69.8 0.7 2,961 5+ 94.5 82.5 89.5 88.5 94.0 72.1 0.6 1,912 Residence Urban 88.2 57.3 64.0 70.3 65.3 47.2 7.1 7,877 Rural 87.0 63.6 69.4 74.2 73.3 53.7 7.3 5,756 Region National Capital Region 91.8 59.3 64.9 71.5 66.1 50.1 5.1 2,387 Cordillera Admin Region 89.4 59.1 68.6 75.0 71.6 50.3 4.5 216 I - Ilocos 87.4 56.8 62.1 70.0 69.5 45.7 7.1 642 II - Cagayan Valley 96.0 75.1 80.5 80.4 78.7 67.7 2.3 426 III - Central Luzon 87.1 60.4 68.7 73.3 68.5 51.7 7.4 1,459 IVA - CALABARZON 87.1 58.4 66.1 72.8 66.9 49.2 7.8 1,890 IVB - MIMAROPA 86.9 70.7 78.1 81.0 81.6 62.2 6.6 340 V - Bicol 86.9 57.2 62.3 66.8 63.2 44.5 8.4 713 VI - Western Visayas 65.0 51.4 61.6 66.0 66.0 42.6 22.1 910 VII - Central Visayas 86.4 60.8 66.6 69.4 70.3 47.9 8.3 1,070 VIII - Eastern Visayas 91.7 56.6 58.3 72.4 64.1 49.4 4.6 555 IX - Zamboanga Peninsula 91.6 70.2 70.5 77.4 76.3 60.4 3.8 465 X - Northern Mindanao 93.1 57.7 62.5 63.1 66.2 44.2 4.0 565 XI - Davao 90.4 55.5 61.8 71.2 64.9 40.0 4.9 654 XII - SOCCSKSARGEN 87.1 64.8 73.9 79.0 75.1 55.3 6.1 524 XIII -Caraga 93.7 66.9 70.2 73.0 71.0 52.7 3.4 327 ARMM 89.9 62.9 68.5 76.4 75.6 57.5 5.6 489 Education No education 88.0 72.7 80.8 82.8 85.2 64.9 7.0 186 Elementary 90.4 71.7 77.9 80.9 81.9 61.2 3.6 3,146 High school 84.1 52.5 59.6 65.7 63.1 44.1 10.6 6,109 College or higher 91.0 61.5 66.7 73.9 66.2 49.4 5.0 4,192 Wealth index quintile Lowest 88.0 68.2 73.8 77.7 80.7 58.7 6.0 2,161 Second 88.3 64.8 72.8 74.5 76.5 54.9 6.9 2,412 Middle 87.3 62.1 69.0 73.9 71.1 52.4 7.0 2,682 Fourth 87.1 57.3 64.5 70.2 65.3 47.5 7.5 2,940 Highest 88.0 52.0 56.4 66.6 56.7 41.1 8.1 3,438 Employment Not employed 83.8 52.3 59.5 65.8 64.2 44.2 10.3 7,399 Employed for cash 93.0 68.0 73.2 79.2 72.0 55.9 3.4 5,198 Employed not for cash 89.7 74.9 79.9 79.5 84.8 61.1 3.9 1,004 Missing 86.3 61.6 71.8 77.1 67.8 50.6 8.1 32 Total 87.7 60.0 66.3 72.0 68.7 49.9 7.2 13,633 Characteristics of Respondents and Women’s Status | 39 Women’s decisionmaking autonomy generally increases with age. For example, while 11 percent of women age 15-19 participate in all specified decisions, the corresponding proportion for women age 45-49 is 72 percent. Widowed women are more likely to have a final say in all specified decisions than other women. Women’s autonomy increases with the number of living children they have. Women’s edu- cation has a nonlinear relationship with decisionmaking; those with the least education are most likely to have the final say in all specified decisions (65 percent), whereas those with high school or higher educa- tion are the least likely to have a say in all decisions. Similarly, this autonomy decreases with increasing wealth status. While 59 percent of women in the poorest quintile have a final say in all specified deci- sions, the corresponding proportion for women in the wealthiest quintile is 41 percent. There are significant variations in the proportion of women who have a final say in all five speci- fied areas of decisionmaking across regions, ranging from 40 percent in Davao to 68 percent in Cagayan Valley. Twenty-two percent of women in Western Visayas participate in none of the specified decisions. Table 3.11 shows the percent distribution of women according to who in the household usually has the final say on each one of the specified decisions, by marital status and employment status. Non- married women tend to have someone else make decisions for them. This is probably because most of these women are still living with their parents. For married women or those who have a live-in partner, there are small variations in women’s participation in decisionmaking by their employment status. Cur- rently married women or those who live with their partners are more likely to make all of the specified household decisions by themselves than women who are currently not married. For instance, 75 percent of married women decide by themselves on their own health care, compared with 70 percent of nonmar- ried women. Table 3.11 Women’s participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to current marital status and type of deci- sion, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Currently married or living together Not married1 ––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––––––––– Decision Decision not not Jointly made/ Jointly made/ Jointly with Some- not with Some- not with some- Hus- one appli- Number some- one appli- Number Self hus- one band else cable/ of Self one else cable/ of Decision only band else only only missing Total women only else only missing Total women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Employed in last 12 months Own health care 75.3 19.3 0.5 4.3 0.6 0.0 100.0 4,150 83.8 3.4 12.3 0.6 100.0 2,055 Large household purchases 23.8 56.9 1.1 15.1 2.9 0.3 100.0 4,150 31.7 12.0 50.5 5.7 100.0 2,055 Daily household purchases 58.4 28.8 1.4 8.3 2.8 0.2 100.0 4,150 33.8 11.4 49.5 5.1 100.0 2,055 Visits to family or relatives 27.3 59.6 1.4 9.6 1.4 0.6 100.0 4,150 50.6 10.2 34.3 4.9 100.0 2,055 What food to cook each day 65.5 21.1 2.2 6.9 3.9 0.5 100.0 4,150 31.2 13.2 49.5 6.0 100.0 2,055 Not employed in last 12 months Own health care 75.5 17.2 0.5 5.4 1.3 0.1 100.0 4,499 60.5 8.7 29.4 1.4 100.0 2,901 Large household purchases 20.0 53.6 1.0 19.5 5.1 0.8 100.0 4,499 7.2 10.5 72.3 9.9 100.0 2,901 Daily household purchases 55.5 28.6 1.2 9.6 4.7 0.3 100.0 4,499 9.8 9.8 70.8 9.5 100.0 2,901 Visits to family or relatives 27.1 57.6 1.1 10.3 2.8 1.0 100.0 4,499 23.4 11.5 57.1 8.0 100.0 2,901 What food to cook each day 69.7 18.3 2.0 5.0 4.7 0.4 100.0 4,499 12.0 12.3 66.9 8.8 100.0 2,901 Total Own health care 75.4 18.2 0.5 4.9 1.0 0.1 100.0 8,671 70.1 6.5 22.3 1.1 100.0 4,962 Large household purchases 21.7 55.2 1.1 17.4 4.1 0.6 100.0 8,671 17.3 11.2 63.3 8.2 100.0 4,962 Daily household purchases 56.9 28.7 1.3 9.0 3.8 0.3 100.0 8,671 19.7 10.5 62.0 7.7 100.0 4,962 Visits to family or relatives 27.2 58.5 1.2 10.0 2.1 0.8 100.0 8,671 34.7 10.9 47.6 6.7 100.0 4,962 What food to cook each day 67.7 19.6 2.1 5.9 4.3 0.4 100.0 8,671 19.9 12.7 59.7 7.6 100.0 4,962 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Total includes women with missing information on employment status. 1 Never-married, divorced, separated, or widowed women 40 | Characteristics of Respondents and Women’s Status For nonmarried women, employment status makes a difference in decisionmaking in the house- hold. Women who were not employed in the 12 months preceding the survey have much less say in all of the specific decisions. 3.7.2 Women’s Attitude toward Wife Beating and Refusing Sex with Husband Female respondents in the 2003 NDHS were asked “Sometimes a husband is annoyed or angered by things that his wife does. In your opinion, is a husband justified in hitting or beating his wife in the following situations?” Five situations were presented to women for their opinion: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses to have sex with him. Responses to these questions are used to assess women’s degree of acceptance of wife beating. The same respondents were also asked whether a wife is justified in refusing to have sex with her husband under four circumstances: she knows her husband has a sexually transmitted disease, she knows her husband has sex with other women, she has recently given birth, and she is tired or not in the mood. These four circumstances for which women’s opinions were sought have been chosen because of their effectiveness in combining issues of women’s rights and consequences for women’s health. Table 3.12 shows the percentage of women who say that a husband is justified in hitting or beat- ing his wife and the percentage of women who say that a wife is justified in refusing to have sex with her husband for specific reasons. The data show that 24 percent of women agree with at least one reason a husband is justified in hitting his wife. The table also shows that a woman is most likely to agree that a husband is justified in hitting or beating his wife if she neglects the children (21 percent). Less than 9 percent of women agree with any of the other four reasons. Ninety percent or more of women agree with any one of the reasons for refusing sex with their husband. While 84 percent of women agree with all of the reasons for a wife to refuse having sex with her husband, only 3 percent of women agree with none of the specified reasons. Table 3.12 Women’s attitude toward wife beating and refusing sex with husband Percentage of women who agree that a husband is justified in hitting or beating his wife and percentage of women who be- lieve that a wife is justified in refusing sex with her husband for specific reasons, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––– Specific reasons Percent –––––––––––––––––––––––––––––––––––––––––––––––––– Husband is justified in hitting or beating his wife if she: Burns the food 3.1 Argues with him 5.1 Goes out without telling him 8.8 Neglects the children 20.5 Refuses to have sex with him 3.3 Agrees with at least one specified reason 24.1 Wife is justified in refusing to have sex with husband if she: Knows husband has a sexually transmitted disease 94.7 Knows husband has sex with other women 89.9 Has recently given birth 94.7 Is tired or not in the mood 90.4 Agrees with all of the specified reasons 84.0 Agrees with none of the specified reasons 3.2 Number of women 13,633 Fertility | 41 FERTILITY 4 To measure fertility levels, trends, and differentials, the Philippines 2003 National Demographic and Health Survey (NDHS) included a set of carefully worded questions to obtain accurate and reliable data on fertility. The fertility indicators discussed in this chapter are based on a pregnancy history pro- vided by women in the NDHS. All women age 15-49 were asked to report on all pregnancies that re- sulted in a live birth, a miscarriage, or stillbirth. For live births, questions were asked about children still living at home, those living elsewhere, and those who had died. The women were asked the month and year of pregnancy termination as well as the duration of pregnancy for pregnancies not ending in a live birth. For pregnancies that were lost before full term, women were asked whether a doctor or anyone else did something to end the pregnancy. This approach maximizes recall of all pregnancies and provides a richer data set for fertility analysis than just asking for a history of live births only. Fertility of women age 15-24 years and males age 15-54 years are also discussed in the last two sections of this chapter. 4.1 CURRENT FERTILITY The most commonly used measures of current fertility are the total fertility rate (TFR) and its components, age-specific fertility rates (ASFRs). The TFR is a summary measure of fertility and can be interpreted as the number of births a woman would have on aver- age at the end of her reproductive life if she were subject to the cur- rently prevailing ASFRs throughout her reproductive years (15-49). The ASFRs are a valuable measure of the age pattern of childbearing. They are defined as the number of live births to women in a particu- lar age group divided by the number of woman-years in that age group during the specified period. To reduce sampling errors and to avoid any possible problems of displacement of births, a three-year TFR was computed to provide the most recent estimates of current levels of fertility.1 Table 4.1 shows that the age pattern of fertility rates shows an inverted-U form that peaks at age 25-29. Table 4.1 also shows a general fertility rate of 119 live births per 1,000 women age 15-44 years and a crude birth rate of 26 births per 1,000 population. Table 4.1 and Figure 4.1 show that urban women have a lower fertility rate than their rural counterparts (3.0 and 4.3 births per woman, respec- tively). Lower urban fertility is observed across all age groups. 1 Numerators of the ASFRs are calculated by summing the number of live births that occurred in the period 1 to 36 months preceding the survey (determined by the date of interview and the date of birth of the child) and classifying them by the age (in five-year groups) of the mother at the time of birth (determined by the mother’s date of birth). The denominators of the rates are the number of woman-years lived in each of the specified five-year groups during the 1 to 36 months preceding the survey. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Philippines 2003 Residence Age group Urban Rural Total 15-19 40 74 53 20-24 157 213 178 25-29 170 219 191 30-34 124 164 142 35-39 77 118 95 40-44 29 61 43 45-49 3 8 5 TFR 3.0 4.3 3.5 GFR 101 144 119 CBR 24.7 26.7 25.6 Note: Rates for age group 45-49 may be slightly biased because of trunca- tion. TFR: Total fertility rate for age 15-49, expressed per woman GFR: General fertility rate (births di- vided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population 42 | Fertility 4.2 FERTILITY BY BACKGROUND CHARACTERISTICS Current and cumulative fertility, as shown in Table 4.2, varies across urban-rural residence, re- gion, educational background, and economic status. The mean number of children ever born (CEB) to women age 40-49 is an indicator of completed fertility. It reflects the fertility performance of women who are nearing the end of their reproductive lifespan. If fertility had remained stable over time, the two fertil- ity measures, TFR and CEB, would be equal or similar. Although this approach may be biased because of understatement of parity reported by older women, comparison of completed fertility among women age 40-49 years with the TFR provides an indication of fertility change. The 2003 NDHS data show consis- tency in differences between the two measures with respect to urban-rural and educational differentials. As noted earlier, urban women have fewer children than their rural counterparts. The differences are also substantial across regions. The National Capital Region (NCR), the center of business, com- merce, and industry in the country, exhibits the lowest TFR (2.8 children per woman) and the lowest mean number of CEB (3.2 children per woman). MIMAROPA, one of the least developed regions in the country, shows the highest TFR (5.0 children per woman) and a mean CEB of 5.1 children per woman. The difference in fertility indicators between the two contrasting regions is about two children, which may be interpreted as arising from differences in levels of development. This is supported with the low TFR of regions adjacent to NCR, which host the spillover from the metropolitan area, namely, Central Luzon and CALABARZON (3.1 and 3.2 births per woman, respectively). Likewise, Davao region, the gateway to the southern Philippines from other Southeast Asian countries, also exhibits a low TFR (3.1 births per woman). The negative relationship between fertility and education is present in the Philippines. The fertil- ity rate of women with college or higher education (2.7 children per woman) is about half that of women with no education (5.3 children) (Table 4.2 and Figure 4.2). Education as a tool for fertility reduction can be considered in policy formulation. Education enables women to be more proactive in addressing their reproductive health and economic well-being. This is further substantiated with the fertility rates by wealth index quintile, which shows that women have a decreasing number of children as the wealth index increases. Figure 4.1 Age-Specific Fertility Rates, by Residence + + + + + + + * * * * * * * & & & & & & & 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age 0 50 100 150 200 250 300 Births per 1,000 women Urban Rural Total& * + NDHS 2003 Fertility | 43 Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, per- centage of women age 15-49 currently pregnant, and mean num- ber of children ever born to women age 40-49, by background characteristics, Philippines 2003 Background characteristic Total fertility rate1 Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 3.0 5.1 3.8 Rural 4.3 6.3 5.0 Region National Capital Region 2.8 4.7 3.2 Cordillera Admin Region 3.8 7.5 4.7 I - Ilocos 3.8 5.4 3.9 II - Cagayan Valley 3.4 6.0 4.1 III - Central Luzon 3.1 5.5 4.1 IVA - CALABARZON 3.2 4.9 3.8 IVB - MIMAROPA 5.0 9.8 5.1 V - Bicol 4.3 5.5 5.5 VI - Western Visayas 4.0 5.4 4.9 VII - Central Visayas 3.6 4.5 4.4 VIII - Eastern Visayas 4.6 6.8 5.4 IX - Zamboanga Peninsula 4.2 6.8 4.9 X - Northern Mindanao 3.8 5.5 4.8 XI - Davao 3.1 5.7 4.6 XII - SOCCSKSARGEN 4.2 6.8 5.0 XIII - Caraga 4.1 8.3 5.4 ARMM 4.2 7.1 5.2 Education No education 5.3 7.0 6.1 Elementary 5.0 6.7 5.3 High school 3.5 5.7 4.2 College or higher 2.7 4.7 2.9 Wealth index quintile Lowest 5.9 9.6 6.0 Second 4.6 8.0 5.2 Middle 3.5 5.1 4.4 Fourth 2.8 4.1 3.7 Highest 2.0 3.2 3.0 Total 3.5 5.6 4.3 1 Women age 15-49 years Table 4.2 also shows that about 6 percent of respondents reported being pregnant at the time of the survey. This proportion varies from less than 5 percent in Central Visayas and NCR to 10 percent in MIMAROPA. 44 | Fertility 4.3 FERTILITY TRENDS Age-specific fertility rates obtained from the 2003 NDHS reflect recent change in fertility trends in the Philippines. The 2003 NDHS rates can be compared with corresponding rates from periodic na- tional demographic surveys from 1973 to 1998. Discrepancies reflect a combination of actual change, differences in geographic coverage, change in data collection procedures, and estimation techniques in one or in all surveys. Table 4.3 and Figure 4.3 show fertility rates for the 30-year period preceding the survey. The rates reflect a five-year average centered on midperiod years for the 1973, 1978, and 1983 surveys and a three-year rate for the 1986, 1993, 1998 and 2003 surveys. Over the three decades, the TFR declined by 2.5 births, from 6.0 children per woman in 1970 to 3.5 children in 2001. The pace of fertility decline var- ied over time. In the early 1970s, the TFR declined by 2.7 percent annually. This was followed by a smaller decline of 0.4 percent during the succeeding five-year period. A larger decline was during the first half of the 1980s, estimated at 2.7 percent annually. The latter half of the 1980s once again revealed a slide back in the progress of fertility reduction, with a decline of just 1.4 percent annually during the period from 1984 to 1991. Between 1991 and 1996, the TFR decreased annually by 1.9 percent. From 1996 to 2001, the decline slowed even more, to about 1 percent per year. Table 4.3 Fertility trends Age-specific and total fertility rates from various surveys, Philippines, 1970- 2001 Age 1973 NDS (1970) 1978 RPFS (1975) 1983 NDS (1980) 1986 CPS (1984) 1993 NDS (1991) 1998 NDHS (1996) 2003 NDHS (2001) 15-19 56 50 55 48 50 46 53 20-24 228 212 220 192 190 177 178 25-29 302 251 258 229 217 210 191 30-34 268 240 221 198 181 155 142 35-39 212 179 165 140 120 111 95 40-44 100 89 78 62 51 40 43 45-49 28 27 20 15 8 7 5 TFR 6.0 5.2 5.1 4.4 4.1 3.7 3.5 Note: Rates for 1970 to 1989 are five-year averages and rates for 1984 to 2001 are three-year averages centered on the year in parentheses. Source: 1970-1996: NSO and Macro International Inc., 1994, Table 3.3 3.0 4.3 5.3 5.0 3.5 2.7 Urban Rural No education Elementary High school College or higher Figure 4.2 Total Fertility Rate by Residence and Education Residence Education NDHS 2003 Children per woman Fertility | 45 The observed decline in fertility can be attributed to changes in family planning practices and programs. Over the past 30 years, the female mean age at first marriage has remained high and relatively stable, at around 22 years (see Chapter 6). Fertility trends can also be established using retro- spective data from a single survey. The ASFRs are progres- sively truncated with increasing number of years from the time of survey. Because of truncation, changes over the past 20 years are observed for women up to age 29 years. ASFRs for the past 20 years by five-year periods based on the 2003 NDHS are shown in Table 4.4. The data confirm the decline in fertility; for each age group, ASFR consistently declines from the distant past to the recent period. 4.4 CHILDREN EVER BORN AND LIVING Information on lifetime fertility is useful for examin- ing the momentum of childbearing and for estimating levels of primary infertility. The number of CEB or parity is based on a cross-sectional view at the time of survey. It does not refer directly to the timing of fertility of the individual re- spondent but is a measure of her completed fertility. The number of CEB by age of women for all women and currently married women and the corresponding mean number of CEB as well as mean number of living children are presented in Table 4.5. Among all women, at least one out of three do not have children. Among married women, only 8 percent do not have children. Table 4.5 and Figure 4.4 show that, on average, women have given birth to less than one child by their early twenties, 3.5 children by their late thirties, and 4.6 children by the end of their reproductive period. Table 4.5 also shows that, overall, the mean number of CEB is 2.2 children for all women and 3.2 for currently married women. Table 4.4 Age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Philippines 2003 Number of years preceding the survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 55 55 66 69 20-24 182 188 206 210 25-29 190 208 230 240 30-34 146 169 180 [214] 35-39 93 116 [137] - 40-44 44 [71] - - 45-49 [6] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 6.0 5.2 5.1 4.4 4.1 3.7 3.5 1973 NDS 1978 RPFS 1983 NDS 1986 CPS 1993 NDS 1998 NDHS 2003 NDHS Children per woman Figure 4.3 Trends in the Total Fertility Rate 46 | Fertility Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Philippines 2003 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 93.9 5.1 1.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,648 0.07 0.07 20-24 55.5 24.1 14.9 4.4 0.9 0.1 0.0 0.0 0.0 0.0 0.0 100.0 2,209 0.71 0.69 25-29 27.2 22.4 22.4 15.6 8.0 2.9 0.7 0.7 0.0 0.0 0.0 100.0 2,034 1.70 1.64 30-34 15.9 13.1 21.3 18.5 13.5 9.2 4.2 2.6 1.3 0.3 0.2 100.0 1,954 2.70 2.58 35-39 10.2 9.3 15.6 19.7 16.3 10.2 7.0 5.4 2.7 1.9 1.8 100.0 1,873 3.53 3.34 40-44 7.6 8.1 11.2 17.9 18.3 11.5 7.9 6.1 4.5 3.0 3.9 100.0 1,564 4.10 3.81 45-49 6.5 5.8 11.1 16.0 16.0 12.3 9.7 7.2 5.5 3.5 6.4 100.0 1,351 4.57 4.20 Total 36.5 12.9 13.5 12.0 9.2 5.7 3.5 2.6 1.6 1.0 1.4 100.0 13,633 2.18 2.05 CURRENTLY MARRIED WOMEN 15-19 40.6 47.5 11.0 0.6 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 239 0.73 0.70 20-24 16.5 43.7 29.0 8.7 1.7 0.3 0.0 0.0 0.0 0.0 0.0 100.0 1,095 1.36 1.31 25-29 9.7 26.2 28.4 19.8 10.1 3.8 1.0 0.9 0.0 0.0 0.0 100.0 1,548 2.15 2.06 30-34 6.6 12.8 23.9 20.9 15.4 10.6 4.9 2.9 1.5 0.3 0.3 100.0 1,663 3.05 2.91 35-39 4.1 8.5 16.3 21.4 18.0 11.1 7.4 6.0 3.0 2.0 2.1 100.0 1,633 3.84 3.63 40-44 2.4 7.2 12.0 18.9 19.3 12.3 8.1 7.0 5.2 3.3 4.3 100.0 1,341 4.42 4.12 45-49 2.5 5.0 11.3 17.0 16.7 13.2 10.0 7.6 5.7 3.7 7.3 100.0 1,152 4.86 4.46 Total 7.7 17.3 20.1 17.9 13.6 8.5 5.1 3.9 2.4 1.4 2.1 100.0 8,671 3.21 3.02 0.1 0.7 1.7 2.7 3.5 4.1 4.6 2.2 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-49 Age 0.0 1.0 2.0 3.0 4.0 5.0 Number of children Figure 4.4 Mean Number of Children Ever Born among Women 15-49 NDHS 2003 Fertility | 47 The proportion of all women as well as currently married women without any children at younger ages is high. This is partly due to the law that sets the minimum legal age at first marriage at 18 years. Considering that most births occur within marriage, the small overall proportion of married women who are childless suggests that high fertility is expected in Philippine society. The proportion of childless women may also be interpreted as an estimate to primary sterility, assuming that voluntary childlessness within marriage is rare. Three percent of married women age 45-49 are childless. The corresponding pro- portion for all women age 45-49 is 7 percent. The difference between these figures reflects the combined impact of marital dissolution, infertility, and celibacy. Although 1 in 15 women age 45-49 are childless, the same proportion has 10 or more births. In addition to giving a description of average family size, information on CEB and number of children surviving also gives an indication on the extent of childhood and adult mortality. On average, women have two living children, and currently married women have three. The difference between mean number of CEB and children still living for the two groups of women increases with the woman’s age. By the end of the reproductive period, women have lost almost one in ten children. 4.5 BIRTH INTERVALS The influence of the timing of births on both fertility and mortality is well documented. Evidence that women with closely spaced births have higher fertility than women with longer birth intervals has been observed in many countries. It has also been shown that short birth intervals, particularly those less than two years, elevate risks of death for mother and child. In general, the median length of birth interval in the Philippines is 31 months (Table 4.6). While 26 percent of births were born four or more years after a previous birth, one in three births occur within two years of a previous birth. The large proportion of births born with short intervals is a cause for concern, as they have negative implications on maternal and child health and survival. Younger women have shorter birth intervals than older women: 25 months for women age 20-29 and 45 months for women 40 years old and older. There is a curvilinear relationship between birth order and median birth interval, from 29 months for second and third births to 33 months for fourth through sixth births, and to 30 months for higher-order births (Figure 4.5). Birth interval does not vary by the sex of previous child, but it does vary by the survival status of the previous birth. For births whose prior sibling survived, the interval is 31 months. For those with a nonsurviving previous birth, the birth interval is 21 months. The difference may be due to different mechanisms through which infant and child mortality influences birth intervals and fertility, particularly whether mothers seek to replace deceased children as soon as possible. Whereas mother’s education does not seem to have a clear relationship with the length of birth in- tervals, mother’s economic status has a positive association. Women in the poorest quintile have the shortest interval, while those in the wealthier quintiles have the longest (29 and 34 to 35 months, respec- tively). 48 | Fertility Table 4.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Philippines 2003 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48+ Total Number of non- first births Median number of months since preceding birth Age 15-19 (45.3) (25.3) (24.1) (5.3) (0.0) 100.0 31 19.4 20-29 23.5 21.0 29.8 13.4 12.4 100.0 1,914 25.4 30-39 13.0 14.4 26.3 15.5 30.7 100.0 2,435 33.5 40-49 5.6 9.9 23.0 14.8 46.8 100.0 615 44.5 Birth order 2-3 20.0 18.0 24.1 13.4 24.5 100.0 2,649 28.5 4-6 11.3 13.8 29.6 15.9 29.4 100.0 1,598 33.4 7+ 14.1 16.7 33.1 15.6 20.4 100.0 749 30.3 Sex of preceding birth Male 16.8 15.8 26.6 14.9 25.8 100.0 2,596 30.9 Female 15.8 17.1 27.8 14.1 25.1 100.0 2,399 30.2 Survival of preceding birth Living 15.4 16.3 27.6 14.6 26.1 100.0 4,790 30.9 Dead 37.3 20.2 18.5 13.0 11.0 100.0 206 20.9 Residence Urban 19.1 15.1 24.1 13.8 27.9 100.0 2,344 30.8 Rural 13.9 17.6 29.9 15.2 23.4 100.0 2,652 30.4 Region National Capital Region 22.6 15.8 24.6 12.3 24.8 100.0 709 27.8 Cordillera Admin Region 12.9 17.6 27.1 18.0 24.4 100.0 83 30.6 I - Ilocos 13.9 18.5 26.5 11.8 29.3 100.0 204 28.8 II - Cagayan Valley 14.6 13.5 26.3 12.6 33.0 100.0 148 34.5 III - Central Luzon 15.5 12.9 25.4 15.9 30.2 100.0 475 34.1 IVA - CALABARZON 17.8 13.5 22.7 16.7 29.3 100.0 543 32.6 IVB - MIMAROPA 13.4 15.7 33.6 18.5 18.9 100.0 185 30.5 V - Bicol 11.5 23.0 30.8 12.7 22.0 100.0 338 28.9 VI - Western Visayas 12.3 17.3 33.1 16.9 20.4 100.0 371 30.7 VII - Central Visayas 16.5 20.0 24.0 14.9 24.5 100.0 397 30.3 VIII - Eastern Visayas 15.2 18.6 30.6 16.6 19.0 100.0 282 27.9 IX - Zamboanga Peninsula 13.7 12.2 27.1 16.1 30.8 100.0 209 32.9 X - Northern Mindanao 12.4 14.3 25.1 13.0 35.1 100.0 218 34.7 XI - Davao 13.5 13.5 30.6 13.3 29.2 100.0 206 32.6 XII - SOCCSKSARGEN 11.2 17.1 29.2 18.9 23.6 100.0 241 31.7 XIII - Caraga 19.8 18.0 26.6 11.3 24.2 100.0 153 30.3 ARMM 28.0 20.0 29.6 7.3 15.1 100.0 234 24.5 Education No education 17.6 11.6 38.1 15.8 16.9 100.0 117 29.5 Elementary 12.3 15.7 30.5 15.3 26.3 100.0 1,709 32.1 High school 17.9 18.3 26.2 15.0 22.6 100.0 2,060 28.6 College or higher 19.5 14.7 22.9 12.3 30.6 100.0 1,109 31.3 Wealth index quintile Lowest 15.1 18.2 34.2 15.4 17.2 100.0 1,505 29.0 Second 16.3 16.8 28.5 14.2 24.3 100.0 1,180 29.4 Middle 18.5 17.7 21.9 13.5 28.4 100.0 942 31.1 Fourth 16.5 13.6 21.7 15.4 32.9 100.0 759 34.7 Highest 15.9 13.1 22.7 13.7 34.7 100.0 609 34.4 Total 16.3 16.5 27.2 14.5 25.5 100.0 4,995 30.5 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Fertility | 49 4.6 AGE AT FIRST BIRTH Postponing the first birth contributes to overall fertility reduction. As such, the onset of child- bearing is an important fertility indicator. Early childbearing in the Philippines is unusual: Only 10 per- cent of women age 45-49 have given birth by age 18 (Table 4.7). This proportion decreases slightly among younger women (7 percent for women age 20-24). The low proportion of women giving birth in their teens can be attributed to the high age at first marriage, which has been around 22 years in the past 25 years. Table 4.7 Age at first birth Percentage of women who gave birth by exact ages, and median age at first birth, by current age, Phil- ippines 2003 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.3 na na na na 93.9 2,648 a 20-24 0.4 6.9 22.6 na na 55.5 2,209 a 25-29 0.8 7.6 22.1 40.0 61.1 27.2 2,034 23.4 30-34 1.0 9.8 23.7 40.9 60.5 15.9 1,954 23.3 35-39 0.7 9.1 24.7 41.1 61.4 10.2 1,873 23.2 40-44 0.7 10.1 25.9 43.4 64.4 7.6 1,564 22.9 45-49 0.9 9.7 24.8 42.7 63.1 6.5 1,351 23.1 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 19.4 25.4 33.5 44.5 28.5 33.4 30.3 15-19 20-29 30-39 40-49 2-3 4-6 7+ Number of months Figure 4.5 Median Number of Months since Previous Birth NDHS 2003 Age of mother Birth order 50 | Fertility The median age at first birth among women age 25-49 is 23.2 years (Table 4.8). Women in the urban areas are two years older than their rural counterparts when they first enter motherhood. Women with higher education and those who belong to higher socioeconomic strata have a higher median age at first birth than other women. Regional variation ranges from 21.6 years in ARMM to 23.8 years in CALABARZON. In NCR, less than half of the women age 25-49 had a birth before age 25. Table 4.8 Median age at first birth by background characteristics Median age at first birth among women age 25-49 years, by current age and background characteristics, Philippines 2003 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 24.2 24.5 24.0 23.7 23.7 24.1 Rural 22.2 22.0 22.3 22.0 22.0 22.1 Region National Capital Region 24.8 25.8 25.2 24.5 23.9 a Cordillera Admin Region 22.8 22.9 23.7 22.0 22.3 22.8 I - Ilocos 23.8 22.1 23.4 23.8 23.2 23.2 II - Cagayan Valley 22.2 22.2 22.8 22.5 22.1 22.3 III - Central Luzon 22.6 23.3 23.5 23.4 23.8 23.3 IVA - CALABARZON 24.2 24.5 23.6 22.4 23.6 23.8 IVB - MIMAROPA 22.0 22.3 21.2 22.5 21.6 21.9 V - Bicol 24.0 21.9 21.6 22.4 22.1 22.4 VI - Western Visayas 22.8 23.0 23.2 22.2 23.5 22.9 VII - Central Visayas 23.4 22.5 22.8 23.3 22.4 22.9 VIII - Eastern Visayas 23.1 22.1 21.7 21.5 21.7 22.2 IX - Zamboanga Peninsula 22.4 22.6 22.2 21.4 23.1 22.3 X - Northern Mindanao 23.5 22.8 23.0 23.5 23.0 23.1 XI - Davao 23.2 23.3 22.5 21.8 22.2 22.6 XII - SOCCSKSARGEN 21.8 21.8 23.5 21.9 21.5 22.2 XIII - Caraga 22.8 22.7 22.9 23.1 21.3 22.5 ARMM 21.5 20.9 22.2 21.1 23.4 21.6 Education No education 19.7 20.1 19.4 20.5 20.5 20.0 Elementary 20.5 20.5 21.0 20.9 21.3 20.8 High school 22.1 22.7 22.4 22.4 22.8 22.4 College or higher a 26.4 26.5 26.2 26.5 a Wealth index quintile Lowest 20.7 20.9 21.2 21.1 21.9 21.0 Second 21.8 21.8 21.8 22.2 22.0 21.9 Middle 23.2 22.9 22.3 22.0 22.3 22.6 Fourth 25.0 24.4 24.2 23.3 22.8 24.0 Highest a 26.5 26.0 25.2 25.1 a Total 23.4 23.3 23.2 22.9 23.1 23.2 a = Omitted because less than 50 percent of the women had a birth before reaching age 25 Fertility | 51 4.7 ADOLESCENT FERTILITY Young women have been the focus of a number of government programs aimed at delaying entry into childbearing and hastening fertility decline. In the Philippines, 26 percent of women age 15-24 years have begun childbearing. Women who have begun childbearing are more likely than other women to live in rural areas, have elementary schooling, and belong to poor families (Table 4.9). Across regions, early childbearing is highest in MIMAROPA and Cagayan Valley, with 40 percent or more of women age 15-24 having had a child or being pregnant with their first child. Table 4.9 Pregnancy and motherhood among young women Percentage of women age 15-24 who are mothers or pregnant with their first child, by background characteristics, Philippines 2003 Percentage who are Background characteristic Mothers Pregnant with first child Percentage who have begun child- bearing Number of women Age 15 0.1 0.3 0.5 585 16 1.5 0.8 2.2 616 17 5.6 1.5 7.0 530 18 8.1 3.8 11.9 495 19 19.8 3.7 23.5 422 15-19 6.1 1.8 8.0 2,648 20-24 44.5 4.0 48.5 2,209 Residence Urban 20.7 2.6 23.3 2,958 Rural 28.1 3.2 31.3 1,898 Region National Capital Region 20.2 3.0 23.1 851 Cordillera Admin Region 24.8 4.5 29.3 82 I - Ilocos 24.5 5.1 29.6 236 II - Cagayan Valley 34.8 5.0 39.8 129 III - Central Luzon 22.3 4.1 26.4 525 IVA - CALABARZON 21.5 2.1 23.6 709 IVB - MIMAROPA 39.1 5.2 44.2 111 V - Bicol 20.5 1.3 21.8 250 VI - Western Visayas 19.3 1.9 21.2 319 VII - Central Visayas 20.4 1.9 22.3 362 VIII - Eastern Visayas 22.3 2.7 25.0 195 IX - Zamboanga Peninsula 28.5 2.4 30.9 150 X - Northern Mindanao 26.2 3.5 29.8 211 XI - Davao 24.2 0.8 25.0 232 XII - SOCCSKSARGEN 33.1 2.0 35.1 178 XIII - Caraga 28.5 5.0 33.5 123 ARMM 30.2 1.9 32.1 192 Education No education * * * 27 Elementary 41.1 4.1 45.2 664 High school 22.1 2.6 24.7 2,822 College or higher 17.7 2.6 20.3 1,344 Wealth index quintile Lowest 42.0 4.1 46.0 690 Second 34.1 3.9 38.0 801 Middle 26.0 3.1 29.1 943 Fourth 18.0 2.4 20.4 1,045 Highest 10.8 1.7 12.5 1,376 Total 23.6 2.8 26.4 4,856 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 52 | Fertility Given the late age at first marriage, only 8 percent of teenagers (age 15-19) in the Philippines have begun childbearing. In comparison with other Southeast Asian countries for which comparable data are available, this proportion is the same as that in Cambodia (National Institute of Statistics et al., 2000), lower than that in Indonesia (10 percent) (BPS and ORC Macro, 2003), and higher than that in Viet Nam (3 percent) (Committee for Population, Family and Children and ORC Macro, 2003). 4.8 MALE FERTILITY The 2003 NDHS included a spe- cial module on men age 15-54 to measure their fertility behavior and aspirations. More than half of these men are fathers. For many, fatherhood starts at age 20-24, when one in five men became fathers. The proportion increases sharply thereafter. By age 25-29, more than half of all men are fathers, and by age 30-34, three in four men have become fathers. This increases to nine in ten by the time the males reach their early forties (Table 4.10). Rural and less educated men, as well as those in the lowest wealth quintile, are more likely than other men to be fathers. Seventy-seven percent of men say that they were married when their first child was born. This proportion is higher among better-educated men and among those who belong to a higher socioeco- nomic group. The proportion of men who were married when their first child was born increases as age increases. Table 4.11 shows that men have fathered, on average, two children. Men have one child by their late twenties, more than three children by their late-thirties, and five children by their early fifties. In each age group, women report more chil- dren than men (see Table 4.5). Table 4.10 Male fertility and fatherhood Percentage of men age 15-54 who are fathers and percentage of fathers who were married when their first child was born and the mean number of chil- dren born to men who were fathers, by background characteristics, Philip- pines 2003 All men All fathers Background characteristic Fathers Number of men Married when first child was born Mean number of children Number of fathers Age 15-19 1.4 918 * * 13 20-24 20.8 785 60.3 1.4 163 25-29 56.7 647 66.5 2.0 367 30-34 76.5 593 75.7 2.8 454 35-39 83.8 586 81.0 3.6 491 40-44 90.9 483 79.1 4.1 439 45-49 91.3 416 83.7 4.6 380 50-54 93.6 338 84.3 5.3 316 Residence Urban 53.7 2,553 76.7 3.2 1,370 Rural 56.6 2,213 77.4 4.0 1,254 Education No education 72.1 84 73.2 5.3 60 Elementary 65.6 1,441 75.9 4.3 946 High school 47.0 2,048 75.0 3.3 962 College or higher 54.9 1,193 82.0 2.8 656 Wealth index quintile Lowest 61.5 884 72.3 4.3 543 Second 57.8 937 74.7 3.8 542 Middle 56.1 992 74.2 3.5 556 Fourth 49.7 957 79.3 3.2 476 Highest 50.9 996 85.5 2.9 507 Total 55.0 4,766 77.0 3.5 2,623 Note: An asterisk indicates that a figure is based on fewer than 25 un- weighted cases and has been suppressed. Fertility | 53 Table 4.11 Mean number of children Percent distribution of men age 15-54 by number of children fathered and mean number of children fathered, by age group, Philippines 2003 Mean number of children fathered Age group 0 1 2 3 4 5 6 7 8+ Total Number of men Mean number of children fathered 15-19 98.6 0.9 0.4 0.1 0.0 0.0 0.0 0.0 0.0 100.0 918 0.0 20-24 79.2 13.2 6.3 1.1 0.2 0.0 0.0 0.0 0.0 100.0 785 0.3 25-29 43.3 21.7 18.4 11.3 3.4 1.4 0.4 0.1 0.0 100.0 647 1.2 30-34 23.5 15.8 23.5 18.1 8.5 5.2 2.8 1.4 1.2 100.0 593 2.1 35-39 16.2 9.6 18.0 16.9 16.0 9.0 6.8 3.9 3.6 100.0 586 3.1 40-44 9.1 8.5 11.7 19.9 18.2 12.3 8.8 5.2 6.3 100.0 483 3.7 45-49 8.7 7.5 9.2 16.9 17.0 12.7 9.9 7.3 10.9 100.0 416 4.2 50-54 6.4 3.5 10.0 14.1 16.1 13.2 10.3 7.6 18.9 100.0 338 5.0 Total 45.0 10.2 11.5 10.6 8.0 5.2 3.7 2.4 3.5 100.0 4,766 2.0 Family Planning | 55 FAMILY PLANNING 5 5.1 KNOWLEDGE OF FAMILY PLANNING Knowledge of family planning methods and their sources are necessary preconditions to the use of contraception. As in the 1993 National Demographic Survey and the 1998 National Demographic and Health Survey (NDHS), information about knowledge of family planning methods was generated by ask- ing the respondent to name the ways or methods that a couple can use to delay or avoid a pregnancy. If the respondent did not spontaneously mention a particular method, the interviewer described that method and asked the respondent if she recognized it. Specific methods are listed in the questionnaire: tubal liga- tion or female sterilization, vasectomy or male sterilization, pill, intrauterine device (IUD), injectables, condom, diaphragm, foam or jelly, implants, female condom, emergency contraception, lactational amenorrhea method (LAM), withdrawal, and various ovulation-based methods (mucus/Billings/ovulation, basal body temperature, sympthothermal, standard days method, and calendar/rhythm/periodic absti- nence). Other methods not listed in the questionnaire but mentioned spontaneously by the respondent were also recorded. For all methods mentioned or recognized, the respondent was asked if she had ever used the method. Table 5.1 and Figure 5.1 show that knowledge of one or more family planning methods is almost universal among currently married women and currently married men (99 and 98 percent, respectively). The level of contraception awareness among all women and men is similar (98 and 97 percent, respec- tively). Table 5.1 Knowledge of contraceptive methods Percentage of all women and currently married women, and percentage of all men and currently married men, who know any contraceptive method, by specific method, Philippines 2003 Method All women Currently married women All men Currently married men Any method 97.9 99.1 97.3 98.2 Any modern method 97.6 98.8 97.1 97.9 Female sterilization 86.5 92.0 72.2 82.1 Male sterilization 66.6 74.3 59.1 71.3 Pill 96.6 98.3 89.6 93.9 IUD 83.6 91.0 64.1 75.2 Injectables 81.5 90.1 49.5 60.2 Male condom 93.9 96.0 95.4 96.3 Diaphragm 16.2 15.7 14.2 15.6 Foam/jelly 11.4 11.5 7.4 8.1 Implants 7.5 6.8 6.5 6.9 Female condom 14.8 13.3 14.9 15.1 Mucus/Billings/ovulation 14.4 15.1 7.3 8.4 Basal body temp 15.3 15.0 7.5 8.0 Symptothermal 6.7 6.8 3.3 4.0 Standard days method 9.8 10.4 5.8 6.4 Lactational amenorrhea 18.8 22.3 7.7 9.9 Emergency contraception 10.4 10.0 11.4 11.4 Any traditional method 83.2 90.3 80.1 88.9 Calendar/rhythm/periodic abstinence 72.6 79.2 57.6 68.7 Withdrawal 76.5 85.8 76.1 85.9 Other traditional methods 4.5 5.4 0.0 0.0 Mean number of methods known 7.9 8.4 6.5 7.3 Number 13,633 8,671 4,766 2,746 56 | Family Planning Six modern methods are known to at least half of the women and men regardless of marital status. They are the pill, male condom, female sterilization, male sterilization, IUD, and injectables. Implants, symptothermal, emergency contraception, and standard days method are less known (10 percent or less among women and 3 to 11 percent among men). Seventy to 80 percent of women and men have heard of withdrawal and periodic abstinence. Currently married women know on average one method more than currently married men (8.4 compared with 7.3 methods). Knowledge of any method and modern methods does not vary greatly by subgroups of respon- dents except by education and region of residence (Table 5.2). Knowledge of contraception among re- spondents with no education is significantly lower than among respondents who have attended formal education. Eighty-five percent of women with no education have heard of a method compared with 100 percent of women with high school or higher education. While in other regions knowledge of family planning is almost universal (99 percent or higher), the corresponding proportion in Autonomous Region in Muslim Mindanao (ARMM) is lower; 86 percent of women in ARMM know a modern method and 90 percent of women know any method, while 64 percent of men in ARMM know a modern method and 69 percent know any method. 98 91 90 96 92 74 15 15 7 22 79 86 Pill IUD Injectables Condom Female sterilization Male sterilization Mucus/Billings/ovulation Basal body temperature Symptothermal Lactational amenorrhea Calendar/rhythm Withdrawal 0 20 40 60 80 100 Figure 5.1 Knowledge of Contraception among Currently Married Women Age 15-49 NDHS 2003 Family Planning | 57 Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men who know at least one contraceptive method and at least one modern method, by background characteristics, Philippines 2003 Women Men Background characteristic Knows any method Knows1 any modern method Number Knows any method Knows1 any modern method Number Age 15-19 99.8 99.4 239 * * 19 20-24 98.8 98.7 1,095 97.1 97.1 206 25-29 99.0 98.6 1,548 98.0 97.5 400 30-34 99.2 99.0 1,663 98.7 98.2 482 35-39 99.5 99.3 1,633 99.2 99.1 504 40-44 99.2 98.9 1,341 98.1 97.9 442 45-49 98.7 98.4 1,152 98.3 97.6 387 50-54 na na 0 97.6 97.4 306 Residence Urban 99.5 99.3 4,643 99.0 98.7 1,459 Rural 98.6 98.3 4,028 97.3 96.9 1,287 Region National Capital Region 99.4 99.3 1,337 100.0 100.0 417 Cordillera Admin Region 99.0 99.0 134 99.0 99.0 44 I - Ilocos 99.5 99.5 420 99.2 99.2 129 II - Cagayan Valley 100.0 100.0 325 100.0 100.0 107 III - Central Luzon 99.6 99.5 960 99.6 99.2 315 IVA - CALABARZON 99.8 99.5 1,139 99.6 99.3 345 IVB - MIMAROPA 99.7 99.4 257 99.1 98.2 77 V - Bicol 99.0 99.0 457 100.0 100.0 139 VI - Western Visayas 99.8 99.6 578 99.4 99.4 182 VII - Central Visayas 98.8 98.8 671 97.7 97.7 204 VIII - Eastern Visayas 99.8 99.5 355 97.8 97.8 117 IX - Zamboanga Peninsula 99.1 98.9 339 100.0 100.0 109 X - Northern Mindanao 99.2 99.2 364 98.5 98.5 125 XI - Davao 99.8 99.5 426 100.0 100.0 134 XII - SOCCSKSARGEN 99.1 98.6 364 99.2 98.6 120 XIII - Caraga 100.0 100.0 217 100.0 100.0 74 ARMM 89.5 86.3 328 68.8 64.2 107 Education No education 85.4 77.7 148 74.4 74.4 62 Elementary 98.5 98.2 2,523 97.9 97.4 969 High school 99.5 99.4 3,545 98.8 98.7 1,017 College or higher 100.0 99.9 2,456 99.9 99.4 698 Wealth index quintile Lowest 97.1 96.3 1,677 92.9 92.3 559 Second 99.2 99.0 1,767 99.3 98.9 575 Middle 99.4 99.2 1,776 99.2 99.2 578 Fourth 99.9 99.8 1,755 99.7 99.3 503 Highest 99.8 99.8 1,697 100.0 99.8 531 Total 99.1 98.8 8,671 98.2 97.9 2,746 Note: An asterisk indicates that an estimate is based on fewer than 25 cases and has been suppressed. na = Not applicable 1 Female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, fe- male condom, diaphragm, mucus/Billings/ovulation, basal body temperature, symptother- mal, foam/ jelly, lactational amenorrhea method (LAM), and emergency contraception 58 | Family Planning 5.2 EVER USE OF FAMILY PLANNING METHODS For each method mentioned spontaneously or recognized after probing, the respondent was asked if she had ever used it. The information on ever use of contraception is shown for all women and currently married women in Table 5.3. The percentage of currently married women who have used contraception is higher than for all women due to their greater exposure to the risk of pregnancy given their marital status. Seven out of 10 currently married women have used a family planning method at some time; 57 percent have used a modern method and 41 percent used a traditional method. The most often used modern method is the pill (39 percent). Other modern methods with significant proportions of users include the male condom (15 percent), injectables (12 percent), female sterilization (11 percent), and IUD (10 per- cent). Four percent of currently married women report using LAM. The remaining modern methods are much less popular (1 percent or less). Regarding traditional methods, one in three married women has used withdrawal (32 percent) and 21 percent have used periodic abstinence. Modern methods are popular among women of all ages. However, younger women (age 15-24) are less likely to have ever used contraception than women in their mid-childbearing years (age 25 and older). Generally, the level of ever use of modern contraception increases with age up to 35-39 and then declines. This pattern varies for specific methods. For currently married women, the ever use rate for the pill, IUD, and injectables reaches the peak at age group 30-34. Table 5.3 Ever use of contraception Percentage of all women and currently married women who have ever used any contraceptive method, by specific method and age, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––––– Calendar/ Female Mucus/ Emer- Any rhythm/ Any steri- In- Male Billings/ Basal Standard gency tradi- periodoc Number Any modern liza- ject- con- ovu- body days contra- tional absti- With- of Age method method tion Pill IUD ables dom lation temp method LAM ception method nence drawal Other women ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– ALL WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 4.0 2.4 0.0 1.1 0.3 0.4 0.6 0.1 0.1 0.0 0.2 0.0 2.3 0.6 2.0 0.1 2,648 20-24 31.8 24.9 0.1 17.4 3.2 5.9 5.3 0.4 0.3 0.1 1.8 0.2 17.3 5.8 15.1 0.5 2,209 25-29 56.6 45.0 2.4 32.9 6.5 11.1 10.8 1.0 0.3 0.2 2.5 0.4 31.7 13.4 26.4 1.2 2,034 30-34 66.5 55.8 6.7 40.1 9.7 13.7 14.9 1.3 0.9 0.2 4.1 0.8 38.2 19.0 30.2 2.1 1,954 35-39 69.7 57.9 12.4 39.3 9.8 11.6 14.8 1.1 0.6 0.3 4.5 0.4 41.9 23.0 31.2 2.3 1,873 40-44 66.5 54.8 17.4 33.6 10.7 6.5 14.6 1.1 0.3 0.4 3.3 0.5 37.5 23.2 29.1 1.8 1,564 45-49 63.1 50.5 19.1 28.7 8.6 4.9 14.8 1.0 0.6 0.4 3.3 0.5 38.1 21.8 28.9 2.7 1,351 Total 47.3 38.5 6.9 25.8 6.4 7.5 9.9 0.8 0.4 0.2 2.6 0.4 27.3 13.8 21.6 1.4 13,633 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– CURRENTLY MARRIED WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 15-19 36.8 21.8 0.0 11.4 3.6 4.4 2.1 0.4 1.0 0.0 1.4 0.4 20.9 5.6 18.1 1.6 239 20-24 61.0 47.8 0.3 33.7 6.2 11.9 9.9 0.7 0.5 0.2 3.6 0.5 33.2 11.1 28.9 1.0 1,095 25-29 71.5 57.2 3.2 42.0 8.2 14.4 13.7 1.3 0.3 0.3 2.9 0.5 39.9 16.6 33.3 1.6 1,548 30-34 75.8 63.7 7.9 45.7 11.2 15.7 16.9 1.4 1.0 0.3 4.7 0.9 43.8 21.9 34.6 2.4 1,663 35-39 76.5 63.4 13.8 43.4 10.9 13.1 16.0 1.3 0.7 0.2 4.7 0.5 45.9 25.3 34.2 2.5 1,633 40-44 72.2 59.6 19.0 36.2 11.9 7.2 16.5 1.0 0.4 0.5 3.6 0.5 41.2 25.6 32.2 1.8 1,341 45-49 67.7 54.0 21.2 30.4 9.4 5.4 16.4 1.1 0.7 0.3 3.7 0.5 41.7 24.3 31.5 2.8 1,152 Total 70.6 57.4 10.5 38.6 9.6 11.5 14.7 1.1 0.6 0.3 3.8 0.6 40.8 20.7 32.3 2.1 8,671 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: Methods ever used by less than 0.5 percent of women in any age group have been omitted. LAM = Lactational amenorrhea method Family Planning | 59 5.3 CURRENT USE OF FAMILY PLANNING METHODS The level of current use of contraception is one of the most widely used indicators to assess the progress of a national family planning program. The contraceptive prevalence rate is defined as the pro- portion of married women age 15-49 who were using some method of family planning at the survey date. As with ever use, information on current use of contraception is available for all women and currently married women, but the analysis will focus on married women, who are at greater risk of pregnancy (Table 5.4). Table 5.4 Current use of contraception Percent distribution of all women and currently married women by contraceptive method currently used, according to age, Philippines 2003 Modern method Traditional method Age Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Male con- dom Mucus/ Billings/ ovula- tion LAM Any tradi- tional method Calendar/ rhythm/ periodic absti- nence With- drawal Other Not currently using Total Number of women ALL WOMEN 15-19 2.4 1.3 0.0 0.0 0.6 0.3 0.1 0.1 0.0 0.0 1.1 0.4 0.7 0.0 97.6 100.0 2,648 20-24 21.6 15.2 0.1 0.0 9.0 2.4 2.1 1.0 0.1 0.6 6.4 1.6 4.6 0.2 78.4 100.0 2,209 25-29 39.3 27.0 2.4 0.0 15.5 3.4 3.2 2.1 0.0 0.3 12.4 4.3 7.7 0.4 60.7 100.0 2,034 30-34 45.6 32.4 6.7 0.1 14.8 4.6 3.5 2.2 0.1 0.2 13.2 5.9 6.8 0.5 54.4 100.0 1,954 35-39 49.8 34.0 12.4 0.1 12.4 3.6 3.2 1.8 0.1 0.1 15.8 7.5 7.4 0.9 50.2 100.0 1,873 40-44 44.0 28.1 17.4 0.3 5.0 3.3 0.8 1.1 0.1 0.1 15.8 8.1 7.4 0.4 56.0 100.0 1,564 45-49 33.3 23.6 19.1 0.2 1.3 1.5 0.9 0.6 0.0 0.0 9.7 5.3 3.9 0.6 66.7 100.0 1,351 Total 31.6 21.6 6.9 0.1 8.4 2.6 2.0 1.2 0.1 0.2 9.9 4.3 5.2 0.4 68.4 100.0 13,633 CURRENTLY MARRIED WOMEN 15-19 25.6 13.2 0.0 0.0 7.1 3.6 1.1 0.4 0.0 0.5 12.3 3.9 8.0 0.5 74.4 100.0 239 20-24 42.7 30.1 0.3 0.0 17.8 4.6 4.2 1.8 0.2 1.2 12.6 3.2 9.0 0.4 57.3 100.0 1,095 25-29 51.3 35.2 3.2 0.0 20.3 4.4 4.2 2.7 0.0 0.2 16.1 5.6 10.0 0.5 48.7 100.0 1,548 30-34 53.4 38.0 7.9 0.1 17.4 5.4 4.0 2.6 0.1 0.3 15.4 6.9 8.0 0.5 46.6 100.0 1,663 35-39 56.6 38.5 13.8 0.2 14.2 4.1 3.7 2.1 0.2 0.1 18.0 8.6 8.5 1.0 43.4 100.0 1,633 40-44 49.9 31.5 19.0 0.3 5.8 3.9 1.0 1.3 0.1 0.1 18.4 9.3 8.6 0.5 50.1 100.0 1,341 45-49 37.7 26.4 21.2 0.2 1.5 1.7 1.1 0.7 0.0 0.0 11.4 6.2 4.6 0.7 62.3 100.0 1,152 Total 48.9 33.4 10.5 0.1 13.2 4.1 3.1 1.9 0.1 0.3 15.5 6.7 8.2 0.6 51.1 100.0 8,671 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method The overall contraceptive prevalence rate among currently married women is 49 percent, with 33 percent using modern methods and 16 percent using traditional methods. The most popular methods are the pill (13 percent) and female sterilization (11 percent). The next most popular methods are traditional: withdrawal (8 percent) and periodic abstinence (7 percent). IUD and injectables are used by 3 to 4 percent of married women. The remaining methods have very few users, each being used by less than 2 percent of married women (Figure 5.2). 60 | Family Planning The age pattern of contraceptive prevalence rates takes the shape of an inverted U. For modern methods, the peak is in age group 35-39 and for traditional methods in age group 40-44 among married women. However, as with the rates on ever use (Table 5.3), the peak occurs in different age groups for specific methods. The pill, injectables, and IUD are more popular among women age 25-34, whereas older women tend to use long-term methods such as female sterilization. Current use of calen- dar/rhythm/periodic abstinence is popular among older women (age 35-44), while withdrawal is consis- tently popular among women of all ages, except the oldest age group (age 45-49). 5.3.1 Trends in Contraceptive Use Table 5.5 and Figure 5.3 show that contraceptive prevalence over the last 35 years has more than doubled, from 15 percent in 1968 to 49 percent in 2003. Increases in contraceptive prevalence rates over time can be grouped into three stages: a period of rapid increase (1968-1978), moderate increase (1978- 1998), and slow increase (1998-2003). Between 1968 and 1978, the contraceptive prevalence rate in- creased from 15 to 39 percent. Most of the increase was in the use of modern methods (from 3 percent in 1968 to 17 percent in 1978). Between 1983 and 1998, while use of traditional methods only went from 13 to 18 percent, use of modern methods increased from 19 to 28 percent. In the past five years, while the overall contraceptive prevalence rate shows little increase (47 to 49 percent), this increase is again because of use of modern methods (NSO, DOH and Macro, 1999). The largest contributor to the increase is the gain in popularity of the pill from 10 percent in 1998 to 13 per- cent in 2003. Figure 5.2 Use of Contraception among Currently Married Women Age 15-49 NDHS 2003 Other methods 1% Pill 13% Condom 2% Withdrawal 8%IUD 4% Female sterilization 11% Injectables 3% Calendar rhythm 7% Not using 51% Family Planning | 61 Table 5.5 Trends in contraceptive use Percentage of currently married women age 15-49 using modern and traditional methods, Philippines 2003 Survey Modern methods Traditional methods All methods 1968 National Demographic Survey1 2.9 12.5 15.4 1973 National Demographic Survey1 10.7 6.7 17.4 1978 Republic of the Philippines Fertility Survey1 17.2 21.3 38.5 1983 National Demographic Survey1 18.9 13.1 32.0 1988 National Demographic Survey 21.6 14.5 36.1 1993 National Demographic Survey 24.9 15.1 40.0 1998 National Demographic and Health Survey 28.2 18.3 46.5 2003 National Demographic and Health Survey 33.4 15.5 48.9 1Calculated for currently married women 15-44 years Sources: World Bank, 1991; NSO and Macro International 1994, and 1999 5.3.2 Differentials in Contraceptive Use Table 5.6 shows that while the overall contraceptive prevalence rates in urban and rural areas do not differ significantly, there are variations by specific methods. Current user rates for female sterilization (12 percent) and withdrawal (10 percent) in urban areas are higher than in rural areas (9 and 7 percent, respectively). Better access to female sterilization facilities in urban than in rural areas largely explains this difference in female sterilization. Use of contraception generally increases with increasing levels of women’s education. Atten- dance in any level of education as compared with having no formal education discriminates current users from those who are not currently using. Use of contraceptive methods is consistently higher among better- educated women than those with less education; however, women with a college education or higher are somewhat less likely than women with a high school education to use a modern method, while being somewhat more likely to use a traditional method. Figure 5.3 Trends in Contraceptive Use Philippines 1968-2003 15 17 39 32 36 40 46 49 1968 NDS 1973 NDS 1978 RPFS 1983 NDS 1988 NDS 1993 NDS 1998 NDS 2003 NDHS 0 10 20 30 40 50 60 Modern methods Traditional methods Percent 62 | Family Planning Table 5.6 Current use of contraception by background characteristics Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Philippines 2003 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- zation Male sterili- zation Pill IUD Inject- ables Male con- dom Mucus/ Billings/ ovula- tion LAM Any tradi- tional method Calendar/ rhythm/ periodic absti- nence With- drawal Other Not currently using Total Number of women Residence Urban 50.1 33.9 12.1 0.1 12.6 3.5 2.5 2.3 0.1 0.4 16.3 6.1 9.7 0.5 49.9 100.0 4,643 Rural 47.4 32.8 8.6 0.1 13.8 4.7 3.7 1.5 0.1 0.2 14.7 7.4 6.5 0.7 52.6 100.0 4,028 Number of living children 0 5.8 1.7 0.1 0.0 0.9 0.0 0.0 0.5 0.0 0.0 4.1 1.8 2.2 0.2 94.2 100.0 700 1-2 49.2 32.2 3.8 0.1 17.2 4.3 3.4 2.7 0.1 0.5 17.0 7.0 9.7 0.4 50.8 100.0 3,378 3-4 61.3 45.7 19.9 0.1 14.5 5.5 3.3 1.8 0.1 0.3 15.6 7.4 7.6 0.7 38.7 100.0 2,793 5+ 45.6 28.7 12.4 0.3 8.3 3.1 3.2 1.1 0.2 0.2 16.9 7.0 8.8 1.1 54.4 100.0 1,800 Education No education 18.1 11.7 6.1 0.0 4.6 0.0 1.1 0.0 0.0 0.0 6.3 1.7 1.6 3.1 81.9 100.0 148 Elementary 44.0 30.3 10.3 0.2 11.0 4.3 3.1 1.0 0.1 0.2 13.8 5.4 7.6 0.7 56.0 100.0 2,523 High school 51.9 35.9 10.0 0.1 14.9 4.7 3.8 1.8 0.0 0.4 16.0 6.1 9.3 0.6 48.1 100.0 3,545 College or higher 51.4 34.2 11.5 0.1 13.4 3.2 2.1 3.1 0.2 0.2 17.2 9.2 7.6 0.4 48.6 100.0 2,456 Wealth index quintile Lowest 37.4 23.8 3.9 0.2 11.4 3.6 3.5 0.8 0.1 0.2 13.6 6.0 6.1 1.4 62.6 100.0 1,677 Second 48.8 33.8 7.9 0.0 14.7 5.2 3.7 1.8 0.2 0.3 15.0 5.7 8.5 0.8 51.2 100.0 1,767 Middle 52.7 35.7 11.2 0.2 14.5 4.6 3.2 1.4 0.1 0.4 17.0 7.0 9.7 0.3 47.3 100.0 1,776 Fourth 54.4 37.9 13.4 0.1 13.6 4.8 3.2 2.2 0.0 0.4 16.5 7.1 9.2 0.3 45.6 100.0 1,755 Highest 50.6 35.2 15.9 0.1 11.5 2.1 1.7 3.3 0.1 0.3 15.3 7.7 7.4 0.3 49.4 100.0 1,697 Total 48.9 33.4 10.5 0.1 13.2 4.1 3.1 1.9 0.1 0.3 15.5 6.7 8.2 0.6 51.1 100.0 8,671 Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method Contraceptive use has an inverted U-shaped relationship with number of children. Use of any method ranges from 6 percent among women with no living children to 61 percent for women with three to four children, after which it declines to 46 percent for women with five or more children. The most popular family planning methods among childless women are withdrawal and calendar/rhythm/periodic abstinence (2 percent each). Pill use increases significantly from less than 1 percent among childless women to 17 percent among women with one or two children. The proportion of women who use female sterilization increases from 4 percent for women who have one or two children to 20 percent for those with three or four children. Use of any method of family planning increases with increasing wealth index quintile from 37 percent for women in the poorest quintile to 54 percent for those in the fourth quintile, but declines to 51 percent for women in the wealthiest quintile. Table 5.7 shows that there are large differentials in current use among the 16 administrative re- gions in the country. The contraceptive prevalence rate ranges from 19 percent in ARMM to 59 percent in Davao. Current use of modern methods, however, shows a different pattern. The proportion of currently married women who use modern methods of contraception is 40 percent or more in Central Luzon, Da- vao, and Cagayan Valley, and only 12 percent in ARMM. Traditional methods are most popular in Bicol (24 percent) and least popular in Cagayan Valley (4 percent). Family Planning | 63 5.3.3 Current Use by Woman’s Status Woman’s status is considered to be one of the factors affecting the use of contraception. The power to decide on matters of sexuality and reproduction depends on the relationship between women and men, and the status given to women by society. Women with higher status are considered empowered and have more freedom in making decisions affecting their sexuality and reproduction than those with lower status. This section analyzes the relationships of current use of contraception and three woman’s status indicators: woman’s participation in making decisions regarding personal health, family, and household matters; woman’s power to refuse marital sex; and a woman’s attitudes toward violence against women. In the 2003 NDHS, these indicators are constructed as follows: Respondent’s participation in household decisionmaking. Respondents were asked who in the family usually has the final say on five areas: the woman’s own health care, large household purchases, daily household purchases, visits to family or relatives, and what food is to be cooked each day. These decisions can be made by the respondent alone, by her husband/partner, jointly by the respondent and her husband/partner, jointly by the respondent and someone else, or by someone else. The response category is coded as “1” if the respondent herself participates in these decisions and “0” if she is not involved in the decisionmaking. Thus, a woman gets a score of “5” if she participates in all five areas of decisionmak- ing and score of “0” if she has no say in any of these matters. Respondent’s attitudes about refusing marital sex. Respondents were asked if a wife is justified in refusing sex with her husband when she knows that her husband has a sexually transmitted disease, she knows her husband has sex with other women, she has recently given birth, or she is tired or not in the mood. The response is coded “1” if she agrees and “0” if she disagrees. A woman receives a score of “4” if she says that a wife is justified in refusing to have sex with her husband in all of the above-mentioned four conditions and a score of “0” if she feels that a wife is not justified in refusing to have sex with her husband in any of those conditions. Table 5.7 Current use of contraception by regions Percent distribution of currently married women by contraceptive method currently used, according to regions, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––––– Calendar/ Female Mucus/ Any rhythm/ Any steri- Male In- Male Billings/ tradi- periodic Not Number Any modern liza- sterili- ject- con- ovu- tional absti- With- currently of Region method method tion zation Pill IUD ables dom lation LAM method nence drawal Other using Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– National Capital Region 48.9 32.1 13.2 0.2 10.4 3.3 2.3 2.2 0.0 0.3 16.8 5.9 10.8 0.1 51.1 100.0 1,337 Cordillera Admin Region 46.3 31.8 10.8 0.0 10.9 0.7 7.3 1.8 0.0 0.0 14.5 2.8 11.7 0.0 53.7 100.0 134 I - Ilocos 50.6 35.0 12.0 0.0 13.3 1.2 6.7 1.7 0.0 0.0 15.7 3.8 11.8 0.0 49.4 100.0 420 II - Cagayan Valley 52.4 48.0 7.2 0.0 26.7 7.1 6.2 0.7 0.0 0.0 4.4 2.7 1.7 0.0 47.6 100.0 325 III - Central Luzon 54.5 40.2 18.3 0.0 15.4 0.7 3.4 1.9 0.1 0.4 14.3 3.5 10.5 0.3 45.5 100.0 960 IVA - CALABARZON 48.4 32.8 11.4 0.0 11.3 3.8 3.2 2.1 0.1 0.7 15.6 4.8 10.7 0.1 51.6 100.0 1,139 IVB - MIMAROPA 42.5 31.0 8.7 0.3 13.7 3.0 4.0 0.8 0.3 0.3 11.5 5.3 6.0 0.3 57.5 100.0 257 V - Bicol 47.4 23.6 5.5 0.0 13.1 2.1 2.0 0.9 0.0 0.0 23.8 7.8 15.1 0.9 52.6 100.0 457 VI - Western Visayas 46.1 30.1 6.8 0.4 14.6 3.6 2.6 1.6 0.0 0.4 16.1 10.2 5.2 0.6 53.9 100.0 578 VII - Central Visayas 52.1 35.6 11.2 0.3 11.5 6.2 2.1 3.7 0.0 0.5 16.5 9.6 6.7 0.2 47.9 100.0 671 VIII - Eastern Visayas 44.4 26.8 9.9 0.0 9.7 2.9 2.9 1.2 0.0 0.2 17.6 8.2 8.0 1.4 55.6 100.0 355 IX – Zamboanga Peninsula 43.1 32.3 5.7 0.0 16.9 6.1 2.1 0.7 0.2 0.0 10.8 8.1 2.5 0.2 56.9 100.0 339 X - Northern Mindanao 55.2 34.6 6.4 0.0 14.7 8.9 1.8 2.0 0.5 0.0 20.6 13.4 5.2 2.0 44.8 100.0 364 XI - Davao 59.3 41.6 10.4 0.4 15.4 8.4 2.4 3.8 0.4 0.4 17.7 9.9 6.5 1.3 40.7 100.0 426 XII - SOCCSKSARGEN 50.7 37.8 8.9 0.3 14.7 8.4 3.9 1.3 0.0 0.2 13.0 8.2 3.9 0.8 49.3 100.0 364 XIII - Caraga 54.6 34.0 7.0 0.3 14.8 7.7 1.4 2.7 0.0 0.0 20.6 13.2 4.7 2.7 45.4 100.0 217 ARMM 18.7 11.6 2.2 0.0 4.9 1.3 2.9 0.2 0.0 0.0 7.2 2.2 2.4 2.6 81.3 100.0 328 Total 48.9 33.4 10.5 0.1 13.2 4.1 3.1 1.9 0.1 0.3 15.5 6.7 8.2 0.6 51.1 100.0 8,671 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– LAM = Lactational amenorrhea method 64 | Family Planning Respondent’s attitudes toward violence against women. Respondents were asked if a husband is justified in hitting or beating his wife if she goes out without telling him, neglects the children, argues with him, refuses to have sex with him, or burns the food. The response is coded “1” if she agrees and “0” if she disagrees. A woman receives a score of “5” if she feels that a husband is justified in hitting or beat- ing his wife in all of the conditions and a score of “0” if she says that a husband is not justified to beat his wife under any condition. Table 5.8 shows the percent distribution of currently married women by contraceptive method currently used, according to three indicators of women’s status. Use of any method and use of any mod- ern method increases with increasing number of decisions in which a woman has a final say. For example, 24 percent of women who have no say in any of the five specified decisions are using a modern method, compared with 34 percent of women who themselves or jointly have a final say in all five decisions. Use of any method also increases with the number of reasons to justify refusing sex with husbands; however, there are no significant differences in modern contraceptive use by the other two women’s status indica- tors. 5.4 NUMBER OF CHILDREN AT FIRST USE OF FAMILY PLANNING Couples may use family planning either for spacing births or limiting family size. Table 5.9 shows the percent distribution of women who have ever used contraception by the number of living chil- dren at the time of first use and by their current age. The table is used primarily to identify the acceptance of the small family norm and the use of family planning as a method for spacing births. Some women adopted family planning early in the family building process; 6 percent of women began using contracep- tion before they had their first child, and 4 in 10 women began using contraception after having had one child. Table 5.8 Current use of contraception by women’s status Percent distribution of currently married women by contraceptive method currently used, according to selected indicators of women’s status, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Modern method Traditional method ––––––––––––––––––––––––––––––––––––––––––––––––––––– –––––––––––––––––––––––– Calendar/ Female Male Mucus/ Any rhythm/ Women’s Any steri- steri- In- Male Billings/ tradi- periodic Not Number status Any modern liza- liza- ject- con- ovula- tional absti- With- currently of indicators method method tion tion Pill IUD ables dom tion LAM method nence drawal Other using Total women –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of decisions in which woman has final say1 0 40.5 24.2 5.0 0.0 9.6 2.7 3.3 3.5 0.0 0.0 16.3 7.5 6.8 2.0 59.5 100.0 92 1-2 44.5 30.7 8.4 0.1 12.6 4.5 2.0 1.7 0.1 0.9 13.8 4.3 9.2 0.2 55.5 100.0 699 3-4 49.9 33.1 9.4 0.1 13.6 4.4 3.0 1.9 0.2 0.5 16.8 6.9 9.2 0.6 50.1 100.0 2,115 5 49.2 33.9 11.2 0.1 13.1 3.9 3.2 1.9 0.1 0.2 15.3 6.9 7.7 0.6 50.8 100.0 5,766 Number of reasons to refuse sex with husband 0 41.5 31.3 9.4 0.0 12.1 2.7 3.7 2.5 0.0 0.4 10.2 3.7 6.2 0.3 58.5 100.0 225 1-2 42.9 29.2 7.6 0.0 13.1 4.1 3.0 1.1 0.3 0.0 13.7 5.6 6.9 1.2 57.1 100.0 297 3-4 49.3 33.6 10.6 0.1 13.2 4.1 3.1 1.9 0.1 0.3 15.7 6.8 8.3 0.6 50.7 100.0 8,149 Number of reasons wife beating is justified 0 48.7 33.4 10.9 0.2 13.0 3.9 2.9 2.0 0.1 0.3 15.3 6.8 8.0 0.4 51.3 100.0 6,463 1-2 49.4 33.2 9.3 0.1 13.6 4.7 3.7 1.5 0.1 0.1 16.3 6.4 8.9 1.0 50.6 100.0 1,804 3-4 48.9 33.1 8.3 0.3 13.5 5.3 2.8 2.0 0.4 0.4 15.8 5.3 9.2 1.3 51.1 100.0 316 5 46.7 32.1 8.0 0.0 16.6 2.0 2.5 2.0 1.1 0.0 14.6 9.3 4.2 1.0 53.3 100.0 88 Total 48.9 33.4 10.5 0.1 13.2 4.1 3.1 1.9 0.1 0.3 15.5 6.7 8.2 0.6 51.1 100.0 8,671 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: If more than one method is used, only the most effective method is considered in this tabulation. LAM = Lactational amenorrhea method 1 Either by herself or jointly with others Family Planning | 65 Table 5.9 Number of children at first use of contraception Percent distribution of women who have ever used contraception by number of living chil- dren at the time of first use of contraception, according to current age, Philippines 2003 Number of living children at time of first use of contraception Current age 0 1 2 3 4+ Missing Total Number of women 15-19 43.4 51.6 2.8 0.0 0.0 2.2 100.0 105 20-24 15.1 63.3 17.8 3.4 0.0 0.4 100.0 701 25-29 8.7 51.1 25.8 10.1 4.0 0.2 100.0 1,151 30-34 4.8 38.5 27.9 15.5 13.0 0.3 100.0 1,299 35-39 4.2 31.2 23.1 17.9 23.4 0.3 100.0 1,306 40-44 2.3 28.4 21.5 20.0 27.6 0.3 100.0 1,039 45-49 2.1 25.2 23.9 21.0 27.5 0.3 100.0 852 Total 6.4 38.8 23.5 14.9 16.2 0.3 100.0 6,453 The timing of first contraceptive use varies by woman’s age. Younger women who ever used con- traception tend to start using family planning when they have fewer children. While 2 percent of women age 40-49 used contraception when they did not have any children, the corresponding proportions for women age 15 19 and 20-24 are 43 and 15 percent, respectively. Twenty-eight percent of women age 40- 49 started using contraception after having had four or more children. 5.5 KNOWLEDGE OF THE FERTILE PERIOD For the successful practice of coitus-related methods, such as withdrawal, condom, and vaginal methods, knowledge of reproductive physiology is essential. Such knowledge is particularly critical in the practice of periodic abstinence such as the calendar/rhythm method and natural family planning methods such as mucus/Billings/ovulation, basal body temperature, and symptothermal method. In the 2003 NDHS, all women age 15-49 and men age 15-54 were asked during which days of a woman’s menstrual cycle a woman has the greatest chance of becoming pregnant. Data in Table 5.10 show that only 27 percent of women correctly identify the fertile period to be halfway between two menstrual periods. Forty-one percent of women incorrectly identified the fertile period to be right after a woman’s period has ended. Furthermore, 15 percent of women have no knowledge of the fertile period. Users of periodic abstinence are more likely to correctly identify the fertile period (43 percent) than nonusers (26 per- cent). The table also shows that 19 per- cent of men correctly identify the fertile period. However, men are as likely as women to report incorrectly the fertile period as right after a woman’s period has ended. Table 5.10 Knowledge of fertile period Percent distribution of women and men by knowledge of the fertile period during the ovulatory cycle, according to current use/nonuse of periodic absti- nence, Philippines 2003 Women Perceived fertile period Users of periodic abstinence Nonusers of periodic abstinence All Men Just before her period begins 4.7 6.3 6.2 7.1 During her period 0.1 0.8 0.8 1.2 Right after her period has ended 40.5 40.9 40.9 40.0 Halfway between two periods 43.3 25.9 26.7 19.3 Other 0.8 0.3 0.3 0.2 No specific time 7.6 10.7 10.5 12.5 Don't know 3.0 15.0 14.5 19.7 Missing 0.0 0.2 0.2 0.0 Total 100.0 100.0 100.0 100.0 Number 587 13,046 13,633 4,766 66 | Family Planning The findings indicate that knowledge of the fertile period, even among women and men who are using periodic abstinence as a family planning method, is limited. This highlights the need to further edu- cate women and men on the physiology of reproduction, particularly regarding the time when ovulation is likely to occur. This knowledge is crucial should they decide to use ovulation-based methods. 5.6 TIMING OF STERILIZATION In the Philippines, given the fact that female sterilization is the second most widely used modern method by currently married women, data on the timing of the sterilization operation is important for pro- gram managers to improve their information, dissemination and services provision plans. Of particular interest is the age of the woman at the time of operation. Table 5.11 presents the percent distribution of sterilized women by age at the time of sterilization, according to the number of years since the operation. The vast majority (68 percent) of women are steril- ized at age 25-34, and 13 percent are sterilized before age 25. The median age at the time of sterilization is 30.1 years, which suggests no change since 1998 (29.6 years) (NSO, DOH and Macro, 1999). Table 5.11 Timing of sterilization Percent distribution of sterilized women by age at the time of sterilization, and median age at sterilization, according to the number of years since the operation, Philippines 2003 Age at time of sterilization Years since operation <25 25-29 30-34 35-39 40-44 45-49 Total Number of women Median age1 <2 1.2 26.5 34.8 28.3 9.2 0.0 100.0 119 32.8 2-3 6.9 14.7 38.4 24.6 13.4 1.9 100.0 111 32.7 4-5 2.6 31.5 38.9 19.4 7.6 0.0 100.0 92 31.3 6-7 17.1 16.3 39.7 18.8 8.2 0.0 100.0 87 31.2 8-9 13.7 29.8 31.4 22.3 2.7 0.0 100.0 68 31.2 10+ 19.1 44.1 31.9 4.9 0.0 0.0 100.0 471 a Total 13.3 33.6 34.4 14.1 4.4 0.2 100.0 947 30.1 a = Not calculated due to censoring 1 Median ages are calculated only for women sterilized at less than 40 years of age to avoid problems of censoring. 5.7 SOURCE OF SUPPLY OF MODERN CONTRACEPTIVE METHODS Information on source of currently used modern methods is useful to guide program policy and implementation, particularly in the area of contraceptive self-reliance. Table 5.12 shows that more than two-thirds of current users of modern methods obtain their contraceptive supplies and services from the public sector (67 percent), 29 percent from the private medical sector, and 3 percent from other sources. The source of method varies according to the method itself. Nearly three in four women who are sterilized had their operation in a government hospital. Barangay health stations and pharmacies are equally likely to supply contraceptive pills (34 and 35 percent, respectively). The majority (80 percent) of IUD users have their IUD inserted in a public facility. Half of these women went to a rural/urban health center for their service. Nine in 10 users of injectables obtained their most recent injection from a public facility, 43 percent from a rural/urban health center, and 46 percent from a barangay health station. Family Planning | 67 Table 5.12 Source of contraception Percent distribution of current users of modern contraceptive methods by most recent source of method, according to specific method, Philippines 2003 Source Female sterili- zation Pill IUD Inject- ables Male condom Total Public sector 75.8 56.6 80.1 92.5 27.0 67.2 Government hospital 68.3 1.0 10.8 3.4 1.8 24.5 Rural/urban health center 7.0 19.8 40.2 42.5 10.6 19.7 Barangay supply/service point officer 0.0 2.0 1.1 0.9 0.0 1.0 Barangay health station 0.0 33.7 27.9 45.8 14.6 21.7 Other public 0.5 0.0 0.0 0.0 0.0 0.2 Private medical sector 23.2 38.6 18.0 7.5 59.6 29.3 Private hospital/clinic 22.1 1.4 14.8 5.2 0.8 10.2 Pharmacy 0.0 35.0 0.0 1.2 57.7 17.2 Private doctor 1.1 1.3 2.9 0.0 0.0 1.2 Private nurse/midwife 0.0 0.6 0.2 1.1 1.0 0.4 Industry-based clinic 0.0 0.3 0.0 0.0 0.0 0.1 Other source 0.0 4.5 2.0 0.0 11.5 2.7 Store 0.0 2.7 0.0 0.0 7.6 1.5 Puericulture center 0.0 1.8 0.2 0.0 3.9 1.0 Church 0.0 0.0 1.7 0.0 0.0 0.2 Other 1.0 0.2 0.0 0.0 0.6 0.5 Missing 0.1 0.1 0.0 0.0 1.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 947 1,148 359 268 169 2,920 Note: Total includes 12 users of male sterilization, one implant user, and two users of emergency con- traception. Table excludes lactational amenorrhea method (LAM). While the public sector is the main service point for female sterilization, the pill, IUD, and in- jectables, pharmacies are the most important source for condoms (58 percent). Users of condoms who obtain their method from the public sector received the condoms from a barangay health station (15 per- cent) or a rural/urban health center (11 percent). In the five years since 1998, there has been a decrease in the use of the public sector for family planning services (72 percent in 1998 to 67 percent in 2003) and an increase in the use of the private sec- tor (26 percent in 1998 to 29 percent in 2003) (NSO, DOH and Macro, 1999). 5.8 INFORMED CHOICE One of the means to increase the levels of contraceptive acceptance and continued use is the pro- vision of informed choice. This is achieved when service providers inform potential users of other meth- ods that could be used. Family planning providers should also inform all method users of potential side effects of each method and what they should do if they encounter signs of a problem. This information assists users in coping with side effects and decreases discontinuation of temporary methods. Users of temporary methods should also be informed of the choices they have with respect to other methods. 68 | Family Planning In the 2003 NDHS, current users of modern methods who adopted the method in the five years preceding the survey were asked whether or not they were informed by a family planning service provider with details about their current method, including its potential side effects, as a basis for exercising free choice. Data in Tables 5.13, 5.14, and 5.15 show the results. Table 5.13 presents the percentage of users of modern contraceptives who were informed that there are potential side effects of their current method and what to do if they experience any of the side effects, by specific method and initial source of method. The data show that 38 percent of current users were informed about possible side effects or problems of the method they are using, and 35 percent of the current users were informed what to do if they experienced side effects. Thirty-nine percent of current users were informed of other methods that could be used. These percentages vary by method. Users of injectables are the most well-informed: 60 percent were informed of the potential side effects of the injec- tion, 57 percent were told what to do if they experience any of the side effects, and 62 percent were given information about other methods. The corresponding percentages for users of the pill and IUD are be- tween 42 and 51 percent. In contrast, only 17 percent of women who were sterilized were informed about possible side effects or problems of the operation, 15 percent were informed what to do if they experi- enced side effects, and 15 percent were informed of other methods available. Table 5.13 Informed choice by method/source Among current users of modern contraceptive methods who adopted the cur- rent method in the five years preceding the survey, percentage who were in- formed about the side effects of the method used, percentage who were in- formed what to do if side effects were experienced, and percentage who were informed of other methods that could be used for contraception, by specific method and initial source of method, Philippines 2003 Method/ Initial source Informed about side effects or problems of method used1 Informed what to do if experienced side effects1 Informed of other methods that could be used2 Method Female sterilization 17.2 14.6 14.6 Pill 48.1 44.7 50.6 IUD 43.6 42.1 45.0 Injectables 60.4 56.9 61.5 Initial source of method3 Public sector 60.6 55.0 61.1 Government hospital 53.6 46.9 48.3 Rural/urban health center 62.2 58.2 62.8 Barangay health station 61.7 55.7 66.4 Private medical sector 56.3 53.9 56.2 Private hospital/clinic 63.9 58.5 62.2 Pharmacy 51.3 50.2 53.3 Other source 32.0 27.2 49.5 Total 37.9 35.1 38.7 1 Among users of female sterilization, pill, IUD, injectables, and implants 2 Among users of female sterilization, pill, IUD, injectables, implants, dia- phragm, and lactational amenorrhea method (LAM) 3 Source at start of current episode of use. Sources with small numbers of users have been omitted. Family Planning | 69 Current users who obtained their method from the public sector were better informed than those who obtained the method from a private sector about side effects or problems associated with the method used (61 compared with 56 percent). Women who obtained their method from the public sector were as likely to be informed as those who obtained the method from a private sector about what to do if they ex- perienced any side effects (55 and 54 percent, respectively). Health workers in a public facility are more likely than those in a private facility to inform their clients about other methods they could use (61 and 56 percent, respectively). All providers of sterilization must inform potential users that they will not be able to have any (more) children because of sterilization. Nine out of ten sterilization acceptors were in- formed that the method was permanent (Table 5.14). Current users of sterilization who obtained the method from private hos- pitals were more likely to be told that the method was permanent (95 percent) than those who obtained the method from public hospitals (88 percent). Table 5.15 presents the percentage of users of modern contraceptives who were informed that there are potential side effects of their current method and what to do if they experience any of the side effects, by background characteristics. Data show that current users in rural areas were better informed than those in urban areas about side effects of the method, what to do if side effects were experienced, and other methods to choose from. Contraceptive users in ARMM, Caraga, and Eastern Visayas are better informed about their method and other choices than in other regions of the country. Users in Ilocos are the least likely to have this information. The National Capital Region (NCR) also shows low levels of information about side effects, what to do about side effects, and about other meth- ods. Data in Table 5.15 show that for all of the indicators, quality of care is negatively associated with the wealth status; current users in the poorest quintile have better services than users in the wealthier quintiles. There is no clear pattern in the relationship between a woman’s education and the quality of care for family planning services. Table 5.14 Informed choice by source Percentage of women who were sterilized in the five years preceding the survey who were informed that they would not be able to have any more children, by initial source of method, Philippines 2003 Initial source of method Informed that sterili- zation is permanent Public sector 87.5 Government hospital 88.6 Rural/urban health center 74.6 Private medical sector 95.1 Private hospital/clinic 94.9 Total 91.9 70 | Family Planning Table 5.15 Informed choice by background characteristics Among current users of modern contraceptive methods who adopted the current method in the five years preceding the survey, percentage who were informed about the side effects of the method used, percentage who were informed what to do if side effects were experienced, percentage who were informed of other methods that could be used for contraception, by background characteristics, Philippines 2003 Background characteristic Informed about side effects or problems of method used1 Informed what to do if experienced side effects1 Informed of other methods that could be used2 Residence Urban 35.9 33.0 36.6 Rural 40.4 37.6 41.2 Region National Capital Region 35.7 33.5 38.8 Cordillera Admin Region 41.6 41.6 40.4 I - Ilocos 31.6 27.9 28.0 II - Cagayan Valley 39.9 37.3 40.2 III - Central Luzon 34.6 28.1 31.7 IVA - CALABARZON 37.2 34.5 31.1 IVB - MIMAROPA 41.3 40.3 46.1 V - Bicol 38.4 41.3 42.7 VI - Western Visayas 36.0 40.1 37.1 VII - Central Visayas 33.0 24.5 35.1 VIII - Eastern Visayas 51.4 47.6 50.8 IX - Zamboanga Peninsula 37.1 37.4 41.2 X - Northern Mindanao 40.6 36.7 50.9 XI - Davao 38.5 35.0 42.4 XII - SOCCSKSARGEN 41.8 41.8 50.4 XIII - Caraga 51.5 45.5 49.7 ARMM 62.7 64.6 58.7 Education No education 36.3 40.9 24.9 Elementary 33.4 28.8 32.8 High school 39.4 37.5 41.2 College or higher 40.1 37.3 40.7 Wealth index quintile Lowest 50.9 48.8 52.7 Second 39.6 35.4 39.5 Middle 39.2 37.9 41.1 Fourth 32.4 28.8 32.8 Highest 32.2 29.6 32.2 Total 37.9 35.1 38.7 1 Among users of female sterilization, pill, IUD, injectables, and implants 2 Among users of female sterilization, pill, IUD, injectables, implants, diaphragm, and lactational amenorrhea method (LAM) 5.9 CONTRACEPTIVE DISCONTINUATION RATES For a contraceptive method to prevent pregnancy, it must be used continuously. One measure of the quality of use is the rate at which users discontinue using a method of contraception. Reasons for dis- continuation may include contraceptive failure, dissatisfaction with the method, side effects, and lack of availability. High rates of discontinuation, method failure, and method switching may indicate that im- provements are needed in counseling in the selection of methods, followup care, and accessibility of ser- vices. Family Planning | 71 Life-table contraceptive discontinuation rates derived from the survey are presented in Table 5.16. These are cumulative first-year discontinuation rates and represent the proportion of users discon- tinuing a method within 12 months after the start of use. The rates are calculated by dividing the number of discontinuations for each reason at each duration of use in single months by the number of months of exposure at that duration. The single-month rates are then totaled to produce a one-year rate. The reasons for discontinuation are treated as competing risks (net rates). Three reasons for discontinuation are tabu- lated: method failure (became pregnant while using contraception), desire to become pregnant, and side effects or health concerns. (For a technical discussion on the methodology of calculating this measure, see Macro International, 1992). Table 5.16 First-year contraceptive discontinuation rate Percentage of contraceptive users who discontinued use of a method within 12 months after beginning its use, by reason for discontinuation and specific method, Philippines 2003 Reason for discontinuation Method Method failure Desire to become pregnant Switched to another method1 Other reason Total Pill 3.7 3.5 11.9 20.1 39.2 IUD 0.6 0.4 5.9 7.1 14.0 Injectables 1.3 4.3 27.7 19.5 52.7 Male condom 7.9 4.0 26.1 20.0 58.0 Calendar/rhythm/periodic abstinence 12.5 4.4 7.8 7.0 31.8 Withdrawal 17.2 5.6 11.2 9.8 43.8 All methods 7.8 4.0 13.3 14.0 39.1 Note: Table is based on episodes of contraceptive use that began 3-59 months prior to the survey. 1 Used a different method in the month following discontinuation or said they wanted a more effective method and started another method within two months of discontinuation Table 5.16 shows that for all methods (including those not shown separately in the table), 39 per- cent of users discontinue during the first year of use. Eight percent do so because they become pregnant while using the method, 4 percent because they wanted to become pregnant, 13 percent due to switching to another method, and 14 percent due to other reasons. The discontinuation rate is highest for condoms (58 percent) and injectables (53 percent); however, nearly half of the discontinuers of these methods switched to another method. Four in ten pill users discontinued during the first year of using; 12 percent switched to another method. The discontinuation rate for the IUD is 14 percent; 6 percent of the women switched to another method, 7 percent give other reasons, and another 1 percent report either method fail- ure or a desire to become pregnant. Although withdrawal and calendar/rhythm/periodic abstinence do not have the highest rates of discontinuation, these methods have the highest failure rates (17 and 13 percent, respectively). Discon- tinuation due to a desire to become pregnant is slightly higher for withdrawal (6 percent) than for other methods (4 percent each). Comparison with data from the 1998 NDHS shows that first-year discontinuation rates due to method failure have declined from 12 to 8 percent in 2003. Similarly, the rates by method remain at the 72 | Family Planning same levels, except for the pill, which declined from 44 to 40 percent, and the calendar/rhythm/periodic abstinence method which declined from 36 to 32 percent (NSO, DOH and Macro, 1999). Reasons for discontinuation may include contraceptive failure, dissatisfaction with the method, side effects, and lack of availability. High rates of discontinuation, method failure, and method switching may indicate that improvements are needed in counseling in the selection of methods, followup care, and accessibility of services. Table 5.17 presents reasons for discontinuation among ever-users who have dis- continued use of a method during the five years preceding the survey. Considering all methods, accidental pregnancy was by far the most important reason for discontinuing use of a family planning method (24 percent), followed by side effects (17 percent) and the desire to become pregnant (16 percent). Table 5.17 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the five years preceding the survey by main reason for discontinuation, according to specific method, Philippines 2003 Reason Pill IUD Injectables Condom LAM Periodic abstinence Withdrawal Other All methods Became pregnant while using 11.7 4.5 3.3 18.1 16.7 42.7 45.0 44.8 23.5 Wanted to become pregnant 17.5 14.2 11.3 11.5 6.8 19.9 14.1 14.8 15.5 Husband disapproved 1.7 3.2 1.9 5.5 1.2 4.1 2.9 6.1 2.7 Side effects 26.3 32.4 32.0 9.2 3.0 0.8 3.9 0.0 16.6 Health concerns 12.8 16.8 21.8 5.7 1.2 2.9 2.0 4.2 9.4 Access/availability 3.7 0.0 7.9 2.8 2.4 0.0 0.3 1.7 2.6 Wanted a more effective method 3.7 6.6 4.2 9.0 28.3 10.4 9.3 5.4 7.0 Inconvenient to use 2.6 5.6 2.7 23.3 0.0 2.8 3.7 9.6 4.4 Infrequent sex/husband away 10.0 2.6 2.5 4.4 2.2 3.7 2.9 0.0 5.6 Cost too much 1.1 0.0 2.2 1.7 0.0 0.0 0.0 0.0 0.8 Fatalistic 0.3 1.5 0.5 0.5 0.0 0.0 0.3 0.0 0.4 Difficult to get pregnant/menopausal 0.6 2.2 0.3 0.4 0.9 1.3 0.7 0.0 0.7 Marital dissolution/separation 0.7 0.9 0.1 1.0 0.0 0.0 0.4 0.0 0.5 Other 3.2 8.0 2.8 3.6 13.8 1.9 1.5 5.3 3.0 Don't know 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.0 0.0 Missing 3.9 1.5 6.5 3.2 23.4 9.7 12.8 8.2 7.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 1,494 181 525 273 73 586 979 54 4,168 Note: Total includes 2 users of foam/jelly. LAM = Lactational amenorrhea method Programmatic factors such as access/availability and cost of the method are only cited by 3 per- cent and less than 1 percent, respectively. This reason for discontinuation varies by method. Eight percent of past users of injectables reported that the method was inaccessible or unavailable. Other reasons for discontinuation also vary by method. The most cited reason for stopping use of modern contraception was method side effects (26 percent of pill users and 32 percent each of IUD and injectables users). Twenty percent of condom users stopped using it because it was inconvenient to use, and 28 percent of LAM users cited the desire for a more effective method. The reason mentioned most often for discontinuing the use of traditional methods was failure of the method (43 percent of users of periodic abstinence and 45 percent of users of withdrawal). The reasons for discontinuing contraceptive methods have changed little since 1998; however, discontinuation due to becoming pregnant while using the method (method failure) declined from 31 per- cent in 1998 to 24 percent in 2003 (NSO, DOH and Macro, 1999). Family Planning | 73 5.10 INTENTIONS FOR FAMILY PLANNING USE AMONG NONUSERS Intention to use contraception in the future provides a forecast of potential demand for family planning services and represents a summary indicator of attitudes toward contraception among current nonusers. In the Philippines, where the contraceptive prevalence rate is high, nonusers are the group most targeted by family planning programs and providers. In the 2003 NDHS, respondents who were not using any method of contraception at the time of the interview were asked if they intended to use a method at any time in the future. Table 5.18 presents the distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children. According to the 2003 NDHS data, 40 percent of nonusers intend to use family planning in the future, and 55 percent of nonusers do not intend to use fam- ily planning in the future. The remaining women are unsure about their intentions (5 percent). Table 5.18 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Philippines 2003 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 32.9 45.3 45.7 44.9 33.1 39.8 Unsure 8.0 6.4 5.3 4.8 3.0 4.9 Does not intend to use 59.1 48.3 49.0 49.2 63.7 55.0 Missing 0.0 0.0 0.1 1.1 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 459 940 849 648 1,538 4,433 1 Includes current pregnancy The intention to use a family planning method in the future increases from 33 percent for nonus- ing married women with no living children to 45 percent for women with one to three living children, af- ter which the desire to use contraception declines. The percentage of nonusing married women who do not intend to use contraception is highest among the women with the most children. Forty-eight percent of married women with one living child say that they do not intend to use a family planning method in the future; the corresponding proportion for women with four or more living children is 64 percent. The intention to use a family planning method in the future is similar to that recorded in the 1998 NDHS (NSO, DOH and Macro, 1999). One of the important ways of assessing obstacles to family planning programs is to ask women why they are not using a contraceptive method; this was done in the 2003 NDHS. Table 5.19 presents the distribution of currently married nonusers who do not intend to use family planning by reason for not us- ing contraception, according to two major age groups. The reasons cited by nonusers for nonuse of con- traception in the future are primarily fertility related (43 percent) and method related (33 percent). Oppo- sition to the use of contraception is cited by 20 percent of nonusers. Fifteen percent of women cite the desire to have as many children as possible as a reason for non- use. Older women are more likely to cite fertility-related reasons for nonuse (47 percent), and younger women are more likely to cite method-related reasons (45 percent). Concerns about their health and the side effects of the method are each expressed by 14 percent of all women. Younger women are more 74 | Family Planning likely than older women to express these two particular concerns. This finding suggests that family planning counseling is needed to eliminate any concerns women may have about methods and the possible side effects. Comprehensive information on available methods in- cluding their advantages and disadvantages would en- able nonusers to make informed choices before decid- ing on a contraceptive method to use. The respondent’s opposition to the use of con- traception is more often cited (9 percent) than religious opposition (6 percent) or husband’s opposition (4 per- cent). Younger women are more likely than older women to cite opposition to the use of contraception (25 compared with 18 percent). The lack of knowledge about methods and where they can be obtained are cited as reasons for nonuse by less than 2 percent of women, with higher proportions of younger women than older women (3 compared with 1 percent) report- ing lack of knowledge. Table 5.20 presents data on currently married women who are not currently using family planning but intend to use in the future. Findings show that a signifi- cantly large proportion of women want to use the pill (48 percent), and 10 percent each say that they want to use female sterilization, injectables, or periodic absti- nence. Younger women are more likely to say that they prefer to use modern methods such as the pill (52 per- cent) and injectables (12 percent); older women also prefer the pill (43 percent), but indicate interest in peri- odic abstinence (14 percent) and female sterilization (13 percent) as well. Comparison of the results of this survey with those of the 1998 NDHS shows that gradually larger proportions of women intend to use the pill (40 percent in 1998 to 48 percent in 2003) and smaller pro- portions intend to use periodic abstinence (from 13 percent in 1998 to 10 percent in 2003) (NSO, DOH and Macro, 1999). Table 5.19 Reason for not intending to use contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not intenting to use, according to age, Philippines 2003 Age Reason 15-29 30-49 Total Fertility-related reasons 24.0 47.3 42.9 Not married 0.3 0.2 0.2 Infrequent sex/no sex 3.2 5.7 5.3 Menopausal/had hysterectomy 0.0 14.3 11.6 Subfecund/infecund 1.4 13.8 11.5 Wants as many children as possible 19.4 13.4 14.5 Opposition to use 25.4 18.4 19.7 Respondent opposed 7.4 9.2 8.8 Husband/partner opposed 5.2 3.3 3.7 Others opposed 0.3 0.0 0.1 Religious prohibition 11.7 4.9 6.2 Fatalistic 0.8 1.0 0.9 Lack of knowledge 2.6 1.1 1.4 Knows no method 1.9 0.9 1.1 Knows no source 0.7 0.2 0.3 Method-related reasons 44.7 29.7 32.5 Health concerns 17.0 13.6 14.3 Fear of side effects 21.8 12.5 14.2 Lack of access/too far 0.9 0.3 0.4 Costs too much 1.8 1.8 1.8 Inconvenient to use 1.8 1.0 1.1 Interfere with body’s normal processes 1.4 0.5 0.7 Other 1.6 2.5 2.3 Don’t know/missing 1.4 1.0 1.1 Total 100.0 100.0 100.0 Number 460 1,978 2,438 Family Planning | 75 Table 5.20 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to age, Philippines 2003 Age Method 15-29 30-49 Total Female sterilization 7.5 12.5 9.7 Male sterilization 0.0 0.1 0.0 Pill 51.9 43.4 48.1 IUD 8.2 8.0 8.1 Injectables 11.9 7.4 9.9 Implants 0.0 0.2 0.1 Condom 2.8 3.2 3.0 LAM 0.0 0.1 0.1 Periodic abstinence 7.4 14.1 10.4 Withdrawal 5.6 6.6 6.0 Other 0.5 0.4 0.5 Unsure 3.4 2.4 3.0 Missing 0.8 1.5 1.1 Total 100.0 100.0 100.0 Number of women 982 784 1,765 LAM = Lactational amenorrhea method 5.11 FAMILY PLANNING MESSAGES IN THE MASS MEDIA In an effort to investigate which sources of family planning information are reaching their in- tended audience, female respondents in the 2003 NDHS were asked a series of questions on their expo- sure to such information. Respondents were asked whether they heard or saw a message on family plan- ning on the radio or television, or if they read it in a newspaper/magazine, poster, or pamphlet in the six months preceding the survey. Respondents were also asked whether they had received any family plan- ning messages through personal contact. Fifty-nine percent of women age 15-49 were reached by family planning messages aired on radio, and 64 percent saw messages on television. Printed messages in newspapers/magazines and posters reached fewer women (40 percent each), and pamphlets reached only 30 percent of women. One in five women was never reached by any of the above-cited media sources of family planning messages. Women age 15-19 are somewhat less likely to receive family planning information through any media than women in older age groups. As expected, women who live in rural areas are less likely to be exposed to family planning information through all sources of media than urban women. Radio, television, and newspapers/magazines are the most likely channels of communicating fam- ily planning messages in more developed than in less developed regions of the country. Exposure to mass media channels can be attributed to the availability of electricity and transportation facilities. Eastern Visayas, Cagayan Valley, and CALABARZON showed the highest proportion of women who have heard family planning messages from the radio (66 to 75 percent), while ARMM showed the lowest radio expo- sure to radio broadcast (39 percent). Television is the source of family planning information for nearly 80 percent of women in Central Luzon, CALABARZON, and NCR, yet only 28 percent of women in ARMM cited the same source. 76 | Family Planning Table 5.21 Exposure to family planning messages Percentage of all women who heard or saw a family planning message on the radio or television, or in a newspa- per/magazine, poster, or pamphlet in the past few months, according to background characteristics, Philippines 2003 Printed media Background characteristic Radio Television Newspaper/ magazine Poster Pamphlet None of these media sources Number of women Age 15-19 51.0 61.3 34.7 31.2 21.9 24.8 2,648 20-24 56.7 65.7 41.2 40.3 29.5 18.9 2,209 25-29 61.5 66.9 42.6 43.5 34.1 17.9 2,034 30-34 61.2 65.1 40.8 43.5 33.0 18.2 1,954 35-39 62.5 64.9 41.6 41.8 31.4 18.3 1,873 40-44 62.5 64.3 40.2 42.9 30.8 19.8 1,564 45-49 62.1 63.3 39.2 40.4 29.1 22.3 1,351 Residence Urban 60.0 73.6 48.0 44.6 33.5 15.8 7,877 Rural 57.6 51.8 28.6 33.7 24.3 26.1 5,756 Region National Capital Region 61.7 79.9 53.2 47.4 31.2 11.6 2,387 Cordillera Admin Region 47.4 46.8 46.4 49.6 41.6 24.5 216 I - Ilocos 59.9 67.6 45.3 38.8 30.9 19.6 642 II - Cagayan Valley 71.2 52.5 34.9 29.6 27.7 13.1 426 III - Central Luzon 62.4 81.3 44.0 32.0 24.0 11.2 1,459 IVA - CALABARZON 65.6 78.0 51.1 45.8 38.0 14.8 1,890 IVB - MIMAROPA 64.6 53.4 34.5 36.9 30.4 19.9 340 V - Bicol 47.6 48.5 27.4 35.1 23.7 28.9 713 VI - Western Visayas 58.8 56.7 31.6 42.0 29.3 21.4 910 VII - Central Visayas 55.5 55.6 36.6 42.5 32.0 26.2 1,070 VIII - Eastern Visayas 74.7 69.0 43.5 55.0 42.2 11.1 555 IX - Zamboanga Peninsula 45.3 33.3 19.6 15.4 14.1 44.6 465 X - Northern Mindanao 55.1 55.4 32.8 36.3 26.2 28.2 565 XI - Davao 50.6 54.8 29.1 44.4 27.4 22.1 654 XII - SOCCSKSARGEN 55.7 53.6 29.5 35.3 24.5 29.9 524 XIII - Caraga 57.2 57.7 29.7 47.7 32.4 21.9 327 ARMM 38.8 28.2 12.4 15.7 14.6 50.1 489 Education No education 24.7 12.3 2.8 4.8 3.2 71.0 186 Elementary 52.3 46.2 19.9 25.0 15.1 32.3 3,146 High school 59.2 65.2 37.1 37.2 25.9 19.4 6,109 College or higher 65.2 79.3 60.4 56.9 47.0 9.9 4,192 Wealth index quintile Lowest 47.0 26.2 13.6 23.3 14.1 43.4 2,161 Second 60.6 54.2 28.1 32.9 22.8 23.2 2,412 Middle 62.5 72.9 41.0 40.0 29.6 15.1 2,682 Fourth 61.3 77.4 48.6 45.3 34.0 12.9 2,940 Highest 60.7 77.9 56.2 50.8 40.2 13.6 3,438 Total 59.0 64.4 39.8 40.0 29.6 20.2 13,633 Family Planning | 77 Printed media are most often cited by women in CAR and Eastern Visayas, while ARMM shows the lowest percentages. Women’s exposure to family planning information dissemination through posters and pamphlets is likely due to their contact with health clinics or health service providers. Exposure to family planning messages increases with education. Nine in ten women with college or higher education saw a family planning message either on the radio, television, or printed materials, yet this is true for only 29 percent of women with no formal education. Women from poor families have less access to family planning messages regardless of mass me- dia source. Fourteen percent of women in the wealthiest quintile say that they have had no exposure to family planning messages in the past few months; the corresponding proportion for women in the poorest quintile is 43 percent. 5.12 CONTACT COMMUNICATION BETWEEN NONUSERS AND FAMILY PLANNING/HEALTH SERVICE PROVIDERS Table 5.22 presents data on exposure to family planning messages through personal contacts. In the 2003 NDHS, women who were not using contraception were asked whether they were visited by a family planning worker who discussed family planning in the 12 months preceding the survey. Women were also asked whether they had visited a health facility in the past year and, if so, whether a staff person at that facility spoke to them about family planning. This information is useful in determining if nonusers of family planning are being reached by family planning programs and initiatives in the Philippines. Nonusers may be encouraged to use contraception if fieldworkers discuss family planning during their home visits. Likewise, nonusers who visit health facilities may be encouraged to use contraception if health service providers discuss family planning with them. Table 5.22 shows that only 12 percent of family planning nonusers were visited by a family plan- ning worker who discussed family planning, and a similar proportion visited a health facility and dis- cussed family planning with a staff person at that facility (14 percent). Seventeen percent of nonusers vis- ited a health facility but did not discuss family planning with any staff member. In all, 80 percent of non- users did not discuss family planning, either with a fieldworker or at a health facility. This indicates missed opportunities to talk to nonusers about contraception and may indicate that family planning has not been fully integrated into the health services delivery system for women. Adolescent women (age 15-19) are the least likely to discuss family planning, either when visited by a fieldworker or when at a health facility. Women age 25-34 are slightly more likely than women in other age groups to have had the opportunity of discussing family planning with a staff member when they visited a health facility. Moreover, women living in rural areas are somewhat more likely than urban women to be visited by a fieldworker who discussed family planning with them, or to have this discussion when they visited a health facility. Missed opportunity for discussion on family planning matters with a fieldworker or at a health fa- cility is 84 percent or higher in NCR, Ilocos, Central Luzon, CALABARZON, and ARMM. Women in the wealthiest quintile are less likely to visit a health facility and discuss family planning than women in the poorest quintile. Women with elementary education are more likely to visit a health facility and dis- cuss family planning than women with other levels of education. 78 | Family Planning Table 5.22 Contact of nonusers with family planning providers Percentage of women who are not using contraception who were visited by a fieldworker who discussed fam- ily planning, who visited a health facility and discussed family planning, and who visited a health facility but did not discuss family planning, in the 12 months preceding the survey, by background characteristics, Philippines 2003 Background characteristic Women who were visited by fieldworker who discussed family planning Women who visited a health facility and discussed family planning Women who visited a health facility and did not discuss family planning Women who did not discuss family planning with a field- worker or at a health facility Number of women Age 15-19 5.9 3.9 10.2 91.9 2,584 20-24 10.0 14.5 18.1 80.8 1,731 25-29 14.4 20.8 22.1 72.8 1,234 30-34 17.9 23.8 20.4 68.2 1,063 35-39 14.5 18.0 18.4 74.0 940 40-44 13.7 14.7 20.0 78.9 876 45-49 13.8 12.6 19.2 79.1 902 Residence Urban 8.7 11.2 16.9 84.1 5,496 Rural 15.6 17.2 17.3 75.0 3,834 Region National Capital Region 8.5 8.5 17.7 86.1 1,715 Cordillera Admin Region 14.2 14.3 15.7 77.4 149 I - Ilocos 9.8 10.2 15.5 85.3 428 II - Cagayan Valley 9.1 20.7 14.1 78.3 253 III - Central Luzon 7.4 9.7 18.5 86.3 929 IVA - CALABARZON 7.7 10.5 9.3 84.7 1,334 IVB - MIMAROPA 21.3 18.5 18.4 69.3 231 V - Bicol 8.9 14.4 22.1 81.4 493 VI - Western Visayas 14.8 18.2 18.2 72.7 640 VII - Central Visayas 12.9 19.7 12.6 75.6 716 VIII - Eastern Visayas 17.9 14.1 14.9 76.6 397 IX - Zamboanga Peninsula 15.2 16.0 16.4 77.1 318 X - Northern Mindanao 21.8 20.7 21.5 67.8 363 XI - Davao 15.0 18.4 25.7 74.3 397 XII - SOCCSKSARGEN 15.2 16.8 17.0 76.8 335 XIII - Caraga 17.5 27.1 25.1 65.3 205 ARMM 10.7 9.5 24.5 84.3 427 Education No education 9.3 9.2 18.7 84.3 158 Elementary 15.5 18.1 18.3 74.4 2,024 High school 11.2 12.7 14.5 81.3 4,240 College or higher 9.3 12.2 19.7 82.9 2,909 Wealth index quintile Lowest 17.5 18.9 19.1 72.4 1,528 Second 16.5 19.8 18.8 72.6 1,540 Middle 12.5 15.3 16.6 78.7 1,730 Fourth 9.8 11.1 15.4 82.9 1,969 Highest 5.6 7.6 16.3 88.9 2,564 Total 11.5 13.6 17.0 80.3 9,331 Determinants of Fertility | 79 DETERMINANTS OF FERTILITY 6 This chapter discusses the proximate determinants of fertility or the intermediate factors, other than contraception, that affect a woman’s risk of becoming pregnant. The 2003 National Demographic and Health Survey (NDHS) included information on the following factors: nuptiality and sexual inter- course; the onset of menstruation (age at menarche); postpartum amenorrhea and postpartum abstinence from sexual relations; breastfeeding; and menopause. Couples who are in legal and consensual unions are considered as married in this survey. Since most births in the Philippines are conceived within marriage, marriage marks the beginning of a woman’s exposure to the risk of childbearing; the younger the woman’s entry to marital union, the longer her expo- sure to the risk of becoming pregnant. A woman’s chance of becoming pregnant is higher if the woman does not use contraception. Moreover, earlier onset of menstruation, due to improvements in health and nutritional status, also increases the risk of pregnancy. Information on more direct measures of the beginning of exposure to pregnancy and the level of exposure, referred to as age of first sexual intercourse and frequency of intercourse, respectively, is also presented in this chapter. 6.1 CURRENT MARITAL STATUS Marriage is almost universal in the Philippines (Table 6.1). Overall, one in three women age 15-49 has never been married, 56 percent are currently married, 8 percent are living together, 3 percent are separated, and 2 percent are widowed. The proportion of women who never married decreases sharply from 91 percent among teenagers to 49 percent among women in their early twenties and to 21 percent among those in their late twenties. The proportion of women who remain single through their forties de- clines to 5 percent. In contrast, the proportion of women who are married or living with their partner is only 9 percent among women under 20 years old. This proportion increases to 50 percent for women age 20-24 and to 76 percent among women age 25-29. The highest proportion of women currently married or living with their partner is at age group 35-39 (87 percent). Lower proportions in older age groups are due to the increase in the proportions of women who are separated or widowed. Table 6.1 Current marital status Percent distribution of women by current marital status, according to age, Philippines 2003 Age Never married Married Living together Separated Widowed Total Number of women 15-19 90.6 3.9 5.1 0.3 0.0 100.0 2,648 20-24 48.7 36.9 12.7 1.8 0.0 100.0 2,209 25-29 20.8 66.4 9.7 2.8 0.2 100.0 2,034 30-34 10.8 77.1 8.0 3.2 0.8 100.0 1,954 35-39 6.9 80.0 7.2 3.7 2.1 100.0 1,873 40-44 5.5 79.0 6.8 4.9 3.8 100.0 1,564 45-49 4.5 78.7 6.6 4.0 6.0 100.0 1,351 Total 32.2 55.6 8.0 2.7 1.5 100.0 13,633 80 | Determinants of Fertility 6.2 AGE AT FIRST MARRIAGE Given that most births in the Philippines occur within marriage, the age at legal or consensual marriage marks the start of women’s exposure to childbearing. Table 6.2 shows the percentage of women who are married by specific exact age and the median age at first marriage, according to their age at the time of the survey. Overall, 91 percent of women age 15-19 have not married. The corresponding propor- tion for women age 30-34 is 11 percent, and for those age 45-49, it is 5 percent. Looking at the exact ages at which women marry, two in ten women age 25-49, marry by age 18, half of all women have married by age 22, and seven in ten are married by age 25. Data in the table imply that younger women tend to delay their entry into marital union, as re- flected by the increasing proportion of women married at exact age 15 to 25. While 14 percent of women age 20-24 are married by age 18, 18 to 19 percent of women age 30-49 are married by age 18. A very slight increase in age at first marriage in the past three decades can also be observed from the increasing median age at first marriage. Whereas the median age at first marriage for women age 45-49 is 21.9 years, the corresponding age for women age 25-29 is 22.2 years. Table 6.2 Age at first marriage Percentage of women who were first married by exact ages and median age at first marriage, according to current age, Philippines 2003 Percentage first married by exact age Current age 15 18 20 22 25 Percentage never married Number of women Median age at first marriage 15-19 1.2 na na na na 90.6 2,648 a 20-24 1.5 14.0 32.7 na na 48.7 2,209 a 25-29 2.7 13.4 31.9 48.4 69.1 20.8 2,034 22.2 30-34 3.4 19.0 33.7 48.1 67.4 10.8 1,954 22.3 35-39 3.2 18.0 34.5 49.8 68.2 6.9 1,873 22.0 40-44 3.4 19.0 37.3 53.0 71.6 5.5 1,564 21.6 45-49 3.2 18.4 35.3 51.0 70.7 4.5 1,351 21.9 20-49 2.8 16.7 34.0 48.9 65.6 18.1 10,985 a 25-49 3.2 17.4 34.3 49.8 69.2 10.4 8,777 22.0 na = Not applicable a = Omitted because less than 50 percent of the women married for the first time before reach- ing the beginning of the age group 6.2.1 Median Age at First Marriage Table 6.3 shows the differentials in age at first marriage by women’s background characteristics. In general, urban, better-educated, and wealthier women marry later than other women. For example, ur- ban women marry two years later than rural women (22.9 and 20.9 years, respectively). The positive as- sociation between education and age at first marriage is obvious: Women who completed high school marry three years later than women with no education (21.2 and 18.2 years, respectively). The differen- tials are even greater by wealth status. On average, women in the wealthiest households marry at age 24.6 years, while women in the poorest households marry when they are 19.7 years old. Determinants of Fertility | 81 Table 6.3 Median age at first marriage Median age at first marriage among women age 25-49, by current age and background characteristics, Philippines 2003 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 23.0 23.5 22.9 22.4 22.6 22.9 Rural 21.1 20.7 21.1 20.7 20.7 20.9 Region National Capital Region 23.3 24.7 24.3 23.3 22.8 23.8 Cordillera Admin Region 21.6 22.1 22.2 20.6 21.2 21.5 I - Ilocos 22.6 20.7 22.3 22.6 22.4 22.1 II - Cagayan Valley 20.9 20.8 21.6 21.0 20.6 20.9 III - Central Luzon 21.6 22.5 22.4 21.7 22.1 22.1 IVA - CALABARZON 23.4 23.0 22.5 21.6 22.7 22.7 IVB - MIMAROPA 21.2 21.6 19.9 21.1 20.2 21.0 V - Bicol 22.7 20.8 21.0 21.4 21.4 21.4 VI - Western Visayas 21.9 22.1 21.7 20.5 22.2 21.8 VII - Central Visayas 22.8 22.0 21.5 22.1 21.2 21.9 VIII - Eastern Visayas 21.7 21.0 20.4 19.8 20.6 20.8 IX - Zamboanga Peninsula 21.0 20.4 21.7 20.3 22.1 20.9 X - Northern Mindanao 22.5 22.1 22.0 22.2 21.2 22.0 XI - Davao 21.7 21.9 21.7 20.5 21.2 21.4 XII - SOCCSKSARGEN 21.0 20.4 22.0 20.4 20.3 21.0 XIII - Caraga 21.2 21.3 21.0 21.8 20.0 21.1 ARMM 20.1 19.4 19.9 19.1 20.5 19.9 Education No education 18.9 18.1 17.1 18.5 18.2 18.2 Elementary 19.3 19.2 19.8 19.7 20.0 19.6 High school 21.0 21.6 21.2 20.8 21.5 21.2 College or higher 24.9 25.2 25.5 25.2 25.3 a Wealth index quintile Lowest 19.5 19.5 20.0 19.6 20.4 19.7 Second 20.6 20.5 20.7 20.5 20.8 20.6 Middle 22.0 22.0 21.1 21.2 20.8 21.5 Fourth 23.6 23.5 22.8 21.8 21.9 22.8 Highest a 24.8 25.0 24.2 23.8 24.6 Total 22.2 22.3 22.0 21.6 21.9 22.0 a = Omitted because less than 50 percent of the women married for the first time before reaching age 25 There are regional variations in median age at first marriage, ranging from a low (19.9 years) in Autonomous Region in Muslim Mindanao (ARMM) to a high (23.8 years) in National Capital Region (NCR). The median age at first marriage is below the national average in all regions except in Ilocos, Central Luzon, CALABARZON, and Northern Mindanao. 82 | Determinants of Fertility 6.3 AGE AT FIRST MENSTRUATION On the whole, the mean age at menarche, which is a biological factor influenced by the woman’s general health and nutritional state, is 13.3 years (Table 6.4). The data reveal that younger women tend to have menarche at an earlier age than older women. For instance, the onset of menstruation for women age 15-19 is 12.8 years, while for women in their forties, it is 13.6 years. Almost one in ten women has her first menstruation before age 12, half of women menstruated at age 12 or 13, and one in five at age 15 or older. The earlier age at menarche among younger women can also be observed from generally larger proportions of younger women at each age at menarche, up to age 13. For instance, while 33 percent of women age 15-19 have their first menstruation at age 12, the corre- sponding proportion for women age 45-49 is only 22 percent. Table 6.4 Age at menarche Percent distribution of women by age at menarche, by age group, Philippines 2003 Current age <10 11 12 13 14 15+ Total Mean 15-19 2.1 8.9 32.5 29.1 17.1 10.3 100.0 12.8 20-24 1.9 6.8 29.4 26.5 18.3 17.1 100.0 13.1 25-29 1.6 6.6 27.1 25.3 20.5 19.0 100.0 13.3 30-34 1.8 6.6 25.1 23.7 20.3 22.5 100.0 13.4 35-39 1.9 5.8 22.8 24.3 20.8 24.4 100.0 13.5 40-44 1.9 4.8 22.8 23.2 20.3 26.9 100.0 13.6 45-49 2.9 6.6 21.7 23.0 16.8 29.0 100.0 13.6 Total 2.0 6.7 26.6 25.4 19.1 20.1 100.0 13.3 6.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first sexual intercourse is another indicator of the beginning of a woman’s exposure to the risk of childbearing. Data on age at first sexual intercourse (Table 6.5) indicate that among women age 25-49, 3 percent of women had their first sexual intercourse by age 15, 36 percent by age 20, and 68 per- cent by age 25. Table 6.5 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact ages and median age at first inter- course, according to current age, Philippines 2003 Percentage who had first sexual intercourse by exact age Current age 15 18 20 22 25 Percentage who never had intercourse Number of women Median age at first intercourse 15-19 1.4 na na na na 89.5 2,648 a 20-24 1.5 14.9 35.5 na na 45.4 2,209 a 25-29 2.8 14.8 33.6 49.3 68.2 18.3 2,034 22.1 30-34 3.3 19.4 35.7 49.8 66.5 9.2 1,954 22.0 35-39 2.6 18.0 36.0 49.7 65.4 6.2 1,873 22.0 40-44 3.3 20.1 38.6 54.0 70.2 4.8 1,564 21.5 45-49 3.2 20.2 37.7 51.8 70.5 3.7 1,351 21.7 20-49 2.7 17.6 36.0 na na 16.3 10,985 a 25-49 3.0 18.3 36.1 50.7 67.9 9.0 8,777 21.9 na = Not applicable a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching the beginning of the age group Determinants of Fertility | 83 The last column in Table 6.5 shows that the median age at first sexual intercourse is slightly higher among younger women: 22.1 years for women age 25-29 and 21.7 years for women age 45-49. It can be surmised that the age at which women became sexually active has increased over time: 15 percent of women age 20-24 had sex at age 18, compared with 20 percent of women age 45-49. Table 6.6 presents the differentials in median age at first sexual intercourse by women’s back- ground characteristics. The data show similar patterns to those on median age at first marriage, with higher age at first sex among urban than rural women and among better educated women than those with no education. Table 6.6 Median age at first intercourse Median age at first sexual intercourse among women age 25-49, by current age and background characteristics, Philippines 2003 Age Women age Background characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 22.9 23.3 23.0 22.2 22.5 22.8 Rural 21.1 20.6 20.9 20.7 20.7 20.8 Region National Capital Region 23.0 24.5 24.4 22.8 22.8 23.5 Cordillera Admin Region 21.2 21.9 22.3 20.8 22.7 21.6 I - Ilocos 22.7 20.7 22.4 22.3 22.7 22.2 II - Cagayan Valley 21.2 20.9 21.3 21.4 20.6 21.1 III - Central Luzon 22.5 22.6 22.2 21.6 21.9 22.2 IVA - CALABARZON 23.2 22.8 23.2 21.5 22.5 22.6 IVB - MIMAROPA 20.9 21.7 20.0 21.9 21.3 21.2 V - Bicol 22.3 20.7 20.6 21.0 20.6 21.0 VI - Western Visayas 21.2 21.7 22.0 20.4 21.9 21.5 VII - Central Visayas 21.9 21.0 21.5 21.9 21.2 21.5 VIII - Eastern Visayas 21.7 20.5 20.4 20.4 20.4 20.7 IX - Zamboanga Peninsula 21.3 20.5 21.8 20.2 21.4 21.0 X - Northern Mindanao 22.5 21.1 21.0 22.1 21.5 21.6 XI - Davao 21.3 21.9 21.3 20.7 20.8 21.2 XII - SOCCSKSARGEN 21.0 20.8 21.7 20.7 19.9 21.0 XIII - Caraga 20.7 20.9 21.2 21.4 19.9 20.7 ARMM 20.3 19.6 20.2 18.8 20.5 20.0 Education No education 18.5 18.1 17.7 18.4 18.0 18.1 Elementary 19.1 19.0 19.6 19.4 19.7 19.4 High school 21.1 21.4 21.1 20.7 21.6 21.1 College or higher 24.7 25.0 25.5 25.2 25.1 a Wealth index quintile Lowest 19.4 19.3 19.9 19.5 19.9 19.5 Second 20.8 20.2 20.7 20.6 20.9 20.6 Middle 21.8 22.0 21.3 20.9 20.9 21.5 Fourth 23.8 23.4 22.5 21.7 21.8 22.8 Highest 24.7 24.7 25.1 24.3 23.7 24.5 Total 22.1 22.0 22.0 21.5 21.7 21.9 a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching age 25 84 | Determinants of Fertility 6.5 RECENT SEXUAL ACTIVITY Information on the frequency of intercourse is important for the refinement of measures of expo- sure to pregnancy. The 2003 NDHS collected information regarding the respondent’s recent sexual activ- ity to derive an indicator of the extent to which women abstain from sex because of such factors as a re- cent birth or temporary separation from husband. Each woman in the survey was asked how long ago was her last sexual intercourse (if ever), her relationship to the person with whom she had the last sex, and how long she has had sexual relations with this person. Table 6.7 presents data on the timing of the last sexual intercourse, according to selected back- ground characteristics. Overall, 49 percent of the women say that they had sex in the four weeks preced- ing the survey, 13 percent had sex in the 1 to 11 months preceding the survey, and 5 percent did not have sex in the one year preceding the survey. Nine in ten women age 15-19 have never had sex. The proportion of women who never had sex declines to 9 percent among women age 30-34 and 4 percent among women age 45-49. Women in their thirties are the most likely to have had sex in the past four weeks (68 to 70 percent). On the other hand, women in their forties are more likely than younger women to report having their last sex in the more dis- tant past (one to eleven months before the survey or prior to that). As expected, women who are married or living together are the most likely to have had sex within the past four weeks than other women (77 percent). Among women who never married, 2 percent say that their last sex was one or more years ago, and less than 1 percent had sex in the past four weeks. Among women in their first marriage, those who have been in union for 5 to 19 years are more likely to have had sexual relations in the four weeks preceding the survey than those who have been married for a longer or shorter period. The likelihood that a woman had sexual relations in the most recent past is negatively associated with her education. While 65 percent of women with no education were sexually active in the four weeks preceding the survey, the corresponding proportion for women with high school or higher education is 45 to 46 percent. Women with college or higher education are less likely than other women to have ever had sex, partly because they marry later than women with less education (see Table 6.4). Urban women were less sexually active in the four weeks preceding the survey than rural women (44 and 56 percent, respectively). Similarly, women in more urbanized regions are less likely to have been sexually active within the last four weeks than in other regions. The urban regions include NCR (41 percent) and CALABARZON (45 percent). The more rural regions, such as Zamboanga Peninsula and Cagayan Valley, have higher proportions of sexually active women in the most recent period covered by the survey (60 to 61 percent). Women in the poorest quintile are much more likely to have engaged in sex in the four weeks preceding the survey than women in the wealthiest quintile (62 and 36 percent, respectively). The last panel in Table 6.7 shows that use of contraception can be associated with sexual activity. Women who are using contraception are two to three times more likely than nonusers to be sexually active (72 to 94 per- cent, compared with 32 percent). Users of the pill and condoms are the most active sexually (94 percent each). Determinants of Fertility | 85 Table 6.7 Recent sexual activity Percent distribution of women by timing of last sexual intercourse, according to background characteristics, Philippines 2003 Timing of last sexual intercourse Background characteristic Within the last 4 weeks Within 1 year1 One or more years Missing Never had sexual inter- course Total Number of women Age 15-19 6.7 3.0 0.3 0.4 89.5 100.0 2,648 20-24 38.8 12.1 2.2 1.5 45.4 100.0 2,209 25-29 61.5 13.9 3.6 2.7 18.3 100.0 2,034 30-34 67.6 15.4 5.0 2.6 9.2 100.0 1,954 35-39 70.0 14.5 7.5 1.8 6.2 100.0 1,873 40-44 65.8 17.5 10.3 1.6 4.8 100.0 1,564 45-49 57.3 21.9 14.9 2.2 3.7 100.0 1,351 Marital status Never married 0.6 1.6 2.2 0.7 94.9 100.0 4,388 Married or living together 77.0 18.8 2.5 1.7 0.0 100.0 8,671 Divorced/separated/widowed 3.7 12.4 72.7 11.1 0.0 100.0 574 Marital duration Married only once2 0-4 years 74.8 21.1 1.1 2.9 0.1 100.0 1,826 5-9 years 80.6 16.0 1.5 1.8 0.0 100.0 1,771 10-14 years 80.8 15.5 2.2 1.4 0.0 100.0 1,456 15-19 years 81.9 14.7 2.4 1.0 0.0 100.0 1,304 20-24 years 75.0 20.1 3.9 1.0 0.0 100.0 1,033 25+ years 63.9 27.5 7.3 1.3 0.0 100.0 757 Married more than once 71.5 24.6 2.2 1.6 0.0 100.0 525 Residence Urban 44.4 13.5 6.3 1.7 34.2 100.0 7,877 Rural 56.1 12.4 4.1 1.8 25.6 100.0 5,756 Region National Capital Region 40.7 14.2 7.8 2.2 35.1 100.0 2,387 Cordillera Admin Region 47.9 13.1 5.5 2.2 31.2 100.0 216 I - Ilocos 50.2 13.0 4.8 2.7 29.4 100.0 642 II - Cagayan Valley 60.4 14.6 3.2 1.7 20.1 100.0 426 III - Central Luzon 51.6 12.0 4.5 1.1 30.8 100.0 1,459 IVA - CALABARZON 44.7 13.2 7.0 1.6 33.5 100.0 1,890 IVB - MIMAROPA 59.3 14.5 4.8 1.9 19.5 100.0 340 V - Bicol 49.9 13.1 4.7 1.5 30.7 100.0 713 VI - Western Visayas 45.1 16.4 4.7 2.1 31.8 100.0 910 VII - Central Visayas 50.2 12.0 4.9 2.1 30.8 100.0 1,070 VIII - Eastern Visayas 49.3 13.3 5.4 2.2 29.8 100.0 555 IX - Zamboanga Peninsula 60.8 9.7 4.0 2.4 23.2 100.0 465 X - Northern Mindanao 51.4 13.6 3.7 1.1 30.2 100.0 565 XI - Davao 54.8 12.8 3.0 0.8 28.6 100.0 654 XII - SOCCSKSARGEN 58.7 9.7 4.6 1.2 25.8 100.0 524 XIII - Caraga 52.8 14.3 4.4 1.6 26.9 100.0 327 ARMM 56.7 8.1 3.8 1.9 29.4 100.0 489 Education No education 64.6 11.2 9.6 3.4 11.3 100.0 186 Elementary 61.3 16.9 6.6 2.1 13.1 100.0 3,146 High school 45.5 11.8 4.4 1.5 36.8 100.0 6,109 College or higher 45.1 12.0 5.7 1.8 35.4 100.0 4,192 Wealth index quintile Lowest 62.0 14.5 3.9 2.2 17.4 100.0 2,161 Second 57.8 13.6 5.1 2.2 21.4 100.0 2,412 Middle 51.8 14.2 4.5 1.5 28.0 100.0 2,682 Fourth 46.0 12.4 5.9 1.4 34.3 100.0 2,940 Highest 36.3 11.3 6.7 1.7 44.0 100.0 3,438 Current contraceptive method Female sterilization 72.2 19.4 7.0 1.4 0.0 100.0 947 Pill 93.5 5.8 0.3 0.5 0.0 100.0 1,148 IUD 88.5 9.3 1.1 1.1 0.0 100.0 359 Condom 94.2 5.1 0.0 0.7 0.0 100.0 169 Periodic abstinence 85.4 14.0 0.0 0.5 0.0 100.0 587 Other method 88.5 10.3 0.4 0.8 0.0 100.0 1,092 No method 32.4 13.8 7.0 2.2 44.6 100.0 9,331 Total 49.3 13.0 5.4 1.8 30.5 100.0 13,633 1 Excludes women who had sexual intercourse within the last four weeks 2 Excludes women who are not currently married 86 | Determinants of Fertility 6.6 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY A woman who has just given birth can reduce the risk of becoming pregnant if she breastfeeds her newborn and delays the resumption of sexual intercourse. Data on the percentage of births whose mothers are postpartum amenorrheic, abstaining, and insusceptible by the number of months since birth are presented in Table 6.8. Women are considered insusceptible if they are either amenorrheic or abstain- ing after giving birth and therefore are not exposed to the risk of pregnancy. The estimates shown in Ta- ble 6.8 are based on current status data; that is, they refer to the woman’s situation at the time of the sur- vey. The data are grouped in two-month intervals to minimize fluctuations in the estimates. Table 6.8 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Philippines 2003 Percentage of births for which the mother is Months since birth Amenorrheic Abstaining Insusceptible Number of births <2 94.6 88.5 98.7 165 2-3 65.4 44.2 77.8 250 4-5 56.3 24.7 68.6 202 6-7 31.9 15.0 40.1 264 8-9 30.3 12.3 38.3 253 10-11 22.5 10.8 30.9 230 12-13 18.6 13.4 27.8 226 14-15 12.8 7.7 18.5 240 16-17 10.1 7.3 14.9 195 18-19 4.4 8.0 10.7 232 20-21 3.3 4.4 7.1 265 22-23 5.3 12.3 14.6 233 24-25 4.2 7.8 10.7 224 26-27 2.4 3.0 4.3 209 28-29 0.9 3.7 4.2 202 30-31 3.7 5.2 7.4 235 32-33 2.0 4.6 5.8 227 34-35 3.8 5.4 8.0 261 Total 19.7 14.4 26.2 4,111 Median 4.6 2.5 6.1 na Mean 7.7 5.9 10.0 na Note: Estimates are based on status at the time of the survey. na = Not applicable Overall, 20 percent of women who gave birth in the three years preceding the survey are amenor- rheic, 14 percent are abstaining, and 26 percent are insusceptible to pregnancy. Women are amenorrheic for a median of 4.6 months and abstain for 2.5 months after birth, resulting in a period of insusceptibility of 6.1 months. These figures are similar to those found in the 1998 NDHS except that the percentage of women who abstain is higher in 2003 (14 compared with 12 percent) (NSO, DOH, and Macro Interna- tional Inc., 1999). Data in Table 6.8 show that within two months after giving birth, 95 percent of women are amenorrheic, 89 percent are abstaining, and 99 percent, in effect, are insusceptible. These three propor- tions decrease sharply for two to three months after birth and steadily thereafter. The data show that the Determinants of Fertility | 87 percentage of women abstaining is less than those amenorrheic from birth up to 17 months after birth, after which the pattern reverses (Table 6.8). 6.6.1 Median Duration of Postpartum Amenorrhea, Abstinence, and Insusceptibility While the period of insusceptibility does not vary by the woman’s age, the median duration of postpartum amenorrhea for women age 30-49 is almost one month longer than that for women age 15-29 (5.1 and 4.3 months, respectively). Urban women are insusceptible to pregnancy for two months less than rural women, because of a shorter duration of amenorrhea (3.9 and 5.9 months, respectively). Better- educated women are more susceptible to the risk of pregnancy than women with less education, because they have a shorter duration of amenorrhea (3.6 and 7 months, respectively). Table 6.9 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhea, postpartum abstinence, and post- partum insusceptibility following births in the three years preceding the survey, by back- ground characteristics, Philippines 2003 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility Number of births Age 15-29 4.3 2.7 6.0 2,307 30-49 5.1 2.3 6.3 1,804 Residence Urban 3.9 2.7 5.0 2,046 Rural 5.9 2.4 7.4 2,065 Region National Capital Region 3.3 3.2 4.6 590 Cordillera Admin Region 4.2 3.2 7.5 70 I - Ilocos 4.0 2.2 5.0 194 II - Cagayan Valley 6.5 2.4 10.5 129 III - Central Luzon 3.8 2.2 5.5 397 IVA - CALABARZON 4.8 3.0 5.6 500 IVB - MIMAROPA 7.1 2.0 8.4 139 V - Bicol 6.2 2.4 6.9 255 VI - Western Visayas 8.6 3.2 9.4 299 VII - Central Visayas 3.7 1.7 4.5 323 VIII - Eastern Visayas 6.9 3.2 8.2 210 IX - Zamboanga Peninsula 6.4 2.9 7.9 167 X - Northern Mindanao 4.2 2.1 4.5 180 XI - Davao 4.3 2.5 7.1 166 XII - SOCCSKSARGEN 6.4 1.8 7.1 190 XIII - Caraga 4.2 2.9 4.9 116 ARMM 3.5 2.4 4.5 187 Education No education 7.0 1.8 8.4 80 Elementary 7.2 2.3 8.2 1,179 High school 4.5 2.5 6.1 1,769 College or higher 3.6 3.0 5.0 1,084 Wealth index quintile Lowest 7.7 2.3 8.9 1,100 Second 5.3 2.4 6.6 956 Middle 4.3 2.6 5.7 822 Fourth 3.9 2.8 4.6 685 Highest 3.2 3.0 4.0 549 Total 4.6 2.5 6.1 4,111 Note: Medians are based on current status. 88 | Determinants of Fertility With respect to the economic status of the women’s household, duration of postpartum insuscep- tibility is longest among women in the poorest quintile (8.9 months) and shortest for women in the wealthiest quintile (4.0 months). This is attributed to longer durations of postpartum amenorrhea (7.7 months for women in the poorest quintile and 3.2 months for women in the wealthiest quintile). There are large differentials in the duration of postpartum insusceptibility across regions, from less than five months in NCR, Central Visayas, Northern Mindanao, Caraga, and ARMM, to nine or more months in Cagayan Valley and Western Visayas. These differences are largely due to variations in post- partum amenorrhea. Women in NCR have the shortest duration of postpartum amenorrhea (3.3 months), while women in Western Visayas have the longest (8.6 months). 6.6.2 Median Duration of Postpartum Amenorrheic Period for Breastfeeding Duration The longer women breastfeed their babies, the longer is their amenorrheic period. This relation- ship is substantiated by data in Table 6.10. Women who breastfed their babies for less than two months have a median duration of postpartum amenorrhea of 2.7 months, whereas the median duration for women who breastfed for two months or longer is 5.8 months. Older women tend to have a longer duration of postpartum amenorrhea than younger women. For example, among women who breastfed for two months or more, the postpartum amenorrheic period for women age 35-49 is 6.1 to 8.0 months, compared with 4.9 to 5.8 months for younger women. Table 6.10 Median duration of postpartum amenorrheic period for breastfeeding duration Median duration of postpartum amenorrhea for women who last gave birth between 12 and 60 months prior to the survey and whose child is still alive for selected breastfeeding durations, by age, Philippines 2003 Women who breasfed for <2 months Women who breastfed for 2 months or more Age Median duration of postpartum amenorrhea Number of children Median duration of postpartum amenorrhea Number of children 15-19 * 6 5.1 51 20-24 2.7 104 4.9 431 25-29 2.6 188 5.6 673 30-34 2.6 148 5.8 621 35-39 2.6 122 6.3 448 40-44 (2.9) 53 8.0 229 45-49 * 18 6.1 103 Total 2.7 639 5.8 2,556 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Determinants of Fertility | 89 6.7 MENOPAUSE The termination of a woman’s fecundity is signified by menopause, that is, the cessation of the menstrual period. Table 6.11 shows the percentage of women who are not currently pregnant and not postpartum amenorrheic but whose last menstrual period occurred six or more months preceding the sur- vey. The proportion of women who are considered menopausal increases with age. This proportion shows a slow increase from 1 percent among women age 30-34 to 5 percent for women age 42-43, and then in- creases rapidly to 38 percent for women age 48-49. Table 6.11 Menopause Percentage of women age 30-49 who are menopausal, by age, Philippines 2003 Age Percentage menopausal1 Number of women 30-34 1.1 1,954 35-39 1.8 1,873 40-41 3.7 651 42-43 5.3 606 44-45 10.8 624 46-47 18.2 531 48-49 38.2 503 Total 6.9 6,742 1 Percentage of all women who are not pregnant and not postpartum amenor- rheic whose last menstrual period oc- curred six or more months preceding the survey Fertility Preferences | 91 FERTILITY PREFERENCES 7 In recognition of the right of couples to decide their own family size, the Philippine Family Plan- ning Program (PFPP) regularly monitors important indicators, such as number of living children, couples’ desired number of children, the demand for contraception, and planned as compared with unplanned fer- tility. This chapter updates these indicators with data collected from the 2003 National Demographic and Health Survey (NDHS) and supplements them with gender-related data from new questions incorporated in the 2003 survey. 7.1 DESIRE FOR ADDITIONAL CHILDREN The information presented in this section is derived from hypothetical questions on whether cur- rently married women age 15-49 wish to have a child, or another child, in the future. For women who are currently pregnant, the question on desire for more children is rephrased to refer to their desire for another child after the one that is currently expected. Table 7.1 and Figure 7.1 show the distribution of currently married women by desire for more children, according to the number of living children. The data show that 51 percent of these women say that they want no more children, while 11 percent have been sterilized. Thirty-one percent of married women say that they want to have additional children: 12 percent want a child within two years, 18 per- cent want a child after two years or more, and 1 percent is unsure about the time. Five percent of women are not sure whether they want another child. Figure 7.1 Fertility Preferences among Currently Married Women Age 15-49 NDHS 2003 Want no more children 51% Want a child later (2+ years) 18% Sterilized 11% Undecided 5% Want a child, undecided when 1% Want a child soon (<2 years) 12% Infecund 3% 92 | Fertility Preferences Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women by desire for children, according to number of living children, Philippines 2003 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total Have another soon2 78.5 22.4 8.9 2.8 2.6 1.8 1.4 11.7 Have another later3 10.3 49.4 24.5 11.6 5.9 3.9 1.9 18.4 Have another, undecided when 0.5 1.7 1.5 0.4 0.3 0.2 0.3 0.8 Undecided 3.6 6.2 6.7 4.7 3.8 2.7 4.5 5.0 Want no more 3.4 17.3 50.0 59.2 64.5 70.5 78.1 50.6 Sterilized4 0.1 0.7 6.4 19.0 20.6 16.7 9.3 10.6 Declared infecund 3.3 2.1 2.1 2.2 2.3 4.1 4.3 2.7 Missing 0.3 0.1 0.0 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 500 1,556 1,896 1,665 1,193 726 1,136 8,671 1 Includes current pregnancy 2 Wants next birth within two years 3 Wants to delay next birth for two or more years 4 Includes both female and male sterilization Table 7.2 shows the percent distribution of currently married women by their desire for more children, according to age. Women in age groups 15-19 and 30-34 are the most likely to say that they would like another child soon (18 and 15 percent, respectively). Proportions of women reporting that they would like to have another child later decrease with increasing age. While younger women are the least likely to say that they want no more children (19 percent), women 35 and over are among the most likely to report the same (about 60 percent). Table 7.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, by age, Philippines 2003 Age Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Wants another soon1 18.2 12.5 13.5 15.1 11.7 9.0 5.6 11.7 Wants another later2 52.9 48.1 35.0 16.6 6.0 1.6 0.5 18.4 Wants another, undecided when 1.0 0.6 1.2 1.2 1.0 0.3 0.3 0.8 Undecided 7.6 8.3 6.8 5.5 5.0 2.6 1.4 5.0 Wants no more 19.2 29.7 39.9 52.9 61.0 63.9 58.0 50.6 Sterilized3 0.0 0.3 3.3 8.0 14.0 19.4 21.4 10.6 Declared infecund 1.1 0.4 0.3 0.7 1.2 3.1 12.7 2.7 Missing 0.0 0.2 0.1 0.1 0.0 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 239 1,095 1,548 1,663 1,633 1,341 1,152 8,671 1 Wants next birth within two years 2 Wants to delay next birth for two or more years 3 Includes both female and male sterilization Table 7.3 shows the percentage of currently married women who want no more children by num- ber of living children and background characteristics. The desire to stop childbearing increases substan- tially after a woman has had two or more children; the proportion of women with two living children who report wanting no more children is, by every background characteristic presented, at least double that proportion among women with one living child. Fertility Preferences | 93 Table 7.3 Desire to limit childbearing Percentage of currently married women who want no more children, by number of living children and background characteristics, Philippines 2003 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 2.9 18.7 58.3 81.7 86.9 89.0 88.9 60.2 Rural 4.4 16.9 53.8 73.5 83.1 85.6 86.7 62.5 Region National Capital Region 4.9 20.1 60.1 87.8 90.0 95.0 89.5 60.6 Cordillera Admin Region 27.6 14.3 37.0 61.5 75.4 84.2 83.2 53.9 I - Ilocos 3.7 7.5 45.9 78.0 87.7 95.2 87.3 57.0 II - Cagayan Valley 0.0 13.2 50.0 85.5 92.1 96.5 96.9 59.7 III - Central Luzon 3.1 13.1 63.4 81.4 93.1 84.6 91.4 63.8 IVA - CALABARZON 4.9 13.9 56.5 78.3 88.4 92.7 91.3 58.1 IVB - MIMAROPA 9.7 10.0 50.0 67.5 92.3 92.3 95.3 64.5 V - Bicol 0.0 18.8 49.4 69.8 84.6 79.9 88.7 64.8 VI - Western Visayas 0.0 23.7 65.4 87.1 85.3 91.2 89.6 69.9 VII - Central Visayas 5.6 20.8 68.2 79.5 85.6 89.7 87.8 65.6 VIII - Eastern Visayas 0.0 16.9 48.5 66.1 79.4 86.4 83.0 61.1 IX - Zamboanga Peninsula 0.0 43.9 63.8 80.9 86.9 90.9 88.7 69.7 X - Northern Mindanao 8.6 23.0 48.1 74.9 87.1 94.6 84.8 62.7 XI - Davao 0.0 27.2 65.6 85.8 80.3 87.8 91.9 66.7 XII - SOCCSKSARGEN 0.0 21.2 48.9 76.9 76.9 70.6 86.2 59.6 XIII - Caraga 0.0 12.7 53.7 71.3 79.8 76.8 89.6 60.2 ARMM 0.0 8.7 18.6 31.5 41.3 44.3 58.7 30.7 Education No education 0.0 20.1 30.0 46.5 54.9 72.8 81.0 57.5 Elementary 7.9 23.5 54.7 76.2 81.5 83.2 87.9 69.6 High school 2.7 18.3 56.2 77.8 87.1 91.1 88.8 60.5 College or higher 2.2 15.3 58.0 81.5 89.3 90.3 82.6 53.9 Wealth index quintile Lowest 4.5 20.7 46.4 64.5 70.2 82.1 86.4 61.2 Second 4.2 21.8 56.4 74.1 87.1 91.4 89.1 65.3 Middle 3.7 15.9 55.6 82.8 88.8 87.1 87.6 61.6 Fourth 2.5 15.4 60.0 83.2 89.4 89.3 87.7 59.6 Highest 3.1 18.0 60.5 82.2 88.9 87.1 85.9 58.3 Total 3.5 18.0 56.4 78.2 85.1 87.2 87.5 61.2 Note: Women who have been sterilized are considered to want no more children. 1 Includes current pregnancy More than half of currently married women with two children want no more (additional) children or have been sterilized (56 percent), while almost eight in ten women with three children either have been sterilized or want no more children. Findings from the 1998 NDHS show similar patterns, with slightly less desire for terminating childbearing. Looking at differentials by background characteristics, Table 7.3 shows that, in each category of living children, urban women are slightly more likely to want to terminate childbearing than rural women; however, in the aggregate, 60 percent of urban woman report a desire for no more children, compared with 63 percent of rural women (Figure 7.2). This pattern is also evident in the 1998 NDHS. Women who fall into the two poorest quintiles and who currently have no living children or one living child are more likely than women in the wealthier quintiles to either be sterilized or say that they want no more children. However, at parities of two through five, the relationship is reversed, with women in the three wealthiest quintiles more likely than poorer women to say that they want no more children. At parities of 94 | Fertility Preferences six or greater, the desire to stop childbearing is approximately equal across the five wealth quintiles. The pattern of reported desire for no more children is quite similar by education, with those having the least education being more likely to desire no more children at parities of zero and one, and those having the most education being more likely to desire no more children at parities of two or greater. Women in Western Visayas and Zamboanga Peninsula are the most likely to say that they desire no more children (70 percent), while only 31 percent of women in Autonomous Region in Muslim Mindanao (ARMM) report the same. 7.2 DEMAND FOR FAMILY PLANNING Unmet need is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family plan- ning. Women with an unmet need for spacing include pregnant women whose pregnancy was mistimed; amenorrheic women whose last birth was mistimed; and fecund women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and are unsure whether they want another child or who want another child but are unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted; amenorrheic women whose last child was unwanted; and women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want no more children. Measures of unmet need for family planning are used to evaluate the extent to which programs are meet- ing the demand for services. Women who have been sterilized are considered to want no more children. According to these criteria, in the 2003 NDHS the total unmet need for family planning services in the Philippines is 17 percent, of which 9 percent is for limiting and 8 percent is for spacing (Table 7.4). The level of unmet need has declined somewhat from that found in the 1998 NDHS (20 percent unmet need, 11 percent for limiting and 9 percent for spacing). 61 60 63 58 70 61 54 61 65 62 60 58 Total Urban Rural No edu- cation Ele- men- tary High school College or higher Lowest Second Middle Fourth Highest 0 10 20 30 40 50 60 70 80 Percent Figure 7.2 Percentage of Currently Married Women Who Want No More Children by Residence, Education, and Wealth Index Quintile NDHS 2003 Residence Education Wealth index quintile Fertility Preferences | 95 Table 7.4 Need for family planning Percentage of currently married women with unmet need for family planning, and with met need for family planning, and the total demand for family planning, by background characteristics, Philippines 2003 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 23.4 5.7 29.1 21.8 3.7 25.6 47.6 9.4 57.0 49.0 239 20-24 19.3 5.6 25.0 28.9 13.8 42.7 51.8 19.7 71.5 65.1 1,095 25-29 13.8 8.4 22.3 26.7 24.5 51.3 43.2 33.8 77.0 71.1 1,548 30-34 8.0 11.3 19.3 15.3 38.1 53.4 25.5 50.7 76.1 74.6 1,663 35-39 3.3 12.2 15.5 6.9 49.7 56.6 10.9 63.0 73.9 79.0 1,633 40-44 1.2 11.8 13.0 2.1 47.8 49.9 3.5 59.9 63.4 79.5 1,341 45-49 0.2 5.6 5.9 0.6 37.2 37.7 0.8 42.9 43.7 86.6 1,152 Residence Urban 7.5 7.8 15.3 14.3 35.8 50.1 23.5 44.3 67.7 77.4 4,643 Rural 8.5 11.2 19.7 12.9 34.5 47.4 22.8 46.5 69.3 71.5 4,028 Region National Capital Region 6.3 8.3 14.6 12.9 36.0 48.9 20.6 44.5 65.2 77.6 1,337 Cordillera Admin Region 12.3 6.1 18.5 18.1 28.2 46.3 33.1 35.3 68.4 73.0 134 I - Ilocos 6.6 7.9 14.5 16.7 34.0 50.6 24.0 42.1 66.1 78.0 420 II - Cagayan Valley 5.1 8.5 13.7 19.2 33.2 52.4 25.3 42.0 67.3 79.7 325 III - Central Luzon 7.7 7.4 15.0 14.4 40.1 54.5 24.1 47.7 71.8 79.1 960 IVA - CALABARZON 7.0 9.1 16.1 14.6 33.9 48.4 23.2 44.0 67.2 76.1 1,139 IVB - MIMAROPA 7.5 9.8 17.3 10.4 32.1 42.5 19.7 42.5 62.2 72.3 257 V - Bicol 10.4 13.3 23.7 12.7 34.7 47.4 24.2 49.5 73.7 67.9 457 VI - Western Visayas 7.6 11.9 19.5 9.6 36.5 46.1 18.9 49.1 68.0 71.4 578 VII - Central Visayas 8.0 8.6 16.6 11.4 40.8 52.1 21.6 50.6 72.2 77.0 671 VIII - Eastern Visayas 12.3 15.5 27.8 12.8 31.6 44.4 26.3 47.3 73.6 62.3 355 IX - Zamboanga Peninsula 8.9 12.8 21.7 9.5 33.6 43.1 19.7 46.7 66.4 67.3 339 X - Northern Mindanao 5.1 11.4 16.4 16.7 38.4 55.2 23.5 50.3 73.7 77.7 364 XI - Davao 5.6 6.4 12.1 15.4 44.0 59.3 22.8 52.0 74.8 83.8 426 XII - SOCCSKSARGEN 7.5 9.9 17.4 16.8 34.0 50.7 24.9 45.0 69.9 75.1 364 XIII - Caraga 9.3 8.2 17.5 16.4 38.2 54.6 28.5 47.8 76.2 77.0 217 ARMM 18.9 8.6 27.4 10.3 8.4 18.7 30.1 17.2 47.3 42.0 328 Education No education 9.0 17.7 26.7 4.8 13.2 18.1 14.4 31.5 46.0 41.9 148 Elementary 6.8 13.3 20.2 8.3 35.7 44.0 16.2 49.6 65.8 69.3 2,523 High school 8.5 8.2 16.7 15.2 36.6 51.9 25.6 45.7 71.3 76.6 3,545 College or higher 8.2 6.6 14.8 17.4 33.9 51.4 27.3 41.2 68.5 78.3 2,456 Wealth index quintile Lowest 10.9 15.8 26.7 11.3 26.1 37.4 23.8 42.7 66.5 59.8 1,677 Second 8.6 11.0 19.6 12.8 36.1 48.8 23.2 47.9 71.1 72.4 1,767 Middle 7.7 7.3 15.0 13.9 38.8 52.7 23.3 46.7 70.0 78.6 1,776 Fourth 6.5 6.9 13.4 15.5 38.9 54.4 23.3 46.6 69.9 80.8 1,755 Highest 6.1 6.2 12.3 14.9 35.7 50.6 22.3 42.4 64.7 81.0 1,697 Total 7.9 9.4 17.3 13.7 35.2 48.9 23.2 45.3 68.5 74.7 8,671 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrheic women who are not using family planning and whose last birth was mistimed, and fecund women who are neither pregnant nor amenorrheic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrheic women whose last child was unwanted, and fecund women who are neither pregnant nor amenor- rheic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrheic women who became pregnant while using a method (these women are in need of a better method of contraception). 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more chil- dren. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrheic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). 96 | Fertility Preferences Demand for family planning is defined as the sum of contraceptive prevalence (including cur- rently pregnant or amenorrheic women whose pregnancy or last birth was the result of a contraceptive failure) and unmet need (Westoff and Ochoa, 1991). The total demand for family planning is 69 percent, of which 75 percent has been satisfied. If all of this need were satisfied, a contraceptive prevalence rate of about 69 percent could, theoretically, be expected. Comparison with the 1998 NDHS findings indi- cates that the percentage of the demand that is satisfied has slightly increased (from 72 to 75 percent). Type of demand for family planning varies with age. Younger women are more likely to express a demand for spacing their births, while older women more often want to limit births. The pattern of total demand for family planning by age shows an inverted U-shaped curve; it is low among women age 15-19 (57 percent) and women age 45-49 (44 percent), and peaks among women age 25-34 (about 77 percent). There are no notable differences in the total demand for family planning between urban and rural women; however, rural women are more likely to exhibit unmet need for family planning, especially for limiting. Unmet need generally declines with increasing education; the more educated the women, the lower the percentage with unmet need. Similarly, satisfaction of contraceptive demand has a direct relationship with household wealth status; the wealthier the household in which the woman lives, the more likely she is to have a met contraceptive need. The percentage of demand for family planning that is satisfied is highest in Davao (84 percent), Cagayan Valley (80 percent), and Central Luzon (79 percent), and lowest in ARMM (42 percent). Table 7.5 indicates the methods that currently married women with unmet need for family planning would prefer to use in the future. The oral contraceptive pill is the method cited by the most women (25 percent). Six percent of women with an unmet need for contracep- tion cite as their preferred future method injections, with an additional 6 percent of women citing sterilization as their preferred method. Nearly half of the women catego- rized as having an unmet need for family planning do not intend to use a method in the future. Table 7.6 shows that among women who are not currently using contraception but who intend to do so in the future, 76 percent are willing to pay for their pre- ferred method. Women who cited the intrauterine device (IUD) as their preferred future method were the most likely to be willing to pay (80 percent), while those de- siring injections or sterilization in the future were least likely to be willing to pay (71 percent). The average price that women were willing to pay for a contraceptive method was about Ph.P 221. However, women who pre- ferred sterilization as their method were willing to pay, on average, Ph.P 1,438. Potential condoms users ex- pected that they would pay Ph.P 36 for their method. Table 7.5 Preferred future method of family planning among women with unmet need Percent distribution of currently married women with unmet need for family planning by preferred future method, Philippines 2003 Women with unmet need for family planning Preferred future method of contraception For spacing For limiting Any unmet need Pill 29.5 21.9 25.3 IUD 5.6 4.4 4.9 Injections 6.4 4.7 5.5 Condom 1.4 1.7 1.5 Female sterilization 6.4 5.2 5.7 Periodic abstinence 4.8 3.7 4.2 Withdrawal 2.8 2.7 2.7 Other 0.6 0.3 0.4 Lactational amenorrhea 0.1 0.0 0.1 Emergency contraception 0.0 0.1 0.1 Symptothermal 0.6 0.5 0.5 Don't know/missing 1.7 0.8 1.2 Does not intend to use a method 40.2 54.1 47.8 Total 100.0 100.0 100.0 Number of women 688 816 1,504 Fertility Preferences | 97 Table 7.6 Willingness to pay for contraceptive method Among women not currently using contraception but who intend to use specific methods in the future, the percentage who are willing to pay for their method and the average cost they are willing to pay, by preferred method, Philippines 2003 Preferred future method of contraception Willing to pay for method Number of women Average cost will- ing to pay (in Ph.P) Number willing to pay Pill 77.3 2,176 77 1,681 IUD 79.5 245 216 195 Injections 70.8 265 162 188 Condom 75.9 124 36 94 Female sterilization 71.0 315 1,438 220 Total 76.3 3,140 221 2,390 Note: Total includes 15 women who use diaphragm, implants, fe- male condom, foam or jelly, emergency contraception, and husband sterilized. Exchange rate at time of survey Philippine Peso = US$1. 7.3 IDEAL NUMBER OF CHILDREN In the 2003 NDHS, each respondent was asked to perform the difficult task of considering, ab- stractly and independently of her actual family size, the number of children she would choose if she could start again. The mean ideal number of children for all women and for those who are currently married is approximately the same (3.0 and 3.2 children, respectively) (Table 7.7). The ideal family size in the Phil- ippines has declined slightly since the 1998 NDHS, which revealed mean ideal numbers of children of 3.2 for all women and 3.5 for currently married women. Seven of every ten women expressed a preference to have three children or fewer; only 9 percent of women want to have five or more children. The correlation between actual and ideal family size can be seen in the fact that women who have a small number of children are more likely to want a small number of children. As parity increases, the ideal number of children also increases, up until the point at which women have five or more living chil- dren, at which point women tend to report wanting fewer children than they currently have. Women who have large families tend to have high ideal family sizes. This may be partly due to the adjustment of their ideal number of children as additional children are born (rationalization), or due to the high ideal family size values of 20 or 30 years ago, which some women still hold. Despite the likeli- hood of some rationalization, respondents frequently state ideal family sizes that are lower than their ac- tual number of living children. The difference can be taken as an indicator of surplus or unwanted fertil- ity. For women with three or more surviving children, a sizeable proportion reports ideal family sizes that are smaller than the number of living children. In fact, among women with six or more children, 77 per- cent say that if they were to start again, they would have fewer children. 98 | Fertility Preferences Table 7.7 Ideal number of children Percent distribution of all women by ideal number of children, and mean ideal number of children for all women and for currently married women, according to number of living children, Philippines 2003 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total Number of children desired 0 5.1 0.2 0.1 0.1 0.2 0.5 0.4 1.9 1 5.7 10.3 2.5 2.8 1.6 1.3 0.6 4.4 2 44.2 45.4 43.9 18.7 19.6 14.2 11.7 34.2 3 29.1 29.2 27.9 46.1 17.4 30.6 29.1 30.2 4 11.6 11.3 19.6 21.9 47.5 20.2 25.2 19.1 5 2.0 1.6 3.1 6.0 5.2 22.4 10.1 4.8 6+ 0.9 1.7 2.4 3.7 7.7 9.8 19.9 4.4 Non-numeric responses 1.3 0.3 0.5 0.7 0.8 1.0 3.0 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 4,800 1,819 2,014 1,768 1,258 769 1,205 13,633 Mean ideal number of children2 for: All women 2.5 2.5 2.9 3.2 3.7 3.9 4.2 3.0 Number 4,735 1,813 2,004 1,756 1,248 761 1,169 13,486 Currently married women 2.7 2.6 2.9 3.2 3.7 3.9 4.2 3.2 Number 498 1,552 1,886 1,654 1,183 719 1,101 8,591 1 Includes current pregnancy 2 Means are calculated excluding the women giving non-numeric responses. Table 7.8 shows the mean ideal number of children for all women, according to their age and other background characteristics. The mean ideal number children increases as women’s age increases. In fact, women age 45-49 and those age 20-24 have, on average, a one-child difference in their reported ideal family size. Poorer women and those with less education are more likely to have higher ideal family sizes than their respective counterparts. Rural women consistently report larger ideal families than urban women do. Examination of mean ideal family size by region discloses a large variation. The largest mean ideal family size is 4.7 children in ARMM, while the smallest is 2.6 in National Capital Region (Figure 7.3). Fertility Preferences | 99 Table 7.8 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and background characteristics, Philippines 2003 Age Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 2.4 2.5 2.7 2.9 3.1 3.2 3.5 2.8 Rural 2.5 2.8 3.1 3.4 3.6 3.6 3.9 3.2 Region National Capital Region 2.3 2.3 2.5 2.6 2.9 2.9 3.2 2.6 Cordillera Admin Region 2.9 3.0 3.3 3.6 4.2 3.6 4.0 3.4 I - Ilocos 2.4 2.8 3.0 3.3 3.4 3.5 3.9 3.1 II - Cagayan Valley 2.3 2.6 2.9 3.0 3.4 3.4 3.7 3.0 III - Central Luzon 2.0 2.6 2.8 2.9 3.2 3.6 3.5 2.8 IVA - CALABARZON 2.5 2.6 2.6 3.0 3.0 3.2 3.3 2.8 IVB - MIMAROPA 2.4 2.7 3.3 3.4 3.9 3.6 3.7 3.2 V - Bicol 2.6 2.7 3.1 3.1 3.3 3.3 3.8 3.1 VI - Western Visayas 2.4 2.6 2.9 3.0 3.1 3.4 3.8 2.9 VII - Central Visayas 2.5 2.6 2.7 3.0 3.3 3.2 3.8 2.9 VIII - Eastern Visayas 2.7 2.6 3.1 3.2 3.5 4.0 4.3 3.2 IX - Zamboanga Peninsula 2.6 2.7 3.0 3.2 3.1 3.5 3.4 3.0 X - Northern Mindanao 2.4 2.6 2.7 3.2 3.7 3.5 3.7 3.0 XI - Davao 2.4 2.4 2.8 2.9 3.2 3.5 3.6 2.9 XII - SOCCSKSARGEN 2.5 2.7 3.0 3.4 3.6 3.6 3.5 3.1 XIII - Caraga 2.4 2.6 2.9 3.5 3.6 4.0 4.1 3.1 ARMM 3.8 4.0 4.9 5.3 5.4 5.0 5.2 4.7 Education No education 3.0 3.3 4.8 4.4 4.9 5.2 4.7 4.6 Elementary 2.5 2.9 3.3 3.5 3.8 3.7 3.9 3.4 High school 2.4 2.6 2.8 3.0 3.2 3.3 3.4 2.8 College or higher 2.5 2.6 2.7 2.8 3.0 3.0 3.4 2.8 Wealth index quintile Lowest 2.7 3.0 3.6 3.6 4.0 3.9 4.3 3.5 Second 2.5 2.6 3.0 3.3 3.5 3.7 3.7 3.1 Middle 2.4 2.6 2.7 3.1 3.3 3.3 3.6 3.0 Fourth 2.4 2.5 2.7 2.7 3.0 3.2 3.5 2.8 Highest 2.4 2.5 2.6 2.8 2.9 3.0 3.4 2.7 Total 2.5 2.6 2.9 3.1 3.3 3.4 3.6 3.0 100 | Fertility Preferences 7.4 UNPLANNED AND UNWANTED FERTILITY In the 2003 NDHS, women were asked a series of questions about each child born in the preced- ing five years and any current pregnancy, to determine whether the pregnancy was wanted then, wanted at a later time, or unwanted. These questions form a particularly powerful indicator of the degree to which couples successfully control childbearing. In addition, the data can be used to gauge the effect on fertility of the prevention of unwanted births. The NDHS questions on fertility planning are extremely demanding. The respondent is required to recall accurately her wishes at one or more points in time during the last five years and to report them honestly. The danger of rationalization is present; an unwanted conception may well have become a cher- ished child. Despite these potential problems of comprehension, recall, and truthfulness, results from pre- vious surveys have proved surprisingly plausible. Respondents are willing to report unwanted concep- tions, although some postpartum rationalization probably occurs. The result is probably an underestimate of unwanted fertility. Table 7.9 shows the percent distribution of births in the five years preceding the survey and cur- rent pregnancies by fertility planning status, according to birth order and mother’s age at birth. Fifty-five percent of births were wanted at the time of conception, an additional 24 percent were wanted but at a later time, and a significant 20 percent were not wanted at all. These figures show that there has been little change since 1998; the little change that did occur served to somewhat increase the proportion of un- wanted pregnancies from 18 percent in 1998 to 20 percent in 2003. Birth order is strongly associated with the planning status of the birth. In the 2003 NDHS, the proportion of births that were wanted at the time of conception decreases with increasing birth order, while the percentage not wanted at all increases. While almost all first births were wanted at the time of conception, more than one-third of fourth or higher order births were unwanted. Figure 7.3 Mean Ideal Number of Children for All Women by Region 2.6 3.4 3.1 3.0 2.8 2.8 3.2 3.1 2.9 2.9 3.2 3.0 3.0 2.9 3.1 3.1 4.7 NC R CA R Ilo co s Ca ga ya n V all ey Ce ntr al Lu zo n CA LA BA RZ ON MI MA RO PA Bic ol W est ern V isa ya s Ce ntr al Vis ay as Ea ste rn Vis ay as Za mb oa ng a P en ins ula No rth ern M ind an ao Da va o SO CC SK SA RG EN Ca rag a AR MM 0.0 1.0 2.0 3.0 4.0 5.0 6.0 2003 NDHS Number of children Fertility Preferences | 101 Table 7.9 Fertility planning status Percent distribution of births in the five years preceding the survey (including current preg- nancies), by fertility planning status, according to birth order and mother's age at birth, Philippines 2003 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 72.6 19.4 7.1 0.9 100.0 2,153 2 55.3 34.2 9.8 0.7 100.0 1,752 3 50.0 27.5 21.9 0.6 100.0 1,218 4+ 42.1 19.2 37.6 1.0 100.0 2,599 Age at birth <20 61.7 26.6 10.9 0.9 100.0 701 20-24 57.7 30.8 10.6 0.9 100.0 2,138 25-29 56.6 25.9 16.8 0.6 100.0 2,084 30-34 52.7 20.1 26.3 0.9 100.0 1,541 35-39 50.8 14.5 34.2 0.5 100.0 887 40-44 35.7 7.9 54.3 2.1 100.0 346 45-49 (16.2) (4.1) (79.7) (0.0) 100.0 26 Total 54.9 24.0 20.3 0.8 100.0 7,723 Note: Figures in parentheses are based on 25-49 unweighted cases. The planning status of births is also associated with the age of the mother. Older mothers tend to be less likely to report their pregnancies as wanted at conception. The percentage of unwanted births in- creases with mother’s age; 11 percent of pregnancies to women under 20 were not wanted at conception, while 80 percent of pregnancies to those age 45-49 were not wanted. Table 7.10 presents total wanted fertility rates alongside actual total fertility rates. The wanted fertility rates are calculated in the same manner as conventional age-specific fertility rates, except that only births classified as “wanted” are included in the numerator. A birth is considered wanted if the num- ber of living children at the time of conception was less than or equal to the current ideal number of chil- dren reported by the respondent. Wanted fertility rates express the level of fertility that would theoreti- cally result if all unwanted births were prevented. Comparison of actual fertility rates and wanted fertility rates suggests the potential demographic impact of the elimination of unwanted births. The smaller the gap is between the actual fertility rate and the wanted fertility rate, the more successful the woman is in achieving her fertility desires. The total wanted fertility rate is lower than the total fertility rate. Thus, if unwanted births could be eliminated, the total fertility rate in Philippines would be 2.5 births per woman, instead of 3.5—a dif- ference of one entire birth. The total wanted fertility rate is lower than that recorded in the 1998 NDHS (2.7 children per woman). The differences between wanted and actual fertility rates are lower among ur- ban women, better educated women, and women in the highest wealth index quintile, indicating that these women have been more successful at implementing their fertility preferences. For example, while the fer- tility gap among women with no formal education is 1.2 children, the corresponding gap among women who have completed college or higher education is 0.5 children. There is wide variation in actual and wanted fertility by region. The gap between total wanted and total actual fertility rates is nearly 2 children in Bicol, Eastern Visayas, and Zamboanga Peninsula. ARMM has the smallest gap among all of the regions, because it still has comparatively high fertility goals. 102 | Fertility Preferences Table 7.10 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Philippines 2003 Background characteristic Total wanted fertility rate Total fertility rate Residence Urban 2.2 3.0 Rural 3.0 4.3 Region National Capital Region 2.0 2.8 Cordillera Admin Region 2.7 3.8 I - Ilocos 3.0 3.8 II - Cagayan Valley 2.6 3.4 III - Central Luzon 2.4 3.1 IVA - CALABARZON 2.3 3.2 IVB - MIMAROPA 3.6 5.0 V - Bicol 2.6 4.3 VI - Western Visayas 2.7 4.0 VII - Central Visayas 2.6 3.6 VIII - Eastern Visayas 2.9 4.6 IX - Zamboanga Peninsula 2.6 4.2 X - Northern Mindanao 2.8 3.8 XI - Davao 2.2 3.1 XII - SOCCSKSARGEN 3.0 4.2 XIII - Caraga 2.8 4.1 ARMM 3.7 4.2 Education No education 4.1 5.3 Elementary 3.3 5.0 High school 2.5 3.5 College or higher 2.2 2.7 Wealth index quintile Lowest 3.8 5.9 Second 3.1 4.6 Middle 2.6 3.5 Fourth 2.2 2.8 Highest 1.7 2.0 Total 2.5 3.5 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. 7.5 IDEAL NUMBER OF CHILDREN AND UNMET NEED BY WOMEN’S STATUS Unmet need for contraceptives was also examined as it relates to three women’s status indicators: women’s involvement in family/household decisionmaking, degree to which refusing sex with one’s spouse is justified, and degree to which wife beating can be justified. Women’s status is assumed to be positively correlated with the number of family decisions women are involved in and the number of cir- cumstances under which refusal of sex is justified, but inversely related to the number of circumstances under which wife beating can be justified. The questionnaire asked whether the woman has the final say (jointly with another person, or by herself) on decisions affecting her own health care, making large household purchases, making household purchases for daily needs, visits to family or relatives, and what food to cook each day. Table 7.11 shows Fertility Preferences | 103 that unmet need for family planning is inversely related to women’s involvement in family decisionmak- ing: the greater the number of decisions in which the woman has the final say, the less likely she is to have an unmet contraceptive need. Similarly, the fewer circumstances under which women agree that wife beating is justified, the less likely she is to be categorized as having an unmet need: while 25 percent of women who agree with all of the given reasons that wife beating might be justified have an unmet need for family planning, 17 percent of women who believe that wife beating is never justified have an unmet need. Given reasons for wife beating included if the woman goes out without telling her husband, if she neglects the children, if she argues with him, if she refuses to have sex with him, and if she burns the food. There is no clear relationship between the number of reasons with which women agree that refus- ing sex with their husband is justified and unmet need for family planning. Reasons for refusing sex in- cluded if the husband has a sexually transmitted infection, the husband has had sex with other women, the woman has had a recent birth, or the woman is tired or not in the mood. Table 7.11 Ideal number of children and unmet need by women's status Mean ideal number of children and unmet need for spacing and limiting, by women's status indi- cators, Philippines 2003 Unmet need for family planning2 Women’s status indicator Mean ideal number of children1 Number For spacing For limiting Total Number of women Number of decisions in which woman has final say3 0 3.0 90 11.7 16.5 28.2 92 1-2 2.9 694 12.9 9.3 22.2 699 3-4 3.2 2,095 9.7 8.3 18.1 2,115 5 3.3 5,713 6.6 9.7 16.3 5,766 Number of reasons to refuse sex with husband 0 3.2 222 8.8 10.0 18.8 225 1-2 3.5 291 8.3 7.5 15.8 297 3-4 3.2 8,079 7.9 9.5 17.4 8,149 Number of reasons wife beating is justified 0 3.2 6,418 7.9 9.2 17.1 6,463 1-2 3.4 1,779 7.9 9.6 17.5 1,804 3-4 3.6 306 7.0 12.1 19.2 316 5 3.4 88 14.8 10.4 25.2 88 Total 3.2 8,591 7.9 9.4 17.3 8,671 1 Totals are calculated excluding the women giving non-numeric responses. 2 See Table 7.4 for definition of unmet need for family planning 3 Either by herself or jointly with others 104 | Fertility Preferences 7.6 FAMILY SIZE DESIRES OF COUPLES Couple’s consensus on family size is often thought to be instrumental in the greater success of couples in achieving their desired number of children. The percent distribution of currently married, non- sterilized women by perceived consensus with husband regarding the number of children desired is shown in Table 7.12, by selected background characteristics. The majority of women report that there is consen- sus with their husbands on the number of children they would like to have (67 percent). Twenty-two per- cent of women believe that their husbands want more children than they themselves do, while only 7 per- cent of husbands want fewer children than their wives do. A very small proportion of the women (5 per- cent) are not aware whether they want the same number of children as their husbands (Figure 7.4). Table 7.12 Couples consensus on family size Percent distribution of currently married, nonsterilized women by perceived consensus with husband regarding the number of children desired, by background characteristic, Philippines 2003 Couple's consensus on desire for children1 Background characteristic Husband and wife want same number Husband wants more than wife Husband wants fewer than wife Don't know/ missing Total Number of women Age 15-19 71.1 19.0 2.8 7.1 100.0 239 20-24 68.9 21.9 6.0 3.2 100.0 1,092 25-29 70.5 20.4 5.6 3.5 100.0 1,498 30-34 68.4 20.9 7.2 3.6 100.0 1,531 35-39 66.2 22.4 6.8 4.5 100.0 1,407 40-44 63.7 23.5 6.9 5.9 100.0 1,086 45-49 61.7 24.2 7.6 6.6 100.0 908 Difference in age between woman and husband/partner 0-1 year 68.4 22.3 6.4 2.8 100.0 2,164 2-3 years 67.5 22.0 6.4 4.2 100.0 2,153 4-5 years 67.0 21.4 6.9 4.7 100.0 1,340 6+ years 65.4 21.9 6.4 6.2 100.0 2,086 No age for husband/partner * * * * 100.0 19 Residence Urban 68.5 20.8 6.5 4.2 100.0 4,079 Rural 65.6 23.2 6.5 4.7 100.0 3,683 Region National Capital Region 69.9 20.3 5.2 4.5 100.0 1,161 Cordillera Admin Region 71.6 17.6 5.5 5.2 100.0 120 I - Ilocos 73.6 14.7 7.5 4.1 100.0 369 II - Cagayan Valley 73.5 17.4 8.8 0.3 100.0 302 III - Central Luzon 76.0 14.1 4.8 5.1 100.0 784 IVA - CALABARZON 72.8 19.2 4.3 3.7 100.0 1,009 IVB - MIMAROPA 77.0 13.7 4.4 5.0 100.0 234 V - Bicol 58.1 25.4 10.8 5.8 100.0 432 VI - Western Visayas 62.0 22.9 6.7 8.4 100.0 539 VII - Central Visayas 66.2 19.1 6.3 8.4 100.0 596 VIII - Eastern Visayas 64.2 28.7 4.3 2.7 100.0 320 IX - Zamboanga Peninsula 57.6 34.4 6.3 1.6 100.0 320 X - Northern Mindanao 63.1 20.6 12.4 3.8 100.0 341 XI - Davao 60.6 25.3 10.3 3.8 100.0 382 XII - SOCCSKSARGEN 62.4 25.0 9.4 3.2 100.0 332 XIII - Caraga 63.1 27.2 9.2 0.6 100.0 202 ARMM 49.3 45.7 1.8 3.2 100.0 321 Education No education 56.0 34.3 2.4 7.3 100.0 139 Elementary 62.2 25.0 6.6 6.2 100.0 2,262 High school 69.1 20.6 6.3 4.1 100.0 3,189 College or higher 70.2 19.8 7.0 3.0 100.0 2,172 Total 67.1 21.9 6.5 4.5 100.0 7,762 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Based on wife's perception of her husband's desire Fertility Preferences | 105 There is little variation by age in whether husbands and wives are believed to have consensus on desired family size, nor is there variation by age difference between husbands and wives. Women with no education (34 percent) and those living in ARMM (46 percent) were more likely than other women to say that their partners want more children than they do. On the other hand, women in Northern Mindanao were more likely than other women to state that their partners want fewer children than they do. 2003 NDHS Figure 7.4 Currently Married Women by Perceived Consensus with Husband Regarding the Number of Children Desired Husband and wife want same number 67% Husband wants more than wife 22% Husband wants fewer than wife 7% Don’t know/missing 5% Infant and Child Mortality | 107 INFANT AND CHILD MORTALITY 8 This chapter presents estimates of childhood mortality, measured by perinatal, infant, and child mortality rates. The chapter includes a description of the indicators, the current levels and trends, differen- tials by selected background characteristics, and factors that contribute to elevating children’s mortality risks. Analyzing the levels and trends of childhood mortality is important in gauging the impact of ma- ternal and child health programs improving the health of infants and children. The data can also be used as input in population projections. Differentials in childhood mortality by selected characteristics are use- ful in identifying groups in need for priority attention and in planning meaningful strategies to address them. 8.1 DEFINITIONS AND ASSESSMENT OF DATA QUALITY Six indicators are analyzed in this chapter: Infant mortality rate, neonatal mortality rate, postneo- natal mortality rate, child mortality rate, under-five mortality rate, and perinatal mortality rate. The infant mortality rate (IMR) is defined as the number of infant deaths per 1,000 live births during the first 12 months of life. It is described as the probability of dying between birth and age one year. Because the level of mortality is higher at the early ages of infancy than at the later ages of infancy, it is useful to break up the rate into neonatal mortality (NN), the probability of dying within the first month of life, and postneonatal mortality (PNN), the probability of dying after the first month of life but before age one year. The child mortality rate is the probability of dying between exact age one and age five, defined as the number of deaths of children age 1-4 years per 1,000 children surviving to age 12 months. Another useful summary indicator of infant and child mortality is the under-five mortality rate or the probability of dying between birth and exact age five, defined as the number of deaths below age five per 1,000 live births during the given period. In this report, the five childhood mortality estimates pertain to periods of 0 to 4, 5 to 9, and 10 to 14 years preceding the survey. Perinatal mortality is also presented in this chapter. It is defined as the number of stillbirths and early neonatal deaths that occurred zero to four years preceding the survey per 1,000 pregnancies of seven or more months’ duration. The above mortality rates are estimated directly from the information derived from the questions asked in the reproductive history section of the Women’s Questionnaire. There are two types of data col- lected in this section. The first refers to a woman’s total number of pregnancies, classified as live births and non-live births. To elicit complete reporting of all live births, interviewers asked the respondents to report the number of children still living and those who died, each classified by sex. The second type of data relates to detailed information on each of the woman’s pregnancies from the first to the last. The fol- lowing information was collected: whether the pregnancy resulted in single or multiple births and the out- come of the pregnancy (born alive, born dead, or lost before full term). 108 | Infant and Child Mortality For all live births, the name, sex, date of birth, and survival status of the child were recorded. For surviving children, their age in completed years at last birthday was recorded. For dead children, the age at death was noted. If the child was born dead (stillbirth) or the pregnancy was lost before term (miscar- riage), the date of pregnancy termination and duration of pregnancy at the time of loss were also recorded. For these pregnancies, the women were asked whether the pregnancy loss was induced. The accuracy of these estimates depends on the respondent’s full recall about all of her births, particularly those who have died, and her ability to accurately report the children’s date of birth and age at death. Table C.4 in Appendix C shows that there are no substantial differentials in the distributions of reported birth dates between living and dead children. The percentage of births in 1997 to 2002 with complete birth dates for living and dead children is equal to 100 percent and close to 100 percent for the earlier period. Moreover, a close examination of the pattern of reporting of age at death (Table C.6 in Appendix C) reveals that for deaths reported to have occurred zero to four years preceding the survey, there is no evidence of substantial heaping of age at death at any age. For deaths 5 to 9 and 10 to 14 years before the survey, there is a heaping at age 12 months. However, it is too small to have an impact on the estimated IMR. The reporting of date of birth and of age at death zero to four years before the survey is reasonable. However, deaths reported in the earlier periods before the survey should be accepted with some reservation. 8.2 LEVELS AND TRENDS IN INFANT, CHILD, AND UNDER-FIVE MORTALITY Table 8.1 shows early childhood mortality rates based on the 2003 National Demographic and Health Survey (NDHS). The IMR during the five-year period before the survey, which centers in year 2000, is 29 deaths per 1,000 live births. The neonatal mortality rate for the same period is 17 deaths per 1,000 live births, and the postneonatal mortality rate is 12 deaths per 1,000 live births. Child mortality is 12 deaths per 1,000 and the under-five mortality rate is 40 deaths per 1,000 live births. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Philippines 2003 Years preceding the survey Approximate calendar years Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 1998-2003 17 12 29 12 40 5-9 1993-1997 17 14 31 12 43 10-14 1988-1992 18 16 34 19 52 1 Computed as the difference between the infant and neonatal mortality rates These estimates are associated with sampling errors. For example, at 95 percent confidence lim- its, for the zero to four years preceding the survey, the actual IMR lies between 24 and 33 deaths per 1,000 live births (Appendix B). The 2003 NDHS data confirm the pattern of decline in childhood mortality in the past 15 years. Under-five mortality has declined from 54 to 48 to 40 per 1,000 as reported in the 1993 NDS, the 1998 NDHS, and the 2003 NDHS, respectively. Infant mortality rates from the three surveys also show a de- cline, from 34 to 35 to 29. Infant and Child Mortality | 109 8.3 SOCIOECONOMIC DIFFERENTIALS IN CHILDHOOD MORTALITY Childhood mortality varies according to residence, education, and socioeconomic status. Data in Table 8.2 show that mortality rates in urban areas are much lower than those in rural areas. For example, the IMR in urban areas is 24 deaths per 1,000 live births, compared with 36 deaths per 1,000 live births in rural areas. Childhood mortality is inversely related to the mother’s education level and wealth status. The IMR for children whose mothers have no education is 65 deaths per 1,000 live births, compared with 15 deaths per 1,000 live births for children whose mothers have college or higher education. The IMR is higher than the national average in seven regions: MIMAROPA, Western Visayas, Eastern Visayas, Northern Mindanao, Davao, Caraga, and Autonomous Region in Muslim Mindanao (ARMM). While there seems to be substantial differentials in childhood mortality by region, the large sampling errors (ex- ceeding 20 points per 1,000 in some regions) suggest that the observed differences should be used with caution. Table 8.2 Early childhood mortality rates by socioeconomic characteristics and region Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preced- ing the survey, by background characteristic, Philippines 2003 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Residence Urban 14 10 24 7 30 Rural 21 15 36 17 52 Region National Capital Region 15 9 24 8 31 Cordillera Admin Region 6 8 14 20 34 I - Ilocos 19 10 29 11 39 II - Cagayan Valley 17 10 28 8 35 III - Central Luzon 15 10 25 6 31 IVA - CALABARZON 17 9 25 6 31 IVB - MIMAROPA 18 26 44 25 68 V - Bicol 19 9 28 15 43 VI - Western Visayas 22 18 39 11 50 VII - Central Visayas 18 10 28 11 39 VIII - Eastern Visayas 24 12 36 22 57 IX - Zamboanga Peninsula 6 21 27 17 43 X - Northern Mindanao 24 15 38 11 49 XI - Davao 18 20 38 10 47 XII - SOCCSKSARGEN 15 13 27 10 37 XIII -Caraga 21 14 35 14 49 ARMM 18 23 41 33 72 Education No education (33) 32 65 42 105 Elementary 22 21 43 20 62 High school 18 9 26 9 35 College or higher 9 7 15 3 18 Wealth index quintile Lowest 21 21 42 25 66 Second 19 13 32 15 47 Middle 15 10 26 6 32 Fourth 15 7 22 4 26 Highest 13 6 19 1 21 Total 17 13 30 12 42 Note: Figures in parentheses are based on 250-499 unweighted exposed persons. 1 Computed as the difference between the infant and neonatal mortality rates 110 | Infant and Child Mortality 8.4 BIODEMOGRAPHIC DIFFERENTIALS IN CHILDHOOD MORTALITY Table 8.3 presents early childhood mortality by demographic characteristics. As expected, the mortality rate is consistently higher for males than for females. For instance, the IMR for males is 35 deaths per 1,000 live births, compared with 25 deaths per 1,000 live births for females. Mother’s age at birth can affect a child’s chances of survival. The table shows that early childhood mortality rates exhibit the expected U-shaped relationship with the mother’s age: high at young ages, low at middle ages, and high at old ages (Figure 8.1). The higher rates for younger and older women may be related to biological factors that lead to complications during pregnancy and delivery. Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the ten-year period preceding the survey, by demographic characteristics, Philippines 2003 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 21 14 35 14 48 Female 13 12 25 9 34 Mother's age at birth <20 28 14 42 15 56 20-29 16 11 26 9 36 30-39 15 14 28 15 43 40-49 32 34 66 24 89 Birth order 1 19 11 29 7 36 2-3 14 9 23 8 31 4-6 14 16 29 16 45 7+ 31 25 56 29 83 Previous birth interval2 <2 23 16 39 20 58 2 years 10 16 26 13 38 3 years 10 9 19 11 30 4+ years 15 10 25 6 31 Birth size3 Small/very small 29 22 52 na na Average or larger 11 9 20 na na na = Not applicable 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey Infant and Child Mortality | 111 The 2003 NDHS results show that there is no clear pattern for neonatal and infant mortality rates by birth order: The IMR is lowest for second- and third-order births (Table 8.3). However, there is a clear positive association between birth order and the probability of dying between ages one and five: Higher order births have higher mortality risks. While the child mortality rate for first-order births is 7 deaths per 1,000, the corresponding rate for births of seventh order or higher is 29 deaths per 1,000. In general, childhood mortality rates decline as the birth interval increases. For example, the IMR for children born less than two years after a previous birth is 39 deaths per 1,000 live births, compared with 25 deaths for children born after an interval of four or more years. Children born three years after a preceding birth have the best chance of surviving infancy, with an IMR of 19 deaths per 1,000 live births. A child’s size at birth has been shown to be associated with the risk of dying during infancy, par- ticularly during the first months of life. For all children born during the five-year period before the sur- vey, mothers were asked about their perception of the child’s size: whether the child was very small, small, average size, large, or very large at birth. Although subjective, the mother’s judgment has been shown to correlate closely with the actual birth weight. The 2003 NDHS results confirm that mortality levels are higher for children perceived by the mother to have been small or very small at birth than among other children. The neonatatal mortality rate for infants who were judged to be small or very small at birth by their mothers are, for example, more than two times higher than that for infants who were re- ported to be average or larger at birth (29 and 11 deaths per 1,000 live births, respectively). 8.5 DIFFERENTIALS IN CHILDHOOD MORTALITY BY WOMEN’S STATUS Although there is no direct association, women’s status has been found to influence infant and child mortality rates through women’s ability to control resources and make decisions. In the 2003 NDHS, women were asked about certain aspects of their autonomy, including the number of household decisions in which the woman participates, the number of reasons for which a woman feels a wife is justi- fied in refusing sexual relations with her husband, and the number of reasons that justify wife beating. With regard to participation in household decisions, the following question was asked: “Who in your family usually has the final say on the following decisions?” Decisions about which women were asked include deciding about her own health care, making large household purchases, making household pur- 30 52 105 62 35 18 56 36 43 89 RESIDENCE Urban Rural MOTHER'S EDUCATION No education Elemenatry High school College or higher MOTHER'S AGE AT BIRTH <20 20-29 30-39 40-49 0 20 40 60 80 100 120 Figure 8.1 Under Five Mortality Rates by Background Characteristics NDHS 2003 112 | Infant and Child Mortality chases for daily needs, visits to family or relatives, and what food should be cooked each day. A woman is considered more independent if she participates in a larger number of household decisions. The second measure is the number of reasons to refuse sex with her husband. The following was presented to the respondents: “Husbands and wives do not always agree on everything. Please tell me if you think a wife is justified in refusing to have sex with her husband when: she knows her husband has a sexually transmitted disease, she knows her husband has sex with other women, she has recently given birth, and she is tired or not in the mood.” A woman is considered more independent if she agrees with a greater number of reasons for a woman to refuse sex. The third indicator is the number of reasons wife beating is justified. The respondent was asked the following: “Sometimes a husband is annoyed or angered by things that his wife does. In your opin- ion, is a husband justified in hitting or beating his wife in the following situations: if she goes out without telling him, if she neglects the children, if she argues with him, if she refuses to have sex with him, and if she burns the food.” A woman is considered less independent if she accepts more reasons for justifying wife beating. Table 8.4 presents childhood mortality rates by women’s status indicators. On the basis of the three indicators, there is no clear relationship between women’s status and childhood mortality. However, the decisionmaking indicator has a weak relationship to under-five mortality, such that the children of women at the extremes of decisionmaking—that is, women who make no decisions and women who par- ticipate in all decisions—are at higher risk for under-five mortality. Women who cannot make decisions are likely to be less empowered to make independent childcare decisions. Table 8.4 Early childhood mortality rates by women's status Neonatal, postneonatal, infant, child, and under-five mortality rates for the ten-year period preceding the survey, by women's status indicators, Philippines 2003 Women's status indicators Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Number of decisions in which woman has final say2 0 * 13 13 29 42 1-2 15 11 25 9 35 3-4 17 14 31 8 38 5 18 13 31 13 44 Number of reasons to refuse sex with husband 0 (16) 9 25 15 40 1-2 36 20 56 9 64 3-4 17 13 29 12 41 Number of reasons wife beating is justified 0 16 10 27 11 38 1-2 21 20 41 13 54 3-4 20 9 29 20 48 5 * 20 24 8 32 Note: Figures in parentheses are based on 250-499 unweighted exposed persons. An asterisk indicates that an estimate is based on fewer than 250 unweighted exposed persons and has been suppressed. 1 Computed as the difference between the infant and neonatal mortality rates 2 Either by herself or jointly with others Infant and Child Mortality | 113 Table 8.5 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background character- istics, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of Number pregnancies Number of early Perinatal of 7+ Background of neonatal mortality months’ characteristic stillbiirths1 deaths2 rate3 duration –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Age at birth <20 9 15 38 649 20-29 30 39 18 3,840 30-39 24 27 23 2,187 40-49 13 11 68 355 Previous pregnancy interval in months First pregnancy 16 26 23 1,837 <15 9 16 35 724 15-26 15 15 18 1,740 27-38 18 13 28 1,102 39+ 17 22 24 1,627 Residence Urban 33 39 21 3,494 Rural 43 53 27 3,536 Region National Capital Region 8 13 19 1,058 Cordillera Admin Region 2 1 23 117 I - Ilocos 4 7 36 314 II - Cagayan Valley 3 0 14 228 III - Central Luzon 6 8 20 689 IVA - CALABARZON 11 10 25 827 IVB - MIMAROPA 2 3 21 243 V - Bicol 7 5 26 439 VI - Western Visayas 11 10 43 493 VII - Central Visayas 2 4 13 537 VIII - Eastern Visayas 2 7 24 359 IX - Zamboanga Peninsula 3 3 21 279 X - Northern Mindanao 3 5 24 304 XI - Davao 3 4 24 298 XII - SOCCSKSARGEN 3 4 21 326 XIII - Caraga 4 3 35 207 ARMM 3 6 28 313 Education No education 2 4 45 135 Elementary 25 35 29 2,065 High school 32 38 23 2,984 College or higher 17 15 17 1,847 Wealth index quintile Lowest 18 28 25 1,876 Second 17 23 25 1,607 Middle 22 13 26 1,374 Fourth 14 20 29 1,176 Highest 4 7 11 997 Total 76 92 24 7,030 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age zero to six days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of seven or more months' duration, multiplied by 1,000. 8.6 PERINATAL MORTALITY In the 2003 NDHS, women were asked to report all pregnancy losses in the five years before the survey. For each such pregnancy, the duration of pregnancy was recorded. In this report, perinatal deaths include pregnancy losses occurring after seven completed months of gestation (still- births) and deaths to live births within the first seven days of life (early neonatal deaths). Thus, the perinatal mortality rate is the sum of the number of stillbirths and early neonatal deaths divided by the num- ber of pregnancies of seven or more months’ duration. The distinction between a stillbirth and an early neonatal death may be a fine one, depending often on the ob- served presence or absence of some faint signs of life after delivery. The causes of stillbirths and early neonatal deaths often overlap, and examining just one or the other can understate the true level of mor- tality around delivery. For this reason, in this report, both event types are combined and examined together. As with other childhood mortality measures, sampling errors associated with perinatal mortality rates are very large. Data in Table 8.5 show that, over- all, 76 stillbirths and 92 early neonatal deaths were recorded in the survey, resulting in a perinatal mortality rate in the Philippines of 24 deaths per 1,000 preg- nancies. Perinatal mortality is slightly higher in rural than in urban areas (27 compared with 21 deaths per 1,000 preg- nancies). Perinatal mortality rates are negatively and monotonically associated with the mother’s education, ranging from 45 deaths for women with no education to 17 deaths per 1,000 pregnancies for those with college or higher education. Varia- tions across mother’s age at birth are the same as those for childhood mortality, with the lowest levels of mortality at a ma- ternal age of 20-29. Perinatal mortality is highest among pregnancies with a preceding birth interval of less than 15 months. Apart from the wealthiest group demonstrating the least perinatal mortality, no substantial differ- entials are evident across wealth status. 114 | Infant and Child Mortality 8.7 HIGH-RISK FERTILITY BEHAVIOR Maternal fertility patterns and children’s survival risks have been known to have a strong rela- tionship. Generally, infants and children have a greater probability of dying if they are born to mothers who are too young or too old, if they are born after a short birth interval, or if they are of high birth order. These factors are of particular interest since they are easily avoidable at low or no cost. For purposes of the analysis of high-risk fertility behavior presented in Table 8.6, a mother is classified as too young if she is less than 18 years of age and too old if she is over 34 years of age at the time of delivery. A short birth interval is defined as a birth occurring less than 24 months after the previ- ous birth, and a child is of high birth order if the mother had previously given birth to three or more chil- dren (i.e., if the child is of birth order four or higher). Although first births are commonly associated with high mortality risk, even if they occur when the mother is between 18 and 34 years old, they are not in- cluded in the high-risk category unless they occurred too early or late; instead, they are considered un- avoidable. Table 8.6 presents the percentage of births in the five years preceding the survey and the percent- age of currently married women according to the level of risk category in relation to the fertility behavior of the mother. The table also presents the risk ratio or the relative risk of dying estimated by comparing the proportion dead among births in a specific high-risk category with the proportion dead among births not in any high-risk category. This information is useful for designing and monitoring programs both to avoid high-risk behavior and to cope with elevated risks. Data in Table 8.6 show the percentage of births occurring in the five years before the survey that fall into these various risk categories. Twenty-one percent of children in the Philippines are not in any high-risk category, and 25 percent have an elevated mortality risk that is unavoidable (first births for which any risk is considered unavoidable). Among those who are at risk, 34 percent of births are in only one of the high-risk categories, while 20 percent are in multiple high-risk categories (because of a combi- nation of mother’s age, birth interval, and birth order). The single avoidable high-risk categories with the highest percentage of births are birth order higher than three (15 percent) and births with intervals of less than 24 months (14 percent). Compared with births with no elevated mortality risk, the mortality risk increase associated with these categories (1.97 and 1.34, respectively) is less than that for births to mothers who were under 18 years at birth (3.41). Mortality risks are most elevated for the single-risk categories of too young mothers and too old mothers: 3 percent of births fell in the latter category, while 2 percent of births fell into the former. The multiple high-risk category with the largest proportion of births is high-order births to older mothers: 10 percent of children fall in this category. Compared with births with no elevated risk, these births are 2.5 times more likely to die in early childhood. The multiple high-risk category with the high- est risk ratio is the combination of mothers giving birth after age 34, birth interval less than 24 months, and birth order higher than three; the 3 percent of children in this category are more than five times as likely to die as children with no elevated mortality risk. Infant and Child Mortality | 115 Table 8.6 also presents the distribution of currently married women according to category of in- creased risk if they were to conceive at the time of the survey. Although many women are protected from conception through the use of family planning, postpartum insusceptibility, and prolonged abstinence, for simplicity, only those who have been sterilized are considered to be in the no-risk category solely on the basis of their contraceptive method. Two in three currently married women (66 percent) are at risk of conceiving a child with an elevated risk of dying; 30 percent of women are at risk because of a single high-risk factor, while 36 percent of women have multiple high-risk factors. The most common risk is late childbearing combined with high birth order (27 percent of currently married women). Table 8.6 High-risk fertility behavior Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribu- tion of currently married women by category of risk if they were to conceive a child at the time of the survey, Philippines 2003 Births in the 5 years preceding the survey Risk category Percentage of births Risk ratio Percentage of currently married women1 Not in any high-risk category 21.4 1.00 28.12 Unavoidable risk category First order births between ages 18 and 34 years 25.1 1.60 5.7 Single high-risk category Mother’s age <18 2.2 3.41 0.3 Mother’s age >34 3.1 2.18 10.9 Birth interval <24 months 13.8 1.34 8.7 Birth order >3 14.5 1.97 9.9 Subtotal 33.7 1.83 29.7 Multiple high-risk category Age <18 and birth interval <24 months 3 0.2 4.06 0.1 Age >34 and birth interval <24 months 0.4 0.00 0.6 Age >34 and birth order >3 10.1 2.48 27.2 Age >34 and birth interval <24 months and birth order >3 2.5 5.10 3.1 Birth interval <24 months and birth order >3 6.6 3.47 5.5 Subtotal 19.8 3.11 36.4 In any avoidable high-risk category 53.5 2.30 66.1 Total 100.0 - 100.0 Number of births 6,954 - 8,671 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher. 2 Includes sterilized women 3 Includes the category age <18 and birth order >3 Maternal and Child Health | 117 MATERNAL AND CHILD HEALTH 9 This chapter presents findings related to maternal and child health, specifically on the following topics: antenatal care, including iron supplementation and tetanus toxoid vaccination; delivery care and services; and postnatal care. This chapter also presents indicators on children’s health, including immuni- zation and prevalence of childhood diseases. These findings can assist in identifying women and children who have less access to maternal and child health services, for whom health planners can formulate plans and programs aimed to improve their services. 9.1 ANTENATAL CARE The quality of antenatal care provided to pregnant women can be assessed in terms of the type of service provider, the number of antenatal care visits made, the timing of the first visit, and the services and information provided during antenatal checkups. In the 2003 National Demographic and Health Sur- vey (NDHS), women who had one or more live births in the five years preceding the survey were asked whether they saw anyone for antenatal care during the pregnancy of their last live birth. 9.1.1 Antenatal Care Coverage Table 9.1 shows the percent distribution of women who had a live birth in the five years preced- ing the survey by source of antenatal care (ANC) received during the pregnancy with the last birth. The interviewers were instructed to record all ANC providers mentioned by the respondent. However, in this table, only the provider with the highest qualification is considered if a respondent mentions more than one provider. Overall, 88 percent of women who had a live birth in the five years preceding the survey received ANC from a medical professional during pregnancy with the most recent birth (Table 9.1). Half of all women with a recent birth received care from a nurse or a midwife, and 38 percent received care from a doctor. Traditional birth attendants provided ANC to 7 percent of women. These figures show lit- tle change from those recorded in the 1998 NDHS (NSO, DOH, and Macro International Inc., 1999). Women who were less than 35 years old when they gave birth, those with a smaller number of children, those who live in urban areas, women with higher education, and women who are economically better off are more likely to have had an antenatal checkup from a doctor, nurse, or midwife. For exam- ple, antenatal coverage ranges from 72 percent of women in the poorest quintile to 97 percent of women in the wealthiest quintile. The most significant difference, however, is by woman’s education. While 96 percent of women with college or higher education have received ANC from a health professional, the corresponding proportion for women with no education is only 33 percent. There are wide variations in antenatal coverage and services across regions. In the majority of re- gions, at least 90 percent of women received ANC from a health professional. Eleven percent of women each in Cordillera Administrative Region (CAR) and Zamboanga Peninsula received no ANC. In gen- eral, midwives and nurses are the most popular antenatal care providers, except in the National Capital Region (NCR) and CAR, where the most likely ANC provider is a doctor (73 and 55 percent, respec- tively). In Eastern Visayas, Zamboanga Peninsula, SOCCSKSARGEN, and Autonomous Region in Mus- lim Mindanao (ARMM), a large proportion of women receive ANC from a traditional birth attendant (TBA). In ARMM, for instance, 45 percent of women are attended by a TBA for ANC. 118 | Maternal and Child Health Table 9.1 Antenatal care Among women who had a live birth in the five years preceding the survey by antenatal care (ANC) pro- vider during pregnancy for the most recent birth, according to background characteristics, Philippines 2003 Background characteristic Doctor Nurse/ midwife Traditional birth attendant/ other No one Missing Total Number of women Age at birth <20 31.5 56.5 7.6 4.3 0.0 100.0 387 20-34 39.8 49.4 5.7 4.9 0.2 100.0 3,492 35-49 34.4 47.1 9.1 8.6 0.9 100.0 923 Birth order 1 52.0 40.9 4.0 2.9 0.2 100.0 1,192 2-3 42.8 48.6 4.3 4.2 0.2 100.0 1,902 4-5 27.9 57.8 7.6 6.3 0.4 100.0 937 6+ 17.3 55.3 14.4 12.3 0.7 100.0 771 Residence Urban 53.0 38.2 3.7 4.7 0.3 100.0 2,447 Rural 22.5 61.3 9.4 6.5 0.3 100.0 2,355 Region National Capital Region 73.0 19.1 3.1 4.4 0.4 100.0 724 Cordillera Admin Region 54.5 31.5 2.9 11.1 0.0 100.0 79 I - Ilocos 37.3 54.0 1.4 6.9 0.5 100.0 220 II - Cagayan Valley 29.6 60.5 3.3 6.5 0.0 100.0 169 III - Central Luzon 46.7 45.7 2.2 4.2 1.1 100.0 480 IVA - CALABARZON 46.7 44.3 1.7 7.3 0.0 100.0 595 IVB - MIMAROPA 19.0 63.0 8.7 8.8 0.5 100.0 155 V - Bicol 30.0 55.6 8.6 5.2 0.6 100.0 290 VI - Western Visayas 34.6 58.8 1.5 5.1 0.0 100.0 324 VII - Central Visayas 31.0 60.4 4.8 3.5 0.3 100.0 359 VIII - Eastern Visayas 19.1 60.0 17.9 3.0 0.0 100.0 230 IX - Zamboanga Peninsula 12.5 64.6 11.7 11.2 0.0 100.0 199 X - Northern Mindanao 20.7 70.4 0.9 7.6 0.4 100.0 219 XI - Davao 30.0 60.2 6.0 3.4 0.4 100.0 216 XII - SOCCSKSARGEN 16.4 65.7 12.3 5.7 0.0 100.0 223 XIII - Caraga 27.6 62.9 5.8 3.7 0.0 100.0 135 ARMM 15.6 34.2 45.3 4.9 0.0 100.0 184 Education No education 6.7 26.5 38.6 27.5 0.7 100.0 80 Elementary 13.0 62.6 12.9 11.3 0.3 100.0 1,349 High school 34.2 58.0 4.1 3.4 0.4 100.0 2,037 College or higher 71.1 25.0 1.9 1.8 0.2 100.0 1,337 Wealth index quintile Lowest 8.6 63.8 16.2 11.2 0.2 100.0 1,162 Second 22.8 65.3 6.0 5.4 0.5 100.0 1,065 Middle 38.9 51.8 4.2 4.7 0.3 100.0 944 Fourth 58.5 37.7 1.5 2.1 0.3 100.0 863 Highest 79.9 16.7 1.0 2.1 0.3 100.0 768 Total 38.1 49.5 6.5 5.6 0.3 100.0 4,802 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Maternal and Child Health | 119 Urban women, women in the wealthiest quintile, and women with college or higher education are more likely to consult a doctor for an antenatal checkup than other women. Table 9.1 also shows that women are more likely to consult a doctor for ANC for their first pregnancy than for subsequent pregnancies (52 percent, compared with 43 percent or less for each subsequent preg- nancy). The Department of Health (DOH) recommends that all pregnant women have at least four ANC visits during each pregnancy. The 2003 NDHS data show that seven in ten women who had a live birth in the five years preceding the survey had the recommended number of ANC visits during the pregnancy with last live birth (Table 9.2). This percent- age is much higher in urban areas (78 per- cent) than in rural areas (62 percent). DOH further recommends that for early detection of pregnancy-related health problems, the first antenatal checkup should occur in the first trimester of the pregnancy. More than half (53 percent) of women who had at least one live birth in the five years preceding the survey adopted this recom- mendation. For three in ten women, the first visit was made when their pregnancy was in the fourth or fifth month, while one in ten had the first antenatal checkup when they were six to seven months pregnant. Women in urban areas tend to have their first checkup earlier than rural women: while 62 percent of urban women had their first ANC visit in the first trimester of pregnancy, the corresponding proportion in rural areas is 44 percent. Half of these women who received ANC had had their visit by the time they were 3.8 months pregnant. This finding is similar to that recorded in the 1998 NDHS (3.9 months) for all births in the pre- ceding five years (not just the most recent) (NSO, DOH, and Macro International Inc., 1999). 9.1.2 Components of Antenatal Care Services High-quality ANC includes educating pregnant women about conditions during pregnancy that they should recognize as dangerous to them or to their baby so as to allow early intervention. In the 2003 NDHS, women who had a live birth in the five years preceding the survey were asked whether in any of their ANC visits, their weight, height, and blood pressure were measured, or samples of their urine or blood were taken. They were also asked whether during any of their ANC visits for their last birth they were informed of symptoms of pregnancy complications. Table 9.3 summarizes the responses to these questions. Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women who had a live birth in the five years preceding the survey, by number of antenatal care (ANC) visits for the most recent birth, and by the timing of the first visit, and whether they had at least one ANC visit in each trimester, according to residence, Philippines 2003 Residence Number and timing of ANC visits Urban Rural Total Number of ANC visits None 4.7 6.5 5.6 1 3.2 5.8 4.5 2-3 12.5 24.9 18.6 4+ 78.2 62.3 70.4 Don't know/missing 1.3 0.5 0.9 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 4.7 6.5 5.6 <4 61.5 44.2 53.0 4-5 23.8 35.0 29.2 6-7 8.1 11.8 9.9 8+ 1.7 2.3 2.0 Don't know/missing 0.3 0.3 0.3 Total 100.0 100.0 100.0 Median months pregnant at first visit (for those with ANC) 3.5 4.2 3.8 Number of women 2,447 2,355 4,802 120 | Maternal and Child Health Table 9.3 Components of antenatal care Among women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth, percentage who received specific antenatal care content, and percentage of women with a live birth in the five years preceding the survey who received iron tablets or syrup for the most recent birth, according to background characteristics, Philippines 2003 Content of care among women who received antenatal care Background characteristic Informed of signs of pregnancy complications Weight measured Height measured Blood pressure measured Urine sample taken Blood sample taken Number of women Percentage of women who received iron tablets or syrup Number of women Age at birth <20 46.0 87.2 58.5 87.2 40.6 33.9 370 75.8 387 20-34 49.6 88.6 60.1 91.4 47.8 37.7 3,314 77.9 3,492 35-49 48.3 85.3 58.7 87.5 45.2 39.2 835 73.3 923 Birth order 1 54.7 91.4 64.1 93.4 58.7 47.7 1,154 82.0 1,192 2-3 50.4 90.2 61.6 92.9 50.2 39.1 1,820 79.7 1,902 4-5 44.9 85.8 57.5 88.2 38.7 31.5 875 73.5 937 6+ 41.0 78.1 50.1 80.7 27.1 24.5 670 65.9 771 Residence Urban 53.0 92.8 67.2 94.1 62.1 49.2 2,324 79.8 2,447 Rural 44.8 82.6 51.8 86.4 30.5 25.4 2,196 73.8 2,355 Region National Capital Region 57.7 95.2 78.5 95.1 76.9 66.6 689 76.6 724 Cordillera Admin Region 47.0 90.4 56.2 93.5 51.9 36.3 70 66.5 79 I - Ilocos 35.1 90.0 54.6 94.5 46.2 36.2 204 77.4 220 II - Cagayan Valley 46.9 90.3 65.7 92.5 39.8 29.6 158 72.7 169 III - Central Luzon 35.8 89.5 58.2 93.9 61.5 44.6 455 80.6 480 IVA - CALABARZON 52.0 93.6 62.7 95.6 57.3 36.3 552 76.9 595 IVB - MIMAROPA 39.9 81.2 49.9 85.4 24.6 25.3 141 73.8 155 V - Bicol 39.0 84.5 40.5 87.6 28.0 19.4 273 73.3 290 VI - Western Visayas 51.5 92.0 68.4 96.9 39.0 36.4 308 84.7 324 VII - Central Visayas 63.2 93.0 58.3 93.3 43.2 40.6 345 86.9 359 VIII - Eastern Visayas 30.9 76.5 48.5 80.8 23.9 21.3 223 74.0 230 IX - Zamboanga Peninsula 40.9 79.5 57.5 84.5 13.6 15.5 177 74.4 199 X - Northern Mindanao 67.6 94.9 59.0 90.3 40.5 38.7 202 79.7 219 XI - Davao 56.6 90.3 55.5 93.7 50.3 40.4 208 80.2 216 XII - SOCCSKSARGEN 48.4 78.1 54.4 81.5 27.7 18.8 210 76.9 223 XIII - Caraga 71.1 91.7 61.0 90.8 43.8 40.5 130 88.8 135 ARMM 35.0 44.5 35.2 52.3 19.0 13.5 175 40.2 184 Education No education 22.2 36.7 23.6 31.1 7.7 7.5 57 29.7 80 Elementary 39.4 79.0 47.9 81.5 26.7 23.4 1,193 67.2 1,349 High school 48.4 88.9 61.0 92.5 45.4 35.5 1,960 78.1 2,037 College or higher 59.9 96.5 70.1 97.7 68.7 55.2 1,310 87.4 1,337 Wealth index quintile Lowest 39.5 73.2 45.1 77.4 19.1 16.8 1,030 64.7 1,162 Second 47.8 86.3 55.8 89.8 35.2 29.5 1,002 75.3 1,065 Middle 49.4 91.5 62.3 93.0 51.8 39.8 896 80.6 944 Fourth 51.7 94.8 66.7 96.3 63.1 49.5 843 82.2 863 Highest 60.4 97.9 74.1 98.9 75.7 61.3 749 86.9 768 Total 49.1 87.9 59.7 90.3 46.7 37.6 4,520 76.8 4,802 Maternal and Child Health | 121 Table 9.3 shows that about half of women who received ANC for the most recent birth in the past five years were informed of pregnancy complications, such as vaginal bleeding, headache, dizziness, blurred vision, swollen face, swollen hands, and paleness or anemia. Women who have had only one birth, live in urban areas, have better education, and fall into the wealthiest quintile are more likely than other women to be informed of potential problems during pregnancy. Women in Caraga are the most likely to have been informed of pregnancy complications (71 percent); women in Eastern Visayas are the least likely to have been informed (31 percent). Nine in ten women had their blood pressure and weight measurements taken during their ANC visit (Table 9.3). Six in 10 women had their height measured, 47 percent of the women had their urine sample taken, and 38 percent had a blood sample taken. As one of the essential services of the maternal care program of DOH, pregnant women are en- couraged to have iron or folate supplementation. Because pregnant women are prone to anemia, they need to take iron tablets or capsules to meet their daily iron requirements. Table 9.3 shows that 77 per- cent of women with a live birth in the five years preceding the survey received iron tablets or syrup dur- ing the pregnancy of their last birth. There are some variations in iron supplementation coverage across subgroups of women, but the most significant differences are by the woman’s education. While 87 per- cent of women with college or higher education received iron supplementation, the corresponding propor- tion for women with no education is only 30 percent. At the regional level, the percentage varies from 40 percent in ARMM to 89 percent in Caraga. 9.1.3 Information about Pregnancy Complications Table 9.4 shows that among women with a live birth in the five years preceding the survey who were informed about danger signs of pregnancy complications, about one-third report that they were told to watch out for vaginal bleeding, headache, dizziness, and paleness or anemia. Less than 30 percent were informed of such symptoms as blurred vision, swollen face, and swollen hands. As in the case of ANC coverage, there are some variations in the likelihood that women were told of potential problems during pregnancy. However, women with no education are the least likely to have received any informa- tion about symptoms of pregnancy complications. There are sharp differentials across regions in the information provided to pregnant women on possible problems during pregnancy: women in Eastern Visayas are the least likely to be informed of any complications that may arise from their pregnancy (31 percent are informed), while women in Caraga have the best chances of having this information (71 percent are informed). Compared with data from the 1998 NDHS, there appears to be an increase in the proportion of pregnant women who were informed of the dangers of pregnancy, from 33 percent in 1998 for all births in the preceding five years to 49 percent in 2003 for the most recent birth in the preceding five years (NSO, DOH, and Macro International Inc., 1999). 122 | Maternal and Child Health Table 9.4 Information about danger signs of pregnancy Among women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth, per- centage who received information about danger signs during pregnancy, according to background characteristics, Philippines 2003 Informed about specific pregnancy complications Background characteristic Not informed of any compli- cations Vaginal bleeding Headache Dizziness Blurred vision Swollen face Swollen hands Pale or anemic Number of women Age at birth <20 54.0 30.1 32.9 37.6 24.1 23.2 24.9 29.0 370 20-34 50.4 32.8 34.8 38.7 27.1 28.6 28.7 34.4 3,314 34-49 51.7 31.3 33.1 35.9 28.0 27.9 28.7 31.4 835 Birth order 1 45.3 36.3 37.9 43.3 29.3 31.7 32.0 36.1 1,154 2-3 49.6 33.9 36.0 39.3 27.8 28.3 28.4 34.5 1,820 4-5 55.1 30.0 30.6 34.8 24.8 25.6 26.7 31.8 875 6+ 59.0 24.3 28.7 29.9 23.9 23.8 24.3 27.8 670 Residence Urban 47.0 35.6 37.4 41.7 28.6 29.8 30.6 36.3 2,324 Rural 55.2 28.8 31.1 34.2 25.4 26.0 26.0 30.3 2,196 Region National Capital Region 42.3 40.3 42.4 47.5 31.3 33.0 33.9 42.0 689 Cordillera Admin Region 53.0 34.5 32.9 38.1 23.6 25.8 27.5 34.6 70 I - Ilocos 64.9 23.7 24.7 27.2 21.7 23.7 22.2 26.2 204 II - Cagayan Valley 53.1 25.6 38.3 38.8 13.3 21.1 23.0 20.5 158 III - Central Luzon 64.2 13.6 17.8 21.9 8.3 11.2 10.4 15.4 455 IVA - CALABARZON 48.0 35.6 36.0 42.4 28.0 29.5 28.7 33.8 552 IVB - MIMAROPA 60.1 19.6 26.1 28.5 23.3 19.1 18.6 23.3 141 V - Bicol 61.0 20.2 22.1 26.0 17.5 15.5 17.3 18.7 273 VI - Western Visayas 48.5 39.8 35.3 38.5 34.4 33.1 33.1 39.8 308 VII - Central Visayas 36.8 44.7 47.0 49.5 42.1 42.4 43.4 47.1 345 VIII - Eastern Visayas 69.1 22.8 22.4 21.3 18.6 17.7 17.7 19.7 223 IX - Zamboanga Peninsula 59.1 20.2 22.0 27.1 17.3 17.2 16.7 23.2 177 X - Northern Mindanao 32.4 45.7 54.4 59.0 46.4 55.3 54.5 59.0 202 XI - Davao 43.4 35.7 38.3 43.3 27.7 30.5 33.1 37.9 208 XII - SOCCSKSARGEN 51.6 41.0 39.5 41.1 34.8 34.6 35.3 40.1 210 XIII - Caraga 28.9 53.4 56.7 64.1 52.3 49.0 49.4 56.6 130 ARMM 65.0 24.4 24.8 23.6 20.2 14.3 17.8 25.1 175 Education No education 77.8 13.7 13.1 11.1 7.6 12.9 14.2 11.4 57 Elementary 60.6 23.9 25.9 29.1 21.5 21.1 21.5 25.9 1,193 High school 51.6 30.9 33.0 37.3 26.0 26.7 27.2 33.2 1,960 College or higher 40.1 42.8 45.0 48.5 34.4 36.8 37.1 41.5 1,310 Wealth index quintile Lowest 60.5 25.6 27.9 29.0 23.7 21.3 21.8 27.9 1,030 Second 52.2 30.0 32.2 36.4 26.6 27.4 27.7 31.5 1,002 Middle 50.6 32.7 34.8 39.2 27.4 28.8 29.4 34.4 896 Fourth 48.3 33.1 34.8 39.4 26.4 26.9 27.0 34.0 843 Highest 39.6 43.3 45.1 49.9 32.5 38.2 38.7 41.7 749 Total 50.9 32.3 34.4 38.1 27.0 28.0 28.4 33.4 4,520 Maternal and Child Health | 123 Table 9.5 indicates that 57 percent of pregnant women who had antenatal care for their most re- cent birth were not told where to go in case of pregnancy complications. Among women who were in- formed about where to go in case of pregnancy complications, 15 percent reported that they were told to go to a government hospital, 11 percent were told to go to a rural or urban health center, and 10 percent each were told to go to a barangay health station or a private hospital or clinic. Again, the most notable differences in the percentages are by the woman’s education. Women with college or higher education are much more likely than other women to be told where to go in case of pregnancy complications (55 per- cent), compared with only 17 percent of women with no education. Table 9.5 Place to go in case of pregnancy complications Among women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth, percentage who were informed to go to a specific facility in case of complications, by type of facility and background characteristics, Philippines 2003 Informed to go to a specific facility Background characteristic Not informed where to go Govern- ment hospital Rural/ urban health center Barangay health station Private hospital/ clinic Private doctor Private nurse/ midwife Other/ missing Number of women Age at birth <20 62.0 12.3 11.5 11.0 6.6 2.5 0.4 0.5 370 20-34 55.7 14.8 10.8 9.6 10.4 5.2 0.3 0.5 3,314 34-49 57.8 15.9 11.0 9.8 7.8 4.4 0.2 0.8 835 Birth order 1 51.9 15.4 10.3 8.7 15.4 6.7 0.2 0.4 1,154 2-3 55.3 14.7 10.1 9.5 10.5 5.9 0.4 0.5 1,820 4-5 59.9 15.1 11.4 10.3 6.5 2.9 0.3 0.8 875 6+ 63.9 13.7 13.3 11.4 1.1 1.2 0.0 0.9 670 Residence Urban 52.5 15.6 10.6 7.4 14.2 5.7 0.4 0.6 2,324 Rural 60.9 14.0 11.1 12.2 4.7 3.9 0.1 0.6 2,196 Region National Capital Region 48.2 19.3 12.4 3.3 17.8 3.2 0.6 0.3 689 Cordillera Admin Region 61.9 16.6 10.3 3.1 8.9 3.2 0.0 1.8 70 I - Ilocos 68.9 7.9 11.3 3.5 5.5 3.4 0.0 0.5 204 II - Cagayan Valley 61.8 11.8 6.0 10.1 6.2 5.7 0.5 0.0 158 III - Central Luzon 71.1 10.5 4.9 7.0 6.2 4.2 0.3 0.5 455 IVA - CALABARZON 52.4 13.5 12.0 5.6 15.7 5.7 0.5 0.0 552 IVB - MIMAROPA 63.1 15.5 11.6 6.1 4.3 1.0 1.0 1.0 141 V - Bicol 68.1 12.7 8.1 8.7 6.3 3.8 0.2 0.8 273 VI - Western Visayas 52.2 21.0 14.5 8.7 4.5 8.6 0.0 0.4 308 VII - Central Visayas 44.1 12.0 18.2 13.8 11.2 7.1 0.0 0.3 345 VIII - Eastern Visayas 73.7 13.6 8.4 1.5 2.3 1.2 0.0 0.0 223 IX - Zamboanga Peninsula 64.9 9.6 5.4 15.6 5.9 0.5 0.0 0.0 177 X - Northern Mindanao 36.5 25.1 7.7 33.7 12.7 4.1 0.0 0.5 202 XI - Davao 51.3 14.6 10.8 14.5 12.1 10.1 0.0 1.4 208 XII - SOCCSKSARGEN 57.0 8.6 14.5 14.5 6.1 7.8 0.0 1.6 210 XIII - Caraga 34.4 25.1 12.5 37.3 8.3 11.0 0.5 1.3 130 ARMM 68.7 15.5 10.5 7.8 1.6 1.3 0.4 2.9 175 Education No education 82.8 3.1 0.8 9.5 0.0 1.3 0.0 3.8 57 Elementary 66.6 10.8 12.1 11.5 1.8 1.2 0.2 0.4 1,193 High school 57.5 16.5 11.7 10.7 5.8 3.7 0.4 0.5 1,960 College or higher 45.0 16.5 8.9 6.7 22.7 9.9 0.1 0.8 1,310 Wealth index quintile Lowest 66.1 11.2 11.9 12.7 1.1 1.3 0.2 0.7 1,030 Second 57.5 16.7 13.1 13.8 3.6 2.8 0.1 0.9 1,002 Middle 56.3 16.5 12.2 9.3 7.2 5.0 0.1 0.5 896 Fourth 54.6 17.2 9.4 7.6 12.7 5.8 0.9 0.4 843 Highest 45.0 12.5 6.6 3.3 28.6 11.3 0.2 0.3 749 Total 56.6 14.8 10.9 9.7 9.6 4.8 0.3 0.6 4,520 124 | Maternal and Child Health As in the case of information on pregnancy complications, there are sharp differentials across regions in the information provided to pregnant women about the place to go should such complications occur. More than 70 percent of women in Central Luzon and Eastern Visayas were not in- formed of where to go for help with any complications that may arise from their pregnancy, while women in Caraga have the best chances of hav- ing this information (66 percent). As was the case with information on dan- ger signs of pregnancy, women in Eastern Visayas have the least infor- mation, while women in Caraga are the most informed. 9.1.4 Tetanus Toxoid Injections One of the maternal and child health programs of DOH is providing tetanus toxoid immunization to preg- nant women in order to protect new- born babies from neonatal tetanus, which is one of the major causes of neonatal deaths. The program recom- mends that women receive at least two tetanus toxoid (TT) injections during their first pregnancy. Table 9.6 shows that 37 per- cent of women who had a live birth in the five years preceding the survey received two or more injections of TT. Twenty-eight percent of these women received no tetanus injection. TT cov- erage in 2003 is similar to that re- corded in the 1998 NDHS (38 per- cent). It is important to note, however, that some women may have had enough TT prior to the index preg- nancy that they did not require further injections. This may be the case in particular for women at higher pari- ties. Births to young women, lower order births, and births to better educated women are more likely than other births to be protected from neonatal tetanus. Interestingly, TT coverage does not vary much by wealth status. Across the regions, TT coverage ranges from 23 percent in ARMM to 49 percent in Davao. Table 9.6 Tetanus toxoid injections Percent distribution of women who had a live birth in the five years preceding the survey, by number of tetanus toxoid injections received during pregnancy for the most recent birth, according to background characteristics, Philippines 2003 Background characteristic None One injection Two or more injections Don't know/ missing Total Number of women Age at birth <20 23.0 31.5 44.5 1.0 100.0 387 20-34 25.7 34.3 38.5 1.5 100.0 3,492 35-49 38.4 30.9 29.5 1.3 100.0 923 Birth order 1 22.4 30.3 45.6 1.6 100.0 1,192 2-3 22.0 37.6 39.1 1.3 100.0 1,902 4-5 31.4 34.9 32.0 1.6 100.0 937 6+ 46.6 26.2 26.1 1.1 100.0 771 Residence Urban 26.5 35.1 36.6 1.9 100.0 2,447 Rural 29.4 31.7 38.0 0.9 100.0 2,355 Region National Capital Region 23.4 39.3 34.9 2.4 100.0 724 Cordillera Admin Region 35.6 35.2 28.7 0.5 100.0 79 I - Ilocos 23.4 37.8 37.4 1.4 100.0 220 II - Cagayan Valley 21.8 30.3 47.9 0.0 100.0 169 III - Central Luzon 31.0 34.9 31.9 2.2 100.0 480 IVA - CALABARZON 27.0 35.0 36.3 1.7 100.0 595 IVB - MIMAROPA 30.9 24.5 43.1 1.5 100.0 155 V - Bicol 34.6 35.7 29.1 0.6 100.0 290 VI - Western Visayas 30.5 28.4 39.6 1.5 100.0 324 VII - Central Visayas 22.2 30.1 46.4 1.3 100.0 359 VIII - Eastern Visayas 33.9 30.2 35.1 0.8 100.0 230 IX - Zamboanga Peninsula 30.5 32.7 36.8 0.0 100.0 199 X - Northern Mindanao 26.0 35.8 36.8 1.3 100.0 219 XI - Davao 19.9 29.4 49.1 1.6 100.0 216 XII - SOCCSKSARGEN 24.9 30.7 42.7 1.8 100.0 223 XIII - Caraga 19.6 38.1 42.3 0.0 100.0 135 ARMM 52.5 24.1 23.4 0.0 100.0 184 Education No education 71.7 13.5 14.0 0.7 100.0 80 Elementary 35.2 29.1 34.8 0.9 100.0 1,349 High school 22.5 35.4 40.6 1.5 100.0 2,037 College or higher 26.1 35.9 36.2 1.8 100.0 1,337 Wealth index quintile Lowest 37.6 29.7 31.9 0.8 100.0 1,162 Second 25.5 30.8 42.3 1.3 100.0 1,065 Middle 22.6 37.5 38.6 1.3 100.0 944 Fourth 23.5 35.2 39.3 2.0 100.0 863 Highest 28.1 35.6 34.5 1.8 100.0 768 Total 27.9 33.4 37.3 1.4 100.0 4,802 Maternal and Child Health | 125 9.2 DELIVERY CARE 9.2.1 Place of Delivery Thirty-eight percent of live births in the five years preceding the survey were delivered in a health facility, and 61 percent were born at home (Table 9.7). These figures show an increase in the proportion of births occurring in a health facility (34 percent in 1998) and a decline in the percentage of births deliv- ered at home (66 percent in 1998) (NSO, DOH, and Macro International Inc., 1999). Table 9.7 Place of delivery Percent distribution of live births in the five years preceding the survey, by place of delivery, according to background characteristics, Philippines 2003 Health facility Background characteristic Government hospital Government health center Private sector Home Other Missing Total Number of births Age at birth <20 21.5 1.3 11.6 64.1 0.3 1.2 100.0 640 20-34 23.4 1.6 14.4 60.0 0.2 0.4 100.0 5,189 35-49 20.5 0.5 11.7 66.1 0.2 0.8 100.0 1,125 Birth order 1 31.4 1.3 20.4 45.5 0.5 0.8 100.0 1,945 2-3 23.1 2.0 15.7 58.7 0.1 0.2 100.0 2,663 4-5 17.3 1.1 8.8 72.1 0.0 0.6 100.0 1,245 6+ 12.8 0.6 2.4 83.5 0.1 0.7 100.0 1,102 Antenatal care visits1 None 9.3 1.3 3.8 85.2 0.0 0.4 100.0 268 1-3 15.2 0.4 4.4 79.9 0.1 0.0 100.0 1,108 4+ 27.6 1.7 19.4 51.0 0.2 0.0 100.0 3,381 Residence Urban 29.5 2.1 22.1 45.5 0.1 0.5 100.0 3,461 Rural 16.0 0.7 5.3 77.0 0.3 0.5 100.0 3,493 Region National Capital Region 38.5 2.7 28.4 30.0 0.0 0.5 100.0 1,050 Cordillera Admin Region 38.6 0.0 6.2 55.2 0.0 0.0 100.0 115 I - Ilocos 21.3 0.3 7.5 70.2 0.3 0.3 100.0 310 II - Cagayan Valley 19.2 0.0 6.5 73.9 0.0 0.4 100.0 224 III - Central Luzon 30.8 0.8 17.8 49.3 0.0 1.4 100.0 683 IVA - CALABARZON 22.6 3.2 20.0 53.5 0.3 0.2 100.0 816 IVB - MIMAROPA 13.0 0.6 2.1 83.0 0.0 1.3 100.0 241 V - Bicol 15.7 0.7 5.5 76.3 1.2 0.5 100.0 432 VI - Western Visayas 24.1 2.4 6.9 65.9 0.0 0.8 100.0 482 VII - Central Visayas 20.7 1.5 17.6 58.8 0.2 1.0 100.0 535 VIII - Eastern Visayas 14.7 0.7 5.3 79.3 0.0 0.0 100.0 357 IX - Zamboanga Peninsula 10.9 1.0 3.7 83.8 0.6 0.0 100.0 276 X - Northern Mindanao 18.5 0.3 10.1 70.2 0.3 0.6 100.0 301 XI - Davao 21.3 0.3 19.4 59.0 0.0 0.0 100.0 295 XII - SOCCSKSARGEN 12.3 1.2 9.6 76.2 0.3 0.0 100.0 324 XIII - Caraga 21.3 0.9 3.9 73.6 0.0 0.3 100.0 203 ARMM 6.3 0.5 3.9 88.4 0.3 0.7 100.0 310 Mother's education No education 3.2 0.0 0.5 95.3 0.0 1.0 100.0 132 Elementary 11.8 1.3 2.6 83.4 0.2 0.8 100.0 2,040 High school 23.9 1.9 9.5 64.0 0.2 0.4 100.0 2,952 College or higher 34.5 0.9 33.7 30.1 0.3 0.4 100.0 1,830 Wealth index quintile Lowest 8.7 0.5 1.2 88.7 0.1 0.7 100.0 1,858 Second 19.6 0.8 4.4 74.3 0.3 0.5 100.0 1,590 Middle 30.4 1.8 11.1 56.2 0.2 0.2 100.0 1,352 Fourth 34.6 3.0 22.2 39.0 0.3 1.0 100.0 1,162 Highest 29.9 1.6 45.5 22.6 0.1 0.1 100.0 993 Total 22.8 1.4 13.7 61.4 0.2 0.5 100.0 6,954 Note: Total includes 46 women with no information on number of antenatal care visits. 1 Includes only the most recent birth in the five years preceding the survey 126 | Maternal and Child Health Twenty-four percent of births took place in a government hospital or health center, and 14 percent occurred in a private facility. First-order births, births to urban women, births to women in the higher wealth quintiles, births to women with college or higher level of education, and births to women who have four or more antenatal visits are more likely to have taken place in a health facility. The vast major- ity of sixth or higher order births (84 percent), births to the poorest women (89 percent), births to women with no education (95 percent), and births to women who had no antenatal checkup (85 percent) were de- livered at home. Delivery in a health facility is most common in NCR (70 percent). In ten regions, at least 70 per- cent of births occurred at home, with ARMM (88 percent), MIMAROPA (83 percent), and Zamboanga Peninsula (84 percent) registering the highest percentages. 9.2.2 Delivery Assistance In the 2003 NDHS, if the respondent was assisted by more than one attendant at delivery, the in- terviewer was instructed to record all persons attending to the delivery. In Table 9.8, only the most quali- fied attendant is considered. Sixty percent of births in the five years preceding the survey are assisted by health professionals: 34 percent by a doctor, 25 percent by a midwife, and 1 percent by a nurse. While coverage of births attended by a health professional has increased in the last five years from 56 percent in 1998 (NSO, DOH, and Macro International Inc., 1999), it remains lower than the target set by DOH (80 percent by 2004). Thirty-seven percent of births in the five years preceding the survey were attended by a hilot. This is to be expected because the majority of deliveries took place at home. It is interesting to note that while 88 percent of women who had a live birth during the reference period saw a health professional for antenatal care, only 60 percent of all births were attended by a health professional during delivery. Assistance by a health professional during delivery is more common for lower-order births, births in urban areas, births of wealthier women, and births to better-educated mothers. The largest gaps in be- ing assisted by a health professional during delivery are between the poorest women and the wealthiest women and between women with no education and those with the highest educational levels. While 25 percent of women in the poorest quintile and only 11 percent of women with no education are assisted by a health professional during delivery, the corresponding proportions for women in the wealthiest quintile and those with college or higher education are 92 and 86 percent, respectively. Almost nine in ten deliveries in NCR are assisted by a health professional (64 percent by a doctor and 24 percent by a midwife or nurse). On the other extreme, the majority of births in ARMM (77 per- cent) are assisted by a hilot. Of those assisted by a health professional, 9 percent are attended by a doctor and 13 percent by a midwife or nurse. While births in CAR are more likely than those in ARMM to re- ceive care from a medically trained person during delivery, a large proportion are assisted by a relative or friend (22 percent), and 3 percent are delivered with no assistance. Maternal and Child Health | 127 Table 9.8 Assistance during delivery Percent distribution of live births in the five years preceding the survey, by person providing assistance during deliv- ery, according to background characteristics, Philippines 2003 Background characteristic Doctor Nurse Midwife Hilot Relative/ friend/ other No one Missing Total Number of births Age at birth <20 29.0 1.4 25.3 40.0 2.8 0.0 1.5 100.0 640 20-34 35.0 1.1 25.9 35.3 2.2 0.2 0.4 100.0 5,189 35-49 30.0 0.9 21.1 44.0 2.8 0.3 0.9 100.0 1,125 Birth order 1 48.2 1.3 23.3 24.9 1.4 0.0 0.9 100.0 1,945 2-3 35.7 1.2 27.1 33.7 1.9 0.1 0.3 100.0 2,663 4-5 23.2 1.3 27.8 43.9 3.0 0.2 0.6 100.0 1,245 6+ 14.7 0.3 19.9 59.1 4.5 0.7 0.7 100.0 1,102 Residence Urban 48.2 1.3 29.5 19.6 0.8 0.1 0.5 100.0 3,461 Rural 19.2 1.0 20.7 54.4 3.9 0.3 0.6 100.0 3,493 Region National Capital Region 64.4 0.7 22.8 11.6 0.0 0.1 0.4 100.0 1,050 Cordillera Admin Region 40.7 3.7 15.2 14.1 22.4 3.4 0.4 100.0 115 I - Ilocos 28.5 0.7 45.0 24.6 1.0 0.0 0.3 100.0 310 II - Cagayan Valley 23.5 1.1 28.6 42.9 3.5 0.0 0.4 100.0 224 III - Central Luzon 43.6 0.4 41.8 12.0 0.4 0.0 1.8 100.0 683 IVA - CALABARZON 40.4 0.5 33.8 24.4 0.7 0.0 0.2 100.0 816 IVB - MIMAROPA 13.7 3.2 12.4 66.3 2.8 0.3 1.3 100.0 241 V - Bicol 19.5 2.1 26.2 50.2 1.2 0.2 0.5 100.0 432 VI - Western Visayas 30.9 0.0 16.5 49.7 2.1 0.0 0.8 100.0 482 VII - Central Visayas 34.2 1.5 32.6 29.0 1.7 0.0 1.0 100.0 535 VIII - Eastern Visayas 16.4 1.4 18.2 62.3 1.7 0.0 0.0 100.0 357 IX - Zamboanga Peninsula 12.9 1.3 16.8 64.3 4.4 0.3 0.0 100.0 276 X - Northern Mindanao 24.6 3.4 13.0 49.4 9.0 0.0 0.6 100.0 301 XI - Davao 31.0 1.2 15.4 43.6 8.8 0.0 0.0 100.0 295 XII - SOCCSKSARGEN 19.7 0.3 17.2 58.7 3.5 0.8 0.0 100.0 324 XIII - Caraga 23.4 2.3 16.8 55.4 1.4 0.3 0.3 100.0 203 ARMM 8.5 0.8 12.4 76.6 0.7 0.2 0.7 100.0 310 Education No education 2.1 0.5 8.3 74.1 12.8 1.2 1.0 100.0 132 Elementary 12.6 0.9 21.3 59.7 4.3 0.4 0.8 100.0 2,040 High school 30.2 1.1 31.7 35.0 1.4 0.0 0.5 100.0 2,952 College or higher 64.8 1.4 19.7 12.6 1.0 0.1 0.4 100.0 1,830 Wealth index quintile Lowest 8.6 0.5 16.0 68.9 4.9 0.4 0.7 100.0 1,858 Second 21.0 1.7 28.7 45.4 2.4 0.2 0.7 100.0 1,590 Middle 37.4 1.8 33.2 26.3 1.1 0.1 0.2 100.0 1,352 Fourth 52.6 0.6 31.2 13.3 1.4 0.0 0.9 100.0 1,162 Highest 73.2 1.2 18.0 7.0 0.6 0.0 0.1 100.0 993 Total 33.6 1.1 25.1 37.1 2.4 0.2 0.6 100.0 6,954 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. Table 9.9 shows the relationship between place and assistance during delivery. As expected, the majority of home deliveries are assisted by a midwife or hilot: 61 percent of births delivered at the mother’s home are assisted by a hilot and 34 percent by a midwife. Nine in ten births delivered at a gov- ernment or private hospital are assisted by a doctor. Midwives play a more important role in assisting deliveries in health centers: Three in four births delivered in a health center are assisted by a midwife. 128 | Maternal and Child Health Table 9.9 Place and assistance during delivery Percent distribution of live births in the five years preceding the survey, by person providing assistance during delivery, according to place of delivery, Philippines 2003 Place of delivery Doctor Nurse Midwife Hilot Relative/ friend/ other No one Missing Total Number of births Home Respondent's home 0.4 0.8 34.0 60.8 3.8 0.3 0.1 100.0 3,989 Other home 0.0 0.4 42.9 54.1 2.6 0.0 0.0 100.0 277 Health facility Government hospital 91.7 2.0 6.0 0.1 0.2 0.0 0.0 100.0 1,582 Government health center 20.8 2.8 75.6 0.0 0.9 0.0 0.0 100.0 98 Private hospital or clinic 88.7 1.3 9.9 0.0 0.0 0.0 0.0 100.0 949 Total 33.6 1.1 25.1 37.1 2.4 0.2 0.6 100.0 6,954 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. Total includes 57 births with no information on place of delivery. 9.2.3 Delivery Characteristics Caesarean operations are generally performed on women with medical problems or with preg- nancy complications. Table 9.10 shows that 7 percent of live births in the five years preceding the survey were delivered by this procedure. This figure is similar to that recorded in the 1998 (6 percent) (NSO, DOH, and Macro International Inc., 1999). Caesarean sections (C-sections) are slightly more common among births to older women (age 35 years and over). However, there are significant variations in the occurrence of caesarean operations by the children’s birth order, residence, mother’s education, and wealth status. First-order births, births to urban women, births to women with college or higher education, and births to women in the wealthiest quintile are much more likely than other births to be delivered by surgery. Sixteen percent of births to the most educated women and 20 percent of births to women in the wealthiest quintile were delivered by this pro- cedure. Across the regions, NCR and Central Luzon have the largest percentage of such births (about 12 percent). The incidence of deliveries by C-section in NCR has increased from 9 percent in 1998 (NSO, DOH, and Macro International Inc., 1999). Birth weight is a proxy indicator of a baby’s health status, because infants born with low birth weight generally face higher morbidity and mortality risks. In the 2003 NDHS, information was obtained on the child’s birth weight and the mother’s perception of the baby’s size at birth. Babies weighing less than 2.5 kilograms at birth are considered to have low birth weight. In this survey, 28 percent of the ba- bies were reported to have not been weighed at birth, and for another 5 percent, the weight is unknown to the mothers (Table 9.10). Maternal and Child Health | 129 Table 9.10 Delivery characteristics Percentage of live births in the five years preceding the survey delivered by caesarean section and percent distribution by birth weight and by mother's estimate of baby's size at birth, according to background characteristics, Philippines 2003 Birth weight Size of child at birth Background characteristic Delivery by C-section Not weighed Less than 2.5 kg 2.5 kg or more Don't know/ missing Total Very small Smaller than average Aver- age or larger Don't know/ missing Total Number of births Age at birth <20 3.1 29.5 12.2 53.0 5.3 100.0 4.9 14.0 79.2 2.0 100.0 640 20-34 7.3 26.0 13.2 56.3 4.5 100.0 5.0 13.4 80.9 0.8 100.0 5,189 35-49 9.3 32.9 12.9 49.0 5.2 100.0 7.9 14.0 76.6 1.5 100.0 1,125 Birth order 1 11.0 17.7 15.7 61.7 4.9 100.0 5.7 14.7 78.1 1.5 100.0 1,945 2-3 8.4 24.5 12.0 59.2 4.3 100.0 4.2 12.1 82.9 0.8 100.0 2,663 4-5 3.5 32.7 13.2 50.2 3.9 100.0 5.8 13.5 79.7 0.9 100.0 1,245 6+ 2.2 46.0 10.8 37.1 6.1 100.0 7.5 14.8 76.7 1.0 100.0 1,102 Residence Urban 9.8 14.3 13.7 66.5 5.5 100.0 5.3 11.1 82.5 1.1 100.0 3,461 Rural 4.7 40.5 12.4 43.2 3.8 100.0 5.6 15.9 77.5 0.9 100.0 3,493 Region National Capital Region 11.7 7.1 12.8 74.5 5.6 100.0 5.0 9.3 84.9 0.8 100.0 1,050 Cordillera Admin Region 7.0 33.8 16.7 44.7 4.8 100.0 2.0 12.6 85.4 0.0 100.0 115 I - Ilocos 5.6 29.7 7.2 56.9 6.2 100.0 3.9 12.1 82.9 1.0 100.0 310 II - Cagayan Valley 6.5 40.8 8.5 50.3 0.4 100.0 2.1 11.0 86.5 0.4 100.0 224 III - Central Luzon 12.5 21.4 11.9 57.5 9.2 100.0 4.0 8.5 85.5 2.0 100.0 683 IVA - CALABARZON 9.7 19.0 11.2 62.7 7.1 100.0 4.0 12.1 82.2 1.7 100.0 816 IVB - MIMAROPA 2.4 50.4 10.1 36.4 3.1 100.0 8.4 15.5 74.9 1.3 100.0 241 V - Bicol 5.9 42.5 11.1 42.4 4.0 100.0 6.5 13.5 79.2 0.8 100.0 432 VI - Western Visayas 5.0 30.9 19.9 42.6 6.6 100.0 11.1 19.7 67.3 2.0 100.0 482 VII - Central Visayas 3.7 15.8 20.4 61.1 2.7 100.0 7.4 15.9 75.2 1.5 100.0 535 VIII - Eastern Visayas 2.9 40.7 18.0 39.9 1.4 100.0 6.5 20.8 72.7 0.0 100.0 357 IX - Zamboanga Peninsula 4.0 40.5 15.3 44.2 0.0 100.0 5.3 16.8 77.9 0.0 100.0 276 X - Northern Mindanao 5.2 25.3 13.1 58.6 3.0 100.0 6.8 16.8 75.7 0.6 100.0 301 XI - Davao 8.8 25.0 16.8 56.6 1.6 100.0 5.5 12.8 81.1 0.6 100.0 295 XII - SOCCSKSARGEN 6.7 37.5 10.1 50.7 1.7 100.0 5.3 12.5 82.3 0.0 100.0 324 XIII - Caraga 4.6 19.3 10.4 70.0 0.3 100.0 4.0 7.1 88.6 0.3 100.0 203 ARMM 2.1 66.5 4.1 21.8 7.7 100.0 1.4 22.3 74.6 1.6 100.0 310 Education No education 0.0 81.8 2.3 13.2 2.6 100.0 5.5 15.8 76.8 1.8 100.0 132 Elementary 2.7 46.4 12.1 36.7 4.8 100.0 7.1 17.0 74.5 1.4 100.0 2,040 High school 5.1 23.9 13.3 57.3 5.5 100.0 4.9 12.6 81.6 0.9 100.0 2,952 College or higher 16.3 8.2 14.4 74.1 3.3 100.0 4.4 11.0 83.8 0.7 100.0 1,830 Wealth index quintile Lowest 1.7 51.2 11.9 33.1 3.8 100.0 7.2 17.8 73.6 1.3 100.0 1,858 Second 3.4 32.8 13.0 49.1 5.2 100.0 5.3 13.5 80.5 0.7 100.0 1,590 Middle 6.8 18.8 14.4 61.2 5.6 100.0 4.7 12.9 81.7 0.7 100.0 1,352 Fourth 10.8 10.6 14.6 69.1 5.8 100.0 4.5 11.9 82.0 1.6 100.0 1,162 Highest 20.3 6.1 11.7 79.3 2.8 100.0 4.4 8.2 86.5 0.9 100.0 993 Total 7.3 27.5 13.0 54.8 4.7 100.0 5.4 13.5 80.0 1.0 100.0 6,954 130 | Maternal and Child Health More than half of all births (55 percent or 81 percent of those weighed) are reported to weigh 2.5 kilograms or more, which is considered a normal birth weight. Thirteen percent of births (19 percent of those weighed) are below the normal weight. This percentage is higher than the level that DOH aims to achieve by 2004 (12 percent). First-order births, births to urban women, births to women with college or higher level of education, and births to women in the middle to wealthier quintiles are more likely to have normal birth weight. Among the regions, NCR and Caraga have the largest percentage of births with normal birth weight (75 and 70 percent, respectively). NCR also has the highest percentage of births that are weighed at birth (87 percent). The mother’s assessment of the size of the child at birth is an alternative source of information for determining the prevalence of low birth weight babies. This measurement is useful when a large proportion of births are not weighed at birth. On the basis of the 2003 NDHS data on mother’s assessment of birth size, 80 percent of births are average or larger than average, 14 percent are smaller than average, and 5 percent are considered very small. Births to women age 35 years and above, high-order births, and those born to women in the poorest quintile are more likely to be reported very small at birth. Mother’s perception of the child’s birth size varies by region. Mothers in Western Visayas are least likely to say that their babies are of average or larger size (67 percent) and the most likely to say that their babies are smaller than average or very small (31 percent). In the 2003 NDHS, mothers who underwent C-section were asked the reason for having the operation. The findings are pre- sented in Table 9.11. The most often cited reasons for having the operation are narrow pelvic bone (27 percent), the baby’s head is not in the normal position (13 percent), preeclampsia (11 percent), and fetal distress (10 percent). 9.3 POSTNATAL CARE 9.3.1 Postnatal Care Coverage Postnatal care is important for the mother, in checking whether there are complications arising from the delivery and providing the mother with information on how to care for herself and her child. The DOH recommends that mothers receive a postpartum check within two days after delivery. In the safe motherhood program, DOH set a target of 80 percent of postpartum women to have at least one post- natal checkup within one week after giving birth. In the 2003 NDHS, respondents with a live birth in the five years preceding the survey were asked whether a health professional or a traditional birth attendant checked on their health after the delivery of their youngest child. Those who answered “yes” were asked how many days or weeks after the delivery the first checkup took place, who did the checkup, what type of services were received, and where the first checkup took place. Because women who delivered in a health facility are assumed to have received postnatal care, Table 9.12 is limited to women who delivered outside a health facility. The table shows the percent distri- bution of women who gave birth in the five years preceding the survey by timing of the first postnatal check. One in three women had a postnatal checkup within two days of delivery and 17 percent of the women received a postnatal checkup from three to six days after delivery, for a total of 51 percent of women receiving a postnatal checkup within seven days of delivery. Combined with 38 percent of women delivering in a health facility, a total of 89 percent of women received postnatal care within six days of delivery. This percentage is higher than the target set by DOH (80 percent). Table 9.11 Reason for caesarean operation Percent distribution of caesarean births in the five years preceding the survey, by reason for the operation, Philippines 2003 Reason for caesarean delivery Percent Preeclampsia 11.4 Eclampsia 2.9 Baby too big 7.5 Narrow pelvic bone 27.2 Head not in position 13.3 Fetal distress 9.5 Labor beyond 12 hours 5.6 Mother tired (<12 hours) 2.3 Water broke early 4.0 Excessive bleeding 1.3 Other 13.3 Don’t know 1.9 Percent 100.0 Number 504 Maternal and Child Health | 131 Table 9.12 Postnatal care by background characteristics Percent distribution of women whose last live birth in the five years preceding the survey occurred outside a health facility by timing of postnatal care, according to background characteristics, Philip- pines 2003 Timing of first postnatal checkup Background characteristic Within 2 days of delivery 3-6 days after delivery 7-41 days after delivery Don't know/ missing Did not receive postnatal checkup1 Total Number of women Age at birth <20 34.2 14.9 15.5 0.0 35.3 100.0 236 20-34 34.0 16.7 15.6 0.2 33.5 100.0 2,041 35-49 32.3 20.6 11.0 0.7 35.4 100.0 597 Birth order 1 33.8 15.6 16.9 0.0 33.7 100.0 518 2-3 33.9 17.0 16.8 0.3 32.1 100.0 1,064 4-5 34.8 18.6 12.9 0.3 33.4 100.0 652 6+ 32.1 18.2 11.1 0.3 38.4 100.0 640 Residence Urban 33.6 15.3 18.3 0.4 32.4 100.0 1,086 Rural 33.7 18.6 12.4 0.1 35.1 100.0 1,789 Region National Capital Region 28.9 10.6 20.0 0.9 39.7 100.0 206 Cordillera Admin Region 16.3 8.6 16.0 0.0 59.1 100.0 41 I - Ilocos 24.6 15.4 14.1 0.0 45.9 100.0 152 II - Cagayan Valley 21.5 7.3 20.3 0.0 50.8 100.0 120 III - Central Luzon 45.0 11.6 12.2 0.0 31.2 100.0 245 IVA - CALABARZON 33.3 6.5 18.8 0.4 40.9 100.0 316 IVB - MIMAROPA 54.3 9.9 12.9 1.1 21.8 100.0 128 V - Bicol 51.8 14.2 7.8 0.0 26.2 100.0 219 VI - Western Visayas 25.1 13.8 14.8 0.6 45.7 100.0 204 VII - Central Visayas 22.7 28.8 17.8 0.6 30.1 100.0 208 VIII - Eastern Visayas 25.0 20.9 15.4 0.0 38.7 100.0 177 IX - Zamboanga Peninsula 19.3 23.0 6.0 0.0 51.8 100.0 166 X - Northern Mindanao 30.2 38.0 12.1 0.0 19.6 100.0 149 XI - Davao 37.1 25.3 13.4 0.0 24.2 100.0 119 XII - SOCCSKSARGEN 44.3 21.6 12.6 0.0 21.4 100.0 162 XIII - Caraga 53.7 19.7 14.9 0.0 11.8 100.0 96 ARMM 31.7 27.2 18.7 0.0 22.4 100.0 163 Education No education 32.0 16.4 7.3 0.0 44.3 100.0 76 Elementary 32.6 18.3 10.8 0.2 38.1 100.0 1,118 High school 33.7 16.5 17.7 0.3 31.7 100.0 1,294 College or higher 37.0 17.8 16.9 0.0 28.4 100.0 387 Wealth index quintile Lowest 33.7 19.4 11.7 0.1 35.1 100.0 1,031 Second 32.5 17.9 15.4 0.5 33.7 100.0 800 Middle 36.2 15.6 16.0 0.2 32.0 100.0 539 Fourth 34.2 14.2 15.2 0.3 36.1 100.0 340 Highest 30.4 14.1 23.5 0.0 32.0 100.0 165 Total 33.7 17.4 14.6 0.2 34.1 100.0 2,874 1 Includes women who received the first postnatal checkup after 41 days 132 | Maternal and Child Health There are no substantial variations in the percentage of women who have a postnatal check within two days of delivery across subgroups of women, except by their region of residence. While more than half of women in MIMAROPA, Bicol, and Caraga have their health checked within two days after giving birth, the corresponding proportions for women in CAR and Zamboanga Peninsula are less than 20 per- cent. Postnatal care within six days of delivery also varies significantly across regions. The percentage meeting the recommended timing ranges from 25 percent in CAR to 73 percent in Caraga. Table 9.12 also shows that one in three women (34 percent) did not receive a postnatal checkup at all. Those with less education are at higher risk of not receiving postnatal care: 44 percent of women with no education did not receive a postnatal check, whereas 28 percent of women with a college or higher education did not get postnatal care. 9.3.2 Place of First Postnatal Checkup Information about the place of first postnatal checkup is presented in Table 9.13. Forty-six per- cent of mothers who obtained postnatal care for a noninstitutional delivery received their first postnatal checkup at home: 43 percent in their own home and 2 percent in other homes. Half of these mothers re- ceived their first postnatal checkup in a health facility, with 35 percent receiving care in a public facility and 19 percent in a private facility. Two in three women who went to a public facility for postnatal care went to a government hospital. Nine in ten mothers who had their first postnatal checkup in the private medical sector went to a private hospital or clinic. Although a large proportion (61 percent) of women deliver at home (Table 9.7), over half of them had their first postnatal check in a health facility. Receiving postnatal care outside a health facility is most common in MIMAROPA (74 percent), Zamboanga Peninsula (72 percent), and ARMM (81 percent), where the vast majority of the mothers who had a postnatal check received their first checkup in their home. The percentage of mothers who received their first postnatal checkup in a health facility ranges from 86 percent in NCR to 19 percent in ARMM. Maternal and Child Health | 133 Table 9.13 Place of postnatal care Among women who had a live birth in the five years preceding the survey, the percent distribution by place of postnatal care for their last live birth, according to background characteristics, Philippines 2003 Home Public Private Background characteristic Respon- dent’s home Other home Govern- ment hospital Barangay health station Barangay supply1 Private hospItal/ clinic Private doctor Private nurse/ midwife Other Missing Percent Number of women Age at birth <20 47.6 3.5 22.0 8.6 0.3 17.1 0.5 0.0 0.0 0.5 100.0 270 20-34 41.6 2.4 22.8 13.0 0.2 17.1 2.1 0.2 0.1 0.3 100.0 2,533 34-49 46.9 2.1 20.7 12.2 0.7 15.5 1.2 0.0 0.3 0.2 100.0 647 Birth order 1 29.1 2.8 30.4 11.0 0.2 23.4 2.2 0.3 0.0 0.6 100.0 890 2-3 39.7 2.5 21.7 12.7 0.0 20.0 2.7 0.1 0.2 0.2 100.0 1,403 4-5 53.3 2.2 17.2 14.1 0.4 11.9 0.5 0.3 0.0 0.2 100.0 657 6+ 64.0 1.7 16.6 12.5 1.4 2.9 0.4 0.0 0.4 0.1 100.0 500 Residence Urban 30.7 1.8 26.6 12.2 0.3 25.9 2.1 0.1 0.1 0.2 100.0 1,841 Rural 57.2 3.2 17.5 12.9 0.4 6.5 1.4 0.3 0.2 0.4 100.0 1,609 Region National Capital Region 13.0 0.9 33.2 17.1 0.0 33.4 1.3 0.2 0.0 0.7 100.0 536 Cordillera Admin Region 16.1 0.0 44.8 15.1 0.9 20.1 2.9 0.0 0.0 0.0 100.0 46 I - Ilocos 40.9 2.8 29.6 15.1 0.0 8.9 2.7 0.0 0.0 0.0 100.0 147 II - Cagayan Valley 20.9 0.8 21.1 36.2 2.2 12.9 2.3 3.8 0.0 0.0 100.0 108 III - Central Luzon 41.5 1.2 26.6 8.4 0.0 19.3 2.3 0.0 0.0 0.7 100.0 351 IVA - CALABARZON 29.9 1.7 20.7 19.6 0.2 25.5 1.6 0.0 0.7 0.0 100.0 414 IVB - MIMAROPA 72.0 2.4 8.1 11.1 0.0 4.5 0.6 0.0 0.0 1.3 100.0 120 V - Bicol 60.4 7.8 18.4 6.9 0.5 5.6 0.5 0.0 0.0 0.0 100.0 224 VI - Western Visayas 38.9 2.4 29.3 14.5 0.6 9.2 5.1 0.0 0.0 0.0 100.0 201 VII - Central Visayas 41.5 2.3 17.1 13.4 0.3 22.1 2.2 0.0 0.0 0.4 100.0 257 VIII - Eastern Visayas 57.8 1.7 17.1 15.4 1.1 6.3 0.0 0.0 0.6 0.0 100.0 151 IX - Zamboanga Peninsula 70.7 0.9 12.0 6.9 0.0 7.0 1.7 0.0 0.0 0.9 100.0 103 X - Northern Mindanao 59.9 2.1 19.7 7.0 0.0 10.8 0.0 0.0 0.5 0.0 100.0 181 XI - Davao 44.7 6.8 23.8 3.1 0.8 18.4 1.9 0.5 0.0 0.0 100.0 168 XII - SOCCSKSARGEN 66.3 2.3 12.2 4.1 0.2 10.9 3.9 0.0 0.0 0.0 100.0 181 XIII - Caraga 62.2 5.7 21.5 4.0 0.0 5.7 1.0 0.0 0.0 0.0 100.0 120 ARMM 79.7 1.5 7.6 5.6 0.5 3.5 1.6 0.0 0.0 0.0 100.0 142 Education No education 84.8 1.9 2.3 7.7 0.0 1.6 1.6 0.0 0.0 0.0 100.0 44 Elementary 65.3 3.5 13.2 13.0 0.9 2.9 0.5 0.2 0.1 0.3 100.0 867 High school 45.5 2.7 23.6 15.4 0.3 11.0 0.8 0.2 0.2 0.2 100.0 1,473 College or higher 19.9 1.2 28.8 8.3 0.1 36.8 4.3 0.1 0.1 0.3 100.0 1,067 Wealth index quintile Lowest 73.4 4.7 10.0 9.6 0.7 0.8 0.3 0.0 0.1 0.4 100.0 765 Second 54.5 2.6 20.2 17.0 0.2 4.2 0.5 0.4 0.1 0.3 100.0 739 Middle 40.8 2.2 27.0 15.2 0.4 11.7 2.4 0.0 0.2 0.1 100.0 686 Fourth 25.8 1.5 32.0 13.4 0.4 23.3 2.6 0.4 0.2 0.2 100.0 642 Highest 12.5 0.6 25.1 6.9 0.2 50.6 3.8 0.0 0.0 0.4 100.0 618 Total 43.1 2.4 22.3 12.5 0.3 16.8 1.8 0.2 0.1 0.3 100.0 3,451 1 Barangay supply/service point officer/barangay health worker/other public source 134 | Maternal and Child Health 9.3.3 Type of Postnatal Checkup Table 9.14 shows the type of services received by mothers during their first postnatal care. Eighty-five percent of mothers report that the baby was examined, 77 percent were provided with baby care advice, 74 percent received breastfeeding advice, and 73 percent had their abdomen examined. Only 36 percent of women reported having internal examination, 47 percent reported having their breasts exam- ined, and 48 percent received advice on family planning. 9.4 REPRODUCTIVE HEALTH CARE BY WOMAN’S STATUS Table 9.15 presents selected indicators on reproductive health care by woman’s status. The 2003 NDHS measured the woman’s status by three indicators: her participation in household decisionmak- ing, her attitude toward a woman’s right to refuse sex with her hus- band, and her attitude toward wife beating. Regarding the decision- making indicators, the more decisions in which the woman has a final say, the more empowered she is. The decision may be made by her- self alone or jointly with others (including her husband). Thus, in Table 9.15, the most empowered woman has a score of “5” on the number of decisions in which she has a final say. Similarly, the woman’s status has a positive relation- ship with the number of reasons for which it is acceptable for a wife to refuse sex with her husband. The most empowered woman has a score of “3-4” on the number of acceptable reasons for a wife to refuse sex with her husband. On the other hand, the woman’s status is inversely related to the number of reasons she believes wife beating is justified. Thus, the most empowered woman is one who has a “0” score on this status indicator. For example, 85 percent of women who were not involved in making household deci- sions received antenatal care from a health professional, compared with 87 percent of women who were involved in five decisions. Women who believe that wife beating is never justified are more likely to receive antenatal care, more likely to receive postnatal care within two days of delivery, and much more likely to have received delivery care from a health professional, compared with women who accept justifications to wife beating. Relationships between reproductive care and the other two indicators of women’s status are either weak or nonexistent. Table 9.14 Postnatal care services Among women who had a live birth in the five years preceding the sur- vey, the percentage who received specific services during a postnatal checkup for their last live birth, Phil- ippines 2003 Type of service Percent Abdominal examination 73.1 Breast examination 46.6 Internal examination 36.1 Family planning advice 48.3 Breastfeeding advice 74.3 Baby care advice 76.8 Baby checkup 84.9 Other 3.6 Number 3,451 Maternal and Child Health | 135 Table 9.15 Reproductive health care by women's status Percentage of women with a live birth in the five years preceding the survey who received antenatal and postnatal care from a health professional for the most recent birth, and percentage of births in the five years preceding the survey for which mothers received professional delivery care, by women's status indi- cators, Philippines 2003 Women's status indicator Percentage of women who received antenatal care from doctor/ nurse/midwife/ auxiliary midwife Percentage of women who received postnatal care within the first two days of delivery1 Number of women Percentage of births for whom mothers received delivery care from doctor/ nurse/midwife/ auxiliary midwife Number of births Number of decisions in which woman has final say2 0 85.2 54.3 82 54.0 108 1-2 88.7 64.4 481 65.5 687 3-4 89.1 59.9 1,203 61.0 1,780 5 86.9 60.0 3,036 58.5 4,379 Number of reasons to refuse sex with husband 0 85.7 56.6 126 60.1 186 1-2 77.5 59.5 154 47.2 226 3-4 88.0 60.4 4,523 60.2 6,542 Number of reasons wife beating is justified 0 89.4 62.7 3,543 64.2 5,081 1-2 83.7 55.1 1,005 49.4 1,490 3-4 77.8 44.6 199 37.7 300 5 81.0 58.6 55 57.4 83 Total 87.6 60.3 4,802 59.8 6,954 1 Includes mothers who delivered in a health facility 2 Either by herself or jointly with others 9.5 IMMUNIZATION OF CHILDREN The Expanded Program on Immunization (EPI) of the Philippine government seeks to achieve universal immunization of children against seven diseases: tuberculosis, poliomyelitis, diphtheria, pertus- sis, tetanus, measles, and hepatitis B (HB). The EPI recommends that children be given the basic vac- cines—one dose of Bacillus Calmette-Guérin (BCG) at birth or at first clinical contact, vaccine against measles at nine months or after but before reaching one year of age, and three doses each of diphtheria, pertussis, tetanus (DPT) vaccine and oral polio vaccine (OPV) at monthly intervals starting at six weeks of age. A child who has received all these vaccines before reaching one year of age is considered fully immunized. In the 2003 NDHS, immunization information was collected for children born in the five years preceding the survey. The information was collected in two ways: from vaccination cards and from the mother’s verbal report. For children with a health card, the interviewer asked the mother to see the card, then copied the vaccination dates onto the questionnaire. If the child had never received a health card or if the mother was unable to show the card to the interviewer, the mother was asked questions about the types of immunizations her children received (specifically, BCG, DPT, OPV, measles, and HB), and whether the required dose of the vaccine was received by the child before reaching one year of age. 136 | Maternal and Child Health Table 9.16 shows that, on the basis of information recorded from the vaccination card or mother’s report, 70 percent of children age 12-23 months have received all of the basic vaccines (BCG, DPT, polio, and measles). Sixty percent of children age 12-23 months received these vaccines before age one. The coverage rate is highest for BCG (91 percent), the first doses of OPV (91 percent), and the first doses of DPT vaccines (90 percent). The dropout rates for DPT and polio vaccines, measured by the difference in coverage between the first and third doses, are 11 percent for DPT and 12 percent for polio. Table 9.16 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Philippines 2003 Source of of information BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All1 No vacci- nations Number of children Vaccinated at any time before survey Vaccination card 38.3 38.4 37.5 35.8 38.7 37.6 36.1 34.1 32.5 0.0 525 Mother's report 52.5 51.6 48.4 43.1 52.6 49.7 43.7 45.6 37.3 7.3 824 Either source 90.8 89.9 85.9 78.9 91.3 87.3 79.8 79.7 69.8 7.3 1,348 Vaccinated by 12 months of age2 89.0 88.4 83.2 75.0 90.0 84.3 75.8 69.7 59.9 8.2 1,348 1 BCG, measles and three doses each of DPT and polio vaccine 2 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. The overall immunization coverage of the six vaccines in 2003 (70 percent) is lower than that re- corded in the 1998 NDHS (73 percent). The percentage of children age 12-23 months who were fully immunized before their first birthday in 2003 is 60 percent, which is lower than the 1998 NDHS figure of 65 percent. However, the proportion of children age 12-23 months who have received no vaccination (7 percent) is similar to the 1998 NDHS figure (8 percent). Table 9.17 shows that immunization coverage varies by the mother’s and child’s characteristics. The coverage declines with an increase in the child’s birth order. While 78 percent of first-order births have been fully immunized, the corresponding proportion for children of birth order six or higher is 53 percent. Immunization coverage is higher for children living in urban areas than for those in rural areas (74 and 65 percent, respectively). The likelihood of a child receiving the six vaccines is positively asso- ciated with the mother’s education: 83 percent of children whose mothers completed college or higher education have received all basic vaccines at any time prior to the survey, compared with less than 70 percent for children whose mothers did not reach a college level. In general, immunization coverage increases with the increase in wealth status. While 56 percent of children whose mothers belong to the poorest quintile have received the six basic vaccines, the corre- sponding proportion for children whose mothers are in the wealthiest quintile is 83 percent. Immunization coverage also varies by region of residence, ranging from 81 percent in Western Visayas to 44 percent in ARMM. The percentage of children age 12-23 months who have received the six vaccines is 75 percent or higher in NCR, Caraga, Central Luzon, Cagayan Valley, and Western Visayas. Maternal and Child Health | 137 Table 9.17 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother's report), and percentage with a vaccination card, by background characteristics, Philippines 2003 Background characteristic BCG DPT 1 DPT 2 DPT 3 Polio 1 Polio 2 Polio 3 Measles All1 No vacci- nations Percentage with a vaccina- tion card seen Number of children Sex Male 90.2 89.9 84.8 77.6 91.0 86.7 79.7 78.3 68.4 7.8 41.4 685 Female 91.4 89.9 87.1 80.2 91.6 87.9 80.0 81.2 71.3 6.8 36.4 664 Birth order 1 93.0 93.5 90.4 85.1 94.7 92.5 86.1 84.9 77.8 4.4 46.9 400 2-3 94.3 92.2 87.9 81.6 93.4 89.2 81.6 81.1 71.7 4.8 38.6 518 4-5 88.1 87.9 85.5 76.6 88.2 84.8 77.6 76.5 66.4 10.0 35.5 228 6+ 80.4 79.6 72.5 62.3 82.4 74.9 65.6 69.7 53.1 16.5 27.6 202 Residence Urban 92.6 92.3 89.5 84.0 92.6 89.8 83.6 81.8 74.4 6.1 38.0 681 Rural 88.9 87.6 82.3 73.7 89.9 84.7 76.0 77.5 65.1 8.5 39.9 667 Region National Capital Region 94.4 94.4 91.7 87.1 94.2 92.3 88.5 81.3 77.8 5.6 26.7 213 Cordillera Admin Region (85.7) (82.4) (80.4) (75.9) (84.4) (75.9) (75.9) (73.3) (67.4) (11.7) (37.2) 22 I - Ilocos 93.6 95.1 90.2 80.4 95.1 90.3 80.4 83.9 72.4 4.9 22.9 62 II - Cagayan Valley 93.9 91.6 91.6 85.2 93.8 91.6 85.2 83.1 76.7 4.0 48.3 39 III - Central Luzon 92.9 90.1 87.0 80.8 93.0 87.9 81.4 83.3 75.0 3.5 43.7 139 IVA - CALABARZON 91.8 90.1 86.6 80.0 90.9 89.2 78.1 77.3 65.6 5.7 37.8 165 IVB - MIMAROPA 94.0 94.3 88.1 80.9 98.0 90.4 81.1 81.2 70.0 2.0 36.8 38 V - Bicol 94.4 90.5 83.2 75.3 93.2 89.3 81.4 81.9 64.7 5.6 36.8 87 VI - Western Visayas 91.3 90.1 87.7 87.7 91.3 91.3 90.1 83.9 81.4 8.7 50.4 94 VII - Central Visayas 90.9 89.7 87.4 71.7 90.9 85.1 73.9 84.1 66.0 7.9 49.0 101 VIII - Eastern Visayas 91.3 93.8 88.8 76.5 95.1 92.6 81.4 79.1 70.3 4.9 45.7 69 IX - Zamboanga Peninsula 76.0 72.8 69.8 63.6 74.2 71.1 62.0 64.0 56.1 22.6 42.2 57 X - Northern Mindanao 89.5 86.5 77.7 68.9 92.5 82.2 73.4 72.0 58.7 7.5 46.2 63 XI - Davao 92.7 92.9 87.5 82.2 94.6 86.5 76.9 89.3 73.2 5.4 44.0 52 XII - SOCCSKSARGEN 88.1 91.7 87.3 85.0 91.0 84.8 81.7 84.2 70.7 7.5 42.8 55 XIII - Caraga 93.5 95.1 90.2 88.6 93.5 90.3 88.6 82.5 77.6 3.3 46.8 37 ARMM 71.0 72.3 65.0 50.5 72.3 66.4 53.3 57.4 44.0 26.3 21.6 54 Mother's education No education * * * * * * * * * * * 21 Elementary 84.9 84.3 77.0 67.2 85.7 79.1 69.0 72.6 59.2 12.4 35.0 377 High school 91.8 91.2 87.2 80.3 92.3 88.3 81.0 79.7 69.1 5.7 42.0 585 College or higher 97.3 96.3 95.5 90.8 97.7 96.2 91.0 89.1 83.4 2.3 38.8 366 Wealth index quintile Lowest 82.2 81.7 74.0 64.0 82.9 76.3 66.0 69.7 55.5 15.1 32.1 355 Second 92.2 89.9 86.4 77.9 91.6 87.8 79.6 81.6 69.3 5.7 46.0 297 Middle 94.0 92.8 90.0 84.9 94.9 91.8 85.9 83.4 77.8 5.0 46.9 261 Fourth 93.1 93.3 90.2 84.9 93.8 91.5 85.1 80.2 72.4 4.4 37.1 240 Highest 97.1 97.1 96.2 92.0 97.8 95.0 90.9 89.4 83.0 2.2 32.1 196 Total 90.8 89.9 85.9 78.9 91.3 87.3 79.8 79.7 69.8 7.3 38.9 1,348 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 BCG, measles, and three doses each of DPT and polio vaccine 138 | Maternal and Child Health 9.6 ACUTE RESPIRATORY INFECTION The Control of Acute Respiratory Infection program of the Philippines DOH seeks to reduce in- fant and child mortality from acute respiratory infection (ARI), which is consistently one of the leading causes of death among children under age five. The program promotes home management, such that the child’s caregiver is able to recognize the disease at an early stage and provide treatment when needed. The program’s strategies include training of health personnel, health advocacy and promotion for family members and child caretakers, and provision of logistical support. In the 2003 NDHS, ARI is identified by mother’s report on the symptoms of ARI—cough ac- companied by short, rapid breathing—in the two weeks preceding the survey. Survey results show that one in ten children under age five had the symptoms of ARI (Table 9.18). Children age 6-23 months, children in rural areas, and children whose mothers are in the poorest quintile are more likely to show symptoms of ARI. Fever is a symptom of various infectious diseases, such as measles, respiratory infections, ty- phoid, and dengue, which are common in the Philippines. Data in Table 9.18 show that 24 percent of children under age five are reported to have had fever in the two weeks preceding the survey. As in the case of symptoms of ARI, children age 6-23 months, rural children, and children in the poorest group are more likely to have fever. The percentage of children with symptoms of ARI and/or fever who are given proper care pro- vides a measure of the effectiveness of the DOH program. Less than half (46 percent) of children with symptoms of ARI and/or fever were taken to a health facility or health provider for treatment. Children in urban areas, those whose mothers have college or higher education, and children in the wealthiest quintile are the most likely to receive care when showing symptoms of ARI and/or fever. The bottom of Table 9.18 shows the differentials in the prevalence of ARI and fever according to mother’s smoking status. The data show that children whose mothers do not smoke are more likely to have symptoms of ARI and/or fever. However, children of these mothers are less likely than those whose mothers smoke to receive treatment for the symptoms. Symptoms of ARI are most often reported for children in Western Visayas (20 percent). Thirty percent or more children in MIMAROPA, Western Visayas, Northern Mindanao, and Caraga were re- ported to have fever in the two weeks preceding the survey. Fever prevalence ranges from 16 percent in NCR to 39 percent in Caraga. Maternal and Child Health | 139 Table 9.18 Prevalence and treatment of symptoms of ARI and fever Percentage of children under five years who had a cough accompanied by short, rapid breathing (symp- toms of ARI), percentage of children who had fever in the two weeks preceding the survey, and percent- age of children with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by background characteristics, Philippines 2003 Background characteristic Percentage of children with symptoms of ARI Percentage of children with fever Number of children Among children with symptoms of ARI and/or fever, percentage for whom treatment was sought from a health facility/provider1 Number of children Age in months <6 6.9 21.1 603 46.7 147 6-11 13.4 31.2 733 57.4 261 12-23 12.9 30.0 1,348 48.9 464 24-35 10.6 24.8 1,326 38.9 369 36-47 8.8 19.4 1,434 45.2 324 48-59 8.4 18.0 1,267 42.2 270 Sex Male 9.9 24.0 3,403 46.1 936 Female 10.6 23.5 3,309 46.5 899 Residence Urban 8.3 21.8 3,361 50.5 827 Rural 12.2 25.8 3,351 42.9 1,009 Region National Capital Region 4.0 15.7 1,020 51.3 178 Cordillera Admin Region 16.9 23.9 113 50.2 37 I - Ilocos 7.2 20.7 299 54.5 69 II - Cagayan Valley 10.7 16.5 220 43.8 48 III - Central Luzon 7.7 20.8 662 47.2 156 IVA - CALABARZON 7.4 20.0 796 49.1 182 IVB - MIMAROPA 18.5 31.5 225 38.1 89 V - Bicol 9.6 25.6 424 38.2 123 VI - Western Visayas 19.9 32.7 458 46.5 176 VII - Central Visayas 11.5 26.4 519 45.5 155 VIII - Eastern Visayas 15.6 27.4 341 51.9 107 IX - Zamboanga Peninsula 5.2 21.0 264 41.5 61 X - Northern Mindanao 15.1 33.2 289 55.0 110 XI - Davao 15.5 29.8 285 41.3 105 XII - SOCCSKSARGEN 11.5 24.6 312 38.2 85 XIII - Caraga 16.8 38.5 195 39.6 84 ARMM 5.2 23.0 291 48.9 71 Mother's education No education 11.8 26.1 120 29.1 35 Elementary 13.3 27.0 1,944 43.8 608 High school 10.2 23.6 2,856 47.0 776 College or higher 6.9 20.5 1,793 50.1 417 Wealth index quintile Lowest 14.6 27.9 1,768 43.6 577 Second 10.9 25.5 1,527 42.9 443 Middle 9.0 22.8 1,312 49.4 345 Fourth 7.6 21.3 1,127 46.0 275 Highest 5.8 17.7 979 57.0 195 Mother's smoking status Smokes cigarettes/tobacco 10.1 23.3 6,378 46.7 1,714 Does not smoke cigarettes/ tobacco 13.7 32.2 335 39.9 121 Total 10.2 23.8 6,712 46.3 1,835 1 Excludes pharmacy, shop, and traditional practitioner ARI = Acute respiratory infection 140 | Maternal and Child Health The 2003 NDHS also collected information on the type of drug taken by children under age five who had fever in the two weeks preceding the survey. As presented in Table 9.19, nine out of ten chil- dren were given non-antimalarial drugs, and eight out of ten were given ibuprofen. Seven percent of children were not given any medication. Urban children are more likely than rural children to be given ibuprofen (87 and 77 percent, respectively). However, aspirin is more often given to rural children than urban children (8 and 3 percent, respectively). Table 9.19 Drugs taken for fever Among children under five years who were ill with fever during the two weeks preceding the survey, percentage who received specific drugs, by residence, Philippines 2003 Residence Drug Urban Rural Total Chloroquine/Nivaquine 0.3 0.2 0.2 Non-antimalarial drug 93.4 90.0 91.5 Aspirin 3.1 8.0 5.7 Acetaminophen/paracetamol 2.0 2.8 2.4 Ibuprofen 87.3 76.8 81.6 No drug 4.9 8.9 7.1 Number of children 732 863 1,596 9.7 DIARRHEAL DISEASE AND RELATED FINDINGS 9.7.1 Disposal of Children’s Stools Improper disposal of children’s stools can cause sanitation-related diseases like diarrhea by food or water contamination. The 2003 NDHS gathered information on mothers’ practices in disposing the stools of their youngest child who lives with them. This information is useful in the evaluation of diar- rhea prevention in the country. More than half of women (53 percent) reported that their youngest child’s stools are contained in one of three ways: the child always uses the toilet/latrine, stools are thrown into the toilet/latrine, or stools are buried in the yard (Table 9.20). One in four women said they use dispos- able or washable diapers. The remaining 21 percent dispose of their children’s stools improperly, such as by throwing them outside their dwelling, throwing them outside the yard, or rinsing them away. Improper practices of stool disposal are more common among rural women, those with no educa- tion, among women in the poorest quintile, and those who have a toilet facility other than pit latrine or flush toilet. More than 30 percent of women in Zamboanga Peninsula, MIMAROPA, and ARMM ad- hered to uncontained stool disposal. Maternal and Child Health | 141 Table 9.20 Disposal of children's stools Percent distribution of mothers whose youngest child under five years is living with her, by way in which child's fecal matter is disposed of, according to background characteristics and type of toilet facilities in household, Philippines 2003 Stools contained Stools uncontained Use diapers Background characteristic Child always uses toilet/ latrine Thrown into toilet/ latrine Buried in yard Thrown outside dwelling Thrown outside yard Rinsed away Not disposed of Dispos- able Wash- able Other Missing Total Number of mothers Residence Urban 33.0 13.3 6.1 2.4 4.4 6.6 0.0 26.3 5.8 1.7 0.3 100.0 2,355 Rural 20.9 15.1 16.3 5.5 11.4 11.6 0.5 7.1 10.0 1.5 0.1 100.0 2,284 Region National Capital Region 37.5 13.8 0.3 1.4 1.4 3.0 0.0 34.4 6.2 1.7 0.4 100.0 686 Cordillera Admin Region 13.0 16.4 4.7 3.1 10.2 10.6 2.8 21.3 15.6 1.8 0.6 100.0 76 I - Ilocos 24.9 17.6 18.9 4.9 9.0 9.0 0.0 8.7 6.6 0.5 0.0 100.0 213 II - Cagayan Valley 23.6 21.3 19.9 3.4 10.1 1.9 0.5 9.7 8.5 1.0 0.0 100.0 166 III - Central Luzon 30.5 13.6 9.5 3.0 5.5 6.0 0.0 26.6 4.8 0.6 0.0 100.0 466 IVA - CALABARZON 36.0 9.3 5.1 1.7 5.1 7.7 0.2 29.2 5.1 0.5 0.0 100.0 574 IVB - MIMAROPA 16.0 14.2 16.7 12.4 14.5 8.6 0.0 5.2 9.4 2.4 0.5 100.0 151 V - Bicol 23.1 9.3 17.7 3.7 12.1 12.4 1.0 7.2 10.8 2.8 0.0 100.0 282 VI - Western Visayas 18.6 14.8 21.7 4.5 9.8 13.4 0.4 8.8 5.2 2.6 0.4 100.0 312 VII - Central Visayas 23.6 16.0 8.6 6.6 11.2 9.5 0.0 12.9 6.9 4.1 0.7 100.0 349 VIII - Eastern Visayas 27.2 4.6 21.8 5.0 10.7 2.7 0.0 8.1 18.4 1.6 0.0 100.0 224 IX - Zamboanga Peninsula 17.7 12.6 8.3 3.1 7.9 27.0 0.0 7.3 15.1 0.9 0.0 100.0 197 X - Northern Mindanao 29.2 21.9 11.1 5.4 3.6 7.9 0.0 9.5 9.7 1.8 0.0 100.0 209 XI - Davao 19.3 17.4 15.9 0.9 7.9 20.7 0.0 11.5 5.1 1.3 0.0 100.0 207 XII - SOCCSKSARGEN 22.6 20.3 21.9 2.7 11.4 15.7 0.0 1.4 2.1 1.6 0.4 100.0 216 XIII - Caraga 19.0 22.7 14.3 12.4 7.6 4.6 0.6 8.7 9.6 0.0 0.6 100.0 134 ARMM 26.7 11.4 2.9 6.3 17.8 8.8 1.6 6.7 15.3 2.4 0.0 100.0 179 Education No education 15.3 8.0 8.2 12.0 26.4 12.9 1.0 2.5 8.9 4.8 0.0 100.0 75 Elementary 19.5 11.6 17.2 7.1 13.6 12.2 0.3 5.1 10.6 2.6 0.1 100.0 1,291 High school 27.4 15.0 11.9 3.1 7.0 9.2 0.3 16.4 8.0 1.6 0.3 100.0 1,968 College or higher 34.7 15.8 4.2 1.6 2.4 5.5 0.2 30.0 5.0 0.4 0.2 100.0 1,305 Wealth index quintile Lowest 12.2 9.7 19.2 8.7 18.7 15.9 0.6 1.9 10.5 2.3 0.2 100.0 1,133 Second 24.6 15.4 15.8 5.0 7.6 9.7 0.2 8.5 10.4 2.5 0.3 100.0 1,032 Middle 29.4 16.6 8.8 1.9 4.6 8.7 0.2 20.1 7.8 1.9 0.1 100.0 919 Fourth 35.8 16.8 5.6 1.5 2.4 5.5 0.0 26.3 5.5 0.6 0.1 100.0 831 Highest 40.9 13.4 1.5 0.2 1.6 2.0 0.0 37.1 3.0 0.0 0.3 100.0 724 Toilet facilities None 23.0 13.9 8.2 8.9 12.7 9.2 1.7 7.6 12.7 2.1 0.0 100.0 127 Pit latrine 15.9 18.6 17.9 4.9 7.6 15.8 1.1 4.4 12.3 1.2 0.4 100.0 290 Improved latrine 9.9 18.9 14.6 10.3 15.7 20.0 0.8 1.7 7.3 0.8 0.0 100.0 198 Flush toilet 32.5 15.6 8.7 2.2 4.3 7.1 0.1 21.1 7.0 1.2 0.2 100.0 3,488 Other 4.6 1.2 23.2 11.0 27.1 14.1 0.4 3.4 10.1 4.7 0.2 100.0 534 Total 27.1 14.2 11.2 3.9 7.8 9.1 0.3 16.8 7.9 1.6 0.2 100.0 4,640 Note: Total includes 3 women with missing information on toilet facility. 9.7.2 Prevalence of Diarrhea Table 9.21 shows that 11 percent of children under age five were reported to have diarrhea during the two weeks preceding the survey, which indicates a slight increase from the 7 percent level in the 1998 NDHS (NSO, DOH, and Macro International Inc., 1999). 142 | Maternal and Child Health Table 9.21 Prevalence of diarrhea Percentage of children under five years with diarrhea in the two weeks preceding the survey, by background characteristics, Philippines 2003 Background characteristic Diarrhea in the two weeks preceding the survey Number of children Age in months <6 7.0 603 6-11 19.2 733 12-23 16.3 1,348 24-35 11.5 1,326 36-47 6.3 1,434 48-59 5.4 1,267 Sex Male 11.1 3,403 Female 10.2 3,309 Residence Urban 10.7 3,361 Rural 10.6 3,351 Region National Capital Region 9.6 1,020 Cordillera Admin Region 20.4 113 I - Ilocos 12.9 299 II - Cagayan Valley 6.6 220 III - Central Luzon 9.5 662 IVA - CALABARZON 10.8 796 IVB - MIMAROPA 17.7 225 V - Bicol 11.4 424 VI - Western Visayas 15.0 458 VII - Central Visayas 8.5 519 VIII - Eastern Visayas 9.8 341 IX - Zamboanga Peninsula 4.2 264 X - Northern Mindanao 10.2 289 XI - Davao 9.6 285 XII - SOCCSKSARGEN 11.4 312 XIII - Caraga 9.5 195 ARMM 12.0 291 Mother's education No education 13.4 120 Elementary 11.1 1,944 High school 11.6 2,856 College or higher 8.4 1,793 Wealth index quintile Lowest 13.0 1,768 Second 11.1 1,527 Middle 9.3 1,312 Fourth 9.1 1,127 Highest 9.2 979 Source of drinking water Piped 10.3 3,397 Protected well 10.3 1,795 Open well 12.6 366 Surface 11.8 651 Other/missing 11.3 503 Total 10.6 6,712 The percentage of children with diarrhea varies little by the child’s sex, urban-rural residence, and source of drinking water. Diarrhea is most prevalent among children age 6-11 months and least prevalent among children age 48-59 months. Children whose mothers have no education and are in the poorest quintile are more likely than other children to have diarrhea. Diarrhea is most prevalent in CAR (20 per- cent) and least prevalent in Zamboanga Peninsula (4 percent). Maternal and Child Health | 143 9.7.3 Knowledge of ORS Packets The Control of Diarrheal Diseases program, one of the Philippines DOH programs, aims to effectively re- duce diarrheal morbidity through oral rehydration ther- apy. It emphasizes home therapy by continued feeding and increased intake of fluids; rational use and dispensa- tion of drugs; public information; and education on cor- rect and prompt management of diarrhea at home. The program makes use of tri-media campaigns, strengthens the essential drug and distribution system, encourages capability building, and recommends provision of pre- packaged oral rehydration salts (ORS). The 2003 NDHS included questions to determine the level of knowledge of ORS, such as Oresol and Hy- drite, for diarrhea treatment. Knowledge about ORS is based on a mother’s ever seeing or hearing about ORS packets, or using ORS packets to treat one of her children for diarrhea in the two weeks preceding the survey. Table 9.22 shows a high level of knowledge of ORS packets among Filipino mothers (92 percent). Knowledge about ORS varies with age, education, wealth index quintile, and region of residence: Teenage mothers, those with no education, and mothers in the poorest quin- tile are the least likely to know about ORS packets. Knowledge about ORS ranges from 97 percent in NCR to 80 percent in ARMM. 9.7.4 Diarrhea Treatment Table 9.23 presents the percentage of children under five years old who were reported to have diarrhea in the two weeks preceding the survey by the form of treatment they received. Thirty-two percent of children who were reported to have diarrhea were taken to a health facility for treatment. Fifty-nine percent of children with diarrhea were treated with oral rehydration therapy (ORT), either with ORS packets (42 percent), recom- mended home fluids (RHF) (24 percent), or increased fluids (2 percent). Other treatments for diarrhea include pill or syrup (30 percent), home remedy (18 percent), in- jection (1 percent), or intravenous solution (1 percent). However, 22 percent of children with diarrhea were not given any treatment. This figure is 11 times that recorded in the 1998 survey (2 percent). Table 9.22 Knowledge of ORS packets Percentage of mothers with a birth in the five years pre- ceding the survey who know about ORS packets for treatment of diarrhea, by background characteristics, Philippines 2003 Background characteristic Percentage of mothers who know about ORS packets Number of mothers Age 15-19 69.3 163 20-24 89.2 955 25-29 92.3 1,265 30-34 94.6 1,111 35-49 93.7 1,309 Residence Urban 94.2 2,447 Rural 89.3 2,355 Region National Capital Region 96.7 724 Cordillera Admin Region 85.6 79 I - Ilocos 90.4 220 II - Cagayan Valley 93.9 169 III - Central Luzon 94.6 480 IVA - CALABARZON 93.9 595 IVB - MIMAROPA 87.9 155 V - Bicol 90.2 290 VI - Western Visayas 94.6 324 VII - Central Visayas 89.9 359 VIII - Eastern Visayas 94.4 230 IX - Zamboanga Peninsula 87.6 199 X - Northern Mindanao 90.7 219 XI - Davao 89.8 216 XII - SOCCSKSARGEN 85.4 223 XIII - Caraga 89.8 135 ARMM 79.9 184 Education No education 59.0 80 Elementary 88.3 1,349 High school 92.8 2,037 College or higher 95.8 1,337 Wealth index quintile Lowest 84.5 1,162 Second 92.8 1,065 Middle 92.8 944 Fourth 95.4 863 Highest 96.3 768 Total 91.8 4,802 ORS = Oral rehydration salts 144 | Maternal and Child Health Table 9.23 Diarrhea treatment Among children under five years who had diarrhea in the two weeks preceding the survey, percentage who were taken for treatment to a health facil- ity, percentage who received oral rehydration therapy, and percentage given other treatments, according to background characteristics, Philippines 2003 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage taken to a health facility1 ORS packets RHF Either ORS or RHF Increased fluids ORS, RHF, or increased fluids Pill/ syrup Injection Intra- venous solution Home remedy/ other No treatment Number of children Age in months <6 (17.0) (19.9) (16.9) (31.8) (20.9) (49.4) (13.2) (0.0) (0.0) (16.7) (27.8) 42 6-11 29.5 36.1 27.1 54.0 1.3 54.6 23.3 1.8 1.8 15.7 29.1 141 12-23 35.6 48.7 24.1 63.4 1.1 63.8 30.1 1.0 0.9 13.6 21.8 220 24-35 30.6 44.8 19.5 59.2 1.0 59.2 32.9 0.3 0.6 16.7 22.4 152 36-47 43.7 42.5 27.0 57.9 1.9 58.4 36.1 1.1 0.0 29.6 12.3 91 48-59 26.9 41.1 22.7 58.3 0.0 58.3 37.0 0.0 0.0 22.9 20.8 68 Sex Male 33.1 41.2 24.2 56.1 2.6 57.3 29.9 0.9 0.8 17.0 23.4 378 Female 31.6 43.3 22.8 59.2 2.0 60.8 29.7 0.8 0.7 18.6 21.3 336 Residence Urban 36.2 51.7 22.9 66.9 2.1 67.6 32.7 0.3 1.0 15.1 18.1 359 Rural 28.6 32.6 24.2 48.2 2.4 50.2 26.9 1.4 0.5 20.5 26.8 355 Region National Capital Region 34.4 48.7 21.2 61.3 0.0 61.3 34.4 0.0 0.0 10.0 24.9 98 Cordillera Admin Region 33.1 25.3 26.4 42.1 1.8 43.9 13.8 2.0 0.0 9.2 48.7 23 I - Ilocos 47.4 39.0 26.6 60.3 5.3 62.9 31.7 2.8 0.0 5.3 26.3 38 II - Cagayan Valley 22.2 16.8 5.7 22.4 0.0 22.4 28.1 0.0 0.0 16.5 38.9 15 III - Central Luzon 39.1 48.6 40.8 70.1 4.6 70.1 51.5 2.1 0.0 21.9 10.7 63 IVA - CALABARZON 31.5 51.9 26.8 72.8 4.8 74.4 22.1 0.0 1.4 6.4 19.4 86 IVB - MIMAROPA 22.3 24.2 17.4 34.5 3.8 38.3 37.8 1.8 5.3 28.5 24.8 40 V - Bicol 25.9 32.8 25.1 55.7 0.0 55.7 9.6 2.1 0.0 38.3 24.3 49 VI - Western Visayas 23.4 38.6 14.9 43.7 1.8 45.5 27.4 0.0 3.1 20.4 23.8 68 VII - Central Visayas 36.6 52.4 13.6 66.0 2.7 68.7 20.9 0.0 0.0 5.3 26.2 44 VIII - Eastern Visayas 43.5 61.5 15.5 69.2 2.6 71.8 23.3 0.0 0.0 15.4 17.8 33 IX - Zamboanga Peninsula 40.1 39.8 0.0 39.8 0.0 39.8 44.3 0.0 0.0 23.5 12.4 11 X - Northern Mindanao 20.3 25.1 18.9 40.8 3.2 44.0 23.3 0.0 0.0 25.2 26.5 30 XI - Davao 28.7 48.7 26.4 66.0 3.7 69.7 35.7 3.6 0.0 22.8 10.0 27 XII - SOCCSKSARGEN 31.2 35.0 14.2 44.4 0.0 44.4 39.6 0.0 0.0 16.8 26.9 35 XIII - Caraga 25.7 28.8 48.2 60.9 0.0 60.9 48.7 0.0 0.0 29.2 6.4 19 ARMM 42.2 47.2 40.3 68.3 0.0 68.3 23.5 2.1 0.0 35.4 20.6 35 Education No education * * * * * * * * * * * 16 Elementary 30.0 34.2 25.4 51.9 2.4 53.8 24.8 0.9 0.0 19.8 25.0 215 High school 29.2 43.7 23.3 58.0 2.3 59.0 28.2 0.4 0.6 18.9 23.0 332 College or higher 44.5 52.2 22.0 66.6 1.7 67.4 42.3 1.5 2.3 11.5 16.7 151 Wealth index quintile Lowest 28.0 30.6 22.9 46.2 3.6 49.8 26.1 0.4 0.0 27.4 22.7 230 Second 29.7 42.2 27.3 58.6 2.2 59.4 26.3 1.0 1.1 15.3 26.9 169 Middle 35.6 49.0 25.7 68.6 1.2 68.6 28.0 1.6 1.1 14.8 16.6 122 Fourth 35.9 52.4 15.6 62.7 1.5 62.7 36.2 0.0 0.0 11.5 22.7 103 Highest 40.5 50.6 24.2 64.0 1.5 64.0 41.0 1.7 2.3 9.1 20.9 90 Total 32.4 42.2 23.5 57.6 2.3 58.9 29.8 0.9 0.8 17.8 22.4 714 Note: ORT includes solution prepared from packets of oral rehydration salts (ORS), recommended home fluids (RHF), or increased fluids. Figures in parentheses are based on 25-49 cases. An asterisk indicates that an estimate is based on fewer than 25 cases and has been suppressed. 1 Excludes pharmacy, shop, and traditional practitioner Maternal and Child Health | 145 Correct treatment of diarrhea is most likely to be administered to children age 12-23 months, those living in urban areas, those whose mothers have college or higher education, and those who belong to the middle quintile. Correct treatment of diarrhea with ORT varies widely across regions, ranging from 74 percent in CALABARZON to 22 percent in Cagayan Valley. The percentage of children who were taken to a health facility declined from 44 percent in 1998 NDHS to 32 percent (NSO, DOH, and Macro International Inc., 1999). 9.7.5 Feeding Practices during Diarrhea The recovery of a child with diarrhea may depend on the amount of liquids and foods received during and between diarrhea episodes. Figure 9.1 presents data on feeding practices of children who had diarrhea in the two weeks preceding the survey. The data show that only 2 percent of children with diar- rhea were given more fluids than usual, while 13 percent were given the same amount of fluids. Eighty- four percent of children with diarrhea were given less fluid, which is contraindicated during a diarrheal episode. Diarrheal episodes are frequently accompanied by vomiting, which makes feeding difficult be- cause the child may refuse food. Figure 9.1 shows that only 6 percent of children were given more food than usual, while 60 percent were given less food or none at all. Overall, results of the 2003 NDHS show that feeding practices of children with diarrhea in the Philippines are not consistent with recommended interventions. 9.8 CHILDREN’S HEALTH CARE BY WOMEN’S STATUS The 2003 NDHS investigated the relationship between children’s health care and women’s status as measured by the mother’s ability to influence household decisionmaking, the number of situations in which mothers believe that a woman is justified in refusing sexual relations with her husband, and the number of circumstances in which the mother believes that a husband is justified in beating his wife. Figure 9.1 Feeding Practices during Diarrhea 29 42 55 17 2 6 13 35 Liquids Foods Same as usual More Somewhat less Much less NDHS 2003 146 | Maternal and Child Health Table 9.24 shows little or no relationship between women’s status and children’s health care, ex- cept for a slight negative relationship between women’s participation in household decisionmaking and the likelihood of children being taken for treatment of childhood fever. Table 9.24 Children’s health care by women's status Percentage of children age 12-23 months who were fully vaccinated, and percentage of children under five years who were ill with a fever, symptoms of ARI, and/or diarrhea in the two weeks preceding the survey and were taken to a health provider for treatment, by women’s status indicator, Philippines 2003 Number of decisions in which woman has final say1 Women's status indicator 0 1-2 3-4 5 Total Percentage of children 12-23 months fully vaccinated2 * 75.5 69.1 69.3 69.8 Number of children 21 140 338 849 1,348 Percentage of children with fever and/or symptoms of ARI taken to a health provider3 (38.6) 49.7 46.5 45.9 46.3 Number of children 34 182 496 1,124 1,835 Percentage of children with diarrhea taken to a health provider * 37.8 28.1 33.5 32.4 Number of children 13 82 191 428 714 Note: Figures in parentheses are based on 25 to 49 cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 Either by herself or jointly with others 2 Those who have received BCG vaccine, measles vaccine, and three doses each of DPT and polio vaccines 3 Excludes pharmacy, shop, and traditional practitioner 9.9 PROBLEMS IN ACCESSING HEALTH CARE In the 2003 NDHS, mothers of children under five years were also asked if they have problems in accessing health care when they are sick. Table 9.25 shows that 77 percent of women mention one of the problems listed in the survey. The most often cited problem was getting money for treatment (67 percent). Other problems include not wanting to go alone (28 percent), access to the health facility because of the distance (27 percent), and having to take transport to go to the health facility (26 percent). Women in their teens, women with five or more children, widowed women, those living in rural areas, those with no education, women in the poorest quintile, and women who are not working for cash are more likely than other women to perceive problems in accessing health care for themselves. Nine in ten women in Northern Mindanao, Caraga, and ARMM mentioned at least one of the problems associated with access to health care. On the other hand, this proportion is 70 percent or less in NCR, Cagayan Val- ley, and Central Luzon. The type of problems in accessing health care varies across regions. More than 80 percent of women in Northern Mindanao, Caraga, and ARMM cited obtaining money for treatment of illness as the most serious problem in getting health care. Women in ARMM also mentioned distance to the health facility and transport as problems in the access to health care (72 percent each). Maternal and Child Health | 147 Table 9.25 Problems in accessing health care Percentage of women who reported they have big problems in accessing health care for themselves when they are sick, by type of problem and background characteristics, Philippines 2003 Problems in accessing health care Background characteristic Know- ing where to go for treat- ment Getting permis- sion to go for treat- ment Getting money for treat- ment Dis- tance to health facility Having to take trans- port Not want- ing to go alone Concern there may not be a female provider Any of the speci- fied prob- lems Number of women Age 15-19 19.6 17.9 72.0 30.1 26.7 46.3 37.0 85.6 2,648 20-29 13.4 9.8 65.4 25.9 24.4 27.0 19.5 76.1 4,243 30-39 13.8 8.2 65.2 26.1 25.3 20.4 14.9 73.0 3,827 40-49 14.3 8.8 69.1 27.8 26.6 23.2 14.6 75.9 2,915 Number of living children 0 14.8 13.1 64.6 24.7 22.3 36.0 29.7 77.9 5,012 1-2 13.1 8.1 63.5 24.3 23.4 22.8 14.4 72.8 3,747 3-4 14.3 9.0 67.8 27.2 26.3 21.9 14.6 74.9 2,961 5+ 19.8 12.3 81.8 39.2 37.3 27.4 17.8 86.4 1,912 Marital status Never married 15.6 13.9 65.4 25.1 22.2 37.9 31.0 78.8 4,388 Married/living together 14.7 9.3 68.3 28.3 27.5 23.6 15.6 76.2 8,671 Divorced/not living together 12.8 7.6 65.6 22.8 20.4 19.6 15.2 73.8 373 Widowed 13.1 8.6 77.4 33.6 28.2 22.9 16.1 82.2 201 Residence Urban 11.1 7.8 62.0 17.1 16.0 23.6 17.5 71.9 7,877 Rural 20.2 14.7 74.9 40.9 38.6 34.2 24.8 84.1 5,756 Region National Capital Region 8.5 6.0 57.1 11.6 10.9 18.4 15.7 65.0 2,387 Cordillera Admin Region 22.3 12.2 65.4 31.9 28.3 37.7 10.8 78.3 216 I - Ilocos 22.7 12.8 75.7 33.0 25.5 31.2 25.6 84.0 642 II - Cagayan Valley 12.2 9.1 60.4 28.5 25.8 24.2 11.9 69.1 426 III - Central Luzon 7.3 4.1 58.6 19.4 17.9 24.9 14.0 70.2 1,459 IVA - CALABARZON 9.0 5.4 62.0 18.2 17.8 23.1 16.4 72.4 1,890 IVB - MIMAROPA 19.1 13.7 74.2 43.1 38.9 28.5 22.2 82.9 340 V - Bicol 12.4 9.4 66.9 31.5 25.7 27.9 17.9 79.6 713 VI - Western Visayas 14.9 8.4 70.2 30.4 29.1 26.2 18.7 80.7 910 VII - Central Visayas 18.0 11.6 77.8 21.1 23.0 22.8 20.6 85.5 1,070 VIII - Eastern Visayas 25.3 21.5 66.3 46.0 43.7 34.7 26.3 77.0 555 IX - Zamboanga Peninsula 24.0 23.5 75.7 43.8 40.3 30.6 23.4 81.4 465 X - Northern Mindanao 32.4 25.5 83.2 38.4 40.5 55.7 39.3 92.2 565 XI - Davao 13.3 10.2 69.9 29.0 24.2 32.9 25.6 82.2 654 XII - SOCCSKSARGEN 29.0 17.9 72.6 40.1 38.1 37.5 37.9 83.5 524 XIII - Caraga 18.2 13.3 83.2 29.5 30.0 32.8 30.6 90.3 327 ARMM 18.9 24.8 85.3 72.0 72.2 52.6 27.9 94.2 489 Education No education 34.6 27.4 87.9 65.4 63.8 51.5 32.4 93.3 186 Elementary 23.0 16.7 81.9 42.7 40.9 33.6 25.2 88.3 3,146 High school 15.6 11.4 72.6 26.8 24.7 30.6 22.7 81.7 6,109 College or higher 6.9 4.6 48.1 14.3 13.6 19.3 13.4 61.1 4,192 Employment Not employed 15.3 11.7 69.6 27.8 25.6 31.0 22.3 79.3 6,590 Working for cash 13.3 9.0 64.0 24.5 23.6 24.3 18.6 73.6 5,952 Not working for cash 21.2 14.5 73.1 37.5 36.0 30.9 20.5 82.2 1,087 Wealth index quintile Lowest 27.4 22.0 87.1 59.1 57.1 44.0 31.5 93.5 2,161 Second 19.2 12.7 80.1 33.8 32.5 28.8 20.9 87.1 2,412 Middle 13.6 8.4 73.0 22.2 20.3 25.2 18.0 80.8 2,682 Fourth 10.7 7.5 62.9 18.7 17.4 25.5 18.5 73.6 2,940 Highest 8.6 6.8 45.6 13.6 12.0 22.0 17.2 59.7 3,438 Total 14.9 10.7 67.4 27.2 25.6 28.1 20.5 77.1 13,633 Infant Feeding and Supplmentation | 149 INFANT FEEDING AND SUPPLEMENTATION 10 Proper and adequate feeding, starting at birth, is vital for the physical and mental development of a child. Breastfeeding is the best form of feeding during the first six months of infancy, for its healthful and economic advantages. Thus, in response to the 1981 International Code of Marketing of Breast-milk Substitutes by the World Health Organization (WHO), the Philippines Department of Health strongly ad- vocates breastfeeding among nursing mothers instead of using breast milk substitutes. Supplementary foods introduced initially at four to six months of infancy are also important for the nutritional health and well-being of the growing child. However, early supplemental feeding exposes infants to pathogens and increases the risks of infection and diarrheal diseases. It also decreases infant’s intake of breast milk and suckling, which in turn reduces breast milk production. This chapter presents the extent of breastfeeding and supplementation received by infants. It dis- cusses various aspects of breastfeeding, including the prevalence and initiation of breastfeeding and prelacteal feeding, the duration and frequency of breastfeeding, and reasons for nonbreastfeeding and for stopping breastfeeding. With respect to supplementary feeding, the type of food supplements, the fre- quency of feeding, and the micronutrient intake of children, as well as those of women in the first two months after delivery, are also discussed in this chapter. 10.1 PREVALENCE OF BREASTFEEDING AND PRELACTEAL FEEDING The prevalence of breastfeeding in the Philippines has remained the same since 1993. Table 10.1 shows that 87 percent of the children born in the five years preceding the 2003 National Demographic Health Survey (NDHS) were ever breastfed. The corresponding figures in the 1993 National Demo- graphic Survey and the 1998 NDHS are 87 and 88 percent, respectively. The breastfeeding prevalence does not vary by sex. However, urban children are less likely to be breastfed than rural children (82 com- pared with 91 percent). While breastfeeding is commonly practiced in all regions, children in CALA- BARZON are the least likely (76 percent) and children in Cagayan Valley are the most likely to be breast- fed (96 percent). While breastfeeding is widely practiced, the mother’s socioeconomic status does have a negative association with the children’s chances of being breastfed. Children of mothers who live in wealthier households are less likely to be breastfed than children of mothers who live in poorer households. While 93 percent of children in the poorest quintile were breastfed at some time, only 79 percent of children in the wealthiest quintile were ever breastfed. The practice of breastfeeding also has a negative association with mother’s level of education; children of better-educated mothers are less likely to be breastfed than children of mothers who have less education. The prevalence of breastfeeding varies according to delivery characteristics. Children whose mothers received assistance from a health professional at delivery are less likely to be breastfed than those delivered by a traditional birth attendant (83 compared with 93 percent). Similarly, children delivered in a health facility are less likely to be breastfed than those who were born at home (81 and 90 percent, re- spectively). 150 | Infant Feeding and Supplementation Table 10.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and among children ever breastfed, percentage who started breastfeeding within one hour and within one day of birth and percentage who received a prelacteal feed, by background characteristics, Philippines 2003 Background characteristic Percentage ever breastfed Number of children Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Percentage who received liquid/ nonliquid prelacteal feed2 Percentage who received liquid only prelacteal feed 2 Number of children ever breastfed Sex Male 85.9 3,544 53.6 79.4 54.3 48.9 3,043 Female 87.2 3,411 54.5 81.4 54.2 49.3 2,975 Residence Urban 82.4 3,461 54.4 80.6 55.6 52.4 2,850 Rural 90.7 3,493 53.7 80.2 53.1 46.2 3,167 Region National Capital Region 78.3 1,050 63.0 82.7 50.0 49.5 823 Cordillera Admin Region 92.4 115 61.1 83.7 31.4 30.8 106 I - Ilocos 87.9 310 28.8 73.3 58.2 55.3 272 II - Cagayan Valley 95.7 224 60.1 78.9 38.3 35.3 215 III - Central Luzon 83.7 683 35.7 73.6 59.4 58.7 572 IVA - CALABARZON 76.1 816 55.1 80.9 56.8 54.3 620 IVB - MIMAROPA 90.9 241 54.0 81.9 48.6 43.6 219 V - Bicol 92.7 432 34.9 72.3 62.2 49.9 401 VI - Western Visayas 91.0 482 60.7 81.7 49.8 48.5 439 VII - Central Visayas 88.8 535 66.5 86.0 57.6 51.1 475 VIII - Eastern Visayas 88.3 357 63.7 83.6 34.1 31.9 315 IX - Zamboanga Peninsula 90.5 276 56.6 88.2 53.4 40.0 250 X - Northern Mindanao 90.4 301 66.6 79.6 68.7 48.7 272 XI - Davao 91.2 295 49.0 80.4 51.2 40.4 269 XII - SOCCSKSARGEN 90.7 324 48.6 79.6 62.9 59.6 294 XIII - Caraga 91.6 203 59.9 80.6 65.7 56.2 186 ARMM 93.4 310 56.7 83.8 57.7 50.0 289 Mother's education No education 94.8 132 60.8 90.7 37.4 35.0 126 Elementary 90.3 2,040 53.2 82.2 52.4 42.4 1,841 High school 86.5 2,952 55.0 80.2 54.8 50.1 2,555 College or higher 81.7 1,830 52.8 77.8 59.5 56.9 1,496 Assistance at delivery Health professional3 82.5 4,159 53.3 79.0 56.1 53.0 3,430 Traditional birth attendant 92.6 2,580 55.8 83.6 53.1 45.0 2,388 Other 90.6 164 56.7 83.3 41.8 36.6 149 No one * 12 * * * * 12 Place of delivery Health facility 80.7 2,636 54.5 78.4 54.6 52.9 2,127 At home 90.0 4,267 54.3 82.3 54.5 47.4 3,841 Other * 14 * * * * 12 Wealth index quintile Lowest 93.2 1,858 54.9 82.3 50.1 41.7 1,732 Second 90.7 1,590 55.9 81.3 53.4 47.7 1,441 Middle 81.8 1,352 52.8 81.3 55.1 50.5 1,105 Fourth 82.2 1,162 53.1 77.4 55.0 52.9 955 Highest 78.9 993 51.5 77.0 63.0 61.5 784 Total 86.5 6,954 54.0 80.4 54.3 49.1 6,017 Note: Table is based on all births whether the children are living or dead at the time of interview. Total includes 39 children with no information on assistance at delivery and place of delivery. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes children who started breastfeeding within one hour of birth 2 Children given some liquid other than breast milk during the first three days of life before the mother started breastfeeding regu- larly 3 Doctor, nurse/midwife, or auxiliary midwife Infant Feeding and Supplmentation | 151 Early initiation of breastfeeding is beneficial to both infant and mother. Colostrum, the first breast milk, is beneficial to infants because it contains a high concentration of antibodies that protect infants against certain infectious diseases. Early initiation increases the bond between mother and child and is beneficial to the mother because early suckling stimulates the release of a hormone that helps the uterus to contract. However, in some places, cultural norms dictate against giving colostrum to infants. Delay in giving the breast suggests the possibility that mothers throw away their colostrum and initially bottle-feed the infant. The 2003 NDHS results show that 54 percent of children born in the five years before the survey were given breast milk within one hour of birth and 80 percent were put to the breast within 24 hours of birth (Table 10.1). While initiation of breastfeeding within one hour of birth has increased by 14 percent- age points over the last five years, initiation within 24 hours remained the same (NSO, DOH, and Macro International Inc., 1999). Initiation of breastfeeding does not vary by the child’s sex and type of residence. Putting the infant to the breast soon after birth is not a common practice in Ilocos, Central Luzon, and Bi- col. In contrast, mothers in Central Visayas and Northern Mindanao tend to give their children breast milk immediately after birth. Children in poorer households are breastfed somewhat sooner after birth than those in wealthier households. The likelihood that children will receive colostrum is negatively associated with whether the mother had any formal education. While at most 55 percent of children whose mothers have gone to school were breastfed within one hour of birth, the corresponding proportion for children whose mothers have no education is 61 percent. The prevalence of breastfeeding within one hour after birth does not vary by assistance at deliv- ery and place of delivery. Newborns are put to the breast within one hour of birth in equal proportions whether born at home or in a health facility. Babies are also equally likely to be breastfed within one hour whether assisted by a health professional or a traditional birth attendant (hilot) at delivery. Prelacteal feeds or liquid and/or nonliquid feeds given to newborns before the mother’s milk be- gins to flow regularly are discouraged, not only because they are less nutritious than breast milk but also because they are more susceptible to contamination. Bottle-feeding also tends to discourage breast suck- ling among infants. For children born in the five years preceding the survey who were ever breastfed, mothers were asked if the child was given anything to drink other than breast milk in the first three days after delivery, before their milk began flowing regularly. Those who answered “yes” were asked if the child was given water or anything else to drink or eat other than breast milk. The percentage of children who received prelacteal feed is shown in Table 10.1. More than half of the children who were ever breastfed received liquid and/or nonliquid feeds in the first three days after delivery before the mother’s milk began flowing regularly, 49 percent received liquids, and 5 percent re- ceived nonliquids. Prelacteal feeding does not differ by the child’s sex. Unlike breastfeeding, prelacteal liquid feeding is slightly more common in urban than in rural areas (52 compared with 46 percent). Among the regions, Northern Mindanao has the highest percentage of children given prelacteal feeds (69 percent), and Cordillera Administrative Region (CAR) and Eastern Visayas have the lowest (31 and 34 percent, respectively). Prelacteal feeding shows a pattern that is different from that of breastfeeding; children of wealth- ier parents, children of better-educated mothers, and children whose mothers were assisted by a health professional at delivery are more likely than other children to receive prelacteal feeding. Although there are no differentials in overall prelacteal feeding, children delivered in a health facility are slightly more likely to receive prelacteal liquid feeding than those delivered at home. 152 | Infant Feeding and Supplementation For children born in the three years preceding survey, mothers were asked about the types of liq- uid and types of food the children received in the day and the night before the interview. The information is used to determine the breastfeeding status: whether the child is exclusively breastfed, or is breastfeed- ing and consuming plain water only, water-based liquids/juices, other milk or any solid/semi-solid foods in the 24 hours before the interview. Children who are exclusively breastfed were given nothing but breast milk in the 24 hours preceding the interview. Breastfeeding children who were given solid/semisolid foods and/or non-breast-milk in the 24 hours before the survey are classified as receiving complementary foods. Table 10.2 shows the percent distribution of youngest children under three years and living with the mother by breastfeeding status, according to the age of the children in months. The results show that among infants under two months, 13 percent are not breastfed, 53 percent are exclusively breastfed, and one in three receive either plain water only, water-based liquids or juice, other milk, and/or complemen- tary foods in addition to breast milk. At age 6-7 months, one in three infants are not breastfed, and only 1 percent are exclusively breastfed. At age 8 months and older, virtually all infants have received liquids or foods other than breast milk. Table 10.2 Breastfeeding status by age Percent distribution of youngest children under three years living with the mother by breastfeeding status and percentage of children under three years using a bottle with a nipple, according to age in months, Philippines 2003 Breastfeeding and consuming Age in months Not breast- feeding Exclusively breastfed Plain water only Water- based liquids/juice Other milk Comple- mentary foods Total Number of children Percentage using a bottle with a nipple1 Number of children <2 13.2 52.5 16.6 2.7 12.2 2.8 100.0 159 30.0 160 2-3 17.2 35.4 20.6 3.1 18.4 5.3 100.0 242 42.9 244 4-5 27.9 16.1 17.0 4.1 8.1 26.8 100.0 200 48.6 200 6-7 32.5 1.4 8.0 2.0 5.1 51.0 100.0 256 54.3 261 8-9 32.9 0.6 0.5 0.0 1.0 65.1 100.0 243 50.2 248 10-11 40.7 0.4 1.4 0.5 0.0 57.1 100.0 219 59.4 224 12-15 44.0 0.3 0.7 0.3 0.5 54.2 100.0 436 54.7 454 16-19 56.9 0.0 0.0 0.0 0.0 43.1 100.0 352 56.9 411 20-23 67.7 0.3 0.0 0.3 0.0 31.7 100.0 392 58.6 484 24-27 74.7 0.0 0.0 0.0 0.0 25.3 100.0 311 47.9 419 28-31 81.5 0.0 0.0 0.0 0.0 18.5 100.0 281 41.7 435 32-35 86.5 0.2 0.0 0.0 0.0 13.3 100.0 299 38.9 472 <6 19.7 33.5 18.4 3.4 13.3 11.8 100.0 602 41.4 603 6-9 32.7 1.0 4.4 1.0 3.1 57.9 100.0 499 52.3 509 Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children classified as breastfeeding and consuming plain water only consume no supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, water-based liquids/juice, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and water-based liquids and who do not receive complementary foods are classified in the water-based liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years Comparison with data from the 1998 NDHS shows that the prevalence of exclusive breastfeeding among children age 4-5 months has declined from 20 to 16 percent (NSO, DOH, and Macro International Inc., 1999). Bottles with nipples are usually used when feeding infants infant formula and other types of sup- plementary foods. The use of bottle is not generally recommended at early stages of infancy due to the risk of exposing the child to the harmful effects of insufficient and unhygienic preparation of the liquid Infant Feeding and Supplmentation | 153 and the feeding bottle, particularly in poor environment and socioeconomic conditions. Thirty percent of infants under two months use a bottle with a nipple. The percentage of children who were given a bottle with a nipple increases with age and peaks at age 10-11 months (Table 10.2). 10.2 MEDIAN DURATION AND FREQUENCY OF BREASTFEEDING The duration and frequency of breastfeeding affect the health and nutritional status of both the mother and child. They also influence the length of postpartum amenorrhea, which in turn leads to longer birth intervals and lower fertility levels. A longer birth interval allows a mother to recover fully before her next pregnancy and averts maternal depletion resulting from too closely spaced births. For children born in the three years preceding the survey, mothers were asked about the number of times the children were breastfed in the 24 hours before the interview. The estimates of mean and me- dian durations are based on current status data; that is, the proportion of children who were being breast- fed at the time of the survey. The median duration of exclusive breastfeeding indicates the age at which half of the children started to receive infant formula, other milk, or food supplement. Predominantly breastfed children are either exclusively breastfed or given breast milk and plain water, water-based liq- uids (such as soft drinks), and/or juices in the 24 hours before the interview. Table 10.3 gives the median duration and frequency of breastfeeding among children born in the three years preceding the survey, according to selected background characteristics. The median duration of breastfeeding is 14 months, which means that half of these children stopped breastfeeding after 14 months. There is no difference in the median duration of breastfeeding by sex. Rural children are breast- fed much longer than urban children (16 compared with 10 months). Table 10.3 also shows that the me- dian duration of breastfeeding is negatively associated with mother’s wealth status and education; chil- dren of poorer parents and whose mothers have less education tend to be breastfed for longer durations than other children. The median duration of exclusive breastfeeding is less than one month, while the duration of pre- dominant breastfeeding is 2.9 months. The variations in the median duration of exclusive and predomi- nant breastfeeding are similar to those of breastfeeding. The median duration of any breastfeeding is shortest in National Capital Region (NCR) (6.3 months) and Central Luzon (9.1 months); it is more than 18 months in MIMAROPA and Autonomous Region in Muslim Mindanao (ARMM). Frequent breastfeeding is common in the Philippines. Nine in ten infants under six months were breastfed six or more times in the 24 hours preceding the survey. On average, infants are breastfed six times during the day and five times at night. Differentials in frequency of breastfeeding are similar to those for median duration of breastfeeding, exclusive, and predominant breastfeeding. There have been changes in breastfeeding practices since 1998. Infants are being breastfed more frequently; the percentage of infants under six months who were breastfed six or more times in the 24 hours preceding the survey increased from 71 percent in 1998 to 92 percent in 2003. The median duration of any breastfeeding increased from 12.8 months in 1998 to 14.1 months in 2003. However, the median duration of exclusive breastfeeding declined slightly from 1.4 months in 1998 to 0.8 months in 2003 (NSO, DOH, and Macro International Inc., 1999). 154 | Infant Feeding and Supplementation Table 10.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by background characteristics, Philippines 2003 Median duration (months) of breastfeeding1 Breastfeeding children under six months2 Background characteristic Any breast- feeding Exclusive breast- feeding Predomi- nant breast- feeding3 Number of children Percentage breastfed 6+ times in last 24 hours Mean number of day feeds Mean number of night feeds Number of children Sex Male 14.5 0.7 2.6 2,140 92.0 6.0 4.7 242 Female 13.8 1.0 3.1 2,005 93.1 6.3 4.6 238 Residence Urban 9.9 0.6 1.9 2,064 90.2 5.7 4.5 208 Rural 16.0 1.7 3.6 2,081 94.3 6.5 4.7 272 Region National Capital Region 6.3 0.5 1.4 594 82.2 4.9 3.6 54 Cordillera Admin Region 16.9 1.8 2.5 70 * * * 8 I - Ilocos 15.9 0.6 4.6 194 * * * 22 II - Cagayan Valley 16.6 1.4 3.2 129 * * * 17 III - Central Luzon 9.1 0.7 1.5 405 * * * 31 IVA - CALABARZON 13.2 0.7 2.2 502 (100.0) (6.1) (4.7) 53 IVB - MIMAROPA 18.1 2.0 3.5 142 (92.5) (6.5) (6.1) 19 V - Bicol 14.8 1.9 2.4 256 (91.3) (7.1) (4.9) 34 VI - Western Visayas 15.2 1.3 4.3 299 (100.0) (7.3) (5.9) 37 VII - Central Visayas 15.5 0.6 2.9 325 (80.6) (5.3) (3.3) 36 VIII - Eastern Visayas 12.3 3.2 5.0 212 (92.4) (6.5) (5.6) 33 IX - Zamboanga Peninsula 16.3 1.3 2.1 168 (83.5) (6.3) (3.9) 24 X - Northern Mindanao 17.0 1.8 2.5 181 * * * 21 XI - Davao 14.2 0.6 3.2 170 * * * 21 XII - SOCCSKSARGEN 13.0 2.1 3.9 193 (92.4) (6.9) (4.6) 32 XIII - Caraga 15.3 1.9 2.7 117 * * * 12 ARMM 19.8 0.6 4.1 188 (94.0 ) (5.8) (4.5) 25 Mother's education No education 20.4 2.4 4.0 80 * * * 12 Elementary 17.0 2.0 3.8 1,190 93.4 6.7 5.0 155 High school 13.9 0.9 3.0 1,780 93.7 6.2 4.6 214 College or higher 6.3 0.5 0.7 1,095 89.4 5.3 4.0 99 Wealth index quintile Lowest 17.1 2.2 4.6 1,109 94.9 6.7 4.8 153 Second 15.5 1.7 3.1 961 91.6 6.3 4.6 122 Middle 12.0 0.6 1.8 832 93.1 5.9 4.7 97 Fourth 7.4 0.6 1.5 692 93.5 5.8 4.5 64 Highest 4.0 0.5 0.6 552 (84.2) (5.1) (3.9) 44 Total 14.1 0.8 2.9 4,145 92.5 6.2 4.6 480 Mean for all children 14.9 2.6 4.0 na na na na na Note: Median and mean durations are based on current status. Figures in parentheses are based on 25-49 unweighted cases. An aster- isk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 It is assumed that non-last-born children or last-born children not living with the mother are not currently breastfeeding 2 Excludes children who do not have a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, water-based liquids, and/or juice only (excludes other milk) Infant Feeding and Supplmentation | 155 10.3 REASONS FOR NOT BREASTFEEDING AND REASONS FOR STOPPING BREASTFEEDING Information on the reasons some mothers do not breastfeed their children and the reasons for stopping breastfeeding are important in formulating plans and programs to promote breastfeeding. Figure 10.1 presents the percent distribution of children born in the five years preceding the survey by reason for not being breastfed at all. The most common reason given by mothers for not breastfeeding their babies is that they do not have enough milk (31 percent). The next two most often reported reasons are that the mothers have nipple or breast problems and that they are working, each given by one in six mothers. Eleven percent of mothers say the child refused to breastfeed. Table 10.4 shows the percent distribution of children by reason breastfeeding was stopped. The most often cited reasons for stopping breastfeeding are that the child has reached the weaning age (23 percent), and there is not enough milk (20 percent). There are no large differences in the reason for stopping breastfeeding according to the child’s sex. Children who live in rural areas, those whose mothers have primary education, and those in the low- est wealth quintile are more likely to stop breastfeeding when they reach weaning age or when their mothers became pregnant. Children in urban areas, those of better-educated mothers, and children in the wealthiest households are more likely to stop breastfeeding because their mothers do not have enough milk or because the mothers are working. Mother ill 9% Child refused 11% Not enough milk 31% Mother working 17% Nipple/breast problem 17% Other 5% Child ill/died 11% Figure 10.1 Reasons for Never Breastfeeding NDHS 2003 156 | Infant Feeding and Supplementation Table 10.4 Reasons for stopping breastfeeding Percent distribution of children born in the five years preceding the survey who were ever breastfed, by reason for stopping breastfeeding, by background characteristics, Philippines 2003 Reason for stopping breastfeeding Background characteristic Mother ill/ weak Child ill/ weak Child died Nipple/ breast problem Not enough milk Mother working Child refused Weaning age stop Became pregnant Started contra- ception Other Missing Total Number of chil- dren Sex Male 5.4 2.3 2.4 5.9 19.4 12.2 11.5 21.7 13.2 3.2 1.2 1.6 100.0 2,111 Female 5.2 1.1 2.0 4.1 20.4 12.9 13.1 23.3 13.6 2.3 1.1 1.0 100.0 2,068 Residence Urban 5.7 1.7 1.5 5.1 23.3 16.3 14.3 15.8 10.6 2.7 1.2 1.7 100.0 2,026 Rural 4.9 1.7 2.8 4.9 16.6 9.0 10.3 28.7 16.0 2.9 1.2 0.9 100.0 2,153 Region National Capital Region 7.3 2.3 1.2 4.5 27.5 19.7 14.9 7.3 9.4 2.1 1.4 2.4 100.0 606 Cordillera Admin Region 3.1 1.3 2.5 6.3 11.6 14.1 9.2 28.7 20.1 2.5 0.6 0.0 100.0 72 I - Ilocos 5.4 2.4 1.9 3.0 18.6 11.0 11.4 28.4 15.0 1.8 0.6 0.6 100.0 169 II - Cagayan Valley 4.1 1.0 3.1 7.3 17.8 12.1 11.1 25.1 14.0 3.2 0.5 0.5 100.0 154 III - Central Luzon 4.3 1.3 0.9 6.0 30.8 10.3 11.9 18.6 9.4 1.6 0.9 4.0 100.0 407 IVA - CALABARZON 5.7 2.4 1.0 4.4 14.5 20.2 14.2 21.2 12.1 3.1 0.4 0.8 100.0 412 IVB - MIMAROPA 5.0 1.0 6.0 2.3 17.7 8.5 7.9 22.6 21.4 4.4 0.5 2.7 100.0 142 V - Bicol 8.1 2.7 0.8 5.0 21.2 11.2 7.8 21.9 16.2 3.3 1.1 0.6 100.0 284 VI - Western Visayas 3.6 1.6 2.6 4.7 22.2 10.4 12.0 18.8 17.1 1.9 3.9 1.3 100.0 294 VII - Central Visayas 7.3 0.7 1.0 7.1 13.9 13.7 12.3 21.8 17.3 1.4 1.7 1.7 100.0 338 VIII - Eastern Visayas 2.8 2.9 2.0 5.3 15.8 10.3 10.6 35.6 11.0 2.8 0.8 0.0 100.0 210 IX - Zamboanga Peninsula 3.1 1.0 5.3 5.3 15.7 9.3 12.9 35.0 9.5 1.9 1.0 0.0 100.0 177 X - Northern Mindanao 4.0 1.5 2.0 6.5 12.4 8.9 10.9 36.6 13.8 1.5 1.0 1.0 100.0 185 XI - Davao 7.5 0.7 3.2 4.1 17.0 7.2 12.5 29.9 10.6 6.3 0.9 0.0 100.0 200 XII - SOCCSKSARGEN 6.5 0.8 3.6 2.9 18.1 11.3 10.6 27.1 12.5 6.0 0.6 0.0 100.0 209 XIII - Caraga 1.7 3.4 3.1 7.3 11.3 6.8 11.0 30.1 19.4 4.3 1.3 0.4 100.0 140 ARMM 1.2 1.2 4.8 2.8 23.9 5.2 19.0 21.2 15.9 2.9 0.8 1.2 100.0 181 Mother’s education No education 1.2 0.0 9.8 4.7 19.4 6.5 11.0 25.6 20.1 0.0 0.0 1.7 100.0 77 Primary 4.8 0.9 3.5 5.7 13.9 6.9 12.1 30.1 16.4 2.8 1.4 1.4 100.0 1,194 Secondary 5.5 2.4 1.7 4.4 18.4 9.9 13.4 24.3 14.5 3.2 1.2 1.1 100.0 1,785 Higher 5.6 1.7 1.1 5.3 28.6 23.1 10.6 11.3 8.1 2.1 0.9 1.5 100.0 1,122 Wealth index quintile Lowest 4.5 1.3 3.9 4.7 11.6 6.4 13.1 30.1 18.9 2.7 1.3 1.4 100.0 1,122 Second 4.2 1.9 2.7 5.0 17.5 8.7 11.5 28.3 14.9 2.8 1.2 1.2 100.0 962 Middle 5.8 1.5 1.7 4.9 23.6 12.2 10.4 20.1 13.6 4.3 1.5 0.5 100.0 776 Fourth 7.3 2.1 0.8 4.8 25.7 17.7 12.7 15.7 8.6 2.1 0.6 1.9 100.0 692 Highest 5.6 2.1 0.4 5.9 27.2 24.1 13.7 10.4 6.1 1.8 1.0 1.6 100.0 627 Total 5.3 1.7 2.2 5.0 19.9 12.5 12.3 22.5 13.4 2.8 1.2 1.3 100.0 4,179 10.4 TYPE OF FOODS AND FREQUENCY OF FEEDING Food supplementation is important for infant growth and development. In particular, nonbreast- feeding and weaned infants need proper and adequate food supplements to meet their nutritional require- ments. The type of foods infants received and the timing of introduction to the infant’s diet not only affect the intensity of breastfeeding but can cause indigestion and diarrhea. WHO recommends the introduction of solid food to infants around the age of six months, when breast milk by itself is no longer sufficient to meet the infant’s nutritional requirements. Infant Feeding and Supplmentation | 157 For the youngest children born in the three years preceding the survey and living with their moth- ers, mothers were asked about the types of food the children drank or ate over the last seven days, as well as the number of times the foods were taken during the day and night preceding the survey. Tables 10.5 and 10.6 show, respectively, the types of food and the number of times specific foods were consumed, in the day or night preceding the interview by breastfeeding status. Table 10.5 shows that among breastfeeding children under two months of age, 14 percent are given infant formula, 5 percent are given other milk/cheese/yogurt, and 6 percent each received other liq- uids and solid or semisolid food. Other liquids include sugar water, tea, fruit juice, coffee, soda, rice wa- ter, and soup broth. At age 4-5 months, the pattern of feeding starts to exhibit dramatic changes; 32 per- cent of infants are given food made of grains and 25 percent receive liquids other than breast milk. Table 10.5 also shows that consumption of fruits and vegetables rich in vitamin A increases with the child’s age. By age 8-9 months, 61 percent of breastfeeding children receive food rich in vitamin A. This proportion increases to 80 percent by the time the child is age 2-3 years. Table 10.5 Foods consumed by children in the day or night preceding the interview Percentage of youngest children under three years of age living with the mother who consumed specific foods in the day or night preceding the interview, by breastfeeding status and age, Philippines 2003 Age in months Infant formula Other milk/ cheese/ yogurt Other liquids1 Food made from grains Fruits/ vege- tables2 Food made from roots/ tubers Food made from legumes Meat/fish/ shellfish/ poultry/ eggs Food made with oil/ fat/butter Fruits and vege- tables rich in vitamin A3 Any solid or semi- solid food Number of chil- dren BREASTFEEDING CHILDREN <2 13.8 4.8 6.3 3.2 3.2 0.6 0.0 1.7 1.7 3.2 5.9 138 2-3 19.9 7.2 10.6 5.0 3.4 1.1 0.0 2.9 0.0 3.4 8.7 201 4-5 20.1 3.0 24.7 31.6 14.2 1.4 3.7 7.7 3.2 11.5 47.0 144 6-7 31.6 9.7 43.7 71.2 44.3 11.9 3.2 29.5 4.9 36.2 87.1 172 8-9 23.8 11.8 59.2 91.5 70.7 20.0 3.5 52.0 9.7 60.6 99.7 163 10-11 34.0 17.6 52.8 88.9 68.5 14.3 3.4 64.1 9.7 57.2 97.9 130 12-15 27.6 19.5 59.0 90.0 74.9 18.9 10.0 68.4 10.8 64.5 99.5 244 16-19 28.0 17.7 72.5 95.4 77.5 22.7 10.7 70.1 16.8 67.9 100.0 152 20-23 34.7 24.8 67.3 92.5 83.3 25.0 16.6 77.3 13.1 78.6 100.0 127 24-35 32.6 24.5 69.2 95.9 84.5 24.2 12.7 77.0 16.4 79.9 100.0 171 <6 18.2 5.3 13.6 12.4 6.6 1.0 1.1 4.0 1.4 5.8 19.3 483 6-9 27.8 10.7 51.2 81.1 57.1 15.9 3.3 40.5 7.3 48.1 93.2 336 NONBREASTFEEDING CHILDREN 6-7 76.4 17.8 49.9 65.1 50.3 26.5 5.3 26.6 3.9 45.2 92.2 83 8-9 84.1 14.9 53.0 75.7 61.0 17.3 1.1 44.7 2.5 46.4 94.8 80 10-11 78.5 22.1 64.6 87.9 71.7 31.1 8.4 63.6 13.6 59.6 97.9 89 12-15 75.2 30.7 62.2 92.6 78.2 24.9 10.0 72.5 12.9 64.5 99.7 192 16-19 69.4 29.4 69.4 97.5 78.9 23.5 7.9 74.7 22.5 72.5 100.0 200 20-23 62.8 28.7 73.7 92.4 82.1 23.7 15.5 78.3 19.9 73.5 99.3 265 24-35 50.9 33.1 71.1 93.9 81.5 22.9 13.7 79.6 17.7 73.0 99.9 719 <6 77.5 6.3 25.5 17.1 17.8 5.9 1.8 9.7 0.4 14.6 40.9 118 6-9 80.2 16.4 51.5 70.3 55.5 22.0 3.2 35.5 3.2 45.7 93.5 163 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitmain A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A 158 | Infant Feeding and Supplementation Table 10.6 shows the frequency of foods consumed in the 24-hour period preceding the survey. Data in this table show that breastfeeding children under six months receive foods other than breast milk very few times. At the same age, nonbreastfeeding children receive infant formula about four times in 24 hours. Breastfeeding children age 6-9 months receive other liquids,1 cereal-type foods, and fruits and vegetables on average twice in the 24-hour period. The frequency of foods consumed generally increases with the child's age. Older children are more likely to receive more varied food. Table 10.6 Frequency of foods consumed by children in the day or night preceding the interview Mean number of times specific foods were consumed in the day or night preceding the interview by youngest children under three years of age living with the mother, according to breastfeeding status and age, Philippines 2003 Age in months Infant formula Other milk/ cheese/ yogurt Other liquids1 Food made from grains Fruits/ vege- tables2 Food made from roots/ tubers Food made from legumes Meat/fish/ shellfish/ poultry/ eggs Food made with oil/ fat/butter Fruits and vegetables rich in vitamin A3 Number of children BREASTFEEDING CHILDREN <2 0.5 0.2 0.2 0.1 0.2 0.0 0.0 0.0 0.0 0.2 138 2-3 0.5 0.2 0.2 0.1 0.1 0.0 0.0 0.0 0.0 0.1 201 4-5 0.6 0.0 0.6 0.7 0.4 0.0 0.0 0.2 0.0 0.3 144 6-7 0.9 0.2 1.1 1.8 1.1 0.2 0.0 0.5 0.1 0.8 172 8-9 0.8 0.2 1.8 2.4 2.0 0.3 0.0 1.0 0.2 1.4 163 10-11 1.0 0.4 1.4 2.4 2.1 0.2 0.0 1.1 0.1 1.4 130 12-15 0.7 0.5 1.5 2.5 2.4 0.3 0.1 1.1 0.1 1.7 244 16-19 0.7 0.3 1.9 2.8 2.7 0.3 0.1 1.2 0.3 2.0 152 20-23 1.2 0.5 1.9 2.6 3.1 0.5 0.2 1.5 0.2 2.4 127 24-35 0.8 0.5 1.8 2.7 2.7 0.3 0.1 1.4 0.2 2.0 171 <6 0.5 0.1 0.3 0.3 0.2 0.0 0.0 0.1 0.0 0.2 483 6-9 0.9 0.2 1.5 2.1 1.6 0.2 0.0 0.7 0.1 1.1 336 NONBREASTFEEDING CHILDREN 6-7 3.8 0.6 1.7 1.6 1.4 0.4 0.1 0.4 0.1 0.9 83 8-9 3.8 0.4 1.7 1.9 1.6 0.3 0.0 0.7 0.0 1.0 80 10-11 3.6 0.6 1.8 2.4 2.0 0.4 0.1 1.1 0.3 1.4 89 12-15 3.4 0.9 1.8 2.8 2.4 0.3 0.1 1.4 0.2 1.5 192 16-19 2.8 0.9 2.2 3.1 2.7 0.3 0.1 1.3 0.3 1.9 200 20-23 2.5 0.9 2.3 2.7 2.9 0.3 0.2 1.6 0.3 2.0 265 24-35 1.7 0.8 2.1 2.9 2.8 0.3 0.2 1.5 0.3 2.0 719 <6 3.7 0.2 0.9 0.5 0.4 0.1 0.0 0.1 0.0 0.3 118 6-9 3.8 0.5 1.7 1.8 1.5 0.3 0.0 0.6 0.0 0.9 163 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitamin A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables rich in vitamin A 10.5 MICRONUTRIENT INTAKE AMONG CHILDREN AND WOMEN Micronutrients help protect children from certain diseases. Micronutrient deficiency can lead to child morbidity and mortality. Poor intake of nutritious food, frequent episodes of infections, and infesta- tion of parasites are some of the primary causes of micronutrient deficiency. Micronutrients can be ob- tained from fruits and vegetables or from direct supplementation. Apart from the types of food listed in Table 10.7, mothers were also asked if their children received vitamin A and iron supplementation during the six months before the survey. 1 Other liquids include sugar water, tea, fruit juice, coffee, soda, rice water, and soup broth. Infant Feeding and Supplmentation | 159 Table 10.7 presents the percentage of youngest children under age three and living with the mother who consumed fruits and vege- tables rich in vitamin A in the seven days pre- ceding the survey and the percentage of children age 6-59 months who received vitamin A cap- sules in the six months preceding the survey, by background characteristics. The results show that more than half (56 percent) of these children consume fruits and vegetables rich in vitamin A and three in four receive vitamin A capsules. These percentages do not vary by the child’s sex, birth order, and urban-rural residence. Infants below six months rarely get vitamin A from foods and do not receive vitamin A supplements. Breastfeeding children, children of poorest par- ents, and children of younger mothers are less likely to receive vitamin A from fruits and vege- tables and supplements. The strongest associa- tion between vitamin A supplements received by children is with their mother’s education. Eighty-five percent of children of mothers with college or higher education receive vitamin A supplements, compared with 37 percent of chil- dren of mothers with no education. There are variations across regions in the consumption of fruits and vegetables rich in vi- tamin A and administration of vitamin A sup- plements to children. Children in ARMM are the least likely to receive vitamin A supplementation (51 percent). Table 10.8 shows the extent of iron sup- plementation among children under five years. Data in Table 10.8 show that 63 percent receive iron drops or syrup. Treatment with iron gener- ally starts at age six months, after which it is not selective of the child’s age and sex. However, the likelihood of receiving such treatments is relatively low among rural children, children of mothers with less education, and children of poor parents. Table 10.7 Micronutrient intake among children Percentage of youngest children under age three living with the mother who consumed fruits and vegetables rich in vitamin A in the seven days preceding the survey, and percentage of children age 6-59 months who received vitamin A supplements in the six months preceding the survey, by background characteristics, Philippines 2003 Background characteristic Consumed fruits and vegetables rich in vitamin A Number of children Consumed vitamin A supple- ments Number of children Age in months <6 7.5 602 na 0 6-9 47.3 499 68.5 509 10-11 58.2 219 64.3 224 12-23 69.8 1,180 77.9 1,348 24-35 74.3 890 78.2 1,326 36-47 na 0 77.6 1,434 48-59 na 0 74.9 1,267 Sex Male 54.2 1,743 76.3 3,088 Female 57.7 1,646 75.7 3,021 Birth order 1 53.1 894 76.7 1,690 2-3 57.5 1,339 77.8 2,380 4-5 55.0 642 76.4 1,097 6+ 57.6 514 69.7 941 Breastfeeding status Breastfeeding 46.3 1,642 69.8 1,354 Not breastfeeding 64.9 1,725 77.7 4,685 Missing * 22 80.1 69 Residence Urban 56.1 1,700 79.9 3,065 Rural 55.7 1,689 72.0 3,044 Region National Capital Region 59.6 484 80.8 941 Cordillera Admin Region 56.7 57 74.9 104 I - Ilocos 50.7 160 74.6 269 II - Cagayan Valley 64.5 112 65.3 201 III - Central Luzon 59.0 323 83.2 612 IVA - CALABARZON 54.4 420 82.3 719 IVB - MIMAROPA 55.6 114 68.5 205 V - Bicol 58.9 211 70.9 385 VI - Western Visayas 43.7 238 76.9 417 VII - Central Visayas 54.2 267 77.9 472 VIII - Eastern Visayas 52.5 171 76.1 304 IX - Zamboanga Peninsula 59.3 137 64.4 235 X - Northern Mindanao 59.9 152 76.7 265 XI - Davao 55.2 146 72.3 260 XII - SOCCSKSARGEN 56.5 155 79.5 277 XIII - Caraga 55.5 98 79.7 178 ARMM 55.2 141 50.5 265 Mother’s age at birth <20 53.5 296 70.2 547 20-24 53.6 899 73.9 1,705 25-29 54.8 925 77.9 1,665 30-34 57.3 669 79.3 1,209 35-49 60.6 600 75.7 983 Mother's education No education 46.7 61 36.9 108 Elementary 53.6 948 67.4 1,775 High school 56.6 1,459 77.7 2,582 College or higher 57.8 920 85.3 1,645 Wealth index quintile Lowest 54.2 887 64.4 1,606 Second 55.5 772 73.3 1,384 Middle 53.8 679 79.5 1,174 Fourth 59.9 576 83.7 1,035 Highest 57.8 475 87.3 909 Total 55.9 3,389 76.0 6,109 Note: Information on vitamin A supplements is based on mother's recall. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mango, papaya, and other locally grown fruits and vegetables that are rich in vitamin A 160 | Infant Feeding and Supplementation Mothers with a live birth in the five years preced- ing the survey were asked if they received iron and vita- min A supplementation in the two months after delivery. They were also asked whether during their last pregnancy they suffered from night blindness. Results in Table 10.9 show that less than half (45 percent) of these women re- ceived vitamin A supplements. Vitamin A supplementa- tion varies little by the woman’s characteristics, except education and region. While only 15 percent of women with no education received vitamin A supplements after giving birth, the corresponding proportion for women with college or higher education is 52 percent. Variations across regions are also notable; while coverage of vitamin A supplementation is 50 percent or higher in NCR, Central Visayas, and SOCCSKSARGEN, it is less than 30 percent in Ilocos and ARMM. Night blindness during pregnancy is reported by 8 percent of women; however, after adjusting for vision problems during the day, the figure drops to 2 percent. This problem has no clear pattern by the woman’s charac- teristics. Night blindness is most often reported in CAR (4 percent) and least reported in Cagayan Valley, Zambo- anga Peninsula, and SOCCSKSARGEN (less than 1 per- cent each). Among women with a birth in the five years pre- ceding the survey, 74 percent received iron supplements (Table 10.9). Two in five women took the iron supple- mentation for less than 60 days, and three in ten took them for 90 or more days. Coverage of iron supplementation across subgroups of women is similar to that of vitamin A supplementation. Table 10.8 Treatment with iron Percentage of living children under five years who received iron drops/syrup during the six months pre- ceding the survey, according to background charac- teristics, Philippines 2003 Background characteristic Received iron drops/ syrup Number of children Age in months 12-23 60.9 2,077 24-35 65.2 3,777 36-47 61.0 858 Sex Male 64.2 3,403 Female 62.5 3,309 Birth order 1 66.6 1,880 2-3 65.2 2,603 4-5 61.9 1,199 6+ 54.3 1,031 Residence Urban 70.4 3,361 Rural 56.2 3,351 Region National Capital Region 75.2 1,020 Cordillera Admin Region 55.7 113 I - Ilocos 59.1 299 II - Cagayan Valley 57.9 220 III - Central Luzon 69.8 662 IVA - CALABARZON 69.4 796 IVB - MIMAROPA 50.9 225 V - Bicol 53.4 424 VI - Western Visayas 62.7 458 VII - Central Visayas 70.4 519 VIII - Eastern Visayas 59.3 341 IX - Zamboanga Peninsula 45.5 264 X - Northern Mindanao 64.0 289 XI - Davao 56.8 285 XII - SOCCSKSARGEN 58.2 312 XIII - Caraga 73.1 195 ARMM 39.7 291 Mother’s education No education 25.9 120 Elementary 50.5 1,944 High school 65.2 2,856 College or higher 76.8 1,793 Wealth index quintile Lowest 47.3 1,768 Second 58.5 1,527 Middle 68.3 1,312 Fourth 74.8 1,127 Highest 80.1 979 Total 63.3 6,712 Note: Total includes one child age 48-59 months with missing information on supplements. Infant Feeding and Supplmentation | 161 Table 10.9 Micronutrient intake among mothers Percentage of women with a birth in the five years preceding the survey who received a vitamin A dose in the first two months after delivery, percentage who suffered from night blindness during pregnancy, percentage who took iron tablets or syrup for specific number of days, by background characteristics, Philippines 2003 Number of days iron tablets/syrup taken during pregnancy Background characteristic Received vitamin A dose postpartum1 Night blindness reported Night blindness adjusted2 None <60 60-89 90+ Don't know/ missing Number of women Age at birth <20 42.9 8.3 2.3 24.2 39.7 5.4 27.1 3.6 387 20-24 43.2 7.6 1.9 21.8 40.5 6.9 28.2 2.6 1,219 25-29 44.7 5.8 1.8 21.5 36.4 6.7 31.6 3.8 1,270 30-34 49.0 8.8 3.1 22.1 39.1 5.7 30.5 2.7 1,003 35-49 42.3 10.1 2.3 25.9 38.7 5.9 26.0 3.5 923 Number of children ever born 1 43.2 7.0 1.6 17.6 34.8 7.3 36.6 3.7 1,192 2-3 47.2 7.0 2.3 20.0 39.2 6.0 31.3 3.5 1,902 4-5 45.2 7.4 2.3 26.0 38.5 7.5 25.1 2.8 937 6+ 39.9 12.1 2.8 33.5 43.6 4.1 16.6 2.1 771 Residence Urban 47.3 6.9 2.1 19.8 35.5 6.1 34.2 4.4 2,447 Rural 41.9 9.0 2.4 25.8 42.0 6.5 23.7 2.0 2,355 Region National Capital Region 55.3 6.1 1.7 22.9 34.9 3.8 30.0 8.3 724 Cordillera Admin Region 44.1 10.1 4.4 33.5 33.7 5.8 25.4 1.7 79 I - Ilocos 28.5 2.8 2.3 22.2 40.7 4.6 30.7 1.8 220 II - Cagayan Valley 43.1 1.9 0.5 27.3 29.9 7.1 35.2 0.5 169 III - Central Luzon 38.5 5.8 2.4 18.3 35.0 7.1 36.7 2.8 480 IVA - CALABARZON 46.5 6.3 3.3 23.1 33.3 8.1 33.0 2.5 595 IVB - MIMAROPA 37.7 12.0 4.0 25.7 46.2 9.3 16.9 1.8 155 V - Bicol 36.9 4.4 1.8 26.1 51.6 5.0 14.0 3.3 290 VI - Western Visayas 48.7 15.5 1.8 14.9 44.9 8.6 23.7 7.9 324 VII - Central Visayas 51.8 11.3 2.2 12.8 29.9 6.2 49.9 1.3 359 VIII - Eastern Visayas 41.1 12.4 2.2 26.0 47.5 7.8 17.2 1.5 230 IX - Zamboanga Peninsula 42.4 4.5 0.4 25.6 51.8 4.8 17.1 0.8 199 X - Northern Mindanao 40.8 10.5 2.5 19.0 41.5 6.5 31.8 1.3 219 XI - Davao 48.8 9.1 2.7 19.0 50.3 5.6 23.3 1.8 216 XII - SOCCSKSARGEN 51.4 9.2 0.7 23.1 38.8 6.3 30.7 1.2 223 XIII - Caraga 49.0 13.0 3.6 11.2 35.6 7.6 44.7 0.9 135 ARMM 25.4 6.8 2.4 59.8 28.3 4.7 6.9 0.4 184 Education No education 14.7 8.3 1.5 69.6 20.1 0.0 7.4 2.9 80 Elementary 37.7 10.7 3.4 32.4 42.5 6.5 16.8 1.8 1,349 High school 45.9 7.2 1.9 21.4 41.2 6.0 28.3 3.1 2,037 College or higher 51.5 6.1 1.6 12.2 32.2 7.0 43.9 4.7 1,337 Wealth index quintile Lowest 37.4 10.9 2.1 35.0 42.1 5.3 15.1 2.4 1,162 Second 42.5 8.5 2.6 24.4 44.9 6.8 21.6 2.3 1,065 Middle 45.9 7.6 3.2 18.9 42.6 6.0 29.5 3.0 944 Fourth 47.0 6.4 1.4 17.4 31.2 8.0 39.4 3.9 863 Highest 54.2 4.6 1.5 12.7 28.5 5.4 48.2 5.1 768 Total 44.6 7.9 2.2 22.8 38.7 6.3 29.1 3.2 4,802 Note: For women with two or more live births in the five-year period, data refer to the most recent birth. 1 In the first two months after delivery 2 Women who reported night blindness but did not report difficulty with vision during the day HIV/AIDS and Other Sexually Transmitted Infections | 163 HIV/AIDS AND OTHER SEXUALLY TRANSMITTED INFECTIONS 11 The first AIDS case was recorded in the Philippines in 1984 following the death of a foreign national from AIDS-related pneumonia. In 1986, HIV/AIDS was classified as a notifiable disease. In 1987, the HIV/AIDS Registry was institutionalized in the Department of Health. This is a passive surveillance system established in 1987 which continuously logs Western Blot-confirmed HIV cases reported by hospitals, laboratories, blood banks and clinics, analyzes the case profiles and monitors the progression of the disease. In 1993, the National HIV/AIDS Sentinel Surveillance System (NHSSS) was established in the Department of Health with funding from the United States Agency for International Development (USAID) through the AIDS Surveillance and Education Project (ASEP). Technical assistance was received from the World Health Organization (WHO). The NHSSS has two components, the Serologic Surveillance System and the Behavioral Surveillance System. The NHSSS objectives include detecting increases in HIV seroprevalence, identifying risk practices, and helping policy-makers to arrive at informed decisions. Both the serologic and behavioral surveillance target the high risk groups: sex workers, men having sex with men, and injecting drug users. In 2003, the Sentinel Sexually Transmitted Infections (STI) Etiologic Surveillance System was established in 11 sites to monitor seven sexually transmitted diseases: gonorrhea, non-gonococcal infection, trichomoniasis, bacterial vaginosis, syphilis, genital warts, and genital herpes. This chapter presents findings about current levels of knowledge on AIDS-related issues, such as transmission and prevention, stigma, and discrimination against people with HIV/AIDS. Knowledge of and experience with other sexually transmitted infections that may be cofactors in HIV transmission are also discussed. The chapter concludes by providing information on knowledge of and access to condoms. 11.1 KNOWLEDGE OF HIV/AIDS Table 11.1 shows the percentage of women and men who have heard of AIDS and who believe there is a way to avoid HIV or AIDS, by background characteristics. The vast majority of the 2003 NDHS respondents have heard of AIDS (95-96 percent). In general, there are only small differences in the level of knowledge of HIV/AIDS between women and men (Figure 11.1). Knowledge also varies little by respondent’s age, marital status, and residence (urban-rural). However, there are substantial differences by respondent’s region, education, and wealth status. The most striking difference is by the level of education: while practically all women and men with college or higher education reported having heard of HIV/AIDS, the corresponding proportion for those with no education is only 56 percent for women and 60 percent for men. Respondents in the lowest (poorest) wealth quintile are much less likely than those in the higher quintiles to have heard of HIV/AIDS. For women, 85 percent of women in the lowest quintile reported having heard of HIV/AIDS compared with 95 percent or higher of women in the second and higher quintiles. In all regions but ARMM, and among men in MIMAROPA, 90 percent or more of women and men have heard of HIV/AIDS. In ARMM, only 75 percent of women and 51 percent of men responded positively to the question on knowledge of HIV/AIDS. 164 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.1 Knowledge of AIDS Percentage of women and men who have heard of AIDS and who believe there is a way to avoid HIV/AIDS, by background characteristics, Philippines 2003 Women Men Background characteristic Has heard of AIDS Believes there is a way to avoid HIV/AIDS Number of women Has heard of AIDS Believes there is a way to avoid HIV/AIDS Number of men Age 15-19 93.1 83.6 2,648 93.3 84.7 918 20-24 95.3 90.0 2,209 96.4 90.9 785 25-29 95.6 90.5 2,034 96.6 91.9 647 30-39 96.5 90.0 3,827 96.3 91.0 1,179 40-49 95.1 87.3 2,915 96.0 88.6 899 50-54 na na 0 95.2 88.6 338 Marital status Never married, ever had sex 92.8 86.7 225 97.2 91.6 626 Never married, never had sex 94.9 87.7 4,163 93.8 85.5 1,288 Married/living together 95.5 88.7 8,671 96.0 90.6 2,746 Divorced/not living together 95.0 89.5 373 100.0 87.3 88 Widowed 91.4 80.5 201 * * 17 Residence Urban 96.6 90.8 7,877 96.9 92.7 2,553 Rural 93.3 84.8 5,756 94.2 85.4 2,213 Region National Capital Region 95.9 91.1 2,387 98.3 93.0 740 Cordillera Admin Region 90.4 77.2 216 93.2 84.3 72 I - Ilocos 95.0 87.3 642 97.9 89.2 232 II - Cagayan Valley 96.5 92.0 426 96.1 81.6 163 III - Central Luzon 97.3 91.0 1,459 97.1 93.1 520 IVA - CALABARZON 97.8 93.4 1,890 99.0 95.7 652 IVB - MIMAROPA 91.5 83.7 340 86.5 77.4 119 V - Bicol 95.6 86.0 713 96.8 85.5 236 VI - Western Visayas 96.9 87.2 910 97.8 87.7 322 VII - Central Visayas 95.6 85.1 1,070 96.0 90.5 373 VIII - Eastern Visayas 96.4 91.3 555 97.4 93.2 229 IX - Zamboanga Peninsula 91.3 84.2 465 95.9 90.0 189 X - Northern Mindanao 95.9 83.8 565 98.2 88.8 202 XI - Davao 97.6 90.5 654 98.1 92.4 212 XII - SOCCSKSARGEN 91.7 83.4 524 96.5 86.8 216 XIII - Caraga 98.2 95.6 327 99.0 97.0 125 ARMM 75.0 67.3 489 51.4 46.7 166 Education No education 56.3 41.3 186 60.0 47.8 84 Elementary 88.9 75.6 3,146 92.5 80.8 1,441 High school 96.7 89.8 6,109 97.3 92.3 2,048 College or higher 99.4 97.6 4,192 99.1 97.3 1,193 Wealth index quintile Lowest 84.5 71.6 2,161 85.4 75.0 884 Second 94.5 86.0 2,412 97.0 89.0 937 Middle 98.0 91.3 2,682 98.2 91.7 992 Fourth 97.8 93.2 2,940 97.8 93.4 957 Highest 98.0 93.8 3,438 98.9 95.7 996 Total 95.2 88.3 13,633 95.6 89.3 4,766 Note: An asterisk indicates that an estimate is based on fewer than 25 cases and has been suppressed. na = Not applicable HIV/AIDS and Other Sexually Transmitted Infections | 165 The second indicator for HIV/AIDS knowledge presented in Table 11.1 refers to the belief about ways to avoid getting HIV/AIDS. Findings show that, overall, 88 percent of women and 89 percent of men say that HIV infection can be avoided. In general, the patterns for this indicator are similar to those for general knowledge and awareness of AIDS. Differences in the belief that there is a way to avoid HIV/AIDS are more pronounced by the respondent’s level of education. For example, 98 percent of women with college or higher education believe that there is a way to avoid getting the AIDS virus, compared with 41 percent of women with no education. 11.2 KNOWLEDGE OF WAYS TO AVOID HIV/AIDS In the 2003 NDHS, information on knowledge of ways to avoid HIV infection was collected in two ways: first, if a respondent reported that AIDS could be avoided, an open-ended question was asked about how “a person could avoid getting the AIDS virus.” Respondents were allowed to give all the ways to avoid HIV/AIDS that they knew of spontaneously. Next, women and men were asked specific questions on whether limiting their sexual activity to just one partner and (in a separate question) condom use can reduce their chances of getting AIDS. Table 11.2 presents the results of the prompted questions, that people can reduce the risk of getting the AIDS virus by using condoms or by having sex with just one uninfected partner who has no other partners, by background characteristics. Knowledge of HIV prevention methods is moderate; 48 percent of women and 62 percent of men know that condom use is a prevention method. Knowledge that limiting sex to only one uninfected partner can reduce the risk of getting HIV is higher (77 percent for women and men). Forty-five percent of women and 56 percent of men know of both preventive measures. 95 88 96 89 Has heard of AIDS Believes there is a way to avoid HIV/AIDS 0 20 40 60 80 100 120 Percent Women Men Figure 11.1 Percentage of Men and Women Who Have Heard of AIDS and Who Believe There Is a Way to Avoid HIV/AIDS NDHS 2003 166 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.2 Knowledge of HIV prevention methods Percentage of women and men age 15-49 who, in response to a prompted question, say that people can reduce the risk of getting the AIDS virus by using condoms and by having sex with just one partner who is not infected and who has no other partners, by background characteristics, Philippines 2003 Women Men Background characteristic Using condoms Limiting sex to one uninfected partner Using condoms and limiting sex to one uninfected partner Number of women Using condoms Limiting sex to one uninfected partner Using condoms and limiting sex to one uninfected partner Number of men Age 15-19 40.8 67.9 36.3 2,648 55.7 67.4 47.7 918 20-24 47.5 78.0 43.2 2,209 63.4 76.9 56.5 785 25-29 50.3 80.1 46.5 2,034 64.9 80.3 59.9 647 30-39 52.3 81.4 49.1 3,827 66.3 80.9 60.6 1,179 40-49 49.8 78.4 46.3 2,915 61.3 79.4 56.2 899 15-24 43.8 72.5 39.4 4,856 59.3 71.8 51.7 1,702 Marital status Never married 44.7 73.1 40.2 4,388 60.5 71.7 52.9 1,899 Ever had sex 49.1 75.0 46.2 225 69.1 75.0 59.3 619 Never had sex 44.5 73.0 39.9 4,163 56.4 70.2 49.8 1,280 Married/living together 50.3 79.6 46.9 8,671 63.6 81.1 58.4 2,440 Divorced/separated/widowed 48.7 77.3 45.3 574 69.6 77.2 64.0 88 Residence Urban 49.7 79.3 45.7 7,877 64.4 78.8 57.1 2,376 Rural 46.7 74.8 43.3 5,756 60.0 74.9 55.1 2,052 Region National Capital Region 45.8 80.4 42.4 2,387 54.5 75.7 45.8 699 Cordillera Admin Region 49.7 72.0 46.8 216 64.6 79.8 61.4 66 I - Ilocos 55.4 75.8 51.3 642 71.7 83.1 68.0 213 II - Cagayan Valley 50.2 87.2 47.2 426 48.8 73.2 45.3 147 III - Central Luzon 58.7 81.5 54.0 1,459 68.2 84.6 63.9 481 IVA - CALABARZON 47.0 79.9 42.3 1,890 68.4 75.8 56.4 608 IVB - MIMAROPA 43.8 71.1 38.4 340 50.0 58.9 40.2 108 V - Bicol 48.2 76.9 45.4 713 74.1 75.1 67.0 220 VI - Western Visayas 41.5 75.8 37.7 910 56.4 77.7 52.6 295 VII - Central Visayas 50.5 70.7 45.9 1,070 65.9 76.5 58.2 354 VIII - Eastern Visayas 43.3 76.6 40.0 555 64.4 84.2 61.1 208 IX - Zamboanga Peninsula 47.5 72.7 44.9 465 80.3 87.1 77.8 174 X - Northern Mindanao 47.9 72.9 43.3 565 62.3 75.0 58.0 187 XI - Davao 61.2 82.4 57.8 654 69.6 80.7 64.9 191 XII - SOCCSKSARGEN 38.2 74.4 35.9 524 43.4 73.5 38.8 204 XIII - Caraga 58.3 85.8 56.2 327 67.3 86.9 64.2 113 ARMM 31.4 61.3 29.8 489 41.3 47.4 41.3 159 Education No education 15.4 30.9 13.2 186 24.0 36.6 21.9 74 Elementary 40.1 65.2 36.8 3,146 52.2 69.1 47.6 1,273 High school 47.6 77.8 43.5 6,109 65.1 79.2 58.3 1,957 College or higher 57.3 88.0 53.7 4,192 71.6 84.7 64.4 1,124 Wealth index quintile Lowest 36.1 61.0 32.9 2,161 50.9 64.6 46.4 825 Second 45.7 75.2 42.2 2,412 61.2 79.2 56.6 876 Middle 50.7 79.5 45.9 2,682 62.1 77.4 55.0 918 Fourth 52.6 81.9 48.8 2,940 68.1 79.7 61.2 894 Highest 52.8 83.8 49.4 3,438 68.5 83.0 60.9 915 Total 48.4 77.4 44.7 13,633 62.4 77.0 56.2 4,428 Total men 15 - 54 na na na na 62.4 77.2 56.4 4,766 na = Not applicable HIV/AIDS and Other Sexually Transmitted Infections | 167 Knowledge of HIV prevention is higher among urban respondents, better educated, and respondents in higher wealth quintiles. Regional variations in the use of condoms for HIV prevention range from 31 percent in ARMM to 61 percent in Davao among women, and from 41 percent in ARMM to 80 percent in Zamboanga Peninsula among men. For both women and men, knowledge of HIV prevention rises with age until age 39. 11.3 BELIEFS ABOUT AIDS Misconceptions about AIDS and HIV transmission is one of the factors that contributes to discrimination and stigmatisation. The 2003 NDHS asked respondents about common misconceptions in the Philippines. Respondents were asked whether AIDS can be transmitted by mosquito bites; whether AIDS can be transmitted by supernatural means; and whether a person can be infected through sharing food with a person who has AIDS. The results are presented in Tables 11.3.1 for women and 11.3.2 for men, by background characteristics. Six in ten women and men know that AIDS cannot be transmitted through mosquito bites. A higher percentage believes AIDS cannot be transmitted by supernatural means (four in five women and men). However, smaller proportions of women and men (53 and 44 percent, respectively) know that a person cannot become infected with HIV/AIDS by sharing food with someone who has AIDS. Only 36 percent of women and 30 percent of men correctly rejected the two most common misconceptions about AIDS (i.e., that AIDS is transmitted by mosquito bites and by sharing food with a person who has AIDS). These figures demonstrate that misconceptions about AIDS transmission remain high in the Philippines. Among men, urban residents are less likely to have misconceptions about HIV/AIDS trans- mission than rural residents; however, the proportions among women are almost the same. Regional variations are notable, with correct beliefs regarding the two most common misconceptions ranging among women from 9 percent in Central Luzon to 73 percent in Cagayan Valley, and among men from 2 percent in ARMM to 47 percent in NCR. Better educated respondents and those in the higher wealth quintiles are more likely to have correct beliefs than other respondents. 62 77 48 77 Use condoms Limit number of sexual partners 0 20 40 60 80 100 Percent Men Women Figure 11.2 Percentage of Men and Women Who Know of Two Specific Ways to Avoid HIV/AIDS NDHS 2003 168 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.3.1 Beliefs about AIDS: women Percentage of women age 15-49 who, in response to a prompted question, correctly rejected local miscon- ceptions about AIDS transmission or prevention, by background characteristics, Philippines 2003 Percentage of respondents who know that: Background characteristic AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by supernatural means A person cannot become infected by sharing food with person with AIDS Percentage who correctly rejected the two most common misconceptions Number of women Age 15-19 58.1 75.4 45.6 33.7 2,648 20-24 62.2 83.0 56.8 36.8 2,209 25-29 62.6 84.0 57.6 39.6 2,034 30-39 59.3 81.1 55.8 37.6 3,827 40-49 58.5 76.3 51.6 33.3 2,915 15-24 60.0 78.8 50.7 35.1 4,856 Marital status Never married 62.5 81.0 53.5 36.8 4,388 Ever had sex 64.1 81.7 55.4 48.2 225 Never had sex 62.4 80.9 53.4 36.2 4,163 Married/living together 58.6 79.2 53.2 35.8 8,671 Divorced/separated/widowed 59.1 77.5 53.4 34.1 574 Residence Urban 63.8 84.1 59.0 35.7 7,877 Rural 54.5 73.6 45.6 36.6 5,756 Region National Capital Region 68.9 86.3 65.6 43.5 2,387 Cordillera Admin Region 58.3 70.6 53.3 49.7 216 I - Ilocos 51.0 71.6 38.0 38.1 642 II - Cagayan Valley 77.5 88.9 60.0 73.4 426 III - Central Luzon 61.9 85.5 61.8 9.0 1,459 IVA - CALABARZON 64.3 87.4 62.2 10.1 1,890 IVB - MIMAROPA 53.2 73.4 44.2 13.6 340 V - Bicol 47.6 66.9 35.1 32.5 713 VI - Western Visayas 42.3 66.2 44.2 34.5 910 VII - Central Visayas 55.6 77.8 43.4 51.3 1,070 VIII - Eastern Visayas 62.4 79.8 60.7 53.8 555 IX - Zamboanga Peninsula 71.3 83.5 61.1 69.2 465 X - Northern Mindanao 50.0 72.2 40.1 43.7 565 XI - Davao 56.8 81.2 53.0 51.1 654 XII - SOCCSKSARGEN 61.1 77.6 46.4 45.2 524 XIII - Caraga 66.7 89.8 56.5 58.9 327 ARMM 49.5 58.0 25.3 25.2 489 Education No education 20.7 32.3 17.8 11.6 186 Elementary 46.1 62.4 36.6 28.7 3,146 High school 60.4 80.8 51.7 35.7 6,109 College or higher 71.1 93.2 69.9 43.3 4,192 Wealth index quintile Lowest 44.2 59.3 33.3 31.8 2,161 Second 55.5 73.2 44.5 36.8 2,412 Middle 60.6 82.5 53.3 35.8 2,682 Fourth 64.4 86.3 59.3 36.9 2,940 Highest 68.3 89.2 67.1 37.8 3,438 Total 59.9 79.7 53.3 36.1 13,633 1 The two most common local misconceptions involve transmission by mosquito bites and by sharing food with a person who has AIDS (both country specific). HIV/AIDS and Other Sexually Transmitted Infections | 169 Table 11.3.2 Beliefs about AIDS: men Percentage of men age 15-49 who, in response to a prompted question, correctly rejected local misconceptions about AIDS transmission or prevention, by background characteristics, Philippines 2003 Percentage of respondents who know that: Background characteristic AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person with AIDS Percentage who correctly rejected the two most common misconceptions Number of men Age 15-19 55.3 76.2 39.8 26.0 918 20-24 60.9 84.4 46.2 31.5 785 25-29 62.1 85.7 47.5 34.0 647 30-39 56.0 81.2 45.6 30.0 1,179 40-49 56.8 78.9 44.1 29.9 899 15-24 57.9 80.0 42.8 28.5 1,702 Marital status Never married 58.5 80.2 44.9 30.4 1,899 Ever had sex 59.1 85.0 49.8 31.1 619 Never had sex 58.2 78.0 42.6 30.1 1,280 Married/living together 57.4 81.5 44.3 29.8 2,440 Divorced/separated/widowed 52.8 79.6 42.2 25.8 88 Residence Urban 62.4 86.7 52.1 35.2 2,376 Rural 52.4 74.3 35.7 24.0 2,052 Region National Capital Region 68.9 88.4 62.8 47.3 699 Cordillera Admin Region 57.3 79.9 47.4 30.9 66 I - Ilocos 51.9 75.5 36.1 24.2 213 II - Cagayan Valley 63.5 76.5 41.7 34.1 147 III - Central Luzon 69.0 86.4 60.2 44.5 481 IVA - CALABARZON 50.6 90.5 52.4 27.7 608 IVB - MIMAROPA 36.7 63.0 31.0 12.8 108 V - Bicol 42.4 68.8 31.1 20.4 220 VI - Western Visayas 38.8 70.5 25.9 15.4 295 VII - Central Visayas 65.7 82.3 38.1 28.9 354 VIII - Eastern Visayas 51.3 82.8 55.7 35.0 208 IX - Zamboanga Peninsula 72.7 85.2 23.3 19.3 174 X - Northern Mindanao 49.3 67.0 33.1 18.8 187 XI - Davao 54.4 85.0 41.9 22.4 191 XII - SOCCSKSARGEN 66.0 81.5 39.2 27.3 204 XIII - Caraga 70.4 91.9 49.5 38.4 113 ARMM 45.2 47.0 3.5 1.7 159 Education No education 28.8 27.3 6.6 4.8 74 Elementary 46.6 65.6 31.2 20.1 1,273 High school 58.9 85.1 43.5 28.7 1,957 College or higher 70.3 94.4 63.8 45.3 1,124 Wealth index quintile Lowest 43.2 61.9 24.9 15.0 825 Second 56.5 78.1 36.3 25.5 876 Middle 58.5 82.2 47.6 30.5 918 Fourth 62.3 88.5 51.1 34.9 894 Highest 66.9 92.0 60.4 42.6 915 Total 57.8 80.9 44.5 30.0 4,428 Total men 15 - 54 57.2 80.6 44.2 29.6 4,766 1 The two most common local misconceptions involve transmission by mosquito bites and by sharing food with a person who has AIDS (both country specific). 170 | HIV/AIDS and Other Sexually Transmitted Infections 11.4 STIGMA AND DISCRIMINATION ASSOCIATED WITH HIV/AIDS In the 2003 NDHS, questions were asked to evaluate the level of stigma attached to AIDS and to persons living with HIV and AIDS. First, respondents were asked “If a member of your family got infected with the virus that causes AIDS, would you want it to remain a secret?” Tables 11.4.1 and 11.4.2 show that 76 percent of women and 79 percent of men feel that HIV-positive status should not necessarily be kept confidential. While 89 percent of women in MIMAROPA believe that the HIV-positive status of individuals does not have to be kept a secret, 64-67 percent of women in Western Visayas and CAR shared this sentiment. Men show larger disparities; the proportions range between 87 percent in Central Luzon and MIMAROPA and 55 percent in Western Visayas. The 2003 NDHS respondents were also asked, “If a relative of yours became sick with AIDS would you be willing to care for her or him in your own household?” Thirty-four percent of women and 29 percent of men said they would be willing to care for a relative with AIDS at their home. The younger respondents, among both men and women, are more likely than older respondents to be willing to care for a family member with AIDS. Willingness to care for an HIV positive relative at home varied little across education or wealth categories. Women in CAR are the most likely (53 percent) to express their willingness to care for a family member who has AIDS, while women in ARMM are the least likely (10 percent). Among men, those in Ilocos and CAR are most likely to take care of a relative sick with AIDS (both 52 percent). Another question was asked to the 2003 NDHS respondents to measure stigma against persons with AIDS. Respondents were asked “If a female teacher has the AIDS virus, should she be allowed to continue teaching in the school?” The response to this question can be used to assess whether there is a discrimination against persons with AIDS in the workplace. Only a small proportion of respondents (14 percent of women and 11 percent of men) said they believe that an HIV-infected female teacher should be allowed to continue teaching. The attitude is only slightly more positive among younger women and men, those living in urban areas, better educated women and men, and those in higher wealth quintiles. 60 80 53 36 58 81 45 30 0 20 40 60 80 100 Percent Women Men Figure 11.3 Beliefs about AIDS NDHS 2003 AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by supernatural means AIDS cannot be transmitted by sharing food with a person with AIDS Rejected two most common misconceptions HIV/AIDS and Other Sexually Transmitted Infections | 171 Table 11.4.1 Accepting attitudes toward those living with HIV: women Among women age 15-49 who have heard about AIDS, percentage who expressed accepting attitudes toward people with HIV, by background characteristics, Philippines 2003 Percentage of respondents who: Background characteristic Are willing to care for family member with HIV at home Believe HIV- positive teacher should be allowed to teach Believe HIV- positive status of family member does not need to remain secret Number of women who have heard of HIV/AIDS Age 15-19 38.4 15.4 73.0 2,466 20-24 36.8 16.5 74.1 2,106 25-29 32.0 15.5 76.0 1,945 30-39 31.1 12.6 78.9 3,692 40-49 31.2 12.3 78.2 2,771 15-24 37.6 15.9 73.5 4,571 Marital status Never married 38.0 16.6 74.2 4,160 Ever had sex 36.6 15.6 78.1 208 Never had sex 38.0 16.7 74.0 3,952 Married/living together 31.5 12.9 77.4 8,282 Divorced/separated/widowed 31.7 14.4 77.9 538 Residence Urban 34.5 16.9 75.7 7,609 Rural 32.3 10.2 77.4 5,370 Region National Capital Region 33.4 19.7 76.5 2,288 Cordillera Admin Region 53.2 19.2 66.7 195 I – Ilocos 32.8 15.3 74.9 610 II – Cagayan Valley 19.2 9.7 87.1 411 III – Central Luzon 26.5 14.4 79.5 1,419 IVA – CALABARZON 37.6 18.6 73.6 1,849 IVB – MIMAROPA 26.4 12.7 88.9 311 V – Bicol 28.9 15.7 70.1 682 VI – Western Visayas 36.8 11.1 64.2 882 VII – Central Visayas 30.9 6.7 82.0 1,023 VIII – Eastern Visayas 35.5 17.0 80.4 535 IX – Zamboanga Peninsula 42.6 8.3 71.7 425 X – Northern Mindanao 41.8 10.5 83.1 542 XI – Davao 49.8 12.6 75.7 638 XII – SOCCSKSARGEN 30.2 10.4 79.3 481 XIII – Caraga 37.7 8.1 81.7 321 ARMM 10.0 4.2 71.5 367 Education No education 28.0 8.8 72.4 105 Elementary 30.1 7.3 76.6 2,798 High school 33.6 12.8 77.2 5,908 College or higher 35.9 20.9 75.2 4,168 Wealth index quintile Lowest 32.4 7.1 73.9 1,826 Second 30.5 9.0 78.8 2,280 Middle 31.4 13.2 79.0 2,627 Fourth 33.8 15.0 76.7 2,876 Highest 37.7 21.5 73.9 3,371 Total 33.6 14.2 76.4 12,980 172 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.4.2 Accepting attitudes toward those living with HIV: men Among men age 15-49 who have heard about AIDS, percentage who expressed accepting attitudes toward people with HIV, by background characteristics, Philippines 2003 Percentage of respondents who: Background characteristic Are willing to care for family member with HIV at home Believe HIV- positive teacher should be allowed to teach Believe HIV- positive status of family member does not need to remain secret Number of men who have heard of HIV/AIDS Age 15-19 36.2 14.9 72.5 857 20-24 31.6 14.0 77.5 756 25-29 29.2 10.8 78.8 625 30-39 27.0 9.7 80.9 1,136 40-49 24.1 6.3 84.3 863 15-24 34.0 14.5 74.8 1,613 Marital status Never married 34.1 14.1 74.7 1,803 Ever had sex 35.0 16.8 75.2 603 Never had sex 33.6 12.7 74.5 1,200 Married/living together 25.9 8.6 82.4 2,346 Divorced/separated/widowed 26.1 9.8 73.8 87 Residence Urban 28.5 13.3 78.4 2,303 Rural 30.4 8.2 79.7 1,934 Region National Capital Region 25.0 16.0 82.3 688 Cordillera Admin Region 52.3 17.0 69.3 63 I - Ilocos 52.0 16.5 83.7 209 II - Cagayan Valley 7.5 7.9 86.3 142 III - Central Luzon 26.7 6.2 87.0 466 IVA - CALABARZON 31.5 16.6 74.7 601 IVB - MIMAROPA 23.5 11.9 86.5 94 V - Bicol 34.0 6.9 74.5 214 VI - Western Visayas 45.3 13.4 54.6 289 VII - Central Visayas 27.1 4.4 80.0 340 VIII - Eastern Visayas 29.7 11.4 84.7 202 IX - Zamboanga Peninsula 10.3 1.0 78.6 167 X - Northern Mindanao 35.9 8.5 77.1 183 XI - Davao 30.6 6.7 74.7 187 XII - SOCCSKSARGEN 20.9 9.3 85.6 197 XIII - Caraga 29.7 8.0 82.2 112 ARMM 18.5 11.7 84.2 84 Education No education (28.4) (4.9) (64.5) 43 Elementary 28.2 7.3 76.2 1,175 High school 30.2 10.3 79.4 1,905 College or higher 29.3 16.2 81.9 1,113 Wealth index quintile Lowest 28.7 5.5 78.9 705 Second 28.5 7.4 77.5 850 Middle 27.7 10.1 79.0 900 Fourth 31.1 12.8 80.6 876 Highest 30.8 17.6 78.9 905 Total 29.4 11.0 79.0 4,236 Total men 15-54 29.0 10.8 79.3 4,558 Note: Figures in parentheses are based on 25-49 unweighted cases. HIV/AIDS and Other Sexually Transmitted Infections | 173 11.5 KNOWLEDGE OF PREVENTION OF MOTHER-TO-CHILD TRANSMISSION While the majority of HIV transmission is through sexual intercourse, there are other ways of contracting the disease. One of the key intervention areas in the dealing with the HIV/AIDS pandemic is the prevention of new infections. In the 2003 NDHS, respondents were asked about their knowledge of HIV transmission from mother to child; whether it can take place during pregnancy, delivery, or during breastfeeding. Respondents were also asked whether the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy. Tables 11.5.1 and 11.5.2 show that general knowledge about HIV transmission during pregnancy, delivery, and breastfeeding is relatively high (63 to 73 percent among women and 60 to 68 percent among men). However, few women and men (20-21 percent) know that the risk of MTCT can be reduced if a mother takes special drugs during pregnancy. This knowledge varies widely across subgroups of women and men. Urban residence, higher education, and living in wealthier households have a positive impact on the respondent’s knowledge of MTCT. Women and men in ARMM are least likely to know that HIV can be transmitted through breastfeeding and that the risk of MTCT can be reduced by mothers taking special drugs during pregnancy. On the other hand, knowledge of MTCT is high among women in Cagayan Valley and Caraga, and among men in Central Luzon and CALABARZON. 174 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.5.1 Knowledge of prevention of mother-to-child transmission of HIV: women Among women age 15-49 who know that HIV can be transmitted from mother to child, percentage who know that HIV can be transmitted during pregnancy, during delivery, and by breastfeeding, and percentage who know that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Philippines 2003 Percentage who know that: Percentage who know that HIV can be transmitted: Background characteristic During pregnancy During delivery By breastfeeding Risk of MTCT can be reduced by mother taking drugs in pregnancy HIV can be transmitted by breastfeeding and risk can be reduced by mother taking drugs during pregnancy Number of women Age 15-19 63.0 54.0 58.0 15.5 13.8 2,648 20-24 73.2 63.1 64.4 19.3 17.3 2,209 25-29 75.5 64.8 66.5 21.3 18.5 2,034 30-39 76.6 66.1 66.8 22.3 19.3 3,827 40-49 73.8 65.4 66.1 21.5 18.8 2,915 15-24 67.6 58.1 60.9 17.2 15.4 4,856 Marital status Never married 68.1 58.0 61.1 17.5 15.4 4,388 Ever had sex 73.0 61.9 64.8 22.4 18.9 225 Never had sex 67.8 57.8 60.9 17.3 15.2 4,163 Married/Living together 74.9 65.5 66.3 21.5 18.9 8,671 Divorced/separated/widowed 73.6 62.1 64.4 20.8 17.3 574 Residence Urban 76.9 65.6 66.9 20.9 18.1 7,877 Rural 66.8 59.2 61.3 19.2 17.2 5,756 Region National Capital Region 78.7 64.3 65.5 23.7 19.4 2,387 Cordillera Admin Region 68.4 57.2 58.4 11.2 10.1 216 I - Ilocos 69.6 61.4 64.8 23.7 21.2 642 II - Cagayan Valley 80.7 72.1 72.3 34.4 31.9 426 III - Central Luzon 75.3 64.7 63.1 12.7 10.4 1,459 IVA - CALABARZON 79.5 73.7 70.6 21.2 19.1 1,890 IVB - MIMAROPA 73.8 68.3 69.2 23.3 21.0 340 V - Bicol 64.1 50.7 56.7 19.5 15.9 713 VI - Western Visayas 64.0 49.4 57.6 23.4 20.3 910 VII - Central Visayas 65.3 60.6 62.0 16.3 14.9 1,070 VIII - Eastern Visayas 72.4 68.7 69.1 21.7 20.6 555 IX - Zamboanga Peninsula 75.2 65.4 67.7 19.5 18.2 465 X - Northern Mindanao 63.6 53.9 59.8 19.6 18.1 565 XI - Davao 77.1 64.6 67.7 22.9 19.9 654 XII - SOCCSKSARGEN 72.2 61.0 66.3 12.1 11.0 524 XIII - Caraga 80.2 69.9 76.2 28.1 25.9 327 ARMM 49.0 46.4 46.1 9.0 7.6 489 Education No education 28.2 26.7 28.5 6.2 5.9 186 Elementary 62.8 55.9 58.7 17.8 16.0 3,146 High school 71.1 61.9 64.0 19.5 17.2 6,109 College or higher 84.2 71.3 71.3 23.6 20.2 4,192 Wealth index quintile Lowest 57.1 51.2 54.2 16.7 15.4 2,161 Second 68.8 59.7 63.6 20.6 18.4 2,412 Middle 74.4 64.9 66.3 21.2 18.6 2,682 Fourth 77.9 66.0 67.9 20.8 18.2 2,940 Highest 79.3 68.3 67.5 20.7 17.4 3,438 Total 72.6 62.9 64.5 20.2 17.7 13,633 HIV/AIDS and Other Sexually Transmitted Infections | 175 Table 11.5.2 Knowledge of prevention of mother-to-child transmission of HIV: men Among men age 15-49 who know that HIV can be transmitted from mother to child, percentage who know that HIV can be transmitted during pregnancy, during delivery, and by breastfeeding, and percentage who know that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Philippines 2003 Percentage who know that: Percentage who know that HIV can be transmitted: Background characteristic During pregnancy During delivery By breastfeeding Risk of MTCT can be reduced by mother taking drugs in pregnancy HIV can be transmitted by breastfeeding and risk can be reduced by mother taking drugs during pregnancy Number of men Age 15-19 55.1 47.7 48.6 17.1 15.2 918 20-24 70.9 60.9 62.3 20.9 17.8 785 25-29 70.1 62.8 61.2 24.8 21.3 647 30-39 71.1 63.7 63.2 21.0 18.3 1,179 40-49 72.8 65.1 64.1 19.8 17.5 899 15-24 62.4 53.8 54.9 18.9 16.4 1,702 Marital status Never married 61.6 53.8 53.7 18.2 15.8 1,899 Ever had sex 67.5 60.1 58.9 19.6 17.7 619 Never had sex 58.8 50.7 51.1 17.5 14.9 1,280 Married/living together 72.8 64.9 64.7 22.0 19.3 2,440 Divorced/separated/widowed 70.0 60.0 61.3 28.1 21.0 88 Residence Urban 71.5 63.1 60.5 19.8 16.8 2,376 Rural 63.9 56.5 59.2 21.3 19.1 2,052 Region National Capital Region 69.7 58.1 57.6 11.4 9.4 699 Cordillera Admin Region 67.8 62.5 58.6 10.5 9.3 66 I - Ilocos 63.4 42.4 50.1 19.4 10.3 213 II - Cagayan Valley 75.3 67.0 74.8 9.6 9.0 147 III - Central Luzon 80.2 78.8 69.2 23.8 21.0 481 IVA - CALABARZON 79.7 71.7 66.5 28.9 25.4 608 IVB - MIMAROPA 56.8 54.7 53.5 15.6 14.9 108 V - Bicol 48.2 46.7 43.0 14.5 13.0 220 VI - Western Visayas 58.4 42.9 57.0 26.1 24.1 295 VII - Central Visayas 66.2 61.3 61.1 27.8 25.5 354 VIII - Eastern Visayas 69.6 66.8 65.2 25.0 23.4 208 IX - Zamboanga Peninsula 53.6 49.1 42.9 9.3 7.8 174 X - Northern Mindanao 73.9 64.6 71.0 25.5 24.0 187 XI - Davao 71.3 64.1 68.0 18.2 16.6 191 XII - SOCCSKSARGEN 63.4 58.8 58.7 15.2 14.4 204 XIII - Caraga 73.5 51.1 61.7 49.3 38.4 113 ARMM 38.4 35.3 35.8 8.4 6.6 159 Education No education 37.4 32.9 35.9 14.2 14.2 74 Elementary 58.8 52.4 53.8 19.2 17.1 1,273 High school 67.7 59.5 60.4 21.8 19.1 1,957 College or higher 80.7 71.5 67.5 20.1 16.9 1,124 Wealth index quintile Lowest 55.0 51.3 53.3 18.9 17.2 825 Second 65.3 55.9 58.4 20.8 18.3 876 Middle 67.9 60.4 60.4 22.4 20.3 918 Fourth 73.2 63.5 62.7 20.2 16.7 894 Highest 77.0 68.0 64.1 20.0 16.7 915 Total 67.9 60.0 59.9 20.5 17.9 4,428 Total men 15-54 68.1 60.5 60.3 20.7 18.1 4,766 176 | HIV/AIDS and Other Sexually Transmitted Infections 11.6 HIV TESTING Voluntary counseling and testing (VCT) is vital in the fight against HIV/AIDS. The 2003 NDHS asked men who had heard of AIDS whether they had ever been tested for the virus, when they were last tested, whether the test was voluntary or mandatory, whether they received the test results, where they went for the test, and if they have not been tested, whether they would like to be tested, and whether they know where to go for the test. Table 11.6 shows that only 3 percent of men age 15-49 reported that they had ever been tested for HIV, and most of them received the results. HIV testing increases with age and residence. Older men, those living in urban areas, and those in the highest wealth quintile are most likely to have been tested. Across regions, the percentage of men who have been tested varies from none in ARMM to 4 percent or higher in CAR, Central Luzon, and MIMAROPA. 11.7 ATTITUDES TOWARD NEGOTIATING SAFER SEX Respondents were asked about their attitude toward negotiating safer sex. Women were asked if a wife is justified in refusing to have sexual intercourse with her husband if she knows that he has an STI. The majority of women and men (95 percent 94 percent, respectively) agreed that a wife is justified in refusing to have sexual intercourse with her husband if he has an STI (Table 11.7). Men were also asked if a wife is justified in asking a man to use a condom if he has an STI. The vast majority of men (80 percent) agreed with this statement. Almost all men believe that a wife can refuse to have sexual intercourse with her husband if he has an STI or that a wife can ask her husband to use a condom to reduce the risk of HIV infection. There are slight differences by background characteristics. HIV/AIDS and Other Sexually Transmitted Infections | 177 Table 11.6 HIV testing status of men Percent distribution of men by HIV testing status and percentage of men who were tested for HIV and received test results in the past 12 months, by background characteristics, Philippines 2003 Percentage ever tested for HIV Background characteristic Received results No results Never tested Don’t know/ missing Total Percentage tested for HIV and received results in past 12 months Number of men Age 15-19 0.2 0.2 92.9 6.7 100.0 0.2 918 20-24 1.7 0.4 94.2 3.7 100.0 0.6 785 25-29 2.0 1.1 93.5 3.4 100.0 0.2 647 30-39 4.1 1.4 90.9 3.7 100.0 0.5 1,179 40-49 3.9 1.5 90.6 4.0 100.0 0.9 899 15-24 0.9 0.3 93.5 5.3 100.0 0.4 1,702 Marital status Never married 1.2 0.4 93.3 5.1 100.0 0.4 1,899 Ever had sex 2.7 1.0 93.8 2.6 100.0 0.7 619 Never had sex 0.5 0.1 93.1 6.3 100.0 0.2 1,280 Married/living together 3.6 1.3 91.1 3.9 100.0 0.6 2,440 Divorced/separated/widowed 0.0 1.5 97.5 1.0 100.0 0.0 88 Residence Urban 3.2 1.2 92.5 3.1 100.0 0.7 2,376 Rural 1.7 0.6 91.9 5.8 100.0 0.2 2,052 Region National Capital Region 3.5 0.9 94.0 1.6 100.0 1.1 699 Cordillera Admin Region 4.7 3.9 86.3 5.1 100.0 0.0 66 I - Ilocos 3.7 0.9 93.5 1.9 100.0 0.0 213 II - Cagayan Valley 0.6 0.0 95.7 3.7 100.0 0.0 147 III - Central Luzon 4.3 1.4 91.2 3.2 100.0 0.6 481 IVA - CALABARZON 3.0 1.5 94.3 1.1 100.0 1.2 608 IVB - MIMAROPA 4.9 1.3 80.4 13.4 100.0 0.7 108 V - Bicol 0.5 0.5 96.1 3.0 100.0 0.0 220 VI - Western Visayas 1.5 0.4 96.0 2.1 100.0 0.0 295 VII - Central Visayas 2.9 1.6 91.6 3.9 100.0 0.6 354 VIII - Eastern Visayas 1.2 1.2 94.7 2.9 100.0 0.4 208 IX - Zamboanga Peninsula 0.5 0.0 95.0 4.5 100.0 0.0 174 X - Northern Mindanao 2.4 1.0 94.7 2.0 100.0 0.0 187 XI - Davao 1.0 0.3 96.5 2.2 100.0 0.0 191 XII - SOCCSKSARGEN 1.6 0.0 94.7 3.7 100.0 0.0 204 XIII - Caraga 1.6 0.0 97.3 1.1 100.0 0.0 113 ARMM 0.0 0.0 52.7 47.3 100.0 0.0 159 Education No education 2.4 0.0 56.4 41.2 100.0 0.0 74 Elementary 1.0 0.6 90.7 7.8 100.0 0.1 1,273 High school 1.9 0.6 94.9 2.6 100.0 0.2 1,957 College or higher 5.3 2.0 91.7 1.0 100.0 1.5 1,124 Wealth index quintile Lowest 1.1 0.2 84.1 14.6 100.0 0.2 825 Second 1.2 0.6 95.2 2.9 100.0 0.3 876 Middle 1.7 0.6 95.6 2.1 100.0 0.2 918 Fourth 3.4 1.4 93.2 1.9 100.0 0.3 894 Highest 5.0 1.6 92.3 1.1 100.0 1.4 915 Total 2.5 0.9 92.2 4.3 100.0 0.5 4,428 Total men 15-54 2.7 0.9 92.0 4.4 100.0 0.6 4,766 178 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.7 Attitudes toward negotiating safer sex with husband Percentage of women and men age 15-49 who believe that if a husband has an STI his wife can refuse to have sex with him or propose that he use a condom, by background characteristics, Philippines 2003 Women Men Background characteristic Refuse sex Number of women Refuse sex Propose condom use Refuse sex or propose condom use Number of men Age 15-19 91.7 2,648 89.5 73.6 94.3 918 20-24 94.8 2,209 93.4 82.1 97.8 785 25-29 96.5 2,034 94.4 81.5 97.9 647 30-39 95.2 3,827 96.4 81.5 98.1 1,179 40-49 95.4 2,915 96.1 79.8 98.2 899 15-24 93.1 4,856 91.3 77.5 95.9 1,702 Marital status Never married 93.0 4,388 91.6 76.1 95.6 1,899 Ever had sex 95.5 225 93.7 81.1 97.6 619 Never had sex 92.9 4,163 90.6 73.6 94.7 1,280 Married/living together 95.5 8,671 95.9 82.3 98.4 2,440 Divorced/separated/widowed 95.3 574 97.6 83.4 99.4 88 Residence Urban 95.1 7,877 94.4 80.0 97.4 2,376 Rural 94.2 5,756 93.7 79.2 97.1 2,052 Region National Capital Region 95.1 2,387 94.0 65.1 96.5 699 Cordillera Admin Region 83.9 216 93.5 82.3 98.8 66 I - Ilocos 92.4 642 91.7 85.4 95.8 213 II - Cagayan Valley 100.0 426 97.8 85.8 98.9 147 III - Central Luzon 95.3 1,459 95.4 80.2 97.8 481 IVA - CALABARZON 97.1 1,890 95.1 87.1 98.3 608 IVB - MIMAROPA 95.2 340 94.2 85.3 98.0 108 V - Bicol 93.3 713 84.6 65.0 92.3 220 VI - Western Visayas 91.9 910 93.5 71.9 96.4 295 VII - Central Visayas 94.0 1,070 94.0 84.1 97.7 354 VIII - Eastern Visayas 96.3 555 97.9 81.1 98.8 208 IX - Zamboanga Peninsula 90.1 465 97.3 87.7 99.0 174 X - Northern Mindanao 94.1 565 92.4 83.7 95.1 187 XI - Davao 97.5 654 93.2 86.6 98.0 191 XII - SOCCSKSARGEN 94.4 524 93.0 85.5 97.5 204 XIII - Caraga 96.2 327 94.2 92.0 98.4 113 ARMM 92.4 489 96.3 79.3 98.2 159 Education No education 91.2 186 96.8 55.3 98.9 74 Elementary 92.8 3,146 93.3 76.9 96.0 1,273 High school 94.7 6,109 93.5 80.6 97.1 1,957 College or higher 96.3 4,192 95.9 82.7 98.8 1,124 Wealth index quintile Lowest 92.7 2,161 94.5 77.0 97.1 825 Second 93.4 2,412 91.7 80.6 96.1 876 Middle 95.2 2,682 94.1 80.4 96.7 918 Fourth 95.3 2,940 93.8 81.2 97.5 894 Highest 95.9 3,438 96.3 78.7 98.8 915 Total 94.7 13,633 94.1 79.6 97.2 4,428 Total men 15-54 na 0 94.3 79.6 97.3 4,766 na = Not applicable HIV/AIDS and Other Sexually Transmitted Infections | 179 11.8 SEXUAL BEHAVIOR AMONG YOUNG WOMEN AND MEN Promoting change in sexual behavior is an important component of many HIV/AIDS prevention programs. Those who are not yet sexually active or those who have recently made their sexual debut are thought to be more accepting of programs focusing on behavioral changes. Tables in this section focus on young women and men age 15-24 and the sexual behaviors that affect their risk of exposure to HIV. Promoting the use of condoms is an important strategy in the fight against HIV/AIDS transmission. Therefore, knowing where to get a condom is essential. Table 11.8 shows the percentage of women and men age 15-24 who know at least one source for condoms. Knowledge of source for condoms among women and men is similar; 64 percent of women and 62 percent of men age 15-24 know a source for a male condom. Knowledge of a source is higher among women and men age 20-24 than among those younger. Knowledge of a condom source is higher among married persons, those better educated, and those in the higher wealth quintiles. There are also regional variations in knowledge of a source of condoms, with women in Caraga being the most knowledgeable (78 percent) and women in ARMM the least knowledgeable (55 percent). Among men, the corresponding figures are 75 percent in NCR and 28 percent in MIMAROPA. Table 11.9 shows the percentage of never-married women and men age 15-24 that had sex in the 12 months preceding the survey. Premarital sex is uncommon among young women in the Philippines. Less than 2 percent of unmarried women reported having had sex in the past 12 months. Older women, women living in urban areas, and women with college education or higher, are slightly more likely to report having had sex. Across regions, 3 to 4 percent of never-married women in CAR, Central Visayas, Northern Mindanao, Davao, and Caraga reported having sex in the past year. Young men are much more likely to report sexual activity; more than half of unmarried men age 15-24 had sex in the 12 months preceding the survey. Unlike women, younger men and men in rural areas are more likely to have engaged in sexual activity in the past year. While sexual activity shows a slight positive association with women’s education, the opposite is true for men. Better-educated men are less likely to have had sex in the past year than men with less education. 180 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.8 Knowledge of a source for condoms among young people Percentage of young people age 15-24 who know at least one source of condoms, Philippines 2003 Women Men Background characteristic Know a source for male condom Number of women age 15-24 Know a source for male condom Number of men age 15-24 Age 15-19 53.2 2,648 52.9 918 20-24 76.8 2,209 72.0 785 Marital status Never married 59.6 3,475 59.8 1,468 Married or living together 78.3 105 73.8 360 Divorced/separated/widowed 59.1 3,370 55.3 1,108 Residence Urban 67.2 2,958 71.4 940 Rural 58.9 1,898 49.7 762 Region National Capital Region 66.9 851 75.1 271 Cordillera Admin Region 65.1 82 63.7 25 I - Ilocos 63.8 236 50.3 81 II - Cagayan Valley 64.8 129 65.0 46 III - Central Luzon 57.8 525 66.5 187 IVA - CALABARZON 64.4 709 70.3 251 IVB - MIMAROPA 64.0 111 27.6 38 V - Bicol 58.0 250 69.0 89 VI - Western Visayas 63.6 319 55.4 95 VII - Central Visayas 66.5 362 57.9 141 VIII - Eastern Visayas 67.5 195 52.7 85 IX - Zamboanga Peninsula 55.6 150 58.7 67 X - Northern Mindanao 59.3 211 42.6 71 XI - Davao 68.7 232 58.4 72 XII - SOCCSKSARGEN 70.4 178 60.5 83 XIII - Caraga 77.8 123 64.7 44 ARMM 55.4 192 32.7 56 Education No education (27.7) 27 * 19 Elementary 44.1 664 37.6 388 High school 59.2 2,822 62.9 923 College or higher 84.4 1,344 86.7 372 Wealth index quintile Lowest 52.9 690 33.6 283 Second 59.8 801 55.2 321 Middle 63.4 943 63.7 333 Fourth 65.9 1,045 71.1 372 Highest 70.8 1,376 76.7 394 Total 63.9 4,856 61.7 1,702 Note: The following sources are not considered sources for condoms in this table: friends, family members and home. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that an estimate is based on fewer than 25 cases and has been suppressed. HIV/AIDS and Other Sexually Transmitted Infections | 181 Table 11.9 Premarital sex and use of condoms among young women and men Percentage of never-married women and men age 15-24 who had sex in the 12 months preceding the survey, by background characteristics, Philippines 2003 Women Men Background characteristic Had sex in past 12 months Number of never- married women age 15-24 Had sex in past 12 months Number of never- married men age 15-24 Age 15-19 0.7 2,400 56.5 895 20-24 4.1 1,075 49.1 572 Residence Urban 2.2 2,222 50.0 803 Rural 1.0 1,253 58.0 665 Region National Capital Region 2.0 641 44.0 229 Cordillera Admin Region 4.6 58 (65.5) 21 I - Ilocos 0.6 163 59.9 73 II - Cagayan Valley 0.0 75 (80.8) 37 III - Central Luzon 0.7 374 47.2 151 IVA - CALABARZON 0.5 517 46.3 224 IVB - MIMAROPA 2.3 60 (72.8) 33 V - Bicol 1.1 192 68.2 73 VI - Western Visayas 1.0 244 60.4 86 VII - Central Visayas 3.4 281 53.7 130 VIII - Eastern Visayas 0.6 146 56.4 80 IX - Zamboanga Peninsula 1.9 92 57.7 56 X - Northern Mindanao 4.6 151 45.6 59 XI - Davao 5.9 170 62.7 61 XII - SOCCSKSARGEN 0.6 111 56.1 72 XIII - Caraga 4.3 82 66.1 40 ARMM 0.0 118 44.4 43 Education No education * 13 * 15 Elementary 1.5 331 64.2 317 High school 1.5 2,071 54.7 807 College or higher 2.3 1,061 41.1 329 Wealth index quintile Lowest 1.5 341 65.3 228 Second 2.2 474 63.4 263 Middle 1.8 642 58.6 285 Fourth 2.0 817 49.0 330 Highest 1.4 1,201 39.5 362 Total 1.7 3,475 53.6 1,468 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Some of the major strategies for reducing HIV infection among young people are the following: delay age at first sex, limit the number of sexual partners to one, and encourage and promote consistent and correct use of condoms. Young men and women are the target of most HIV/AIDS interventions aimed at changing sexual behavior. Sexual intercourse with more than one partner is associated with a high risk of exposure to STIs. Table 11.10 shows that 6 percent of men age 15-24 had sexual intercourse with more than one partner in the 12 months preceding the survey. Sexual intercourse with more than one partner is more common among men age 20-24, men living in urban areas, and men who have college or higher education. Men in MIMAROPA, NCR, and CAR are the most likely to report having multiple sexual partners. 182 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.10 Multiple sex partners among young men Among men age 15-24 who have ever had sex, percentage who have had sex with two or more partners in the 12 months preceding the survey, by background characteristics, Philippines 2003 Background characteristic Percentage who had 2+ partners in the past 12 months Number of men age 15-24 Age 15-19 3.2 918 20-24 9.7 785 Residence Urban 7.2 940 Rural 4.9 762 Region National Capital Region 10.5 271 Cordillera Admin Region 10.4 25 I - Ilocos 4.9 81 II - Cagayan Valley 3.9 46 III - Central Luzon 1.5 187 IVA - CALABARZON 4.6 251 IVB - MIMAROPA 14.8 38 V - Bicol 6.3 89 VI - Western Visayas 9.7 95 VII - Central Visayas 5.8 141 VIII - Eastern Visayas 3.0 85 IX - Zamboanga Peninsula 6.4 67 X - Northern Mindanao 3.8 71 XI - Davao 8.7 72 XII - SOCCSKSARGEN 6.4 83 XIII - Caraga 8.1 44 ARMM 1.3 56 Education No education 0.0 19 Elementary 1.8 388 High school 6.0 923 College or higher 11.6 372 Wealth index quintile Lowest 3.4 283 Second 6.7 321 Middle 7.2 333 Fourth 5.4 372 Highest 7.5 394 Total 6.2 1,702 The use of condoms reduces the risk of contracting HIV. Table 11.11 shows the percentage of young men who used a condom the first time they had sex. One in six men age 15-24 used a condom when they had sex the first time. There are large differences by background characteristics. Urban men, those with college or higher education, and men in the highest wealth quintile are the most likely to report using a condom the first time they had sex. HIV/AIDS and Other Sexually Transmitted Infections | 183 Table 11.11 Condom use at first sex among young men Among men age 15-24 who have ever had sex, percentage who used a condom the first time they ever had sex, by background characteristics, Philippines 2003 Background characteristic Percentage who used a condom at first sex Number of men age 15-24 who have ever had sex Age 15-19 18.6 141 20-24 15.6 453 Residence Urban 20.7 353 Rural 9.9 241 Region National Capital Region 26.3 101 Cordillera Admin Region * 11 I - Ilocos * 19 II - Cagayan Valley * 14 III - Central Luzon (11.0) 62 IVA - CALABARZON 17.9 95 IVB - MIMAROPA * 16 V - Bicol (25.6) 26 VI - Western Visayas (10.9) 30 VII - Central Visayas (14.2) 51 VIII - Eastern Visayas * 20 IX - Zamboanga Peninsula (19.9) 24 X - Northern Mindanao (25.5) 26 XI - Davao (20.9) 29 XII - SOCCSKSARGEN (6.0) 37 XIII - Caraga (17.9) 20 ARMM * 15 Education No education * 5 Elementary 6.5 131 High school 14.5 280 College or higher 26.8 178 Wealth index quintile Lowest 6.0 93 Second 10.4 106 Middle 15.0 130 Fourth 18.5 124 Highest 26.8 141 Total 16.3 594 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 11.9 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS (STIS) There is a strong link between other sexually transmitted infections (STI) and HIV infection. It is believed that people having any other STI apart from HIV infection are more likely to be infected with HIV. STIs are therefore identified as co-factors in HIV transmission. Table 11.12 shows the percentage of men who have ever had sex who self-reported an STI and/or symptoms of an STI in the 12 months preceding the survey. Less than 2 percent of men reported having an STI and/or symptoms of an STI in the past 12 months. Very few men reported any of the symptoms of STIs; each less than 1 percent. Six percent of men in the youngest age group reported having abnormal genital discharge and 3 percent reported having genital sore/ulcer. This is the largest group reporting any STIs or symptoms of STIs. 184 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.12 Self-reporting of sexually-transmitted infection (STI) and STI symptoms Among men age 15-49 who ever had sex, percentage self-reporting an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Philippines 2003 Background characteristic Percentage with STI Percentage with abnormal genital discharge Percentage with genital sore/ulcer Percentage with STI/ discharge/ genital sore/ ulcer Number of men who ever had sex Age 15-19 0.9 6.2 3.1 7.6 141 20-24 0.6 1.3 1.3 2.2 453 25-29 0.4 0.4 0.7 1.3 555 30-39 0.7 1.0 0.7 1.9 1,110 40-49 0.3 0.6 0.7 1.1 888 Marital status Married or living together 0.7 2.4 1.6 3.7 619 Residence Urban 0.7 0.8 0.6 1.5 1,693 Rural 0.3 1.3 1.2 2.3 1,455 Region National Capital Region 0.6 0.4 0.3 0.7 496 Cordillera Admin Region 0.0 1.7 1.7 2.6 50 I - Ilocos 0.7 0.7 2.8 4.2 142 II - Cagayan Valley 0.0 0.0 0.0 0.0 109 III - Central Luzon 0.7 0.7 0.4 1.1 333 IVA - CALABARZON 0.0 0.7 0.0 0.7 439 IVB - MIMAROPA 0.0 0.8 0.9 1.8 84 V - Bicol 0.0 1.4 1.4 1.4 146 VI - Western Visayas 0.0 2.1 0.5 2.1 207 VII - Central Visayas 0.0 0.9 2.3 2.8 256 VIII - Eastern Visayas 0.0 0.7 3.2 3.9 132 IX - Zamboanga Peninsula 0.0 1.1 0.0 1.1 125 X - Northern Mindanao 1.0 1.7 0.0 1.7 133 XI - Davao 3.4 2.7 2.7 6.8 146 XII - SOCCSKSARGEN 2.6 3.3 0.6 4.3 152 XIII - Caraga 0.0 0.7 1.4 1.4 87 ARMM 0.0 0.0 0.6 0.6 110 Education No education 0.0 1.3 1.4 2.7 57 Elementary 0.3 1.0 1.1 1.9 977 High school 0.7 1.5 1.1 2.5 1,236 College or higher 0.6 0.4 0.3 1.1 878 Wealth index quintile Lowest 0.3 1.4 0.8 2.3 602 Second 0.5 1.4 1.6 2.4 635 Middle 0.6 1.4 0.7 2.2 677 Fourth 0.3 0.3 1.0 1.3 607 Highest 0.9 0.7 0.3 1.2 626 Total 0.5 1.0 0.9 1.9 3,148 Total men 15-54 0.5 1.0 0.8 1.7 3,478 HIV/AIDS and Other Sexually Transmitted Infections | 185 11.10 STI TREATMENT-SEEKING BEHAVIOR Stigma and discrimination can discourage infected persons from seeking professional health care and lead some to resort to self-medication. Table 11.13 shows treatment-seeking behavior among men who reported an STI or symptoms of an STI, by source of advice or treatment. Less than half of men sought care (46 percent). About one third of the men who reported an STI or symptoms of an STI sought advice or obtained medicine from a clinic, hospital, or a health professional. Three in ten men sought help from a shop or pharmacy, and one in four sought the advice of friends or relatives. Table 11.13 Men seeking treatment for STIs Among men age 15-49 reporting an STI or symptoms of an STI in the past 12 months, percentage who sought advice or treat- ment, Philippines 2003 Source of advice or treatment Percent Clinic/hospital/health professional 33.4 Traditional healer 8.4 Advice or medicine from shop/pharmacy 29.6 Advice from friends/relatives 24.8 Advice or treatment from any source 46.4 No advice or treatment 53.6 Number with STI and/or symptoms of STI 60 Note: Symptoms of an STI are an abnormal genital discharge, a genital sore, or a genital ulcer. 11.11 PAYMENT FOR SEXUAL RELATIONS Male respondents in the 2003 NDHS were asked whether they had paid money in exchange for sex in the 12 months preceding the survey. Table 11.14 shows that 2 percent of men who had sex in the past 12 months reported paying for sex during that period. There is substantial variation among subgroups. Men in their twenties, married men, men living in urban areas, better educated men, and men in the wealthiest quintiles are more likely than other men to have paid for sex in the past 12 months. Among men who paid for sex, 38 percent used a condom during their last sexual encounter (data not shown). 186 | HIV/AIDS and Other Sexually Transmitted Infections Table 11.14 Payment for sex Percentage of men age 15-49 who reported paying for sex in the past 12 months, by background characteristics, Philippines 2003 Background characteristic Percentage who paid for sex in past 12 months Number of men Age 15-19 0.6 918 20-24 3.3 785 25-29 3.2 647 30-39 1.7 1,179 40-49 1.4 899 15-24 1.8 1,702 Marital status Married or living together 7.8 619 Divorced/separated/widowed 0.5 1,280 Residence Urban 2.5 2,376 Rural 1.2 2,052 Region National Capital Region 3.0 699 Cordillera Admin Region 1.4 66 I - Ilocos 0.9 213 II - Cagayan Valley 1.1 147 III - Central Luzon 0.9 481 IVA - CALABARZON 1.7 608 IVB - MIMAROPA 3.9 108 V - Bicol 0.9 220 VI - Western Visayas 2.7 295 VII - Central Visayas 4.2 354 VIII - Eastern Visayas 1.7 208 IX - Zamboanga Peninsula 3.4 174 X - Northern Mindanao 0.5 187 XI - Davao 1.1 191 XII - SOCCSKSARGEN 1.1 204 XIII - Caraga 0.5 113 ARMM 0.0 159 Education No education 0.0 74 Elementary 1.2 1,273 High school 1.6 1,957 College or higher 3.4 1,124 Wealth index quintile Lowest 1.1 825 Second 1.7 876 Middle 2.0 918 Fourth 2.5 894 Highest 2.3 915 Total 1.9 4,428 HIV/AIDS and Other Sexually Transmitted Infections | 187 11.12 MEN HAVING SEX WITH MEN Of the 3,478 men who have ever had sex, 5 percent reported having sexual relations with a man; less than 1 percent reported having sex with a man in the 12 months preceding the survey (Table 11.15). Nonmarried men and men with high school education are more likely to engage in homosexual relations than other men. Men in the poorest wealth quintile are the least likely to have sex with a man. Table 11.15 Men having sex with men Among men who have ever had sex, percentage who ever had sex with a man, and percentage who had sex with a man in the past 12 months, by background characteristics, Philippines 2003 Background characteristic Percentage who ever had sexual relations with a man Percentage who had sexual relations with a man in the past year Number of men Age 15-19 14.6 2.9 141 20-24 8.7 1.1 453 25-29 6.4 0.2 555 30-39 5.2 0.2 1,110 40-49 2.8 0.1 888 50-54 2.6 0.0 330 Current marital status Married/living together 3.9 0.3 2,746 Never married 10.9 0.8 626 Widowed/divorced/separated 11.6 0.0 106 Residence Urban 5.5 0.4 1,866 Rural 5.2 0.4 1,612 Education No education 1.2 0.0 67 Elementary 4.1 0.3 1,141 High school 7.3 0.5 1,325 College or higher 4.6 0.3 945 Wealth index quintile Lowest 3.3 0.3 660 Second 6.1 0.3 695 Middle 6.4 0.1 748 Fourth 6.3 0.7 668 Highest 4.6 0.6 707 Total 5.4 0.4 3,478 Tuberculosis | 189 TUBERCULOSIS 12 This chapter examines awareness and incidence of tuberculosis (TB) in the Philippines, and be- havior and attitudes toward the disease. The 2003 National Demographic and Health Survey (NDHS) asked the same set of questions about TB to both female and male respondents; hence comparisons be- tween women and men are possible. There are six sections in this chapter. Section 12.1 addresses the status of TB in the Philippines and worldwide, and discusses the medical aspects of the disease. Section 12.2 examines the level of awareness of women and men of TB itself, its signs and symptoms, cause, mode of transmission, and treatment. Section 12.3 deals with self-reported diagnosis, symptoms, and treatment, and Section 12.4 focuses on stigma issues. Section 12.5 examines the level of awareness of women and men of the Directly Observed Treatment Short (DOTS) course chemotherapy program of the Department of Health (DOH). 12.1 BACKGROUND ON TB TB is one of the ten leading causes of morbidity and mortality in the Philippines, and is a major health problem. The Philippine government has been implementing DOTS, the TB control strategy rec- ommended by the World Health Organization (WHO). DOTS combines the following: 1) case detection by sputum smear microscopy among patients with TB symptoms who report to health services, 2) stan- dardized short-course chemotherapy with directly observed treatment, and 3) a standardized recording and reporting system that tracks the treatment of each patient and in turn provides data to the TB control program. TB is primarily caused by bacteria (Mycobacterium tuberculosis). The majority of cases are pul- monary, but in about 15 percent of cases, the bacteria disseminate to other areas of the body and are classified as nonpulmonary TB. Transmission is mainly airborne, through the inhalation of bacteria- carrying droplets produced by individuals with active pulmonary TB. Less commonly, infection may also occur through skin wounds, such as those associated with intravenous drug use. Among people directly exposed to TB, only about 30 percent will actually become infected. In the general population, only about 5 percent of infected persons will develop active primary TB within two years. This activation rate is much higher for both the very young and very old, and for persons with a suppressed immune system (because of HIV infection or other causes). The activation rate is about 40 percent for persons with HIV, thus making TB diagnosis and treatment an important part of health care for HIV-infected individuals. Symptoms of active primary TB include persistent cough, chest pain, coughing up blood or sputum, fatigue, weight loss, loss of appetite, chills, fever, and nighttime sweating. In persons who are infected but do not show symptoms of TB, the immune system is able to de- stroy or “wall off” the TB bacteria. These enclosed bacteria can remain dormant for many years and be reactivated. Risk factors for reactivation include old age, immunosuppression, diabetes, kidney insuffi- ciency, and malnutrition. The reactivation rate is about 5 percent in the general population. Worldwide, the case fatality rate for TB has been estimated to be 55 percent for untreated persons and 15 percent for persons receiving treatment. TB fatality estimates vary widely by region and by level of socioeconomic development. 190 | Tuberculosis 12.2 RESPONDENTS’ KNOWLEDGE OF TB Table 12.1 presents the level of women’s and men’s awareness of TB and the fact that it can be cured, according to age, marital status, residence, region, education, and wealth index quintile. Almost all of the women and men surveyed (97 percent of women and 96 percent of men) have heard of TB. The percentage who believe that TB can be cured is a little lower: 92 percent for women and 89 percent for men. Table 12.1 Knowledge of tuberculosis Percentage of women and men who have heard of tuberculosis and who believe that tuberculosis can be cured, by background characteristics, Philippines 2003 Women Men Background characteristic Has heard of TB Believes TB can be cured Number of women Has heard of TB Believes TB can be cured Number of men Age 15-19 95.8 85.5 2,648 93.2 80.5 918 20-24 97.1 90.1 2,209 95.7 87.3 785 25-29 97.7 94.1 2,034 96.8 92.2 647 30-34 97.9 95.0 1,954 96.8 91.0 593 35-39 97.7 95.4 1,873 98.4 92.5 586 40-44 98.3 95.5 1,564 96.8 91.6 483 45-49 97.5 95.8 1,351 98.0 95.1 416 50-54 na na 0 98.1 95.2 338 Marital status Never married 96.8 89.2 4,388 95.1 85.3 1,914 Married or living together 97.6 93.9 8,671 97.1 92.2 2,746 Divorced/separated/widowed 97.1 94.2 574 97.0 91.5 106 Residence Urban 97.6 93.5 7,877 96.2 91.2 2,553 Rural 96.9 90.9 5,756 96.5 87.4 2,213 Region National Capital Region 98.0 95.6 2,387 99.6 95.6 740 Cordillera Admin Region 94.2 83.5 216 95.8 87.4 72 I - Ilocos 96.4 88.4 642 95.7 88.3 232 II - Cagayan Valley 98.3 91.9 426 98.6 87.7 163 III - Central Luzon 95.9 92.5 1,459 95.0 91.6 520 IVA - CALABARZON 97.1 95.0 1,890 92.3 90.0 652 IVB - MIMAROPA 95.5 92.2 340 92.1 83.5 119 V - Bicol 97.5 91.8 713 98.2 91.3 236 VI - Western Visayas 98.1 90.9 910 97.8 90.6 322 VII - Central Visayas 98.1 89.7 1,070 95.9 85.1 373 VIII - Eastern Visayas 99.2 95.7 555 100.0 92.9 229 IX - Zamboanga Peninsula 97.4 92.3 465 97.2 88.0 189 X - Northern Mindanao 96.4 86.2 565 98.6 75.6 202 XI - Davao 97.7 91.0 654 99.5 89.0 212 XII - SOCCSKSARGEN 96.1 90.3 524 98.4 91.3 216 XIII - Caraga 99.3 92.7 327 100.0 92.0 125 ARMM 97.3 93.4 489 80.3 76.1 166 Education No education 87.9 79.6 186 80.5 65.1 84 Elementary 94.4 88.3 3,146 94.8 84.2 1,441 High school 97.8 91.8 6,109 96.4 90.0 2,048 College or higher 99.3 96.9 4,192 99.1 96.5 1,193 Wealth index quintile Lowest 94.8 86.5 2,161 92.3 80.2 884 Second 97.1 91.8 2,412 97.0 89.1 937 Middle 97.9 93.6 2,682 97.3 91.7 992 Fourth 98.1 94.3 2,940 97.3 91.7 957 Highest 98.0 94.1 3,438 97.3 93.6 996 Total 97.3 92.4 13,633 96.3 89.4 4,766 na = Not applicable Tuberculosis | 191 The level of awareness of TB does not vary much by age, marital status, residence, region, and wealth index quintile. However, the level increases with education, regardless of sex. Those with no edu- cation are least likely to have heard of TB (88 percent among women and 81 percent among men), and those with college or higher education are the most likely (99 percent for both women and men). The percentages believing that TB can be cured do not differ by age, marital status, and residence for women and men. They rise with the level of education (80 percent among women with no education to 97 percent among those with at least some college, and 65 percent among men with no education to 97 percent among those with at least some college) and by wealth index quintile for women and men. The Cordillera Administrative Region (CAR) has the lowest level of women who know that TB can be cured (84 percent), while the National Capital Region (NCR) and Eastern Visayas have the highest (96 percent). Northern Mindanao and the Autonomous Region in Muslim Mindanao (ARMM) have the lowest levels of men with knowledge that TB can be cured (76 percent), and the NCR has the highest (96 percent). The signs and symptoms of TB most commonly re- ported by women and men (Table 12.2) are coughing (55 percent for women and 57 percent for men), weight loss (42 percent for both sexes), and blood in sputum (36 percent for women and 33 percent for men). While the symptoms of TB next most commonly cited by women are coughing for several weeks (28 percent), coughing with sputum (27 per- cent), and fever (23 percent), those cited by men are cough- ing with sputum (23 percent), coughing for several weeks (23 percent), and fatigue (18 percent). Smoking (47 percent among women and 57 percent among men), alcohol drinking (35 percent for women and 47 percent for men), fatigue (34 percent among women and 33 percent among men), and microbes/germs/bacteria (24 percent among women and 17 percent among men) emerge as the identified top-ranking causes of TB (Table 12.3). Eight to 9 percent of respondents say they do not know the cause of TB. The two most commonly cited modes of transmission reported by both sexes are sharing eating utensils (79 percent for women and 72 percent for men) and through the air when coughing (52 percent among women and 46 percent among men) (Table 12.4). Table 12.2 Knowledge of specific symptoms of tuberculosis Among women and men who have heard of tuberculosis, percentage who cite specific symp- toms of TB, Philippines 2003 Symptom of TB Women Men Coughing 55.1 57.4 Coughing with sputum 27.1 22.7 Coughing for several weeks 28.1 22.5 Fever 23.2 11.5 Blood in sputum 35.5 33.4 Loss of appetite 7.2 5.2 Night sweating 2.6 2.1 Pain in chest/back 12.5 9.4 Fatigue 14.7 18.1 Weight loss 41.6 42.0 Breathing problems 1.2 1.1 Bad posture 0.7 0.8 Other 2.4 2.7 Does not know 2.3 4.5 Number of women/men 13,270 4,766 Table 12.3 Knowledge of the cause of tuberculosis Among women and men who have heard of tuberculosis, percentage who cite specific causes of TB, Philippines 2003 Cause of TB Women Men Microbes/germs/bacteria 23.6 17.2 Inherited 16.1 11.2 Lifestyle 14.2 14.7 Smoking 47.4 57.1 Alcohol drinking 35.3 47.2 Fatigue 34.0 32.7 Extensive coughing 0.9 0.0 Other 4.9 4.4 Does not know 8.4 9.3 Number of women/men 13,270 4,766 192 | Tuberculosis Table 12.4 Knowledge of the modes of transmission of tuberculosis Among women and men who have heard of tuberculosis, percentage who cite specific means of transmission of TB, Philippines 2003 Means of transmission of TB Women Men Airborne when coughing 52.4 46.3 Sharing eating utensils 79.1 72.4 Touching a person with TB 5.5 6.6 Sharing food 0.6 0.9 Other 1.9 1.6 Does not know 4.8 7.8 Number of women/men 13,270 4,766 Differentials in knowledge that TB is caused by bacteria are not marked (Table 12.5). The only clear differential observed relates to education; those with no education are the least aware (13 percent for women and 9 percent for men) and those with college or higher education are the most aware (32 percent among women and 26 percent among men). Ilocos and Western Visayas regions show the lowest levels of women with knowledge that TB is caused by a microbe (13 and 14 percent, respectively), and CAR and Caraga show the highest (35 and 36 percent, respectively); however, among men, ARMM and SOCCSKSARGEN depict the lowest levels (6 and 5 percent, respectively), and Cagayan Valley and Caraga have the highest (47 and 32 percent, respectively). Awareness of the fact that TB is mainly transmitted through the air when coughing does not differ significantly by age and marital status. Urban women and, especially, urban men are more likely to know how TB is transmitted than are rural residents. The higher the education of the women and men and the higher the wealth index quintile, the higher the level of awareness. SOCCSKSARGEN shows the lowest level of women who know that TB is transmitted through the air (38 percent), and Ilocos and MIMA- ROPA show the lowest levels of men (25 and 28 percent, respectively); while Caraga shows the highest levels for both women and men (73 and 84 percent, respectively). Tuberculosis | 193 Table 12.5 Knowledge of TB causes and transmission modes by background characteristics Among women and men who have heard of tuberculosis, percentage who know that it is caused by microbes/bacteria and percentage who know that it is transmitted through the air when coughing, by background char- acteristics, Philippines 2003 Women Men Background characteristic Know TB is caused by microbes/ germs/ bacteria Knows TB is transmitted through the air when coughing Number of women Know TB is caused by microbes/ germs/ bacteria Knows TB is transmitted through the air when coughing Number of men Age 15-19 23.1 50.9 2,537 15.6 44.6 918 20-24 24.1 52.8 2,145 16.5 46.5 785 25-29 24.4 52.2 1,988 18.9 46.6 647 30-34 25.3 52.5 1,914 17.9 47.3 593 35-39 22.2 54.9 1,830 17.6 46.2 586 40-44 22.6 50.8 1,538 18.3 49.4 483 45-49 23.2 53.7 1,317 15.9 48.4 416 50-54 na na 0 18.2 41.7 338 Marital status Never married 26.2 54.4 4,248 17.1 46.3 1,914 Married or living together 22.3 51.4 8,464 17.2 46.5 2,746 Divorced/separated/widowed 23.7 53.8 558 18.6 41.9 106 Residence Urban 25.8 55.8 7,692 18.9 53.8 2,553 Rural 20.5 47.9 5,577 15.3 37.7 2,213 Region National Capital Region 26.6 59.4 2,340 25.1 65.4 740 Cordillera Admin Region 35.3 62.8 203 27.2 61.2 72 I - Ilocos 13.4 49.5 619 12.0 24.5 232 II - Cagayan Valley 21.0 41.7 419 47.0 47.8 163 III - Central Luzon 22.2 51.7 1,399 15.0 49.7 520 IVA - CALABARZON 24.7 56.0 1,836 11.0 42.2 652 IVB - MIMAROPA 23.1 46.7 325 7.7 27.5 119 V - Bicol 22.7 58.2 695 13.9 37.1 236 VI - Western Visayas 13.7 39.7 892 11.8 35.0 322 VII - Central Visayas 25.4 47.7 1,049 21.4 50.8 373 VIII - Eastern Visayas 19.9 47.8 551 22.5 33.3 229 IX - Zamboanga Peninsula 31.8 54.0 453 15.6 63.6 189 X - Northern Mindanao 26.8 49.7 545 18.8 48.4 202 XI - Davao 18.4 48.1 639 10.0 37.7 212 XII - SOCCSKSARGEN 21.0 37.5 504 5.1 27.6 216 XIII - Caraga 35.7 72.5 325 31.8 84.1 125 ARMM 29.6 60.8 476 5.9 30.6 166 Education No education 13.1 39.0 164 8.9 25.8 84 Elementary 18.5 40.1 2,970 12.2 34.3 1,441 High school 20.8 50.3 5,975 16.1 48.0 2,048 College or higher 31.6 64.9 4,161 25.8 59.3 1,193 Wealth index quintile Lowest 22.0 42.4 2,047 11.8 33.5 884 Second 19.3 45.5 2,343 15.6 40.0 937 Middle 20.0 50.5 2,626 14.5 45.1 992 Fourth 23.9 56.0 2,885 19.3 51.7 957 Highest 30.0 61.8 3,368 24.2 59.7 996 Total 23.6 52.4 13,270 17.2 46.3 4,766 na = Not applicable 194 | Tuberculosis 12.3 SELF-REPORTED DIAGNOSIS, SYMPTOMS, AND TREATMENT Less than 1 percent of women and 1 percent of men reported that they had been told by a doctor or a health professional that they had TB in the five years preceding the survey (Table 12.6). Differentials are very small. Table 12.6 Diagnosis of tuberculosis Among women and men who have heard of tuberculosis, percentage who have been diagnosed with tuberculosis in the five years preceding the survey and percentage who have ever taken anti-TB medicine, by background characteristics, Philippines 2003 Women Men Background characteristic Percentage with TB diagnosed in the past 5 years Percentage who have taken anti-TB medicine Number of women Percentage with TB diagnosed in the past 5 years Percentage who have taken anti-TB medicine Number of men Age 15-19 0.3 0.4 2,537 0.6 0.3 855 20-24 0.3 0.6 2,145 0.7 0.8 751 25-29 0.5 0.5 1,988 0.2 0.4 626 30-34 0.9 1.1 1,914 1.5 1.8 574 35-39 0.4 0.8 1,830 1.7 1.9 577 40-44 0.6 1.8 1,538 2.1 3.9 468 45-49 1.1 2.2 1,317 1.8 3.7 407 50-54 na na 0 3.0 5.9 332 Marital status Never married 0.3 0.5 4,248 0.5 0.8 1,820 Married or living together 0.6 1.1 8,464 1.7 2.4 2,668 Divorced/separated/widowed 0.9 1.8 558 1.9 7.4 103 Residence Urban 0.6 1.0 7,692 1.2 1.6 2,454 Rural 0.5 0.9 5,577 1.3 2.1 2,136 Region National Capital Region 0.5 0.9 2,340 1.0 2.1 737 Cordillera Admin Region 1.1 1.1 203 0.6 1.8 69 I - Ilocos 0.8 1.1 619 0.0 0.4 222 II - Cagayan Valley 0.2 0.5 419 1.5 2.5 161 III - Central Luzon 0.4 0.6 1,399 0.3 1.1 494 IVA - CALABARZON 0.5 1.2 1,836 1.5 2.0 601 IVB - MIMAROPA 0.7 1.1 325 2.0 2.6 110 V - Bicol 0.6 1.3 695 1.5 1.8 232 VI - Western Visayas 0.5 1.4 892 0.7 3.0 315 VII - Central Visayas 0.4 0.9 1,049 0.0 0.0 357 VIII - Eastern Visayas 0.0 0.2 551 0.7 0.7 229 IX - Zamboanga Peninsula 0.8 0.8 453 2.3 1.8 183 X - Northern Mindanao 1.2 1.3 545 1.8 1.4 199 XI - Davao 0.6 0.7 639 4.0 4.9 211 XII - SOCCSKSARGEN 0.6 0.9 504 3.0 4.2 212 XIII - Caraga 0.4 0.2 325 0.9 0.9 125 ARMM 0.6 0.8 476 1.5 1.0 133 Education No education 0.5 2.2 164 1.2 5.3 67 Elementary 0.6 1.1 2,970 1.6 2.3 1,366 High school 0.6 1.0 5,975 1.0 1.6 1,975 College or higher 0.4 0.7 4,161 1.2 1.6 1,182 Wealth index quintile Lowest 0.6 0.7 2,047 1.8 2.1 816 Second 0.9 1.6 2,343 1.1 2.0 909 Middle 0.5 1.2 2,626 0.5 1.6 965 Fourth 0.4 0.8 2,885 1.1 2.0 931 Highest 0.3 0.6 3,368 1.6 1.6 969 Total 0.5 0.9 13,270 1.2 1.9 4,590 na = Not applicable Tuberculosis | 195 Less than 1 percent of women and 2 percent of men have taken anti-TB medicine. Among women, those age 45- 49, those not currently married, and those with no education reported slightly higher than average levels of medication. Among men, a similar but stronger pattern holds. Government hospitals, urban-rural health centers, and pharmacies emerge as the most common sources of treatment among those women and men who ever took anti- TB medicine (Table 12.7). While the total level of diagnosed TB is only 1 to 2 percent (Table 12.6), the percentage of respondents who ever had at least one symptom of TB is 35 to 36 percent for women and men (Tables 12.8.1 and 12.8.2, respectively). Roughly one in five women and men have ever had either chest or back pain or cough for two weeks or more (Figure 12.1). Having ever had a symptom of TB increases with age, but it does not vary much by marital status. Urban women and men have much lower levels of reported symptoms than their rural counterparts. Having a symptom of TB is negatively related to education and household wealth index quintile. NCR and Cagayan Valley (and ARMM for men only) show the lowest levels of those with symptoms, while Davao and Caraga manifest the highest levels reporting to have ever had a symptom of TB. Table 12.7 Source of TB treatment Among women and men who have ever taken anti-TB medicine, percentage who received treatment from specific sources, Philippines 2003 Source of treatment Women Men Government hospital 22.8 21.7 Rural/urban health center 36.6 33.7 Outreach clinic 0.8 0.0 Other public facility 1.6 0.0 Private hospital/clinic 12.2 12.0 Pharmacy 15.3 24.1 Private doctor 9.7 6.0 Other 0.8 2.4 Number of women/men 124 85 20 19 9 12 23 22 Women Men 0 5 10 15 20 25 Percent Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Figure 12.1 Percentage of Women and Men Who Ever Had Symptoms of Tuberculosis NDHS 2003 196 | Tuberculosis Table 12.8.1 Experience of symptoms of tuberculosis: women Percentage of women who have ever had specific symptoms of tuberculosis, by background character- istics, Philippines 2003 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweating At least one symptom Number of women Age 15-19 17.5 11.2 15.0 1.6 7.8 30.8 2,648 20-24 17.7 8.9 20.4 1.0 8.6 32.1 2,209 25-29 16.9 7.6 20.3 1.3 8.4 31.7 2,034 30-34 20.0 8.3 25.2 1.2 9.3 36.2 1,954 35-39 20.1 7.8 25.5 1.7 9.1 35.7 1,873 40-44 24.0 10.3 29.2 2.9 9.8 40.3 1,564 45-49 28.9 11.5 34.1 3.4 12.4 45.8 1,351 Marital status Never married 17.1 10.0 17.1 1.4 7.2 30.5 4,388 Married or living together 21.5 8.9 26.0 1.9 10.0 37.4 8,671 Divorced/separated/widowed 19.9 11.3 25.3 1.9 10.7 36.3 574 Residence Urban 17.4 7.5 19.3 1.4 6.5 30.4 7,877 Rural 23.6 11.9 28.4 2.3 12.6 41.7 5,756 Region National Capital Region 12.3 4.5 11.7 0.6 2.7 20.6 2,387 Cordillera Admin Region 37.0 16.8 34.9 2.3 11.0 54.1 216 I - Ilocos 19.6 7.6 24.6 2.5 8.3 37.7 642 II - Cagayan Valley 10.4 5.9 15.0 0.9 4.2 21.7 426 III - Central Luzon 12.1 4.2 12.9 0.7 4.1 23.5 1,459 IVA - CALABARZON 14.5 5.5 15.5 1.2 6.7 24.1 1,890 IVB - MIMAROPA 27.4 11.1 28.0 2.0 17.5 41.2 340 V - Bicol 20.2 6.9 11.2 2.6 4.7 27.8 713 VI - Western Visayas 29.5 14.6 39.5 4.7 18.7 54.4 910 VII - Central Visayas 34.3 18.2 33.1 2.7 10.0 51.0 1,070 VIII - Eastern Visayas 17.3 5.1 18.5 0.6 4.3 29.5 555 IX - Zamboanga Peninsula 16.3 9.5 23.4 1.1 4.2 35.3 465 X - Northern Mindanao 28.2 14.8 40.2 2.1 22.6 54.4 565 XI - Davao 32.7 18.4 56.3 3.2 27.3 69.7 654 XII - SOCCSKSARGEN 26.5 14.6 31.1 3.2 12.5 45.4 524 XIII - Caraga 33.0 20.4 48.6 1.6 24.5 61.2 327 ARMM 14.8 11.1 15.0 1.5 6.4 29.5 489 Education No education 30.1 21.6 27.0 4.0 17.8 43.5 186 Elementary 27.6 14.2 31.7 3.0 14.7 45.8 3,146 High school 18.9 9.2 21.1 1.6 8.7 33.8 6,109 College or higher 15.7 5.3 19.4 1.0 5.2 28.8 4,192 Wealth index quintile Lowest 27.5 15.9 31.9 3.0 15.7 45.6 2,161 Second 23.3 11.5 28.6 2.0 11.4 42.1 2,412 Middle 20.4 9.6 22.5 2.0 10.1 35.3 2,682 Fourth 16.2 6.2 19.1 1.0 5.9 29.8 2,940 Highest 16.1 6.1 17.6 1.2 5.3 28.3 3,438 Total 20.0 9.3 23.1 1.7 9.1 35.2 13,633 Tuberculosis | 197 Table 12.8.2 Experience of symptoms of tuberculosis: men Percentage of men who have ever had specific symptoms of tuberculosis, by background characteristics, Philippines 2003 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweating At least one symptom Number of men Age 15-19 14.5 11.9 15.1 2.3 11.6 30.6 918 20-24 16.5 11.0 18.1 2.1 11.4 30.3 785 25-29 14.3 10.3 17.9 1.9 9.9 29.6 647 30-34 20.2 14.6 27.5 2.0 11.4 38.7 593 35-39 18.4 9.8 25.0 2.5 12.6 36.8 586 40-44 22.1 11.8 25.0 5.3 13.3 39.7 483 45-49 24.8 12.4 29.7 5.5 12.9 41.8 416 50-54 29.8 16.7 34.3 7.4 16.0 50.4 338 Marital status Never married 15.9 11.6 17.4 2.3 11.0 31.1 1,914 Married or living together 20.7 12.1 25.7 3.5 12.4 38.4 2,746 Divorced/separated/widowed 20.3 17.0 27.4 10.3 19.6 38.8 106 Residence Urban 14.7 7.8 17.1 1.8 9.7 28.8 2,553 Rural 23.4 16.9 28.5 4.7 14.6 43.3 2,213 Region National Capital Region 10.7 3.3 10.2 1.2 6.4 19.1 740 Cordillera Admin Region 30.9 22.7 40.0 6.2 22.0 58.3 72 I - Ilocos 23.5 19.9 24.6 1.7 25.1 48.2 232 II - Cagayan Valley 7.4 6.6 12.5 3.0 8.5 15.9 163 III - Central Luzon 11.1 6.8 17.9 1.0 6.8 24.7 520 IVA - CALABARZON 14.5 7.8 19.2 2.8 10.9 31.3 652 IVB - MIMAROPA 28.1 20.1 36.8 3.6 27.7 59.4 119 V - Bicol 11.7 9.2 12.2 3.9 5.6 20.4 236 VI - Western Visayas 20.8 20.0 40.3 7.9 22.5 52.8 322 VII - Central Visayas 25.6 16.8 18.1 2.5 10.8 37.4 373 VIII - Eastern Visayas 23.7 10.7 35.5 4.1 6.8 48.6 229 IX - Zamboanga Peninsula 32.9 21.8 23.3 0.5 7.3 48.0 189 X - Northern Mindanao 14.1 11.3 28.5 4.9 16.2 41.9 202 XI - Davao 39.7 22.4 42.6 8.6 28.8 63.1 212 XII - SOCCSKSARGEN 26.9 16.2 29.3 5.6 7.3 43.8 216 XIII - Caraga 46.3 31.1 42.9 4.1 22.1 65.5 125 ARMM 3.0 2.7 4.2 0.0 3.4 8.2 166 Education No education 23.8 21.5 24.8 8.1 16.9 38.1 84 Elementary 23.5 17.0 30.5 4.8 15.7 45.7 1,441 High school 17.6 11.6 20.1 2.6 11.8 33.9 2,048 College or higher 14.5 6.0 16.4 1.6 7.6 25.8 1,193 Wealth index quintile Lowest 23.3 19.7 30.0 5.4 15.2 44.2 884 Second 24.0 16.6 26.4 3.6 14.7 42.2 937 Middle 17.5 11.3 21.7 2.7 11.5 34.9 992 Fourth 16.7 8.5 17.4 3.0 11.1 30.6 957 Highest 13.0 4.8 17.3 1.2 8.0 26.8 996 Total 18.7 12.0 22.4 3.1 12.0 35.5 4,766 198 | Tuberculosis A little less than half of the women and men who have ever had at least one symptom of TB sought consultation or treatment for the symptom (Tables 12.9.1 and 12.9.2). Of the more than half not seeking consultation or treatment, the most commonly cited reason is that the symptom is harmless (37 percent for both women and men). The percentage seeking consultation or treatment (for both sexes) in- creases with age, education, and wealth index quintile. Among women, Bicol shows the highest percent- age (58 percent) seeking treatment and Zamboanga Peninsula (27 percent) the lowest. Among men, Table 12.9.1 Reasons for not seeking treatment for symptoms of tuberculosis: women Percent distribution of women who have ever had symptoms of tuberculosis, by whether they sought treatment for the symptoms and reason for not seeking treatment, according to background characteristics, Philippines 2003 Reason for not seeking consultation/treatment Background characteristic Sought treatment Symptoms harmless Cost Distance Embarrassed Self - medication Don’t know/ other Missing Total Number of women Age 15-19 36.8 41.9 9.0 2.0 2.3 4.6 3.3 0.1 100.0 815 20-24 44.0 40.0 6.0 2.9 0.6 2.3 3.9 0.3 100.0 709 25-29 45.4 38.8 6.0 2.6 1.2 2.8 2.9 0.3 100.0 646 30-34 46.5 37.6 8.0 2.4 0.8 2.4 2.2 0.2 100.0 708 35-39 48.6 36.2 7.4 1.4 1.0 2.4 2.8 0.2 100.0 668 40-44 52.7 33.4 6.9 2.0 0.5 2.3 2.3 0.0 100.0 630 45-49 55.3 32.4 5.5 1.5 0.4 2.6 2.0 0.2 100.0 619 Marital status Never married 41.8 41.0 7.0 1.6 1.6 3.3 3.4 0.3 100.0 1,340 Married or living together 48.5 36.0 7.0 2.3 0.8 2.7 2.6 0.2 100.0 3,246 Divorced/separated/widowed 47.7 35.8 9.0 3.2 0.5 1.2 2.5 0.0 100.0 208 Residence Urban 48.7 37.7 5.1 1.0 1.1 2.8 3.1 0.3 100.0 2,393 Rural 44.4 37.1 9.0 3.2 0.9 2.8 2.5 0.1 100.0 2,401 Region National Capital Region 49.3 35.6 7.3 1.3 1.1 0.8 4.5 0.0 100.0 492 Cordillera Admin Region 51.9 29.9 7.5 2.7 1.1 3.8 2.8 0.4 100.0 117 I - Ilocos 45.8 35.4 7.6 3.3 1.6 2.9 3.3 0.0 100.0 242 II - Cagayan Valley 53.3 22.1 8.8 0.9 3.6 5.1 6.3 0.0 100.0 92 III - Central Luzon 45.7 47.5 3.7 0.4 0.4 1.3 1.0 0.0 100.0 342 IVA - CALABARZON 52.1 33.0 5.0 0.6 1.5 2.2 4.7 0.9 100.0 455 IVB - MIMAROPA 48.8 30.5 8.3 5.1 1.5 4.2 1.1 0.6 100.0 140 V - Bicol 57.8 22.2 4.9 0.5 1.1 8.5 4.0 1.0 100.0 198 VI - Western Visayas 46.5 38.9 7.1 1.9 0.2 4.0 1.4 0.0 100.0 495 VII - Central Visayas 50.5 37.9 6.1 1.9 0.2 2.3 0.8 0.2 100.0 545 VIII - Eastern Visayas 41.4 42.3 7.9 4.2 0.5 3.1 0.5 0.0 100.0 164 IX - Zamboanga Peninsula 26.5 55.0 11.6 2.6 2.2 0.6 1.6 0.0 100.0 164 X - Northern Mindanao 40.2 49.1 6.2 1.5 1.5 0.0 1.5 0.0 100.0 308 XI - Davao 48.8 28.4 7.3 1.9 1.0 6.5 6.0 0.2 100.0 456 XII - SOCCSKSARGEN 39.8 38.8 11.0 3.2 1.8 2.9 2.5 0.0 100.0 238 XIII - Caraga 42.1 49.2 5.7 1.2 0.3 0.3 1.2 0.0 100.0 200 ARMM 34.8 33.3 14.0 11.8 1.0 1.6 3.5 0.0 100.0 144 Education No education 31.0 27.2 27.5 9.3 2.0 2.0 1.0 0.0 100.0 81 Elementary 44.1 35.4 9.9 3.5 1.0 3.3 2.6 0.1 100.0 1,442 High school 44.5 38.9 6.7 1.6 1.4 2.9 3.9 0.1 100.0 2,064 College or higher 54.1 37.9 2.9 0.9 0.2 2.1 1.3 0.6 100.0 1,207 Wealth index quintile Lowest 40.1 32.0 13.8 6.5 1.2 3.4 3.0 0.0 100.0 985 Second 46.3 38.0 7.6 1.6 1.5 2.1 2.9 0.1 100.0 1,015 Middle 47.6 39.3 6.0 0.6 0.7 3.1 2.6 0.1 100.0 948 Fourth 47.1 41.5 3.5 0.9 0.7 3.4 2.7 0.2 100.0 875 Highest 51.9 36.8 3.9 0.8 1.1 2.2 2.9 0.5 100.0 971 Total 46.6 37.4 7.1 2.1 1.0 2.8 2.8 0.2 100.0 4,794 Tuberculosis | 199 Davao registers the highest (75 percent), and ARMM (10 percent), followed by Zamboanga Peninsula (17 percent), the lowest. There are no marked differentials observed with the level of consultation or treat- ment by marital status and residence. The proportion who said they did not seek treatment because they felt the symptoms were harmless shows little marked differentials by background characteristics among women; however, less than 20 percent of men in Davao and Central Visayas state it as a reason for not seeking treatment. Table 12.9.2 Reasons for not seeking treatment for symptoms of tuberculosis: men Percent distribution of men who have ever had symptoms of tuberculosis by whether they sought treatment for the symptoms and reason for not seeking treatment, according to background characteristics, Philippines 2003 Reason for not seeking consultation/treatment Background characteristic Sought treatment Symptoms harmless Cost Distance Embarrassed Self- medication Don’t know/ other Missing Total Number of men Age 15-19 41.9 40.5 8.8 1.7 1.5 2.8 3.0 0.0 100.0 281 20-24 44.7 35.6 9.2 3.6 1.6 2.9 2.3 0.0 100.0 238 25-29 47.5 41.6 4.0 3.3 0.0 1.5 1.1 1.1 100.0 192 30-34 46.0 38.5 7.2 1.3 0.7 4.0 2.2 0.0 100.0 230 35-39 45.8 35.8 7.7 3.5 1.9 3.6 1.2 0.5 100.0 215 40-44 51.2 37.1 4.0 2.7 0.5 1.3 3.2 0.0 100.0 192 45-49 49.4 38.5 4.7 0.8 0.0 4.4 1.1 1.1 100.0 174 50-54 59.9 28.7 2.8 4.0 0.0 2.3 2.4 0.0 100.0 170 Marital status Never married 43.1 40.5 7.2 2.6 0.9 2.9 2.6 0.2 100.0 595 Married or living together 50.2 35.3 6.0 2.7 0.9 2.8 1.9 0.4 100.0 1,055 Divorced/separated/widowed (46.8) (42.8) (4.1) (0.0) (0.0) (5.0) (1.1) (0.0) 100.0 41 Residence Urban 48.1 37.5 6.5 1.4 0.6 2.1 3.2 0.6 100.0 734 Rural 47.2 37.1 6.3 3.5 1.1 3.4 1.3 0.1 100.0 958 Region National Capital Region 46.3 39.5 3.7 2.5 0.0 3.0 3.6 1.3 100.0 142 Cordillera Admin Region 39.1 49.0 2.1 2.2 1.1 5.3 1.1 0.0 100.0 42 I - Ilocos 37.0 29.5 8.2 3.6 5.4 15.3 0.0 0.9 100.0 112 II - Cagayan Valley (56.3) (34.1) (6.2) (0.0) (0.0) (0.0) (3.3) (0.0) 100.0 26 III - Central Luzon 54.3 32.9 4.1 2.6 1.1 1.0 4.0 0.0 100.0 129 IVA - CALABARZON 39.4 48.9 5.8 2.1 0.0 0.7 3.3 0.0 100.0 204 IVB - MIMAROPA 34.6 43.2 11.2 6.1 0.0 0.0 4.9 0.0 100.0 71 V - Bicol (55.8) (26.9) (10.8) (0.0) (2.2) (4.3) (0.0) (0.0) 100.0 48 VI - Western Visayas 43.7 40.4 8.3 2.7 0.0 4.9 0.0 0.0 100.0 170 VII - Central Visayas 69.7 18.5 9.4 1.6 0.0 0.0 0.0 0.8 100.0 139 VIII - Eastern Visayas 38.9 50.2 4.7 3.1 1.5 0.8 0.8 0.0 100.0 111 IX - Zamboanga Peninsula 16.8 65.1 11.4 2.9 0.0 2.8 0.9 0.0 100.0 91 X - Northern Mindanao 53.2 37.1 3.2 2.1 2.2 0.0 2.2 0.0 100.0 84 XI - Davao 75.0 7.6 3.4 2.9 0.7 2.6 7.1 0.8 100.0 134 XII - SOCCSKSARGEN 50.8 36.9 5.8 2.8 0.9 2.8 0.0 0.0 100.0 95 XIII - Caraga 50.8 45.5 2.9 0.0 0.7 0.0 0.0 0.0 100.0 82 ARMM * * * * * * * * 100.0 14 Education No education (29.6) (41.4) (12.7) (6.9) (0.0) (9.4) (0.0) (0.0) 100.0 32 Elementary 43.9 39.0 7.9 3.3 0.9 2.6 1.8 0.6 100.0 659 High school 51.2 34.6 5.9 1.8 0.8 3.1 2.6 0.0 100.0 693 College or higher 49.3 39.2 3.6 2.3 1.1 2.0 2.0 0.4 100.0 308 Wealth index quintile Lowest 44.0 33.2 11.9 4.8 0.4 3.5 2.0 0.3 100.0 390 Second 48.3 38.9 5.4 1.9 1.4 2.2 0.9 1.0 100.0 395 Middle 47.2 36.3 7.4 2.9 0.6 3.9 1.7 0.0 100.0 346 Fourth 48.8 39.4 3.1 1.2 1.2 2.0 4.3 0.0 100.0 293 Highest 51.1 40.0 2.1 1.6 0.8 2.4 2.1 0.0 100.0 267 Total 47.6 37.3 6.4 2.6 0.9 2.9 2.1 0.3 100.0 1,692 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 200 | Tuberculosis Service (40 percent), distance (29 percent), and cost (20 percent) are the most popular reasons for going to the most recent source of treatment, as reported by women who sought treatment (Table 12.10). With distance as the reason for choosing the last source of treatment, the relevant sources of treatment are rural/urban health center and pharmacy. The main reason for choosing a private hospital/clinic or private doctor is quality of service. Table 12.10 Reasons for choosing source of treatment for symptoms of TB Percentage of women who have ever had symptoms of tuberculosis and who sought treatment, by last source of treatment, by reason for choosing the source, Philippines 2003 Source of treatment Distance Cost Service Quality of drugs Other Missing Total Number Government hospital 26.8 30.8 35.2 4.6 2.7 0.0 100.0 426 Rural/Urban health center 45.8 28.3 18.0 5.6 2.0 0.3 100.0 685 Private hospital/clinic 20.6 7.7 61.6 5.8 4.2 0.0 100.0 588 Pharmacy (38.0) (26.9) (2.6) (30.0) (2.6) (0.0) 100.0 36 Private doctor 14.3 5.8 65.1 10.4 3.5 0.9 100.0 303 Other 21.5 18.9 35.7 1.3 21.5 1.1 100.0 156 Total 28.9 19.6 40.3 6.1 4.4 0.7 100.0 2,233 Note: Some sources with small numbers of users have been omitted from the table. Figures in parentheses are based on 25-49 unweighted cases. 12.4 WILLINGNESS TO WORK WITH SOMEONE WHO HAS PREVIOUSLY BEEN TREATED FOR TUBERCULOSIS Six in ten women and men who have heard of TB say they are willing to work with someone who has previously been treated for TB (Table 12.11). While no strong differentials exist by marital status, substantial differences are evident by age, residence, education, wealth index quintile, and region. Older respondents are more likely than younger respondents to be willing to work with someone who has had TB. Urban women and men are more likely to be willing to do so than their rural counterparts. The higher the respondent’s level of education and wealth index quintile, the greater the percentage willing to work with a treated TB patient. ARMM has the lowest level of acceptance, followed by Zamboanga Peninsula. Among women, Eastern Visayas and Bicol, have levels of acceptance below 50 percent, and among men, Western Visayas is below 40 percent. Tuberculosis | 201 Table 12.11 Positive attitudes toward those with TB Among women and men who have heard of tuberculosis, percentage who are willing to work with someone who has previously been treated for tuberculosis, by background characteristics, Philippines 2003 Women Men Background characteristic Percent Number Percent Number Age 15-19 51.8 2,537 50.8 918 20-24 62.6 2,145 58.5 785 25-29 64.4 1,988 62.2 647 30-34 65.0 1,914 62.8 593 35-39 63.7 1,830 64.5 586 40-44 64.2 1,538 65.0 483 45-49 65.5 1,317 64.6 416 50-54 na 0 66.9 338 Marital status Never married 60.5 4,248 56.1 1,914 Married or living together 62.3 8,464 63.8 2,746 Divorced/separated/widowed 64.6 558 58.4 106 Residence Urban 67.3 7,692 69.5 2,553 Rural 54.3 5,577 50.3 2,213 Region National Capital Region 72.9 2,340 83.7 740 Cordillera Admin Region 70.8 203 77.7 72 I - Ilocos 73.7 619 66.2 232 II - Cagayan Valley 76.4 419 54.5 163 III - Central Luzon 64.5 1,399 69.5 520 IVA - CALABARZON 74.9 1,836 72.9 652 IVB - MIMAROPA 52.6 325 66.1 119 V - Bicol 46.5 695 45.1 236 VI - Western Visayas 50.4 892 38.4 322 VII - Central Visayas 55.1 1,049 52.0 373 VIII - Eastern Visayas 44.9 551 52.8 229 IX - Zamboanga Peninsula 44.2 453 28.1 189 X - Northern Mindanao 52.0 545 52.4 202 XI - Davao 65.3 639 55.6 212 XII - SOCCSKSARGEN 58.1 504 49.9 216 XIII - Caraga 63.9 325 62.6 125 ARMM 26.4 476 28.4 166 Education No education 32.0 164 24.5 84 Elementary 49.9 2,970 50.3 1,441 High school 60.4 5,975 61.2 2,048 College or higher 73.5 4,161 74.4 1,193 Wealth index quintile Lowest 40.7 2,047 37.0 884 Second 55.7 2,343 53.4 937 Middle 63.8 2,626 67.4 992 Fourth 68.0 2,885 69.0 957 Highest 72.0 3,368 73.3 996 Total 61.8 13,270 60.6 4,766 na = Not applicable 202 | Tuberculosis 12.5 AWARENESS OF THE DOTS CHEMOTHERAPY PROGRAM Table 12.12 shows that 18 percent of women and 12 percent of men are aware of the DOTS pro- gram of DOH. The level increases with age, education, and wealth index quintile, irrespective of sex. Regions with levels below average among women are Ilocos, Central Luzon, MIMAROPA, Bicol, Cen- tral Visayas, Northern Mindanao, and ARMM, while those among men are NCR, Ilocos, MIMAROPA, Bicol, Eastern Visayas, Zamboanga Peninsula, SOCCSKSARGEN, and ARMM. No strong differentials exist by marital status or residence. Table 12.12 Awareness of DOTS Percentage of women and men who are aware of the DOTS (Directly Observed Treatment Short-course) chemotherapy program, by background characteristics, Philippines 2003 Women Men Background characteristic Percent Number Percent Number Age 15-19 12.6 2,648 6.6 918 20-24 16.2 2,209 7.5 785 25-29 21.5 2,034 11.7 647 30-34 19.9 1,954 14.7 593 35-39 20.1 1,873 16.0 586 40-44 21.2 1,564 13.4 483 45-49 21.2 1,351 12.6 416 50-54 na 0 16.8 338 Marital status Never married 16.7 4,388 7.6 1,914 Married or living together 19.2 8,671 14.3 2,746 Divorced/separated/widowed 20.4 574 12.0 106 Residence Urban 20.2 7,877 13.3 2,553 Rural 16.0 5,756 9.5 2,213 Region National Capital Region 18.5 2,387 8.7 740 Cordillera Admin Region 18.1 216 15.1 72 I - Ilocos 15.3 642 5.2 232 II - Cagayan Valley 18.6 426 13.8 163 III - Central Luzon 15.5 1,459 12.9 520 IVA - CALABARZON 19.9 1,890 18.6 652 IVB - MIMAROPA 10.1 340 9.6 119 V - Bicol 11.1 713 6.3 236 VI - Western Visayas 30.0 910 21.1 322 VII - Central Visayas 17.4 1,070 11.3 373 VIII - Eastern Visayas 19.4 555 4.8 229 IX - Zamboanga Peninsula 21.2 465 5.4 189 X - Northern Mindanao 15.4 565 12.2 202 XI - Davao 20.1 654 17.1 212 XII - SOCCSKSARGEN 18.4 524 4.0 216 XIII - Caraga 28.7 327 19.7 125 ARMM 12.6 489 0.4 166 Education No education 11.8 186 2.9 84 Elementary 10.5 3,146 7.7 1,441 High school 16.5 6,109 11.2 2,048 College or higher 27.4 4,192 17.4 1,193 Wealth index quintile Lowest 12.6 2,161 7.3 884 Second 15.1 2,412 9.5 937 Middle 16.1 2,682 12.6 992 Fourth 20.5 2,940 11.7 957 Highest 24.3 3,438 16.0 996 Total 18.4 13,633 11.5 4,766 na = Not applicable General Health | 203 GENERAL HEALTH 13 The 2003 National Demographic and Health Survey (NDHS) included the Health Module, which is aimed at assessing the health status, practices, and attitudes of the population. The respondent for this module is any household member who is knowledgeable about other members of the household. 13.1 COMMUNICABLE DISEASES 13.1.1 Dengue Fever As stated in the Philippine National Objectives for Health, one of the country’s important goals is to reduce morbidity and mortality from dengue fever. Three specific health status objectives were identi- fied to fulfill this aim: 1) reduce the incidence rate of dengue hemorrhagic fever to 20 cases per 100,000 population, 2) reduce the case fatality rate of dengue hemorrhagic fever to less than 1 percent, and 3) de- crease the number of dengue outbreaks to less than 10 a year (Department of Health, 2000). In line with these health goals, the Dengue Control Program of the Department of Health (DOH) perseveres in in- creasing public awareness of dengue, its mode of transmission, and its prevention. Table 13.1 shows that effective ways to prevent dengue fever are well known in the Philippines. More than two-thirds of household respondents reported that removing mosquito breeding places is one way to avoid dengue. Eliminating mosquitoes was cited by about half; using mosquito nets, by a quarter; and spraying/fogging/fumigating, by another quarter. Small proportions have misconceptions on dengue prevention, like staying away from people with dengue (2 percent) and washing hands before eating (2 percent). The success of the government’s information campaign is most evident in the National Capital Region (NCR) and Zamboanga Peninsula, where more than 80 percent of households know that removing mosquito breeding places can prevent the spread of dengue fever. A more vigorous information campaign could be needed in the Autonomous Region in Muslim Mindanao (ARMM), which registered the largest percentage of household respondents with misconceptions on dengue prevention. In this region, 8 percent cited staying away from people with dengue, and 5 percent mentioned washing hands before eating as ways of preventing dengue fever. 13.1.2 Leprosy To assess DOH’s information campaign on leprosy, the 2003 NDHS asked respondents whether they have ever heard of leprosy, how it spreads from one person to another, whether it is curable, and whether a person with leprosy can be treated at home. Table 13.2 summarizes the responses to these ques- tions. About three in four household respondents (76 percent) have heard of leprosy. The proportion ranges from as high as 89 percent in Western Visayas to as low as 54 percent in ARMM. On the mode of transmission, contact with leprosy patient and skin-to-skin transmission were correctly identified by 31 and 28 percent of household respondents, respectively. Still, a considerable proportion (26 percent) of respondents did not know how leprosy spreads from one person to another. 204 | General Health Table 13.1 Dengue fever prevention Percentage of household respondents who know that dengue fever can be prevented, and among those the percentage who report various means of preventing it, by region, Philippines 2003 Means of preventing dengue fever among respondents who know that it can be prevented Region Percent- age knowing how to prevent dengue fever Number of house- holds Elimi- nate mos- quitoes Remove mosquito breeding places Spraying/ fogging/ fumi- gating Stay away from people with dengue Take medi- cines Use mos- quito coils Use mos- quito nets Use mos- quito repel- lants Wash hands before eating Other Don't know Number of house- hold respon- dents National Capital Region 99.4 1,846 53.1 83.6 21.2 3.1 1.5 2.8 8.5 5.5 2.5 4.8 0.2 1,835 Cordillera Admin Region 97.7 187 50.6 77.3 15.8 1.7 4.7 2.2 25.5 4.0 2.6 5.7 0.5 183 I - Ilocos 90.9 645 50.5 59.8 26.7 1.4 5.8 4.8 28.3 2.8 1.8 11.9 2.3 586 II - Cagayan Valley 96.8 452 31.0 54.8 20.7 1.1 7.7 5.1 53.2 4.7 1.1 10.8 0.0 437 III - Central Luzon 97.6 1,276 51.1 70.4 15.3 2.0 1.4 9.7 23.0 5.4 2.2 4.2 0.3 1,245 IVA - CALABARZON 98.4 1,611 52.8 68.9 21.8 2.7 1.8 3.3 20.1 9.3 2.6 16.2 0.2 1,585 IVB - MIMAROPA 95.3 343 45.2 59.1 23.3 1.0 0.9 3.8 49.9 2.9 2.2 14.8 2.2 327 V - Bicol 95.7 655 47.7 67.3 31.9 1.4 1.8 7.8 24.3 7.0 2.7 26.3 0.9 627 VI - Western Visayas 90.9 916 45.2 66.3 29.6 2.4 2.1 3.0 17.9 1.5 1.5 19.2 1.0 833 VII - Central Visayas 91.9 985 48.7 69.9 45.1 2.2 1.6 3.9 19.4 5.1 2.2 8.3 0.4 905 VIII - Eastern Visayas 93.8 544 35.3 59.8 22.4 1.4 11.7 13.6 35.8 2.1 2.6 8.6 0.3 511 IX - Zamboanga Peninsula 95.1 424 41.1 81.2 27.1 1.5 1.6 6.0 44.2 1.4 2.6 5.5 0.0 403 X - Northern Mindanao 89.9 515 51.8 71.9 40.6 1.3 2.0 11.4 26.2 5.3 1.6 5.9 0.0 463 XI - Davao 92.2 574 30.5 65.0 32.6 0.0 0.7 6.2 26.0 5.5 0.6 31.8 0.2 529 XII - SOCCSKSARGEN 94.7 519 51.5 65.0 24.8 1.3 1.8 4.1 32.1 1.8 2.1 3.1 0.7 491 XIII - Caraga 96.7 310 71.4 65.3 23.7 1.1 2.6 7.9 57.8 7.5 3.9 1.2 0.0 299 ARMM 97.7 314 40.4 59.1 14.3 7.8 0.9 15.4 60.8 4.3 5.4 3.7 0.0 306 Total 95.5 12,115 48.2 69.5 25.5 2.1 2.5 5.8 25.8 5.1 2.3 10.9 0.5 11,566 Table 13.2 Perceived mode of transmission of leprosy Percentage of household respondents who have heard of leprosy, and among those the percentage who cite various modes of transmission of leprosy, by region, Philippines 2003 Perceived mode of transmission of leprosy among respondents who have heard of leprosy Region Percentage who heard of leprosy Number of house- holds Contact with leprosy patient Droplets/ airborne Eating certain types of food Exposure to hot then cold "pasma" Heredi- tary Skin to skin Other Don't know Number of house- hold respon- dents National Capital Region 80.8 1,889 23.4 5.5 1.5 13.8 17.7 30.2 5.7 26.8 1,522 Cordillera Admin Region 66.5 198 57.9 7.9 4.9 1.4 9.9 38.9 8.6 12.7 131 I - Ilocos 74.7 673 30.0 7.2 3.7 5.5 10.4 35.2 11.9 28.6 502 II - Cagayan Valley 72.7 458 42.6 10.0 2.0 1.4 21.1 53.0 5.9 0.2 332 III - Central Luzon 67.1 1,317 17.4 5.6 1.7 6.4 13.1 23.5 4.0 41.0 881 IVA - CALABARZON 71.6 1,641 33.3 6.1 2.6 6.7 15.3 21.4 8.6 29.1 1,175 IVB - MIMAROPA 72.5 358 31.6 5.6 3.4 2.2 7.8 24.8 13.2 37.1 260 V - Bicol 70.7 687 30.3 17.6 2.7 0.9 9.3 12.5 15.7 38.1 485 VI - Western Visayas 89.0 934 26.8 21.6 3.5 0.9 4.2 15.1 10.6 34.6 830 VII - Central Visayas 83.7 1,000 36.8 11.8 6.9 2.1 15.4 27.6 10.3 23.7 837 VIII - Eastern Visayas 71.0 566 21.9 5.7 3.1 2.0 10.7 54.5 8.1 12.0 402 IX - Zamboanga Peninsula 71.6 459 40.7 7.7 6.9 0.7 18.4 50.6 12.9 4.7 327 X - Northern Mindanao 85.5 544 37.2 11.3 7.0 0.2 8.1 24.3 13.9 30.9 465 XI - Davao 87.7 592 33.5 10.6 3.8 0.2 5.5 15.9 29.5 28.9 517 XII - SOCCSKSARGEN 71.6 544 33.8 17.0 8.6 1.8 15.2 27.8 7.8 19.5 388 XIII - Caraga 85.1 322 45.0 29.0 9.3 0.9 4.8 50.2 2.9 3.3 274 ARMM 53.9 396 29.2 12.7 34.3 4.4 15.2 39.4 4.8 7.3 212 Total 76.0 12,577 30.5 10.4 4.5 4.7 12.6 28.4 9.8 26.2 9,540 General Health | 205 Among household respondents who had heard of leprosy, 63 percent reported that leprosy is cur- able (Figure 13.1). Almost one in seven household respondents (15 percent) stated that leprosy can be treated at home. The proportion who said that it can be treated at home ranges from 10 percent in Western Visayas to 21 percent in Eastern Visayas (regional data not shown). On the other hand, 23 percent re- ported that leprosy cannot be cured. Among the regions, Cagayan Valley had the highest proportion of household respondents reporting this (44 percent), while NCR and ARMM had the lowest proportions (14 and 13 percent, respectively). Fifteen percent of household respondents did not know whether leprosy can be cured. Figure 13.1 Percent Distribution of Household Respondents By Whether They Think Leprosy Is Curable NDHS 2003 Curable, cannot be treated at home 48% Curable, can be treated at home 15% Don’t know 15% Not curable 23% 13.1.3 Malaria About 86 percent of household respondents have heard of malaria, and 61 percent of them are right in saying that a mosquito bite is the major means of transmission (Table 13.3). The other means of transmission identified by the respondents are drinking contaminated water (12 percent), contact with ma- laria patient (10 percent), and polluted air (5 percent). Six percent cited other reasons, while more than 3 percent gave wrong notions, like eating sour food and fatigue. More than 22 percent of respondents said that they did not know how malaria is transmitted. A much larger proportion of household respondents residing in Caraga (99 percent), Davao (98 percent), and Cagayan Valley (97 percent) have heard of malaria, as compared with those in other re- gions. Malaria is least known in Central Luzon, where 74 percent of respondents have heard of the dis- ease (Table 13.3). 206 | General Health Table 13.3 Perceived transmission of malaria Percentage of household respondents who have heard of malaria, and among those the percentage who report specific modes of transmission of malaria, by region, Philippines 2003 Modes of transmission of malaria among respondents who have heard of malaria Region Percent- age heard of malaria Number of house- holds Polluted air Contact with malaria patient Drinking contami- nated water Eating sour foods Mos- quito bites Fatigue Other Don't know Number of house- hold respon- dents National Capital Region 83.4 1,889 6.9 10.7 12.3 0.9 63.9 1.2 3.4 22.1 1,571 Cordillera Admin Region 95.5 198 2.3 11.1 8.5 0.5 76.9 2.5 6.0 7.2 188 I - Ilocos 90.7 673 5.0 12.9 10.6 0.2 48.8 3.1 5.8 35.6 608 II - Cagayan Valley 96.7 458 5.1 10.1 20.0 0.0 79.9 4.0 5.2 0.4 442 III - Central Luzon 73.9 1,317 4.1 9.0 11.6 1.4 51.0 0.5 3.9 27.2 974 IVA - CALABARZON 81.6 1,641 5.8 14.9 9.2 0.9 56.7 1.1 8.1 23.7 1,338 IVB - MIMAROPA 94.4 358 2.2 14.4 8.5 0.6 58.8 0.6 9.7 23.8 338 V - Bicol 79.3 687 4.3 10.6 12.4 0.7 44.4 1.1 10.5 33.5 544 VI - Western Visayas 86.2 934 3.7 10.1 4.8 1.4 39.7 0.1 4.9 42.9 805 VII - Central Visayas 81.8 1,000 3.1 6.8 8.3 1.8 64.5 1.3 2.9 24.3 818 VIII - Eastern Visayas 86.1 566 3.8 6.9 8.4 2.2 75.5 1.6 5.4 9.4 486 IX - Zamboanga Peninsula 95.2 459 4.7 8.7 23.0 1.0 88.0 2.5 2.5 2.6 436 X - Northern Mindanao 88.3 544 2.1 4.1 15.3 1.4 68.9 1.2 4.9 20.7 480 XI - Davao 97.7 592 2.8 4.5 7.4 0.8 56.7 0.8 19.1 21.0 577 XII - SOCCSKSARGEN 90.2 544 3.8 9.9 13.5 0.8 56.4 7.9 5.6 23.5 489 XIII - Caraga 98.6 322 6.6 6.1 24.7 3.8 89.2 7.4 1.3 0.6 317 ARMM 83.8 396 11.6 14.8 29.7 2.0 73.9 6.7 4.1 5.3 331 Total 85.5 12,577 4.8 10.0 12.1 1.2 61.0 2.0 5.9 22.2 10,741 13.2 NONCOMMUNICABLE DISEASES 13.2.1 Cancer Prevention and control of cancer is the government’s response to the increasing incidence of can- cer of the lungs, breasts, and other parts of the body among Filipinos. According to the 2001 Vital Statis- tics Report, malignant neoplasm (or “cancer” in the layman’s term), is the second leading cause of death in the Philippines (National Statistics Office, 2001). The 2003 NDHS asked respondents questions on awareness of cancer and its signs and symp- toms. The result shows that 94 percent of the household respondents are aware of cancer (Table 13.4). Of those who are aware of this disease, 35 percent mentioned that the presence of a lump or mass in any part of a person’s body would make them suspect that he/she may have cancer. Two in 10 household respon- dents cited weakness, persistent pain, and sudden loss of weight as signs and symptoms of cancer. How- ever, 21 percent who have heard of cancer do not know any of its signs and symptoms. General Health | 207 Table 13.4 Signs and symptoms of cancer Percentage of household respondents who have heard of cancer, and among those the percentage who know about specific signs and symptoms of cancer, by region, Philippines 2003 Signs and symptoms of cancer among respondents who have heard of cancer Region Percent age heard of cancer Number of house- holds Bleed- ing Change of bowel move- ment Hoarse- ness of voice Irregu- lar urina- tion Lump or mass in any part of the body Persis- tent pain Sore (wound) that does not heal Sudden loss of weight Weak Other None Don't know Number of house- hold respon- dents National Capital Region 95.0 1,889 6.8 3.0 2.8 1.7 45.7 26.7 10.1 19.6 20.0 11.7 1.5 18.6 1,791 Cordillera Admin Region 89.7 198 2.9 2.7 3.2 1.9 40.7 18.2 9.4 30.7 35.0 18.0 6.1 6.6 177 I - Ilocos 95.2 673 4.5 2.6 2.4 2.3 27.7 15.9 7.1 20.7 23.6 16.0 3.2 30.3 641 II - Cagayan Valley 92.3 458 5.3 6.7 5.2 1.2 43.5 21.6 3.0 31.3 36.3 18.7 1.5 0.4 422 III - Central Luzon 92.5 1,317 5.5 3.1 1.9 1.7 42.6 21.9 4.0 27.1 18.9 9.7 1.6 16.7 1,217 IVA - CALABARZON 94.4 1,641 6.9 2.1 1.4 1.8 40.3 26.0 13.0 20.1 20.9 16.8 3.1 16.5 1,549 IVB - MIMAROPA 87.7 358 3.3 1.1 1.1 1.1 30.1 25.5 7.1 18.8 14.1 18.1 3.3 29.0 314 V - Bicol 93.8 687 2.3 0.7 1.2 1.3 32.5 21.7 10.4 11.4 13.7 21.3 3.1 31.6 644 VI - Western Visayas 98.5 934 2.5 0.9 0.8 0.4 25.5 21.4 4.0 13.6 12.8 17.9 1.8 35.9 920 VII - Central Visayas 97.9 1,000 2.8 1.8 1.0 1.2 26.2 17.7 5.2 30.4 36.6 11.6 1.0 25.9 980 VIII - Eastern Visayas 95.5 566 5.0 1.6 4.5 1.1 44.2 22.6 9.3 21.8 25.2 8.5 1.8 10.1 541 IX - Zamboanga Peninsula 94.1 459 7.0 1.0 3.3 0.6 23.1 45.8 12.4 37.2 48.2 6.8 2.0 4.5 431 X - Northern Mindanao 95.5 544 3.4 2.3 1.1 0.9 27.8 33.3 2.6 15.2 23.2 11.9 2.8 34.2 518 XI - Davao 97.9 592 1.9 0.8 0.8 0.7 25.0 15.3 3.1 14.6 23.8 32.0 9.0 23.6 579 XII - SOCCSKSARGEN 91.9 544 1.5 1.6 0.6 0.6 19.4 27.6 2.3 28.7 36.1 8.9 1.9 24.7 499 XIII - Caraga 98.5 322 1.9 2.1 4.2 1.5 31.2 52.6 7.2 42.7 48.5 11.0 0.8 1.9 317 ARMM 75.3 396 8.3 2.2 1.5 1.2 44.6 34.2 7.7 21.1 36.2 8.3 1.7 8.6 297 Total 94.2 12,577 4.7 2.2 2.0 1.3 35.0 24.9 7.4 22.4 24.8 14.4 2.5 20.5 11,836 13.2.2 Diabetes Household respondents were also asked about their awareness of and opinion on the characteris- tics of persons likely to have diabetes. Table 13.5 shows the percentage of household respondents who have heard of diabetes and who know persons who are likely to have diabetes, by region. Almost all Fili- pino households (95 percent) have heard of diabetes. Awareness of this disease is high for all regions, but highest in Western Visayas (98 percent) and lowest in CAR (86 percent). Regarding respondents’ views on what persons are likely to have diabetes, the majority (85 per- cent) stated that those eating sweets and fatty foods are most likely to have diabetes (Table 13.5). Mean- while, 16 percent cited that diabetes runs in the family or is hereditary. Ten percent said that being fat or obese can cause diabetes, while a smaller proportion (3 percent) said that not exercising regularly is a pos- sible cause of diabetes. 208 | General Health Table 13.5 Awareness of diabetes Percentage of households respondents who have heard of diabetes, and among those the percentage who know specific character- istics of persons who are likely to have diabetes, by region, Philippines 2003 Characteristics of persons likely to have diabetes among respondents who have heard of diabetes Region Percentage heard of diabetes Number of house- holds Fat/ obese Drink alcohol heavily Smoke heavily Older people/ meno- pausal women Eat sweets and fatty foods Do not exercise regularly Family history of dia- betes Other Don’t know Number of house- hold respon- dents National Capital Region 97.1 1,889 14.3 3.5 2.6 6.6 84.5 5.3 20.6 6.3 4.0 1,834 Cordillera Admin Region 85.6 198 19.1 5.5 3.6 2.8 82.7 2.3 11.5 7.3 2.3 169 I - Ilocos 93.3 673 9.0 2.8 2.3 1.3 83.3 1.8 12.7 7.7 9.7 628 II - Cagayan Valley 94.1 458 6.8 3.6 1.5 0.4 95.5 2.1 8.6 5.7 0.2 431 III - Central Luzon 95.2 1,317 17.6 3.6 1.4 3.4 83.8 2.0 11.5 5.0 5.3 1,253 IVA - CALABARZON 95.9 1,641 13.7 6.0 3.1 2.7 79.4 2.6 25.1 11.3 4.3 1,574 IVB - MIMAROPA 90.8 358 8.3 5.1 3.5 0.4 79.8 1.3 11.6 10.9 10.1 325 V - Bicol 92.2 687 6.3 3.4 0.8 1.0 80.1 1.0 13.1 12.6 12.7 634 VI - Western Visayas 97.9 934 3.7 3.4 1.6 1.5 77.5 1.4 9.7 8.8 14.5 914 VII - Central Visayas 95.9 1,000 5.6 6.3 3.0 2.0 84.7 3.0 15.7 5.0 7.8 960 VIII - Eastern Visayas 95.5 566 5.5 1.3 0.8 1.3 92.7 1.0 13.2 4.5 1.5 541 IX - Zamboanga Peninsula 93.2 459 7.3 4.0 1.7 0.6 94.9 2.1 15.1 3.7 0.6 427 X - Northern Mindanao 94.0 544 4.8 4.5 2.2 1.4 84.5 2.8 11.4 5.8 8.7 511 XI - Davao 96.8 592 4.3 4.6 1.7 1.5 83.5 3.7 11.2 23.8 5.5 572 XII - SOCCSKSARGEN 89.5 544 8.0 4.5 3.7 0.7 89.0 3.9 13.9 6.8 4.9 487 XIII - Caraga 97.2 322 6.7 8.6 1.6 2.3 96.5 4.2 16.6 1.5 0.2 313 ARMM 88.6 396 16.0 5.2 2.5 1.9 89.4 2.1 15.2 3.0 1.8 351 Total 94.8 12,577 10.0 4.3 2.2 2.5 84.5 2.7 15.5 7.9 6.0 11,922 13.3 HEALTH CARE FINANCING The Philippine Health Insurance Corporation (PhilHealth), under the National Health Insurance Program of the Philippines, aims to enroll all Filipinos into a health insurance program to have access to affordable, adequate, and quality health care services. In the 2003 NDHS, household respondents were asked whether they or anyone in the household were members of PhilHealth and, if so, what type of mem- bers they were. Thirty percent of household respondents in the 2003 NDHS reported having at least one member in their household with PhilHealth membership (data not shown). The largest proportion (43 percent) of PhilHealth members are employed in privately owned businesses or establishments (Table 13.6). Gov- ernment employees compose slightly more than a quarter (27 percent), while individual/voluntary payers and indigents compose smaller percentages (15 and 11 percent, respectively). Overseas Filipino workers (OFW) and nonpaying members compose the smallest percentages, at 2 percent each. PhilHealth mem- bers who are employed in the private sector are, on average, younger than other members. PhilHealth members residing in urban areas as well as those living in the NCR are more likely private employees; those living in ARMM are more likely government employees. Meanwhile, Northern Mindanao and Ca- gayan Valley have the highest percentage of indigent members. General Health | 209 Table 13.6 Profile of PhilHealth members Percent distribution of PhilHealth members, by type of membership and background characteristics, Philippines 2003 Type of PhilHealth membership Background characteristic Indigent Private employed Government employed Individual paying/ voluntary Non- paying OFW Don’t know Missing Number of PhilHealth members Sex Male 12.7 46.3 23.9 12.5 2.0 1.9 0.3 0.4 2,790 Female 9.3 37.9 31.9 17.4 1.7 1.3 0.2 0.2 1,969 Average age 43.8 36.0 43.0 40.5 52.1 38.7 39.0 38.1 4,759 Residence Urban 4.9 51.6 25.7 13.6 1.7 1.6 0.4 0.5 3,291 Rural 25.7 23.0 30.5 16.6 2.3 1.8 0.0 0.1 1,468 Region National Capital Region 0.7 67.1 17.5 11.1 0.7 1.6 0.6 0.7 978 Cordillera Admin Region 26.5 27.2 27.3 14.4 3.8 0.9 0.0 0.0 96 I - Ilocos 16.4 21.7 32.3 20.2 6.2 2.3 0.4 0.4 231 II - Cagayan Valley 36.4 9.9 35.3 12.4 1.9 4.0 0.0 0.0 123 III - Central Luzon 1.4 47.9 22.8 18.7 2.7 5.5 0.4 0.7 396 IVA - CALABARZON 8.0 51.7 25.6 11.4 1.4 1.3 0.4 0.3 793 IVB - MIMAROPA 28.7 14.2 38.2 14.3 3.5 1.1 0.0 0.0 60 V - Bicol 13.5 28.4 43.5 12.4 0.6 1.7 0.0 0.0 189 VI - Western Visayas 17.8 44.6 26.4 7.0 1.0 3.1 0.0 0.0 333 VII - Central Visayas 7.0 45.1 25.9 19.2 2.2 0.3 0.0 0.3 365 VIII - Eastern Visayas 4.2 17.6 59.7 12.6 5.0 0.8 0.0 0.0 105 IX - Zamboanga Peninsula 17.3 20.6 46.5 13.5 0.7 0.7 0.0 0.7 122 X - Northern Mindanao 36.9 20.6 24.8 14.9 2.5 0.3 0.0 0.0 283 XI - Davao 11.4 35.7 26.3 22.8 2.8 0.0 0.5 0.5 308 XII - SOCCSKSARGEN 20.5 29.2 22.8 25.6 1.0 0.8 0.0 0.0 204 XIII - Caraga 14.9 27.7 39.1 15.7 2.2 0.4 0.0 0.0 135 ARMM (0.0) (22.1) (72.4) (5.5) (0.0) (0.0) (0.0) (0.0) 39 Total 11.3 42.8 27.2 14.5 1.9 1.7 0.3 0.3 4,759 Note: Figures in parentheses are based on 25-49 unweighted cases. 13.4 TRADITIONAL MEDICINES DOH continues to promote locally produced herbs with scientifically proven medicinal uses through its Traditional Medicine Program. These medicinal herbs include ampalaya, lagundi, niyog- niyogan, sambong, tsaang gubat, yerba buena, ulasimang bato (shrub with small, shiny, dark green leaves, used to relieve stomach pain), bayabas or guava leaves, bawang, and acapulco. The 2003 NDHS investigated on the familiarity of Filipino households with these herbal medi- cines and their medicinal uses. Table 13.7 indicates that the most popular herbal medicines are bayabas (guava) (98 percent), bawang (garlic) (92 percent), and ampalaya (bitter gourd) (88 percent). Tsaang gubat (juicy grass with heart-shaped leaves, used to reduce uric acid in the blood) (23 percent) and niyog- niyogan (Chinese honeysuckle) (14 percent) are the least popular. Seventy-two percent of respondents who claimed familiarity with bawang identified it as treatment for high blood pressure, and 2 percent identified it for hypercholesterolemia. Bayabas and acapulco (ringworm bush) are known to heal skin in- fections and clean wounds by 80 and 74 percent of respondents familiar with these herbs, respectively. More than half (56 percent) of respondents who know tsaang gubat as having medicinal value correctly identified it as a remedy for abdominal pain or diarrhea. Sambong (camphor), which was incorrectly iden- tified to cure cough or asthma by 35 percent of respondents, was correctly recognized to act as a diuretic or treat urinary stones by only 8 percent. Table 13.7 Familiarity with herbal medicines Percentage of household respondents who are familiar with traditional medicines and, among those the percentage who report specific uses of the medicine, by type of herb, Philippines 2003 Condition treated Traditional herbal medicines Percent- age who know medicinal value of each herb Number of house- holds Abdominal pain/ diarrhea Anemia Ascaris Cold Cough/ asthma Diabetes Diuretic/ urinary stone Fever Gouty arthritis/ rayuma Edema (manas) High blood pres- sure Hyper- choles- terolemia Skin infection/ cleaning wounds Malaise Other Don’t know Number of house- hold respon- dents Lagundi 59.5 12,577 14.9 0.3 0.5 11.6 41.8 1.2 1.9 20.4 2.3 0.7 1.4 0.2 5.5 4.3 15.3 10.7 7,464 Yerba buena 53.0 12,577 21.6 0.6 0.9 13.0 30.8 0.3 0.9 17.7 1.9 0.9 0.5 0.3 5.2 7.8 15.7 10.5 6,649 Sambong 74.3 12,577 22.3 0.4 0.5 10.2 34.7 0.8 8.3 13.4 5.4 2.5 1.9 0.2 8.1 12.1 20.1 4.2 9,307 Tsaang gubat 22.6 12,577 55.7 0.4 0.6 3.8 8.3 1.8 6.3 6.1 1.3 0.7 2.6 0.8 3.5 2.2 13.8 11.7 2,830 Niyog-niyogan 13.7 12,577 15.2 0.6 16.9 1.7 4.9 2.5 4.9 5.2 1.4 1.0 2.8 0.7 7.8 2.6 17.4 24.1 1,704 Bayabas 97.6 12,577 49.1 0.3 0.8 0.9 2.9 0.4 0.7 1.3 0.1 0.2 0.3 0.3 80.3 1.4 7.0 0.7 12,256 Acapulco 47.2 12,577 3.0 0.2 4.8 0.5 0.8 0.0 0.4 0.7 0.4 0.5 0.2 0.0 73.5 3.3 12.3 5.0 5,919 Ulasimang bato 34.6 12,577 9.7 0.4 0.5 1.6 6.8 4.2 30.8 5.0 12.1 0.8 18.1 0.8 13.0 2.6 7.0 9.4 4,328 Bawang 92.0 12,577 8.7 0.6 0.6 0.9 2.0 0.5 0.3 1.8 0.7 0.1 72.1 1.5 20.4 1.2 15.2 1.5 11,547 Ampalaya 87.9 12,577 7.3 35.6 1.7 4.4 17.2 43.8 0.8 0.9 0.9 0.2 5.5 0.8 4.6 0.5 9.2 2.0 11,045 210 | G eneral H ealth General Health | 211 Compared with data from the 1998 NDHS, the perception of households on the correct use of the herbal medicines improved somewhat. The awareness level of respondents on ampalaya as a cure for dia- betes mellitus surged from 5 percent in 1998 to 44 percent in 2003. Public knowledge of the correct use of acapulco also improved over the five years. The percentage of respondents who identified it as treatment for skin infections or as a cleaning agent for wounds rose from 55 percent in 1998 to 74 percent in 2003. Respondents were also asked whether any member of their household used any of the cited herbal medicines during the three months preceding the survey. Bayabas remains the most commonly used (50 percent) medicinal herb, followed by ampalaya (35 percent), bawang (34 percent), and sambong (33 per- cent) (Table 13.8). Lagundi (five-leaved chaste tree), yerba buena (mint or peppermint), and acapulco were used by 18, 17, and 15 percent of respondents, respectively. The least used were ulasimang bato (10 percent), tsaang gubat (7 percent), and niyog-niyogan (3 percent). Table 13.8 also shows that bayabas, ampalaya, bawang, and sambong were most widely used in Northern Mindanao. Table 13.8 Use of herbal medicines Among household respondents who are familiar with traditional medicines, the percentage who report at least one member of their households using specific herbal medicines in the three months preceding the survey, by region, Philippines 2003 Traditional herbal medicines used Region Number of house- holds Lagundi Yerba buena Sambong Tsaang gubat Niyog- niyogan Bayabas Acapulco Ulasimang bato Bawang Ampalaya National Capital Region 1,713 9.3 5.2 17.8 2.6 1.6 38.4 1.7 5.6 31.2 31.9 Cordillera Admin Region 168 16.7 10.2 8.5 11.5 1.5 49.5 8.9 1.8 37.1 30.7 I - Ilocos 654 32.7 17.5 18.7 15.8 1.7 49.7 11.5 4.0 26.4 34.7 II - Cagayan Valley 441 41.0 21.4 18.6 7.1 5.3 58.1 15.4 3.3 44.2 42.5 III - Central Luzon 1,235 27.3 11.9 25.9 11.5 6.1 59.9 6.6 12.6 42.8 45.1 IVA - CALABARZON 1,509 10.4 9.0 20.8 4.3 3.0 30.1 5.6 5.3 21.0 21.4 IVB - MIMAROPA 314 15.5 22.9 34.1 12.2 1.6 39.1 8.8 4.7 29.7 22.0 V - Bicol 544 24.7 30.6 76.9 10.7 2.2 61.7 17.8 14.9 45.1 35.8 VI - Western Visayas 889 10.1 17.1 29.9 6.3 2.8 31.7 10.6 6.1 28.0 28.3 VII - Central Visayas 827 9.8 17.0 45.9 4.2 2.3 59.8 25.2 13.3 37.2 39.6 VIII - Eastern Visayas 479 17.6 19.9 36.3 3.7 1.7 46.4 14.4 12.9 24.0 20.6 IX - Zamboanga Peninsula 382 29.2 15.5 52.3 3.7 2.7 68.7 35.8 40.7 36.1 41.2 X - Northern Mindanao 372 23.9 35.5 78.3 9.2 12.0 87.1 46.4 17.9 57.0 56.6 XI - Davao 480 10.3 24.6 48.3 5.2 0.2 51.7 23.8 9.0 24.6 26.7 XII - SOCCSKSARGEN 428 26.8 16.9 27.1 4.3 1.2 50.1 17.0 8.0 28.0 40.0 XIII - Caraga 285 14.8 48.9 75.6 2.8 2.7 78.7 45.6 19.8 54.4 52.2 ARMM 339 31.9 22.5 29.1 5.2 1.4 80.6 36.8 10.6 52.0 55.7 Total 11,061 18.4 16.5 33.0 6.6 3.0 49.9 14.5 9.8 33.8 34.7 13.5 HEALTH FACILITY UTILIZATION One of the main focuses of the reform strategies of the Health Sector Reform Agenda of DOH is increasing investments in public health programs and improving health facilities. Information on the utili- zation of health facilities is useful for national and local government planners in assessing the coverage and utilization of social services in hospitals and rural health units (RHUs) urban health centers (UHCs). In the 2003 NDHS, respondents were asked if a member of their household visited any health facility in the six months preceding the survey. The results show that more than half (57 percent) of the 212 | General Health households utilized a health facility. Barangay health stations, which are public health facilities operated at the grassroots level, emerged as the most utilized health facilities (22 percent) (Table 13.9). This is par- ticularly true in Caraga, Northern Mindanao, Zamboanga Peninsula, MIMAROPA, SOCCSKSARGEN, and Davao, where more than three out of ten households went to these health facilities for their health care needs and concerns. Rural Health Units (RHUs) and Urban Health Centers (UHCs) are the next most utilized health facilities (16 percent), followed by private clinics (14 percent) and private hospitals (9 percent). In Ilocos, NCR, Cordillera Administrative Region (CAR), ARMM, and CALABARZON, RHUs/UHCs are the most utilized health facilities. Table 13.9 Utilization of health facilities Percentage of households that utilized specific health facilities in the six months preceding the survey, by region, Philippines 2003 Region Barangay health station Rural health unit/ urban health center Municipal hospital District hospital Provincial hospital Regional hospital/ public medical center Private clinic Private hospital Other Any health facility Number of household respondents National Capital Region 4.6 18.5 3.2 1.9 1.1 6.4 14.6 11.5 1.0 52.1 1,889 Cordillera Admin Region 13.2 16.6 4.4 4.6 14.3 4.4 15.4 9.1 1.1 59.4 198 I - Ilocos 13.6 20.6 4.2 2.1 4.6 3.2 13.4 7.4 0.5 55.2 673 II - Cagayan Valley 25.0 14.6 3.2 3.5 5.1 3.8 11.1 3.9 0.7 55.7 458 III - Central Luzon 22.0 4.5 2.3 3.7 4.8 1.2 16.0 9.3 2.1 54.7 1,317 IVA - CALABARZON 13.8 15.7 3.9 1.5 4.4 2.2 12.2 11.1 1.6 50.8 1,641 IVB - MIMAROPA 36.8 17.4 7.5 4.0 6.3 1.0 10.1 2.8 1.3 61.9 358 V - Bicol 28.8 20.5 3.4 2.0 6.0 4.2 16.7 7.5 5.3 64.7 687 VI - Western Visayas 29.9 22.4 3.0 7.7 6.4 0.5 18.8 6.9 1.0 62.5 934 VII - Central Visayas 28.7 19.3 4.9 6.2 5.5 0.7 13.4 9.2 0.2 61.2 1,000 VIII - Eastern Visayas 22.5 21.7 3.6 6.1 4.3 2.7 10.9 4.5 1.3 54.2 566 IX - Zamboanga Peninsula 39.2 9.5 2.7 2.3 2.1 3.4 8.0 7.2 0.6 57.6 459 X - Northern Mindanao 39.6 12.6 6.7 3.3 10.0 3.5 12.7 16.0 0.5 64.8 544 XI - Davao 32.6 14.6 1.6 4.2 3.7 10.1 22.9 14.6 18.5 69.3 592 XII - SOCCSKSARGEN 35.3 15.5 4.4 3.0 3.8 1.7 14.3 15.3 0.3 59.6 544 XIII - Caraga 42.3 20.2 8.4 3.6 11.5 4.0 8.7 9.9 0.0 72.3 322 ARMM 11.9 16.1 2.8 0.7 8.4 3.4 9.8 3.9 0.2 46.5 396 Total 22.4 16.3 3.8 3.4 4.9 3.3 14.0 9.4 2.0 57.4 12,577 13.6 ALTERNATIVE HEALTH CARE Respondents were asked whether they have heard of any of the alternative health care modalities, such as acupuncture, acupressure/therapeutic massage, iridology, pranic healing, aromatherapy, chiro- practic, and homeopathy. Iridology is the most familiar alternative health care modality; 50 percent of household respon- dents said that they heard of it (Table 13.10). This is followed by acupressure/therapeutic massage (44 percent), acupuncture (28 percent), and aromatherapy (21 percent). Among the regions, Davao had the largest proportion of households that have heard of all types of alternative health care, except for acupuncture (where CAR had the largest proportion) and aromather- apy (where NCR had the largest proportion). General Health | 213 Table 13.10 Alternative health care Percentage of household respondents who have heard of specific types of alternative health care, by region, Philippines 2003 Type of alternative health care Region Acupuncture Acupressure/ therapeutic massage Iridology Pranic healing Aroma- therapy Chiro- practic Home- opathy Number of household respondents National Capital Region 40.9 47.3 62.9 8.8 33.3 10.0 4.5 1,889 Cordillera Admin Region 54.5 69.4 65.1 17.1 24.2 10.8 14.4 198 I - Ilocos 22.2 43.0 63.4 6.3 16.5 3.7 3.7 673 II - Cagayan Valley 21.0 43.2 40.3 3.4 9.6 3.7 2.7 458 III - Central Luzon 23.9 34.6 47.4 5.2 17.7 2.4 1.8 1,317 IVA - CALABARZON 30.0 37.8 47.9 8.8 24.1 5.5 3.8 1,641 IVB - MIMAROPA 9.4 32.3 32.4 5.5 12.3 2.5 7.5 358 V - Bicol 21.4 33.4 40.3 7.4 17.5 3.5 8.8 687 VI - Western Visayas 28.1 51.5 41.6 8.4 21.8 5.3 2.1 934 VII - Central Visayas 22.6 67.6 67.6 16.2 21.9 7.8 8.1 1,000 VIII - Eastern Visayas 19.0 40.1 38.7 7.9 14.5 3.4 12.7 566 IX - Zamboanga Peninsula 22.8 47.1 42.5 7.3 23.3 1.1 2.1 459 X - Northern Mindanao 26.4 41.5 37.1 9.2 18.9 4.3 3.3 544 XI - Davao 46.5 71.0 78.1 26.0 25.7 13.8 18.6 592 XII - SOCCSKSARGEN 22.5 36.9 51.7 5.6 12.6 1.4 1.4 544 XIII - Caraga 27.0 39.4 30.7 9.0 16.2 5.4 2.4 322 ARMM 9.6 13.0 22.5 6.9 8.0 0.3 0.4 396 Total 27.7 44.2 50.4 9.2 21.0 5.5 5.2 12,577 References | 215 REFERENCES BPS-Statistics Indonesia (BPS) and ORC Macro. 2003. Indonesia Demographic and Health Survey, 2002-2003. Calverton, Maryland, USA: BPS and ORC Macro. Commission on Population (POPCOM). 2000. The Philippine Population Management Program (PPMP) Directional Plan 2001-2004. Manila: POPCOM. Commission on Population (POPCOM). 2002. PPMP Strategic Operational Plan for CY 2002-2004. Manila: POPCOM. Committee for Population, Family and Children [Vietnam], and ORC Macro. 2003. Vietnam Demographic and Health Survey 2002. Calverton, Maryland, USA: Committee for Population, Family and Children and ORC Macro. Department of Health, (DOH) [Philippines]. 1995. Expanded Program on Immunization Manual. Manila, Philippines: DOH. Department of Health, (DOH) [Philippines]. 1999. National Objectives for Health 1999-2004. Manila, Philippines: DOH. National Census and Statistics Office (NCSO) [Philippines]; University of the Philippines Population Institute, Commission on Population; and National Economic and Development Authority. 1979. Republic of the Philippines Fertility Survey 1978: First Report. World Fertility Survey. Manila: NCSO and World Fertility Survey. National Institute of Statistics, Director General of Health, and ORC Macro. 2000. Cambodia Demographic and Health Survey 2000. Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Statistics, Director General of Health, and ORC Macro. National Statistics Office (NSO) [Philippines]. 1992. 1990 Census of Population and Housing. Report No. 3: Socioeconomic and Demographic Characteristics. Manila. National Statistics Office (NSO) [Philippines] and Macro International Inc. (MI). 1994. National Demographic Survey 1993. Manila. National Statistics Office (NSO) [Philippines]. 2001. 2001 Vital Statistics Report. Manila: NSO. National Statistics Office (NSO) [Philippines], Department of Health (DOH) [Philippines], and Macro International Inc. (MI). 1999. National Demographic and Health Survey 1998. Manila: Philippines: NSO and MI. ORC Macro. 2001. DHS Model “B” Questionnaire with Commentary for Low Contraceptive Prevalence Countries. MEASURE DHS+ Basic Documentation No. 2. Calverton, Maryland, U.S.A.: ORC Macro. World Health Organization. 1981. International Code of Marketing of Breast Milk Substitute by the World Health Organization. Geneva: World Health Organization. Appendix A | 217 SURVEY DESIGN Appendix A A.1 INTRODUCTION The 2003 National Demographic and Health Survey (NDHS), which interviewed women age 15-49 and men age 15-54 was designed to • Collect data at the national level, which will allow the calculation of demographic rates and, particularly, the fertility and under-five mortality rates. • Analyze the direct and indirect factors that determine the level and trends of fertility. Indicators related to fertility will serve to inform plans for social and economic development. • Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. • Collect data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluate patterns of recent behavior regarding condom use. • Collect high-quality data on family health, including immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding. The sample was selected to allow separate estimates for the national level, for urban and rural areas separately, and for each of the 17 regions. Results of the household sample implementation by urban-rural residence, by region, and by male and female subsamples are shown in Tables A.1.1 through A.2.2. As shown in Table A.1.1, 13,914 households were selected for the 2003 NDHS. Of these, 91 percent were successfully interviewed, 7 percent were not interviewed because the dwelling was vacant, and 1 percent were away during the survey fieldworkers’ visit. Other reasons for not interviewing households include the following: no competent respondent was in the household, the dwelling was not found, or the dwelling had been destroyed (each less than 1 percent). The overall household response rate is 99 percent (see Table A.1.1 for definition). The level of successful household interviews varies little across regions. Table A.1.2 presents the survey coverage for individual interviews with women. Of the 13,935 women eligible for the individual interview, 98 percent were successfully interviewed, and 1 percent were not interviewed because they were not at home (see Table A.1.2 for definition). Urban women are as likely as rural women to be interviewed in the survey. The response rate does not vary much by region. The lowest overall response rate is in Cordillera Administrative Region (CAR) (94 percent), while in Eastern Visayas, it is almost 100 percent. Table A.2.1 shows that 4,615 households were selected for the male subsample. This is approximately one-third the number of households selected for the female subsample. Ninety-one percent of those households were successfully interviewed, and less than 1 percent each were not interviewed because no competent respondent was found at home, the interview was refused, the dwelling was not found, the household was absent during the fieldworkers’ visit, or the dwelling was destroyed. The overall household response rate is 99 percent, with negligible variations across regions. 218 | Appendix A Table A.2.2 shows that 4,992 eligible men were identified for the individual interview, and of these, interviews were completed with 96 percent. The principal reason for nonresponse among eligible men was the failure to find them at home despite repeated visits to the household. The level of successful household interviews among the regions ranges from 85 percent in CAR to 99 percent in Autonomous Region in Muslim Mindanao (ARMM). Table A.1.1 Sample implementation: results of the household interview: women Percent distribution of households selected for the female subsample by results of the household interview, and household response rates, according to urban-rural residence and region, Philippines 2003 Selected households Result Completed (C) Household present but no competent respondent at home (HP) Refused (R) Dwelling not found (DNF) House- hold absent (HA) Dwelling vacant/ address not a dwelling (DV) Dwelling destroyed (DD) Total Number of sampled house- holds Household response rate (HRR)1 Residence Urban 89.9 0.4 0.3 0.2 1.1 7.8 0.3 100.0 6,878 99.0 Rural 91.0 0.3 0.0 0.3 1.1 7.1 0.2 100.0 7,036 99.3 Region National Capital Region 87.5 0.4 0.9 0.3 1.4 9.1 0.4 100.0 1,958 98.2 Cordillera Admin Region 85.2 0.2 0.0 0.0 1.7 12.9 0.0 100.0 535 99.8 I - Ilocos 93.2 0.7 0.3 0.0 1.2 4.6 0.0 100.0 695 98.9 II - Cagayan Valley 90.6 0.8 0.2 0.0 1.6 6.7 0.2 100.0 628 99.0 III - Central Luzon 90.3 0.5 0.1 0.4 1.2 7.4 0.1 100.0 1,077 99.0 IVA - CALABARZON 90.4 0.3 0.2 0.3 1.2 7.3 0.3 100.0 1,361 99.1 IVB - MIMAROPA 90.3 0.0 0.0 0.9 2.1 6.4 0.4 100.0 565 99.0 V - Bicol 89.4 0.4 0.0 0.3 1.3 8.2 0.4 100.0 777 99.3 VI - Western Visayas 90.7 0.2 0.0 0.7 0.4 7.8 0.1 100.0 892 99.0 VII - Central Visayas 93.0 0.5 0.0 0.2 0.3 5.4 0.5 100.0 927 99.2 VIII - Eastern Visayas 91.1 0.3 0.0 0.0 0.6 7.9 0.1 100.0 707 99.7 IX - Zamboanga Peninsula 93.4 0.5 0.0 0.2 0.2 5.4 0.3 100.0 574 99.3 X - Northern Mindanao 87.9 0.3 0.0 0.2 2.0 9.4 0.2 100.0 639 99.5 XI - Davao 88.6 0.0 0.0 0.3 1.4 9.2 0.6 100.0 720 99.7 XII - SOCCSKSARGEN 90.0 0.0 0.0 0.3 0.8 8.7 0.3 100.0 739 99.7 XIII - Caraga 93.5 0.0 0.0 0.4 0.5 5.7 0.0 100.0 566 99.6 ARMM 98.7 0.4 0.0 0.0 0.4 0.2 0.4 100.0 554 99.6 Total 90.5 0.3 0.2 0.3 1.1 7.4 0.3 100.0 13,914 99.1 1 With the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ——————————— C + HP + P + R + DNF Appendix A | 219 Table A.1.2 Sample implementation: results of the individual interview: women Percent distribution of eligible women by results of the individual interview, and eligible woman and overall response rates, according to urban- rural residence and region, Philippines 2003 Eligible women Result Completed (EWC) Not at home (EWNH) Refused (EWR) Partly completed (EWPC) Incapaci- tated (EWI) Other (EWO) Total Number of women Eligible women response rate (EWRR)1 Overall response rate (ORR)2 Residence Urban 97.8 1.2 0.2 0.0 0.5 0.2 100.0 7,605 97.8 96.8 Rural 97.9 1.2 0.1 0.0 0.6 0.1 100.0 6,330 97.9 97.2 Region National Capital Region 97.8 0.8 0.4 0.0 0.7 0.3 100.0 2,216 97.8 96.1 Cordillera Admin Region 94.3 4.3 0.0 0.0 1.2 0.2 100.0 511 94.3 94.1 I - Ilocos 99.4 0.2 0.2 0.0 0.2 0.2 100.0 637 99.4 98.3 II - Cagayan Valley 97.1 1.6 0.0 0.2 0.7 0.4 100.0 547 97.1 96.1 III - Central Luzon 97.3 1.5 0.0 0.1 0.9 0.2 100.0 1,109 97.3 96.3 IVA - CALABARZON 97.8 1.2 0.2 0.1 0.5 0.1 100.0 1,457 97.8 96.9 IVB - MIMAROPA 96.6 2.6 0.2 0.0 0.6 0.0 100.0 498 96.6 95.6 V - Bicol 97.8 1.5 0.1 0.0 0.3 0.3 100.0 740 97.8 97.1 VI - Western Visayas 96.6 1.2 0.9 0.0 0.9 0.5 100.0 812 96.6 95.6 VII - Central Visayas 97.7 1.7 0.1 0.0 0.5 0.0 100.0 949 97.7 96.9 VIII - Eastern Visayas 99.5 0.2 0.0 0.2 0.2 0.0 100.0 650 99.5 99.2 IX - Zamboanga Peninsula 98.2 1.2 0.0 0.0 0.4 0.2 100.0 562 98.2 97.5 X - Northern Mindanao 99.2 0.2 0.0 0.0 0.7 0.0 100.0 597 99.2 98.6 XI - Davao 98.1 1.5 0.0 0.0 0.4 0.0 100.0 739 98.1 97.8 XII - SOCCSKSARGEN 98.8 0.5 0.0 0.0 0.6 0.2 100.0 663 98.8 98.5 XIII - Caraga 98.6 0.9 0.0 0.0 0.4 0.2 100.0 553 98.6 98.2 ARMM 98.3 0.7 0.0 0.0 0.7 0.3 100.0 695 98.3 97.9 Total 97.8 1.2 0.2 0.0 0.6 0.2 100.0 13,935 97.8 97.0 1 With the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: 100 * EWC ————————————————————————— EWC + EWNH + EWP + EWR + EWPC + EWI + EWO 2 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100 220 | Appendix A Table A.2.1 Sample implementation: results of the household interview: men Percent distribution of households selected for the male subsample by results of the household interview, and household response rates, according to urban-rural residence and region, Philippines 2003 Selected households Result Completed (C) Household present but no competent respondent at home (HP) Refused (R) Dwelling not found (DNF) Household absent (HA) Dwelling vacant/ address not a dwelling (DV) Dwelling destroyed (DD) Total Number of sampled households Household response rate (HRR)1 Residence Urban 90.4 0.5 0.4 0.4 0.9 7.3 0.1 100.0 2,277 98.6 Rural 91.2 0.3 0.0 0.2 1.0 7.1 0.2 100.0 2,338 99.4 Region National Capital Region 86.9 0.6 1.1 0.3 1.2 9.8 0.2 100.0 655 97.8 Cordillera Admin Region 87.7 0.0 0.0 0.0 1.2 11.1 0.0 100.0 171 100.0 I - Ilocos 93.1 1.3 0.4 0.0 0.9 4.3 0.0 100.0 232 98.2 II - Cagayan Valley 91.4 0.0 0.0 0.0 1.0 7.7 0.0 100.0 209 100.0 III - Central Luzon 90.0 0.8 0.0 1.1 1.4 6.7 0.0 100.0 360 97.9 IVA - CALABARZON 90.2 0.4 0.4 0.2 0.7 7.9 0.2 100.0 457 98.8 IVB - MIMAROPA 92.0 0.0 0.0 1.1 2.1 4.3 0.5 100.0 187 98.9 V - Bicol 90.2 0.0 0.0 0.4 0.8 8.7 0.0 100.0 254 99.6 VI - Western Visayas 91.6 0.0 0.0 0.3 0.3 7.4 0.3 100.0 297 99.6 VII - Central Visayas 92.7 0.7 0.0 0.3 0.3 6.0 0.0 100.0 302 98.9 VIII - Eastern Visayas 89.9 0.4 0.0 0.0 0.0 9.2 0.4 100.0 238 99.5 IX - Zamboanga Peninsula 95.4 0.5 0.0 0.0 0.0 4.1 0.0 100.0 195 99.5 X - Northern Mindanao 89.4 1.0 0.0 0.0 2.4 6.7 0.5 100.0 208 98.9 XI - Davao 87.6 0.0 0.0 0.4 2.1 9.4 0.4 100.0 234 99.5 XII - SOCCSKSARGEN 91.4 0.0 0.0 0.0 0.8 7.8 0.0 100.0 243 100.0 XIII - Caraga 95.6 0.0 0.0 0.0 0.0 4.4 0.0 100.0 183 100.0 ARMM 98.4 0.5 0.0 0.0 0.5 0.0 0.5 100.0 190 99.5 Total 90.8 0.4 0.2 0.3 0.9 7.2 0.2 100.0 4,615 99.0 1 With the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ——————————— C + HP + P + R + DNF Appendix A | 221 Table A.2.2 Sample implementation: results of the individual interview: men Percent distribution of eligible men by results of the individual interview, and eligible man and overall response rates, according to urban- rural residence and region, Philippines 2003 Eligible men Result Completed (EMC) Not at home (EMNH) Refused (EMR) Partly completed (EMPC) Incapaci- tated (EMI) Other (EMO) Total Number of men Eligible man response rate (EMRR)1 Overall response rate (ORR)2 Residence Urban 94.6 3.5 0.6 0.0 1.2 0.2 100.0 2,516 94.6 93.2 Rural 96.4 2.6 0.2 0.0 0.8 0.0 100.0 2,476 96.4 95.8 Region National Capital Region 96.3 1.3 1.0 0.0 1.1 0.3 100.0 702 96.3 94.1 Cordillera Admin Region 89.5 9.3 0.0 0.0 1.2 0.0 100.0 172 89.5 89.5 I - Ilocos 98.7 1.3 0.0 0.0 0.0 0.0 100.0 234 98.7 96.9 II - Cagayan Valley 94.4 4.7 0.5 0.0 0.5 0.0 100.0 214 94.4 94.4 III - Central Luzon 95.1 4.4 0.2 0.2 0.0 0.0 100.0 405 95.1 93.1 IVA - CALABARZON 94.0 3.3 1.2 0.0 1.0 0.6 100.0 514 94.0 92.8 IVB - MIMAROPA 94.9 2.8 0.6 0.0 1.7 0.0 100.0 177 94.9 93.8 V - Bicol 95.2 3.2 0.0 0.0 1.6 0.0 100.0 250 95.2 94.8 VI - Western Visayas 94.8 3.8 1.0 0.0 0.3 0.0 100.0 291 94.8 94.5 VII - Central Visayas 94.7 2.7 0.0 0.0 2.7 0.0 100.0 338 94.7 93.7 VIII - Eastern Visayas 98.2 1.1 0.0 0.0 0.7 0.0 100.0 273 98.2 97.7 IX - Zamboanga Peninsula 97.8 2.2 0.0 0.0 0.0 0.0 100.0 229 97.8 97.3 X - Northern Mindanao 99.1 0.9 0.0 0.0 0.0 0.0 100.0 218 99.1 98.0 XI - Davao 92.6 7.0 0.0 0.0 0.4 0.0 100.0 243 92.6 92.1 XII - SOCCSKSARGEN 92.7 5.5 0.0 0.0 1.5 0.4 100.0 275 92.7 92.7 XIII - Caraga 95.8 1.4 0.0 0.0 2.8 0.0 100.0 215 95.8 95.8 ARMM 98.8 0.0 0.0 0.0 1.2 0.0 100.0 242 98.8 98.2 Total 95.5 3.0 0.4 0.0 1.0 0.1 100.0 4,992 95.5 94.5 1 With the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: 100 * EMC ————————————————————————— EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 2 The overall response rate (ORR) is calculated as: ORR = HRR * EMRR/100 Appendix B | 223 ESTIMATES OF SAMPLING ERRORS APPENDIX B The estimates from a sample survey are affected by two types of errors: 1) nonsampling errors and 2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collec- tion and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2003 National Demographic and Health Survey (NDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents se- lected in the 2003 NDHS is only one of many samples that could have been selected from the same popu- lation, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (e.g., mean, percentage), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2003 NDHS sam- ple is the result of a multistage stratified design, and consequently, it was necessary to use more complex formulas. The computer software used to calculate sampling errors for the 2003 NDHS is the Integrated System for Survey Analysis (ISSA) Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics, such as fertility and mortal- ity rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error (SE) being the square root of the variance: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )= = − −=∑ in which hihihi rxyz −= , and hhh rxyz −= 224 | Appendix B where h represents the stratum, which varies from 1 to H, mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of sev- eral replications of the parent sample and calculates standard errors for these estimates using simple for- mulas. Each replication considers all but one cluster in the calculation of the estimates. Pseudo- independent replications are thus created. In the 2003 NDHS, there were 819 non-empty clusters; hence, 818 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )= = − −=∑ in which )()1( ii rkkrr −−= where r is the estimate computed from the full sample of 819 clusters, r(i) is the estimate computed from the reduced sample of 818 clusters (Ith cluster excluded), and k is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates that the increase in the sampling errors is due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the 2003 NDHS were calculated for selected variables considered to be of primary interest for the women’s survey and for the men’s survey. The results are presented in this ap- pendix for the country as a whole, for urban and rural areas, and for each of the 17 regions. For each vari- able, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Ta- bles B.2 to B.21 present the value of the statistic (R), its standard error (SE), the number of unweighted cases (N) and weighted cases (WN), the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE) for each variable. The DEFT is considered undefined when the standard error considering the simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known un- weighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to women age 40-49) can be in- terpreted as follows: the overall average from the national sample is 4.321, and its standard error is 0.065. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate (i.e., 4.32 ± 2 × 0.065). There is a high probability (95 percent) that the true average number of children ever born to all women age 40 to 49 is between 4.192 and 4.451. Appendix B | 225 Sampling errors were analyzed for the national sample of women and for two separate groups of estimates: 1) means and proportions and 2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 0.1 and 29.1 percent, with an average of 3.27 per- cent; the highest relative standard errors are for estimates of very low values (e.g., currently using male sterilization). If estimates of very low values (less than 10 percent) are removed, then the average drops to 1.81 percent. So in general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small (1.9 percent). However, for the mortality rates, the average relative standard error is much higher (8.95 percent). There are differentials in the relative standard error for the estimates of subpopulations. For ex- ample, for the variable “want no more children,” the relative standard errors as a percent of the estimated mean for the whole country and for the urban areas are 0.9 and 1.4 percent, respectively. For the total sample, the value of the DEFT, averaged over all variables, is 1.167, which means that, because of multistage clustering of the sample, the average standard error is increased by a factor of 1.167 over that in an equivalent simple random sample. 226 | Appendix B Table B.1 List of selected variables for sampling errors, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion All women 15-49 Literate Proportion All women 15-49 No education Proportion All women 15-49 Secondary education or higher Proportion All women 15-49 Never married Proportion All women 15-49 Currently married (in union) Proportion All women 15-49 Married before age 20 Proportion All women 20-49 Had first sexual intercourse before 18 Proportion All women 20-49 Currently pregnant Proportion All women 15-49 Children ever born Mean Currently married women 15-49 Children surviving Mean Currently married women 15-49 Children ever born to women over 40 Mean Women age 40-49 Knowing any contraceptive method Proportion Currently married women 15-49 Knowing any modern contraceptive method Proportion Currently married women 15-49 Ever used any contraceptive method Proportion Currently married women 15-49 Currently using any contraceptive method Proportion Currently married women 15-49 Currently using a modern contraceptive method Proportion Currently married women 15-49 Currently using female sterilization Proportion Currently married women 15-49 Currently using male sterilization Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUD Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using condom Proportion Currently married women 15-49 Currently using periodic abstinence Proportion Currently married women 15-49 Currently using withdrawal Proportion Currently married women 15-49 Obtained method from public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay birth at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean Women 15-49 Mothers received tetanus injection for last birth Proportion Last birth in 5 years Mothers received medical assistance at delivery Proportion Births in last 5 years Had diarrhea in two weeks before survey Proportion Children under 5 Treated with oral rehydration salts (ORS) Proportion Children under 5 with diarrhea in last 2 weeks Taken to a health provider Proportion Children under 5 with diarrhea in last 2 weeks Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received DPT vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all vaccinations Proportion Children 12-23 months Total fertility rate (3 years) Rate Women-years of exposure to childbearing Perinatal mortality (0-4 years) Ratio Number of pregnancies of 7+ months Neonatal mortality rate (10 years)1 Rate Children exposed to the risk of mortality Postneonatal mortality rate (10 years)1 Rate Children exposed to the risk of mortality Infant mortality rate (10 years)1 Rate Children exposed to the risk of mortality Child mortality rate (10 years)1 Rate Children exposed to the risk of mortality Under-five mortality rate (10 years)1 Rate Children exposed to the risk of mortality –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion Men 15-54 No education Proportion Men 15-54 Secondary education or higher Proportion Men 15-54 Knowing any contraceptive method Proportion Currently married men 15-54 Knowing any modern contraceptive method Proportion Currently married men 15-54 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 5 years for national sample Appendix B | 227 Table B.2 Sampling errors for national sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.578 0.006 13633 13633 1.520 0.011 0.565 0.591 Literate 0.961 0.002 13633 13633 1.247 0.002 0.957 0.966 No education 0.014 0.001 13633 13633 1.429 0.104 0.011 0.017 Secondary education or higher 0.756 0.005 13633 13633 1.431 0.007 0.745 0.766 Never married 0.322 0.006 13633 13633 1.375 0.017 0.311 0.333 Currently married (in union) 0.636 0.005 13633 13633 1.329 0.009 0.625 0.647 Married before age 20 0.340 0.006 10987 10985 1.316 0.017 0.328 0.352 Had first sexual intercourse before age 18 0.176 0.005 10987 10985 1.279 0.026 0.167 0.185 Currently pregnant 0.056 0.002 13633 13633 1.114 0.039 0.052 0.061 Children ever born 2.180 0.027 13633 13633 1.269 0.012 2.126 2.233 Children surviving 2.051 0.024 13633 13633 1.266 0.012 2.002 2.100 Children ever born to women age 40-49 4.321 0.065 2884 2915 1.264 0.015 4.192 4.451 Knowing any contraceptive method 0.991 0.001 8764 8671 1.084 0.001 0.989 0.993 Knowing any modern contraceptive method 0.988 0.001 8764 8671 1.081 0.001 0.986 0.991 Ever used any contraceptive method 0.706 0.006 8764 8671 1.286 0.009 0.693 0.718 Currently using any contraceptive method 0.489 0.006 8764 8671 1.161 0.013 0.476 0.501 Currently using a modern method 0.334 0.006 8764 8671 1.205 0.018 0.321 0.346 Currently using female sterilization 0.105 0.004 8764 8671 1.103 0.034 0.098 0.112 Currently using male sterilization 0.001 0.000 8764 8671 1.010 0.291 0.001 0.002 Currently using pill 0.132 0.004 8764 8671 1.129 0.031 0.124 0.140 Currently using IUD 0.041 0.003 8764 8671 1.193 0.062 0.036 0.046 Currently using injectables 0.031 0.002 8764 8671 1.115 0.067 0.027 0.035 Currently using condom 0.019 0.002 8764 8671 1.089 0.083 0.016 0.022 Currently using periodic abstinence 0.067 0.003 8764 8671 1.061 0.042 0.061 0.073 Currently using withdrawal 0.082 0.003 8764 8671 1.113 0.040 0.076 0.089 Obtained method from public sector source 0.672 0.010 2917 2920 1.162 0.015 0.652 0.692 Want no more children 0.612 0.006 8764 8671 1.111 0.009 0.601 0.624 Want to delay birth at least 2 years 0.184 0.004 8764 8671 1.072 0.024 0.175 0.193 Ideal number of children 2.980 0.016 13491 13486 1.306 0.005 2.948 3.011 Mothers received tetanus injection for last birth 0.707 0.008 4920 4802 1.216 0.011 0.691 0.723 Mothers received medical assistance at delivery 0.598 0.010 7145 6954 1.400 0.017 0.577 0.619 Had diarrhea in two weeks before survey 0.106 0.005 6892 6712 1.131 0.043 0.097 0.115 Treated with oral rehydration salts (ORS) 0.422 0.021 749 714 1.069 0.050 0.379 0.464 Taken to a health provider 0.324 0.018 749 714 0.962 0.056 0.288 0.360 Vaccination card seen 0.389 0.015 1370 1348 1.131 0.039 0.359 0.419 Received BCG vaccination 0.908 0.009 1370 1348 1.105 0.010 0.890 0.925 Received DPT vaccination (3 doses) 0.789 0.012 1370 1348 1.075 0.015 0.765 0.813 Received polio vaccination (3 doses) 0.798 0.012 1370 1348 1.131 0.016 0.774 0.823 Received measles vaccination 0.797 0.012 1370 1348 1.063 0.015 0.774 0.820 Received all vaccinations 0.698 0.014 1370 1348 1.080 0.019 0.671 0.726 Total fertility rate (3 years) 3.534 0.068 na 38209 1.278 0.019 3.399 3.670 Perinatal mortality (0-4 years) 23.892 1.969 7224 7030 1.038 0.082 19.953 27.831 Neonatal mortality rate (0-4 years) 17.060 1.710 7210 7022 1.045 0.100 13.640 20.481 Postneonatal mortality rate (0-4 years) 11.688 1.434 7212 7024 1.078 0.123 8.820 14.556 Infant mortality rate (0-4 years) 28.748 2.294 7213 7025 1.085 0.080 24.160 33.336 Infant mortality rate (5-9 years) 31.267 2.374 7212 7003 1.057 0.076 26.519 36.015 Infant mortality rate (10-14 years) 33.664 2.290 6516 6385 0.968 0.068 29.085 38.243 Child mortality rate (0-4 years) 11.511 1.363 7242 7050 1.031 0.118 8.785 14.238 Under-five mortality rate (0-4 years) 39.928 2.771 7246 7054 1.106 0.069 34.386 45.471 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.536 0.008 4766 4766 1.157 0.016 0.519 0.552 No education 0.018 0.002 4766 4766 1.060 0.115 0.014 0.022 Secondary education or higher 0.680 0.008 4766 4766 1.222 0.012 0.664 0.697 Knowing any contraceptive method 0.982 0.003 2766 2746 1.074 0.003 0.977 0.987 Knowing any modern contraceptive method 0.979 0.003 2766 2746 1.043 0.003 0.973 0.984 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 228 | Appendix B Table B.3 Sampling errors for urban sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 7436 7877 na 0.000 1.000 1.000 Literate 0.978 0.002 7436 7877 1.275 0.002 0.974 0.983 No education 0.006 0.001 7436 7877 1.153 0.166 0.004 0.009 Secondary education or higher 0.837 0.006 7436 7877 1.334 0.007 0.826 0.848 Never married 0.363 0.008 7436 7877 1.419 0.022 0.347 0.379 Currently married (in union) 0.589 0.008 7436 7877 1.353 0.013 0.574 0.605 Married before age 20 0.287 0.008 5959 6332 1.328 0.027 0.271 0.302 Had first sexual intercourse before age 18 0.134 0.005 5959 6332 1.195 0.039 0.124 0.145 Currently pregnant 0.051 0.003 7436 7877 1.103 0.055 0.046 0.057 Children ever born 1.822 0.031 7436 7877 1.232 0.017 1.761 1.883 Children surviving 1.737 0.029 7436 7877 1.234 0.017 1.679 1.795 Children ever born to women age 40-49 3.758 0.077 1511 1615 1.232 0.021 3.604 3.912 Knowing any contraceptive method 0.995 0.001 4389 4643 1.120 0.001 0.993 0.998 Knowing any modern contraceptive method 0.993 0.001 4389 4643 1.004 0.001 0.991 0.996 Ever used any contraceptive method 0.721 0.008 4389 4643 1.186 0.011 0.705 0.737 Currently using any contraceptive method 0.501 0.008 4389 4643 1.093 0.016 0.485 0.518 Currently using a modern method 0.339 0.008 4389 4643 1.146 0.024 0.322 0.355 Currently using female sterilization 0.121 0.005 4389 4643 1.037 0.042 0.111 0.132 Currently using male sterilization 0.001 0.001 4389 4643 0.992 0.408 0.000 0.002 Currently using pill 0.126 0.006 4389 4643 1.114 0.044 0.115 0.137 Currently using IUD 0.035 0.003 4389 4643 1.188 0.094 0.029 0.042 Currently using injectables 0.025 0.002 4389 4643 1.049 0.099 0.020 0.030 Currently using condom 0.023 0.003 4389 4643 1.108 0.109 0.018 0.028 Currently using periodic abstinence 0.061 0.004 4389 4643 1.082 0.064 0.053 0.069 Currently using withdrawal 0.097 0.005 4389 4643 1.084 0.050 0.087 0.106 Obtained method from public sector source 0.600 0.014 1503 1600 1.111 0.023 0.572 0.629 Want no more children 0.602 0.008 4389 4643 1.103 0.014 0.585 0.618 Want to delay birth at least 2 years 0.183 0.006 4389 4643 1.078 0.034 0.171 0.196 Ideal number of children 2.813 0.018 7384 7815 1.213 0.006 2.778 2.849 Mothers received tetanus injection for last birth 0.717 0.011 2335 2447 1.128 0.015 0.696 0.738 Mothers received medical assistance at delivery 0.790 0.012 3291 3461 1.339 0.015 0.766 0.813 Had diarrhea in two weeks before survey 0.107 0.007 3196 3361 1.146 0.063 0.093 0.120 Treated with oral rehydration salts (ORS) 0.517 0.033 337 359 1.107 0.063 0.452 0.582 Taken to a health provider 0.362 0.027 337 359 0.958 0.075 0.308 0.416 Vaccination card seen 0.380 0.020 642 681 1.037 0.053 0.340 0.420 Received BCG vaccination 0.926 0.011 642 681 1.041 0.012 0.905 0.948 Received DPT vaccination (3 doses) 0.840 0.014 642 681 0.997 0.017 0.811 0.869 Received polio vaccination (3 doses) 0.836 0.016 642 681 1.109 0.020 0.803 0.869 Received measles vaccination 0.818 0.015 642 681 1.002 0.019 0.788 0.849 Received all vaccinations 0.744 0.019 642 681 1.086 0.025 0.707 0.782 Total fertility rate (3 years) 2.996 0.080 na 22242 1.214 0.027 2.835 3.157 Perinatal mortality (0-4 years) 20.588 2.593 3323 3494 0.980 0.126 15.403 25.774 Neonatal mortality rate (10 years) 13.591 1.648 6514 6828 1.029 0.121 10.295 16.888 Postneonatal mortality rate (10 years) 10.314 1.506 6519 6834 1.149 0.146 7.302 13.326 Infant mortality rate (10 years) 23.905 2.335 6519 6834 1.128 0.098 19.236 28.575 Child mortality rate (10 years) 6.678 1.277 6522 6837 1.111 0.191 4.124 9.232 Under-five mortality rate (10 years) 30.424 2.891 6527 6844 1.200 0.095 24.642 36.205 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 2379 2553 na 0.000 1.000 1.000 No education 0.008 0.002 2379 2553 1.064 0.244 0.004 0.012 Secondary education or higher 0.814 0.010 2379 2553 1.195 0.012 0.795 0.833 Knowing any contraceptive method 0.990 0.003 1358 1459 1.034 0.003 0.984 0.996 Knowing any modern contraceptive method 0.987 0.003 1358 1459 0.969 0.003 0.981 0.993 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 229 Table B.4 Sampling errors for rural sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 6197 5756 na na 0.000 0.000 Literate 0.938 0.004 6197 5756 1.278 0.004 0.930 0.946 No education 0.024 0.003 6197 5756 1.567 0.128 0.018 0.030 Secondary education or higher 0.644 0.009 6197 5756 1.550 0.015 0.625 0.663 Never married 0.266 0.007 6197 5756 1.218 0.026 0.252 0.279 Currently married (in union) 0.700 0.007 6197 5756 1.214 0.010 0.686 0.714 Married before age 20 0.412 0.009 5028 4653 1.297 0.022 0.394 0.430 Had first sexual intercourse before age 18 0.233 0.008 5028 4653 1.376 0.035 0.217 0.249 Currently pregnant 0.063 0.003 6197 5756 1.123 0.055 0.056 0.070 Children ever born 2.669 0.045 6197 5756 1.298 0.017 2.579 2.759 Children surviving 2.480 0.041 6197 5756 1.286 0.016 2.398 2.561 Children ever born to women age 40-49 5.021 0.100 1373 1300 1.249 0.020 4.822 5.220 Knowing any contraceptive method 0.986 0.002 4375 4028 1.091 0.002 0.982 0.990 Knowing any modern contraceptive method 0.983 0.002 4375 4028 1.136 0.002 0.979 0.988 Ever used any contraceptive method 0.688 0.010 4375 4028 1.392 0.014 0.669 0.708 Currently using any contraceptive method 0.474 0.009 4375 4028 1.234 0.020 0.456 0.493 Currently using a modern method 0.328 0.009 4375 4028 1.270 0.028 0.310 0.346 Currently using female sterilization 0.086 0.005 4375 4028 1.186 0.059 0.076 0.096 Currently using male sterilization 0.001 0.001 4375 4028 1.027 0.415 0.000 0.003 Currently using pill 0.138 0.006 4375 4028 1.145 0.043 0.126 0.150 Currently using IUD 0.047 0.004 4375 4028 1.215 0.083 0.039 0.055 Currently using injectables 0.037 0.003 4375 4028 1.181 0.091 0.031 0.044 Currently using condom 0.015 0.002 4375 4028 1.009 0.125 0.011 0.018 Currently using periodic abstinence 0.074 0.004 4375 4028 1.038 0.056 0.066 0.082 Currently using withdrawal 0.065 0.004 4375 4028 1.148 0.066 0.057 0.074 Obtained method from public sector source 0.758 0.014 1414 1319 1.197 0.018 0.731 0.785 Want no more children 0.625 0.008 4375 4028 1.115 0.013 0.608 0.641 Want to delay birth at least 2 years 0.185 0.006 4375 4028 1.057 0.034 0.172 0.197 Ideal number of children 3.209 0.027 6107 5671 1.363 0.008 3.155 3.264 Mothers received tetanus injection for last birth 0.697 0.012 2585 2355 1.318 0.017 0.673 0.721 Mothers received medical assistance at delivery 0.408 0.015 3854 3493 1.527 0.037 0.378 0.438 Had diarrhea in two weeks before survey 0.106 0.006 3696 3351 1.119 0.057 0.094 0.118 Treated with oral rehydration salts (ORS) 0.326 0.025 412 355 1.008 0.078 0.275 0.376 Taken to a health provider 0.286 0.024 412 355 0.970 0.082 0.239 0.333 Vaccination card seen 0.399 0.023 728 667 1.238 0.057 0.354 0.444 Received BCG vaccination 0.889 0.014 728 667 1.180 0.016 0.862 0.917 Received DPT vaccination (3 doses) 0.737 0.019 728 667 1.167 0.026 0.698 0.775 Received polio vaccination (3 doses) 0.760 0.019 728 667 1.173 0.025 0.722 0.797 Received measles vaccination 0.775 0.018 728 667 1.137 0.023 0.740 0.811 Received all vaccinations 0.651 0.020 728 667 1.095 0.030 0.612 0.690 Total fertility rate (3 years) 4.282 0.100 na 15967 1.219 0.023 4.082 4.483 Perinatal mortality (0-4 years) 27.157 2.966 3901 3536 1.103 0.109 21.225 33.088 Neonatal mortality rate (10 years) 20.715 1.950 7895 7185 1.101 0.094 16.816 24.615 Postneonatal mortality rate (10 years) 15.067 1.540 7902 7190 1.068 0.102 11.987 18.148 Infant mortality rate (10 years) 35.783 2.527 7903 7191 1.112 0.071 30.728 40.837 Child mortality rate (10 years) 16.993 1.663 7913 7200 1.036 0.098 13.666 20.320 Under-five mortality rate (10 years) 52.168 3.176 7922 7208 1.142 0.061 45.816 58.519 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 2387 2213 na na 0.000 0.000 No education 0.029 0.004 2387 2213 1.079 0.129 0.021 0.036 Secondary education or higher 0.526 0.014 2387 2213 1.383 0.027 0.497 0.554 Knowing any contraceptive method 0.973 0.005 1408 1287 1.116 0.005 0.963 0.982 Knowing any modern contraceptive method 0.969 0.005 1408 1287 1.102 0.005 0.959 0.979 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 230 | Appendix B Table B.5 Sampling errors for National Capital Region sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 2168 2387 na 0.000 1.000 1.000 Literate 0.985 0.003 2168 2387 1.160 0.003 0.979 0.991 No education 0.002 0.001 2168 2387 0.929 0.408 0.000 0.004 Secondary education or higher 0.883 0.010 2168 2387 1.449 0.011 0.863 0.903 Never married 0.378 0.018 2168 2387 1.713 0.047 0.343 0.414 Currently married (in union) 0.560 0.017 2168 2387 1.583 0.030 0.526 0.594 Married before age 20 0.251 0.014 1806 1989 1.416 0.058 0.222 0.280 Had first sexual intercourse before age 18 0.108 0.009 1806 1989 1.275 0.086 0.090 0.127 Currently pregnant 0.047 0.006 2168 2387 1.284 0.124 0.036 0.059 Children ever born 1.641 0.064 2168 2387 1.499 0.039 1.514 1.768 Children surviving 1.571 0.059 2168 2387 1.480 0.038 1.453 1.689 Children ever born to women age 40-49 3.197 0.152 428 481 1.382 0.047 2.894 3.501 Knowing any contraceptive method 0.994 0.003 1238 1337 1.266 0.003 0.989 1.000 Knowing any modern contraceptive method 0.993 0.003 1238 1337 1.233 0.003 0.987 0.999 Ever used any contraceptive method 0.682 0.013 1238 1337 1.012 0.020 0.656 0.709 Currently using any contraceptive method 0.489 0.016 1238 1337 1.145 0.033 0.456 0.521 Currently using a modern method 0.321 0.015 1238 1337 1.138 0.047 0.291 0.351 Currently using female sterilization 0.132 0.010 1238 1337 1.086 0.079 0.111 0.153 Currently using male sterilization 0.002 0.001 1238 1337 1.030 0.628 0.000 0.005 Currently using pill 0.104 0.009 1238 1337 1.063 0.089 0.085 0.122 Currently using IUD 0.033 0.006 1238 1337 1.136 0.174 0.022 0.045 Currently using injectables 0.023 0.005 1238 1337 1.115 0.208 0.013 0.032 Currently using condom 0.022 0.005 1238 1337 1.114 0.212 0.013 0.031 Currently using periodic abstinence 0.059 0.007 1238 1337 1.090 0.124 0.044 0.074 Currently using withdrawal 0.108 0.009 1238 1337 1.045 0.086 0.089 0.126 Obtained method from public sector source 0.598 0.025 395 441 1.029 0.043 0.547 0.648 Want no more children 0.606 0.015 1238 1337 1.054 0.024 0.576 0.635 Want to delay birth at least 2 years 0.149 0.011 1238 1337 1.118 0.076 0.126 0.171 Ideal number of children 2.632 0.028 2150 2362 1.149 0.011 2.577 2.688 Mothers received tetanus injection for last birth 0.742 0.017 673 724 1.003 0.023 0.707 0.776 Mothers received medical assistance at delivery 0.878 0.018 965 1050 1.401 0.021 0.842 0.915 Had diarrhea in two weeks before survey 0.096 0.013 939 1020 1.317 0.139 0.069 0.123 Treated with oral rehydration salts (ORS) 0.487 0.070 89 98 1.238 0.143 0.348 0.627 Taken to a health provider 0.344 0.054 89 98 1.042 0.158 0.235 0.453 Vaccination card seen 0.267 0.032 195 213 0.999 0.119 0.203 0.331 Received BCG vaccination 0.944 0.017 195 213 1.020 0.018 0.911 0.978 Received DPT vaccination (3 doses) 0.871 0.025 195 213 1.023 0.028 0.821 0.920 Received polio vaccination (3 doses) 0.885 0.022 195 213 0.950 0.025 0.841 0.929 Received measles vaccination 0.813 0.028 195 213 1.008 0.035 0.756 0.870 Received all vaccinations 0.778 0.031 195 213 1.048 0.040 0.715 0.841 Total fertility rate (3 years) 2.758 0.157 na 6851 1.302 0.057 2.445 3.072 Perinatal mortality (0-4 years) 19.251 3.932 972 1058 0.828 0.204 11.387 27.115 Neonatal mortality rate (10 years) 15.203 3.448 1851 2005 1.127 0.227 8.307 22.099 Postneonatal mortality rate (10 years) 8.744 2.785 1852 2007 1.286 0.319 3.173 14.315 Infant mortality rate (10 years) 23.948 5.083 1852 2007 1.380 0.212 13.781 34.115 Child mortality rate (10 years) 7.674 3.093 1854 2009 1.321 0.403 1.488 13.860 Under-five mortality rate (10 years) 31.438 7.044 1855 2011 1.578 0.224 17.350 45.526 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 676 740 na 0.000 1.000 1.000 No education 0.002 0.001 676 740 0.847 0.712 0.000 0.005 Secondary education or higher 0.862 0.019 676 740 1.396 0.022 0.824 0.899 Knowing any contraceptive method 1.000 0.000 380 417 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 380 417 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 231 Table B.6 Sampling errors for Cordillera Administrative Region sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.402 0.047 482 216 2.092 0.116 0.309 0.496 Literate 0.952 0.015 482 216 1.538 0.016 0.922 0.982 No education 0.022 0.009 482 216 1.417 0.434 0.003 0.040 Secondary education or higher 0.804 0.028 482 216 1.539 0.035 0.749 0.860 Never married 0.339 0.035 482 216 1.625 0.104 0.268 0.409 Currently married (in union) 0.623 0.033 482 216 1.479 0.052 0.558 0.689 Married before age 20 0.354 0.033 388 173 1.368 0.094 0.288 0.421 Had first sexual intercourse before age 18 0.168 0.026 388 173 1.363 0.154 0.117 0.220 Currently pregnant 0.075 0.016 482 216 1.355 0.217 0.042 0.108 Children ever born 2.198 0.179 482 216 1.619 0.082 1.840 2.557 Children surviving 2.076 0.152 482 216 1.505 0.073 1.772 2.381 Children ever born to women age 40-49 4.725 0.206 97 43 0.804 0.044 4.313 5.138 Knowing any contraceptive method 0.990 0.005 301 134 0.959 0.005 0.980 1.000 Knowing any modern contraceptive method 0.990 0.005 301 134 0.959 0.005 0.980 1.000 Ever used any contraceptive method 0.755 0.033 301 134 1.330 0.044 0.689 0.821 Currently using any contraceptive method 0.463 0.041 301 134 1.437 0.089 0.380 0.546 Currently using a modern method 0.318 0.032 301 134 1.176 0.099 0.255 0.381 Currently using female sterilization 0.108 0.023 301 134 1.268 0.210 0.063 0.154 Currently using male sterilization 0.000 0.000 301 134 na na 0.000 0.000 Currently using pill 0.109 0.019 301 134 1.036 0.171 0.072 0.146 Currently using IUD 0.007 0.005 301 134 0.996 0.696 0.000 0.016 Currently using injectables 0.073 0.015 301 134 1.026 0.212 0.042 0.103 Currently using condom 0.018 0.013 301 134 1.635 0.698 0.000 0.043 Currently using periodic abstinence 0.028 0.011 301 134 1.120 0.384 0.006 0.049 Currently using withdrawal 0.117 0.029 301 134 1.585 0.251 0.058 0.176 Obtained method from public sector source 0.694 0.041 102 46 0.886 0.059 0.613 0.775 Want no more children 0.539 0.029 301 134 1.025 0.055 0.480 0.598 Want to delay birth at least 2 years 0.275 0.024 301 134 0.930 0.087 0.227 0.323 Ideal number of children 3.417 0.149 475 213 1.733 0.044 3.119 3.715 Mothers received tetanus injection for last birth 0.639 0.043 178 79 1.195 0.068 0.552 0.725 Mothers received medical assistance at delivery 0.596 0.061 259 115 1.589 0.102 0.474 0.717 Had diarrhea in two weeks before survey 0.204 0.027 254 113 1.004 0.134 0.149 0.258 Treated with oral rehydration salts (ORS) 0.253 0.078 52 23 1.143 0.307 0.098 0.409 Taken to a health provider 0.331 0.090 52 23 1.174 0.273 0.150 0.512 Vaccination card seen 0.372 0.062 49 22 0.903 0.168 0.247 0.497 Received BCG vaccination 0.857 0.049 49 22 0.986 0.058 0.758 0.956 Received DPT vaccination (3 doses) 0.759 0.058 49 22 0.947 0.076 0.643 0.875 Received polio vaccination (3 doses) 0.759 0.058 49 22 0.947 0.076 0.643 0.875 Received measles vaccination 0.733 0.061 49 22 0.967 0.084 0.610 0.855 Received all vaccinations 0.674 0.066 49 22 0.985 0.098 0.542 0.806 Total fertility rate (3 years) 3.784 0.429 na 604 1.514 0.113 2.926 4.641 Perinatal mortality (0-4 years) 23.344 8.917 263 117 0.975 0.382 5.510 41.177 Neonatal mortality rate (10 years) 6.082 3.435 510 226 0.994 0.565 0.000 12.952 Postneonatal mortality rate (10 years) 7.625 4.362 511 227 1.133 0.572 0.000 16.349 Infant mortality rate (10 years) 13.707 5.653 511 227 1.103 0.412 2.401 25.013 Child mortality rate (10 years) 20.481 10.869 513 228 1.551 0.531 0.000 42.219 Under-five mortality rate (10 years) 33.906 14.440 514 228 1.635 0.426 5.026 62.787 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.366 0.039 154 72 1.011 0.108 0.287 0.444 No education 0.029 0.010 154 72 0.720 0.335 0.010 0.049 Secondary education or higher 0.736 0.043 154 72 1.211 0.059 0.650 0.822 Knowing any contraceptive method 0.990 0.010 94 44 0.984 0.010 0.970 1.000 Knowing any modern contraceptive method 0.990 0.010 94 44 0.984 0.010 0.970 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 232 | Appendix B Table B.7 Sampling errors for I - Ilocos sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.496 0.021 633 642 1.032 0.041 0.455 0.537 Literate 0.972 0.007 633 642 1.080 0.007 0.957 0.986 No education 0.008 0.003 633 642 0.977 0.433 0.001 0.015 Secondary education or higher 0.825 0.020 633 642 1.316 0.024 0.785 0.864 Never married 0.311 0.021 633 642 1.136 0.067 0.269 0.353 Currently married (in union) 0.654 0.022 633 642 1.182 0.034 0.609 0.699 Married before age 20 0.297 0.027 490 497 1.317 0.092 0.242 0.351 Had first sexual intercourse before age 18 0.147 0.020 490 497 1.245 0.135 0.107 0.187 Currently pregnant 0.054 0.006 633 642 0.708 0.118 0.041 0.067 Children ever born 2.103 0.123 633 642 1.338 0.058 1.858 2.349 Children surviving 2.014 0.117 633 642 1.343 0.058 1.781 2.248 Children ever born to women age 40-49 3.912 0.252 150 152 1.218 0.064 3.408 4.416 Knowing any contraceptive method 0.995 0.003 414 420 0.973 0.003 0.989 1.000 Knowing any modern contraceptive method 0.995 0.003 414 420 0.973 0.003 0.989 1.000 Ever used any contraceptive method 0.727 0.019 414 420 0.882 0.027 0.688 0.765 Currently using any contraceptive method 0.506 0.023 414 420 0.952 0.046 0.460 0.553 Currently using a modern method 0.350 0.025 414 420 1.079 0.072 0.299 0.400 Currently using female sterilization 0.120 0.014 414 420 0.894 0.119 0.092 0.149 Currently using male sterilization 0.000 0.000 414 420 na na 0.000 0.000 Currently using pill 0.133 0.015 414 420 0.904 0.114 0.103 0.163 Currently using IUD 0.012 0.008 414 420 1.467 0.654 0.000 0.028 Currently using injectables 0.067 0.015 414 420 1.183 0.217 0.038 0.096 Currently using condom 0.017 0.006 414 420 0.873 0.327 0.006 0.028 Currently using periodic abstinence 0.038 0.010 414 420 1.068 0.263 0.018 0.059 Currently using withdrawal 0.118 0.017 414 420 1.077 0.145 0.084 0.153 Obtained method from public sector source 0.801 0.034 146 148 1.012 0.042 0.733 0.868 Want no more children 0.570 0.024 414 420 0.989 0.042 0.522 0.618 Want to delay birth at least 2 years 0.235 0.020 414 420 0.968 0.086 0.194 0.275 Ideal number of children 3.079 0.060 631 640 1.083 0.019 2.959 3.199 Mothers received tetanus injection for last birth 0.752 0.035 217 220 1.180 0.046 0.682 0.821 Mothers received medical assistance at delivery 0.742 0.050 305 310 1.683 0.067 0.642 0.841 Had diarrhea in two weeks before survey 0.129 0.023 294 299 1.081 0.177 0.083 0.174 Treated with oral rehydration salts (ORS) 0.390 0.093 38 38 1.112 0.238 0.204 0.575 Taken to a health provider 0.474 0.081 38 38 0.966 0.170 0.313 0.636 Vaccination card seen 0.229 0.056 61 62 1.036 0.244 0.117 0.341 Received BCG vaccination 0.936 0.021 61 62 0.664 0.022 0.894 0.977 Received DPT vaccination (3 doses) 0.804 0.050 61 62 0.972 0.062 0.705 0.903 Received polio vaccination (3 doses) 0.804 0.050 61 62 0.972 0.062 0.705 0.903 Received measles vaccination 0.839 0.050 61 62 1.050 0.059 0.739 0.938 Received all vaccinations 0.724 0.055 61 62 0.956 0.076 0.614 0.833 Total fertility rate (3 years) 3.752 0.285 na 1783 1.170 0.076 3.182 4.322 Perinatal mortality (0-4 years) 35.682 10.404 309 314 0.998 0.292 14.874 56.491 Neonatal mortality rate (10 years) 18.773 5.408 592 601 0.986 0.288 7.957 29.589 Postneonatal mortality rate (10 years) 10.382 5.915 592 601 1.227 0.570 0.000 22.213 Infant mortality rate (10 years) 29.155 7.809 592 601 1.086 0.268 13.537 44.774 Child mortality rate (10 years) 10.616 3.715 593 602 0.884 0.350 3.186 18.045 Under-five mortality rate (10 years) 39.462 8.323 593 602 1.033 0.211 22.817 56.107 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.447 0.029 231 232 0.880 0.065 0.390 0.505 No education 0.005 0.004 231 232 1.001 0.978 0.000 0.013 Secondary education or higher 0.698 0.035 231 232 1.142 0.050 0.629 0.767 Knowing any contraceptive method 0.992 0.008 129 129 0.986 0.008 0.977 1.000 Knowing any modern contraceptive method 0.992 0.008 129 129 0.986 0.008 0.977 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 233 Table B.8 Sampling errors for II - Cagayan Valley sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.229 0.010 531 426 0.574 0.046 0.208 0.250 Literate 0.970 0.007 531 426 0.926 0.007 0.957 0.984 No education 0.013 0.006 531 426 1.253 0.481 0.000 0.025 Secondary education or higher 0.706 0.026 531 426 1.301 0.036 0.654 0.757 Never married 0.201 0.023 531 426 1.333 0.115 0.155 0.248 Currently married (in union) 0.763 0.022 531 426 1.213 0.029 0.719 0.808 Married before age 20 0.412 0.029 450 361 1.257 0.071 0.353 0.470 Had first sexual intercourse before age 18 0.191 0.019 450 361 1.000 0.097 0.154 0.228 Currently pregnant 0.060 0.011 531 426 1.064 0.183 0.038 0.082 Children ever born 2.299 0.110 531 426 1.161 0.048 2.080 2.518 Children surviving 2.171 0.096 531 426 1.108 0.044 1.979 2.364 Children ever born to women age 40-49 4.085 0.326 123 99 1.442 0.080 3.433 4.736 Knowing any contraceptive method 1.000 0.000 405 325 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 405 325 na 0.000 1.000 1.000 Ever used any contraceptive method 0.719 0.027 405 325 1.209 0.038 0.665 0.773 Currently using any contraceptive method 0.524 0.026 405 325 1.056 0.050 0.472 0.576 Currently using a modern method 0.480 0.029 405 325 1.152 0.060 0.423 0.537 Currently using female sterilization 0.072 0.014 405 325 1.088 0.194 0.044 0.100 Currently using male sterilization 0.000 0.000 405 325 na na 0.000 0.000 Currently using pill 0.267 0.027 405 325 1.241 0.102 0.213 0.322 Currently using IUD 0.071 0.019 405 325 1.449 0.260 0.034 0.108 Currently using injectables 0.062 0.014 405 325 1.177 0.228 0.034 0.090 Currently using condom 0.007 0.004 405 325 1.014 0.582 0.000 0.016 Currently using periodic abstinence 0.027 0.007 405 325 0.880 0.265 0.012 0.041 Currently using withdrawal 0.017 0.005 405 325 0.748 0.280 0.008 0.027 Obtained method from public sector source 0.774 0.040 196 159 1.336 0.052 0.694 0.854 Want no more children 0.597 0.027 405 325 1.101 0.045 0.543 0.651 Want to delay birth at least 2 years 0.248 0.023 405 325 1.070 0.093 0.202 0.293 Ideal number of children 2.999 0.060 529 425 1.145 0.020 2.879 3.120 Mothers received tetanus injection for last birth 0.782 0.017 211 169 0.614 0.022 0.747 0.817 Mothers received medical assistance at delivery 0.532 0.047 280 224 1.303 0.088 0.438 0.626 Had diarrhea in two weeks before survey 0.066 0.018 274 220 1.219 0.277 0.030 0.103 Treated with oral rehydration salts (ORS) 0.168 0.079 18 15 0.901 0.472 0.009 0.326 Taken to a health provider 0.222 0.076 18 15 0.777 0.343 0.070 0.373 Vaccination card seen 0.483 0.084 48 39 1.158 0.173 0.316 0.650 Received BCG vaccination 0.939 0.034 48 39 0.972 0.036 0.871 1.006 Received DPT vaccination (3 doses) 0.852 0.054 48 39 1.057 0.064 0.744 0.960 Received polio vaccination (3 doses) 0.852 0.054 48 39 1.057 0.064 0.744 0.960 Received measles vaccination 0.831 0.070 48 39 1.300 0.084 0.691 0.972 Received all vaccinations 0.767 0.075 48 39 1.226 0.098 0.617 0.916 Total fertility rate (3 years) 3.399 0.226 na 1210 1.028 0.067 2.947 3.852 Perinatal mortality (0-4 years) 14.024 7.231 284 228 1.038 0.516 0.000 28.486 Neonatal mortality rate (10 years) 17.190 9.676 575 461 1.120 0.563 0.000 36.541 Postneonatal mortality rate (10 years) 10.361 5.086 575 461 1.225 0.491 0.189 20.533 Infant mortality rate (10 years) 27.551 13.027 575 461 1.229 0.473 1.497 53.604 Child mortality rate (10 years) 7.991 4.237 575 461 1.177 0.530 0.000 16.465 Under-five mortality rate (10 years) 35.322 15.945 575 461 1.417 0.451 3.431 67.213 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.161 0.012 202 163 0.464 0.075 0.137 0.185 No education 0.010 0.007 202 163 1.007 0.712 0.000 0.024 Secondary education or higher 0.620 0.038 202 163 1.118 0.062 0.544 0.697 Knowing any contraceptive method 1.000 0.000 133 107 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 133 107 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 234 | Appendix B Table B.9 Sampling errors for III - Central Luzon sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.697 0.013 1079 1459 0.964 0.019 0.670 0.724 Literate 0.980 0.005 1079 1459 1.105 0.005 0.971 0.989 No education 0.003 0.002 1079 1459 0.984 0.570 0.000 0.006 Secondary education or higher 0.778 0.013 1079 1459 1.026 0.017 0.752 0.804 Never married 0.310 0.018 1079 1459 1.267 0.058 0.274 0.345 Currently married (in union) 0.658 0.018 1079 1459 1.244 0.027 0.622 0.694 Married before age 20 0.344 0.017 865 1170 1.052 0.049 0.310 0.378 Had first sexual intercourse before age 18 0.167 0.017 865 1170 1.331 0.101 0.133 0.200 Currently pregnant 0.055 0.007 1079 1459 0.945 0.119 0.042 0.068 Children ever born 2.046 0.054 1079 1459 0.808 0.026 1.938 2.153 Children surviving 1.934 0.056 1079 1459 0.911 0.029 1.821 2.046 Children ever born to women age 40-49 4.066 0.181 213 290 1.118 0.045 3.703 4.428 Knowing any contraceptive method 0.996 0.002 710 960 0.813 0.002 0.992 1.000 Knowing any modern contraceptive method 0.995 0.002 710 960 0.860 0.002 0.990 0.999 Ever used any contraceptive method 0.732 0.017 710 960 0.994 0.023 0.699 0.765 Currently using any contraceptive method 0.545 0.017 710 960 0.892 0.031 0.511 0.578 Currently using a modern method 0.402 0.018 710 960 0.956 0.044 0.367 0.437 Currently using female sterilization 0.183 0.014 710 960 0.935 0.074 0.156 0.210 Currently using male sterilization 0.000 0.000 710 960 na na 0.000 0.000 Currently using pill 0.154 0.016 710 960 1.157 0.102 0.123 0.185 Currently using IUD 0.007 0.003 710 960 0.992 0.443 0.001 0.013 Currently using injectables 0.034 0.005 710 960 0.686 0.138 0.024 0.043 Currently using condom 0.019 0.005 710 960 0.914 0.249 0.009 0.028 Currently using periodic abstinence 0.035 0.008 710 960 1.101 0.216 0.020 0.051 Currently using withdrawal 0.105 0.009 710 960 0.767 0.084 0.087 0.122 Obtained method from public sector source 0.704 0.030 288 388 1.128 0.043 0.644 0.765 Want no more children 0.638 0.017 710 960 0.946 0.027 0.604 0.672 Want to delay birth at least 2 years 0.184 0.015 710 960 1.019 0.081 0.154 0.214 Ideal number of children 2.830 0.044 1076 1455 1.090 0.016 2.742 2.918 Mothers received tetanus injection for last birth 0.668 0.030 359 480 1.188 0.044 0.608 0.727 Mothers received medical assistance at delivery 0.858 0.014 512 683 0.770 0.016 0.830 0.886 Had diarrhea in two weeks before survey 0.095 0.012 496 662 0.804 0.123 0.071 0.118 Treated with oral rehydration salts (ORS) 0.486 0.054 46 63 0.680 0.111 0.378 0.595 Taken to a health provider 0.391 0.072 46 63 0.900 0.184 0.247 0.535 Vaccination card seen 0.437 0.051 105 139 1.015 0.116 0.336 0.538 Received BCG vaccination 0.929 0.030 105 139 1.197 0.033 0.868 0.990 Received DPT vaccination (3 doses) 0.808 0.040 105 139 1.040 0.050 0.727 0.889 Received polio vaccination (3 doses) 0.814 0.049 105 139 1.215 0.060 0.717 0.912 Received measles vaccination 0.833 0.039 105 139 1.044 0.046 0.756 0.910 Received all vaccinations 0.750 0.048 105 139 1.093 0.064 0.654 0.846 Total fertility rate (3 years) 3.121 0.186 na 4049 1.101 0.060 2.749 3.492 Perinatal mortality (0-4 years) 19.884 8.217 516 689 1.338 0.413 3.450 36.319 Neonatal mortality rate (10 years) 15.337 4.392 1041 1395 0.981 0.286 6.554 24.120 Postneonatal mortality rate (10 years) 9.752 4.160 1042 1396 1.237 0.427 1.431 18.072 Infant mortality rate (10 years) 25.088 5.919 1042 1396 1.075 0.236 13.251 36.926 Child mortality rate (10 years) 5.878 2.252 1044 1399 0.939 0.383 1.373 10.382 Under-five mortality rate (10 years) 30.819 6.264 1045 1400 1.060 0.203 18.290 43.347 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.686 0.020 385 520 0.865 0.030 0.645 0.727 No education 0.008 0.005 385 520 1.019 0.575 0.000 0.017 Secondary education or higher 0.715 0.023 385 520 0.994 0.032 0.669 0.761 Knowing any contraceptive method 0.996 0.004 233 315 1.014 0.004 0.987 1.000 Knowing any modern contraceptive method 0.992 0.006 233 315 1.010 0.006 0.979 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 235 Table B.10 Sampling errors for IVA - CALABARZON sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.734 0.016 1425 1890 1.341 0.021 0.703 0.766 Literate 0.979 0.004 1425 1890 1.136 0.004 0.971 0.988 No education 0.002 0.001 1425 1890 1.006 0.573 0.000 0.005 Secondary education or higher 0.823 0.012 1425 1890 1.159 0.014 0.799 0.846 Never married 0.346 0.016 1425 1890 1.243 0.045 0.315 0.378 Currently married (in union) 0.602 0.016 1425 1890 1.205 0.026 0.571 0.634 Married before age 20 0.304 0.015 1155 1527 1.127 0.050 0.273 0.334 Had first sexual intercourse before age 18 0.156 0.014 1155 1527 1.305 0.089 0.128 0.184 Currently pregnant 0.049 0.006 1425 1890 1.114 0.130 0.036 0.061 Children ever born 1.850 0.063 1425 1890 1.112 0.034 1.724 1.977 Children surviving 1.770 0.061 1425 1890 1.119 0.034 1.649 1.892 Children ever born to women age 40-49 3.821 0.139 317 424 1.013 0.036 3.544 4.099 Knowing any contraceptive method 0.998 0.002 856 1139 1.006 0.002 0.994 1.000 Knowing any modern contraceptive method 0.995 0.002 856 1139 0.733 0.002 0.992 0.999 Ever used any contraceptive method 0.682 0.018 856 1139 1.139 0.027 0.646 0.718 Currently using any contraceptive method 0.484 0.017 856 1139 1.004 0.035 0.450 0.519 Currently using a modern method 0.328 0.020 856 1139 1.226 0.060 0.289 0.368 Currently using female sterilization 0.114 0.011 856 1139 1.038 0.099 0.092 0.137 Currently using male sterilization 0.000 0.000 856 1139 na na 0.000 0.000 Currently using pill 0.113 0.011 856 1139 1.030 0.099 0.091 0.135 Currently using IUD 0.038 0.009 856 1139 1.312 0.225 0.021 0.056 Currently using injectables 0.032 0.007 856 1139 1.135 0.215 0.018 0.045 Currently using condom 0.021 0.006 856 1139 1.213 0.280 0.009 0.033 Currently using periodic abstinence 0.048 0.007 856 1139 0.952 0.146 0.034 0.062 Currently using withdrawal 0.107 0.012 856 1139 1.093 0.108 0.084 0.130 Obtained method from public sector source 0.634 0.031 280 368 1.058 0.048 0.573 0.695 Want no more children 0.581 0.019 856 1139 1.135 0.033 0.543 0.620 Want to delay birth at least 2 years 0.196 0.017 856 1139 1.225 0.085 0.163 0.229 Ideal number of children 2.843 0.033 1407 1865 1.112 0.012 2.777 2.910 Mothers received tetanus injection for last birth 0.712 0.021 446 595 0.988 0.030 0.670 0.755 Mothers received medical assistance at delivery 0.747 0.028 608 816 1.304 0.038 0.691 0.804 Had diarrhea in two weeks before survey 0.108 0.015 593 796 1.070 0.135 0.079 0.137 Treated with oral rehydration salts (ORS) 0.519 0.079 64 86 1.168 0.153 0.360 0.677 Taken to a health provider 0.315 0.060 64 86 0.988 0.190 0.196 0.435 Vaccination card seen 0.378 0.055 123 165 1.274 0.147 0.267 0.488 Received BCG vaccination 0.918 0.022 123 165 0.887 0.024 0.874 0.962 Received DPT vaccination (3 doses) 0.800 0.032 123 165 0.885 0.040 0.736 0.863 Received polio vaccination (3 doses) 0.781 0.039 123 165 1.053 0.050 0.702 0.859 Received measles vaccination 0.773 0.038 123 165 1.003 0.049 0.697 0.848 Received all vaccinations 0.656 0.041 123 165 0.958 0.062 0.574 0.737 Total fertility rate (3 years) 3.155 0.159 na 5289 1.029 0.050 2.836 3.473 Perinatal mortality (0-4 years) 25.194 7.226 616 827 1.030 0.287 10.743 39.645 Neonatal mortality rate (10 years) 16.555 4.274 1221 1620 1.077 0.258 8.006 25.104 Postneonatal mortality rate (10 years) 8.688 2.532 1220 1619 0.957 0.291 3.625 13.752 Infant mortality rate (10 years) 25.244 5.355 1221 1620 1.142 0.212 14.534 35.953 Child mortality rate (10 years) 6.410 2.212 1222 1622 0.996 0.345 1.986 10.834 Under-five mortality rate (10 years) 31.492 5.934 1223 1623 1.163 0.188 19.624 43.360 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.728 0.023 483 652 1.128 0.031 0.683 0.774 No education 0.005 0.003 483 652 1.095 0.721 0.000 0.012 Secondary education or higher 0.793 0.024 483 652 1.317 0.031 0.744 0.841 Knowing any contraceptive method 0.996 0.004 256 345 0.984 0.004 0.988 1.000 Knowing any modern contraceptive method 0.993 0.005 256 345 0.952 0.005 0.983 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 236 | Appendix B Table B.11 Sampling errors for IVB - MIMAROPA sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.326 0.030 481 340 1.425 0.093 0.265 0.387 Literate 0.928 0.025 481 340 2.134 0.027 0.878 0.979 No education 0.033 0.017 481 340 2.060 0.509 0.000 0.067 Secondary education or higher 0.635 0.045 481 340 2.069 0.072 0.544 0.726 Never married 0.206 0.024 481 340 1.296 0.116 0.158 0.254 Currently married (in union) 0.756 0.027 481 340 1.399 0.036 0.701 0.811 Married before age 20 0.426 0.040 394 278 1.597 0.094 0.346 0.505 Had first sexual intercourse before age 18 0.220 0.033 394 278 1.572 0.149 0.154 0.286 Currently pregnant 0.098 0.013 481 340 0.926 0.128 0.073 0.123 Children ever born 2.911 0.159 481 340 1.297 0.055 2.593 3.228 Children surviving 2.654 0.126 481 340 1.143 0.047 2.403 2.906 Children ever born to women age 40-49 5.051 0.245 108 77 0.949 0.049 4.560 5.542 Knowing any contraceptive method 0.997 0.003 361 257 1.066 0.003 0.991 1.000 Knowing any modern contraceptive method 0.994 0.004 361 257 1.006 0.004 0.986 1.000 Ever used any contraceptive method 0.632 0.054 361 257 2.124 0.085 0.524 0.740 Currently using any contraceptive method 0.425 0.045 361 257 1.726 0.106 0.335 0.515 Currently using a modern method 0.310 0.037 361 257 1.529 0.120 0.236 0.385 Currently using female sterilization 0.087 0.020 361 257 1.344 0.230 0.047 0.126 Currently using male sterilization 0.003 0.003 361 257 1.002 1.017 0.000 0.008 Currently using pill 0.137 0.018 361 257 0.987 0.131 0.101 0.172 Currently using IUD 0.030 0.011 361 257 1.270 0.378 0.007 0.053 Currently using injectables 0.040 0.015 361 257 1.492 0.383 0.009 0.071 Currently using condom 0.008 0.005 361 257 0.999 0.578 0.000 0.018 Currently using periodic abstinence 0.053 0.010 361 257 0.838 0.188 0.033 0.072 Currently using withdrawal 0.060 0.014 361 257 1.133 0.237 0.031 0.088 Obtained method from public sector source 0.775 0.041 111 79 1.025 0.053 0.694 0.857 Want no more children 0.645 0.024 361 257 0.970 0.038 0.596 0.694 Want to delay birth at least 2 years 0.202 0.021 361 257 0.995 0.104 0.160 0.244 Ideal number of children 3.239 0.082 478 338 1.189 0.025 3.074 3.403 Mothers received tetanus injection for last birth 0.676 0.051 219 155 1.620 0.076 0.574 0.779 Mothers received medical assistance at delivery 0.293 0.046 339 241 1.516 0.157 0.201 0.385 Had diarrhea in two weeks before survey 0.177 0.021 318 225 0.948 0.119 0.135 0.218 Treated with oral rehydration salts (ORS) 0.242 0.060 56 40 1.017 0.248 0.122 0.362 Taken to a health provider 0.223 0.058 56 40 1.015 0.260 0.107 0.339 Vaccination card seen 0.368 0.064 53 38 0.994 0.174 0.240 0.496 Received BCG vaccination 0.940 0.031 53 38 0.942 0.033 0.878 1.001 Received DPT vaccination (3 doses) 0.809 0.050 53 38 0.933 0.062 0.708 0.909 Received polio vaccination (3 doses) 0.811 0.046 53 38 0.853 0.056 0.719 0.902 Received measles vaccination 0.812 0.040 53 38 0.752 0.050 0.731 0.892 Received all vaccinations 0.700 0.057 53 38 0.904 0.081 0.586 0.814 Total fertility rate (3 years) 4.978 0.389 na 961 1.263 0.078 4.199 5.756 Perinatal mortality (0-4 years) 20.508 6.126 342 243 0.811 0.299 8.256 32.760 Neonatal mortality rate (10 years) 17.688 4.823 677 481 0.902 0.273 8.043 27.333 Postneonatal mortality rate (10 years) 25.865 6.410 677 481 0.937 0.248 13.046 38.685 Infant mortality rate (10 years) 43.553 9.694 677 481 1.080 0.223 24.166 62.940 Child mortality rate (10 years) 25.232 10.384 680 483 1.498 0.412 4.464 46.000 Under-five mortality rate (10 years) 67.686 15.960 680 483 1.226 0.236 35.766 99.607 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.388 0.035 168 119 0.940 0.091 0.317 0.458 No education 0.043 0.019 168 119 1.227 0.446 0.005 0.082 Secondary education or higher 0.559 0.059 168 119 1.527 0.105 0.441 0.676 Knowing any contraceptive method 0.991 0.009 109 77 0.974 0.009 0.973 1.000 Knowing any modern contraceptive method 0.982 0.012 109 77 0.965 0.013 0.957 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 237 Table B.12 Sampling errors for V - Bicol sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.322 0.020 724 713 1.130 0.061 0.283 0.361 Literate 0.965 0.006 724 713 0.857 0.006 0.954 0.977 No education 0.003 0.002 724 713 0.992 0.735 0.000 0.006 Secondary education or higher 0.721 0.028 724 713 1.654 0.038 0.666 0.777 Never married 0.320 0.018 724 713 1.024 0.056 0.284 0.355 Currently married (in union) 0.640 0.014 724 713 0.770 0.021 0.613 0.668 Married before age 20 0.379 0.026 560 549 1.249 0.068 0.328 0.431 Had first sexual intercourse before age 18 0.197 0.015 560 549 0.863 0.074 0.168 0.226 Currently pregnant 0.055 0.008 724 713 0.888 0.137 0.040 0.070 Children ever born 2.759 0.154 724 713 1.406 0.056 2.450 3.067 Children surviving 2.591 0.140 724 713 1.379 0.054 2.311 2.872 Children ever born to women age 40-49 5.459 0.270 164 161 1.114 0.050 4.918 6.000 Knowing any contraceptive method 0.990 0.004 468 457 0.960 0.004 0.982 0.999 Knowing any modern contraceptive method 0.990 0.004 468 457 0.960 0.004 0.982 0.999 Ever used any contraceptive method 0.775 0.022 468 457 1.140 0.028 0.731 0.819 Currently using any contraceptive method 0.474 0.028 468 457 1.229 0.060 0.418 0.531 Currently using a modern method 0.236 0.021 468 457 1.090 0.091 0.193 0.279 Currently using female sterilization 0.055 0.009 468 457 0.870 0.167 0.037 0.073 Currently using male sterilization 0.000 0.000 468 457 na na 0.000 0.000 Currently using pill 0.131 0.012 468 457 0.790 0.094 0.107 0.156 Currently using IUD 0.021 0.009 468 457 1.435 0.459 0.002 0.039 Currently using injectables 0.020 0.005 468 457 0.806 0.260 0.010 0.031 Currently using condom 0.009 0.005 468 457 1.026 0.496 0.000 0.018 Currently using periodic abstinence 0.078 0.013 468 457 1.075 0.171 0.052 0.105 Currently using withdrawal 0.151 0.018 468 457 1.096 0.120 0.114 0.187 Obtained method from public sector source 0.695 0.031 115 112 0.708 0.044 0.634 0.756 Want no more children 0.648 0.028 468 457 1.259 0.043 0.592 0.704 Want to delay birth at least 2 years 0.162 0.018 468 457 1.081 0.114 0.125 0.199 Ideal number of children 3.057 0.053 720 709 1.155 0.017 2.951 3.163 Mothers received tetanus injection for last birth 0.648 0.030 298 290 1.087 0.047 0.588 0.709 Mothers received medical assistance at delivery 0.478 0.044 446 432 1.548 0.092 0.390 0.566 Had diarrhea in two weeks before survey 0.114 0.023 437 424 1.364 0.198 0.069 0.160 Treated with oral rehydration salts (ORS) 0.328 0.060 51 49 0.798 0.183 0.208 0.447 Taken to a health provider 0.259 0.050 51 49 0.696 0.192 0.159 0.358 Vaccination card seen 0.368 0.041 87 87 0.781 0.111 0.286 0.450 Received BCG vaccination 0.944 0.025 87 87 1.018 0.026 0.894 0.994 Received DPT vaccination (3 doses) 0.753 0.051 87 87 1.101 0.067 0.651 0.854 Received polio vaccination (3 doses) 0.814 0.045 87 87 1.092 0.056 0.723 0.905 Received measles vaccination 0.819 0.036 87 87 0.872 0.044 0.747 0.890 Received all vaccinations 0.647 0.046 87 87 0.907 0.072 0.554 0.740 Total fertility rate (3 years) 4.348 0.273 na 1941 0.964 0.063 3.803 4.893 Perinatal mortality (0-4 years) 25.915 7.062 453 439 0.950 0.272 11.792 40.038 Neonatal mortality rate (10 years) 19.001 5.858 946 915 1.203 0.308 7.285 30.717 Postneonatal mortality rate (10 years) 9.242 3.141 947 916 1.014 0.340 2.960 15.524 Infant mortality rate (10 years) 28.243 6.967 947 916 1.236 0.247 14.309 42.177 Child mortality rate (10 years) 14.958 3.940 947 916 0.969 0.263 7.078 22.837 Under-five mortality rate (10 years) 42.778 8.028 948 917 1.166 0.188 26.721 58.835 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.218 0.024 238 236 0.911 0.112 0.169 0.267 No education 0.009 0.006 238 236 0.908 0.619 0.000 0.020 Secondary education or higher 0.642 0.042 238 236 1.344 0.065 0.559 0.726 Knowing any contraceptive method 1.000 0.000 142 139 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 142 139 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 238 | Appendix B Table B.13 Sampling errors for VI - Western Visayas sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.346 0.021 784 910 1.248 0.061 0.303 0.388 Literate 0.946 0.010 784 910 1.293 0.011 0.925 0.967 No education 0.018 0.007 784 910 1.384 0.367 0.005 0.031 Secondary education or higher 0.712 0.022 784 910 1.336 0.030 0.669 0.755 Never married 0.326 0.017 784 910 0.993 0.051 0.292 0.359 Currently married (in union) 0.635 0.018 784 910 1.026 0.028 0.600 0.670 Married before age 20 0.349 0.025 619 719 1.318 0.072 0.298 0.399 Had first sexual intercourse before age 18 0.207 0.021 619 719 1.317 0.104 0.164 0.250 Currently pregnant 0.054 0.009 784 910 1.056 0.158 0.037 0.071 Children ever born 2.519 0.141 784 910 1.398 0.056 2.237 2.801 Children surviving 2.345 0.128 784 910 1.389 0.055 2.089 2.600 Children ever born to women age 40-49 4.930 0.276 192 223 1.211 0.056 4.378 5.482 Knowing any contraceptive method 0.998 0.002 497 578 0.994 0.002 0.994 1.000 Knowing any modern contraceptive method 0.996 0.003 497 578 0.977 0.003 0.990 1.000 Ever used any contraceptive method 0.727 0.024 497 578 1.208 0.033 0.679 0.775 Currently using any contraceptive method 0.461 0.029 497 578 1.280 0.062 0.404 0.519 Currently using a modern method 0.301 0.026 497 578 1.265 0.087 0.249 0.353 Currently using female sterilization 0.068 0.012 497 578 1.068 0.177 0.044 0.093 Currently using male sterilization 0.004 0.003 497 578 0.995 0.708 0.000 0.010 Currently using pill 0.146 0.020 497 578 1.238 0.135 0.107 0.185 Currently using IUD 0.036 0.010 497 578 1.221 0.284 0.015 0.056 Currently using injectables 0.026 0.007 497 578 0.957 0.261 0.013 0.040 Currently using condom 0.016 0.005 497 578 0.968 0.338 0.005 0.027 Currently using periodic abstinence 0.102 0.014 497 578 1.043 0.139 0.074 0.131 Currently using withdrawal 0.052 0.011 497 578 1.129 0.216 0.030 0.075 Obtained method from public sector source 0.730 0.048 151 175 1.316 0.065 0.634 0.825 Want no more children 0.699 0.023 497 578 1.111 0.033 0.653 0.744 Want to delay birth at least 2 years 0.161 0.015 497 578 0.905 0.093 0.131 0.191 Ideal number of children 2.949 0.059 770 894 1.240 0.020 2.831 3.067 Mothers received tetanus injection for last birth 0.680 0.035 279 324 1.242 0.051 0.610 0.749 Mothers received medical assistance at delivery 0.474 0.050 415 482 1.665 0.107 0.373 0.575 Had diarrhea in two weeks before survey 0.150 0.021 394 458 1.149 0.143 0.107 0.192 Treated with oral rehydration salts (ORS) 0.386 0.049 59 68 0.746 0.126 0.289 0.484 Taken to a health provider 0.234 0.055 59 68 0.948 0.234 0.125 0.344 Vaccination card seen 0.504 0.078 81 94 1.382 0.154 0.349 0.659 Received BCG vaccination 0.913 0.045 81 94 1.450 0.050 0.823 1.004 Received DPT vaccination (3 doses) 0.877 0.048 81 94 1.320 0.055 0.780 0.973 Received polio vaccination (3 doses) 0.901 0.046 81 94 1.397 0.051 0.808 0.994 Received measles vaccination 0.839 0.048 81 94 1.174 0.057 0.743 0.935 Received all vaccinations 0.814 0.049 81 94 1.123 0.060 0.717 0.912 Total fertility rate (3 years) 3.992 0.315 na 2531 1.371 0.079 3.362 4.622 Perinatal mortality (0-4 years) 42.831 10.761 424 493 1.052 0.251 21.309 64.354 Neonatal mortality rate (10 years) 21.628 6.891 872 1014 1.243 0.319 7.847 35.410 Postneonatal mortality rate (10 years) 17.801 4.849 872 1014 0.986 0.272 8.103 27.499 Infant mortality rate (10 years) 39.429 7.290 872 1014 1.005 0.185 24.848 54.010 Child mortality rate (10 years) 11.404 3.976 873 1015 0.948 0.349 3.453 19.355 Under-five mortality rate (10 years) 50.384 8.298 873 1015 0.986 0.165 33.789 66.979 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.276 0.030 276 322 1.111 0.109 0.216 0.336 No education 0.033 0.014 276 322 1.272 0.417 0.005 0.060 Secondary education or higher 0.621 0.038 276 322 1.295 0.061 0.545 0.697 Knowing any contraceptive method 0.994 0.006 156 182 0.966 0.006 0.982 1.000 Knowing any modern contraceptive method 0.994 0.006 156 182 0.966 0.006 0.982 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 239 Table B.14 Sampling errors for VII - Central Visayas sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.581 0.023 927 1070 1.421 0.040 0.535 0.627 Literate 0.966 0.006 927 1070 0.936 0.006 0.954 0.977 No education 0.013 0.004 927 1070 0.950 0.271 0.006 0.020 Secondary education or higher 0.689 0.022 927 1070 1.441 0.032 0.645 0.733 Never married 0.344 0.014 927 1070 0.873 0.040 0.317 0.371 Currently married (in union) 0.627 0.015 927 1070 0.920 0.023 0.598 0.656 Married before age 20 0.323 0.022 749 864 1.258 0.067 0.280 0.366 Had first sexual intercourse before age 18 0.140 0.012 749 864 0.982 0.089 0.115 0.165 Currently pregnant 0.045 0.007 927 1070 1.090 0.164 0.031 0.060 Children ever born 2.193 0.095 927 1070 1.167 0.043 2.004 2.382 Children surviving 2.069 0.085 927 1070 1.128 0.041 1.898 2.239 Children ever born to women age 40-49 4.437 0.300 202 233 1.480 0.068 3.836 5.038 Knowing any contraceptive method 0.988 0.006 581 671 1.368 0.006 0.976 1.000 Knowing any modern contraceptive method 0.988 0.006 581 671 1.368 0.006 0.976 1.000 Ever used any contraceptive method 0.753 0.019 581 671 1.046 0.025 0.716 0.791 Currently using any contraceptive method 0.521 0.017 581 671 0.807 0.032 0.488 0.555 Currently using a modern method 0.356 0.023 581 671 1.142 0.064 0.311 0.402 Currently using female sterilization 0.112 0.014 581 671 1.094 0.128 0.083 0.141 Currently using male sterilization 0.003 0.002 581 671 0.975 0.692 0.000 0.008 Currently using pill 0.115 0.018 581 671 1.320 0.152 0.080 0.150 Currently using IUD 0.062 0.010 581 671 1.046 0.170 0.041 0.082 Currently using injectables 0.021 0.004 581 671 0.758 0.216 0.012 0.030 Currently using condom 0.037 0.008 581 671 0.981 0.209 0.021 0.052 Currently using periodic abstinence 0.096 0.014 581 671 1.176 0.150 0.067 0.125 Currently using withdrawal 0.067 0.010 581 671 1.012 0.157 0.046 0.088 Obtained method from public sector source 0.605 0.036 208 240 1.062 0.060 0.533 0.677 Want no more children 0.656 0.024 581 671 1.200 0.036 0.608 0.703 Want to delay birth at least 2 years 0.134 0.018 581 671 1.271 0.134 0.098 0.170 Ideal number of children 2.923 0.060 909 1049 1.224 0.020 2.804 3.043 Mothers received tetanus injection for last birth 0.766 0.027 311 359 1.112 0.035 0.712 0.819 Mothers received medical assistance at delivery 0.683 0.044 464 535 1.624 0.064 0.595 0.770 Had diarrhea in two weeks before survey 0.085 0.015 450 519 0.998 0.171 0.056 0.114 Treated with oral rehydration salts (ORS) 0.524 0.103 38 44 1.194 0.197 0.317 0.731 Taken to a health provider 0.366 0.086 38 44 0.975 0.234 0.195 0.538 Vaccination card seen 0.490 0.057 88 101 1.072 0.117 0.375 0.604 Received BCG vaccination 0.909 0.031 88 101 1.016 0.034 0.847 0.972 Received DPT vaccination (3 doses) 0.717 0.035 88 101 0.724 0.049 0.647 0.787 Received polio vaccination (3 doses) 0.739 0.050 88 101 1.073 0.068 0.638 0.839 Received measles vaccination 0.841 0.037 88 101 0.954 0.044 0.766 0.915 Received all vaccinations 0.660 0.046 88 101 0.903 0.069 0.568 0.751 Total fertility rate (3 years) 3.574 0.250 na 2981 1.228 0.070 3.074 4.074 Perinatal mortality (0-4 years) 12.536 5.909 466 537 0.998 0.471 0.718 24.354 Neonatal mortality rate (10 years) 17.710 4.007 947 1092 0.859 0.226 9.696 25.724 Postneonatal mortality rate (10 years) 10.088 2.706 949 1095 0.857 0.268 4.676 15.500 Infant mortality rate (10 years) 27.798 4.824 949 1095 0.872 0.174 18.150 37.446 Child mortality rate (10 years) 11.414 4.537 948 1094 0.952 0.397 2.340 20.488 Under-five mortality rate (10 years) 38.895 7.413 950 1096 1.044 0.191 24.069 53.721 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.560 0.027 320 373 0.962 0.048 0.506 0.613 No education 0.022 0.009 320 373 1.136 0.427 0.003 0.040 Secondary education or higher 0.659 0.030 320 373 1.148 0.046 0.598 0.720 Knowing any contraceptive method 0.977 0.014 176 204 1.230 0.014 0.949 1.000 Knowing any modern contraceptive method 0.977 0.014 176 204 1.230 0.014 0.949 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 240 | Appendix B Table B.15 Sampling errors for VIII - Eastern Visayas sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.218 0.020 647 555 1.223 0.091 0.178 0.258 Literate 0.977 0.008 647 555 1.413 0.009 0.960 0.993 No education 0.006 0.003 647 555 1.028 0.508 0.000 0.013 Secondary education or higher 0.622 0.028 647 555 1.479 0.045 0.566 0.679 Never married 0.313 0.019 647 555 1.017 0.059 0.276 0.351 Currently married (in union) 0.640 0.020 647 555 1.048 0.031 0.601 0.680 Married before age 20 0.404 0.023 520 446 1.088 0.058 0.357 0.450 Had first sexual intercourse before age 18 0.242 0.026 520 446 1.403 0.109 0.189 0.294 Currently pregnant 0.068 0.012 647 555 1.163 0.169 0.045 0.091 Children ever born 2.681 0.110 647 555 0.977 0.041 2.461 2.900 Children surviving 2.463 0.098 647 555 0.965 0.040 2.268 2.658 Children ever born to women age 40-49 5.447 0.290 120 103 1.090 0.053 4.866 6.028 Knowing any contraceptive method 0.998 0.002 414 355 0.985 0.002 0.993 1.000 Knowing any modern contraceptive method 0.995 0.003 414 355 0.990 0.003 0.989 1.000 Ever used any contraceptive method 0.647 0.036 414 355 1.527 0.055 0.575 0.719 Currently using any contraceptive method 0.444 0.036 414 355 1.490 0.082 0.371 0.517 Currently using a modern method 0.268 0.034 414 355 1.554 0.126 0.200 0.336 Currently using female sterilization 0.099 0.024 414 355 1.633 0.242 0.051 0.147 Currently using male sterilization 0.000 0.000 414 355 na na 0.000 0.000 Currently using pill 0.097 0.012 414 355 0.846 0.127 0.072 0.121 Currently using IUD 0.029 0.006 414 355 0.700 0.200 0.017 0.040 Currently using injectables 0.029 0.013 414 355 1.550 0.442 0.003 0.055 Currently using condom 0.012 0.004 414 355 0.766 0.342 0.004 0.020 Currently using periodic abstinence 0.082 0.016 414 355 1.162 0.191 0.051 0.113 Currently using withdrawal 0.080 0.019 414 355 1.387 0.231 0.043 0.117 Obtained method from public sector source 0.791 0.035 110 94 0.911 0.045 0.720 0.862 Want no more children 0.611 0.019 414 355 0.774 0.030 0.574 0.648 Want to delay birth at least 2 years 0.200 0.018 414 355 0.915 0.090 0.164 0.237 Ideal number of children 3.233 0.074 639 548 1.201 0.023 3.084 3.382 Mothers received tetanus injection for last birth 0.653 0.034 268 230 1.153 0.051 0.586 0.720 Mothers received medical assistance at delivery 0.360 0.062 417 357 2.094 0.172 0.237 0.484 Had diarrhea in two weeks before survey 0.098 0.017 398 341 1.120 0.174 0.064 0.132 Treated with oral rehydration salts (ORS) 0.615 0.104 39 33 1.297 0.170 0.406 0.824 Taken to a health provider 0.435 0.083 39 33 0.996 0.192 0.268 0.601 Vaccination card seen 0.457 0.060 81 69 1.083 0.131 0.337 0.577 Received BCG vaccination 0.913 0.030 81 69 0.970 0.033 0.852 0.974 Received DPT vaccination (3 doses) 0.765 0.063 81 69 1.337 0.083 0.638 0.891 Received polio vaccination (3 doses) 0.814 0.052 81 69 1.201 0.064 0.710 0.918 Received measles vaccination 0.791 0.038 81 69 0.829 0.048 0.716 0.866 Received all vaccinations 0.703 0.062 81 69 1.228 0.089 0.578 0.828 Total fertility rate (3 years) 4.554 0.324 na 1545 1.277 0.071 3.907 5.202 Perinatal mortality (0-4 years) 23.923 8.171 419 359 1.010 0.342 7.582 40.264 Neonatal mortality rate (10 years) 23.743 5.088 848 727 0.951 0.214 13.566 33.919 Postneonatal mortality rate (10 years) 12.048 3.663 849 728 1.076 0.304 4.723 19.374 Infant mortality rate (10 years) 35.791 6.660 849 728 1.037 0.186 22.470 49.112 Child mortality rate (10 years) 21.834 5.026 850 729 0.973 0.230 11.782 31.885 Under-five mortality rate (10 years) 56.843 9.568 851 729 1.160 0.168 37.708 75.979 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.163 0.023 268 229 1.010 0.140 0.117 0.208 No education 0.019 0.009 268 229 1.036 0.456 0.002 0.036 Secondary education or higher 0.439 0.034 268 229 1.126 0.078 0.371 0.508 Knowing any contraceptive method 0.978 0.013 137 117 1.026 0.013 0.952 1.000 Knowing any modern contraceptive method 0.978 0.013 137 117 1.026 0.013 0.952 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 241 Table B.16 Sampling errors for IX - Zamboanga Peninsula sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.267 0.020 552 465 1.041 0.074 0.227 0.306 Literate 0.917 0.010 552 465 0.822 0.011 0.898 0.936 No education 0.011 0.004 552 465 1.011 0.410 0.002 0.020 Secondary education or higher 0.628 0.027 552 465 1.298 0.043 0.574 0.681 Never married 0.241 0.020 552 465 1.074 0.081 0.202 0.280 Currently married (in union) 0.730 0.020 552 465 1.055 0.027 0.690 0.770 Married before age 20 0.411 0.033 454 381 1.433 0.081 0.344 0.477 Had first sexual intercourse before age 18 0.224 0.020 454 381 1.001 0.088 0.185 0.263 Currently pregnant 0.068 0.013 552 465 1.242 0.196 0.041 0.095 Children ever born 2.634 0.135 552 465 1.185 0.051 2.363 2.904 Children surviving 2.472 0.120 552 465 1.157 0.049 2.231 2.713 Children ever born to women age 40-49 4.915 0.277 124 104 1.071 0.056 4.361 5.468 Knowing any contraceptive method 0.991 0.006 400 339 1.227 0.006 0.980 1.000 Knowing any modern contraceptive method 0.989 0.006 400 339 1.185 0.006 0.976 1.000 Ever used any contraceptive method 0.633 0.031 400 339 1.290 0.049 0.570 0.695 Currently using any contraceptive method 0.431 0.027 400 339 1.073 0.062 0.378 0.485 Currently using a modern method 0.323 0.025 400 339 1.050 0.076 0.274 0.373 Currently using female sterilization 0.057 0.012 400 339 0.997 0.202 0.034 0.081 Currently using male sterilization 0.000 0.000 400 339 na na 0.000 0.000 Currently using pill 0.169 0.019 400 339 1.030 0.114 0.131 0.208 Currently using IUD 0.061 0.013 400 339 1.124 0.222 0.034 0.087 Currently using injectables 0.021 0.007 400 339 1.028 0.353 0.006 0.036 Currently using condom 0.007 0.004 400 339 1.022 0.590 0.000 0.016 Currently using periodic abstinence 0.081 0.016 400 339 1.181 0.199 0.049 0.113 Currently using withdrawal 0.025 0.009 400 339 1.173 0.370 0.006 0.043 Obtained method from public sector source 0.630 0.066 129 110 1.549 0.105 0.498 0.762 Want no more children 0.697 0.022 400 339 0.958 0.032 0.653 0.741 Want to delay birth at least 2 years 0.157 0.012 400 339 0.678 0.079 0.132 0.181 Ideal number of children 3.035 0.056 549 462 0.955 0.019 2.922 3.147 Mothers received tetanus injection for last birth 0.695 0.042 234 199 1.387 0.060 0.612 0.778 Mothers received medical assistance at delivery 0.310 0.047 324 276 1.556 0.151 0.217 0.404 Had diarrhea in two weeks before survey 0.042 0.012 310 264 1.018 0.297 0.017 0.067 Treated with oral rehydration salts (ORS) 0.398 0.112 14 11 0.742 0.281 0.174 0.622 Taken to a health provider 0.401 0.112 14 11 0.742 0.280 0.176 0.625 Vaccination card seen 0.422 0.080 67 57 1.331 0.189 0.262 0.582 Received BCG vaccination 0.760 0.071 67 57 1.370 0.094 0.617 0.902 Received DPT vaccination (3 doses) 0.636 0.070 67 57 1.199 0.110 0.496 0.776 Received polio vaccination (3 doses) 0.620 0.078 67 57 1.323 0.126 0.464 0.776 Received measles vaccination 0.640 0.070 67 57 1.194 0.109 0.501 0.779 Received all vaccinations 0.561 0.075 67 57 1.245 0.134 0.410 0.711 Total fertility rate (3 years) 4.179 0.281 na 1306 1.059 0.067 3.617 4.741 Perinatal mortality (0-4 years) 21.416 10.344 328 279 1.323 0.483 0.728 42.105 Neonatal mortality rate (10 years) 5.928 2.793 684 581 0.959 0.471 0.341 11.514 Postneonatal mortality rate (10 years) 20.730 7.236 684 581 1.279 0.349 6.258 35.201 Infant mortality rate (10 years) 26.657 8.239 684 581 1.309 0.309 10.180 43.134 Child mortality rate (10 years) 17.255 5.688 685 582 1.169 0.330 5.878 28.632 Under-five mortality rate (10 years) 43.452 9.219 685 582 1.170 0.212 25.013 61.891 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.250 0.014 224 189 0.488 0.057 0.222 0.278 No education 0.018 0.009 224 189 0.984 0.484 0.001 0.036 Secondary education or higher 0.487 0.035 224 189 1.059 0.073 0.416 0.558 Knowing any contraceptive method 1.000 0.000 130 109 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 130 109 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 242 | Appendix B Table B.17 Sampling errors for X - Northern Mindanao sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.363 0.017 592 565 0.867 0.047 0.329 0.398 Literate 0.974 0.008 592 565 1.212 0.008 0.958 0.990 No education 0.003 0.002 592 565 0.964 0.702 0.000 0.008 Secondary education or higher 0.728 0.021 592 565 1.165 0.029 0.685 0.771 Never married 0.321 0.025 592 565 1.327 0.079 0.270 0.372 Currently married (in union) 0.645 0.025 592 565 1.285 0.039 0.594 0.695 Married before age 20 0.334 0.026 463 441 1.188 0.078 0.282 0.386 Had first sexual intercourse before age 18 0.210 0.018 463 441 0.952 0.086 0.174 0.246 Currently pregnant 0.055 0.009 592 565 0.953 0.162 0.037 0.073 Children ever born 2.379 0.123 592 565 1.127 0.052 2.133 2.624 Children surviving 2.186 0.109 592 565 1.133 0.050 1.968 2.404 Children ever born to women age 40-49 4.761 0.256 133 128 1.044 0.054 4.250 5.273 Knowing any contraceptive method 0.992 0.004 385 364 0.955 0.004 0.984 1.000 Knowing any modern contraceptive method 0.992 0.004 385 364 0.955 0.004 0.984 1.000 Ever used any contraceptive method 0.796 0.037 385 364 1.795 0.046 0.723 0.870 Currently using any contraceptive method 0.552 0.036 385 364 1.423 0.065 0.479 0.624 Currently using a modern method 0.346 0.030 385 364 1.218 0.086 0.286 0.405 Currently using female sterilization 0.064 0.010 385 364 0.809 0.157 0.044 0.085 Currently using male sterilization 0.000 0.000 385 364 na na 0.000 0.000 Currently using pill 0.147 0.016 385 364 0.903 0.111 0.114 0.179 Currently using IUD 0.089 0.018 385 364 1.229 0.201 0.053 0.124 Currently using injectables 0.018 0.008 385 364 1.245 0.471 0.001 0.035 Currently using condom 0.020 0.009 385 364 1.189 0.422 0.003 0.037 Currently using periodic abstinence 0.134 0.019 385 364 1.114 0.144 0.095 0.173 Currently using withdrawal 0.052 0.015 385 364 1.357 0.296 0.021 0.083 Obtained method from public sector source 0.708 0.045 134 127 1.139 0.063 0.618 0.798 Want no more children 0.627 0.022 385 364 0.901 0.035 0.583 0.672 Want to delay birth at least 2 years 0.176 0.015 385 364 0.770 0.085 0.146 0.206 Ideal number of children 3.027 0.082 588 562 1.320 0.027 2.864 3.190 Mothers received tetanus injection for last birth 0.727 0.043 234 219 1.447 0.059 0.641 0.812 Mothers received medical assistance at delivery 0.410 0.036 322 301 1.119 0.087 0.339 0.481 Had diarrhea in two weeks before survey 0.102 0.017 309 289 0.986 0.165 0.069 0.136 Treated with oral rehydration salts (ORS) 0.251 0.076 31 30 0.973 0.302 0.099 0.403 Taken to a health provider 0.203 0.072 31 30 0.994 0.354 0.059 0.347 Vaccination card seen 0.462 0.044 67 63 0.718 0.096 0.374 0.551 Received BCG vaccination 0.895 0.052 67 63 1.359 0.058 0.792 0.998 Received DPT vaccination (3 doses) 0.689 0.078 67 63 1.367 0.113 0.533 0.845 Received polio vaccination (3 doses) 0.734 0.062 67 63 1.142 0.085 0.610 0.859 Received measles vaccination 0.720 0.074 67 63 1.335 0.103 0.572 0.868 Received all vaccinations 0.587 0.086 67 63 1.411 0.146 0.415 0.759 Total fertility rate (3 years) 3.785 0.339 na 1560 1.348 0.090 3.107 4.462 Perinatal mortality (0-4 years) 24.232 10.688 325 304 1.122 0.441 2.856 45.609 Neonatal mortality rate (10 years) 23.610 6.493 663 623 0.958 0.275 10.623 36.596 Postneonatal mortality rate (10 years) 14.554 5.629 663 623 1.022 0.387 3.295 25.812 Infant mortality rate (10 years) 38.163 9.977 663 623 1.177 0.261 18.210 58.117 Child mortality rate (10 years) 11.040 4.144 664 624 1.059 0.375 2.753 19.327 Under-five mortality rate (10 years) 48.782 12.060 664 624 1.288 0.247 24.661 72.903 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.364 0.033 216 202 0.994 0.090 0.299 0.430 No education 0.009 0.006 216 202 0.998 0.711 0.000 0.022 Secondary education or higher 0.624 0.056 216 202 1.704 0.090 0.512 0.737 Knowing any contraceptive method 0.985 0.015 134 125 1.408 0.015 0.956 1.000 Knowing any modern contraceptive method 0.985 0.015 134 125 1.408 0.015 0.956 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 243 Table B.18 Sampling errors for XI - Davao sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.550 0.035 725 654 1.897 0.064 0.480 0.620 Literate 0.947 0.013 725 654 1.590 0.014 0.920 0.973 No education 0.010 0.008 725 654 2.164 0.791 0.000 0.026 Secondary education or higher 0.723 0.022 725 654 1.333 0.031 0.678 0.767 Never married 0.313 0.024 725 654 1.407 0.077 0.265 0.362 Currently married (in union) 0.651 0.023 725 654 1.287 0.035 0.605 0.696 Married before age 20 0.359 0.024 562 513 1.205 0.068 0.310 0.408 Had first sexual intercourse before age 18 0.186 0.021 562 513 1.303 0.115 0.143 0.228 Currently pregnant 0.057 0.008 725 654 0.942 0.142 0.041 0.074 Children ever born 2.240 0.101 725 654 1.094 0.045 2.039 2.442 Children surviving 2.095 0.094 725 654 1.115 0.045 1.906 2.284 Children ever born to women age 40-49 4.650 0.204 165 149 1.017 0.044 4.242 5.058 Knowing any contraceptive method 0.998 0.002 464 426 1.050 0.002 0.993 1.000 Knowing any modern contraceptive method 0.995 0.005 464 426 1.487 0.005 0.986 1.000 Ever used any contraceptive method 0.850 0.021 464 426 1.254 0.024 0.808 0.892 Currently using any contraceptive method 0.593 0.024 464 426 1.064 0.041 0.545 0.642 Currently using a modern method 0.416 0.021 464 426 0.905 0.050 0.375 0.458 Currently using female sterilization 0.104 0.015 464 426 1.039 0.142 0.074 0.133 Currently using male sterilization 0.004 0.003 464 426 1.032 0.722 0.000 0.011 Currently using pill 0.154 0.018 464 426 1.086 0.118 0.117 0.190 Currently using IUD 0.084 0.013 464 426 1.042 0.160 0.057 0.111 Currently using injectables 0.024 0.011 464 426 1.502 0.445 0.003 0.045 Currently using condom 0.038 0.007 464 426 0.799 0.187 0.024 0.052 Currently using periodic abstinence 0.099 0.014 464 426 1.000 0.140 0.071 0.127 Currently using withdrawal 0.065 0.014 464 426 1.242 0.219 0.037 0.093 Obtained method from public sector source 0.549 0.035 194 178 0.969 0.063 0.479 0.618 Want no more children 0.667 0.024 464 426 1.078 0.035 0.620 0.715 Want to delay birth at least 2 years 0.179 0.017 464 426 0.941 0.094 0.146 0.213 Ideal number of children 2.904 0.050 719 649 1.015 0.017 2.805 3.004 Mothers received tetanus injection for last birth 0.785 0.032 235 216 1.217 0.041 0.721 0.850 Mothers received medical assistance at delivery 0.477 0.039 319 295 1.179 0.082 0.399 0.555 Had diarrhea in two weeks before survey 0.096 0.020 308 285 1.093 0.213 0.055 0.137 Treated with oral rehydration salts (ORS) 0.487 0.118 30 27 1.155 0.243 0.250 0.723 Taken to a health provider 0.287 0.074 30 27 0.890 0.256 0.140 0.434 Vaccination card seen 0.440 0.087 56 52 1.313 0.198 0.266 0.614 Received BCG vaccination 0.927 0.036 56 52 1.067 0.039 0.854 1.000 Received DPT vaccination (3 doses) 0.822 0.055 56 52 1.081 0.066 0.713 0.931 Received polio vaccination (3 doses) 0.769 0.053 56 52 0.950 0.069 0.663 0.875 Received measles vaccination 0.893 0.039 56 52 0.967 0.044 0.815 0.972 Received all vaccinations 0.732 0.065 56 52 1.106 0.088 0.603 0.862 Total fertility rate (3 years) 3.146 0.274 na 1835 1.317 0.087 2.597 3.694 Perinatal mortality (0-4 years) 23.827 7.325 323 298 0.876 0.307 9.177 38.478 Neonatal mortality rate (10 years) 17.968 5.620 677 632 1.041 0.313 6.727 29.209 Postneonatal mortality rate (10 years) 20.093 5.522 679 634 0.996 0.275 9.049 31.138 Infant mortality rate (10 years) 38.061 7.245 679 634 0.959 0.190 23.571 52.551 Child mortality rate (10 years) 9.761 3.222 680 635 0.898 0.330 3.317 16.205 Under-five mortality rate (10 years) 47.451 8.725 682 636 1.066 0.184 30.000 64.901 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.498 0.030 225 212 0.899 0.060 0.438 0.558 No education 0.015 0.005 225 212 0.610 0.333 0.005 0.025 Secondary education or higher 0.644 0.042 225 212 1.318 0.066 0.559 0.728 Knowing any contraceptive method 1.000 0.000 140 134 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 140 134 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 244 | Appendix B Table B.19 Sampling errors for XII - SOCCSKSARGEN sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.377 0.046 655 524 2.409 0.121 0.286 0.469 Literate 0.929 0.016 655 524 1.551 0.017 0.898 0.960 No education 0.040 0.012 655 524 1.537 0.295 0.016 0.064 Secondary education or higher 0.707 0.038 655 524 2.110 0.053 0.632 0.782 Never married 0.272 0.028 655 524 1.588 0.101 0.217 0.328 Currently married (in union) 0.695 0.028 655 524 1.575 0.041 0.638 0.752 Married before age 20 0.437 0.041 537 428 1.904 0.093 0.355 0.518 Had first sexual intercourse before age 18 0.244 0.034 537 428 1.818 0.138 0.176 0.311 Currently pregnant 0.068 0.014 655 524 1.394 0.201 0.041 0.096 Children ever born 2.570 0.145 655 524 1.393 0.056 2.281 2.859 Children surviving 2.421 0.127 655 524 1.314 0.052 2.167 2.674 Children ever born to women age 40-49 5.039 0.301 129 104 1.168 0.060 4.437 5.641 Knowing any contraceptive method 0.991 0.005 452 364 1.028 0.005 0.981 1.000 Knowing any modern contraceptive method 0.986 0.006 452 364 1.148 0.006 0.974 0.999 Ever used any contraceptive method 0.740 0.038 452 364 1.838 0.051 0.664 0.816 Currently using any contraceptive method 0.507 0.029 452 364 1.249 0.058 0.449 0.566 Currently using a modern method 0.378 0.029 452 364 1.284 0.078 0.319 0.436 Currently using female sterilization 0.089 0.015 452 364 1.118 0.169 0.059 0.119 Currently using male sterilization 0.003 0.002 452 364 0.901 0.724 0.000 0.008 Currently using pill 0.147 0.015 452 364 0.880 0.100 0.118 0.176 Currently using IUD 0.084 0.021 452 364 1.583 0.246 0.043 0.125 Currently using injectables 0.039 0.011 452 364 1.201 0.279 0.017 0.061 Currently using condom 0.013 0.005 452 364 0.985 0.407 0.002 0.023 Currently using periodic abstinence 0.082 0.008 452 364 0.612 0.096 0.067 0.098 Currently using withdrawal 0.039 0.010 452 364 1.107 0.258 0.019 0.060 Obtained method from public sector source 0.645 0.055 178 141 1.533 0.085 0.535 0.755 Want no more children 0.596 0.022 452 364 0.965 0.037 0.551 0.640 Want to delay birth at least 2 years 0.195 0.015 452 364 0.822 0.079 0.164 0.225 Ideal number of children 3.128 0.100 653 523 1.682 0.032 2.929 3.328 Mothers received tetanus injection for last birth 0.734 0.039 276 223 1.457 0.053 0.656 0.811 Mothers received medical assistance at delivery 0.371 0.054 398 324 1.839 0.146 0.263 0.479 Had diarrhea in two weeks before survey 0.114 0.021 384 312 1.160 0.183 0.072 0.155 Treated with oral rehydration salts (ORS) 0.350 0.075 43 35 0.969 0.214 0.200 0.499 Taken to a health provider 0.312 0.087 43 35 1.129 0.277 0.139 0.486 Vaccination card seen 0.428 0.081 71 55 1.361 0.189 0.266 0.590 Received BCG vaccination 0.881 0.039 71 55 0.995 0.044 0.803 0.958 Received DPT vaccination (3 doses) 0.850 0.050 71 55 1.165 0.059 0.750 0.950 Received polio vaccination (3 doses) 0.817 0.051 71 55 1.097 0.062 0.715 0.919 Received measles vaccination 0.842 0.045 71 55 1.036 0.054 0.751 0.933 Received all vaccinations 0.707 0.059 71 55 1.077 0.083 0.589 0.825 Total fertility rate (3 years) 4.181 0.329 na 1472 1.273 0.079 3.524 4.839 Perinatal mortality (0-4 years) 20.691 6.950 401 326 1.004 0.336 6.792 34.591 Neonatal mortality rate (10 years) 14.645 4.068 789 634 0.971 0.278 6.510 22.780 Postneonatal mortality rate (10 years) 12.840 4.069 791 636 1.067 0.317 4.702 20.978 Infant mortality rate (10 years) 27.485 5.756 791 636 1.005 0.209 15.972 38.997 Child mortality rate (10 years) 9.616 3.144 789 634 0.904 0.327 3.328 15.904 Under-five mortality rate (10 years) 36.836 7.505 791 636 1.122 0.204 21.827 51.846 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.349 0.045 255 216 1.494 0.128 0.259 0.438 No education 0.011 0.007 255 216 0.995 0.582 0.000 0.025 Secondary education or higher 0.612 0.027 255 216 0.875 0.044 0.559 0.666 Knowing any contraceptive method 0.992 0.007 140 120 1.020 0.008 0.978 1.000 Knowing any modern contraceptive method 0.986 0.010 140 120 0.996 0.010 0.966 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 245 Table B.20 Sampling errors for XIII - Caraga sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.458 0.025 545 327 1.190 0.056 0.407 0.508 Literate 0.964 0.010 545 327 1.278 0.011 0.943 0.984 No education 0.009 0.005 545 327 1.193 0.532 0.000 0.019 Secondary education or higher 0.727 0.025 545 327 1.319 0.035 0.676 0.777 Never married 0.296 0.019 545 327 0.956 0.063 0.258 0.333 Currently married (in union) 0.664 0.017 545 327 0.847 0.026 0.630 0.698 Married before age 20 0.402 0.034 435 260 1.449 0.085 0.333 0.470 Had first sexual intercourse before age 18 0.252 0.026 435 260 1.255 0.104 0.200 0.304 Currently pregnant 0.083 0.012 545 327 1.018 0.145 0.059 0.107 Children ever born 2.535 0.122 545 327 1.049 0.048 2.291 2.780 Children surviving 2.338 0.112 545 327 1.066 0.048 2.114 2.562 Children ever born to women age 40-49 5.361 0.252 110 66 0.893 0.047 4.857 5.866 Knowing any contraceptive method 1.000 0.000 362 217 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 362 217 na 0.000 1.000 1.000 Ever used any contraceptive method 0.818 0.024 362 217 1.191 0.030 0.770 0.867 Currently using any contraceptive method 0.546 0.026 362 217 0.991 0.048 0.494 0.598 Currently using a modern method 0.340 0.024 362 217 0.965 0.071 0.291 0.388 Currently using female sterilization 0.070 0.012 362 217 0.909 0.174 0.046 0.095 Currently using male sterilization 0.003 0.003 362 217 0.968 0.985 0.000 0.008 Currently using pill 0.148 0.020 362 217 1.095 0.138 0.107 0.189 Currently using IUD 0.077 0.009 362 217 0.664 0.121 0.059 0.096 Currently using injectables 0.014 0.006 362 217 0.964 0.431 0.002 0.025 Currently using condom 0.027 0.008 362 217 0.883 0.277 0.012 0.043 Currently using periodic abstinence 0.132 0.014 362 217 0.806 0.109 0.104 0.161 Currently using withdrawal 0.047 0.011 362 217 1.017 0.241 0.024 0.070 Obtained method from public sector source 0.687 0.043 127 76 1.033 0.062 0.602 0.772 Want no more children 0.602 0.024 362 217 0.941 0.040 0.554 0.651 Want to delay birth at least 2 years 0.227 0.014 362 217 0.645 0.063 0.199 0.256 Ideal number of children 3.148 0.080 542 325 1.181 0.026 2.987 3.308 Mothers received tetanus injection for last birth 0.804 0.034 225 135 1.285 0.042 0.736 0.872 Mothers received medical assistance at delivery 0.426 0.037 337 203 1.155 0.087 0.351 0.500 Had diarrhea in two weeks before survey 0.095 0.025 325 195 1.488 0.264 0.045 0.145 Treated with oral rehydration salts (ORS) 0.288 0.106 31 19 1.263 0.367 0.077 0.499 Taken to a health provider 0.257 0.073 31 19 0.911 0.285 0.111 0.404 Vaccination card seen 0.468 0.052 62 37 0.817 0.111 0.364 0.571 Received BCG vaccination 0.935 0.030 62 37 0.954 0.032 0.875 0.995 Received DPT vaccination (3 doses) 0.886 0.054 62 37 1.331 0.061 0.779 0.993 Received polio vaccination (3 doses) 0.886 0.054 62 37 1.331 0.061 0.779 0.993 Received measles vaccination 0.825 0.033 62 37 0.681 0.040 0.759 0.890 Received all vaccinations 0.776 0.047 62 37 0.887 0.060 0.682 0.870 Total fertility rate (3 years) 4.102 0.309 na 908 1.171 0.075 3.483 4.721 Perinatal mortality (0-4 years) 35.208 6.858 344 207 0.702 0.195 21.492 48.924 Neonatal mortality rate (10 years) 21.218 6.099 667 400 1.058 0.287 9.019 33.416 Postneonatal mortality rate (10 years) 14.074 3.808 668 401 0.844 0.271 6.459 21.689 Infant mortality rate (10 years) 35.291 7.539 668 401 0.935 0.214 20.214 50.368 Child mortality rate (10 years) 13.699 4.849 667 400 0.958 0.354 4.001 23.397 Under-five mortality rate (10 years) 48.506 8.267 668 401 0.922 0.170 31.972 65.041 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.362 0.023 206 125 0.692 0.064 0.316 0.408 No education 0.025 0.015 206 125 1.401 0.611 0.000 0.056 Secondary education or higher 0.629 0.051 206 125 1.519 0.082 0.526 0.731 Knowing any contraceptive method 1.000 0.000 122 74 na 0.000 1.000 1.000 Knowing any modern contraceptive method 1.000 0.000 122 74 na 0.000 1.000 1.000 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 246 | Appendix B Table B.21 Sampling errors for Autonomous Region in Muslim Mindanao (ARMM) sample, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.304 0.034 683 489 1.915 0.111 0.237 0.372 Literate 0.805 0.022 683 489 1.466 0.028 0.760 0.849 No education 0.150 0.024 683 489 1.788 0.163 0.101 0.198 Secondary education or higher 0.519 0.036 683 489 1.898 0.070 0.446 0.591 Never married 0.297 0.024 683 489 1.398 0.082 0.248 0.346 Currently married (in union) 0.671 0.030 683 489 1.644 0.044 0.611 0.730 Married before age 20 0.505 0.020 540 388 0.913 0.039 0.465 0.544 Had first sexual intercourse before age 18 0.323 0.016 540 388 0.774 0.048 0.292 0.355 Currently pregnant 0.071 0.012 683 489 1.243 0.172 0.047 0.096 Children ever born 2.485 0.155 683 489 1.512 0.062 2.176 2.795 Children surviving 2.286 0.141 683 489 1.542 0.062 2.003 2.569 Children ever born to women age 40-49 5.163 0.403 109 79 1.412 0.078 4.357 5.969 Knowing any contraceptive method 0.895 0.018 456 328 1.233 0.020 0.860 0.931 Knowing any modern contraceptive method 0.863 0.021 456 328 1.303 0.024 0.821 0.905 Ever used any contraceptive method 0.316 0.046 456 328 2.091 0.144 0.225 0.407 Currently using any contraceptive method 0.187 0.032 456 328 1.759 0.172 0.123 0.252 Currently using a modern method 0.116 0.029 456 328 1.916 0.248 0.058 0.173 Currently using female sterilization 0.022 0.006 456 328 0.888 0.277 0.010 0.034 Currently using male sterilization 0.000 0.000 456 328 na na 0.000 0.000 Currently using pill 0.049 0.017 456 328 1.719 0.355 0.014 0.084 Currently using IUD 0.013 0.007 456 328 1.254 0.509 0.000 0.027 Currently using injectables 0.029 0.011 456 328 1.371 0.370 0.008 0.051 Currently using condom 0.002 0.002 456 328 1.027 0.998 0.000 0.007 Currently using periodic abstinence 0.022 0.006 456 328 0.928 0.290 0.009 0.035 Currently using withdrawal 0.024 0.011 456 328 1.487 0.447 0.003 0.045 Obtained method from public sector source 0.826 0.052 53 38 0.993 0.063 0.722 0.931 Want no more children 0.307 0.029 456 328 1.343 0.095 0.249 0.365 Want to delay birth at least 2 years 0.270 0.022 456 328 1.081 0.083 0.225 0.315 Ideal number of children 4.681 0.161 656 470 1.920 0.034 4.360 5.003 Mothers received tetanus injection for last birth 0.475 0.062 257 184 1.997 0.131 0.350 0.599 Mothers received medical assistance at delivery 0.217 0.026 435 310 1.015 0.117 0.166 0.268 Had diarrhea in two weeks before survey 0.120 0.018 409 291 1.067 0.149 0.084 0.156 Treated with oral rehydration salts (ORS) 0.472 0.066 50 35 0.874 0.140 0.340 0.603 Taken to a health provider 0.422 0.084 50 35 1.088 0.198 0.255 0.589 Vaccination card seen 0.216 0.051 76 54 1.083 0.237 0.114 0.319 Received BCG vaccination 0.710 0.060 76 54 1.138 0.084 0.591 0.829 Received DPT vaccination (3 doses) 0.505 0.070 76 54 1.209 0.138 0.366 0.645 Received polio vaccination (3 doses) 0.533 0.074 76 54 1.280 0.138 0.385 0.680 Received measles vaccination 0.574 0.065 76 54 1.141 0.113 0.443 0.704 Received all vaccinations 0.440 0.061 76 54 1.058 0.138 0.319 0.561 Total fertility rate (3 years) 4.209 0.361 na 1383 1.204 0.086 3.486 4.932 Perinatal mortality (0-4 years) 27.753 5.092 439 313 0.614 0.183 17.569 37.937 Neonatal mortality rate (10 years) 17.641 5.156 849 605 1.085 0.292 7.330 27.952 Postneonatal mortality rate (10 years) 23.500 7.076 850 606 1.333 0.301 9.347 37.652 Infant mortality rate (10 years) 41.141 7.694 850 606 1.103 0.187 25.752 56.530 Child mortality rate (10 years) 32.512 9.149 851 606 1.204 0.281 14.214 50.811 Under-five mortality rate (10 years) 72.316 11.427 852 607 1.075 0.158 49.462 95.170 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.275 0.028 239 166 0.976 0.103 0.219 0.332 No education 0.155 0.028 239 166 1.189 0.180 0.099 0.211 Secondary education or higher 0.423 0.032 239 166 0.986 0.075 0.360 0.486 Knowing any contraceptive method 0.688 0.049 155 107 1.308 0.071 0.590 0.785 Knowing any modern contraceptive method 0.642 0.050 155 107 1.304 0.078 0.542 0.743 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 247 DATA QUALITY TABLES APPENDIX C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Male Female Male Female –––––––––––––––––– ––––––––––––––––– ––––––––––––––––– –––––––––––––––––– Age Number Percentage Number Percentage Age Number Percentage Number Percentage –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 0 750 2.6 712 2.5 37 360 1.2 385 1.3 1 733 2.5 669 2.3 38 362 1.2 378 1.3 2 753 2.6 722 2.5 39 336 1.1 358 1.2 3 724 2.5 798 2.7 40 369 1.3 374 1.3 4 743 2.5 650 2.2 41 301 1.0 298 1.0 5 805 2.7 730 2.5 42 350 1.2 289 1.0 6 770 2.6 740 2.5 43 318 1.1 342 1.2 7 782 2.7 719 2.5 44 283 1.0 312 1.1 8 762 2.6 649 2.2 45 311 1.1 327 1.1 9 776 2.6 721 2.5 46 266 0.9 280 1.0 10 794 2.7 769 2.6 47 294 1.0 260 0.9 11 738 2.5 692 2.4 48 267 0.9 277 1.0 12 809 2.8 770 2.7 49 226 0.8 232 0.8 13 714 2.4 740 2.5 50 229 0.8 270 0.9 14 723 2.5 735 2.5 51 198 0.7 215 0.7 15 611 2.1 622 2.1 52 235 0.8 258 0.9 16 675 2.3 632 2.2 53 216 0.7 266 0.9 17 614 2.1 549 1.9 54 184 0.6 231 0.8 18 604 2.1 501 1.7 55 174 0.6 191 0.7 19 551 1.9 430 1.5 56 159 0.5 183 0.6 20 533 1.8 473 1.6 57 158 0.5 147 0.5 21 496 1.7 453 1.6 58 158 0.5 177 0.6 22 504 1.7 451 1.6 59 132 0.5 133 0.5 23 520 1.8 475 1.6 60 161 0.5 213 0.7 24 473 1.6 459 1.6 61 105 0.4 103 0.4 25 470 1.6 459 1.6 62 129 0.4 123 0.4 26 411 1.4 403 1.4 63 127 0.4 147 0.5 27 450 1.5 409 1.4 64 111 0.4 117 0.4 28 427 1.5 414 1.4 65 124 0.4 132 0.5 29 372 1.3 414 1.4 66 73 0.2 95 0.3 30 402 1.4 422 1.5 67 83 0.3 112 0.4 31 374 1.3 381 1.3 68 81 0.3 98 0.3 32 425 1.4 397 1.4 69 63 0.2 81 0.3 33 419 1.4 410 1.4 70+ 639 2.2 882 3.0 34 344 1.2 385 1.3 Don't know/ 35 420 1.4 415 1.4 missing 0 0.0 3 0.0 36 344 1.2 391 1.3 Total 29,399 100.0 29,050 100.0 248 | Appendix C Table C.2.1 Age distribution of eligible and interviewed women De facto household population of women age 10-54, interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), by five-year age groups, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household Interviewed women Percentage population age 15-49 of eligible Age of women –––––––––––––––––––– women group age 10-54 Number Percent interviewed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 10-14 3,707 na na na 15-19 2,734 2,684 19.5 98.2 20-24 2,311 2,233 16.2 96.6 25-29 2,099 2,049 14.9 97.6 30-34 1,995 1,963 14.3 98.4 25-39 1,926 1,886 13.7 97.9 40-44 1,614 1,579 11.5 97.8 45-49 1,376 1,348 9.8 98.0 50-54 1,240 na na na 15-49 14,055 13,743 100.0 97.8 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Table C.2.2 Age distribution of eligible and interviewed men De facto household population of men age 10-64, interviewed men age 15-59 and percentage of eligible men who were interviewed (weighted), by five-year age groups, Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Household Interviewed men Percentage population age 15-54 of eligible Age of men –––––––––––––––––––– men group age 10-59 Number Percent interviewed ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 10-14 1,260 na na na 15-19 962 924 19.4 96.1 20-24 836 789 16.5 94.3 25-29 681 642 13.5 94.3 30-34 628 588 12.3 93.6 25-39 619 589 12.3 95.1 40-44 510 484 10.2 95.0 45-49 436 415 8.7 95.2 50-54 353 335 7.0 94.9 55-59 291 na na na 15-59 5,024 4,766 100.0 94.9 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Appendix C | 249 Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living , dead, and total children (weighted), Philippines 2003 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage with Number of births complete birth date1 Sex ratio at birth2 Calendar year ratio3 ––––––––––––––––––––––– ––––––––––––––––––––––– –––––––––––––––––––––– –––––––––––––––––––––– Year Living Dead Total Living Dead Total Living Dead Total Living Dead Total ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 2002 716 17 733 100.0 100.0 100.0 106.1 105.0 106.0 na na na 2001 1,359 45 1,404 100.0 100.0 100.0 106.0 117.6 106.3 na na na 2000 1,340 47 1,386 100.0 100.0 100.0 106.7 120.0 107.1 96.1 79.2 95.4 1999 1,429 73 1,502 100.0 100.0 100.0 94.7 224.1 98.6 108.4 163.8 110.2 1998 1,296 42 1,339 100.0 100.0 100.0 97.4 89.0 97.2 94.4 75.3 93.7 1997 1,317 40 1,356 100.0 100.0 100.0 114.0 173.8 115.3 95.2 72.8 94.3 1996 1,470 66 1,536 99.6 98.4 99.6 106.8 99.8 106.5 113.2 139.2 114.1 1995 1,280 56 1,336 99.9 95.1 99.7 110.4 129.3 111.1 91.1 78.4 90.5 1994 1,341 76 1,417 99.6 96.9 99.5 118.7 165.2 120.8 105.6 135.8 106.8 1993 1,260 56 1,316 99.4 95.8 99.3 110.6 238.0 114.0 94.7 75.2 93.7 1997-2001 6,140 223 6,363 100.0 100.0 100.0 101.6 135.5 102.6 na na na 1992-1996 6,667 294 6,961 99.7 97.1 99.6 111.9 150.6 113.3 na na na 1987-1991 6,204 344 6,548 99.5 96.5 99.3 103.9 139.7 105.5 na na na 1982-1986 4,635 405 5,040 99.4 94.0 99.0 105.2 108.4 105.4 na na na < 1982 4,310 491 4,801 99.3 95.8 98.9 115.7 126.8 116.8 na na na All 27,956 1,758 29,714 99.6 96.3 99.4 107.2 129.3 108.4 na na na ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)*100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]*100, where Bx is the number births in calendar year x Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage with Number missing of Subject Reference group information cases –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth date Births in the 15 years preceding the survey Month only 0.33 20,364 Month and year 0.04 20,364 Age at death Dead children born in the 15 years preceding the survey 0.44 896 Age/date at first union1 Ever-married women age 15-49 0.03 9,245 Respondent's education All women age 15-49 0.00 13,633 Diarrhea in last 2 weeks Living children age 0-59 months 1.05 6,712 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Both year and age missing 250 | Appendix C Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey (weighted), Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Age at ––––––––––––––––––––––––––––––––––– Total death (days) 0-4 5-9 10-14 15-19 0-19 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <1 32 23 34 30 120 1 26 46 26 22 120 2 8 5 10 3 26 3 11 9 12 10 42 4 5 1 1 2 10 5 7 1 4 4 15 6 2 1 0 1 4 7 8 15 8 13 43 8 0 1 1 2 4 9 2 1 1 0 3 10 0 1 1 4 5 11 5 0 1 0 6 12 1 0 2 0 2 13 1 1 0 1 3 14 5 4 3 0 11 15 1 6 0 0 7 16 0 1 0 0 1 17 0 0 1 0 1 18 0 0 2 0 2 20 1 1 1 1 4 21 0 2 1 0 3 22 0 0 2 0 2 23 1 0 0 0 1 24 1 0 0 1 3 25 1 0 1 0 2 26 1 0 1 0 2 28 1 0 1 1 2 30 0 3 0 0 3 31+ 0 0 0 1 1 Total 0-30 121 121 111 95 447 Percent early neonatal1 76.0 71.6 77.0 76.5 75.2 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 (0-6 days/0-30 days) * 100 Appendix C | 251 Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five-year periods of birth preceding the survey, Philippines 2003 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of years preceding the survey Age at ––––––––––––––––––––––––––––––––––– Total death (months) 0-4 5-9 10-14 15-19 0-19 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– <1a 121 121 111 95 447 1 13 20 11 14 59 2 10 12 12 9 42 3 10 5 7 10 31 4 6 6 7 11 29 5 7 4 5 6 23 6 7 5 12 12 36 7 6 8 6 10 30 8 6 4 11 13 34 9 5 14 18 11 49 10 4 3 7 7 21 11 2 5 6 7 20 12 4 16 19 31 69 13 1 1 5 6 13 14 0 2 1 2 6 15 1 0 5 5 11 16 0 1 3 6 11 17 2 0 1 1 4 18 2 2 3 5 12 19 3 0 0 1 4 20 0 3 2 4 9 21 1 0 1 0 2 22 2 0 1 1 3 23 0 1 0 1 1 24+ 1 0 0 0 1 1 year 2 3 4 5 14 Total 0-11 199 206 211 205 822 Percent neonatal1 60.8 58.5 52.7 46.2 54.5 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– a Includes deaths under one month reported in days 1 Under one month/under one year Appendix D | 253 PERSONS INVOLVED IN THE 2003 PHILIPPINES DEMOGRAPHIC AND HEALTH SURVEY APPENDIX D PRE-TEST 1 Department of Health Dr. Leticia Olivar Dr. Aura C. Corpuz Dr. Franklin Diza Dr. Nemia Sucaldito Engr. Joselito Riego Engr. Ma. Sonabel Anarna University of the Philippines Population Institute Zenaida Quiray Dr. Zelda C. Zablan Dr. Josefina V. Cabigon Population Commission Fe Lotho Erlina Castillo National Statistics Office Benedicta A. Yabut Divina Grace L. del Prado Jeremias A. Luis Maria Virginia R. Olveña Elpidio A. Maramot Glenn B. Barcenas Edna B. Rapanot Amelia G. Saripada Wilma S. Sulit Maritess Q. Tan Shanna Elaine B. Rogan Ma. Goretti M. Novilla Norma J. Ayuban Filipinas G. Lim Maricel Caragas Gil Gumasing Rogelio Nuera Segundo Lozada Edgar Dagdag Richard Raagas Emmanuel Ruaya PRE-TEST 2 ORC Macro Sri Poedjastoeti (consultant) National Statistics Office Socorro D. Abejo Benedicta A. Yabut Divina Grace L. del Prado Aurora T. Reolalas Maria Virginia R. Olveña Glenn B. Barcenas Amelia G. Saripada Wilma S. Sulit Norma Ayuban Roca Redaja Emmanuel Ruaya Ma. Theresa T. Rapanan Luzviminda G. Buensalida Shanna Elaine B. Rogan Ma. Goretti M. Novilla Norma J. Ayuban Filipinas G. Lim Charito L. Capacete Mercedes C. Hoquis Hired Statistical Researchers Catherine Pineda Ma. Florena Genio Christine Angeles Marileen Avañez Emily Caparas Javier dela Cruz Jr. Cleofe Roque Ma. Florena Barras Rebecca Caacbay Cherry Angeles Benilyn Bala Michael Bautista 254 | Appendix D TRAINING TASK FORCE Resource Persons Trainers ORC Macro Sri Poedjastoeti (Consultant) National Statistics Office Socorro D. Abejo Benedicta A. Yabut Department of Health Dr. Leticia Olivar Dr. Aura Corpuz Dr. Nemia Sucaldito Earlynne Hernandez Divina Grace L. del Prado Aurora T. Reolalas Ma. Virginia R. Olveña Elpidio A. Maramot Erma Y. Aquino Amador Trazo PhilHealth Gilda Diaz University of the Philippines Population Institute Prof. Eliseo de Guzman Dr. Nimfa B. Ogena Dr. Zelda C. Zablan Dr. Josefina V. Cabigon Participants Central Office Edna B. Rapanot Priscilla E. Bacus Zenaida M. Tapire Amelia G. Saripada Wilma S. Sulit Ma. Theresa T. Rapanan Maritess Q. Tan Mario V. Olivar Evelyn Ogbinar Ma. Goretti Novilla Norma Ayuban Regional Offices Jocelyn Otgalon Rosemarie Regio Reyma Tabalno Concepcion Angeles Aireen Pucyutan Jesus Sorima Maria Dulce Padayao Consuelo Virgula Charito Doller Eutemio A. Llevado Jr. Fe Consolacion Atay Ma. Liza Bigornia Ma. Leah C. Magracia Jurilyn P. Abraham Lourdes Grace Plomillo Noronisah Dimaronsing Appendix D | 255 FIELDWORK INTERVIEW TEAMS Region I – Ilicos Marietta Zapanta (Regional Supervisor) TEAM 1 Florentino P. Queinan (Team Supervisor) Marizel G. Llavore (Field Editor) Lorraine Q. Andallo Jennifer L. Andrada Miriam Q. Carig Cheng S. Harnois Magdalena M. Magayano Brendalyne T. Pomoy Freddie C. Villanueva TEAM 2 Aniceta Z. Nipal (Team Supervisor) Mark Anthony R. Tandoc (Field Editor) Milagros B. de Guzman Sylvia V. de Guzman Eraño Q. Jocutan Hilda L. Ocampo Teresita Pamintuan Priscila B. Tandoc Nestor D. Pecson Region II – Cagayan Valley Reyma Tabalno (Regional Supervisor) TEAM 3 Johnny P. Agustin (Team Supervisor) Nadine C. Pagalilauan (Field Editor) Ma. Charina de Asis Joan Te Michelle de la Cruz Janver Dumaya Landerlyne Belen Ferdinand Torres Joe Louise Puerto TEAM 4 Tomas M. Domingo (Team Supervisor) Fe. P. Cansino (Field Editor) Elaine Feria Ma. Cristina Cabacoan Ferdinand Torres Analiza Gammad Janet Hermoso Expidito Maddumba Jr. Ma. Elijah Salva Region III – Central Luzon Concepcion Angeles (Regional Supervisor) TEAM 5 Cordella M. Capili (Team Supervisor) Cleofe A. Roque (Field Editor) Concepcion C. Angeles Marileen S. Avoñez Benilyn P. Bala Javier T. dela Cruz Ma. Florena B. Genio Benneth L. Mariano TEAM 6 Remedios de Guzman (Team Supervisor) Luz G. Torres (Field Editor) Ma. Luisa S. Arcelo Glenda Basilio Jeffry D. Garcia Marivic C. Mutuc Perseveranda Rodriguez Randy S. Sode Joy Tuazon TEAM 7 Corazon P. Bonifacio (Team Supervisor) Catherine A. Apolonio (Field Editor) Marilyn M. Alfonso Winnie Grace C. dela Cruz Rosario W. Querimit Lucila G. Raner Glenn M. Salvador Crispina D. Sarte 256 | Appendix D Region IVA and IVB – CALABARZON and MIMAROPA Carlito Torres and Rose Bagay (Regional Supervisors) TEAM 8 Rodolfo Vergara (Team Supervisor) Marissa Custodio (Field Editor) Manuel Andal Jr. Baby Veronica Buhay Belinda Siscar Amie de Guzman Anastacia Ebora Elsie Borras TEAM 9 Annelyn Aguila (Team Supervisor) Mary Ann Collado (Field Editor) Carlo Encarnacion Arlene Iranzo Blesilda Manaog Marina Cagayan Roselle Ramos TEAM 10 Renato B. Berzabal (Team Supervisor) Pamela Gay Abella (Field Editor) Eric Sibug Racquel Rivera Lanie Garcia Flor de Luna Gilda Era Ermelle Alfonso TEAM 11 Cesar Arevalo (Team Supervisor) Jocelyn Magsino (Field Editor) Bonalyn Antipala Lorna de Guia Dolores Fausto Rubygail Anciado Babylyn Porciocula Estela Silangan Sherwin Dalman Marcos Limon TEAM 12 Margarita Cada (Team Supervisor) Zandra Malabanan (Field Editor) Geraldine Anap Ma. Lourdes Lingon Fe Fadilane Ma. Theresa Acoba Maricon Mogol Allan Cera Rolando Tan Jr. Ruth Pera TEAM 13 Jesus Sorima (Team Supervisor) Marlon Gando (Field Editor) Cherrie Ann Gallardo Mailanie Cervantes Rachel Concepcion Janelyn Hoybia Region V – Bicol Maria Dulce Padayao (Regional Supervisor) TEAM 14 Mely Gualvez (Team Supervisor) Joseph Obeña (Field Editor) Mary Rosellen Alonzo Secyl Amante Feda Bajamundi Ninia Empleo Dina Fulgosino Salvacion Sarzuela Jimmy Toledo TEAM 15 Nancy Nillo (Team Supervisor) Lilia Caudilla (Field Editor) Maria Angiela Balingbing Joji del Rosario Rowena Olayta Perla Rapisura Gilbert Surtido Lani Sto. Tomas Appendix D | 257 Region VI – Western Visayas Consuelo Virgula (Regional Supervisor) TEAM 16 Judy Jordan (Team Supervisor) Natividad Dormis (Field Editor) Helen Calur Lucita Trajeras Eunice Mae Cabataña Marivic Villanueva Renee Rose Esmillarin Moises Flores Jasmin Buala Jojun Quezon TEAM 17 Salvacion Lemos (Team Supervisor) Glenda Policarpio (Field Editor) Jay-R Matutina Mary Ruth Dolar Cecile Lourdes Tabiana Ritchel Joy Garcia Karen Villavicencio Dativa Cuello TEAM 18 Antonette Catubuan (Team Supervisor) Mary Grace Abucay (Field Editor) Veronica Serrano Levie Tejada Mary Claire Almalbis Princess Bagsic Rheian Borres Region VII – Central Visayas Charito Doller (Regional Supervisor) TEAM 19 Colita Montoya (Team Supervisor) Nimfa Aray (Field Editor) Sisinia Mirontos Divinagracia Basio Nelson Torreon Anecita Rante Sheila Diana Ma. Theresa Sollano Luchi Amora TEAM 20 Mary Ann C. Villasan (Team Supervisor) Ma. Marcia Daan (Field Editor) Em’Maria Abangan Mengil Almento Maria Cristina Blando Jacqueline Ilustrisimo Angie Perez Elisa Rosalita Lebriendo Tarongoy TEAM 21 Hera Juarez (Team Supervisor) Marion Louise Veradio (Field Editor) Gemma Baguio Gemma Ganibi Harold Roy Infante Russel Radoc Leslie Ta-ala Albert Uy Riza Vailoces 258 | Appendix D Region VIII – Eastern Visayas Eutemio A. Llevado Jr. (Regional Supervisor) TEAM 22 Necitas E. Flores (Team Supervisor) Andrio M. Abad (Field Editor) Marina M. Abello Juliet S. Daga Mila M. Ibañez Merle E. Jaro Anna Mabelle Lim Vivian S. Villacarillo Bibiano B. Remetilla TEAM 23 Felimon M. Garcia (Team Supervisor) Marciano M. Yanto (Field Editor) Alisa A. Abella Sylvia O. Aclan Karin G. Alegre Milalyn R. Balicot Rosalia D. Emphasis Elvie Quiles Jonathan Gutierrez Region IX – Zamboanga Peninsula Fe Consoliacion Atay (Regional Supervisor) TEAM 24 Nerissa Lim (Team Supervisor) Milan Aswali (Field Editor) Benfadjar Yunos Genevieve Panday Daryl Antigua Rosalina Hassiman Jennylyn Desiongco Lilibeth Magtuba TEAM 25 Gemma B. Vidal (Team Supervisor) Catherine Daphne S. Baes (Field Editor) Rhea Dee n. Lumilay Saida M. Lapasaran Paking L. Sacaludan Roseller Q. Ramos Dina D. Kiskis Suzette A. Bagatua Region X – Northern Mindanao Ma. Liza Birgonia (Regional Supervisor) TEAM 26 Juliet Cordero (Team Supervisor) Pamela Pauline A. Guimalan (Field Editor) Rowena Tumangday Deana dell B. Pornia Joyna Buhisan Febies Chan Zoraida C. Yana Camilo Ranoa TEAM 27 Osler Mejares (Team Supervisor) Jenelyn A. Modequillo (Field Editor) Farrah Angela P. Allonar Stephanie dela Calzada Maratha Kim M. Bacas Jenalyn T. Torres Maureen May B. Tumanda Maedi M. Bolotaolo Region XI – Davao Ma. Leah C. Magracia (Regional Supervisor) TEAM 28 Genoveva Manio (Team Supervisor) Michelle Sescon (Field Editor) Analyn Burlaza Judy Ann Dagatan Joan gamad Mary Jane Mirambel Liezel Polinar Marilou Mapa TEAM 29 Judith Perito (Team Supervisor) Gladys May Adanza (Field Editor) Beverly Borgonia Ofelia Duños Relita Kudera Geraldine Lopez Miralee Navarro Rex Agang Appendix D | 259 TEAM 30 Niel Gonzaga (Team Supervisor) Cecilia Catedral (Field Editor) Bernadeth Aquino Ma. Mirasol Canceran Maureen Duco Flora Mary Mae Manahan Rhina Tiwo Jay del Socorro Region XII – SOCCSKSARGEN Jurilyn P. Abraham (Regional Supervisor) TEAM 31 Rachel Fe M. Cortez (Team Supervisor) Maribel Silva (Field Editor) Irvin L. Baligasa Riza Nacar Jeanette Cabug Bena Gomez Delia Damolo Betty Aquillo TEAM 32 Sally Fe Dato-on (Team Supervisor) Karla Yadao (Field Editor) Regie Taran Lea Ortiz Jovelyn Pablo Eunice Bustos Solaiba Lakman Iren Lomugdang Region XIII – Caraga Lourdes Grace Plomillo (Regional Supervisor) TEAM 33 Lolita A. Espinosa (Team Supervisor) Fe P. Agustin (Field Editor) Mylen T. Dela cruz Cathelyn R. Jandug Irish B. Laña Gina M. Dumaguit Flordeliza Q. Lapuz Rosalia T. Paez Adrian F. Jaranilla TEAM 34 Susan G. Pantillo (Team Supervisor) Rhodora S. Ebabao (Field Editor) Catherine Mendoza Aida Rosal Araceli Patriana Janet Tabugon Jhunybe Escartin Joeyconsly Loay Nonito Serrano National Capital Region Rosemarie Regio and Soraya de Guzman (Regional Supervisors) TEAM 35 Yolanda Mantaring (Team Supervisor) Catalina Catanawuan (Field Editor) Ma. Cristina Lotho (Field Editor) Editha Inez Corazon Martinez Francisco Tabjan, Jr. Shyrelle Mateo Joseph laver Pedro Zenaida Gonzales TEAM 36 Estrella Vargas (Team Supervisor) Ma. Eleanor Adaoag (Field Editor) Evelyn Rubis (Field Editor) Jennievive delos Reyes Rosalie Fontanilla Richelle Lolong Malyn Anthony Molano Salvadora Prila Woody Lopez TEAM 37 Amelia Basilio (Team Supervisor) Pacita Liboon (Field Editor) Rosafe Ortega (Field Editor) Bernardo Alonzo Cristina Manalo William Ordiz Ma. Azelina Odiver Gloria Palmencio Cristina Manalo TEAM 38 Adelfa Yepes (Team Supervisor) Aida Gallardo (Field Editor) Felicita Cano (Field Editor) Arsenia Gabriel Lolita Conchas Lilian Calayag Raymon Sta. Ana Velmor Fabian Josephine Abtuh 260 | Appendix D TEAM 39 Elnora Estalle (Team Supervisor) Haydee Rafael (Field Editor) Lirio Jariel (Field Editor) Emmanuel Ruaya Hennessy Mamuyac Cecilia Temporada Lotis Brazas Mary Ann Tepino Criselvania Mantua Roca Redaja TEAM 40 Noime Guevarra (Team Supervisor) Mary Jean Acena (Field Editor) Florfil Rodrigo (Field Editor) Janet Esta Jezreel Urita Melanie Santiago Dennis Mendoza Jenny Reyes Glecy Hermo Cordillera Administrative Region Jocelyn Octagon (Regional Supervisor) TEAM 41 Windelen C. Caballar (Team Supervisor) Emmalyn C. Esnara (Field Editor) Ma. Visitacion B. Balbuena Melba K. Banes Mary Grace B. Benabese Perlita L. Emperador Odessa O. Guanzon Jonas Clement V. Palangyos Ma. Teresa S. Cruz Evangeline dela Peña TEAM 42 Bernadette Gudelew (Team Supervisor) Janevive A. Base (Field Editor) Myrna Bang-alan Ma. Regina Batil Priscilla Uyami Arnold Gonzales Haydee Pad-ay Ronalyn Ayat Autonomous Region in Muslim Mindanao Noronisah Dimaronsing (Regional Supervisor) TEAM 43 Soraida U. Macalaba (Team Supervisor) Jasmin M. Tumindig (Field Editor) Rohaima B. Ambor Swanie M. Disangcopna Abdullah D. Guro Mussah B. Macud Rashiba D. Magangcong Anwar M. Abdul Marifei A. Ayob Maribel Vialani U. Naki Jubaida C. Tamon TEAM 44 Vilma Halud (Team Supervisor) Khambra Mohammad (Field Editor) Defina W. Bisman Andrew M. Shadal Shaharazad T. Tantung FIELD SUPERVISORS FROM CENTRAL OFFICE Macro International. Inc. Sri Poedjastoeti (Consultant) National Statistics Office Josie B. Perez Socorro D. Abejo Benedicta A. Yabut Aurora T. Reolalas Apolinar F. Oblea Edna B. Rapanot Ma. Virginia R. Olveña Priscilla E. Bacus Elpidio A. Maramot Zenaida M. Tapire Erlinda G. Silang Girlie M. Salvacion Wilma S. Sulit Amelia G. Saripada Ma. Theresa T. Rapanan Maritess Q. Tan Ma. Goretti M. Novilla Mario V. Olivar Appendix D | 261 DATA PROCESSING STAFF Macro International Inc. Glen Heller (Consultant) National Statistics Office Socorro D. Abejo Glenn B. Barcenas Elpidio A. Maramot Wilma S. Sulit Amelia G. Saripada Luzviminda G. Buensalida Ronald Calub Charito L. Capacete Mercedes C. Hoquis Hired Data Processors Romeo L. Abuan Dolores L. Aurelio Joan C. Basilio Noemi C. Benedicto Theresa O. Cua Christian Risseane A. de Castro Rene Rudino C. Dela Cruz Aser L. Dela Rosa Carlito G. Esmero Jeffrey U. Francisco Maria Fe B. Gane Brian A. Juyanan Anthony P. Mendoza Marlon B. Ortiz Cheryl P. Perez Davy Ser C. Robles Jeffry M. Sagala Elmer S. Samaniego Richard S. Tangi Allan Roy B. Tarrazona Aileen N. Tiangga Larry G. Tolentino Jona M. Valente Rialyn E. Zaldivar Christie A. Bulawan Deo Roel G. Catarroja Fondador A. Cornejo Christopher S. Galvez Charllot M. Garcia Dan Paolo M. Guevarra Edgardo P. Ranchez Mark M. Salomon Ronaldo M. Salvador Paulito Jr. H. Viray Appendix E | 263 QUESTIONNAIRES APPENDIX E AUTHORITY: Commonwealth Act No. 591 authorizes this survey and the Philippines National Statistics Office to collect information on fertility, family planning and health. CONFIDENTIALITY: Sec. 4 of CA No. 591 provides that all information furnished on this form is held STRICTLY CONFIDENTIAL. PHILIPPINES NATIONAL STATISTICS OFFICE 2003 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD QUESTIONNAIRE NDHS Form 1 NSCB Approval No. NSO-0305-01 Expires March 31, 2004 Set _____ of_____ sets IDENTIFICATION PROVINCE CITY/MUNICIPALITY_____________________________________________________________________ BARANGAY ____________________________________________________________________________ URBAN/RURAL (URBAN=1, RURAL=2). REPLICATE . PSU. EA . STRATUM. HOUSEHOLD CONTROL NUMBER . NDHS HOUSEHOLD SEQUENTIAL NUMBER. SELECTED FOR MALE SURVEY 1 YES 2 NO NAME OF HOUSEHOLD HEAD ADDRESS _____________________________________________________________________________ INTERVIEW RECORD 1 2 3 FINAL VISIT DAY MONTH YEAR 2 0 0 3 DATE INTERVIEWER’S NAME RESULT* INTERVIEWER CODE RESULT* NEXT VISIT: DATE TIME TOTAL NO. OF VISITS 7 TOTAL HOUSEHOLD MEMBERS AND VISITORSLANGUAGE OF QUESTIONNAIRE** LOCAL LANGUAGE OF RESPONDENT** TOTAL ELIGIBLE WOMEN LANGUAGE OF INTERVIEW** TOTAL ELIGIBLE MEN TRANSLATOR USED YES 1 NO 2 LINE NO. OF RESPONDENT TO THE HOUSEHOLD QUESTIONNAIRE TIME OF INTERVIEW TIME STARTED HR MIN TIME ENDED HR MIN *RESULT CODES: 01 COMPLETED, ORIGINAL HOUSEHOLD 02 COMPLETED, PRESENT OCCUPANT OF DWELLING 03 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 04 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 05 POSTPONED 06 REFUSED 07 DWELLING VACANT OR ADDRESS NOT A DWELLING 08 DWELLING DESTROYED 09 DWELLING NOT FOUND 10 OTHER (SPECIFY) **LANGUAGE CODES 1 TAGALOG 5 HILIGAYNON 2 CEBUANO 6 WARAY 3 ILOCANO 7 ENGLISH 4 BICOL 8 OTHER______________ (SPECIFY) OFFICE EDITOR ENCODER SUPERVISOR FIELD EDITOR Name and Signature Date Name and Signature Date 265Appendix E | HOUSEHOLD SCHEDULE Now I would like to ask you some information about the people who usually live in your household or who are staying with you now. USUAL RESIDENTS AND VISITORS RELATIONSHIP TO HEAD OF THE HOUSEHOLD** SEX RESIDENCE AGE ELIGIBILITY LINE NO. Please give me the names of the persons who usually live in your household and guests of the household who slept here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household? Is (NAME) male or female? Does (NAME) usually live here? Did (NAME) sleep here last night? How old is (NAME) as of his/her last birthday? CIRCLE LINE NUMBER OF ALL WOMEN AGE 15-49 CIRCLE LINE NUMBER OF ALL MEN AGE 15-54 (1) (2) (3) (4) (5) (6) (7) (8) (9) 01 M F 1 2 Y N 1 2 Y N 1 2 IN YEARS 01 01 02 1 2 1 2 1 2 02 02 03 1 2 1 2 1 2 03 03 04 1 2 1 2 1 2 04 04 05 1 2 1 2 1 2 05 05 06 1 2 1 2 1 2 06 06 07 1 2 1 2 1 2 07 07 08 1 2 1 2 1 2 08 08 09 1 2 1 2 1 2 09 09 10 1 2 1 2 1 2 10 10 11 1 2 1 2 1 2 11 11 12 1 2 1 2 1 2 12 12 1) Are there any other persons such as small children or infants that we have not listed? YES ENTER EACH IN TABLE NO 2) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends who usually live here? YES ENTER EACH IN TABLE NO 3) Are there any guests or temporary visitors staying here, or anyone else who slept here last night, who have not been listed? YES ENTER EACH IN TABLE NO TICK HERE IF CONTINUATION SHEET IS USED **CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 04 = SON-IN-LAW OR DAUGHTER-IN-LAW 07 = PARENT-IN-LAW 10 = ADOPTED/FOSTER/STEPCHILD 02 = WIFE OR HUSBAND 05 = GRANDCHILD 08 = BROTHER OR SISTER 11 = NOT RELATED 03 = SON OR DAUGHTER 06 = PARENT 09 = OTHER RELATIVE 98 = DON’T KNOW 266 | Appendix E HOUSEHOLD SCHEDULE EDUCATION IF AGE IS 5 YEARS OR OLDER IF ATTENDED SCHOOL IF AGE IS 5–24 YEARS CURRENT SCHOOL YEAR PREVIOUS SCHOOL YEAR LINE NO. Has (NAME) ever attended school? What is the highest grade/year (NAME ) completed?*** During the school year June 2003- April 2004, is (NAME) attending school at any time? During this school year, what grade/year is (NAME) attending?*** During the school year June 2002-April 2003, did (NAME) attend school at any time? During that school year, what grade/year did (NAME) attend?*** (10) (11) (12) (13) (14) (15) YES NO GRADE/YEAR YES NO GRADE/YEAR YES NO GRADE/YEAR 01 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 02 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 03 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 04 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 05 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 06 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 07 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 08 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 09 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 10 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 11 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 12 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 1 2 GO TO 14 1 2 GO TO NEXT HHOLD MEMBER, ELSE GO TO 16 ***CODES FOR Q. 11, 13 and 15 GRADE/YEAR: 00 = NO GRADE COMPLETED 01 = PRE-SCHOOL 11 = ELEMENTARY GRADE 1 12 = ELEMENTARY GRADE 2 13 = ELEMENTARY GRADE 3 14 = ELEMENTARY GRADE 4 15 = ELEMENTARY GRADE 5 16 = ELEMENTARY GRADE 6 17 = ELEMENTARY GRADE 7 18 = ELEMENTARY GRADUATE 21 = HIGH SCHOOL YEAR 1 22 = HIGH SCHOOL YEAR 2 23 = HIGH SCHOOL YEAR 3 24 = HIGH SCHOOL YEAR 4 25 = HIGH SCHOOL YEAR 5 26 = HIGH SCHOOL GRADUATE 31 = POSTSECONDARY YEAR 1 32 = POSTSECONDARY YEAR 2 OR MORE 41 = COLLEGE YEAR 1 42 = COLLEGE YEAR 2 43 = COLLEGE YEAR 3 44 = COLLEGE YEAR 4 45 = COLLEGE YEAR 5 46 = COLLEGE YEAR 6 OR HIGHER 47 = COLLEGE GRADUATE 51 = POST BACCALAUREATE 98 = DON’T KNOW 267Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 16 Does your household or any member of your household have: Electricity? A radio/radio cassette? A television? A landline telephone? A cellular phone? A washing machine? A refrigerator/freezer? A CD/VCD/DVD player? A component/karaoke? A personal computer? YES NO ELECTRICITY .1 2 RADIO/RADIO CASSETTE.1 2 TELEVISION .1 2 LANDLINE TELEPHONE .1 2 CELLULAR PHONE .1 2 WASHING MACHINE.1 2 REFRIGERATOR/FREEZER .1 2 CD/VCD/DVD PLAYER.1 2 COMPONENT/KARAOKE.1 2 PERSONAL COMPUTER .1 2 17 Does your household or any member of your household own: A tractor? A motorized banca/boat? A car/jeep/van? A motorcycle/tricycle? A bicycle/pedicab? YES NO TRACTOR .1 2 MOTORIZED BANCA/BOAT.1 2 CAR/JEEP/VAN.1 2 MOTORCYCLE/TRICYCLE .1 2 BICYCLE/PEDICAB .1 2 18 What is the main source of drinking water for members of your household? COMMUNITY WATER SYSTEM PIPED INTO DWELLING. 11 YARD/PLOT. 12 PUBLIC TAP . 13 POINT SOURCE PROTECTED WELL . 21 UNPROTECTED (OPEN DUG WELL) . 22 DEVELOPED SPRING. 31 UNDEVELOPED SPRING. 32 RIVER/STREAM/POND/LAKE/DAM. 33 BOTTLED WATER/REFILLING STATION. 41 RAINWATER. 51 TANKER TRUCK/PEDDLER. 61 OTHER 96 (SPECIFY) 19 How long does it take you to go there, get water, and come back? MINUTES .11 ON PREMISES .996 19A In the last month, how frequently is water available from (SOURCE IN Q.18)? USUALLY ALWAYS AVAILABLE.1 SEVERAL HOURS PER DAY .2 ONCE OR TWICE A WEEK .3 INFREQUENTLY.4 20 How do you make your water safe for drinking? PROBE: Anything else? CIRCLE ALL MENTIONED. DO NOT READ OUT RESPONSES. BOILING. A CHLORINATION . B FILTER EQUIPMENT.C IMPROVISED FILTER.D NONE . Y OTHER X (SPECIFY) 19A 19A 268 | Appendix E NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 21 What kind of toilet facility does your household use? FLUSH TOILET OWN TOILET .11 SHARED TOILET.12 PIT TOILET/LATRINE CLOSE PIT.21 OPEN PIT.22 DROP/OVERHANG.31 NO TOILET/FIELD/BUSH .41 OTHER 96 (SPECIFY) 22 What is the tenure status of your lot? OWNED/BEING AMORTIZED .1 RENTED.2 RENT-FREE WITH CONSENT OF OWNER.3 RENT-FREE WITHOUT CONSENT OF OWNER.4 23 MAIN MATERIAL OF THE FLOOR RECORD OBSERVATION. NATURAL FLOOR EARTH/SAND .11 RUDIMENTARY FLOOR WOOD PLANKS.21 PALM/BAMBOO.22 FINISHED FLOOR PARQUET OR POLISHED WOOD.31 VINYL OR ASPHALT STRIPS .32 CERAMIC TILES.33 CEMENT .34 MARBLE.35 OTHER 96 (SPECIFY) 24 MAIN MATERIAL OF OUTER WALLS RECORD OBSERVATION. CONCRETE/BRICK/STONE.11 WOOD.12 HALF CONCRETE/BRICK/STONE/AND HALF WOOD.13 GALVANIZED IRON/ALUMINUM.14 BAMBOO/SAWALI/COGON/NIPA .15 ASBESTOS .16 GLASS.17 MAKESHIFT/SALVAGED/IMPROVISED MATERIALS.18 NO WALLS.19 OTHER 96 (SPECIFY) 269Appendix E | AGE – BIRTH YEAR CONSISTENCY CHART Age Has not had birthday in 2003 Has already had birthday in 2003 Age Has not had birthday in 2003 Has already had birthday in 2003 Don’t Know Don’t Know 0 2002 -- 30 1972 1973 1 2001 2002 31 1971 1972 2 2000 2001 32 1970 1971 3 1999 2000 33 1969 1970 4 1998 1999 34 1968 1969 5 1997 1998 35 1967 1968 6 1996 1997 36 1966 1967 7 1995 1996 37 1965 1966 8 1994 1995 38 1964 1965 9 1993 1994 39 1963 1964 10 1992 1993 40 1962 1963 11 1991 1992 41 1961 1962 12 1990 1991 42 1960 1961 13 1989 1990 43 1959 1960 14 1988 1989 44 1958 1959 15 1987 1988 45 1957 1958 16 1986 1987 46 1956 1957 17 1985 1986 47 1955 1956 18 1984 1985 48 1954 1955 19 1983 1984 49 1953 1954 20 1982 1983 50 1952 1953 21 1981 1982 51 1951 1952 22 1980 1981 52 1950 1951 23 1979 1980 53 1949 1950 24 1978 1979 54 1948 1949 25 1977 1978 55 1947 1948 26 1976 1977 56 1946 1947 27 1975 1976 57 1945 1946 28 1974 1975 58 1944 1945 29 1973 1974 59 1943 1944 270 | Appendix E AUTHORITY: Commonwealth Act No. 591 authorizes this survey and the Philippines National Statistics Office to collect information on fertility, family planning and health. CONFIDENTIALITY: Sec. 4 of CA No. 591 provides that all information furnished on this form is held STRICTLY CONFIDENTIAL. PHILIPPINES NATIONAL STATISTICS OFFICE 2003 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY INDIVIDUAL WOMAN’S QUESTIONNAIRE NDHS Form 2 NSCB Approval No. NSO-0305-02 Expires March 31, 2004 Set ____ of ____sets IDENTIFICATION PROVINCE _________________________________________________________________________ CITY/MUNICIPALITY _________________________________________________________________ BARANGAY ________________________________________________________________________ URBAN/RURAL (URBAN=1, RURAL=2). REPLICATE. PSU . EA . STRATUM . HOUSEHOLD CONTROL NUMBER. NDHS HOUSEHOLD SEQUENTIAL NUMBER . NAME OF HOUSEHOLD HEAD_________________________________________________________ NAME AND LINE NUMBER OF ELIGIBLE WOMAN_________________________________________ ADDRESS INTERVIEW RECORD 1 2 3 FINAL VISIT DATE ________________ _________________ ___________________ DAY MONTH YEAR 2 0 0 3 INTERVIEWER’S NAME ________________ _________________ ___________________ INTERVIEWER CODE RESULT* ________________ _________________ ___________________ RESULT* NEXT VISIT: DATE ________________ _________________ TOTAL NO. OF VISITS TIME ________________ _________________ *RESULT CODES : 1 COMPLETED 4 REFUSED 7 OTHER_____________________________ 2 NOT AT HOME 5 PARTLY COMPLETED (SPECIFY) 3 POSTPONED 6 RESPONDENT INCAPACITATED LANGUAGE OF QUESTIONNAIRE** 7 LANGUAGE OF INTERVIEW** TRANSLATOR USED YES 1 LOCAL LANGUAGE OF NO 2 RESPONDENT** **LANGUAGE CODES 1 TAGALOG 3 ILOCANO 5 HILIGAYNON 7 ENGLISH 2 CEBUANO 4 BICOL 6 WARAY 8 OTHER (SPECIFY) SUPERVISOR FIELD EDITOR OFFICE EDITOR ENCODER ____________________________ Name and Signature _______ Date _____________________________ Name and Signature _______ Date 271Appendix E | SECTION 1. RESPONDENT’S BACKGROUND INTRODUCTION AND CONSENT Hello. My name is and I am working with the Philippines National Statistics Office. We are conducting a national survey about the health of women and children. We would very much appreciate your participation in this survey. I would like to ask you about your health (and the health of your children). This information will help the government to plan health services. Whatever information you provide will be kept strictly confidential and will not be shown to other persons. Do you have any questions about the survey? May I begin the interview now? SIGNATURE OF INTERVIEWER: DATE: NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 101 RECORD THE TIME. HOUR . MINUTES . 102 First I would like to ask some questions about you. For most of the time until you were 12 years old, did you live in a city, in a town/poblacion or in the barrio/rural area? CITY .1 TOWN/POBLACION.2 BARRIO/RURAL AREA.3 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? IF LESS THAN ONE YEAR, RECORD ‘00' YEARS. YEARS . SINCE BIRTH.95 VISITOR .96 104 Just before you moved here, did you live in a city, in a town/poblacion, or in the barrio/rural area? CITY .1 TOWN/POBLACION.2 BARRIO/RURAL AREA.3 105 In what month and year were you born? MONTH . DON’T KNOW MONTH .98 YEAR. DON’T KNOW YEAR.9998 106 How old were you at your last birthday? COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. AGE IN COMPLETED YEARS. 107 Have you ever attended school? YES .1 NO .2 105 110 272 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 108 What is the highest grade/year you completed? NO GRADE COMPLETED 00 PRE-SCHOOL 01 ELEMENTARY GRADE 1 11 ELEMENTARY GRADE 2 12 ELEMENTARY GRADE 3 13 ELEMENTARY GRADE 4 14 ELEMENTARY GRADE 5 15 ELEMENTARY GRADE 6 16 ELEMENTARY GRADUATE 17 HIGH SCHOOL YEAR 1 21 HIGH SCHOOL YEAR 2 22 HIGH SCHOOL YEAR 3 23 HIGH SCHOOL YEAR 4 24 HIGH SCHOOL GRADUATE 25 POSTSECONDARY YEAR 1 31 POSTSECONDARY YEAR 2 OR MORE 32 COLLEGE YEAR 1 41 COLLEGE YEAR 2 42 COLLEGE YEAR 3 43 COLLEGE YEAR 4 44 COLLEGE YEAR 5 45 COLLEGE YEAR 6 OR HIGHER 46 COLLEGE GRADUATE 47 POST-BACCALAUREATE 51 DON’T KNOW 98 109 CHECK 108: ELEMENTARY HIGH SCHOOL GRADUATE OR YEAR 1 OR HIGHER LOWER � 110 Now I would like you to read this sentence to me. SHOW CARD TO RESPONDENT. IF RESPONDENT CANNOT READ WHOLE SENTENCE, PROBE: Can you read any part of the sentence to me? CANNOT READ AT ALL .1 ABLE TO READ ONLY PARTS OF SENTENCE.2 ABLE TO READ WHOLE SENTENCE.3 NO CARD WITH REQUIRED LANGUAGE 4 (SPECIFY LANGUAGE) VISION PROBLEMS .5 111 Have you ever participated in a literacy program or any other program that involves learning to read or write (not including primary school)? YES .1 NO .2 112 CHECK 110: CODE ‘2', ‘3' CODE ’1' OR ’4' CIRCLED CIRCLED 113 114 115 273Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 113 Do you read a newspaper or magazine daily, at least once a week, less than once a week or not at all? DAILY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 114 Do you watch television daily, at least once a week, less than once a week or not at all? DAILY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 115 Do you listen to the radio daily, at least once a week, less than once a week or not at all? DAILY .1 AT LEAST ONCE A WEEK .2 LESS THAN ONCE A WEEK .3 NOT AT ALL .4 116 What is your religion? ROMAN CATHOLIC .1 PROTESTANT .2 IGLESIA NI KRISTO.3 AGLIPAY .4 ISLAM.5 OTHER 6 (SPECIFY) NONE .7 117 How do you classify yourself? Are you a Tagalog, Cebuano, Ilocano, Ilonggo, Bicolano, Waray, Kapampangan, or something else? TAGALOG .1 CEBUANO.2 ILOCANO .3 ILONGGO.4 BICOLANO .5 WARAY .6 KAPAMPANGAN.7 OTHER 8 (SPECIFY) . 274 | Appendix E 6 1 SECTION 2: REPRODUCTION Now I would like to ask about all the pregnancies you have had during your life. By this I mean all the children born to you, whether they were born alive or dead, whether they are still living or not, whether they live with you or somewhere else, and all the pregnancies which you have had that did not result in a live birth. I understand that it is not easy to talk about children who have died or pregnancies that ended before full term, but it is important that you tell us about all of them, so that we can develop programs to improve children’s health. NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 201 Have you ever given birth? YES .1 NO .2 202 Do you have any sons or daughters to whom you have given birth who are now living with you? YES .1 NO .2 203 How many sons live with you? And how many daughters live with you? IF NONE, RECORD ‘00'. SONS AT HOME . DAUGHTERS AT HOME. 204 Do you have any sons or daughters to whom you have given birth who are alive but do not live with you? YES .1 NO .2 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live with you? IF NONE, RECORD ‘00'. SONS ELSEWHERE. DAUGHTERS ELSEWHERE . 206 Have you ever given birth to a boy or girl who was born alive but later died? IF NO, PROBE: Any baby who cried or showed signs of life but did not survive? YES .1 NO .2 207 How many boys have died? And how many girls have died? IF NONE, RECORD ‘00'. BOYS DEAD. GIRLS DEAD. 208 Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end early, in a miscarriage or the child can be born dead. Have you ever had a pregnancy that did not end in a live birth? YES .1 NO .2 209 In all, how many such pregnancies have there been? PREGNANCY LOSSES . 210 SUM ANSWERS TO 203, 205, 207, AND 209 AND ENTER TOTAL. IF NONE, RECORD ‘00'. TOTAL . 211 CHECK 210: Just to make sure that I have this right: you have had _____ children who are still living (CHECK 203 AND 205) _____ children who have died (CHECK 207) _____ pregnancies that did not result in a live birth (CHECK 209). You have had in TOTAL _____ pregnancies during your life. Is that correct? PROBE AND YES NO CORRECT 201-210 AS NECESSARY. 212 CHECK 210: ONE OR MORE NO PREGNANCIES PREGNANCIES 206 204 206 208 210 234 275Appendix E | 213 Now I would like to record all your pregnancies, whether born alive, born dead, or lost before birth. Start with the first pregnancy you had. RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 214 215 216 217 218 219 220 221 Think back to the time of your first/next pregnancy. Was that a single or multiple pregnancy? Was the baby born alive, born dead, or lost before full term? Did that baby cry, move, or breathe when it was born? What name was given to that child? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? 01 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 02 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 03 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 04 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 05 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 06 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 07 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 08 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 ________________________ (NAME) BOY .1 GIRL.2 MONTH…. YEAR YES.1 NO .2 226 225 226 225 226 225 226 225 226 225 226 225 226 225 226 225 276 | Appendix E 6 1 IF BORN ALIVE AND STILL LIVING IF BORN ALIVE, BUT NOW DEAD IF BORN DEAD OR LOST BEFORE BIRTH 222 223 224 225 226 227 228 229 How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00' IF CHILD NOT LISTED IN HOUSEHOLD) How old was (NAME) when he/she died? IF ‘1 YR’, PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS. In what month and year did this pregnancy end? How many months did the pregnancy last? RECORD IN COMPLETED MONTHS. Did you or someone else do anything to end this pregnancy? Were there any other pregnancies between the previous pregnancy and this pregnancy? 01 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (NEXT PREGNANCY) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 02 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 03 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 04 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 05 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 06 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 07 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 08 AGE IN YEARS YES. 1 NO . 2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES. 1 NO. 2 YES.1 NO.2 277Appendix E | 213 RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES. 214 215 216 217 218 219 220 221 Think back to the time of your first/next pregnancy. Was that a single or multiple pregnancy? Was the baby born alive, born dead, or lost before full term? Did that baby cry, move, or breathe when it was born? What name was given to that child? Is (NAME) a boy or a girl? In what month and year was (NAME) born? PROBE: What is his/her birthday? Is (NAME) still alive? 09 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 10 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 11 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 12 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 13 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 14 SINGLE….1 MULTIPLE.2 BORN ALIVE.1 (SKIP TO 218) BORN DEAD .2 LOST BEFORE FULL TERM .3 (SKIP TO 226) YES . 1 NO. 2 _________________________ (NAME) BOY.1 GIRL .2 MONTH…. YEAR YES . 1 NO . 2 225226 225226 225226 225226 225226 225226 278 | Appendix E 6 1 IF BORN ALIVE AND STILL LIVING IF BORN ALIVE, BUT NOW DEAD IF BORN DEAD OR LOST BEFORE BIRTH 222 223 224 225 226 227 228 229 How old was (NAME) at his/her last birthday? RECORD AGE IN COM- PLETED YEARS. Is (NAME) living with you? RECORD HOUSEHOLD LINE NUMBER OF CHILD (RECORD ‘00' IF CHILD NOT LISTED IN HOUSEHOLD) How old was (NAME) when he/she died? IF ‘1 YR’, PROBE: How many months old was (NAME)? RECORD DAYS IF LESS THAN 1 MONTH; MONTHS IF LESS THAN 2 YEARS; OR YEARS. In what month and year did this pregnancy end? How many months did the pregnancy last? RECORD IN COMPLETED MONTHS. Did you or someone else do anything to end this pregnancy? Were there any other pregnancies between the previous pregnancy and this pregnancy? 09 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 10 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 YES .1 NO .2 11 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 YES .1 NO .2 12 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 YES .1 NO .2 13 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 YES .1 NO .2 14 AGE IN YEARS YES.1 NO.2 LINE NUMBER (SKIP TO 229) DAYS………1 MONTHS….2 YEARS…….3 (SKIP TO 229) MONTH…. YEAR MONTHS YES .1 NO.2 YES .1 NO .2 230 Have you had any pregnancy since the last pregnancy mentioned? YES . 1 NO. 2 231 COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY ABOVE AND MARK: NUMBERS NUMBERS ARE ARE SAME DIFFERENT (PROBE AND RECONCILE) CHECK: FOR EACH PREGNANCY: YEAR IS RECORDED IN 220 OR 226. FOR EACH LIVING CHILD: CURRENT AGE IS RECORDED IN 222. FOR EACH DEAD CHILD: AGE AT DEATH IS RECORDED IN 225 FOR AGE AT DEATH 12 MOS OR 1 YR: PROBE FOR EXACT NO. OF MONTHS. 279Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 232 CHECK 220 AND ENTER THE NUMBER OF LIVE BIRTHS SINCE JANUARY 1998. IF NONE, RECORD ‘0'. 233 FOR EACH BIRTH SINCE JANUARY 1998, ENTER ‘B’ IN THE MONTH OF BIRTH IN COLUMN 1 OF THE CALENDAR. FOR EACH BIRTH, ASK THE NUMBER OF MONTHS THE PREGNANCY LASTED AND RECORD ‘P’ IN EACH OF THE PRECEDING MONTHS ACCORDING TO THE DURATION OF PREGNANCY. (NOTE: THE NUMBER OF ‘P’s MUST BE ONE LESS THAN THE NUMBER OF MONTHS THAT THE PREGNANCY LASTED.) WRITE THE NAME OF THE CHILD TO THE LEFT OF THE ‘B’ CODE. 234 Are you pregnant now? YES .1 NO .2 UNSURE .8 235 How many months pregnant are you? RECORD NUMBER OF COMPLETED MONTHS. ENTER ‘P’s IN COLUMN 1 OF CALENDAR, BEGINNING WITH THE MONTH OF INTERVIEW AND FOR THE TOTAL NUMBER OF COMPLETED MONTHS. MONTHS . 236 At the time you became pregnant did you want to become pregnant then, did you want to wait until later, or did you not want to become pregnant at all? WANTED THEN .1 WANTED TO WAIT LATER .2 DID NOT WANT AT ALL .3 237 When did your last menstrual period start? (DATE, IF GIVEN) DAYS AGO. 1 WEEKS AGO. 2 MONTHS AGO . 3 YEARS AGO . 4 IN MENOPAUSE/ HAS HAD HYSTERECTOMY .994 BEFORE LAST BIRTH .995 NEVER MENSTRUATED.996 238 From one menstrual period to the next, is there a time when a woman is more likely to become pregnant if she has sexual relations? YES .1 NO .2 DON’T KNOW .8 239 Is this time just before her period begins, during her period, right after her period has ended, or half way between two periods? JUST BEFORE HER PERIOD BEGINS.1 DURING HER PERIOD .2 RIGHT AFTER HER PERIOD HAS ENDED.3 HALF WAY BETWEEN TWO PERIODS.4 OTHER 6 (SPECIFY) DON’T KNOW .8 240 How old were you when you had your first menstrual period? AGE . 237 280 | Appendix E 6 1 SECTION 3. CONTRACEPTION Now I would like to talk about family planning - the various ways or methods that a couple can use to delay or avoid a pregnancy. CIRCLE CODE 1 IN 301 FOR EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN COLUMN 301, READING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTANEOUSLY. CIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 CIRCLED IN 301, ASK 302. 301 Which ways or methods have you heard about? FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: Have you ever heard of (METHOD)? 302 Have you ever used (METHOD)? 01 LIGATION/FEMALE STERILIZATION Women can have an operation to avoid having any more children. YES. 1 NO . 2 Have you ever had an operation to avoid having any more children? YES . 1 NO. 2 02 VASECTOMY/MALE STERILIZATION Men can have an operation to avoid having any more children. YES. 1 NO . 2 Have you ever had a partner who had an operation to avoid having any more children? YES . 1 NO. 2 DON’T KNOW . 8 03 PILL Women can take a pill every day to avoid becoming pregnant. YES. 1 NO . 2 YES . 1 NO. 2 04 IUD Women can have a loop or coil placed inside them by a doctor or a nurse. YES. 1 NO . 2 YES . 1 NO. 2 05 INJECTABLES Women can have an injection by a health provider that stops them from becoming pregnant for one or more months. YES. 1 NO . 2 YES . 1 NO. 2 06 CONDOM Men can put a rubber sheath on their penis during sexual intercourse. YES. 1 NO . 2 Have you ever had a partner who used condom? YES . 1 NO. 2 07 DIAPHRAGM Women can place a thin flexible disk in their vagina before intercourse. YES. 1 NO . 2 YES . 1 NO. 2 08 FOAM OR JELLY Women can place a suppository, jelly, or cream in their vagina before intercourse. YES. 1 NO . 2 YES . 1 NO. 2 09 IMPLANTS Women can have several small rods placed in their upper arm by a doctor or nurse which can prevent pregnancy for one or more years. YES. 1 NO . 2 YES . 1 NO. 2 10 FEMALE CONDOM Women can place a sheath in their vagina before sexual intercourse. YES. 1 NO . 2 YES . 1 NO. 2 11 MUCUS, BILLINGS, OVULATION Women can monitor the cervical mucus to determine the days of the month they are most likely to get pregnant. YES. 1 NO . 2 YES . 1 NO. 2 12 BASAL BODY TEMPERATURE Women can monitor the body temperature to determine the days of the month they are most likely to get pregnant. YES. 1 NO . 2 YES . 1 NO. 2 13 SYMPTOTHERMAL It is a combination of Basal Body Temperature and Mucus, Billings, Ovulation Method. YES. 1 NO . 2 YES . 1 NO. 2 281Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 301 CONTINUATION 302 CONTINUATION 14 STANDARD DAYS METHOD This method uses a beaded necklace on which each bead represents the days of a woman’s cycle. The necklace would help determine the days when the woman is likely to get pregnant. YES. 1 NO . 2 YES . 1 NO. 2 15 LACTATIONAL AMENORRHEA METHOD (LAM) Method used by women with less than 6 months old baby, whose period has not returned, and are breastfeeding the baby day and night. The baby may be given little or no food or drink other than breastmilk. YES. 1 NO . 2 YES . 1 NO. 2 16 EMERGENCY CONTRACEPTION Women can take pills up to three days after sexual intercourse to avoid becoming pregnant. YES. 1 NO . 2 YES . 1 NO. 2 17 CALENDAR OR RHYTHM OR PERIODIC ABSTINENCE Every month that a woman is sexually active she can avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant. YES. 1 NO . 2 YES . 1 NO. 2 18 WITHDRAWAL Men can be careful and pull out before climax. YES. 1 NO . 2 YES . 1 NO. 2 19 Have you heard of any other ways or methods that women or men can use to avoid pregnancy? YES. 1 (SPECIFY) (SPECIFY) NO . 2 YES . 1 NO. 2 YES . 1 NO. 2 303A CHECK 301: AT LEAST ONE NOT A SINGLE “YES” “YES” (EVER HEARD) (NEVER HEARD) 303B CHECK 302: NOT A SINGLE AT LEAST ONE “YES” “YES” (NEVER USED) (EVER USED) 304 Have you ever used anything or tried in any way to delay or avoid getting pregnant? YES .1 NO.2 305A ENTER ‘0’ IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. 305B ENTER ‘0' IN COLUMN 1 OF CALENDAR IN EACH BLANK MONTH. 306 What have you used or done? CORRECT 301 302 AND 303B (AND 301 IF NECESSARY). 306A CHECK 301(01): LIGATION/FEMALE STERILIZATION CODE “1” CODE ‘2” CIRCLED CIRCLED 306B CHECK 302(01): LIGATION/FEMALE STERILIZATION WOMAN WAS NOT WOMAN WAS STERILIZED STERILIZED 302(01)=2 302(01)=1 306A 306 329 306D 306D 305B 306A 282 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 306C What have you heard about ligation or female sterilization? Anything else? RECORD ALL MENTIONED. PERMANENT/EFFECTIVE METHOD A SIMPLE/SAFE SURGERY B NO EFFECT ON SEXUAL ACTIVITY C NO SERIOUS SIDE EFFECTS D NONE OF THE ABOVE E NONE/DON’T KNOW Z 306D CHECK 301(02): VASECTOMY/MALE STERILIZATION CODE “1” CODE ‘2” CIRCLED CIRCLED 306E CHECK 302(02): VASECTOMY/MALE STERILIZATION CODE “2” CODE “1” CIRCLED CIRCLED 306F What have you heard about vasectomy or male sterilization? Anything else? RECORD ALL MENTIONED PERMANENT/EFFECTIVE METHOD A SIMPLE/SAFE SURGERY B NO EFFECT ON SEXUAL ACTIVITY C NO SERIOUS SIDE EFFECTS D NONE OF THE ABOVE E NONE/DON’T KNOW Z 306G CHECK 301(03): PILL CODE “1” CODE ‘2” CIRCLED CIRCLED 306H CHECK 302(03): PILL WOMAN HAS WOMAN HAS NEVER USED PILL USED PILL 306I What have you heard about the family planning pill? Anything else? RECORD ALL MENTIONED. CONTAINS HORMONES A TAKEN DAILY B PREVENT OVULATION C 21 OR 28 PILLS PER PACKET D NOT A PERMANENT METHOD E NO SERIOUS SIDE EFFECTS F EFFECTIVE METHOD G NONE OF THE ABOVE H NONE/DON’T KNOW Z 306J CHECK 301(04): IUD CODE “1” CODE ‘2” CIRCLED CIRCLED 306K CHECK 302(04): IUD WOMAN HAS WOMAN HAS NEVER USED IUD USED IUD 306M 306J 306J 306M 306G 306G 283Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 306L What have you heard about the Intra Uterine Device or IUD? Anything else? RECORD ALL MENTIONED. LONG LASTING A PREVENT FERTILIZATION B SMALL LOOP OR COIL INSERTED IN A WOMAN BY A DOCTOR, NURSE OR MIDWIFE C NOT A PERMANENT METHOD D NO SERIOUS SIDE EFFECTS E NONE OF THE ABOVE F NONE/DON’T KNOW Z 306M CHECK 301(05): INJECTABLES CODE “1” CODE ‘2” CIRCLED CIRCLED 306N CHECK 302(05): INJECTABLES WOMAN HAS NEVER WOMAN HAS USED INJECTION USED INJECTION 302(05)=2 302(05)=1 306O What have you heard about the family planning Injections? Anything else? RECORD ALL MENTIONED. INJECTED ONCE EVERY THREE MONTHS A EFFECTIVE METHOD B PREVENTS OVULATION C CONTAINS HORMONES D CHANGES IN MENSTRUAL FLOW E NOT A PERMANENT METHOD F NONE OF THE ABOVE G NONE/DON’T KNOW Z 306P CHECK 301(06): CONDOM CODE “1” CODE ‘2” CIRCLED CIRCLED 306Q CHECK 302(06): CONDOM CODE “2” CODE “1” CIRCLED CIRCLED 306R What have you heard about condoms? Anything else? RECORD ALL MENTIONED. PREVENT STDs/STIs A PRACTICAL/EASY TO USE B AVAILABLE IN STORES C RUBBER SHEATH PUT ON PENIS DURING SEX D PREVENT FERTILIZATION E NO NEED FOR MEDICAL CONSULTATION F NONE OF THE ABOVE G NONE/DON’T KNOW Z 306S CHECK 301(11): MUCUS, BILLINGS, OVULATION CODE “1” CODE ‘2” CIRCLED CIRCLED 306S 306S 307 306P 306P 284 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 306T CHECK 302(11): MUCUS, BILLINGS, OVULATION WOMAN HAS NEVER WOMAN HAS USED MUCUS, USED MUCUS, BILLINGS, OVULATION BILLINGS, OVULATION 302(11)=2 302(11)=1 306U What have you heard about mucus, Billings or ovulation method? Anything else? RECORD ALL MENTIONED. ACCEPTED BY RELIGION A VERY LITTLE OR NO COST B REQUIRES MAN’S COOPERATION C NO PHYSICAL SIDE EFFECT D REQUIRES MONITORING OF MENSTRUAL CYCLE/FERTILE PERIOD E CANNOT HAVE SEXUAL INTERCOURSE DURING CERTAIN DAYS OF THE MONTH F NONE OF THE ABOVE G NONE/DON’T KNOW Z 307 CHECK 302: AT LEAST ONE NOT A SINGLE “YES” “YES” (EVER USED) (NEVER USED) 307A Now I would like to ask you about the first time that you did something or used a method to avoid getting pregnant. How many living children did you have at that time, if any? IF NONE, RECORD ‘00'. NUMBER OF CHILDREN. 307B How old were you when you first started using a method of family planning? AGE . 308 CHECK 302 (01): WOMAN NOT WOMAN STERILIZED STERILIZED 302(01)=2 302(01)=1 309 CHECK 234: NOT PREGNANT PREGNANT OR UNSURE 310 Are you currently doing something or using any method to delay or avoid getting pregnant? YES . 1 NO . 2 311A 318 318 307 329 285Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 311 311A Which method are you using? IF MORE THAN ONE METHOD MENTIONED, FOLLOW SKIP INSTRUCTION FOR HIGHEST METHOD ON LIST. CIRCLE ‘A' FOR FEMALE STERILIZATION. FEMALE STERILIZATION .A MALE STERILIZATION .B PILL .C IUD .D INJECTABLES .E CONDOM . F DIAPHRAGM. G FOAM/JELLY.H IMPLANTS. I FEMALE CONDOM. J MUCUS, BILLINGS, OVULATION .K BASAL BODY TEMPERATURE. L SYMPTOTHERMAL . M STANDARD DAYS METHOD .N LACTATIONAL AMEN. METHOD. O EMERGENCY CONTRACEPTION .P CALENDAR/RHYTHM/PERIODIC ABSTINENCE . Q WITHDRAWAL .R OTHER___________________________X (SPECIFY) 312 May I see the package of pills you are now using? RECORD NAME OF BRAND IF PACKAGE IS SEEN. PACKAGE SEEN .1 BRAND NAME _________________________ PACKAGE NOT SEEN.2 312A What is the brand name of the pills you are using now? RECORD NAME OF BRAND. BRAND NAME ________________________ DON’T KNOW .98 312B How much (in cash) does one packet (cycle) of pills cost you? PESO. FREE . 996 DON’T KNOW . 998 313 In what facility did the sterilization take place? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) PUBLIC SECTOR GOVT. HOSPITAL . 11 RURAL/URBAN HEALTH CENTER. 12 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PRIVATE DOCTOR . 22 PRIVATE NURSE/MIDWIFE. 23 OTHER 96 (SPECIFY) 314 CHECK 311: CODE ‘A’ CIRCLED Before your sterilization operation, were you told that you would not be able to have any (more) children because of the operation? CODE ‘B’ CIRCLED Before the sterilization operation, was your husband/partner told that he would not be able to have any (more) children because of the operation? YES . 1 NO . 2 DON’T KNOW . 8 313 312B 315A 312 315A 286 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 315 In what month and year was the sterilization performed? MONTH . YEAR. 315A For how long have you been using (CURRENT METHOD) now without stopping? PROBE: In what month and year did you start using (CURRENT METHOD) continuously? MONTH . YEAR. 315B CHECK 311: CODE ‘A’ TO ‘F’ CODE ‘G’ TO ‘X’ CIRCLED CIRCLED 316 How much would you be willing to pay for (METHOD)(including all costs)? FOR: PILL AND CONDOM, ASK COST OF ONE PACKET IUD, ASK COST OF INSERTION AND ANY OTHER FEES INJECTABLE, ASK COST OF VIAL AND SERVICE STERILIZATION, ASK COST OF OPERATION AND SERVICE PESO. FREE . 99996 DON’T KNOW . 99998 316A How long did it take to travel from your home to where you or your partner had the operation/obtain/learn about the (CURRENT METHOD)? IF LESS THAN 2 HOURS, RECORD IN MINUTES. ELSE, RECORD IN HOURS. MINUTES . 1 HOURS. 2 DON’T KNOW . 9998 316B CHECK 315/315A, 220 AND 226: ANY BIRTH OR PREGNANCY TERMINATION AFTER MONTH YES NO AND YEAR OF START OF USE OF CONTRACEPTION IN 315/315A � � GO BACK TO 315/315A, PROBE AND RECORD MONTH AND YEAR AT START OF CONTINUOUS USE OF CURRENT METHOD (MUST BE AFTER LAST BIRTH OR PREGNANCY TERMINATION). 317 CHECK 315/315A: YEAR IS 1998 OR LATER ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND IN EACH MONTH BACK TO THE DATE STARTED USING. YEAR IS 1997 OR EARLIER ENTER CODE FOR METHOD USED IN MONTH OF INTERVIEW IN COLUMN 1 OF THE CALENDAR AND EACH MONTH BACK TO JANUARY 1998. THEN SKIP TO 327. 315B 316A 287Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 318 I would like to ask you some questions about the times you or your partner may have used a method to avoid getting pregnant during the last few years. USE CALENDAR TO PROBE FOR EARLIER PERIODS OF USE AND NONUSE, STARTING WITH MOST RECENT USE, BACK TO JANUARY 1998. USE NAMES OF CHILDREN, DATES OF BIRTH, AND PERIODS OF PREGNANCY AS REFERENCE POINTS. IN COLUMN 1, ENTER METHOD USE CODE OR ‘0’ FOR NONUSE IN EACH BLANK MONTH. ILLUSTRATIVE QUESTIONS: COLUMN 1: • When was the last time you used a method? Which method was that? • When did you start using that method? How long after the birth of (NAME)? • How long did you use the method then? IN COLUMN 2, ENTER METHOD SOURCE CODE IN FIRST MONTH OF EACH USE. ILLUSTRATIVE QUESTIONS: COLUMN 2: • Where did you obtain the method when you started using it? • Where did you get advice on how to use the method [for LAM, mucus, billings, ovulation, basal body temperature, symptothermal, rhythm, periodic abstinence, standard days method, calendar or withdrawal]? IN COLUMN 3, ENTER CODES FOR REASONS FOR DISCONTINUATION NEXT TO LAST MONTH OF USE. NUMBER OF CODES IN COLUMN 3 MUST BE SAME AS NUMBER OF INTERRUPTIONS OF METHOD USE IN COLUMN 1. ASK WHY SHE STOPPED USING THE METHOD. IF A PREGNANCY FOLLOWED, ASK WHETHER SHE BECAME PREGNANT UNINTENTIONALLY WHILE USING THE METHOD OR DELIBERATELY STOPPED TO GET PREGNANT. ILLUSTRATIVE QUESTIONS: COLUMN 3: • Why did you stop using the (METHOD)? • Did you become pregnant while using (METHOD), or did you stop to get pregnant, or did you stop for some other reason? IF DELIBERATELY STOPPED TO BECOME PREGNANT, ASK: • How many months did it take you to get pregnant after you stopped using (METHOD)? AND ENTER ‘0’ IN EACH SUCH MONTH IN COLUMN 1. 319 CHECK CALENDAR COLUMN (3) FOR THE LAST DISCONTINUATION: CODE 5 OR 6 OTHER CODES OR BLANK COLUMN 320 You said that you stopped using (METHOD) because of (PROBLEM MENTIONED BY RESPONDENT). IF PROBLEM IS NOT SPECIFIED: What are the problems which caused you to stop using (METHOD)? IF SPECIFIED: Are there any other problems? RECORD ALL MENTIONED. IRREGULAR MENSTRUAL FLOW A INFREQUENT/NO MONTHLY PERIOD B NAUSEA, VOMITING, HEADACHE C BREAST TENDERNESS/SENSITIVITY D WEIGHT GAIN/LOSS E UPSET STOMACH, DIARRHEA F DEPRESSION, IRRITABILITY G LOSS OF INTEREST IN SEX H SKIN PROBLEMS I ITCHINESS/PAIN IN GENITAL AREA J HYPERTENSION K ANEMIA L OTHER X (SPECIFY) 321 288 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 321 CHECK 311/311A: CIRCLE METHOD CODE: IF MORE THAN ONE METHOD CODE CIRCLED IN 311/311A, CIRCLE CODE FOR HIGHEST METHOD IN LIST. NO CODE CIRCLED . 00 FEMALE STERILIZATION . 01 MALE STERILIZATION . 02 PILL . 03 IUD . 04 INJECTABLES . 05 CONDOM . 06 DIAPHRAGM. 07 FOAM/JELLY. 08 IMPLANTS. 09 FEMALE CONDOM. 10 MUCUS, BILLINGS, OVULATION . 11 BASAL BODY TEMPERATURE. 12 SYMPTOTHERMAL . 13 STANDARD DAYS METHOD . 14 LACTATIONAL AMEN. METHOD. 15 EMERGENCY CONTRACEPTION . 16 CALENDAR/RHYTHM/PERIODIC ABSTINENCE . 17 WITHDRAWAL . 18 OTHER METHOD _________________ 96 322 You obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE). At that time, were you ever told about side effects or problems you might have with the method? YES . 1 NO . 2 323 Were you ever told by a health or family planning worker about side effects or problems you might have with the method? YES . 1 NO . 2 324 Were you told what to do if you experienced side effects or problems? YES . 1 NO . 2 324A Are you having any problem with using (NAME OF METHOD)? YES .1 NO .2 324B What is your main problem with using (NAME OF METHOD)? HUSBAND DISAPPROVES .1 SIDE EFFECTS.2 HEALTH CONCERNS.3 DIFFICULT TO OBTAIN.4 COSTS TOO MUCH.5 INCONVENIENT TO USE .6 OTHER _________________________ 8 (SPECIFY) 325 CHECK 322: CODE ‘1’ CIRCLED � When you obtained (CURRENT METHOD), were you told about other methods of family planning that you could use? CODE ‘1’ NOT CIRCLED When you obtained (CURRENT METHOD) from (SOURCE OF METHOD FROM CALENDAR) in (DATE), were you told about other methods of family planning that you could use? YES . 1 NO . 2 329 322 331 328 324A 331 324A 324 324A 325 327 289Appendix E | NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 326 Were you ever told by a health or family planning worker about other methods of family planning that you could use? YES . 1 NO . 2 327 CHECK 311/311A: CIRCLE METHOD CODE: FEMALE STERILIZATION . 01 MALE STERILIZATION . 02 PILL . 03 IUD . 04 INJECTABLES . 05 CONDOM . 06 DIAPHRAGM. 07 FOAM/JELLY. 08 IMPLANTS. 09 FEMALE CONDOM. 10 MUCUS, BILLINGS, OVULATION . 11 BASAL BODY TEMPERATURE. 12 SYMPTOTHERMAL . 13 STANDARD DAYS METHOD . 14 LACTATIONAL AMEN. METHOD. 15 EMERGENCY CONTRACEPTION . 16 CALENDAR/RHYTHM/PERIODIC ABSTINENCE . 17 WITHDRAWAL . 18 OTHER METHOD _________________ 96 328 Where did you obtain (CURRENT METHOD) the last time? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) PUBLIC SECTOR GOVT. HOSPITAL . 11 RURAL/URBAN HEALTH CENTER. 12 BARANGAY HEALTH STATION. 13 BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW . 14 OTHER PUBLIC 16 (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . 21 PHARMACY. 22 PRIVATE DOCTOR . 23 PRIVATE NURSE/MIDWIFE. 24 NGO . 25 INDUSTRY-BASED CLINIC. 27 OTHER PRIVATE MEDICAL 26 (SPECIFY) OTHER SOURCE PUERICULTURE CENTER. 31 STORE . 32 CHURCH. 33 FRIENDS/RELATIVES. 34 OTHER 96 (SPECIFY) 331 331 331 331 290 | Appendix E 6 1 NO. QUESTIONS AND FILTERS CODING CATEGORIES SKIP 329 Do you know of a place where you can obtain a method of family planning? YES . 1 NO . 2 330 Where is that? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _____________________________________ (NAME OF PLACE) Any other place? RECORD ALL PLACES MENTIONED. PUBLIC SECTOR GOVT. HOSPITAL .A RURAL/URBAN HEALTH CENTER.B BARANGAY HEALTH STATION.C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW .D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC . F PHARMACY. G PRIVATE DOCTOR .H PRIVATE NURSE/MIDWIFE. I NGO . J INDUSTRY-BASED CLINIC.K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE PUERICULTURE CENTER. M STORE .N CHURCH. O FRIENDS/RELATIVES.P OTHER X (SPECIFY) 331 In the last 12 months, were you visited by a health worker or health professional who talked to you about family planning? YES . 1 NO . 2 332 In the last 12 months, have you visited a health facility for care for yourself (or your children)? YES . 1 NO . 2 333 Did any staff member at the health facility speak to you about family planning methods? YES . 1 NO . 2 334 Have you had a pap smear within the past 5 years? YES . 1 NO . 2 DON’T KNOW PAP SMEAR . 8 335 Have you examined your breast for any sign of a mass within the last month? YES . 1 NO . 2 331 334 291Appendix E | SECTION 4A. PREGNANCY, POSTNATAL CARE AND BREASTFEEDING 401 CHECK 232: ONE OR MORE NO BIRTHS BIRTHS IN 1998 IN 1998 OR LATER OR LATER 402 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES). Now I would like to ask you some questions about the health of all your children born in the last five years. (We will talk about each separately) 403 LINE NUMBER FROM 214 LAST BIRTH LINE NUMBER. NEXT-TO-LAST BIRTH LINE NUMBER. 404 FROM 218 AND 221 NAME LIVING DEAD NAME LIVING DEAD 405 At the time you became pregnant with (NAME), did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all? THEN . 1 (SKIP TO 407) LATER. 2 NOT AT ALL. 3 (SKIP TO 407) THEN . 1 (SKIP TO 421) LATER. 2 NOT AT ALL. 3 (SKIP TO 421) 406 How much longer would you like to have waited? MONTHS.1 YEARS.2 DON’T KNOW. 998 MONTHS.1 YEARS . 2 DON’T KNOW . 998 407 Did you see anyone for prenatal care for this pregnancy? IF YES: Whom did you see? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. HEALTH PROFESSIONAL DOCTOR . A NURSE . B MIDWIFE .C HILOT .D OTHER X (SPECIFY) NO ONE. Y (SKIP TO 415) 408 How many months pregnant were you when you first received prenatal care for this pregnancy? MONTHS. DON’T KNOW. 8 409 How many times did you receive prenatal care during this pregnancy? NO. OF TIMES. DON’T KNOW. 98 410 CHECK 409: NUMBER OF TIMES RECEIVED PRENATAL CARE ONCE (SKIP TO 412) MORE THAN ONCE OR DK 411 How many months pregnant were you the last time you received prenatal care? MONTHS. DON’T KNOW.8 487 292 | Appendix E 6 1 LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 412 During this pregnancy, were any of the following done at least once? Were you weighed? Was your height measured? Was your blood pressure measured? Did you give a urine sample? Did you give a blood sample? YES NO WEIGHT.1 2 HEIGHT.1 2 BLOOD PRESSURE.1 2 URINE SAMPLE .1 2 BLOOD SAMPLE.1 2 413 During any of your prenatal visits, were you informed about symptoms or conditions which may occur during pregnancy that may be dangerous to you or to your baby? YES . 1 NO. 2 (SKIP TO 415) DON’T KNOW . 8 413A What symptoms or conditions were mentioned during any of your prenatal visit? YES NO DK Vaginal bleeding? VAGINAL BLEEDING .1 2 8 Headache? HEADACHE .1 2 8 Dizziness? DIZZINESS .1 2 8 Blurred Vision? BLURRED VISION.1 2 8 Swollen Face? SWOLLEN FACE.1 2 8 Swollen Hands? SWOLLEN HANDS.1 2 8 Pale or Anemic? PALE OR ANEMIC.1 2 8 414 Were you told where to go if you had these complications? YES. 1 NO. 2 (SKIP TO 415) DON’T KNOW . 8 414A Where will you go? IF SOURCE IS HOSPITAL, HEALTH CENTER, OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. ____________________________ (NAME OF PLACE) Any other place? RECORD ALL PLACES MENTIONED. PUBLIC SECTOR GOVT. HOSPITAL. A RURAL/URBAN HEALTH CENTER . B BARANGAY HEALTH STATION .C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW.D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . F PHARMACY .G PRIVATE DOCTOR.H PRIVATE NURSE/MIDWIFE . I NGO.J INDUSTRY-BASED CLINIC . K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER X (SPECIFY) 414B How long does it take you to travel from your home to this place? MINUTES.1 HOURS .2 DON’T KNOW.9998 415 During this pregnancy, were you given an injection in the arm to prevent the baby from getting tetanus, that is, convulsions after birth? YES . 1 NO. 2 (SKIP TO 416A) DON’T KNOW . 8 293Appendix E | LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 416 During this pregnancy, how many times did you get this injection? TIMES . DON’T KNOW . 8 416A Prior to this pregnancy, have you received Tetanus Toxoid Injection? YES . 1 NO. 2 (SKIP TO 417) DON’T KNOW . 8 416B How many times? DO NOT INCLUDE INJECTION(S) RECEIVED DURING THIS PREGNANCY. TIMES . 417 During this pregnancy, were you given or did you buy any iron tablets or iron capsules? SHOW TABLET/CAPSULE. YES . 1 NO. 2 (SKIP TO 419) DON’T KNOW . 8 418 During the whole pregnancy, for how many days did you take the tablets or the capsules? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER OF DAYS. NUMBER OF DAYS . DON’T KNOW.998 419 During this pregnancy, did you have difficulty with your vision during the day? YES . 1 NO. 2 DON’T KNOW . 8 420 During this pregnancy, did you suffer from night blindness [matang manok]? YES . 1 NO. 2 DON’T KNOW . 8 Around the time of the birth of (NAME), did you have any of the following problems: YES NO Long labor, that is, your regular contractions last more than 12 hours? LABOR MORE THAN 12 HOURS 1 2 Excessive bleeding that you feared it was live threatening? EXCESSIVE BLEEDING 1 2 A high fever with bad smelling vaginal discharge? FEVER WITH BAD SMELLING VAGINAL DISCHARGE 1 2 420A Convulsions not caused by a fever? CONVULSIONS 1 2 421 When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small? VERY LARGE . 1 LARGER THAN AVERAGE . 2 AVERAGE. 3 SMALLER THAN AVERAGE . 4 VERY SMALL. 5 DON’T KNOW . 8 VERY LARGE . 1 LARGER THAN AVERAGE . 2 AVERAGE. 3 SMALLER THAN AVERAGE . 4 VERY SMALL. 5 DON’T KNOW . 8 422 Was (NAME) weighed at birth? YES . 1 NO. 2 (SKIP TO 424) DON’T KNOW . 8 YES . 1 NO. 2 (SKIP TO 424) DON’T KNOW . 8 294 | Appendix E 6 1 LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 423 How much did (NAME) weigh? RECORD WEIGHT FROM HEALTH CARD, IF AVAILABLE. POUNDS OUNCES FROM CARD. 1 POUNDS OUNCES FROM RECALL. . 2 DON’T KNOW. 99998 POUNDS OUNCES FROM CARD . 1 POUNDS OUNCES FROM RECALL. . 2 DON’T KNOW . 99998 424 Who assisted with the delivery of (NAME)? Anyone else? PROBE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS ASSISTING. IF RESPONDENT SAYS NO ONE ASSISTED, PROBE TO DETERMINE WHETHER ANY ADULTS WERE PRESENT AT THE DELIVERY. HEALTH PROFESSIONAL DOCTOR . A NURSE . B MIDWIFE .C HILOT .D RELATIVE/FRIEND . E OTHER X (SPECIFY) NO ONE. Y HEALTH PROFESSIONAL DOCTOR .A NURSE .B MIDWIFE .C HILOT .D RELATIVE/FRIEND .E OTHER X (SPECIFY) NO ONE .Y 425 Where did you give birth to (NAME)? IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE, PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. ____________________________ (NAME OF PLACE) HOME YOUR HOME. 11 (SKIP TO 428) OTHER HOME. 12 PUBLIC SECTOR GOVT. HOSPITAL . 21 GOVT. HEALTH CENTER. 22 (SKIP TO 428) OTHER PUBLIC 26 (SPECIFY) (SKIP TO 428) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . 31 OTHER PVT. MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) (SKIP TO 428) HOME YOUR HOME . 11 (SKIP TO 428) OTHER HOME. 12 PUBLIC SECTOR GOVT. HOSPITAL . 21 GOVT. HEALTH CENTER . 22 (SKIP TO 428) OTHER PUBLIC 26 (SPECIFY) (SKIP TO 428) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC. 31 OTHER PVT. MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) (SKIP TO 428) 426 Was (NAME) delivered by caesarian section? YES. 1 NO. 2 (SKIP TO 428) YES . 1 NO. 2 (SKIP TO 428) 295Appendix E | LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 427 What was the main reason for having a delivery by caesarian section? HIGH BLOOD PRESSURE AND SWELLING OF FACE AND HAND W/O CONVULSION (PRE-ECLAMPSIA) . 01 CONVULSION, HIGH BLOOD PRESSURE, SWELLING OF FACE AND HAND (ECLAMPSIA) . 02 BABY TOO BIG. 03 PELVIC BONE TOO NARROW. 04 BABY’S HEAD NOT IN RIGHT POSITION. 05 BABY MIGHT DIE INSIDE MOTHER’S WOMB (FETAL DISTRESS). 06 LABOR BEYOND 12 HOURS. 07 MOTHER TIRED (LABOR LESS THAN 12 HOURS). 08 WATER BROKE EARLY. 09 EXCESSIVE BLEEDING. 10 OTHER 96 (SPECIFY) DON’T KNOW . 98 HIGH BLOOD PRESSURE AND SWELLING OF FACE AND HAND W/O CONVULSION (PRE-ECLAMPSIA) . 01 CONVULSION, HIGH BLOOD PRESSURE, SWELLING OF FACE AND HAND (ECLAMPSIA) . 02 BABY TOO BIG. 03 PELVIC BONE TOO NARROW . 04 BABY’S HEAD NOT IN RIGHT POSITION. 05 BABY MIGHT DIE INSIDE MOTHER’S WOMB (FETAL DISTRESS). 06 LABOR BEYOND 12 HOURS. 07 MOTHER TIRED (LABOR LESS THAN 12 HOURS) . 08 WATER BROKE EARLY. 09 EXCESSIVE BLEEDING. 10 OTHER 96 (SPECIFY) DON’T KNOW . 98 428 After (NAME) was born, did a health professional or a traditional birth attendant check on your health? YES .1 NO.2 (SKIP TO 433) YES .1 NO.2 429 How many days or weeks after the delivery did the first check up take place? RECORD ‘00’ DAYS IF SAME DAY. DAYS .1 WEEKS .2 DON’T KNOW. 998 430 Who checked on your health at that time? HEALTH PROFESSIONAL DOCTOR . A NURSE . B MIDWIFE .C OTHER PERSON.D HILOT . E RELATIVE/FRIEND . F OTHER X (SPECIFY) NO ONE. Y 296 | Appendix E 6 1 LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 431 Did you receive the following services at that time? Y N DK Abdominal examination? ABDOMINAL EXAM.1 2 8 Breast examination? BREAST EXAM.1 2 8 Internal examination? INTERNAL EXAM .1 2 8 Family planning advice? FAMILY PLANNING ADVICE 1 2 8 Breastfeeding advice? BREASTFEEDING ADVICE .1 2 8 Baby care advice? BABY CARE ADVICE .1 2 8 Check-up of baby? CHECK-UP OF BABY.1 2 8 Any other service? OTHER_________________1 2 8 (SPECIFY) 432 Where did this first check up take place? IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. _______________________________ (NAME OF PLACE) HOME YOUR HOME. 11 OTHER HOME. 12 PUBLIC SECTOR GOVT. HOSPITAL. 21 BARANGAY HEALTH STATION . 22 BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW. 23 OTHER PUBLIC 26 (SPECIFY) PRIVATE MEDICAL SECTOR PVT. HOSPITAL/CLINIC . 31 PRIVATE DOCTOR. 32 PRIVATE NURSE/MIDWIFE . 33 NGO. 34 INDUSTRY-BASED CLINIC . 35 OTHER PVT. MEDICAL 36 (SPECIFY) OTHER 96 (SPECIFY) 433 In the first two months after delivery, did you receive a vitamin A dose like this? SHOW AMPULE/CAPSULE/SYRUP. YES . 1 NO. 2 434 Has your period returned since the birth of (NAME)? YES. 1 (SKIP TO 436) NO. 2 (SKIP TO 437) 435 Did your period return between the birth of (NAME) and your next pregnancy? YES . 1 NO. 2 (SKIP TO 439) 297Appendix E | LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 436 For how many months after the birth of (NAME) did you not have a period? MONTHS. DON’T KNOW .98 MONTHS. DON’T KNOW . 98 437 CHECK 234: IS RESPONDENT PREGNANT? NOT PREGNANT PREG- OR UNSURE NANT � (SKIP TO 439) 438 Have you resumed sexual relations since the birth of (NAME)? YES . 1 NO. 2 (SKIP TO 440) 439 For how many months after the birth of (NAME) did you not have sexual relations? MONTHS. DON’T KNOW .98 MONTHS. DON’T KNOW .98 440 Did you ever breastfeed (NAME)? YES . 1 (SKIP TO 441) NO. 2 YES . 1 (SKIP TO 441) NO. 2 440A Why did you not breastfeed (NAME)? MOTHER ILL/WEAK.01 CHILD ILL/WEAK.02 CHILD DIED.03 NIPPLE/BREAST PROBLEM .04 NOT ENOUGH MILK .05 MOTHER WORKING.06 CHILD REFUSED .07 OTHER_____________________96 (SPECIFY) (SKIP TO 447) MOTHER ILL/WEAK .01 CHILD ILL/WEAK.02 CHILD DIED.03 NIPPLE/BREAST PROBLEM .04 NOT ENOUGH MILK .05 MOTHER WORKING .06 CHILD REFUSED .07 OTHER ____________________ 96 (SPECIFY) (SKIP TO 447) 441 How long after birth did you first put (NAME) to the breast? IF LESS THAN 1 HOUR, RECORD ‘00’ HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. IMMEDIATELY. 000 HOURS .1 DAYS .2 IMMEDIATELY. 000 HOURS .1 DAYS .2 442 In the first three days after delivery, before your milk began flowing regularly, was (NAME) given anything to drink other than breast milk? YES . 1 NO. 2 (SKIP TO 443A) YES . 1 NO. 2 (SKIP TO 443A) 298 | Appendix E 6 1 LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 443 What was given (NAME) to drink before your milk began flowing regularly? Anything else? RECORD ALL LIQUIDS MENTIONED. DO NOT READ OUT RESPONSES. MILK (OTHER THAN BREAST MILK) . A PLAIN WATER. B SUGAR OR GLUCOSE WATER .C GRIPE WATER.D SUGAR-SALT-WATER SOLUTION . E FRUIT JUICE . F INFANT FORMULA.G TEA/INFUSIONS.H HONEY . I OTHER X (SPECIFY) (SKIP TO 444) MILK (OTHER THAN BREAST MILK).A PLAIN WATER.B SUGAR OR GLUCOSE WATER .C GRIPE WATER .D SUGAR-SALT-WATER SOLUTION .E FRUIT JUICE . F INFANT FORMULA.G TEA/INFUSIONS.H HONEY . I OTHER X (SPECIFY) (SKIP TO 444) 443A Was (NAME) ever given water or anything else to drink or eat other than breastmilk? YES.……1 NO.……2 ( SKIP TO 444) YES.……1 NO.……2 ( SKIP TO 444) 443B How many months old was (NAME) when you first started giving him/her any food or liquid other than breastmilk? MONTHS. MONTHS. 444 CHECK 404: IS CHILD LIVING? LIVING � DEAD (SKIP TO 446) LIVING DEAD (SKIP TO 446) 445 Are you still breastfeeding (NAME)? YES . 1 (SKIP TO 448) NO. 2 YES . 1 (SKIP TO 448) NO. 2 446 For how many months did you breastfeed (NAME)? MONTH. DON’T KNOW . 98 MONTH . DON’T KNOW . 98 446A Why did you stop breastfeeding (NAME)? MOTHER ILL/WEAK.01 CHILD ILL/WEAK.02 CHILD DIED.03 NIPPLE/BREAST PROBLEM .04 NOT ENOUGH MILK .05 MOTHER WORKING.06 CHILD REFUSED .07 WEANING AGE/AGE TO STOP.08 BECAME PREGNANT.09 STARTED USING CONTRACEPTION.10 OTHER 96 (SPECIFY) MOTHER ILL/WEAK .01 CHILD ILL/WEAK.02 CHILD DIED.03 NIPPLE/BREAST PROBLEM .04 NOT ENOUGH MILK .05 MOTHER WORKING .06 CHILD REFUSED .07 WEANING AGE/AGE TO STOP .08 BECAME PREGNANT .09 STARTED USING CONTRACEPTION .10 OTHER 96 (SPECIFY) 299Appendix E | LAST BIRTH NAME________________________ NEXT-TO-LAST BIRTH NAME_________________________ 447 CHECK 404: IS CHILD LIVING? LIVING DEAD � � (GO BACK TO 405 IN NEXT COLUMN; OR,IF NO MORE BIRTHS, GO (SKIP TO 450) TO 454)� LIVING DEAD � � � � (GO BACK TO 405 IN LAST COLUMN OF NEW (SKIP TO 450) QUESTIONNAIRE; OR, IF NOMORE BIRTHS, GOTO 454) 448 How many times did you breastfeed last night between sunset and sunrise? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF NIGHTTIME FEEDINGS. NUMBER OF NIGHTTIME FEEDINGS. 449 How many times did you breastfeed yesterday during the day hours? IF ANSWER IS NOT NUMERIC, PROBE FOR APPROXIMATE NUMBER. NUMBER OF DAYLIGHT FEEDINGS. NUMBER OF DAYLIGHT FEEDINGS. 450 Did (NAME) drink anything from a bottle with a nipple yesterday or last night? YES . 1 NO. 2 DON’T KNOW . 8 YES . 1 NO. 2 DON’T KNOW . 8 451 Was sugar added to any of the foods or liquids (NAME) ate yesterday? YES . 1 NO. 2 DON’T KNOW . 8 YES . 1 NO. 2 DON’T KNOW . 8 452 How many times did (NAME) eat solid, semisolid, or soft foods other than liquids yesterday during the day or at night? IF 7 OR MORE TIMES, RECORD ‘7’. NUMBER OF TIMES. DON’T KNOW . 8 NUMBER OF TIMES. DON’T KNOW . 8 453 GO BACK TO 405 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 454. GO BACK TO 405 IN LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 454. 300 | Appendix E 6 1 SECTION 4B. IMMUNIZATION, HEALTH AND NUTRITION 454 ENTER IN THE TABLE THE LINE NUMBER, NAME, AND SURVIVAL STATUS OF EACH BIRTH IN 1998 OR LATER. (IF THERE ARE MORE THAN 2 BIRTHS, USE LAST COLUMN OF ADDITIONAL QUESTIONNAIRES). 455 LINE NUMBER FROM 214 LAST BIRTH LINE NUMBER. NEXT-TO-LAST BIRTH LINE NUMBER . 456 FROM 218 AND 221 NAME NAME LIVING DEAD � (GO TO 456 IN NEXT COLUMN OR, IF NO MORE BIRTHS, GO TO 484) LIVING DEAD (GO TO 456 IN LAST COLUMN OF NEW QUESTION- NAIRE OR, IF NO MORE BIRTHS, GO TO 484) 457 At any time during the last six months, did (NAME) receive any of the following: YES NO DK YES NO DK Vitamin A capsule? VITAMIN A 1 2 8 VITAMIN A 1 2 8 Iron drops/syrup? IRON 1 2 8 IRON 1 2 8 458 Do you have a card where (NAME’S) vaccinations are written down? IF YES: May I see it please? YES, SEEN . 1 (SKIP TO 460) YES, NOT SEEN. 2 (SKIP TO 462) NO CARD. 3 YES, SEEN. 1 (SKIP TO 460) YES, NOT SEEN . 2 (SKIP TO 462) NO CARD . 3 459 Did you ever have a vaccination card for (NAME)? YES .1 (SKIP TO 462) NO .2 YES . 1 (SKIP TO 462) NO .2 460 (1) COPY VACCINATION DATE FOR EACH VACCINE FROM THE CARD. (2) WRITE ‘44’ IN ‘DAY’ COLUMN IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE IS RECORDED. MONTH DAY YEAR MONTH DAY YEAR BCG POLIO 1 POLIO 2 POLIO 3 DPT 1 DPT 2 DPT 3 MEASLES ňņņŎņņŦņņŎņņŦņņŎņņŎņņŎņņʼn BCG . ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P1. ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P2. ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P3. ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D1 . ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D2 . ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D3 . ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō MEA . ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ Ŋņņŏņņũņņŏņņũņņŏņņŏņņŏņņŋ ňņņŎņņŦņņŎņņŦņņŎņņŎņņŎņņʼn BCG.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P1.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P2.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō P3.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D1.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D2.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō D3.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ ŌņņŐņņŬņņŐņņŬņņŐņņŐņņŐņņō MEA.ŇųųŇųųŒųųŇųųŒųųŇųųŇųųŇųųŇ Ŋņņŏņņũņņŏņņũņņŏņņŏņņŏņņŋ 301Appendix E | LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 461 Has (NAME) received any vaccinations that are not recorded on this card? RECORD ‘YES’ ONLY IF RESPONDENT MENTIONS BCG, POLIO 1-3, DPT 1-3, AND/OR MEASLES VACCINE. YES . 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 460) (SKIP TO 464) NO. 2 (SKIP TO 464) DON’T KNOW . 8 YES . 1 (PROBE FOR VACCINATIONS AND WRITE ‘66’ IN THE CORRESPONDING DAY COLUMN IN 460) (SKIP TO 464) NO . 2 (SKIP TO 464) DON’T KNOW . 8 462 Did (NAME) ever receive any vaccinations to prevent him/her from getting diseases, including vaccinations received in a national immunization day campaign? YES . 1 NO. 2 (SKIP TO 466) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 466) DON’T KNOW . 8 463 Please tell me if (NAME) received any of the following vaccinations: 463A A BCG vaccination against tuberculosis, that is, an injection in the arm or shoulder that usually causes a scar? YES . 1 NO. 2 (SKIP TO 463C) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 463C) DON’T KNOW . 8 463B Did (NAME) receive the BCG vaccine before his/her first birthday? YES……………………………………1 NO…………………………………….2 YES……………………………………1 NO…………………………………….2 463C Polio vaccine, that is, drops in the mouth? YES . 1 NO. 2 (SKIP TO 463G) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 463G) DON’T KNOW . 8 463D When was the first polio vaccine received, just after birth or later? JUST AFTER BIRTH. 1 LATER. 2 JUST AFTER BIRTH. 1 LATER. 2 463E How many times was the polio vaccine received? NUMBER OF TIMES. NUMBER OF TIMES. 463F Did (NAME) receive the third (last) polio vaccine before his/her first birthday? YES .1 NO.2 YES .1 NO .2 463G A DPT vaccination, that is, an injection given in the thigh or buttocks, sometimes at the same time as polio drops?3 YES . 1 NO. 2 (SKIP TO 463J) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 463J) DON’T KNOW . 8 463H How many times? NUMBER OF TIMES. NUMBER OF TIMES. 463I Did (NAME) receive the third (last) DPT vaccine before his /her first birthday? YES .1 NO.2 YES .1 NO .2 302 | Appendix E 6 1 LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 463J An injection to prevent measles? YES . 1 NO. 2 (SKIP TO 464) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 464) DON’T KNOW . 8 463K Did (NAME) receive the measles vaccine before his/her first birthday? YES……………………………………1 NO…………………………………….2 YES……………………………………1 NO…………………………………….2 464 Did (NAME) receive an injection to prevent Hepatitis B? YES . 1 NO. 2 (SKIP TO 466) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 466) DON’T KNOW . 8 464A How many times? NUMBER OF TIMES. NUMBER OF TIMES. 465 Did (NAME) receive the third (last) Hepatitis B vaccine before his/her first birthday? YES . 1 NO. 2 DON’T KNOW . 8 YES . 1 NO . 2 DON’T KNOW . 8 466 Has (NAME) been ill with a fever at any time in the last 2 weeks? YES . 1 NO. 2 DON’T KNOW . 8 YES . 1 NO . 2 DON’T KNOW . 8 467 Has (NAME) had an illness with a cough at any time in the last 2 weeks? YES . 1 NO. 2 (SKIP TO 469) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 469) DON’T KNOW . 8 468 When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, fast breaths? YES . 1 NO. 2 DON’T KNOW . 8 YES . 1 NO . 2 DON’T KNOW . 8 469 CHECK 466 AND 467: FEVER OR COUGH? “YES” IN 466 OR 467 OTHER (SKIP TO 475) “YES” IN 466 OR 467 OTHER (SKIP TO 475) 470 Did you seek advice or treatment for the fever/cough? YES . 1 NO. 2 (SKIP TO 472) YES . 1 NO . 2 (SKIP TO 472) 303Appendix E | LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 471 Where did you seek advice or treatment? Anywhere else? RECORD ALL SOURCES MENTIONED. DO NOT READ OUT RESPONSES. PUBLIC SECTOR GOVT. HOSPITAL A RURAL/URBAN HEALTH CENTER B BARANGAY HEALTH STATION C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC F PHARMACY G PRIVATE DOCTOR H PRIVATE NURSE/MIDWIFE I NGO J INDUSTRY-BASED CLINIC K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE PUERICULTURE CENTER M STORE N CHURCH O FRIENDS/RELATIVES P OTHER X (SPECIFY) PUBLIC SECTOR GOVT. HOSPITAL A RURAL/URBAN HEALTH CENTER B BARANGAY HEALTH STATION C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC F PHARMACY G PRIVATE DOCTOR H PRIVATE NURSE/MIDWIFE I NGO J INDUSTRY-BASED CLINIC K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE PUERICULTURE CENTER M STORE N CHURCH O FRIENDS/RELATIVES P OTHER X (SPECIFY) 472 CHECK 466: HAD FEVER? “YES” IN 466 “NO”/”DK” IN 466 (SKIP TO 475) “YES” IN 466 “NO”/”DK” IN 466 (SKIP TO 475) 473 Did (NAME) take any drugs for the fever? YES . 1 NO. 2 (SKIP TO 475) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 475) DON’T KNOW . 8 474 What drugs did (NAME) take? RECORD ALL MENTIONED. ASK TO SEE DRUG(S) IF TYPE OF DRUG IS NOT KNOWN. IF TYPE OF DRUG IS STILL NOT DETERMINED, SHOW TYPICAL ANTIMALARIAL DRUGS TO RESPONDENT. FANSIDAR .A CHLOROQUINE .B ASPIRIN.C IBUPROFEN/ACETAMINOPHEN.D PARACETAMOL .E OTHER X (SPECIFY) DON’T KNOW . Z FANSIDAR .A CHLOROQUINE.B ASPIRIN .C IBUPROFEN/ACETAMINOPHEN .D PARACETAMOL .E OTHER X (SPECIFY) DON’T KNOW . Z 304 | Appendix E 6 1 LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 475 Has (NAME) had diarrhea in the last 2 weeks? YES . 1 NO. 2 (SKIP TO 483) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 483) DON’T KNOW . 8 476 Now I would like to know how much (NAME) was offered to drink during the diarrhea. Was he/she offered less than usual to drink, about the same amount, or more than usual to drink? IF LESS, PROBE: Was he/she offered much less than usual to drink or somewhat less? SAME . 1 MORE. 2 LESS . 3 NOTHING. 4 DON’T KNOW . 5 SAME . 1 MORE. 2 LESS . 3 NOTHING. 4 DON’T KNOW . 5 477 When (NAME) had diarrhea, was he/she offered less than usual to eat, about the same amount, more than usual, or nothing to eat? IF LESS, PROBE: Was he/she offered much less than usual to eat or somewhat less? SAME . 1 MORE. 2 LESS . 3 NOTHING. 4 DON’T KNOW . 5 SAME . 1 MORE. 2 LESS . 3 NOTHING. 4 DON’T KNOW . 5 478 Was he/she given any of the following to drink: YES NO DK YES NO DK a) A fluid made from a special packet called Oresol or from a tablet called Hydrite? FLUID FROM PACKET/ TABLET 1 2 8 FLUID FROM PACKET/ TABLET 1 2 8 b) A government-recommended homemade fluid? HOMEMADE FLUID 1 2 8 HOMEMADE FLUID 1 2 8 479 Was anything (else) given to treat the diarrhea? YES . 1 NO. 2 (SKIP TO 481) DON’T KNOW . 8 YES . 1 NO . 2 (SKIP TO 481) DON’T KNOW . 8 480 What (else) was given to treat the diarrhea? Anything else? RECORD ALL TREATMENTS MENTIONED. TABLET OR SYRUP.A INJECTION .B (I.V.) INTRAVENOUS .C HOME REMEDIES/ HERBAL MEDICINES.D OTHER X (SPECIFY) TABLET OR SYRUP .A INJECTION .B (I.V.) INTRAVENOUS.C HOME REMEDIES/ HERBAL MEDICINES.D OTHER X (SPECIFY) 481 Did you seek advice or treatment for the diarrhea? YES . 1 NO. 2 (SKIP TO 483) YES . 1 NO . 2 (SKIP TO 483) 305Appendix E | LAST BIRTH NAME NEXT-TO-LAST BIRTH NAME 482 Where did you seek advice or treatment? IF SOURCE IS HOSPITAL, HEALTH CENTER OR CLINIC, WRITE THE NAME OF THE PLACE. PROBE TO IDENTIFY THE TYPE OF SOURCE AND CIRCLE THE APPROPRIATE CODE. (NAME OF PLACE) Anywhere else? RECORD ALL PLACES MENTIONED. DO NOT READ OUT RESPONSES. PUBLIC SECTOR GOVT. HOSPITAL A RURAL/URBAN HEALTH CENTER B BARANGAY HEALTH STATION C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC F PHARMACY G PRIVATE DOCTOR H PRIVATE NURSE/MIDWIFE I NGO J INDUSTRY-BASED CLINIC K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE PUERICULTURE CENTER M STORE N CHURCH O FRIENDS/RELATIVES P OTHER X (SPECIFY) PUBLIC SECTOR GOVT. HOSPITAL A RURAL/URBAN HEALTH CENTER B BARANGAY HEALTH STATION C BARANGAY SUPPLY/SERVICE POINT OFFICER/BHW D OTHER PUBLIC E (SPECIFY) PRIVATE MEDICAL SECTOR PRIVATE HOSPITAL/CLINIC F PHARMACY G PRIVATE DOCTOR H PRIVATE NURSE/MIDWIFE I NGO J INDUSTRY-BASED CLINIC K OTHER PRIVATE MEDICAL L (SPECIFY) OTHER SOURCE PUERICULTURE CENTER M STORE N CHURCH O FRIENDS/RELATIVES P OTHER X (SPECIFY) 483 GO BACK TO 456 IN NEXT COLUMN; OR, IF NO MORE BIRTHS, GO TO 484. GO BACK TO 456 IN LAST COLUMN OF NEW QUESTIONNAIRE; OR, IF NO MORE BIRTHS, GO TO 484. 484 CHECK 220 AND 223, ALL ROWS: NUMBER OF CHILDREN BORN IN 1998 OR LATER AND LIVING WITH THE RESPONDENT ONE OR NONE MORE 485 What is usually done to dispose of your (youngest) child’s stools when he/she does not use any toilet facility? CHILD ALWAYS USE TOILET/LATRINE .01 THROW IN THE TOILET/LATRINE .02 THROW OUTSIDE THE DWELLING.03 THROW OUTSIDE THE YARD.04 BURY IN THE YARD.05 RINSE AWAY.06 USE DISPOSABLE DIAPERS .07 USE WASHABLE DIAPE