Philippines - Demographic and Health Survey - 2009

Publication date: 2009

Philippines 2008National Demographic and Health Survey N ational D em ographic and H ealth Survey Philippines 2008 Philippines National Demographic and Health Survey 2008 National Statistics Office Manila, Philippines ICF Macro Calverton, Maryland, USA December 2009 National Statistics Office Manila, Philippines This report summarizes the findings of the 2008 Philippines National Demographic and Health Survey (NDHS) carried out by the National Statistics Office (NSO). The NDHS is part of the worldwide MEASURE Demographic and Health Surveys program, which is designed to collect information on a variety of health-related topics including fertility, family planning, and maternal and child health. The United States Agency for International Development (USAID) provided financial assistance for some activities during the preparatory and processing phases of the project, as well as funding for technical assistance through ICF Macro, an ICF International Company. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID, the Government of the Philippines, or donor organizations. Additional information about the survey may be obtained from the Demographic and Social Statistics Division (DSSD) of the Household Statistics Department, NSO, Solicarel Building 1, Ramon Magsaysay Boulevard, Sta. Mesa, Manila (Telephone: (632) 713-7245; Fax (632) 716-1612), or by writing to E-mail address: info@mail.census.gov.ph. Information about the Demographic and Health Surveys program may be obtained from the MEASURE DHS project, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200; Fax: 301-572-0999, E-mail: reports@macrointernational.com, Internet: http://www.measuredhs.com. Recommended citation: National Statistics Office (NSO) [Philippines], and ICF Macro. 2009. National Demographic and Health Survey 2008. Calverton, Maryland: National Statistics Office and ICF Macro. Contents | iii CONTENTS Page TABLES AND FIGURES .ix PREFACE. xvii SUMMARY OF FINDINGS . xix MAP OF PHILIPPINES . xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy.1 1.2 Population and Family Planning Program .2 1.3 Objectives of the Survey .3 1.4 Organization of the Survey.4 1.5 Sample Design and Implementation.4 1.6 Questionnaires.5 1.7 Training and Fieldwork .6 1.8 Data Processing.6 1.9 Response Rates .6 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Age and Sex Composition of the Household Population.9 2.2 Household Composition .11 2.3 Education of Household Population .11 2.4 Housing Characteristics .14 2.5 Household Durable Goods .19 2.6 Wealth Index .20 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents.23 3.2 Mobility .25 3.3 Educational Attainment by Background Characteristics.26 3.4 Literacy .28 3.5 Access to Mass Media .29 3.6 Employment .30 3.7 Occupation.32 3.8 Earnings and Type of Employment .34 3.9 Use of Tobacco.35 3.10 Health Insurance Coverage .37 iv │ Contents CHAPTER 4 FERTILITY 4.1 Current Fertility.39 4.2 Fertility by Background Characteristics .41 4.3 Fertility Trends .42 4.4 Children Ever Born and Living.44 4.5 Birth Intervals.46 4.6 Age at First Birth.48 4.7 Adolescent Fertility.50 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Family Planning Methods .51 5.2 Ever Use of Family Planning Methods.52 5.3 Current Use of Family Planning Methods .54 5.3.1 Current Contraceptive Use.54 5.3.2 Differentials in Contraceptive Use .55 5.3.3 Trends in Contraceptive Use .57 5.4 Number of Children at First Use of Family Planning .58 5.5 Knowledge of Fertile Period .59 5.6 Timing of Sterilization .60 5.7 Source of Supply of Modern Contraceptive Methods .60 5.8 Cost of Family Planning Methods .61 5.9 Informed Choice.62 5.10 Intentions for Family Planning Use among Nonusers .65 5.11 Family Planning Messages in the Mass Media .67 5.12 Contact between Nonusers and Family Planning/Health Service Providers .68 5.13 Husband’s Knowledge of Wife’s Use of Contraception. 70 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .71 6.2 Age at First Menstruation.72 6.3 Age at First Marriage .72 6.4 Age at First Sexual Intercourse.74 6.5 Recent Sexual Activity .75 6.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility.77 6.7 Menopause.80 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children .81 7.2 Desire to Limit Childbearing by Background Characteristics .83 7.3 Need for Family Planning Services.85 7.4 Ideal Number of Children .88 7.5 Wanted and Unwanted Fertility .89 7.6 Couples’ Consensus on Family Size .92 Contents | v CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality.95 8.2 Data Quality .96 8.3 Socioeconomic Differentials in Infant and Child Mortality .97 8.4 Demographic Differentials in Infant and Child Mortality.98 8.5 Perinatal Mortality. 100 8.6 High-Risk Fertility Behavior . 102 CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care . 105 9.1.1 Antenatal Care Coverage. 105 9.1.2 Components of Antenatal Care Services . 108 9.1.3 Tetanus Toxoid Injections. 110 9.2 Delivery Care. 111 9.2.1 Place of Delivery. 111 9.2.2 Delivery Assistance. 113 9.3 Postnatal Care. 114 9.4 Problems in Accessing Health Care . 117 CHAPTER 10 CHILD HEALTH 10.1 Child Size at Birth . 119 10.2 Vaccination Coverage . 121 10.3 Acute Respiratory Infection . 124 10.4 Fever. 125 10.5 Diarrheal Disease and Related Findings. 127 10.5.1 Prevalence of Diarrhea . 127 10.5.2 Diarrhea Treatment . 127 10.5.3 Feeding Practices during Diarrhea. 129 10.5.4 Knowledge of ORS Packets . 130 10.5.5 Disposal of Children’s Stools . 131 CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN 11.1 Initiation of Breastfeeding and Prelacteal Feeding. 133 11.2 Breastfeeding Status by Age. 137 11.3 Duration and Frequency of Breastfeeding . 138 11.4 Types of Complementary Foods . 140 11.5 Infant and Young Child Feeding (IYCF) Practices . 142 11.6 Micronutrient Intake among Children. 144 11.7 Foods Consumed by Mothers. 147 11.8 Micronutrient Intake among Mothers . 148 vi │ Contents CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12.1 Introduction. 151 12.2 HIV/AIDS Knowledge, Transmission, and Prevention Methods . 152 12.2.1 Awareness of HIV/AIDS and Means of Transmission. 152 12.2.2 Rejection of Misconceptions about HIV/AIDS . 154 12.3 Higher-Risk Sexual Intercourse. 156 12.4 Coverage of HIV Testing. 159 12.5 HIV/AIDS Knowledge and Sexual Behavior among Youth. 161 12.5.1 Knowledge about HIV/AIDS and Source for Condoms . 161 12.5.2 Age at First Sex . 163 12.5.3 Condom Use at First Sexual Intercourse. 164 12.5.4 Premarital Sexual Activity. 164 12.5.5 Higher-Risk Sexual Intercourse among Young Women. 165 12.5.6 Voluntary HIV Counseling and Testing among Young Women . 167 CHAPTER 13 TUBERCULOSIS KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13.1 Background. 169 13.2 Women’s Knowledge of TB. 170 13.3 Self-Reported Diagnosis, Symptoms, and Treatment. 174 13.4 Stigma Regarding TB . 176 CHAPTER 14 HEALTH CARE UTILIZATION AND FINANCING 14.1 Health Insurance Coverage . 177 14.2 Health Care Treatment . 180 14.3 Hospital Care . 184 14.4 Cost of Treatment . 186 CHAPTER 15 WOMEN’S EMPOWERMENT 15.1 Employment and Form of Earnings . 188 15.2 Married Women’s Control Over Their Own Earnings . 188 15.3 Control Over Men’s Earnings. 190 15.4 Control Over Her Own Earnings and Over Those of Her Husband. 192 15.5 Women’s Participation in Decisionmaking . 192 15.6 Attitudes Toward Wife Beating. 195 15.7 Indicators of Women’s Empowerment . 197 15.8 Current Use of Contraception by Women’s Empowerment . 198 15.9 Ideal Family Size and Unmet Need by Women’s Empowerment. 198 15.10 Reproductive Health Care by Women’s Empowerment. 199 CHAPTER 16 VIOLENCE AGAINST WOMEN 16.1 Introduction. 201 16.2 Measurement of Violence . 201 Contents | vii 16.3 Experience of Violence by Women Age 15-49 . 204 16.3.1 Physical Violence Since Age 15. 204 16.3.2 Sexual Violence Since Age 15 . 207 16.3.3 Experience of Physical or Sexual Violence Since Age 15 . 210 16.4 Measures of Marital Control . 211 16.5 Marital Violence. 213 16.5.1 Experience of Physical, Sexual, or Other Types of Violence Within Marriage . 213 16.5.2 Frequency of Spousal Violence . 217 16.5.3 Consequences of Spousal Violence . 219 16.6 Violence Initiated by Women against Husbands. 220 16.7 Response to Violence. 222 REFERENCES . 225 APPENDIX A SAMPLE DESIGN . 229 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 233 APPENDIX C DATA QUALITY TABLES .257 APPENDIX D PERSONS INVOLVED IN THE 2008 PHILIPPINES DEMOGRAPHIC AND HEALTH SURVEY . 263 APPENDIX E QUESTIONNAIRES. 277 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household, women’s, and women's safety interviews.7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.10 Table 2.2 Dependency ratios.10 Table 2.3 Household composition.11 Table 2.4.1 Educational attainment of the female household population .12 Table 2.4.2 Educational attainment of the male household population .13 Table 2.5 Household drinking water.15 Table 2.6 Household sanitation facilities.16 Table 2.7 Household characteristics: electricity, housing materials, and tenure status .17 Table 2.8 Household characteristics: rooms for sleeping, place for cooking, cooking fuel, and type of fire/stove .19 Table 2.9 Household durable goods .20 Table 2.10 Wealth quintiles.21 Figure 2.1 Population Pyramid .10 Figure 2.2 Median Years of Schooling by Sex and Region .14 Figure 2.3 Housing Amenities by Urban-Rural Residence .18 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .24 Table 3.2 Childhood residence and mobility .26 Table 3.3 Educational attainment .27 Table 3.4 Literacy.28 Table 3.5 Exposure to mass media.30 Table 3.6 Employment status.31 Table 3.7 Occupation.33 Table 3.8 Type of employment.34 Table 3.9 Use of tobacco.36 Table 3.10 Health insurance coverage.37 Figure 3.1 Educational Attainment of Women Age 15-49 .25 CHAPTER 4 FERTILITY Table 4.1 Current fertility .40 x | Tables and Figures Table 4.2 Fertility by background characteristics .41 Table 4.3 Fertility trends from various surveys.43 Table 4.4 Trends in fertility rates from 2008 NDHS .44 Table 4.5 Children ever born and living.45 Table 4.6 Birth intervals.47 Table 4.7 Age at first birth .48 Table 4.8 Median age at first birth .49 Table 4.9 Teenage pregnancy and motherhood.50 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence.40 Figure 4.2 Fertility Rates by Residence and Education.42 Figure 4.3 Trends in the Total Fertility Rate.43 Figure 4.4 Mean Number of Children Ever Born among Women Age 15-49.46 Figure 4.5 Median Number of Months since Previous Birth .48 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .51 Table 5.2 Knowledge of contraceptive methods by background characteristics .52 Table 5.3 Ever use of contraception.53 Table 5.4 Current use of contraception by age .54 Table 5.5 Current use of contraception by background characteristics .56 Table 5.6 Trends in contraceptive use .57 Table 5.7 Number of children at first use of contraception .58 Table 5.8 Knowledge of fertile period.59 Table 5.9 Timing of sterilization.60 Table 5.10 Source of modern contraception methods .61 Table 5.11 Cost of modern contraceptive methods.62 Table 5.12 Informed choice .63 Table 5.13 Informed choice by background characteristics .64 Table 5.14 Future use of contraception .65 Table 5.15 Reason for not intending to use contraception in the future .66 Table 5.16 Preferred method of contraception for future use.66 Table 5.17 Exposure to family planning messages .68 Table 5.18 Contact of nonusers with family planning providers .69 Table 5.19 Husband's knowledge of wife’s use of contraception.70 Figure 5.1 Use of Contraception among Currently Married Women Age 15-49 .55 Figure 5.2 Trends in Contraceptive Use, Philippines 1968-2008.58 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .71 Table 6.2 Age at menarche.72 Table 6.3 Age at first marriage .72 Table 6.4 Median age at first marriage.73 Table 6.5 Age at first sexual intercourse .74 Tables and Figures | xi Table 6.6 Median age at first sexual intercourse.75 Table 6.7 Recent sexual activity.76 Table 6.8 Postpartum amenorrhea, abstinence and insusceptibility.78 Table 6.9 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility.79 Table 6.10 Median duration of postpartum amenorrhea by breastfeeding duration .80 Table 6.11 Menopause.80 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children .81 Table 7.2 Fertility preferences by age .83 Table 7.3 Desire to limit childbearing .84 Table 7.4 Need and demand for family planning among currently married women .86 Table 7.5 Ideal number of children .88 Table 7.6 Mean ideal number of children.89 Table 7.7 Fertility planning status.90 Table 7.8 Wanted fertility rates.92 Table 7.9 Couples’ consensus on family size.93 Figure 7.1 Fertility Preferences among Currently Married Women Age 15-49.82 Figure 7.2 Percentage of Currently Married Women Who Want No More Children, by Number of Children.82 Figure 7.3 Percentage of Currently Married Women Who Want No More Children by Background Characteristics .85 Figure 7.4 Trends in Unmet Need for Family Planning.87 Figure 7.5 Trends in Wanted and Unwanted Fertility for Births in the Five Years Preceding the Survey, NDHS 2003 and NDHS 2008 .91 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates .96 Table 8.2 Early childhood mortality rates by socioeconomic characteristics.98 Table 8.3 Early childhood mortality rates by demographic characteristics.99 Table 8.4 Perinatal mortality. 101 Table 8.5 High-risk fertility behavior . 103 Figure 8.1 Under-Five Mortality Rates by Background Characteristics .99 CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care. 106 Table 9.2 Number of antenatal care visits and timing of first visit . 107 Table 9.3 Components of antenatal care . 109 Table 9.4 Tetanus toxoid injections . 110 Table 9.5 Place of delivery . 112 Table 9.6 Assistance during delivery . 113 xii | Tables and Figures Table 9.7 Timing of first postnatal checkup. 115 Table 9.8 Provider of first postnatal checkup . 116 Table 9.9 Problems in accessing health care . 118 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth. 120 Table 10.2 Vaccinations by source of information. 121 Table 10.3 Vaccinations by background characteristics . 123 Table 10.4 Prevalence of symptoms of ARI . 124 Table 10.5 Prevalence and treatment of fever. 126 Table 10.6 Prevalence of diarrhea . 127 Table 10.7 Diarrhea treatment . 128 Table 10.8 Feeding practices during diarrhea . 129 Table 10.9 Knowledge of ORS packets or pre-packaged liquids. 130 Table 10.10 Disposal of children's stools. 132 Figure 10.1 Percentage of Children Age 12-23 Months Vaccinated at Anytime Before the Survey (Information from Health Cards and Mothers’ Reports) . 122 Figure 10.2 Prevalence and Treatment of Acute Respiratory Infection (ARI) in Children Under Age Five. 125 CHAPTER 11 NUTRITION OF CHILDREN AND WOMEN Table 11.1 Initial breastfeeding. 134 Table 11.2 Breastfeeding status by age . 137 Table 11.3 Median duration and frequency of breastfeeding . 139 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview. 141 Table 11.5 Infant and young child feeding (IYCF) practices . 143 Table 11.6 Micronutrient intake among children . 146 Table 11.7 Foods consumed by mothers in the day and night preceding the interview . 148 Table 11.8 Micronutrient intake among mothers . 149 Figure 11.1 Among Youngest Children Born in the Five Years Preceding the Survey, Percentage Who Received Specific Prelacteal Liquids . 136 Figure 11.2 Infant Feeding Practices by Age. 138 Figure 11.3 Infant and Young Child Feeding (IYCF) Practices . 144 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 12.1 Knowledge of HIV prevention methods. 153 Table 12.2 Comprehensive knowledge about AIDS . 155 Table 12.3 Higher-risk sexual intercourse in the past 12 months. 158 Table 12.4 Coverage of prior HIV testing . 160 Table 12.5 Comprehensive knowledge about AIDS and a source of condoms among young women . 162 Tables and Figures | xiii Table 12.6 Age at first sexual intercourse among young women . 163 Table 12.7 Condom use at first sexual intercourse among young women. 164 Table 12.8 Premarital sexual intercourse and condom use among young women . 165 Table 12.9 Higher-risk sexual intercourse among young women and condom use at last higher-risk intercourse in the past 12 months . 166 Table 12.10 Recent HIV tests among young women. 167 Figure 12.1 Awareness of AIDS and Knowledge of HIV Prevention Methods among Women Age 15-49 . 154 Figure 12.2 Rejection of Misconceptions about AIDS Transmission, and Compre- hensive Knowledge about AIDS among Women Age 15-49 . 156 CHAPTER 13 TUBERCULOSIS KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 13.1 Knowledge of tuberculosis . 170 Table 13.2 Knowledge of signs and symptoms of tuberculosis. 171 Table 13.3 Knowledge of causes of tuberculosis . 172 Table 13.4 Knowledge of modes of transmitting tuberculosis . 173 Table 13.5 Experience of symptoms of tuberculosis . 174 Table 13.6 Treatment of tuberculosis. 175 Table 13.7 Positive attitudes about tuberculosis. 176 CHAPTER 14 HEALTH CARE UTILIZATION AND FINANCING Table 14.1 Health insurance coverage. 178 Table 14.2 PhilHealth insurance coverage . 179 Table 14.3 Treatment-seeking behavior. 180 Table 14.4 Use of specific types of health facilities. 182 Table 14.5 Reason for seeking health care . 183 Table 14.6 Average travel time to health facility visited. 184 Table 14.7 In-patient hospital care . 185 Table 14.8 Aspects of in-patient care. 186 Table 14.9 Cost of health care at public and private facilities . 186 Figure 14.1 Proportion of People who Visited a Health Facility/Provider in the 30 Days Before the Survey. 181 Figure 14.2 Reasons for Visiting a Health Facility/Provider in the 30 Days Before the Survey. 183 CHAPTER 15 WOMEN’S EMPOWERMENT Table 15.1 Employment and cash earnings of currently married women. 188 Table 15.2 Control over women's cash earnings and relative magnitude of women's earnings. 189 Table 15.3 Control over men's cash earnings . 191 Table 15.4 Women's control over their own earnings and the earnings of their husband. 192 xiv | Tables and Figures Table 15.5 Women's participation in decisionmaking . 193 Table 15.6 Women's participation in decisionmaking by background characteristics. 194 Table 15.7 Attitude toward wife beating. 196 Table 15.8 Indicators of women's empowerment. 197 Table 15.9 Current use of contraception by women's status. 198 Table 15.10 Women's empowerment and ideal number of children and unmet need for family planning . 199 Table 15.11 Reproductive health care by women's empowerment . 200 Figure 15.1 Number of Decisions in Which Currently Married Women Participate. 193 CHAPTER 16 VIOLENCE AGAINST WOMEN Table 16.1 Experience of physical violence. 205 Table 16.2 Persons committing physical violence . 206 Table 16.3 Violence during pregnancy . 207 Table 16.4 Force at sexual initiation . 208 Table 16.5 Experience of sexual violence . 209 Table 16.6 Persons committing sexual violence . 210 Table 16.7 Experience of different forms of violence . 210 Table 16.8 Degree of marital control exercised by husbands . 212 Table 16.9 Forms of spousal violence . 213 Table 16.10 Spousal violence by background characteristics. 215 Table 16.11 Spousal violence by husband's characteristics and empowerment indicators. 217 Table 16.12 Frequency of spousal violence among those who reported violence. 218 Table 16.13 Consequences of spousal violence . 220 Table 16.14 Violence by women against their spouse. 221 Table 16.15 Responses to violence . 223 Table 16.16 Sources from which help was sought. 224 Figure 16.1 Forms of Spousal Violence . 214 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation . 230 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 235 Table B.2 Sampling errors for National sample,. 236 Table B.3 Sampling errors for Urban sample . 237 Table B.4 Sampling errors for Rural sample. 238 Table B.5 Sampling errors for National Capital Region sample . 239 Table B.6 Sampling errors for Cordillera Admin Region sample. 240 Table B.7 Sampling errors for I - Ilocos Region sample . 241 Table B.8 Sampling errors for II - Cagayan Valley sample . 242 Table B.9 Sampling errors for III - Central Luzon sample . 243 Tables and Figures | xv Table B.10 Sampling errors for IVA - CALABARZON sample. 244 Table B.11 Sampling errors for IVB - MIMAROPA sample . 245 Table B.12 Sampling errors for V - Bicol Region sample . 246 Table B.13 Sampling errors for VI - Western Visayas sample . 247 Table B.14 Sampling errors for VII - Central Visayas sample . 248 Table B.15 Sampling errors for VIII - Eastern Visayas sample . 249 Table B.16 Sampling errors for IX - Zamboanga Peninsula sample. 250 Table B.17 Sampling errors for X - Northern Mindanao sample. 251 Table B.18 Sampling errors for XI - Davao Peninsula sample. 252 Table B.19 Sampling errors for XII - SOCCSKSARGEN sample . 253 Table B.20 Sampling errors for XIII - Caraga sample. 254 Table B.21 Sampling errors for ARMM sample . 255 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 257 Table C.2 Age distribution of eligible and interviewed women . 258 Table C.3 Completeness of reporting . 258 Table C.4 Births by calendar years . 259 Table C.5 Reporting of age at death in days . 260 Table C.6 Reporting of age at death in months. 261 Preface | xvii PREFACE The National Statistics Office (NSO) is pleased to present this final report on the 2008 National Demographic and Health Survey (NDHS). The survey is the ninth in a series of surveys conducted every five years since 1968 designed to assess the demographic and health situation in the country. The 2008 NDHS provides basic indicators on fertility, childhood mortality, contraceptive knowledge and use, maternal and child health, nutritional status of mothers and children, and knowledge, attitude and behavior regarding HIV/AIDS and tuberculosis. For the first time, data on violence against women were collected in this round of the DHS. Fieldwork for the 2008 NDHS was carried out from August 7 to September 27, 2008 covering a national sample of approximately 13,000 households and 14,000 women aged 15 to 49 years. I would like to acknowledge with deepest gratitude the organizations and individuals who contributed to the successful completion of the 2008 NDHS. Dr. Mercedes Concepcion, and the other members of the 2008 NDHS Steering Committee from the Department of Health, University of the Philippines Population Institute, Commission on Population, National Economic and Development Authority, National Statistical Coordination Board, National Institutes of Health, University of the Philippines School of Economics, Food and Nutrition Research Institute, National Commission on the Role of Filipino Women (now Philippine Commission on Women), Department of Social Welfare and Development, Philippine Health Insurance Corporation, the Philippine Legislator’s Committee on Population Development, the Professional Managers, Inc., the United States Agency for International Development (USAID), and ICF Macro put forth their valuable advice and suggestions in the design of the questionnaires and also in the planning of the survey. The Technical Working Group (TWG) for Health was formed to formulate country-specific health-related questions, and the TWG for Violence Against Women (VAW), on questions related to VAW. I also would like to extend my appreciation to the USAID for providing financial assistance for the preparatory and processing phases of the survey. My gratitude also goes to Dr. Elizabeth M. Go, ICF Macro consultant, for her technical assistance throughout the various stages of the survey. My appreciation also goes to the staff of the Demographic and Social Statistics Division of the Household Statistics Department who worked untiringly and patiently during all stages of the survey, to the employees of NSO Regional and Provincial Offices who served as supervisors during data collection, and to the 57 interviewing teams composed of team supervisors, field editors and interviewers. Without their hard work and dedication, the survey would not have been successful. My gratitude also goes to the staff of the Information Resources Department and the hired data processors who worked 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 information to enable us to gather crucial data for our country’s future population and health plans and programs. Manila, Philippines December 2009 Summary of Findings | xix SUMMARY OF FINDINGS The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representa- tive survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health sur- veys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women. The 2008 NDHS was conducted by the Phil- ippine National Statistics Office (NSO). Techni- cal assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Gov- ernment of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID). FERTILITY Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Phil- ippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman. Fertility Differentials. Fertility varies substan- tially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fer- tility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households. Unplanned Fertility. Despite a steady rise in the level of contraceptive use over the past 30 years, the 2008 NDHS data indicate that unplanned preg- nancies are common in the Philippines. Overall, one in three births in the Philippines is either unwanted (16 percent) or mistimed and wanted later (20 per- cent). These figures are lower than the findings from the 2003 NDHS (20 percent and 24 percent, respec- tively. Fertility Preferences. There is a considerable desire among currently married Filipino women to stop having children. Over half (54 percent) of mar- ried women age 15-49 do not want another child and an additional 9 percent are already sterilized. Nine- teen percent of married women want to have another child but would prefer to wait two or more years. Thus, 82 percent of married women want either to space their births or to limit childbearing altogether. Only 12 percent of women would like to have a child soon (within two years). The mean ideal num- ber of children for all women and for those who are currently married is approximately the same (2.8 and 3.1 children, respectively). These numbers are slightly lower than the 2003 NDHS figures of 3.0 children for all women and 3.2 children for currently married women. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is universal in the Philippines— almost all women know at least one method of fam- xx | Summary of Findings ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On aver- age, currently married women know eight meth- ods of family planning. Use of Contraception. The contraceptive prevalence rate (CPR) among currently married women is 51 percent. The most commonly used modern method is the pill (16 percent), followed by female sterilization (9 percent). Another 17 percent are using a traditional method, including periodic abstinence (rhythm) and withdrawal. Trends in Contraceptive Use. In the last 40 years, the use of family planning has increased. Remarkable increases occurred in the 1970s and 1980s. From 17 percent in 1973, the CPR in- creased to 40 percent in 1993. Since then, the CPR has increased gradually to 51 percent in 2008. In the last 15 years, the use of modern methods rose by only 9 percentage points, from 25 to 34 percent, despite women’s expressed desire to space or limit childbearing. However, the majority of users use modern methods; cur- rently, users of modern methods comprise two- thirds of all family planning users. Differentials in Contraceptive Use. Use of family planning varies by residence and region. Contraceptive methods are used by 53 percent of married women in urban areas, compared with 48 percent of those in rural areas. Contraceptive use ranges from a low of 15 percent of married women in ARMM to a high of 60 percent in Da- vao. Use of family planning varies very little by wealth quintile, except at the lowest quintile with only 41 percent of married women using any method of family planning. Thus, the data indicate that while family planning programs are reaching women of all economic levels, the ac- cess of the poorest group to these programs is still somewhat limited. Source of Modern Methods. Both the pri- vate and public sectors are important sources of modern contraceptive methods, with 51 percent of users of modern methods getting their supply from private sector sources, compared with 46 percent who access the public sector. The private sector is the major source of supply for pills and male condoms, while the public sector is the main source for injectables, IUDs, and female steriliza- tion. Knowledge of Fertile Period. Only about one in three women (35 percent) correctly identified the fertile period in a woman’s menstrual cycle as fal- ling halfway between two menstrual periods. The level is somewhat higher for women using ovulatory cycle-related methods (49 percent) than for women not using these methods (35 percent). Thirty-nine percent of women incorrectly identified the fertile period to be right after a woman’s menstrual period. Unmet Need for Family Planning. Unmet need for family planning 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 planning. The 2008 NDHS data show that the total unmet need for family planning in the Philip- pines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003. Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of de- mand satisfied has declined from 75 percent. MATERNAL HEALTH Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 per- cent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received ante- natal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus. Summary of Findings | xxi Delivery and Postnatal Care. Only 44 per- cent of births in the Philippines occur in health facilities—27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional—35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth atten- dant or hilot. About 10 percent of births are de- livered by C-section. The Department of Health (DOH) recom- mends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery. CHILD HEALTH Childhood Mortality. Childhood mortality continues to decline in the Philippines. Cur- rently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years be- fore the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortal- ity decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families. There is a strong association between under- five mortality and mother’s education. It ranges from 47 deaths per 1,000 live births among chil- dren of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births). Childhood Vaccination Coverage. Seven in ten children age 12-23 months had received all the recommended vaccines—BCG, measles, and three doses each of DPT and polio vaccines—before reaching age one. Six percent of children had not received any of the recommended vaccines. Vacci- nation coverage is slightly higher in urban areas than rural areas (82 percent compared with 77 percent of children with all basic vaccines). There is marked variation in vaccination coverage by region, ranging from 31 percent in ARMM to 92 percent in Western Visayas. Vaccination coverage increases with mother’s education; only 66 percent of children whose mothers have some primary education have been fully vaccinated compared with 87 percent of children whose mothers have some college educa- tion or higher. Child Illness and Treatment. Only five percent of children under five had symptoms of an acute respiratory infection (ARI) in the two weeks before the survey. Half of these children were taken to health facility for treatment, while 42 percent were given antibiotics. Twenty-two percent of children under five had a fever in the two weeks before the survey. Thirty-nine percent of these cases were taken to a health facility or health provider and 30 percent were given antibiotic drugs. During the two weeks before the survey, 9 per- cent of children under five had diarrhea. The level was highest among children 12-23 months (16 per- cent) and children age 6-11 months (15 percent). Three in five children with diarrhea were treated with oral rehydration therapy (ORT), either with oral rehydration salts (ORS) packets or recommended home fluids (RHF), and about one in three received increased fluids, as recommended. Twenty-seven percent received home remedies and 17 percent re- ceived antibiotics. Sixteen percent received no treat- ment. NUTRITION Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, re- spectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino xxii | Summary of Findings children under six months are exclusively breastfed. Complementary foods should be in- troduced when a child is six months old to re- duce the risk of malnutrition. More than half of children ages 6-9 months are eating complemen- tary foods in addition to being breastfed. The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in vari- ous age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines. Vitamin A and Iron Intake. Micronutrients help protect children from certain diseases. Vi- tamin A, which prevents blindness and infection, and iron are particularly important for children and their mothers. Survey data indicate a high level of dietary intake of both these items—in the 24 hours before the survey, 89 percent of children age 6-35 months ate fruits and vegeta- bles rich in vitamin A and 78 percent ate foods rich in iron. Three out of four children (76 per- cent) age 6-59 months received a vitamin A supplement in the six months prior to the survey. Iron supplementation during pregnancy is important to prevent iron deficiency anemia and other complications. Eighty-one percent of women took iron supplements during their last pregnancy. In addition, 46 percent of women received a vitamin A supplement postpartum. HIV/AIDS Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for pre- venting transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmis- sion. Knowledge of prevention methods is higher in urban areas than in rural areas and in- creases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college. Misconceptions about HIV transmission are still common in the Philippines. Only 58 percent of women know that AIDS cannot be transmitted by sharing food with someone who has AIDS and 63 percent know that AIDS cannot be transmitted through mosquito bites. Premarital Sex and Use of Condoms among Youth. Among never-married women age 15-24 years, four percent said they had sex in the 12 months preceding the survey and 14 percent of these women said they used a condom at their last sexual intercourse. Overall, four percent of young women said they used a condom the first time they ever had sex. Condom use at first sex is more likely among those with higher educational attainment, those in higher wealth quintiles, and those residing in urban areas. Higher-Risk Sex and Condom Use. Among women who had sex in the 12 months before the survey, 3 percent reported having had higher-risk sexual intercourse (i.e., sexual intercourse with someone other than their spouse or cohabiting part- ner). Higher-risk sex is more prevalent among younger women, those living in urban areas, and those in the National Capital Region. Higher-risk sexual behavior increases with education and wealth. Of the women who engaged in higher-risk sex, 11 percent reported using a condom at their last sexual intercourse. TUBERCULOSIS Knowledge of TB. While awareness of tubercu- losis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent men- tioned blood in sputum, and 30 percent cited cough- ing with sputum. Treatment of TB. About one in five women have ever had either a cough that lasted 2 weeks or Summary of Findings | xxiii chest or back pain. Overall, 33 percent of women have had at least one symptom that is associated with TB. Of those, 43 percent sought treatment, while one in seven women said the symptoms were harmless and therefore decided not to seek treatment. Self medication is a major reason for not seeking treatment, cited by one in three women who ever had TB symptoms. TB-related Discrimination. Six in ten women report they are willing to work with someone who has previously been treated for TB. The higher the respondent’s level of educa- tion and wealth, the more tolerant they are of those with a history of TB. WOMEN’S STATUS Women’s Status and Employment. Sixty percent of currently married women age 15-49 interviewed in the 2008 NDHS were employed in the year before the survey. Among those who are employed, most earn cash, while 6 percent are unpaid. Most women decide how their earn- ings are spent jointly with their husbands. Only four percent report that mainly their husband decides how their earnings are spent. Women’s Participation in Household De- cisions. Filipino women contribute to many household decisions. Eighty-six to 94 percent of women report that they participate in decisions concerning their own health care, daily and ma- jor household purchases, and visits to family or relatives. About three in four women participate in all four of these decisions; only one percent participates in none of them. Attitudes Toward Wife Beating. In the 2008 NDHS, women were asked whether they think a husband is justified in hitting or beating his wife under a series of circumstances: 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 sexual inter- course with him. Only 14 percent of women agree that a husband is justified in beating his wife for any of the reasons. Neglecting the chil- dren is the most commonly justified reason for wife beating among women (12 percent), while the least common reason is refusal to have sex- ual intercourse with him or burning the food (2 per- cent each). Women’s Empowerment and Health Out- come. Women who participate in more household decisions are more likely to use a family planning method than women who do not participate in any decisions. Women who participate in more decisions are also more likely to receive postnatal care from a medically trained provider. DOMESTIC VIOLENCE Spousal Violence. Emotional and other forms of non-personal violence—such as insults, humiliation, and threats of harm—are the most common types of spousal violence: 23 percent of ever-married women report having experienced such violence by their husbands, with 15 percent reporting these types of violence occurred in the year prior to the survey. One in seven ever-married women report having experienced physical violence by their husbands. Eight percent report that violence has occurred in the year before the survey. Slapping and pushing/ shaking/throwing something at her are the most commonly reported types of physical violence. Eight percent of ever-married women report having ever experienced sexual violence by their husbands, while 5 percent report such violence oc- curred in the previous year. About three in ten women report having experi- enced spousal violence (physical, sexual, or other type of violence). Women who are divorced, sepa- rated, or widowed (52 percent) are more likely to report having ever experienced some form of spousal violence than women who are currently mar- ried. Experience of violence increases with the num- ber of children (22 percent among women with no children compared with 33 percent among women with five or more children), but decreases with wealth (34 percent among women in the lowest wealth quintiles compared with 19 percent for those in the highest quintile). Women living in Caraga, SOCCSKSARGEN, Central Visayas, and MIMA- ROPA are most likely to report spousal violence (40 percent or higher), while women in ARMM and CALABARZON are least likely to report violence (lower than 20 percent). xxiv | Summary of Findings Spousal Violence and Husband’s Charac- teristics. Men’s characteristics also affect the likelihood of spousal violence. Women whose husbands have no education are more likely than those with highly educated husbands to report violence (32 percent versus 23 percent). In addi- tion, the more the husband’s/partner’s alcohol consumption and marital control behaviors, the greater the likelihood of the woman reporting experience of spousal violence. Consequences of Spousal Violence. About three in five women who experienced either physical or sexual spousal violence reported having experienced psychological consequences like depression, anxiety and anger. Physical in- juries such as cuts, bruises or aches are reported by one in three women who experience physical or sexual violence. More than 10 percent reported that they suffered eye injuries, sprains, dislocations or burns and about the same proportion reported that they attempted to commit suicide. Help Seeking to Stop Violence. Eighteen per- cent of women sought help from someone about the physical or sexual violence committed against them. About one in four women fought back either physi- cally or verbally (21 percent and 27 percent, respec- tively). Among those who sought help, about half went to their own family for help, while three in ten went to a friend or neighbor. Only 15 percent sought help from the husband’s family. xxvi | Map of Philippines Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY The Philippine archipelago is located about 1,210 km east of the coast of Vietnam and separated from Taiwan in the north by the Bashi Channel. It is bounded by the Philippine Sea (and Pacific Ocean) on the east, by the Celebes Sea on the south, and by the South China Sea on the west. The Philippines comprise 7,107 islands and has a total land area of 300,000 km2. There are three main island groups: Luzon, Visayas, and Mindanao. The Philippines is divided into local government units (LGUs). The provinces are the largest political unit in the governmental structure of the Philippines. These are subdivided into cities and municipalities, which are composed of barangays. The barangays are the smallest local government unit. Provinces are grouped into regions which have more or less homogeneous characteristics, such as ethnic origin of inhabitants, dialect spoken, and agricultural produce, among others. The regions are subnational administrative divisions that serve primarily to organize the provinces for administrative convenience. The National Capital Region, however, is composed of four special districts. Most government agencies establish regional offices instead of individual provincial offices, usually (but not always) in the city designated as the regional center. The regions do not possess a separate local government except for the Autonomous Region in Muslim Mindanao (ARMM) with an elected regional assembly and governor. The Philippines has a tropical wet climate dominated by a rainy season and a dry season. The wet or rainy season is from June to October and the dry season is from November to May. The weather is cool and dry from November to February while it is hot and dry from March to May. Following the Japanese occupation during World War II, the Philippines obtained its full independence from the United States in 1946, and had a promising economy in the 1950s and 1960s. However, the country was faced with civil unrest against the dictatorship of President Ferdinand Marcos, who declared martial law in 1972. The 20-year Marcos rule brought about economic stagnation and macroeconomic instability. In 1986, the bloodless People Power Revolution overthrew Marcos and democracy was restored in the country. During the Aquino administration, perceptions of political instability further worsened the economy that had shrunk by 10 percent during severe recession in 1985 and 1986. In the 1990s, economic reforms led by President Ramos brought back business and foreign investment to the country, which resulted in higher growth; however, this was interrupted by the Asian financial crisis in 1997. The administration under President Arroyo brought substantial progress in restoring macroeconomic stability. Economic growth has averaged 5 percent since 2001. New revenue measures and tightened expenditures helped avert the fiscal crisis and resulted in declining fiscal deficits, narrowing debt and debt service ratios, and increased spending on infrastructure and social services. The Philippine economy grew at its fastest pace in three decades in 2007 with real GDP growth at 7.1 percent. However, the global financial crisis slowed growth to 3.8 percent in 2008. High government spending, a relatively small trade sector, a resilient service sector, and large remittances from overseas Filipino workers have helped cushion the economy from the current global financial crisis (CIA, 2009). 2 | Introduction 1.2 POPULATION AND FAMILY PLANNING PROGRAM In 1970, the Philippine government launched the National Population Program following the creation in 1969 of the Commission on Population (POPCOM) by former President Marcos. The program’s principal thrust was the reduction of fertility and its core strategy was the provision of family planning services using a clinic-based and contraceptive-oriented approach. To improve access to services, a community-based approach was later adopted to extend and integrate family planning services with other development activities in rural areas (POPCOM, 2002). However, the weak economic situation of the country in the early 1980s and during the Aquino administration affected logistical aspects of the program. In addition, the program was faced with institutional instability because of changing POPCOM leadership, opposition from the Catholic Church, and local criticism of its demographic targets. In response, the program changed its emphasis to family welfare and development and broadened its scope to include family formation, status of women, maternal and child health, child survival, and mortality and morbidity. Other areas covered under the program were population distribution and urbanization, internal and international migration, and population structure. The program adopted a two-pronged strategy: 1) integration of population and development (POPDEV), and 2) responsible parenthood and family planning (FP/RP) (POPCOM, 2002). During this period, institutional and operational responsibility for the family planning program was transferred to the Department of Health (DOH) as part of promoting maternal and child health and other health initiatives (PCPD, 2008). Responsible parenthood and family planning was then transformed into a health program and was called the Philippine Family Planning Program. The Ramos administration, which strongly supported the population program, paved the way for the redefinition of the country’s population program from “population control” to “population management.” Anchored by the population-resource-environment (PRE), or sustainable development, framework, the program was renamed the Philippine Population Management Program (PPMP). The Ramos administration’s support to the PPMP led to the Philippines’ participation in various international fora and the program’s integration into the national policy agenda. The PPMP Directional Plan for 1998- 2003, which was based on the PRE framework, served as the blueprint of the PPMP’s direction for the six-year period (POPCOM, 2002). With the passage of the Local Government Code of the Philippines, health service delivery including family planning services, training and counseling became a mandate of the local government units, while POPCOM’s functions were redefined to include planning, policy formulation, and advocacy (PCPD, 2008). POPCOM further expanded this framework in three areas: 1) to explicitly consider the role of human resource development (the expansion of knowledge, skills, and improved health and nutrition to enhance productivity), 2) to explicitly incorporate PPMP’s other major concerns of reproductive health, adolescent health and development, and gender equity, and 3) to explicitly expand POPCOM’s role to include acting as a champion for reducing unmet need for family planning and helping couples to achieve their fertility preferences through the Responsible Parenthood and Family Planning Program. Aside from giving value to the balance between and among population levels, resources, and environment, the Population and Sustainable Development framework redefined development as the sustained capacity to achieve a better quality of life or well-being. Quality of life includes the capacity to be free from avoidable illness, be nourished, be educated, have employment and income opportunities, meet one’s fertility preferences, and enjoy social justice and equity, among others (POPCOM, 2002). Introduction | 3 In 2000, the PPMP Directional Plan for 2001-2004, which was based on the Population and Sustainable Development framework, was prepared and finalized under former President Estrada. The plan promoted responsible parenthood within the context of sustainable development, with emphasis on the health rationale of family planning and the exercise of reproductive health and sexual rights. The plan also responded strongly to the problem of unmet need for family planning to achieve an overall desired number of children of 2.7 and replacement-level fertility of 2.1 children per couple in 2004 (POPCOM, 2002). To contribute to President Arroyo’s poverty alleviation program, the POPCOM Board of Commissioners updated the PPMP Directional Plan of 2001-2004 through the development of a PPMP Strategic Operational Plan (SOP) for 2002-2004. As an expansion of the Population and Sustainable Development framework, the PPMP SOP focused on addressing unmet need for family planning among poor couples, and the sexuality and fertility information needs of adolescents and young people, especially those who are poor. The SOP aimed to concentrate on three strategic action areas, namely, service delivery, information, education, and communication or advocacy, and capacity building (POPCOM, 2002). As the Arroyo administration has declared natural family planning as the focus of reproductive health services, the DOH issued Administrative Order No. 125 or the National Natural Family Planning (NFP) Strategic Plan for 2002-2006 with the policies, standards, strategies, and activities for mainstreaming NFP methods (PCPD, 2008). In 2006, President Arroyo gave full responsibility of implementing the Responsible Parenthood and Natural Family Planning Program to the DOH, POPCOM, and the local government units. The Responsible Parenthood and Natural Family Planning Program primarily promotes natural family planning, birth spacing (three years birth spacing) and breastfeeding (POPCOM, 2008). Currently, the PPMP includes four major areas: 1) Population and Development Planning, 2) Reproductive Health/Family Planning, 3) Adolescent Health and Youth Development, and 4) Resource Generation and Mobilization (PCPD, 2008). 1.3 OBJECTIVES OF THE SURVEY Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives: • Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level. • Analyze the direct and indirect factors which determine the levels and patterns of fertility. • Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. • Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years. • Collect data on environmental health, utilization of health facilities, prevalence of common non- communicable and infectious diseases, and membership in health insurance plans. 4 | Introduction • Collect data on awareness of tuberculosis. • Determine women’s knowledge about HIV/AIDS and access to HIV testing. • Determine the extent of violence against women. 1.4 ORGANIZATION OF THE SURVEY The 2008 Philippines National Demographic and Health Survey (NDHS) was implemented by the National Statistics Office (NSO). Funding for the survey was received from the Government of the Philippines. The United States Agency for International Development (USAID) provided financial support in the preparatory phase of the project, as well as technical assistance from ICF Macro on questionnaire design, training, data processing, generation of tables, weights and sampling errors, and review of reports through the global MEASURE Demographic and Health Surveys (DHS) program. A survey Steering Committee was established which provided overall direction for the 2008 NDHS activities. The committee was headed by Dr. Mercedes Concepcion and consisted of senior representatives from USAID, ICF Macro, the Department of Health (DOH), the National Institutes of Health (NIH), the National Statistical Coordination Board (NSCB), the University of the Philippines Population Institute (UPPI), the University of the Philippines School of Economics, the National Economic and Development Authority (NEDA), the Food and Nutrition Research Institute (FNRI), the Population Commission (POPCOM), the Philippine Legislators’ Committee on Population Development (PLCPD), the Philippine Health Insurance Corporation (Philhealth), the National Commission on the Role of Filipino Women (NCRFW), and the Department of Social Welfare and Development (DSWD). Two technical working groups—one on health and another on violence against women—were also formed with representatives from the above-mentioned agencies. These working groups identified and recommended survey items for inclusion in or deletion from the survey; the items were reviewed and approved by the Steering Committee. The Regional Directors of the regional statistical offices, assisted by the Provincial Statistics Officers, were mainly responsible for the administrative aspects of the survey, while the designated Regional Supervisors were responsible for the survey’s technical concerns. 1.5 SAMPLE DESIGN AND IMPLEMENTATION The 2008 NDHS used the 2003 master sample created by NSO for its household-based surveys. The 2008 NDHS used one of the four replicates of the master sample. The NDHS sample was designed to represent each of the country’s 17 administrative regions. In each region, a stratified three-stage sample design was employed. At the first stage, primary sampling units (PSUs) were selected with probability proportional to the estimated number of households from the 2000 Census. PSUs consisted of one barangay or a group of contiguous barangays. At the second stage, enumeration areas (EAs) were selected within sampled PSUs with probability proportional to size. At the third stage, housing units were selected with equal probability within sampled EAs. An EA is defined as an area with discernable boundaries within barangays and consisting of about 150 contiguous households. These EAs were identified during the 2000 Census. The 2008 NDHS sample contains 794 enumeration areas (EAs). From each EA, an average of 17 housing units was selected using systematic sampling. All households in a sampled housing unit were interviewed, except when there were three or more households in the housing unit. For such a housing unit, three households were selected using simple random sampling. Over 13,500 households were selected for the 2008 NDHS. The sampled households per EA ranged from as low as 3 to as high as 32. Introduction | 5 1.6 QUESTIONNAIRES Three questionnaires were used for the 2008 NDHS: the Household Questionnaire, the Women’s Questionnaire and the Women’s Safety Module. These questionnaires were based on the standard questionnaires developed by the MEASURE DHS program and modified—as recommended by the technical working groups and approved by the Steering Committee—to address relevant family planning and health issues in the Philippines. The three questionnaires were translated from English into six major dialects—Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray. The Household Questionnaire was used to list all the usual members and visitors in the selected households, as well as some background information on each person listed such as age, sex, relationship to head of the household, health insurance coverage, and education. The main purpose of the Household Questionnaire was to identify women 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, roof, and walls of the house, and ownership of various durable goods was recorded in the Household Questionnaire. These items are indicators of the household’s socioeconomic status. Finally, this questionnaire was used to gather information on prevalence of common noncommuni- cable and infectious diseases, health-seeking behavior, and utilization of health facilities by household members. 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 • Prenatal, delivery, and postnatal care and breastfeeding • Child immunization and health and nutrition of mothers and children • Marriage and sexual activity • Fertility preferences • Woman’s work and husband’s background characteristics • Awareness and behavior regarding HIV/AIDS • Other health issues The Women’s Safety Module was used to interview one respondent selected from all eligible women age 15 to 49 years who were identified from the Household Questionnaire. It collected information on the following topics: • Women’s experience of violence since age 15 and in the 12 months preceding the survey • Violence during pregnancy • Marital control • Interspousal violence • Experience of forced sex at sexual initiation • Help-seeking behavior by women who have experienced violence Three pretests were conducted in 2008 prior to finalizing the survey instruments. The first was conducted in March, the second in April, and the third in May. The pretests primarily aimed to test the questionnaires for clarity and correctness of the new questions; the suitability of the translations in the six dialects (Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray); the sustainability of respondents’ participation in the survey; and the actual field operation procedures. 6 | Introduction 1.7 TRAINING AND FIELDWORK Training of the field staff was conducted at two levels. The first was Task Force training for the instructors and regional supervisors; this was followed by training for the interviewing teams. The Task Force training was conducted in Manila on July 7-18, 2008. There were 36 participants, including 17 regional supervisors and 19 central office staff. Selected staff from the Demographic and Social Statistics Division (DSSD) at the NSO and professors from the University of the Philippines served as trainers. A consultant from ICF Macro and staff from the Department of Health, the National Commission on the Role of Filipino Women, and the Department of Social Welfare and Development served as resource persons. The second-level training for the interviewers took place in 12 training centers from July 21 through August 5, 2008: Antipolo, Rizal; San Fernando Pampanga; Agoo, La Union; Lipa City, Batangas; Calapan City, Oriental Mindoro; Legazpi City; Iloilo City; Cebu City; Zamboanga City; Cagayan de Oro City; Davao City; and Cotabato City. Instructors for the training were members of the Task Force who had been trained in the first-level training. Data collection was carried out from August 7 to September 27, 2008 by 57 interviewing teams. Each team consisted of a team supervisor, a field editor, and 3-6 female interviewers. 1.8 DATA PROCESSING Data processing was carried out at the NSO central office in Manila. It consisted of manual editing, data entry, verification, and editing of computer-identified errors. Forty-five hired data processors who underwent training October 6-17, 2008 processed the 2008 NDHS data. An ad hoc group composed of eight employees from the Demographic and Social Statistics Division, the Information Resources Division, and the Information Technology Operations Division of the NSO was created. They worked full time at the NDHS Data Processing Center and were responsible for various aspects of the NDHS data processing. Manual editing began October 7, 2008 and data entry began October 21, 2008. The computer software package called CSPro (Census and Survey Processing System) was used for data entry. The data entry program was developed in Manila at NSO with the assistance of data processing specialists from ICF Macro. Data processing was completed on December 22, 2008. 1.9 RESPONSE RATES In the 2008 NDHS a total of 13,764 households were selected in the sample, of which 12,555 households were occupied. Of these households, 12,469 were successfully interviewed, yielding a household response rate of 99 percent (Table 1.1). In the interviewed households 13,833 women were identified for the individual interview. A total of 13,594 women were successfully interviewed, yielding a response rate of 98 percent. A total of 9,458 women were identified as eligible for the Women’s Safety Module, of whom 9,316 were interviewed with privacy, yielding a response rate of 99 percent. Response rates in urban and rural areas were similar. Introduction | 7 Table 1.1 Results of the household, women’s, and women's safety inter- views Number of households, number of interviews, and response rates according to residence, Philippines 2008 Residence Result Urban Rural Total Household interviews Households selected 6,207 7,557 13,764 Households occupied 5,602 6,953 12,555 Households interviewed 5,544 6,925 12,469 Household response rate1 99.0 99.6 99.3 Interviews with women age 15-49 Number of eligible women 6,880 6,953 13,833 Number of eligible women interviewed 6,762 6,832 13,594 Eligible women response rate2 98.3 98.3 98.3 Women's safety module interviews Number of eligible women 4,410 5,048 9,458 Number of eligible women interviewed with privacy 4,353 4,963 9,316 Woman's safety module response rate2 98.7 98.3 98.5 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter provides a summary of the demographic and socioeconomic characteristics of the household population in the 2008 National Demographic and Health Survey (NDHS). The 2008 NDHS provides valuable inputs for social and economic development planning and it is also useful for understanding and identifying the major factors that determine or influence the basic demographic indicators of the population. The Household Questionnaire used in the 2008 NDHS collected data on the demographic and social 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 slept in the household the night prior to the interview. In the 2008 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 facilities. The information on household assets was used to create an index representing the wealth of the households interviewed in the survey. 2.1 AGE AND SEX COMPOSITION OF THE HOUSEHOLD POPULATION Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. In general, the presentation of indicators according to sex is useful for analysis. The 2008 NDHS collected information on a total of 57,629 persons. This number is almost equally divided between males and females, and the overall sex ratio (the number of males per 100 females) is 101. The sex ratio differs by residence; it is lower in urban areas than in rural areas (97 and 107, respectively) (Table 2.1). The proportion of the population below age 15 years is larger in rural than in urban areas (39 and 33 percent, respectively), indicating a younger age structure for the rural population. Table 2.2 shows that the proportion under age 15 has declined somewhat over the past five years, leading to a narrowing of the base of the population pyramid (Figure 2.1). 10 | Household Population and Housing Characteristics 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 residence, Philippines 2008 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 11.9 10.3 11.1 12.6 11.8 12.2 12.2 11.1 11.6 5-9 12.4 10.2 11.3 13.2 13.2 13.2 12.8 11.6 12.2 10-14 10.9 10.2 10.6 13.5 13.1 13.3 12.2 11.6 11.9 15-19 10.7 10.7 10.7 10.8 9.3 10.1 10.8 10.1 10.4 20-24 9.0 8.9 8.9 7.6 6.7 7.1 8.3 7.8 8.0 25-29 8.1 8.5 8.3 6.7 6.8 6.7 7.4 7.7 7.5 30-34 7.0 7.5 7.3 5.9 6.0 5.9 6.4 6.8 6.6 35-39 6.4 6.7 6.6 5.7 6.2 6.0 6.1 6.5 6.3 40-44 5.7 5.9 5.8 5.2 5.2 5.2 5.4 5.5 5.5 45-49 5.1 5.1 5.1 5.0 5.0 5.0 5.0 5.1 5.1 50-54 3.8 4.6 4.2 4.1 4.8 4.4 4.0 4.7 4.3 55-59 3.1 3.2 3.1 3.1 3.2 3.2 3.1 3.2 3.1 60-64 2.3 2.8 2.6 2.4 2.6 2.5 2.4 2.7 2.5 65-69 1.7 1.9 1.8 1.6 2.2 1.8 1.6 2.0 1.8 70-74 0.9 1.4 1.2 1.2 1.6 1.4 1.0 1.5 1.3 75-79 0.6 1.0 0.8 0.9 1.1 1.0 0.7 1.0 0.9 80 + 0.5 1.0 0.7 0.7 1.1 0.9 0.6 1.1 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 14,299 14,777 29,076 14,728 13,825 28,553 29,027 28,602 57,629 Table 2.2 Dependency ratios Percent distribution of the household population by broad age groups from censuses and NDHS surveys, Philippines Age group 1970 Census 1980 Census 1990 Census 1993 NDHS 1995 Census 1998 NDHS 2000 Census 2003 NDHS 2008 NDHS <15 45.7 42.0 39.5 39.3 38.4 38.5 37.0 38.0 35.7 15-64 51.4 54.6 57.1 56.8 58.1 57.3 59.2 57.8 59.3 65+ 2.9 3.4 3.4 3.9 3.5 4.2 3.8 4.2 4.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency ratio 94.6 83.2 75.1 76.1 72.2 74.5 69.0 73.0 68.3 Figure 2.1 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 2008 Male Percent Female Age Household Population and Housing Characteristics | 11 2.2 HOUSEHOLD COMPOSITION Information on the distribution of households by selected background characteristics is useful for several reasons. For example, female-headed house- holds are often found to be poorer than male-headed households. The size and composition of the house- hold 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. Around 17 percent of households are headed by women. This proportion is higher in urban areas than in rural areas (19 and 14 percent, respectively). On average, a household is composed of 4.8 persons, and the figure is the same in urban and rural areas (4.8 persons for both). 2.3 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, specifically Goal 2, which is aimed at achieving universal primary education and gender equity by 2015. Information on the highest level of education attained or completed by the population, according to selected background characteristics, is presented in Tables 2.4.1 and 2.4.2 for females and males, respectively. The results of the 2008 NDHS indicate that the vast majority of the population has some formal education. Among females age six and over, only about 7 percent have no formal education. Among females and males, two in five attended or completed elementary school; three in ten attended or completed high school, and one in five attended college or another form of higher education. No major gender differences were seen by level of education. However, there are substantial differences between urban and rural areas. Urban residents are more likely than rural residents to have completed high school or higher education. This finding likely reflects better access to education facilities by urban residents than by rural residents because colleges and universities are more likely to be situated in cities and urbanized areas. The distribution of population by highest level of education attended varies substantially among the regions of the country (Figure 2.2). Residents of the National Capital Region (NCR) and CALABARZON tend to have more education than residents in the rest of the country; the median duration of schooling in these regions is 8 to 9 years, compared with only 3 to 7 years in most of the other regions. Residents of the Autonomous Region in Muslim Mindanao (ARMM) have the lowest median duration of schooling (4 years for women and 3 years for men). Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Philippines 2008 Residence Characteristic Urban Rural Total Household headship Male 81.3 85.6 83.4 Female 18.7 14.4 16.6 Total 100.0 100.0 100.0 Number of usual members 1 5.2 5.3 5.3 2 10.0 10.1 10.0 3 15.3 14.9 15.1 4 18.6 19.4 19.0 5 18.0 17.3 17.6 6 13.0 12.6 12.8 7 8.9 8.5 8.7 8 4.7 5.8 5.2 9+ 6.4 6.2 6.3 Total 100.0 100.0 100.0 Mean size of households 4.8 4.8 4.8 Number of households 6,277 6,192 12,469 Note: Table is based on de jure household members, i.e., usual residents. 12 | Household Population and Housing Characteristics Table 2.4.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Philippines 2008 Background characteristic No education Some elementary Completed elementary1 Some high school Completed high school2 College or higher Total Number Median years completed Age 6-9 40.2 59.2 0.5 0.0 0.0 0.0 100.0 2,674 0.4 10-14 2.1 55.8 18.5 23.0 0.5 0.1 100.0 3,318 4.6 15-19 1.2 6.4 7.5 39.6 26.9 18.4 100.0 2,880 8.8 20-24 1.1 4.9 5.7 13.3 33.5 41.4 100.0 2,232 9.7 25-29 1.0 6.5 8.8 12.2 32.4 39.0 100.0 2,190 9.7 30-34 1.2 8.7 10.4 12.7 28.3 38.7 100.0 1,940 9.6 35-39 1.8 10.4 16.4 13.0 27.7 30.6 100.0 1,851 9.3 40-44 2.2 11.0 16.8 13.8 23.5 32.6 100.0 1,581 9.3 45-49 3.4 14.2 19.6 11.1 20.0 31.7 100.0 1,453 9.1 50-54 3.4 15.8 22.8 13.7 17.4 26.9 100.0 1,347 7.9 55-59 3.2 20.6 27.7 10.3 15.3 22.8 100.0 915 5.9 60-64 4.4 27.5 26.4 7.2 12.6 21.9 100.0 773 5.7 65+ 10.3 36.4 23.0 8.6 9.3 12.3 100.0 1,619 5.2 Residence Urban 4.5 18.0 10.9 14.8 21.6 30.2 100.0 12,953 9.1 Rural 9.0 29.5 16.3 16.1 15.3 13.8 100.0 11,825 5.7 Region National Capital Region 4.1 14.3 9.4 14.6 23.1 34.5 100.0 4,079 9.3 Cordillera Admin Region 9.4 20.7 13.9 15.5 15.8 24.6 100.0 413 7.2 I - Ilocos 4.7 20.5 15.5 14.7 20.9 23.6 100.0 1,244 8.0 II - Cagayan Valley 5.7 23.4 16.9 15.7 16.5 21.8 100.0 743 7.0 III - Central Luzon 4.2 21.5 16.4 13.3 24.1 20.5 100.0 2,649 7.7 IVA - CALABARZON 4.2 19.8 12.1 14.2 25.0 24.7 100.0 3,179 9.0 IVB - MIMAROPA 11.2 28.6 16.9 13.5 14.6 15.2 100.0 674 5.6 V - Bicol 6.7 25.6 19.4 16.7 13.2 18.4 100.0 1,500 5.9 VI - Western Visayas 6.9 25.1 13.4 14.5 17.7 22.4 100.0 1,916 7.1 VII - Central Visayas 6.3 26.5 14.1 17.4 16.6 19.1 100.0 1,743 6.6 VIII - Eastern Visayas 7.6 31.8 14.8 15.6 12.1 18.1 100.0 996 5.7 IX - Zamboanga Peninsula 8.2 30.2 13.7 15.2 12.1 20.6 100.0 954 5.8 X - Northern Mindanao 6.9 27.0 12.9 18.0 15.2 20.1 100.0 1,079 6.6 XI - Davao 7.3 27.6 14.0 19.0 15.0 16.9 100.0 1,112 6.2 XII - SOCCSKSARGEN 11.5 28.4 11.2 20.5 15.2 13.0 100.0 910 5.9 XIII - Caraga 6.8 28.4 14.4 19.6 14.9 15.9 100.0 607 6.1 ARMM 22.9 37.0 10.0 13.0 5.6 11.5 100.0 980 3.8 Wealth quintile Lowest 15.6 41.6 17.7 14.3 8.2 2.6 100.0 4,446 4.2 Second 7.8 29.5 17.1 18.7 18.0 8.9 100.0 4,703 5.7 Middle 5.3 21.7 15.5 18.5 23.0 16.0 100.0 4,814 7.3 Fourth 3.6 16.5 11.3 14.8 24.0 29.8 100.0 5,163 9.2 Highest 2.5 12.1 7.5 11.6 18.5 47.9 100.0 5,652 9.9 Total 6.6 23.5 13.5 15.4 18.6 22.4 100.0 24,778 7.4 Note: Total includes 3 women whose age is missing 1 Completed grade 6 at the primary level 2 Completed 4th year of the secondary level Household Population and Housing Characteristics | 13 Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Philippines 2008 Background characteristic No education Some elementary Completed elementary1 Some high school Completed high school2 College or higher school Total Number Median years completed Age 6-9 46.7 52.4 0.7 0.1 0.0 0.0 100.0 2,966 0.1 10-14 3.5 61.4 16.0 18.2 0.8 0.1 100.0 3,552 4.2 15-19 1.2 14.9 13.0 36.8 22.1 12.2 100.0 3,133 8.0 20-24 1.6 10.0 9.6 16.6 27.6 34.5 100.0 2,396 9.4 25-29 1.7 12.8 10.5 14.8 27.7 32.5 100.0 2,134 9.4 30-34 1.6 14.6 12.1 13.3 26.1 32.2 100.0 1,869 9.3 35-39 1.4 14.7 15.2 13.2 26.7 28.7 100.0 1,758 9.2 40-44 2.0 17.0 14.5 12.9 24.5 29.1 100.0 1,579 9.2 45-49 2.8 18.6 16.4 11.1 23.3 27.8 100.0 1,465 9.1 50-54 3.4 20.9 20.4 10.5 20.8 24.1 100.0 1,147 7.7 55-59 4.6 23.5 18.7 8.8 20.2 24.3 100.0 898 7.4 60-64 3.9 25.7 26.3 8.1 15.6 20.4 100.0 686 5.8 65+ 8.7 34.5 20.4 7.6 11.8 17.1 100.0 1,143 5.4 Residence Urban 6.3 20.4 10.0 15.1 20.6 27.5 100.0 12,230 8.7 Rural 9.5 34.5 15.9 15.0 14.4 10.7 100.0 12,499 5.4 Region National Capital Region 5.7 17.9 7.2 14.7 23.9 30.5 100.0 3,712 9.2 Cordillera Admin Region 7.9 28.4 13.4 15.7 17.1 17.6 100.0 458 6.1 I - Ilocos 5.7 21.0 15.0 13.6 23.9 20.8 100.0 1,269 7.9 II - Cagayan Valley 6.0 25.5 14.5 16.6 16.9 20.5 100.0 769 6.9 III - Central Luzon 6.3 23.6 15.5 16.1 20.5 18.0 100.0 2,652 7.1 IVA - CALABARZON 6.1 20.4 12.7 14.1 23.7 22.8 100.0 3,076 8.4 IVB - MIMAROPA 12.0 33.7 15.2 15.5 11.5 12.1 100.0 697 5.3 V - Bicol 8.7 29.3 19.1 15.3 12.7 14.9 100.0 1,467 5.6 VI - Western Visayas 8.3 30.6 13.0 16.6 14.5 17.0 100.0 2,043 5.9 VII - Central Visayas 5.9 32.6 14.2 16.1 14.7 16.5 100.0 1,717 5.8 VIII - Eastern Visayas 8.6 40.0 13.5 13.8 11.4 12.7 100.0 1,043 5.1 IX - Zamboanga Peninsula 8.9 34.1 12.4 12.7 13.2 18.6 100.0 947 5.6 X - Northern Mindanao 8.4 33.0 11.6 18.0 12.2 16.7 100.0 1,070 5.8 XI - Davao 8.8 33.3 14.7 14.2 13.5 15.5 100.0 1,140 5.6 XII - SOCCSKSARGEN 10.6 33.1 14.1 15.1 14.4 12.6 100.0 1,028 5.5 XIII - Caraga 7.6 36.3 13.5 16.6 13.4 12.3 100.0 640 5.5 ARMM 23.0 40.2 9.5 11.4 6.7 9.2 100.0 1,002 3.2 Wealth quintile Lowest 15.7 47.1 15.9 11.6 7.4 2.3 100.0 4,992 3.7 Second 8.3 33.8 18.2 17.4 15.7 6.6 100.0 5,109 5.4 Middle 6.4 23.8 14.8 18.2 22.9 13.8 100.0 5,149 6.9 Fourth 4.8 17.3 9.9 16.9 24.1 26.9 100.0 4,879 9.1 Highest 4.0 14.3 5.1 10.7 17.2 48.7 100.0 4,600 9.9 Total 7.9 27.5 13.0 15.0 17.5 19.0 100.0 24,729 6.4 Note: Total includes 3 men whose age is missing 1 Completed grade 6 at the primary level 2 Completed 4th year of the secondary level 14 | Household Population and Housing Characteristics 2.4 HOUSING CHARACTERISTICS The physical characteristics of households are important indicators of health and of the general socioeconomic condition of the population. In the 2008 NDHS, respondents were asked about sources of drinking water and time taken to reach the nearest source, type of toilet facility, access to electricity, main housing materials, number of rooms used for sleeping in the dwelling, the place where cooking is done, and type of fuel used for cooking. The percent distribution of households by housing characteristics according to urban-rural residence is shown in Tables 2.5, 2.6, and 2.7. Controlling water-borne diseases is a major concern of health program managers. Safe drinking water is important for health and sanitation. Three out of ten households (30 percent) in the Philippines have water piped into the dwelling, yard, or plot as their main source of drinking water. In rural areas, the main source of drinking water is tube wells or boreholes (29 percent), while in urban areas the main source is water piped into the premises (38 percent). Overall, the majority of households in the Philippines have drinking water available on the premises (72 percent). Ninety-five percent of households live within 30 minutes of their source of drinking water or have water available on the premises. Seventy percent of households do not do anything to make the water they drink safer, while 20 percent boil their water and 6 percent use a cloth strainer (Table 2.5). Differences by urban-rural resi- dence are small. Figure 2.2 Median Years of Schooling by Sex and Region 9 7 8 7 8 9 6 6 7 7 6 6 7 6 6 6 4 9 6 8 7 7 8 5 6 6 6 5 6 6 6 6 6 3 National Capital Region Cordillera Admin Region I - Ilocos II - Cagayan Valley III - Central Luzon IVA - CALABARZON IVB - MIMAROPA V - Bicol VI - Western Visayas VII - Central Visayas VIII - Eastern Visayas IX - Zamboanga Peninsula X - Northern Mindanao XI - Davao XII - SOCCSKSARGEN XIII - Caraga ARMM 0 2 4 6 8 10 Median years of schooling Women Men NDHS 2008Note: De facto household population age six and over Household Population and Housing Characteristics | 15 Table 2.5 Household drinking water Percent distribution of households and de jure population by source and time to collect drinking water and percentage of households and de jure population by treatment of drinking water, according to residence, Philippines 2008 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 60.3 79.5 69.8 60.6 79.7 70.1 Piped water into dwelling/yard/plot 38.2 22.0 30.2 38.2 21.6 29.9 Public tap/standpipe 3.2 7.0 5.1 3.4 7.1 5.2 Tube well or borehole 14.3 29.2 21.7 14.4 29.6 21.9 Protected dug well 2.2 7.8 5.0 2.2 7.9 5.0 Semi-protected well 0.3 1.9 1.1 0.3 2.0 1.1 Protected spring 1.7 10.7 6.2 1.8 10.8 6.2 Rainwater 0.4 0.9 0.6 0.4 0.9 0.7 Non-improved source 3.0 12.0 7.4 3.2 12.3 7.7 Unprotected dug well 0.6 5.2 2.9 0.6 5.4 3.0 Unprotected spring 0.5 5.2 2.8 0.6 5.2 2.9 Tanker truck/cart with small tank 1.6 1.3 1.4 1.7 1.2 1.4 Surface water 0.2 0.4 0.3 0.3 0.4 0.4 Bottled water, improved source for cooking/washing1 33.6 6.6 20.2 33.0 6.4 19.8 Bottled water, non-improved source for cooking/washing 1.7 0.4 1.0 1.6 0.3 1.0 Other 1.5 1.5 1.5 1.5 1.3 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 93.6 84.2 88.9 93.4 84.2 88.8 Time to obtain drinking water (round trip) Water on premises 84.4 59.0 71.8 83.8 58.8 71.4 Less than 30 minutes 12.6 34.5 23.5 13.0 34.7 23.8 30 minutes or longer 1.0 5.9 3.5 1.2 6.0 3.6 Don't know/missing 2.0 0.6 1.3 2.0 0.6 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment2 Boiled 18.8 21.2 20.0 20.3 22.2 21.2 Bleach/chlorine 0.2 1.0 0.6 0.2 1.2 0.7 Strained through cloth 4.3 7.6 5.9 4.2 7.6 5.9 Ceramic, sand or other filter 4.4 1.4 2.9 4.5 1.4 3.0 Solar disinfection 0.1 0.2 0.2 0.1 0.2 0.2 Other 1.3 2.4 1.8 1.2 2.5 1.8 No treatment 72.3 68.2 70.3 70.9 67.1 69.1 Percentage using an appropriate treatment method3 26.3 29.5 27.9 27.7 30.5 29.1 Number 6,277 6,192 12,469 30,002 29,615 59,617 1 Because the quality of bottled water used by households as drinking water is not known, the “source of drinking water” (improved or non-improved) for households using bottled water is determined by the source of water used for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Hygienic treatment of human waste can have a positive impact on reducing disease and mortality. In the Philippines, three in five households have a private flush toilet (Table 2.6). Toilets that flush into a septic tank are much more common in urban areas than in rural areas, while pit latrines are more common in rural than urban areas. Fifteen percent of households in rural areas have no toilet facility, compared with only 4 percent in urban areas. 16 | Household Population and Housing Characteristics Table 2.6 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Philippines 2008 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 3.0 2.7 2.8 3.0 2.6 2.8 Flush/pour flush to septic tank 66.9 40.0 53.6 68.0 40.5 54.3 Flush/pour flush to pit latrine 3.0 11.1 7.0 3.4 11.4 7.4 Ventilated improved pit (VIP) latrine 0.2 1.0 0.6 0.3 1.0 0.6 Pit latrine with slab 0.3 2.5 1.4 0.4 2.6 1.4 Composting toilet 0.1 0.6 0.4 0.1 0.7 0.4 Non-improved facility Any facility shared with other households 18.9 19.3 19.1 17.3 18.3 17.8 Flush/pour flush not to sewer/septic tank/pit latrine 0.8 0.8 0.8 0.8 0.7 0.8 Pit latrine without slab/open pit 0.9 3.4 2.1 1.1 3.5 2.3 Bucket 0.1 0.2 0.2 0.1 0.2 0.1 Hanging toilet/hanging latrine 0.3 1.5 0.9 0.4 1.7 1.1 No facility/bush/field 3.9 15.2 9.5 3.9 15.3 9.6 Missing 1.3 1.6 1.5 1.2 1.6 1.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,277 6,192 12,469 30,002 29,615 59,617 Table 2.7 and Figure 2.3 show that more than eight in ten households have electricity, although there is a substantial difference between urban and rural areas: 94 percent of households in urban areas have electricity, compared with 73 percent in rural areas. More than half of all households (52 percent) have cement flooring. Urban households are more likely to have cement floors than rural households (58 and 46 percent, respectively). Palm and bamboo are used as flooring materials in 21 percent of households in the rural areas. The vast majority of households in the Philippines have roofs made of galvanized iron or aluminum (84 percent), while only 11 percent have roofs made of thatch or palm (Nipa). More than half of households have walls made of cement or cement blocks, with both being more common in urban than rural households. A basic measure of housing security is the tenure status of the lot. Over half of households (56 percent) own or are amortizing the lot they occupy, while 29 percent live rent-free with the consent of the lot owner, and 14 percent are renting their lots. Two percent of households appear to be squatters because they are living rent-free without the consent of the owner. Household Population and Housing Characteristics | 17 Table 2.7 Household characteristics: electricity, housing materials, and tenure status Percent distribution of households and de jure population by presence of electricity, housing materials, and tenure status, according to residence, Philippines 2008 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 93.7 72.8 83.3 93.7 73.0 83.4 No 6.2 27.2 16.6 6.2 26.9 16.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 4.6 12.8 8.7 4.7 12.6 8.6 Wood/planks 8.1 11.6 9.8 8.2 11.7 10.0 Palm/bamboo 4.8 20.9 12.8 4.8 21.1 12.9 Parquet or polished wood 0.6 0.4 0.5 0.6 0.3 0.4 Vinyl or asphalt strips 4.9 2.8 3.8 4.6 2.7 3.7 Ceramic tiles 16.5 5.0 10.8 16.9 4.7 10.9 Cement 57.7 45.7 51.7 68.0 40.5 54.3 Carpet 0.2 0.2 0.2 0.2 0.3 0.2 Marble 2.5 0.6 1.6 2.6 0.5 1.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Roof material None 0.1 0.0 0.0 0.1 0.0 0.1 Thatch/palm leaf (Nipa) 3.7 17.6 10.6 3.5 18.0 10.7 Sod/grass (Cogon) 0.7 3.4 2.1 0.9 3.2 2.0 Rustic mat 0.1 0.0 0.0 0.1 0.0 0.0 Palm bamboo 0.2 0.9 0.6 0.2 0.8 0.5 Wood planks 0.0 0.1 0.1 0.0 0.1 0.0 Makeshift/cardboard 0.3 0.1 0.2 0.2 0.1 0.2 Galvanized iron/aluminum 91.8 76.4 84.2 92.1 76.4 84.3 Wood 0.1 0.1 0.1 0.1 0.0 0.1 Calamine/cement fiber 0.2 0.0 0.1 0.2 0.0 0.1 Ceramic tiles 0.3 0.0 0.2 0.4 0.1 0.2 Cement 1.7 0.5 1.1 1.6 0.5 1.1 Roofing shingles 0.6 0.8 0.7 0.6 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Wall materials Cane/palm/trunks 0.7 3.3 2.0 0.7 3.2 1.9 Bamboo 6.8 24.9 15.8 7.0 24.5 15.7 Plywood 11.6 10.5 11.1 11.4 10.7 11.0 Cardboard/reused material 1.0 0.9 1.0 0.9 1.0 0.9 Cement 35.3 17.6 26.5 35.2 17.2 26.3 Stone with lime/cement 0.8 0.2 0.5 0.8 0.2 0.5 Bricks 0.2 0.1 0.2 0.2 0.1 0.2 Cement blocks 37.6 27.1 32.4 37.6 27.1 32.4 Wood planks/shingles 4.9 13.8 9.3 5.1 14.4 9.7 Galvanized iron/aluminum 0.8 1.1 1.0 0.8 1.1 1.0 Other/missing 0.3 0.4 0.3 0.4 0.5 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Tenure status of lot Owned/being amortized 54.9 56.3 55.6 57.1 55.5 56.3 Rented 21.4 5.5 13.5 19.1 5.5 12.4 Rent-free with consent of owner 21.0 36.1 28.5 21.1 36.7 28.8 Rent-free without consent of owner 2.2 1.6 1.9 2.3 1.7 2.0 Missing 0.4 0.6 0.5 0.5 0.6 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population 6,277 6,192 12,469 30,002 29,615 59,617 18 | Household Population and Housing Characteristics The number of persons in the household and the number of rooms used for sleeping are important indicators of the extent of crowding, which can have adverse effects on health. Almost two in five households use only one room for sleeping, while about the same proportion use two rooms, and more than one in five households uses three or more rooms for sleeping. There are no substantial differences in the number of rooms used for sleeping in urban or rural households (Table 2.8). Information on the type of fuel used for cooking is another measure of the socioeconomic status of the household. The use of some cooking fuels causes pollution and can have adverse consequences on health and the environment. Smoke from solid fuels is a serious health hazard, particularly for persons with respiratory ailments. Sixty-four percent of households use solid fuel for cooking, mostly wood (48 percent) and charcoal (16 percent). One in three households uses liquid petroleum gas (LPG), natural gas or biogas. Use of wood for cooking is common in rural areas, while use of LPG, natural gas or biogas is more common in urban areas. The majority (75 percent) of households cook inside the house. This practice is common in both urban and rural households (78 and 72 percent, respectively). Among households using solid fuel, 9 in 10 use an open fire or stove without a hood or chimney. Figure 2.3 Housing Amenities by Urban-Rural Residence 94 94 73 58 73 84 54 46 83 89 63 52 Electricity Improved source for drinking water Flush toilet, not shared Cement flooring 0 20 40 60 80 100 Percentage of households Urban Rural Total NDHS 2008 Household Population and Housing Characteristics | 19 Table 2.8 Household characteristics: rooms for sleeping, place for cooking, cooking fuel, and type of fire/stove Percent distribution of households and de jure population by rooms used for sleeping, place used for cooking, and type of cooking fuel; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Philippines 2008 Households Population Housing characteristic Urban Rural Total Urban Rural Total Rooms used for sleeping One 36.8 38.6 37.7 30.8 33.3 32.0 Two 37.2 41.1 39.1 37.4 42.6 40.0 Three or more 25.7 20.1 22.9 31.5 24.0 27.8 Missing 0.3 0.2 0.3 0.3 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 77.8 72.3 75.1 77.5 72.2 74.9 In a separate building 9.1 14.9 12.0 9.6 15.2 12.4 Outdoors 12.4 12.6 12.5 12.7 12.6 12.6 Missing 0.7 0.3 0.5 0.2 0.1 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 1.7 0.4 1.0 1.6 0.4 1.0 LPG/natural gas/biogas 51.5 13.4 32.6 50.5 12.3 31.5 Kerosene 3.0 0.4 1.7 3.0 0.4 1.7 Charcoal 16.7 14.5 15.6 17.1 14.1 15.6 Wood 25.3 70.5 47.7 26.2 72.0 49.0 Agricultural crop 0.9 0.5 0.7 1.1 0.6 0.9 No food cooked in household 0.7 0.2 0.5 0.2 0.1 0.1 Other/missing 0.1 0.0 0.1 0.2 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 43.1 85.6 64.2 44.6 86.8 65.6 Number of households/population 6,277 6,192 12,469 30,002 29,615 59,617 Type of fire/stove among households using solid fuel1 Closed stove with chimney 1.0 1.0 1.0 1.2 1.0 1.0 Open fire/stove with chimney 2.4 2.8 2.7 2.4 2.8 2.7 Open fire/stove with hood 1.7 1.2 1.4 1.9 1.2 1.5 Open fire/stove without chimney or hood 93.3 94.1 93.8 93.0 94.2 93.8 Other/missing 1.6 0.8 1.2 1.5 0.8 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using solid fuel 2,704 5,299 8,003 13,387 25,719 39,106 LPG = Liquid petroleum gas 1 Includes charcoal, wood, and agricultural crops 2.5 HOUSEHOLD DURABLE GOODS In the 2008 NDHS, information on the possession of selected durable consumer goods was collected at the household level. The percentage of households possessing various durable goods is shown in Table 2.9. There is a substantial difference between urban and rural households, with urban households more likely than rural households to own each of the items (except for tractors, boats, and animal carts). The urban-rural difference is especially pronounced for ownership of modern conveniences such as a television, telephone, washing machine, refrigerator, CD/VCD/DVD player, component/karaoke player, personal computer, and car. 20 | Household Population and Housing Characteristics Table 2.9 Household durable goods Percentage of households and de jure population possessing various household effects and means of transportation, by residence, Philippines 2008 Households Population Possession Urban Rural Total Urban Rural Total Household effects Radio/radio cassette 69.8 60.5 65.2 70.5 61.0 65.8 Television 84.6 57.5 71.1 86.1 58.9 72.6 Landline telephone 20.0 3.0 11.6 21.5 3.0 12.3 Cellular telephone 81.3 58.7 70.1 83.1 62.0 72.6 Washing machine 45.1 17.9 31.6 48.3 18.6 33.5 Refrigerator 53.0 26.4 39.8 54.3 26.4 40.4 CD/VCD/DVD player 62.7 38.2 50.5 65.3 39.8 52.6 Component/karaoke 37.7 21.8 29.8 39.9 22.4 31.2 Personal computer or laptop 21.0 4.4 12.7 22.3 4.8 13.6 Means of transport Tractor 0.9 2.3 1.6 0.9 2.4 1.7 Boat/banca with motor 1.3 5.5 3.4 1.4 6.1 3.7 Car/jeep/van 15.3 5.1 10.2 16.4 5.3 10.8 Motorcycle/tricycle 22.5 20.6 21.5 24.5 22.0 23.2 Bicycle/trisikad 25.1 21.8 23.5 27.2 23.0 25.1 Animal-drawn cart 0.9 6.6 3.7 1.0 6.8 3.9 None of the above 4.6 14.3 9.4 4.0 12.8 8.4 Number of households/population 6,277 6,192 12,469 30,002 29,615 59,617 Nine percent of households do not possess any of the specified durable goods or means of transport. Rural households are more likely than urban households to have none of the specified household durable goods (14 and 5 percent, respectively). 2.6 WEALTH INDEX The wealth index is a proxy measure of the long-term standard of living of the household. It is based on household ownership of durable goods; dwelling characteristics; source of drinking water; type of sanitation facilities; and other characteristics related to the household’s socioeconomic status. A wealth index for the 2008 NDHS was constructed by assigning a weight or factor score to each household asset through principal component analysis. These scores were summed by household, and individuals were ranked according to the total score of the household in which they reside. The sample was then divided into quintiles—five groups, each with the same number of individuals. Table 2.10 shows the distribution of the population by wealth quintile, urban-rural residence, and region. As expected, urban residents are more likely to be in the higher wealth quintiles, while rural residents are found more commonly in the lower wealth quintiles. Among regions, NCR, CALABARZON and Central Luzon have the largest proportions in the two highest wealth quintiles. In contrast, ARMM, SOOCSKSARGEN and MIMAROPA have the largest proportions in the lowest wealth quintile. Household Population and Housing Characteristics | 21 Table 2.10 Wealth quintiles Percent distribution of de jure population by wealth quintiles, according to residence and region, Philippines 2008 Wealth quintile Residence/region Lowest Second Middle Fourth Highest Total Number of population Residence Urban 6.2 14.5 20.1 25.8 33.4 100.0 30,002 Rural 34.0 25.6 19.9 14.1 6.4 100.0 29,615 Region National Capital Region 0.9 7.2 18.6 28.5 44.7 100.0 9,064 Cordillera Admin Region 15.6 24.2 22.8 19.5 17.9 100.0 1,082 I - Ilocos 9.9 26.3 26.8 20.5 16.5 100.0 3,082 II - Cagayan Valley 17.5 25.3 23.3 20.3 13.6 100.0 1,870 III - Central Luzon 5.3 17.9 28.6 26.3 21.8 100.0 6,370 IVA - CALABARZON 5.0 12.4 20.8 29.8 32.0 100.0 7,495 IVB - MIMAROPA 40.2 22.6 19.4 14.2 3.6 100.0 1,686 V - Bicol 32.6 24.1 16.3 14.8 12.2 100.0 3,636 VI - Western Visayas 25.9 26.6 20.7 15.2 11.6 100.0 4,701 VII - Central Visayas 23.3 23.2 20.3 17.2 16.0 100.0 4,126 VIII - Eastern Visayas 37.2 22.9 16.4 15.1 8.5 100.0 2,470 IX - Zamboanga Peninsula 35.6 22.2 16.3 14.3 11.6 100.0 2,379 X - Northern Mindanao 30.7 23.2 19.5 15.0 11.6 100.0 2,568 XI - Davao 35.7 25.2 15.4 10.3 13.3 100.0 2,713 XII - SOCCSKSARGEN 38.3 31.5 15.6 9.4 5.2 100.0 2,390 XIII - Caraga 30.7 32.7 17.4 13.8 5.4 100.0 1,532 ARMM 56.2 22.7 10.7 7.9 2.4 100.0 2,453 Total 20.0 20.0 20.0 20.0 20.0 100.0 59,617 Characteristics of Respondents | 23 CHARACTERISTICS OF RESPONDENTS 3 This chapter provides a demographic and socioeconomic profile of the women respondents age 15-49 who were interviewed in the 2008 National Demographic and Health Survey (NDHS). Information on the background characteristics of the respondents helps in understanding the factors that affect reproductive behavior, contraceptive use, and other health practices because it provides a context for interpretation of the demographic and health indices presented later in this report. The survey collected information on a number of basic characteristics of the women including: age, marital status, urban-rural residence, region, level of education, economic status, and religion. The chapter also explores women’s educational status, literacy, exposure to mass media, employment status, and occupation. Additional information was collected on women’s use of tobacco and health insurance coverage. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The distribution of women age 15-49 interviewed in the 2008 NDHS is shown in Table 3.1 by selected background characteristics, including age, marital status, residence, educational level, wealth quintile, and religion. Results show that more than half of women age 15-49 (52 percent) are under age 30. The proportion in each age group tends to decrease with increasing age, from 20 percent for the age group 15-19 years to 10 percent for the age group 45-49 years. Three in five women (62 percent) are married or are living together with a partner, while one in three has never been married. The rest of the women are either separated or divorced (3 percent) or widowed (2 percent). The majority of respondents live in urban areas (56 percent). Sixty percent of women are from Luzon, the largest island in the country, with 19 percent from the National Capital Region (NCR). About one-fifth (18 percent) of respondents live in the Visayas region, while the remaining 22 percent are in Mindanao. Education is highly valued by Filipino women. Only 1 percent of women age 15-49 have no formal education, while two-thirds (66 percent) have some elementary or secondary education, and one in three women has attended college (Figure 3.1). The respondents are predominantly Roman Catholic (80 percent). Other religions with notable proportions are Born-Again Christian (6 percent) and Islam (5 percent). 24 | Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Philippines 2008 Background characteristic Weighted percent Weighted number Unweighted number Age 15-19 20.2 2,749 2,766 20-24 15.8 2,147 2,143 25-29 15.5 2,106 2,067 30-34 13.7 1,865 1,857 35-39 13.1 1,777 1,787 40-44 11.3 1,532 1,529 45-49 10.4 1,418 1,445 Marital status Never married 33.3 4,530 4,400 Married/living together 61.9 8,418 8,564 Divorced/not living together 3.1 420 400 Widowed 1.7 226 230 Residence Urban 55.7 7,574 6,762 Rural 44.3 6,020 6,832 Region National Capital Region 18.5 2,522 1,828 Cordillera Admin Region 1.7 225 536 I - Ilocos 4.5 613 657 II - Cagayan Valley 2.8 382 523 III - Central Luzon 10.9 1,486 1,157 IVA - CALABARZON 13.3 1,808 1,325 IVB - MIMAROPA 2.5 340 537 V - Bicol 5.6 755 768 VI - Western Visayas 7.2 976 885 VII - Central Visayas 7.2 983 909 VIII - Eastern Visayas 3.6 488 609 IX - Zamboanga Peninsula 3.7 505 637 X - Northern Mindanao 4.3 585 681 XI - Davao 4.5 618 715 XII - SOCCSKSARGEN 3.5 480 584 XIII - Caraga 2.3 312 573 ARMM 3.8 516 670 Education No education 1.2 167 218 Elementary 19.5 2,653 2,840 High school 46.7 6,352 6,267 College 32.5 4,422 4,269 Wealth quintile Lowest 15.9 2,160 2,562 Second 17.8 2,419 2,664 Middle 19.6 2,661 2,648 Fourth 21.6 2,937 2,771 Highest 25.1 3,417 2,949 Religion Roman Catholic 79.7 10,837 10,453 Protestant 3.9 528 616 Iglesia Ni Kristo 2.5 347 350 Aglipay 1.4 188 207 Islam 5.2 705 887 Born-Again Christian 5.9 808 880 Jehovah's Witness 0.6 84 86 Other 0.6 84 95 None 0.1 13 20 Total 15-49 100.0 13,594 13,594 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Respondents | 25 3.2 MOBILITY Women who were interviewed in the 2008 NDHS were asked several questions concerning residential mobility. They were first asked in what type of place they lived most of the time until they were 12 years old—a city, a town, the barrio or rural area, or abroad. They were also asked how long they had been living continuously in their current place of residence and the type of place they lived just before they moved to their current place of residence. The questions on childhood residence and mobility are meant to provide a basis for developing an index of rural-to-urban migration. This has been determined to be a better predictor of contraceptive use and fertility than either childhood or current residence alone (ORC Macro, 2001). Table 3.2 shows the distribution of women by type of residence in childhood and by type of residence immediately preceding their current residence. More than three in five women spent their childhood in a barrio, while 21 percent lived in a city and 15 percent grew up in a town. About two in five women have never moved from their place of birth. Twenty-seven percent of women reported that they relocated from a barrio, 22 percent relocated from a city, and 9 percent moved from a town. Less than 2 percent of respondents were visitors in the households in which they were interviewed. NDHS 2008 Figure 3.1 Educational Attainment of Women Age 15-49 No education 1% Note: Levels refer to the highest level attended. High school 47% College 33% Elementary 20% 26 | Characteristics of Respondents Table 3.2 Childhood residence and mobility Percent distribution of women by type of residence until age 12 and type of previous residence, Philippines 2003 Residence Weighted percent Weighted number Unweighted number Residence during first 12 years City 21.3 2,889 2,511 Town 15.2 2,071 2,155 Barrio 63.1 8,574 8,872 Abroad 0.1 16 16 Missing 0.3 44 40 Previous residence Lived in current residence since birth 38.3 5,201 5,433 Moved from: City 22.3 3,030 2,684 Town 8.7 1,177 1,222 Barrio 27.4 3,719 3,795 Abroad 0.5 68 72 Missing 1.3 172 172 Visitor 1.7 227 216 Total 100.0 13,594 13,594 3.3 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Educational attainment is a key indicator of a society’s stock of human capital and level of socioeconomic development. Moreover, education enhances the ability of individuals to achieve their desired demographic and health goals. This section presents the distribution of respondents by highest level of schooling attained according to selected background characteristics. Table 3.3 shows that younger women have reached higher levels of schooling than older women. For example, 87 percent of women age 15-24 have gone beyond primary school, compared with 63 percent of women age 45-49. Women in urban areas are more likely to have more education, especially at the college level; almost twice as many women in urban areas as in rural areas have some college or higher education (41 and 22 percent, respectively). The distribution of women by educational attainment is similar across regions with the exception of ARMM. In almost all regions, a majority of women have completed high school; however, in ARMM, only 28 percent of women have completed high school and 40 percent have not completed primary school. The NCR has the highest proportion of women who have attended college (44 percent). Surprisingly, Central Luzon and CALABARZON regions, which are contiguous to the NCR, have lower proportions of women who attended college (31 and 34 percent, respectively). Higher wealth status is associated with attaining a higher level of schooling. An analysis of education by household wealth status indicates that women in the highest wealth quintile are more likely to have some college education than women in other wealth quintiles. Three out of five women in the highest wealth quintile have attended college, compared with only 5 percent of women in the bottom quintile. Characteristics of Respondents | 27 Table 3.3 also shows the comparison of the median number of years of education completed by selected background characteristics. The median number of years of school completed is around 9 in almost all categories and is similar across regions. The lowest median number of years of education completed is among women in ARMM and those in the lowest wealth quintile (both 6 years), while the highest is among women in the highest wealth quintile (14 years). Table 3.3 Educational attainment Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Philippines 2008 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some high school Completed high school2 College Total Median years completed Number of women Age 15-24 0.6 5.5 6.6 28.6 30.2 28.4 100.0 9.3 4,896 15-19 0.7 6.1 7.3 40.4 27.2 18.3 100.0 8.8 2,749 20-24 0.6 4.8 5.8 13.5 34.1 41.2 100.0 9.7 2,147 25-29 0.7 6.5 8.8 12.6 32.5 38.9 100.0 9.7 2,106 30-34 0.7 8.6 10.6 12.7 28.3 39.0 100.0 9.6 1,865 35-39 1.5 10.3 16.3 13.3 28.5 30.1 100.0 9.3 1,777 40-44 2.1 10.9 17.0 14.0 23.3 32.7 100.0 9.3 1,532 45-49 3.3 13.9 19.6 11.2 20.2 31.8 100.0 9.1 1,418 Residence Urban 0.3 4.7 7.8 16.1 30.2 41.0 100.0 9.7 7,574 Rural 2.4 12.7 15.7 21.4 25.8 21.9 100.0 8.7 6,020 Region National Capital Region 0.0 3.1 6.4 15.2 31.1 44.2 100.0 9.8 2,522 Cordillera Admin Region 1.5 6.4 12.7 18.8 23.0 37.6 100.0 9.5 225 I - Ilocos 0.0 3.2 11.1 15.9 33.1 36.7 100.0 9.6 613 II - Cagayan Valley 0.4 6.1 15.0 21.3 24.5 32.7 100.0 9.3 382 III - Central Luzon 0.2 5.4 12.9 14.5 36.3 30.6 100.0 9.5 1,486 IVA - CALABARZON 0.1 4.5 8.9 15.4 36.9 34.2 100.0 9.6 1,808 IVB - MIMAROPA 5.8 12.1 15.5 17.0 24.4 25.4 100.0 9.0 340 V - Bicol 0.3 8.4 17.9 23.5 22.1 27.8 100.0 9.0 755 VI - Western Visayas 0.8 8.3 9.5 17.8 28.4 35.3 100.0 9.5 976 VII - Central Visayas 0.9 12.1 14.4 20.3 25.7 26.6 100.0 9.1 983 VIII - Eastern Visayas 0.8 15.3 14.9 19.9 20.2 28.8 100.0 8.9 488 IX - Zamboanga Peninsula 2.7 13.2 13.4 20.1 19.1 31.5 100.0 9.0 505 X - Northern Mindanao 1.8 12.7 11.9 21.6 23.7 28.2 100.0 9.1 585 XI - Davao 1.1 10.8 13.3 26.2 23.1 25.6 100.0 8.8 618 XII - SOCCSKSARGEN 3.1 13.2 10.0 28.0 25.0 20.8 100.0 8.6 480 XIII - Caraga 0.9 9.7 12.5 28.2 24.2 24.6 100.0 8.9 312 ARMM 12.6 27.3 13.2 18.6 9.8 18.6 100.0 5.8 516 Wealth quintile Lowest 6.2 27.2 22.9 23.5 15.4 4.8 100.0 5.7 2,160 Second 0.9 10.5 16.4 26.1 31.0 15.0 100.0 8.6 2,419 Middle 0.2 5.8 12.4 21.7 35.4 24.4 100.0 9.3 2,661 Fourth 0.1 2.3 5.6 14.2 35.2 42.7 100.0 9.8 2,937 Highest 0.0 1.5 4.4 11.1 22.9 60.1 100.0 13.5 3,417 Total 1.2 8.2 11.3 18.5 28.2 32.5 100.0 9.4 13,594 1 Completed grade 6 at the primary level 2 Completed grade 4 at the secondary level 28 | Characteristics of Respondents 3.4 LITERACY Literacy is a fundamental aspect of an individual’s ability to fully participate and take advantage of socioeconomic development and advancements in health and nutrition. The 2008 NDHS determined respondents’ literacy based on their ability to read all or part of a sentence. Interviewers carried a set of flashcards containing simple sentences printed in English and six common local languages (Tagalog, Ilocano, Bicolano, Hiligaynon, Cebuano, and Waray). Only women who had never attended school or who had some or completed elementary education were asked to read a sentence card during the interview. Those who had at least some secondary education were assumed to be literate. Table 3.4 shows the distribution of women by level of literacy and percentage literate, according to selected background characteristics. Table 3.4 Literacy Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Philippines 2008 No schooling or primary school Background characteristic Secondary school or higher Can read whole sentence Can read part of sentence Cannot read at all Blind/ visually impaired Missing Total Percentage literate1 Number Age 15-19 85.9 9.5 2.9 1.5 0.0 0.2 100.0 98.2 2,749 20-24 88.8 7.3 2.5 1.3 0.0 0.1 100.0 98.6 2,147 25-29 83.9 9.9 4.2 1.9 0.0 0.2 100.0 98.0 2,106 30-34 80.1 13.5 3.8 2.4 0.1 0.2 100.0 97.3 1,865 35-39 71.9 19.0 5.2 3.6 0.0 0.3 100.0 96.0 1,777 40-44 70.0 18.7 6.3 4.6 0.2 0.1 100.0 95.0 1,532 45-49 63.1 23.8 7.1 5.2 0.3 0.5 100.0 94.1 1,418 Residence Urban 87.3 9.0 2.4 1.0 0.1 0.2 100.0 98.7 7,574 Rural 69.1 19.1 6.6 4.8 0.1 0.2 100.0 94.9 6,020 Region National Capital Region 90.6 7.5 1.4 0.3 0.0 0.2 100.0 99.4 2,522 Cordillera Admin Region 79.4 13.4 4.3 2.4 0.0 0.6 100.0 97.0 225 I - Ilocos 85.7 10.5 3.1 0.2 0.0 0.6 100.0 99.2 613 II - Cagayan Valley 78.5 14.6 5.7 1.1 0.0 0.0 100.0 98.9 382 III - Central Luzon 81.4 14.3 2.5 1.4 0.2 0.2 100.0 98.3 1,486 IVA - CALABARZON 86.5 9.3 3.4 0.7 0.0 0.1 100.0 99.2 1,808 IVB - MIMAROPA 66.7 21.6 3.3 7.6 0.2 0.6 100.0 91.6 340 V - Bicol 73.4 19.8 4.4 1.8 0.5 0.0 100.0 97.7 755 VI - Western Visayas 81.5 12.0 4.0 2.5 0.0 0.0 100.0 97.5 976 VII - Central Visayas 72.6 19.2 4.8 2.9 0.0 0.4 100.0 96.6 983 VIII - Eastern Visayas 68.9 24.0 3.5 3.3 0.0 0.3 100.0 96.4 488 IX - Zamboanga Peninsula 70.6 17.5 7.4 4.3 0.0 0.2 100.0 95.5 505 X - Northern Mindanao 73.6 15.6 6.7 3.8 0.1 0.1 100.0 95.9 585 XI - Davao 74.8 16.1 5.4 3.5 0.0 0.1 100.0 96.3 618 XII - SOCCSKSARGEN 73.8 12.9 7.0 6.0 0.0 0.3 100.0 93.7 480 XIII - Caraga 77.0 11.4 7.8 3.3 0.0 0.5 100.0 96.2 312 ARMM 47.0 18.3 15.7 18.6 0.0 0.4 100.0 81.0 516 Wealth quintile Lowest 43.7 30.9 13.3 11.6 0.2 0.3 100.0 87.9 2,160 Second 72.1 18.9 6.1 2.3 0.1 0.4 100.0 97.2 2,419 Middle 81.5 14.3 2.7 1.2 0.0 0.3 100.0 98.5 2,661 Fourth 92.1 5.9 1.3 0.5 0.0 0.1 100.0 99.3 2,937 Highest 94.0 4.6 1.0 0.3 0.0 0.0 100.0 99.6 3,417 Total 79.3 13.5 4.3 2.7 0.1 0.2 100.0 97.0 13,594 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Characteristics of Respondents | 29 Literacy rates in the Philippines are high; 97 percent of women age 15-49 are literate. In general, literacy does not vary much across background characteristics. Younger respondents are slightly more likely to be literate than older respondents; 99 percent of women age 20-24 are literate, compared with 94 percent of women age 45-49. As expected, women who live in urban areas (99 percent) are more likely to be literate than their counterparts in rural areas (95 percent). Literacy does not vary greatly by region; in all regions but ARMM (81 percent), more than 90 percent of women are literate. As with educational attainment, literacy shows a direct relationship with wealth status. Almost 100 percent of women in the highest wealth quintile are literate, compared with 88 percent of women in the lowest wealth quintile. 3.5 ACCESS TO MASS MEDIA Access to information through the media is essential to increasing people’s knowledge and awareness of events and activities taking place around them, and directly affects their perceptions and behavior. Identifying the subgroups most likely to be reached by various media is important for planning programs that disseminate health and family planning information. The 2008 NDHS assessed exposure to mass media by asking women how often they read a newspaper or magazine, watch television, or listen to the radio. Table 3.5 shows the percentage of women who are exposed to specific types of mass media on a weekly basis by background characteristics. Television is the medium most commonly accessed by women age 15-49. More than four in five women watch television at least once a week, while three in ten women read a newspaper or magazine at least once a week, and two in three women listen to the radio regularly. Twenty-four percent of women are exposed to all three media sources at least once a week, while only 7 percent have no regular exposure to mass media. Younger women are slightly more likely to read a newspaper, watch television and listen to the radio than older women. Urban residents are much more likely to have access to mass media than rural residents. Substantial differences are seen in the proportion of women who read a newspaper or magazine once a week (42 percent among urban women and 18 percent among rural women) and in the proportion of women who watch television at least once a week (92 percent among urban women and 77 percent among rural women). Among regions, there is no distinct pattern of exposure to mass media. However, women in ARMM are least likely to have access to newspapers, magazines, television, and radio; 38 percent of women in ARMM do not have access to any of the three mass media on a weekly basis, which is more than five times the national level. Media exposure is related to the respondent’s educational level and socioeconomic status. The proportion of women who access various media at least once a week increases steadily with increasing level of educational attainment. A similar pattern is seen in the relationship between exposure to mass media and wealth quintile. 30 | Characteristics of Respondents Table 3.5 Exposure to mass media Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Philippines 2008 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 33.6 87.8 69.6 26.0 6.0 2,749 20-24 36.1 87.1 69.5 28.8 6.7 2,147 25-29 31.3 86.2 64.7 22.4 6.4 2,106 30-34 31.8 85.6 62.7 22.8 8.2 1,865 35-39 28.2 83.2 65.3 20.4 7.7 1,777 40-44 26.6 82.5 63.6 20.5 9.2 1,532 45-49 27.2 82.9 63.9 20.4 8.8 1,418 Residence Urban 41.8 92.4 66.7 31.6 3.5 7,574 Rural 18.0 76.6 65.2 13.4 12.2 6,020 Region National Capital Region 55.1 94.1 60.8 39.3 2.6 2,522 Cordillera Admin Region 21.9 66.3 61.7 16.6 17.9 225 I - Ilocos 36.2 94.6 76.9 30.7 2.6 613 II - Cagayan Valley 23.3 84.5 77.5 20.3 6.0 382 III - Central Luzon 28.3 94.0 62.7 21.4 3.6 1,486 IVA - CALABARZON 35.7 92.0 61.4 27.6 4.6 1,808 IVB - MIMAROPA 20.3 71.9 56.7 12.3 14.7 340 V - Bicol 13.7 83.6 82.5 11.5 5.3 755 VI - Western Visayas 27.0 82.9 72.9 21.5 6.6 976 VII - Central Visayas 35.3 86.1 78.5 29.1 5.2 983 VIII - Eastern Visayas 15.4 82.1 61.9 10.8 8.5 488 IX - Zamboanga Peninsula 22.6 71.0 65.6 17.5 15.8 505 X - Northern Mindanao 23.3 79.6 72.1 17.3 10.2 585 XI - Davao 21.3 76.7 72.9 15.6 8.6 618 XII - SOCCSKSARGEN 16.5 74.2 62.8 11.0 11.6 480 XIII - Caraga 18.0 85.9 59.0 10.8 7.8 312 ARMM 10.0 53.1 40.0 7.4 38.3 516 Education No education 0.8 25.8 31.8 0.5 55.3 167 Elementary 9.6 67.4 58.5 6.6 17.8 2,653 High school 27.2 87.9 67.1 20.4 5.5 6,352 College 51.1 94.9 70.4 39.1 1.9 4,422 Wealth quintile Lowest 7.9 45.7 52.4 3.8 30.3 2,160 Second 17.7 82.9 66.0 12.3 7.6 2,419 Middle 27.1 93.1 67.2 19.8 2.7 2,661 Fourth 38.3 96.1 69.6 30.0 2.0 2,937 Highest 52.7 97.1 70.8 41.3 0.9 3,417 Total 31.2 85.4 66.0 23.5 7.3 13,594 3.6 EMPLOYMENT The ability of a country’s economy to provide gainful employment is an important aspect of its level of development. In the 2008 NDHS, respondents were asked whether they were employed in the week preceding the survey and if not, whether they were employed in the 12 months preceding the survey. Measuring employment status is difficult, however, because some work, especially work on family farms, in family businesses, or in the informal sector, may not be perceived as employment, and hence not reported as such. To avoid underestimating respondent’s employment, respondents were asked several questions to probe for their employment status and to ensure complete coverage of employment in both the formal or informal sectors. They were also asked about their occupation, the continuity of employment in the 12 months prior to the survey, and type of remuneration. Employed persons are those who say that they are currently working (i.e., worked in the past 7 days) and those who worked at any time during the 12 months prior to the survey. Table 3.6 shows the percent distribution of women by employment status according to selected background characteristics. Characteristics of Respondents | 31 Table 3.6 Employment status Percent distribution of women age 15-49 by employment status, according to background characteristics, Philippines 2008 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 20.8 8.1 71.0 0.0 100.0 2,749 20-24 41.5 11.9 46.6 0.0 100.0 2,147 25-29 47.3 11.0 41.6 0.1 100.0 2,106 30-34 55.0 8.1 36.8 0.0 100.0 1,865 35-39 57.9 8.1 33.8 0.1 100.0 1,777 40-44 64.0 6.8 29.0 0.2 100.0 1,532 45-49 69.3 5.8 24.8 0.1 100.0 1,418 Marital status Never married 38.6 8.0 53.3 0.0 100.0 4,530 Married/living together 51.0 9.3 39.6 0.1 100.0 8,418 Divorced/not living together 65.4 7.3 27.2 0.0 100.0 420 Widowed 71.2 5.8 22.4 0.6 100.0 226 Number of living children 0 39.8 9.1 51.1 0.0 100.0 5,116 1-2 48.5 9.0 42.5 0.0 100.0 3,985 3-4 54.9 8.0 37.1 0.0 100.0 2,810 5+ 57.5 8.6 33.5 0.4 100.0 1,683 Residence Urban 50.5 8.4 41.1 0.0 100.0 7,574 Rural 44.1 9.3 46.6 0.1 100.0 6,020 Region National Capital Region 51.3 9.1 39.5 0.1 100.0 2,522 Cordillera Admin Region 54.3 7.5 38.2 0.0 100.0 225 I - Ilocos 42.6 9.6 47.8 0.0 100.0 613 II - Cagayan Valley 47.3 10.3 42.4 0.0 100.0 382 III - Central Luzon 44.2 11.4 44.4 0.0 100.0 1,486 IVA - CALABARZON 45.8 6.3 47.7 0.1 100.0 1,808 IVB - MIMAROPA 52.1 13.3 34.6 0.0 100.0 340 V - Bicol 47.0 9.6 43.4 0.0 100.0 755 VI - Western Visayas 48.5 8.6 42.9 0.1 100.0 976 VII - Central Visayas 49.4 8.2 42.1 0.2 100.0 983 VIII - Eastern Visayas 51.9 9.9 38.1 0.2 100.0 488 IX - Zamboanga Peninsula 48.8 5.7 45.5 0.0 100.0 505 X - Northern Mindanao 53.0 11.6 35.4 0.0 100.0 585 XI - Davao 51.5 10.0 38.5 0.0 100.0 618 XII - SOCCSKSARGEN 48.0 7.2 44.8 0.0 100.0 480 XIII - Caraga 48.1 7.3 44.7 0.0 100.0 312 ARMM 26.4 3.5 70.1 0.0 100.0 516 Education No education 47.4 8.2 44.4 0.0 100.0 167 Elementary 49.7 9.0 41.1 0.1 100.0 2,653 High school 41.4 9.6 48.9 0.1 100.0 6,352 College 55.5 7.4 37.1 0.0 100.0 4,422 Wealth quintile Lowest 41.6 9.1 49.1 0.2 100.0 2,160 Second 43.7 11.6 44.6 0.1 100.0 2,419 Middle 44.0 11.2 44.8 0.0 100.0 2,661 Fourth 48.2 7.7 44.1 0.0 100.0 2,937 Highest 56.7 5.6 37.6 0.1 100.0 3,417 Total 47.7 8.8 43.5 0.1 100.0 13,594 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or other such reason. 32 | Characteristics of Respondents At the time of the survey, more than half of the women (57 percent) reported that they had been employed in the past 12 months. The proportion who were not employed in the past 12 months decreases with age, from 71 percent among women age 15-19 to 25 percent among women age 45-49. Women who have never been married are more likely to be unemployed; more than half of these women (53 percent) said they had not been employed in the 12 months before the survey. A much higher proportion of women who are divorced or separated (65 percent) or widowed (71 percent) are currently employed, compared with women who are currently married or living together with a partner (51 percent). Women who have children are also more likely to be working than women with no children. The proportion of women who are working is higher in urban areas than rural areas. Employment levels do not vary much among regions, except in ARMM, where only 30 percent of women were employed in the past 12 months. Differentials in employment patterns by education level are minimal. Women with some high school education are more likely to be unemployed (49 percent) than women with no education (44 percent) and those with only elementary education (41 percent). Women who have reached college level are most likely to be currently employed (56 percent). The proportion of women who are currently employed increases with household wealth. More than half of women in the highest wealth quintile are currently employed (57 percent), compared with 42 percent of women in the lowest wealth quintile. 3.7 OCCUPATION Respondents who had worked in the 12 months prior to the survey were asked about their occupation. Table 3.7 presents the distribution of employed women by occupation, according to selected background characteristics. The results show that the sales and services sector employs the largest proportion of women age 15-49 (30 percent). One in four working women is employed in a professional, technical or managerial occupation, while 14 percent are engaged in domestic service and 14 percent are involved in agriculture. Women’s occupation varies by age. Younger women (under age 30) tend to be involved in sales and services, while older women are likely to be employed in the professional, technical and managerial occupations. The analysis of occupation by marital status indicates that single women are most likely to be employed in sales and services, while married women are about equally divided between sales and services and the professional, technical and managerial occupations. Widows who are working are most likely to have a professional, technical or managerial job. Thirty-three percent of working women with five or more children are involved in agriculture. Women with fewer than three children are most likely to be employed in sales and services, while almost one-third of those with three to four children have professional, technical or managerial jobs. Urban-rural residence is related to occupation. As expected, working women in rural areas are more likely to be engaged in agricultural occupations (28 percent) than women in urban areas (3 percent). In contrast, employed women in urban areas are more likely than those in rural areas to be engaged in sales and services or domestic service. Zamboanga Peninsula has the highest proportion of working women employed in professional, technical, and managerial positions. Agricultural occupations predominate in only three of the 17 regions—CAR, Cagayan Valley, and ARMM. Characteristics of Respondents | 33 Table 3.7 Occupation Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Philippines 2008 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 3.0 3.8 40.4 5.1 4.1 34.0 9.3 0.3 100.0 795 20-24 15.5 11.8 36.2 9.4 5.3 15.1 6.4 0.2 100.0 1,147 25-29 24.5 11.1 30.2 8.6 4.6 10.4 10.5 0.2 100.0 1,228 30-34 30.5 6.9 28.1 6.5 3.8 11.4 12.7 0.0 100.0 1,178 35-39 30.0 5.8 26.0 6.2 4.3 11.4 16.0 0.2 100.0 1,174 40-44 31.1 4.2 27.6 5.1 2.6 11.2 17.7 0.5 100.0 1,086 45-49 30.4 3.6 24.3 6.3 1.7 10.4 23.1 0.2 100.0 1,064 Marital status Never married 16.6 12.2 33.4 6.9 3.9 22.3 4.5 0.2 100.0 2,113 Married/living together 27.5 5.1 28.9 6.7 3.6 10.0 17.9 0.2 100.0 5,079 Divorced/not living together 23.4 4.1 30.6 8.9 6.5 19.2 7.2 0.0 100.0 306 Widowed 31.3 3.9 19.9 5.9 3.6 20.1 15.2 0.0 100.0 174 Number of living children 0 17.8 11.5 33.2 7.1 4.0 20.9 5.3 0.2 100.0 2,500 1-2 30.8 7.2 31.0 7.0 4.0 9.2 10.4 0.3 100.0 2,292 3-4 30.8 3.8 27.0 6.2 3.2 10.5 18.3 0.2 100.0 1,766 5+ 16.1 1.4 25.6 6.9 3.9 13.6 32.5 0.0 100.0 1,113 Residence Urban 26.7 9.2 32.6 7.1 4.3 16.5 3.2 0.3 100.0 4,460 Rural 21.2 3.9 26.4 6.5 3.1 10.4 28.3 0.2 100.0 3,212 Region National Capital Region 25.2 12.5 32.7 5.6 4.7 18.3 0.6 0.4 100.0 1,523 Cordillera Admin Region 21.0 3.6 19.7 2.4 1.4 5.8 46.0 0.3 100.0 139 I - Ilocos 23.9 3.7 34.9 4.1 4.7 14.2 14.6 0.0 100.0 320 II - Cagayan Valley 18.5 4.0 30.3 1.0 1.0 12.5 32.7 0.0 100.0 220 III - Central Luzon 25.9 5.9 32.8 10.1 3.4 15.1 6.4 0.3 100.0 826 IVA - CALABARZON 26.1 8.7 25.9 17.7 5.7 12.9 2.9 0.0 100.0 943 IVB - MIMAROPA 18.7 5.4 34.2 3.7 2.0 10.7 24.8 0.5 100.0 223 V - Bicol 23.4 4.1 32.0 4.6 4.0 13.8 17.9 0.2 100.0 427 VI - Western Visayas 25.6 7.1 27.2 5.6 2.5 15.9 16.0 0.0 100.0 557 VII - Central Visayas 22.9 5.6 23.8 9.2 4.2 18.4 15.5 0.4 100.0 566 VIII - Eastern Visayas 24.0 6.1 29.0 9.3 0.8 11.1 19.7 0.0 100.0 301 IX - Zamboanga Peninsula 26.7 6.3 30.2 1.1 4.1 12.0 19.5 0.0 100.0 275 X - Northern Mindanao 22.6 4.4 29.2 2.9 2.0 10.4 28.6 0.0 100.0 378 XI - Davao 25.3 3.9 31.3 0.9 3.9 9.9 24.8 0.0 100.0 380 XII - SOCCSKSARGEN 25.5 2.7 29.5 0.9 5.2 6.5 29.3 0.4 100.0 265 XIII - Caraga 22.8 6.0 37.0 4.1 1.6 11.4 17.1 0.0 100.0 173 ARMM 23.8 2.2 27.4 2.8 3.9 5.7 32.8 1.5 100.0 154 Education No education 3.6 0.0 13.9 6.8 5.5 3.9 66.4 0.0 100.0 93 Elementary 11.3 0.4 20.9 5.2 3.8 23.1 35.2 0.1 100.0 1,559 High school 16.0 2.6 35.4 9.5 5.5 19.3 11.5 0.2 100.0 3,239 College 42.3 16.0 29.4 4.7 1.8 3.0 2.5 0.2 100.0 2,781 Wealth quintile Lowest 7.9 0.6 20.0 5.1 3.6 12.5 50.2 0.2 100.0 1,095 Second 14.8 2.6 33.7 6.9 4.8 15.8 21.1 0.1 100.0 1,338 Middle 21.9 5.3 36.0 10.2 5.5 10.2 10.7 0.1 100.0 1,468 Fourth 30.1 9.3 34.5 9.2 4.6 8.9 3.0 0.5 100.0 1,642 Highest 36.4 12.4 25.3 3.5 1.5 20.1 0.7 0.2 100.0 2,128 Total 24.4 7.0 30.0 6.9 3.8 14.0 13.7 0.2 100.0 7,671 34 | Characteristics of Respondents Women’s occupations are related to level of education and wealth status. Women with higher levels of education are more likely to be employed in professional, technical, and managerial positions than less educated women. Conversely, women with little or no education are more likely to work in agriculture than those with more education. Half of women in the lowest wealth quintile are employed in agriculture, while more than one-third of women in the highest wealth quintile have professional, technical, and managerial jobs. 3.8 EARNINGS AND TYPE OF EMPLOYMENT Table 3.8 shows the percent distribution of women who were employed in the 12 months preceding the survey by type of earnings, type of employment, and continuity of employment. The results are presented according to whether the women were involved in agricultural or nonagricultural occupations. The vast majority of working women earn cash, either cash only (86 percent) or cash and in-kind (7 percent). Overall, only 5 percent of women who are employed receive no pay for their work. Table 3.8 Earnings and type of employment Percent distribution of women age 15-49 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 2008 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 50.2 91.6 85.9 Cash and in-kind 20.6 4.7 6.9 In-kind only 7.6 0.4 1.4 Not paid 21.4 2.8 5.3 Missing 0.3 0.4 0.4 Type of employer Employed by family member 33.7 6.7 10.4 Employed by non-family member 44.1 55.6 54.0 Self-employed 22.1 28.0 27.2 Employed by the government 0.0 9.8 8.4 Continuity of employment All year 50.5 70.0 67.3 Seasonal 43.5 21.8 24.8 Occasional 5.8 7.9 7.6 Missing 0.1 0.2 0.2 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 1,054 6,601 7,671 Note: Total includes 16 women with information missing on type of employment who are not shown separately. The type of earnings differs by whether women work in the agricultural or nonagricultural sector. Half of women engaged in agricultural work are paid in cash only, while 21 percent are paid in cash and in-kind, and another 21 percent are not paid. Women are more likely to be paid in cash only if they are employed in the nonagricultural sector (92 percent) than if they are employed in agriculture (50 percent). Characteristics of Respondents | 35 More than half of working women (54 percent) are employed by a non-family member, while 27 percent are self-employed, 10 percent are employed by a family member, and 8 percent are employed by the government. A similar pattern is seen for women engaged in nonagricultural work, while agricultural employment tends to be more family-oriented. Regardless of whether they are employed in agricultural or nonagricultural occupations, the majority of employed women work all year (67 percent). One in four working women has seasonal employment. 3.9 USE OF TOBACCO Tobacco smoking has been shown to have adverse health effects, including increased risk of lung and heart disease. For women, tobacco smoking has additional risks such as osteoporosis, cervical cancer, and early menopause. Furthermore, smoking during pregnancy can lead to complications that increase the risk of growth retardation and may cause fetal death and neonatal death. The 2008 NDHS collected information on women’s tobacco use. Table 3.9 shows the percentage of women who smoke cigarettes or use other tobacco products, and the percent distribution of cigarette smokers by the number of cigarettes smoked in the preceding 24 hours, according to background characteristics and maternity status. Figures on use and nonuse of tobacco do not sum to 100 percent because respondents who smoke cigarettes may also use other tobacco products. Tobacco use is uncommon among women. Ninety-five percent of women age 15-49 do not use any kind of tobacco products. Only 5 percent of the women smoke cigarettes and 2 percent use other forms of tobacco. Thirty percent of women who smoke cigarettes said they smoked fewer than three cigarettes in the 24 hours preceding the survey, and another one in three (32 percent) smoked 3-5 cigarettes. Twenty-five percent of women smoked 10 or more cigarettes in the past 24 hours. Use of tobacco is more common among older women than younger women. Smoking differs by educational attainment, with women with lower levels of education more likely to smoke than those with higher levels of education. Women in households in the lower wealth quintiles are slightly more likely to smoke than women in households in the higher wealth quintiles. Regional variations in tobacco use are not large. The National Capital Region and MIMAROPA have the highest proportions of women who smoke cigarettes or use other tobacco products (both 7 percent), while Bicol and Ilocos have the lowest proportions (both 3 percent). Differentials by other characteristics are minimal. Less than 3 percent of pregnant women smoke cigarettes or use any kind of tobacco product. 36 | Characteristics of Respondents Table 3.9 Use of tobacco Percentage of women age 15-49 who smoke cigarettes or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics and maternity status, Philippines 2008 Number of cigarettes in the past 24 hours Background characteristic Cigarettes Other tobacco Does not use tobacco Number of women 0 1-2 3-5 6-9 10+ Don't know/ missing Total Number of cigarette smokers Age 15-19 2.3 0.9 97.6 2,749 3.6 34.2 43.5 1.9 10.6 6.3 100.0 65 20-24 4.9 1.8 95.0 2,147 5.0 35.2 33.9 4.8 15.8 5.3 100.0 106 25-29 4.7 1.8 95.0 2,106 5.0 33.4 25.8 8.5 21.5 5.9 100.0 99 30-34 5.2 2.0 94.7 1,865 3.0 23.5 38.1 12.2 16.8 6.5 100.0 97 35-39 5.8 2.4 93.8 1,777 1.7 23.8 33.8 7.2 27.1 6.4 100.0 103 40-44 6.6 3.4 92.8 1,532 1.1 22.5 29.3 8.0 34.7 4.3 100.0 101 45-49 8.5 4.6 89.6 1,418 3.3 18.3 22.6 13.6 39.8 2.4 100.0 120 Residence Urban 5.5 2.3 94.3 7,574 3.5 26.4 30.1 9.8 24.2 6.1 100.0 420 Rural 4.5 2.1 94.8 6,020 2.8 27.1 33.9 6.4 26.0 3.8 100.0 270 Region National Capital Region 6.9 3.8 93.0 2,522 4.5 25.3 33.0 10.5 20.4 6.1 100.0 174 Cordillera Admin Region 3.6 2.8 94.9 225 * * * * * * 100.0 8 I - Ilocos 3.5 2.0 96.5 613 * * * * * * 100.0 21 II - Cagayan Valley 4.9 3.6 95.1 382 (7.8) (35.1) (22.9) (0.0) (34.2) (0.0) 100.0 19 III - Central Luzon 6.5 0.7 93.5 1,486 1.3 28.2 31.4 1.2 35.4 2.5 100.0 96 IVA - CALABARZON 4.1 2.0 95.9 1,808 0.0 24.4 29.4 18.7 24.1 3.3 100.0 74 IVB - MIMAROPA 5.3 3.1 93.1 340 (3.3) (17.1) (31.9) (10.4) (30.5) (6.8) 100.0 18 V - Bicol 3.1 0.7 96.5 755 * * * * * * 100.0 24 VI - Western Visayas 4.9 1.8 93.6 976 (0.0) (22.3) (36.1) (14.6) (25.0) (2.1) 100.0 49 VII - Central Visayas 4.2 4.9 94.2 983 (2.6) (36.5) (34.3) (5.2) (10.4) (11.0) 100.0 41 VIII - Eastern Visayas 3.8 1.7 95.5 488 * * * * * * 100.0 19 IX - Zamboanga Peninsula 3.9 1.9 95.5 505 (9.0) (27.1) (36.3) (11.9) (11.9) (3.8) 100.0 20 X - Northern Mindanao 3.8 0.6 95.8 585 (11.3) (30.6) (19.0) (3.8) (22.4) (12.8) 100.0 22 XI - Davao 5.1 1.0 94.7 618 (0.0) (26.4) (38.3) (5.4) (24.7) (5.1) 100.0 32 XII - SOCCSKSARGEN 5.6 1.8 93.8 480 (2.9) (31.4) (24.0) (3.0) (32.2) (6.5) 100.0 27 XIII - Caraga 5.8 0.9 94.2 312 (0.0) (24.0) (39.5) (5.9) (27.5) (3.1) 100.0 18 ARMM 5.4 0.9 94.2 516 (2.4) (16.6) (22.0) (12.9) (37.9) (8.2) 100.0 28 Education No education 11.8 10.3 81.8 167 (0.0) (12.0) (30.5) (13.7) (39.1) (4.7) 100.0 20 Elementary 7.6 3.9 91.5 2,653 2.1 29.4 34.4 7.7 24.7 1.7 100.0 203 High school 4.6 1.9 95.1 6,352 4.3 28.1 29.7 6.6 24.2 7.0 100.0 296 College 3.9 1.4 96.0 4,422 3.1 22.8 31.6 11.9 24.5 6.1 100.0 172 Maternity status Pregnant 2.3 1.0 97.5 705 * * * * * * 100.0 16 Breastfeeding (not pregnant) 3.9 2.1 95.6 1,584 5.5 27.3 43.4 8.6 11.0 4.3 100.0 61 Neither 5.4 2.3 94.2 11,304 3.0 26.7 30.3 8.3 26.4 5.3 100.0 612 Wealth quintile Lowest 6.2 3.4 92.5 2,160 2.5 27.4 36.7 8.2 21.5 3.8 100.0 133 Second 5.6 2.8 93.8 2,419 3.0 29.3 30.5 7.6 26.5 3.1 100.0 135 Middle 5.2 1.7 94.5 2,661 4.7 26.3 30.9 7.9 28.6 1.7 100.0 139 Fourth 4.2 1.8 95.6 2,937 1.6 24.2 25.9 9.8 29.2 9.4 100.0 124 Highest 4.6 1.7 95.3 3,417 4.0 26.3 33.3 8.9 19.8 7.8 100.0 159 Total 5.1 2.2 94.5 13,594 3.2 26.7 31.6 8.4 24.9 5.2 100.0 690 Note: Numbers in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure based on fewer than 25 unweighted cases and has been suppressed. Characteristics of Respondents | 37 3.10 HEALTH INSURANCE COVERAGE Access to health care improves when individuals are covered by health insurance. The 2008 NDHS collected information on women’s health insurance coverage in the Household Questionnaire. A maximum of three health insurance schemes were recorded per respondent. Table 3.10 shows the information on health insurance coverage by selected background characteristics. More than half of women do not have any health insurance (57 percent). Seventeen percent of women have insurance through PhilHealth as dependent of a paying member of their household, while 14 percent are themselves paying members of PhilHealth; another 14 percent are covered by the Social Security System (SSS), and 6 percent are dependents of indigent members of PhilHealth. Table 3.10 Health insurance coverage Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Philippines 2008 Background characteristic Philhealth paying member Philhealth dependent of paying member Philhealth indigent member Philhealth dependent of indigent member GSIS Social Security System Private insurance company/ Health mainte- nance, etc. Other None Number Age 15-19 1.4 22.7 0.1 7.5 0.1 2.1 1.2 0.1 67.1 2,749 20-24 13.5 11.3 0.8 3.2 0.8 15.0 1.4 0.2 66.2 2,147 25-29 19.2 14.8 1.0 4.0 2.0 20.1 2.7 0.4 56.1 2,106 30-34 18.2 18.1 1.6 5.4 3.6 18.6 2.2 0.4 50.8 1,865 35-39 17.1 18.3 2.9 6.8 3.5 16.1 2.6 0.4 50.4 1,777 40-44 16.0 18.8 3.2 7.4 3.5 15.7 3.2 0.5 48.9 1,532 45-49 17.0 16.3 3.8 6.6 6.3 13.4 4.7 0.8 52.1 1,418 Residence Urban 18.1 20.6 1.1 2.6 2.7 20.0 3.6 0.4 51.4 7,574 Rural 8.1 13.3 2.3 9.8 2.2 5.8 0.8 0.4 64.5 6,020 Region National Capital Region 20.4 20.3 0.5 0.3 2.4 24.9 5.9 0.4 50.5 2,522 Cordillera Admin Region 14.6 15.4 2.3 9.9 2.4 10.6 1.6 0.2 54.2 225 I - Ilocos 10.9 19.0 2.4 7.4 2.4 12.2 1.0 0.0 55.2 613 II - Cagayan Valley 8.2 17.0 1.1 9.0 4.6 4.0 1.5 1.0 62.6 382 III - Central Luzon 14.1 16.7 1.0 3.0 1.8 12.7 1.3 0.2 61.3 1,486 IVA - CALABARZON 20.3 20.2 0.3 2.5 1.6 20.9 2.2 0.3 52.1 1,808 IVB - MIMAROPA 5.3 9.3 0.9 6.4 3.4 9.2 1.3 0.4 71.8 340 V - Bicol 8.0 13.3 3.8 10.7 3.3 11.0 0.5 1.7 59.0 755 VI - Western Visayas 9.5 16.5 3.2 9.6 3.5 9.3 1.5 0.0 58.0 976 VII - Central Visayas 13.7 18.8 2.3 4.6 2.2 13.2 2.3 0.3 56.5 983 VIII - Eastern Visayas 10.6 12.4 1.3 4.8 3.9 4.4 0.6 0.5 69.5 488 IX - Zamboanga Peninsula 8.1 14.1 0.2 3.7 2.9 6.5 1.8 0.3 71.0 505 X - Northern Mindanao 9.9 15.5 6.4 32.6 2.1 6.6 1.3 0.1 34.0 585 XI - Davao 11.9 22.7 0.7 2.0 2.0 10.2 2.7 0.6 60.6 618 XII - SOCCSKSARGEN 13.2 21.8 2.2 5.0 1.2 9.6 2.0 0.3 55.5 480 XIII - Caraga 8.4 14.0 5.7 16.5 2.6 5.1 0.9 0.4 54.1 312 ARMM 3.7 6.0 0.9 4.6 2.8 0.5 0.8 0.1 84.3 516 Education No education 1.9 0.7 1.1 4.1 0.0 0.5 0.7 0.0 91.6 167 Elementary 2.4 8.4 2.2 9.1 0.1 2.7 0.7 0.4 75.9 2,653 High school 6.8 18.2 1.7 6.8 0.2 8.8 1.1 0.2 63.0 6,352 College 30.9 22.2 1.4 2.5 7.2 27.9 5.3 0.7 36.4 4,422 Wealth quintile Lowest 0.9 4.4 3.0 11.7 0.1 0.9 0.2 0.2 79.3 2,160 Second 4.8 11.3 2.7 11.2 0.6 4.1 0.2 0.4 68.0 2,419 Middle 10.1 18.2 1.9 5.3 1.9 10.0 1.2 0.2 60.5 2,661 Fourth 19.7 24.4 0.9 3.2 3.5 19.5 2.1 0.4 46.7 2,937 Highest 25.7 23.2 0.6 0.9 4.8 26.6 6.4 0.7 42.1 3,417 Total 13.7 17.4 1.7 5.8 2.4 13.7 2.4 0.4 57.2 13,594 GSIS = Government Service Insurance System 38 | Characteristics of Respondents Older women are more likely than younger women to be covered by health insurance. As expected, women who reside in urban areas are more likely to have health insurance coverage. Among the regions, only Northern Mindanao reported more than half of the women having some form of health insurance system (66 percent). ARMM has the highest proportion of women with no health insurance (84 percent). Women’s education is strongly associated with the likelihood of having health insurance coverage. Women with no education are much more likely to not have health insurance (92 percent) than those with college or higher education (36 percent). The same pattern can be observed with household wealth. The higher the household wealth quintile, the more likely it is that women are covered by health insurance. Fertility | 39 FERTILITY 4 This chapter looks at a number of fertility indicators including levels, patterns, and trends in both current and cumulative fertility; the length of birth intervals; and the age at which women initiate childbearing. Information on current and cumulative fertility is essential for monitoring population growth. The data on birth intervals are important because short intervals are strongly associated with childhood mortality. The age at which childbearing begins can have a major impact on the health and well-being of both the mother and the child. The 2008 National Demographic and Health Survey (NDHS) collected information on the total number of sons and daughters women have given birth to in their lifetime. To improve their recall and hence obtain a complete reporting of all their children, the women were asked to provide the number of children living at home, the number living elsewhere, and the number who have died. A complete preg- nancy history was subsequently obtained, including information on the sex, date of birth, and survival status of each live-born child, and age at death of children who have died, if any. For pregnancies not ending in a live birth, the month and year that pregnancy ended as well as the duration of the pregnancy was obtained. For pregnancies that were lost before full term, information on whether a doctor or someone else did something to end the pregnancy was obtained. These data were used in the calculation of the measures of fertility as well as child mortality (see Chapter 8). 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 average, at the end of her reproductive years if she experienced the currently prevailing ASFRs for women age 15-49. ASFRs, which are a valuable measure of the age pattern of childbearing, are defined as the number of live births among women in a particular 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 the current level of fertility.1 Table 4.1 presents the age-specific and total fertility rates, the general fertility rate (GFR) and the crude birth rate (CBR), by urban-rural residence. The age pattern of fertility rates shows an inverted U-shape that peaks at age 25-29 as shown in Figure 4.1. Fertility in urban areas is lower than that in rural areas. Women in urban areas have, on average, 2.8 children compared with 3.8 children for women in rural areas. For all age groups, childbearing is lower among women in urban areas than those in rural areas. The general fertility rate for urban women is 96 live births per 1,000 women age 15-44, compared with 128 per 1,000 for rural women. 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. 40 | Fertility Table 4.1 Current fertility Age-specific and total rate, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Philippines 2008 Residence Age group Urban Rural Total 15-19 42 71 54 20-24 134 202 163 25-29 159 190 172 30-34 126 149 136 35-39 73 96 84 40-44 27 50 38 45-49 4 7 6 TFR 2.8 3.8 3.3 GFR 96 128 110 CBR 23.4 24.6 21.6 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR: Total fertility rate for 15-49, expressed per woman GFR: General fertility rate (births divided by the number of women age 15-44), expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population + + + + + + + # # # # # # #) ) ) ) ) ) ) 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Age 0 50 100 150 200 250 Births per 1,000 women Urban Rural Total) # + NDHS 2008 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence Fertility | 41 4.2 FERTILITY BY BACKGROUND CHARACTERISTICS Table 4.2 highlights differences between the TFR and two other fertility measures—the per- centage currently pregnant and the mean number of children ever born to women age 40-49 by back- ground characteristics. Like the TFR, the percentage pregnant provides a measure of current fertility, although it is subject to some degree of error because women may not recognize or report all first trimester pregnancies. The mean number of children ever born (CEB) to women age 40-49 is an indicator of com- pleted fertility. It reflects the fertility performance of women who are nearing the end of their reproductive years. If fertility has remained stable over time, the two measures, TFR and CEB, will be about equal. Although this approach may be biased because of understated parity among older women, it does provide an indication of fertility change. In the 2008 NDHS, the difference between the TFR (3.3) and the number of children ever born (4.0) is 0.7 children, indicating a decline in fertility. The decline is larger for women in rural areas (0.9 children) than for those in urban areas (0.5 children). Likewise, differentials between the two measures by level of education are larger for women with less education than for those with higher education. Women in rural areas have an average of one more child than women in urban areas (TFR 3.8 and 2.8 children per woman, respectively). The differ- ences are also substantial across regions. The National Capital Region (NCR), the center of govern- ment, business, commerce, and industry in the country, has the lowest TFR (2.3 children per woman) and the lowest mean number of CEB (3.0 children per woman). Four regions, MIMAROPA (one of the least developed regions in the country), Eastern Visayas, Caraga, and ARMM have the highest TFRs (each with 4.3 children per woman). These regions also tend to have the highest mean CEB. The mean CEB in ARMM is 5.7 children per woman, followed by MIMAROPA (5.2), Eastern Visayas (5.0), Bicol (4.8), and Caraga and CAR (4.7 each). The difference in fertility indicators between the two groups of regions is about two children, which may be interpreted as stemming from differ- ences 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 (both with TFRs of 3.0 births per woman). Likewise, Central Visayas exhibits a low TFR (3.2 births per woman). Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Philippines 2008 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 2.8 4.3 3.3 Rural 3.8 6.3 4.7 Region National Capital Region 2.3 3.9 3.0 Cordillera Admin Region (3.3) 4.8 4.7 I - Ilocos (3.4) 4.9 3.8 II - Cagayan Valley (4.1) 5.6 3.8 III - Central Luzon 3.0 4.4 3.6 IVA - CALABARZON 3.0 4.9 3.5 IVB - MIMAROPA (4.3) 5.8 5.2 V - Bicol 4.1 6.9 4.8 VI - Western Visayas 3.3 5.1 4.0 VII - Central Visayas 3.2 4.8 4.0 VIII - Eastern Visayas (4.3) 7.1 5.0 IX - Zamboanga Peninsula (3.8) 5.7 4.3 X - Northern Mindanao (3.3) 5.7 4.1 XI - Davao (3.3) 5.7 4.5 XII - SOCCSKSARGEN (3.6) 6.4 4.5 XIII - Caraga (4.3) 6.3 4.7 ARMM (4.3) 7.6 5.7 Education No education * 5.9 6.4 Elementary 4.5 6.3 5.1 High school 3.5 5.5 4.0 College 2.3 4.0 2.7 Wealth quintile Lowest 5.2 8.6 5.8 Second 4.2 6.8 4.8 Middle 3.3 5.6 4.1 Fourth 2.7 3.7 3.4 Highest 1.9 2.8 2.5 Total 3.3 5.2 4.0 Note: Total fertility rates are for the period 1-36 months prior to interview. Total fertility rates in parentheses are based on 500-749 unweighted women; an asterisk indicates a figure is based on fewer than 500 unweighted women and has been suppressed. 42 | Fertility There is a negative relationship between fertility and education in the Philippines. The total fertility rate for women with college or higher education (2.3 children per woman) is about half that of women with elementary education (4.5 children) (Table 4.2 and Figure 4.2). Similar differentials are seen by wealth status, with women in households in the higher wealth quintiles having fewer children than women in households in the lower wealth quintiles. Table 4.2 shows that 5 percent of respondents reported being pregnant at the time of the survey. This proportion varies from less than 4 percent in NCR to almost 8 percent in ARMM. 4.3 FERTILITY TRENDS Fertility rates estimated from the 2008 NDHS can be compared with corresponding rates from national demographic surveys from 1973 to 2003. Differences reflect a combination of actual change, variations in geographic coverage, and changes in data collection procedures and estimation techniques in one or all surveys. Table 4.3 and Figure 4.3 show fertility rates for the 30-year period preceding the survey. The rates reflect five-year averages centered on mid-period years for the 1973, 1978, and 1983 surveys and a three-year rate for the 1986, 1993, 1998, 2003 and 2008 surveys. Over the three decades, the TFR declined by 2.7 births, from 6.0 children per woman in 1970 to 3.3 children in 2006. The pace of fertility decline varied over time. In the early 1970s, the TFR declined by 2.7 percent annually. This was followed by a smaller decline during the succeeding five-year period. A larger decline occurred during the first half of the 1980s, but the latter half of the 1980s again showed reduced progress in fertility reduction. Between 1991 and 1996, the TFR decreased annually by 1.9 percent. From 2001 to 2006, the decline continued, but again at a slower pace. 3.3 2.8 3.8 4.5 3.5 2.3 TOTAL RESIDENCE Urban Rural EDUCATION Elementary High school College 0 1 2 3 4 5 Fertility rate Figure 4.2 Fertility Rates by Residence and Education NDHS 2008 Note: There were too few women with no education to calculate a fertility rate. Fertility | 43 Table 4.3 Fertility trends from various surveys Age-specific and total fertility rates from various surveys, Philippines Age group 1973 NDS (1970) 1978 RPFS (1975) 1983 NDS (1980) 1986 CPS (1984) 1993 NDS (1991) 1998 NDHS (1996) 2003 NDHS (2001) 2008 NDHS (2006) 15-19 56 50 55 48 50 46 53 54 20-24 228 212 220 192 190 177 178 163 25-29 302 251 258 229 217 210 191 172 30-34 268 240 221 198 181 155 142 136 35-39 212 179 165 140 120 111 95 84 40-44 100 89 78 62 51 40 43 38 45-49 28 27 20 15 8 7 5 6 Total fertility rate 6.0 5.2 5.1 4.4 4.1 3.7 3.5 3.3 The results in Table 4.3 indicate that all age groups have contributed to the decline in fertility rates. However, the decline has been more rapid among older women than among younger women. Age- specific fertility rates among women age 30 and over fell 50 percent or more between the 1973 NDS and the 2008 NDHS. In contrast, fertility rates among women age 20-30 declined by about one-third during this same period. Fertility trends can also be established using retrospective data from a single survey. Table 4.4 uses information from the retrospective birth histories obtained in the 2008 NDHS to examine trends in age-specific fertility rates for successive five-year periods before the survey. To calculate these rates, births were classified according to the period of time in which the birth occurred and the mother’s age at the time of birth. Because women 50 years and over were not interviewed in the 2008 NDHS, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and more prior to the 6 5.2 5.1 4.4 4.1 3.7 3.5 3.3 1973 NDS (1970) 1978 RPFS (1975) 1983 NDS (1980) 1986 CPS (1984) 1993 NDS (1991) 1998 NDHS (1996) 2003 NDHS (2001) 2008 NDHS (2006) 0 2 4 6 8 Fertility rate Figure 4.3 Trends in the Total Fertility Rate Year of survey 6.0 44 | Fertility survey because women in that age group would have been 50 years or older at the time of the survey. Because of truncation, changes over the past 20 years are best observed for women up to age 29 years. The results presented in Table 4.4 show a declining trend in fertility in the Philippines. For almost all age groups, the ASFRs consistently decline from past periods to the most recent period. The most notable decline is in age group 25-29 (peak of childbirth), from 225 births per 1,000 women in the period 15-19 years before the survey to 172 births per 1,000 women in the five-year period preceding the survey. The observed decline in fertility can most likely be attributed to changes in family planning practices and programs. Over the past 30 years, the mean age at first marriage among women has remained high and relatively stable, at around 22 years (see Chapter 6). Table 4.4 Trends in fertility rates from 2008 NDHS Age-specific fertility rates for five-year periods preceding the survey from the NDHS birth history data, by mother's age at the time of the birth, Philippines 2008 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 53 58 55 67 20-24 166 182 192 212 25-29 172 200 207 225 30-34 140 154 165 [192] 35-39 86 100 [124] - 40-44 39 [59] - - 45-49 [6] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. 4.4 CHILDREN EVER BORN AND LIVING Information on lifetime fertility is useful for examining the momentum of childbearing and for estimating levels of primary infertility. The number of children ever born (CEB) or parity is a cross- sectional view at the time of the survey. It does not refer directly to the timing of fertility of the individual respondent but is a measure of her completed fertility. Table 4.5 shows the number of children ever born by women’s age, for all women and for currently married women and the corresponding mean number of children ever born, and the mean number of living children. The results show that among all women, more than one in three does not have any 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, 3.4 children by their late thirties, and 4.2 children by the end of their reproductive period. Table 4.5 also shows that, overall, the mean number of CEB is 2.0 children for all women and 3.0 for currently married women. Fertility | 45 The proportion of women with no children is high in the younger age groups among both all women and currently married women. This pattern is partly due to the law specifying 18 as the minimum legal age for marriage, but also to the fact that most births occur within marriage. Childlessness is uncommon in Philippine society; among older married women only 4 percent are childless. Assuming that voluntary childlessness within marriage is rare, the 4 percent of married women age 45-49 who are childless may be interpreted as an estimate of primary sterility in the Philippines. The corresponding figure for all women age 45-49 is 8 percent, which reflects the combined impact of infertility, marital dissolution, and celibacy. In addition to giving a description of average family size, information on children ever born and the number of children surviving gives an indication of the extent of childhood and young adult mortality. For younger women, the difference between the mean number of children ever born and the mean number of children surviving is very small. However, the difference increases with women’s age. By the end of the reproductive period, women have lost almost one in ten children. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Philippines 2008 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 92.7 6.3 0.9 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,749 0.08 0.08 20-24 57.5 25.3 13.0 3.2 0.7 0.2 0.1 0.0 0.0 0.0 0.0 100.0 2,147 0.65 0.63 25-29 27.2 25.3 22.8 14.1 6.6 3.1 0.7 0.3 0.0 0.0 0.0 100.0 2,106 1.62 1.55 30-34 15.5 16.0 21.2 20.2 12.9 7.7 3.8 1.7 0.6 0.3 0.1 100.0 1,865 2.52 2.43 35-39 10.3 10.1 17.3 20.7 15.8 10.2 5.6 3.8 2.7 1.8 1.7 100.0 1,777 3.37 3.21 40-44 9.2 8.4 14.4 19.4 15.1 13.0 7.2 4.9 3.4 2.6 2.4 100.0 1,532 3.74 3.55 45-49 7.8 6.8 13.4 20.0 13.3 11.3 8.2 6.3 4.3 3.2 5.5 100.0 1,418 4.20 3.90 Total 37.4 14.3 14.0 12.5 8.1 5.5 3.0 2.0 1.3 0.9 1.1 100.0 13,594 2.02 1.92 CURRENTLY MARRIED WOMEN 15-19 42.1 49.4 7.6 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 283 0.67 0.66 20-24 18.7 46.8 25.7 6.9 1.4 0.4 0.2 0.0 0.0 0.0 0.0 100.0 1,000 1.28 1.24 25-29 8.9 30.2 29.1 17.9 8.5 4.0 1.0 0.4 0.1 0.0 0.0 100.0 1,560 2.05 1.97 30-34 5.6 16.0 24.2 22.8 14.8 9.1 4.4 1.9 0.7 0.4 0.1 100.0 1,573 2.87 2.77 35-39 4.1 8.7 18.7 22.9 17.3 11.3 6.0 4.3 3.0 1.9 1.7 100.0 1,522 3.66 3.49 40-44 3.5 7.7 15.1 21.0 16.3 13.7 7.7 5.5 3.8 2.9 2.8 100.0 1,299 4.06 3.85 45-49 3.7 5.7 13.8 20.6 14.5 11.4 8.4 7.2 4.8 3.5 6.3 100.0 1,181 4.52 4.19 Total 8.1 19.4 20.9 18.7 12.2 8.3 4.5 3.1 2.0 1.3 1.6 100.0 8,418 3.01 2.86 46 | Fertility 4.5 BIRTH INTERVALS Children’s health status is closely related to the length of the preceding birth interval. Research has shown that children born too soon after a previous birth (i.e., within 24 months) are at greater risk of illness and death than those born after a longer interval. In addition, short birth intervals may have consequences for other children in the family. The occurrence of closely spaced births gives the mother insufficient time to restore her health, which may limit her ability to take care of her children. The duration of breastfeeding for the older child may also be shortened if the mother becomes pregnant within a shorter interval. 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 the Philippines, the median interval between births is 33 months (Table 4.6). While 30 percent of births occur four or more years after a previous birth, the same proportion occur within two years of a previous birth. The large proportion of births that take place after a short birth interval is a cause for concern because it has negative implications for maternal and child health and survival. Younger women have shorter birth intervals than older women: 27 months for women age 20-29 and 45 months for women age 40 and older. There is a curvilinear relationship between birth order and median birth interval, from 33 months for second and third births to 35 months for fourth through sixth births, and to 30 months for higher-order births (Figure 4.5). The length of the birth interval does not vary by sex of previous child, but it does vary by survival status of the previous birth. For births whose prior sibling survived, the interval is 34 months; for those with a nonsurviving previous birth, the birth interval is 24 months. The difference is due to a variety of mechanisms through which infant and child mortality influence birth intervals and fertility, particularly whether the mother seeks to replace a dead child as soon as possible. 0.1 0.7 1.6 2.5 3.4 3.7 4.2 2 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-49 Age 0 1 2 3 4 5 Number of children ever born Figure 4.4 Mean Number of Children Ever Born among Women Age 15-49 2.0 NDHS 2008 Fertility | 47 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, and median number of months since preceding birth, according to background characteristics, Philippines 2008 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Number of non- first births Median number of months since preceding birth Age 15-19 (34.9) (37.5) (24.3) (3.3) (0.0) (0.0) 100.0 29 (20.3) 20-29 19.9 20.6 27.9 14.7 7.9 9.0 100.0 1,718 26.8 30-39 10.9 13.2 25.2 14.5 10.7 25.6 100.0 2,181 36.5 40-49 5.4 8.9 22.6 16.7 10.3 36.1 100.0 552 45.3 Birth order 2-3 16.1 15.6 23.6 14.5 9.4 20.9 100.0 2,490 33.2 4-6 9.8 14.8 27.2 15.6 10.1 22.6 100.0 1,446 35.1 7+ 14.0 18.6 33.2 13.7 8.6 11.9 100.0 545 29.8 Sex of preceding birth Male 14.6 14.9 26.0 15.4 10.3 18.8 100.0 2,328 33.3 Female 12.9 16.5 25.8 14.0 8.7 22.1 100.0 2,152 33.0 Survival of preceding birth Living 12.9 15.7 26.3 15.0 9.6 20.5 100.0 4,296 33.5 Dead 34.8 15.1 17.2 7.9 7.6 17.4 100.0 184 24.0 Residence Urban 14.2 15.6 24.2 14.4 9.3 22.2 100.0 2,098 34.0 Rural 13.4 15.7 27.4 15.1 9.7 18.7 100.0 2,382 32.5 Region National Capital Region 14.7 14.0 21.3 15.3 9.1 25.7 100.0 607 36.1 Cordillera Admin Region 15.7 15.2 26.2 16.2 11.0 15.7 100.0 77 33.0 I - Ilocos 15.4 15.0 25.9 11.8 9.9 22.0 100.0 207 31.7 II - Cagayan Valley 12.9 14.8 26.6 12.8 8.7 24.3 100.0 160 34.3 III - Central Luzon 11.9 15.0 27.7 16.7 10.8 17.8 100.0 413 32.8 IVA - CALABARZON 13.6 16.6 23.5 13.3 11.3 21.7 100.0 539 34.1 IVB - MIMAROPA 10.0 16.6 33.0 15.8 8.1 16.4 100.0 148 30.5 V - Bicol 15.0 16.2 31.7 15.5 8.1 13.5 100.0 323 30.2 VI - Western Visayas 14.5 13.6 24.7 18.6 8.9 19.6 100.0 319 34.1 VII - Central Visayas 11.5 18.5 29.1 10.9 9.3 20.7 100.0 320 32.3 VIII - Eastern Visayas 14.8 18.6 26.1 15.9 7.6 17.1 100.0 211 30.5 IX - Zamboanga Peninsula 12.0 18.8 27.2 11.4 9.3 21.3 100.0 181 31.3 X - Northern Mindanao 12.1 18.0 25.7 16.0 8.8 19.4 100.0 203 33.5 XI - Davao 12.4 13.4 18.7 15.9 11.9 27.7 100.0 201 39.7 XII - SOCCSKSARGEN 12.4 10.3 26.3 16.7 10.8 23.4 100.0 178 36.2 XIII - Caraga 15.1 20.2 22.6 10.6 8.8 22.8 100.0 136 31.0 ARMM 19.7 14.4 30.5 15.3 8.3 11.8 100.0 258 29.0 Education No education 19.5 15.7 31.8 11.1 6.5 15.4 100.0 94 28.9 Elementary 11.9 14.7 29.8 14.9 8.9 19.8 100.0 1,293 32.8 High school 13.6 16.9 26.0 14.4 9.7 19.4 100.0 2,101 32.4 College 16.2 14.3 20.0 15.6 10.2 23.7 100.0 992 35.8 Wealth quintile Lowest 13.3 17.5 31.9 14.9 8.0 14.4 100.0 1,357 30.0 Second 14.0 17.2 28.0 13.8 10.1 16.9 100.0 1,075 31.0 Middle 13.9 14.0 22.7 14.7 10.6 24.1 100.0 846 35.7 Fourth 15.5 14.5 20.7 13.5 9.8 26.1 100.0 682 35.6 Highest 12.4 11.9 17.9 18.0 10.3 29.5 100.0 520 40.5 Total 13.8 15.7 25.9 14.7 9.5 20.4 100.0 4,480 33.2 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. Numbers in parentheses are based on 25-49 unweighted cases. 48 | Fertility Whereas mother’s education does not have a strong relationship with the length of birth intervals, mother’s economic status has a positive association. Women in the poorest wealth quintile have the shortest birth interval (30 to 31 months), while those in higher wealth quintiles have the longest birth intervals (36 to 41 months). 4.6 AGE AT FIRST BIRTH Postponing the first birth contributes to overall fertility reduction. As such, the onset of childbearing is an important fertility indicator. Early childbearing in the Philippines is unusual: only 10 percent of women age 45-49 gave 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 median age at first marriage, which has been about 22 years for the past 25 years. The median age at first birth among women age 25-49 is 23 years (Table 4.7). Table 4.7 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Philippines 2008 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 0.2 na na na na 92.7 2,749 a 20-24 0.5 7.1 21.3 na na 57.5 2,147 a 25-29 0.5 8.5 22.5 40.5 61.4 27.2 2,106 23.1 30-34 0.4 8.7 22.3 40.3 63.1 15.5 1,865 23.3 35-39 1.0 10.0 24.7 41.1 61.8 10.3 1,777 23.2 40-44 0.8 8.3 21.1 38.8 60.5 9.2 1,532 23.4 45-49 0.8 9.8 23.8 40.8 60.2 7.8 1,418 23.3 20-49 0.6 8.7 22.6 na na 23.3 10,845 a 25-49 0.7 9.0 22.9 40.3 61.5 14.9 8,698 23.2 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 20.3 26.8 36.5 45.3 33.2 35.1 29.8 15-19 20-29 30-39 40-49 2-3 4-6 7+ 0 10 20 30 40 50 Figure 4.5 Median Number of Months since Previous Birth Age of mother Birth order NDHS 2008 Fertility | 49 As shown in Table 4.8, women in the urban areas have their first birth two years later than their rural counterparts. Women with higher education and those in higher socioeconomic strata have a higher median age at first birth than other women. Regional variation in age at first birth ranges from 21.5 years in ARMM and SOCCSKSARGEN to 24.8 years in NCR. Table 4.8 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Philippines 2008 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 24.0 23.8 24.3 24.3 24.8 24.2 Rural 22.0 22.4 22.0 22.5 21.9 22.2 Region National Capital Region a 24.2 24.3 24.8 25.5 24.8 Cordillera Admin Region 22.1 23.1 22.1 21.9 21.4 22.1 I - Ilocos 23.3 22.8 24.2 24.6 24.4 23.8 II - Cagayan Valley 21.7 22.4 22.6 23.1 22.0 22.3 III - Central Luzon 23.6 23.4 22.7 25.0 23.2 23.5 IVA - CALABARZON 23.0 24.4 24.6 24.1 23.5 24.0 IVB - MIMAROPA 21.6 21.5 22.4 21.4 21.6 21.6 V - Bicol 22.5 23.1 21.8 22.1 24.2 22.6 VI - Western Visayas 23.8 23.9 23.9 23.3 24.1 23.7 VII - Central Visayas 23.2 23.4 22.5 22.7 22.6 22.9 VIII - Eastern Visayas 23.4 22.0 23.4 21.7 22.5 22.6 IX - Zamboanga Peninsula 22.9 23.2 22.3 23.2 22.0 22.8 X - Northern Mindanao 22.8 22.9 22.6 22.9 22.6 22.7 XI - Davao 22.0 22.5 22.4 21.8 21.7 22.1 XII - SOCCSKSARGEN 21.0 21.3 21.2 22.3 21.8 21.5 XIII - Caraga 22.5 21.6 22.1 23.2 22.7 22.3 ARMM 21.0 20.7 21.6 22.7 22.7 21.5 Education No education * * (18.7) (20.8) 21.6 20.0 Elementary 20.8 20.7 20.8 21.4 21.1 21.0 High school 22.0 22.0 22.6 22.5 22.5 22.3 College a 25.8 26.7 27.0 26.3 a Wealth quintile Lowest 20.6 20.8 21.3 21.5 21.6 21.1 Second 21.7 21.7 21.7 22.5 21.7 21.9 Middle 22.6 23.1 22.6 22.9 22.1 22.7 Fourth 24.9 24.3 24.4 23.8 24.1 24.4 Highest a 26.0 25.9 25.9 26.2 a Total 23.1 23.3 23.2 23.4 23.3 23.2 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. a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group 50 | Fertility 4.7 ADOLESCENT FERTILITY Young women have been the focus of a number of government programs aimed at delaying the beginning of childbearing and thereby hastening fertility decline. In the Philippines, 26 percent of women age 15-24 years have begun childbearing (Table 4.9). Young women in rural areas are more likely than those in urban areas to have begun childbearing. Similarly, young women with no school or only elementary schooling and those in the poorer wealth quintiles are more likely to have started childbearing than better educated and young women in wealthier households. Across regions, early childbearing is highest in MIMAROPA (37 percent) and SOCCSKSARGEN (35 percent), and lowest in NCR (18 percent). Given the late age at first marriage, only 10 percent of teenagers age 15-19 in the Philippines have begun childbearing. Table 4.9 Teenage pregnancy and motherhood Percentage of women age 15-24 who have had a live birth or who are pregnant with their first child and percentage who have begun childbearing, by background characteristics, Philippines 2008 Percentage who: Background characteristic Have had a live birth Are pregnant with first child Percentage who have begun childbearing Number of women Age 15 0.3 0.6 0.9 626 16 3.5 1.1 4.6 552 17 4.6 2.5 7.1 502 18 9.7 4.7 14.4 537 19 19.5 4.7 24.1 532 15 - 19 7.3 2.6 9.9 2,749 20 - 24 42.5 4.4 46.8 2,147 Residence Urban 18.5 2.7 21.2 2,784 Rural 28.2 4.3 32.6 2,112 Region National Capital Region 15.1 2.6 17.7 916 Cordillera Admin Region 19.4 6.5 25.9 85 I - Ilocos 25.1 4.4 29.4 213 II - Cagayan Valley 27.8 4.4 32.2 118 III - Central Luzon 22.8 2.7 25.5 527 IVA - CALABARZON 22.9 3.6 26.6 650 IVB - MIMAROPA 35.6 1.5 37.0 126 V - Bicol 22.3 4.3 26.6 292 VI - Western Visayas 20.6 4.5 25.1 324 VII - Central Visayas 22.8 3.2 26.0 370 VIII - Eastern Visayas 28.2 2.7 30.9 150 IX - Zamboanga Peninsula 28.8 2.4 31.3 197 X - Northern Mindanao 23.2 3.9 27.1 220 XI - Davao 25.3 3.4 28.6 233 XII - SOCCSKSARGEN 29.2 6.0 35.1 170 XIII - Caraga 27.8 6.1 33.9 107 ARMM 26.5 0.7 27.2 198 Education No education (48.9) (1.2) (50.2) 32 Elementary 34.0 3.3 37.4 597 High school 23.1 3.6 26.7 2,880 College 16.4 3.0 19.4 1,388 Wealth quintile Lowest 40.3 3.8 44.1 698 Second 30.0 4.6 34.6 861 Middle 22.9 4.3 27.3 917 Fourth 19.7 3.1 22.9 1,078 Highest 11.1 2.0 13.1 1,343 Total 22.7 3.4 26.1 4,896 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. Family Planning | 51 FAMILY PLANNING 5   5.1 KNOWLEDGE OF FAMILY PLANNING METHODS   Acquiring knowledge about fertility control is an important step toward gaining access to contraceptive methods and using a suitable method in a timely and effective manner. In the 2008 National Demographic and Health Survey (NDHS), information on knowledge of family planning methods was obtained by first asking the respondent to name ways that a couple can delay or avoid a pregnancy or birth. If the respondent did not spontaneously mention a particular method, the interviewer described the method and asked the respondent if she recognized it. Descriptions were included in the questionnaire for 14 modern family planning methods: female sterilization, male sterilization, the pill, intrauterine device (IUD), injectables, implants, patch, condom, female condom, mucus/Billings/ovulation, basal body tem- perature, symptothermal, standard days method, and lactational amenorrhea method (LAM). Information was also collected on two traditional methods: calendar/rhythm/periodic abstinence and withdrawal. All other traditional or folk methods mentioned by respondents, such as herbs and abdominal massage, were recorded as well. Table 5.1 shows knowledge of contra- ceptive methods for all women and currently married women as well as for sexually active unmarried women. The results indicate that knowledge of contraceptive methods is wide- spread among women. Almost all women and currently married women know at least one method of family planning (98 and 99 percent, respectively). Knowledge of modern methods among all women and currently married women is as high as knowledge of any method. Eight of ten women know at least one tradi- tional method. Knowledge of at least one modern con- traceptive method among women has remained unchanged since 2003, while knowledge of tra- ditional methods has increased slightly from 83 to 84 percent for all women and 90 to 91 per- cent for currently married women. The most widely known methods for both all women and currently married women are the pill and male condom. Female sterilization and injectables are known by 84 percent of all women and from 90 to 91 percent of currently married women. Knowledge of the lactational amenor- rhea method (LAM) and standard days method among women is relatively low (16 and 15 percent, respectively). The patch is the least-known method among both all women and currently married women. There is limited knowledge of the patch because this method is relatively new and has not been included in the national family planning program. Table 5.1 Knowledge of contraceptive methods Percentage of all women, currently married women and sexually active unmarried women age 15-49 who know any contraceptive method, by specific method, Philippines 2008 Method All women Currently married women Sexually active unmarried women1 Any method 97.8 98.9 99.4 Any modern method 97.5 98.6 99.4 Female sterilization 84.0 89.6 87.3 Male sterilization 62.3 68.4 66.6 Pill 96.4 97.8 99.4 IUD 78.9 86.6 75.6 Injectables 83.6 91.1 87.7 Implants 11.6 11.1 15.7 Patch 7.6 7.2 15.4 Male condom 92.2 93.9 95.9 Female condom 15.3 14.0 22.5 Mucus/Billings/ovulation 16.8 17.5 26.2 Basal body temperature 15.9 16.0 25.8 Symptothermal 8.1 7.7 14.7 Standard days method 14.6 15.1 28.1 Lactational amenorrhea (LAM) 15.7 17.7 21.9 Emergency contraception 9.7 8.8 18.4 Any traditional method 84.1 91.0 93.5 Rhythm 70.7 78.0 71.9 Withdrawal 78.5 87.1 91.0 Folk method 4.7 6.0 5.0 Mean number of methods known by women 15-49 7.7 8.1 8.7 Number of women 13,594 8,418 115 1 Had last sexual intercourse within 30 days preceding the survey 52 | Family Planning In general, sexually active unmarried women are more knowledgeable about contraceptive methods than currently married women and all women. The average number of methods known is 7.7 for all women, 8.1 for currently married women, and 8.7 for sexually active unmarried women. Table 5.2 shows the percentage of currently married women who know at least one contraceptive method by background characteristics. The differentials are small because almost all currently married women know at least one method of contraception. Knowledge of any method of contraception is notably lower in ARMM, where only four in five women have ever heard of any method or any modern method of contraception. Almost all currently married women with edu- cation know at least one modern method, compared with 69 percent of women with no education. A similar pattern is seen by household wealth status with almost all women in the highest wealth quintile knowing a modern method of contraception, compared with 95 percent of women in the lowest wealth quintile. 5.2 EVER USE OF FAMILY PLANNING METHODS All women interviewed in the 2008 NDHS who said they had heard of a method of family planning were asked if they had ever used that method. Table 5.3 indicates that about 3 out of 4 currently married women have used a method (77 percent). As in previous sur- veys, the pill is by far the most widely used method among currently married women (43 percent), having increased by more than 4 percentage points in the past five years. The proportions of women who have ever used other modern methods have also increased. For example, the proportion of currently married women who have ever used male condoms has increased from 15 percent in 2003 to 17 percent in 2008, while the proportion that have ever used injectables has increased from 12 to 14 percent. Nine percent of currently married women reported having been sterilized. Few women have used other modern methods. The level of ever use of traditional methods is high in the Philip- pines. More than one in three currently married women (38 percent) has used withdrawal, while one-fifth have used rhythm/periodic abstinence (20 percent). In 2003, 32 and 21 percent, respectively, had used these methods at some time. Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women age 15-49 who have heard of at least one contraceptive method and who have heard of at least one modern method by background characteristics, Philippines 2008 Background characteristic Heard of any method Heard of any modern method1 Number Age 15-19 96.3 96.3 283 20-24 99.4 99.2 1,000 25-29 99.2 99.0 1,560 30-34 99.4 99.2 1,573 35-39 98.8 98.5 1,522 40-44 98.9 98.6 1,299 45-49 98.2 97.7 1,181 Residence Urban 99.5 99.3 4,297 Rural 98.3 97.9 4,121 Region National Capital Region 99.9 99.9 1,343 Cordillera Admin Region 99.7 99.5 143 I - Ilocos 100.0 100.0 415 II - Cagayan Valley 99.7 99.7 273 III - Central Luzon 100.0 100.0 897 IVA - CALABARZON 99.3 98.8 1,089 IVB - MIMAROPA 95.9 94.9 241 V - Bicol 100.0 99.8 470 VI - Western Visayas 99.8 99.8 627 VII - Central Visayas 100.0 100.0 599 VIII - Eastern Visayas 99.5 99.5 337 IX - Zamboanga Peninsula 98.7 97.5 316 X - Northern Mindanao 100.0 100.0 373 XI - Davao 99.4 98.7 406 XII - SOCCSKSARGEN 99.2 99.2 338 XIII - Caraga 99.5 99.5 212 ARMM 82.6 80.5 337 Education No education 73.3 68.5 133 Elementary 98.2 97.7 2,034 High school 99.5 99.3 3,727 College 100.0 99.9 2,524 Wealth quintile Lowest 95.6 94.5 1,661 Second 99.2 99.1 1,683 Middle 99.9 99.9 1,737 Fourth 100.0 99.9 1,710 Highest 99.8 99.6 1,627 Total 15-49 98.9 98.6 8,418 1 Female sterilization, male sterilization, pill, IUD, inject- ables, implants, patch, male condom, female condom, mucus/Billings/ovulation, basal body temperature, sympto- thermal, standard days method, diaphragm, foam or jelly, lactational amenorrhea method (LAM), and emergency contraception T ab le 5 .3 E ve r u se o f c on tra ce pt io n P er ce nt ag e of a ll w om en a nd c ur re nt ly m ar rie d w om en a ge 1 5- 49 w ho h av e ev er u se d an y co nt ra ce pt iv e m et ho d by m et ho d, a cc or di ng to a ge , P hi lip pi ne s 20 08 M od er n m et ho d Tr ad iti on al m et ho d A ge An y m et ho d An y m od er n m et ho d Fe m al e st er ili - za tio n M al e st er ili - za tio n Pi ll IU D In je ct - ab le s M al e co nd om Fe m al e co nd om M uc us / bi lli ng s/ ov ul at io n Ba sa l bo dy te m pe r- at ur e Sy m pt o- th er m al S ta nd ar d da ys m et ho d LA M Em er - ge nc y co nt ra - ce pt io n An y tra di - tio na l m et ho d Rh yt hm W ith - dr aw al Fo lk m et ho d N um be r of w om en AL L W O M EN 1 5- 19 6. 1 3. 5 0. 0 0. 0 1. 7 0. 2 0. 4 1. 4 0. 0 0. 1 0. 1 0. 0 0. 0 0. 2 0. 2 4. 1 1. 0 3. 5 0. 2 2, 74 9 2 0- 24 36 .1 27 .0 0. 2 0. 1 18 .8 2. 5 6. 1 6. 7 0. 0 0. 2 0. 2 0. 1 0. 1 0. 8 0. 1 21 .6 6. 0 19 .5 0. 5 2, 14 7 2 5- 29 64 .1 52 .9 2. 3 0. 0 39 .6 5. 5 12 .4 14 .0 0. 1 0. 7 0. 5 0. 3 0. 5 2. 7 0. 3 38 .0 13 .2 33 .8 1. 5 2, 10 6 3 0- 34 72 .5 60 .5 7. 2 0. 0 44 .2 8. 1 15 .0 16 .2 0. 1 1. 2 0. 7 0. 2 0. 5 2. 0 0. 5 43 .3 16 .8 35 .7 2. 3 1, 86 5 3 5- 39 72 .8 61 .0 11 .4 0. 1 42 .2 10 .6 14 .2 17 .8 0. 2 0. 7 0. 2 0. 1 0. 3 2. 2 0. 2 44 .1 20 .8 35 .4 1. 9 1, 77 7 4 0- 44 73 .0 59 .2 15 .2 0. 1 37 .3 12 .0 12 .1 16 .3 0. 2 1. 6 0. 6 0. 1 0. 1 1. 9 0. 3 44 .2 22 .5 34 .4 2. 7 1, 53 2 4 5- 49 67 .9 51 .4 13 .4 0. 0 31 .5 9. 4 8. 8 12 .7 0. 0 1. 0 0. 7 0. 1 0. 4 1. 1 0. 3 42 .9 24 .8 32 .6 3. 3 1, 41 8 T ot al 51 .6 41 .5 6. 0 0. 1 28 .5 6. 1 9. 1 11 .2 0. 1 0. 7 0. 4 0. 1 0. 3 1. 5 0. 3 31 .3 13 .3 25 .8 1. 6 13 ,5 94 C U RR EN TL Y M A RR IE D W O M EN 1 5- 19 46 .0 26 .3 0. 0 0. 0 14 .5 2. 1 3. 6 7. 8 0. 0 0. 8 0. 8 0. 0 0. 0 1. 7 0. 8 29 .9 8. 5 25 .7 1. 4 28 3 2 0- 24 67 .8 51 .7 0. 5 0. 2 37 .1 5. 2 12 .8 10 .2 0. 0 0. 5 0. 5 0. 2 0. 3 1. 5 0. 2 39 .4 10 .2 35 .7 0. 9 1, 00 0 2 5- 29 80 .8 67 .3 3. 0 0. 1 51 .1 7. 4 16 .2 17 .3 0. 1 0. 7 0. 6 0. 4 0. 6 3. 5 0. 4 47 .1 16 .3 41 .8 1. 9 1, 56 0 3 0- 34 82 .3 69 .0 8. 5 0. 0 50 .2 9. 2 17 .5 18 .4 0. 1 1. 4 0. 7 0. 3 0. 6 2. 4 0. 6 48 .6 19 .2 40 .1 2. 6 1, 57 3 3 5- 39 79 .4 66 .5 12 .5 0. 1 46 .1 11 .5 15 .4 19 .9 0. 2 0. 9 0. 3 0. 1 0. 4 2. 5 0. 2 48 .6 23 .0 39 .0 1. 9 1, 52 2 4 0- 44 79 .5 65 .2 16 .6 0. 1 40 .9 13 .5 13 .3 18 .4 0. 2 1. 7 0. 5 0. 1 0. 1 2. 0 0. 2 48 .2 24 .4 37 .4 3. 0 1, 29 9 4 5- 49 72 .3 55 .1 15 .4 0. 0 33 .6 9. 7 8. 9 13 .7 0. 0 1. 0 0. 7 0. 2 0. 5 1. 0 0. 3 45 .8 26 .2 35 .3 3. 3 1, 18 1 T ot al 76 .7 62 .2 9. 2 0. 1 43 .1 9. 3 14 .0 16 .5 0. 1 1. 0 0. 6 0. 2 0. 4 2. 2 0. 4 46 .2 19 .7 38 .1 2. 3 8, 41 8 L A M = L ac ta tio na l a m en or rh ea m et ho d Family Planning | 53 54 | Family Planning Ever-use rates vary by age group and are lowest among the youngest women. However, the fact that 46 percent of currently married women age 15-19 and 68 percent of those age 20-24 have used contraception at some time indicates that women in the Philippines understand the advantages of practicing family planning early in their reproductive years. The level of ever use rises to a high of 82 percent among currently married women age 30-34, then declines to 72 percent among those age 45-49. 5.3 CURRENT USE OF FAMILY PLANNING METHODS The level of current use of contraceptive methods is one of the indicators most frequently used to assess the success of family planning program activities. It is also widely used as a measure in analyzing the determinants of fertility. This section focuses on the levels and differentials in current use of family planning in the Philippines. 5.3.1 Current Contraceptive Use Current use of contraception among all women and currently married women is shown in Table 5.4 by age group. Fifty-one percent of married women are currently using a method of family planning. This includes 34 percent who are using a modern method and 17 percent who are using a traditional method. The most widely used method is the pill (16 percent) followed by withdrawal (10 percent), female sterilization (9 percent), and rhythm (6 percent). The remaining methods have few users, each being used by less than 4 percent of married women (Figure 5.1). Table 5.4 Current use of contraception by age Percent distribution of all women and currently married women age 15-49 by contraceptive method currently used, according to age, Philippines 2008 Modern method Traditional method Age Any method Any modern method Female sterili- zation Pill IUD Inject- ables Male condom LAM Any tradi- tional method Rhythm With- drawal Folk method Not currently using Total Number of women ALL WOMEN 15-19 3.1 1.6 0.0 0.9 0.2 0.2 0.3 0.0 1.5 0.2 1.3 0.0 96.9 100.0 2,749 20-24 23.3 16.3 0.2 10.6 1.5 2.4 1.4 0.2 7.1 1.7 5.3 0.1 76.7 100.0 2,147 25-29 39.3 27.0 2.3 16.6 2.9 2.6 2.2 0.3 12.3 3.4 8.7 0.3 60.7 100.0 2,106 30-34 49.3 33.4 7.2 16.8 3.4 2.6 2.7 0.5 15.9 5.4 9.8 0.6 50.7 100.0 1,865 35-39 50.0 34.9 11.4 14.7 3.7 1.7 2.7 0.6 15.0 6.6 8.1 0.3 50.0 100.0 1,777 40-44 49.2 31.7 15.2 8.9 4.1 1.4 1.7 0.1 17.5 9.0 8.1 0.5 50.8 100.0 1,532 45-49 31.1 19.4 13.4 2.4 1.8 0.6 0.9 0.0 11.7 6.1 5.4 0.2 68.9 100.0 1,418 Total 32.5 21.8 6.0 9.9 2.3 1.6 1.6 0.2 10.7 4.1 6.3 0.3 67.5 100.0 13,594 CURRENTLY MARRIED WOMEN 15-19 25.9 14.3 0.0 8.6 1.7 2.4 1.6 0.0 11.6 1.8 9.8 0.0 74.1 100.0 283 20-24 46.3 32.5 0.5 21.9 3.1 5.0 1.6 0.4 13.8 3.1 10.5 0.2 53.7 100.0 1,000 25-29 51.3 35.6 3.0 21.9 3.9 3.5 2.7 0.4 15.7 4.3 11.0 0.4 48.7 100.0 1,560 30-34 57.6 38.9 8.5 19.7 3.9 3.1 3.0 0.6 18.6 6.4 11.5 0.8 42.4 100.0 1,573 35-39 57.0 39.5 12.5 16.8 4.3 2.0 3.2 0.6 17.5 7.7 9.5 0.3 43.0 100.0 1,522 40-44 56.1 35.7 16.6 10.5 4.7 1.7 1.9 0.1 20.3 10.3 9.4 0.6 43.9 100.0 1,299 45-49 36.5 22.5 15.4 2.9 2.1 0.7 1.0 0.0 14.0 7.3 6.4 0.3 63.5 100.0 1,181 Total 50.7 34.0 9.2 15.7 3.7 2.6 2.3 0.4 16.7 6.4 9.8 0.4 49.3 100.0 8,418 Note: If more than one method is used, only the most effective method is considered in this tabulation. Methods used by less than 0.05 percent of women have been omitted but are included in totals. LAM = Lactational amenorrhea method Family Planning | 55 The age pattern of contraceptive use takes the shape of an inverted U. For currently married women using modern methods, the peak is in age group 35-39; for traditional methods the peak is in age group 40-44. However, as with rates of ever use (Table 5.3), the peak for specific methods occurs in different age groups. The pill and injectables are more popular among younger women, whereas older women tend to use long-term methods such as female sterilization and IUD. Current use of calendar/rhythm/periodic abstinence is popular among older women (age 40-44), while withdrawal is popular among women age 20-34 years old. 5.3.2 Differentials in Contraceptive Use The study of differentials in current use of contraception is important because it helps identify subgroups of the population in need of family planning services. Table 5.5 shows the percent distribution of currently married women by current use of family planning methods, according to background characteristics. The table allows comparison of contraceptive use among major population subgroups. It also permits an examination of differences in the method mix among current users within the various subgroups. Figure 5.1 Use of Contraception among Currently Married Women Age 15-49 NDHS 2008 Not using 49% Condoms 2% Injectables 3% IUD 4% Calendar/ rhythm 6% Female sterilization 9% Withdrawal 19% Pill 16% Other methods 1% 56 | Family Planning Table 5.5 Current use of contraception by background characteristics Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Philippines 2008 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- zation Pill IUD Inject- ables Male con- dom Mucus/ Billings/ ovula- tion LAM Any tradi- tional method Rhythm With- drawal Folk method Not currently using Total Number of women Residence Urban 53.4 35.3 10.5 15.3 3.1 2.6 3.0 0.1 0.6 18.0 6.5 11.2 0.3 46.6 100.0 4,297 Rural 48.0 32.7 7.8 16.2 4.3 2.6 1.6 0.1 0.1 15.3 6.3 8.4 0.5 52.0 100.0 4,121 Region National Capital Region 54.1 32.3 9.3 13.8 2.0 2.4 3.5 0.0 1.2 21.9 7.6 14.2 0.1 45.9 100.0 1,343 Cordillera Admin Region 54.9 38.9 15.2 12.5 4.7 4.1 2.3 0.0 0.0 16.1 3.5 12.3 0.3 45.1 100.0 143 I - Ilocos 54.2 36.4 10.8 17.7 1.3 3.6 2.7 0.0 0.2 17.8 3.8 14.0 0.0 45.8 100.0 415 II - Cagayan Valley 54.3 46.2 7.5 27.0 7.0 3.7 1.1 0.0 0.0 8.0 1.6 6.4 0.0 45.7 100.0 273 III - Central Luzon 57.8 40.3 17.2 15.9 1.7 3.3 1.9 0.1 0.0 17.5 4.0 13.4 0.1 42.2 100.0 897 IVA - CALABARZON 46.8 32.4 10.0 14.0 2.0 3.3 2.5 0.0 0.6 14.4 4.3 10.1 0.0 53.2 100.0 1,089 IVB - MIMAROPA 53.6 36.1 6.4 22.4 3.2 1.4 2.3 0.3 0.0 17.5 4.3 11.6 1.5 46.4 100.0 241 V - Bicol 39.4 24.2 6.5 10.9 1.0 3.4 1.9 0.3 0.0 15.3 6.3 7.5 1.4 60.6 100.0 470 VI - Western Visayas 51.9 33.4 7.0 18.5 3.5 2.3 1.7 0.0 0.4 18.5 9.4 8.5 0.5 48.1 100.0 627 VII - Central Visayas 55.7 35.5 6.8 14.4 8.1 1.9 3.6 0.0 0.4 20.2 10.9 9.3 0.0 44.3 100.0 599 VIII - Eastern Visayas 47.5 28.0 7.6 14.5 2.8 1.2 1.4 0.2 0.0 19.5 7.1 11.5 1.0 52.5 100.0 337 IX - Zamboanga Peninsula 43.8 28.6 4.2 18.6 3.1 1.4 1.3 0.0 0.0 15.2 8.6 5.4 1.2 56.2 100.0 316 X - Northern Mindanao 53.2 38.5 5.9 18.4 10.5 0.7 1.4 0.2 0.9 14.8 8.5 6.1 0.2 46.8 100.0 373 XI - Davao 60.2 44.7 9.6 21.2 8.4 2.5 2.8 0.2 0.0 15.5 10.0 4.8 0.6 39.8 100.0 406 XII - SOCCSKSARGEN 55.1 41.4 11.6 19.2 5.8 2.9 1.9 0.0 0.0 13.7 7.1 6.1 0.5 44.9 100.0 338 XIII - Caraga 51.7 37.2 9.3 14.9 8.3 1.3 2.6 0.3 0.0 14.6 7.2 6.4 1.0 48.3 100.0 212 ARMM 15.1 9.9 3.1 2.5 0.7 3.2 0.5 0.0 0.0 5.2 0.9 2.8 1.4 84.9 100.0 337 Education No education 18.5 8.7 4.4 2.5 1.8 0.0 0.0 0.0 0.0 9.8 1.1 5.0 3.7 81.5 100.0 133 Elementary 45.3 30.3 9.8 13.0 4.4 1.9 0.7 0.0 0.4 15.0 5.1 9.2 0.7 54.7 100.0 2,034 High school 53.2 35.6 8.5 17.7 3.7 2.7 2.4 0.1 0.5 17.6 5.7 11.7 0.3 46.8 100.0 3,727 College 53.1 36.1 10.1 15.6 3.1 3.1 3.6 0.1 0.2 17.0 8.9 8.0 0.2 46.9 100.0 2,524 Number of living children 0 6.6 1.4 0.0 1.1 0.0 0.0 0.3 0.0 0.0 5.3 1.4 3.8 0.0 93.4 100.0 706 1-2 51.5 34.2 3.1 20.4 4.1 3.2 3.0 0.0 0.2 17.3 6.2 10.7 0.4 48.5 100.0 3,517 3-4 61.7 43.5 17.6 16.3 4.0 2.6 2.3 0.1 0.5 18.2 7.8 10.0 0.4 38.3 100.0 2,618 5+ 50.4 32.6 13.1 10.8 3.8 2.4 1.6 0.2 0.7 17.8 6.8 10.4 0.7 49.6 100.0 1,576 Wealth quintile Lowest 40.8 26.0 4.2 14.6 4.2 2.0 0.6 0.0 0.2 14.8 5.5 8.3 1.1 59.2 100.0 1,661 Second 52.7 35.7 8.9 17.9 4.3 2.3 1.6 0.1 0.6 16.9 6.4 10.1 0.4 47.3 100.0 1,683 Middle 54.0 36.6 9.5 16.6 4.3 2.7 2.6 0.1 0.7 17.4 5.2 11.9 0.3 46.0 100.0 1,737 Fourth 55.8 38.5 11.7 15.9 3.8 3.3 3.4 0.0 0.2 17.3 6.4 10.6 0.2 44.2 100.0 1,710 Highest 50.0 33.1 11.6 13.3 1.6 2.6 3.3 0.1 0.1 16.9 8.7 8.1 0.0 50.0 100.0 1,627 Total 50.7 34.0 9.2 15.7 3.7 2.6 2.3 0.1 0.4 16.7 6.4 9.8 0.4 49.3 100.0 8,418 Note: If more than one method is used, only the most effective method is considered in this tabulation. Methods used by less than 0.05 percent of women have been omitted but are included in totals. LAM = Lactational amenorrhea method Substantial differences in the use of contraceptive methods among subgroups of currently married women can be seen in Table 5.5. Women in urban areas are more likely to use a family planning method than women in rural areas, reflecting wider availability and easier access to contraceptive methods in urban areas than in rural areas. The contraceptive prevalence rate is 53 percent in urban areas, compared with 48 percent in rural areas. Family Planning | 57 Contraceptive use among currently married women is highest in Davao (60 percent), followed by Central Luzon (58 percent) and Central Visayas (56 percent) and is lowest in ARMM (15 percent). The use of female sterilization is most common in Cordillera Administrative Region (15 percent) and Central Luzon (17 percent). Use of withdrawal is highest in National Capital Region and Ilocos (both 14 percent). In ARMM, injectables, female sterilization, withdrawal, and pill are used almost equally; contraceptive use in the rest of the regions is predominantly the pill. Contraceptive use is associated with the number of living children a woman has; it is highest among women with three to four children (62 percent) and lowest among women with no children (7 percent). Use of contraception increases with educational attainment and wealth quintile. Nineteen percent of married women with no education are currently using contraception, compared with 53 percent of married women with high school and college education. Use of contraception rises steadily with wealth quintile, from 41 percent among women in the lowest wealth quintile to 50 percent among women in the highest wealth quintile. 5.3.3 Trends in Contraceptive Use The contraceptive prevalence rate for married women in the Philippines has increased from 15 percent in 1968 to 51 percent in 2008, an almost fourfold increase over four decades (Table 5.6 and Figure 5.2). However, while use of any method increased by two percentage points between 2003 and 2008 (from 49 percent to 51 percent), use of any modern method increased by less than one percentage point. Table 5.6 Trends in contraceptive use Percentage of currently married women age 15-19 using modern, traditional, or any methods, various surveys 1968-2008, Philippines Survey Modern methods Traditional methods Any method 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 2008 National Demographic and Health Survey 34.0 16.7 50.7 1 Calculated for currently married women 15-44 years Source: World Bank, 1991; NSO and Macro International 1994; NSO, DOH and Macro International 1999; NSO and ORC Macro, 2004 58 | Family Planning 5.4 NUMBER OF CHILDREN AT FIRST USE OF FAMILY PLANNING Family planning may be used to limit family size or to delay a birth. Typically, couples using family planning to limit family size adopt contraception when they have had the number of children they want. When contraception is used to delay or space births, couples may start using family planning earlier, with the intention of delaying a possible pregnancy. This may be done even before a couple has had their desired number of children. Women interviewed in the 2008 NDHS were asked how many children they had at the time they first used a contraceptive method. Table 5.7 shows the percent distribution of women by the number of living children at the time of first use of contraception, according to current age. Table 5.7 Number of children at first use of contraception Percent distribution of women age 15-49 by number of living children at the time of first use of contraception, according to current age, Philippines 2008 Number of children at first use of contraception Current age Never used contraception 0 1 2 3 4+ Total Number of women 15-19 93.9 3.2 2.5 0.3 0.0 0.0 100.0 2,749 20-24 63.9 9.6 20.4 5.3 0.8 0.0 100.0 2,147 25-29 35.9 8.3 36.1 13.0 4.2 2.5 100.0 2,106 30-34 27.5 3.8 35.0 17.0 9.0 7.6 100.0 1,865 35-39 27.2 2.7 26.8 18.6 12.6 12.0 100.0 1,777 40-44 27.0 1.8 23.8 18.2 13.4 15.6 100.0 1,532 45-49 32.1 1.9 19.9 17.1 12.6 16.3 100.0 1,418 Total 48.4 4.7 22.4 11.5 6.5 6.5 100.0 13,594 3 11 17 19 22 25 28 33 34 13 7 21 13 15 15 18 16 17 1968 NDS 1973 NDS 1978 RPFS 1983 NDS 1988 NDS 1993 NDS 1998 NDHS 2003 NDHS 2008 NDHS 0 10 20 30 40 50 60 Percent Modern methods Traditional methods Figure 5.2 Trends in Contraceptive Use, Philippines 1968-2008 Survey Family Planning | 59 The results show that 7 percent of women first used contraception when they had three or more children. Only 5 percent of women first used contraception before having any children. Twenty-two percent of women began using contraception after the birth of their first child. Table 5.7 shows that women are using contraception at lower parities (i.e., when they have fewer children). Among women age 25-29, 8 percent first used contraception before having any children and 36 percent used contraception after having their first child. Among older women (age 45-49), only 2 percent used contraception before having any children and 20 percent used contraception after having their first child. 5.5 KNOWLEDGE OF FERTILE PERIOD An elementary knowledge of reproductive physiology provides a useful background for the successful practice of the rhythm method. As shown in Tables 5.1, 5.3 and 5.4, respectively, 71 percent of all women have heard of the rhythm method, 13 percent have used it at some time in the past, and 4 percent are currently using the method. Table 5.8 shows respondents’ knowledge of the time during the menstrual cycle when a woman is most likely to get pregnant. Overall, only 35 percent of women correctly identified the most fertile time in the ovulatory cycle as halfway between two menstrual periods. Among users of the rhythm method, 49 percent were able to correctly identify when during a woman’s cycle she is most likely to get pregnant, although 41 percent incorrectly reported that a woman’s fertile period is right after menstruation has ended. Thirteen percent of non-users did not know about the fertile period, and 39 percent of nonusers said that a woman is most susceptible to pregnancy just after her period has ended. Table 5.8 Knowledge of fertile period Percent distribution of women age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of cycle-related methods, Philippines 2008 Perceived fertile period Users of ovulatory cycle-related methods1 Nonusers of ovulatory cycle-related methods All women Just before menstrual period begins 4.5 5.6 5.6 During menstrual period 0.5 0.8 0.8 Right after menstrual period has ended 41.2 39.3 39.4 Halfway between two menstrual periods 48.5 34.6 35.1 Other 0.0 0.0 0.0 No specific time 3.7 6.5 6.4 Don't know 1.5 13.1 12.6 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women 565 13,029 13,594 1 Includes users of mucus/Billlings/ovulation method, basal body temperature, sympto- thermal, standard days, and rhythm method 60 | Family Planning 5.6 TIMING OF STERILIZATION Nine percent of married women of reproductive age rely on sterilization as their method of contraception. Table 5.9 shows the distribution of sterilized women by age at the time of sterilization. Almost eight in ten women were sterilized before the age of 35. The operation takes place most commonly among women age 30 to 34 (36 percent); another 32 percent were sterilized between the ages of 25 and 29. The median age at sterilization does not vary by current age, indicating there is no strong trend over time. Table 5.9 Timing of sterilization Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according to the number of years since the operation, Philippines 2008 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 3.9 27.3 35.6 24.2 6.9 2.0 100.0 122 31.6 2-3 2.7 24.7 39.4 24.7 8.5 0.0 100.0 127 31.9 4-5 2.6 26.8 37.3 19.7 13.7 0.0 100.0 87 32.2 6-7 7.4 27.3 37.7 22.8 4.9 0.0 100.0 97 31.5 8-9 3.6 25.3 45.6 23.3 2.2 0.0 100.0 79 32.1 10+ 21.8 40.4 32.1 5.7 0.0 0.0 100.0 301 a Total 10.6 31.5 36.3 16.7 4.6 0.3 100.0 813 30.8 a = Not calculated due to censoring 1 Median age at sterilization is calculated for women sterilized before age 40 to avoid problems of censoring 5.7 SOURCE OF SUPPLY OF MODERN CONTRACEPTIVE METHODS Information on where women obtain their contraceptive methods is useful for family planning program managers and implementers of logistic planning. In the 2008 NDHS, women who reported using a modern contraceptive method at the time of the survey were asked where they obtained the method the last time. Because some women may not know in which source category their method falls (e.g., government or private, health center or clinic), interviewers were instructed to note the full name of the source or facility. Supervisors and field editors were told to verify that the name and source type were consistent, asking informants in the clusters for the names of local family planning outlets, if necessary. This practice was designed to improve the accuracy of source reporting. Table 5.10 shows that public (government) facilities provide contraceptive methods to 46 percent of users, while 51 percent obtain their method from private medical sources, and 2 percent obtain their method from other sources (e.g., shops, friends). The most common single source of contraceptive methods in the Philippines is the pharmacy, which supply 40 percent of users of modern methods. Government hospitals supply about one-fifth of users. As expected, government sources supply a large proportion of users of permanent methods, such as female sterilization (73 percent). On the other hand, more than seven in ten women who use the pill obtain it at a private medical source: 72 percent from a pharmacy, and 1 percent from a private hospital or doctor. Most condom users (85 percent) get their supplies from the private medical sector, primarily pharmacies (84 percent); 7 percent get their supplies from the public sector, primarily from barangay health stations (3 percent) and rural/urban health centers (3 percent); and 8 percent obtain their condoms from other private (nonmedical) sources such as stores (6 percent) and friends and relatives (2 percent). Family Planning | 61 Table 5.10 Source of modern contraception methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Philippines 2008 Source Female sterili- zation Pill IUD Injectables Male condom Total Public sector 73.0 22.2 80.8 83.9 6.7 46.2 Government hospital 64.7 0.2 12.1 3.9 0.0 19.8 Rural Health Unit/Urban Health Center 8.2 6.9 37.1 34.2 2.9 12.3 Barangay health station 0.0 13.6 30.1 44.9 3.2 13.2 Barangay supply/Service Point Officer/BHW 0.0 1.2 1.2 0.9 0.6 0.8 Other public 0.0 0.3 0.3 0.0 0.0 0.2 Private medical sector 26.6 74.3 17.3 15.3 84.9 51.1 Private hospital or clinic 25.9 0.9 12.0 8.6 0.4 9.6 Pharmacy 0.0 71.7 0.0 2.5 84.0 39.5 Private doctor 0.6 1.1 4.0 1.7 0.0 1.2 Private nurse/ midwife 0.0 0.4 1.4 2.0 0.0 0.5 Non-governmental organization 0.0 0.1 0.0 0.6 0.0 0.1 Industry-based clinic 0.0 0.1 0.0 0.0 0.5 0.1 Other private 0.2 0.1 0.0 0.0 0.0 0.1 Other private 0.0 3.3 1.6 0.7 8.0 2.4 Puericulture center 0.0 0.0 1.0 0.0 0.0 0.1 Store 0.0 2.7 0.0 0.3 6.2 1.7 Friends/ relatives 0.0 0.7 0.6 0.4 1.8 0.5 Other 0.3 0.0 0.0 0.0 0.4 0.1 Missing 0.1 0.1 0.3 0.0 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 813 1,349 316 222 218 2,927 Note: Total includes other modern methods but excludes lactational amenorrhea method (LAM). Since the 2003 NDHS, there has been a decrease in the use of the public sector for family planning services (from 67 percent in 2003 to 46 percent in 2008) and an increase in the use of the private medical sector (from 29 percent in 2003 and 51 percent in 2008). 5.8 COST OF FAMILY PLANNING METHODS Information on the cost of obtaining contraceptive methods is useful to family planning programs. In the Philippines, to improve accessibility, family planning services provide contraceptive methods free of charge in government health facilities. In the 2008 NDHS, for the first time, women who were using modern methods of contraception were asked how much they paid (in total) the last time they obtained their method, including the cost of the method and any consultation costs they may have paid. Table 5.11 shows the percentage of women who obtained their method free and, for those who paid, the median cost by method and source. These results should be used with caution, however, because of the large proportion of respondents that were unable to report the cost of the contraceptive method they were using. 62 | Family Planning Table 5.11 Cost of modern contraceptive methods Percentage of current users of modern contraceptive methods age 15-49 who did not pay for their method, percentage who did not know the cost of their method, and the median cost of the method, by source of method, Philippines 2008 Source of method/cost Female sterili- zation Pill IUD Injectables Male condom Total Public sector Method free 23.2 28.0 39.6 17.6 * 26.5 Did not know cost 2.2 0.3 0.0 0.0 * 1.3 Median cost (pesos)1 1,476 25 50 100 * 36 Number of women 594 300 256 186 15 1,352 Private medical sector/other Method free 6.9 1.0 8.4 3.7 1.4 2.2 Did not know cost 3.5 0.5 10.4 0.0 22.2 4.2 Median cost (pesos)1 9,929 35 300 (239) 24 35 Number of women 220 1,049 61 36 203 1,575 Total Method free 18.8 7.0 33.6 15.4 2.3 13.4 Did not know cost 2.5 0.5 2.0 0.0 21.9 2.8 Median cost (pesos)1 2,451 34 100 119 24 35 Number of women 813 1,349 316 222 218 2,927 Note: Table excludes lactational amenorrhea method (LAM). Costs are based on the last time current user obtained method. Costs include consultation costs, if any. For condom, costs are per package; for pills, per cycle. For sterilization, figures are based on women sterilized in the five years before the survey. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Median cost among women who reported a cost The median cost is calculated based on users who paid for their method. For example, 23 percent of sterilization users who had their operation in a public facility did not pay for the service and 2 percent did not know how much the operation cost. Therefore, the median cost was based on the remaining 75 percent of women (443 women) who paid for the sterilization operation. Similarly, 7 percent of users who had the operation in a private facility did not pay for the service and 4 percent did not know how much they paid for the operation. Therefore, the median cost was based on the remaining 89 percent of women (196 women) who paid for the sterilization operation. The reason respondents were unable to report the cost of the sterilization services they received is partly due to payment procedures, especially in the private sector where the claims are handled by the service providers. Overall, male condoms are the least expensive contraceptive method (Php 24) and female sterilization is the most expensive (Php 2,451). The cost for contraception varies markedly between public and private sectors. For example, the cost of female sterilization in the public sector is Php 1,476, compared with Php 9,929 in the private sector. While a cycle of pills costs Php 25 in the public sector, it is Php 35 in the private sector. 5.9 INFORMED CHOICE Informed choice is an important tool for monitoring the quality of family planning services. All providers of sterilization must inform potential users that the operation is a permanent, irreversible procedure; potential users also must be informed of alternate contraceptive methods that could be used. Users of temporary methods also should be informed about choices they have and other methods available. Family planning providers should inform all users of the potential side effects of their method Family Planning | 63 and what to do if they experience a problem. This information helps users deal with side effects and decreases unnecessary discontinuation of temporary methods. Table 5.12 presents information on informed choice by type of method and source of method. The results show that 68 percent of current users were informed about the possible side effects or problems associated with their method, 67 percent were informed about what to do if they experienced side effects, and 63 percent were informed of other methods that could be used. It is encouraging to note that 93 percent of users of female sterilization were informed that the method is permanent. Table 5.12 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the five years preceding the survey, percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method and source; and among sterilized women, the percentage who were informed that the method is permanent, by initial source of method, Philippines 2008 Among women who started last episode of modern contraceptive method within the past five years: Among women who were sterilized: Method/source Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Percentage who were informed that sterilization is permanent1 Number of women Method Female sterilization 66.2 58.2 47.4 296 92.5 296 Pill 63.1 64.7 63.3 998 na 0 IUD 80.2 77.0 74.6 164 na 0 Injectables 82.3 79.9 78.0 196 na 0 Initial source of method2 Public sector 76.7 72.5 69.2 899 91.1 222 Government hospital 65.4 57.1 50.8 216 92.3 190 Rural health unit/urban health center 80.1 77.7 71.9 283 (84.4) 32 Barangay health station 80.8 77.7 77.4 373 na 0 Private medical 57.8 60.0 56.3 746 98.1 72 Private hospital or clinic 74.0 68.4 62.5 133 98.9 71 Pharmacy 51.2 56.0 53.5 550 na 0 Private doctor 89.5 83.8 67.7 41 * 1 Other private (46.9) (56.6) (53.0) 28 na 0 Store (46.1) (60.5) (51.1) 26 na 0 Total 67.6 66.6 63.2 1,678 92.5 296 Note: Table excludes users who obtained their method from friends/relatives. Total includes users of other methods, the number of which are too small to show separately. Numbers 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. na = Not applicable 1 Women who were sterilized in the five years preceding the survey 2 Source at start of current episode of use Among the three main sectors providing methods (public, private medical, and other private), the public sector is the most likely to fully inform clients about contraceptive methods. Seventy-seven percent of women who obtained their method from the public sector were informed about the side effects or problems of the method, 73 percent were informed about what to do if they experienced side effects, and seven in ten current users of modern methods were informed of other methods that could be used. 64 | Family Planning Table 5.13 shows data on informed choice by background characteristics. Differences by residence, education, and wealth are minimal in the proportion of women who are informed of side effects or problems with their method, who are informed of what to do if they experience side effects, and who are told of other methods they could use. Modern method users in Bicol are most likely to report having informed choice on all three indicators, while women in SOCCSKSARGEN and CAR are generally the least likely to be informed. The number of women who were sterilized is too small in most cases to draw accurate conclusions about informed knowledge that the operation is permanent. Table 5.13 Informed choice by background characteristics Among current users of modern methods age 15-49 who started the last episode of use within the five years preceding the survey, percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods that could use, by method and source; and among sterilized women, the percentage who were informed that the method is permanent, by background characteristics, Philippines 2008 Among women who started last episode of modern contraceptive method within five years preceding the survey: Among women who were sterilized Background characteristic Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Percentage who were informed that sterilization is permanent1 Number of women Residence Urban 67.9 67.4 63.0 856 91.5 164 Rural 67.4 65.7 63.4 822 93.8 132 Region National Capital Region 66.3 64.3 60.5 228 (96.7) 39 Cordillera Admin Region 51.8 53.6 54.8 34 * 8 I - Ilocos 75.1 73.1 56.7 94 * 19 II - Cagayan Valley 68.0 66.1 61.6 77 * 8 III - Central Luzon 61.7 58.9 53.2 175 (89.9) 48 IVA - CALABARZON 71.6 74.0 60.9 208 (89.1) 48 IVB - MIMAROPA 57.6 66.9 70.0 60 * 8 V - Bicol 76.2 85.2 75.8 69 * 7 VI - Western Visayas 64.7 60.9 73.3 130 * 13 VII - Central Visayas 69.1 61.7 69.1 118 * 16 VIII - Eastern Visayas 76.2 68.6 78.1 54 * 10 IX - Zamboanga Peninsula 69.3 62.5 66.5 61 * 5 X - Northern Mindanao 73.4 72.7 68.7 83 * 8 XI - Davao 72.6 68.4 64.8 120 (88.2) 21 XII - SOCCSKSARGEN 51.8 56.4 51.7 92 (95.9) 20 XIII - Caraga 75.2 74.1 69.7 48 * 9 ARMM (69.7) (72.5) (49.5) 27 * 7 Education No education * * * 6 * 2 Elementary 67.0 66.5 62.5 306 92.1 58 High school 64.9 64.7 61.2 817 93.3 130 College 72.2 69.2 66.8 548 91.7 107 Wealth quintile Lowest 64.1 67.3 65.0 315 (90.0) 38 Second 65.2 65.5 60.9 390 94.8 69 Middle 70.8 69.0 62.7 345 93.7 61 Fourth 69.7 66.3 67.1 340 91.7 62 Highest 68.6 64.5 60.2 288 91.4 65 Total 67.6 66.6 63.2 1,678 92.5 296 Note: Table excludes users who obtained their method from friends/relatives. Numbers in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure based on fewer than 25 unweighted cases and has been suppressed. 1 Among women who were sterilized in the five years preceding the survey Family Planning | 65 5.10 INTENTIONS FOR FAMILY PLANNING USE AMONG NONUSERS An important indicator of changing demand for family planning is the extent to which nonusers of contraception plan to use family planning in the future. Currently married women who were not using contraception at the time of the survey were asked about their intention to use family planning in the future. The results are presented in Table 5.14. Table 5.14 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Philippines 2008 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 33.6 50.5 48.9 41.0 34.0 41.9 Unsure 9.6 5.5 4.5 3.7 3.0 4.7 Does not intend to use 56.9 44.0 46.1 55.2 62.6 53.1 Missing 0.0 0.0 0.5 0.1 0.5 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 447 981 831 652 1,236 4,147 1 Includes current pregnancy Among currently married women who are not using contraception, 42 percent reported that they intend to use a family planning method in the future, 53 percent said that they do not intend to use a method in the future, and 5 percent are unsure of their future intention. There are differences in the percentage of women who intend to use family planning according to number of living children. The proportion of women who intend to use family planning is highest (51 percent) among nonusers with one child, declines to 41 percent among women with three children, and declines to 34 percent among women who have four or more children. An understanding of the reasons women give for not using family planning methods is critical to designing programs that will improve the quality of services. Table 5.15 shows the percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by the main reason for not intending to use. Half of women do not intend to use contraception in the future because of fertility-related reasons. Most of these women (16 percent) want as many children as possible. Nine percent of women do not intend to use because of opposition to use, either because their husband or partner is opposed or because they themselves are opposed. Thirty-nine percent of women cited method-related reasons for nonuse, the most important of these being health concerns (21 percent). 66 | Family Planning Table 5.15 Reason for not intending to use contraception in the future Percent distribution of currently married women age 15-49 who are not using contraception and who do not intend to use in the future by main reason for not intending to use, Philippines 2008 Age Reason 15-29 30-49 Total Fertility-related reason Infrequent sex/no sex 4.5 11.0 9.8 Menopausal/had hysterectomy 0.0 18.1 14.8 Subfecund/infecund 3.2 11.2 9.8 Wants as many children as possible 18.6 14.8 15.5 Opposition to use Respondent opposed 1.9 3.0 2.8 Husband/partner opposed 7.5 2.3 3.2 Others opposed 0.2 0.0 0.1 Religious prohibition 3.6 2.7 2.9 Lack of knowledge Knows no method 0.9 0.3 0.4 Knows no source 0.6 0.1 0.2 Method-related reason Health concerns 26.5 19.6 20.9 Fear of side effects 23.3 11.8 13.9 Lack of access/too far 1.5 0.2 0.4 Costs too much 3.5 1.9 2.2 Inconvenient to use 1.9 1.1 1.2 Interfere with body's normal process 0.1 0.7 0.6 Other 0.5 0.6 0.6 Don't know 1.4 0.4 0.6 Missing 0.3 0.1 0.2 Total 100.0 100.0 100.0 Number of women 397 1,805 2,202 Women age 15-29 are most likely to cite method-related reasons (57 percent), with health concerns being the primary reason (27 percent). Twenty-six percent of young women mentioned fertility-related reasons—primarily that they want as many children as possible (19 percent)—as the main reason for nonuse in the future. On the other hand, 55 percent of women age 30-49 cited fertility- related reasons for nonuse in the future, with 18 percent reporting themselves as menopausal or having had a hysterectomy. Thirty-five percent of women in this age group cited method-related reasons, primarily health concerns (20 percent), as the main reason for nonuse in the future. Overall, these results suggest that there is substantial scope for family planning programs to increase contraceptive use by providing advocacy and high-quality services. Improved information and education activities will play an important role in dispelling fears and misconceptions about specific contraceptive methods and contra- ceptive use in general. Future demand for specific methods of family planning can be assessed by asking nonusers who intend to use in the future which methods they prefer to use. Table 5.16 provides information on currently married women’s preferences of contraceptive methods for Table 5.16 Preferred method of contraception for future use Percent distribution of currently married women age 15-49 who are not using a contraceptive method but who intend to use in the future by preferred method, Philippines 2008 Method Percent distribution Female sterilization 9.4 Pill 51.5 IUD 7.5 Injectables 11.3 Implants 0.1 Condom 3.9 Patch 0.2 Mucus/ Billings/ ovulation 0.3 Standard days 0.1 Herbal medicine 1.0 Lactation amenorrhea 0.1 Calendar rhythm method 6.2 Withdrawal 4.6 Other 0.5 Unsure 3.4 Total 100.0 Number of women 1,738 Family Planning | 67 use in the future. However, the information should be interpreted with caution because two conditions are implied: intention to use and method preferred if intention is followed. Most currently married women would prefer to use pills (52 percent) and injectables (11 percent) in the future. About 9 percent of women mentioned female sterilization as a potential future method, and 8 percent mentioned the IUD. There has been little change in method preference over the past five years. Results from the 2003 NDHS indicate that 48 percent of currently married women who were not using contraception reported that they intended to use the pill in the future and 10 percent said they intended to use injectables. 5.11 FAMILY PLANNING MESSAGES IN THE MASS MEDIA The media can be a major source of family planning messages. Information about exposure to family planning messages through specific types of media allows policymakers to ensure the use of the most effective means of communication for targeting subgroups of the population. To assess the effectiveness of electronic and print sources on the dissemination of family planning information, respondents in the 2008 NDHS were asked if they had heard or seen family planning messages on the radio or television, or read a family planning message in a newspaper, magazine, poster, leaflet, or brochure in the months leading up to the survey. The results are shown in Table 5.17. Media messages about family planning are largely accessed through television and radio with less access through the print media. For example, 76 percent of women had recently heard about family planning on television and 48 percent had recently heard about family planning on the radio. By contrast, only 30 percent of women got such information from newspapers or magazines. About one in five women were not exposed to family planning messages through any of the three media in the months preceding the survey. There are substantial differences in exposure to family planning messages by background characteristics. Women in rural areas are less exposed to family planning messages through television and print media than women in urban areas, although the two groups are equally exposed to family planning messages on the radio (48 percent each). Educational attainment and wealth quintile are both associated with improved access to family planning messages in the media. For example, only 13 percent of women with primary education were exposed to a family planning message in a newspaper or magazine, compared with 26 percent of women who attended high school, and 48 percent of those who attended college. In addition, the proportion of women exposed to family planning messages on television increases steadily from 36 percent among women in the lowest wealth quintile to 88 percent among those in the highest wealth quintile. Exposure to family planning messages through the media is highest in Ilocos Region, National Capital Region, and Cagayan Valley. Less than half of women in ARMM were exposed to a message on family planning through any of the three types of media. 68 | Family Planning Table 5.17 Exposure to family planning messages Percentage of women age 15-49 who heard or saw a family planning message on the radio or television or in a newspaper, magazine, or poster in the past few months, according to background characteristics, Philippines 2008 Background characteristic Radio Television Newspaper/ magazine/ poster None of these three media sources Number Age 15-19 40.2 71.8 26.1 23.6 2,749 20-24 46.6 79.3 31.0 16.8 2,147 25-29 50.3 78.8 33.6 15.5 2,106 30-34 50.7 77.6 31.5 16.9 1,865 35-39 50.4 74.8 29.9 17.9 1,777 40-44 51.0 74.3 29.9 19.1 1,532 45-49 55.4 75.1 31.9 19.0 1,418 Residence Urban 48.4 83.1 36.0 13.7 7,574 Rural 48.3 66.8 23.1 24.9 6,020 Region National Capital Region 46.4 87.8 39.8 10.0 2,522 Cordillera Admin Region 46.6 54.3 23.1 34.4 225 I - Ilocos 56.4 87.1 39.6 9.8 613 II - Cagayan Valley 63.4 79.3 28.1 13.5 382 III - Central Luzon 47.7 83.3 34.6 14.1 1,486 IVA - CALABARZON 46.4 81.8 29.9 16.0 1,808 IVB - MIMAROPA 55.4 65.9 36.6 22.5 340 V - Bicol 55.6 75.2 27.2 17.2 755 VI - Western Visayas 51.7 76.8 29.0 15.8 976 VII - Central Visayas 55.2 78.1 30.5 15.5 983 VIII - Eastern Visayas 50.9 70.1 29.0 20.0 488 IX - Zamboanga Peninsula 48.2 60.6 21.4 30.1 505 X - Northern Mindanao 38.7 60.3 21.9 29.8 585 XI - Davao 44.3 66.6 24.0 25.8 618 XII - SOCCSKSARGEN 57.2 68.8 21.1 20.2 480 XIII - Caraga 42.1 65.6 23.8 25.6 312 ARMM 20.4 33.0 8.2 62.4 516 Education No education 21.1 14.4 0.0 71.3 167 Elementary 39.8 53.8 12.7 36.5 2,653 High school 47.9 77.4 26.1 17.4 6,352 College 55.1 89.3 48.1 7.7 4,422 Wealth quintile Lowest 38.6 35.9 11.8 48.3 2,160 Second 48.5 73.2 22.7 19.7 2,419 Middle 49.9 82.0 27.9 14.4 2,661 Fourth 53.6 88.3 37.7 9.8 2,937 Highest 48.6 87.6 42.9 10.2 3,417 Total 15-49 48.3 75.9 30.3 18.6 13,594 5.12 CONTACT BETWEEN NONUSERS AND FAMILY PLANNING/HEALTH SERVICE PROVIDERS In the 2008 NDHS, women who were not using any family planning method were asked whether they had been visited by a health worker who talked to them about family planning in the 12 months preceding the survey. This information is useful for determining whether nonusers of family planning are being reached by family planning outreach programs. Nonusers were also asked if they had visited a health facility in the preceding 12 months for any reason and, if so, whether any health worker at the facility spoke to them about family planning. These questions can assess the level of so-called “missed opportunities” to inform women about contraception. The findings are presented in Table 5.18. Family Planning | 69 Table 5.18 Contact of nonusers with family planning providers Among women age 15-49 who are not using contraception, the percentage who during the past 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who neither discussed family planning with a fieldworker nor at a health facility, by background characteristics, Philippines 2008 Percentage of women who visited a health facility in the past 12 months and who: Background characteristic Percentage of women who were visited by fieldworker who discussed family planning Discussed family planning Did not discuss family planning Percentage of women who neither discussed family planning with fieldworker nor at a health facility Number of women Age 15-19 4.6 3.5 12.7 92.6 2,663 20-24 8.4 13.1 18.9 82.4 1,647 25-29 12.9 20.8 23.2 73.2 1,279 30-34 12.7 19.1 22.6 75.6 945 35-39 13.7 18.2 20.4 75.2 889 40-44 13.4 14.0 23.3 79.1 778 45-49 11.4 10.4 22.4 83.4 977 Residence Urban 8.5 9.5 17.6 85.2 5,182 Rural 11.1 15.9 20.8 79.0 3,996 Region National Capital Region 7.9 8.6 12.1 86.1 1,741 Cordillera Admin Region 10.8 12.8 19.0 83.1 146 I - Ilocos 8.0 10.6 20.7 86.2 385 II - Cagayan Valley 9.4 18.9 13.9 78.6 231 III - Central Luzon 9.7 11.2 24.1 84.5 935 IVA - CALABARZON 7.6 8.4 14.5 87.2 1,287 IVB - MIMAROPA 13.2 14.6 28.2 79.2 210 V - Bicol 7.8 13.7 28.7 82.7 563 VI - Western Visayas 15.9 18.2 18.0 72.9 647 VII - Central Visayas 8.6 16.9 26.8 78.7 636 VIII - Eastern Visayas 8.9 12.0 28.3 83.3 325 IX - Zamboanga Peninsula 14.8 16.4 17.2 75.5 362 X - Northern Mindanao 12.4 15.4 26.9 77.7 385 XI - Davao 8.6 19.3 17.9 77.5 368 XII - SOCCSKSARGEN 12.3 12.5 21.8 79.7 291 XIII - Caraga 18.0 22.9 23.5 67.0 200 ARMM 5.8 3.9 8.2 91.8 465 Education No education 12.7 8.3 13.2 83.1 142 Elementary 12.6 14.2 19.1 78.7 1,714 High school 10.1 12.8 17.5 82.0 4,310 College 7.2 10.7 21.3 85.3 3,011 Wealth quintile Lowest 14.0 18.2 18.7 74.5 1,475 Second 14.1 15.9 21.8 76.9 1,518 Middle 10.3 13.9 18.8 81.1 1,707 Fourth 7.1 9.6 19.0 86.3 1,933 Highest 5.9 7.6 17.6 88.6 2,544 Total 9.6 12.3 19.0 82.5 9,177 Among women who were not using family planning, 10 percent were visited by a community health worker and discussed family planning and 12 percent went to a health facility and discussed family planning. However, the majority of women (83 percent) neither discussed family planning at home with a fieldworker nor at a health facility with staff. The extent of missed opportunities does not vary much by background characteristics, except for region. The percentage of women who neither discussed family planning with a fieldworker nor with staff at a health facility ranges from 67 percent in Caraga to 92 percent in ARMM. 70 | Family Planning 5.13 HUSBAND’S KNOWLEDGE OF WIFE’S USE OF CONTRACEPTION Concealing the use of contraception from a spouse/partner is an indication of absence of com- munication or disagreement on use of family planning. To shed light on the extent of communication among married couples on the use of contraception, married women who were using contraception at the time of the survey were asked whether their husband knew of their use. Almost all users (99 percent) reported that their husband knows about their use of contraception (Table 5.19), and there was no substantial variation by background characteristics. Table 5.19 Husband's knowledge of wife’s use of contraception Percent distribution of currently married women age 15-49 who are using a contraceptive method by whether their husband knows about their use of contraception, according to background characteristics, Philippines 2008 Husband’s knowledge of wife’s use of contraception Background characteristic Knows1 Does not know Unsure/ missing Total Number of women Age 15-19 100.0 0.0 0.0 100.0 73 20-24 98.3 1.3 0.4 100.0 463 25-29 98.6 0.4 1.0 100.0 801 30-34 98.7 0.9 0.4 100.0 906 35-39 98.8 0.7 0.5 100.0 868 40-44 99.0 0.6 0.4 100.0 728 45-49 98.5 1.1 0.4 100.0 431 Residence Urban 99.1 0.8 0.1 100.0 2,292 Rural 98.3 0.7 1.0 100.0 1,978 Region National Capital Region 98.6 1.2 0.2 100.0 727 Cordillera Admin Region 100.0 0.0 0.0 100.0 79 I - Ilocos 99.2 0.8 0.0 100.0 225 II - Cagayan Valley 98.5 0.0 1.5 100.0 148 III - Central Luzon 98.8 0.9 0.2 100.0 518 IVA - CALABARZON 96.8 0.5 2.7 100.0 510 IVB - MIMAROPA 98.6 0.9 0.5 100.0 129 V - Bicol 99.0 1.0 0.0 100.0 185 VI - Western Visayas 100.0 0.0 0.0 100.0 326 VII - Central Visayas 98.8 0.9 0.3 100.0 334 VIII - Eastern Visayas 100.0 0.0 0.0 100.0 160 IX - Zamboanga Peninsula 100.0 0.0 0.0 100.0 139 X - Northern Mindanao 98.2 0.9 0.9 100.0 198 XI - Davao 99.2 0.4 0.4 100.0 244 XII - SOCCSKSARGEN 99.2 0.8 0.0 100.0 187 XIII - Caraga 100.0 0.0 0.0 100.0 110 ARMM 93.1 6.9 0.0 100.0 51 Education No education (96.2) (3.8) (0.0) 100.0 25 Elementary 98.3 1.1 0.7 100.0 922 High school 98.7 0.9 0.4 100.0 1,983 College 99.1 0.2 0.6 100.0 1,341 Wealth quintile Lowest 98.7 0.9 0.4 100.0 677 Second 98.4 1.0 0.6 100.0 887 Middle 98.6 0.7 0.7 100.0 938 Fourth 98.8 0.8 0.4 100.0 954 Highest 99.2 0.4 0.5 100.0 814 Total 98.7 0.8 0.5 100.0 4,270 Note: Numbers in parentheses are based on 25-49 unweighted cases. 1 Includes women who reported use of male sterilization, male condoms, or withdrawal. Other Proximate Determinants of Fertility | 71 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6 The 2008 National Demographic and Health Survey (NDHS) included information on the proximate determinants of fertility or the intermediate factors. Factors that affect a woman’s risk of becoming pregnant, other than contraception, that are discussed in this chapter are the onset of menstruation (age at menarche); nuptiality and sexual intercourse; postpartum amenorrhea and postpartum abstinence from sexual relations; breastfeeding; and menopause. 6.1 CURRENT MARITAL STATUS Marriage is a primary indication of the regular exposure of women to the risk of pregnancy and therefore is important for the understanding of fertility. Populations in which age at first marriage is low tend to have early childbearing and high fertility. Table 6.1 shows the percent distribution of women by marital status, according to age. The term “married” refers to legal or formal marriage, while “living together” designates an informal union in which a man and a woman live together, even if a formal civil or religious ceremony has not occurred. In later tables that do not list “living together” as a separate category, these women are included in the “currently married” group. Respondents who are currently married, widowed, divorced, or separated are referred to as “ever married.” Table 6.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Philippines 2008 Marital status Age Never married Married Living together Separated Divorced Widowed Total Percentage of women currently in union Number of women 15-19 88.8 2.9 7.4 0.9 0.0 0.0 100.0 10.3 2,749 20-24 50.9 26.8 19.8 2.3 0.1 0.2 100.0 46.6 2,147 25-29 22.5 58.3 15.7 3.1 0.0 0.3 100.0 74.1 2,106 30-34 12.2 73.4 11.0 2.5 0.0 0.9 100.0 84.4 1,865 35-39 7.4 76.9 8.7 4.3 0.2 2.5 100.0 85.6 1,777 40-44 6.2 77.3 7.5 4.8 0.1 4.1 100.0 84.7 1,532 45-49 5.0 76.6 6.7 5.3 0.1 6.4 100.0 83.3 1,418 Total 15-49 33.3 50.7 11.2 3.0 0.1 1.7 100.0 61.9 13,594 Overall, one in three women age 15-49 has never been married, about half are currently married, 11 percent are living together with a partner, 3 percent are separated, and 2 percent are widowed or divorced. Table 6.1 shows that the proportion of women who never married decreases sharply as age increases, from 89 percent among teenagers, to 51 percent among women in their early twenties and to 23 percent among women in their late twenties. The proportion of women who remain single through their forties is about 5 percent. Sixty-two percent of women age 15-49 are married or living with a partner. Only 10 percent of women under 20 are currently in a union, compared with nearly half of women age 20-24 and 74 percent of women age 25-29. The highest proportion of women currently married or living with a partner is in age group 35-39 (86 percent). The small decline in the proportion currently married among women in their forties is due to increases in the proportions who are separated or widowed. 72 | Other Proximate Determinants of Fertility 6.2 AGE AT FIRST MENSTRUATION The onset of menstruation is a biological factor influenced by the woman’s general health and nutritional state. On average, the age at menarche among Filipino women is 13.2 years (Table 6.2). The data reveal that younger women tend to begin menstruation at an earlier age than older women. For instance, the mean age at menarche for women age 15-19 is 12.8 years, while for women age 45-49, it is 13.7 years. Table 6.2 Age at menarche Percent distribution of women by age at first menstruation (menarche), according to current age, Philippines 2008 Age at menarche Current age ≤10 11 12 13 14 15 + Total Mean 15-19 2.5 9.0 31.3 29.0 19.1 9.2 100.0 12.8 20-24 2.9 8.9 28.2 27.3 17.9 14.9 100.0 13.0 25-29 2.4 8.6 26.0 26.5 19.1 17.5 100.0 13.2 30-34 3.0 7.5 23.0 24.5 22.4 19.6 100.0 13.3 35-39 2.0 7.6 22.1 22.5 22.4 23.3 100.0 13.4 40-44 2.5 6.2 24.8 21.1 19.1 26.3 100.0 13.5 45-49 1.4 6.0 20.9 20.6 20.4 30.7 100.0 13.7 Total 2.4 7.9 25.8 25.1 19.9 18.8 100.0 13.2 One in ten women experienced her first menstruation (menarche) before age 12, while more than half of women had menarche at age 12 or 13, and less than one in five began menstruating at age 15 or older. The earlier age at menarche among younger women can be seen in the generally larger proportions of younger women experiencing menarche at each age up to age 13. For instance, 31 percent of women age 15-19 had their first menstruation at age 12, compared with only 21 percent of women age 45-49. In contrast, only 9 percent of teenagers had their first menstruation at age 15 or older, compared with three in ten women age 45-49. 6.3 AGE AT FIRST MARRIAGE Most births in the Philippines occur within marriage. Hence, the age at legal or consensual marriage marks the start of women’s exposure to childbearing. Table 6.3 shows the percentage of women who are married by exact age and the median age at first marriage, according to their age at the time of the survey. Table 6.3 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Philippines 2008 Percentage first married by exact age: Current age 15 18 20 22 25 Percentage never married Number Median age at first marriage 15-19 1.5 na na na na 88.8 2,749 a 20-24 2.1 14.2 30.7 na na 50.9 2,147 a 25-29 2.2 15.0 32.0 49.5 67.5 22.5 2,106 22.1 30-34 2.1 15.5 31.0 47.6 67.5 12.2 1,865 22.3 35-39 2.7 18.1 34.0 48.9 66.6 7.4 1,777 22.2 40-44 2.5 15.5 31.7 49.3 67.8 6.2 1,532 22.1 45-49 3.0 18.2 33.8 49.7 67.3 5.0 1,418 22.1 20-49 2.4 15.9 32.1 na na 19.3 10,845 a 25-49 2.5 16.4 32.4 49.0 67.3 11.5 8,698 22.2 Note: The age at first marriage is defined as the age at which the respondent began living with her first husband/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group Other Proximate Determinants of Fertility | 73 Overall, one in six women age 25-49 was married by age 18, while about half of women married by age 22, and nearly seven in ten were married by age 25. The results in Table 6.3 suggest that younger women are delaying entry into marital union, For example, only 14 percent of women age 20-24 were married by age 18, compared with 18 percent of women age 45-49. Table 6.4 shows the median age at first marriage for women age 25-49 by background characteristics. Because of the late age at marriage in the Philippines, data for women age 15-24 have been omitted. Table 6.4 Median age at first marriage Median age at first marriage among women age 25-49 by five-year age groups, according to background characteristics, Philippines 2008 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 23.0 23.0 23.4 23.1 23.7 23.2 Rural 20.9 21.4 20.9 21.2 20.6 21.0 Region National Capital Region 23.9 23.6 23.5 23.8 24.1 23.7 Cordillera Admin Region 21.2 21.7 21.3 20.9 20.1 21.0 I - Ilocos 22.1 22.2 23.3 23.3 22.9 22.7 II - Cagayan Valley 20.7 21.7 21.5 21.8 20.3 21.1 III - Central Luzon 22.9 22.1 21.7 24.1 21.7 22.4 IVA - CALABARZON 22.2 23.1 23.9 22.6 22.5 22.9 IVB - MIMAROPA 20.3 19.7 20.7 20.4 20.4 20.3 V - Bicol 21.2 21.8 20.7 21.1 22.4 21.4 VI - Western Visayas 23.0 22.9 22.9 21.6 22.9 22.7 VII - Central Visayas 21.9 22.3 21.7 21.9 21.7 21.9 VIII - Eastern Visayas 22.2 21.1 22.2 20.7 22.4 21.7 IX - Zamboanga Peninsula 21.6 22.7 20.9 21.7 20.9 21.7 X - Northern Mindanao 21.6 21.9 21.4 22.1 21.4 21.6 XI - Davao 21.0 21.5 22.2 20.9 20.7 21.2 XII - SOCCSKSARGEN 20.3 20.7 19.8 21.1 20.6 20.6 XIII - Caraga 21.0 20.7 21.1 21.1 21.4 21.0 ARMM 19.4 19.6 19.9 19.9 20.4 19.8 Education No education * * (17.5) (18.3) 19.9 18.4 Elementary 19.6 19.6 19.6 20.0 19.9 19.7 High school 20.9 21.2 21.6 21.1 21.4 21.2 College a 24.9 25.5 25.6 25.0 a Wealth quintile Lowest 19.4 19.7 19.9 20.1 20.3 19.8 Second 20.7 21.0 20.6 21.1 20.6 20.8 Middle 21.6 21.9 21.5 21.6 20.9 21.5 Fourth 23.9 23.5 23.4 22.7 22.9 23.3 Highest a 25.2 24.8 24.9 24.8 a Total 22.1 22.3 22.2 22.1 22.1 22.2 Note: The age at first marriage is defined as the age at which the respondent began living with her first husband/partner. Numbers 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. a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group 74 | Other Proximate Determinants of Fertility In general, urban, better-educated, and wealthier women marry later than other women. Women in urban areas marry two years later than their rural counterparts (23.2 and 21.0 years, respectively). There is positive association between education and age at first marriage. Women who completed high school marry three years later than women with no education (21.2 and 18.4 years, respectively). The differentials are even greater by wealth status. For example, among women age 30-34, the median age at first marriage ranges from just under 20 among those in the lowest quintile to over 25 among those in the highest quintile. The median age at first marriage also varies by geographic areas. The lowest median age at marriage is 19.8 years in the Autonomous Region in Muslim Mindanao (ARMM) and the highest is 23.7 years in the National Capital Region (NCR). The median age at first marriage is below the national level in all regions except NCR, Ilocos, Central Luzon, CALABARZON, and Western Visayas regions. 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. Women interviewed in the NDHS were asked how old they were when they had sexual intercourse for the first time (if ever). Table 6.5 shows results that are similar to those in Table 6.3 on age at first marriage, implying that most women wait until marriage to have sexual intercourse. For example, among women age 25-49, the median age at first sexual intercourse is 21.5 years, only slightly lower than the median age at first marriage of 22.2 years. Table 6.5 shows that among women age 25-49, 3 percent had their first sexual intercourse by age 15, 37 percent by age 20, 54 percent by age 22 and 71 percent by age 25. Differences in these proportions by current age of women are small. Table 6.5 Age at first sexual intercourse Percentage of women age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had intercourse, and median age at first intercourse, according to current age, Philippines 2008 Percentage who had first sexual intercourse by exact age: Current age 15 18 20 22 25 Percentage who never had intercourse Number Median age at first intercourse 15-19 2.1 na na na na 86.4 2,749 a 20-24 2.1 17.1 37.8 na na 43.7 2,147 a 25-29 2.1 17.3 37.3 55.6 73.5 16.9 2,106 21.3 30-34 2.2 17.6 35.3 51.8 70.7 8.9 1,865 21.8 35-39 3.1 20.5 38.2 53.3 69.8 5.8 1,777 21.5 40-44 2.7 18.0 36.7 53.9 71.0 5.3 1,532 21.5 45-49 2.9 20.3 38.5 52.6 70.3 4.0 1,418 21.6 20-49 2.5 18.3 37.3 na na 15.7 10,845 a 25-49 2.6 18.6 37.2 53.5 71.2 8.8 8,698 21.5 na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reaching the beginning of the age group Table 6.6 presents differentials in median age at first sexual intercourse by women’s background characteristics. The results show patterns similar to those for median age at first marriage, with higher age at first sexual intercourse among women in urban areas, women with college education, and women in households in the highest wealth quintile. Regions that reported a median age at first sexual intercourse higher than the national median are NCR, CALABARZON, Ilocos, Central Luzon, and Western Visayas. Other Proximate Determinants of Fertility | 75 Table 6.6 Median age at first sexual intercourse Median age at first sexual intercourse among women age 25-49 by five-year age groups, according to background characteristics, Philippines 2008 Age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 21.9 22.4 22.6 22.1 23.1 22.3 Rural 20.6 20.9 20.4 20.8 20.4 20.6 Region National Capital Region 22.7 22.3 22.5 22.5 23.7 22.6 Cordillera Admin Region 21.0 21.5 20.6 20.4 19.9 20.7 I - Ilocos 21.1 21.6 22.8 22.9 22.7 22.3 II - Cagayan Valley 20.8 20.9 21.4 21.1 20.3 20.9 III - Central Luzon 21.5 22.3 21.2 23.2 21.7 21.9 IVA - CALABARZON 21.6 23.0 23.3 22.3 22.4 22.5 IVB - MIMAROPA 20.0 19.7 21.3 20.1 19.9 20.0 V - Bicol 21.4 21.6 20.4 21.2 21.9 21.3 VI - Western Visayas 22.3 22.5 22.2 21.2 22.7 22.1 VII - Central Visayas 20.7 21.6 20.2 20.7 21.2 20.8 VIII - Eastern Visayas 22.0 20.9 21.4 20.8 21.2 21.2 IX - Zamboanga Peninsula 20.7 21.8 20.5 20.9 19.9 20.9 X - Northern Mindanao 20.5 20.8 20.9 21.4 20.8 20.8 XI - Davao 20.2 20.8 20.1 20.5 20.5 20.5 XII - SOCCSKSARGEN 19.9 19.6 19.8 20.3 20.3 20.0 XIII - Caraga 20.5 20.5 20.6 20.2 20.5 20.5 ARMM 19.4 19.8 20.0 20.2 20.0 19.9 Education No education * * (17.4) (18.2) 19.6 18.2 Elementary 19.0 19.2 19.0 19.5 19.4 19.2 High school 20.4 20.6 21.0 20.8 21.1 20.7 College 23.9 24.3 25.2 24.8 24.6 24.5 Wealth quintile Lowest 19.0 19.4 19.4 19.8 19.7 19.4 Second 20.1 20.4 20.0 20.5 20.2 20.2 Middle 21.1 21.4 21.2 21.3 20.5 21.1 Fourth 22.8 22.8 23.1 21.6 22.5 22.6 Highest 24.0 23.8 24.0 24.4 24.3 24.1 Total 21.3 21.8 21.5 21.5 21.6 21.5 Note: Numbers 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. a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching the beginning of the age group. 6.5 RECENT SEXUAL ACTIVITY Information on the frequency of intercourse is important for refining the measures of exposure to pregnancy. The 2008 NDHS collected information on respondents’ recent sexual activity to derive an indicator of the extent to which women abstain from sexual intercourse as a result of factors such as a recent birth or temporary separation from their husband. Each woman interviewed was asked when she last had sexual intercourse, her relationship to the person with whom she last had sexual intercourse, and how long she had sexual relations with this person. Table 6.7 presents information on the timing of last sexual intercourse, according to selected background characteristics. Overall, 47 percent of women age 15-49 reported having sexual intercourse in the four weeks preceding the survey, while 15 percent had sexual intercourse in the period 1 to 11 months preceding the survey, 8 percent did not have sexual intercourse in the past year, and 30 percent have never had sexual intercourse. 76 | Other Proximate Determinants of Fertility Table 6.7 Recent sexual activity Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Philippines 2008 Timing of last sexual intercourse Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Never had sexual intercourse Total Number of women Age 15-19 8.1 4.5 1.0 0.0 86.4 100.0 2,749 20-24 39.6 11.7 5.1 0.0 43.7 100.0 2,147 25-29 57.5 17.6 7.7 0.3 16.9 100.0 2,106 30-34 65.7 17.0 8.1 0.3 8.9 100.0 1,865 35-39 65.7 17.3 10.8 0.3 5.8 100.0 1,777 40-44 64.0 19.0 11.5 0.2 5.3 100.0 1,532 45-49 55.6 21.7 18.5 0.2 4.0 100.0 1,418 Marital status Never married 2.1 3.0 4.9 0.0 90.0 100.0 4,530 Married or living together 75.2 20.3 4.2 0.3 0.0 100.0 8,418 Divorced/separated/widowed 3.1 18.5 78.2 0.1 0.0 100.0 646 Marital duration2 0-4 years 73.5 23.5 2.7 0.3 0.0 100.0 1,773 5-9 years 78.3 17.4 4.1 0.2 0.0 100.0 1,722 10-14 years 79.0 16.4 4.3 0.3 0.0 100.0 1,410 15-19 years 76.0 20.3 3.3 0.4 0.0 100.0 1,160 20-24 years 73.8 20.9 5.1 0.3 0.0 100.0 988 25+ years 66.0 25.5 8.4 0.1 0.0 100.0 711 Married more than once 74.6 21.3 4.1 0.0 0.0 100.0 655 Residence Urban 42.7 14.4 9.3 0.2 33.4 100.0 7,574 Rural 53.4 14.6 6.2 0.2 25.7 100.0 6,020 Region National Capital Region 39.2 15.5 9.5 0.2 35.7 100.0 2,522 Cordillera Admin Region 51.1 12.8 6.9 0.2 29.0 100.0 225 I - Ilocos 49.8 16.3 6.3 0.0 27.5 100.0 613 II - Cagayan Valley 59.2 10.8 6.5 0.4 23.2 100.0 382 III - Central Luzon 45.3 15.7 9.5 0.1 29.4 100.0 1,486 IVA - CALABARZON 44.6 14.5 9.2 0.1 31.6 100.0 1,808 IVB - MIMAROPA 56.6 14.4 6.0 0.2 22.9 100.0 340 V - Bicol 43.9 16.6 8.3 0.3 31.0 100.0 755 VI - Western Visayas 45.6 17.6 6.7 0.2 29.8 100.0 976 VII - Central Visayas 49.4 12.1 7.4 0.0 31.1 100.0 983 VIII - Eastern Visayas 53.8 15.0 6.2 0.8 24.2 100.0 488 IX - Zamboanga Peninsula 46.3 17.3 7.4 0.4 28.6 100.0 505 X - Northern Mindanao 51.8 12.0 7.8 0.2 28.3 100.0 585 XI - Davao 53.8 12.6 7.3 0.4 26.0 100.0 618 XII - SOCCSKSARGEN 60.2 9.6 5.3 0.0 24.8 100.0 480 XIII - Caraga 55.4 14.8 6.7 0.2 22.9 100.0 312 ARMM 55.1 9.1 5.2 0.0 30.6 100.0 516 Education No education 58.8 15.8 14.1 0.5 10.7 100.0 167 Elementary 59.6 16.4 8.0 0.2 15.9 100.0 2,653 High school 44.9 14.0 7.0 0.1 34.0 100.0 6,352 College 43.3 14.0 9.0 0.2 33.5 100.0 4,422 Wealth quintile Lowest 60.7 15.7 5.4 0.2 18.1 100.0 2,160 Second 53.9 15.3 6.4 0.2 24.2 100.0 2,419 Middle 50.5 14.2 7.4 0.2 27.6 100.0 2,661 Fourth 44.9 14.2 7.8 0.2 32.9 100.0 2,937 Highest 34.2 13.6 11.1 0.2 40.9 100.0 3,417 Total 47.4 14.5 7.9 0.2 30.0 100.0 13,594 1 Excludes women who had sexual intercourse within the past 4 weeks 2 Excludes women who are not currently married Other Proximate Determinants of Fertility | 77 There are large differences in recent sexual activity by age of women. For example, almost nine in ten women age 15-19 have never had sex. This proportion 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 sexual intercourse in the past four weeks (66 percent). As expected, women who are married or living in a marital union are more likely to have had sexual intercourse in the past four weeks (75 percent) than women who have never married (2 percent) or who are divorced, separated, or widowed (3 percent). Among women who never married, 10 percent reported having had sexual intercourse, although half (5 percent) said their last sexual intercourse was one or more years ago. Among women in their first marriage, those who have been in union for 5 to 14 years are more likely to have had sexual relations in the past four weeks than those who have been married for longer or shorter durations. Women in urban areas are less likely to have had sexual intercourse in the past four weeks than women in rural areas (43 and 53 percent, respectively). Similarly, women in more urbanized regions are less likely to have been sexually active within the past four weeks than those in other regions. NCR has the lowest proportion of women who were sexually active in the four weeks before the survey while SOCCSKSARGEN has the highest proportion (39 and 60 percent, respectively). The likelihood that a woman was sexually active in the recent past is negatively associated with her education. While 59 percent of women with no education were sexually active in the past four weeks, the corresponding proportions for women with high school and college education are 45 and 43 percent, respectively. Women with high school or higher education are more likely than other women to have never had sexual intercourse, partly because they marry later than women with less education. Similarly, women in households in the poorest wealth quintile are more likely to have engaged in sexual intercourse in the four weeks preceding the survey than women in households in the highest wealth quintile (61 and 34 percent, respectively). About two in five women age 15-49 in the highest quintile have never had sexual intercourse, compared with less than one in five women in the lowest quintile. 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 or delays the resumption of sexual intercourse. Postpartum amenorrhea refers to the interval between childbirth and the return of menstruation. The length and intensity of breastfeeding influence the duration of amenorrhea, which offers protection from conception. Postpartum abstinence refers to the period between childbirth and the time when a woman resumes sexual activity. Women are considered to be insusceptible to pregnancy if they are not exposed to the risk of conception either because their menstrual period has not resumed since a birth or because they are abstaining from intercourse after childbirth. Table 6.8 shows the percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible by the number of months since birth. The results are grouped in two-month intervals to minimize fluctuations in the estimates. 78 | Other Proximate Determinants of Fertility 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 2008 Percentage of births for which the mother is: Months since birth Amenorrheic Abstaining Insusceptible1 Number of births < 2 92.6 92.4 97.9 144 2-3 63.0 44.6 73.0 233 4-5 49.9 21.6 57.0 203 6-7 37.2 11.2 43.3 206 8-9 24.1 6.5 26.4 228 10-11 17.9 10.5 26.5 217 12-13 16.8 6.7 21.2 229 14-15 7.8 7.1 13.2 230 16-17 7.0 6.0 11.3 203 18-19 1.9 5.9 7.8 184 20-21 1.7 6.7 8.4 231 22-23 1.7 3.6 5.3 239 24-25 2.3 6.0 8.3 209 26-27 0.9 2.1 2.7 225 28-29 0.5 5.3 5.7 174 30-31 0.0 2.8 2.8 183 32-33 0.0 3.5 3.5 217 34-35 0.9 4.7 5.6 248 Total 16.9 12.4 22.1 3,802 Median 4.6 2.4 5.5 na Mean 6.8 5.2 8.7 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstain- ing (or both) following birth Overall, 17 percent of women who gave birth in the three years preceding the survey are amenorrheic, 12 percent are abstaining, and 22 percent are insusceptible to pregnancy. Women are amenorrheic for a median of 4.6 months and abstaining for a median of 2.4 months, resulting in a median period of insusceptibility of 5.5 months. These figures are slightly lower than those found in the 2003 NDHS. The results in Table 6.8 show that for births less than two months of age, 93 percent of women are amenorrheic, 92 percent are abstaining, and 98 percent are insusceptible. These proportions decrease sharply for the period 2-3 months after birth and decline steadily thereafter. The percentage of women abstaining is less than the percentage who are amenorrheic up to the period 16-17 months after birth; thereafter, the pattern reverses. Table 6.9 shows differences in the median duration of postpartum amenorrhea, abstinence and insusceptibility according to background characteristics. While the period of postpartum abstinence does not vary by the woman’s age, the median duration of postpartum amenorrhea for women age 30-49 is almost two months longer than that for women age 15-29 (5.7 and 3.9 months, respectively). Conse- quently, the period of insusceptibility is longer for women age 30-49 than women age 15-29. Other Proximate Determinants of Fertility | 79 Table 6.9 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Philippines 2008 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility Number of births Mother's age 15-29 3.9 2.4 4.9 2,206 30-49 5.7 2.4 6.3 1,595 Residence Urban 3.8 2.4 5.0 1,862 Rural 5.4 2.5 6.1 1,940 Region National Capital Region 3.4 2.4 4.7 528 Cordillera Admin Region 6.8 3.0 8.0 59 I - Ilocos 6.5 3.2 6.5 180 II - Cagayan Valley 8.6 2.0 8.6 130 III - Central Luzon 3.6 3.2 4.7 388 IVA - CALABARZON 3.4 2.7 4.9 495 IVB - MIMAROPA 6.1 2.4 6.9 127 V - Bicol 7.2 4.1 7.8 255 VI - Western Visayas 6.0 2.1 6.6 267 VII - Central Visayas 7.0 2.3 7.6 266 VIII - Eastern Visayas 5.2 2.5 6.4 177 IX - Zamboanga Peninsula 4.2 2.3 5.5 158 X - Northern Mindanao 4.8 2.9 5.2 158 XI - Davao 4.4 2.2 4.7 176 XII - SOCCSKSARGEN 5.1 2.2 6.8 144 XIII - Caraga 5.3 0.8 5.8 112 ARMM 3.2 2.1 3.9 184 Education No education 7.5 2.1 8.2 56 Elementary 6.7 2.2 7.3 897 High school 4.6 2.6 5.6 1,863 College 3.5 2.5 4.1 986 Wealth quintile Lowest 7.2 2.2 7.7 973 Second 4.9 2.5 5.6 876 Middle 4.7 3.1 5.3 728 Fourth 2.5 2.4 3.8 698 Highest 2.9 2.4 4.4 526 Total 4.6 2.4 5.5 3,802 Note: Medians are based on the status at the time of the survey (current status). 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Women in urban areas are insusceptible to pregnancy for about one month less than women in rural areas because of a slightly shorter duration of amenorrhea. There are large differentials in the duration of postpartum insusceptibility across regions, from less than five months in NCR, Central Luzon, CALABARZON, Davao, and ARMM, to eight or more months in CAR and Cagayan Valley. These differences are largely due to variations in postpartum amenorrhea. Women in ARMM have the shortest duration of postpartum amenorrhea (3.2 months), while women in Cagayan Valley have the longest (8.6 months). During the postpartum period, better-educated women are more susceptible to the risk of pregnancy than women with less education because they have a shorter duration of amenorrhea (3.5 and 80 | Other Proximate Determinants of Fertility 7.5 months, respectively). With respect to economic status, the duration of postpartum insusceptibility is longest among women in households in the poorest wealth quintile (7.7 months) and shortest for women in households in the highest wealth quintile (4.4 months). This is attributable to longer durations of postpartum amenorrhea among women in the poorest households (7.2 months) compared with women in the wealthiest households (2.9 months). The longer women breastfeed their babies, the longer the duration of amenorrhea. This relation- ship is substantiated by the findings presented in Table 6.10. Women who breastfed their babies for less than two months have a median duration of post- partum amenorrhea of 2.6 months, whereas the median duration for women who breastfed for two months or longer is 5.4 months. In general, older women have longer dura- tions of postpartum amenorrhea than younger women. For example, women age 45-49 who breast- fed two months or more, the median duration of amenorrhea is 7.5 months, compared with 5.0 to 5.7 months for women age 15-29. 6.7 MENOPAUSE The termination of a woman’s fecundity is signified by menopause, that is, the cessation of the menstrual period. Women are considered menopausal if they are neither pregnant nor postpartum amenorrheic and have not had a menstrual period in the six months preceding the survey. Table 6.11 shows the percentage of women age 30-49 who are menopausal. The proportion of women who are considered meno- pausal increases with age, from 1 percent among women age 30-34 to about 5 percent among women age 42-43; the propor- tion menopausal increases to 35 percent among women age 48-49. Table 6.10 Median duration of postpartum amenorrhea by breastfeeding duration Median duration of postpartum amenorrhea among women whose most recent birth took place 12 to 60 months preceding the survey and whose child is living, according to selected breastfeeding durations and age, Philippines 2008 Median duration of postpartum amenorrhea among women who: Age Breastfed less than 2 months Number of children Breastfed 2 months or more Number of children 15-19 * 13 5.7 65 20-24 2.5 107 5.0 413 25-29 2.5 197 5.3 679 30-34 2.5 177 5.7 562 35-39 2.8 112 5.5 450 40-44 2.8 66 5.6 213 45-49 * 20 7.5 80 Total 2.6 693 5.4 2,461 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 6.11 Menopause Percentage of women age 30-49 who are menopausal, by age, Philippines 2008 Age Percentage menopausal Number of women 30-34 1.3 1,865 35-39 1.6 1,777 40-41 1.5 621 42-43 4.5 637 44-45 8.4 580 46-47 16.3 562 48-49 35.1 551 Total 6.4 6,592 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey Fertility Preferences | 81 FERTILITY PREFERENCES 7 Updating differentials in fertility preferences is fundamentally important for population policy and for refining and modifying existing family planning programs. In recognition of the right of couples to decide their own family size, the Philippine Family Planning Program (PFPP) regularly monitors the following six key fertility preferences indicators: 1) desire for additional children; 2) desire to limit childbearing; 3) need and demand for family planning; 4) ideal number of children; 5) fertility planning status (wanted and unwanted fertility); and 6) couples’ consensus on family size. This chapter updates these indicators with data collected from the 2008 National Demographic and Health Survey (NDHS) using the same series of questions asked in previous NDHS surveys to ascertain women’s fertility preferences. 7.1 DESIRE FOR MORE CHILDREN Desire for additional children among currently married women age 15-49 is determined by asking whether or not they want to have another child and, if so, how soon. 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 they are carrying. Table 7.1 shows the percent distribution of currently married women by desire for another child, according to the number of living children. Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Philippines 2008 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total Have another soon2 74.8 19.0 8.0 4.5 2.1 2.1 1.1 11.6 Have another later3 13.0 50.5 22.3 8.6 5.7 3.1 1.9 19.1 Have another, undecided when 2.8 2.3 0.7 0.7 0.4 0.2 0.3 1.0 Undecided 1.4 5.8 5.9 4.2 3.2 3.5 2.3 4.4 Want no more 3.3 20.8 57.0 63.0 71.4 74.3 82.2 53.5 Sterilized4 0.0 0.6 5.3 18.0 16.3 15.6 10.5 9.2 Declared infecund 4.7 1.0 0.8 1.0 1.0 1.2 1.6 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 494 1,750 1,874 1,644 1,027 690 938 8,418 1 The number of living children includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization More than three in five currently married women in the Philippines want to limit childbearing: 54 percent say they want no more children, and an additional 9 percent have been sterilized (Figure 7.1). These figures indicate that since the 2003 NDHS there has been a small increase in the proportion of women who want no more children (from 51 to 54 percent) and a small decrease in the proportion who have been sterilized (from 11 to 9 percent). Thirty-two percent of married women want to have a child at some time in the future, but most do not want a child soon. Only 12 percent of women want a child within two years, 19 percent would prefer to wait two or more years, and 1 percent are undecided on the timing. Thus, the vast majority of married women want either to space their next birth or to limit childbearing altogether. 82 | Fertility Preferences The proportion of women who want to stop childbearing increases rapidly with the number of living children, from 21 percent among women with one child to 62 percent among women with two children, to 81 percent among women with three children, and to around 90 percent among those with four or more children (Figure 7.2). In contrast, the proportion of women who want to have another child decreases with the number of living children. These patterns are similar to those observed in the 2003 NDHS. Figure 7.1 Fertility Preferences among Currently Married Women Age 15-49 Want another soon 11% Want another later 19% Undecided 4% Declared infecund 1% Want another, undecided when 1% NDHS 2008 Want no more 54% Sterilized 9% 3 21 62 81 88 90 93 0 1 2 3 4 5 6+ 0 20 40 60 80 100 Percent Figure 7.2 Percentage of Currently Married Women Who Want No More Children, by Number of Children Note: Includes women who are sterilized NDHS 2008 Number of children Fertility Preferences | 83 Table 7.2 shows the percent distribution of currently married women by their desire for more children, according to age. As expected, the proportion of women who want no more children, or are sterilized, increases with age; 19 percent of women age 15-19 want no more children, compared with 87 percent of women age 45-49. The proportion of women who want to delay the next birth for two or more years is highest among women age 15-19 (50 percent) then decreases to less than 1 percent among women age 45-49. The proportion of women who want the next birth within two years is also highest among women age 15-19 (17 percent) and lowest among women age 45-49 (5 percent). The proportion of women who said they were unable to have any more children (infecund) is less than 1 percent among women under age 40, but rises to 7 percent among women age 45-49. Table 7.2 Fertility preferences by age Percent distribution of currently married women age 15-49 by desire for children, according to age, Philippines 2008 Age Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon1 17.0 12.4 12.9 14.8 12.3 9.2 5.0 11.6 Have another later2 50.3 49.9 34.8 18.3 7.1 1.6 0.1 19.1 Have another, undecided when 3.3 1.7 0.9 1.4 0.7 0.6 0.5 1.0 Undecided 10.0 7.6 5.2 5.2 3.9 2.3 1.1 4.4 Want no more 19.4 27.7 43.0 51.6 63.0 68.3 71.3 53.5 Sterilized3 0.0 0.5 3.1 8.5 12.6 16.7 15.4 9.2 Declared infecund 0.0 0.1 0.2 0.2 0.4 1.3 6.5 1.2 Missing 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 283 1,000 1,560 1,573 1,522 1,299 1,181 8,418 1 Wants next birth within 2 years 2 Wants to delay next birth for 2 or more years 3 Includes both female and male sterilization 7.2 DESIRE TO LIMIT CHILDBEARING BY BACKGROUND CHARACTERISTICS The proportion of women who want no more children (63 percent) is an important and easily understood measure of fertility preference. Table 7.3 shows the percentage of currently married women who want to stop childbearing by number of living children and background characteristics. Overall, about the same proportion of women in urban areas as in rural areas want to limit childbearing (62 and 63 percent, respectively) (Figure 7.3). However, as seen in the 2003 NDHS, when the number of living children is considered, the proportion of women who want to limit childbearing is consistently higher in urban areas than in rural areas. For example, among women who have two living children, 65 percent in urban areas, compared with 59 percent in rural areas, want to limit childbearing. However, because women in rural areas already have more children than women in urban areas (see Chapter 4) the overall proportions are similar for urban and rural areas. The desire to limit childbearing varies substantially among the administrative regions. For example, respondents in Western Visayas Region (71 percent) and Bicol Region (70 percent) are about twice as likely to want to stop childbearing as their counterparts in ARMM (37 percent). ARMM is the only region in which less than half of currently married women want to limit childbearing. This pattern is seen particularly among women with two living children; only 13 percent of married women with two children in ARMM want no more children, compared with over 50 percent in the other regions—except Cordillera Administrative Region (44 percent) and Eastern Visayas (49 percent). 84 | Fertility Preferences Table 7.3 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Philippines 2008 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ Total Residence Urban 3.5 23.9 65.4 84.0 91.0 91.5 95.6 62.4 Rural 2.9 18.1 58.5 77.5 84.6 88.4 91.3 63.0 Region National Capital Region 2.3 23.3 67.9 83.7 94.1 94.9 (98.0) 62.0 Cordillera Admin Region * 8.3 44.3 78.6 (95.7) (89.0) (96.1) 60.6 I - Ilocos (6.6) 19.0 57.0 89.1 88.3 (78.3) (90.3) 61.0 II - Cagayan Valley * 10.1 70.4 80.4 (95.6) (93.3) (96.9) 66.7 III - Central Luzon (4.4) 12.6 59.1 84.7 94.3 98.3 97.1 62.2 IVA - CALABARZON 1.6 21.9 64.6 85.6 86.5 94.8 95.2 60.8 IVB - MIMAROPA * 16.9 61.6 71.0 (79.2) (89.2) 94.2 63.2 V - Bicol * 19.1 63.1 77.7 96.6 89.0 95.8 69.7 VI - Western Visayas * 27.0 75.5 88.6 90.3 (95.1) 98.3 71.2 VII - Central Visayas (0.0) 29.7 71.0 88.3 89.1 (97.9) 91.1 67.0 VIII - Eastern Visayas * 20.3 49.4 74.1 86.0 (85.5) 86.8 61.1 IX - Zamboanga Peninsula * 19.3 56.7 75.0 77.3 (82.9) 89.4 58.4 X - Northern Mindanao (4.3) 26.5 55.8 80.8 91.7 (86.5) 91.1 63.6 XI - Davao * 28.8 64.5 74.8 85.6 (90.3) 96.2 63.8 XII - SOCCSKSARGEN * 21.8 62.4 78.2 93.2 (92.2) 85.6 65.4 XIII - Caraga * 25.3 62.0 76.5 87.6 (90.3) 98.3 67.2 ARMM (6.5) 9.9 13.2 23.8 41.0 53.0 78.6 37.2 Education No education * * * * (48.5) (75.4) 82.2 60.1 Elementary 1.6 27.3 57.3 78.4 84.2 87.7 92.1 72.2 High school 2.9 20.2 62.2 80.8 90.4 92.2 94.9 62.0 College 4.3 20.9 65.1 84.0 90.6 90.2 94.3 56.2 Wealth quintile Lowest 2.0 16.8 49.8 67.9 78.9 84.1 89.9 63.5 Second 1.0 22.8 59.3 80.3 89.0 88.9 93.0 66.0 Middle 0.0 20.2 65.0 84.3 88.6 92.7 96.6 64.5 Fourth 4.4 21.2 63.7 84.8 93.1 93.8 93.2 60.1 Highest 5.8 24.1 69.3 84.5 91.5 (93.4) (100.0) 59.2 Total 3.3 21.4 62.3 81.0 87.6 89.8 92.7 62.7 Note: Women who have been sterilized are considered to want no more children. Numbers 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 The number of living children includes the current pregnancy. There are differences in women’s fertility preferences by level of education. The desire to limit childbearing generally decreases with increasing education, starting with elementary. However, among women with no education, the proportion wanting no more children is lower than the proportions for women with elementary or high school education. Examining the relationship between fertility desire and educational attainment by number of living children shows a positive relationship between education and desire for no more children among women who have two or three children. There are small differences in the desire to limit childbearing by household wealth status, with the proportion wanting to limit childbearing generally decreasing with increasing wealth quintile (except for the lowest wealth quintile). However, among women with two children, the desire to stop childbearing increases with increasing wealth quintile (except for the fourth quintile). Fertility Preferences | 85 7.3 NEED FOR FAMILY PLANNING SERVICES The proportion of women who want to stop childbearing or who want to space their next birth is a crude measure of the extent of the need for family planning, given that not all of these women are exposed to the risk of pregnancy and some of them may already be using contraception. Measures of unmet need for family planning are used to evaluate the extent to which programs are meeting the demand for services. Unmet need is defined as the percentage of currently married, fecund 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. 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. Women who have been sterilized are considered to want no more children. Women who are currently using family planning are said to have a met need for family planning. The total demand for family planning services comprises those who fall in the met need and unmet need categories. Overall, 22 percent of currently married women in the Philippines have an unmet need for family planning services, 9 percent for spacing and 13 percent for limiting births (Table 7.4). The level of unmet need has increased by more than one-third since the 2003 NDHS (17 percent) (Figure 7.4). The increase in unmet need appears to reflect the impact of the withdrawal of the USAID commodities supply and/or an increase in demand for family planning. 63 62 63 60 72 62 56 64 66 65 60 59 Total Urban Rural No edu- cation Ele- men- tary High school College Lowest Second Middle Fourth Highest 0 20 40 60 80 Percent Figure 7.3 Percentage of Currently Married Women Who Want No More Children by Background Characteristics NDHS 2008 Residence Education Wealth quintile 86 | Fertility Preferences Table 7.4 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for family planning that is satisfied, by background characteristics, Philippines 2008 Unmet need for family planning1 Met need for family planning (currently using) 2 Total demand for family planning 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 30.5 5.3 35.8 19.5 6.4 25.9 50.0 11.8 61.7 42.0 283 20-24 19.3 5.3 24.6 32.7 13.6 46.3 52.0 18.9 70.9 65.3 1,000 25-29 14.4 11.4 25.8 26.1 25.2 51.3 40.6 36.6 77.2 66.5 1,560 30-34 8.4 12.0 20.4 17.4 40.1 57.6 25.9 52.1 78.0 73.8 1,573 35-39 5.6 17.2 22.8 8.0 49.0 57.0 13.6 66.2 79.8 71.4 1,522 40-44 1.7 17.8 19.5 3.4 52.7 56.1 5.0 70.5 75.6 74.2 1,299 45-49 0.8 16.8 17.6 0.5 36.0 36.5 1.3 52.9 54.2 67.4 1,181 Residence Urban 7.9 13.2 21.1 15.7 37.7 53.4 23.6 50.9 74.4 71.7 4,297 Rural 10.1 13.6 23.7 13.7 34.3 48.0 23.7 47.9 71.7 67.0 4,121 Region National Capital Region 7.1 13.6 20.7 16.3 37.8 54.1 23.4 51.4 74.8 72.3 1,343 Cordillera Admin Region 6.8 9.7 16.5 15.0 39.9 54.9 21.8 49.6 71.4 76.9 143 I - Ilocos 7.6 11.0 18.7 16.0 38.2 54.2 23.7 49.2 72.9 74.4 415 II - Cagayan Valley 6.7 13.1 19.8 14.1 40.1 54.3 20.9 53.2 74.1 73.3 273 III - Central Luzon 7.1 10.5 17.6 18.3 39.5 57.8 25.4 50.0 75.4 76.6 897 IVA - CALABARZON 9.2 14.4 23.6 15.9 31.0 46.8 25.1 45.4 70.5 66.5 1,089 IVB - MIMAROPA 9.6 12.3 21.9 17.8 35.7 53.6 27.4 48.0 75.4 71.0 241 V - Bicol 10.2 22.0 32.2 9.4 30.0 39.4 19.6 52.0 71.6 55.0 470 VI - Western Visayas 6.3 17.6 23.9 11.7 40.2 51.9 18.0 57.8 75.8 68.4 627 VII - Central Visayas 10.1 11.4 21.5 12.2 43.5 55.7 22.3 54.9 77.2 72.2 599 VIII - Eastern Visayas 13.6 14.0 27.6 13.5 34.0 47.5 27.1 48.0 75.1 63.2 337 IX - Zamboanga Peninsula 12.1 15.3 27.4 15.0 28.8 43.8 27.1 44.1 71.2 61.5 316 X - Northern Mindanao 7.7 11.0 18.7 16.5 36.8 53.2 24.2 47.7 71.9 74.0 373 XI - Davao 5.1 9.7 14.8 17.5 42.7 60.2 22.5 52.4 75.0 80.3 406 XII - SOCCSKSARGEN 9.8 12.0 21.8 14.5 40.6 55.1 24.3 52.7 77.0 71.7 338 XIII - Caraga 10.5 15.5 26.1 11.3 40.4 51.7 21.9 55.9 77.8 66.5 212 ARMM 22.2 10.6 32.7 6.4 8.8 15.1 28.6 19.3 47.9 31.6 337 Education No education 11.4 17.2 28.6 5.3 13.2 18.5 16.6 30.5 47.1 39.3 133 Elementary 8.2 16.4 24.5 7.9 37.4 45.3 16.1 53.8 69.9 64.9 2,034 High school 9.3 13.1 22.4 16.2 37.0 53.2 25.5 50.1 75.6 70.4 3,727 College 9.0 11.2 20.2 18.4 34.7 53.1 27.4 45.9 73.3 72.5 2,524 Wealth quintile Lowest 11.9 16.3 28.2 11.8 29.0 40.8 23.7 45.3 69.0 59.1 1,661 Second 8.9 13.7 22.7 14.0 38.7 52.7 22.9 52.4 75.4 69.9 1,683 Middle 7.8 13.2 21.0 14.9 39.1 54.0 22.7 52.3 75.0 72.0 1,737 Fourth 8.9 10.6 19.5 17.7 38.0 55.8 26.6 48.6 75.3 74.1 1,710 Highest 7.3 13.2 20.5 14.9 35.2 50.0 22.2 48.4 70.5 70.9 1,627 Total 9.0 13.4 22.3 14.7 36.0 50.7 23.6 49.4 73.1 69.4 8,418 1 Unmet need for spacing: includes women who are fecund and not using family planning and who say they want to wait two or more years for their next birth, or who say they are unsure whether they want another child, or who want another child but are unsure when to have the child. In addition, unmet need for spacing includes pregnant women whose current pregnancy was mistimed, or whose last pregnancy was unwanted but who now say they want more children. Unmet need for spacing also includes amenorrheic women whose last birth was mistimed, or whose last birth was unwanted but who now say they want more children. Unmet need for limiting: includes women who are fecund and not using family planning and who say they do not want another child. In addition, unmet need for limiting includes pregnant women whose current pregnancy was unwanted but who now say they do not want more children or who are undecided whether they want another child. Unmet need for limiting also includes amenorrheic women whose last birth was unwanted but who now say they do not want more children or who are undecided whether they want another child. 2 Using for spacing refers to women who are using a method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting refers to women who are using a method of family planning and who want no more children. Fertility Preferences | 87 The total demand for family planning in the Philippines is 73 percent, an increase from 69 percent in 2003. Sixty-nine percent of family planning demand is satisfied, a reduction from 75 percent in the preceding survey. If all unmet need were satisfied, a contraceptive prevalence rate of about 69 percent could theoretically be expected. Unmet need for family planning decreases with age, from 36 percent among women age 15-19 to 18 percent among women age 45-49. It is slightly higher in the rural areas (24 percent) than in the urban areas (21 percent). Among the regions, unmet need is highest in ARMM (33 percent), followed by Bicol (32 percent), Eastern Visayas (28 percent) and Zamboanga Peninsula (27 percent). It is lowest in Davao Peninsula (15 percent) and Cordillera Administrative Region (17 percent). Unmet need decreases steadily with increasing education and increasing wealth status, except for the highest wealth quintile. Compared with the 2003 NDHS, unmet need has increased across almost all categories of age, residence, region, educational group, and wealth quintile. As expected, met need (i.e., the level of current contraceptive use) for limiting is almost twice that for spacing. Met need is higher for spacing among young women and for limiting among older women. The higher level of met need for limiting than for spacing persists for residence, region, education, and wealth index. Total demand for family planning is also associated with age and peaks at 78 to 80 percent among women age 30-39. Differentials in total demand by residence, region, and wealth quintile are minimal, except for the low levels among women in ARMM region (48 percent) and women with no education (47 percent). Similar patterns are observed in the percentage of demand satisfied. It is notable that the percentage of demand satisfied is much lower for currently married women age 15-19 than for older women. This suggests that young women are less well served by family planning programs than older women. It is slightly lower in rural areas than in urban areas. The percentage of demand satisfied is lowest in ARMM and highest in Davao. It increases with educational level and wealth quintile, except for the highest quintile. 8 9 9 13 2003 2008 0 5 10 15 20 25 30 Percent Spacing Limiting Figure 7.4 Trends in Unmet Need for Family Planning NDHS 2008 17 22 88 | Fertility Preferences 7.4 IDEAL NUMBER OF CHILDREN In order to assess ideal family size, the 2008 NDHS asked women who did not have any living children, “If you could choose exactly the number of children to have in your whole life, how many would that be?” For respondents who had living children, the question was rephrased as follows, “If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Although these questions are based on hypothetical situations, they provide two measures. First, for women who have not yet started childbearing, the data provide an idea of future fertility. Second, for older and high parity women, the excess of past fertility over the ideal family size provides a measure of unwanted fertility. Table 7.5 shows that 42 percent of women consider a two-child family to be ideal, while 28 percent prefer three children, 14 percent prefer four children, and 8 percent prefer five or more children. Among women who have two or fewer children, around half think two children are ideal. Table 7.5 Ideal number of children Percent distribution of women age 15-49 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 2008 Number of living children1 Ideal number of children 0 1 2 3 4 5 6+ Total 0 2.2 0.2 0.4 0.2 0.4 0.7 0.6 1.0 1 7.0 11.5 3.3 3.2 2.0 1.2 1.4 5.5 2 55.6 51.1 48.1 21.5 25.1 15.5 11.3 41.5 3 23.5 26.9 29.7 47.1 16.5 34.5 28.8 28.4 4 7.9 7.5 12.6 17.8 42.3 17.3 22.9 14.2 5 1.6 1.3 3.8 5.8 5.8 20.5 9.9 4.4 6+ 1.0 1.0 1.8 3.9 7.0 9.8 21.8 4.0 Non-numeric response 1.3 0.4 0.3 0.4 0.9 0.6 3.3 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 4,878 2,092 2,024 1,758 1,107 740 995 13,594 Mean ideal number children for:2 All women 2.4 2.4 2.7 3.2 3.5 3.8 4.3 2.8 Number 4,815 2,082 2,019 1,750 1,097 736 963 13,462 Currently married women 2.5 2.4 2.7 3.2 3.5 3.8 4.3 3.1 Number 491 1,744 1,869 1,639 1,018 686 906 8,353 1 The number of living children includes current pregnancy. 2 Means are calculated for women who gave numeric responses. The mean ideal family size in the Philippines is 2.8 children for all women and 3.1 children for currently married women. The ideal family size has declined slowly but steadily, from a mean of 3.2 children for all women in 1998 to 3.0 in 2003 and to 2.8 in 2008. The ideal number of children increases with the actual number of living children that a woman has, from an average ideal family size of 2.4 for women with no children to 4.3 for women with six or more children. This increase may be due to the fact that women who want more children actually end up having more. It may also be due to women adjusting their ideal number of children as additional children are born (rationalization). Nevertheless, at higher parities, there is evidence of surplus or unwanted fertility. For example, among women with six or more children, 75 percent reported that their ideal number of children is less than six. Fertility Preferences | 89 Table 7.6 presents information on the mean ideal number of children for all women age 15-49 by age group, according to background characteristics. The mean ideal number of children for all women increases with age, from 2.4 children among women age 15-19 to 3.3 children among women age 40-49. Ideal family size is slightly higher in rural areas than urban areas, and it is inversely related to education and household wealth. There are notable variations by region. The mean ideal number of children is highest in ARMM (5.1 children) and lowest in the National Capital Region and CALABARZON (2.6 children). Table 7.6 Mean ideal number of children Mean ideal number of children for all women age 15-49 by background characteristics, Philippines 2008 Age Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 2.3 2.5 2.5 2.8 3.0 3.1 3.1 2.7 Rural 2.5 2.6 2.9 3.3 3.4 3.6 3.6 3.1 Region National Capital Region 2.3 2.3 2.4 2.7 2.9 2.9 3.0 2.6 Cordillera Admin Region 2.6 2.6 3.0 3.2 3.4 4.1 3.7 3.1 I - Ilocos 2.2 2.4 2.5 3.0 3.1 3.0 3.3 2.7 II - Cagayan Valley 2.2 2.3 2.7 2.8 3.2 3.2 3.3 2.8 III - Central Luzon 2.3 2.6 2.7 2.9 3.2 3.1 3.3 2.8 IVA - CALABARZON 2.3 2.4 2.5 2.8 2.8 3.1 3.0 2.6 IVB - MIMAROPA 2.5 2.5 2.9 3.1 3.5 3.8 3.7 3.0 V - Bicol 2.5 2.5 2.7 3.0 3.0 3.2 3.1 2.8 VI - Western Visayas 2.3 2.5 2.5 2.8 2.9 3.4 3.1 2.8 VII - Central Visayas 2.2 2.5 2.7 3.0 2.9 3.5 3.1 2.7 VIII - Eastern Visayas 2.5 2.7 2.9 3.3 3.4 3.5 3.5 3.1 IX - Zamboanga Peninsula 2.3 2.7 2.6 3.1 3.3 3.4 3.5 2.9 X - Northern Mindanao 2.4 2.4 2.7 3.3 3.6 3.2 3.0 2.9 XI - Davao 2.2 2.5 2.5 2.9 2.8 3.2 3.6 2.7 XII - SOCCSKSARGEN 2.3 2.6 2.9 3.2 3.4 3.4 4.0 3.0 XIII - Caraga 2.5 2.5 2.7 3.0 3.6 3.2 3.5 3.0 ARMM 3.8 4.3 4.8 5.3 6.2 6.1 6.7 5.1 Education No education * * * * (5.4) (5.5) 5.8 5.0 Elementary 2.5 2.9 3.1 3.5 3.6 3.6 3.6 3.3 High school 2.4 2.5 2.6 2.9 3.1 3.3 3.2 2.7 College 2.3 2.5 2.5 2.8 2.9 3.0 2.9 2.7 Wealth quintile Lowest 2.7 2.9 3.2 3.8 3.8 4.1 4.2 3.5 Second 2.5 2.6 2.8 3.1 3.4 3.4 3.6 3.0 Middle 2.3 2.5 2.5 2.8 3.1 3.3 3.1 2.8 Fourth 2.3 2.4 2.6 2.9 3.0 3.1 3.2 2.7 Highest 2.3 2.4 2.4 2.7 2.7 2.9 2.9 2.6 Total 2.4 2.5 2.7 3.0 3.2 3.3 3.3 2.8 Note: Numbers 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. Means are calculated for women who gave numeric responses. 7.5 WANTED AND UNWANTED FERTILITY There are two ways of estimating levels of unwanted fertility from the NDHS data. One is based on women’s responses to a question as to whether each birth in the five years preceding the survey was planned (wanted then), mistimed (wanted but at a later time), or unwanted (wanted no more children). These data are likely to result in underestimates of unplanned childbearing because women may rationalize unplanned births and declare them to be planned once the children are born. Another way of measuring unwanted fertility uses information on ideal family size to calculate what the total fertility rate would be if all unwanted births were avoided. This measure may also suffer from underestimation, to the 90 | Fertility Preferences extent that women are unwilling to report an ideal family size lower than their actual family size. Estimates of unwanted fertility using both of these approaches are presented below. Interviewers asked women a series of questions regarding each child born in the five years preceding the survey and any current pregnancy to determine whether each birth or current pregnancy was wanted then, wanted later, or unwanted. These results provide a powerful indicator of the degree to which couples successfully control fertility. The data can be used to gauge the effect of preventing unwanted births on fertility rates. Table 7.7 shows the percent distribution of births in the five years preceding the survey by whether the birth was wanted by the mother then, wanted later, or not wanted at all, according to birth order and age of mother at birth. Table 7.7 Fertility planning status Percent distribution of births to women age 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother's age at birth, Philippines 2008 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 78.2 16.9 4.5 0.4 100.0 2,103 2 64.6 28.5 6.5 0.4 100.0 1,595 3 59.5 22.1 18.1 0.3 100.0 1,165 4+ 49.2 16.2 33.7 0.9 100.0 2,202 Mother's age at birth <20 69.2 24.1 6.5 0.2 100.0 723 20-24 65.0 26.7 7.9 0.4 100.0 1,921 25-29 65.0 20.2 14.3 0.5 100.0 1,939 30-34 62.1 15.9 21.3 0.6 100.0 1,345 35-39 56.2 12.8 30.2 0.8 100.0 801 40-44 46.8 8.6 44.0 0.6 100.0 310 45-49 (49.9) (2.9) (36.9) (10.3) 100.0 25 Total 63.0 20.2 16.3 0.5 100.0 7,065 Note: Figures in parentheses are based on 25-49 unweighted cases. Results show that only 63 percent of births in the Philippines are planned, while 20 percent are mistimed, and 16 percent are unwanted. The proportion of births that are unwanted increases with birth order. For example, over one-third of fourth and higher births are unwanted, compared with only 5 percent of first births. In contrast, the percentage of mistimed births decreases with birth order 2 or higher. A similar pattern is observed for the mother’s age at birth: the proportion of births reported to be unwanted increases with age because older women have larger families and younger women have not yet achieved their desired family size. Only 8 percent of births to mothers age 20-24 are unwanted, compared with more than 30 percent of births to mothers age 35 or older. The percentage of mistimed births declines with age, excluding the youngest age group. Figure 7.5 shows that there has been improvement in fertility planning over the past five years. The proportion of births that were wanted at the time they occurred increased from 55 to 63 percent, while the proportion wanted at a later time declined from 24 to 20 percent, and the proportion of births that were unwanted declined from 20 to 16 percent. Fertility Preferences | 91 The impact of unwanted fertility can be measured by comparing the total wanted fertility rate (TWFR) with the total fertility rate (TFR). The total wanted fertility rate represents the level of fertility that theoretically would result if all unwanted births were prevented. A comparison of the TFR with the total wanted fertility indicates the potential demographic impact of the elimination of all unwanted births. The total wanted fertility rates presented in Table 7.8 are calculated in the same manner as the total fertility rate (TFR), but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those that exceed the number considered ideal by the respondent. Women who did not report a numeric ideal family size were assumed to want all of their births. Overall, the total wanted fertility rate for the Philippines is 2.4 children, 27 percent lower than the actual total fertility rate of 3.3 children. This implies that if all unwanted births could be eliminated, the TFR would drop to 2.4 children per woman, close to the “replacement” level of 2.1. The total wanted fertility rate declined slightly from 2.7 and 2.5 children per woman in 1998 and 2003, respectively. Wanted fertility is lower than replacement level only in National Capital Region (1.7), among those who have attended college (1.9) and those in the highest wealth quintile (1.6). The gap between wanted and observed total fertility rates, as measured by the ratio of observed fertility rate to wanted fertility rate is larger for women in Bicol, SOCCSKSARGEN, and CARAGA, as well as for women with elementary education, and women in the lowest wealth quintile. For all of these women, the actual fertility rate is at least 50 percent higher than the wanted fertility rate. The gap between wanted and actual fertility is smallest for women in the highest wealth quintile and women who have college education, and among women in CALABARZON, Cordillera Administrative Region, and ARMM. 55 24 20 63 20 16 Wanted then Wanted later Unwanted 0 20 40 60 80 Percent 2003 NDHS 2008 NDHS Figure 7.5 Trends in Wanted and Unwanted Fertility for Births in the Five Years Preceding the Survey, NDHS 2003 and NDHS 2008 92 | Fertility Preferences Table 7.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Philippines 2008 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 2.1 2.8 Rural 2.7 3.8 Region National Capital Region 1.7 2.3 Cordillera Admin Region (2.7) (3.3) I - Ilocos (2.5) (3.4) II - Cagayan Valley (3.0) (4.1) III - Central Luzon 2.3 3.0 IVA - CALABARZON 2.4 3.0 IVB - MIMAROPA (3.0) (4.3) V - Bicol 2.5 4.1 VI - Western Visayas 2.3 3.3 VII - Central Visayas 2.4 3.2 VIII - Eastern Visayas (2.9) (4.3) IX - Zamboanga Peninsula (2.7) (3.8) X - Northern Mindanao (2.3) (3.3) XI - Davao (2.3) (3.3) XII - SOCCSKSARGEN (2.4) (3.6) XIII - Caraga (2.8) (4.3) ARMM (3.5) (4.3) Education No education * * Elementary 2.9 4.5 High school 2.6 3.5 College 1.9 2.3 Wealth quintile Lowest 3.3 5.2 Second 2.9 4.2 Middle 2.4 3.3 Fourth 2.2 2.7 Highest 1.6 1.9 Total 2.4 3.3 Note: Rates are calculated for 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. Rates in parentheses are based on 500-749 unweighted women; an asterisk indicates that a figure is based on fewer than 500 unweighted women and has been suppressed. 7.6 COUPLES’ CONSENSUS ON FAMILY SIZE As mentioned above, an important indicator related to fertility desires is the extent to which wives and husbands agree on the number of children to have. In the 2008 NDHS, married women were asked if their husbands wanted the same number of children as they did, or more or fewer children. As shown in Table 7.9, about 7 in 10 women reported that their husband wants the same number of children as they do. One-fifth of married women said that their husband wants more children than they do, and 6 percent said that their husband wants fewer children than they do. The percentage of women reporting that their husband wants more children than they do increases slightly with age. There is little variation in couples’ fertility desires by age differences between the woman and her husband. Fertility Preferences | 93 Less than half of married women in ARMM region said that they and their husband have the same preferences regarding the number of children to have; 45 percent reported that their husband wants more children than they do. SOCCSKSARGEN and Bicol have low proportions of married women reporting consensus on family size desires and high proportions reporting that the husband wants more children than they do. The proportion of women with the same desired family size as their husband increases with education and wealth quintile except for the fourth quintile. Similarly, the proportion who reported that their husband wants more children than they do generally decreases as education and wealth increase. Table 7.9 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 characteristics, Philippines 2008 Couple’s consensus on desired number of 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 75.8 16.0 5.1 3.1 100.0 283 20-24 72.1 19.2 5.0 3.7 100.0 995 25-29 71.7 19.4 6.8 2.0 100.0 1,513 30-34 72.5 18.4 7.1 2.0 100.0 1,440 35-39 71.2 19.0 6.1 3.7 100.0 1,331 40-44 69.3 21.1 6.5 3.1 100.0 1,083 45-49 68.4 22.0 4.4 5.2 100.0 999 Difference in age between woman and husband 0-1 year 72.3 20.1 4.2 3.4 100.0 2,068 2-3 years 71.6 19.5 6.3 2.6 100.0 1,966 4-5 years 70.3 20.1 6.8 2.7 100.0 1,410 6+ years 70.4 18.8 7.1 3.6 100.0 2,185 Residence Urban 73.5 17.4 6.0 3.1 100.0 3,844 Rural 68.9 21.7 6.2 3.2 100.0 3,800 Region National Capital Region 75.8 16.0 5.3 2.9 100.0 1,218 Cordillera Admin Region 66.2 21.4 5.3 7.1 100.0 121 I – Ilocos 73.6 21.3 3.3 1.8 100.0 370 II – Cagayan Valley 77.4 15.7 4.7 2.3 100.0 253 III – Central Luzon 76.5 15.5 5.1 2.8 100.0 743 IVA – CALABARZON 77.8 14.6 5.3 2.3 100.0 980 IVB – MIMAROPA 76.3 14.7 8.0 1.1 100.0 226 V – Bicol 58.0 29.2 6.1 6.6 100.0 439 VI – Western Visayas 70.7 16.2 10.6 2.4 100.0 583 VII – Central Visayas 71.0 19.0 7.5 2.5 100.0 559 VIII – Eastern Visayas 65.2 25.5 5.9 3.3 100.0 311 IX – Zamboanga Peninsula 65.1 25.7 6.8 2.4 100.0 303 X – Northern Mindanao 71.5 15.1 6.9 6.5 100.0 351 XI – Davao 75.4 14.9 7.3 2.4 100.0 367 XII – SOCCSKSARGEN 58.8 30.6 7.2 3.3 100.0 299 XIII – Caraga 72.1 15.3 9.0 3.6 100.0 193 ARMM 49.4 45.4 0.7 4.4 100.0 326 Education No education 47.2 41.1 2.9 8.8 100.0 127 Elementary 66.2 23.2 6.1 4.5 100.0 1,836 High school 73.0 18.2 6.0 2.7 100.0 3,412 College 74.0 17.4 6.3 2.3 100.0 2,269 Wealth quintile Lowest 63.5 26.7 6.1 3.7 100.0 1,590 Second 69.1 20.2 6.7 3.9 100.0 1,534 Middle 74.5 16.2 6.1 3.2 100.0 1,571 Fourth 73.8 17.4 6.5 2.3 100.0 1,509 Highest 75.7 16.8 4.9 2.6 100.0 1,439 Total 71.2 19.6 6.1 3.1 100.0 7,644 Note: Total includes 15 women for whom no age was given for husband. 1 Based on wife’s perception of her husband’s desires. Infant and Child Mortality | 95 INFANT AND CHILD MORTALITY 8 The health of newborns, infants, and young children is foremost in any human development pro- gram of the Department of Health (DOH). Children’s Health 2025 is the blueprint for a holistic and integrated approach to promote the health of Filipino children through sector-specific plans of action. One of the DOH’s goals is to ensure the survival, health, and development of infants and children. Infant and child mortality rates are relevant not only in evaluating the progress of health programs but also in monitoring the current demographic situation and providing input for population studies like population projections or estimates. Differentials in childhood mortality by selected background characteristics are useful in identifying groups in need of priority attention and in planning meaningful strategies to address these needs. This chapter presents estimates of childhood mortality, namely: perinatal, neonatal, postneonatal, infant, child, and under-five mortality. The chapter includes definitions of these indicators, current levels and trends, differentials by selected background characteristics, and factors that contribute to elevating children’s mortality risks. The information needed for mortality estimation was collected in the reproductive history section of the Women’s Questionnaire. The section begins with questions about the respondent’s experience with childbearing (i.e., the number of sons and daughters living with the mother, the number who live elsewhere, and the number who have died). These questions are followed by a retrospective pregnancy history in which each respondent is asked to list each of her pregnancies, starting with the first. For each pregnancy, information is obtained on the outcome of the pregnancy—born alive, born dead, or lost before full term—and, for all live births, the sex, month and year of birth, survivorship status, and current age, or if the child was dead, age at death. For stillbirths and pregnancies lost before full term, information was collected on the duration of the pregnancy at the time of loss and whether the loss was induced or not. This information is used to directly estimate mortality. Age-specific mortality rates are categorized and defined as follows: Neonatal mortality (NN): the probability of dying within the first month of life Postneonatal mortality (PNN): the difference between infant and neonatal mortality Infant mortality (1q0): the probability of dying before the first birthday Child mortality (4q1): the probability of dying between the first and fifth birthday Under-five mortality (5q0): the probability of dying between birth and fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. 8.1 LEVELS AND TRENDS IN INFANT AND CHILD MORTALITY Table 8.1 shows neonatal, postneonatal, infant, child, and under-five mortality rates for successive five-year periods before the 2008 National Demographic and Health Survey (NDHS). For the five years immediately preceding the survey (approximately calendar years 2004-2008), the infant 96 | Infant and Child Mortality mortality rate is 25 deaths per 1,000 live births.1 The neonatal mortality rate for the same period is 16 deaths per 1,000 live births, and the postneonatal mortality rate is 9 deaths per 1,000 live births. Child mortality is 9 deaths per 1,000 and the under-five mortality rate is 34 deaths per 1,000 live births. The 2008 NDHS results confirm the pattern of declining childhood mortality in the past 15 years. Under-five mortality has decreased from 48 deaths per 1,000 births in the 1998 NDHS to 40 deaths per 1,000 in the 2003 NDHS and to 34 deaths per 1,000 in the 2008 NDHS. Infant mortality rates show a similar decline, from 35 deaths per 1,000 to 29 deaths per 1,000 to 25 deaths per 1,000 for the three surveys, respectively. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five-year periods preceding the survey, Philippines 2008 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 2004-2008 16 9 25 9 34 5-9 1999-2003 17 13 31 10 41 10-14 1994-1998 18 14 32 14 45 1 Computed as the difference between the infant and neonatal mortality rates 8.2 DATA QUALITY Even though the training and field procedures for the 2008 NDHS were designed to minimize data problems, no amount of attention to field procedures can eliminate errors in data altogether. Retrospective birth history data are known to be susceptible to several possible types of errors. The quality of mortality estimates calculated from retrospective birth histories depends upon the completeness with which births and deaths are reported and recorded. One source of error relates to the fact that only surviving women age 15-49 were interviewed, eliminating data on children of women who were not represented in the sample because they have died. Resulting mortality estimates will be biased if the fertility of surviving and non-surviving women differ substantially. A second factor that affects childhood mortality estimates is the quality of reporting of age at death, which may distort the age pattern of mortality. If age at death is misreported, it will bias the estimates, especially if the net effect of the age misreporting results in transference from one age bracket to another. For example, a net transfer of deaths from under one month to a higher age will affect the estimates of neonatal and postneonatal mortality. To minimize errors in reporting of age at death, interviewers were instructed to record age at death in days if the death took place in the month following the birth, in months if the child died before age two, and in years if the child was at least two years of age. They were also asked to probe for deaths reported at one year to determine a more precise age at death in terms of months. Because transference and omission occur more frequently regarding very early deaths, it is useful to examine details about reported age at death. Appendix Table C.6 shows that in the Philippines, two-thirds of deaths in the first year of life take place during the first month of life. While the 1 Mortality estimates are associated with sizeable sampling errors. For example, the 95 percent confidence interval for the infant mortality rate for the five years preceding the survey ranges from 21 to 29 deaths per 1,000 live births (Appendix B). Infant and Child Mortality | 97 ratio is higher for the most recent period (67 percent) than for periods further in the past, there is some heaping of reported age at death in all periods. Another potential data quality problem is the selective omission from the birth histories of births that did not survive, which can lead to underestimation of mortality rates. When selective omission of childhood deaths occurs, it is usually more severe for deaths occurring early in infancy. One way such omissions can be detected is by examining the proportion of neonatal deaths to infant deaths. Generally, if there is substantial underreporting of deaths, the result is an abnormally low ratio of early neonatal deaths to all neonatal deaths. Appendix Table C.5 shows that 85 percent of deaths under one month of age occur during the first week of life.2 Another potential data quality problem includes displacement of birth dates, which can cause a distortion of mortality trends. This can occur if an interviewer knowingly records a death as occurring in a different year, which might happen if an interviewer is trying to cut down on the workload. Live births occurring in the five years preceding the survey are the subject of a lengthy set of additional questions. In the 2008 NDHS questionnaire, the cutoff year for these questions was 2003. Data in Appendix Table C.4 shows no evidence of displacement of births from 2003 to 2002. A fifth issue—censoring of events—derives from the fact that the NDHS mortality estimates refer to the survival status of births that occurred in a given period of time (e.g., 0 to 4 years before the survey). However, because only women who were of reproductive age (15-49) at the time of the survey were interviewed, women age 50 and over were not interviewed and thus could not report the survival of any births they may have had in the period being considered. Associated censoring of information becomes progressively more severe for events occurring further in the past. To minimize the effect of censoring, analysis of infant and child mortality trends in the 2008 NDHS is limited to periods not more than 15 years prior to the survey. 8.3 SOCIOECONOMIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY Childhood mortality varies by place of residence, region, educational level of the mother, and socioeconomic status. These differentials are presented in Table 8.2. For a sufficient number of births to analyze mortality differentials across population subgroups, period-specific rates are presented for the ten-year period preceding the survey (approximately 1999 to 2008). The results show that mortality rates in urban areas are much lower than those in rural areas. For example, the under-five mortality rate in urban areas is 28 deaths per 1,000 live births, compared with 46 deaths per 1,000 live births in rural areas (Figure 8.2). Childhood mortality is inversely related to mother’s education level and wealth status. The under-five mortality rate for children whose mothers have no education is 136 deaths per 1,000 live births, compared with 18 deaths per 1,000 live births for children whose mothers have attended college. The under-five mortality rate is highest in ARMM, followed by Eastern Visayas. It is lowest in NCR and Ilocos. While there appear to be substantial differentials in childhood mortality by region, the large sampling errors (exceeding 20 points per 1,000 in some regions) suggest that the differences should be viewed with caution. 2 There are no models for mortality patterns during the neonatal period. However, one review of data from several developing countries concluded that, at neonatal mortality levels of 20 per 1,000 or higher, approximately 70 percent of neonatal deaths occur within the first six days of life (Boerma, 1988). 98 | Infant and Child Mortality Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background characteristic, Philippines 2008 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Residence Urban 13 8 20 8 28 Rural 20 15 35 12 46 Region National Capital Region 15 7 22 3 24 Cordillera Admin Region 20 10 29 (2) (31) I - Ilocos 15 9 24 2 26 II - Cagayan Valley 24 13 38 (8) (46) III - Central Luzon 14 10 24 5 29 IVA - CALABARZON 12 8 20 8 28 IVB - MIMAROPA 23 14 37 13 49 V - Bicol 11 8 19 16 34 VI - Western Visayas 28 11 39 5 43 VII - Central Visayas 22 9 31 4 35 VIII - Eastern Visayas 22 23 45 19 64 IX - Zamboanga Peninsula 6 8 14 17 31 X - Northern Mindanao 11 8 19 8 27 XI - Davao 29 6 34 10 44 XII - SOCCSKSARGEN 12 11 23 11 34 XIII - Caraga 15 6 21 10 30 ARMM 14 42 56 40 94 Mother's education No education (37) (50) (87) (53) (136) Elementary 16 16 32 15 47 High school 19 10 29 8 37 College 11 5 15 3 18 Wealth quintile Lowest 20 20 40 19 59 Second 19 10 29 9 38 Middle 15 9 24 8 32 Fourth 15 8 23 4 27 Highest 10 5 15 2 17 Note: Rates in parentheses are based on 250-499 unweighted children. 1 Computed as the difference between the infant and neonatal mortality rates 8.4 DEMOGRAPHIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY The demographic characteristics of both mother and child have been found to play an important role in the survival probability of children. Table 8.3 presents early childhood mortality rates by demographic characteristics (i.e., sex of child, mother’s age at birth, birth order, previous birth interval, and birth size). As expected, the mortality rate is consistently higher for males than for females. For instance, the infant mortality rate for males is 31 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. Table 8.3 shows that under-five mortality rates exhibit the expected U-shaped relationship with mother’s age—higher mortality among women in the youngest and oldest age groups and lower mortality among women in the middle age groups. (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. Infant and Child Mortality | 99 Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic characteristics, Philippines 2008 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 20 11 31 10 41 Female 13 11 25 9 34 Mother's age at birth <20 23 13 36 12 47 20-29 14 11 25 8 33 30-39 19 10 29 11 39 40-49 20 (28) (48) (19) (66) Birth order 1 21 7 28 5 33 2-3 13 9 22 8 30 4-6 13 14 28 13 40 7+ 27 24 51 25 75 Previous birth interval2 <2 years 16 19 35 19 54 2 years 15 12 27 11 38 3 years 6 11 18 9 26 4+ years 16 6 22 3 25 Birth size3 Small/very small 25 12 37 na na Average or larger 12 7 19 na na Note: Rates in parentheses are based on 250-499 unweighted children. 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 28 46 136 47 37 18 47 33 39 66 RESIDENCE Urban Rural MOTHER'S EDUCATION No education Elementary High school College MOTHER'S AGE AT BIRTH <20 20-29 30-39 40-49 0 20 40 60 80 100 120 140 160 Deaths per 1,000 live births NDHS 2008 Figure 8.1 Under-Five Mortality Rates by Background Characteristics 100 | Infant and Child Mortality The 2008 NDHS results do not show a clear pattern for neonatal and infant mortality by birth order, although infant mortality is lowest for second- and third-order births (Table 8.3). There is a clear positive association between birth order and the probability of dying between ages one and five (child mortality), and higher order births have higher mortality risks. While the child mortality rate for first births is 5 deaths per 1,000, the corresponding mortality rate for births of order seven and higher is five times greater, or 25 deaths per 1,000. In general, childhood mortality rates decline as the length of the birth interval increases. For example, the under-five mortality rate for children born less than two years after a previous birth is 54 deaths per 1,000 live births, compared with 25 deaths per 1,000 for children born after an interval of four or more years. A child’s size at birth (proxy for birth weight) has been shown to be associated with the risk of dying during infancy, particularly during the first months of life. For all children born during the five-year period before the survey, mothers were asked about their perception of the child’s size at birth: 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 well with the actual birth weight. The 2008 NDHS results indicate that mortality levels for children perceived by their mother to have been small or very small at birth are higher than those of other children. The neonatal mortality rate for infants reported by their mother to be small or very small at birth is, for example, more than twice that of infants reported to be average or larger at birth (25 and 12 deaths per 1,000 live births, respectively). 8.5 PERINATAL MORTALITY Pregnancy losses occurring after seven completed months of gestation (stillbirths) plus deaths among live births that occur in the first seven days of life (early neonatal deaths) constitute perinatal deaths. The distinction between a stillbirth and an early neonatal death may be a fine one, often depending on the woman observing and then remembering sometimes faint signs of life after delivery. The causes of stillbirths and early neonatal deaths are closely linked, and examining just one or the other can understate the true level of mortality around delivery. For this reason deaths around delivery are combined into the perinatal mortality rate. To calculate the perinatal mortality rate, the number of perinatal deaths is divided by the total number of pregnancies reaching seven months of gestation. The perinatal mortality rate is a useful indicator of the state of delivery services, both in terms of the use of these services and their ability to ensure delivery of healthy babies. Table 8.4 shows the number of stillbirths and early neonatal deaths and the perinatal mortality rate for the five-year period preceding the survey. The results in Table 8.4 show that overall, 93 stillbirths and 85 early neonatal deaths were reported by women interviewed in the 2008 NDHS, resulting in a perinatal mortality rate of 28 per 1,000 pregnancies in the Philippines. The 2003 NDHS results were slightly lower, with a perinatal mortality rate of 24 per 1,000 pregnancies. Table 8.4 shows that the duration of the previous pregnancy interval has an effect on the outcome of the index pregnancy. Pregnancies occurring within 15 months of a previous birth have the highest risk of pregnancy loss or early death (39 pregnancy losses or early deaths per 1,000 pregnancies). Perinatal mortality rate is higher in rural areas than in urban areas (32 and 22 per 1,000 pregnancies, respectively). Perinatal mortality is highest among births to women in the lowest wealth quintile and lowest among those in the highest quintile. Infant and Child Mortality | 101 Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year period preceding the survey, by background characteristics, Philippines 2008 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother's age at birth <20 23 26 23 2,122 20-29 57 47 26 3,928 30-39 7 12 (52) 369 40-49 * * * 13 Previous pregnancy interval in months4 First pregnancy 21 24 26 1,752 <15 10 11 39 534 15-26 19 22 27 1,492 27-38 18 11 29 1,012 39+ 25 17 25 1,663 Residence Urban 37 34 22 3,142 Rural 56 51 32 3,311 Region National Capital Region 13 14 30 916 Cordillera Admin Region 1 1 (22) 105 I - Ilocos 1 3 (12) 297 II - Cagayan Valley 2 5 (34) 214 III - Central Luzon 6 9 (24) 635 IVA - CALABARZON 4 4 10 814 IVB - MIMAROPA 5 4 (39) 214 V - Bicol 9 6 (35) 430 VI - Western Visayas 7 12 (41) 458 VII - Central Visayas 3 5 (17) 462 VIII - Eastern Visayas 6 3 (33) 290 IX - Zamboanga Peninsula 3 0 (12) 264 X - Northern Mindanao 6 4 (34) 287 XI - Davao 10 8 (60) 305 XII - SOCCSKSARGEN 5 2 (29) 250 XIII - Caraga 1 2 (18) 181 ARMM 11 2 (41) 330 Mother's education No education * * * 108 Elementary 26 20 29 1,578 High school 54 47 33 3,108 College 12 15 16 1,659 Wealth quintile Lowest 39 24 37 1,725 Second 17 20 25 1,478 Middle 20 22 34 1,239 Fourth 14 12 24 1,128 Highest 2 7 10 882 Total 93 85 28 6,452 Note: Rates in parentheses are based on 250-499 unweighted pregnancies; an asterisk indicates that a figure is based on fewer than 250 unweighted pregnancies and has been suppressed. 1 Stillbirths are fetal deaths in pregnancies lasting seven or more months. 2 Early neonatal deaths are deaths at age 0-6 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, expressed per 1000. 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. 102 | Infant and Child Mortality 8.6 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 because they are easily avoidable at low or no cost. Very young mothers may experience difficult pregnancies and deliveries because of their physical immaturity. Older women may experience age-related problems during pregnancies and delivery. For purposes of the analysis of high-risk fertility behavior presented in Table 8.5, 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 previous birth, and a child is of high birth order if the mother has previously given birth to more than three children (i.e., 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 age 18 and 34, they are not included in the high-risk category unless they occur too early or late; instead, they are considered unavoidable. Table 8.5 presents the distribution of births in the five years preceding the survey by risk category in relation to the fertility behavior of the mother. Twenty-four percent of births in the Philippines are not in any high-risk category, while 26 percent have an elevated mortality risk that is considered unavoidable (first births between age 18-34). About one-third of births (32 percent) are in one high-risk category, while 19 percent are in a multiple high-risk category (because of a combination of mother’s age, length of birth interval, and birth order). The single high-risk categories with the highest percentage of births are birth order greater than three (14 percent) and births with intervals of less than 24 months (12 percent). Column 2 of the table shows 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 at the birth of a child. Compared with births with no elevated mortality risk, the largest single-risk category occurs for births that follow a short interval; such births have a 68 percent higher risk of dying prematurely than births that are not in any high-risk category. Births to mothers age 35 and older also have increased mortality risk (1.37); however, only 4 percent of births are in this single-risk category. The multiple high-risk category with the largest proportion of births is high-order births to older mothers; 10 percent of births are in this category. Compared with births with no elevated risk, these births are 2.3 times more likely to die in early childhood. The multiple high-risk category with the highest risk ratio is the combination of mothers with birth interval less than 24 months and birth order higher than three; the 6 percent of births in this category are more than three times as likely to die as children with no elevated mortality risk. Infant and Child Mortality | 103 The last column in Table 8.5 looks to the future and addresses the question of how many currently married women have the potential for having a high-risk birth. The results were obtained by simulating the risk category into which a birth to a currently married woman would fall if she were to become pregnant 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. About two in three currently married women (65 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 35 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 8.5 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 distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Philippines 2008 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 23.7 1.00 28.9a Unavoidable risk category First-order births between ages 18 and 34 years 25.7 1.25 5.9 Single high-risk category Mother’s age <18 2.8 0.72 0.3 Mother’s age >34 4.1 1.37 12.6 Birth interval <24 months 11.7 1.68 8.2 Birth order >3 13.5 1.20 8.9 Subtotal 32.1 1.36 30.0 Multiple high-risk category Age <18 and birth interval <24 months2 0.3 * 0.2 Age >34 and birth interval <24 months 0.4 * 0.4 Age >34 and birth order >3 9.5 2.32 26.7 Age >34 and birth interval <24 months and birth order >3 2.0 2.55 3.0 Birth interval <24 months and birth order >3 6.3 3.37 5.0 Subtotal 18.5 2.66 35.2 In any avoidable high-risk category 50.6 1.83 65.2 Total 100.0 na 100.0 Number of births/women 6,359 na 8,418 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. An asterisk indicates that a figure is based on fewer than 25 unweighted births and has been suppressed. na = Not applicable 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 the category age <18 and birth order >3 a Includes sterilized women Maternal Health │ 105 MATERNAL HEALTH 9 Improving the quality of maternal health services is an important part of the health care system aimed at reducing the high rates of death and disability caused by complications of pregnancy and childbirth, as well as improving the survival rate of newborns in the Philippines. This chapter presents findings related to maternal health on the following topics: antenatal care, including iron supplementation and tetanus toxoid vaccination; delivery care and services; postnatal care; and problems accessing health services. Information on antenatal care and postnatal care is important for identifying subgroups of women who are not using such services and for planning improvements in services. This chapter discusses the findings on a number of antenatal care indicators including: type of provider, number of antenatal care visits, timing of first antenatal checkup, and services and information provided during antenatal care, including whether a tetanus toxoid injection was received. Delivery services are assessed according to the person who assisted with the delivery, the place of delivery, and the rate of caesarean section. Information on postnatal care was collected for all women with a live birth in the five years preceding the survey, including those who did not give birth in a health facility; it includes the time since delivery that postnatal care was received and the provider of the care. 9.1 ANTENATAL CARE Antenatal care aims to monitor the health of the mother and the baby and to diagnose pregnancy- related problems. 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 their antenatal checkups. In the 2008 NDHS, information on antenatal care coverage was obtained from women who had a live birth in the five years preceding the survey; the results presented on antenatal care refer to the pregnancy for the 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 pre- ceding the survey by source of antenatal care (ANC), according to background characteristics. The interviewers were instructed to record all ANC providers mentioned by the respondent. But for the purpose of this analysis, the results presented in Table 9.1 are based on the provider with the highest qualifications. Ninety-one percent of women with a live birth in the five years preceding the survey received antenatal care from a skilled provider (52 percent provided by a nurse or a midwife and 39 percent provided by a doctor). Five percent of women received antenatal care from a traditional birth attendant, or hilot, while 4 percent did not receive any antenatal care. These figures indicate there has been an increase in the proportion of births attended by a skilled provider (from 88 percent in 2003 to 91 percent in 2008), and a decline in the percentage of births assisted by a traditional birth attendant (from 7 percent in 2003 to 5 percent in 2008) (NSO and ORC Macro, 2004). 106 │ Maternal Health Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Philippines 2008 Background characteristic Doctor Nurse Midwife Hilot No one Other/ missing Total Percentage receiving antenatal care from a skilled provider1 Number of women Mother's age at birth <20 32.2 2.0 56.6 6.5 2.6 0.0 100.0 90.9 425 20-34 40.8 1.2 49.7 4.7 3.4 0.1 100.0 91.8 3,315 35-49 36.0 1.7 50.9 5.2 6.0 0.1 100.0 88.7 850 Birth order 1 52.8 1.3 41.1 2.8 1.8 0.1 100.0 95.2 1,282 2-3 42.7 1.5 49.2 4.0 2.7 0.0 100.0 93.3 1,824 4-5 26.8 1.1 59.9 6.7 5.6 0.0 100.0 87.7 900 6+ 17.1 1.8 61.4 10.0 9.1 0.6 100.0 80.3 584 Residence Urban 52.5 1.8 39.9 2.3 3.5 0.1 100.0 94.2 2,283 Rural 25.9 1.0 61.1 7.6 4.2 0.2 100.0 88.1 2,307 Region National Capital Region 63.8 3.2 27.4 1.5 4.1 0.0 100.0 94.4 688 Cordillera Admin Region 50.4 2.7 38.8 1.1 7.1 0.0 100.0 91.8 72 I - Ilocos 48.3 0.4 41.3 3.5 6.4 0.0 100.0 90.1 218 II - Cagayan Valley 27.8 1.5 65.5 2.7 2.6 0.0 100.0 94.8 142 III - Central Luzon 50.7 1.1 43.9 0.5 3.6 0.3 100.0 95.6 468 IVA - CALABARZON 55.7 0.2 39.5 1.0 3.5 0.0 100.0 95.4 602 IVB - MIMAROPA 28.8 1.6 54.9 9.7 4.9 0.0 100.0 85.4 151 V - Bicol 29.5 0.7 61.8 5.2 2.8 0.0 100.0 92.0 280 VI - Western Visayas 33.7 1.3 59.5 1.8 3.3 0.4 100.0 94.6 324 VII - Central Visayas 21.0 1.7 74.4 0.6 2.0 0.3 100.0 97.1 328 VIII - Eastern Visayas 29.2 2.0 59.0 4.1 5.7 0.0 100.0 90.2 196 IX - Zamboanga Peninsula 18.7 0.4 66.8 9.4 4.3 0.4 100.0 85.9 189 X - Northern Mindanao 26.2 0.9 65.2 2.7 5.0 0.0 100.0 92.2 198 XI - Davao 25.9 0.4 67.3 5.3 0.8 0.4 100.0 93.6 224 XII - SOCCSKSARGEN 13.5 1.4 71.2 7.3 6.6 0.0 100.0 86.1 178 XIII - Caraga 22.8 3.0 70.7 1.3 2.2 0.0 100.0 96.6 124 ARMM 21.5 1.3 23.9 48.9 4.4 0.0 100.0 46.7 207 Mother's education No education 6.1 1.8 36.1 39.4 16.6 0.0 100.0 44.0 68 Elementary 12.6 1.2 66.8 10.5 8.7 0.2 100.0 80.6 1,061 High school 35.6 1.7 56.8 3.1 2.6 0.1 100.0 94.2 2,198 College 69.3 1.1 26.8 1.6 1.2 0.0 100.0 97.1 1,263 Wealth quintile Lowest 8.6 1.0 67.5 14.5 8.2 0.2 100.0 77.1 1,103 Second 24.0 1.7 65.7 4.3 4.1 0.2 100.0 91.4 1,007 Middle 39.6 1.9 54.4 1.5 2.6 0.0 100.0 95.9 906 Fourth 61.6 1.5 34.4 1.2 1.1 0.1 100.0 97.6 863 Highest 80.1 0.8 17.4 0.1 1.5 0.0 100.0 98.3 711 Total 39.1 1.4 50.6 5.0 3.8 0.2 100.0 91.1 4,590 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. 1 Skilled provider includes doctor, nurse, midwife Maternal Health │ 107 Receipt of antenatal care from a skilled provider is higher in urban areas (94 percent) than in rural areas (88 percent). It is also strongly related to the mother’s level of education, birth order, and economic status. Women who have attended college are more than twice as likely to receive antenatal care from a skilled professional (97 percent) as women with no education (44 percent). Women are more likely to consult a medical professional for antenatal care for the pregnancy for their first birth than for subsequent pregnancies (95 percent, compared with 93 percent or lower for subsequent pregnancies). While 98 percent of women in the highest wealth quintile consulted a health professional for antenatal care, the corresponding proportion for women in the lowest quintile is 77 percent. Urban women, women who are economically better off, women with higher education, and women with fewer children are more likely than other women to receive antenatal care from a doctor. Differences in antenatal care by women’s age at delivery are not large. There are wide variations in ANC coverage and services across regions. In the vast majority of regions, at least 90 percent of women received antenatal care from a health professional; however, in ARMM, the corresponding figure is only 47 percent. Seven percent of women in Cordillera Administrative Region (CAR) and SOCCSKSARGEN received no antenatal care. Midwives are the most popular antenatal care providers in 11 regions. In five Luzon regions (National Capital Region (NCR), CAR, Ilocos, Central Luzon, and CALABARZON), the most popular antenatal care provider is a doctor. Almost half of women in the ARMM were attended by a traditional birth attendant. Antenatal care is most beneficial in pre- venting negative pregnancy outcomes when it is sought early in the pregnancy and is continued through to delivery. The Department of Health (DOH) recommends that all pregnant women have at least four ANC visits during each pregnancy. The 2008 NDHS results show that four in five women who had a live birth in the five years preceding the survey had the recommended number of ANC visits during the pregnancy for the last live birth (Table 9.2). There is some variation between women in urban areas (83 percent) and those in rural areas (73 percent). Table 9.2 also shows that 18 percent of women had fewer than four visits while 4 percent did not have any ANC visits at all. DOH further recommends that the first ANC visit should occur in the first trimester of the pregnancy for early detection of pregnancy-related health problems. More than half (54 percent) of women who had a birth in the five years preceding the survey followed the recommended timing of the first ANC visit. Three in ten women made their first visit on the fourth or fifth month of their pregnancy, while one in ten had their first ANC visit when they were six or more months pregnant. Women in urban areas tend to have their first visit earlier than women in rural areas: 61 percent of women in urban areas had their first ANC visit in the first trimester of pregnancy, compared with 48 percent of women in rural areas. Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Philippines 2008 Residence Number and timing of ANC visits Urban Rural Total Number of ANC visits None 3.5 4.2 3.8 1 2.4 3.6 3.0 2-3 10.6 19.3 15.0 4+ 83.0 72.6 77.8 Don't know/missing 0.6 0.2 0.4 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 3.5 4.2 3.8 <4 60.7 47.5 54.0 4-5 27.2 35.9 31.6 6-7 7.6 10.7 9.2 8+ 0.9 1.6 1.2 Don't know/missing 0.1 0.2 0.1 Total 100.0 100.0 100.0 Number of women 2,283 2,307 4,590 Median months pregnant at first visit (for those with ANC) 3.5 4.0 3.8 Number of women with ANC 2,202 2,209 4,411 108 │ Maternal Health Half of the women who received antenatal care had their first ANC visit by the time they were 3.8 months pregnant (3.5 months in urban areas and 4.0 months in rural areas). These findings are similar to those reported in the 2003 NDHS (NSO and ORC Macro, 2004). 9.1.2 Components of Antenatal Care Services The content of antenatal care is essential in assessing the quality of services offered. Important elements of antenatal care are: providing iron supplements, educating women on the signs of pregnancy complications, performing screening tests like urine and blood tests, and measuring weight gain and blood pressure. Table 9.3 presents information on the percentage of women who received these routine antenatal care services during the pregnancy for their most recent live birth in the five years before the survey. Because pregnant women are prone to developing anemia and their daily iron requirements may be difficult to meet with their regular diets, they are encouraged to take iron supplements. Table 9.3 shows that among women with a live birth in the past five years, 82 percent took iron tablets or syrup during the pregnancy with their last birth. There are some variations in iron supplementation coverage across subgroups of women, but the largest differential is by women’s education. Ninety-two percent of women with at least some college education took iron supplements, compared with only 32 percent of women with no education. At the regional level, the percentage of women who took iron tablets or syrup ranges from 39 percent in ARMM to 90 percent in Western Visayas. Only 4 percent of women reported taking de-worming medication during the pregnancy for their most recent birth in the past five years. Variations by background characteristics are small. Almost seven in ten women who received antenatal care for the most recent birth in the past five years were informed of signs of pregnancy complications, such as vaginal bleeding, dizziness, blurred vision, swollen face, etc. Women below age 20, women pregnant with their first child, women in urban areas, women who have attended college, and women in the higher wealth quintiles are more likely than other women to be informed of potential problems during pregnancy. While women in Cagayan Valley are the most likely to have been informed of pregnancy complications (78 percent), women in ARMM are the least likely to have been informed (45 percent). More than 90 percent of women who received antenatal care for their last pregnancy in the past five years had their blood pressure monitored (93 percent) and weight measured (91 percent) during their ANC visit (Table 9.3). Fifty-four percent of the women had a urine sample taken, and 47 percent had a blood sample taken. All four of these ANC services are more commonly reported by women in urban areas, those with more education, and those in the higher wealth quintiles than other women. Maternal Health │ 109 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Philippines 2008 Among women with a live birth in the past five years, the percentage who during the pregnancy for their last birth: Among women who received antenatal care for their most recent birth in the past five years, the percentage receiving selected services Background characteristic Took iron tablets or syrup Took intestinal parasite drugs Number of women with a live birth in the past five years Informed of signs of pregnancy complications Weighed Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother's age at birth <20 82.2 3.7 425 71.8 90.3 88.4 49.6 41.4 414 20-34 83.1 3.5 3,315 69.3 91.4 93.5 55.9 48.3 3,200 35-49 79.5 5.3 850 65.2 92.0 92.9 50.7 42.7 798 Birth order 1 86.7 3.3 1,282 76.9 94.1 94.1 66.2 57.9 1,259 2-3 84.9 3.4 1,824 69.5 93.4 94.4 57.2 50.6 1,775 4-5 78.3 3.9 900 64.3 88.5 91.5 44.4 34.6 850 6+ 71.2 6.4 584 54.5 82.9 87.3 32.3 26.0 528 Residence Urban 86.4 2.1 2,283 72.3 95.8 95.9 68.8 60.7 2,202 Rural 78.3 5.5 2,307 65.4 87.0 89.9 39.9 32.7 2,209 Region National Capital Region 87.8 2.8 688 77.0 96.9 97.5 86.3 81.2 660 Cordillera Admin Region 80.7 4.2 72 53.5 93.0 94.3 51.2 46.4 67 I - Ilocos 79.2 0.0 218 67.3 91.7 95.3 47.5 34.3 204 II - Cagayan Valley 83.5 2.6 142 77.5 93.6 94.1 45.0 35.5 138 III - Central Luzon 84.9 0.3 468 68.4 96.3 97.6 70.7 56.4 450 IVA - CALABARZON 89.2 1.3 602 73.6 97.0 98.7 69.9 57.3 581 IVB - MIMAROPA 76.5 3.0 151 62.5 82.0 87.1 39.9 25.6 144 V - Bicol 73.5 8.0 280 60.8 85.8 92.1 28.3 18.1 272 VI - Western Visayas 89.7 5.6 324 75.2 95.4 95.5 57.5 52.0 312 VII - Central Visayas 87.7 5.0 328 72.9 97.1 93.6 29.2 24.3 321 VIII - Eastern Visayas 77.9 8.2 196 64.6 88.3 92.6 44.1 35.4 185 IX - Zamboanga Peninsula 81.0 3.3 189 68.6 85.8 87.6 20.4 21.7 181 X - Northern Mindanao 84.2 7.5 198 69.4 95.3 96.3 43.3 40.6 188 XI - Davao 86.6 8.0 224 64.6 91.2 93.5 65.1 68.5 222 XII - SOCCSKSARGEN 79.3 6.6 178 53.1 90.0 90.3 34.8 26.5 167 XIII - Caraga 84.8 7.4 124 76.0 98.3 97.4 52.7 39.5 122 ARMM 38.5 1.8 207 45.4 43.9 47.0 18.2 16.8 198 Mother's education No education 32.0 2.6 68 44.6 45.8 46.7 15.9 15.9 57 Elementary 67.3 6.7 1,061 57.8 80.8 85.2 28.6 25.0 969 High school 85.4 3.4 2,198 68.3 93.9 94.7 54.3 45.9 2,138 College 92.4 2.3 1,263 79.5 97.3 97.9 76.1 66.2 1,247 Wealth quintile Lowest 66.0 6.4 1,103 57.8 77.5 81.4 23.9 21.6 1,011 Second 82.6 4.3 1,007 64.0 90.7 92.7 42.5 35.6 966 Middle 85.9 3.1 906 71.1 95.8 96.0 58.3 46.5 882 Fourth 91.7 2.5 863 75.1 98.5 98.2 73.2 63.4 852 Highest 91.5 1.9 711 80.9 98.1 99.5 86.7 77.9 700 Total 82.4 3.8 4,590 68.8 91.4 92.9 54.3 46.6 4,411 110 │ Maternal Health 9.1.3 Tetanus Toxoid Injections Neonatal tetanus is a leading cause of neonatal death in developing countries where a high proportion of deliveries take place at home or in locations where hygienic conditions may be poor. To protect newborn babies from this infection, pregnant women should be provided with tetanus toxoid immunization. The DOH recommends that women receive at least two tetanus toxoid (TT) injections during their first pregnancy. However, if a woman was immunized be- fore she became pregnant, she may require one or no TT injections during pregnancy, depending on the number of injections she has ever received and the timing of the last injection. For a woman to have lifetime protection, a total of five doses are required. The 2008 NDHS collected informa- tion on whether the women received any TT vaccinations during pregnancy and whether the pregnancy was protected against neo- natal tetanus. Table 9.4 shows the results on tetanus toxoid coverage during the preg- nancy for the last live birth in the five years preceding the survey. Almost half of women who had a live birth in the five years preceding the survey received two or more injections of TT during their last pregnancy. It is impor- tant to note, however, that some women may have received TT injections prior to the index pregnancy and did not require further injections. This may be the case in particular for women at higher parities. When prior vaccination is taken into account, the pro- portion of women whose last birth was protected against neonatal tetanus is 76 percent. The differentials in protection against neonatal tetanus among subgroups of women vary. Across regions, TT coverage ranges from 39 percent in ARMM to 88 percent in Central Visayas and Cagayan Valley. By level of education, TT coverage is lowest for women with no education (34 percent) and highest for women with high school education (80 percent). Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the five years preceding the survey, the percentage receiving two or more tetanus toxoid injections (TTI) during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Philippines 2008 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother's age at birth <20 58.0 67.9 425 20-34 49.3 77.4 3,315 35-49 36.3 72.4 850 Birth order 1 64.1 68.6 1,282 2-3 49.3 82.2 1,824 4-5 33.5 75.7 900 6+ 28.6 69.9 584 Residence Urban 50.1 73.8 2,283 Rural 45.4 77.3 2,307 Region National Capital Region 52.5 71.9 688 Cordillera Admin Region 37.3 64.3 72 I - Ilocos 44.6 71.6 218 II - Cagayan Valley 56.3 87.5 142 III - Central Luzon 49.8 77.3 468 IVA - CALABARZON 49.4 67.9 602 IVB - MIMAROPA 54.6 74.6 151 V - Bicol 44.1 81.0 280 VI - Western Visayas 47.4 83.0 324 VII - Central Visayas 54.0 87.6 328 VIII - Eastern Visayas 39.9 82.0 196 IX - Zamboanga Peninsula 49.9 74.4 189 X - Northern Mindanao 39.9 78.7 198 XI - Davao 51.9 85.9 224 XII - SOCCSKSARGEN 50.7 81.0 178 XIII - Caraga 39.0 85.2 124 ARMM 24.3 39.1 207 Mother's education No education 20.1 34.2 68 Elementary 37.0 69.7 1,061 High school 50.5 80.0 2,198 College 53.3 74.9 1,263 Wealth quintile Lowest 37.0 69.6 1,103 Second 49.0 81.3 1,007 Middle 49.4 79.5 906 Fourth 54.6 76.8 863 Highest 52.1 70.1 711 Total 47.7 75.6 4,590 1 Includes mothers with two injections during the pregnancy for their last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within ten years of the last live birth), or five or more injections prior to the last birth. Maternal Health │ 111 9.2 DELIVERY CARE 9.2.1 Place of Delivery Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may cause the death or serious illness of the mother and the baby or both. Hence, an important component of the effort to reduce the health risks of mothers and children is to increase the proportion of babies delivered in a safe and clean environment and under the supervision of health professionals. Table 9.5 shows the percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics. Only 44 percent of births in the Philippines are delivered in a health facility: 27 percent in a public health facility and 18 percent in a private health facility. More than half (56 percent) of births take place at home. These figures show an increase in the proportion of births occurring in a health facility (from 38 percent in 2003 to 44 percent in 2008) and a decline in the percentage of births delivered at home (from 61 percent in 2003 to 56 percent in 2008) (NSO and ORC Macro, 2004). Women are more likely to deliver in a health facility if they are having their first child (60 percent), if they have had at least four ANC visits (54 percent), if they have attended college (73 percent), and if they belong to the highest wealth quintile (84 percent). Births in urban areas are twice as likely to be delivered in a health facility as those in rural areas. Delivery at home is more common for sixth or higher order births (80 percent), births to the poorest women (87 percent), births to women under age 20 (62 percent), births to women with no education (94 percent), and births to women who received no antenatal care (82 percent). Births in rural areas are more likely to be delivered at home than births in urban areas (70 and 40 percent, respectively). Across regions, delivery in a health facility is most common in NCR (69 percent). In five regions, at least 70 percent of births occurred at home: ARMM (85 percent), SOCCSKSARGEN (77 percent), MIMAROPA (73 percent), Zamboanga Peninsula (71 percent), and Cagayan Valley (70 percent). 112 │ Maternal Health Table 9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health facility, according to background characteristics, Philippines 2008 Health facility Background characteristic Public sector Private sector Home Other/ missing Total Percentage delivered in a health facility Number of births Mother's age at birth <20 26.1 11.5 62.4 0.0 100.0 37.6 640 20-34 27.0 18.6 54.1 0.2 100.0 45.6 4,704 35-49 24.5 17.3 58.0 0.2 100.0 41.8 1,015 Birth order 1 34.4 25.4 40.0 0.2 100.0 59.8 1,869 2-3 27.3 19.4 52.9 0.4 100.0 46.7 2,500 4-5 20.0 10.7 69.0 0.3 100.0 30.7 1,176 6+ 15.0 4.8 79.8 0.4 100.0 19.8 815 Residence Urban 32.1 27.1 40.3 0.5 100.0 59.2 3,105 Rural 21.1 8.7 70.0 0.2 100.0 29.8 3,255 Region National Capital Region 32.5 36.9 30.2 0.4 100.0 69.3 903 Cordillera Admin Region 42.8 8.3 48.0 0.8 100.0 51.1 104 I - Ilocos 32.0 10.1 57.9 0.0 100.0 42.1 296 II - Cagayan Valley 22.4 6.5 70.4 0.7 100.0 28.9 212 III - Central Luzon 39.9 16.4 43.3 0.4 100.0 56.3 629 IVA - CALABARZON 23.1 30.1 46.3 0.5 100.0 53.2 810 IVB - MIMAROPA 20.0 6.8 73.1 0.0 100.0 26.9 209 V - Bicol 24.0 8.5 66.9 0.7 100.0 32.4 421 VI - Western Visayas 37.5 8.9 53.4 0.3 100.0 46.3 452 VII - Central Visayas 25.3 20.4 54.3 0.0 100.0 45.7 459 VIII - Eastern Visayas 27.2 6.5 66.3 0.0 100.0 33.7 283 IX - Zamboanga Peninsula 21.6 6.8 71.2 0.3 100.0 28.5 261 X - Northern Mindanao 25.1 8.2 66.7 0.0 100.0 33.3 282 XI - Davao 18.3 24.1 57.3 0.3 100.0 42.4 295 XII - SOCCSKSARGEN 10.1 13.3 76.5 0.0 100.0 23.5 245 XIII - Caraga 23.4 6.7 69.9 0.0 100.0 30.1 180 ARMM 4.0 10.7 85.1 0.2 100.0 14.7 318 Mother's education No education 4.6 1.7 93.7 0.0 100.0 6.3 106 Elementary 13.4 3.7 82.6 0.2 100.0 17.1 1,552 High school 30.1 13.4 56.2 0.3 100.0 43.5 3,054 College 33.5 39.8 26.3 0.4 100.0 73.3 1,647 Antenatal care visits1 None 12.9 5.2 81.9 0.0 100.0 18.1 176 1-3 15.7 7.7 76.6 0.0 100.0 23.4 825 4+ 31.4 22.4 46.1 0.1 100.0 53.7 3,569 Wealth quintile Lowest 11.5 1.5 86.8 0.2 100.0 13.0 1,686 Second 26.9 7.1 65.5 0.6 100.0 34.0 1,460 Middle 33.0 15.3 51.5 0.2 100.0 48.3 1,219 Fourth 39.0 29.7 30.9 0.4 100.0 68.7 1,114 Highest 29.4 54.5 15.8 0.2 100.0 83.9 880 Total 26.5 17.7 55.5 0.3 100.0 44.2 6,359 Note: Total includes 20 women missing as to number of antenatal care visits. 1 Includes only the most recent birth in the five years preceding the survey Maternal Health │ 113 9.2.2 Delivery Assistance In addition to place of birth, assistance during childbirth is an important variable that influences the birth outcome and the health of the mother and the infant. This is because the skills and performance of the birth attendant determine whether or not he or she can manage complications and observe hygienic practices. Table 9.6 shows the person providing assistance during delivery for most recent birth in the five years preceding the survey. If the delivery was assisted by more than one person, only the most qualified person is shown in the table. Table 9.6 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage of births assisted by a skilled provider, and percentage delivered by caesarean-section, according to background characteristics, Philippines 2008 Person providing assistance during delivery Background characteristic Doctor Nurse Midwife Hilot Relative/ other No one Don't know/ missing Total Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Mother's age at birth <20 28.1 1.9 29.0 39.9 1.1 0.0 0.0 100.0 59.0 4.3 640 20-34 35.9 1.5 26.4 34.9 1.0 0.1 0.2 100.0 63.8 9.4 4,704 35-49 35.2 1.4 20.6 40.9 1.4 0.4 0.1 100.0 57.2 12.9 1,015 Birth order 1 48.3 1.9 24.9 24.3 0.4 0.0 0.2 100.0 75.1 12.8 1,869 2-3 37.5 1.2 27.4 32.8 0.8 0.1 0.1 100.0 66.2 11.6 2,500 4-5 22.1 1.8 27.9 46.3 1.3 0.3 0.3 100.0 51.8 5.0 1,176 6+ 15.2 1.1 19.3 60.6 2.8 0.6 0.3 100.0 35.6 1.7 815 Place of delivery Health facility 78.7 2.7 18.5 0.1 0.0 0.0 0.0 100.0 99.9 21.5 2,809 Elsewhere 0.4 0.6 31.6 65.3 1.9 0.3 0.0 100.0 32.5 0.0 3,540 Residence Urban 47.8 1.5 28.2 21.6 0.6 0.1 0.3 100.0 77.5 13.8 3,105 Rural 22.8 1.5 23.4 50.5 1.5 0.3 0.1 100.0 47.7 5.3 3,255 Region National Capital Region 57.1 0.1 29.6 12.9 0.3 0.0 0.0 100.0 86.8 14.9 903 Cordillera Admin Region 47.2 2.0 18.2 19.1 12.4 1.1 0.0 100.0 67.4 11.7 104 I - Ilocos 38.0 0.9 42.9 17.8 0.3 0.0 0.0 100.0 81.9 10.3 296 II - Cagayan Valley 26.5 2.1 30.6 37.4 2.7 0.0 0.7 100.0 59.2 7.2 212 III - Central Luzon 44.8 2.6 34.6 17.3 0.4 0.0 0.4 100.0 81.9 15.4 629 IVA - CALABARZON 43.1 0.5 30.9 24.5 0.5 0.0 0.5 100.0 74.5 16.3 810 IVB - MIMAROPA 20.3 2.9 15.9 54.5 5.5 0.9 0.0 100.0 39.1 5.9 209 V - Bicol 24.1 1.9 23.9 49.0 0.9 0.2 0.0 100.0 49.9 4.0 421 VI - Western Visayas 36.0 1.6 22.8 38.3 1.0 0.0 0.3 100.0 60.4 5.9 452 VII - Central Visayas 31.0 2.7 33.2 32.7 0.5 0.0 0.0 100.0 66.8 6.9 459 VIII - Eastern Visayas 26.7 2.0 14.4 56.9 0.0 0.0 0.0 100.0 43.1 5.3 283 IX - Zamboanga Peninsula 21.2 2.9 14.3 59.2 1.9 0.3 0.3 100.0 38.4 4.7 261 X - Northern Mindanao 25.8 2.1 19.8 51.9 0.4 0.0 0.0 100.0 47.8 4.5 282 XI - Davao 28.9 0.3 22.2 47.1 0.6 0.6 0.3 100.0 51.4 6.7 295 XII - SOCCSKSARGEN 17.6 1.7 16.3 60.2 2.9 1.3 0.0 100.0 35.6 6.3 245 XIII - Caraga 24.4 3.0 22.5 49.8 0.3 0.0 0.0 100.0 49.9 5.5 180 ARMM 11.5 1.0 6.8 80.3 0.3 0.2 0.0 100.0 19.2 2.7 318 Mother's education No education 5.2 1.8 3.9 78.6 7.9 2.6 0.0 100.0 10.9 0.0 106 Elementary 12.0 1.4 20.3 63.9 2.0 0.3 0.1 100.0 33.7 2.2 1,552 High school 32.2 1.4 31.7 33.7 0.8 0.0 0.2 100.0 65.2 7.4 3,054 College 63.9 1.9 21.2 12.6 0.2 0.1 0.1 100.0 87.0 20.8 1,647 Wealth quintile Lowest 9.4 0.7 15.6 71.4 2.3 0.4 0.1 100.0 25.7 1.3 1,686 Second 24.4 2.1 29.1 42.8 1.3 0.2 0.2 100.0 55.6 5.1 1,460 Middle 34.5 2.4 38.9 23.7 0.4 0.0 0.2 100.0 75.8 7.3 1,219 Fourth 55.0 1.7 29.3 13.6 0.1 0.0 0.3 100.0 86.0 15.5 1,114 Highest 77.1 0.7 16.6 5.1 0.3 0.0 0.1 100.0 94.4 27.7 880 Total 35.0 1.5 25.7 36.4 1.1 0.2 0.2 100.0 62.2 9.5 6,359 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. Total includes 11 births missing place of delivery 1 Skilled provider includes doctor, nurse, and midwife. 114 │ Maternal Health Table 9.6 shows that 62 percent of births in the five years preceding the survey were assisted by health professionals: 35 percent by a doctor and 27 percent by a midwife or nurse. While the proportion of births attended by a health professional has increased slightly from 60 percent in 2003 (NSO and ORC Macro, 2004), it remains lower than the target set by DOH (80 percent by 2004). Thirty-six 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 take place at home. It is interesting to note that while 91 percent of women with a live birth in the past five years consulted a skilled professional for antenatal care, only 62 percent of births were assisted at delivery by a health professional. Delivery assistance by a skilled provider varies according to background characteristics of the mother. The percentage of births delivered by a skilled provider increases with mother’s level of education and wealth status, and it decreases with increasing birth order. In urban areas, 78 percent of births are attended by skilled professionals, compared with 48 percent of births in rural areas. Eighty-seven percent of deliveries in NCR are assisted by health professionals (57 percent by a doctor and 30 percent by a midwife or nurse). In contrast, 80 percent of births in ARMM are assisted by a hilot. Interestingly, 12 percent of births in CAR are assisted by a relative or friend and 1 percent are delivered with no assistance. Caesarean operations are necessary for women with medical problems or with pregnancy complications. The rate of caesarean sections is an indicator of access to essential obstetric care. Table 9.6 shows that one in ten live births (10 percent) in the five years preceding the survey was delivered by caesarean section, which is an increase from the proportion reported in the 2003 NDHS (7 percent) (NSO and ORC Macro, 2004). Delivery by caesarean section is highest among births to older women (13 percent), first births (13 percent), births to women in urban areas (14 percent), births to highly educated mothers (21 percent) and births to mothers in the highest wealth quintile (28 percent). The occurrence of caesarean operations varies across regions, from 3 percent in ARMM to 16 percent in CALABARZON. The proportion of deliveries by C-section in CALABARZON has increased six percentage points, from 10 percent in 2003 (NSO and ORC Macro, 2004). 9.3 POSTNATAL CARE Postnatal care is a crucial component of safe motherhood. A postnatal checkup provides an opportunity to assess and treat delivery complications and to advise the mother on how to care for herself and her baby. The first two days after delivery are critical because most maternal and neonatal deaths occur during this period. The DOH recommends that mothers receive a postnatal checkup within 48 hours after delivery. In the 2008 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. Unlike the 2003 NDHS, these questions were asked regardless of whether the birth took place in a facility or at home. Table 9.7 shows the percent distribution of women who gave birth in the five years preceding the survey by timing of the first postnatal checkup. Maternal Health │ 115 Table 9.7 Timing of first postnatal checkup Percent distribution of women age 15-49 with a birth in the five years preceding the survey by timing of first postnatal checkup for the last live birth, according to background characteristics, Philippines 2008 Time after delivery of mother's first postnatal checkup Background characteristic Less than 4 hours 4-23 hours 2 days 3-41 days Don't know/ missing No postnatal checkup1 Total Number of women Mother's age at birth <20 37.8 13.0 21.2 16.8 0.6 10.6 100.0 425 20-34 40.4 15.1 21.8 13.3 0.4 9.0 100.0 3,315 35-49 43.5 15.0 19.6 12.7 0.8 8.4 100.0 850 Birth order 1 40.4 17.1 19.8 13.7 0.4 8.5 100.0 1,282 2-3 42.1 15.8 21.4 11.9 0.5 8.2 100.0 1,824 4-5 41.0 11.8 21.4 15.8 0.4 9.7 100.0 900 6+ 36.8 12.3 24.0 14.7 1.0 11.3 100.0 584 Residence Urban 41.6 14.8 21.9 11.8 0.6 9.2 100.0 2,283 Rural 39.9 15.0 20.7 15.2 0.4 8.8 100.0 2,307 Region National Capital Region 50.1 7.9 17.8 12.8 0.2 11.2 100.0 688 Cordillera Admin Region 43.5 19.9 12.1 5.9 5.2 13.3 100.0 72 I - Ilocos 31.1 33.4 24.6 4.8 0.4 5.7 100.0 218 II - Cagayan Valley 33.9 18.0 32.0 6.2 0.0 9.9 100.0 142 III - Central Luzon 41.4 22.6 23.4 8.1 0.3 4.3 100.0 468 IVA - CALABARZON 26.8 11.2 28.2 19.5 1.5 12.9 100.0 602 IVB - MIMAROPA 39.3 14.6 27.6 9.0 0.0 9.4 100.0 151 V - Bicol 36.7 31.2 25.8 5.6 0.0 0.7 100.0 280 VI - Western Visayas 53.2 17.2 12.5 7.7 0.0 9.3 100.0 324 VII - Central Visayas 35.6 11.4 18.7 24.2 0.4 9.8 100.0 328 VIII - Eastern Visayas 34.1 8.5 25.0 21.2 0.8 10.3 100.0 196 IX - Zamboanga Peninsula 32.9 11.2 26.4 19.0 0.0 10.5 100.0 189 X - Northern Mindanao 45.0 18.5 15.5 16.2 1.3 3.5 100.0 198 XI - Davao 40.8 9.8 19.0 19.4 1.2 9.9 100.0 224 XII - SOCCSKSARGEN 49.1 9.1 16.5 10.3 0.0 15.0 100.0 178 XIII - Caraga 51.6 14.0 13.9 16.6 0.0 3.9 100.0 124 ARMM 53.5 5.7 16.1 13.5 0.0 11.2 100.0 207 Education No education 43.3 7.8 15.2 14.7 0.0 19.1 100.0 68 Elementary 39.9 9.5 21.7 16.6 0.7 11.7 100.0 1,061 High school 39.3 15.0 22.5 13.3 0.4 9.5 100.0 2,198 College 43.9 19.7 19.2 11.2 0.7 5.4 100.0 1,263 Wealth quintile Lowest 39.3 10.1 20.4 18.6 0.4 11.3 100.0 1,103 Second 39.0 15.4 21.4 13.3 0.4 10.5 100.0 1,007 Middle 40.2 15.7 22.5 11.6 0.5 9.5 100.0 906 Fourth 40.3 18.2 21.7 12.1 0.7 6.9 100.0 863 Highest 46.7 16.8 20.5 10.0 0.8 5.3 100.0 711 Total 40.7 14.9 21.3 13.5 0.5 9.0 100.0 4,590 1 Includes women who received a checkup after 41 days Seventy-seven percent of women had a postnatal checkup within two days after giving birth and 14 percent of the women received a postnatal checkup 3 to 41 days after delivery. Education is related to the timing of postnatal care. Mothers who attended college are more likely to receive postnatal care within two days than other women. The percentage meeting the recommended timing for the first postnatal checkup varies across region, from 66 percent in Central Visayas and CALABARZON to 94 percent in Bicol. Table 9.7 also shows that almost one in ten women (9 percent) did not receive a postnatal checkup at all. Women with little or no education are most likely to not receive postnatal care: 19 percent of women with no education did not receive a postnatal checkup, compared with 5 percent of women who attended college. 116 │ Maternal Health Table 9.8 presents information on the provider of the mother’s first postnatal checkup by background characteristics. Health professionals provide postnatal care to 60 percent of mothers. At the same time, a substantial proportion of mothers (31 percent) receive postnatal care from a traditional birth attendant. Health professionals are more likely to provide postnatal care to mothers of first-order births, mothers in urban areas, mothers with college or higher education, and mothers in the highest wealth quintile. Table 9.8 Provider of first postnatal checkup Percent distribution of women age 15-49 with a birth in the five years preceding the survey by provider of mother's first postnatal checkup for the last live birth, according to background characteristics, Philippines 2008 Provider of mother's first postnatal checkup Background characteristic Doctor/ nurse/ midwife Hilot Other Don't know/ missing No postnatal checkup1 Total Number of women Mother’s age at birth <20 52.8 36.5 0.1 0.0 10.6 100.0 425 20-34 61.2 29.3 0.5 0.1 9.0 100.0 3,315 35-49 58.4 32.2 0.9 0.0 8.4 100.0 850 Birth order 1 70.0 21.2 0.2 0.1 8.5 100.0 1,282 2-3 64.6 26.6 0.6 0.1 8.2 100.0 1,824 4-5 51.3 38.3 0.7 0.0 9.7 100.0 900 6+ 36.3 51.3 1.0 0.0 11.3 100.0 584 Residence Urban 72.6 18.0 0.1 0.1 9.2 100.0 2,283 Rural 47.3 42.9 0.9 0.0 8.8 100.0 2,307 Region National Capital Region 77.0 11.6 0.2 0.0 11.2 100.0 688 Cordillera Admin Region 70.2 13.3 3.2 0.0 13.3 100.0 72 I – Ilocos 81.8 12.1 0.4 0.0 5.7 100.0 218 II – Cagayan Valley 66.1 24.0 0.0 0.0 9.9 100.0 142 III – Central Luzon 77.5 17.6 0.5 0.0 4.3 100.0 468 IVA – CALABARZON 64.3 22.3 0.2 0.2 12.9 100.0 602 IVB – MIMAROPA 40.6 47.6 2.4 0.0 9.4 100.0 151 V – Bicol 52.7 46.6 0.0 0.0 0.7 100.0 280 VI – Western Visayas 62.0 28.7 0.0 0.0 9.3 100.0 324 VII – Central Visayas 64.1 25.2 1.0 0.0 9.8 100.0 328 VIII – Eastern Visayas 44.3 44.9 0.0 0.4 10.3 100.0 196 IX – Zamboanga Peninsula 38.2 50.9 0.4 0.0 10.5 100.0 189 X – Northern Mindanao 46.6 49.5 0.4 0.0 3.5 100.0 198 XI – Davao 50.7 39.0 0.4 0.0 9.9 100.0 224 XII – SOCCSKSARGEN 37.9 46.2 0.9 0.0 15.0 100.0 178 XIII – Caraga 43.4 48.3 4.4 0.0 3.9 100.0 124 ARMM 19.5 69.3 0.0 0.0 11.2 100.0 207 Education No education 17.1 61.7 2.1 0.0 19.1 100.0 68 Elementary 32.3 55.4 0.7 0.0 11.7 100.0 1,061 High school 60.8 29.1 0.6 0.1 9.5 100.0 2,198 College 83.9 10.4 0.3 0.0 5.4 100.0 1,263 Wealth quintile Lowest 23.6 63.7 1.4 0.1 11.3 100.0 1,103 Second 52.7 36.3 0.5 0.0 10.5 100.0 1,007 Middle 69.2 21.1 0.1 0.0 9.5 100.0 906 Fourth 80.2 12.4 0.3 0.1 6.9 100.0 863 Highest 89.9 4.8 0.0 0.0 5.3 100.0 711 Total 59.9 30.5 0.5 0.0 9.0 100.0 4,590 1 Includes women who received a checkup after 41 days Maternal Health │ 117 9.4 PROBLEMS IN ACCESSING HEALTH CARE Many factors can prevent women from getting medical advice or treatment for themselves when they are sick. Information on such factors is particularly important in understanding and addressing the barriers women may face in seeking care during pregnancy and at the time of delivery. In the 2008 NDHS, women were asked what hinders them in obtaining medical advice or treatment when they are sick. Possible answers were: getting permission to go for treatment, getting money for treatment, distance to health facility, having to take transport, not wanting to go alone, concern that there is no female provider available, concern that there is no provider available, and concern that there are no drugs available. The results are shown in Table 9.9. Three in four women reported having at least one problem in accessing health care. The problem cited most often was getting money for treatment (55 percent). Other problems include concern that there are no drugs available (47 percent) and concern that there is no provider available (37 percent). Highly educated women and women in the upper wealth quintiles are less likely than other women to have a problem in accessing health care. Across regions, the percentage of women who had at least one problem in accessing health care ranges from 59 percent in NCR to 96 percent in Central Visayas. Women in rural areas are more likely than women in urban areas to report each of the specified problems. As expected, having to take transport and distance to health facility are more common problems for women in rural areas than those in urban areas. The type of problems women have in accessing health care varies across regions. More than 80 percent of women in Zamboanga Peninsula, Caraga, and Central Visayas cited concern that there would be no drugs available as a serious problem in getting health care. 118 │ Maternal Health Table 9.9 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Philippines 2008 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern no female provider available Concern no provider available Concern no drugs available At least one problem accessing health care Number of women Age 15-19 10.6 56.8 29.5 25.9 30.5 22.5 40.6 51.4 78.5 2,749 20-34 7.3 53.1 25.2 25.3 17.6 16.4 35.4 45.1 73.2 6,118 35-49 8.5 56.7 29.2 28.4 16.5 15.3 36.5 47.4 74.1 4,727 Number of living children 0 8.7 52.9 25.2 23.7 24.9 19.1 36.1 45.4 73.9 5,116 1-2 6.7 51.2 24.4 24.3 15.3 14.3 35.3 45.3 71.4 3,985 3-4 8.6 57.0 27.2 27.6 16.7 16.4 35.8 46.6 74.2 2,810 5+ 11.1 67.8 41.9 38.5 20.6 20.1 44.5 58.0 84.8 1,683 Marital status Never married 8.7 52.9 24.8 22.8 24.8 19.2 35.7 45.1 73.4 4,530 Married or living together 8.2 55.9 28.8 28.5 17.6 16.5 37.5 48.2 75.1 8,418 Divorced/separated/widowed 9.5 61.2 28.1 26.6 13.8 14.4 36.8 48.1 75.6 646 Employed last 12 months Not employed 9.1 56.2 29.4 27.3 22.4 18.3 37.5 48.0 75.5 5,914 Employed for cash 7.6 53.2 24.5 24.4 17.0 15.9 35.6 45.3 72.7 7,128 Employed not for cash 12.3 68.6 45.2 44.9 29.9 23.7 46.1 62.8 88.6 519 Residence Urban 6.3 49.9 17.3 17.1 15.6 13.1 29.9 39.6 67.9 7,574 Rural 11.1 61.6 40.1 38.3 25.2 22.5 45.6 56.6 83.0 6,020 Region National Capital Region 5.6 48.2 12.4 13.0 10.8 6.6 19.1 26.7 59.0 2,522 Cordillera Admin Region 6.5 63.3 32.0 25.8 12.9 6.3 15.4 21.2 74.2 225 I – Ilocos 8.3 51.0 23.8 17.0 27.5 13.7 25.9 29.9 66.2 613 II – Cagayan Valley 2.5 59.7 24.6 18.7 10.5 3.7 12.4 18.8 70.3 382 III – Central Luzon 5.2 48.9 20.4 21.4 18.7 10.7 21.9 22.7 61.7 1,486 IVA – CALABARZON 6.2 47.8 19.6 20.6 13.6 11.5 20.6 28.2 62.0 1,808 IVB – MIMAROPA 14.5 61.8 43.0 46.6 27.5 25.7 46.4 51.1 82.7 340 V – Bicol 7.1 60.5 31.0 29.5 22.7 12.0 26.6 33.4 77.8 755 VI – Western Visayas 11.7 38.8 30.7 33.2 19.5 28.2 54.6 69.2 79.5 976 VII – Central Visayas 11.0 71.3 30.7 29.0 23.6 24.8 65.9 83.5 96.2 983 VIII – Eastern Visayas 8.7 43.4 31.1 31.0 21.8 19.1 69.9 76.4 86.8 488 IX – Zamboanga Peninsula 5.6 74.2 45.1 43.3 24.6 27.8 48.4 88.5 95.2 505 X – Northern Mindanao 11.6 66.8 40.3 38.2 29.2 34.3 67.8 75.5 90.8 585 XI – Davao 10.0 66.6 39.4 34.8 22.7 27.7 38.4 75.1 89.6 618 XII – SOCCSKSARGEN 7.8 60.1 32.6 32.1 31.7 35.5 69.6 74.8 92.3 480 XIII – Caraga 13.9 66.2 36.9 37.3 24.9 29.9 68.9 84.7 92.8 312 ARMM 25.2 72.5 64.6 54.5 39.6 26.4 54.4 61.7 88.2 516 Education No education 28.8 84.9 71.1 67.7 44.0 40.8 68.8 76.8 95.5 167 Elementary 13.9 70.8 44.3 42.1 26.1 23.1 45.1 60.4 87.5 2,653 High school 8.8 58.1 27.3 26.4 20.8 18.4 37.9 48.7 77.3 6,352 College 3.9 40.4 15.9 15.7 13.8 11.3 29.0 35.9 62.0 4,422 Wealth quintile Lowest 16.1 74.0 57.8 56.1 31.8 29.6 54.0 71.0 92.3 2,160 Second 10.1 65.4 34.4 31.5 22.1 22.2 46.1 59.1 85.5 2,419 Middle 8.3 59.7 26.4 25.7 19.5 16.7 36.1 46.6 78.6 2,661 Fourth 5.2 48.4 17.2 17.3 16.5 12.9 32.9 40.2 69.0 2,937 Highest 5.2 38.2 12.9 12.8 13.8 10.1 23.4 30.0 57.2 3,417 Total 8.4 55.1 27.4 26.5 19.8 17.3 36.8 47.2 74.6 13,594 Note: Total includes 33 women with information missing on employment. Child Health | 119 CHILD HEALTH 10 This chapter presents findings on several indicators related to children’s health, such as birth weight, immunizations, and treatment practices for three major childhood diseases: acute respiratory infection, fever, and diarrhea. Childhood mortality can be reduced if children are immunized against preventable diseases and if they receive prompt and appropriate treatment when they are sick. In the 2008 NDHS, mothers were asked for the birth weight and estimated size at birth of all live births in the five years preceding the survey, to obtain information on nutritional status. Information on immunizations and illnesses was collected only for surviving children. The findings can assist in identifying children who have greater need for health services, and for whom health planners can formulate programs aimed at improving services. 10.1 CHILD SIZE AT BIRTH Birth weight is an important indicator of a newborn’s health status. Babies born with low birth weight generally have higher rates of morbidity and mortality. A decrease in the proportion of births with low birth weight contributes to reducing child mortality, which is one of the Millennium Development Goals. Babies weighing less than 2.5 kilograms at birth are considered to have low birth weight. Table 10.1 shows the distribution of births for which mothers reported a birth weight, and the distribution of all births by the child’s size at birth according to the mother. Because a large proportion of births occur at home, birth weight was not reported for more than one in four births (28 percent) (Table 10.1). Babies are more likely to be weighed at birth if they are born to women age 20 to 34, they are first births, the mother lives in an urban area, the mother is better educated, and the mother is in the highest wealth quintile. For example, while 89 percent of births to women with college or higher education were weighed at birth, the corresponding percentage of births to women with no education is only 15 percent. Among the regions, the National Capital Region has the highest percentage of births that were weighed (91 percent), whereas only one in five births in ARMM was weighed. Among babies for whom a birth weight was reported, 80 percent were classified as having normal or higher birth weight, while 20 percent were classified as being below normal birth weight. There is not much variation in the percentage of babies with normal birth weight among subgroups. Across regions, Ilocos had the highest percentage of births with normal birth weight (89 percent). Because some babies were not weighed at birth, the mother’s estimate of the baby’s size at birth was also obtained. Although the mother’s estimate is subjective, it is an alternative source of information for determining the prevalence of low birth weight babies. In the 2008 NDHS, respondents were asked about their perception of the size of their newborn. Four in five births were considered average or larger than average, 16 percent were described as smaller than average, and 5 percent were reported as very small. Looking at the variation by background characteristics of the mother, there are only minor differences in the reported size of the child at birth. Mothers in Ilocos are the most likely to say that their babies are of average or larger size (87 percent) and the least likely to say that their babies are smaller than average or very small (13 percent). 120 | Child Health Table 10.1 Child's weight and size at birth Percent distribution of live births in the five years preceding the survey with a reported birth weight by birth weight; percentage of all births with a reported birth weight; and percent distribution of all live births in the five years preceding the survey by mother's estimate of baby's size at birth, according to background characteristics, Philippines 2008 Percent distribution of births with a reported birth weight1 Percent distribution of all live births by size of child at birth Background characteristic Less than 2.5 kg 2.5 kg or more Total Number of births Percentage of all births with a reported birth weight Very small Smaller than average Average or larger Don't know/ missing Total Number of births Mother's age at birth <20 22.9 77.1 100.0 457 71.4 5.7 16.6 76.9 0.8 100.0 640 20-34 18.9 81.1 100.0 3,463 73.6 4.1 15.5 79.9 0.6 100.0 4,704 35-49 21.2 78.8 100.0 691 68.1 6.4 15.7 77.7 0.2 100.0 1,015 Birth order 1 22.8 77.2 100.0 1,516 81.1 5.2 16.8 77.5 0.5 100.0 1,869 2-3 17.1 82.9 100.0 1,883 75.3 4.1 14.5 81.0 0.4 100.0 2,500 4-5 18.4 81.6 100.0 784 66.7 4.0 16.5 78.8 0.7 100.0 1,176 6+ 21.3 78.7 100.0 428 52.5 5.8 15.1 78.4 0.7 100.0 815 Mother's smoking status Smokes cigarettes/tobacco 24.4 75.6 100.0 227 67.2 8.1 16.6 75.3 0.0 100.0 338 Does not smoke 19.4 80.6 100.0 4,384 72.8 4.4 15.6 79.4 0.6 100.0 6,022 Residence Urban 18.7 81.3 100.0 2,589 83.4 4.7 14.2 80.6 0.6 100.0 3,105 Rural 20.8 79.2 100.0 2,023 62.2 4.6 17.0 77.9 0.5 100.0 3,255 Region National Capital Region 18.3 81.7 100.0 824 91.2 4.1 15.3 80.2 0.4 100.0 903 Cordillera Admin Region 14.1 85.9 100.0 70 67.2 1.1 12.7 86.2 0.0 100.0 104 I - Ilocos 11.3 88.7 100.0 208 70.2 2.8 9.8 87.1 0.3 100.0 296 II - Cagayan Valley 16.6 83.4 100.0 113 53.5 2.4 12.1 84.8 0.7 100.0 212 III - Central Luzon 15.7 84.3 100.0 455 72.3 4.2 16.2 79.4 0.2 100.0 629 IVA - CALABARZON 17.9 82.1 100.0 663 81.9 4.4 13.3 80.7 1.6 100.0 810 IVB - MIMAROPA 22.4 77.6 100.0 112 53.3 3.9 16.9 79.1 0.0 100.0 209 V - Bicol 27.7 72.3 100.0 262 62.1 3.2 15.3 81.5 0.0 100.0 421 VI - Western Visayas 25.7 74.3 100.0 347 76.7 7.8 19.7 72.1 0.5 100.0 452 VII - Central Visayas 20.2 79.8 100.0 376 82.0 6.2 10.9 82.9 0.0 100.0 459 VIII - Eastern Visayas 25.2 74.8 100.0 182 64.2 5.6 14.4 79.9 0.0 100.0 283 IX - Zamboanga Peninsula 21.1 78.9 100.0 202 77.6 4.6 22.2 73.0 0.3 100.0 261 X - Northern Mindanao 16.3 83.7 100.0 230 81.7 3.7 18.6 76.0 1.7 100.0 282 XI - Davao 17.2 82.8 100.0 214 72.6 5.5 14.5 78.8 1.2 100.0 295 XII - SOCCSKSARGEN 23.4 76.6 100.0 129 52.8 5.1 16.1 78.8 0.0 100.0 245 XIII - Caraga 28.5 71.5 100.0 156 86.3 9.1 15.5 75.4 0.0 100.0 180 ARMM 16.2 83.8 100.0 70 21.9 3.4 24.8 71.2 0.6 100.0 318 Mother's education No education 15.3 84.7 100.0 16 15.3 8.8 19.8 67.5 3.8 100.0 106 Elementary 24.2 75.8 100.0 803 51.8 5.3 18.8 75.2 0.7 100.0 1,552 High school 19.5 80.5 100.0 2,319 75.9 4.4 16.3 78.8 0.6 100.0 3,054 College 17.4 82.6 100.0 1,473 89.4 4.1 11.2 84.7 0.1 100.0 1,647 Wealth quintile Lowest 25.5 74.5 100.0 817 48.5 5.2 18.9 75.3 0.6 100.0 1,686 Second 22.5 77.5 100.0 994 68.1 5.0 17.4 77.3 0.3 100.0 1,460 Middle 17.2 82.8 100.0 984 80.7 3.3 15.4 80.5 0.8 100.0 1,219 Fourth 16.9 83.1 100.0 992 89.1 4.7 11.5 83.2 0.6 100.0 1,114 Highest 16.5 83.5 100.0 825 93.7 4.5 12.0 83.2 0.3 100.0 880 Total 19.6 80.4 100.0 4,611 72.5 4.6 15.6 79.2 0.5 100.0 6,359 1 Based on either a written record or the mother's recall Child Health | 121 10.2 VACCINATION COVERAGE According to the World Health Organization, a child is fully immunized if he or she has received the following vaccinations before reaching one year of age: one dose of BCG vaccine at birth or at the first clinical contact, a measles vaccination at about nine months of age, and three doses each of diphtheria, pertussis, tetanus (DPT) vaccine and oral polio vaccine (OPV). The DPT and OPV vaccines should be given at monthly intervals starting at six weeks of age. In addition to these basic vaccines, the standard immunization schedule in the Philippines includes three doses of hepatitis B vaccine. This immunization schedule provides maximum resistance against the seven vaccine-preventable diseases: tuberculosis, poliomyelitis, diphtheria, pertussis, tetanus, hepatitis B, and measles. Information on vaccination coverage among children born in the five years preceding the survey was collected in two ways in the 2008 NDHS. Mothers were asked to show the interviewer health cards for all children born since January 2003. If the cards were available, the interviewer copied the vaccination dates directly onto the questionnaire. If the mother was not able to present a health card, or if a vaccine had not been recorded on the card as being given, the mother was asked what vaccinations the child had received. Table 10.2 shows the results for children age 12-23 months, which is the youngest cohort to have reached the age by which they should be fully vaccinated. The results indicate that, based on the information from the vaccination cards and mother’s reports, four in five children (80 percent) age 12-23 months received all of the basic vaccinations (BCG, DPT, polio, and measles) at some time before the survey, and 70 percent of children received them before reaching age one.1 Vaccination coverage (for any time prior to the survey) is highest for BCG (94 percent), the first dose of DPT vaccine (93 percent), and the first dose of OPV (93 percent) (Figure 10.1). The dropout rates for DPT, polio, and hepatitis B vaccines, measured by the difference in coverage between the first and third doses, are 7 percent, 7 percent, and 8 percent, respectively. Table 10.2 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 2008 DPT Polio Hepatitis Source of information BCG 1 2 3 1 2 3 1 2 3 Measles All basic vaccina- tions1 No vaccina- tions Number of children Vaccinated at any time before survey Vaccination card 42.2 42.3 41.6 40.9 42.2 41.7 40.9 42.1 41.0 39.6 39.0 38.6 0.0 546 Mother's report 51.7 50.2 48.0 44.7 50.4 48.3 44.2 46.2 44.1 40.7 45.5 40.9 5.6 740 Either source 93.9 92.5 89.6 85.6 92.6 90.0 85.2 88.2 85.1 80.3 84.5 79.5 5.6 1,286 Vaccinated by 12 months of age2 92.3 91.2 88.3 82.8 91.2 88.7 82.6 86.5 82.4 75.7 76.2 70.0 6.1 1,286 1 BCG, measles, and three doses each of DPT and polio vaccine (excludes hepatitis B) 2 For children whose information was based on the mother's report, the proportion of vaccinations received during the first year of life was assumed to be the same as for children with a written record of vaccination. 1 Note that hepatitis B vaccine is not included in the calculation of “All basic vaccinations.” 122 | Child Health Table 10.3 shows vaccination coverage for children age 12-23 months by background characteristics. The results are based on information from health cards and mothers’ reports. Health cards were available for only 43 percent of the children in this age group. Overall, 80 percent of children age 12-23 months have received all of the recommended vaccinations at some time before the survey. The corresponding figure from the 2003 NDHS is 70 percent (NSO and ORC Macro, 2004). Vaccination coverage is generally high for each type of vaccine; 94 percent of children have received the BCG vaccine, 93 percent have received the first dose of DPT, and 93 percent have received the first dose of polio vaccine. There is a decline in coverage for subsequent doses, with 86 percent of children receiving the third DPT dose and 85 percent receiving the third polio dose. Coverage rates for the third dose of hepatitis B and measles are 80 percent and 85 percent, respectively. Six percent of children have not received any vaccination. The corresponding proportion in 2003 was 7 percent (NSO and ORC Macro, 2004). Male children and urban children are slightly more likely than female children and rural children to have been vaccinated against the six preventable childhood diseases. Immunization coverage varies by background characteristics; for example, vaccination coverage declines as birth order increases, from 85 percent among first births to 64 percent among sixth and higher births. Immunization coverage also varies slightly by residence (81 percent in urban areas and 79 percent in rural areas), but there are large variations by region. ARMM has the lowest vaccination coverage rate (31 percent), while children in Western Visayas have the highest (92 percent). The percentage of children age 12-23 months who have received the six immunizations is 85 percent or higher in CALABARZON, Caraga, and Western Visayas. Full immunization coverage increases with mother’s level of education, from 26 percent among children whose mothers have no education to 87 percent among children whose mothers have college or higher education. In general, immunization coverage increases with wealth status; 64 percent of children in households in the poorest wealth quintile are fully immunized, compared with 87 percent of children in households in the highest wealth quintile. 94 93 90 86 93 90 85 88 85 80 85 80 6 BCG DPT 1 2 3 POLIO 1 2 3 HEPATITIS 1 2 3 Measles All No vaccinations 0 20 40 60 80 100 Percent Figure 10.1 Percentage of Children Age 12-23 Months Vaccinated at Anytime Before the Survey (Information from Health Cards and Mothers’ Reports) NDHS 2008 Note: "All" vaccinations includes BCG, measles, and three doses each of DPT and polio; hepatitis B is excluded. Child Health | 123 Table 10.3 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 2008 DPT Polio Hepatitis Background characteristic BCG 1 2 3 1 2 3 1 2 3 Measles All basic vaccina- tions1 No vaccina- tions Percent- age with a vaccina- tion card seen Number of children Sex Male 94.3 93.1 90.5 86.7 93.2 90.2 86.6 88.7 85.1 80.8 85.0 80.5 5.0 42.6 667 Female 93.4 91.8 88.6 84.3 91.9 89.7 83.6 87.8 85.1 79.7 83.8 78.5 6.2 42.3 619 Birth order 1 97.4 95.6 92.2 89.6 96.0 92.6 89.1 93.5 90.8 86.4 88.5 84.5 2.1 48.2 392 2-3 96.1 95.3 93.4 89.0 95.2 92.9 88.5 92.9 89.7 84.2 89.3 84.1 3.7 44.7 490 4-5 90.6 89.7 87.3 82.7 89.3 87.4 82.2 82.7 79.1 75.1 76.9 72.6 9.0 37.7 243 6+ 83.4 80.6 75.0 69.7 81.1 78.6 70.0 69.6 66.3 61.4 71.2 63.8 14.6 28.5 161 Residence Urban 96.2 94.6 92.2 88.2 94.4 92.2 87.2 90.5 88.8 83.2 86.8 82.3 3.5 43.3 635 Rural 91.6 90.4 87.1 82.9 90.7 87.9 83.2 86.1 81.5 77.4 82.1 76.8 7.5 41.7 650 Region National Capital Region 98.1 95.6 95.0 89.1 95.5 94.8 86.9 92.4 91.8 83.1 87.7 83.4 1.9 43.4 182 Cordillera Admin Region 92.7 96.1 91.1 85.8 94.4 91.0 84.0 94.4 89.2 82.3 90.8 84.0 3.9 45.8 23 I - Ilocos 96.9 92.3 86.4 81.8 93.9 89.4 83.4 89.3 86.3 83.2 84.9 75.8 3.1 31.7 62 II - Cagayan Valley 97.0 97.0 95.4 82.5 97.0 93.9 84.2 89.0 85.7 76.0 88.9 79.3 3.0 25.1 46 III - Central Luzon 95.9 95.0 88.1 82.9 93.2 88.1 84.8 89.0 84.8 80.3 85.4 77.9 4.1 41.6 136 IVA - CALABARZON 95.7 96.4 92.7 91.2 96.4 93.4 90.4 88.9 85.1 81.4 90.5 87.4 3.6 34.0 164 IVB - MIMAROPA 87.4 87.4 84.6 81.9 88.7 87.4 77.6 84.6 83.1 77.6 77.6 70.6 11.3 40.0 44 V - Bicol 93.9 91.7 89.4 79.9 91.7 88.1 81.1 88.1 84.5 76.3 78.3 71.3 6.1 44.2 82 VI - Western Visayas 96.1 96.1 95.0 95.0 96.1 96.1 95.0 95.0 92.7 90.4 91.5 91.5 3.9 60.1 91 VII - Central Visayas 97.7 95.6 94.5 92.3 95.6 94.5 92.3 93.1 90.9 87.5 86.2 82.9 2.3 66.8 97 VIII - Eastern Visayas 93.9 90.9 89.3 84.9 92.5 89.4 86.4 89.5 77.3 77.3 83.4 80.3 4.5 41.0 53 IX - Zamboanga Peninsula 90.5 92.1 92.1 86.0 92.1 92.1 86.0 81.4 81.4 78.3 83.0 81.5 7.9 30.4 51 X - Northern Mindanao 92.3 93.7 93.7 91.8 93.7 92.2 90.3 88.4 85.3 80.8 87.9 83.0 4.8 45.6 56 XI - Davao 95.2 92.0 92.0 88.9 93.6 93.6 85.7 91.9 90.4 88.8 88.9 84.1 4.8 51.8 53 XII - SOCCSKSARGEN 94.6 91.8 86.1 84.9 91.8 87.9 86.1 89.2 83.5 80.9 80.1 77.0 5.4 45.5 60 XIII - Caraga 100.0 100.0 98.2 94.7 100.0 94.7 91.1 100.0 96.5 91.1 96.5 89.4 0.0 54.7 30 ARMM 58.1 50.9 42.6 41.1 52.2 45.4 40.0 44.3 41.4 35.8 39.8 30.6 39.3 10.1 56 Mother's education No education (45.7) (44.2) (38.5) (35.8) (44.2) (41.5) (35.8) (38.5) (38.5) (35.8) (32.5) (25.9) (47.9) (19.1) 22 Elementary 85.0 82.0 79.1 73.5 83.4 80.1 73.6 75.7 71.8 65.3 71.8 65.9 14.4 34.5 291 High school 97.6 96.4 92.9 88.7 96.6 93.7 88.3 92.6 89.3 84.5 88.5 83.3 1.8 46.9 619 College 97.7 97.2 95.8 93.0 95.9 94.7 92.2 94.0 91.5 88.0 90.9 87.4 2.3 42.7 354 Wealth quintile Lowest 85.1 82.9 76.7 71.3 83.9 79.7 71.2 76.1 70.3 64.6 71.4 63.6 13.4 37.0 317 Second 94.1 92.3 90.8 86.7 92.8 90.7 86.7 89.3 87.5 81.3 85.1 81.6 5.7 43.3 290 Middle 97.5 95.4 92.3 88.5 95.4 91.6 88.2 89.0 86.1 82.7 86.8 82.3 2.0 45.1 256 Fourth 98.0 97.7 96.8 93.4 97.6 96.7 92.3 95.9 95.2 89.3 93.2 89.4 2.0 46.5 243 Highest 98.3 98.5 96.9 94.0 96.6 95.6 93.3 96.4 92.3 90.8 91.3 87.1 1.5 41.6 179 Total 93.9 92.5 89.6 85.6 92.6 90.0 85.2 88.2 85.1 80.3 84.5 79.5 5.6 42.5 1,286 Note: Figures in parentheses are based on 25-49 unweighted children. 1 BCG, measles, and three doses each of DPT and polio vaccine (excludes hepatitis B) 124 | Child Health 10.3 ACUTE RESPIRATORY INFECTION Acute respiratory infection (ARI) is a leading cause of childhood morbidity and mortality throughout the world. Early diagnosis and treatment with antibiotics can reduce the number of deaths caused by ARI, par- ticularly deaths from pneumonia. In the 2008 NDHS, the prevalence of ARI was estimated by asking mothers whether their children under age five had been ill with a cough accompanied by short, rapid breathing and difficulty breathing as a result of a problem in the chest, in the two weeks pre- ceding the survey. These symptoms are compatible with ARI. It should be noted that the morbidity data collected are subjective because they are based on the mother’s perception of illness, without validation by medical personnel. Table 10.4 shows that 5 percent of children under five years had symptoms of ARI at some time during the two weeks preceding the survey. Children age 6-11 months, children in rural areas, male children, and children whose mothers are in the poorest wealth quin- tile are more likely to show symptoms of ARI. Children whose mothers smoke and those whose households use wood or straw as a cooking fuel also are more likely to have had ARI symptoms. Symptoms of ARI are most often reported for children in SOCCSKSARGEN (12 percent). Among children with symptoms of ARI, 50 percent were taken to a health facility and 42 percent received antibiotics (Figure 10.2). Female children, children in urban areas, and those whose mothers have high school or higher education are the most likely to receive care when showing symptoms of ARI.2 2 Because of the small number of children with recent symptoms of ARI, details are not shown in the table. Table 10.4 Prevalence of symptoms of ARI Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey, according to background characteristics, Philippines 2008 Children under age five Background characteristic Percentage with symptoms of ARI1 Number of children Age in months <6 2.3 575 6-11 6.9 640 12-23 6.1 1,286 24-35 5.9 1,225 36-47 5.1 1,238 48-59 4.3 1,221 Sex Male 6.1 3,244 Female 4.3 2,941 Mother's smoking status Smokes cigarettes/tobacco 7.1 329 Does not smoke 5.1 5,856 Cooking fuel Electricity or gas 3.4 1,723 Kerosene 0.0 112 Charcoal 5.0 1,036 Wood/straw/agricultural crop 6.4 3,305 Residence Urban 4.2 3,037 Rural 6.2 3,148 Region National Capital Region 3.3 888 Cordillera Admin Region 3.5 102 I - Ilocos 4.9 290 II - Cagayan Valley 2.9 201 III - Central Luzon 4.0 613 IVA - CALABARZON 2.1 801 IVB - MIMAROPA 7.7 202 V - Bicol 6.9 410 VI - Western Visayas 10.2 432 VII - Central Visayas 7.8 442 VIII - Eastern Visayas 5.6 271 IX - Zamboanga Peninsula 3.3 258 X - Northern Mindanao 6.8 276 XI - Davao 5.2 284 XII - SOCCSKSARGEN 12.2 239 XIII - Caraga 6.2 177 ARMM 3.2 300 Mother's education No education 2.0 96 Elementary 7.0 1,499 High school 5.0 2,964 College 4.3 1,626 Wealth quintile Lowest 7.4 1,615 Second 5.4 1,419 Middle 5.1 1,188 Fourth 3.7 1,093 Highest 3.0 870 Total 5.2 6,185 Note: Total includes 8 children in households using coal/ lignite as fuel, or in which no food was cooked in the household. Figures in parentheses are based on 25-49 unweighted children; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Cough accompanied by short, rapid breathing that is chest-related; considered a proxy for pneumonia Child Health | 125 10.4 FEVER Fever is a symptom of various infectious diseases, such as measles, respiratory infections, typhoid, and dengue, which are common in the Philippines. Table 10.5 shows the percentage of children under five with fever during the two weeks preceding the survey and the percentage receiving various treatments, by selected background characteristics. Twenty-two percent of children under five were reported to have had fever in the two weeks preceding the survey. The prevalence of fever varies by age of child. Children age 6-11 months and 12-23 months are more likely to have fever (30 and 28 percent, respectively) than other children. Fever is more prevalent among children in rural areas (25 percent) than among those in urban areas (19 percent). Among the regions, fever prevalence ranges from 11 percent in Cagayan Valley to 33 percent in Northern Mindanao and SOCCSKSARGEN. Thirty percent or more of children in Eastern Visayas, Northern Mindanao, SOCCSKSARGEN, and Caraga were reported to have had fever in the two weeks preceding the survey. The prevalence of fever is higher among children in the two lowest wealth quintiles (25-26 percent) than among children in the three higher wealth quintiles. Among children under five who had fever in the two weeks preceding the survey, 39 percent were taken to a health facility or health provider and 30 percent received antibiotics as treatment. Treatment with antimalarial drugs is virtually non-existent. Figure 10.2 Prevalence and Treatment of Acute Respiratory Infection (ARI) in Children Under Age Five 5 50 42 Percentage of children under five with symptoms of Percentage of children under five with symptoms of Percentage of children under five with symptoms of 0 10 20 30 40 50 60 Percent NDHS 2008 Percentage of children under five with symptoms of ARI Among children with ARI, percentage who received antibiotics Among children with ARI, percentage taken to health facility or provider 126 | Child Health Table 10.5 Prevalence and treatment of fever Among children under age five, the percentage who had a fever in the two weeks preceding the survey; and among children with fever, the percentage for whom treatment was sought from a health facility or provider, the percentage who received antimalarial drugs and the percentage who received antibiotic drugs, by background characteristics, Philippines 2008 Children under age five with fever Children under age five Background characteristic Percentage with fever Number of children Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who received antimalarial drugs Percentage who received antibiotic drugs Number of children Age in months <6 17.7 575 40.8 0.0 28.0 102 6-11 29.9 640 45.9 0.0 28.8 192 12-23 27.7 1,286 43.4 0.0 34.3 357 24-35 22.5 1,225 38.4 0.0 30.6 275 36-47 19.6 1,238 30.6 0.3 25.7 243 48-59 17.8 1,221 37.1 0.0 28.3 217 Sex Male 23.4 3,244 39.9 0.1 29.5 759 Female 21.3 2,941 38.5 0.0 30.4 626 Residence Urban 19.3 3,037 47.0 0.0 31.6 586 Rural 25.4 3,148 33.7 0.1 28.6 799 Region National Capital Region 15.9 888 55.1 0.0 34.7 141 Cordillera Admin Region 14.6 102 42.2 0.0 18.2 15 I - Ilocos 23.3 290 29.0 0.0 20.5 68 II - Cagayan Valley 11.3 201 48.7 0.0 42.4 23 III - Central Luzon 21.5 613 47.8 0.0 34.9 132 IVA - CALABARZON 13.9 801 39.3 0.0 15.9 111 IVB - MIMAROPA 27.8 202 31.2 1.1 37.3 56 V - Bicol 25.8 410 47.4 0.0 21.4 106 VI - Western Visayas 24.9 432 41.9 0.0 24.5 107 VII - Central Visayas 26.2 442 42.4 0.0 44.1 116 VIII - Eastern Visayas 31.9 271 29.7 0.0 29.4 86 IX - Zamboanga Peninsula 23.7 258 33.2 0.0 26.8 61 X - Northern Mindanao 32.6 276 29.8 0.0 27.6 90 XI - Davao 25.1 284 42.6 0.0 45.6 71 XII - SOCCSKSARGEN 32.8 239 35.6 0.0 33.3 78 XIII - Caraga 32.2 177 24.9 0.0 22.6 57 ARMM 22.2 300 24.0 0.0 24.3 66 Mother's education No education 19.4 96 25.1 0.0 11.5 19 Elementary 24.1 1,499 36.7 0.2 28.3 361 High school 22.4 2,964 37.6 0.0 30.2 663 College 21.1 1,626 46.0 0.0 32.1 343 Wealth quintile Lowest 24.8 1,615 33.3 0.2 25.4 400 Second 25.8 1,419 38.4 0.0 34.2 367 Middle 23.0 1,188 37.4 0.0 28.6 274 Fourth 19.4 1,093 43.8 0.0 32.6 212 Highest 15.2 870 56.5 0.0 29.9 132 Total 22.4 6,185 39.3 0.0 29.9 1,385 1 Excludes pharmacy, shop, and traditional practitioner Child Health | 127 10.5 DIARRHEAL DISEASE AND RELATED FINDINGS 10.5.1 Prevalence of Diarrhea Table 10.6 shows the percentage of chil- dren under five with diarrhea in the two weeks preceding the survey, according to background characteristics. Overall, 9 percent of children under five years had diarrhea in the two weeks preceding the survey. This is a slight decrease from 2003, when the prevalence was 11 percent (NSO and ORC Macro, 2004). Only a small fraction of children (less than 1 percent) had diarrhea with blood, a symptom of dysentery. Diarrhea is more prevalent among chil- dren age 12-23 months, children whose mothers have elementary education, and children in the poorer wealth quintiles. Prevalence of diarrhea varies across regions from 5 percent in Bicol to 16 percent in SOCCSKSARGEN. 10.5.2 Diarrhea Treatment Table 10.7 shows the percentage of children under five years with diarrhea in the two weeks preceding the survey who received specific treatments. Thirty-four percent of chil- dren who were reported to have diarrhea were taken to a health facility for treatment. This fig- ure is slightly higher than that reported in the 2003 NDHS (32 percent) (NSO and ORC Macro, 2004). As shown in Table 10.7, 59 per- cent of children with diarrhea were treated with oral rehydration therapy (ORT), either oral rehydration salts (ORS) or recommended home fluids (RHF). Other treatments for diarrhea in- clude home remedies (27 percent), antibiotic drugs (17 percent), anti-motility drugs (8 per- cent), and zinc supplements (2 percent). Sixteen percent of children with diarrhea did not receive any treatment; however, this figure is lower than that reported in the 2003 NDHS (22 percent) (NSO and ORC Macro, 2004). Table 10.6 Prevalence of diarrhea Percentage of children under age five who had diarrhea in the two weeks preceding the survey, by background characteristics, Philippines 2008 Diarrhea in the two weeks preceding the survey Background characteristic All diarrhea Diarrhea with blood Number of children Age in months <6 5.3 0.6 575 6-11 14.6 0.9 640 12-23 16.0 0.6 1,286 24-35 10.0 0.6 1,225 36-47 5.5 0.6 1,238 48-59 3.1 0.2 1,221 Sex Male 9.5 0.7 3,244 Female 8.5 0.4 2,941 Source of drinking water1 Improved 9.0 0.4 5,397 Not improved 9.1 1.4 636 Other/missing 10.1 1.5 152 Toilet facility2 Improved, not shared 8.5 0.5 3,623 Non-improved or shared 10.1 0.6 2,470 Missing 5.4 0.6 92 Residence Urban 8.8 0.5 3,037 Rural 9.3 0.6 3,148 Region National Capital Region 7.5 0.3 888 Cordillera Admin Region 6.6 0.8 102 I - Ilocos 10.7 0.3 290 II - Cagayan Valley 7.6 0.7 201 III - Central Luzon 10.8 0.2 613 IVA - CALABARZON 9.1 0.4 801 IVB - MIMAROPA 11.5 0.9 202 V - Bicol 5.0 0.5 410 VI - Western Visayas 12.8 1.0 432 VII - Central Visayas 8.0 0.7 442 VIII - Eastern Visayas 9.5 0.3 271 IX - Zamboanga Peninsula 7.4 0.3 258 X - Northern Mindanao 6.6 0.9 276 XI - Davao 5.5 1.2 284 XII - SOCCSKSARGEN 16.2 1.1 239 XIII - Caraga 9.6 0.6 177 ARMM 10.7 0.5 300 Mother's education No education 4.6 0.0 96 Elementary 10.7 1.1 1,499 High school 9.2 0.5 2,964 College 7.4 0.2 1,626 Wealth quintile Lowest 10.3 1.1 1,615 Second 11.1 0.3 1,419 Middle 8.1 0.6 1,188 Fourth 6.9 0.0 1,093 Highest 7.4 0.5 870 Total 9.0 0.5 6,185 1 See Table 2.5 for definition of categories. 2 See Table 2.6 for definition of categories. 128 | Child Health Table 10.7 Diarrhea treatment Among children under age five who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who received oral rehydration therapy (ORT), the percentage who received increased fluids, the percentage who received ORT or increased fluids, and the percentage who received other treatments, by background characteristics, Philippines 2008 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage of children with diarrhea for whom advice or treatment was sought from a health facility or provider1 ORS packets or pre- pack- aged liquid Recom- mended home fluids (RHF) Either ORS or RHF In- creased fluids ORT or in- creased fluids Anti- biotic drugs Anti- motility drugs Zinc supple- ments Intra- venous solution Home remedy/ other No treat- ment Number of children Age in months <6 (12.9) (33.4) (24.7) (55.5) (13.6) (58.0) (11.2) (0.0) (1.8) (0.0) (19.8) (35.4) 31 6-11 47.7 40.2 15.2 51.6 33.2 69.0 21.4 8.7 5.6 0.0 21.4 22.9 94 12-23 36.1 54.1 21.4 65.1 34.3 75.2 16.5 6.7 0.4 0.0 25.3 15.2 206 24-35 28.8 40.7 22.5 54.0 42.8 71.1 19.7 8.0 0.0 0.0 39.2 10.3 122 36-47 27.5 47.7 24.5 58.3 40.4 76.1 9.1 14.5 0.0 0.0 19.6 11.2 69 48-59 (37.5) (47.4) (25.1) (58.6) (38.0) (77.3) (22.3) (11.8) (4.6) (1.0) (28.1) (11.3) 38 Sex Male 31.8 49.3 22.1 59.9 36.7 73.8 17.3 8.0 2.0 0.1 21.9 16.6 308 Female 37.2 43.1 20.5 57.0 34.9 71.1 17.1 8.6 0.8 0.0 33.0 14.8 251 Type of diarrhea Non bloody 33.4 47.0 20.9 58.8 36.2 73.0 15.8 8.4 1.0 0.1 26.7 15.7 524 Bloody (47.6) (36.9) (26.4) (54.7) (32.0) (64.0) (36.1) (6.5) (9.2) (0.0) (30.3) (17.1) 34 Residence Urban 37.4 57.7 17.6 66.2 40.3 79.5 16.8 10.6 2.2 0.0 25.0 11.8 266 Rural 31.3 36.3 24.9 51.7 31.8 66.3 17.6 6.1 0.9 0.1 28.5 19.4 294 Mother's education No education * * * * * * * * * * * * 4 Elementary 31.6 36.2 31.2 54.0 37.8 68.8 13.0 6.5 0.6 0.0 38.6 18.1 161 High school 34.9 48.7 17.6 58.9 33.9 72.1 21.9 9.9 2.2 0.1 21.9 15.6 274 College 37.4 56.1 16.9 64.7 38.9 79.9 11.9 7.1 1.1 0.0 21.2 13.7 121 Wealth quintile Lowest 30.4 37.3 24.6 54.5 30.6 67.8 10.7 10.3 0.0 0.2 35.8 16.8 167 Second 28.8 42.2 19.1 53.7 31.7 69.3 17.0 10.1 1.4 0.0 26.5 19.3 157 Middle 37.4 55.5 24.2 65.8 34.3 74.6 24.3 6.7 2.5 0.0 23.9 10.4 96 Fourth 37.3 57.1 19.6 63.3 46.9 79.6 16.3 6.4 0.0 0.0 19.6 17.0 75 Highest 48.8 54.7 16.7 64.9 49.0 81.6 25.0 3.3 5.7 0.0 17.7 11.2 65 Total 34.2 46.5 21.4 58.6 35.9 72.6 17.2 8.3 1.5 0.1 26.9 15.8 560 Note: ORT includes solution prepared from oral rehydration salt (ORS), pre-packaged ORS packet, and recommended home fluids (RHF). Figures in parentheses are based on 25-49 unweighted children; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes pharmacy, shop and traditional practitioner Mother’s level of education is related to whether treatment was sought for the child’s diarrheal illness. Better-educated mothers were more likely than less educated mothers to seek advice or to administer ORS to their children with diarrhea. Use of ORT (ORS or RHF) varies by background characteristics. Children in urban areas with diarrhea were more likely than those in rural areas to be treated with either ORS or RHF (66 and 52 percent, respectively). Mother’s level of education and household wealth status are related to the type of treatment received by children with diarrheal disease. For example, the proportion of children treated with ORS or RHF increases from 54 percent among those whose mothers had elementary education to 65 percent of those whose mothers attended college. Child Health | 129 10.5.3 Feeding Practices during Diarrhea Mothers are encouraged to continue normal feeding of children with diarrhea and to increase the amount of fluids given. These practices help to reduce dehydration and minimize the adverse consequences of diarrhea on children’s nutritional status. Table 10.8 presents information on feeding practices among children with diarrhea in the two weeks preceding the survey. The results show that 36 percent of children with diarrhea received more fluids than usual, while 46 percent received the same amount of fluids. Seventeen percent of children with diarrhea received less fluids, which is contraindicated during an episode of diarrhea. Table 10.8 Feeding practices during diarrhea Percent distribution of children under age five who had diarrhea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, the percentage of children given increased fluids and continued feeding during the diarrhea episode, and the percentage of children who continued feeding and were given ORT and/or increased fluids during the episode of diarrhea, by background characteristics, Philippines 2008 Amount of liquids offered Amount of food offered Background characteristic More Same as usual Some- what less Much less None Don’t know/ missing Total More Same as usual Some- what less Much less None Don't know/ missing Total Percentage who continued feeding and received increased fluids1 Percentage who continued feeding and received ORT and /or increased fluids1 Number of children with diarrhea Age in months <6 (13.6) (65.7) (7.4) (3.4) (9.8) (0.0) 100.0 (1.8) (28.0) (14.5) (2.6) (51.0) (2.1) 100.0 (6.3) (34.4) 31 6-11 33.2 46.5 12.7 7.6 0.0 0.0 100.0 14.2 49.3 21.6 7.4 7.6 0.0 100.0 26.8 57.8 94 12-23 34.3 48.6 11.1 5.5 0.4 0.0 100.0 9.9 51.6 21.6 16.0 0.9 0.0 100.0 26.3 60.7 206 24-35 42.8 42.8 7.8 3.8 1.1 1.6 100.0 13.1 49.8 23.3 8.4 4.0 1.3 100.0 34.3 59.9 122 36-47 40.4 35.0 10.8 13.8 0.0 0.0 100.0 11.0 51.8 19.3 18.0 0.0 0.0 100.0 31.7 62.4 69 48-59 (38.0) (44.3) (8.2) (5.3) (1.8) (2.5) 100.0 (11.4) (46.9) (25.0) (12.6) (0.0) (4.2) 100.0 (36.1) (71.3) 38 Sex Male 36.7 44.9 11.7 5.4 1.0 0.3 100.0 13.1 47.9 20.6 12.2 5.6 0.7 100.0 28.8 60.1 308 Female 34.9 47.3 8.5 7.6 1.1 0.7 100.0 8.8 50.8 22.6 12.2 4.9 0.7 100.0 27.8 58.8 251 Type of diarrhea Non bloody 36.2 45.9 10.3 6.1 1.1 0.4 100.0 10.4 50.0 21.6 12.0 5.3 0.7 100.0 28.7 60.1 524 Bloody (32.0) (48.6) (5.8) (10.6) (0.0) (3.1) 100.0 (22.9) (39.2) (17.1) (15.3) (5.5) (0.0) 100.0 (24.5) (50.3) 34 Residence Urban 40.3 44.4 8.8 5.3 0.0 1.1 100.0 11.9 52.5 14.8 13.8 6.3 0.7 100.0 30.2 63.5 266 Rural 31.8 47.4 11.5 7.4 2.0 0.0 100.0 10.4 46.2 27.6 10.7 4.3 0.7 100.0 26.7 56.0 294 Mother's education No education * * * * * * 100.0 * * * * * * 100.0 * * 4 Elementary 37.8 45.4 8.3 6.5 2.0 0.0 100.0 12.9 42.6 24.1 13.3 5.9 1.3 100.0 28.1 54.8 161 High school 33.9 46.8 11.1 6.4 0.7 1.1 100.0 11.3 51.8 19.9 10.5 5.8 0.7 100.0 26.7 60.6 274 College 38.9 44.2 10.6 5.8 0.6 0.0 100.0 8.7 51.5 22.4 14.0 3.4 0.0 100.0 33.5 64.7 121 Wealth quintile Lowest 30.6 47.8 10.7 8.7 2.2 0.0 100.0 11.1 47.4 26.1 9.5 5.1 0.8 100.0 26.1 58.5 167 Second 31.7 47.0 13.6 5.3 0.7 1.9 100.0 8.4 47.6 25.1 12.3 4.9 1.6 100.0 22.2 57.0 157 Middle 34.3 51.1 7.5 7.1 0.0 0.0 100.0 9.8 54.8 14.1 14.4 6.8 0.0 100.0 24.3 58.0 96 Fourth 46.9 37.1 8.7 5.6 1.6 0.0 100.0 9.7 52.2 18.5 15.0 4.7 0.0 100.0 38.3 64.4 75 Highest 49.0 41.4 6.8 2.8 0.0 0.0 100.0 21.4 45.8 15.6 12.3 4.8 0.0 100.0 43.5 65.0 65 Total 35.9 46.0 10.2 6.4 1.0 0.5 100.0 11.1 49.2 21.5 12.2 5.3 0.7 100.0 28.4 59.6 560 Note: Figures in parentheses are based on 25-49 unweighted children; an asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Continued feeding includes children who received more, same as usual, or somewhat less food during the diarrhea episode 130 | Child Health Diarrheal episodes are frequently accompanied by vomiting, which makes feeding difficult because the child may refuse food. Table 10.8 shows that only 11 percent of children received more food than usual, while 49 percent received the same amount of food. Five percent of children received no food at all. Overall, 60 percent of children with diarrhea continued feeding at more or less the same level as usual, and received ORT and/or increased fluids. Differences by background characteristics in feeding practices among children with diarrhea are not large. Children in urban areas are more likely than those in rural areas to receive increased fluids and continued feeding during a diarrheal episode. Better-educated mothers and mothers in the highest wealth quintiles are more likely than other mothers to give increased fluids and continued feeding to their children with diarrhea. 10.5.4 Knowledge of ORS Packets A simple and effective response to dehydration caused by diarrhea is prompt increase in the child’s fluid intake through some form of oral rehydration therapy (ORT) that includes administering a solution prepared from packets of oral rehydration salts (ORS) or pre- packaged ORS liquid. The 2008 NDHS included questions to deter- mine the level of knowledge of ORS, such as Oresol, Hydrite, and Pedialyte, for diarrhea treatment among women who had a birth in the five years before the survey. Knowledge of ORS is based on whether a mother has seen or heard of ORS, or used ORS to treat one of her children with diarrhea in the two weeks preceding the survey. Table 10.9 shows a high level of knowledge of ORS packets among Filipino mothers (92 percent). Knowledge of ORS increases with age, education, and economic status. It is also higher among mothers in urban areas than those in rural areas. Teenage mothers, those with no education, and mothers in the poorest wealth quintile are the least likely to know about ORS. Across regions, knowledge about ORS ranges from 76 percent in ARMM to 96 percent in Central Luzon. Table 10.9 Knowledge of ORS packets or pre-packaged liquids Percentage of mothers age 15-49 with a birth in the five years preceding the survey who know about ORS packets or ORS pre-packaged liquids for treatment of diarrhea, by background characteristics, Philippines 2008 Background characteristic Percentage of women who know about ORS packets or ORS pre- packaged liquids Number of women Age 15-19 72.8 199 20-24 85.0 879 25-34 94.7 2,291 35-49 94.1 1,220 Residence Urban 94.8 2,283 Rural 88.7 2,307 Region National Capital Region 95.2 688 Cordillera Admin Region 92.0 72 I - Ilocos 94.4 218 II - Cagayan Valley 92.7 142 III - Central Luzon 96.1 468 IVA - CALABARZON 94.6 602 IVB - MIMAROPA 88.6 151 V - Bicol 94.0 280 VI - Western Visayas 94.7 324 VII - Central Visayas 92.8 328 VIII - Eastern Visayas 92.2 196 IX - Zamboanga Peninsula 84.0 189 X - Northern Mindanao 86.7 198 XI - Davao 87.4 224 XII - SOCCSKSARGEN 83.5 178 XIII - Caraga 88.6 124 ARMM 76.1 207 Education No education 54.3 68 Elementary 84.8 1,061 High school 92.9 2,198 College 97.5 1,263 Wealth quintile Lowest 83.7 1,103 Second 92.8 1,007 Middle 93.1 906 Fourth 96.1 863 Highest 95.6 711 Total 91.7 4,590 ORS = Oral rehydration salts Child Health | 131 10.5.5 Disposal of Children’s Stools Poor personal hygienic practices contribute to the spread of diarrhea. The proper disposal of children’s stools is extremely important in preventing the spread of diarrheal disease. If stools are left uncontained, disease may spread by direct contact or through animal contact. The 2008 NDHS gathered information from mothers on the most recent practices used to dispose of the stools of the youngest child living with them. This information is useful in the evaluation of diarrhea prevention in the country. Table 10.10 shows that half of the women disposed of their youngest child’s stools safely, i.e., contained in one of three ways: the child used the toilet or latrine, stools were thrown into the toilet or latrine, or stools were buried in the yard. The remaining women disposed of their children’s stools improperly, such as by throwing them into drains or garbage or rinsing them away. The use of proper practices for the disposal of children’s stools increases with children’s age and mother’s level of education. Stools of children age 48-59 months are much more likely to be disposed of safely (88 percent) than those of younger children. Mothers with college or higher education are much more likely to dispose of their children’s stools safely (55 percent) than mothers with no education (37 percent). Access to a private toilet facility increases the likelihood that a child’s stools are disposed of safely; 54 percent of children in households with an improved, private toilet facility have their stools disposed of safely, compared with 43 percent of children in households without an improved, private toilet facility. Across regions, SOCCSKSARGEN has the highest percentage of young children whose stools are disposed of safely (64 percent), while ARMM has the lowest percentage (37 percent). 132 | Child Health Table 10.10 Disposal of children's stools Percent distribution of youngest children under age five living with the mother by the manner of disposal of the child's last fecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Philippines 2008 Manner of disposal of children's stools Background characteristic Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Rinsed away Other Missing Total Percentage of children whose stools are disposed of safely Number of children Age in months <6 0.2 6.8 3.4 20.6 60.5 2.5 5.5 0.5 100.0 10.4 569 6-11 2.0 11.9 6.2 10.6 58.5 3.1 6.4 1.3 100.0 20.1 627 12-23 12.5 15.7 10.3 5.6 44.6 6.0 5.2 0.2 100.0 38.4 1,148 24-35 41.9 11.6 11.8 3.5 20.3 5.4 5.2 0.3 100.0 65.3 856 36-47 61.2 9.0 9.7 2.0 6.6 5.9 4.6 1.0 100.0 79.8 662 48-59 77.5 6.2 4.2 0.3 3.5 3.6 3.7 0.8 99.9 87.9 556 Toilet facility Improved, not shared1 37.2 11.9 5.2 5.2 36.1 2.1 1.8 0.7 100.0 54.2 2,649 Non-improved or shared 20.2 9.4 13.2 8.6 28.7 8.8 10.6 0.5 100.0 42.8 1,698 Missing 33.5 17.8 5.6 15.5 23.0 4.5 0.0 0.0 100.0 57.0 70 Residence Urban 36.1 10.3 3.7 3.2 40.9 1.9 3.0 0.7 100.0 50.2 2,169 Rural 25.2 11.6 12.6 9.9 25.5 7.4 7.1 0.5 100.0 49.5 2,248 Region National Capital Region 44.3 6.4 0.2 0.8 44.4 0.4 2.7 0.9 100.0 50.9 641 Cordillera Admin Region 32.2 15.3 1.1 10.3 28.4 10.9 0.5 1.2 100.0 48.6 71 I - Ilocos 30.2 8.2 7.0 3.5 44.9 5.3 0.4 0.4 100.0 45.4 215 II - Cagayan Valley 27.9 20.2 6.5 5.3 34.3 4.8 1.1 0.0 100.0 54.5 137 III - Central Luzon 32.7 7.1 9.4 4.7 41.6 1.6 1.8 1.1 100.0 49.2 460 IVA - CALABARZON 36.0 8.1 3.7 1.0 48.1 1.3 1.4 0.4 100.0 47.8 579 IVB - MIMAROPA 21.5 16.7 13.5 7.8 22.2 11.9 5.1 1.3 100.0 51.7 145 V - Bicol 20.0 8.1 10.1 19.8 25.8 8.4 7.7 0.0 100.0 38.3 277 VI - Western Visayas 24.3 16.7 15.2 5.4 23.8 8.0 5.9 0.7 100.0 56.2 313 VII - Central Visayas 23.1 7.5 13.4 5.2 34.9 11.9 3.6 0.4 100.0 44.1 307 VIII - Eastern Visayas 30.2 5.1 11.5 8.5 22.3 10.9 11.5 0.0 100.0 46.8 190 IX - Zamboanga Peninsula 23.4 19.1 5.6 13.5 19.3 8.8 10.3 0.0 100.0 48.2 184 X - Northern Mindanao 34.1 13.1 15.8 10.8 18.5 1.9 5.0 0.9 100.0 62.9 192 XI - Davao 27.1 19.1 11.5 12.3 18.9 2.4 5.9 2.4 99.6 57.8 213 XII - SOCCSKSARGEN 29.6 11.3 23.5 6.8 23.9 0.5 4.5 0.0 100.0 64.4 173 XIII - Caraga 33.9 17.5 3.5 10.7 19.2 3.2 11.6 0.4 100.0 54.9 121 ARMM 16.4 18.1 2.8 13.4 19.7 6.1 23.5 0.0 100.0 37.3 200 Education No education 13.0 12.6 11.3 10.5 13.7 13.7 25.3 0.0 100.0 36.8 66 Elementary 21.2 10.3 12.4 9.9 24.9 10.9 9.8 0.6 100.0 43.9 1,023 High school 30.5 10.6 9.1 6.5 34.4 3.7 4.3 0.9 100.0 50.2 2,101 College 39.5 12.2 3.2 3.9 38.5 0.8 1.5 0.3 99.9 54.9 1,227 Wealth quintile Lowest 15.0 9.8 15.2 12.4 20.8 12.9 13.3 0.6 100.0 39.9 1,071 Second 26.7 13.5 11.4 8.8 28.6 4.1 6.1 0.8 100.0 51.5 985 Middle 36.8 11.6 6.8 4.6 35.2 2.2 2.0 0.8 99.9 55.2 875 Fourth 38.8 9.9 2.5 3.3 43.2 1.1 0.7 0.4 100.0 51.2 833 Highest 43.3 9.9 1.5 0.9 44.1 0.0 0.0 0.4 100.0 54.7 653 Total 30.6 11.0 8.3 6.6 33.1 4.7 5.1 0.6 100.0 49.8 4,417 1 Non-shared facilities of the following types: flush or pour flush into a piped sewer system/septic tank/pit latrine; ventilated, improved pit (VIP) latrine; pit latrine with a slab; and a composting toilet. Nutrition of Children and Women | 133 NUTRITION OF CHILDREN AND WOMEN 11 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 because of its health 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 advocates breastfeeding for nursing mothers instead of using breast milk substitutes. Republic Act 7600, known as “The Rooming-In and Breastfeeding Act of 1992,” provides incentives to all government and private health institutions in the Philippines that support rooming-in and breastfeeding. The Act provides that newborn infants with normal deliveries be put to the mother’s breast immediately after birth, and roomed-in within 30 minutes; infants delivered by caesarean section should be roomed-in and breastfed within 3 to 4 hours after delivery. The introduction of supplementary foods at age four to six months is important for the nutritional health and well-being of the growing child. Early supplemental feeding, however, is discouraged because it 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. Complementary feeding is recommended at ages 6 to 24 months. This is a vulnerable period for the child because it is when breast milk is no longer sufficient to meet his/her nutritional needs. This chapter presents information on breastfeeding and supplementation among infants. It discusses various aspects of breastfeeding, including the prevalence and initiation of breastfeeding and prelacteal feeding, and the duration and frequency of breastfeeding. The chapter presents survey results on supplementary feeding, specifically, the types of food supplements and the frequency of feeding. The micronutrient intake of children and of the mothers in the first two months after delivery is discussed in this chapter. 11.1 INITIATION OF BREASTFEEDING AND PRELACTEAL FEEDING The survey results indicate that the prevalence of breastfeeding in the Philippines has not changed over the past two decades. Table 11.1 shows that 88 percent of the children born in the five years preceding the 2008 National Demographic Health Survey (NDHS) had been breastfed at some time (ever breastfed), meaning that the other 12 percent were not breastfed at all. The proportion of children ever breastfed in the previous NDHS surveys was 87 percent in 2003, 88 percent in 1998, and 87 percent in 1993. The proportion ever breastfed does not vary by sex and children in urban areas are less likely to be breastfed than those in rural areas (83 and 92 percent, respectively). While breastfeeding is commonly practiced in all regions, children in CALABARZON are the least likely to have ever been breastfed (77 percent) and children in Bicol and Cordillera Administrative Region are the most likely to be breastfed (95 and 94 percent, respectively). 134 | Nutrition of Children and Women Table 11.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and for last-born children ever breastfed, the percentage who started breastfeeding within one hour and within one day of birth, and the percentage who received a prelacteal feed, by background characteristics, Philippines 2008 Breastfeeding among children born in past five years Among last-born children ever breastfed: Background characteristic Percentage ever breastfed Number of children born in past five years Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 86.8 3,351 52.8 82.3 55.4 2,148 Female 88.6 3,008 54.3 81.6 53.5 1,951 Residence Urban 83.1 3,105 52.5 79.4 57.7 1,942 Rural 92.1 3,255 54.4 84.4 51.6 2,157 Region National Capital Region 80.7 903 49.1 82.3 52.0 576 Cordillera Admin Region 94.4 104 56.2 89.5 16.2 69 I - Ilocos 91.2 296 54.2 82.1 54.7 199 II - Cagayan Valley 91.5 212 61.7 84.0 55.2 132 III - Central Luzon 88.4 629 26.3 71.0 74.2 417 IVA - CALABARZON 77.2 810 53.3 78.5 60.1 479 IVB - MIMAROPA 90.9 209 44.9 79.3 56.2 136 V - Bicol 94.9 421 47.1 88.7 43.3 272 VI - Western Visayas 89.6 452 66.9 84.6 59.3 296 VII - Central Visayas 90.8 459 75.3 89.7 47.7 301 VIII - Eastern Visayas 91.6 283 58.6 81.6 41.4 180 IX - Zamboanga Peninsula 87.1 261 40.6 77.7 68.4 164 X - Northern Mindanao 93.7 282 75.1 91.9 42.3 191 XI - Davao 91.6 295 57.1 87.2 42.6 211 XII - SOCCSKSARGEN 93.1 245 58.4 82.6 56.6 171 XIII - Caraga 88.9 180 60.0 88.8 55.1 111 ARMM 89.5 318 51.9 69.8 59.3 192 Mother's education No education 92.3 106 73.7 89.4 35.4 64 Elementary 92.0 1,552 55.2 85.8 48.1 992 High school 87.5 3,054 54.8 83.0 55.7 1,980 College 83.8 1,647 48.3 76.2 59.4 1,063 Assistance at delivery Health professional3 85.3 3,959 50.7 80.0 56.6 2,610 Hilot 91.8 2,313 58.3 85.6 51.5 1,439 Other 90.7 67 62.4 87.4 34.1 40 Place of delivery Health facility 83.7 2,809 49.7 77.8 54.2 1,828 At home 90.9 3,531 56.7 85.5 54.7 2,265 Wealth quintile Lowest 93.9 1,686 59.0 85.2 47.7 1,056 Second 90.5 1,460 54.1 83.0 54.8 930 Middle 87.2 1,219 50.9 83.4 56.8 812 Fourth 82.2 1,114 50.3 79.8 56.6 732 Highest 78.8 880 50.3 75.3 60.4 569 Total 87.7 6,359 53.5 82.0 54.5 4,099 Note: Table is based on births in the five years preceding the survey, regardless of survival status. Totals for assistance at delivery and place of delivery include some births with information missing. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life 3 Doctor, nurse or midwife Nutrition of Children and Women | 135 The mother’s socioeconomic status is associated 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 94 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; better-educated mothers are less likely to breastfeed their children than 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 or hilot (85 percent compared with 92 percent). Similarly, children delivered in a health facility are less likely to be breastfed than those who were born at home (84 percent compared with 91 percent). Early initiation of breastfeeding is beneficial to both infant and mother. Placing the infant at the breast immediately after birth and early suckling stimulates the release of a hormone that helps the uterus contract to its normal size more rapidly, thus reducing the mother’s blood loss. Also, for approximately three days after delivery, the breasts secrete colostrum, which is yellow and thicker than the later breast milk. It contains a high concentration of antibodies that protect infants against certain infectious diseases. Delay in putting the infant to the breast and initial bottle-feeding may result in the colostrum being lost to the infant. The 2008 NDHS results show that 54 percent of children born in the five years before the survey who were ever breastfed were given breast milk within one hour of birth and 82 percent were put to the breast within 24 hours of birth (Table 11.1). There has been little change in these proportions over the past five years. In the 2003 NDHS, initiation of breastfeeding within one hour of birth was also 54 percent among children who were ever breastfed, while initiation within 24 hours was slightly lower, 80 percent of children ever breastfed (NSO and ORC Macro, 2004).1 Initiation of breastfeeding does not vary by the child’s sex and type of residence. However, it differs across regions. Putting the infant to the breast soon after birth is not a common practice in Central Luzon. Mothers in Central Visayas and Northern Mindanao, on the other hand, are more likely to give their children breast milk immediately after birth than mothers in other regions. Children in poorer households are breastfed somewhat sooner after birth than those in wealthier households. The likelihood that a child will receive breast milk within the first hour or first day of birth is negatively associated with the mother’s level of education; it is higher among children born to mothers with no formal education or with elementary or high school education than among children whose mothers attended college. The prevalence of breastfeeding within one hour after birth varies by assistance at delivery and place of delivery. Children born at home are more likely put to the breast within one hour of birth than those born in a health facility (57 and 50 percent, respectively), while babies delivered with the assistance of a traditional birth attendant or hilot are more likely to be breastfed within one hour of birth than those delivered by a health professional (58 and 51 percent, respectively). 1 The 2008 data on initiation of breastfeeding are based on the last live birth in the five years preceding the survey, while the 2003 data were based on all live births in the five years preceding the survey. This would not be expected to make a sizeable difference in results. 136 | Nutrition of Children and Women Prelacteal feeds, or liquid and/or nonliquid feeds given to newborns before the mother’s milk begins 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 suckling 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. 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 feeds is shown in Table 11.1. More than half of children (55 percent) who were ever breastfed received prelacteal feeds in the first three days after delivery. Prelacteal feeding does not vary by the child’s sex. Unlike breastfeeding, prelacteal liquid feeding is slightly more common in urban than in rural areas (58 compared with 52 percent). Among the regions, Central Luzon has the highest percentage of children given prelacteal feeds (74 percent), and Cordillera Administrative Region (CAR) has the lowest proportion (16 percent). Children in wealthier households, 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. As shown in Figure 11.1, most children who are given prelacteal feeds are given plain water (56 percent), infant formula (33 percent), or other milk (15 percent). Only small proportions of children are given other liquids before starting breastfeeding. Figure 11.1 Among Youngest Children Born in the Five Years Preceding the Survey, Percentage Who Received Specific Prelacteal Liquids 15 33 56 4 2 1 5 3 2 7 2 Milk other than breast milk Infant formula Plain water Sugar or glucose water Gripe water Sugar- salt- water- solution Fruit juice Tea Honey Multi- vitamins Other 0 10 20 30 40 50 60 70 Percent NDHS 2008 PRELACTEAL LIQUID Milk other than breast milk Nutrition of Children and Women | 137 11.2 BREASTFEEDING STATUS BY AGE For children born in the three years preceding survey, mothers were asked about the liquids and foods consumed in the day and the night preceding the interview. The information is used to determine breastfeeding status: whether the child is exclusively breastfed, or is breastfeeding and consuming plain water only, water-based liquids/juices, other milk, or any solid/semi-solid foods. Children classified as exclusively breastfed received nothing but breast milk in the 24 hours before the interview. Breastfeeding children who received solid/semisolid foods and/or non-breast milk in the 24 hours preceding the interview are classified as receiving complementary foods. Table 11.2 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 children in the Philippines are given supplemental foods very early. Among infants under two months, 8 percent are not being breastfed, one in two infants (50 percent) is exclusively breastfed, and two in five infants (42 percent) receive either plain water only (18 percent), other milk (23 percent), or complementary foods (1 percent) in addition to breast milk. At age 6-9 months, 37 percent of infants are not being breastfed, and only 3 percent are exclusively breastfed. At age 6 months and older, virtually all infants have received liquids or foods other than breast milk (Figure 11.2). Comparison with data from the 2003 NDHS shows that the prevalence of exclusive breastfeeding among infants under 6 months has remained at 34 percent (NSO and ORC Macro, 2004). Table 11.2 Breastfeeding status by age Percent distribution of youngest children under three years living with their mother by breastfeeding status and percentage currently breastfeeding; and among all children under three years, the percentage using a bottle with a nipple, according to age in months, Philippines 2008 Percent distribution of youngest children under three living with their mother by breastfeeding status Breastfeeding and consuming Age in months Not breast- feeding Exclusively breastfed Plain water only Non-milk liquids/ juice Other milk Comple- mentary foods Total Percentage currently breast- feeding Number of youngest child under three years Percentage using a bottle with a nipple1 Number of children under three years 0-1 8.4 49.6 17.6 0.0 23.3 1.0 100.0 91.6 141 34.6 143 2-3 14.8 34.3 20.3 1.2 24.4 4.9 100.0 85.2 231 42.3 233 4-5 25.8 22.6 14.7 2.5 11.1 23.3 100.0 74.2 197 43.7 199 6-8 37.4 2.8 2.2 0.0 0.8 56.8 100.0 62.6 306 48.3 311 9-11 36.3 2.2 0.0 0.0 0.1 61.3 100.0 63.7 321 52.6 329 12-17 46.1 0.7 0.2 0.0 0.0 53.0 100.0 53.9 608 53.4 648 18-23 61.7 0.9 0.1 0.0 0.0 37.3 100.0 38.3 540 50.4 638 24-35 82.8 0.2 0.0 0.0 0.0 17.0 100.0 17.2 856 40.5 1,225 0-3 12.4 40.1 19.3 0.7 24.0 3.4 100.0 87.6 371 39.3 376 0-5 17.1 34.0 17.7 1.3 19.5 10.3 100.0 82.9 569 40.9 575 6-9 36.9 2.9 1.6 0.0 0.6 58.0 100.0 63.1 422 48.4 429 12-15 42.3 0.7 0.0 0.0 0.0 57.0 100.0 57.7 427 50.5 449 12-23 53.4 0.8 0.2 0.0 0.0 45.6 100.0 46.6 1,148 51.9 1,286 20-23 65.8 0.4 0.0 0.0 0.0 33.8 100.0 34.2 377 51.6 459 Note: Breastfeeding status refers to a 24-hour period (yesterday and the past night). Children classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories “not breastfeeding,” “exclusively breastfed,” “breastfeeding and consuming plain water, non-milk liquids/juice, other milk, and complementary foods (solids and semi-solids)” are hierarchical and mutually exclusive, so their percentages add to 100 percent. Thus children who receive breast milk and non-milk liquids and who do not receive complementary foods are classified in the non-milk liquid category even though they may also get plain water. Children who receive complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years 138 | Nutrition of Children and Women Bottles with nipples are usually used when feeding infants with infant formula and other types of supplementary foods. The use of bottles is not generally recommended in early infancy because of the potential for undernutrition as well as the possibility of exposing the child to infection through unhygienic procedures in the preparation of the liquid and feeding bottle, particularly in poor environmental and socioeconomic conditions. The use of a feeding bottle is thought to put children at increased risk of diarrheal diseases. The survey results show that bottle feeding is common in the Philippines; 35 percent of infants under two months use a bottle with a nipple. The percentage of children who received a bottle with a nipple increases with age, peaking at age 12-17 months (Table 11.2). 11.3 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 affects birth intervals and fertility levels. A longer birth interval allows a mother to recover fully before her next pregnancy and averts maternal depletion resulting from births occurring too close together. In the 2008 NDHS, for children born in the three years preceding the survey who were being breastfed at the time of the survey, mothers were asked about the number of times their children were breastfed in the 24 hours preceding the interview. Estimates of mean and median durations of breastfeeding are based on current status information; that is, the proportion of children who were being breastfed at the time of the survey. The median duration of exclusive breastfeeding is the age at which half of the children began receiving infant formula, other milk, or food supplements. Predominant breastfeeding refers to children who are exclusively breastfed or receiving breast milk and plain water, water-based liquids (such as soft drinks), and/or juices in the 24 hours preceding the interview. Table 11.3 gives the median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, and the frequency of breastfeeding among children under six months, according to selected background characteristics. Figure 11.2 Infant Feeding Practices by Age <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Age in months 0 20 40 60 80 100 Exclusively breastfed Breast milk and plain water Breast milk and nonmilk liquids Breast milk and other milk Breast milk and complementary foods Not breastfeeding NDHS 2008 Percent Nutrition of Children and Women | 139 Table 11.3 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 2008 Median duration (months) of breastfeeding among children born in the past three years1 Frequency of breastfeeding among children under six months2 Background characteristic Any breast- feeding Exclusive breast- feeding Predomi- nant breast- feeding3 Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children Sex Male 14.4 0.8 2.2 95.1 6.4 5.4 248 Female 14.2 0.7 3.2 97.0 6.7 5.1 224 Residence Urban 7.0 0.7 1.8 95.8 6.4 5.4 190 Rural 17.4 1.0 3.5 96.2 6.7 5.2 281 Region National Capital Region 5.7 0.7 2.0 (97.1) (5.2) (4.6) 49 Cordillera Admin Region 15.7 0.5 0.7 * * * 6 I - Ilocos 17.2 1.2 3.4 * * * 21 II - Cagayan Valley 18.9 2.6 3.2 * * * 13 III - Central Luzon 13.2 0.5 0.6 (91.1) (6.3) (4.4) 40 IVA - CALABARZON 4.3 0.6 1.6 (100.0) (6.4) (5.8) 48 IVB - MIMAROPA 19.9 0.7 0.7 * * * 15 V - Bicol 19.8 3.2 4.4 (100.0) (6.5) (5.9) 34 VI - Western Visayas 13.6 0.5 0.8 (100.0) (7.5) (6.5) 31 VII - Central Visayas 12.9 0.7 5.0 (97.1) (7.6) (5.9) 40 VIII - Eastern Visayas 16.9 2.3 3.2 (93.9) (5.6) (5.3) 26 IX - Zamboanga Peninsula 14.3 0.4 0.4 (93.9) (7.6) (4.9) 25 X - Northern Mindanao 14.9 4.0 4.1 (93.6) (7.7) (6.3) 25 XI - Davao 13.0 2.8 4.7 (97.1) (7.4) (4.7) 29 XII - SOCCSKSARGEN 19.8 2.8 4.1 (92.8) (7.3) (5.2) 22 XIII - Caraga 16.7 0.5 0.5 * * * 11 ARMM 18.2 0.7 2.6 (88.8) (5.3) (3.8) 36 Mother's education No education 24.9 0.6 4.1 * * * 6 Elementary 19.2 1.9 4.1 96.7 6.6 4.8 146 High school 14.0 0.7 2.7 95.9 6.7 5.6 224 College 5.6 0.7 1.0 95.0 6.2 5.2 95 Wealth quintile Lowest 19.2 1.9 4.3 98.1 6.9 5.2 151 Second 15.8 1.6 3.3 95.9 6.8 5.4 120 Middle 14.0 0.7 2.3 92.7 6.2 5.3 86 Fourth 8.8 0.5 0.6 94.7 6.0 5.0 77 Highest 3.7 0.6 0.6 (98.0) (6.7) (5.3) 36 Total 14.3 0.7 2.7 96.0 6.6 5.2 472 Mean for all children 15.1 2.8 3.9 na na na na Note: Median and mean durations are based on current status. Includes all children regardless of survival status. na = Not applicable 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding 2 Excludes children for whom there was not a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water and/or non-milk liquids only 140 | Nutrition of Children and Women The median duration of any breastfeeding is 14 months, which means that half of children under age three are not being breastfed after 14 months. There is no difference in the median duration of breastfeeding by sex. Children in rural areas are breastfed longer than children in urban areas (17 months compared with 7 months). Table 11.3 shows that the median duration of breastfeeding is negatively associated with mother’s wealth status and education; children of poorer parents and those whose mothers have less education tend to be breastfed longer than other children. The median duration of any breastfeeding is shortest in CALABARZON (4.3 months) and NCR (5.7 months), while it is almost 20 months in MIMAROPA, Bicol, and SOCCSKSARGEN. The median duration of exclusive breastfeeding is less than one month, while the duration of predominant breastfeeding is 2.7 months. Variations in the median duration of exclusive and predominant breastfeeding are similar to those of any breastfeeding. Frequent breastfeeding is common in the Philippines. Ninety-six percent of infants under six months were breastfed six or more times in the 24 hours preceding the survey. On average, infants are breastfed seven times during the day and five times at night. Frequency of breastfeeding does not vary by residence, mother’s education or economic status. There have been only slight changes in breastfeeding practices since 2003. The percentage of infants under six months who were breastfed six or more times in the 24 hours preceding the survey increased from 93 percent in 2003 to 96 percent in 2008. There were no substantial changes in the median duration of any breastfeeding (14.1 months in 2003 compared with 14.3 months in 2008), or in the median duration of exclusive breastfeeding (0.8 months in 2003 compared with 0.7 months in 2008) (NSO and ORC Macro, 2004). 11.4 TYPES OF COMPLEMENTARY FOODS Food supplementation is important for infant growth and development. WHO recommends the introduction of solid or semi-solid food to infants around the age of six months because by that age breast milk by itself is no longer sufficient to either meet the infant’s nutritional requirements or maintain the child’s optimal growth. In the 2008 NDHS, for the youngest children born in the three years preceding the survey and living with their mothers, mothers were asked about the types of liquid and food the children had during the day or night preceding the interview, as well as the number of times solid, semi-solid, or soft foods were taken during the same period. Table 11.4 shows the types of food consumed during the day or night preceding the interview by breastfeeding status. Among breastfeeding children under two months of age, 26 percent were given infant formula during the day and night preceding the survey; 8 percent were given other milk (that is, fresh, tinned, and powdered cow’s milk, or other animal milk), and 1 percent were given solid or semisolid food. As expected, food supplementation increases with the child’s age. At age 4-5 months, the pattern of feeding shows marked changes; 15 percent of infants are given liquids other than breast milk and 24 percent are given food made from grains and 30 percent are given solid or semisolid food. Table 11.4 shows that consumption of fruits and vegetables rich in vitamin A increases with the child’s age. By age 6-8 months, 43 percent of breastfeeding children receive food rich in vitamin A. This proportion increases to 77 percent by the time the child is age 24 to 35 months. Nutrition of Children and Women | 141 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under three years of age living with their mother who consumed specific foods in the day and night preceding the interview, by breastfeeding status and age, Philippines 2008 Solid or semisolid foods Liquids Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Food made from grains3 Fruits and vegetables rich in vitamin A4 Other fruits and vege- tables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry, and eggs Cheese, yogurt, other milk product Any solid or semi- solid food Food made with oil, fat, and butter Sugary foods Number of children BREASTFEEDING CHILDREN 0-1 26.0 8.4 0.5 0.0 0.6 0.6 0.6 0.0 0.6 0.6 0.0 1.1 0.6 0.6 129 2-3 28.8 16.0 4.3 1.6 5.8 0.6 0.6 0.6 0.0 0.6 0.6 5.8 0.6 1.5 196 4-5 19.0 11.8 15.0 10.0 24.4 10.1 4.4 3.7 0.8 8.4 0.8 29.5 4.9 13.2 146 6-8 17.7 25.7 41.1 27.7 87.4 42.6 29.8 14.4 8.2 42.2 3.1 89.0 22.6 44.2 192 9-11 20.6 31.3 48.0 25.8 94.6 71.4 58.5 22.1 17.5 67.8 11.3 96.4 46.9 61.8 204 12-17 15.8 39.9 56.8 8.8 96.2 75.9 53.7 20.4 13.5 78.4 13.1 98.3 57.5 70.2 328 18-23 14.5 41.5 60.5 6.4 96.2 69.7 54.4 22.2 18.0 80.6 11.3 96.9 63.1 72.3 207 24-35 8.2 41.0 64.7 5.6 98.3 76.5 57.0 26.2 19.8 85.2 13.9 98.8 62.8 80.5 147 0-5 25.0 12.6 6.6 3.8 10.1 3.5 1.8 1.4 0.4 3.0 0.5 11.8 1.9 4.9 472 6-9 18.7 25.4 43.1 25.3 89.7 48.9 34.1 15.8 8.5 48.9 5.5 90.8 25.9 47.1 266 6-23 17.0 35.5 52.5 15.9 94.0 66.7 50.0 19.9 14.3 69.1 10.2 95.7 49.2 63.5 930 Total 18.6 29.0 39.7 11.2 68.9 48.4 36.0 14.9 10.6 50.5 7.6 70.5 36.1 47.3 1,549 NONBREASTFEEDING CHILDREN 0-1 * * * * * * * * * * * * * * 12 2-3 (98.4) (44.9) (0.0) (21.5) (21.5) (3.5) (3.5) (7.2) (0.0) (0.0) (0.0) (26.3) (0.0) (3.1) 34 4-5 (86.7) (48.5) (21.7) (24.3) (34.7) (13.9) (4.7) (2.4) (0.0) (1.2) (0.0) (34.7) (2.5) (7.8) 51 6-8 86.4 69.0 37.8 46.6 88.8 37.8 32.5 22.4 9.0 42.4 6.9 89.9 20.7 45.7 114 9-11 79.8 74.9 47.1 36.2 96.0 57.1 48.4 27.2 13.2 72.4 23.7 97.1 52.0 63.0 117 12-17 57.4 76.4 52.1 15.3 95.8 70.8 56.9 20.8 17.8 80.2 24.7 97.3 57.9 75.5 280 18-23 44.1 76.4 62.4 9.5 98.4 75.6 62.6 25.3 23.3 89.0 22.2 99.2 65.6 82.7 333 24-35 34.0 67.8 64.9 6.7 97.8 77.1 62.5 28.0 20.8 90.0 24.5 99.3 65.0 80.4 708 0-5 91.6 46.3 11.4 20.3 25.8 8.5 3.7 3.8 0.0 0.6 0.0 27.5 1.3 5.2 97 6-9 84.0 69.0 40.3 42.9 89.1 42.5 38.3 23.1 8.2 51.2 9.5 90.4 28.7 48.2 156 6-23 59.2 75.2 53.6 20.1 95.9 66.3 54.7 23.7 18.1 77.5 21.2 97.0 55.1 72.6 844 Total 50.3 70.3 55.9 14.4 92.6 67.5 55.0 24.4 18.2 78.3 21.3 93.9 56.2 72.0 1,650 Note: Breastfeeding status and foods consumed refer to a 24-hour period (yesterday and the past night). Numbers 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 Other milk includes fresh, tinned and powdered cow or other animal milk 2 Does not include plain water 3 Includes fortified baby food 4 Includes pumpkin, orange or yellow squash or sweet potato, carrots, dark green leafy vegetables, mango, papaya, chesa, sineguela, jackfruit Nonbreastfeeding children should be given appropriate and adequate food to meet their nutritional requirements because they are not receiving the benefits of breast milk. Moreover, nonbreastfeeding children should be fed safe, clean food to protect them from pathogens and the risks of infection and diarrheal diseases. Table 11.4 shows that for nonbreastfeeding children, the introduction of solid or semisolid food starts very early. Among nonbreastfeeding infants age 2-3 months, 26 percent are receiving solid or semisolid food, although the numbers of nonbreastfeeding children are too small at the younger ages to draw firm conclusions. 142 | Nutrition of Children and Women 11.5 INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES The first two years of life is a critical period for a child’s physical and behavioral development. Guidelines have been established on complementary feeding of breastfeeding children. The WHO and UNICEF recommend that children should be exclusively breastfed from birth to 6 months of age, and complementary foods should be introduced at 6 months of age. Moreover, frequent and on-demand breastfeeding should be continued until the child reaches the age of 2 years or beyond. At 6 months of age, complementary foods should be given in small amounts and as the child gets older, the amount of complementary foods is gradually increased. The number of times per day the child is fed complementary foods and the variety of foods consumed are also increased as the child gets older. For the average healthy breastfed infant, meals of complementary foods should be given 2-3 times per day at age 6-8 months, and 3-4 times per day at age 9-23 months, with additional nutritious snacks offered 1-2 times per day as desired. If the amount of food per meal is low, or if the child is no longer breastfed, then more frequent meals may be required. It is recommended that meat, poultry, fish or eggs should be eaten daily, or as often as possible (PAHO, 2003; WHO, 2005). Analogous guidelines for feeding nonbreastfed children age 6-24 months have also been established. It is recommended that the nonbreastfed child be fed solid or semisolid foods 4 or 5 times a day at age 6-23 months, with an additional snack once or twice a day as desired. Table 11.5 presents infant and young child feeding practices among youngest children age 6-23 months living with their mother, by background characteristics and breastfeeding status. Overall, 55 percent of children age 6-23 months are fed according to the recommended IYCF practices, that is, they are given breast milk or milk products, foods from the recommended number of food groups, and are fed at least the recommended minimum number of times per day (Figure 11.3). Nearly all children age 6-23 months (95 percent) are breastfed or given milk products, 79 percent are given the recommended number of food groups, and 65 percent are fed at least the minimum number of times per day. Breastfed children are more likely than nonbreastfed children to be fed according to the recommended IYCF practices in terms of frequency of feeding. Four in five (81 percent) breastfed children age 6-23 months are fed at least the minimum number of times per day, compared with 48 percent of nonbreastfed children. Feeding the recommended number of food groups is the same for both breastfed and nonbreastfed children; 79 percent of both breastfed and nonbreastfed children receive the recommended number of food groups (that is, three or more food groups for breastfed children and four or more food groups for nonbreastfed children). The percentage of children who are fed according to all three recommended IYCF practices increases with age of the child; the percentage for both breastfed and nonbreastfed children is lowest at age 6-8 months. For breastfed children, adherence to appropriate feeding practices does not vary by urban-rural residence and mother’s education, but it does vary by wealth quintile, with children in wealthier households (middle to highest quintiles) receiving more appropriate feeding than children in poorer households (lowest and second quintiles). Among nonbreastfed children, those living in urban areas, those whose mothers attended college, and those in wealthier households are more likely to receive appropriate feeding than other nonbreastfed children. Nutrition of Children and Women | 143 Table 11.5 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding status, number of food groups consumed, and number of times fed during the day and night preceding the survey, by background characteristics, Philippines 2008 Among breastfed children age 6-23 months, percentage fed: Among nonbreastfed children age 6-23 months, percentage fed: Among all children age 6-23 months, percentage fed: Background characteristic 3+ food groups1 Mini- mum times or more2 Both 3+ food groups and minimum times or more Number of breast- fed children 6-23 months Milk or milk products3 4+ food groups 4+ times or more With 3 IYCF prac- tices4 Number of non- breast- fed children 6-23 months Breast milk or milk prod- ucts3 3+ or 4+ food groups5 Mini- mum times or more6 With all 3 IYCF prac- tices Number of all chil- dren 6-23 months Age 6-8 49.0 80.1 45.5 192 97.6 40.5 21.7 13.5 114 99.1 45.8 58.3 33.5 306 9-11 81.1 78.4 70.0 204 94.3 75.8 35.0 28.1 117 97.9 79.2 62.6 54.7 321 12-17 87.2 81.1 73.3 328 90.3 83.4 52.8 45.0 280 95.5 85.4 68.1 60.3 608 18-23 90.5 82.9 79.3 207 85.9 89.1 58.1 50.4 333 91.3 89.6 67.6 61.4 540 Sex Male 78.9 82.1 68.3 489 91.1 78.0 48.3 39.7 444 95.8 78.5 66.0 54.7 933 Female 78.5 79.2 68.1 442 88.9 79.7 48.2 41.5 400 94.7 79.0 64.5 55.4 842 Residence Urban 81.2 79.5 69.7 376 94.1 77.9 48.2 43.0 504 96.6 79.3 61.6 54.4 880 Rural 77.1 81.6 67.2 554 84.2 80.1 48.3 36.9 341 94.0 78.2 68.9 55.7 895 Region National Capital Region 77.9 75.9 65.2 93 98.5 75.3 47.4 41.9 164 99.1 76.2 57.7 50.4 257 Cordillera Admin Region (86.7) (97.8) (86.7) 17 * * * * 10 95.9 87.5 91.5 80.4 27 I - Ilocos 87.5 84.3 79.7 60 (94.6) (81.0) (51.3) (46.0) 34 98.1 85.1 72.3 67.5 95 II - Cagayan Valley 86.2 89.3 83.1 48 (84.4) (88.6) (62.2) (54.1) 19 95.5 86.9 81.5 74.8 67 III - Central Luzon 81.6 82.4 69.6 81 97.6 88.5 55.1 53.9 101 98.7 85.4 67.2 60.9 182 IVA - CALABARZON 87.0 57.6 53.8 96 89.6 74.8 26.3 23.7 138 93.9 79.8 39.2 36.1 234 IVB - MIMAROPA 71.0 69.2 54.0 40 (91.3) (83.8) (18.1) (15.1) 21 97.0 75.4 51.7 40.7 61 V - Bicol 74.9 84.9 71.0 78 (86.2) (77.1) (57.8) (44.0) 42 95.2 75.7 75.3 61.5 120 VI - Western Visayas 78.0 83.8 68.5 77 (93.2) (82.4) (59.8) (50.7) 48 97.4 79.7 74.6 61.7 125 VII - Central Visayas 88.7 95.3 85.5 67 84.8 76.3 72.2 62.7 56 93.1 83.0 84.8 75.2 122 VIII - Eastern Visayas 73.8 83.0 66.2 43 (70.1) (80.0) (57.0) (36.9) 24 89.2 76.0 73.6 55.6 67 IX - Zamboanga Peninsula (68.2) (88.6) (65.8) 35 (84.2) (80.4) (64.6) (46.6) 35 92.1 74.3 76.6 56.2 70 X - Northern Mindanao (80.2) (81.4) (69.0) 37 (83.6) (85.7) (45.4) (36.2) 36 92.0 82.9 63.8 52.9 73 XI - Davao (79.2) (95.3) (77.0) 37 (85.5) (76.3) (51.9) (32.9) 41 92.4 77.7 72.5 53.8 77 XII - SOCCSKSARGEN 75.4 77.9 62.1 46 (82.9) (85.6) (50.7) (36.3) 28 93.5 79.3 67.6 52.3 74 XIII - Caraga (58.4) (70.5) (52.2) 26 (85.0) (65.0) (47.5) (39.9) 22 93.2 61.4 60.0 46.6 48 ARMM 63.0 81.1 58.0 49 (74.0) (62.5) (16.3) (6.4) 25 91.2 62.8 59.1 40.5 75 Mother's education No education (74.9) (57.3) (46.8) 22 * * * * 7 (85.6) (69.8) (48.9) (35.3) 29 Elementary 74.3 82.6 66.5 276 78.6 78.6 47.3 34.1 117 93.6 75.6 72.1 56.8 393 High school 79.2 82.0 69.3 468 90.0 76.0 45.7 37.4 406 95.4 77.7 65.1 54.5 874 College 85.1 77.2 70.5 165 95.5 83.0 52.4 48.0 314 97.1 83.7 60.9 55.8 479 Wealth quintile Lowest 72.3 83.1 64.7 310 68.8 74.1 51.4 32.7 121 91.2 72.8 74.2 55.7 431 Second 76.5 79.4 66.7 241 83.5 79.0 47.8 36.8 165 93.3 77.5 66.5 54.5 406 Middle 85.2 78.7 70.6 188 97.6 82.6 51.2 45.1 168 98.8 84.0 65.7 58.6 356 Fourth 83.7 80.3 72.1 130 94.8 79.3 45.3 41.0 199 96.8 81.0 59.2 53.3 329 Highest 89.9 81.2 75.6 62 97.9 77.7 47.0 44.3 191 98.4 80.7 55.4 52.0 253 Total 78.7 80.7 68.2 930 90.1 78.8 48.2 40.5 844 95.3 78.7 65.3 55.0 1,775 Note: Numbers 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 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge, fortified baby food from grains; c. vitamin A-rich fruits and vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts; h. foods made with oil, fat, butter. 2 At least twice a day for breastfed infants 6-8 months and at least three times a day for breastfed children 9-23 months 3 Includes commercial infant formula, fresh, tinned and powdered animal milk, and cheese, yogurt and other milk products 4 Nonbreastfed children age 6-23 months are considered fed according to the minimum standard of three Infant and Young Child Feeding practices if they receive other milk or milk products and are fed at least the minimum number of times per day with at least the minimum number of food groups. 5 3+ food groups for breastfed children and 4+ food groups for nonbreastfed children 6 Fed solid or semisolid food at least twice a day for infants 6-8 months, 3+ times for other breastfed children, and 4+ times for nonbreastfed children 144 | Nutrition of Children and Women 11.6 MICRONUTRIENT INTAKE AMONG CHILDREN Micronutrients help protect children from some diseases. Micronutrient deficiency can lead to child morbidity and mortality. Poor intake of nutritious food, frequent episodes of infections, and prolonged exposure to internal parasites are some of the primary causes of micronutrient deficiency. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency can cause eye damage and increase the severity of infections such as measles and diarrheal diseases in children and slow recovery from illness. Vitamin A is found in breast milk, other milks, liver, eggs, fish, butter, red palm oil, mangos, papayas, carrots, pumpkins, and dark green leafy vegetables. In humans, the liver can store an adequate amount of the vitamin A for four to six months. Periodic dosing (usually every six months) with vitamin A supplements is one method of ensuring that children at risk do not develop vitamin A deficiency. Iron is essential for cognitive development. Low iron intake can also contribute to anemia. Iron requirements for young children are greatest at age 6 to 11 months, when growth is rapid. Micronutrients can be obtained from foods or from direct supplementation. The 2008 NDHS collected information on vitamin A supplementation in the six months preceding the survey and iron supplementation in the 7 days preceding the survey among children under five years. The survey also collected information on the consumption of foods rich in vitamin A and iron, by children under three years, during the 24 hours preceding the interview. 68 41 55 32 59 45 Breastfed age 6-12 months Nonbreastfed age 6-12 months All age 6-23 months 0 20 40 60 80 100 Percent Fed with all 3 IYCF practices Not fed with all 3 IYCF practices Figure 11.3 Infant and Young Child Feeding (IYCF) Practices NDHS 2008 Nutrition of Children and Women | 145 Table 11.6 shows the percentage of youngest children age 6-35 months living with their mother who consumed fruits and vegetables rich in vitamin A in the 24 hours preceding the interview, and the percentage of all children age 6-59 months who received vitamin A capsules in the six months preceding the survey and iron supplements in the past seven days, by background characteristics. The results show that nine of ten children (89 percent) consumed fruits and vegetables rich in vitamin A in the 24 hours preceding the interview, and three in four (76 percent) received a vitamin A supplement in the six months preceding the survey. These percentages do not vary much by the child’s sex or by urban-rural residence. Children age 6-8 months, children of the least educated mothers, and children born to women age 15-19, are less likely to receive vitamin A from either their diet or from vitamin A supplements. The strongest association is seen between vitamin A supplementation of children and mother’s level of education. For example, only 47 percent of children whose mothers have no formal education received vitamin A supplements, compared with 78 percent of children whose mothers attended high school and 79 percent of children whose mothers attended college. There are variations across regions in the consumption of fruits and vegetables rich in vitamin A and the administration of vitamin A supplements to children. The coverage of vitamin A supplementation is high in all regions except ARMM, ranging from 70 percent in CAR and Zamboanga Peninsula to 84 percent in Davao. Less than 50 percent of children in ARMM receive vitamin A supplements. Table 11.6 shows that the consumption of foods rich in iron and iron supplementation is generally lower than the consumption of foods rich in vitamin A and vitamin A supplementation. Older children and those whose mothers have more education are more likely than other children to consume foods rich in iron. Younger children (less than 18 months), children in urban areas, children whose mothers attended college, and children in the higher wealth quintiles are the most likely to receive iron supplements. Children in MIMAROPA and ARMM are the least likely to receive iron supplements. The 2008 NDHS collected information about deworming of children under five years of age in the six months preceding the survey. Table 11.6 shows that 2 percent of children age 6-8 months received deworming medication in the six months preceding the survey. As expected, the percentage increases with age, and among children age 36-59 months, more than half received deworming medication in the six months preceding the survey. Nonbreastfeeding children are more likely than breastfeeding children to receive deworming medication (43 percent compared to 19 percent). The children least likely to receive deworming medication are children whose mothers were age 15-19 at the time of their birth, children whose mothers have no education, and children in the wealthiest households (highest quintile). Variations in deworming coverage across regions are notable, with coverage 50 percent or higher in CAR (58 percent), MIMAROPA (50 percent), Eastern Visayas (50 percent), Northern Mindanao (55 percent) and Davao (54 percent); coverage is less than 30 percent in NCR (27 percent), CALABARZON (26 percent) and ARMM (29 percent). These findings suggest that deworming coverage is not closely associated with economic development because MIMAROPA and Eastern Visayas, which are among the less developed regions, have higher deworming coverage than NCR and CALABARZON, which are among the more highly developed regions. 146 | Nutrition of Children and Women Table 11.6 Micronutrient intake among children Among youngest children age 6-35 months living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day and night preceding the survey; and among all children age 6-59 months, the percentage who were given vitamin A supplements in the six months preceding the survey, the percentage who were given iron supplements in the past seven days, and the percentage who were given deworming medication in the six months preceding the survey, by background characteristics, Philippines 2008 Among youngest children age 6-35 months living with the mother: Among all children age 6-59 months: Background characteristic Percentage who consumed foods rich in vitamin A in past 24 hours1 Percentage who consumed foods rich in iron in past 24 hours2 Number of children Percentage given vitamin A supplements in past 6 months Percentage given iron supplements in past 7 days Percentage given deworming medication in past 6 months3 Number of children Age in months 6-8 56.6 42.2 306 65.1 43.4 1.6 311 9-11 83.4 69.5 321 76.9 43.6 6.2 329 12-17 91.2 79.2 608 76.5 42.1 12.9 648 18-23 94.6 85.8 540 77.1 36.2 28.3 638 24-35 97.5 89.2 856 78.8 37.0 43.1 1,225 36-47 na na 0 75.4 34.2 52.7 1,238 48-59 na na 0 74.8 34.2 54.1 1,221 Sex Male 88.8 78.8 1,376 76.3 37.4 38.5 2,938 Female 89.2 77.8 1,255 75.4 36.6 37.4 2,671 Breastfeeding status Breastfeeding 85.5 71.3 1,078 73.8 32.3 19.1 1,154 Not breastfeeding 91.4 83.2 1,550 76.4 38.2 42.9 4,433 Residence Urban 88.8 79.9 1,299 76.1 47.8 31.8 2,774 Rural 89.1 76.8 1,331 75.6 26.4 44.0 2,835 Region National Capital Region 88.2 77.9 371 80.2 62.3 27.2 818 Cordillera Admin Region 93.9 82.2 43 69.9 24.5 57.6 95 I - Ilocos 90.0 83.6 132 70.5 33.5 31.9 268 II - Cagayan Valley 91.3 81.6 92 76.2 35.6 42.0 187 III - Central Luzon 91.6 83.3 273 80.8 35.0 32.5 557 IVA - CALABARZON 87.4 76.7 348 73.3 51.8 25.6 726 IVB - MIMAROPA 86.1 72.4 90 71.8 11.9 49.9 184 V - Bicol 85.7 77.8 183 78.0 23.5 36.9 371 VI - Western Visayas 92.2 79.6 188 78.6 29.8 46.8 395 VII - Central Visayas 95.1 79.8 176 81.5 33.6 46.3 398 VIII - Eastern Visayas 92.4 85.4 115 78.7 21.4 50.0 243 IX - Zamboanga Peninsula 87.5 78.8 108 70.1 42.1 40.2 228 X - Northern Mindanao 87.2 75.9 102 74.8 30.7 54.6 249 XI - Davao 90.8 79.9 123 84.1 34.9 54.1 253 XII - SOCCSKSARGEN 88.2 72.5 103 72.7 25.4 42.6 215 XIII - Caraga 79.9 64.7 75 81.1 29.4 43.2 162 ARMM 82.0 70.1 107 48.0 15.6 29.3 260 Mother's education No education 83.0 61.0 36 46.5 5.7 29.9 90 Elementary 89.5 74.9 590 69.6 22.3 43.0 1,342 High school 87.7 77.4 1,283 78.3 35.4 38.3 2,683 College 91.1 83.5 721 78.8 55.0 33.4 1,494 Mother's age at birth 15-19 82.9 74.0 128 65.5 34.9 17.8 167 20-29 88.2 77.2 1,343 74.6 36.9 37.8 2,701 30-39 90.3 80.5 953 78.1 37.8 39.1 2,205 40-49 92.1 78.3 207 76.3 34.9 40.3 536 Wealth quintile Lowest 88.9 71.8 643 67.1 16.2 42.9 1,453 Second 86.8 76.2 588 78.1 27.2 40.8 1,284 Middle 90.6 83.7 532 80.3 37.8 42.0 1,088 Fourth 90.1 81.4 497 81.9 54.8 32.3 975 Highest 89.0 81.1 370 74.7 67.4 26.0 809 Total 89.0 78.3 2,630 75.9 37.0 38.0 5,609 Note: Information on vitamin A and iron supplements and deworming medication is based on the mother’s recall. Total includes 23 children whose breastfeeding status was missing. na = Not applicable 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, orange or yellow squash or sweet potato, carrots, dark green leafy vegetables, mango, papaya, chesa, sineguela, jackfruit 2 Includes meat (including organ meat) 3 Deworming for intestinal parasites is commonly done for helminths and for schistosomiasis. Nutrition of Children and Women | 147 11.7 FOODS CONSUMED BY MOTHERS The types of food consumed by mothers influence their health and that of their breastfeeding children. In the 2008 NDHS, women with children under three years living with them were asked the types of food they consumed during the day and night preceding the interview. Table 11.7 shows that 96 percent of mothers of children under three years reported that they consumed food made from grains in the day and night preceding the interview, while 91 percent consumed fish, shellfish, meat, poultry, or eggs, and 84 percent consumed vegetables or fruits rich in vitamin A. These results are to be expected because the staple diet of most families in the Philippines comprises rice, fish, and vegetables. Table 11.6 shows that in the 24 hours preceding the interview at least six in ten mothers reported that they consumed other fruits and vegetables (62 percent of mothers), foods made with oil, fat, or butter (68 percent), and sugary foods (60 percent). The types of food consumed by mothers do not vary substantially by background characteristics. Regardless of age, urban-rural residence, region, education, and wealth quintile, the staple diet of mothers consists of foods made from grains, meat, fish, shellfish, poultry, and eggs, and vitamin A-rich fruits and vegetables. There are types of food, however, that are more commonly consumed by some groups of women than others. Urban mothers, mothers who have attended college, and mothers in wealthier households are more likely than other mothers to eat foods made with oil, fat, or butter and sugary foods, which may not be beneficial to health if consumed frequently. By comparison, mothers in the lowest wealth quintile and mothers in Davao and Zamboanga Peninsula are the least likely to consume food made with oil, fat, or butter. 148 | Nutrition of Children and Women Table 11.7 Foods consumed by mothers in the day and night preceding the interview Among mothers age 15-49 with a child under age three years living with them, the percentage who consumed specific types of foods in the day and night preceding the interview, by background characteristics, Philippines 2008 Solid or semi-solid foods Liquids Background characteristic Milk Tea/ coffee Other liquids Foods made from grains Foods made from roots/ tubers Foods made from legumes Meat/ fish/ shellfish/ poultry/ eggs Cheese/ yogurt Vitamin A -rich fruits/ vege- tables1 Other fruits/ vege- tables Other solid or semi- solid food Foods made with oil/ fat/ butter Sugary foods Number of women Age 15-19 19.2 67.3 50.8 94.1 27.5 14.5 93.1 9.3 83.4 57.8 69.7 65.5 59.6 185 20-29 26.4 71.0 54.8 96.2 30.7 20.4 90.2 10.3 82.9 61.1 70.0 66.5 62.4 1,646 30-39 24.5 78.2 51.8 95.0 30.7 20.0 91.7 9.0 85.9 62.5 67.1 69.2 57.6 1,133 40-49 18.1 78.1 51.7 94.4 30.1 17.1 87.1 7.6 82.0 63.9 63.5 69.4 51.7 236 Residence Urban 24.9 75.5 57.4 96.3 29.7 19.7 93.6 13.9 82.5 63.1 66.9 72.8 62.4 1,559 Rural 24.6 72.3 49.4 94.8 31.2 19.7 87.9 5.5 85.2 60.2 69.9 62.6 57.2 1,640 Region National Capital Region 22.2 78.2 59.3 96.2 35.1 22.1 91.7 19.4 82.9 63.5 65.7 73.6 57.6 441 Cordillera Admin Region 25.8 86.5 29.7 96.9 30.3 32.7 85.3 11.0 93.5 77.8 65.5 71.4 54.6 50 I - Ilocos 24.0 81.1 67.0 98.8 31.0 22.8 95.8 7.9 90.9 66.6 73.1 80.0 64.2 155 II - Cagayan Valley 23.4 89.0 53.4 94.4 29.5 31.9 88.1 9.8 91.7 71.9 67.0 84.1 71.7 106 III - Central Luzon 14.0 85.7 60.0 98.2 32.9 11.7 94.6 7.9 80.9 57.4 66.4 82.7 61.3 329 IVA - CALABARZON 22.3 82.6 48.4 97.0 35.6 19.6 91.9 15.1 79.9 63.6 70.2 75.9 60.7 422 IVB - MIMAROPA 28.2 65.4 32.3 98.3 33.4 19.5 84.5 7.1 84.0 53.8 65.0 67.3 56.4 107 V - Bicol 37.0 80.4 53.6 98.2 38.6 9.8 92.1 7.2 81.2 63.0 61.0 73.7 63.5 221 VI - Western Visayas 24.9 63.7 51.1 95.1 25.5 23.5 88.7 5.6 80.8 57.9 70.2 59.2 67.5 224 VII - Central Visayas 30.9 52.2 54.4 95.5 19.0 25.1 89.3 8.3 87.4 58.9 84.1 71.9 68.7 220 VIII - Eastern Visayas 16.8 58.2 53.0 89.7 13.6 10.1 92.1 6.9 79.1 46.2 96.0 68.9 48.5 142 IX - Zamboanga Peninsula 21.8 66.6 47.3 94.4 28.4 26.3 91.4 5.7 85.6 69.2 68.8 33.7 66.2 138 X - Northern Mindanao 36.8 49.8 54.6 94.7 24.6 30.5 87.6 8.0 86.9 64.8 58.9 69.3 57.9 128 XI - Davao 44.0 70.6 48.9 91.5 22.3 17.7 92.9 2.9 86.2 59.6 55.9 29.5 55.1 154 XII - SOCCSKSARGEN 23.7 69.7 51.9 92.3 31.3 21.4 83.7 3.8 87.3 62.8 70.1 59.4 51.5 127 XIII - Caraga 25.3 63.7 63.1 92.8 18.7 16.3 86.7 10.3 85.4 57.5 61.6 49.0 55.7 89 ARMM 14.0 86.5 49.7 90.4 45.4 11.9 87.7 2.1 86.3 63.3 58.8 49.9 40.8 146 Education No education 11.3 74.7 28.9 89.0 42.1 24.4 69.8 3.8 81.6 46.9 58.3 33.5 36.8 42 Elementary 16.9 76.8 43.5 93.3 31.6 18.8 84.5 4.6 83.9 53.7 72.6 57.1 47.7 745 High school 24.3 73.0 53.9 96.0 28.8 20.1 91.2 9.2 83.0 61.4 68.4 69.3 62.0 1,560 College 33.0 72.8 62.1 96.8 32.0 19.6 96.2 15.0 85.7 69.6 65.6 75.2 67.3 852 Wealth quintile Lowest 16.7 72.1 41.0 92.7 33.3 17.9 82.0 3.9 85.5 52.9 67.0 52.5 48.0 803 Second 20.9 76.1 47.2 95.8 24.5 19.5 89.0 6.1 85.1 61.5 74.1 65.3 62.7 720 Middle 30.4 76.2 59.6 96.3 27.4 23.3 94.8 9.7 80.3 64.8 69.4 72.2 60.5 631 Fourth 28.0 74.2 60.0 96.9 32.9 18.1 94.2 12.5 84.4 64.6 65.7 74.9 66.5 613 Highest 33.1 69.4 67.9 97.0 36.2 20.5 98.5 21.6 83.6 69.0 64.2 82.3 66.1 431 Total 24.7 73.8 53.3 95.5 30.5 19.7 90.7 9.6 83.9 61.6 68.5 67.6 59.7 3,199 Note: Foods consumed in the past 24-hour period (yesterday and the past night). 1 Includes pumpkin, orange or yellow squash or sweet potato, carrots, dark green leafy vegetables, mango, papaya, chesa, sineguela, jackfruit 11.8 MICRONUTRIENT INTAKE AMONG MOTHERS Mothers with a live birth in the five years preceding the survey were asked if they received iron supplements during the pregnancy for their youngest child and vitamin A supplementation in the two months after delivery. They were also asked whether during their last pregnancy they suffered from night blindness. The results in Table 11.8 show that 98 percent of mothers consumed foods rich in vitamin A in the 24 hours preceding the interview and 91 percent consumed iron-rich foods. Nutrition of Children and Women | 149 Table 11.8 Micronutrient intake among mothers Among women age 15-49 with a child under three years living with them, the percentages who consumed vitamin A-rich and iron-rich foods in the 24 hours preceding the survey; and among women age 15-49 whose last child was born in the past five years, the percentage who received a vitamin A dose in the first two months after the birth of the last child, the percentage who during pregnancy for their last child had night blindness, the percentage who took iron tablets or syrup for specific numbers of days, and the percentage who took deworming medication; Philippines 2008 Among women whose last birth is a child under five years Women with a child under three years living with them Number of days women took iron tablets or syrup during pregnancy for last birth Percentage with night blindness during pregnancy for last birth Background characteristic Percentage consumed vitamin A- rich foods1 Percentage consumed iron-rich foods2 Number of women Percentage who received vitamin A dose post- partum3 Reported Adjusted4 None <60 60-89 90+ Don't know/ missing Percentage who took deworming medication during pregnancy for last birth Number of women Age 15-19 98.5 93.1 185 36.6 7.1 1.3 19.9 49.5 5.1 24.2 1.3 4.0 199 20-29 97.7 90.2 1,646 44.1 4.3 1.3 17.2 39.2 7.7 34.8 1.1 2.9 2,149 30-39 99.2 91.7 1,133 47.5 4.3 1.2 17.1 39.5 7.4 34.7 1.4 4.5 1,766 40-49 98.8 87.1 236 48.7 5.6 1.5 19.1 41.8 6.0 32.2 0.9 5.8 476 Residence Urban 98.6 93.6 1,559 48.0 3.7 1.2 13.3 37.6 8.1 39.3 1.6 2.1 2,283 Rural 98.2 87.9 1,640 43.2 5.4 1.4 21.5 42.4 6.5 28.8 0.8 5.5 2,307 Region National Capital Region 97.3 91.7 441 56.5 3.6 1.7 11.8 33.3 9.7 43.3 1.8 2.8 688 Cordillera Admin Region 98.5 85.3 50 55.5 4.6 1.1 19.3 47.6 6.1 24.1 2.9 4.2 72 I - Ilocos 100.0 95.8 155 31.1 1.3 0.4 20.4 29.7 11.5 37.2 1.3 0.0 218 II - Cagayan Valley 97.9 88.1 106 42.7 4.6 3.6 16.5 50.8 7.7 24.5 0.5 2.6 142 III - Central Luzon 98.9 94.6 329 37.8 4.1 0.8 14.8 43.0 8.7 32.6 0.8 0.3 468 IVA - CALABARZON 98.8 91.9 422 43.4 2.1 0.7 10.6 44.5 8.4 33.3 3.1 1.3 602 IVB - MIMAROPA 96.6 84.5 107 30.5 4.9 2.4 23.5 56.1 6.6 13.4 0.4 3.0 151 V - Bicol 98.6 92.1 221 47.2 4.2 0.7 26.5 53.4 5.2 14.6 0.3 8.0 280 VI - Western Visayas 96.7 88.7 224 57.6 9.6 2.3 9.9 26.5 6.4 55.5 1.7 5.6 324 VII - Central Visayas 99.5 89.3 220 51.8 4.9 1.3 12.3 43.7 4.0 39.4 0.6 5.0 328 VIII - Eastern Visayas 100.0 92.1 142 43.2 4.9 1.6 22.1 40.9 6.9 30.2 0.0 8.2 196 IX - Zamboanga Peninsula 98.3 91.4 138 43.5 3.8 0.0 19.0 42.8 6.7 31.5 0.0 3.3 189 X - Northern Mindanao 99.4 87.6 128 47.1 6.3 0.8 15.8 28.5 6.9 48.3 0.4 7.5 198 XI - Davao 99.5 92.9 154 53.4 6.1 1.2 13.4 44.4 7.7 33.4 1.1 8.0 224 XII - SOCCSKSARGEN 97.2 83.7 127 43.3 7.6 2.3 20.7 44.3 6.3 27.9 0.9 6.6 178 XIII - Caraga 96.4 86.7 89 49.7 5.3 1.3 15.2 35.8 4.4 44.2 0.5 7.4 124 ARMM 98.0 87.7 146 20.5 5.3 1.0 61.5 30.4 1.9 5.8 0.4 1.8 207 Education No education 96.1 69.8 42 23.2 8.6 2.9 68.0 24.6 0.0 6.3 1.1 2.6 68 Elementary 97.3 84.5 745 39.3 6.2 1.5 32.5 43.9 4.5 18.3 0.8 6.7 1,061 High school 98.4 91.2 1,560 45.6 4.4 1.3 14.4 44.2 7.8 32.3 1.3 3.4 2,198 College 99.3 96.2 852 51.9 3.2 1.0 7.4 30.3 9.2 51.6 1.5 2.3 1,263 Wealth quintile Lowest 97.4 82.0 803 37.9 7.0 2.2 33.9 41.4 4.6 19.2 0.9 6.4 1,103 Second 98.0 89.0 720 44.4 5.1 1.2 17.4 48.2 6.2 27.8 0.4 4.3 1,007 Middle 98.8 94.8 631 45.9 4.2 1.3 13.9 43.9 9.8 31.5 0.8 3.1 906 Fourth 98.7 94.2 613 50.1 3.3 0.7 8.1 37.1 7.1 45.2 2.4 2.5 863 Highest 99.7 98.5 431 53.3 2.0 0.6 8.0 24.7 10.0 55.3 2.0 1.9 711 Total 98.4 90.7 3,199 45.6 4.6 1.3 17.5 40.0 7.3 34.0 1.2 3.8 4,590 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, orange or yellow squash or sweet potato, carrots, dark green leafy vegetables, mango, papaya, chesa, sineguela, jackfruit 2 Includes meat (and organ meat), fish, poultry, eggs 3 In the first two months after delivery 4 Women who reported night blindness but did not report difficulty with vision during the day 5 Deworming for intestinal parasites is commonly done for helminths and for schistosomiasis 150 | Nutrition of Children and Women Postpartum supplementation with vitamin A is important in reducing the risk of night blindness among women during pregnancy. Among women whose last birth was in the five years preceding the survey, less than half (46 percent) received vitamin A supplements in the two months after delivery. Vitamin A supplementation varies by the women’s age, education, economic status, and region. Mothers age 15-19 are less likely to receive vitamin A supplementation (37 percent) than older mothers. Women with no education (23 percent) and women with elementary education (39 percent) are less likely to receive vitamin A supplements than women with college education (52 percent). Likewise, 38 percent of women in the poorest households (lowest wealth quintile) received vitamin A supplementation within two months after delivery, compared with 53 percent of women in the wealthiest households (highest wealth quintile). Variations across regions are notable; while the coverage of vitamin A supplementation is 50 percent or higher in NCR, CAR, Western Visayas, Central Visayas, and Davao, it is less than 30 percent in ARMM. Night blindness during pregnancy, which is associated with vitamin A deficiency, was reported by 5 percent of women. However, when this figure was adjusted to include women who had difficulty with their vision at night but not during the day, the proportion drops to 1 percent. The prevalence of night blindness does not vary substantially by background characteristics, although the adjusted rate is slightly higher among women in Cagayan Valley. For the majority of the regions, night blindness among recent mothers is 1 percent or lower. Iron supplementation during pregnancy is important to prevent iron-deficiency anemia. Iron is an essential part of hemoglobin, which is the protein in red blood cells that carries oxygen to the other cells. Iron is essential for a healthy immune system. Pregnant women need extra iron, especially in the second and third trimester of pregnancy, for their growing baby and placenta. Full-term babies get enough iron from their mothers in the last trimester of pregnancy to last them for the first 4 to 6 months of life. After that age, iron deficiency can cause serious delays in the child’s growth and development. Among women with a birth in the five years preceding the survey, 18 percent did not receive any iron supplementation during the pregnancy for their last birth, two in five (40 percent) took iron supplements for less than 60 days, and three in ten (34 percent) took iron supplements for 90 or more days (Table 11.8). Variations in the intake of iron supplementation by background characteristics are similar to those observed for vitamin A supplementation. Likewise, coverage of iron supplementation across subgroups of women, particularly supplementation for 60 days or more, is similar to that of vitamin A supplementation. Iron-deficiency anemia can be caused by blood loss due to hookworm infection. Administering deworming pills to pregnant women, especially those in hookworm-endemic areas, can prevent this type of anemia, thereby improving both the health of the woman and that of her unborn child. In the 2008 NDHS, women age 15-49 with a birth in the five years preceding the survey were asked if they took any drug for intestinal worms during the pregnancy for their last birth. Table 11.8 shows that, overall, 4 percent of these women took deworming medication during the pregnancy for their last birth. In Bicol, Eastern Visayas, Northern Mindanao, and Davao, 8 percent of women reported taking a deworming drug. Women age 45-49, women in rural areas, women with elementary schooling only, and women in the lowest wealth quintile are more likely to take deworming medication during pregnancy than other women. HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 151 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 12 12.1 INTRODUCTION Acquired Immune Deficiency Syndrome (AIDS) was first recognized internationally in 1981. It is caused by the human immunodeficiency virus (HIV), which weakens the immune system and makes the body susceptible to and unable to recover from other opportunistic diseases. Secondary infections lead to death if not adequately treated. A large proportion of those infected with HIV die within five to ten years (WHO, 1992). Epidemiological studies have identified the main routes of transmission of HIV to be unsafe sexual intercourse, intravenous injections with contaminated needles, unscreened or contaminated blood transfusions, and transmission from an infected mother to her child during pregnancy, delivery, or breastfeeding. HIV cannot be transmitted through food, water, insect vectors, or casual contact like shaking of hands. 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 established in the Department of Health. This is a passive surveillance system that 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 risky practices, and helping policymakers to arrive at informed decisions. Both the serologic and behavioral surveillance target high-risk groups: sex workers, men having sex with men, and injecting drug users. From the time the first AIDS case was reported in 1984 until the end of 2004, a total of 2,205 HIV-positive cases have been reported to the national registry. The Philippines has implemented an HIV prevention program through awareness-raising activities. In recent years, the HIV program has grown in size and quality, involving a wider network of stakeholders and increasing coverage of most-at-risk populations, including young people. There have been various efforts implemented to prevent HIV transmission, such as public health education through the media and program activities through both the government and non-governmental organizations. These efforts have particularly targeted groups that are considered to be at high risk for the transmission of HIV. Because the Philippines is still considered a low-prevalence country, no special HIV prevention focus has been placed on the general population. The major challenge for the Philippines is that HIV is not seen as posing an immediate threat. As a result, the focus continues to be mainly on high-risk groups and known vulnerable populations such as overseas workers, female sex workers, men having sex with men, and injecting drug users. 152 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Despite the slow and limited progression of the HIV epidemic in the country, it is a major public health concern. With an increasing prevalence of risky behaviors and a fertile socio-cultural milieu, a single case can grow into hundreds and thousands over time. To help meet this challenge, this chapter presents findings about current levels of knowledge about AIDS-related issues such as transmission and prevention, stigma, and discrimination against people with HIV/AIDS. The chapter concludes by providing information on knowledge of and access to condoms. 12.2 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHODS 12.2.1 Awareness of HIV/AIDS and Means of Transmission In the 2008 National Demographic and Health Survey (NDHS), women were asked if they had ever heard of an illness called AIDS. Those who reported having heard of HIV or AIDS were asked a number of questions about how HIV/AIDS could be avoided. HIV/AIDS prevention programs focus their messages and efforts on three important aspects of behavior: use of condoms, limiting the number of sexual partners or staying faithful to one uninfected partner, and delaying sexual debut among young persons (abstinence). To ascertain whether the programs have communicated these messages effectively, respondents were prompted with specific questions about whether it is possible to reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having one sex partner who is not infected and has no other partners, and by abstaining from sexual intercourse. Table 12.1 and Figure 12.1 show the percentage of women who have heard of AIDS and the percentage who know three specific ways to prevent transmission of HIV, by background characteristics. The results show that almost all Filipino women have heard of AIDS (94 percent). Knowledge of condom use as a method of preventing HIV/AIDS is moderate (59 percent), but higher than the level reported in 2003 (48 percent). Seventy-seven percent of women know that people can reduce their chances of getting the AIDS virus by having just one HIV-negative partner who has no other partners. However, only 53 percent of women are aware of both these means of prevention, namely that using condoms and limiting sexual intercourse to one HIV-negative and faithful partner can reduce the risk of getting the AIDS virus. Two in three women (67 percent) know that abstinence is a way to prevent transmission of HIV. There are only small differences in knowledge of AIDS and ways to prevent the transmission HIV by age group, although the percentage of women who know that abstinence can reduce HIV transmission increases slightly with age. Awareness of HIV/AIDS among women varies more by marital status and urban-rural residence. The percentage of women who have heard of AIDS is highest among never-married women who have ever had sex (98 percent). These women also tend to be more knowledgeable about the means of preventing the spread of HIV. Ninety-seven percent of women in urban areas have heard of HIV/AIDS, compared with 91 percent of women in rural areas; women in urban areas are also more likely than women in rural areas to know that condom use, limiting partners, and abstinence are ways to reduce the risk of getting HIV. In all regions except ARMM, 89 percent or more of women have heard of HIV/AIDS; in ARMM, only 57 percent of women have heard of AIDS, which is a decline from the level in 2003 of 75 percent. Regional variations in knowledge of condom use for HIV prevention range from 35 percent among women in ARMM to 66 percent in Bicol. Similarly, ARMM has the lowest proportion of women (47 percent) who know that limiting sexual intercourse to one partner is a method of HIV prevention, while Bicol has the highest proportion (85 percent). Knowledge that abstinence is a way to prevent HIV/AIDS is lowest in ARMM (35 percent) and highest in Central Visayas (81 percent). HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 153 Table 12.1 Knowledge of HIV prevention methods Percentage of women age 15-49 who have ever heard of AIDS and who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having one sex partner who is HIV negative and has no other partners, and by abstaining from sexual intercourse, by background characteristics, Philippines 2008 Means of reducing the risk of getting the AIDS virus Background characteristic Has heard of AIDS Using condoms1 Limiting sexual intercourse to one HIV- negative partner2 Using condoms and limiting sexual intercourse to one HIV- negative partner1,2 Abstaining from sexual intercourse Number of women Age 15-24 92.8 54.3 74.9 48.9 63.8 4,896 15-19 90.6 50.7 70.8 45.2 61.3 2,749 20-24 95.5 58.9 80.0 53.6 67.1 2,147 25-29 95.1 61.2 78.8 55.5 66.5 2,106 30-39 95.5 62.3 78.1 56.0 69.0 3,642 40-49 94.0 60.7 77.0 53.6 69.1 2,950 Marital status Never married 93.4 56.1 75.2 50.6 64.6 4,530 Ever had sex 98.1 62.5 83.7 56.1 71.8 454 Never had sex 92.8 55.3 74.2 50.0 63.8 4,077 Married/living together 94.6 60.2 77.6 53.7 67.6 8,418 Divorced/separated/widowed 93.1 62.4 77.9 56.7 71.4 646 Residence Urban 96.7 61.7 81.2 56.6 68.1 7,574 Rural 90.9 55.3 71.3 48.1 65.2 6,020 Region National Capital Region 96.8 62.3 82.1 58.1 63.9 2,522 Cordillera Admin Region 91.6 57.0 71.3 50.0 68.8 225 I - Ilocos 96.9 61.3 70.0 51.0 58.2 613 II - Cagayan Valley 91.4 56.4 75.2 52.2 71.1 382 III - Central Luzon 97.0 62.3 81.3 55.5 63.4 1,486 IVA - CALABARZON 97.6 61.6 84.4 57.4 67.0 1,808 IVB - MIMAROPA 88.8 55.1 78.3 51.4 68.3 340 V - Bicol 97.4 66.2 85.1 61.9 76.9 755 VI - Western Visayas 96.1 53.6 69.6 46.7 66.8 976 VII - Central Visayas 96.6 64.3 79.7 55.4 81.0 983 VIII - Eastern Visayas 96.5 59.4 79.6 53.8 75.3 488 IX - Zamboanga Peninsula 88.8 60.9 75.3 55.2 69.2 505 X - Northern Mindanao 90.7 53.9 63.4 42.2 70.3 585 XI - Davao 95.9 58.9 77.6 51.9 75.1 618 XII - SOCCSKSARGEN 90.0 41.8 64.9 34.4 57.0 480 XIII - Caraga 96.5 55.8 67.5 47.0 71.8 312 ARMM 57.4 35.2 47.4 32.1 34.5 516 Education No education 40.3 16.3 24.9 13.0 16.0 167 Elementary 84.1 47.0 63.0 39.8 57.2 2,653 High school 96.0 57.7 76.7 51.0 66.6 6,352 College 99.4 69.3 87.3 64.8 74.8 4,422 Wealth quintile Lowest 81.0 45.4 62.1 39.4 55.8 2,160 Second 93.3 54.3 72.6 47.5 66.5 2,419 Middle 96.4 59.3 77.3 52.0 68.0 2,661 Fourth 97.8 64.4 81.6 57.9 68.8 2,937 Highest 98.1 65.6 84.6 61.4 71.3 3,417 Total 15-49 94.1 58.9 76.8 52.8 66.8 13,594 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners 154 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior The most striking differences in AIDS-related knowledge are by level of education: while practically all women with college or higher education (99 percent) have heard of AIDS, the corresponding proportion for those with no education is only 40 percent. There are similarly large differentials by education in the proportion who know about the three main ways to prevent the spread of AIDS. Respondents in the lowest (poorest) wealth quintile are much less likely than those in the higher quintiles to have heard of AIDS. For example, 81 percent of women in the lowest wealth quintile reported having heard of AIDS, compared with 93 percent or higher of women in the second and higher wealth quintiles. The proportions of women who know that condom use, limiting sexual intercourse to one faithful partner, and abstinence are ways to reduce the risk of getting HIV all increase steadily with increasing wealth quintile. 12.2.2 Rejection of Misconceptions about HIV/AIDS In addition to knowing about effective ways to avoid contracting HIV, it is also useful to be able to identify incorrect beliefs about AIDS to eliminate misconceptions. Misconceptions about AIDS and HIV transmission contribute to discrimination and stigmatization of persons with HIV/AIDS. Common misconceptions about AIDS include the following: all people with HIV/AIDS appear ill, the virus can be transmitted through mosquito bites or other insect bites, the virus can be transmitted by hugging or shaking hands with someone who is HIV positive, and the virus can be transmitted by sharing food with someone who has HIV/AIDS. Respondents were asked about these misconceptions and the results are presented in Table 12.2 by background characteristics. 94 59 77 53 67 Has heard of AIDS Using condoms Limiting sexual intercourse to one uninfected part Using condoms and limiting sexual intercourse to o Abstaining from sexual intercourse 0 20 40 60 80 100 Figure 12.1 Awareness of AIDS and Knowledge of HIV Prevention Methods among Women Age 15-49 NDHS 2008 Limiting sexual intercourse to one HIV-negative partner Using condoms and limiting sexual intercourse to one HIV-negative partner Percent HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 155 Table 12.2 Comprehensive knowledge about AIDS Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Philippines 2008 Percentage of respondents who say that: Background characteristic A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by hugging or shaking hands A person cannot get HIV by sharing food with a person who has AIDS Percentage who say that a healthy looking person can have the AIDS virus and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Number of women Age 15-24 63.7 63.8 74.6 54.7 32.4 20.7 4,896 15-19 59.9 62.4 70.9 51.4 29.7 18.7 2,749 20-24 68.6 65.7 79.4 58.9 35.8 23.2 2,147 25-29 66.3 65.1 79.2 59.9 33.9 22.9 2,106 30-39 67.9 63.1 77.4 60.9 34.9 23.1 3,642 40-49 66.3 60.6 72.1 58.1 33.6 21.8 2,950 Marital status Never married 65.5 65.7 76.8 58.1 35.5 23.2 4,530 Ever had sex 71.6 68.3 85.7 67.2 39.0 24.5 454 Never had sex 64.9 65.5 75.8 57.1 35.1 23.1 4,077 Married/living together 66.0 61.8 75.0 57.9 32.6 21.2 8,418 Divorced/separated/widowed 64.7 62.6 73.7 57.1 31.9 22.3 646 Residence Urban 69.8 67.3 80.9 62.8 37.8 25.5 7,574 Rural 60.8 57.9 68.8 51.8 28.2 17.4 6,020 Region National Capital Region 68.7 73.0 84.1 68.2 41.7 29.5 2,522 Cordillera Admin Region 62.9 61.3 72.1 64.6 37.9 27.3 225 I - Ilocos 54.3 65.8 72.4 47.0 23.9 16.1 613 II - Cagayan Valley 60.3 64.1 65.6 50.5 26.3 13.4 382 III - Central Luzon 68.8 65.3 82.8 61.5 35.1 22.1 1,486 IVA - CALABARZON 72.5 61.4 79.5 63.7 41.1 25.8 1,808 IVB - MIMAROPA 63.6 56.3 72.2 53.1 30.3 21.3 340 V - Bicol 68.5 67.5 79.8 56.9 34.0 25.3 755 VI - Western Visayas 59.8 55.5 69.8 47.9 23.2 14.6 976 VII - Central Visayas 74.5 66.9 78.1 57.7 36.4 23.4 983 VIII - Eastern Visayas 72.0 60.1 79.1 64.0 38.8 23.2 488 IX - Zamboanga Peninsula 65.4 52.3 69.5 56.5 29.8 20.7 505 X - Northern Mindanao 68.1 56.6 65.8 51.1 28.1 16.0 585 XI - Davao 61.7 60.5 68.1 54.5 25.4 16.5 618 XII - SOCCSKSARGEN 51.8 62.4 70.3 52.5 24.7 12.2 480 XIII - Caraga 68.0 59.3 72.8 54.9 28.1 18.7 312 ARMM 39.5 44.3 41.8 30.4 20.2 12.3 516 Education No education 21.7 18.4 25.4 17.5 6.8 3.1 167 Elementary 51.3 48.8 58.9 43.5 20.7 11.5 2,653 High school 64.4 63.5 74.2 55.9 30.3 18.5 6,352 College 78.1 73.0 89.3 70.9 47.0 33.9 4,422 Wealth quintile Lowest 49.7 47.3 57.1 41.3 19.4 11.5 2,160 Second 61.1 57.6 67.8 49.3 25.4 15.3 2,419 Middle 66.6 63.6 76.3 57.5 31.6 19.3 2,661 Fourth 71.5 68.0 81.5 64.4 39.2 25.9 2,937 Highest 73.8 72.5 86.9 69.2 45.0 31.8 3,417 Total 15-49 65.8 63.1 75.5 57.9 33.6 21.9 13,594 1 Two most common local misconceptions (mosquito bites and sharing food) 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one HIV- negative and faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission and prevention. 156 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior More than six in ten women know that a healthy-looking person can have the AIDS virus and that AIDS cannot be transmitted through mosquito bites (Figure 12.2); three in four women (76 percent) know that AIDS cannot be transmitted by hugging or shaking hands, and just over half (58 percent) know that a person cannot get AIDS by sharing food with someone who has AIDS. However, only 34 percent of women 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 indicate that misconceptions about AIDS transmission remain high in the Philippines. Women in urban areas are less likely to have misconceptions about HIV/AIDS transmission than women in rural areas. Regional variations are notable, with correct responses for “knowing that a healthy looking person can have the AIDS virus and rejecting the two most common local misconceptions about HIV/AIDS” ranging from 20 percent among women in ARMM to 42 percent of those in NCR. Better educated women and those in the higher wealth quintiles are more likely to have correct knowledge about HIV/AIDS than other women. Table 12.2 provides an assessment of the level of comprehensive knowledge of HIV prevention and transmission. Comprehensive knowledge is defined as knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission, namely that HIV can be transmitted by mosquito bites and by sharing food with a person who has HIV. The results show that the percentage of Filipino women with comprehensive knowledge of AIDS is low: 22 percent. The low level of comprehensive knowledge is of particular concern regarding women with no education, for whom comprehensive knowledge is only 3 percent. 12.3 HIGHER-RISK SEXUAL INTERCOURSE The 2008 NDHS included questions on women’s most recent sexual partner in the 12 months preceding the survey and use of condoms at the last sexual intercourse. Sexually active women were asked about the total number of partners they had during their lifetime. These questions are, of course, 66 63 76 58 34 22 0 20 40 60 80 Figure 12.2 Rejection of Misconceptions about AIDS Transmission, and Comprehensive Knowledge about AIDS among Women Age 15-49 NDHS 2008 Percent A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by hugging or shaking hands A person cannot become infected by sharing food with a person who has AIDS A healthy- looking person can have the AIDS virus and rejects the two most common local miscon- ceptions Percentage with a comprehensive knowledge about AIDS HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 157 sensitive, and it is important when interpreting the results in this section to remember that women’s answers may be subject to some reporting bias. Table 12.3 presents several indicators related to sexual partnerships. The first two indicators assess the prevalence of higher-risk sexual intercourse among all women and among women who had sexual intercourse during the 12 months preceding the survey. Higher-risk sexual intercourse is intercourse with a partner who is neither a spouse nor a cohabiting partner (i.e., a nonmarital, noncohabiting partner). The third indicator relates to condom use during the last higher-risk sexual intercourse. The fourth indicator is the mean number of sexual partners that a woman has had during her lifetime; it provides an assessment of lifetime exposure to elements of higher-risk sexual intercourse and multiple partners. Only 2 percent of all Filipino women age 15-49 had higher-risk sexual intercourse in the 12 months preceding the survey. Among women who had sexual intercourse in the past 12 months, 3 percent reported having higher-risk sexual intercourse. The differentials presented in Table 12.3 suggest that higher-risk sexual intercourse is concentrated in a limited number of population subgroups. First, the prevalence of higher-risk sexual intercourse is, by definition, universal among never-married women who had sexual intercourse in the 12 months preceding the survey. Looking at the other marital status categories, no currently married women reported having higher-risk sexual intercourse during the 12 months preceding the survey. In contrast, more than one in four divorced, separated, and widowed women (27 percent) had higher-risk sexual intercourse in the 12 months preceding the survey. The prevalence of higher-risk sexual intercourse is high among young, sexually active women age 15-24; one in ten reported sexual intercourse with someone other than their spouse or cohabiting partner in the past 12 months. Because many respondents in age group 15-19 are likely to be never-married, it is expected that the prevalence of higher-risk sexual intercourse in this age group will be higher than the prevalence in older age groups. Higher-risk sexual intercourse is slightly more prevalent among women in urban areas and in the National Capital Region. It also increases directly with level of education and wealth status: as education and wealth increase, so does risky sexual behavior. Condom use is an important tool in the fight to curtail the spread of HIV/AIDS. Although truly effective protection would require correct condom use at every sexual encounter, condom use among those at higher risk is a useful indicator in the absence of other information. Table 12.3 shows that, among women who had higher-risk sexual intercourse in the 12 months preceding the survey, 11 percent reported that a condom was used the last time they had higher-risk sexual intercourse. The number of women reporting higher-risk sexual intercourse is often quite small, making it difficult to assess differences in the prevalence of condom use across subgroups. However, the results suggest that among women who engage in higher-risk sexual intercourse, condom use is highest among those in rural areas, those with college education, and those in the highest wealth quintiles. Finally, women who ever had sexual intercourse were asked about the number of sexual partners they had in their lifetime. Table 12.3 shows that women who have ever had sexual intercourse reported an average (mean) of one lifetime sexual partner. There is almost no difference in this figure by background characteristics. 158 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.3 Higher-risk sexual intercourse in the past 12 months Among all women age 15-49, the percentage who had higher-risk sexual intercourse in the past 12 months; among women age 15- 49 who had sexual intercourse in the past 12 months, the percentage who had higher-risk sexual intercourse in the past 12 months; among women who had higher-risk sexual intercourse in the past 12 months, the percentage who used a condom at last higher-risk sexual intercourse; and the mean number of sexual partners during lifetime for women who ever had sexual intercourse, by background characteristics, Philippines 2008 All women Women who had sexual intercourse in the past 12 months Women who had higher-risk sexual intercourse in the past 12 months1 Among women who ever had sexual intercourse Background characteristic Percentage who had higher-risk sexual inter- course in the past 12 months1 Number Percentage who had higher-risk sexual inter- course in the past 12 months1 Number Percentage who used a condom at last higher-risk sexual intercourse Number Mean number of sexual partners in lifetime Number Age 15-24 3.1 4,896 10.5 1,448 12.9 153 1.2 1,580 15-19 2.0 2,749 15.5 347 8.7 54 1.2 374 20-24 4.6 2,147 8.9 1,101 15.2 99 1.2 1,206 25-29 3.1 2,106 4.0 1,581 11.9 66 1.2 1,742 30-39 1.2 3,642 1.4 3,019 (3.1) 44 1.2 3,361 40-49 0.4 2,950 0.5 2,367 * 13 1.2 2,805 Marital status Never married 5.2 4,530 100.0 231 12.7 237 1.7 451 Married or living together 0.0 8,418 0.0 8,044 * 1 1.1 8,393 Divorced/separated/widowed 5.8 646 26.8 140 (0.0) 37 1.4 645 Residence Urban 2.6 7,574 4.3 4,324 9.2 193 1.2 5,025 Rural 1.4 6,020 2.0 4,091 15.0 82 1.2 4,463 Region National Capital Region 3.5 2,522 6.3 1,378 10.0 89 1.2 1,617 Cordillera Admin Region 1.9 225 3.0 144 * 4 1.1 160 I - Ilocos 0.7 613 1.1 406 * 5 1.1 444 II - Cagayan Valley 0.0 382 0.0 267 * 0 1.1 292 III - Central Luzon 2.9 1,486 4.7 907 (25.0) 43 1.3 1,043 IVA - CALABARZON 1.5 1,808 2.4 1,068 * 27 1.1 1,234 IVB - MIMAROPA 0.4 340 0.5 241 * 1 1.1 262 V - Bicol 1.3 755 1.9 457 * 10 1.2 519 VI - Western Visayas 1.6 976 2.4 617 * 16 1.1 683 VII - Central Visayas 2.2 983 3.6 605 * 22 1.2 677 VIII - Eastern Visayas 1.6 488 2.4 335 * 8 1.2 366 IX - Zamboanga Peninsula 2.1 505 3.4 322 * 11 1.2 360 X - Northern Mindanao 2.0 585 3.2 373 * 12 1.2 419 XI - Davao 2.4 618 3.7 410 * 15 1.2 455 XII - SOCCSKSARGEN 0.5 480 0.7 335 * 2 1.1 360 XIII - Caraga 3.1 312 4.5 220 * 10 1.2 240 ARMM 0.3 516 0.4 331 * 1 1.1 358 Education No education 0.4 167 0.5 125 * 1 1.2 149 Elementary 0.7 2,653 0.9 2,016 * 18 1.2 2,226 High school 1.8 6,352 2.9 3,741 5.2 113 1.2 4,181 College 3.3 4,422 5.6 2,534 14.7 144 1.1 2,931 Wealth quintile Lowest 0.5 2,160 0.7 1,650 * 11 1.2 1,766 Second 1.1 2,419 1.6 1,673 (3.5) 27 1.2 1,829 Middle 1.4 2,661 2.2 1,722 (3.1) 38 1.2 1,919 Fourth 3.1 2,937 5.2 1,735 13.5 92 1.2 1,965 Highest 3.2 3,417 6.4 1,634 14.3 109 1.2 2,009 Total 15-49 2.0 13,594 3.2 8,415 10.9 276 1.2 9,488 Note: Numbers 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 Higher-risk sexual intercourse refers to intercourse with a nonmarital, noncohabiting partner. HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 159 12.4 COVERAGE OF HIV TESTING Knowledge of HIV status helps persons who are HIV negative make specific decisions that will reduce risk and promote safer sex practices, so they can remain disease free. For those who are HIV positive, knowledge of their status allows them to take action to protect their sexual partners, to access treatment, and to plan for the future. Testing of pregnant women is especially important so action can be taken to prevent mother-to-child transmission. Where migration is common, knowing one’s HIV status is especially important for curbing the spread of the disease and empowering women to seek preventive and curative measures to protect themselves and their children. To obtain information on the prevalence of HIV testing, all respondents in the 2008 NDHS were asked whether they know of a place where people can go to get tested for HIV and whether they themselves had ever been tested for HIV. If they said that they had been tested, respondents were asked whether they had received the results of their last test. Table 12.4 shows that 52 percent of women know where to go to be tested for HIV. Knowledge of HIV testing facilities differs by respondents’ background characteristics. For instance, women age 25-29 (56 percent) are the most likely to know of a place where they can get tested for HIV. Similarly, knowledge about HIV testing facilities is higher among women in urban areas than their rural counterparts. Education and wealth status have a positive relationship with knowledge of HIV testing facilities. For example, 71 percent of women who attended college know of an HIV testing facility, compared with only 10 percent of women with no education; likewise, women in households in the higher wealth quintiles are more likely to know places to go to be tested for HIV than those in households in the lower wealth quintiles. Among the regions, Bicol and Caraga (63 percent each) have the highest levels of knowledge of a place to get tested for HIV, while ARMM has the lowest level (27 percent). Only 3 percent of women age 15-49 have ever been tested for HIV, with most reporting that they received their results (2 percent). Differentials by background characteristics in the percentage of women tested for HIV are small. The results presented in Table 12.4 indicate that women with college education and those in the wealthiest households are more likely to have been tested than women in other categories. Across regions, the percentage of women who have been tested varies from almost nil in ARMM to more than 4 percent in Caraga, Central Luzon, and NCR. 160 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.4 Coverage of prior HIV testing Among women age 15-49, the percentage who know where to get an HIV test, the percent distribution by testing status and by whether they received the results of the last test, the percentage of women ever tested, and the percentage of women who received the results of the last HIV test taken in the past 12 months, according to background characteristics, Philippines 2008 Percent distribution of women by testing status and by whether they received the results of the last test Background characteristic Percentage who know where to get an HIV test Ever tested and received results Ever tested did not receive results Never tested1 Total Percentage ever tested Percentage who received results of last HIV test taken in the past 12 months Number of women Age 15-24 46.8 1.3 0.3 98.5 100.0 1.5 0.6 4,896 15-19 41.9 0.3 0.1 99.6 100.0 0.4 0.1 2,749 20-24 53.1 2.5 0.4 97.0 100.0 3.0 1.2 2,147 25-29 56.0 3.3 1.0 95.8 100.0 4.2 1.2 2,106 30-39 54.5 2.9 0.7 96.4 100.0 3.6 0.8 3,642 40-49 53.4 2.6 0.6 96.8 100.0 3.2 0.5 2,950 Marital status Never married 50.9 1.5 0.2 98.3 100.0 1.7 0.5 4,530 Ever had sex 63.1 5.7 0.5 93.7 100.0 6.3 1.7 454 Never had sex 49.5 1.0 0.2 98.8 100.0 1.2 0.4 4,077 Married/living together 52.3 2.7 0.8 96.5 100.0 3.5 0.8 8,418 Divorced/separated/widowed 49.7 3.5 0.0 96.5 100.0 3.5 0.6 646 Residence Urban 55.4 2.6 0.7 96.8 100.0 3.2 0.9 7,574 Rural 47.0 2.0 0.4 97.6 100.0 2.4 0.5 6,020 Region National Capital Region 60.2 3.4 0.6 95.9 100.0 4.1 1.3 2,522 Cordillera Admin Region 45.4 2.0 0.2 97.8 100.0 2.2 0.6 225 I - Ilocos 58.2 2.4 0.6 97.0 100.0 3.0 0.9 613 II - Cagayan Valley 54.3 2.7 0.2 97.2 100.0 2.8 0.8 382 III - Central Luzon 45.8 3.6 1.0 95.4 100.0 4.6 1.2 1,486 IVA - CALABARZON 40.6 2.0 0.6 97.4 100.0 2.6 0.6 1,808 IVB - MIMAROPA 48.1 1.6 0.7 97.6 100.0 2.4 0.6 340 V - Bicol 63.0 1.0 0.1 98.8 100.0 1.2 0.1 755 VI - Western Visayas 57.5 2.2 0.6 97.2 100.0 2.8 0.3 976 VII - Central Visayas 46.8 0.9 0.9 98.2 100.0 1.8 0.3 983 VIII - Eastern Visayas 42.7 2.3 0.0 97.7 100.0 2.3 0.2 488 IX - Zamboanga Peninsula 52.5 2.1 0.3 97.6 100.0 2.4 0.3 505 X - Northern Mindanao 60.4 2.3 0.3 97.4 100.0 2.6 1.0 585 XI - Davao 57.7 1.8 0.7 97.5 100.0 2.5 0.7 618 XII - SOCCSKSARGEN 51.8 1.3 0.2 98.6 100.0 1.4 0.0 480 XIII - Caraga 62.6 3.7 1.0 95.3 100.0 4.7 1.2 312 ARMM 27.3 0.1 0.2 99.7 100.0 0.3 0.1 516 Education No education 10.4 0.0 0.0 100.0 100.0 0.0 0.0 167 Elementary 33.8 0.7 0.4 98.9 100.0 1.1 0.1 2,653 High school 47.2 1.7 0.5 97.8 100.0 2.2 0.5 6,352 College 70.5 4.2 0.7 95.0 100.0 5.0 1.4 4,422 Wealth quintile Lowest 37.1 0.7 0.3 99.0 100.0 1.0 0.1 2,160 Second 47.3 1.6 0.5 97.9 100.0 2.1 0.5 2,419 Middle 49.4 1.7 0.5 97.8 100.0 2.2 0.5 2,661 Fourth 55.4 2.9 0.5 96.6 100.0 3.4 1.0 2,937 Highest 62.7 3.7 0.9 95.4 100.0 4.6 1.3 3,417 Total 15-49 51.7 2.3 0.6 97.1 100.0 2.9 0.7 13,594 1 Includes “don't know/missing” HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 161 12.5 HIV/AIDS KNOWLEDGE AND SEXUAL BEHAVIOR AMONG YOUTH Knowledge of HIV/AIDS issues and related sexual behavior among youth age 15-24 is of particular interest because the period between sexual initiation and marriage is for many young people a time of experimentation that may involve risky behaviors. Special attention is paid to this group because it accounts for a large proportion of all new HIV cases worldwide. This section considers a number of issues that relate to both transmission and prevention of HIV/AIDS among youth, including the level of comprehensive knowledge of HIV/AIDS transmission and prevention modes and knowledge of a source where they can obtain condoms. Issues such as abstinence, age at sexual debut, and condom use are also covered in this section. 12.5.1 Knowledge about HIV/AIDS and Source for Condoms Knowledge on how HIV is transmitted is crucial in enabling young people to avoid contracting the virus. Young people are often at greater risk because they may have shorter relationships and more partners, or engage in other risky behaviors. Knowledge of HIV among youth is part of the Millennium Development Goals (MDGs) indicators, and should be monitored periodically by all developing countries. As discussed earlier, comprehensive knowledge of HIV is defined as: 1) knowing that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the likelihood of getting HIV; 2) knowing that a healthy-looking person can have HIV; and 3) rejecting the two most common local misconceptions about HIV transmission and prevention. Table 12.5 shows that only 21 percent of women age 15-24 have comprehensive knowledge about HIV/AIDS. The level of comprehensive knowledge does not vary substantially by age. Among young women, comprehensive knowledge is somewhat higher among those who are never-married than those who are ever-married (22 percent compared with 18 percent). As expected, comprehensive knowledge about HIV/AIDS among women age 15-24 is higher in urban areas (23 percent) than in rural areas (17 percent). Across regions, the level of comprehensive knowledge ranges from 11 percent among young women in SOCCSKSARGEN to 29 percent in NCR. Consistent with the patterns seen for other indicators, increases in education and wealth quintile are associated with increases in comprehensive knowledge about HIV/AIDS. Condom use among young adults plays an important role in combating the transmission of HIV and other sexually transmitted infections (as well as preventing unwanted pregnancies). Knowledge of a source of condoms is prerequisite to young adults obtaining and using them. Young women were asked whether they knew where they could go to get condoms. Only formal sources of condoms were counted; friends, family members, home, and other similar informal sources were not included. As shown in Table 12.5, about two in three young women (65 percent) know a source where they can get a condom. Knowledge of a condom source among young women varies by background characteristics and tends to increase with age. Ever-married young women are more likely to know about a source for condoms than those who have never married. Young women in urban areas are more likely than those in rural areas to know of a condom source. Knowledge of a condom source among young women is lowest in ARMM (33 percent) and highest in NCR (76 percent). As expected, the proportion of young women who know where to get condoms increases with level of education and wealth quintile. 162 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.5 Comprehensive knowledge about AIDS and a source of condoms among young women Percentage of young women age 15-24 with comprehensive knowledge about AIDS and the percentage with knowledge of a source of condoms, by background characteristics, Philippines 2008 Background characteristic Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of women Age 15-19 18.7 56.0 2,749 15-17 16.2 48.2 1,680 18-19 22.7 68.1 1,069 20-24 23.2 75.9 2,147 20-22 23.7 75.7 1,323 23-24 22.3 76.3 825 Marital status Never married 21.7 62.2 3,534 Ever had sex 21.2 84.9 222 Never had sex 21.7 60.7 3,311 Ever married 18.0 71.1 1,363 Residence Urban 23.4 69.4 2,784 Rural 17.1 58.6 2,112 Region National Capital Region 28.5 75.6 916 Cordillera Admin Region 26.0 66.5 85 I - Ilocos 16.9 62.3 213 II - Cagayan Valley 17.4 66.5 118 III - Central Luzon 19.1 69.4 527 IVA - CALABARZON 24.1 54.9 650 IVB - MIMAROPA 20.1 52.0 126 V - Bicol 23.1 74.5 292 VI - Western Visayas 13.1 64.2 324 VII - Central Visayas 22.5 72.2 370 VIII - Eastern Visayas 24.4 62.0 150 IX - Zamboanga Peninsula 18.6 56.9 197 X - Northern Mindanao 14.1 68.0 220 XI - Davao 12.7 56.6 233 XII - SOCCSKSARGEN 10.7 62.4 170 XIII - Caraga 18.9 63.4 107 ARMM 12.4 33.3 198 Education No education (0.0) (15.4) 32 Elementary 9.5 35.8 597 High school 17.7 60.5 2,880 College 32.1 87.0 1,388 Wealth quintile Lowest 14.3 41.4 698 Second 14.8 58.6 861 Middle 18.9 65.2 917 Fourth 23.8 73.3 1,078 Highest 26.4 73.5 1,343 Total 20.7 64.7 4,896 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one HIV-negative and faithful partner can reduce the chances of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about AIDS transmission and prevention. The components of comprehensive knowledge are presented in Tables 13.1 and 13.2. 2 Friends, family members, and home are not considered sources for condoms. HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 163 12.5.2 Age at First Sex Information from the 2008 NDHS can be used to examine age at first sexual intercourse. Table 12.6 shows the proportion of women age 15-24 who had sexual intercourse before age 15 and before age 18. Only 2 percent of young women had sexual intercourse by age 15, while 17 percent of young women had sexual intercourse by age 18. Table 12.6 Age at first sexual intercourse among young women Percentage of young women age 15-24 who had sexual intercourse before age 15 and the percentage of young women age 18-24 who had sexual intercourse before age 18, by background characteristics, Philippines 2008 Background characteristic Percentage who had sexual intercourse before age 15 Number of women age 15-24 Percentage who had sexual intercourse before age 18 Number of women age 18-24 Age 15-19 2.1 2,749 na na 15-17 2.2 1,680 na na 18-19 1.8 1,069 17.4 1,069 20-24 2.1 2,147 17.1 2,147 20-22 2.4 1,323 17.9 1,323 23-24 1.5 825 15.9 825 Marital status Never married 0.2 3,534 2.9 1,939 Ever married 6.9 1,363 38.9 1,277 Knows condom source1 Yes 1.9 3,168 15.5 2,357 No 2.4 1,728 21.9 859 Residence Urban 1.8 2,784 13.7 1,896 Rural 2.5 2,112 22.3 1,320 Region National Capital Region 1.1 916 11.5 646 Cordillera Admin Region 0.9 85 15.2 56 I - Ilocos 0.4 213 15.2 146 II - Cagayan Valley 0.6 118 19.7 74 III - Central Luzon 2.1 527 16.8 350 IVA - CALABARZON 1.7 650 15.8 440 IVB - MIMAROPA 4.9 126 22.8 81 V - Bicol 2.0 292 14.0 173 VI - Western Visayas 0.0 324 12.6 207 VII - Central Visayas 3.0 370 19.2 236 VIII - Eastern Visayas 2.7 150 22.4 89 IX - Zamboanga Peninsula 2.8 197 24.3 121 X - Northern Mindanao 2.5 220 21.2 139 XI - Davao 4.3 233 19.9 158 XII - SOCCSKSARGEN 4.4 170 27.7 101 XIII - Caraga 4.0 107 28.4 67 ARMM 3.6 198 25.5 132 Education No education (14.3) 32 (40.0) 21 Elementary 8.1 597 40.1 341 High school 1.6 2,880 22.7 1,586 College 0.1 1,388 3.7 1,268 Wealth quintile Lowest 5.8 698 36.7 440 Second 2.9 861 25.7 530 Middle 2.0 917 14.8 591 Fourth 0.8 1,078 10.9 730 Highest 0.7 1,343 9.5 924 Total 2.1 4,896 17.2 3,216 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Friends, family members, and home are not considered sources for condoms. 164 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Looking at age at first sexual intercourse by background characteristics, the proportion of young women who had sexual intercourse before age 15 and before age 18 are markedly lower among women who have never married than among those who have ever married. Young women in urban areas are less likely to have had sexual intercourse than young women in rural areas, whether by age 15 or 18. Education and wealth status have a negative association with early initiation of sexual activity; as education and wealth increase, the proportion of women reporting first sexual intercourse before the age of 18 decreases. 12.5.3 Condom Use at First Sexual Intercourse To assess the extent to which condoms are used at the time of first sexual intercourse, young women were asked whether they had used a condom during first sexual intercourse. Table 12.7 shows that only 4 percent of young women age 15-24 used a condom during first sexual inter- course. This low figure is not surprising because most Filipino women are newly married at the time they first have sexual intercourse, and are therefore unlikely to use contraception. Higher educational attainment, higher wealth status, and urban resi- dence are related to increased likelihood that a con- dom was used the first time a young woman had sexual intercourse. 12.5.4 Premarital Sexual Activity The period between first sexual intercourse and marriage is often a time of sexual experimenta- tion. Unfortunately, in the era of HIV/AIDS, it can also be a risky time. Table 12.8 presents informa- tion on sexual activity among never-married young women age 15-24 and condom use: the percentage of never-married young women who have never had sexual intercourse, the percentage who had sexual intercourse in the past 12 months, and the percent- age who used a condom at last sexual intercourse. The great majority (94 percent) of never- married young women have never had sexual inter- course. As a result, the proportion reporting sexual activity in the 12 months preceding the survey is relatively low (4 percent). Given the comparatively small proportion of never-married young women reporting premarital intercourse, differentials in this indicator are minimal. Among never-married young women who reported having sexual intercourse in the 12 months preceding the survey, 14 percent said they used a condom the last time they had sexual intercourse. The numbers are too small to show meaningful differences by subgroups. Table 12.7 Condom use at first sexual intercourse among young women Among young women age 15-24 who have ever had sexual intercourse, the percentage who used a condom the first time they had sexual intercourse, by background characteristics, Philippines 2008 Background characteristic Percentage who used a condom at first sexual intercourse Number of women age 15-24 who have ever had sexual intercourse Age 15-19 4.7 375 15-17 2.7 99 18-19 5.4 276 20-24 4.1 1,210 20-22 3.9 651 23-24 4.4 559 Marital status Never married 10.4 222 Ever married 3.2 1,363 Knows condom source1 Yes 5.4 1,157 No 1.1 427 Residence Urban 5.1 769 Rural 3.4 815 Region National Capital Region 5.9 240 Cordillera Admin Region 0.0 30 I - Ilocos 8.7 76 II - Cagayan Valley 1.6 45 III - Central Luzon 6.2 175 IVA - CALABARZON 4.3 195 IVB - MIMAROPA 3.5 54 V - Bicol 2.1 93 VI - Western Visayas 3.6 98 VII - Central Visayas 1.9 121 VIII - Eastern Visayas 5.9 54 IX - Zamboanga Peninsula 2.3 70 X - Northern Mindanao 3.8 75 XI - Davao 3.1 86 XII - SOCCSKSARGEN 3.0 64 XIII - Caraga 5.0 43 ARMM 3.7 68 Education No education (0.0) 17 Elementary 0.9 258 High school 4.0 935 College 7.4 374 Wealth quintile Lowest 1.2 343 Second 2.8 345 Middle 3.9 309 Fourth 5.6 316 Highest 8.7 272 Total 4.2 1,585 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Friends, family members, and home are not considered sources for condoms. HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 165 Table 12.8 Premarital sexual intercourse and condom use among young women Among never-married women age 15-24, the percentage who have never had sexual intercourse and the percentage who had sexual intercourse in the 12 months preceding the survey, and among those who had sexual intercourse in the past 12 months, the percentage who used a condom at the last sexual intercourse, by background characteristics, Philippines 2008 Background characteristic Percentage who have never had sexual intercourse Percentage who had sexual intercourse in the past 12 months Number of never- married women Percentage who used condom at last sexual intercourse Number of women who had sexual intercourse Age 15-19 97.2 2.1 2,441 9.3 50 15-17 99.1 0.6 1,595 * 9 18-19 93.7 4.9 846 (11.4) 41 20-24 85.8 8.1 1,093 17.0 88 20-22 87.1 7.1 771 10.4 55 23-24 82.6 10.2 322 (28.2) 33 Knows condom source1 Yes 91.4 5.5 2,199 16.3 120 No 97.5 1.3 1,334 * 18 Residence Urban 93.5 4.2 2,156 9.2 90 Rural 94.1 3.5 1,378 23.6 48 Region National Capital Region 91.7 5.8 737 (11.6) 43 Cordillera Admin Region 90.8 6.4 61 * 4 I - Ilocos 95.5 1.9 144 * 3 II - Cagayan Valley 97.2 0.0 76 * 0 III - Central Luzon 92.1 6.2 383 * 24 IVA - CALABARZON 95.6 3.1 476 * 15 IVB - MIMAROPA 94.7 1.6 75 * 1 V - Bicol 96.2 0.5 207 * 1 VI - Western Visayas 95.5 2.6 237 * 6 VII - Central Visayas 92.3 4.5 270 * 12 VIII - Eastern Visayas 93.7 4.7 102 * 5 IX - Zamboanga Peninsula 94.2 4.0 134 * 5 X - Northern Mindanao 93.3 3.8 156 * 6 XI - Davao 88.4 5.3 167 * 9 XII - SOCCSKSARGEN 99.1 0.0 107 * 0 XIII - Caraga 89.4 7.5 72 * 5 ARMM 100.0 0.0 130 * 0 Education No education 94.7 0.0 15 * 0 Elementary 96.2 1.4 352 * 5 High school 95.2 3.1 2,043 5.4 63 College 90.2 6.2 1,124 21.6 70 Wealth quintile Lowest 96.1 1.9 369 * 7 Second 95.5 2.6 541 * 14 Middle 94.6 3.0 643 * 19 Fourth 92.8 5.7 820 (16.6) 47 Highest 92.2 4.4 1,161 (21.3) 51 Total 93.7 3.9 3,534 14.2 138 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 Friends, family members, and home are not considered sources for condoms. 12.5.5 Higher-Risk Sexual Intercourse among Young Women The most common mode of transmission of HIV in the Philippines is through unprotected sexual intercourse with a person who is HIV positive. To prevent HIV transmission, it is important that young people practice safe sex through the ABC method (abstinence, being faithful to one HIV-negative partner, and condom use). Table 12.9 presents information on the percentage of young women who had higher- risk sexual intercourse (i.e., intercourse with a nonmarital, noncohabiting partner) in the 12 months preceding the survey, and the rate of condom use at last higher-risk sexual intercourse. 166 │ HIV/AIDS-Related Knowledge, Attitudes, and Behavior Table 12.9 Higher-risk sexual intercourse among young women and condom use at last higher-risk sexual intercourse Among young women age 15-24 who had sexual intercourse in the past 12 months, the percentage who had higher-risk sexual intercourse, and among those who had higher-risk sexual intercourse in the past 12 months, the percentage who used a condom at last higher-risk sexual intercourse, by background characteristics, Philippines 2008 Women age 15-24 who had sexual intercourse in the past 12 months Women age 15-24 who had higher-risk sexual intercourse in the past 12 months1 Background characteristic Percentage who had higher-risk sexual intercourse in the past 12 months1 Number of women Percentage who used a condom at last higher-risk sexual intercourse1 Number of women Age 15-19 15.5 347 8.7 54 15-17 14.0 90 * 13 18-19 16.0 256 (11.4) 41 20-24 8.9 1,101 15.4 98 20-22 9.8 587 9.9 58 23-24 7.8 514 (23.2) 40 Marital status Never married 100.0 138 14.2 138 Ever married 1.0 1,309 * 13 Knows condom source2 Yes 12.4 1,051 15.1 130 No 5.2 397 * 21 Residence Urban 14.0 692 8.6 97 Rural 7.2 756 21.0 54 Region National Capital Region 21.4 212 (10.9) 45 Cordillera Admin Region 14.3 27 * 4 I - Ilocos 3.8 72 * 3 II - Cagayan Valley 0.0 41 * 0 III - Central Luzon 16.8 164 * 28 IVA - CALABARZON 8.1 181 * 15 IVB - MIMAROPA 2.5 48 * 1 V - Bicol 4.8 82 * 4 VI - Western Visayas 6.8 91 * 6 VII - Central Visayas 12.3 107 * 13 VIII - Eastern Visayas 9.5 50 * 5 IX - Zamboanga Peninsula 9.4 65 * 6 X - Northern Mindanao 8.6 68 * 6 XI - Davao 12.0 74 * 9 XII - SOCCSKSARGEN 0.0 61 * 0 XIII - Caraga 16.5 40 * 7 ARMM 1.0 66 * 1 Education No education 4.3 16 * 1 Elementary 3.0 240 * 7 High school 8.4 867 4.7 73 College 21.6 325 21.6 70 Wealth quintile Lowest 2.3 327 * 8 Second 5.1 324 * 16 Middle 7.6 284 * 21 Fourth 16.4 295 (16.2) 48 Highest 26.3 218 19.0 57 Total 15-24 10.5 1,448 13.0 151 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 Higher-risk sexual intercourse refers to intercourse with a nonmarital, noncohabiting partner. 2 Friends, family members, and home are not considered sources for condoms. HIV/AIDS-Related Knowledge, Attitudes, and Behavior │ 167 Among young women age 15-24 who had sexual intercourse in the past 12 months, 11 percent had higher-risk sexual intercourse during this period. Thirteen percent of these women reported condom use at last higher-risk sexual intercourse. There are substantial differences in the prev- alence of higher-risk sexual intercourse among young women by background characteristics. Young women with higher levels of education and those in wealthier households are more likely than other young women to have engaged in higher-risk sexual intercourse. Young women in urban areas are twice as likely as those in rural areas to have engaged in risky sexual behavior, although they are less likely than those in rural areas to use condoms when they do so. 12.5.6 Voluntary HIV Counseling and Testing among Young Women A person’s knowledge of their own HIV- positive sero-status can motivate them to practice safer sexual behavior to avoid transmitting the virus to others. Voluntary counseling and testing (VCT) provides this information, but young women may think there are barriers to accessing and using health facilities, particularly for sensitive concerns about sexually transmitted infections like HIV/AIDS. Table 12.10 presents information on recent HIV testing among young women age 15-24. Only 1 percent of sexually active young women were tested for HIV in the 12 months preceding the survey and received the results. The differentials by background character- istics are minimal, although 5 percent of young women in Central Luzon and 3 percent in Cagayan Valley were tested in the 12 months preceding the survey and received the results. Table 12.10 Recent HIV tests among young women Among young women age 15-24 who had sexual intercourse in the past 12 months, the percentage who had an HIV test in the past 12 months and received the results, by background characteristics, Philippines 2008 Background characteristic Percentage who were tested for HIV in the past 12 months and received the results Number of women who had sexual intercourse in the past 12 months Age 15-19 0.2 347 15-17 0.0 90 18-19 0.3 256 20-24 1.4 1,101 20-22 1.2 587 23-24 1.7 514 Marital status Never married 1.5 138 Ever married 1.1 1,309 Knows condom source1 Yes 1.3 1,051 No 0.8 397 Residence Urban 1.4 692 Rural 0.9 756 Region National Capital Region 1.1 212 Cordillera Admin Region 0.0 27 I - Ilocos 0.0 72 II - Cagayan Valley 3.4 41 III - Central Luzon 5.2 164 IVA - CALABARZON 0.7 181 IVB - MIMAROPA 0.0 48 V - Bicol 0.0 82 VI - Western Visayas 1.2 91 VII - Central Visayas 0.0 107 VIII - Eastern Visayas 1.6 50 IX - Zamboanga Peninsula 0.0 65 X - Northern Mindanao 1.4 68 XI - Davao Peninsula 0.0 74 XII - SOCCSKSARGEN 0.0 61 XIII - Caraga 0.0 40 ARMM 0.0 66 Education No education * 16 Elementary 0.5 240 High school 1.1 867 College 1.8 325 Wealth quintile Lowest 0.3 327 Second 1.7 324 Middle 1.0 284 Fourth 0.8 295 Highest 2.1 218 Total 15-24 1.1 1,448 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Friends, family members, and home are not considered sources for condoms. Tuberculosis Knowledge, Attitudes, and Behavior │ 169 TUBERCULOSIS KNOWLEDGE, ATTITUDES, AND BEHAVIOR 13 This chapter examines knowledge of tuberculosis (TB) among Filipino women age 15-49, its symptoms and causes, and stigma attached to the disease. Section 13.1 discusses the status of tuberculosis in the Philippines and worldwide, and the medical aspects of the disease. Section 13.2 examines the level of awareness of tuberculosis, its signs and symptoms, cause, mode of transmission, and treatment. Section 13.3 deals with self-reported diagnosis, symptoms, and treatment, and Section 13.4 focuses on issues of stigma. 13.1 BACKGROUND In 2005, tuberculosis was the fifth leading cause of morbidity and mortality in the Philippines. The burden of the disease is made more serious by the fact that in 2003, the country had the 8th highest incidence of tuberculosis in the world and the 3rd highest in the Western Pacific Region. The Philippine government has been implementing a program called DOTS (Directly Observed Treatment, Short- course), which is the primary TB control strategy recommended by the World Health Organization (WHO). DOTS combines the following: 1) case detection by sputum smear microscopy among patients with TB symptoms who went to a health facility, 2) standardized 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 information to the TB control program. DOTS PLUS was implemented as a project to manage patients with multi-drug resistant tuberculosis. Tuberculosis is primarily caused by a bacterium (Mycobacterium tuberculosis). The majority of cases are pulmonary, but in about 15 percent of cases, the bacteria disseminate to other areas of the body and are classified as nonpulmonary tuberculosis. Transmission is mainly airborne, through the inhalation of bacteria-carrying droplets produced by individuals with active pulmonary tuberculosis. Less commonly, infection may occur through skin wounds, such as those associated with injecting drug use. Among people directly exposed to tuberculosis, only about 30 percent will actually become infected. In the general population, only about 5 percent of infected persons will develop active pulmonary tuberculosis 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-positive individuals. In the Philippines, any person with a history of cough for two or more weeks is a suspected case of tuberculosis. Other than a persistent cough, symptoms of active pulmonary tuberculosis include chest pain, coughing up blood or sputum, fatigue, weight loss, loss of appetite, chills, fever, and night sweats. In persons who are infected but do not show symptoms of tuberculosis, the immune system is able to destroy or “wall off” the TB bacteria. These enclosed bacteria can remain dormant for many years and later be reactivated. Risk factors for reactivation include old age, immunosuppression, diabetes, kidney malfunction, and malnutrition. The reactivation rate is about 5 percent in the general population. Worldwide, two-thirds of untreated smear-positive cases will die within five to eight years, the majority within the first two years (Stybo, 1999). The case fatality rate for untreated smear-positive TB is about 10 to 15 percent (Rieder, 1999). The case fatality rate for smear-positive TB patients can exceed 10 percent if adherence to treatment is low, as in cases of HIV co-infection, or in areas with high anti-TB drug resistance (WHO, 2002). 170 │ Tuberculosis Knowledge, Attitudes, and Behavior 13.2 WOMEN’S KNOWLEDGE OF TB Table 13.1 shows the level of women’s knowledge of tuberculosis and whether they think that tuberculosis can be cured, according to age, residence, region, education, and wealth quintile. Almost all women age 15-49 (98 percent) have heard of tuberculosis. The percentage of women who know that tuberculosis can be cured is slight- ly lower (94 percent). Knowledge of tuberculosis does not vary much by age, residence, and region; however, it increases with level of education and wealth quin- tile. Women with no education are least likely to have heard of tuberculosis (78 percent) and those with college or higher education are most likely to have heard of tuberculosis (100 percent). Simi- larly, women in households in the lowest wealth quintile are least likely to have heard of tubercu- losis (95 percent) and those in the highest wealth quintile are the most likely (100 percent) to have heard of the disease. The percentage of women who think that tuberculosis can be cured does not differ much by age and residence. However, knowledge that tu- berculosis can be cured rises steadily with the level of education and wealth quintile; the knowl- edge that TB can be cured ranges from 66 percent among women with no education to 98 percent among those with college or higher education. Likewise, women in the lowest wealth quintile are least likely to know that tuberculosis can be cured (87 percent) while those in the highest wealth quintile are most likely to know that TB can be cured (96 percent). ARMM has the lowest proportion of women who know that tuberculosis can be cured (85 percent), while the National Capital Region has the highest proportion (97 percent). Table 13.2 shows the percentage of women who know specific signs and symptoms of tuberculosis. Less than 2 percent of women do not know any TB-related symptoms. The signs and symp- toms of tuberculosis most commonly reported by women are coughing (59 percent), weight loss (39 percent), and blood in sputum (35 percent). The next most commonly cited symptoms are coughing with sputum (30 percent), coughing for several weeks (27 percent), and fever (24 percent). Knowledge of specific symptoms of tubeculosis does not vary much by background characteristics, except that women with no education and poorer women are generally less likely to know about each of the symptoms than better educated and wealthier women. Table 13.1 Knowledge of tuberculosis Percentage of women who have heard of tuberculosis and who believe that tuberculosis can be cured, by background characteristics, Philippines 2008 Background characteristic Has heard of TB Believes TB can be cured Number of women Age 15-19 97.5 87.8 2,749 20-24 98.5 92.4 2,147 25-29 98.6 94.3 2,106 30-34 98.9 95.9 1,865 35-39 98.6 96.8 1,777 40-44 98.9 96.7 1,532 45-49 98.6 96.4 1,418 Residence Urban 99.1 95.0 7,574 Rural 97.6 92.2 6,020 Region National Capital Region 99.7 97.4 2,522 Cordillera Admin Region 97.7 87.2 225 I - Ilocos 99.3 93.9 613 II - Cagayan Valley 96.0 92.4 382 III - Central Luzon 98.9 95.7 1,486 IVA - CALABARZON 98.9 94.7 1,808 IVB - MIMAROPA 95.1 90.6 340 V - Bicol 99.7 95.3 755 VI - Western Visayas 98.6 93.8 976 VII - Central Visayas 99.6 93.7 983 VIII - Eastern Visayas 99.2 92.9 488 IX - Zamboanga Peninsula 98.4 90.2 505 X - Northern Mindanao 96.4 88.2 585 XI - Davao 98.1 90.9 618 XII - SOCCSKSARGEN 96.2 91.8 480 XIII - Caraga 99.3 94.0 312 ARMM 91.9 85.2 516 Education No education 77.5 65.8 167 Elementary 96.1 88.1 2,653 High school 99.1 94.2 6,352 College or higher 99.7 97.5 4,422 Wealth quintile Lowest 94.8 86.7 2,160 Second 98.4 92.9 2,419 Middle 99.0 94.6 2,661 Fourth 99.3 95.6 2,937 Highest 99.5 96.4 3,417 Total 98.4 93.7 13,594 Tuberculosis Knowledge, Attitudes, and Behavior │ 171 Table 13.2 Knowledge of signs and symptoms of tuberculosis Among women who have heard of tuberculosis, percentage who know specific signs and symptoms of tuberculosis, by background characteristics, Philippines 2008 Signs and symptoms of tuberculosis Background characteristic Cough- ing Cough- ing with sputum Cough- ing for several weeks Fever Blood in sputum Loss of appetite Night sweats Pain in chest or back Tired- ness/ fatigue Weight loss Breath- ing prob- lems Pale Ele- vated shoul- der Other Don’t know Number of women Age 15-19 60.0 28.5 23.8 16.6 33.7 9.1 2.2 8.8 10.9 34.7 0.6 1.4 0.1 0.9 2.8 2,679 20-24 58.6 31.5 27.0 21.4 36.3 11.7 3.8 13.1 11.7 37.9 0.6 1.6 0.0 1.1 1.8 2,115 25-29 58.0 31.2 27.5 21.7 36.1 14.6 3.2 13.0 12.5 39.9 0.6 1.6 0.1 1.1 1.5 2,077 30-34 60.4 30.0 28.5 24.3 35.1 14.5 4.2 14.7 12.2 40.0 0.7 1.4 0.3 0.6 0.9 1,843 35-39 57.3 30.6 29.4 27.8 34.4 12.8 4.0 13.8 13.6 38.7 0.6 2.2 0.2 1.3 1.4 1,753 40-44 60.2 27.4 25.0 30.7 35.9 16.1 3.4 15.1 15.8 40.6 0.5 1.7 0.2 1.1 1.0 1,516 45-49 59.4 27.8 27.7 29.2 30.9 16.4 3.9 12.7 14.3 39.7 0.6 1.8 0.5 1.8 1.3 1,398 Residence Urban 58.5 30.0 27.4 28.9 35.0 15.9 3.8 13.3 12.8 39.6 0.6 1.3 0.1 0.9 1.6 7,504 Rural 59.9 29.2 26.0 16.9 34.4 9.6 2.9 12.0 12.6 37.0 0.6 2.1 0.2 1.4 1.7 5,877 Region National Capital Region 57.7 30.7 30.1 40.8 34.6 20.5 4.4 16.3 12.9 40.0 0.2 0.1 0.2 0.5 1.2 2,514 Cordillera Admin Region 57.7 38.8 36.5 17.7 37.4 10.2 6.0 15.8 9.4 22.9 1.1 0.5 2.0 0.0 3.6 220 I - Ilocos 48.2 24.0 40.4 16.5 42.8 10.2 1.8 12.7 9.3 30.5 0.3 0.3 0.3 1.2 1.4 609 II - Cagayan Valley 51.0 34.9 33.5 15.7 44.0 7.8 2.2 15.5 11.7 38.7 0.4 0.2 0.6 0.2 1.4 366 III - Central Luzon 52.4 21.8 28.1 30.1 36.6 13.7 2.7 15.2 11.1 37.0 0.2 0.4 0.0 1.3 1.5 1,470 IVA - CALABARZON 58.0 44.7 28.1 27.0 33.1 19.2 4.4 11.3 11.4 37.0 0.1 0.1 0.1 0.1 2.0 1,788 IVB - MIMAROPA 63.4 27.5 21.7 22.6 32.0 7.3 2.2 14.7 10.0 35.1 0.4 0.6 0.2 2.5 4.1 324 V - Bicol 60.7 21.6 33.5 19.5 45.3 13.5 3.3 14.1 15.6 49.1 0.6 1.4 0.0 1.6 1.2 753 VI - Western Visayas 73.8 16.8 12.0 18.4 36.8 11.1 5.1 17.4 10.6 32.4 1.1 1.2 0.0 1.3 3.1 963 VII - Central Visayas 66.8 19.0 22.7 16.0 31.2 10.5 3.4 9.1 16.2 40.0 1.6 6.9 0.0 1.1 0.7 978 VIII - Eastern Visayas 73.1 39.8 22.3 13.7 30.1 8.8 3.3 7.3 17.7 46.3 1.3 4.1 0.0 1.1 0.3 483 IX - Zamboanga Peninsula 69.0 38.8 17.9 18.2 27.8 5.9 2.5 7.1 14.3 38.6 0.2 1.3 0.7 1.9 1.4 497 X - Northern Mindanao 48.0 34.0 38.3 15.1 34.8 6.9 1.8 6.5 13.2 39.8 0.9 3.3 0.3 0.8 2.4 564 XI - Davao 65.1 24.6 18.2 14.4 28.2 8.5 2.7 9.0 15.5 36.2 2.5 5.4 0.3 4.7 0.6 606 XII - SOCCSKSARGEN 55.1 27.4 25.0 15.0 36.5 9.7 2.8 10.6 15.4 35.7 0.9 3.1 0.4 1.1 2.7 462 XIII - Caraga 60.7 27.7 23.6 13.2 38.8 7.3 2.3 10.2 19.5 48.2 0.2 5.8 0.0 2.0 2.3 310 ARMM 45.4 38.6 19.2 3.3 21.5 5.2 1.8 9.5 4.6 41.5 0.0 0.7 0.0 1.1 1.4 474 Education No education 51.1 31.2 17.1 6.5 19.8 2.5 0.6 8.9 6.5 30.0 0.0 0.8 0.0 1.6 5.4 129 Elementary 61.2 25.4 21.5 15.7 27.4 6.7 2.3 10.4 10.6 32.0 0.8 1.9 0.1 1.0 3.0 2,549 High school 58.8 28.5 24.7 20.7 34.1 11.1 2.4 11.4 12.2 35.4 0.6 1.7 0.2 1.2 1.8 6,292 College or higher 58.7 33.8 33.1 32.8 40.4 20.2 5.7 16.1 14.8 46.8 0.5 1.4 0.2 1.0 0.5 4,411 Wealth quintile Lowest 60.8 26.5 22.6 9.9 29.2 6.6 2.2 10.3 10.3 32.8 1.0 2.5 0.1 1.5 2.1 2,049 Second 60.5 26.8 24.0 17.6 33.5 8.7 2.3 11.1 12.7 36.5 0.6 2.2 0.4 1.4 2.2 2,380 Middle 59.6 28.4 25.6 22.1 33.2 11.0 2.9 12.5 13.7 37.3 0.7 2.2 0.1 1.3 1.8 2,634 Fourth 58.4 31.9 27.3 27.9 34.7 16.9 3.8 13.3 12.2 39.6 0.5 1.2 0.1 0.9 1.5 2,917 Highest 57.5 32.7 31.7 33.5 40.1 18.7 5.1 14.9 13.8 43.2 0.4 0.7 0.2 0.8 1.1 3,401 Total 59.1 29.7 26.8 23.6 34.7 13.2 3.4 12.7 12.7 38.5 0.6 1.6 0.2 1.1 1.6 13,381 In addition to the signs and symptoms of tuberculosis, women in the 2008 NDHS were asked what they thought were the causes of tuberculosis. Table 13.3 shows for women who have heard of tuberculosis, the percentage who cited specific causes for the infection by background characteristics. Smoking (59 percent), drinking alcohol (44 percent), microbes/germs/bacteria (23 percent), inherited (23 percent), and fatigue (22 percent) emerged as the top-ranking causes of tuberculosis identified by the women. Five percent of women said they did not know any causes of tuberculosis. It must be noted that the correct answer—microbes, germs, or bacteria—was cited by only 23 percent of women. 172 │ Tuberculosis Knowledge, Attitudes, and Behavior Table 13.3 Knowledge of causes of tuberculosis Among women who have heard of tuberculosis, percentage citing specific causes of tuberculosis, by background characteristics, Philippines 2008 Causes of tuberculosis Background characteristic Microbes/ germs/ bacteria Inheri- ted Life- style Smok- ing Alcohol drink- ing Fatigue Malnu- trition Unhy- gienic prac- tices Pol- lution Letting sweat dry Has prob- lems Slept on cold floors Chang- ing weather Un- treated cough Other Don’t know Number of women Age 15-19 23.2 19.1 6.9 61.4 43.6 12.9 9.5 6.5 11.0 0.3 0.3 0.3 0.2 0.2 0.9 8.3 2,679 20-24 25.4 22.4 10.7 63.3 46.3 17.8 12.1 9.2 11.3 0.6 0.3 0.1 0.1 0.3 0.8 4.8 2,115 25-29 23.5 24.2 10.1 60.6 44.7 21.6 13.0 9.4 11.3 0.7 0.3 0.3 0.0 0.4 0.7 4.2 2,077 30-34 22.7 25.0 11.0 57.6 41.9 24.7 13.6 9.7 10.9 0.8 0.3 0.2 0.1 0.0 0.8 4.6 1,843 35-39 23.4 23.6 10.8 56.4 43.7 25.8 16.4 8.2 11.0 0.3 0.6 0.1 0.1 0.1 1.3 4.2 1,753 40-44 21.8 26.1 11.0 55.3 44.0 28.8 21.2 10.1 11.6 0.5 0.5 0.1 0.0 0.5 1.0 4.4 1,516 45-49 20.2 23.8 12.0 56.1 42.7 27.2 22.1 9.6 10.0 0.3 0.5 0.1 0.1 0.2 1.5 3.1 1,398 Residence Urban 26.8 26.3 12.6 59.5 43.3 19.7 16.0 9.7 12.8 0.5 0.2 0.1 0.1 0.2 0.8 4.5 7,504 Rural 18.3 19.1 6.8 58.7 44.7 24.2 12.7 7.6 8.8 0.6 0.6 0.3 0.1 0.2 1.1 5.8 5,877 Region National Capital Region 34.4 27.7 17.6 66.0 53.0 15.8 16.9 10.0 16.1 0.1 0.0 0.0 0.0 0.0 0.3 2.9 2,514 Cordillera Admin Region 23.2 27.8 6.5 60.0 38.0 10.0 9.3 10.6 13.3 0.0 0.0 0.0 0.4 0.5 1.5 9.9 220 I - Ilocos 11.9 23.2 5.2 65.0 50.8 12.1 8.6 9.1 7.7 0.8 0.0 0.2 0.3 0.6 0.5 6.3 609 II - Cagayan Valley 21.0 19.6 6.4 67.0 50.8 19.6 9.7 7.8 16.6 0.0 0.0 0.0 0.0 0.4 0.2 4.0 366 III - Central Luzon 17.7 18.8 6.7 62.2 37.7 18.9 17.2 8.8 13.3 1.5 0.0 0.1 0.2 0.0 1.1 5.3 1,470 IVA - CALABARZON 28.9 40.5 16.6 62.6 37.3 12.2 8.6 5.7 16.4 0.2 0.0 0.1 0.0 0.0 0.4 5.2 1,788 IVB - MIMAROPA 16.0 15.1 8.1 48.5 38.8 22.4 13.4 9.1 11.7 0.9 0.0 0.4 0.0 0.0 2.0 10.6 324 V - Bicol 17.6 11.8 15.9 52.8 41.8 22.2 40.1 15.6 6.3 0.9 0.0 1.2 0.7 0.1 0.9 3.3 753 VI - Western Visayas 16.5 13.0 8.0 43.1 35.1 28.5 17.9 12.1 6.3 0.6 0.0 0.0 0.1 0.1 0.2 9.8 963 VII - Central Visayas 20.7 19.6 6.9 51.0 42.8 33.8 12.3 8.5 9.9 0.2 0.3 0.0 0.2 0.7 2.4 3.6 978 VIII - Eastern Visayas 19.5 29.7 6.8 56.7 53.9 29.7 17.4 11.1 5.6 0.5 0.7 0.0 0.2 0.3 1.5 1.6 483 IX - Zamboanga Peninsula 18.2 16.4 6.6 65.5 49.5 32.5 11.4 10.7 4.5 0.0 0.2 0.1 0.0 0.0 1.3 2.7 497 X - Northern Mindanao 17.2 14.9 5.0 58.8 43.9 28.3 13.4 7.4 9.4 0.3 0.3 0.4 0.0 1.2 1.4 7.4 564 XI - Davao 17.7 10.5 2.2 58.6 55.7 34.6 10.8 3.9 6.1 1.9 0.4 0.5 0.0 0.7 3.7 4.0 606 XII - SOCCSKSARGEN 20.8 20.0 3.8 60.2 51.2 27.3 6.9 5.2 4.2 0.2 0.2 0.2 0.0 0.5 0.7 10.3 462 XIII - Caraga 20.8 14.5 3.8 58.3 54.3 43.0 11.8 8.8 5.3 0.2 0.4 0.0 0.0 0.2 0.4 4.4 310 ARMM 31.8 32.0 2.9 48.8 10.8 11.5 4.0 2.2 6.1 0.0 7.9 0.0 0.0 0.2 0.5 4.5 474 Education No education 16.5 11.9 3.2 55.6 24.2 20.7 5.1 1.5 4.0 0.6 1.7 0.0 0.0 0.0 0.6 13.2 129 Elementary 14.7 16.6 6.4 53.3 41.0 23.5 10.3 5.3 6.7 0.6 0.6 0.2 0.1 0.1 0.9 8.7 2,549 High school 19.9 20.7 7.6 60.5 45.3 20.3 11.7 7.7 9.8 0.5 0.4 0.2 0.1 0.3 0.9 5.5 6,292 College or higher 32.6 30.5 15.9 60.6 44.2 22.5 21.4 12.5 15.5 0.5 0.2 0.1 0.1 0.2 1.0 2.1 4,411 Wealth quintile Lowest 17.0 14.1 4.8 54.6 42.1 26.4 9.0 5.8 4.6 0.3 1.0 0.4 0.2 0.2 1.3 7.3 2,049 Second 16.5 19.1 6.2 56.2 44.3 24.8 12.4 7.4 7.9 0.7 0.7 0.3 0.0 0.4 0.9 7.0 2,380 Middle 19.0 21.7 9.2 58.5 45.0 22.1 12.9 8.6 11.0 0.6 0.3 0.1 0.1 0.3 1.1 5.0 2,634 Fourth 25.3 26.0 12.1 62.1 42.1 19.4 16.5 8.6 12.1 0.6 0.1 0.0 0.1 0.2 1.1 3.6 2,917 Highest 32.6 29.9 14.9 61.8 45.5 18.2 19.0 11.8 16.2 0.3 0.1 0.1 0.1 0.1 0.5 3.7 3,401 Total 23.1 23.1 10.1 59.1 43.9 21.6 14.6 8.8 11.0 0.5 0.4 0.2 0.1 0.2 0.9 5.1 13,381 In this analysis, special attention is given to differentials in the knowledge that tuberculosis is caused by microbes, germs, or bacteria. Table 13.3 shows that women in urban areas (27 percent) are more aware that tuberculosis is caused by microorganisms than women in rural areas (18 percent). Among the regions, NCR and ARMM have the highest proportions of women (35 and 32 percent, respectively) who know that tuberculosis is caused by microbes, germs, or bacteria. Ilocos Region (12 percent) has the lowest proportion of women who cited bacteria as the cause of tuberculosis. Women with lower levels of education are less likely to know that tuberculosis is caused by bacteria than women with college education (17 percent among women with no education, compared with 33 percent among women with college education). Knowledge of the correct cause of tuberculosis increases with wealth quintile, from 17 percent among women in the two lowest wealth quintiles to 33 percent among those in the highest wealth quintile. Tuberculosis Knowledge, Attitudes, and Behavior │ 173 The 2008 NDHS asked women how tuberculosis spreads from one person to another. The most commonly cited modes of transmission were through the air when coughing (50 percent), by sharing utensils (78 percent), by sharing food (38 percent), and through saliva (30 percent) (Table 13.4). Only small proportions of women said that tuberculosis is spread through blood (less than 1 percent), by mosquito bites (1 percent), by touching someone with tuberculosis (5 percent), or through sexual contact (6 percent). Table 13.4 Knowledge of modes of transmitting tuberculosis Among women who have heard of tuberculosis, percentage who cite specific means of transmission, by background characteristics, Philippines 2008 Means of transmission of tuberculosis Background characteristic Through the air when coughing Sharing utensils Touching a person with TB Sharing food Sexual contact Mosquito bites Saliva Through blood Pollution Other Don’t know Number of women Age 15-19 49.2 70.6 4.5 34.6 4.5 0.9 26.5 0.2 0.0 0.3 5.4 2,679 20-24 51.7 76.0 5.1 37.7 5.9 0.7 32.0 0.2 0.1 0.5 3.3 2,115 25-29 48.1 79.8 3.4 40.3 6.0 1.2 30.9 0.4 0.0 0.3 2.6 2,077 30-34 51.8 78.8 4.7 38.2 6.0 0.5 30.6 0.4 0.0 0.5 2.8 1,843 35-39 51.0 80.7 3.9 39.2 5.6 0.6 30.9 0.6 0.0 0.5 2.0 1,753 40-44 50.3 83.1 4.8 39.2 5.5 0.7 30.7 0.2 0.3 0.2 1.3 1,516 45-49 48.7 81.1 5.0 40.3 5.4 0.5 28.1 0.1 0.0 0.5 2.0 1,398 Residence Urban 54.3 77.3 4.6 39.9 6.3 0.9 33.4 0.3 0.0 0.4 2.6 7,504 Rural 44.7 78.6 4.2 36.1 4.5 0.6 25.4 0.3 0.1 0.4 3.5 5,877 Region National Capital Region 62.3 79.8 5.6 47.5 8.1 0.7 39.0 0.2 0.0 0.2 1.9 2,514 Cordillera Admin Region 57.1 83.2 2.9 20.6 1.1 0.3 21.1 0.4 0.0 0.2 5.7 220 I - Ilocos 37.3 79.4 3.4 22.7 4.1 0.8 27.3 0.0 0.0 0.9 1.7 609 II - Cagayan Valley 40.6 87.9 2.6 38.3 5.8 0.8 34.8 0.4 0.0 0.0 0.6 366 III - Central Luzon 48.0 70.1 5.8 38.4 4.3 1.1 27.6 0.0 0.1 0.7 3.5 1,470 IVA - CALABARZON 57.3 76.3 4.9 37.7 4.1 2.1 33.3 0.2 0.0 0.2 3.5 1,788 IVB - MIMAROPA 49.9 75.9 5.1 39.7 2.6 0.6 19.1 0.6 0.0 0.4 5.5 324 V - Bicol 60.6 81.3 3.9 34.4 10.0 0.7 29.1 0.5 0.2 0.3 1.7 753 VI - Western Visayas 39.8 76.7 2.9 38.1 5.2 0.4 21.8 0.3 0.1 0.6 4.2 963 VII - Central Visayas 47.2 83.1 3.0 35.4 4.6 0.0 23.5 0.5 0.1 0.8 2.0 978 VIII - Eastern Visayas 48.9 82.6 10.1 41.5 10.1 0.8 31.1 0.2 0.0 0.3 1.3 483 IX - Zamboanga Peninsula 45.8 85.4 2.6 27.5 7.5 1.0 30.1 0.8 0.0 0.8 2.9 497 X - Northern Mindanao 44.7 81.4 3.8 26.2 3.1 0.3 32.6 0.0 0.0 0.3 2.8 564 XI - Davao 45.5 72.4 2.0 27.6 3.8 0.2 25.6 0.6 0.2 1.0 3.0 606 XII - SOCCSKSARGEN 34.6 77.5 2.1 45.1 3.7 0.2 26.6 0.2 0.2 0.3 6.7 462 XIII - Caraga 41.2 78.2 7.6 46.1 4.0 0.5 42.1 0.9 0.0 0.4 3.1 310 ARMM 34.1 62.7 3.0 52.7 3.0 0.0 13.4 0.1 0.0 0.0 6.0 474 Education No education 31.4 59.9 1.9 36.6 0.6 0.4 12.3 0.0 0.0 0.0 12.0 129 Elementary 38.0 74.9 3.4 38.0 2.7 0.3 18.5 0.2 0.0 0.4 5.4 2,549 High school 46.6 77.6 4.1 37.4 4.4 0.7 27.9 0.2 0.0 0.3 3.2 6,292 College or higher 62.5 80.5 5.6 39.5 8.9 1.2 39.8 0.5 0.1 0.7 1.1 4,411 Wealth quintile Lowest 37.1 76.6 3.1 38.7 3.3 0.4 17.6 0.3 0.0 0.2 4.8 2,049 Second 42.2 78.0 4.7 39.9 3.4 0.4 24.4 0.3 0.1 0.5 3.4 2,380 Middle 48.0 77.8 4.4 35.8 4.6 0.8 28.2 0.3 0.0 0.6 3.7 2,634 Fourth 54.6 77.6 5.1 36.1 6.0 0.8 34.7 0.2 0.0 0.3 2.3 2,917 Highest 61.2 78.8 4.6 40.3 8.6 1.2 38.2 0.4 0.1 0.4 1.7 3,401 Total 50.1 77.9 4.5 38.2 5.5 0.8 29.9 0.3 0.0 0.4 3.0 13,381 Awareness that tuberculosis is mainly transmitted through the air by coughing and sneezing does not differ substantially by age. Women in urban areas are more likely to know how tuberculosis is transmitted than are women in rural areas; likewise, women with higher education and those in the higher wealth quintiles are more likely to know how tuberculosis is spread than women with no education and those in the lowest wealth quintile. ARMM has the lowest proportion of women who know that tuberculosis is transmitted through the air (34 percent), while NCR has the highest proportion (62 percent). 174 │ Tuberculosis Knowledge, Attitudes, and Behavior 13.3 SELF-REPORTED DIAGNOSIS, SYMPTOMS, AND TREATMENT In the 2008 NDHS, women were asked if they had ever had any of five TB-related symptoms, specifically, a cough for two weeks or longer, a fever for two weeks or longer, chest pain or back pain, coughing up blood, or sweating at night. Table 13.5 shows the percentage of women who ever had symptoms of tuberculosis. It is important to note that not all women with these symptoms were necessarily infected with tuberculosis because many other conditions can cause similar symptoms or manifestations. Twenty-three percent of women had chest or back pain and 19 percent had a cough for two weeks or more. Eight percent of women had a fever for two weeks or more, or night sweats. Less than 2 percent of women said they had blood in their sputum. Overall, one in three women reported experiencing at least one symptom associated with tuberculosis. Table 13.5 Experience of symptoms of tuberculosis Percentage of women who have ever had symptoms of tuberculosis, by background characteristics, Philippines 2008 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweats At least one symptom Number of women Age 15-19 15.4 9.2 14.3 1.3 6.5 26.9 2,749 20-24 14.7 6.4 17.1 1.1 6.6 27.6 2,147 25-29 17.3 7.7 22.6 1.2 6.8 32.0 2,106 30-34 19.5 7.4 24.5 1.5 7.0 35.1 1,865 35-39 19.6 7.1 26.1 1.8 8.4 33.9 1,777 40-44 21.8 8.4 29.8 2.6 10.4 40.0 1,532 45-49 27.3 10.0 32.3 2.4 8.8 44.1 1,418 Residence Urban 16.0 6.0 19.1 1.2 5.7 28.4 7,574 Rural 22.0 10.6 27.0 2.1 9.9 39.0 6,020 Region National Capital Region 12.9 4.3 15.8 0.8 4.7 23.2 2,522 Cordillera Admin Region 22.1 8.0 16.6 2.1 3.7 30.1 225 I - Ilocos 14.2 6.7 22.4 1.0 4.8 30.0 613 II - Cagayan Valley 15.8 7.2 18.4 1.6 10.0 29.7 382 III - Central Luzon 11.3 3.7 13.6 0.9 3.3 20.8 1,486 IVA - CALABARZON 11.9 2.6 10.5 0.8 3.1 18.7 1,808 IVB - MIMAROPA 28.6 13.3 31.1 3.2 11.4 46.2 340 V - Bicol 23.3 9.2 25.0 3.1 9.1 38.6 755 VI - Western Visayas 29.0 14.2 33.5 2.6 15.5 51.3 976 VII - Central Visayas 34.8 16.3 45.5 3.6 14.7 59.8 983 VIII - Eastern Visayas 26.0 13.1 30.3 2.8 11.0 45.8 488 IX - Zamboanga Peninsula 15.6 9.0 29.9 0.9 8.8 38.9 505 X - Northern Mindanao 10.5 4.0 12.6 1.0 4.4 18.8 585 XI - Davao 31.2 15.0 38.9 1.3 13.8 54.3 618 XII - SOCCSKSARGEN 38.2 19.7 46.2 3.3 15.8 61.1 480 XIII - Caraga 5.8 2.3 8.2 1.2 3.3 13.5 312 ARMM 13.5 9.2 20.2 1.0 6.4 31.9 516 Education No education 26.6 16.6 36.1 4.7 10.1 47.5 167 Elementary 26.1 14.7 31.9 2.9 12.5 44.7 2,653 High school 18.5 7.6 21.5 1.3 7.5 32.6 6,352 College or higher 14.1 4.3 18.0 1.1 4.7 26.3 4,422 Wealth quintile Lowest 26.4 15.5 32.0 3.3 14.0 45.6 2,160 Second 22.9 10.5 28.7 1.7 9.8 40.5 2,419 Middle 19.6 7.8 22.9 1.5 7.2 34.1 2,661 Fourth 16.1 5.8 18.7 1.3 5.4 28.6 2,937 Highest 12.2 3.6 15.4 0.8 4.2 23.1 3,417 Total 18.7 8.0 22.6 1.6 7.6 33.1 13,594 Tuberculosis Knowledge, Attitudes, and Behavior │ 175 The proportion of women who have ever had a symptom of tuberculosis increases with age. Women in urban areas are less likely to have had symptoms than their rural counterparts. Caraga (14 percent), CALABARZON (19 percent), and Northern Mindanao (19 percent) show the lowest proportions of women who have had at least one symptom of tuberculosis, while SOCCSKSARGEN (61 percent), Central Visayas (60 percent), and Davao (54 percent) have the highest proportions of women who have ever had symptoms of tuberculosis. The experience of tuberculosis symptoms is inversely related to education and the wealth quintile. Women who reported having symptoms of tuberculosis were asked whether they had sought consultation or treatment for the symptoms. Table 13.6 shows that slightly more than two in five women who ever experienced a symptom of tuberculosis sought consultation or treatment for the symptom. The percentage seeking consultation or treatment increases with age, education, and wealth quintile. Women in Cordillera Administrative Region were the most likely to seek treatment (57 percent) and those in the Autonomous Region in Muslim Mindanao were the least likely to seek treatment (19 percent). Table 13.6 Treatment of tuberculosis Percent distribution of women who have ever had symptoms of tuberculosis, by whether they sought treatment, or the reason for not seeking treatment, according to background characteristics, Philippines 2008 Reason for not seeking consultation/treatment Background characteristic Sought consultation or treatment Symp- toms harm- less Cost Distance Embar- rassed Self- medi- cation Other Fear No time Missing Total Number of women Age 15-19 35.1 19.4 9.8 1.0 0.4 31.3 0.7 0.7 1.2 0.4 100.0 739 20-24 38.5 17.7 6.5 0.4 0.0 35.6 0.1 0.5 0.6 0.0 100.0 593 25-29 40.2 13.7 5.0 1.6 0.3 37.3 0.9 0.1 0.7 0.2 100.0 673 30-34 40.9 13.0 6.7 1.9 0.2 34.6 0.7 0.3 1.0 0.9 100.0 655 35-39 46.5 12.1 6.4 0.7 0.1 32.5 0.2 0.4 0.6 0.7 100.0 602 40-44 45.8 12.5 5.1 1.2 0.0 34.4 0.7 0.1 0.2 0.0 100.0 613 45-49 52.8 9.4 5.3 0.6 0.0 30.2 0.7 0.1 0.4 0.5 100.0 626 Residence Urban 43.6 12.5 4.5 0.6 0.1 35.8 0.9 0.3 1.1 0.6 100.0 2,153 Rural 41.6 15.5 8.3 1.5 0.2 31.7 0.2 0.4 0.3 0.2 100.0 2,347 Region National Capital Region 42.9 11.4 4.3 0.2 0.2 36.8 1.9 0.2 1.6 0.4 100.0 586 Cordillera Admin Region 56.8 7.5 6.2 0.0 0.0 29.4 0.0 0.0 0.0 0.0 100.0 68 I - Ilocos 43.8 16.7 5.6 1.0 0.0 30.4 0.5 1.0 0.5 0.5 100.0 184 II - Cagayan Valley 47.2 11.0 7.1 0.0 0.0 31.5 0.7 0.6 1.3 0.7 100.0 113 III - Central Luzon 48.5 18.6 3.5 0.0 0.0 28.3 0.7 0.0 0.0 0.4 100.0 309 IVA - CALABARZON 45.6 3.8 5.9 2.1 0.0 40.0 0.0 0.4 1.4 0.8 100.0 338 IVB - MIMAROPA 49.4 4.9 11.5 3.1 0.4 27.4 1.4 1.2 0.8 0.0 100.0 157 V - Bicol 52.3 15.0 7.0 2.3 0.7 22.7 0.0 0.0 0.0 0.0 100.0 291 VI - Western Visayas 47.0 18.8 7.3 1.1 0.4 23.9 0.2 0.4 0.4 0.4 100.0 501 VII - Central Visayas 43.2 14.3 4.8 0.2 0.0 35.5 0.4 0.4 0.7 0.5 100.0 588 VIII - Eastern Visayas 41.8 11.8 6.8 1.4 0.0 37.7 0.0 0.4 0.0 0.0 100.0 223 IX - Zamboanga Peninsula 31.7 9.0 9.5 1.2 0.0 45.7 0.8 0.4 0.8 0.9 100.0 196 X - Northern Mindanao 33.9 20.6 9.0 1.7 0.0 31.8 0.0 0.7 1.5 0.8 100.0 110 XI - Davao 37.4 12.1 6.2 0.5 0.0 42.0 0.8 0.3 0.5 0.2 100.0 336 XII - SOCCSKSARGEN 34.9 18.5 10.4 1.2 0.0 34.4 0.3 0.0 0.3 0.0 100.0 293 XIII - Caraga 41.6 15.8 15.5 0.0 1.4 23.2 0.0 0.0 2.5 0.0 100.0 42 ARMM 19.0 30.5 4.9 4.7 0.0 40.5 0.5 0.0 0.0 0.0 100.0 164 Education No education 22.7 17.4 16.8 6.6 0.0 33.8 0.8 0.8 0.0 1.0 100.0 79 Elementary 38.4 13.3 10.0 1.5 0.1 35.1 0.6 0.3 0.4 0.3 100.0 1,187 High school 41.3 15.0 6.4 1.1 0.2 33.9 0.7 0.3 0.9 0.2 100.0 2,073 College or higher 50.6 13.0 2.3 0.2 0.2 31.7 0.4 0.3 0.7 0.7 100.0 1,161 Wealth quintile Lowest 35.1 13.7 12.4 2.9 0.2 34.4 0.5 0.3 0.2 0.3 100.0 985 Second 40.9 15.2 7.8 0.8 0.3 33.3 0.5 0.3 0.6 0.3 100.0 978 Middle 45.7 14.3 5.4 0.3 0.1 32.6 0.7 0.1 0.8 0.1 100.0 909 Fourth 47.5 13.5 2.3 0.9 0.0 33.3 0.2 0.5 1.3 0.5 100.0 840 Highest 45.2 13.5 3.1 0.3 0.2 34.8 1.2 0.4 0.7 0.8 100.0 788 Total 42.6 14.1 6.5 1.1 0.1 33.7 0.6 0.3 0.7 0.4 100.0 4,500 176 │ Tuberculosis Knowledge, Attitudes, and Behavior The most commonly cited reasons for not seeking consultation or treatment for symptoms of tuberculosis were self-medication (34 percent), belief that the symp- toms are harmless (14 percent), and cost (7 percent). Only 1 percent or less of women cited distance, embarrassment, fear, or lack of time as their reason for not seeking con- sultation or treatment for symptoms of tuberculosis. 13.4 STIGMA REGARDING TB Six in ten women who have heard of tuberculosis said that they are willing to work with someone who has previously been treated for tuberculosis (Table 13.7). There are substantial differences in this indicator of stigma by age, residence, region, education, and wealth quintile. Older women are slightly more likely than younger women to be willing to work with someone who has had tubercu- losis. Women in urban areas are more likely to be willing to do so than their rural counterparts. The higher the woman’s level of education and wealth status, the greater the likelihood that she is willing to work with a treated tuberculosis patient. Women in Western Visayas are least likely to accept working with someone who has had tuber- culosis, followed by women in ARMM. Table 13.7 Positive attitudes about tuberculosis Among women who have heard of tuberculosis, percentage who are willing to work with someone who has previously been treated for tuberculosis, according to background characteristics, Philippines 2008 Background characteristic Percent Number of women Age 15-19 51.6 2,679 20-24 59.6 2,115 25-29 62.3 2,077 30-34 63.4 1,843 35-39 63.4 1,753 40-44 64.0 1,516 45-49 64.2 1,398 Residence Urban 64.2 7,504 Rural 55.6 5,877 Region National Capital Region 72.2 2,514 Cordillera Admin Region 71.3 220 I - Ilocos 68.0 609 II - Cagayan Valley 78.4 366 III - Central Luzon 69.4 1,470 IVA - CALABARZON 59.5 1,788 IVB - MIMAROPA 67.3 324 V - Bicol 72.2 753 VI - Western Visayas 26.1 963 VII - Central Visayas 54.5 978 VIII - Eastern Visayas 52.0 483 IX - Zamboanga Peninsula 48.7 497 X - Northern Mindanao 57.1 564 XI - Davao 58.6 606 XII - SOCCSKSARGEN 62.7 462 XIII - Caraga 45.4 310 ARMM 38.2 474 Education No education 37.4 129 Elementary 51.4 2,549 High school 58.6 6,292 College or higher 69.0 4,411 Wealth quintile Lowest 47.3 2,049 Second 55.2 2,380 Middle 61.1 2,634 Fourth 66.2 2,917 Highest 66.5 3,401 Total 60.4 13,381 Health Care Utilization and Financing | 177 HEALTH CARE UTILIZATION AND FINANCING 14 The 2008 National Demographic and Health Survey (NDHS) included a module of questions concerning health care utilization and costs. First, information about health insurance coverage was obtained for each person listed on the Household Questionnaire. Second, respondents for the Household Questionnaire were asked whether any member of the household had visited a health facility or sought advice or treatment anywhere in the 30 days preceding the survey. If so, information was collected on where the person sought treatment, why he/she sought treatment, how he/she traveled to the place of treatment, how long it took to get there, how much it cost for treatment, and how the cost of treatment was covered. Information was asked separately about each member of the household who sought treatment and, if they had more than one visit to a health facility in the past 30 days, the same information was collected for the second visit. Finally, information was collected about any household members who were confined in a hospital or health center in the 12 months preceding the survey, including the type of facility, the reason for the confinement, the number of days confined, the cost of transportation and treatment, and how costs were met. 14.1 HEALTH INSURANCE COVERAGE Information in Table 14.1 shows that only 42 percent of Filipinos are covered by some form of health insurance. Insurance coverage is highest in Northern Mindanao (68 percent) and lowest in ARMM (18 percent). Coverage is higher in urban areas (49 percent) than in rural areas (35 percent). Persons under age 21 are less likely to have health insurance than those age 21 and over. Coverage ranges from 21 percent among persons in households in the lowest wealth quintile to 65 percent among those in households in the highest wealth quintile. Although it is the dominant insurance provider, PhilHealth coverage at the national level remains low (38 percent of the population). Patterns of coverage for PhilHealth by background characteristics are similar to those of other insurance providers. For example, PhilHealth coverage is highest in Northern Mindanao and lowest in ARMM. At the national level, coverage through the Social Security System (SSS) is higher (11 percent of the population) than coverage through the Government Service Insurance System (GSIS) (2 percent of the population). SSS coverage is substantially higher among persons age 21-59 and, to a lesser extent, those age 60 and over than among persons under age 21. SSS coverage is also substantially higher among urban residents (17 percent) than rural residents (5 percent) and among persons in the highest wealth quintile (24 percent), compared with those in the lowest wealth quintile (1 percent). Only 2 percent of Filipinos are covered by private insurance or membership in health maintenance organizations (HMOs). Among the regions, private insurance/HMO coverage is highest in NCR (5 percent); by household wealth status, it is highest for those in the highest wealth quintile (7 percent). 178 | Health Care Utilization and Financing Table 14.1 Health insurance coverage Percentage of de jure household population with specific health insurance coverage, according to background characteristics, Philippines 2008 Background characteristic No insurance Any insurance Phil Health GSIS SSS Private insurance/ HMO, etc. Other Don't know/ missing Number Sex Male 57.7 42.0 37.4 1.6 13.0 2.2 0.5 0.3 30,335 Female 57.8 41.9 38.1 1.9 9.6 2.0 0.4 0.3 29,282 Age 0-20 62.6 37.0 36.2 0.1 1.1 1.0 0.3 0.3 27,958 21-59 53.4 46.4 39.6 3.1 21.3 3.2 0.6 0.2 27,339 60+ 53.7 46.0 35.9 4.1 14.0 2.6 1.3 0.3 4,317 Residence Urban 50.7 49.0 42.9 2.3 17.2 3.4 0.5 0.3 30,002 Rural 64.9 34.8 32.5 1.2 5.3 0.8 0.4 0.3 29,615 Region National Capital Region 48.4 51.3 43.0 2.0 22.8 5.4 0.5 0.3 9,064 Cordillera Admin Region 54.3 45.3 42.3 1.7 8.1 1.1 0.4 0.5 1,082 I - Ilocos 54.7 45.2 40.8 1.8 10.7 1.1 0.1 0.2 3,082 II - Cagayan Valley 62.2 37.7 35.4 3.3 3.9 1.1 0.6 0.1 1,870 III - Central Luzon 63.3 36.5 32.3 1.2 10.3 1.5 0.2 0.3 6,370 IVA - CALABARZON 52.3 47.6 43.4 1.6 16.3 2.2 0.5 0.1 7,495 IVB - MIMAROPA 73.3 26.1 20.8 1.7 7.1 1.1 0.9 0.5 1,686 V - Bicol 61.0 38.7 34.5 2.1 7.9 0.6 1.8 0.2 3,636 VI - Western Visayas 58.1 41.3 36.3 1.9 10.0 2.2 0.3 0.6 4,701 VII - Central Visayas 55.8 43.6 39.2 1.6 11.8 2.2 0.5 0.6 4,126 VIII - Eastern Visayas 72.2 27.6 26.1 1.9 3.7 0.6 0.5 0.2 2,470 IX - Zamboanga Peninsula 70.7 29.2 25.8 2.3 6.3 1.6 0.3 0.1 2,379 X - Northern Mindanao 32.2 67.5 66.0 2.1 6.6 1.6 0.1 0.3 2,568 XI - Davao 60.8 38.8 36.1 1.5 9.8 2.4 0.5 0.4 2,713 XII - SOCCSKSARGEN 59.0 40.6 38.4 1.0 6.9 1.2 0.3 0.4 2,390 XIII - Caraga 51.8 48.1 46.4 1.7 5.0 0.8 0.3 0.0 1,532 ARMM 82.3 17.5 17.1 1.4 0.4 0.4 0.1 0.2 2,453 Wealth quintile Lowest 79.1 20.6 19.6 0.1 1.4 0.2 0.1 0.3 11,918 Second 68.9 31.0 28.6 0.3 4.3 0.3 0.3 0.2 11,924 Middle 60.2 39.4 35.3 1.1 9.6 1.1 0.3 0.4 11,926 Fourth 46.0 53.8 48.2 2.8 16.8 2.0 0.6 0.2 11,928 Highest 34.7 65.0 57.0 4.5 24.4 7.0 1.0 0.3 11,922 Total 57.8 42.0 37.7 1.8 11.3 2.1 0.5 0.3 59,617 Note: Total includes 4 people with age missing. Numbers may not sum to the total for “any insurance” because individuals may be covered by more than one type of insurance. GSIS = Government Service Insurance System SSS = Social Security System For those who were covered by PhilHealth, questions were asked as to whether the person was a paying member, a dependent of a paying member, an indigent member, or a dependent of an indigent member. Table 14.2 shows the distribution of those covered by PhilHealth according to these categories. The results show that more than three-quarters of those covered by PhilHealth are covered by paying members, while 22 percent are covered as indigents. Half of all people covered by PhilHealth are dependents of paying members, while only 29 percent are direct paying members. Similarly, most of those who are covered as indigents are dependents of indigents. Health Care Utilization and Financing | 179 Table 14.2 PhilHealth insurance coverage For all persons covered by PhilHealth insurance, percentage who are paying for coverage and the percentage who are indigent, by membership category (member or dependent), according to background characteristics, Philippines 2008 Paying Indigent Background characteristic Total Member Dependent Total Member Dependent Number Sex Male 77.4 34.4 43.0 22.7 8.5 14.3 11,345 Female 78.8 24.4 54.4 21.4 3.6 17.8 11,157 Age 0-20 74.0 1.4 72.6 26.1 0.2 25.9 10,111 21-59 81.6 55.3 26.4 18.6 10.8 7.9 10,839 60+ 80.2 31.8 48.4 20.3 11.3 9.0 1,552 Residence Urban 90.4 36.5 53.9 9.8 3.0 6.8 12,876 Rural 61.7 20.0 41.7 38.6 10.2 28.4 9,626 Region National Capital Region 98.1 42.1 56.0 2.1 1.1 1.0 3,897 Cordillera Admin Region 70.4 23.3 47.1 29.6 6.8 22.9 457 I - Ilocos 71.3 22.2 49.1 28.9 7.6 21.3 1,259 II - Cagayan Valley 71.5 22.9 48.6 28.5 8.4 20.0 662 III - Central Luzon 86.6 34.3 52.3 13.4 4.4 9.0 2,059 IVA - CALABARZON 92.7 37.3 55.4 7.5 1.9 5.6 3,255 IVB - MIMAROPA 58.4 17.9 40.5 41.8 10.0 31.9 350 V - Bicol 58.2 19.3 38.8 42.2 10.4 31.8 1,254 VI - Western Visayas 67.8 23.9 43.9 32.2 10.0 22.2 1,709 VII - Central Visayas 79.5 30.7 48.8 20.8 6.7 14.1 1,619 VIII - Eastern Visayas 76.4 24.7 51.7 23.9 5.2 18.7 644 IX - Zamboanga Peninsula 80.8 30.9 49.9 19.6 5.8 13.9 613 X - Northern Mindanao 37.2 13.6 23.6 63.2 17.0 46.2 1,695 XI - Davao 91.2 32.1 59.1 9.2 2.5 6.8 979 XII - SOCCSKSARGEN 82.6 26.2 56.4 17.9 4.8 13.1 919 XIII - Caraga 46.9 16.0 30.9 53.3 11.8 41.5 710 ARMM 65.6 16.2 49.4 34.4 8.0 26.4 421 Wealth quintile Lowest 27.5 6.9 20.5 72.6 17.8 54.8 2,335 Second 51.6 14.4 37.2 48.8 12.2 36.6 3,416 Middle 78.7 25.5 53.2 21.4 6.5 14.8 4,204 Fourth 90.9 34.9 56.0 9.3 3.0 6.2 5,748 Highest 97.6 42.5 55.1 2.6 1.2 1.4 6,799 Total 78.1 29.4 48.7 22.1 6.1 16.0 22,502 Among persons covered under PhilHealth, coverage under the paying program is highest in NCR, CALABARZON, and Davao, with over 90 percent of the population covered. Among persons covered under the PhilHealth indigent program, the highest proportion is in Northern Mindanao (63 percent). Beneficiary coverage under the paying program increases with economic status, from 28 percent among those in the lowest wealth quintile to 98 percent among those in the highest wealth quintile. Under the paying program, the member-to-dependent ratio at the national level is 1 member to 1.7 dependents. For the sponsored program, the member-to-dependent ratio is 1 member to 2.6 dependents. 180 | Health Care Utilization and Financing 14.2 HEALTH CARE TREATMENT Table 14.3 shows that 8 percent of Filipinos visited a health facility or sought advice or treatment in the 30 days before the survey (Figure 14.1). The use of public medical facilities and providers is slightly higher (4 percent) than the use of private medical providers (3 percent). The use of alternative medical providers and non-medical providers is negligible. Table 14.3 Treatment-seeking behavior Percentage of de jure household population that visited a health facility or sought advice or treatment in the 30 days preceding the survey, by type of facility/provider visited and background characteristics, Philippines 2008 Type of facility/provider Background characteristic All facilities/ providers Public medical Private medical Alternative medical Non- medical Other/ missing Number Sex Male 7.0 3.6 2.9 0.3 0.2 0.1 30,335 Female 8.7 4.4 3.8 0.3 0.3 0.1 29,282 Age 0-4 22.1 13.1 7.0 1.2 0.7 0.1 6,706 5-29 4.9 2.4 2.1 0.2 0.2 0.1 29,674 30-59 6.0 2.8 2.9 0.1 0.1 0.1 18,917 60+ 14.1 5.4 8.2 0.2 0.3 0.1 4,317 Residence Urban 7.8 3.5 4.1 0.1 0.1 0.0 30,002 Rural 7.9 4.4 2.6 0.4 0.4 0.1 29,615 Region National Capital Region 7.1 3.1 3.9 0.0 0.0 0.0 9,064 Cordillera Admin Region 7.5 4.0 3.4 0.0 0.0 0.0 1,082 I - Ilocos 6.8 3.9 2.8 0.1 0.0 0.0 3,082 II - Cagayan Valley 7.6 4.9 2.7 0.0 0.0 0.0 1,870 III - Central Luzon 8.7 4.2 4.3 0.0 0.1 0.0 6,370 IVA - CALABARZON 5.8 2.2 3.5 0.1 0.0 0.0 7,495 IVB - MIMAROPA 9.2 5.1 3.0 0.6 0.4 0.1 1,686 V - Bicol 13.0 5.7 3.4 0.7 2.7 0.6 3,636 VI - Western Visayas 8.6 5.1 3.4 0.2 0.0 0.0 4,701 VII - Central Visayas 9.9 5.4 3.6 0.7 0.2 0.1 4,126 VIII - Eastern Visayas 9.2 4.4 3.1 1.1 0.5 0.0 2,470 IX - Zamboanga Peninsula 6.8 4.0 2.2 0.4 0.1 0.1 2,379 X - Northern Mindanao 8.9 4.8 3.4 0.6 0.1 0.0 2,568 XI - Davao 6.8 3.0 3.6 0.2 0.0 0.1 2,713 XII - SOCCSKSARGEN 8.2 5.2 2.5 0.4 0.1 0.1 2,390 XIII - Caraga 4.9 3.3 1.5 0.0 0.0 0.0 1,532 ARMM 4.2 2.0 1.9 0.2 0.1 0.0 2,453 Wealth quintile Lowest 7.8 5.2 1.1 0.6 0.7 0.1 11,918 Second 8.2 5.4 2.0 0.4 0.3 0.1 11,924 Middle 7.7 4.3 2.9 0.3 0.1 0.0 11,926 Fourth 8.1 3.3 4.6 0.1 0.1 0.0 11,928 Highest 7.6 1.5 6.0 0.0 0.0 0.0 11,922 Total 7.9 3.9 3.3 0.3 0.2 0.1 59,617 Note: Total includes 4 people with age missing. If the respondent visited more than one facility/provider, only the first one is included in the tabulation. Health Care Utilization and Financing | 181 Children under five and people age 60 and over are more likely than those age 5-59 to seek health care. More than one in five children under five years of age visited a health facility or sought advice or treatment in the 30 days preceding the survey. Use of health facilities is highest in Bicol (13 percent) and lowest in ARMM (4 percent). Overall, differentials by sex, residence, and wealth quintile in use of health facilities are small. However, use of private health facilities increases with economic status, from 1 percent among persons in the lowest wealth quintile to 6 percent among those in the highest wealth quintile. Table 14.4 provides information on specific types of facilities and providers (public and private) visited by persons who sought care in the 30 days preceding the survey. Of those who sought care, over one-third visited a rural health unit (RHU) or a barangay health center (BHC), one-fifth sought care at a private hospital, and 19 percent went to a private clinic for care. Some interesting use patterns can be seen for those who visited a health facility or provider in the 30 days before the survey. The proportion who visited regional hospitals is highest in NCR and Zamboanga Peninsula (14 percent) and lowest in Bicol (1 percent). Use of regional hospitals is also higher in urban areas than in rural areas. The proportion who visited provincial hospitals is highest in Cordillera Administrative Region (14 percent) and lowest in NCR and Central Visayas (1 percent each). Use of district hospitals is highest in CAR (11 percent) and virtually nil in ARMM. Among those who sought medical care, children under five and people in rural areas are more likely to have visited an RHU or a barangay health center than older children and persons in urban areas. Use of RHUs and barangay health centers is highest in Caraga and SOCCSKARGEN (52 percent each) and lowest in CAR (21 percent). The use of RHU and barangay health center services decreases as household wealth status increases, from 52 percent in the lowest wealth quintile to 11 percent in the highest wealth quintile. NDHS 2008 Figure 14.1 Percentage of the Population that Visited a Health Facility/Provider in the 30 Days Preceding the Survey Visited facility/provider 8% Did not visit facility/provider 92% 182 | Health Care Utilization and Financing Table 14.4 Use of specific types of health facilities Among persons who visited a health facility or sought advice or treatment in the 30 days preceding the survey, percentage who visited specific types of public and private facilities/providers, by background characteristics, Philippines 2008 Public Private Other Background characteristic Regional hospital/ medical center Provincial hospital District hospital Municipal hospital RHU/ Barangay health center Other public Private hospital Private clinic Other private Alterna- tive medical Non- medical Number Sex Male 6.6 4.5 4.8 2.1 32.1 0.5 19.5 19.3 2.0 3.8 3.2 2,131 Female 4.7 4.0 3.8 1.8 34.9 0.7 20.9 19.1 2.7 3.2 2.9 2,558 Age 0-4 5.1 3.1 3.5 1.2 45.7 0.6 12.8 16.9 2.3 5.3 3.0 1,480 5-29 5.6 4.2 4.2 1.5 32.9 0.8 18.9 20.1 2.2 3.7 4.1 1,464 30-59 6.3 5.5 5.1 2.9 26.2 0.3 23.9 20.2 3.4 2.0 2.4 1,135 60+ 5.2 4.8 4.7 3.0 19.8 0.6 35.3 20.8 1.2 1.2 1.9 608 Residence Urban 8.1 4.3 3.0 1.5 26.6 0.8 28.3 21.2 2.6 1.8 1.1 2,346 Rural 3.1 4.2 5.6 2.4 40.7 0.4 12.2 17.2 2.2 5.2 5.0 2,343 Region National Capital Region 14.1 1.2 1.7 1.5 24.9 0.8 34.0 19.1 1.9 0.5 0.0 640 Cordillera Admin Region 6.6 13.5 10.7 1.5 20.9 0.0 16.3 27.3 0.5 0.5 0.5 81 I - Ilocos 9.2 7.8 6.4 0.5 33.2 0.0 21.4 20.1 0.0 0.9 0.5 210 II - Cagayan Valley 6.9 5.7 6.9 1.6 43.4 0.0 16.8 17.8 0.0 0.0 0.0 142 III - Central Luzon 3.3 5.8 7.0 1.5 30.2 0.4 20.2 28.6 0.7 0.4 1.3 557 IVA - CALABARZON 4.9 4.8 3.0 1.6 23.1 0.0 37.8 20.6 1.7 1.5 0.6 434 IVB - MIMAROPA 3.2 5.7 2.4 5.6 37.8 0.8 11.6 18.9 0.4 6.9 4.1 156 V - Bicol 1.0 1.7 5.2 2.1 32.3 1.4 4.9 10.0 10.8 5.4 20.6 474 VI - Western Visayas 2.4 5.7 5.4 3.4 41.5 0.5 13.4 24.2 0.3 2.0 0.0 407 VII - Central Visayas 3.3 1.3 5.3 0.8 42.1 1.1 21.3 12.1 1.9 7.4 1.8 411 VIII - Eastern Visayas 1.8 5.9 5.5 2.2 32.6 0.0 11.6 19.2 0.4 12.3 5.5 227 IX - Zamboanga Peninsula 14.3 3.8 1.5 2.0 37.2 0.5 17.5 12.8 1.5 6.0 1.0 161 X - Northern Mindanao 2.6 7.1 3.1 3.0 36.0 1.6 19.1 12.4 5.6 6.7 1.3 230 XI - Davao 9.2 2.7 2.8 0.5 28.1 0.0 17.7 32.0 2.3 2.8 0.0 186 XII - SOCCSKSARGEN 2.5 2.4 1.2 4.3 52.0 0.4 13.8 15.8 0.4 4.5 0.8 197 XIII - Caraga 3.0 8.3 4.5 0.0 52.2 0.0 19.3 10.4 0.0 0.7 0.7 75 ARMM 5.2 5.0 0.0 0.7 35.7 0.0 17.4 23.2 5.2 5.1 1.6 104 Wealth quintile Lowest 2.3 4.1 4.8 2.4 52.1 0.5 5.0 6.9 2.0 8.0 9.2 925 Second 6.0 4.7 4.2 3.6 47.3 0.6 8.2 12.6 3.3 4.5 3.3 975 Middle 7.1 5.9 5.9 1.3 34.7 1.3 13.3 21.8 2.1 3.3 1.7 920 Fourth 8.3 3.9 4.1 2.0 22.5 0.2 30.1 23.8 2.5 1.1 0.8 967 Highest 4.0 2.6 2.2 0.2 10.6 0.4 45.6 31.4 1.9 0.4 0.2 901 Total 5.6 4.2 4.3 1.9 33.6 0.6 20.3 19.2 2.4 3.5 3.1 4,689 Note: Total includes 2 people with age missing. If the respondent visited more than one facility/provider, only the first one is included in the tabulation. Use of private hospital services tends to increase with age and is higher in urban areas than rural areas. Use of private hospitals increases with economic status, from 5 percent in the lowest wealth quintile to 46 percent in the highest wealth quintile. By region, people in CALABARZON and NCR were more likely to visit a private hospital in the past 30 days than those in other regions (38 and 34 percent, respectively). Health Care Utilization and Financing | 183 Use of private clinic services varies little by background character- istics, although it increases with wealth status. Use of other types of private health services and non-medical services is higher in Bicol than in other regions, while use of alternative medical services is high in Eastern Visayas. Table 14.5 and Figure 14.2 show that the most common reasons for visits to health facilities are illness or injury (68 percent) and medical checkups (28 percent); 2 percent come for dental care and 1 percent for medical requirement. In the 2008 NDHS, persons who visited a health facility in the 30 days preceding the survey were asked how long it took to travel there. Overall, the average travel time was 39 minutes (Table 14.6); travel time was longest in ARMM (83 minutes) and shortest in NCR and Northern Mindanao (both 28 minutes). As expected, average travel time is longer for persons in rural areas (45 minutes) than for those in urban areas (32 minutes). Looking at economic status, the average travel time was longest for persons in the lowest wealth quintile (47 minutes) and shortest for those in the highest wealth quintile (35 minutes). Interestingly, the survey results indicate that older persons seeking care have a longer average travel time than younger persons. Table 14.5 Reason for seeking health care Percent distribution of persons who visited a health facility or sought advice or treatment in the 30 days preceding the survey, by reason for seeking health care, Philippines 2008 Reason Percent Ill/injured 67.6 Dental 1.9 Medical checkup 28.1 Medical requirement 0.9 Other 1.3 Missing 0.2 Total 100.0 Number 4,689 Note: If a respondent made two or more visits, only the reason for the first visit is included in the tabulation. NDHS 2008 Figure 14.2 Reasons for Visiting a Health Facility/Provider in the 30 Days Before the Survey Ill/injured 68% Dental 2% Medical checkup 28% Other 1% Medical requirement 1% 184 | Health Care Utilization and Financing Table 14.6 Average travel time to health facility visited Among persons who visited a health facility or sought advice or treatment in the 30 days preceding the survey, the average travel time (in minutes) to the facility/provider visited, by background characteristics, Philippines 2008 Background characteristic Average travel time to health facility/ provider (in minutes) Number Sex Male 39.5 2,108 Female 38.0 2,537 Age 0-4 31.1 1,469 5-29 35.8 1,453 30-59 42.4 1,118 60+ 56.7 603 Residence Urban 32.0 2,328 Rural 45.3 2,318 Region National Capital Region 27.9 634 Cordillera Admin Region 63.3 81 I - Ilocos 31.8 209 II - Cagayan Valley 46.9 141 III - Central Luzon 35.3 557 IVA - CALABARZON 31.8 430 IVB - MIMAROPA 42.2 139 V - Bicol 30.9 472 VI - Western Visayas 37.0 402 VII - Central Visayas 43.3 409 VIII - Eastern Visayas 62.3 227 IX - Zamboanga Peninsula 60.9 159 X - Northern Mindanao 28.0 228 XI - Davao 47.7 185 XII - SOCCSKSARGEN 31.5 195 XIII - Caraga 45.8 74 ARMM 83.2 103 Wealth quintile Lowest 46.8 913 Second 39.1 966 Middle 37.0 915 Fourth 35.9 959 Highest 34.6 892 Total 38.7 4,645 Note: Total includes 2 people with age missing. If the respondent visited more than one facility/provider, only the first one is included in the tabulation. 14.3 HOSPITAL CARE In the 2008 NDHS, respondents to the Household Questionnaire were asked if any member of their household had been confined (was an in-patient) in a hospital or clinic in the 12 months preceding the survey. Only 4 percent of the household population was reported to have been confined in the past 12 months (Table 14.7). As expected, children under age five and persons age 60 and older were more likely to have had in-patient hospital care than persons age 5-59. Differentials by other background character- istics are not large. Health Care Utilization and Financing | 185 Persons who were confined in a hospital or clinic were about equally likely to have been in a public facility as a private facility: 51 percent of in-patients were confined in public health facilities, while 48 percent were confined in private health facilities. Private hospitals account for the largest share of those who were confined, followed by provincial hospitals, regional hospitals, and district hospitals. Table 14.7 In-patient hospital care Percentage of household population who were confined to a hospital or clinic in the 12 months before the survey, and among those confined, percent distribution by type of facility, according to background characteristics, Philippines 2008 Facility in which person received in-patient care Public Private Background characteristic Percentage confined to hospital/ clinic in past 12 months Number Any public facility Regional hospital/ public medical center Provincial hospital District hospital Munici- pal hospital Any private facility Private hospital Lying- in clinic/ Birthing home Private clinic Missing Total Number confined Sex Male 3.4 30,335 50.1 15.6 18.2 10.6 5.7 49.3 46.1 0.4 2.9 0.6 100.0 1,025 Female 4.8 29,282 52.0 17.9 16.8 12.2 5.1 47.0 42.0 2.9 2.1 1.0 100.0 1,392 Age 0-4 6.2 6,706 53.4 16.9 17.1 12.6 6.7 46.1 42.1 0.5 3.5 0.5 100.0 417 5-29 2.8 29,674 54.3 18.6 19.0 11.6 5.1 45.1 39.2 3.7 2.1 0.7 100.0 835 30-59 4.2 18,917 51.5 18.0 17.6 10.9 5.0 47.9 44.3 1.2 2.4 0.6 100.0 791 60+ 8.7 4,317 41.2 11.0 13.8 11.4 5.0 56.6 54.6 0.2 1.8 2.2 100.0 374 Residence Urban 4.0 30,002 42.9 19.4 13.7 5.9 3.8 56.5 52.3 2.6 1.6 0.7 100.0 1,186 Rural 4.2 29,615 59.2 14.5 20.9 16.9 6.8 39.8 35.6 1.0 3.2 1.0 100.0 1,231 Region National Capital Region 3.3 9,064 39.9 31.1 3.4 2.3 3.0 58.4 52.0 4.5 1.9 1.7 100.0 295 Cordillera Admin Region 5.6 1,082 63.7 8.0 36.9 18.1 0.6 35.7 33.7 0.0 2.0 0.6 100.0 61 I - Ilocos 5.1 3,082 59.1 27.3 17.3 13.8 0.6 40.3 37.4 0.6 2.4 0.6 100.0 158 II - Cagayan Valley 5.0 1,870 59.2 13.6 15.9 20.9 8.8 40.0 34.3 0.8 4.8 0.8 100.0 93 III - Central Luzon 3.9 6,370 49.6 6.8 25.0 16.4 1.5 49.9 48.4 0.5 1.0 0.5 100.0 251 IVA - CALABARZON 3.2 7,495 37.8 16.4 12.6 4.8 3.9 60.1 55.7 1.7 2.6 2.2 100.0 242 IVB - MIMAROPA 4.4 1,686 61.9 5.1 38.9 6.8 11.0 37.3 37.3 0.0 0.0 0.9 100.0 75 V - Bicol 3.3 3,636 57.1 14.3 15.9 17.0 9.9 42.9 40.5 0.8 1.6 0.0 100.0 121 VI - Western Visayas 4.1 4,701 71.1 10.8 22.1 30.4 7.7 28.3 26.1 1.7 0.5 0.6 100.0 195 VII - Central Visayas 4.3 4,126 53.4 22.2 17.3 12.2 1.8 46.0 43.0 2.4 0.6 0.6 100.0 179 VIII - Eastern Visayas 3.8 2,470 72.6 5.3 32.9 22.3 12.1 26.5 25.6 0.9 0.0 0.9 100.0 93 IX - Zamboanga Peninsula 3.7 2,379 60.2 22.6 24.7 3.7 9.2 39.8 36.1 0.0 3.7 0.0 100.0 88 X - Northern Mindanao 5.6 2,568 41.1 7.6 14.1 7.5 11.9 58.9 54.7 0.0 4.2 0.0 100.0 145 XI - Davao 5.6 2,713 42.6 24.9 10.2 6.3 1.1 56.3 47.6 3.4 5.2 1.1 100.0 152 XII - SOCCSKSARGEN 4.5 2,390 44.4 13.7 13.8 5.3 11.7 55.6 51.6 0.7 3.3 0.0 100.0 108 XIII - Caraga 4.7 1,532 56.5 14.0 23.8 13.3 5.4 43.5 42.7 0.8 0.0 0.0 100.0 72 ARMM 3.6 2,453 37.2 21.7 10.7 0.0 4.8 61.1 42.4 8.0 10.6 1.8 100.0 88 Wealth quintile Lowest 3.2 11,918 77.4 20.2 24.4 19.9 12.9 21.5 18.9 0.3 2.3 1.1 100.0 387 Second 3.7 11,924 68.9 18.5 23.4 18.6 8.4 31.1 26.0 1.7 3.4 0.0 100.0 446 Middle 4.1 11,926 57.4 19.2 21.2 12.1 5.0 41.7 36.6 2.5 2.5 0.8 100.0 484 Fourth 4.6 11,928 41.0 16.5 14.7 7.4 2.4 57.0 51.6 3.5 1.9 1.9 100.0 554 Highest 4.6 11,922 23.0 11.8 6.9 3.6 0.8 76.7 74.1 0.6 2.0 0.3 100.0 547 Insurance status Not insured 3.1 34,430 66.1 20.7 22.6 15.9 6.8 33.1 28.1 2.5 2.5 0.9 100.0 1,057 Insured PhilHealth 5.6 22,502 38.6 13.7 12.6 8.2 4.0 60.7 56.9 1.3 2.5 0.7 100.0 1,266 Insured private 4.1 392 * * * * * * * * * * 100.0 16 Total 4.1 59,617 51.2 16.9 17.4 11.5 5.3 48.0 43.8 1.8 2.4 0.9 100.0 2,417 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 14.7 shows a number of differentials between use of public and private facilities. Persons age 60 and over are more likely to have been confined in private facilities, particularly private hospitals, than younger persons. Similarly, persons in urban areas are more likely to use private facilities than those in rural areas. The proportion confined in public hospitals is highest in Eastern Visayas (73 percent) and lowest in ARMM (37 percent). Among those who were confined, use of public facilities decreases as 186 | Health Care Utilization and Financing economic status increases, from 77 percent among persons in the lowest wealth quintile to 23 percent among those in the highest quintile. Use of public hospitals for in-patient care is higher for persons without insurance coverage (66 percent) than for those with PhilHealth (39 percent) coverage. Table 14.8 presents information on several aspects of in-patient care including the reason for the confinement, the length of the stay, and the cost of the confinement. More than four in five people (82 percent) who were confined in a health facility in the 12 months preceding the survey were there because of illness or injury. Another 16 percent were confined in order to give birth. More than one-quarter of in-patients were confined for six or more days, while about half were confined for three days or less. Over three-quarters of in-patients paid 3,000 pesos or more for their treat- ment. 14.4 COST OF TREATMENT As shown in Table 14.9, the average travel cost for persons who visited a health facility or provider in the 30 days preceding the survey was 109 pesos, while the average cost of treatment was 1,872 pesos. For persons who were confined in the facility, the average cost of treatment was almost 17,000 pesos. As expected, the cost of health care received in private facilities is substantially higher than the cost of care received in public facilities. The average cost of treatment for a visit to a private health facility (2,864 pesos) is almost three times the cost of a visit to a public health facility (1,051 pesos). Similarly, the average cost of in-patient care at private facilities (24,278 pesos) is almost three times that of confine- ment at a public facility (9,849 pesos). Table 14.9 Cost of health care at public and private facilities Average cost (in pesos) per person for those who visited a health facility in the past 30 days and for those who were confined in a hospital or clinic in the past 12 months, by whether the facility was public or private, Philippines 2008 Total Public facility Private facility Type of care Average cost (pesos) Number Average cost (pesos) Number Average cost (pesos) Number Person visited a health facility in past 30 days Average cost of transport 109 3,490 80 1,625 134 1,864 Average cost of treatment 1,872 4,642 1,051 2,540 2,864 2,102 Person confined in a hospital or clinic in past 12 months Average cost of confinement 16,802 2,376 9,849 1,231 24,278 1,145 Table 14.8 Aspects of in-patient care Percent distribution of persons confined in a hospital or clinic in the 12 months preceding the survey, by reason for confinement, length of stay, and cost of confinement, Philippines 2008 Characteristic of confinement Percent Reason Ill/injured 82.4 Gave birth 15.8 Executive check-up 0.7 Other 0.1 Missing 1.0 Total 100.0 Length of stay 0 0.4 1 12.6 2 14.8 3 23.6 4 11.4 5 10.1 6+ 26.4 Still confined/missing 0.8 Total 100.0 Cost (pesos) Free 0.8 <1000 4.4 1000-1999 8.2 2000-2999 8.0 3000+ 76.9 Still in hospital/missing/ don’t know/in-kind 1.7 Total 100.0 Number 2,417 Women’s Empowerment | 187 WOMEN’S EMPOWERMENT 15 The Philippines is committed to improving the socioeconomic conditions for women. In August 2009, the Republic Act Number 9710: Magna Carta of Women was signed into law by the President (NCRFW, 2009). The law prohibits discrimination against women and recognizes, promotes, and protects their rights. Implementation of the law by all government agencies will be overseen by the Philippine Commission on Women (formerly the National Commission on the Role of Filipino Women), under the Office of the President. The law also applies to women working abroad through the designation of a gender focal point in the consular section of the Philippines’ embassies or consulates, who will be trained on handling gender concerns of women migrant workers, especially those in distress. This chapter examines indicators of women’s empowerment and relates them with selected demographic and health outcomes. Results from the 2008 NDHS discussed in earlier chapters show that women are at equivalent or sometimes better status than men. Because primary and secondary education are free in public schools in the country, women have better educational attainment and are more likely to be literate than men. More than half of the women interviewed in the 2008 NDHS were employed in the 12 months preceding the survey. There is also no disparity in exposure to mass media between women and men in the Philippines. The Human Development Index (HDI) provides a picture of a country’s development. It combines life expectancy, educational attainment, and income into a composite index. Countries with the same level of HDI can have very different levels of income and countries with similar levels of income can have very different HDIs. According to the United Nations Development Program’s (UNDP) Human Development Report for 2009, the Philippines ranks 105 among 182 countries on the HDI and ranks 59 out of 109 countries on the Gender Empowerment Measure (GEM), which measures gender inequality from an economic and political perspective (UNDP, 2009). The Global Gender Gap Index 2008, developed by the World Economic Forum, ranks the Philippines 9th out of 134 countries in terms of gender equality. (World Economic Forum, 2009). Empowerment of women is essential for the achievement of sustainable development. The full participation and partnership of both women and men is required in productive and reproductive life, including shared responsibilities for the care and nurturing of children and maintaining the household. The 2008 NDHS explores women’s empowerment in terms of employment, type of earnings, control over cash and earnings, and freedom of movement. The Women’s Questionnaire collected information on general background characteristics including age, education, and household wealth status, for women age 15-49. In addition, the 2008 NDHS collected information on other measures of women’s autonomy and status, particularly women’s roles in making household decisions. Information collected in the survey is used to estimate two indicators of women’s empowerment: women’s participation in household decisionmaking and women’s acceptance of wife beating. The extent to which women’s empowerment influences health outcomes (such as reproductive health care practices, contraceptive use, and unmet need) is also examined. 188 │ Women’s Empowerment 15.1 EMPLOYMENT AND FORM OF EARNINGS Currently married women were asked whether they were employed at the time of survey and, if not, whether they were employed at any time during the 12 months preceding the survey. Table 15.1 shows what percentage of currently married women age 15-49 were employed during the 12 months preceding the survey, and the percent distribution of employed women by the type of earnings they received (cash, in-kind, both, or neither). Three of five (60 percent) currently married women age 15-49 reported being employed in the 12 months before the survey. Women in the youngest age group were least likely to have been employed (41 percent). The proportion employed increases with each age group to a high of 75 percent among married women age 45-49. Table 15.1 Employment and cash earnings of currently married women Percentage of currently married women age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently married women employed in the past 12 months by type of earnings, according to age, Philippines 2008 Currently married women Percent distribution of currently married women employed in the past 12 months, by type of earnings Age Percentage employed Number of women Cash only Cash and in-kind In-kind only Not paid Missing Total Number of women 15-19 40.9 283 86.4 6.5 1.6 5.4 0.0 100.0 116 20-24 43.7 1,000 87.0 6.1 1.7 5.2 0.0 100.0 437 25-29 52.0 1,560 88.2 5.9 1.3 4.6 0.0 100.0 810 30-34 60.3 1,573 86.5 6.2 1.3 6.1 0.0 100.0 949 35-39 64.2 1,522 84.0 8.5 1.5 5.9 0.0 100.0 977 40-44 70.0 1,299 82.7 8.9 1.6 6.7 0.1 100.0 910 45-49 74.5 1,181 80.8 8.2 1.8 8.8 0.4 100.0 880 Total 15-49 60.3 8,418 84.7 7.4 1.5 6.3 0.1 100.0 5,079 Although employment is assumed to generate income, not all women receive earnings for the work they do. Furthermore, not all women who receive earnings are paid in cash. Table 15.1 shows that 85 percent of currently married women who were employed in the past 12 months earn only cash, while 7 percent receive both cash and in-kind payment, 2 percent receive in-kind payment only, and 6 percent do not receive any payment for their work. 15.2 MARRIED WOMEN’S CONTROL OVER THEIR OWN EARNINGS Besides having access to income, women need to have control over their earnings in order to be empowered. To assess control over earnings, currently married women with cash earnings in the 12 months before the survey were asked who usually decides how the money she earns will be used: mainly the woman herself, mainly her husband, or the woman and her husband jointly. Table 15.2 shows women’s control over their earnings by background characteristics. Overall, about two in five (41 percent) currently married women with cash earnings decide themselves how their earnings are used, while more than half (54 percent) say that they decide jointly with their husband. Only 4 percent of women said that their husband mainly decides how their earnings are used. The proportion of married women who say that they mainly decide themselves how their earnings are used has decreased from 60 percent in 2003 to the current level of 41 percent.1 1 It should be noted that the wording of the question changed slightly between the 2003 and 2008 NDHS surveys. Women’s Empowerment | 189 Women age 15-24 are more likely than older women to mainly decide how their earnings are used. Women with more children are more likely to make independent decisions about spending their earnings than women with fewer children. Table 15.2 Control over women's cash earnings and relative magnitude of women's earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife's cash earnings are used, and percent distribution by whether woman earned more or less than her husband, according to background characteristics, Philippines 2008 Person who decides how the wife's cash earnings are used: Women's cash earnings compared with husband's cash earnings: Background characteristic Mainly wife Wife and husband jointly Mainly husband Other Missing Total More Less About the same Husband/ partner has no earnings Don't know/ missing Total Number of women Age 15-19 47.2 42.8 8.0 2.0 0.0 100.0 18.2 65.8 11.4 3.9 0.8 100.0 108 20-24 47.4 45.9 5.7 0.7 0.3 100.0 18.1 57.5 21.6 2.1 0.7 100.0 407 25-29 37.7 58.7 3.1 0.0 0.4 100.0 21.3 57.8 18.4 1.4 1.1 100.0 762 30-34 38.8 54.8 5.8 0.0 0.6 100.0 24.1 54.8 18.6 1.4 1.2 100.0 879 35-39 40.8 54.9 3.7 0.1 0.6 100.0 22.3 54.3 21.2 1.4 0.7 100.0 905 40-44 43.6 52.6 3.5 0.0 0.3 100.0 23.8 51.0 23.3 1.5 0.4 100.0 833 45-49 42.3 54.6 3.1 0.0 0.1 100.0 21.8 50.9 25.0 1.6 0.7 100.0 783 Number of living children 0 39.6 56.5 2.6 0.3 0.9 100.0 24.2 52.2 18.6 2.4 2.6 100.0 439 1-2 40.1 55.1 4.4 0.2 0.2 100.0 24.7 52.0 21.2 1.5 0.6 100.0 1,864 3-4 41.9 54.1 3.7 0.0 0.3 100.0 20.7 55.1 22.1 1.4 0.6 100.0 1,490 5+ 44.0 50.1 5.2 0.1 0.5 100.0 18.4 59.0 20.3 1.5 0.7 100.0 885 Residence Urban 42.7 52.5 4.4 0.1 0.3 100.0 24.9 50.0 22.4 2.0 0.8 100.0 2,615 Rural 39.7 55.8 3.8 0.1 0.6 100.0 18.8 59.8 19.4 1.1 0.8 100.0 2,062 Region National Capital Region 44.4 51.2 3.9 0.2 0.3 100.0 28.0 44.3 24.4 2.3 0.9 100.0 851 Cordillera Admin Region 41.9 56.4 1.1 0.0 0.6 100.0 16.7 59.4 19.6 1.4 2.9 100.0 67 I - Ilocos 49.8 44.7 5.0 0.5 0.0 100.0 21.3 51.0 23.6 4.1 0.0 100.0 206 II - Cagayan Valley 39.8 54.5 5.3 0.0 0.5 100.0 16.7 60.7 21.5 0.0 1.1 100.0 139 III - Central Luzon 45.7 50.4 3.4 0.0 0.5 100.0 20.1 57.7 19.8 1.5 1.0 100.0 496 IVA - CALABARZON 31.7 64.0 3.9 0.2 0.2 100.0 23.6 47.1 26.3 2.1 0.9 100.0 595 IVB - MIMAROPA 25.9 64.3 9.8 0.0 0.0 100.0 15.7 65.6 17.5 1.2 0.0 100.0 154 V - Bicol 43.3 53.5 3.1 0.0 0.0 100.0 14.9 76.6 7.3 1.3 0.0 100.0 246 VI - Western Visayas 46.8 46.6 5.4 0.0 1.2 100.0 22.2 55.5 18.7 2.0 1.6 100.0 358 VII - Central Visayas 42.8 51.9 5.3 0.0 0.0 100.0 27.2 47.6 24.1 0.7 0.4 100.0 306 VIII - Eastern Visayas 43.0 53.5 1.7 0.0 1.7 100.0 18.4 63.3 16.1 0.4 1.7 100.0 188 IX - Zamboanga Peninsula 41.4 55.2 3.3 0.0 0.0 100.0 24.0 54.3 19.8 1.9 0.0 100.0 166 X - Northern Mindanao 37.3 59.5 1.8 0.7 0.7 100.0 21.2 55.1 22.7 0.3 0.7 100.0 243 XI - Davao 44.8 50.4 4.8 0.0 0.0 100.0 20.7 60.1 17.4 1.4 0.4 100.0 246 XII - SOCCSKSARGEN 41.6 54.5 3.8 0.0 0.0 100.0 21.5 63.1 14.2 0.4 0.8 100.0 198 XIII - Caraga 35.4 60.2 3.5 0.5 0.4 100.0 18.1 62.8 18.6 0.0 0.4 100.0 123 ARMM 36.9 55.7 6.5 0.0 0.8 100.0 17.9 44.0 35.5 1.8 0.8 100.0 96 Education No education 25.6 69.8 4.6 0.0 0.0 100.0 13.9 41.0 44.0 1.1 0.0 100.0 54 Elementary 44.5 49.9 4.6 0.3 0.8 100.0 17.7 60.9 18.9 1.3 1.2 100.0 1,032 High school 44.2 50.9 4.6 0.2 0.1 100.0 19.6 57.7 20.4 1.8 0.5 100.0 1,916 College 36.7 59.5 3.3 0.0 0.5 100.0 28.3 46.9 22.5 1.6 0.9 100.0 1,675 Wealth quintile Lowest 40.2 55.2 4.0 0.0 0.6 100.0 14.7 63.5 20.3 0.9 0.6 100.0 724 Second 43.8 51.2 4.2 0.2 0.6 100.0 18.7 60.9 18.2 1.1 1.0 100.0 900 Middle 42.1 53.0 4.5 0.0 0.3 100.0 19.4 58.2 20.5 1.0 0.9 100.0 952 Fourth 42.7 51.7 5.3 0.0 0.2 100.0 25.2 52.1 19.7 2.5 0.5 100.0 987 Highest 38.3 58.3 2.8 0.3 0.3 100.0 29.7 41.8 25.6 2.0 0.9 100.0 1,114 Total 41.4 54.0 4.1 0.1 0.4 100.0 22.2 54.3 21.1 1.6 0.8 100.0 4,677 190 │ Women’s Empowerment Women in urban areas are more likely than those in rural areas to make independent decisions about spending their earnings, although the differences are small (43 and 40 percent, respectively). Decisionmaking varies across regions. Married women living in Ilocos (50 percent), Western Visayas (47 percent), Central Luzon (46 percent), Davao (45 percent), and National Capital Region (NCR) (44 percent) have more independence in deciding how to spend their earnings than women living in MIMAROPA (26 percent) and CALABARZON (32 percent). Women in MIMAROPA are also the most likely to report that their husbands are the ones who mainly decide how their earnings are used (10 percent). Women’s decisionmaking power regarding their earnings shows no clear pattern by level of education and household wealth status. The proportion of married women who mainly decide themselves how to use their earnings increases from 26 percent among those with no education to 45 percent among those with elementary education, and then decreases to 37 percent among those with some college. Similarly, married women in middle wealth quintiles are slightly more likely to decide themselves than women in the lowest and highest quintiles. Table 15.2 shows the findings on women’s cash earnings relative to those of their husband (more, less, or about the same). Overall, a majority of married women (54 percent) say that they earn less than their husband, while 22 percent say they earn more than their husband, and 21 percent say they earn about the same. Across almost all background characteristics, more than half of married women say they earn less than their husband. Exceptions are NCR, CALABARZON, Central Visayas, ARMM, and women with either no education or some college education, as well as women in the highest wealth quintile. The proportion of women who earn more than their husband is highest in NCR (28 percent) and Central Visayas (27 percent), as well as among women with some college education (28 percent) and those in the highest wealth quintile (30 percent). 15.3 CONTROL OVER MEN’S EARNINGS The extent of women’s participation in the family’s decisionmaking can also be measured by the amount of control they have over the use of their husband’s cash earnings Table 15.3 shows that for almost two-thirds (63 percent) of currently married women whose husbands receive cash earnings report that decisions about the use of the husband’s earnings are made jointly by the husband and wife. Surprisingly, 27 percent of women say that they themselves are the ones who mainly decide how their husbands’ earnings are used. The differentials in women’s involvement in decisions regarding how to use their husband’s earnings by background characteristics are small. However, the variations across regions indicate that women in NCR (31 percent) and Central Luzon (36 percent) are the most likely to decide themselves how the husband’s earnings are spent. On the other hand, women in MIMAROPA (15 percent), Western Visayas (14 percent), and Ilocos (13 percent) are the most likely to say they have no involvement at all in making decisions about their husband’s earnings. Women’s Empowerment | 191 Table 15.3 Control over men's cash earnings Percent distribution of currently married women age 15-49 whose husbands receive cash earnings, by person who decides how husband’s cash earnings are used, according to background characteristics, Philippines 2008 Background characteristic Mainly wife Husband and wife jointly Mainly husband Other Missing Total Number of women Age 15-19 25.1 62.4 11.0 1.5 0.0 100.0 275 20-24 25.9 63.2 10.1 0.5 0.2 100.0 984 25-29 25.7 64.7 9.4 0.1 0.1 100.0 1,546 30-34 26.9 63.0 9.9 0.2 0.0 100.0 1,555 35-39 25.7 64.9 9.3 0.1 0.0 100.0 1,508 40-44 29.9 60.6 9.5 0.0 0.0 100.0 1,281 45-49 28.6 62.8 8.5 0.0 0.1 100.0 1,163 Number of living children 0 25.3 64.2 9.8 0.4 0.3 100.0 689 1-2 26.1 63.8 9.8 0.3 0.1 100.0 3,468 3-4 27.6 63.2 9.1 0.1 0.0 100.0 2,593 5+ 28.8 61.7 9.6 0.0 0.0 100.0 1,560 Residence Urban 28.9 60.7 10.1 0.2 0.1 100.0 4,222 Rural 25.0 65.9 8.9 0.2 0.0 100.0 4,089 Region National Capital Region 31.2 58.7 9.9 0.1 0.1 100.0 1,313 Cordillera Admin Region 19.6 71.0 9.2 0.3 0.0 100.0 142 I - Ilocos 24.3 62.7 13.0 0.0 0.0 100.0 404 II - Cagayan Valley 14.6 78.3 6.8 0.3 0.0 100.0 272 III - Central Luzon 36.3 55.3 8.2 0.3 0.0 100.0 887 IVA - CALABARZON 25.3 66.5 8.1 0.1 0.0 100.0 1,073 IVB - MIMAROPA 19.3 65.3 15.4 0.0 0.0 100.0 239 V - Bicol 18.7 71.2 10.1 0.0 0.0 100.0 465 VI - Western Visayas 29.8 56.5 13.6 0.2 0.0 100.0 617 VII - Central Visayas 28.9 61.8 9.0 0.0 0.3 100.0 596 VIII - Eastern Visayas 24.9 67.4 7.6 0.0 0.0 100.0 335 IX - Zamboanga Peninsula 23.6 67.3 7.9 1.3 0.0 100.0 312 X - Northern Mindanao 26.1 67.0 6.4 0.2 0.2 100.0 372 XI - Davao 27.4 61.9 10.3 0.2 0.2 100.0 401 XII - SOCCSKSARGEN 23.5 67.5 8.8 0.3 0.0 100.0 338 XIII - Caraga 23.5 69.1 7.5 0.0 0.0 100.0 212 ARMM 27.6 61.3 10.9 0.2 0.0 100.0 333 Education No education 25.8 64.4 9.7 0.0 0.0 100.0 132 Elementary 28.0 61.2 10.7 0.2 0.0 100.0 2,020 High school 27.7 63.1 9.0 0.2 0.1 100.0 3,681 College 25.2 65.1 9.4 0.2 0.1 100.0 2,478 Wealth quintile Lowest 25.7 64.8 9.4 0.1 0.0 100.0 1,653 Second 27.0 64.2 8.5 0.4 0.0 100.0 1,670 Middle 28.9 61.7 9.2 0.1 0.1 100.0 1,723 Fourth 28.0 61.4 10.5 0.2 0.0 100.0 1,677 Highest 25.2 64.4 10.1 0.1 0.2 100.0 1,590 Total 15-49 27.0 63.3 9.5 0.2 0.1 100.0 8,311 192 │ Women’s Empowerment 15.4 CONTROL OVER HER OWN EARNINGS AND OVER THOSE OF HER HUSBAND Table 15.4 shows, for currently married women who earned cash in the past 12 months, the person who mainly decides how their cash earnings are used, and for all currently married women whose husbands earned cash in the past 12 months, the person who decides how their husband’s cash earnings are used, according to the relative magnitude of the earnings of women and their husbands. Women whose husbands are not working or who do not earn cash are the most likely to be the one who mainly decides how their own earnings will be used (64 percent). Women who earn either more or less than their husbands are almost equally likely to be the main decisionmaker with regard to how their own earnings are used (45 percent). It is interesting to note that women whose cash earnings are the same as their husband’s are the least likely to make their own decisions about their earnings and are much more likely to make decisions jointly with their husbands (68 percent) about their earnings. With regard to decisions about how the husband’s earnings are spent, the differences in the main decisionmaker are not large. Around two-thirds of women in each category say that decisions about how their husband’s earnings are used are made jointly, although the proportion is somewhat lower among women who say they earn more than their husbands (54 percent). Table 15.4 Women's control over their own earnings and the earnings of their husband Percent distribution of currently married women age 15-49 with cash earnings in the past 12 months by person who decides how the woman's cash earnings are used, and percent distribution by person who decides how the husband’s cash earnings are used, according to the relative amount of the woman's and husband's cash earnings, Philippines 2008 Person who decides how the wife's cash earnings are used: Person who decides how husband's cash earnings are used: Women's earnings relative to husband's earnings Mainly wife Wife and husband jointly Mainly husband Other Missing Total Number Mainly wife Wife and husband jointly Mainly husband Other Missing Total Number of women More than husband 45.0 50.7 4.1 0.1 0.0 100.0 1,039 36.2 53.7 9.9 0.2 0.0 100.0 1,029 Less than husband 44.5 51.2 4.2 0.1 0.0 100.0 2,542 28.0 62.6 9.5 0.0 0.0 100.0 2,542 Same as husband 28.5 67.5 3.9 0.1 0.0 100.0 986 21.4 70.8 7.5 0.2 0.0 100.0 986 Husband has no cash earnings/did not work 63.7 30.0 3.3 3.0 0.0 100.0 74 na na na na na na 0 Woman has no cash earnings na na na na na na 0 20.1 69.2 10.7 0.1 0.0 100.0 401 Woman did not work in past 12 months na na na na na na 0 25.9 63.9 9.9 0.3 0.1 100.0 3,316 Total1 41.5 54.0 4.1 0.1 0.4 100.0 4,677 27.0 63.3 9.5 0.2 0.1 100.0 8,311 na = Not applicable 1 Excludes cases in which the woman or her husband has no earnings, and includes cases in which the woman does not know whether she earned more or less than her husband 15.5 WOMEN’S PARTICIPATION IN DECISIONMAKING In the 2008 NDHS, currently married women were asked who usually makes decisions on four specific issues: decisions regarding her own health care; making major household purchases; making purchases for daily household needs; and making visits to her family or relatives. Table 15.5 shows the percent distribution of currently married women age 15-49 by who usually makes these four decisions. Women’s Empowerment | 193 Table 15.5 Women's participation in decisionmaking Percent distribution of currently married women by person who usually makes decisions about four kinds of issues, Philippines 2008 Decision Mainly wife Wife and husband jointly Mainly husband Someone else Other/ missing Total Number of women Own health care 49.6 44.0 6.1 0.2 0.1 100.0 8,418 Major household purchases 20.7 64.8 13.6 0.6 0.3 100.0 8,418 Purchases of daily household needs 59.1 33.3 6.5 0.9 0.3 100.0 8,418 Visits to her family or relatives 22.5 70.3 6.8 0.2 0.2 100.0 8,418 The results show that married Filipino women are usually involved in all four decisions (Figure 15.1), although the extent of their involvement depends on what is being decided. Almost six in ten women say they alone make decisions about purchases for daily household needs; however, decisions about visits to the woman’s family or relatives are most likely to be made jointly by the woman and her husband (70 percent). Decisions on making major household purchases are also likely to be made jointly (65 percent); however, 14 percent of women say their husband usually decides about major purchases. Half of married women say they make decisions themselves about their own health care, while 44 percent say they make such decisions jointly with their husband. Table 15.6 shows differences by background characteristics in the percentage of married women who reported that they make each of the four specified decisions either themselves or jointly with their husband. Over 85 percent of married women participate in each type of decision and more than three in four (77 percent) participate in all four decisions. Only 1 percent of married women reported that they do not participate in any of the decisions. NDHS 2008 Figure 15.1 Number of Decisions in Which Currently Married Women Participate 3 decisions 15% 4 decisions 77% 2 decisions 5% 1 decision 2% 0 decisions 1% 194 │ Women’s Empowerment Table 15.6 Women's participation in decisionmaking by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Philippines 2008 Background characteristic Own health care Making major household purchases Making purchases for daily household needs Visits to her family or relatives Percentage who participate in all four decisions Percentage who participate in none of the four decisions Number of women Age 15-19 89.1 75.3 81.5 89.7 65.7 3.4 283 20-24 92.4 82.3 89.1 92.6 72.5 1.5 1,000 25-29 93.4 84.8 91.2 92.0 74.4 1.1 1,560 30-34 93.2 85.7 92.2 91.7 76.3 1.2 1,573 35-39 94.9 87.2 94.0 92.9 78.7 0.8 1,522 40-44 94.2 87.7 94.8 94.9 80.8 0.7 1,299 45-49 94.6 86.9 94.6 94.3 78.8 0.7 1,181 Employment (past 12 months) Not employed 92.7 83.9 90.5 92.7 74.5 1.4 3,332 Employed for cash 94.3 86.8 93.6 93.0 78.3 1.0 4,677 Employed not for cash 93.5 84.5 93.5 93.0 75.8 0.1 398 Number of living children 0 91.5 84.8 89.7 92.4 75.9 2.0 706 1-2 93.6 84.9 91.8 92.8 76.2 1.0 3,517 3-4 94.4 86.3 93.6 93.5 77.8 0.8 2,618 5+ 93.4 85.8 92.8 92.2 76.1 1.3 1,576 Residence Urban 94.8 86.0 93.0 93.5 78.6 1.0 4,297 Rural 92.4 85.0 91.7 92.2 74.6 1.2 4,121 Region National Capital Region 96.4 88.8 94.7 94.6 82.2 0.8 1,343 Cordillera Admin Region 94.5 90.3 93.8 94.8 84.9 1.4 143 I - Ilocos 91.8 83.8 89.6 88.5 77.3 5.2 415 II - Cagayan Valley 94.4 90.1 97.3 94.9 80.9 0.3 273 III - Central Luzon 95.8 84.9 95.1 93.8 77.2 0.1 897 IVA - CALABARZON 96.4 89.9 95.4 95.5 84.4 0.6 1,089 IVB - MIMAROPA 90.4 81.9 92.5 85.8 67.0 1.0 241 V - Bicol 91.4 81.4 88.4 89.4 68.5 0.8 470 VI - Western Visayas 94.5 80.1 88.2 93.3 70.9 0.5 627 VII - Central Visayas 92.3 80.5 91.2 92.0 73.2 1.4 599 VIII - Eastern Visayas 97.6 88.1 94.5 94.6 82.5 0.2 337 IX - Zamboanga Peninsula 91.5 86.9 91.1 93.4 76.0 0.8 316 X - Northern Mindanao 93.7 85.4 93.2 92.7 76.5 0.7 373 XI - Davao 89.4 83.0 89.8 91.1 72.4 2.9 406 XII - SOCCSKSARGEN 87.5 87.0 91.5 90.9 72.5 1.6 338 XIII - Caraga 93.3 81.4 91.0 88.3 68.1 0.5 212 ARMM 84.7 84.2 83.1 93.0 64.5 2.0 337 Education No education 87.4 82.0 91.9 92.9 69.4 1.6 133 Elementary 92.0 84.0 90.9 91.2 73.1 1.4 2,034 High school 93.9 85.1 92.5 92.7 76.4 1.0 3,727 College 94.9 87.5 93.4 94.4 80.1 0.9 2,524 Wealth quintile Lowest 90.0 85.7 91.0 91.6 73.0 1.5 1,661 Second 92.5 82.7 90.8 91.3 72.4 1.2 1,683 Middle 94.5 83.7 93.0 92.4 76.9 1.3 1,737 Fourth 95.3 86.9 93.4 93.6 78.9 0.5 1,710 Highest 95.8 88.7 93.5 95.4 82.1 0.9 1,627 Total 93.6 85.5 92.4 92.8 76.6 1.1 8,418 Note: Total includes 11 women with information missing on employment status. Women’s Empowerment | 195 The proportion of women who participate in all four decisions varies somewhat according to their characteristics. Participation in decisionmaking increases with age, from 66 percent among women age 15-19 to 81 percent among women age 40-44. Employed women who receive cash earnings are slightly more likely to have a say in all four decisions (78 percent) than women who are not employed (75 percent) or women who work but not for cash (76 percent). The number of children a woman has does not seem to make a difference in her participation in decisionmaking. Women in urban areas are more likely to participate in decisionmaking than women in rural areas (79 percent compared with 75 percent). Women’s participation in making all four decisions is lowest in ARMM (65 percent) and MIMAROPA (67 percent). The higher the level of education, the more likely the woman is to participate in all four decisions (69 percent among women with no education, compared with 80 percent among woman who attended college). In general, household wealth is directly related to decisionmaking; as wealth status increases, so does the proportion of married women who participate in all four decisions. 15.6 ATTITUDES TOWARD WIFE BEATING The problems women face are many and diverse. One of the most serious is violence, particularly domestic violence. The 2008 NDHS obtained information on women’s attitudes towards wife beating. Women were asked whether a husband is justified in hitting or beating his wife under a series of circumstances: 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 sexual intercourse with him. A woman’s attitude toward wife beating is considered to be a proxy for her perception of her status. A lower score on the “number of reasons wife beating is justified” indicates a woman’s greater sense of entitlement, self-esteem and status, and reflects positively on her sense of empowerment. In contrast, a woman who believes that a husband is justified in hitting or beating his wife for most or all of these reasons may consider herself to be of low status, both absolutely and relative to men. Such a perception could act as a barrier to accessing health care for herself and her children, affect her attitude toward contraceptive use, and impact her general well- being. Table 15.7 shows the percentage of women age 15-49 who agree with specific reasons that justify a husband beating his wife, by background characteristics. Overall, 14 percent of women believe that a husband is justified in beating his wife for at least one of the reasons listed. The most widely accepted reason for wife beating among women in the Philippines is neglecting the children (12 percent), followed by going out without telling her husband (5 percent). Three percent of women feel a husband is justified in beating his wife if she argues with him, while only 2 percent of women agree that a husband is justified in hitting or beating his wife if she burns the food or refuses to have sexual intercourse with him. Approval of at least one reason for wife beating varies little with age. Women are less likely to accept wife beating for any reason if they live in an urban area, have attended college, or belong to the highest wealth quintile. Women in NCR and Western Visayas are the least likely to accept wife beating for any reason. 196 │ Women’s Empowerment Table 15.7 Attitude toward wife beating Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Philippines 2008 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Percentage who agree with at least one specified reason Number of women Age 15-19 2.4 2.8 5.0 11.9 1.7 14.6 2,749 20-24 1.4 3.0 4.1 11.2 1.7 13.4 2,147 25-29 1.8 2.6 4.9 11.7 1.7 13.8 2,106 30-34 2.2 3.0 4.9 10.6 2.0 13.2 1,865 35-39 2.5 2.9 5.3 11.9 2.4 14.5 1,777 40-44 1.7 3.0 6.1 11.5 1.9 14.7 1,532 45-49 2.9 3.1 6.0 11.6 2.4 15.0 1,418 Employment (past 12 months) Not employed 2.1 2.6 5.0 12.0 1.9 14.5 5,914 Employed for cash 2.0 3.0 4.9 10.8 1.9 13.4 7,119 Employed not for cash 3.9 4.6 8.4 16.6 3.0 19.9 519 Marital status Never married 2.0 2.7 4.0 10.3 1.3 12.3 4,530 Married or living together 2.1 3.0 5.7 12.1 2.1 14.9 8,418 Divorced/separated/widowed 3.2 3.7 4.5 12.9 3.1 16.4 646 Number of living children 0 1.9 2.5 4.0 10.4 1.5 12.5 5,116 1-2 1.7 2.6 4.5 10.8 1.5 13.1 3,985 3-4 2.1 3.5 5.8 12.3 2.6 15.5 2,810 5+ 3.6 3.7 8.7 15.5 3.0 19.3 1,683 Residence Urban 1.6 2.4 3.8 9.4 1.4 11.6 7,574 Rural 2.8 3.5 6.8 14.2 2.5 17.4 6,020 Region National Capital Region 0.9 1.6 2.1 6.2 0.8 8.0 2,522 Cordillera Admin Region 2.7 3.6 3.4 12.5 1.4 15.4 225 I - Ilocos 4.1 7.4 10.3 19.7 4.1 24.9 613 II - Cagayan Valley 8.0 9.6 8.3 17.0 6.3 20.9 382 III - Central Luzon 2.4 3.9 3.7 10.7 1.9 12.4 1,486 IVA - CALABARZON 1.2 1.9 3.7 8.6 1.1 11.0 1,808 IVB - MIMAROPA 1.9 3.3 3.9 16.6 2.7 20.5 340 V - Bicol 1.0 1.2 3.5 9.6 1.2 11.7 755 VI - Western Visayas 0.7 2.1 2.6 6.3 1.2 8.4 976 VII - Central Visayas 1.5 1.9 2.7 9.7 0.9 11.6 983 VIII - Eastern Visayas 2.0 1.8 2.9 6.9 0.6 9.7 488 IX - Zamboanga Peninsula 0.8 0.8 3.6 7.7 0.5 10.2 505 X - Northern Mindanao 0.3 2.1 5.1 10.1 0.6 12.4 585 XI - Davao 1.2 1.5 5.4 12.7 1.2 15.1 618 XII - SOCCSKSARGEN 6.2 4.6 11.8 26.1 3.8 30.8 480 XIII - Caraga 1.9 2.1 5.3 15.7 0.7 18.7 312 ARMM 9.5 9.6 30.0 41.1 12.7 47.0 516 Education No education 6.3 7.8 15.9 23.5 8.6 33.3 167 Elementary 3.6 4.3 9.2 16.1 3.2 20.5 2,653 High school 2.1 2.9 4.5 11.8 1.9 14.3 6,352 College 1.0 1.9 3.1 7.9 0.9 9.3 4,422 Wealth quintile Lowest 4.1 4.5 9.4 16.9 4.1 20.9 2,160 Second 2.5 3.3 6.7 16.1 2.2 19.1 2,419 Middle 2.3 3.3 6.0 11.5 2.2 14.6 2,661 Fourth 1.6 2.3 3.2 9.6 1.1 11.6 2,937 Highest 0.9 1.7 2.3 6.6 0.7 8.1 3,417 Total 2.1 2.9 5.1 11.5 1.9 14.1 13,594 Note: Total includes 43 women with information missing on employment status. Women’s Empowerment | 197 15.7 INDICATORS OF WOMEN’S EMPOWERMENT To examine how selected demographic and health outcomes vary by indicators of women’s empowerment, information on women’s participation in decisionmaking and their attitudes towards wife beating are summarized in two separate indices. These indices are based only on women’s responses to the survey. The first index is the number of decisions in which women participate alone or jointly with their husbands (see Table 15.5 for the list of decisions). This index ranges in value from 0 to 4 and is positively related to women’s empowerment. This index reflects the degree of control that women are able to exercise through making decisions in areas that affect their own lives and environments. The second index, which ranges in value from 0 to 5, is the number of reasons that a woman believes justifies a husband beating his wife (see Table 15.7). A lower score on this indicator is interpreted as reflecting a greater sense of entitlement, higher self-esteem, and a higher status of women. In general, it is expected that women who participate in making decisions are also more likely to disagree with all reasons for justifying wife beating. Note that the decisionmaking index is defined for currently married women, whereas the index on attitudes toward wife beating is defined for all women. Table 15.8 provides a brief overview on how these two basic empowerment indicators—the number of decisions in which women participate and the number of reasons for which wife beating is justified—relate to one another. The relationship is not clear, partly because the vast majority of women fall in the higher group since they participate in making 3-4 decisions. Eighty-six percent of women who participate in three to four household decisions disagree with all reasons justifying wife beating. This percentage is higher than for women who participate in two or fewer decisions (77 percent). Similarly, the more reasons a woman believes that wife beating is justifiable, the less likely she is to participate in all four household decisions. Almost four in five married women (78 percent) who do not support wife beating for any reason participate in all household decisions, compared with only 62 percent of those who think that wife beating is justified in all five situations. Table 15.8 Indicators of women's empowerment Percentage of women age 15-49 who participate in all decisionmaking and percentage who disagree with all reasons justifying wife beating, by value on each of the indicators of women's empowerment, Philippines 2008 Currently married women Empowerment indicator Percentage who participate in all decision- making1 Number of women Percentage who disagree with all the reasons justifying wife beating Number of women Number of decisions in which women participate1 0 na 92 84.5 92 1-2 na 599 77.4 599 3-4 na 7,726 85.7 7,726 Number of reasons for which wife beating is justified2 0 78.0 7,161 na 11,673 1-2 70.0 1,050 na 1,603 3-4 61.0 178 na 270 5 (62.4) 28 na 48 Note: Figures in parentheses are based on 25-49 unweighted cases 1 Restricted to currently married women. See Table 15.5 for the list of decisions. 2 See Table 15.6 for the list of reasons. na = Not applicable 198 │ Women’s Empowerment 15.8 CURRENT USE OF CONTRACEPTION BY WOMEN’S EMPOWERMENT A woman’s desire and ability to control her fertility and her choice of contraceptive method are affected in part by her status in the household and her own sense of empowerment. A woman who feels that she is unable to control her life may be less likely to feel that she can make and carry out decisions about her fertility. She may also feel the need to choose methods that are less obvious or which do not depend on her husband’s cooperation. Table 15.9 shows the distribution of currently married women age 15-49 by the contraceptive method they are currently using, if any, according to women’s empowerment indicators. Results show that married women who participate in more decisions and women who accept fewer justifications for wife beating are more likely to use contraception. Current use of any contraceptive method increases from 39 percent among women who do not participate in any decision to 51 percent among women who participate in 3-4 household decisions. In general, this pattern is consistent for most of the different types of contraceptive methods. For example, use of temporary modern methods increases from 17 percent among women who participate in less than three household decisions to 23 percent among women who participate in 3-4 decisions. Similarly, the fewer reasons women accept as justifying wife beating, the more likely they are to use a method of contraception. Table 15.9 Current use of contraception by women's status Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women's status, Philippines 2008 Modern methods Empowerment indicator Any method Any modern method Female sterili- zation Male sterili- zation Temporary modern female methods1 Male condom Any traditional method Not currently using Total Number of women Number of decisions in which women participate2 0 38.7 23.5 6.8 0.0 16.8 0.0 15.1 61.3 100.0 92 1-2 43.2 25.2 6.6 0.1 16.8 1.7 18.0 56.7 100.0 599 3-4 51.3 34.7 9.4 0.0 22.8 2.4 16.6 48.6 100.0 7,726 Number of reasons for which wife beating is justified3 0 51.0 34.2 9.4 0.0 22.4 2.4 16.8 48.8 100.0 7,161 1-2 48.8 31.7 7.8 0.1 21.9 1.9 17.2 51.1 100.0 1,050 3-4 44.7 32.8 10.9 0.0 20.9 1.0 11.9 55.3 100.0 178 5 (49.4) (44.0) (8.3) (0.0) (35.7) (0.0) (5.4) (50.6) 100.0 28 Total 50.6 33.9 9.2 0.0 22.4 2.3 16.7 49.3 100.0 8,418 Note: If more than one method is used, only the most effective method is considered in this tabulation. Numbers in parentheses are based on 25-49 unweighted cases. 1 Pill, IUD, injectables, implants, female condom, diaphragm, foam/jelly, and lactational amenorrhea method 2 See Table 15.5 for the list of decisions. 3 See Table 15.6 for the list of reasons. 15.9 IDEAL FAMILY SIZE AND UNMET NEED BY WOMEN’S EMPOWERMENT The ability of women to make decisions has important implications for their fertility preferences and whether or not they practice family planning. The more able a woman is to make decisions, the more empowered she is to negotiate decisions regarding her fertility and contraceptive use and thus her chances of becoming pregnant and giving birth. Women’s Empowerment | 199 Table 15.10 shows the relationship between women’s empowerment indicators and their ideal family size and unmet need for family planning. The results do not indicate a strong relationship between participation in decisionmaking and mean ideal number of children. Ideal family size is almost the same among women who do not participate in decisionmaking (3.3 children) and those who do (3.1 children). However, there is a relationship between ideal family size and attitudes towards wife beating. Women who believe that wife beating is justified for three to five reasons have higher ideal family size (3.5 to 3.6 children) than women who do not believe wife beating is justified for any reason (2.8 children). There is a positive association between participation in decisionmaking and unmet need for family planning. The findings show that women who participate in three to four decisions have the lowest unmet need for family planning. There is no clear relationship between unmet need and agreement with reasons justifying wife beating. Table 15.10 Women's empowerment and ideal number of children and unmet need for family planning Mean ideal number of children for women 15-49 and the percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women's empowerment, Philippines 2008 Percentage of currently married women with an unmet need for family planning2 Empowerment indicator Mean ideal number of children1 Number of women For spacing For limiting Total Number of women Number of decisions in which women participate3 0 3.3 91 16.3 11.7 28.0 92 1-2 3.1 591 12.6 16.4 28.9 599 3-4 3.1 7,671 8.6 13.2 21.8 7,726 Number of reasons for which wife beating is justified4 0 2.8 11,561 8.9 13.4 22.2 7,161 1-2 3.1 1,590 9.4 13.1 22.5 1,050 3-4 3.6 265 11.0 14.7 25.7 178 5 3.5 46 (8.3) (12.9) (21.2) 28 Total 2.8 13,462 9.0 13.4 22.3 8,418 Note: Numbers in parentheses are based on 25-49 unweighted cases. 1 Mean excludes respondents who gave non-numeric responses. 2 See Table 7.4 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 15.5 for the list of decisions. 4 See Table 15.6 for the list of reasons. 15.10 REPRODUCTIVE HEALTH CARE BY WOMEN’S EMPOWERMENT Table 15.11 examines whether access to antenatal, delivery, and postnatal care services from medically trained health professionals is related to women’s empowerment. In societies where health care is widespread, women’s empowerment may not affect their access to reproductive health services, however, increased empowerment of women is likely to increase their ability to seek out and use health services from qualified health providers to better meet their own reproductive health goals, including the goal of safe motherhood. The table is based on women who had a birth in the five years preceding the survey. 200 │ Women’s Empowerment The results show that women’s empowerment, as measured by participation in household decisionmaking, is not strongly related to whether they receive appropriate antenatal care or delivery assistance. However, utilization of postnatal care is related to women’s decisionmaking power; the proportion of women receiving timely postnatal care from a health professional increases from 45 percent among women who participate in none of the decisions to 53 percent among women who participate in 3-4 decisions. Similarly, there is no clear association between women’s attitudes toward wife beating and the likelihood that they received antenatal care or delivery assistance from health personnel. However, postnatal care seems to be related to attitudes towards wife beating: the proportion of women with a live birth in the five years preceding the survey who received postnatal care from a medically trained provider in the first two days after giving birth increases from 40 percent among women who believe wife beating is justified for 3-4 reasons to 55 percent among women who believe that wife beating is not justified for any reason. Table 15.11 Reproductive health care by women's empowerment Percentage of women age 15-49 with a live birth in the five years preceding the survey who received antenatal care, delivery assistance, and postnatal care from health personnel for the most recent birth, by indicators of women's empowerment, Philippines 2008 Empowerment indicator Received antenatal care from health personnel Received delivery assistance from health personnel Received postnatal care from health personnel within the first two days after delivery1 Number of women with a live birth in the past five years Number of decisions in which women participate2 0 93.8 100.0 44.6 53 1-2 95.6 97.9 50.4 329 3-4 96.3 98.9 53.1 3,897 Number of reasons for which wife beating is justified3 0 96.2 98.9 55.0 3,862 1-2 95.7 98.2 41.9 610 3-4 93.6 99.6 40.0 99 5 * * * 19 Total 96.1 98.8 53.0 4,590 Note: Health personnel include doctor, nurse or midwife. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes deliveries in a health facility and deliveries not in a health facility 2 Restricted to currently married women. See Table 15.5 for the list of decisions. 3 See Table 15.6 for the list of reasons. Violence Against Women | 201 VIOLENCE AGAINST WOMEN 16 16.1 INTRODUCTION The World Health Organization defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation” (Krug et al., 2002). Violence can be self-directed, such as suicidal behavior; interpersonal, such as family or intimate partner violence or violence between individuals who are not related; or collective, including violence by states or organized groups of people. Furthermore, the nature of violent acts may be physical, sexual, emotional, economic, or may involve neglect or deprivation. Intimate partner violence, often called domestic violence, is one of the most common forms of violence experienced by women. A special study of violence against women prepared for the Secretary General of the United Nations reaffirms that all forms of violence against women, including domestic violence, is a violation of human rights, and that “violence against women stops them from fulfilling their potential, restricts economic growth and undermines development.” (United Nations, 2006). Further, an increasing body of research is highlighting the health burdens, intergenerational effects, and demographic consequences of such violence for women and children (Heise et al., 1999; Kishor and Johnson, 2004). In 2004, the Philippines passed Republic Act 9262, the Anti-Violence Against Women and Their Children Act. Under the law, violence against women is not limited to physical harm, but extends to emotional and psychological injuries and also addresses discrimination in work places. A significant feature of the act is the involvement of the citizenry in addressing domestic violence (Philippine Star, 2009). The 2008 NDHS included a separate questionnaire (Women’s Safety Questionnaire) that focuses on specific aspects of violence within this broad realm. This was the first time that questions on violence against women have been included in an NDHS survey in the Philippines. The questionnaire addresses women’s experience of interpersonal violence, including acts of physical, sexual and emotional violence. Information was collected on both domestic violence (spousal violence) and violence by other family members or unrelated individuals. Specifically, this chapter presents the prevalence among women of interpersonal violence (physical violence since the age of 15 and lifetime experience of sexual violence), and, among ever-married women, the prevalence of spousal violence ever, and in the past 12 months. In addition, detailed information is presented on the types and consequences of spousal violence for women who have experienced such violence. 16.2 MEASUREMENT OF VIOLENCE Collecting valid, reliable, and ethical information on violence poses particular challenges because: a) what constitutes violence or abuse varies across cultures and individuals; b) a culture of silence surrounds domestic violence that can affect reporting; and c) the sensitivity of the topic, concerns for the safety of respondents and interviewers when asking about domestic violence in a familial setting, and the protection of women who disclose violence, all raise specific ethical concerns. The responses by the 2008 NDHS to these challenges are described below. 202 | Violence Against Women International research on violence shows that intimate partner violence is one of the most common forms of violence against women. Thus, spousal violence was measured in more detail than violence by other perpetrators by using a greatly shortened and modified Conflict Tactics Scale (CTS) (Straus, 1990). Specifically, partner-related violence was measured using the following set of questions for women: Does/Did your (last) husband/partner/boyfriend ever do any of the following things to you: a) Push you, shake you, or throw something at you? b) Slap you? c) Twist your arm or pull your hair? d) Punch or hit you with something that could hurt you? e) Kick you, drag you, or beat you up? f) Try to choke you or burn you on purpose? g) Threaten or attack you with a knife, gun, or any other weapon? h) Physically force you to have sexual intercoursewith him even when you did not want to? i) Force you to perform any other sexual acts you did not want to? j) Try or attempt to force you to have sexual intercourse with him or perform any other sexual acts against your will? k) Persuade or threaten you to have sexual intercourse with him or perform any other sexual acts against your will? The questions were asked with reference to the current husband for women currently married, the last husband for women who were separated, widowed, or divorced, and for any boyfriend or dating partner for women who had never been married.1 In cases when the answer was “yes,” women were asked about the frequency of the act in the 12 months preceding the survey. A “yes” answer to one or more of items (a) to (g) constitutes evidence of physical violence, while a “yes” answer to items (h) to (k) constitutes evidence of sexual violence. Prevalence of other forms of violence, including emotional and economic violence, was measured in a similar way. Respondents were asked: Does/Did your (last) husband/partner/boyfriend ever: a) Say or do something to humiliate you in front of others? b) Threaten to hurt or harm you or himself or someone close to you? c) Insult you or make you feel bad about yourself? d) Not allow you to engage in any legitimate work nor practice your profession? e) Control your own money or properties or force you to work? f) Destroy your personal properties, pets or belongings, or threaten or actually harm your pets? g) Have other intimate relationships? 1 Typically in a DHS survey, questions on intimate partner violence are asked in relation to marital and co-habiting partners. In the Philippines, the questions were broadened to include questions for never-married women about violence by boyfriends. Nevertheless, for comparability, the tables and discussion regarding intimate partner violence in this chapter have been restricted to violence by women’s husbands or live-in partners. Violence Against Women | 203 This approach of asking separately about specific acts has the advantage of not being affected by different understandings of what constitutes violence. A woman has to say whether she has, for example, ever been slapped, not whether she has ever experienced any violence. All women would probably agree on what constitutes a slap, but what constitutes a violent act or is understood as violence may vary across women as it does across cultures. In fact, summary terms such as “abuse” or “violence” were avoided in the title, design, or implementation of the Women’s Safety Questionnaire. Further, this approach has the advantage of giving the respondent multiple opportunities to disclose any experience of violence and, if the different violent acts included in the list are chosen carefully, also allows the assessment of the severity of violence. In addition to partner violence, women were asked whether they had experienced violence at the hands of anyone other than their current or last husband or boyfriend: “From the time you were 15 years old, has anyone other than your (current/last) husband/boyfriend hit, slapped, kicked, or done anything else to hurt you physically?” Women who responded “yes” to this question were asked who had done this and the frequency of such violence during the 12 months preceding the survey. Finally, all women were also asked: At any time in your life, as a child or as an adult, has any one ever forced you in any way to have sexual intercourse or perform any other sexual acts against your will? Respondents who said “yes” were then asked questions about the age at which this first happened and the person who committed the act. In addition to questions about their experience of violence, women were asked whether they had ever hit, slapped, kicked, or done anything else to physically hurt their husband or partner at any time when he was not already beating or physically hurting them. They were further asked whether their husband/partner drinks alcohol or takes illegal drugs, both of which are known risk factors for women’s experience of intimate partner violence. Although this approach to questioning is widely considered to be optimal, the possibility of some underreporting of violence cannot be entirely ruled out in any survey. Caution should be used in interpreting not only the overall prevalence of violence information, but also differentials in prevalence between subgroups of the population. Although much of any large difference in violence between subgroups undoubtedly reflects actual differences in prevalence, differential underreporting by women in the subgroups can contribute to larger or smaller differences. There is a culture of silence surrounding gender-based violence that makes collection of information on this sensitive topic particularly challenging. Even women who want to speak about their experiences of domestic violence may find it difficult because of feelings of shame or fear. The need to establish rapport with the respondent and to ensure confidentiality and privacy during the interview is important throughout the survey, but especially critical to ensure the validity of the information on domestic violence. Complete privacy is also essential for ensuring the security of the respondent and the interviewer. Asking about or reporting violence, especially in households where the perpetrator may be present at the time of interview, carries the risk of further violence. Three specific protections were built into the questionnaire, in accordance with the World Health Organization’s ethical and safety recommendations for research on domestic violence (WHO, 2001): a) Only one eligible woman in each household was administered the Women’s Safety Questionnaire. In households with more than one eligible woman, the respondent to be asked the questions on violence was randomly selected through a specially designed simple selection procedure (based on the “Kish Grid”) which was built into the Household Questionnaire (see Appendix E). Interviewing only one woman with the violence module in 204 | Violence Against Women each household provides assurance to the selected respondent that other respondents in the household will not know the types of questions the selected woman was asked. b) Informed consent was obtained from the woman for the survey at the start of the individual interview. In addition, at the start of the Women’s Safety Questionnaire, woman were read an additional statement informing them the proceeding questions could be sensitive and reassuring them of the confidentiality of their responses. c) The questionnaire on women’s safety was implemented only if privacy could be obtained. If privacy could not be obtained, the interviewer was instructed to skip the module, thank the respondent, and end the interview. 16.3 EXPERIENCE OF VIOLENCE BY WOMEN AGE 15-49 This section of the chapter discusses women’s experience of violence by any individual. It begins by examining experience of physical violence since age 15 and physical violence during pregnancy, then presents results on lifetime experience of sexual violence. It concludes with a summary of these types of violence. 16.3.1 Physical Violence Since Age 15 Table 16.1 shows the distribution of women who have experienced physical violence since age 15 (ever, and in the past 12 months), by background characteristics. One in five women (20 percent) experienced violence since the age of 15, and 7 percent experienced violence in the 12 months preceding the survey. The social and economic background of a woman has a bearing on her chances of experiencing domestic violence. The percentage of women who have ever experienced violence is lower for women age 15-19 (15 percent) than for older women (20-22 percent). The survey results suggest that domestic violence may contribute to separation and divorce. Over one-third (37 percent) of divorced, separated or widowed women report having experienced physical violence since age 15, compared with 22 percent of married women and 11 percent of those who have never been married. The more children a woman has, the more likely she is to have experienced violence. There are differentials in levels of violence by region. Women in SOCCSKSARGEN are most likely to have experienced violence since age 15 (35 percent), followed by women in Central Visayas and Northern Mindanao (28 percent); women in CALABARZON region are least likely to have experienced violence (13 percent). Experience of violence varies with education level; women who have at least some high school education, and especially those who have been to college, are less likely to have experienced violence than those who have either no education or only elementary school education. There is a strong negative relationship between prevalence of physical violence and the wealth quintile. Violence Against Women | 205 Table 16.1 Experience of physical violence Percentage of women age 15-49 who have ever experienced physical violence since age 15 and percentage who experienced physical violence during the 12 months preceding the survey, by background characteristics, Philippines 2008 Percentage who experienced physical violence in the past 12 months Background characteristic Percentage who have ever experienced physical violence since age 151 Often Sometimes Often or sometimes Number of women Current age 15-19 15.1 0.8 7.5 8.3 1,410 20-24 19.9 1.2 7.1 8.3 1,352 25-29 21.4 0.8 7.8 8.6 1,593 30-39 20.7 0.9 6.3 7.2 2,957 40-49 21.8 0.4 4.6 5.0 2,004 Employed last 12 months Not employed 18.2 0.8 6.4 7.2 4,032 Employed for cash 21.4 0.8 6.4 7.2 4,900 Employed not for cash 22.4 1.0 7.7 8.6 367 Marital status Never married 11.3 0.5 4.6 5.1 2,384 Married or living together 22.3 0.8 7.1 8.0 6,522 Divorced/separated/widowed 36.5 2.6 7.0 9.6 410 Number of living children 0 12.5 0.6 4.8 5.4 2,829 1-2 21.3 0.9 7.1 8.0 3,097 3-4 24.4 1.1 6.7 7.8 2,192 5+ 27.0 0.6 8.4 9.0 1,198 Residence Urban 18.9 0.9 6.4 7.2 5,215 Rural 21.6 0.8 6.6 7.4 4,101 Region National Capital Region 16.2 1.0 6.4 7.4 1,718 Cordillera Admin Region 16.4 0.8 6.4 7.2 157 I - Ilocos 18.7 0.5 5.1 5.5 423 II - Cagayan Valley 16.7 0.3 4.9 5.2 258 III - Central Luzon 16.5 0.2 4.8 5.0 1,025 IVA - CALABARZON 12.7 0.4 4.7 5.2 1,249 IVB - MIMAROPA 26.7 1.4 10.8 12.2 236 V - Bicol 18.6 0.5 4.1 4.5 509 VI - Western Visayas 21.6 0.7 5.9 6.6 670 VII - Central Visayas 28.1 1.2 9.1 10.3 668 VIII - Eastern Visayas 24.2 1.2 5.0 6.2 341 IX - Zamboanga Peninsula 21.3 1.2 7.9 9.2 347 X - Northern Mindanao 27.8 1.5 9.1 10.6 405 XI - Davao 25.4 1.6 8.7 10.3 427 XII - SOCCSKSARGEN 34.7 1.4 9.0 10.5 314 XIII - Caraga 27.2 1.2 9.3 10.6 216 ARMM 23.2 0.2 7.9 8.1 354 Education No education 26.3 1.6 11.3 12.9 113 Elementary 26.7 1.2 8.0 9.1 1,856 High school 21.7 1.0 7.6 8.6 4,323 College 13.5 0.3 3.8 4.1 3,024 Wealth quintile Lowest 28.5 1.4 8.6 10.1 1,609 Second 25.8 0.6 9.1 9.7 1,727 Middle 19.8 0.8 6.8 7.5 1,861 Fourth 17.3 0.4 5.6 6.1 2,002 Highest 11.9 0.9 3.2 4.2 2,117 Total 20.1 0.8 6.5 7.3 9,316 Note: Total includes 17 women with information missing on employment status. 1 Includes physical violence in the past 12 months 206 | Violence Against Women Table 16.2 shows that for women who have ever been married, the main perpetrators of physical violence are husbands and, to a lesser extent, mothers or stepmothers, fathers or stepfathers, and other relatives. Among never-married women who have experienced physical violence, the main perpetrators are mothers or stepmothers, fathers or stepfathers, sisters or brothers, and boyfriends. Table 16.2 Persons committing physical violence Among women age 15-49 who have experienced physical violence since age 15, percentage who reported specific persons who committed the violence, by marital status, Philippines 2008 Marital status Person committing violence Ever married Never married Total Current husband 54.7 na 46.8 Former husband 12.1 na 10.3 Current boyfriend 0.3 19.8 3.1 Former boyfriend 0.6 0.6 0.6 Father/step-father 16.6 25.9 17.9 Mother/step-mother 18.5 34.5 20.8 Sister/brother 9.3 21.0 11.0 Daughter/son 0.9 0.0 0.8 Other relative 11.6 9.6 11.3 Mother-in-law 0.2 na 0.2 Father-in-law 0.1 na 0.1 Other in-law 1.2 na 1.0 Teacher 0.0 0.3 0.0 Employer/someone at work 0.8 0.8 0.8 Other 1.1 0.4 1.0 Number of women 1,601 269 1,870 na = Not applicable Pregnancy places women in a more vulnerable state. Moreover, violence affects not only the woman herself, but also her unborn baby. In the NDHS, women who had ever been pregnant were asked about experience of physical violence during pregnancy. The findings presented in Table 16.3 indicate that overall, 4 percent of women in the Philippines experience physical violence while pregnant. The proportion of women who have experienced violence during pregnancy declines with age from 6 percent of women age 15-19 to 3 percent for women in their 30s and 40s. Differences by other background characteristics are minor. For example, the likelihood of having experienced violence during pregnancy increases only slightly with the number of living children, despite the fact that women with more children have had greater exposure to the risk of violence during pregnancy. However, marital status and region do appear to be associated with the risk of physical violence during pregnancy. Only 3 percent of never- married and currently married women who have ever been pregnant were physically abused during pregnancy, compared with 8 percent of women who were formerly married. By region, experience of violence during pregnancy ranges from only 1 percent among women in ARMM to 7 percent of those in Eastern Visayas and Caraga regions. The likelihood of experiencing physical violence during pregnancy declines steadily as wealth quintile increases. Violence Against Women | 207 Table 16.3 Violence during pregnancy Among women age 15-49 who have ever been pregnant, percentage who have ever experienced physical violence during pregnancy, by background characteristics, Philippines 2008 Background characteristic Percentage who have ever experienced physical violence during pregnancy Number of women who have ever been pregnant Current age 15-19 5.8 174 20-24 4.4 734 25-29 4.1 1,274 30-39 3.4 2,660 40-49 3.1 1,819 Marital status Never married 2.5 111 Married or living together 3.3 6,160 Divorced/separated/widowed 8.2 390 Number of living children 0 3.3 174 1-2 3.1 3,097 3-4 3.8 2,192 5+ 4.7 1,198 Residence Urban 3.7 3,548 Rural 3.5 3,113 Region National Capital Region 3.1 1,109 Cordillera Admin Region 3.9 110 I - Ilocos 3.7 326 II - Cagayan Valley 2.9 205 III - Central Luzon 2.0 716 IVA - CALABARZON 3.1 859 IVB - MIMAROPA 6.3 184 V - Bicol 2.5 368 VI - Western Visayas 4.4 492 VII - Central Visayas 5.0 471 VIII - Eastern Visayas 7.3 263 IX - Zamboanga Peninsula 3.3 267 X - Northern Mindanao 3.6 285 XI - Davao 4.7 332 XII - SOCCSKSARGEN 3.5 246 XIII - Caraga 6.7 164 ARMM 1.3 263 Education No education 2.2 101 Elementary 5.4 1,564 High school 3.9 3,057 College 1.7 1,938 Wealth quintile Lowest 5.2 1,343 Second 4.1 1,362 Middle 3.8 1,385 Fourth 2.9 1,370 Highest 1.8 1,201 Total 3.6 6,661 16.3.2 Sexual Violence Since Age 15 The 2008 NDHS investigated women’s experience of sexual violence, including whether the respondent’s first sexual intercourse was forced against her will. Force at first sexual intercourse is not widespread among Filipino women; nevertheless, 4 percent of women age 15-49 report that their first sexual intercourse was forced against their will (Table 16.4). 208 | Violence Against Women Table 16.4 Force at sexual initiation Among women age 15-49 who have ever had sexual intercourse, the percentage who said that their first experience of sexual intercourse was forced against their will, by age at first sexual intercourse and whether first sexual intercourse was at the time of first marriage or before, Philippines 2008 Age/timing of first sex Percentage whose first sexual intercourse was forced against their will Number of women who have ever had sexual intercourse Age at first sexual intercourse <15 14.7 239 15-19 5.1 3,032 20-24 3.3 2,547 25-29 1.4 964 30-49 0.8 323 First sexual intercourse was: At the time of first marriage/ first cohabitation 3.0 5,046 Before first marriage/first cohabitation1 6.7 2,059 Total 4.1 7,208 Note: Total includes 102 women with information missing on age and timing of first sexual intercourse 1 Includes never-married women In addition to the question on whether first sexual intercourse was forced, the 2008 NDHS included two sets of questions on sexual violence. The first set of questions asked women about sexual violence committed by their current husband or partner, if they were currently married, and by their most recent husband or partner, if they were currently divorced, separated, or widowed. The second set asked all respondents whether they had ever, as a child or as an adult, experienced sexual violence. Sexual violence here includes being forced to have sexual intercourse or perform any other sexual acts against one’s will. Tables 16.5 and 16.6 present the results on experience of any sexual violence. The subset of results on sexual violence committed by the husband or partner is explored later in the chapter. As shown in Table 16.5, 9 percent of women age 15-49 have ever experienced sexual violence. Women age 15-19 are least likely to have experienced sexual violence. Women who are employed, but are not paid in cash, those who are divorced, separated, or widowed, and those who live in rural areas are more likely than other women to have experienced sexual violence. By region, the proportion of women who have experienced sexual violence ranges from 3 percent in CALABARZON to almost six times that—18 percent—in MIMAROPA, SOCCSKSARGEN, and Caraga regions. The likelihood of experi- encing sexual violence decreases with increasing educational attainment and household wealth status. Violence Against Women | 209 Table 16.5 Experience of sexual violence Percentage of women age 15-49 who have ever experienced sexual violence, by background characteristics, Philippines 2008 Background characteristic Percentage who have ever experienced sexual violence1 Number of women Current age 15-19 5.1 1,410 20-24 8.3 1,352 25-29 9.7 1,593 30-39 10.1 2,957 40-49 8.7 2,004 Employed last 12 months Not employed 6.9 4,032 Employed for cash 9.9 4,900 Employed not for cash 12.6 367 Marital status Never married 4.3 2,384 Married or living together 9.6 6,522 Divorced/separated/widowed 19.7 410 Residence Urban 7.1 5,215 Rural 10.7 4,101 Region National Capital Region 5.6 1,718 Cordillera Admin Region 6.0 157 I - Ilocos 7.7 423 II - Cagayan Valley 10.8 258 III - Central Luzon 4.2 1,025 IVA - CALABARZON 3.2 1,249 IVB - MIMAROPA 17.8 236 V - Bicol 8.6 509 VI - Western Visayas 9.0 670 VII - Central Visayas 12.4 668 VIII - Eastern Visayas 13.7 341 IX - Zamboanga Peninsula 11.8 347 X - Northern Mindanao 11.7 405 XI - Davao 16.2 427 XII - SOCCSKSARGEN 18.0 314 XIII - Caraga 18.0 216 ARMM 8.8 354 Education No education 14.5 113 Elementary 11.9 1,856 High school 9.1 4,323 College 6.0 3,024 Wealth quintile Lowest 13.9 1,609 Second 11.9 1,727 Middle 8.8 1,861 Fourth 5.6 2,002 Highest 4.9 2,117 Total 8.7 9,316 Note: Total includes 17 women with information missing on employment status. 1 Includes women whose sexual initiation was forced against their will 210 | Violence Against Women Table 16.6 shows the perpetrators of sexual violence for women who have experienced such vio- lence, according to marital status. Overall, 53 percent of women who have experienced sexual violence expe- rienced this violence at the hands of a current husband or partner, while 13 percent experienced sexual vio- lence by a former husband or partner. Other perpe- trators of sexual violence reported by women are cur- rent or former boyfriend (11 percent), a friend or acquaintance (3 percent), or other relative (2 percent). Among ever-married women, the main perpetrators of sexual violence are current husbands (61 percent) or former husbands (15 percent), while among never- married women, the main perpetrators are current or former boyfriends (58 percent). 16.3.3 Experience of Physical or Sexual Violence Since Age 15 Table 16.7 shows the percentages of women who have experienced different combinations of physi- cal and sexual violence, by age. Overall, almost one in four (24 percent) women age 15-49 have experienced either physical or sexual violence. Specifically, 15 percent of women have experienced only physical violence, 4 percent have experienced only sexual violence, and 5 percent have experienced both physical and sexual violence. Table 16.7 Experience of different forms of violence Percentage of women age 15-49 who have experienced various forms of physical and sexual violence, by current age, Philippines 2008 Age Physical violence Sexual violence1 Physical and sexual violence1 Physical or sexual violence1 Number of women 15-19 12.1 2.1 3.0 17.2 1,410 15-17 11.3 1.4 1.5 14.2 829 18-19 13.3 3.0 5.2 21.5 581 20-24 15.3 3.7 4.6 23.5 1,352 25-29 15.9 4.2 5.5 25.6 1,593 30-39 14.8 4.2 5.9 24.9 2,957 40-49 16.1 2.9 5.7 24.7 2,004 Total 14.9 3.5 5.2 23.6 9,316 1 Includes forced sexual initiation Table 16.6 Persons committing sexual violence Among women age 15-49 who have experienced sexual violence, percentage who reported specific persons who committed the violence, by current marital status, Philippines 2008 Marital status Person committing violence Ever married Never married Total Current husband /partner 60.5 na 52.9 Former husband /partner 15.2 na 13.3 Current /former boyfriend 4.4 57.7 11.1 Father 0.1 0.0 0.1 Step father 0.5 1.8 0.7 Other relative 2.4 1.9 2.4 In-law 0.0 0.8 0.1 Own friend /acquaintance 1.8 10.2 2.8 Family friend 0.4 1.4 0.6 Employer /someone at work 1.5 0.0 1.3 Police /soldier 0.1 0.0 0.1 Priest /religious leader 0.1 0.0 0.1 Stranger 1.0 5.7 1.6 Missing 7.0 5.5 6.8 Other 3.7 12.5 4.8 Number of women 708 102 810 na = Not applicable Violence Against Women | 211 16.4 MEASURES OF MARITAL CONTROL Certain male behaviors meant to keep tight control over women, particularly wives, have been identified in the literature as risk factors for violence (Kishor and Johnson, 2004). Accordingly, women interviewed in the 2008 NDHS were also asked about various ways in which their husbands try to control their actions. Specifically, ever-married women were asked if their husband: a) Is jealous or angry if she communicates with other men; b) Frequently accuses her of being unfaithful; c) Does not permit her to see her female friends; d) Tries to limit her contact with her family; e) Insists on knowing where she is at all times; and f) Does not trust her with his money. As shown in Table 16.8, the most commonly reported controlling behavior exhibited by husbands is to be jealous or angry when the woman communicates with other men (reported by 30 percent of ever- married women). Almost one-fifth of women report that their husbands want to know where they are at all times (18 percent), while 13 percent of women say their husbands frequently accuse them of being unfaithful. Less common behaviors are not permitting her to meet her female friends (6 percent), not trusting her with his money (5 percent), and trying to limit her contact with her family (4 percent). One in ten ever-married women say their husbands display at least three of the six types of controlling behaviors, while 61 percent say their husbands do not display any of the behaviors. Older women are generally less likely than younger women to report most of the controlling behaviors by their husbands. Women who are divorced, separated, or widowed are more likely to report that their current or last husband displayed controlling behaviors than are women who are currently married. Similary, those who have been married more than once are more likely than those in their first marriage to say that their husbands try to control their actions. The proportion of women who report that their husbands show controlling behavior tends to decline with increasing education of the woman for most of the behaviors specified in the survey. 212 | Violence Against Women Table 16.8 Degree of marital control exercised by husbands Percentage of ever-married women age 15-49 whose husbands have ever exhibited specific types of controlling behaviors, by background characteristics, Philippines 2008 Percentage of women whose husband: Background characteristic Is jealous or angry if she talks to other men Frequently accuses her of being unfaithful Does not permit her to meet her female friends Tries to limit her contact with her family Insists on knowing where she is at all times Does not trust her with any money Displays 3 or more of the specific behaviors Displays none of the specific behaviors Number of women Current age 15-19 44.5 15.7 8.9 3.7 25.0 3.7 13.6 48.6 204 20-24 35.2 12.0 6.9 4.7 20.8 4.8 9.5 55.1 773 25-29 32.3 14.6 7.4 3.6 18.6 5.5 11.0 58.4 1,322 30-39 29.7 11.7 5.4 3.8 17.4 4.8 9.6 62.3 2,737 40-49 26.2 12.4 5.1 4.3 15.8 4.2 8.9 65.6 1,896 Employed past 12 months Not employed 30.1 11.1 5.7 3.4 17.3 4.6 8.9 62.1 2,801 Employed for cash 30.6 13.2 6.0 4.4 17.9 4.9 10.2 60.7 3,822 Employed not for cash 28.6 18.7 7.3 5.3 20.7 5.3 12.5 60.9 307 Number of living children 0 33.0 10.2 5.9 4.6 20.8 4.4 8.3 57.9 548 1-2 29.7 11.2 5.8 3.6 16.6 4.4 8.9 62.4 2,995 3-4 29.8 13.0 5.9 4.0 17.5 5.3 9.8 61.2 2,191 5+ 31.6 16.4 6.5 4.8 20.2 5.0 12.6 60.1 1,198 Marital status and duration Currently married woman 29.6 11.8 5.5 3.7 17.2 4.4 9.0 62.2 6,522 Married only once 28.7 11.3 5.2 3.6 16.7 4.3 8.6 63.0 5,871 0-4 years 31.5 10.8 6.7 4.0 17.5 3.9 9.5 60.2 1,282 5-9 years 27.7 10.5 4.7 3.2 15.8 4.1 7.3 63.9 1,428 10+ years 28.1 11.9 4.9 3.6 16.7 4.4 8.7 63.8 3,162 Married more than once 37.1 15.9 8.2 4.6 22.1 5.4 13.2 54.7 651 Divorced/separated/widowed 42.0 25.8 12.3 9.4 27.7 11.0 21.8 46.6 410 Residence Urban 30.4 12.0 6.4 4.2 16.8 4.4 9.5 62.0 3,692 Rural 30.3 13.3 5.5 3.8 18.9 5.2 10.1 60.4 3,240 Region National Capital Region 32.0 11.9 5.7 3.9 15.2 3.8 9.2 60.7 1,161 Cordillera Admin Region 19.6 12.4 5.5 4.4 13.6 5.8 8.9 73.7 113 I - Ilocos 27.4 12.6 4.8 2.4 17.3 4.9 9.7 66.1 340 II - Cagayan Valley 16.3 9.3 5.7 2.6 11.2 4.2 7.0 75.8 213 III - Central Luzon 25.6 8.5 3.8 3.8 12.8 3.4 7.2 67.9 748 IVA - CALABARZON 23.5 6.0 3.1 2.3 12.9 2.3 5.1 73.9 892 IVB - MIMAROPA 28.6 15.1 4.2 6.3 23.5 4.5 11.0 60.7 192 V - Bicol 26.4 12.2 3.7 3.5 11.4 4.7 7.1 66.6 385 VI - Western Visayas 37.5 14.0 5.7 5.4 20.2 3.7 9.3 53.4 510 VII - Central Visayas 40.7 23.8 11.3 7.3 20.2 8.3 17.3 49.2 495 VIII - Eastern Visayas 31.7 15.9 7.8 4.9 24.6 4.6 14.1 56.3 270 IX - Zamboanga Peninsula 35.9 12.1 6.3 4.1 28.3 6.2 10.4 50.6 274 X - Northern Mindanao 32.1 16.3 7.8 5.1 15.8 4.0 12.6 62.1 297 XI - Davao 29.8 15.3 11.3 4.1 17.0 6.0 13.0 59.8 337 XII - SOCCSKSARGEN 42.2 15.8 7.8 1.8 34.2 5.7 13.1 44.4 252 XIII - Caraga 37.6 22.6 9.2 7.8 23.8 9.2 17.2 49.7 169 ARMM 28.0 7.7 4.8 1.7 29.3 10.8 7.5 51.0 283 Education No education 34.9 15.4 6.0 3.3 26.0 5.8 15.5 54.5 104 Elementary 32.3 16.0 6.0 5.9 19.0 5.6 11.9 59.1 1,617 High school 32.3 13.0 6.7 3.8 19.1 5.0 10.5 58.9 3,166 College 25.5 9.1 4.8 2.8 14.6 3.7 6.7 67.0 2,044 Wealth quintile Lowest 32.6 16.7 6.1 5.6 23.4 6.1 12.3 55.7 1,392 Second 32.2 15.6 7.1 4.2 18.6 4.8 10.8 57.6 1,400 Middle 33.0 12.3 6.1 3.5 18.7 5.5 10.0 58.6 1,425 Fourth 28.4 10.2 5.5 3.8 16.1 4.3 8.6 65.2 1,441 Highest 24.9 7.9 4.8 2.9 11.9 3.0 7.0 69.9 1,273 Total 30.3 12.6 5.9 4.0 17.8 4.8 9.8 61.3 6,932 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. Total includes 2 women with information missing on employment status. Violence Against Women | 213 16.5 MARITAL VIOLENCE 16.5.1 Experience of Physical, Sexual, or Other Types of Violence Within Marriage Marital violence refers to violence perpetrated by partners in a marital union. Since spousal or intimate partner violence is the most common form of violence for women age 15-49, the 2008 NDHS collected detailed information on the different types of violence experienced. Currently married women were asked about violence perpetrated by their current husband, and formerly married women were asked about violence perpetrated by their most recent husband. Respondents were asked about seven specific acts of physical violence, four of sexual violence, and seven other forms of violence, including emotional violence. The acts are listed in Table 16.9. Note that the different types of violence are not mutually exclusive; therefore, women may report experiencing multiple forms of violence. Table 16.9 Forms of spousal violence Percentage of ever-married women age 15-49 who have experienced specific forms of violence committed by their husband (ever) and in the 12 months preceding the survey, Philippines, 2008 Experienced violence in the past 12 months1 Type of violence Ever experi- enced violence Often Sometimes Often or sometimes Physical violence Any 14.4 0.9 6.6 7.5 Pushed her, shook her, or threw something at her 8.2 0.6 3.9 4.5 Slapped her 8.5 0.5 3.4 3.9 Twisted her arm or pulled her hair 3.6 0.3 1.7 2.0 Punched her with his fist or with something that could hurt her 4.7 0.3 2.1 2.5 Kicked her, dragged her, or beat her up 3.3 0.4 1.4 1.8 Tried to choke her or burn her on purpose 2.0 0.3 0.7 1.0 Threatened her or attacked her with a knife, gun, or any other weapon 2.3 0.2 1.0 1.2 Sexual violence Any 8.0 0.8 4.2 4.9 Physically forced her to have sexual intercourse with him even when she did not want to 6.3 0.7 3.7 4.3 Forced her to perform any sexual acts she did not want to 2.2 0.3 1.3 1.6 Tried or attempted to force her to have sexual intercourse with him or perform any other sexual acts against her will 2.3 0.2 0.6 0.8 Persuaded or threatened her to have sexual intercourse with him or performed any other sexual acts against her will 1.6 0.2 0.6 0.9 Sexual initiation was with current or most recent husband and was forced2 1.8 na na na Other forms of violence Any 22.6 4.8 10.5 15.3 Said or did something to humiliate her in front of others 7.4 1.1 3.8 5.0 Threatened to hurt or harm her or someone close to her 6.5 0.9 3.2 4.1 Insulted her or made her feel bad about herself 10.9 1.6 6.0 7.6 Did not allow to engage in any legitimate work nor practice profession 8.9 0.6 1.5 2.1 Controlled her own money or properties or forced her to work 2.4 0.6 0.8 1.4 Destroyed her personal properties, pets or belongings, or threatened or actually harmed her pets 3.8 0.6 1.1 1.8 Had other intimate relationships 5.6 0.4 0.7 1.1 Any form of physical and/or sexual violence 17.9 1.4 8.9 10.3 Any form of physical and sexual violence 4.4 0.3 1.6 1.9 Any form of physical, sexual, and/or other form of violence 29.0 5.3 13.5 18.9 Any form of physical, sexual, and other form of violence 3.8 0.3 1.3 1.5 Number of ever-married women 6,932 6,783 6,783 6,783 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. 1 Excludes widows 2 Excludes women who have been married more than once since their sexual initiation could not have been with the current/most recent partner. na = Not applicable 214 | Violence Against Women According to Table 16.9, 14 percent of women have ever experienced physical violence at the hands of their husband, 8 percent have experienced sexual violence, and 23 percent have experienced other forms of violence. Overall, almost one-third of ever-married women (29 percent) have experienced any kind of violence (physical, sexual or other) by a husband or partner. Among the spousal acts of physical violence, slapping was the most commonly reported act, experienced by 9 percent of ever-married women, followed closely by being pushed, shaken or had something thrown at them—reported by 8 percent of women (Figure 16.1). Six percent of women report that they were forced to have sexual intercourse by their husbands when they did not want to, and 11 percent of women were insulted or made to feel bad about themselves. Six percent of women report that their husband had other intimate relationships. Table 16.10 shows the prevalence of different forms of violence experienced by ever-married women according to background characteristics. In general, the percentage of women who have experienced any of the different forms of violence tends to decline with women’s age but increase with women’s number of children. Women who are employed, particululary if they are employed without earning cash, are more likely than women who are not employed to experience spousal violence. Once again, the experience of spousal violence shows a strong relationship with marital status. Women who are divorced, separated, or widowed are by far the most likely to have experienced each type of violence. This finding suggests thatthe experience of violence may increase the likelihood of a relationship ending. Currently married women who have been married more than once are more likely than currently married women in their first marriage to have experienced physical, sexual, or other forms of violence by their current husbands. Figure 16.1 Forms of Spousal Violence 14 8 9 4 5 3 2 2 8 6 2 2 2 2 ANY PHYSICAL VIOLENCE Pushed, shook, or threw something at her Slapped her Twisted arm or pulled her hair Punched with fist or something that could hurt her Kicked, dragged, or beat her up Tried to choke or burn her on purpose Threatened or attacked with knife, gun, or other w ANY SEXUAL VIOLENCE Forced into sexual intercourse against will Forced into performing sexual acts against will Attempted to force her into sexual intercourse or Persuaded or threatened her to have sexual interco Sexual initiation with current or most recent husb 0 5 10 15 20 Percent NDHS 2008 Threatened with knife, gun, or other weapon Tried or attempted to force her into sexual intercourse or perform any other sexual acts against her will Persuaded or threatened to have sexual intercourse with himor performed any other sexual acts against her will Sexual initiation was with current or most recent husband and was forced Violence Against Women | 215 Table 16.10 Spousal violence by background characteristics Percentage of ever-married women age 15-49 who have ever experienced physical, sexual, or other forms of violence by their husband, according to background characteristics, Philippines, 2008 Background characteristic Physical violence Sexual violence Other violence Physical or sexual violence Physical, sexual, or other violence Number of women Current age 15-19 17.5 11.0 24.9 21.6 30.5 204 20-24 15.6 8.0 24.6 19.2 32.7 773 25-29 14.7 8.0 22.6 19.0 30.1 1,322 30-39 13.6 8.2 22.0 17.3 28.0 2,737 40-49 14.3 7.3 22.4 17.2 27.8 1,896 Employed past 12 months Not employed 13.2 7.1 20.4 16.8 27.3 2,801 Employed for cash 15.1 8.4 24.0 18.4 29.7 3,822 Employed not for cash 16.3 10.3 25.6 22.4 34.6 307 Number of living children 0 7.9 5.0 18.6 9.9 21.8 548 1-2 12.9 7.0 22.2 16.4 27.8 2,995 3-4 15.5 9.2 22.6 19.5 30.3 2,191 5+ 18.8 9.5 25.7 22.4 32.8 1,198 Marital status and duration Currently married woman 13.4 7.4 21.2 16.9 27.5 6,522 Married only once 13.0 7.4 20.6 16.7 27.0 5,871 0-4 years 10.7 6.4 20.0 14.3 25.3 1,282 5-9 years 13.2 7.0 19.5 16.8 27.1 1,428 10+ years 13.9 8.0 21.4 17.7 27.6 3,162 Married more than once 16.2 7.9 27.0 18.6 32.4 651 Divorced/separated/widowed 30.0 16.7 44.6 33.9 52.1 410 Residence Urban 14.6 6.8 21.9 17.4 28.2 3,692 Rural 14.1 9.4 23.4 18.5 29.9 3,240 Region National Capital Region 12.9 5.8 18.5 15.1 24.3 1,161 Cordillera Admin Region 11.7 6.4 14.6 15.0 20.0 113 I - Ilocos 16.9 8.3 17.8 19.0 24.5 340 II - Cagayan Valley 14.2 11.4 22.1 19.0 27.0 213 III - Central Luzon 12.0 3.9 19.1 13.9 25.2 748 IVA - CALABARZON 10.4 2.4 13.8 11.0 18.2 892 IVB - MIMAROPA 22.0 17.1 29.9 28.8 39.6 192 V - Bicol 13.3 8.5 19.2 18.1 27.4 385 VI - Western Visayas 14.0 8.7 20.5 18.4 27.2 510 VII - Central Visayas 23.8 9.0 37.7 26.7 43.5 495 VIII - Eastern Visayas 17.4 12.6 30.3 23.4 38.3 270 IX - Zamboanga Peninsula 13.5 7.6 27.8 16.7 32.1 274 X - Northern Mindanao 13.6 10.2 30.4 18.6 36.0 297 XI - Davao 17.7 12.3 31.9 23.4 39.3 337 XII - SOCCSKSARGEN 16.7 17.2 34.3 26.1 43.8 252 XIII - Caraga 20.9 14.8 43.2 27.3 48.0 169 ARMM 6.1 9.3 8.8 13.2 18.6 283 Education No education 13.6 13.0 16.6 19.8 24.8 104 Elementary 17.9 9.9 25.2 21.3 32.7 1,617 High school 16.1 8.6 25.1 20.2 32.2 3,166 College 8.9 5.2 17.1 11.7 21.2 2,044 Wealth quintile Lowest 17.8 11.6 26.2 22.7 34.1 1,392 Second 17.0 10.6 25.7 22.4 34.0 1,400 Middle 15.7 7.7 24.6 19.5 31.5 1,425 Fourth 12.0 4.9 20.1 13.8 25.2 1,441 Highest 8.9 4.9 16.0 10.7 19.1 1,273 Respondent's father beat her mother Yes 23.2 13.4 32.1 28.1 41.9 1,224 No 12.3 6.8 20.4 15.5 25.9 5,524 Does not know 18.0 8.4 27.6 22.8 33.6 184 Total 14.4 8.0 22.6 17.9 29.0 6,932 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. Total includes 2 women with information missing on employment status. 216 | Violence Against Women Women in Caraga region are most likely to have experienced physical, sexual, or other forms of violence by their husbands (48 percent), followed by women in Central Visayas and SOCCSKSARGEN (44 percent each). Women in CALABARZON (18 percent) and ARMM (19 percent) regions are least likely to have experienced any type of spousal violence. Women who have attended college are least likely to have suffered each type of violence at the hands of their husband. Differences in spousal violence by wealth quintile are quite apparent; 34 percent of women in the lowest wealth quintile have experienced physical, sexual, or other types of violence, comared with 19 percent of women in the highest wealth quintile. Table 16.10 also shows that women whose fathers beat their mothers are almost twice as likely to experience physical or sexual violence as women whose fathers did not beat their mothers. Table 16.11 shows similar information about spousal violence according to characteristics of the husband and indicators of women’s empowerment. Excluding the small number of women whose husbands have no education, spousal violence tends to decline as the husband’s education increases. The husband’s alcohol consumption and, particularly, how often he gets drunk are associated with spousal violence. There is little difference in the level of spousal violence between women who say their husbands do not drink at all and those who say their husbands drink but do not get drunk. However, there is a sharp increase in all three types of violence for those who say their husbands get drunk sometimes and especially for those who say their husbands get drunk very often. For example, 63 percent of women whose husbands get drunk very often have experienced physical, sexual, or other types of violence, compared with 29 percent of those whose husbands get drunk sometimes, 23 percent of those whose husbands drink but do not get drunk, and 21 percent of those whose husbands do not drink. The number of marital control behaviors displayed by the husband is also highly associated with the prevalence of violence. The more controlling behaviors displayed by the husband, the greater the likelihood of the wife experiencing spousal violence. Violence Against Women | 217 Table 16.11 Spousal violence by husband's characteristics and empowerment indicators Percentage of ever-married women age 15-49 who have ever experienced physical, sexual, or other forms of violence, by husband’s characteristics and empowerment indicators, Philippines, 2008 Husband’s characteristics/ empowerment indicators Physical violence Sexual violence Other violence Physical or sexual violence Physical, sexual, or other violence Number of women Husband's education No education 17.6 12.4 20.5 22.2 31.7 110 Elementary 18.3 10.6 25.9 22.8 33.7 1,931 High school 15.5 7.9 23.6 19.1 30.2 2,773 College 9.0 5.4 18.3 11.6 22.6 2,096 Husband's alcohol consumption Does not drink 7.7 4.7 15.6 10.6 20.7 1,504 Drinks/never gets drunk 7.5 4.7 18.0 10.5 22.6 693 Gets drunk sometimes 14.0 7.5 21.8 17.7 28.6 4,166 Gets drunk very often 44.0 25.1 54.3 48.9 62.7 546 Spousal age difference1 Wife older 12.0 6.6 20.5 15.4 26.0 1,278 Wife is same age 13.7 6.1 22.5 16.5 27.7 620 Wife's 1-4 years younger 13.1 7.6 20.1 16.7 26.9 2,439 Wife's 5-9 years younger 14.3 8.5 22.1 18.2 28.5 1,428 Wife's 10+ years younger 14.3 7.3 23.8 17.7 29.9 744 Spousal education difference Husband better educated 14.4 8.9 24.3 18.3 30.8 1,918 Wife better educated 13.3 7.7 21.3 17.0 27.2 3,439 Both equally educated 16.6 7.2 23.5 19.2 30.4 1,510 Neither educated 17.3 15.2 18.4 22.0 27.8 43 Number of marital control behaviors displayed by husband 0 6.1 2.8 10.8 7.8 15.3 4,247 1-2 19.2 10.7 31.4 24.9 41.0 2,007 3-4 47.2 28.7 66.5 56.6 75.6 541 5-6 69.9 47.3 88.5 77.3 91.7 136 Number of decisions in which women participate 0 10.8 8.9 17.3 12.3 19.3 77 1-2 21.3 12.9 30.7 27.3 40.9 460 3-4 12.8 7.0 20.6 16.2 26.6 5,984 Number of reasons for which wife beating is justified 0 13.2 6.9 21.3 16.3 26.9 5,887 1-2 20.6 12.9 29.7 26.0 39.4 882 3-4 20.4 19.6 30.9 32.2 44.1 139 5 (22.6) (21.6) (48.5) (33.7) (52.9) 23 Total 14.4 8.0 22.6 17.9 29.0 6,932 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. Total includes 21 women with information missing on husband’s education, 23 women with information missing on husband’s alcohol consumption, 11 women with information missing on spousal age difference, and 21 women with information missing on spousal education difference. Numbers in parentheses are based on 25-49 unweighted numbers. 1 Currently married women 16.5.2 Frequency of Spousal Violence Frequency of spousal violence is an indication of the extent to which domestic violence is a cur- rent or recurring problem for Filipina women. Table 16.12 shows the percent distribution of currently married, divorced, or separated women who reported having ever experienced physical, sexual, or other forms of violence by their current or last husband by the frequency of violence in the 12 months preceding the survey, according to selected background characteristics. 218 | Violence Against Women Table 16.12 Frequency of spousal violence among those who reported violence Percent distribution of ever-married women age 15-49 (excluding widows) who have ever experienced other forms of violence committed by their current or most recent husband in the 12 months preceding the survey, by frequency of violence; and the percent distribution of ever-married women age 15-49 (excluding widows) who have ever experienced physical or sexual violence committed by their current or most recent husband in the 12 months preceding the survey, by frequency of violence, according to background characteristics, Philippines 2008 Frequency of other forms of violence in the past 12 months Frequency of physical or sexual violence in the past 12 months Background characteristic Often Sometimes Not at all Total Number of women Often Sometimes Not at all Total Number of women Current age 15-19 27.5 68.3 4.3 100.0 47 (10.4) (69.8) (19.8) 100.0 43 20-24 28.8 60.1 11.1 100.0 165 9.4 61.0 29.7 100.0 139 25-29 20.2 63.1 16.7 100.0 256 8.8 55.8 35.4 100.0 236 30-39 26.2 52.0 21.8 100.0 507 8.5 53.6 37.9 100.0 442 40-49 22.6 45.5 31.9 100.0 335 5.4 37.3 57.3 100.0 303 Employed past 12 months Not employed 30.4 49.7 19.9 100.0 460 9.0 51.4 39.6 100.0 444 Employed for cash 21.9 55.9 22.2 100.0 783 7.3 50.8 42.0 100.0 655 Employed not for cash 14.9 63.1 22.0 100.0 67 7.3 55.8 36.9 100.0 64 Number of living children 0 31.9 55.6 12.6 100.0 88 10.0 66.6 23.4 100.0 52 1-2 23.2 58.7 18.1 100.0 547 8.3 55.5 36.2 100.0 458 3-4 23.9 51.3 24.9 100.0 420 8.0 46.8 45.2 100.0 402 5+ 25.8 48.4 25.8 100.0 255 6.5 47.8 45.7 100.0 252 Marital status and duration Currently married woman 23.8 56.8 19.4 100.0 1,209 7.6 54.5 37.9 100.0 1,057 Married only once 22.7 58.1 19.2 100.0 1,053 7.0 55.3 37.8 100.0 938 0-4 years 23.0 69.1 7.8 100.0 231 7.2 65.9 26.9 100.0 167 5-9 years 20.9 62.7 16.4 100.0 238 8.0 58.9 33.0 100.0 231 10+ years 23.3 51.9 24.8 100.0 584 6.4 50.4 43.1 100.0 540 Married more than once 31.0 48.1 20.9 100.0 156 12.7 48.5 38.7 100.0 119 Divorced/separated 33.4 21.6 45.0 100.0 101 10.8 19.2 69.9 100.0 106 Residence Urban 27.2 52.4 20.4 100.0 661 8.3 50.7 41.0 100.0 605 Rural 21.8 55.8 22.4 100.0 649 7.5 52.0 40.5 100.0 558 Region National Capital Region 33.3 51.7 15.0 100.0 188 12.4 60.5 27.2 100.0 169 Cordillera Admin Region (18.1) (57.4) (24.4) 100.0 15 (9.7) (61.6) (28.7) 100.0 16 I - Ilocos 20.5 43.6 35.9 100.0 56 4.4 39.3 56.3 100.0 64 II - Cagayan Valley 8.2 37.9 53.9 100.0 41 0.0 45.9 54.1 100.0 38 III - Central Luzon 30.5 57.5 12.0 100.0 95 4.7 44.0 51.3 100.0 99 IVA - CALABARZON 27.5 47.8 24.8 100.0 93 9.6 46.8 43.6 100.0 93 IVB - MIMAROPA 25.8 61.5 12.7 100.0 48 10.7 55.3 34.0 100.0 51 V - Bicol 16.8 65.1 18.1 100.0 53 4.0 50.6 45.4 100.0 65 VI - Western Visayas 19.6 53.3 27.1 100.0 91 6.4 48.7 45.0 100.0 89 VII - Central Visayas 21.1 45.9 33.1 100.0 164 5.1 48.5 46.4 100.0 123 VIII - Eastern Visayas 18.9 53.2 27.9 100.0 72 12.0 42.8 45.2 100.0 60 IX - Zamboanga Peninsula 25.1 60.2 14.7 100.0 65 8.5 60.6 30.9 100.0 41 X - Northern Mindanao 19.4 68.7 11.9 100.0 84 11.9 58.2 30.0 100.0 48 XI - Davao 21.8 58.8 19.5 100.0 89 7.1 54.1 38.8 100.0 73 XII - SOCCSKSARGEN 29.5 49.9 20.6 100.0 74 7.8 47.3 44.9 100.0 60 XIII - Caraga 27.8 63.1 9.2 100.0 59 12.9 56.2 31.0 100.0 41 ARMM (37.8) (62.2) (0.0) 100.0 23 (5.2) (64.4) (30.3) 100.0 34 Education No education * * * 100.0 16 (15.1) (51.1) (33.8) 100.0 19 Elementary 21.6 57.4 21.0 100.0 351 9.0 49.1 42.0 100.0 326 High school 25.1 54.5 20.3 100.0 662 7.5 53.4 39.1 100.0 599 College 25.9 49.3 24.8 100.0 281 6.8 49.0 44.2 100.0 219 Wealth quintile Lowest 22.9 57.1 20.0 100.0 324 9.0 50.2 40.7 100.0 297 Second 20.9 59.3 19.9 100.0 312 5.3 56.4 38.3 100.0 290 Middle 22.8 54.9 22.3 100.0 284 6.7 51.2 42.1 100.0 259 Fourth 29.7 49.1 21.2 100.0 231 6.6 51.6 41.8 100.0 189 Highest 30.4 43.6 26.0 100.0 158 15.6 42.0 42.4 100.0 128 Total 24.5 54.1 21.4 100.0 1,310 7.9 51.3 40.8 100.0 1,163 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. Numbers in parentheses are based on 25-49 unweighted cases; an asterisk indicates that a figure is based on less than 25 unweighted cases and has been suppressed. Violence Against Women | 219 Table 16.12 shows that 59 percent of those who have ever experienced physical or sexual violence by their husbands experienced such violence in the 12 months preceding the survey; 8 percent experience physical or sexual violence often. Similarly, 79 percent of women who have experienced other forms of violence by their husbands experienced such violence in the 12 months preceding the survey and 25 percent experience such violence often. Among women who have ever experienced spousal physical or sexual violence or other forms of spousal violence, the likelihood of experiencing such violence in the past 12 months decreases with increasing age and with increasing number of children. Differences by employment status are small. As expected, frequency of violence in the 12 months preceding the survey among women who report ever experiencing the violence is higher for currently married women than for women who are separated or divorced. Among women married only once who have experienced spousal abuse, the likelihood of violence in the 12 months before the survey decreases as the number of years of marriage increases. Differentials by urban-rural residence are small. By region, women in Cagayan Valley and Ilocos who have ever experienced spousal violence are least likely to have experienced different forms of violence in the past 12 months. Women who have ever experienced spousal violence and have been to college are less likely than other women to have experienced spousal violence in the past 12 months. There is no uniform relationship between the likelihood of experiencing violence in the past 12 months and wealth quintile among those who have ever experienced violence. 16.5.3 Consequences of Spousal Violence In the 2008 NDHS, women who ever experienced spousal physical or sexual violence were asked about the consequences of the violence. Specifically, they were asked if, as a consequence of what their husbands did to them, they ever had any of three different sets of physical injuries: 1) cuts, bruises or aches; 2) eye injuries, sprains, or dislocations, or burns; and 3) deep wounds, broken bones, broken teeth or any other serious injury. They were further asked about three other types of consequences of the violence: 1) loss of job; 2) depression, anxiety, anger, sleeplessness, irritability, confusion, or feelings of isolation; and 3) attempted suicide. Table 16.13 shows the percentage of ever-married women who report any spousal physical or sexual violence by the different types of physical and psychological consequences according to the type of violence ever experienced. Almost two-thirds (63 percent) of ever-married women who have experienced physical or sexual violence by their current or most recent husband report one or more physical or psychological consequences of the violence. Women were most likely to report having experienced psychological consequences like depression, anxiety, and anger; almost six in ten women report such symptoms related to the violence they experienced. Physical injuries like cuts, bruises or aches are also widely reported as consequences of spousal violence (reported by about one-thrid of women). More than 10 percent of women who experienced spousal violence say that they suffered eye injuries, sprains, dislocations or burns as a result of the violence. About the same proportion report that they attempted to commit suicide. Loss of a job or income is a less common consequence of spousal violence. Women are least likely to report having suffered the most severe injuries; nevertheless, more than one in twenty women who have ever experienced physical or sexual violence by their husband reported suffering deep wounds, broken bones, broken teeth, or other serious injuries. 220 | Violence Against Women Table 16.13 Consequences of spousal violence Percentage of ever-married women age 15-49 who have experienced specific types of spousal violence by types of consequences resulting from what their husband did to them, according to the type of violence and whether they have experienced the violence ever and in the 12 months preceding the survey, Philippines 2008 Type of violence Cuts, bruises, or aches Eye injuries, sprains, dislocations, or burns Deep wounds, broken bones, broken teeth, or any other serious injury Lost your job/source of income Had depression, anxiety, anger, sleeplessness, irritable, confused, feeling of isolation Attempted to commit suicide Any of the specified consequences Number of ever- married women Physical violence1 Ever2 35.4 13.5 5.7 8.4 58.0 12.8 67.7 995 In the past 12 months3 40.4 15.1 7.2 10.4 60.6 16.0 70.4 507 Sexual violence4 Ever2 30.3 13.6 6.0 9.9 60.3 13.8 65.3 487 In the past 12 months3 29.7 13.4 5.8 10.8 60.5 13.6 65.6 335 Physical or sexual violence 4 Ever2 29.9 11.2 4.7 7.5 54.8 11.0 63.4 1,199 In the past 12 months3 31.6 12.4 5.3 8.7 56.3 13.1 64.5 695 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated or widowed women. 1 Excludes women who experienced physical violence only during pregnancy 2 Includes violence in the past 12 months 3 Excludes widows 4 Excludes women whose sexual initiation was forced but who have not experienced any other forms of physical or sexual violence 16.6 VIOLENCE INITIATED BY WOMEN AGAINST HUSBANDS Violence by husbands against wives is not the only form of spousal violence; women can also be perpetratators of violence. To measure spousal violence initiated by women in the 2008 NDHS, women were asked, “Have you ever hit, slapped, kicked, or done anything else to physically hurt your (last) husband at times when he was not already beating or physically hurting you?” Respondents who said yes to this question were asked about the frequency of such violence in the 12 months preceding the survey. This line of questioning may result in underreporting if women find it difficult to admit that they themselves initiated violence. Table 16.14 shows the percentage of ever-married women who have ever initiated violence against their current or most recent husband, and the percentage of all ever-married women (excluding widows) who say that they have initiated spousal violence in the 12 months preceding the survey. Overall, 16 percent of ever-married women report that they have ever initiated physical violence against their current or most recent husband, while 9 percent say they have committed such violence in the 12 months preceding the survey. Women’s initiation of violence against their spouse is much more common among women who have also experienced spousal physical violence than among women who have not experienced physical violence (40 percent, compared with 12 percent). Differentials in women initiating physical violence against their current or most recent husbands are generally small. Younger women, those with five or more children, those in the lower wealth quintiles, those in Central Visayas, and those whose husbands get drunk often, are more likely to report initiating physical violence against their husbands than other women. Violence Against Women | 221 Table 16.14 Violence by women against their spouse Percentage of ever-married women age 15-49 who have committed physical violence against their husband when he was not already beating or physically hurting them (ever) and in the past 12 months, by women's own experience of spousal violence and their own and their husband's characteristics, Philippines 2008 Percentage of ever-married women who have committed physical violence against their current or most recent husband Characteristic Ever committed violence against husband Number of women Committed violence against husband in the past 12 months1 Number of women1 Woman's experience of spousal physical violence Ever 39.6 995 20.9 973 In the past 12 months 42.4 507 33.4 500 Not past 12 months/widow/ missing 36.7 488 7.7 473 Never 11.7 5,937 6.8 5,811 Current age 15-19 19.4 204 17.0 204 20-24 18.6 773 13.0 771 25-29 18.2 1,322 10.9 1,320 30-39 14.6 2,737 7.8 2,689 40-49 14.0 1,896 5.9 1,800 Employed past 12 months Not employed 15.2 2,801 8.7 2,771 Employed for cash 16.0 3,822 8.8 3,712 Employed not for cash 16.9 307 9.4 300 Number of living children 0 12.2 548 8.4 540 1-2 15.6 2,995 9.2 2,948 3-4 15.3 2,191 7.8 2,140 5+ 18.5 1,198 9.7 1,155 Residence Urban 15.1 3,692 8.8 3,607 Rural 16.4 3,240 8.8 3,176 Region National Capital Region 14.4 1,161 9.6 1,142 Cordillera Admin Region 5.7 113 5.2 109 I - Ilocos 18.7 340 8.9 334 II - Cagayan Valley 14.4 213 7.4 209 III - Central Luzon 9.7 748 4.2 729 IVA - CALABARZON 8.4 892 4.3 868 IVB - MIMAROPA 17.6 192 10.3 189 V - Bicol 17.6 385 8.6 375 VI - Western Visayas 15.4 510 8.6 497 VII - Central Visayas 30.2 495 17.7 492 VIII - Eastern Visayas 17.5 270 9.6 265 IX - Zamboanga Peninsula 19.4 274 12.8 269 X - Northern Mindanao 14.0 297 7.5 291 XI - Davao 19.5 337 10.5 328 XII - SOCCSKSARGEN 24.9 252 10.4 248 XIII - Caraga 24.2 169 15.5 165 ARMM 11.5 283 6.7 274 Wealth quintile Lowest 18.1 1,392 10.7 1,363 Second 19.7 1,400 11.1 1,373 Middle 17.0 1,425 9.6 1,387 Fourth 13.7 1,441 7.4 1,416 Highest 9.5 1,273 4.8 1,244 Continued. 222 | Violence Against Women Table 16.14—Continued Percentage of ever-married women who have committed physical violence against their current or most recent husband Characteristic Ever committed violence against husband Number of women Committed violence against husband in the past 12 months1 Number of women1 Marital status and duration Currently married woman 15.5 6,522 8.9 6,522 Married only once 15.2 5,871 8.5 5,871 0-4 years 15.0 1,282 11.2 1,282 5-9 years 15.9 1,428 8.9 1,428 10+ years 14.9 3,162 7.2 3,162 Married more than once 18.3 651 12.8 651 Divorced/separated/widowed 19.5 410 5.6 262 Education No education 14.4 104 8.5 101 Elementary 17.1 1,617 8.1 1,568 High school 17.7 3,166 10.8 3,107 College 11.5 2,044 6.3 2,007 Husband's education No education 11.5 110 8.0 105 Elementary 17.9 1,931 9.5 1,890 High school 17.2 2,773 10.6 2,711 College 11.6 2,096 5.6 2,057 Husband's alcohol consumption Does not drink 10.6 1,504 6.0 1,462 Drinks/never gets drunk 13.5 693 6.5 682 Gets drunk sometimes 16.1 4,166 8.9 4,102 Gets drunk very often 29.5 546 18.6 517 Spousal age difference2 Wife older 14.7 1,278 9.1 1,278 Wife is same age 16.8 620 8.7 620 Wife's 1-4 years younger 15.4 2,439 8.4 2,439 Wife's 5-9 years younger 16.8 1,428 9.9 1,428 Wife's 10+ years younger 13.4 744 8.4 744 Spousal education difference Husband better educated 17.1 1,918 8.8 1,862 Wife better educated 14.4 3,439 8.1 3,385 Both equally educated 16.8 1,510 10.2 1,475 Neither educated 13.6 43 10.5 41 Total 15.7 6,932 8.8 6,783 Note: Husband refers to the current husband for currently married women and the most recent husband for divorced, separated, or widowed women. Total includes 21 women with information missing on husband’s education, 20 women with information missing on husband’s alcohol consumption, 11 women with information missing on spousal age difference, and 21 women with information missing on spousal education difference. 1 Excludes widows 2 Currently married women 16.7 RESPONSE TO VIOLENCE All respondents who ever experienced physical or sexual violence by any person were asked a series of questions about whether and from whom they sought help to try to end the violence. Table 16.15 shows that among women who have experienced physical or sexual violence, 21 percent fought back physically, 27 percent fought back verbally, and 18 percent sought help to try to stop the violence. Women who have experienced both physical and sexual violence are more likely to fight back and to seek help than those who experienced only one or the other. Violence Against Women | 223 Table 16.15 Responses to violence Among women age 15-49 who have ever experienced physical or sexual violence, percentage who fought back physically, fought back verbally or sought help from any source to stop the violence, by type of violence and background characteristics, Philippines 2008 Background characteristic Fought back physically Fought back verbally Sought help from a source to stop violence Number of women Type of violence Physical 18.8 24.6 13.8 1,390 Sexual 15.5 22.1 13.6 329 Both physical and sexual 32.0 37.2 30.9 481 Current age 15-19 13.9 22.2 15.6 242 20-24 22.2 27.1 18.2 318 25-29 24.1 29.0 15.7 407 30-39 21.4 26.8 18.6 736 40-49 21.2 27.7 17.8 496 Employed past 12 months Not employed 20.2 23.7 16.6 857 Employed for cash 22.1 29.3 18.2 1,232 Employed not for cash 17.6 27.5 16.3 104 Number of living children 0 14.6 24.3 17.7 412 1-2 23.4 26.4 17.4 783 3-4 20.1 27.8 16.7 633 5+ 25.4 29.5 18.8 371 Marital status and duration Never married 12.1 22.1 17.1 325 Currently married woman 22.5 27.5 16.4 1,707 Married only once 21.7 26.9 15.5 1,470 0-4 years 26.9 27.8 15.5 300 5-9 years 21.3 25.6 15.1 364 10+ years 20.0 27.2 15.8 805 Married more than once 26.9 30.7 22.1 237 Divorced/separated/widowed 25.6 31.1 28.9 167 Residence Urban 22.8 27.0 18.4 1,125 Rural 19.5 26.9 16.5 1,075 Region National Capital Region 28.1 32.6 13.5 310 Cordillera Admin Region 29.4 27.2 21.4 29 I - Ilocos 28.9 23.7 11.2 87 II - Cagayan Valley 19.3 20.0 16.6 55 III - Central Luzon 24.2 37.6 11.5 186 IVA - CALABARZON 13.6 12.9 22.0 169 IVB - MIMAROPA 17.4 35.7 20.0 75 V - Bicol 24.9 34.0 20.6 114 VI - Western Visayas 15.6 22.2 26.3 169 VII - Central Visayas 19.4 21.5 20.8 219 VIII - Eastern Visayas 22.6 32.4 22.7 102 IX - Zamboanga Peninsula 30.3 25.0 14.0 96 X - Northern Mindanao 13.0 27.6 19.1 134 XI - Davao 20.4 22.3 17.2 140 XII - SOCCSKSARGEN 17.6 32.8 17.3 136 XIII - Caraga 25.7 37.2 20.5 76 ARMM 14.2 11.4 4.9 101 Education No education 7.7 9.6 12.5 37 Elementary 22.0 26.4 15.5 566 High school 22.0 27.5 18.2 1,097 College 19.3 27.6 18.7 499 Wealth quintile Lowest 21.6 27.9 16.9 551 Second 21.0 26.3 15.6 531 Middle 20.8 27.4 19.2 434 Fourth 21.3 22.7 17.3 391 Highest 21.1 31.4 19.9 292 Total 21.2 26.9 17.5 2,199 Note: Excludes women whose sexual initiation was forced but who have not experienced any other form of physical or sexual violence. Total includes 7 women with information missing on employment status. 224 | Violence Against Women Differences by background characteristics in reactions to violence are not large. Women who are divorced, separated, or widowed and have ever experienced physical or sexual violence, are more likely than currently married women to seek help. Currently married women who have been married more than once are more likely than currently married women in their first marriage to seek help. Women in ARMM region who have ever experienced violence are least likely to seek help (5 percent). Women with no education are somewhat less likely than other women to either fight back or seek help when they experience violence. Help-seeking varies little by wealth. Table 16.16 shows the sources of help among women who have ever experienced violence and have sought help, by type of violence. Among all those who sought help, women are most likely to have sought help from their own family (45 percent). Friends and neighbours are also an important source of help, sought out by 29 percent of women. Fifteen percent of women sought help from their in-laws. Table 16.16 Sources from which help was sought Among women age 15-49 who have ever experienced physical or sexual violence and sought help to stop the violence, percentage who sought help from specific sources, by type of violence experienced, Philippines 2008 Type of violence Source of help Physical Sexual Both physical and sexual Total Own family 45.0 54.0 42.5 45.1 In-laws 15.8 8.2 14.9 14.5 Husband/partner boyfriend 1.0 0.0 0.9 0.8 Friend/neighbor 26.4 23.9 32.6 28.5 Religious leader 0.0 0.0 0.7 0.3 Doctor/medical personnel 2.0 0.0 3.4 2.3 Police 7.4 8.1 12.3 9.3 Lawyer 1.5 3.9 0.8 1.5 Social service organization 4.8 0.0 9.2 6.0 Other 2.6 9.3 6.2 4.7 Number of women 191 45 149 385 References | 225 REFERENCES Boerma, T.J. 1988. 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Appendix A | 229 SAMPLE IMPLEMENTATION Appendix A T ab le A .1 S am pl e im pl em en ta tio n P er ce nt d ist rib ut io n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le w om en , a nd o ve ra ll re sp on se r at es , a cc or di ng t o ur ba n- ru ra l r es id en ce a nd re gi on , P hi lip pi ne s 20 08 Re sid en ce Re gi on R es ul t U rb an Ru ra l N at io na l C ap ita l Re gi on C or di lle ra Ad m in Re gi on I - Ilo co s Re gi on II - C ag ay an Va lle y III - C en tra l Lu zo n IV A – C AL A- BA RZ O N IV B – M IM A- RO PA V - Bi co l Re gi on VI - W es te rn Vi sa ya s VI I - C en tra l Vi sa ya s VI II - Ea st er n Vi sa ya s IX - Za m bo an ga Pe ni ns ul a X - N or th er n M in da na o XI - D av ao Pe ni ns ul a XI I – SO C C S- KS AR G EN XI II - C ar ag a AR M M To ta l S el ec te d h ou se ho ld s C om pl et ed (C ) 89 .3 91 .6 89 .3 90 .8 90 .1 89 .5 88 .9 89 .9 92 .0 93 .2 91 .4 90 .9 88 .2 93 .9 91 .3 92 .0 91 .5 94 .5 85 .6 90 .6 H ou se ho ld pr es en t b ut n o co m pe te nt re sp on de nt a t ho m e (H P) 0. 2 0. 1 0. 3 0. 3 0. 1 0. 0 0. 0 0. 2 0. 0 0. 1 0. 0 0. 6 0. 0 0. 0 0. 1 0. 3 0. 2 0. 0 0. 7 0. 2 Po st po ne d (P ) 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 Re fu se d (R ) 0. 4 0. 0 1. 3 0. 2 0. 1 0. 2 0. 0 0. 1 0. 0 0. 0 0. 2 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 D w el lin g no t fo un d (D N F) 0. 3 0. 2 0. 0 0. 0 0. 0 0. 3 0. 1 0. 6 0. 0 0. 1 1. 3 0. 0 0. 0 0. 0 0. 3 0. 1 0. 8 0. 2 0. 3 0. 3 H ou se ho ld ab se nt (H A) 1. 1 1. 6 0. 9 1. 7 2. 2 2. 2 0. 7 0. 3 1. 0 2. 3 0. 7 0. 9 2. 8 0. 8 0. 6 1. 1 0. 8 1. 0 6. 6 1. 4 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V) 7. 0 4. 9 6. 8 6. 5 6. 3 6. 9 8. 5 8. 1 5. 0 3. 3 4. 4 6. 2 7. 6 4. 6 6. 0 4. 7 4. 5 2. 9 1. 7 5. 8 D w el lin g de st ro ye d (D D ) 1. 4 1. 2 1. 4 0. 5 1. 1 0. 9 1. 7 0. 9 2. 0 1. 0 1. 7 1. 5 1. 4 0. 3 1. 0 1. 8 1. 5 1. 4 1. 5 1. 3 O th er (O ) 0. 2 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 2 0. 6 0. 0 0. 8 0. 0 3. 6 0. 2 To ta l 10 0. 0 10 0. 0 1 00 .0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f sa m pl ed ho us eh ol ds 6, 20 7 7, 55 7 1 ,4 90 58 6 75 9 63 7 1, 14 7 1, 28 3 61 4 79 1 98 9 89 4 71 3 62 5 67 0 72 1 66 2 57 7 60 6 1 3, 76 4 H ou se ho ld re sp on se ra te (H RR )1 99 .0 99 .6 98 .3 99 .4 99 .7 99 .5 99 .8 99 .1 10 0. 0 99 .7 98 .4 99 .4 10 0. 0 99 .8 99 .5 99 .5 99 .0 99 .8 98 .9 99 .3 C on tin ue d. . 230 | Appendix A T ab le A .1 — C on tin ue d Re sid en ce Re gi on R es ul t U rb an Ru ra l N at io na l C ap ita l Re gi on C or di lle ra Ad m in Re gi on I - Ilo co s Re gi on II - C ag ay an Va lle y III - C en tra l Lu zo n IV A – C AL A- BA RZ O N IV B – M IM A- RO PA V - Bi co l Re gi on VI - W es te rn Vi sa ya s VI I - C en tra l Vi sa ya s VI II - Ea st er n Vi sa ya s IX - Za m bo an ga Pe ni ns ul a X - N or th er n M in da na o XI - D av ao Pe ni ns ul a XI I – SO C C S- KS AR G EN XI II - C ar ag a AR M M To ta l E lig ib le w om en C om pl et ed (E W C ) 98 .5 98 .3 98 .2 99 .1 98 .8 98 .1 98 .8 99 .2 99 .1 96 .7 97 .8 98 .0 99 .3 98 .5 99 .0 98 .1 97 .0 99 .1 98 .4 98 .4 N ot a t h om e (E W N H ) 0. 6 0. 4 0. 6 0. 4 0. 0 0. 2 0. 0 0. 0 0. 0 1. 4 0. 9 1. 1 0. 2 0. 2 0. 3 1. 1 1. 5 0. 3 0. 7 0. 5 Re fu se d (E W R) 0. 1 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 Pa rtl y co m pl et ed (E W PC ) 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 In ca pa ci ta te d (E W I) 0. 6 1. 0 0. 5 0. 6 0. 9 1. 1 0. 9 0. 6 0. 7 1. 5 1. 3 0. 5 0. 5 1. 1 0. 7 0. 8 1. 0 0. 5 0. 4 0. 8 O th er (E W O ) 0. 2 0. 2 0. 3 0. 0 0. 3 0. 6 0. 3 0. 1 0. 2 0. 3 0. 0 0. 1 0. 0 0. 3 0. 0 0. 0 0. 5 0. 0 0. 4 0. 2 T ot al 10 0. 0 1 00 .0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f w om en 6, 86 7 6 ,9 47 1, 86 1 54 1 66 5 53 3 1, 17 1 1, 33 6 54 2 79 4 90 5 92 8 61 3 64 7 68 8 72 9 60 2 57 8 68 1 13 ,8 14 E lig ib le w om en re sp on se ra te (E W RR )2 98 .5 98 .3 98 .2 99 .1 98 .8 98 .1 98 .8 99 .2 99 .1 96 .7 97 .8 98 .0 99 .3 98 .5 99 .0 98 .1 97 .0 99 .1 98 .4 98 .4 O ve ra ll re sp on se ra te (O RR )3 97 .5 97 .9 96 .6 98 .5 98 .5 97 .6 98 .6 98 .2 99 .1 96 .5 96 .2 97 .4 99 .3 98 .3 98 .5 97 .6 96 .1 99 .0 97 .3 97 .7 1 U sin g th e nu m be r o f h ou se ho ld s fa lli ng in to s pe ci fic re sp on se c at eg or ie s, th e ho us eh ol d re sp on se ra te (H RR ) i s ca lc ul at ed a s: 10 0 * C — — — — — — — — — — — C + H P + P + R + D N F 2 U sin g th e nu m be r o f e lig ib le w om en fa lli ng in to s pe ci fic re sp on se c at eg or ie s, th e el ig ib le w om an re sp on se ra te (E W RR ) i s ca lc ul at ed a s: 10 0 * EW C — — — — — — — — — — — — — — — — — — — — — — — — — EW C + E W N H + E W P + E W R + E W PC + E W I + E W O 3 T he o ve ra ll re sp on se ra te (O RR ) i s ca lc ul at ed a s: O RR = H RR * E W RR /1 00 Appendix A | 231 Appendix B │ 233 ESTIMATES OF SAMPLING ERRORS Appendix B The estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection 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 numer- ous efforts were made during the implementation of the 2008 Philippines 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 2008 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 (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calcu- late 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 2008 NDHS sam- ple is the result of a multi-stage stratified design, and, consequently, it was necessary to use more com- plex formulae. The computer software used to calculate sampling errors for the 2008 NDHS is a Macro SAS procedure. This procedure 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 mortality 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 being the square root of the variance: ∑ ∑ = = ⎥⎥⎦ ⎤ ⎢⎢⎣ ⎡ ⎟⎟⎠ ⎞ ⎜⎜⎝ ⎛ −− −== H h h h m i hi h hh m z z m fm x rvarrSE h 1 2 1 2 2 2 1 )1(1 )()( in which hihihi rxyz −= , and hhh rxyz −= 234 | 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 fh is the sampling fraction in stratum h, 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- mulae. Each replication considers all but one cluster in the calculation of the estimates. Pseudo- independent replications are thus created. In the 2008 NDHS, there were 792 non-empty clusters. Hence, 792 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 792 clusters, r(i) is the estimate computed from the reduced sample of 791 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, the procedure computes the design effect (DEFT) for each esti- mate, which is defined as the ratio between the standard error using the given sample design and the stan- dard 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 the increase in the sampling error because of the use of a more complex and less statistically efficient design. The procedure also computes the relative error and confidence limits for the estimates. Sampling errors for the 2008 NDHS are calculated for selected variables considered to be of pri- mary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the 17 geographical regions. For each variable, the type of statistic (mean, propor- tion, or rate) and the base population are given in Table B.1. Tables B.2 to B.21 present the value of the statistic (R), its standard error (SE), the number of unweighted (N-UNWE) and weighted (N-WEIG) cases, 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 sim- ple 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 unweighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to women 40-49) can be inter- preted as follows: the overall average from the national sample is 3.964 and its standard error is 0.060. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.964±2×0.060. There is a high probability (95 percent) that the true average number of children ever born to all women is between 3.845 and 4.083. For the total sample, the value of the DEFT, averaged over all variables, is 1.219. This means that, because of multi-stage clustering of the sample, the average standard error is increased by a factor of 1.219 over that in an equivalent simple random sample. Appendix B │ 235 Table B.1 List of selected variables for sampling errors, Philippines DHS 2008 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education Proportion All women 15-49 At least some secondary education Proportion All women 15-49 Children ever born to women 40-49 Proportion All women 40-49 Currently using any method Proportion Currently married women 15-49 Currently using any modern method Proportion Currently married women 15-49 Currently using female 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 male condoms 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 Using public sector source for family planning Proportion All women 15-49 using a modern method Want no more children or sterilized Proportion Currently married women 15-49 Unmet need for family planning Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Prenatal care from doctor, nurse, or midwife for last birth Proportion Women 15-49 with birth in past 5 years Last birth protected against tetanus Proportion Women 15-49 with birth in past 5 years Delivery assistance from doctor, nurse, midwife Proportion Births in past 5 years Delivery in health facility Proportion Births in past 5 years Postnatal care for mothers Proportion Women 15-49 with birth in past 5 years Child received DPT 3 Proportion Children 12-23 months Child fully immunized Proportion Children 12-23 months Child had diarrhea in past 2 weeks Proportion Children under 5 Sought treatment for diarrhea from health facility/provider Proportion Children under 5 with diarrhea in past 2 weeks Child treated with oral rehydration salt (ORS) Proportion Children under 5 with diarrhea in past 2 weeks Child had acute respiratory illness (ARI) in past 2 weeks Proportion Children under 5 Sought treatment for ARI from health facility/provider Proportion Children under 5 with ARI in past 2 weeks Vitamin A supplementation in past 6 months Proportion Children 6-59 months Comprehensive knowledge about HIV Proportion All women 15-49 Sex with a non-marital/cohabiting partner in past 12 months Proportion Women 15-49 who had sex in past 12 months Ever experienced physical or sexual violence by husband Proportion Ever-married women 15-49 Total fertility rate (past 3 years) Rate All women 15-49 Neonatal mortality rate (past 5 or 10 years)1 Rate Births in past 5 or 10 years Post-neonatal mortality rate (past 5 or 10 years)1 Rate Births in past 5 or 10 years Infant mortality rate (past 5 or 10 years)1 Rate Births in past 5 or 10 years Child mortality rate (past 5 or 10 years)1 Rate Births in past 5 or 10 years Under-five mortality rate (past 5 or 10 years)1 Rate Births in past 5 or 10 years –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 5 years at the national level; 10 years for residence and province 236 | Appendix B Table B.2 Sampling errors for National sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.012 0.001 13594 13594 1.350 0.104 0.010 0.015 At least some secondary education 0.793 0.006 13594 13594 1.772 0.008 0.780 0.805 Children ever born to women age 40-49 3.964 0.060 2974 2950 1.227 0.015 3.845 4.083 Currently using any method 0.507 0.006 8564 8418 1.186 0.013 0.494 0.520 Currently using a modern method 0.340 0.006 8564 8418 1.255 0.019 0.328 0.353 Currently using pill 0.157 0.005 8564 8418 1.224 0.031 0.147 0.167 Currently using IUD 0.037 0.002 8564 8418 1.205 0.067 0.032 0.042 Currently using male condoms 0.023 0.002 8564 8418 1.047 0.074 0.020 0.026 Currently using injectables 0.026 0.002 8564 8418 1.113 0.074 0.022 0.030 Currently using female sterilization 0.092 0.004 8564 8418 1.175 0.040 0.085 0.099 Currently using withdrawal 0.098 0.004 8564 8418 1.219 0.040 0.091 0.106 Currently using rhythm 0.064 0.003 8564 8418 1.115 0.046 0.058 0.070 Obtained method from public sector source 0.462 0.010 3007 2928 1.095 0.022 0.442 0.482 Want no more children or sterilized 0.627 0.006 8564 8418 1.148 0.010 0.615 0.639 Ideal number of children 2.843 0.017 13454 13462 1.399 0.006 2.809 2.877 Unmet need for family planning 0.223 0.005 8564 8418 1.091 0.022 0.214 0.233 Prenatal care from doctor, nurse or midwife for last birth 0.911 0.006 4712 4590 1.389 0.006 0.899 0.923 Delivery in health facility 0.442 0.011 6572 6359 1.507 0.025 0.420 0.464 Last birth protected against tetanus 0.756 0.008 4712 4590 1.251 0.010 0.740 0.771 Delivery assistance from doctor, nurse, midwife 0.622 0.012 6572 6359 1.586 0.019 0.599 0.646 Postnatal care from doctor,nurse or midwife for last birth 0.599 0.011 4712 4590 1.500 0.018 0.577 0.620 Child had diarrhea in the past 2 weeks 0.090 0.004 6382 6185 1.086 0.047 0.082 0.099 Sought treatment for diarrhea 0.342 0.025 571 560 1.155 0.072 0.293 0.391 Child treated with oral rehydration salts (ORS) 0.465 0.024 571 560 1.054 0.051 0.417 0.513 Child had acute respiratory illness (ARI) in past 2 weeks 0.052 0.003 6382 6185 1.028 0.060 0.046 0.059 Sought treatment for ARI from health facility/provider 0.498 0.032 348 324 1.121 0.065 0.434 0.563 Vitamin A supplementation in past 6 months 0.759 0.008 5781 5609 1.193 0.011 0.743 0.775 Received DPT vaccination (3 doses) 0.856 0.011 1320 1286 1.088 0.012 0.834 0.877 Fully immunized 0.795 0.013 1320 1286 1.117 0.016 0.770 0.820 Sex with a non-marital/cohabiting partner in past 12 months 0.032 0.003 8562 8415 1.481 0.088 0.026 0.038 Comprehensive knowledge about HIV 0.219 0.006 13594 13594 1.571 0.025 0.208 0.230 Ever experienced physical or sexual violence by husband 0.179 0.005 7157 6932 1.172 0.030 0.169 0.190 Total fertility rate (past 3 years) 3.262 0.065 na 38066 1.217 0.020 3.132 3.393 Neonatal mortality (past 0-4 years) 15.835 1.738 6632 6419 1.040 0.110 12.358 19.311 Post-neonatal mortality (past 0-4 years) 9.066 1.331 6641 6431 1.059 0.147 6.404 11.728 Infant mortality (past 0-4 years) 24.900 2.117 6639 6424 1.034 0.085 20.667 29.134 Child mortality (past 0-4 years) 8.843 1.214 6652 6429 1.039 0.137 6.415 11.272 Under-five mortality (past 0-4 years) 33.524 2.465 6666 6447 1.032 0.074 28.593 38.454 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 237 Table B.3 Sampling errors for Urban sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.003 0.001 6762 7574 1.272 0.300 0.001 0.004 At least some secondary education 0.873 0.006 6762 7574 1.449 0.007 0.861 0.885 Children ever born to women age 40-49 3.338 0.077 1412 1578 1.239 0.023 3.185 3.491 Currently using any method 0.534 0.010 3838 4297 1.194 0.018 0.514 0.553 Currently using a modern method 0.353 0.010 3838 4297 1.244 0.027 0.334 0.372 Currently using pill 0.153 0.007 3838 4297 1.226 0.047 0.138 0.167 Currently using IUD 0.031 0.003 3838 4297 1.076 0.097 0.025 0.037 Currently using male condoms 0.030 0.003 3838 4297 1.025 0.094 0.024 0.036 Currently using injectables 0.026 0.003 3838 4297 1.080 0.107 0.020 0.031 Currently using female sterilization 0.105 0.005 3838 4297 1.104 0.052 0.094 0.116 Currently using withdrawal 0.112 0.006 3838 4297 1.198 0.054 0.100 0.124 Currently using rhythm 0.065 0.005 3838 4297 1.164 0.071 0.056 0.074 Obtained method from public sector source 0.414 0.014 1448 1555 1.091 0.034 0.386 0.443 Want no more children or sterilized 0.624 0.009 3838 4297 1.153 0.014 0.606 0.642 Ideal number of children 2.670 0.020 6701 7506 1.353 0.008 2.629 2.711 Unmet need for family planning 0.211 0.007 3838 4297 1.081 0.034 0.196 0.225 Prenatal care from doctor, nurse or midwife for last birth 0.942 0.007 2049 2283 1.319 0.007 0.928 0.955 Delivery in health facility 0.592 0.017 2795 3105 1.519 0.029 0.559 0.626 Last birth protected against tetanus 0.738 0.012 2049 2283 1.193 0.016 0.715 0.762 Delivery assistance from doctor, nurse, midwife 0.775 0.014 2795 3105 1.426 0.018 0.747 0.803 Postnatal care from doctor,nurse or midwife for last birth 0.726 0.013 2049 2283 1.344 0.018 0.699 0.753 Child had diarrhea in the past 2 weeks 0.088 0.006 2730 3037 1.112 0.073 0.075 0.100 Sought treatment for diarrhea 0.374 0.040 237 266 1.180 0.106 0.294 0.453 Child treated with oral rehydration salts (ORS) 0.577 0.036 237 266 1.086 0.063 0.504 0.650 Child had acute respiratory illness (ARI) in past 2 weeks 0.042 0.004 2730 3037 1.078 0.106 0.033 0.051 Sought treatment for ARI from health facility/provider 0.544 0.052 125 127 1.103 0.096 0.439 0.649 Vitamin A supplementation in last 6 months 0.761 0.011 2494 2774 1.123 0.015 0.739 0.784 Received DPT vaccination (3 doses) 0.882 0.015 575 635 1.120 0.017 0.852 0.913 Fully immunized 0.823 0.018 575 635 1.117 0.022 0.788 0.859 Sex with a non-marital/cohabiting partner in last 12 months 0.043 0.004 3866 4324 1.213 0.092 0.035 0.051 Comprehensive knowledge about HIV 0.255 0.008 6762 7574 1.538 0.032 0.239 0.271 Ever experienced physical or sexual violence by husband 0.174 0.008 3147 3692 1.172 0.046 0.158 0.190 Total fertility rate (past 3 years) 2.829 0.085 na 21354 1.253 0.030 2.659 3.000 Neonatal mortality (past 0-9 years) 12.755 1.638 5621 6245 1.052 0.128 9.479 16.031 Post-neonatal mortality (past 0-9 years) 7.508 1.194 5628 6256 1.076 0.159 5.120 9.895 Infant mortality (past 0-9 years) 20.263 2.003 5623 6248 1.058 0.099 16.257 24.268 Child mortality (past 0-9 years) 7.565 1.362 5595 6201 1.082 0.180 4.841 10.289 Under-five mortality (past 0-9 years) 27.674 2.397 5630 6254 1.059 0.087 22.880 32.469 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 238 | Appendix B Table B.4 Sampling errors for Rural sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.024 0.003 6832 6020 1.431 0.109 0.019 0.030 At least some secondary education 0.691 0.011 6832 6020 1.921 0.016 0.670 0.713 Children ever born to women age 40-49 4.684 0.083 1562 1372 1.162 0.018 4.518 4.849 Currently using any method 0.480 0.009 4726 4121 1.182 0.018 0.463 0.497 Currently using a modern method 0.327 0.009 4726 4121 1.276 0.027 0.310 0.345 Currently using pill 0.162 0.006 4726 4121 1.190 0.039 0.149 0.174 Currently using IUD 0.043 0.004 4726 4121 1.314 0.090 0.035 0.051 Currently using male condoms 0.016 0.002 4726 4121 1.035 0.119 0.012 0.019 Currently using injectables 0.026 0.003 4726 4121 1.138 0.101 0.021 0.031 Currently using female sterilization 0.078 0.005 4726 4121 1.263 0.063 0.068 0.088 Currently using withdrawal 0.084 0.005 4726 4121 1.168 0.056 0.075 0.094 Currently using rhythm 0.063 0.004 4726 4121 1.017 0.057 0.056 0.070 Obtained method from public sector source 0.516 0.014 1559 1373 1.079 0.026 0.488 0.543 Want no more children or sterilized 0.630 0.008 4726 4121 1.120 0.012 0.614 0.646 Ideal number of children 3.061 0.027 6753 5956 1.439 0.009 3.006 3.115 Unmet need for family planning 0.237 0.007 4726 4121 1.095 0.029 0.223 0.250 Prenatal care from doctor, nurse, or midwife for last birth 0.881 0.009 2663 2307 1.438 0.010 0.862 0.899 Delivery in health facility 0.298 0.014 3777 3255 1.550 0.045 0.271 0.325 Last birth protected against tetanus 0.773 0.011 2663 2307 1.305 0.014 0.751 0.794 Delivery assistance from doctor, nurse, midwife 0.477 0.017 3777 3255 1.689 0.035 0.444 0.511 Postnatal care from doctor, nurse, or midwife for last birth 0.473 0.015 2663 2307 1.583 0.032 0.442 0.504 Child had diarrhea in the past 2 weeks 0.093 0.006 3652 3148 1.057 0.060 0.082 0.105 Sought treatment for diarrhea 0.313 0.030 334 294 1.097 0.095 0.254 0.373 Child treated with oral rehydration salts (ORS) 0.363 0.030 334 294 1.036 0.083 0.303 0.424 Child had acute respiratory illness (ARI) in past 2 weeks 0.062 0.004 3652 3148 0.983 0.069 0.054 0.071 Sought treatment for ARI from health facility/provider 0.469 0.041 223 197 1.167 0.088 0.386 0.551 Vitamin A supplementation in past 6 months 0.756 0.011 3287 2835 1.265 0.015 0.734 0.779 Received DPT vaccination (3 doses) 0.829 0.015 745 650 1.080 0.018 0.799 0.859 Fully immunized 0.768 0.017 745 650 1.114 0.023 0.733 0.802 Sex with a non-marital/cohabiting partner in past 12 months 0.020 0.004 4696 4091 1.991 0.203 0.012 0.028 Comprehensive knowledge about HIV 0.174 0.007 6832 6020 1.487 0.039 0.161 0.188 Ever experienced physical or sexual violence by husband 0.185 0.007 4010 3240 1.132 0.037 0.171 0.199 Total fertility rate (past 3 years) 3.828 0.094 na 16712 1.192 0.025 3.639 4.017 Neonatal mortality (past 0-9 years) 20.320 1.779 7714 6642 0.974 0.088 16.762 23.879 Post-neonatal mortality (past 0-9 years) 14.791 1.992 7727 6655 1.289 0.135 10.808 18.775 Infant mortality (past 0-9 years) 35.112 2.710 7719 6647 1.128 0.077 29.692 40.532 Child mortality (past 0-9 years) 11.557 1.382 7702 6629 0.954 0.120 8.792 14.321 Under-five mortality (past 0-9 years) 46.263 3.230 7737 6661 1.119 0.070 39.803 52.723 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 239 Table B.5 Sampling errors for National Capital Region sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.000 0.000 1828 2522 na na 0.000 0.000 At least some secondary education 0.906 0.008 1828 2522 1.108 0.008 0.890 0.921 Children ever born to women age 40-49 3.014 0.129 368 516 1.181 0.043 2.756 3.273 Currently using any method 0.541 0.019 958 1343 1.170 0.035 0.504 0.579 Currently using a modern method 0.323 0.016 958 1343 1.085 0.051 0.290 0.355 Currently using pill 0.138 0.013 958 1343 1.197 0.097 0.112 0.165 Currently using IUD 0.020 0.004 958 1343 0.915 0.208 0.012 0.028 Currently using male condoms 0.035 0.006 958 1343 1.043 0.178 0.022 0.047 Currently using injectables 0.024 0.005 958 1343 1.085 0.224 0.013 0.035 Currently using female sterilization 0.093 0.008 958 1343 0.829 0.084 0.078 0.109 Currently using withdrawal 0.142 0.012 958 1343 1.073 0.085 0.118 0.166 Currently using rhythm 0.076 0.008 958 1343 0.919 0.104 0.060 0.091 Obtained method from public sector source 0.394 0.027 335 455 1.007 0.068 0.340 0.448 Want no more children or sterilized 0.620 0.018 958 1343 1.145 0.029 0.584 0.656 Ideal number of children 2.566 0.034 1802 2483 1.249 0.013 2.498 2.633 Unmet need for family planning 0.207 0.012 958 1343 0.942 0.060 0.182 0.232 Prenatal care from doctor, nurse, or midwife for last birth 0.944 0.011 492 688 1.063 0.012 0.922 0.966 Delivery in health facility 0.693 0.038 639 903 1.745 0.055 0.617 0.769 Last birth protected against tetanus 0.719 0.024 492 688 1.165 0.033 0.672 0.766 Delivery assistance from doctor, nurse, midwife 0.868 0.017 639 903 1.063 0.019 0.835 0.902 Postnatal care from doctor, nurse, or midwife for last birth 0.770 0.020 492 688 1.066 0.026 0.729 0.810 Child had diarrhea in the past 2 weeks 0.075 0.010 627 888 0.941 0.138 0.055 0.096 Sought treatment for diarrhea 0.360 0.069 48 67 0.946 0.192 0.221 0.498 Child treated with oral rehydration salts (ORS) 0.521 0.080 48 67 1.051 0.154 0.360 0.681 Child had acute respiratory illness (ARI) in past 2 weeks 0.033 0.008 627 888 1.077 0.250 0.017 0.050 Sought treatment for ARI from health facility/provider 0.553 0.119 21 30 1.088 0.215 0.315 0.791 Vitamin A supplementation in past 6 months 0.802 0.021 576 818 1.065 0.026 0.760 0.843 Received DPT vaccination (3 doses) 0.891 0.030 127 182 1.096 0.034 0.831 0.951 Fully immunized 0.834 0.033 127 182 1.002 0.039 0.769 0.900 Sex with a non-marital/cohabiting partner in past 12 months 0.063 0.009 985 1378 1.157 0.142 0.045 0.081 Comprehensive knowledge about HIV 0.295 0.016 1828 2522 1.479 0.054 0.264 0.327 Ever experienced physical or sexual violence by husband 0.151 0.017 753 1161 1.268 0.110 0.118 0.184 Total fertility rate (past 3 years) 2.328 0.169 na 7153 1.366 0.073 1.990 2.666 Neonatal mortality (past 0-9 years) 14.564 3.552 1331 1878 1.096 0.244 7.459 21.668 Post-neonatal mortality (past 0-9 years) 7.214 2.457 1336 1887 1.101 0.341 2.299 12.128 Infant mortality (past 0-9 years) 21.777 4.316 1333 1880 1.118 0.198 13.146 30.409 Child mortality (past 0-9 years) 2.767 1.376 1323 1865 0.944 0.497 0.015 5.519 Under-five mortality (past 0-9 years) 24.484 4.462 1333 1880 1.097 0.182 15.561 33.407 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 240 | Appendix B Table B.6 Sampling errors for Cordillera Admin Region sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.015 0.007 536 225 1.284 0.445 0.002 0.029 At least some secondary education 0.794 0.024 536 225 1.354 0.030 0.746 0.841 Children ever born to women age 40-49 4.693 0.270 118 51 1.067 0.058 4.154 5.233 Currently using any method 0.549 0.031 338 143 1.155 0.057 0.487 0.612 Currently using a modern method 0.389 0.031 338 143 1.150 0.079 0.327 0.450 Currently using pill 0.125 0.025 338 143 1.397 0.202 0.075 0.175 Currently using IUD 0.047 0.015 338 143 1.260 0.308 0.018 0.076 Currently using male condoms 0.023 0.007 338 143 0.851 0.303 0.009 0.037 Currently using injectables 0.041 0.011 338 143 1.032 0.271 0.019 0.064 Currently using female sterilization 0.152 0.025 338 143 1.279 0.165 0.102 0.202 Currently using withdrawal 0.123 0.024 338 143 1.341 0.195 0.075 0.172 Currently using rhythm 0.035 0.011 338 143 1.059 0.305 0.014 0.056 Obtained method from public sector source 0.517 0.069 133 56 1.572 0.133 0.379 0.654 Want no more children or sterilized 0.606 0.028 338 143 1.034 0.045 0.551 0.662 Ideal number of children 3.111 0.087 528 222 1.439 0.028 2.937 3.285 Unmet need for family planning 0.165 0.023 338 143 1.162 0.143 0.118 0.212 Prenatal care from doctor, nurse, or midwife for last birth 0.918 0.026 178 72 1.228 0.028 0.867 0.970 Delivery in health facility 0.511 0.046 256 104 1.190 0.089 0.420 0.603 Last birth protected against tetanus 0.643 0.043 178 72 1.169 0.067 0.558 0.729 Delivery assistance from doctor, nurse, midwife 0.674 0.042 256 104 1.139 0.062 0.591 0.757 Postnatal care from doctor, nurse, or midwife for last birth 0.702 0.047 178 72 1.338 0.067 0.608 0.796 Child had diarrhea in the past 2 weeks 0.066 0.020 250 102 1.180 0.302 0.026 0.105 Sought treatment for diarrhea 0.406 0.143 17 7 1.114 0.352 0.120 0.692 Child treated with oral rehydration salts (ORS) 0.480 0.178 17 7 1.335 0.371 0.124 0.837 Child had acute respiratory illness (ARI) in past 2 weeks 0.035 0.009 250 102 0.799 0.269 0.016 0.054 Sought treatment for ARI from health facility/provider 0.470 0.146 9 4 0.851 0.310 0.178 0.761 Vitamin A supplementation in past 6 months 0.699 0.055 233 95 1.518 0.079 0.589 0.810 Received DPT vaccination (3 doses) 0.858 0.048 55 23 1.004 0.056 0.762 0.953 Fully immunized 0.840 0.047 55 23 0.930 0.055 0.747 0.933 Sex with a non-marital/cohabiting partner in past 12 months 0.030 0.010 340 144 1.116 0.346 0.009 0.050 Comprehensive knowledge about HIV 0.273 0.040 536 225 2.058 0.146 0.193 0.352 Ever experienced physical or sexual violence by husband 0.150 0.023 285 113 1.084 0.153 0.104 0.195 Total fertility rate (past 3 years) 3.286 0.266 na 630 1.021 0.081 2.755 3.818 Neonatal mortality (past 0-9 years) 19.574 4.262 537 220 0.713 0.218 11.049 28.098 Post-neonatal mortality (past 0-9 years) 9.535 3.660 535 220 0.909 0.384 2.214 16.856 Infant mortality (past 0-9 years) 29.109 6.138 537 220 0.858 0.211 16.833 41.384 Child mortality (past 0-9 years) 1.775 1.784 550 226 0.938 1.005 0.000 5.344 Under-five mortality (past 0-9 years) 30.832 6.925 538 221 0.894 0.225 16.981 44.683 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 241 Table B.7 Sampling errors for I - Ilocos Region sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.000 0.000 657 613 na na 0.000 0.000 At least some secondary education 0.857 0.015 657 613 1.089 0.017 0.827 0.887 Children ever born to women age 40-49 3.753 0.260 143 133 1.184 0.069 3.232 4.273 Currently using any method 0.542 0.029 444 415 1.203 0.053 0.485 0.599 Currently using a modern method 0.364 0.032 444 415 1.409 0.089 0.299 0.428 Currently using pill 0.177 0.018 444 415 1.016 0.104 0.140 0.214 Currently using IUD 0.013 0.011 444 415 2.048 0.841 0.000 0.036 Currently using male condoms 0.027 0.007 444 415 0.950 0.270 0.012 0.042 Currently using injectables 0.036 0.010 444 415 1.118 0.275 0.016 0.056 Currently using female sterilization 0.108 0.016 444 415 1.094 0.149 0.076 0.140 Currently using withdrawal 0.140 0.019 444 415 1.176 0.139 0.101 0.179 Currently using rhythm 0.038 0.007 444 415 0.795 0.189 0.024 0.053 Obtained method from public sector source 0.535 0.040 163 152 1.032 0.076 0.454 0.616 Want no more children or sterilized 0.610 0.025 444 415 1.062 0.040 0.560 0.659 Ideal number of children 2.739 0.056 656 612 1.355 0.021 2.627 2.852 Unmet need for family planning 0.187 0.021 444 415 1.132 0.112 0.145 0.229 Prenatal care from doctor, nurse, or midwife for last birth 0.901 0.022 233 218 1.107 0.024 0.857 0.944 Delivery in health facility 0.421 0.044 316 296 1.381 0.106 0.332 0.510 Last birth protected against tetanus 0.716 0.037 233 218 1.246 0.051 0.642 0.790 Delivery assistance from doctor, nurse, midwife 0.819 0.041 316 296 1.487 0.050 0.737 0.901 Postnatal care from doctor, nurse, or midwife for last birth 0.818 0.037 233 218 1.472 0.046 0.743 0.892 Child had diarrhea in the past 2 weeks 0.107 0.021 310 290 1.061 0.192 0.066 0.148 Sought treatment for diarrhea 0.451 0.097 33 31 1.103 0.214 0.258 0.645 Child treated with oral rehydration salts (ORS) 0.633 0.115 33 31 1.289 0.182 0.402 0.863 Child had acute respiratory illness (ARI) in past 2 weeks 0.049 0.014 310 290 1.113 0.295 0.020 0.077 Sought treatment for ARI from health facility/provider 0.600 0.140 15 14 1.013 0.233 0.320 0.881 Vitamin A supplementation in past 6 months 0.705 0.042 286 268 1.291 0.059 0.621 0.789 Received DPT vaccination (3 doses) 0.818 0.051 66 62 1.076 0.062 0.716 0.920 Fully immunized 0.758 0.057 66 62 1.091 0.076 0.643 0.873 Sex with a non-marital/cohabiting partner in past 12 months 0.011 0.006 434 406 1.113 0.500 0.000 0.023 Comprehensive knowledge about HIV 0.161 0.015 657 613 1.062 0.095 0.131 0.192 Ever experienced physical or sexual violence by husband 0.190 0.019 379 340 0.932 0.099 0.153 0.228 Total fertility rate (past 3 years) 3.399 0.258 na 1736 1.135 0.076 2.884 3.914 Neonatal mortality (past 0-9 years) 15.127 4.866 663 620 0.957 0.322 5.395 24.859 Post-neonatal mortality (past 0-9 years) 9.122 3.350 658 615 0.918 0.367 2.422 15.822 Infant mortality (past 0-9 years) 24.249 5.651 664 621 0.917 0.233 12.946 35.551 Child mortality (past 0-9 years) 1.558 1.562 661 617 0.998 1.003 0.000 4.682 Under-five mortality (past 0-9 years) 25.769 6.117 665 622 0.960 0.237 13.536 38.002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 242 | Appendix B Table B.8 Sampling errors for II - Cagayan Valley sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.004 0.003 523 382 0.964 0.681 0.000 0.009 At least some secondary education 0.785 0.026 523 382 1.463 0.034 0.732 0.838 Children ever born to women age 40-49 3.804 0.215 137 100 1.072 0.057 3.374 4.234 Currently using any method 0.543 0.027 374 273 1.037 0.049 0.489 0.596 Currently using a modern method 0.462 0.028 374 273 1.082 0.060 0.407 0.518 Currently using pill 0.270 0.023 374 273 0.997 0.085 0.224 0.316 Currently using IUD 0.070 0.015 374 273 1.170 0.221 0.039 0.101 Currently using male condoms 0.011 0.005 374 273 0.951 0.476 0.001 0.021 Currently using injectables 0.037 0.012 374 273 1.275 0.336 0.012 0.062 Currently using female sterilization 0.075 0.013 374 273 0.981 0.179 0.048 0.102 Currently using withdrawal 0.064 0.014 374 273 1.077 0.213 0.037 0.092 Currently using rhythm 0.016 0.007 374 273 1.096 0.442 0.002 0.031 Obtained method from public sector source 0.414 0.038 176 128 1.027 0.092 0.338 0.491 Want no more children or sterilized 0.667 0.024 374 273 1.003 0.037 0.618 0.716 Ideal number of children 2.800 0.064 510 372 1.428 0.023 2.672 2.929 Unmet need for family planning 0.198 0.022 374 273 1.084 0.113 0.153 0.243 Prenatal care from doctor, nurse, or midwife for last birth 0.948 0.015 194 142 0.927 0.016 0.918 0.977 Delivery in health facility 0.289 0.040 289 212 1.319 0.139 0.209 0.369 Last birth protected against tetanus 0.875 0.023 194 142 0.976 0.026 0.829 0.921 Delivery assistance from doctor, nurse, midwife 0.592 0.067 289 212 1.852 0.114 0.457 0.726 Postnatal care from doctor, nurse, or midwife for last birth 0.661 0.053 194 142 1.569 0.081 0.554 0.768 Child had diarrhea in the past 2 weeks 0.076 0.015 275 201 0.935 0.201 0.046 0.107 Sought treatment for diarrhea 0.424 0.125 21 15 1.094 0.296 0.173 0.674 Child treated with oral rehydration salts (ORS) 0.424 0.125 21 15 1.094 0.296 0.173 0.674 Child had acute respiratory illness (ARI) in past 2 weeks 0.029 0.011 275 201 1.087 0.377 0.007 0.051 Sought treatment for ARI from health facility/provider 0.756 0.154 8 6 1.015 0.204 0.447 1.065 Vitamin A supplementation in past 6 months 0.762 0.028 256 187 0.872 0.037 0.705 0.818 Received DPT vaccination (3 doses) 0.825 0.047 63 46 0.908 0.056 0.731 0.918 Fully immunized 0.793 0.049 63 46 0.910 0.062 0.694 0.891 Sex with a non-marital/cohabiting partner in past 12 months 0.000 0.000 366 267 na na 0.000 0.000 Comprehensive knowledge about HIV 0.134 0.025 523 382 1.687 0.188 0.084 0.185 Ever experienced physical or sexual violence by husband 0.190 0.020 333 213 0.942 0.107 0.149 0.230 Total fertility rate (past 3 years) 4.094 0.368 na 1069 1.418 0.090 3.358 4.831 Neonatal mortality (past 0-9 years) 24.356 7.373 531 388 0.934 0.303 9.610 39.101 Post-neonatal mortality (past 0-9 years) 13.438 5.097 528 386 1.031 0.379 3.244 23.633 Infant mortality (past 0-9 years) 37.794 8.483 531 388 0.924 0.224 20.829 54.760 Child mortality (past 0-9 years) 8.318 3.815 515 376 0.930 0.459 0.688 15.948 Under-five mortality (past 0-9 years) 45.798 9.527 531 388 0.960 0.208 26.745 64.851 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 243 Table B.9 Sampling errors for III - Central Luzon sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.002 0.001 1157 1486 0.977 0.575 0.000 0.005 At least some secondary education 0.814 0.021 1157 1486 1.795 0.025 0.773 0.856 Children ever born to women age 40-49 3.557 0.186 260 335 1.274 0.052 3.186 3.929 Currently using any method 0.578 0.019 701 897 1.010 0.033 0.540 0.616 Currently using a modern method 0.403 0.023 701 897 1.215 0.056 0.358 0.448 Currently using pill 0.159 0.014 701 897 0.980 0.085 0.132 0.186 Currently using IUD 0.017 0.005 701 897 1.086 0.313 0.006 0.028 Currently using male condoms 0.019 0.005 701 897 1.020 0.279 0.008 0.029 Currently using injectables 0.033 0.007 701 897 0.979 0.201 0.020 0.046 Currently using female sterilization 0.172 0.018 701 897 1.259 0.105 0.136 0.208 Currently using withdrawal 0.134 0.014 701 897 1.116 0.107 0.105 0.162 Currently using rhythm 0.040 0.010 701 897 1.325 0.246 0.020 0.059 Obtained method from public sector source 0.466 0.031 302 382 1.078 0.067 0.404 0.528 Want no more children or sterilized 0.622 0.019 701 897 1.019 0.030 0.584 0.659 Ideal number of children 2.803 0.047 1156 1485 1.434 0.017 2.710 2.897 Unmet need for family planning 0.176 0.015 701 897 1.071 0.087 0.146 0.207 Prenatal care from doctor, nurse, or midwife for last birth 0.956 0.012 363 468 1.117 0.013 0.932 0.980 Delivery in health facility 0.563 0.038 485 629 1.444 0.068 0.487 0.639 Last birth protected against tetanus 0.773 0.025 363 468 1.138 0.032 0.723 0.823 Delivery assistance from doctor, nurse, midwife 0.819 0.035 485 629 1.662 0.042 0.750 0.888 Postnatal care from doctor, nurse, or midwife for last birth 0.775 0.035 363 468 1.586 0.045 0.706 0.845 Child had diarrhea in the past 2 weeks 0.108 0.019 474 613 1.269 0.180 0.069 0.147 Sought treatment for diarrhea 0.433 0.085 47 66 1.182 0.196 0.263 0.603 Child treated with oral rehydration salts (ORS) 0.510 0.058 47 66 0.791 0.113 0.395 0.626 Child had acute respiratory illness (ARI) in past 2 weeks 0.040 0.009 474 613 0.957 0.232 0.022 0.059 Sought treatment for ARI from health facility/provider 0.484 0.130 19 25 1.133 0.268 0.224 0.743 Vitamin A supplementation in past 6 months 0.808 0.025 428 557 1.165 0.031 0.758 0.859 Received DPT vaccination (3 doses) 0.829 0.037 99 136 1.008 0.045 0.755 0.903 Fully immunized 0.779 0.043 99 136 1.065 0.055 0.693 0.865 Sex with a non-marital/cohabiting partner in past 12 months 0.047 0.017 709 907 2.157 0.365 0.013 0.082 Comprehensive knowledge about HIV 0.221 0.014 1157 1486 1.132 0.062 0.194 0.249 Ever experienced physical or sexual violence by husband 0.139 0.015 571 748 1.055 0.110 0.109 0.170 Total fertility rate (past 3 years) 3.048 0.236 na 4183 1.237 0.077 2.576 3.519 Neonatal mortality (past 0-9 years) 14.430 3.262 980 1278 0.876 0.226 7.905 20.955 Post-neonatal mortality (past 0-9 years) 9.666 5.053 986 1288 1.547 0.523 0.000 19.772 Infant mortality (past 0-9 years) 24.096 6.836 982 1281 1.258 0.284 10.423 37.769 Child mortality (past 0-9 years) 4.911 2.835 986 1283 1.229 0.577 0.000 10.581 Under-five mortality (past 0-9 years) 28.889 6.588 984 1283 1.150 0.228 15.713 42.065 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 244 | Appendix B Table B.10 Sampling errors for IVA - CALABARZON sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.001 0.001 1325 1808 0.949 0.711 0.000 0.003 At least some secondary education 0.865 0.015 1325 1808 1.555 0.017 0.836 0.894 Children ever born to women age 40-49 3.492 0.195 262 350 1.236 0.056 3.103 3.882 Currently using any method 0.468 0.020 795 1089 1.147 0.043 0.428 0.509 Currently using a modern method 0.324 0.021 795 1089 1.270 0.065 0.282 0.366 Currently using pill 0.140 0.014 795 1089 1.151 0.101 0.112 0.169 Currently using IUD 0.020 0.006 795 1089 1.168 0.293 0.008 0.031 Currently using male condoms 0.025 0.005 795 1089 0.896 0.198 0.015 0.035 Currently using injectables 0.033 0.006 795 1089 0.914 0.175 0.022 0.045 Currently using female sterilization 0.100 0.013 795 1089 1.266 0.135 0.073 0.127 Currently using withdrawal 0.101 0.013 795 1089 1.191 0.126 0.076 0.127 Currently using rhythm 0.043 0.012 795 1089 1.705 0.285 0.019 0.068 Obtained method from public sector source 0.417 0.033 268 353 1.099 0.080 0.350 0.483 Want no more children or sterilized 0.608 0.018 795 1089 1.037 0.030 0.572 0.644 Ideal number of children 2.635 0.037 1319 1801 1.264 0.014 2.560 2.709 Unmet need for family planning 0.236 0.018 795 1089 1.225 0.078 0.199 0.273 Prenatal care from doctor, nurse, or midwife for last birth 0.954 0.014 436 602 1.442 0.015 0.926 0.983 Delivery in health facility 0.532 0.038 590 810 1.571 0.071 0.457 0.607 Last birth protected against tetanus 0.679 0.028 436 602 1.272 0.042 0.622 0.735 Delivery assistance from doctor, nurse, midwife 0.745 0.032 590 810 1.477 0.043 0.681 0.809 Postnatal care from doctor, nurse, or midwife for last birth 0.643 0.036 436 602 1.589 0.056 0.571 0.716 Child had diarrhea in the past 2 weeks 0.091 0.013 583 801 0.988 0.143 0.065 0.117 Sought treatment for diarrhea 0.377 0.092 52 73 1.261 0.243 0.194 0.560 Child treated with oral rehydration salts (ORS) 0.615 0.077 52 73 1.043 0.125 0.462 0.768 Child had acute respiratory illness (ARI) in past 2 weeks 0.021 0.006 583 801 1.057 0.299 0.008 0.033 Sought treatment for ARI from health facility/provider 0.631 0.150 12 17 1.083 0.237 0.332 0.930 Vitamin A supplementation in past 6 months 0.733 0.024 528 726 1.135 0.033 0.685 0.782 Received DPT vaccination (3 doses) 0.912 0.030 123 164 1.146 0.033 0.852 0.971 Fully immunized 0.874 0.033 123 164 1.109 0.038 0.808 0.941 Sex with a non-marital/cohabiting partner in past 12 months 0.024 0.006 781 1068 1.055 0.242 0.012 0.035 Comprehensive knowledge about HIV 0.258 0.020 1325 1808 1.679 0.078 0.217 0.298 Ever experienced physical or sexual violence by husband 0.110 0.016 642 892 1.293 0.145 0.078 0.142 Total fertility rate (past 3 years) 3.041 0.155 na 5084 1.089 0.051 2.731 3.351 Neonatal mortality (past 0-9 years) 12.392 3.363 1157 1575 0.980 0.271 5.666 19.117 Post-neonatal mortality (past 0-9 years) 8.036 2.318 1160 1578 0.892 0.288 3.400 12.671 Infant mortality (past 0-9 years) 20.427 4.091 1158 1576 0.969 0.200 12.245 28.610 Child mortality (past 0-9 years) 8.021 2.454 1130 1532 0.942 0.306 3.113 12.930 Under-five mortality (past 0-9 years) 28.285 4.753 1158 1576 0.983 0.168 18.780 37.790 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 245 Table B.11 Sampling errors for IVB - MIMAROPA sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.058 0.026 537 340 2.552 0.448 0.006 0.109 At least some secondary education 0.667 0.041 537 340 2.009 0.061 0.585 0.749 Children ever born to women age 40-49 5.170 0.314 115 72 1.110 0.061 4.543 5.798 Currently using any method 0.536 0.028 387 241 1.086 0.051 0.480 0.591 Currently using a modern method 0.361 0.033 387 241 1.353 0.092 0.295 0.427 Currently using pill 0.224 0.027 387 241 1.264 0.120 0.170 0.277 Currently using IUD 0.032 0.010 387 241 1.071 0.301 0.013 0.051 Currently using male condoms 0.023 0.007 387 241 0.875 0.290 0.010 0.036 Currently using injectables 0.014 0.006 387 241 1.035 0.445 0.002 0.026 Currently using female sterilization 0.064 0.014 387 241 1.161 0.227 0.035 0.093 Currently using withdrawal 0.116 0.018 387 241 1.117 0.157 0.080 0.152 Currently using rhythm 0.043 0.010 387 241 0.986 0.236 0.023 0.063 Obtained method from public sector source 0.476 0.050 138 86 1.169 0.105 0.376 0.576 Want no more children or sterilized 0.632 0.030 387 241 1.219 0.047 0.572 0.692 Ideal number of children 3.035 0.111 534 338 1.615 0.037 2.813 3.257 Unmet need for family planning 0.219 0.026 387 241 1.242 0.120 0.166 0.271 Prenatal care from doctor, nurse, or midwife for last birth 0.854 0.036 241 151 1.564 0.042 0.783 0.925 Delivery in health facility 0.269 0.050 335 209 1.789 0.186 0.169 0.368 Last birth protected against tetanus 0.746 0.034 241 151 1.227 0.046 0.677 0.815 Delivery assistance from doctor, nurse, midwife 0.391 0.051 335 209 1.621 0.130 0.289 0.493 Postnatal care from doctor, nurse, or midwife for last birth 0.406 0.052 241 151 1.635 0.128 0.302 0.509 Child had diarrhea in the past 2 weeks 0.115 0.018 323 202 0.897 0.155 0.079 0.151 Sought treatment for diarrhea 0.200 0.064 36 23 0.930 0.318 0.073 0.327 Child treated with oral rehydration salts (ORS) 0.416 0.122 36 23 1.273 0.292 0.173 0.659 Child had acute respiratory illness (ARI) in past 2 weeks 0.077 0.015 323 202 0.890 0.189 0.048 0.107 Sought treatment for ARI from health facility/provider 0.409 0.107 25 16 0.980 0.261 0.196 0.622 Vitamin A supplementation in past 6 months 0.718 0.029 293 184 0.954 0.041 0.659 0.776 Received DPT vaccination (3 doses) 0.819 0.045 71 44 0.979 0.055 0.728 0.909 Fully immunized 0.706 0.063 71 44 1.154 0.090 0.579 0.833 Sex with a non-marital/cohabiting partner in past 12 months 0.005 0.004 386 241 0.977 0.703 0.000 0.012 Comprehensive knowledge about HIV 0.213 0.028 537 340 1.560 0.130 0.158 0.268 Ever experienced physical or sexual violence by husband 0.288 0.030 339 192 1.214 0.104 0.228 0.347 Total fertility rate (past 3 years) 4.282 0.405 na 960 1.471 0.095 3.472 5.091 Neonatal mortality (past 0-9 years) 22.709 6.782 690 432 0.850 0.299 9.146 36.273 Post-neonatal mortality (past 0-9 years) 14.146 4.726 693 434 1.069 0.334 4.694 23.597 Infant mortality (past 0-9 years) 36.855 8.859 690 432 0.942 0.240 19.136 54.574 Child mortality (past 0-9 years) 12.996 3.530 679 425 0.821 0.272 5.936 20.057 Under-five mortality (past 0-9 years) 49.372 10.398 692 433 0.994 0.211 28.577 70.168 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 246 | Appendix B Table B.12 Sampling errors for V - Bicol Region sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.003 0.002 768 755 1.012 0.688 0.000 0.007 At least some secondary education 0.734 0.024 768 755 1.492 0.032 0.687 0.782 Children ever born to women age 40-49 4.787 0.280 179 176 1.240 0.059 4.226 5.348 Currently using any method 0.394 0.021 479 470 0.950 0.054 0.352 0.437 Currently using a modern method 0.242 0.017 479 470 0.887 0.072 0.207 0.276 Currently using pill 0.109 0.017 479 470 1.219 0.159 0.074 0.144 Currently using IUD 0.010 0.005 479 470 1.138 0.517 0.000 0.020 Currently using male condoms 0.019 0.006 479 470 0.959 0.315 0.007 0.031 Currently using injectables 0.034 0.007 479 470 0.877 0.213 0.020 0.049 Currently using female sterilization 0.065 0.010 479 470 0.875 0.152 0.045 0.084 Currently using withdrawal 0.075 0.012 479 470 1.027 0.164 0.051 0.100 Currently using rhythm 0.063 0.009 479 470 0.856 0.151 0.044 0.082 Obtained method from public sector source 0.474 0.043 120 117 0.936 0.090 0.388 0.560 Want no more children or sterilized 0.697 0.019 479 470 0.916 0.028 0.658 0.735 Ideal number of children 2.782 0.056 762 749 1.380 0.020 2.669 2.895 Unmet need for family planning 0.322 0.019 479 470 0.899 0.060 0.284 0.361 Prenatal care from doctor, nurse, or midwife for last birth 0.920 0.019 286 280 1.210 0.021 0.881 0.959 Delivery in health facility 0.324 0.033 430 421 1.256 0.103 0.257 0.391 Last birth protected against tetanus 0.810 0.021 286 280 0.904 0.026 0.768 0.852 Delivery assistance from doctor, nurse, midwife 0.499 0.038 430 421 1.307 0.077 0.422 0.575 Postnatal care from doctor, nurse, or midwife for last birth 0.527 0.037 286 280 1.250 0.070 0.453 0.601 Child had diarrhea in the past 2 weeks 0.050 0.011 418 410 0.966 0.222 0.028 0.072 Sought treatment for diarrhea 0.288 0.094 21 20 0.913 0.326 0.100 0.476 Child treated with oral rehydration salts (ORS) 0.477 0.124 21 20 1.039 0.260 0.229 0.725 Child had acute respiratory illness (ARI) in past 2 weeks 0.069 0.011 418 410 0.800 0.162 0.047 0.092 Sought treatment for ARI from health facility/provider 0.493 0.113 29 28 1.217 0.229 0.268 0.719 Vitamin A supplementation in past 6 months 0.780 0.028 379 371 1.116 0.036 0.724 0.836 Received DPT vaccination (3 doses) 0.799 0.044 84 82 1.001 0.055 0.710 0.887 Fully immunized 0.713 0.051 84 82 1.030 0.072 0.611 0.815 Sex with a non-marital/cohabiting partner in past 12 months 0.019 0.006 466 457 0.897 0.298 0.008 0.030 Comprehensive knowledge about HIV 0.253 0.022 768 755 1.373 0.085 0.209 0.296 Ever experienced physical or sexual violence by husband 0.181 0.020 404 385 1.032 0.109 0.141 0.221 Total fertility rate (past 3 years) 4.143 0.277 na 2070 1.203 0.067 3.589 4.698 Neonatal mortality (past 0-9 years) 11.316 3.614 903 885 1.032 0.319 4.088 18.544 Post-neonatal mortality (past 0-9 years) 7.556 3.015 901 883 1.064 0.399 1.527 13.586 Infant mortality (past 0-9 years) 18.872 4.759 903 885 1.085 0.252 9.354 28.390 Child mortality (past 0-9 years) 15.825 4.447 901 883 1.130 0.281 6.930 24.719 Under-five mortality (past 0-9 years) 34.398 6.623 904 886 1.192 0.193 21.152 47.645 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 247 Table B.13 Sampling errors for VI - Western Visayas sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.008 0.005 885 976 1.688 0.639 0.000 0.018 At least some secondary education 0.815 0.024 885 976 1.839 0.030 0.767 0.863 Children ever born to women age 40-49 4.025 0.200 228 251 1.163 0.050 3.626 4.425 Currently using any method 0.519 0.021 568 627 1.019 0.041 0.476 0.562 Currently using a modern method 0.334 0.024 568 627 1.202 0.071 0.286 0.382 Currently using pill 0.185 0.021 568 627 1.278 0.113 0.144 0.227 Currently using IUD 0.035 0.009 568 627 1.200 0.265 0.016 0.053 Currently using male condoms 0.017 0.006 568 627 1.072 0.344 0.005 0.028 Currently using injectables 0.023 0.007 568 627 1.091 0.296 0.010 0.037 Currently using female sterilization 0.070 0.011 568 627 1.005 0.154 0.048 0.091 Currently using withdrawal 0.085 0.014 568 627 1.162 0.160 0.058 0.113 Currently using rhythm 0.094 0.012 568 627 0.966 0.126 0.071 0.118 Obtained method from public sector source 0.409 0.035 193 210 0.974 0.084 0.340 0.479 Want no more children or sterilized 0.712 0.019 568 627 1.013 0.027 0.673 0.750 Ideal number of children 2.752 0.048 884 974 1.187 0.017 2.655 2.848 Unmet need for family planning 0.239 0.017 568 627 0.943 0.071 0.205 0.273 Prenatal care from doctor, nurse, or midwife for last birth 0.946 0.015 297 324 1.117 0.016 0.916 0.975 Delivery in health facility 0.463 0.041 412 452 1.465 0.089 0.380 0.546 Last birth protected against tetanus 0.830 0.023 297 324 1.060 0.028 0.783 0.876 Delivery assistance from doctor, nurse, midwife 0.604 0.049 412 452 1.684 0.081 0.506 0.702 Postnatal care from doctor, nurse, or midwife for last birth 0.620 0.047 297 324 1.651 0.076 0.526 0.714 Child had diarrhea in the past 2 weeks 0.128 0.018 394 432 1.049 0.140 0.092 0.164 Sought treatment for diarrhea 0.361 0.081 49 55 1.108 0.225 0.198 0.524 Child treated with oral rehydration salts (ORS) 0.375 0.076 49 55 1.050 0.202 0.224 0.527 Child had acute respiratory illness (ARI) in past 2 weeks 0.102 0.017 394 432 1.027 0.163 0.069 0.135 Sought treatment for ARI from health facility/provider 0.662 0.101 41 44 1.292 0.152 0.461 0.863 Vitamin A supplementation in past 6 months 0.786 0.022 361 395 0.879 0.028 0.741 0.831 Received DPT vaccination (3 doses) 0.950 0.030 83 91 1.250 0.032 0.890 1.010 Fully immunized 0.915 0.035 83 91 1.136 0.038 0.846 0.985 Sex with a non-marital/cohabiting partner in past 12 months 0.024 0.007 560 617 1.078 0.293 0.010 0.037 Comprehensive knowledge about HIV 0.146 0.012 885 976 1.048 0.085 0.121 0.171 Ever experienced physical or sexual violence by husband 0.184 0.020 487 510 1.135 0.109 0.144 0.224 Total fertility rate (past 3 years) 3.283 0.231 na 2741 1.038 0.070 2.821 3.744 Neonatal mortality (past 0-9 years) 28.245 6.630 832 917 0.950 0.235 14.984 41.506 Post-neonatal mortality (past 0-9 years) 10.588 3.072 830 915 0.922 0.290 4.444 16.731 Infant mortality (past 0-9 years) 38.833 7.304 832 917 0.932 0.188 24.224 53.442 Child mortality (past 0-9 years) 4.709 2.278 841 926 0.955 0.484 0.152 9.266 Under-five mortality (past 0-9 years) 43.359 7.996 833 918 0.974 0.184 27.368 59.351 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 248 | Appendix B Table B.14 Sampling errors for VII - Central Visayas sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.009 0.003 909 983 0.922 0.313 0.004 0.015 At least some secondary education 0.726 0.026 909 983 1.733 0.035 0.675 0.777 Children ever born to women age 40-49 4.032 0.236 181 195 1.245 0.058 3.561 4.504 Currently using any method 0.557 0.024 555 599 1.125 0.043 0.510 0.605 Currently using a modern method 0.355 0.023 555 599 1.122 0.064 0.310 0.401 Currently using pill 0.144 0.017 555 599 1.112 0.115 0.111 0.178 Currently using IUD 0.081 0.015 555 599 1.292 0.185 0.051 0.111 Currently using male condoms 0.036 0.008 555 599 0.987 0.218 0.020 0.051 Currently using injectables 0.019 0.007 555 599 1.133 0.342 0.006 0.033 Currently using female sterilization 0.068 0.011 555 599 1.016 0.160 0.046 0.089 Currently using withdrawal 0.093 0.014 555 599 1.156 0.154 0.064 0.121 Currently using rhythm 0.109 0.012 555 599 0.894 0.109 0.085 0.133 Obtained method from public sector source 0.513 0.034 201 217 0.961 0.066 0.446 0.581 Want no more children or sterilized 0.670 0.020 555 599 0.998 0.030 0.630 0.710 Ideal number of children 2.745 0.068 902 975 1.503 0.025 2.609 2.882 Unmet need for family planning 0.215 0.020 555 599 1.119 0.091 0.176 0.254 Prenatal care from doctor, nurse, or midwife for last birth 0.971 0.011 302 328 1.108 0.011 0.949 0.992 Delivery in health facility 0.457 0.035 423 459 1.211 0.076 0.388 0.527 Last birth protected against tetanus 0.876 0.021 302 328 1.088 0.024 0.835 0.917 Delivery assistance from doctor, nurse, midwife 0.668 0.045 423 459 1.597 0.068 0.578 0.759 Postnatal care from doctor, nurse, or midwife for last birth 0.641 0.037 302 328 1.325 0.057 0.568 0.714 Child had diarrhea in the past 2 weeks 0.080 0.013 408 442 0.917 0.162 0.054 0.105 Sought treatment for diarrhea 0.425 0.094 33 35 1.008 0.222 0.236 0.613 Child treated with oral rehydration salts (ORS) 0.609 0.084 33 35 0.944 0.138 0.442 0.777 Child had acute respiratory illness (ARI) in past 2 weeks 0.078 0.014 408 442 1.019 0.185 0.049 0.106 Sought treatment for ARI from health facility/provider 0.480 0.106 32 34 1.161 0.220 0.268 0.691 Vitamin A supplementation in past 6 months 0.815 0.029 368 398 1.151 0.035 0.757 0.872 Received DPT vaccination (3 doses) 0.923 0.029 90 97 1.033 0.032 0.865 0.981 Fully immunized 0.829 0.044 90 97 1.106 0.053 0.741 0.917 Sex with a non-marital/cohabiting partner in past 12 months 0.036 0.010 560 605 1.203 0.262 0.017 0.056 Comprehensive knowledge about HIV 0.234 0.021 909 983 1.472 0.088 0.193 0.276 Ever experienced physical or sexual violence by husband 0.267 0.025 447 495 1.177 0.092 0.218 0.316 Total fertility rate (past 3 years) 3.225 0.214 na 2716 1.191 0.066 2.796 3.653 Neonatal mortality (past 0-9 years) 22.264 6.095 816 884 1.039 0.274 10.075 34.453 Post-neonatal mortality (past 0-9 years) 8.587 3.479 816 884 1.076 0.405 1.629 15.546 Infant mortality (past 0-9 years) 30.851 7.127 816 884 1.114 0.231 16.597 45.106 Child mortality (past 0-9 years) 4.055 2.292 821 889 1.014 0.565 0.000 8.639 Under-five mortality (past 0-9 years) 34.782 7.664 816 884 1.148 0.220 19.454 50.109 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 249 Table B.15 Sampling errors for VIII - Eastern Visayas sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.008 0.003 609 488 0.933 0.418 0.001 0.015 At least some secondary education 0.689 0.029 609 488 1.559 0.042 0.631 0.748 Children ever born to women age 40-49 4.951 0.287 141 113 1.119 0.058 4.378 5.525 Currently using any method 0.475 0.024 421 337 0.998 0.051 0.426 0.524 Currently using a modern method 0.280 0.020 421 337 0.920 0.072 0.240 0.320 Currently using pill 0.145 0.015 421 337 0.853 0.101 0.115 0.174 Currently using IUD 0.028 0.009 421 337 1.161 0.331 0.010 0.047 Currently using male condoms 0.014 0.006 421 337 0.985 0.401 0.003 0.025 Currently using injectables 0.012 0.005 421 337 0.926 0.411 0.002 0.022 Currently using female sterilization 0.076 0.013 421 337 0.973 0.166 0.051 0.101 Currently using withdrawal 0.115 0.014 421 337 0.918 0.124 0.086 0.143 Currently using rhythm 0.071 0.014 421 337 1.130 0.200 0.042 0.099 Obtained method from public sector source 0.480 0.049 119 95 1.058 0.101 0.383 0.578 Want no more children or sterilized 0.611 0.031 421 337 1.296 0.050 0.550 0.673 Ideal number of children 3.080 0.082 596 477 1.305 0.027 2.917 3.243 Unmet need for family planning 0.276 0.021 421 337 0.964 0.076 0.234 0.318 Prenatal care from doctor, nurse, or midwife for last birth 0.902 0.028 245 196 1.491 0.031 0.846 0.959 Delivery in health facility 0.337 0.048 354 283 1.506 0.142 0.242 0.432 Last birth protected against tetanus 0.820 0.033 245 196 1.331 0.040 0.755 0.886 Delivery assistance from doctor, nurse, midwife 0.431 0.047 354 283 1.450 0.110 0.336 0.525 Postnatal care from doctor, nurse, or midwife for last birth 0.443 0.046 245 196 1.456 0.104 0.351 0.536 Child had diarrhea in the past 2 weeks 0.095 0.019 338 271 1.130 0.196 0.057 0.132 Sought treatment for diarrhea 0.185 0.085 32 26 1.126 0.460 0.015 0.356 Child treated with oral rehydration salts (ORS) 0.371 0.093 32 26 1.013 0.249 0.186 0.556 Child had acute respiratory illness (ARI) in past 2 weeks 0.056 0.013 338 271 0.936 0.228 0.030 0.081 Sought treatment for ARI from health facility/provider 0.419 0.128 19 15 1.050 0.306 0.163 0.675 Vitamin A supplementation in past 6 months 0.787 0.029 304 243 1.034 0.037 0.728 0.846 Received DPT vaccination (3 doses) 0.849 0.036 66 53 0.805 0.042 0.778 0.920 Fully immunized 0.803 0.046 66 53 0.935 0.057 0.711 0.895 Sex with a non-marital/cohabiting partner in past 12 months 0.024 0.007 419 335 0.961 0.302 0.009 0.038 Comprehensive knowledge about HIV 0.232 0.027 609 488 1.599 0.118 0.177 0.287 Ever experienced physical or sexual violence by husband 0.234 0.023 363 270 1.043 0.099 0.188 0.281 Total fertility rate (past 3 years) 4.296 0.272 na 1356 1.125 0.063 3.752 4.840 Neonatal mortality (past 0-9 years) 22.066 6.834 723 579 1.121 0.310 8.399 35.733 Post-neonatal mortality (past 0-9 years) 23.268 7.093 724 580 1.331 0.305 9.082 37.455 Infant mortality (past 0-9 years) 45.334 8.417 723 579 1.048 0.186 28.500 62.169 Child mortality (past 0-9 years) 19.048 5.231 752 602 1.018 0.275 8.587 29.509 Under-five mortality (past 0-9 years) 63.519 10.843 726 581 1.108 0.171 41.832 85.205 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 250 | Appendix B Table B.16 Sampling errors for IX - Zamboanga Peninsula sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.027 0.012 637 505 1.814 0.430 0.004 0.051 At least some secondary education 0.706 0.037 637 505 2.049 0.053 0.632 0.780 Children ever born to women age 40-49 4.298 0.330 138 110 1.462 0.077 3.638 4.958 Currently using any method 0.438 0.037 397 316 1.492 0.085 0.363 0.512 Currently using a modern method 0.286 0.030 397 316 1.321 0.105 0.226 0.346 Currently using pill 0.186 0.025 397 316 1.258 0.132 0.137 0.235 Currently using IUD 0.031 0.010 397 316 1.097 0.309 0.012 0.050 Currently using male condoms 0.013 0.006 397 316 0.960 0.416 0.002 0.024 Currently using injectables 0.014 0.006 397 316 0.939 0.391 0.003 0.026 Currently using female sterilization 0.042 0.012 397 316 1.191 0.287 0.018 0.065 Currently using withdrawal 0.054 0.014 397 316 1.205 0.255 0.026 0.081 Currently using rhythm 0.086 0.015 397 316 1.058 0.173 0.057 0.116 Obtained method from public sector source 0.414 0.049 118 94 1.068 0.118 0.316 0.511 Want no more children or sterilized 0.584 0.027 397 316 1.101 0.047 0.529 0.638 Ideal number of children 2.905 0.100 626 497 1.756 0.035 2.704 3.105 Unmet need for family planning 0.274 0.025 397 316 1.103 0.090 0.225 0.324 Prenatal care from doctor, nurse, or midwife for last birth 0.859 0.048 239 189 2.135 0.056 0.763 0.956 Delivery in health facility 0.285 0.047 329 261 1.633 0.167 0.190 0.380 Last birth protected against tetanus 0.744 0.044 239 189 1.564 0.060 0.656 0.833 Delivery assistance from doctor, nurse, midwife 0.384 0.056 329 261 1.726 0.145 0.273 0.495 Postnatal care from doctor, nurse, or midwife for last birth 0.382 0.051 239 189 1.617 0.134 0.280 0.484 Child had diarrhea in the past 2 weeks 0.074 0.016 325 258 1.052 0.212 0.042 0.105 Sought treatment for diarrhea 0.242 0.079 24 19 0.887 0.325 0.085 0.400 Child treated with oral rehydration salts (ORS) 0.407 0.085 24 19 0.822 0.208 0.237 0.577 Child had acute respiratory illness (ARI) in past 2 weeks 0.033 0.012 325 258 1.201 0.362 0.009 0.057 Sought treatment for ARI from health facility/provider 0.823 0.105 11 9 0.904 0.128 0.612 1.033 Vitamin A supplementation in past 6 months 0.701 0.051 287 228 1.563 0.073 0.598 0.803 Received DPT vaccination (3 doses) 0.860 0.055 65 51 1.266 0.064 0.751 0.970 Fully immunized 0.815 0.052 65 51 1.073 0.064 0.711 0.918 Sex with a non-marital/cohabiting partner in past 12 months 0.034 0.010 404 322 1.106 0.296 0.014 0.053 Comprehensive knowledge about HIV 0.207 0.026 637 505 1.619 0.126 0.155 0.259 Ever experienced physical or sexual violence by husband 0.167 0.018 359 274 0.935 0.110 0.131 0.204 Total fertility rate (past 3 years) 3.825 0.269 na 1398 0.968 0.070 3.288 4.363 Neonatal mortality (past 0-9 years) 6.250 2.917 647 515 0.942 0.467 0.416 12.084 Post-neonatal mortality (past 0-9 years) 7.915 3.271 645 513 0.891 0.413 1.373 14.457 Infant mortality (past 0-9 years) 14.165 3.889 647 515 0.794 0.275 6.386 21.944 Child mortality (past 0-9 years) 17.255 4.316 626 498 0.828 0.250 8.622 25.887 Under-five mortality (past 0-9 years) 31.175 5.561 650 517 0.716 0.178 20.054 42.296 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 251 Table B.17 Sampling errors for X - Northern Mindanao sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.018 0.006 681 585 1.153 0.325 0.006 0.030 At least some secondary education 0.736 0.043 681 585 2.535 0.059 0.650 0.822 Children ever born to women age 40-49 4.125 0.158 159 136 0.770 0.038 3.808 4.441 Currently using any method 0.532 0.031 436 373 1.293 0.058 0.470 0.594 Currently using a modern method 0.385 0.026 436 373 1.113 0.068 0.333 0.436 Currently using pill 0.184 0.031 436 373 1.678 0.170 0.122 0.247 Currently using IUD 0.105 0.020 436 373 1.328 0.186 0.066 0.145 Currently using male condoms 0.014 0.006 436 373 1.080 0.442 0.002 0.025 Currently using injectables 0.007 0.004 436 373 0.968 0.545 0.000 0.015 Currently using female sterilization 0.059 0.012 436 373 1.038 0.200 0.035 0.082 Currently using withdrawal 0.061 0.015 436 373 1.289 0.244 0.031 0.090 Currently using rhythm 0.085 0.014 436 373 1.025 0.161 0.057 0.112 Obtained method from public sector source 0.547 0.047 162 139 1.208 0.087 0.452 0.642 Want no more children or sterilized 0.636 0.027 436 373 1.149 0.042 0.583 0.689 Ideal number of children 2.882 0.078 664 570 1.335 0.027 2.725 3.039 Unmet need for family planning 0.187 0.018 436 373 0.937 0.094 0.152 0.222 Prenatal care from doctor, nurse, or midwife for last birth 0.922 0.030 231 198 1.694 0.032 0.863 0.982 Delivery in health facility 0.333 0.054 329 282 1.746 0.163 0.224 0.442 Last birth protected against tetanus 0.787 0.040 231 198 1.477 0.051 0.707 0.867 Delivery assistance from doctor, nurse, midwife 0.478 0.067 329 282 1.976 0.140 0.344 0.612 Postnatal care from doctor, nurse, or midwife for last birth 0.466 0.063 231 198 1.910 0.135 0.340 0.591 Child had diarrhea in the past 2 weeks 0.066 0.017 322 276 1.006 0.257 0.032 0.100 Sought treatment for diarrhea 0.134 0.067 21 18 0.973 0.501 0.000 0.269 Child treated with oral rehydration salts (ORS) 0.242 0.069 21 18 0.721 0.285 0.104 0.380 Child had acute respiratory illness (ARI) in past 2 weeks 0.068 0.016 322 276 0.949 0.237 0.036 0.100 Sought treatment for ARI from health facility/provider 0.327 0.138 22 19 1.102 0.423 0.051 0.603 Vitamin A supplementation in past 6 months 0.748 0.049 290 249 1.596 0.066 0.649 0.846 Received DPT vaccination (3 doses) 0.918 0.032 65 56 0.933 0.035 0.855 0.982 Fully immunized 0.830 0.037 65 56 0.786 0.044 0.757 0.904 Sex with a non-marital/cohabiting partner in past 12 months 0.032 0.009 436 373 1.094 0.289 0.013 0.050 Comprehensive knowledge about HIV 0.160 0.014 681 585 1.016 0.089 0.131 0.188 Ever experienced physical or sexual violence by husband 0.186 0.028 343 297 1.352 0.153 0.129 0.243 Total fertility rate (past 3 years) 3.264 0.255 na 1615 1.210 0.078 2.753 3.774 Neonatal mortality (past 0-9 years) 11.186 3.252 629 539 0.724 0.291 4.682 17.689 Post-neonatal mortality (past 0-9 years) 8.232 3.204 627 537 0.859 0.389 1.823 14.641 Infant mortality (past 0-9 years) 19.418 4.720 629 539 0.787 0.243 9.978 28.858 Child mortality (past 0-9 years) 7.821 3.819 620 532 0.936 0.488 0.183 15.459 Under-five mortality (past 0-9 years) 27.087 6.671 630 540 0.822 0.246 13.746 40.428 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 252 | Appendix B Table B.18 Sampling errors for XI - Davao Peninsula sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.011 0.004 715 618 1.084 0.390 0.002 0.019 At least some secondary education 0.748 0.025 715 618 1.567 0.034 0.697 0.799 Children ever born to women age 40-49 4.507 0.194 155 134 0.947 0.043 4.120 4.895 Currently using any method 0.602 0.024 471 406 1.062 0.040 0.554 0.650 Currently using a modern method 0.447 0.024 471 406 1.045 0.054 0.399 0.495 Currently using pill 0.212 0.017 471 406 0.919 0.082 0.177 0.247 Currently using IUD 0.084 0.015 471 406 1.176 0.179 0.054 0.114 Currently using male condoms 0.028 0.007 471 406 0.906 0.246 0.014 0.042 Currently using injectables 0.025 0.007 471 406 1.019 0.291 0.011 0.040 Currently using female sterilization 0.096 0.016 471 406 1.197 0.170 0.063 0.128 Currently using withdrawal 0.048 0.009 471 406 0.930 0.190 0.030 0.067 Currently using rhythm 0.100 0.012 471 406 0.846 0.117 0.077 0.123 Obtained method from public sector source 0.470 0.035 215 186 1.020 0.074 0.400 0.539 Want no more children or sterilized 0.638 0.024 471 406 1.097 0.038 0.589 0.686 Ideal number of children 2.723 0.044 713 617 0.912 0.016 2.634 2.812 Unmet need for family planning 0.148 0.016 471 406 0.949 0.105 0.117 0.179 Prenatal care from doctor, nurse, or midwife for last birth 0.936 0.018 260 224 1.197 0.019 0.899 0.972 Delivery in health facility 0.424 0.050 342 295 1.583 0.118 0.324 0.524 Last birth protected against tetanus 0.859 0.020 260 224 0.923 0.023 0.819 0.899 Delivery assistance from doctor, nurse, midwife 0.514 0.049 342 295 1.553 0.096 0.416 0.613 Postnatal care from doctor, nurse, or midwife for last birth 0.507 0.046 260 224 1.478 0.091 0.415 0.599 Child had diarrhea in the past 2 weeks 0.055 0.012 330 284 0.859 0.218 0.031 0.079 Sought treatment for diarrhea 0.342 0.120 18 16 1.017 0.351 0.102 0.582 Child treated with oral rehydration salts (ORS) 0.342 0.116 18 16 0.979 0.338 0.110 0.573 Child had acute respiratory illness (ARI) in past 2 weeks 0.052 0.014 330 284 1.093 0.268 0.024 0.081 Sought treatment for ARI from health facility/provider 0.296 0.120 17 15 1.067 0.406 0.055 0.536 Vitamin A supplementation in past 6 months 0.841 0.023 294 253 0.953 0.027 0.795 0.886 Received DPT vaccination (3 doses) 0.889 0.044 62 53 1.109 0.050 0.801 0.978 Fully immunized 0.841 0.054 62 53 1.153 0.064 0.733 0.948 Sex with a non-marital/cohabiting partner in past 12 months 0.037 0.012 475 410 1.344 0.317 0.013 0.060 Comprehensive knowledge about HIV 0.165 0.015 715 618 1.081 0.091 0.135 0.195 Ever experienced physical or sexual violence by husband 0.234 0.019 411 337 0.915 0.082 0.196 0.272 Total fertility rate (past 3 years) 3.285 0.202 na 1728 0.813 0.061 2.881 3.688 Neonatal mortality (past 0-9 years) 28.752 7.727 681 587 1.018 0.269 13.298 44.206 Post-neonatal mortality (past 0-9 years) 5.731 2.693 690 595 0.914 0.470 0.345 11.117 Infant mortality (past 0-9 years) 34.483 8.230 681 587 0.935 0.239 18.024 50.942 Child mortality (past 0-9 years) 9.513 4.368 676 582 1.116 0.459 0.777 18.249 Under-five mortality (past 0-9 years) 43.668 10.472 682 588 1.100 0.240 22.723 64.613 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 253 Table B.19 Sampling errors for XII - SOCCSKSARGEN sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.031 0.008 584 480 1.134 0.264 0.014 0.047 At least some secondary education 0.738 0.035 584 480 1.903 0.047 0.668 0.807 Children ever born to women age 40-49 4.544 0.209 131 107 0.998 0.046 4.127 4.961 Currently using any method 0.551 0.030 414 338 1.207 0.054 0.492 0.611 Currently using a modern method 0.414 0.032 414 338 1.310 0.077 0.351 0.478 Currently using pill 0.192 0.022 414 338 1.148 0.116 0.147 0.236 Currently using IUD 0.058 0.015 414 338 1.268 0.251 0.029 0.088 Currently using male condoms 0.019 0.008 414 338 1.192 0.420 0.003 0.035 Currently using injectables 0.029 0.009 414 338 1.105 0.315 0.011 0.047 Currently using female sterilization 0.116 0.020 414 338 1.277 0.174 0.076 0.156 Currently using withdrawal 0.061 0.014 414 338 1.191 0.230 0.033 0.089 Currently using rhythm 0.071 0.011 414 338 0.839 0.149 0.050 0.092 Obtained method from public sector source 0.534 0.039 175 142 1.028 0.073 0.456 0.611 Want no more children or sterilized 0.654 0.026 414 338 1.104 0.039 0.603 0.706 Ideal number of children 2.996 0.108 582 478 1.560 0.036 2.780 3.212 Unmet need for family planning 0.218 0.022 414 338 1.096 0.102 0.174 0.263 Prenatal care from doctor, nurse, or midwife for last birth 0.861 0.032 218 178 1.378 0.038 0.797 0.926 Delivery in health facility 0.235 0.036 299 245 1.314 0.153 0.163 0.307 Last birth protected against tetanus 0.810 0.031 218 178 1.157 0.038 0.748 0.871 Delivery assistance from doctor, nurse, midwife 0.356 0.048 299 245 1.510 0.135 0.260 0.452 Postnatal care from doctor, nurse, or midwife for last birth 0.379 0.043 218 178 1.314 0.114 0.293 0.466 Child had diarrhea in the past 2 weeks 0.162 0.029 292 239 1.167 0.176 0.105 0.219 Sought treatment for diarrhea 0.273 0.059 47 39 0.858 0.216 0.155 0.391 Child treated with oral rehydration salts (ORS) 0.286 0.076 47 39 1.040 0.265 0.134 0.438 Child had acute respiratory illness (ARI) in past 2 weeks 0.122 0.021 292 239 1.053 0.175 0.079 0.164 Sought treatment for ARI from health facility/provider 0.480 0.063 36 29 0.774 0.131 0.354 0.606 Vitamin A supplementation in past 6 months 0.727 0.047 263 215 1.461 0.065 0.633 0.822 Received DPT vaccination (3 doses) 0.849 0.051 74 60 1.225 0.060 0.747 0.950 Fully immunized 0.770 0.069 74 60 1.415 0.090 0.632 0.908 Sex with a non-marital/cohabiting partner in past 12 months 0.007 0.006 409 335 1.611 0.983 0.000 0.019 Comprehensive knowledge about HIV 0.122 0.019 584 480 1.407 0.157 0.083 0.160 Ever experienced physical or sexual violence by husband 0.261 0.023 356 252 0.999 0.089 0.215 0.308 Total fertility rate (past 3 years) 3.588 0.265 na 1316 1.154 0.074 3.058 4.119 Neonatal mortality (past 0-9 years) 11.927 4.282 617 508 0.880 0.359 3.362 20.492 Post-neonatal mortality (past 0-9 years) 10.798 5.173 619 509 1.077 0.479 0.452 21.144 Infant mortality (past 0-9 years) 22.725 6.971 618 509 1.024 0.307 8.783 36.668 Child mortality (past 0-9 years) 11.218 4.976 623 513 1.167 0.444 1.265 21.170 Under-five mortality (past 0-9 years) 33.688 7.355 618 509 0.926 0.218 18.977 48.399 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 254 | Appendix B Table B.20 Sampling errors for XIII - Caraga sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.009 0.003 573 312 0.903 0.404 0.002 0.016 At least some secondary education 0.770 0.027 573 312 1.536 0.035 0.716 0.824 Children ever born to women age 40-49 4.713 0.294 125 68 1.116 0.062 4.124 5.302 Currently using any method 0.517 0.022 390 212 0.871 0.043 0.473 0.562 Currently using a modern method 0.372 0.031 390 212 1.248 0.082 0.310 0.433 Currently using pill 0.149 0.019 390 212 1.037 0.125 0.112 0.187 Currently using IUD 0.083 0.020 390 212 1.448 0.244 0.043 0.124 Currently using male condoms 0.026 0.008 390 212 0.993 0.310 0.010 0.042 Currently using injectables 0.013 0.006 390 212 1.114 0.497 0.000 0.025 Currently using female sterilization 0.093 0.015 390 212 1.011 0.160 0.063 0.122 Currently using withdrawal 0.064 0.015 390 212 1.177 0.229 0.035 0.093 Currently using rhythm 0.072 0.014 390 212 1.078 0.196 0.044 0.100 Obtained method from public sector source 0.571 0.042 147 81 1.027 0.074 0.487 0.655 Want no more children or sterilized 0.672 0.024 390 212 0.989 0.035 0.625 0.719 Ideal number of children 2.956 0.072 571 311 1.115 0.024 2.812 3.100 Unmet need for family planning 0.261 0.021 390 212 0.957 0.082 0.218 0.303 Prenatal care from doctor, nurse, or midwife for last birth 0.966 0.014 229 124 1.168 0.015 0.937 0.994 Delivery in health facility 0.301 0.042 333 180 1.428 0.139 0.217 0.385 Last birth protected against tetanus 0.852 0.028 229 124 1.175 0.033 0.796 0.907 Delivery assistance from doctor, nurse, midwife 0.499 0.033 333 180 1.016 0.067 0.432 0.566 Postnatal care from doctor, nurse, or midwife for last birth 0.434 0.043 229 124 1.316 0.100 0.347 0.520 Child had diarrhea in the past 2 weeks 0.096 0.017 326 177 1.000 0.176 0.062 0.130 Sought treatment for diarrhea 0.417 0.086 31 17 0.925 0.206 0.246 0.589 Child treated with oral rehydration salts (ORS) 0.517 0.081 31 17 0.911 0.157 0.354 0.679 Child had acute respiratory illness (ARI) in past 2 weeks 0.062 0.014 326 177 0.984 0.220 0.035 0.089 Sought treatment for ARI from health facility/provider 0.298 0.120 20 11 1.151 0.404 0.057 0.538 Vitamin A supplementation in past 6 months 0.811 0.026 300 162 0.961 0.032 0.760 0.862 Received DPT vaccination (3 doses) 0.947 0.036 55 30 1.169 0.038 0.876 1.018 Fully immunized 0.894 0.042 55 30 1.000 0.047 0.810 0.977 Sex with a non-marital/cohabiting partner in past 12 months 0.045 0.010 403 220 0.953 0.220 0.025 0.064 Comprehensive knowledge about HIV 0.187 0.026 573 312 1.570 0.137 0.136 0.239 Ever experienced physical or sexual violence by husband 0.273 0.022 324 169 0.901 0.082 0.229 0.318 Total fertility rate (past 3 years) 4.308 0.319 na 868 1.143 0.074 3.669 4.947 Neonatal mortality (past 0-9 years) 14.956 4.880 666 362 1.036 0.326 5.197 24.716 Post-neonatal mortality (past 0-9 years) 6.123 2.995 672 365 1.007 0.489 0.133 12.112 Infant mortality (past 0-9 years) 21.079 5.238 666 362 0.937 0.249 10.602 31.556 Child mortality (past 0-9 years) 9.571 3.959 652 354 1.004 0.414 1.653 17.488 Under-five mortality (past 0-9 years) 30.448 5.703 668 363 0.866 0.187 19.042 41.854 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B │ 255 Table B.21 Sampling errors for ARMM sample, Philippines DHS 2008 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 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 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– No education 0.126 0.021 670 516 1.652 0.169 0.083 0.168 At least some secondary education 0.470 0.045 670 516 2.339 0.096 0.379 0.560 Children ever born to women age 40-49 5.716 0.349 134 103 1.229 0.061 5.017 6.415 Currently using any method 0.151 0.021 436 337 1.231 0.140 0.109 0.194 Currently using a modern method 0.099 0.018 436 337 1.252 0.181 0.063 0.135 Currently using pill 0.025 0.008 436 337 1.052 0.317 0.009 0.040 Currently using IUD 0.007 0.004 436 337 1.012 0.563 0.000 0.016 Currently using male condoms 0.005 0.003 436 337 0.987 0.674 0.000 0.012 Currently using injectables 0.032 0.014 436 337 1.604 0.425 0.005 0.059 Currently using female sterilization 0.031 0.009 436 337 1.146 0.309 0.012 0.050 Currently using withdrawal 0.028 0.010 436 337 1.217 0.341 0.009 0.048 Currently using rhythm 0.009 0.005 436 337 0.988 0.491 0.000 0.018 Obtained method from public sector source 0.607 0.091 42 33 1.193 0.151 0.424 0.790 Want no more children or sterilized 0.372 0.031 436 337 1.331 0.083 0.310 0.434 Ideal number of children 5.060 0.144 649 500 1.437 0.028 4.772 5.348 Unmet need for family planning 0.327 0.022 436 337 0.968 0.066 0.284 0.371 Prenatal care from doctor, nurse, or midwife for last birth 0.467 0.052 268 207 1.685 0.110 0.364 0.570 Delivery in health facility 0.147 0.049 411 318 2.137 0.332 0.050 0.245 Last birth protected against tetanus 0.391 0.047 268 207 1.570 0.120 0.297 0.485 Delivery assistance from doctor, nurse, midwife 0.192 0.054 411 318 2.105 0.278 0.085 0.300 Postnatal care from doctor, nurse, or midwife for last birth 0.195 0.046 268 207 1.895 0.236 0.103 0.287 Child had diarrhea in the past 2 weeks 0.107 0.017 387 300 0.927 0.155 0.074 0.140 Sought treatment for diarrhea 0.239 0.091 41 32 1.219 0.381 0.057 0.422 Child treated with oral rehydration salts (ORS) 0.275 0.096 41 32 1.237 0.351 0.082 0.467 Child had acute respiratory illness (ARI) in past 2 weeks 0.032 0.009 387 300 0.953 0.291 0.013 0.050 Sought treatment for ARI from health facility/provider 0.079 0.080 12 10 1.025 1.004 0.000 0.239 Vitamin A supplementation in past 6 months 0.480 0.044 335 260 1.308 0.092 0.392 0.568 Received DPT vaccination (3 doses) 0.411 0.060 72 56 1.039 0.147 0.290 0.531 Fully immunized 0.306 0.070 72 56 1.280 0.228 0.167 0.446 Sex with a non-marital/cohabiting partner in past 12 months 0.004 0.003 429 331 0.974 0.701 0.000 0.011 Comprehensive knowledge about HIV 0.123 0.021 670 516 1.663 0.172 0.081 0.166 Ever experienced physical or sexual violence by husband 0.132 0.019 361 283 1.043 0.141 0.095 0.169 Total fertility rate (past 3 years) 4.280 0.402 na 1443 1.204 0.094 3.475 5.084 Neonatal mortality (past 0-9 years) 14.386 3.752 932 719 0.996 0.261 6.881 21.891 Post-neonatal mortality (past 0-9 years) 41.974 11.845 935 721 1.515 0.282 18.284 65.663 Infant mortality (past 0-9 years) 56.360 13.476 932 719 1.539 0.239 29.408 83.311 Child mortality (past 0-9 years) 40.111 7.516 941 726 0.949 0.187 25.078 55.144 Under-five mortality (past 0-9 years) 94.210 16.396 939 725 1.347 0.174 61.419 127.002 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C │ 257 DATA QUALITY TABLES AppendixC Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Philippines 2008 Women Men Age Number Percent Number Percent 0 631 2.2 713 2.5 1 638 2.2 681 2.3 2 632 2.2 704 2.4 3 627 2.2 742 2.6 4 638 2.2 707 2.4 5 658 2.3 751 2.6 6 655 2.3 731 2.5 7 659 2.3 754 2.6 8 697 2.4 792 2.7 9 663 2.3 689 2.4 10 727 2.5 733 2.5 11 619 2.2 725 2.5 12 659 2.3 684 2.4 13 655 2.3 714 2.5 14 658 2.3 697 2.4 15 676 2.4 718 2.5 16 567 2.0 603 2.1 17 524 1.8 659 2.3 18 567 2.0 615 2.1 19 545 1.9 539 1.9 20 465 1.6 480 1.7 21 445 1.6 537 1.9 22 462 1.6 522 1.8 23 431 1.5 475 1.6 24 429 1.5 383 1.3 25 435 1.5 454 1.6 26 439 1.5 404 1.4 27 440 1.5 438 1.5 28 479 1.7 426 1.5 29 397 1.4 412 1.4 30 464 1.6 421 1.5 31 381 1.3 373 1.3 32 405 1.4 363 1.3 33 366 1.3 350 1.2 34 323 1.1 362 1.2 35 366 1.3 381 1.3 36 363 1.3 330 1.1 37 365 1.3 350 1.2 38 382 1.3 361 1.2 39 376 1.3 335 1.2 40 332 1.2 378 1.3 41 297 1.0 279 1.0 42 335 1.2 346 1.2 43 325 1.1 289 1.0 44 293 1.0 287 1.0 45 329 1.1 293 1.0 46 315 1.1 295 1.0 47 247 0.9 259 0.9 48 317 1.1 326 1.1 49 246 0.9 292 1.0 50 288 1.0 271 0.9 51 258 0.9 201 0.7 52 270 0.9 225 0.8 53 253 0.9 233 0.8 54 280 1.0 216 0.7 55 229 0.8 212 0.7 56 174 0.6 192 0.7 57 172 0.6 156 0.5 58 194 0.7 187 0.6 59 146 0.5 151 0.5 60 204 0.7 183 0.6 61 134 0.5 127 0.4 62 171 0.6 148 0.5 63 118 0.4 130 0.4 64 147 0.5 98 0.3 65 146 0.5 114 0.4 66 140 0.5 102 0.4 67 95 0.3 81 0.3 68 109 0.4 92 0.3 69 94 0.3 76 0.3 70+ 1,036 3.6 677 2.3 Don't know/missing 3 0.0 3 0.0 Total 28,602 100.0 29,027 100.0 258 | Appendix C Table C.2 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 2008 Interviewed women age 15-49 Age group Household population of women age 10-54 Number Percent Percentage of women 10-14 3,318 na na na 15-19 2,880 2,826 20.4 98.1 20-24 2,232 2,182 15.7 97.7 25-29 2,190 2,154 15.5 98.3 30-34 1,940 1,907 13.7 98.3 35-39 1,851 1,817 13.1 98.2 40-44 1,581 1,562 11.3 98.7 45-49 1,453 1,430 10.3 98.4 50-54 1,347 na na na 15-49 14,127 13,878 100.0 98.2 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.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Philippines 2008 Subject Reference group Percentage with information missing Number of cases Birth date Births in past 15 years Month only 0.25 18,470 Month and year 0.02 18,470 Age at death Deaths to births in past 15 years 0.00 729 Age/date at first union1 Ever-married women 0.05 9,064 Respondent's education All women 0.00 13,594 Diarrhea in past 2 weeks Living children age 0-59 months 0.96 6,185 1 Both year and age missing Appendix C │ 259 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 (L), dead (D), and total (T) children (weighted), Philippines 2008 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year L D T L D T L D T L D T 2008 807 9 815 100.0 100.0 100.0 108.0 113.2 108.0 na na na 2007 1,271 38 1,308 100.0 100.0 100.0 114.3 123.4 114.5 na na na 2006 1,221 39 1,260 100.0 97.6 99.9 103.9 229.9 106.4 97.8 112.6 98.2 2005 1,225 32 1,258 99.8 93.3 99.6 110.4 176.4 111.7 99.5 75.4 98.7 2004 1,241 47 1,288 100.0 100.0 100.0 113.1 130.5 113.7 100.8 130.0 101.7 2003 1,236 39 1,276 99.9 96.3 99.8 115.8 235.2 118.2 97.9 79.6 97.2 2002 1,285 52 1,337 99.9 98.5 99.8 111.1 86.4 110.0 106.2 95.3 105.8 2001 1,182 70 1,252 99.8 97.6 99.7 108.3 132.5 109.5 90.3 115.4 91.4 2000 1,335 69 1,404 99.7 98.7 99.7 129.5 131.9 129.7 112.3 122.5 112.8 1999 1,195 43 1,238 99.6 96.0 99.5 92.6 140.8 93.9 94.4 71.3 93.4 2004-2008 5,765 164 5,929 100.0 98.1 99.9 110.1 154.3 111.1 na na na 1999-2003 6,233 274 6,507 99.8 97.6 99.7 111.2 132.9 112.1 na na na 1994-1999 5,422 281 5,704 99.8 95.8 99.6 109.9 115.3 110.1 na na na 1989-1993 4,548 254 4,802 99.8 92.3 99.4 102.4 162.5 104.9 na na na <1989 4,076 385 4,460 99.6 94.6 99.2 110.9 126.3 112.1 na na na All 26,044 1,359 27,403 99.8 95.5 99.6 109.0 134.3 110.2 na na na na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x 260 | 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 2008 Number of years preceding the survey Age at death (days) 0-4 5-9 10-14 15-19 Total 0-19 <1 26 28 27 21 102 1 27 23 25 18 93 2 4 7 6 6 24 3 13 17 10 6 46 4 5 3 1 3 11 5 7 1 6 2 16 6 2 2 0 3 7 7 6 15 14 7 42 8 0 0 0 1 1 9 0 2 2 1 4 10 1 2 2 1 6 11 1 1 0 0 2 12 1 1 0 3 5 13 0 1 1 0 2 14 1 3 1 2 7 15 1 1 2 1 5 17 1 0 0 0 1 18 1 0 0 0 1 20 0 0 1 1 2 21 0 2 1 1 4 22 0 1 0 1 2 23 2 1 1 0 5 24 0 0 1 0 1 26 0 1 0 0 1 27 0 0 1 0 1 29 0 0 1 1 3 30 0 1 0 0 1 Total 0-30 101 113 102 77 392 Percent early neonatal1 84.6 72.0 73.4 74.6 76.1 1 (0-6 days)/(0-30 days) * 100 Appendix C │ 261 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 2008 Number of years preceding the survey Age at death (months) 0-4 5-9 10-14 15-19 Total 0-19 <1a 101 113 102 77 392 1 14 11 12 13 51 2 6 7 11 5 30 3 6 11 10 5 31 4 3 7 5 5 20 5 6 5 2 4 18 6 2 7 8 2 20 7 4 9 7 8 28 8 2 12 11 6 31 9 3 9 9 6 27 10 1 0 1 2 4 11 3 5 2 6 16 12 6 16 12 17 51 13 1 2 3 2 8 14 3 4 0 1 7 15 3 3 2 2 10 16 0 0 1 2 3 17 0 0 4 0 4 18 0 2 3 6 11 19 0 1 1 1 3 20 0 0 1 2 3 21 0 0 1 1 2 22 0 1 0 1 2 23 1 0 0 0 1 1 year 1 1 0 1 3 Total 0-11 151 197 180 139 667 Percent neonatal1 66.8 57.2 56.4 55.2 58.7 a Includes deaths under one month reported in days 1 Under one month/under one year Appendix D | 263 PERSONS INVOLVED IN THE 2008 PHILIPPINES DEMOGRAPHIC AND HEALTH SURVEY APPENDIX D PRE-TEST 1 National Statistics Office Socorro Abejo Benedicta Yabut Elpidio Maramot Ma. Virginia Olveña Priscilla Bacus Edna Rapanot Ana Cadaro Charito Capacete Mercedes Hoquis Vinhs Llan Jumawan Ma. Theresa Rapanan Marjorie Villaver Amelia Saripada Percival Salting Linda Silang Wilma Sulit Maritess Tan Zenaida Tapire Filipinas Lim Joan Martinez Gene Lorica Nazaria Guerra PRE-TEST 2 ICF Macro Dr. Elizabeth Go (Consultant) National Statistics Office Benedicta Yabut Aurora Reolalas Edna Rapanot Erma Aquino Elpidio Maramot Shanna Elaine Rogan Ma. Virginia Olveña Percival Salting Zenaida Tapire Gloria Morales Ma. Theresa Rapanan Mercedes Hoquis Joan Martinez Gemelyn Macabiog Wilma Sulit Charito Capacete Amelia Saripada Erlinda Silang Filipinas Lim Vinhs Llan Jumawan 264 | Appendix D TRAINING TASK FORCE Resource Persons Trainers National Statistics Office Dr. Socorro Abejo Department of Health Dr. Diego Danila Zenaida Recidoro UP Economics Foundation, Inc. Dr. Carlos Antonio Tan Jr. University of the Philippines Population Institute Dr. Josefina Cabigon Dr. Zelda Zablan National Commission on the Role of Filipino Women Anita Baleda Anastacio Lagumbay, Jr. ICF Macro Dr. Elizabeth Go Department of Social Welfare and Development Ma. Elena Orbano National Statistics Office Benedicta Yabut Aurora Reolalas Glenn Barcenas Erma Aquino Priscilla Bacus Elpidio Maramot Ma. Virginia Olveña Edna Rapanot Percival Salting Amelia Saripada Wilma Sulit Zenaida Tapire Marjorie Villaver Participants Central Office Divina Gracia del Prado Ma. Corazon de Luna Pepito Escarian Clemente Manaog Maritess Tan Erlinda Silang Ma. Theresa Rapanan Joan Martinez Ana Cadaro Filipinas Lim Regional Offices Precy Deveraturda Valentina Domaoa Marietta Zapanta Reyma Tabalno Concepcion Angeles Rosenda Bagay Maribel Bernardo Amelia Rebollo Arleen Bagoning Edwina Carriaga Mae Almonte Naser Usman Gerasol Lourdes Mugot Judith Perito Jurilyn Abraham Noronisa Macadadaya Reynelo Magno Appendix D | 265 FIELDWORK INTERVIEW TEAMS REGION I - Ilocos Marieta P. Zapanta (Regional Supervisor) TEAM 1 TEAM 2 Gloria Pascua (Team Supervisor) Dolores Tipon (Team Supervisor) Brendalyne Pomoy (Field Editor) Teresita Pamintuan (Field Editor) Lanie Bumanglag Evangeline Capulong Patricia Calapit Lailani Gamboa Romina Carasi Michelle Gorospe Helen Viloria Mirasol Manongdo TEAM 3 Aniceta Estimo (Team Supervisor) Sylvia De Guzman (Field Editor) Milagros De Guzman Gina Nipal Bernalie Remegio Eden Grace Tirao Cherila Torio REGION II - Cagayan Valley Reyma C. Tabalno (Regional Supervisor) TEAM 4 TEAM 5 Marilou Contillo (Team Supervisor) Ma. Emielee Eugenie Pataueg (Team Supervisor) Marites Malenab (Field Editor) Elaine Diaz (Field Editor) Wenonah Gumabao Milgrace Baniaga Roda Santos Ma. Cristina Cabaccan Lerma Adviento Sheryl Guzman Maricris Pagulayan Juliet Sotelo Charina de Asis Angelyn Villanoza TEAM 6 Anna B. Dumangeng (Team Supervisor) Ma. Cristina Degala (Field Editor) Lovejoy Andres Jenelyn Viernes Evangelyn Camangeg Jeraldine Agustin REGION III - Central Luzon Concepcion Angeles(Regional Supervisor) TEAM 7 TEAM 8 Ma. Rosario Dela Rosa (Team Supervisor) Lorena Lorenzo (Team Supervisor) Marifer Visda (Field Editor) Marileen Avañez (Field Editor) Marian Antonio Cherry Anicete Ma. Luisa Arcelo Deserie Gonzales Ma. Lourdes Clor Benedicta Mariano Maricel Javier Ma. Cristina Mendoza Concepcion Tamayo 266 | Appendix D TEAM 9 TEAM 10 Yolanda Rimada (Team Supervisor) Remedios de Guzman (Team Supervisor) Amorcita Murao (Field Editor) Marie Cris Lopez (Field Editor) Ursula Legaspi Remy Rose de Castro Janet Marquez Ferry Dolores Dulay Zenaida Rebaya Carolyn Ibarra Elenita Rimada Helen Maglalang Jeraldine Villanueva TEAM 11 Corazon Bonifacio (Team Supervisor) Maria Baun (Field Editor) Erlinda Andres Elvira Duenos Ma. Theresa Inong Merlita Teh REGION IVA - CALABARZON Charity O. Bautista (Regional Supervisor) TEAM 12 TEAM 13 Lyn Jerusalem (Team Supervisor) Lolita Bocalan-Ragas (Team Supervisor) Gina dela Cruz (Field Editor) Efigenia Lontoc (Field Editor) Donna Rose Troyo Mary Grace Ambat Yehlen Bolire Rodenalyn Mabansag Christie Grace Tibay Melissa Ocampo Catherine Quiacos Aiza Rodil Khristine Ernacio TEAM 14 TEAM 15 Annelyn Aguila (Team Supervisor) Marissa Dalida (Team Supervisor) Marilou Aguila (Field Editor) Fe Fabilane (Field Editor) Elenita Bareza Ailene Calderon Remigia Alcantara Marilyn Asantor Norlyn Cabrera Ma. Teresa Quintillano Elma Nuevo Marites Napagal Marites Callejo TEAM 16 Rosenda Bagay (Team Supervisor) Gemma Mercado (Field Editor) Baby Veronica Buhay Editha Vergara Ana Tubino Cecilia Mendoza REGION IVB - MIMAROPA Maribel Bernardo (Regional Supervisor) TEAM 17 TEAM 18 Ester Buñag (Team Supervisor) Veneranda Mendoza (Team Supervisor) Esperanza Saducoz (Field Editor) Erlyn Rafa (Field Editor) Ella Jane del Rosario Yolanda Alea Fe Villanueva Melinda Nocillado leodelyn Fajardo Marilyn mingo Amary Ann Magsisi Appendix D | 267 TEAM 19 Eva Dalonos (Team Supervisor) Chelin Dacuan (Field Editor) Eldy Benito Jeanette Degilio Merlyn Oab Riza Lucero REGION V - Bicol Amelia I. Rebollo (Regional Supervisor) TEAM 20 TEAM 21 Emelinda Gualvez (Team Supervisor) Nancy Nillo (Team Supervisor) Salve Bangate (Field Editor) Anna Bajamundi (Field Editor) Desiree Aragon Melinda Castillo Cristina Arellano Joji Del Rosario Maricris Marcos Maria Lucila Matos Rowena Olayta Nora Ramos Maria Socorro Manlagnit Fe Reglos TEAM 22 Marivel Alarcon (Team Supervisor) Mylene Nebres (Field Editor) Rosie Briol Alma Fellone Emmienor Jazmin Sheryl Rubia REGION VI - Western Visayas Arlene Bagoning (Regional Supervisor) TEAM 23 TEAM 24 Antonet Catubuan (Team Supervisor) Salvacion Lemos (Team Supervisor) Jerlen Publico (Field Editor) Rechelle Teneso (Field Editor) Ma. Joan Batican Lana Dolorfino Precy Lima Christine Fajardo Jenny Bagohara Rowena Lescain Meaziel Esmael Ma. Czarina Labrador Gerrylyn Aguihap TEAM 25 TEAM 26 Alma Bella Oreto (Team Supervisor) Irna Asuero (Team Supervisor) Ligaya Gillesaria (Field Editor) Luz Monteveros (Field Editor) Analou Gubaton Florie Mae Baito Irene Aragon Grace Clavines Ma. Theresa Escañan Mary Joy Toledo 268 | Appendix D REGION VII - Central Visayas Edwina M. Carriaga (Regional Supervisor) TEAM 27 TEAM 28 Colita Montuya (Team Supervisor) Marie Blythe Mejia (Team Supervisor) Nimfa Aray (Field Editor) Anecita Licardo (Field Editor) Aimee Bullecer Analyn Delos Cientos Debbie Quimpo Christlor Laping Jasmin Cagasan Doris Mag-usara Michelle Cabanlit Isabelita Labuga Sisinia Mirontos Lineth Capa Marites Sombilon TEAM 29 Hera Juarez (Team Supervisor) Riza Vailoces (Field Editor) Blair Joy Agan Jean Lyn Oraba Jessica Culi Jonilyn Gatinao Really Mae Coronacion REGION VIII - Eastern Visayas Mae R. Almonte (Regional Supervisor) TEAM 30 TEAM 31 Edna Felicita (Team Supervisor) Necitas Flores (Team Supervisor) Ginalyn Heidi Caballes (Field Editor) Bona Villa Casil (Field Editor) Caren Jane Aporador Mila Ibanez Venice Belandres Juliet Daga ligaya Durna Elizabeth Magcuro Maristela Mandras Jennifer Germones Josephine Rufin TEAM 32 Ma. Theresa Elizalde (Team Supervisor) Milalyn Balicot (Field Editor) Alisa Abella Karen Alegre Mary Ann Balawang Cecilia Daguman Sergette Tanauan REGION IX - Zamboanga Peninsula Naser S. Usman (Regional Supervisor) TEAM 33 TEAM 34 Fe Atay (Team Supervisor) Gemma Vibal (Team Supervisor) Jennylynn Desiongco (Field Editor) Guindelyn Yabo (Field Editor) Ma. Socorro Nurulla Lanibel Pamatong (Field Editor) Aisah Unacan Jo-ann Dacles Maricel Francisco April Rose Figueras Rosemarie Nuñal Jamela Gimar Juvian Gumotud Wenna Palongpalong Elgin Opada Angelynn Samporna Faith Tabigne Appendix D | 269 REGION X – Northern Mindanao Gerasol Lourdes G. Mugot (Regional Supervisor) TEAM 35 TEAM 36 Rowena Linaban (Team Supervisor) Georgette Gayomali (Team Supervisor) Ethyl Jane Binayao (Field Editor) Pinky Rose Rabina (Field Editor) Vanessa Joy Mirafuentes Genisa Duhaylungsod Hacel Rose Penales Ladylou Plantar Carmila Lumbad Geny Luz Dangin Romelyn Bongabong Annalaida Tawantawan TEAM 37 Joy Nacario (Team Supervisor) Olga Nono (Field Editor) Marites Gomez Divine Gelogo Judent Faith Famador Cheryl Quilang Rudy Tusloc REGION XI – Davao Peninsula Corazon P. Dres (Regional Supervisor) TEAM 38 TEAM 39 Imelda Mata (Team Supervisor) Judith Perito (Team Supervisor) Rhodora Grenien (Field Editor) Mary Jane Paradero (Field Editor) Marilou Aldeguer Relita Bulac Gerlie Dormitorio Chill Carcallas Russel Enferto Reynilda Gulay Rosalie Suarez Honey Faye Espinosa Jane Maghanoy TEAM 40 Genoveva Manio (Team Supervisor) Cecilia Catedral (Field Editor) Irene Gayta Richelle Casagda Elizabeth Ancog Julieta Corpuz REGION XII – SOCCSKSARGEN Jurilyn P. Abraham (Regional Supervisor) TEAM 41 TEAM 42 Helen Colango (Team Supervisor) Marifi De Asis (Team Supervisor) Tessie Arago (Field Editor) Maribel Silva (Field Editor) Pinky Amban Delia Damolo Solaiba Andatuan Magdalena Garcia Dally Joy Penaso Riza Nacar Jeanette Sedigo Bena Organiza Annabelle Tambara TEAM 43 Rachel Cortez (Team Supervisor) Khrisma Viceno (Field Editor) Josie Estipano Resyl Rose Palmes Iren Baligasa Raquisa Vicente 270 | Appendix D REGION XIII – Caraga Reynelo S. Magno (Regional Supervisor) TEAM 44 TEAM 45 Eva Tulang (Team Supervisor) Susan Pantilo (Team Supervisor) Princess Denuro (Field Editor) Analyn Cortina (Field Editor) Janice Cuevas Joyce Fallado Noreza Hampac Lyka Acosta Mary Grace Plaza Jovelyn dela Cruz Jhunybe Escartin Fe Lao TEAM 46 Lolita Espinosa (Team Supervisor) Janel Muego (Field Editor) Jackelyn Aratea Dina Ringor Gretchen Cabillo Jean Pedrablanca National Capital Region Precy Z. Deveraturda (Regional Supervisor) TEAM 47 TEAM 48 Maricel Caragan (Team Supervisor) Estrella Vargas (Team Supervisor) Delma Dalwatan (Field Editor) Maria Antonette Adelaida (Field Editor) Ma. Meliantte Adao Analie Fontanilla Michelle Galera Viola Irabon Charita Nacinopa Melissa Marbella Rowena Sanoy Merlyn Panganiban Melanie Tayco TEAM 49 TEAM 50 Amelia Basilio (Team Supervisor) Adelfa Yepes (Team Supervisor) Criselda Tiamzon (Field Editor) Arsenia Gabriel (Field Editor) Pacita Liboon Marites Dominguez Ma. Azelina Odiver Olie Gabriel Ann Khrislyn Supil Divine Grace Lao Gertrudes Inalgan Catherine Real Nairen Saturre Melanie Zosimo TEAM 51 TEAM 52 Evelyn Bermudez (Team Supervisor) Catherine Aguilar (Team Supervisor) Lorna Torralba (Field Editor) Naomi Guevarra (Field Editor) Marilou Bacolocos Analyn Caole Rutchie Domingo Emily Quinto Perlita Abalos Felmar Acidre Jomar Sanggalang Appendix D | 271 Cordillera Administrative Region Valentina Domaoa (Regional Supervisor) TEAM 53 TEAM 54 Ara Leonarda Bongaoil (Team Supervisor) Maribel Dalayday (Team Supervisor) Lorie Jane Solano (Field Editor) Arfelle Dumlanos (Field Editor) Saura Donglasan Myrna Emmingga Perlita Emperador Lorraine Calimuhayan Vida Vina del Mundo Julie Ann Dawagui Precy Bazar Medy Sot-oy Ma. Teresa Belen Marlyn Calingayan ARMM Noronisa D. Macadadaya (Regional Supervisor) TEAM 55 TEAM 56 Ma. Flerida Tan (Team Supervisor) Alnairah Macalaba (Team Supervisor) Milan Asmawil (Field Editor) Sahira Dimaronsing (Field Editor) Artini Usman Hiyazmenh Ismael Norshe Salam Ominah Macud Kimjiok Gordon Nor-ain Bubong Shuaida Sahiron Soraida Arasid TEAM 57 Ma. Judema Angot (Team Supervisor) Mariffie Ayob (Field Editor) Monisa Aminola Sakina Mala Saadah Sakito Baimanot Sampiano 272 | Appendix D QUESTIONNAIRE DESIGN STEERING COMMITTEE National Statistics Office Adm. Carmelita Ericta (Chairperson) National Academy for Science and Technology Dr. Mercedes Concepcion (Co-chairperson) Members University of the Philippines Population Institute Dr. Grace Cruz Commission on Population Dep. Exec. Dir. Mia Ventura Victoria Corpuz Department of Health Dr. Diego Danila Dr. Juan Lopez Dr. Marina Baquilod Dr. Maria Rosario Clarissa Vergeire ICF Macro Dr. Elizabeth Go United States Agency for International Development Dr. Aye Aye Thwin Reynalda Perez Consuelo Añonuevo National Economic Development Authority Dr. Erlinda Capones Professional Managers, Inc. Manuel Arejola National Statistical Coordination Board Lina Castro University of the Philippines School of Economics Carlos Antonio Tan University of the Philippines National Institute of Health Dr. Jaime Galvez-Tan Philippine Legislators Committee on Population Development Ramon San Pascual Vincent Hermogeno Elenor de Leon Food and Nutrition Research Institute Wilma Molano National Commission on the Role of Filipino Women Comm. Amaryllis Torres Mary Alice Rosero National Statistics Office Dep. Adm. Paula Monina Collado Dr. Socorro Abejo Benedicta Yabut Aurora Reolalas Appendix D | 273 TECHNICAL WORKING GROUP ON HEALTH Department of Health Dr. Maria Rosario Clarissa Vergerie (Chairperson) National Statistics Office Dr. Socorro Abejo (Co-chairperson) Members National Economic Development Authority Arlene Ruiz Liya Gopez-Tandoc Philippine Health Insurance Corporation Violeta Padilla Melissa Pineda University of the Philippines Population Institute Dr. Josefina Cabigon Department of Health Dr. Lourdes Paulino ICF Macro Dr. Elizabeth Go University of the Philippines National Institute of Health Dr. Jaime Galvez-Tan University of the Philippines School of Economics Carlos Antonio Tan National Statistical Coordination Board Racquel Dolores Sabeñano Commission on Population Dep. Exec. Dir. Mia Ventura National Statistics Office Benedicta Yabut Aurora Reolalas TECHNICAL WORKING GROUP ON VIOLENCE AGAINST WOMEN National Commission for the Role of Filipino Women Anita Baleda (Chairperson) Department of Social Welfare and Development Delilah Fuertes (Co-Chairperson) Members National Economic Development Authority Aleli Joy Cortez National Statistical Coordination Board Teresita Almarines Department of Social Welfare and Development Sylvia Red Delilah Fuertes ICF Macro Dr. Elizabeth Go National Commission for the Role of Filipino Women Ferly Enriquez Alice Rosero Nharleen Millar Anastacio Lagumbay, Jr. National Statistics Office Dr. Socorro Abejo Benedicta Yabut Aurora Reolalas 274 | Appendix D DATA PROCESSING STAFF ICF Macro Alex Izmukhambetov Glen Heller Jeanne Cushing National Statistics Office Elpidio Maramot Manuel Rivera Percival Salting Zenaida Tapire Wilma Sulit Lawrence Marquez Nancy Ignacio Loraina Gasmen Charito Capacete Mercedes Hoquis Hired Data Processors Abraham Abelido Ernesto Abuan Jr. Ma. Meliantte Adao Maria Antonnete Adelaida Harlika Ambrosio Sorena Arroyo Rowena Balala Alvin Buyco Analyn Caole Catherine Castillo Riza Cayabyab Evelyn Domingo Jackielyn Anne Domingo Marites Dominguez Michelle Duario Ma. Antonnete Fernandez Rhyan Paul Florentino Arsenia Gabriel Mary Grace Garduque Viola Irabon Natalie Leyson Madel Llorera Jay Lobarbio Ma. Eleonor Macayaon Catherine Makiramdam Ma. Gloria Mogote Mildred Pineda John Purisima Jerico Quijano Emily Quinto Buena Rabe Ma. Soledad Radores Tommy Replentes Gilberto Rosal Sheryl Santos Janeth Schofield Meliza Semblante Edison Sepulvida Rea Luz Simagala Ann Khrislyn Supil Lorna Torralba Annie Rose Urbano Vangilyn Varona Sherilyn Vera Richiel Viñas Appendix D | 275 FINAL REPORT WRITERS National Statistics Office Paula Monina Collado (Deputy Administrator) Dr. Socorro Abejo Benedicta Yabut Aurora Reolalas Jeremias Luis Erma Aquino Marjorie Villaver Imelda Agsalud Shanna Elaine Rogan Percival Salting University of the Philippines Population Institute Dr. Josefina Cabigon Dr. Nimfa Ogena Department of Health Dr. Juanita Basilio University of the Philippines Economic Foundation Dr. Carlos Antonio Tan Jr. National Commission on the Role of Filipino Women Anita Baleda NSO Technical Experts Gene Lorica Elpidio Maramot NSO Technical Support Staff Maritess Tan Lawrence Marquez ICF Macro Staff Anne Cross Chris Gramer Andrew Inglis Sunita Kishor Joanna Lowell Kaye Mitchell Sidney Moore Erica Nybro Sri Poedjastoeti Ruilin Ren Blake Zachary QUESTIONNAIRES Appendix E 277Appendix E | AUTHORITY: Commonwealth Act No. 591 NDHS FORM 1 authorizes this survey and the Nationa Statistics Office to collect information NSCB Approval No. NSO-0813-01 on fertility, family planning and health. Expires July 31, 2009 CONFIDENTIALITY : Sec. 4 of CA No. 591 provides that all information furnished on this form is held STRICTLY CONFIDENTIAL. Booklet _____ of _____ Booklets PROVINCE CITY/MUNICIPALITY BARANGAY EA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SAMPLE HOUSING UNIT SERIAL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD CONTROL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NDHS HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NUMBER OF HOUSEHOLDS IN THE HOUSING UNIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAME OF HOUSEHOLD HEAD ADDRESS DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. CODE RESULT* RESULT NEXT VISIT: TOTAL NUMBER OF VISITS *RESULT CODES: LANGUAGE OF TOTAL HH 1 COMPLETED QUESTIONNAIRE** MEMBERS AND 2 NO HOUSEHOLD MEMBER AT HOME OR NO VISITORS COMPETENT RESPONDENT AT HOME LOCAL LANGUAGE OF AT TIME OF VISIT RESPONDENT** TOTAL ELIGIBLE 3 ENTIRE HOUSEHOLD ABSENT FOR WOMEN EXTENDED PERIOD OF TIME LANGUAGE OF INTERVIEW** 4 POSTPONED LINE NO. OF 5 REFUSED RESPONDENT 6 DWELLING VACANT OR ADDRESS NOT A TRANSLATOR USED 1 TO HOUSEHOLD DWELLING QUESTIONNAIRE 7 DWELLING DESTROYED 2 8 DWELLING NOT FOUND 9 OTHER **LANGUAGE CODES 1 TAGALOG 5 HILIGAYNON 2 CEBUANO 6 WARAY TIME HR 3 ILOCANO 7 ENGLISH STARTED 4 BICOL 8 OTHER MIN NATIONAL STATISTICS OFFICE HOUSEHOLD QUESTIONNAIRE IDENTIFICATION INTERVIEW RECORD 2008 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY ENCODER 2 0 1 2 TIME OF INTERVIEW SPECIFY Name and Signature Date OFFICE EDITOR DateName and Signature SUPERVISOR FIELD EDITOR (SPECIFY) AND TIME NO 3 7 YES DATE FINAL VISIT 0 8 279Appendix E | Hello. My name is _______and I am working with the National Statistics Office. We are conducting a national survey about various health issues. We would very much appreciate your participation in this survey. As part of the survey, we would first like to ask some questions about your household. All of the answers you give will be confidential. We LINE NO. USUAL RESIDENTS AND VISITORS Please give me the LINE names of the persons (NAME) NO. OF who usually sleep and eat in ALL your household or those who WOMEN slept here last night, AGE starting with the head 15-49 of the household. (1) (2) (8) M F Y N Y N 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 1 2 PUT AN X MARK IF CONTINUATION SHEET IS USED 2A) Are there any other persons such as OFW, small children or infants that we have not listed? YES ENTER EACH IN TABLE NO 2B) In addition, are there any other people who may not be members of your family, such as domestic servants, lodgers or friends YES ENTER EACH IN TABLE NO who usually live here? 2C) Are there any guests or temporary visitors staying here, or anyone else who slept here YES ENTER EACH IN TABLE NO last night, who have not been listed? CODES FOR Q.3: RELATIONSHIP TO HEAD OF HOUSEHOLD 01 = HEAD 05 = GRANDCHILD 09 = OTHER RELATIVE 02 = WIFE OR HUSBAND 06 = PARENT 10 = ADOPTED/FOSTER/STEPCHILD 03 = SON OR DAUGHTER 07 = PARENT-IN-LAW 11 = NOT RELATED of his/her last birthday? ALL PERSONS ELIGI- BILITYSEX (7)(5) RELATION- SHIP TO HEAD OF 08 06 (6)(3) (4) 10 09 10 09 household? 07 02 03 04 05 06 1 01 0 05 IN YEARS 03 01 02 07 08 the head Is of the 04 night? last HOUSEHOLD here (NAME) male or What is the female? live Did relationship of (NAME) to RESIDENCE usually sleep (NAME) here? Does (NAME) as AGE CIRCLE How old is = DON'T KNOW04 = SON-IN-LAW OR DAUGHTER-IN-LAW 08 = BROTHER OR SISTER 98 280 | Appendix E hope you will participate in the survey since your views are important. Now, I would like to ask you some information about the people who usually live in your household or who are staying with you. LINE NO. RANDOM WOMAN RESPONDENT. COUNT THE TOTAL NO. OF ELIGIBLE WOMEN IN COL.8; CIRCLE THE NO. IN THE TABLE. Y N DK Y N 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 07 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 NEXT HH MEMBER 1 2 8 1 2 (14) RECORD THE NAME AND LINE NUMBER OF THE RESPONDENT NEXT HH MEMBER FOR THE WOMEN'S SAFETY MODULE 1 2 8 1 2 NEXT HH MEMBER A = PHILHEALTH PAYING MEMBER 00 = NO GRADE COMPLETED 31 = POST SECONDARY YEAR 1 B = PHILHEALTH DEPENDENT OF PAYING MEMBER 01 = PRE-SCHOOL 32 = POST SECONDARY YEAR 2 C = PHILHEALTH INDIGENT MEMBER 11 = ELEMENTARY GRADE 1 OR MORE D = PHILHEALTH DEPENDENT OF INDIGENT MEMBER 12 = ELEMENTARY GRADE 2 E = GSIS 13 = ELEMENTARY GRADE 3 41 = COLLEGE YEAR 1 F = SSS 14 = ELEMENTARY GRADE 4 42 = COLLEGE YEAR 2 G = PRIVATE INSURANCE COMPANY/ 15 = ELEMENTARY GRADE 5 43 = COLLEGE YEAR 3 HEALTH MAINTENANCE ORGANIZATION/ 16 = ELEMENTARY GRADE 6 44 = COLLEGE YEAR 4 PRE-NEED INSURANCE PLAN COMPANY X = OTHER, SPECIFY 18 = ELEMENTARY GRADUATE 45 = COLLEGE YEAR 5 47 = COLLEGE GRADUATE 51 = POST BACCALAUREATE 2 5 1 0 8 24 = HIGH SCHOOL YEAR 4 DIGIT AND TOTAL NUMBER OF ELIGIBLE RESPONDENT FOR THE WS MODULE. WOMEN MEET; THIS IS THE RANK OF THE NAME 9 21 = HIGH SCHOOL YEAR 1 46 = COLLEGE YEAR 6 OR MORE 22 = HIGH SCHOOL YEAR 2 23 = HIGH SCHOOL YEAR 3 IF ONLY ONE ELIGIBLE WOMAN, GO TO 14.Any other health year (NAME) completed? NEXT HH MEMBER, OR IF (12) CHECK COVER PAGE FOR LAST DIGIT OF THE NDHS HOUSEHOLD NUMBER. CIRCLE LAST DIGIT IN THE TABLE CIRCLE THE NUMBER WHERE THE LAST GRADE/YEAR Medicare, GSIS, IF NO, GO TO SSS, or any belong to? LAST MEMBERor dependent? 01 GO TO 11 GO TO 11 CODES FOR Q.10 GO TO 11 USE THE TABLE BELOW TO SELECT 5 5 3 2 4 4 1 3 4 RANK IS IF THE TOTAL NUMBER OF ELIGIBLE WOMEN IN THE HOUSEHOLD IS 2 3 (13) SELECTION OF RESPONDENT FOR WOMEN'S SAFETY (WS) MODULE IF MORE THAN 1 ELIGIBLE WOMEN LAST DIGIT OF NDHS HOUSEHOLD NUMBER IS 24 3 3 4 1 1 1 (10) Which health (NAME) insurance? highest grade/ Has (NAME) ever attended What is the (9) school? SKIP TO 13 06 GO TO 11 03 05 4 11 7 6 5 2 3 2 21 2 2 04 1 1 1 3 2 2 4 3 2 GO TO 11 02 GO TO 11 08 1 10 GO TO 11 2 1 09 LN 2 31 2 GO TO 11 HEALTH INSURANCE insurance does Is (NAME) covered by PhilHealth or GO TO 11 GO TO 11 ALL PERSONS health insurance, either as member 6 YEARS OLD AND OVER SCHOOL EVER ATTENDED (11) CODES FOR Q.12 98 = DON'T KNOW26 = HIGH SCHOOL GRADUATE 281Appendix E | NO 15 In the last 30 days, has any member of your household been YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 sick or injured? By injured, I mean cuts, burns, and injury NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 that require medical attention. (GO TO 20) 16 Now I would like to ask you some questions about each person who is sick/injured or got sick/injured at any time in the last 30 days. Could you tell me the name of each household member who is sick/injured or got sick/injured in the last 30 days? ENTER THE LINE NUMBER AND NAME OF EACH PERSON WHO IS SICK OR INJURED. ENTER THE LINE NUMBER IN ASCENDING ORDER. ASK ALL QUESTIONS ABOUT ALL OF THESE PERSONS IF THE PERSON IS DECEASED, ENTER '00' FOR LINE NUMBER. IF THERE ARE MORE THAN 3 PERSONS, USE ADDITIONAL QUESTIONNAIRE. 17 LINE NUMBER LINE LINE LINE AND NAME FROM NUMBER . . . . . . NUMBER . . . . . . NUMBER . . . . . . COL. (1) AND (2). NAME NAME NAME 18 What was COMMON NON- COMMON NON- COMMON NON- (NAME IN 17)'s COMMUNICABLE DISEASES COMMUNICABLE DISEASES COMMUNICABLE DISEASES illness or injury? DIABETES . . . . . . . . A DIABETES . . . . . . . . A DIABETES . . . . . . . . A CANCER . . . . . . . . . . B CANCER . . . . . . . . . . B CANCER . . . . . . . . . . B IF COMMON NON- HYPERTENSION . . . . . C HYPERTENSION . . . . . C HYPERTENSION . . . . . C COMMUNICABLE OR INFECTIOUS COMMON INFECTIOUS COMMON INFECTIOUS COMMON INFECTIOUS DISEASES, DISEASES DISEASES DISEASES PROBE: Was TUBERCULOSIS TUBERCULOSIS TUBERCULOSIS (NAME)'s illness (TB) . . . . . . . . . . . . D (TB) . . . . . . . . . . . . D (TB) . . . . . . . . . . . . D diagnosed by a ACUTE RESPIRATORY ACUTE RESPIRATORY doctor? INFECTION . . . . . . E INFECTION . . . . . . E INFECTION . . . . . . E ACUTE GASTRO- ACUTE GASTRO- ACUTE GASTRO- IF NOT DIAGNOSED ENTERITIS . . . . . . F ENTERITIS . . . . . . F ENTERITIS . . . . . . F SPECIFY IN 'OTHER'. COMMON COLDS AND COMMON COLDS AND COMMON COLDS AND COUGH/ FLU/FEVER . G COUGH/ FLU/FEVER . G COUGH/ FLU/FEVER . G IF YES, CIRCLE INJURY INJURY INJURY APPROPRIATE CUT/WOUND . . . . . . H CUT/WOUND . . . . . . H CUT/WOUND . . . . . . H CODE. BURN . . . . . . . . . . . . I BURN . . . . . . . . . . . . I BURN . . . . . . . . . . . . I FRACTURE/ FRACTURE/ FRACTURE/ BROKEN BONE . . . J BROKEN BONE . . . J BROKEN BONE . . . J DISLOCATION/ DISLOCATION/ DISLOCATION/ SLIPPED DISK . . . . . K SLIPPED DISK . . . . . K SLIPPED DISK . . . . . K OTHER X OTHER X OTHER X 19 GO BACK TO 18 IN GO BACK TO 18 IN GO BACK TO 18 OF NEW NEXT COLUMN; OR, IF NEXT COLUMN; OR, IF QUESTIONNAIRE; OR, IF NO MORE SICK PERSON NO MORE SICK PERSON NO MORE SICK PERSON IN 17, GO TO 20 IN 17, GO TO 20 IN 17, GO TO 20 20 In the last 30 days, has any member of your household YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 visited a health facility or sought advice or treatment anywhere? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (GO TO 44) 21 Could you tell me the name of each household member who visited a health facility or sought advice or treatment in the last 30 days? ENTER IN 22, 29, AND 34 THE LINE NUMBER AND NAME OF EACH PERSON WHO VISITED A HEALTH FACILITY. ENTER THE LINE NUMBER IN ASCENDING ORDER. ASK ALL QUESTIONS ABOUT ALL OF THESE PERSONS IF MORE THAN TWO VISITS, ASK ONLY ABOUT THE FIRST TWO VISITS IN THE LAST 30 DAYS. IF THE PERSON IS DECEASED, ENTER '00' FOR LINE NUMBER. IF THERE ARE MORE THAN 3 PERSONS, USE ADDITIONAL QUESTIONNAIRE. QUESTIONS AND FILTERS CODING CATEGORIES SICK/INJURED PERSONS IN THE LAST 30 DAYS (SPECIFY) (SPECIFY) (SPECIFY) ACUTE RESPIRATORY 282 | Appendix E 22 LINE NUMBER LINE LINE LINE AND NAME FROM NUMBER . . . . . . NUMBER . . . . . . NUMBER . . . . . . COL. (1) AND (2). NAME NAME NAME 23 Where was advice PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR or treatment first REGIONAL HOSP./ REGIONAL HOSP./ REGIONAL HOSP./ sought for PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 (NAME IN 22)'s PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 illness/injury/ DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 check-up/ MUNICIPAL HOSP. . . . 14 MUNICIPAL HOSP. . . . 14 MUNICIPAL HOSP. . . . 14 laboratory? RURAL HEALTH UNIT/ RURAL HEALTH UNIT/ RURAL HEALTH UNIT/ URBAN HLTH CTR. . 15 URBAN HLTH CTR. . 15 URBAN HLTH CTR. . 15 BARANGAY HLTH ST. 16 BARANGAY HLTH ST. 16 BARANGAY HLTH ST. 16 OTHER PUBLIC . . . . . 17 OTHER PUBLIC . . . . . 17 OTHER PUBLIC . . . . . 17 (GO TO 25) (GO TO 25) (GO TO 25) IF "HOSPITAL", PRIVATE SECTOR PRIVATE SECTOR PRIVATE SECTOR PROBE: PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 Regional Hospital, LYING-IN CLINIC/ LYING-IN CLINIC/ LYING-IN CLINIC/ Provincial Hospital, BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 District Hospital, PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 Health Center, or PRIVATE PHARMACY. 24 PRIVATE PHARMACY. 24 PRIVATE PHARMACY. 24 Private Hospital? OTHER PRIVATE. . . . . 26 OTHER PRIVATE. . . . . 26 OTHER PRIVATE. . . . . 26 IF "HEALTH ALTERNATIVE MEDICAL ALTERNATIVE MEDICAL ALTERNATIVE MEDICAL WORKER/NURSE", HILOT/HERBALISTS . 31 HILOT/HERBALISTS . 31 HILOT/HERBALISTS . 31 PROBE: THERAPEUTIC THERAPEUTIC THERAPEUTIC Did the health MASSAGE CENTER 32 MASSAGE CENTER 32 MASSAGE CENTER 32 worker/nurse OTHER ALTERNATIVE OTHER ALTERNATIVE OTHER ALTERNATIVE visit (NAME) HEALING . . . . . . . . 36 HEALING . . . . . . . . 36 HEALING . . . . . . . . 36 or did (NAME) NOT MEDICAL SECTOR NOT MEDICAL SECTOR NOT MEDICAL SECTOR go to his/her SHOP SELLING SHOP SELLING SHOP SELLING clinic/home? DRUGS/MARKET. . . 41 DRUGS/MARKET. . . 41 DRUGS/MARKET. . . 41 FAITH HEALER . . . . . 42 FAITH HEALER . . . . . 42 FAITH HEALER . . . . . 42 OTHER 96 OTHER 96 OTHER 96 (GO TO 25) (GO TO 25) (GO TO 25) 24 Was (NAME IN 22) YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 confined in the NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 hospital/clinic then? 25 Why did (NAME ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 IN 22) visit a DENTAL . . . . . . . . . . . . . . 2 DENTAL . . . . . . . . . . . . . . 2 DENTAL . . . . . . . . . . . . . . 2 health facility or MEDICAL CHECK-UP . . 3 MEDICAL CHECK-UP . . 3 MEDICAL CHECK-UP . . 3 sought advice/ MEDICAL MEDICAL MEDICAL treatment? REQUIREMENT . . . . . 4 REQUIREMENT . . . . . 4 REQUIREMENT . . . . . 4 OTHER _______________ 6 OTHER _______________ 6 OTHER _______________ 6 26 How long did HOURS HOURS HOURS it take to travel from your home to (NAME OF MINUTES MINUTES MINUTES SOURCE IN 23)? 27 How did you reach BY FOOT . . . . . . . . . . . . A BY FOOT . . . . . . . . . . . . A BY FOOT . . . . . . . . . . . . A this (NAME OF BICYCLE/TRISIKAD . . . B BICYCLE/TRISIKAD . . . B BICYCLE/TRISIKAD . . . B SOURCE IN 23) MOTORCYCLE/ MOTORCYCLE/ MOTORCYCLE/ from your home? TRICYCLE . . . . . . . . C TRICYCLE . . . . . . . . C TRICYCLE . . . . . . . . C CAR/TAXI . . . . . . . . . . . . D CAR/TAXI . . . . . . . . . . . . D CAR/TAXI . . . . . . . . . . . . D Any other means? JEEPNEY/BUS . . . . . . . . E JEEPNEY/BUS . . . . . . . . E JEEPNEY/BUS . . . . . . . . E BANCA . . . . . . . . . . . . . . F BANCA . . . . . . . . . . . . . . F BANCA . . . . . . . . . . . . . . F IF BY FOOT ONLY, MOTORIZED BOAT . . . . . G MOTORIZED BOAT . . . . . G MOTORIZED BOAT . . . . . G SKIP TO 30 AIRPLANE . . . . . . . . . . . . H AIRPLANE . . . . . . . . . . . . H AIRPLANE . . . . . . . . . . . . H OTHER X OTHER X OTHER X NO NEED TO TRAVEL . Y NO NEED TO TRAVEL . Y NO NEED TO TRAVEL . Y (GO TO 30) (GO TO 30) (GO TO 30) 28 How much in total PhP PhP PhP was the cost of transportation in FREE/NO COST . . . 00000 FREE/NO COST . . . 00000 FREE/NO COST . . . 00000 going to (SOURCE IN KIND . . . . . . . . . . 99996 IN KIND . . . . . . . . . . 99996 IN KIND . . . . . . . . . . 99996 IN 23) and back? DON'T KNOW . . . . . 99998 DON'T KNOW . . . . . 99998 DON'T KNOW . . . . . 99998 (SPECIFY) (SPECIFY)(SPECIFY) PERSONS WHO VISITED A HEALTH FACILITY IN THE LAST 30 DAYS . . . . . . . . . (SPECIFY)(SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283Appendix E | COPY LINE LINE LINE LINE 29 NUMBER AND NUMBER . . . . . . NUMBER . . . . . . NUMBER . . . . . . NAME FROM 22 NAME NAME NAME 30 How much in total COST IN PESOS COST IN PESOS COST IN PESOS was spent on (NAME IN 29)'s treatment at the DONATION IN PESOS DONATION IN PESOS DONATION IN PESOS (SOURCE IN 23)? IF AMOUNT FREE/NO COST . 0000000 FREE/NO COST . 0000000 FREE/NO COST . 0000000 PAID IS STILL IN STILL IN STILL IN P999,994 OR HOSPITAL . . . 9999995 HOSPITAL . . . 9999995 HOSPITAL . . . 9999995 MORE, RECORD IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 999994. (GO TO 32) (GO TO 32) (GO TO 32) DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 31 Did (NAME IN 29) SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A use any health insu- LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B rance or did he/she SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C have to borrow or DONATION/CHARITY/ DONATION/CHARITY/ DONATION/CHARITY/ use savings to pay ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D for the advice or PHILHEALTH . . . . . . E PHILHEALTH . . . . . . E PHILHEALTH . . . . . . E treatment at the SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F (NAME OF HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED SOURCE IN 23) or INSURANCE . . . . . . G INSURANCE . . . . . . G INSURANCE . . . . . . G what? OTHER X OTHER X OTHER X What else? 32 Was there a YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 second visit to this NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 place/person or GO BACK TO 23 GO BACK TO 23 GO BACK TO 23 was advice/ IN NEXT COLUMN; IN NEXT COLUMN; OF NEW QUESTIONNAIRE treatment sought OR, IF NO MORE OR, IF NO MORE OR IF NO MORE PERSON anywhere else for PERSON IN 22, PERSON IN 22, IN 22, GO TO 44 the same illness or GO TO 44 GO TO 44 other purpose? 33 Where was advice PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR or treatment REGIONAL HOSP./ REGIONAL HOSP./ REGIONAL HOSP./ sought for PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 (NAME IN 29)'s PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 illness/injury/ DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 check-up/ MUNICIPAL HOSP. . . . 14 MUNICIPAL HOSP. . . . 14 MUNICIPAL HOSP. . . . 14 laboratory? RURAL HEALTH UNIT/ RURAL HEALTH UNIT/ RURAL HEALTH UNIT/ URBAN HLTH CTR. . 15 URBAN HLTH CTR. . 15 URBAN HLTH CTR. . 15 IF "HOSPITAL", BARANGAY HLTH ST. 16 BARANGAY HLTH ST. 16 BARANGAY HLTH ST. 16 PROBE: OTHER PUBLIC . . . . . 17 OTHER PUBLIC . . . . . 17 OTHER PUBLIC . . . . . 17 Regional Hospital, (GO TO 36) (GO TO 36) (GO TO 36) Provincial Hospital, District Hospital, PRIVATE SECTOR PRIVATE SECTOR PRIVATE SECTOR Health Center, or PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 Private Hospital? LYING-IN CLINIC/ LYING-IN CLINIC/ LYING-IN CLINIC/ BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 IF "HEALTH PRIVATE PHARMACY. 24 PRIVATE PHARMACY. 24 PRIVATE PHARMACY. 24 WORKER/NURSE", OTHER PRIVATE. . . . . 26 OTHER PRIVATE. . . . . 26 OTHER PRIVATE. . . . . 26 PROBE: Did the health ALTERNATIVE MEDICAL ALTERNATIVE MEDICAL ALTERNATIVE MEDICAL worker/nurse HILOT/HERBALISTS . 31 HILOT/HERBALISTS . 31 HILOT/HERBALISTS . 31 visit (NAME) THERAPEUTIC THERAPEUTIC THERAPEUTIC or did (NAME) MASSAGE CENTER 32 MASSAGE CENTER 32 MASSAGE CENTER 32 go to his/her OTHER ALTERNATIVE OTHER ALTERNATIVE OTHER ALTERNATIVE clinic/home? HEALING . . . . . . . . 36 HEALING . . . . . . . . 36 HEALING . . . . . . . . 36 NOT MEDICAL SECTOR NOT MEDICAL SECTOR NOT MEDICAL SECTOR SHOP SELLING SHOP SELLING SHOP SELLING DRUGS/MARKET. . . 41 DRUGS/MARKET. . . 41 DRUGS/MARKET. . . 41 FAITH HEALER . . . . . 42 FAITH HEALER . . . . . 42 FAITH HEALER . . . . . 42 OTHER 96 OTHER 96 OTHER 96 (GO TO 36) (GO TO 36) (GO TO 36) (SPECIFY)(SPECIFY) 0 0 0 (SPECIFY) 2 1 PERSONS WHO VISITED A HEALTH FACILITY IN THE LAST 30 DAYS 1 (SPECIFY)(SPECIFY) 1 220 (SPECIFY) 00 0 00 284 | Appendix E 34 COPY LINE LINE LINE LINE NUMBER AND NUMBER . . . . . . NUMBER . . . . . . NUMBER . . . . . . NAME FROM 22 NAME NAME NAME 35 Was (NAME IN 34) YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 confined in the NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 hospital/clinic then? 36 Why did (NAME ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 in 34) visit a DENTAL . . . . . . . . . . . . 2 DENTAL . . . . . . . . . . . . 2 DENTAL . . . . . . . . . . . . 2 health facility or MEDICAL CHECK-UP . 3 MEDICAL CHECK-UP . 3 MEDICAL CHECK-UP . 3 sought advice/ MEDICAL MEDICAL MEDICAL treatment? REQUIREMENT . . . . . 4 REQUIREMENT . . . . . 4 REQUIREMENT . . . . . 4 OTHER _______________ 6 OTHER _______________ 6 OTHER _______________ 6 37 Was it the same YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 illness/injury? NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 38 How long did HOURS HOURS HOURS it take to travel from your home to (NAME OF MINUTES MINUTES MINUTES SOURCE IN 33)? 39 How did you reach BY FOOT . . . . . . . . . . . . A BY FOOT . . . . . . . . . . . . A BY FOOT . . . . . . . . . . . . A this (NAME OF BICYCLE/TRISIKAD . . . B BICYCLE/TRISIKAD . . . B BICYCLE/TRISIKAD . . . B SOURCE IN 33) MOTORCYCLE/ MOTORCYCLE/ MOTORCYCLE/ from your home? TRICYCLE . . . . . . . . C TRICYCLE . . . . . . . . C TRICYCLE . . . . . . . . C CAR/TAXI . . . . . . . . . . . . D CAR/TAXI . . . . . . . . . . . . D CAR/TAXI . . . . . . . . . . . . D Any other means? JEEPNEY/BUS . . . . . . . . E JEEPNEY/BUS . . . . . . . . E JEEPNEY/BUS . . . . . . . . E BANCA . . . . . . . . . . . . . . F BANCA . . . . . . . . . . . . . . F BANCA . . . . . . . . . . . . . . F IF BY FOOT ONLY MOTORIZED BOAT . . . . . G MOTORIZED BOAT . . . . . G MOTORIZED BOAT . . . . . G SKIP TO 41 AIRPLANE . . . . . . . . . . . . H AIRPLANE . . . . . . . . . . . . H AIRPLANE . . . . . . . . . . . . H OTHER X OTHER X OTHER X NO NEED TO TRAVEL. . . Y NO NEED TO TRAVEL. . . Y NO NEED TO TRAVEL. . . Y (GO TO 41) (GO TO 41) (GO TO 41) 40 How much in total PhP PhP PhP was the cost of transportation in FREE/NO COST . . . 00000 FREE/NO COST . . . 00000 FREE/NO COST . . . 00000 going to (SOURCE IN KIND . . . . . . . . . . 99996 IN KIND . . . . . . . . . . 99996 IN KIND . . . . . . . . . . 99996 IN 33) and back? DON'T KNOW . . . . . 99998 DON'T KNOW . . . . . 99998 DON'T KNOW . . . . . 99998 COST IN PESOS COST IN PESOS COST IN PESOS 41 How much in total was spent on (NAME)'s treatment DONATION IN PESOS DONATION IN PESOS DONATION IN PESOS at the (SOURCE IN 33)? FREE/NO COST . 0000000 FREE/NO COST . 0000000 FREE/NO COST . 0000000 IF AMOUNT PAID IS STILL IN STILL IN STILL IN P999,994 OR HOSPITAL . . . 9999995 HOSPITAL . . . 9999995 HOSPITAL . . . 9999995 MORE, RECORD IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 999994. (GO TO 43) (GO TO 43) (GO TO 43) DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 42 Did (NAME IN 34) SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A use any health insu- LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B rance or did he/she SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C have to borrow or DONATION/CHARITY/ DONATION/CHARITY/ DONATION/CHARITY/ use savings to pay ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D for the advice or PHILHEALTH . . . . . . . . E PHILHEALTH . . . . . . . . E PHILHEALTH . . . . . . . . E treatment at the SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F (NAME OF HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED SOURCE IN 33) or INSURANCE . . . . . . G INSURANCE . . . . . . G INSURANCE . . . . . . G what? OTHER X OTHER X OTHER X What else? 43 GO BACK TO 23 IN NEXT GO BACK TO 23 IN NEXT GO BACK TO 23 OF NEW COLUMN; OR, IF NO MORE COLUMN; OR, IF NO MORE QUESTIONNAIRE; IF NO PERSON IN 22, GO TO 44 PERSON IN 22, GO TO 44 MORE PERSON IN 22, GO TO 44. 2 PERSONS WHO VISITED A HEALTH FACILITY IN THE LAST 30 DAYS (SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) 0 0 (SPECIFY) 000 (SPECIFY) 1 2 1 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (SPECIFY) (SPECIFY) 1 (SPECIFY) 0 00 2 285Appendix E | 44 In the last 12 months, has any member of your household been YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 confined in a hospital/clinic? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 (GO TO 53) 45 Now I would like to ask you some questions about each person who was confined in a hospital/clinic in the last 12 months. Could you tell me the name of each household member who was confined during the last 12 months? ENTER THE LINE NUMBER AND NAME OF EACH PERSON WHO WAS CONFINED IN A HOSPITAL. ENTER THE LINE NUMBER IN ASCENDING ORDER. IF THE PERSON IS DECEASED, ENTER '00' FOR LINE NUMBER. IF THERE ARE MORE THAN 3 PERSONS, USE ADDITIONAL QUESTIONNAIRE. 46 LINE NUMBER LINE LINE LINE AND NAME FROM NUMBER . . . . . . NUMBER . . . . . . NUMBER . . . . . . COL. (1) AND (2). NAME NAME NAME 47 Where was PUBLIC SECTOR PUBLIC SECTOR PUBLIC SECTOR (NAME IN 46) (last) REGIONAL HOSP./ REGIONAL HOSP./ REGIONAL HOSP./ confined? PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 PUBLIC MED. CTR . 11 PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 PROVINCIAL HOSP. . 12 IF CONFINED DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 DISTRICT HOSPITAL . 13 MORE THAN MUNICIPAL MUNICIPAL MUNICIPAL ONCE, REPORT HOSPITAL . . . . . . 14 HOSPITAL . . . . . . 14 HOSPITAL . . . . . . 14 THE LAST ONE. PRIVATE SECTOR PRIVATE SECTOR PRIVATE SECTOR PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 PRIVATE HOSP. . . . . . 21 LYING-IN CLINIC/ LYING-IN CLINIC/ LYING-IN CLINIC/ BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 BIRTHING HOME. . . 22 PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 PRIVATE CLINIC . . . . . 23 48 Why was (NAME ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 ILL/INJURED . . . . . . . . 1 IN 46) (last) GAVE BIRTH. . . . . . . . . . 2 GAVE BIRTH. . . . . . . . . . 2 GAVE BIRTH. . . . . . . . . . 2 confined in the EXECUTIVE EXECUTIVE EXECUTIVE hospital/clinic? CHECK UP . . . . . . . . 3 CHECK UP . . . . . . . . 3 CHECK UP . . . . . . . . 3 OTHER _______________ 6 OTHER _______________ 6 OTHER _______________ 6 49 How long was (NAME IN 46) confined? DAYS . . . . . . DAYS . . . . . . DAYS . . . . . . IF CONFINED STILL CONFINED . . . 995 STILL CONFINED . . . 995 STILL CONFINED . . . 995 MORE THAN ONCE, REPORT THE LAST ONE. 50 How much was COST IN PESOS COST IN PESOS COST IN PESOS the total medical expenditures for the (last) confine- DONATION IN PESOS DONATION IN PESOS DONATION IN PESOS ment in (NAME OF SOURCE IN 47)? FREE/NO COST . 0000000 FREE/NO COST . 0000000 FREE/NO COST . 0000000 IF AMOUNT PAID IS STILL CONFINED 9999995 STILL CONFINED 9999995 STILL CONFINED 9999995 P999,994 OR IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 IN KIND . . . . . . . . 9999996 MORE, RECORD (GO TO 52) (GO TO 52) (GO TO 52) 999994. DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 DON'T KNOW . . . 9999998 51 Did (NAME IN 46) SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A SALARY/ INCOME . . . . . A use any health insu- LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B LOAN/MORTGAGE . . . . . B rance or did he/she SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C SAVINGS . . . . . . . . . . . . C have to borrow or DONATION/CHARITY/ DONATION/CHARITY/ DONATION/CHARITY/ use savings to pay ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D ASSISTANCE . . . . . . D for the confinement PHILHEALTH . . . . . . E PHILHEALTH . . . . . . E PHILHEALTH . . . . . . E at the (NAME OF SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F SSS/GSIS/ECC . . . . . . F SOURCE IN 47) or HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED HMO/PRIVATE/PRE-NEED what? INSURANCE . . . . . . G INSURANCE . . . . . . G INSURANCE . . . . . . G OTHER X OTHER X OTHER X What else? 52 GO BACK TO 47 IN NEXT GO BACK TO 47 IN NEXT GO BACK TO 47 OF NEW COLUMN; OR, IF NO MORE COLUMN; OR, IF NO MORE QUESTIONNAIRE; OR, IF NO MEMBER CONFINED MEMBER CONFINED MORE CONFINED MEMBER IN 46, GO TO 53. IN 46, GO TO 53. IN 46, GO TO 53. 0 1 2 1 2 1 20 0 0 (SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) (SPECIFY) 0 0 0 PERSONS CONFINED IN A HOSPITAL IN THE LAST 12 MONTHS (SPECIFY) 0 0 286 | Appendix E HOUSEHOLD CHARACTERISTICS/ PRACTICES NO. QUESTIONS AND FILTERS SKIP 53 PIPED WATER PIPED INTO DWELLING . . . . . . . . 11 PIPED TO YARD/PLOT . . . . . . . . . . 12 PUBLIC TAP/STAND PIPE . . . . . . . . 13 TUBE WELL OR BOREHOLE . . . . . . 21 DUG WELL PROTECTED WELL . . . . . . . . . . . . 31 SEMI-PROTECTED . . . . . . . . . . . . 32 UNPROTECTED WELL . . . . . . . . . . 33 WATER FROM SPRING PROTECTED SPRING . . . . . . . . . . 41 UNPROTECTED SPRING . . . . . . . . 42 RAINWATER . . . . . . . . . . . . . . . . . . . . . 51 TANKER TRUCK . . . . . . . . . . . . . . . . . . 61 CART WITH SMALL TANK . . . . . . . . . . 71 SURFACE WATER (RIVER,DAM, ETC.)81 BOTTLED/MINERAL WATER . . . . . . 91 OTHER 96 (SPECIFY) 54 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 55 BOIL . . . . . . . . . . . . . . . . . . . . . . . . . . . A ADD BLEACH/CHLORINE . . . . . . . . . . B IMPROVISED FILTER (CLOTH, SPONGE, ETC.) . . . . . . . . C USE WATER FILTER (CERAMIC/ SAND/COMPOSITE/ETC.) . . . . . . . . D SOLAR DISINFECTION . . . . . . . . . . . . E RECORD ALL MENTIONED. LET IT STAND AND SETTLE . . . . . . . . F OTHER X DON'T KNOW . . . . . . . . . . . . . . . . . . . Z 56 PIPED WATER PIPED INTO DWELLING . . . . . . . . 11 PIPED TO YARD/PLOT . . . . . . . . . . 12 PUBLIC TAP/STANDPIPE . . . . . . . . 13 TUBE WELL OR BOREHOLE . . . . . . 21 DUG WELL PROTECTED WELL . . . . . . . . . . . . 31 SEMI-PROTECTED . . . . . . . . . . . . 32 UNPROTECTED WELL . . . . . . . . . . 33 WATER FROM SPRING PROTECTED SPRING . . . . . . . . . . 41 UNPROTECTED SPRING . . . . . . . . 42 RAINWATER . . . . . . . . . . . . . . . . . . . . . 51 59 TANKER TRUCK . . . . . . . . . . . . . . . . . . 61 CART WITH SMALL TANK . . . . . . . . . . 71 SURFACE WATER (RIVER,DAM, ETC.)81 OTHER 96 57 Where is that water source located? IN OWN DWELLING . . . . . . . . . . . . . . 1 IN OWN YARD/PLOT . . . . . . . . . . . . . . 2 ELSEWHERE, SPECIFY 3 58 MINUTES . . . . . . . . . . . . . . DELIVERED WATER . . . . . . . . . . . . 000 OWN PREMISES . . . . . . . . . . . . . . . . 996 DON'T KNOW . . . . . . . . . . . . . . . . . . 998 What is the main source of drinking water for members of your household? Do you do anything to the water to make it safer to drink? What do you usually do to make the water safer to drink? What is the main source of water used by your household for other purposes such as cooking and handwashing? How long does it take to go there, get water, and come back? Anything else? 59 59 CODING CATEGORIES (SPECIFY) (SPECIFY) 56 287Appendix E | NO. QUESTIONS AND FILTERS SKIPCODING CATEGORIES 59 What kind of toilet facility do members of your FLUSH OR POUR FLUSH TOILET household usually use? TO PIPED SEWER SYSTEM . . . . . . 11 TO SEPTIC TANK . . . . . . . . . . . . . . 12 IF FLUSH OR POUR FLUSH TOILET TO PIT LATRINE . . . . . . . . . . . . . . . . 13 TO SOMEWHERE ELSE . . . . . . . . 14 PROBE: Do you have a septic tank? FLUSH, DON'T KNOW WHERE . . . 15 IF YES, PROBE: PIT LATRINE Does your septic tank have concrete VENTILATED IMPROVED . . . . . . . . 21 lining, that is, walls and flooring? WITH SLAB . . . . . . . . 22 WITHOUT SLAB/OPEN PIT . . . . . . 23 IF NO, PROBE: COMPOSTING TOILET . . . . . . . . . . . . 31 Where does your wastewater BUCKET TOILET . . . . . . . . . . . . . . . . . . 41 flow? DROP/HANGING TOILET . . . . . . . . . . 51 NO FACILITY/BUSH/FIELD/RIVER . . . 61 61 OTHER 96 60 Do you share this toilet facility with YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 other households? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 61 Does your household or any member YES NO of your household have/own: Electricity? ELECTRICITY . . . . . . . . . . . . . . 1 2 A radio / radio cassette? RADIO . . . . . . . . . . . . . . . . . . . 1 2 A television? TELEVISION . . . . . . . . . . . . . . . . 1 2 A landline/wireless landline telephone? LANDLINE/WIRELESS . . . . . . 1 2 A cellular phone? CELLULAR PHONE . . . . . . . . 1 2 A personal computer or laptop? PC OR LAPTOP . . . . . . . . . . . . 1 2 A washing machine? WASHING MACHINE . . . . . . . . 1 2 A refrigerator or freezer? REF/ FREEZER . . . . . . . . . . . . 1 2 A CD or VCD or DVD player? CD/ VCD/ DVD PLAYER . . . . . . 1 2 A component or karaoke? COMPONENT/KARAOKE . . . . . 1 2 62 ELECTRICITY . . . . . . . . . . . . . . . . . . . 01 LPG . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 65 NATURAL GAS. . . . . . . . . . . . . . . . . . . 03 BIOGAS . . . . . . . . . . . . . . . . . . . . . . . . . 04 KEROSENE . . . . . . . . . . . . . . . . . . . . . 05 COAL, LIGNITE . . . . . . . . . . . . . . . . . . 06 CHARCOAL . . . . . . . . . . . . . . . . . . . . . 07 WOOD . . . . . . . . . . . . . . . . . . . . . . . . . 08 STRAW/SHRUBS/GRASS . . . . . . . . . . 09 AGRICULTURAL CROP/BIOMASS (SAWDUST, HULL, ETC.) . . . . . . . . 10 ANIMAL DUNG . . . . . . . . . . . . . . . . . . . 11 NO FOOD COOKED IN HH . . . . . . . . 95 66 OTHER 96 (SPECIFY) 63 In this household, is food cooked on an open fire, OPEN FIRE . . . . . . . . . . . . . . . . . . . . . 1 an open stove or a closed stove? OPEN STOVE . . . . . . . . . . . . . . . . . . . 2 CLOSED STOVE WITH CHIMNEY . . . 3 OTHER 6 (SPECIFY) 64 Does this (fire/stove) have a chimney, a hood, or CHIMNEY . . . . . . . . . . . . . . . . . . . . . . . 1 neither of these? HOOD . . . . . . . . . . . . . . . . . . . . . . . . . 2 NEITHER . . . . . . . . . . . . . . . . . . . . . . . 3 65 Is the cooking usually done in the kitchen in SEPARATE ROOM IN THE HOUSE . . . 1 a separate room in the house, kitchen but NO SEPARATE ROOM IN THE HSE . 2 no separate room in the house, kitchen SEPARATE FROM THE HOUSE . . . . . 3 separate from the house or outdoor? OUTDOOR . . . . . . . . . . . . . . . . . . . . . 4 What type of fuel does your household mainly use for cooking? (SPECIFY) 65 288 | Appendix E NO. QUESTIONS AND FILTERS SKIPCODING CATEGORIES 66 MAIN MATERIAL OF THE FLOOR. NATURAL FLOOR EARTH/SAND . . . . . 11 RUDIMENTARY FLOOR RECORD OBSERVATION. WOOD PLANKS . . . . . . . . . . . . . . . . 21 PALM/BAMBOO . . . . . . . . . . . . . . . . 22 FINISHED FLOOR PARQUET OR POLISHED WOOD . 31 VINYL, LINOLEUM . . . . . . . . . . . . . . 32 CERAMIC TILES . . . . . . . . . . . . . . . . 33 CEMENT . . . . . . . . . . . . . . . . . . . . . 34 CARPET . . . . . . . . . . . . . . . . . . . . . 35 MARBLE . . . . . . . . . . . . . . . . . . . . . 36 OTHER 96 67 MAIN MATERIAL OF THE ROOF. NATURAL ROOFING NO ROOF . . . . . . . . . . . . . . . . . . . . . 11 RECORD OBSERVATION. THATCH/PALM LEAF (NIPA) . . . . . . 12 SOD/GRASS (COGON) . . . . . . . . . . 13 RUDIMENTARY ROOFING RUSTIC MAT. . . . . . . . . . . . . . . . . . . 21 PALM/BAMBOO . . . . . . . . . . . . . . . . 22 WOOD PLANKS . . . . . . . . . . . . . . . . 23 MAKESHIFT/CARDBOARD . . . . . . 24 FINISHED ROOFING GALVANIZED IRON/ALUMINUM . . . 31 WOOD . . . . . . . . . . . . . . . . . . . . . . . 32 CALAMINE/CEMENT FIBER . . . . . . 33 CERAMIC TILES . . . . . . . . . . . . . . . . 34 CEMENT . . . . . . . . . . . . . . . . . . . . . 35 ROOFING SHINGLES . . . . . . . . . . 36 OTHER 96 68 MAIN MATERIAL OF THE EXTERIOR WALLS. NATURAL WALLS CANE/PALM/TRUNKS . . . . . . . . . . 11 RECORD OBSERVATION. DIRT . . . . . . . . . . . . . . . . . . . . . . . . . 12 RUDIMENTARY WALLS BAMBOO . . . . . . . . . . . . . . . . . . . . . 21 STONE WITH MUD . . . . . . . . . . . . . . 22 UNCOVERED ADOBE . . . . . . . . . . 23 PLYWOOD . . . . . . . . . . . . . . . . . . . 24 MAKESHIFT/CARDBOARD/ REUSED MATERIAL . . . . . . . . . . 25 FINISHED WALLS CEMENT . . . . . . . . . . . . . . . . . . . . . 31 STONE WITH LIME/CEMENT. . . . . . 32 BRICKS . . . . . . . . . . . . . . . . . . . . . . . 33 CEMENT BLOCKS . . . . . . . . . . . . . . 34 COVERED ADOBE . . . . . . . . . . . . . . 35 WOOD PLANKS/SHINGLES . . . . . . 36 GALVANIZED IRON/ALUMINUM . . . 37 OTHER 96 69 What is the tenure status of your lot? OWNED/BEING AMORTIZED . . . . . . 1 RENTED . . . . . . . . . . . . . . . . . . . . . . . 2 RENT-FREE W/ OWNER CONSENT 3 RENT-FREE W/O OWNER CONSENT 4 70 How many rooms in this household are used for sleeping? . . . . . . . . . . . . . . . . . . . 71 Does your household or any member of YES NO your household own: A bicycle or trisikad? BICYCLE / TRISIKAD . . . . . . . . 1 2 A motorcycle or tricycle? MOTORCYCLE / TRICYCLE . . . 1 2 An animal-drawn cart? ANIMAL-DRAWN CART . . . . . . 1 2 A car or jeep or van? CAR / JEEP / VAN . . . . . . . . . . 1 2 A tractor? TRACTOR . . . . . . . . . . . . . . . . . . 1 2 A boat or banca with a motor? BOAT / BANCA W/ MOTOR . . . 1 2 RECORD THE TIME. HOUR . MINUTES. (SPECIFY) (SPECIFY) (SPECIFY) 72 ROOMS 289Appendix E | COMMENTS ON SPECIFIC QUESTIONS: 0 2007 40 1967 1968 1 2006 2007 41 1966 1967 2 2005 2006 42 1965 1966 3 2004 2005 43 1964 1965 4 2003 2004 44 1963 1964 5 2002 2003 45 1962 1963 6 2001 2002 46 1961 1962 7 2000 2001 47 1960 1961 8 1999 2000 48 1959 1960 9 1998 1999 49 1958 1959 10 1997 1998 50 1957 1958 11 1996 1997 51 1956 1957 12 1995 1996 52 1955 1956 13 1994 1995 53 1954 1955 14 1993 1994 54 1953 1954 15 1992 1993 55 1952 1953 16 1991 1992 56 1951 1952 17 1990 1991 57 1950 1951 18 1989 1990 58 1949 1950 19 1988 1989 59 1948 1949 20 1987 1988 60 1947 1948 21 1986 1987 61 1946 1947 22 1985 1986 62 1945 1946 23 1984 1985 63 1944 1945 24 1983 1984 64 1943 1944 25 1982 1983 65 1942 1943 26 1981 1982 66 1941 1942 27 1980 1981 67 1940 1941 28 1979 1980 68 1939 1940 29 1978 1979 69 1938 1939 30 1977 1978 70 1937 1938 31 1976 1977 71 1936 1937 32 1975 1976 72 1935 1936 33 1974 1975 73 1934 1935 34 1973 1974 74 1933 1934 35 1972 1973 75 1932 1933 36 1971 1972 76 1931 1932 37 1970 1971 77 1930 1931 38 1969 1970 78 1929 1930 39 1968 1969 79 1928 1929 Has already had birthday in 2008 Don't Know Don't Know -- INTERVIEWER'S OBSERVATION TO BE FILLED IN AFTER COMPLETING INTERVIEW AGE-BIRTH DATE CONSISTENCY CHART Age Has not had birthday in 2008 Has already had birthday in 2008 Age Has not had birthday in 2008 290 | Appendix E AUTHORITY: Commonwealth Act No. 591 NDHS FORM 2 authorizes this survey and the National Statistics Office to collect information NSCB Approval No. NSO-0813-02 on fertility, family planning and health. Expires July 31, 2009 CONFIDENTIALITY : Sec. 4 of CA No. 591 provides that all information furnished on this form is held STRICTLY CONFIDENTIAL. PROVINCE CITY/MUNICIPALITY BARANGAY EA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SAMPLE HOUSING UNIT SERIAL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD CONTROL NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NDHS HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAME OF HOUSEHOLD HEAD NAME AND LINE NUMBER OF ELIGIBLE WOMAN ADDRESS DATE DAY MONTH YEAR INTERVIEWER'S NAME INT. CODE RESULT* RESULT NEXT VISIT: TOTAL NUMBER OF VISITS *RESULT CODES: 1 COMPLETED 5 PARTLY COMPLETED 2 NOT AT HOME 6 RESPONDENT INCAPACITATED 3 POSTPONED 7 OCW/OFW 4 REFUSED 8 OTHER LANGUAGE OF QUESTIONNAIRE** LANGUAGE OF INTERVIEW** LOCAL LANGUAGE OF **LANGUAGE CODES RESPONDENT** 1 TAGALOG 5 HILIGAYNON TRANSLATOR USED YES 1 2 CEBUANO 6 WARAY NO 2 3 ILOCANO 7 ENGLISH 4 BICOL 8 OTHER AND TIME DATE 02 0 OFFICE EDITOR ENCODER 8 INDIVIDUAL WOMAN'S QUESTIONNAIRE Name and Signature Date FIELD EDITOR DateName and Signature SUPERVISOR (SPECIFY) (SPECIFY) 7 NATIONAL STATISTICS OFFICE 2008 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY 3 IDENTIFICATION INTERVIEW RECORD FINAL VISIT1 2 Booklet __ of __ Booklets 291Appendix E | 0 2007 30 1977 1978 1 2006 2007 31 1976 1977 2 2005 2006 32 1975 1976 3 2004 2005 33 1974 1975 4 2003 2004 34 1973 1974 5 2002 2003 35 1972 1973 6 2001 2002 36 1971 1972 7 2000 2001 37 1970 1971 8 1999 2000 38 1969 1970 9 1998 1999 39 1968 1969 10 1997 1998 40 1967 1968 11 1996 1997 41 1966 1967 12 1995 1996 42 1965 1966 13 1994 1995 43 1964 1965 14 1993 1994 44 1963 1964 15 1992 1993 45 1962 1963 16 1991 1992 46 1961 1962 17 1990 1991 47 1960 1961 18 1989 1990 48 1959 1960 19 1988 1989 49 1958 1959 20 1987 1988 50 1957 1958 21 1986 1987 51 1956 1957 22 1985 1986 52 1955 1956 23 1984 1985 53 1954 1955 24 1983 1984 54 1953 1954 25 1982 1983 55 1952 1953 26 1981 1982 56 1951 1952 27 1980 1981 57 1950 1951 28 1979 1980 58 1949 1950 29 1978 1979 59 1948 1949 COMMENTS ABOUT RESPONDENT: COMMENTS ON SPECIFIC QUESTIONS: ANY OTHER COMMENTS: NAME OF SUPERVISOR: DATE: NAME OF EDITOR: DATE: Don't Know Has not had birthday in 2008 Has already had birthday in 2008 Don't Know AGE-BIRTH DATE CONSISTENCY CHART Age SUPERVISOR'S OBSERVATIONS EDITOR'S OBSERVATIONS -- Age INTERVIEWER'S OBSERVATION TO BE FILLED IN AFTER COMPLETING INTERVIEW Has not had birthday in 2008 Has already had birthday in 2008 292 | Appendix E INTRODUCTION AND CONSENT Hello. My name is _______ and I am working with the 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. We hope that you will participate in this survey since your views are important. At this time, do you want to ask me anything about the survey? May I begin the interview now? SIGNATURE OF INTERVIEWER: DATE: RESPONDENT AGREES RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . . . . . . . . . . . . . . 1 TO BE INTERVIEWED . . . . . . . . . . . . . . . . . . . . . . . . . 2 END NO. QUESTIONS AND FILTERS SKIP 101 RECORD THE TIME STARTED. HOUR . . . . . . . . . . . . . . . . . . MINUTE . . . . . . . . . . . . . . . . . . 102 First I would like to ask some questions about you. CITY . . . . . . . . . . . . . . . . . . . . . . . . . 1 For most of the time until you were 12 years old, TOWN PROPER/POBLACION . . . . . 2 did you live in a city, in a town/poblacion, in the BARRIO/RURAL AREA . . . . . . . . . . 3 barrio or rural area, or abroad? ABROAD . . . . . . . . . . . . . . . . . . . . . 4 103 How long have you been living continuously in (NAME OF CURRENT PLACE OF RESIDENCE)? YEARS . . . . . . . . . . . . . . . . . . IF LESS THAN ONE YEAR, RECORD '00' YEARS. SINCE BIRTH . . . . . . . . . . . . . . . . . . 95 VISITOR. . . . . . . . . . . . . . . . . . . . . . . 96 104 Just before you moved here, did you live in a city, CITY . . . . . . . . . . . . . . . . . . . . . . . . . 1 in a town/poblacion, in the barrio or rural area, TOWN PROPER/POBLACION . . . . . 2 or abroad? BARRIO/RURAL AREA . . . . . . . . . . 3 ABROAD . . . . . . . . . . . . . . . . . . . . . 4 105 How long had you continuously lived in your previous place of residence? YEARS . . . . . . . . . . . . . . . . . . IF LESS THAN ONE YEAR, RECORD '00' YEARS. SINCE BIRTH . . . . . . . . . . . . . . . . . . 95 106 In what month and year were you born? MONTH . . . . . . . . . . . . . . . . . . DON'T KNOW MONTH . . . . . . . . . . 98 YEAR . . . . . . . . . . . . DON'T KNOW YEAR . . . . . . . . . . 9998 107 How old were you at your last birthday? AGE IN COMPLETED YEARS COMPARE AND CORRECT 106 AND/OR 107 IF INCONSISTENT. 108 Have you ever attended school? YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 111 109 What is the highest grade or year you completed? CODING CATEGORIES SECTION 1. RESPONDENT'S BACKGROUND (SPECIFY) 106 293Appendix E | NO. QUESTIONS AND FILTERS SKIP 110 CHECK 109: ELEMENTARY HIGH SCHOOL GRADUATE OR YEAR 1 OR HIGHER 113 LOWER 111 Now I would like you to read this sentence to me. CANNOT READ AT ALL . . . . . . . . . . 1 ABLE TO READ ONLY PARTS OF SHOW CARD TO RESPONDENT. SENTENCE . . . . . . . . . . . . . . . . . . 2 ABLE TO READ WHOLE SENTENCE 3 IF RESPONDENT CANNOT READ WHOLE SENTENCE, NO CARD WITH REQUIRED PROBE: LANGUAGE 4 Can you read any part of the sentence to me? BLIND/VISUALLY IMPAIRED . . . . . . 5 112 CHECK 111: CODE '2', '3' CODE '1' OR '4' CIRCLED 114 CIRCLED 113 Do you read a newspaper or magazine almost every ALMOST EVERY DAY. . . . . . . . . . . . 1 day, at least once a week, less than once a week AT LEAST ONCE A WEEK . . . . . . . . 2 or not at all? LESS THAN ONCE A WEEK . . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . 4 114 Do you watch television almost everyday, at least ALMOST EVERY DAY. . . . . . . . . . . . 1 once a week, less than once a week or not at all? AT LEAST ONCE A WEEK . . . . . . . . 2 LESS THAN ONCE A WEEK . . . . . . 3 NOT AT ALL . . . . . . . . . . . . . . . . . . . 4 115 Do you listen to the radio almost every day, ALMOST EVERY DAY. . . . . . . . . . . . 1 at least once a week, less than once a week AT LEAST ONCE A WEEK . . . . . . . . 2 or not at all? 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 NONE . . . . . . . . . . . . . . . . . . . . . . . . . 7 117 How do you classify yourself? Are you a Tagalog, TAGALOG . . . . . . . . . . . . . . . . . . . . . 1 Cebuano, Ilocano, Ilonggo, Bicolano, Waray, CEBUANO . . . . . . . . . . . . . . . . . . . 2 Kapampangan, or something else? ILOCANO . . . . . . . . . . . . . . . . . . . . . 3 ILONGGO . . . . . . . . . . . . . . . . . . . . . 4 BICOLANO . . . . . . . . . . . . . . . . . . . 5 WARAY . . . . . . . . . . . . . . . . . . . . . . . 6 KAPAMPANGAN . . . . . . . . . . . . . . . . 7 OTHER 8 (SPECIFY) (SPECIFY) 115 CODING CATEGORIES (SPECIFY LANGUAGE) 294 | Appendix E 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 pregnancies which you have had that did not result in a live birth. I understand that it is not easy to talk about all the 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 SKIP 201 Have you ever given birth? YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 202 Do you have any sons or daughters whom you YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 have given birth to who are now living with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 204 203 How many sons live with you? SONS AT HOME . . . . . . . . . . And how many daughters live with you? DAUGHTERS AT HOME . . . IF NONE, RECORD '00'. 204 Do you have any sons or daughters whom you have YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 given birth to who are alive but do not live with you? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 206 205 How many sons are alive but do not live with you? And how many daughters are alive but do not live SONS ELSEWHERE . . . . . . with you? DAUGHTERS ELSEWHERE IF NONE, RECORD '00'. 206 Have you ever given birth to a boy or girl who was born alive but later died? YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 IF NO, PROBE:Any baby who cried or showed signs NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 208 of life but did not survive? 207 How many boys have died? BOYS DEAD . . . . . . . . . . . . . . And how many girls have died? GIRLS DEAD . . . . . . . . . . . . IF NONE, RECORD '00'. 208 Women sometimes have pregnancies that do not result in a live born child. That is, a pregnancy can end early, YES . . . . . . . . . . . . . . . . . . . . . . . . . 1 in a miscarriage or the child can be born dead. Have NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 210 you ever had a pregnancy that did not end in a live birh? 209 In all, how many pregnancies have you had that did not end in a live born child? 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/births during your life. Is that correct? PROBE AND YES NO CORRECT 201-210 AS NECESSARY. 212 CHECK 210: ONE OR MORE NO PREGNANCIES PREGNANCIES CODING CATEGORIES 233 295Appendix E | 213 Now I would like to record all your pregnancies, whether born alive, born dead, or lost before full term. Start with the first pregnancy you had. RECORD ALL THE PREGNANCIES. RECORD TWINS AND TRIPLETS ON SEPARATE LINES, IF LIVE BIRTHS. 214 L Think back Was the baby born Did that What name Is (NAME) In what month Is (NAME) I to the time alive, born dead, or baby cry, was given to a boy or a and year was still alive? N of your (first/ lost before full term? move, or that child? girl? (NAME) born? E next) breathe pregnancy. when it was PROBE: N born? What is his/her U Was that a birthday? M single or B multiple E pregnancy? R 01 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 02 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 03 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 04 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 05 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 06 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 ( (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 07 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 ( (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 08 SINGLE . . . 1 BORN ALIVE . . . . . 1 YES . . . . . 1 . . . . . 1 YES . . . . . 1 (SKIP TO 218) MONTH MULTIPLE . 2 BORN DEAD . . . . . 2 NO . . . . . 2 . . . . . 2 NO . . . . . 2 LOST BEFORE FULL YEAR TERM . . . . . . . . . . . . 3 (SKIP TO 226) 226 221 225 218 (NAME) 219 BOY GIRL 215 216 217 220 226 (NAME) 226 225 (NAME) 226 225 BOY GIRL 225 (NAME) GIRL (NAME) 226 225 BOY GIRL (NAME) GIRL (NAME) 225 BOY GIRL 225 BOY BOY 225 GIRL BOY GIRL BOY 226 (NAME) 226 226 296 | Appendix E How old was RECORD How old was (NAME) In what month How many Did you or Were there (NAME) at HOUSEHOLD when he/she died? and year did months someone any other his/her last LINE NUMBER IF '1 YR', PROBE: this pregnancy did the else do pregnan- birthday? OF CHILD How many months end? pregnancy anything to cies bet- (RECORD '00' old was (NAME)? last? end this ween the IF CHILD NOT pregnancy? previous RECORD AGE LISTED IN RECORD DAYS IF LESS RECORD IN pregnancy IN COMPLETED HOUSEHOLD) THAN 1 MONTH; COMPLETED and this YEARS. MONTHS IF LESS THAN MONTHS. preg- 2 YEARS; OR YEARS. nancy? LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 . . . 3 (SKIP TO NEXT PREGNANCY) LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 LINE NUMBER YES . . . 1 DAYS . . . 1 MONTH YES . . . 1 YES . . . 1 NO . . . 2 MONTHS . 2 YEAR NO . . . 2 NO . . . 2 . . . 3 (SKIP TO 229) YEARS YEARS (SKIP TO 229) (SKIP TO 229) YEARS YEARS (SKIP TO 229) YEARS (SKIP TO 229) IF BORN ALIVE, BUT NOW DEAD 227224 IF BORN ALIVE AND STILL LIVING 226 IF BORN DEAD OR LOST BEFORE BIRTH 222 225223 MONTHS MONTHS YEARS YEARS (SKIP TO 229) (SKIP TO 229) (SKIP TO 229) YEARS PREGNANCY) 02 AGE IN YEARS AGE IN 03 229228 (SKIP TO NEXT 01 AGE IN YEARS MONTHS Is (NAME) living with you? AGE IN AGE IN 06 04 05 YEARS AGE IN YEARS YEARS (SKIP TO 229) (SKIP TO 229) (SKIP TO 229) YEARS AGE IN 07 (SKIP TO 229) YEARS (SKIP TO 229) YEARS 08 (SKIP TO 229) AGE IN MONTHS MONTHS MONTHS MONTHS MONTHS 297Appendix E | NO. QUESTIONS AND FILTERS SKIP 230 Have you had any pregnancy since the last YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 215 pregnancy mentioned? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 EXCLUDE CURRENT PREGNANCY 231 COMPARE 210 WITH NUMBER OF PREGNANCIES IN HISTORY AND PUT X 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 MONTHS OR 1 YR: PROBE FOR EXACT NO. OF MONTHS. CHECK 220 AND ENTER THE NUMBER OF LIVE BIRTHS SINCE JANUARY 2003. IF NONE, RECORD '0' 233 Are you pregnant now? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UNSURE . . . . . . . . . . . . . . . . . . . . . . . 8 234 How many months pregnant are you? MONTHS . . . . . . . . . . . . . . . . 235 At the time you became pregnant did you want to become WANTED THEN . . . . . . . . . . . . . . . . . . 1 pregnant then, did you want to wait until later, or did you WANTED TO WAIT LATER . . . . . . . . 2 not want to become pregnant at all? DID NOT WANT AT ALL . . . . . . . . . . . . 3 236 When did your last menstrual period start? DAYS AGO . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . 3 YEARS AGO . . . . . . . . . . . . 4 IN MENOPAUSE/ HAS HAD HYSTERECTOMY . . . . . 994 IF SAME DAY, RECORD "00" BEFORE LAST BIRTH . . . . . . . . . . 995 NEVER MENSTRUATED . . . . . . . . 996 238 237 How old were you when you had your first menstrual period? AGE . . . . . . . . . . . . . . . . . . . . . 238 From one menstrual period to the next, is there a time YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 when a woman is more likely to become pregnant if she NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 has sexual relations? DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 IF NO, PROBE: Do you know if there is a time when it is not safe for a woman to have sex because she can get pregnant? 239 Is this time JUST BEFORE HER PERIOD just before her period begins, BEGINS . . . . . . . . . . . . . . . . . . . . . . . 1 during her period, DURING HER PERIOD . . . . . . . . . . . . 2 right after her period has ended, RIGHT AFTER HER or half way between two periods? PERIOD HAS ENDED . . . . . . . . . . 3 HALFWAY BETWEEN TWO PERIODS . . . . . . . . . . . . . . . . 4 OTHER 6 DON'T KNOW . . . . . . . . . . . . . . . . . . . 8 CODING CATEGORIES (DATE, IF GIVEN) (SPECIFY) 232 236 301 298 | Appendix E 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. ENCIRCLE 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. ENCIRCLE CODE 1 IF METHOD IS RECOGNIZED, AND CODE 2 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 ENCIRCLED IN 301, ASK 302. 301 Which ways or methods have you heard about? Have you ever used FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: (METHOD)? Have you ever heard of (METHOD)? 01 LIGATION/FEMALE STERILIZATION. Woman can YES . . . . . . . . . . 1 Have you ever had an have an operation to avoid having any more children. NO . . . . . . . . . . . . 2 operation to avoid having any more children? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 02 VASECTOMY/MALE STERILIZATION. Men can YES . . . . . . . . . . 1 Have you ever had a partner have an operation to avoid having any more children. NO . . . . . . . . . . . . 2 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 everyday to avoid YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 becoming pregnant. NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 04 IUD. Women who have a loop or coil placed inside YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 them by a doctor or a nurse. NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 05 INJECTABLES. Women can have an injection by a YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 health provider that stops them from becoming NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 pregnant for one or more months. 06 IMPLANTS. Women can have several small rods YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 placed in their upper arm by a doctor or nurse which NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 can prevent pregnancy for one or more years. 07 PATCH. Women can put a hormonal patch on their YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 upper outer arm, buttocks, abdomen or thigh to avoid NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 getting pregnant. 08 CONDOM. Men can put a rubber sheath on their YES . . . . . . . . . . 1 Have you ever had a partner penis during sexual intercourse. NO . . . . . . . . . . . . 2 who used condom? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 09 FEMALE CONDOM. Women can place a sheath in YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 their vagina before sexual intercourse. NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 10 MUCUS, BILLINGS, OVULATION. Women can monitor YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 the cervical mucus to determine the days of the month NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 they are most likely to get pregnant. 11 BASAL BODY TEMPERATURE. Women can monitor YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 the body temperature to determine the days of the NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 month they are most likely to get pregnant. 12 SYMPTOTHERMAL. It is a combination of Basal Body YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 Temperature and Mucus, Billings, Ovulation Method. NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 302 299Appendix E | 301 Which ways or methods have you heard about? Have you ever used FOR METHODS NOT MENTIONED SPONTANEOUSLY, ASK: (METHOD)? Have you ever heard of (METHOD)? 13 STANDARD DAYS METHOD. This method uses YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 a beaded necklace on which each bead represents NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 the days of a woman's cycle. The necklace would help determine the days when the woman is likely to get pregnant. 14 LACTATIONAL AMENORRHEA METHOD (LAM). YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 15 CALENDAR OR RHYTHM OR PERIODIC ABSTINENCE. YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 Every month that a woman is sexually active she can NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 avoid pregnancy by not having sexual intercourse on the days of the month she is most likely to get pregnant. 16 WITHDRAWAL. Men can be careful and pull out before YES . . . . . . . . . . 1 Have you ever had a partner climax. NO . . . . . . . . . . . . 2 who used withdrawal? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 17 EMERGENCY CONTRACEPTION. Women can take YES . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 pills up to three days after sexual intercourse to avoid NO . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 becoming pregnant. 18 Have you heard of any other ways or methods that YES . . . . . . . . . . 1 women or men can use to avoid pregnancy? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . 2 NO. QUESTIONS AND FILTERS 303 CHECK 302: NOT A SINGLE AT LEAST ONE "YES" "YES" 306 (NEVER USED) (EVER USED) 304 Have you ever used anything or tried in any way to YES . . . . . . . . . . . . . . . . . . . . . . . 1 delay or avoid getting pregnant? NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 341 305 What have you used or done? CORRECT 302 AND 303 (AND 301 IF NECESSARY). 306 Now I would like to ask you about the first time NUMBER OF that you did something or used a method to avoid CHILDREN . . . . . . . . . . . . getting pregnant. How many living childr