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 met

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