Philippines- Demographic and Health Survey - 2014

Publication date: 2014

PhilippinesPhilippines National Demographic and Health Survey 2013 Philippines National Demographic and Health Survey 2013 Philippine Statistics Authority Manila, Philippines ICF International Rockville, Maryland, USA August 2014 This report summarizes the findings of the 2013 Philippines National Demographic and Health Survey (NDHS) carried out by the Philippine Statistics Authority (PSA). 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 technical assistance through ICF International. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID and the Government of the Philippines. Additional information about the survey may be obtained from the Demographic and Social Statistics Division (DSSD) of the Household Statistics Department, PSA, Solicarel Building 1, Ramon Magsaysay Boulevard, Sta. Mesa, Manila; Telephone: (632) 713-7245, Fax (632) 716-1612, E-mail: info@mail.census.gov.ph. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1.301-407-6500, Fax: +1.301-407-6501, E-mail: reports@dhsprogram.com, Internet: http://www.dhsprogram.com. Recommended citation: Philippine Statistics Authority (PSA) [Philippines], and ICF International. 2014. Philippines National Demographic and Health Survey 2013. Manila, Philippines, and Rockville, Maryland, USA: PSA and ICF International. Contents • iii CONTENTS Page TABLES AND FIGURES . vii PREFACE . xiii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xv MAP OF PHILIPPINES . xvi 1 INTRODUCTION . 1 1.1 Background 1 1.2 Objectives of the Survey 2 1.3 Organization of the Survey 2 1.4 Questionnaires 3 1.5 Pretest 4 1.6 Training and Fieldwork 5 1.7 Data Processing 5 1.8 Sample Design and Implementation 5 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS . 7 2.1 Household Characteristics. 8 2.1.1 Drinking Water . 8 2.1.2 Household Sanitation Facilities . 9 2.1.3 Housing Characteristics . 10 2.2 Household Possessions . 12 2.3 Wealth Index . 12 2.4 Household Composition . 14 2.5 Household Population by Age and Sex . 14 2.6 Education of Household Population . 16 3 CHARACTERISTICS OF RESPONDENTS . 19 3.1 Characteristics of Women Respondents 19 3.2 Mobility 21 3.3 Educational Attainment 22 3.4 Access to Mass Media and Internet 23 3.5 Employment 24 3.6 Occupation 26 3.7 Type of Employment 28 3.8 Health Insurance Coverage 29 3.9 Use of Tobacco 30 4 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY . 33 4.1 Current Marital Status . 33 4.2 Age at First Marriage . 34 4.3 Age at First Menstruation (Menarche). 35 4.4 Age at First Sexual Intercourse . 36 4.5 Recent Sexual Activity . 37 iv • Contents 5 FERTILITY . 41 5.1 Current Fertility . 42 5.2 Fertility Trends . 44 5.3 Children Ever Born and Living . 45 5.4 Birth Intervals . 46 5.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 48 5.6 Menopause. 50 5.7 Age at First Birth . 51 5.8 Pregnancy and Motherhood among Youth . 52 6 FERTILITY PREFERENCES . 55 6.1 Desire for More Children . 55 6.2 Desire to Limit Childbearing by Background Characteristics . 58 6.3 Ideal Number of Children . 60 6.4 Fertility Planning . 63 6.5 Couple’s Consensus on Family Size . 65 7 FAMILY PLANNING . 69 7.1 Knowledge of Contraceptive Methods . 70 7.2 Current Use of Contraception. 72 7.3 Differentials in Contraceptive Use by Background Characteristics . 74 7.4 Trends in Current Use of Family Planning. 76 7.5 Timing of Sterilization . 77 7.6 Source of Modern Contraceptive Methods . 78 7.7 Cost of Family Planning Methods . 79 7.8 Informed Choice . 80 7.9 Knowledge of the Fertile Period . 81 7.10 Need for Family Planning Services . 82 7.11 Future use of Contraception . 85 7.12 Exposure to Family Planning Messages . 86 7.13 Contact of Nonusers with Family Planning Providers . 87 8 INFANT AND CHILD MORTALITY . 89 8.1 Definitions and Concepts . 90 8.2 Data Quality . 90 8.3 Levels and Trends . 91 8.4 Socioeconomic Differentials in Infant and Child Mortality . 92 8.5 Demographic Differentials in Infant and Child Mortality . 94 8.6 Perinatal Mortality. 95 8.7 High-Risk Fertility Behavior . 97 9 MATERNAL HEALTH . 99 9.1 Antenatal Care . 100 9.1.1 Antenatal Care Coverage . 100 9.1.2 Components of Antenatal Care Services . 102 9.1.3 Tetanus Toxoid Injection . 104 9.2 Delivery Care . 106 9.2.1 Place of Delivery. 106 9.2.2 Delivery Assistance . 108 9.3 Post Natal Care . 112 9.4 Newborn Care . 115 9.5 Problems in Accessing Health Care . 118 Contents • v 10 CHILD HEALTH . 121 10.1 Child’s Weight at Birth . 121 10.2 Vaccination Coverage . 122 10.2.1 Full Immunization Coverage for Children Age 12-23 Months . 123 10.2.2 Vaccination Coverage by Background Characteristics . 125 10.2.3 Trends in Vaccination Coverage . 126 10.3 Acute Respiratory Infection (ARI) . 126 10.4 Fever . 128 10.5 Diarrhea . 129 10.5.1 Prevalence of Diarrhea . 130 10.5.2 Diarrhea Treatment . 130 10.5.3 Feeding Practices during Diarrhea . 131 10.5.4 Knowledge of ORS Packets . 133 10.5.5 Disposal of Stools . 134 11 BREASTFEEDING AND MICRONUTRIENT SUPPLEMENTATION . 137 11.1 Breastfeeding . 137 11.1.1 Initial Breastfeeding . 138 11.1.2 Breastfeeding Status by Age . 140 11.1.3 Duration of Breastfeeding . 140 11.2 Micronutrient Intake among Children . 141 11.3 Micronutrient Intake among Mothers . 143 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES AND BEHAVIOR . 145 12.1 Knowledge of HIV/AIDS . 146 12.2 Specific Knowledge about AIDS. 147 12.3 Coverage of HIV Testing . 149 12.4 HIV/AIDS Knowledge and Sexual Behavior among Youth . 151 12.4.1 Knowledge of Condom Sources among Young Adults . 151 12.4.2 Age at First Sexual Intercourse among Young People . 152 12.4.3 Premarital Sexual Activity . 152 12.4.4 Cross-generational Sexual Partners . 154 12.4.5 Voluntary HIV Counseling and Testing among Young Women . 154 13 HEALTHCARE UTILIZATION AND FINANCING . 157 13.1 Health Insurance Coverage . 157 13.2 Health Care Treatment . 161 13.3 Hospital Care . 166 13.4 Cost of Treatment . 168 14 WOMEN’S EMPOWERMENT . 169 14.1 Employment and Form of Earnings . 170 14.2 Controls over Earnings . 171 14.2.1 Control over and Relative Magnitude of Women’s Earnings . 171 14.2.2 Women’s Control over their Own Earnings and Over those of their Husbands . 173 14.3 Ownership of Assets . 174 14.4 Participation in Decision Making . 174 14.5 Attitude toward Wife Beating . 177 14.6 Indicators of Women’s Empowerment . 180 14.7 Women’s Empowerment and Health Indicators . 181 vi • Contents 15 VIOLENCE AGAINST WOMEN . 185 15.1 Measurement of Violence . 186 15.2 Experience of Physical Violence . 188 15.3 Experience of Sexual Violence . 190 15.4 Experience of Different Forms of Violence . 193 15.5 Violence during Pregnancy . 193 15.6 Marital Control by Husband . 195 15.7 Spousal Violence . 197 15.8 Recent Experience of Spousal Violence . 202 15.9 Onset of Spousal Violence . 203 15.10 Consequences of Spousal Violence . 203 15.11 Violence Initiated by Women against their Spouse . 204 15.12 Help-Seeking Behavior by Women Who Experienced Violence . 207 REFERENCES . 209 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 213 A.1 Introduction . 213 A.2 Sample Design . 213 A.3 Sample Implementation . 216 A.4 Sampling Weight . 219 ESTIMATES OF SAMPLING ERRORS . 223 DATA QUALITY TABLES . 247 APPENDIX B APPENDIX C APPENDIX D PERSONS INVOLVED IN THE 2013 NATIONAL DEMOGRAPHIC AND HEALTH SURVEY . 251 QUESTIONNAIRES. 265 APPENDIX E Tables and Figures • vii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION . 1 Table 1.1 Results of the household and individual interviews . 6 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS . 7 Table 2.1 Household drinking water . 8 Table 2.2 Household sanitation facilities . 9 Table 2.3 Housing characteristics . 10 Table 2.4 Household characteristics . 11 Table 2.5 Household possessions . 12 Table 2.6 Wealth quintiles . 13 Table 2.7 Household composition . 14 Table 2.8 Household population by age, sex and residence . 15 Table 2.9.1 Educational attainment of the female household population . 16 Table 2.9.2 Educational attainment of the male household population . 17 Figure 2.1 Housing amenities by urban-rural residence . 11 Figure 2.2 Population pyramid . 15 Figure 2.3 Median years of schooling by sex and region. 18 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS . 19 Table 3.1 Background characteristics of respondents . 20 Table 3.2 Residence characteristics of respondents . 21 Table 3.3 Educational attainment . 22 Table 3.4 Exposure to mass media . 24 Table 3.5 Employment status . 25 Table 3.6 Occupation . 27 Table 3.7 Type of employment . 28 Table 3.8 Health insurance coverage . 29 Table 3.9 Use of tobacco . 31 Figure 3.1 Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, Philippines 2008 and 2013 . 28 CHAPTER 4 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY . 33 Table 4.1 Current marital status . 33 Table 4.2 Age at first marriage . 34 Table 4.3 Median age at first marriage by background characteristics . 35 Table 4.4 Age at first menstruation . 36 Table 4.5 Age at first sexual intercourse . 36 Table 4.6 Median age at first sexual intercourse by background characteristics . 37 Table 4.7 Recent sexual activity . 38 viii • Tables and Figures CHAPTER 5 FERTILITY . 41 Table 5.1 Current fertility . 42 Table 5.2 Fertility by background characteristics . 43 Table 5.3 Trends in age-specific fertility rates . 44 Table 5.4 Trends in fertility from various sources . 45 Table 5.5 Children ever born and living . 46 Table 5.6 Birth intervals . 47 Table 5.7 Postpartum amenorrhea, abstinence and insusceptibility . 49 Table 5.8 Median duration of amenorrhea, postpartum abstinence and postpartum insusceptibility . 50 Table 5.9 Menopause . 51 Table 5.10 Age at first birth . 51 Table 5.11 Median age at first birth . 52 Table 5.12 Teenage pregnancy and motherhood . 53 Figure 5.1 Age-specific fertility rates by urban-rural residence . 43 Figure 5.2 Trends in the total fertility rate . 45 Figure 5.3 Median number of months since previous birth . 48 CHAPTER 6 FERTILITY PREFERENCES . 55 Table 6.1 Fertility preferences by number of living children . 57 Table 6.2 Fertility preferences by age . 58 Table 6.3 Desire to limit childbearing . 59 Table 6.4 Ideal number of children by number of living children . 61 Table 6.5 Mean ideal number of children . 62 Table 6.6 Fertility planning status . 64 Table 6.7 Wanted fertility rates . 65 Table 6.8 Couples’ consensus on family size . 67 Figure 6.1 Fertility preferences among currently married women age 15-49 . 56 Figure 6.2 Percentage of currently married women who want no more children, by number of children . 57 Figure 6.3 Percentage of currently married women who want no more children, by background characteristics . 60 Figure 6.4 Mean ideal number of children for all women age 15-49 by region. 63 Figure 6.5 Trends in wanted and unwanted fertility for births in the five years preceding the survey, NDHS 2008 and NDHS 2013 . 64 Figure 6.6 Currently married women by perceived consensus with husband regarding the number of children desired . 66 CHAPTER 7 FAMILY PLANNING . 69 Table 7.1 Knowledge of contraceptive methods . 70 Table 7.2 Knowledge of contraceptive methods by background characteristics . 71 Table 7.3 Current use of contraception by age . 73 Table 7.4 Current use of contraception by background characteristics . 75 Table 7.5 Trends in the current use of contraception . 76 Table 7.6 Timing of sterilization . 78 Table 7.7 Source of modern contraception methods . 78 Table 7.8 Cost of modern contraceptive methods . 79 Tables and Figures • ix Table 7.9 Informed choice . 81 Table 7.10 Knowledge of fertile period . 82 Table 7.11 Need and demand for family planning among currently married women . 84 Table 7.12 Future use of contraception . 86 Table 7.13 Exposure to family planning messages . 87 Table 7.14 Contact of non-users with family planning providers . 88 Figure 7.1 Use of contraception among currently married women age 15-49 . 74 Figure 7.2 Trends in contraceptive use among currently married women . 77 Figure 7.3 Trends in unmet need for family planning . 85 CHAPTER 8 INFANT AND CHILD MORTALITY . 89 Table 8.1 Early childhood mortality rates . 91 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 93 Table 8.3 Early childhood mortality rates by demographic characteristics . 95 Table 8.4 Perinatal mortality . 96 Table 8.5 High-risk fertility behavior . 98 Figure 8.1 Trends in early childhood mortality rates for the period 0-4 years, Philippines 2003-2013 . 92 Figure 8.2 Under-five and infant mortality by background characteristics . 94 CHAPTER 9 MATERNAL HEALTH . 99 Table 9.1 Antenatal care . 100 Table 9.2 Number of antenatal care visits and timing of first visit . 101 Table 9.3 Components of antenatal care . 103 Table 9.4 Tetanus toxoid injections . 104 Table 9.5 Problems experienced during pregnancy and delivery . 105 Table 9.6 Pre-term births . 106 Table 9.7 Place of delivery . 107 Table 9.8 Reasons for not delivering in a health facility . 108 Table 9.9 Assistance during delivery . 109 Table 9.10 Cost of delivery . 111 Table 9.11 Timing of first postnatal check-up . 113 Table 9.12 Type of provider of first postnatal checkup for the mother . 114 Table 9.13 Timing of first postnatal checkup for the newborn . 116 Table 9.14 Type of provider of first postnatal checkup for the newborn . 117 Table 9.15 Problems in accessing healthcare . 119 CHAPTER 10 CHILD HEALTH . 121 Table 10.1 Child’s weight at birth . 122 Table 10.2 Vaccination by source of information . 124 Table 10.3 Vaccination by background characteristics . 125 Table 10.4 Prevalence and treatment of symptoms of ARI . 127 Table 10.5 Prevalence and treatment of fever . 129 Table 10.6 Prevalence of diarrhea . 130 Table 10.7 Diarrhea treatment . 131 Table 10.8 Feeding practices during diarrhea . 132 Table 10.9 Knowledge of ORS packets or pre-packaged liquids . 134 x • Tables and Figures Table 10.10 Disposal of children’s stools . 135 Figure 10.1 Vaccination by 12 months of age . 124 Figure 10.2 Trends in vaccination coverage excluding Hepatitis B. 126 Figure 10.3 Prevalence and treatment of acute respiratory infection (ARI) in children under age five . 128 Figure 10.4 Trends in feeding practices during diarrhea 2003, 2008, 2013 NDHS . 133 CHAPTER 11 BREASTFEEDING AND MICRONUTRIENT SUPPLEMENTATION . 137 Table 11.1 Initial breastfeeding . 139 Table 11.2 Breastfeeding status by age . 140 Table 11.3 Median duration of breastfeeding . 141 Table 11.4 Micronutrient intake among children . 142 Table 11.5 Micronutrient intake among mothers . 144 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES AND BEHAVIOR . 145 Table 12.1 Knowledge of HIV prevention methods . 147 Table 12.2 Specific knowledge about AIDS . 148 Table 12.3 Coverage of prior HIV testing . 150 Table 12.4 Knowledge about a source of condoms among young women . 151 Table 12.5 Age at first sexual intercourse among young women . 152 Table 12.6 Premarital sexual intercourse and condom use during premarital sexual intercourse among young women. 153 Table 12.7 Age-mixing in sexual relationships among women age 15-19 . 154 Table 12.8 Recent HIV tests among youth . 155 Figure 12.1 Rejection of misconception about AIDS transmission among women age 15-49 . 149 CHAPTER 13 HEALTHCARE UTILIZATION AND FINANCING . 157 Table 13.1 Health insurance coverage . 158 Table 13.2 Type of PhilHealth Insurance . 160 Table 13.3 Treatment seeking behavior . 162 Table 13.4 Specific types of health facilities utilized . 164 Table 13.5 Reasons for seeking health care . 165 Table 13.6 Average travel time to health facility visited . 166 Table 13.7 In-patient hospital care . 167 Table 13.8 Aspects of in-patient care . 168 Table 13.9 Average costs of care . 168 Figure 13.1 Percentage of household population with specific health insurance coverage . 159 Figure 13.2 Among those with PhilHealth Insurance, percentage who are paying or indigent members/dependent . 161 Figure 13.3 Percentage of household population who visited a health facility/provider in the 30 days preceding the survey . 163 Figure 13.4 Reason for seeking health care . 165 CHAPTER 14 WOMEN’S EMPOWERMENT . 169 Table 14.1 Employment and cash earning of currently married women . 170 Table 14.2 Control over women’s cash earning and relative magnitude of women’s cash earnings . 172 Tables and Figures • xi Table 14.3 Women’s control over their own earnings and over those of their husbands . 173 Table 14.4 Ownership of assets . 175 Table 14.5 Participation in decision making . 175 Table 14.6 Women’s participation in decision making by background characteristics . 177 Table 14.7 Attitudes toward wife beating . 179 Table 14.8 Indicators of women’s empowerment . 181 Table 14.9 Current use of contraception by women’s empowerment . 182 Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment . 183 Table 14.11 Reproductive healthcare by women’s empowerment . 183 Table 14.12 Early childhood mortality rates by women’s status . 184 Figure 14.1 Type of earnings of employed currently married women . 171 Figure 14.2 Number of decisions in which currently married women participate . 176 Figure 14.3 Specific reasons for which wife beating is justified . 178 Figure 14.4 Number of reasons for which wife beating is justified . 181 CHAPTER 15 VIOLENCE AGAINST WOMEN . 185 Table 15.1 Experience of physical violence . 189 Table 15.2 Persons committing physical violence . 190 Table 15.3 Experience of sexual violence . 191 Table 15.4 Persons committing sexual violence . 192 Table 15.5 Age at first experience of sexual violence . 193 Table 15.6 Experience of different forms of violence . 193 Table 15.7 Experience of violence during pregnancy . 194 Table 15.8 Marital control exercised by husbands . 196 Table 15.9 Forms of spousal violence . 197 Table 15.10 Spousal violence by background characteristics . 199 Table 15.11 Spousal violence by husband’s characteristics and empowerment indicators . 201 Table 15.12 Recent physical or sexual violence by any husband\partner . 202 Table 15.13 Experience of spousal violence by duration of marriage . 203 Table 15.14 Injuries to women due to spousal violence . 204 Table 15.15 Women’s violence against their spouse . 205 Table 15.16 Women’s violence against their spouse by husband’s by characteristics . 206 Table 15.17 Help seeking to stop violence . 207 Table 15.18 Sources for help to stop the violence . 208 Figure 15.1 Percentage of ever-married women age 15-49 who have experienced various forms of violence ever or in the 12 months preceding the survey, committed by their husband/partner . 198 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 213 Table A.1 Households in sampling frame . 215 Table A.2 Sample allocation of enumeration areas . 216 Table A.3 Sample implementation . 217 Table A.4 Sample implementation . 218 xii • Tables and Figures APPENDIX B ESTIMATES OF SAMPLES ERRORS . 223 Table B.1 List of selected variables for sampling errors, Philippines, 2013 . 225 Table B.2 Sampling errors: Total sample, Philippines 2013 . 226 Table B.3 Sampling errors: Urban sample, Philippines 2013 . 227 Table B.4 Sampling errors: Rural sample, Philippines 2013 . 228 Table B.5 Sampling errors: National Capital Region sample, Philippines 2013 . 229 Table B.6 Sampling errors: Cordillera Administrative Region sample, Philippines 2013 . 230 Table B.7 Sampling errors: Ilocos Region sample, Philippines 2013 . 231 Table B.8 Sampling errors: Cagayan Valley sample, Philippines 2013 . 232 Table B.9 Sampling errors: Central Luzon sample, Philippines 2013 . 233 Table B.10 Sampling errors: CALABARZON sample, Philippines 2013 . 234 Table B.11 Sampling errors: MIMAROPA sample, Philippines 2013 . 235 Table B.12 Sampling errors: Bicol Region sample, Philippines 2013 . 236 Table B.13 Sampling errors: Western Visayas sample, Philippines 2013 . 237 Table B.14 Sampling errors: Central Visayas sample, Philippines 2013 . 238 Table B.15 Sampling errors: Eastern Visayas sample, Philippines 2013 . 239 Table B.16 Sampling errors: Zamboanga Peninsula sample, Philippines 2013 . 240 Table B.17 Sampling errors: Northern Mindanao sample, Philippines 2013 . 241 Table B.18 Sampling errors: Davao Region sample, Philippines 2013 . 242 Table B.19 Sampling errors: SOCCSKSARGEN sample, Philippines 2013 . 243 Table B.20 Sampling errors: Caraga sample, Philippines 2013 . 244 Table B.21 Sampling errors: ARMM sample, Philippines 2013 . 245 APPENDIX C DATA QUALITY TABLES . 247 Table C.1 Household age distribution . 247 Table C.2 Age distribution of eligible and interviewed women . 248 Table C.3 Completeness of reporting . 248 Table C.4 Births by calendar years . 248 Table C.5 Reporting of age at death in days . 249 Table C.6 Reporting of age at death in months . 250 Preface • xiii   PREFACE The Philippine Statistics Authority (PSA) is pleased to present the final report on the 2013 Philippines National Demographic and Health Survey (NDHS). The survey is designed to provide indicators on fertility, fertility preferences, family planning practice, childhood mortality, maternal and child health, knowledge and attitude regarding HIV/AIDS and tuberculosis, and violence against women. These indicators are crucial in policymaking, program planning, and monitoring and evaluation of population and health programs, including those anchored on the attainment of related Millennium Development Goals (MDGs). The 2013 NDHS is the tenth in a series of national demographic surveys conducted every five years since 1968 by the National Statistics Office (NSO), which is one of the four statistical agencies comprising the newly created Philippine Statistics Authority (PSA). Fieldwork for the survey was carried out from August 12 to October 16, 2013 covering a national sample of approximately 15,000 households and more than 16,000 women aged 15 to 49 years. The 2013 NDHS was funded by the Government of the Philippines. The United States Agency for International Development (USAID) provided technical assistance through ICF International under the MEASURE Demographic and Health Surveys (DHS) program. PSA would like to express its deepest gratitude to the organizations and individuals who are behind the successful completion of the 2013 NDHS. National Scientist Dr. Mercedes B. Concepcion, the Department of Health (DOH), the United States Agency for International Development (USAID), University of the Philippines Population Institute (UPPI), Commission on Population (POPCOM), PSA-National Statistical Coordination Board (PSA-NSCB), University of the Philippines School of Economics (UPEcon), 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 Philippine Commission on Women (PCW), Breastfeeding Philippines (BF), Philippine Institute for Development Studies (PIDS), and the Department of Social Welfare and Development (DSWD) participated in the design of the questionnaires. PSA also extends its appreciation to the ICF International team and consultants: Dr. Elizabeth M. Go, for her technical assistance throughout the planning and implementation stages of the survey; David J. Megill, for the sampling design; Alexander Izmukhambetov and Jeanne Cushing for their assistance during data processing, Anne R. Cross and Dr. Gulnara Semenov, and Natalie La Roche for their valuable assistance in the preparation of the final report. Great appreciation is also due to the survey team of the former NSO for their hard work and dedication: the staff of the Demographic and Social Statistics Division of the Household Statistics Department (HSD) who worked tirelessly throughout all stages of the survey; selected staff of the Census Planning and Operations Division and the Income and Employment Statistics Division of HSD for their support during training and preparation of the report; the Information Resources Department for their assistance during data processing, the staff of the Regional and Provincial Offices for overseeing the data collection activities, and to the 70 interviewing teams composed of team supervisors, field editors and interviewers. Finally, the PSA is grateful to the survey respondents who patiently shared us their time and information. LISA GRACE S. BERSALES, PhD National Statistician Philippine Statistics Authority Millennium Development Goal Indicators • xv MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators by sex Philippines 2013 Value Goal Female Male Total 4. Reduce child mortality 4.1 Under five mortality rate1 31 34 31 4.2 Infant mortality rate1 22 25 23 4.3 Proportion of 1 year-old children immunized against measles 84.9 82.8 83.9 5. Improve maternal health 5.2 Percentage of births attended by skilled health personnel2 na na 72.8 5.3 Contraceptive prevalence rate3 55.1 na na 5.4 Adolescent birth rate4 57.1 na na 5.5a Antenatal care coverage: at least one visit5 95.4 na na 5.5b Antenatal care coverage: four or more visits6 84.3 na na 5.6 Unmet need for family planning 17.5 na na 6. Combat HIV/AIDS, malaria and other diseases 6.2 Condom use at last high-risk sex7 8.1 na na Goal Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source9 98.6 92.2 95.2 7.9 Percentage of population with access to improved sanitation10 73.7 66.8 70.1 na = Not applicable 1 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 2 Among births in the five years preceding the survey 3 Percentage of currently married women age 15-49 using any method of contraception 4 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year preceding the survey, expressed in terms of births per 1,000 women age 15-19 5 With a skilled provider 6 With any healthcare provider 7 Higher-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of women age 15-24 who had higher-risk sex in the past 12 months. 8 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 9 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, bottled water or rainwater collection. 10 Improved sanitation technologies are: flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet. xvi • Map of Philippines Introduction • 1 INTRODUCTION 1 1.1 BACKGROUND he Philippines lies strategically within the arc of nations that sweeps southeastward from mainland Asia to Australia. The country is bordered by the waters of the Bashi Channel to the north, the Sulu and Celebes Seas to the south, the Pacific Ocean to the east, and the South China Sea to the west. Its total land area of 300,000 km2, comprise 7,107 islands, of which about 3,144 islands are named. Luzon, Visayas, and Mindanao are the three largest groups of islands. Luzon is the largest group situated in the north, covering 47 percent of the total land area; Mindanao, the second largest group is located in the south, covering 34 percent of the total land area; and the Visayas, the smallest group consisting of island provinces between Luzon and Mindanao, accounts for 19 percent of the country’s total land area. A total of 92.3 million Filipinos are residents as of May 1, 2010. The climate in the country is characterized by two distinct seasons, the wet and the dry. The rainy or wet season occurs across the land from June to November, while the cool and dry season starts from December to May. The Philippines has 17 administrative regions namely, Regions I-XIII, the National Capital Region (NCR) or Metro Manila, Cordillera Administrative Region (CAR), and the Autonomous Region in Muslim Mindanao (ARMM). Region IV is divided into 2 regions—IVA and IVB. Each of these regions is composed of provinces, which are subdivided into cities, municipalities and barangays. The barangays are the smallest local government unit. National government offices are usually (but not always) concentrated in the regional centers and the seat of the provincial government is situated in each of the respective provinces. As of September 30, 2011, the country has 80 provinces, 137 cities, 1,496 municipalities and 41,946 barangays (NSO, 2013). The Philippines is the third fastest growing economy in Asia with a gross domestic product (GDP) of 7.2 percent in the last three years. Despite the so-called Priority Development Assistance Fund (PDAF) scam and the natural calamities such as the earthquake and Typhoon Yolanda (Haiyan) that struck the country in 2013, the government is optimistic to sustain the country’s economic growth. The Department of Labor and Employment (DOLE) is tasked with creating more jobs to expand operations, shelter, livelihood, infrastructure and social services nationwide, including the provinces devastated by the typhoon and earthquake. The Department of Social Welfare and Development (DSWD)is spearheading poverty alleviation programs, such as the Pantawid Pamilya Pilipino Program (4Ps) and the Kapit-Bisig Laban sa Kahirapan-Comprehensive and Integrated Delivery of Social Services (Kalahi-CIDSS), serving as indicators that the country is on a path towards fighting poverty (DSWD, 2014). Along with the Aquino government’s thrust of “daang matuwid” (right way/path), aiming for good governance and hastening growth and development for empowerment of its constituents, particularly Filipino women, the Department of Health (DOH) adopted and implemented health reforms to rapidly reduce maternal and newborn mortality. The Millennium Strategic Plan 2013-2017 (Development Goals Commitments by 2015) addresses and strengthens the Millennium Development Goals (MDGs) 4 and 5 through the Maternal, Newborn, Child Health and Nutrition (MNCHN) Strategy. This is an integrated package of services to ensure equitable, accessible, and efficient health services to communities, through dynamic partnerships and shared advocacy, responsibility and accountability. The program’s guiding principle covers all stages of pregnancy to T 2 • Introduction ensure its vision of “Every woman, child and their families utilize quality health services in a continuum of care”. The Philippine National Demographic and Health Survey (NDHS) has been successfully conducted in the country every five years since 1968to monitor and evaluate the impact of population programs being implemented in the country. The 2013 NDHS is the tenth such survey. 1.2 OBJECTIVES OF THE SURVEY The 2013 NDHS is designed to provide information on fertility, family planning, and health in the country for use by the government in monitoring the progress of its programs on population, family planning and health. In particular, the 2013 NDHS has the following specific objectives: • Collect data which will allow the estimation of demographic rates, particularly fertility rates and under-five mortality rates by urban-rural residence and region. • Analyze the direct and indirect factors which determine the level and patterns of fertility. • Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region. • Collect data on health, immunizations, prenatal and postnatal check-ups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever and acute respiratory infections among children below five years old. • Collect data on environmental health, utilization of health facilities, health care financing, prevalence of common non-communicable and infectious diseases, and membership in the National Health Insurance Program (PhilHealth). • Collect data on awareness of cancer, heart disease, diabetes, dengue fever and tuberculosis. • Determine the knowledge of women about AIDS, and the extent of misconception on HIV transmission and access to HIV testing. • Determine the extent of violence against women. 1.3 ORGANIZATION OF THE SURVEY The 2013 National Demographic and Health Survey (NDHS) was conducted by the Philippines National Statistics Office (NSO) from August 12, 2013 to September 24, 2013. The NSO is now merged with the National Statistical Coordination Board (NSCB), Bureau of Agricultural Statistics (BAS), and the Bureau of Labor and Employment (BLES), by virtue of Republic Act (R.A.) 10625 known as the “Philippine Statistical Act of 2013”,to become the newly created Philippine Statistics Authority (PSA). Funding for the 2013 NDHS came from the Philippine government. Technical assistance was provided by ICF International through the MEASURE DHS program funded by the United States Agency for International Development (USAID). A series of consultative meetings on four different occasions were undertaken for the development of the survey instruments through consultation with stakeholders, academics, and foreign and local partner Introduction • 3 agencies. These meetings were chaired by the former NSO Administrator Carmelita N. Ericta and co-chaired by National Scientist Dr. Mercedes B. Concepcion. Participants included representatives from USAID, ICF International, the United Nations Population Fund (UNFPA), the World Health Organization (WHO), the Department of Health (DOH), PSA-NSCB, the University of the Philippines Population Institute (UPPI), the PSA-NSO, the University of the Philippines School of Economics (UPSE), 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 Philippine Commission on Women (PCW), Breastfeeding Philippines (BF), Philippine Institute for Development Studies (PIDS), and the Department of Social Welfare and Development (DSWD). The group identified and recommended survey items for inclusion in the survey questionnaires; the items were reviewed and approved together with representatives and consultants from the above-mentioned agencies, as well as by ICF. The Regional Directors (RDs) of the PSA-NSO’s Regional Statistical Offices were the overseers of field activities in their respective regions. The Provincial Statistics Officers (PSOs) were the implementers and field coordinators and were mainly responsible for the administrative aspects of the survey in their respective provinces. Meanwhile, the designated Regional Supervisors were responsible for the survey’s operations phase and mainly responsible for the teams in their region. 1.4 QUESTIONNAIRES The 2013 NDHS used three questionnaires: Household Questionnaire, Individual Woman’s Questionnaire, and Women’s Safety Module. The development of these questionnaires resulted from the solicited comments and suggestions during the deliberation in the consultative meetings and separate meetings conducted with the various agencies/organizations namely: PSA-NSO, POPCOM, DOH, FNRI, ICF International, NEDA, PCW, PhilHealth, PIDS, PLCPD, UNFPA, USAID, UPPI, UPSE, and WHO. The three questionnaires were translated from English into six major languages - Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray. The main purpose of the Household Questionnaire was to identify female members of the sample household who were eligible for interview with the Individual Woman’s Questionnaire and the Women’s Safety Module. The Household Questionnaire was used to obtain the following information: • Usual members and visitors in the selected households • Background information on each person listed, such as relationship to head of the household, age, sex, and highest educational attainment • Health insurance coverage for each household member • 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 (these items are used as proxy indicators of the household’s socioeconomic status) • Utilization of health facilities of household members The Individual Woman’s Questionnaire was used to collect information from all women aged 15-49 years. These women were asked questions on the following topics: 4 • Introduction • Background characteristics (e.g., place of residence, age, marital status, education, employment status, religion and ethnic group) • Reproductive history • Knowledge and use of family planning methods • Pregnancy, postnatal care, and breastfeeding initiation • Child immunization and health 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 collect information on domestic violence in the country, its prevalence, severity and frequency from only one selected respondent from among all the eligible women who were identified from the Household Questionnaire. The module included the following topics: • Measures of physical, sexual and emotional violence • Women’s experience of violence since age 15 and recent violence in the 12 months preceding the survey • Violence during pregnancy • Marital control • Inter-spousal violence • Help-seeking behavior by women who have experienced violence 1.5 PRETEST Three pretests were conducted prior to finalizing the design and development of survey materials. The first pretest was conducted on March 27, 2013 in Barangay Talaba II, Bacoor, Cavite. It was aimed at checking the flow, clarity of questions, and the sustainability of the respondent’s attitude and motivation in answering the questions. The second pretest was carried out in San Jose del Monte, Bulacan Province on April 8-9, 2013, to see if the Tagalog translation of the questionnaire was suitably worded and also to improve the prescribed field operation procedures. The training for the pretests field staff took place in DSSD, NSO Central Office in Manila from April 2-5, 2013. For the third pretest, a trainer’s training was conducted on May 20, 24 and 25, 2013 in Mandaluyong City, participated in by selected central office personnel and field staff of Regions V, VII and VIII. In each of the pretest regions, a four-day training for interviewers was conducted prior to data collection. Pretest III involved five teams. Each of the four teams was composed of four interviewers, a field editor and a supervisor while the team from Region VII was composed of six interviewers and a team Introduction • 5 supervisor who also acted as field editor. All five teams had their respective observer from Central Office. The objective of the third pretest was to test the correctness and clarity of the translations of the NDHS questions into the five major languages- Ilocano, Bicol, Waray, Hiligaynon and Cebuano- in the regions where these dialects are spoken. 1.6 TRAINING AND FIELDWORK Training of the field staff was conducted in two levels. The first was the training of the Task Force for instructors, regional coordinators, and supervisors, and the second was the training of the interviewing teams. The Task Force training was conducted in Manila from July 15 to 26, 2013. Fifty-four persons participated as trainees: 35 from RSOs (consisting of Regional Statisticians and Team Supervisors), and 19 from the PSA- NSO Central Office. The trainers were staff of the Demographic and Social Statistics Division (DSSD) at PSA-NSO and guest lecturers and resource persons from the University of the Philippines Population Institute (UPPI), the Department of Health (DOH), the University of the Philippines School of Economics (UPEcon), and the Philippines Commission on Women (PCW). The second-level training took place from June 29 through August 10, 2013, in 17 regional training centers: NCR, CAR, I, II, III, IV-A, IV-B, V, VI, VII , VIII, IX, X, XI, XII, XIII (Caraga) and ARMM. Instructors in this training were members of the Task Force who were trained in the first level training. Data collection was carried out from August 12 through September 24, 2013, by 70 interviewing teams. A total of 284 field interviewers, 70 team supervisors and field editors, and 17 regional supervisors joined the workforce. However, due to the peace and order situation in Zamboanga City, the data collection in Region IX was extended up to October 16, 2013 to complete the survey. Each team consisted of a team supervisor, a field editor, and four female interviewers. 1.7 DATA PROCESSING All completed questionnaires and the control forms were returned to the PSA-NSO central office in Manila for data processing, which consisted of manual editing, data entry and verification, and editing of computer-identified errors. An ad-hoc group of thirteen regular employees from the DSSD, the Information Resources Department (IRD), and the Information Technology Operations Division (ITOD) of the NSO was created to work fulltime and oversee data processing operation in the NDHS Data Processing Center that was carried out at the NSO-CVEA Building in Quezon City, Philippines. This group was responsible for the different aspects of NDHS data processing. There were 19 data encoders hired to process the data who underwent training on September 12-13, 2013. Data entry started on September 16, 2013. The computer package program called Census and Survey Processing System (CSPro) was used for data entry, editing, and verification. Mr. Alexander Izmukhambetov, a data processing specialist from ICF International, spent two weeks at NSO in September 2013 to finalize the data entry program. Data processing was completed on December 6, 2013. 1.8 SAMPLE DESIGN AND IMPLEMENTATION The sample selection methodology for the 2013 NDHS is based on a stratified two-stage sample design, using the 2010 Census of Population and Housing (CPH) as a frame. The first stage involved a systematic selection of 800 sample enumeration areas (EAs) distributed by stratum (region, urban/rural). In the second stage, 20 sample housing units were selected from each sample EA, using systematic random sampling. All households in the sampled housing units were interviewed. An EA is defined as an area with discern able 6 • Introduction boundaries consisting of contiguous households. The sample was designed to provide data representative of the country and its 17 administrative regions. For the 2013 NDHS sample, 16,732 households were selected, of which 14,893 were occupied (Table 1.1). Of these households, 14,804 were successfully interviewed, yielding a household response rate of 99.4 percent. The household response rates in urban and rural areas are almost identical. Among the households interviewed, 16,437 women were identified as eligible respondents, and the interviews were completed for 16,155 women, yielding a response rate of 98.3 percent. On the other hand, for the women’s safety module, from a total of 11,373 eligible women, 10,963 were interviewed with privacy, translating to a 96.4 percent response rate. At the individual level, urban and rural response rates showed no difference. The principal reason for non-response among women was the failure to find individuals at home, despite interviewers’ repeated visits to the household. Further details on the sample design and implementation are given in Appendix A. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Philippines 2013 Residence Total Result Urban Rural Household interviews Households selected 7,098 9,634 16,732 Households occupied 6,299 8,594 14,893 Households interviewed 6,251 8,553 14,804 Household response rate1 99.2 99.5 99.4 Interviews with women age 15-49 Number of eligible women 7,742 8,695 16,437 Number of eligible women interviewed 7,609 8,546 16,155 Eligible women response rate2 98.3 98.3 98.3 Women’s safety module interviews Number of eligible women 5,072 6,301 11,373 Number of eligible women interviewed 4,889 6,074 10,963 Women’s safety module response rate2 96.4 96.4 96.4 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Household Characteristics • 7 HOUSEHOLD POPULATION AND HOUSEHOLD CHARACTERISTICS 2 his chapter provides a summary of the socioeconomic characteristics of the household population, including household composition, source of drinking water, sanitation facility, housing characteristics, and possession of household assets. In addition, this chapter also describes the socio-demographic characteristics of the population, particularly their age, sex, and educational attainment. The 2013 National Demographic and Health Survey (NDHS) provides valuable inputs for social and economic development planning. It is also useful for understanding and identifying the major factors that determine or influence the basic demographic indicators of the population. 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. The Household Questionnaire used in the 2013 NDHS collected data on the demographic and social characteristics of the usual residents of the sample household (de jure population) as well as persons who stayed with the sample household the night before the interview (de facto population). The 2013 NDHS collected information on the household’s ownership of a number of consumer items, such as radio, television, or car, as well as on housing characteristics and sanitation facilities. The information on household assets was used to create an index representing the relative wealth of the households interviewed in the survey. T Key Findings • Almost all households in the Philippines (96 percent) use an improved source of drinking water. • Fifty-nine percent of households do not treat their water. • Seventy percent of households have improved toilet facilities that are not shared with other households. • Eighty-eight percent of households have electricity. • More than half (55 percent) of households own/amortize the lot they dwell on. • Over 3 in 5 households use solid fuel for cooking. Rural residents commonly use wood for cooking while LPG, natural gas or biogas is used by a majority of urban residents. • Urban households are more likely to own household effects than rural households. Eighty-four percent of households own a mobile telephone (91 and 78 percent for urban and rural households, respectively). • Nineteen percent of households are beneficiaries of the 4Ps or CCT program. • Education is widespread in the Philippines. Only 5 percent of the population age 6 and over have no formal education and around 40 percent have completed high school or have some college. 8 • Household Population and Household Characteristics 2.1 HOUSING CHARACTERISTICS The physical characteristics of households are important indicators of health and of the general socioeconomic condition of the population. In the 2013 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. Tables in this chapter show the percent distribution of households by housing characteristics according to urban-rural residence. 2.1.1 Drinking Water A major concern of health program managers is to control water-borne diseases. Safe drinking water is important for health and sanitation. Nationally, 96 percent of Filipino households have an improved source of drinking water (Table 2.1). Twenty-seven percent of households have water piped into the dwelling, yard, or plot as their main source of drinking water, while 37 percent drink mostly bottled water. Tube wells or boreholes are the main source of drinking water in rural areas (24 percent), while in urban areas the main source is water piped into the premises (31 percent). Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Philippines 2013 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 98.6 92.8 95.6 98.6 92.2 95.2 Piped into dwelling/yard/ plot 31.2 22.2 26.5 31.9 21.9 26.7 Public tap/standpipe 3.3 9.2 6.4 3.6 9.4 6.7 Tube well or borehole 8.6 23.7 16.5 8.8 23.5 16.5 Protected dug well 1.5 6.6 4.1 1.4 6.6 4.1 Semi-protected dug well 0.3 1.4 0.9 0.4 1.4 0.9 Protected spring 1.4 6.9 4.3 1.3 7.1 4.3 Rain water 0.1 0.6 0.3 0.1 0.6 0.4 Bottled water 52.2 22.3 36.6 51.0 21.6 35.7 Non-improved source 1.4 7.1 4.3 1.4 7.8 4.7 Unprotected dug well 0.3 2.4 1.3 0.3 2.6 1.5 Unprotected spring 0.9 3.9 2.5 1.0 4.3 2.7 Tanker truck/cart with drum 0.1 0.5 0.3 0.2 0.5 0.4 Surface water 0.1 0.3 0.2 0.0 0.3 0.2 Other source 0.0 0.1 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 37.0 41.3 39.2 38.0 40.7 39.4 Less than 30 minutes 59.7 50.7 55.0 58.7 51.0 54.7 30 minutes or longer 3.0 7.7 5.5 3.1 8.0 5.7 Don’t know/missing 0.2 0.3 0.3 0.2 0.3 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 25.6 33.8 29.9 27.7 36.0 32.0 Bleach/chlorine added 0.5 2.0 1.3 0.5 2.1 1.3 Strained through cloth 6.5 11.4 9.1 6.7 11.8 9.3 Ceramic, sand or other filter 3.6 2.1 2.8 3.8 2.0 2.8 Solar disinfection 0.1 0.2 0.2 0.1 0.2 0.2 Other 2.8 4.5 3.7 2.9 4.5 3.7 No treatment 65.0 53.6 59.1 62.8 51.4 56.9 Percentage using an appropriate treatment method2 28.9 36.8 33.0 31.1 39.0 35.2 Number 7,104 7,700 14,804 33,607 36,493 70,100 1 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Household Population and Household Characteristics • 9 Households were additionally asked if they treat their water prior to drinking because drinking water, even from an improved source, may be contaminated during transport or storage. For 94 percent of households, their source of drinking water is either on their premises or is within 30 minutes to and from their residence. Treatment of water is not common in the Philippines; 59 percent of households do not do anything to treat their water to make it safer to drink. On the other hand, three out of ten households boil their water and 9 percent strain water through cloth (Table 2.1). Treatment of drinking water is more common among rural than urban households, presumably because fewer rural households get their water from an improved source. 2.1.2 Household Sanitation Facilities Hygienic treatment of human waste can have a positive impact on reducing disease and mortality. In the Philippines, seven in ten households use improved toilet facilities that are not shared with other households, while two in ten households use improved facilities that are shared (Table 2.2). Almost one in ten households uses a non-improved facility. The most common type of toilet is a flush toilet connected to a septic tank. This kind of toilet is most widely used in both urban and rural areas. The percentage of households having no toilet facility decreased from 10 percent in 2008 to 6 percent in 2013. Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Philippines 2013 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 5.2 1.4 3.3 5.2 1.4 3.2 Flush/pour flush to septic tank 66.2 55.9 60.8 66.9 55.6 61.0 Flush/pour flush to pit latrine 1.0 6.3 3.7 1.1 6.8 4.0 Ventilated improved pit (VIP) latrine 0.1 0.5 0.3 0.1 0.6 0.4 Pit latrine with slab 0.4 2.1 1.3 0.4 2.4 1.4 Composting toilet 0.0 0.1 0.1 0.0 0.1 0.1 Total 72.9 66.4 69.6 73.7 66.8 70.1 Shared facility1 Flush/pour flush to piped sewer system 1.9 0.4 1.1 1.7 0.4 1.0 Flush/pour flush to septic tank 18.5 15.9 17.2 17.7 14.8 16.2 Flush/pour flush to pit latrine 0.7 2.7 1.8 0.7 2.7 1.8 Ventilated improved pit (VIP) latrine 0.0 0.2 0.1 0.0 0.3 0.1 Pit latrine with slab 0.1 0.9 0.5 0.2 0.9 0.5 Total 21.3 20.1 20.7 20.3 19.1 19.7 Non-improved facility Flush/pour flush not to sewer/septic tank/pit latrine 1.7 0.5 1.1 1.7 0.5 1.1 Pit latrine without slab/open pit 0.3 2.2 1.3 0.4 2.4 1.4 Bucket 0.0 0.1 0.0 0.0 0.0 0.0 Hanging toilet/hanging latrine 0.2 0.6 0.4 0.3 0.7 0.5 No facility/bush/field 2.9 9.0 6.1 3.1 9.3 6.3 Total 5.2 12.3 8.9 5.5 13.0 9.4 Public toilet 2 0.5 0.7 0.6 0.5 0.7 0.6 Other 0.0 0.4 0.2 0.0 0.3 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 7,104 7,700 14,804 33,607 36,493 70,100 1 Facilities that would be considered improved if they were not shared by two or more households. 2 It is not possible to determine if the public toilet is improved or non-improved. 10 • Household Population and Household Characteristics 2.1.3 Housing Characteristics Housing characteristics such as the type of building materials, presence of electricity, and tenure of status of the lot can be used as indicators of the socioeconomic condition of the household. As shown in Table 2.3, 88 percent of households in the country have electricity. There is an observed difference in the percentage of households with electricity in urban and rural areas: 94 percent of urban households have electricity, compared with only 82 percent of those in rural areas. There has been an increase in electrification, from 83 percent of households in 2008 to 88 percent in 2013. The increase is entirely due to an increase for rural households, from 72 percent in 2008 to 82 percent in 2013. Nationally, more than half of households (51 percent) have cement flooring. Urban households are more likely to have cement floors than rural households (55 and 48 percent, respectively). Ceramic tiles are used as flooring materials by 21 percent of households in urban areas. The overwhelming majority of households in the Philippines have roofs made of galvanized iron or aluminum (87 percent), while only 8 percent have roofs made of thatch or palm leaf (Nipa). Six in every ten households have walls made of cement or cement or hollow blocks, with both being more common in urban than in rural households. Tenure of status of the lot is a basic measure of housing security. Over half of households in the country (55 percent) own or are amortizing the lot they occupy, while 31 percent occupy their lots rent-free with the consent of the owner, and 12 percent are renting their lots. Two percent of the households are occupying their lots rent-free, without the consent of the owner. Figure 2.1 provides an overview of some of the indicators related to housing characteristics. Table 2.3 Housing characteristics Percent distribution of households by presence of electricity, housing materials, and tenure status, according to residence, Philippines 2013 Residence Total Housing characteristic Urban Rural Electricity Yes 94.1 81.5 87.5 No 5.9 18.4 12.4 Total 100.0 100.0 100.0 Main flooring material Earth, sand 4.5 13.3 9.1 Wood planks 7.5 9.2 8.4 Palm, bamboo 3.8 15.5 9.9 Parquet, polished wood 0.9 0.5 0.7 Vinyl or asphalt strips 6.8 3.1 4.9 Ceramic tiles 20.5 9.6 14.8 Cement 54.6 48.1 51.2 Carpet 0.2 0.1 0.2 Marble 1.2 0.4 0.8 Total 100.0 100.0 100.0 Main roof material Thatch, palm leaf (nipa) 2.9 13.0 8.2 Sod, grass (cogon) 0.5 3.3 2.0 Palm, bamboo 0.3 1.7 1.0 Wood planks 0.2 0.1 0.1 Makeshift, cardboard 0.2 0.1 0.1 Galvanized iron, aluminum 93.6 80.4 86.7 Wood 0.3 0.1 0.2 Calamine, cement fiber 0.4 0.1 0.3 Ceramic tiles 0.1 0.0 0.1 Cement 1.2 0.8 1.0 Roofing shingles 0.2 0.3 0.3 Total 100.0 100.0 100.0 Main wall material Cane, palm, trunks 0.6 3.6 2.2 Bamboo 7.0 22.5 15.1 Plywood 10.3 7.1 8.6 Makeshift, cardboard, reused materials 1.3 1.1 1.2 Cement 35.3 23.6 29.2 Stone with lime, cement 1.6 0.6 1.1 Bricks 0.2 0.2 0.2 Cement/hollow blocks 36.9 26.4 31.4 Wood planks, shingles 5.5 13.3 9.6 Galvanized iron, aluminium 0.8 1.2 1.0 Other/Missing 0.3 0.4 0.3 Total 100.0 100.0 100.0 Tenure status of lot Owned, being amortized 52.7 56.9 54.9 Rented 19.3 5.0 11.8 Rent-free with owner consent 24.8 36.4 30.8 Rent-free without owner consent 3.1 1.6 2.3 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number 7,104 7,700 14,804 Household Population and Household Characteristics • 11 Figure 2.1 Housing amenities by urban-rural residence 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 unfavorable effects on health. As shown in Table 2.4, about two in five households use only one rooms for sleeping, while the same proportion uses two rooms for sleeping and about 1 in 5 households uses three or more rooms for sleeping. There are no significant differences in the number of rooms used for sleeping in urban or rural households. Information on the type of fuel used for cooking and the place where cooking is done can be used as indicators of the socioeconomic status of the household. The location of the place where food is prepared—whether the kitchen is in the house, in a separate building or outdoor— provides an indication of the air quality inside and around the dwelling. The use of certain 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 people with respiratory disorders. 94 99 73 55 82 93 66 48 88 96 70 51 With electricity With improved source for drinking water With flush toilet, not shared With cement flooring Urban Rural Total Table 2.4 Household characteristics Percent distribution of households by rooms used for sleeping, cooking characteristics, and percentage using solid fuel for cooking, according to residence, Philippines 2013 Residence TotalHousing characteristic Urban Rural Rooms used for sleeping One 37.6 37.2 37.4 Two 37.9 41.9 40 Three or more 23.7 20 21.8 Missing 0.8 0.9 0.9 Total 100 100 100 Place for cooking In the house 77.7 72.4 74.9 In a separate building 5 9.4 7.3 Outdoors 16.5 17.8 17.2 No food cooked in household 0.8 0.3 0.5 Total 100 100 100 Cooking fuel Electricity 2.2 0.6 1.4 LPG/natural gas/ biogas 55.9 17.8 36.1 Kerosene 2.4 0.1 1.2 Charcoal 16.2 14.2 15.1 Wood 22.4 65.5 44.8 Agricultural crop 0.1 1.3 0.7 No food cooked in house 0.8 0.3 0.5 Missing 0.1 0.1 0.1 Total 100 100 100 Percentage using solid fuel for cooking1 38.7 81.1 60.8 Number 7,104 7,700 14,804 LPG = Liquid petroleum gas 1 Includes charcoal, wood, and agricultural crops Percentage of Households NDHS 2013 12 • Household Population and Household Characteristics Table 2.4 shows that more than three in five households use solid fuel for cooking, mostly wood (45 percent) and charcoal (15 percent). Thirty-six percent of households use liquid petroleum gas (LPG), natural gas or biogas. Use of wood for cooking is most 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). 2.2 HOUSEHOLD POSSESSIONS In the 2013 NDHS, information on the possession of selected durable consumer goods was collected at the household level. The percentage of households possessing various durable goods and various means of transportation is shown in Table 2.5. More than eight in ten households own a mobile telephone, while three-quarters have a television. Over half of households have a radio, and half have a CD/VCD or DVD player. Only 40 percent of households have a refrigerator, while one-third have a washing machine and about one-quarter have karaoke components and personal computers. Very few households (8 percent) have landline telephones. There are differences between ownership of durable goods among households in urban and rural areas, with urban households more likely to own each of the designated household effects than rural households. Ownership of radios has declined from 65 percent in 2008 to 57 percent in 2013, with the decline occurring in both urban and rural households, while television ownership increased in rural households from 58 percent to 65 percent. Between 2008 and 2013, ownership of mobile telephones and personal computers/laptops increased by 14 and 10 percentage points, respectively. With regard to means of transport, 30 percent of households own a motorcycle or tricycle, while 20 percent own a bicycle or trisikad. Only 9 percent of Filipino households own a car or truck. Urban households are more likely to own cars/trucks, jeeps or vans and bicycles or trisikad/pedicab than rural households. Ownership of motorcycles and tricycles increased from 22 percent of households in 2008 to 30 percent in 2013, with the increase occuring among both urban and rural households. Nineteen percent of households are beneficiaries of the Pantawid Pamilyang Pilipino Program (4Ps) or the Conditional Cash Transfer (CCT) program. There are more beneficiaries from rural residences than from urban residences (27 and 11 percent, respectively). 2.3 WEALTH INDEX Information on household assets was used to create an index that is used throughout this report to represent the wealth of the households interviewed in the 2013 NDHS. This method for calculating the country-specific wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein and Johnson, 2004). It has been shown to be consistent with expenditure and income measures. Table 2.5 Household possessions Percentage of households possessing various household effects, means of transportation, and participation in government support programs, by residence, Philippines 2013 Residence Total Possession Urban Rural Household effects Radio 62.4 52.3 57.2 Television 85.3 65.4 75.0 Landline, wireless 13.4 3.2 8.1 Mobile telephone 90.9 77.5 83.9 Washing machine 47.1 21.9 34.0 Refrigerator, freezer 51.1 29.7 40.0 CD, VCD, DVD player 60.5 39.8 49.7 Component, karaoke 32.0 17.9 24.7 Personal computer, laptop 32.5 14.0 22.9 Means of transport Bicycle, trisikad (pedicab) 21.2 18.3 19.7 Animal drawn cart 1.2 4.4 2.8 Motorcycle, tricycle 28.9 30.3 29.6 Car/truck, jeep, van 11.5 5.8 8.5 Tractor 1.4 2.3 1.9 Non-motorized boat or banca 0.7 2.8 1.8 Boat or banca with a motor 0.7 3.0 1.9 Beneficiary of 4Ps or CCT1 10.9 27.1 19.3 Number 7,104 7,700 14,804 1 Refers to whether the household or any member of the household is a beneficiary of the Pantawid Pamilyang Pilipino Program (4Ps) or the Conditional Cash Transfer (CCT) program of the government. Household Population and Household Characteristics • 13 The wealth index is constructed using household asset data, including ownership of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of flooring material. In its current form, which takes better account of urban-rural differences in the indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to both in urban and rural areas is used to create wealth scores for households in both areas. Categorical variables to be used are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then analyzed using principal components analysis to produce a common factor score for each household. In a second step, separate factor scores are produced for households in urban and in rural areas using area-specific indicators (Rutstein, 2008). The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting the area- specific score through regression on the common factor scores. This three-step procedure permits greater adaptability of the wealth index in both urban and rural areas. The resulting combined wealth index has a mean of zero and a standard deviation of one, and once it is obtained, national-level wealth quintiles are obtained by assigning the household score to each de jure household member, ranking each person in the population by their score and then dividing the ranking into five equal parts, from quintile one (lowest-poorest) to quintile five (highest-wealthiest), each having approximately 20 percent of the population. Table 2.6 shows the distribution of the population by wealth quintile, according to urban-rural residence and region. As expected, urban residents are more likely to be in the higher wealth quintiles, while rural residents are more commonly found in the lower wealth quintiles. Among regions, NCR, CALABARZON and Central Luzon have the largest proportions of population in the two highest quintiles. In contrast, ARMM, Zamboanga Peninsula and MIMAROPA have the largest proportions in the lowest wealth quintile. Table 2.6 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Philippines 2013 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 7.2 14.0 21.3 27.6 29.9 100.0 33,607 0.15 Rural 31.8 25.6 18.7 13.0 10.9 100.0 36,493 0.28 Region National Capital Region 1.0 9.0 22.4 31.3 36.4 100.0 10,440 0.13 Cordillera Admin Region 12.0 21.8 20.5 24.2 21.5 100.0 1,232 0.24 I - Ilocos Region 13.2 28.1 21.4 19.5 17.9 100.0 3,526 0.21 II - Cagayan Valley 19.1 25.5 20.9 18.7 15.8 100.0 2,512 0.25 III - Central Luzon 6.2 14.7 24.6 26.5 28.0 100.0 7,611 0.17 IVA - CALABARZON 5.2 13.9 20.1 29.1 31.8 100.0 9,387 0.16 IVB - MIMAROPA 36.5 23.1 22.1 11.2 7.1 100.0 1,825 0.29 V - Bicol 31.3 26.7 19.3 11.3 11.5 100.0 3,900 0.31 VI - Western Visayas 31.6 24.9 20.7 12.4 10.4 100.0 5,004 0.28 VII - Central Visayas 23.0 24.5 20.6 15.6 16.3 100.0 4,785 0.26 VIII - Eastern Visayas 25.3 31.3 16.7 15.5 11.2 100.0 2,812 0.26 IX - Zamboanga Peninsula 38.5 25.6 16.2 10.3 9.3 100.0 2,918 0.30 X - Northern Mindanao 33.1 25.0 16.1 14.6 11.1 100.0 3,200 0.29 XI - Davao 31.0 20.3 16.9 16.1 15.7 100.0 3,615 0.28 XII - SOCCSKSARGEN 35.2 26.1 17.7 14.3 6.7 100.0 3,327 0.29 XIII - Caraga 31.1 25.8 21.5 12.4 9.2 100.0 1,917 0.27 ARMM 73.1 17.2 6.2 2.0 1.5 100.0 2,087 0.29 Total 20.0 20.0 20.0 20.0 20.0 100.0 70,100 0.22 Also included in Table 2.5 is the Gini coefficient, which indicates concentration of wealth, with 0 being an equal distribution and 1 a totally unequal distribution. The figures indicate that the economic status of urban households is more equal or homogeneous compared to rural households. Between regions, it can be observed that urbanized areas like NCR, Central Luzon and CALABARZON have less economic inequality of 14 • Household Population and Household Characteristics economic status among households (0.13, 0.17 and 0.16, respectively). Meanwhile, Bicol region (0.31) and Zamboanga Peninsula (0.30) have greater inequality in the distribution of household wealth. 2.4 HOUSEHOLD COMPOSITION Information on the distribution of the households by selected background characteristics such as household headship, sex, and household size is useful for several reasons. For example, female-headed households are often found to be poorer than male-headed households. The size and composition of the household influence the allocation of limited resources and affect the living condition of individuals in the household. Information on the size and composition of the sample households by urban-rural residence is presented in Table 2.7. Nineteen percent of households are headed by women. The proportion of female-headed households is higher among households in urban areas than in rural areas (22 and 17 percent, respectively). The proportion of households headed by women has been increasing gradually over time, from 15 percent in 2003 to 17 percent in 2008 and 19 percent in 2013. On average, a household is composed of 4.7 persons, and the figure is the same in urban and rural areas. 2.5 HOUSEHOLD POPULATION BY AGE AND SEX 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 2013 NDHS collected information on a total of 67,429 persons. This number is almost equally divided between males and females, and the overall sex ratio (number of males per 100 females) is 99. The sex ratio differs by residence; it is lower in urban areas than in rural areas (95 and 103, respectively) (Table 2.8). The proportion of the population below age 15 years is larger in rural than in urban areas (37 and 32 percent, respectively), indicating a younger age structure for the rural population. Figure 2.2 shows the proportion under age 15 has declined somewhat over the past five years, leading to a narrowing of the base of the population pyramid. There has been a gradual decline in the proportion of the overall population under age 15, from 38 percent in 2003 to 36 percent in 2008 and to 34 percent in 2013. Table 2.7 Household composition Percent distribution of households by sex of head of household and by household size and mean size of household, according to residence, Philippines 2013 Residence Characteristic Urban Rural Total Household headship Male 78.4 83.5 81.1 Female 21.6 16.5 18.9 Total 100.0 100.0 100.0 Number of usual members 0 0.2 0.1 0.2 1 4.6 5.2 4.9 2 9.8 10.5 10.2 3 15.9 14.9 15.3 4 20.7 19.7 20.2 5 17.3 17.1 17.2 6 13.1 12.8 12.9 7 8.0 8.2 8.1 8 4.3 5.4 4.8 9+ 6.1 6.1 6.1 Total 100.0 100.0 100.0 Mean size of households 4.7 4.7 4.7 Number of households 7,104 7,700 14,804 Note: Table is based on de jure household members, i.e., usual residents. Household Population and Household Characteristics • 15 Table 2.8 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 2013 Urban Rural Male Female Total Age Male Female Total Male Female Total <5 11.1 9.6 10.3 11.8 11.4 11.6 11.5 10.5 11.0 5-9 11.5 10.1 10.8 12.5 12.7 12.6 12.0 11.4 11.7 10-14 11.1 10.5 10.8 12.4 12.4 12.4 11.8 11.5 11.7 15-19 10.4 10.5 10.5 10.8 9.2 10.0 10.7 9.8 10.2 20-24 9.7 9.4 9.6 8.1 7.2 7.7 8.9 8.3 8.6 25-29 7.7 7.4 7.6 5.9 5.8 5.9 6.8 6.6 6.7 30-34 7.1 7.6 7.4 6.1 6.0 6.1 6.6 6.8 6.7 35-39 6.2 6.1 6.1 5.6 5.8 5.7 5.9 6.0 5.9 40-44 5.8 6.1 6.0 5.8 5.6 5.7 5.8 5.8 5.8 45-49 5.0 5.7 5.4 4.8 5.3 5.1 4.9 5.5 5.2 50-54 4.7 4.9 4.8 4.9 4.9 4.9 4.8 4.9 4.9 55-59 3.4 3.8 3.6 3.4 4.0 3.7 3.4 3.9 3.7 60-64 2.7 3.2 3.0 2.8 3.2 3.0 2.8 3.2 3.0 65-69 1.5 1.9 1.7 1.8 2.2 2.0 1.6 2.0 1.8 70-74 0.9 1.3 1.1 1.4 1.7 1.6 1.2 1.5 1.3 75-79 0.5 1.0 0.8 0.8 1.3 1.0 0.7 1.1 0.9 80 + 0.4 0.9 0.7 0.8 1.3 1.1 0.6 1.1 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 15,797 16,657 32,454 17,743 17,233 34,975 33,540 33,890 67,429 Figure 2.2 Population pyramid 7 5 3 1 1 3 5 7 < 5 5 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 + Male Female Percent of total population NDHS 2013 16 • Household Population and Household Characteristics 2.6 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 the 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 a set of Millennium Development Goals (MDGs), including 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 age six and over, according to selected background characteristics, is presented in Tables 2.9.1 and 2.9.2 for females and males, respectively. Table 2.9.1 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 2013 Background characteristic No educa- tion Some elementary Completed elementary1 Some high school Completed high school2 College or higher3 Don’t know/ missing Total Number Median years completed Age 6-9 30.1 69.3 0.0 0.2 0.0 0.0 0.2 100.0 3,047 0.7 10-14 0.8 53.2 20.5 24.8 0.5 0.1 0.1 100.0 3,894 4.8 15-19 0.9 5.0 5.0 40.4 28.6 20.1 0.0 100.0 3,329 8.9 20-24 0.8 4.2 5.5 12.0 32.3 45.1 0.1 100.0 2,815 9.9 25-29 1.2 6.1 7.4 12.2 32.5 40.7 0.0 100.0 2,237 9.7 30-34 1.7 6.5 7.9 12.7 32.2 39.0 0.0 100.0 2,314 9.7 35-39 1.5 9.3 10.7 12.4 31.4 34.7 0.1 100.0 2,019 9.5 40-44 2.1 10.6 14.6 12.6 29.6 30.5 0.1 100.0 1,981 9.3 45-49 2.7 11.5 17.1 12.8 26.1 29.8 0.0 100.0 1,854 9.2 50-54 2.8 14.6 19.2 11.5 22.8 29.1 0.0 100.0 1,659 9.1 55-59 2.6 16.1 25.2 13.7 18.0 24.3 0.1 100.0 1,322 7.4 60-64 3.9 19.7 26.3 11.3 16.2 22.4 0.2 100.0 1,077 6.0 65+ 7.6 29.9 28.3 8.0 11.0 14.9 0.2 100.0 1,971 5.4 Residence Urban 4.0 17.7 10.4 15.1 23.1 29.7 0.1 100.0 14,711 9.1 Rural 5.9 27.1 15.2 16.2 18.1 17.5 0.1 100.0 14,810 6.3 Region National Capital Region 2.9 14.3 8.3 13.5 27.2 33.6 0.1 100.0 4,770 9.4 Cordillera Admin Region 7.2 18.7 10.5 13.6 15.0 34.9 0.2 100.0 497 9.0 I - Ilocos Region 3.2 19.7 14.6 15.4 24.1 22.9 0.0 100.0 1,413 8.5 II - Cagayan Valley 4.1 25.5 13.6 14.6 17.9 24.1 0.2 100.0 1,010 7.4 III - Central Luzon 4.2 18.9 15.5 15.6 23.1 22.6 0.1 100.0 3,127 8.2 IVA - CALABARZON 3.4 18.1 12.4 14.8 26.0 25.2 0.1 100.0 4,067 9.0 IVB - MIMAROPA 7.3 28.2 17.7 17.2 12.2 17.3 0.1 100.0 770 5.8 V - Bicol 4.5 24.8 18.2 16.7 16.5 19.3 0.1 100.0 1,573 6.4 VI - Western Visayas 4.1 26.6 13.2 16.0 18.6 21.4 0.0 100.0 2,027 7.2 VII - Central Visayas 5.6 27.6 12.5 16.0 16.5 21.8 0.1 100.0 1,987 6.9 VIII - Eastern Visayas 3.9 27.4 14.9 17.1 15.3 21.4 0.0 100.0 1,138 6.7 IX - Zamboanga Peninsula 6.3 27.4 13.7 19.5 14.2 18.9 0.0 100.0 1,273 6.5 X - Northern Mindanao 7.4 26.8 12.6 16.1 16.1 21.0 0.1 100.0 1,335 6.7 XI - Davao 5.3 26.1 11.4 16.2 19.4 21.6 0.1 100.0 1,539 7.4 XII - SOCCSKSARGEN 8.0 26.3 12.0 18.0 17.8 17.7 0.1 100.0 1,339 6.8 XIII - Caraga 4.6 26.6 14.9 17.4 16.6 19.8 0.1 100.0 802 6.6 ARMM 19.2 34.9 10.9 13.8 11.0 9.8 0.3 100.0 853 4.3 Wealth quintile Lowest 11.5 41.1 16.2 16.6 11.4 3.1 0.1 100.0 5,280 4.7 Second 5.6 28.0 16.4 20.0 20.2 9.7 0.1 100.0 5,545 6.0 Middle 3.4 20.6 14.7 17.6 26.1 17.6 0.1 100.0 5,774 8.0 Fourth 3.1 15.1 11.1 14.3 25.7 30.6 0.1 100.0 6,234 9.2 Highest 2.4 11.5 7.1 10.7 18.5 49.7 0.1 100.0 6,688 10.0 Total 5.0 22.4 12.8 15.6 20.5 23.6 0.1 100.0 29,520 7.9 Note: Totals include 2 women with age missing 1 Completed grade 6 at the primary level 2 Completed 4th year at the secondary level 3 Includes all post-secondary Household Population and Household Characteristics • 17 Table 2.9.2 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 2013 Background characteristic No educa- tion Some elementary Completed elementary1 Some high school Completed high school2 College or higher3 Don’t know/ missing Total Number Median years completed Age 6-9 32.5 67.0 0.0 0.2 0.0 0.0 0.3 100.0 3,186 0.6 10-14 1.7 60.6 18.8 18.1 0.6 0.1 0.2 100.0 3,969 4.4 15-19 1.5 13.1 10.1 38.4 23.7 13.2 0.0 100.0 3,572 8.2 20-24 1.2 10.3 8.4 15.8 29.2 35.1 0.0 100.0 2,971 9.5 25-29 1.9 11.9 9.1 14.7 28.1 34.4 0.0 100.0 2,271 9.4 30-34 0.9 13.2 9.8 13.6 30.8 31.6 0.1 100.0 2,198 9.4 35-39 1.6 16.1 11.1 13.7 27.9 29.4 0.1 100.0 1,976 9.3 40-44 2.1 16.6 15.8 12.6 25.7 27.1 0.1 100.0 1,950 9.1 45-49 2.6 18.1 15.6 12.1 25.4 26.2 0.1 100.0 1,655 9.1 50-54 2.4 18.3 16.3 10.9 23.0 28.9 0.2 100.0 1,625 9.1 55-59 2.6 21.6 20.6 10.0 20.4 24.7 0.1 100.0 1,150 7.7 60-64 3.0 23.3 23.8 9.4 19.5 20.7 0.2 100.0 928 6.0 65+ 4.8 32.4 21.6 9.2 12.4 19.3 0.3 100.0 1,373 5.6 Residence Urban 4.5 21.9 9.7 14.9 22.3 26.6 0.1 100.0 13,633 8.8 Rural 6.0 33.1 14.9 15.8 16.1 14.0 0.1 100.0 15,194 5.7 Region National Capital Region 3.4 17.2 7.6 13.9 26.4 31.4 0.1 100.0 4,246 9.3 Cordillera Admin Region 4.9 27.6 10.0 14.4 17.1 25.9 0.1 100.0 498 7.4 I - Ilocos Region 4.5 21.8 14.1 13.5 25.5 20.7 0.0 100.0 1,479 8.0 II - Cagayan Valley 4.4 30.7 13.6 15.1 15.9 20.0 0.2 100.0 1,060 6.2 III - Central Luzon 4.2 23.0 14.9 16.7 22.3 18.8 0.2 100.0 3,113 7.4 IVA - CALABARZON 4.5 19.4 11.1 15.2 25.3 24.4 0.1 100.0 3,738 8.9 IVB - MIMAROPA 6.0 35.2 16.0 18.1 12.4 12.2 0.2 100.0 740 5.5 V - Bicol 4.6 30.1 17.9 17.9 14.6 14.9 0.1 100.0 1,589 5.9 VI - Western Visayas 4.9 34.2 12.7 14.7 16.9 16.4 0.1 100.0 2,061 5.9 VII - Central Visayas 4.9 34.4 12.2 14.1 15.2 19.1 0.1 100.0 1,988 5.9 VIII - Eastern Visayas 5.3 37.2 13.2 17.0 13.2 14.0 0.1 100.0 1,186 5.6 IX - Zamboanga Peninsula 6.7 33.7 14.6 17.2 11.4 16.1 0.2 100.0 1,202 5.6 X - Northern Mindanao 6.7 35.9 11.4 16.5 14.8 14.4 0.2 100.0 1,390 5.6 XI - Davao 6.6 33.9 12.2 14.4 14.2 18.5 0.1 100.0 1,463 5.8 XII - SOCCSKSARGEN 8.0 31.7 13.0 17.3 15.4 14.6 0.1 100.0 1,401 5.8 XIII - Caraga 5.3 32.9 15.0 16.3 14.5 15.8 0.1 100.0 812 5.8 ARMM 16.1 44.9 11.1 10.4 9.8 7.4 0.2 100.0 863 3.6 Wealth quintile Lowest 10.6 49.7 15.3 13.5 8.3 2.5 0.1 100.0 5,895 4.0 Second 5.5 33.9 16.7 18.8 17.8 7.1 0.1 100.0 6,015 5.6 Middle 4.0 23.5 14.3 18.6 24.7 14.7 0.2 100.0 5,881 7.4 Fourth 3.2 17.5 9.1 14.6 27.4 28.2 0.1 100.0 5,673 9.2 Highest 2.8 12.8 5.9 10.7 17.1 50.5 0.1 100.0 5,364 10.1 Total 5.3 27.8 12.4 15.3 19.0 19.9 0.1 100.0 28,828 6.9 Note: Totals include 3 men with age missing 1 Completed grade 6 at the primary level 2 Completed 4th year at the secondary level 3 Includes all post-secondary The results of the 2013 NDHS indicate that the vast majority of the population has some formal education. Among females and males aged six years and over, only around 5 percent have no formal education, while about two in five attended or completed elementary education, more than three in ten attended or completed high school, and more than one in five attended or completed college or some other form of higher education. Women tend to have slightly more schooling than men, with a median of 8 years of school, compared to only 7 for men. There are substantial differences in education attainment between urban and rural population. Urban residents are more likely to have completed high school or higher education than rural residents. 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. 18 • Household Population and Household Characteristics The distribution of population by highest level of education completed varies substantially among the regions of the country (Figure 2.3). Residents of the National Capital Region (NCR), and CALABARZON and women in CAR tend to have more years of education than residents in the rest of the country. The median years of schooling in these regions is 9 or more years, compared with only 5 to 7 years in most of the other regions. Residents of the Autonomous Region of Muslim Mindanao (ARMM) have the lowest median duration of schooling which is 4 years for both men and women. Figure 2.3 Median years of schooling by sex and region 3.6 5.8 5.8 5.8 5.6 5.6 5.6 5.9 5.9 5.9 5.5 8.9 7.4 6.2 8.0 7.4 9.3 9.4 ARMM XIII - Caraga XII - SOCCSKSARGEN XI - Davao X - Northern Mindanao IX - Zamboanga Peninsula VIII - Eastern Visayas VII - Central Visayas VI - Western Visayas V- Bicol IVB - MIMAROPA IVA - CALABARZON III - Central Luzon II - Cagayan Valley I - Ilocos Region Cordillera Admin Region National Capital Region Female Male Note: De facto household population age six and over NDHS 2013 Characteristics of Respondents • 19 CHARACTERISTICS OF RESPONDENTS 3 he purpose of this chapter is to provide a demographic and socio economic profile of women aged 15-49 in the Philippines. Background information about each respondent such as age, marital status, residence, education, literacy, access to media and employment status was gathered in the 2013 NDHS. This information will help in understanding factors that affect reproductive behavior, contraceptive use and other health practices of women. 3.1 CHARACTERISTICS OF WOMEN RESPONDENTS Table 3.1 shows the background characteristics of women respondents aged 15-49 such as age, religion, ethnic group, marital status, residence, region, education and wealth quintile. Results of the survey show that over half of the women respondent aged 15-49 (51 percent) are under age 30. Three out of five respondents are either married or living together with a man. Over one-third are never married (35 percent), while the remaining 5 percent are either divorced, separated or widowed. Four out of 5 respondents are Roman Catholic (79 percent); much lower proportions are Muslim (6 percent) and Protestant (5 percent). Tagalog is the predominant ethnic group of the respondents (35 percent). This was followed by Cebuano (19 percent), Ilonggo (9 percent), Ilocano (8 percent) and Bicolano (6 percent). Tausog and Maranao, Muslim ethnic groups, together comprise three percent of respondents. T Key Findings • Over half of women age 15 to 49 are under 30 years old. • Three out of five women aged 15 to 49 are married or living together with a man. • Only one percent of women age 15-49 have no formal education. • Almost three in women aged 15-49 (58 percent) were born in the barrios. • Three in ten women check email or surf the internet at least once a week. Younger women access the internet more than older women. • Almost 3 out of 5 women aged 15-49 (57 percent) were employed in the 12 months preceding the survey. • The proportion of women employed in sales and services occupations (18 percent) has decreased since 2008 (30 percent). • One out of ten employed women aged 15-49 receive no pay for their work. • There has been a sharp decline in the proportion of women not covered by any health insurance, from 57 percent in 2008 to 38 percent in 2013. • Only 6 percent of women aged 15-49 use tobacco products. 20 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Philippines 2013 Background characteristic Weighted percent Weighted number Unweighted number Age 15-19 20.0 3,237 3,261 20-24 17.3 2,789 2,809 25-29 13.3 2,156 2,171 30-34 13.9 2,250 2,206 35-39 12.2 1,976 1,974 40-44 11.9 1,924 1,916 45-49 11.3 1,823 1,818 Religion Roman Catholic 78.6 12,702 12,078 Protestant 5.1 817 894 Iglesia Ni Kristo 3.0 481 466 Aglipay 0.8 122 123 Islam 5.5 881 1,346 Other 7.0 1,132 1,228 None 0.0 3 4 Ethnic group Tagalog 35.2 5,691 4,571 Cebuano 19.1 3,086 3,168 Ilocano 7.8 1,257 1,406 Ilonggo 8.6 1,384 1,346 Bicolano 5.5 886 827 Waray 3.3 532 518 Kapampangan 2.3 379 309 Maranao 1.4 225 361 Tausog 1.3 212 351 Other 15.4 2,495 3,291 Missing 0.0 7 7 Marital status Never married 34.8 5,615 5,512 Married 45.8 7,392 7,645 Living together 14.5 2,336 2,221 Divorced/separated 3.6 588 547 Widowed 1.4 223 230 Residence Urban 53.1 8,585 7,609 Rural 46.9 7,570 8,546 Region National Capital Region 18.1 2,924 2,249 Cordillera Admin Region 1.6 252 672 I - Ilocos Region 4.3 691 708 II - Cagayan Valley 3.4 550 694 III - Central Luzon 10.6 1,720 1,380 IVA - CALABARZON 14.2 2,293 1,590 IVB - MIMAROPA 2.3 372 576 V - Bicol 4.9 798 796 VI - Western Visayas 6.2 996 930 VII - Central Visayas 6.4 1,030 957 VIII - Eastern Visayas 3.5 571 592 IX - Zamboanga Peninsula 4.5 725 936 X - Northern Mindanao 4.3 697 699 XI - Davao 5.5 893 898 XII - SOCCSKSARGEN 4.6 744 754 XIII - Caraga 2.7 435 803 ARMM 2.9 465 921 Education No education 1.2 188 248 Elementary 16.1 2,593 2,819 High school 49.0 7,916 7,747 College 33.8 5,458 5,341 Wealth quintile Lowest 16.2 2,620 3,194 Second 17.9 2,886 3,087 Middle 19.8 3,199 3,127 Fourth 22.1 3,572 3,286 Highest 24.0 3,878 3,461 Total 15-49 100.0 16,155 16,155 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Respondents • 21 Access to services and exposure to mass media pertaining to reproductive health and other aspects of life are often determined by one’s area of residence. More than half of the women respondents are living in urban areas (53 percent). Almost three out five are from Luzon (59 percent), with 18 percent from National Capital Region (NCR). One-sixth (16 percent) of respondents live in the Visayas region, while 25 percent come from Mindanao. Only one percent of women aged 15-49 have no formal education, while almost two-thirds (65 percent) have some elementary or secondary education, and one-third of the respondents have attended college (33 percent). Socio-economic status often influences the health practices of the population. Sixteen percent of the respondents belong to the lowest quintile while 24 percent belong to the highest quintile. 3.2 MOBILITY Residential mobility has some relationship with contraceptive use and health practices of the population. The urban population has more access to information and services than the rural population. Women interviewed in the 2013 NDHS were asked several questions concerning residential mobility. They were asked the type of place of residence of their mother at the time of their birth—a city, a town, a barrio or rural area, or abroad. They were also asked what type of place they lived in five years ago. This type of question is used to determine migration pattern in a five-year interval. Table 3.2 Residence characteristics of respondents Percent distribution of women age 15-49 by type of residence at birth, in 2008, and at the time of the survey, Philippines 2013 Number of women Background characteristic Weighted percent Weighted number Unweighted number Type of residence at birth City 23.0 3,716 3,275 Town/poblacion 18.6 3,004 2,800 Barrio/rural area 58.0 9,374 10,015 Abroad 0.1 23 23 Don’t know 0.2 39 42 Total 100.0 16,155 16,155 Type of residence in 2008 City 32.4 5,241 4,644 Town/poblacion 17.3 2,790 2,637 Barrio/rural area 49.7 8,029 8,772 Abroad 0.3 56 61 Don’t know 0.2 39 41 Total 100.0 16,155 16,155 Type of residence in 2013 Urban 53.1 8,585 7,609 Rural 46.9 7,570 8,546 Total 100.0 16,155 16,155 Table 3.2 shows that almost three in five women were born in a barrio/rural area (58 percent) while about 42 percent were born in a city or town/poblacion. Five years before the survey, half of women aged 15- 49 lived in the barrio/rural areas and the other half lived in cities and towns. Currently, there are more women living in urban areas (53 percent) than in rural areas (47 percent). These figures reflect the movement from rural to urban areas. 22 • Characteristics of Respondents 3.3 EDUCATIONAL ATTAINMENT Education is one of the most influential determinants of an individual’s knowledge, attitudes, and behaviors. It enhances one’s ability to achieve desired demographic and health goals. Table 3.3 presents differentials in the educational attainment of women in terms of age group, residence, region, and socio-economic status. 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 2013 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some elementary Completed elementary1 Some high school Completed high school2 College or higher3 Age 15-24 0.5 4.4 5.3 27.5 30.7 31.5 100.0 9.4 6,026 15-19 0.4 4.8 5.0 40.8 29.0 19.9 100.0 9.0 3,237 20-24 0.7 4.0 5.6 12.1 32.7 45.0 100.0 9.8 2,789 25-29 0.8 6.0 7.4 12.3 32.8 40.8 100.0 9.7 2,156 30-34 1.3 6.5 7.7 12.6 33.0 38.9 100.0 9.7 2,250 35-39 1.5 9.0 10.9 12.6 31.7 34.3 100.0 9.5 1,976 40-44 1.8 10.4 14.7 12.8 29.9 30.4 100.0 9.3 1,924 45-49 2.5 11.6 17.3 13.0 26.0 29.6 100.0 9.2 1,823 Residence Urban 0.7 4.2 6.6 16.6 32.1 39.9 100.0 9.7 8,585 Rural 1.7 10.2 11.8 20.0 29.3 26.9 100.0 9.2 7,570 Region National Capital Region 0.0 2.4 4.7 13.9 35.7 43.4 100.0 9.8 2,924 Cordillera Admin Region 0.7 4.3 4.9 16.1 21.3 52.6 100.0 10.3 252 I - Ilocos Region 0.1 2.2 7.3 16.7 37.9 35.7 100.0 9.6 691 II - Cagayan Valley 1.3 9.7 9.6 16.0 27.5 35.9 100.0 9.5 550 III - Central Luzon 0.4 3.9 11.3 17.4 34.4 32.7 100.0 9.5 1,720 IVA - CALABARZON 0.4 4.1 7.6 15.3 38.2 34.3 100.0 9.6 2,293 IVB - MIMAROPA 2.9 12.3 15.3 21.7 20.7 27.1 100.0 8.8 372 V - Bicol 0.2 5.9 14.9 21.6 27.3 30.1 100.0 9.3 798 VI - Western Visayas 0.9 6.7 7.6 19.9 31.9 33.0 100.0 9.5 996 VII - Central Visayas 0.8 11.4 9.8 19.1 26.8 32.1 100.0 9.3 1,030 VIII - Eastern Visayas 0.5 10.1 9.8 22.3 24.7 32.6 100.0 9.3 571 IX - Zamboanga Peninsula 1.9 10.9 12.6 25.2 21.5 28.0 100.0 8.9 725 X - Northern Mindanao 2.7 11.7 10.8 21.0 23.8 30.0 100.0 9.2 697 XI - Davao 1.4 11.9 8.9 18.8 28.2 30.7 100.0 9.3 893 XII - SOCCSKSARGEN 4.8 10.2 9.2 23.9 26.5 25.4 100.0 9.1 744 XIII – Caraga 1.0 8.6 12.9 21.5 25.9 30.0 100.0 9.2 435 ARMM 9.6 23.0 13.1 20.2 18.6 15.6 100.0 6.9 465 Wealth quintile Lowest 5.2 23.9 19.1 25.1 21.2 5.5 100.0 6.3 2,620 Second 0.9 9.4 13.5 26.0 33.9 16.3 100.0 9.0 2,886 Middle 0.3 3.7 9.8 20.3 39.1 26.8 100.0 9.4 3,199 Fourth 0.2 1.9 4.3 14.0 35.8 43.8 100.0 9.8 3,572 Highest 0.2 1.2 2.7 9.8 23.5 62.4 100.0 11.4 3,878 Total 1.2 7.0 9.1 18.2 30.8 33.8 100.0 9.5 16,155 1 Completed grade 6 at the primary level 2 Completed 4th year at the secondary level 3 Includes all post-secondary As mentioned above, only a tiny fraction of women aged 15-49 (1 percent) have never attended school, while almost two-thirds have completed high school. The median number of years of school completed is 9.5. Younger women have reached higher levels of schooling than older women. For example, women age 20-24 have the highest percentage with at least some college education (45 percent). This proportion falls in older age groups, with the lowest for age group 45-49 (30 percent). From age group 20-24, the median years of schooling shows a steady decline with increasing age. Characteristics of Respondents • 23 Urban women have more education than rural women. Table 3.3 shows that two in five women in urban areas (40 percent) have some college education, compared to only just over one in five women living in rural areas (27 percent). The distribution of women by educational attainment across regions shows that a majority of women have at least some high school education except for Zamboanga Peninsula, MIMAROPA and ARMM (49 percent, 48 percent and 34 percent, respectively). Interestingly, Cordillera Administrative Region (CAR) has a higher proportion of women who attended college than NCR (53 percent and 43 percent, respectively). Central Luzon and CALABARZON which are adjacent to NCR show only 33 percent and 34 percent of respondents with some college education. The wealth status of women is highly associated with their level of education. Analysis of education by household wealth status indicates that women in the highest wealth quintile are much more likely to have some college education than women in other wealth quintiles. Table 3.3 shows that the proportion of women with at least some college education increases from 6 percent of those in the lowest quintile to 62 percent of those in the highest wealth quintile. 3.4 ACCESS TO MASS MEDIA AND INTERNET Access to information is essential to increasing people’s knowledge and awareness of what is taking place around them that may eventually affect their perceptions and behavior. It is important to know which groups are likely to be reached by the media for purposes of planning programs intended to disseminate information about health and family planning. In the 2013 NDHS, exposure to mass media was assessed by asking how often a respondent reads a newspaper or magazine, listens to the radio, watches television and checks email or surfs the internet. Table 3.4 shows that television is the most popular mass media for women (81 percent watching at least once a week). Majority of respondents are exposed to radio at least once a week (53 percent), while only 27 percent read a newspaper or magazine at least once a week. Almost one in three women accesses the internet at least once a week (30 percent). There is no significant difference across ages in terms of access to different mass media except for internet access. Younger women access the internet more than older women. More than two out of five women ages 15-19 access the internet at least once a week (43 percent), compared with only 12 percent of those age 45-49. Table 3.4 shows that women in urban areas have more access to mass media. For example, access to the internet is more than double for women in the urban areas (40 percent) compared to those in rural areas (18 percent). Among regions, there is no distinct pattern of exposure to mass media. However, women in ARMM are least likely to have access to television, radio and the internet; three in five women do not have access to any of the four media on a weekly basis (59 percent). Media exposure increases with both educational level and wealth quintile of the respondent. For example, 89 percent of women with some college education watch television at least once per week, compared with 27 percent of women with no education at all. In addition, 42 percent of women with some college education read a newspaper or magazine at least once a week, compared with 3 percent of women with no education. Similarly, 92 percent of women in the highest wealth quintile watch television at least once a week, compared with only 27 percent of women with no schooling. More than half of women with at least some college education (56 percent) and three in five women in the highest wealth quintile access the internet at least once a week. 24 • Characteristics of Respondents Table 3.4 Exposure to mass media Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Philippines 2013 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Checks e- mail or surfs the internet at least once a week Accesses none of the four media at least once a week Number of women Age 15-19 29.4 83.0 55.3 21.6 10.5 42.9 9.1 3,237 20-24 28.7 82.1 55.7 21.3 10.4 41.5 9.6 2,789 25-29 29.7 81.7 51.2 20.7 11.3 32.4 10.8 2,156 30-34 26.9 81.3 51.4 19.2 11.1 27.7 10.4 2,250 35-39 25.8 78.8 49.5 17.8 12.9 22.1 12.4 1,976 40-44 23.4 78.5 51.3 17.3 13.6 16.8 13.0 1,924 45-49 23.9 77.2 51.9 16.7 13.7 12.6 13.4 1,823 Residence Urban 34.6 86.7 55.9 25.5 7.1 40.4 6.1 8,585 Rural 18.8 74.0 49.0 12.9 16.9 18.3 16.4 7,570 Region National Capital Region 47.2 87.0 60.0 34.4 5.2 48.2 4.0 2,924 Cordillera Admin Region 35.4 77.4 51.2 24.3 12.7 29.8 12.6 252 I - Ilocos Region 16.7 85.5 57.4 13.2 8.9 23.1 8.4 691 II - Cagayan Valley 22.4 76.4 55.1 15.9 12.7 23.1 12.6 550 III - Central Luzon 27.0 92.3 55.2 21.5 4.6 34.9 4.1 1,720 IVA - CALABARZON 22.4 88.5 44.0 17.1 8.1 37.1 6.9 2,293 IVB - MIMAROPA 9.2 63.6 34.8 4.7 23.7 12.2 22.8 372 V - Bicol 15.9 77.6 48.1 11.2 13.4 17.2 13.0 798 VI - Western Visayas 22.8 80.1 61.8 15.6 8.9 22.9 8.7 996 VII - Central Visayas 43.4 80.7 64.3 30.1 9.4 34.4 8.1 1,030 VIII - Eastern Visayas 14.9 84.5 43.9 9.8 12.3 18.4 11.5 571 IX - Zamboanga Peninsula 13.5 69.1 42.7 8.6 21.3 17.4 20.7 725 X - Northern Mindanao 20.7 74.3 51.4 13.9 17.5 23.0 16.2 697 XI - Davao 21.2 71.9 50.9 11.4 15.1 23.9 14.7 893 XII - SOCCSKSARGEN 26.4 74.8 58.2 21.2 16.2 18.6 15.5 744 XIII - Caraga 24.1 82.1 59.9 18.3 12.2 23.1 12.1 435 ARMM 11.9 28.6 24.0 5.8 59.0 6.0 58.5 465 Education No education 3.3 27.2 26.7 1.5 58.7 2.5 58.2 188 Elementary 11.0 63.5 43.9 7.6 24.7 4.0 24.5 2,593 High school 23.0 81.7 52.6 16.3 10.6 21.4 10.0 7,916 College 41.7 89.3 57.9 30.6 5.4 55.9 4.1 5,458 Wealth quintile Lowest 10.9 45.1 41.8 6.5 37.0 3.4 36.8 2,620 Second 17.3 77.7 48.7 11.5 13.3 11.5 12.9 2,886 Middle 23.9 87.6 52.8 16.8 6.7 22.1 5.9 3,199 Fourth 31.9 90.7 56.1 23.6 4.7 37.7 3.6 3,572 Highest 44.0 92.1 59.8 33.0 4.0 61.5 2.9 3,878 Total 27.2 80.7 52.7 19.6 11.7 30.1 10.9 16,155 3.5 EMPLOYMENT Measuring employment status is difficult in part because some work, especially work in family farms or business or in the informal sector, may not be perceived as employment. To avoid underestimating respondents’ employment, women were asked several questions to determine if they were employed or not. They were asked whether, aside from household work, they were working in the seven days before the survey and if not, whether they done any work in the 12 months preceding the survey. They were also asked about their occupation, whether they worked in a family farm or business or for someone else or if they were self- employed. Continuity of employment was also ascertained by asking if their work continued throughout the year, was seasonal or occasional. Employed women were also asked whether they were paid in cash or in kind or not paid at all. Table 3.5 shows the percent distribution of women by employment status according to selected background characteristics. More than half of women (57 percent) reported that they had been employed in the Characteristics of Respondents • 25 past 12 months, with just under half being currently employed. The proportion currently employed increases with age, from 20 percent among women aged 15-19 to 69 percent among women aged 45-49. Table 3.5 Employment status Percent distribution of women age 15-49 by employment status, according to background characteristics, Philippines 2013 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 20.2 8.1 71.6 100.0 3,237 20-24 42.9 13.4 43.7 100.0 2,789 25-29 48.5 10.1 41.4 100.0 2,156 30-34 54.5 9.7 35.7 100.0 2,250 35-39 60.9 7.1 32.0 100.0 1,976 40-44 63.6 7.7 28.7 100.0 1,924 45-49 68.7 6.1 25.2 100.0 1,823 Marital status Never married 40.2 8.2 51.6 100.0 5,615 Married or living together 51.3 9.6 39.0 100.0 9,729 Divorced/separated 66.4 10.8 22.9 100.0 588 Widowed 71.7 6.4 21.9 100.0 223 Number of living children 0 40.6 9.4 50.0 100.0 6,144 1-2 49.1 9.4 41.4 100.0 5,123 3-4 56.2 8.7 35.1 100.0 3,135 5+ 58.6 8.2 33.2 100.0 1,753 Residence Urban 50.2 8.5 41.4 100.0 8,585 Rural 46.2 9.9 43.9 100.0 7,570 Region National Capital Region 49.5 6.7 43.8 100.0 2,924 Cordillera Admin Region 55.2 14.0 30.8 100.0 252 I - Ilocos Region 43.4 11.1 45.4 100.0 691 II - Cagayan Valley 54.6 12.8 32.6 100.0 550 III - Central Luzon 42.2 11.1 46.6 100.0 1,720 IVA - CALABARZON 46.9 6.5 46.6 100.0 2,293 IVB - MIMAROPA 47.4 12.5 40.1 100.0 372 V - Bicol 50.5 10.3 39.1 100.0 798 VI - Western Visayas 47.2 11.9 40.8 100.0 996 VII - Central Visayas 56.0 9.5 34.5 100.0 1,030 VIII - Eastern Visayas 53.9 6.1 40.0 100.0 571 IX - Zamboanga Peninsula 36.7 9.2 54.1 100.0 725 X - Northern Mindanao 57.7 14.0 28.3 100.0 697 XI - Davao 50.0 11.8 38.2 100.0 893 XII - SOCCSKSARGEN 56.9 9.3 33.8 100.0 744 XIII - Caraga 46.6 5.0 48.4 100.0 435 ARMM 29.9 3.1 67.0 100.0 465 Education No education 55.6 7.8 36.6 100.0 188 Elementary 49.7 10.3 40.0 100.0 2,593 High school 41.3 9.6 49.1 100.0 7,916 College 57.6 7.9 34.5 100.0 5,458 Wealth quintile Lowest 41.9 11.2 46.8 100.0 2,620 Second 41.6 11.8 46.6 100.0 2,886 Middle 44.9 10.6 44.5 100.0 3,199 Fourth 50.5 7.9 41.6 100.0 3,572 Highest 58.4 5.7 35.9 100.0 3,878 Total 48.3 9.1 42.6 100.0 16,155 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 any other such reason. 26 • Characteristics of Respondents Half of the women who are married or living with a man are currently employed (51 percent). Ten percent were not working although they had been employed in 12 months prior to survey, while the remaining 39 percent said that they had not employed in the previous 12 months. Women who were divorced/separated or widowed are more likely to be employed than currently married women. The more children women have, the more likely they are to be currently employed. Urban women are more likely than rural women to be currently employed (50 percent compared with 46 percent). Small variations are found across regions except for ARMM, where the proportion of women who were not employed at all in the 12 months before the survey is double the proportion currently employed (67 percent compared to 30 percent). Table 3.5 shows that women with some college education and those with no education are more likely to be employed than women with some elementary and high school education. For example, 58 percent of women with at least some college education are currently employed, compared to 41 percent of those with some high school education. The proportion of women with elementary education who are currently employed is less than for women with no education at all, 50 percent and 57 percent, respectively. The proportion of women who are currently employed increases with their socio economic status. For example, 58 percent of women in the highest quintile are currently employed, compared to only 42 percent of women in the lowest quintile. 3.6 OCCUPATION Women who had worked in the 12 months before the survey were asked about their occupations. As shown in Table 3.6, over one-quarter of employed women work in professional, technical, or managerial positions and almost one-fifth work in sales and services. Roughly one in ten working women are employed in each of the following sectors: domestic service, agriculture, unskilled manual jobs, and clerical positions; only 6 percent of women are employed in skilled manual jobs. Younger women are more likely to work in sales and service occupations than older women. About two out of five women in the 15-19 age group and 27 percent of those in the 20-24 age group are engaged in sales and services. Older women tend to have professional/technical/managerial occupations. About 3 out of 10 employed women in age groups 30-34, 35-39, 40-44 and 45-49 have professional, technical or managerial occupations. As expected, a larger proportion of rural women than urban women are engaged in agriculture, while there is a higher proportion of urban women than rural women engaged in clerical jobs. The proportion of women employed in agricultural occupations decreases substantially with increasing education, from 63 percent among employed women with no education to 2 percent among women with higher education. The inverse is true for women who work in professional, technical, or managerial occupations; 48 percent of those with higher education work in such jobs, compared with 8 percent of women with no education. There is a similar pattern for socio-economic status of women. Almost half (47 percent) of employed women in the lowest wealth quintile are engaged in agricultural occupations, compared with less than 1 percent of those in the highest wealth quintile. Women in the higher wealth quintiles are more likely to work in professional, technical, or managerial jobs than those in the lower quintiles. Characteristics of Respondents • 27 Table 3.6 Occupation Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Philippines 2013 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Other/ Missing Total Number of women Age 15-19 6.3 5.9 37.0 5.1 8.9 24.2 12.4 0.1 100.0 918 20-24 23.1 16.8 26.6 4.9 7.7 14.4 6.3 0.2 100.0 1,570 25-29 28.9 14.6 19.3 6.3 10.3 10.6 9.9 0.1 100.0 1,264 30-34 32.9 10.6 14.1 6.3 11.8 10.8 13.1 0.5 100.0 1,446 35-39 32.9 8.1 11.8 4.2 14.5 14.0 14.3 0.3 100.0 1,344 40-44 31.8 6.1 10.9 6.7 14.1 12.5 17.6 0.2 100.0 1,373 45-49 31.9 6.3 12.2 4.7 14.1 12.9 17.6 0.4 100.0 1,364 Marital status Never married 23.2 15.5 25.8 5.2 6.6 17.6 6.1 0.1 100.0 2,720 Married or living together 30.2 7.7 14.5 5.5 13.9 11.3 16.6 0.3 100.0 5,930 Divorced/separated 24.1 10.6 22.1 6.1 10.7 20.8 5.7 0.0 100.0 453 Widowed 27.4 4.6 11.1 4.8 18.6 19.3 13.6 0.7 100.0 174 Number of living children 0 24.9 14.7 25.1 5.0 6.9 16.7 6.6 0.1 100.0 3,072 1-2 32.9 11.5 18.0 5.3 11.4 10.5 10.1 0.3 100.0 2,999 3-4 30.8 5.3 13.2 6.4 16.2 12.3 15.7 0.2 100.0 2,035 5+ 17.1 2.6 8.5 5.3 17.3 16.8 31.7 0.7 100.0 1,171 Residence Urban 30.1 13.3 19.7 6.0 11.8 15.2 3.6 0.3 100.0 5,032 Rural 25.0 6.2 16.2 4.8 11.5 12.0 24.0 0.2 100.0 4,246 Region National Capital Region 29.1 18.8 18.4 4.4 11.8 17.0 0.1 0.4 100.0 1,644 Cordillera Admin Region 27.0 9.7 11.6 3.2 8.2 7.5 32.7 0.2 100.0 174 I - Ilocos Region 22.3 7.4 21.3 2.0 18.8 16.6 11.5 0.0 100.0 377 II - Cagayan Valley 19.0 5.4 19.3 1.9 10.7 10.1 33.6 0.0 100.0 371 III - Central Luzon 28.8 10.7 20.7 9.6 10.6 10.0 8.9 0.7 100.0 918 IVA - CALABARZON 34.0 9.0 19.3 12.6 10.6 12.8 1.6 0.1 100.0 1,225 IVB - MIMAROPA 22.4 7.5 12.8 5.5 15.9 13.4 22.5 0.0 100.0 223 V - Bicol 27.9 7.1 18.4 8.9 11.4 12.0 14.4 0.0 100.0 485 VI - Western Visayas 29.8 8.0 18.0 2.0 6.6 18.4 17.1 0.2 100.0 589 VII - Central Visayas 25.2 9.9 14.8 7.0 13.7 16.1 13.2 0.0 100.0 675 VIII - Eastern Visayas 36.4 6.0 14.4 2.8 13.5 12.7 14.0 0.3 100.0 343 IX - Zamboanga Peninsula 27.3 4.2 18.9 1.2 17.7 12.8 17.8 0.2 100.0 333 X - Northern Mindanao 19.6 9.4 16.8 3.0 11.2 12.2 27.6 0.2 100.0 500 XI - Davao 24.9 8.5 21.4 1.1 11.4 14.6 18.2 0.0 100.0 552 XII - SOCCSKSARGEN 22.8 7.2 18.0 2.4 12.4 13.8 22.7 0.6 100.0 492 XIII - Caraga 32.6 9.2 15.7 4.3 9.7 10.9 17.3 0.2 100.0 224 ARMM 32.0 1.5 10.9 1.3 5.6 5.0 43.1 0.6 100.0 153 Education No education 7.6 0.0 2.6 5.5 8.9 12.1 63.4 0.0 100.0 119 Elementary 11.1 1.1 10.2 5.8 13.0 23.8 34.5 0.4 100.0 1,555 High school 16.9 4.3 23.6 7.3 16.1 18.9 12.6 0.2 100.0 4,028 College 47.9 20.8 15.8 3.2 6.2 3.6 2.2 0.2 100.0 3,575 Wealth quintile Lowest 9.5 1.4 9.7 4.4 11.2 16.6 46.8 0.3 100.0 1,392 Second 15.2 4.9 20.4 5.1 16.0 18.1 20.0 0.4 100.0 1,538 Middle 23.2 8.6 23.2 7.3 16.7 11.7 9.1 0.1 100.0 1,775 Fourth 32.9 13.2 23.0 8.2 12.4 7.1 3.0 0.2 100.0 2,086 Highest 44.8 16.6 13.6 2.6 5.0 16.4 0.6 0.3 100.0 2,486 Total 27.8 10.1 18.1 5.5 11.7 13.7 12.9 0.2 100.0 9,278 The proportion of women employed in sales and services has decreased substantially from 30 percent (2008 NDHS) to 18 percent (2013 NDHS) as shown in Figure 3.1. An increase was observed for women with the following occupations: professional/technical/managerial (from 24 to 28 percent) and unskilled manual (from 4 to 12 percent). 28 • Characteristics of Respondents Figure 3.1 Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, Philippines 2008 and 2013 3.7 TYPE OF EMPLOYMENT Table 3.7 shows the percent distribution of women who were employed during the 12 months preceding the survey by the type of earnings received, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural). Overall, 84 percent of women receive their earnings in cash only, while 6 percent are paid in cash and in kind and 10 percent work with no payment. The type of earnings differs substantially by type of employment. Almost one-third of women who work in agriculture (31 percent) receive no payment, while 88 percent of women engaged in non-agricultural work receive payment in cash only. Table 3.7 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 2013 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 52.9 88.4 83.8 Cash and in-kind 13.0 4.6 5.7 In-kind only 3.6 0.4 0.8 Not paid 30.5 6.6 9.7 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Type of employer Employed by family member 38.6 12.0 15.4 Employed by nonfamily member 46.6 67.7 64.9 Self-employed 14.7 20.2 19.5 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Continuity of employment All year 43.5 70.5 67.0 Seasonal 49.4 23.5 26.8 Occasional 7.0 5.9 6.1 Missing 0.0 0.1 0.1 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 1,200 8,056 9,278 Note: Total includes 22 women with missing information on type of employment who are not shown separately. 24 7 30 7 4 14 14 28 10 18 6 12 14 13 0 5 10 15 20 25 30 35 Professional/  technical/  managerial Clerical Sales and  services Skilled  manual Unskilled  manual Domestic  service Agriculture 2008 NDHS 2013 NDHS Characteristics of Respondents • 29 Almost two-thirds (65 percent) of women are employed by a non-family member, while 15 percent are employed by a relative and 20 percent are self-employed. Employment by a family member is much more common for those in agricultural work (39 percent) than those engaged in non-agricultural work (12 percent). The majority of women working in non-agricultural work (68 percent) are employed by a non-family member. A large majority of working women are employed all year (67 percent). Almost half of women doing agricultural work seasonally (49 percent), while most of those in non-agricultural work are employed throughout the year (71 percent). 3.8 HEALTH INSURANCE COVERAGE Access to health can improve when individuals are covered by health insurance and one of the objectives of the Universal Health Program of the Philippines is to provide Filipinos with 100 percent coverage with health insurance. Table 3.8 shows that only three out of five women aged 15-49 are covered by health insurance, mostly by a government institution. Only two percent are covered by private insurance. Table 3.8 Health insurance coverage Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Philippines 2013 Background characteristic PhilHealth paying member PhilHealth dependent of paying member PhilHealth indigent member PhilHealth dependent of indigent member GSIS SSS Private insurance company Other None Missing Number of women Age 15-19 1.8 28.1 0.7 23.8 0.0 1.8 0.4 0.3 44.8 0.1 3,237 20-24 20.2 11.7 2.6 7.6 0.9 18.0 1.7 0.2 55.2 0.1 2,789 25-29 26.4 13.2 6.3 11.0 1.8 23.2 2.7 0.2 39.5 0.0 2,156 30-34 26.2 20.2 7.3 14.2 3.2 22.4 2.4 0.4 29.5 0.0 2,250 35-39 21.5 21.1 9.1 17.9 3.7 18.2 2.5 0.5 26.8 0.1 1,976 40-44 20.6 18.8 9.6 19.3 3.3 18.4 2.3 0.5 28.9 0.0 1,924 45-49 21.0 18.3 10.3 16.4 4.2 18.0 3.2 0.4 29.8 0.0 1,823 Residence Urban 24.4 23.7 3.3 6.0 1.8 23.5 2.8 0.2 39.1 0.1 8,585 Rural 11.8 13.9 8.7 27.1 2.5 7.8 1.2 0.6 36.8 0.1 7,570 Region National Capital Region 28.7 22.9 1.2 1.2 1.2 30.8 3.3 0.2 41.5 0.0 2,924 Cordillera Admin Region 20.7 19.3 4.0 17.7 4.3 12.3 1.2 0.0 35.4 0.0 252 I - Ilocos Region 12.5 20.1 6.0 20.2 2.5 9.5 0.6 0.0 40.7 0.0 691 II - Cagayan Valley 11.8 17.8 5.0 24.8 1.9 4.4 1.3 5.0 36.1 0.0 550 III - Central Luzon 19.9 23.7 2.3 11.6 2.8 19.3 2.4 0.0 37.6 0.2 1,720 IVA - CALABARZON 24.5 25.8 2.9 6.7 1.6 19.4 3.1 0.6 37.8 0.0 2,293 IVB - MIMAROPA 8.7 8.5 5.0 36.5 2.4 4.7 1.2 0.2 40.0 0.0 372 V - Bicol 12.1 10.6 13.2 31.4 3.3 15.0 0.6 0.4 29.9 0.0 798 VI - Western Visayas 13.1 18.9 7.5 28.6 3.3 11.3 2.3 0.1 29.4 0.0 996 VII - Central Visayas 16.3 18.5 3.7 12.8 2.0 12.4 1.7 0.1 46.6 0.2 1,030 VIII - Eastern Visayas 11.7 10.5 13.3 32.2 5.0 8.3 0.2 0.2 31.5 0.0 571 IX - Zamboanga Peninsula 9.0 10.9 15.8 24.1 2.1 5.6 0.9 0.0 39.6 0.0 725 X - Northern Mindanao 13.7 10.8 18.1 27.9 2.0 11.0 2.2 0.0 28.3 0.0 697 XI - Davao 20.8 22.6 4.7 14.9 2.0 17.5 1.3 0.2 34.7 0.0 893 XII - SOCCSKSARGEN 16.4 15.8 7.2 19.7 1.5 11.1 1.7 0.0 39.5 0.0 744 XIII - Caraga 15.5 17.1 7.7 24.2 2.6 6.1 0.6 0.0 34.5 0.1 435 ARMM 1.8 6.8 9.9 24.5 0.5 0.2 0.4 0.2 56.3 0.4 465 Education No education 1.5 1.5 10.4 28.9 0.0 1.7 0.5 0.0 56.2 0.6 188 Elementary 3.3 9.7 12.3 28.6 0.0 3.0 0.2 0.4 44.9 0.1 2,593 High school 9.6 19.9 5.7 18.4 0.1 9.9 0.8 0.3 43.6 0.1 7,916 College 39.1 23.1 2.9 5.6 6.3 32.0 4.7 0.3 26.0 0.0 5,458 Wealth quintile Lowest 1.6 5.1 13.1 40.9 0.0 1.0 0.1 0.2 39.1 0.1 2,620 Second 6.1 10.7 9.5 28.4 0.4 5.3 0.5 0.4 44.0 0.0 2,886 Middle 12.7 18.9 5.5 13.0 0.8 11.4 0.8 0.5 46.7 0.1 3,199 Fourth 25.1 26.3 2.5 5.2 2.9 22.6 1.7 0.4 36.6 0.1 3,572 Highest 37.7 28.4 1.7 1.8 5.4 32.3 5.7 0.2 26.9 0.0 3,878 Total 18.5 19.1 5.9 15.9 2.2 16.1 2.0 0.3 38.0 0.1 16,155 GSIS = Government Service Insurance System; SSS = Social Security System Note: Results refer to women interviewed with the Woman’s Questionnaire, although data are taken from answers to the Household Questionnaire; thus, answers may not be given by the woman herself but rather by the respondent to the Household Questionnaire. Numbers do not sum to 100.0 percent because women may report more than one type of insurance. 30 • Characteristics of Respondents Women aged 15-19 and 20-24 are more likely than older women to have no health insurance. As expected, the youngest women are more likely than older women to be covered as dependents of health insurance members. Health insurance coverage is slightly higher among rural than urban women, mostly because of higher coverage as dependents of indigent members. Among regions, Northern Mindanao, Western Visayas, and Bicol, (70 percent each) have the highest coverage of health insurance, while ARMM (44 percent) has the lowest coverage. Surprisingly, NCR has the third highest proportion of women with no health insurance coverage (42 percent), after ARMM (56 percent) and Central Visayas (47 percent). The proportion of women with no health insurance declines steadily as education level increases. Women who have attended college are mostly covered by being a paying member of PhilHealth (39 percent) or SSS (32 percent), while women with no education or only some elementary education are more likely than those with more education to be covered as dependents of an indigent member (29 percent each). Similar patterns are found in terms of socio-economic status of a woman, with women in the highest quintile mostly covered by being paying PhilHealth members (38 percent) and those in the lowest quintile most likely to be covered as dependents of an indigent member (41 percent). Interestingly, the proportion of women who are not covered by any health insurance fluctuates by wealth quintile; although it is lowest among those in the highest quintile, it is highest for those in the middle quintile. There has been a sharp decline in the proportion of women not covered by any health insurance, from 57 percent in 2008 to 38 percent in 2013. Coverage as a dependent of an indigent member of PhilHealth shows the largest increase (from 6 percent to 16 percent of women), but there have also been increases in coverage as a paying member of PhilHealth (from 14 to 19 percent) and as an indigent member in PhilHealth (from 2 to 6 percent), as well as in other types of insurance. 3.9 USE OF TOBACCO Smoking is a risk factor for cardiovascular disease, lung cancer, and other forms of cancer, and it contributes to the severity of pneumonia, emphysema, and chronic bronchitis symptoms. The use of tobacco in the household adversely affects the health status of all household members. Secondhand smoke may adversely affect the health of children and aggravate childhood illnesses. In the 2013 NDHS, women were asked about their use of tobacco. As shown in Table 3.9, only 6 percent of women aged 15-49 are using tobacco, mostly cigarettes. Use of tobacco gradually increases with age. For example, women aged 45-49 are more likely to smoke cigarettes (9 percent) than women aged 15-19 (2 percent). Two percent of pregnant women and 4 percent of breastfeeding women smoke cigarettes. Women with no education are more likely to use tobacco than women with some education. Other differences in tobacco use are minimal. Characteristics of Respondents • 31 Table 3.9 Use of tobacco Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Philippines 2013 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Pipe Other tobacco Age 15-19 2.2 0.0 0.3 97.7 3,237 20-24 6.0 0.1 1.4 93.8 2,789 25-29 6.0 0.0 1.3 93.8 2,156 30-34 6.0 0.1 1.1 93.8 2,250 35-39 5.9 0.0 1.9 93.2 1,976 40-44 6.4 0.1 2.2 92.6 1,924 45-49 9.2 0.1 3.2 89.6 1,823 Maternity status Pregnant 2.3 0.0 0.9 97.3 686 Breastfeeding (not pregnant) 4.4 0.0 1.7 94.6 1,948 Neither 6.0 0.1 1.5 93.6 13,522 Residence Urban 6.7 0.1 1.4 93.1 8,585 Rural 4.4 0.0 1.6 94.7 7,570 Region National Capital Region 8.2 0.2 2.0 91.8 2,924 Cordillera Admin Region 4.6 0.0 1.9 94.2 252 I - Ilocos Region 4.5 0.0 0.6 95.2 691 II - Cagayan Valley 5.0 0.0 0.9 94.3 550 III - Central Luzon 6.2 0.1 1.3 93.8 1,720 IVA - CALABARZON 6.7 0.0 1.0 93.2 2,293 IVB - MIMAROPA 4.7 0.0 5.5 91.7 372 V - Bicol 4.7 0.0 1.0 94.5 798 VI - Western Visayas 4.3 0.0 1.8 94.2 996 VII - Central Visayas 4.2 0.1 1.7 95.3 1,030 VIII - Eastern Visayas 4.2 0.0 2.5 94.6 571 IX - Zamboanga Peninsula 4.2 0.0 0.6 95.4 725 X - Northern Mindanao 4.0 0.0 0.7 95.9 697 XI - Davao 6.7 0.1 1.0 93.1 893 XII - SOCCSKSARGEN 2.9 0.0 2.1 95.4 744 XIII - Caraga 3.0 0.0 0.6 96.6 435 ARMM 4.9 0.0 1.2 94.9 465 Education No education 11.9 0.0 14.8 77.1 188 Elementary 8.1 0.0 3.2 90.3 2,593 High school 5.4 0.0 1.1 94.4 7,916 College 4.5 0.1 0.8 95.4 5,458 Wealth quintile Lowest 6.1 0.0 3.6 91.5 2,620 Second 5.5 0.0 1.3 94.2 2,886 Middle 6.3 0.0 0.9 93.5 3,199 Fourth 5.3 0.1 1.2 94.7 3,572 Highest 5.2 0.1 0.9 94.7 3,878 Total 5.6 0.1 1.5 93.9 16,155 32 • Characteristics of Respondents Marriage and Exposure to the Risk of Pregnancy • 33 MARRIAGE AND EXPOSURE TO THE RISK OF PREGNANCY 4 his chapter presents findings related to some key factors that affect a woman’s risk of becoming pregnant such as marriage and sexual activity. Marriage signals the regular exposure of women to the risk of becoming pregnant. It has been known that in societies where age at first marriage is low, childbearing also starts early which results in higher fertility. Specifically, this chapter explores age at first marriage, age at first sexual intercourse and recent sexual activity among Filipino women. 4.1 CURRENT MARITAL STATUS Table 4.1 shows the distribution of women in childbearing ages according to their marital status and age. As shown in the table, 35 percent have never been married, 60 percent are currently in a union, either formally married or living together but not formally married, and the remaining 5 percent have been in a union previously but their union was dissolved either through separation, divorce or death of the spouse. Table 4.1 Current marital status Percent distribution of women age 15-49 by current marital status, according to age, Philippines 2013 Marital status Total Percentage of respondents currently in union Number of respondentsAge Never married Married Living together Divorced Separated Widowed 15-19 89.6 2.1 7.6 0.0 0.7 0.0 100.0 9.7 3,237 20-24 53.9 19.8 23.0 0.0 3.0 0.2 100.0 42.9 2,789 25-29 26.1 45.0 23.8 0.0 4.7 0.3 100.0 68.8 2,156 30-34 11.7 67.5 15.3 0.1 4.6 1.0 100.0 82.7 2,250 35-39 6.8 74.8 12.5 0.0 4.2 1.6 100.0 87.3 1,976 40-44 7.1 75.5 9.6 0.1 4.6 3.1 100.0 85.1 1,924 45-49 6.3 74.1 8.8 0.1 5.5 5.3 100.0 82.9 1,823 Total 15-49 34.8 45.8 14.5 0.0 3.6 1.4 100.0 60.2 16,155 T Key Findings • Sixty percent of women ages 15 to 49 years are currently in a union, and one-quarter of these women are in a consensual union. • The percentage of women in consensual unions is highest among women in their 20s. • The median age at first marriage among women age 25-49 is 22.3 years. Women in rural areas, those with less education and those who belong to the lower wealth quintiles marry earlier than their counterpart. • The median age at menarche among Filipino women is 13.1 years. • The median age at first sexual intercourse among women ages 25-49 is 21.5 years. Women in rural areas, those with less education and those in the lower wealth quintiles have lower median ages at first sexual intercourse than urban residents, better educated women and those belonging to households in higher wealth quintiles. • Forty-six percent of women had sexual intercourse in the four weeks prior to the survey. 34 • Marriage and Exposure to the Risk of Pregnancy The percentage of women who are in a marital union increases with age and consequently, the percentage who have never married decreases. Particularly noteworthy is the percentage of young women (less than 30 years old) who are in consensual unions (living together with a partner but not formally married). The percentage of young women less than 25 years old who reported to be cohabiting with a partner is higher than the percentage to who are formally married. A third of women in their late 20s and who are in a marital union are in a live-in arrangement. The percentage of women living in informal unions has increased since 2008 at every age group. Overall, the proportion of women in informal union has increased from 11 percent in 2008 to 15 percent in 2013 (NSO and ICF Macro, 2009). 4.2 AGE AT FIRST MARRIAGE Most births in the Philippines still occur within marriage and this continues to underscore the importance of examining age at first marriage. On average, women who marry early are more likely to have their first child at a young age and give birth to more children, thus contributing to higher fertility. In this section, marriage refers to both formal and consensual marriage, unless otherwise noted. Table 4.2 shows the percentage of women who are married by selected ages and the median ages at first marriage, according to their age at the time of the survey. Age at first marriage is defined as the age at which the woman began living with her first spouse or partner. Among women ages 25-49, 15 percent were married by age 18 and this percentage more than doubles by age 20. By age 22, 48 percent of women were married, increasing further to 66 percent by age 25. Similar patterns are found in the other age groups. Overall, the median age at first marriage among women ages 25-49 is 22.3 years and this is not very different across age groups. Table 4.2 Age at first marriage Percentage of women age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Philippines 2013 Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage Current age 15 18 20 22 25 15-19 1.5 na na na na 89.6 3,237 a 20-24 2.0 15.0 30.8 na na 53.9 2,789 a 25-29 2.8 14.2 32.8 49.4 66.8 26.1 2,156 22.1 30-34 2.1 13.5 29.5 46.4 65.5 11.7 2,250 22.5 35-39 2.8 14.5 29.6 46.5 65.8 6.8 1,976 22.4 40-44 2.5 16.7 32.6 48.3 66.6 7.1 1,924 22.2 45-49 2.8 17.1 32.2 47.8 67.0 6.3 1,823 22.3 20-49 2.4 15.1 31.2 na na 21.0 12,918 a 25-49 2.6 15.1 31.3 47.7 66.3 12.0 10,129 22.3 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner na = Not applicable due to censoring a = Omitted because less than 50 percent of the women began living with their spouse or partner for the first time before reaching the beginning of the age group The median age at first marriage is further examined by the women’s background characteristics and shown in Table 4.3. Because very few women are married before age 25, the table is limited to women ages 25-49. In general, women from urban areas, those who are better educated and wealthier marry later than their counterparts. Urban women marry about two years later than women in rural areas (23.1 years versus 21.5 years). This is also reflected in the regional data in Table 4.3 where women in the National Capital Region, the only region that is 100 percent urban, register the highest median age at first marriage (23.7). Other regions with high median ages at marriage include CALABARZON (23.0 years), Ilocos (22.8 years) Marriage and Exposure to the Risk of Pregnancy • 35 and Central Visayas (22.7 years). In contrast, women in ARMM, MIMAROPA and SOCCSKSARGEN marry earlier than women in other regions. Table 4.3 Median age at first marriage by background characteristics Median age at first marriage among women age 25-49, according to background characteristics, Philippines 2013 Age Ages 25-49 Background characteristic 25-29 30-34 35-39 40-44 45-49 Residence Urban 23.3 23.3 22.9 22.8 23.2 23.1 Rural 21.1 21.6 22.0 21.7 21.4 21.5 Region National Capital Region 23.8 23.7 23.8 23.3 23.8 23.7 Cordillera Admin Region 21.9 22.7 23.4 22.2 22.6 22.5 I - Ilocos Region 21.9 22.0 23.2 24.2 22.7 22.8 II - Cagayan Valley 20.7 21.7 21.5 20.0 21.2 21.0 III - Central Luzon 23.0 22.4 22.8 22.5 22.6 22.6 IVA - CALABARZON 23.3 23.7 22.5 22.7 22.7 23.0 IVB - MIMAROPA 19.8 21.7 20.1 20.4 20.1 20.5 V - Bicol 21.4 21.5 22.7 22.9 21.5 22.0 VI - Western Visayas 22.4 22.3 22.8 22.2 22.6 22.5 VII - Central Visayas 21.6 23.2 23.1 22.0 23.8 22.7 VIII - Eastern Visayas 21.1 21.1 21.8 22.3 21.8 21.6 IX - Zamboanga Peninsula 21.2 21.3 21.4 19.9 21.2 21.0 X - Northern Mindanao 21.7 22.5 20.7 22.9 20.9 21.6 XI - Davao 21.6 21.5 21.7 21.6 21.7 21.6 XII - SOCCSKSARGEN 20.9 20.8 20.8 20.4 20.4 20.7 XIII - Caraga 20.9 21.2 21.5 21.5 20.8 21.1 ARMM 19.7 19.4 20.8 20.5 20.3 20.0 Education No education * (19.2) (17.4) (17.7) 19.3 18.2 Elementary 19.0 19.3 19.6 19.9 20.1 19.6 High school 20.8 21.4 21.7 21.6 22.0 21.4 College a 25.2 25.5 25.9 25.4 a Wealth quintile Lowest 19.2 19.8 20.5 20.2 20.2 19.8 Second 20.5 20.9 21.6 20.7 21.2 20.9 Middle 22.1 22.1 22.2 21.6 21.4 21.9 Fourth 23.8 24.0 23.1 23.2 23.1 23.4 Highest a 25.4 24.9 25.0 24.6 a Total 22.1 22.5 22.4 22.2 22.3 22.3 Note: The age at first marriage is defined as the age at which the respondent began living with her first spouse/partner. Numbers in parentheses are based on 25-49 unweighted cases; an asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. a = Omitted because less than 50 percent of the respondents began living with their spouse/partners for the first time before reaching the beginning of the age group 4.3 AGE AT FIRST MENSTRUATION (MENARCHE) Menarche, or onset of menstruation, signals the start of puberty. In 2013, the mean age at menarche among women ages 15 to 49 years is 13.1 years (Table 4.4). A look at mean age of menarche across different age groups indicates a declining trend over time. Compared to the oldest group of women (ages 45-49) where mean age at menstruation is at 13.6 years, the youngest group (15-19) have a mean age at first menstruation of 12.8 years. Over one in ten women experienced her first menstruation before age 12, while more than half of women had menarche between ages 12 or 13and 18 percent began menstruating at age 15 or older. 36 • Marriage and Exposure to the Risk of Pregnancy Table 4.4 Age at first menstruation Percentage of women age 15-49 by age at first menstruation (menarche) and mean age at menarche, according to age, Philippines 2013 Age at menarche Total Number of women Mean age at menarche Current age ≤10 11 12 13 14 15+ Never menstruated Don’t know/ missing 15-19 3.3 11.4 29.2 28.3 18.0 9.3 0.5 0.0 100.0 3,237 12.8 20-24 3.4 9.5 27.0 26.9 17.8 15.3 0.0 0.0 100.0 2,789 13.0 25-29 3.2 9.7 28.1 26.2 16.6 16.1 0.0 0.1 100.0 2,156 13.0 30-34 3.6 9.2 26.1 25.2 16.5 19.4 0.0 0.0 100.0 2,250 13.1 35-39 2.5 7.6 23.6 25.6 19.5 21.1 0.2 0.0 100.0 1,976 13.3 40-44 3.0 8.0 22.8 22.0 19.1 25.1 0.0 0.0 100.0 1,924 13.4 45-49 2.2 7.0 21.0 21.6 19.5 28.6 0.0 0.1 100.0 1,823 13.6 Total 3.1 9.2 25.9 25.5 18.1 18.1 0.1 0.0 100.0 16,155 13.1 4.4 AGE AT FIRST SEXUAL INTERCOURSE Age at first sexual intercourse is another indicator of the beginning of a woman’s exposure to the risk of childbearing. In the survey, women were asked how old they were when they had their first sexual intercourse. Table 4.5 shows that the median age at first sexual intercourse of women ages 25-49 is 21.5 years. Compared with the median age at first marriage shown earlier (22.3 years), these two figures indicate that first sexual intercourse (on average) occurs before first marriage. Table 4.5 Age at first sexual intercourse Percentage of women age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Philippines 2013 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse Current age 15 18 20 22 25 15-19 2.2 na na na na 85.3 3,237 a 20-24 2.2 19.3 41.3 na na 41.9 2,789 a 25-29 2.2 17.8 40.2 58.7 75.6 18.1 2,156 21.0 30-34 1.9 17.0 35.4 53.8 71.9 8.6 2,250 21.5 35-39 2.6 16.8 36.1 52.2 69.6 4.7 1,976 21.7 40-44 2.6 18.3 37.3 53.0 71.2 5.4 1,924 21.5 45-49 3.0 18.3 36.9 52.0 71.3 5.1 1,823 21.7 20-49 2.4 18.0 38.1 na na 15.8 12,918 a 25-49 2.4 17.6 37.2 54.1 72.0 8.6 10,129 21.5 15-24 2.2 na na na na 65.2 6,026 a na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Table 4.5 also shows that among women ages 25-49, the percentage having their first sexual intercourse increases sharply from age 15 to age 18. In fact, the percentage who had their first sexual intercourse by age 20 is almost double that found at age 18. This pattern persists across all age groups. The median ages of women at first sexual intercourse by background characteristics are shown in Table 4.6. The patterns are almost similar to median age at marriage: women in urban areas, those with higher education and women from households that belong to the highest wealth quintile had their first sexual experience at later ages than their rural, less educated, and poorer counterparts. However, the differences are not as marked as those found in median age at first marriage. For example, median age at first sexual intercourse between urban and rural areas differs by one year, while the difference in age at first marriage between the two areas is 1.6 years. Among the regions, NCR, CAR, Ilocos, Central Luzon Marriage and Exposure to the Risk of Pregnancy • 37 and CALABARZON exhibited higher median ages at first sexual intercourse than the national figure. ARMM and SOCCSKSARGEN registered the earliest median ages at first sexual intercourse. Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 25-49, according to background characteristics, Philippines 2013 Age Ages 25-49 Background characteristic 25-29 30-34 35-39 40-44 45-49 Residence Urban 21.6 22.0 22.1 22.0 22.3 22.0 Rural 20.5 21.0 21.3 21.1 21.0 21.0 Region National Capital Region 21.9 22.0 22.7 22.5 23.0 22.4 Cordillera Admin Region 21.3 21.9 22.9 22.2 22.2 22.1 I - Ilocos Region 21.7 21.5 22.5 22.9 22.1 22.0 II - Cagayan Valley 20.3 20.8 21.0 19.8 19.9 20.4 III - Central Luzon 21.8 21.8 22.8 22.3 22.4 22.2 IVA - CALABARZON 22.0 22.9 21.9 21.8 22.2 22.2 IVB - MIMAROPA 19.5 21.3 20.0 21.4 19.6 20.5 V - Bicol 21.2 21.2 22.1 22.4 21.2 21.5 VI - Western Visayas 20.9 21.5 21.5 21.1 21.8 21.4 VII - Central Visayas 19.9 21.0 21.7 20.9 22.1 20.9 VIII - Eastern Visayas 20.3 20.6 20.4 22.1 21.5 20.7 IX - Zamboanga Peninsula 20.7 20.9 21.2 19.7 20.8 20.6 X - Northern Mindanao 20.6 21.7 19.9 21.7 20.9 20.9 XI - Davao 20.1 21.0 21.2 20.4 20.8 20.8 XII - SOCCSKSARGEN 20.3 20.6 20.2 19.9 19.5 20.1 XIII –Caraga 19.7 20.7 20.8 20.4 20.2 20.3 ARMM 19.7 19.3 20.6 20.3 20.3 20.1 Education No education * (18.7) (17.2) (17.8) 18.8 18.2 Elementary 18.6 19.0 19.3 19.1 19.5 19.2 High school 20.1 20.6 21.1 21.0 21.4 20.7 College 23.3 24.1 24.6 25.0 24.1 24.1 Wealth quintile Lowest 18.8 19.6 19.7 19.5 19.8 19.4 Second 20.1 20.3 21.1 20.1 20.4 20.3 Middle 20.9 21.2 21.4 20.7 20.8 21.0 Fourth 21.9 22.5 22.4 22.6 22.6 22.4 Highest 23.9 23.9 23.7 24.2 23.5 23.8 Total 21.0 21.5 21.7 21.5 21.7 21.5 Note: Numbers in parentheses are based on 25-49 unweighted cases; an asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 4.5 RECENT SEXUAL ACTIVITY In the absence of contraception, the chance of pregnancy is related to the regularity of sexual intercourse. The 2013 NDHS collected information regarding the respondents’ recent sexual activity to derive an indicator of the frequency of sexual intercourse. Each woman in the survey who had ever had sexual intercourse was asked how long ago she last had intercourse, her relationship to the person with whom she last had sexual intercourse, and how long she has had sexual relations with this person. Table 4.7 shows that in general, seven out of 10 women ages 15 to 49 reported ever having sexual intercourse, with a large percentage reporting having had sex within the four weeks (46 percent) before the survey. Sixteen percent of women had sex within the year before the survey but not during the four weeks immediately before the survey, and 9 percent had their last sexual intercourse a year or more before the survey. 38 • Marriage and Exposure to the Risk of Pregnancy The percentage of women who had recently been sexually active, increases with age peaking at 67 percent among those ages 35 to 39 but decreasing thereafter. Almost three-fourths of currently married women reported being sexually active within the four weeks prior to the survey. More than three-fourths of women who are divorced, separated or widowed reported it had been one year or more since they last had sexual intercourse. The proportion of women who were sexually active in the four weeks before the survey increases slightly with marital duration up to 10-14 years of marriage, after which it falls among those married longer. Table 4.7 also shows that sexual activity in the four weeks prior to the survey is higher among women in rural areas, women with less education and those belonging to the lower wealth quintiles than among their urban, better educated and wealthier counterparts. Recent sexual activity is also highest among women in Cagayan Valley, ARMM and Caraga. Table 4.7 Recent sexual activity Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Philippines 2013 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 7.9 4.9 1.8 0.1 85.3 100.0 3,237 20-24 35.7 14.7 7.6 0.0 41.9 100.0 2,789 25-29 54.7 17.7 9.2 0.2 18.1 100.0 2,156 30-34 64.0 17.5 9.6 0.3 8.6 100.0 2,250 35-39 67.3 17.1 10.6 0.3 4.7 100.0 1,976 40-44 62.3 20.3 11.8 0.2 5.4 100.0 1,924 45-49 52.7 24.1 17.8 0.3 5.1 100.0 1,823 Marital status Never married 2.7 4.7 7.0 0.1 85.6 100.0 5,615 Married or living together 73.8 21.7 4.4 0.2 0.0 100.0 9,729 Divorced/separated/widowed 4.7 17.5 77.4 0.4 0.0 100.0 811 Marital duration2 0-4 years 72.0 24.8 3.1 0.1 0.0 100.0 1,832 5-9 years 77.3 18.5 3.8 0.3 0.0 100.0 1,953 10-14 years 78.1 18.3 3.5 0.2 0.0 100.0 1,717 15-19 years 75.2 20.1 4.6 0.1 0.0 100.0 1,362 20-24 years 68.7 24.4 6.6 0.3 0.0 100.0 1,118 25+ years 63.0 28.7 8.0 0.4 0.0 100.0 923 Married more than once 76.6 20.2 3.1 0.1 0.0 100.0 825 Residence Urban 41.8 15.3 10.8 0.2 31.9 100.0 8,585 Rural 49.8 15.9 6.8 0.2 27.3 100.0 7,570 Region National Capital Region 39.4 13.9 12.2 0.0 34.5 100.0 2,924 Cordillera Admin Region 46.8 14.1 10.2 0.0 28.8 100.0 252 I - Ilocos Region 46.8 17.0 8.6 0.0 27.6 100.0 691 II - Cagayan Valley 54.1 15.5 5.5 0.0 24.9 100.0 550 III - Central Luzon 46.6 13.6 8.3 0.6 30.9 100.0 1,720 IVA - CALABARZON 40.9 17.4 10.7 0.1 30.9 100.0 2,293 IVB - MIMAROPA 49.7 18.4 4.7 0.0 27.2 100.0 372 V - Bicol 44.3 19.2 8.1 0.2 28.1 100.0 798 VI - Western Visayas 46.2 18.9 7.6 0.0 27.2 100.0 996 VII - Central Visayas 46.9 16.1 9.1 0.2 27.7 100.0 1,030 VIII - Eastern Visayas 52.3 14.2 7.3 0.2 26.0 100.0 571 IX - Zamboanga Peninsula 43.7 15.4 7.7 0.3 32.9 100.0 725 X - Northern Mindanao 50.7 13.0 8.7 0.9 26.6 100.0 697 XI - Davao 48.6 16.6 8.0 0.1 26.7 100.0 893 XII - SOCCSKSARGEN 49.8 15.4 6.9 0.1 27.8 100.0 744 XIII - Caraga 53.0 16.7 6.9 0.1 23.3 100.0 435 ARMM 53.5 8.5 4.4 0.4 33.2 100.0 465 Continued… Marriage and Exposure to the Risk of Pregnancy • 39 Table 4.7—Continued Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Education No education 57.7 18.7 11.1 0.4 12.0 100.0 188 Elementary 58.5 17.8 8.9 0.2 14.5 100.0 2,593 High school 44.9 14.7 7.8 0.2 32.4 100.0 7,916 College 40.0 15.6 10.5 0.2 33.7 100.0 5,458 Wealth quintile Lowest 57.7 16.1 5.0 0.3 20.9 100.0 2,620 Second 52.4 15.0 6.8 0.1 25.7 100.0 2,886 Middle 48.1 15.5 8.2 0.2 28.0 100.0 3,199 Fourth 43.5 15.4 9.4 0.2 31.5 100.0 3,572 Highest 32.1 15.7 13.4 0.2 38.7 100.0 3,878 Total 45.6 15.6 8.9 0.2 29.8 100.0 16,155 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 40 • Marriage and Exposure to the Risk of Pregnancy Fertility • 41 FERTILITY 5   ertility is one of the three principal components of population dynamics, the others being mortality and migration. Collection of data on fertility levels, trends and differentials has remained a prime objective of demographic and health surveys. In the Philippines, continued collection of such data is carried out through a pregnancy history approach in the demographic and health survey being conducted every five years. Pregnancy and fertility data were collected by asking women of reproductive age (15-49 years) to provide the complete history of all of their live births, stillbirths, miscarriages, and pregnancy terminations. In order to ensure a complete enumeration of live births, women’s responses to questions about the total number of children currently living with them, those living away, and those who had died were recorded. Moreover, information about the total number of lost pregnancies was recorded. Specifically, the following information was collected for each pregnancy loss: date of loss, duration of pregnancy, and whether the pregnancy ended in a miscarriage, a stillbirth, or pregnancy termination. In cases of live births, the following information was collected: name, sex, date of birth, survival status, current age (if alive), and age at death (if dead). The 2013 NDHS used the conventional practice of recording pregnancies in the pregnancy history starting from the first pregnancy. Although efforts were made during training to impress upon the interviewers the importance of collecting accurate and complete information on pregnancy histories, it is important to note that information collected through the pregnancy history approach has limitations that might bias pregnancy and fertility levels and patterns. For instance, women may include relatives’ children as their own or omit children who died at a young age, while older women may omit grown children who have left home (United Nations, 1983). Accordingly, the results should be viewed with these caveats in mind. 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. F Key Findings • The total fertility rate for the three years preceding the 2013 NDHS is 3.0 births per woman. • Fertility decreased by 3 births between 1970 and 2012 (from 6.0 to 3.0 births per woman). • Childbearing begins early with 22 percent of women age 25-49 giving birth by age 20 and 40 percent by age 22. • Ten percent of adolescent women age 15-19 are already mothers or pregnant with their first child. • Twenty-six percent of births occur within 24 months of a previous birth. • 42 • Fertility 5.1 CURRENT FERTILITY Several measures of current fertility are derived from the pregnancy history data. Age-specific fertility rates (ASFRs) refer to the average number of live births per 1,000 women in a certain age group.1They are a valuable measure to assess the current age pattern of childbearing. The total fertility rate (TFR) is defined as the total number of births a woman would have by the end of her childbearing period if she were to pass through those years bearing children at the currently observed ASFRs. The TFR is obtained by summing the ASFRs and multiplying by five. The general fertility rate (GFR) is expressed as the annual number of live births per 1,000 women age 15-44, and the crude birth rate (CBR) is expressed as the annual number of live births per 1,000 population. The various measures of current fertility are calculated for the three-year period preceding the survey. A three-year period was chosen because it reflects the current situation without unduly increasing sampling errors. Table 5.1 shows a TFR of 3.0 children per woman for the three-year period preceding the survey. The estimated TFR in the 2008 NDHS was 3.3 children, and thus the decrease in the TFR over the past five years is only 0.3 births per woman. Fertility is considerably higher in rural areas (3.5 births per woman) than in urban areas (2.6 births per woman), a pattern that is evident at every age group. The persistence of a disparity in fertility between urban and rural women is most probably due to factors associated with urbanization, such as better education, higher status of women, better access to health and family planning information and services, and later marriage. On the whole, fertility peaks at age 20-24, a pattern evident in rural areas as well as urban areas. Fertility falls sharply after age 35-39.The age pattern of fertility rates shows an inverted U-shape as shown in Figure 5.1. Table 5.2 highlights differences between the TFR and two other fertility measures—the percentage of women age 15-49who are currently pregnant and the mean number of children ever born to women age 40-49, by background 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 completed 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 2013 NDHS, the difference between the TFR (3.0 births per woman) and the number of children ever born to women age 40-49 (3.7) is 0.7 children, indicating a decline in fertility. Differentials between the two measures by level of education are largest for women with no education.                                                              1Numerators for age-specific fertility rates are calculated by summing the number of live births that occurred in the period 1-36 months preceding the survey (determined by the date of the interview and the date of birth of the child) and classifying them by the age of the mother (in five-year groups) at the time of birth of the child (determined by the mother’s date of birth and the date of birth of the child). The denominators for the rates are the number of woman-years lived in each specific five-year age group during the period 1 to 36 months preceding the survey. Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by residence, Philippines 2013 Residence Total Age group Urban Rural 15-19 52 63 57 20-24 128 174 148 25-29 127 172 147 30-34 110 147 127 35-39 75 94 84 40-44 30 45 37 45-49 4 10 7 TFR(15-49) 2.6 3.5 3.0 GFR 88 115 101 CBR 21.5 22.6 22.1 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 expressed per woman GFR: General fertility rate expressed per 1,000 women age 15-44 CBR: Crude birth rate, expressed per 1,000 population Fertility • 43 As mentioned above, women in rural areas have an average of almost one more child than women in urban areas (TFR 3.5 and 2.6 children per woman, respectively). The differences are also substantial across regions. The National Capital Region (NCR), the center of government, 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). Two regions have a TFR higher than 4.0 children per woman: ARMM (4.2 children per woman) and Bicol (4.1 children per woman).These regions also have the highest mean CEB. The mean CEB is 5.5 children per woman in ARMM and 4.6 children per woman in Bicol. The difference in fertility indicators between the NCR and these two cited regions is about two children, which may be interpreted as stemming from differences in levels of urbanization. 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 (2.8 and 2.7 births per woman, respectively). There is a negative relationship between fertility and education in the Philippines. The total fertility rate for women with at least some college or higher education (2.1 children per woman) is 0 50 100 150 200 15‐19 20‐24 25‐29 30‐34 35‐39 40‐44 45‐49 Bi rt hs  p er  1 ,0 00  w om en Figure 5.1 Age-specific fertility rates by urban-rural residence Urban Rural Total Table 5.2 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 2013 Background characteristic Total fertility rate (TFR) Percentage of women age 15-49 currently pregnant Mean number of children ever born (CEB) to women age 40-49 Residence Urban 2.6 3.8 3.3 Rural 3.5 4.8 4.2 Region National Capital Region 2.3 3.0 3.0 Cordillera Admin Region 2.9 4.8 4.0 I - Ilocos Region 2.8 4.5 3.2 II - Cagayan Valley 3.2 6.1 3.7 III - Central Luzon 2.8 4.1 3.3 IVA - CALABARZON 2.7 3.1 3.4 IVB - MIMAROPA 3.7 5.8 4.5 V - Bicol 4.1 4.0 4.6 VI - Western Visayas 3.8 4.2 4.2 VII - Central Visayas 3.2 3.9 3.6 VIII - Eastern Visayas 3.5 5.9 4.0 IX - Zamboanga Peninsula 3.5 6.4 4.5 X - Northern Mindanao 3.5 5.7 4.3 XI - Davao 2.9 5.0 3.9 XII - SOCCSKSARGEN 3.2 3.8 4.2 XIII - Caraga 3.6 6.6 4.4 ARMM 4.2 4.7 5.5 Education No education 3.8 3.4 6.1 Elementary 4.6 4.8 4.9 High school 3.3 4.6 3.7 College 2.1 3.5 2.6 Wealth quintile Lowest 5.2 6.8 5.6 Second 3.7 5.3 4.6 Middle 3.1 4.1 3.8 Fourth 2.4 3.6 3.0 Highest 1.7 2.4 2.5 Total 3.0 4.2 3.7 Note: Total fertility rates are for the period 1-36 months prior to interview. 44 • Fertility less than half that of women with elementary education (4.6 children) (Table 5.2). Similar differentials are seen by wealth status, with women in households in the higher wealth quintiles having fewer children than women in the lower wealth quintiles. Table 5.2 shows that 4 percent of respondents reported being pregnant at the time of the survey. This proportion varies from 3 percent in NCR to almost 7 percent in Caraga. 5.2 FERTILITY TRENDS In addition to comparisons of current and completed fertility, trends in fertility can be assessed in two other ways. First, fertility trends can be investigated using retrospective data from birth histories collected in the 2013 NDHS. Second, the TFR from the 2013 NDHS can be compared with estimates obtained in earlier surveys. Trends in fertility over time can be examined by comparing age-specific fertility rates from the 2013 NDHS for successive five-year periods preceding the survey, as presented in Table 5.3. The rates in older age groups become progressively more truncated for periods more distant from the survey date, because women age 50 and older were not interviewed in the survey. For example, rates cannot be calculated for women age 35-39 during the period of 15-19 years before the survey because these women would have been over age 50 at the time of the survey and therefore not eligible to be interviewed. Nonetheless, the results in Table 5.3 show that fertility has dropped among all age groups over the past two decades, with the largest declines occurring between 15-19 and 10-14 years before the survey, and between 5-9 and 0-4 years before the survey. Data in Table 5.3 indicate that fertility has been declining in all age groups. For example, the age- specific fertility rate for women age 25-29 declined from 214 births per 1,000 women in the 15-19 years preceding the survey to 181 births per 1,000 women in the 5-9 year period before the survey, a 15 percent decline. More recently, between the 5-9 year period and 0-4 year period prior to the survey a similar pace in fertility decline is observed. Another way to examine fertility trends is to compare the current TFR with estimates from previous DHS surveys. Table 5.4 and Figure 5.2 show fertility rates over a 40-year period. 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, 2008 and 2013 surveys. Over the four decades, the TFR declined by 3.0 births, from 6.0 children per woman in 1970 to 3.0 children in 2011. The pace of fertility decline varied over time. In the early 1970s, the TFR declined by almost one birth, from 6.0 children per woman in 1970 to 5.2 in 1975, a 2.7 percent reduction annually. The TFR remained almost constant during the succeeding five-year period. A noticeable decline similar to that in the early 1970’s occurred during the first half of the 1980s. Fertility reduction has slowed since then. The 2013 NDHS revealed that in the period 2007-2012, the TFR declined at 1.8 percent annually. The results in Table 5.4 indicate that all age groups have contributed to the decline in fertility rates. However, the decline has been more rapid among women age 35 years and over than among younger women. Age-specific fertility rates among women age 35 years and over fell 60 percent or more from 1970 to 2012, based on the 1973 NDS and the 2013 NDHS. In contrast, fertility rates among women age 25 to 34 years declined by about one-half, and among women age 20 to 24 years, by more than one-third (35 percent) during Table 5.3 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Philippines 2013 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 59 57 61 54 20-24 156 169 173 184 25-29 154 181 193 214 30-34 129 145 152 [173] 35-39 84 96 [118] - 40-44 37 [56] - - 45-49 [8] - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude births in the month of interview. Fertility • 45 this same period. In contrast, the fertility rate of the youngest age group 15-19 has remained somewhat constant. Table 5.4 Trends in fertility from various sources Age-specific and total fertility rates from various surveys, Philippines, 1970-2011 1973 1978 1983 1986 1993 1998 2003 2008 2013 NDS RPFS NDS CPS NDS NDHS NDHS NDHS NDHS Age (1970) (1975) (1980) (1984) (1991) (1996) (2002) (2007) (2012) 15-19 56 50 55 48 50 46 53 54 57 20-24 228 212 220 192 190 177 178 163 148 25-29 302 251 258 229 217 210 191 172 147 30-34 268 240 221 198 181 155 142 136 127 35-39 212 179 165 140 120 111 95 84 84 40-44 100 89 78 62 51 40 43 38 37 45-49 28 27 20 15 8 7 5 6 7 TFR 6.0 5.2 5.1 4.4 4.1 3.7 3.5 3.3 3.0 Note: Age-specific fertility rates are per 1,000 women. Rates for 1970 to 1980 are five-year averages and rates for 1984 to 2012 are three- year averages centered on the year in parentheses. 5.3 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 5.5 shows the distribution of women by number of children ever born and 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 7 percent do not have children. Table 5.5 shows that, on average, women have given birth to less than one child (0.65) by their early twenties, 3.1 children by their late thirties, and 4.0 children by 6.0 5.2 5.1 4.4 4.1 3.7 3.5 3.3 3.0 0 2 4 6 8 1973 NDS (1970) 1978 RPFS (1975) 1983 NDS (1980) 1986 CPS (1984) 1993 NDS (1991) 1998 NDHS (1996) 2003 NDHS (2001) 2008 NDHS (2007) 2013 NDHS (2012) Figure 5.2 Trends in the total fertility rate 46 • Fertility the end of their reproductive period. Table 5.5 also shows that, overall, the mean number of CEB is 1.9 children for all women and 2.9 for currently married women. Table 5.5 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Philippines 2013 Number of children ever born Number of women Mean number of children ever born Mean number of living children Age 0 1 2 3 4 5 6 7 8 9 10+ Total ALL WOMEN 15-19 92.3 6.8 0.8 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3,237 0.09 0.08 20-24 57.4 25.6 12.1 4.2 0.6 0.1 0.0 0.0 0.0 0.0 0.0 100.0 2,789 0.65 0.64 25-29 28.9 24.8 24.4 13.9 5.5 1.7 0.7 0.1 0.1 0.0 0.0 100.0 2,156 1.51 1.46 30-34 16.0 18.4 26.1 18.0 10.8 6.3 2.3 1.2 0.6 0.2 0.0 100.0 2,250 2.29 2.22 35-39 10.4 11.7 21.8 21.6 12.9 9.0 5.3 3.5 1.6 1.1 1.0 100.0 1,976 3.07 2.96 40-44 9.4 7.8 19.2 19.8 14.1 10.6 7.3 5.2 3.1 1.7 1.7 100.0 1,924 3.54 3.38 45-49 8.6 7.6 16.1 16.3 15.7 11.5 8.0 5.3 4.3 2.3 4.2 100.0 1,823 3.97 3.72 Total 37.8 14.9 15.9 12.0 7.4 4.8 2.8 1.8 1.2 0.6 0.8 100.0 16,155 1.90 1.82 CURRENTLY MARRIED WOMEN 15-19 36.1 55.1 7.8 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 313 0.74 0.72 20-24 16.5 46.7 25.9 9.4 1.2 0.3 0.0 0.0 0.0 0.0 0.0 100.0 1,196 1.33 1.29 25-29 7.4 29.2 32.8 19.4 7.6 2.3 1.0 0.2 0.1 0.0 0.0 100.0 1,484 2.03 1.96 30-34 6.4 18.8 29.6 20.6 12.4 7.2 2.7 1.3 0.6 0.2 0.0 100.0 1,862 2.59 2.51 35-39 4.6 11.2 23.2 23.6 13.9 9.5 5.9 3.9 1.9 1.3 1.1 100.0 1,725 3.32 3.21 40-44 3.6 7.2 20.1 21.0 15.7 11.8 7.6 5.7 3.6 1.9 1.8 100.0 1,638 3.84 3.67 45-49 3.2 7.0 16.7 17.3 16.8 12.8 8.5 5.7 4.6 2.6 4.8 100.0 1,511 4.28 4.01 Total 7.4 19.9 24.2 18.5 11.4 7.4 4.3 2.8 1.8 1.0 1.3 100.0 9,729 2.89 2.77 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 3 percent are childless. Assuming that voluntary childlessness within marriage is rare, the 3 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 9 percent, which reflects the combined impact of infertility, marital dissolution, and celibacy. In addition to giving a description of average family size, information on the number of 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 16 children. 5.4 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. Fertility • 47 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 35 months (Table 5.6). While 24 percent of births occur five or more years after a previous birth, a similar proportion, one in four non-first births, occurs 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. Table 5.6 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 2013 Months since preceding birth Number of non-first births Median number of months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Total Age 15-19 (52.7) (18.3) (20.6) (8.5) (0.0) (0.0) 100.0 32 (17.3) 20-29 16.5 20.5 29.9 14.4 9.2 9.5 100.0 1,768 28.3 30-39 8.0 12.4 24.7 14.4 10.8 29.7 100.0 2,315 39.8 40-49 3.9 7.5 20.4 15.9 9.6 42.7 100.0 706 50.7 Sex of preceding birth Male 11.8 14.3 25.3 14.7 10.9 22.9 100.0 2,464 35.2 Female 9.7 15.1 26.6 14.6 9.0 25.1 100.0 2,356 34.9 Survival of preceding birth Living 10.2 14.4 26.1 14.7 10.2 24.4 100.0 4,651 35.5 Dead 26.2 22.1 21.7 12.8 4.1 13.0 100.0 170 24.6 Birth order 2-3 12.1 14.9 22.8 14.0 10.6 25.7 100.0 2,861 36.2 4-6 8.4 13.6 29.3 15.5 9.3 23.8 100.0 1,436 35.3 7+ 10.2 16.5 34.2 15.5 8.5 15.2 100.0 524 31.1 Residence Urban 11.1 13.9 23.8 14.5 9.9 26.9 100.0 2,127 36.8 Rural 10.6 15.3 27.7 14.7 10.0 21.7 100.0 2,694 33.8 Region National Capital Region 13.3 13.1 19.8 14.9 11.4 27.6 100.0 637 38.3 Cordillera Admin Region 9.0 17.0 26.5 14.7 8.5 24.3 100.0 66 34.8 I - Ilocos Region 10.3 14.2 30.1 17.4 8.5 19.6 100.0 218 33.7 II - Cagayan Valley 9.5 14.7 24.6 12.7 12.3 26.2 100.0 174 37.5 III - Central Luzon 9.8 14.1 23.4 13.3 10.4 29.1 100.0 442 38.9 IVA - CALABARZON 8.3 15.4 26.6 13.4 10.2 26.1 100.0 574 35.9 IVB - MIMAROPA 14.3 13.7 21.8 11.4 14.2 24.6 100.0 142 36.1 V - Bicol 9.2 17.4 34.5 13.5 7.4 18.1 100.0 327 31.7 VI - Western Visayas 6.8 10.8 25.5 19.7 10.2 27.1 100.0 348 39.3 VII - Central Visayas 10.5 16.4 27.6 13.8 9.5 22.0 100.0 327 33.3 VIII - Eastern Visayas 10.0 17.1 24.8 12.4 14.8 20.9 100.0 202 34.8 IX - Zamboanga Peninsula 9.7 16.5 29.5 12.5 9.7 22.1 100.0 248 32.8 X - Northern Mindanao 14.3 11.5 23.9 18.9 6.0 25.4 100.0 216 36.1 XI - Davao 11.3 14.9 22.5 14.9 9.5 26.9 100.0 274 36.7 XII - SOCCSKSARGEN 9.4 14.8 31.2 14.3 7.0 23.3 100.0 241 33.6 XIII - Caraga 13.6 14.3 27.8 15.6 10.9 17.9 100.0 163 33.5 ARMM 18.7 17.6 28.1 15.0 8.6 11.9 100.0 221 28.6 Education No education 14.7 12.7 31.3 21.4 9.1 10.7 100.0 93 32.0 Elementary 10.3 15.0 33.1 13.2 9.2 19.2 100.0 1,243 31.8 High school 10.9 16.0 24.6 15.0 10.0 23.5 100.0 2,401 34.8 College 10.8 11.7 20.3 14.8 10.8 31.6 100.0 1,083 42.3 Wealth quintile Lowest 10.7 16.3 32.9 14.4 9.8 15.8 100.0 1,570 31.2 Second 11.9 15.7 27.3 15.3 9.5 20.3 100.0 1,104 33.3 Middle 10.5 13.5 23.4 15.0 9.4 28.2 100.0 911 37.1 Fourth 11.0 14.7 19.0 14.6 8.9 31.8 100.0 702 41.1 Highest 8.9 9.8 16.4 13.3 13.5 38.1 100.0 534 50.6 Total 10.8 14.7 25.9 14.6 10.0 24.0 100.0 4,821 35.1 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 Younger women have shorter birth intervals than older women. The median birth interval is 28 months for women age 20-29 and 51 months for women age 40 and older. There is a decreasing relationship between birth order and median birth interval, from 36 months for second and third births to 35 months for fourth through sixth births, and to 31 months for higher-order births (Figure 5.3). 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 median birth interval is 36 months; for those with a non-surviving previous birth, the birth interval is 25 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. Mother’s education is also associated with the length of birth intervals, but its association is not as strong as that with the mother’s economic status. Mothers with at least some college or higher education have a longer birth interval than mothers with lower education. For such mothers, the median birth interval is 42 months compared to 32 months for mothers with no education or with at most an elementary education, and 35 months for those with at most a high school education. By comparison, women in the lowest and second wealth quintiles have the shortest birth interval (31 to 33 months), while those in higher wealth quintiles have longer birth intervals (41 to 51 months). 5.5 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY A woman who has just given birth can reduce the risk of becoming pregnant if she breastfeeds her newborn or delays the resumption of sexual intercourse. Postpartum amenorrhea refers to the interval between childbirth and the return of menstruation. The length and intensity of breastfeeding influence the duration of amenorrhea, which offers protection from conception. Postpartum abstinence refers to the period between childbirth and the time when a woman resumes sexual activity. Women are considered to be insusceptible to pregnancy if they are not exposed to the risk of conception either because their menstrual period has not resumed since a birth or because they are abstaining from intercourse after childbirth. (17.3) 28.3 39.8 50.7 36.2 35.3 31.1 0 10 20 30 40 50 60 15‐19  20‐29  30‐39  40‐49  2‐3 4‐6 7+  Age of mother                                                               Birth order Figure 5.3 Median number of months since previous birth Fertility • 49 Table 5.7 shows the percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible by the number of months since birth. The results are grouped in two-month intervals to minimize fluctuations in the estimates. Overall, 17 percent of women who gave birth in the three years preceding the survey are amenorrheic, 14 percent are abstaining, and 23 percent are insusceptible to pregnancy. Women are amenorrheic for a median of 4.1 months and abstain for a median of 2.7 months, resulting in a median period of insusceptibility of 5.7 months. The median duration of amenorrhea went down from 4.6 to 4.1 months; otherwise, the figures are slightly higher than those recorded in the 2008NDHS. The results in Table 5.7 show that for births less than two months of age, 92 percent of women are amenorrheic, 86 percent are abstaining, and 99 percent are insusceptible. These proportions decrease sharply for the period 2-3 months after birth and decline steadily thereafter. The percentage of women abstaining is less than the percentage who are amenorrheic up through the period 14 to 15 months after birth; thereafter, the pattern reverses. Table 5.7 Postpartum amenorrhea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrheic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Philippines 2013 Percentage of births for which the mother is: Number of births Months since birth Amenorrheic Abstaining Insusceptible1 < 2 92.2 86.1 98.7 181 2-3 57.2 48.1 75.6 251 4-5 45.7 28.8 57.1 220 6-7 36.0 18.0 44.0 245 8-9 21.7 10.4 29.4 229 10-11 20.3 10.8 27.4 251 12-13 13.7 7.1 19.8 237 14-15 8.9 4.4 12.5 243 16-17 8.9 9.0 15.2 217 18-19 4.0 4.8 8.9 204 20-21 1.8 5.2 6.4 269 22-23 0.9 4.4 4.8 244 24-25 0.0 3.2 3.2 213 26-27 1.4 7.1 7.6 211 28-29 1.5 4.1 5.7 216 30-31 0.7 3.7 3.9 200 32-33 0.5 3.7 3.7 254 34-35 2.6 4.5 6.1 216 Total 17.2 14.0 23.4 4,102 Median 4.1 2.7 5.7 na Mean 6.7 5.6 8.9 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth Table 5.8 shows differences in the median duration of postpartum amenorrhea, abstinence and insusceptibility according to background characteristics. In general, the differences in the median duration of postpartum insusceptibility are small. Women in urban areas are insusceptible to pregnancy for about one month less than women in rural areas because of a slightly shorter duration of amenorrhea. During the postpartum period, better-educated women are more susceptible to the risk of pregnancy than women with less education because they have a shorter duration of amenorrhea. The median duration of insusceptibility is 4.8 months for women with college or higher level of education and 8.4 months for women with at most an elementary education. With respect to economic status, the duration of postpartum 50 • Fertility insusceptibility is longest among women in households in the poorest wealth quintile (7.4 months) and shortest for women in households from middle to the highest wealth quintile (5.1 months). This is attributable to longer durations of postpartum amenorrhea among women in the lowest quintile or poorest households (6.4 months) compared with women in the highest quintile or wealthiest households (3.2 months). Table 5.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility Median number of months of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Philippines 2013 Background characteristic Postpartum amenorrhea Postpartum abstinence Postpartum insusceptibility1 Mother's age 15-29 4.0 2.7 5.8 30-49 4.2 2.8 5.5 Residence Urban 3.3 2.9 5.1 Rural 4.9 2.5 6.2 Region National Capital Region 2.8 2.8 4.6 Cordillera Admin Region (4.6) * (5.2) I - Ilocos Region * * (4.8) II - Cagayan Valley (4.5) * (5.2) III - Central Luzon 3.1 * 4.9 IVA - CALABARZON 3.1 3.9 5.0 IVB - MIMAROPA (6.7) (3.5) (7.8) V - Bicol (6.0) (3.0) (7.9) VI - Western Visayas 6.4 (2.9) (8.7) VII - Central Visayas (6.1) * (6.8) VIII - Eastern Visayas * * * IX - Zamboanga Peninsula (3.7) (2.5) (6.6) X - Northern Mindanao (5.8) * (8.9) XI - Davao (4.3) (3.1) (5.1) XII - SOCCSKSARGEN (2.5) * (4.4) XIII - Caraga (5.1) (2.9) (6.1) ARMM 4.6 a 5.4 Education No education * * * Elementary 7.5 (2.4) 8.4 High school 4.0 2.7 5.4 College 2.8 3.0 4.8 Wealth quintile Lowest 6.4 2.2 7.4 Second 4.2 (2.5) 5.9 Middle 3.6 3.3 5.1 Fourth 3.0 3.2 5.0 Highest 3.2 3.4 5.1 Total 4.1 2.7 5.7 Note: Medians are based on the status at the time of the survey (current status). Numbers in parentheses are based on 25-49 unweighted cases (using smoothed data); an asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. 1 Includes births for which mothers are either still amenorrheic or still abstaining (or both) following birth a Not possible to calculate     5.6 MENOPAUSE After age 30, women’s susceptibility to pregnancy declines as an increasing proportion of women become infecund. The term infecundity denotes a process rather than a well-defined event. Although the onset of infecundity is difficult to determine for an individual woman, one indicator of infecundity is menopause.     Fertility • 51 Menopause is the culmination of a gradual decline in fecundity with increasing age. Women were considered menopausal if they were neither pregnant nor postpartum amenorrheic at the time of the survey and had not had a menstrual period for at least six months prior to the survey. Women who report that they have had a hysterectomy are also defined as menopausal. Table 5.9 presents data on menopause for women age 30 and older. Six percent of women age 30-49 are estimated to be menopausal. The proportion of women who are menopausal increases with age, from 1 percent among women age 30-34 to 32 percent among women age 48-49. 5.7 AGE AT FIRST BIRTH Age at first birth has a direct impact on fertility. Early initiation of childbearing lengthens the reproductive period and subsequently increases fertility. In many countries, postponement of first births— reflecting an increase in the age at marriage—has contributed greatly to overall fertility declines. Moreover, bearing children at a young age involves substantial risks to the health of both the mother and the child. Early childbearing also tends to restrict educational and economic opportunities for women. Table 5.10 presents, by age cohort, the percentage of all women who gave birth by specific ages. Overall, the median age at first birth is 23.5 years. This median fluctuates between 23.0 and 23.6 years across age groups and shows a slight tendency to rise among the older age groups. Slightly more than one-fifth of women in the Philippines give birth before reaching age 20, while almost two-fifths give birth by age 22 and about three-fifths by age 25.Changes in the median age at first birth among women age 25-49 over time (23.5 years in 2013 versus 23.2 years in 2008) are small. Table 5.10 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 2013 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.4 na na na na 92.3 3,237 a 20-24 0.3 8.4 24.4 na na 57.4 2,789 a 25-29 0.7 8.6 23.7 41.9 61.9 28.9 2,156 23.0 30-34 0.4 7.3 20.8 38.7 59.6 16.0 2,250 23.5 35-39 0.5 7.4 22.4 38.7 58.7 10.4 1,976 23.6 40-44 0.8 8.9 22.7 40.0 59.4 9.4 1,924 23.5 45-49 0.7 9.1 21.7 38.0 59.9 8.6 1,823 23.6 18-24 0.4 8.4 na na na 65.4 3,956 a 20-49 0.6 8.2 22.7 na na 24.2 12,918 a 25-49 0.6 8.2 22.3 39.5 59.9 15.1 10,129 23.5 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group   As shown in Table 5.11, women in the urban areas have their first birth about two years later than their rural counterparts. Women with higher education and those in higher socioeconomic strata have a higher Table 5.9 Menopause Percentage of women age 30-49 who are menopausal, by age, Philippines 2013 Age Percentage menopausal1 Number of women 30-34 0.9 2,250 35-39 1.5 1,976 40-41 2.8 786 42-43 4.0 767 44-45 7.9 818 46-47 15.6 699 48-49 31.8 677 Total 6.2 7,973 1 Percentage of all women who are not pregnant and not postpartum amenorrheic whose last menstrual period occurred six or more months preceding the survey 52 • Fertility median age at first birth than other women. Regional variation in age at first birth ranges from 21.6 years in MIMAROPA to 25.0 years in NCR. Table 5.11 Median age at first birth Median age at first birth among women age 25-49 years, according to age group and background characteristics, Philippines 2013 Age Ages Background characteristic 25-29 30-34 35-39 40-44 45-49 25-49 Residence Urban 24.2 24.4 24.3 24.2 24.3 24.3 Rural 22.1 22.6 22.9 22.9 22.9 22.6 Region National Capital Region 24.7 24.9 25.2 25.2 24.9 25.0 Cordillera Admin Region 22.4 24.1 24.2 23.1 23.6 23.4 I - Ilocos Region 22.8 22.9 24.1 25.5 24.3 23.8 II - Cagayan Valley 22.0 23.1 22.7 21.3 23.2 22.3 III - Central Luzon 24.2 23.2 24.0 23.7 23.7 23.8 IVA - CALABARZON 24.2 24.7 23.7 23.9 24.0 24.1 IVB - MIMAROPA 20.8 22.6 21.3 21.7 21.3 21.6 V - Bicol 22.6 23.1 24.0 24.5 23.4 23.3 VI - Western Visayas 22.8 23.5 23.6 22.9 24.1 23.4 VII - Central Visayas 22.1 23.3 24.1 23.2 24.0 23.4 VIII - Eastern Visayas 21.8 22.3 23.0 23.3 23.3 22.8 IX - Zamboanga Peninsula 22.0 22.7 22.6 21.5 22.4 22.2 X - Northern Mindanao 23.0 23.1 22.0 23.9 22.9 22.9 XI - Davao 22.3 22.4 23.2 22.1 22.5 22.5 XII - SOCCSKSARGEN 22.1 21.9 21.7 21.6 21.5 21.8 XIII - Caraga 21.8 23.1 22.6 22.9 22.6 22.4 ARMM 21.5 21.0 22.3 23.1 22.9 22.0 Education No education * (21.2) (18.5) (19.4) 21.6 20.1 Elementary 20.3 20.6 21.0 21.1 21.5 21.0 High school 21.8 22.3 22.9 22.9 23.3 22.5 College a 26.3 26.9 27.3 26.4 a Wealth quintile Lowest 20.3 20.9 21.4 21.6 21.8 21.1 Second 21.4 21.8 22.6 22.0 22.6 21.9 Middle 22.9 22.9 23.4 22.6 22.7 22.9 Fourth a 25.3 24.5 24.5 24.0 24.7 Highest a 26.7 26.2 26.2 25.7 a Total 23.0 23.5 23.6 23.5 23.6 23.5 Note: Numbers in parentheses are based on 25-49 unweighted cases; an asterisk denotes a figure based on fewer than 25 unweighted cases that has been suppressed. a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the age group   5.8 PREGNANCY AND MOTHERHOOD AMONG YOUTH Teenage pregnancy and motherhood is a major social and health concern. Early pregnancy can cause health problems for the mother as well as the child. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, young mothers may not be sufficiently emotionally mature to bear the burden of childbearing and child rearing. Moreover, an early start to childbearing often reduces women’s educational and employment opportunities and is associated with higher levels of fertility. Table 5.12 shows that 27 percent of young women age 15-24 in the Philippines have begun childbearing. Twenty-four percent of young women have given birth, and another 3 percent are pregnant with their first child. As expected, the proportion of women who have begun childbearing rises with age, from less than 2 percent among women age 15 to 22 percent of women age 19 and to 59 percent of those age 24. Fertility • 53 Early childbearing varies by urban-rural residence. The proportion of young women who have begun childbearing is 25 percent in urban areas and 29 percent in rural areas. Early childbearing is more common in Caraga (38 percent) than in other regions, especially NCR, CALABARZON and ARMM (24 percent). It is less common among women with a higher education and among women in the highest wealth quintile. Table 5.12 Early 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 2013 Percentage who: Percentage who have begun childbearing Number of women Background characteristic Have had a live birth Are pregnant with first child Age 15 1.0 0.6 1.6 781 16 2.6 2.4 5.0 650 17 6.7 2.3 9.0 638 18 13.1 3.9 17.0 632 19 18.3 3.8 22.1 535 20 27.7 5.1 32.8 618 21 36.2 2.8 39.0 549 22 45.9 2.9 48.8 542 23 49.3 4.5 53.8 578 24 56.9 2.2 59.1 503 15-19 7.7 2.5 10.1 3,237 20-24 42.6 3.6 46.2 2,789 Residence Urban 22.2 2.6 24.9 3,264 Rural 25.8 3.4 29.2 2,762 Region National Capital Region 21.9 2.4 24.3 1,086 Cordillera Admin Region 24.6 3.9 28.5 96 I - Ilocos Region 27.7 2.4 30.1 237 II - Cagayan Valley 30.6 5.9 36.5 216 III - Central Luzon 22.3 3.6 25.9 619 IVA - CALABARZON 22.7 1.5 24.2 844 IVB - MIMAROPA 24.2 3.9 28.1 134 V - Bicol 23.5 3.1 26.6 290 VI - Western Visayas 24.3 2.3 26.6 370 VII - Central Visayas 22.9 1.8 24.6 367 VIII - Eastern Visayas 20.9 3.9 24.8 194 IX - Zamboanga Peninsula 21.6 4.9 26.4 301 X - Northern Mindanao 26.3 2.6 28.9 266 XI - Davao 26.2 4.0 30.2 346 XII - SOCCSKSARGEN 25.6 3.9 29.5 301 XIII - Caraga 32.8 4.8 37.6 170 ARMM 22.3 2.1 24.4 190 Education No education (43.5) (0.0) (43.5) 32 Elementary 39.8 4.3 44.1 584 High school 24.5 2.8 27.2 3,510 College 17.5 3.1 20.5 1,900 Wealth quintile Lowest 34.0 3.3 37.3 902 Second 29.6 4.4 34.0 1,134 Middle 27.8 3.2 30.9 1,236 Fourth 21.7 2.7 24.4 1,338 Highest 11.4 1.8 13.2 1,415 Total 23.9 3.0 26.8 6,026 Note: Numbers in parentheses are based on 25-49 unweighted cases. 54 • Fertility Fertility Preferences • 55 FERTILITY PREFERENCES 6 nformation on fertility preferences is of considerable importance to family planning policies and programs as this allows planners to assess not only the desire of women and couples for children but also the extent of unwanted and mistimed pregnancies. In recognition of the right of couples to decide their own family size, the Philippine Family Planning Program (PFPP) regularly monitors the following five key fertility preferences indicators: 1) desire for additional children; 2) desire to limit childbearing; 3) ideal number of children; 4) fertility planning status (wanted and unwanted fertility); and 5) couples’ consensus on family size. This chapter updates these indicators with data collected from the 2013 National Demographic and Health Survey (NDHS) using the same series of questions asked in previous NDHS rounds to ascertain women’s fertility preferences (NSO and ICF Macro, 2009). Interpretation of data on fertility preferences is often difficult since it is understood that respondents’ reported preferences are, in a sense, hypothetical and are thus subject to change and rationalization. Still, data on fertility preferences indicate the direction of future fertility to the extent that individuals and couples will act to achieve their preferred family sizes (NIPS and ICF International, 2013). 6.1 DESIRE FOR MORE CHILDREN Desire for additional children among currently married women age 15-49 is determined by asking whether or not they want to have another child and, if so, how soon. The question was phrased differently in I Key Findings • More than half (54 percent) of married women age 15-49 do not want another child and an additional 9 percent are already sterilized. Nineteen percent of married women want to have another child but would prefer to wait two or more years. Thus, 81 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). These figures are similar to those reported in the 2008 NDHS. • The proportion of currently married women who want no more children increases with increasing number of living children and age of the women. • The mean ideal number of children for all women is 2.8 children which remains unchanged from the 2008 NDHS figure. For currently married women, the mean ideal family size is 3.0 children, slightly lower than the mean of 3.1 children in the 2008 NDHS. • Unplanned pregnancies are common in the Philippines. Nearly three in ten births are either unwanted (11 percent) or mistimed and wanted later (17 percent). These figures are lower than those reported in the 2008 NDHS (16 percent and 20 percent, respectively). • The total wanted fertility rate for the Philippines is 2.2 children per woman, 27 percent lower than the actual total fertility rate of 3.0 children. 56 • Fertility Preferen the case of women we more child Fi 15-49. Thr more child child at so birth for a women ar unable to reported in birth or to F T child, acco child decr childbearin child soon child, but percent of In number of increasing percent am percent am rounds (20 nces f pregnant wo ere not asked dren (NSC, M igure 6.1 illus ree in five wo dren, while 9 ome time in th at least two ye re undecided o become pregn n the 2008 ND limit childbea Figure 6.1 F able 6.1 show ording to the reases rapidly ng at the time n, that is, with nearly half (4 f women with n contrast wit f living childr g number of liv mong women mong those w 003 and 2008) anot d w U omen to refer t questions abo OH, and ICF strates the bre omen in the P percent have b he future, but m ears while 12 on the timing nant (infecund DHS. In all, a aring altogethe Fertility pre ws the percent number of liv y with increa e of the surve hin the next tw 49 percent) w six or more ch th the proport ren, the propo ving children with two chil with four or mo ). Have ther, undecide when, < 1% Undecided, 5% to a subsequen out their desire International, eakdown of th hilippines wan been sterilized most do not w percent want g of their next d). This distri a vast majority er. ferences am distribution o ving children. asing number ey want to hav wo years. Sev want to wait at hildren want to tion of women ortion of wom (Figure 6.2), f ldren, to 82 pe ore children. T Have an later, nt child after c e for more chil 2013). he desire for c nt to stop chil d. In addition, want a child so t to have a ch t birth. Two p ibution of fert y of Filipino m mong curre of currently m . As expected of children. ve a child wit ven in ten wom t least two ye o have anothe n who want t men who wan from 21 perce ercent among The same pat Have soo nother 19% Want no mo 54% completion of ldren because children amon ldbearing: 54 , 31 percent o oon. Nineteen hild within the percent of ma tility preferenc married wome ently marrie married women d, the proporti Nine in ten th a majority ( men who have ears before ha er child. to have anoth nt to limit chi ent among mar women with ttern was obse e another on, 12% ore Sterilized, 9% f the current pr they were con ng currently m percent do no of married wom percent prefer e next two yea arried women ces is very sim en want either d women ag n age 15-49 by ion of women n women who (76 percent) p e one child w aving the next her child that ildbearing inc rried women w three children erved in the tw Declared infecund, 2% Missing, < 1% regnancy. Ster nsidered to wa married wome ot want to hav men want to h r to delay thei ars. One perc declare them milar to the p r to space thei ge 15-49 y desire for an n who want an o have not s preferring to h ant to have an t child. Less t decreases wi reases rapidly with one child n, and to arou wo previous N % rilized ant no en age ve any have a ir next ent of selves pattern ir next nother nother started have a nother than 5 th the y with d to 64 und 90 NDHS Fertility Preferences • 57 Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women age 15-49 by desire for children, according to number of living children, Philippines 2013 Desire for children Number of living children1 Total 15-49 0 1 2 3 4 5 6+ Have another soon2 75.7 19.8 7.7 4.1 3.3 2.1 2.5 12.0 Have another later3 13.1 49.2 20.1 8.9 3.9 3.3 1.8 18.7 Have another, undecided when 2.5 0.6 0.6 0.5 0.2 0.3 0.2 0.6 Undecided 0.6 7.2 5.4 3.1 3.7 2.4 3.4 4.5 Want no more 1.9 21.0 59.5 65.0 71.5 75.8 78.2 53.7 Sterilized4 0.0 0.4 4.9 17.0 15.8 15.0 11.3 8.6 Declared infecund 6.0 1.7 1.7 1.1 1.4 0.7 2.4 1.8 Missing 0.2 0.0 0.1 0.2 0.1 0.5 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 10.0 10.0 Number 550 2,031 2,494 1,845 1,151 686 972 9,729 1 The number of living children includes the current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilization Figure 6.2 Percentage of currently married women who want no more children, by number of children Table 6.2 shows the percent distribution of currently married women by their desire for more children, according to age. The proportion of married women who want the next birth within two years is highest among women age 30-34 (17 percent) and lowest among women age 45-49 (6 percent). Meanwhile, the proportion of women who want to delay the next birth for two or more years is highest among women age 15-19 (58 percent) then decreases to less than one percent among women age 45-49. As expected, the proportion of women who want no more children or are sterilized, increases with increasing age: 20 percent of women age 15-19 want no more children, compared with 84 percent among women age 45-49. The proportion of women who said they were unable to have any more children (infecund) is less than one percent among women under age 35, but rises to 8 percent among women age 45-49. 2 21 64 82 87 91 90 0 1 2 3 4 5 6+ Number of children Percent 58 • Fertility Preferences Table 6.2 Fertility preferences by age Percent distribution of currently married women age 15-49 by desire for children, according to age, Philippines 2013 Desire for children Age Total 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Have another soon1 11.0 10.7 12.7 17.0 13.4 10.3 6.4 12.0 Have another later2 57.9 49.5 37.4 18.2 7.1 1.7 0.3 18.7 Have another, undecided when 0.3 1.2 0.7 0.4 0.9 0.2 0.2 0.6 Undecided 10.9 6.8 6.4 5.3 3.9 2.7 1.0 4.5 Want no more 19.6 31.2 40.1 51.0 62.7 67.0 70.3 53.7 Sterilized3 0.0 0.5 2.6 7.7 10.7 16.1 13.5 8.6 Declared infecund 0.3 0.1 0.1 0.1 1.2 1.9 7.7 1.8 Missing 0.0 0.0 0.0 0.2 0.1 0.1 0.6 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 313 1,196 1,484 1,862 1,725 1,638 1,511 9,729 1 Wants next birth within 2 years 2 Wants to delay next birth for 2 or more years 3 Includes both female and male sterilization 6.2 DESIRE TO LIMIT CHILDBEARING BY BACKGROUND CHARACTERISTICS The proportion of women who want no more children is an important and easily understood measure of fertility preference. Table 6.3 shows the percentage of currently married women who want to stop childbearing by the number of living children and background characteristics. The proportion of women who desire to stop childbearing increases substantially as the number of living children increases; from 2 percent among women with no child to 22 percent among women with one child, to 64 percent among women with two children, and to 90 percent among women with five or more children. Overall, the same proportion of married women (62 percent) in urban and rural areas wants to limit childbearing (Figure 6.3). However, as observed in the 2003 and 2008 NDHS, when the number of living children is considered, the proportion of women who want to limit childbearing is consistently higher among women in urban areas than in rural areas (NSO and ORC Macro, 2004 and NSO and ICF Macro, 2009). For example, among women who have two living children, 68 percent in urban areas want to limit childbearing, compared with 61 percent in rural areas. The desire to limit childbearing varies substantially across the administrative regions. The proportion who want no more children is highest among married women in Western Visayas (69 percent) and Cagayan Valley (68 percent) and lowest among women in the Autonomous Region of Muslim Mindanao (31 percent). In addition to ARMM, another region with less than half of women wanting no more children is Zamboanga Peninsula (49 percent). Fertility Preferences • 59 Table 6.3 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, according to background characteristics, Philippines 2013 Number of living children1 Total Background characteristic 0 1 2 3 4 5 6+ Residence Urban 1.4 23.2 67.8 85.1 89.4 93.5 90.9 62.4 Rural 2.4 19.4 60.5 79.0 85.5 89.0 88.8 62.2 Region National Capital Region 1.5 20.9 72.2 87.2 93.0 94.5 94.5 62.3 Cordillera Admin Region * 14.3 46.3 84.0 91.7 (89.7) (97.4) 57.8 I - Ilocos Region (3.8) 20.3 67.5 81.1 (98.0) (100.0) (100.0) 64.4 II - Cagayan Valley * 21.4 70.9 90.9 (92.7) (97.1) (93.8) 68.2 III - Central Luzon 0.0 14.2 63.2 89.5 93.5 (93.0) 95.1 62.2 IVA - CALABARZON 0.0 30.6 69.3 85.6 92.4 97.3 89.2 66.0 IVB - MIMAROPA * 16.1 63.8 73.6 83.2 (86.0) 86.5 62.5 V - Bicol (3.8) 24.7 61.7 73.5 90.4 (88.4) 94.4 66.1 VI - Western Visayas 0.0 17.9 67.1 85.6 94.6 (97.5) 93.4 69.0 VII - Central Visayas (2.9) 27.5 69.3 86.8 87.9 (90.9) 91.5 66.2 VIII - Eastern Visayas * 25.2 51.1 70.8 87.6 (88.9) 93.0 61.1 IX - Zamboanga Peninsula (6.9) 10.5 47.8 64.0 58.5 (77.8) 83.1 48.8 X - Northern Mindanao 0.0 16.6 60.9 84.9 88.9 (97.1) 93.0 62.2 XI - Davao (2.9) 28.5 64.4 84.8 77.4 (92.5) (86.7) 61.8 XII - SOCCSKSARGEN * 23.2 61.1 76.3 86.2 (93.3) 92.2 62.5 XIII - Caraga (2.3) 20.0 56.2 81.2 87.6 (86.0) 92.0 60.0 ARMM * 2.5 17.2 24.0 39.3 50.0 54.3 31.4 Education No education * (19.9) (46.5) * * (83.4) 75.9 61.1 Elementary 5.5 23.1 61.5 76.5 84.4 87.6 89.0 71.3 High school 1.0 22.8 64.0 82.2 88.1 93.3 91.7 63.2 College 1.5 19.5 66.6 85.6 90.3 91.5 90.3 54.7 Wealth quintile Lowest 3.1 20.0 48.8 70.4 77.4 83.9 86.2 63.7 Second 2.5 20.4 60.0 80.4 87.5 93.8 92.5 65.0 Middle 1.8 20.1 64.3 85.5 90.1 94.1 90.4 63.2 Fourth 1.4 21.4 70.7 87.1 93.3 95.2 95.7 60.3 Highest 1.5 24.1 70.8 84.7 94.3 92.8 (85.3) 59.2 Total 1.9 21.5 64.3 82.0 87.3 90.7 89.5 62.3 Note: Women who have been sterilized are considered to want no more children. Numbers in parentheses are based on 25-49 unweighted cases; an asterisk denotes a number based on fewer than 25 unweighted cases that has been suppressed. 1 The number of living children includes the current pregnancy The proportion of women who want no more children generally decreases as the level of education increases, starting with elementary (71 percent) to women with college education (55 percent). However, the proportion of women who want no more children among those with no education (61 percent) is lower than the corresponding proportions among women with elementary or high school education. Examining the relationship between fertility desire and educational attainment by number of living children shows a positive relationship between education and desire for no more children among women who have two to four children. 60 • Fertility Preferences Figure 6.3 Percentage of currently married women who want no more children, by background characteristics There are small differences in the desire to limit childbearing by household wealth status, with the proportion wanting to limit childbearing generally decreasing with increasing wealth quintile (except for the lowest wealth quintile). However, among women with two or four children, the proportion of women who want to stop childbearing generally increases with increasing wealth quintile. Overall, the levels and patterns in the desire to stop childbearing across residence, education and wealth quintile as shown in Figure 6.3 are similar to those observed in the 2008 NDHS (NSO and ICF Macro, 2009). 6.3 IDEAL NUMBER OF CHILDREN To ascertain the ideal number of children, respondents were asked to consider abstractly, and independent of their actual family size, the number of children they would choose if they could start childbearing again. Most women provided numeric responses to the questions on ideal family size but a few women gave non-numeric responses, such as: “It’s up to God” or “It is not for me to say”, etc. These non- numeric responses are excluded in the computation of mean ideal number of children. Although the questions on ideal number of children are based on hypothetical situations, two measures of fertility can be derived from the results. First, for women who have not yet started childbearing, the data provide an idea of future fertility. Second, for older and high-parity women, the excess of past fertility over the ideal family size provides a measure of unwanted fertility. Table 6.4 presents the percent distribution of women by ideal number of children according to their actual number of living children. Forty-three percent of women in the Philippines consider two children as the ideal family size, while 28 percent prefer three children, 13 percent prefer four children and 8 percent prefer five or more children. Among women who have two or fewer children, more than half think that a two-child family size is ideal. 62  62  62  61  71  63  55  64  65  63  60  59  0  10  20  30  40  50  60  70  80  Total Urban  Rural  No edu‐ cation  Ele‐ men‐ tary  High school  College  Lowest  Second  Middle  Fourth  Highest  Percent Residence Education Wealth quintile Fertility Preferences • 61 Table 6.4 Ideal number of children by number of living children Percent distribution of women 15-49 by ideal number of children, and mean ideal number of children for all respondents and for currently married women, according to the number of living children, Philippines 2013 Ideal number of children Number of living children1 Total 0 1 2 3 4 5 6+ 0 2.7 0.2 0.2 0.2 0.2 0.0 0.0 1.1 1 7.9 12.0 4.3 3.8 2.7 2.4 0.6 6.3 2 54.9 51.3 50.4 23.0 28.7 18.6 13.7 43.4 3 23.4 26.6 26.2 44.4 18.9 34.8 30.3 27.6 4 7.2 7.5 14.5 16.7 37.3 13.1 23.4 13.3 5 2.0 1.4 2.5 7.5 5.5 20.5 9.1 4.2 6+ 1.1 0.9 1.9 4.1 6.3 9.9 22.0 3.7 Non-numeric responses 0.8 0.1 0.0 0.2 0.3 0.8 0.8 0.5 Total 100 100 100 100 100 100 100 100 Number 5,909 2,533 2,721 1,972 1,234 742 1,045 16,155 Mean ideal number of children for:2 All women 2.4 2.4 2.7 3.2 3.4 3.7 4.3 2.8 Number of women 5,860 2,530 2,720 1,968 1,230 736 1,036 16,080 Currently married women 2.5 2.5 2.7 3.2 3.4 3.7 4.3 3.0 Number of currently married women 549 2,029 2,493 1,841 1,147 680 965 9,703 1 The number of living children includes current pregnancy 2 Means are calculated excluding respondents who gave non-numeric responses. The mean ideal family size in the Philippines of 2.8 children for all women remains unchanged from the 2008 NDHS figure, while there is a slight decline in the mean ideal family size for currently married women, from 3.1 children in 2008 to 3.0 children in 2013. As parity increases, the ideal number of children also increases: from a mean ideal family size of 2.4 children among women with no children to 4.3 children among women with six or more children. The data indicate a high level of surplus fertility that exceeds the ideal. For example, almost 70 percent of women with five children say they would ideally like fewer than five and 77 percent of those with six or more children say their ideal number is five or fewer. Table 6.5 shows information on the mean ideal number of children for all women age 15-49 by age group, according to background characteristics. The mean ideal number of children increases as women’s age increases, from 2.4 children among women age 15-19 to 3.3 children among women age 45-49. Ideal family size is higher among rural than urban women, and it is negatively associated with education and wealth quintile. 62 • Fertility Preferences Table 6.5 Mean ideal number of children Mean ideal number of children for all women age 15-49 by age according to background characteristics, Philippines 2013 Age Total Number of women1 Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban 2.3 2.4 2.4 2.6 2.8 3.0 3.1 2.6 8,549 Rural 2.5 2.6 2.9 3.1 3.3 3.4 3.6 3.0 7,531 Region National Capital Region 2.2 2.3 2.3 2.5 2.5 2.7 2.8 2.4 2,911 Cordillera Admin Region 2.7 2.4 2.9 3.0 3.3 4.0 4.0 3.1 249 I - Ilocos Region 2.3 2.4 2.5 2.8 2.8 2.9 3.3 2.7 689 II - Cagayan Valley 2.4 2.4 2.5 3.0 2.9 3.

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