Barriers to Contraceptive Use in the Philippines - Philippine Culture

Barriers to Contraceptive Usein the Philippinesfrom a new fact sheet by the Guttmacher Instituteand Likhaan Center for Women's Health Inc.

Contraceptives & the MDGsGoal 5. Improvematernal healthTarget 5.A:Reduce by 3/4, between1990 & 2015, thematernal mortality ratioTarget 5.B:Achieve, by 2015,universal access toreproductive healthIndicators:• MMR• births attended by skilledhealth personnel• Contraceptive prevalence• Adolescent birth rate• Antenatal care• Unmet need for FP

Sources of unintendedpregnancy risksBIGGEST RISKScan getpregnant,want tospace orlimitchildren,but…not using anymethod -"unmet need"usingtraditionalmethodsunintendedpregnanciesmaternalcomplications& deaths,abortion,unplannedbirths, otherconsequencesmodernmethod failure& other risks

Rich & poor face highunintended pregnancyrisks…15…but poorwomen'sunmetneed givesthem thehighestriskTrad. MethodUsers17171717Unmet Need21 20 21 2328% of married women of reproductive age, NDHS 2008Richest Richer Middle Poorer Poorest

%, most recent source of supply, NDHSFailure to replace USAID supplies100Govt (nat'l & local) as most recent source, %75pillsall modern methodscontraceptivephase-out50condoms2006 poverty line (33%)462501993 1998 2003 2008227eventuallyhitting thepoor

Discriminatory policyDOH buys vaccines & anti-TB drugs forlocalities, while spending zero oncontraceptives despite budget availability2010 DOH MOOE Budget for AmountTB ControlVaccine-Preventable Disease ControlFamily Health including Family Planning1.11 B1.02 B0.93 B

LGU contraceptive banNGO FP outreach using makeshift clinic, MANILA 2009

Manila community hit bycontraceptive ban

Reasons for non-use by women withunmet needHealthconcernssameUnlikely to bepregnantincrease20032008CostincreasePersonal orreligiousoppositiondecrease0 10 20 30 40 50% of women with unmet need, NDHS 2003 & 2008

ConsequencesPreventable if all women whowanted to avoid a pregnancyused modern methods:• 800,000 unintended births• 500,000 abortions• 200,000 miscarriages• 2,100 maternal deaths• other health, economicand social costs

Stagnation in maternal death reduction500400▬ NSO surveys, direct sisterhood ........... slight decline▬ NSO vital registration data ................. no decline• WHO, adjusted sisterhood data ........... almost same as NSO• Hogan et al estimates (Lancet 2010) ... rapid decline (being questioned)300200213209200172 162100Target 5201980 1985 1990 1995 2000 2005 2010 2015

Poor women & families suffer mostUnintended birthsper woman among richest: 0.3among poorest: 2

New path for the new administrationFive Immediate Doables1. Restore "cafeteria policy"• support for the widest rangeof FP choices2. Buy contraceptives• use DOH 2010 FP budget3. Reverse LGU bans• use standard-setting setting &regulatory authority

New path for the new administrationFive Immediate Doables4. More PhilHealth funding• e.g., 3-year 3birth spacing FPsupplies in maternity carepackage5. Focus on quality of carestandards and training

New path for the new administrationMore Doables• Pass the RH bill• Promote FP as one of thekey pillars of reducingmaternal mortality• Stop using health forpolitical-religiouspatronage

In sum• Contraceptives and reproductive healthare part of the MDG• Hardly any progress in contraception inthe past decade• Government failures & quality of careproblems are the key barriers• Lives and health, especially of the poor,are threatened• The new administration can still changecourse to achieve the MDG