Barriers to Contraceptive Use Barriers to Contraceptive Use in the Philippinesin the Philippines

from a new fact sheet by the Guttmacher Institute from a new fact sheet by the Guttmacher Institute and Likhaan Center for Women's Health Inc.and Likhaan Center for Women's Health Inc.

Contraceptives & the MDGsContraceptives & the MDGsGoal 5. Improve maternal health Indicators:

• MMRTarget 5.A:Reduce by 3/4, between 1990 & 2015, the maternal mortality ratio

• births attended by skilled health personnel

• Contraceptive prevalence

• Adolescent birth rate

• Antenatal care

• Unmet need for FP

Target 5.B:Achieve, by 2015, universal access to reproductive health

Sources of unintended Sources of unintended pregnancy riskspregnancy risks

not using any method -

"unmet need"

using traditional methods

can get pregnant, want to space or

limit children,

but…

unintended pregnancies

maternal complications

& deaths, abortion,

unplanned births, other

consequences

BIGGEST RISKS

modern method failure & other risks

Rise in unintended pregnancy riskRise in unintended pregnancy risk

20 1722

1816

17

1998 2003 2008

Trad. MethodUsers

Unmet Need

% of married women of reproductive age, NDHS

Rich & poor face high Rich & poor face high unintended pregnancy unintended pregnancy risksrisks……

21 20 21 2328

17 1717

17

15

Richest Richer Middle Poorer Poorest

Trad. MethodUsers

Unmet Need

% of married women of reproductive age, NDHS 2008

…but poor women's

unmet need gives them the highest

risk

Why?Why?

1. government 1. government failuresfailures

2. quality of care 2. quality of care problemsproblems

FP client from Manila, 2008

Failure to replace USAID suppliesFailure to replace USAID supplies

46

22

70

25

50

75

100

1993 1998 2003 2008

condoms

pills

all modern methods

contraceptivephase-out

eventually hitting the

poor

2006 poverty line (33%)

Govt (nat'l & local) as most recent source, %

%, most recent source of supply, NDHS

Broken promise: Broken promise: ""Contraceptive SelfContraceptive Self--Reliance Strategy"Reliance Strategy""Government, to include

national and local levels,shall act as

'guarantor of last resort'assuring that contraceptives remain available for current

users who depend on donated supplies…."

- DOH AO 158 s. 2004

Discriminatory policyDiscriminatory policy

DOH buys vaccines & antiDOH buys vaccines & anti--TB drugs for TB drugs for localities, while spending zero on localities, while spending zero on contraceptives despite budget availabilitycontraceptives despite budget availability

2010 DOH MOOE Budget for Amount

TB Control 1.11 B

Vaccine-Preventable Disease Control 1.02 B

Family Health including Family Planning 0.93 B

Failed NFPFailed NFP--focused policyfocused policy"… as many as 67.6% of currently married women

stand to benefit from using modern NFP methods." …

"[by 2006]… raise NFP use rate to 20%among currently married women/couples who are not

yet using any method of contraception"- DOH AO 125 s. 2002

NFP current users

0.1% 0.3% 0.5%

1998 2003 2008

% current use, married women of reproductive age, NDHS

LGU contraceptive banLGU contraceptive ban

NGO FP outreach using makeshift clinic, MANILA 2009

Manila community hit by Manila community hit by contraceptive bancontraceptive ban

Reasons for nonReasons for non--use by women with use by women with unmet needunmet need

0 10 20 30 40 50

Personal orreligious

opposition

Cost

Unlikely to bepregnant

Healthconcerns

20032008

same

increase

increase

decrease

% of women with unmet need, NDHS 2003 & 2008

ConsequencesConsequencesPreventable if all women who wanted to avoid a pregnancy used modern methods:

200,000 miscarriages200,000 miscarriages2,100 maternal deaths2,100 maternal deathsother health, economic other health, economic

and social costs and social costs

800,000 unintended births800,000 unintended births500,000 abortions500,000 abortions

Stagnation in maternal death reductionStagnation in maternal death reduction

200209213172 162

0

100

200

300

400

500

1980 1985 1990 1995 2000 2005 2010 2015

▬ 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)

Target 52

Poor women & families suffer mostPoor women & families suffer mostUnintended births

per woman among richest: 0.3

among poorest: 2

New path for the new administrationNew path for the new administration

1. Restore "cafeteria policy"1. Restore "cafeteria policy"support for the widest range support for the widest range of FP choicesof FP choices

2. Buy contraceptives 2. Buy contraceptives use DOH 2010 FP budgetuse DOH 2010 FP budget

3. Reverse LGU bans3. Reverse LGU bansuse standarduse standard--setting & setting & regulatory authorityregulatory authority

Five Immediate Doables

New path for the new administrationNew path for the new administration

4. More PhilHealth funding4. More PhilHealth fundinge.g., 3e.g., 3--year birth spacing FP year birth spacing FP supplies in maternity care supplies in maternity care packagepackage

5. Focus on quality of care 5. Focus on quality of care standards and trainingstandards and training

Five Immediate Doables

New path for the new administrationNew path for the new administration

Pass the RH billPass the RH billPromote FP as one of the Promote FP as one of the key pillars of reducing key pillars of reducing maternal mortalitymaternal mortalityStop using health for Stop using health for politicalpolitical--religious religious patronagepatronage

More Doables

In sumIn sumContraceptives and reproductive health Contraceptives and reproductive health are part of the MDGare part of the MDGHardly any progress in contraception in Hardly any progress in contraception in the past decadethe past decadeGovernment failures & quality of care Government failures & quality of care problems are the key barriersproblems are the key barriersLives and health, especially of the poor, Lives and health, especially of the poor, are threatenedare threatenedThe new administration can still change The new administration can still change course to achieve the MDGcourse to achieve the MDG