Executive Summary

WE all have our roles in life.

Parents must feed, shelter, clothe and educate their children. Ideally, they should provide their children with a decent, above subsistence-level life, and enable them to acquire knowledge and skills needed in this age of technological marvels. Teachers educate. Businessmen make money. NGOs help a disadvantaged community.

The government is concerned, among other issues, with how population growth can be managed to achieve sustained growth of national income and bring about a fair distribution of the fruits of progress.

These objectives are difficult to obtain with a rapid population growth.

In a developing society like the Philippines, rapid population growth means slower per capita income. This translates to smaller savings and grinding poverty. The government must see to it that society's overhead capital is adequate and properly maintained. As it is, some demographic trends pose a threat to the goal of development with equity.

Based on the preliminary findings of the 2000 Census of Population, the present population of the Philippines is 75.3 million. The population growth rate between 1995 and 2000, the two national censuses, was about 2 percent, representing a decline since 1980.

At this intercensal growth rate, the population is expected to double in 2035. Using the 1995 census as the basis for a medium projection, the population is estimated to be 99.7 million from 2000-2010, and 113.3 million in 2010-2020.

Six regions showed an annual population growth rate greater than the national average: Southern Tagalog, Central Luzon, Southern and Northern Mindanao.

By 2000, Southern Tagalog had a population of 11.3 million, with a growth rate of 2.8 percent, followed by the National Capital Region with 10.5 million and a growth rate of 2.02 percent. The least populated region was the Cordillera Administrative Region (CAR), with 1.3 million and a growth rate of 1.60 percent.

The youth continued to form a large base within the population. In 1995, those aged 14 and below comprised 38.3 percent of the total population, while those aged 15-64 totalled 58.2 percent. The average age of marriage for a woman in 1998 was 23.3 years.

As of October 1998, the number of families was estimated at 14.40 million; and the average family size had declined from 5.2 persons in 1990 to five persons in 1998.

A comparison of the economic performances within ASEAN will underscore the link between population and development. Population growth imposes certain constraints which make economic growth difficult to obtain.

In terms of per capita GNP, the country grew by 1.4 percent in 1999. If the country continues to grow at this pace, per capita GNP will double after almost 49 years. This implies a very slow improvement in standards of living for at least two generations.

However, if the population growth rate declines by 0.2 percent, and GNP growth remains the same, real per capita GNP will double in about 43 years. If the population growth rate declines further and brings per capita GNP growth rate to 2 percent, then per capita GNP will double in 35 years.

Another demographic factor is this country's high age-dependency ratio of 72 percent in 1995, with the very young members of the household (aged 14 and below) and the old (over 65 years) being dependent on the working members (aged 15-64).

Given this high age-dependency ratio, much of household income goes to personal spending on basic goods and services, leaving only a negligible amount for savings, if at all. As a result, the country's savings-GNP ratio remains modest.

Another consequence is that economic growth, in the long run, tends to be moderate and unstable. Savings are needed to finance investments. If domestic savings are low, the economy cannot be too productive. Low savings mean low investments and modest productive growth.

Also cause for concern is the uneven growth rate of labor productivity. From 1980 to 1996 labor productivity did not grow beyond 2 percent, and there have even been several episodes of negative growth rates.

Low productivity may be attributed to lack of skills, low educational attainment, and inadequate training. The bigger the population, the bigger the school enrollment and the bigger the budget requirement for education. However, the 1994 budget in real terms was actually 4 percent lower than that of the 1991 level.

As for poverty incidence, the proportion has been declining through the years; but the actual number of poor families has been increasing: from 4.23 million in 1988 to 4.51 million in 1997.

All these and other related factors point out the need for a coherent and comprehensive population policy framework that will integrate population policy into the government's broad socioeconomic development plan.

This policy framework will take into consideration population management, fertility, family planning, reproductive health and rights, and equality between men and women.

Women who would like to space or limit births but, for some reason, are not using any family planning method are said to have an "unmet need" for family planning. This is one of the many important concerns in the broad field of population and development, family planning, reproductive health, and status of women.

This unmet need of women is largely due to the high costs—monetary or nonfinancial, such as psychological consequences—associated with contraception and obtaining the service. However, users say the benefits outweigh the costs.

The husband may also object to family planning, many children being supposed proof of his virility. The dutiful wife will then become a dropout from contraceptive use, although she does not want to bear more children for health and financial reasons. Studies have borne this out.

A 1998 survey has shown that unmet need for contraception is high, and that non-use of contraception is related, among others, to concerns about adverse health effects and "husband's objection." In general, husbands and wives have different fertility preferences, with the husband wanting more children.

About half of currently married women say they want no more children, but not all are able to achieve their desired family size. Unmet need is increasing in Eastern Visayas, Central Mindanao, and CAR. It is substantial in Caraga and the Autonomous Region of Muslim Mindanao. The more developed regions, like NCR, Central Luzon and Central Visayas, have the lowest levels of unmet need.

The proportion of women aged 15-49 using a family planning method—the contraceptive prevalence rate (CPR)—was 40 and 47 percent in 1993 and 1998, respectively.Of these, less than 30 percent used modern methods; the rest resorted to traditional methods.

Two serious consequences of unmet need are unintended pregnancies and induced abortion, which is illegal in this country. The latter is often the result of unintended pregnancies. In undergoing abortion, itself a difficult decision, a woman is faced with the possibility of permanent injuries, even death, and of being charged in court, and condemned by the Church.

It is difficult to ascertain the magnitude of the problem nationwide, but a study conducted in 1994 estimated the number of induced abortions annually anywhere from a low of 320,000 to a high of 480,000.

Through a wider and more effective use of contraceptives, the incidence of abortion will be lessened. Data has shown that this has been the experience in many countries in Europe and in Chile.

A major factor of unmet need is the inequality between men and women in this country. Despite advances in women's rights here and abroad, it is still a man's world. With marriage, a woman is treated as her husband's possession and the husband behaves as though he has the right to her body, as a 1998 study here has pointed out. Sex becomes an obligation to one's husband, although this does not mean the wife will give in all the time.

Often the woman will submit out of the need to maintain harmony, pity and fear that a refusal will cause her husband to think her unfaithful, or that he may look for sex somewhere else.

In some cases, a husband denied his "marital rights" may become violent. Violence against women (VAW) is an international problem, a priority area of concern, a violation of human rights and, most certainly, a public-health issue. In 1997, a Progress of Nations Report issued by the United Nations Children's Fund (UNICEF) declared that 60 million women are missing due to violence arising out of gender discrimination.

In the Philippines, there are many acts of domestic violence, and the victims are often women. This is a national shame. A few were even harmed during pregnancy. One way of curbing this is to involve the men, in partnership with the women, in reproductive health. This is a new advocacy, and it is not an easy task. But there are gender-sensitive and peaceful men who can possibly take the lead in this crusade for human rights.

The costs of not meeting the need for family planning are serious, sometimes tragic. Unmet need leads to unplanned pregnancies, closely spaced births, larger families, more abortion cases, higher death rates among infants, children and mothers; malnourished mothers and children, and lowered productivity. The 1983 Cebu Longitudinal Health and Nutrition Survey of more than 3,000 women supports the link between unmet need and lowered productivity.

A potent weapon in lowering the infant mortality rate is child immunization. The fully immunized child is protected from such diseases as polio and measles.

Data from the 1993 and 1998 National Demographic Surveys show that the ARMM had the lowest immunization coverage at 47 percent, followed by the Ilocos at 61 percent. The highest coverage rates were in Western Visayas (87percent), Cagayan Valley (83 percent), Southern Mindanao (83 percent), and Caraga (79 percent).

The good news is that the national child mortality rate has been decreasing, from 24.3 deaths per 1,000 population in 1993 to about 18.9 deaths per 1,000 in 1998. The maternal mortality ratio was 209 deaths per 1,000 live births in 1993, and 172 deaths per 1,000 live births. This also indicates a decline, but the findings have to be validated. Equally important is prenatal care. However, only eight out of 10 mothers received the minimum prenatal checkup. A related component is nutritional status. In the 1980s, the proportion of underweight children was about 33 percent (compared to 39 percent in the mid-1970s), and remained stable until the 1990s. This is still not an encouraging indication since in comparison to Thailand it dropped to 13 percent in the 1990s.

One objective of the Philippine Population Management Program is to lessen the number of high-risk pregnancies, which could be said of 60 percent of all pregnancies in the country in 1998. Risk of complication rises steadily after the third birth onward.

Most maternal deaths are due to hemorrhage, hypertension and complications. These occur during and shortly after delivery, indicating shortcomings in maternal care, particularly prenatal checkups and safe delivery practices.

Teenage pregnancies (and those of women over 35) are considered high risk. The sobering fact is that about 1.8 million Filipino males and 670,000 females aged 15-24 are already sexually active. At greater risk are the out-of-school youth (estimated at 5.5 million), mostly urban, and those youths in the labor force, mostly rural.

Many of the sexually active adolescents do not have the necessary knowledge to avoid pregnancy and sexually transmitted diseases.

The government has adopted a two-pronged strategy to address the unmet need of individuals and households for family planning, contraceptive choice and reproductive health. First, it encourages self-reliance and freedom of choice. Second, it strengthens its role in equalizing access to reliable and safe contraceptive methods and enhances the knowledge base about fertility regulation and reproductive health.

The government launched its population policy and family planning program under the Commission on Population (Popcom) in 1971. At first the program was mainly one of setting numerical targets for crude birth and death rates, and directly providing all acceptable contraceptive methods. Today the program integrates family planning with reproductive health, adolescent health, gender equity and sustainable development.

For the program to succeed, it is deemed important to empower women by allowing them to be better educated and economically independent, with greater access to quality health care and actively participating in decisions that affect their lives. This way they have more dignity, self-respect and space to assert their will in reproductive and sexual matters. But they need to overcome some barriers to seeking family planning services. These barriers are: access to information, limited resources and lack of appropriate and accessible facilities with quality services for maternal care.

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