FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS: 2003 NDHS

III. FERTILITY DIFFERENTIALS

3.1 By Residence

Data in Table 10 indicate that for the country as a whole, the total fertility rate in urban is lower than that of rural. In 1993, the TFR for urban area is 3.53 births per woman, 1.29 less than the rural TFR. In 1998, the TFR for urban area is 1.66 births less than the rural TFR while in 2003, the rural TRF is 1.3 births per woman more than that of the TFR of urban. The age-specific fertility rates (ASFRs) among the rural women are higher than among the urban residents, irrespective of age group.

Urban-rural differentials in age-specific fertility rates by age group in 1993 tended to be high in the early (15-24 years) and age 45-49 years. The largest differential by residence was manifested in age 45-49 years. The same pattern is observed in 1998 and 2003. The highest differential by age group is observed in age 45-49 years. The pattern is increasing. From 140 percent in 1993, the difference decreased to 150 percent in 1998 and 167 percent in 2003. The trend is contrary to the previous results where the highest urban-rural differential is noted in the early years (De Guzman, 1980). Substantial differences were observable also for women aged 15-24 years and 40-44 years (1993), 15-24 years and 35-44 years (1998) and 15-19 years and 35-44 years (2003).

High urban-rural differentials may eventually disappear with the growing efforts in successful contraceptive use in both urban and rural areas (United Nations, 1975) but the data presented above does not seem to support this, yet. The percentage difference of births per 1,000 women in urban and rural is quite high on based on the latest three national demographic and health surveys conducted. The figures are 36 percent, 55 percent and 43 percent for 1993, 1998 and 2003, respectively.

and by Age Group, Philippines: 1993, 1998 and 2003
Table 10
Age-Specific Fertility Rates Per 1,000 Women by Residence

Year/ Residence	Births Per 1,000 Women Aged							TFR
	15-19	20-24	25-29	30-34	35-39	40-44	45-49
1993
Urban	36	157	203	161	102	42	5	3.53
Rural	72	239	236	205	140	62	12	4.82
Total	50	190	217	181	120	51	8	4.09
% Difference
(R/U–1.0x100)	100	52	16	27	37	48	140	36
1998
Urban	30	137	182	133	84	32	4	3.01
Rural	69	233	247	183	142	50	10	4.67
Total	46	177	210	155	111	40	7	3.73
% Difference
(R/U–1.0x100)	130	70	36	38	69	56	150	55
2003
Urban	40	157	170	124	77	29	3	3.0
Rural	74	213	219	164	118	61	8	4.3
Total	53	178	191	142	95	43	5	3.5
% Difference
(R/U–1.0x100)	85	36	29	32	53	110	167	43

Sources: 1993, 1998 and 2003 NDHS


3.2 By Education

The negative relationship between fertility and education is present in the Philippines. This is clearly borne out by the data given on Table 11. The decrease in total fertility rates, however, has not changed drastically over time with increasing educational level for the last decade. In 1993 married woman with elementary education have a higher fertility than those who have no education at all. This indicates that acquiring only a modicum of education may not guarantee reductions in fertility. However, the fertility level of married women with no education showed an increasing trend (4.9 in 1993, 5.0 in 1998 and 5.3 in 2003). The depressing effect of education on fertility is best indicated by the difference in fertility rates between women with no education (4.9 children per woman in 1993, 5.0 in 1998 and 5.3 in 2003) and those with college or higher education (2.8 children per woman in 1993, 2.9 in 1998 and 2.7 in 2003). Thus, a Filipino woman without education can be expected to have almost as twice as many children as a highly educated woman.

Philippines: 1993, 1998 and 2003
Table 11

Total Fertility Rates Per Ever-Married Woman by Education,

Education	Total Fertility Rate (TFR)*
	1993	1998	2003
No education	4.9	5.0	5.3
Elementary	5.5	5.0	5.0
High school	3.9	3.6	3.5
College or higher	2.8	2.9	2.7

* Rate for women age 15-49 years

Source: 1993, 1998 and 2003 NDHS

There is also a decreasing pattern in the mean children ever born per ever-married woman with increasing level of education. However, between 1998 and 2003 there is an increase in the mean children ever born among those women who had no education and those with college education or higher in the same period. All of these data imply that there is a need to improve the educational status of the population especially among the females. Different Philippine studies consistently pointed that education per se has a significant role in lowering fertility. Education enables women to be more proactive in addressing their economic well-being and reproductive health.

Table 12
Philippines: 1993, 1998 and 2003


Children Ever Born Per Ever-Married Woman by Education,

Education	Children Ever Born (CEB)*
	1993	1998	2003
No education	6.07	5.42	6.10
Elementary	5.93	5.46	5.30
High school	4.40	4.24	4.20
College or higher	3.10	2.86	2.90

* Refers to women age 40-49 years

Source: 1993, 1998 and 2003 NDHS

Age has been considered as the most basic characteristic of a population. It has a considerable impact on its demographic and socio-economic behavior. For instance, older women produce greater number of children. The cumulative fertility or the mean children ever born per married woman by age in three different periods are displayed in Table 14. It can be observed from the table above that there is a pattern of a rising cumulative fertility with increasing age in three sources of data. Current parity as a measure of fertility makes no reference to the timing of fertility of individual women but refers merely to the cross-sectional view at the time of the interview. The average CEB of women who are nearing the end of their childbearing, that is, aged 45-49 years, is used as an indicator of completed fertility. This measure of completed fertility is commonly used in fertility differential analysis provided the data for these women are not subject to errors of age-misreporting and omission of births. All age groups exhibited a declining pattern in the average CEB from 1993 to 2003. Women belonging to age group 25-29 exhibited the biggest percentage of decline among the childbearing age groups from 1993 to 2003 (2.58 children and 2.15 children, respectively) which is 17 percent. Age group 15-19 declined by 12 percent which is the lowest decrease among the childbearing age groups. Age of woman is positively related to fertility.

Table 14

Average Number of Children Ever Born Per Ever-Married Woman

by Age, Philippines: 1993, 1998 and 2003

Age Group	1993	1998	2003
15-19	0.83	0.79	0.73
20-24	1.62	1.53	1.36
25-29	2.58	2.35	2.15
30-34	3.55	3.25	3.05
35-39	4.40	4.11	3.84
40-44	5.09	4.58	4.42
45-49	5.67	5.14	4.86

Sources: 1993, 1998 and 2003 National Demographic and Health Survey

Attitudes Relating to Family Size Structure and Formation/ Knowledge of and Attitudes Towards Contraception

The effects of this group of explanatory variables on fertility may be more indirect through the intermediate variables, namely: age at marriage, voluntary abstinence, use or non-use of contraception, induced abortion, and fecundity or infecundity. Some Philippines studies are cited for a better understanding of the complicated causal mechanism of the fertility determinants.

The very high level of contraceptive knowledge (above 90 percent) at national or regional levels implies that if there is consistency between preferences and behavior, knowledge of contraception is a strong factor affecting fertility indirectly via use and non-use of contraception. However, as yielded by the 1978 RPFS, only 60.3 percent of women at risk of pregnancy who do not want another child used some method of family planning. Of them, less than one-half (29 percent) used a modern method – pill, IUD, condom, male or female sterilization (Pullum, Immerwar, and Cabigon, 1982). The same authors discovered that actual family size, i.e., the number of living children including any current pregnancy, played the greatest role in explaining the desire to stop childbearing but was slightly associated with current use. Moreover, it was found that the likelihood of use did not increase with the number of unwanted children already born t the woman. It will be recalled that ethnicity, religion and education emerged as strong determinants of the desired family size. A related study by Palmore and Concepcion (1981) found that only 5 percent of the variance in current use was accounted for by the desire for another child, after the inclusion of other life cycle and socio-economic variables. Whether the women are rationalizing achieved family size or implementing family size desired leads one to question the data on desired family size.

In studying the value of children to Filipino parents, Bulatao (1975) found a poor association between contraceptive use and child values. This finding suggests that many couples do not attempt to control family size to maximize child values. The link between social interaction values and family size desires suggests that a change in the quality of social relations could reduce preferences. What is probably involved here is a modernization of the value system which is a long drawn-out process, difficult to achieve and massive in scale. The connection found between the financial burden of children and the desire for fewer children was taken as an indication that the burden should be increased particularly for higher-order children. A few positive values, for example, children as incentive to succeed, sometimes have negative consequences on number preference and positive influences on family planning practice. Since these values seem to be generally related to education, Bulatao proposed that if these could be pinned down with greater precision “it might be useful to emphasize such values at the expense of other values that lead to large families”.

Intermediate Variables

The variables falling this group are only those through which modernization an other processes can affect fertility in any society. Davis and Blake (1956) identified eleven “intermediate” variables:

1. Factors Affecting Exposure to Intercourse
1. Formation and dissolution of unions

<!--[if !supportLists]-->1. Age at entry into sexual unions<!--[endif]-->

<!--[if !supportLists]-->2. Permanent celibacy<!--[endif]-->

<!--[if !supportLists]-->3. Amount of reproductive period spent after or between unions<!--[endif]-->

2. Exposure to intercourse within unions

<!--[if !supportLists]-->4. Voluntary abstinence<!--[endif]-->

<!--[if !supportLists]-->5. Involuntary abstinence<!--[endif]-->

<!--[if !supportLists]-->6. Coital frequency<!--[endif]-->

2. Factors Affecting Exposure to Conception

<!--[if !supportLists]-->7. Fecundity or infecundity as affected by involuntary causes<!--[endif]-->

<!--[if !supportLists]-->8. Use or non-use of contraception<!--[endif]-->

<!--[if !supportLists]-->9. Fecundity a affected by involuntary causes<!--[endif]-->

3. Factors Affecting Gestation and Successful Parturition

<!--[if !supportLists]-->10. Fetal mortality from involuntary causes<!--[endif]-->

<!--[if !supportLists]-->11. Fetal mortality from voluntary causes<!--[endif]-->

Only four of these variables are examined in detail here using Philippine data. These are: a) age-at-first marriage or age at entry into sexual unions, b) contraceptive use, c) breastfeeding, and d) fetal mortality.

Table 15

Mean Number of Children Ever Born to Ever-Married Women Who are Near the Childbearing by Occupation

Occupation	1993 NDHS	1998 NDHS	2003 NDHS
Not working		3.8
Farmers		4.4
Blue Collar		2.1
White Collar		2.0

Table 16

Mean Number of Children Ever Born to Ever-Married Women Who are Near the Childbearing by Labor Force Status

Labor Force Status	1993 NDHS	1998 NDHS	2003 NDHS
In the labor force	2.7
Not in the labor force	2.6

Age-at-Marriage. It can be seen from Table 17 that the average number of children per woman decreased systematically with increasing age at first marriage in three surveys. It has been repeatedly asserted that the fertility decline in the Philippines in the sixties was attributed to delayed marriage or to an increase in the average age at first marriage.

Given the important role of nuptiality in directly affecting fertility, the role of the socio-economic structure, environment and cultural characteristics in affecting fertility via age at first marriage is worth including. In his analysis of the determinants of age at marriage, de Guzman (1982) fixed upon the region of residence and education as the most important determinants.

The average age at first marriage in the Philippines currently falls between that of countries to the north (China, Korea, Japan – average age 25 years or older) and countries to the south (Indonesia, Vietnam – average age 21 years or younger). The average age at first marriage has been relatively stable in the Philippines for several decades. It is usually assumed that age at first marriage is especially sensitive to changes in school participation rates, but in the Philippines female educational attainment has been relatively high for some time and there seems little room for substantial increase on average. In short, it is difficult to evaluate the prospects for an increase in the age at first marriage – a two- or three-year increase to East Asia n patterns is conceivable, but there is at present no evidence of a shift in this direction. Were such marriage postponement to occur, it seems likely that there would be attendant increases in pre-marital conceptions and births that would at least partially offset the fertility depressing effect of marriage delay (Costello, Casterline).

Table 17

Mean Number of Children Ever Born to Ever-Married Women Who are Near the Childbearing by Age at First Marriage

Age at First Marriage	1993 NDHS	1998 NDHS	2003 NDHS
15-19	4.5	4.0	5.2
20-24	3.6	3.9	4.5
25-29	2.8	3.5	4.4

Contraceptive Use. One of the challenges facing the Philippines during the next 25 years derives in part from the future growth in the number of women of reproductive ages (15-49) – the number rises from 18 million in 1995 to 30 million in the year 2020 (Population Trends in the Philippines: U.S. Bureau of the Census). The level of contraceptive use is a very important variable in the study of fertility. Contraceptive use has the significant role in effecting changes in marital fertility as shown in all existing findings. Estimates of the percentage reduction in conceptions by Laing (1981) indicated that use of even the least effective methods, rhythm, withdrawal and condoms, reduced the conception rate by 50 percent or more. The use of pills, combinations, and abstinence reduced the likelihood of conception by about four-fifths. The IUD reduced the probability of conception by about 95 percent. Sterilization, as expected, virtually eliminated the possibility of conception.

Education, religion, ethnicity, and region of residence emerged as important determinants of use (Pullum, Immerwahar and Cabigon, 1982). Other multivariate analyses done by the author suggest that field workers acting as source of supplies had a greater impact on current use than when they are served only to disseminate family planning knowledge and access. With the analyses of determinants of some related methods, it was seen that in urban areas, the closer the perceived distance to obtain a supply of condoms and the less expensive it is, the more likely it will be used.

Survey data on unwanted fertility show that the fraction of births that were unwanted increased during the 1990s, from 15.9 per cent in 1993 to 18.2 per cent in 1998. According to the 1998 NDHS, a further 27 per cent of births in the three years prior to the survey were mistimed (wanted later), resulting in a total of 45 per cent of births unplanned. The key component for this discussion is unwanted fertility.

If these were eliminated and other aspects of reproduction were held constant, the TFR would have been about one birth less in the mid 1990s—yet still well above replacement—at 2.7 births per woman. Unless this substantial amount of unwanted fertility is largely eliminated, it is difficult to imagine how fertility in Philippines could fall to replacement-level during the next few decades.

Contraceptive prevalence increased from 40.0 per cent in 1993 to 46.5 per cent in 1998 and to 48.9 percent in 2003 (see Table 18), and during the same period unmet need declined from 26.2 per cent to 19.8 per cent. The increase in prevalence occurred in both urban and rural areas, although the increase was larger in urban areas. These figures indicate important progress towards contraceptive protection for those couples who do not want to conceive.

Nevertheless, there are significant programmatic, social, cultural, and economic barriers to contraceptive use. In the first place, problems of inaccessible services continue to plague the Philippine population program. The shift in the management of the family planning program from the national Department of Health to the local government, as mandated by the Local Government Code of 1991, has created discontinuities in political commitment and localized weaknesses in the financial and technical support for the program. Compounding the management problems created by devolution is the already noted Catholic Church opposition to contraceptive practice. One consequence of this opposition is a shortfall in the allocation of funds by some local government officials to family planning, compounded by declines in external donor support. For this and other reasons, problems of sustainability and logistics continue to plague the program. There are reports of absence of contraceptive supplies, for example in remote areas of Mindanao. Finally, due to the bias of service providers, contraceptive services are largely unavailable to the young and unmarried.

One expression of these shortcomings in the provision of family planning supplies and services is that contraceptive discontinuation rates remain high, in fact increasing from 1993 to 1998. The major reasons for discontinuation cited in the 1998 NDHS are method failure and fear of side effects. In fact the fraction of contraceptive discontinuations due to method failure remained constant between 1993 and 1998, and this might be taken as a sign of greater attention to quality of care in the provision of family planning. Among the efforts in this direction is the recent development of the Sentrong Sigla (Centers of Wellness) program of the Department of Health. Nevertheless, method failure remains among the most common causes of discontinuation, and this in turn directs attention to the problem of low contraceptive efficacy. Contraceptive practice in the Philippines is characterized by a method mix of modern and “traditional” (and less effective) methods, with traditional methods constituting a far higher portion of the mix than is found in most countries, on the order of forty percent according to the 1998 NDHS (see Table 18). The two main traditional methods are periodic abstinence and withdrawal, both of which have relatively low use-effectiveness. The rising price of contraceptives and the decreased provision of contraceptives free of charge are incentives for continued heavy reliance on these two cost-free methods.

A program to introduce the standard days approach for the practice of natural family planning, which might serve to increase its use-effectiveness, has recently been implemented in pilot areas in the country. It is hoped that this new approach enjoys some success. Otherwise, significant reliance on natural family planning without an increase in its effectiveness means either a continued relatively high level of unwanted fertility and/or recourse to clandestine abortion, with the attendant risks to the health and wellbeing of women. If desired fertility were indeed to fall to replacement level (or even further), then couples in the Philippines would be subjected to even longer periods of risk of unwanted pregnancies than is the case at present (provided that sexual exposure does not decline). While some unwanted pregnancies in the Philippines are intentionally aborted, this remains an inconvenient and health-threatening option for most women. We believe that it is highly unlikely that induced abortion will become a common means of avoiding unwanted births in the near future. Hence, the prevention of unwanted births depends on the use of effective means of family planning by couples who wish to avoid pregnancies. As briefly reviewed here, there are a variety of barriers – programmatic, social, cultural, economic – to effective contraceptive practice. Most of these barriers, moreover, have been widely-known features of the contraceptive decision-making environment in the Philippines for decades. If unwanted fertility is fall to a level consistent with the attainment of replacement-level fertility, there will need to be radical changes in contraceptive practice. And these in turn will depend on sharp reduction in the current barriers to effective contraceptive practice.

Table 18

Trends in Age at First Marriage and Contraceptive Use: Philippines, 1983-2003
Survey	Age at	Contraceptive Prevalence
	First Marriage	Modern Methods	Traditional Methods	Total
1983 NDHS	23.3	18.9	13.1	32
1988 NDHS	23.8	21.6	14.5	36.1
1993 NDHS	23.4	24.9	15.1	40
1998 NDHS	23.5	28.2	18.3	46.5
2003 NDHS	22	33.4	15.5.	48.9

Source: 2003 National Demographic and Health Survey

REFERENCES:

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Cabigon, Josefina V. “Why is Philippines Lagging Behind her Southeast Asian Neighbors in Fertility. Decline?” www.populationasia.org/Events/2002/Event_100402/PaperList_Workshop10Apr02.pdf

Costello, Marilou P. and John B. Casterline. “Fertility Decline in the Philippines: Current Status, Future Prospects.” www.un.org/esa/population/publications/completingfertility/RevisedCOSTELLO-CASTERLINEpaper.PDF

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