Cablegate: Health and Population in the Philippines

Published: Thu 31 Jul 2008 07:19 AM
DE RUEHML #1818/01 2130719
P 310719Z JUL 08
E.O. 12958: N/A
1. (SBU) Summary: In the aftermath of the July
11 World Population Day ceremonies in Manila,
many civil society and legislators have expressed
their opinions on the country's need and ability
to extend family planning services more widely.
There has been a vigorous public debate,
extensively covered by the news media, between
those who advocate the Catholic Church position
against all "artificial" family planning and
contraceptive methods and others who caution
that the Philippines' population growth is
outpacing the country's economic growth and its
ability to meet the food-supply needs of the
entire population. Landmark appropriations and
draft legislation reflect increasing commitment
within the Philippine Government to further
expand and sustain programs started forty years
ago with U.S. Government's assistance through
USAID. The U.S. Government continues to be the
largest donor in the Philippine population
sector supporting efforts to improve local
government service delivery and increase
private sector contributions to family health
World Population Day in the Philippines
2. (SBU) World Population Day was initiated
on July 11, 1989. This day was inspired by the
"Five Billion Day," which occurred on July 11,
1987, when the world's population was estimated
to have reached 5 billion people. Over the
past 19 years, World Population Day has been a
focal point for bringing to light connections
between reproductive rights, population size
and environmental, economic, and human rights
issues. "Family Planning: It's a Right,
Let's Make It Real," is the global theme for
this year's World Population Day. The
Philippines conducted a number of events
starting first with a national-level forum
supported by the United Nations Population Fund.
Activities included a national essay-writing
contest held by youth groups; a provincial
poster-making contest sponsored by the
Philippine Department of Education;
intercollegiate debates hosted by the University
of the Philippines and Ateneo de Manila
University; and discussions on radio stations
on the current situation and the implications of
population growth on economic development. An
NGO-led Family Planning Fair was held in
cooperation with the Health Office of Manila
City to provide modern family planning services
signifying the revival of publicly funded
reproductive health care services. Numerous
articles, talk shows and debates on the state
of the Philippine population sector with emphasis
on a draft legislative bill promoting access to
family planning services were also published and
aired on major media networks.
Population and family planning in the
3. (SBU) The latest Philippine census results
were released on April 16, 2008. Based on the
findings, the population count in the country as
of August 1, 2007 was 88.6 million. According
to the census, three Filipinos are born every
minute, 200 babies per hour. The National
Demographic and Health Survey of 2003 reports
that the average Filipino woman has, on average,
three children during her reproductive life span.
According to the survey, most women would desire
to have only two. Two out of five married women
of reproductive age have reported that they are
not using family planning methods even though
they desire to practice contraception indicating
an unmet need for services. The Philippines,
the twelfth most populous country in the world,
is expected to double its population size by
4. (SBU) The Philippine National Family Planning
Policy of 2001 affirms the importance of family
planning as an essential health service to prevent
high-risk pregnancies, reduce maternal deaths and
contribute towards poverty reduction. The
Department of Health (DOH) is the national
government agency entrusted to formulate policy
and set standards. Under the auspices of the DOH,
the Population Commission (POPCOM) is responsible
for advocacy and institutional support to all
agencies involved in population and development.
As the Philippine health sector is decentralized,
publicly funded family planning services and
commodities are provided by local government
units (LGUs), i.e. chartered cities and
municipalities. Currently, the Department of
Health is not directly providing funds for
contraceptives but is planning to provide grants
to LGUs for a range of family health services
and commodities. The availability of subsidized
commodities to be provided to the poor is
dependent upon the ability of local government
to allocate budgetary resources for family
planning. Recently, a group of Philippine
Congressional Representatives crafted a
consolidated reproductive health bill that
promotes access to family planning along with
other health services such as safe delivery,
breastfeeding, prevention and treatment of
HIV/AIDS and sexually transmitted infections.
The bill discusses extending services
through mobile clinics and coverage for family
planning services by the national health
insurance program. The bill also refers to the
need for a nationwide information campaign
on responsible parenthood and reproductive
health and states that abortion would continue
to be illegal in the Philippines. The new bill
and its previous versions have raised the volume
of the vigorous public debate on reproductive
issues among between civil society, NGOs, the
Catholic Church and legislators. The controversy
has generated news media coverage and editorial
commentary from all sides.
US Government's assistance program
5. (SBU) USAID's family planning assistance
is channeled through a comprehensive health
sector support program that also emphasize
maternal care and child survival, prevention of
HIV/AIDS, control of tuberculosis and prevention
of avian influenza. The focus of the family
planning component is to promote access of
Filipino couples to quality services and
commodities. The key activities within the
public sector are to build the capacity of local
government to effectively serve the poor, reach
households most in need, and strengthen LGU
systems to plan, budget, procure and distribute
commodities, and improve the quality of care and
counseling. In parallel, within the private
sector, USAID technical assistance enables
pharmaceutical companies to launch lower-priced
contraceptive products, and to expand choices
among consumers with more brands on the market.
The private sector program also prioritizes low
income communities, with a focus to improve
access to quality services through midwives and
workplace health programs.
6. (SBU) The 2003 National Demographic and
Health survey reports that the key reason why
most Filipinos do not practice family planning
is because of myths and misconceptions around
modern methods. USAID assistance is helping
disseminate complete and accurate information by
improving the counseling skills of service
providers, and by expanding the availability of
accurate information on modern family planning
methods within grass-roots communities. USAID
programs engage with almost 700 municipalities
and major cities, and provide technical advisory
support to the Philippine Department of Health
on sector reform and financing policies.
7. (SBU) Within the past three years, annual
funding levels for population and family planning
from the US Government have increased from around
$13M to $15M. Since 2003, in response to the
Philippine Government's move to reach
self-reliance in contraceptive supply, USAID has
phased down the support for condoms, pills,
injectable contraceptives and intra-uterine
devices. The final shipment of US donated
commodities will be at the end of December 2008.
Previously, the private pharmaceutical sector
was not able to compete with free commodities
from the public sector. The decision to phase
out contraceptive donations was made to support
the Philippine Government's contraceptive
self-reliance initiative and to focus US
resources on helping develop ways to reach
those who currently lack access to family
planning services. USAID and the Philippine
Government continue to monitor the impact of
The phase out on availability and use of family
planning services within the population.
So far, so good
8. (SBU) Use of family planning methods
remains stable even with the phase-out of
donated contraceptive supplies. Data from 2005
and 2006 national family planning surveys indicate
that contraceptive use has not declined. The use
of oral contraceptive pills has increased
steadily among the poor (by 30% in the past five
years) with no significant difference between
urban and rural households. The increase in
modern family planning use in rural areas from
2000 to 2006 is due to an increase in the use of
pills. The private sector as a source of supply
has increased significantly, from 33% to 41%, in
the past three years. The poor spend around
US$0.40 for pills, and the rich pay about
US$1 for the same method. It appears that the
private sector is reaching both poor and
non-poor consumers. The use of private sector
sources in both groups has increased, by 41%
among the poor and 21% among the non-poor. The
commitment and capability for service provision
within local government units has improved
significantly within the past three years with
LGUs approving medium-term investment plans to
provide family planning services together with
other basic health services. Around 60% of
municipalities have issued local policies to
provide reproductive health services and/or have
allocated funding for contraceptives. At the
national level, the Philippine Congress
allocated $3.38 M in 2007 earmarked for family
planning commodities within the General
Appropriations Act, which was significantly
increased to $27 M in 2008. This is a major
milestone indicating fiscal readiness to move
towards self sufficiency for contraceptive
Looking to the Future
9. (SBU) The ability to plan family size and
spacing of births leads to better health of
mothers and children. The 2003 National
Demographic and Health Survey points out that
one out of every two deliveries resulted from
a mistimed or unwanted pregnancy. Further
analyses reveal that mothers with unintended
pregnancies are less likely to deliver in a
health facility under hygienic conditions
assisted by trained practitioners. The sector
requires continued support to improve local
level service delivery, scale up successful
private sector efforts, ensure contraceptive
security and implement nation-wide health
promotion interventions. These approaches,
in combination, would enable Filipino men and
women to make appropriate choices for better
family health outcomes. The U.S. Government
continues to be a leader in population assistance
to the Philippines. This assistance is an
important factor in sustaining momentum as the
nation's family planning program moves toward
self sufficiency.
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