National Demographic and Health Survey 2008

The 2008 National Demographic and Health Survey (2008 NDHS) is a nationally representa­tive survey of 13,594 women age 15-49 from 12,469 households successfully interviewed, covering 794 enumeration areas (clusters) throughout the Philippines. This survey is the ninth in a series of demographic and health sur­veys conducted to assess the demographic and health situation in the country. The survey obtained detailed information on fertility levels, marriage, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, and knowledge and attitudes regarding HIV/AIDS and tuberculosis. Also, for the first time, the Philippines NDHS gathered information on violence against women.

The 2008 NDHS was conducted by the Phil­ippine National Statistics Office (NSO). Techni­cal assistance was provided by ICF Macro through the MEASURE DHS program. Funding for the survey was mainly provided by the Gov­ernment of the Philippines. Financial support for some preparatory and processing phases of the survey was provided by the U.S. Agency for International Development (USAID).

Like previous Demographic and Health Surveys (DHS) conducted in the Philippines, the 2008 National Demographic and Health Survey (NDHS) was primarily designed to provide information on population, family planning, and health to be used in evaluating and designing policies, programs, and strategies for improving health and family planning services in the country. The 2008 NDHS also included questions on domestic violence. Specifically, the 2008 NDHS had the following objectives:

• Collect data at the national level that will allow the estimation of demographic rates, particularly, fertility rates by urban-rural residence and region, and under-five mortality rates at the national level.
• Analyze the direct and indirect factors which determine the levels and patterns of fertility.
• Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region.
• Collect data on family health: immunizations, prenatal and postnatal checkups, assistance at delivery, breastfeeding, and prevalence and treatment of diarrhea, fever, and acute respiratory infections among children under five years.
• Collect data on environmental health, utilization of health facilities, prevalence of common non­communicable and infectious diseases, and membership in health insurance plans.
• Collect data on awareness of tuberculosis.
• Determine women's knowledge about HIV/AIDS and access to HIV testing.
• Determine the extent of violence against women.

MAIN RESULTS

FERTILITY

Fertility Levels and Trends. There has been a steady decline in fertility in the Philippines in the past 36 years. From 6.0 children per woman in 1970, the total fertility rate (TFR) in the Phil­ippines declined to 3.3 children per woman in 2006. The current fertility level in the country is relatively high compared with other countries in Southeast Asia, such as Thailand, Singapore and Indonesia, where the TFR is below 2 children per woman.

Fertility Differentials. Fertility varies substan­tially across subgroups of women. Urban women have, on average, 2.8 children compared with 3.8 children per woman in rural areas. The level of fer­tility has a negative relationship with education; the fertility rate of women who have attended college (2.3 children per woman) is about half that of women who have been to elementary school (4.5 children per woman). Fertility also decreases with household wealth: women in wealthier households have fewer children than those in poorer households.

FAMILY PLANNING

Knowledge of Contraception. Knowledge of family planning is universal in the Philippines- almost all women know at least one method of fam-ily planning. At least 90 percent of currently married women have heard of the pill, male condoms, injectables, and female sterilization, while 87 percent know about the IUD and 68 percent know about male sterilization. On aver­age, currently married women know eight meth­ods of family planning.

Unmet Need for Family Planning. Unmet need for family planning is defined as the percentage of currently married women who either do not want any more children or want to wait before having their next birth, but are not using any method of family planning. The 2008 NDHS data show that the total unmet need for family planning in the Philip­pines is 22 percent, of which 13 percent is limiting and 9 percent is for spacing. The level of unmet need has increased from 17 percent in 2003.

Overall, the total demand for family planning in the Philippines is 73 percent, of which 69 percent has been satisfied. If all of need were satisfied, a contraceptive prevalence rate of about 73 percent could, theoretically, be expected. Comparison with the 2003 NDHS indicates that the percentage of de­mand satisfied has declined from 75 percent.

MATERNAL HEALTH

Antenatal Care. Nine in ten Filipino mothers received some antenatal care (ANC) from a medical professional, either a nurse or midwife (52 percent) or a doctor (39 percent). Most women have at least four antenatal care visits. More than half (54 per­cent) of women had an antenatal care visit during the first trimester of pregnancy, as recommended. While more than 90 percent of women who received ante­natal care had their blood pressure monitored and weight measured, only 54 percent had their urine sample taken and 47 percent had their blood sample taken. About seven in ten women were informed of pregnancy complications. Three in four births in the Philippines are protected against neonatal tetanus.

Delivery and Postnatal Care. Only 44 per­cent of births in the Philippines occur in health facilities-27 percent in a public facility and 18 percent in a private facility. More than half (56 percent) of births are still delivered at home. Sixty-two percent of births are assisted by a health professional-35 percent by a doctor and 27 percent by a midwife or nurse. Thirty-six percent are assisted by a traditional birth atten­dant or hilot. About 10 percent of births are de­livered by C-section.

The Department of Health (DOH) recom­mends that mothers receive a postpartum check within 48 hours of delivery. A majority of women (77 percent) had a postnatal checkup within two days of delivery; 14 percent had a postnatal checkup 3 to 41 days after delivery.

CHILD HEALTH

Childhood Mortality. Childhood mortality continues to decline in the Philippines. Cur­rently, about one in every 30 children in the Philippines dies before his or her fifth birthday. The infant mortality rate for the five years be­fore the survey (roughly 2004-2008) is 25 deaths per 1,000 live births and the under-five mortality rate is 34 deaths per 1,000 live births. This is lower than the rates of 29 and 40 reported in 2003, respectively. The neonatal mortality rate, representing death in the first month of life, is 16 deaths per 1,000 live births. Under-five mortal­ity decreases as household wealth increases; children from the poorest families are three times more likely to die before the age of five as those from the wealthiest families.

There is a strong association between under-five mortality and mother's education. It ranges from 47 deaths per 1,000 live births among chil­dren of women with elementary education to 18 deaths per 1,000 live births among children of women who attended college. As in the 2003 NDHS, the highest level of under-five mortality is observed in ARMM (94 deaths per 1,000 live births), while the lowest is observed in NCR (24 deaths per 1,000 live births).

NUTRITION

Breastfeeding Practices. Eighty-eight percent of children born in the Philippines are breastfed. There has been no change in this practice since 1993. In addition, the median durations of any breastfeeding and of exclusive breastfeeding have remained at 14 months and less than one month, re­spectively. Although it is recommended that infants should not be given anything other than breast milk until six months of age, only one-third of Filipino children under six months are exclusively breastfed. Complementary foods should be in­troduced when a child is six months old to re­duce the risk of malnutrition. More than half of children ages 6-9 months are eating complemen­tary foods in addition to being breastfed.

The Infant and Young Child Feeding (IYCF) guidelines contain specific recommendations for the number of times that young children in vari­ous age groups should be fed each day as well as the number of food groups from which they should be fed. NDHS data indicate that just over half of children age 6-23 months (55 percent) were fed according to the IYCF guidelines.

HIV/AIDS

Awareness of HIV/AIDS. While over 94 percent of women have heard of AIDS, only 53 percent know the two major methods for pre­venting transmission of HIV (using condoms and limiting sex to one uninfected partner). Only 45 percent of young women age 15-49 know these two methods for preventing HIV transmis­sion. Knowledge of prevention methods is higher in urban areas than in rural areas and in­creases dramatically with education and wealth. For example, only 16 percent of women with no education know that using condoms limits the risk of HIV infection compared with 69 percent of those who have attended college.

TUBERCULOSIS

Knowledge of TB. While awareness of tubercu­losis (TB) is high, knowledge of its causes and symptoms is less common. Only 1 in 4 women know that TB is caused by microbes, germs or bacteria. Instead, respondents tend to say that TB is caused by smoking or drinking alcohol, or that it is inherited. Symptoms associated with TB are better recognized. Over half of the respondents cited coughing, while 39 percent mentioned weight loss, 35 percent men­tioned blood in sputum, and 30 percent cited cough­ing with sputum.

WOMEN'S STATUS

Women's Status and Employment. Sixty percent of currently married women age 15-49 interviewed in the 2008 NDHS were employed in the year before the survey. Among those who are employed, most earn cash, while 6 percent are unpaid. Most women decide how their earn­ings are spent jointly with their husbands. Only four percent report that mainly their husband decides how their earnings are spent.

DOMESTIC VIOLENCE

Spousal Violence. Emotional and other forms of non-personal violence-such as insults, humiliation, and threats of harm-are the most common types of spousal violence: 23 percent of ever-married women report having experienced such violence by their husbands, with 15 percent reporting these types of violence occurred in the year prior to the survey.