Assessment of Intervention Programs on Sexual Reproductive Health of Couples in Catbalogan City Philippines

Journal of Academic Research 01:1(2016), pp. 21-32

Nora L. Lopez1 Laura B. Boller, Anacorita M. Villanueva & Art T. Roncesvalles College of Education, Samar State University, Philippines [email protected]

Abstract: The study presented sexual reproductive health (SRH) programs provided to couples in Catbalogan City, Philippines. Data was gathered using a survey questionnaire interviews, and supplemented with secondary data from local SRH providers in Catbalogan and those from the Philippine Statistics Authority. Data showed that efforts from the government and other non- governmental organizations have influenced couples to practice or participate in several family planning related interventions. Half of the respondents reported positive effects on their lives. Over the years, SRH programs have resulted into declining trend in population growth and fertility rate in the Philippines while there is a sustained positive trend on the use/access of various form of contraception. The said improvement however resulted into outcomes below the desired values. SRH programs and its implementation strategies need to be revisited to identify additional or more effective forms of interventions to achieve the targets.

Keywords: family planning, population, contraceptive use, maternal and child care

1. Introduction the Supreme Court of the Philippines has declared some of the law unconstitutional The Philippines sexual and (SC, 2014). The same decision also issued reproductive health (SRH) status is lagging Temporary Restraining Order (TRO) on behind in Southeast Asia (WHO, nd). In some contraceptive drugs and devices for 2012, the Philippine Government passed a violation of constitutional requirements of Reproductive Health (RH) Law or the due process. Republic Act (RA) No. 10354. It is an act providing for a national policy on The religious, specifically the responsible parenthood and reproductive Catholic faithful headed by the Catholic health. The law was passed as it recognizes Bishops Conference of the Philippines on of the fundamental rights of a person, (CBCP) is against the RH Law and identify which is the right to health which includes it as intrinsically evil (Bantiles, 2013). It reproductive health (Congress of the was believed that the deeply rooted Philippines, 2012). It was primarily traditional Filipino culture makes it hard to introduced to manage the rapid growth rate implement policies such as RH law. of the Philippines and address rights of However, there seems a change in mind-set people to choose the life they desire. In the of many Filipinos as revealed in the surveys. 2004 Pulse Asia Survey reveals that 97% of The 2004 Pulse Asia survey reveals that Filipinos believe the importance to have the 83% of voters in the 2004 national elections ability to control one’s fertility or to plan will favour candidates who support the one’s family. However, about a year later, allocation of government funds for family JOURNAL OF ACADEMIC RESEARCH Vol. 01 No. 1

planning with only 2% saying otherwise. In Catbalogan? What are the programs or the 2013 National Demographic and Health intervention activities and how good is it? Survey reveals that about 54% of married women do not want additional children and 2. Objectives an additional 9% are already sterilized. The same survey says that 81% of married This paper assessed the SRH women want either to space their births or to intervention programs provided and the limit childbearing altogether. This change of extent of awareness and practices of couples attitude towards having children can be seen in Catbalogan City, Philippines, specifically in the downtrend of women fertility rate. In it; 1973 it was 6.0% and was reduced to half 1. Identified agencies and organization (3.0%) in 2013. The growth rate of the implementing SRH intervention Philippines has also declined from 2.35 for programs; years 1990-2000 and went 1.9% for years 2. Determined the SRH awareness and 2000-2010 (PSA). This suggests that the practices of the respondents as a result of efforts to manage population is working, intervention programs implemented; and however the ideal growth rate is yet to be 3. Determined the satisfaction level of achieved. respondents regarding the SRH programs provided. Samar Island is the third largest in the Philippines where a total of about 1.75M 3. Methodology population (PSA, 2010). As of August 2015, (Western) Samar Province has a total of The paper used descriptive research 780,581 people, 103,879 (13.3%) of which methodology. It uses survey instruments to are in Catbalogan City. Like that of the gather responses from randomly selected whole Philippines, Samar population growth couples in the City of Catbalogan followed- rate was also declining from 1.85% at the up by an interview to supplement data beginning of year 2000, 1.35% in 2010 and acquired. It also used secondary data from goes down to 1.25% as of August 2015. The various sources. decline can be attributed to the success of the government RH programs such as those Respondents come from the five that are stipulated in the RH law. most populous barangays (villages) in Catbalogan. Names of couples were taken In the Philippines 2013 National from the Barangay records. Tables 1 and 2 Demographic Survey revealed that women are the respondents profile in terms of sex, surveyed have knowledge of at least one occupation and religion. All records were method of contraception, 55% of them are secured to protect identity of the using it and 38% uses modern methods. The respondents. same report have shown that 18% of women have an unmet need for family planning, 7% The respondents are couple, however because they wanted to delay their next only six of the 85 couples have agreed to pregnancy and 11% because they wanted no participate as respondent in the research. more children. The response of the female partner was considered as the couple’s response. Who is providing the SRH services in Samar, specifically in its capital city of

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Table 1. Couple Respondents Table 2. Profile of Respondents

Baranggay Sex Total Occupation % Religion % M % F % % White Collar 1.0 Roman Catholic 90.8 Mercedes 0 0.00 18 100.00 18.75 Blue Collar 18.8 Iglesia ni Cristo 3.1 Guindapunan 0 0.00 20 100.00 20.83 Pink Collar 5.2 Born Again 3.1 Canlapwas 2 8.33 22 91.66 25.00 Grey Colalr 16.7 UCCP 1.0 Barangay 13 3 15.76 16 84.21 19.79 Housewife 56.3 Mormons 1.0 Bu-ao, Ubanon 1 6.66 14 93.33 15.62 Others 2.1 Ohers 1.0 Total 6 6.25 90 93.75 100.00 Total 100.0 100.0

Table 3. Occupation of (Couple) Respondents

Barangay Occupation % Mercedes Guindapunan Canlapwas Brgy.13 Bu-ao Total OFW 0 0 2 0 0 2 2.08 Saleslady 1 0 1 1 1 4 4.16 Employee 1 0 0 1 1 3 3.12 Caretaker 1 0 2 0 0 3 3.12 Teacher 1 0 0 0 0 1 1.04 Manicurist 1 0 0 1 0 2 2.08 Vendor 0 2 4 1 3 10 10.41 Laundrywoman 0 2 0 0 1 3 3.12 Maid 0 3 0 2 2 7 7.29 Welder 0 0 0 1 0 1 1.04 housewife 13 13 14 8 6 54 56.25 Waiter 0 0 0 0 1 1 1.04 Tricycle Driver 0 0 1 2 0 3 3.12 Others 0 0 0 2 0 2 2.08 Total 18 20 24 19 15 96 100

Table 4. Occupation of (Couple) Respondents

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Rating of SRH services uses a 5 planning organization in the Philippines point scale with aggregated score interpreted providing SRH services (IPPF, nd.) as follows; 4.2 Family Planning Profile 1.00-1.5 – Poor 1.51-2.5 – Unsatisfactory According to the 2003, 2008 and 2.51-3.5 – Moderately Satisfactory 3.51-4.5 – Satisfactory 2013 National Demographic and Health 4.51-5.0 – Very satisfactory Survey, sexually active women have used any form of contraceptives (modern and Frequency counts, percentage and traditional method) have declined from diagrams/chart were used to present 47.3% to 32.6% or a total % drop of 31.1%. gathered data. About 39% drop of modern use of contraceptive was observed in the 2013 4. Results and Discussion survey. Based on the 2013 survey, married women in the Philippines uses modern The foregoing are the results of contraceptives such as pill (19%), female survey, interviews and documentary analysis sterilization (9%) and 4% each for related to SRH in Catbalogan City, Samar injectables and IUD (PSA, 2014). The Philippines. Catbalogan City data was number of married women using pill has compared with national level data. declined by about half as compared to 2003 and 2008 similar surveys wherein 38 to 43% 4.1 Agencies Providing SRH Interventions of them using it (NSO, 2004; PSA 2009).

There are only three Table 5. Oral Contraceptive Pills (OCP) agencies/organizations currently providing SRH intervention activities in the city. Type of Year Total These agencies are the Samar Provincial OCP 2010 2011 2012 n % Exluton 350 1,100 410 1,860 27.9 Hospital (SPH), Family Planning Office of Nordett 473 612 - 1,085 16.3 the Philippines (FPOP) and the Rural Health Roselle - 180 383 563 8.5 Unit (RHU) of the City of Catbalogan, Triquilar 184 278 - 462 6.9 Philippines. All of these identified Microgynon - - 60 60 0.9 organizations provided information Trust - 96 - 96 1.4 Lady Pill 82 412 105 599 9.0 dissemination campaign in various forms Micropil - 222 23 245 3.7 including flyer/leaflets distribution, radio Althea 10 18 - 28 0.4 programs, symposia, seminars and the likes. Marvelon 72 428 420 920 13.8 More importantly, these units also have Ruby- - - 780 780 11.7 provided medical assistance to couples Natasha Total 1131 3346 2181 6,658 100.0 seeking help. Smaller unit such as local youth organizations also provide Oral contraceptives Pills (birth-control interventions through information pills). OCP are extremely effective if used dissemination activities. The SPH and the correctly at preventing pregnancy with only RHU are very dependent on government five getting pregnant in every 1000 women funds while the FPOP relies from private taking it (Womens Health, 2013). The pill donors. The FPOP is the largest and most prevents ovulation by maintaining more prominent non-governmental family consistent hormone levels in the body of the woman. Table 5 shows the type of pills

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accessed from the FPOP in Catbalogan. Table 6. Condom Most of them uses Excluton and Nordentt totalling to about 72.77% of all OCP Condom Year Total consumed in 2010. In 2011 and 2012, the Brand 2010 2011 2012 n % other types of OCPs have also been accessed Skinless 1,413 1,615 2,668 5696 80.8 Skin by couples. The Ruby-Natasha type of OCP IPPF - 46 110 156 2.2 was the most accessed pill in 2012. For the Generic three year period of observation, it was Trust 15 24 1,116 1155 16.4 revealed that top five OCPs used are Frenzy 17 22 - 39 0.6 Excluton, Nordett, Marvelon and Ruby Total 1,445 1,707 3,894 7046 100.0 Natasha. There was an observed spike of the Intra-Uterine Device (IUD). IUD is not that Trust condom brand from 15 and 24 in 2010 popular in the City of Catbalogan as and 2012 to about 1,116, about 45.5 times revealed in the data from FPOP Catbalogan. higher in 2012. In contrast, there was a Which is similar for the entire country. decline of women in the Philippines who Based on the PSA survey, IUD by the said that their partners used condom, from sexually active women in the Philippines is 9.9% in 2003 it went slightly up to 11.2% in also not that popular. The use of IUD has 2008 and down to 1.4% in 2013 (NSO, gone down from 6.4% in 2003 to 2.2% in 2004; PSA 2009, PSA, 2014). Purchasing, 2013. The contraceptive prevents carrying, storing, using and disposing of fertilization of the egg by damaging or condoms cause embarrassment to users. A killing the sperm, it also affects the uterine number of articles illustrates this reality and lining where a fertilized egg would implant was a subject of study of Moore et.al.(2007). and grow (WebMD). The IUD is estimated The study showed that purchasing condoms to be effective at 99% while pills are elicits the most embarrassment of all. The estimated at 95% success rate in preventing use of condom is also considered by many pregnancy. Majority of respondents who as less enjoyable (Thornton, 2014). were asked about preference between IUD and pills choose the later because the Injectables. Depo-Provera a type of insertion of a plastic string with an IUD injectable is a progestin-only method, done through the cervix into the vigina is in a 3-month period to inhibit ovulation uncomfortable and they believe it to be (ARHP, 2014). The failure rate with perfect painful. use is only 0.2% while typical use is about six percent (Trussell, 2011). The use of Condom. Another form of contraceptive is injectable in Catbalogan City has declined the wearing of condom of males during by about 84.4% from 1445 in 2010 to only intercourse. As shown on table 6, the use of about 225 in 2012. condoms in Catbalogan City have increased by about 169% in a matter of three years. Of Table 7. Injectables (amp and vial) the available condoms, males prefer to use Type of Year Total the skinless skin type totaling to about Injectable 2010 2011 2012 n % 80.8% followed by the use of Trust branded Depo-Proera 230 621 225 1076 80.2 condom having 16.4% share of users. Petogen 264 2 - 266 19.8 Total 1445 1707 225 1342 100.0

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Table 8 on the other hand shows an highly probable when one of them has increase of counselling services, most of multiple partners. About six in every ten which are on SRH related counselling. The women surveyed in 2008 and 2013 were in low availment of the two other services may union (PSA, 2009; PSA, 2014). In 2011, be attributed to socio-cultural factors there were 476,408 marriages registered in (NEDA, 2011) such as stigma and the Philippines, about 1.3% lower than 2010 discrimination, fear of disclosure preventing registry (PSA, 2013). Eastern Visayas people to talk about it. Table 5 also suggest recorded the biggest decrease at about that there is an increase of people engaged 18.8% (ibid). The decrease of the number of into sex. This is similar to the national couples going into legal marriage is due to profile on number of people engaged in the increase of cohabitation as it is fast sexual contact as early as 15 years old. In becoming acceptable. Vancio (1980) says 2014, the Philippine Council for Health that 36% males and only 2% females among Research and Development (PCHRD) married couples in the urban areas of the reported that 32% of young Filipinos aged Philippines have extramarital affairs, this 15-24 has engaged in pre-marital sex, about numbers must have changed in the later 9% higher than the 2002 survey according to years. In this study, out of 96 respondents, the 2013 Young Adult Fertility and 82% were married, 5% are widowed and 4% Sexuality study. have never married. About 6% of them have extramarital affairs. Table 8. Family Planning Counselling Services in Catbalogan City Table 9 shows the annual contraceptive service provision by six Type of Year drugstores in Catbalogan City and volume is Counseling 2010 2011 2012 n % almost similar from 2008 to 2012. SRH 1,253 817 1306 3376 99.3 Purchasing of condoms and contraceptive Counseling Abortion 4 0 0 4 0.1 pills share almost similar percentage related followed by procurement of contraceptive counseling injection. This is similar to the 2013 survey STI Services 20 0 0 20 0.6 showing pill is best known (99%) Total 1277 817 1306 3400 100.0 contraceptive and followed by male condom (97%). The first two are readily accessible in The prevalence of STI infections in the local drugstores in Catbalogan City. The the country’s general population is high frequency of condom sales in the six (UNICEF, 2006). STI among couples is drugstore is different from the condoms

Table 9. Annual contraceptive service provision (2008-2012)

Year Total Item 2008 2009 2010 2011 2012 n % Condom 3631 6552 7056 6792 5520 29551 42.78 Contraceptive Injection 1548 1548 1648 1648 1648 8040 11.64 Contraceptive Patch 0 0 0 0 0 0 0.00 Contraceptive Pills 6110 6552 6200 6506 6120 31488 45.58 Contraceptive Ring 0 0 0 0 0 0 0.00 Diaphragm (contraception) 0 0 0 0 0 0 0.00 Emergency Contraception 0 0 0 0 0 0 0.00 Total 11289 14652 15210 14946 13288 69079 100%

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made available through FPOP. Four in every ten respondents said they have used a particular method of family planning 4.2 Programs attended by respondents because it is effective based on their experience and of others. Only two in every Almost all of the respondents have ten says they use of it because the attended at least one activities related to doctor/health practitioner recommended it. SRH provided by the SPH, RHU and FPOP. Their attendance was encouraged through the benefits they will gain in doing so. Most (91.7%) of the respondents have attended or Others have accessed information about SRH at the RHU, 56.2% from SPH and about 29.2% withdrawal from FPOP all in Catbalogan, About 5.2% Use have accessed services from private doctors within and outside of the city. The kind of implant Knowledge services received or sought were those free since most of the respondents come from tubal ligation lower income bracket. A little more than half of the, are plain housewife, followed by vasectomy blue collar (manual labor) and grey collar (manual, gets dirty labor). IUD

4.2.2 Knowledge acquired from programs injectables

All of the respondents are aware on contraceptive pills various methods of family planning. They have attributed this awareness to the condom activities they have attended, some however also claimed that their friends, relatives, TV 0 10 20 30 40 50 60 and the internet has provided them some knowledge about family planning and other information relative to SRH and child health. The respondents are most aware of Figure 1: Family planning method learned the use of contraceptive pills (56%) and 37% are users of the method. In comparison Almost seven in every ten to the 2013 national survey (PSA, 2014), respondents says, the use of family planning this number is lower by about 43% however methods have allowed them to manage their number of users (specifically on pills) are meager income. They were able to eat higher by18%. regularly and with better food, send their kids to school and is able to provide time to Despite knowledge about methods raise well their children. Furthermore, that requires operation such as tubal ligation majority of mothers using family planning & vasectomy, very few have actually used it methods have said that the use of as family planning strategy. Overall, only contraceptives and other methods made about six in every ten respondents have them feel good, they can attend to affairs actually used any form of contraceptives. and other activities such as attending work

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(61%), other affairs/events (55%) and 4.2.4 Assessment on the implementation of continuing their education or of their maternal and child care program children (46%).

EIC on mother and child Parents, friends and personnel of the health SRH service providers have influenced the Provision of ferous respondents their use of family planning sulfate methods. The number of respondents saying Tooth exam and they were influenced to use family planning prescription methods as espoused by the SRH service providers is only 37%. Home-based mother's record About six in ten respondents believes that many women (63.5%) unintentionally get First trimester check-up pregnant. Despite not intentional, aborting conception is not a choice as it is against 3.6 3.8 4 4.2 4.4 4.6 their belief. None of those who were interviewed even consider going into an Figure 3: Pre-natal check-up actual abortion. Prenatal checkup. Respondents rated 4.2.3 Frequency of consultation the pre-natal check-up as satisfactory with the education and information campaign About four in every ten have visited (EIC) on child health as well as the first SRH service provider one to three times in a trimester check-up receiving the highest year. Most of those who have visited more score. Tooth examination and prescription is than three are those who are already done by a dentist outside of the facility pregnant and needs to consult a health through referral. practitioner regarding their pregnancy.

Free anti-measles vaccine not sure Oral polio vaccine provision >12

Provision of Vitamin A 10-12 EIC on importance of 7-9 vaccination

Regular provision 4-6

4 4.1 4.2 4.3 4.4 4.5 4.6 1-3

0 10 20 30 40 The percentage of pregnant women

with at least four prenatal visits decreased Figure 2: Frequency of consultation from 77% in 1998 to 70.4 in 2003. Also, those who received at least two doses of

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tetanus toxoid also has decreased to 37.3% them. Most of the respondents belong to in 2003 from 38% in 1998 and about 76.8% low-income groups, buying milk formula as of pregnant women received iron much as possible must be avoided. supplementation during the pregnancy (Vera, 2012). Mixed feeding Figure 4: Under five-year old vaccination Exclusive bottlefeeding Children Vaccination. All of respondents says they have received satisfactory to very Exclusive breastfeeding satisfactory services when it comes to vaccination of their children below five EIC on proper feeding years old. Receiving lowest score was the provision of vitamin A. Few has said that 2.5 3 3.5 4 4.5 5 there are cases when the needed vaccine is unavailable on the scheduled date their Figure 5: Children Feeding children are supposed to receive it. Those who can afford and who cannot wait go to 4.2.6 Methods of family planning private clinic for the vaccination. Others will just have to wait until the vaccine is The Philippine National available. Demographic and Health Survey categorized two sets of family planning interventions, Despite the unavailability of some the modern and traditional methods. In this vaccine, respondents have not rated it low study, only five of the several methods were since the access to this services are considered in the assessment including EIC relatively new. They further said that it’s far activities. better than before when there were dismal services when it comes to child health care. Today according to them, the health centers Rhythm and in Barangays have scheduled services and temperature monitor mothers always look forward to those dates. Even those who can afford services from Use of IUD private clinics find time to visit Barangay Health Centers to access of free vaccination Use of injectables for children. Use of pills 4.2.5 Education on proper feeding of children under five years old EIC on family planning methods The mixed and exclusive bottle 1.5 2 2.5 3 3.5 4 feeding method of feeding were rated by respondents as just good. This score was not because they have least understood the Figure 5: Family planning method evaluation method but was an expression of preference. Based on follow-up interview, they rated it Respondents rated the services low because they don’t prefer using this received from the SRH providers relatively method because it will be very expensive for low except the EIC which is found to be

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satisfactory. The unsatisfactory rating and family planning methods, practice or received for the rhythm and temperature influence is still at 53.2% (PSA, 2014). method, use of IUD and injectables is due to the complicatedness or the process needed to Table 7: Overall assessment on influence of practice it. Some respondents interviewed programs to respondents practices said that the said methods requires higher compared to buying pills or condom. This Particulars % perceptions were based on the respondent’s 1. Understood ways of planning a 54.16 experiences and by someone they know. family 2. Have ample time for self, family 53.12 4.2.6 Perception on the impact of and other activities intervention SRH programs 3. Learned the obligations of 53.12 parents to his/her partner and to Respondents were asked as to the the child impact of the programs implemented to their 4. Learned personal rights 56.25 attitude towards practicing what are espoused by the SRH programs and the benefit they received from it. 5. Conclusion and Recommendation

The family planning interventions, Data have showed that efforts from specifically the SRH programs were not the government and other non-governmental only focused on the use of contraception. organizations have influenced couples to There were activities specifically through practice or participate in several family the EIC activities touching on right of planning related interventions. About half of women, their children and their rights as the respondents surveyed have said they citizens of the Philippines. About one in two have benefited positively from the of the respondents have said they were able interventions they have received from the to learn family planning methods, service provided. Overall, there have been a understood the obligations of parents to their declining trend in population growth rate children and their spouses. About six in and fertility rate, while there is a sustained every ten of them was able to realize that positive trend on the use/access of various they own their body and they have all the form of contraception, an indicator that the right on how to use it and care for it. Half of SRH programs are gaining a certain success. those who availed of the services have said The said improvement however resulted into that they were able to gain more time for outcomes that are still below the desired themselves, their family and other activities values. Efforts need to be revisited to because they have manageable family size. identify additional or more effective forms The rest of the respondents however also of interventions to achieve the targets. expressed that for some, even if they have managed their family size, they still can 6. Bibliography hardly met a better life. They claim that their earning is not enough to raise a descent Association of Reproductive Health family. Professionals (ARHP) (2014). Choosing a Birth Control Method. In the Philippine context, despite the http://www.arhp.org/Publications-and- 99% knowledge about any contraception Resources/Quick-Reference-Guide-for-

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