l'h lippines ::- ) 1~ational ~;al ~ )therhood ,~U ey 19 ¢. REPUBLIC OF THE PHILIPPINES National Safe Motherhood Survey 1993 National Statistics Office Manila, Philippines Macro International Inc. Calverton, Maryland USA October 1994 This report summarizes the findings of the 1993 National Safe Motherhood Survey (SMS) under- taken by the National Statistics Office in collaboration with the Department of Health, the University of the Philippines, and other concerned agencies in the Philippine government. Funding for the 1993 SMS was provided by the Rockefeller Foundation and the U.S. Agency for International Development, through the MotherCare Project of John Snow, Inc. The 1993 SMS was a follow-on to the 1993 National Demographic Survey (NDS), which is a part of the worldwide Demographic and Health Surveys (DHS) program. This program is designed to collect, analyze, and disseminate demographic data on fertility, family planning, and maternal and child health. Additional information on the 1993 SMS may be obtained from the National Statistics Office, Solicarel Building, Ramon Magsaysay Boulevard, Santa Mesa, Manila, Philippines. Additional information about the DHS program may be obtained by writing to: Macro International Inc., 11785 Beltsville Drive, Calverton, MD 20705-3119, USA (Telephone 301,572-0200, Fax 301-572-0999). Recommended citation: National Statistics Office (NSO) [Philippines] and Macro International Inc.(MI). 1994. National Safe Motherhood Survey 1993. Calverton, Maryland: NSO and MI. CONTENTS Tables ............................................................................ vii Figures ............................................................................ xi Preface ........................................................................... xiii Preface ........................................................................... xv Summary of Findings ............................................................... xvii Map of the Philippines .............................................................. xxii CHAPTER 1 INTRODUCTION ..................................................... 1 1.1 Philippine geography, history, and economy .................................. 1 1.2 Population growth ...................................................... 4 1.3 Health policies and programs ............................... .............. 5 1.4 Objectives of the survey ................................................. 5 1.5 Institutions supporting and implementing the survey ........................... 6 1.6 Sample design and implementation ............................... .......... 6 CHAPTER 2 DEVELOPMENT OF THE SAFE MOTHERHOOD SURVEY QUESTIONNAIRE ........................................... 9 2.1 Validation survey ....................................................... 9 2.2 Major findings of the validation study ...................................... 10 2.3 Qualitative study ...................................................... 11 2.4 Major findings of the qualitative study ..................................... 12 2.5 Content of the SMS questionnaire ......................................... 12 2.6 Questionnaire translation ................................................ 12 2.7 Pretest of the SMS questionnaire .......................................... 13 CHAPTER 3 RESULTS OF FOLLOW-UP EFFORTS, RESPONSE RATES, AND BACKGROUND CHARACTERISTICS OF RESPONDENTS .......... 15 3.1 Follow-up efforts ...................................................... 15 3.2 Response rates ........................................................ 16 3.3 Background characteristics of respondents .................................. 16 CHAPTER 4 REPRODUCTIVE HISTORY .......................................... 21 4.1 Current pregnancy ..................................................... 24 4.2 Perinatal mortality 24 IIIo°* CHAPTER 5 MATERNAL CARE ......... .... ~. .................................... 27 5.1 Prenatal care provider and place of first visit ................................ 27 5,2 Number of prenatal visits and gestation at first visit ........................... 32 5.3 Reason for first visit ...................................... .............. 33 5.4 Content of prenatal care ................................................. 33 5.5 Delivery care provider .................................................. 36 5.6 Place of delivery ...................................................... 40 5.7 Mode of transportation .................................................. 41 5.8 Intended place of delivery ............................................... 42 5.9 Perceptions of delivery care .............................................. 42 5.10 Postpartum care ....................................................... 43 5.11 Consistency of service use ........................... .................... 45 CHAPTER 6 OBSTETRIC COMPLICATIONS AND TREATMENT .................... 49 6.1 Obstetric complications ever experienced ................................... 50 6.2 Obstetric complications in the last three years ........ ...................... 54 6.3 Other obstetric complications ....................................... ..... 62 6.4 Medical procedures for births in the last three years ........................... 63 6.5 Problem recognition and refereal for major complications ...................... 66 CHAPTER 7 GENERAL HEALTH, ANTHROPOMETRY, CHRONIC AND OTHER REPRODUCTIVE MORBIDITIES AND INDUCED ABORTION ........... 71 7.1 Perceived general health condition ........................................ 71 7.2 Diagnosed illnesses .................................................... 73 7.3 Illness during pregnancy ................................................ 74 7.4 Anthropometry ........................................................ 74 7.5 Other reproductive morbidities ........................................... 78 7.6 Type of provider sought ................................................. 82 7.7 Reasons for not seeking care ............................................. 83 7.8 Sexual activity ........................................................ 84 7.9 Induced abortion ...................................................... 84 7.10 Results from the pregnancy history ........................................ 88 7.11 Results on hospitalization after an early loss ................................. 89 7.12 Results from later section of questionnaire .................................. 89 CHAPTER 8 DOMESTIC VIOLENCE AND RAPE ................................... 91 8.1 Domestic violence ..................................................... 91 8.2 Rape ................................................................ 93 8.3 Domestic violence and women's status ..................................... 96 iv CHAPTER 9 POLICY RELEVANT FINDINGS AND RECOMMENDATIONS ........... :*. 97 9.1 Prena•alca•m o. o o, Q o** D** o o o m o** o ,. o o o o o o , I i . o. o, , t o ° J t °. , , , , , o o o,** ** 97 9.2 Delivery care ... ....................................................... 97 9.3 F~mily planning ......... ............................................... 98 9.4 Reproductive morbidity ................................................. 98 9.5 STDs/HIV ............................................... ........... 99 9.6 Social services ....................................................... .. 99 REFERENCES ................................................................... 101 APPENDIX A DEFINITION OF URBAN AND RURAL AREAS ..................... 103 APPENDIX B SCHEDULE OF ACTIVITIES ..................................... 107 APPENDIX C DATA QUALITY ................................................ 111 APPENDIX D SAMPLING ERRORS ............................................ 121 APPENDIX E SURVEY STAFF .................................................. 135 APPENDIX F QUESTIONNAIRE ............................................... 141 LIST OF TABLES Table 1.1 Health indicators ....................................................... 4 Table 3.1 Results of SM$ interviews ............................................... 16 Table 3.2 Number of visits made by interviewers ..................................... 16 Table 3.3 Characteristics of SMS respondents ....................................... 17 Table 3.4 Respondent's age relative to husband's age ................................. 18 Table 3.5 Wage/salary employment and presence of a paid helper in home ................. 19 Table 4.1 Average number of pregnancies by outcome ................................ 21 Table 4.2 Pregnancy loss and stillbirths ............................................ 23 Table 4.3 Current pregnancies .................................................... 24 Table 4.4 Gestational age: current pregnancies ....................................... 25 Table 4.5 Perinatal mortality ..................................................... 26 Table 5.1 Recent pregnancies .................................................... 28 Table 5.2 Prenatal care .......................................................... 29 Table 5.3 Place of first prenatal care ............................................... 31 Table 5.4 Number of prenatal care visits 32 Table 5.5 Median number of prenatal care visits ...................................... 32 Table 5.6 Reasons for furst prenatal care visit ........................................ 34 Table 5.7 Components of prenatal care ............................................. 35 Table 5.8 Recommended components of prenatal care ................................. 37 Table 5.9 Delivery care