Coping with adolescent fertility

In the Philippines, despite the conservative values of the population, factors brought about by increasing modernization encurage the youth to practice sex, although actual sexual behavior lags behinds attitudes. This is particlarly the case in Metropolitan Manila, the country's most urbanized region. In 1982, 4 of 10 live births were to women aged 15-24. There also are reports that births out of wedlock have increased in the past few years, with the biggest number of such births registered by women in the younger age groups. The magnitude of the problem causes concern among the policymakers, throughout the world, the Philippines included. The government and the private sector in the philippines have started to recognize the need to protect adolescents, particularly girls, from unplanned parenthood. Adolescent fertility programs in the Philippines and neighboring countries are relatively new and policymakers are working to strengthen them. Recently, the Commission on population (Popcom) organized the Youth and Premarriage Task Forces to address the specific needs and concerns of the youth. In line with this objective, private and government agencies have developed programs and projects for specific youth sectors which influence or may be influenced by adolescent secxuality norms. There are projects designed to suit the specific needs of in school youth, out of school youth, working youth, pregnnant unmarried women, and adolescent counselors. Some of these programs and projects are described. Similar to other projects, the adolescent fertility projects in the Philippines experience their share of problems and constrants, including shortage of trainers, lack of reliable data, inadequate supply of resource materials, and the need to strengthen government policy. In view of all this, a need exists to attract more people to train service providers who will attend to adolescents' information needs, ranging from common concerns like dating to more serious concerns like pregnancy. In a recent survey many service providers indicated that the were wary of providing contraceptive information and services to adolescents for 2 reasons: they believe these might promote sexual promiscuity among the married; and the fear they might be sued by irate parents. Coupled with the problem of lack of reliable data is the fact that few materials on sexually related materials have been developed in the philippines. Such local materials are needed for the benefit of both the youth and the service providers and counselors.     

Traditional health workers finally earn recognition

In the Philippines the growing need for medical manpower and services can no longer ignore the traditional birth attendant, the hilot, who always played a big role in obstetrical practices, particularly in areas where paramedical workers are not available. In 1974 a survey identified more than 31,000 hilots, who assisted about 40% of all births in the islands. It must be remembered that in the Philippines 70% of the population lives in rural areas, that 65% of physicians live in urban areas, and that almost all hospitals are in metropolitan Manila. Until the early 50s the government's attitude was to discourage hilot practices, but limited resources and the small magnitude of existing health programs prompted the government to grant hilots official permission to continue their work. In 1955 the Philippines Dep. of Health and the WHO initiated a training program for 9000 selected hilots, to enable them to handle maternal and health situations in rural areas in the absence of physicians or nurses. From 1955 to 1972 only about 9200 hilots attended training programs, but from 1975 to 1977 about 10,500 hilots were trained to respond to local community health demands. Maternal and perinatal morbidity and mortality has sharply decreased from 1954 to 1972; with nearly half of the births attended by hilots it is valid to assume that the program of teaching and supervising them has contributed to such a decline.     

ASEAN projects reviewed

The ASEAN Population Expert Group met in Manila and was followed by a meeting of the ASEAN heads of population programs, during the period November 5-10, 1979. Heads of population programs from Indonesia, Malaysia, Singapore, Thailand, and the Philippines attended. The meetings were held to review progress-to-date on phase 1 projects and to consider the development of an expanded population program. 5 projects funded by UNFPA are reviewed in tabular form with the project, the sponsoring country, date of implementation, data analysis, and date of completion. Suggestions were made for improving and extending these projects and it was also suggested that all projects being developed and proposed should include a section on use of research. 7 new projects were proposed as phase 2 projects. The 1st, sponsored by Malaysia, deals with women in development; project 2, lead by Thailand, will investigate population movement and its effect on development; project 3, led by the Philippines, will develop and strengthen national population information systems and networks in ASEAN countries; project 4, led by Indonesia, is directed towards institutional development and exchanges of personnel; project 5, led by the Philippines, will examine population and development dynamics and the man/resources balance; project 6, led by Thailand, will develop ASEAN social indicators; and project 7, led by Indonesia and Malaysia, will make a comprehensive analysis of existing medical/health care and family planning systems. It was recommended that an executive director of the proposed ASEAN population coordination unit should be appointed to expedite the recommendations of the meeting related to preparation and submission of phase 2 project proposals.     

Psychosocial contexts of the homosexuality of Filipino men in heterosexual unions

The Philippines is one developing country in which a systematic inquiry on the homosexuality of men in heterosexual consensual union is rare. With the thought that the public can be guided more knowledgeably in forming some responsible knowledge and opinion about homosexual men's lives within heterosexual unions, a small-scale exploratory study was carried out and completed in 1997 among 15 married or co-habiting men in Metro Manila, the Philippines. The research delved into respondents' sexual histories; their perceptions of own homosexual attraction, desire and orientation; and their reasons, motivations and expectations for marrying or cohabiting. It also looked into respondents' reports of whether their partners knew their sexual orientation; respondents' roles and responsibilities in household management and decision making; and effects of respondents' homosexuality on marital and familial relationships.     

Explaining regional fertility variations in the Philippines

Analysis of the 1993 National Demographic Survey in the Philippines has uncovered regional variations in fertility-related behavior. The total fertility rate ranged from 2.8 in Manila to 5.9 in Bicol and averaged 4.1 for the entire country, but contraceptive prevalence rates were not highly correlated with total fertility (Manila showed the fifth highest prevalence, and Bicol the fifth lowest). This lack of correlation may be caused by the mix of contraceptive methods chosen with a high proportion of women using ineffective methods (40% of all currently married women of reproductive age [MWRA] were using contraceptives, but only 25% were using the most effective methods). Thus, low fertility was associated with use of the most effective methods regionally. Fertility also was lower in regions where women spent more time unmarried. Infecundity added to the discrepancy (Bicol had the lowest regional infecundity rate in the country). The total protection rate, which can be derived from three factors (contraceptive usage, time spent unmarried, and infecundity), accounts for must of the regional variation. Unmet need for contraception was found in 26% of currently MWRA, and another 12% were using ineffective methods. In designing effective family planning programs, policy-makers must understand the various factors that contribute to high levels of fertility in different regions and must be flexible enough to plan regionally-specific strategies. As the government decentralizes programs and resource management decisions, local-level analysis will be increasingly important.     

Internal migration: why do Filipinos move?

The rapid movement of Filipinos from 1 part of the Philippines to another is not a new phenomenon, but mobility has been increasing. A study conducted by Peter C. Smith revealed that interprovincial lifetime mobility of the national population increased from 15.8% in 1960 to 17.6% in 1970, while interregional mobility increased from 12.7% to 13.4%. People still disagree as to whether the size and rate of growth of the population are excessive, but there seems to be total consensus as regards its spatial imbalance. Because internal migration appears to be an important factor in national development, a need exists to examine different aspects of internal migration, such as the directions taken by migration flows, the migrants' reasons for moving, the migrants' characteristics, the migrants' success or lack of success at their places of destination, the social problems accompanying internal migration, effforts to deal with the problems caused by internal migration, and the implications of migration trends for policy and for the country's development programs. The most dominant migration trend in the Philippines in recent years has been toward the urban, or more accurately the suburban, areas adjacent to Metropolitan Manila. The city of Manila itself suffered a net outflow, further pointing to the trend toward suburbanization. Migration flows are primarily caused by economic reasons. About one half the sample of a Filipinas Foundation Study moved to provinces other than the province of birth in the pursuit of employment and other economic opportunities. A study of the country's migrant population age 15 and older showed that 53% of migrants were female. For male migrants, age ranges from 20-40; it ranges from 15-35 for females. Where cash income is concerned, migrants in Pernia's study of rural urban migration were better off than nonmigrants. Migrants were, on the average, as well off as native urbanites or metropolitanites. Among the more significant points raised by scholars and researchers are the following: urbanization is an inevitable and irreversible process, and it is wise to plan for it; the problem is not rapid urbanization but unbalanced urbanization, i.e., the concentration of urbanization in Metro Manila; steps to alter national urban patterns might include establishing a migration guidance office; the need exists for an explicit, firm, and consistent population distribution policy; and solutions that anticipate problems having to do with internal migration and prevent these problems from arising will, in the long run, be more effective than curative solutions.     

Linkages between internal and international migration: the Ilocos Norte experience

This paper reviews the arguments concerning whether internal and international migration can or should be incorporated in the same migration theories or models and examines the ways in which the 2 processes are linked in a variety of contexts. To provide some illustrative empirical results, reference is made to the Philippine Migration Study (PMS), a research project which incorporates both internal and international migration in its research design. The study examined migration from Ilocos Norte to the principal internal destination, Manila, and the principal international destination, Honolulu. Ilocos Norte is a largely rural, resource poor province with a long history of outmigration that is attributable primarily to population pressure in the region. Due to the fact that 1 of the principal migration streams from the Ilocos is within the Philippines and the other is outside the country, the Ilocos presents an ideal situation for a comparative analysis of internal and international migration. The study consists of 7 different surveys conducted in Ilocos Norte, Manila, and Honolulu between 1980-83. More than 5000 interviews were conducted in the 3 locations. The initial baseline survey in Ilocos Norte was conducted in 1980. After 2-1/2 years, the initial 830 households in the Ilocos Baseline Survey were recontacted to determine the migration behavior of the household members since the 1st survey. Those who had moved to either Manila or Hawaii during this period were traced to the destination and interviewed there. The PMS uses a single integrated model (the value-expectancy or VE framework) to explore migration decision making for both internal and external migration. Despite the complexity of the VE questions, respondents were able to distinguish different locations as being relatively good places or bad places to realize their different goals. Manila was not highly regarded by Ilocanos in most respects, and there was not a single value on which Manila ranked higher than both alternative locations. Relative to the other values, however, Manila is seen as being a good place for educational opportunities and entertainment. Hawaii rated very well on items having to do with wealth and status, but was regarded as a relatively poor place to satisfy one's desire for affiliation. Comfort, affiliation, and morality were viewed as being most easily achieved in the present barangay. Based upon the value-expectancy framework, the findings of the Philippine Migration Study confirm that a global model of migration decision making is feasible and that other important concepts in migration equally apply well in the case of both internal and international population movements.     

The Catholic response to the population problem

A survey of efforts led or sponsored by the Catholic church in response to the population problem in the Philippines. These efforts stem from the Church's belief that population growth is related to the overall picture of development, and that priority must go to social and economic justice. The Catholic Church of the Philippines (to which 85% of the population belong) views it as a problem basically involving care of people, and directs its efforts primarily at internal human sexual control rather than external contraceptive control. Family Life Education began as a program in the church in the 1960s. Efforts by priests, nuns, and lay leaders in Mindanao eventually resulted in counseling in husband-wife relations, marriage commitment, human sexuality, parent-child relations, and responsible parenthood, and to the creation of college courses to prepare teachers in tackling sex education. A program offering natural family planning was also started, initially for employees of a packing firm and later expanding throughout the province. In 1975, the program was launched in Manila, and a year later had 3 family life centers. The ovulation (or Billings) method is offered -- an advantage to low income people because it does not require purchase of a thermometer. Success of this method requires a sense of responsibility on the part of both husband and wife. Widespread international interest in the ovulation method has led to formation of an International Federation for Family Life Promotion, to which the Philippine Federation for Natural Family Planning has applied for membership. The IFFLP is working with the WHO Human Reproduction Unit on 2 projects, part of one of them (a field trial for evaluation) being conducted in Iligan City, Iloilo City, and Manila. Among the concerns of the IFFLP-WHO collaboration is developing a standardized Natural Family Planning curriculum or educational package.     

Adolescent fertility programs: taking the first few steps

Adolescent fertility programs in Asia and the Pacific have a long way to go to check the problems associated with adolescent fertility, but a start has been made. Delegates from 8 countries met in 1982 to share their problems and experiences in their own countries. The conference participants drew up plans to deal with a high rate of adolescent fertility, sexually active adolescents, out-of-wedlock births, unwanted pregnancies, sexually transmitted diseases, prostitution, rape, abortion, and drug addiction. The delegates felt that for adolescent fertility programs to be effective the program workers must first be equipped with the needed skills through proper training. Inadequate knowledge of the subject matter, inability to communicate with adolescents, personal bias, and lack of counseling skills were among the worker-related problems that conference participants identified. A few months after the conference, participant countries conducted a training program on the effective delivery of adolescent fertility-related information and counseling services. The training program, held in Manila from January 23 to February 2, 1984, was conducted by the Population Center Foundation and sponsored by the Family Planning International Assistance. Training program objectives included: in crease the participants' knowledge of sexuality-related matters; help them to communicate better with adolescents on matters related to sexuality and fertility; make them aware of other ways of responding to fertility-related information needs of adolescents; and improve their skills in counseling adolescents. Lectures, structured learning activities, discussions, role playing, and other methods were used to maximize learning. The training program was divided into 6 modules: group dynamics; human sexuality; information dissemination; counseling techniques; management; and action planning. The plans of Fiji, India, Indonesia, Nepal, Sri Lanka, Thailand, and the Philippines are reviewed. Organizers of the training program are confident that the action plans of the individual countries will take shape soon and clear the path toward more effective adolescent fertility programs.     

Understanding the population dimension in development planning

In the Philippines initial efforts to adopt population policies focused on reducing rapid population growth through fertility control. The history of the national population welfare congress, which started in 1978, reflects this emphasis on family planning as a major deterrent to rapid population growth. It was only in recent years that the 2-way relationship between population and development came to be better appreciated. The 6th National Populaton Welfare Congress was a response to this need to broaden the scope of population concerns and integrate the population dimension into development planning. This viewpoint regards population not as a demand variable but as a factor that can be influenced by economic and social development. Dr. Mercedes B. Concepcion, dean of the University of the Philippines Population Institute (UPPI), discussed population trends, prospects, and problems in a paper presented before the 6th congress. In 1980, she said, the Philippine population was 48.1 million persons, up by 11.4 million persons or 31%, over the3l.7 million enumerated in 1970. While the rate of populated growth remains high, data indicate a decreasing post-World War II trend, from 3.06% in 1948-60 to 2.68% in 1975-80. The proportion of the population below 15 has dropped by 2 percentage points, while the number of persons in the working ages 15-64 has increased. In 1 of the 3 group sessions during the congress, the participants tried to define the Philippines' population distribution goals, the requirement of an urban-rural balance, and priority intervention areas. In that session 2 main papers were presented -- one on human settlements and urbanization and the other on macroeconomic policies and their spatial implications. In another sessionplanners and researchers examined the socioeconomic and demographic impact of development programs, specifically the impact of rural electrification on fertility change in Misamis Oriental, a province in Southern Philippines. In the main paper presented in that session, Dr. Herrin indicated that the most rapid decline in marital fertility in the Philippines occurred among highly educated parents with high incomes and living in the urbanized areas of Metro Manila, Southern Luzon, and Central Luzon. The 3rd group session discussed mortality trends and prospects as well as the present forms of government intervention to reverse these trends. Generally, a declining trend has been observed in the crude death rate and in infant mortality.     

Breastfeeding as a means of contraception

The University of the Philippines Institute of Public Health (UPIPH) and the Family Health International (FHI) brought together health professionals, nutritionists, and family planning experts from different parts of the world to share and gain insights into the issue of breastfeeding and contraception. The participants met in Manila in 1983 and analyzed research findings on breastfeeding and discussed their implications relevant to nutrition and family planning policies and programs. Studies conducted in several countries show a general decline of breastfeeding practice in both urban and rural areas. The issue appears to be not whether women in developing countries breastfeed their infants but for how long. Popkin cites a study in Thailand, which showed very little change in the proportion of babies ever breastfed but large declines in the duration of breastfeeding from 1969-79. In the Philippines, national surveys since 1973 indicate that mothers throughout the country practice breastfeeding but do so for a relatively short period. Scientific data supporting the folk belief that breastfeeding delays the return of fertility after childbirth is growing. The phenomenon is believed to be governed by a sophisticated control mechanism in the female reproductive system. Some researchers suggest that prolactin may be responsible for the delay of fertility in breastfeeding mothers. In a series of studies done in the Philippines and Australia, researchers Barbara Gross and C.J. Eastman found that high prolactin levels were almost always associated with proloned amenorrhea during lactation. A decline in prolactin concentrations accompanied the resumption of menstruation. Gross and Eastman found evidence of ovulation before the 1st menses in only 1 out of 54 fully breastfeeding mothers, or less than 2%. This implies that at least the first few menses of most fully breastfeeding mothers are not accompanied by ovulation, suggesting that breastfeeding continues to affect fertility even after the resumption of breastfeeding. Zablan's study in the Philippine analyzed the various factors contributing to fertility reduction. Breastfeeding appeared to have the greatest impact on the Filipino woman's level of fertility. Zablan points out that, while breastfeeding is a major factor influencing fertility in the Philippines, it "can be relied upon only to postpone childbearing (and then only at the aggregate level), but not to prevent childbearing altogether." Much work needs to be done to help people realize the value of breastfeeding, to encourage mothers to practice it, and to do so for as long as possible.     

Philippines: total maternal care programme

The Total Maternity Care Programme, launched in June 1975 by the University of the Philippines at the Philippine General Hospital, aims at complete care for both mother and baby. Since the program began, requests for female postpartum sterilization have exceeded capacity. The postpartum ligation rate increased from 14% to 30% in a 6-month period. Reasons for this increase are word of mouth publicity, growing consciousness of the disadvantages of large families, and diseases contraindicating pregnancy. Reasons why women declined sterilization are mentioned. Based on the success of the program so far, it is recommended that Total Maternity Care Programmes be extended to the other maternity hospitals in metropolitan Manila.     

Everything changes to stay the same: persistent global health inequalities amidst new therapeutic opportunities and mobilities for Filipino nurses

ABSTRACT

The global migration of Filipino nurses has received significant attention, yet little is known of these healthcare workers’ experiences and mobilities within the Philippines. I explore the experiences and narratives of Filipino nurses living in Manila, some of whom have no desires to migrate. I uncover the often novel forms of therapeutic mobilities undertaken by these nurses, focusing on call centre nursing and entrepreneurship as key alternative career pathways within the realms of ‘therapeutics’. Through interrogating the various mobilities undertaken by nurses – physical mobilities and migration, socioeconomic mobilities and occupational mobilities in the form of a career change – it becomes clear that international physical mobility is no longer key. Nevertheless, Filipino nurses continue to provide care in global contexts in novel ‘therapeutic’ industries and doing so allows them to increase their socioeconomic mobility.     

The best-laid schemes: An analysis of discrepancies between migration intentions and behavior

A longitudinal survey approach is used in a largely rural area in the Philippines to examine consistency between migration intentions and subsequent migration behavior. Inconsistencies in movement behavior, the timing of a move, and the destination are analyzed. Discrepancies between intentions and behavior are explained in terms of unanticipated constraints and facilitators as well as changes in the conditions that precipitated the migration intention in the first place. Intended international movers who did not actually move in a 2-1/2 year period were thwarted mainly by legal hurdles that could not be overcome. Intended internal migrants who did not actually move remained in their origin area primarily because of changes in job opportunities or family relationships. Methodological and theoretical implications of the findings are discussed.The best laid schemes o' Mice an' Men Gang aft agley, An' la'e us nought but grief an' pain, For promis'd joy! we must bear in mind the distinction between direct and facilitating factors involved in migration processes . migration analysis should consider some factors that facilitate or impede migration rather than determine migration directly (Goldscheider, 1971:38).This article was originally presented at the annual meetings of the Population Association of American in Minneapolis, Minnesota, May 2–5, 1984. The authors wish to thank Lynna Sycip for her assistance in the preparation of the tabulations for this article. In addition to the authors, the co-investigators for this project are James T. Fawcett, East-West Population Institute and Ricardo G. Abad, Institute of Philippine Culture, Ateneo de Manila University. Research for this article has been supported by NIH Grant No. R01-HD13115, the Population Center Foundation, Manila, Philippines, and the East-West Population Institute.     

Human sexuality: the controversy continues

Sex education should be an integrated component of population education programs in the Philippines. There are, however, a variety of objections to this approach, which are linked to proposals that sex education is more relevant to biology and medicine curriculums. The Population Education Program of the Philippines conducted a study of 2093 parents and 4550 teachers to determine who registered objections to teaching certain population education content, what they objected to, and why such objections were raised. Findings show that only 3% of the sample reacted unfavorably to the inclusion of controversial topics, such as sex terms, illustrations of sex organs and the naming of contraceptive devices. The issues remaining to be solved are: content, terminology, teacher competence, parents' involvement, and teaching aids.     

ESCAP migration study gathers momentum

A comparative study is being conducted in the ESCAP (Economic and Social Commission for Asia and the Pacific) region on the relationships of migration and urbanization to development. The 1st stage of the study will entail the preparation of country reports on the census analysis of migration, urbanization and development. The 2nd stage will involve preparation of a series of national migration surveys. The 3rd phase will involve assisting member governments to formulate a comprehensive population redistribution policy as part of their national development planning. 1st-phase country reports have been completed in Sri Lanka, South Korea, the Philippines, and Indonesia. Migration in Sri Lanka has largely been rural-to-rural with little urbanization so far. The picture in South Korea has been the opposite, with rapid urbanization in the 1960s and 1970s; the government is hoping to divert some population to smaller cities away from Seoul. The pattern in the Philippines is 1 of urban primacy with the metropolis of Manila accounting for over 1/3 of the country's total population. Indonesia is characterized by a dense heartland in the Java-Bali regions. However, the rate of urbanization here has been slower. Migrants in all the countries studied are preponderantly young. The sex differential varies from country to country. The influence of migration on subsequent fertility is unknown.     

Population education: a life experience course for the young

The Philippines is the 1st country to adopt an extensive population education program at an early stage of its national population program. Population education is a "life experience" course with the following 5 areas of study: 1) demography, 2) determinants of population growth, 3) consequences of population growth, 4) human sexuality and reproduction, and 5) planning for the future. Many institutions in the Philippines are teaching the course materials and training teachers for the course. Difficulties encountered in initiating the course are: 1) lack of administrative support, 2) lack of cooperation from conservative parents, and 3) an overcrowded curriculum. It has been decided to integrate the aspects of this course into existing areas of the curriculum. Topics for future research in population are outlined. Use of the research was also covered.     

Deforestation and detribalization in the Philippines: The Palawan case

Palawan Island contains the largest remaining expanse of unbroken forest cover in the Philippines. The forest is currently threatened by agricultural colonization, as numerous migrants from throughout the Philippines settle annually in the island's forested uplands. Further, Palawan is being heavily logged and is, in consequence, the focus of an acrimonious national environmental debate. This paper examines how land alienation and other forms of socioeconomic marginalization attending these pressures have undermined the well-being of Palawan's indigenous tribal peoples. It also explains how lack of secure tenure and failure to achieve popular participation so distort the gap between the ideal and the practice of agroforestry programs aimed at these peoples that such programs not only fail to ameliorate the ecological situation but further undermine tribal well-being.Paper presented at the Annual Meeting of the American Association for the Advancement of Science, New Orleans, LA, February 15–20, 1990.     

Outreach: helping achieve coordination in the field

The outreach officials of the National Population Program of the Philippines, with its 4 basic functions of research, training, information-education-communication, and clinic services, are trying to solve pressing problems which have been an outgrowth of developments of the early 1970s when population and family planning concepts were integrated into other government programs. Given the task of attacking these problems and coordinating the whole program was the newly organized Commission on Population (Popcom). The organizations which had their own programs cooperated with the government agencies. Initially thought of as workable, the early strategy was soon found to be inadequate, and in July 1975, Popcom implemented an integrated development approach in population work. The strategy is complex, and as it undergoes refinement, the program may well profit from the experiences or lessions gained by a number of agencies in carrying out population/development activities. The approach used by the Office of Nonformal Education of the Philippines Rural Reconstruction Movement is seen as potentially helpful to the outreach project in developing 3 types of leadership in order to properly integrate or link private and public agencies, and ensure a continuing development program: political, educational, and technical. It is stressed that outsiders can help, but it is the community which must basically do the job themselves. So different government technicians are trained so that they can effectively train other people from the community, and do it in such a way that the program will be continuing and self-releasing.     

A cast of 40: population and family planning agencies at work in the Philippines

This is a compilation of 42 agencies, both government and private, participating in the Philippine population program. Each listing includes: the purpose of the organization; a summary of its activities for fiscal year 1974-1975; the name of the project director; and the address. A large number of these agencies are engaged primarily in population or family planning work. Others, such as the medical schools at the University of the Philippines and the University of Santo Tomas, have family planning programs as part of a broader effort.