Endangered families

"LISTEN to mother," Winnie Monsod declared to the audience. An economist and former director of the National Economic and Development Authority (NEDA), feisty Winnie was reacting to the findings of the 2003 National Demographic and Health Survey (NDHS) released just last week by the National Statistics Office and the US-based ORC Macro.

Her point is that while we're always preaching about the need to listen to the advice of our mothers, we don't seem to be as willing to listen to them when they talk about their problems and needs. The NDHS gives us an important opportunity to listen to the mothers, since it involved interviews with 13,945 women nationwide, a large percentage of whom were mothers.

The 2003 NDHS is actually the eighth of a series of surveys that started in 1968. It was originally called the National Demographic Survey and focused only on family planning. Over the years, the surveys have been expanded to include all kinds of health issues. The latest report, summarized -- note, summarized -- in a 377-page volume and covering a wide range of topics, from breastfeeding incidence to awareness of tuberculosis.

Because so many facts and figures go into the NDHS reports, they can be overwhelming and when picked up by the press, their impact tends to be reduced, people ending up bewildered by all the percentages.

Red flags

I will be using other NDHS findings in future columns but for today, I wanted to put up some red flags, picking out the more striking figures and supplementing them with statistics from other surveys to highlight the great risks faced by Filipino families, especially mothers and children.

o Some 2.5 million babies will be born this year -- that's four babies born every minute.

o The number of pregnancies here was probably higher, many lost through miscarriages and abortions. Some of these losses were due to poor maternal health, aggravated by the pregnancies being unplanned or unwanted. The NDHS reveals that only 55 percent of the pregnancies were wanted or planned.

o Of the 2.5 million babies born this year, 1,350,000 are in high-risk categories for illness or death because of fertility-rated factors, meaning their mothers' age (too young or too old), short birth intervals or too many siblings born before them.

o Of the 2.5 million babies that will be born this year, 10,000 will die before the age of 5.

o The high child death rates should not be surprising considering that in the NDHS, 30 percent of children aged 12 to 23 months had not received full immunization against six preventable diseases. Seven percent of the children (that would be about 175,000 if the trend continues) received no vaccinations at all.

Unequal risks

The NDHS reminds us that health risks aren't shared equally. The inequality is most obvious with gender. Only two-thirds of the women interviewed said that they had "consensus" with their husbands on the number of children to have. In other words, behind the unplanned pregnancies aren't just lack of access to contraceptives but also a man who wants to have more children than his wife does.

The NDHS breaks some of their figures down by age, residence (rural/urban, region), educational attainment and, for the first time, wealth or income. The figures are consistent in showing more serious problems in rural areas, in regions such as the Autonomous Region in Muslim Mindanao (ARMM) and with the poor.

To give one example, in Metro Manila, 70 percent of births were in health facilities while in the ARMM, the figure was only 11 percent.
We could look, too, at the total fertility rate (TFR) or the number of children a woman has in her lifetime. On average, a Filipina wants to have 2.5 children but ends up having 3.5. The gap between the wanted and actual TFR grows as you go down the income ladder. Women in the richest 20 percent of households in the NDHS wanted an average of 1.7 children but ended up having 2. In contrast, women in the poorest 20 percent of households wanted an average of 3.8 children but ended up having 5.9.

Even the risks for early marriage, which generally means more children and problems with child-rearing, will vary by income group. The median age for first marriage among women from the richest 20 percent of households was 24.6 years. For the poorest 20 percent it was 19.7 years.

Who is to blame?

It's tempting to blame this dismal state of affairs on a particular president, or Cabinet member, but the period between the NDHS surveys is a gray area. The current report is about data collected in 2001, while the previous report's data were collected in 1996. Between 1996 and 2001 we had three presidents: Fidel Ramos, Joseph Estrada and Gloria Macapagal-Arroyo. This was also the period when the "Asian flu" (the regional economic crisis) broke out.

But we have to remember that despite the Asian flu, neighboring countries were able to keep their social services running, meaning education, health, nutrition, population and social welfare. In contrast, our already weak social services were further emasculated: education and health budgets being the first to be cut each time the government called for austerity. As if all that were not enough, corruption further eroded the already paltry budgets.

When I realized the NDHS data were collected shortly after Arroyo became President, I became even more uneasy. What happens as we go through more years of a national leadership marked by a continuing refusal to recognize the problems of runaway population growth, by a shunting aside of family planning supposedly to uphold family values?

Certainly, family planning alone will not solve the problems enumerated in the NDHS but it can help us buy time as we try to solve the problems. During the opening ceremonies for the NDHS launch, Carina Stover of USAID called on the audience to "listen to the numbers" and shared some figures to remind us we are racing against time. The 2.5 million babies born this year will mean P3.4 billion more each year just for the vaccines (sourced at the lowest prices) to protect them from life-threatening diseases. Those babies also mean we will need some P2 billion to build 52,000 more classrooms for them, when they get to be of school age.

Do we need more shortages in vaccines, textbooks, health care centers and classrooms, as well as the 2008 NDHS figures, to convince us that the Filipino family is indeed endangered?