Family Planning in Asia and the Pacific - International Council on ...

Figure<strong>the</strong> use of contraceptives, urban woman had almost noadvantage over rural women. The same pattern is found <strong>in</strong><strong>in</strong>equities based on education <strong>and</strong> region.For contraception, it is apparent that percentages for<strong>the</strong> usually advantaged sectors are unusually dampened.Whereas <strong>the</strong>se high-perform<strong>in</strong>g sectors got 78-94 per cent<strong>in</strong> skilled attendants, <strong>the</strong>y achieved only moderate levels of47-62 per cent <strong>in</strong> contraception. As a result, better equitywas achieved through roughly equal levels of dampenedcontraceptive use.Unwanted fertilityAlthough <strong>in</strong>equities <strong>in</strong> contraceptive use are somewhatmoderated, <strong>the</strong>re are large <strong>in</strong>equities <strong>in</strong> unwanted birthsor fertility. In <strong>the</strong> 2008 NDHS, 37 per cent of all births bywomen <strong>in</strong> <strong>the</strong> lowest qu<strong>in</strong>tile were unwanted, comparedwith 16 per cent <strong>in</strong> <strong>the</strong> highest. There are two possibleexplanations shown <strong>in</strong> Figure 13. First, wealthier womenare better at avoid<strong>in</strong>g early pregnancy. Only 13 per cent ofwomen <strong>in</strong> <strong>the</strong> highest qu<strong>in</strong>tile began childbear<strong>in</strong>g between<strong>the</strong> ages of 15 <strong>and</strong> 24, compared with 44 per cent of women<strong>in</strong> <strong>the</strong> poorest qu<strong>in</strong>tile. This may be related to <strong>the</strong> lengthof time <strong>the</strong>y spent <strong>in</strong> school – 66 per cent of <strong>the</strong> richestwomen f<strong>in</strong>ished high school or reached college, comparedwith only 11 per cent of <strong>the</strong> poorest women. Second, poorwomen had lower rates of us<strong>in</strong>g sterilization to limit <strong>the</strong>irchildbear<strong>in</strong>g*5 – 7 per cent for <strong>the</strong> poorest comparedwith 20 per cent for <strong>the</strong> richest – most likely due to <strong>the</strong>higher costs of <strong>the</strong> procedure compared with o<strong>the</strong>r familyplann<strong>in</strong>g methods. The median cost of female sterilizationwas recorded by <strong>the</strong> 2008 NDHS at 1,476 pesos <strong>in</strong> <strong>the</strong>public sector <strong>and</strong> 9,929 pesos <strong>in</strong> <strong>the</strong> private sector, some30-33 times <strong>the</strong> cost of an IUD*6 <strong>in</strong> <strong>the</strong> same sector.Voluntary sterilization <strong>and</strong> <strong>in</strong>equityInequity <strong>in</strong> rates of tubal ligation has been observed s<strong>in</strong>cewealth qu<strong>in</strong>tiles were added to <strong>the</strong> DHS. In <strong>the</strong> 1998 <strong>and</strong>2003 surveys, among women who do not want any morechildren, <strong>the</strong> percentage that got a tubal ligation <strong>in</strong>creasedat a constant rate with every rise <strong>in</strong> wealth qu<strong>in</strong>tile, with <strong>the</strong>highest gett<strong>in</strong>g four times <strong>the</strong> rate of <strong>the</strong> lowest (see Figure14). This pattern changed <strong>in</strong> 2008. The percentage among<strong>the</strong> highest, fourth <strong>and</strong> middle fell while <strong>the</strong> second <strong>and</strong>lowest qu<strong>in</strong>tiles rema<strong>in</strong>ed <strong>the</strong> same. The highest ended upwith just three times <strong>the</strong> rate of <strong>the</strong> lowest. The lessen<strong>in</strong>gof <strong>in</strong>equity came from decl<strong>in</strong>es <strong>in</strong> <strong>the</strong> better-off qu<strong>in</strong>tiles,not from any improvement for <strong>the</strong> poor.To both elim<strong>in</strong>ate <strong>in</strong>equity <strong>and</strong> return to <strong>the</strong> 2003 peakrate achieved by <strong>the</strong> highest qu<strong>in</strong>tile, that is, 27 per centof all those who wanted no more children, regardless ofwealth, <strong>and</strong> are able to get tubal ligation, it is estimatedthat for 2010, some 1.13 million procedures were needed:370,000 for <strong>the</strong> lowest; 260,000 for <strong>the</strong> second; 240,000for <strong>the</strong> middle; 136,000 for <strong>the</strong> fourth; <strong>and</strong> 126,000 for<strong>the</strong> highest qu<strong>in</strong>tile. The two poorest qu<strong>in</strong>tiles need 55 percent (630,000) of all <strong>the</strong>se procedures <strong>and</strong> required easieraccess to subsidies from public health funds to elim<strong>in</strong>ate<strong>the</strong> equity gap. In October 2008, <strong>the</strong> country's nationalFigure12Comparison of <strong>in</strong>equities <strong>in</strong> maternal care <strong>and</strong> family plann<strong>in</strong>g, married women (15-49)312