Addressing the Unmet Need for Family Planning Among the Young ...

UNFPA-­‐ICOMP Workshop on Operationalizing the Call for Elimination of Unmet Need for Family Planning in Asia and the Pacific Region 18-­‐19 September 2012 The Imperial Queen’s Park Hotel, Bangkok Addressing the Unmet Need forFamily Planning Among the YoungPeople in the PhilippinesPrepared by:Assoc. Prof. Dr. Mary Huang Soo LeeMs Lim Shiang ChengAsia and the Pacific Regional OfficeInternational Council on Management of Population Programmes

1. National Overview The Republic of the Philippines is an Archipelago in South East Asia. It is the only Catholic country in south East Asia with 82.9% of her population professing Catholicism. The country is basically made up of more than 7,000 islands, the biggest of which are Luzon, Mindanao and Samar. Geographical divisions of the country include Luzon, Visayas and Mindanao with the capital city being Manila. The Philippines were divided into 17 regions, 80 provinces, 138 cities, 1,496 municipalities, and 42,025 villages or Barangays in their native language. Philippines is unfortunately prone to earthquakes and typhoons because if its location on the Pacific Ring of Fire. This 12 th most populous country in the world has an estimated population of about 94 million people with an additional 11 million who live overseas. People are of mix ethnicities reflecting the different cultures including that of the Spanish, who ruled the country for 300 years and the Americans. The official language is Tagalog and English but there are other dialects spoken in different parts of the country. It is estimated that half of the population reside on the island of Luzon. The population growth rate between 1995 and 2000 was 3.21% but in 2007 it was reported that the growth rate had declined to 2.04%. In 2007 median age was a low of 22.7 years and life expectancy at birth was 71.7 years (Table 1). Most of the people live in urban areas (59%) but nonetheless the Philippines has a formidable rural population made even harder to reach due to fact that the country is made up of more than 7,000 islands.

Table 1: Country Context – Social Demographic Characteristic Size of population 88,548,366 1Population Growth (%) 2.04 2Median Age 22.7 years Ethnic groups Tagalog (28.1%), Cebuano (13.1%), Ilocano (9%), Bisaya/Binisaya (7.6%), Hiligaynon Ilonggo (7.5%), Bikol (6%), Waray (3.4%), other (25.3%) 3Religions Catholic (82.9%), Muslim (5%), Evangelical (2.8%), Iglesia ni Kristo (2.3%), other Christian (4.5%), other (1.8%), unspecified (0.6%), none (0.1%) 4Languages Filipino (official; based on Tagalog) and English (official); eight major dialects -­‐ Tagalog, Cebuano, Ilocano, Hiligaynon or Ilonggo, Bicol, Waray, Pampango, and Pangasinan 5Life expectancy at birth (years) 71.7 6Literacy Rate Aged 10+ 95.6 7 (Male – 95.1; Female – 96.1) Population living below the national 26.5 8poverty line (%) Median age at first marriage for 22.2 9women (ages 15-­‐49) Contraceptive prevalence rate for 50.7 10women (ages 15-­‐49) Total Fertility rate 3.2 11Maternal mortality ratio 162 12 (per 100,000 live births) Infant mortality rate 25 13 (per 1,000 life births) HIV prevalence rate (15 – 49)

2. Overall Status of Young People in the Philippines 2.1 Demographic Profile of Young People Compared to other neighboring countries such as Malaysia, Singapore and Thailand, the Philippines are experiencing a slower change in its population age-­‐structure. The country still has a young population and it is estimated that young people aged 10 to 24 years totaled 29.1 million, or 31% of the total population according to the Population Division of the Department of Economic and Social Affairs, United Nations in 2010 (Table 2). The number of adolescents and young adults in Philippines has increased rapidly from 5,481,000 to 29,062,000 between 1950 and 2010. In fact in a period of sixty years the number of young people grew five folds (Figure 1). Although the period of rapid increase in the youth population seem to be over in some countries of Southeast Asia, the youth bulge in the Philippines has remained due in part to the slow decline in fertility, from 3.7 in 1998 and 3.5 in 2003 to 3.2 in 2011. Table 2: Demographic profile of adolescents in Philippines, 2010 16Estimated Population aged 10-­‐24 (millions) Estimated Population aged 10-­‐14 (thousands) Estimated Population aged 15-­‐19 (thousands) Estimated Population aged 20-­‐24 (thousands) Young People aged 10-­‐19 as a %age of total population Young People aged 15-­‐24 as a %age of total population Young People aged 10-­‐24 as a %age of total population 29.1 10,500 9,701 8,861 22.8 21.0 31.0 15 2009 Integrated HIV and Behavior Serologic Surveillance (IHBSS). Philippines 16 United Nations, Department of Economic and Social Affairs, Population Division (2011). World Population Prospects: The 2010 Revision, CD-­‐ROM Edition

Figure 1: Number and %age of Young People aged 10 – 24 in Philippines, 1950 -­‐ 2010 17Number and Percentage of Young People aged 10 - 243500030000250002000015000100005000Number of Estimated Populationaged 10 - 24 (thousand)01950 1960 1970 1980 1990 2000 20105481 7746 11830 15875 19966 24805 290623534333231302928Young People aged 10 - 24 as apercentage of total population30 30 33 34 32 32 312.2 Youth Literacy Rate The literacy rate of youth aged 15-­‐24 in Philippines was reported at 98 in 2008, according to the World Bank and the Philippines Progress Report on the Millennium Development Goals in 2010 18 . The literacy rate of young Filipinos has improved over the last 30 years, from 92 % in 1980 to 98 % in 2008 (Figure 2). Generally, the data showed that the literacy rates among young females aged 15 to 24 years in Philippines were higher than that of the males in the same age group. As reported in the MDG Report 2010, girls were more likely to stay in schools and complete their secondary school education but more boys dropped out as they needed to work because they lack financial support for school requirements and some due to low motivation to study. It is therefore not surprising that, the UNESCO EFA Global Monitoring Report 2010 projected that there will be an estimated 618,140 young men and only 378,860 young girls (age 15 to 24) who are illiterate in 2015.(Figure 3). 17 Ibid 16 18 Ibid 8.

Figure 2: Youth (15 – 24 years old) Literacy Rate 19Youth (15 – 24 years old) Literacy Rate, 1980 - 2008100989694929088861980 1990 2000 2003 2008Total 92 97 95 95 98Male 91 96 94 94 97Female 92 97 96 97 98Figure 3: Total Numbers of Youth Illiterates, 1985 – 2015 (Projected) 20Total Number of Illiterate Youths (15-24) by year12001000(Thousand)80060040020001985 - 1994 2000 - 2007 Projected 2015Total 428 975 997Male 235.4 575.25 618.14Female 192.6 399.75 378.8619 The World Bank. World Development Indicators. Youth Literacy. website, date accessed 2 March 2012.http://data.worldbank.org/indicator/SE.ADT.1524.LT.MA.ZS/countries?page=6 20 UNESCO. EFA Global Monitoring Report 2010 -­‐ Reaching the marginalized.

2.3 Youth Employment According to the International Labor Organization (ILO) Report, 2011, there was an estimated 75.1 million unemployed young people world wide 21 . The unemployment is usually higher among younger people in the world including the Asia Pacific region; and sometimes it is more than twice as high as total unemployment in the general population. The similar trend was also observed for the Philippines. While the total unemployment rate remained at 7.5% of the labor force in 2009, the total unemployment rate among youths stood at 17.4%, which more than doubled of the total unemployment rate of the country (Figure 4). On the other hand, it should be noted that the unemployment rate among young females was even higher compared to young males despite the higher literacy rate among them. Aside from lack of job opportunities, one of the main reasons for the low employment opportunities among youths is the skills mismatch 22 . Most of the young people do not have the adequate skills that are required by key industries in Philippines such as aviation, cyber services, hotel and restaurants, agribusiness, health services, medical tourism and mining, etc. As a result it is difficult for them to get find a decent job and are at greater risk of working in a low-­‐productivity jobs under unsafe and risky conditions, unable to access entitlements such as health insurance, social security and other social protection measures thus resulting in them become part of the working poor group (people who work but live in households in which income/expenditure is less than US$1.25 per person a day) 23 . 21 International Labor Office -­‐ Geneva: ILO, 2011. Global Employment Trends for Youth: 2011 update October 2011. 22 Ibid 8. 23 United Nations Department of Economic and Social Affairs. (2012). UN World Youth Report. Youth Employment: Youth Perspectives On The Pursuit Of Decent Work In Changing Times. http://www.unworldyouthreport.org/

Figure 4: Youth (aged 15 – 24) Unemployment Rate, 1995 – 2009 Youth (aged 15 - 24) unemployment rate , 1995 - 2009262422(%)2018161412Total Youth UnemploymentRateTotal Youth (Male)Unemployment RateTotal Youth (Female)Unemployment Rate101995 2000 2008 200916.1 21.2 17.5 17.414.4 19.8 16.2 16.219.1 23.6 19.6 19.32.4 Age at first marriage, first sexual intercourse and first birth (Female aged 25 – 49), Philippines, 1993 -­‐ 2008 In many countries in the Asia Pacific region, the mean age at first marriage for both men and women has increased over the years. For example, the mean age at first marriage has gone beyond 25 for males and 23 for females in China, Republic of Korea and Thailand 24 . On the other hand, in Malaysia, the average age at first marriage has increased to 28 years for men and 25.1 years for women in 2010 25 . Compared to the neighboring countries, the mean age at first marriage among women aged 25 to 49 in Philippines has stagnated at around 22 years since 1998. According the Philippines National Demographic and Health Survey (NDHS) in 2008, 16.7 % of the women married at 18, half of them married by age 22, and nearly seven in ten were married by age 25. The survey also found that women from urban areas, better-­‐educated, and wealthier tended to marry later. 24 United Nations Economic and Social Commission for Asia and the Pacific (ESCAP). Fact Sheet March 2007. 25 Department of Statistics, Malaysia. The 2010 Population and Housing Census of Malaysia.

Figure 5: Age at first marriage, first sexual intercourse and first birth (Female aged 25 – 49, both married and unmarried), Philippines, 1993 -­‐ 2008 26Mean Age at First Marriage, First Sexual Intercourse and First Birth(Female aged 25 - 49), Philippines, 1993 - 200823.52322.5Age2221.52120.51993 1998 2003 2008First Marriage 21.6 22.1 22 22.2First SexualIntercourse21.5 22.1 21.9 21.5First Birth 22.8 23.3 23.2 23As shown in Figure 5, the mean age at first sexual intercourse has declined slowly over the last ten years, from 22.1 in 1998 to 21.5 in 2008, while the mean age at first marriage has increased slightly in the same period. According to the 2008 National Demographic and Health survey (NDHS), 2.1% of the women aged 15 to 24 said that they had their first sex before the age of 15 and 17.1% of them before the age of 18. Nonetheless the 2008 NDHS survey still reported that most of the women in the Philippines waited until marriage to have the first sexual intercourse as the mean age at first sexual intercourse was only slightly lower than the mean age at first marriage. On the other hand, the 3 rd Young Adult Fertility and Sexuality (YAFS) Study conducted in 2002 among 19,728 youths aged 15 to 27 showed that the mean age at first sexual intercourse among the youths was much earlier. The average age for young men to have their first sex was 17 and for young women, most of them cited that they had it at 18 26 National Statistics Office, Manila, Philippines. Philippines National Demographic and Health Survey, 1993, 1998, 2003 and 2008

years old. The reasons Filipino youths gave for having their first sex included the fact that they wanted it to happened at that time, followed about one third of them who said that it happened without planning and about a quarter of them said that they did not want it to happen but they went along with it (Table 3). It should be noted that a total of 4.5 % of the young women said that their first sex happened against their will. Table 3: Filipino Youths’ (15 to 27 years) Reason for Having First Sex 27Reason % distribution by reason for having first sex Women Men Wanted to happened at that time 34.6 46.5 Did not want but went along with it 27.2 21.4 Did not plan but happened anyway 33.8 31.2 Happened against will 4.5 0.7 The 2008 NDHS reported that most women had their first births at 23 years old, implying that most of them gave birth a year after they married. At the same time women who lived in urban areas, those with higher education and those with higher socioeconomic status had their first births later than their other counterparts. Although majority of the women had their first birth at 23 years, there were about 10% who gave birth before 18 years old (0.7% of the women had their first birth at age 15 and 9% at age 18) while 22.9% of them gave birth at aged 20. For the young women who married and gave birth at an early age, most of them had shorter birth intervals than older women. For example, the birth interval for women aged 15 to 19 was 20.3 months compared to 27 months for women age 20 to 29 and 36.5 months for women aged 30 to 39. The early childbearing and shorter birth interval can put younger women at higher risk of maternal mortality and morbidity. 27 Demographic Research and Development Foundation, Inc. and University of the Philippines Population Institute. 2002 Young Adult Fertility and Sexuality Study (YAFS3).

2.5 Adolescent fertility rate (the number of births per 1,000 women ages 15-­‐19) The adolescent fertility rate in the Philippines stood at 54 births per 1,000 women aged 15 to 19 and the figure was slightly higher in the Asia Pacific Region, with the regional averages standing at 42 births per 1,000 women in 2006 28 . According to the 2008 NDHS report, the adolescent fertility rate had increased since 1998, from 46 to 54 births per 1,000 women in 2008 (Figure 6). In addition, it also reported that, out of 2,749 female adolescent aged 15 to 19 interviewed in the 2008 NDHS, 9.9% of them had begun childbearing. At the same time, half of the women aged 20 to 24 had also started childbearing. Most of these young women who have begun their childbearing at a young age were those from poor families, those who lived in rural areas and those who were poorly educated. Figure 6: Adolescent Fertility Rate, 1993 -­‐ 2008 29Adolescent Fertility Rate, 1993 - 200856545250484644421993 1998 2003 200850 46 53 5428 Ibid 24. 29 Ibid 26

3. Young People Reproductive Health Status 3.1 Knowledge of Sexual and Reproductive Health Table 4 shows that knowledge of sexual and reproductive health including knowledge on contraceptive methods for all married women and knowledge on HIV and STIs among both married women and unmarried women and men. The NDHS 2008 reported that knowledge of contraceptive methods was widespread among married women aged 15 to 24. Almost all married women aged 15 to 24 had heard of at least one contraceptive method (96.3 to 99.4%) and had heard of at least one modern method (96.3 to 99.2%). It should be noted that recent studies on knowledge of contraceptive methods among the married men and unmarried young people is limited and the 2008 NDHS only focused on married women. However, the 2003 NDHS showed that the level of contraception awareness among married men aged 20 to 24 was similar to that of the women, where 97.1 % of them knew at least one contraceptive method and at least one modern method 30 . Although the NDHS showed that majority of the married youths have heard about contraceptive methods, an earlier nationwide study conducted in 1994, the Young Adult Fertility Survey among 11,000 young people, aged 15 to 24 found that some of the young people did not really understand how to use contraceptive methods despite the fact that majority of them (84%) had heard of it 31 . For example, one third of young people in this study thought that the pill was taken either before or after sexual intercourse and 17% of them thought that tubal ligation is an object inserted into the female before intercourse. 30 National Statistics Office, Manila, Philippines. Philippines National Demographic and Health Survey, 2003. 31 University of the Philippines Population Institute. (1996). 1994 Young Adult Fertility Survey (YAFS II).

Table 4: Percentage of Filipino Youths with correct responses on fertile period, risk of pregnancy, STI and HIV/AIDS, by gender Knowledge Family Planning Method Contraceptive method – any method (Currently married women) Contraceptive method –modern method (Currently married women) HIV/AIDS and STIs Philippines 2002 YAFS Study – 15 – 27) 32 Women 33Filipino Youth (aged NDHS 2008 – Married Female Male 15 -­‐ 19 20 -­‐ 24 -­‐ -­‐ 96.3 99.4 -­‐ -­‐ 96.3 99.2 AIDS – Have heard of AIDS 95.5 95.0 90.6 95.5 Comprehensive knowledge about 18.7 23.2 AIDS Believe that AIDS is curable 25.4 30.5 -­‐ -­‐ Agree that one gets STIs from kissing 29.6 34.6 -­‐ -­‐ Agree that only those with multiple 76.6 80.5 -­‐ -­‐ sex partners get AIDS A healthy-­‐looking person can have -­‐ -­‐ 59.9 68.6 AIDS HIV/AIDS cannot be transmitted by -­‐ -­‐ 62.4 65.7 mosquito bites HIV/AIDS cannot be transmitted by -­‐ -­‐ 70.9 79.4 hugging or shaking hands HIV/AIDS cannot be transmitted by -­‐ -­‐ 51.4 58.9 sharing food Know where to get HIV test -­‐ -­‐ 41.9 53.1 Know a condom source -­‐ -­‐ 56.0 75.9 HIV prevention method -­‐ Condom -­‐ -­‐ 50.7 58.9 HIV prevention method -­‐ Limiting -­‐ -­‐ 70.8 80.0 sexual intercourse to one uninfected partner HIV prevention method -­‐ Using -­‐ -­‐ 45.2 53.6 condoms and limiting sexual intercourse to one HIV negative partner HIV prevention method -­‐ -­‐ -­‐ 61.3 67.1 Abstinence Heard of STIs 62.5 69.8 -­‐ -­‐ 32 Ibid 27 33 National Statistics Office, Manila, Philippines. Philippines National Demographic and Health Survey, 2008.

Generally, there were more studies on young people’s knowledge of HIV and AIDS and the literature reviewed showed that almost all young people in Philippines had heard of AIDS. However, the understanding of these issues was varied and only about one fifth had comprehensive knowledge about AIDS (Table 4). About one third of the young people believed that AIDS is curable. In addition, some young women were unsure about the mode of HIV transmission, i.e. only about two thirds of the women knew that HIV cannot be transmitted by mosquito bites, hugging or shaking hands and sharing foods. Furthermore, only about half of them knew where to get a HIV test and about the condom as a HIV prevention method. Compared to HIV and AIDS, the awareness of Filipino youths about STIs was poorer with only about two thirds having heard of it. With regards to the channels from where they obtain information on sexual and reproductive health, about two thirds of the young women said that they heard or saw a family planning message on the television, followed by 40.2 to 46.6% who reported that they received the family planning messages through the radio and about a quarter of the young married women had heard or saw it in a newspaper, magazine or poster (Table 5). Table 5: Percentage distribution of Filipino young married women by source of information on family planning 34Exposure Married Women 15 -­‐ 19 20 -­‐ 24 Heard or saw a family planning message on the radio 40.2 46.6 Heard or saw a family planning message on the television 71.8 79.3 heard or saw a family planning message in a newspaper/ magazine or poster 26.1 31.0 Another study conducted among 4,000 Filipino students aged 13 to 18 reported that they received information regarding love and sexuality from their friends (both boys and girls), followed by internet or magazines (mainly for boys) and parents (mainly for girls) 35 . Generally, the information sources reported by most of the young people (peers, internet and media) are not normally described as ideal for educating teens as some of 34 Ibid 33 35 Irala, J.D., Osorio, A., Burgo, C. L. D.,Belen, V.A., Guzman, F.O., Calatrava, M. C. and Torralba, A. N. Relationships, love and sexuality: what the Filipino teens think and feel. BMC Public Health 2009, 9:282 doi:10.1186/1471-­‐2458-­‐9-­‐282

these sources, especially the pornography materials, can distort adolescents’ understanding of sexual and reproduction health and increase their risk of aggression, rape myths and gender stereotypes. The 2002 Young Adult Fertility and Sexuality Study showed that more than three quarters of the young men had been exposed to pornography videos and half of them had read sexually explicated materials since the age of 15 (Table 6). Compared to boys, only about one third of the girls said that they had been exposed to the pornography videos and materials. Table 6: Percentage distribution of Filipino Youths (aged 15 – 27), who were expose to pornography 36Exposure Filipino Youth (aged 15 – 27) Female Male Watched x-­‐rated movies/videos 36.5 75.7 Read sexually explicated materials 29.9 48.5 Mean age first exposed to pornographic materials 16 15 3.2 Sexual Development Limited literature on sexual development was found in the desk review except for information on menarche for girls and wet dreams for boys. For menarche, both the 2002 YAFS Study and the 2008 NDHS showed that the overall mean age at menarche among the Philippines women was around 13 years (Table 7). Based on the 2008 NDHS report, majority (70.8%) of the women aged 15 to 49 had their first menstruation at the age of 12 to 14. In addition, the survey also found that younger women tend to begin menstruation at an earlier age than older women. For example, the mean age at menarche for women age 15-­‐19 was 12.8 years, while for women age 45-­‐49, it was 13.7 years. In terms of wet dreams, the 2002 YAFS study reported that the mean age at first wet dream among the boys was 14 years. In the same study, majority of the young men (79.9%) were reported to have practiced masturbation compared to only 4.7% of the girls who did it. An exploratory study conducted among 91 youths aged 16 to 25 from the College of Social Sciences and Philosophy in the University of the Philippines Diliman 36 Ibid 27

in 2004 showed that Filipinos are now more liberal in terms of masturbation and most of them thought that masturbation was just a natural activity 37 . Table 7: Age at First Menstruation And First Wet Dream Philippines 2002 YAFS Study – Filipino Youth (aged 15 – 27) 38 NDHS 2008 -­‐ Women 39Female Male 15 -­‐ 19 20 -­‐ 24 Mean age at first menstruation 13 -­‐ 12.8 13 Mean age at first wet dream -­‐ 14 -­‐ -­‐ Masturbation (%) 4.7 79.9 -­‐ -­‐ 3.3 Sexual Behavior 3.3.1 Dating and Sexual Experience The 2002 National Study on YAFS reported that the mean age both young girls and boys began having crushes with each other was 13 years and the mean age both sexes had their first single date was 16. The average age of dating experiences among the Filipino youths, especially among the young girls declined from 15.1 years in 1982 to 14.2 in 1994 and it further dropped to 13 in 2002 40 . The data on boys also showed a similar trend with the boys saying that they had their first crush at age14 in 2002 while the 1994 data showed that they had their first crush at aged 15.1. The mean age, at which Filipino youths had their first single date, also declined from aged 17.8 for girls in 1982, to 16 in 2002. It should be noted that 6.2 % of boys and 1.1 % of girls reported that they had sex during the first single date in the 2002 YAFS study. On the other hand, the 2002 YAFS study also revealed that more than almost a quarter or 23 % of young people (15-­‐24 years old) reported to have had premarital sexual experiences (PMS). The prevalence among boys is double that of girls (31.2% vs. 15.9%) 37 Gerry M. Lanuza. (2004). The Structuration of the Sexual Habitus of Youth Culture -­‐ An Exploratory Study of Some of the Sexual Dimensions of Youth Culture of the College of Social Sciences and Philosophy 38 Ibid 27 39 Ibid 33 40 Nimfa B. Ogena. (1999). How are the Filipino Youth Changing? The Shifting Lifestyles Of Our Nation’s Young, 1970s To 1990s. Philippine Social Sciences Review. vol. 56 nos.1-­‐4, jan-­‐dec 1999

and the average age for the young people to have their first sex was at aged 17.5. The proportion of young people who engaged in premarital sex had increased compared to the data of 1994 YAFS study. In 1994, only 18 % of the youths, (26% of the boys and 10% of the girls) reported that they have had premarital sex experience. Most of the Filipino youths (40%) cited “expression of love” as the main reason for engaging in the first premarital sex, followed by 20% who said that they did it due to curiosity, 14% said that it was a way for them to release their urge and 8% had their first premarital sex because their partners wanted it. Table 8: Sexual Practices among Unmarried Women and Men Age 15-­‐24, 2002 41Female Male Mean age began having crushes 13 14 Mean age at first single date 16 16 Ever had premarital sex (%) 15.9 31.2 Used contraception during first premarital sex (%) 14.5 27.6 Used contraception during last/only premarital sex (%) 22.3 27.3 Had more than one premarital sexual partner (%) 9.1 50.0 Mean number of sexual partners 2.8 4.1 A total of 57% of the first sexual experiences reported by these young people were not planned or were something they did not want to happen at the time. Therefore, it was not surprising that the use of contraception was low among these young people, especially among the girls at the time they had their first sexual encounter. Only 14.5% of the girls and 27.6% of the boys reported that they used contraception the first time they had premarital sex. When the young people were asked about the types of contraceptives they used, condom was the most common method, followed by withdrawal, pills and the unreliable rhythm method. In addition to not practicing safe sex and not using any contraception during the sexual intercourse, the 2002 YAFS study also revealed that more young men were involved in high-­‐risk sexual behavior, with half of them having more than one premarital sexual partner and the mean number of the sexual partners was 4.1. On the other hand, a total 41 Ibid 27

of 9.1% of the young women said that they had more than one sexual partners and the average number was 2.8. 3.3.2 Contraceptive Use and Unmet Needs The contraceptive prevalence rate in Philippines is low compared to her Asian counterparts despite the fact that it has increase in recent years. In addition, the rate of increase has been very minimal with the use of any method increasing by only ten percentage points over the past 15 years (from 40% in 1993 to 50.7% in 2008) (Figure 7). The practice of modern, more effective methods was even lower; with only about one third of the married women aged 15 to 49 years ever using modern methods in 2008. The very slow increase in the use of contraception, especially the use of modern contraception in Philippines is mainly due to the limited social, religious and political support. The previous president, Gloria Macapagal-­‐Arroyo, who supported only natural family planning programme for the past ten years and the withdrawal of The U. S. Agency for International Development (USAID)’s funding on Philippine public contraceptive services between 2004 and 2008 had created a negative effect on the family planning programme 42 . While CPR for the Philippines was low, the use of contraceptive among youth aged 15 to 24 was dismal. The 2008 NDHS reported that only 46.3% young married women aged 20 to 24 and 25.9% of those aged 15 to 19 used any family planning method. On the other hand, there were less women aged 20 to 24 and those aged 15 to 19 who cited that they were using modern contraceptive methods (32.5% and 14.3% respectively). Nevertheless, the contraceptive prevalence rate for young married women (aged 15 to 24) in the Philippines has shown an increase over the past 15 years with the rate of increase among women aged 20 to 24 being higher than women in the age group of 15 to 19. 42 The Guttmacher Institute. (May 2010). In Brief. Facts on Barriers to Contraceptive Use In the Philippines

Figure 7: Trends in Contraceptive Use among Currently Married Women, 1993 -­‐ 2008 43According to the NDHS 2008, the most widely used method among the young married women aged 15 to 19 was withdrawal (9.8%) followed by the pill (8.6 %), injectables (2.4%), and rhythm (1.8%) (Table 9). While for those women aged 20 to 24, the most preferred method was the pill (21.9%), followed by withdrawal (13.8%), injectables (5%), IUCD and rhythm (3.1% respectively) (Table 8). The Guttmacher Institute, in a paper titled, “Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons With Adult Women”, reported that most of the young women in Philippines continue to use the less efficient contraceptive methods 43 Ibid 26.

such as withdrawal and rhythm and there seem to be a trend of contraceptive shift from the pill to withdrawal 44 . Table 9: Percentage of Ever-­‐Married Women and of Currently Married Women Who Have Ever Used A Contraceptive Method and Currently Using a Contraceptive Method, 2008 45Contraceptive Ever use of contraception (%) Current use of contraception (%) Method All women Currently Married Women All women Currently Married Women 15-­‐19 20-­‐24 15-­‐19 20-­‐24 15-­‐19 20-­‐24 15-­‐19 20-­‐24 Any Method 6.1 36.1 46.0 67.8 3.1 23.3 25.9 46.3 Any modern 3.5 27.0 26.3 51.7 1.6 16.3 14.3 32.5 method Pill 1.7 18.8 14.5 37.1 0.9 10.6 8.6 21.9 IUCD 0.2 2.5 2.1 5.2 0.2 1.5 1.7 3.1 Injectables 0.4 6.1 3.6 12.8 0.2 2.4 2.4 5.0 Male Condom 1.4 6.7 7.8 10.2 0.3 1.4 1.6 1.6 Any traditional 4.1 21.6 29.9 39.4 1.5 7.1 11.6 13.8 Method Rhythm 1.0 6.0 8.5 10.2 0.2 1.7 1.8 3.1 Withdrawal 3.5 19.5 25.7 35.7 1.3 5.3 9.8 10.5 When the women aged 15 to 29 were asked about the reason for not using contraception, slightly more than one quarter of them (26.5%) cited “health concerns” as the main reason, followed by another quarter (23.3%) who said that they fear of side effects and 18.6% of the women said that because of fertility-­‐related reasons, i.e. they wanted as many children as possible (Table 10). There were 7.5% who said they were not able to use any contraceptive method because of husband/partner’s objection. Only a small proportion (around 3%) of the women cited “cost” and “religion” as reasons for not using contraception. 44 Ann K.Blanc, A. K., Tsui, A. O., Croft, T. N. And Trevitt, J. L. (2009). Patterns and Trends in Adolescents’ Contraceptive Use and Discontinuation in Developing Countries and Comparisons With Adult Women. International Perspectives on Sexual and ReproductiveHealth,2009,35(2):63–71 45 Ibid 33

Table 10: Reason for not using contraception, 2008 46Reason Want as many children as possible Husband/partner opposed to use Health concerns Fear of side effects Infrequent sex/no sex Religious prohibition Costs too much Percentage Distribution Of Currently Married Women (15 – 29 Year) 18.6 7.5 26.5 23.3 4.5 3.6 3.5 As shown in Table 11, more than one third of the married women aged 15 to 19 (35.8%) and about a quarter of women aged 20 to 24 years old (24.6%) had an unmet need for family planning. Majority of these women reported that their unmet need was mainly for spacing. According to NDHS 2008, women with an unmet need for spacing include “pregnant women whose pregnancy was mistimed; amenorrheic women whose last birth was mistimed; and fecund women who are neither pregnant nor amenorrheic, who were not using any method of family planning, and who wanted to wait two or more years for their next birth” and unmet need for limiting refers to “pregnant women whose pregnancy was unwanted; amenorrheic women whose last child was unwanted; and women who are neither pregnant nor amenorrheic, who are not using any method of family planning, and who want no more children”. It should be noted that the level of unmet need among women aged 15 to 19 increased from 29.1% in the 2003 NDHS to 35.8% in 2008, which implies that there was an indeed increase demand for family planning among this age group. Table 11: Unmet Need for family planning among currently married women, 2008 47Unmet Need for Family Planning Currently Married Women 15 -­‐ 19 20 -­‐ 24 For spacing 30.5 19.3 For limiting 5.3 5.3 Total 35.8 24.6 46 Ibid 33 47 Ibid 33

3.4 Pregnancy and Child Birth Generally Filipino women in their younger age (15 to 19) received poorer care for maternal and child health compared to women who are aged 20 and above despite the fact that they have higher risks in pregnancy and birth. Although only one in nine women aged 15 to 19 received antenatal services from a skilled provider, majority of them (56.6%) received it from midwives (Table 12). In addition, about two third of the young girls (aged 15 to 19) delivered at home, while only 37.6% delivered in a health facility. In fact, in 39.9% of these women delivery was conducted by a hilot (ancient Filipino art of healing, commonly used today to relax stressed muscles) practitioner. About 10.9% of the adolescent girls had no postnatal checkups after delivery. Table 12: Maternal and Child Health, 2008 48Indicator -­‐ Maternal and Child Health Mother's age at birth 15 -­‐ 19 20 -­‐ 34 Percentage receiving antenatal care from a 90.9 91.8 skilled provider Percentage delivered in a health facility 37.6 45.6 Percentage delivered at home 62.4 54.1 Percentage delivered by a skilled provider 59.0 63.8 No postnatal checkup 10.9 9.0 Problems in accessing health care 78.5 73.2 Getting permission to go for treatment 10.6 7.3 Getting money for treatment 56.8 53.1 Distance to health facility 29.5 25.2 Having to take transport 25.9 25.3 Not wanting to go alone 30.5 17.6 Concern no female provider available 22.5 16.4 Concern no provider available 40.6 35.4 Concern no drugs available 51.4 45.1 Percent distribution of births with a 22.9 18.9 reported birth weight – Less than 2.5kg Percentage of all live births by size of child 5.7 4.1 at birth – very small Percent distribution of all live births by size of child at birth – smaller than average 16.6 15.5 48 Ibid 33

When the young mothers were asked about the reasons not receiving pre and post natal check ups in a healthcare facility, majority said that they had problems in accessing health care facility and “lack of money” was the main problem (56.8%). Furthermore, most of them were also concern with the availability of the service provider (40.6%) and drugs (51.4%) in the healthcare facility. The other barriers mentioned included distance to health facility, transportation, waiting time and availability of female providers. It should also be noted that about 10% of the young women aged 15 to 19 said that they needed to get their husbands’ permission to go for health services. There were also more young women aged 15 to 19 who had a low birth weight babies. The NDHS 2008 showed that a total of 22.9% of the young mothers aged 15 to 19 had underweight babies (less than 2.5 kg), with 5.7% of them having very small babies and in general 16.6% of their babies were smaller than national average (Table 12). 3.5 Abortion The literature review showed that the data on abortion in Philippines is limited in view of the laws which state that abortion is only permissible to save the life of the woman. Nevertheless, many women still seek an abortion despite conditions that may put their health at risk rather than give birth to children they cannot care for or do not want. According to the results of the 2008 NDHS, among women age 15-­‐19, 31% of births were unplanned, of which, 21% were unwanted. Juarez et al., postulated that one third of pregnancies, especially those unplanned and unwanted would end in abortion 49 . Based on the Guttmacher study, an estimated 473,000 abortions occur annually and young women accounted for 17% of induced abortions 50 . However data obtained from the Department of Health website quoted that in 2000 induced abortion among adolescents reached 319,000. Majority of women cited inability of support and raise another child (72%) as the reason they sought for abortion services, followed by more than half who reported that the pregnancy occurred too soon after their last one (57%) and another 54% who said that they had enough children. 49 Ibid 8. 50 Juarez, F., Cabigon, J., Singh, S. and Hussain, R. The Incidence of Induced Abortion in the Philippines: Current Level and Recent Trends. International Family Planning Perspectives, 2005, 31(3):140–149

4. Laws and Policies 4.1 Legal age at marriage The legal age of marriage is 18 years for both men and women. However it must be recognized that 5% of the population who are Muslims. Therefore while for the rest of the country age at marriage is governed by the Family Code of the Philippines, 1987, Presidential decree No. 1083 is issued for Muslim marriages. 4.1.1 The Family Code of the Philippines, 1987 Article 5 of the Family code of the Philippines stipulates that males or females of the age of eighteen years or upwards not under any of the impediments mentioned in Articles 37 and 38, (both referring to marriages among family members) may contract marriage. This age at marriage is reinforced by Article 35 which reiterates that marriages contracted by any party below eighteen year of age even with the consent of parents or guardians shall be void from the beginning. 4.1.2 Decree No. 1083 -­‐ "Code of Muslim Personal Laws of the Philippines" Article 16 covers capacity to contract marriage and it states that: (a) Any Muslim male at least fifteen years of age and any Muslim female of the age of puberty or upwards and not suffering from any impediment under the provisions of this Code may contract marriage. A female is presumed to have attained puberty upon reaching the age of fifteen. (b) However, the Shari'a District Court may, upon petition of a proper wali, (representative) order the solemnization of the marriage of a female who is less than fifteen but not below twelve years of age, and who has attained puberty.

4.2 Reproductive Health Policy (2000) As a follow-­‐up to the International Conference on Population and Development (ICPD) the Department of Health formulated the Reproductive Health Policy (2000) with the vision to promote reproductive health as a way of life for every man and woman and a goal of universal access to quality RH service. While this policy covered all Filipinos, special mention was made of the RH needs of the adolescents. In fact the policy spelt out health of “adolescents and youths” as one of ten elements of RH regarded under priority health care service and item seventeen of the Guiding Principles reiterates that “Reproductive health should pay special attention to the adolescents and in·∙ particular the girl-­‐child. They should be protected from all forms of violence and should be provided with factual information that will develop in them the level of maturity required to make responsible decisions.” 4.3 The Reproductive Health Bills The Reproductive health bill if it can be passed provides for universal distribution of family planning devices and its enforcement and this in itself will improve access to family planning for all women including young people. However despite of its failure to get the approval of law makers, in 2010 the newly elected president, Benigno Aquino III publicly announced a 5 point position on family planning among which was the fact that the “state must respect individual’s right to follow his or her conscience and religious conviction on matters and issues pertaining to the unity of the family and the sacredness of human life from conception to natural death”. The opposition to the passing of the Bill has been attributed to the Catholic Church and affiliated organizations who are afraid that the passing of the law could lead to legalization of abortions. In addition, the bills also included Mandatory Age-­‐Appropriate Reproductive Health and Sexuality Education. Based on the bills, age-­‐appropriate Reproductive Health and Sexuality Education shall be taught by adequately trained teachers in formal and non-­formal educational system starting from Grade five up to the fourth year of High School using life-­‐skills and other approaches. Reproductive Health and Sexuality Education was to commence at the start of the school year immediately following the effective passing of this Act to allow the training of concerned teachers. The Department of Education (DEPED), Commission on Higher Education (CHED), Technical Education and skills development authority (TESDA), Department of Social Welfare and Development

(DSWD), and the Department of Health (DOH) were to formulate the RH and Sexuality Education curriculum. Such curriculum was to be common to both public and private schools, out of school youth, and enrollees in the Alternative Learning System (ALS) based on, but not limited to, the following contents: psycho-­‐social wellbeing, legal aspects of RH, demography and RH and physical wellbeing. 4.4 National Adolescent and Youth Health Policy (2000) The above policy was issued by the Department of Health in 2000 under Administrative Order No. 34-­‐A series 2000. It recognized adolescents and youth as a group with special health needs and the mission was to ensure access to quality comprehensive health care and services. It focused on the prevention of health risk and promotion of healthy activities and included the provision of information and services that could improve their reproductive health, nutrition, immunity from common illnesses, psychosocial health, oral health, sexual health and environmental safety. In 2010 the Department of Health (DOH) established the National Standards and Implementation Guide for the provision of Adolescent-­‐friendly Health Services. In the guidelines the objective of the Sexual and Reproductive Health portion of the services aimed to 51 : a) Reduce too early, unwanted pregnancy b) Reduce mortality and morbidity during pregnancy, child birth, c) Reduce Sexually Transmitted Infections/Human Immunodeficiency Virus (STI/HIV) d) Reduce health and social consequences of STI / HIV infection when they occur The plan was to implement the core package at the Rural Health Unit (RHU). However, the district, provincial and tertiary level hospitals was to provide services in other areas including substance use, sexual abuse, sexual violence and mental health. They were also to cater to clients and patients referred from the Rural Health Units (RHU) and the Barangay (village) Health Service (BHS). Services providers were encouraged to deal with adolescents in a non-­‐judgmental and caring manner and should be accorded respect and courtesy in the same way as all their 51 Department of Health, Philippines (2008). Manual of Standards for Adolescent-­‐Friendly Health Services

clients. Facility staff should be polite and considerate and avoid making any hurtful or damaging remarks for what so ever reason. They were encouraged to behave in a manner not to deprive adolescents from appropriate services on extraneous grounds including those on gender, education, social class, marital status, religious and political beliefs and orientation. Assurance of confidentiality was to be taken into consideration in the design of the clinic layout as well as in the implementation of programs for them. While guidelines have been issued there is little evidence to show that the guidelines have reached the staff in the RHU. There is no guarantee that the young especially the unmarried in need of reproductive health service including family planning will be entertained in a country where the Catholic Church frowns on all forms of family planning except natural family planning 52 . 5. Programmes and Services 5.1 UNFPA-­‐Assisted Project: Institutionalizing Adolescent Reproductive Health (ARH) Through Life skills-­‐Based Education The above project conceived with the assistance of UNFPA was specially design to address the various reproductive health concerns of the in-­‐school and out-­‐of school youth population and thus contribute to the over-­‐all wellness of the Filipino adolescents i.e. the physical, mental, emotional, social and spiritual development as well as to contribute to better learning outcomes, reduced dropout rate, increased completion rate and improved quality of learning 53 . This project cumulated in Department of Education Memorandum No. 261 sent out by the undersecretary of the department of education to all members of the Ministry of Education hierarchy informing them of the project and to give full cooperation for the implementation of the project in schools. It also called upon the schools to work with other Local Government units of relevant Ministries (Health, Youth etc.) and NGOS. 52 C.A. Varga and Zosa-­‐Feranil. (2003). Adolescent Reproductive Health in the Philippines -­‐ Status, Policies, Programs and Issues 53 DepEd Memorandum No. 261 s. 2005: Operationalization of the UNFPA-­‐Assisted Project “Institutionalizing Adolescent Reproductive Health (ARH) through Lifeskills-­‐Based Education”

5.2 Adolescent health/sex education in Schools In line with memorandum 261 of the Department of Education, efforts to introduce sex education into schools has met with strong opposition from the Church whose leaders felt that that the responsibility should fall on parents rather than on the schools. The memorandum had called for the incorporation of sex education into the entire curriculum, not only in classes such as health, science, and physical education, but also music, arts, mathematics and English. However efforts to pilot the curriculum in 80 primary and 79 secondary schools to enable schoolchildren to make inform choices and decisions had to be cancelled. Meanwhile HIV and AIDS education in schools is still very limited with teachers not yet trained in life skills education for HIV and AIDS. As of 2009, there were no data available as to the number of elementary and secondary schools in the country with HIV integrated into the curriculum. The education agencies like DepEd, CHED and TESDA should mainstream HIV and AIDS into their respective curricula and capacity building of teachers would have to be stepped up. 5.3 The Adolescent and Youth Health Program (AYHP) The Adolescent and Youth Heath Program was established in 2001 under the auspices of the Department of Health in partnership with other related government agencies and other stakeholders. Targeting youths age 10 to 24, the program provides comprehensive implementation guidelines for youth-­‐friendly comprehensive health care and services at multiple levels. i.e. national, regional, provincial/city, and municipal. Solidly anchored on International and laws, passage of the polices was meant to address adolescent health concerns including disability, mental and environmental health, reproductive and sexuality, violence and injury prevention among others. The gender sensitive program covered all aspects of adolescent and youth health including policy, IEC and advocacy particularly among teachers, families, and peers, building technical capacity of providers of care, and support for youth; improving accessibility and availability of quality health services, strengthening multi-­‐sectoral partnerships, resource mobilization, allocation and improved data collection and management. The AYHDP was supposed to be mainstreamed into the health system

with the responsibility for the implementation falling on the regional and provincial/city sectors. Guidelines cover service delivery, IEC, training, research and information collection, monitoring and evaluation, and quality assurance. 5.4 Family Planning Organization of the Philippines (FPOP) FPOP is a reproductive health service provider and an advocate of sexual and reproductive health and rights (SRHR) for all Filipinos with branches in 25 provinces across the country. In addition to health services FPOP informs and educate communities, especially the poor, marginalized, socially excluded and underserved about SRHR. Through their 30 Community Health Care Clinics (CHCCs) they provide a range of reproductive health care services including Youth Friendly Services (YFS). 5.4.1 Youth Friendly Services (YES4YES project of FPOP) The youth-­‐friendly ASRH services provided by FPOP are gender-­‐sensitive to and cater for the Out-­‐of-­‐School Youth (OSY) by increasing access of this group to correct and accurate ASRH information, developing life skills and nurturing positive attitudes and values. The program recognizes the fact that the out-­‐of-­‐school youths are the most vulnerable and disadvantaged often only involved in menial or itinerant jobs. Sub-­‐ sectors of the OSY population are the young people in prostitution (YPIP), young men having sex with men (YMSM) and sexually active unmarried young women who are most vulnerable to unintended pregnancy. The project was piloted in four areas, namely, Baguio City, Angeles City, Quezon City and Naga City with each one having an average effective reach of 500 OSYs. The advantage of this project is that FPOP already has a network of clinics providing reproductive health services. Extending the services to vulnerable young people will only need some retraining of family planning workers (to be youth friendly and gender sensitive) especially when FPOP’s philosophy in the provision of RH services is governed by the right of everybody, irrespective of gender or sexual orientation, to reproductive health services.

6. Gaps and Barriers 6.1 Policies The Philippines has no lack of policies on the introduction of sex education into the school curriculum. There is also ample evidence to showcase the need of the Filipino young people both married and otherwise for reproductive health information as well as services. However every time there is an attempt to introduce RH education into schools it has met with opposition from the religious hierarchy. The National Adolescent and Youth Health Policy (2000) are very comprehensive and have all the elements of a reproductive health program that meets the needs of young Filipinos. In 2010 the Department of Health (DOH) established the National Standards and Implementation Guide for the provision of Adolescent-­‐friendly Health Services. The effort was indeed noble but the implementation through the RHUs and BHS. This would indeed take care of RH problems of young people, married or otherwise but with decentralization of health services there is no guarantee that provisions for such service is guarantee. A lot would depend on the local government but with frequent strong religious opposition little can be expected from this program. Although two Reproductive Bills which covered access to family planning, procurement and distribution of family planning supplies and mandatory age-­‐appropriate reproductive health and sexuality education has been proposed since 2010, the bills have not been passed by the senate after countless debates. 6.2 Programmes and services Despite the 2002 YAFS study showing that the number of Filipino youths who engaged in premarital sexual is increasing, their knowledge on sexual and reproductive health is limited and that the majority of them were not using any form of protection the first time they had premarital sex, interventions introduced to address the issue has made little headway. Although the Department of Education tried to pilot the Adolescent Reproductive Health program in 80 public elementary and 79 high schools in 2010, the program was stopped as the Catholic Bishops felt that it encouraged promiscuity among the youths and insisted that sex education should left to parents and taught within the confines of the home.

The Philippine government and politicians have always placed importance on the Church’s position on key political issues and events. In view of the fact that the Catholic Church have long maintained a strong position against the introduction of sex education, the use of artificial contraceptives and are instead in favor of natural family planning (NFP), the reproductive health programmes and services, especially the family planning services have always being affected. The previous president, Gloria Macapagal-­‐Arroyo, who supported only natural family planning programme for the past ten years, had created a negative effect on the family planning programme. The overall contraceptive prevalence for the Philippines remains low. Furthermore, the use of contraceptive among youth aged 15 to 24 are even more dismal and most of them prefer to use natural family planning methods such as withdrawal and rhythm, which are not efficient nor effective to protect them from unplanned pregnancies. It should be noted that most women cited “health concerns” and “side effects” as the main reasons for not using contraception and only a small proportion of the women cited “religion” as a reason. These results clearly indicate that the Church’s position on family planning and contraception has little effect on individuals’ decisions to practice family planning. In addition to the government’s non support family planning programmes as well as the decentralization of the Philippine health system are barriers to women’s access to contraceptive services. The responsibility for providing health care are shared by the national government and autonomous local government units (LGUs). As such, the allocation and the type of family planning services available are mainly decided by the LGUs. It should be noted that most of the LGUs only supply permanent method, such as female sterilization. For young women who have not completed their families, most of them obtain their modern contraceptive methods such as pills from pharmacies if they can afford it. For those who cannot afford family planning services from private sectors, their needs on family planning are neglected. This situation is even worse when the U.S. Agency for International Development (USAID), the largest contributor to Philippine public contraceptive services for several decades, withdrew their support for the family planning programmes in the Philippines. NGOs in the Philippines have since stepped up their services but access to reproductive health services including family planning remains a major problem not just for the young, the unmarried but also for married women.

7. The way forward The agencies advocating RH services for the young in the Philippines more than any country will need to adopt culturally sensitive approaches to ensure that the RH needs of the young Filipino are met. It would be advantageous to work together with the Church in areas where objectives coincide while respecting the boundaries in each other’s mandate. The common objective to work on must surely be saving the many lives lost to maternal mortality as well as those lost to abortion. It should also include infant and child mortality in families whose parents are hardly old enough to be parents or even saving the life of a young Filipino from HIV. It helps to keep young girls who otherwise would have an unwanted pregnancy in school long enough for her to finish her schooling and contribute to the development of the country. If the Church does not want contraceptives to be taught in school then engaging NGOs who are active in RH must be explored. The Philippines has no short of NGOs who have worked tirelessly over the past twenty years to advocate for the passing of the RH bill. Some of the members of the Philippine Council of Population, Health and Welfare have years of experience working on RH of young people. Perhaps engaging them in co-­‐curricular activities as a means of getting RH knowledge to young people may in fact be more meaningful because very often knowledge acquired through the curricular may not be as meaningful/useful because of the limitations in the education system. The very premise RH knowledge is taught is to arm the young with knowledge in order to make informed decisions so that they do not risk their physical as well as mental health. Other ways of getting RH information to people who need it must also be explored. The radio is a relatively cheap way of getting information out to those in need. This is especially useful for those who live in rural areas. The focus should be on the health benefits of RH services and the health complications that arise from a lack of it. Within the Catholic Church, there may be certain progressive branches, including Catholic clergy who understand the harsh realities of the country's poor and are ardent advocates on their behalf. Finding areas in which the interests and goals of the Catholic Church and the Department of Health coincide, and building from this base, could be a way to bridge the differences between the two institutions. If the Church feels that RH knowledge should be given by parents then ways by which parent can be educated should be explored. A good start would be women organizations where members are generally more sensitive to RH especially when we employ the health approach. Perhaps pertinent elements of Reproductive health can be incorporated into the

premarital course that the Church requires all couples to undergo before they get married. This way at least the couples who marry in church will have some reproductive health knowledge to make healthy decisions on planning and spacing their births as well as protection from infections. These couples can also be peer educators for others married or otherwise. 8. Conclusion The Philippines has a big population of young people who are in need of reproductive health knowledge as well as services. Like all young people of the world they are maturing earlier and marrying later. The have better access to education and are more mobile than any generation before them. All these factors expose them to increase risk of social problems including unwanted pregnancies and infections. With more than ninety % of the people Catholics it is inevitable that there needs to be close relationship with the Churches’ hierarchy. The common goals must be explored and intervention acceptable decided upon so that lives can be saved and the future of young people not destroyed by ignorance or a lack of access to services. Bibliography 1. Blanc A.K., Tsui A. O., Croft T.N., & Trevitt J. L. (2009). Trends in Contraceptive Use and Discontinuation among Adolescents: A Multi-­‐Country Comparison. 2. Central Intelligence Agency (CIA). The World Factbook, Philippines, website, date accessed 2 March 2012.

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