Fertility The 2006 FPS collected information about the number and timing of births each woman interviewed

had up to the date of interview, including children still living in the household, children living elsewhere, and children who later died. This chapter presents the results if the survey on levels, trends, and differentials in fertility based on the analysis of the complete pregnancy histories collected from currently married women ages 15-49 interviewed during the survey. Women were first asked a series of questions to determine the total number of live births that occurred in their lifetime. Second, for each live birth, information was collected on the date of the birth, sex, and survival status of the child. For dead children, age at death was recorded. Information from the birth history is used to assess current fertility (age-specific and total fertility) and completed fertility (number of children ever born alive to the woman), as well as to look at other fertility-related factors, such as age at first birth, birth intervals, and teenage childbearing. Furthermore, the number of births in this module was used for the denominator to estimate Maternal Mortality Ratio. Fertility level, age-specific fertility pattern, and mean children ever born are useful program performance indicators in that they provide some evidence of the impact and effectiveness of family planning programs. Current fertility and trends in fertility also provide insight into national and regional population growth today and shed light on the prospect for growth in the years ahead. In addition, child bearing patterns, including birth intervals, age at first birth, and childbearing among both teenage and older, higher parity women are closely linked to the percentage of births considered to be high-risk to the mother or child. This section of report presents information from the 2006 FPS on current fertility level, age pattern of fertility, mean children ever born, and birth intervals. Fertility Level Measures of current fertility are presented in Table 2.1 for the three-year period preceding the survey, which corresponds to the period 36 months before April 2006. This period was chosen in order to be comparable to the 2003 NDHS as well as to provide data on the inter-survey period.

The most widely used measures of current fertility are the total fertility rate (TFR) and age-specific fertility rates (ASFRs). The TFR is calculated by summing the ASFRs and can be defined as the total number of births a woman would have by the end of her childbearing period if she were to pass through those years bearing children at the currently observed rates of age-specific fertility. To obtain the most recent estimates of fertility without compromising the statistical precision of estimates and in an attempt to avoid possible displacement of births from five to six years before the survey the three-year period preceding the survey is used. Table 2.1

Age specific and cumulative fertility rates, general fertility rate, and total fertility rate for the three years preceding the survey by urban rural residence, Philippines: 2006 Age Group 15 - 19 20 - 24 25 - 29 30 -34 35 - 39 40 -44 45 - 49 TFR GFR Residence Urban Rural 34 43 126 181 158 187 126 149 78 109 29 44 4 8 2.8 91 3.6 115 Total 38 149 171 137 93 37 6 3.2 102

Figure 4. Age specific fertility rates by residence, Philippines: 2006

200 150 100 50 0 15 - 19 20 - 24 25 - 29 Urban Rural 30 -34 35 - 39 40 -44 45 - 49

Age Group
Total

Table 2.1 presents the TFR and ASFRs for the Philippines by urban-rural residence from the 2006 FPS. Table 2.1 and Figure 4 show that urban women have lower fertility that their rural counterparts (TFR of 2.8 and 3.6 children per women, respectively). Lower urban fertility is observed across all age groups. The general fertility rate (GFR), calculated as the average annual ratio of births to 1,000 women ages 15-49 during the 3-year period preceding the survey, is also higher for rural woman than urban women. The TFR and GFR measured in the 2006 FPS are slightly lower than the corresponding rates of 3.5 and 119 from the 2003 NDHS.

Differentials in Current and Completed Fertility Table 2.2 shows fertility differentials by urban-rural residences and education. Rural women have higher fertility, are slightly more likely to be pregnant, and have higher cumulative fertility (as measured by mean children ever born for women at or near the end of their childbearing years) by ages 40-49 than urban women. Results of the 2006 FPS also show an inverse relationship between education and fertility: women with less education generally have higher current fertility, are more likely to be pregnant, and have higher completed fertility than women with more education.

Table 2.2

Total Fertility rate for the three years preceding the survey, percentage of women age 15-49 years who were curently pregnant, and mean number of children ever born to women age 40-49 years by background characteristics, Philippines: 2006 Mean Number of Children Ever Born to Women Age 40-49 4.1

Background Characteristics

Total Fertility Rate

Percentage Currently Pregnant

Total Residence Urban Rural Region NCR CAR Region I - Ilocos Region Region II - Cagayan Valley Region III - Central Luzon Region IVA CALABARZON Region IVB - MIMAROPA Region V - Bicol Region VI - Western Visayas

3.2

4.6

5.1 3.6

4.1 5.1

3.6 4.7

2.6 3.2 3 2.8 2.7

3.8 4.6 4.6 4.9 4.4

3.2 4.6 3.9 4 3.6

2.9 4.1 4.1

4.1 5.4 5.4

3.8 5.1 5

3.3

4.4

4.1

Region VII - Central Visayas Region VIII - Eastern Visayas Region IX - Zamboanga Peninsula Region X - Northern Mindanao Region XI - Davao Region XII SOCCSKSARGEN Region XIII - Garaga ARMM Education Elementary Undergraduate Elementary Graduate High School Undergraduate High School Graduate College Undergraduate Baccalaureate (First Stage) Post Graduate ( 2nd stage) Don't know

3.3

4.3

4.3

3.9

5.8

3.7

4.9

4.9

3.4 3.4

4.1 5.2

4.2 4.5

3.4 3.7 3.1

4.2 4.2 7.9

4.6 5 4.4

4.9 4 3.9 3.1 2.6 2.1 1.1 4.6

5.8 4.7 4.7 4.9 3.8 4.2 1.1 6.5

5.5 5 4.6 3.8 3.3 2.7 2.8 4.8

Figure 5 show the regional differentials in fertility. Fertility does not vary much across regions. TFRs range from 2.6 children per woman in the National Capital Region to 4.1 children per woman in the Bicol Region and MIMAROPA. Figure 5 shows TFR level by region in descending order.

Figure 5. total Fertility rate by region, Philippines: 2006

Number of Children per Woman MIMAROPA Bicol Region Eatern Mindanao Zamboanga Peninsula Caraga Northern Mindanao Davao Region SOCCSKSARGEN Western Visayas Central Visayas Cordillera Administrative Region Autonomous Region in Muslim Ilocos Region CALABARZON Cagayan Valley Central Luzon National Capital Region 4.1 4.1 3.9 3.7 3.7 3.4 3.4 3.4 3.3 3.3 3.2 3.1 3 2.9 2.8 2.7 2.6

Fertility Trends Age-specific and total fertility rates from the 2006 FPS reflect a continuing, long term decline in births per woman in the Philippines. Since the mid-1970s total fertility has decreased by about 2 births per woman, with the greatest proportionate decreases occurring at older ages. During the past decade, however, changes have occurred in both the pace and pattern of changes. During the 1970s and 1980s TFR declined by about one birth per woman per decade, from 6 to 5.1 over period from 1970 to 1980 and from 5.1 to 4.1 for the 1980-91 period. However, measured decreases from 1996 to the present indicate a slowing of decline, particularly during the 1996-2001 period (Figure

6). Changes have also occurred in age pattern during decline. The largest proportionate decreases (comparing 2006 FPS ASFRs with either 1998 or 2003 NDHS ASFRs table 2.3) have taken place among women in the primary reproductive years (ages 20-34) Table 2.3 Age-specific and total fertility rates from various surveys, Philippines: 2006 1973 NDS 1978 RPFS 1983 NDS (1980) 55 220 258 221 165 78 20 5.1 1986 CPS (1984) 48 192 229 198 140 62 15 4.4 1993 NDS (1991) 50 190 217 181 120 51 8 4.1 1998 NDHS (1996) 46 177 210 155 111 40 7 3.7 2003 NDHS (2001) 53 178 191 142 95 43 5 3.5 2006 FPS (2004) 38 149 171 137 93 37 6 3.2

Age Group 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR

(1970) (1975) 56 228 302 268 212 100 28 6 50 212 251 240 179 89 27 5.2

There is a steady decline from 4.1 children per woman in 1990-1993 to 3.7 children per woman in 1995-1998, to 3.5 children per woman in 2000-2003 to 3.2 children per woman in 2003-2006.

Figure 6. Trends in the total fertility rate, Philippines: 2006

6 5.2 5.1 4.4 4.1 3.7 3.5

3.2

1973 NDS

1978 RPFS

1983 NDS

1986 CPS

1993 NDS

1998 NDHS

2003 2006 FPS NDHS

Children Ever Born The distribution of all women and currently married women by age and number of children ever born (CEB) is presented in table 2.4. The table also shows the mean number of children ever born and the mean number of living children for each five-year age group. The distribution of children ever born is the outcome of lifetime fertility. It reflects the accumulation of births over the past 30 years to women interviewed in the 2006 FPS. Although completed fertility data may be subject to recall error, which typically is greater for older than for younger women, the data in table 2.4 show the expected patterns of children ever born by age of mother, both for all women and for ever-married women. The data indicate that only 4.6 percent of all women age 15-19 have given birth. On average, women in their early thirties have given birth to three children, while women in their early 40s have given birth to four children. The statistics for currently married women do not differ greatly from those for all women at older ages; however, at younger ages the percentage of currently married women who have had children is

much higher than the percentage among all women. This may be due to the fact that there are more never-married women in the younger age groups. Table 2.4 also shows that nine out of ten women age 15-19 (95.4 percent) have never given birth. However, this proportion declines rapidly to less than 10 percent for women age 35 and above, indicating that childbearing among Filipino women is nearly universal. On average, Filipino women attain a parity of 4.3 children per woman at the end of their childbearing. This is a little more than one child above the fertility rate, a discrepancy that is attributed to the decline in fertility during the 1980s and 1990s. The same pattern on mean parity is replicated for currently married women, except that only a little more than 40 percent of the married women age 15-19 have not borne a child. As with all women, this proportion diminishes rapidly, to 5 percent or less for women age 30 and above. This difference in childbearing parity can be explained by the presence of many young and unmarried women in the all women category, who are known to exhibit extremely low fertility. On average, currently married women age 45-49 have 4.7 children each, of which one child on average has died. As expected, women above 40 years have much higher parities, with small proportions having 10 or more births by the end of their childbearing years. Birth Intervals Examination of birth intervals is important in providing insights into birth spacing patterns and, subsequently, maternal and child health. Studies have shown that children born less than 24 months after a previous sibling risk poorer health. Maternal health is also jeopardized when births are closely spaced.

Table 2.5 provides a glimpse into the birth intervals of children born to Filipino women of reproductive age during the five years preceding the survey across selected subgroups. First births have been omitted from the table. Results of the 2006 FPS indicate that the overall median birth interval is 33 months, which is higher than the median birth interval of the 2003 NDHS (31 months). Median birth interval is relatively shorter for children born to younger women; to women in ARMM, NCR and Bicol Region; and women with less than secondary education. The shortest birth interval is observed among children born to women age 15-19 (20.4 months) and children whose preceding sibling died (25.1 months), while the longest is among children born to women with at least a post graduate education (50.6 months) and women age 40-49 (45.3 moths). Overall, 30 percent of Filipino children are born less than 24 months after a previous birth, which is lower than the percentage reported in the 2003 NDHS (33 percent) and therefore indicative of some improvement in lowering the percentage of births followed short birth intervals over the past few years. While the overall percentage for the country is high, high risk births associated with short birth intervals are particularly numerous among younger women age 15-19 (66 percent of their births), women in NCR (35 percent), and women with at least post-graduate education (36 percent). Age at First Birth One of the factors that determine the fertility in a population is the average age at first birth. Women ho marry early are typically exposed to pregnancy for a longer period. Thus, early childbearing generally leads to a large family size and is often associated with increased health risks for the mother and child. A rise in the median age at first birth is typically a sign of transition to lower fertility levels.

Table 2.6 presents the percentage of women who have given birth by specified ages and the median age at first birth, according to current page. The results indicate that women are delaying having their first child. This distribution is similar to that in the 2003 NDHS and shows that the prevalence of early childbearing has declined over time. While one percent of women age 45-49 had their first child by age 15, less than 0.5 percent of women age 15-19 did so. Again, the percentage of women who had their first child by age 20 is highest among women age 45-49 (24.2 percent) and lowest among women age 20-24 (18.6 percent). The increase in the median age at first birth among Filipino women can also be observed in the last column of table 2.7 23.1 years for women age 45-49 to 23.4 years for women age 25-29.

Table 2.7 presents data on differentials in median age at first birth among women age 25-49 by age, residence, and education. Results of the 2006 FPS indicate that there are wide differences in the age at which women have their first child. Overall, the median age at first birth is 23.2 years, which is the same as the 2003 NDHS. Urban women start childbearing two years later than their rural counterparts (24.2 years compared with

22.3 years). Among the regions, a higher median is recorded in NCR (24.9 percent) for women age 25-29, followed by Western Visayas (23.9 percent), while the lowest was recorded in MIMAROPA (21.9 percent). This implies that women in MIMAROPA, on average, have their first birth three years earlier than those in NCR. Clearly, the onset of childbearing is significantly related to education of women. According to Table 2.7, women ages 25-49 with some college education and above begin their childbearing about four years (24.5 percent) later than women with some elementary education (20.7 percent). Teenage Pregnancy and Motherhood It is well known that adolescent pregnancy, early childbearing, and motherhood have negative socioeconomic and health consequences. Adolescent mothers are more likely to have complications during labor, which result in higher morbidity and mortality for themselves and their children. Moreover, childbearing during the teenage years frequently has adverse social consequences, particularly on female educational attainment, because women who become mothers in their teens are more likely to curtail education.

Table 2.8 shows the percentage of women age 15-19 (teenagers) who are mothers or pregnant with their first child, by background characteristics. Overall, 6.3 percent of teenagers in the Philippines have begun childbearing, 4.8 percent are already mothers, and 1.5 percent is pregnant with their first child. As expected, the proportion of young women who have begun childbearing increases rapidly with age, from less than 1 percent among women age 15 to 18 percent of women age 19. Almost a fourth of uneducated teenagers (22.7 percent) have begun childbearing, compared with only 3 percent of those who attended college or higher. Teenagers from the poorest households are more likely to have begun childbearing (8.7 percent), as compared from those of richest households (3.2 percent). Teenage fertility varies slightly by urban-rural residence. The proportion of teenagers who have begun childbearing is 5.6 percent in urban areas compared with 7.0 percent in urban areas. Teenage childbearing varies significantly across regions, ranging from 3.5 percent in Bicol Region to 9.1 percent in SOCCSKSARGEN. In terms of trends, at the national level there is little difference overall in adolescent fertility between the 2000 and 2006 FPSs. High-Risk Fertility by Risk Category Table 2.9 shows the percent distribution of children born in the 12-month period preceding the 2006 FPS by risk category, along with the implied percentage of currently married women at risk of conceiving a child with an elevated risk of mortality. Over half of all births in the Philippines are considered high-risk births. Table 2.9 indicates that about 1 in four births reported in the 2006 FPS were either to women under 18 years of age or to women over 34 years of age, follow another birth by fewer the 24 months, or are a womans fourth, fifth or higher order birth. About 1 in 5 fell into multiple risk categories, such as higher order births to older women (22.4 percent). The 2006 FPS also indicates that 3.5 million Filipino women in the reproductive ages 15-49 may be considered to be at risk if they become pregnant because they are too

young (less than 18 years) or to old (age 35 or older), have more than 3 previous births, or would have an unacceptably short birth interval (under 24 months). However, the 2006 FPS offers encouraging evidence success in reducing the proportion of births considered high risk in recent years. While the differences are small, comparison of the percentages of all births classified as high-risk child births in the 2006 FPS and the 2003 NDHS suggest continuing declines in high-risk childbearing in the country. Births classified as high risk on a single-risk category have decreased from about 36 percent of all births to about 27 percent from 2005 to 2006; and those classified as high risk on multiple grounds increased, from 15 percent to 22 percent of

all birth. A decreased in the proportion of births that are higher order births (fourth births, fifth births, and higher-order births) accounts for part of the change in the single-risk

factor. The percentage of births to older women (aged 35-49) that are also higher order births increased from 6 percent in 2005 to 13 percent in 2006 (Table 2.9). Fewer women are choosing to have larger numbers of births in the Philippines, which is what the estimated mean CEB tables presented at the beginning of this chapter also show.