A look back at natural family planning

With a population of 86 million and growing, the Philippines needs to implement a sound population policy which is deemed crucial to a country’s development.

In a discussion paper, economists from the UP School of Economics (UPSE) maintain that although rapid population growth is not the country’s main problem, it nevertheless exacerbates poverty.

They contend that an “unequivocal and coherent” national population policy, backed by a strong family planning program that provides relevant information and enables access to contraceptives, is crucial to eradicating poverty and, ultimately, promoting economic development.

To this day, however, many Filipino women and couples still do not have access to various tools for them to improve their sexual and reproductive health.

A joint study by the UP Population Institute and the Guttmacher Institute (UPPI-Guttmacher) finds that more than half of all pregnancies in the country are unintended and that the incidence of unintended pregnancies occurs more often with women in the poorest fifths of the Philippine population.

Sadly, the national government has been unable to promote a program to address this pressing problem adequately. As was pointed out by the UP economists, the Catholic Church’s hard-line stance against modern family planning methods, plus pressures from interest groups, has prevented the government from formulating a coherent population policy. With the population debate still unresolved, it is but apt to ask how else the government can address the population issue.

The current administration advocates various natural family planning (NFP) methods. According to the handbook released by the Population Commission (Popcom) on responsible parenting, The NFP methods require couples to constantly observe the changes in the woman’s body during her menstrual cycle to determine when it is right for them to have sexual intercourse, whether they intend to have a child or not.

The handbook further highlights the advantages of the NFP program, asserting that it is simple to learn, highly effective, and relatively inexpensive. Most important, the handbook elaborates the role NFP plays in fostering positive communication between couples which, in turn, leads to better relationships.

As a concrete illustration of NFP, we focus on the lactational amenorrhea method, or LAM, which is based on the physiology of breastfeeding.

Breastfeeding as a contraceptive

According to the Popcom handbook, LAM is a contraceptive method that “takes advantage of the natural physiological response of a woman’s body to a suckling infant,” which is to inhibit ovulation. Research indicates that LAM can provide up to 98% contraception, if the following three criteria are met.

First, there should be an absence of menses, a state known as lactational amenorrhea. This means that the woman must not experience at least two sequential days of menstrual bleeding, which may occur two months after childbirth. Second, a woman must fully or nearly fully breastfeed. This implies that breast milk should constitute the majority of a baby’s diet. Alternative feeding methods such as feeding formula must not act as replacements for breastfeeding, as these reduce the effectiveness of LAM. Third, the baby should be less than six months old.

LAM, however, is a temporary family planning method. Once changes have occurred in any one of the LAM criteria, the woman must switch to another contraceptive method in order to have continued pregnancy protection.

Most of the family planning methods recommended for breastfeeding women, however, are modern, artificial contraceptive methods, which include barrier methods (condoms), IUDs, male or female sterilization, and the use of hormonal pills.

Breastfeeding in the Philippines

Although the role of breastfeeding for optimal infant growth, development, and health cannot be discounted, its use as a contraceptive method for Filipinos is not viable.

Data from the 2003 National Demographic and Health Survey (NDHS) indicate that on average, the duration for exclusive breastfeeding of a Filipino baby is 24 days, down from 1.4 months in 1998. The NDHS also showed that only 16.1% of babies are exclusively breastfed for 4 to 5 months of age, and only 1.6% of babies are breastfed for 6 to 7 months.

Research on the determinants of breastfeeding in the Philippines also underscores the lack of a “breastfeeding culture” in the country. Although breast milk is widely regarded as superior over typical baby formula, Filipino women�”especially the poor�”often regard breast milk as inferior to commercial milk formula: Research indicates that they would rather feed their babies with formula instead of breast milk if they had the money (Tanaka 2008).

Breastfeeding is also seen by women as a “costly” activity: a 1990 research by Williamson indicates that breastfeeding declines as a mother’s educational level increases. The same study also notes that mothers with modern jobs breastfeed the least, among employed and non-employed mothers. Tanaka hypothesizes that this might probably be due to the opportunity cost of a Filipino mother’s time that comes with an increase in educational attainment, or the demands of the workplace.

Dissecting the NFP method

The weaknesses of LAM as a contraceptive method for Filipinos also illustrate the weaknesses of the NFP as a whole. As the UPSE discussion paper notes, NFP has not been an effective method for family planning, especially for poor and less-educated couples; it is generally perceived as being too complicated and cumbersome. Statistics from the UPPI-Guttmacher study supports this assertion; the results indicate that out of all the contraceptive methods used by Filipino women, NFP methods were the least used.

The UPSE discussion paper also asserts that limiting family planning options to NFP also fails to address the private and social costs of unintended pregnancies. Poor Filipino families rely on government for the services that they are unable to provide for their children; as such, the greater the number of poor people, the higher the taxes that the non-poor must pay to sustain the quality of social services. Sadly, with the weak tax administration in the country, high population growth implies that poverty will be perpetuated.

The need for a coherent population policy

There is, therefore, a need for a coherent population policy that ensures access to modern family planning methods and provides accurate information about family planning. As the UPPI-Guttmacher study notes, full access to reproductive health care is crucial to meeting the country’s Millennium Development Goals, which include, among other things, eradicating poverty and hunger, improving maternal health, and promoting women’s empowerment.

Critics of modern family planning methods point out the costs of providing contraception to all as an argument against such policy. The expenses associated with unintended pregnancies, on the other hand, are even higher.

According to estimates, expenditures on pregnancy-related services, plus the current cost of contraceptive services (P1.9 billion) total at least P9.3 billion. This is in contrast to the scenario without current contraceptive use, where the cost of medical care for pregnant women amounts to roughly P12.1 billion. All in all, savings in these areas can then be used to improve and expand the range of public services, enabling the country to effectively solve the poverty problem.

Population policy and economic development

The lack of a coherent population policy indicates how behind the Philippines is in terms of economic development. The current Reproductive Health bill being debated upon in Congress is a big step toward an “unambiguous and consistent population policy,” according to the UP economists.

They note that although there are notable weaknesses in the current form of the bill, its main thrust, which is to “enable couples and individuals to decide freely and responsibly the number and spacing of their children and to have the information and means to carry out their decisions,” is something that the national government must fully support.

The Institute for Development and Econometric Analysis, Inc. (IDEA) is an economic think-tank based in the University of the Philippines - Diliman. For inquiries on IDEA, please contact Eduard Robleza at edjrobleza@idea.org.ph.

References:
Alonzo, R., et al. 2004. “Population and Poverty: The Real Score.” Discussion Paper no. 0415 (December) UP School of Economics.

Daroch, JE et al. 2009. “Meeting women’s contraceptive needs in the Philippines, In Brief,” New York: Guttmacher Institute, No. 1.

Tanaka, R. 2008. “Determinants of breastfeeding: The case of a Philippine urban barangay.” Undergraduate thesis. UP School of Economics.

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A look back at natural family planning