Explaining regional fertility variations in the Philippines.

Analysis of the 1993 National Demographic Survey in the Philippines has uncovered regional variations in fertility-related behavior. The total fertility rate ranged from 2.8 in Manila to 5.9 in Bicol and averaged 4.1 for the entire country, but contraceptive prevalence rates were not highly correlated with total fertility (Manila showed the fifth highest prevalence, and Bicol the fifth lowest). This lack of correlation may be caused by the mix of contraceptive methods chosen with a high proportion of women using ineffective methods (40% of all currently married women of reproductive age [MWRA] were using contraceptives, but only 25% were using the most effective methods). Thus, low fertility was associated with use of the most effective methods regionally. Fertility also was lower in regions where women spent more time unmarried. Infecundity added to the discrepancy (Bicol had the lowest regional infecundity rate in the country). The total protection rate, which can be derived from three factors (contraceptive usage, time spent unmarried, and infecundity), accounts for must of the regional variation. Unmet need for contraception was found in 26% of currently MWRA, and another 12% were using ineffective methods. In designing effective family planning programs, policy-makers must understand the various factors that contribute to high levels of fertility in different regions and must be flexible enough to plan regionally-specific strategies. As the government decentralizes programs and resource management decisions, local-level analysis will be increasingly important.