Pamilyang Planado, Kinabukasay Sigurado

INTRODUCTION

The situational analysis of Barangay 655 in Intramuros, Manila gave a clear

picture of the health problem of the community. The highest priority project was given
to family planning because 63% of women of reproductive age do not practice family
planning.
The use of modern methods of family planning (FP) is critical in managing the
countrys population growth which has been established to have a strong link to
economic development. Results of the 2011 Family Health Survey (FHS) which updated
the findings from the 2006 Family Planning Survey (FPS) and 2008 National
Demographic and Health Survey (NDHS) show an almost stagnant trend in the use of
contraception among currently married women of reproductive age (CMWRA), which is
15 to 49 years of age in the Philippines.
According to the National Statistics Office (NSO), the unmet need for FP among
married women in the Philippines increased, from 15.7 percent (2006 FPS) to 19.3
percent (2011 FHS). Unsurprisingly, unmet need for FP decreases with womans age,
from 37.0 percent among women aged 15-19 to 7.8 percent among women aged 45-49.
As a legislative intervention, on December 21, 2012, Republic Act No. 10354
entitled, An Act Providing for a National Policy on Responsible Parenthood and
Reproductive Health (popularly known as the RH Law) was enacted into law. It
mandated the provision of a full range of natural and modern methods of family planning
that are affordable, medically safe and legal, thereby addressing the unmet need of
CMWRA for FP methods, and the need to improve the contraceptive prevalence rate
(CPR) in the country. The law likewise calls for age-appropriate RH and sexuality
education among the youth and the integration of Responsible Parenthood and Family
Planning component in the governments anti-poverty programs. However, the
implementation of the RH Law was stalled following a temporary restraining order
(TRO) by the Supreme Court on March 18, 2013 upon consideration of a consolidated
appeal from petitioners who claim that certain provisions of the law violate
constitutional rights.
Hence, the group has come up with a project proposal of health education that
aims to increase the knowledge, skills and awareness of women aged 15-44 years in
Brgy 655, Intramuros, Manila.

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Pamilyang Planado, Kinabukasay Sigurado

PROBLEM ANALYSIS

Problem Identification
Under maternal and reproductive health, five problems were identified. These are:
1.
2.
3.
4.

17% prevalence of teenage pregnancy

6.8% home and 3.8% health center deliveries
17% did not have prenatal consultations
23% did not meet the recommended number of prenatal consultations

5. 63% of women aged 15-44 years old do not practice family planning.
Problem Prioritization
The group used Hanlon Method in determining the problem to be given the highest
priority. The table shown below served as the guide for the group in giving socres in
each component of the Hanlon Method.
Table 1. Guide in determining the score of each component of Hanlon method

Component

Score

Size of the Problem (Percentage of the population affected)

<0.01%
0
0.01-0.09%
1-2
0.1%-0.9%
3-4
1.0%-9.9%
5-6
10.0%-24.9%
7-8
25% or more
9-10
Seriousness of the Problem (Subjective assessment on the potential or actual severity
and impact of the problem)

Not serious
0-2
Moderately serious
3-5
Serious
6-8
Very serious
9-10
Effectiveness of Interventions (Availability of data (numbers or perceptions) to measure
the outcome of any intervention)

None
Perceptions only
Perceptions and some numbers
Perceptions and baseline data available for comparison
Perceptions and baseline data available for many years & establish trends
FORMULA: Total =[Size of Problem + (2 x Seriousness of Problem)] x
Effectiveness of Intervention

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0
1-2
3-5
6-7
8-10

Pamilyang Planado, Kinabukasay Sigurado

Problem 1: 17% prevalence of teenage pregnancy

Problem
17% prevalence of teenage pregnancy

Size
7

Seriousness
5

Effectiveness
10

Total
170

Health analysis of the women of reproductive age in Barangay 655 revealed that
out of the 40 females aged 15-19 years old, 7 have been or are currently pregnant.
This indicates that there is a crude teenage pregnancy rate of 17.5% in the barangay. At
the national level, 11.58% of the pregnant women in 2010 were below within the age
range of 15-19 years old, and this trend has been increasing since 2000. (NSO, 2010)
In developing countries, the leading cause of death among women aged 15-19
are complications which arise from pregnancy and childbirth. (Mayor, 2004) A report
published by the United Nations Population Fund (UNFPA) estimated that 70,000
adolescent mothers die each year from developing countries because they have children
before they are physically ready for parenthood. This is also in line with the
achievement of MDG 5, since maternal mortality is directly related to the percentage of
high risk pregnancies, which includes teenage pregnancy. In fact, in the Philippines, an
estimated 9.54% of maternal deaths are from the 15-19 age group.
This being said, it is worth noting that in Barangay 655, a project focusing on the
15-19 age group may be needed to improve reproductive health awareness and
prevention of high rates of pregnancy and, consequently, maternal mortality rate.
Interventions, once properly implemented, can be monitored and evaluated for
effectiveness. However, it is also worth noting that of the 209 women aged 15-44 years
old in Barangay 655, only 19% are 15-19 years old. Moreover, there has been no
mortality or reported morbidity in the barangay originating from adolescent
pregnancies. Hence, this health problem was given a priority score of 170.
Problem 2: 6.8% home and 3.8% health center deliveries
Problem
6.8% home and 3.8% health center
deliveries

Size

Seriousness

Effectiveness

Total

70

For the size of the problem, a score of 7 was given. The total percentage of the
population of reproductive age women affected by the problem is 10.6%.
According to the 2013 National Demographic and Health Survey (NDHS), among
all births in the 5 years preceding the 2013 NDHS, 60 percent were delivered in a

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Pamilyang Planado, Kinabukasay Sigurado

health facility. This is higher than the figure reported in the 2008 NDHS, which is 44
percent. Moreover, the percentage of births delivered by a health professional
increased from 62 percent in 2008 to 73 percent in 2013. There is still a need to further
improve and strengthen the implementation of the National Safe Motherhood Program
by Department of Health in order to achieve the Millennium Development Goal target by
2015 at 100% (Philippine Statistics Authority, 2014). According to the Department of
Health, among total number of normal vaginal deliveries in the National Capital Region
(NCR), 13.81% occurred at home, 86.17% at a hospital and 0.02% at other health
facilities (Department of Health, 2011). Majority (89.4%) of the population gave birth in
a health facility (lying-in or hospital). This is much higher than the national data which
is 60%. This is also higher than that of NCR which is 86.19%. Because of this, only a
score of 2 was given for the seriousness of the problem.
The NDHS (2009) shows that 88% of women who had a live birth during the
survey period saw a health professional for antenatal care. Yet, a significant number
eventually ended up giving birth at home, attended by a TBA. This indicates that women
are generally aware of the importance of skilled care by a health professional during
pregnancy. However, when it comes to childbirth, a significant number are either
unwilling to seek the same level of care or are unable to overcome obstacles to
accessing such care. Thus, any intervention that seeks to address the maternal
mortality situation would need to find ways to help women overcome these obstacles.
According to DOH, failure of the health system to address womens issues that result to
their deciding to give birth at home rather than in hospitals or health centers were one
of the 5 gaps that result to poor access and utilization of childbirth services that
consequently contribute to the decline of maternal and neonatal mortality. Local
residents, especially the women, enlist to the services of traditional health attendants
who usually live in the area such as hilots or traditional birth attendants (TBAs) for
certain health concerns, in particular, birth deliveries. Cost is another major hindering
factor for Skilled birth attendants deliveries. Home birthing with a midwife costs only a
few hundreds of pesos which mothers pay in installment or even in kind through goods
like rice, fruits, vegetables or chicken.
Midwives are usually present only during deliveries while hilots stay for a longer
period to feed the mothers, sometimes even to wash their clothes. Pregnant women also
feel embarrassed to seek the assistance of SBAs because they feel that they have to
show adequate supplies during deliveries such as clean towels, linens, baby clothes,
disposable diapers, and presentable kettles for sterilization. Lancet (2006) argues that
while the necessary level of skilled care could very well be delivered at home for
mothers who prefer to give birth there, a strategy encouraging home deliveries has
distinct disadvantages: For one, home conditions can be very basic and could limit the

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Pamilyang Planado, Kinabukasay Sigurado

ability of the skilled attendant to deal with emergencies, especially since the attendant
has only the family to rely on to assist rather than other providers such as doctors or
nurses in health centers or hospitals. Moreover, home-based deliveries are inefficient
in terms of not only the skilled attendants time but also that of the supervisor (who is
most likely the already overburdened rural health physician). The government
implements No Home Birthing Policy as an answer to the soaring number of maternal
and neo-natal deaths. It blames the rise in Maternal Mortality Rates to home births
unsupervised by skilled health professionals. The policy states that all pregnant women
should give birth only in facility-based centers attended by skilled health personnel.
For the effectiveness of possible intervention, only a score of 7 was given
because although there is baseline data available for comparison, this data is inadequate
to serve the purpose of evaluating the effectiveness of the intervention. For this type of
intervention, trends are more important than snapshot surveys of the deliveries
stratified according to type of healthcare facility. The type of healthcare facility should
also be well-defined because some women might think that a health center is same as a
lying in clinic. In terms of being able to cater the needs of women undergoing childbirth,
these two facilities differ in a lot of ways. The lying in clinic is equipped with the
necessary facilities and manpower for childbirth assistance, while the health center is
not.

Problem 3: 17% did not have prenatal consultations

Problem
17% did not have prenatal consultations

Size
7

Seriousness
5

Effectiveness
8

Total
136

In the Philippines, in the 1998 to 2003 data of DOH on maternal health, it was
reported that pregnant women with at least 4 prenatal visits decreased from 77% in
1998 to 70.4% in 2003. However, there was a notable increase to 51% in 2003 from
43% in 1998 in those women with at least 1 prenatal checkup.
In the Maternal Child Health Survey (MCHS) from 2002, 94% of women who had at
least 1 birth in 5 years had received prenatal check-up from a doctor, nurse or midwife
for their most recent birth. Maternal care utilization is lowest in ARMM with only 85%
for prenatal care, while NCR accounts for the highest percentage with 97% for prenatal
(Rogan & Olvena, 2004).
Prenatal care aims to identiy and monitor women at risk of future complications, to
detect and treat pre-existing & concurrent illnesses of pregnancy, to provide
preventive measure and information to the women and their families, and to establish a
relationship between health care provider and the women early in pregnancy.

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Pamilyang Planado, Kinabukasay Sigurado

In the study of Rogan and Olvena (2004), education was stated as the most important
determinant of prenatal care. Women having tertiary level of education showed 6 times
more likely to access prenatal care than women with primary education, and twice more
likely than those that reached secondary education. The study also identified various
factors that affect prenatal visits independently, such as urbanity, parity, age of woman
and work status. In urban areas, women are 0.88 times more likely to avail prenatal
services than their rural counterpart. Parity shows little difference in the likelihood to
use prenatal services. However, odds of having prenatal care decreases as the number
of children increases. In addition, women 15-19 years old are 2x more likely to access
maternal care as the 45-49 years old women.
Barangay 655, being in the urban area, implies that there is a higher prenatal service
utilization compared to its rural counter part. However, NCR even with a high level of
service utilization, have the poorest residents marginalized in terms of Maternal and
Child Health Services. The study concluded that even with the uptake of maternal and
child health programs being successful focus on the poor remains very low. With
wealth as a factor, it is likely that only those in the richest quintile show improvements
while the poor are left out (Lavado & Lagrada, 2008). Thus, must be a need to address
maternal and child health services, especially prenatal check-up, as it serves to
improve the quality of life of both mother and child by avoiding and identifying
complications, and to plan for the management for the patient. Barangay 655, which has
mostly poor constituents, is a definite target for programs to improve such need. With
application of certain interventions,
Problem 4: 23% did not meet the recommended number of prenatal consultations
Problem
23% did not meet the recommended
number of prenatal consultations

Size

Seriousness

Effectiveness

Total

120

The situational analysis of Bgy. 655 of Intramuros, Manila revealed that around
23% of pregnant females did not meet the recommended standards of having at least 4
prenatal checkups during pregnancy. However this is still below that national average of
30% that did not receive prenatal services at least four times last 2009 (UNICEF, 2010).
Several benefits of prenatal care are well recognized. Studies have shown that good
prenatal has a direct contribution on the survival of the infant and more positive health
outcomes. Other studies have also shown relationship between good prenatal care and
birth weight. On the other hand, pregnant women who did not receive the recommended
prenatal visits usually end up with a premature delivery. Premature infants then are
more predisposed short and long term complications such as disabilities and problems
with growth and development (Lavado, 2010).

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Pamilyang Planado, Kinabukasay Sigurado

Results from logistic regression reveals that the level education of the woman is
the most relevant factor in determining prenatal care as women with tertiary education
are six times more likely to access prenatal care than women with primary education
and twice more likely than women who received secondary education (Rogan, 2004).
Logistic regression also revealed that urbanity, parity, age of the woman and work
status are significant and independent factors for the use of prenatal services in the
Philippines.
With this in mind, the possible areas of intervention for Bgy. 655 are the use of
educational materials more appropriate for secondary and primary educated women of
the barangay as tertiary educated women are more aware and enlightened about the
benefits of prenatal care. As the barangay is of a small area, regular bi-annual or annual
survey of the population with regards to the women who are pregnant may provide
more opportunities to deliver health education to the target population. Efficient
implementation of this intervention may result to a decrease on the number of pregnant
women who will not meet the required number of prenatal checkups as set by the WHO.
Problem 5: 63% of women aged 15-44 years old do not practice family planning
A score of 10 was given to the size of the problem because of the high
prevalence of non-usage of any form of family planning among women in their
reproductive age. According to National Statistics Office, women in urban areas are
more likely to practice family planning as compared to those in rural areas. In 2000, the
prevalence of using any method of family planning among urban-dwelling women was
48.6%. This is higher as compared to the prevalence of family planning usage among
women in Brgy 655 (37%).
In 2006, a study headed by Josefina Cabigon of the University of the Philippines
Population Institute (UPPI) showed that six in 10 Filipino women had an unintended
pregnancy at some point in their lives because of lack of access to and knowledge of
modern family planning methods. This translated to about 1.43 million unintended
pregnancies each year, a third of which end in abortion. Hence, seriousness of the
problem was given 10 points.
A score of 7 was given to the effectiveness of interventions because data are
available with regards to the proportion of women aged 15-45 years on the usage of
family planning. Also, data into which of the methods they are using is available.
However, information on these things are only for one year and do not establish a trend

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Pamilyang Planado, Kinabukasay Sigurado

which is more important. Over-all, this problem has a total of 210 points, the highest
among the five enumerated problems. Hence, the problem the group addressed.
Problem
63% of women aged 15-44 years old do
not practice family planning

Size

Seriousness

Effectiveness

Total

10

10

210

Summary of Problem Prioritization

Below is the table showing the summary of scores of the five problems
identified.
Table 2. Scores of each problem using Hanlon Method

Problem
17% prevalence of teenage pregnancy
6.8% home and 3.8% health center
deliveries
17% did not have prenatal consultations
23% did not meet the recommended
number of prenatal consultations
63% of women aged 15-44 years old do
not practice family planning

Size
7

Seriousness
5

Effectiveness
10

Total
170

70

136

120

10

10

210

PROJECT DESCRIPTION

Project Title
PAMILYANG PLANADO, KINABUKASAY SIGURADO
Isang Workshop Tungkol sa Wastong Pagpa-plano ng Pamilyang Pilipino

General and Specific Objectives

The project aims to increase the knowledge, skills and attitude (KSA) on family
planning among women in reproductive age in Barangay 655, Manila City

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Pamilyang Planado, Kinabukasay Sigurado

Specifically, the project aims to:

Form a project committee composed of six (6) members. The six members are
composed of one project head, resource, technical, program and 2 externals.

Increase knowledge of the participants on family planning by 30% at the end of

the workshop.

Improve skills of participants on family methods by 30% percent

Determine the change in attitude of the participants towards family planning

during the workshop

Project Activities
A consultation with the key stakeholders of the projected will be first conducted.
A manual will be drafted for the committee to use in the fulfillment of this project.
Identification of people who can be part of the committee will be done and election of
officers as well as oath-taking of the members will be completed
Prior to the lecture of family planning, a pre-test will be conducted using a selfadministered questionnaire to measure the initial knowledge of the participant regarding
Family Planning. Then, workshop kits will be distributed to the participants of the
project. A presentable lecture regarding family planning will be conducted. The lecture
will utilize different visual aids to guide and help them appreciate better the topics being
discussed. Along with this, other tools are utilized like sound system, LCD projectors
and the use of workshop kits like IEC and writing materials. Proper usage of
contraceptives will demonstrated to the participants using dummies and actual
contraceptives. At the end of the workshop, a post-test questionnaire will be given and
a return demonstration will be conducted on the proper use of contraceptives which will

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Pamilyang Planado, Kinabukasay Sigurado

be scored using an observation checklist. These are done to assess how much
knowledge the participants have gained, how much skills they have improved, and to
determine if there has been a change in the pattern of their behavior.
The project will employ the medical clerks rotating in family medicine, barangay
health workers and the local barangay officials.
Monitoring and Evaluation
The success of the workshop can then be correlated in terms of the scores of
the patients. Higher scores indicate an improved understanding of proper Family
Planning by the participants, after the seminar lectures. Specifically, the success
indicators of the activities of the project can be gauged through the following

100% of the invited members of the community have attended the meeting on the
development of a committee on family planning.

A 30 % increase in the proportion of participants who got a score of 75 and

above in the post-test is attained

A 30 % increase in the proportion of participants who got a score of 75 and

above in the return demo is observed

The proportion of participants who answered positive and negative attitudes in

pre- and post tests

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Pamilyang Planado, Kinabukasay Sigurado

REFERENCES
Department of Health. (2011). Livebirths by Type and Place. Retrieved from
http://www.doh.gov.ph/content/livebirths-type-and-place.html
Ericta, C.N. (2010). Teenage Pregnancy in the Philippines: Facts and Figures from NSO
Data. Manila: Philippines.
Lavado, R. F. (2010). Who Provides Good Quality Prenatal Care in the Philippines?
Makati City: Philippine Institute for Development Studies.
Lavado, R. F., & Lagrada, L. P. (2008). Are maternal and child care programs reaching
the poorest regions in the Philippines? (No. DP 2008-30). Philippine Institute for
Development Studies.
Mayor, S. (2004). Pregnancy and childbirth are leading causes of death in teenage girls
in developing countries. British Medical Journal, 328 (1), 1152.
National Statistics Office. (2001). Contraceptive use in the Philippines. Retrieved from
http://web0.psa.gov.ph/content/contraceptive-use-philippines
Philippine Statistics Office. (2014). Six in Ten Births Are Delivered in a Health Facility
(Preliminary Results
from the 2013 National Demographic and Health Survey) .
Retrieved from http://web0.psa.gov.ph/content/six-ten-births-are-deliveredhealth-facility-preliminary-results- 2013-national-demographic
Rogan, S. E. B., & Olvea, M. V. R. (2004). Factors affecting maternal health utilizaiton
in the Philippines. Manila: National Statistics Office .
United Nations Childrens Fund. (2010). Hilots getting on board facility-based
deliveries. Retrieved from
http://www.unicef.org/philippines/brief01_fnl.pdf
UNICEF. (2010). The Filipino CHild: Global study on child poverty and disparities:
Philippines. Manila: UNICEF.

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