Population policy at a crossroads as population growth dramatically slows

The Philippine Statistics Authority (PSA) recently came out with a preliminary report on births and deaths in 2022: Filipinos are having fewer children, and smaller families are now the norm. The births in 2022 are lower by 111,000 compared to 2021 (1,364,739 in 2021, down to 1,253,472 last year).

The trend for Total Fertility Rate (TFR) has been going down. The TFR was 3.1 children per woman in 2013. In 2017, TFR was 2.7 children per woman. And in 2022, TFR went down to 1.9 children per woman.

In “Population Planning Policy in the Philippines” (1973), Dr. Juan M. Flavier wrote that the country’s Commission on Population and Development (POPCOM) had recommended “to examine legal and administrative policies and measures affecting family size, and if necessary, to revise them to bring about a balance between family size and social and economic goals.”

Apparently, the Responsible Parenthood and Reproductive Health (RPRH) Law was the final measure that brought about that “balance between family size and social and economic goals.” But do we achieve the “social and economic goals” automatically? Why has poverty persisted, despite smaller family sizes? The legally mandated wages continue to fall below the minimum level of income that defines the poverty line.

Dr. Flavier was crystal clear in his paper: “Economic considerations are felt to be the most compelling reason for the national population planning policy. Written documents invariably comment on the economic implications of unbridled population growth.”

Clearly, population policy should not be about responsible parenthood and family planning alone. Even during the COVID pandemic, POPCOM has been drawing attention to increasing poverty and the need for a living wage. Most Filipino families need two jobs to sustain two children, which is now the average Filipino family size.

In 2021, at the height of the pandemic, President Rodrigo Duterte called out POPCOM and the Department of Health (DoH) to address population and urban growth, which was contributing to the country’s vulnerability to COVID. The recommendations of Secretary Karl Chua of the National Economic and Development Authority as POPCOM Chair, Secretary Francisco Duque of DoH and the writer of this column still have to be carried out.

The Department of Budget and Management convinced the Duterte administration to pass on the functions in health and population and family planning completely to local government units (LGUs). This disregarded the complementarity of health and population and family planning programs. The DoH was required to reduce budgets for family health, and family planning was made a partially devolved program, thus affecting the sustainability of the program.

Now that the major assumption for the country’s poverty has seemingly been solved (“too many Filipinos”), policy makers are talking about transforming the large labor force into inputs for economic recovery.

They quickly forget that the decline in fertility has come at a cost that must be maintained. The family planning (FP) program more than doubled, from 3.94 million women in 2012 to over 8 million women and couples in 2021. This came about due to the heroic efforts of local government health and population workers, the POPCOM, and the DoH. Family planning was the only public health program that expanded during the pandemic.

In a Social Weather Stations’ survey in November 2020 on the most important problem of women, a majority cited avoidance of pregnancy as their major problem during the pandemic. Their cited reasons: higher costs, fear of infections in hospitals, and lack of maternity services. It was also noted that marriages declined by 50% in 2020. This resulted in only 1.3 million births in 2021. As over 872,000 Filipinos died that year, the population grew at the lowest rate by around 400,000.

With the pandemic receding in 2022, the assumption is that marriages, births, and population growth might increase, but not to pre-pandemic levels.

These assumptions are only partially true: Marriages are up to around 401,000 (still 10% lower than 2019) and population growth is now 700,000 (from 400,000 in 2021).

However, births have continued to decline, with births down by 111,000 compared to 2021.

One reason is that Filipinos are now more comfortable with smaller family sizes. Only a few regions such as the Bangsamoro Autonomous Region in Muslim Mindanao continue to have more than two children per average family.

A second reason is that couples are still wary of the effects of the pandemic on the health system. They worry over increased health costs and fear of infection.

A third reason is that even if marriages are up, women are choosing to have children at later ages, with highest fertility at the 25-29 age group of women (Source: PSA).

A fourth reason is that women and increasingly men have accepted FP as a part of their daily lives. They see FP as a means to postpone having children or to limit the number of children through modern methods (leaving behind traditional methods). FP is accepted as a method to avoid poverty.

FP demand has been noted to increase as economies worsen and poverty increases. With stagnant wages that cannot sustain more than one or two children, modern FP has become an essential commodity.

Despite all the successes of FP in the previous nine years, erosion has started to set in due to complacency.

In 2021, maternal deaths numbered 2,478 or seven mothers dying in childbirth every day. It was the highest number of deaths in 69 years. They did not die of COVID. They fell victim as collateral damage of the pandemic as birthing centers closed and hospitals limited admissions. The most probable cause would have been a delay in referral for proper care. With the maternal mortality rate now up to 189 per 100,000 births, our Sustainable Development Goals (SDG) target by 2030 now seems insurmountable.

The family health budget in DoH has remained stagnant and will be reduced starting 2024. Unprepared LGUs are now being asked to buy pills and condoms, but their share of national taxes is due to decline in the next two years.

The signs are now clear. The Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program reports that from a high of 50% free contraceptives in 2018 from government, the share of free contraceptives has gone down to 17% in early 2022. Women are now getting their pills from boticas (pharmacies) and supermarkets as health centers run out of pills.

Even POPCOM has closed its family planning clinic and converted it into an employees’ clinic, just as the demand for tubal ligations and vasectomies is increasing. That clinic alone performed over 4,000 tubal ligations and 1,000 vasectomies in the last four years, even during the pandemic.

To further the success of family planning and reproductive health, what we need is a commitment for more resources, not complacency and reduced services.

Juan A. Perez III specializes in public health administration and primary healthcare. He was undersecretary for Population and Development and executive director of the country’s Commission on Population and Development up to Sept. 8, 2022. He occasionally writes for Action for Economic Reforms.