Contraceptive access in the Philippines: The influence of decreased public funding

Under the Philippine government Contraceptive Independence Initiative (CII), public contraceptive funding declined due to decreased international aid and limited domestic funding from 2004-2008. We examine the effects of the CII on contraceptive access. We used the Demographic Health Survey, a nationally representative, household-based survey administered to women ages 15-49 before and after the implementation of the CII, including years 1998, 2003, and 2008. Using weighted survey analysis with adjusted logistic regression modeling, we evaluated temporal trends and predictors for contraceptive use, contraceptive source (public or private), and unmet need for contraception. Among respondents (N=13,983 in 1998; N=13,633 in 2003; N=13,594 in 2008), source of contraception shifted significantly from public sector sources (71.4% in 1998, 67.2% in 2003, and 46.3% in 2008, p<0.001) to the private sector. After CII implementation in 2004, current use of contraception remained stable (17.2% in 1998, 21.6% in 2003 and 21.8% in 2008, p=0.75) while the unmet need for contraception increased (18.8% in 1998, 17.4% in 2003, and 22.3% in 2008, p<0.001). Compared to the highest wealth quintile, women in the lowest wealth quintile were more likely to rely on public sector sources for contraception (adjusted odds ratio, AOR 4.98 (95% CI 3.53, 7.03) and report higher unmet need for contraception (AOR 2.25, 95% CI 1.81, 2.81). In the Philippines, the increase in unmet need for contraception may stem from policies defunding public contraceptive subsidies. Low-income women may experience decreased access to public contraceptive sources and disproportionate unmet contraceptive need associated with withdrawal of public funds.