NGO clinics and government hospitals fill family planning needs of urban poor women

For families living in the slums of Manila who can barely make ends, contraceptives are one more burden which compete with their basic needs of food, utilities, housing, and education for their children. This puts the poor families in a quandary forcing them to make tough choices like food or utilities versus pills or condoms.

Thanks to government hospitals and a non-government (NGO) outfit called Likhaan which maintains clinics throughout Manila, the city’s poorest families are able to fulfill their wishes of limiting the number of their children or increasing birth spacing at a lower, subsidized cost or for free.

This was revealed in a study done by the Demographic Research and Development Foundation (DRDF) in the three poorest districts of the city of Manila- Tondo, Port Area, and San Andres. Commissioned by the European Union in collaboration with Likhaan Center for Women’s Health and Save the Children, it was conducted to (1) identify the most prevalent problems that discourage or prevent the women from using modern FP methods, (2) determine the changes in key indicators, and (3) describe barriers to access to and utilization of FP services. Called Study on Access to Information and Services on Family Planning Among Women in Urban Poor Areas in Manila, researchers used random sampling methods to survey a total of 518 and 513 respondents of women aged 15-49 years in the three abovementioned districts in 2012 and 2015, respectively.

Data showed that for the baseline study, pharmacies were the top source of contraceptives at 38.7% followed by government hospitals at 33.3%, the NGO Likhaan at 18%, and barangay health centers (BHCs) at 8%. After three years, in 2015, there occurred a dramatic shift with Likhaan leading the pack at 41.3% followed by government hospitals at 33%, pharmacies at 16.8% and BHCs at 6%.

Showing the shift in the source of contraceptives is the ramping up of services or their use, thereof, for pills from Likhaan and the NGO’s introduction of implants in its clinics in 2012. In the baseline study, pharmacies controlled 77.6% of the source for pills with Likhaan and BHCs a distant second and third at 14.9% and 7.5%, respectively. This changed in the endline study as Likhaan beneficiaries grew to 40% and pharmacy and BHC patrons dropped to 52.5% and 5%, respectively. Meanwhile, by 2015, implants- exclusively available in Likhaan clinics- were being utilized by 7% of all women currently using any contraceptive method.

For government hospitals, female sterilization remained the major contraceptive service offered. From a 95.6% share of the service in 2012, it even increased to 96.2% in 2015. In terms of injectables, its share of the market remained virtually at 5.6% after three years, third only to Likhaan and BHCs at 50% and 44.4%, respectively.

Nominal median cost grew in the three-year lag for most of the modern contraceptive methods. According to cost, female sterilization remains on top, increasing from P1,387.00 in the baseline to P3,891.00 in the endline, for service done in government hospitals and P21,000.00 in private hospitals. Pills per cycle, meanwhile, grew from P40.00 to P50.00.

While the nominal median cost has risen for most of the modern contraceptive methods in the three-year lag, this is cushioned by data which shows that that the percentage of women who availed of services for free in government hospitals, BHCs, and the NGO sector has increased as well. This is true for female ligation where the percentage of women sterilized in government hospitals for free rose from 9.3% to 25.5%, the pill where NGO recipients grew from only 10.3% to 43.2%, the IUD method where recipients of free service went up from 69% to 90%, and implants which is totally free.