1

CHAPTER I
THE PROBLEM AND ITS BACKGROUND

Introduction
Access to safe, voluntary family planning is a human right. Family planning is central to
gender equality and womens empowerment, and it is a key factor in reducing poverty. Yet some
225 million women who want to avoid pregnancy are not using safe and effective family
planning methods, for reasons ranging from lack of access to information or services to lack of
support from their partners or communities. Most of these women with an unmet need for
contraceptives live in 69 of the poorest countries on earth. (UNFPA.org)
Family Planning means deciding when the best time to have children is, and what is the
appropriate number of children for a couple to have. The right time to have children is when a
woman is between 20 and 35 years old, when a woman has not been pregnant for the last 2-3
years, when a woman has fewer than 4 children, when a woman has no illness that would place
herself or her baby in danger and when the couple wants to have a baby. (WHO.int)
United Nations Millennium Development Goals (MDGs) are the goals crafted and
agreed by the different countries and leading development institutions in order to meet the needs
of the worlds poorest. All of these goals are targeted to be achieved by 2015. (United Nations,
2013)
One of the millennium Development Goals, MDG5 (Improve Maternal Health), is
geared towards the improvement of maternal health care by targeting to reduce by three-quarters

the maternal mortality ratio in 1990 by 2015 and by achieving universal access to reproductive
health. United Nations (2013) reported positive gains in the recent past but the condition in the
developing countries continues to be a concern. The mortality rate ratio in the world has declined
by 47 percent since 1990 but the ratio in developing counties is still higher than the developed.
Moreover, there were gains in terms of access to reproductive health with the increase in the
number of women receiving the antenatal care in developing countries from 63 percent in 1990
to 81 percent in 2011, but it remains that only half of women receive substantial health care in
the developing countries. Also, the progress made in terms of lowering the rates of teenage
pregnancy has slow down.
In the Philippines, the concern for higher maternal deaths remains. Recently, the United
Nations Development Programme ( UNDP, 2013) described the country as in critical danger of
not achieving the target on improving maternal health by 2015. The maternal rate mortality
(MMR) in the country was reported to have increased from 162 per 100,000 live births in 2009
to 221 per 100,000 live births in 2011 (Alave, 2012). This is far from the countrys target of 52
per 100,000 live births in 2015 in line with MDG5. Earlier, there was a prediction that the MMR
of the country in 2015 is 140 (2.7 times the target) (UNFPA, 2005; Conception, 2013).
Should the current trend continue, the overall maternal mortality ratio (presently
estimated at 162 as measured by the 2006 Family Planning Survey), is forecast to decrease to
140 in 2015, 2.7 times the target of 52 (Romualdez, 2010). The contraceptive prevalence rate
(CPR) as a measure of access to reproductive health services is projected to increase from the
50.7 percent in 2008 to 60 percent in 2015- far below the target of 80 percent. Thus, without
extraordinary effort in health sector, attaining MDG4 is virtually impossible.

One effective and efficient way to address the problem of MMR is Family Planning
(UNFPA, 2008). It reduces the number of pregnancies, the number of abortions, and the
proportion of births at high risk because of complication. Although there was an increasing trend
in the contraceptive prevalence rate (CPR) of married women in the country since the late 1960s
(15 percent in 1968, 18 percent in 1975, 32 percent in 1985, 40 percent in 1995, 49 percent in
2005, and 51 percent in 2008) there has not been much progress in the last decade (NSO and ICF
Macro, 2009), between 2003 and 2008, the use of any method increased only by two percentage
points (49% to 51%), while use of any modern method increased only by less than one
percentage point. The 2011 Health Family Survey revealed the same result with the 2011
prevalence rate for modern methods placed at 37.7 percent, or 13 times the estimate for 1968,
which was 2.9 percent (NSO, 2013).
More than the low contraceptive prevalence rate (CPR) is the concern for the unmet need
for Family Planning in the country. Unmet need for Family Planning refers to the proportion of
currently married women who are not using any family planning method but do not want any
more children or prefer to birth space (Ericta, 2012). Filipino women with unmet need for
modern family planning, either to limit (women who want to stop childbearing) or space (want a
child after three or more years) was estimated from the 2008 National Demographic and Health
Survey to be about 22 percent with the following breakdown: 9 percent for spacing and 13
percent for limiting birth (NSO and ICF Macro, 2010). Recent estimate from 2011 Family Health
Survey placed the unmet need for family planning among married women in the Philippines at
19.3 percent, 10.5 percent for birth spacing and 8.8 percent for limiting births (Ericta, 2012).
Addressing the problem of unmet need for Family Planning has an important function towards
the attainment of the MDGs and health security for all (UNFPA, 2010).

The low contraceptive prevalence rate (CPR) and high unmet need are found among the
poorest households result from the 2011 Family Health Survey showed that the use of family
planning method is lower among women in poor households than those in non-poor households,
43.1% versus 51.3% (Ericta 2012). The difference is mainly due to the lowest quintile, 28.2%
while the lowest unmet needs are with the second, 19.5% and first quintile 20.5% (NSO, ICF
Macro, 2011).
In 2010, to promote universal health care, particularly for the Filipino poor families and
to respond to the challenges of meeting the MDGs by 2015, the Aquino Health Agenda
Achieving Universal Health Care for all Filipinos was launched (DOH administrative Order
No. 2010- 0036). One of the three thrust of the Agenda is the attainment of the health-related
MDGs by applying additional effort and resources in localities with high concentration of
families who are unable to receive critical public health services.
Always let the clients decide for themselves on the method that they will use, and help
them choose the method that is most appropriate for them. Factors to consider include the age of
the woman, woman's reproductive stage, the effectiveness of a method, the woman's health status
and personal considerations. No method is best for all women, nor is any method best for a
woman throughout her reproductive life.
The researcher wants to know the effects of the natural and artificial family planning
methods in the health condition of the selected mothers. This research will help us gather
relevant information that will be helpful to the community, especially Barangay San Antonio,
Fourth Estate Subdivision, Paranaque, City which is the location of this study.

Theoretical Framework
Banduras Social Cognitive Theory. A focus on family planning knowledge, comfort,
self-efficacy, perceived social workers and moral attitudes toward providing information on
family planning clients.
Three trials were based on social cognitive theory interventions and results were mixed.
Social cognitive theory focuses on understanding the risks and benefits of changing ones
behavior, developing self-efficacy, and assessing outcome expectations of the change in
behaviour. One study used a customized intervention programme to delay second births among
adolescents and results showed that adolescents in the treatment group were less likely to have
had a second birth within two years compared with usual care (the standard sex education class)
[Odds Ratio (OR) 0.41, 95% confidence interval (CI) 0.171.00]. However, two cluster
randomized trials using enhanced school-based curricula versus usual sex education found no
difference in (reported) pregnancy for both study arms. One of these studies found no significant
differences in contraceptive use within gender. The other study reported that males in the
intervention group were more likely to use a condom at last intercourse [relative risk (RR) 1.47,
95% CI 1.121.93] but not females.

Figure1. Conceptual Paradigm of the Study (Banduras Social Cognitive Theory)

Self-efficacy Theory. This method is somewhat complicated to use involving charting (on a
calendar) a womans menstrual cycle and using these dates to estimates the likely day of
ovulation. The method can involve the tactile inspection of the womans cervical mucus, with a
thinning of this mucus being a sign of pending ovulation.

Conceptual Framework

The 2011 Family Health Survey (FHS) provides information on key family planning
indicators including the contraceptive prevalence rate (CPR), contraceptive method mix, and
contraceptive users by background characteristics such as age, education and socio-economic
status. The CPR is defined as the percentage of currently married women of reproductive age
(15-49) reporting current use of any method of contraception. Acquiring knowledge about

fertility control is an important step forward in gaining access to contraceptive methods and
using a suitable method in a timely and effective manner.
Although year-to-year variations are not significant, the CPR has exhibited a generally
increasing trend (Figure 1). In the late 1960s and early 1970s, fewer than two in 10 married
women used any form of contraception. Contraceptive prevalence rate rose during the late 1970s.
By 1993, two in five women were practicing contraception. Since the mid-1990s however, a
fairly steady figure of 45 to 50 percent of married women of reproductive age have been reported
using some form of family planning in successive Demographic and Health Surveys and Family
Planning Surveys.
Fluctuations in the CPR can be attributed to the erratic trend of the prevalence rate of
traditional methods. In contrast, the prevalence rate of modern methods had generally increased.
In

2011,

the

prevalence rate for modern methods was 13 times the estimate for 1968, which was 2.9 percent.
Figure2. Contraceptive Prevalence Rate of Currently Married women Aged 15-49 years.
In the 2011 FHS, the pill was the leading contraceptive method with 19.8 percent of
currently married women reported they are currently using this method (Figure 3). Ligation or

female sterilization (8.6 percent), withdrawal (8.2 percent) and calendar method (3.7 percent)
were the next three most commonly used methods. Injectables was used by 3.4 percent of
currently married women; IUD, by 3.1 percent; and male condom, by 1.2 percent. Vasectomy
(male sterilization) and those classified under Natural Family Planning Methods such as
Lactational amenorrhea method (LAM), and Standard Days Method (SDM) were each reported
by less than one percent of currently married women as their current contraceptive method
(Table 1).

Figure.3 Percent of Currently Married women by current contraceptive method

used.
The proportion of women using oral contraceptives has generally increased over the last
15 years with notable increase between 2006 and 2011, wherein the prevalence rate of oral
contraceptives increased from 16.6 percent to 19.8 percent.

The proportion of women using other modern methods has been nearly constant since
1995. In particular, the use of ligation or female sterilization was almost constant at about 11
percent from 1996 to 2003, dropped in 2004 and 2005 to 9.4 percent, then rose in 2006 to 10.4
percent and dropped again in 2011 to 8.6 percent. The percentage using injectables slightly
increased from 2.8 percent in 2006 to 3.4 percent in 2011.About four in ten (37.5 percent) of
currently married women in the oldest age group (45 to 49 years) were still using contraceptives
in 2011. The prevalence rate for modern methods was higher than for traditional methods for all
age groups of currently married women (Table 2).
According to the 2011 FHS, the contraceptive prevalence rate (CPR) ranged from 23.5
percent in the Autonomous Region in Muslim Mindanao (ARMM) to 56.3 percent in Davao
Region. Modern or more effective methods were more likely to be used than traditional or less
effective methods in all regions (Table 3.4). ARMM had the lowest prevalence rate for modern
methods (19.1 percent).
Educational attainment and contraceptive use are correlated; that is, women with higher
educational attainment are more likely to be using any form of contraception than less educated
women.
Regardless of their educational attainment, women preferred modern contraceptive
methods over traditional methods. With the exception of women with postgraduate education,
oral contraceptives were the most commonly reported contraceptive method; ligation, the second
most popular method. Among women with postgraduate education, ligation was the most popular
method while oral contraceptives were the next commonly used method (Table 2).

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The 2011 FHS provides contraceptive prevalence and method mix by socio-economic
status (SES). A household is classified into either poor or non-poor thru the use of proxy
variables or the presence of household conveniences and ownership of vehicle or vehicles.
Table 2 shows that the overall CPR for all currently married women belonging to nonpoor households was higher by 8.2 percentage points than the CPR for currently married women
belonging to poor households (51.3 percent versus 43.1 percent). This difference is due mainly to
a much higher prevalence of female sterilization among non-poor women than among poor
women (10.0 percent versus 5.2 percent).
Modern methods were more widely used than traditional methods regardless of the socioeconomic standing of the women. Use of modern contraceptive methods by both the poor and
non-poor women has been generally increasing during the past rounds of FPSs. It is also
important to note that the gap between the CPR for modern methods between women by SES has
been closing over time and this gap has not widened since the implementation of the
Contraceptive Self-Reliance Strategy, that is, when the aide for supplies of family planning
methods was withdrawn by donors. A scrutiny of the distribution by contraceptive method, of
women in poor and non-poor households shows that, overall, oral contraceptives were the most
popular contraceptive method for both the poor (18.7 percent) and non-poor (20.3 percent).

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Table1. Percent Distribution of Currently Married Women by current contraceptive

method used.

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Table2. The percentage of distribution of currently married women aged 15-49 years by
current contraceptive method used by region.
Type of Family Planning Method
1. Natural Family Planning Method
Standard Base Method. The SDM is based on the physiology of the menstrual cycle and
the functional life span of the ovum and the sperm. It can be used by women if their menstrual
cycles are 26 to 32 days long. The client uses color-coded CycleBeads to mark the fertile and
infertile days of her menstrual cycle and to monitor her cycle length. Clients using this method

13

abstain from sexual intercourse on fertile days (days 8 to 19) to avoid pregnancy. About 5 per
100 women who consistently and correctly use the method and abstain on fertile days become
pregnant over the first year of use. The SDM works well for women who usually have menstrual
cycles that are 26 to 32 days long. Women with cycles that are NOT 26 to 32 days long cannot
use the method. The client keeps track of the days of her menstrual cycle and counts the first day
of her monthly bleeding as day 1. Using the CycleBeads, the client moves the ring to the red
bead to begin a new cycle and marks that day on her calendar. She moves the rubber ring one
bead every day. Days 8 to 19 of every cycle (when the ring is on the white beads) are considered
fertile days for all SDM users. The couple avoids vaginal sex (or uses condoms, spermicides, or
withdrawal) during days 8 to 19. The couple can have unprotected sex on all the other days of the
cycle (when the ring is on the brown beads)days 1 to 7 at the beginning of the cycle and from
day 20 until her next monthly bleeding begin.
Lactation Amenorrhea Method. The LAM primarily works by preventing ovulation.
Frequent breastfeeding temporarily prevents the release of the natural hormones that cause
ovulation. This method is considered effective under the following three conditions: (1) the
monthly menstruation has not returned, (2) the baby is fully or nearly fully breastfed and often
day and night, and (3) the baby is less than six months old. When typically used, about 2 per 100
women in the first six months after childbirth become pregnant. When used correctly, about 1 per
100 women who use the method in the first six months after childbirth become pregnant. The
risk of pregnancy is the greatest when a woman cannot fully or nearly fully breastfeed her infant.
The LAM can be started immediately after birth up to six months after childbirth. The client
should breastfeed immediately (within one hour) or as soon as possible after the baby is born.
The method can be used any time if the client has been fully or nearly fully breastfeeding her
baby since birth and her monthly bleeding has not returned. The following points should be

14

provided to the client: Feed on demand (whenever the baby wants to be fed) and at least 10 to 12
times a day in the first few weeks after childbirth and 8 to 10 times a day thereafter, including at
least once at night in the first months. Daytime feedings should not be more than four hours
apart, and nighttime feedings should not be more than six hours apart. Some babies may need
gentle encouragement to breastfeed more often even at night. Start other foods at six months in
addition to breast milk. At this age, breast milk can no longer fully nourish a growing baby. The
client should plan for another method while the LAM criteria still apply to continue protection
from pregnancy. The LAM is universally available to all postpartum breastfeeding women. With
the LAM, protection from an unplanned pregnancy begins immediately postpartum. The LAM
contributes to improved maternal and child health and nutrition breastfeeding and weaning
practices. The LAM serves as a bridge toward the use of other FP methods. The effectiveness of
the LAM may decrease among mothers who are separated from their child for extended periods.
Full or nearly full breastfeeding may be difficult to maintain for up to six months. All
breastfeeding women can safely use the LAM, but a client in the following circumstances may
want to consider other contraceptive methods: Has HIV/AIDS. Is using certain medications
during breastfeeding (including mood-altering drugs, reserpine, ergotamine, antimetabolites,
cyclosporine, high doses of corticosteroids, bromocriptine, radioactive drugs, lithium, and certain
anticoagulants). The newborn has a condition that makes breastfeeding difficult (including
premature babies and those that need intensive neonatal care, are unable to digest food normally,
or have deformities of the mouth, jaw, or palate)
Basal Body Temperature. The BBT method involves identifying the fertile and infertile
periods of a womans cycle by taking and recording daily the rise in body temperature during and
after ovulation. BBT is the temperature of the body at rest after at least three hours of continuous

15

sleep before temperature taking. A womans BBT rises during her ovulation period and stays
high until the next menstruation because of a rise in progesterone level. About 1 per 100 women
who consistently and correctly use the method and abstain on fertile days becomes pregnant over
the first year of use. The client takes her body temperature at the same time each morning before
she gets out of bed or does anything. She records her temperature on a special graph using a
special thermometer. She watches for her temperature to rise slightly0.2 C to 0.5 C (0.4 F to
1.0 F)just after ovulation (about midway through the menstrual cycle). The couple should
avoid sex or use another method from the first day of menses until three days after the rise in
temperature. A BBT that has risen above the clients regular temperature and stayed high for
three full days indicates that ovulation has occurred and that the fertile period has passed. The
couple can have unprotected sex on the fourth day and until her next monthly bleeding begins. A
client who has fever/colds or other changes in the body temp

erature may find the method

difficult to use. The BBT method has no known side effects.

2. Artificial Family Planning Method
Pills. The most widely used CHCs are COCs, which are commonly referred to as pills.
The readily available preparations are as follows:
1

Monophasic low-dose COCs contain 20 g to 35 g ethinyl estradiol (EE) and

progestogen-like levonorgestrel (LNG) in all 21 active tablets. (High-dose COCs that
contain 50 g EE or more plus a high dose of progestogen are only used for special
indications.)

2
3

Biphasic low-dose COCs contain two combinations of estrogen and progestogen, e.g., 7
tablets of 40 g EE plus 25 g desogestrel and 15 tablets of 30 g EE plus 125 g
desogestrel.

16

Triphasic low-dose COCs contain the same hormones but in three dose ratios, e.g., 6
tablets of 30 mcg EE plus 50 mcg LNG, 5 tablets of 40 mcg EE plus 75 mcg LNG, and
10 tablets of 30 mcg EE plus 125 mcg LNG.

Quadriphasic preparations include four different combinations of estradiol valerate (EV)

and dienogest.

The following significant changes have been made over the past decades to improve the
combined oral contraceptives: Gradual reduction in the estrogen component from the
original 175 mcg mestranol to the present-day pills that contain 30 mcg to 35 mcg EE and
the very low-dose pills with only 20 mcg EE .Use of different estrogens (estradiol [E2]
and EV) and progesterones (drospirenone, dienogest, and nomegestrol). Extended or
continuous contraceptive cycles.

HOW ARE COC PILLS USED? Pills should be taken once daily even if the client is not
having sex daily. If monthly menstruation/withdrawal bleeding is desired, a pack with 21
active pills that contain the active hormones estrogen and progestogen should be taken
with a seven-day rest period before starting a new pack. A 28-day pack including seven
placebo or nonhormone tablets should be taken continuously. The client should start a
new pack immediately the day after the last pill of the current pack. A rest period is not
required. If menstruation/withdrawal bleeding is not desired (continuous or extended use
of pills may be resorted to): A monophasic pack with 21 active pills that contain the
hormones estrogen and progestogen should be taken continuously, and a new pack should
be started immediately the day after the last pill of the current pack.

A 28-day

monophasic pack may be used similarly and continuously (taking only the 21 active
pills) after discarding the seven additional placebo or non-hormone tablets. A seven-day

17

rest period may be ideal every after three continuous cycles (menstruates every three
months or four times a year). With multiphasic preparations, skipping the placebo week
may result in a sudden change in hormone levels. As this change may cause irregular
bleeding, multiphasic preparations are not recommended for continuous use. Pill users
should have a backup contraceptive method, such as condoms, in case of missed pills.
The clients clinical history should be taken to determine her medical eligibility.
WHEN SHOULD USE OF COCs BEGIN? COCs are best taken within the first five
days of the menstrual period because pregnancy is not possible at this time. Women who start
COCs after the fifth day of the onset of their menstruation should practice abstinence or use a
backup contraceptive for the next seven days. Women who have not recently given birth can start
taking COCs any time as long they are certain that they are not pregnant. Postpartum/postabortion women: Breastfeeding women may begin COCs at six months postpartum or when they
quit breastfeeding. COCs contain estrogen, which may decrease breast milk production.
Postpartum women who are not breastfeeding may begin taking COCs three weeks after
delivery. Following an abortion, women may begin taking oral contraceptives immediately. No
backup contraception is needed if the method is started within the first five days following an
abortion.
4

Figure4. A procedure when a woman misses her pills.

a. If a woman misses 1 or 2 active COCs pills or start a pack 1 day late:

Take a pill as soon as she

remember

Take the next a pill in a

regular time

Continue taking 1 pill at a time until

packed is finished. No backup necessary.

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b. If a woman misses 3 or more active pills or start a pack 2 to 3 days late:

Take a pill as soon as she

remember

Take
a next pill as a
7
schedule until finish the
pack

Abstain for sex or use additional

contraceptive for 7 days

8
c. If a woman misses 3 or more contraceptive pills
on the third week:

Take
1 pill as
soon the
as she
Continue
taking
pillsremember,
until the
if possible from
a
new
pack;
or she
new is finish.
can take an active pills from the
current pack until she get a new pack

Injectable. Combined injectable contraceptives (CICs) are monthly injectable

preparations that contain a short-acting natural estrogen and a long-acting progestogen. Once
given intramuscularly, these hormones are slowly released for 28 to 30 days. CICs come in the
following preparations: 25 mg depot-medroxyprogesterone acetate(DMPA) and 5 mg estradiol
cypionate (Cyclofem) intramuscularly injected once a month. 50 mg norethindrone enanthate
and 5 mg estradiol valerate (Mesigyna) intramuscularly injected once a month. This preparation
is available in the Philippines as Norifam. HOW EFFECTIVE ARE CICs? CICs are 99.9%
effective in preventing pregnancy when used properly. With typical use, the effectiveness rate is
lower at 97.0%. WHAT ARE THE ADVANTAGES OF USING CICs? Immediate effectiveness;
Pelvic examination not required prior to use; Does not interfere with intercourse; Few side
effects; Can be provided by a trained nurse or midwife; Contributes to decreased menstrual flow
(lighter, shorter periods); Reduces menstrual cramps; May improve anemia as menses are
reduced; Reduces the risk of ectopic pregnancy; Protects against some causes of pelvic
inflammatory disease (PID). WHAT ARE THE DISADVANTAGES OF USING CICs?Some

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nausea, dizziness, mild breast tenderness, headaches, and spotting (minimal bleeding) caused by
the estrogen component of CICs but to a lower degree than those caused by COCs. These side
effects disappear within two or three injections because the natural estrogen approximates the
physiologic dose. Effectiveness may be lowered by rifampicin and most anticonvulsants. CICs
can delay return to fertility by a few weeks from the last injection. CICs can cause serious side
effects, such as cardiovascular disease, but such cases are rare. CICs do not protect against STIs,
such as the human papillomavirus and HIV/ AIDS. CICs cause changes in the menstrual
bleeding pattern (irregular bleeding/ spotting) of some women. Users of CICs must return for
injection every 30 days. WHO CAN USE CICs? This method is useful for women who want a
highly effective contraceptive method but have problems adhering to other CHC regimens. This
method is also suitable for women who want the convenience of an injectable contraceptive
without the bleeding irregularities associated with progesterone-only injectable. WHEN
SHOULD USE OF CICs BEGIN? Any time as long as the client is not pregnant; Between day 1
and day 7 of the menstrual cycle, preferably on day 1; If the client is reasonably sure that she is
not pregnant, she may start using CICs even after the first seven days of her menstrual cycle.
However, she will need to abstain from sex or use a backup for the next seven days after the
injection; and Among postpartum women: Later than six months for breastfeeding women
because CICs may affect the quantity of breast milk; At three to six weeks after childbirth for
non-breastfeeding women; Immediately or within seven days for clients who just had an
abortion. WHEN CAN THE NEXT INJECTION BE PROVIDED? The best time to provide the
next injection is on the same date each month (a fourweek schedule is practical). This
information must be emphasized when counseling clients because it indicates the duration of
drug effectiveness.

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Condom. A male condom is a thin sheath of latex rubber made to fit on a mans erect
penis to prevent the passage of sperm cells by forming a barrier that prevents pregnancy. It also
helps keep infections in semen, on the penis, or in the vagina from infecting the other partner.
HOW EFFECTIVE IS THE MALE CONDOM? The effectiveness of this method depends on
the user. The risk of pregnancy or sexually transmitted infection (STI) is greatest when condoms
are not used with every sexual intercourse. Protection against pregnancy: When used correctly
with every sexual intercourse, only 2 per 100 women whose partners use male condoms become
pregnant over the first year of use; as commonly used, about 15 per 100 women whose partners
use male condoms become pregnant over the first year of use. Protection against human
immunodeficiency virus (HIV) and other STIs: When used consistently and correctly, condoms
prevent 80% to 95% of HIV transmission that would have occurred without a condom. When
used consistently and correctly, condoms reduce the risk of STIs. WHO CAN USE THE MALE
CONDOM? Couples who ask for its use and are reliable users; Couples who want to use it as a
backup method when the use of another method is interrupted; Couples who are at high risk of
STIs; Couples who want to use it as a temporary method until another method is preferred;
Couples who have medical contraindications with other methods or those who personally prefer
condom use; Men who have problems with premature ejaculation, as condoms can help delay
ejaculation; Postvasectomy clients who are waiting for sperm check or semen analysis after three
months. WHO CANNOT USE THE MALE CONDOM? Either or both sex partners with allergic
reaction to latex rubber. WHAT ARE THE KNOWN HEALTH BENEFITS AND RISKS OF
MALE CONDOM USE? Protects against the risks of pregnancy and against microorganisms that
cause STIs, including HIV; Protects women against some STI-induced conditions (recurring
pelvic inflammatory disease and chronic pelvic pain [endometriosis], cervical cancer, and

21

infertility); Can cause severe allergic reaction among individuals with latex allergy (extremely
rare).
Bilateral Tubal Ligation. It is a safe and simple surgical procedure that provides
permanent contraception for women who do not want more children. The procedure, also known
as bilateral tubal ligation (BTL), involves cutting or blocking the two fallopian tubes. Although
this section also presents endoscopic approaches to BTL, the standard procedure is
minilaparotomy under local anesthesia with light sedation. BTL by minilaparotomy under local
anesthesia is the accepted standard procedure of the Department of Health (DOH). Local
anesthesia is used because it is safe and allows the client to go home the same day. General
anesthesia is riskier than the sterilization procedure itself. Correct use of local anesthesia
removes the single greatest source of risk in female sterilization procedures, that is, general
anesthesia. Moreover, women usually feel nauseous after general anesthesia (which does not
occur as often after local anesthesia). However, when using local anesthesia with sedation,
providers must take care not to overdose the client with the sedative. Through a small incision in
the clients abdomen, a segment of both fallopian tubes. HOW EFFECTIVE IS FEMALE
STERILIZATION? Female sterilization is 99.5% effective with perfect and typical use.
WHAT ARE THE ADVANTAGES OF FEMALE STERILIZATION? Permanent method of
contraception. A single procedure leads to lifelong, safe, and very effective contraception; Does
not involve hormones; No changes in libido (sexual desire), menstrual cycle, or breastfeeding
ability; It is an outpatient procedure; Nothing to remember, no supplies needed, and no repeated
clinic visits required; Results in increased sexual enjoyment, as the woman does not need to
worry about pregnancy; No known long-term side effects or health risks; Can be performed
immediately after a woman gives birth; Can be performed without any routine laboratory tests,

22

blood tests, or cervical cancer screening is cut off or blocked. With disruption in the continuity of
the tubes, the womans egg cannot meet the mans sperm.

WHAT ARE THE

DISADVANTAGES OF FEMALE STERILIZATION? Uncommon complications of surgery:

Infection or bleeding at the incision site; Injury to internal organs; Anesthesia risks, which are
uncommon with local anesthesia; BTL is a permanent method of family planning (FP), and some
women may regret the decision later. Reversal surgery is difficult, expensive, and unavailable in
most areas. Successful reversal is not guaranteed. Clients who may want to become pregnant in
the future should not choose this method. FP counseling is crucial. In rare cases when pregnancy
occurs, it is more likely to be ectopic compared with pregnancies in women who have not
undergone the procedure. The procedure requires an operating room set-up and should be
performed by a trained provider. Physical activities, such as heavy work and lifting heavy objects
immediately after surgery are limited. The client may resume normal activities a week after the
procedure. The method does not protect against STIs such as HIV/AIDS.
Intrauterine Device. An IUD is a small plastic device inserted into a womans uterine
cavity to prevent pregnancy. It releases copper or a hormone. Almost all IUDs have one or two
strings or nylon threads tied to the plastic frame. The strings hang through the cervical opening
into the vagina. In the Philippines, two types of IUD are available: Copper T380 (TCu) is the
IUD currently used in the Philippine Family Planning Program. It is a T-shaped plastic device
with a copper coil wrapped around its stem and copper bands around its arms. The device
releases copper to prevent fertilization. It has a two-stranded monofilament tail. This type of IUD
is effective for 12 years. Hormone-releasing IUDs (e.g., levonorgestrel-releasing IUS or Mirena)
are made of plastic and steadily release small amounts of progesterone. This type of IUD is of
limited availability locally and is effective for five years. IUDs are 99.4% effective with perfect

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use and 99.2% effective with typical use. These rates indicate that 992 to 994 of every 1,000
women who use IUDs over the first year will not become pregnant. WHAT ARE THE
ADVANTAGES OF USING THE TCu IUD? Highly effective; Very safe; Local action; Has no
effect on the amount or quality of breast milk; Low cost; Does not interfere with sexual
intercourse; One time application; Immediate return to fertility upon removal; Can be inserted
immediately after childbirth or after abortion; Can be easily inserted or removed by a trained
provider; and Long-lasting effectiveness (12 years). WHAT ARE THE DISADVANTAGES OF
USING THE TCu IUD? Adverse effects: Pain and cramping; Long and heavy menstrual
bleeding; Menstrual irregularities; Device may be expelled, possibly without the client knowing
it (especially for postpartum insertions); requires a pelvic examination prior to insertion;
Requires a trained health service provider for insertion and removal; Does not protect against
sexually transmitted infections (STIs); and Requires regular self-checking of IUD strings during
the first year of use.

Role of the Health Centers and Midwives regarding Family Planning Program
Family planning centers are the main interface with the health care system for many of
the clients they serve. Increasingly, centers are leveraging that reality to connect clients not only
to insurance coverage but also to needed health care beyond what the centers provide directly.
This unique role could serve as a critically important stepping stone toward a sustainable path for
the family planning provider network in the emerging health care landscape.
The nationwide network of more than 8,000 publicly funded family planning centers
provides contraceptive and related services to more than seven million women a year.1 One in
four women who obtain contraceptive services in the United Statesincluding half of poor

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women accessing contraceptive caredoes so at a publicly funded family planning center. These
women receive other important, related care as well, including Pap tests, breast exams, and
testing and treatment for STIs. One in three women who get tested for HIV does so at a family
planning center.
It is therefore not at all surprising that six in 10 women who obtain care at a family
planning center describe it as their usual source of medical care.1 In fact, in many cases it may
be their exclusive source of care: according to one study conducted at Planned Parenthood
centers in Los Angeles, 29% of adults and 19% of teens said the center was their only source of
medical care.2 In other words, family planning centers are a significant entry point to the health
care system in the United States.

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Research Paradigm of the Study

Independent Variables

Dependent Variables

Profile of Mother in terms of:

Health Condition of the
Couples:

Age

Physical Aspect
Educational Attainment
Psychological Aspect
Civil Status
Emotional Aspect

Number of Children
Family Planning Methods
1.

Natural Methods:
a. Standard Based Method
b. Basal Body Temperature
c. Lactation Amenorrhea

Method
2. Artificial Methods
a. Pills
b. Injectable
c. Condom
d. IUD
e. Bilateral Tubal Ligation
Frame 1

Frame 1

Frame 2
Figure5: Research Paradigm of the Study

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Frame 1. Its show the independent variables which consist of the profile of the mother
and family planning methods that can be used by the respondents.
Frame 2. Shows the dependent variables which consist of the health condition of the
couples in terms of physical, psychological, and emotional aspect.

Statement of the Problem

This study aimed to determine the Effects of Natural and Artificial Family Planning
Methods to the Health Condition of the Selected Mothers in Brgy. San Antonio, Fourth Estate
Subdivision, Paranaque, City.
Specifically, study answered the following questions:
1. What is the profile of the respondent according to:
1.1 Age;
1.2 Civil Status;
1.3 Educational Attainment;
1.4. Number of Children
2. What is the family planning method used by the mother?
2.1 Natural Method
a. Lactation Amenorrhea Method;
b. Standard Base Method;
c. Basal Body Temperature;
2.2 Artificial Method
a. Pills;
b. Condom;

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c. Injectable;
d. IUD; and
e. Bilateral Tubal Ligation;
3. What is the status of the health conditions of the mother when using the Natural and
Artificial family planning methods in terms of:
3.1 Physical aspect;
3.2 Emotional aspect; and
3.3 Psychological aspect
4. Is there significant effect of Natural and Artificial family planning methods to the
health condition of the couples in terms of:
4.1 Physical aspect;
4.2 Emotional aspect; and
4.3 Psychological aspect

Objectives of the Study

The main objective of this study is to determine the Effects of Natural and Artificial
Family Planning Methods to the Health Condition of Selected Mothers of Brgy. San Antonio,
Fourth Estate Subdivision, Paranaque, City.
Specifically, it aimed to accomplish the following:
1.
2.

To determine the profile of the respondent;

To identify the effect of natural and artificial family planning methods to the
health condition of the mother in terms of physical aspect, emotional aspect
and psychological aspect;

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3.
4.

To determine what type of family planning method they used;

To know the status of the health conditions of the couples when using the
family planning methods in terms of physical aspect, emotional aspect and
psychological aspect.

Hypothesis

There is a significant effect of the natural and artificial family planning methods on the
health condition of mothers.

Scope and Limitation of the Study

The scope of the study is all about the effect of the natural and artificial family planning
method in the health condition of mothers in Brgy. San Antonio, 4 th Estate Subdivision. The
study focused on the personal profile of the mothers regarding with their age, civil status,
educational attainment and number of children in the family. The study will consider in the
selection of 50 respondents. The researchers believed that this number of respondents is enough
to assess the validity and reliability of the study.

Significance of the Study

This study will give contribution to midwife education. The result can be utilize as a
basis for further study on the effects of the natural and artificial family planning methods on the
health conditions of the selected mothers in Brgy. San Antonio Fourth Estate, Paranaque, City.

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This study was significant to the following target population:

Selected Mothers
To provides right information regarding family planning method. Enables her to regain
her health after the delivery and give enough time and opportunity to love and provide attention
to her husband and children.
Future Researchers
This study will serve as reference and to the authority to help in advocacy to control the
increasing number of population in barangay San Antonio, Fourth Estate Subdivision.
Community Health Nurse/Midwife
This study could to have different experience and for their job to be able to diagnose well
the community and too much prioritize the needs of community.
Department of Health
This study will help them to improve the program and services of the Family Planning in
our country.
Barangay Health Center
To give and disseminate the information to the mothers regarding the family planning
program in the Philippines.
Nurse/ Midwife Educator
This study will help them to give more information and health teachings regarding the
importance of family planning to their family and their health and to give counseling to them.
Local Government Unit
This study will help them to emphasize the importance of the family planning in the
mothers and the availability of the contraceptives in the Rural Health Unit.

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Rural Health Unit

To provides the needs of our couples in terms of family planning and explain the
importance of birth control to their health. To improves the services to the couple who
counseling the family planning.
Midwifery 2 Students
This study will serve as the guide to the students to show to the couples about the benefits
and effect of family planning method according to their uses and help the RHU and BHC to give
the information to the mother who will undergo the family planning method.

Definition of Terms

The following terms are defined operationally to serve as a guide for the readers to have a
better understanding of the terms used in the research:
Age. This refers to the age of selected mother as a respondent of this study.
Artificial Family Planning. This refers to the process used to prevent pregnancy and plan for
the birth of children at the most optimum time. Commonly referred to as birth control, family
planning can be accomplished using a variety of methods.
Effect of Artificial Family Planning Method. It is refers to the respondents body adapt the
contraceptive method.

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Emotional Aspects. This is another factor that had the most influential to the couples. Examples
are episodes of depressions; relationship satisfaction; experienced nervousness when
contraceptive is used; mood swing and episode of anger outburst.
Family Planning Methods. This refers to the planning when to have children and the birth
control.
Mother. This refers to the respondents women who inhabit or perform the role of bearing some
relation to their children, who may or may not be their biological offspring.
Natural Family Planning. This is a method used to help couple determine when sexual to help
a couple determine when sexual intercourse can and cannot result in pregnancy.
Effect of Natural Family Planning Method. It is refers to the respondent body stimuli to the
method.
Physical Aspects. This refers as the contributing factor that affects the couples in their health
condition. Examples are decrease in libido, able to maintain body weight, experience dizziness /
drowsiness, feeling of nausea and vomiting and feeling of light headache .
Profile. This refers to the respondents mother according to their civil status, age, educational
attainment and number of children in the family.
Psychological Aspects. This refers to the factor that has great effects to the couples in terms of
choosing their methods to use and satisfaction. Examples are stress when family planning
method is unavailable, feeling of guilt using contraceptive methods, difficulty in thinking or
concentrating, cerate positive outlook in life / inability to thinking positively and change in selfperception.