BACKGROUND

In the absence of comprehensive registration of population and vital statistics, demographic surveys are the primary source of data used in monitoring the progress and evaluating the impact of the population program of the country. The Philippine Population Program was officially launched in 1970. Since then, it has undergone many changes in its policy and program directions. In the beginning, the program was centered on fertility reduction and contraceptive distribution, using a clinic-based approach. In the 1970s, the family planning program shifted to a family welfare approach, adopting a combined clinic and community-based delivery approach. In the 1980s, the population policy was restated, calling for the broadening of population concerns beyond fertility reduction to cover family formation, the status of women, maternal and child health, morbidity and mortality, population distribution and urbanization, internal and international migration, and population structure (Commission on Population, 1997: 1).

The Philippine Population Management Program (PPMP) was developed in 1993 to supplant the Philippine Population Program (Philippine NGO Council on Population, Health and Welfare, Inc., 1998:25). The PPMP adopted the population, resources and environment (PRE) framework, which defines the connection between population and sustainable development. Its overall goal is the improvement of quality of life by creating a favorable environment for achieving rational growth and distribution of population, defined in relation to resources and environment. Since 1998, the program has aimed to promote the reproductive health approach in the implementation of population policies and programs. Specifically, the Philippine Family Planning Program promotes family planning within a comprehensive package of reproductive health services (Commission on Population, 1997: 17).

The action agenda includes the following (Commission on Population, 1997: 19):

1.        Reducing unmet need for family planning services

2.        Reducing incidence of high-risk pregnancies

3.        Making available high-quality family planning services

4.        Reducing abortion

5.        Increasing the participation and sharing of responsibility of men in the practice of family planning.

The Department of Health (DOH) is the lead agency for the reproductive health and family planning component of the PPMP. The Commission on Population (POPCOM) is the coordinating body of the PPMP (Commission on Population, 1997: 5-6).

OBJECTIVES OF THE SURVEY

The 2003 Philippines National Demographic and Health Survey (NDHS) is designed to provide up-to-date information on population, family planning, and health to assist policymakers and program managers in evaluating and designing strategies for improving health and family planning services in the country. In particular, the 2003 NDHS has the following objectives:

• Collect data at the national level, which will allow the calculation of demographic rates and, particularly, fertility and under-five mortality rates.
• Analyze the direct and indirect factors that determine the level and trends of fertility. Indicators related to fertility will serve to inform plans for social and economic development.
• Measure the level of contraceptive knowledge and practice by method, urban-rural residence, and region.
• Collect data on knowledge and attitudes of women and men about sexually transmitted infections and HIV/AIDS and evaluate patterns of recent behavior regarding condom use.
• Collect high-quality data on family health, including immunizations, prevalence and treatment of diarrhea and other diseases among children under five, antenatal visits, assistance at delivery, and breastfeeding.

ORGANIZATION OF THE SURVEY

The 2003 NDHS was implemented by the Philippines National Statistics Office (NSO) from June 16 to September 3, 2003. Financial support for the local costs of the survey was provided by the United States Agency for International Development (USAID). ORC Macro provided technical assistance to the project through the MEASURE/Demographic and Health Surveys+ (MEASURE/DHS+) program.

The 2003 NDHS is the eighth in a series of demographic surveys in the Philippines taken at five year intervals since 1968. It is the third survey conducted under the auspices of the Demographic and Health Surveys program. Thus, the data collected in the 2003 NDHS provide updated estimates of basic demographic and health indicators covered in previous NDHS surveys.

QUESTIONNAIRES

The 2003 NDHS used four questionnaires: Household Questionnaire, Health Module, Women's Questionnaire, and Men's Questionnaire. The content of the Women's Questionnaire was based on the MEASURE/DHS+ Model "A" Questionnaire, which was developed for use in countries with high levels of contraceptive use. To modify the questionnaire to reflect relevant family planning and health issues in the Philippines, program input was solicited from DOH, POPCOM, the University of the Philippines Population Institute (UPPI), the Food and Nutrition Research Institute (FNRI), the Philippine Health Insurance Corporation (PhilHealth), USAID, the National Statistics Coordination Board (NSCB), the National Economic and Development Authority (NEDA), the United Nations Children's Fund (UNICEF), and Dr. Mercedes B. Conception, professor emeritus at the University of the Philippines, as well as managers of USAID-sponsored projects in the Philippines. The questionnaires were translated from English into six major languages: Tagalog, Cebuano, Ilocano, Bicol, Hiligaynon, and Waray.

The Household Questionnaire was used to list all of the usual members and visitors in the selected households. Basic information collected for each person listed includes age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Information on characteristics of the household's dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, and ownership of various durable goods, was also recorded in the Household Questionnaire. These items are indicators of the household's socioeconomic status.

The Health Module was aimed at apprising concerned agencies on the health status, practices, and attitude of the population. The module included the following topics:

• Health facility utilization
• Noncommunicable diseases
• Infectious diseases
• Traditional medicines, healing practices, and alternative health care modalities
• Health care financing
• Environmental health.

The Women's Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics:

• Background characteristics (age, education, religion, etc.),
• Reproductive history,
• Knowledge and use of family planning methods,
• Fertility preferences
• Antenatal, delivery, and postnatal care
• Breastfeeding and infant feeding practices
• Vaccinations and childhood illnesses
• Marriage and sexual activity
• Woman's work and husband's background characteristics
• Infant's and children's feeding practices
• Childhood mortality
• Awareness and behavior regarding AIDS and other sexually transmitted infections
• Awareness and behavior regarding tuberculosis.

The Men's Questionnaire was administered to all men age 15-54 living in every third household in the NDHS sample. The Men's Questionnaire collected much of the same information found in the Women's Questionnaire but was shorter because it did not contain questions on reproductive history, maternal and child health, and nutrition. Instead, men were asked about their knowledge and participation in health-seeking practices for their children. 

PRETEST

Three pretests were conducted prior to finalizing the survey instruments. The first pretest was conducted on January 6 through 10, 2003, in Caloocan City and Marikina City, both located in the National Capital Region (NCR). It was aimed at checking the flow of questions and the practicability of administering the Men's Questionnaire, which was used for the first time in the Philippines NDHS. The second pretest was carried out in Bulacan Province. The aim was to test the Tagalog translation of the questionnaires and also the field operation procedures. Training for the pretest field staff took place in the NSO Central Office in Manila from February 24 through March 7, 2003, with fieldwork on March 10 through 22, 2003.

The NDHS questionnaires were later translated into other dialects: Cebuano, Ilocano, Bicol, Hiligaynon, and Waray:with assistance from staff of the Regional Statistics Offices (RSOs). The third pretest was mainly carried out to check the translation of the questionnaires. It was conducted on April 2 through 9, 2003, in the NSO Central Office, with personnel assigned at the Household Statistics Department and the NSO NCR office who spoke any of the five dialects acting as the interviewers. Selected male and female employees from different departments of NSO who spoke the dialects were interviewed with the translated questionnaires. Some of the third pretest interviewers administered the translated questionnaires to their neighbors and relatives who spoke the dialects.

TRAINING AND FIELDWORK

Training of the field staff was conducted in two phases. The first was the Task Force training (instructors and regional coordinators), followed by training of the interviewing teams. The Task Force training was conducted in Manila from April 28 through May 17, 2003. Thirty-six persons participated as trainees: 17 from RSOs and 19 from the NSO Central Office. The trainers were staff of the Demography and Social Statistics Division (DSSD) at NSO and professors from UPPI. Staff from DOH and PhilHealth served as resource persons in the training.

The second-level training took place from May 21 through June 6, 2003, in eight training centers:

Antipolo, Rizal; San Fernando, La Union; Legazpi City; Iloilo City; Cebu City; Zamboanga City; Cagayan de Oro City; and Davao City. Instructors in this training were members of the Task Force who were trained in the first-level training.

Data collection was carried out from June 16 to September 3, 2003, by 44 interviewing teams. Each team consisted of a team supervisor, a field editor, three or four female interviewers, and one male interviewer.

DATA PROCESSING

All completed questionnaires and the control forms were returned to the NSO Central Office in Manila for data processing, which consisted of manual editing, data entry and verification, and editing of computer-identified errors. An ad hoc group of seven regular employees of DSSD was created to work full time in the NDHS Data Processing Center. This group was responsible for the different aspects of NDHS data processing. There were 10 manual processors and 25 data encoders hired to process the data.

Manual editing started on July 15, 2003, and data entry started on July 21, 2003. The computer package program called CSPro (Census and Survey Processing System) was used for data entry, editing, and tabulation. To prepare the data entry programs, two NSO staff members spent three weeks in ORC Macro offices in Calverton, Maryland, in April and May 2003. Data processing was completed in October 29, 2003.

SAMPLE DESIGN AND IMPLEMENTATION

The 2003 NDHS is the first survey that used the new master sample created for household surveys on the basis of the 2000 Census of Population and Housing. The 2003 NDHS used one of the four replicates of the master sample. The sample was designed to represent the country as a whole, urban and rural areas, and each of the 17 administrative regions. In each region, a stratified, three-stage cluster sampling design was employed. In the first stage, 819 primary sampling units (PSUs) were selected with probability proportional to the number of households in the 2000 census. PSUs consisted of a barangay or a group of contiguous barangays. In the second stage, in each PSU, enumeration areas (EAs) were selected with probability proportional to the number of EAs. An EA is defined as an area with discernable boundaries consisting of about 150 contiguous households. All households in the selected EAs were listed in a separate field operation conducted May 7 through 21, 2003. In the third stage, from each EA, an average of 17 households was selected using systematic sampling.

For the 2003 NDHS sample, 13,914 households were selected, of which 12,694 were occupied (Table 1.1). Of these households, 12,586 were successfully interviewed, yielding a household response rate of 99 percent. Household response rates are similar in rural areas and in urban areas (99 percent).

Among the households interviewed, 13,945 women were identified as eligible respondents, and interviews were completed for 13,633 women, yielding a response rate of 98 percent. In a subsample of every third household, 5,009 men were identified to be eligible for individual interview. Of these, 4,766 were successfully interviewed, yielding a response rate of 95 percent.

The principal reason for nonresponse among women and men was the failure to find individuals at home, despite interviewers' repeated visits to the household.