Philippines
Nutritional Status of High-Fertility Women
In spite of efforts to in the Philippines to promote family planning, fertility remains high among older rural women with little formal education. Numerous studies in developing countries have shown that high-fertility women are at increased risk for maternal mortality and morbidity. The effect of high fertility on the nutritional status of the mother, however, has been less consistent.
Study Design
The original Cebu Longitudinal Health and Nutrition Survey (CLHNS) recruited 3,327 pregnant women from 33 barangays in the Cebu City metropolitan area. These women subsequently had a birth or pregnancy termination within a one-year period beginning in 1983. A follow-up survey was successfully conducted with 2,395 of the women in 1991. This descriptive analysis is based on 2,037 women who were not pregnant at the 1991 follow-up survey.
Higher fertility was defined as six or more pregnancies; there were 825 higher fertility women in the study and 1,212 lower fertility women. Higher and lower fertility women were compared, based on socioeconomic characteristics, reproductive events and nutritional status.
In order to compare higher and lower fertility women in terms of nutritional status and reproductive patterns, researchers from the University of North Carolina, Family Health International (FHI) and the University of San Carlos in Cebu, Philippines, have analyzed data from the Cebu Longitudinal Health and Nutrition Survey (CLHNS), collected in 1983–86, and from the follow-up study in 1991–92.
Research Findings
In comparison with lower fertility women:
- Higher fertility women were older, less educated, rural, had fewer household assets and earned less money.
- Higher fertility women were more likely to have experienced at least one fetal loss (44 percent) than low fertility women (19 percent). Higher fertility women had shorter birth intervals, were less likely to be using family planning, had breastfed a greater proportion of their children for longer than 12 months, and were more likely to experience overlap of lactation and pregnancy (68 percent experienced overlap, compared with 32 percent of lower fertility women).
- Higher fertility women had poorer diets, with lower intakes of energy, protein and fat. The lowest intake was found in rural, low-income, older, higher fertility women.
- Higher fertility women weighed less and had a higher prevalence of chronic energy deficiency than women with lower fertility.
- Higher fertility women appear to be at greater risk for poor nutritional status because of the stresses of multiple pregnancies and lactations with inadequate recuperative intervals between pregnancies rather than from the stress of excessively long duration of lactation. An overlap of pregnancy and lactation caused additional stress. However, lactation was generally discontinued soon after a pregnancy was identified, although some women continued to breast-feed for several months; the mean overlap was 16.5 weeks.
- In addition to reproductive stresses, the poor nutritional status of higher fertility women was related to inadequate dietary intake, older age, and characteristics such as rural residence, low income and low education.
Recommendations
For programs serving high fertility women in the Philippines, recommendations include:
- Adequate birth spacing, especially for rural women, should be promoted; this means that access to family planning must be improved to make birth spacing possible;
- Dietary intake needs to be improved for older higher fertility women; and
- Breastfeeding should be promoted, combined with recognition of the importance of meeting women's increased energy and nutrient needs during lactation.
Study Details
This summary is based on a paper by Barbara Polhamus, "A Profile of High-fertility Women in the Philippines," Carolina Population Center, University of North Carolina, Chapel Hill, NC, l996. It was supported by the Women's Studies Project through a Cooperative Agreement from the U.S. Agency for International Development.
