Adolescent Health and Responsible Parenthood: Shaping Policies for Child Protection and Well-being by Usec. Lisa Grace Bersales, PhD

I really appreciate the invitation for me to be part of the 11th NSSC. Maraming salamat sa PSSC, sa aking kaibigang si Dr. Lourdes “Odette” Portus. It is really my privilege to be talking to you today on a very important topic and I am very happy that we have young people here with us. Sila talaga yung kailangang makarinig din nito.

My talk will be about, “Adolescent Health and Responsible Parenthood: Shaping Policies for Child Protection and Well-being.”

I would like to talk about POPCOM, now CPD, just to introduce my agency to you because we are working with other agencies and other stakeholders as regards population issues and social issues with economic issues add to the x environments. I will talk about demographic trends, child marriage, adolescent pregnancy, some protective factors and risk factors, existing policies, programs, and interventions, and you can see there the wealth of information and possible research and research gaps that we need to work on together.  So, I am very happy about the launch of PCRN. 

So, what is the POPCOM, now CPD, Commission of Population Development? We were created in 1969 through an executive order by President Ferdinand Marcos Sr. During that time, in the 70s, all countries were experiencing population growth. So, at that time, actually, the time of my mother, on average, the number of children of women was six, so an average of six children to a woman through her reproductive life. You will see later that this has come down, it is now 1.9, from 6.0 to 1.9. So the population issues now are different. 

The Executive Order 171 actually just created a group, if you know Dr. Mercedes Conception, she headed the Commission on Population then, and the instruction of the president was, “Commission, you look into population issues, especially in our population growth, and how we will be able to address the consequences of population growth” 

Then in 1971, Republic Act 6365 was enacted. And this is where the actual responsibilities of POPCOM were listed. This became the Population act of the Philippines. It has not been amended. So, my office is now looking at a new population development act, given that the population issues now are different. 

Further, the president again issued the Presidential Decree 1979, this is where POPCOM became what we call, “Commission of Population”. And in 2018–so when POPCOM was created, it was first under the office of the President, and then it went to  the Department of Health, then it went to the Department of Social Work and Development, back to the office of the President, to NEDA—National Economic and Development Authority, then back to the Department of Health, and we were with the Department of Health before 2018. In 2018, President Duterte issued Executive Order 721, wherein POPCOM was renamed to “Commission on Development”. So, the ‘development’ was attached to POPCOM, emphasising that population issues affect the country’s development. 

See, it was not just about managing population, but it is really looking at all population issues that could enhance development development, and of course, Mr. Xavier mentioned demographic dividend earlier, and this is really the battlecry of my office—we should be doing policies, programs so that the Philippines experiences demographic dividend, which is really socio-economic development, socio-economic progress that a country experiences because of the change in population structure, specifically more working age population. Of course, there are other requirements there such as having a more working age population, but the quality of working age must also be addressed.

And, just this year, RA 12145 created the Department of Economy, Planning and Development (DEPDev). So, this was NEDA before, now it is DEPDev. And, there’s a section there where CPD, Commission on Population and Development is listed as among the attached agencies of DEPDev. So, we’re hoping na hindi na kami pupunta sa kung saan-saan pa, and we remain with DEPDev. 

So, the vision of the Commission on Population and Development is that we will be the lead—we are the lead agency in advancing the country’s population and development policies and programs towards increased share and opportunity for each Filipino in socio-economic progress. And, our mission is to strengthen institutional capacities to formulate, coordinate, and  implement integrated population and development strategies, policies, and programs based on socio-economic and demographic data, information, and knowledge. 

Our country does not say to women and couples, “you have only this number of children,” –we do not have a one-child policy, we do not have a two-child policy, we do not have a three-child policy. Our population policy is that of human rights, “women, couples have the right to choose their number of children and how they will space these children. And no interference to the decision-making of the couples” But, the role of all government agencies, but especially the Commission on Population and Development is to provide information for couples, women, to make decisions, and to provide services and assistance for them to actualise their fertility intention. 

So, I would like to say that because now there is a question, and you will see, we are still a growing population, but the growth is slowing down. And soon, we will be considered an aging population. So, what does that mean? We have to start planning. Family planning is not about having less children, family planning is about teaching couples, women, how to decide on their family, specifically the number of children. 

So, we had the Philippine Population and Development Plan of Action (PPD-POA) 2023-2028, which is anchored on the Philippine Development Plan, but focused on population issues for the PDP to be actualised. 

I would like to thank Dr. Lourdes Portus and Mr. Wilson Villones—PSSC for helping us write this development plan. And the President has already approved this through a Memorandum Circular. 

So, what is our population’s situation? If we look at this graph, you first have the common graph, you have our population count. So, in 1948, there were just 19.2 million of us. Then in 1970, this was when the president or Congress did the Republic Act, which is our Population Act, there were 36.7 million of us, so you can see that we still are a growing population, and we are now, based on the 2024 census—were you, na-census ba kayo? Yes noh, kasi census, lahat counted, but of course, actually, the census has limitations. There are some areas in the country that are not included in the count, pero konti lang naman ‘yon. So, there are already 112.7 of us under 13 million. We are still a growing population. 

However, our growth is slowing down. So, take a look at the line graph. The line graph shows our population growth, annually, so, it is an estimate based on the census. So, during the time of president Marcos, the population growth rate was 2.9 percent annually. It increased to 3 percent, then slowly, it slowed down. You have a deep decrease from 1.6 percent annually to 0.8 annually. So, that is the situation of our population. Now, it is different when POPCOM was created, the time we were growing fast, approximately 3 percent. 

And this is our famous population pyramid. So, the population age, sex—population pyramid, I am showing you only 2015 and 2020 because the Philippine Statistics Authority has not yet released the age-sex pyramid for 2024. And as you will see here, we divided the different population groups into three, the middle one is our working age population, 15-64 years old, that is the statistical definition of working age based on international standards, led by the international labour organisation. So, you will see that in 2015 the share of the working age population was 63%, in 2022, it grew to 64%. And for the young population, 0-14, from 32% share of the population, to 31. And by percentage, our older persons, 5%–if you express the growth in whole numbers, it is still 5%, but you can see that the growth, from 4.8 million to 5.9 million, from 2015-2020; 101 million in 2015, 109 million in 2020. And the household size in 2015 was 4.4, in 2020 it is 4.1. So, it is consistent with the slowing population; growth, the number of the household size.

This is the total fertility rate. How do you read the total fertility rate? This is the average number of children of a woman in her reproductive age. So, this is what I told you before during my mother’s time, 6.0 children to a woman. And, in 2022 from the National Demographic and Health survey, it became 1.9 children to a woman. 

Now, please, statistics provides decimal places, and you will think, “Bakit nag decimal ‘yan, eh tao yung pinag-uusapan natin” So, how do you read this? I suggest you read it this way, if you have 10 women in the 70s, in  ‘73 specifically, you invite those women to a congress, and you tell them to bring all your children with you. So, ten women, six children each, how many children would that be? Sixty children. PSSD will provide for 70 people; accommodation and needs, transportation. In 2022, if you invite 10 women, you tell them to bring all your children, how many children will you have? 1.9 per woman; 10 women, 19. So, 10 women will have 19 children. You will have to prepare for 29. Look at the difference, 70 to 29. That is the implication of the growth rate, which is going down. You can have more resources–the government can provide for more resources because they have less people to prepare for. That’s simplistic, but that’s how we can interpret the total fertility rate.

There is what we call replacement rate. So, we do not say, “you should have this number of children”—no, but we talk about what we call replacement rate. This is like how many people you should have in your population to replace a couple. So, dalawa kayo, ilan dapat yung anak para ma-replace? So, actually your replacement rate is 2.1. Therefore, in the Philippines in 2022, our total fertility rate is already below replacement rate. 

And I believe this was also presented or mentioned by Mr. Xavier earlier. Our Philippine population is projected to transition to an aging society. Malapit na, in 5 years, in 2030. But, what is the definition of aging? 

So, we’re using the UN definition, which is if you have a population wherein the share of population of 65 and above is 7% and above, that’s already aging. So, the share would be more than 7%. I think it will be 7% in 2030. And so, we will soon really have the situation—please, look at the blue line. We are going to have more working age people, 15-64, we will have more older people, the orange line, 65 and over, and the projection is we will just standardise on the number of young 0-14. And this is called demographic opportunity, meaning we are moving towards this population structure, where you have an opportunity for more people to take care of the dependence; the dependence of the young and the older people.

But, let me say it now, that is not enough for us to really beat the demographic dividend, meaning more economic progress because of the changing structure of the population, our working age should be of good health, good education, and skills. So, the discussion earlier of Mr. Xavier on health is a big issue because how can you have a productive working age if they were stunted as children? If they were part of the wasting group, when they were children? How can you have a productive working age if the boys do not finish school? They are not in school? And if I may share with you, if you look at statistics, our men are in elementary occupations. These are minimum wage, even less than minimum wage. Our women are in the service sector. So, this is our situation; the boys are very important. We talk about women and girls, but we should not forget boys.

So, but, we still have other challenges. Uneven distribution of population across regions, higher unplanned fertility among women and girls with less education, lower income in rural areas. We still have stunting, and under five infant mortality rates remain the same, they have not grown, they remain the same.

Students’ performance in PISA, we have lower quality of education compared to other countries, and I will be talking about adolescent pregnancy among 10-14. Adolescent pregnancy among 15-19 is going down, but 10-14 is increasing—imagine, these are children, we have not been thinking about reproductive health education really for these 14 and below. We were more on the older adolescent.

So, this is now about child marriages. We already have the law prohibiting child marriages, it is a criminal offense to facilitate child marriage. And marriage here is not just legal, but cohabitation as well. So, even cohabitation, facilitating cohabitation of children, and children are defined as 18 and below. Okay, so, it is very important for us to define what is a child, what is an adolescent, what is youth. 

So just to give a clear definition of the Philippines uses—this is how the Philippines Statistics Authority produces its statistics where the definition of a child is based, the definition of youth, child are all based on our laws, and adolescence is 10 to 19, and this is based on statistical standards.

So, as you can see, please, we have been having less child marriages as registered in PSA, from 2021-2023 and this, I believe, is because of the law. However, they still exist. Child marriages still exist. 233 girls were registered as married by PSA in 2023, 71 boys. And the percentage of registered marriages involving a child by age of partner, males of below 18 had women partners under 15-17 and 18 and over. And, most of the partners of males below 18 are 15-17. This is something that is worrying, the case of females. Females aged 18, most of them had partners 18 and over, 73.6%. And the most number of child marriages in 2023 are in BARMM, region XII, region IX, region X, and region XI, and these are all in Mindanao—plus MIMAROPA. So, these are Muslim and indigenous peoples. 

Among adolescents in 2023, adolescent pregnancies in 2023, one of ten registered live births in the Philippines were born to mothers aged 10-19. And among adolescent births, 2% were born to mothers aged below 14. So, the prevalence of adolescent pregnancy is not that high, it is just 10%. Actually, about 9.8%, not yet a high prevalence rate. But my office is not talking about prevalence rate, we are talking about trends. So, the prevalence is still not of concern, but the trend is of concern. And the trend of concern is those under 15, it has been increasing to the years–older adolescents going down.

It is not a first time birth, repeat pregnancy, 83.6% of births among adolescents 19 years old and below were first time. However, you have 23,267 births to adolescent mothers that were repeat pregnancies, and 4,220 of them were minors. So, some of them even had fifth children already. And this is the issue because we still have a restraining order to provide family planning services to minors without consent of parents. So, the issue is they have had children already–so, they keep on having children because they do not have access to services by themselves. 

So, if you look at this left pie, what is the age gap between fathers and adolescent mothers? If you look,   20.6% of partners of adolescent mothers are 6-10 years older, the orange one, 8.6% are 11-20 years older. And, you have this neon yellow, you have 1.12% father more than 20 years older than the adolescent mothers. And these are, in the civil registration and vital statistics system, that means recorded. We are not even able to capture those that did not register with a civil registration vital statistics system. So, why are we concerned again about adolescent pregnancy? Women and girls in the country continue to die from preventable causes related to pregnancy and child birth. So, maternal mortality is still a problem.

What are the causes of adolescent pregnancy? This is a conceptual framework, possible causes are institutional factors, where you have environmental, educational school factors, socio-cultural factors, but you have family factors; parental skills and guidance, interpersonal relationships within the family, attitude and norms and behaviours related to sexuality, and sexual attitude and behaviours of family; then you have peer factors, peer values, exposure to sexually explicit content, group dynamics, peer support system, engagement and risky activities, and; risky behaviour includes alcohol and drugs.

Media factors; accessibility to social media without supervision, and individual factors; intentional sexual activities, individual demographic factors; sexual abuse, coupled with unprotected sexual activities and so, this resulted in adolescents. So, that is conceptual. So, we need to have studies, research to test this conceptual framework. 

And, the northern Bukidnon State University, where you have the highest prevalence of adolescent pregnancy. Northern Mindanao did a study of correlates of adolescent pregnancy. What are the correlates; they reside in urban areas, they do not have access to productive health educational services, they are out of school, they are in early relationships–cohabitation, they come from low income families. And, this was also mentioned by Mr. Xavier, the local longitudinal study of the Filipino child, which is done office of population studies, university of San Carlos, being supported the UNFA, DEPDev, UNICEF and so, this is a–longitudinal–, in 2016, they chose 5,000 ten-year olds, and they monitored them through the years, even during the COVID years. And so, what happened, what were the results? So, protective family and housing factors during childhood, which provide or promote their being on track in school, they have fewer absences, they have higher grades at age 16, they are in the higher wealth index, so higher—better socio-economic status, they are 4Ps beneficiary for those poorer families, mother is at least a household graduate, mother believes child can achieve college education, and less violence at home as witnessed by a child. So, you do that flip, those that will have risk are those opposite of this. And, the risk factor of children at age 11 associated with ever having sex at 16 being male, being poor, being off-track in schooling, having less educated mothers not reaching high school, ever had a boy/girlfriend, have ever chatted with strangers online, have witnessed violence at home. These are the children at risk to have started sex by age 16. Girls are at risk of getting pregnant at 16 less likely if they are in school and they’re close to their mothers. More likely to get pregnant at 16 if already in union, smoking, consuming alcoholic drinks, watching pornographic videos and having friends who ever had sex. 

Do you see a pattern now? Less education, poorer, but the 4Ps intervention for the poor family seems to be working, but mothers keep repeating–they are always there. That is why, our concern in my office is children left behind by OFW mothers. Their  mothers are not with them so they are at risk.

So, actually, I requested the University of San Carlos, “Could you please produce data on OFW families where the OFW is a mother and let’s see how it is.” 

This got my attention. This was called by the University of San Carlos as edad de peligro. These are the ages at which the children are at risk of leaving school. So, these are the edad de peligro for girls and boys. Males tend to drop out after grade 6, then grade 9, then grade 10 because they are not interested in school and the family has financial difficulties. Females tend to drop out also at grade 6, grade 10–a year later on the boys, because they are already in union, grade 11, those are financial difficulties, possibly again, due to being pregnant. 

So, these are our problems. Yes, we will have a more working age population, but if we were not able to experience grabbing opportunities of better education, better health, they will have to work harder. May I share with you that I also try to ask about stories about adolescent pregnancies, marami din naman nagiging adolescent mothers sa mga mas middle class and richer. So, nangyayari din ‘yan, but because the family can still afford to bring the child to school and take care of their grandchildren, the girls still are able to have all the opportunities that those who are not yet mothers have. Kaya, the poorer sector, the mothers of lower education attainment, these are where the government has to have intervention. And you know, when the adolescent pregnancy prevention bill died last year, we will still continue to do interventions for our girls to lessen the risk of adolescent pregnancy, but that bill would have provided a budget for those at risk; the poorer girls, the ones that are usually in poverty. So, that really died, so other legislators have now refiled the bill and we hope that it will really be approved. 

So, we actually have a lot of laws that protect our women and girls, they are all there. We have the Magna Carta of Women, and we are very proud of this as a country. You don’t have this—I don’t think other Asian countries have this. And, already, there is section 32, protection of girl children.

Republic Act of 19262, Anti-Violence against Women and Children Act—VAWC, you also have an act prohibiting, I mentioned this, child marriage. Promoting protection against rape, so this is increasing the age of consent. And you have this one, responsible parenthood reproductive health act, this is where I mentioned the restraining order, preventing minors to access services and commodities without consent of the parent. 

And we have an executive order 141, we do not have a law, but we have an EO, which addresses the root causes of the rising number of teenage pregnancy. It is a priority as a nation and mobilising government agencies.

Thank you very much for your time.