Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines

Abstract

Background: Health-related within-country inequalities continue to be a matter of great interest and concern to both policy makers and researchers. This study aims to assess the level and the distribution of child mortality outcomes in the Philippines across geographical and socioeconomic indicators.

Methodology: Data on 159,130 children ever borne were analysed from five waves of the Philippine Demographic and Health Survey. Direct estimation was used to construct under-five and neonatal mortality rates for the period 1980-2013. Rate differences and ratios, and where possible, slope and relative indices of inequality were calculated to measure disparities on absolute and relative scales. Stratification was undertaken by levels of rural/urban location, island groups and household wealth.

Findings: National under-five and neonatal mortality rates have shown considerable albeit differential reductions since 1980. Recently released data suggests that neonatal mortality has declined following a period of stagnation. Declines in under-five mortality have been accompanied by decreases in wealth and geography-related absolute inequalities. However, relative inequalities for the same markers have remained stable over time. For neonates, mixed evidence suggests that absolute and relative inequalities have remained stable or may have risen.

Conclusion: In addition to continued reductions in under-five mortality, new data suggests that the Philippines have achieved success in addressing the commonly observed stagnated trend in neonatal mortality. This success has been driven by economic improvement since 2006 as well as efforts to implement a nationwide universal health care campaign. Yet, such patterns, nonetheless, accorded with persistent inequalities, particularly on a relative scale. A continued focus on addressing universal coverage, the influence of decentralisation and armed conflict, and issues along the continuum of care is advocated.

Fig 1. Under-five and neonatal mortality rates (per 1,000 live births) at the national level with and without the 2013 DHS wave.

Notes: National estimates using pooled data are displayed with and without including DHS 2013. Loess regression using a smoothing parameter of 0.5 was applied to produce the continuous series.[53] The last set of parameter estimates for the Loess regression were utilised to project mortality rates toward 2015. The solid and semi-broken lines represent the continuous mortality estimates calculated from the two-year estimates, while the shaded area and area bars signify 95% confidence intervals. DHS, Demographic Health Survey; CI, confidence intervals

Fig 2. Trends in relative and absolute inequalities in mortality by island groups, with 95% confidence intervals, 1980–2013.

Notes: See Table B in S1 File for full results. Base group is Luzon.