- Details
- Category: Region IV-A Profile
The region known by the acronym CaLaBaRZon (Region IV-A) is one of 17 regions in the Philippines and is in the southwestern part of the island of Luzon. It consists of 5 provinces, namely Cavite, Laguna, Batangas, Rizal and Quezon, covering 18 cities, 124 municipalities and 3,985 barangays (excluding barangays of the cities). It has a total land area of 16,560 square kilometers and was the region with the highest population in the country as of 2015. The region is marked by rapid urbanization due to the influx and growth of major industrial and economic opportunities, and it is now recognized as the industrial hub of the country.
The population of CALABARZON in 2015 reached 14.4 million, which was greater than the population of the National Capital Region (NCR) by 1.53 million. With an annual growth rate of 2.58% between 2010 and 2015, the region’s population is expected to double by 2042, a rate much faster than that of the Philippines and NCR. Its population density of 888 persons per square kilometer is much lower than NCR’s 20,247 persons per square kilometer, indicating its potential for urban expansion. The rapid population movement is most evident towards the highly urbanizing and industrializing areas, particularly in Cavite, Laguna and Rizal (NEDA, 2017).
From 2010 to 2015, the average contribution of CALABARZON to the Philippine economy stood at 16 percent, second only to NCR with 38 percent. The region’s per capita gross regional domestic product (GRDP) has grown at an annual average of 3.17 percent since 2011. In 2015, the region’s per capita GRDP was PHP 92,285 -- higher than the Philippine per capita of PHP 74,770. CALABARZON had the second highest per capita GRDP and the increasing growth of the per capita GRDP reflects the sustained economic performance of the region.
CALABARZON continues to attract investors because of its strategic location, huge population size, manufacturing hubs, and abundant agricultural produce, as well as the presence of top universities and international research institutions. It is drawing in new residents to new township developments with good schools and modern medical facilities. The region is also home to the largest number of Filipinos working overseas, whose remittances contribute to the local economy.
MALNUTRITION IN CALABARZON REGION
Despite the rapid development and good economic performance of CALABARZON, the incidence of malnutrition in the region has raised concerns. The data from the National Nutrition Updating Survey of 2015 show that the prevalence of stunting among children under five years old increased from 25.2 percent in 2013 to 27.7 percent in 2015. Stunting is the impaired growth and development that children experience as a result of poor nutrition, repeated infection, and inadequate psychosocial stimulation (WHO, 2018). Children are considered stunted if their height-for-age is more than two standard deviations below the WHO Child Growth Standards median.
Among the provinces in the region, Cavite, Laguna and Rizal recorded increasing prevalence of stunting among under-five children. Comparing the years 2013 and 2015, Rizal showed the highest increase, from 21.4 percent in 2013 to 29.7 percent in 2015; Laguna, from 22.4 percent to 27.7 percent; Cavite, from 23.0 percent to 27.0 percent. Although there was a decrease in Quezon, the province still had the highest prevalence of stunting in the region at 33.9 percent (Figure 3).
The large numbers of stunted and wasted children in CALABARZON have been cause of concern for its regional authorities.
Even though the prevalence of wasting among children under five declined from 8.8 percent in 2013 to 7.6 percent in 2015, the prevalence of wasting in CALABARZON was still higher than the national estimate of 7.1 percent (Figure 3). Wasting or thinness indicates in most cases a recent and severe process of weight loss, which is often associated with acute starvation and/or severe disease (WHO, 2018). However, wasting may also be the result of a chronic unfavorable condition. The prevalence of wasting increased in Cavite from 6.3 percent to 6.9 percent, and in Quezon from 7.5 percent to 7.7 percent. Some improvement was seen in Laguna with a decrease from 12.7 percent in 2013 to 7.7 percent in 2015. Although Rizal had a decrease in wasting prevalence between 2013 and 2015, the province still had the highest prevalence rate in CALABARZON at 9.0 percent.
Overweight and obesity among children under 5 years 
old is less of a problem now, decreasing from 6.7 percent in 2013 to 5.0 percent in 2015. However, overweight and obesity have become a serious health concern among adults. As seen in Figure 4, prevalence rates of overweight and obesity among adults are 25.8 percent and 8.4 percent, respectively. Among all the provinces in CALABARZON, Rizal has the highest prevalence of both obesity and overweight.
The prevalence of nutritionally at-risk pregnant women in the region is 26.6 percent and is higher than the national prevalence of 24.8 percent. Vitamin A deficiency was found among 14.6 percent of children 6 months to 5 years old (NNS 2015) which is under moderate public health significance. Iodine deficiency disorders among 8.1 percent of 6-12 year-old children and 33.8 percent of lactating women continue to be of public concern.
CAUSES OF MALNUTRITION IN CALABARZON
The causes of the various manifestations of undernutrition (stunting, wasting, underweight), overnutrition (overweight/obesity) and micronutrient deficiencies can be more easily understood by looking at the ASEAN Conceptual Framework on Malnutrition (Figure 5). The framework identifies poor dietary intake, disease, and physical inactivity as immediate causes. The underlying causes at household level point to insufficient access to healthy foods, sedentary lifestyle, inadequate care and feeding practices, inadequate health systems, poor water and sanitation. Basic causes at the societal level pertain to factors such as access to resources, income, economic activity, political stability, climate change, and governance, among others.
The First One Thousand Days
In analyzing the immediate and underlying causes of stunting and other forms of malnutrition, it is important to look at dietary intake and diseases, as well as care and feeding practices, in the first 1000 days i.e., for the period starting with pregnancy to the first two years of life.
In a detailed analysis of these factors, it became clear that adequate antenatal care, safe deliveries, exclusive breastfeeding for infants 0-5 months, and complementary feeding for infants 6-23 months old are critical to prevention and reduction of stunting and other forms of malnutrition in the region. However, data revealed that provision of these services in the region were uniformly and grossly deficient relative to the standards set by the Department of Health. Table 1 shows the data from Field Health Service Information System (FHSIS) and National Nutrition Survey (NNS) on the coverage of such services relative to the standards of DOH for the F1K (First One Thousand Days ) program.
Up until this year, there is a very low proportion (37.21 percent) of pregnant women who are given complete iron with folic acid supplements. Iron with folic acid plays a significant role in pregnancy because it prevents maternal anemia, low birth weight and preterm birth (WHO, 2018).
The prevalence of low birth weight of 11.9 percent in the region is still higher than the national prevalence of 11.5 percent. Infants with low birth weight have higher risks of stunting and mortality. This is illustrated in Figure 6 which shows that in 2015, stunting among children 0-5 months was at 12.7 percent, increasing to 17.3 percent for those 6-11 months, abruptly rising to 36.2 percent at the end of the first year, on to 38.4 percent in the second year and maintained at such level at 2-4 years of age. Stunting at age 2 is irreversible.
The data on stunting indicates sub-optimal quality of infant and young child (IYCF) practices in the region. The 
National Nutrition Survey (NNS) 2015 reported that only 32.4 percent of children aged 0-5 months were exclusively breastfed. While regional data for exclusively breastfed infants aged 5 months are not available, the mean duration of exclusive breastfeeding in the region (4 months) indicates sub-optimal exclusive breastfeeding practices. In addition, only 18.6 percent of children aged 6-23 months in the region received the Minimum Acceptable Diet[1] (MAD). Dietary diversity thus becomes an even bigger concern for CALABARZON
[1] Proportion of children 6-23 months meeting both the minimum dietary diversity (foods from at least 4 food groups) and the minimum meal frequency (energy intake from foods other than breastmilk)
As evidenced in global studies, the low level of compliance to antenatal service standards, together with the lack of adequate dietary intake by pregnant women, particularly those who are nutritionally-at-risk, and the low rate of exclusive breastfeeding can explain stunting within the first five months, while poor dietary intake among children 6 to 23 months old may explain the spike in the stunting levels at the end of the First 1000 Days.
Unless the major gaps in the compliance of the standards of F1K are addressed immediately, the regional outcomes in stunting and other outcomes will prove elusive at the end of the PPAN period 2022.
Adolescent Pregnancy
The health and nutrition situation of adolescents is closely related with the health and nutrition of mothers. In the Philippines, the gap between adolescence and motherhood is narrowing due to the increasing incidence of teenage pregnancy. The Young Adult Fertility and Sexuality Study (YAFS) 4 indicated that teenage pregnancy rose dramatically in the last 15 years, doubling from 6.3 percent in 2002 to 13.6 percent in 2013. In 2013, 1.0 percent of the 15-19 year-olds were already mothers while 2.6 percent were pregnant with their first child. Meanwhile, CALABARZON has an 8.0 percent prevalence of teenage childbearing, and is among the regions with lowest teenage pregnancy prevalence.
Adolescence and pregnancy are two physiological states with high nutritional requirements for growth and development. Thus, the occurrence of both states in an individual (e.g. pregnant and adolescent) increases the risk of undernutrition and low birth weight. According to NNS 2015, one out of 4 pregnant Filipino women (24.5 percent) was nutritionally at risk of delivering low birth weight babies and developing other pregnancy complications. This condition was more pronounced among teenage pregnant women (37.4 percent) than their adult counterparts (22.6 percent).
Adolescents do not usually avail of prenatal care and their pregnancy is kept secret until it becomes obvious. Very few health centers in the region have been part of the movement towards adolescent-friendly health services. A lower proportion of teenage pregnant women go for their first prenatal care (39.2 percent) and take micronutrient supplements (21.5 percent) compared to their adult counterparts (NNS, 2015).
Food Security
Food insecurity underlies much of the manifestations of malnutrition. People are considered food secure when they have adequate access at all times to sufficient, safe, nutritious food to maintain a healthy and active life (WFP, 2018). Food security remains a major concern affecting Filipino households.
In CALABARZON, 44.4 percent of households consider themselves as food secure (compared to 39.9 percent for the Philippines) while 19 percent consider themselves as severely food insecure (against 21.9 percent for the Philippines). Among the provinces in the region, Laguna has the highest percentage of food secure households while Quezon has the highest percentage of severely food insecure households (Figure 7). Food security analysts look at the combination of food availability, food access, and food utilization in determining food security of households.
Lack of access to health and nutrition services
The Regional Development Plan (Chap 10 RDP) cited the increasing infant, under 5 years old, and maternal mortality rates despite the increasing proportion of births delivered in health facilities and attended by health professionals.
Maternal mortality rate in the region surged from 39 per 100,000 live births in 2012 to 76 in 2015. The RDP attributed the increase in maternal deaths to factors such as inaccessible locations of birthing homes especially in the rural areas, limited number of midwives and other health professionals, and pregnancy complications. The report indicated that the target on decreasing infant mortality rate was not attained due to insufficient postnatal care such as new born screening and immunization, inadequate child spacing, insufficient child care and knowledge on breast feeding.
Indigenous Peoples. Malnutrition is widely prevalent in the region but there are groups that are more affected than others. Indigenous peoples (IPs) communities such as the Badjao, Aeta, Remontado, and Dumagat show even slightly worse prevalence of stunting, wasting, and anemia (Figure 10). As they are mostly residing in geographically isolated and disadvantaged areas (GIDAs) in the region, they have difficulty accessing basic services such as health and livelihood services.
