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It is one thing to believe and practice our faith, it is another thing to really go down to the ground and see how our faith can be translated into use for people who are asking for help.
Pastor Pax Tan Chiow Lian, Prison Drugs and AIDS, Malaysian Care

Will Philippine Women Continue to Die During Childbirth?

 

Every year almost 500,000 lives are lost around the world due to maternity-related causes, 99% of these deaths occur in developing countries1 and almost all of them are preventable. In the Philippines, more than 10 mothers die everyday leaving more than 30 children motherless. In effort to reduce this burden, Target 6 of MDG 5 envisions the reduction of maternal mortality ratio (MMR) by 75% between 1990 and 2015 while also including universal access to reproductive health services. This target was in line in the program of action of the ICPD (International Conference on Population and Development) with President Gloria Macapagal-Arroyo, along with other world leaders, reaffirming this commitment at the 2005 World Summit in New York.2

As MMR in the Philippines was 209 in the early 90s, the target MMR for 2015 has been set at 52. In 1998 MMR fell from 209 to 172 but seems to have plateaued thereafter stagnating at 162 in 2006.3 At this pace of reduction, by 2015 MMR will have only declined to 140 and the target of 52 will be unachievable.

 

Reduction in MMR, while a multifaceted and difficult goal, has been successfully achieved in several countries (Thailand, Malaysia and Sri Lanka). In most developing countries, the causes of maternal mortality are similar. Direct causes such as hemorrhage, hypertensive disorders of pregnancy, unsafe abortion, obstructed labor, etc. constitute the majority of obstetric complications resulting in fatalities. In the Philippines, while 40% of maternal deaths are unclassified, it is clear that hypertension (27%), hemorrhage (18%) and unsafe abortion (11%) are the three major causes of maternal mortality.5 All of these problems are preventable and can be addressed through adequate medical care such as the presence of skilled birth attendants, emergency obstetric care (EmOC), when necessary, and access to family planning services.

In the Philippines, almost 4,600 women die giving birth each year.4“No woman should die giving life” – Thoraya Ahmed Obaid,UNFPA Executive Director As a measure to accelerate efforts on MMR reduction, the government has adopted Women’s Health and Safe Motherhood as its flagship program under the sector-wide Fourmula One (F1)6 with the help of other stakeholders such as the World Bank, ADB, EU/GTZ, JICA, USAID, WHO, UNICEF and UNFPA. In order to address maternal and newborn mortality, it has been agreed that a 3- pronged strategy be adopted, namely: skilled attendants at birth; EmOC referral system(Basic EmOC and Comprehensive EmOC); and reproductive health/FP services (informed choices). Advocacy, community involvement, male participation, and empowerment of women play a major role.

High MMR disparities between the rich and poor are reflected through important indicators such as the presence of skilled professionals at birth, availability of caesarian section (comprehensive EmOC), increased contraceptive prevalence rate, and teenage pregnancy. The poor marry earlier, have more children and less access to RH leading them further into poverty. 

Comparison of RH Indicators by Wealth Index

Wealth Index
Quintile

Percentage of delivery
by Skilled Health
Professionals 7

Caesarian
Section
Rate8

Total
Fertility
Rate9

Unmet Need for
Family
planning10

Age specific
Fertility Rate
(15-19)11

Rich

92

20

2

13

5

Poor

25

2

6

20

9

Poverty, remote location and lack of education exaggerate the three delays associated with saving a woman’s life: the decision when to seek care (knowledge on danger signs, empowered decision making), reaching the health/EmOC facility (expenses especially for communication/transportation, clinic or hospital services are a concern), and receiving appropriate care in the facility (availability of gender and culture-sensitive doctors/health staff, adequate drugs, supplies, blood and equipment, etc.). Six out of ten births in the Philippines take place at home making it crucial to follow a woman from prenatal to postnatal stage. In Autonomous Region of Muslim Mindanao (ARMM), nine out of ten births take place at home and together with Caraga and other Mindanao regions, MMR is twice as high than the national average.12 However, it has been globally proven that Traditional Birth Attendants (hilots) alone do not contribute to reduction of maternal mortality13. It is thus critical that trained health professionals are given necessary competencies in home delivery including neonatal care until an adequate number of institutions/ birthing clinics are developed to care for poor mothers in rural and hard to reach areas. Instituting one midwife per barangay would be a positive development, however this may not be attainable in the near future. Hence alternate strategies of tapping existing health professionals could be considered as an initial step.

The MDGs, particularly the eradication of poverty and hunger, cannot be achieved if questions of population and reproductive health are not squarely addressed. And that means stronger efforts to promote women’s rights, and greater investment in education and health, including reproductive health and family planning.” --Former UN Secretary General Kofi Annan

As a new paradigm, each pregnancy should be considered at risk and with large numbers of trained health professionals leaving the country, the problem of availability of doctors, nurses and midwives who provide emergency obstetric and newborn care is becoming critical. It is estimated that in 2006 alone, more than 171 medical doctors, 13,977 nurses, 385 midwives and 14,412 caregivers left for overseas work. 14

Couples have the right to information and access to the right contraceptive method at the right time and at the right place. Furthermore, it is estimated that there are 3.1 million pregnancies in the Philippines every year, half of which are unplanned, with one third ending in abortions.15 UNFPA does not support abortion being used as a family planning method. Rather, UNFPA promotes planned families. It has been realized that through appropriate family planning, MMR could fall by almost 30%. In the Philippines, four babies are born every minute, exerting pressure on the country’s resources to support these children and plan for their future. None of the MDGs can be achieved if we do not address the issues of population squarely.

References:

1 Maternal Mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA, and the World Bank, 2005
2 Resolution Adopted by the General Assembly: 60/1., 2005 World Summit Outcome, 2005. New York
3 2006 Family Planning Survey. National Statistics Office, Manila.
4 Maternal Mortality in 2005: Estimates developed by WHO, UNICEF, UNFPA, and the World Bank, 2005
5 2003 Philippine Health Statistics. Department of Health, Manila.
6 Administrative Order 2007-0038 Department of Health, Manila
7 Ibid.
8 2003 National Demographic Health Survey. National Statistics Office, Manila.
9 Ibid.
10 2006 Family Planning Survey. National Statistics Office, Manila.
11 Ibid.
12 2006 Field Health Services Information System Annual Report. National Epidemiology Center, Department of Health, Manila.
13 Maternal Mortality Update 2004: Delivering into good hands, UNFPA and University of Aberdeen, New York 2004
14 http://www.poea.gov.ph/stats/skills/skill_sex/rptperskill. OFW Deployment per Skill and Country 2006.
15 Singh, S., et.al., Unintended Pregnancy and Induced Abortion in the Philippines: Causes and Consequences, New York: Guttmacher Institute, 2006.