race to save the lives of filipino mothers by pia rufino

7/31/2019 Race to Save the Lives of Filipino Mothers by Pia Rufino

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CONTENTS NATION WORLD BUSINESS

NATION

The Last Two Minutes for ReducingMaternal Mortality

Despite its progress to date, the Philippines wants to

redouble its efforts to reduce maternal mortality in line

with the United Nations' Millennium Development Goal

Globally, the number of women dying inpregnancy and childbirth has fallen by47% in two decades, according to the most

recentWorld Health Organization (WHO),

United Nations Children's Fund (UNICEF),

United Nations Population Fund (UNFPA)

and the World Bank estimates. The reportTrends in maternal mortality: 1990 to

2010 released in May said the number of

maternal deaths in the world decreased from

543,000 in 1990 to 287,000 in 2010.

Based on the study that presents the

global, regional and country estimates of

maternal death, the maternal mortality ratio

(MMR), or the number of maternal deathper 100,000 live births, in the Philippines

dropped from 170 in 1990 to 99 in 2010--

a decrease of 43% over 20 years. In 2010,

2,300 maternal deaths occurred in the

country. (p. 35)

According to the report, several factors

may have contributed to the global decline,

such as: improvement in health systems

and coverage in health-care interventions,

STRATEGY POINTS

Depending on the source, the local maternalmortality ratio may have dropped anywhere

from 22.48% in 16 years to 43% in 20 years

Local maternal mortality continues on adownward trend, but a lot more progresswill be needed to achieve the United Nations'Millennium Development Goal 5 target of a

75% reduction in maternal mortality ratioby 2015

Even as the country's likelihood of achievingMillennium Development Goal 5 is regarded

as slim, the Department of Health hasassembled a public-private coalition todevelop health interventions in priority areas

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The last two minutes for reducing maternal mortality

increased physical accessibility to health

facilities, and factors outside the health

sector, e.g., increased female education,

according to the report. (p. 27)

However, despite substantial reductions

in maternal deaths (except in SouthernAfrica, where MMR increased by 19%

from 1990 to 2010), the joint UN report

said all regions are still very unlikely to

achieve the Millennium Development Goal

(MDG) target for improvement in maternal

health. (p. 22)

The Millennium Development Goals are

eight international development goals thatall 193 United Nations member states have

goal (MDG 5) is improving maternal health,

which calls for the reduction of maternal

deaths by 75% between 1990 and 2015, and

achieving universal access to reproductive

health care by 2015.

Comparing maternal mortality across

southeast Asia. Maternal mortality

across Southeastern Asia dropped by

63% in 20 years. Among southeast Asian

countries, Vietnam has already achieved

75% reduction in maternal deaths from

1990 to 2010, while Laos and Cambodia

both have registered 70% declines. To

achieve a 75% reduction in 20 years wouldrequire a compounded annual average

reduction rate of about 7.0%, while a 70%

reduction over the same period would

require a compounded annual average

reduction rate of about 6.0%.

Alongside the Philippines' MMR of 99

maternal deaths per 100,000 live births,

elsewhere in southeast Asia, the MMRs inBrunei, Malaysia, Singapore and Thailand

in 2010 are 24, 29, 3, and 48, respectively.

The Philippines, along with Myanmar

and Indonesia, are categorized as

making progress towards improving

maternal health, with average annual

declines in maternal deaths of between

2% and 5.5%, according to the report.

(See table next page)



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Country MMR % changein MMRbetween

1990 and2010

Averageannual %change

in MMRbetween1990 and

2010

Range ofuncertanity on

annual % change in

MMR

Progresstowards

improving

maternalhealth1990 1995 2000 2005 2010 Lower

estimateUpper

estimate

BruneiDarussalem

29 25 24 25 24 -16 -0.9 -1.6 -0.2

Cambodia 830 750 510 340 250 -70 -5.8 -7.1 -4.7 on track

Indonesia 600 420 340 270 220 -63 -4.9 -5.9 -4.0 makingprogress

Lao People'sDemocratic

Republic

1600 1200 870 650 470 -70 -5.9 -6.7 -5.1 on track

Malaysia 53 44 39 34 29 -45 -3.0 -8.1 2.2

Myanmar 520 380 300 230 200 -62 -4.8 -5.4 -4.2 makingprogress

Philippines 170 140 120 110 99 -43 -2.8 -3.1 -2.5 makingprogress

Singapore 6 6 15 9 3 -40 -2.5 -5.9 1.0

Thailand 54 54 66 54 48 -11 -0.6 -1.7 1.1

Vietnam 240 160 100 74 59 -76 -6.9 -12.0 -2.0 on track

MMR= no. of maternal deaths during a given time period per 100,000 live births during the same time period

TRENDS IN ESTIMATES OF MMR IN SOUTHEAST ASIAN COUNTRIES

BY 5-YEAR INTERVALS, 19902010

Source: TCRcompilation of data from Trends in maternal mortality: 1990 to 2010,WHO, UNICEF, UNFPA, and World Bank, May 6, 2012, p. 37-45

in 1990 are categorized as on track if

MMR has had 5.5% or more average annual

decline; making progress if MMR has

had 2% to 5.5% average annual decline;

less than 2% average annual decline; andno progress if MMR has had an average

annual increase. Countries with MMR


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Year MMR

(per 100,000 live births)

Source

1990 209 TWG on Maternal and Child Mortality (MCM),

National Statistical Coordination Board

1991 203 TWG MCM

1992 197 TWG MCM1993 191 TWG MCM

1994 186 TWG MCM

1991 180 TWG MCM

1993 209 National Demographic and Health Survey (NDHS), National

1998 172 NDHS

2000 163 Yabut and Yabut (2004 NCS)

2000 96 Civil Registry, NSO

2003 108 Civil Registry, NSO

death, and to have well-functioning

health information systems that combine

data from facilities, administrative sources

and surveys by 2015.

Chaired by the WHO, the commission

was created in 2011 to propose a

framework for global reporting, oversight

and accountability on women's and

children's health.

Philippines has inconsistent maternal

The 2012 joint UN

reportalso noted that maternal mortality

estimates are not necessarily the same as

WHO, UNICEF, UNFPA and World Bank

MMR estimate in 1990 170 maternal

deaths per 100,000 live births is the basis,

the Philippines should aim for the maternal

mortality ratio of 42.5 deaths per 100,000

live births by 2015.

maternal death in the Philippines provided

by the (NSO)

through its 2006 Family Planning Survey

shows that the MMR in the country declined

from 209 maternal deaths per 100,000

live births in 1990 to 162 in 2006-- 22.48%

decline in 16 years. So for NSO, the MMR

in 2015 should be 52.25. However, it

also said that the MDG target may not be

achievable and maternal health program

implementers need to redouble efforts to

achieve this target.

Figures of maternal deaths in the

country from 1990 to 2006 are compiled

in Indirect Estimates of MaternalMortality: Philippines in 2006, a 2007

paper by Benedicta Yabut of the NSO and

Faye Bautista of the Bangko Sentral. (See

table below)

Maternal deaths are obviously

underregistered, because of the rarity of

the event and the hardship in determining

if a death is related to or aggravated by apregnancy, according to the study.

MATERNAL DEATHS IN THE PHILIPPINES, 1990 TO 2006

Source: Indirect Estimates of Maternal Mortality: Philippines in 2006by Benedicta A. Yabut and Faye Y. Bautista




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The report further said that assessing the

Philippines' achievement in terms of MDG

goal 5 using data from Technical Working

Group on Maternal and Child Mortality

and from the National Demographic Health

Survey is misleading and tricky since the

two are not comparable.

The former considers

some assumptions; while

the latter, which costs the

government hundreds of

thousands of pesos, still is

not representative of the true

situation because the eventis so rare to be captured only

through a survey.

Meanwhile, a separate study

titled Maternal mortality for

181 Countries, 1980-2008:

A Systematic Analysis of

Progress towards Millennium

Development Goal 5. published in April2010 in The Lancet

leading and oldest general medical journals,

indicates that the country reduced its MMR

by 61% from 1980 to 1990, and by 81% from

1980 to 2008. (The study is available free of

charge, but registration is required.)

In the abstract of the study, the authors said

they constructed a database of observations

of maternal mortality for the countries from

vital registration data, censuses, surveys,

and verbal autopsy studies.

But these estimates are disputed by Junice

Demetrio Melgar and Alfredo Melgar of

, a

non-government organization dedicated

to the promotion of women's health and

quite far from reality. In a June 2010

letter to The Lancet, the Melgars said it

was unlikely the Philippines achieved a

record-setting decline in MMR amid all

the economic and political problems

during the 1980s.

Citing data from NSO, the

two argues that MMR has

declined only slightly over

the past 25 years. If Hogan

were accurate, the great

mystery is: how was it

Other indicators of maternal

health support a scenario of

little progress. For example,

the proportion of deliveries

by health professionals in

the Philippines has risen

very slowlya mere 17%

over 15 years (from 53%

to 62% from 1993 to 2008), the Melgarswrote in their letter.

DOH, doctors to review maternal

. Alarming discrepancies

measurement standards used by

government and private hospitals have led

Department of Health (DOH) Secretary

Enrique Ona and doctors in Northern

Luzon to

rate of maternal deaths, as reported in the

Philippine Daily Inquirer in May 2011.

According to the report, Ona addressed the

discrepancy after local hospitals and health

centers in Apayao included women who

died outside the province in its maternal

death records in 2010. A public health

to use a system that counts the health

The Melgars said

it was unlikely

the Philippines

achieved a record-

setting decline

in MMR amid all

the economic and

political problems

during the 1980s



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The UNFPA's three-pronged strategy to reducematernal mortality

According to the United Nations Population Fund (UNFPA), the following three-pronged strategy is the

key to the accomplishment of a 75%-reduction in the maternal mortality ratio between 1990 and 2015:

The international development agency

mortality have occurred in several

countries -- China, Cuba, Egypt, Jamaica,

Malaysia, Morocco, Sri Lanka, Thailandand Tunisia where more women have

gained access to family planning and

skilled birth attendance, while severe

shortages of trained health providers with

midwifery skills are holding back progress

in many countries.

UNICEF Chief of Health Dr. Peter

Salama also stressed the need to

scale up family planning servicesaccording to international policies and

laws and to support antenatal care and

Malaria and HIV programs to decrease

maternal mortality.

We also need to have skilled birth

attendants that can deliver emergency

obstetrics care or certainly be able to

refer women suffering from complications

to emergency obstetric care, he added.

For UNICEF Gender Specialist Noreen

Khan, it is important to educate women

to reduce their risk of death during

pregnancy. Khan said she has observed

that women in Southeast Asia are being

more educated thus making informed

decisions to have a traditional birth

attendant during child delivery. These women respect and uses the information on reproductive health

UNICEF Chief of Health Dr. Peter Salama said antenatal care,

skilled birth attendants, emergency obstetrics are important

to reduce maternal mortality

UNICEF Gender Specialist Noreen Khan talks about the

importance of education in reducing risks of death in pregnancy




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condition of residents hospitalized or

treated outside the province.

Ona also said the country has a lot of

that indicated 162 maternal deaths per

100,000 live births in the country.

Maternal mortality and its causes.

The WHO describes maternal death as

the death of a woman while pregnant or

within 42 days of termination of pregnancy,

irrespective of the duration and site of

the pregnancy, from any cause related

to or aggravated by the pregnancy or itsmanagement but not from accidental or

incidental causes.

According to a September 2010 UN

fact sheet, most maternal deaths could

be avoided. More than 80% of maternal

deaths are caused by hemorrhage, sepsis,

unsafe abortion, obstructed labor and

hypertensive diseases of pregnancy.

However, most of these deaths are

preventable with access to adequate

reproductive health services, equipment,

supplies and skilled healthcare workers.

Based on the 2006 records of DOH,

732 died of complications related to

pregnancy occurring in the course of

labor, delivery and puerperium (the time

immediately after the delivery of a baby),

565 died of hypertension complicating

pregnancy, childbirth and puerperium,

261 of postpartum hemorrhage and 163

pregnancies led to abortive outcome.

Philippines unlikely to meet MDG 5

target.As of September 2011, statisticsof the Philippines' progress based on the

MDG indicators, compiled by the National

Statistics Coordinating Board, show that the

reduction in maternal mortality is low.

According to National Economic

Development Authority (NEDA)'s Jan. 2010

DevPulse development advocacy fact sheet,

maternal mortality is rooted in poverty and

lack of education. The DOH said maternal



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poverty and poor education are associated

with delays in seeking, reaching, and

receiving appropriate care, the report cited.

Over half of births occurred at home, and

only a third was assisted by skilled birth

attendants, it added.

High fertility rates and high unmet

need for family planning and poor

nutrition of women also lead to poor

pregnancy outcomes and infant deaths.

Data from the NSO have shown that

having too many children and having them

in close succession corresponds to higher

infant, child, and maternal mortality rates,according to the fact sheet.

Similarly, the country has not been

performing well in terms of contraceptive

prevalence rate from 40% in 1993 the

rate only increased to 51% in 2008,

according to NEDA's own Philippines

Progress Report on the Millenium

Development Goals 2010, which also said

that the 2015 target of 52 maternal deaths

per 100,000 live births is unlikely to be met.

(See graph below)

According to the progress report, the DOH

has shifted from a risk approach that

focuses on identifying pregnant women

at risk to one that considers all pregnant

women at risk to develop complications.

As a result, the DOH strategy will involve

encouraging women to give birth in

conveniently located health facilities thatare equipped to provide basic emergency

obstetric and newborn care,

and implementing the Maternal,

Neonatal and Child Health and Nutrition

(MNCHN) Strategy, which involves a

shift from health programs controlled

at the national-government level to an

250

200

150

100

50

0

209 203197

191 186180

172162

52

1990 1991 1992 1993 1994 1995 1998 2006 2015

1993-2008 data

Current Rate of Progress

2015 Target

PHILIPPINE MATERNAL MORTALITY RATES, 1993-2006

Source: Philippines Progress Report on the Millenium Development Goals 2010,National Economic Development Authority, p. 116




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integrated mother-and-child health and

nutrition package administered at the local-

government-unit level.

Launched in 2008, the MNCHN Strategy

aims to ensure that all pregnancies are

wanted, planned, supported, and well-

managed; deliveries are facility-based and

managed by skilled birth attendants; and

all mothers and newborns receive good

postpartum and postnatal care.

Private sector to help government

achieve MDG 5. To reduce maternal deaths

in the country and to achieve benchmarksfor health conditions set in the MDG, the

DOH, through the Bureau of Local Health

Development, formed a multisectoral

consortium called 162-52 Coalition, which

encourages public-private partnerships to

develop health interventions in priority

areas in the country and deliver better

maternal services.

The coalition is the outcome of the Third

Philippine Health Outlook Forum, held

in December 2011. The forum, an annual

activity of the Zuellig Family Foundation,

brought government and private-sector

stakeholders together to discuss the state

of health in the country, and to form

partnerships to address the health inequities.

The lead convenors of the 162-52

Coalition include: Philippine Health

Insurance Corporation; ZuelligFamily

Foundation; League of Provinces of the

Philippines; Union of Local Authorities of

]the Philippines; Dr. Jaime GalvezTan;

Philippine Business for Social Progress;

Ayala TBI/ACCESS Health Philippines; and

.

The priority areas of the coalition comprise

20 provinces and the National Capital

Region, which account for 42% of the

population and 47% of the poorest families.

These priority areas contribute 39% of the

maternal deaths in the country. The coalition

created a framework for action in developing

interventions for the priority areas with three

major components:

units and support groups

behavior

services, facilities, personnel, essential

medicines and commodities

To take part in the multisectoral effort,

Smart Communications Inc developed

Secured Health Information Network and

Exchange (SHINE), a web- and mobile-based

platform for use by health-care workers, for

addressing the lack of interconnected healthdata, as reported in theInquireron May 12.

SHINE uses mobile and ICT technologies

to create electronic medical records for

reports and consultations, based on the

report.

It might be the proverbial last two

minutes for the country in terms of

trying to achieve the Millennium

Development Goal of reducing the

maternal mortality ratio by 75% by

2015, but given that the game will not

end in 2015, the continuing sense of

urgency is somewhat warranted, if not

actually welcome.



race to save the lives of filipino mothers by pia rufino

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