With the deadline drawing near, the Philippines remains far from achieving the fifth Millennium Development Goal (MDG 5) of reducing maternal mortality rate and achieving universal access to reproductive health. "We have not made any headway in reducing maternal mortality in the Philippines," admitted former Health secretary Esperanza Cabral during the Secretary's Cup on Maternal Health Care held last November 27. Presenting data from the Department of Health (DOH) and the National Statistics Office (NSO), Cabral said maternal deaths in 2011 was even higher than in 1993 — 221 deaths per 100,000 deliveries compared to 209 deaths per 100,000 deliveries, which was nowhere near the 52 deaths per 100,000 deliveries target by 2015. While there has been a gradual fall in the total fertility rate from 1993 to 2011, Cabral noted that it is still a long way from zero population growth. The replacement fertility rate—or the average number of children born per woman in her lifetime that would result in zero population growth—is 2.1 children. In 1993, the country's total fertility rate was 4.1. It dropped to 3.1 in 2011. "It seems like it is still more fun to have babies in the Philippines,” Cabral said. “On the other hand, it is not more fun for the 221 mothers per 100,000 live births who actually die during childbirth." In an overview of the reproductive health situation in the country, Cabral showed that the actual fertility or birth rate in a woman's lifetime was 3.3 in 2008, while the target fertility was 2.8 births, translating to a 0.5 difference in actual vs. wanted births. As of 2011, 19.3 percent of married women had unmet needs for family planning — a decrease from 26.2 percent in 1993. The target of 15 percent for 2010, however, was not met. According to Cabral, the contraceptive prevalence rate of currently married women is about 48.9 percent, including both traditional and modern methods. "Over the years, the need for family planning of women has not really been met completely," she said, noting that the unmet needs go up and down depending on the current administration and whether or not it actually promoted modern family planning methods.
In 1993, 24.9 percent of married women of reproductive age used modern contraceptive methods. In 2011, 36.9 percent used modern contraceptive methods, far from the 60 percent target set by Department of Health for 2010.
According to Cabral, it is more important to note the condition of disparity in health care in the Philippines. "The inequity is nowhere more evident than in reproductive health care," she said.
In affluent areas like Metro Manila, poverty indicators such as life expectancy at birth, infant mortality rate and maternal mortality rate approach the indicators in developed countries. On the other hand, there are many areas in the country where the indicators approach the data in places like Sub-Saharan Africa, where the life expectancy is short, and infant mortality and maternal mortality are high, Cabral said.
"There is among the poor a much greater disparity between the number of children they want and the number of children they actually have," she said.
The actual fertility rate among the poorest women in the country is 5.2 children, noticeably higher than the 1.9 among the richest. However, the wanted fertility is 3.5 for the poor and 1.6 for the rich. This could be explained by the poor's lack of access to family planning methods, Cabral said.
Family planning is part of comprehensive reproductive healthcare, a core health strategy for reducing maternal mortality. The other strategies are skilled care for all pregnant women by a qualified midwife, nurse or doctor during pregnancy and childbirth, and emergency care for all women and infants with life-threatening complications.
"The consequences of poor women's inability to access family planning methods are the following: 800,000 unintended births in a year, 560,000 abortions, 4,600 maternal deaths, and many, many other health, economic, and social costs," Cabral said.
Pantawid Pamilyang Pilipino program
Meanwhile, Social Welfare and Development Secretary Corazon Juliano-Soliman discussed how the government's conditional cash transfer program, the Pantawid Pamilyang Pilipino program, impacts maternal and child health.
"The Pantawid program contributes to the improvement of maternal health by teaching mothers the benefits of preventive health checkup," Soliman said, noting that one of the provisions of the program is for pregnant women to visit health centers and avail of pre- and post-natal care.
Soliman presented the results of a survey conducted in October to November 2011, comparing 1,418 households eligible for the program. A total of 704 households were enrolled in the program during the survey, and 714 were enrolled after the survey.
The survey showed 64 percent of pregnant mothers in the program had four prenatal care visits, compared to only 54 percent of those not in the program. Meanwhile, 36 percent of mothers in the program receive postnatal care within 24 hours after delivery, compared to only 27 percent of those not in the program.
Soliman said the findings suggest that mothers in the program receive more medical care based on the DOH standards during and after pregnancy. "These standards were designed to help minimize the occurence of complications in pregnancy," she said.
Soliman also shared that the DSWD and DOH are working together to help address the dearth of medical professionals in many areas in the country. Their projects include the Registered Nurse Health Enhancement and Local Service project, which deployed 20,000 nurses, and the Doctors to the Barrios Program, which deployed 590 physicians in 106 hard to reach areas and critical municipalities.
Last May, United Nations Population Fund (UNFPA) executive director Babatunde Osotimehin said “rapidity to deploy people” such as doctors, midwives and nurses who will provide the services remains a problem in the Philippines.
Both Soliman and Cabral concluded that there is still much to be done.
"Maternal mortality rate is dropping too slowly," Cabral said, adding that even though solutions exist to achieve mdg 5, what is needed most is political will. — KBK, GMA News