Saving moms from dying in childbirth

Here’s the good news: The Philippines’ maternal mortality ratio (MMR), which refers to the number of women dying during pregnancy or in the first six weeks after delivery, has declined from an estimated 209 per 100,000 live births in 1987-1993 to an estimated 162 per 100,000 today.

The bad news is that this ratio is still one of the highest in the region.

In fact, among Asean countries, only Laos (580 per 100,000), Cambodia (290 per 100,000), Myanmar and Indonesia (240 per 100,000) have much worse records while the rest already enjoy a double if not single digit MMR.

Severe problem

The problem is particularly severe in several Muslim communities in Mindanao, wherein, according to the United Nations Development Program, as many as 320 mothers die per 100,000 live births—that’s double the national average.

“With just three years left, the Philippines is behind the target MMR of 52 per 100,000. There is still hope if all sectors both in the private and public fields will unite and make strong push to attain the UNDP’s Millennium Development Goal No. 5 (which seeks to reduce the MMR by three quarters between 1990 and 2015),” urged President Aquino in his message read by Health Secretary Enrique Ona during last week’s “162 to 52 Summit: Accelerating Collective Impact on Maternal and Child Health” held at the Philippine International Convention Center in Pasay.

In the same message, the President commended the DOH, the LGUs, private sector as well as the nongovernment organizations (NGOs) for coming out with the multisectoral organization “162 to 52 coalition” which envisions itself to be a catalyst for strategic, targeted and innovative public-private partnerships for the attainment of better maternal indicators.

“Based on the data provided by the United Nations Fund for Population Agency, 11 mothers die every day in the Philippines due to maternity-related causes, leaving more than 30 children motherless. It is time for our new mothers to stop dying while giving life,” pleaded Department of Health head executive assistant and Bureau of Local Health Development head Dr. Juan Antonio Perez III.

To improve the MMR situation here in the country, the DOH together with fellow convenors—Philippine Business for Social Progress, Union of Local Authorities of the Philippines, League of Provinces of the Philippines, League of Municipalities of the Philippines, League of Cities of the Philippines, Health Futures Foundation, Ayala Technology Business Innovation/Access Health Philippines, and Zuellig Family Foundation—organized the one-day “162 to 52 Summit: Accelerating Impact on Maternal and Child Health” last week.

Tough mission

“We understand that we have a tough mission ahead of us considering we only have three more years to meet the goal of achieving no more than 52 per 100,000 by 2015. However, with what we were able to accomplish from the summit yesterday, we may still be able to meet the deadline,” observed Rafael Lopa, executive director of PBSP, one of the country’s largest business-backed NGOs supporting the “162 to 52” initiative.

Lopa lauded the much closer collaboration of the stakeholders, which is crucial for “162 to 52” initiative to succeed.

Oriental Mindoro Gov. Alfonso Umali Jr., president of the League of Governors of the Philippines, agreed with the DOH chief that all the stakeholders should come up with uniform data on the number of the maternal mortality rate, which is needed to monitor progress of the coalition.

According to Prof. Ernesto Garilao, president of Zuellig Family Foundation, the LGU’s commitment is very important considering maternal mortality remains unacceptably high in some of the provinces despite the declines in recent years.

He also added that the need to intensify campaign in depressed and remote areas around the country that will convince women to try the services of these clinics and assure them that in most cases, they would not be charged.

P15 billion

The President, through Ona, revealed that for the last two years, the government has spent P15 billion for the improvement and construction of health facilities, including health centers with operating rooms nationwide to prevent maternal deaths.

“In this regard, the DOH hired more than 20,000 nurses and 7,000 midwives to serve in the barrios, including in the far-flung areas where the poorest of the poor hardly get proper medical care,” Ona said.

Perez said that considering half of births in the Philippines still occur at home, and a third assisted by “hilots,” the coalition members should also make an effort to remind expectant mothers that going to the nearest birthing facility is still the best decision.

Obstetric causes

Perez shared that almost all maternal deaths in the Philippines are caused by direct obstetric causes including hemorrhage, sepsis, eclampsia, unsafe abortions and prolonged or obstructed labor.

“Moreover, the lack of municipal or barangay health offices with good birthing facility, limited number of skilled birth attendants who must be also adept at hygienic and proper birth delivery practices have contributed to the high rate of maternal deaths,” Perez lamented.

To effectively reduce maternal mortality, he suggested the need for specific solutions that not only deliver proven interventions within poorly resourced health systems of the provinces, but are designed to navigate complex social dynamics.

“There are so many issues to consider and the 162 to 52 Summit held yesterday is just the beginning,” the doctor said. –Charles E. Buban, Philippine Daily Inquirer