Maternal healthcare struggles for survival after Typhoon Haiyan

MANILA, 5 December 2013 (IRIN) – The massive destruction of healthcare facilities, with disruption to access and delivery as well as protracted displacement caused by Typhoon Haiyan (local name Yolanda) will further undermine precarious maternal health provision in the Philippines, warn experts.

“Before the typhoon, 60 percent of women were delivering in [healthcare] facilities—this will drop drastically. There will be more deliveries… [without] skilled birth attendants [present], and more unintended pregnancies. We expect to see a regression in the progress that we have made in maternal healthcare,” said Ugochi Daniels, chief of the humanitarian branch of the UN Population Fund (UNFPA) in New York, currently on assignment in the Philippines.

According to the recently released Multi-Cluster/Sector Rapid Assessment (MIRA), produced by more than 40 agencies across nine provinces, damage to health facilities varied from 50 to 90 percent in typhoon-affected areas.

Emergency deployment of local and foreign health workers has helped fill the gap. But these healthcare services treat mainly trauma injuries and do not address the needs of the estimated 292,000 pregnant women affected by Typhoon Haiyan, who need urgent maternal and newborn health services. The number was calculated by multiplying 11.2 million, the total number of affected people, by 2.6 percent, the country’s annual crude birth rate.

“At the onset of an emergency, in the rush to provide hygiene, water and sanitation, and relief food to the general population, the special needs of pregnant women are overlooked,” said Daniels. Approximately 3.6 million women and girls of reproductive age are among the affected, according to the Philippine Department of Social Welfare and Development (DSWD).

Pregnant and evacuated

Based on the latest government emergency report, some four million people were displaced when the super typhoon hammered into the Philippines on 8 November 2013, ravaging nine regions in the central islands. Close to 100,000 displaced people are living in evacuation centres, while the rest are living in makeshift homes or staying with host families.

“The biggest challenge is really the continuation of maternal healthcare services. With so many health centres destroyed, women have no place to go for their pre-natal examinations. Midwives will have to go find the pregnant women, but often the midwives are also among the affected population,” said Amelita Robles, a provincial health officer based in northern Panay island. Up to half of the medical personnel working in some areas were affected by the typhoon, according to the NGO, Action Contre la Faim International.

The World Health Organization (WHO) recommends at least four prenatal checkups for the early detection and treatment of pregnancy complications.

Health experts fear conditions in evacuation centres can put pregnant women at heightened risk of malnutrition and pre-term labour. “In the centres, she is dependent on food rations, which are usually rice and canned goods. These will not provide the necessary nutrients that a pregnant woman needs,” Angel Umali, a medical officer for UNFPA told IRIN. WHO also notes that malnutrition in pregnant women can increase the chances that their babies will be sick, or die.

The psychological trauma of a disaster on the scale of Typhoon Haiyan, which has killed more than 5,000 people and left another 1,700 missing, may bring on premature labour, say health workers. “If the baby is delivered pre-term, there is a lower rate of survival,” Umali said.

The number of deaths of children under five years old in the Philippines dropped by 46 percent from 1998 to 2008, according to the United Nations Children’s Fund (UNICEF). However, these gains are threatened by the small decline of only 2 percent during that period in the death rate of babies in their first 28 days of life.

Include maternal health

“The needs of pregnant women from [confirmation of] pregnancy to… giving birth need to be integrated into emergency and relief response,” said Nandy Senoc, officer-in-charge of the local Family Planning Organization of the Philippines (FPOP), based in Manila, the capital. The organization, the Department of Health and aid agencies are providing reproductive healthcare to women in evacuation centres.

Under the internationally approved Minimum Initial Service Package (MISP) for reproductive health, certain activities must be implemented at the onset of every emergency, including distributing emergency delivery kits to displaced pregnant women in their last trimester, which FPOP is doing. The emergency kits for women and traditional birth attendants to aid safe delivery may contain a plastic sheet, a razor blade and a bar of soap.

“What is also really needed is the provision of contraceptives like pills, condoms and injectables to prevent mistimed pregnancies. Many women want to avoid getting pregnant under these dire conditions,” said Senoc.

The 2011 Family Planning Survey noted that the country’s maternal mortality ratio jumped by 35 percent, from 162 deaths per 100,000 live births in 2006, to 221 in 2011.

The Philippines was hit by 126 natural disasters during that same period, including Typhoon Ketsana (local name Ondoy) in 2009 and Typhoon Washi (local name Sendong) in 2011.

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