Maternity death road

“I’ve been running a crap game since I was a juvenile delinquent,” boasts this chap in “Guys and Dolls,” the 1950 Tony Award-winning Broadway play. And Miss Adelaide snaps back: “Speaking of chronic conditions, happy anniversary.”

This exchange came to mind as the Senate debates on the reproductive health bill zig-zagged from a chronic “war of words into a battle of figures.”

Today’s crap shoot pivots around a critical issue: On average, how many mothers die daily during childbirth?

“Eleven,” say Senators Miriam Defensor-Santiago and Pia Cayetano, co-sponsors of the RH bill. That’s almost triple Vietnam’s maternal deaths, UN Human Development Report 2010 shows.

“No,” counters Sen. Vicente Sotto III, who bucks the RH bill. “Probably four or five.” He cites a Lancet article and a United Nations study which imply that deaths of Filipina mothers have been whittled down in little over a decade to China’s maternal mortality levels. That would be one for demographic record books—if true.

At the 2000 Millennium Summit, the Philippines pledged to slash maternal deaths down to 52 out of every 100,000 live births. Fatalities towered at 209 in 1990, then slowly slipped to 162 last year. “That’s too far from (Millennium Development) Goal No. 5 of 52 deaths,” the National Economic and Development Authority said. “Goal 5 is least likely to be achieved by 2015.”

In its latest “MDG Watch,” the National Statistical Coordination Board agreed with Neda. So does the United Nations Children’s Fund’s “Report Card on Maternal Mortality” which noted, “In the Philippines, an estimated 4,500 women die every year because of complications from pregnancy and childbirth.” Australian Aid also made the same point.

Come 2013, the European Union will augment its P2.7 billion for ongoing programs by P4.7 billion, Ambassador Alistair MacDonald pledged. This would buttress efforts to meet MDG goals. “Some 42 children are orphaned daily,” the EU envoy said. “Yet, 90 percent of all maternal deaths could have been averted, with proper care and services.”

Is everyone else tilting at windmills, given Sotto’s claims?

“Statistics are people with the tears wiped from their eyes.” Look at what went before—and what occurs beyond RH debates. “Based on present trends most poor countries will miss almost all MDG goals, in some cases by epic margins,” the World Bank stated five years after the MDG summit. “Less than one-fifth of all countries are currently on target to reduce child and maternal mortality and provide access to water and sanitation.”

Two years later, the unusually frank “2007 MDG Midterm Progress Report” noted that in the Philippines, “the funding gap to achieve MD Goals by 2015 is estimated at around P15 billion… [But] expenditures for social and economic services, as a percentage of the total budget, had been declining for the past seven years.”

Thus, only 6 out of 10 Filipino mothers deliver babies with properly trained birth attendants. All births in Malaysia, in contrast, have medical personnel present.

Why? Out of every 100 Filipino doctors, 68 practice abroad. Over 164,000 nurses left over the past four decades. “The proportion of Filipinos dying without medical attention has risen to 70 percent, a figure not seen since the mid-1970s,” the Washington Post reported. “A health care brain drain is strangling (public) hospitals.”

Four out of 10 Filipinas “deliver either in a public or private health facility.” That’s a sliver lower than that of Mali in Africa.

Worse, underground abortionists account for nearly 12 percent of maternal deaths. The UP Population Institute estimates 560,000 abortions are induced yearly. Some 90,000 mothers are lucky to seek post-abortion care. About half of 3.4 million pregnancies in 2008 were unintended.

On the maternity death road, most victims are poor and clustered in remote barangays. Often ill-fed school dropouts, these women lack access to what is, at best, patchy health services. “Giving midwives access to further training in life-saving skills could prevent up to 80 percent of maternal deaths.” These mothers have “no escape routes,” i.e. options that give them “quality information that would enable them to avoid unwanted pregnancies or space pregnancies, and plan families.”

“We don’t realize the economic distortions and human pain that stem from corrupt and bad government,” Harvard professor John Kenneth Galbraith once said. Is that why the House of Representatives named as chair of its committee on Millennium Development Goals the honorable representative from Ilocos Norte, Imelda Marcos?

Four years from now, President Aquino and 188 other heads of state will convene and report on how each country delivered on the MDGs. “We should have achieved MDGs under the (Arroyo) regime,” says the study “Winning the Numbers, Losing the War.” We flunked. Don’t ask Mike Arroyo why.

At the start of P-Noy’s only term, the prevalence of underweight children under 5 was “comparable to Sub-Saharan Africa,” the last national nutrition survey notes. Only 3 out of 10 drink potable water in the Autonomous Region in Muslim Mindanao. Gloria Macapagal-Arroyo’s decade in office, by happenstance, straddled the first decade of MDGs. It squandered opportunities to achieve the human ends of MDGs.

That leaves little elbow room to buttress programs like the one midwife per barangay policy and upgrading health facilities, especially in Mindanao. Now, all must pitch in to meet the 2015 targets. This is not just a “Guys and Dolls” crap shoot. “No woman should die giving life.”

Even Sotto will agree with that. –Juan L. Mercado, Philippine Daily Inquirer

(Email: juanlmercado@gmail.com)