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Philippine Government Policies in Reducing Maternal Mortality

Philippine Government Policies in Reducing Maternal Mortality

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Published by Carlos Tulali
This policy brief is intended to give guidance to policy-makers and others engaged in planning and implementing policies and programs in maternal health in the Philippines with recommendations that might be useful in reviewing and assessing the country’s maternal health care policies and programs. The analysis is based on a review of literature, policy documents, tools, and other relevant materials to bring together up-to-date evidence from a variety of sources.
This policy brief is intended to give guidance to policy-makers and others engaged in planning and implementing policies and programs in maternal health in the Philippines with recommendations that might be useful in reviewing and assessing the country’s maternal health care policies and programs. The analysis is based on a review of literature, policy documents, tools, and other relevant materials to bring together up-to-date evidence from a variety of sources.

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Published by: Carlos Tulali on Feb 10, 2010
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12/23/2013

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PEOPLE COUNT 
PLCPD POLICY BRIEF
Expanding choices, uplifting lives through responsive population and human development legislation 
health (RH) services by women, including poor adolescents and men. Most maternal death anddisability could be averted if:- all pregnancies were wanted,- all births were attended by skilled healthprofessionals and- all complications were managed in qualityreferral facilities offering emergencyobstetric care.
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This policy brief is intended to give guidance topolicy-makers and others engaged in planning andimplementing policies and programs in maternalhealth in the Philippines with recommendationsthat might be useful in reviewing and assessingthe country’s maternal health care policies andprograms. The analysis is based on a reviewof literature, policy documents, tools, and other relevant materials to bring together up-to-dateevidence from a variety of sources. Moreover,a focus group discussion was conducted withselected key informants among officers andmembers of the Integrated Midwives Associationof the Philippines (IMAP) who are closely involvedwith safe motherhood/maternal health programsof the country for many years.Since the late 1980s, improving maternal health andreducing maternal mortality have been key concernsof several international summits and conferences,including the Millennium Summit in 2000.
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One of the eight Millennium Development Goals (MDGs)adopted following the Millennium Summit involvesimproving maternal health (MDG5). Within the MDGmonitoring framework, the international communitycommitted itself to reducing the maternal mortalityratio (MMR), and set a target of a decline of threequarters between 1990 and 2015. Thus, the MMRis a key indicator for monitoring progress towardsthe achievement of MDG5.In the Philippines, eleven women die every 24hours from almost entirely preventable causesrelated to pregnancy and childbirth.
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Maternalmortality ratio (MMR) continues to be staggeringlyhigh, at 162 maternal deaths for every 100,000live births
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compared with 110 in Thailand, 62 inMalaysia, and 14 in Singapore.Universal access to sexual and reproductive healtheducation, information, and services improveshealth, saves lives and reduces poverty. The slowdecline in MMR in the country may be traced toinadequate access to integrated reproductive
Overview
By Carlos O. Tulali
Maternal Mortality
Philippine Government Policies in Reducing
 
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PLCPD POLICY BRIEF
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Philippine Government Policies in Reducing Maternal Mortality
Maternal Health Situation
Results of the 2008 National Demographic andHealth Survey (NDHS) indicate that about 91percent of Filipino women with at least one livebirth in the 5 years prior to the 2008 NDHS hadreceived antenatal care from a health professionalcompared to 88 percent of the women based onthe 2003 NDHS (Table 1). Among all births in the 5years preceding the 2008 NDHS, 62 percent weredelivered by a health professional compared to 60percent reported in the 2003 NDHS.
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While thisrepresents adequate coverage, there is markeddifference in access across regions and incomegroups.Based on the 2008 NDHS results, the contraceptiveprevalence rate (CPR) of the Philippines is only50.7 percent (Table 2). This means that only alittle more than half of married Filipino women useFP methods, whether traditional (16.7 percent) or modern (34 percent). Only 0.4 percent use “other traditional method” (natural family planning).
Table 1. Selected maternal care indicators, Philippines: 2003 and 2008 NDHS
Indicators20032008
Percentage of women age 15-49 with one or more live births in the 5 years before thesurvey who received antenatal care for the youngest child from a health professional87.691.0Percentage delivered by a health professional among all births in the 5 years beforethe survey59.861.8Percentage delivered in a health facility among all births in the 5 years before thesurvey37.943.8
Sources: 2003 and 2008 National Demographic and Health Surveys
Table 2. Percent distribution of currently married women by contraceptive method used, Philippines: 2003,2008
Method20032008
Any method48.950.7Any modern method 33.434.0Any traditional method15.516.7Not currently using51.149.3Total100.0100.0
Sources: 2003 and 2008 National Demographic and Health Surveys
 
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PLCPD POLICY BRIEF
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Philippine Government Policies in Reducing Maternal Mortality
This situation leads to more pregnancies anddeliveries among Filipino women. And yet, anoverwhelming majority of Filipinos (92%) believethat it is important to manage fertility and plantheir family, and most (89 percent) say that thegovernment should provide budgetary support for 
modern articial methods of FP, including the pill,
intra-uterine devices (IUDs), condoms, ligation,and vasectomy, based on a 2007 survey on FPin the Philippines conducted by Pulse Asia.
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Inanother survey, the majority (55%) of respondentssaid that they are willing to pay for the FP methodof their choice.
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These survey results prove that Filipino womenlack RH care, including information on, and accessto, FP methods of their choice. Births that are toofrequent and spaced too closely take a debilitatingtoll on their health, so that many of them dieduring pregnancy or at childbirth. Some of them,despairing over yet another pregnancy, seek anabortion, from which they also die and along withthem, their unborn child. Based on another studyconducted by the Allan Guttmacher Institute in2006, of the three million annual pregnancies inthe country, half were unplanned and one-third of these end in abortions.
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Causes and prevention of maternal deaths
The Philippine government’s MDG progressreport states that 1 in 100 women die as a resultof “maternal causes,” and that maternal deathsaccounted for about 14 percent of all deathsamong women of reproductive age (15–49).
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 The underlying causes for the situation are: (1)inadequate capacity of the health/medical facilityto provide quality emergency obstetric care(EmOC) services in terms of human resource,skills, equipment, and medicine; and nonfunctionalreferral system for referring high-risk pregnancies.Lack of awareness on the part of mothers to seektimely medical care and preference of mothersto conduct deliveries at their homes are alsocontributing factors.As revealed by the State of Filipino Mothers 2008report by Save the Children, not only do Filipinomothers die because of biomedical causesand risk factors, they also lack access to bothlifesaving care and quality maternal/reproductivehealth care.
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According to the report, these arethe reasons why Filipino mothers die:1. limited access to health facilities andquality maternal care;2. lack of access to a full-range of reproductivehealth care, including family planninginformation and services;3. unplanned pregnancies leading to inducedabortion, and consequently, maternaldeaths;4. lack of political will to provide maternalhealth services;5. lack of a reproductive health law thatwould require appropriate funds to ensurefull access to quality RH information andservices that include maternal health andfamily planning.The dangers of childbearing can be greatlyreduced if a woman is healthy and well-nourishedbefore becoming pregnant, if she has a healthcheckup by a trained health worker during her pregnancy, and if a skilled birth attendant assiststhe birth. The woman should also be checkedduring the 12 hours after delivery until six weeksafter giving birth. The government has a particular responsibility to make prenatal and postnatalservices available, to train health workers toassists at birth, and to provide special care andreferral services for women who have seriousproblems during pregnancy and childbirth.
Unmet need and short birth intervals
Research from developing countries revealedthat unhealthy timing or spacing of pregnanciesis linked to increased risk of multiple adversehealth outcomes.
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Following a pregnancy thatoccurred quickly after a previous birth, the risk of a child dying is at least twice as high as that for longer intervals. A recent study of Filipino women’scontraceptive needs revealed that one-third of women at risk did not want to become pregnantwithin the next two years, while the remaining two-thirds did not want any more children.
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Comparedto women who want to end childbearing, women

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