Page |1

I. Brief Background of the Millennium Development Goals

In September 2000, world leaders came together at the United Nations Headquarters in

New York to adopt the United Nations Millennium Declaration. The Declaration committed

nations to a new global partnership to reduce extreme poverty, and set out a series of eight time-

bound targets - with a deadline of 2015 - that have become known as the Millennium

Development Goals (MDGs)1.

TABLE 1.12

The Millennium Development Goals (MDGs)

Goal 1 Eradicate extreme poverty and hunger
Goal 2 Achieve universal primary education
Goal 3 Promote gender equality and empower women
Goal 4 Reduce child mortality
Goal 5 Improve maternal health
Goal 6 Combating HIV/AIDs, malaria, and other diseases
Goal 7 Ensure environmental sustainability
Goal 8 Develop a global partnership for development

Table 1.1 shows the eight MDGs to be achieved by 2015 with their corresponding

targets.

For 15 years, the MDGs drove progress in several important areas: reducing income

poverty, providing much needed access to water and sanitation, driving down child mortality and

drastically improving maternal health. They also kick-started a global movement for free primary

education, inspiring countries to invest in their future generations. Most significantly, the MDGs

1
United Nations Millennium Development Goals. (n.d.). Retrieved March 6, 2019, from
http://www.un.org/millenniumgoals/bkgd.shtml
2
Millennium Development Goals. (n.d.). Retrieved March 6, 2019, from
https://www.undp.org/content/undp/en/home/sdgoverview/mdg_goals.html
 Page |2

made huge strides in combatting HIV/AIDS and other treatable diseases such as malaria and

tuberculosis3.

II. Brief Background of Millennium Development Goal Number 5: Maternal Health

Hunger and malnutrition were observed to increase the incidence and fatality rate of the

conditions that contribute to nearly 80 percent of maternal deaths.

In this regard, millennium development goal 5 has two targets:

1. TARGET 5.A. – To reduce the maternal mortality ratio by 75 percent

2. TARGET 5.B. – To achieve universal access to reproductive health

Improving maternal health is critical to saving the lives of hundreds of thousands of

women who die due to complication from pregnancy and childbirth each year. Over 90 percent

of these deaths could be prevented if women in developing regions had access to sufficient diets,

basic literacy and health services, and safe water and sanitation facilities during pregnancy and

childbirth.

Some of the achievements of MDG 5 include:

 A 45 percent reduction in the maternity mortality ratio worldwide since 1990, though
most of the reduction occurred since 2000
 A 64 percent reduction in maternal mortality ratio in Southern Asia between 1990 and
2013, and 49 percent in sub-Saharan Africa.
 A 12 percent increase in the number of births assisted by skilled health personnel globally
in 2014 compared to 1990 – 59 percent to 71 percent.
 An increase in the proportion of pregnant women receiving four or more antenatal visits
in North Africa from 50 percent in 1990 to 89 percent in 2014.
 Increase in contraceptive prevalence among women 15 – 49 years old – whether married
or in some other union – from 55 to 64 percent between 1990 and 2015.

*Source: (see footnote)4

3
Background of the Sustainable Development Goals. (n.d.). Retrieved February 27, 2019, from
https://www.undp.org/content/undp/en/home/sustainable-development-goals/background.html
4
Max. (2016, November 15). MDG 5: Improve maternal health. Retrieved March 6, 2019, from
https://www.mdgmonitor.org/mdg-5-improve-maternal-health/
 Page |3

Globally, over 10% of all women do not have access to or are not using an effective

method of contraception. It is estimated that satisfying the unmet need for family planning alone

could cut the number of maternal deaths by almost a third.

The UN Secretary-General's Global Strategy for Women's and Children's Health aims to

prevent 33 million unwanted pregnancies between 2011 and 2015 and to save the lives of women

who are at risk of dying of complications during pregnancy and childbirth, including unsafe

abortion5.

5
MDG 5: Improve maternal health. (2015, May 13). Retrieved March 6, 2019, from
https://www.who.int/topics/millennium_development_goals/maternal_health/en/
 Page |4

III. Definition of Terms

Maternal death

A maternal death is the death of a woman while pregnant or within 42 days of

termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any

cause related to or aggravated by the pregnancy or its management, but not from accidental or

incidental causes6.

Maternal mortality ratio (MMR)

The number of maternal deaths per 100,000 live births, a measure of the risk of death

once a woman has become pregnant.

Example: There is town which has 1,000 people. Eleven women in the town become

pregnant. One baby miscarries. Ten women give birth to ten live babies. One of the women who

gave birth dies due to complications in the pregnancy. The maternal mortality ratio is 1 out of 10.

It is 10%.

Maternal mortality rate

The number of maternal deaths (direct and indirect) in a given period per 100,000

women of reproductive age during the same time period.

Example: There is a town which has 1,000 people. 500 are women. 400 are women of

reproductive age. Last year, ten women gave birth to ten live babies. One of the women died due

to complications in the pregnancy. The maternal mortality rate is 1 out of 400: it is 0.25%.

*Source for definitions of maternal mortality ratio and maternal mortality rate: (see footnote)7

6
Definition and classification of Maternal Death. (n.d.). Retrieved from
https://www.ucc.ie/en/mde/definitionandclassificationofmaternaldeath/
International Classification of Diseases, 10th Revision, Geneva, World Health Organization, 2004
7
Definitions of Maternal Mortality. (2018, February 24). Retrieved March 6, 2019, from
https://www.pop.org/definitions-of-maternal-mortality/
 Page |5

IV. Global Maternal Health

Maternal Mortality (Indicator No. 1)

Maternal mortality is relatively high. In fact, about 830 women die from pregnancy or

childbirth-related complications around the world every day. It was estimated that in 2015,

roughly 303,000 women died during and following pregnancy and childbirth. Almost all of these

deaths occurred in low-resource settings, despite the fact that most could have been prevented8.

TABLE 2.19

Table 2.1 shows us the decline of maternal mortality rate through the recent years. In

Sub-Saharan Africa, for example, the number of maternal deaths fell by almost half from 987 to

546. However, it is sad to consider that maternal deaths are still prevalent in least developed

countries despite the fact that it can be prevented. Evidence of such lies on the huge disparities

8
Maternal mortality. (n.d.). Retrieved February 20, 2019, from https://www.who.int/news-room/fact-
sheets/detail/maternal-mortality
9
Maternal mortality. (n.d.). Retrieved March 6, 2019, from https://data.unicef.org/topic/maternal-
health/maternal-mortality/
 Page |6

between the developed countries and underdeveloped ones. The annual rate reduction based on

the data gathered by researchers has an average of 2.3. This alone is impressive, but according to

UNICEF this is less than half of the 5.5 percent annual rate needed to achieve the maternal

mortality reduction targeted for MDG No. 5 in 2015.

The high number of maternal deaths in some areas of the world reflects inequalities with

regards to the access of health services, further highlighting the gap between high-income and

low-income places. As can be seen above, almost all maternal deaths occur in developing

countries. More than half of these deaths occur in Sub-Saharan Africa and almost one third occur

in South Asia.

TABLE 2.210

10
Maternal mortality. (n.d.). Retrieved March 4, 2019, from https://data.unicef.org/topic/maternal-
health/maternal-mortality/
 Page |7

Furthermore, women in developing countries have, on average, many more pregnancies

than women in developed countries, and their lifetime risk of death due to pregnancy is higher. A

woman’s lifetime risk of maternal death in low-income setting is 1 in 41, while only 1 in 3300

women die in rich countries. This is another manifestation of unequal distribution and

availability of services catered towards maternal health-care.

TABLE 2.311

Based on the chart above, the top 5 major reasons that account for nearly all maternal deaths are:

 Indirect causes (e.g., malaria, AIDS)

 Haemorrhage
 Hypertension
 Sepsis
 Other direct causes (e.g., unsafe environment, accidents)

11
Maternal mortality. (n.d.). Retrieved March 4, 2019, from https://data.unicef.org/topic/maternal-
health/maternal-mortality/
 Page |8

Number of Skilled Birth Attendants (Indicator No. 2)

One important approach in reducing maternal mortality is ensuring that every baby is

delivered with the assistance of skilled birth personnel, which generally includes a medical

doctor, nurse or midwife. Experts agree that the risk of stillbirth or death due to complications

can be reduced by about 20 percent with the presence of a professional. Reflecting its importance

in reducing maternal mortality, skilled birth attendance was included as indicator under the new

Sustainable Development Goals or SDGs.

TABLE 3.112

Table 3.1 shows the percentage of births assisted by a skilled birth attendant in 2011-

2016. From this data, we can say that Sub-Saharan Africa has the lowest number of skilled birth

attendants; this explains the high mortality ratio of the region as can be seen in tables 2.1 and 2.2.

12
Delivery care. (n.d.). Retrieved February 28, 2019, from https://data.unicef.org/topic/maternal-health/delivery-
care/
 Page |9

In terms of skilled birth attendants or SBAs, large equity gaps still remain. For one,

rural or the poorest population are often left behind. Globally, approximately 67% of births

among rural mothers are attended by skilled health personnel, compared to about 90% percent of

births among urban mothers. The urban rural gap remains at over 20 percentage points despite

progress in the past 15 years13.

Contraceptive Prevalence Rate (Indicator No. 3)

Contraceptive prevalence is the percentage of women who are currently using, or whose sexual

partner is currently using, at least one method of contraception, regardless of the method used. It

is usually reported for married or in-union women aged 15 to 4914.

TABLE 3.215

The demographics above (Table 3.2) show us the degree of contraceptive use

throughout the world. Norway has the highest rate at 80-90%, followed by Portugal and China.

On the other hand, the African region garnered the lowest at around 0-15% only. Based on prior

13
Delivery care. (n.d.). Retrieved February 28, 2019, from https://data.unicef.org/topic/maternal-health/delivery-
care/
14
Contraceptive prevalence, modern methods (% of women ages 15-49). (n.d.). Retrieved March 6, 2019, from
https://data.worldbank.org/indicator/SP.DYN.CONM.ZS
15
Contraceptive prevalence. (2016, May 06). Retrieved March 6, 2019, from
https://www.who.int/reproductivehealth/topics/family_planning/contraceptive_prevalence/en/
 P a g e | 10

knowledge, teenagers or young women all over the world are at risk of problems in pregnancy.

Contraception allows them to put off having children until they are financially and physically

able to support a pregnancy. It can also prevent pregnancy for older and sick women who face

pregnancy-related risks.

Contraceptive use can lessen the need for abortion by preventing unwanted pregnancies.

It therefore reduces cases of unsafe abortion, which is one of the leading causes of maternal

death worldwide.
 P a g e | 11

V. National Maternal Health

Present Status

Target 5.A:

Reduce by three quarters, between 1990 and 2015 the maternal mortality ratio

The country’s maternal mortality ratio (MMR) decreased from 209 per 100,000

livebirths in 1990 to 172 per 100,000 livebirths in 1998 and to 162 per 100,000 livebirths in

2006. However, based on the 2011 Family Health Survey, the MMR increased to 221 per

100,000 livebirths. While the difference between the 2006 and 2011 figures may not be

statistically significant, the previous observation that the country is not on track in meeting

MDG5 still holds.

Target 5.B:

Achieve by 2015, universal access to reproductive health

Based on National Statistics Office (NSO) data, the target for universal access to

reproductive health is unlikely to be achieved, as determined by the contraceptive prevalence rate

(CPR). The CPR among currently married women (15-49 years) remains stagnant at almost 50

percent (from 1998 to 2011). From 2006 to 2011, the CPR even decreased from 50.6 percent to

48.9 percent. For the same period, the prevalence rate for modern methods was roughly constant,

while the traditional methods decreased by 2.8 percentage points.

*Source for Target 5.A. and 5.B.: (see footnote)16

16
Fifth MDG Progress Report [PDF]. (2014). Pasig City: National Economic and Development Authority.
 P a g e | 12

In order to determine the present status of maternal health in the Philippines, the

researcher chose the following indicators namely (1) maternal mortality ratio and proportion of

births attended by skilled health personnel in correspondence to Target 5.A. and (2) the

contraceptive prevalence rate for Target 5.B.

Maternal Mortality (Indicator No. 1)

TABLE 4.1and TABLE 4.217

YEAR MATERNAL MORTALITY RATIO

1990 209
1991 203
1992 197
1993 191
1994 186
1995 180
1998 172
2006 162
2011 221
2015 52

Table 4.1 shows the Philippines' progress in the attainment of the first target of reducing

maternal mortality ratio (1990 to 2015). Fortunately, the data shows a positive result in the area

of lessening maternal deaths within the span of 10 years, with exception of a slight spike in 2011.

MATERNAL MORTALITY RATIO

MATERNAL MORTALITY RATIO

209 203 197 221

191 186 180 172 162

52

1990 1991 1992 1993 1994 1995 1998 2006 2011 2015

17
Concepcion, M.B. (2014, May 14). The MDGs: A look at goals 4 and 5. Retrieved from
http://www.bsp.gov.ph/events/pcls/downloads/2014s1/BSP_03_MBC_Luncheon_Speech.pdf
 P a g e | 13

Based on the data shown, we can deduce that mortality rate in the 1990s up to 2011 was

relatively high, with the highest rate recorded in 1990 at 209 maternal deaths per 100,000 live

births. Notably, the reduction of maternal mortality ratio since 1990 had been fairly slow. The

most intense drop in the rate of maternal deaths only took place in 2015 wherein the MMR

reached as low as 52.

Number of Skilled Birth Attendants (Indicator No. 2)

TABLE 4.318

PROPORTION OF BIRTHS ATTENDED BY

SKILLED HEALTH PERSONNEL
80
70
60
50
40 PROPORTION OF BIRTHS ATTENDED
BY SKILLED HEALTH PERSONNEL
30
20
10
0
1993 1998 1999 2000 2003 2006 2008 2011 2013

Table 4.3 shows the first target based on its second indicator – proportion of births

attended by skilled health personnel from 1993 to 2013. As seen on the graph above, there has

been considerable increase in the number of births attended by skilled health personnel.

However, in 1999, it decreased by almost 10 percent in a span of one year. In the following

years, despite the increase of births attended by health professionals, the improvement was still at

a rather slow pace.

18
Countdown to 2015. Maternal, newborn snd child survival: Philippines: Retrieved from
http://countdown2030.org/documents/2010/2010-Philippines.pdf
 P a g e | 14

According to the IRIN, some of the main causes of maternal deaths in the Philippines

are haemorrhages, sepsis, obstructed labor, hypertensive disorders during pregnancy and

complications associated with unsafe abortions19.

TABLE 4.420

SKILLED ATTENDANT
AT BIRTH (%)
RESIDENCES
URBAN 83.2
RURAL 63.6

HOUSEHOLD WEALTH
RICHEST 96.2
POOREST 42.2

MOTHER'S AGE
LESS THAN 20 74.8
20-34 74
35-49 66.2

MOTHER'S EDUCATION
NO EDUCATION 16.9
PRIMARY 48.5
SECONDARY 75.6
HIGHER 90.3

In the table above, we can see that more or less 80 percent of women in the urban areas

seek help from skilled attendants during birth, in comparison to the 63% in rural areas. The

disparity becomes even wider within the issue of wealth, the rich employs skilled birth attendants

at a rate of 96%, more than twice higher than poor households at only 42%.

19
Maternal Mortality in the Philippines. (2018, February 14). Retrieved from https://borgenproject.org/maternal-
mortality-philippines/
20
Maternal and newborn health disparities: Philippines. Retrieved from https://data.unicef.org/wp-
content/uploads/country_profiles/Philippines/country%20profile_PHL.pdf
 P a g e | 15

Having a physician, nurse or midwife who has undergone formal training present

during the birth is vital in decreasing the maternal mortality rate, but currently, these skilled

birthing attendants supervise only a portion of births in the Philippines. Others, especially those

living in rural areas, rely on traditional birthing attendants or “hilot”. These people do not have

formal training and therefore are mostly if not completely unable to deal with complications.

Contraceptive Prevalence Rate (Indicator No. 3)

Aside from the lack of professional help, rural areas also have higher maternal mortality

rates because many women get pregnant at a young age due to lack of contraceptive use. Since

adolescent women are normally not developed enough for childbirth, these young mothers face

many complications during and after pregnancy and contribute to the high maternal mortality

rate.

TABLE 4.521

TRENDS IN CONTRACEPTIVE PREVALENCE

RATE
70

60

50

40

30

20

10

0
1993 1998 2001 2003 2006 2008 2011 2015

ALL TRADITIONAL MODERN

21
The Philippines. Fifth progress report of the millenium development goals. Retrieved from
http://www.neda.gov.ph/wp-content/uploads/2014/08/MDG-Progress-Report-5-Final.pdf
 P a g e | 16

We can see from Table 4.5 that in 1993, 40% of Filipinos are already using

contraceptives. In the following years, the contraceptive prevalence rate had been slowly

increasing, but not once going past the 50% mark based on the years included in data. However,

in 2015 there was considerable increase of more or less 13% in contraceptive use wherein the

rate increased from 50 percent in 2011 to 63 percent.

According to an article published by Rappler, despite the Supreme Court’s temporary

restraining order (TRO) against the implementation of the Reproductive Health (RH) law, the

use of modern family planning methods in the country still increased in 201522. Despite the

Filipino’s becoming predominantly Catholic, there has been a slow shift in ideology regarding

the use of contraceptives, mainly due to modernization and the availability or easy access to

contraceptive products.

22
Geronimo, J. Y. (2016, June 22). Use of modern family planning methods in PH rose in 2015 – report [Web log
post]. Retrieved March 1, 2019, from https://www.rappler.com/nation/137256-2nd-report-implementation-
reproductive-health-rh-law-family-planning
 P a g e | 17

VI. Local Maternal Health

The researcher selected the following indicators to further study the current status of

maternal health in the locality; namely (1) maternal mortality ratio and proportion of births

attended by skilled health personnel in correspondence to Target 5.A. and (2) the contraceptive

prevalence rate for Target 5.B.

Maternal Mortality (Indicator No. 1)

TABLE 5.1 and 5.223

MATERNAL MORTALITY RATIO 2002-2018 PER 100,000 LIVEBIRTHS

2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
0 50 100 150 200 250 300

23
[MCHN Indicator DOH]. (n.d.). Unpublished raw data. Maternal Mortality Ratio 2002-2018 per 100,000 Livebirths
 P a g e | 18

YEAR NO.OF MATERNAL DEATHS MMR

2002 17 69.26
2003 15 63.52
2004 12 50.04
2005 13 53.7
2006 17 73.9
2007 24 101.15
2008 27 105.82
2009 29 115.07
2010 19 77.72
2011 16 68.17
2012 29 125.84
2013 16 68.83
2014 24 90.5
2015 28 145.58
2016 26 100.89
2017 29 115.56
2018 35 242.26

Table 5.2 shows us that in a span of 16 years there wasn’t a progressive increase or

decrease in the number of maternal deaths but rather a constant scuffle between the two.

However, in 2018 there was an increase from an MMR of 115.5 in 2017 to 242.2 in 2018, a very

significant increase within the period of one year. The DOH in Dumaguete did not provide a

concrete explanation for this sudden increase; however, it could’ve been attributed to common

factors such as disease-related causes or a surge in teenage in pregnancy.

Furthermore, Dr. Edgardo Barredo, head of the Provincial Nutrition Council, said one of

the factors that contribute to the maternal mortality rate in Negros is poor nutrition. Based on

surveys conducted, majority of the mothers who died after childbirth had poor nutrition24.

24
Aranas, M. (2018, July 31). IPHO Targets Lower Maternal Mortality Rate [Metro Post]. Retrieved March 7, 2019,
from http://dumaguetemetropost.com/ipho-targets-lower-maternal-mortality-rate-p1585-338.htm
 P a g e | 19

Number of Skilled Birth Attendants (Indicator No. 2)

TABLE 5.325

YEAR NO.OF BIRTHS ATTENDED BY SBA

2002 23,865
2003 22,755
2004 23,093
2005 22,830
2006 21,933
2007 18,110
2008 16,285
2009 16,244
2010 16,593
2011 18,003
2012 17,770
2013 18,548
2014 20,532
2015 14,123
2016 21,441
2017 21,401
2018 11,463

Table 5.3 gives us a detailed view on the number of births attended by skilled health

personnel in Dumaguete from 2002 – 2018. As manifested in the data above, there has been a

slow decrease in birth attendants from 23,865 in 2002 to just 11,463 in 2018.

Theoretically speaking, this phenomenon could be attributed to the growing concern on

healthcare professional shortages happening in our country. Healthcare workers, consisting of

doctors, nurses, midwives, and community health workers are driven to seek greener pastures

elsewhere that offer higher wages, more benefits and better career opportunities26.

25
[MCHN Indicator DOH]. (n.d.). Unpublished raw data. Maternal Mortality Ratio 2002-2018 per 100,000 Livebirths
26
Shortage of health professionals in the Philippines, a growing concern. (2017, February 21). Retrieved from
http://www.healthcareasia.org/2017/shortage-of-health-professionals-in-the-philippines-a-growing-concern/
 P a g e | 20

WHO, which acknowledges in its 2013 report, Migration of Health Workers, also

indicates the need to address this issue in policy level, because, first of all, the unequal

distribution of healthcare providers across the globe could have detrimental effects, especially in

a provincial level where healthcare is already in short supply to begin with.

Contraceptive Prevalence Rate (Indicator No. 3)

TABLE 5.4 and 5.627

CONTRACEPTIVE PREVALENCE RATE 2002-2018

120

100

80

60

40

20

27
[MCHN Indicator DOH]. (n.d.). Unpublished raw data. Maternal Mortality Ratio 2002-2018 per 100,000 Livebirths
 P a g e | 21

YEAR CONTRACEPTIVE PREVALENCE RATE

2002 101
2003 91
2004 95
2005 59
2006
2007 47
2008 47
2009 49
2010 47
2011 48
2012 51
2013 52
2014 41
2015 53
2016 52
2017 54
2018 55

Ironically, contraceptive prevalence rates have been higher in the years between 2002 to

2004, when contraceptive use should’ve gone more rampant in the recent years due to

modernization and less conservatism in the society. In the years of 2008 up to 2018, the

numbers are more or less the same, recorded around the range of 47-55. From this data, we can

conclude that contraceptive use in the local scene still has a long way to go.

However, it should not be disregarded due to the various detrimental effects of unsafe-

sex, especially in a university town like Dumaguete. Low contraceptive prevalence rates may

bring with it diseases such as HIV/AIDS and increase the number of unwanted pregnancies,

which later on may cause abortions and maternal deaths.

 P a g e | 22

VII. Programs and Policies

National

 National safe motherhood program (DOH)

Objectives:

Collaborating with Local Government Units in establishing sustainable, cost-effective

approach of delivering health services that ensure access of disadvantaged women to

acceptable and high quality maternal and new-born health services and enable them to

safely give birth in health facilities near their homes

Establishing core knowledge base and support systems that facilitate the delivery of

quality maternal and new-born health services in the country.

Program Accomplishments/Status:

The Department of Health through the National Safe Motherhood Program shall continue

to update its strategies to address critical reproductive health concerns including control

of sexually transmitted infections and mother to child transmission of HIV while

confronting both demand and supply side obstacles to access for disadvantaged women

including indigenous women of reproductive age.

 Republic Act No. 10354: Responsible Parenthood and Reproductive Health Law (RPRH

Act of 2012)

An Act providing for a National Policy on Responsible Parenthood and Reproductive

Health

 National Safe Motherhood Program

A. Local Delivery of the Maternal–New-born Service Package

 P a g e | 23

o Establishment of critical capacities to provide quality maternal–new-born services

through the organization and operation of a network of Service Delivery Teams

o Establishment of Reliable Sustainable Support Systems for Maternal–New-born

Service Delivery

B. National Capacity to Sustain Maternal–New-born Services

o Operational and Regulatory Guidelines

o Network of Training Providers

o Monitoring, Evaluation, Research, and Dissemination with support from the

Epidemiology Bureau and Health Policy Development and Planning Bureau

*Source for Programs and Policies: (see footnote)28

Local

 Reaching Every Purok (REP) Program

1. Puts the focus on the barangay at the purok, block and sitio level to reduce the

immunity gap in high risk puroks (sub-villages)

2. The strategy includes door-to-door monitoring of vaccination status, which is

designed for densely- or highly-populated areas,

3. Aside from ensuring the safety of mothers, the DOH also has a program to reduce

the probability of infancy deaths due to lack of immunization.

4. The health facilities established in villages will also extend services to provide the

services to babies and children.

28
DOH Maternal Health Programs. (n.d.). Retrieved March 7, 2019, from https://www.doh.gov.ph/national-safe-
motherhood-program
 P a g e | 24

*Source for Local Programs and Policies: (see footnote)29

VIII. Remaining Challenges

Maternal health refers to the health of women during pregnancy, childbirth and the

postpartum period. While motherhood is often a positive experience, for too many women it is

associated with suffering, ill-health and even death. The major direct causes of maternal

morbidity and mortality include haemorrhage, infection, high blood pressure, unsafe abortion,

and obstructed labour. The high number of maternal deaths in some areas of the world reflects

inequities in access to health services, and highlights the gap between rich and poor.

Some of the remaining challenges in achieving Millennium Development Goal No. 5

includes; (1) Lack of facilities and funding – few sub-districts have a health post, the lack of

funding mostly leads to deprioritizing the establishment of such facilities that could potentially

extend the services needed to achieve the ideals of said MDG, (2) Shortage of health-care

providers – healthcare workers, namely the doctors, nurses, midwives, and community health

workers are driven to work abroad due to higher wages, more benefits and better career

opportunities, (3) Poverty and overpopulation – the scarcity of resources due to poverty often

leads to poor nutrition, which is detrimental, especially to a nursing mother, one of the leading

causes of maternal death in the Philippines is poor nutrition. Some other challenges faced by the

improvement of maternal health are the (4) lack of information dissemination regarding

reproductive health and (5) spread of diseases such as measles and HIV/AIDS.

29
Philippine Ambulatory Pediatric Association, Inc. (PAPA) - A member of the Philippine Pediatric Society - Projects.
(n.d.). Retrieved March 7, 2019, from https://papainc.org/projects.do?id=25507. Philippine Ambulatory Pediatric
Association, Inc
 P a g e | 25

IX. Recommendations

A woman in Sub-Saharan Africa has a 1 in 36 chance of dying in pregnancy or

childbirth, compared to a 1 in 2,200 risk in a developed country – the largest difference between

poor and rich countries of any health indicator.

This glaring disparity is reflected in a number of global declarations and resolutions. In

September 2001, 147 heads of states collectively endorsed Millennium Development Goals 4

and 5: To reduce child mortality rate by 2/3 and maternal mortality ratio by 3/4 between 1990

and 2015. Strongly linked to these is Goal 6: To halt or begin to reverse the spread of HIV/AIDS,

malaria and other diseases.

The direct causes of maternal deaths are haemorrhage, infection, obstructed labour,

hypertensive disorders in pregnancy, and complications of unsafe abortion. There are birth-

related disabilities that affect many more women and go untreated like injuries to pelvic muscles,

organs or the spinal cord. At least 20 percent of the burden of disease in children below the age

of 5 is related to poor maternal health and nutrition, as well as quality of care at delivery and

during the new-born period. And yearly 8 million babies die before or during delivery or in the

first week of life. Further, many children are tragically left motherless each year. These children

are 10 times more likely to die within two years of their mothers' death.

A majority of these deaths and disabilities are preventable, being mainly due to

insufficient care during pregnancy and delivery. Only about 15 percent of pregnancies and

childbirths need emergency obstetric care because of complications that are difficult to predict.

Access to skilled care during pregnancy, childbirth and the first month after delivery is key to

saving these women's lives – and those of their children.

UNICEF responds by responding to these recommendations:

 P a g e | 26

1. Helping improve emergency obstetric care. Almost half of births in developing

countries take place without a skilled birth attendant.

2. Laying the foundations for good prenatal care.

Out of 100 women aged 15-40, 30 do not have antenatal care – 46 in South Asia

and 34 in sub-Saharan Africa. The results of this deficiency include untreated

hypertensive disorders leading to death and disability, or unmarked mal- or sub-

nutrition. Iron deficiency anaemia among pregnant women is associated with

some 111,000 maternal deaths each year. Some 17 per cent of infants in

developing countries had low birth weight in 2003,and these babies are 20 times

more likely to die in infancy.

3. Local communities should provide information to women and their families on

signs of pregnancy complications, on birth spacing, timing and limiting for

nutrition and health, and on improving the nutritional status of pregnant women

to prevent low birth weight or other problems.

A comprehensive community programme also promotes and helps provide anti-

malarial therapy and insecticide-treated bed nets. Tetanus, a bacterial disease

that’s a result of unhygienic and unsafe childbirth delivery practices, killed

200,000 new-borns and 30,000 mothers in 2001 alone.

4. Be responsive to the prevention mother-to-child transmission of HIV.

5. Getting girls to school. Helping governments provide a quality primary school

education, a UNICEF priority, also benefits maternal and infant health –

particularly education for girls. Educating girls for six years or more drastically

and consistently improves their prenatal care, postnatal care and childbirth
 P a g e | 27

survival rates. Educating mothers also greatly cuts the death rate of children

under five. Educated girls have higher self-esteem, are more likely to avoid HIV

infection, violence and exploitation, and to spread good health and sanitation

practices to their families and throughout their communities. And an educated

mother is more likely to send her children to school.

*Source for Recommendations: (see footnote)30

30
Goal: Improve maternal health. (n.d.). Retrieved March 7, 2019, from
https://www.unicef.org/mdg/maternal.html
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