THE STATE OF HEALTH OF FILIPINO MOTHERS
Manila, July 1, 2003 (BULLETIN) With an annual population growth rate of 2.36 percent, 2.4 million Filipino women will become pregnant this year, resulting in two million full term births. This data came from the Department of Health (DoH) Safe Motherhood and Women’s Health Project. About 300,000 of these women would experience a major obstetrical complication requiring hospitalization. Forty percent or 960,000 would develop some other pregnancy and delivery related disease conditions. Of the estimated nine million married Filipino women of reproductive age in the 1998 National Demographic and Health Survey (NDHS), six million were regarded as high risk.
Maternal mortality accounts for one percent of the total deaths in the country and 14 percent of the deaths of women in the 15-49 age group. Despite a continuous downward trend from 1992-1998, maternal mortality ratios (MMR) remain high when compared to neighboring countries. Furthermore, wide variations in MMR rates among regions and provinces still exist. These services are often particularly limited in rural areas, so special steps must be taken to increase the availability of services in those areas.
At its current level, it is estimated that the lifetime risk of dying from maternal causes is about 1 in every 100 Filipino women. The main causes are preventable with family planning, routine prenatal care, attendance by trained physicians or midwives during delivery and emergency care for obstetric complications. Conditions such as anemia, diabetes, malaria, sexually transmitted infections (STIs), and others can also increase a woman’s risk for complications during pregnancy and childbirth, and thus, are indirect causes of maternal mortality and morbidity.
The 1998 National Demographic and Health Survey (NDHS) estimated the country’s maternal mortality ratio (MMR) at 172 per 100,000 live births. This is lower than the 1995 figure of 209 per 100,000 live births. The Millennium Development Goal (MDG) for the MMR is to bring it down to 105 per 100,000 live births in 2000 and to further reduce it by half to 2015.
Disparities across provinces also remain with pockets of populations that reach more than double the national rate. MMR in the Autonomous Region of Muslim Mindanao (ARMM), for example is 320, which is almost three times the rate of the more urbanized region of Metro Manila with an MMR of 119 in 1995.
Data collected by the DoH show that most maternal deaths are due to hemorrhage, hypertension and complications from sepsis or widespread infection, obstructed labor, complications arising from abortion. In the 1998 NDHS, prolonged labor was the most common complication (17 percent), followed by excessive bleeding (seven percent). Hemorrhage can result from prolonged labor, uterine rupture or early separation of the placenta from the uterine wall. Hemorrhage also occurs after miscarriage or induced abortion. Complications from unsafe abortion are a major cause of maternal mortality and morbidity in the country and is estimated to occur at the rate of 20 to 30 induced abortions per 1,000 women aged 15-49 or about 400,000 abortions per year.
The risk of maternal death is linked to the characteristics of women. According to the 1998 NDHS, over 60 percent of all pregnancies in the country are considered high risk. The age of the mothers seems to be a strong determinant, with the very young (less than 18 years old) and the older groups (more than 35 years old) facing the likelihood of death. Other risks for pregnant women are: height of less than 145 cm., having a fourth or more babies, history of complicated childbirth, such as previous cesarean section, three consecutive miscarriages, or a still born baby, and medical conditions such as tuberculosis, heart disease, diabetes, bronchial asthma and goiter. The high incidence of high risk births, inadequate prenatal care and lack of information and means to manage complications in difficult pregnancies account for much of the increased risks of dying during pregnancy and childbirth.
Overall, there have been modest gains that have been achieved on factors related to risks of maternal mortality. There is still so much more to be done in family planning, provision of prenatal care, access to safe delivery services by trained and skilled health personnel and professionals, provision of post natal care, micronutrient supplementation, tetanus toxoid immunization, breastfeeding advisory, access to potable water supply and sanitary toilet facilities.
So, do you have a woman friend, relative, neighbor or officemate who is pregnant today? You and all of us have a role to play to safeguard her pregnancy, her delivery and post-birth condition by encouraging them to seek quality maternal health care. Remember, every minute four to five Filipino women get pregnant; every minute, four of them will deliver a child; but also every other minute, one Filipino woman would have her child aborted. Let us uphold the right to health of every Filipino mother.
Dr. Jaime Z. Galvez Tan M.D., M.P.H is the Vice Chancellor for Research of U.P. Manila and concurrent Executive Director of the National Institutes of Health Philippines. He is also president of Health Futures Foundation Inc. He holds clinic at the PGH Traditional and Integrative Medicine Clinic every Tuesday and Thursday. Call 521 8450 local 3953 and 3170 c/o Irene Sulla. Do drop a line, say hello, ask a question or give comments via e-mail: firstname.lastname@example.org. Or write a letter to the Manila Bulletin Health and Science Section or Health Futures P.O. Box 13, U.P. Diliman, Quezon City 1101.
Reported by: Sol Jose Vanzi
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