The challenges of maternal health in PH

Poor, unemployed mothers' struggle to find ways of putting a meal on their table is constant, and their health and that of their children take the back seat

Diego is now a healthy, bright, and curious 3-year old boy. I remember the wonderful time I was pregnant with him. I did not have to worry about having my regular prenatal visits and giving birth in a hospital in Metro Manila.

And after childbirth, I had postpartum visits including family planning counselling and essential newborn care. I have religiously brought my son to a doctor for the required basic immunization. I am gainfully employed, have health insurance, and access to quality health services for mothers and babies. 

Metro Manila boasts of world-class modern facilities that mainly the wealthy and middle class families have easy access to for quality and affordable maternal and child health services. However, this is not always the case for poor families. 

My work on maternal and child health in marginalized communities in Metro Manila brings me up close and personal to the everyday struggle of poor, unemployed mothers with usually 4 or more young children. The struggle to find ways of putting a meal on their table is constant, and more often than not, their health and that of their children take the back seat. It is a stark contrast to what I take for granted as one of the basic rights of a mother and her child to live in a safe and healthy environment. 

These poor urban mothers are highly at risk of dying due to pregnancy and childbirth because of lack of access to quality health services. These are mothers, including teenagers as young as 13, who experience unplanned pregnancies, lack adequate prenatal care, give birth at home with no skilled birth professional in attendance and have no access to basic emergency obstetric and neonatal care, and have no postpartum care.

Poor urban children are twice as likely to die due to treatable and preventable causes compared to those from wealthy families. 

A spark of hope

In my work, I get to listen to the people behind inspiring stories who unceasingly assist vulnerable mothers and children to access basic health care. They are committed community health workers and volunteers who do regular home visits and face-to-face counselling to pregnant and lactating women to ensure healthy pregnancy, safe delivery and appropriate care for newborns such as  the importance of exclusive breastfeeding. They are barangay (village) leaders who are passionate in learning and addressing children and women’s issues by supporting projects and implementing local policies on maternal and child health and nutrition, women’s empowerment, and livelihood. 

Over the years, Metro Manila has seen progress for services and programs for mothers and children through the national social protection program called the Pantawid Pamilyang Pilipino Program or 4Ps, public-private partnerships, inter-city health agreements and referral system, strengthening of frontline workers, and healthcare innovations in local government units.

Despite this, however, it remains a challenge for local government units to consistently put children and women on their agenda given the possible change in leadership every 3 years. A change in leadership more often translates to a change in local priority programs and policies.

There is therefore a need to persistently advocate for children and women concerns among local elected officials, community leaders and public health program implementers to become aware of pressing issues, sustain health and nutrition programs, and buy in to the importance of saving children’s and women’s lives. 

Meeting MDG 4 and 5 targets

The Philippines has made significant improvement in the lives of children. Based on the progress made for Millennium Development Goal (MDG) 4 on reducing child mortality, under-5 mortality declined from 80 deaths in 1990 to 30 deaths per 1,000 live births in 2011. This is an indication that the country will more likely meet its 2015 MDG target of 27 deaths per 1,000 live births. 

A Filipino mother and her child eat their lunch while waiting for their ship back to their provinces in Port Area, Manila, Philippines on 07 January 2010. Slightly fewer Filipinos look forward to 2010 with hope after experiencing a series of tragedies in 2009, among them epic floods in Metro Manila and Luzon, a survey by the Social Weather Stations (SWS) showed. The survey, conducted from 05 to 10 December 2009, found that while nine out of 10 Filipinos were hopeful, the rate was lower than in the previous three years. Photo by Dennis M. Sabangan/EPA

Similarly, infant deaths or deaths of children below one year old decreased from 25 to 22 deaths per 1,000 live births – which is also close to the 2015 MDG target of 19 deaths per 1,000 live births.  However, almost half of the infant deaths are neonatal deaths, or fatalities occurring within the first 28 days of life, which show a slow decline in reduction from 18 to 14 per 1,000 live births from 1993 to 2011. 

It is a different story for the lives of Filipino mothers. Maternal deaths remain high at 221 per 100,000 live births in 2011, making it unlikely for the country to reach the 2015 MDG 5 target of 52 deaths per 100,000 live births. Mothers are dying due to delays in deciding to seek medical attention, delays in reaching appropriate care facility, and delays in receiving quality services at health facilities.

The universal access to basic reproductive health services is unlikely to be achieved as the contraceptive prevalence rate for modern family planning methods remains at 50 percent, far from the 2015 target of 63 percent. 

A current worrying concern is also the increasing trend in teenage pregnancy – one in 10 girls aged 15 to 19 is already a mother.

The country’s universal health care strategy called Kalusugan Pangkalahatan and the national social protection program (4Ps) have been significant in improving the health and nutrition status of marginalized mothers and children by focusing on the poor to have health insurance coverage through PhilHealth and access to affordable and quality health benefit packages such as basic maternity and newborn care services.

The recently approved implementation of the Reproductive Health Law will also play a very crucial role in this as it will provide universal access to quality, appropriate and affordable reproductive healtcare serviceand information including family planning options that will benefit women, mothers, children, families, and communities. 

Challenges remain but it is important that we keep moving forward for Filipino women and children. – Rappler.com

Kit Oñate, a mother to a 3-year old boy, is the project coordinator of Save the Children’s maternal health project in Metro Manila. For over a decade, she has been involved in policy advocacy to help advance children and women’s rights including the landmark law on reproductive health in the Philippines that addresses preventable maternal and newborn deaths.

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