MANILA, Philippines –  The Philippines is making progress in maternal health but needs to accelerate improvements, said the executive director of the United Nations Population Fund (UNFPA) who is in the Philippines to meet with government officials, including President Benigno Aquino III. 

“The Philippines is not the worst place for maternal health, but there is a need to accelerate the rate of progress,” said UNFPA executive director Dr Babatunde Osotimehin during his Philippine visit to tackle maternal health.

Osotimehin also noted President Benigno Aquino III’s seeming support for the Reproductive Health (RH) bill, which the influential Catholic Church has consistently urged Aquino not to sign. 

“My impression from the meeting with the President is that he is committed to the RH bill. He is talking about country development on the basis of RH rights and the ability of people to make decisions for themselves,” said Osotimehin.

‘Unlikely’ MDG

The reduction of maternal deaths is one of the Millennium Development Goals (MDG), a set of 8 international development goals that 193 UN member states have agreed to meet by 2015.

In the Philippines, it is one of the MDGs least likely to be met, according to experts. 

Based on the 2006 Family Planning Survey, the Philippines has a recorded maternal mortality ratio (MMR) of 162 deaths per 100,000 live births. The goal, on the other hand, is to lower the MMR to 52-55 deaths per 100,000 live births.

The main causes of maternal death are hemorrhage, sepsis, obstructed labor, hypertensive disorders in pregnancy, and complications of unsafe abortion – most of which are highly preventable with proper pre-natal care and the presence of a skilled birth attendant during delivery.

“The government is putting money into health and prioritizing it,” added Osotimehin. “There is an increase in the health care budget, an increase in health care practitioners, more health facilities, and a conditional cash transfer (CCT) that has been put into place to make health care more accessible.”

CCT program

The CCT program, or Pantawid Pamilyang Pilipino Program (4Ps), is a social assistance program that gives cash assistance to extremely poor households. Positioned as a conditional cash grant, recipients are given monthly cash grants that range from P500 to P1,400 per household, depending on the number of eligible children.

In exchange, the family is required to meet certain requisites like sending their children to school and availing of healthcare services. Expectant mothers, in particular, are expected to get regular pre- and post-natal check-ups, and professional health personnel must be present during the delivery.

An estimated 3 million people are enrolled in the CCT program. The number of beneficiaries is expected to go up to 5 million in 2016.

“Maganda ‘yung conditional cash transfer ngayon kasi mayroon na siyang kondisyon na pre-natal at saka mag-attend ng session ng family planning,” said Lina Bacalando, a community health worker at Likhaan Center for Women’s Health, a women’s NGO that provides RH care and services in the most depressed areas in Manila like Vitas, Baseco, and Tondo. (The conditional cash transfer program is better now because it comes with a condition to undergo a pre-natal check-up and to attend a family planning session.)

Addressing inequity

The CCT is seen as one concrete way to address the inequity between the rich and the poor, which has been shown to have a direct correlation to maternal health.

The National Demographic Health Survey of 2008 reported that 70% of births take place at home, and 94% of women in the richest quintile has a skilled birth attendant (SBA) during their delivery, while only 26% of women have SBA present. 

According to a study published by the Guttmacher Institute, a US-based reproductive health think-tank, the poorest women (those whose households fall under the lowest wealth quintile) have about two more children than they want, while those in the richest quintile have only 0.3 more children than they want.

The report also said that only 41% of the poorest women use contraceptives, compared with 50% of the wealthiest.

“There are 3 things that we need to focus on to prevent maternal deaths: access to emergency obstetric care, availability of these services, and the affordability of these services. It is crucial that family planning services reach the poor,” said Ugochi Florence Daniels, the UNFPA country representative to the Philippines.

According to a cost-benefit analysis presented by the UNFPA, the government stands to have $5 in health care and capital expenditure for every $1 spent on maternal health.

Maternal health a global concern

The report “Trends in maternal mortality: 1990 to 2010” shows that from 1990 to 2010, the annual number of maternal deaths dropped from more than 543,000 to 287,000 – a decline of 47%.

According to the report, while substantial progress has been achieved in almost all regions, many countries particularly in sub-Saharan Africa will fail to reach the MDG target of reducing maternal death by 75% from 1990 to 2015. – Rappler.com