No urgency, no outrage

Last month, in October, I gave a presentation to the Human Development and Poverty Reduction Cluster, composed of the secretaries of the Department of Health, the Department of Social Welfare and Development, the Department of Environment and Natural Resources, the Department of the Interior and Local Government, the National Economic and Development Authority, and other commission executive directors.

I pointed out that the decline of maternal mortality ratio in our country is scandalously slow. Since 1990 and up to 2010, our maternal mortality ratio experienced an average annual decline of -1.19% to -1.2%. This roughly translates into about 4,288 women dying every year from complications related to pregnancy and childbirth. Put another way, from 1990 to 2010, about 50,349 to 86,221 women have already died. If we have to be dramatic about these figures, that’s about 287 jet crashes, without any survivors.

I continued my presentation, and I thought, since this is the Human Development and Poverty Reduction cluster, it should start with human beings, with women who could die during pregnancy and childbirth. When women die, their newborns face dim prospects.  They could die with them, or become sickly, or die within a year or so after childbirth.

So if we want to achieve our goal to reduce maternal deaths by 2/3rd by 2015, we should prevent at least 14,520 women’s deaths in 5 years’ time. And we should have started in 2011. But it’s not too late.

I explained why women continue to die during pregnancy and childbirth in our country. Women don’t have access to life-saving obstetric services. Access could mean that health facilities and hospitals don’t provide the full range of services because they might not be capable of doing so. For example:

    •    Medical doctors, nurses, and midwives are not competent and skilled enough to manage a complication.
    •    There isn’t any available anesthesiologist.
    •    There just isn’t enough blood.
    •    Drugs are not available.
    •    There isn’t enough equipment and the autoclave, the machine that sterilizes the equipment, isn’t working.
    •    The district or provincial hospital is several kilometers away, over unpaved roads, and there isn’t any available ambulance or jeep.
    •    Political leaders and bureaucrats simply don’t think saving women from life-threatening complications during pregnancy is problematic enough to be a priority.

Women treated badly

But from the perspective of women, access could mean various things. 

Health staff in hospitals treat them disrespectfully. Shouting at them and making judgments about them, especially women who’ve had 5 or more pregnancies, are common occurrences. Reporting women who seek post-abortion care to the police happens, despite a DOH administrative order on the prevention and management of abortion complications. Medical clerks or health staff perform vaginal examinations on them frequently, without any thought as to how they feel and how this increases their risk of infections.

And so, it doesn’t really come as a surprise when women refuse to deliver in hospitals and that they would rather give birth at home, assisted by hilots.

But then, nobody is accountable when a woman dies during pregnancy and childbirth. Not the medical doctor or nurse or midwife. Not women’s groups. Not health NGOs. Not PhilHealth. Not professional medical groups. Not provincial and municipal health officers. Not mayors and governors. Not the DOH. Not Congress. And not PNOY. So, why should anybody care?

The World Bank says that access to family planning could reduce maternal deaths by 25% to 40%. Contraceptives are important in this sense. But once a woman gets pregnant, contraceptives won’t alter the outcome of pregnancy because she’s pregnant already.  Either she has a normal delivery; or she acquires a complication during pregnancy and childbirth; or she dies, if she doesn’t get treated immediately; or if she doesn’t die and she survives the complications, she could be disabled. And her quality of life is affected, depending on the disability that she has.

What should be done

I told the Cabinet members what we should do.

Just focus on four priorities: a) immediately assess the capabilities and effectiveness of health facilities and hospitals all over the country in providing life-saving emergency obstetric services; b) then make plans and act on the basis of these assessments that focus on making services available, i.e., evidence-based contraceptives and obstetric services; c) make hospitals and health facilities accessible to women, bearing in mind what women think about “access”; and d) persuade, exhort, urge, cajole, entice, “incentivize” local government units to make saving women’s lives a priority.

Women don’t have to die because we already know what to do. We have the evidence, the experience, and the tools. We should just do what needs to be done so that women would have access to life-saving obstetric services. And we should do this – now! -

(Marilen J Danguilan, a medical doctor, worked with WHO Western Pacific Region Office and UNFPA New York on family planning and maternal death reduction. She was once the UNICEF Global Senior Adviser in Maternal Health. She is now an independent consultant.)