Other than the factors discussed in the lecture, what do you think are other factors affecting maternal mortality rate in the Philippines?
It is common knowledge how the COVID-19 has affected us all, not only in the Philippines. A significant economic impact due to the reduction of businesses and workforce and a huge comprise to healthcare with the rising number of positive cases, deaths but with a decreasing number of frontliners and medical supplies. Focusing on maternal health, pregnant women and mothers have the same risk for COVID-19 infection compared to people who are not pregnant. However, outside of direct infection, the impact of the pandemic and pandemic-control policies on societies, and the global economy has brought a significant increase in the maternal mortality rate (MMR) in the country. To be exact, the maternal mortality cases in 2020 can increase to up to 26% additional deaths from 2019 (Regala, 2020). There is the factor of possible adverse effects of the infection itself to both the mother and the baby. Studies have shown that pregnant participants were more likely to be admitted to the ICU, to be intubated, to require mechanical ventilation, and were at increased risk of composite morbidity (Zambrano et. al, 2020). There has also been an increase in maternal mental health issues and domestic violence for women are more likely to be stuck with the abusers at home, increasing the risk for miscarriage. Women were more likely to lose their income due to the pandemic than men, and working mothers struggled with increased childcare demands (Kotlar et. al, 2021). With how infrastructures were strained, and potentially harmful policies implemented, the increase in MMR is no surprise.
Another factor to consider is the socioeconomic status of the family. Some low-income countries (LICs) have more than 100 times the maternal mortality ratio than high-income countries (HICs) caused by pre-eclampsia/eclampsia (Goldenberg, 2011). According to statistics (Papp & Kleiman, n.d), high maternal morbidity and mortality have been found in rural, isolated regions/communities that exist far from the country’s capital and urban centers. Their distance from a health facility and Prevalent poor birthing practices including home births or births without a skilled birth attendant increases their risk for infections, hemorrhage, miscarriages, and eventually death of the mother. This is because medical services such as medication, laboratory fees, and midwife/physician fees are too costly. There is also the judgment towards unconventional families especially on the mother therefore they are hesitant in going to hospitals. These can also be due to a lack of patient education. There is a prevalent number of unwanted teenage pregnancies in the Philippines (67% increase from 2019) because they do not use contraception (Regala, 2020).
What are the top 3 causes of maternal mortality ratio in the Philippines? Top 3 maternal morbidity?
According to the Department of Health (2013), the top 3 main causes of maternal mortality ratio in the Philippines are:
- Complications related to pregnancy occurring in the course of labor, delivery, and puerperium
- Hypertension complicating pregnancy, childbirth, and puerperium
- Postpartum hemorrhage
According to Papp & Kleiman (n.d), the top 3 main causes of maternal morbidity and mortality in the Philippines is:
- Poor Access to Health Care Services – specifically poor birthing practices leading to hemorrhage, infections, etc.
- Poverty – Lack of funds for medical services, laboratory fees, medication
- Geographic Isolation – statistics have shown that isolated regions/communities that exist far from the country’s capital and urban centers have a higher morbidity and mortality rate
References:
Dept. of Health (2013). MATERNAL DEATHS BY MAIN CAUSE. Retrieved from https://doh.gov.ph/Statistics/Maternal-Deaths-By-Main-Cause
Goldenberg, R. L., McClure, E. M., Macguire, E. R., Kamath, B. D., & Jobe, A. H. (2011). Lessons for low-income regions following the reduction in hypertension-related maternal mortality in high-income countries. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 113(2), 91–95. https://doi.org/10.1016/j.ijgo.2011.01.002
Kim, M. K., Lee, S. M., Bae, S.-H., Kim, H. J., Lim, N. G., Yoon, S.-J., Lee, J. Y., & Jo, M.-W. (2018). Socioeconomic status can affect pregnancy outcomes and complications, even with a universal healthcare system. In International Journal for Equity in Health (Vol. 17, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12939-017-0715-7
Kotlar, B., Gerson, E., Petrillo, S., Langer, A., & Tiemeier, H. (2021). The impact of the COVID-19 pandemic on maternal and perinatal health: a scoping review. In Reproductive Health (Vol. 18, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12978-021-01070-6
Papp, L., Kleiman, M. (n.d). Maternal Morbidity and Mortality. Retrieved from http://philippineshealthdata.blogs.wm.edu/sample-page/maternal-morbidity-and-mortality/#
Regala, A. (2020). Significant rise in maternal deaths and unintended pregnancies feared because of COVID-19, UNFPA and UPPI study shows. Retrieved from https://reliefweb.int/report/philippines/significant-rise-maternal-deaths-and-unintended-pregnancies-feared-because-covid#:~:text=MANILA%2C%20the%20Philippines%20%2D%2D%20The,years%2C%20a%20study%20by%20the
Zambrano, L. D., Ellington, S., Strid, P., Galang, R. R., Oduyebo, T., Tong, V. T., Woodworth, K. R., Nahabedian, J. F., III, Azziz-Baumgartner, E., Gilboa, S. M., Meaney-Delman, D., Akosa, A., Bennett, C., Burkel, V., Chang, D., Delaney, A., Fox, C., Griffin, I., … Hsia, J. (2020). Update: Characteristics of Symptomatic Women of Reproductive Age with Laboratory-Confirmed SARS-CoV-2 Infection by Pregnancy Status — United States, January 22–October 3, 2020. In MMWR. Morbidity and Mortality Weekly Report (Vol. 69, Issue 44, pp. 1641–1647). Centers for Disease Control MMWR Office. https://doi.org/10.15585/mmwr.mm6944e3