1. Other than the factors discussed in the lecture, what do you think are other factors affecting maternal mortality rate in the Philippines?
The factors that were discussed in the lecture that affect the country’s mortality rate ratio are lack of access to adequate antenatal care during pregnancy, lack proper delivery care during labor, and the lack of post-partum care. But aside from these, other factors that contribute to maternal mortality rate in the Philippines include governance (adequate healthcare funding & healthcare subsidies), poverty (i.e. woman’s socioeconomic status), economic policies (i.e. privatization of healthcare services), education (i.e. reproductive and sexual education such as the use of contraceptives), and sociocultural policies (i.e. illegal abortion); wherein these given factors are also drivers of the inequities in access to and quality of sexual, reproductive, maternal, and newborn health.
In the lecture, maternal mortality rate has been mentioned as a “good sensitive indicator of a country’s healthcare status” as not only does it reflect the country’s national healthcare system, but also its socioeconomic development, as well as its environmental, cultural, and political structure (Sajedinejad, 2015). As such, one major factor that affects maternal mortality rate in the Philippines is the lack of adequate funding for the health sector that is also exacerbated by privatization of health facilities and services, resulting to a system where health is treated as a commodity rather than a service (NOP, 2012).
On a macro-scale, this factor can be attributed to the national government’s lack of allocation of human and financial resources to reach underserved populations in the Philippines and increase the overall availability of maternal and newborn health services. This lack of allocation also includes the lack of prioritization in formulating pro-poor policies such as health insurance and healthcare subsidies that can increase the access of health care services of Filipino women to maternal and childcare (Sajedinejad, 2015; Ruiz-Cantero et. al, 2019). An example of this is revealed in a study conducted by Japan International Cooperation Agency (JICA) wherein 63 barangays in 3 Cordillera provinces namely: Benguet, Abra, and Apayao, have not allocated for maternal and newborn emergencies in their annual budget which implies that pregnant women, especially those who belong to indigent families, may lack medical or financial support in times of emergencies (Lacsamana, 2016).
Another factor affecting maternal mortality rate is the household income or the socioeconomic standing of Filipino women, which is regarded as a crucial contributor to the inequalities in the use of maternal and child health services due to a healthcare system that provides services according to an individual’s capability to afford the said services (Paredes, 2016). Because of this, Filipino women especially those who belong to low-income households and marginalized communities find it difficult not only to access health services, but also sustain conditions necessary to ensure positive pregnancy outcomes such as getting proper nutrition and having an environment free from toxicants due to their insufficient financial resources (DOH, 2008).
On a different note, sociocultural policies such as illegal abortion in the Philippines is also a significant factor to maternal mortality rates. Data from DOH (2013) shows that postpartum hemorrhage and severe abortive outcomes are the leading causes of maternal deaths in the country; And it may be argued that abortion occurs due to unwanted pregnancies. Although unwanted pregnancies may be combated through proper education on sexual and reproductive health and the use of contraceptives, cultural and religious beliefs remain a barrier to the accessibility and acceptability of these health services especially in a predominantly Catholic country like the Philippines (Ruiz Austria, 2004).
Taken altogether, we can infer that the factors affecting maternal mortality ratio in the Philippines must be viewed holistically as these factors often stem from complex societal problems rather than individual choices of Filipino women alone. After all, recognizing the root problems that cause maternal mortality is an imperative step in designing and developing multifaceted solutions to decrease it.
2. What are the top 3 causes of maternal mortality ratio in the Philippines? Top 3 maternal morbidity?
The top three (3) causes of maternal mortality ration in the Philippines are: (1) complications related to pregnancy, occurring in the course of labor, delivery, and puerperium, (2) hypertension complicating pregnancy, and (3) post-partum hemorrhage. Meanwhile, the top three (3) causes of maternal morbidity ratio in the Philippines in a descending order are: hemorrhage with an incidence rate of 31%, infection with a rate of 19%, and unsafe abortion with an incidence rate of 16%.
References:
DOH. (2008). Health Policy Notes: Accelerate a unified strategy to save mothers, newborns, and children Majority of maternal and newborn deaths occur during labor, delivery, and the immediate post- partum. Retrieved from https://doh.gov.ph/sites/default/files/publications/Vol1Issue2April2008_3.pdf
DOH. (2013). Maternal Deaths By Main Cause. Retrieved from https://doh.gov.ph/Statistics/Maternal-Deaths-By-Main-Cause.
Lacsamana, H. (2016). 63 brgys allot no funds for maternal, newborn crises. Retrieved from Baguio Midland Courier website: http://baguiomidlandcourier.com.ph/archiveview.asp?mode=%20archives/2016/january/1-31-2016/front1.txt
NOP (2012). Privatization: A Tool of Oppression. http://notoprivatization.blogspot.com/2012/10/privatization-tool-of-oppression.html.
Paredes, K.P.P. Inequality in the use of maternal and child health services in the Philippines: do pro-poor health policies result in more equitable use of services?. Int J Equity Health 15, 181 (2016). https://doi.org/10.1186/s12939-016-0473-y
Ruiz Austria, C. S. (2004). The Church, the State and Women’s Bodies in the Context of Religious Fundamentalism in the Philippines. Reproductive Health Matters, 12(24), 96–103. https://doi.org/10.1016/s0968-8080(04)24152-0
Ruiz-Cantero, M. T., Guijarro-Garvi, M., Bean, D. R., Martínez-Riera, J. R., & Fernández-Sáez, J. (2019). Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries. Health & place, 57, 313–320. https://doi.org/10.1016/j.healthplace.2019.05.012
Sajedinejad, S., Majdzadeh, R., Vedadhir, A., Tabatabaei, M. G., & Mohammad, K. (2015). Maternal mortality: a cross-sectional study in global health. Globalization and health, 11, 4. https://doi.org/10.1186/s12992-015-0087-y