Other than the factors discussed in the lecture, what do you think are other factors affecting the maternal mortality rate in the Philippines?
From 2014 to 2017, the Philippines maternal mortality rate or the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births had a decreasing trend. From 131 in 2014 which was already a 3.68% decline from 2013, to 121 in 2017 a 7.63% decline from 2014. This seem to be aligned with the Goal 3 of the Sustainable Development Goals, Good health and well-being that at 2030, the MMR should be at least less than 70 per 100,000 live births. However, the data available does not include years 2018 up to the present where there has already been huge changes in economy and most especially health care not only in the Philippines, but globally due to the Covid-19 pandemic. According to Commission on Population (PopCom) in 2021, there has been an increase in maternal deaths in the country due to the pandemic. Juan Antonio Perez III, the executive director of PopCom said that women could be part of the “collateral damage” of this health crisis. In addition, based on reports received by the commission, the increasing rates were seen in particular areas like Metro Manila, Cebu, and Zamboanga.
Because of months of intermittent lock downs on both rural and urban areas, many of the pregnant women missed their follow-up check ups with their health care provider. And because of the fact that the Covid-19 virus is easily transmissible, these pregnant women were scared of going out especially to the clinics and hospitals where Covid-19 patients are being brought to. There were times where even hospitals and clinics are not accepting any more patients due to reaching its maximum capacity rendering its full service to Covid-19 patients and those who are only critically ill. This in turn caused pregnant women to just stay at home and sometimes prefer traditional birth attendants to help them for the delivery of their child. This is despite the Maternal, Newborn and Child Health and Nutrition Strategy policy, referred to as the “no home birth” policy the country passed in 2008. With pandemic-related restrictions on transportation options like cabs and motorized tricycles, women who do not own a car have fewer choices. Home births and traditional healings or the procedures done by a local healer after birth are the usual causes of maternal and neonatal deaths, said Dr. Agnes Bernabe, an obstetrician and gynecologist. And because of the pandemic anxiety, lock down restrictions, and lack of health care facilities, some pregnant women especially in the rural areas just opt to deliver their baby at home which in turn heightens the risk for maternal mortality and morbidity.
Moreover, Philippines is a third world country, and the fact cannot be denied that a lot of people belong to the low socioeconomic class. Because of the pandemic, the socioeconomic divide became more prominent. Some people lost their jobs, some business operators decided to close their stores and businesses, and some were struggling in meeting their daily financial demands. Pregnant women belonging to this class not only cannot attend clinical check-ups but also cannot meet the appropriate nutrition necessary for the development of their child. Meeting the nutritional needs is a requirement for the mother for her to develop a healthy infant. More adverse pregnancy outcomes may occur due to limited resources leaving the poor pregnant women vulnerable. And because of the global situation, even the fathers who are working for their family is affected.
Lastly, related to maternal mortality and morbidity is the unwanted pregnancies. Due to the pandemic according to Perez again of PopCom, although the numbers are not that high, there was an increase in teenage pregnancies. Some underaged or teenage women who stopped schooling and also unemployed living with their partners, are much more likely to get pregnant given that they are forced to stay home doing almost nothing. Adolescent pregnancy is not only associated with maternal mortality and morbidity but also with higher rates of low birth weight, pre term delivery, respiratory diseases, and infant mortality. Teenage pregnancy can also contribute to poorer financial, emotional, social and health outcomes, often compounded by generally sub-optimal nutritional intake and limited access to atenatal and postnatal care. Even those who did not really stop school will be forced to leave school early which will give them lack of education about family planning and proper health care during pregnancy which may affect their future pregnancies heightening again the risk of maternal mortality and morbidity.
What are the top 3 causes of maternal mortality ratio in the Philippines? Top 3 maternal morbidity?
Top 3 causes of maternal mortality ratio in the Philippines:
1. Pregnancy complications
2. Pregnancy-induced hypertension
3. Postpartum hemorrhage
Top 3 causes of maternal morbidity in the Philippines:
1. Hemorrhage
2. Infection
3. Unsafe abortion
Adell R. (2021). As pandemic lingers, pregnant women struggle with strict COVID-19 protocols. PhilStar Global. https://www.philstar.com/headlines/2021/06/14/2105430/pandemic-lingers-pregnant-women-struggle-strict-covid-19-protocols
Bacani, X. (2020). THE CORONAVIRUS CRISIS The Philippines Has A Policy Against Home Births. It's Not Playing Well In A Pandemic. https://www.npr.org/sections/goatsandsoda/2020/10/25/925442135/the-philippines-has-a-policy-against-home-births-its-not-playing-well-in-a-pande
Chmielewska, B., Barratt, I., Townsend, R., Kalafat, E., van der Meulen, J., Gurol-Urganci, I., … Khalil, A. (2021). Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis. The Lancet Global Health, 9(6), e759–e772. https://doi.org/10.1016/s2214-109x(21)00079-6
Daquioag, J. L. (2021). What causes early pregnancy in the Philippines during the pandemic?. https://nrcp.dost.gov.ph/latest-news/683-what-causes-early-pregnancy-in-the-philippines-during-the-pandemic
Department of Health. (2013). Maternal deaths by main cause. https://doh.gov.ph/Statistics/Maternal-Deaths-By-Main-Cause
MacroTrends. (2022). Philippines Maternal Mortality Rate 2000-2022. https://www.macrotrends.net/countries/PHL/philippines/maternal-mortality-rate
Sychareun, V., Vongxay, V., Houaboun, S. et al. Determinants of adolescent pregnancy and access to reproductive and sexual health services for married and unmarried adolescents in rural Lao PDR: a qualitative study. BMC Pregnancy Childbirth 18, 219 (2018). https://doi.org/10.1186/s12884-018-1859-1