- Other than the factors discussed in the lecture, what do you think are other factors affecting maternal mortality rate in the Philippines?
Historically, the leading causes of maternal morbidity and mortality have often been related to delivery (i.e. hemorrhage, infection, and unsafe abortion). But in order to make a comprehensive assessment of the factors affecting maternal mortality rate through a multidimensional lens, we must recognize the social determinants and systemic problems that predispose women at risk for maternal mortality.
- The prevalence of pre-existing chronic conditions among childbearing women, pregnant women, and mothers is linked to negative health outcomes for both mothers and babies. Chronic conditions like heart diseases or diabetes can lead to life-threatening complications, especially among poor women and those living in far-flung communities.
- Recent studies have related mental health problems as a cause for concern because they may directly and/or indirectly increase the risk for maternal morbidity. Since mental health problems often go undiagnosed, many issues such as fatigue and anxiety are commonly associated with motherhood or pregnancy itself and the gender stereotype (e.g. women as “emotional”). Both pregnant women and mothers with mental health problems usually have poor physical health and persistent high-risk behaviors such as substance abuse, putting them at an increased risk of obstetric complications and preterm labor. They are less likely able to adequately take care of their own needs, seek or receive antenatal or postnatal care, and adhere to the prescribed health regimens. And although mental health has emerged as a public health concern just in recent years, mental health needs are still unmet. Likewise, so much is still needed to be done to ensure proper and accessible mental health promotion, care, and promotion for all. Efforts to improve maternal health fall under the Sustainable Development Goal 3: Good Health and Wellbeing, and it should include measures to prevent and manage mental health problems during pregnancy until after childbirth. Mental health should be incorporated as one of the integral components of maternal health plans and policies in the country. This approach includes integrating mental health into ongoing maternal health services and implementing community-based interventions while strengthening the basic healthcare system.
- Maternal morbidity can also be attributed to ill-equipped medical facilities, overworked yet underpaid healthcare professionals (or lack thereof), scarcity in resources, underfunded healthcare sector, significant gaps in the educational curriculum (including patient & family education), and above all, lack of access to even the most basic healthcare services—all of which have been exposed and further exacerbated during the pandemic.
The maternal morbidity and mortality ratio is a public health indicator that reflects the quality of healthcare services. Just by the looks of the abovementioned problems, it would be an understatement to say that the healthcare system in the country is handicapped. There is no single root cause for the high incidence of maternal mortality as these are all interconnected, which means that until we address ALL of the contributing factors, we will never get even close to achieving SDG 3.
- What are the top 3 causes of maternal mortality ratio in the Philippines? Top 3 maternal morbidity?
According to the Philippine Statistics Authority (2015), the top 3 causes of maternal mortality in the Philippines are eclampsia with 337 deaths, gestational pregnancy-induced hypertension with significant proteinuria with 292 deaths, and abnormalities of forces of labor with 2016 deaths.
Meanwhile, the leading causes of maternal morbidity are hemorrhage, infection, and unsafe abortion, respectively. In many cases, unsafe abortion can also be associated with hemorrhage and infection, ultimately leading to death. More importantly, it is worth noting that unsafe abortion is a leading but preventable cause of maternal deaths and morbidities as deemed by many esteemed institutions like WHO. Thus, unsafe abortion stands as a pressing issue because as stated by Haddad and Nour (2009): “both of the primary methods for preventing unsafe abortion—less restrictive abortion laws and greater contraceptive use—face social, religious, and political obstacles, particularly in developing nations, where most unsafe abortions (97%) occur.” In a conservative Third World country like the Philippines, the practice of abortion remains illegal while contraceptive use still entails social stigma and financial burden, which is why many women continue to risk their lives by undergoing unsafe abortions for their own justified reasons. In fact, it constitutes a public health emergency more so now amid the pandemic that unintended pregnancies have risen, access to reproductive health information and basic services have become further out of reach, and incidences of gender-based violence have spiked. The first step is to advocate for decriminalizing abortion in the country (both in public perception and national policies). This way, we can finally move forward from archaic laws and a backward mindset, granting women freedom of choice and bodily autonomy. This must go hand in hand with ensuring universal access to reproductive healthcare services, incorporating proper sex education in school curricula, and normalizing reproductive freedom altogether.
Haddad, L. B., & Nour, N. M. (2009). Unsafe abortion: unnecessary maternal mortality. Reviews in obstetrics & gynecology, 2(2), 122–126.
Philippine Statistics Authority. (2015). Number of Maternal Deaths by Cause and by Age Group, Philippines 2006-2015. https://psa.gov.ph/system/files/kmcd/Table%205.%20Number%20of%20Maternal%20Deaths%20by%20Cause%20and%20by%20Age%20Group%2C%20Philippines%202006-2015.xlsx