1. Other than the factors discussed in the lecture, what do you think are other factors affecting maternal mortality rate in the Philippines?
The lecture discussed factors affecting maternal mortality rate in the Philippines including lack of access to adequate care during pregnancy, low utilization rates of maternal health services due to distance from health centers, costs and time demands of women, delivery care provided by non-specialists such as family members or traditional birth attendant (”hilot”) and lack of postpartum care resulting in hemorrhage. Other factors affecting the maternal mortality rate in the Philippines include:
a. Low Maternal Educational Attainment- According to Karlsen et. al’s (2011) analysis of the WHO Global Survey on Maternal and Perinatal Health, women with no education had 2.7 times and those with between one and six years of education had twice the risk of maternal mortality of women with more than 12 years of education. Women's ability to receive, process, and understand fundamental health information regarding the benefits of proper prenatal care and the reproductive health services needed to make optimal health decisions is anticipated to improve as their level of educational attainment increases. More educated women, for example, are less likely to accept traditional explanations for life and death and are more likely to accept broad information about birth spacing, signs of pregnancy complications, and the need to improve their nutritional status to reduce the risk of iron deficiency anemia, all of which are critical in the effort to reduce maternal deaths. Increased self-esteem and consequently empowerment to make health-related decisions may be the indirect association between educational levels and maternal mortality.
b. Poor Contraceptive Use- Although contraception is already legally available, according to a 2017 report, only four in 10 married women use a modern form of contraception. The women cited several reasons for not using contraception such as infrequent sex, inappropriate health concerns, religion-based opposition to contraception, and low accessibility (Nagai et al., 2019) Additionally, the law used to allow adults to legally engage in sexual intercourse with children as young as 12 (the age of sexual consent is now 16) but did not permit minors to use birth control methods or services in government health facilities without parental consent. In the Philippines, 54% of all pregnancies (1.9 million pregnancies) are reported to be unintended (Goldberg, 2022). Unintended pregnancies do not always imply unwanted pregnancies, but they can cause a variety of health problems for the mother and child, including hunger, disease, abuse and neglect, and even death. Unintended pregnancies can also contribute to high fertility cycles, as well as lower educational and employment prospects, and poverty (World Health Organization, 2019).
c. Restrictive Abortion Policies- With an 80 percent Catholic population, abortion is still illegal in the country, with no apparent exceptions even for pregnancies that endanger the woman's life or health, pregnancies resulting from rape or incest, and pregnancies resulting from fetal impairment. Despite this, many Filipino women still seek abortions, and due to the restrictive regulations, these women end up undergoing unsafe abortions. According to independent studies, 610,000 illegal and unsafe abortions were performed in the country in 2012, and tens of thousands of Filipino women are hospitalized each year as a result of complications such as incomplete abortion or retained products of conception, severe blood loss, and infection (Goldberg, 2022). The stigma associated with abortion also makes it difficult for a woman to seek post-abortion care, as some women are shamed and intimidated by healthcare providers, and treatment is sometimes delayed or denied entirely (Finer & Hussain, 2013)
2. What are the top 3 causes of maternal mortality ratio in the Philippines? Top 3 maternal morbidity?
According to the Department of Health (2010), the following are the leading causes of maternal mortality in the Philippines: (1) complications related to pregnancy such as infection or cardiac problems, comprising 38.4% of the maternal mortality cases, (2) hypertension for 35.4% of the maternal mortality cases, and (3) Postpartum hemorrhage for 17.2% of of the maternal mortality cases.
The following are the leading causes of maternal morbidity in the Philippines: (1) Hemorrhage comprising 31% of the maternal morbidity cases, (2) Infection for 19% of the maternal morbidity cases and (3) Unsafe abortion for 16% of of the maternal morbidity cases.
The statistics presented point to the key areas that need to be addressed in order to improve pregnancy outcomes among Filipinos through programs and initiatives improving preconception and atenatal care, and pushing for safe abortion practices.
References:
Baccay, K.B. (2022). Prenatal Care and Safe Motherhood Lecture Video PART I. VLE. https://drive.google.com/file/d/1SXIWQpPevbtDjGVAOOlWiDtyE9CqJskQ/view
Department of Health. (2013). Maternal Deaths by Main Cause. https://doh.gov.ph/Statistics/Maternal-Deaths-By-Main-Cause
Finer, L. B., & Hussain, R. (2013, August). Unintended pregnancy and unsafe abortion in the Philippines: Context and consequences. Guttmacher Institute. https://www.guttmacher.org/report/unintended-pregnancy-and-unsafe-abortion-philippines-context-and-consequences
Goldberg, J. (2022, February 3). The center's work in the Philippines. Center for Reproductive Rights. https://reproductiverights.org/center-reproductive-rights-work-philippines/
Karlsen, S., Say, L., Souza, J.-P., Hogue, C. J., Calles, D. L., Gülmezoglu, A. M., & Raine, R. (2011, July 29). The relationship between maternal education and mortality among women giving birth in health care institutions: Analysis of the cross sectional who global survey on maternal and perinatal health - BMC public health. BioMed Central. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-11-606#:~:text=Results,than%2012%20years%20of%20education.
Nagai, M., Bellizzi, S., Murray, J., Kitong, J., Cabral, E. I., & Sobel, H. L. (2019, July 25). Opportunities lost: Barriers to increasing the use of effective contraception in the Philippines. PLOS ONE. https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0218187
World Health Organization. (2019, October 25). High rates of unintended pregnancies linked to gaps in family planning services: New who study. World Health Organization. https://www.who.int/news/item/25-10-2019-high-rates-of-unintended-pregnancies-linked-to-gaps-in-family-planning-services-new-who-study