Maternal care and childbirth: When life and death are decided by economic status

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October 26, 2022

MANILA – It was in 1972 when Beth Gaon gave birth, but a few days later she and her child died due to complications, said her parent, Arceli Estioco.

As reported by the then Ministry of Health and Philippine Health Statistics, the maternal mortality rate in 1972 was 1.4%, while the neonatal mortality rate was 31.9%.

Estioco told INQUIRER.net that Gaon, who received no prenatal check-ups, gave birth at home and was only attended by hilots, traditional birth attendants.

It was pointed out that in 1972 maternal deaths, which were 1.4 per 1,000 live births, accounted for 0.5% of all deaths in the Philippines.

Then, in 2000, as the maternal mortality rate declined by 1.0 per 1,000 live births, the Philippines pledged to reduce maternal deaths to 55 per 100,000 live births by 2015.

So, years later, to achieve its Millennium Development Goal, the government adopted the Maternal, Newborn and Child Health and Nutrition Strategy.

The said strategy, known as the “No Home Birth Policy,” mandated local governments to generate revenue for improving birthing facilities.

This is because home births were considered by the government to be the reason for the high number of maternal deaths in the Philippines.

However, as the Philippine Statistics Authority (PSA) indicates in its “Causes of Death in the Philippines” data, maternal and newborn deaths continue to rise.

GRAPHIC: Ed Lustan

While direct obstetric deaths fell to 1,055 in 2021 from 1,519 in 2020, an increase in maternal deaths was observed in the first six months of 2022 compared to the same period last year.

READ:PSA has a higher infant mortality rate; Popcom says this is due to lack of access to health care

Direct obstetric deaths, or direct maternal deaths, are those that result from obstetric complications of pregnancy, and from interventions, omissions, or mistreatment.

Based on PSA data, deaths classified as such rose to 468 from January to June 2022 compared to 425 from January to June 2021.

Similarly, the Commission on Population and Development (PopCom) said newborn deaths were lower in the first six months of 2022 (3,686) compared to the same period in 2021 (4,424).

However, he said newborn deaths, or deaths caused by certain conditions originating in the perinatal period, are now the 17th leading cause of death in the Philippines, higher than 18th last year.

So should the government say home birth is still the problem?

Lack of access
No less than PopCom’s executive director, Lolito Tacardon, said “the reasons [for this] could be the delay in referral and, in general, the quality of services provided in the health facility.

He told the ANC that “if we are to assess the overall situation, it indicates the overall quality of the health system”.

Tacardon, however, pointed out that “we do not yet have strong evidence as to the particular aspect of the overall quality of health care provided in our facilities.”

But PopCom said one thing is clear: “The rising rate of their mortality over the past two years has been indicative of the difficulties in obtaining services related to maternal and newborn health.”

This, he said, “has had fatal consequences” and is now prompting the government to provide sufficient medical care to mothers and their newborn babies, especially in the first 1,000 days of life.

GRAPHIC: Ed Lustan

As Tacardon stated, “this condition indicates a problem with access to appropriate, quality and timely services in health facilities”.

While he stressed that “we also need to investigate whether the increase in deaths was caused by home births”, the increase in deaths “poses a challenge to improve our local health system for obstetric care and emergency neonatal”, which was definitely affected by the COVID-19 crisis.

“Our health system should now slowly recover from the deluge of cases caused by the pandemic to ensure adequate services for other health issues such as those related to maternal, infant and child health,” he said. .

deadly poverty
According to data from the 2017 National Demographics and Health Survey (NDHS), more than half of women aged 15 to 49 have at least one problem accessing health care, and the most common , at 45%, was “to get money for treatment”. .”

Younger women, aged 15-19 (64%), uneducated women (76%) and women from the poorest households (72%) are more likely than other women to report access problems health care for themselves.

As reported in the NDHS, nine out of 10 Filipino women received prenatal care from a skilled provider such as a midwife (50%), doctor (39%) or nurse (4%).

However, three percent of women received no prenatal care.

It was also learned that women with higher levels of education and those from wealthier households are more likely to receive antenatal care from a skilled provider.

GRAPHIC: Ed Lustan

The NDHS said seven out of 10 women had their first prenatal visit during the first trimester, as recommended. Eighty-seven percent of women make four or more prenatal visits.

GRAPHIC: Ed Lustan

As the Ministry of Health has pointed out, there should be at least four prenatal checks – at least one in the first three months; at least one between the fourth and sixth month; and at least two between the seventh and ninth month.

The World Health Organization has stated that if a mother attends regularly for antenatal care, gives birth in a health facility, and is assisted during childbirth by a skilled birth attendant, the mortality risk for that mother and her newborn born is less.

Unequal access to services
More than three in four births (78%) took place in a health facility, mostly in public health facilities, the NDHS learned, while one in five births were delivered at home.

Births in health facilities were more common among women with a university education (92%) and those from the wealthiest households (97%). Deliveries in health facilities almost tripled, from 28% in 1993 to 78% in 2017.

Overall, 84% of births were attended by a skilled provider, mostly doctors, while 14% were attended by hilots.

The NDHS found that birthing assistance from a skilled provider was highest among urban women (92 percent), those with a college education (97 percent), and those from the wealthiest households (99 percent). %).

Postnatal care helps prevent complications after childbirth, he said, however, nine percent did not have a postnatal check-up within 41 days of giving birth.

GRAPHIC: Ed Lustan

This, even if more than 80% of mothers (15 to 49 years old) benefited from a postnatal check-up within two days of delivery. Eighty-six percent of newborns received a postnatal examination within two days of birth.

As Karlo Paredes stated in his study, “Inequality in the Utilization of Maternal and Child Health Services in the Philippines,” inequality in the utilization of maternal and child health services has limited improvements in favor poor.

“Household income remains the main driver of inequalities in the use of maternal and child health services in the Philippines.”

Tacardon pointed out that this issue “now calls for the full and intensified implementation of the Universal Health Care Act, as well as the Responsible Parenthood and Reproductive Health Act, which require the maintenance of well-being and the overall health of Filipino mothers and their young children.”

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