UNICEF: Report highlights risk of maternal mortality in developing world

Nearly all maternal deaths occur in developing countries; over 80 per cent in sub-Saharan Africa and South Asia.

GENEVA, 19 September 2008

A new report on maternal mortality, released by UNICEF today, highlights the risks faced during pregnancy and childbirth by women in developing countries. Progress for Children: A Report Card on Maternal Mortality states that, according to the latest data, more than 99 per cent of all maternal deaths occur in developing countries, with some 84 per cent concentrated in sub-Saharan Africa and South Asia. The tragic fact is that every year more than half a million women lose their lives as a result of complications due to pregnancy or childbirth, said Peter Salama, UNICEFs Chief of Health. The causes of maternal mortality are clear as are the means to combat them. Yet women continue to die unnecessarily. In the Philippines, an estimated 4,500 women die every year because of complications from pregnancy and childbirth. This is because public reproductive health service is not comprehensive enough, too few mothers receive skilled care before, during, and after pregnancy and lastly, most mothers do not always have access to quality emergency obstetric care services. Although over 90 percent of Filipino mothers do seek prenatal care, only 60 percent deliver babies with properly trained skilled birth attendants and less than 40 percent deliver either in a public or private health facility. Haemorrhage is the most common cause of death, particularly in Africa and Asia. A womans overall health including her nutritional level and HIV status also influences the chances of a positive outcome to her pregnancy and childbirth. Other influences include societal factors, such as poverty, inequity and general attitudes towards women and their health. Maternal mortality rates are often impacted by cultural or traditional practices that often prevent women from seeking delivery or post-partum care. In the developing world, the risk of death from complications relating to pregnancy and childbirth over the course of a womans lifetime is one in 76, compared with one in 8,000 in the industrialized world. The riskiest place to give birth is Niger, where that risk is estimated to be one in seven. In the Philippines, the risk is one in 140. Most maternal deaths are avoidable. A key to avoiding them is better health care particularly during pregnancy, delivery and in the post-partum period. Interventions that improve maternal health include: antenatal care, provider-initiated HIV testing and counseling, skilled attendance at birth, emergency obstetric care, post-partum care and family planning in keeping with national policies. When offered across a continuum of care that integrates home, community, outreach and facility-based services, these interventions can have multiple benefits for mothers, children and the communities in which they live. UNICEF Philippines, in close collaboration with World Health Organization (WHO) and the UN Population Fund (UNFPA) supports interventions seeking to lower maternal mortality, which include increased access to skilled birth attendance, the upgrading of health facilities to provide Basic and Comprehensive Emergency Obstetric Care, and the reduction of iron deficiency in women. There have been some promising areas of improvement in maternal health interventions in the world in recent years. Coverage of antenatal care throughout the developing world has increased by 15 percentage points in the past decade, with 75 per cent of expectant mothers now receiving some antenatal care. At the same time, many countries have boosted coverage of skilled delivery

attendance. In parts of Asia, for example, the proportion of women who have a skilled attendant present during delivery jumped from 31 to 40 per cent between 1995 and 2005. Increases have also been seen in many African countries. Ensuring that skilled personnel are present at all deliveries and that these personnel have access to emergency care where necessary is the most effective means of saving the lives of mothers. However the pace of progress towards reaching the Millennium Development Goal on maternal health, which calls for a 75 per cent reduction in the maternal mortality ratio between 1990 and 2015, has been too slow throughout the developing world and must now be accelerated if the goal is to be reached. To achieve the MDG target, maternal health must be addressed as part of a continuum of care that connects essential maternal, newborn and child health services. Indeed, levels of maternal mortality often reflect the overall performance of a countrys national health system particularly during delivery and in the postnatal period, when mothers and newborns are most vulnerable. To fill this critical gap, services that benefit both mother and child need to be scaled up, as the health of the mother is closely linked to that of her newborn. Saving mothers lives is not only a moral imperative, but a sound investment that benefits their children, their families, their communities and their countries, said Tessa Wardlaw, UNICEFs Chief of Statistics and Monitoring. Indeed, there is a clear connection between maternal health and other Millennium Development Goals, such as eradicating extreme poverty, reducing child mortality, and combating HIV and AIDS and other diseases.

http://www.unicef.org/philippines/8891_9545.html

223555

Philippines ranks # 48 in Maternal Mortality

230 maternal deaths per 100,000 live births The United Nations established a high-level commission to develop an accountability framework for the Global Strategy for Women's and Children's Health. "Strengthening accountability is critical if we are to save the lives of more women and children," said UN SecretaryGeneral Ban Ki-moon. "We must ensure that partners deliver on their promises but, in turn, it is crucial that they know whether investments are leading to sustainable progress. In September, at the Summit in New York, stakeholders committed US$40 billion in resources to a global effort to save the lives of 16 million women and children by 2015. Adopted by world leaders in the year 2000 and set to be achieved by 2015, the Millennium Development Goals (MDGs) provide a framework for the entire international community to work together towards a common end making sure that human development reaches everyone, everywhere. According to the 2009 UN Childrens Fund report, The State of the Worlds Children, the Philippines has an MMR average of 230 per 100,000 live births. Health officials predict the 2015 Millennium Development Goal of 55-60 per 100,000 live births will not be met.

Some 230 women die here for every 100,000 live births, compared with 110 in Thailand, 62 in Malaysia and 14 in Singapore, according to United Nations figures. Causes of maternal deaths are hemorrhage, sepsis, obstructed labour, hypertensive disorders in pregnancy, and complications of unsafe abortion most of which are preventable with proper diagnosis and intervention, health specialists said. The maternal mortality ratio in the Philippines is listed as the Millennium Development Goal least likely to be achieved by 2015, said Vanessa Tobin, the UNICEF country representative for the Philippines. The country has an adjusted maternal mortality ratio of 160 per 100,000 live births against a goal of 55-60 deaths per 100,000 live births Crucial to reducing maternal deaths is having a skilled attendant present during a delivery. Only 60 percent of the births in the Philippines are supervised by a skilled birth attendant, who can be a physician, a nurse or a midwife with 18 months to two years of adequate training. What is not accepted in this definition is a traditional birth attendant [who have had no formal training], the UNICEF official said. EMPOWERING MIDWIVES TO CURB MATERNAL DEATHS There is a need to increase of the number of skilled birth-attendants, including midwives, nurses and doctors, to improve maternal health. In the Philippine Framework for Maternal Mortality Reduction, health workers are identified as playing an integral part in achieving a lower MMR in the country. However the lack of professional health practitioners (such as doctors and nurses) in rural areas in the country is a major concern. The gap between health need and the available services is being bridged by the midwives. Although trained only to provide maternal and child health care services, midwives are currently implementing all public health programs. Giving midwives access to further training in life-saving skills could prevent up to 80 percent of maternal deaths in the Philippines, says Rosalie Paje, division chief of the Family Health Office under the Department of Health (DOH). Midwives play a crucial role in providing maternal healthcare, especially in geographically isolated and disadvantaged areas and those affected by armed conflict where doctors and nurses are scarce, Paje said. The Integrated Midwives Association of the Philippines (IMAP) Inc. called for government support for the training and education of additional midwives in the country. Midwives can help prevent up to 90 percent of maternal deaths when they are supported to provide basic life-saving skills in functioning health systems, Patricia Mines Gomez, IMAP president, said. CAPACITY ENHANCEMENT PROJECT FOR MIDWIVES ON MATERNAL AND NEWBORN CARE In 2010, the Philippine Obstetrical & Gyneocological Society launched a training program on Maternal and Immediate Newborn Care for Midwives, focusing onlife saving skills and interventions of the Midwifery Act of 1992. With the Registered midwives in government or private practice as its target audience, the general objectives were: To strengthen the basic knowledge, skills and attitude of midwives in providing the added skills of midwives under the Midwifery Law (repair of 1st and 2nd degree perineal lacerations, insertion of intravenous fluids during obstetric emergencies, internal examination during labor, administration of oxytocin after delivery of the placenta, and injection of Vitamin K to the newborn) for the improvement of maternal and newborn care.

http://www.pogsinc.org/v2/index.php/component/content/article/10/58-philippines-ranks--48-inmaternal-mortality

POGS Position Statement on RH Bill

PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIETY (Foundation), INC. POSITION STATEMENT ON THE PROPOSED 2010 REPRODUCTIVE HEALTH BILLS

Click here to download in PDF The PHILIPPINE OBSTETRICAL AND GYNECOLOGICAL SOCIETY (Foundation), INC. has stated in its Mission Statement that we are a society of Godfearing ObstetricianGynecologists committed to serve the Filipino people by advancing the art and science of reproductive health, enhancing professional growth and welfare of its members through training and research, fostering womens advocacy programs and upholding the high est ethical standards of practice through excellent health care delivery. The Society envisions itself as the leading organization in reproductive health, working towards significant reduction in maternal and perinatal morbidity and mortality, reproductive tract infections and cancer. It aims to promote increased awareness of womens health issues through expanded community service, continuing medical education, training of members, efficient networking, active linkages and collaboration with GOs and NGOs, relevant research programs, effective public education and information dissemination, and sound health policy reforms and advocacy guided by our moral, socio-cultural and ethical values. The POGS (Foundation), INC. is a national organization whose membership includes the whole spectrum of Philippine society. We are a heterogenous and pluralistic group of medical specialists of diverse cultural mores and persuasions with different religious affiliations and beliefs. We are singularly bound by our commitment to the Societys aforementioned mission and vision. We stand united in our diversity, respecting each others right to his/her religious beliefs and not imposing our own standards on anyone. Collateral to these, we uphold the high ethical and moral standards of medical practice expected of us by the Society. We support the REPRODUCTIVE HEALTH CARE BILL in the context of our mission vision to uphold the equality of the rights to life for both mother and child, freedom of religious beliefs, a right to proper education on health and right to health services as may be necessary for patients need and also the rights of the physician to his/her beliefs on certain provisions on services. We agree with the dismal figures presented two years ago in the hearing of Senate Bill No. 3122. To us obstetricians, the introduction of reproductive health bills in Congress is long overdue. As regards the current RH Bills proposed in Congress, a comparative review was done on the following bills by the Ethics and Medical Practice Committee with assistance from the Womens Reproductive Health Advocacy Committee.

H.B. No. 96 Hon. Representative Lagman H.B. No. 101 Hon. Representative Garin H.B No. 513 Hon. Representative Bagao and Bello 1 H.B. No. 1160 Hon. Representative Biazon H.B. No. 1520 Hon. Representative Syjuco H.B. No. 3387 Hon. Representative Ilagan and de Jesus

Although expressed differently, all the proposed House Bills espouse the following: 1. 2. 3. 4. 5. 6. Setting up more maternal healthcare facilities and services. Building more modern and complete Nursery Health Care Facilities and Services. Setting up blood banks in hospitals and other health facilities. Establishing centers for education and information on Reproductive Health. Government to supply centers of family planning materials to help prevent unwanted pregnancies. Providing mobile clinics in congressional districts that render education and information on reproductive health and sex education. 7. Humane and non-discriminating healthcare to post abortive complication cases. 8. Mandatory ageappropriate reproductive health and sexuality education in schools by adequately trained teachers. 9. Premarital counseling centers in churches and in government offices that conduct marriage licensure services. 10. Ensuring that reproductive health services are delivered with a full range of supplies, facilities and equipment and that service providers are adequately trained for such reproductive health care delivery; 11. Expanding the coverage of the Philippine Health Insurance Corporation (PhilHealth), especially among poor and marginalized women, to include the full range of reproductive health services and supplies as health insurance benefits

All the proposed aforementioned measures should be consolidated into one Reproductive Health Bill, with the inclusion of our recommendations. We support also these provisions under Section on Prohibited acts: a. Refuse to perform legal and medicallysafe reproductive health procedures on any person of legal age on the ground of lack of third party consent or authorization. In case of married persons the mutual consent of the spouses shall be preferred. However in case of disagreement, the decision of the one undergoing the procedure shall prevail. In the case of abused minors where parents and/or other family members are the perpetrators as certified to by the Department of Social Welfare (DSWD) and Development, no prior parental consent shall be necessary. b. Refuse to extend quality health care services and information on account of the persons mar ital status, gender, sexual orientation, age, religion, personal circumstances, or nature of work, provided that, the conscientious objection of a 2 Recommendations: We strongly recommend inclusion of the following: Inclusion of fetal health care in the element of Maternal, Infant and Child health and Nutrition, including Breastfeeding. b. Protection of physicians right to give medical advice and intervention in the case of minors, in due consideration of the latters right to reproductive health care. c. We support patient autonomy in seeking reproductive health care. Consolidate all proposed RH Bills into one. To have a successful implementation of a Reproductive Health Bill, an increase in the National Budget with a corresponding increase in the allotment for health be effected so that even though the government may not afford a health budget as high as 7% as in Scandinavian countries, the government may reach the WHO recommendation of 5%, a far cry from the present 2% of the 1.6 trillion pesos. We recommend the retention of the Population Commission and representation of POGS as a member of the said Commission. Standardization of premarital counseling to be given in churches and government offices by properly trained and competent counselors. Clarifications: There is much disinformation and misconception in media and other fora on the following issues. We would like to state that: Contraceptive pills: Do not cause abortion; in fact they prevent unwanted pregnancies hence nothing to abort. b. Do not cause death and disease when used appropriately. Pregnancy and childbirth cause more death and disability than taking oral contraceptives. The hormones in the pills are synthetic hormones that are comparable to those produced by womens ovaries. They are modified in doses and composition to make them better, safer and predictable in their medical effects. c. Do not cause cancer; in fact they reduce cancer of endometrium and ovaries. The reported slight increase in the risk for breast cancer is obviated by taking pills based on the national clinical guidelines Availability of Family Planning information and materials will not cause promiscuity but will reduce unwanted pregnancies, teenage pregnancies, criminal abortions and consequently reduce maternal and fetal mortality. Definition of terms: 1. a. 1. a.

Abortion is the termination of pregnancy before the 20th week of gestation. It can either be: o spontaneous (often referred to as miscarriage) o induced (criminal).

Remarks:

Every pregnancy should be planned, cared for and supported.

A consolidated and comprehensive Reproductive Health Bill should be enacted immediately to lessen the number of mothers, unborn and newborn lives wasted daily.

http://www.pogsinc.org/v2/index.php/component/content/article/10/53-pogs-position-statement-onrh-bill