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2 PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality
Table 1. Selected maternal care indicators, Philippines: 2003 and 2008 NDHS
Table 2. Percent distribution of currently married women by contraceptive method used, Philippines: 2003,
2008
Method 2003 2008
Any method 48.9 50.7
Any modern method 33.4 34.0
Any traditional method 15.5 16.7
Not currently using 51.1 49.3
Total 100.0 100.0
Sources: 2003 and 2008 National Demographic and Health Surveys
PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality 3
This situation leads to more pregnancies and and risk factors, they also lack access to both
deliveries among Filipino women. And yet, an lifesaving care and quality maternal/reproductive
overwhelming majority of Filipinos (92%) believe health care.12 According to the report, these are
that it is important to manage fertility and plan the reasons why Filipino mothers die:
their family, and most (89 percent) say that the
government should provide budgetary support for 1. limited access to health facilities and
modern artificial methods of FP, including the pill, quality maternal care;
intra-uterine devices (IUDs), condoms, ligation, 2. lack of access to a full-range of reproductive
and vasectomy, based on a 2007 survey on FP health care, including family planning
in the Philippines conducted by Pulse Asia.8 In information and services;
another survey, the majority (55%) of respondents 3. unplanned pregnancies leading to induced
said that they are willing to pay for the FP method abortion, and consequently, maternal
of their choice.9 deaths;
4. lack of political will to provide maternal
These survey results prove that Filipino women health services;
lack RH care, including information on, and access 5. lack of a reproductive health law that
to, FP methods of their choice. Births that are too would require appropriate funds to ensure
frequent and spaced too closely take a debilitating full access to quality RH information and
toll on their health, so that many of them die services that include maternal health and
during pregnancy or at childbirth. Some of them, family planning.
despairing over yet another pregnancy, seek an
abortion, from which they also die and along with The dangers of childbearing can be greatly
them, their unborn child. Based on another study reduced if a woman is healthy and well-nourished
conducted by the Allan Guttmacher Institute in before becoming pregnant, if she has a health
2006, of the three million annual pregnancies in checkup by a trained health worker during her
the country, half were unplanned and one-third of pregnancy, and if a skilled birth attendant assists
these end in abortions.10 the birth. The woman should also be checked
during the 12 hours after delivery until six weeks
Causes and prevention of maternal deaths after giving birth. The government has a particular
responsibility to make prenatal and postnatal
The Philippine government’s MDG progress services available, to train health workers to
report states that 1 in 100 women die as a result assists at birth, and to provide special care and
of “maternal causes,” and that maternal deaths referral services for women who have serious
accounted for about 14 percent of all deaths problems during pregnancy and childbirth.
among women of reproductive age (15–49).11
The underlying causes for the situation are: (1) Unmet need and short birth intervals
inadequate capacity of the health/medical facility
to provide quality emergency obstetric care Research from developing countries revealed
(EmOC) services in terms of human resource, that unhealthy timing or spacing of pregnancies
skills, equipment, and medicine; and nonfunctional is linked to increased risk of multiple adverse
referral system for referring high-risk pregnancies. health outcomes.13 14 Following a pregnancy that
Lack of awareness on the part of mothers to seek occurred quickly after a previous birth, the risk of
timely medical care and preference of mothers a child dying is at least twice as high as that for
to conduct deliveries at their homes are also longer intervals. A recent study of Filipino women’s
contributing factors. contraceptive needs revealed that one-third of
women at risk did not want to become pregnant
As revealed by the State of Filipino Mothers 2008 within the next two years, while the remaining two-
report by Save the Children, not only do Filipino thirds did not want any more children.15 Compared
mothers die because of biomedical causes to women who want to end childbearing, women
4 PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality
who wanted to delay a birth were more likely to be to all the people at affordable cost, and giving
using no method and therefore to have an unmet priority to the needs of the underprivileged,
need for contraception. sick, elderly, disabled, women and children, the
Philippine government has committed to achieve
The Philippines has a contraceptive prevalence the Millennium Development Goals (MDGs) by
rate (CPR) of over 50 percent, however, available 2015. This commitment includes, among others,
data and information indicate that the higher risks reducing the maternal mortality ratio (MMR)
of short birth intervals and early pregnancies by 75 percent from 1990 to 2015, along with
still represent a major RH issue. The problem of increasing access to reproductive health (RH)
short birth intervals is even more pronounced in by 2015. The health goals and the strategies
younger women, among whom the highest risks to reach these targets are further reiterated in
from very short birth intervals are more common.16 the Medium Term Philippine Development Plan
To reduce the current number of pregnancies that 2004-2010 and the National Objectives for Health
occur less than recommended intervals, couples 2005-10 (Table 3).
will need easier access to spacing services that
are responsive to their circumstances. MDG 5 also highlights the crucial role of midwives
and others with midwifery skills on the path
MDG and ICPD maternal health targets to improved maternal health by including as
its second indicator the proportion of births
The Philippines is a signatory to the UN attended by skilled health providers. Although
Millennium Declaration on the global agenda the percentages are not specified, it is assumed
for development by 2015. Consistent with its that the target for 2015, “universal access to a
constitutional mandate of making essential skilled birth attendant”, translates into between
goods, health and other social services available 90 percent and 100 percent coverage.
PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality 5
critical health interventions as a single package, within one hour travel time, operational on a 24-
backed by effective management infrastructure hour basis, and capable to carry out emergency
and financing arrangements.21 responses. A CEmONC facility should be
staffed with at least one obstetrician/surgeon,
Maternal health programs and policies pediatrician, anesthesiologist, six nurses, medical
technologist, and six midwives.23
To concretize its commitment to rapidly reduce
maternal and neonatal mortality, the DOH Government health spending
issued Administrative Order No. 2008-2009 in
September 2007 to implement a strategy on Appropriate investment in health, if used effectively,
integrated maternal and newborn child health improves health standard of the population. In
and nutrition (MNCHN). It aims to address service turn, a healthier population generates incremental
delivery, regulation, financing, and governance of gains in economic growth, which increases
the Philippines’ health system.22 The integrated the resources that institutions and households
MNCHN strategy, implemented in all Philippine can use for health. However, those additional
provinces and cities, is aimed to meet the resources need to be distributed and used
following RH indicators by 2010: equitably to secure higher marginal gains from
1. increase CPR to 60 percent; the poorer segment of the population.
2. increase the proportion of pregnant women
having at least four antenatal care visits to Based on the 2003 National Health Accounts
80 percent; (NHA) estimates, national government spending
3. increase skilled birth attendance and for health was still predominantly used for the
facility-based births to 80 percent; and operation of public hospitals, accounting for about
4. increase percentage of fully-immunized 70 percent. Local government expenditures for
children to 95 percent. health mainly paid for the operation of general
hospitals (26%) as well as public integrated care
Through the MNCHN strategy, the Philippine centers, including rural health units (25%), and for
government has committed itself to ensure the provision of public health programs (21%).24
that: Curative care services and medical goods
- every pregnancy is wanted, planned, and accounted for 55 and 22 percent, respectively, or a
supported; total of about three quarters, of the national health
- every childbirth is facility-based and expenditures. The remaining health expenditures
managed by skilled birth attendants; and went to preventive and public health services (11
- mothers and their newborns are provided %), health administration and insurance including
with proper post-partum care, as well as government regulation (9%), and health-related
other relevant services included in women’s services such as research and training (1%).
health care and the child survival package. The top spenders of curative care services were
households (40%), national government (17%),
Essential to the MNCHN strategy are facilities PhilHealth (15%), and local government units
that can provide basic emergency obstetric (10%).25
and neonatal care (BEmONC). These facilities
should operate on a 24-hour basis, and are In 2005, the Philippines’ total health expenditure
accessible within 30 minutes of travel, equipped went up by 9.4 percent, from P165.3 billion in
with communication and transportation systems 2004 to P180.8 billion in 2005. However, the share
for referrals. Every BEmONC facility should of health expenditure to GDP was lower at 3.3
have a physician, nurse, and midwife. Also percent in 2005 compared to 3.4 percent in 2004.
essential to the MNCHN strategy are the It is still below the 5 percent standard set by the
comprehensive emergency obstetric and neonatal World Health Organization (WHO) for developing
care (CEmONC) facilities which are accessible countries. The WHO database showed total per
PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality 7
Box 1. Types of skilled attendants and the mix of skills and abilities34
While it is up to each country to decide on how maternity care should be organized, much depends on the
availability of skilled attendants, the composite set of skills and abilities they possess, and the resources available
to recruit, train and retain these staff. The principal categories of skilled attendants found in many countries
include:
- Midwives (including nurse-midwives): Persons who, having been regularly admitted to an educational
program duly recognized in the country in which it is located, have successfully completed the prescribed course of
studies in midwifery and acquired the requisite qualifications to be registered and/or legally licensed to practice
midwifery.
- Nurses with midwifery skills: Nurses who have acquired midwifery knowledge and skills either as a result
of midwifery being part of their nursing curricula or through special post-basic training in midwifery.
- Doctors with midwifery skills: Medical doctors who have acquired competency in midwifery skills through
specialist education and training, either during their pre-service education or as part of a post-basic program of
studies.
- Obstetricians: Medical doctors who have specialized in the medical management and care of pregnancy
and childbirth and in pregnancy-related complications, but not usually complications of the newly born infant. They
have usually undergone additional education and clinical training to acquire these additional skills and have been
certified or accredited in obstetrics.
Source: Making Pregnancy Safer: the critical role of the skilled attendant. Joint statement by WHO, ICM and FIGO, 2004: 7.
8 PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality
For the first time, in 2007, the Philippines’ annual is an accredited health professional, such as a
national budget included a specific line item midwife, doctor or nurse, who has been educated
for FP funding. The General Appropriations Act and trained to proficiency in the skills needed to
(GAA) of 2007 allocated P180 million to the DOH manage normal (uncomplicated) pregnancies,
for operational costs associated with providing childbirth, and the immediate postnatal period,
contraceptive services; P30 million for the routine and in the identification, management, and referral
functions of DOH in support of FP and, through of complications in women and newborns.33
congressional initiative, another P150 million
to be sub-allocated to LGUs for purchasing RH During pregnancy, skilled attendants monitor the
commodities and conducting FP seminars.30 As progress of the pregnancy, detect complications,
of the end of 2008, less than one-third of the provide preventive measures, develop birth and
budgeted funds had been released to regional emergency plans with the woman and her family
centers for distribution to LGUs.31 Another P1.2 and advise women on health, lifestyle and nutrition
billion was budgeted in 2008, again through in pregnancy.
congressional initiative, for the DOH to allocate
to LGUs for procuring RH commodities for free During childbirth, skilled attendants monitor the
distribution to the poor. In 2008, the government progress of labor, are vigilant for complications
national budget allocated P19.8 billion to the and stay with the women and support them
DOH, of which, P386.5 million was allocated to in many ways. They know how to manage
the Commission on Population (POPCOM). abnormalities such as breech delivery and, in
a team of various professionals with obstetric,
Skilled Attendance neonatal and anesthesia skills, they deal
with complications as severe as eclampsia or
Skilled care/attendance refers to the care obstructed labor.
provided to a woman and her newborn during
pregnancy, childbirth and immediately after birth In the postnatal period, the range of care varies
by an accredited health care provider who has from helping mothers and babies in breastfeeding
at her/his disposal the necessary equipment to managing complications such as severe
and the support of a functioning health system, postpartum bleeding, infection or depression. If
including transport and referral facilities for babies have problems, either because of preterm
emergency obstetric care.32 A skilled attendant birth or complications of birth, they receive timely
and appropriate treatment. Skilled attendants also
Box 2. Models of service delivery for midwifery and provide counseling on postnatal contraception to
obstetric care the mothers.
playing an integral part in achieving a lower MMR and academics, without robust evidence, have
in the country. However the lack of professional persuaded governments to stop training TBAs.
health practitioners (such as doctors and nurses) Furthermore, TBAs, regardless whether or not they
in rural areas in the country is a major concern. have received training, are being excluded from
The gap between health need and the available having a role in maternity care programs.
services is being bridged by the midwives.
Although trained only to provide maternal and When the professional midwives make a sincere
child health care services, midwives are currently effort to learn about and honor local customs and
implementing all public health programs. traditions, when they approach local people with
an attitude of respect and demonstrate willingness
Midwives constitute a large segment of the to work with TBAs, honoring them as colleagues,
Philippine health personnel sector. In 2005, there this hierarchical system can function effectively.39
were 16,967 government midwives in the country. In such cases, TBAs are generally very willing to
Records show 150,722 registered midwives as advise women to go to the clinic or hospital. But
of June 2007, of which, 3,498 were registered when doctors and professional midwives approach
in 2007. Midwives work in the private or public the community with an attitude of arrogance, treat
sector, in hospitals, birthing clinics, barangay the TBA with disdain and punish women who attempt
health stations, or rural health units, or they work homebirth by treating them badly, mothers and their
abroad. They comprise 65 percent of the public at-home attendants avoid the clinic or hospital at all
health workforce. In the rural areas, they are the costs. Such a situation leaves the TBA to cope with
first point of contact for patients coming into the emergencies as best as she can; often until too late
health system.38 to seek help.40
Midwives, as the public health workers at primary A study in 2006 proved that facility-based births with
health care facilities, are the main implementers of skilled midwives and assistants working under TBA
the county’s health programs. Its original focus of supervision effectively increased the number and
providing maternal and child health care has become proportion of women with professionally assisted
only one of the many responsibilities they have to births.41 These findings support the idea of a health
handle. More than 40 programs of the DOH rest care model, where trained TBAs work under close
on the midwives’ shoulders, including immunizing supervision of authorized midwives. Countries such
mothers and their children. In the rural areas, as Malaysia that have successfully moved from
midwives are on-call 24 hours a day, seven days a the use of TBAs to skilled birth attendants even
week. This working arrangement has not changed sought to include TBAs as partners and allies in the
for decades and is expected to continue in the future. process, and constructively used their social status
Midwives and community health workers often have and relationships in the community to promote the
no equipment at all, no transport except their feet, use of skilled birth attendants.
and they work under the most difficult of conditions.
Although the recommended ratio was one midwife
for every 3,000 individuals, many midwives have
10,000-30,000 individuals in their catchment area.
In the Philippines, TBAs are found in almost every - Primary health care services.
barangay and in many urban neighborhoods. In
these areas, they deliver the majority of births. Provide clear policy framework
Therefore, the potential of TBAs as FP change
agents cannot be ignored. The TBA has a potential A comprehensive approach to accelerating
role to play in modern maternity care programs progress in maternal health begins with a clear
in the country. However, eliminating traditional national policy framework that encompasses
health practices and beliefs that work against the multiple levels, from presidential decrees and
common good should be one of the main areas statutory laws to health systems’ policies,
to be addressed in mobilizing TBAs for them to standards, and protocols. Many laws and
participate effectively in maternal care programs. policies that fall completely outside the health
Instead of excluding TBAs from providing maternity sector also have a bearing on maternal health.
care, they may be considered as resource These include laws and regulations relating
persons, who could be involved in maternity care to education, social welfare, transport, justice,
programs, provided they are working under close finance, employment, etc. Government has the
supervision from trained nurses/midwives. Hence, responsibility to ensure that the laws, regulations,
alternative strategies where TBAs knowledge and and policies that affect particular aspects of
skills are acknowledged and incorporated within maternal health are harmonized and are in line with
the existing health system may prove beneficial. human rights enshrined in national constitutions,
regional and international human rights treaties,
and international consensus documents. The
Policy Options and Recommendations Philippine Congress should enact the proposed
Reproductive Health and Population Development
Some of the policy options that the Philippine Act of 2008 which aims to promote information
Legislators’ Committee on Population and and access to natural and modern FP; breast
Development (PLCPD) Foundation recommends feeding, prevention of abortion and management
to reduce maternal mortality in the country are as of post-abortion complications; adolescent and
follows: youth health; prevention and management of
reproductive tract infections, HIV/AIDS and
Promote the rights perspective to health care STDs; elimination of violence against women;
counseling; treatment of breast and reproductive
A rights perspective helps legitimize prioritizing tract cancers; male involvement and participation
women’s health. Strong political support and in RH; and RH education for the youth.
national ownership are essential to create
enabling health policies, to attract resources for Integrate family planning in safe motherhood
safe motherhood, and to ensure those resources program
reach groups with the highest maternal mortality.
The right to health includes entitlements to a range Family planning can prevent many maternal
of health interventions which have an important deaths by helping women prevent unintended
role to play in reducing maternal mortality. The pregnancies and by reducing their exposure to
government has an obligation to provide goods the risks involved in pregnancy and childbirth. FP
and services in order to prevent maternal mortality. allows women to delay motherhood, space births,
These include: prevent unsafe abortions, protect themselves from
- Emergency obstetric care (EmOC); sexually transmitted infections (STIs), including
- A skilled birth attendant; HIV/AIDS, and stop childbearing when they have
- Education and information on sexual and reached the desired family size.
reproductive health;
- Other sexual and reproductive health care More lives would certainly be saved if all women
services, such as family planning services; had access to good prenatal, delivery, and
12 PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality
Box 3. WHO recommendations for birth spacing Promote healthy timing and spacing of pregnancy
Birth spacing after a live birth: After a live birth, Communication, counseling and services for
the recommended interval before attempting the adolescents should focus on the health risks
next pregnancy is at least 24 months in order to associated with the timing of a first pregnancy and
reduce the risk of adverse maternal, perinatal birth. Healthy timing and spacing of pregnancy
and infant outcomes. (HTSP) is an intervention to help women and
families delay or space their pregnancies to
Birth spacing after an abortion: After achieve the healthiest outcomes for women,
a miscarriage or induced abortion, the newborns, infants, and children, within the context
recommended minimum interval to next of free and informed choice.
pregnancy is at least six months in order to
reduce risks of adverse maternal and perinatal Specific recommendations for HTSP:54
outcomes. - Implement HTSP behavior change
Source: World Health Organization, 2006 Report of a WHO Tech-
communication and counseling
nical Consultation on Birth Spacing. interventions as an integral risk prevention
strategy in all FP, child and maternal health
communications and client counseling
protocols.
postpartum care. It must also be acknowledged - Ensure that the two 2006 WHO pregnancy
that the interventions to reduce maternal death spacing recommendations, as well as
also significantly contribute to reducing newborn information on the specific health benefits
mortality. associated with the healthy timing and
spacing of pregnancy are included in all
Make emergency obstetric care available to all communications and protocols.
women - Develop or strengthen pregnancy delay
or spacing services and communication
In addition to facility based skilled attendance, activities for young (15-29 years) clients.
a well functioning health system with provision - To achieve a more balanced method
of equipment, drugs and other supplies is mix, help families understand that long-
needed for the effective and timely management acting and intermediate methods (IUDs
of delivery complications, which may lead to and injectables) are safe, and can
maternal deaths. Recently, much emphasis effectively help them achieve their spacing
has been on making emergency obstetric care preferences.
(EmOC) available to all women, who need it. It
does not imply that all births should take place Reduce impact of unsafe abortion
in well-equipped health facilities, but only that
if a pregnant woman develops complications, The ICPD commitment to address the problem
she should be able to access essential obstetric of unsafe abortion is reflected in Paragraph
care. To ensure improved access to EmOC, a 8.25 in the ICPD PoA, which acknowledges that
well functioning referral system is mandatory. improving abortion-related care is an essential
This means overcoming delays in recognition strategy for improving women’s health. On this
of complications and in gaining timely access background and based on years of advocacy
to appropriate EmOC facilities.53 Additionally, by NGOs on the need to integrate sexual
for those women who develop obstetric and reproductive health objectives into the
complications, a health worker (or team of MDGs, 55 it was in 2005 suggested that the
health workers) who is trained, authorized, and risks women face from unplanned births and
supported to deliver the emergency care required unsafe abortion should be incorporated into the
has to be present. monitoring of the MDG framework.56 In October
PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality 13
Endnotes
1
United Nations Millennium Declaration. Fifty-fifth 16
Jansen WH, “Extending Service Delivery (ESD)
Session of the United Nations General Assembly. New Project: Country profile: Philippines,” Washington
York: United Nations; 18 September 2000. (General DC: U.S. Agency for International Development
Assembly document, No. A/RES/55/2). (USAID) Bureau for Global Health, (n.d),
2
Commission on Population (POPCOM). State of 17
National Statistics Office, op cit.
the Philippine Population Report: Time to Act: Needs, 18
Philippines midterm Progress Report on the
Options, Decisions, State of Philippine Population Report Millennium Development Goals, page 34.
2000, Mandaluyong City: POPCOM, 2001. 19
The Health Sector Reform Agenda (HSRA) does not
3
National Statistics Office (NSO), 2006 Family include two priority areas of human resource development,
Planning Survey. or improving the health information systems. HSRA-plus
4
WHO. op cit. will include these two cross-cutting areas.
5
Ibid. 20
Asian Development Bank, Technical Assistance to the
6
NSO, 2006 Family Planning Survey, Manila: NSO, Republic of Philippines for the Support for Health
2006. Sector Reform (TAR: PHI 39066), Sept 2005
7
NSO, 2008 National Demographic and Health Survey, 21
Department of Health, Philippines website, < http://
Preliminary Report. www.doh.gov.ph/fourmulaone>.
8
Pulse Asia, Ulat ng Bayan survey media release on 22
Save the Children, op cit.
family planning, March 2007. Available at 23
Ibid.
9
http://pulseasia.com.ph/pulseasia/story.asp?id=545. 24
National Statistical Coordination Board (NSCB), 2003
Social Weather Stations, SWS 4th Quarter 2004 survey Philippine National Health Accounts, NSCB, 2004,
report on family planning for the Department of in Racelis, Rachel H “The National Health Accounts
Health (DOH), 24 Feb. 2005. of the Philippines: Continuing Development and
Available at http://www.sws.or.ph. New Findings, “Philippine Journal of Development,
10
Singh S et al., Adding It Up: The Benefits of Investing FindArticles.com, <http://findarticles.com/p/articles/
in Sexual and Reproductive Health Care. New York: mi_qa5519/is_200601/ai_n21407228/>.
The Alan Guttmacher Institute and United Nations 25
Ibid.
Population Fund, 2003. 26
World Health Organization (WHO), National Health
11
Government of the Philippines. Philippines Progress Accounts, World Health Statistics, 2006.
Report on the Millennium Development Goals. Manila: 27
NSCB, 2004, op cit.
Government of the Philippines and United Nations, 28
Wardlaw T and Maine D, “Process indicators for
2003. maternal mortality programmes,” in Reproductive
12
Save the Children, State of Filipino Mothers 2008: Health Matters. Safe Motherhood Initiatives: Critical
Saving Mothers’ Lives, Ensuring Children’s Survival, Issues, Oxford: Blackwell, 1999:24-30.
March 2009. 29
Ibid.
13
Conde-Agudelo A, Rosas-Bermúdez A, and Kafury- 30
Darroch JE et al, op cit.
Goeta AC, “Birth Spacing and Risk of Adverse 31
Office of the Secretary, Department of Health
Perinatal Outcomes: A Meta-analysis,” Journal of the (Philippines), Department memorandum 2008-0272,
American Medical Association 2006;295:1809-1823. Dec. 16, 2008. Available at <http://home.doh.gov.ph/
14
Da Vanzo, J., Razzaque A, Rahman M, Hale L, Ahmed dm/dm2008-0272.pdf>.
K, Khan MA, Mustafa G and Gauzia K, “The Effects 32
World Health Organization (WHO), “Making
of Birth Spacing on Infant and Child Mortality, pregnancy safer: the critical role of the skilled
Pregnancy Outcomes, and Maternal Morbidity and attendant,” Joint statement by WHO, ICM and
Mortality in Matlab, Bangladesh,” Rand Corporation: FIGO, 2004:1. (This revised definition has been
Rand Labor and Population Working Paper Series, WR- endorsed by the United Nations Population Fund and
198, October 2004. the World Bank.)
15
Darroch JE, Singh S, Bal H, Cabigon JV, “Meeting 33
Ibid.
women’s contraceptive needs in the Philippines,” Issues 34
WHO, 2004, op cit.
in Brief, Alan Guttmacher Institute 2009;1:1-8. 35
WHO. 2005, op cit.
16 PLCPD POLICY BRIEF | Philippine Government Policies in Reducing Maternal Mortality
36
Koblinsky, M. A., C. Conroy, N. Kureshy, M. E. 48
Black R et al, “Maternal and child undernutrition:
Stanton, and S.Jessop, Issue in Programming for Safe global and regional exposures and health
Motherhood, Washington, D.C.: MotherCare/JSI, 2000. consequences,” Lancet 2008;371:243-260.
37
Department of Health, Philippine Framework for 49
West K et al, “Double blind, cluster randomised trial
Maternal Mortality Reduction. Available at http://doh. of low dose supplementation with vitamin A or beta
gov.ph/mmr/mmr_framework.htm carotene on mortality related to pregnancy in Nepal,”
38
International Confederation of Midwives , “Midwifery BMJ 1999;318:570-75.
in the Philippines,” 2008. 50
Evidence is building to suggest that child and maternal
39
Davis F, “Some perspectives on global issues in mortality can be further reduced by additional
midwifery,” Midwifery Today, in Women’s International micronutrient supplementation beyond iron, folate and
Network News, Summer 2000;26.3:22-23 Vitamin A e.g. see Shankar A et al, “Effect of maternal
40
Ibid. multiple micronutrient supplementation on fetal loss
41
Koblinsky M, Matthews Z, Hussein J, Mavalankar D., and infant death in Indonesia: a double-blind cluster-
Mridha M.K., Anwar I., et al, “Going to scale with randomised trial” Lancet 2008;371:215-27.
professional skilled care,” Lancet 2006;368:1377-86. 51
Black R et al , op cit.
42
World Vision and The Nossal Institute for Global 52
Costello A et al, “An alternative strategy to reduce
Health, University of Melbourne, “Reducing maternal, maternal mortality” Lancet 2006;368:1477-9.
newborn and child deaths in the Asia Pacifc: Strategies 53
Thaddeus S and Maine D., “Too far to walk: maternal
that work.” Melbourne: World Vision and The Nossal mortality in context,” Soc Sci Med 1994;38:1091-110.
Institute for Global Health, University of Melbourne, 54
Jansen, op cit.
2008:4. 55
Rasch, V, Maternal death and the Millenium
43
Department for International Development (DFID), Development Goals,” Dan Med Bull 2007;54:167-9.
“DFID 2004 Maternal health strategy: Reducing 56
Technical consultation on reproductive health
maternal deaths: evidence and action,” London: DFID, indicators, summary report 2006, Geneva: World
2007:9. Health Organization, 2006.
44
Bernstein S. et al, “Sexual and reproductive health: 57
Family Care International, <http://www.familycareintl.
completing the continuum,” Lancet 2008;372:1225-6. org/en/issues/24>, 2007.
45
Bearinger L. et al, “Global perspectives on the sexual and 58
Koblinsky M, Campbell O, Heichelheim J.,
reproductive health of adolescents: patterns, prevention, “Organizing delivery care: what works for safe
and potential,” Lancet 2007; 369:1220-1231. motherhood?” Bull World Health Organ 1999;399-406.
46
A more extensive care continuum advocated by some 59
Reduction of maternal mortality. A joint WHO/
authors includes adolescent health support. For UNFPA/UNICEF/World Bank statement, Geneva:
example see Kerber K et al, “Continuum of care for WHO, 1999.
maternal, newborn, and child health: from slogan to 60
Garcia P and MJ Vital, “Living on the edge,”
service delivery” Lancet 2007;370:1358-69. BusinessWorld, 24 July 2009. Available at http://www.
47
World Health Organization, Regional Office for bworldonline.com/BW072409/content.php?id=059.
South-East Asia (WHO-SEARO), Adolescent Nutrition:
A Review of the Situation in Selected South-East Asian
Countries, New Delhi: WHO-SEARO, 2006:47-50.
PEOPLE COUNT
PLCPD POLICY BRIEF 2009
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2/F AVECSS Building, #90 Kamias Road. cor. K-J Street, East Kamias, Quezon City 1102, Philippines
Tel. nos.: (+632)925-1800 • (+632)436-2373
E-mail: plcpdfound@plcpd.org.ph
Website: http://www.plcpd.org.ph Since 1989
Executive Director: Ramon San Pascual, MPH
Editors: Floreen M. Simon, Ernesto Almocera, Jr. and Romeo C. Dongeto
Layout: Dodie Lucas
PLCPD
Philippine Legislators’ Committee
on Population and Development
Foundation, Inc.