TRANS #21, EXAM #3 – JOSHUA R.

CRUZ

Maternal Health Status in the Philippines

CHRISTOPHER JOSEPH L. SORIANO, M.D.
03/19/2018

OUTLINE Reporter’s Notebook: Labor of Death (Maki Pulido)

I. Importance of Obstetrics A. MDG Progress Report 2014
A. Millennium Development Goals B. DOH goals for MNCHN
 In the Philippines, 200 babies are born per hour
(2015) V. Reproductive and Maternal  24 out of 1000 babies are born dead
B. Administrative Order 2008-0029 Health Policy
II. Reproductive Health A. Reproductive Health Programs Sitio Tanza 1, Antipolo City
A. Millennium Development Goal B. Magna Carta
#5 C. RP-RH Law  No access to public health services
B. Sustainable Development Goals D. Integrated MNCHN  Nearest health center is 30km away, no midwives available
III. Philippines: Maternal Health VI. Obstetrics Submodule  Community is too far to be reached
Status Introduction
A. Demographics Quick Review
 In the Philippines [at time of documentary], 61% of childbirth was
B. Philippine Status Review Questions not facility-based
IV. Programs for Reproductive References  At Tanza 1, almost all pregnant women are dependent on a hilot
Health in the Philippines or traditional birth attendant
 Never experienced any form of checkup before delivery
I. IMPORTANCE OF OBSTETRICS  13-hour travel to reach the nearest hospital
 According to the 2003 National Demographic Health Survey (NDHS)
 Adolescent mothers are more likely to have complications during Flor (hilot)
labor
 Uses traditional birthing methods
 Especially when not assisted by a skilled midwife/doctor
 No medical apparatus except for razor blade and ethyl alcohol
 Higher morbidity and mortality for them or their children
 By age 19, 23.5% of women have been pregnant
Manilyn
 Teenage pregnancies are high due to:
 Less education  First pregnancy, but cannot afford to deliver in a hospital
 Poor household  Traditional rituals were used (e.g. malunggay broth)
 United Nations Population Fund study (2008)  Unfounded belief: malunggay supports uterine contraction
 11 Filipino mothers die every day while giving birth mechanism and eases labor pain and childbirth
 Only 16,000 out of the 42,000 barangays nationwide have  Underwent almost 24 hours of labor, but baby was born dead
available midwives  Brought to the hospital for hemorrhage and extreme weakness
 85% of deaths are due to complications (e.g. hemorrhage)  Diagnosis: Normal findings
 Belief: baby was taken by an aswang
A. MILLENNIUM DEVELOPMENT GOALS (2015)  Reality: miscarriage
 Previous targets were based off the Millennium Development Goals
 Decreased number of maternal deaths Melanie
 Decreased infant mortality  Has never gone for a check-up because of lack of funds and
 Statistics (deaths per 100,000 live births) inaccessibility of the health center
 1993: 209 deaths  Higher morbidity and mortality for them or their children
 2015 target: 52 deaths  Asked, why not just go to the hospital?
 By 2015: Target for maternal death was far from reach  “Mayroon namang hilot.”
 Underscores the importance of passing laws for both maternal and  Cheaper
child health  Dangerous environment
 Such as the RH Law which stipulates prenatal and postnatal care  Works as a junk collector (mangangalakal ng basura)
for the mother  Does not rest even in her 8th month of pregnancy
 Predicament: because she has never been checked up, what was
B. ADMINISTRATIVE ORDER 2008-0029 thought to be her 8th month of pregnancy was actually her 9th
 Implementing Health Reforms for the Rapid Reduction of Maternal
Ricky
Neonatal Mortality
 Mandates the following:  Lost his wife to childbirth in their own home
 That every delivery is facility-based  Situated far from the hospital, hence opted to employ hilot to
 That every delivery is managed by skilled birth attendants deliver their child
 Strategy for rapidly reducing maternal and neonatal deaths through  All known rituals were performed—woman’s hands were held,
provision of MNCHN services salts and lemon juice were used, etc.
 MNCHN: maternal, newborn, child health and nutrition  All to no avail
 Enacted in response to slow decline in maternal and newborn
mortality rates II. REPRODUCTIVE HEALTH
 Implementation of this administrative order requires:  Reproductive health is a human right
 A strong national policy for maternal and child health  Reproductive health as a “state of complete physical, mental,
 Increase in funds and resources and social well-being in matters relating to the reproductive
system and its functions and processes”
Strong National Policy for Maternal and Child Health  Recognized by the 1994 International Conference on Population and
 RH Bill: House Bill No. 5043 Development (ICPD)
 An act providing for a national policy on reproductive health  Conference articulated relationships between population,
development, and individual well-being
Increase in Funds and Resources  With the participation of 179 countries
 Only 7% of the PHP 1.4 T national budget (2009) is allotted for the  Thus, individuals have the:
entire public health sector  Capability to reproduce
 Amounting to a total of PHP 27.9 B or roughly PHP 300 per person  Freedom to decide when and how often they want to reproduce
 Compared to the PHP 681.5 B allocated for the country’s debts  Right to information and to have access family planning

Trans #21 Group #9: Años, Apolonio, Barin, Maan, Te, Sagsagat 1 of 7
 A. MILLENNIUM DEVELOPMENT GOAL #5 Maternal Mortality Ratio (MMR)
 Goal #5: Improve Maternal Health  Common causes of maternal mortality:
 Indicators:  Hemorrhage
 To reduce by 3 quarters the maternal mortality ratio  Bleeding after delivery
 To achieve universal access to reproductive health  Traditional birth attendants lack knowledge and training
(absence of formal training, only apprenticeship)
 Hypertension in pregnancy (eclampsia)
 Unsafe abortion
 Most women in poverty resort to underground clinics
 Use of unsanitized catheter to drain the fetus
 Use of hanger wire to scrape off fetus from the uterus
 Increases risk for infections (i.e. tetanus)
 NTK: Tetanus is a severe infection from bacteria which can
enter the body through breaks in the skin — usually cuts or
puncture wounds caused by contaminated objects.
 Sepsis (infection)
 Obstructed labor
 Labor against tight pelvis resulting to rupture of uterus and
death of both mother and baby
 Patients in geographically isolated and depressed areas
(GIDAs) have no access to hospitals
 To reiterate, all these causes of death are preventable.

Note:
 For this obstetrics submodule, we are primarily concerned with
MDG #5 (improve maternal health) and SDG #3 (good health
and well-being).
 MDG #5 should have been completed in 2015

III. PHILIPPINES: MATERNAL HEALTH STATUS

Figure 1. The 8 Millennium Development Goals (United Nations, 2000) A. PHILIPPINE DEMOGRAPHICS
 The Philippines is the 12th most populous country in the world at
B. SUSTAINABLE DEVELOPMENT GOALS 92.34 million (NSO, May 2010)
 Target year of completion: 2030  NTK: Latest UN estimates project that the population of the
 17 global goals for sustainable development country will be 106,512,074 in 2018.
 The Philippines has committed to participate  Furthermore, the Commission of Population (POPCOM) projects
 Note that the SDGs are not legally binding, and the country is not around 4965 Filipinos will be added per day or about 206 every
penalized if goals are not reached hour in 2018.
 However, there is a primary responsibility to follow up data with  The Philippines was among the 68 countries which contributed to
regard to achieving the 17 goals 97% of maternal, neonatal and child health related deaths worldwide
(UNICEF 2009)
 3.4 M pregnancies occur every year
 Half [1/2] are unintended
 One-third [1/3] end in abortion

B. PHILIPPINE STATUS
 Recall – MDG #5: Improve Maternal Health (see fig 1)
 Indicators
 Maternal Mortality Ratio (MMR)
 Births attended by skilled health personnel
 Contraceptive prevalence rate
 Adolescent birth rate
 Antenatal coverage
 Unmet need for family planning services

Maternal Mortality Ratio (MMR)

 MDG #5: <52 deaths per 100,000 live births [far from target]
 SDG #3: <70 deaths per 100,000 live births [more realistic]

Figure 2. Global goals for sustainable development (United Nations, 2015)

SDG #3: Good Health and Well-Being

 Maternal Health Target: Reduce maternal mortality ratio (MMR)
 By 2030: Reduction to <70 deaths per 100,000 live births

Maternal deaths are preventable

 289,000: Estimated number of maternal deaths in 2013 due to
preventable causes (e.g. bleeding/ hemorrhage, hypertension)
 Vaginal delivery is physiological Figure 3. MMR per 100,000 live births, 1990-2015 (Soriano, 2018)

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 Births Attended by Skilled Provider
 Health provider may be midwife, nurse, or doctor
 Trend: steadily improving

Figure 8. Type of birthing facility: National percentage (FHS, 2011)

 Birthing conditions (Table 2)

Figure 4. Births attended by skilled provider, 1993-2017 (Soriano, 2018)  Note that the choice of a skilled birth attendant still predominates
in the rural community
 Traditional birth attendants are the attendants of choice in areas  In the entire country, the lowest is the ARMM region.
where midwives and Barangay Health Centers (BHCs) are
unavailable Table 2. Percentages of deliveries by skilled birth attendant and in birthing facilities
Location Skilled Birth Birthing Facility (%)
Table 1. Comparison of national percentage vs. percentage of birth attendant types Attendant (%)
among the poor population
Urban 92 85
National Percentage Among Poor Population
Rural 79 72
Type of Birth Attendant % Type of Birth Attendant %
NCR 96 92
Doctor 40 Doctor 19
ARMM 34 28
Midwife 29 Midwife 27
National 84 78
Hilot / Traditional birth 27 Hilot / Traditional birth 50
attendants attendants
Others (any person) 04 Others (any person) 04 Contraceptive Prevalence Rate (CPR)
 CPR: Use of modern and traditional methods of contraception
 As of 2017, is at 54% in the Philippines

Figure 5. Birth attendant type: National percentage (FHS, 2011)

Figure 9. Type of methods: National percentage (NDHS, 2017)

Figure 6. Birth attendant type: Percentage among poor population (FSH, 2011)

Number of Health Facility Deliveries

 Recall – Administrative Order 2008-0029
 Mandates that all births are health-facility based
 Previous system: Midwives do prenatal check-ups house to house
 Problems:
 No monitoring after consultation from midwife
 If bleeding occurs within first two hours after delivery and after
the midwife has left, the patient dies
Figure 10. Type of method: Poor population (NDHS, 2017)
 Note the following:
 National percentage: Pill is still the most common method
 Poorest of the poor: No method used to practice birth control in
56.9%, indicating a high possibility of pregnancy
 Among the poorest of the poor:
 No money for education and sustenance, and thus do not have
the funds to pay for certain birth control methods
 Large households (more children) inside small spaces (barong-
barong)
 Implication: high chances of incest and sexual molestation

Unmet Need for Family Planning

 Married women who prefer to avoid pregnancy but are not using any
Figure 7. Number of health facility deliveries, 1993-2017 (Soriano, 2018) form of family planning method.
Reproductive 11.21: MATERNAL HEALTH STATUS IN THE PHILIPPINES 3 of 7
 When you ask the parent how many children he/she desires, the
answer is 2, but ask for the actual number of children they have, there  NTK: Antenatal care is defined as:
are 5 already.  routine health control of presumed healthy pregnant women
 Highest in terms of age group is 15-19 years, highest in terms of area without symptoms (screening)
is Zamboanga (see table 3).  in order to diagnose diseases or complicating obstetric conditions
without symptoms
Table 3. Unmet need for family planning in currently married women (FHS, 2011).  to provide information about lifestyle, pregnancy and delivery
Category ANC (%) ANC 4+ (%)  Trend in the country: increasing, which can be interpreted as good
15-19 y/o 28 66  NTK: According to DOH (2013), antenatal care coverage hardly
30-34 y/o 13 75 increased in the past five years, but according to the lecture there
NCR 12 67 is a considerable increase in the coverage.
Zamboanga 25 74
National 17 71 Table 4. Women with live births since 5 years prior to the study (in %) who have / are
receiving antenatal care (Philippines).
Location ANC (%) ANC 4+ (%)
Antenatal Coverage
Urban 94 88
Rural 94 85
Eastern Visayas 99 90
ARMM 69 48
NCR 93 94
Lowest %ile 86 76
Highest %ile 98 96
National 94 87

 There is a relatively higher percentage of pregnant women who have

Figure 11. National Percentage of women 15-49 y/o with live birthsin the 5 years
four or more antenatal checkups.
preceding the survey (FHS, 2011).  This includes women with live births 5 years prior to survey.
 NCR: highest %; ARMM: lowest %
 There is increase in the number of those receiving four or more
antenatal checkups.
 80% go to midwives, 15% to doctors, and 5% to traditional birth
attendants (hilot).

Postnatal Coverage
Table 5. Women (in %) receiving postnatal care in the country.
Location ANC (%)
Urban 89
Rural 84
NCR 97
Zamboanga 63
Figure 12. Poor Population of women 15-49 y/o with live births in the 5 years preceding Lowest %ile 75
the survey (FHS, 2011). Fourth %ile 92
National 86
 Compare: among the poor, 80% entrust their deliveries to midwife,
15% to doctors, and the remaining 5% to hilot.  Postnatal Care: defined as checkup two days after birth
 The trend is the same with the national percentage, but there is a  In hospitals, the mother is discharged only two days after giving
considerable increase in those who go to doctors for delivery. birth thus the postnatal care is already completed by then.
 Hilot still accounts for 2% of deliveries in the country.  Zamboanga (63%) accounts for lowest proportion of women
 Consider risk involved. undergoing postnatal care in the country (see table 4).
 Doctors are supposed to deliver only complicated pregnancies
while midwives are expected to be capable of handling Adolescent Sexual Behavior
uncomplicated pregnancies. Premarital sex
 Midwives are frontliners in providing health care.
 This is the health system model in US and UK.
 In the Philippines, this is observable in hospitals only such as
Ospital ng Makati.
 If your pregnancy is uncomplicated, you will be sent to the
health facility designated for such purposes.
 But those who can afford to pay, opt to be checked up by doctors
in private facilities and deliver there as well (e.g. The Medical City).

Figure 14. Use of protection in first sexual encounter (YAFS4, 2013).

 In 78% of first sexual encounter, no form of protection against the

risk of pregnancy and/or sexually-transmitted infections (STI) is used.
 Those in ages 20-24 have reportedly lower sexual encounters than
those in ages 15-19.
 Source: 2013 Young Adult Fertility and Sexuality Study (YAFS4)
Figure 13. Data on antenatal care coverage in the Philippines (NDHS, 2017).

Reproductive 11.21: MATERNAL HEALTH STATUS IN THE PHILIPPINES 4 of 7

 Figure 15. % of youth engaged in premarital sex. Males on top, females follow
(YAFS4, 2013).
Figure 18. Proportion of teenage females who have begun childbearing
(YASF4, 2013).
 Narrowing gap in levels of engagement in premarital sex between
males and females Teenage Fertility
 Males use more contraception than women do.
 Men are more concerned/afraid of the possible consequences.

Anecdotes featuring teenagers:

 One high school patient admitted for nausea and vomiting
(hyperemesis gravidarum)
 Upon admission, she was watching cartoon network in her
room. Her boyfriend was beside her, playing some game.
 Another encounter, high school students kissing at noontime in a
jeepney, a very hot and uncomfortable place
 Alarming because adolescents already engage in mature
sexual behavior
 If PDA is normal, what more would they do if teenagers are
alone with each other?

Adolescent Fertility Figure 19. Teenage fertility is highest in CAR and Cagayan Valley; lowest in Bicol and
CALABARZON (YASF4, 2013).
 Implication:
 Those in the mountainous regions engage more in sex.
 Cold climate
 “Pwedeng mag-sex sa gubat” (more areas of privacy in nature)
 Those on the plains experience hot climate.
 Cultural perspective:
 Belief system in mountainous regions: arranged marriages to
avert poverty
 Issue of harassment and incest prevails.

IV. PROGRAMS FOR REPRODUCTIVE HEALTH IN THE

PHILIPPINES
A. MDG PROGRESS REPORT 2014
Goals lagging behind the 2015 targets

Figure 16. Adolescent Fertility (YASF4, 2013).

 Rising rates as of present (see fig 16).

 Teenage pregnancy rises

Figure 20. The Philippines Fifth Progress Report: Millennium Development Goals
Executive Summary (NEDA, 2014).

1. Elementary education in terms of completion rate (MDG #2)

2. Maternal mortality ratio (MDG #5)
3. Access to reproductive health [services] (MDG #6)
4. HIV/AIDS – Rate of increase of persons living with HIV (PLHIV) is
rapid

B. DOH GOALS FOR MATERNAL, NEONATAL, CHILD HEALTH

Figure 17. Increased teenage fertility (YASF4, 2013).
 Proportion of teenage females who have begun childbearing
increases with age (see fig 17 and 18).
AND NUTRITION (MNCHN)
1. Every pregnancy should be wanted, planned and supported.
2. Every pregnancy adequately managed throughout its course.
3. All delivery is facility-based and managed by a skilled birth
attendant
4. Every mother-and-child pair secures proper postpartum and
postnatal care.

Reproductive 11.21: MATERNAL HEALTH STATUS IN THE PHILIPPINES 5 of 7

 Anecdote from PLHIV friend:
 Counseling is provided
 Free antiretroviral (ARV) drugs given (i.e. every 3 months) in San
Lazaro Hospital
 Before, it was quick and easy.
 Now, with the increase in the number of HIV+ Filipinos, there
is already a queue to get the medications at 5 in the morning.
 HIV Patients in Ward (“H4” Ward in San Lazaro)
 Mostly college-level students, call center agents
 “Pasaway” – promiscuous
 Friend is a nurse by profession: feeling of invincibility
 Contact tracing is needed
– Sexual partner is not known
– What if you met your partner through Tinder?
 You have to inform your partner if you have HIV (or that
you got HIV from him/her).
 Reality: Delivery is done in just any condition (e.g., through a
typhoon)
 Midwives: Heroes of health
 Doctors to Barrios: majority of cases are pregnant teenagers in
far-flung areas
 After giving birth, mother should return for checkup.
 Vaccination for the baby must be secured as well.
V. REPRODUCTIVE AND MATERNAL HEALTH POLICY
A. DOH: REPRODUCTIVE HEALTH PROGRAM (AO 43, S. 1999)
1. Family Planning
2. Maternal & Child Health and Nutrition (MCHN)
3. Prevention & Management of Reproductive Tract Infections (RTI’s)
including STI, and HIV/AIDS
4. Adolescent Reproductive Health
5. Prevention & Management of Abortion and its Complications (PMAC)
6. Prevention and Management of Breast & ReproductiveTract Cancers
7. Education and Counseling on Sexuality & Sexual Health
8. Men’s Reproductive Health and Involvement
9. Violence Against Women & Children (VAWC)
10. Prevention and management of infertility & sexual dysfunction
B. MAGNA CARTA OF WOMEN (RA9710)
 Eliminate discrimination
 All women should have access to maternal care, responsible, ethical,
legal, safe and effective methods of family planning
 Access to information and services pertaining to women's health
 Access to maternal care, responsible, ethical, legal, safe and
effective methods of family planning
 Freely to decide on the number of pregnancies
C. RP-RH ACT OF 2012
 Responsible Parenting and Reproductive Health Law (RP-RH), more
commonly known as RH Law
 Right to make free and informed decisions by the couple
 Respect for protection and fulfillment of reproductive health and rights
which seek to promote the rights and welfare of every person
particularly couples, adult individuals, women and adolescents
Among the 8 Struck Down Elements of the Original RP-RH Law
 NTK: RP-RH Law was signed by President Aquino on 2012 but in
2013, a temporary restraining order (TRO) was ordered by the
Supreme Court (SC) following several consolidated complaints.
When the TRO, with a duration of 120 days, was about to end, SC
extended its effect while discussions on whether the RP-RH law is
“unconstitutional” ensued. In 2014, the RP-RH law was declared
partially constitutional and the TRO was lifted on the condition that
8 elements from the original approved law were struck down.
 Patriarchy in the laws, dependent on husband’s approvals
 Prevents ligation (e.g. husband abroad wouldn’t consent)
 Permission from parents to get condoms and contraceptive
pills from health centers
 Health center need permissions also
 Result: Condoms are left sitting in their boxes, unused.
 NTK: What to do with them then? Use condoms as balloons
during parties!
Reproductive 11.21: MATERNAL HEALTH STATUS IN THE PHILIPPINES
RP-RH Law: Sec 3. Guiding principles for implementation
i. Provision of ethical and medically safe, legal, accessible, affordable,
non-abortifacient, effective and quality reproductive health care
services and supplies… especially those of women, poor and
marginalized
ii. Promote information and access, without bias, to all methods of
family planning, including effective natural and modern methods
which have been proven medically safe, legal, non-abortifacient,
and effective in accordance with scientific and EBM research
standards.
iii. Provision of non-abortifacient family planning methods
 Case of Implanon & Implanon NXT contraceptives (implants)
 Government stocked enough to give out for free in health centers
following RP-RH law implementation.
 However, another TRO was issued by the SC in 2015 because
Implanon and Implanon NXT were claimed to be “abortifacients”
 Because these prevented pregnancy for up to three years
 Result: Implanon set to expire in 2018 remain stocked.
 In November 2017, TRO was lifted when FDA completed its report
on all 51 contraceptive brands/types wherein none was found to
be abortifacient.
 Because the implants are about to expire in 2018, the government
is hurrying to dispense the supplies (effectivity will be the same, it
will work for 3 years but it has to be “used” before its expiration
date).
 Implication: consideration to the poorest of the poor
 Prevention of ligation: implying that it is morally wrong to be ligated
 22 kids (reported in news) but still refuses to undergo ligation
despite having nothing to feed the children
 Concept of going to hell if you choose to be ligated
 Problem with RP-RH Law: no punitive sanctions!
 Original: “If a health professional withholds complete information,
they are liable and they can be imprisoned.”
 Among the 8 struck down elements as well.
 Stipulation: “If the health provider refuses to inform the patient of
all other methods because of religious or whatever convictions,
that doctor or health professional is not liable.”
 Mandated to refer to another health professional
 Still a violation of the human rights
 What if there are no other health professional available in the
area?
D. INTEGRATED MATERNAL, NEWBORN, CHILD HEATH AND
NUTRITION (MNCHN)
Figure 19. Integrated MNCHN (Soriano, 2018).
 All women must experience these levels of care.
 From preconceptional care to prenatal care to labor and delivery and
postnatal care.
V. OBSTETRICS SUBMODULE INTRODUCTION
 Desired competencies of the ASMPH students Graduate
 Provide appropriate prenatal, intrapartal, and postnatal care to
normal pregnant women.
 Consulting pregnant woman: Be able to provide services and
perform procedures and entertain concerns
 Point of flipped classroom sessions
6 of 7
 Propose plans to improve the maternal health situation in the
community using relevant public health policies 3. True or False: Those among the poor population choose to utilize
 MBA and MD degree to help the Philippines traditional contraceptive methods as they cannot afford to pay for
 “Anong plano sa Pilipinas learning from ASMPH?” modern methods.

Program of Learning 4. True or False: DOH addressed the issue of high MMR by issuing a
 Maternal Physiology policy wherein giving birth at home, not attended by a skilled worker,
 Parturition is no longer allowed.
 Labor & Delivery
5. “All women should have access to maternal care, responsible,
 Prenatal Care
ethical, legal, safe and effective methods of family planning” is a
 Postpartum Care
mandate of:
a. RP-RH Law
Textbook: Williams Obstetrics 24th Edition b. Magna Carta of Women
 Do not use Williams 22nd Ed & Earlier c. Both A and B
 Different definitions used d. None of the above

Patient Encounter History Taking & PE Answers: 1B, 2D, 3 False, 4 True, 5C
 Previously held at Quirino Medical Center
 Leopold’s Maneuver REFERENCES
 Patient Encounter: Observe deliveries (1) Christopher Joseph Soriano, M.D. March 19, 2018. Maternal Health
 Quirino Medical Center, Ospital ng Makati, Pasig City General Status in the Philippines [Lecture slides].
Hospital, Rizal Medical Center, East Avenue Med Center, Amang Helpful References
Rodriguez in Marikina (2) [Video]. Viral Doctor to the Rescue.
 8-12 activity. Rotation is for the whole batch. https://www.youtube.com/watch?v=5GoEU5s2wGo
 Goal: Be able to deliver a child
FREEDOM SPACE
Dr. Mikko Manalastas
 Fresh grad doctor who delivered a baby in a car
 “nakalabas na yung ulo” – crowning
 Hospital is far away, happened in Pasig
 SUPER TRAFFIC

QUICK REVIEW
SUMMARY OF TERMS
Pertinent statistics
By age 19, 23.5% of women have been pregnant
11 Filipino mothers die every day while giving birth
Only 16,000 out of the 42,000 barangays nationwide have available A message to all of us.
midwives
46% of deaths are due to complications (e.g. hemorrhage)

Reproductive health is a human right which implies that every individual:

Has the capability to reproduce
Has the freedom to decide when and how often they want to
reproduce
Has the right to be informed and to have access to family planning
methods

MDG #5 Improve Maternal Health: <52 deaths per 100,000 live births
SDG #3 Good Health and Well-Being: <70 deaths per 100,000 live births
Imagine if Filipinos were to become zombies.
 Doctors are supposed to delivery only complicated cases, midwives
at the forefront should handle uncomplicated deliveries..
 Pregnant women receiving antenatal and postnatal checkups are
increasing, but still low in some areas of the Philippines.
 More adolescents are engaging in premarital sex without any form of
protection; males use more protection than females do.
 Rates of teenage pregnancy are rising.

REVIEW QUESTIONS
1. The following are true EXCEPT:
a. Statistic: 23.5% of women have been pregnant by age 19 Relevant: Sen. Tito Sotto breaks down during speech against RH Bill.
b. Statistic: Facility-based childbirth comprised 61% of births in
2009
c. MDG by 2015: Per 100,000 live births, 52 deaths or less
d. MDG by 2015: Reduce by 3 quarters the maternal mortality
ratio

2. Which of the following is not a common cause of MMR in the

Philippines?
a. Sepsis
b. Obstructed labor
c. Hemorrhage
d. Thromboembolism
Reproductive 11.21: MATERNAL HEALTH STATUS IN THE PHILIPPINES 7 of 7