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• Poor women and infants carry the most risk of death and
disability from lack of access to reproductive health services.
LIKHAAN
More than 400,000 women ventions like caesarean sec- tions that are often unpre-
suffer from maternal mor- tion (CS) deliveries and blood dictable and require life-sav-
bidities every year in the transfusion require second- ing access to quality obstetric
Philippines. ary to tertiary level facili- services.” *(1997, pp. 3-4)
These are life-threatening ties (UN Millennium Project
complications from pregnan- 2005, pp. 83-84).
cies and deliveries that often Women suffer more from
require hospital care. The The Department of Health maternal morbidities than
2005 World Health Report of and international health au- any other illness.
the WHO (p. 62) has stated thorities agree on the mag- If the estimated number of
that globally, around 80% of nitude and severity of this morbidities is compared with
all maternal deaths are the problem. The DOH (2005a, the Department of Health’s
tragic end results of the fol- pp. 207-208) estimates that list of notifiable diseases, then
lowing complications: there are three million preg- maternal morbidities clearly
nancies every year, each one surpass the number of females
• hemorrhage or severe of which “entails risks to both that are sick each year with
bleeding; the mother and the unborn.” other serious illnesses like
• sepsis (bloodstream UNICEF, WHO and UNFPA pneumonias, bronchitis, diar-
infection); estimate that “at least 15 per rheas, hypertension, influenza,
• hypertensive disorders of cent of all pregnant women or tuberculosis (see Figure 1).
pregnancy like eclamp- develop serious complica-
sia and pre-eclampsia;
• prolonged or obstructed
Figure 1. Maternal Morbidities Compared to the Top Ten
labor; and
Female Morbidities of 2005
• complications of unsafe
abortion. Maternal Morbidities 400,000
* 15% x 3 million pregnancies = 450,000 estimated maternal complications. This estimate is consistent with another esti-
mate shown in Table 2.
Sources: WHO, UNICEF & UNFPA 2004; UN Population Division 2004 How many infant deaths can
be prevented through birth
spacing? The 2003 NDHS
The lifetime risk of maternal the recommended interval (p. 115) had estimated that
death combines the impact before attempting the next 23.5% of births were of less
of the frequency of preg- pregnancy is at least 24 months than 24 months interval, and
nancies and the danger of in order to reduce the risk of the NSO registered 1.71 mil-
each pregnancy. Using this adverse maternal, perinatal and lion live births in 2004 (NSO
measure, the risk faced by infant outcomes. 2008). Putting all these data
women in the Philippines is together, at least 7,800 infant
five to seven times that faced … To summarize, BTP [birth- deaths a year can be pre-
by women in Malaysia and to-pregnancy] intervals of six vented through proper birth
Thailand. The Philippines is a months or shorter are associated spacing.*
disproportionate contributor with elevated risk of mater-
of maternal deaths in South- nal mortality. BTP intervals of
east Asia and the world. around 18 months or shorter are Poor women and infants
associated with elevated risk of carry the most risk of death
Proper birth spacing reduces infant, neonatal and perinatal and disability from lack
by half the risk of death for mortality, low birth weight, small of access to reproductive
newborns and infants. More size for gestational age, and pre- health services.
than 7,800 infant deaths can term delivery. Women want fewer children
be prevented yearly through than they actually get. The
family planning. Two of the WHO-reviewed poorer they are, the larger
A recent review of birth studies show that BTP inter- the gap between wanted
spacing studies published by vals of less than 18 months and actual fertility. On aver-
the WHO in 2006 states that are linked to a two-fold age, every 10 women from
after a live birth, increase (1.9-2.6) in neo- the wealthiest quintile will
natal and infant mortality end up with three extra,
* 1.71 M (registered live births only; NDHS 2003 data on fertility rates combined with NSO population projections indicate
that 2.1 M live births occurred in 2000, according to Singh S et al 2006) x 23.5% (proportion of all births with <24 months
interval) x 39/1000 (mortality rate of infants with < 24 months interval) x 50% (mortality risk reduction if birth spacing of
less than 2 years is increased to 3 years)
Figure 3. Family Planning versus Maternal Care Costs for Unintended Pregnancies
TOTAL 5.523
Sources: Singh et al 2006; NSO & ORC Macro 2004; PhilHealth 2003; Festin M 2003
Department of Health. (2005b). Field Health Information System Annual Report 2005.
National Epidemiology Center.
Fajardo L. (2006 February 24). PhilHealth pays P17.5B in health insurance benefits.
PhilHealth News. Retrieved 2 October 2008 from http://www.philhealth.gov.ph/
media/news/2006/022406a.htm
Festin M. (2003). Are we doing too many caesarean sections? The HTA Forum, Vol. 1 No. 2
National Statistics Office. (2004). Table 2. Number of Deaths by Age Group by Sex and
Sex Ratio, Philippines: 2000. Retrieved 26 September 2008 from http://www.
census.gov.ph/data/sectordata/2000/ds0002.htm
National Statistics Office. (2008). Live Birth Statistics: 2004. Retrieved 30 September
2008 from http://www.census.gov.ph/data/sectordata/sr08321tx.html
National Statistics Office and ORC Macro. (2004). National Demographic and Health
Survey 2003. Calverton, Maryland: NSO and ORC Macro.
UNICEF, WHO, UNFPA. (1997). Guidelines for Monitoring the Availability and Use of
Obstetric Services.
UN Millennium Project. (2005). Who’s Got the Power? Transforming Health Systems for
Women and Children. Task Force on Child Health and Maternal Health.
WHO, UNICEF & UNFPA. (2004). Maternal mortality in 2000: Estimates developed by
WHO, UNICEF and UNFPA. Available at http://www.who.int/reproductive-health/
publications/maternal_mortality_2000/index.html
World Health Organization. (2005). The World Health Report: 2005: Make Every Mother
and Child Count. Available at http://www.who.int/whr/2005/en/index.html
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