Letâ€™s talk about Maternal Health 75% of all maternal deaths could be averted with the presence of skilled birth attendants, along with emergency obstetric care when needed. In developing countries, emergency obstetric care is only available to those who are near hospitals or can use roads to get there. According to the UNFPA, â€œThe number of maternal deaths is highest in countries where women are least likely to have skilled attendance at delivery, such as a midwife, doctor or other trained health professional. An estimated 35 percent of pregnant women in developing countries do not have contact with health personnel prior to giving birth.â€?1 In the Philippines, the maternal mortality rate has decreased slowly along with slowly increasing rates of skilled birth attendance. In order for there to be a reduction in maternal mortality rates in the Philippines, infrastructure must be provided and improved in order to enable pregnant women to reach hospitals to receive treatment and skilled care.
The remaining maternal deaths could be lowered to developed country levels with the presence of technology and equipment to prevent deaths from infection and hypertension. A 2010 study of maternal health in Chile found that the number of maternal deaths dropped 97.6% during 1957-2008. After therapeutic abortion was outlawed in 1989, the rate decreased from 13.62 to 1.65 percent for every 100,000 live births, that is, a drop of 87.9 percent.2 Using proper education and technology, Chile has practically alleviated maternal deaths. The Philippines would do well to follow the example of Chile. In the Philippines, there remains a lack of education and access to proper technologies. In order to see a reduction of maternal deaths and improvement in maternal health, there is an increased need for educated midwives and doctors, supplies of antibiotics for infections, medicine to prevent bleeding, transfusion capability, forceps and vacuums for obstructed labor, medicine and induction capacity for hypertensive disease, and operating rooms for cesarean sections.
Maternal deaths have gone down in the last 30 years. A recently published study in The Lancet medical journal, highlights that maternal mortality has decreased steadily from 1980 to 2008 in 181 countries. The four main causes of lower maternal mortality rates (MMR) are: fewer pregnancies in some countries, higher income, which improves nutrition and access to healthcare, more education for women and an increased number of births attended by a skilled birth attendant.3 Access to safe abortion was not listed as a primary reason for decreased MMR, which makes sense, as many countries with legal restrictions on abortion have the lowest maternal mortality rates. Egypt managed to substantially decrease its MMR (from 174 to 84) by increasing the number of births attended by a skilled healthcare providers by 100%.4
The 4 main causes of maternal death infection, hemorrhage, obstructed labor, hypertensive disorders are preventable by the presence of skilled birth attendants. The primary causes of maternal mortality worldwide are hemorrhage (severe bleeding), hypertensive disorders (high blood pressure), infection and obstructed labor. These account for almost 2/3 of all maternal deaths in developing countries.5 All of these causes of death are preventable. A skilled birth attendant can recognize hypertension and obstructed labor early, can stop severe bleeding, and has the tools to prevent infection. We know what works – it’s time for action.
Most maternal deaths are preventable, so why is progress so slow? Most maternal deaths are preventable, so why is progress so slow? Attention needs to be placed on the factors that make change possible: education and technology. Education improves skilled birth attendants during labor. It also allows for mothers to become more educated on their bodies and their natural biological functions, which they can then pass on to their own children. Technology provides the necessary medicines, tools, and infrastructure—such as hospitals and care centers—for safe birth to occur.
The UNFPA lists “access to voluntary family planning” as the first step towards achieving maternal health.6 In the same breath, it admits that access to family planning could only hope to reduce the maternal mortality rate by 20%. This keeps the statistics low by reducing the number of pregnancies, but it does little to keep women healthy during pregnancy and delivery. The longer we continue to focus most of our attention on family planning rather than on skilled care during delivery, the longer women will wait for MDG 5 to be achieved.
It is estimated that family planning only has the potential to reduce maternal deaths by 20%. Maternal deaths result from major complications, most of which occur during labor, delivery, and the postpartum period. Rather than focusing on family planning, where the potential is so limited, the focus should be on creating a climate for healthy mothers—and hence, healthy children and communities. Family planning has never produced real signs of social progress. In the Philippines, the maternal mortality rate has been dropping despite no real change in contraceptive use for the past decade. Also, in Sweden, maternal mortality rates fell by 1900 through the education of midwives. Throughout the rest of the developed world maternal mortality dropped when healthcare workers were educated and given proper
tools. This happened before 1960 and contraception did not hit the market until after this time.7 Evidence shows us that family planning has little to do with the developed world’s low maternal mortality rates.8
1000 out of every 100000 women will die in childbirth without a skilled birth attendant. That’s right – before we figured out that women need to be attended by a skilled health worker at birth, 1% of women would die during childbirth. Today, 11 Filipinas die daily due to complications arising from pregnancy and childbirth. Only 61% of births in the Philippines are attended. If the presence of a skilled birth attendant will prevent ¾ of all maternal deaths, then investing in SBAs in the Philippines would save the lives of 8 women daily. The RH Bill is 31 pages long. Only one paragraph is devoted to skilled birth attendants. Congress hasn’t done the math on maternal health.
Infrastructure development needed: roads, hospitals, access. 99% of maternal deaths occur in the least developed countries.9 When women are provided with proper healthcare facilities—and the roads and means to reach these facilities—the probability of a safe and health pregnancy and delivery is greatly increased.
UNFPA “Giving Birth Should Not be a Matter of Life and Death,” page 1.
Koch, Elard. Department of Medicine at the University of Chile study. Lecture given in January 2010 at the International Working Group for Global Women's Health Research, Washington, D.C., USA. 3
The Lancet, Maternal mortality for 181 countries, 1980–2008 (…) by M C Hogan, K J Foreman, M Naghavi, S Y ahn, M Wang, S M Makela, A D Lopez, R Lozano, C J L Murray. 4
United Nations Development Programme 2010 Report – What Will It Take to Achieve the Millennium Development Goals? – An International Assessment 5
Lancet 2006, WHO Analysis of causes of maternal death: a systematic review. Khalid S Khan, Daniel Wojdyla, Lale Say, A Metin Gulmezoglu, Paul F A Van Look. 6
UNFPA “Giving Birth Should Not be a Matter of Life and Death,” page 1.
Scanlon, Robert. “What Good Maternal Health Looks Like.” Lecture given on March 10, 2010, New York, USA.
Ron I et al.,Local-Level Contraceptive Prevalence Rate Performance Analysis in the Philippines: Selected Main Findings vis-à-vis Study Objectives, Manila, Philippines: ABT-PSPOne and UPPI, 2010.) 9
2005 World Health Report