The MDG consist of eight development targets that members of the United Nations agreed to achieve by 2015, including a two-thirds reduction in maternal and under-five mortality rates between 1990 and 2015.

     "When we talk about maternal-mortality-rate reduction, we are very slow in achieving our targets for 2015," said Dr. Yolanda Oliveros, director of the Department of Health's National Center for Disease Prevention and Control.

     Speaking at a forum on the Health Research Towards the Achievement of Millennium Development Goals held to mark the 12th anniversary of the University of the Philippines-National Institutes of Health, Oliveros noted that under the MDG, the Philippine target is to bring down maternal-mortality rate to 52.5 per 1,000 live births. But as of 2006, the rate remained high at 152.

     Meanwhile, deaths of children under five have also gone down from 52 per 1,000 live births in 1993 to 31 in 2006 while infant mortality has also dropped from 34 per 1,000 live births to 23.

     Oliveros, however, pointed out that the rate of decline in both infant and under-five mortality has decelerated in the past 10 years, putting the Philippines behind many other countries in the race to achieve the MDG.

     "We are one of the six countries that contribute to 75 percent of all under-five deaths in the Western Pacific region and one of 60 countries that account for 90 percent of all under-five deaths worldwide," she said. She also pointed out that there were barely improvements in the neonatal and post-neonatal deaths, which account for most of under-five deaths. In fact, half of neonatal deaths occur in the first two days from birth.

     On the other hand, the risk of maternal death is highest within the first 24 hours from delivery.

    Oliveros also noted the wide disparities in maternal and under-five deaths among regions. In the case of maternal deaths, for instance, the rates range from 83 per 1,000 live births in Region 10 to 175 per 1,000 live births in the Autonomous Region for Muslim Mindanao where some provinces have rates as high as 300.

     Demographically, the risks of under-five mortality may be summed up in the phrase, "too young, too old, too frequent, and too many," Oliveros said. The rates are high among those whose mothers were below 20 years old (56 per 1,000 live births) and 40 to 49 (89), those who were born fourth to sixth (45 per 1,000 live births) or seventh (83 per 1,000 live births), and those who were born less than two years apart (58 per 1,000 live births).

     A mother's level of education is also a factor, with the death rates more than three times higher among mothers with little or no education compared with those who have had college education. "As the educational level of the mother increases, the mortality risk decreases," observed Oliveros. The death rates are also higher among those who belong to the lower economic stratum.

Direct causes

    Hypertension as a complication of pregnancy, childbirth, and puerperium is the single biggest cause of maternal deaths, accounting for more than one out of every four. Blood loss because of postpartum hemorrhage accounts for 17.7 percent of deaths while pregnancies with abortive outcome make up 10 percent. Forty-five percent of deaths arise from other complications related to pregnancy occurring in the course of labor, delivery, and puerperium.

    Meanwhile, infectious diseases-pneumonia, diarrhea, in particular-still constitute the top causes of under-five and neonatal deaths, with undernutrition playing a key role as an underlying condition. Among neonatal deaths, which account for 37 percent of total under-five deaths, the top causes are preterm delivery, pneumonia, and asphyxia.

    Oliveros cited the following predisposing factors for the high maternal and under-five deaths: maternal and child malnutrition, high fertility and short birth intervals, insufficient newborn care, inappropriate infant- and child-feeding practices, poor access to safe water and sanitation facilities, and poor access to basic health services.

    As of 2003, for instance, anemia prevalence remains high among pregnant (44 percent) and lactating (42 percent) women, as well as among children six months to less than one year (66 percent) and one to five years old (29 percent). Ditto with vitamin-A deficiency, which affects 17.5 percent of pregnant and 20 percent of lactating women, as well as 47 percent of children six to 12 months to less than one year (47 percent) one to five years old (39 percent). Also, among all children under five, 27 percent are below normal weight and 27 are below normal height.

    Maternal care leaves much to be desired. "We have very poor maternal care based on the data that we have gathered," Oliveros lamented, citing results of the 2203 National Demographic and Health Survey. She noted that while a high percentage of pregnant women undergo weight (90 percent) and blood-pressure (88 percent) measurements or receive iron supplements (77 percent), less than half undergo biochemical screening for infections or counseling on pregnancy dangers and complications. "The test of whether there is infection to detect complication is not fully done at the health facility," she said. Moreover, only 48 percent of mothers who had prenatal were given information on possible pregnancy complications.

    Postpartum care, meanwhile, is heavily tilted in favor of baby care. "Services provided in health facilities focus on the baby, few are done on mothers," Oliveros pointed out, citing the lack of breast and internal examinations, as well as advice on family planning for mothers.

    Still, Oliveros noted inequities in access to health services. Among women belonging to the richest 20 percent of the population, 97.6 percent received prenatal care from health professionals and 92.4 percent were attended by health professionals during delivery as against 80 percent and 25 percent among the poorest 20 percent. The imbalance is also seen among children in, among other areas, the administration of immunization against at least six pathogens (83 percent of the richest 20 percent vis-à-vis 55.5 of the poorest 20 percent), vitamin-A supplementation (87.3 v. 64.4 percent), iron supplementation (69.3 v. 47.3 percent), and oral-rehydration solution in case of diarrhea (50.6 v. 30.6 percent). Lack of money is the main hindrance to access, cited by nearly nine out of 10 of the poorest 20 percent.

Problem-program mismatch

    One major obstacle to the attainment of the MGD is what Oliveros termed as "a mismatch between the problems and the programs meant to address them." She cited the following:

• The problem is mainly in the first week of an infant's life, but the programs don't address survival in the first week of life.

• The problem involves both the mother and the newborn, but the programs separately address either mother or the newborn.

• The problem is in the home or community, but the programs are mainly based in hospitals, health centers and other health facilities.

• The problem is getting supplies and medicines to homes and communities where they are needed most, but the programs see health centers as the end point in the supply chain.

    Oliveros called for an integrated maternal-newborn-child health strategy to address these gaps and bring the country closer to MDGs. M

 

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