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Missing Targets: An alternative MDG midterm report Breastfeeding immediately after delivery increases the levels of oxytocin, which stimulates contraction of the uterus, thereby reducing blood loss and risk of hemorrhage, a major cause of maternal mortality. who were breastfed for only an hour, a day or a week, and includes as well those children given liquid or food other than breastmilk within the first 72 hours of life (3.4 million Filipino children). Exclusive breastfeeding is down to 6 percent and a staggering 15 percent of infants were never breastfed. According to Unicef and the World Health Organization (WHO), the Philippines is one of 42 countries that account for 90 percent of under-5 deaths globally. The Department of Health said that of these deaths, “16,000 deaths could be prevented with, first, the initiation of breastfeeding in the first hour of life; second, by exclusively breastfeeding the infant for the first six months; and third, for a mother to continue with breastfeeding and appropriate complementary feeding until a child reaches two years of age” (Babao- Guballa, 2007). Breastfeeding does not only save the child, but the mother as well. Due to the hormonal effects of breastfeeding, a mother develops lactational infertility, a period when the mother does not become pregnant. The more the infant suckles and is exclusively breastfed, the greater the effect. The mother also develops lactational amenorrhea, a postnatal period when the mother does not menstruate due to the same hormonal effects of breastfeeding. Lactational amenorrhea reduces menstrual blood loss, thus prevents anemia by conserving the mother’s iron stores. Longer birth intervals reduce the risk of maternal and infant mortality. Goal 5: Improve maternal health Target 6: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. While there has been some progress in child mortality targets, improvement in maternal health is nil. Maternal death remains a significant cause of death in the Philippines, comprising 14 percent of the total deaths of women aged 15-49 years old (2003 PPR on MDG). MMR is unacceptably high and yet decline in maternal death over the past 20 years has been very slow at 22.5 percentg or at 1.6 percent per annum over 18 years (2006 FP Survey). Maternal Mortality Rate, 2001 data Country Ratio Philippines 170 Thailand 44 Malaysia 41 South Korea 20 Japan 8 Source: Dr. Manuel M. Dayrit’s presentation on the International Conference on Population and Development at 10 (4 October 2004 t the Heritage Hotel) Although MMR has declined from 209 in 1993 to 162 in 2006, the rate of reduction is still critically off-track, given the MDG target of 52 maternal deaths per 100,000LB. 34 S O C I A L W A T C H P H I L I P P I N E S
Missing Targets: An alternative MDG midterm report MMR is higher in poor provinces. Regional figures show MMR at 320/100,000 to 119/100,000. The MMR for ARMM is 320/100,000 in 1998, nearly three times the rate in Metro Manila (ADB, 2005). The morbidity picture reflects this regional disparity. Life-and-death issues for mothers and children Access to EmOC About 85 percent of maternal deaths are due to direct complications that require emergency obstetrics care (EmOC). Such care has three essential elements: a skilled attendant at delivery; access to emergency obstetric care (EmOC) in case of complications; and a functioning health referral system in place to allow the unimpeded flow of services to any pregnant woman who needs them at any place and at any time. Access to this package of critical services is sorely lacking, especially for poor women. Abortion dilemmas Women continue to die from the complications of unsafe abortion. Given that contraceptive commodities are unavailable and unaffordable, unwanted pregnancies remain to be a problem in this country where abortion is illegal and services that terminate a pregnancy are nonexistent. Thus, women resort to illicit abortions and run the risk of acquiring life-threatening complications. Unless contraceptive commodities and FP services become more available and accessible and women are provided quality post-abortion care, this country will not be able to lower its maternal mortality. In the Philippines, about 3.1 million pregnancies occur each year and nearly half of these pregnancies are unintended and about one-third ends up in abortion. In 1994, abortion reached a total of 400,000 cases, with teenagers accounting for 17 percent of these cases. Based on DOH records, abortion has also become the fourth leading cause of maternal mortality, representing 12 percent of all maternal deaths resulting from complications related to abortion. It remains the third leading cause of hospital discharges. Fertility and mortality Reducing the number of pregnancies prevents maternal deaths. “One in three deaths related to pregnancy and childbirth could be avoided” if all women have access to FP/contraceptive services, as pointed out by UNFPA. Contraceptive use among married women has almost tripled over the last three decades, although the Contraceptive Prevalence Rate (CPR) or the proportion of women using any FP method in 2006 is 50.6 percent, a rate that has not changed in the last six years. Based on the FP Survey in 2001, only half of Filipino married women are using FP methods. For every 100 married Filipino women who are not using any FP method, nine do not want more children and eight want to space births. Filipino women have consistently had one more child than they wanted (NDHS 1993, 1998, and 2003). In 2003 an average Filipino woman wanted 2.5 children but had actually 3.5 children, higher among rural women at 4.3 compared to urban women at 3.0. The difference between the desired and actual number of children translates to about 800,000 unwanted births. The unmet need for family planning in the Philippines is at 15.7 percent in 2006, of which 8 percent is for spacing. The level of unmet need has declined from the 20 percent level in 1998; 17 percent in 2003; and 15.7 percent in 2006 (Philippines National Demographic and Health Survey 2003). The Population Commission also pointed out an increasing incidence of teenage pregnancy. Reports show that 10 percent of all births involve girls from ages 15-19; and 23 percent of adolescents aged 15-24 engage in premarital sex. The use of any FP method increases with rise in wealth and educational status. More than half of women with at least a high school education use contraceptives, compared with less than one in five women with no formal education. More than two thirds of current users of modern methods get their contraceptive supplies from public sources (67 percent), 29 percent from a private medical source and 3 percent from other sources. Compared with data from the 1998 NDHS, there has been a decrease in reliance on the public sector (from 72 percent) and an increase in use from the private sector (from 26 percent). The Botika ng Barangays do not include in their list essential and affordable family planning commodities. Maternal mortality could drop by 20-35 percent given access to full information, options, effective contraception. The DOH Natural Family Planning Program The Catholic Church has been a dominant influence on the government’s family planning program. The S O C I A L W A T C H P H I L I P P I N E S 35
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Page 7 and 8: FIES FIVIMS FLEMMS FNRI FP FPIC FRM
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Table A2.1: Annual Per Capita Pover
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Table A2.3: Annual Per Capita Food
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Table A3.1: Table A3.1. Annual Per
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Table A3.3: Annual Per Capita Food
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Table A4: Annual Per Capita Poverty
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Table A6.3: Environmental Health Re
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Table A6.9: Percent of Families wit
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Table B.3: Health Indicators: Liveb
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Table B4.3: Health and Nutrition In
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Table B9.2: Education Indicators: S
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Table B10.2 Reconstructed Cohort Su
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Table B11.1: National Elementary Ac
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Table C3.2: Labor Productivity, by
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