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Missing Targets: An alternative MDG midterm report More than any other facet of health services, good interpersonal relations was emphasized time and again as an important factor in poor women’s continued use of a health service. Services that were inadequate—meager facilities, insufficient medical supplies and limited personnel—were as critical an issue as health service providers who did not treat them with dignity and respect. Women responded feeling degraded and widely exposed in an assembly line-like delivery. The geographic maldistribution, the generally low quality and underfunded government facilities, and the burden of paying for services deny poor women and children effective access to critical health interventions during pregnancy, particularly before and after childbirth. In urban slums, women are near hospital facilities but they do not utilize. This is where it is probably most pronounced but GPS data conservatively show that over half of home deliveries occur near a health facility. Health facility delivery in ARMM and Zamboanga Peninsula are lower than the rest of Mindanao, which in turn are lower than the Philippine average. richest quintile had home births. (WHO Fact Sheet, 2007). More so, less than 20 percent of poor mothers were assisted during delivery by trained health professionals, e.g., a doctor, nurse or midwife, while more than 80 percent of mothers from the richest quintile received assistance. A tale of disparities: An issue of poverty, gender and inequity Statistics are blind to inequity. Disparities are hidden in the national averages which fail to show the picture of maternal and child mortality in the country. Poor women and children consistently are not able to access services. Access to health care services is fast becoming an issue of inequity, with poor Filipino women unable to access the services, information, supplies and facilities that could prevent and reduce maternal and child mortality. The services are inaccessible because often they cannot afford treatment or, because as women, do not have the time or the social support to avail themselves of the service. 1998 2003 ARMM Health Facility 34 38 Zamboanga Peninsula Mimaropa Eastern Visayas Home 66 61 88.4 83.8 83 79.3 76.3 Govt. Hospital 6.3 10.9 13 14.7 15.7 Govt. Health Center 0.5 1.0 0. 6 0.7 0.7 Private 3.9 3.7 2.1 5.3 5.5 Source: NSO, DOH, and Macro International Inc., 1999 Bicol 2003 NDHS reveal 38 percent of live births were delivered in a health facility, and 61 percent were born at home. These figures show an increase in the proportion of births occurring in a health facility (34 percent in 1998) and a decline in the percentage of births delivered at home (66 percent in 1998) (NSO, DOH, and Macro International Inc., 1999). Delivery in a health facility is most common in NCR (70 percent). On the other extreme, only 6 percent of births in ARMM are d<strong>one</strong> in health facilities. In 10 regions, at least 70 percent of births occurred at home, with ARMM (88 percent), Mimaropa (83 percent), and Zamboanga Peninsula (84 percent) registering the highest percentage. Over 90 percent of women from the poorest quintile gave birth at home while a mere 20 percent of the Improving equity within countries would prevent 40 percent of all child deaths. Poverty and maternal and under-five child mortality The disproportionate number of women and under-five child mortality among poor households is borne by the environmental risk and hazards that the poor mostly endure in their living areas. The major causes of child deaths in developing countries, in particular in South Asia and Southeast Asia, reveal the link between maternal and child mortality and poverty. Major causes of deaths in the region are found to have been largely contracted and transmitted in conditions of poverty such as crowded living quarters, intergenerational malnutrition, indoor and outdoor air pollu- 40 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 tion, unsafe drinking water, and improper sanitation. (WHO, 2006). Poverty is the greatest threat to maternal and child survival and is a formidable obstacle to the achievement of the MDGs by 2015. Poor women and children are more exposed to health risks and have lesser access to preventive and curative interventions compared to those in the higher socioeconomic strata. One of the important findings of the 2003 NDHS documents the inability of poorer women and children to access health services. When cross-national data is applied, findings show that immunization programs disproportionately benefit the richest quintile than the poorest quintile; and that about 15 percent of the children in the poorest quintile have no basic coverage compared to only 2 percent in the richest quintile (Gwatkin et al, WB 2007). Coverage of child immunization by wealth quintiles Source: Congressional Planning & Budget Department 2008 Budget Briefer The following figures show poorer women in the lowest quintile have the least access to skilled birthing attendants; doctors, nurses, and midwives to assist them during delivery, as well as access to health facilities, including public facilities. The women in the highest quintile are about 9 times more likely to have a medical doctor assist them during delivery and are 38 times more likely to deliver in a private facility than women in the lowest quintiles. Another gauge of poor women’s inability to gain effective access to life-saving services is the low percentage of women—about 1.7 percent—who had delivered through a caesarean section. This figure is way below the 5-15 percent range as the proportion of complications requiring caesarean sections among a group of women giving birth. Below 5 percent would indicate women are dying or suffering from a disability because they are not receiving treatment; above 15 percent may indicate that women are receiving caesarean sections for reasons other than those strictly required by their medical condition or fetal indications. Apart from caesarean sections, poor women are not able to access other services even if these are being provided. S O C I A L W A T C H P H I L I P P I N E S 41
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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 A3.3: Annual Per Capita Food
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Table A3.5: Poverty Incidence of Fa
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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 C3.2: Labor Productivity, by
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