In the Philippines, Giving Birth Kills: Maternal Mortality in the Philippines

Summary

The video script addresses the alarming maternal mortality rates in the Philippines, highlighting the stark contrast with countries like Canada. It emphasizes the preventable nature of these deaths and the role of traditional birth attendants, or 'helots', in this silent epidemic. The script calls for improved access to skilled birth attendance, better prenatal care, and the importance of the reproductive health bill in reducing maternal mortality. It underscores the need for a collective effort from government, NGOs, and society to ensure safe pregnancies and childbirths, advocating for a healthy population as a foundation for national development.

Takeaways

• 🌎 Maternal and child health is a global measure of a country's health system efficiency.
• 😔 The scale of maternal mortality is high but not well-known; it's considered a silent epidemic.
• 📊 In 2008, the Philippines had a higher maternal mortality ratio compared to Canada, with 11 Filipino mothers dying daily.
• 🤰 Complications during pregnancy can be fatal, with the World Health Organization identifying five main causes of maternal mortality.
• 🚑 Most maternal deaths are preventable, and the United Nations aims to improve maternal health through skilled care during pregnancy and childbirth.
• 👶 In the Philippines, about 36.4% of pregnant women receive assistance from traditional birth attendants, known as 'helots'.
• 🛑 The lack of training for helots can lead to inadequate care and increased maternal mortality risks.
• 🏥 Access to healthcare is a significant issue, with various barriers such as lack of permission, money, and transportation.
• 📈 The three delays model in maternal health includes decision-making delays, accessibility and transport delays, and delays in the provision of appropriate care.
• 🏛️ Initiatives like the MNCHN strategy and local campaigns aim to reduce maternal mortality by improving access to skilled birth attendance and healthcare facilities.
• 🌱 The reproductive health bill, if passed, would provide a comprehensive health care program to improve maternal health, including family planning and education.

Q & A

What is considered a measure of the efficiency of a country's health system?

Maternal and child health is considered a measure of the efficiency of a country's health system.

Why is the high maternal mortality rate not well known despite its scale?

The high maternal mortality rate is not well known because it is often overshadowed by other diseases and lacks public and policy maker awareness.

According to the United Nations Children's Fund, how many Filipino mothers die daily due to pregnancy and childbirth complications?

According to UNICEF, 11 Filipino mothers die every day due to complications related to pregnancy and childbirth.

What is the maternal mortality ratio in the Philippines in 2008, and how does it compare to Canada's?

In 2008, the maternal mortality ratio in the Philippines ranges from 94 to 160 deaths per 100,000 live births, which is significantly higher than Canada's ratio of 12 per 100,000.

What are the five natural causes of maternal mortality as identified by the World Health Organization?

The five natural causes of maternal mortality are hemorrhage (25%), infection (15%), unsafe abortion (13.3%), eclampsia (12%), and obstructed labor (8%).

What is the United Nations Millennium Development Goal five aiming to achieve?

UN Millennium Development Goal five aims to improve maternal health through access to skilled care during pregnancy, childbirth, and the first month after delivery.

What is a traditional birth attendant (helot) in the Philippines?

A traditional birth attendant (helot) is a person who assists mothers during childbirth, having initially acquired skills through self-teaching, observation, or apprenticeship.

Why do women still choose to have their babies delivered by helots despite the risks?

Women may choose helots due to cultural and financial reasons, as well as the personal care provided by helots, which may not be as personalized with professional midwives.

What are the three levels of delay in the Thaddeus and Maine's framework model of maternal mortality?

The three levels of delay are decision-making at the community level, accessibility and transport to a health facility, and the availability and quality of appropriate care.

What is the MNCHN strategy implemented by the Department of Health in the Philippines?

The MNCHN (Maternal, Neonatal, Child Health, and Nutrition) strategy aims to improve maternal health by organizing a service delivery network at the community level, basic emergency obstetrics and newborn care, and comprehensive emergency obstetric and newborn care.

What is the significance of the reproductive health bill in improving maternal health in the Philippines?

The reproductive health bill, if passed, would provide an integrated health care program that includes family planning, maternal and infant health services, and other measures to significantly improve maternal health in the country.

Outlines

00:00

🤰 Maternal Mortality: A Silent Epidemic

The first paragraph addresses the critical issue of maternal mortality, highlighting the significant number of deaths among women due to pregnancy and childbirth complications. It emphasizes the lack of public awareness and the disparity in maternal mortality rates between the Philippines and Canada. The World Health Organization's identification of the five main causes of maternal mortality is noted, along with UNICEF's assertion that most of these deaths could be prevented. The paragraph also touches on the traditional practice of 'helots' or birth attendants in the Philippines and the government's efforts to train them to improve maternal health outcomes.

05:08

🏥 Cultural and Logistical Barriers to Maternal Care

This paragraph delves into the cultural and logistical challenges faced by pregnant women in accessing skilled birth attendance. It discusses the preference for traditional birth attendants, known as 'helots,' over professional midwives due to cultural familiarity and financial constraints. The paragraph also outlines the 'three delays' model, which identifies the delays in decision-making, accessibility and transport, and the availability and quality of care as contributing factors to maternal mortality. Initiatives to address these issues are mentioned, including the Department of Health's efforts to improve maternal health through better coordination and training.

10:10

🛑 Initiatives to Reduce Maternal Mortality

The third paragraph focuses on various initiatives aimed at reducing maternal mortality rates. It describes the implementation of the integrated Maternal Neonatal and Child Health and Nutrition (MN CHN) strategy by the Department of Health, which organizes a service delivery network at the community, basic emergency, and comprehensive emergency levels. The paragraph also highlights a local government's campaign for maternal care, including the establishment of a database for pregnant women, the use of cell phones for medical advice, and the availability of ambulance services. Additionally, it mentions the construction of birthing facilities through public-private partnerships.

15:12

📜 Policy and Advocacy for Maternal Health

This paragraph discusses policy and advocacy efforts to improve maternal health in the Philippines. It details a municipal ordinance regulating the practices of trained birth attendants and health workers, as well as the involvement of non-government organizations in promoting safe motherhood. The push for the passage of the reproductive Health Bill, which has been in Congress for 16 years, is emphasized, outlining its potential to provide a comprehensive health care program covering family planning, maternal and child health, and other reproductive health services.

20:12

🌟 The Importance of a Holistic Approach to Maternal Health

The fifth paragraph underscores the need for a comprehensive approach to maternal health, involving cooperation among different sectors and the prioritization of health services. It stresses the importance of education, informing people of their rights to health, and the government's role in addressing maternal health as a top priority. The paragraph also mentions the universal healthcare approach and the importance of starting health services from the local level, emphasizing the need for political will and coordination among various health levels. The role of health workers and the necessity of providing necessary health services, including reproductive health, are also highlighted.

25:13

💔 The Human Cost of Maternal Mortality

The final paragraph reflects on the human cost of maternal mortality, arguing that it is not just a measure of a country's health system efficiency but also a reflection of a society's values towards women. It calls for a just and humane society that does not let mothers die in childbirth and emphasizes the importance of a healthy population for national development. The paragraph concludes with a call to action to invest in social services like education and health to build a strong foundation for the country's future.

Keywords

💡Maternal Mortality

Maternal mortality refers to the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. In the video's context, it is a significant issue in the Philippines, with a high ratio compared to countries like Canada, indicating a major concern in the health system.

💡Maternal Health

Maternal health encompasses the health of women during pregnancy, childbirth, and the postnatal period. The video discusses the importance of maternal health as a measure of a country's health system efficiency and highlights the efforts to improve it through access to skilled care during pregnancy and childbirth.

💡Pregnancy Complications

Pregnancy complications are health issues that arise during pregnancy and can potentially lead to the death of the mother. The script mentions that the World Health Organization has identified five major causes of maternal mortality, such as hemorrhage and infection, which are directly related to pregnancy complications.

💡Skilled Birth Attendance

Skilled birth attendance refers to childbirth care provided by professionals such as midwives, doctors, or nurses who have been trained to manage normal childbirth and provide emergency care. The video emphasizes the importance of skilled birth attendance in reducing maternal mortality rates and contrasts it with traditional birth attendants.

💡Traditional Birth Attendants (TBAs)

Traditional birth attendants, or helots in the context of the Philippines, are individuals who assist mothers during childbirth, often having acquired their skills through self-study or apprenticeship. The video discusses the limitations of TBAs, such as lack of formal training and the risks associated with their practices, which can contribute to maternal mortality.

💡Maternal Mortality Ratio

Maternal mortality ratio is a measure of the number of maternal deaths per 100,000 live births. The script provides specific ratios for the Philippines and Canada, highlighting the disparity and indicating the scale of the issue in the Philippines.

💡Preventable Maternal Deaths

Preventable maternal deaths are those that could be avoided through timely and appropriate medical intervention. The video script points out that most maternal deaths are preventable and emphasizes the need for better access to healthcare and skilled birth attendance.

💡Healthcare Access

Healthcare access refers to the availability and affordability of healthcare services for individuals. The video discusses various barriers to healthcare access, such as financial constraints, lack of transportation, and cultural factors, which can influence a pregnant woman's choice of birth attendant and contribute to maternal mortality.

💡Reproductive Health Bill

The reproductive health bill mentioned in the video is a proposed legislation in the Philippines aimed at improving maternal health by providing integrated health care programs, including family planning, maternal and child health services, and reproductive health education. The bill has been a subject of debate for many years, reflecting the broader social and political context around maternal health.

💡Healthcare Coordination

Healthcare coordination refers to the organization and management of healthcare services across different levels, from local to national. The video calls for improved coordination among various sectors to address the issue of maternal mortality and to ensure that health services are effectively delivered to those in need.

💡Community-Level Services

Community-level services are healthcare services provided at the local community level, often by health workers or community health volunteers. The video discusses the role of community-level service providers in identifying pregnant women, providing prenatal care, and assisting with facility-based births, which is crucial in reducing maternal mortality.

Highlights

Maternal and child health is a measure of the efficiency of a country's health system.

11 Filipino mothers die every day due to complications related to pregnancy and childbirth.

The maternal mortality ratio in the Philippines in 2008 ranged from 94 to 160 deaths per 100,000 live births.

In contrast, the maternal mortality ratio in Canada in 2008 was only 12 per 100,000 live births.

There is a significant lack of public awareness about maternal mortality, which is considered a silent epidemic.

25% of pregnant women die of hemorrhage, 15% of infection, 13% of unsafe abortion, 12% of eclampsia, and 8% due to obstructed labor.

Most maternal deaths could be avoided, according to UNICEF.

36.4% of pregnant women in the Philippines receive assistance from traditional birth attendants, known as helots.

The Department of Health has been training helots since 1974 to make them competent birth attendants.

Training helots has sometimes created a false sense of confidence, leading to complications not being referred to professional healthcare providers.

UNICEF identifies the use of helots as a major factor in maternal death.

Many women choose helots due to cultural preferences and financial constraints.

Accessing healthcare is hindered by issues such as getting permission for treatment, transportation, and the availability of female healthcare providers.

The 2008 Philippine national demographic and health survey highlights various barriers to accessing healthcare.

The Department of Health released administrative order 2008-0029 to implement the integrated maternal, neonatal, and child health and nutrition (MNCHN) strategy to reduce maternal mortality.

Mayor Leo Vildo Basmayor launched the Project Mama initiative to assist pregnant women from pregnancy awareness to delivery.

Non-government organizations are pushing for the passage of the reproductive health bill to improve maternal health.

Undersecretary Herbosa calls for cooperation among different sectors to improve maternal health.

Universal healthcare initiatives aim to provide free or minimal cost healthcare to all people.

Investing in maternal and child health is essential for national development and creating a healthy workforce.

Maternal health reflects the worth of women in society and is crucial for a country's future.

Transcripts

maternal and child health has been a

measure of how efficient the health

system of any country works that's the I

think the tragedy that it's such a big

scale of death but uh it's not very well

known if you die from a disease it is

understandable you were saying pregnancy

is that the disease and how come women

are dying from

it we always want the pregnancy to

culminate in a healthy baby and a

healthy mother

[Music]

right according to the United Nations

Children's Fund 11 Filipino mothers die

every day due to complications related

to pregnancy and child birth maternal

mortality ratio in the Philippines in

2008 ranges from a low of 94 to a high

of 160 deaths in every 100,000 live

births this is high compared to the

maternal mortality ratio in Canada in

the same year which is only 12 per

100,000 there's a lot of uh lack of U

understanding about the problem because

people worry here about the Deni

hemorrhagic fever right now which kills

300 not knowing that the the death rates

for women who die of preventable

maternal uh deaths are are are really

great and it's not the rates are not

coming down and it's a silent uh

epidemic actually that uh has not

figured into the consciousness of the

public and uh especially of policy

makers so so that's the uh that's the I

think the tragedy that it's such a big

scale of death but uh it's not very well

known they were saying it is not a

disease you have not you don't have to

treat it but it is the only condition

that is not a disease and yet women are

dying from

it okay if you die from a disease it is

understandable you were saying pregnancy

is at the disease and how come women are

dying from

it mothers May develop complications

during pregnancy that could lead to

their death the World Health

Organization identified five natural

causes of maternal mortality 25% of

pregnant women die of hemorrhage 15% of

infection 133% of unsafe abortion 12% of

eclampsia and 8% due to obstructed labor

however UNICEF explains that most

maternal deaths could be avoided United

Nations Millennium Development Goal five

aims to improve maternal Health through

access to Skilled care during pregnancy

child birth and a first month after

delivery to save the lives of both the

mother and the child in the Philippines

about 36.4% of pregnant women receive

assistance from the helots helots are

traditional birth

attendants the Department of Health

defines traditional birth attendant as a

person who assist mothers during child

birth and who initially acquired her

skills by delivering babies by self or

through observation or apprenticeship

with other helots the practices of

helots are naturally passed on in the

family the Department of Health has been

providing intensive training since 1974

to make he's competent birth attendance

one of those who received training was

Leonor

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Vel

1976 we actually in the past tried to

teach the uh traditional birth

attendance in the H with some skills but

the experience of that was not very

ideal in fact it it created a syndrome

we called little knowledge is dangerous

the more the complicated deliveries were

not being referred because as we

imparted a lot of knowledge to them it

also created them a false sense of uh

confidence and the one at risk is

actually the mother the lack of the

heal's training may be manifested in

their varying

practices

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these practices are often opposed by the

skilled birth

attendance

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and repair number one the control the

infection they are not trained for that

they're not trained to do um minor

surgery like otomies and everything so I

think it's they are not trained to to do

um IV therapy for example because in in

in child birth there's a lot of

hemorrhages in uh there are a lot of um

it is a very Bloody Business right

giving birth so they're not trained so

they do not they cannot give emergency

measures to the

patient UNICEF identifies the pregnant

women subscription to the hilot as a

major factor in maternal death the

United Nations sees the successful child

births can be achieved more with the

help of skilled birth attendance but why

do women still gamble in choosing helots

to deliver their babies poor women uh

culturally financially

they will deliver with a with a

attendant that they are most comfortable

with and there's the cultural difference

is that the traditional birth attendants

are actually very personal in their care

the professional Midwife does not have

that

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personalized

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there are more and the Midwife so um the

cultural the norm is to go to the hot

first before going to the midwe the 2008

Philippine national demographic and

health survey by the national Statistics

Office points to the different problems

in accessing Healthcare among these are

getting permission to go for treatment

getting money for treatment the

assistance of Health Facilities having

to take transport not wanting to go

alone having no female provider

available having no provider available

and having no drugs available the survey

shows that choosing the healers is not a

direct cause of maternal mortality but

these problems in accessing Health Care

May influence the pregnant women's

choice of a birth attendant seeking care

from the healers they have risks in the

mother's pregnancy these risks are

referred to in the and Main's framework

model of three level LS of delay the

first level of delay is in a decision-

making at the community level ignorance

on the part of the patient no they were

not they not having any prenatal care at

all they may be having a watery

discharge for one week maybe bleeding

for a long period of time only at the

time that the condition become uh

irreversible that's the only time they

will go to the hospital so how how how

how good a doctor you may be

you will not be able to reverse the

condition the second delay is in the

accessibility and transport to a health

facility and the options for

communication second that can also be

because the health facilities are quite

far from them you know and it's not

unusual uh for our people to live hours

away from the nearest hospital you know

some even have to ride boats to be able

to go to to to to the nearest clinic or

or Hospital the third delay is in the

availability and quality of appropriate

care and the third if they do get to

reach a hospital but unfortunately not

all our hospitals are fully equipped so

some of our hospitals the anesthesiology

is not available they have no anesthesia

machine so that they need to do

emergency intervention but the emergency

intervention is again delayed the delay

in the decision to seek care delaying

the arrival at the health facility And

Delay the provision of appropriate care

are all interconnected and may occur all

at the same time all of this as you can

see is a

Continuum and some of them are entirely

preventable because if you if the mother

gets good prenatal care you can actually

identify already who should be giving

birth in a hospital and who who should

be given in less safe condition so you

second delivery normal without any

complications initiatives are being done

to address the three levels of delay to

reduce maternal mortality in 2008 the

Department of Health released

administrative order

2008-2 n to implement the integrated

maternal neonatal and child health and

nutrition or MN chn strategy the 2008

0029 administrative order is really all

about improving maternal mortal through

a strategy the goal of the administra

order is to significantly lower maternal

mortality the MN chn Service delivery

Network shall be organized as

follows number one is the community

level service

providers they are the health workers

tasked to give primary healthc care

services including the campaign for

proper birth spacing complete required

antenatal care visits Aid in the shift

to facility based birth assisted by

professional attendance postpartum and

postnatal care and assistance in other

health packages for women and

children this also limits the role of

the heot to assisting the professional

attendants and health

workers number two is the basic

emergency Obstetrics and newborn care or

bamun the bong facility is comprised a

core District Hospital or similar

facilities capable of Performing the

obstetric functions neonatal emergency

care and blood transfusions number three

is the comprehensive emergency obstetric

and newborn care or

seon the seon facilities are and

referral public and private facilities

capable of managing complicated

deliveries including the same functions

as the Bon cesarian section and other

highly specialized obstetric

services in the municipality of minaba

kamarin Mayor Leo vildo basmayor has

launched a strong campaign for maternal

care one of his initiatives is the

project maternal assistance monitoring

activity or project Mama Our intention

is uh to identify every household that

has got pregnant women and this is done

by uh by a maximum cooperation between

uh bangi leaders our health

workers and uh uh our bangai officials

the intention is uh to come up with a um

a

database uh so we can uh assist all of

them uh from the time they are are aware

that they are pregnant up to the time

that they will

deliver uh also we have uh try to

institutionalize one uh program like uh

uh giving um uh medical advice to uh uh

pregnant women via cell phone so they

can uh text us uh for whatever problem

that uh they are encountering while uh

uh

they are waiting for the delivery they

can they can call us or we can call them

uh we always make our ambulance uh

available so we can pick them up any

time uh there need to bring them to the

hospital mayor M Mayo's other initiative

is ordinance number 121

d201 regulating the practices of trained

birth attendance and all health workers

on Safe Motherhood or maternal and Child

Health Care

Program

as far as uh the municipal ordinance is

concerned um if they bring uh pregnant

women in our facilities uh they will be

given a second amount uh part of their

share if they help if they help they

will just be assisting Our Midwives and

uh and the part of the money that uh we

will uh collect will be returned to the

uh hos the local government unit in

minaba also tap resources of private

corporations in building lying in and

birthing

facilities two birthing facilities have

already been constructed in the

municipality by theik

Foundation another one would be built by

the end of 2011 from fiser Park Davis so

there are two birthing facilities now

and um uh with this new one from uh

fiser I think the the building will be a

lot better A lot bigger uh to

accommodate uh more patients so we are

we are putting in a facility beside the

rural health unit um this facility is

for natural birth and this is under

partnership with the Department of

Health and participating local

government units the main purpose of

this is uh to provide an alternative

because despite an administrative order

Banning a a homebased delivery there's

still a lot of people in fact in 2009 um

statistics would dictate that uh 60% of

women gave birth in their houses so we

want to lessen that so we would want

them to just go into the facility and

under Trin uh birth attendance so that's

the whole project there um when you look

at it 2015 is uh is uh is so near so

that's why we created the facility out

of shipping containers which can be done

in 2 weeks time so we knew that we

wanted to put up something fast

something that works and something

that's easily replicable in

record-breaking time because the window

is closing in and we we need to and part

of that is we believe that the

facilities would play a vital role in

terms of uh curving maternal

Health similar to project mama is the

reproductive Health Sentinels by lean an

organization advocating the health and

rights of disadvantaged women and their

communities their job they're actually

leaders in the

community who uh whose uh tasks

involve involve or include uh watching

over women with

pregnancies and making sure that the

women who deliver with complications are

brought to the

fastest uh facility available

non-government organizations also push

for the passage of the reproductive

Health Bill to significantly improve

maternal Health in the country the bill

has been languishing in the Philippine

Congress for the past 16 years it is

only now that it is getting a fair

chance of becoming law reproductive

Health uh it requires a series of interl

uh

elements uh to ensure that every woman

can can have a safe uh reproductive life

and every F not just every woman every

man woman and even children can have

safe uh lives when it comes to the area

of reproduction the reproductive health

or RH bill shall provide an integrated

healthc CARE program that includes the

following Family Planning information

and services maternal infant and child

health and nutrition including

breastfeeding

prescription of abortion and management

of abortion

complications Adolescent and youth

reproductive Health prevention and

management of reproductive tract

infections HIV and AIDS and other

sexually transmittable

infections elimination of violence

against women education and counseling

on sexuality and reproductive health

treatment of breast and reproductive

tract cancers and other gynecological

conditions and

disorders male responsibility and

participation in reproductive Health

prevention and treatment of infertility

and sexual

dysfunction reproductive health

education for the

adolescents and the mental health aspect

of reproductive Health Care conscious

efforts are being made to reduce

maternal mortality but there is still a

lot to be done under secretary herbosa

calls for cooperation among the

different sectors and a gold improve

maternal Health none of us want our

mothers to die giving birth is there

anyone out there from the NGO the

government or the other sectors who want

mothers to die uh while giving birth

none the key is to act accordingly

there's a lot of things to be done like

uh uh educating our people informing our

people that these are their rights

health is a basic right of our people

and uh government must must also show uh

some honest efforts in addressing this

problem it should be among the top

priorities that is tighter coordination

of health services at the national the

regional the provincial and the local he

Health level so that that will take a

great deal of political will there are

uh initial steps to this uh there is uh

an

initiative both uh NGO and government

now which is called the universal

healthcare uh

approach we cannot do this alone in fact

it is imperative that the the uh

Health the health uh health facilities

and services should start from the

bottom it should start from the

municipality we have to work with the

government with the politicians we have

to have a really nice health care we

have to reduce the

population I think it's not just on the

health side or maternity maternity side

it has to go with the economic ution

also as health workers we will take care

of whatever is task to us but the others

the rest I hope would do their part in

alleviating the situation of this people

the thing to do is to make pregnancies

and child birth safe the question of

course is how and the answer is uh uh by

providing the services that are

necessary

to make the pregnancies and uh child

births safe if we say that 80% are

because of complications that are that

uh women incur before or during child

birth then the the the the solution is

really to have the services and then

also the availability of standby uh

ambulances or transport just in case

problem arises the patient can be

transported

immediately and then and then to

continue providing this free medicine

especially for for uh anemia feros

sufate folic acids for pregnant mother

and the uh vaccinations for toxoid tanos

toxoid prevent

thator I think if the mortality and

morbidity gets higher if the patient are

are those among those patient who have

higher parity and gravidity so if you

have birth proper birth spacing or

proper birth control then I think it

would be a very big factor to bring down

the maternal mortality and morbidity

rate all necessary health services

including reproductive Health should be

provided it's possible it's entirely

possible for a country such as ourselves

no matter how much is our poverty level

at the moment to be able to provide uh

free health care or minimal payment

healthare to all our people and I am one

of those people who thinks that if you

want National development we have to

have

massive uh investment in social services

such as education and health build up

the basic Foundation which is maternal

and child and newborn care build up that

basic and then we can proceed and

compete in the global market the key is

we need to have a healthy population

Healthy Mothers Healthy Children healthy

newborns that's the only time we can

have a healthy Workforce with a healthy

Workforce that is educated and trained

we can compete as a country in the

global World maternal health is not just

a measure of efficiency of the country's

Health System it is a statement of

women's worth in a society that claims

to be just and Humane letting mothers

die makes the future Loom with darkness

and to see more and more of them die is

to lose a future

altogether

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