Maternal Health In The Philippines

Transcription

1 Figure 1 Maternal Health In The Philippines By Sean Goodwin S.C.M. 1

2 Contents: Page 1 Title Page Page 2 Contents Page 3 Maternal Health Page 3 The Situation in the Philippines Page 3 The Problem Page 4 Major Stakeholders Page 4 Causes Page 4 Strategies to Help Page 4 Governmental Efforts Page 5 NGO Efforts Page 5 UN Efforts Page 5 Implications of Achieving the Goal Page 6 MDGs in Reducing Structural Injustice Page 6 Overview Page 6 Positive Page 6 Negative Page 6 My Overall Impression 2

3 Maternal Health in the Philippines Figure 2 Maternal Health Maternal health is a critical problem in the world. Mothers dying during pregnancy, childbirth and postpartum is a very serious and preventable issue. The major causes of maternal deaths are haemorrhage, unsafe abortion, high blood pressure, infection and obstructed labour. Some 1,400 women die every day around the world during childbirth and tens of thousands more have complications with their health during maternity. In 2000 the UN decided to include reducing the maternal mortality ratio by three quarters between 1990 and 2015 and creating access to universal reproductive health in their Millennium Development Goals (MDG). The Situation in the Philippines The Problem In the Philippines, many women do not have adequate access to maternal health services. A study by the UN Population Fund (UNFPA), the State of the World Population 2008, found that the maternal mortality ratio in the Philippines is shocking at 230 deaths per 100, 000 live births. This is drastically higher than its neighbouring countries with Thailand at 110, Malaysia at 62 and Singapore at 14. According to Vanessa Tobin from the UN Children s Fund, the Maternal Mortality Ratio (MMR) in the Philippines is the MDG that is least likely to be achieved by the country, by Figure 3 In the Philippines only 60% of live births have a skilled birth attendant present. This indicates the structural injustice present in the system in the way that a large proportion of the populace does not have access to sufficient health and maternity care. If a pregnant woman does not have adequate access to healthcare many of the large killers such as haemorrhage, obstructed labour, hypertensive disorders in pregnancy and complications of unsafe abortion that are easily treatable go undiagnosed and untreated. Figure 4 Also the Philippines has poor reproductive health. Due to the vast majority (80%) of the population being Catholic many contraceptive devices are considered similar to abortion and are illegal. In a survey of 3 million Filipino pregnancies, half were planned and one third ended in abortion or attempted abortion. This means that women are getting pregnant without planning. When this happens women are not financially ready to cope with the health needs associated with pregnancy. Many of the abortions can have complications and this can lead to many maternal deaths. 3

4 Major Stakeholders The main stakeholders are obviously women as they are the only ones who can give birth. Mainly lower socio economic women are worst affected because they do not have the access to the above mentioned skilled healthcare professionals. Women living in regional areas are worse off as there simply are not the facilities available. There is usually one professional birth attendant per two to three islands, separated by large bodies of water. The attendants are usually overstretched as they have large workloads that they are not able to perform. This is evident through vast differences in maternal mortality rates in the urban region of Manila having 90% of supervised births and Mindanao having an appalling 24%. Causes The main root of the issue of lack of maternal health in the Philippines is the ongoing armed conflict in the region. There are a number of rebel armies that have accepted responsibility for many bombings, random attacks, kidnappings and shootings throughout the country. These are groups such as, the Moro Islamic Liberation Front (MILF), the Moro National Liberation Front (MNLF), Abu Sayyaf and the New People s Army (Communist Rebels). Most of the groups are based in the autonomous, predominantly Muslim region of Mindanao, in the south. The paramilitaries fight for the independence of Mindanao. The mass of money that has been spent of the conflict, 3 4 billion dollars between 1970 and 2008, deducts money that the country could be spending on other things. Through the political instability that this has brought, it has become harder to distribute sufficient Figure 5 Figure 6 healthcare throughout the country. Also the economic repercussions that this conflict has brought on directly effect maternal health as poverty stricken areas do not have access to health and maternity services. Strategies to Help Governmental Efforts The Philippine Government recognises the poor standards of maternal health in the country. In an effort to improve this, they have placed the health of mothers and babies at the centre of their Health Sector Reform, consistent with advocating that all women have the right to emergency obstetric services. Through the Department of Health (DOH), implementing the Administrative Order on Implementing Health Reforms for Rapid Reduction of Maternal and Neonatal Mortality. This order takes into consideration, three major factors, emergency obstetric care, skilled birth attendants and family planning. The specific implementations are, ensuring that at least eighty per cent of pregnant women have at least for antenatal care visits and increase the amount of women with a skilled birth attendant and facility based births to eighty per cent as well. 4

5 NGO Efforts The maternal health situation in the Philippines has attracted much attention from a long list of non governmental organisations. The main campaign is the Second Women s Health and Safe Motherhood Project (WHSMP2), those organisations such as World Bank, Asian Development Bank (ADB), European Union (EU), Japan International Cooperation Agency (JICA) and United States Agency for International Development (USAID). This includes, demonstrating a sustainable, costeffective way of delivering health services that improve the accessibility that disadvantaged women have to high quality reproductive services and education on how to attain their desired number and spacing of pregnancies. This is mainly being carried out through working with the government and advising best solutions and setting up independent health and maternity care clinics. UN Efforts Three United Nations organisations, United Nations Population Fund (UNFPA), United Nations Children s Fund (UNICEF) and the World Health Organisation (WHO) have banned together to tackle this issue. They have undertaken a joint program to rapidly reduce the number of maternal and neonatal deaths in the country to assist them to meet the MDG. This project, with the support of the Australian Agency for International Development (AusAID), has two phases. The transition period will cover the provinces of Eastern Samar, Ifugao, Lanao del Sur, Maguindanao, North Cotabato, Saranggani, the urban areas of Tacloban, General Santos, Taguig, Navotas, Paranaque and Makati. The second phase, The Full Operational Period will cover the years The main work that the UN is doing is assessing the progress and evaluating the methods that the government is using to counteract the problem. The UN is being very critical in pressuring the government to improve their maternal health situation. The Implications of Achieving the Goal If the Philippines were to achieve the goal and improve their maternal health, their society would notice a series of related benefits. In terms of health, the government is currently implementing a health reform. The reform was created due to the international pressure that the government was facing, mainly related to their maternal health situation. However, this reform also includes all other health systems as well. This is likely to improve hospitals, emergency care and family care in disadvantaged areas. The economy will benefit from having a larger workforce as mothers will not be dying and fathers will not be left with the burden of a child. Also, jobs will be created in maternity care for midwives, obstetricians and gynaecologists. The education system will face increasing enrolment numbers due to the predicted boom in births with the new maternal health standards. The system will need increased funding and support in order to keep up with the increasing numbers. There would be a boom in population as people can now have safe pregnancies. This factor would have the largest impact on the country. The government would have to improve the other infrastructure such as roads, police, transport and education. If the country achieves all of the goals, there will be a general sense of accomplishment and international recognition. With the recognition, countries will 5

6 most likely see the Philippines as a valid trading partner and this will have a range of constructive impacts on the country. MDGs in Reducing Structural Injustice Overview The Millennium Development Goals were created as a way to make concrete objectives for developing sustainable human rights and improving society. These goals aimed to be achievable, effective, universal goals that all countries would strive to achieve. Positive The goals are effective in reducing structural injustice in the way that they force and encourage countries to care for marginalised minorities. The countries all of a sudden pay attention to the basic needs of people in regional areas and poor communities. From what we can tell, much progress has been made and most countries are on track to meet many of the goals, so in terms of achievability, they fit the criteria. They give countries set goals to work towards and specific rates to reduce or increase such as percent of population under poverty line and primary school enrolment. This puts pressure on from other countries governments to improve their human rights. Failure to achieve these goals might have economic consequences. The goals set universal standards that will not be lowered in the future. This ensures that this world will be moving forward and setting higher standards, once we achieve these. As the main people affected by human rights violations and structural injustice are poorer people, many countries are forced to develop their economies, in a way that eliminates structural injustice and creates an economically sustainable population. Negative The MDGs can be seen to have some areas in which they to not work to their full potential to alleviate structural injustice. Specifically, they are voluntary, leave margin for people to be left out and do not cover all issues effectively. There is no incentive behind the MDGs or force to pressure countries to accomplish them. This means that many countries will not put a maximum amount of effort into the goals and, thus will not put the effort into reducing structural injustice. A good example is in North Korea where they do not care about the MDGs as they have no incentive to. The goals also leave margin for people to be left out. This is because many of the goals include things like, Halving extreme poverty and hunger and Promoting gender equality. This does not directly eradicate the problem and still leaves lee way for people to be in poverty or still face gender inequalities. For instance, if a country had 40% of its population under the poverty line, if that country met the goal, would still have 20% of their population under the poverty line. This is a downfall when trying to reduce structural injustice. There are many other issues in the world that are in desperate need of attention which are not covered by the MDGs. The goals do not cover all issues, and although they aim to cover the main ones, they do not cover all. There are many problems such as refugees, drugs, sex trade and war, to 6

7 name a few, that are not directly targeted by the MDGs. These issues all relate to structural injustice. My Overall Impression In my opinion, the MDGs do not reach their potential, in terms of effectiveness, but without them, we would be much worse off. The Millennium Development Goals have faults and could improve, but they have achieved a number of great things across the globe. We are on track to meet many of them and could meet the others if some political changes were made, although many of these changes are unlikely to be made. Without the MDGs we would be in a much worse place, so for that, I think that they are very useful and am eternally grateful. Bibliography BBC, 2007, Guide to the Philippines conflict, British Broadcasting Company, accessed 08 June 2011, < pacific/ stm>. Figure 1: < Figure 2: < Figure 3: < Figure 4: < Figure 5: < Provinces 675x561.png> Figure 6: < pacific/ stm> IRIN, 2009, Philippines: Maternal Mortality Rates Not Making Sufficient Progress to Meet MDGs, UNFPA, accessed 08 June 2011, < NGLS, 2003, NGOs Assess the Millennium Development Goals, United Nations Non Governmental Liaison Service, accessed 08 June 2011, < Peters, D 1981, Philippines, 3rd edn, Lonely Planet, Hawthorn, Australia. Ross, J 2004, Maternal and Neonatal Program Effort Index: Philippines, MNPI, accessed 08 June 2011, < Waage, J, Banerji, R & Campbell, O 2010, 'The Millennium Development Goals: a crosssectoral analysis and principles for goal setting after 2015', Lancet, vol. 336, no. 9745, 18/09/2010, pp Wagner, D 2011, 2000 Millennium Development Goals, University of Iowa Center for International Fincance and Development, accessed 08 June 2011, < 7

8 WHO, 2004, Maternal mortality ratio, The United Nations, accessed 07 June 2011, < Women Deliver Philippines to Promote Investment in Maternal and Newborn Health 2010, Women Deliver, accessed 08 June 2011, < deliver philippines to promoteinvestment in maternal and newborn hea/>. 8