Maternal mortality remains a significant public health concern in the Philippines. In 2019, prior to the COVID-19 pandemic, the United Nations Population Fund (UNFPA) estimated that approximately 2,600 women in the country die every year — seven each day — due to complications from pregnancy or childbirth. The agency feared a marked rise in maternal deaths as a result of a health system challenged, overwhelmed, and overburdened by COVID-19. The agency also warned that maternal mortality could increase by 26% from the 2019 level.
Although the World Health Organization (WHO) has recently declared that COVID-19 is no longer a public health emergency of international concern, this does not signify the end of the pandemic, especially its impact on key health indicators. The recent Health Connect Forum by the Philippine Medical Association (PMA) and the Philippine Foundation for Vaccination (PFV) highlighted that COVID-19 continues to challenge the healthcare system on both the supply side or the delivery of services, as well as on the demand side or access to maternal or newborn health services.
Dr. Manuel Vallesteros, the Chief of the Department of Health (DoH) Child, Adolescent and Maternal Health Division, said that the DoH aims to provide Filipino women with full access to health services to make their pregnancy and childbirth safer. He said that the department’s ultimate goal is to reduce the country’s maternal mortality ratio to 70/100,000 live births by 2030.
To promote maternal and child health, the DoH provides antenatal care (ANC), facility-based delivery (FBD), and postnatal care (PNC), as well as implements the DoH Health Sector Strategy for Maternal Health (“Enable, Protect, Care, & Strengthen”) to fulfill the country’s Sustainable Development Goals (SDGs).
ANC is the care a woman gets from health professionals, such as a doctor or midwife, during pregnancy. It includes complete general and obstetrical examination; nutritional assessment; oral health check-up and prophylaxis; screening for smoking, alcohol/substance abuse; health information (Mother Baby Book); iron and folic acid, calcium carbonate supplements, and immunization; laboratory tests for diabetes, HIV, syphilis; and management according to risk to pregnancy.
He cited the 2022 Philippine National Demographic and Health Survey (NDHS), which showed that 86% of Filipino women received antenatal care from skilled providers, 83% had four or more ANC visits during their most recent pregnancy; and 86% who had a live birth took iron supplementation.
Through FBD, the DoH seeks to ensure that all births take place in health facilities where obstetric complications can be treated when they arise. “Over the last 30 years, there has been an upward trend in the percentage of live births delivered by a skilled provider — from 54% in 1993 to 90% in 2022,” Dr. Vallesteros said.
PNC is the care given by health professionals to the mother and her newborn baby immediately after delivery and for the first six weeks of life. The DoH recommends all women receive a health evaluation two days after giving birth. PNC includes immunization such as BCG, DPT, Hepatitis B, and Hib vaccines, among others; lactation management services to support breastfeeding; and education about birth spacing and family planning including postpartum contraception. It also includes nutrition counseling because lactating women have increased nutritional demands; and immediate postpartum and postnatal care including screening for postpartum depression.
“The postpartum visit is an ideal time to access contraception services. Studies show that waiting at least two years between births can optimize health outcomes of both mother and baby,” Dr. Vallesteros said.
It is crucial for government and private sector stakeholders to work together in a whole-of-society approach to address the challenges faced by Filipino women during pregnancy and find solutions to improve maternal health outcomes. There is also a need to emphasize the benefits of promoting maternal health through medically proven interventions such as vaccination, among others. In this day and age, no woman should die giving birth and no child should lose a mother in the process. More about the actions required to urgently address the needs of pregnant women and mothers will be featured in the next column.
Teodoro B. Padilla is the executive director of Pharmaceutical and Healthcare Association of the Philippines (PHAP). PHAP represents the biopharmaceutical medicines and vaccines industry in the country. Its members are in the forefront of research and development efforts for COVID-19 and other diseases that affect Filipinos.