Region failing MDG 5

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Wednesday, August 27, 2014


THE end of the 15-year work period is so near yet the regions all across the Philippines are still far behind in meeting its target on improving maternal health, one of the eight Millennium Development Goals (MDGs).
The chance is even much bleaker for Davao Region if the indicators are to be the gauge.

The first among them is the maternal mortality ratio (MMR) in which the region recorded 119 per 100,000 livebirths in 2013, higher as compared to the 73.8 per 100,000 livebirths recorded in 2012 based on the data from the Department of Health (DOH) 11.

This makes the region's probability to hitting its target of 52 per 100,000 livebirths low.

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MMR is defined as the ratio between the number of women who died (for reasons of pregnancy, childbirth, and puerperium) to the number of reported livebirths in a given year, expressed as the number of maternal deaths per 100,000 livebirths.

The other indicators are the proportion of mothers immunized with tetanus toxoid; contraceptive prevalence rate; and proportion of births attended by skilled health personnel.

Even as the number of mothers who die in childbirth remains high, Davao Region has made improvements in bringing the trajectory down from 208 per 100,000 livebirths recorded in 1990.

The MMR in Typhoon Pablo-stricken Compostela Valley took a major leap from 70.4 in 2012 to 192 in 2013, the highest among four provinces and one city.

Coming in second was Davao City with 117, Davao del Norte with 100, Davao del Sur with 98, and Davao Oriental with 95.

Dr. Raul Delosa, head for Family Health Cluster of DOH 11, conceded this early that the region may not succeed in attaining the 52 per 100,000 MMR target.

"Pero improving naman ang MMR.It's continously decreasing. In fact, the number of facility-based deliveries and skilled birth attendants are increasing," he added.

City Population Division officer-in-charge (OIC) Jeff Fuentes expressed the same in forum earlier on "Conduct of Young Adults Fertility and Sexuality" where he said that the maternal health is where the region is lagging behind.

"Mahirap man tanggapin pero kailangan na din nating tanggapin na ang maternal death ay mahirap talagang abutin for the 2015," he said.
The region, or the country as a whole, can achieve its 52 per 100 livebirths target but maybe later than the September 2015 deadline, Delosa added.

Also, based on the MDG watch released by the National Statistical Coordination Board (NSCB), the proportion of mothers immunized with tetanus toxoid stood at 38.9 in 2012, even lower than the 65.2 recorded in 1993. The target supposedly is 100.

A turtle-paced progress was also noted when it comes to attaining the target on contraceptive prevalence rate, which was pegged at 56.3 percent in 2011, still more than halfway to its target of 100 percent.

Early pregnancy

If the United Nations Development Programme (UNDP) were to say what cripples the progress, teenage pregnancy is partly to blame on this, along with other factors.

The increase in the number of young pregnant women may sometimes lead to unwanted pregnancies and induced abortions, which may cause maternal deaths.

The UNDP, citing a 2006 report on Family Planning Survey (FPS), stated that of the three million pregnancies each year, young women accounted for 17 percent.

Delosa said still much has to be done in educating the youth on teenage pregnancy now that more and more young people engage in premarital sexual activities.

"Ang ating teenage pregnancy tumataas, so kailangan natin ng more information dissemination to the teens, yun maraming nabubuntis, at maraming maternal deaths," he added.

He also said unwanted pregnancies result in abortion, which poses risks to young moms.

Teenage moms up

In a study on Young Adult Fertility and Sexuality (Yafs), the Population Commission (Popcom) 11 revealed that the number of females, aged 15 to 19, who have begun childbearing was up by more than two folds from 7.9 percent in 2002 to 16.7 percent in 2013 in Davao Region.

Yafs examines the non-sexual and sexual risk behaviors of the 19,178 young people surveyed nationwide. Popcom 11 did not disclose how many were surveyed for the region.

The increase in teenage pregnancy can be attributed to young people's risky sexual behavior, in which the study showed an increase in the proportion of young males, aged 18 to 24, who have engaged in sex before the age 18 from 19.5 percent in 1994 to 30.5 percent in 2013 while for the females, 12 percent and 30.3 percent, respectively.

While the prevalence of pre-marital sex activity increases, the study noted that most of the premarital sexual encounters are unprotected against unwanted pregnancy.

"At least 80.2 percent of the first premarital sex encounters are unprotected," the study cited.

Of the respondents, 6.3 percent admitted of engaging in casual sex with low level of protection.

"Also, the age of the youth engaging in sexual activity for the first-time is also getting younger as indicated by the mean age declined from 18 years in 1994 to 17.2 years in 2013 for males while for females, 18.6 years and 17.4 years, respectively," it added.

Getting younger

Perhaps to some extent, the rise of technology has altered young people's behaviour toward sex, which can explain why more people have engaged in sex at younger age.

With the growing number of smartphone users, access to media or the internet becomes easy, allowing for much easier to gain access to websites that have explicit sexual contents.

The study showed that 14.5 percent of the young respondents admitted visiting websites with pornographic contents; one in five sent or received sex videos through cellphones or internet; 8 in 100 have engaged in phone sex; 4 in 100 had sex with someone they met online or through text messages; 1 in 100 has recorded himself/herself having sex.

The study found that more than half of the youth have already watched movies with sexual explicit content, 79.1 percent of them were males and 40.4 percent were females.

Same old habits

For UNDP, other reasons why the pace to bringing down maternal deaths are slow is because a significant number of Filipino women lack access to qualified reproductive health services.

"Poor women are greatly disadvantaged with around 75 percent of the poorest quintile have no access to skilled birth attendants compared to only 20 percent of the richest quintile," it added.

Delosa said there are still some pregnant women who seek the help of "mananabang" or "hilot", or the traditional birth attendants to assist them in childbirth rather than going to hospitals and clinics and be attended to by skilled birth attendants.

Many of them would rather not undergo prenatal check ups, especially in the geographically disadvantaged areas. Some don't get the much needed shots for vaccination like the tetanus toxoid.

He added others would only go to hospital when it's too late, when laboring mothers are already critical.

These old habits have to be changed, Delosa said.

"We need to further strengthen our advocacy on pregnant women that they need, at an early stage of pregnancy, to seek medical health and have a good birth plan," he said.

But, the official added that more women are actually becoming open to seek for medical help and give birth at the hospitals.

"Now, 70 percent to 80 percent of the pregnant women are assisted by doctors and skilled birth attendants.

Davao City, having the most number of population in the region, is also banking on Implanon, a kind of birth control implant in a bid to curb child and maternal deaths.

Implanon, which is the size of a matchstick, is injected into the non-dominant arm of the woman. This can prevent women from getting pregnant for three years.

Causes of death

Topping the list of causes of death of mothers in childbirth is the complication of labor and delivery, which noted 49 maternal deaths in 2013. Cedema, proteinuria and hypertensive disorder in pregnancy comes second highest with 39 deaths; then followed by maternal care related to the fetus and amniotic with nine; pregnancy with abortive outcome is also listed as among the top causes with two deaths last year.

MDG is a set of commitments provided for in the Millennium Declaration signed by 189 member-states of the United Nations in September 2000.

Improving maternal health is the fifth goal of the eight MDGs; eradicate extreme poverty; achieve universal primary education; promote gender equality and empower women; reduce child mortality; combat HIV/AIDS, malaria and other diseases; ensure environmental sustainability; develop a global partnership for development.

Published in the Sun.Star Davao newspaper on August 27, 2014.

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