Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Towards Achieving
MDGs 4 and 5
Carlos O. Tulali
Introduction
I
n the Philippines, 3.4 million pregnancies occur every year, half are unintended, one-third
of which end in abortions.1 An estimated 11 mothers die of pregnancy-related causes
every day, most of these deaths could have been avoided in a properly functioning
health care delivery system. Among the leading direct causes of maternal deaths in the
country are: post-partum hemorrhage, hypertensive disorders of pregnancy, abortion-
related complications and obstructed labor. Beyond the glaring data of mortality lies a
huge toll of ill health and disability due to pregnancy-related complications and infant and
child deaths and deepening poverty in families where a mother has died. It is estimated
that for every maternal death there is at least 20 to 30 other women who suffer from serious
complications, some of which are life-long. Maternal health conditions are the leading
causes of burden of disease among women.
Based on the State of the World’s Children of maternal, newborn and child health
2009 report of the United Nations Children’s and nutrition (MNCHN) for the Philippines
Fund (UNICEF), the Philippines is among 68 to achieve Millennium Development Goals
countries, which contributed to 97 percent 4 (Reduce child mortality) and 5 (Improve
of maternal, neonatal, and child health maternal health). This paper identifies
deaths worldwide.2 Statistics also show that and discusses currently available data
almost half of the deaths of Filipino children used to monitor the potential and actual
under five years old is within the first 28 days effects of Philippine government policies
of life’3 According to UNICEF, complications on maternal, newborn and child health
in childbirth are brought by hemorrhage, and nutrition (MNCHN) status. In addition,
sepsis, hypertension and abortive outcomes, recommendations will be made on how
which are actually preventable.4 to better meet the data needs for timely
analyses of the effects of policy on Filipino
Due to these reasons, monitoring and mothers and their children. The paper also
evaluation (M&E) system in health programs identifies critical gaps in MNCHN services and
play a crucial role in addressing the issue suggests a set of priorities for action to extend
Expanding choices, uplifting lives through responsive population and human development legislation
PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5
and strengthen them. The aim of this paper declines in the fertility rates of women
is to provide access to, and understanding ages 25 to 34 have continued to be
of, this information to help legislators, more noticeable. The fertility rates of
policymakers, and health professionals to plan women ages 15-19 and 45-49 have
effective MNCHN programs and mobilize remained almost unchanged in the last
additional resources to improve the lives of 15 years while the rate of birth remains
Filipino mothers, newborns, and children. higher among women aged 25 to 29.
city mayor for the city, and life cycle, and which addresses
municipal mayor for the the major causes of women’s
municipality) as chair; mortality and morbidity,
local health officer including access to among
(i.e., provincial, city, or others, maternal care,
municipal health officer) responsible, ethical, legal,
as vice-chairperson; the safe and effective methods
committee chair on health of family planning, and
of every local legislative encouraging healthy lifestyle
body sangguniang activities to prevent diseases;
panlalawigan (provincial 2. Leave benefits of two
board), sangguniang (2) months with full pay based
panlunsod (city board), and on gross monthly compensation,
sangguniang bayan (municipal for women employees who undergo
board), a representative from the private surgery caused by gynecological
sector or NGO involved in health services, disorders, provided that they have
and a DOH representative (provincial, city, or rendered continuous aggregate
municipality). The main function of the LHB is employment service of at least six (6)
to formulate policies on budget allocations months for the last twelve (12) months;
and act as advisory committee for the 3. Equal rights in all matters relating to
sanggunian. marriage and family relations. The State
shall ensure the same rights of women
Magna Carta of Women (RA 9710) and men to: enter into and leave
marriages, freely choose a spouse,
On August 15, 2009, Philippine President decide on the number and spacing
Gloria Macapagal-Arroyo signed Republic of their children, enjoy personal rights
Act 9710, also known as the Magna Carta of including the choice of a profession,
Women, which is a comprehensive women’s own, acquire, and administer their
human rights law that seeks to eliminate property, and acquire, change, or
discrimination against women by recognizing, retain their nationality. It also states that
protecting, fulfilling, and promoting the rights the betrothal and marriage of a child
of Filipino women, especially those in the shall have no legal effect.
marginalized sectors. All rights in the Philippine 4. Review amendment or repeal of laws
Constitution and those rights recognized that are discriminatory to women.
under international instruments duly signed 5. Mandate access to information and
and ratified by the Philippines, in consonance services pertaining to women’s health.
with Philippine laws, shall be rights of women
under the Magna Carta of Women. These There are several other national laws
rights shall be enjoyed without discrimination and issuances that support maternal and
since the law prohibits discrimination against child health interventions and services in
women, whether done by public and private particular, and public health affecting
entities or individuals. maternal and child health in general.
Among these are:
Features of the law include:
- Newborn Screening Law (RA 9288);
1. Comprehensive health services and - An Act Increasing Maternity Benefits
health information and education in Favor of Women Workers in the
covering all stages of a woman’s Private Sector (RA 7322);
PLCPD POLICY BRIEF | Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5
- Magna Carta of Public Health Workers MDG target to cut maternal and child
(RA 7305); deaths by 2015.
- Barangay Health Workers’ Benefits
and Incentives Act of 1995 (RA 7883); With pregnancy and childbirth posing
- The Paternity Leave Act of 1995 (RA serious risks to Filipino mothers and their
8187); and newborn, the country recognizes the need
- Philippine Midwifery Act of 1992 (RA to accelerate the reduction in maternal and
7392). child mortality. In response to this need, the
Department of Health (DOH) has initiated
Other MNCHN-related government key health reforms for the rapid reduction
issuances are: of maternal and neonatal mortality through
- maternal package for normal the DOH Administrative Order (AO) No.
spontaneous vaginal delivery in non- 2008-0029 on Implementing Health Reforms
hospital facilities (PhilHealth Circular for Rapid Reduction of Maternal and
No. 6); Neonatal Mortality.17 This mandates the
- supplemental guide for implementation of an Integrated Maternal,
“Garantisadong Pambata” (DOH Neonatal and Child Health and Nutrition
Circular 265-A); Strategy within the framework of the F1. It
- setting standard labeling for adopts a unified strategic framework for
breastmilk substitutes, infant formula, maternal and newborn health that is linked
other milk products, foods and with child survival strategies, maximizing the
beverages (DOH Circular 2008-0006); delivery of service packages, and ensuring
- Bright Child Program (EO 286); and a continuum of care across the life cycle
- national commitment for “Bakuna stages. Under this strategy, all pregnancies
and Una sa Sanggol at Ina” (EO 663). are considered at-risk. Likewise, it takes
into consideration the three major pillars in
reducing maternal mortality and morbidity,
Government Policies and Programs namely, emergency obstetric care, skilled
birth attendants and family planning.
Integrated Maternal, Neonatal, and Child
Health and Nutrition Strategy AO 2008-0029, issued on September 9,
2008, outlines specific actions for national
The health of mothers and children were and local health systems to systematically
placed at the center of health sector address health risks with the end goal of
reform, consistent with rapidly reducing maternal and neonatal
the advocacy that deaths. It states that the “strategy shall
all women have guide the development, implementation,
the right to safe and evaluation of various programs aimed
and quality at women, mothers and children, with the
emergency ultimate goal of rapidly reducing maternal
obstetric and neonatal mortality in the country.”18 It
services aims to address service delivery, regulation,
(EmOC) financing, and governance of the Philippines’
to prevent health system. The integrated MNCHN
maternal strategy, implemented in all provinces
and newborn and cities, is aimed to meet the following
deaths, and reproductive health (RH) indicators by 2010:
achieve the - increase CPR to 60 percent;
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF
mothers, children, and other members of the development. It encourages the active
family. It also provides information and services involvement of parents and communities.
for the couples of reproductive age to plan The implementation of this system shall be
their family according to their beliefs and the responsibility of the national government,
circumstances through legally and medically LGUs, NGOs, and private organizations.
acceptable family planning (FP) methods. The rearing of a child is a traditional role
of mothers. With the enactment and
Philippine National Strategic Framework for implementation of this law, raising a child is
Plan Development for Children, 2000-2025 no longer solely the responsibility of mothers.
(Child 21) The community, the national and local
governments, and other institutions are now
The health sector’s contribution to the obliged to assist in providing for the basic
Philippine National Development Plan for holistic needs of young children. ECCD
Children defines the vision for children by programs include: child care programs;
2025, formulates cost-effective interventions, parent effectiveness seminars; child
and outlines a budget that will reflect minding centers; family day care services;
contributions of different national and local parent-child development programs; and
government units, the private sector, NGOs, kindergartens in public schools.
and international organizations. It serves as a
framework for local government units (LGUs) Promotion of Breastfeeding program /
in the formulation of their development plans. Mother and Baby Friendly Hospital Initiative
Children’s Health 2025, a subdocument of
Child 21, realizes that health is a critical and Realizing optimal maternal and child health
fundamental element in children’s welfare. nutrition is the ultimate concern of the
Promotion of Breastfeeding Program. Thus,
The vision of Child 21 has been concretized exclusive breastfeeding in the first four to
through the formulation of the National six months after birth is encouraged as well
Plan of Action for Children for the period as enforcement of legal mandates. The
2005-2010, aimed at reducing disparities Mother and Baby Friendly Hospital Initiative
in development indicators for children. (MBFHI) is the main strategy to transform all
Subsequently, there will be a National Plan hospitals with maternity and newborn services
of Action 2011-2015 (Catching up with the into facilities which fully protect, promote,
Millennium Development Goals); a National and support breastfeeding and rooming-in
Plan of Action 2016-2020 (Sustaining the practices. The legal mandate to this initiative
gains); and a National Plan of Action 2021- are the RA 7600 (The Rooming-In and
2025 (Achieving the Child 21 vision). Breastfeeding Act of 1992) and the Executive
Order 51 of 1986 (The
Early Childhood Care and Development Milk Code). National
Program assistance
in terms of
Republic Act 8980, known as the Early financial
Childhood Care and Development (ECCD) support for
Act of 2000, defines the ECCD System as this strategy
the full range of health, nutrition, early ended in
education, and social services programs 2000, thus
that provide for the basic holistic needs LGUs were
of young children from birth to age six (6), advocated to
to promote their optimum growth and promote and
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 11
sustain this initiative. To sustain this initiative, diseases. The Expanded Program on
the field health personnel has to provide Immunization is one of the DOH Programs
antenatal assistance and breastfeeding that has already been institutionalized
counseling to pregnant and lactating mothers and adopted by all LGUs in the region. Its
as well as to the breastfeeding support objective is to reduce infant mortality and
groups in the community; there should also morbidity through decreasing the prevalence
be continuous orientation and re-orientation/ of six immunizable diseases (TB, diphtheria,
updates to newly hired and old personnel, pertussis, tetanus, polio and measles).
respectively, in support of this initiative.
The Food Fortification program is the Health care financing system refers to
government’s response to the growing various structures, methods, processes and
micronutrient malnutrition, which have procedures in which financial resources
been prevalent in the Philippines for the are made available to fund health sector
past several years. Food Fortification is the activities, and how it is used on the delivery
addition of Sangkap Pinoy or micronutrients of health services. The purpose of health
such as Vitamin A, Iron and/or Iodine to food, financing is to make funding available,
whether or not they are normally contained to set the right financial incentives for
in the food, for the purpose of preventing or providers, as well as ensure that all
correcting a demonstrated deficiency with individuals have access to effective public
one or more nutrients in the population or health and personal health care.21 Poor
specific population groups. Micronutrients women, their children, and families use
are vitamins and minerals required by the public-funded maternal and child health
body in very small quantities. These are (MCH) services worldwide. However, with
essential in maintaining a strong, healthy, the decline in public-funded health services
and active body; sharp mind; and for and the growing role of private-financed
women to bear healthy children. systems, poor women and their children
are at risk of falling through the cracks of
Expanded Program on Immunization business-driven health systems.22
Children who are not fully immunized are Based on the 2003 Philippine National
more susceptible to common childhood Health Accounts (PNHA) estimates,
Catholics the state must also serve. The State - Advocating with national and local
has the responsibility to provide information, authorities the importance of having
assistance, and access to all types of FP systems for regular maternal, infant,
methods. Thus, the government is expected and child mortality monitoring;
to develop policies including health - Selection of indicators and
programs based on these general principles. procedures, by consensus;
- Design and implementation of local
The government violates the constitution and national maternal, infant, and
when it promotes and emphasizes particular child mortality monitoring plans; and
programs that are discriminatory to certain - Performance audits and maternal,
groups either because of religious or political infant, and child mortality monitoring
beliefs. The government’s promotion of the processes.
natural family planning (NFP) method over
the other methods available to our people is Monitoring at the local level provides
a de facto violation of our constitution in this information for planning and improving
regard. This policy is obviously designed to interventions, and for building consensus
please the Roman Catholic church. among stakeholders: service providers,
policymakers, women, community
leaders, and local authorities. Local
Policy Options and Recommendations: monitoring should include indicators
of access to quality obstetric care, as
Strengthen monitoring system at national well as socioeconomic determinants
and local levels of risk of maternal deaths, such as
health infrastructure, institutional and
At the national level, policies and plans social responsibilities, levels of local
concerning maternal, infant, and child government commitment, and community
mortality outcomes should be monitored, participation.
including legislation and reforms, policies,
and programs that promote healthy The monitoring of maternal, infant, and child
pregnancy, contraceptive services, and death is the responsibility of health workers
gender-based violence prevention. Equally and community members who should
important are indicators of stakeholder represent different sectors and groups (age,
participation in determining and monitoring sex, and ethnicity) to ensure the participation
progress, which includes their role in of the populations most affected by
communication, organization, training, maternal, infant, and child deaths.
supervision, planning,
local and social These stakeholders should organize
management, committees that provide immediate
emergency information and actions for interventions to
networks and local authorities and program managers at
referral systems, the local, district, and health center levels.
and budget Monitoring committees play an important
appropriations. role in:
- Strengthening the information systems
National by involving community organizations;
monitoring - Selecting priority areas for
systems should, intervention;
therefore, include: - Strengthening administrative
Philippine Policies on Maternal, Newborn, and Child Health and Nutrition: Towards Achieving MDGs 4 and 5 | PLCPD POLICY BRIEF 17
Endnotes
1
Darroch JE, Singh S, Bal H, Cabigon JV, “Meeting women’s 17
http://home.doh.gov.ph/ao/ao2008-0029.pdf
contraceptive needs in the Philippines,” Issues in Brief, Alan 18
http://www.doh.gov.ph/files/ao2008-0029.pdf.
Guttmacher Institute 2009;1:1-8. 19
http://www.doh.gov.ph/node/2423.
2
United Nations Children’s Fund. The State of the World’s 20
http://www.doh.gov.ph/node/2506;
Children 2009, New York: UNICEF, December 2008. 21
Department of Health, National Objectives for Health
3
“UN urges DoH to probe why 11 mothers die due to pregnancy 2005-2010 (Manila: DOH, 2005).
or childbirth,” UNICEF Philippines, 11 May 2009. Available at 22
Akukwe C., “Maternal and child health services in the twenty-first
http://www.unicef.org/philippines/8891_10641.html; century: critical issues, challenges, and opportunities,” Health Care for
4
Senate of the Philippines, “Accelerate efforts on maternal Women International, 07399332, Oct/Nov2000, Vol. 21, Issue 7.
and newborn deaths prevention thru research – Angara,” 23
Ibid.
23 February 2009. Available at http://www.senate.gov. 24
http://www2.doh.gov.ph/f1primer/F1-Page.htm#pg6a;
ph/press_release/2009/0223_angara1.asp. 25
Wardlaw T and Maine D, “Process indicators for maternal
5
Anne Tinker et al., “A Continuum of Care to Save Newborn mortality programmes,” in Reproductive Health Matters.
Lives,” The Lancet Neonatal Survival Series, No. 3 (March 2005). Safe Motherhood Initiatives: Critical Issues, Oxford:
6
Anne Tinker, “Safe Motherhood is a Vital Social and Economic Blackwell, 1999:24-30.
Investment” (paper delivered at Technical Consultation on 26
Darroch JE, Singh S, Bal H, Cabigon JV, “Meeting women’s
Safe Motherhood, Colombo, Sri Lanka, Oct. 18-23, 1997). contraceptive needs in the Philippines,” Issues in Brief, Alan
7
National Statistics Office (Philippines), 2008 National Guttmacher Institute 2009;1:1-8..
Demographic and Health Survey, Preliminary Report. 27
Department of the Interior and Local Government (DILG)
8
http://www.census.gov.ph/data/pressrelease/2007/ website, http://www.dilg.gov.ph.
pr0718tx.html. 28
Libo-on, D. “Family planning budget for 2007 and 2008:
9
http://www.census.gov.ph/data/pressrelease/2009/ What has happened? Research paper submitted and to be
pr0930tx.html. published by PLCPD. (May 2009).
10
Food and Nutrition Research Institute, “6th National Nutrition 29
World Health Organization, “The World Health Report
Survey Results.” Available at http://www.fnri.dost.gov.ph/ 2006: working together for health” (Geneva: WHO, 2006).
files/fnri%20files/nns/6thnns.pdf. 30
World Health Organization,, National Health Accounts,
11
International Monetary Fund (IMF), Organization for Economic World Health Statistics, 2006.
Co-operation and Development (OECD), United Nations (UN) 31
http://www.doh.gov.ph/fourmulaone/primer.
and World Bank Group (WBG), 2000 A Better World for All: 32
Basics Support for Institutionalizing Child Survival Project (BASICS
Progress towards the International Development Goals (2000). II), “Newborn Health in the Philippines: A Situation Analysis,”
12
The Partnership for Maternal, Newborn, and Child Health published by the BASICS II for the United States Agency for
(PMNCH) website, http://www.pmnch.org/.. International Development: Arlington, Virginia, June 2004.
13
The Partnership for Maternal, Newborn, and Child Health, “New 33
Ibid.
Global Consensus on maternal, Newborn and Child Health to save 34
http://www.globalhealth.org/view_top.php3?id=225.
10 million lives,” 23 September 2009 Available at http://www. 35
UNICEF website, http://www.unicef.org/;
familycareintl.org/UserFiles/File/PMNCH_pressrelease_final.pdf. 36
Akukwe, C. “The growing influence of non government organizations
14
Ibid. in international health: Challenges and opportunities.” Journal Royal
15
1987 Constitution of the Republic of the Philippines. Society of Health, 1998, 118, 107-115.
16
The Local Government Code of the Philippines (Republic Act 37
Neonatal and Perinatal Mortality: Country, Regional and
No. 7160). Global Estimates, WHO 2006.
PEOPLE COUNT
PLCPD POLICY BRIEF March 2010
A publication of the Philippine Legislators’ Committee on Population and Development Foundation, Inc. (PLCPD)
with support from the United Nations Population Fund (UNFPA).
2/F AVECSS Building, #90 Kamias Road. cor. K-J Street, East Kamias, Quezon City, 1102
Tel. nos.: (+632)925-1800 • (+632)436-2373
E-mail: plcpdfound@plcpd.org.ph Since 1989
Website: http://www.plcpd.org.ph
Executive Director: Ramon San Pascual, MPH
Editors: Ernesto M. Almocera Jr., Romeo C. Dongeto and Floreen Simon
PLCPD
Philippine Legislators’ Committee