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Helping ‘nanays’ survive

“THREE DELAYS” are said to account for the majority of maternal deaths: delay in the decision to seek care, delay in reaching care, and delay in receiving care.

In a presentation at the Bulong-Pulungan sa Sofitel yesterday (Tuesday), maternal health expert, Dr. Rebecca Ramos, explained that delays in the decision to seek care often stem from a lack of understanding of the complications that attend childbirth (or even the need for care before birth) either of the birth attendant or the mother’s family. In many cases, the social acceptance of maternal death—that death from childbirth is a risk every woman who gets pregnant takes—is what allows helplessness or indifference to take over. This is also an indication of what Ramos calls “the low status of women” in Philippine society. There may also be “socio-cultural barriers” in play, such as the preference of women to give birth at home or the general mistrust of hospitals and doctors.

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“Delay in reaching care” can result from the isolation of many homes, lack of transportation to ferry a woman in labor, the lack of good roads, bridges or other infrastructure to facilitate transportation, and what Ramos calls “poor organization” that makes it impossible to rush a woman undergoing problematic labor to a health facility.

But even when she does reach a clinic, birthing center or hospital, a woman may still experience “delay in receiving care,” due to factors like the “lack of supplies, personnel and finances” or the lack of a swift and timely response from “poorly trained personnel with punitive attitude,” that is, health personnel who tend to blame the woman for her own life-threatening problem (“she should have gone to us sooner”; “she shouldn’t have gotten pregnant again”;  “she shouldn’t live so far away”).

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PERHAPS this explains why the Philippines has slowed down or gotten stuck in its efforts to bring down the number of maternal deaths. While neighbors like Singapore have been able to bring down their MMR to four for every 100,000 live births, our own MMR is still 162. This despite our own Millennium Development Goal to improve maternal health by bringing down our MMR to 52 by 2015.

Undersecretary of Health Dr. Ted Herbosa, who was present at the media forum, believes this goal is “attainable” although not perhaps by 2015. But he also questions the MMR figure of 162, saying the “real” number may lie between 74 and 90. (Does Herbosa mean the current estimate is nearly double the actual count?)

But as other experts have said, even an MMR of 52 is still “52 maternal deaths too many.” We should strive to achieve zero maternal mortality, or bring down MMR levels to that of the developed world.

As it is, a mother who gives birth in the National Capital Region is four times as likely to give birth in a health facility as a mother in the Autonomous Region in Muslim Mindanao. Or as Ramos puts it: “The percentage of births delivered by a skilled provider increases with the mother’s level of education and wealth status. In urban areas, 78 percent of births are attended by skilled professionals, compared to 48 percent in rural areas.”

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FORTUNATELY, the government through the Department of Health has been enacting policies and implementing programs to save the lives of mothers and newborns.

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Beginning in 2008, the DOH issued an administrative order (shepherded mainly by former Undersecretary Mario Villaverde) that enunciated the following principles: every pregnancy is wanted, planned and supported; every pregnancy is adequately managed throughout its course; every delivery is facility based and managed by skilled birth attendants; and every mother and baby pair secures proper postpartum and postnatal care with smooth transitions to the women’s health care package to the mother and child survival package for the baby.

Putting these principles to work has meant revising maternal and child health targets to more ambitious goals, i.e. increasing modern contraceptive use from 36 percent to 60 percent; increasing skilled birth attendance from 40 percent to 80 percent. It also meant setting up or funding centers for emergency obstetric and newborn care, including hiring more staff, training more staff, and improving the overall standards of care.

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MORE important, the DOH is reaching out to the private sector for help in achieving the goal of saving the lives of mothers and babies.

The “Bulong” forum also served to introduce the “NayBahay Ligtas Paanakan Centers,” or safe birthing centers, a joint project of Pfizer Parke Davis (the generic medicines company of Pfizer) and the DOH. The first such “NayBahay” (a play on “Nanay Bahay” or mother’s home) will be inaugurated in Minalabac, Camarines Sur, to serve as a model for other such centers in the 16 provinces with the highest rates of maternal mortality.

Constructed at three-fourths the cost of a traditional lying-in center, the “NayBahay” will be constructed around a core of a used shipping container, and provide four beds for lying-in and two beds for delivery. An artist’s concept shows a modern structure with bright, lively colors, a green roof and plenty of space for family members to wait while the mother delivers.

Everything about the “NayBahay” was conceived to make it more attractive to mothers, with the aim of making them “feel at home,” since many mothers complain about the institutional feel of hospitals and health centers.

At the same time, Pfizer Parke Davis will embark on a social marketing campaign designed to overcome mothers’ reluctance to give birth outside the home (most cite economic considerations), and convince them that it’s worth their while (and their lives) to give birth in a place that assures them safety, cleanliness and compassionate care.

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