In 2000, the Philippines with many other countries worldwide, adopted the Millennium Development Goals (MDGs) that provided a framework for the international community to work together toward common targets and ensure that human development would reach one and all.
Next year, 2015, the Philippines will be reporting on its progress toward meeting the MDGs which marked a strong commitment to the right to development, to the eradication of the many dimensions of poverty, and to gender equality and the empowerment of women.
In the following paragraphs, progress toward meeting MDG 4 on reducing child mortality and MDG 5 on improving maternal health will be reviewed.
On MDG 4: Reducing child mortality
MDG 4, which has for its goal the reduction of child mortality by two-thirds between 1990 and 2015, has three indicators: (1) under-five mortality rate which is the probability of dying between birth and the fifth birthday; (2) infant mortality rate which is the probability of dying before the first birthday; and (3) the proportion of one-year-old children immunized against measles.
The latest data from the 2013 round of the National Demographic and Health Survey (NDHS) revealed that the under-five mortality rate stood at 31 per thousand live births as against the 48 deaths per 1,000 live births reported in the 1998 NDHS. In 2013, the infant mortality rate (IMR) stood at 23 deaths per 1,000 live births as compared with 35 deaths per 1,000 live births in 1998. Even with the passage of Republic Act 10152 — Mandatory Infants and Children Health Immunization Act — only 78.2 percent of children aged 12–23 months at the time of the 2013 NDHS received the measles vaccine by 12 months of age. Less than six of 10 mothers (57.6 percent) could show a vaccination card to the interviewer which accounts for the far from complete immunization of infants against measles.
Have we progressed well toward achieving MDG 4?
Significant reduction in child mortality has been made due to intensified government programs on health, and the adoption of the life cycle approach in ensuring continuum of care.
The Department of Health (DOH) strategies for achieving MDG 4 include: skilled birth attendance; essential newborn care; integrated management of sick children; micronutrient supplementation; immunization; breastfeeding; and birth spacing.
According to the 2013 NDHS data, the goal of reducing the under-five mortality rate to a level of 26.7 deaths per 1,000 live births is likely to be achieved in 2015. The goal for reducing the IMR to 19 infant deaths per 1,000 live births is also achievable by 2015.
On MDG 5: Improving maternal health
MDG 5 has for its 2015 goal the reduction of the maternal mortality ratio, MMR, (the number of deaths of mothers due to pregnancy- or childbirth-related causes per 100,000 live births) by three-quarters between 1990 and 2015, that is, from a level of 209 in 1990 to 52 deaths per 100,000 live births in 2015. The 2011 Family Health Survey (FHS) disclosed that the MMR rose to 221 deaths from 162 in the preceding five years and 172 10 years earlier. The seeming increase is not statistically significant as the values are within the 95 percent confidence interval, signifying that the MMR has not varied during the 15-year period.
Another indicator of maternal health is the proportion of births attended by skilled health personnel. In the 2006 Family Planning Survey (FPS), the percentage of births delivered in a health facility was reported to be 42.4 percent. In the 2013 NDHS the proportion rose to 60 percent. Over six out of 10 births (62.3 percent) were attended by a doctor, nurse or midwife in 2006 as compared to more than seven out of 10 births (73 percent) in 2013.
One of the targets of MDG 5 is to achieve universal access to reproductive health by 2015 which is indicated by the contraceptive prevalence rate (CPR). In the 1993 National Demographic Survey (NDS), one-fourth (25 percent) of married women were using a modern method of contraception as compared to close to two-fifths (38 percent) in 2013. The corresponding proportions of women who were using traditional methods were 15 and 18 percent, respectively. These contraceptive prevalence rates are far from the target of 80 percent, a level already achieved by our ASEAN neighbors.
Proper care during pregnancy and delivery are important for the health of both the mother and the baby. In the 2013 NDHS, women who had given birth in the five years preceding the survey were asked a number of questions about maternal and child healthcare. For the last live birth in that period, mothers were asked whether they had obtained antenatal care (ANC).
Antenatal care from a health professional is important in order to monitor the risks associated with pregnancy and delivery for the mother and her child. Antenatal care is most beneficial in preventing negative pregnancy outcomes when it is sought early in the pregnancy and continued through to delivery. The DOH recommends that all pregnant women have at least four ANC visits during each pregnancy. The 2013 NDHS disclosed that close to seven out of eight women (84 percent) who had a live birth in the five years preceding the survey had the recommended number of ANC visits during the pregnancy for the last live birth. One in eight (12 percent) mothers made fewer than four visits while two out of a hundred had one visit and double that proportion, none at all.
Total unmet need for family planning (FP) refers to the proportion of currently married women who are not using any FP method but do not want any more children or prefer to space their births. In the 2011 FPS, the unmet need was substantially greater among women considered poor (25.8 percent) compared to non-poor women (16.6 percent). In particular, 13.1 percent of poor women as compared to 9.4 percent of the non-poor women have unmet need for spacing their births, while 12.6 percent of poor women and 7.2 percent of non-poor women, respectively, preferred to limit their births. Comparable data from the 2013 NDHS were not available at the time of writing.
Progress report for MDG 5
High unmet need for family planning has been brought about by the largely high cost associated with practicing contraception. But not only costs discourage women from availing themselves of FP methods. Non-monetary costs include the following: (1) perceived effects on the health of husbands and wives; (2) husband’s fertility preference; (3) strength of fertility preference; and (4) couple’s acceptance of FP. The perceived effects of contraception on health have indeed resulted in low contraceptive use. One of the reasons for the high unmet need cited from the 2011 FHS is related to exposure to contraceptives, including fear of side effects.
Key bottlenecks
The high MMR levels can be attributed to delays in (1) deciding to seek medical care; (2) reaching appropriate care; and (3) receiving care at health facilities.
Mothers do not seek help from health facilities because of lack of funds, lack of transportation, no information on PhilHealth insurance benefits, and unavailability or inaccessibility of health facilities.
Priorities for action
The following priorities are therefore recommended for action: (a) accelerating efforts to improve access and delivery of quality services; (b) strengthening LGU capacities to support and provide quality health services; (c) communication/advocacy for behavior change, particularly on the health-seeking behavior of women and mothers; and (d) full and proper implementation of the RH Law.
From the above, it can be noted that the country can be given a high score of 95 percent for MDG 4 but it fails miserably and deserves a failing score of 30 percent for MDG 5.
* * *
Dr. Mercedes B. Concepcion is a member of the National Academy of Science and Technology Philippines (NAST PHL) and a National Scientist. A well-known Filipino expert in demography, Concepcion was instrumental in the establishment of the University of the Philippines Population Institute (UPPI), serving as its director and then its dean from 1965 to 1985. Upon retirement from the UP in 1993, she was appointed university professor emeritus. Concepcion was appointed as the first Philippine representative to the United Nations Population Commission in 1967, the first woman to chair this commission from 1969 to 1977, and the first Asian woman to be elected president of the International Union for the Scientific Study of Population in 1981-1985. She chaired the Special Committee to Review the Philippine Statistical System which led to the establishment of the National Statistical Coordination Board in 1976 and 20 years later, was appointed member of the Review Committee on the Statistical System which recommended legislation for setting up the Philippine Statistics Authority which was passed into law on Oct. 31, 2013. Concepcion is presently the chair of the Inter-Agency Working Group on Population Projections. She can be contacted at NAST PHL at secretariat@nast.ph.