Let’s Rally ‘Round the MMR Strategies!
Ten years after world leaders committed to reduce extreme poverty through the Millennium Development Goals’ eight (
concrete objectives, governments and civil society are now asking: How far have we come? What do we do in the next five years to meet the 2015 target?
Health is part of an overarching strategy for poverty reduction. However, the general picture shows the global community still has a long way to go, especially with Goal 5 A and B: reducing maternal mortality ratio (MMR) and universal access to reproductive health.
Maternal mortality remains unacceptably high across much of the developing world. In spite of the fact that pregnancy and childbirth complications causing these deaths can be treated and prevented, the access of poor women to emergency obstetric care (EmOC) including post-abortion care; the access to effective contraceptives and access to skilled delivery , which are the three (3 ) fundamental requirements to reduce maternal deaths, remain dismally weak.
In the Philippines, failure by our health sector to actively address issues of equity in the delivery of health services is very much relevant to the status of the MDGs. Socio-economic disparity is very evident between the rich and the poor in accessing reproductive health services.
The poorest women have two children more than they want while richest women experience a gap of less than one child. This indicates that unmet need for family planning is particularly high among poor women who are especially in need of help in preventing unintended pregnancy. It is the poor and marginalized women who face greater risks and even death from pregnancy and childbirth complications. Only 26% of the poorest women deliver by skilled health workers compared to 95% of the wealthiest. Only 13% of the poorest deliver in a facility while 84% of the wealthiest are able to do so. This is proof that the poor have the least access to emergency obstetric care (EmOC) including Caesarean section, a life-saving procedure in maternal complications. C-section is required in 5 to 15% of obstetric cases but only 1.3% of the poorest women have access to C-sections compared to the 28% of the richest. This means that many of the poorest women are not getting the surgery necessary for them to survive; while almost half of the richest women are getting the C-section they don’t need, exposing them to the risks of surgery and anesthesia.
Our Adolescent fertility rate– 54 births per 1,000 women – is moderate and remains stable, compared to neighboring countries. However, girls aged 15-20 are twice as likely to die in childbirth as those in their twenties, while girls under the age of 15 are five times as likely to die in childbirth.
The MDGs represent the most important collective promise ever made to the world’s most vulnerable people—the poor and marginalized. Born of solidarity, justice and the recognition of global cooperation for our shared prosperity and security, this promise is not based on pity or charity. This promise is not just among governments but also among all development stakeholders, each with a specific role.
Another promise that we all are holding on to is the one that our President-elect Benigno “Noynoy” Aquino III has made in his platform, titled A Social Contract with the Filipino People. In the section: “Commitment to a Transformational Leadership” wherein he underscores “responsible parenthood”, Noynoy says that the advancement and protection of public health are key measures of good governance.
There has been no significant decline in maternal mortality ratio (MMR) between 1998 and 2006. In 1998, we had 172 maternal deaths per 100,000 live births and in 2006 we still had 162.
A 5.5% annual improvement is needed to reach the MDG target. With 162 MMR in 2006, the 52 MMR target in 2015 seems impossible to achieve.
This disheartening picture mirrors the situation of women here in the Philippines and all over the developing world. But stakeholders led by the UN Secretary-General, remain optimistic. They say that “the achievement of the MDGs remains feasible with adequate commitment and levels of investment, right policies, resources, effort and international support.
Too many promises have been made to the most vulnerable people, especially poor women, but this time around, to back up a strong political commitment, certain enabling policies have to be there to ensure that our government and other stakeholders take on the challenges of MDG5.
We have to rally ‘round the following pillars of maternal death reduction:
• Ensure skilled attendance at every delivery
• Strengthen the health system to ensure 24-hour EmOC
• Reduce health risks of early, unwanted, poorly-timed pregnancy through effective contraceptives.
As the World Health Organization Chief Margaret Chan bluntly put it, “if we miss the poor, we miss the point.”
Reproductive Health Advocacy Network (RHAN)
International Women’s Health Day
28 May 2010