The women in the world are real-life heroes. And in most cases, they spend so much time caring for their family, only to neglect their own health. They always remind their loved ones to see their family doctor whenever they have bothersome signs or symptoms; yet, they ignore their own symptoms, and when they finally consult a doctor, it might be too late already.
It seems to be a female trait—they prioritize the health of everyone, especially their husband and children—over their own health.
One of the biggest ironies in life, too, is that women give life in pregnancy and childbirth, but in the process, some of them may lose their own due to gestational and peripartal complications.
Maternal health is really a major issue not only in our country but worldwide. In fact, the United Nations (UN) has made it a key part of its sustainable Millennium Development Goals (MDG). According to the UN, more than three million women are dying yearly from complications of pregnancy and childbirth in the world. Although some improvement in prenatal and peripartal care has been noted in developing countries like the Philippines, this maternal healthcare benefits have not trickled down to all levels, especially the marginalized sectors of society.
This is why the role of the Philippine Obstetrical and Gynecological Society, Inc. or POGS is very important. Ignorance or lack of awareness on how to prevent common complications during pregnancy and childbirth is still a prevalent problem. Through the years, the POGS has been leveling up with its public awareness programs to equip and empower the female population in the country of the needed knowledge to deal with their reproductive health and other medical issues.
At the turn of the century, the Philippines had one of the highest maternal mortality rates (MMR) in developing countries, with an MMR of more than 200 per 100,000 live births. The goal was to reduce it to 52 deaths per 100,000 live births by 2015, but I don’t think we achieved this target. However, a significant reduction in MMR has been noted. I’m not aware of the current statistics, but as of three years ago, MMR has been reduced to close to 100 per 100,000 live births.
The usual causes of maternal deaths remain the same, including uterine hemorrhages, severe infection sometimes associated with abortions, obstructed labor, preeclampsia and eclampsia. The POGS has been stressing that all pregnant women should be attended by a trained healthcare personnel, preferably a physician. In areas where a physician is not available, a properly trained nurse or midwife is acceptable. However, despite the efforts of our Department of Health, only around 60 percent of births are supervised by skilled birthing healthcare professionals.
Around 40 percent of our women giving birth still go to traditional hilots or untrained birthing attendants who are simply not competent to deal with complications if they arise. The percentage in impoverished rural areas can actually reach up to 75 percent, and this is where most of the maternal deaths are coming from.
It’s another irony that the families in the marginalized sectors have more children than families who are more economically well-off. A low use of contraception is still another major issue. It’s logical to assume that if our mothers in the lower quintiles of society who already have more than two children could have free access to contraceptives, this can contribute significantly to reducing our MMR. This may require a resetting of mindsets to convince everyone that the use of condoms, birth-control pills, and other contraceptive modes is not tantamount to abortion.
A local study done several years ago showed that nearly half of the more than three million pregnancies in the Philippines were unplanned. And in about 30 percent of these unplanned pregnancies, an abortion was decided by the pregnant women, with or without the consent of their partners or spouses. This is another major cause of the high MMR in the country.
Hopefully, the Reproductive Health law, the implementation of which has been derailed for quite some time, could enable government health centers all over the country to give away free condoms and contraceptive pills; and this can subsequently impact favorably the country’s MMR.
Of course, the POGS public health education program goes beyond aiming to reduce maternal deaths. They’re also busy educating the public on how to detect early signs of common cancers like breast and cervical cancers. These remain as the two most common cancers affecting our women; and early detection can be curative for women afflicted with these cancers. Unfortunately, many women who have them are coming from low and middle income countries, who discover that they have these cancers when they’re at a late stage already. The timely administration of the human papilloma virus vaccine has been shown to be cost-effective in preventing cervical cancer. The government should allocate some funds so more indigent women could have access to this type of vaccination.
We wish the POGS more success in its screening and prevention programs. And we remain confident that our goal of remarkably reducing our maternal mortality rate, and other causes of female morbidity would be realized in the foreseeable future. Education of our women on their reproductive and overall health is essential to equip them with the important basic information to prevent maternal mortality and morbidity. In my book, this is what real women empowerment is all about.
RAFAEL R. CASTILLO, MD
Oct 2018 Health and Lifestyle