Determinants of maternal mortality in Cagayan Valley Philippines

Introduction

The World Health Organization reported approximately 810 maternal death cases every day from preventable causes related to pregnancy and childbirth in 2017 (WHO, 2019). Most of these maternal mortality cases occur in Low and Lower Middle-Income Countries (LMICs), including the Philippines. Data from the internationally comparable MMR estimates by the Maternal Mortality Estimation Inter-Agency Group (MMEIG), which comprises the WHO, UNICEF, UNFPA, World Bank Group, and the United Nations Population Division, reveal that there was a worldwide reduction in maternal mortality cases in the last two decades. It is the same in the context of the Philippines, one of the nations that have been battling to achieve the Millennium Development Goal of improving maternal health by reaching at least 54 death cases per 100,000 live births. (WHO, 2019). 

There are many causes of the high maternal death rate. According to World Health Organization research from 2014, direct obstetric reasons include hemorrhage, infection, unsafe abortion, hypertensive disorders of pregnancy, and obstructed labor account for about three-quarters of maternal deaths in underdeveloped countries. Additionally, women in rural and low-income communities have disadvantages. In the poorest quintile, around 75% of pregnant women lack a trained birth attendant to assist them. Rural places have their own greater incidence of maternal mortality because many rural women give birth to children at an early age. Adolescent moms frequently experience issues during and after pregnancy since they are typically not developed enough to give birth, which contributes to the high maternal death rate. 

Health professionals such as physicians, nurses, or midwives with formal training who are present during birth can decrease maternal mortality.Yet, according to surveys, barely 60% of births in the Philippines are under the supervision of these trained birth attendants. Others continue to rely on conventional birth attendants, who have no official training but are frequently able to handle difficulties. The woman's condition is yet another issue that leads to the high maternal mortality rate in the Philippines. Habits, lifestyle, and practices towards health, especially those who engage in vices like alcohol consumption, smoking, and poor nutritional habits, putting them at risk of developing complications during pregnancy, labor, and delivery. Further studies have also shown that delays in health-seeking, health services, and health facilities impact said phenomena. 

Maternal death cases could have a great degree of impact on the family, especially on children's health and well-being. They are more susceptible to longterm health issues and social issues connected to abuse, early unions, pregnancy, education, and work. Children who were female were particularly affected because they were frequently required to handle the majority of home duties. Many participants were not aware of the programs available to help them raise orphaned children or how to obtain these services, which they said prevented them from receiving highquality child health care or support services.

In response to this scenario, the Department of Health (2011) has initiated key health reforms for the rapid reduction of maternal and neonatal mortality through the DOH Administrative Order (AO) No. 2008-0029 on implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality (DOH, 20011). It mandates the implementation of an integrated Maternal Newborn Child Health and Nutrition (MNCHN) strategy. Under this, all pregnancy is considered at risk, and it considers the three central pillars in reducing maternal mortality and morbidity: emergency obstetric care, skilled birth attendants, and family planning. It aims to address service delivery, regulation, financing, and governance of the Philippines' health system. Furthermore, the Integrated MNCHN strategy implemented in all provinces and cities encourages increasing skilled birth attendance and facility-based births by 80 percent. However, despite the numerous and rigorous implementation of the maternal health service program by the Department of Health (DOH) in Region 02, the struggle with maternal mortality remains a significant problem as it ranks, hence, identifying the factors contributing to the maternal mortality case is critical but significant to improve the existing maternal health program policy further.