THE MATERNAL HEALTH PROGRAM

FAMILY HEALTH

THE MATERNAL HEALTH PROGRAM

Introduction

  • The Philippines is committed to reducing the maternal mortality ratio (MMR) by three-quarters by 2015 to meet its Millennium Development Goal (MDG).

    • Target MMR:

    • 112/100,000 live births by 2010

    • 80/100,000 live births by 2015

  • Historical MMR Data:

    • Estimated MMR in 1987-93: 209/100,000 live births (NDHS 1993)

    • MMR decreased to 172/100,000 live births in 1998 (NDHS 1998)

  • Challenges in maternal mortality reduction persist.

  • Perinatal mortality has only seen minimal progress:

    • Decreased from 27.1 to 24 per 1,000 live births over ten years (1993 - 2003, NDHS).

Prenatal Care Indicators

  • Percentage of pregnant women with at least four prenatal visits:

    • Decreased from 77% in 1998 to 70.4% in 2003.

  • Pregnant women receiving at least two doses of tetanus toxoid:

    • Decreased from 38% in 1998 to 37.3% in 2003.

  • Iron supplementation received by pregnant women:

    • Only about 76.8% received iron during pregnancy.

Causes of Maternal Deaths

  • According to the 2000 Philippine Health Statistics:

    • 25% due to hypertension

    • 20.3% due to postpartum hemorrhage

    • 9% due to pregnancies with abortive outcomes that are unpredictable and unpreventable.

  • Increase in births attended by health professionals:

    • From 56% in 1998 to 59.8% in 2003.

  • Increase in women with at least one prenatal visit:

    • Rise from 43% in 1998 to 51% in 2003.

  • Only 44.6% of postpartum women received a dose of Vitamin A.

Underlying Causes of Maternal Deaths

  • Delays in critical actions including:

    • Delay in seeking care

    • Delay in making referrals

    • Delay in providing appropriate medical management

  • Contributing factors:

    • Closely spaced births

    • Frequent pregnancies

    • Poor detection and management of high-risk pregnancies

    • Poor access to health facilities due to geographic distance and transportation cost

    • Health care staff inadequately trained in handling obstetrical emergencies.

Program Goals and Strategic Thrusts (2005-2010)

  • Overall goal:

    • Improve the survival, health, and well-being of mothers and their unborn children through comprehensive services across pre-pregnancy, prenatal, natal, and postnatal stages.

  • Strategic Thrusts:

    • Launch and implement the Basic Emergency Obstetric Care (BEMOC) strategy in coordination with the Department of Health (DOH).

    • Establish facilities to provide emergency obstetric care for every 125,000 population.

    • Strategies to encourage childbirth planning by families and communities and upgrade skills of local health providers.

    • Improve quality of prenatal and postnatal care, ensuring pregnant women have at least four prenatal visits.

    • Expand postpartum care availability for women after childbirth, miscarriage, or abortion.

    • Reduce exposure to health risks through:

    • Institutionalization of responsible parenthood

    • Provision of comprehensive health care packages for women of reproductive age, especially vulnerable groups.

    • Engage local government units (LGUs), non-governmental organizations (NGOs), and stakeholders in advocating for health resource allocation for mothers and unborn children.

Essential Health Service Packages Available in Health Care Facilities

  • Package of services provided to women before and after pregnancy.

A. Antenatal Registration

  • Importance of antenatal care:

    • Risks associated with pregnancy increase potential for complications and maternal death.

    • Every woman should visit the nearest health facility for antenatal registration and prenatal care services.

  • Standard Prental Visits Schedule:

    • 1st Visit: As early as possible (before 4 months, or during the first trimester)

    • 2nd Visit: During the second trimester

    • 3rd Visit: During the third trimester

    • Every 2 Weeks: After the 8th month of pregnancy until delivery.

B. Tetanus Toxoid Immunization

  • Addressing Neonatal Tetanus:

    • Tetanus toxoid immunization is crucial for pregnant women to protect against neonatal tetanus.

    • Recommended vaccination schedule:

    • 2 Doses: One month before delivery

    • 3 Booster Doses: To complete a total of five doses as per recommended schedule ensures protection for both mother and child.

    • Mothers receiving the complete schedule are referred to as "fully immunized mothers" (FIM).

C. Micronutrient Supplementation

  • Importance of micronutrients in pregnancy:

    • Essential for preventing anemia and vitamin A deficiency.

  • Recommended Nutritional Supplements:

    • Vitamin A: 10,000 IU

    • Given twice a week starting from the 4th month of pregnancy (not administered before).

    • Iron: 60 mg/400 µg tablet

    • Administered daily throughout pregnancy.

D. Treatment of Diseases and Other Conditions

  • Management of complications:

    • Difficulty in Breathing/Airway Obstruction:

    • Clear the airway

    • Place her in the best position

    • Refer to hospital with EmOC capabilities.

    • Unconsciousness:

    • Keep on her back with arms to the side

    • Tilt head back unless trauma is suspected

    • Do not give Oral Rehydration Solution or Intravenous Fluids unless trained.

  • Postpartum management for bleeding:

    • Massage uterus to expel clots and check the contracting state of the fundus.

    • If bleeding persists after massage, administer ergometrine (0.2 mg IM) and monitor closely.

E. Clean and Safe Delivery

  • Importance of skilled birth attendance for hygienic labor and delivery, ensuring safe and non-traumatic care.

  • Steps in Labor and Delivery Care:

    1. Quick check for emergency signs upon admission:

    • Unconsciousness, vaginal bleeding, severe abdominal pain, severe headache, visual disturbances, etc.

    1. Assessment of labor status:

    • Taking history to determine LMP, number of pregnancies, and danger signs.

    1. Monitoring labor progress and performing necessary examinations at different labor stages.

    2. Continuous supportive care throughout labor, guiding the mother and monitoring fetal condition.

F. Support to Breastfeeding

  • Critical importance of breastfeeding education and support.

  • Health workers' roles in promoting breastfeeding practices.

G. Family Planning Counseling

  • Counseling couples on family planning (FP) importance,

    • Promote proper spacing of births (ideally 3-5 years).

    • Address health recovery time between pregnancies, preventing complications in subsequent births.