Improving maternal health

Hunger and malnutrition were observed to increase the incidence and

fatality rate of the conditions that contribute to nearly 80 percent of
maternal deaths.
In this regard, millennium development goal 5 has two targets:
1. To reduce the maternal mortality ratio by 75 percent
2. To achieve universal access to reproductive health
Improving maternal health is critical to saving the lives of hundreds of
thousands of women who die due to complication from pregnancy and
childbirth each year. Over 90 percent of these deaths could be prevented
if women in developing regions had access to sufficient diets, basic
literacy and health services, and safe water and sanitation facilities during
pregnancy and childbirth.

Some of the achievements of MDG 5 include:

A 45 percent reduction in the maternity mortality ratio worldwide
since 1990, though most of the reduction occurred since 2000
A 64 percent reduction in maternal mortality ratio in Southern Asia
between 1990 and 2013, and 49 percent in sub-Saharan Africa
A 12 percent increase in the number of births assisted by skilled
health personnel globally in 2014 compared to 1990 59 percent to
71 percent.
An increase in the proportion of pregnant women receiving four or
more antenatal visits in North Africa from 50 percent in 1990 to 89
percent in 2014.
Increase in contraceptive prevalence among women 15 49 years
old whether married or in some other union from 55 to 64
percent between 1990 and 2015.

Target #1: Maternal survival

Maternal death has dropped significantly since the adoption of the MDGs.
The universal maternal mortality ratio has reduced by 45 percent between
1990 and 2013, from 380 to 210 maternal deaths per 100,000 live births.
Despite the progress, every day lots of women die during pregnancy or
from complications arising from childbirth. The maternal mortality rate in
developing regions is around 14 percent higher than in developed
nations. Universally, there were an estimated 289,000 maternal deaths in
2013, which is equivalent to around 800 women dying daily. The highest
rate of maternal deaths is in sub-Saharan Africa and Southern Asia, which
collectively accounted for 86 percent of global maternal deaths.
Most of these deaths are preventable, with hemorrhage ac1counting for
over 27 percent of maternal deaths in developing regions and about 16
percent in the developed regions. Other complications leading to death
include high blood pressure during pregnancy, infections, unsafe
abortion, and complications from delivery.
Proven health-care interventions can help manage or prevent these
complications, including skilled care during childbirth, antenatal care in
pregnancy, and care and support in the weeks following childbirth.
Target #2: Universal Access to reproductive health
The WHO recommends four or more antenatal care visits during
pregnancy to ensure the wellbeing of mothers and newborns. During
these visits, women should be given nutritional advice, alerted to warning
signs indicating possible problems during their term, and given support
when planning a safe delivery.
Progress has been slow since 1990, with an average of 52 percent of
pregnant women in developing regions receiving the recommended
number of antenatal care visits in 2014, a 17 percent increase in 25 years.
Coverage levels in sub-Saharan Africa have remained still for the past two
decades, with slight improvement in the number of women receiving the
recommended care: 47 to 49 percent.

Use of contraceptives
Universally, the number of women aged 15 49 in marriage or a union,
who were using contraceptives (as a way to reduce the incidence of
unintended pregnancies, maternal deaths, and unsafe abortions) has
increased from 55 to 64 percent between 1990 and 2015. The proportion
in sub-Saharan Africa has more than doubled, from 13 to 28 percent,
while that in Southern Asia increased from 39 to 59 percent in the same
25 years.
Nine in every 10 contraceptive users were using effective methods,
including condoms, injectables, intrauterine devices, female and male
sterilisation, oral hormonal pills, or an implant.
Early childbearing
Adolescent childbearing is not only harmful to the health of both the girls
and child they bear, but also reflects the broader forms of social and
economic marginalisation of girls. Certain measures have been taken to
delay childbearing and prevent unintended pregnancies among this
vulnerable age group, including increasing their opportunities for
education and eventual paid employment. As a result, the birth rate
among adolescent girls aged 15 19 has reduced from 59 births per 1,000
girls to 51 births between 1990 and 2015.
Final note
One of the most fundamental ways to reduce maternal morbidity and
mortality is ensuring that every birth occurs with the help of skilled health
personnel midwife, nurse, or doctor. Progress in increasing the
proportion of births delivered with skilled attendance has been modest
over the MDG time frame, which is an indication of the lack of universal
access to care.
Significant progress has been made in reducing maternal deaths and
increasing global access to reproductive health, though the targets were
not achieved. Improvements can be made by addressing the large
inequities in maternal health, and strengthening individual country
capacity to tackle the problems.

Target 6. Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio
Indicators
16. Maternal mortality ratio (UNICEF-WHO)
17. Proportion of births attended by skilled health personnel (UNICEF-WHO)

Immunization coverage goals were largely attained. The Maternal and Child Health
Survey reported that in 2000, 65 percent of all children aged 12-23 months were
fully immunized before turning 1 year old. This shows an improvement from the
survey of 1997 where only 58 percent were fully immunized. There are more
immunized children in the urban areas (68%) than in the rural areas (63%). The
reduction in maternal mortality rate was substantial. The maternal mortality rate
(MMR) in 1991-97 is 172 per 100,000 live births as estimated by the 1998 National
Demographic and Health Survey (NDHS). This is slightly lower than the estimated
MMR of 209 per 100,000 live births in 1987-93 based on the 1993 National
Demographic Survey (NDS). Care for mothers is a big challenge, considering that a
low percentage of women get pre- and post-natal checkups, iron and iodine
supplements and tetanus toxoid immunization.

Since 1990, the maternal mortality ratio has declined by 45 per cent
worldwide, and most of the reduction has occurred since 2000.

In Southern Asia, the maternal mortality ratio declined by 64 per cent

between 1990 and 2013, and in sub-Saharan Africa it fell by 49 per cent.

More than 71 per cent of births were assisted by skilled health personnel
globally in 2014, an increase from 59 per cent in 1990.

In Northern Africa, the proportion of pregnant women who received four or

more antenatal visits increased from 50 per cent to 89 percent between 1990
and 2014.

Contraceptive prevalence among women aged 15 to 49, married or in a

union, increased from 55 per cent in 1990 worldwide to 64 per cent in 2015.

Similarly, infant deaths or deaths of children below one year old decreased from 25 to 22 deaths per 1,000 live births
which is also close to the 2015 MDG target of 19 deaths per 1,000 live births. However, almost half of the infant
deaths are neonatal deaths, or fatalities occurring within the first 28 days of life, which show a slow decline in
reduction from 18 to 14 per 1,000 live births from 1993 to 2011.
It is a different story for the lives of Filipino mothers. Maternal deaths remain high at 221 per 100,000 live births in
2011, making it unlikely for the country to reach the 2015 MDG 5 target of 52 deaths per 100,000 live births. Mothers
are dying due to delays in deciding to seek medical attention, delays in reaching appropriate care facility, and delays
in receiving quality services at health facilities.

The universal access to basic reproductive health services is unlikely to be achieved as the contraceptive prevalence
rate for modern family planning methods remains at 50 percent, far from the 2015 target of 63 percent.
A current worrying concern is also the increasing trend in teenage pregnancy - one in 10 girls aged 15 to 19 is
already a mother.
The countrys universal health care strategy called Kalusugan Pangkalahatan and the national social protection
program (4Ps) have been significant in improving the health and nutrition status of marginalized mothers and children
by focusing on the poor to have health insurance coverage through PhilHealth and access to affordable and quality
health benefit packages such as basic maternity and newborn care services.
The recently approved implementation of the Reproductive Health Law will also play a very crucial role in this as it
will provide universal access to quality, appropriate and affordable reproductive health care services and information
including family planning options that will benefit women, mothers, children, families, and communities.
Challenges remain but it is important that we keep moving forward for Filipino women and children

Combatting HIV/AIDS, malaria and other diseases

HIV, malaria, and other diseases directly and indirectly impact food and
nutrition security, rural development, and agricultural productivity. At the
same time, malnutrition and food and nutrition insecurity can increase
vulnerability to disease.
In this regard, millennium development goal 6 has three targets:

1. To halt by 2015 and have started to reverse the spread of

HIV/AIDS
2. To achieve global access to treatment for HIV/AIDS for those
who need it by 2010
3. To have ceased and started reversal of the incidence of malaria
and other major diseases by 2015
Some of the achievements of MDG 6 include:
40 percent reduction in new HIV infections from 3.5 million cases in
2000 to 2.1 million cases in 2013
A massive increase in the number of people living with HIV receiving
anti-retroviral therapy (ART) globally, from 800,000 in 2003 to 13.6
million in 2014. ART have helped avoid over 7.6 million deaths from
AIDS between 1995 and 2013.
Averting over 6.2 million deaths associated with malaria between
2000 and 2015, mostly of children under five years in sub-Saharan
Africa. The universal malaria incidence rate has also reduced by an
estimated 37 percent, and the mortality rate by 58 percent.
The delivery of over 900 million insecticide-treated mosquito nets to
malaria-endemic countries in sub-Saharan Africa between 2004 and
2014.
Tuberculosis prevention, diagnosis, and treatment interventions
conducted between 2000 and 2013 saved an estimated 37 million
lives. The TB mortality rate reduced by 45 percent between 1990 and
2013, while prevalence rate fell by 41 percent within the same time
period.

Target #1: Halt and reversal of the spread of HIV/AIDS

New HIV human immunodeficiency virus infections have declined

universally by nearly 40 percent between 2000 and 2013, indicating a drop
from an estimated 3.5 million to 2.1 million new infections. Among the
countries with sufficient data, 10 countries recorded a drop of more than
75 percent in new HIV infections from 2000 to 2013, while another 27
countries recorded a decline of more than 50 percent.
More than 75 percent of new infections recorded in 2013 occurred in only
15 nations, though sub-Saharan Africa is still the most severely affected by
the epidemic with an estimated 1.5 million new infections in 2013. Of
these, nearly 50 percent have occurred in three countries: South Africa,
Nigeria, and Uganda.
That said, South Africa, which has the largest number of people living with
HIV, recorded the largest decline in the total number of new infections,
with 98,000 fewer infections in 2013 compared to 2010. Additionally, the
number of new infections among young people (15 24) in the subSaharan region has declined by 45 percent between 2000 and 2013.
In the Caribbean, new HIV infections reduced by 56 percent, while
Southern Asia and Southern Africa recorded a 49 percent decrease. There
wasnt much change in Latin America and South-Eastern Asia, while new
infections increased in Western Asia, North Africa, and Eastern Asia.
AIDS related deaths dropped in 2013, with an estimated 1.5 million deaths
from AIDS-related illnesses. This represents a 35 percent decline since the
2.4 million peak recorded in 2005. In the short period between 2010 and
2013, AIDS-related deaths dropped by 19 percent, though AIDS-related
deaths have not decreased among adolescents aged 10 19, probably
due to lack of testing and treatment for this age group. As such, AIDS
remains the number one adolescent killer in sub-Saharan Africa.
Source: un.org

Target #2: Universal access to HIV/AIDS treatment

In 2013, an estimated 17.7 million children across the globe (under 18) has
lost at least one parent due to AIDS-related causes. Between 2000 and
2009, the number rose from 10.5 to reach a peak of 18.5 million. Since

then, this number has been dropping gradually, through investment in

social protection and economic support will be needed for years to come
to mitigate the impact of HIV on these children.
Education is a critical source of stability and protection for vulnerable
children. Fortunately, the rate of school attendance for orphaned and
non-orphaned children has increased from 0.80 to 0.96 between 2000 and
2014.
Access to ART has increased at an amazing pace, with an estimated 13.6
million people living with HIV receiving ART globally1. Of those, 12.1
million were in developing regions, indicating a huge increase from
375,000 in 2003.
The world is still on track to get 15 million people to receive ART by 2015, a
goal set out in the UN General Assembly Special Session on HIV and AIDS
in 2011. This accomplishment can be attributed to the power of
community mobilisation, the political resolve of leaders, the commitment
of health care workers, and international funding that continues to fuel
the universal scaling-up of ART.

Target #3: Reversal of the incidence of malaria and other major diseases
Global malaria incidence rate has dropped by about 37 percent between
2000 and 2015, while mortality rate has dropped by 58 percent in the
same period. Consequently, the global MDG malaria target has been
achieved.
Increased universal attention, combined with considerable expansion of
anti-malaria efforts have helped avert more than 6.2 million malaria
deaths in the 15 year period, especially in children under five in subSaharan Africa. The estimated 69 percent reduction in malaria mortality
for children under five in this region helped improve child survival rates,
directly contributing to MDG4 reduction of child mortality by two-thirds.
The massive gains since 2000 have been attributed to the tenfold increase
in international funding for malaria, with stronger political commitment
and the availability of new, more effective tools. This has increased access
to malaria prevention and treatment interventions, including indoor

residual spraying, long-lasting insecticide-treated mosquito nets,

diagnostic testing, and artemisinin-based combination therapies.
Source: un.org

Final note
In 2013, there were an estimated 35 million people living with HIV in the
world. This number is increasing as more people gain access to
antiretroviral therapy (ART). And while ART has averted 7.6 million deaths
worldwide, including 4.8 million in sub-Saharan Africa, this is only 36
percent of the 31.5 million people living with HIV in developing regions.
And while 98 malaria-endemic nations have reversed malaria incidence
nationally in 2015 compared to 2000, malaria continues to pose a huge
public health challenge with an estimated 214 million cases and 472,000
deaths worldwide in 2015. 97 countries and territories across the globe, or
3.3 billion people, are still at risk of malaria infection, so more still needs
to be done.
For patients diagnosed with tuberculosis in 2012, 86 percent were
successfully treated globally, hitting the target of 85 percent set in 1991.

Target 7. Have halted by 2015 and begun to reverse the spread of HIV/AIDS
Indicators
18. HIV prevalence among pregnant women aged 15-24 years (UNAIDS-WHO-UNICEF)
19. Condom use rate of the contraceptive prevalence rate (UN Population Division) c*
19a. Condom use at last high-risk sex (UNICEF-WHO)
19b. Percentage of population aged 15-24 years with comprehensive correct knowledge of HIV/AIDS (UNICEF-WHO) d*
19c. Contraceptive prevalence rate (UN Population Division)
20. Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years (UNICEF-UNAIDS-WHO)
Target 8. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases
Indicators
21. Prevalence and death rates associated with malaria (WHO)
22. Proportion of population in malaria-risk areas using effective malaria prevention and treatment measures (UNICEFWHO) e*
23. Prevalence and death rates associated with tuberculosis (WHO)
24. Proportion of tuberculosis cases detected and cured under DOTS (internationally recommended TB control strategy)
(WHO)

With regard to HIV/AIDS, the HIV/ AIDS Registry has recorded 1,441 HIV AB
seropositive cases (1984-2000), 486 of whom had AIDS; with 218 deaths. Majority of
the cases were in the 20-49 years age group. Most cases were male. Of the 1,441
HIV cases, 371 or 26 percent are Overseas Filipino Workers (OCWs). The

predominant mode of transmission is sexual intercourse. Between 1984 and 1992,

the reported annual number of confirmed cases remained below 100. However, in
the last seven years, 1993-99, the number of cases per year had exceeded 100, but
remained below 200. The number of cases each year has been increasing but there
seems to be no indication that such increse will be significant. While the number of
confirmed cases of HIV/AIDS is low and the rate of increase in the number of cases
is slow, the potentials for a full-blown epidemic continue to exist. Thus, the country
cannot be complacent on this. The challenge with other major diseases like malaria
and tuberculosis is daunting, though. TB incidence in the country remains one of the
highest in the world, with 75 Filipinos dying daily from the disease.

Goal 5. Improve maternal health

o Target 6. Reduce by three quarters, between 1990 and 2015, the
maternal mortality ratio
Births attended by skilled health personnel, percentage
Maternal mortality ratio per 100,000 live births
Goal 6. Combat HIV/AIDS, malaria and other diseases
o Target 7. Have halted by 2015 and begun to reverse the spread of
HIV/AIDS
AIDS deaths
Condom use to overall contraceptive use among currently
married women 15-49 years old, percentage
Contraceptive use among currently married women 15-49
years old, any method, percentage
Contraceptive use among currently married women 15-49
years old, condom, percentage
Contraceptive use among currently married women 15-49
years old, modern methods, percentage
Men 15-24 years old, who know that a person can protect
himself from HIV infection by consistent condom use,
percentage

 People living with HIV, 15-49 years old, percentage

Ratio of school attendance rate of orphans to school
attendance rate of non orphans
Women 15-24 years old, who know that a healthy-looking
person can transmit HIV, percentage
Women 15-24 years old, who know that a person can
protect himself from HIV infection by consistent condom
use, percentage
o Target 8. Have halted by 2015 and begun to reverse the incidence
of malaria and other major diseases
Tuberculosis death rate per 100,000 population
Tuberculosis detection rate under DOTS, percentage
Tuberculosis prevalence rate per 100,000 population
Tuberculosis treatment success rate under DOTS,
percentage