“Recent data shows that there are 11 Mothers dying daily from preventable maternal complications…”

11 mothers die every day?

Data from recent and independent studies suggest that maternal mortality in the Philippines has been declining for the past several years even without a reproductive health measure.

11 mothers die daily or roughly 4,100 women die each year due to complications related to childbirth. The figure is reportedly based on a 2006 Family Planning Survey by the National Statistics Office.[1] One report cites a 2004 publication entitled ‘Maternity Mortality in 2000: Estimates developed by WHO, UNICEF and UNFPA’ as the source of the ‘11 maternal deaths a day’.[2] The Philippine Obstetrical and Gynecological Society, citing a 2009 UN Children’s Fund report, claims that the Philippines has an MMR average of 230 per 100,000 live births and that maternal deaths are caused by “hemorrhage, sepsis, obstructed labor, hypertensive disorders in pregnancy, and complications of unsafe abortion”.[3] Another report estimates that around 4,500 women die each year due to complications related to child birth.[4]

The ‘11 maternal deaths a day’ is a figure commonly cited by various persons and groups[5] to effect passage of House Bill 4244: The Responsible Parenthood, Reproductive Health and Population and Development Act of 2011, popularly known as the Reproductive Health or RH Bill.[6]

Is the figure accurate? Are there 11 mothers who die every day due to childbirth-related complications?

Recent independent studies, both local and international, suggest otherwise.

A study from the Institute for Health Metrics and Evaluation of the University of Washington in Seattle, published in The Lancet, indicates that maternal mortality from 1980 to 2008 for 181 countries has shown a substantial decline in maternal deaths.[7] There were 342,900 maternal deaths in 2008, down from 526,300 and that MMR worldwide decreased from 422 in 1980 to 320 in 1990, and was 251 per 100,000 livebirths in 2008. In the Philippines, maternal mortality ratio per 100,000 livebirths has decreased accordingly: 443 in 1980, 174 in 1990, 103 in 2000, and 84 in 2008. For 2008, it translates to 4.1 maternal deaths per day.

Based on this study, “the Philippines outpaced first-world nations like Germany, Russia and Israel — where abortions are legal — in cutting maternal mortality rates”.[8] [9] Authors of the University of Washington study conclude that the new evidence suggests a much greater reason for optimism than has been generally perceived, and that substantial decreases in the MMR are possible over a fairly short time [italics my emphasis].

Another set of estimates by the WHO, UNICEF, UNFPA and The World Bank indicate that the Philippines in 2008 has a maternal mortality ratio of 90 and 2,100 maternal deaths (5.75 deaths per day).[10] Based on these data, the Philippines has improved in reducing maternal mortality with MMR plunging by 48% from 1990 to 2008 and did a better job than Germany, Russia, Israel, Hungary and Malaysia in reducing maternal deaths in terms of percentage drop in MMR.[11]

The WHO report, published in 2010, concludes that its “analysis of all available data for maternal mortality from 1980 to 2008 for 181 countries has shown a substantial decline in maternal death” having narrowed the “uncertainty around global and national estimates… This improved accuracy is a result of an extensive database and the use of analytical methods with increased explanatory power and improved out-of-sample predictive validity”.

It adds that “although the [2008 maternal mortality] point estimates are considered the most likely levels of MMR, the uncertainty ranges are intervals estimated to contain the true MMR with 95% probability”. For comparison, A WHO report published in 2004 and cited as the source of the ‘11 maternal deaths a day’, warns that its figures “cannot be used to analyze trends because of the wide margins of uncertainty associated with the estimates.”[12]

The Guardian places the Philippines 106th in its MMR global rank with 83.6 in 2008.[13]

The 2010 WHO, University of Washington and The Guardian results are validated by National Statistical Coordination Board figures which show a drop of MMR from 121-207 in 1990 to 95-163 in 2010.[14] In 2008, MMR was estimated at 99-169 per 100,000 live births.[15]

Earlier, preliminary results from the 2006 Family Planning Survey, already show slightly declining maternal mortality with 162 women dying during pregnancy and childbirth, or shortly after childbirth.[16]

The UN gives the following Philippine maternal mortality ratio per 100,000 live births: 180 for 1990, 140 for 1995, 120 for 2000, 110 for 2005, and 94 for 2008.[17] For the period 2005-2009, the value is 160 deaths for every 100,000 live births.[18] Furthermore, for the year 1990 and the period 2000-2010, interim estimates of national-level maternal mortality ratios show a systematic decline.[19]

These studies support the claim that maternal mortality in the Philippines for the last couple of years has been declining even without a reproductive health measure.

One news carrier puts it succinctly: “The Philippines is winning the battle against maternal deaths even without any reproductive health law. Recent studies released by the government and major research institutes show a marked decline in maternal deaths, contradicting old data used by birth control supporters.”[20]

Perhaps legislators, government and non-government agencies, and other stakeholders can look into this positive development, identify the reasons for the decline in maternal deaths, and strengthen existing programs to improve maternal health care in the Philippines without channeling much needed resources to an unnecessary and redundant RH bill.