A few weeks ago, we admitted another case of a housewife who has been caring for her sick husband and mother, without realizing that she herself had a bad heart needing urgent treatment.

The women in the world are truly real-life heroes. They spend so much time caring for their family, only to neglect their own health. They remind their loved ones to see their family doctor whenever they have bothersome symptoms, yet ignore their own symptoms, and often consult a doctor when it is too late.

Our patient recalled that she would have chest tightness every now and then which would go away after a minute or two, which she dismissed as muscle pain or fatigue. She didn’t bother to get a checkup, while accompanying her husband who had a stroke and her diabetic mother to their checkups.

One of the biggest ironies in life is that women give life in pregnancy and childbirth, but in the process, some may lose their own lives due to complications.

3 million deaths

Maternal health is really a major issue not only in the Philippines, but worldwide. The United Nations (UN) has made it a key part of its Millennium Development Goals (MDG).

According to the UN, more than three million women in the world are dying every year from complications of pregnancy and childbirth.

Although some improvement in prenatal and childbirth care has been noted in developing countries like the Philippines, these maternal healthcare benefits have not trickled down, especially to the marginalized sectors of society.

This is why the role of the Department of Health (DOH) and the Philippine Obstetrical and Gynecological Society Inc. (POGS) is very important.

POGS is the national organization of doctors who specialize in the care of women—pregnancy, childbirth and diseases of the female reproductive organs.

Ignorance

Ignorance of how to prevent common complications during pregnancy and childbirth is still a prevalent problem. Through the years, DOH and POGS have been conducting public awareness programs to educate and empower the female population with 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, 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. As of three years ago, MMR has been reduced to close to 100 per 100,000 live births.

The usual causes of maternal death remain the same, including uterine hemorrhages, severe infection sometimes associated with abortion, obstructed labor, preeclampsia and eclampsia, which are characterized by elevated blood pressure during pregnancy that may lead to serious complications in the heart, brain and kidneys.

DOH and POGS have 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 DOH, only around 60 percent of births are supervised by skilled birthing healthcare professionals.

Irony

Around 40 percent of women giving birth still go to traditional hilot or birthing attendants who are simply not competent to deal with complications. The percentage in impoverished rural areas can reach 75 percent, and this is where most of the maternal deaths occur.

It’s another irony that families in the marginalized sectors have more children than families who are more well off. A low use of contraception is another major issue. It’s logical to assume that if 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.

Unplanned

A local study done years ago showed that nearly half of more than three million pregnancies in the Philippines were unplanned. And in about 30 percent of these unplanned pregnancies, the pregnant women had abortions, 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—also known as the Responsible Parenthood and Reproductive Health Act of 2012 —can help address the high MMR in the country, by enabling government health centers all over the country to give away free condoms and contraceptive pills, which can lower the country’s MMR.

The law was intended to guarantee universal access to suitable methods of contraception, fertility control, sexual education, and maternal care.

Although there was general agreement to strongly address maternal and child health issues, the disagreement was on its provisions for government through its nationwide health centers, and for the private sector to distribute various contraceptive methods.

The Supreme Court resolved the issue in 2014 by ruling the law as “not unconstitutional,” but it also watered down key provisions. In a way, it would seem, it was more of a political resolution of the reproductive health controversy, rather than the most suitable medical evidence-based recommendation.

In the end, our women—our real-life heroes—may stand to lose.