By DAVID DIZON
Majority of pregnant women in the provinces of Western Samar, Surigao del Sur and Sorsogon still prefer to give birth at home instead of delivering their babies in a lying-in clinic or private hospital in their area, according to a recent study sponsored by the Department of Health.
The baseline survey, which was conducted from June 2007 to March 2008, showed that up to 75 percent or three out of four babies in parts of the three provinces are delivered at home. Less than three percent of deliveries in the three provinces were in private hospitals or private clinics.
Twenty-two percent of deliveries in Western Samar, 19 percent of deliveries in Surigao del Sur and 38 percent of deliveries in Sorsogon were done in government hospitals.
The survey interviewed 1,200 women and 350 health care providers including doctors, midwives and traditional birth attendants in the three provinces. It was conducted by the UP Center for Economic Policy Research for the DOH Women's Health and Safe Motherhood Project.
The survey showed that traditional birth attendants or hilots attended to about a third of deliveries in Western Samar, 20 percent of deliveries in Sorsogon and 43 percent of deliveries in Surigao del Sur.
In Sorsogon, 20 percent of pregnant women were attended to by physicians compared to 18 percent in Surigao del Sur and 15 percent in Western Samar. On the other hand, nurses attended to 18 percent of pregnancies in Surigao del Sur, 11 percent in Sorsogon and nine percent in Western Samar.
Zenaida Dy Recidoro, chief health program officer of the DOH Safe Motherhood Program, said trust in traditional birth attendants plays an important role as to why pregnant women in provinces still prefer to deliver their babies at home instead of going to a public hospital.
"We want the women to deliver in a health facility rather than in the home. There has to be a shift in attitude and make these women build their trust in the public health system," she told abs-cbnNEWS.com.
Cost, travel time
In the interview, Recidoro cited four possible reasons why some Filipino women still prefer to deliver their babies at home than in the hospital. These are 1) cost; 2) distance of health facility; 3) responsibilities at home; and 4) attitude of health worker.
Recidoro said cost should not be an issue since most public health facilities in the three provinces only charge up to P500 per delivery, which could also be subsidized through Philhealth. She said that since most of the babies are delivered at home, the costs are paid directly out of pocket.
She said some pregnant women would rather stay at home than go to the lying-in clinic "because they have no one else to take care of the other children." This, she said, is why hilots are popular since they can help in the delivery, tend to the mother and the children and even do the laundry in the house for a small fee.
She said the government should focus on the problem of distance since some of the government-run hospitals that provide emergency obstetric care are too far.
"The most important criterion is travel time. If it takes you 30 minutes to an hour to get to a hospital, it is unlikely that the patient will go there unless it is an emergency case. Even then, it may be too late. Some of the pregnancy women don't even get prenatal care," she said.
Dr. Juan Pablo Nañagas, former director of the Philippine General Hospital, said some provincial hospitals are built on donated land with no thought as to the accessibility of the health facility to the public. "In Palawan, for example, there are hospitals that you can't even go to if it rains because the roads are flooded," he said.
Recidoro said the solution for this is to upgrade barangay health clinics to be able to provide basic obstetric health care as well as comprehensive emergency obstetric and newborn care to pregnant mothers.
7 mothers dying daily
The 2007 survey revealed that rural health units provide maternal health care for normal delivery and post-partum care and temporary family planning services. Few facilities, however, offer blood transfusion services, Caesarean and non-Caesarean deliveries, permanent family planning services, HIV/AIDS tests and lab services for other sexually transmitted illnesses, the study said.
Nañagas said one of the main causes of maternal deaths is post-partum hemorrhage, which means that a facility must have at least a blood bank to handle emergency cases. "Without these emergency facilities, maternal deaths could become an even bigger problem if not addressed immediately," he said.
Recidoro said 15 percent of total pregnancies will develop complications from the start of the pregnancy up to 42 days after delivery. She said that out of the 15 percent, five to seven percent might suffer from fatal complications including Caesarean sections or emergency blood transfusions.
She said the upgrade of barangay health clinics is especially important to cut the incidence of maternal deaths in the country, which is part of the United Nations Millennium Development Goals.
"Under the MDGs, there should only be 52 maternal deaths per 100,000 live births. Right now, we're about 162 per 100,000 live births. That means about seven mothers are dying due to pregnancy-related causes per day. People might not see this but there should really be zero mortality of mothers," she said.
MATERNAL MORTALITY RATIO (per 100,000 live births)
Source: National Statistics Office - 1998 and 2000 data: National Demographic and Health Survey; 1990 to 1995 data: TWG on Maternal and Child Mortality-National Statistical Coordination Board
Recidoro said that more than just the cost, the government should see the upgrade of barangay health facilities as a moral issue.
"If I give birth at the barangay health center, does that mean I can’t have access to emergency obstetric care? It’s not all about cost. Life is a gift and it is expensive. Every decision that leads to the upgrade of health facilities could be another life saved," she said.
Trust in public health care
Recidoro said that aside from upgrading barangay health facilities, the DOH is also proposing the enactment of local ordinances that would regulate the practice of traditional birth attendants.
She said DOH recently launched Women's Health Teams that would track every pregnancy in the community, assist in accomplishing the birth plan and providing quality supportive maternal care such as assisting the midwife in labor watch and in the delivery.
She said one example of a successful Women's Health Team can be found in a lying-in clinic in Barangay Aras-asan in Cagwait, Surigao del Sur.
She said the clinic, which is operated by a midwife and seven TBAs, has covered 97 percent of deliveries in Cagwait with zero maternal deaths for the past five years. Patients are usually charged P500, which is split up to P200 for the midwife, P200 for the hilot and P100 for the upkeep of the clinic. Supplies used during the delivery are shouldered by the patient, which is sold at cost at a drugstore in the clinic.
"Since the supplies are sold at cost, the patients prefer to go there because it’s cheaper than the private hospitals. There is very little resistance from the community. Even those who are a little bit more well-off like public school teachers go there. Why? Because they’ve built the trust with the midwife and the TBAs. There’s a personal touch," she said.
Drop in breastfeeding rate
The 2007 survey also showed an improvement in prenatal care, which involve advising expectant mothers on nutrition and health care, education on the symptoms of risk conditions, examination, screening, immunization and micronutrient supplementation.
It said 53 percent of respondents in Western Samar and 68 percent in Surigao del Sur had a birth plan during their pregnancies. On the other hand, only 28 percent of respondents in Sorsogon said they had a birth plan.
The survey also revealed that 87%-93% of respondents consulted a health professional during their pregnancy and had three to four prenatal visits. The most common prenatal services provided were weighing and measuring of blood pressure. However, routine urinalysis and blood examination were not performed.
The survey also showed that postnatal care focused on aspects of the baby's health rather than on breast examination, internal examination and family planning for the mother. Most health care providers said they provided breastfeeding instructions, umbilical cord check and advice on family planning to their patients.
The survey also showed a drop in breastfeeding rates. A DOH survey conducted in 2004 showed that 90 percent of home-based respondents breastfed their last two children with 80 percent or more exclusively breastfeeding for at least six months.
On the other hand, 60 percent or more facility-based respondents breastfed in 2007 and almost no one exclusively breastfed.
The study recommended several actions by the DOH and Philhealth including:
- DOH to develop strategy to promote knowledge about maternal care specifically on birth plan
- Health care facilities to improve quality and availability of MC services including postnatal care, range of available family planning methods offered, and availability of supplies and equipment
- Health care facilities to provide all types of services including maternal health and family planning any day of the week
- Regular trainings of health care providers on prenatal services, recognition of different stages of labor, family planning services, sexually transmitted illnesses and safe handling of sharps and other activities related to HIV/AIDS
- Philhealth to inform public on support for birth, family planning and maternal care packages