Maternal Health

The quality of care that both mother and newborn receive during pregnancy, at
delivery, and in the early postnatal period is essential to ensuring women remain healthy and
that children get a strong start. Many stillbirths and newborn deaths could be averted if more
women were in good health, well-nourished, and receiving quality care during pregnancy,
labor, and delivery, and if both mother and newborn received appropriate care in the
postpartum period.

Related Laws

Magna Carta for Women (RA 9710)

It is a comprehensive womens human rights law that seeks to eliminate
discrimination against women by recognizing, protecting, fulfilling, and
promoting the rights of Filipino women, especially those in the marginalized sectors.

Features of the Law:

1. Health information and education covering all stages of a womans life cycle, and
which addresses the major causes of womens mortality and morbidity, including
access to among others, maternal care, responsible, ethical, legal, safe and effective
methods of family planning, and encouraging healthy lifestyle activities to prevent
diseases

2. Leve benefits of two (2) months with full pay based on gross monthly
compensation, for women employees who undergo surgery caused by gynecological
disorders, provided that they have rendered continuous aggregate employment service
of at least six (6) months for the last twelve (12) months

3. Equal rights in all matters relating to marriage and family relations. The State shall
ensure the same rights of women and men to: enter into and leave marriages, freely
choose a spouse, decide on the number and spacing of their children, enjoy personal
rights including the choice of a profession, own, acquire, and administer their
property, and acquire, change, or retain their nationality. It also states that the
betrothal and marriage of a child shall have no legal effect.

4. Review amendment or repeal of laws that are discriminatory to women.

5. Mandate access to information and services pertaining to womens health.

The Rooming-In and Breastfeeding Act of 1992 (RA 7600)

An act providing incentives to all government and private health institutions with
rooming-in and breastfeeding practices and for other purposes

The State adopts roomingin as a national policy to encourage, protect

and support the practice of breastfeeding. It shall create an environment where the
basic physical, emotional, and psychological needs of mothers and infants are
fulfilled through the practice of rooming
in and breastfeeding.
 Breastfeeding has distinct advantages which benefit the infant and the mother
including the hospital and the country that adopt its practice. It is the first preventive
health measures that can give to the child at birth. It also enhances mother-
infant relationship, Furthermore, the practice of Breastfeeding could save the country
valuable foreign exchange that may otherwise be used for milk importation.

Breastmilk is the best food since it contains essential completely suitable for the infan
ts needs. It is also natures first immunization, enabling the infant to fight potential
serious infection, It containsgrowth factors that enhance the maturization of an
infants organ systems.

Executive Order 51 0f 1986 (The Milk Code)

It ensures safe and adequate nutrition for infants through the promotion of
breastfeeding and the regulation of promotion, distribution, selling, advertising,
product public relations, and information services artificial milk formulas and other
covered products.

Policies of the Milk Code:

1. Exclusive breastfeeding is for infants from 0 to 6 months.

2. Breast milk has no substitute or replacement.
NOTE: Breastfeeding is best for babies ESPECIALLY during disasters.
3. In addition to breastfeeding, appropriate and safe complementary feeding of
infants should start from 6 months onwards.
4. Breastfeeding is still appropriate for children up to 2 years of age and beyond.
5. Infant or milk formula may be harmful to a child's health and may damage a
child's formative development.
6. Other related products such as teats, feeding bottles, and artificial feeding
paraphernalia are prohibited in health facilities.

An Act Increasing Maternity Benefits in Favor of Women Workers in the Private

Sector (RA 7322)
An act increasing maternity benefits in favor of women workers in the private sector,
amending for the purpose section 14-a of republic act no. 1161, as amended, and for
other purposes

Philippine Midwifery Act of 1992 (RA 7392)

Setting standard labeling for breastmilk substitutes, infant formula, other milk
products, foods and beverages (DOH Circular 2008-0006)

National Commitment for Bakuna and Una sa Sanggol at Ina (EO 663)
It is for children to attain the highest possible attainable level of health, survival and
protection; and supported the World Health Assembly resolutions for improving child
health and survival
 Responsible Parenthood and Reproductive Health Act of 2012 (RA 10354)

The Responsible Parenthood and Reproductive Health Act of 2012 (Republic Act No.
10354), informally known as the Reproductive Health Law or RH Law, is a law in
the Philippines, which guarantees universal access to methods on contraception,
fertility control, sexual education, and maternal care.

Incidences

MATERNAL MORTALITY: BY MAIN CAUSE

Number, Rate/1000 Livebirths & Percent Distribution
Philippines, 2010
CAUSE Number Rate Percent*
TOTAL 1,719 1.0 100.0
1. Complications related to pregnancy occuring
660 0.4 38.4
in the course of labor, delivery and puerperium

2. Hypertension complicating pregnancy,

605 0.3 35.2
childbirth and puerperium
3. Postpartum hemorrhage 298 0.2 17.3
4. Pregnancy with abortive outcome 156 0.1 9.1
*Percent share to total number of maternal deaths

Rate per 1,000 live births

Percent share to total number of maternal deaths

Extent of Implementation

The Maternal, Newborn, And Child Health And Nutrition Strategy

In its response to the maternal and child health situation, the DOH takes into consideration
the interrelatedness of (1) direct threats to the life o mothers and children that necessitate
immediate health care and managing risks that tend to increase maternal and child deaths and
(2) underlying socioeconomic conditions that hinder the provision and utilization of MNCHN
core package of services.

The MNCHN (Maternal, Neonatal and Child Health and Nutrition) core package of services

The maternal and newborn care package is characterized by a paradigm shift from the risk
approach that focuses on identifying pregnant women at risk of complications to one
considers all pregnant women at risk of such complications. This is mainly in response to
findings that reveal the inability of antenatal protocols to accurately predict the onset of
complications during childbirth (DOH, 2009)

1. Pre-pregnancy: provision of iron and folate supplementation, advice on family

planning and healthy lifestyle, provision of family planning services,
prevention and management of infection and lifestyle-related diseases. In particular, modern
family planning reduces unmet need and unwanted pregnancies that expose mothers to
unnecessary risk from pregnancy and childbirth. Unwanted pregnancies are also associated
with poorer health outcomes for both mother and her newborn. Effective provision of FP
services can potentially reduce maternal deaths by around 20 percent. This also encompass
adolescent health services, deworming of women of reproductive age (to reduce other causes
of iron deficiency anemia), nutritional counseling, oral health.

2. Pregnancy: first prenatal visit at first trimester, at least 4 prenatal visits throughout the
course of pregnancy to detect and manage danger signs and complications of pregnancy,
provision of iron and folate supplementation for 3 months, iodine supplementation and 2
tetanus toxoid immunization, counselling on healthy lifestyle and breastfeeding, prevention
and management of infection, as well as oral health services. While the contribution of
antenatal care in anticipating and preventing maternal and newborn emergencies is unclear,
components of prenatal care remain effective in reducing perinatal deaths10 and serves as a
venue for birth planning and promotion of facility based deliveries.

3. Delivery: skilled birth attendance/skilled health professional-assisted delivery and facility-

based deliveries including the use of partograph, proper management of pregnancy and
delivery complications and newborn complications, and access to BEmONC or CEmONC
services. The recent emphasis on the importance of access to emergency obstetrics and
newborn care (EmONC) services is due to the shift from the risk approach to pregnancy
management to that which considers all pregnancies to be at risk. Under the risk approach
pregnant women are screened for risk factors and only those diagnosed with pregnancy
complications are referred to facilities capable of providing EmONC services. The approach
that considers all pregnancies to be at risk recommends that all pregnant women should
deliver with assistance from skilled health professionals and have access to EmONC services
since most maternal deaths occur during labor, delivery or the first 24 hours post-partum and
most complications cannot be predicted or prevented. The best intra-partum care strategy is
likely to be one in which women routinely choose to deliver in health centers with midwives
as the main providers but with other attendants working with them in a team.

4. Post-Partum: visit within 72 hours and on the 7th day postpartum to check for conditions
such as bleeding or infections, Vitamin A supplements to the mother, and counselling on
family planning and available services. It also includes maternal nutrition and lactation
counseling and postnatal visit of the newborn together with her visit. 5. Newborn care until
the first week of life: Interventions within the first 90 minutes such as immediate drying, skin
to skin contact between mother and newborn, cord clamping after 1 to 3 minutes, non-
separation of baby from the mother, early initiation of breastfeeding, as well as essential
newborn care after 90 minutes to 6 hours, newborn care prior to discharge, after discharge as
well as additional care thereafter as provided for in the Clinical Practice Pocket Guide,
Newborn Care Until the First Week of Life. 6. Child Care: immunization, micronutrient
supplementation (Vitamin A, iron); exclusive breastfeeding up to 6 months, sustained
breastfeeding up to 24 months with complementary feeding, integrated management of
childhood illnesses, injury prevention, oral health and insecticide-treated nets for mothers and
children in malaria endemic areas

Essential to the MNCHN strategy are facilities that can provide basic emergency obstetric
and neonatal care (BEmONC). These facilities operate on a 24-hour basis, and are accessible
within 30 minutes of travel, equipped with communication and transportation systems for
referrals. Every BEmONC facility should have a physician, nurse, and midwife. Also
essential to the MNCHN strategy are the comprehensive emergency obstetric and neonatal
care (CEmONC) facilities which are accessible within one hour travel time, operational on a
24-hour basis, and capable to carry out emergency responses. A CEmONC facility should be
staffed with at least one obstetrician/surgeon, pediatrician, anesthesiologist, six nurses,
medical technologist, and six midwives.

A BEmONC-capable facility or provider can perform the following six signal obstetric
functions

Womens Health and Safe Motherhood Project

As a measure to accelerate efforts on MMR reduction, the Philippine government has

adopted Womens Health and Safe Motherhood as its flagship program under the sector
wide F1.
The Second Womens Health and Safe Motherhood Project (WHSMP2) will contribute to the
national goal of improving womens health by: Demonstrating in selected sites a sustainable,
cost-effective model of delivering health services that increases access of disadvantaged
women to acceptable and high quality reproductive health services and enables them to safely
attain their desired spacing and number of children. The main objectives of the WHSMP2 in
the Philippines are the following:

1. To increase the access of disadvantaged women ofreproductive age to acceptable, high

quality, and cost-effective reproductive health services and enable them to safely attain their
desired spacing and number of children.
2. To assist in the development and implementation of sustainable and replicable systems
within the framework of the Health Sector Reform Agenda for financing and delivery of
reproductive health services.

The Philippine Family Planning Program (PFPP)

It started in the 1970s as a family planning service delivery component to achieve fertility
reduction. It has evolved to its present-day health orientation of improving the health of
women and chidren and has been integrated with other RH programs giving importance to
reorganizing choice and rights of FP users.

The National Family Planning Policy, articulated through A.O. 50-A, asserts that family
planning as a health intervention, shall be made available to all men and women of
reproductive age (15-44 years old). FP is a means to prevent high-risk pregnancies brought
about by the following conditions:

1. Being too young (less than 18 years old) or too old (over 34 years old)
2. Having had too many (4 or more) pregnancies
3. Having closely spaced pregnancies (less than 36 months)
4. Being too ill or unhealthy/too sick or having an existing disease or disorder like iron
deficiency anemia

Four Pillars of the PFPP

The guiding principles of the FP program are as follows:

1. Responsible parenthood. This refers to the will and ability to respond to the needs and
aspirations of the family. It promotes the freedom of responsible parents to decide on
 the timing and size of their families in pursuit of a better life.

2. Respect for life. The 1987 Constitution protects the life of the unborn from the
moment of conception. FP aims to prevent abortions, thereby saving lives of both
women and children.

3. Birth spacing. Proper spacing of 3-5 years from recent pregnancy enables a woman to
recover from pregnancy and to improve her well-being, the health of the child, and
the relationship between husband and wife and between parents and children.

4. Informed choice. Couples and individuals are fully informed on the different FP
methods. Couples and individuals decide and may choose the methods that they will
use based on informed choice and to exercise responsible parenthood in accordance
with their religious ethical values and cultural background, subject to conformity with
universally recognized international human rights.

Benefits of Family Planning to mothers:

1. Enables her to regain health after delivery

2. Gives enough time and opportunity to love and provide attention to her husband and
children
3. Gives more time for her family and own personal advancement
4. When suffering from an illness, gives enough time for treatment and recovery

Promotion of Breastfeeding Program/ Mother and Baby Friendly Hospital Initiative

Realizing optimal maternal and child health nutrition is the ultimate concern of the Promotion
of Breastfeeding Program. Thus, exclusive breastfeeding in the first four to six months
after birth is encouraged as well as enforcement of legal mandates. The Mother and Baby
Friendly Hospital Initiative (MBFHI) is the main strategy to transform all
hospitals with maternity and newborn services into facilities which fully protect, promote,
and support breastfeeding and rooming-in practices. The legal mandate to this initiative
are the RA 7600 (The Rooming-In and Breastfeeding Act of 1992) and the Executive
Order 51 of 1986 (The Milk Code). National assistance in terms of financial support for
this strategy ended in 2000, thus LGUs were advocated to promote and increase the
proportion of pregnant women having at least four antenatal care visits to 80 percent;
increase skilled birth attendance and facility-based births to 80 percent; and increase
percentage of fully immunized children to 95 percent.
 Republic of the Philippines
Mariano Marcos State University
College of Health Sciences
DEPARTMENT OF NURSING
City of Batac

MATERNAL
HEALTH

Submitted by:

Abran, John Dave C.

Alibuyog, Ian Warren

Submitted to:

Mrs. Rosemarie G. Asuncion

October 2016