Friday, June 17, 2011

The major cause of maternal deaths, really (Part 2)

(or why getting pregnant is like getting hit by a car) huh?

I came across an article which that annotates the problem with data and illustrations, and it helps understand the issue of maternal health. The article concentrates on showing data as a comparison of maternal deaths with our neighboring countries, and shows the 4 points where the RH bill aims to address the issue.

I like the analogy of pedestrians crossing the street - there are bound to be accidents. I think one of the obvious solutions is to reduce or minimize the number of people crossing the street. It's just the same as students taking exams where there is a high failure rate. You just reduce the number of examinees and ergo - you reduce the number of failures! I thought this was the magical solution of the RH bill in addressing maternal deaths. Reduce pregnancies via provision of free contraceptives and therefore reduce maternal deaths. So why don't we go a step further and eliminate pregnancies altogether by legislation and then presto: ZERO maternal deaths. I am just kidding, of course :-)

The overall picture in the article indeed shows that as far as maternal mortality is concerned, we are woefully behind in comparison with our neighboring countries.It would be better if we can further distill the attributes of the data. In cases like this, it is good to apply the principle behind the Pareto analysis. An applicable principle here maybe is that 80% of the problem is caused by 20% of the attributes. The most recent study I can get hold of that can be helpful here is one made by NSO statisticians, in a presentation made at a 2004 convention. It should be good enough for establishing the trend.

On page 7, the table shows that the areas of ARMM, Regions 12 and 9, account for the lowest utilization of prenatal, delivery, and postnatal care. The dismal 20.6% utilization of delivery care in the ARMM region is illustrative. If we go through the rest of the regions, we clearly see a strong correlation between low maternal care percentages and poverty by region. This is punctuated by the fact that the most populated (and by the way - the richest by per capita income) region in the country, NCR, has the highest percentage of prenatal and delivery care in the entire country: 96.6%. It is indeed ironic that among the regions that need more support in terms of health care, the poorest regions get the least attention. We must bear in mind with this observation that with the passage of the Local Government Code in 1991, delivery of health care services was devolved to the LGUs. And as we all know, the classification of regional areas directly corresponds to the budget of LGUs, leaving the needy LGUs with less resources than it actually needs. The RH bill aims to be objective in that it proposes maternal health care in terms of population and number of deliveries. However, this approach fails to take into consideration the demographics of the picture. The data shows that highly populated areas happen to be the high-income, high healthcare penetration areas, and if straight headcount data is used, this approach will only manage to perpetrate the imbalance of support that has become typical in the government approach to the delivery of basic services. The RH bill should have said the poor should be provided MORE instead of the SAME level of access. The poor, rural areas always happen to be the most neglected, in contrast with the developed cities where its residents can generally afford health care.

Talking about Region 12 and ARMM, these areas also happen to be perpetually saddled with conflict. It is a given that conflict-ridden areas suffer the most in terms of basic services: food, water, sanitation, electricity, education, and yes - basic health care. It is not any secret that these areas are also the poorest in the entire Philippines. Recurring and recent events also show they are also the most deprived of fair play and JUSTICE. As in healthcare, those who have less in life should have more of justice. Indeed, regional conflict that has historical roots is very complicated to solve. One solution proposed is to bombard these areas with free condoms to finally solve the problem. On this last sentence, I am again just kidding. :-)
Well, maybe not.

I agree with the four points raised in the article (in reference to the intents of the RH bill) in addressing maternal health. Hopefully, the actual methodology used in implementing any solution will be adjusted to take into consideration the concern I raise about demographics, and seamlessly integrated with existing DOH systems addressing the same needs. Also, I would like to point out further that the Pareto principle of 80-20 also has to assume a much more fundamental concept. It is called root-cause analysis.
Part 1 here.

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