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Maternal Mortality Ratio
In
the Philippines, 10 women die every 24 hours from causes related
to pregnancy and childbirth.
The
death of a mother has a profound impact on her surviving children,
her family and also the community. An untimely death means
losing a productive worker and a primary caregiver.
The
maternal mortality rate, or the proportion of women dying
from pregnancy and birth-related causes, is intimately linked
to the quality of the health system's prenatal and delivery
services. However, the maternal mortality rate is difficult
to measure. Because maternal death is a relatively rare event,
large sample sizes are required in order to make reliable
estimates. Weaknesses in the registration system can also
cause inaccurate and underestimated figures on maternal death.
The
World Health Organization (WHO) defines maternal death as
"the death of a woman during pregnancy or within 42 days
after childbirth, from any cause related to or aggravated
by the pregnancy or its management."
The
maternal mortality ratio (MMR), defined as the number of maternal
deaths per 100,000 live births, is the most common indicator
of maternal death. It measures a woman's chances of dying
from a given pregnancy.60
Most
figures on maternal deaths are generally underestimated because
of weaknesses in the registration system. For example, deaths
of unmarried women resulting from complications due to abortions
may be classified under another cause to avoid embarrassing
the family.
The
total number of maternal deaths is a function of two variables:
fertility (the probability of getting pregnant) and the risk
of dying from maternity-related causes.
A
reduction in either component can reduce the proportion of
women dying from maternal causes. Since prenatal and delivery
services of the health system have a direct effect on the
MMR, it is tempting to attribute the declining MMR to gains
in prenatal and delivery services.
However,
repeated measurements are needed for validation. Even a few
additional maternal deaths reported or omitted can radically
change the MMR, thereby limiting the usefulness of this approach
in measuring change in MMR over short periods of time.
The
information on MMR from the various national demographic surveys
(NDS) are based on estimates of sibling survival, which is
referred to as the "sisterhood approach."
In
1993, the MMR was reported at 209 deaths per 100,000 live
births. In 1998, it was reported at 172 deaths per 100,000.
This would seem to indicate a declining trend, but more measurements
over time are needed to validate this decline. Among other
factors, the absence of sampling error measurements calls
for further studies.
All
regional rates appear to have declined in 1998 (Figure 7).
However,
there are wide variations in MMR across the country. It is
highest in the ARMM and Northern Mindanao, where it is between
200 to 300 deaths per 100,000 live births, and it is lowest
in Metro Manila and Southern Luzon.
These
figures should be interpreted with caution. Figure 7 is meant
to illustrate relative differences among regions between 1993
and 1998, but actual values may not mean much in view of the
limitations of the measurements described above. Thus, while
all regional rates in 1998 declined, the MMRs for ARMM, Caraga
and Region 5 were still quite high compared to the rest of
the country.
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