Reproductive Health

The International Conference on Population and Development (ICPD) held in 1994 in Cairo and attended by representatives from 165 nations came up with the following definition of reproductive health (RH):

"Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health therefore implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this last condition is the right of men and women to be informed and to have access to safe, effective, affordable and acceptable methods of family planning of their choice, as well as other methods of their choice for regulation of fertility which are not against the law, and the right of access to appropriate health-care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant".

The ICPD also issued the following statement on the scope of such care:

"Reproductive health care is defined as the constellation of methods, techniques and services that contribute to reproductive health and well-being by preventing and solving reproductive health problems. It also includes sexual health".

Thus, by definition, all women and men have the human right to reproductive health care.

RH services in the Philippines continue to fall short of demand. Women, in particular those who cannot afford the services of the private sector, are directly affected as they are not given much options on the RH services available in government health units.

Tomas Osias, head of the Commission on Population (Popcom), the state agency tasked to implement the government’s family planning programs, attributed the high maternal mortality rate to women being "too young (less than 18 years old), too old (over 34 years old), or having babies too close or unspaced (less than two years)."

Suneeta Mukherjee of the UNFPA also said that 99% of maternal deaths are preventable, and that by promoting family planning in places with high birth rates maternal mortality rate can be reduced by as much as 35%.

While NGOs doubt the data on maternal health, they are one in saying that the government’s decision to provide family planning materials and supplies to women who want to plan how many children they will have and when, but who are unable to afford these materials on a regular basis play a vital role in women’s RH. Hence, an effective and more efficient intervention programs are need to reach those who are in the rural areas and those who lack access to family planning information and materials.

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Importance of Reproductive Health

The right to enjoy reproductive health is related to having healthy children and grown-ups, and happy relationships and families. RH encompasses key areas of the UNFPA vision – that every child is wanted, every birth is safe, every young person is free of HIV and every girl and woman is treated with dignity and respect.

Reproductive health for women is important because women face health problems in relation to their reproductive system that could cause maternal mortality. They face complications during pregnancy and childbirth and are more prone to risks while preventing unplanned pregnancies, unsafe abortions, reproductive tract infections and in using contraception.

Even with the recognition that RH is important, reproductive health problems remain the leading cause of sickness and death for women of childbearing age worldwide, and even for infant mortality. RH also become significant in the light of the AIDS crisis. The Philippines has recorded a growing number of people who are HIV positive which has doubled in just over three years.

The present initiative of NGOs and other members of the society to ensure that sex educatin is taught in high schools forms part of the overall goal of disseminating RH information. By teaching the youth the basics of reproductive health and responsible parenthood would help reduce teen pregnancies and alleviate the spread of sexually transmitted diseases. It is founded on the basis that the youth should be empowered through knowledge.

The Department of Education (DepEd) is being urged to push through with the RH module. The revised modules which include teaching notes on pre-marital sex, commercial sex, abortion and homosexuality, and high-risk sexual practices are geared to inform the youth on the long-term health and social consequences of sexual risk-taking. However, the new textbooks emphasize sexual abstinence among adolescents, and ask teachers to lead discussions on the advantages of delaying sexual activities during adolescence.

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RH and Safe Motherhood

The WHO defines maternal mortality as "the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes."

Maternal mortality is one indicator in assessing the quality of a health care system, although a number of issues are recognized. First, aside from the WHO definition, other definitions exist and some include accidental and incidental causes. "Incidental causes" include deaths secondary to violence against women that may be related to the pregnancy and be affected by the socioeconomic and cultural environment. Also, it has been reported that about 10% of maternal deaths may occur later, that is after 42 days after a termination or delivery, thus some definitions extend the time period of observation to one year after the end of the gestation. Further, it is well recognized that maternal mortality numbers are often significantly underreported. Worldwide, the major causes of maternal death are bacterial infection, variants of gestational hypertension including pre-eclampsia and HELLP syndrome, obstetrical hemorrhage, ectopic pregnancy, puerperal sepsis, amniotic fluid embolism, and complications of abortions. A report by the WHO in 2005 enumerated other cases: severe bleeding/hemorrhage (25%), infections (13%), unsafe abortions (13%), eclampsia (12%), obstructed labor (8%), other direct causes (8%), and indirect causes (20%). Indirect causes such as malaria, anemia, HIV/AIDS and cardiovascular disease, complicated pregnancy, among others.

Maternal Mortality Ratio (MMR) is the ratio of the number of maternal deaths per 100,000 live births. The MMR is used as a measure of the quality of a health care system.

The 2006 Family Planning Survey determined maternal mortality through an interview conducted with about 45,000 women in April 2006. The survey definesd MMR as the number of women who die from any cause related to or aggravated by pregnancy or its management (excluding accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, per 100,000 live births.

The survey’s estimates on the MMR were made by asking women about the survivorship of their sisters and whether any deaths of sisters were maternity-related. The estimates refer to a 7-year period prior to the year the survey was conducted. Because maternal deaths are relatively rare, MMR estimates from sample surveys are subject to large sampling errors and differences in estimates are not always statistically significant. Results of the latest FPS showed that for every 100,000 live births in the Philippines, 162 women die during pregnancy and childbirth or shortly after childbirth. The last available estimate was 172 deaths from the 1998 National Demographic and Health Survey (NDHS). While the decline tends to reflect improvements in maternal health in the country, the difference is not statistically significant.

The MDGs target is to reduce by three quarters the number of maternal deaths between 1990 and 2015. For the Philippines, and using the 1993 NDS MMR as base estimate, the number of maternal deaths per 100,000 live births in 2015 should be equal to 53. The 2006 FPS MMR is a decrease of only 22% from the base estimate, meaning maternal health stakeholders need to exert greater efforts to meet the MDG target.

The reduction of maternal mortality and focus on women’s health is important given significant findings that healthy women produce healthy children. And women’s special role in raising their children into productive citizens of the country is enough reason to focus on women’s health.

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RH and Infant Health

The WHO defines infant mortality rate (IMR) is the probability of a child born in a specific year or period dying before reaching the age of one, if subject to age-specific mortality rates of that period. While Under-five mortality rate (U-5MR) is the probability of a child born in a specific year or period dying before reaching the age of five, if subject to age-specific mortality rates of that period. Both indicators are not rates (i.e. the number of deaths divided by the number of population at risk during a certain period of time) but a probability of death derived from a life table and expressed as rate per 1000 live births.

The 2006 Family Planning Survey also provided the following estimates:

  • IMR showed 24 deaths per 1,000 as compared to 35 in the 1998 NDHS.
  • Among the regions, Zamboanga Peninsula exhibited the highest IMR (38 deaths per 1,000 live births) while Northern Mindanao had the lowest IMR with 16 deaths per 1,000 live births.
  • U-5MR showed 32 deaths per 1,000 as compared to 48 in the 1998 NDHS
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