Health of mums and kids - Philippines and UK

[Doc Alan]

Elsewhere in the forum teen pregnancies and the Philippines Reproductive Health Bill have been discussed. I’m not qualified to discuss politics or the attitude of the Catholic Church, but a health comparison might be of interest.
• The life ( or death ) of a mother in labour and delivery is an indicator of the health of a nation.
• Maternal mortality ( death of a woman while pregnant or within 42 days of delivery, spontaneous abortion or termination ) is unacceptable, because such deaths are nearly always preventable. 99% occur in low-income countries, nearly 3/5 in sub-Saharan Africa. The mortality rate is about 220 / 100,000 live births in Philippines, and about 5% ( 11 ) of this in UK.
• Mothers’ lives can’t be saved by any one intervention alone. It requires family planning information and means, then quality antenatal / obstetric care when and where it is needed. Otherwise they die from treatable complications – haemorrhage, infection and high blood pressure.
• In the UK, women can look forward to the birth of their children, knowing that if things go wrong, medical teams can help them – for free – such that the vast majority will be safely delivered. Risk factors include social disadvantage, minority ethnic groups, poor/late attenders at antenatal clinics, obesity and age over 35. Only a handful ( less than 100 / year – obviously still too many ) - die from causes related to pregnancy.
• South-East Asian maternal and child mortality are in overall decline, but there is variation within the 10 countries of ASEAN. Brunei, Singapore and Malaysia fare best; Myanmar, Cambodia and Laos worst. Philippines is in between, with maternal mortality apparently rising last year. Problems in the Philippines, apart from being on a larger scale, are different to the UK – far more teen pregnancies, malnutrition, illegal/unsafe abortions, and fewer doctors / midwives.
• Infant and under-5 mortality have levelled off in the Philippines to about 30 / 1000 live births – again, in between other ASEAN countries. Up to half die as neonates. The main causes are pneumonia and diarrhoea ( for which vaccinations are available ), other infections, undernutrition and congenital abnormalities. Most are not medically certified. The mortality is far lower in the UK ( 5 ).
• Chances of the Philippines reaching United Nations “ Millenium Development Goals “ ( MDG’s) by 2015 – maternal mortality 52, and child mortality reduced by 2/3 from 1990 – are probably zero across the entire country , although it’s not alone. Ultimately this is down to investment in and coordination of health care facilities, and how much of the country’s GDP can be spent on health.

[Steve.r]

Thanks Alan, another treasure of facts.

I think myself lucky that my Charie was one of the lucky ones. As you know, my baby son was borm 6 weeks early, primarily caused by a fall that Charie had while pregnant at our farm. The reason for his premature birth was that during the fall the uterus was ripped away causing a bad bleed. At first after having pains, I told her to go to the local hospital in our town. They told her it was normal to have this during late prengancy, but as the pains got worse she decided to go to the main hospital, where they rushed he in for an emergency cesarean. The doctor told me that because of this rip, it could have been touch and go as to whether she could save the uterus, but she was particulaly skilled and was able to save everything and save Charie from having a hysterectomy and no chance of more children.

I know this time I had the money to pay for the operations and the weeks that Vincent spent in the incubator. If however I did not have the money... what would the outcome have been. This is the worry with a vast number of Philppine nationals who cannot afford the hospital.

[imagine]

good post Doc Alan, thats an area of health i hadnt thought of, must be quite scary for those that cant afford proper care when pregnant and giving birth, realising too that after care is also needed

[lastlid]

This is an area of Philippine life that my wife made quite plain to me. And yet another reason why she advocates the swift passing of the RH Bill.

Also, she and her immediate family seem to be acutely aware of the common sense in having a small family unless one can afford otherwise.

[Doc Alan]

• Thanks Steve.r, Stewart ( imagine ), and the other members who have bothered to read this thread, also Lastlid and CBM for raising the issue of teen pregnancies and the Reproductive Health Bill in the Philippines .
• Health of mums and kids surely concerns us all. We know that as individuals. Every person should have the right to live a healthy and fulfilling life. On a global scale, increasingly it’s being accepted that family planning is one aspect of improving their health. Access to family planning is an investment that can reduce broader costs of healthcare as well as mortality.
• On 11 July there is to be a London Summit on Family Planning ( http://www.londonfamilyplanningsummit.co.uk/ ) to support the rights of women and girls – wherever they live – to use contraceptive information, services and supplies, without coercion or discrimination, by 2020. It’s supported by the Bill & Melinda Gates Foundation. For many of the millions of women and girls who don’t want to get pregnant, such lack of access will cost them their lives. Family planning is about enabling women and their partners to decide freely when and how many children they want to have. It’s an important part – but not the only one – of improving reproductive health.
• In the UK a maternal death is such an unusual event that it triggers a full blown enquiry – ANY such loss of life is a tragedy, as is that of a child. Access to family planning is one aspect of reducing the high rates of mortality in the Philippines, even higher in some of the other 75 countries where 98% of maternal and child deaths occur.
• I’m neither a politician nor do I have strong religious views – merely a doctor who thinks this topic is important enough to raise on the forum. “ The Lancet “ medical journal this week publishes a series of articles to coincide with the London Summit ( http://www.thelancet.com/ ).

[sars_notd_virus]

very interesting thread, the real essence of being a woman is to give birth ,to become a Mum ... having a child!! but this is not all easy !!....so men love your mother ,wife or gf after reading doc alans thread.
if i may add more information like this should be given to the mum's out there all over the world the population seems to be growing fast and so is the mortality rate

[CBM]

Thank you for a really excellent post; factual, thoughtful and informative.

[gWaPito]

Elsewhere in the forum teen pregnancies and the Philippines Reproductive Health Bill have been discussed. I’m not qualified to discuss politics or the attitude of the Catholic Church, but a health comparison might be of interest.
• The life ( or death ) of a mother in labour and delivery is an indicator of the health of a nation.
• Maternal mortality ( death of a woman while pregnant or within 42 days of delivery, spontaneous abortion or termination ) is unacceptable, because such deaths are nearly always preventable. 99% occur in low-income countries, nearly 3/5 in sub-Saharan Africa. The mortality rate is about 220 / 100,000 live births in Philippines, and about 5% ( 11 ) of this in UK.
• Mothers’ lives can’t be saved by any one intervention alone. It requires family planning information and means, then quality antenatal / obstetric care when and where it is needed. Otherwise they die from treatable complications – haemorrhage, infection and high blood pressure.
• In the UK, women can look forward to the birth of their children, knowing that if things go wrong, medical teams can help them – for free – such that the vast majority will be safely delivered. Risk factors include social disadvantage, minority ethnic groups, poor/late attenders at antenatal clinics, obesity and age over 35. Only a handful ( less than 100 / year – obviously still too many ) - die from causes related to pregnancy.
• South-East Asian maternal and child mortality are in overall decline, but there is variation within the 10 countries of ASEAN. Brunei, Singapore and Malaysia fare best; Myanmar, Cambodia and Laos worst. Philippines is in between, with maternal mortality apparently rising last year. Problems in the Philippines, apart from being on a larger scale, are different to the UK – far more teen pregnancies, malnutrition, illegal/unsafe abortions, and fewer doctors / midwives.
• Infant and under-5 mortality have levelled off in the Philippines to about 30 / 1000 live births – again, in between other ASEAN countries. Up to half die as neonates. The main causes are pneumonia and diarrhoea ( for which vaccinations are available ), other infections, undernutrition and congenital abnormalities. Most are not medically certified. The mortality is far lower in the UK ( 5 ).
• Chances of the Philippines reaching United Nations “ Millenium Development Goals “ ( MDG’s) by 2015 – maternal mortality 52, and child mortality reduced by 2/3 from 1990 – are probably zero across the entire country , although it’s not alone. Ultimately this is down to investment in and coordination of health care facilities, and how much of the country’s GDP can be spent on health.

Good post yet again Alan.....as always, extremely informative....which asks the question why you have only 53 reps..not that it matters

[Terpe]

I just saw a news item on the London Summit on Family Planning.

Seems to be gaining in momentum. Hopefully the Philippine government will also take notice of the key issues.

[Arthur Little]

Seems to be gaining in momentum. Hopefully the Philippine government will also take notice of the key issues.

... let's hope so! And - even more particularly - the Church Bishops. I only wish all of them were able to read [and heed] Alan's timely words of wisdom and sound commonsense.

[Steve.r]

Until the Pope realises that overpopulation in the world is a bad thing, I fear the philippines will keep on over producing unwanted children and the problems therein.

This is not meant to be a religeous post, but it is a major force holding back common sence imo

[Arthur Little]

...which asks the question why you have only 53 reps..

... 54 now!

[lastlid]

I am surprised that the RH Bill gets so little attention on the forum. I know it isn't a particularly jovial subject, but holds the key to the future of the Philippines and our relatives back there and our futures if we move there.

Perhaps it has been covered frequently in the past?

[Doc Alan]

• You’ve had the statistics and medical references. Here is my opinion – ONLY an opinion - about health of mums and kids and how it may be improved in the Philippines. This is in addition to family planning.
• Spend more of the GDP ( Gross Domestic Product ) on a better coordinated and locally available health service.
• More health insurance.
• Train – and retain in the Philippines - more specialist doctors. There are enough nurses/midwives.
• Vaccinations – routine use of rotavirus vaccine ( already planned ) to reduce childhood diarrhoea cases ; pneumococcal vaccine for childhood pneumonia ; BCG for tuberculosis ; hepatitis B vaccine ( prevents commonest form of hepatitis and liver cancer in later life ); vaccines for other childhood infections such as measles ; HPV ( human papilloma virus ) vaccine for 12-13 year old female teenagers ( prevents adult cervical cancer ; cervical screening still necessary). Dengue vaccine – not yet available ; rabies vaccine should be more readily available. Polio has been eradicated ; AIDS and malaria – no vaccines yet, but not major problems.
• Health and Safety – reduce chances of serious injuries, whether on the roads, as a result of “ natural disasters “, or in the home.
• Better / earlier diagnosis and treatment of congenital abnormalities.
• Malnutrition – many factors inter-relate here :- cost and knowledge about healthy / unhealthy foods. Teenage mums especially have poor eating habits, together with smoking, drinking alcohol, and taking illicit drugs.
• Obesity – ironically, also a problem which leads to adult health risks similar to those in the UK. Screening for diabetes is cheap.
• Cataracts – simply and effectively treated – are a major problem. Poor nutrition, measles, and prematurity are others affecting eyesight.
• Better dental care – for a start, regular brushing of teeth with fluoridated toothpaste.
• Obviously some – maybe most - of this is wishful thinking, but it concerns all of us with connections to the country.

[RickyR]

When Josh was born it cost us 73,000 PHP (£1100) and we were required to pay 10,000 immediately upon arrival prior to admission. Marvie has Thalassemia and had a post-partum heamorrhage when Angel was born, so no risks were taken by going to the best hopital on the island (Cebu), and by having both a Anaesthetist and Heamatologist in presence as well as the OB/GYN.
There was a lot of costs involved prior to going in and the care was generally quite good.
The interesting thing, in contrast to the UK, was when we arrived at the hospital Marvie was sent into the delivery room with several nurses, and I was sent up to the room which had two beds so that I (her minder) had somewhere to sleep. They also brought food for both of us (and could get Jollibee delivered direct to the room).
The thing I really noticed was that we had to be motivated and interested at every step to get the doctors to help us.

When we were in the UK during the early stages of the pregnancy they discovered marvie thalassemia and assigned her someone who helped her bring all the different doctors together (GP, Hematologist, OB/GYN etc), for a meeting and kept her informed at all stages and even wrote a several page letter to take to the doctors in the philippines explaining the risks and how to deal with the pregnancy and birth which I think helped us a greatdeal.

Whilst I don't doubt that there are great Doctors and Nurses in the Philippines, the system around them doesn't provide the same support, education and advancement that the people of the UK are blessed with.

Also as has been mentioned, the costs make it very difficult.

We were told Marvie's delivery was a 50:50 chance of survival at one point, and I dread to think what would have happened if we had no money to pay for the best hospital and support.

[RickyR]

Here is a post I made elsewhere shortly after the birth for anyone interested in the process

Our new baby Son, Joshua, was welcomed into the world at Chong Hua on Friday (10th Sep 2010). Due to complications (previous postpartum heamorrhage, and mother has Alpha Thalassaemia), we had required an Anaesthetist and Heamatologist on standby at all times.
We were advised that a normal deliver is around 40,000 PHP, and know that other patients paid around 38,000 PHP roughly. Our costs were increased because of having a total of 4 doctors involved in the delivery, including the Hospital Director. Also Marvie underwent an Epidural, and was hospital induced into labour since despite the waters breaking she never commenced contractions.
Our total costs on discharge today came to 73,173 PHP, which to be honest we are very happy with.

In all honesty, with the history of complications and this being a high risk pregnancy I would not have considered having the baby delivered at any other hospital in Cebu then Chong Hua. Earlier this year I took Marvie to see some senior doctors in the UK who made a detailed report on how the delivery should take place and what preparations should be in place and Chong Hua's findings thankfully concurred with all of this.

The procedures at the Chong Hua were very good, on arrival Marvie was given an examination, then once they decided she was definately in labour, they called the OB/GYN and I went to the admissions. Yes, I was required to pay a deposit of 10,000 PHP onto the account, this could be paid by cash or card.
A private room was organised for 1700 php per day and included a daybed and bedding for me to stay with her. We were provided with all the kits and equipment we would need immediately. I was informed at all stages, and was asked for permission before the Epidural was given (we had also discussed this prior). I also was invited in for the delivery of the baby at the final stages.
I can say that all of the Doctors we encountered (although they were the senior doctors), were excellent, spoke English at all times and we're very informative. Also, all of the doctors we encountered have been for training and seminars in the Europe and USA recently, and seemed aware of new procedures in these countries.

So, to be completely honest, I would recommend this hospital for high risk pregnancies, and would highly recommend it as your backup if ever some complications presented themselves should you be delivering your baby elsewhere. It is expensive, and you are paying for the facilities, equipment and availability of expertise.

I would say the hospital isn't as good as the hopsitals we used in Manila (St Lukes and Manila Doctors Hospital), and isn't quite the quality of an average UK state hospital. But for a city other then the capital in a 3rd World Country, it's pretty good.

I can't compare it against other hospitals in Cebu, as I haven't had a baby delivered in others, but have visited other hospitals on occasions whilst doing volounteer work and visiting family, and would choose Chong Hua over the ones I did visit.


Breakdown of Costs

Central Supply Room 651.30
Delivery Room 15,825.60
Laboratory 2,849.50
Nursery 926.16
Pharmacy 7,746.75 + 645.78
Room Accomodation 4900.00
Main OB/GYN 20,000
Secondary OB/GYN 4,800
Anaethetist 8,000
Pediatrician 7,500

[Doc Alan]

Thanks Steve and Ricky for your interesting and personal posts . To my knowledge the Reproductive Health Bill has not been discussed here until recently, despite it being a decade old.
What shocks me is that the 2011 Family Health Survey estimates 11 women die every day in the Philippines from preventable complications arising from pregnancy and childbirth . Family planning supplies such as condoms, intrauterine devices, birth control pills, and other contraceptives would help - the government has allocated P 500 million for nationwide distribution. It’s also recognised that access in rural areas to modern maternal healthcare systems needs improving. Fewer pregnancies, better nutrition and access to healthcare, and more births attended by skilled birth attendants would all help reduce maternal mortality to the country’s target rate.
The Philippines’ population growth rate of about 2% is one of the highest in Asia . Understandably, a fully comprehensive reproductive health policy and access to family planning education and services may not be possible for financial reasons. I’ve made clear before – politics and religion are not my fields of expertise and I try not to be judgemental. However, it’s sad when they get in the way of the obvious need to improve health of mums and kids - of importance to us ALL.

[Dedworth]

A very interesting and informative thread, thanks Doc and all contributors

[lastlid]

Thanks Steve and Ricky for your interesting and personal posts . To my knowledge the Reproductive Health Bill has not been discussed here until recently, despite it being a decade old.
What shocks me is that the 2011 Family Health Survey estimates 11 women die every day in the Philippines from preventable complications arising from pregnancy and childbirth . Family planning supplies such as condoms, intrauterine devices, birth control pills, and other contraceptives would help - the government has allocated P 500 million for nationwide distribution. It’s also recognised that access in rural areas to modern maternal healthcare systems needs improving. Fewer pregnancies, better nutrition and access to healthcare, and more births attended by skilled birth attendants would all help reduce maternal mortality to the country’s target rate.
The Philippines’ population growth rate of about 2% is one of the highest in Asia . Understandably, a fully comprehensive reproductive health policy and access to family planning education and services may not be possible for financial reasons. I’ve made clear before – politics and religion are not my fields of expertise and I try not to be judgemental. However, it’s sad when they get in the way of the obvious need to improve health of mums and kids - of importance to us ALL.

I agree.

Interesting that you say that the RH Bill is 10 years old. And evidently still hasn't been passed.

[Doc Alan]

Other members may know more – my limited understanding is that a Reproductive Health Bill was first proposed over a decade ago, with several versions over the years, the latest being that of Senator Miriam Defensor-Santiago.
The Philippines legal system – derived from Spanish and American law – consists of three institutions
• Executive – headed by the President –enforces laws.
• Legislative – Congress ( House of Representatives and Senate ) – makes laws.
• Judicial ( Judiciary ) – Supreme Court and lower courts – interprets laws.
The new Congress session starts on July 23. In the Senate, the period of interpellations ( demanding explanations ) on the Bill is finished. At the House of Representatives the measure “ remains in interpellation “.
Add to this severe criticism of the Bill, particularly by the Roman Catholic Church, and it’s possible to understand – but not condone - why it’s been stalled in Congress for a decade .

[lastlid]

Not all Catholics are anti-RH Bill.

[lastlid]

The Anti-RH side calls themselves “Pro-Life.” Maybe the RH side should not only be Pro-Choice but also “Pro-Quality Life.”

[Doc Alan]

Not all Catholics are anti-RH Bill.

I'm sure you're right - which is why it's hard to explain how the Bill has stalled for so many years. One filipina senior obstetrician and gynaecologist was quoted as saying - based on her decades-long experience - with more pregnancies patients are more prone to complications. She said she had dealt with many cases involving the death of not only mothers but also babies. " If a patient comes to you with eight children, she wants to ask for pills or she wants to have ligation, why can't I give it to her? I'm Catholic, I'm pro the Bill ... people should open their minds about these things. Like ligation, we're not killing anyone ... We're just preventing future pregnancy...".
There are clearly factors beyond my comprehension why this Bill has not ( yet ) been passed, to ensure birth control methods are distributed across the Philippines for the first time. But surely members who have followed this topic would be happy if passage of the RH Bill was achieved without further delay.

[lastlid]

Seen on a joke poster website....

http://jokephotos.org/funny-photos-a...-joke-posters/

[lastlid]

RH bill advocates welcome Aquino support

MANILA, Philippines - "A day after President Benigno Aquino endorsed the consolidated responsible parenthood bill, or more popularly known as the reproductive health (RH) bill, advocates pushing for the measure held an executive meeting to discuss their next moves to make sure that the bill will be tackled in the coming weeks.

RH bill advocates thanked the President for endorsing the proposal.

They hope that lower House leaders and members of Congress will support President Aquino to pushing for the bill.

Rep. Edcel Lagman said with the President's endorsement and House Speaker Sonny Belmonte's resolve, the RH bill will be approved by the House of Representatives.

He hopes that Liberal Party (LP) members will toe the line and vote for what the President wants.

Ifugao Rep. Teddy Baguilat, an LP member, said that the party's leadership should make a stand and support the President in his legislative agenda to push for the passage of the RH bill.

Pangasinan Rep. Kimi Cojuangco said it is time that the House approved the RH bill because Filipinos people need a comprehensive reproductive healthcare program.

Belmonte said he has called a caucus of House leaders to fast-track priority bills."


http://www.abs-cbnnews.com/nation/07...aquino-support

[Doc Alan]

Two further key articles, each from trustworthy sources, may be of interest :-
• " Choice not chance – Family planning returns to the international development agenda " ( http://www.economist.com/search/apac...20not%20chance

). You may access the comments but possibly not the full text. This quotes calculation that there will be about 80m unintended pregnancies in developing countries this year, resulting in 40m abortions, 10m miscarriages, 100,000 maternal deaths, 800,000 stillbirths, and 600,000 infant deaths. " What vaccinations are to infant mortality, contraception is to maternal mortality. " It goes on to say : " The medical evidence is clear : if a woman conceives within 18 months of bearing a child, the chances of miscarriage or still birth, low birth weight, infant death and stunted physical development are much increased. Spacing births improves child health. "
• " Fight for Reproductive Health Bill grows in the Philippines " (
http://www.thelancet.com/journals/la...162-3/fulltext
). Citing the results of the 2011 Family Health Survey, an estimated 11 women die every day in the Philippines from preventable complications arising from pregnancy and childbirth. According to the Philippine Legislators Committee on Population and Development Foundation ( PLCPD ) the Philippines’ population growth rate of 1.9%, one of the highest in Asia, is attributed to the absence of a comprehensive health policy and lack of access to family planning education and services.

[CBM]

Alan, you may like to refer to this, which I have cited in the "Philippines News" thread - it seems very pertinent to this thread:

http://business.inquirer.net/72469/n...ter-says-study

[CBM]

This is from the University of the Philippines Population Centre:

http://www.drdf-uppi.net/News/MBC%20lecture.pdf

[CBM]

Facts and figures on the Philippines from the University of the Philippines Population Centre:

http://www.drdf-uppi.net/facts001.htm

[Doc Alan]

Thanks for the links, CBM.
I’ve commented on malnutrition, and obesity, on your separate thread.
The demographics are interesting, if rather out of date, particularly that half of Filipinos don’t use any contraceptive method; and only a third, of those who do, use “ modern methods “.
The Philippines birth rate of around 25 / 1000 population is over twice that in the UK. Infant mortality rate is over 4 times the UK rate. Maternal mortality rate is vastly more in the Philippines – here it’s around 11 / 100,000 live births. Life expectancy at birth is now around 69 for males and 75 for females ( but varies markedly in different regions ) in Philippines, compared to 78 and 82 in UK ( with less marked variation ).
The population of the Philippines now exceeds 100m, compared to an estimated 63m in UK.
Age structure for Philippines is a third ( 0-14 years ), compared to less than a fifth in UK. Three-fifths are 15-64 in Philippines, compared to two thirds in UK. Only 4% are over 65 in Philippines – compared to one in six in UK.
Health expenditure in the Philippines is between 1-4% of GDP ( various estimates ), compared to about 10% in UK. There is around 1 doctor / 867 population in Philippines, compared to 1 /365 in UK.
I’ve made more detailed comparisons of health in Philippines and UK in separate threads in the Health Section. It may surprise some members that the most serious illnesses in the Philippines are now the same as UK – cardiovascular disease and cancers. What is of interest is that a “ blueprint for universal health care “ in the Philippines models itself on our NHS (http://xa.yimg.com/kq/groups/2226691...ly,+6+Nov).pdf ). Improvement of health - mums, kids, and everyone else - depends on MANY factors, some easier than others to implement.