Reduce Maternal Mortality in Davao, Philippines Region

Reduce Maternal Mortality in Davao, Philippines Region

Rationale

The likelihood of survival through childhood is still unequal in middle-income countries. This study will address the maternal mortality rates and aims to reduce the mortality rates by minimizing early pregnancies in women by educating the people in the Davao region against the consequences.

Despite a significant reduction in the infant and under-five mortality rates in the 1990s, the recent years have seen slowing down the rate of declines, and neonatal mortality rates stand stubbornly high. Huge evident discrepancies across regional, urban-rural, and wealth suggest that the gaps between the best performing and underperforming segments of the population will remain constant or increase in the upcoming future. The Davao Region of the Philippines serves as an opportunity to investigate the context of the abovementioned issue. It is surprising to note that despite achieving an average growth rate in the per capita income of 3% in the years 2000-2010 (World Bank, 2012), the declines in maternal mortality rates have faltered.

Statistics show that 1 in 4 women in the age bracket on 15-24 have begun childbearing(Gibson, 2012). According to the data by World meters, the Philippines is the 13th most populated country in the world, and the Davao region is home to almost 1.2 million people. According to a report by UNICEF in 2015, 2300,000 babies were born in the Philippines, which equals an alarmingly high number of 6400 childbirths every day (UNICEF, 2016).1 in 4 pregnancies are reported to be unintentional, which proves as an additional burden on the mothers. Around 610 000 unsafe abortions have been practiced annually in the country, which poses a severe threat to the women who underwent abortions. Due to this, there have been 114 deaths reported per 100,000 lives births in the year 2015, according to UNICEF. Due to such prevailing negligence, according to the Philippine National Demographic and Health survey in 2017, 9% of teenage women from ages 15-19 have begun childbearing, which is highly unsafe for young women. Teenage pregnancies are reported to be 18 %, the highest and most common in the Davao region, 15% in the Northern Mindanao region, and 15% in Soccsksargen. These regions have the highest percentages as compared to other regions of the country, which indicates that the most concentrated effects of the problem seem to exist in the Davao region. There has been a steep increase in the fertility rates from 49 to 59.2 births per 1000 women aged 15-19 years in the years 1997-2015 (PSA, 2016). The fertility rates of adolescents in the age bracket of 15-19 years is 59.9 in the year 2016 as compared to 51.9 in the year 2000.

Thousands of Filipino women are dying due to complications related to childbirth, according to health specialists (UNFPA, 2009). There are several different causes attributed to maternal deaths, such as hemorrhage, obstructed labor, and complications from unsafe abortions, which can be avoided if women have access to proper intervention and diagnosis. In the Philippines, 80% of the population is Catholic, and the Church sanctions the use of natural family planning methods. The use of condoms and birth control pills are considered illegal as they are equated with abortion. Due to this religious belief, contraceptives are not available in government and rural health clinics. Women who belong to lower-income households do not have access to adequate health care facilities and thus are often found resorting to new and improper childbirth procedures and abortions, which hurt the health of the mothers. Inaccessibility and lack of adequately trained staff are the main reasons that contribute to the Davao region, having one of the highest maternal mortality rates in the country. Women have to resort to giving childbirth outside of proper health facilities due to the costs being high, having no access to transport facilities, and the dominant belief that it is not necessary to deliver a child in a proper health care facility. The region has been suffering from nearly four decades of armed conflict, which has exacerbated the problem of lack of personnel and accessibility.

The costs for birth and delivery are very high in the region ranging from 15000-170000 pesos (Nagai, 2019). This makes it hard for lower-income families to be able to afford proper medical care for women who are undergoing pregnancy. The low literacy rate also serves as a contributor to the maternal mortality rate and higher population because families who are less educated are more likely to have more children. The average income for a family living in the Davao region is 227000 pesos per household, which makes them believe that spending more than half of their monthly income on childbirth is not the right way to go. The dominance of a Catholic culture, which is against abortion and birth control, also contributes to the problem at hand. Due to religious beliefs, families do not take part in active family planning as it is considered against the norms of society. Women usually give birth at homes in the care of untrained women that have experience of giving birth to children in unhygienic environments.

This study aims to propose an educational campaign addressed at providing the locals with information on how inadequate education can put mothers at risk and what measures should be taken on a community level to counter this problem.

Program Goals and Objectives

Goal: Reduce Maternal Mortality rate in Davao Philippines

Objectives

1. By September 2020 75% of Teenage girls and parents in Davao Philippines will have reported they have acquired basic knowledge of sex education
2. By November 2020 50% of the residents of Davao will have been educated on the types and importance of contraceptives
3. By January 2021, 80% of health facilitators including nurses, clinical assistants, and doctors will be able to advise patients on the importance of prenatal care
4. By March 2021, 40% of the Davao region will understand family planning and have healthy spacing between pregnancies
5. By June 2021, 10% of youths will be able to understand the risks of teenage pregnancy and will be more likely to say no to sex before marriage.

Program Narrative

Goal: Reduce maternal mortality in Davao, Philippines region

Objective 1: By September 2020, 75% of Teenage girls and boys in Davao Philippines will have reported they have acquired basic knowledge of sex education.

Objective 2: By November 2020, 50% of the residents of Davao will have been educated on the types and importance of contraceptives.

The first objective for the main goal of reducing maternal mortality in Davao will necessitate the use of a campaign within the public. Educational sessions will then be used to achieve the second objective. The campaign to help teenagers practice safe sex as a way of preventing teen pregnancies is a powerful evidence-based policy initiative. The best activity for objective one involves encouraging at least 75% of teenagers to ensure they can access reproductive and sexual health services. In the Philippines, 8 percent of teenagers were already mothers by 2013. An additional three percent were expecting their first child. Most teenagers believe that a good way of expressing love and affection involves is through indulging in sexual intercourse. In 2017 and 2018 alone, the health department had reported approximately 20,000 new cases of HIV/AIDs (Merchant, 2018). The disease was mainly transmitted through sexual intercourse (97%). These statistics reveal the acute shortage of sexual education among Filipino youth. Through concerted campaigns, the 75% target is much achievable.

According to a 2014 article that used evidence and rights-based approach to significant decisions regarding sexual behavior, an in-depth sexual education helps the teenagers to take individual health responsibility (Bridges & Hauser, 2014). The information offered in this education should be honest and age-appropriate. It is advisable to deliver educational messages in Filipino, English, Spanish, and Arabic languages because all teenagers from different backgrounds are conversant with at least one of them. According to research, the youth have been able to take relevant actions to safeguard their health through the provision of complete and accurate information on sexual behaviors, which includes contraception and other strategies to reduce risk. Incase pregnancy happens, teenagers are advised to take the necessary actions that will enable the delivery of a healthy baby and ensures the mother remains free from any complication or fatality (Hofmeyr, 2018). As a way of reducing the risk of maternal death, they are advised to use calcium supplementation. Clear information should be available to all, thus necessitating a consensus between future parents and healthcare professionals on the guidelines. For women with low calcium diets, the effects of pre-eclampsia are greatest. WHO has recommended a daily calcium 1.5 g to 2 g for these pregnant women. The information is developmentally appropriate because it promotes being monogamous, using contraception, and delaying sex. Sixty-six comprehensive programs for reduction of sexual risk were examined in a 2012 study. They were discovered to be very effective in reducing STIs, HIV, and early pregnancies (Chin B et al. 2012). A clear roadmap becomes possible through national sexuality education standards. The standards are created by sexuality education and public health experts. Students can make sound decisions regarding their sexual health by receiving guidance concerning necessary skills as well as minimum significant content.

For schools that serve communities at risk, there is proven effectiveness of evidence-based interventions. Multiple EBIs where the subjects revealed a statistically significant decrease in STIs, HIV, and early pregnancies have been identified by researchers. The programs described in the reviews would help to adapt the activity for this Davao program. The only exception will be the exact areas in which these messages will be availed. According to objective 1, teenagers who will have acquired basic knowledge of sex education will increase by a huge margin by September 2020. The challenge now is to attain this objective within the designated period. To achieve this, the whole community will participate in sharing campaign messages from June 2020 to August 2020.

In terms of origin, the activities of both objectives will not be synonymous. The objective two activity will not utilize evidence from past interventions’ reviews. Rather, it is set to be theory-based. The activity will be founded on the theory of planned behavior because there seems to be good alignment between the two. There is a likely success for educational sessions targeting teenagers to teach them the types of contraception and why they should use them.

A team of experts on sexual health will spearhead the educational sessions to attain objective two. The sessions will occur weekly from January to October 2020. The teenagers will have to meet with an expert to discuss and mutually agree on the materials to use in the curriculum. The whole of January 2020 will be used to design a plan for this curriculum. Sessions will then be advertised locally. The participants to be included will be aged 14-19 years, although the research and policy-making have varied age-range for young adults and adolescents, who may still participate. The four widely used languages in Davao will help to offer this activity. Schools will be the preferred venues for these sessions because of their easy accessibility among all teenagers. An informational video will feature in the sessions where instructions will be provided regarding different methods of contraceptive use. The students will then be assessed on how well they can use contraceptives through a survey. 1-3 sessions of an average of 45 minutes will be involved as strategies. Besides informational video, oral communication will also apply. Students will receive text messages that will act as additional reminders.

A few reversible contraception methods will have to be emphasized by the behavioral strategy under testing. Modern methods of family planning will be addressed in this intervention, which will also comprise the highly successful in pregnancy prevention. 98% accuracy will be considered, where using more effective methods will be consistent and correct. The methods comprise emergency contraception, lactation amenorrhea, vaginal ring, contraceptive patch, injectable, and pills. Different methods, such as improved adherence and consistent use, will be used to assess contraceptive use. The focus will be on consistency in use as assessed by the investigator in case of numerous measures within a study. For contraception use, a period of six months will be the timeframe for assessment to extract high-quality evidence. Outcome measures are likely to be more meaningful if timeframes involved are longer. The last construct related to this activity will be perceived behavioral control. To focus on it, students will be encouraged to focus on behaviors acquired in the curriculum. It is the same manner of addressing the behavior intention construct (Greaves et al. 2013). Participants will be likely to use contraceptives effectively are they if they trust in their abilities to do so. Individual behavior would change after the planned behavior constructs are assessed. The curriculum will also include osteoporosis prevention and treatment (Hofmeyr, 2018). After presentation, there shall be discussion whereby participants will ask questions. Eventually, participants of this program will report to have learnt the importance of calcium supplements. They shall discover why it is healthier to eat a diet rich in calcium and exercise regularly a month after these sessions.

The two main activities described in the first and second objectives are supported by the information derived from theory and evidence. Resource allocation, extensive research, partnership, and adequate funding will favor these activities. Their completion will see the rise of contraceptives’ use by 50%, besides ensuring that teenagers receive the basic knowledge of sex education. The whole program has two activities as its components. However, they will surely affect a huge change in the use of contraceptives, where the next step will involve offering them for free and reducing costs to different study groups.

Monitoring and Evaluation Plan

Monitoring and Evaluation to Reduce Maternal Mortality in Davao, Philippines Region

Activity 1: Hold an education program to educate teenagers on how to prevent unwanted pregnancies. The education program will utilize the lecture mode of teaching. The method will be reinforced by the use of videos and simulations for clarity and avoiding boredom. Three local languages will be used.

• Monitoring Indicator: The number of teenagers and women attending the sessions.

Activity 2:  create a community group to advocate for access to quality and affordable maternity services for members of the Davao area in the Philippine. The social group aims to promote best practices in the health facilities through training of the nursing team.

• Monitoring indicator: Count the number of people willing to join the group.

Evaluation questions

• Question 1– How participants indicated that they had used family planning before?
• Data collection: questionnaires will be issued to the participants before and after the training. They will be required to indicate the number of family planning choices available. They will also indicate which method they prefer using or would prefer using in the future. This question will help in measuring the extent of knowledge about contraceptives that the residents know. The result of the pre-test and post-test will be evaluated.
• Question 2– Are the local leaders ready to support the community group advocating for the improvement of services in health facilities?
• Data collection- the community will be sensitized through community forums and meetings. Leaders in Davao, Philippines Region, will be invited to attend these meetings. After the campaign has started, the members of the campaign team will evaluate community support of their initiative. Local leader’s support will help solicit funding from the local government. After two months, evaluations will be done to see if the training of hospital nurses has commenced.

REFERENCES

Bridges, E., & Hauser, D. (2014). Sexuality Education: Building an Evidence-and Rights-Based Approach to Healthy Decision-Making. Advocates for Youth.

Chin B et al. “The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.” American Journal of Preventive Medicine, March 2012.

Gipson, J. D., Gultiano, S. A., Avila, J. L., & Hindin, M. J. (2012). Old ideals and new realities: The changing context of young people’s partnerships in Cebu, Philippines. Culture, Health, and Sexuality, 14(6), 613-627. https://doi.org/10.1080/13691058.2012.684222

Greaves, M., Zibarras, L. D., & Stride, C. (2013). Using the theory of planned behavior to explore environmental, behavioral intentions in the workplace. Journal of Environmental Psychology, 34, 109-120.

Hofmeyr, G. J., Lawrie, T. A., Atallah, Á. N., & Torloni, M. R. (2018). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane database of systematic reviews, (10).

Merchant, A. (2018). Children and Disaster Education: An Analysis of Disaster Risk Reduction within the School Curricula of Oregon, Texas, and the Philippines.

Nagai, M., Bellizzi, S., Murray, J., Kitong, J., Cabral, E., & Sobel, H. (2019).Opportunities lost: Barriers To Increasing the Use of Effective Contraception in the Philippines. PLoS ONE, 14(7): e0218187. https://doi.org/10.1371/journal.pone.0218187

Philippine Statistics Authority. (2018). Philippines National Demographic and Health Survey, 2017. [PDF file]. Quezon City, Philippines, and Rockville, Maryland, USA. https://dhsprogram.com/pubs/pdf/FR347/FR347.pdf

UNICEF Philippines. (2016). Situation analysis of children in the Philippines. [PDF file]. https://www.unicef.org/philippines/media/556/file

UNFPA. (2009, 8 7). Philippines: Maternal Mortality Rates Not Making Sufficient Progress to Meet MDGs. Retrieved from United Nations Population Fund: UNFPA

World Bank. (2012). World Development Indicators Online (WDI) database. Washington, DC: The World Bank.