We acknowledge the various concerns raised by certain sectors over the discrepancy of the estimated average number of maternal deaths due to pregnancy-related complications per day in the Philippines. The reason for the variance in the data on the average number of maternal deaths per day is differences in methodology. Eleven (11) mothers dying every day is based on 4,100 maternal deaths per year divided by 365 days in a year. These are estimates derived from the 2006 Family Planning Survey conducted by the National Statistics Office which used a survey-based method following the direct sisterhood approach, where respondents are interviewed about the survival of their older sisters.
On the other hand, the lower value of almost six (6) mothers dying every day or 2,100 maternal deaths per year in 2008 is from The Maternal Mortality Estimation Inter-Agency Group, composed of the World Health Organization (WHO), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF) and the World Bank, which used econometric modeling to generate estimates of maternal deaths based on secondary and vital registration data for each year between 1980 and 2008. The global estimates have been derived using standard categories and methods to enhance cross-national comparability. Given the difference in methodologies, a difference in the numbers is to be expected.
More importantly, in spite of differences in the methodology in estimating data on maternal deaths and the maternal mortality ratio, it is unacceptable for a single mother to die or mothers to continue to die from preventable causes. Regardless of the variance, the estimated number of maternal deaths and the estimated maternal mortality ratio, regardless of source, validate that by year 2015, MDG 5 targets to improve maternal health and ensure universal access to reproductive health care will not be achieved. Women and girls will still continue to die from preventable causes and therefore ensuring universal access to reproductive health care should still be a priority of the Government of the Philippines and all Filipinos.
In the Philippines, the vital registration system at present is weak and greatly underestimates maternal mortality. A recent formal evaluation of the vital registration system in Bukidnon conducted by the DOH National Epidemiology Center in 2008 compared maternal deaths recorded in the civil registry with those found using the Reproductive Age Mortality Studies (RAMOS) methodology. This approach involves identifying and investigating the causes of all deaths of women of reproductive age in a defined area/population by using multiple sources of data. If properly conducted, this approach provides a fairly complete estimation of maternal mortality (in the absence of reliable routine registration systems). The Bukidnon RAMOS study revealed that the local civil registry missed three-fourths of all maternal deaths. In a setting where the vital registration system is incomplete, it is expected that the results generated using vital registration would also be lower as compared to a survey which reflects the sample population.
As to the maternal mortality ratio, we also recognize the various concerns raised by certain sectors over the discrepancy of the official country estimates on MMR vis-a-vis the recent Inter-UN Agency estimates on MMR for the Philippines. As stated by the Technical Committee on Population and Housing Statistics, one of the sectoral interagency committees created and being coordinated by the National Statistical Coordination Board (NSCB) of the Philippines, “the Inter-UN Agency estimates cannot be expected to be consistent with those of the Technical Working Group on Mortality Statistics of the Philippine National Statistical Coordination Board nor with the existing survey-based estimates for the country.” In addition we also note the position of the Department of Health that “correlating maternal mortality ratio statistical estimates with the actual situation of maternal care in the country will clearly show incongruence between the estimate and reality,” referring to indicators that were expected to improve as maternal mortality decreased such as facility based delivery and skilled birth attendance but which have not substantially increased.
The national MMR of 162 per 100,000 live births for the Philippines was generated from the 2006 Family Planning Survey of 46,000 respondents. The UN estimates are based on secondary data and civil registration reports encompassing 2,961 country-years of data from 172 countries and territories to allow for cross national comparability. As stated earlier, here in the Philippines, the vital registration system is weak and suffers from underreporting, hence it is expected that results generated would also be lower as compared to a survey which reflects the sample population. In the Inter-agency final report, the Philippines is classified among the 85 countries “lacking good complete registration data but where registration and/or other types of data are available.”
Given the strengths of the methodology used in the country's population-based surveys, to this end, the United Nations agencies in the Philippines concur with the official national-level estimates of maternal mortality ratios for 1990 and 2000-2010 as stated in National Statistical Coordination Board Resolution No. 11, Series of 2010. The MMR estimates in NSCB Resolution No. 11 Series of 2010 are to be used “as interim estimates for planning and policy/decision-making purposes until such time that the results of population censuses and surveys and updated data from the civil registration system are made available.”
Lastly, it is also important to note that the latest round of UN estimates which reflect the change from 120 MMR in 2000, to 110 MMR in 2005, and finally 94 MMR in 2008 does not necessarily reflect any decrease in MMR as these values all remain within the 95 percent confidence intervals.
The present discussions have once again surfaced that the civil registration system needs to be improved, strengthened and sustained.