1. Overview of
Community-Managed
Maternal and
Newborn Care
PPT 1

2. “Nasa hukay ang isang paa
ng isang manganganak”
photo courtesy of: BEMOC: A Trainers’ Guide (DOH) 2004.
Photo Courtesy of BEmOC: A Trainer’s Guide (2004)

3. Maternal Mortality
1/10 Filipino mothers die everyday
from complications related to
pregnancy and childbirth
14 % of deaths among women aged
15-49 are due to maternal deaths
172 Filipino mothers die for every
100,000 live births

4. Health Care During Pregnancy,
Childbirth and After Delivery
Percentage of Antenatal Care Provider
88% of women No one , 5.6
receive prenatal
care from health TBA, 6.5
professionals Doctor , 38.1
Nurse/Midwife
, 49.5

5. 3/10 women do not get at least 4
visits for prenatal care
50% of women from among those
who received prenatal care were
informed of danger signs of
pregnancy
Source: www.iccdrb.org
57% of women were not informed to
go to a specific facility in case of
complications

6. Percent distribution of women by number of TT injections
during pregnancy
Two or more None , 27.9
injections, 37.3
One injection,
33.4
28% of women didn’t receive any tetanus toxoid
injections during pregnancy
37% of mothers reported to have TT2 coverage

7. Percent distribution of live births by place of delivery
govt hospital ,
22.8
govt health
center, 1.4
hom e , 61.4
private sector ,
13.7
61% of births are delivered at home

8. Percent distribution of live births by person providing
assistance during delivery
relative/friend
, 2.4
doctor , 33.6
TBA, 37.1
nurse, 1.1
midwife, 25.1
60% of deliveries are attended by health professionals

9. 6 /10 deliveries are attended by a
traditional birth attendant at home
3/10 deliveries are attended by a
midwife at home
1/3 women who delivered outside a
health facility receive post natal
check up within 2 days after
delivery

10. Child Survival
17/ 1,000 babies die within
their first 28 days of life
29/ 1,000 babies die under 12
months
40/ 1,000 children die under the
age of five

11. Family Planning
49 % of married women use a
contraceptive method (either
traditional or modern)
Source: www.scienceclarified.com
33 % use modern methods
16% use traditional methods
Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)

12. Why integrate maternal and
newborn care?
• Intrauterine life as the
foundation for child
survival
Source: www.scienceclarified.com

13. Reasons why children die due
to maternal factors
Mother’s age at Biodemographic differentials
birth
Neonatal Infant Child
mortality mortality mortality
High mortality at < 20 28 42 15
young ages
Low mortality at 20-29 16 26 9
middle ages
30-39 15 28 15
High at old ages 40-49 32 66 24

14. Early childhood mortality rates
by birth order
Birth Order Neonatal mortality Infant mortality Child mortality
1 19 29 7
2-3 14 23 8
4-6 14 29 16
7+ 31 56 29
Note:
Clear positive association between birth order and probability of dying between
ages one and five. Higher birth order have higher mortality ratio.

15. Early childhood mortality rates
by previous birth interval
Previous birth Neonatal Infant mortality Child mortality
interval mortality
<2 23 39 20
2 years 10 26 13
3 years 10 19 11
4 + years 15 25 6
Note:
Childhood mortality rates decline as the birth interval increases. Children born
3 years after a preceding birth have the best chance of surviving infancy, with
IMR of 19 deaths/1,000 live birth.

16. Early childhood mortality rates
by birth size
Birth weight Neonatal Infant Child
mortality mortality mortality
Small/ very 29 52 na
small
Average or 11 20 na
larger
* No available data

17. Perinatal Mortality Rate by
mother’s age at birth
Age No. of Still No. of early Perinatal mortality
births neonatal deaths rate
<20 9 15 38
20-29 30 39 18
30-39 24 27 23
40-49 13 11 68
* The sum of stillbirths and early neonatal deaths divided by
the number of pregnancies of seven or more months’ duration,
multiplied by 1000

18. Perinatal Mortality Rate by Previous
pregnancy interval in months
Interval in months No. of still No. of early Perinatal
births neonatal mortality*
1st pregnancy 16 26 23
<15 9 16 35
15-26 15 15 18
27-38 18 13 28
39 + 19 22 24
* The sum of stillbirths and early neonatal deaths divided by
the number of pregnancies of seven or more months’ duration,
multiplied by 1000

19. Why are mothers and children
dying?
•Not just biological reasons, but
also because of economic, socio-
cultural, political and
environmental factors.
•Disparities exist
Geographic – rural vs. urban, etc
Economic – rich vs. poor
Socio-cultural – women vs. men,
indigenous peoples,
level of education
Sources: NDHS (1998 and 2003); FHSIS (2000); MCHS-PNSO Philippines (2002)

20. Socio-economic differentials in
Perinatal Mortality
Socio-demographic factor Still births Early neonatal Perinatal mortality
Residence
Urban 33 39 21
Rural 43 53 27
Education
No education 2 4 45
Elementary 25 35 29
High School 32 38 23
College or higher 17 15 17
Wealth index quintile
Lowest 18 28 25
Second 17 23 25
Middle 22 13 26
Fourth 14 20 29
Highest 4 7 11
Note:
Perinatal mortality is slightly higher in rural than in urban areas; highest among pregnancies with preceding
birth interval or less than 15 months. Wealthiest groups have the least perinatal mortality rate.

21. Socio-economic differentials in
childhood mortality
Factor Neonatal Mortality Infant mortality Child mortality
Residence
Urban 14 24 7
Rural 21 36 17
Education
No education 33 65 42
Elementary 22 43 20
High School 18 26 9
College or higher 9 15 3
Wealth index quintile
Lowest 21 42 25
Second 19 32 15
Middle 15 26 6
Fourth 15 22 4
Highest 13 19 1
Notes:
- mortality rates in urban areas are much lower than in rural areas; inversely related to
mortality education level and wealth status
- regional differences should be used with caution due to large sampling errors

22. The Three Delays
1. Delay in deciding to seek
medical care
2. Delay in identifying and
reaching the appropriate
health facility; and
3. Delay in receiving
appropriate and adequate
care at the health facility.

23. What is our role?
• Save the lives of mothers
and newborns
• Combat the Three Delays
through provision of
Emergency Obstetric Care
(EmOC)

24. Emergency Obstetric Care
• Part of Emergency Obstetric Care which includes pre- and
postnatal care, clean and safe delivery, neonatal care and
family planning (4 pillars of safe motherhood)
• Assurance of a skilled birth attendant
How can we help save?
• Be equipped with essential skills both clinical and non-clinical to
deliver maternal and newborn health services effectively
• Health is the responsibility of everyone

25. The Right to Health
• Every woman has a
right to a safe
pregnancy and
childbirth

26. MCH in the Principle of Primary
Health Care • Address MCH problems by
providing promotive,
preventive, curative and
rehabilitative services in
communities
• Participation of people
individually and
collectively in the planning,
implementation and
evaluation of their health
care
• “Health in the hands of the
people”

27. What are the current efforts to ensure
that women and newborns enjoy their
rights?
At the National Level
• Health Sector Reform Program
( Fourmula One)
• Women’s Health and
Development Programs
• Safe Motherhood Policy
• Family Planning Policy

28. International Covenants
• Beijing Platform of Action
• Convention on the Elimination of
All- Forms of Violence Against
Women
• Convention on the Rights of the
Child
• Millennium Development Goals,
meet the following goals by 2015
• Goal number 4: Reduce the
mortality rate among children
under five by two thirds.
• Goal number 5: Reduce by three
quarters the maternal mortality
ratio.
• Alma Ata Declaration