A nationwide conditional cash transfer programme in the Philippines is slowly improving maternal health, but more is needed to reverse the climbing maternal mortality ratio, say women’s groups.
Known locally as “Pantawid Pamilyang Pilipino Program” (4Ps), five-year conditional cash transfers (CCTs) were first rolled out in 2007 as a pilot programme to cut poverty. Now, with a budget of US$227 million, the Department of Social Welfare and Development (DSWD) aims make CCTs available to 5.2 million eligible households by 2015.
The 4Ps identified 5.2 million of the poorest households with pregnant women and children aged 0-14, three million of which have been receiving cash grants since April 2012. In exchange, beneficiaries must meet certain health and education goals.
Participants receive a monthly grant of $12 for getting pre- and post-natal check-ups and delivering their babies in a health centre under the supervision of a skilled birth attendant, rather than with a traditional birth attendant as most women currently do, and must attend monthly parenting seminars offered by the DSWD.
National surveys indicate that prenatal check-ups average 4.4 visits per woman - the international recommendation is four - but only 44.2 percent of births occur in a health facility.
Beneficiaries also receive a monthly grant of $7 per child, for a maximum of three children, in exchange for proof of regular paediatric check-ups and school-aged children attending at least 85 percent of their classes.
Cash not enough
Perla Maribel Diotor, 36, a CCT beneficiary who lives in Baseco, one of the biggest slum communities in Manila, the capital, gave up paid employment when she became pregnant with her first child, now five children ago. She said the programme had helped her in the two years since she joined.
Her husband works “occasionally”, doing construction work, fishing or “whatever job is available”. On some days, he brings home the equivalent of $2. “I only wanted three kids, but I kept getting pregnant,” Diotor said.
The World Bank estimates that 22 percent of women of reproductive age in the Philippines (about six million) do not have access to contraception.
According to the 2008 National Demographic Health Survey (NDHS), women surveyed reported wanting 2.4 children, but had on average 3.3 each.
Until late 2011, the distribution of modern contraceptives was banned at public health clinics in Manila. The city government now allows it if the contraceptives are donated by development groups and NGOs, but has not used its own funds for contraception.
Diotor and others like her have had to find contraception on their own, usually going to NGOs, where the supply is often erratic and insufficient.
“Interventions made when a woman is already pregnant are already too late. We can save lives by preventing unwanted pregnancies,” said Junice Melgar, executive director of Likhaan Centre for Women’s Health, a local NGO working in some of Manila’s poorest communities.
A study published in 2010 by the Guttmacher Institute, a German reproductive health think-tank, estimated that up to 2,100 maternal deaths could be prevented each year by providing modern contraceptives to all women at risk of unintended pregnancy.
The maternal mortality ratio (MMR) in the Philippines has jumped by 35 percent, from 162 deaths per 100,000 live births in 2006 to 221 in 2011, according to the 2011 Family Planning Survey.
“We need a more serious approach to family planning. The family development sessions that beneficiaries are required to take are more of lectures that focus on natural family planning methods. Even then, were the women given beads or calendars to track their cycles? [No.] It’s more of a lip service to family planning,” said Melgar.
During the administration of previous President Gloria Macapagal Arroyo, from 2001 to 2010, the government supported only natural family planning methods, leaving NGOs and women’s groups to provide for the contraceptive needs of poor women. “We are really feeling the results of nine years under the Arroyo government,” Melgar noted.
The current government recently approved the purchase of $12 million in family planning commodities in an attempt to counter rising maternal deaths. “This administration [of President Benigno Aquino] has been very clear about its support for responsible parenthood, but admittedly, there is really a problem on the supply side,” said DSWD Secretary Corazon Soliman.
“We lack midwives to attend our pregnant mothers. We lack adequate healthcare facilities. We are doing what we can, given our limited resources. We have started nursing programmes to fill the manpower gap, but building healthcare infrastructures and equipping them takes time,” she said.
Enrique Ona, the Department of Health Secretary, told IRIN, “The latest family planning survey covers the period 2006 to 2010. We don’t have a survey that will reflect the effect of a fully implemented CCT programme yet.”