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Maternal Newborn Child Health and Nutrition Services

Oct 03, 202411 min read

Reference

Nies, M., McEwen, M. (2020). Maternal, child and adolescent health services. In Community and Public Health Nursing (2nd Philippine ed., pp. 261-304). C&E Publishing, Inc.

The Department of Health issued Administrative Order 2008-0029 entitled, “Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality” as a response to the slow decline in maternal and child mortality in the Philippines, far beyond the Millennium Development Goals in 2015. Interventions are made for each stage of life— prepregnancy, pregnancy, delivery, postpartum, newborn, and childcare— which will ensure the following results:

  1. Every pregnancy is wanted, planned, and supported;
  2. Every pregnancy is adequately managed throughout its course;
  3. Every delivery is facility-based and managed by skilled birth attendants or skilled health professionals; and,
  4. Every mother and newborn pair secures proper postpartum and newborn and childhood care.

In 2018, the challenges faced in the delivery of maternal and child health services include the following (DOH RPRH Report, 2018):

  1. Low utilization of Family Planning Packages of PhilHealth. This low utilization may arise from confusion between patients and providers brought about by differing interpretations in the implementation of guidelines;
  2. Decrease in the number of PhilHealth-accredited Maternal and Child Program (MCP) facilities;
  3. Antenatal and postpartum care services lag; and,
  4. Measles and polio outbreaks and increase in measles-related mortalities.

Safe Motherhood Program

The Philippines faces unique challenges in aligning its health system with the needs of its inhabitants, primarily because of the country’s geography and income distribution. The DOH Women’s Health and Safe Motherhood Project 2 (WHSMP2) aims to strengthen interventions with a priority on serving disadvantaged women. It is a fast-tracked system-wide reform in maternal health in selected provinces through a set of interventions:

  1. Sector governance: improving accountability and regulatory oversight.
  2. Infrastructure and essential medical products and equipment
  3. Human resource development: clinical skill-building; formation of village-based women’s health teams.
  4. Financing: results-based financing mechanisms, insurance
  5. Service delivery: availability, quantity, quality of health services

The National Safe Motherhood Program envisions that Filipino women have full access to health services to ensure safe pregnancy and delivery. It brought about a strategic change in the design of services provided, which includes:

  1. Shift in handling pregnant clients from risk approach to preparing all pregnant women for complications of childbirth. It follows the principle of “there is no low-risk pregnant woman”. Instead, all pregnant women are considered at-risk for pregnancy and childbirth complications. This brings about the establishment of the BemONC-CemONC network.
  2. Improved quality of Family Planning counselling and expanded service availability of postpartum family planning in hospitals and primary birthing centers.
  3. The integration of cervical cancer, syphilis, hepatitis B, and HIV screening among others into the antenatal care protocols.
  1. Administrative Order 2018-0014: Strategic Framework for Implementing Guidelines for FOURmula One Plus for Health (F1+). This aligns health initiatives into four strategic pillars: financing, regulation, service delivery, and governance. It also added the initiative for performance accountability.
  2. Republic Act No. 10354: Responsible Parenthood and Reproductive Health Act of 2012
  3. Republic Act No. 11148: The “Kalusgan at Nutrisyon ng Mag-Nanay Act”, which scales up national and local health nutrition programs for pregnant and lactating women, adolescent girls, infants, and young children in the first 1,000 days.
  4. Republic Act No. 11210: The “105-day Expanded Maternity Leave Law”, with an optional extension for 30 days without pay, and 15 days for single parents.
  5. Administrative Order 2008-0029: Implementing Health Reforms to Rapidly Reduce Maternal and Neonatal Mortality
  6. Department Order 2009-0084: Guidelines Governing the Payment of Training Feeds relative to the Attendance of Health Workers to Basic Emergency Obstetric and Newborn Care Skills Training Course at Duly Designated Training Centers
  7. Administrative Order 2011-0011: Establishment of Basic Emergency Obstetric and Newborn Care Training Centers in Regional Hospitals and Medical Centers
  8. Administrative Order 2015-0020: Guidelines in the Administration of Life Saving Drugs During Maternal Care Emergencies by Nurses and Midwives in Birthing Centers
  9. Administrative Order 2016-0035: Guidelines on the Provision of Quality Antenatal Care in All Birthing Centers and Health Facilities Providing Maternity Care Services
  10. Administrative Order 2018-0003: National Policy on the Prevention of Illegal and Unsafe Abortion and Management of Post-Abortion Complications
  11. Administrative Order 2016-0035: The National Policy on the Provision of Quality Antenatal Care in Birthing Centers and Health Facilities Providing Maternal Care Services.
  12. Republic Act No. 10028: Expanded Breastfeeding Promotion Act of 2009
  13. Republic Act No. 11166: Philippine HIV and AIDS Policy Act of 2018. This strengthens HIV/AIDS prevention, treatment, care, and support policies. It also lowers the minimum age requirement for HIV testing without parental or guardian consent from 18 to 15.

RMNCAHN Core Package Services

Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAHN) core package services are health systems-oriented, multi-sectoral approaches in strengthening the continuum of care for women, children, families, and communities. The main objective is to enable all adolescents to make informed choices on reproductive health issues by creating awareness and providing access to information, education, support, services, and necessary treatments in the field of reproductive health. It covers the spectrum of known appropriate clinical case management services and known cost-effective public health measures to reduce risk.

These are the health providers that are part of the MNCHN Service Delivery Network:

  1. Community-level service providers (Community Health Team; CHT) comprise of out-patient departments, barangay health stations, rural health units, and private clinics led by a midwife. These conduct health risks and needs assessment and provide basic service delivery functions such as birth spacing and counselling.
  2. BEmONC-capable Facility, potentially barangay health stations, lying-in clinics, or birthing homes that provide parenteral administration of oxytocin (3rd stage), loading anticonvulsant, initial dose of antibiotic, assisted imminent breech deliveries, removal of retained products and placenta, and emergency newborn interventions (e.g., resuscitation, sepsis, and oxygen treatment). These facilities are able to transfuse blood, if needed.
  3. CEmONC-capable Facility: a facility with all the capabilities of BEmONC facilities, with the addition of cesarean section, blood banking, highly specialized obstetric intervention, management of low birth weight and preterm babies, and other newborn specialized services. Intrauterine device insertion, vasectomy, and bilateral tubal ligation. A physician, nurse, and midwife are in charge for outreach services. One CEmONC facility caters to at least 500,000 population.

Reproductive Health

Reproductive health is the state of complete physical, mental, and social well-being and not merely the absence of infirmity in all matters relating to reproductive system and to its functions and processes. It is based on the right to access appropriate health care services which enable women to go safely through pregnancy and childbirth and provides couples with the best chance of having a healthy infant (WHO, 2008). On the other hand, reproductive health care refers to the constellation of methods, techniques, and services which contribute to reproductive health and well-being by preventing and solving reproductive health problems (WHO, 2008).

  1. Republic Act No. 9710: The Magna Carta of Women of 2009, “the State shall, at all times, provide for a comprehensive, culture sensitive, and gender responsive health services and programs covering all stages of a woman’s life cycle and which addresses the major causes of woman’s morbidity and mortality”.
  2. Republic Act No. 10354: The Responsible Parenthood and Reproductive Health (RPRH) Law of 2013 recognizes and guarantees the human rights to sustainable human development, health, education and information, and the right to choose and make decisions and in accordance with one’s religious convictions, ethics, cultural beliefs, and demands of responsible parenthood.

Responsible Parenthood

Family Planning

A program which enables couples and individuals to decide freely and responsible the number and spacing of their children and to have the information and means to do so, and to have access to a full range of safe, affordable, effective, non-abortifacient modern natural and artificial methods of planning pregnancy (Congress of the Philippines, 2012). This is enforced by R.A. 10354. It stands upon the four pillars of family planning:

  1. Responsible Parenthood: the couple has the right to determine the number of children they want to have provided they can support the needs and provide better life to their children.
  2. Child Spacing: a birth interval of 3 to 5 years is encouraged. This also gives more time for the couple and other children to establish a strong relationship or bond.
  3. Respect for Life: abortion is considered illegal, as protected by the 1987 constitution.
  4. Informed Choice: the couple has the right to determine the kind of method in conformity with the universally recognized international human rights. The nurse is responsible for fully informing the couple regarding the options, advantages, and disadvantages of each method.

The mother is able to regain health after delivery, prevent pregnancy-related health risks, gives enough time for bonding with family and personal advancement, and enough time for treatment and recovery if ill. Infant mortality is reduced, healthy children start with healthy mothers, and children are able to receive attention, security, love and care that they deserve. The father also benefits, as the burden is lightened in supporting the family. He is then able to give his children their basic needs.

There are many methods of family planning. According to the WHO, contraceptives for family planning may either be modern or traditional. In most developing countries, limitations in modern methods may be due to limited choice of methods, access, fear or experience of side effects, cultural or religious opposition, poor availability. The following are contraceptive methods for family planning (WHO, 2018)

TraditionalDescriptionEffectivity
Calendar or Rhythm MethodWomen monitor their pattern of menstrual cycle over 6 months, subtracts 18 from shortest cycle length (estimated 1st fertile day) and subtracts 11 from longest cycle length (estimated last fertile day)91% with correct and consistent use.
75% if commonly used.
Withdrawal (Coitus Interruptus)Man withdraws his penis from his partner’s vagina, and ejaculates outside the vagina, keeping semen away from her external genitalia.96% with correct and consistent use.
73% if commonly used.
ModernDescriptionEffectivity
Combined Oral Contraceptive (COC)Contains two hormones (estrogen and progestogen)>99% with correct and consistent use.
92% if commonly used.
Progesterone-Only Pills (POP)Contains progestogen>99% with correct and consistent use.
90% to 97% if commonly used.
Implants (Implanon)Small, flexible rods or capsules placed under the skin of the upper arm; contains progesterone hormone only.>99%
Progesterone-only Injectables (Depo Provera)Injected into the muscle or under the skin every 2 or 3 months, depending on product.>99% with correct and consistent use.
97% if commonly used
Monthly Injectables or Combined Injectable Contraceptives (CIC)Injected monthly into the muscle, contains estrogen and progesterone.>99% with correct and consistent use.
97% if commonly used
Combined contraceptive path and combined contraceptive vaginal ring (CVR)Continuously releases 2 hormones—a progestin and an estrogen- directly through the skin (patch) or from the ring.New; research is limited. It is reports as more effective than COCs.
Intrauterine Device (IUD): Copper ContainingSmall flexible plastic device containing copper sleeves or wire that is inserted into the uterus.>99%
Intrauterine Device (IUD): LevonorgestrelA T-shaped plastic device inserted into the uterus that steadily releases small amounts of levonorgestrel each day.>99%
Male CondomsSheaths or coverings that fit over a man’s erect penis.98% with correct and consistent use.
85% if commonly used.
Female CondomsSheaths, or linings, that fit loosely inside a woman’s vagina, made of thin, transparent, soft plastic film.90% with correct and consistent use.
79% if commonly used.
Male Sterilization: VasectomyPermanent contraception to block or cut the vas deferens tubes that carry sperm from the testicles.>99% after 3 months semen evaluation. 97% to 98% if no evaluation.
Female Sterilization: Tubal LigationPermanent contraception to block or cut the fallopian tubes.>99%
Lactational Amenorrhea Method (LAM)Temporary contraception for new mothers whose monthly bleeding has not returned; requires exclusive or full breastfeeding day and night of an infant less than 6 months old.99% with correct and consistent use.
98% if commonly used.
Emergency Contraception Pills (ulipristal acetate 30 mg or levonorgestrel 1.5 mg)Pills taken to prevent pregnancy up to 5 days after unprotected sex.99%
Standard Days Method (SDM)Women track their fertile periods (usually days 8 to 19 of each 26 to 32-day cycle) using cycle beads or other aids.95% with correct and consistent use.
88% if commonly used.
Basal Body Temperature (BBT) MethodWoman takes her body temperature at the same time each morning before getting out of bed observing for an increase of 0.2 to 0.5°C.99% with correct and consistent use.
75% with typical or common use.
Two-Day MethodWomen track their fertile periods by observing presence of cervical mucus (if any type color or consistency)96% with correct and consistent use.
86% with typical or common use.
Sympto-Thermal MethodWomen track their fertile periods by observing changes in the cervical mucus (clear texture), body temperature (slight increase) and consistency of the cervix (softening).98% with correct and consistent use.
98% with typical or common use.

Maternal-Newborn Health

Pre-pregnancy Services

Prepregnancy services include provision of iron and folate supplementation, counselling and provision of Family Planning (FP) methods, and prevention and management of infection and lifestyle-related diseases.

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