Peer-reviewed article
Equity-focused investment strategies to reduce maternal mortality in the Philippines: a subnational analysis using EQUIST.
Whitley K, Lebedeva P, Christie AC, Sim A, Thompson D et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed maternal mortality inequities across Philippine regions and modelled the impact of targeted health interventions. Using the EQUIST tool, researchers estimated that three intervention packages—upgrading emergency obstetric care facilities, ensuring availability of life-saving medicines, and expanding contraception access—could prevent 1,000 to 2,500 maternal deaths by 2030. Modern contraception expansion was the most cost-effective strategy. The findings highlight that maternal mortality remains concentrated among poor, rural, and conflict-affected populations in the Philippines.
Key points
- Maternal mortality ratios in the Philippines vary substantially across regions and socioeconomic groups, with higher rates in poor, rural, and conflict-affected areas
- Facility readiness upgrades projected to avert 1,000–1,500 maternal deaths; life-saving commodities 1,500–2,000; and modern contraception expansion 2,000–2,500 deaths through 2030
- Modern contraception expansion had lowest cost per DALY averted at approximately US$150, compared with US$300 for life-saving commodities and US$450 for facility upgrades
- Sensitivity analysis varying inputs by ±15% produced ranges of 850–1,750, 1,275–2,300, and 1,700–2,875 maternal deaths averted respectively
- Equity-targeted investments combined with strengthened emergency obstetric care can achieve substantial mortality reductions at highly cost-effective levels
Limitations
This is a modelling study based on published evidence and 2019 subnational estimates; it does not directly measure real-world implementation outcomes or actual mortality reductions achieved. The findings depend on the accuracy of intervention effectiveness estimates and costing assumptions used in the EQUIST model.
Abstract
Background Despite sustained national progress in maternal and child health, maternal mortality in the Philippines remains uneven across regions and socioeconomic groups. Women in poor, rural, and conflict-affected areas experience substantially higher maternal mortality than those in higher-income and urban populations. We aimed to assess subnational inequities in maternal mortality and estimate the potential impact and cost-effectiveness of prioritised maternal health interventions in Philippine regions with maternal mortality ratios exceeding the national benchmark. Methods We conducted an equity analysis and developed an investment case using the UNICEF Equitable Impact Sensitive Tool (EQUIST). Regional maternal mortality ratios were based on 2019 subnational estimates, with the 2017 national maternal mortality ratio used as the benchmark for regional stratification. Intervention effectiveness estimates were drawn from published evidence syntheses and global clinical guidelines, and EQUIST's costing module draws on LiST and the Marginal Budgeting for Bottlenecks approach. Three intervention packages were modelled: upgrading basic and comprehensive emergency obstetric and newborn care facility readiness; ensuring universal availability of uterotonics and magnesium sulphate; and expanding access to modern contraception among adolescents, women from poor households, and high-parity women. Projected maternal deaths averted, disability-adjusted life years averted, and cost per DALY were estimated through 2030. Results Our modelling suggested that prioritised intervention packages could avert approximately 1,000-2,500 maternal deaths cumulatively through 2030. Facility readiness upgrades were projected to avert 1,000-1,500 maternal deaths, life-saving commodities 1,500-2,000, and modern contraception expansion 2,000-2,500. Sensitivity analysis varying key inputs by ±15% produced corresponding sensitivity ranges of 850-1,750, 1,275-2,300, and 1,700-2,875 maternal deaths averted, respectively. Modern contraception expansion had the lowest modelled cost per DALY averted at approximately US$150, compared with USD 300 for life-saving commodities and USD 450 for facility readiness upgrades. Conclusions Maternal mortality in the Philippines remains concentrated among disadvantaged subnational populations. Equity-targeted investments, combined with strengthened emergency obstetric care, reliable life-saving commodities, and expanded access to modern contraception, can achieve substantial mortality reductions at highly cost-effective levels.