By Perla Aragon-Choudhury,Womens Feature Service
When a very pregnant Jean Cruz (name changed) told her neighbour that she had not visited a doctor during her entire pregnancy, she was shocked. “What! Not even now – in your eighth month?” the neighbour had exclaimed, before frantically referring her to the nearby Community Health Care Clinic that charged only a nominal fee for consultation.
Cruz, a poor housemaid, lived in her employer’s home with her first-born and her husband, who was looking for a steady job. Later, she also had to ask her employer to pay the clinic where she gave birth to her second child. In the Philippines, there are many women like Cruz who are unable to access medical care during pregnancy, putting them at high risk of complications during childbirth.
Like other countries around the world, the Philippines, too, has pledged to fulfil its Millennium Development Goal (MDG) related to maternal mortality. But the combined factors of poverty, limited access to medical facilities and inadequate hospitals and medical personnel still see 11 Filipinas die every day during childbirth, and over 100,000 suffering from pregnancy-related complications (UNFPA and WHO Reports, 2005).
At a recent seminar, ‘Changing Course to Achieve MDG5: A Policy Forum’, on maternal mortality and reproductive health, Dr Junice Melgar, Executive Director of Likhaan, a women’s health advocacy group, painted a dismal picture of the future. “We will continue to have on an yearly basis 800,000 unintended births, over 500,000 abortions, 200,000 miscarriages, 2,100 maternal deaths and billions in healthcare and economic costs,” warned the expert, if the current social barriers related to contraceptive care were allowed to persist.
One of the main aims of MDG 5 is to reduce by three quarters, between 1990 and 2015, a country’s maternal mortality ratio (MMR). In the case of the Philippines, its MMR was 209 in 1990 and 162 in 2005. But it seems highly unlikely that the country will be able to meet its MDG target of achieving by 2015, an MMR of 52.
According to the UNFPA, family planning can prevent 20-35 per cent of all maternal deaths. And it is in this area that the Philippines faces a grave challenge. Data from the Guttmacher Institute has revealed that the use of modern contraceptives among married women in the country did not increase in the past decade and has remained at 33-34 per cent between 2003 and 2008.
A growing number of women, especially the poor, do not have access to family planning methods. In fact, according to media reports, only one-third of married Filipino women use modern contraceptives. “The rich and poor both face unintended pregnancy risks. But the unmet need for contraceptives for poor women puts them at the highest risk,” said Melgar.
Melgar believes that there is limited access to contraceptives because, ever since 2004, when USAID started decreasing its donations in terms of contraceptives, there have been cutbacks in the availability of publicly-funded contraceptives.
In order to make contraceptives readily available, Likhaan urged the Department Of Health (DOH) and the Philippine Health Insurance Corporation (PhilHealth) to make family planning a public health priority, ensure seamless funding for this national programme and guarantee supplies and services.
Since PhilHealth funds only tubal ligation, vasectomy and Intrauterine Device (IUD) insertion, Alberto Romualdez, Former Health Secretary, called for more benefits under a universal health coverage scheme. He asked authorities to “consider re-listing the morning-after pill”, which he said was removed a week after had left the Department of Health.
Likhaan also advocated that the Department of Health and the local government units not only provide a wide choice of contraceptive methods but also respond to the actual and perceived needs of women. It further urged the health authorities and the Office of the President to fully exercise their standard-setting and regulatory powers over LGUs to prevent contraceptive bans and to reverse bans when these exist – as in Manila since 2000.
Another way to ensure that mothers like Cruz get the care they need and deserve was “greater access to skilled birth attendants and emergency obstetric care that can reduce maternal deaths by 40 per cent”, as Suneeta Mukherjee, UNFPA Country Director for the Philippines, put it.
She also had some good news to give in this regard. She said that midwives are now being supported by doctors and by the Philippine Obstetrics and Gynecological Society (POGS) because they are the frontline providers of maternal and newborn care. Midwives are present at most deliveries: They are present in six out of 10 cases that occur at home and in 9 out of the 10 cases in the Autonomous Region in Muslim Mindanao or ARMM. In fact, they are now allowed by the Department of Health to deliver oxytocin and magnesium sulfate, which used to be done only by doctors earlier.
So does that mean that women like Cruz can now hope to give birth safely and get contraceptives on time? At least some efforts are being made to turn this into a reality for them. Speaking at the seminar, Esperanza Cabral, who was the Health Secretary at the time, urged the Congress to “pass a law that will promote access to services, champion freedom of information and choice, and empower the Department and LGUs with the legal mandate, as well as the resources, to deliver the services”.
She argued that any progress on this issue will only happen when the discussion on sexual and reproductive health transcends “the rigid plane of spirituality and morality, and [move] into the plane of hard science and economics, of human rights, good governance and sustainable development.”
Concluded Cabral, “We can only hope that sooner rather than later, our national leadership will come to realise the impact of this institutionalised neglect on our country and society.” In the meanwhile she argued for continuing support to educate and inform the people, as well as lobby for appropriate legislative measures.