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Childbirth, still a grim reality for many Filipino mothers and babies


MANILA, Philippines - It’s a breezy afternoon in a cold January, but it’s humid as usual in this block of cramped small houses where walls are pushed against each other and where windows, standing a few inches away a neighbor’s wall, make no difference. Ventilation almost comes nil. And the dark narrow alleys that separate some of these houses ooze an obvious stench. This is a stark contrast to its backdrop of glistening skyscrapers and perfumed office ladies and men walking hastily on the busy streets of the commercial district of Makati City. Also, in this area of Barangay Bangkal where informal settlers nestle hides a sad reality of babies dying either before they were born or shortly after birth. The gloom can be easily masked by children who, although filthy, are gleefully playing on the crowded alleys. It doesn’t even show on the face of 22-year-old mother, Marife Javines, who manages to tease her two male toddlers despite a pain made more scorching by guilt feelings following the loss of her baby 12 hours after his birth due to pneumonia a few weeks earlier. “Ilang gabi akong di makatulog (There were many nights when I couldn’t sleep)," sobs Javines, even blaming herself for not taking vitamins while pregnant and failing to see a doctor until the baby was on the last trimester. Tragic and traumatic, Javines’ third birth delivery in December almost cost her own life as well. High death toll Javines’ case is not isolated. And it is not happening only in Barangay Bangkal. It is true across the nation. The Philippines is among 68 countries, which contributed to 97 percent of maternal, neonatal and child health deaths worldwide, according to United Nations Children’s Fund (UNICEF) in its State of the World’s Children 2009 report. The report says that a child born in a developing country like the Philippines is almost 14 times more likely to die during the first month of life than a child born in a developed one. In the Philippines alone, about half of the deaths of Filipino children under five years old happen in the first 28 days of life. The incidence of fetal deaths in the country is as alarming as the maternal mortality rate. After all, the health and survival of mothers and their newborn are linked. One in every 140 pregnant women dies in childbirth in the Philippines. Too many compared to, for example, Ireland’s one in 8,000. Each day, 11 Filipino pregnant women or some 4,500 each year due to complications in childbirth brought by hemorrhage, sepsis, hypertension and abortive outcomes, which are actually preventable. Seventy percent of these deaths occur at childbirth or within a day after delivery. The population growth rate in the Philippines stands above 2 percent, the highest in Southeast Asia. There are now about 89 million Filipinos. UNICEF says every year, more than half a million women die worldwide as a result of pregnancy or childbirth complications, including about 70,000 girls and young women aged 15 to 19. It attributes this to a lack of information on proper pregnancy and access to quality health care especially to women in urban poor areas and in far-flung places. In a statement posted by UNICEF on its Web site, it says that “maternal mortality offers a litmus test of the status of women, their access to health care and the adequacy of the health care system in responding to their needs." It adds that malnourished pregnant women are most likely to give birth to underweight infants, and mothers who are iodine-deficient suffer frequent miscarriages, still births, and early infant deaths. “Babies who survive will most likely be born deformed and mentally challenged." UNICEF also points to the common Filipino practice of deliveries outside a health facility as a major factor in the maternal or fetal deaths. Eight out of 10 births in rural areas are delivered outside a health facility and in the absence of medical professionals like doctors, nurses and midwives. Most of these deliveries are home-based and are attended by unprofessional attendants, commonly known as “hilot" or “comadrona." Department of Health (DOH) data show that poor and uneducated women who are living in rural areas or in urban poor communities have a high risk for neonatal and maternal death. According to the Center for Women’s Resources, the risks of maternal and neonatal death are also magnified by unplanned, unwanted or unsupported pregnancies. Domestic violence and rape continue to threaten women's health. Based on its 2007 data, one woman is battered every one hour and 50 minutes, and one woman is raped every seven hours and 30 minutes. Prostitution is still a way out for many poor Filipino women. And compromises between the government and the Catholic Church have kept adolescent women from accessing reproductive health services. Government response Recognizing the problem, the DOH has given attention to the state of maternal and neonatal state of Filipinos. It has jumpstarted various health reforms aimed at rapidly reducing maternal and neonatal mortality. These efforts range from an active information campaign to training health personnel to building health facilities in remote villages. The DOH has also called on the local government units (LGUs) and other pubic/private providers of health care and development partners to actively support the implementation of these health reforms. A number of LGUs have upgraded their primary hospitals to secondary hospitals, which have extended obstetric and gynecological and surgical services to pregnant women. Health Undersecretary Yolanda Oliveros also says the government has received grants worth four billion pesos to set up facilities with OB-Gyne care even in far-flung areas. “This is to discourage women to go to unprofessional medical attendants like hilots because even if a woman is healthy, we can’t predict when emergencies come. And a hilot doesn’t know how to handle emergencies," says Oliveros. The government has also expanded its immunization programs, promoted breastfeeding practices, and provided vitamin and mineral supplementation for children under the age of five. MDG targets Government efforts have borne some fruits, actually. The rates of decline in maternal and neonatal mortality have decelerated in the past decades. Though slow, there has been a steady increase in the percentage of birth delivery assisted by trained health personnel - from 58.5 percent in 1990 to 69 percent in 2000. More mothers have also received a minimum of prenatal check-ups and postpartum care, resulting in the decline of maternal mortality rate from 209 per 100,000 live births in 1990 to 172 per 100,000 live births in 1998. The mortality rate of children under-five has also plummeted to 48 per 1,000 live births in 1998 from a high of 80 per 1,000 live births in 1990. Yet, despite this, the UNICEF and DOH both concede, the Philippines’ commitments to the Millennium Development Goals (MDGs) of lowering maternal mortality ratio and infant mortality rates by 75 percent by 2015 may not be achieved. The Philippines is a signatory to the 2000 Millennium Declaration on the global agenda for development by 2015. The eight MDGs seek to reduce by half extreme poverty and hunger; achieve universal primary education; promote gender equality; reduce child mortality; improve women’s health; and stop and reverse the spread of HIV/AIDS and other diseases. “We are still committed to these targets. We are on track in reducing under-5 mortality, but the problem is on newborn," says Oliveros. UNICEF agrees that the Philippines is in a much better situation than in least developed countries, “but it still lags quite behind in terms of targets," says UNICEF representative Vanessa Tobin. “MDG goal 5 (Improve maternal health) is one of the MDGs that are least likely to be achieved by the Philippines by 2015. This situation presents a major challenge. A huge effort is needed to improve public reproductive and maternal health services and educate mothers," adds Tobin. UNICEF says that saving the lives of mothers and their newborns requires more than just medical intervention. Health services are most effective in an environment supportive of women’s empowerment, protection and education. But until the divide between the rich and the poor countries closes, and the Philippines advances fully in its effort, childbirth, a supposed celebration of life, will stay a nightmare not only for many Filipino mothers but for their children and families as well. - GMANews.TV (The author is a television news reporter of GMA Network, Inc. and is a regular contributor of special reports on women, children, education, health, and the environment to the network’s news Web site GMANews.TV.)
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