Maternal deaths put heavier toll on daughters

BAYAWAN CITY, Negros Oriental – It was drizzling and the narrow path was muddy and slippery. From Nangka 1 village proper, it took an hour’s walk to reach the solitary wooden hut on a hill, overlooking a rice field on one side and a stream on the other.

Behind the open door stood nine-year-old Michelle Esconde. Most kids her age are often seen holding a doll, but not Michelle. Her tiny arms were tightly wrapped around the small frame of her one-year-old brother.

Their mother Julia died last year, just five minutes after giving birth to the eighth child in the family. Julia was 39 years old.

Since then, the responsibility of taking care of the baby has been passed on to Michelle. For a year now, she has missed out on playing with other kids and going to school – rights that duly belong to a child like her.

“I want to go to school but I cannot because I have to take care of my brother,” said Michelle in the Visayan language. She would have been in Grade 3 now.

Michelle’s 14-year old sister Daisy also had to stop her schooling in order to take care of the other siblings and do household chores – obligations that mothers normally carry out.

While he pities the plight of the children, their father Desiderio said there is not much he can do. No one will take care of the smaller kids while he’s away in the farm to toil for their food.

“Life is harder now without their mother,” said Desiderio.

Maternal death

Julia is only one of the names in the long list of women who died while giving birth in Bayawan, which registered the highest record of maternal deaths in the country, according to the 2006 Department of Health data.

But tragic deaths are not happening only in Bayawan. It is true across the nation.

The Philippines is among the 68 countries that contribute to 97 per cent of maternal and children’s deaths worldwide, according to the United Nations Children’s Fund (UNICEF) in its State of the World’s Children 2009 report.

Eleven Filipino pregnant women die each day, or some 4,500 each year, due to complications in childbirth. These are caused by hemorrhage, sepsis, hypertension and abortive outcomes, which are preventable. An overwhelming majority, 70 percent of the deaths, occur at childbirth or within a day after delivery.

According to the report, one out of 140 pregnant women dies in childbirth in the Philippines, too many compared to Ireland’s one in 8,000, to cite just one example.

Further highlighting the contrast, the UNICEF reported that a child born in a developing country 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 occur within a month after they are born.

Despite the high mortality rate, population growth in the Philippines stands above two percent, the highest in Southeast Asia. There are now about 89 million Filipinos, according to the latest census.

A child born in a developing country is almost 14 times more likely to die during the first month of life than a child born in a developed one.

Relying on the hilot

The high incidence of maternal deaths in the Philippines was attributed to inadequate information on pregnancy care and access to quality health services, especially for women in urban poor and far-flung areas. The UNICEF report also pointed 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 babies in rural areas are delivered in the absence of medical professionals like doctors, nurses, and midwives. Instead, most of the pregnant mothers are assisted by attendants commonly known as “hilot” or “comadrona,” who have no professional training.

All of these factors were present in Julia’s case. Without money, she relied on a hilot when she delivered her baby. The nearby health center, where she could have delivered her baby with the presence of a midwife, had been closed for three years due to a land dispute.

The hilot does come in handy for pregnant women in the villages, as they are usually available anytime of day. Often old women, they possess motherly instincts and take care of the pregnant woman like their own daughter.

“I’ve experienced giving birth in the hospital. It’s lonely there. The nurses don’t really take care of you. It’s not like the hilot. She will not leave you from the time you labor until several hours after you’ve given birth. She is just beside you like a mother,” said Mary Jean Faburada, who recently gave birth to her second child with the help of a hilot.

Sixty-year-old Candelaria Combite has been a hilot for three decades but it was only a few years ago that she received training, and consequently, a license from the City Health Office.

“This is the gift that God gave me. So, this is the mission that I have to do,” Candelaria said.

Contraceptives and religion

Records from the Bayawan City Health Office show high contraceptive usage, reaching 62 per cent in 2010. Despite the high prevalence rate, most couples have as many as seven or eight children, especially in the remote villages.

These figures, says midwife Naida Cuenca, reflect the lack of proper knowledge of many residents when it comes to the use of modern family planning methods.

“They also have superstitious beliefs. They think, for example, that ligation is bad and can kill them,” Cuenca said.

Others shy away from artificial contraceptives because of religious convictions, such as 43-year old Editha of neighboring Basay town, who is seven months pregnant with her seventh child. A Catholic, she believes that taking artificial contraceptive is a sin.

“Having many children is God’s will,” Editha said. Once, she got a free supply of pills from the health center but did not develop the discipline to take it regularly so she stopped it.

At her age, Editha’s pregnancy poses a high risk to her health but she is not worried and does not even bother to visit the health center near her house.

“I don’t get anything from going to the health center. The midwife gives me prescriptions for iron supplements but I have no money to buy these in the drugstore.”

Instead, she gets a regular massage from her hilot, who happens to be her mother-in-law.

Strong-willed and industrious, Editha continues to go out to the sea to fish despite her condition. The only fisherwoman in the village, she wakes up early and by four in the morning, she pushes her boat as she sails off to the sea.

“If labor pains hit me while I’m at sea, I would just shout and the other fishermen will help me. If there’s no one, then I will have to row the boat fast back to the shore,” she said.

In rural Philippines, the female is the face of poverty.

Unreachable goal

The government has introduced health reforms to rapidly reduce maternal mortality such as active information campaigns, training of health personnel, and building health facilities in remote villages. Bayawan City and other local governments have upgraded to secondary hospitals, which extend obstetric and gynecological services to pregnant women.

These efforts have borne fruit in the past few decades. The percentage of childbirths assisted by trained health personnel has steadily increased from 58.5 percent in 1990 to 69 percent in 2000. More mothers are receiving prenatal check-ups and postpartum care, resulting in the decline of maternal mortality rate from 209 per 100,000 live births in 1990 to 160 in 2009.

Yet, both the government and the UNICEF concede that the Philippines’ commitment to the UN Millennium Development Goal of lowering maternal mortality rates by 75 percent by 2015 may not be achieved.

President Noynoy Aquino has lowered the target for pregnancies attended by skilled health workers from 100 percent to 85 percent by 2015. But according to the UNICEF, saving the lives of mothers requires more than just medical intervention. Health services are most effective in an environment supportive of women’s empowerment, protection, and education.

Unfortunately, the passage of the Responsible Parenthood bill that Aquino promised during his campaign was not included in his administration’s 23 priority bills. And when Congress reopens this month, there is a long queue of lawmakers who are set to question the controversial measure.

Daughters suffer

Women’s groups are worried that if lower maternal mortality is not achieved soon, more and more children, especially the girls, will suffer.

Beth Angsioco, national chairperson of the Democratic Socialist Women of the Philippines, said when mothers die, her responsibilities are usually passed on to the living daughter. In many cases, she is forced to quit schooling, just like in the case of sisters Michelle and Daisy.

“Gender roles are traditionally defined in poor communities. The female is the face of poverty,” Angsioco said.

If lower maternal mortality is not achieved soon, more and more daughters will suffer.

When girls are deprived of their right to education, the cycle of high maternal death rate and poverty continues. This is highlighted in the UNICEF report: “If a girl is educated six years or more, as an adult her prenatal care, postnatal care and childbirth survival rates will dramatically and consistently improve.”

Armed with appropriate information about child-rearing practices, educated adults are more likely to have fewer children and will ensure that their children start school on time, according to UNICEF, based on global statistics.

Until Michelle goes back to school, she will have to continue dealing with the pain of losing a mother and the pressure of filling the shoes of a missing parent. Her chances of finishing school, and ending her poverty, are gloomy. It’s too much tragedy for a nine-year-old girl. – YA, GMA News

(The author is a senior correspondent of GMA Network and is a regular contributor of special reports on women, children, education, health, and the environment to GMA News Online.)