Monday, June 04, 2007

Pinay moms rate an ‘X’

A PERFECT ‘X’ rating is still what the missus deserves even after going through the body-wracking ordeal of pregnancy capped by a high-wire act called childbirth—that wreaks devastation on her waistline, distends the pelvic girdle causing the bosom to swell out, so goes her figure. So I pried from a wizened comadrona cum apothecary the secrets of a quaint massage technique called kaban—literally “chest” which holds treasures usually, actually a euphemism for portions of the female anatomy showcasing the reproductive organs—to tune up, probably bring healing and tender loving post-partum care to the beloved.

Filipino moms nationwide also get an undeserved ‘X’ rating—that is, done in and crossed out as in a killer’s hit list. Pregnancy isn’t just about bearing life in mom’s belly—it’s a tightrope act, no nets most times as womb drops to tomb.

On any day, 10 Filipino mothers die. Culprit: childbirth and pregnancy-related causes.

“Ten Filipino fathers are also grieving everyday from such loss. Ten Filipino families everyday suffer from the inestimable economic, social and emotional loss. Since most of these mothers who die are among the poor and the poorest, the orphaned newborn babies will most likely not survive their first year of life. Every maternal death is a family tragedy, a neighborhood tragedy, a community tragedy.”

So laments extant Secretary of Health and current University of the Philippines-Manila’s Vice Chancellor for Research Dr. Jaime Z. Galvez Tan as he points out such daily deadly toll can be prevented.

“The Philippines does not need new technologies to prevent maternal deaths. The phenomenon has been studied well enough. The strategies have been laid out. What we need is courage, the commitment and the political will to act,” he avers.

Filipino mothers give birth to about three children. Every dead mother leaves behind three orphans. For 10 dead mothers that turn up daily, 30 children are orphaned.

Dead count aside, some 30 other mothers survive. Survive injured—debilitated by uncontrollable leakage of urine and feces resulting from obstetric fistula, infertility, and depression.

Unafraid for their lives but most moms are doubtful for their family’s capacity to feed, clothe, shelter and rear on to decent schooling another child. Thus, about 473,000 abortions occur each year in the Philippines.

“The tragedy is that the causes of maternal deaths are preventable,” stresses United Nations Population Fund (UNPFA) country representative Suneeta Mukherjee as she rues: “The greater tragedy is that these deaths are taken for granted; even though they occur daily, the whole year round.”

In face of such apathy and neglect, UNFPA strongly asserts that no woman, no Filipina should die giving life and points up to three pillars of safe motherhood, “cost-effective interventions that would cut down maternal deaths.”

The pillars of safe motherhood:
• Access to family planning enables a woman to decide when to become pregnant and how many children she will bear;
• Skilled attendance at birth that can avert four of five maternal deaths due to childbirth complications; and
• Access to emergency obstetrics care that can greatly reduce life-threatening delays.

For a country that conveniently tabs itself as Christian—whatever that means—even divine example speaks less volume than any peroration at the pulpit. The heart-meat of the Scriptures may point up family planning and replacement fertility, “For God so loved the world that He gave His only begotten Son…” but mortal teachings moored on more mundane grounds can dump divine example.

Thus, access to family planning is often barred and family planning commodity security placed at risk. Donated commodities such as pills, injectables and prophylactics have been gradually phased out since 2003. The final phase-out is set for 2008 and at the same time, the national government is no longer procuring contraceptives in keeping with a so-called “Pro-Life” policy.

However, family planning can save the lives of 150,000 women worldwide yearly. Birth spacing by at least two years means more than a million under five children saved each year.

Ms. Mukherjee notes an equally important fact: “Family planning also prevents recourse to abortion. In the Philippines, this could reduce, if not eliminate some 473,000 yearly abortions.”

Abortion can co-exist with the government’s hands-off stance on population concerns. But the most affected will be the poorest individuals and couples in the dirt-poor towns nationwide. As UNFPA data shows, the poorest 20 percent of Filipinos have a fertility rate of about six children compared to their desired number, about four. The haves usually have two children.

UNFPA projects the country would need an average of $2 million a year from 2007 to 2010 to import family planning commodities. These are to be given free or at subsidized prices for the poorest Filipino couples.

In providing skilled attendance at birth, Ms. Mukherjee points up UNFPA’s key focus on MOMS—midwives and others with midwifery skills, including nurses, physicians, and specialist obstetricians and gynecologists.

Properly trained, empowered and supported, “midwives in the community offer the most cost-effective low-technology, high-quality path to maternal health care. The midwife provides essential care during delivery, and can play several important roles by offering immunizations health education, family planning information and promotion on many aspects of healthy lifestyles.

“In fact, many obstetricians and gynecologists readily acknowledge that they learned their midwifery skills from midwives,” she notes.

As of 2004, DoH records show that there were 16,067 government midwives that typically endure low status, poor pay and a lack of support despite enormous responsibilities. The calling call for great stamina, physical and mental strength and the ability to be flexible and ready for the unexpected: an unbooked birth, undiagnosed twins, or complications of pregnancy, she relates.

Running EmOC

“While severe bleeding during childbirth results in the death of the woman in less than two hours, the window period for saving a mother’s life is 6-12 hours. This is where emergency obstetric care (EmOC) proves decisive,” she states.

In running EmOC, fatal delays can be reduced—“failure to recognize the danger signs of pregnancy and childbirth complications, lack of money to avail of emergency obstetric services, lack of transportation to the health facility; inadequate equipment, and lack od staff or inadequately trained staff at the health facility,” cites Ms. Mukherjee.

She informs that the DoH assisted by UNFPA, UNICEF, JICA and Plan International is “still in the initial stages of training health professionals for EmOC—90 obstetric teams have been trined, each team composed of a doctor, a nurse, and a midwife.”

For his part, Dr. Galvez-Tan is batting for a nine-point plan to ensure “quick wins” in enhancing maternal health in the Philippines. These include:

• Make every local government chief executive—at barangay, municipal and provincial levels—accountable for every maternal death that occurs within the political boundary as they are “powerful moblizers of resources, particularly transportation support, communication facilities, social and health referral system linkages and emergency fund allocations”;
• Deploy a trained health professional or a midwife in every barangay;
• Ensure community involvement in maternal care;
• Focus targeting on the poorest, least educated, the most hungry, the most isolated women of reproductive age;
• Establish a network of functional emergency obstetrical care services in key health facilities nationwide;
• Make quality family planning services and contraceptives available, accessible and affordable in all barangays;
• Install community-based financing schemes for maternal health complimented by PhilHealth’s Philippine Health Insurance Program;
• Ensure every girl finishes basic education; and
• Continuously improve the status of Filipino women.

Such quick wins coming at the loss of 10 Filipina mothers on any day ought to help “transform childbirth and motherhood to the valued, joyful moment that it should be.”

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