Maternal concerns: A look into the urban complexities of pregnancy and healthcare for women

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Pregnancy and all its implications can all together be difficult to bear by women who live in varying social and economic conditions.

To some it’s a joy; to others, it’s a result of cascading life situations that seem to be out of control.

Pregnancy covers health, social and psychological issues that many women have long been living with.

In time for the International Day of Action for Women’s Health, Gabriela representative Luzviminda Ilagan said that there is a need to look into health access for women.

“Filipino women’s access to healthcare services and malnutrition have gone from bad to worse in the past few years,” she said. “Unemployment, poverty and hunger have resulted to widespread malnutrition among Filipino mothers and their children.”

Ilagan expressed her alarm over a recent survey released by the Food and Nutrition Research Institute (FNRI).

She said the study revealed that one of every four pregnant Filipino mothers is nutritionally at risk. The same survey revealed that the incidence of malnutrition increases among the younger mothers and especially among those in the lowest income brackets.

According to a Gabriela press release, “almost four out of ten or 37.2% of young pregnant women aged 20 years old and below are nutritionally at risk. The prevalence of malnutrition among women in the lower income bracket is at 30% and 14.4% among women in the higher income brackets.”

“Amid such malnutrition and poverty exacerbated by the inaccessibility of healthcare services, it is not surprising that maternal mortality rate in the Philippines is now at 221 for every 100,000 live births,” said Ilagan.

Gabriela also pointed out that malnutrition among pregnant women, the lack of key nutritional supplements, deficiencies in iron, iodine, and calcium have been found to have adverse effects on a women’s pregnancy and delivery. The risk of mortality due to hemorrhage and eclampsia is high among malnourished women.

Gabriela held a women’s health fair last May 28 at the Davao Medical School Foundation to commemorate the International Day of Action for Women’s Health.

Ilagan said that there is no sufficient access to affordable healthcare throughout the country—especially now that private sectors and big businesses are integrating control into public hospitals.

It also doesn’t help that more and more women continue to suffer the cascading problems brought about by insurgencies and displacement, creating hostile situations for them—even in evacuation centers.

The potential solution that she sees is to ensure that the budget for health is properly allocated and is set as a priority as it trickles from the national level to the local areas.

To her, women’s health encompasses well-being. It also covers the important process of pregnancy—and all the other issues that surround it.

This was the main topic of various stakeholders this week when they all gathered to come up with an action plan to address healthcare access and teenage pregnancies.

The need to be educated

CHO population officer Jeff Fuentes said that teenage pregnancy reflects other problems in the community; its increase is attributed to the lack of access to correct information of teens. There is also an interplay of cultural tradition (by tribal) women in this increase.

This is proposed to be solved by conducting special health dialogues and making information campaigns to specific groups of people regarding pregnancy.

And when not enough care and concern is given to these teenage mothers-to-be, maternal deaths are inevitable.

Maternal deaths continue to recur, but CHO chief Josephine Villafuerte is hoping that one, day, this will end.

“No woman should ever die because of childbirth,” she said. To her, everything about pregnancy—from conceiving to raising a child—should be thoroughly prepared.

Contrary to Ilagan’s statement, Villafuerte said there is more than enough budget to cover women’s health but “it’s the national government that handles this and not the local government.”

One of the challenges that Villafuerte sees is the lack of manpower. She said that the number is just not enough.

Women’s access to health, she said, is different when they’re in the poblacion area as compared to when they’re in Marilog where they have to walk long distances.

The health center situations vary per districts; in some remote areas, it’s the doctors who traverse long distances on specific occasions to deliver medical services. On regular days, the patients themselves have to make the long journey.

Can’t go the distance

Three women who live far from the city’s downtown area narrated their experiences in accessing health services from their side of the city.

Panacan resident Alma Tilos, 41-year-old mother of three, said that there is a health center near their barangay, except that their definition of “near” is a distance that requires two or three rides to traverse.

She lives in barangay Ilang, a community of about 10,000 individuals within a 3.9-hectare area.

Their health center offers basic services and has made medicines and immunization shots available for pregnant women like her. For Tilos, however, the distance to the health center is a challenge. Fare and time are luxuries that she can’t afford, especially when accessing services that go beyond pre-natal care.

This took a toll on her in 2007 when she was bearing her third child. On the day that she felt that she was going to deliver, she took on the long journey from her house to the city’s downtown area to reach the Southern Philippines Medical Center (SPMC).

Unfortunately, her baby didn’t make it; the unborn child was declared dead on arrival.

Tilos said that early pregnancy is also an issue that proliferates in her community; girls as young as 14 get pregnant; she points out poverty, influence of peers, and lack of sex education as the causes.

Arlene, 44, another mother of three, echoed the sentiments of Tilos. She said that access to health services requires her to ride a motorcycle and walk long distances. Trips to SPMC often take two to three hours for only one way.

Meanwhile, Gina Soldawan, 19, who is bearing her first child, said that the health center in her community in Tambungon, Lasang caters to the needs of pregnant women like her. However, distance and access continue to be challenging. For her, money to spend for transportation is hard to come by.

The situation draws itself to be even more difficult to bear in Pacquibato, Marilog, and Baguio districts–areas in the city that the CHO pointed to have high number of teenage pregnancy cases.

More manpower, please

Villafuerte said that for medical services to become available, trained personnel have to go out of their way and tread their own paths just to reach communities in far-flung areas. She said that there are currently 165 health centers in the city; there are also infirmaries in barangays.

But Villafuerte reiterated that manpower is not enough. “Kulang jud sya,” she said.

Based on standards set by the Department of Health, these are the number of medical personnel required to cater to certain populations: there should be at least one doctor, one nurse, and one dentist for every 20,000 individuals; there should also be one midwife for every 500 individuals.

According to the 2014 annual report of the CHO, these are the numbers of personnel from the department that are deployed throughout the city: 28 doctors, 16 dentists, 101 nurses, 103 midwives, and 26 medical technologists.

The same report said that based on DOH’s standards, there is a deficiency of 53 for doctors, 63 for dentists, zero for nurses, 212 for midwives, and 53 for medical technologists.

Pregnancy and its complexities

Villafuerte briefly talked about the physical and social complexities of pregnancy during the interview for this story. But she clearly said that pregnancy is everything but a disease.

To her, it should be planned so that women know how to take care of themselves with support by medical services.

When a woman is pregnant, it is important for her to know her health status—whether she’s at risk of certain diseases, whether the delivery will be normal, and whether there will be other health concerns to be considered.

Even with the available technologies, there is no way to clearly see the baby inside the womb. “Pregnancy needs to be planned,” she said, adding that there are pre-existing methods to make this less of a burden and to keep health complications at bay.

Addressing all the other issues that surround pregnancy—like rape, for instance—requires collaboration with concerned sectors and local government units.

Ideally, pregnancy is a happy affair, Villafuerte said. But when it’s a result of rape, it’s the kid that suffers; sometimes, the child is not loved.

This is where social services come in.

Lorna Mandin, officer in charge of the Integrated Gender and Development Unit of the city said in a multi-sectoral stakeholders forum on Thursday that concerned groups are collaborating to come up with long-term and short-term interventions against unwanted teen pregnancies.

There is also a need to strengthen partnership with schools and barangay who know their citizens better. She said that it’s important to inform the affected populations of risks and clear out any misconceptions before these proliferate.

Meanwhile, councilor Maria Belen Acosta, chair of the city council committee on education, reminded the public that there are special services that young mothers can sign up should they decide to go back to school.

These educational services teach them technical skills and certain home-based livelihood programs. “It’s not limited to formal education,” she said, referring to her Abot Alam program, a 2014 program that brings together help from various agencies like DILG, TESDA, DTI, and DepEd.

When young mothers sign up for this, they’re able to help themselves keep post natal depression away; this psychological “illness” is caused by severe drop in hormone levels.

It is important to keep in mind that pregnancy is not just about reproduction or a happy affair. There is a social and health system that needs to be considered not just by the mother and the father but by everyone in the community as well.

Words to ponder

“… teenage pregnancy reflects other problems in the community; its increase is attributed to the lack of access to correct information of teens.” CHO Jeff Fuentes

“It also doesn’t help that more and more women continue to suffer the cascading problems brought about by insurgencies and displacement, creating hostile situations for them—even in evacuation centers.” Gabriela partylist Rep. Luz Ilagan (Jesse Pizarro Boga/MindaNews)

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