Story of Digna (And other mothers in coffins)

MANILA – This is not her story, Adelaida Alhambra, 32, a resident of San Mateo, Rizal, clarified to me.

But she said: the story is very close to her heart, for it is the story of a person who had been very close to her: Digna, a former playmate and a childhood friend.

Pareho kaming namuhay sa isang mahirap na komunidad sa San Mateo (Digna is a playmate, a childhood friend),” Adel started her story. A pause of silence followed. She made a sigh, and then continued Digna’s story:

Sa edad na 16, at katatapos pa lamang ng high school, nag-asawa siya at nabuntis. Labing-pitong taong gulang lamang siya nang magsilang ng isang anak na babae, si Jonna. Dahil sa kahirapan, tulad ng ibang karaniwang babae [sa aming komunidad], sa bahay lamang siya nanganak, sa tulong isang komadrona (At the age of 16, just finishing her high school, she had her a husband and became pregnant. She gave birth to a baby girl, Jonna at the age of 15. Due to poverty, she gave birth to her daughter in their home, with the help of a midwife).”

The joy of motherhood, for Digna, Adel said, did not last that long. Why? She continued the saga of Digna’s life:

Ilang araw pa lamang siyang nakakapanganak, nagtrabaho na siya sa bahay.  Nilagnat siya nang pabalik-balik at sa pang-labing-apat na araw, pagkapanganak niya, binawian siya ng buhay. (Just a few days, after giving birth, she was already doing the house work. She had fever, and that fever came repeatedly. On the 14th day, she died).”

Another short pause, before she has afforded to continue Digna’s tale.

Hindi man lamang siya nadala sa doktor, dahil sa kawalan ng perang pampagamot. Ang sabi ng matatandang kapitbahay [namin], namatay siya dahil nasumpit ng hangin. (She has not been sent to a doctor for a checkup because they cannot afford to pay. The elders in the neighborhood said, she died because she was struck by a bad wind).”

She has given another sigh, and then continued storytelling.

Dalawang buwan pagkalibing ni Digna, bumalik ang asawa niya sa mga magulang nito at iniwan ang anak sa kanyang biyenan, si Aling Beth. Ang biyudang si Aling Beth, ang nag-alaga sa bata dahil tuluyan nang pinabayaan ng ama… na nag-asawa ulit. Sa pamamagitan ng pagtitind ang balut sa gabi at paglalaba at pamamalantsa sa araw, mag-isang itinataguyod at pinag-aaral ni Aling Beth si Jonna. (Two months after Digna’s burial, her husband returned to his parents and left the child to his mother-in-law, Aling Beth, a widower. She has taken care of the child, who was completely abandoned by her father who had himself another wife. By selling one-day old egg at night, doing laundry and ironing clothes by the day, she sends the child to school.)

Horrible statistics

Digna is only one of the 4,000 mothers (or 11 mothers daily) who die annually due to pregnancy-related complications, orphaning almost 12,000 children.

The Save the Children-Philippines, a non-profit organization that advocates the promotion and protection of children’s and their parents’ rights and welfare reports in 2008, the leading causes of maternal death are blood loss, infection and hypertension.

Save the Children explained, these deaths occur mostly during labor and within the first hours and days of delivery.

Though deliveries in health facilities, such as hospitals and lying-in clinics, are crucial to ensuring that complications during and after childbirth are addressed immediately, only 38.8 percent of all births are delivered in these facilities. Only 22 percent of deliveries in the rural areas are done in health facilities and 54 percent in the urban areas.

Like the case of Digna, who gave birth at her home in San Mateo, she has no access to vital resources and facilities such as skilled birth attendance, emergency obstetric care and blood supply.

Distance, shortage of health workers and essential supplies like blood, emergency obstetric medicines, midwifery kits, etc. are among factors that prevent mothers from accessing the care they need, say Save the Children report.

The 2003 Health and Demographic Survey (2003 NDHS), the health survey conducted by the National Statistics Office, the United States Agency for International Development (US Aid), and ORC-Macro, an agency specializes in health and development polls, said despite the increase of birth deliveries with the help of health professionals (six out of 10 births or almost 60 percent in 2003-2004) it remains lower than the target by the Department of Health (DOH) which is 80 percent.

Her friend Adel failed to mention if Digna had had an antenatal during the time of her pregnancy, which also crucial in preventing maternal mortality.

“Many mothers in developing countries die because they do not have access to quality antenatal care… many cannot afford it, or simply do not know about it,” the Save the Children stated.

Just like Adel, she cannot afford to have that service because of poverty.

Danger signs of pregnancy and childbirth remain unnoticed

Adel, meanwhile, failed to inform this reporter if her friend, Digna, knows the danger signs, connected to pregnancy and childbirth.

The 2003 NDHS said only five out of 10 women in the Philippines are informed about the danger signs of pregnancy which include vaginal bleeding, headache, dizziness, blurred vision, swollen face, swollen hands, and paleness due to anemia.

The 2003 NDHS also reported 43.9 percent of pregnant women in the country has iron-deficiency anemia (IDA). IDA, health experts said, increases the risk of maternal death due to hemorrhage (bleeding) during or after delivery.

The Save the Children-Philippines reports, 23 percent of maternal deaths in Asia results from anemia.

Young mothers have higher risk of death during pregnancy and birthing

“Anemic and adolescent mothers face an even higher risk of dying,” says Save  the Children-Philippines.

The DOH in 1999 stated, three out of four pregnancy and/or childbirth related deaths happen to 15-19 year old women.

Three other studies, namely he Lancet’s Maternal Survival Series (2006), the 2005 World Health Report: Make Every Mother and Child Count (World Health Organization or WHO), and the WHO-United Nations’ Children’s Fund (Unicef)-United Nations Population Fund (UNFPA) maternal mortality estimates from 2000, said that girls aged 15 – 20 are twice as likely to die in childbirth as those in their twenties and girls under the age of 15 are five times as likely to die.

In the Young Adolescent Fertility and Sexuality Study 3 (YAFS 3), it is stated that 10 percent of adolescent had been pregnant by the age of 18; 25 percent by the age of 20; and 48 percent by the age of 24.

It is also said in YAFS 3, pregnancy among adolescents is more common among the less educated youth (see table below).

The YAFS 3 stated that the lower the education of the girl is, the more that she gets pregnant easily. (Table extracted from Survey Methods and the Young Adolescent Fertility and Sexuality Study (YAFS), by Grace T. Cruz, Ph. D., of the UP Population Institute; accessed July 25, 2009)

The YAFS 3 stated that the lower the education of the girl is, the more that she gets pregnant easily. (Table extracted from Survey Methods and the Young Adolescent Fertility and Sexuality Study (YAFS), by Grace T. Cruz, Ph. D., of the UP Population Institute; accessed July 25, 2009)

Digna, as this reporter mentioned earlier, got married at the age 16, just after graduating from high school.

Low spending on health care services also risk mothers’ and children’s lives

Meanwhile, giving birth to a health facility doesn’t guarantee safe birth.
The Special Release No. 320 of the National Statistics Office (NSO), released on February 19, 2008, titled Maternal Deaths 2004, it says: “Most maternal deaths were attended to by hospital authorities (1,096 cases or 59.8%). Those that were not medically attended totaled to 676 or 36.9 percent. Physicians and public health officers attended to 45 (2.5%) and 12 cases (0.7%) of maternal deaths, respectively.” (See table below)

(Extracted from Special Release No. 320 by the NSO; accessed July 25, 2009)

(Extracted from Special Release No. 320 by the NSO; accessed July 25, 2009)

Save the Children explained this phenomenon because of the low priority given by the national and local government units to quality health care, which includes maternal and child care, as reflected by low government investments in health-related initiatives.

Citing the data from the DOH, Save the Children said, that the Philippine government only spends 3.3 percent of the country’s gross domestic product (GDP), lower than all Southeast Asian countries, except Myanmar (Burma).

“This does not meet one of the WHO’s indicators for adequate health coverage where at least five percent of a country’s Gross National Product (GNP) is spent on health,” Save the Children furthered.

Delay of the passage of reproductive health bill worsens the situation

The Philippine Legislators’ Committee on Population & Development Foundation, Inc. (PLCPD) said the continued delay in the passing of House Bill 5043 and Senate Bill 3122, or the Reproductive Health Bills (RHB), means more mothers in coffins in the days to come.

The bill authored by Albay Rep. Edcel B. Lagman Sr. in House of Representatives and has been signed by 133 congresspersons, including the party-lists and by Sen. Rodolfo Biazon, advocates a comprehensive range of programs and services addressing sexual and reproductive health, including education and universal access to both traditional and modern family planning services.

Ramon San Pascual, PLCPD executive director said in a press conference prior to the civil society’s “State of the Nanay’s (Mother’s) Address” held in UP Bahay ng Alumni last July 22, they will make a stronger push and pressure Malacañang to certify the Reproductive Health Act of 2008 as urgent.

But he fears that Mrs. Arroyo will do so because of its alleged fear of the Roman Catholic Church (RCC). The RCC has been blocking the passage of the bill due to moral issues.

Moreover, San Pascual also fears that the RCC will bargain its support for Charter Change, which now brews in the HOR, for the non-passage of the RH bill.

He said there are already indicators of this scenario.

“The missing RH agenda in the opening of the Congress, notwithstanding Speaker (Prospero) Nograles’s promise to the advocates that he will expedite the passage of the bill in Congress and the sudden passive stance of the bishops on the issue of Cha-Cha, are portents of the scenario that will unfold before our very eyes. Although we will not make it happen,” he said.

But San Pascual did not disclose much detail about the bishops and/or archbishops who will give their nod to Cha-Cha, in exchange of the non-passage of the bill.

Nonetheless, in their spoofed SONA or State of the Nation’s address by Mrs. Arroyo in UP, the advocates still hope that the 10 years of struggle for the creation of an RH law will not go to waste, and that Mrs. Arroyo will sign the controversial bill.

However, upon writing this piece, sad news came via email saying: “Today, July 24, we lost one of our great friend and comrade Maolin Bustamante. It has come to our knowledge that she succumbed this afternoon due to complications delivering her child. Their child with Mark survives, but Maolin’s health deteriorates after the delivery due to some poor health conditions prior to this circumstance.”

And the words in the introductory part of the Chapter 3 of the World Health Report 2005, again, came to me, stating:

“Pregnancy is not just a matter of waiting to give birth. Often a defining phase in a woman’s life, pregnancy can be a joyful and ful?lling period, for her both as an individual and as a member of society. It can also be one of misery and suffering, when the pregnancy is unwanted or mistimed, or when complications or adverse circumstances compromise the pregnancy, cause ill-health or even death. Pregnancy may be natural, but that does not mean it is problem-free.” (Dateline Philippines)