Fetal, Maternal Deaths in the Philippines, Alarming

MANILA, Philippines — The anti-poverty groups Global Call to Action Against Poverty (GCAP) and Womanhealth Philippines have raised alarm over the reported increase in fetal deaths due to short gestation and low birth weight as shown in the latest study of the National Statistics Office released this month.

"This report punctuates the problem on maternal health that remains a challenge to the government in meeting the United Nations' Millenium Development Goals of reducing child mortality and improving maternal health towards completely eradicating poverty in the country," said Joel Saracho, GCAP Philippines Coordinator.

In a paper that Mercedes Fabros of Womanhealth Philippines wrote, the Department of Health recommends all pregnant women to have at least four prenatal visits, with emphasis on receiving care as early as the first trimester. Prenatal care includes advice to expectant mothers on nutrition and health care, education on the symptoms of risk conditions, examination, screening, immunization and micronutrient supplementation.

"The proportion of women attended by skilled service providers has improved over the past years with almost three fourths or 70.4 percent of women having at least 4 prenatal visits. However, only a little more than half of them or 53 percent had their first visit during the first trimester that is the most critical stage," said Fabros.

GCAP and Womenhealth Philippines have launched a campaign to address maternal and child mortality by weaving the stories of mothers in the communities in a tapestry of tales and help these women reclaim their right to maternal health as provided for in the UN Millenium Development Goals.

The sharing of stories started last Saturday in Barangay Bago Bantay in Quezon City. "We will bring this to other barangays in Metro Manila where maternal mortality and teenage pregnancy cases are high," Saracho said.

According to the NSO study, the National Capital Region (NCR) posted the highest number of fetal deaths with 2,550 cases or 24.6 percent of the total in the country's 17 regions. Regions IV-A and VII ranked second and third with 1,681 and 1,264, respectively.

"As alarming as fetal deaths is maternal mortality that contribute to 14 percent of the total deaths of women aged 15-49. Each day, 10 Filipino women die from pregnancy and childbirth-related complications. These are all preventable if poor women are given access to correct health services," said Fabros.

Threat to life while giving birth

Freda Atienza knew giving birth to her second child will be difficult. Three months into her pregnancy, her husband left her and their eight year old daughter for another woman. She's also been diagnosed as having a cyst in the right ovary. She's been in and out the hospital for excessive bleeding. According to her, she has mastered the art of enduring and suppressing her pain.

On September 21, 2008 at around 11:30 in the evening, her water bag broke. Accompanied only by her eight year old daughter, she sought help from the Ramos General Hospital in Quezon City. She was told there was no bed for her. After three hours, she was referred to the nearby Sioson General Hospital.

Having had a previous caesarian operation, the 37-year old Freda was told that the hospital has no available anesthesiologist. The hospital also asked for P10,000 deposit but Freda said she does not have the full amount. The staff of Sioson Hospital then advised her to go the Quezon City General Hospital but to first go back to Ramos Hospital to ask a nurse to accompany her.

The pain has taken toll on Freda. At this point, she admitted that the staff of the two hospitals were virtually dealing with and giving instructions to her eight year old daughter.

Her daughter decided to go home to ask help from their landlady. She even climbed the terrace leading to the unit of their landlady's house to wake her up.

Her landlady, Nelia Pagulayan, 42 accompanied her to Quezon City General Hospital, where they were told that it was a Sunday, and there is no available operating room for her. There were talks about her being sent to yet another hospital.

But Pagulayan insisted that she be treated in QCGH. Preda was bleeding profusely at that time and Pagulayan feared that she might die on arrival at the next, if there is indeed another available hospital without an excuse to treat her.

Still half-conscious at that time, Freda learned from conversations between the doctor and the staff who brought her to a delivery room that theirs is 40-60 chance.

One of them asks her to pray for a miracle.

"Misis, magdasal ka na kung marunong kang magdasal. Doktor lang kami. Diyos na ang may hawak sa buhay mo," Freda recounted.

A few more minutes later, the doctors are almost ready to give up on her.

"Patay na ako para sa kanila. Pero sinabihan nila akong lumaban alang-alang sa baby ko. Dahil lumalaban siya," Freda said.

At 4:45 am the following day, she gave birth to a boy. She would later learn that the doctors actually forced the baby out of her just to save him. They stayed for several more days in the hospital to ensure that both Freda and her child are now safe.

Child carrying a child

At the age of 13, Ellen (not her real name) is already carrying a child. When Ellen first sought prenatal check ups from a lying-in clinic in Quezon City, she was refused. The staff explained that their policies require them to give prenatal check up to expecting moms who are at least 20 years old.

She was able to get two check ups at the government-run Quezon City General Hospital.

Unlike Freda, Ellen went directly to the QCGH after experiencing pain. Unlike Freda, Ellen was with her husband, who was also a teenager. Fortunately, her parents are with them.

At the hospital, instead of immediately addressing her pain, the staff required her to first get a blood test and a urinalysis. Ellen was also given a list of medicines and things they would need in giving birth.

"Bilhin daw muna bago ako manganak," she said. Ellen's companions were able to buy some of the things they need.

"Kulang pa daw sabi nila. Mabuti na lang naawa iyong isang doctor sa amin," she recounted.

Ellen was told to stay in a labor room, which they later learned has to be paid for P200. The doctor told Ellen that she needs to deliver by C-section, since as she is not yet fully developed as a woman who can give birth.

"Maliit daw ang sipit-sipitan ko. Hindi daw kakayanin ng normal," Ellen said.

She gave birth to a boy.

The hospital however told them that both mother and child cannot leave the hospital until they settle all the bills. Aside from what they already bought, they were to pay the hospital P7,000 for the medicines and another P11,000 for her C-section delivery.

Fortunately, the Social Welfare Administration shouldered the payment for the C-section. Ellen's family paid for the remainder of the bill.

A month after giving birth, Ellen's teenage husband left her and their son.

"It is fortunate that Freda survived her sure death at that time. In her condition and accompanied only by a child, she should have been helped at the least by the two semi-private hospitals that refused her for various reasons," Fabros explained.

Saracho said Ellen would not have suffered too much if QCGH staff exerted the better part of their time assisting her than worrying how to replenish their medical stock. There are more stories, probably worse than what happened to Preda and Ellen.

"We want to give the issue a face. We want our national government and local government units to listen. Something must be done to curb maternal and child mortality. No woman, no mother deserves to die while giving life," said Saracho. (Global Call to Action Against Poverty / pinoypress.net)
http://news.xinhuanet.com/english/2008-05/25/content_8249337.htm

also appeared in The Daily Star - http://www.dailystar.com.b/article.asp?edition_id=10&categ_id=28&article_id=92406