MANILA, Philippines--THE CHRISTMAS story really revolves around a maternity story, and a high-risk maternity at that. To begin with, Mary was young (scholars estimate her age at 14 when she became "with child") and thus was already at high risk. (On the other hand, her aunt Ann, whose first pregnancy occurred when she was already "old," likewise was at high risk.)
Having joined her husband in a long, arduous journey from Nazareth to Bethlehem, Mary was further put at risk when she was forced to deliver her baby in unsanitary conditions (you can't get any dirtier than in a manger) and without skilled assistance. After all, even if he had thought of getting a birth attendant, Joseph would have been hard put finding one in a place where he was a stranger. Young, fatigued, with only her husband (and a few angels and shepherds) by her side, Mary's survival and that of her baby, was in itself a miracle, even if only in medical terms.
But while the miracle of Jesus' birth is celebrated yearly, and according to tradition heralded by angels and attended by shepherds and wise men, the birth of "ordinary" babies in this country--by many estimates two million a year--is taken for granted. Sadly, so are the deaths of many of these babies' mothers. Maternal mortality, the deaths of our nanay (mothers) due to causes related to pregnancy and child birth, is a continuing scandal that most of us seem to be unaware of, or choose to ignore.
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WHILE our maternal mortality rates have been falling, they have been falling too slowly, so much so that our neighboring countries, which have taken more decisive action to bring down maternal mortality, have left us behind.
Health Undersecretary Dr. Mario Villaverde, who was part of the Philippine delegation to the "RHCS Advocacy" workshop in Bangkok, says the health department takes the problem of maternal mortality so seriously that "we now consider every pregnancy and delivery as high-risk."
Still, the risks for nanay remain high. Seven out of 10 births here take place at home, with 45 percent of the mothers attended to by "traditional birth attendants" or TBAs, more commonly known as "hilot." Women die during delivery, says Dr. Villaverde, because even women who don't exhibit any problems during their pre-natal checkups can suddenly develop complications. It takes a trained health professional, or a highly compassionate hilot, to recognize signs of these complications and rush the women in time to a health facility where they can get help.
The trouble is that many hilot may persist in caring for the mothers under their care even in the face of problems, because turning them over to a hospital will mean a loss of income for them. "That is why any solution to maternal mortality must involve compensating the hilot so she may more willingly rush women with problems to a health facility," says Dr. Villaverde.
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IN SOME cases, the hilot may want to rush a woman to a hospital, but they live in a remote village without roads, or no form of transportation is available.
Why do women continue to give birth at home? The answer, surprisingly, is not just cost or convenience, but also "quality of care." "Many mothers feel they are not treated well in a hospital," admits Dr. Villaverde, "they prefer giving birth at home where they can find comfort from the hilot they have known all their lives, and from their mothers and other female relatives."
Our nanay die, then, because of the same reasons poor "Mrs. X" in my previous column died. They die because they don't have the capacity or ability to decide for themselves--whether they should get pregnant and whether they can space their pregnancies. They die because they are in poor health, and with anemia and poor nutrition affecting almost half of all pregnant women. And our nanay die because the system fails them many times along the way to delivery: in providing pre-natal care, in providing enough hospital beds or trained attendants during delivery, and in providing quality emergency obstetric care when a crisis occurs.
Where are the angels attending to our nanay and singing of the miracle of their survival?
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"BUILDING Partnerships for Effective Local Governance" is the theme of Panibagong Paraan 2008, the annual search for innovative ideas to address development challenges.
Deadline for the submission of entries, in the form of concept papers, is next Saturday, Dec. 22.
Winners of "Panibagong Paraan," sponsored by the local World Bank office in cooperation with other international agencies, embassies and development offices, will win up to P1 million to be used to turn their innovative ideas into action within a year.
Civil society organizations, educational and research institutions, local government units--or any of them working in partnership--are invited to send proposals under any of the following categories: governance and administration, delivery of basic social services, economic development, environmental management, disaster risk reduction and rehabilitation, and population and development.
From the submitted project proposals, semi-finalists will be selected and asked to submit full-blown proposals. After a screening process, the field will be further narrowed down to finalists who will be asked to take part in a two-day exhibit during which a panel of jurors will evaluate their entries and select the winners.
Entries should be submitted via e-mail or courier/mail/hand delivery to dimp@worldbank.org, cc: dimp2008_wb@yahoo.com or to the Panibagong Paraan 2008 Secretariat, 23rd floor, Taipan Place, F. Ortigas Jr. Road (formerly Emerald Ave.), Ortigas, Pasig (Please indicate Subject as: Project Grant Competition Entry).
More Inquirer columns
Previous columns:
Why ‘Mrs. X’ died – 12/14/07
Migrant nation – 12/12/07
Markets and gifts – 12/09/07
Boarding the e-jeepney bandwagon – 12/07/07
‘I am fighting for you’ – 12/04/07
