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Pinoy Kasi
Mothers and elections

By Michael Tan
Philippine Daily Inquirer
First Posted 23:58:00 05/11/2010

Filed Under: Elections, Women

THE SATURDAY BEFORE ELECTION DAY, I WAS WATCHING a CNN newscast where they featured the latest ?State of the World?s Mothers? from Save the Children, which ranks countries from the best to the worst for mothers to live in.

The newscast reminded me of how close Mother?s Day and election day are in the Philippines; yet its symbolism is always overlooked. The health and welfare of mothers should be a primary issue in every election and now that we know, more or less, who our new crop of leaders will be, health groups should be preparing concrete proposals for the politicians, from the president down to city and municipal mayors and councilors, on ways of improving the situation of Filipino mothers.

Save the Children is a large non-government organization found in several countries. They started out mainly to get people in developed countries to support children in poor countries, a kind of distance adoption. Through the years, they have diversified toward programs with stronger self-help components. Their special interest in children inevitably led them to look as well at maternal health.

Mother- and child-friendly

The 2010 ?State of the World?s Mothers? report is the 11th international yearbook that has been produced. By ranking countries according to how ?mother-friendly? they are, they are in effect also evaluating how ?child-friendly? they are.

The rankings use various indicators around women?s health status, women?s educational, economic and political status, and children?s well being. The results? Norway, Australia, Iceland, Sweden and Denmark topped the list while at the bottom were Afghanistan, Niger, Chad, Guinea-Bissau and Yemen.

The Philippines ranked 48th among 77 ?less developed? countries, down from 42nd in last year?s ratings. There should be reason for alarm here. Our maternal mortality rate (the number of women who die during pregnancy or labor) is still very high with about 4,000 each year. That?s more than 10 maternal deaths a day.

Most deaths occur among the poor, but even the upper classes are not spared. The daughter-in-law of Makati Mayor Jejomar Binay was one of those mothers who died last year.

The consequences can be devastating: each maternal death is amplified many times over because of the children and family members left behind.

The statistics over the last 20 years have not been encouraging, showing very slow progress in bringing down the number of deaths. Even less attention has been given to illnesses and the many other health problems that women face as part of motherhood: hypertension (high blood pressure), severe anemia, calcium deficiency, to name a few. In addition, women?s immune systems are weakened during pregnancies, making them more vulnerable to a wide range of infectious diseases, from malaria to tuberculosis.

Health worker shortage

The usual reasons given for poor maternal health is the lack of access to services and facilities. Save the Children?s latest report goes a step further to remind people that the problem is often a shortage of front-line health workers, particularly midwives and community health workers. The report notes that for every 10,000 people, there should be a minimum of 23 doctors, nurses and midwives. In the Philippines, we have towns with 30,000 to 50,000 people without a doctor, and perhaps one or two nurses and midwives.

The frontline workers (midwives and community health workers) play a particularly crucial role providing health education, home visits and close monitoring of high-risk pregnancies. The best frontline workers are women, preferably those who come from the community itself.

This focus on health workers has special significance for the Philippines, given the irony that we produce so many health professionals and workers, from physicians and nurses to caregivers and community health workers, yet continue to lag behind many of our neighbors when it comes to maternal and child health.

The main reason we have a shortage is brain drain. We produce health professionals and workers mainly for export, to care for other countries? children, elderly and the sick. Save the Children notes that 85 percent of our nurses ?leave to pursue better pay and higher standards of living overseas.? I think the figure is much too high, but there is no doubt that we are losing too many of our nurses and other health professionals.

Our new leaders will have to re-think our human development policies around health. There?s no way we can stop our health professionals from leaving to work overseas, but we also have to find ways to make it worthwhile to stay. The health professionals I have talked to, including those who have worked overseas, say that there?s more to their choices than dollars. They will stay with decent pay, a work environment that doesn?t overload them (and compromise quality of care), and a system that recognizes merit, with career advancement.

I am also wondering about the quality of training we have, given the many diploma mills that have sprouted for nurses and caregivers in particular. One would think that with the thousands of graduates from these courses, we would have seen an improvement in health literacy among Filipinos because these graduates would at least help educate their own families and communities. Instead, we still have massive misinformation going around on vital public health issues, maternal and child health in particular.

Finally, our new leaders will have to show they are serious about getting more Filipinos to work with the poor, whether in urban slums or remote rural areas. Special incentives will help, and I would push for hardship pay even for urban poor areas, where the work can be more difficult than dealing with residents in some remote mountain sitio.

Besides incentives, health workers serving in such areas need to be assured that they will not be harassed by the police and the military. The recent raid on a training session of health-care workers in Morong, Rizal, and the maltreatment of the arrested workers remain a festering issue that will keep health professionals away from ?hot spots.?

The military continues to insist that the health workers they arrested in Morong were subversives, and as ?proof,? keep pointing to their low educational attainment. We need a new and enlightened leadership in the military who will make an effort to understand how they can contribute to, rather than hinder, public health. They should be made to read the Save the Children 2010 report, which emphasizes that it?s community health workers with very little formal education who are making a difference in saving the lives of many mothers and children.

Our message to our new leaders should be brief but unequivocal, and I?m borrowing this from the UN Population Fund: No woman should die giving life.

The Save the Children 2010 report can be downloaded from www.savethechildren.org/publications/state-of-the-worlds-mothers-report/

Save the Children Philippines produced a more specific ?State of Filipino Mothers? report in 2008, with rankings by province.

Email mtan@inquirer.com.ph

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