Sometimes, mothers die during childbirth not only because they bleed excessively or suffer from hypertension or infection, but also because there just wasn’t enough time for them to reach a hospital or health facility where they could receive the needed care or medical attention.
Or it could also be because of a missing bridge.
During a recent media training in Baguio where I was a speaker, I asked the participants—all of them personnel of the Department of Health in the Cordillera Administrative Region (CAR)—to divide themselves into groups, and together each write a “feature story” illustrating the issues involved in a project (of the DOH and JICA, the Japan International Cooperation Agency) focusing on maternal and child health.
One of the groups had a rather dramatic title: “If Only There was a Bridge!” It told the story of a couple in a remote barangay of Kabugao, the capital town of Apayao province, who had been preparing for the birth of their first child. They had dutifully boarded a banca and crossed the river to the town proper where the wife went for her prenatal consultations. Unfortunately, her birth pains started up just as a storm began brewing in their area. There was a midwife present at the wife’s side, but the midwife quickly recognized that the mother-to-be’s condition needed more care than she could provide. But a banca trip across the storm-tossed river was much too risky, and they decided to wait out the storm. By the time it was possible to cross the river and bring the mother to the town proper, she had lost too much blood and passed away. “If only there was a bridge!” moaned the young husband, who not only lost his wife but was facing the difficult task of raising his firstborn all by himself.
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Another story, accessed through the website Rappler.com and written by freelance journalist Rochit Tanedo, relays the first-person account of Abdul Ibno, 29, a tricycle driver and mason who lives in Patikul, Sulu.
Shortly after noon that day, recalls Ibno, his wife Catherine, 23, told him to fetch their “panday” (the local term for a “hilot” or village midwife) as she was beginning to feel abdominal pains. When the panday arrived, she ordered Catherine to lie down and rest, and within less than an hour, the contractions began.
“I knelt behind her, and she clung to my forearms as she pushed,” recalled Ibno. When the baby came out, “I thought it looked purplish,” said Ibno, but the panday whacked the baby’s butt and it began to cry. Catherine began hyperventilating and Ibno brought the infant to her to start breastfeeding.
Shortly after, he recalled, the panday ordered him to buy some amoxicillin, explaining that his wife was undergoing internal bleeding. When he got back, Ibno saw his wife was fading fast and decided he should rush her to the hospital, about 11 kilometers away, and contracted a jeepney for P150. “The doctor saw us right there in the lobby,” says Ibno, “he ordered the staff to put an intravenous drip on Catherine and oxygen too.” All this time, Catherine seemed oblivious to what was happening all around her.
Again Ibno was ordered to buy medicines for his wife outside the hospital. But even before he could leave the drugstore, his cousin who had joined him in bringing Catherine to the hospital approached him and told him to just return the medicines because his wife had passed away.
When he got to the hospital, Ibno was told the staff wanted to do an autopsy to determine what caused his wife’s death. “I refused, what was the use?” Ibno said. “I needed to bury her before sundown.”
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These stories, to me, illustrate the complexity of maternal mortality, and the interlocking factors that put mothers at risk. There are many reasons for mothers dying during pregnancy, and during or soon after childbirth. These include the lack of infrastructure like bridges and roads, means of transportation, and even unnecessary delays in recognizing signs of a crisis and in deciding to transport the mother to the hospital.
It is no accident, though, that these accounts involve mothers in the CAR and the Autonomous Region in Muslim Mindanao, two of the poorest areas in the country, and which rack up the highest maternal mortality rates. Poverty certainly has a lot to do with the lack or absence of infrastructure and transportation, as well as an inadequate health care system. But culture also plays a part, including the insistence on relying on untrained village midwives to attend at births, and the subordinate status of women that puts their needs last among the members of the family.
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The “road” to maternal mortality begins long before delivery. It begins even before a woman gets married or pregnant. It starts in childhood, when gender determines a girl’s status in the family and access to education. After puberty, she may not receive the information and education she needs to make responsible choices about sexuality and health.
When she reaches marriageable and reproductive age, a young woman may not have access to contraceptives (if she thinks about it at all), or may even think she needs the “permission” of her husband or partner, parents or in-laws before using protection. Neither may she have been oriented on the need to “space” her pregnancies, if only to protect her health and that of her children.
So by the time a mother is lying in bed, delivering her baby, where, as the saying goes, she has put one leg in her grave, in many ways, it may well be too late to save her.
Unless, somewhere down the road, someone or some institution reached out to her and gave her the means to save herself—with or without a bridge.