Forced to stay pregnant

Her name is Marlise Munoz, and she is 33, the mother of a year-old boy and pregnant with her second child.

She is also lying in her bed at the ICU of John Peter Smith Hospital in Fort Worth, Texas, in the United States, declared “brain dead” by her doctors.

But Marlise and her ordeal, as well as that of her husband and parents, resonate with Filipino women, who share her condition—pregnant and forced to proceed with it, despite her own personal preferences.

Marlise collapsed on the kitchen floor of her home last November “from what appears to be a blood clot in her lungs,” the New York Times reports.

Despite her own expressed wishes not to be put on life support, which her husband and parents want to respect, doctors told them that the hospital could not comply with their wishes. Texas, it turns out, is one of more than 20 states that prohibit “medical officials from cutting off life

support to a pregnant patient.”

The case, observes the Times, “has become a strange collision of law, medicine, the ethics of end-of-life care and the issues swirling around abortion—when life begins and how it should be valued.”

Marlise’s parents, Lynne and Ernest Machado, are understandably upset at the situation. “It’s not a matter of pro-choice or pro-life,” said Lynne. “It’s about a matter of our daughter’s wishes not being honored by the state of Texas.” Said Ernest: “All she is is a host for a fetus. I get angry with the state. What business did they have delving into these areas? Why are they practicing medicine up in Austin?”

Caregivers have told the family that more than an hour may have elapsed from the time Marlise collapsed and her husband Erick woke up and found her. In that case, the fetus, which has not yet reached the stage of viability, may have been irreparably harmed.

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There are no statistics on the number of pregnant women in the Philippines kept on life support because they were pregnant. Some women in similar situations in the United States who had fallen into a coma were kept alive and successfully delivered their babies, although in all cases, doctors stress, this was done only in accordance with the women’s wishes and those of their families.

I have heard of stories, though, of local doctors attempting “heroic” measures to keep a fetus alive while gestating in the wombs of their brain-dead, comatose, or fatally ill mothers. Doctors tell me, though, that the old dramatic cliché of a husband being made to “choose” between the survival of a baby or its mother is no longer practiced. “Nowadays, we try to save the life of both mother and child, but tend to try to save the life of the mother if we have no choice,” one doctor-friend told me.

But the law, policy and social attitudes in the Philippines do “force” women to carry their pregnancies to term, even if it is against their wishes, or if the pregnancy threatens their survival.

In the first place, under the law, abortion is illegal, and even if only by statute, a medical practitioner, caregiver, the institution and the mother are liable and considered criminals. Still, despite this stringent regulation, some half-a-million women are estimated to undergo an induced abortion here, each year.

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There are other ways to force pregnancy on women.

Getting a woman pregnant, through forced or coerced sex or by withholding the contraceptives she needs is one such way.

Currently, while the total fertility rate (TFR) in the Philippines has decreased from 7.2 children per woman in 1960 to 3.1 in 2010, current rates remain the highest among Southeast Asian countries. Our neighbors have managed a more rapid and drastic decline in the number of births per woman: 1.80 in Vietnam, 2.61 in Malaysia, and 1.20 in Singapore (all for 2011).

The National Statistical Coordination Board, in an analysis of the latest population census, says that “even if the TFR continues to decline in the Philippines … replacement fertility levels (of 2.0 births per woman) will only be reached by 2040… The effects of population momentum will still persist another several decades before a demographic winter (when population ceases to grow) begins.”

In the meantime, some commentators have said that a growing population (based on estimates that we will reach 100 million before the year ends) is not necessarily bad, since a young, productive and growing population could produce a dynamic economy.

But this can come to pass only if enough jobs are made available, here or overseas, while “gains in living standards can be made if the working age population will be equipped with sufficient education that will provide them opportunities for decent employment.”

It’s a vicious cycle, indeed.

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We know what it will take to speed up the advent of the “demographic dividend” in this country: universal access to quality education, quality health care, a sustainable environment, enlightened economic policies, and wise and inclusive development.

But we also know the many obstacles that need to be overcome: the lack or absence of political will to address the reproductive health needs of our people, continuing deterioration of our educational system, corruption and degradation in the delivery of basic services, environmental deterioration, including failure to mitigate the worst effects of global warming, and the constriction of democratic space.

We are caught between these competing spheres, both the promise and the perils. But we can choose what path to follow. And in choosing the right path, we can always follow where the women want to go: the path of choice, freedom, autonomy and decision-making.