Caring for the caregivers

Who cares for our caregivers? What happens to a family when the mother—usually the primary caregiver—falls ill or, heaven forbid, passes away?

It’s said that when a mother dies, say, at childbirth, the life not just of the newborn infant but of all her living children and of her family is put at risk as well. It isn’t just the mother’s absence that threatens the life of the baby. Apart from having to deal with the scarcity or absence of breast milk, the baby must cope as well with the lack of proper care and nurturing, which involves not just food and pampering, but affection, too. Indeed, a study of babies who had to spend their first days in incubators found that the lack of “cuddling” was as much a health factor as the baby’s fragile state and feeding difficulties. This was why many hospitals adopted the practice of taking out “preemies” from time to time so they could be carried, giving them much-needed warmth and human contact.

The overall health and emotional equilibrium of surviving children are compromised as well. The level of maternal care certainly falls, and without relatives intervening or fathers stepping up to their “natay,” or nanay-tatay (mother-father) role, the children will be left to fend for themselves, having to deal with questions about their mother’s sudden absence by themselves.

Too often, the father’s response to the death of his spouse is to seek another partner, who he hopes will step into the breach of the missing mother. Not such a good beginning for a relationship, admittedly. Otherwise, an alternative is to break up the family, with relatives—propelled by the best of intentions—offering to take in the children, even if it’s the rare relative willing or able to raise all the children together. The most common solution is to simply parcel out the siblings, who will grow up wondering what happened to the family unit to which they once belonged.

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Fortunately, within Filipino culture, with the prevalence of the extended family, the surviving spouse has a whole lot of other women to count on.

Usually it is the grandmothers who will step into the breach, moving into the family home (if both or one of them don’t yet share the home) to take over the role of the missing mother. Sometimes, if there is no grandmother available, a maiden aunt will take up the slack, running the household with efficiency, if not exactly with warmth. In large families, the oldest daughter steps into the caregiver role, a role she assumes even while her mother is alive.

Otherwise, many Filipino families rely on a network of women—usually poorer, bereft of other opportunities—to manage the home, look after the nitty-gritty of child-rearing, take on common household chores and otherwise free the mother to take up work outside the home or indulge her social amenities.

In Filipino homes, it is the women who keep the seams of connectivity intact, who hold the family together and, beyond the basics of health and nutrition, add the seasonings of care and nurturance, values and discipline to family life.

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Which is why, when we contemplate what happens to children and families when mothers or other caregivers are suddenly gone, we must ask why women’s health doesn’t receive the requisite attention from our health policymakers.

Global studies show that medical specialists—especially cardiologists, internists, oncologists—tend to be more aggressive and proactive when treating male patients. While a doctor would recommend a series of tests and medications for, say, a middle-aged male reporting elevated blood pressure, that same doctor would take a more benign attitude toward a women patient showing the same health profile.

Some theorize that medical practitioners tend to internalize the belief that a man, being the primary breadwinner, deserves greater vigilance and monitoring from his doctor, since preserving or lengthening his life benefits not just him but his family as well. But does not the life of the mother have as much of an impact on family welfare?

Another more plausible explanation is that, with health insurance and greater resources, men enjoy more access to healthcare, and doctors feel justified to expend more money on their monitoring and care. Besides, with no employment insurance to bank on, housewives, for instance, are hard put to find the needed resources for the full range of health services.

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And then there is the entire range of health problems that women and girls uniquely confront—gynecological issues, including menarche, menstruation, and menopause; pregnancy and childbirth; and women’s cancers including the “top two” killers, breast and cervical cancer.

As mothers, women tend to prioritize the health of their husbands and children before paying attention to their own aches and pains. When I was still with a health NGO, it was deemed that the best way to get women to visit the clinics and get advice on family planning was to offer pediatric services as well. Focus group discussions showed that a woman would leave the home to visit a clinic (or health center) only if a child was sick or needed immunization, say. But once in the clinic, the women would be a “captive” market, and the clinic staff could then approach them, asking the right questions and offering the whole range of family planning and other health services.

We are just beginning our observance of Women’s Month and women’s health deserves as much of a focus as women’s political and economic empowerment. After all, good health and a healthy appreciation for life’s challenges are just as much a form of empowerment for women as the right to vote and to lead.