13 AUGUST 2007


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UBAY, BOHOL — Antonia Quirino sits with a dazed look on top of the stairs of her bamboo house amid a large swath of cornfield. She speaks laconically, as if every word is a labor. Filth surrounds her; debris of past meals remain on the dirty kitchen and table, the clotheslines display tiny clothes too grimy and stained to be considered ready for wear. Nearby, a few of her children sleep the day away.

IT'S rice porridge for lunch for Antonia Quirino and
her young brood.
[photo by Jaileen Jimeno]
At 40, Quirino is a mother of 10 children, and is four months away from giving birth to her 11th. She delivers at home and has known no prenatal or postnatal care, yet her nipa hut is just a few meters off the main road that leads to Bohol’s tourist-drawing resorts. She is a mother at risk, but she is below the radar of the government, which has sworn off providing free contraceptives, and which does not encourage information about their use.

About a 90-minute plane ride away, in Malacañang, sits a woman whose family planning policy, many say, has directly or indirectly consigned Quirino to her fate.

When she first took power in 2001, President Gloria Macapagal Arroyo initially issued confusing statements on her family planning policy. She once admitted using pills in her early years as a mother and wife, but said that as a Roman Catholic, it made her go to confession. In 2002, in an apparent effort to woo the Church, which supported her predecessor’s ouster, she ruled out the purchase of contraceptive materials and tossed the responsibility of buying these supplies to local governments. She has since fortified that policy to placate the Church as her government battled numerous threats to its survival. It has also resulted to the undue delegation of official power and handing over of state funds to a private group allied with the Church.

Government health workers and nongovernmental organizations (NGOs) exposed to the realities in the field say Arroyo’s position has deadly effects on numerous fronts. They say it keeps the poorest women uninformed of all the options available to them to limit or space their children. It deprives women of the free contraceptive materials previously available to them in barangay health centers. Worse, private groups like Couples for Christ (CFC), using government funds, preached against artificial contraception. This has prompted a longtime government health expert, who spoke on condition of anonymity, to warn of a rise in abortion rates because of the dearth of contraceptives, formerly available but now absent, in health centers.

“When the census numbers are out next year, this government will be shocked by the high incidence of abortion,” says the government health official. The same official is aghast at how women’s health is being regarded as just another political issue.

Dr. Junice Melgar, head of the NGO Linangan ng Kababaihan or Likhaan, also says that women’s health is now being sacrificed for political expediency. “This is her legacy,” she says, referring to President Arroyo. “Women will remember her harshly for this. This is a woman who has been very unkind. She is pushing women into unsafe pregnancies, and probably even death.”

In a paper that reported the effects of the contraceptive ban in the city of Manila, Likhaan noted that Arroyo “is the first president since 1969 to weld its policies not to medical standards, but to the moral standards of the (Roman) Catholic Church.” (See sidebar) Melgar also asserts, “The major battle is the president herself. It’s not just the Church, but the president’s own attitude toward women.”

A 2006 study done by Josefina Cabigon of the University of the Philippines Population Institute (UPPI) and five other experts at the Alan Guttmacher Institute, an international NGO that focuses on sexual and reproductive rights worldwide, says that six in 10 Filipino women had an unintended pregnancy at some point in their lives because of lack of access to and knowledge of modern contraceptives. That fraction, says the study, translates to some 1.43 million unintended pregnancies each year, a third of which end in abortion.

It also says that while the women who had abortion come from all classes, the majority are “married, poor, and Catholic.” The study adds that poor women tend to use unsafe methods because they cannot afford safe procedures by trained providers. These unsafe methods include massage, insertion of a catheter, and the use of Misoprostol, which is prescribed by doctors to treat gastric ulcers. Eight of 10 of the women who use such methods suffer complications, says the study.

A July 2007 World Bank report on population issues also says that the main reason women in developing countries like the Philippines seek abortion is “often due to difficulties in obtaining access to an appropriate method of contraception, incorrect or inconsistent use of contraceptive methods, and contraceptive method failure.”

Meanwhile, the Department of Health (DOH) says it has reduced maternal deaths from 172 per 100,000 births in 1998 to 162 per 100,000 in 2006. But that still means 10 to 12 women die everyday, or around 3,650 to 4,380 every year, because of pregnancy and related cases. Originally, too, DOH had aimed to reduce the maternal mortality rate to 100 per 100,000 births by 2004.

Tomas Osias, head of the Commission on Population (Popcom), the state agency that determines the direction and implementation of the government’s family-planning programs, traces the maternal death rate to women being “too young (less than 18 years old), too old (over 34 years old), or having babies too close or unspaced (less than two years).”

Suneeta Mukherjee of the United Nations Population Fund (UNFPA) has also said that 99 percent of maternal deaths are preventable, adding that promoting family planning in places with high birth rates could help cut the maternal mortality rate by as much as 35 percent. Media reports last March also quoted her as saying that it is unlikely that the Philippines will meet its target of reducing the maternal mortality rate to 52 per 100,000 births by 2015 without “political will.”

As it is, NGOs even doubt the data on maternal health now in use by the DOH. Melgar explains that the maternal mortality rate of 162 per 100,000 is not the result of the regular census conducted every five years. She says it is the result of a survey, which has an error margin of plus or minus 30. This is because the president, whose much-vaunted field of expertise is economics, was not able to fund a census in 2005, because the budget was again re-enacted. A census is a basic requirement in economic planning, as well as in goal- and policy-setting.

Melgar says that veteran health department officials know it is critical to provide family-planning materials to women who want to plan how many children they will have and when, but who are unable to afford these materials on a regular basis. But Melgar asks, “How can you do that, (provide supplies) if your boss does not allow it?”

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