'Hospital shopping' a dangerous experience

MANILA, Philippines - Llanelyn Sotto, 35 weeks pregnant, was rushed by her mother Nellie to a hospital in Manila when her water bag broke. But the hospital staff said that since it was a premature delivery she would need an incubator for which they demanded a P30,000 down payment. When all she could offer was P5,000, the hospital refused to admit Sotto. After three more hours of pleading, they asked her to sign a release form, saying she was voluntarily declining the hospital’s services due to financial constraints. At another hospital, they said they had no incubator available, sending distraught mother and dilated daughter into a frenzy. At the third hospital, eleven hours later, Llanelyn’s baby girl was delivered by caesarian section, sans the need for an incubator.

Although now deep in debt, Llanelyn, 23, is considered lucky since many more like her die from “hospital shopping”, said Chona Lobitana, 42, a midwife who trains community health workers in Vitas, Tondo. “Turning away women because they are poor seems to be a knee-jerk reaction of many hospitals, and many women end up bleeding to death while traveling from one hospital to another.”

In the Philippines eleven women die each day from pregnancy and birth complications and most of these deaths are preventable. Poor women and infants carry the most risk of death and disability from lack of access to reproductive health services.

Socio-economic disparity is very evident between the rich and poor in accessing reproductive health services. The poorest women have two more children than they want, while the richest women experience a gap of less than one child. This means the unmet need for family planning is particularly high among poor women in need of help in preventing unintended pregnancy. They face greater risks and even death from pregnancy and childbirth complications.

The Millennium Development Goals (MDGs) are the global community’s collective promise to stop poverty. Specifically for the Philippines, MDG goals 5 A&B: Reducing maternal mortality and the universal access to reproductive health are the two unmet challenges.

According to the UN Population Fund, the Philippines has a maternal mortality ratio (MMR) of 200 deaths every for 100,000 births. “This means one dead mother for every 500 live births, a fact that is so distressing when compared to our Asian neighbors who have much lower MMRs or fewer mothers dying,” says Dr. Junice Lirza Melgar, Reproductive Health Advocacy Network (RHAN) spokesperson. Thailand has 41 and Malaysia has 44 MMR, while Vietnam has 130. “The very slow decline in our MMR as evidenced between 1990 and 2007 – a 3 percent decline – is quite problematic and will likely result in the Philippines not meeting MDG 5,” adds Melgar.

Which is why the women in Towerville, Letre Malabon and Vitas, Tondo belonging to the Reproductive Health Advocacy Network are gearing up for battle when Congress hearings begin on the Reproductive Health Bill this year.

Presently, only 26 percent of the poorest women deliver by skilled health workers, compared to 95 percent of the wealthiest.  Only 13 percent of the poorest deliver in a facility while 84 percent of the wealthiest are able to do so. Only 1.3 percent of the poorest women have access to life-saving Caesarian sections, while almost half of the richest women are getting C-sections they don’t need.

In order to significantly get closer to the target of 52 MMR by 2015, each town or city needs to ensure skilled care for all pregnant women by qualified nurses, midwives or doctors at every delivery; emergency care for all women and infants with life-threatening complications; and reduce health risks of early and mistimed pregnancies through effective contraceptives or, where necessary, provide compassionate post-abortion care, all of which are the guiding principles of proposed House Bill No.96, the Reproductive Health, and Population and Development Act of 2010.

Asked if they were daunted by the CBCP’s objections to the proposed RH Bill, Lina Bacalando, 44, of Tonsuya, Malabon who runs the Mothers’ Clinic in Letre, with a population of 40,000, said: “Couples want to have just the right number of children they can feed and send to school. But they need access to RH services, including modern contraceptives. Now, CBCP is telling government that they should not listen to us, poor women?”

Jerelyn del Castillo, 49, of Towerville, adds: “Since 2007, RH Bill advocates like Cong. Edcel Lagman, Janette Garin and Riza Hontiveros have been consulting us, women from poor communities. There is nothing in the RH Bill that promotes abortion. The Catholic bishops who don’t respect our right to a decent life continue to spread myths and lies about RH but the evidence lies in how the poor continue to suffer due to lack of RH services.”

At least P5.5 billion are spent each year in health care costs for managing unintended pregnancies and its complications. An annual budget of P2 billion to P3 billion for family planning is a cost-effective public health measure, according to RHAN.

Women like Bacalando and Lobitana say they are determined to put the RH Bill at the forefront of President Aquino’s agenda since he is the MDG President. Every sitting president worldwide will have to account for the MDGs or why he failed to meet them. “We trust that P-Noy has a conscience, since he is neither deaf nor blind,” said the community health workers.