Two days before Christmas morning in 2011, someone gave me a notebook with an inscription “no women should die giving life.” She said she wanted me to have that, along with a UNFPA bag and mug, as token for having traveled from Mindanao to attend my final interview for a job at UNFPA I was applying for. It was the beginning of another journey. After a year and 9 months, I was with some health service providers in the Province of Masbate crossing the clear sea waters of Masbate mainland to Ticao Island to conduct a Maternal Death Review cum Community Dissemination Forum. Two women just recently died while giving birth in San Jacinto Municipality. In 2012, 22 women died while giving birth in the Province of Masbate. Although, the numbers are decreasing from 35 in 210 and 29 in 2011, these figures are still alarming contributing to the some 230 women for every 100,000 live births who die each year in the Philippines while giving birth. These figures make MDG 5 the least likely MDG goal to be achieved by the Philippines in 2015.
Delay in Accessing Health Care and the Road Network
The recent obvious development in the Island is the construction of kilometers of roads connecting the four fourth class municipalities of Batuan, Monreal, San Fernando and San Jacinto. I was with our Maternal Health Officer, Angel and five other health service providers from the Province. The more than an hour boat ride from Masbate City mainland continued with a 45 minutes land trip to reach the Municipality of San Jacinto. The almost two hours of journey lead us to discussions on the renowned politician who died of plane crashed in the middle of the sea we were traversing to the issue of road development in Ticao Island.
Debbie, the provincial family planning coordinator, shared that it will take them more than three hours to travel on an uncemented road from Batuan to San Jacinto before. But the new road network is allowing the population to access services, including health services, in 45 minutes. However, some communities are still very difficult to reach due to distance of health facilities, poor roads in geographically isolated barangays, and availability of transportation. In 2012, I witnessed a Maternal Death Community Dessimination Forum in Lebak, Sultan Kudarat held a remote barangay with a very poor road network. The community was successful deciding to put up a “bayanihan” system of a involving the barangay officials by providing a “pre-paid” motorcycle that will bring the woman to the birthing clinic, blood donation from family members to assure blood transfusion in case of blood loss, and some homes nearer to the birthing clinic as halfway homes for pregnant women while waiting for the delivery period.
Delay in the Decision to Seek Care and a Personal Experience
The death of two women in Ticao is a result of delay in reaching care. Presumably, health service providers in the island have been providing “community-based” awareness campaign maternal health. I couldn’t imagine the daily sacrifice relayed by some midwives during the forum on traversing mountains and slippery slopes while conducting maternal health advocacy campaigns. However, Ticao Island, with four 4th municipalities, have very poor families which can may have resulted to low status of women in seeking health care and its financial implications. Furthermore, the maternal death may also happen as when the pregnant woman and her family have “poor understanding of complications and risk factors in pregnancy and of when medical interventions are needed.” In 2006, my sister died after giving birth to her second child due to pregnancy related complications. The physician said it is my sister’s incapacity to seek care which resulted to this tragic event in our family. She has a heart disease which the doctor already warned when she gave birth to her first child in 2002 (the child also died a month after). She was already advised to use family planning method to save her life but she didn’t. The women in Ticao, Lebak and my sister have one thing in common—their late decision to seek care due to lack of knowledge, financial incapacity and poor understanding if the risk of pregnancy.
Delay in Receiving Adequate Health Care
As the Maternal Death Review cum Dissemination Forum in Ticao is heating, Dr. Angel quickly pointed out that the review process shall never be a fault-finding exercise but an avenue to discuss measures reduce maternal deaths in the future. San Jacinto has a total population of 27,974 (as of 2010) for its 17 barangays. As to number of midwives per 5,000 population, San Jacinto has enough. But, it is not the number of midwives that concerns adequacy in health care but the terrain and location of areas of assignments of the midwives. Many of the barangays in San Jacinto belongs to the “geographically isolated and disadvantage area or GIDA” which might lead to inadequate referral system in tracking high risk pregnancy and difficultly of health service providers to reach these GIDAs. As of 2012, it is worth mentioning that the Province of Masbate has already 18 of its 21 RHUs certified birthing clinics and MCP accredited. Coupled with more support from UNFPA and other stakeholders on trainings and capacity development on maternal health and family planning, this development will eventually result to more motivated health service providers and increase their referral system for a delivery of birth by a skilled birth attendant.
Hopes in the Future
As I peeped from terrace of the Municipal Hall of San Jacinto, I saw the crystal water of the sea and it seems inviting me to take a deep. Surely, I think, more children will swim in that sea with their mothers with them. The MDR cum Community Dissemination Forum is only an awakening exercise for San Jacinto and the whole Province of Masbate to reflect on reducing maternal deaths. As we travelled back to mainland Masbate late that afternoon, I am already starting to feel the breeze of the “ber months” (Filipinos’ concept of celebrating early Christmas starting from September to December) and for now, one of my wish list is to reduce maternal deaths and make that inscription in my notebook a reality, that, “no woman should die giving life.”