Two mothers

MAKE every mother and child count. That was the theme of this year's World Health Day, which is celebrated each year on April 7. This year it passed unnoticed, overshadowed by the Pope's death and funeral.

Maybe, too, the theme just didn't catch the media's imagination. It's hard doing stories around maternal and child health. We're gripped by stories of diseases like SARS because the threat seems so imminent. In 2004, the one SARS death involving a Filipina, who had contracted the disease in Canada, got much more media coverage than the 55,000 infants who died that year in the Philippines from various health problems; and the 4,000 Filipinas whose lives were claimed by pregnancy-related conditions.

I won't go into detailed statistics here and will instead share with you two stories that personally affected me and which I hope will remind readers about the issues on maternal and child health.

Botched

The first mother I never met; I came to know of her from a friend. I hadn't seen him for several years and ran into him accidentally. He was gaunt and distraught, but I went through the ritual of asking how he was doing, and how his family was. He was direct to the point: "My wife died last year." The answer shocked me because he was only 25, certainly not an age to be a widower.

Over beer, I listened to his horror story. In different circumstances, the pregnancy -- the wife's first -- would have been a joyful event, but this was unplanned. His wife was about to graduate from dental school, and they had high hopes about the future, of migrating to the United States where the wife had relatives. After much agonizing, they decided on an abortion.

They went through the usual route asking around in front of the basilica in Quiapo. They tried the herbs -- "pampabalik ng regla" [to "induce" menstruation] -- but the concoctions didn't work. The vendors told them about Cytotec, but each one seemed to have a different advice.

They heard of midwives and doctors doing "it," but again they couldn't be sure, until someone they really trusted gave them the name of a midwife in Pangasinan. They went up and found her. She was practicing out of a run-down apartment but seemed very confident about what to do. She told my friend to leave his wife for the afternoon, time for the procedure, and for my friend's wife to rest.

My friend returned in the evening and immediately sensed something was wrong. The apartment was quiet, and the lights were out. No one answered as he called out. The main door was locked and, as his apprehensions grew, he finally forced his way in to find his wife bleeding profusely. The midwife was nowhere to be seen. He rushed his wife to the hospital, but he felt they were unsympathetic, asking all kinds of questions about the abortion. She died shortly after being admitted.

He swore he'd kill the midwife if he ever found her. I didn't have the heart to ask him for other details to establish why the abortion was botched. His concern, which he kept repeating, was simple: "Was it a sin, what we did? Were we being punished?"

Hemorrhage

The second story I have is more recent. Last year, I noticed that Bert, one of the security guards in our apartment complex, had not been showing up for work. I asked one of the other guards what had happened and he gave me the story.

The guard began by asking me if I remembered Bert's wife, who would pass by the apartment complex occasionally with their two children. Yes, I did remember, a young and pleasant woman.

Yes, she was pregnant with a third child and the pregnancy had gone well. When the labor pains began, she was brought to one of the many lying-in centers in the city. This one was in Tondo. There were no problems during labor and a baby boy was delivered. The mother rested awhile but about an hour after delivery, she began to bleed profusely.

The relatives and the midwife were aghast, frantically mobilizing to get the mother to a hospital. But there were delays: they had to find a jeepney; they had to get to Bert, who was on duty; they had to ask around about a hospital. Then they had to get the woman from the lying-in center to the jeep, and negotiate their way out of the narrow streets and alleys.
Bert's wife didn't have a fighting chance and died before she could get to the hospital. She was 23.

It took Bert a month before he could get back to work -- he buried his wife and then went back to his home province with the three children, leaving them with his mother. A year after his wife's death, he still walks around with a mournful pall.

Names, lives

These two mothers are not atypical. Ask around, especially in our urban poor communities and in rural areas, and you'd be surprised how easy it is to find someone who knows of a recent maternal death. I have many more stories to tell, but what I've realized is that each time I remember them, I find myself mentally blocking out their names. It's almost like I am writing about illegal activities and have to protect those concerned.

It isn't just the stories around abortion, which is a crime with heavy penalties in the Philippines. I feel, strongly, that abortion should be decriminalized and the really heinous crime is the women's continuing lack of access-even in the heart of Manila -- to reproductive health services.

Ah, reproductive health -- that much maligned, much hated term. "Shorthand for abortion," my conservative friends argue. In the Philippine context, abortion is indeed part of reproductive health, but only as post-abortion care, trying to help the woman after she's had complications. That's often too little, too late. People don't want to see reproductive health in terms of educating people about pregnancies, about family planning, about prenatal checkups and care, and about safe deliveries, including referrals from midwives and lying-in centers to hospitals.

In my research among urban poor communities in Metro Manila, I am shocked at the number of women (no, some are really just girls, themselves barely out of childhood) already into their sixth or seventh month of pregnancy but without having gone for a pre-natal checkup yet. They think youth makes a pregnancy safe. Some are single mothers and are ashamed to go to the health center. Others, quite simply, don't know where to go.

It's the younger Filipinos who run the greatest risks because of our neglect of reproductive health. This is a generation that knows how babies are made and not much more. Condoms? They giggle. Pills and injectables they associate with cancer, and the IUD they know only as the chicken intestines sold by sidewalk vendors. As for childcare, ah, there's "lola" [grandmother] when the time comes.

We will have the babies and children, many, many more of them, reflected in the cold numbers of each census. How many will be loved and raised well? We can't be satisfied with "many," even with "most," for answers. Every child's life, every mother's life, must count.