The Realities of Women and Their Children

No woman should die giving life. Yet, in the Philippines, 10 women die every 24 hours from almost entirely preventable causes related to pregnancy and childbirth (POPCOM 2000). Our maternal mortality rate continues to be staggeringly high, at 162 maternal deaths for every 100,000 live births (National Statistics Office (NSO), 2006 Family Planning Survey (FPS)). More lives would certainly be saved if all women had access to good prenatal, delivery, and postpartum care.

The reality, however, is that 3 out of 10 Filipino women do not have the recommended number of prenatal care visits (at least 4); and 6 out of 10 women still deliver at home, where they rarely have access to a skilled birth attendant, or to quality obstetric services in case complications arise (NSO and ORC Macro 2004, 2003 National Demographic and Health Survey (NDHS)). Moreover, because a woman’s life and wellbeing are inextricably linked to that of her child’s, it is not surprising that the country’s infant mortality and under-five mortality ratios remain also worrisome: for every 1,000 live births, 24 children die before they reach the age of one, and 32 children die before they reach the age of five (NSO, 2006 FPS).

Aside from poor maternal care, our alarming maternal mortality rate also stems from the high incidence of induced abortions. The silence on this topic shrouds the tragedy of many Filipino women who have resorted to it in desperation. An estimated 473,400 women had induced abortions in 2000, translating to an abortion rate of 27 abortions per 1,000 women aged 14-44, and an abortion ratio of 18 abortions per 100 pregnancies (Juarez, Cabigon, Singh and Hussain 2005). Abortion not only terminates the life of an unborn child but also imperils the life of the mother, especially if performed in unsafe clandestine clinics by untrained personnel, or induced by the woman herself, as is the case of poor women who cannot afford a surgical abortion, or the services of a traditional practitioner (hilot). Of the nearly half a million women who had abortions in 2000, 79,000, or 17 percent, wound up in hospitals as a result of abortion complications (ibid.). Induced abortions accounted for 12 percent of all maternal deaths in the Philippines in 1994 (ibid.), and is the fourth leading cause of maternal deaths.

Studies show that the majority of women who go for an abortion are married or in a consensual union (91%), the mother of three or more children (57%), and poor (68%) (Juarez, Cabigon, and Singh 2005). For these women, terminating a pregnancy is an anguished choice they make in the face of severe contraints. When women who had attempted an abortion were asked their reasons for doing so, their top three responses were: they could not afford the economic cost of raising another child (72%); their pregnancy occurred too soon after the last one (57%); and they already have enough children (54%). One in ten women (13%) who had attempted an abortion revealed that this was because her pregnancy resulted from forced sex (ibid.). Thus, for these women, abortion has become a family planning method, in the absence of information on and access to any reliable means to prevent an unplanned and unwanted pregnancy. The fact is, our women are having more children than they desire, as seen in the gap between desired fertility (2.5 children) and actual fertility (3.5 children), implying a significant unmet need for reproductive health services (NSO and ORC Macro 2004, 2003 NDHS)

The importance of family planning to the lives of women and their children cannot be emphasized enough. The United Nations Population Fund (UNFPA n.d.) asserts that women’s access to effective contraception would avert 30 percent of maternal deaths, 90 percent of abortion-related deaths and disabilities, and 20 percent of child deaths. In the Philippines, however, women sorely lack adequate access to integrated reproductive health services. This stems mainly from an inconsistent national population policy which has always been dependent on the incumbent leader. For example, studies have pointed out that former President Fidel V. Ramos and then Health Secretary Juan Flavier showed strong support for family planning initiatives. In contrast, President Gloria Macapagal Arroyo appears to have an incoherent national population policy, because while she recognizes the need to reduce the country’s population growth rate, on the one hand, she relegates the responsibility of crafting, funding, and implementing population and reproductive health programs to local government units (LGUs), on the other. Thus, we are witness to uneven reproductive health and family planning policies and programs across LGUs: Whereas Aurora and the Mountain province, and Davao, Marikina, and Quezon Cities have put in place commendable RH policies and programs, a metropolitan city like Manila teeming with informal settlers had banned modern artificial methods of family planning under the administration of Mayor Joselito Atienza.

From the foregoing, it is easy to understand why the contraceptive prevalence rate of the Philippines is only 50.6 percent (NSO, 2006 FPS). This means that only a little over half of married women use any family planning (FP) method, whether traditional FP (14.8%), modern natural or NFP (0.2%), or modern artificial FP (35.6%). And yet an overwhelming majority of Filipinos (92%) believe that it is important to manage fertility and plan their family, and most (89%) say that the government should provide budgetary support for modern artificial methods of family planning, including the pill, intra-uterine devices (IUDs), condoms, ligation, and vasectomy (Pulse Asia, 2007 Ulat ng Bayan survey on family planning). In another survey, the majority (55%) of respondents said that they are willing to pay for the family planning method of their choice (Social Weather Stations, 2004 survey on family planning).

The evidence is clear: Our women lack reproductive health care, including information on and access to family planning methods of their choice. Births that are too frequent and spaced too closely take a delibitating toll on their health, so that many of them die during pregnancy or at childbirth. Some of them, despairing over yet another pregnancy, seek an abortion, from which they also die ― and along with them, their unborn child too.