War, Peace and Maternal and Child Health in the ARMM

War, Peace and Maternal and Child Health in the ARMM,”  is published in the social media news site Women Writing Women. This was first submitted to Women’s Peace Table.

By Bugan Ni-Rosipan, (a nom de plume) a feature writer and multimedia artist, a hiker and cyclist, a mystic and a witch.

 

MOST PHILIPPINE regions, despite nuances in language and culture, agree that pregnant women have borrowed lives.  Conceiving is akin to a death threat for pregnant Filipinas for whom “isang paa ay nasa hukay” (one foot is inside the grave).  This is truest in the Autonomous Region in Muslim Mindanao (ARMM) where more mothers die in pregnancy-related causes compared to the rest of the country.

In 2008, maternal mortality in the ARMM was 245 per 100,000 livebirths.   Infant mortality rate was 55 per 1,000 live births.

Anisa Taha, 51, an aleemat (Muslim religious leader) says, “Pag buntis ka, maraming nangyayari sa loob mo. E pano na kung marami ring nangyayaring gulo sa labas mo?” (When you are pregnant, there are many changes inside you.  What more if there are also upheavals in your environment?)  Taha is a member of Noorus Salam, a network of Muslim religious scholars.

Taha recalls how it was to be Maguindanaoan in 1972 when Martial Law was in effect, and how mothers and mothering at war have not really changed since then.  A student in Cotabato City at that time, she received a call from her father asking her to go home to Datu Odin Sinsuat or “hindi na tayo magkikita kasi lilikas na kami” (we will be evacuating so we may not see each other again). 

Aside from the few elderly men like her father, most of those who evacuated were women, she remembers, mothers packed and ready, most with young babies and children carried one on each arm, another on the hip and still another on piggyback.  In 2000, during President Joseph ‘Erap’ Estrada’s “all out war,” it was Taha’s turn to mother her fledgling brood to safety, packed and ready.

Pregnant women, often in their third trimester, get their bags filled with the essentials of birthing for a faster trip to a birthing facility.  Those who prefer giving birth at home arrange to have their children taken care of by other female family members or friends.  In Maguindanao, mothers for at least three generations now, as Anisa remembers it, are always packed and ready regardless of season, whether they are pregnant or not.

“Sa kultura naming mga Maguindanaoan, ang buntis na babae ang nag-aalaga sa sarili nya. At kung may anak sya, alaga rin n’ya,” (In the Maguindanaoan culture, a pregnant women takes care of herself.  And if she has children, also takes cares of them) says Taha. The load is tripled, she says, when mothers are forced to evacuate due to armed conflicts because the burden of safety and survival from the time they uproot themselves to coping in evacuation centers is entirely up to them.

Husbands, fathers and most adult males are either away fighting with the MILF or hiding.  Whether they are combatants or civilians, male presence in evacuation centers put their families at risk so many women only have other women to lean on.  “Apat ang anak mo, ikaw lang mag-isa.  Walang facilities sa evacuation center, walang supply ng tubig o pagkain.  Ganun na nung panahon ng nanay ko, ganun pa rin ngayong panahon ko,” (You are alone with four kids.  There are no facilities or food and water supplies in the evacuation center. It was already like this in my mother’s time and it is still the same now) she says.

Conflict exacerbates the more basic health gaps, says Dr. Farah Tan-Omar, Sulu Provincial Health Officer. “We still lack hospitals and health centers in island barangays, and there are not enough health personnel to cover the population.”

For mothers to have safe pregnancies and deliveries, Dr. Omar says, “they need quality prenatal services and give birth in equipped facilities that they can easily access. This is challenging in an archipelago.”  Access is difficult for Tausug mothers living in distant islands, she says, due to the irregularity of transport and often difficult sea conditions.

While the Sulu Health Office invests in capacitating health staff already based in the villages so they could be closer to the people who most need their care, there is also the question of their safety.  At least three midwives have been abducted in separate incidents in Patikul and Indanan.

There is always the threat of kidnapping for health workers and mothers seeking care.  Virgie Cadano, a midwife in Lamitan, Basilan, remembers being stranded in a foxhole while war raged, also raging within herself because she couldn’t attend an emergency delivery.

Health service delivery may be constantly disrupted, but slowly and steadily, health workers are pulling out, not just one foot, but both feet of pregnant women out of the grave.  In 2013, according to the ARMM Health Department, maternal mortality rate decreased to 64 per 100,000 livebirths.

Communities are mobilized to increase their stake in their own health.  Locals secure the health station in Barangay Limook, which Cadano oversees, especially at night when there are women in labor.  Health volunteers in Basilan, Sulu and Tawi-Tawi knock on pregnant women’s doors to take them for prenatal check-ups, and secure habal-habalskylab (motorcycle “taxi”) and lantsa (outrigger boat) when it is time.

More local midwives are hired for the frontlines and they wade among mangroves to get vaccines to Yakan and Tausug children in remote island villages stricken by measles. When huge waves hamper their mobility, Tawi-Tawi health workers partner with traditional birth attendants and Muslim religious leaders to blast health service announcements on their community radio program.

“Pag maayos ang lagay ng nanay, mas malaki ang tsansa ng baby,” (If the mother’s health status is stable, the baby has more chances of surviving) says Taha.