Gabriela holds dialogue with local govt re no home-birth ordinance

Gabriela asserts that the no home-birth policy of the national government will not solve the high maternal mortality rate in the Philippines rather it will compound the long festering problem of lack of basic health services and facilities in the country.

"More health facilities, not anti-home birthing ordinance." This is the call of the members of women's group Gabriela when they met with the local government officials of Quezon city to discuss an ordinance in the city that bans births at home.

The policy enforces “facility-based” child delivery in hospitals, and prohibits any form of home birthing. Any person who will violate the ordinance will have to pay P5,000 as penalty. Gabriela, however, asserts that the ordinance violates the rights of mothers who are not capable of paying for the health care facilities, and hospital charges and requirements. The policy, according to Gabriela, has created more problems than solutions to poor pregnant mothers.

The city ordinance is part of the national government's no home-birthing policy implemented as part of its commitment to the United Nation's Millennium Development Goals (MDG) of lowering maternal mortality rate from 221 per 100,000 live births (2009) to 52 by this year (2015), the MDG's deadline.

The city government has claimed that home births are the major cause of maternal and newborn deaths in the Philippines citing that 8 out of 10 births in rural  and urban poor areas are delivered outside  health facilities and in the absence of health professionals like doctors, nurses and midwives. Most of these deliveries are home-based and attended by unprofessional attendants.

The ordinance has also prohibited traditional birth attendants to deliver babies and required all professional health practitioners to deliver babies only in health facilities.

But Gabriela asserts that the ordinance is anti-poor and that it does not address the basic health issues that lead to the high maternal death rate in the country.

“It is wrong to assume that home birthing is the major factor in maternal and neonatal deaths if basic health care services for women, much less prenatal checkups, are limited and inaccessible,” Gabriela deputy secretary general Obeth Montes said.

“It is equally wrong to penalize traditional birth attendants and mothers who resort to home birthing when it is the only accessible option for poor women,” she added.

Gabriela party-list in Congress filed last year a resolution that directs the House Committee on Health and Women & Gender Equality to review the national policy of the Department of Health (DOH) that pushes local government units to take away the option of home births from poor pregnant mothers without guaranteeing the setting up of quality and accessible services for both expectant mothers and born babies.

House Resolution 1531 cited that at present, out of 42, 027 barangays (villages) in the Philippines, only 17, 000 have health stations. Most of these health stations have limited or no personnel at all and that they have no adequate health facilities and equipment, and even lack medicines and supplies. A DOH report revealed that there are only 584 district hospitals, 89 provincial hospitals and 45 city hospitals in the country whose population has already reached the 100 million mark. Fifty six percent of the said hospitals have limited capacity and are comparable only to infirmaries.

In addition to insufficient facilities are insufficient public health practitioners and skilled birth attendants. In the Philippines, there is 1 midwife per 13,160 population, 1 public health nurse per 37,998 population and 1 doctor per 67,987 population.

With the current state of the country's health system, Gabriela asserts that the ordinance might frustrate its own aim of lowering maternal deaths as the lack of affordable and accessible lying-in clinics remains unanswered.

During the dialogue, Gabriela presented testimonies of women who bore the brunt of the enforcement of the ordinance:

A woman had to hold back giving birth at home for fear of paying penalties for violating the ordinance. She and her child  almost died during the incident. Family members rushed her to the nearest hospital but the hospital asked for a down payment before they could be admitted.

Another woman, for fear of being charged with P5,000 penalty, was compelled to go to the nearest hospital. Her hospital bill reached P15,000. But the local government did not provide her any financial assistance.

They also said that a woman who gave birth at home will find a difficult time getting the child’s birth certificate, as no hospital or midwife will sign it for fear of being penalized.

Also, those who gave birth at home have been denied vaccination services for their children.

 Gabriela party-list representative Emmi de Jesus who led Gabriela members in the dialogue advised  local governments to review their adherence to this DOH policy which threatens poor women with worsening reproductive health.

"A more comprehensive women's health delivery system in consultation with poor women and other stakeholders should have more encouraging policy and programs and avoid punitive measures that sow fear and worse health risks," De Jesus said

Vice Mayor Joy Belmonte, who represented the Quezon City government, pledged to consult with all stakeholders in reviewing the implementing rules and regulations of the ordinance.

Belmonte noted the need to clarify certain issues such as imposition of fine for mothers who give birth at home. She also said that they will include a provision allowing traditional birth attendants and other medical practitioners to assist mothers during emergencies.

Belmonte assured Gabriela members that the city government is committed in constructing additional lying-in clinics to provide services to pregnant women.