In Palawan, reproductive health remains a top concern

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Inaccessibility of hospitals and clinics, and pushback from religious leaders and politicians are some of the reasons why quality reproductive healthcare in Palawan is scarce. Photo courtesy of ROOTS OF HEALTH

Manila (CNN Philippines Life) — “If you have sex but don’t want to have a baby, all you have to do is jump up and down to avoid pregnancy.”

This is one of the many myths that continue to exist in Palawan.

“There is just so much disinformation. There is still so much that people don't know,” says Amina Evangelista-Swanepoel, one of the founders of Roots of Health or Ugat ng Kalusugan, an organization based in Puerto Princesa that provides reproductive health lessons and services to the women in the province.

A 2018 data from the Provincial Health Office shows that Palawan still has the highest number of maternal deaths in MIMAROPA (Occidental and Oriental Mindoro, Marinduque, Romblon, and Palawan). Palawan also has one of the highest rates of teen pregnancies in the country.

With this information, it should seem that the local government should be laying down frameworks that would inhibit the continued rise of maternal deaths, teen pregnancies, or other issues like HIV, and yet local government units have sometimes made it difficult.

“It can be challenging when you are trying to provide services and there are local government units or somebody who is anti-reproductive health who doesn’t want us to come in,” Evangelista-Swanepoel shares.

Roots of Health started to only provide education in 2009, but since the government does not provide free contraceptives to barangay health centers, they started providing those services as well.

22179923_10155849624476289_3425517208155887866_o.jpg Palawan is comprised of 1,780 islands, yet all of its hospitals are situated in Puerto Princesa, meaning that women who live outside of the capital are more vulnerable to maternal deaths. Photo courtesy of ROOTS OF HEALTH

Accessibility of services

Besides institutions that can pose as a hindrance to the dissemination of reproductive health information and services, a problem in Palawan is that it is made up of thousands of islands. Of the Philippines’ 7,107 islands, 1,780 of these are in Palawan, making some places inaccessible and difficult to get to.

All the hospitals are also situated in Puerto Princesa, so women who live outside of the capital are even more prone to vulnerability. “A lot of maternal deaths happen because of delays,” shares Evangelista-Swanepoel. “[There are also women] in their mid-30s or 40s and they can’t access contraceptives and they’re in their eighth or ninth baby then of course that’s a recipe for high-risk pregnancy.”

Accessibility is not necessarily a problem for organizations in Metro Manila. Likhaan, an NGO that provides health services for women, for instance, has clinics in Navotas and Quezon City, which are in the middle of urban poor communities.

“Densely populated na where we are in Metro Manila. These are really slum areas. Ang problema namin diyan ‘yung mobility ng mga tao. Because they don’t often stay in one place,” says Dr. Junice Melgar, one of the founders of the organization.

Likhaan has also been providing services in Eastern Samar since 2006 and she says that they do have to organize vehicles just to get to the towns. They also have community organizers who are from the locality who bring patients to them.

Much like Likhaan, Roots of Health also taps what they call community advocates who become their eyes and ears in far flung communities. There are youth advocates as well who are young people who serve as a resource of correct information for their peers.

Having youth advocates has been important for the organization as they’ve seen that if young people get through all the way to college without a pregnancy, they are already much better off than a lot of other girls who get pregnant at 14 or 15.

18403335_10155350741536289_3663945976487890110_n.jpg More often than not the quality of care in government health care centers is very poor. “Talagang hindi natatrato ng mahusay [ang mga pasyente],” says Dr. Junice Melgar, one of the founders of women's health NGO Likhaan. “They get insulted. They're made to wait. Pinapagalitan for whatever reason.” Photo courtesy of ROOTS OF HEALTH

Behavior change

More than the issue of accessibility, however, Evangelista-Swanepoel says that the root of the challenge in educating women on reproductive health is seeing actual behavioral change in the culture.

The topic of pre-marital sex, for example, is still so taboo so even when women know that they are engaging in sexual intercourse, some women still wouldn’t get contraceptives because they think it’s as good as admitting that they are having sex.  

“Most of the time people are very secretive about the fact that they’re having sex until they can’t hide it anymore because they’re pregnant,” she says. “We teach thousands of young people every year but not that many come to our services and there are still hundreds of teen pregnancies every year.”

She adds that the issues in Palawan are not so different from other reproductive health issues across the country in that a shift in behavior alone can already be incremental to ensure that reproductive health education is effective.

Another behavior change that Melgar suggests is one that should come from government health care centers. She says that more often than not the quality of care in these centers is very poor.

“Talagang hindi natatrato ng mahusay [ang mga pasyente]. They get insulted. They're made to wait. Pinapagalitan for whatever reason.”

“Actually, we have a very alienating health system,” she adds. “The bad behavior is more awful if the patients are poor kasi may tendency talagang mababa ang tingin sa isang walang pera at hindi masyadong edukado, ‘yung hindi nakakarespond sayo, ‘yung hindi nakakasagot ng mga tanong mo nang mabilis.”

Melgar explains that this behavior could be because health providers may not be well-treated or are not paid properly within the hierarchy of the government’s health system.

In Palawan’s case, Evangelista-Swanepoel says that their governor and vice governor, the ones on top of the hierarchy, are not supportive of reproductive health, so even when barangays and municipalities see the need for these services, they don’t have a lot of government funding particularly towards reproductive health personnel, teen pregnancy prevention programs, and contraception.

22528904_10155890999746289_3913850724565502372_o.jpg Reproductive health in Palawan has become political when leaders of government do not allot money for these services. To bridge this gap, NGO Roots of Health conducts maternal health sessions where they discuss the women’s rights to access contraception as well as their right to their own bodies. Photo courtesy of ROOTS OF HEALTH

Separation of church and state

Palawan’s Vice Governor, Dennis Socrates, a member of Opus Dei, is one of the high-ranking officials in the province that has refused to give funding towards providing contraceptives. He has recently said that “the solution lies in a more intensive education campaign to tell young people that sex is good, but it has to be within the context of a loving and insoluble marriage.”

He added: “Even withdrawal is an immoral means for preventing birth because there's an active, a positive act to prevent the outcome which is the natural consequence of the marital act.”

In this sense, Evangelista-Swanepoel says that reproductive health in Palawan has become political when the leaders of government do not allot money for these services. She says that it is a violation of people’s basic rights to not be able to access medicine that they need just because of somebody else’s religious conviction. To get this across, Roots of Health would conduct maternal health sessions where they discuss the women’s rights to access contraception as well as their right to their own bodies.

Even after almost five and a half years since the Reproductive Health bill was passed, it seems that there is still continued resistance.

In January 2017, President Duterte ordered for universal access to modern family planning. However, 24 hours after the president signed the executive order, Luis Cardinal Tagle, the archbishop of Manila echoed the longstanding stance of the church that it is “against any law that promotes both natural and artificial family planning methods.”

Evangelista-Swanepoel says that despite what the chief bishop says, they haven’t had any problems with local priests in Palawan.

“I really think that there’s a big difference between the bishops in Manila who participate in policies and in trying to play government … and the priests in provinces, in barangays, in municipalities who see the need of the people,” she says. “My point is I respect your view, you can have your view but you should not be forcing your view on others who don’t share it.”