Six month old baby Airish is an argument for the passage of the RH bill
Ginalyn Ortiz is only 17 years old but she’s already a mother. She was only able to attend school until the third grade, and from the time she was 14, worked as a live-in housemaid in Galas, Quezon City.
She met her partner, Robert Yu,29, at her former employer’s house where he also worked as a houseboy. When they realized that she was pregnant, they immediately went home to Pitogo, Quezon where Ginalyn’s father and twin sister still lived. Robert originally hailed from Atimonan, also in Quezon. He was accepted into Ginalyn’s family and planned to get married as soon as they had enough money to do so.
Airish has meningocele, meaning she has a growth next to her small head that’s much bigger in circumference, and it grows at an alarmingly fast rate as Airish also develops.
According to online medical websites, meningocele is a form of spina bifida, which in turn refers to any birth defect involving incomplete closure of the spine. It is a congenital malformation, an error in the development of the central nervous system and particularly affects the spinal cord and spine.
As descriptions go, a child with meningocele has an an out-pouching of the coverings of the spinal cord that results in a defect in the bone and soft-tissue coverings of the back part of the spine. This pouch, or sac, is filled with cerebrospinal fluid can lead to a bulging mass on the back. The malformation does not include any malformation of the spinal cord itself or any of the spinal nerves. In Airish’s case, the sac is connected directly to her head, resting against her skull and the top of her spine.
No prenatal, maternal healthcare
“The midwife came every month from the time I was two months pregnant. We had no money to go to Gumaca or Lucena to consult a doctor, so we were already grateful for the midwfe’s visits,” Ginalyn said.
According to Ginalyn, the midwife only told her to drink ferrous sulfate tablets but did not recommend vitamins. Neither did the midwife give her any advice to stop lifting heavy objects, get proper rest and nutrition. Ginalyn did not benefit from ultrasound check-ups, or receive information on how pregnant women should always take calcium and folate tablets or capsules to help strengthen her body and to help in the development of her yet-unborn baby.
In the meantime, because of poverty, she was also unable to eat the kind of food that obstetrician-gynecologists usually order pregnant women to eat and make sure that she ate the proper amounts.
According to local health standards, the following should be done during a prenatal check-up are: (1) weight check; (2) height check; (3) blood pressure check (4) urine examination ; (5) blood sample examination ; (6) consultation about pregnancy complications; (7) instruction and preparations as to where to go for pregnancy complications; (8) tetanus toxoid injection; and (9) ensure iron supplementation and intake of prenatal vitamins.
Ginalyn can only remember having her blood pressure checked and that it was always low. The midwive did not tell her to do anything about the low BP much less to take anything to regulate and normalize it. As for to other prenatal check up necessities, there were none.
“The midwife just told me to take the little red iron tablets. It was good that the tablets were cheap,” she said.
When Ginalyn reached her fifth month, the midwife felt her stomach and said that Ginalyn might be having twins.
“She told me that she felt two heads, but she couldn’t feel the body of the other baby. I was worried at first because even then my stomach felt uncomfortably heavy like the baby inside was going to come out anytime soon. The midwife didn’t raise any alarm afterwards, so we thought that nothing was really wrong,” she said.
The entire time that she carried Airish, Ginalyn also worked as a laundrywoman. She lifted heavy pails of water and bundles of clothes. Robert in the meantime worked as a farmhand for a small agricultural company that grew ampalaya (bitter gourd), eggplants and tomatoes. For his labor he earned P200 a day.
When Airish was finally born on November 27, 2010, she weighed a healthy 3.5 kilos. Her skin was a creamy white and she had a head full of coal-black hair. She had her mother’s slightly chinky eyes and her father’s thin lips. Her parents thought she was perfect, but there was a sac filled with fluid connected to her skull and spine.
Folic acid prevents neurological disorders in newborns
What makes Airish’s condition tragic is that it could very well have been avoided.
Online medical sites refer to various research studies saying that insufficient intake of folic acid – a common B vitamin – in the mother’s diet is a key factor in causing spina bifida and other neural tube defects. Prenatal vitamins that are prescribed for the pregnant mother typically contain folic acid as well as other vitamins.
For the most part, the medical sites say that meningocele is unknown. They go on to say that low levels of folic acid in a woman’s body before and during early pregnancy is thought to play a part in this type of birth defect. The vitamin folic acid (or folate) is important for brain and spinal cord development.
Prenatal screening is also said to be valuable in diagnosing neural disorders like Airish’s. During the second trimester, pregnant women can have a blood test called the quadruple screen. This test screens for myelomeningocele, Down syndrome, and other congenital diseases in the baby. Most women carrying a baby with spina bifida will have a higher-than-normal levels of a protein called maternal alpha fetoprotein (AFP).
Told this information, Ginalyn could only shake her head. She was pregnant at 16 years old and had never had access to medical services even in her early youth. She underwent the period of her pregnancy merely hoping for the best and relying mainly on the advise of family and the midwife who visited every month. She even gave birth at home, with the midwife delivering Airish.
Airish, in the meantime, previous to being brought to Muntinlupa, had never been checked by a pediatrician.
Now almost six months old, Airish now lives temporarily in a small apartment rented by Ginalyn’s cousin Irene Cruzat in Muntinlupa.
Irene is currently unemployed and has a three year old daughter. Her own partner works as a pedicab driver. Despite having very small means of survival herself, Irene is determined to help her cousin and her baby.
“I look at the baby and it breaks my heart that she has to suffer such a burden at so young an age. Anyone can see that she’s beautiful. I want so much to help her,” Irene said.
Irene took Ginalyn and Airish to the GMA-7 television station main office in Quezon City, and secured the assistance of the Kapwa Ko, Mahal Ko Foundation. The foundation promised to shoulder the costs of Airish’s check ups at the Philippine Children’s Medical Center (PCMC) as well as the operation Airish needs to have the sac removed. This was in March, and from then on they had been going to the PCMC regularly, initially every two days, then eventually it became every week.
“We spend at least P500 in transportation fares with every visit to the PCMC. A one way trip from Muntinlupa costs P68 for each of us, so imagine how much we spent for fare alone every time, ” said Irene.
Robert explains that he wants to find a job but as yet cannot focus on employment hunting because he wants to help Ginalyn and Airish whenever they go to the doctor.
“Sometimes I feel desparate thinking about my baby and where I’m going to get the money for her medical needs. The doctors told us that the operation will cost at least P100,000, so we’re thankful that the foundation is helping us. The medical expenses after the operation are a completely different thing. We don’t know who else to turn to,” said Robert.
The RH Bill and provisions for maternal health care
As Ginalyn and Robert struggle from one day to the next to keep Airish alive, the debate about the Reproductive Health bill (RH Bill) continues to rage not only within the halls of the House of Representatives and outside in the public arena.
Many critics of the RH bill neglect to acknowledge how the proposal provides for more than just family planning and making artificial contraceptive methods available to the poor. They stand against the RH Bill without acknowledging its other provisions, such as those that provide for people’s right to reproductive health care information.
In a nutshell, the section of the bill lay down the government’s responsibility to the Filipino people to provide them with information about the availability of reproductive health care services, including family planning, and prenatal care. The DOH and government information agencies are being tasked to sustain a heightened nationwide multi-media campaign to raise the level of public awareness of the protection and promotion of reproductive health and rights.
There’s also a provision stating that each province and city, with the assistance of the DOH, must establish or upgrade hospitals with adequate and qualified personnel, equipment and supplies to be able to provide emergency obstetric and neonatal care.
For every 500,000 population, there shall be at least one (1) hospital with comprehensive emergency obstetric and neonatal care and four (4) hospitals or other health facilities with basic emergency obstetric and neonatal care. Those living in isolated and depressed areas will also be provided the same level of access.
In the meantime, there’s also a provision on age-appropriate reproductive health and sexuality education.
This proposed curriculum is aimed to be taught by from grade five up to the fourth year level of high school.The curriculum will be common to both public and private schools, out of school youth, and enrollees in the Alternative Learning System (ALS) based on, but not limited to, the psychosocial and the physical wellbeing, the demography and reproductive health, and the legal aspects of reproductive health. The topics will include knowledge and skills in self protection against discrimination, sexual violence and abuse, and teen pregnancy; physical, social and emotional changes in adolescents; children’s and women’s rights; fertility awareness; family planning methods; and responsible parenthood.
Airish and other babies
As things currently stand, the standard of prenatal and maternal health care in the country remains very dismal. Its necessity is widely accepted, yes; but because of the extreme poverty of most Filipinos, a large majority of pregnant women do not have access to quality prenatal care.
In an August2010 study titled Who Provides Good Quality Prenatal Care in the Philippines, (Rouselle F. Lavado, Leizel P. LagradaValerie Gilbert T. Ulep, and Lester M. TanWomen) , it was stated that women who are older, poorer and with lower educational attainment received poorer quality of prenatal care compared to women who are younger, richer and better educated. Multiparous women are also said to receive poorer quality of prenatal care.
Morbidity and mortality related to pregnancy according to the study are still high. Infant and maternal mortalities are still major problems, where 26 infants in every 1000 live births die and 162 women per 100,000 die due to childbirth. These put the Philippines’ IMR still above its Millennium Development Goal target of 19/1000 live births and its MMR way above the target of 52/100,000 live births in 2015 (NSCB, 2010).
Airish has many challenges ahead of her, and her own mother — herself still a minor — needs to learn so many things to be able to take of her baby. Even if poverty is factored out, the lack of valuable information and immediate access to it makes the battle for Airish’s life and survival an uphill one.
Proponents of the RH Bill say that while the proposal will not put an immediate end to infant and maternal deaths (much has to be done to rework the national government’s fiscal priorities where allocations for public health services and education remain pegged to the floor compared to high appropriations for foreign debt servicing and military spending), babies can at least have a fighting chance of being taken care off even while still in their mothers’ wombs.
If only her mother knew to take a P6.00 tablet of folic acid or folate per day, Airish could have been spared from having meningocele.