Safe, Accessible and Culturally-Appropriate Reproductive Health Care for Indigenous Women
judy a. pasimio / LILAK
As we celebrate the International Day of Action on Women’s Health, LILAK (Purple Action for Indigenous Women’s Rights) would like to profile the urgent issues that indigenous women in the Philippines face on access to safe, affordable, appropriate health care.
Imagine you are a pregnant B’laan woman living in the mountains of Brgy. ‘Tmurok, in South Cotabato. You are due to give birth anytime now. The nearest health center is in the town proper of Malungon. To get there, you have to either walk 4 hours or ride a horse. At the foot of the mountain, you can take the habal-habal (motorcycle) and pay around P200 pesos to get to the health center in the town of Malungon. Upon reaching the health center, you are told that you are not yet ready and have to come back after 24 hours. You would not want to get back home to spend another 200P and walk another 4 hours, and do that all over again the next day. So you need a place to stay. Most likely, you have to pay – for space, and for food. Not just for yourself, but probably for 2 or 3 more companions, for a day or two. How much would that cost? And then when finally you are ready to give birth, you are asked to pay P1,500 for all sorts of things in the center, even if they say the birthing service is free. Easily, you will have to shell out P3,500 for basic expenses. Where will you get that? For a woman who could barely afford to feed her family regularly, this amount is not just prohibitive, but scandalous.
So you decide not to go to the health center, and instead, do what your mother, your grandmother and other mothers in your community have done for generations – homebirth. The traditional hilot or paltera or community midwife who has known you for a long time, takes care of you, until you give birth at home. She stays with you to see how you are, and prepares herbal bath for your body. She tells you how to take care of yourself, and your newborn baby. In return, you promise her a kilo of root crop from your next harvest.
Then comes the collection of the cash benefit from the 4Ps (Pantawid Pamilyang Pilipino Program). You borrowed money so you could go to town and claim your cash benefit. But after hours of walking and taking the habal-habal with your newborn, you could not claim anything because of deductions made for not meeting the set conditions. You did not have your monthly checkup at the health center, and you did not give birth at the health center. Your children were also absent in their classes as you were not able to provide food for them to take to school. With all these deductions, you were not able to claim anything at all.
Since you were already in town, you went to the health center to have your newborn get her free vaccines. But since you did not give birth in the center, your child is not eligible for free vaccines.
You go home empty-handed, and with a heavy heart.
This is the same story we hear from Mangyan, Dumagat, Subanen and other indigenous women in the two years that we have been having our community visits, as well as regional and national gatherings of indigenous women in Luzon, Visayas and Mindanao.
In some communities, the women hilot are being threatened to be put in jail for doing what they have been doing for decades – take care of pregnant women in their community the way they know how and assist women give birth in ways that have been handed down from generation to another.
It is not safe, both for the mother and for the child – that’s the main argument for prohibiting homebirth, criminalizing and penalizing, both the hilot and the mother. “Then make it safe for us,” is the call of the indigenous women. Make it safe for them by not making them walk for several hours, up and down a rough mountain road, and ride a motorcycle to the nearest health center. Make it safe for them by having a local midwife present in the community on a regular basis, at least 5 days a week. Some indigenous women refuse to give birth in health centers because they are surrounded by strangers who look at and touch their bodies as if they are dolls. Make it safe for them by encouraging them to go to health centers by having culturally-appropriate health services, and environment. Most indigenous women feel safer with the community hilot because they are provided with care and attention that they are familiar with – using herbal and indigenous methods. Make it safe for them by integrating safe natural and indigenous methods with western and mainstream medicine. Penalizing indigenous women for their belief, and customary ways is a gross act of discrimination. Penalizing indigenous women for not being able to afford the health services of the government, which excludes them, is a form of violence, and an act of injustice.
Make childbirth and reproductive health care safe for the indigenous women by making reproductive health services accessible, free, and culturally-appropriate.
(photo attached: B’laan women of Brgy. ‘Tmurok, Malungon, South Cotabato)
May 28, 2014
judy a. pasimio / email@example.com