"We go to the doctor when we have money. When we don't have any money, we just pray and do what we can to take care of it."
by Ami Evangelista Swanepoel
Last
week, Ugat ng Kalusugan returned to Barangay Bagong Silang to carry out
a mini-survey among Badjao families. Like our first survey in Bagong
Silang, our purposes for carrying out another survey were two-fold: we
wanted to test out our community health survey, and we wanted to get
more information on one purok (area) of Bagong Silang because it is a
possible site for our work.
The results of our second survey are summarized below. As with our first survey, there are several caveats. These survey results are not representative of the whole Barangay.
We only interviewed 11 women and one man from 12 different households,
and only households in the Muslim, Badjao portion of the community. We
employed convenience or accidental sampling - a type of nonprobability
sampling wherein the sample (interviewees) are selected from the
general population because they are readily available and convenient.
There is an added bias to the group we interviewed: they were all
mothers (or a father) whose children under five years of age were
receiving their regular deworming and vitamin supplements distributed
by the barangay health workers. We opted to accompany the barangay
health workers as they went from home to home so they could provide an
introduction for us to meet women within the community. Because our
sample is comprised of women (and one man) whose children are being
cared for by the health workers, it is important to remember that they
and their children are likely much healthier and better off than their
counterparts who do not access any health professionals or receive any
free medicine.
While
we cannot make any generalizations about the community based on our
survey results, the results do offer some insights into this community,
and we found some of the results interesting.
We
interviewed 11 women ranging in age from 19 to 35, and one man who is
48. We generally plan to interview only women but in one household the
woman we wished to speak to was sick and resting and her husband
offered to answer our questions.
Family Planning
We
asked the interviewees if they practice family planning. Two women
answered that they do use contraception. One uses hormonal pills and
the other uses the injectable DMPA (Depo Provera). Both women pay for
the contraception themselves. One of the women is Catholic and the
other belongs to the Iglesia ni Christo church.
The
rest of the women in our sample do not use any form of family planning,
artificial or natural. When asked why, every single person said that
they do not use any form of contraception because it is forbidden as it
is against Islam. Several of the women who do not use contraception
because it goes against their religious beliefs are young (ages 19-21)
and as yet each have only one child. Among the older respondents (ages
28-40) most women have had multiple pregnancies and children. Maida,
who is 28, has 5 children. Sherwina is 29 and has four children but has
had five pregnancies. Tina, who is 30, has three children. Her friend
Adea, who is 32, has three children but has had eight pregnancies.
Sandra is 35 and has had seven pregnancies and has six living children.
48 year old Cesar's wife has had 13 pregnancies, and has nine living
children.
We
asked the respondents what they think the ideal number of children is
and most of them answered that the ideal is between two and four
children. Some of the women with multiple children said that two or
three is ideal, but that they couldn't achieve their ideal because
using contraception is against Islam. One women said the ideal is two
or three but she has had seven pregnancies. She says she is too scared
to use contraceptives. Cesar's wife has had the greatest number of
pregnancies and children (13 and 9 respectively) and in answer to what
his ideal number of children is, he said, "Allah forbids planning. But
in terms of what I think, this number [9] is enough. We're already
having a hard time and more children would be difficult. But if it is
Allah's will, then we will have more."
Islam and Contraception
While
we were carrying out our surveys, we asked the interviewees their
beliefs and practices and we recorded their answers. We did not
question people further about their religious beliefs but I was very
confused as to why everyone was telling me that Islam forbids the use
of contraception. I didn't think Islam forbade family planning, but I
wasn't sure, and even if I was, I did not feel that it would have been
appropriate to give an impromptu lesson on Islam and contraception. We
completed the surveys and upon returning to our office, I conducted
some internet research and found that Islam very clearly allows the use
of contraception. I was stumped and continue to be. How is it possible
that a large population of Muslims in this one particular community
believe that Allah and the Koran prohibit something that in fact is
allowed? These Muslim families are some of the poorest in the province,
and most households are too large to support with one or two people's
meagre salaries. Yet families are large because men and women wrongly
believe that their God prohibits planning their families. I have to
assume that this group's imam or their community elders have received
incorrect information about Islam's view of family planning and have
successfully spread this misinformation among the population. I suppose
that spreading the misinformation could be intentional, though I cannot
comprehend why anyone would do that. This remains a mystery to me and I
hope to have the opportunity to speak further with some of the people
we interviewed to find out more about how they came to have this
erroneous belief.
Care from Health Professionals
Eight
of the women we interviewed had prenatal check ups with their last
pregnancies. Among these eight women, none had regular checkups
throughout her pregnancy. Most had only two or three check ups before
delivering. The other four interviewees did not have any prenatal check
ups and cited lack of money as the primary reason for not seeking care.
When
asked what type of health professional they consult when they or their
children are sick, six respondents answered that they seek care from
Barangay Health Workers, four see doctors, and one goes to the City
Health Center. One of the interviewees said, "We go to the doctor when
we have money. When we don't have any money, we just pray and do what
we can to take care of it."
When
asked what type of birth attendant they prefer, eight stated
manghihilot or traditional healer, two like doctors and one prefers a
midwife. One respondent said she would really prefer to have a doctor,
but her family cannot afford one so she uses a manghihilot or
traditional healer.
Unlike
their counterparts in other neighborhoods in Bagong Silang, the Badjao
women we interviewed overwhelmingly prefer to give birth at home. When
asked where their ideal birthing place would be, all but one of the
interviewees said that they prefer to give birth at home. One women
said she prefers the hospital. All the women who prefer home births did
actually deliver their children at home, save for one woman whose
parents took her to a birthing center because it was her first
delivery. One interviewee noted that the home is best because their
family does not have the money for a hospital birth, and another women
said that she prefers the home because she is scared to give birth in a
hospital.
Of
the women we spoke with, only two had seen a health professional for a
postnatal check up after their last pregnancy. These two women were the
two women that gave birth outside the home - one at a birthing home and
another at a hospital. None of the others had heard of the need for
postnatal visits, and a few added that their health was fine after
giving birth so there really was no need for a check up.
Beliefs about Family Planning
We
asked the people we spoke with about their thoughts or beliefs relating
to family planning. The following are some of their statements:
"It is forbidden by Islam to plan our families."
"Islam forbids us to use contraception."
"We
don't plan families because we are scared of Allah. We do not know more
than Him so His will be done. Only God can let us survive."
(-Cesar, whose wife has had 13 pregnancies and 9 living children)
You need to only have a few children so that you can
send them to school and feed them sufficiently.
(-Sonya, 19 years old with one child, not currently on any form of contraception)
"I'd like to give my children a good life -
have enough for them to go to school and to eat."
(-Damesa, 21 years old with one child, not currently on any form of contraception)
"It's better not to have too many children so that life isn't too hard."
(-Sherwina, 29 years old with four children, not currently on any form of contraception)
Beliefs about Pregnancy
We
asked the interviewees about their beliefs regarding pregnancy. Most of
the responses centered around a pregnant woman's safety at night and
included the beliefs that when you are pregnant you should cover your
head if you go out of your home at night, that at night a pregnant
woman should have garlic hanging in her house so that vampires will not
be able to find her, and that generally pregnant women should not walk
around at night. One woman said that pregnant women should not carry
anything too heavy, and another said that when a pregnant woman reaches
the month in which she will give birth, she should regularly drink
ginger tea.
Immunizations
Like
their counterparts whom we interviewed earlier in the week, all the
children of the mothers we interviewed were up to date with their
immunizations - or will complete them shortly (for babies under 1).
These immunizations include BCG (Bacille Calmette-Guérin - a vaccine
against tuberculosis), three doses of DPT (DPT refers to a class of
combination vaccines against three infectious diseases in humans:
diphtheria, pertussis [whooping cough] and tetanus), three Hepatitis
shots, and three doses of the Polio vaccine. These results are probably
not typical. It is important to remember that the women we interviewed
were the mothers of children receiving medicine from the Barangay
Health Workers. There is a bias here - these children are receiving
care from the health center and thus are more likely to have completed
all the requisite immunizations. If we were to randomly sample families
within the community, we might not find 100% compliance with these
immunizations.
Finances and Employment
Only
two of the women we spoke with are currently employed. One delivers
soap, and the other, who is the wealthiest of the women we surveyed,
sells fish in the market. The man who we interviewed works as a street
cleaner for the government. All of the other women have no work and
expressed the desire to work in any kind of position that becomes
available - especially being a saleslady or a maid.
Two
of the people I spoke with have a monthly household income between
P500-1,500 ($11-$32.) Three respondents have a monthly household income
between P1,501-3,000 ($33-$64.) Two women reported a monthly household
income between P3,001-4,500 ($64-$94.) Two of the families have a
monthly household income between P4,501-6,000 ($94-$125.) One family's
monthly earnings totals P5,000 ($105). Another's is P6,000-7,500
($125-$161.) The wealthiest of the women represented had a monthly
household income between P9,001-1o,500($188-$220.)
Supplemental Support
None
of the children among the sample households we surveyed receives any
regular supplemental feeding, despite the fact that Badjaos are
referred to by city health officers as being some of the "poorest of
the poor" and with some of the greatest number of children that are
malnourished.
Most
of the families do not receive any regular support from any outside
groups but some families sometimes avail of services or food from the
Department of Social Welfare and Development, Barangay Health Workers,
from the city health center and from a nonprofit called Balikatan. One
interviewee mentioned that her family sometimes receives free food when
local officials celebrate their birthdays and feed the masses - an
activity that is popular in Palawan and which Mayor Hagedorn and
Governor Reyes both recently did for their birthdays.
Yesterday Ugat ng Kalusugan carried out a mini-survey in Barangay Bagong Silang.
Our purposes were two-fold: we wanted to test out our community health
survey, and we wanted to get more information on one purok (area) of
Bagong Silang because it is a possible site for our work.
Bagong
Silang is a sea-front community with around 5,000 people - a third of
whom are Cuyunon (a native group in Palawan), a third who are Bisaya
(migrants from the Visayas) and a third Badjao. The Badjao are a
traditionally marginalized group, looked down upon by non-Badjaos even
in Islamic areas. Badjaos tend to be very poor and uneducated and are
frequently beggars. The majority of the non-Badjao men are fishermen,
and women either sell fish at the market, work at the local department
store, NCCC, or stay at home. Some children go to school but many do
not. Average families in Bagong Silang have four or more children - a
bit above the national average. The average age for a first child is 19
but there are also mothers as young as 14 or 15 - particularly among
the Badjaos. To read more about Bagong Silang, click here.
The results of our survey are summarized below. Before sharing these, there are several caveats. These survey results are not representative of the whole Barangay.
We only interviewed women from nine different households, and only
households in the Catholic portion of the community. We employed
convenience or accidental sampling - a type of nonprobability sampling wherein
the sample (interviewees) are selected from the general population
because they are readily available and convenient. There is an added
bias to the group we interviewed: they were all mothers whose children
under five years of age were receiving their regular
deworming and vitamin supplements distributed by the barangay health
workers. We opted to accompany the barangay health workers as they went
from home to home so they could provide an introduction for us to meet
women within the community. Because our sample is comprised of women
whose children are being cared for by the health workers, it is
important to remember that they and their children are likely much
healthier and better off than their counterparts who do not access any
health professionals or receive any free medicine. We do hope to
accompany the health workers again when they do their medicine
distributions among the Badjao population of Bagong Silang.
While
we cannot make any generalizations about the community based on our
survey results, the results do offer some insights into this community,
and we found some of the results interesting.
We interviewed nine women ranging in age from 20 to 51.
Family Planning
We
asked the women we interviewed if they practice family planning. Two
women answered that they do not use any family planning. One did not
explain why, and the other said she does not use anything because she
doesn't have a husband -- but she does have a two year old son.
The
great majority of women do use some form of family planning. Two use
natural methods (withdrawal and calendar method), three use pills, one
uses an IUD and one used DMPA (Depo Provera). Of the women using
artificial forms of family planning, only one pays for the medicine
herself - the others rely on receiving them for free at the Barangay
Health Center.
All
of the women we spoke with think that the ideal number of children is
between two and three. Just over half of the interviewees have the same
number of children as this ideal, or one less child. Of the rest of the
women, two reported having five children -- and they explained that
they really wanted to have a baby girl, so they kept trying beyond the
ideal number they desired. One woman with six children reported
achieving her ideal of two or three children -- but did so with several
different partners (!) One woman with five children said she had
definitely wanted less children, but the five "had just happened". She
was one of the women who reported using contraception when it was given
away for free.
All
but one of the women we interviewed had prenatal check ups with their
last pregnancy. Of those women who did get check ups, only one woman
saw a doctor regularly from her first month of pregnancy until giving
birth. The rest of the women saw a health professional between 2 and 4
times throughout their pregnancy.
When
asked what type of health professional they consult when they or their
children are sick, seven of the women answered that they consult
doctors, three consult Barangay Health Workers, two consult a
manghihilot (traditional healer), and one consults a nurse.
When
asked what type of birth attendant they prefer, six stated doctors, two
like nurses, and two women prefer midwives. One of the interviewees
reported that for her last birth, she called a nurse to come but ended
up having to give birth with a manghihilot (traditional healer) because
the nurse got stuck in traffic and didn't make it in time.
When
asked where they prefer to give birth, two of the women listed their
home and the local health center as places that would be ok, but 100%
of the interviewees said that their first choice would be to give birth
in a hospital. When asked why, most reasoned that a hospital setting is
safest because there, they could have access to doctors and to any
special equipment should there be any problems or complications with
delivery. We did not ask the respondents where they did in fact give
birth to their children, and will include this question in the next
iteration of the survey.
Of
the women we spoke with, only three had seen a health professional for
a postnatal check up after their last pregnancy. None of the others had
heard of the need for postnatal visits.
Beliefs about Family Planning
We
asked the women we spoke with about their thoughts or beliefs relating
to family planning. The following are some of their statements:
"I wanted to get a ligation but my blood pressure was
too high. So we just use the withdrawal method.
I don't want to do pills or get the injectable type of
contraception - I heard those can lead to tumors."
"You really should just have the right number of kids -
otherwise life will be full of hardship."
"If your family is small, you'll be able to satisfy the
needs of your family and be true to your beliefs."
"It's really hard to feed your family when you have too many children."
"It's good to plan your pregnancies because it is too hard
when the children come one right after another!"
"Life is very hard when you have too many children."
Beliefs about Pregnancy
We
asked the interviewees about beliefs they have regarding pregnancy. A
few women answered that one should not drink or smoke while pregnant,
and that one should always go for check ups and get a lot of sleep. We
also heard the beliefs that a pregnant woman should never eat eggplant
(no explanation) or drink cold water because that might make the baby
get too big. Several women also said that a pregnant woman should wear
black panties at night so that monsters or evil spirits will not be
able to find the baby and harm it.
Immunizations
All
the children of the mothers we interviewed were up to date with their
immunizations - or will complete them shortly (for babies under 1).
These immunizations include BCG (Bacille Calmette-Guérin - a vaccine
against tuberculosis), three doses of DPT (DPT refers to a class of
combination vaccines against three infectious diseases in humans:
diphtheria, pertussis [whooping cough] and tetanus), three Hepatitis
shots, and three doses of the Polio vaccine. These results are probably
not typical. It is important to remember that the women we interviewed
were the mothers of children receiving medicine from the Barangay
Health Workers. There is a bias here - these children are receiving
care from the health center and thus are more likely to have completed
all the requisite immunizations. If we were to randomly sample families
within the community, we might not find 100% compliance with these
immunizations.
Finances and Employment
One
woman's monthly household income is P500-1,500 ($11-$32.) Another's is
P1,501-3,000 ($33-64.) Three women reported a monthly household income
of P3,001-4,500 ($64-$97.) Another's is P6,000-7,500 ($129-$161.) The
wealthiest of the women represented had a monthly household income of
PhP10,500-12,000 ($226-$258.) One of the women has no income and is
being supported by her parents. Another woman had a monthly income of
PhP1,500-2,000 ($32-$43) when her husband was alive, but he passed away
last month and she and her two children are now being supported by her
sister.
Only
three of the women we spoke with are currently employed. One is a
Barangay Health Counselor (and is the woman with the highest monthly
household income), another takes care of pigs and another sells fish at
the local market. One woman does laundry for her neighbors but does not
have regular clients and sometimes has no work. Of the rest of the
women without work, two expressed the desire to work if it was
something they could do at home so they could care for their young
children. Another respondent would like to be a saleslady and two
expressed the desire for any kind of work - becoming a maid, a laundry
washer, participating in a buy and sell scheme (like Avon) or anything
else.
Supplemental Support
None
of the children were receiving regular supplemental feeding, but a few
of the children occasionally get some extra food from special feeding
programs that the Barangay Health Center sometimes has funding for.
None
of the families receive any regular support from any groups, but some
have sometimes been able to avail of medical services or food from
medical mission trips carried out by both foreign and local groups.
For more, visit Ami's blog at http://rootsofhealthphilippines.blogspot.com/
Ami Evangelista Swanepoel recently moved from the U.S. to her home in the Philippines to start a new health rights NGO, Roots of Health. This week, she shares the disturbing results of their second-ever community health survey.
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