Why are Palawan’s Reproductive Health Statistics So Bad?

Yesterday was World Population Day, an international event celebrated on the 11th of July. This year’s theme was “Family Planning: Empowering People, Developing Nations”. To mark the day, Roots of Health partnered with the City Health Office and the POPCOM Office to hold a health fair in City Hall. Our staff conducted information on family planning and provided men and women with their contraceptives of choice. By the end of the day, we had provided 27 women with a combination of pills, injectables and implants. We had also given out 73 boxes of condoms.

I’m glad that we provided these services in City Hall but I’m always surprised at the low numbers of women who access our services in the city. We held a similar event in Robinsons in March and also served under 30 women.

In contrast, last week we sent our clinical team to Brooke’s Point. In one day alone they provided 375 women with implants. They were there for three days and during that time served over 800 women who wanted an implant in order to prevent pregnancy for 3 years. Last month, our team traveled to Taytay and served 901 women who wanted implants over the course of 3 days.

Why are implants so much more popular in municipalities outside of Puerto Princesa? I think the major reason is that women in those municipalities know what it is like to be unable to access services. Many of the places we travel to are difficult to get to, and are places where doctors, nurses and midwives aren’t always able to visit. Many of the women we serve have experienced wanting to control the number and spacing of their pregnancies but have not been able to access contraceptives, either because they can’t afford them, or because they are simply not available where they live. Many of the women have more children than they say they wanted to have, so when they have the opportunity to use a contraceptive that lasts for 3 years (the implant) or 10 years (the IUD), they jump at it.

In Puerto Princesa, and in other cities around the country, demand is usually lower for services like these because people have choices and don’t feel the need to grab opportunities when they’re available, because they can usually have that opportunity again at another time.

The health of people living in cities is better than those in geographically isolated areas (think mountains and islands), because people in cities have more access to programs and services. Palawan province’s reproductive health statistics are worse than most other areas of the country. Our maternal mortality rate or rate of women dying of preventable deaths during pregnancy and childbirth is the highest in the MIMAROPA region and it keeps climbing.

While the maternal mortality rate is improving in Puerto Princesa City, it is getting worse throughout the rest of the province. The province’s numbers include the geographically isolated disadvantaged areas (GIDA) where people have limited access to medical professionals, programs and services. They cover areas like Balabac, where we have observed pregnancies in girls as young as 12, and where we met a pregnant 17-year-old who already had 3 children, and a 30-year-old with 11 children. The stats include places like Agutaya, which doesn’t even have a pharmacy. It is not surprising that girls and women have more pregnancies than they want, and have more negative pregnancy outcomes when they can’t access medicines and have limited chances for checkups.

It is important to increase the number of programs and services that are offered in isolated municipalities. Medical missions are helpful, but for long-term improvement in health, services should be regular and sustained. The provincial government is building more hospitals around Palawan. Facilities are good, but there is also the need for qualified, caring staff, modern equipment and a steady supply of medicines.

It is easier to offer services and reach large numbers of people in cities, but these services are often much more needed in far-flung locations. Clearly the Puerto Princesa City government has realized this as it has been investing in more rural health facilities for the barangays further from the city center. In addition, it has also been steadily increasing the number of doctors, nurses, midwives and other health professionals to serve the needs of the people.

It is also important to keep educating people on the programs that are available, and encourage them to take the opportunities presented even if they don’t feel any urgency. Everyone in the city and the province will have to improve their health-seeking behaviors for Palawan to be able to start improving its health outcomes.

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