The death of a young woman named Katherine Bulatao a few weeks ago highlights the need for more work to enable women and girls to protect and enjoy their sexual and reproductive health and rights, as guaranteed under the Philippine Constitution, the Magna Carta for Women, and the Convention for the Elimination of Discrimination against Women – among other laws governing our people, as well as ethical and moral principles that must be universally upheld and applied.
I graduated from the University of the Philippines College of Medicine in 1959 and practiced in several places in the Philippines, with most of my patients being women and children. From my over half a century of medical practice, I know that certain deaths and complications arising from pregnancy and childbirth could be avoided through simple, inexpensive, and effective methods. Some cases could also be prevented if health care providers have access to life-saving drugs, particularly misoprostol, and trained to perform manual vacuum aspiration which should be available in specified licensed clinics. Unplanned and forced pregnancies could also be avoided if women and girls had access to the full range of modern contraceptives, which should include emergency contraceptives.
Katherine gave birth at her home in Caloocan City. However, the midwife who attended to her delivery advised that Katherine be brought to a hospital because of her continued bleeding after the baby was born. She was refused admission and care by 6 hospitals. She was declared dead on arrival by the time she arrived at the seventh hospital. One hospital which refused Katherine’s admission was reported to have done so because it had no available blood supply for transfusion. I wonder if they even bothered to insert IV fluid instead or had done any other emergency measure to prevent further blood loss. The act of another hospital that refused to admit her after her husband could not pay the demanded amount of deposit is blatantly against the law.
Postpartum hemorrhage (PPH) or profuse bleeding after childbirth is often due to a retained placenta. In some cases, an abdominal or uterine massage to help the uterus contract after childbirth could help expel the retained placenta and save the life of the mother. When I was a medical student being trained at the Philippine General Hospital, we would let the newborn infant suck from the mother's breast as another method to help initiate placental expulsion.
All hospitals, particularly in our geographically isolated and disadvantaged areas, should be able to use misoprostol or manual vacuum aspiration (MVA) to save women's lives. As many pregnant women still choose deliver at home, more so during the COVID-19 pandemic lockdowns, it is important that the government is able to provide alternative methods which are both safe and effective for treating any pregnancy-related complications. (READ: Isolated and afraid: How the pandemic is changing pregnancy)
Katherine’s life may have been saved if those health facilities had access to misoprostol, an inexpensive life-saving drug which is on the World Health Organization’s Model List of Essential Medicines. Misoprostol has been found to be effective in the prevention and treatment of postpartum hemorrhage, particularly when oxytocin is not available. The drug has a long shelf life and, unlike oxytocin, does not even need refrigeration. A UP grad gynecologist told me, "It is sad that misoprostol has been prohibited in our country since 2002 despite the evidence that it can save lives." Ensuring the drug’s availability should be one of the reproductive health priorities of our government to reduce maternal deaths.
MVA – a safe and effective alternative method to manage PPH – may also have saved Katherine's life. MVA can be done by trained midwives or nurses who would relieve our "frontline heroes" to focus on other life-threatening cases and serve where they are most needed now. MVA is an outpatient procedure that does not require general anesthesia. The procedure is not only cheaper than other procedures like dilation and curettage (commonly known as “raspa”), but it can also be completed within a few minutes by a trained provider. The late former Department of Health Secretary Dr. Alberto G. Romualdez had started training of health professionals on the use of MVA for incomplete abortion during his time. The need to continue this program has become more urgent.
All women and girls have a right to enjoy a healthy, productive, satisfying, and dignified life. During this lockdown, women and girls can become pregnant with or without their consent. If they get pregnant, they may experience spontaneous or threatened or incomplete abortion. They could go into labor under conditions not suitable to childbirth or without adequate resources to seek care from qualified health facilities and providers. To mitigate these risks during quarantine, women and girls should continue to have access to support mechanisms against violence and abuse, particularly domestic violence. They should also continue to have access to modern contraceptives including emergency contraceptives which actually are legal, without need for prescription so they can be protected from any forced pregnancy. (READ: [OPINION] We need to tackle the pregnancy crisis)
Katherine’s death should serve as a rallying point for strengthened commitment and government, as well as the private health care system's action for the realization of women’s and girls’ sexual and reproductive health, even during the COVID-19 pandemic.
I join other sexual and reproductive health advocates who have expressed their utmost concern and grief over the preventable suffering and death of Katherine. We strongly urge the government to ensure the availability and equitable access of essential sexual and reproductive health services during this crisis.
I also call on everyone to participate in some way in marking the May 28 International Day of Action for Women’s Health.
Let us remember that women's health always matters! – Rappler.com
Florence Tadiar is the Current President of PROCESS. She is the former Executive Director and President of Women's Health Care Foundation and Institute of Social Studies and Action.
She is a retired faculty member of the UP College of Public Health.