KIDAPAWAN CITY, NORTH COTABATO, The Philippines – The progression of pregnancy or childbirth does not wait for a recovery from a natural disaster or a pandemic --- a 30-year-old Margie Betil appreciates how true this is, recalling how she went through her second pregnancy recently.

North Cotabato and Davao del Sur Provinces were hit by a series of large-scale earthquakes in October 2019.  More than a dozen earthquakes were above Magnitude 5.0, even up to M6.6.  Hundreds of aftershocks ensued after these big earthquakes. Strong shaking damaged or completely destroyed 73,100 houses, and compromised vital infrastructure, including roads, schools and hospitals, thus disrupting basic services to health, clean water, hygiene and sanitation, and education.  Out of some 1.8 million people living in the affected areas, close to 630,000 people fell in need of assistance, including 70,000 people displaced and forced to stay in tents and government facilities-turned evacuation centers.  In total 36 were killed and over 770 people were injured by collapsing structures, falling debris, cardiac arrest and other earthquake-related traumas.

A pregnant mother’s worry at an evacuation site

Margie was two months pregnant at that time.  She recalled that she, her son and her mother were inside their small wooden shack close to the crater of Mt. Apo, the country’s dormant volcano, when a strong earthquake hit her town. They had to run and look for a cover, as big rocks were falling towards their house. “Just like everybody else, we fled to safer grounds without bringing clothes or any valuables.”

“There were so many people in evacuation centers. I was so scared.  I was completely at a loss, not knowing what to do, where to go to stay and sleep, where to get our food the next day.  We did not have a fixed income, either.  So we were lucky to receive some help.  But, it was never enough.”

“The situation got worse with COVID-19,” Margie said.  Her family and other people continued to be displaced from the October 2019 earthquakes so long that they have had to also endure the additional worry brought about by the outbreak of the mega-scale pandemic too in temporary shelters. “Our movements were already limited, but we do not want to get sick, either,” Margie said.  “I feared that my second baby in my womb would not survive this stressful situation.” 

“I just thought I should be alive for a few more months until I give birth”

In humanitarian emergencies such as natural disasters and pandemics, women and children bear the brunt of negative impacts. One in every five affected women of reproductive age is most likely pregnant, making expectant mothers more vulnerable to health issues. Access to maternal health services may be disrupted due to damaged health facilities, and the number of available health service providers may reduce.

“I did not know where I could go to give birth.  So I started getting ready to give birth at the evacuation center,” shared Margie. “I did not consider going to see a doctor for prenatal check-ups, because we did not have enough money, not even for food. I thought I should be just alive for a few more months for the baby.”

Maternal Health Tents and ‘Cash for Health’ saved the babies and the mothers

Even prior to COVID-19 outbreak, the Philippines saw 2,600 to 2,700 women die every year due to complications from pregnancy or childbirth.  The maternal mortality in 2020 could jump up to 3,170 because of the effects of the pandemic and quarantines, according to a recent study conducted by the University of the Philippines Population Institute (UPPI) with support from the United Nations Population Fund (UNFPA) in the Philippines.

In the towns of Makilala and Tulunan as well as Kidapawan City severely affected by the earthquakes, UNFPA with its NGO implementing partner, the Mindanao Organization for Social and Economic Progress, Inc. (MOSEP), set up three Emergency Maternity Tents to be used as temporary birthing clinics. These facilities that UNFPA established with the support of the UN Central Emergency Response Fund (CERF), supported around 1,800 pregnant women, including Margie.

Kidapawan City’s maternal health facility was also damaged by the earthquakes. “But the City’s life-saving reproductive health services did not stop even after the earthquakes, because of the donation of the fully-furnished birthing tents and other supports,” Dr. Joselyn Etulle-Encienzo, Kidapawan City Health Officer, appreciated emergency assistance provided by UNFPA and MOSEP as well as other partners. “And even now with the COVID-19 pandemic, these tents give us the assurance that  our City is able to continue necessary services to pregnant women.”

In addition to providing the maternal health tents that also help segregate pregnant women from COVID-19 patients, UNFPA also initiated a new “Cash for Health” (C4H) scheme.  The C4H was an innovation to help discourage unsafe home-delivery practices, but instead promote safe pregnancies, facility-based deliveries, and post-partum care, by removing economic barriers for them in accessing these essential services.  UNFPA provides cash incentives worth PHP 800 (approx. USD 16) for women who complete the recommended four ante-natal care visits at a health facility; PHP 1,000 ($20) for giving birth in the Rural Health Unit; and PHP 200 ($4) for utilizing post-partum care. UNFPA also provided maternity kits to Margie and other pregnant and lactating women.

Dr. Etulle-Encienzo believes that the cash incentives motivated pregnant women in earthquake-affected areas to improve their health-seeking behaviors to utilize services in health facilities. Margie attested, “I did not expect to receive money every time I visit the health center for check-ups. Even with COVID-19, I knew where to go to keep my unborn baby and myself healthy and safe.”

The future of those displaced by the earthquakes is uncertain, because returning to their original home is still considered risky because of the vulnerability to potential another big earthquake. Nevertheless, Margie is thankful to UNFPA, MOSEP, and local government agencies who continue to look after their needs during their prolonged stay in the evacuation centers.

“I want to celebrate the fact that my daughter survived.  I have kept some of the money received from C4H for her future,” Margie said with a disarming smile holding her 2-month-old daughter in her arms.

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To reinforce its life-saving reproductive health support for those women and girls affected amid the pandemic, UNFPA Philippines is appealing for additional financial support as part of the Global Humanitarian Response Plan to COVID-19.