New mothers breastfeeding their infants

“There’s a 14-year-old girl. She was raped by her father and older brother.” Fe Madrid, the chief nurse overseeing Ward 4 of the Jose Fabella Memorial Hospital, looked at the rows of girls and women cradling their babies. “Yesterday, we discharged a 12-year-old. She was raped by three male relatives – her father, older brother and an uncle. The other day, there was an 11-year-old. She was raped by her stepdad. ”

Madrid made the unsettling reality look normal when she recited the details the way one

of the nurses called out individual patients’ numbers on the microphone: “Mother 156, mother 67, mother 94,” for the new mothers to bring their babies for the scheduled check-up and weighing by a medical team.

“I’m shocked by the stories but I think it doesn’t show on my face anymore.” Madrid said the life stories of women and girls in the hospital are as common as the daily childbirths, but they hunt her every single moment she thinks about them, especially the most disturbing ones.

She said the hospital’s army of social workers and psychosocial specialists – both employed and as consultants — are on call for counseling and other kinds of support as there is always a 24/7 need for their services, and the reasons are often harsh and intricate.

“What happened to the male offenders who raped the girls? Where are they? Have they been arrested? Are they in jail?” Madrid expected the alarm in the questions, but could only say that this is the concern of the welfare and psychosocial specialists. She works with them, but she has her hands full, often with extra burden to manage. Her daily hospital work is already a struggle, but she noted with apprehension that that part of the girls’ life stories may be unfolding in a different drama somewhere, especially after the teen incestuous rape survivors leave the hospital.

Madrid was interviewed during a photo walk and observation tour for documentarists and photo enthusiasts organized by reproductive rights advocacy groups Philippine Safe Abortion Advocacy Network (PINSAN) and Women’s Global Network for Reproductive Rights (WGNRR) in mid-June.

Counting 28 years in her work that started in the delivery room, Madrid said she was looking forward to the transfer of the hospital from Lope de Vega St. in Sta. Cruz, Manila to the compound of the nearby Department of Health (DOH) along Rizal Ave. in an envisioned tri-medical complex that includes San Lazaro Hospital, which specializes in infectious diseases, and Jose Reyes Memorial Medical Center that provides general medicine.

The maternity hospital, named after Dr. Jose Fabella who was the first secretary of health in 1941 and was regarded as the country’s pioneer of maternal and child health care, social welfare and midwifery, has been in its location for 66 years. It started as a six-bed maternity house in Sampaloc, Manila in1920 run by the public welfare board that in 1922 added a pediatric clinic and a school of midwifery. In 1931, it was handled by the bureau of health and hospitals until 1951 when it transferred to its current location.

Madrid said the 700-bed hospital with more than 1,000 employees has been seeing lesser patients in the last few months because they are referred to other hospitals and in order to make way for the transfer, which has started gradually, as the target completion date of the new hospital, May 2017, has passed.

Often called the country’s “birthing capital” and “baby factory” because it has the highest birth rate of as many as 100 births in 24 hours and 200 admissions a day on average, which makes it the biggest maternity ward in the country, the new Fabella Hospital, according to Health Secretary Paulyn Jean Rosell-Ubial, is a seven-storey modern hospital costing P750 million. In 2015, the government decided on building and relocating after engineers declared the structural integrity of the hospital’s eight buildings already unsuitable for occupancy.

Showing the beds with two women each, Madrid said the hospital usually overflows because there are not enough beds, so four or five women share one bed. Because of its standing as the country’s premier maternity hospital and its reputation as having multiple patients in one bed, Fabella receives visitors on observation or study tours.

A similar visit organized by another non-government advocacy group The Forum for Family Planning in early June for health workers from five provinces in Luzon and Visayas elicited reactions of disbelief from those seeing for the first time the hospital’s busiest ward full of women in white hospital gowns.

“This place looks like someone’s breeding machine,” one of the health workers said, her mouth open at the sight of about more than a hundred women in one day, cuddling or breastfeeding their infants.

A woman waits for her turn to have her baby bathed by a nurse

The mothers were mostly friendly when visitors talked to them or requested for photos with their babies. A few of them clamp up. A photographer said one can sense each woman’s situation during their contact with people they don’t know.  “It is easy when you just take photos, but very difficult to initiate a talk,” she said.

Nursing attendant Jay Ann Tabores said the women and girls in Ward 1, the abortion ward, so called because they sought medical help after an abortion, are usually the ones who do not provide full information. “We accept whatever information they provide but we let them know that it is necessary for them to cooperate if they want to recover,” she said. “But from their medical charts, you can determine what exactly happened, and from most of the data, the unpleasant truth comes out.”

On the day of the visit, she said of the 12 women who were in the abortion ward, only one, a 26-year-old, admitted to taking in misoprostol, an anti-ulcer drug with the brand name Cytotec, which is known to induce abortion. “She said she has seven children already, and her husband doesn’t get why they had to stop.” This was her second attempt and it was successful.

There have been deaths among women and girls who were rushed to the hospital after inducing their own unsafe abortions using crude means. “Nakakapagod din. Mauubusan ka ng lakas sa mga kwento ng buhay nila. (It’s tiresome and draining knowing their stories),” she said.

Ward 2 is for women with high-risk pregnancies waiting to give birth. Ward 3, which is for caesarian patients with complications, is the second most populous ward that has an average of 100 mother and infant pairs daily. Ward 4 is for patients with normal delivery. This ward is the one with 200 to 300 pairs at any given day.

For all its troubling images that reflect the country’s problematic family planning and population management program, Fabella Hospital is a model for a World Health Organization (WHO) scheme emphasizing skin-to-skin contact between mothers and newborn to enhance the bond and to reduce infant mortality, which is called “unang yakap” or first embrace that it initiated in 2008. The hospital also introduced the kangaroo mother care (KMC) system that involves the mother wrapping the preterm baby in embrace for breastfeeding and warmth through skin contact.

In 2016, the WHO noted that over the last four years, the hospital has reduced by half the number of newborns requiring admission to the intensive care unit (ICU) because of these initiatives.

The stark truths remain, however, of girls too young to be pregnant, women carrying another unintended pregnancy despite already having too many children they could no longer afford or care for, and the appalling stories the women and girls bring with them, such as pregnancies borne from rape. Many young patients have no clue as to what awaits them and are lacking in preparations for a life ahead as they are rushed into parenthood.

Ana Marie, 17, gave birth to a premature baby who was put in the Neonatal Intensive Care Unit (NICU) for respiratory air distress syndrome. “I only see him when I bring him my breast milk,” she said. Her boyfriend, the baby’s father, is 20. She has stopped schooling due to her pregnancy while her boyfriend works in temporary construction jobs. “We’ll get married when we save some money,” she said. “All of us get married eventually, right?”

Across Ana Marie’s bed is Leilani, 16, whose preterm baby is in the NICU for heart complications and may not survive. Leilani had antepartal hemorrhage or bleeding on the seventh month. The boy who made her pregnant is 15. They are both out of school and live on scavenging. “Sabi ng mama ko ihanda ko na sarili ko kung mamamatay si baby. Tutal daw hindi naman namin kayang buhayin (My mom told me to accept whatever happens should my baby die, as we can’t care for him anyway),” she said.

A mother cuddles her baby

The bleak stories amplify the facts. The 2016 Philippine Responsible Parenthood and Reproductive Health Report put the country’s adolescent and teenage pregnancies at 57 births per 1,000 girls aged 15-19 years. The 2015 Civil Registration and Vital Statistics reported that 12% (210,000) of all deliveries recorded in the country belong to girls aged 10-19 years old. More than one in 10 pregnant girls and women has tried to end a pregnancy through abortion.

Likewise, the Philippine Statistics Authority said every female has an average of three children during her childbearing age of15-49 years, which is one child more than what they planned or intended.  Women in poor socio-economic conditions have an average of five children – two children more than what they planned.

The cycle of difficulties, the surplus of babies, the multitude of sad stories continues as Fabella Hospital moves to a better place. There may be heartwarming stories and improvements in reproductive health strategies, but the reality remains. The Commission on Population expects at least 1.69 million births, and with this, an expected 105.75 million population by the end of 2017.