Women’s Role in Health and Development

(Keynote Speech delivered by Gabriela Women's Party Rep. Luzviminda C. Ilagan at the forum entitled The Role of Women in Health and Development held at the College of Medicine of the University of the Philippines on 3 March 2015. The forum, organized by the Gender and Development Committee of the UP College of Medicine and the Social Medicine Unit and attended by UP College of Medicine Dean Agnes Mejia, faculty members, students, and staff, was the first of a series of activities for the Women's Month celebration of the said college.)

Good morning!

Let us begin with a short quiz. Choose the letter containing the right answer. Women’s role in health and development began:

a) After the passage of the Magna Carta of Women
b) During the fight of the suffragettes
c) Before the coming of the Spanish colonizers
d) Upon the ratification of the UN Convention on the Elimination of Discrimination Against Women (CEDAW)

Friends, the correct answer is letter C.

Before the Spaniards came to colonize this group of islands we now call the Philippines, women and men possessed equal rights in society. In fact, women enjoyed equal rank and positions of power with men.

During the Spanish times, native women enjoyed a highly respected and elevated status. They were the first agriculturists, planting crops that would feed the villages while the men were away hunting. They also gathered seashells and berries. We are told that fossilized human waste showed that most of the food of the ancient villagers consisted of vegetables and seafood.

In the course of the women’s agricultural activities, they discovered medicinal plants, so that the women became the first herbalists or medicine people. Becoming close to Nature, it became a natural course that they developed an affinity and belief in the spiritual side of life. These women who were consulted as to the proper time to plant, to hunt or to go to the sea were commonly known as Babaylans.

Among other indigenous tribes of our country, they were called by other names but they had the same important role in their societies.

In the early times the Babaylan was an important figure in ancient pre-colonial villages. Babaylans were leaders who were more influential than the warrior class who sought the Babaylans’ wisdom in many aspects of community life. Babaylans were healers; not just of the illnesses that afflict the body but those that burdened the spirit. They were valuable therefore in the creation and maintenance of balance and harmony in the community.

However, all these changed upon the coming of the Spaniards. Women’s equal rights and standing in the community were eroded by the patriarchal and feudal institutions in Philippine society established during the 300 years of Spanish colonization. Women were taught to always obey and serve their fathers, husbands, brothers, or any other men in their family. The communal system and relationships were replaced. Mother right was overtaken by Father right.

Women, however, continue to play an important role in ensuring the well-being of their family and members of their community. This is partly because of their biological make-up. Women carry the next generation in their wombs, nurture and care for them until they are able to stand on their own. It is their awareness of people’s needs and their ability to perceive and empathize with others’ suffering that make women the best caretakers of the well-being of our communities and the whole of society.

While these physical, productive and reproductive make up of women ensure the survival and growth of populations, women in our country are not given the attention, support and services they need to carry out the role they play in building a healthy and developed society.

Today, the majority of Filipino women belong to the agriculture sector, where they work alongside men in all aspects of production. Women in the agriculture sector, however, are among the poorest; around three million peasant women receive an average daily wage of P148 (compared with P171 average wage received by men), while 1.52 million are unpaid family workers. Majority are not allowed to own land and thus are forced to be employed as farm workers or farm hands in haciendas or agro-corporations. According to Bureau of Labor and Employment Statistics (BLES), around 721,000 women work in private agricultural establishments or corporations where they earn less than minimum wages. These women are often forced to acquire loans or to take on domestic work and other similar types of jobs just to have food on their tables. This unequal treatment of peasant women reflects how insignificant women’s contribution in agricultural production and rural development is viewed.

Women’s role in the labor sector is also important. But just like in the agriculture sector, their significance is underestimated. While majority of our workers, both women and men, experience poor working conditions, women workers are more vulnerable to abuse and exploitation because of institutionalized discrimination. Aside from the 1.12 million unemployed women, 7 out of 10 of women with jobs are in the service sector, 69% of whom receive an average daily wage of less than P270. Slightly more than four million of them are in the wholesale and retail trade, mainly as sales workers in shopping malls. The manufacturing sector employs 1.38 million women, most receiving P316 average daily wage.

According to the International Trade Union Confederation, the Philippines is among the worst places to be a worker, receiving a score of “5”, the lowest possible score, in the 2014 Global Rights Index, because of the country’s lack of safeguards on workers’ human rights, including the rights to form and join unions. Likewise, workers’ health and safety in the workplace are not guaranteed. According to the Institute for Occupation Health Safety and Development, in 2011 alone, 126 workers died in work-related accidents. In May 2014, eight women workers died after they were trapped in a burning building in Pasay City.

There are 42,027 barangays in our country. Only 17,000 of them, however, have health centers. Most of these health centers have no or limited adequate facilities and personnel. Some even lack medicines and supplies. In 2009, the Department of Health reported that the country only had 584 district hospitals, 89 provincial hospitals, and 45 city hospitals. More than half of them had limited capacity and are comparable to clinics or infirmaries.  

For the longest time, health is considered a drain in public expenditure. While the total health expenditure as part of the Philippine Gross Domestic Product has improved, the Philippine health budget is still below the 5% set by the World Health Organization. In 2012, the Philippine expenditure on public health had been the lowest among ASEAN countries.

Many of you can probably relate to, or at least, have knowledge of this: In many public hospitals all over the country, doctors, nurses and health care workers have no choice but to regularly shell out money to help their patients get immediate medical attention in “do or die” situations. In some remote provinces, health care workers use their own meager allowances to buy even the most basic supplies such as cotton and alcohol.

Instead of increasing the budget allocation for health, what we have been seeing in the past years is the privatization of the public health care system. The Lung Center of the Philippines and the National Kidney Transplant Institute have already been privatized under the guise of “modernization”. More than 70 hospitals are at risk of being privatized in the coming years, including the Dr. Jose Fabella Memorial Hospital where a baby is said to be born every minute, the Gat Andres Bonifacio Memorial Hospital, Ospital ng Tondo, Ospital ng Sampaloc, Ospital ng Sta. Ana, and the Ospital ng Maynila. Without the united and sustained resistance of the hospital staff, officers, and parents of the sick children, as well as the support of different groups and organizations such as Gabriela Women’s Party, the Philippine Children’s Medical Hospital which caters to around 80,000 out-patients and 55,000 patients annually, would have been demolished and in its place, erected a commercial center, leaving thousands of children under PCMC’s care at the mercy of private and income-oriented hospitals.
The hilot or tradition birth attendants are traditionally considered complementary to public health workers in rural areas. The Department of Health used to provide training to hilots in recognition of the inadequate public health facilities and personnel, and in an attempt to provide effective and efficient basic health services. In 1994, the department, then under the leadership of Secretary Juan Flavier, issued Department Circular No. 69-A “Allowing trained hilots to attend normal home deliveries especially in areas where services of registered midwife or licensed trained health personnel not available at all times”.

This, however, was reversed by the “no home-birthing policy” of the Arroyo administration and which the current Aquino government continues to implement. In 2011, the DOH updated the policy through the “Maternal, Newborn and Child Health and Nutrition” strategy as part of the national government commitment to the Millennium Development Goals, in particular, in the reduction of maternal mortality rate. This policy has been adopted by a number of local governments, including that of Cagayan de Oro which penalizes traditional birth attendants who violate the no home-birthing policy. The City of Talisay in Cebu, the municipality of Danao in Bohol, the municipality of Minalin in Pampanga, Dingle and Estancia in Iloilo, and Quezon City passed various ordinances prohibiting and penalizing home birthing.

The no home-birthing policy did not help us reach our MDG target of lowering maternal mortality rate to 52 per 100,000 live births by this year, 2015. National Economic and Development Authority Secretary Arsenio Balisacan himself, said that there is low probability that the country will reach this target and that this may be due to the lack of health facilities and services, among other socio-economic factors.

The Council for Health and Development believes that aside from being culturally insensitive, the policy may even result in the increase in the incidence of maternal and infant deaths, especially in far-flung areas where there are no or limited health facilities and personnel. Such was the case of a woman in Nueva Ecija who had to walk a few kilometers from her house and to cross a river to reach the nearest birthing center. She and her child died before she reached the facility.

The role of women in development is tied to their role in health. Women are important in all aspects of economic development and the national government recognizes this. In 1992, Republic Act No. 7192 or the Women in Development and Nation-Building Act was signed, declaring that “The State recognizes the role of women in nation building and shall ensure the fundamental equality before the law of women and men. The State shall provide women rights and opportunities equal to that of men.”

Women make up the majority of the health care professionals and workers in the country. Currently, there are less than 500,000 Filipino health care practitioners. As you in the public health sector most probably know, this number is sorely inadequate and is reflected in the pitiable overall conditions of the majority of the Filipino people. We only have one midwife for 13,160 Filipinos; one public health nurse for 37,998 people; and one doctor for 67,987 people.

This low priority given to health has also resulted in the brain drain among our health care workers. The country has become the top exporter of health care workers; Filipino nurses, for instance make up around 25% of all the nurses worldwide. We have seen in the past years, doctors and nurses leaving behind their white coats for higher-paying jobs overseas.

Data from the Philippine Overseas Employment Administration revealed that in 1992-2009, 160,000 nurses went out of the Philippines to work in 50 foreign countries. Saudi Arabia is the primary destination of Filipino nurses. Other top destination are the United Kingdom, the United Arab Emirates, Ireland, Singapore, Kuwait, Qatar, Taiwan, and Canada.

Low salary and poor working conditions force our nurses, and other professionals, to seek greener pastures. On average, Filipino nurses earn five times more than mid-career professionals including lawyers, in the Philippines. Nurses in the US earn 15 times higher than their local counterparts.

Filipino nurses, along with other overseas workers, contribute greatly to the Philippine economy. Their remittance amount to around US$1 billion annually, which make up a large chunk of the total remittances from all OFWs, as well as of the GDP. However, this Labor Export Policy has also caused the high cost of migration.

Women are agents of development. They are the nurturers and caretakers of their families, communities, and the whole nation. They have not and cannot, however, realize their full potential. This is because of the dysfunctional and corrupt political and economic system in the country and the institutionalized discrimination against women. The women poverty and inequalities suffered by women is rooted in their lack of access and control of economic resources and involvement in political decision making. These - their discrimination in the education system, their poor involvement in the labor force, and their lack of ownership and control of land, among others - must first be addressed. To realize women’s full potential as agents of development, therefore, we must first work towards social change. #