At a Manila Hospital, Making Mothers by the Minute

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MANILA -- In the main ward at Dr. Jose Fabella Memorial Hospital, 171 women and nearly as many newborns share fewer than 100 beds. Dozens more expectant mothers line the street outside, some sleeping on the sidewalk while waiting to get in.

The women, most of whom cannot afford to give birth at a private hospital, move through a type of controlled chaos from the street, to the labor room, to the delivery room, to the maternity ward and back out the door, usually in less than 48 hours.

"It's a never-ending story, 24 hours a day, every day," said Dr. Romeo Bituin, who added that the government-run maternity hospital was legally required to serve as a safety net for the poor. "We can't reject patients. If we turn them away, where will they go?"

After years of rancorous discussion in the Philippine Congress, the House of Representatives finally decided in August to end debate on a reproductive health bill that would subsidize contraception and require sex education in the Philippines, a country with one of the highest birthrates in Asia. If it passes in the House, which returned to session on Monday, it would also need to be approved by the Senate.

The bill's proponents, led by President Benigno S. Aquino III, who has made the issue a priority of his two-year-old administration, say the measure will give poor women a chance to have fewer children and rise out of poverty. Opponents, backed principally by the Roman Catholic Church, say the bill is out of step with the moral tenets of the overwhelmingly Catholic Philippines and argue that a high birthrate lessens poverty.

"Our country's positive birthrate and a population composed of mostly young people are the main players that fuel the economy," said Jose D. S. Palma, the president of the Catholic Bishops' Conference of the Philippines.

Whether it is a bane or a boon, the birthrate in the Philippines -- 24.8 out of 1,000 people, compared with 13.7 in the United States -- is not a matter of statistics at Fabella hospital. It is a matter of logistics.

The hospital, located in a former prison between a public market and the city jail, delivers more babies than any other facility in the Philippines. Last year, 17,639 babies were born there.

The women are allowed into the hospital only when they are ready to give birth. After the birth, they sleep two to a bed in the maternity ward. If they had a healthy delivery without complications, they are sent home after one day.

"We don't have the capacity to let them come in early or stay long after delivery," said Dr. Marie Pacapac, a spokeswoman for the hospital. "Our delivery room fills up."

The hospital averages about 60 deliveries a day in the summer and about 80 deliveries in a 24-hour period during the peak delivery season, September to December.

"These are the babies made last December, during the cold months, the months of love," said Dr. Pacapac with a smile as she walked through the bustling ward.

The hospital, which accepts pregnant women that other facilities reject charges 3,000 pesos, about $60, for a normal delivery. Women who cannot afford that pay whatever they can. Some babies have been delivered for 100 pesos, or $2.50, while some expectant mothers show up at the hospital without a single peso, hospital officials said.

Most of the women who deliver at Fabella have never had any sexual or reproductive health education -- which is rarely taught here -- and many cannot afford to buy contraception, said Dr. Bituin, who noted that these issues would be addressed by the pending legislation.

"These women will use birth control pills, they will use condoms, but they can't afford them," Dr. Bituin said as he stood in front of the hospital while a line of taxis and tricycles unloaded expectant mothers.

"If they received these things for free, they would use them, and fewer of them would end up here," he said. "We are just the last step in the process. We need to advocate reproductive health in the community at the grass roots. The church is already there spreading their message through services every Sunday."

The hospital does offer family planning information, but budget constraints prevent it from giving patients contraceptives, said Dr. Esmeraldo Ilem, the facility's head of family planning services.

"Family planning in the Philippines is not about population control," Dr. Ilem said. "It is a health intervention. We are focusing on women who are too young, too old, too poor or too sick to have babies but their situation does not allow them to stop."

That description could be applied to Jelly Galia, a 44-year-old with seven children who was in the main ward after her eighth child died shortly after birth the night before.

Sitting on a bed surrounded by women nursing their newborns, Ms. Galia said she lived with her children in a slum. Her husband is an unemployed taxi driver, and her family has no income.

"I don't want to have any more babies," she said, wiping tears from her eyes. "I would take the pills, but we don't have money to buy those. We'll try 'control,' " she said, using the local term for abstinence.

world

This article originally appeared in The New York Times.


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