We walk into the Likhaan Center for Women’s health one afternoon to see Lina Bacalando counselling Melody about what contraceptive method to use. Melody is a resident of Building 9, in Bgy 105, Tondo, Manila. She is 25 years old and has 4 children. Melody seems convinced to use an injectable which, Lina explains , will keep her from getting pregnant for the next three months. It is a typical day for Lina, an NGO worker in the slums of Tondo.
Lina is a community health worker from Likhaan, a non-government organization focused on women’s health. The Likhaan clinic in Tondo has been around for more than two years now and is enjoying a grant from Hewlett Packard so they were able to put up a small center in Bgy 105, Vitas, Tondo. It serves about 1,500 women daily.
“ The women are often misinformed about contraception and family planning and that’s why counselling is also one of our services. The center gives out various contraceptives such as condoms, pills, injectables, arrange for tubal ligation at our partner hospitals, and IUD. All these are free.” Lina speaks in a clear and confident manner in Filipino. She has been an advocate of family planning for close to 16 years as an original board member of Likhaan. She is also a favorite speaker on many occasions about reproductive health and women’s issues. The president of a network of 20 women’s groups from Malabon, Tondo, Pasig, and Quezon City, Lina is a passionate advocate of family planning and a supporter of the current controversial Reproductive Health Bill (RH) in the Philippines. The bill is currently undergoing interpelletion at the Philippine Senate. The fight for its passage in the mostly Catholic Philippines has been a long 10 years.
“When we first started our center here in Tondo, women got to hear about us from their neighbors, friends and families. It spread quickly and we now have an average of 50 women daily. There are many cases where the women are as young as 14, 15, 16 years old and pregnant for the first time. Teenage pregnancy is a common thing here. Some go to the nearby hospitals of Fabella, Gat San Andres or Ospital ng Maynila to give birth. But it also takes money for one to hire a “kuliglig” (a local motor transport ) which can cost 300 pesos to bring you to the hospital. Home births are usually not encouraged but what can you do if the young mother is alone, the husband is at the dumpsite working and there is no money for fare? In cases like these, a “hilot”, a traditional woman in the barangay (village) is called to assist in the birth. Many of these “hilots” are not trained at all to assist in birthing. Asking them to come also costs money. “
Lina went on to talk about the economics of earning an income in the Tambakan charcoal pits and the garbage dumpsite in Vitas.
“The people here mainly earn from either making charcoal at the “Ulingan”(charcoal site) or rummaging through the garbage at the barge. Bgy 105 has 20,000 residents. In Sitio Damayan alone, there are 3000 families earning 100-150 pesos daily from sifting through the garbage. It is not enough for a basic living. Many of the children do not finish school and go on to work at the garbage dump. This is where the young girls meet their boyfriends whom they live with as partners. Living-in is common. Getting married is expensive but some couples take advantage of mass weddings that politicians organize once a year. They also get invited to mass baptismal ceremonies of various religious groups in the area that are free. “
What myths or misconceptions do women in the Tondo area have about contraception, we ask Lina.
“ There are many beliefs that the women hear from their neighbors, their families or their friends. For example, one of our clients stopped taking pills because it was causing varicose veins in her legs. She did not ask for medical advice but just assumed the varicose veins were caused by the pills she was taking so she stopped taking them. Others start to be scared when their menses don’t come after they start using injectables. Their neighbors and friends say they should always have their monthly periods even after using injectables. They say that the blood that’s inside them is “dirty blood” and will make them sick and will cause tumors to grow. Then of course, if they are Catholic, they will hear at mass that all kinds of family planning methods cause cancer. It is really sad that their ignorance about their reproductive health is compounded by what they hear from people like priests, who are supposed to know better.”
We visit Vilma, a client of Lina in Sitio Damayan the next day. She is 37 years old and is on her 11th pregnancy. But she has twins already so she will actually have her 12th child. Her husband is 33 years old and works at the garbage dumpsite. Vilma still goes to sift through garbage even if she is on her 9th month. Their house is small with one side wide open. It rained while we were there and we wondered how the family manages during the monsoon months. We also learn that after her 9th child, Vilma had an IUD insertion . Not long after, she complained of not being able to breathe properly and of having asthma attacks. She then asked to have her IUD taken out. But even after Lina explained that her asthma attacks were not due to the IUD insertion, Vilma still believed it was the cause of her shortness of breathe. Lina says that conditions at the garbage dump and the nearby charcoal pits was causing her asthma attacks. Vilma without her IUD insertion then got pregnant with her 10th baby.
At the Likhaan clinic’s visit to nearby Baseco barangay the next day, we meet 14 year old Mary Joy, who is pregnant for the second time. Her boyfriend is 17 years old. Mary Joy stopped going to school when she found out she was pregnant. Her mother, a vendor of cooked food, was anguished when she learned of her daughter’s second pregnancy. “I already felt sad when she got pregnant for the first time at 13. But her second pregnancy really made me angry”, she says. “I had always imagined that she would be our only hope in improving our lives, if she finishes school. Now, I think she may be like me because I was also pregnant at 17”. Lina asks more questions from Mary Joy and tells her about what services she can avail of at Likhaan, after she gives birth at the hospital.
Lina seems tireless. The 170 patients they saw that morning did not seem to faze her.It was just another working day for her. Asked if urban poor women really like having many children, Lina replies, “politicians and rich people are wrong when they say that urban poor women just keep having babies. These women want to have less children.They want to give the best for their children too—just like any mother. But they have nowhere to go for proper information and for free services. When I first saw babies drinking what I thought was iced tea because of its brown color, I wanted to cry. It was actually brown sugar mixed with water. These women can not afford formula milk. They could not also breastfeed because they themselves had not eaten that day. It is sad but we continue on. There is much to be done still.” With community health workers like Lina who persist and are passionate about their work, there is hope for the women of Vitas and Baseco. We just need to keep telling their stories so that more people will know, be aware and understand. Hopefully too, more influential people will see why we need to pass the Reproductive Health Bill (RH Bill). It will bring back more women’s clinics in Manila and in the country to provide the same services that Likhaan does for the majority of urban poor communities.
