The Municipality of Mina participated in the Regional Technical Conference on Unmet Need Reduction Strategy with the theme: Expanding Options, Transforming Lives at the Iloilo Convention Center June 8-9.
Unmet Need Reduction Strategy (UNRS) has been piloted in Iloilo and Negros Occidental with very encouraging results. Experiences and recommendations of pilot implementers are being presented before an audience from DOH, LGUs, private sector officials, other government agencies, health managers and service providers for possible scaling-up of UNRS.
The topic “Increasing Family Planning Awareness and Use Among Adolescent Parents in Mina, Iloilo” was presented by Former Mayor Lydia E. Grabato in behalf of Mayor Rey P. Grabato in the Regional Technical Conference on Unmet Need Reduction Strategy last June 9, 2017 which was organized by the DOH Region 6 in collaboration with Visayas Health in line with President Rodrigo Duterte’s Executive Order No. 12 dated January 9, 2017 on attaining and sustaining Zero Unmet Needs for Family Planning through strict implementation of Responsible Parenthood and Reproductive Health Act.
“Thank you very much for that introduction and for inviting me to speak before you. Distinguished guests – DOH Sec. Pauline Ubial, representatives from USAID, NGO’s, DOH Regional & Provincial Directors and LGU representatives, guests, Ladies & Gentlemen. I immediately accepted the invitation in as much as the topic for me to tackle is close to my heart. The DOH Family Planning – Maternal Child Health Nutrition Program (FPMCHN) particularly the Adolescent and Reproductive Health Clinic (AYRHC).
— The Teen Mom’s Clinic was established and launched at the Municipality of Mina on February 20,2015 as the pilot area wherein it provides comprehensive services for adolescents mainly on preventive health management and counseling on unplanned pregnancies. Its establishment was made through the technical assistance provided by the DOH RO 6, PHO and the untiring support of Engender Health Inc. through their project Visayas Health. This development is very crucial and timely because of the current growing pregnancy problems among our teenagers. Earlier on, we recognized a need that this project should be available in our LGU. Even then we know that this project is achievable and sustainable. With your kind indulgence, let me tell you why we embrace the program, and how we did it to achieve our goal.
I have served as Mayor for 12 years. At present, I am the Executive Assistant, the Administrator of the said office. Although my husband is the current Mayor, our partnership to uplift the lot of Minanhons since 1992 during the first year of the operation of Local Autonomy has kept me busier and more involved in a hundred other things outside of our domicile, including this role I play this morning, on the mayor’s behalf. Although men and women interpret development issues and enact plans differently, women focus on the quality of life issues and respond to social injustice more successfully.
Ours is a long-term partnership for the development of Mina in coordination with different government agencies local and national most especially with the department of health. Mina, is a 5th income class rice producing municipality in the province. Truth be told, at the beginning of my administration we were a cash-strapped IRA-dependent municipality for many years. The long journey towards financial independence, economic growth, social progress and environmental security was truly nothing short of phenomenal. But the situation did not deter us not to do something to alleviate our condition from its poor situation; in fact we took it as a challenge with open mind and hard work.
Mina has a land area of 4,340 hectares, the smallest town in Iloilo with population of 23,921 and 21% of the population belongs to the 10-19 age range. For those who don’t know, we are located in the central part of Iloilo, landlocked by the bigger and richer first class municipalities of Pototan, Janiuay, New Lucena, and Cabatuan. Ours is an agricultural economy where croplands covering 84% of our total land area are devoted to rice production, the main source of income of our people.
Back then, at the start of my administration, I made the health of our people my No.1 priority because we truly aspire for a healthy citizenry. During that time we are in the top three highest in number of cases of malnutrition in the province. When malnutrition is high a lot of health concerns follow. Being A 6TH income class municipality then, was not a hindrance for our administration to embark on developmental programs and projects to benefit our people. From scratch, we abstracted the socio-economic development targets, establishing the vision and mission and focused primarily our development programs in four important areas: Health, Economic, Education and Social services, underlying the importance on the peace and order situation.
All of the national government programs were taken in and brought down to the grassroots level. Though we lack the essential funds to govern well, we remained pragmatic about what works for us. Our desire for change, economic development and healthy citizenry cannot be done for us by the outsiders. Our financial means were the most challenged. But then before, empathy compelled us to sharply focus on addressing numerous health issues affecting our constituents due to widespread poverty in our municipality. The program required an assessment of the existing health and medical situation in the community. This requires the conduct social interviews of household members and numerous consultations at the barangay level. Our objective was to gain insights on the problems. We did this with the coordination with Municipal Social Welfare Development Office (MSWDO), Municipal Planning Development Office (MPDO), the POPCOM thru Barangay Service Point Officer (BSPO) and Municipal Disaster Risk Reduction Management Office (MDRRMO) who are in –charge of the demography or social profiling of our people.
It definitely opened my eyes to the faces of poverty wherever I went. It was common place in many rural household to have 8 to 9 children, a husband working as a farm hand or laborer, and a wife as a homemaker and laundry woman. Many of these families lived in makeshift houses, unusually; there was also the phenomenon of rising single parent families. Based on our findings aside from economic problems the presence of domestic violence, incest, child abuse were also dominant problems in these families. Teenage pregnancies are also increasing in number. The need for help was palpable; the situation is giving a negative effect to our people’s desire for a long-term economic stability. The strategy we employed was to implement holistic approach, practical and low cost projects to address health care issues. This is an important component for the application of the Family planning program and health services more effectively.
In 2009, the Philhealth Regional Office 6 gave us recognition as the 1st LGU in the province of iloilo to have a 100% enrollment of our poorest of the poor in its program. With this, we gain capitation share that played a big role in the acquisition of RHU equipment, improvement of the facility and enhancement of skills/training of health personnel that improved the quality of delivery of health services to all Minanhons.
Over the past five (5) years, Mina Health Center had served an average of 411 (359 adults and 52 teens) prenatal cases per year with the teens constituting about 13% of the total pre-natal cases. For the same period, an average of 190 (145 adults and 45 teens) clients were provided with postpartum care per year with the teens constituting 24% of the total postpartum cases seen. Hence establishment of AYRH Clinic in our municipality was a vital response to this social problem.
Further, prior to AYRH scheme, the LGU through the help of provincial government, established a teen center at Mina national high school with a population of 2,003 students (school year 2015) and an average of not less than 2% increase in enrollment every school year. Statistics show that our country has one of the highest numbers of teen pregnancies in Southeast Asia. According to the United Nations Population Fund Agency, it is “a communal problem, a family problem, and a personal problem all rolled into one”. This is how we saw the situation in Mina. A need for a Holistic approach to counter the problems. The teen center established support the programs of AYRH especially in the preventive measures wherein RHU personnel, MSWDO, POPCOM and PNP women’s desk joined forces to continuously educate our young people especially on the difficulties in raising a family when they are not yet ready. Advocacies conducted through symposium, meetings and small group discussions wherein responsible sexuality, normal male and female anatomy and risk/danger of pregnancy and other significant issues at adolescent age are dealt with. (10-19 years old)
Our surveys in mina showed that the common reasons for teenagers becoming pregnant includes unplanned sexual encounters, social media or influence of internet based pornography, peer pressure to try out, lack of information on safe sex and contraception, brake down of family life, drunkenness and effects of use of illegal drugs or substances, lack of good female role models in the family, and the relationship within the family. Many of these teenagers are from poor backgrounds whose families suffer from dire economic conditions.
Although our RHU is well equipped as birthing facility, the DOH and Philhealth guideline also states that all teen pregnancies should be delivered at the hospitals since it is considered as high risk pregnancy. As one of the member municipalities of the Central Iloilo Health Zone Alliance (CIHZA), Mina refer pregnant teens to the Program for Young Parents (PYP) Center at the Iloilo Provincial Hospital (IPH) on their seventh month of pregnancy. The PYP in IPH was launched in August 2014. The PYP provides a dedicated space and day for antenatal consultations for mothers 19 years old & below. Interactive educational sessions are conducted to reach out to teen mothers, their partners and significant adults. The sessions include: Danger signs of pregnancy, FP and Gender, Breastfeeding and Life skills. Linkages with partner institutions like DepEd, TESDA, DSWD and DOLE are established once the teen clients complete the sessions and deliver their babies to allow them, their partners, & significant adults preferential access to services & programs for education & livelihood.
Being at high risk, pregnant teens are supposed to deliver in a facility that can provide comprehensive emergency maternal and newborn care (CEMoNC), hence the referral to IPH for delivery. Upon discharge, IPH refers mothers back to the RHU for postnatal care, family planning, and well-baby care. It has been observed, however, that at least 50% of young mothers come to the hospital just as they ready to deliver (direct to delivery room), thus, they are unable to benefit from the educational sessions under the PYP designed specifically for them at IPH. Many of these young mothers are not ready to accept Post Partum Family Planning (PPFP) and are discharged without any method and these are the clients lost to follow up and can benefit from the educaional sessions and postpartum care in Mina RHU. Hospitals are usually unable to follow up cases once discharged.
Objectives:
- To increase FP awareness and use among adolescent pregnant and postpartum mothers and their partners in Mina
- To strengthen referral system between Mina AYRHC and IPH PYP especially discharged adolescent postpartum clients who did not avail of FP services in the hospital.
Program Intervention:
An orientation on the Unmet Needs Reduction Strategy (UNRS) and the PYP educational sessions was held on 11 May 2017, with the AYRHC core team (MHO, PHN (Public Health Nurse), four RHMs (Rural Health Midwives), and the MSWDO in attendance. The orientation was to enhance the knowledge and skills of the AYRHC core team on how to deal with adolescent pregnant and postpartum mothers. Ten (10) satisfied users were coached on how to share theirs for family planning. They will support BHWs, BSPOs, and Nurse Deployment Program (NDPs) in generating demand for family planning. Mina RHU proposed the inclusion of a tracking portion in Referral Form to indicate what sessions the client has attended, so that these may be duly noted when they are referred to IPH for delivery. To the extent possible, young clients are provided FP services before they are discharged from IPH. Should the client opt to access family planning services at the RHU, IPH indicates this at the Back of the referral Form for follow up at the RHU. The PYP Champions at the IPH secures a list of the teen moms from Mina who delivered at IPH and provides this to Mina AYRHC for follow up by the Mina Satisfied Users (SUs) and BHWs. The Teen mothers followed up by the SUs and BHWs will be referred to the RHU on Fridays. Every Friday will be Teen Moms’ Day at the AYRHC wherein educational sessions are conducted to pregnant and postpartum teen mothers and their partners. Different educational sessions are scheduled every Friday. For example, danger signs and symptoms of pregnancy, birth planning and PhilHealth will be covered on the first Friday of each month; family planning and gender on the second Friday; breastfeeding and life skills on the third Friday; and linkages with development partners on the fourth Friday. Teen Mothers interested to use an FP method will be provided the method of choice also on Fridays.
Results:
For the month of May, 2017, a total of 62 pregnant women came for prenatal check-up, 38 were adults or 61% and 24 (39%) were teens. The 24 pregnant teens were seen at the AYRHC on the last three Fridays of May for prenatal check-up and attendance to educational sessions are for referral to IPH.
Likewise, 31 postpartum teen moms were followed up at AYRHC on the last three Fridays of May, 2017. Twenty five teen mothers were referred from IPH and 6 was referred from other facilities Of those referred from IPH, 2 were IUD users and the rest are not using any FP methods. The 31 PP teen moms attended the educational session at Mina AYRH. Ten or 35% of the PP teens not using a method were provided and FP method five pills, three DMPA, two IUD. Post Partum teens refer to those teens who delivered inIPH and referred to Mina AYRH regardless of the number ofd weeks post partum.
Our town also has share of problems related to use of prohibited drugs, domestic violence and child abuses, teen pregnancy and more. We have successfully implemented programs to counter drug problems. Today, all barangays have been declared as drug free. For domestic violence and child abuse, we have established the 1st Balay Paglaum in Iloilo to handle such incidence wherein counseling to pregnant teens and young fathers as well as those minors who are victims of rape or other forms of abuse. For alternative source of income among farmers, we set up program, entitled Municipal Agriculture Information System (MAIS) to address the problem of food shortage, low household income and employment in the agricultural sector. For those young girls who quit going to school because of their condition they could still continue afterwards, we have Alternative Learning System (ALS)given for free to take care of that situation. We also have a skills training center which is TESDA accredited for our teen moms or their partner to avail of free vocational skills training to be able to land a job to support their family.
The DOH has been a veritable source of very good and workable ideas, programs and projects, and solutions to the health concerns of our people. Thank you also to the USAID and Engender Health incorporated for your Visayas health project. In behalf of Mina LGU, please allow me to commend you for your people centered outlook to the health issues affecting especially the poor and marginalized sectors of our society. We are grateful and we look forward to the implementation of people oriented programs and projects that benefit our country as a whole. I hope you continue to make funding accessible to support our health programs and uplift the lives of the poor. We at the LGU will do our best to lead in implementing your programs at the grassroots level. Key components of your family planning program are already being implemented in our town. Our joint effort proves that this program can be feasible, and being a 5th income class LGU with limited resources is not an excuse for not establishing your programs especially the essential teen clinic among others and give the badly needed support to the teen moms.
CONCLUSION:
Teen mothers unable to avail of FP services in the hospital can still be given the opportunity to avail of the services by strengthening referral connections and intensive follow up. RHUs can play an important role in addressing gaps that hospitals can’t respond to. Other LGUs may come up with their own version of the AYRH program depending on their situation or need. The important is the universal effort that government can provide to resolve problems arising from teenage pregnancies, mortalities and population control and for LGUs to maximize the implementation of family planning and AYRH programs to truthfully reach the grassroots levels.
It is recommended that the system successfully implemented by our town be adopted for nationwide implementation.
- Ensure FP info and service are provided to teen mothers before discharge
- Ensure that Post- Partum teen mothers are located and followed-up
- Ensure that there is a strong and functional referral system between the hospital and the RHU especially where teen mothers are concerned.
If a 5th income class IRA dependent LGU like our town can do this as much for its people in facing the challenges involving poverty and population control most likely other LGUs can do a lot better. In our case we still hope to avail the grant for Adolescent friendly health facility to upgrade further our services.
With your continued guidance and support together with our dedication and commitment to do what needs to be done, we can also be a model of sustainable partnership in reaching our goal— A COUNTRY WITH EFFECTIVE AND SUSTAINBLE FAMILY PLANNING PROGRAM .
Thank you and once again good morning “