In order to study how gender intersects with cultural, social, political, and economic models of medicine and its issues around the world, over the course of this class I have been delving into the health issue of maternal mortality and child malnourishment in the Philippines; I have been doing so looking through the lens of a critical medical anthropological theory. However, as I have learned, most gendered health issues today are analyzed using a combination of the five theoretical models. This is why I will also touch on the epidemiological theory as it pertains to infant/maternal mortality and malnourishment in the Philippines.
To give some background information, the Philippines’ biggest goal as of late has been to realign and improve their biomedical system related to malnutrition of children and babies and available care for expecting mothers. However, this has not been easy for several reasons that have social, economic, and political flaws. For example, there is a large gap in income distribution when it comes to geography. Many communities are located in isolated mountain regions on the islands of the Philippines and several others are in coastal areas that are hard to get to and from. One of the biggest social determinants of this health issue is poverty. Large gaps can be seen in the usage of health services among different income groups—94% of women in the wealthiest quintile of society gave birth with a skilled birth attendant present, while that percentage was only at 25% for the poorest quintile of women. The numbers are even more skewed when looking at facility-based birth rates (such as hospitals), where 84% of the richest women are in hospitals compared to 13% for the poorest. In the Philippines, the United Nation’s Millennium Development Goals’ (MDG) target in 2011 was to bring the number down to 52 deaths of the mother per 100,000 births, but the number is still at 162—which is the same as 7 women dying every 24 hours while giving birth with improper faculties (Huntington et al., 2011).
As the health industry has been going through rapid changes, so has the way of viewing health itself. Fortunately, people have started to realize that health entails more than just biological factors. The critical medical anthropological theory has recognized “that social class, supported by political and economic structures, has a profound impact on human health” and that medicine is largely a social science, (Joralemon, 2017).Specifically, this perspective focuses on the inequalities that cause better or worse outcomes for specific groups of people (Gabriel, 2018). Though biomedicine has done a stellar job of directing our attention to the biological and chemical reasons behind health issues, it is time to weigh in other factors too in order to start solving some of these problems. Contrary to the current popular opinion, human health relies heavily on social and political issues within a region, like the Philippines. This perspective outlines how power and authority help some people at the expense of others. This can be applied to the Philippines because mothers in urban Philippines with money and power are close to hospitals, while those without control in rural areas aren’t receiving proper prenatal care or child carebecause they are impoverished and too far away from health facilities. Several organizations have aimed to reduce levels of hunger, disease, maternity death rates, and child malnutrition by researching the surprising impacts that a social hierarchy and poverty can have on health. When the research is conducted, it is not forgotten that biology plays a factor, it is just acknowledging that health is also inherited through cultural and social aspects of a community (Singer, Erickson, 2011).
The biggest social determinant impeding mothers from receiving prenatal care in the Philippines is poverty/income. Approaching it from an economic perspective, the biggest factor involves money and is area of residence, as those without enough income cannot afford to live in big cities. They live in rural areas and live off of their own foods grown from their farms. With the help of epidemiological anthropology, it is known through measurable factors and statistics that those who live in rural areas have more complications with birthing and nourishing their children. Using this, a critical medical anthropologist would ask why. They would soon find that those who weren’t receiving ample income couldn’t even afford small things like a radio or television. To be exact, 23% of people living in rural areas had a radio or television and therefore were not able to listen to maternal health tips given out by the Philippine Department of Health’s health campaigns (Becker, et al., 1993). Even small things like this could improve a mother’s pregnancy habits; this shows that poverty and area of residence are, indeed, the largest social and economic determinants of maternal mortality and complications with raising a child in the Philippines. The lack of power and wealth in rural areas of the Philippines leave those people to suffer in the birthing process because travel times and costs are unreasonable; people with power in the cities use up health care resources disproportionately as they take advantage of the costs they can afford and nearby health infrastructure. Overall, using this anthropological perspective to look at the poor prenatal care in the Philippines tells us who suffers and who benefits from the distribution of power. This could, in turn, help integrate the aspects of biology and social, economic, and political culture (Singer, Erickson, 2011).
To expand on the biggest determinant of maternal mortality malnourishment among children, I’d like to talk more about the impacts of poverty on health. The unfortunate large amounts of maternal death and child death or malnourishment under the age of 5 in the Philippines is predominantly due to a family’s income level. Just like anywhere else in the world, environment and lifestyle choices are huge causes of health problems—so in the Philippines where large portions of the population are impoverished and live in dirtier and less safe environments (rural communities), health issues are bound to happen. The UN’s Millennium Developments Goals for the country have recently been focused on improving premature deaths due to poverty, as they can easily be prevented by offering more public health services. One of the bigger goals is to reduce child mortality, which is the most prevalent issue stemming from the impacts of monetary deprivation (Marmot, 2005). According to UNICEF, malnutrition remains a serious problem in the Philippines, in that it can stick with someone for the entirety of their life. Specifically, iodide and iron deficiencies can have grave impacts on learning ability and studies have shown that those with deficiencies have 10-15 IQ points lower than those who were properly nourished (UNICEF, 2008).
To continue, child mortality or illness in the Philippines, and also all around the world, is frequently caused by poverty, as poor living conditions and circumstances during pregnancy can lead to poor development of the fetus. Along with the biological effects that poverty can have on an expecting mother, she is also often stressed about her situation which can lead to higher chances of maternal smoking or drinking, and overall improper and lacking prenatal care caused by a small amount of helpful resources (Geneva, 1999). Furthermore, as if child mortality and malnourishment weren’t already a big enough problem to start with, it also tends to have a horrific cycle with poverty being the health determinant. The cycle is as follows: poverty can cause illness and in return, illness can foster more poverty. To explain, if a child is born from a mother who had a hard time accessing prenatal care and didn’t have ample money or resources to stay healthy for herself and for her baby, that child would be likely to take on an insecure attachment style with negative brain stimulation. If this were to occur, the child might only attain a low education level, problems with behavior which may cause social marginalization as an adult, and ultimately a low paying job and poverty (Wilkinson & Marmot, 2003).
In Cebu, Philippines a study was done on the causes of childhood survival and their inequalities as it pertains to area of residence: rural or urban. In this study, several determinants of health were analyzed such as mother’s education, health insurance (if applicable), income, drinking water availability and cleanliness, sanitation, travel time to a hospital, and access to key medical drugs. Among all of these factors, income had the biggest contribution to child survival rate inequalities between poor and non-poor children (Wagstaff, 1970). In a separate study, individuals with health insurance reported higher hospitalization rates when they needed attention, higher rates of births with a skilled attendant present—which corresponds to lower rates of risky home deliveries, more primary care physician encounters, more chronic diseases diagnosed, and better compliance to prescribed drugs (Dror, 2005). Overall, these studies show that the huge differences in uses of medical facilities in order to keep a person’s health in line are, in fact, due to different income levels and poverty among people in rural areas of the Philippines.
On top of the social determinant of poverty and the economic/geographic determinant of area of residence, there is also a political side to the health issue, as defined by the critical medical anthropological theory. These political aspects include, but are not limited to: laws, taxes, social security benefits, and public services that, in the end, will produce health and other societal outcomes that are of interest to citizens who can afford the benefits (Mackenbach, 2014). Laws and public health benefits are applicable to the health issue of poor prenatal care and malnourishment because they could undermine the effects of poverty and allow all people to have access to medical attention. In fact, if the political situation in the Philippines changed, I believe there would be a solution to this problem. Though changing public health policies would not change the fact that more than a quarter of the country is impoverished, it could allow everyone to have access to health care so that expecting mothers could have regular check-ups to ensure the best outcome possible; by doing so, I also believe the cycle of illness and poverty would end—if people aren’t spending tremendous amounts of money when they become ill or have a child, they won’t be in a bad financial situation. The Philippines is actually starting to implement new health policies with the election of the new president of the Republic of The Philippines, Rodrigo Duterte. Before he was elected in 2016, The Philippine Health Insurance Corporation (PhilHealth) required that enrollees must have made three monthly monetary contributions within the last six months in order to receive benefits (Yamada, 2016). However, during his presidential campaign, Duterte promised to improve poor conditions. He would do so by requiring all private hospitals to set aside 20-30 bed spots for the poor to be taken care of, while their expenses would be paid for by the government (Yamada, 2016). Though this isn’t exactly free health care, it is a step in the right direction. I believe the combination of this political change and the decision to build more hospitals closer to rural areas, the numbers of maternal deaths and child malnourishment cases could really decrease.
All things considered, it would be so momentous to address child and mother malnourishment on a social, economic, political, and cultural basis because right now it is a part of Filipino culture to endure everyday inconveniences that come along with poor health care in poor regions, such as malnutrition, lower intelligence levels, and the spreading of diseases. If the government could change that stereotype and perspective on the Philippines by implementing new political policies to get rid of these social determinants and allow for a new developing culture of accessible and affordable health, that would be of grand significance for the development of the Philippines and the growth within its mountain region communities and all the way to the ocean side communities, too. Not only is it necessary for health care to be affordable, but there need to be more facilities available. Additionally, it is so important to view these health issues as more than just biology and weigh in environmental and social factors. If this isn’t done, change cannot happen and women and children all over the globe will continue to suffer the health consequences of poverty; if a combination of the five theories of anthropology are used to address a problem within a cultural model of medicine intersected with gender, anything can have a more positive outlook.
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