“We go to the doctor when we have money. When we don’t have any money, we just pray and do what we can to take care of it.”

Last week, Ugat ng Kalusugan returned to Barangay Bagong Silang to carry out a mini-survey among Badjao families. Like our first survey in Bagong Silang, our purposes for carrying out another survey were two-fold: we wanted to test out our community health survey, and we wanted to get more information on one purok (area) of Bagong Silang because it is a possible site for our work. Photos from our trip are here.

The results of our second survey are summarized below. As with our first survey, there are several caveats. These survey results are not representative of the whole Barangay. We only interviewed 11 women and one man from 12 different households, and only households in the Muslim, Badjao portion of the community. We employed convenience or accidental sampling - a type of nonprobability sampling wherein the sample (interviewees) are selected from the general population because they are readily available and convenient. There is an added bias to the group we interviewed: they were all mothers (or a father) whose children under five years of age were receiving their regular deworming and vitamin supplements distributed by the barangay health workers. We opted to accompany the barangay health workers as they went from home to home so they could provide an introduction for us to meet women within the community. Because our sample is comprised of women (and one man) whose children are being cared for by the health workers, it is important to remember that they and their children are likely much healthier and better off than their counterparts who do not access any health professionals or receive any free medicine.

While we cannot make any generalizations about the community based on our survey results, the results do offer some insights into this community, and we found some of the results interesting.

We interviewed 11 women ranging in age from 19 to 35, and one man who is 48. We generally plan to interview only women but in one household the woman we wished to speak to was sick and resting and her husband offered to answer our questions.

Family Planning

We asked the interviewees if they practice family planning. Two women answered that they do use contraception. One uses hormonal pills and the other uses the injectable DMPA (Depo Provera). Both women pay for the contraception themselves. One of the women is Catholic and the other belongs to the Iglesia ni Christo church.

The rest of the women in our sample do not use any form of family planning, artificial or natural. When asked why, every single person said that they do not use any form of contraception because it is forbidden as it is against Islam. Several of the women who do not use contraception because it goes against their religious beliefs are young (ages 19-21) and as yet each have only one child. Among the older respondents (ages 28-40) most women have had multiple pregnancies and children. Maida, who is 28, has 5 children. Sherwina is 29 and has four children but has had five pregnancies. Tina, who is 30, has three children. Her friend Adea, who is 32, has three children but has had eight pregnancies. Sandra is 35 and has had seven pregnancies and has six living children. 48 year old Cesar’s wife has had 13 pregnancies, and has nine living children.

We asked the respondents what they think the ideal number of children is and most of them answered that the ideal is between two and four children. Some of the women with multiple children said that two or three is ideal, but that they couldn’t achieve their ideal because using contraception is against Islam. One women said the ideal is two or three but she has had seven pregnancies. She says she is too scared to use contraceptives. Cesar’s wife has had the greatest number of pregnancies and children (13 and 9 respectively) and in answer to what his ideal number of children is, he said, “Allah forbids planning. But in terms of what I think, this number [9] is enough. We’re already having a hard time and more children would be difficult. But if it is Allah’s will, then we will have more.”

Islam and Contraception

While we were carrying out our surveys, we asked the interviewees their beliefs and practices and we recorded their answers. We did not question people further about their religious beliefs but I was very confused as to why everyone was telling me that Islam forbids the use of contraception. I didn’t think Islam forbade family planning, but I wasn’t sure, and even if I was, I did not feel that it would have been appropriate to give an impromptu lesson on Islam and contraception. We completed the surveys and upon returning to our office, I conducted some internet research and found that Islam very clearly allows the use of contraception. I was stumped and continue to be. How is it possible that a large population of Muslims in this one particular community believe that Allah and the Koran prohibit something that in fact is allowed? These Muslim families are some of the poorest in the province, and most households are too large to support with one or two people’s meagre salaries. Yet families are large because men and women wrongly believe that their God prohibits planning their families. I have to assume that this group’s imam or their community elders have received incorrect information about Islam’s view of family planning and have successfully spread this misinformation among the population. I suppose that spreading the misinformation could be intentional, though I cannot comprehend why anyone would do that. This remains a mystery to me and I hope to have the opportunity to speak further with some of the people we interviewed to find out more about how they came to have this erroneous belief.

Care from Health Professionals

Eight of the women we interviewed had prenatal check ups with their last pregnancies. Among these eight women, none had regular checkups throughout her pregnancy. Most had only two or three check ups before delivering. The other four interviewees did not have any prenatal check ups and cited lack of money as the primary reason for not seeking care.

When asked what type of health professional they consult when they or their children are sick, six respondents answered that they seek care from Barangay Health Workers, four see doctors, and one goes to the City Health Center. One of the interviewees said, “We go to the doctor when we have money. When we don’t have any money, we just pray and do what we can to take care of it.”

When asked what type of birth attendant they prefer, eight stated manghihilot or traditional healer, two like doctors and one prefers a midwife. One respondent said she would really prefer to have a doctor, but her family cannot afford one so she uses a manghihilot or traditional healer.

Unlike their counterparts in other neighborhoods in Bagong Silang, the Badjao women we interviewed overwhelmingly prefer to give birth at home. When asked where their ideal birthing place would be, all but one of the interviewees said that they prefer to give birth at home. One women said she prefers the hospital. All the women who prefer home births did actually deliver their children at home, save for one woman whose parents took her to a birthing center because it was her first delivery. One interviewee noted that the home is best because their family does not have the money for a hospital birth, and another women said that she prefers the home because she is scared to give birth in a hospital.

Of the women we spoke with, only two had seen a health professional for a postnatal check up after their last pregnancy. These two women were the two women that gave birth outside the home - one at a birthing home and another at a hospital. None of the others had heard of the need for postnatal visits, and a few added that their health was fine after giving birth so there really was no need for a check up.

Beliefs about Family Planning

We asked the people we spoke with about their thoughts or beliefs relating to family planning. The following are some of their statements:

“It is forbidden by Islam to plan our families.”

“Islam forbids us to use contraception.”

“We don’t plan families because we are scared of Allah. We do not know more than Him so His will be done. Only God can let us survive.”

(-Cesar, whose wife has had 13 pregnancies and 9 living children)

You need to only have a few children so that you can

send them to school and feed them sufficiently.

(-Sonya, 19 years old with one child, not currently on any form of contraception)

“I’d like to give my children a good life -

have enough for them to go to school and to eat.”

(-Damesa, 21 years old with one child, not currently on any form of contraception)

“It’s better not to have too many children so that life isn’t too hard.”

(-Sherwina, 29 years old with four children, not currently on any form of contraception)

Beliefs about Pregnancy

We asked the interviewees about their beliefs regarding pregnancy. Most of the responses centered around a pregnant woman’s safety at night and included the beliefs that when you are pregnant you should cover your head if you go out of your home at night, that at night a pregnant woman should have garlic hanging in her house so that vampires will not be able to find her, and that generally pregnant women should not walk around at night. One woman said that pregnant women should not carry anything too heavy, and another said that when a pregnant woman reaches the month in which she will give birth, she should regularly drink ginger tea.

Immunizations

Like their counterparts whom we interviewed earlier in the week, all the children of the mothers we interviewed were up to date with their immunizations - or will complete them shortly (for babies under 1). These immunizations include BCG (Bacille Calmette-Guérin - a vaccine against tuberculosis), three doses of DPT (DPT refers to a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis [whooping cough] and tetanus), three Hepatitis shots, and three doses of the Polio vaccine. These results are probably not typical. It is important to remember that the women we interviewed were the mothers of children receiving medicine from the Barangay Health Workers. There is a bias here - these children are receiving care from the health center and thus are more likely to have completed all the requisite immunizations. If we were to randomly sample families within the community, we might not find 100% compliance with these immunizations.

Finances and Employment

Only two of the women we spoke with are currently employed. One delivers soap, and the other, who is the wealthiest of the women we surveyed, sells fish in the market. The man who we interviewed works as a street cleaner for the government. All of the other women have no work and expressed the desire to work in any kind of position that becomes available - especially being a saleslady or a maid.

Two of the people I spoke with have a monthly household income between P500-1,500 ($11-$32.) Three respondents have a monthly household income between P1,501-3,000 ($33-$64.) Two women reported a monthly household income between P3,001-4,500 ($64-$94.) Two of the families have a monthly household income between P4,501-6,000 ($94-$125.) One family’s monthly earnings totals P5,000 ($105). Another’s is P6,000-7,500 ($125-$161.) The wealthiest of the women represented had a monthly household income between P9,001-1o,500($188-$220.)

Supplemental Support

None of the children among the sample households we surveyed receives any regular supplemental feeding, despite the fact that Badjaos are referred to by city health officers as being some of the “poorest of the poor” and with some of the greatest number of children that are malnourished.

Most of the families do not receive any regular support from any outside groups but some families sometimes avail of services or food from the Department of Social Welfare and Development, Barangay Health Workers, from the city health center and from a nonprofit called Balikatan. One interviewee mentioned that her family sometimes receives free food when local officials celebrate their birthdays and feed the masses - an activity that is popular in Palawan and which Mayor Hagedorn and Governor Reyes both recently did for their birthdays.