Friends. I have an idea and I want to know what you think. I'm considering starting a fund that will sponsor tubal ligations for the women that really want it and really need it.
In my short time at the clinic I have seen numerous women give birth to their 5th, 6th, 7th, 8th, or 9th babies. Many of these have had several other pregnancies in addition that ended in miscarriage. The majority of these women are anemic. Some of them are in their 40s. They all have a higher risk of hemorrhaging to death with each subsequent pregnancy. Most of these women really want to stop having babies - as they can barely feed the children they already have. Many of them have husbands who don't work for whatever reason, there is a lack job opportunities, especially for those who never finished high school. And so this story goes for so so many Filipino families struggling to survive. For at least the few women who have specifically requested help with having tubal ligation done, they have husbands who refuse to use condoms and the other forms of birth control - IUDs, Depoprovera shots, & birth control pills cost money and require regular check ups in order for them to be used safely. Frankly, these birth control methods are rarely used by the moms that we see.
So let me say clearly that I am not interested in advocating that every woman with lots of babies has tubal ligation done. I am just thinking about the few women that come along every once in a while that are desperate to stop having babies. I can think of two very clear examples. One being Florenda that I posted about recently. She is desperate. She can not take care of her children adequately. She's had 7 pregnancies and she's only 27. What's to keep this from happening again? She's not using birth control. And I can guarantee that she doesn't want to get pregnant again.
Example #2: A 41 year old woman who we go to church with. She has become our friend. We are in the same home group. I have been to visit her in her tiny one-room house. This is her 10th pregnancy and she was so upset with the news that she was pregnant... again. Her husband has no job. The only income that they have is when she is able to find some work washing clothes and this is very inconsistent and doesn't pay much. She also sends her 13 year old son to collect garbage to sell it. I have taken her on as my patient at the clinic. We have paid for all of her labs and meds so far and we will continue to pick up all of her birth-related expenses because of her desperate situation. They have little to no food to eat so we've been providing weekly groceries so she can at least get some nutrition while she is pregnant. And she is anemic and is taking iron provided by the clinic. She has made it clear that she wants ligation. And I told her we would help her.
I recently asked the obstetrician I know who works with our patients how much it would cost to have her do ligation at the public hospital. She doesn't charge any personal fees. The only fees are that of the anesthesiologist and the use of the OR. She estimated it would cost about 5,000 pesos - that's about $120 USD.
I'm considering starting a fund that would sponsor the ligations of only the most desperate of women. I would choose them wisely and would blog about their situations. I would personally arrange the procedure and may even get to observe one. What do you think?
4 comments:
I think this is an excellent idea. It is permanent and reliable, unlike the other birth control methods you mentioned. It requires no cooperation on the part of the husband. And, if women are thoroughly educated regarding this option (and others), pros and cons, it just may liberate the most desperate women from fear and anxiety surrounding another pregnancy, and free them up to focus on improving their health and the health of their families.
Some things to think about:
-would you also consider subsidizing other methods? If other methods are so financially unattainable women may choose ligation when they would rather have the choice of a more temporary and reversible method, simply because you offer it for free. This is ethically uncomfortable and not really a 'choice' in the true sense because there are only 2 affordable options to choose from: nothing and ligation.
-the education level of the women to whom this is offered...will she truly understand the risks of the surgical ligation? Will she truly understand the procedure?
-the possibility of word of mouth. If you offer this to 'only a few' the word may spread quickly and your fund be overwhelmed with need. Will you have a strict checklist to rule in or out women who want ligation? What will be on your list, besides "desperate need" as defined by your gut? Age? 27 is young by our standards. Health? Number of pregnancies/births? Income? Support network? Will you counsel women on adoption? NFP? etc...
Just some things to think about.
When you were telling me about Florenda's situation I was wondering about ligation.
I don't know if this situation is unusual or relatively common but I knew one young mom in Winnipeg. She was a victim of Fetal Alcohol Syndrome and because of this consequencial thinking was affected. Which meant that she had a lot of trouble seeing through to the consequences of her actions. Anyway after her third unplanned child (the first two were being cared for by her parents) she requested ligation. She was told she was "too young" to make that permanent decision. Again after her fourth unplanned child she was told at the hospital that they would not perform the procedure on her. Apalling, I think.
Anyway I think you are onto something, but Melissa has brought up some valid concerns.
I wonder if NFP workshops or even flyers might be helpful. Perhaps if the women were more aware when they are fertile they could avoid their husband's advances for those days. Obviously impossible to avoid him all month long but maybe more attainable if it's a few defined days?
wow, Jen, quite the issue to sort through. I don't know if I have anything to add other than I think Melissa has some good points about whether or not subsidizing other options of birth control is a possibility. It's a tremendous ethical question I wish we could have discussed in my ethics class last quarter because it is very real, and being thought through by a good person.
I think what I am going to do is research all available contraceptive methods in Cebu and their cost so I can make that information available to our moms. For those who really want help with family planning - whichever method they choose - and who wouldn't be able to afford it otherwise, I'd really like to be able to help them get it. I'm not sure yet how/if that will work but I agree with Mel that other forms should be offered so the moms really have a choice. My goal is to make these things available to those who really want/need it. I'll let you know what I learn. Oh real quick - I did recently learn of an establishment that provides ligation for around 600 pesos ($15) and several women in our church community have utilized it. I'm going to find out more - is it safe? who's funding it?, etc... it may be a viable option for those women who choose to go that route.
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