Last of two parts
The State’s pandemic response, characterized by a preoccupation with the enforcement of law and order and public compliance to health protocols heavy on lockdowns and punitive policies, have left many low-income families with limited options.
Peoples on the margins, especially women, have had to adapt quickly and devise means to eke out a living amidst persistent uncertainty and economic anxieties. These pressures in turn have had a negative effect on the state of physical and mental health of many urban poor women.
Access to health services: limited and compromised
The imposition of lockdowns has impacted the access and delivery of health services in communities, including urban areas. The closures of barangay health centers or community clinics have left urban poor women no alternative to avail essential health services, drugs, and medicines badly needed by family members.
Pregnant women could not access prenatal services, but in instances when they could, were prohibited from traveling by local authorities even with valid appointment papers. The necessities of their condition compelled them to secure prenatal services provided by health nongovernment organizations (NGOs) and other health professionals via telemedicine or online medical consultation.
However, obstacles such as the unavailability of or unfamiliarity with gadgets used for teleconsultations, made it difficult for urban poor women to fully benefit from these services. Community leaders also cited the cost of purchasing internet data for online consultations requiring virtual inspection by the physician through Web cameras and paying the professional fees online as major challenges for accessing virtual health services.
Urban poor mothers also experienced difficulties bringing their infants and children for check-ups at the height of community quarantines. At the same time, the elderly could not access medical care and secure medicines for their non-Covid related diseases like tuberculosis, hypertension, diabetes, and skin problems due to travel restrictions. Some decided not to go to the community health facility for fear of Covid-19.
An NGO leader in Bulacan revealed that at the height of the pandemic, people have resorted to non-medical therapeutic remedies like tuob (steaming) and herbal medicines to alleviate pain and other bodily discomforts.
The UN Women Rapid Assessment Survey conducted in April 2020 revealed that 66% of women and 75% of men were unable to seek the necessary medical care because of the measures implemented under the community quarantine. In a report released by the National Economic and Development Authority (NEDA) in April 2020, 38.5% of survey respondents indicated difficulties accessing health facilities, while 49.1% in accessing pharmacies.
Even with a lowering of the classification of community quarantine due to a decline in the number of reported Covid-19 cases and barangay health centers allowed to open, the elderly continued to be prohibited from leaving their homes to seek medical care and purchase their medicines because of belonging to the high-risk group. There were instances of the elderly experiencing a stroke or heart attack, and dying in their houses without seeing a doctor, as relayed by a community leader in Bulacan.
Financial pressures lead to falsified Covid-19 deaths
Several people interviewed for this story have reported how some deaths in urban poor communities were falsely documented by health personnel. An example is the case of a mother who died from a stroke but whose family members were advised by hospital staff to declare her as a Covid-19 case so that they would not have to pay for anything. Because the family is poor, they consented to the arrangement to settle the hospital bill. Unfortunately, the family received the mother’s remains in ashes, which was the hospital protocol. The left-behind family members also faced discrimination from the community since they were viewed as possible carriers of the virus.
One child rights NGO leader in Metro Manila further said: “We received reports that some of the families that we serve went to the hospital for non-Covid-19 illnesses. They were advised by the personnel that they can deliberately and falsely diagnose their patient as a Covid-19 case so that they won’t pay anything because of the Covid package of PhilHealth.”
Without proper laboratory tests to establish the real cause of death, these deaths end up being tagged as Covid-19 cases and automatically cremated without the family’s consent. These irregularities instilled fear and stress, particularly among the elderly, contributing to their unwillingness to be brought to the hospital, added a community leader in Manila.
These issues indicate how ill-prepared local governments were in coming up with appropriate measures to respond to the communities’ health needs and concerns. As stipulated in Republic Act 10121 or the Philippine Disaster Risk Reduction and Management Act of 2010, local government units (LGUs) down to the barangay level are mandated to develop local disaster risk reduction and management (LDRRM) programs that should take effect once an emergency or unforeseen event requiring immediate action takes place in the community. While it has been over a decade since the passage of the law, LGUs — similar to the national government — have failed to take appropriate measures when disasters and emergencies like a pandemic occur.
As a community leader in Manila suggested, one action which barangay health centers could have adopted is for local health personnel to visit the elderly and vulnerable members of the community in their homes once the lockdown was imposed and people were prohibited from leaving their homes.
Lockdowns lead to stressful and unsafe homes for women and girls
Women are stereotypically assigned the role of caregiver at home. When a member of the family is sick, women are expected to take care of the member’s needs, from taking them to the barangay health center or doctor for consultation and treatment, monitoring the doctor’s instructions, administering of medicines, to preparing meals, and ensuring that the essential needs of the sick person are met.
These forms of unpaid domestic labor were further exacerbated by pressures arising from the loss of jobs and sources of income. Women interviewed for this story reported experiencing sleepless nights, acute anxiety, stress, and depression. The constant worry of how and where to get the family's next meal has been their foremost concern, caring less about the health risks brought by the pandemic. Limited resources have forced them to eat less or skip meals altogether, prioritizing children and the elderly. At times, they cannot help but resort to crying and self-pity. These experiences have considerably drained the women’s energy.
According to the World Health Organization, the home is not always safe for women, children, adolescents, and the elderly. This is evidenced by the increase in sexual and gender-based violence cases like rape, physical and verbal abuse, and domestic violence, a serious consequence of lockdowns on urban poor women and girls. Trapped inside the house with abusive partners, husbands and/or male family members, women and girls have become the targetsof men's anger, frustration, and boredom.
Without jobs and restrictions on travel forcing them to stay at home, men’s attention and behavior have focused on women leading to frequent disputes or arguments stemming from stress and economic difficulties. Confined in limited or overcrowded settings where physical distancing is not feasible, conflicts and fights ensue, often becoming violent. Women are usually the victims of aggressive behaviors and sexual abuse, especially when men are high on illegal drugs, intoxicated, or both.
The lockdowns prevented the victims from reporting these incidents to the Violence Against Women and Children’s (VAWC) Desk of the barangay and from seeking assistance and accessing protective shelter and appropriate health services for survivors. During the enhanced community quarantine (ECQ), the Philippine National Police reportedthat from March to May 2020, 602 rape cases occurred or an average of 8 people a day.
The lockdowns also had detrimental consequences on children, specifically girls. Several interviewees shared cases of children left at home raped or sexually abused by a male family member, a relative or a neighbor while mothers were away looking for provisions for the family. Some children became pregnant and had to be separated from the family.
Many children also fell victims to online sexual exploitation with some persuasion and aid of their parents out of desperation, according to several interviewees.
Drawing strength from each other
The support and encouragement given by women to each other served as consolation and encouragement for them to bear the difficulties; they run to each other in times of need. Even if they cannot help financially because they are in a similar predicament, finding time to share and listen to each other’s stories, problems and grievances was more than enough support. It helped release tension and lighten their load. As a respondent in Manila expressed, having someone pour out your problems and having someone listen to you was a big deal.
NGOs and church groups in Manila, Navotas, and Caloocan also organized online sessions for women to share their experiences and serve as an outlet to vent their grievances. Cognizant of the difficulties women go through, organizations saw it fit to provide venues for community residents to extend support by listening to one another. One woman who attended these sessions said, “It is good to have a support group in these troubling times. By simply listening, we were able to help each other.”
Human resource is the most significant wealth of any nation. In a country where women constitute about 50% of the population, they are an essential asset that should be valued and further developed considering their significant contributions to society’s growth and advancement, Covid or no Covid.
As a State Party to numerous international human rights laws which recognize the rights and freedoms of women like the International Covenant on Civil and Political Rights, International Covenant on Economic, Social and Cultural Rights, and the Convention on the Elimination of all Forms of Discrimination Against Women, the Philippine government is obligated to take appropriate measures necessary to respect, protect and fulfill women’s rights. Moreover, ensuring women's active and meaningful participation in decision-making and policy-making is essential to achieve equality, opportunity, and social protection in addressing the social, economic, and political impact of crises like pandemics. END
Nymia Pimentel Simbulan is a Doctor of Public Health. She is the Vice-Chancellor for Academic Affairs at the University of the Philippines Manila where she also teaches courses in behavioral sciences and public health. She is also the Chairperson of the Philippine Alliance of Human Rights Advocates (PAHRA) and the Executive Director of the Philippine Human Rights Information Center (PhilRights).
This two-part report explores through a human rights lens the issues affecting urban poor women during the pandemic. Throughout 2021, the author interviewed urban poor women, community leaders, local government officials, and non-government organizations to gather their stories and experiences.
Part 1 looks into the multiple burdens that urban poor women are carrying in adapting to the COVID-19 pandemic and the government’s response and how both have significantly exacerbated urban poor women’s vulnerability and threatened their well-being.
Part 2 explores the problems, challenges, and coping behaviors adopted by urban poor women to navigate and survive the pandemic and an environment characterized by deprivation, marginalization, and inequality.
Photograph: PhilRights
