THE NEXUS BETWEEN EXTREME WEATHER …...(Millennium Development Goal (MDG) 5 Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 209 to 52) Child health Indicators

THE NEXUS BETWEEN EXTREME WEATHER EVENTS, MATERNAL CARE, AND CHILD NUTRITION PRESERVATION THROUGH A GENDER LENS

ERLIDIA F. LLAMAS - CLARK, MD (PHIL) , MPH (UNIVERSITY OF ADELAIDE)

PHD (EPIDEMIOLOGY AND POPULATION HEALTH, ANU)

FELLOW, PHILIPPINE OBSTETRICAL AND GYNAECOLOGICAL SOCIETY

FELLOW, PHILIPPINE SOCIETY ULTRASOUND IN OBSTETRICS AND GYNAECOLOGY

CLINICAL ASSOCIATE PROFESSOR AND ATTENDING CONSULTANT OBSTETRICIAN-GYNAECOLOGIST

UNIVERSITY OF THE PHILIPPINES - PHILIPPINE GENERAL HOSPITAL

COLLEGE OF MEDICINE, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY

SECTION OF OB-GYN ULTRASOUND

email: [email protected]

September 1-2, 2016 Australian National University PHILIPPINE UPDATE

OBJECTIVES

GENERAL OBJECTIVES

To present the links between Extreme Weather events (typhoon flooding disaster), maternal care and child nutrition preservation through a Gender perspective

SPECIFIC OBJECTIVES

To review the gender roles of women and men operating in the Filipino households and communities

To examine what happens to these gender roles during and after a disaster

To highlight that maternal care strongly contributes to child nutrition preservation in pre-disaster conditions and more so during EWEs and disasters

PURPOSE AND ADVOCACY

Gain support for women in pre, disaster and post disaster conditions to ensure better health and nutrition outcomes for children

September 1-2, 2016 Australian National University

OUTLINE

Introduction

State of Extreme weather Events, Health and Nutrition, and Gender in the Philippines

Conceptual Framework: EWE/Disaster Food Security and Undernutrition Conceptual Framework

Objective

Methods

Results /Discussion

Characteristics of the mothers, her children and households

Women as the main actors who exercised their agency to ensure that the children’s and household’s nutritional condition is not worsened by the EWEs.

Women’s experience of the TS Ketsana / TY Parma and flooding

Understanding of flood causes

Their actions during and after the flood

Coping with the challenges of their role as a mother to their children in a calamity

Conclusion/Summary

Implications of this typhoon-flood experience to local nutrition, health and disaster policies and practice


INTRODUCTION: EXTREME WEATHER EVENTS


MOST COMMON WEATHER/

DISASTER EVENTS:

TYPHOONS

FLOODS

STORM SURGES

-DROUGHTS

El Nino Southern Oscillation(ENSO)

VOLCANOES

TSUNAMIS

EARTHQUAKES

Source: law.georgetown.edu

INTRODUCTION: HEALTH AND NUTRITION

Maternal health Indicators

95% antenatal care at least 1 visit

73% of livebirths attended by skilled attendants

55% contraceptive prevalence rate

Main causes of maternal deaths are hemorrhage (30%), indirect causes (17%), hypertension (15%)

1990-2015 maternal mortality ratio =

110-120 /100,000 livebirths

(Millennium Development Goal (MDG) 5 Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 209 to 52)

Child health Indicators High coverage of immunization for DPT,

influenza, measles

20% underweight and 30% stunting in children under 5.

34% are exclusively breastfed

45% of child deaths are in neonatal period

31 under-five mortality rate

MDG 4 Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate 80 to 27)

1990-2015 Infant mortality = 58-28/1,000 livebirths (MDG Target 4 = 19)

http://www.countdown2015mnch.org/documents/2015Report/Philippines_2015.pdfhttp://www.nscb.gov.ph/stats/mdg/mdg_watch.asp

INTRODUCTION GENDER REVIEW: DEFINITION OF TERMS


Gender

the state of being male or female typically used with reference to social and cultural differences rather than biological ones

Oxford Dictionary. Oxford University Press, 2013

socially and culturally constructed and change over time and are reflected in:

roles and responsibilities

access to resources

constraints, opportunities, needs

perceptions and views

not a synonym for women but considers both women and men and their interdependent relationships

Moser, C. Gender Planning and Development: Theory, Practice and Training. London: Routledge, 1993.

INTRODUCTION GENDER ROLES

set of societal norms that guide one’s behaviors which are generally considered acceptable, appropriate, or desirable for people based on their actual or perceived sex/sexuality

Gender roles are embedded in the generalized gender belief system

how people have come to view men and women

qualities of masculinity and femininity

ascribed values, norms, roles surrounding gender in a society


INTRODUCTION: GENDER

MDG 3. Promote gender equality and empower women

MDG 3.1 a-c Participation in elementary to tertiary education

MDG 3.2 Share of women in wage employment in the non-agricultural sector

MDG 3.3 Proportion of seats held by women in national parliament

September 1-2, 2016 Australian National University http://www.mb.com.ph/vp-robredo-receives-most-influential-filipina-woman-award/

http://www.mb.com.ph/de-lima-urges-duterte-admin-to-stop-tolerating-extra-judicial-killings/

http://www.unicef.org/philippines/reallives_11785.html

http://www.rappler.com/move-ph/47204-un-resolution-violence-women-migrant-workers

Duterte draws support of gender rights groups

Duterte comes out strongly for family planning, reproductive health

REVIEW AND APPLICATION: GENDER DIVISION OF LABOUR AND ROLES IN FILIPINO HOUSEHOLDS AND COMMUNITIES

Male Roles Female Roles

ustralian National

http://blogs.reuters.com/photographers-blog/2013/12/13/challenging-gender-roles-in-the-philippines/

http://pulitzercenter.org/reporting/asia-philippines-gender-role-family-migrant-labor-domestic

https://filipinolifeinpictures.wordpress.com/category/mother/page/2/

SIGNIFICANCE OF GENDER IN DISASTER AND HEALTH RESEARCH

vulnerability and helplessness of women during disasters due to socio-cultural norms

Enarson & Meyreles, 2004; Enarson & Morrow, 1998; Fothergill, 1998; Ikeda, 1995; Islam, 2011; Rashid, 2002


HYPOTHESIS FOR PHILIPPINE CONTEXT• women are not just vulnerable

and helpless victims• capable of agency• gender division of labour-

women’s caring role for children influence nutrition and health outcomes

PROCESS : HOW?

SIGNIFICANCE OF GENDER IN DISASTER AND HEALTH RESEARCH

Argument: To improve the overall health of

Filipinos, including women and children’s health in disaster settings, there is a need to address the social determinants of health including the gender dimensions in the Filipino’s way of life.


Application:

During a flooding disaster, how will gender division of labour and gender roles operate?My assumption women protected her child’s health

and nutrition and household’s food security which can be compromised during episodes of EWEs, particularly in a post-flooding disaster.

CASE STUDY OF THE EWES : TROPICAL STORM KETSANA ( ONDOY) AND TYPHOON PARMA (PEPENG) (2009)



EWE/DISASTER FOOD AND NUTRITION SECURITY CONCEPTUAL FRAMEWORK

CONCEPTUAL FRAMEWORKMATERNAL CHARACTERISTICS AND CHILD NUTRITION

14

Care for Mother/ Children- Inadequate care

Health Status-Disease

statesNutritional

Status0-5 years Children

Normal Malnutrition

UndernutritionOvernutrition

Maternal characteristics- Age, education, occupation, employment status, income, reproductive history, cultural: food habits, preferences, feeding practices http://www.childslife.nl/typo3temp/pics/b0fa81e289.jpg

Extreme Weather Events

Food Supply/

Production-Decrease

Food Access

Inadequate access

Food Use

Inadequate access

Household Food Security

METHOD

•Extreme weather events - effects of tropical cyclones and its related flooding (most common)

• The geographical site : randomly selected local villages in District 4, Laguna Province,

Philippines affected by the Ketsana/Parma flooding disaster Sept- Oct, 2009

• nutritional status of 0-5 years of age children

•Household and Maternal characteristics


METHOD

Phase 1 Cross-sectional Study (Quanti/Qualitative)Child Health and Nutrition SurveyHousehold Food Security Survey Key Informant Interviews

Children 0-5 yrs Sept 2009Mothers Ketsana/Parma lag time March/Apr 2011

18 months Village Growth Data CollectionmonitoringSurveillance

Phase 2 Qualitative: MOTHERS’ n-depth Interviews, Key informant Interview


RESULTS AND DISCUSSION


72.7%

27.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

Normal weight Underweight

Child underweight

63.3%

36.7%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Normal height Underheight

Child Stunting

27.3% underweight children vs 20% National Nutriton National Survey (2013)

36.9% stunting vs 30%National Nutriton National Survey (2013)

RESULTS: PREDICTORS OF UNDERWEIGHT

Association with underweight

Older children >24 mos.

higher number of siblings

water sourced outside premises


RESULTS: PREDICTORS OF STUNTING

Child health status

Children with illness experience slower growth

Maternal education

Low maternal education associated with stunting

Flood level and duration (inconsistent)

Low flood level is associated with stunting

Up to 2 weeks flood exposure is associated with child stunting


RESULTS: CHANGE IN UNDERWEIGHT BEFORE AND AFTER FLOOD


There was a significant change in

WAZ scores (underweight)

More children became underweight versus underweight who improved-62/946 nearly two years post-flooding disaster -193/946 (20.4%)

Hypothesis: Can the household food security mechanism explain this?

YES and Women and Children were disadvantaged

Change in WAZ scores before and after floodPost-flood WAZ score Total

normal

weight

Under

Weight

Pre-flood WAZ

score

normal

Count 626 193819

% within pre-

flood score 76.4% 23.6% 100.0%

% of Total 66.2% 20.4% 86.6%

underweight

Count 62 65 127

% within pre-

flood score48.8% 51.2% 100.0%

% of Total 6.6% 6.9% 13.4%

Total

Count 688 258 946

% within pre-

flood score72.7% 27.3% 100.0%

% of Total 72.7% 27.3% 100.0%

McNemar Test < .001

Source: BNS Record s and Child Health Survey 2011

RESULTS: CHARACTERISTICS OF MOTHERS OF UNDERWEIGHT CHILDREN

Mothers with more than one child had higher odds of being underweight with the odds being greatest (2.5 times) if their mothers had six or more children compared to mothers with one child (p=.002)

Children had 1.8 (p=.001) and 1.5 times (p=.043) the odds of being underweight if their mothers had an elementary or high school education, respectively, compared with a mother with a college/postgraduate degree.

Children had twice the odds of being underweight if their mothers read a newspaper less often compared to mothers who read a newspaper daily (p=.011 and p=.020, respectively).

Mothers listening to the radio less often compared to mothers more frequently (p=.048) had an underweight child


QUALITATIVE RESULTS AND DISCUSSION: MATERNAL INTERVIEWS

Women’s gender roles played a crucial role in the entire family and child nutrition preservation.

Specifically, she protected her child’s and household’s health and nutritional status by

using meticulous caring practices – strict sanitation and hygiene, cleaning, feeding well

using coping strategies during episodes of EWEs post-flooding disaster – giving up her food for them, engaging in income-generating activities like food vending, domestic work when husband cannot work

Thinks and acts for the FAMILY during and after calamities with GREAT DIFFICULTY.


QUALITATIVE RESULTS AND DISCUSSION: MATERNAL INTERVIEWS

In low-resourced settings frequented by EWEs and flooding, the disaster experience brings short-term protection from immediate food insecurity and low weight gain through relief assistance and maternal care.

However, when resources and coping are stretched, the development of child stunting post-flood is inevitable.

Women as the main actors exercised their agency to ensure that the children’s and household’s nutritional condition is not worsened by the EWEs – coping strategies


CONCLUSION

Using a gender lens, maternal care strongly contributes to child nutrition preservation in normal pre-crisis conditions and more so during EWEs and disasters.

This role is ultimately translated to the special care and overt coping strategies when these difficult situations arise.

In many circumstances during and after the disaster, women acted positively and used their capacity to assert and try to change their dire state.

Challenges in the performance of this social role highlight the need for acknowledgment and support for women in crisis situations to ensure that better nutrition and health outcomes are achieved for children.


REFLECTION/RECOMMENDATION

The typhoon-flood experience has many implications to local nutrition, health and disaster policies and practice

With the future threat of climate change, investment in public health initiatives incorporating food and nutrition security, livelihood support and gender-sensitive disaster-risk reduction measures need to be strengthened.

Investing on WOMEN is good value!


We are guilty of many errors and many faults, but our worst crime is abandoning the children, neglecting the foundation of life. Many of the things we need can wait. The child cannot. Right now is the time his bones are being formed, his blood is being made and his senses are being developed.To him we cannot answer "Tomorrow". His name is "Today".“

- Gabriela Mistral, 1948

THANK YOU!SALAMAT PO!

University of the PhilippinesPhilippine General Hospital

Department of Obstetrics and Gynecology

University of the PhilippinesPhilippine General Hospital

Department of Obstetrics and Gynecology

ACKNOWLEDGMENTS

Australian National University – Scholarship , VC fieldwork and travel grant

National Centre of Epidemiology and Population Health

Australasian Society for Nutrition in Medicine, Student Conference Award

University of the Philippines (UP) System and its Libraries

Philippine Food and Nutrition Research Institute

UP College of Medicine and Philippine General Hospital Volunteer doctors

Laguna Provincial Government, District IV Municipality Mayors, Local Doctors, Village Captains, Health and Nutrition Workers

Family, friends and many nameless people who helped me with this research

Participants: Mothers and Children 27

Documents

THE NEXUS BETWEEN EXTREME WEATHER …...(Millennium Development Goal (MDG) 5 Reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio 209 to 52) Child health Indicators