A woman and her newborn baby lay on the floor in Tacloban Hospital on November 15, 2013 in Leyte, Philippines. Photographer: Dan Kitwood/Getty Images
Rizza Jo Jaro, 18, went into labor in an evacuation center in Tacloban on Nov. 8 as Super Typhoon Haiyan, one of the worst storms on record to hit land, ripped through the Philippine city in Eastern Visayas.
"My mother was whispering to my baby, "˜don't come out yet,'" Jaro said, recounting how storm surges flooded the shelter. "I was so scared and felt like all hope was lost."
She doesn't remember being transported by her parents to Tacloban's airport, where a C-130 flew her the next day to a military base in Cebu, a staging ground for relief operations. Later that night, baby girl Haiyan Angel, named after the storm, was born. After spending time in the intensive care unit for dehydration and low blood sugar, the baby is now fully recovered. Haiyan Angel is one of the lucky ones.
Haiyan slammed into the central Philippines 10 days ago, knocking down most buildings including medical facilities, killing thousands, displacing 4 million people and affecting more than 10 million. There are almost 25,000 women expected to give birth each month in the disaster area, which will strain an international relief effort that's already facing logjams. The challenge may be compounded by disease brought on by a scarcity of clean water and poor sanitation.
"In crisis or not, women continue to deliver," Sew Lun Genevieve Ah-Sue, country representative of UNFPA, the United Nations Population Fund, said in a Nov. 14 interview. "We have to therefore ensure that those services are there, in addition to food and water of course."
The UN said the typhoon killed at least 4,460 people, making it one of the deadliest in Philippine history. The National Disaster Risk Reduction and Management Council's figure stood at 3,976 as of 6 a.m. In December 2012, Typhoon Bopha killed 1,067 people while Typhoon Thelma, the deadliest in Philippine history, killed 5,080 in November 1991.
There are about 222,000 pregnant women in areas hit by Haiyan, according to UNFPA data as of Nov. 15. Eastern Visayas, the hardest hit region, has about 57,000 pregnant women, the second highest among nine regions monitored by UNFPA. Almost half of that would be in Leyte province, where Tacloban is located.
Eastern Visayas was the third-poorest of 17 Philippine regions in the first half of 2012, down from fifth-poorest in 2009, according to the National Statistical Coordination Board. Poverty incidence among families in the region, which includes the devastated Leyte and Samar areas, climbed to 37.2 percent in 2012 from 36.2 percent in 2009, and 33.3 percent in 2006.
The economy of Eastern Visayas contracted by 6.2 percent in 2012 after growing 2.1 percent in 2011, the statistical board said in a July 2013 statement.
Haiyan's devastation is a further challenge to the nation's maternal and infant health targets. About 230 out of 100,000 women giving birth in the Philippines die, compared with 110 inThailand, 62 in Malaysia and 14 in Singapore, according to the UN in April 2009.
While the National Statistics Office said that number had dropped to 221 in 2011, it was still four times more than the Philippines' 2015 Millennium Development Goal of limiting maternal deaths to 55 to 60.
The Philippines narrowed infant mortality to 22 out of 1,000 live births in 2011 from 29 in 2003, according to the statistics office. The target is to reduce this to 19 by 2015.
Bernadette Villarin, 20, was due to give birth the week Haiyan struck Tacloban. She and her husband Henry ran to the second floor of a neighbor's house to escape the rising water. As she felt contractions the next day, Villarin's husband sought a midwife without success. "I think all midwives in our city died," she said.
When Villarin started bleeding, her aunt and husband rushed her to the airport, where only the runway was left, to fight for limited space in a C-130 aircraft. Her son Lando Joe was born in Cebu City, named after Haiyan's local name Yolanda and the doctor who delivered him. Villarin worries for a friend who is eight months pregnant and remained in Tacloban.
UNFPA's main goal is to identify pregnant women in devastated areas and offer them care, Ah-Sue said. "The difficulty is really trying to identify where they are because with the search for food and water, people are moving around," she said.
"The challenge of public health is there" as survivors had no clean water or shelter for some days and are at risk from diarrhea, asthma, skin disease, pneumonia and rat-borne leptospirosis, Health Undersecretary Janette Garin said by phone Nov. 15. "You have children swimming in dirty water."
The military hospital in Cebu has been treating about 100 patients daily, many of them ill due to a lack of sanitation, according to Patty dela Cruz, a doctor.
"They have been drinking and eating whatever is available," dela Cruz said Nov. 15. "They were out there for several days, they have no shelter."
The United Nations Children's Fund, or Unicef, estimates 1.5 million children are at risk of acute malnutrition and about 800,000 pregnant and lactating women are in need of nutritional support after Haiyan, according to a Nov. 15 statement.
Unicef is working with the World Health Organization and the local government for mass immunization against measles and polio. The target is to start administering vaccines in Tacloban in one to three weeks, according to the statement.
As survivors of Haiyan rebuild their homes and put their lives back in order, UNFPA will also roll out an information campaign on family planning for couples who may prefer not to raise a child under "extraordinary circumstances," Ah-Sue said. "It will take some time for recovery, for them to rebuild and reclaim their lives."
Birth control is a delicate subject in the predominantly Catholic country. President Benigno Aquino signed a bill into law last December to allow the government to distribute contraceptives to the poor and pursue sex education. The Supreme Court in March stopped the law's implementation amid objections from the church, and in July indefinitely extended a restraining order against it.
Villarin, whose grandmother and two sisters died in the storm, said she and husband Henry and Lando Joe will live with relatives in Manila and not return to Tacloban. "There's nothing left to come home to."