Integration and control: The eradication of traditional birth attendants in the Philippines

In 1958, the Philippines Republic Act 2644, An Act Regulating Midwifery Training and Practice, authorized Traditional Birth Attendants to practice in areas not served by professional health workers. This was the earliest example of integration of heterodox health care practices into the formal health care system in the Philippines. The Department of Health of the Philippines began conducting training programs for Traditional Birth Attendants with UNICEF. Trainings concerned sterile techniques and germ theory, in attempts to reduce infant and maternal mortality. However, for the past three years the Department of Health of the Philippines has ceased these trainings and have ordered that all women are to be considered at risk during pregnancy and must be delivered in facility by skilled medical professionals.

This research examines the feasibility and potential outcomes of this policy to stop the practice of traditional birth attendants on local level health care and health care access. A qualitative design of data collection was utilised. Convenience samples (n =500) of community members, community leaders, health-care providers and key policy actors participated in semi-structured interviews and focus groups to assess the changes in community health-care systems and community health-care access in following this policy. Findings demonstrate that a majority of Filipino women prefer to deliver at home with a traditional birth attendant- regardless that they are no longer being trained or supplied with sterile birthing kits. Thereby, a potential for increased maternal and infant morbidity and mortality, especially in remote, poor and inaccessible areas where the implementation of this policy is least feasible is predicted from these findings.