'Midwifery in the Philippines: 'a laudable service' but there are issues and challenges: Alice de la Gente, former President of the Integrated Midwives Association of the Philippines (IMAP), wrote about midwives' key healthcare role in this country.

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ICM learned with great sadness of Alice de la Gente's death in November 2008. Alice was President of the ICM 1996-1999, and played a major part in hosting the 1999 Manila Congress. This article was written by Alice earlier in the year and is now published as a tribute to her life and achievements. The Philippines is a signatory to the 2000 Millennium Declaration on the global agenda for development by 2015. Among the eight Millennium Development Goals (MDGs), the country is said to be on schedule except with Goal 5, which aims to improve maternal health by reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015. Using data from the 1993 National and Demographic Survey as a base, the MMR at that time of 209 per 100,000 live births, should be reduced by 2015 to 53. In fact, only slow progress has so far been observed. The 2006 Family Planning Survey estimated an MMR of 162 per 100,000. This is a decrease of only 22% from the base estimate. There is a need to redouble efforts to achieve the desired MDG target on maternal mortality.

In the Philippine Framework for Maternal Mortality Reduction, health workers are identified as playing an integral part in achieving a lower MMR in the country. However the lack of professional health practitioners (such as doctors and nurses) in rural areas in the country is a major concern. The gap between health need and the available services is being bridged by the midwives. Although trained only to provide maternal and child health care services, midwives are currently implementing all public health programmes.

Indeed, the midwives in the country play a key role in delivering patient-focused services that are accessible, affordable and appropriate to the needs of patients as individuals and their families. The midwifery profession is central to the delivery of an effective health service, particularly in the rural areas. The midwifery profession, however, is facing issues that may constrain their effectiveness.

Midwives in the Philippines

Midwives constitute a large segment of the health personnel sector. Records show 150,722 registered midwives as of June 2007, and there were 3,498 newly registered midwives in 2007. Midwives work in the private or public sector--in hospitals, birthing clinics, barangay (village) health stations, or rural health units--or they work abroad. They comprise 65% of the public health workforce. In the rural areas, they are the first...