First of two parts
IT takes a village to raise a child. Before that child is even touched by the mother, the hand that holds is that of the midwife. In fact, these unsung heroes have been partners of the mothers — and the entire family — in pregnancy and beyond. But they are neglected.
Before the child enters school for teachers to nurture, the midwives immunized both the mother and the child, promoted breastfeeding for best child nutrition, mentored mothers and families on parenting and other needs of the family, post-natal and neonatal checkups, and many more. They are the front-liners of public health — the stewards leading the barangay health workers (BHWs) in barangay health stations and mobile professionals performing home visits in the village we call barangay. But they are neglected.
A teacher cannot teach a hungry child — more so, a child malnourished since conception, then the child is breastfed by a malnourished mother. There are midwives who are tasked by their profession to nurture the mother and child but are loaded with community health tasks that are beyond what their two years of education can train them for.
Then when more health care is needed, the nurses are there amid the attractive global employment. Then, when it is time to go to school, the teachers are there. But they are also neglected, and not protected.
Midwives as heroes
Republic Act 7392, or the Midwifery Law, has been the foundation of the practice of the profession since 1992. The law defined the profession legally, including its five-member Regulatory Board, which is chaired by an obstetrician and with a nurse-midwife. Its expanded functions were laid down in response to primary health care being thrust in the hands of these professionals amid the nurses’ opting for greener pastures overseas. Midwifery since then has covered functions beyond maternal and childcare. It covers health education, primary health care services including nutrition and family planning, and carrying out doctors orders.
The 34-year-old law has not been fixed to define what midwives are doing, so much are midwives being ordered to do in a devolved system of health care.
Since then, midwifery is a Diploma degree of two years. This provided a limit to their career path as progress requires higher education.
This gave birth to the Bachelor in Community Health Service (BCHS) offered by the Pamantasan ng Lungsod ng Maynila (PLM) in the mid-1990s to provide an opportunity for these registered midwives of a supplementary two years of education toward a bachelor’s degree — making them at par with their professional counterparts like nurses, medical technologists, nutritionists and others. Thanks to the brilliant vision of then-PLM president Benjamin Tayabas, who worked closely with Fabella Memorial Hospital Dr. Roberto Gonzalez to deliver the BCHS in an open university mode.
I was privileged to have been its first director. The program, supported by the Integrated Midwives Association of the Philippines (IMAP) through its president, the late Alice de la Gente, and then-House speaker, the late Jose de Venecia. It reached thousands of midwives nationwide.
Many midwifery leaders had been through this program, enabling their promotions as midwife supervisors, which required higher education and even graduate studies. Dependent on government funding, politicized and caught between midwifery organization tug-of-war, the program faded away but benefited many midwives until up to today.
In 2007, Commission on Higher Education Memorandum 33 envisioned the development of the program Bachelor in Midwifery, whose road map is toward its transition in 10 years. It went ahead with the amendment of the Midwifery Law, and is now facing mis-alignment with the Civil Service policies, which still refers to the old law in terms of midwifery as a profession. The specialization, even in entrepreneurship, is not harmonized with the government dynamics to optimize the value of education to public health and specifically to universal health care.
There were also the birth of midwifery organizations aside from accredited professional organizations called IMAP. There is the National Capital Region Midwives Association that transformed into the Midwives Foundation of the Philippines Inc. and the birth of the Philippine League of Government Midwives Inc. founded by the Department of Health’s (DOH) assistant secretary Cecille Banca Santos, which is now Philippine League of Government and Private Midwives Inc. The latter is very active and has become big and respected with many advocacies for the benefit of the midwives.
For the past elections, the Komadrona Party-list has failed to deliver the votes required of them to be represented in Congress. The midwives, just like many sectors, are not united enough for the strength it needs politically.
The realities on the ground
Devolved to the local government, the health care system has become politicized with less intention to invest in health. Obviously, a sick constituent will benefit a politician who holds the resources for the Filipino whose life is on the line.
The midwives are in this health care system which is less prioritized in many settings.
Midwives in public health are handling health programs cascaded by the DOH. They lead in the case findings and data establishment which requires them to conduct home visitations as they ride boats across islands, and walk by hills and mountains, even ride horses to reach many geographically isolated areas.
They head barangay health stations, which are the nearest health care facility for almost all services like immunization. Doctors trust these midwives with treatment responsibilities for basic care. The World Health Organization and the DOH prescribes one midwife per 5,000 population. But this is not true, especially in remote provinces.
And midwives are supported by BHW and Barangay Nutrition Scholars who are mere volunteers who are mostly politically mobilized. And we are talking of universal health care?
Lowly paid midwives
Public health midwives receive salary grade 11, which gives them a take-home pay of around P20,000, plus other allowances. This is compared with nurses, who under the law receives salary grade 15, which is above P30,000.
In the local government units (LGU), there are plantilla items but are unfilled. There were reports of drivers occupying the midwife position. Other items are diverted for other privileged personnel. Then the LGU depends on the DOH for their health human resource supply.
Salary in fifth- and sixth-class municipalities are affected by the provision, “subject to availability of funds.” But many midwives bite the bullet so they can have the privilege to practice their profession.
It is good that in national and urban areas, there are supervisory midwife VII positions, which is comparable to nurses. But these are more exceptions. Not typical in communities where health is more challenging and people are more in need.
Entrepreneurial midwives now own lying-in clinics, but are not insulated from the bureaucratic regulatory restraints of government and social insurance like PhilHealth.
To be concluded on March 6, 2026
