Assessing the State of Professional Practice of Midwifery in the Philippines

Abstract

Background and Objectives: Midwives have been the country's frontline health care providers in communities. Their role was expanded from largely providing maternal and child care services in the 1920s to provision of basic Primary Health Care services since 1970s. Despite their extensive roles, there has been no comprehensive enquiry on the professional practice of midwifery in the Philippines since it formally started in 1901. This study was conducted to (1) describe the evolution of midwifery education and regulation; (2) describe professional practice of midwifery and the midwives' role in the local health system; (3) identify gaps in the current midwifery practice, and; (4) recommend to improve and standardize the competencies of practicing midwives.

Methodology: The study is qualitative with a grounded theory approach using face-to-face Key Informant Interview (KII), Focus Group Discussion (FGD), and document review. The study, conducted from January to December 2015, purposively sought experts from different fields of midwifery, including midwifery-service providers, birthing home managers from public and private sector, academe, Department of Health (DOH), development partners, the country's three leading midwifery organizations, and the Board of Midwifery (BOM) of the Philippine Professional Regulation Commission (PRC).

Results: Changes in midwifery education, scope of practice and standards were in response to the country's health challenges in maternal and child health. Public midwives were frontline implementors of 57 DOH programs. Despite their vital role and expanded workload, the tenure or plantilla positions of government midwives continued to have the same salary grade promulgated in 2000 while others, although the numbers are unknown, do not have security of tenure. There were no learning and development initiatives designed to enable midwives to become implementors of multiple programs. Regulation of midwifery practice was not cohesive. The standards of practice were program-based and were scattered in different policies.

Recommendation: The study recommends that the DOH, PRC, and midwives' organizations review and revise the scope of midwifery practice in line with global standards, as well as to implement a competency-based career development pathway that is integrated with the regulatory system.