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Datu Piang, Maguindanao, the Philippines“The most challenging of them all is delivering a baby with no limbs,” narrates Kinengko Ebad, a 64-year-old hilot. “What came out first was the lower torso and I had nothing to hold to pull the slippery body,” she recalls. 

Kinengko has many memorable stories to share as a hilot. Her hometown recognizes her as an expert with decades of experience.

What is a hilot?

A “hilot” or a traditional birth attendant (TBA), is known in the community as a quasi-midwife assisting mothers in their birth deliveries, usually at home. They have no formal training; they first observe, then assist,  and later would progress to the actual handling of the stages of giving birth. Normally, other TBAs, typically relatives, guide this “on-the-job training.” In Kinengko’s case, as a teenager, she often accompanied her grandmother, who back then was also the hometown’s popular hilot.

Challenges of  at-home and facility-based deliveries

People in rural areas like Datu Piang often view Facility-based deliveries or giving birth at hospitals and health centers, as a luxury. In contrast, at-home deliveries entail relatively modest costs for pregnant women, according to Kinengko.  “Still, if I know that the family has no money, I give my services for free,” she reveals.

“At times, I feel bad about not being fairly compensated.  This is not an easy job. Sometimes the labor is long that lasts for hours or even days, and I  have to stay with the mother,” she continues.

Notwithstanding at-home delivery as a more affordable option for pregnant mothers, the lack of a hilot’s proper supplies and training could contribute to pregnancy complications and maternal deaths,   which in the first place could be prevented. 

Access to a skilled health provider is one of the key interventions necessary in preventing maternal deaths. In the 2017 National and Demographic Health Survey, 9.8 percent of all women aged 15 to 49 who gave birth within the last 5 years in ARMM have been attended by a hilot -- the highest in the country. 

Transforming hilots to formal health workers

UNFPA  works closely with the Department of Health (DOH) in making every pregnancy and childbirth safe. One way to ensure this is to strengthen the health systems of the country, including providing support to hilots or TBAs.

TBAs are being recognized nowadays as important maternity care providers.  The government and its partners, like UNFPA, integrate TBAs into the formal health system through training programs. Keningko herself acquired her training on pregnancy tracking, the importance of delivering in health facilities, and the dangers of home-based deliveries.

In addition, UNFPA, through the support of the Government of Japan, introduced the Cash for Health Program in Maguindanao. This incentivizes TBAs to track pregnant women and refer them to health facilities for safe births. As one of the two hundred beneficiaries, Keningko is very much grateful. “With the cash incentives I receive, I am more eager to refer pregnant women to deliver in health facilities. It will help me buy medicines for my bedridden husband too,” she smiles.

Kinengko’s vocation

For almost five decades, she has been assisting mothers in giving birth. “For as long as I could, I will continue helping pregnant women. This is my calling,” shares Kinengko.

“I am glad that UNFPA and its partners are organizing different seminars.  I am learning more about safety methods in my work. Now I tell mothers, ‘please give birth in medical facilities such as the hospital and health centers for you and your child’s safety and well-being,” she emphasizes.

Passing the vocation to the next generation

Kinengko also shared that her granddaughter wants to follow in her footsteps.

One day, she will become like me, and more.  I pray that she will become a licensed midwife and will be instrumental in making each childbirth safe. She will hold on to more knowledge and training, and more mothers can hold on to her for their safety,” Kinengko hopes. 



--- Angeli "Ann" Regala, UNFPA Philippines Media and Communications Officer