.pnuih-
nf Mif, 
( plnrt1
SEVENTEENTH CONGRESS OF THE 
]
REPUBLIC OF THE PHILIPPINES 
]
F irst R egular Session 
]
S.B. No.
SENATE
1196
■16 
O C m  
All :01
:i'.t
Introduced by SEN. WIN GATCHALIAN
AN ACT
PROVIDING FOR THE IMPROVEMENT OF MATERNAL AND CHILDBIRTH 
SERVICES BY ESTABLISHING BIRTHING CENTERS AND TRAINING TRADITIONAL 
BIRTH ATTENDANTS, AND APPROPRIATING FUNDS THEREFOR
EXPLANATORY NOTE
The commitment of the Philippines to the Millennium Development Goals (MDG) 
of reducing m aternal mortality rate (MMR) has not been achieved and the decline 
appears to have stalled, making the target reduction in MMR of 52 deaths per 100,000 
live births by 2015 highly unprobable. The high rate of m aternal deaths may be 
attributed to inadequate access to integrated reproductive health services by women, 
including poor adolescents and men. For one, significant num ber of Filipino women lack 
access to qualified reproductive health services. Over half of births in the country 
occurred at home, and a third of them  were assisted by traditional birth attendants. 
Poor women are greatly disadvantaged with around 75 percent of the poorest quintile 
having no access to skilled birth attendants compared to only 20 percent of the richest 
quintile.1
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The filing of this bill was spurred by several calls for the ban of home births and 
the practice by many in the urban areas to avail of the services of traditional birth 
attendants or “hilots” because of the relative ease and accessibility which they bring to 
expectant m others. It is the humble proposal of this representation to improve m aternal 
and newborn care by establishing birthing facilities as well as the training of traditional 
birth attendants to become part of the formal health system. It seeks the improvement 
of local health facilities towards services that can provide the underserved or 
underprivileged women with comprehensive care and access to safe m aternal and 
newborn care delivery system.
Instead of a complete ban, home births should be allowed, except where health 
clinics and birthing centers are present in the community. In the absence of these 
facilities, where greater risks and danger to the life of the m other and the unborn is 
imminent if transport to a health facility is made, midwives and trained traditional birth 
attendants should be allowed to attend to the childbirth to ensure m aternal and 
neonatal safety. In order to ensure the competency of traditional birth attendants in 
assisting during childbirth, the Department of Health will conduct the necessary 
training to properly equip them  with the skills to provide proper care during pregnancy, 
childbirth and postnatal periods in health clinics or birthing stations.
Inspired by a successful United Nations program in G attaran, Cagayan, this bill 
proposes an innovation to provide greater access and affordable childbirth in healthcare 
facilities by instituting a lay-away program where a pregnant woman shall pay in 
portions the fees to cover for the expenses in delivery.
In view of the necessity to complement the efforts of the DOH and the local 
government units to contribute in the improvement of m aternal and nepnatal care, we 
urge the support of the legislature in the immediate passage of this worthwhil^ initiative.


v.f-' tOflirt of f h f . 11 i > r 11»I
SEVENTEENTH CONGRESS OF THE 
]
REPUBLIC OF THE PHILIPPINES 
]
F irst R egular Session 
]
■16 
OCT n  
All :01
f:(
S.B. No.
SENATE
1196
Introduced by SEN. WIN GATCHALIAN
AN ACT
PROVIDING FOR THE IMPROVEMENT OF MATERNAL AND CHILDBIRTH 
SERVICES BY ESTABLISHING BIRTHING CENTERS AND TRAINING TRADITIONAL 
BIRTH ATTENDANTS, AND APPROPRIATING FUNDS THEREFOR
Be it enacted by the Senate and the House of Representatives of the Philippines in 
Congress assembled:
SECTION 1. D eclaration of Policy. -  It is the duty of the State to protect the life 
of the m other and the life of the unborn from conception. Towards this end, the State 
shall endeavor to provide quality health interventions and appropriate facilities as well 
as services that shall address m aternal and neonatal mortalities and ensure efficient 
strategies to lessen the risk that continuously occur during pregnancy and childbirth, 
especially of the underprivileged.
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SEC. 2. Objective. -  To emphasize the government’s commitment to improve 
m aternal and newborn health interventions, this Act shall undertake the following 
objectives:
(a) 
Ensure that all women and newborns have skilled care during pregnancy, 
childbirth and the immediate post-natal period;
(b) 
Promote pre-natal health education and safe birthing practices;


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(c) 
Improve the capacity of the local government units (LGUs) to deliver the 
basic health service delivery from antenatal to post-partum  care;
(d) 
Upgrade health facilities, both in term s of additional hum an resource and 
infrastructure facilities suitably equipped to address basic and emergency services, 
when necessary;
(e) 
Introduce local strategies to improve m echanism s for dem and to access or 
seek care and health interventions in health clinics;
(f) 
Train health workers, including traditional birth attendants, to deliver 
quality obstetric and newborn care services;
(g) 
Develop incentives to entice and promote antenatal care in a Barangay 
Health Station (BHS), Rural Health Unit (RHU) and the District and Community 
Hospitals;
(h) 
Establish an effective referral and monitoring system in barangays to 
monitor m aternal and newborn care; and
(i) 
Deploy birthing facilities equipped with trained obstetric and newborn care 
provider in areas where health facilities are unavailable.
SEC. 3. Scope an d  Coverage. -  This Act aims to improve m aternal and newborn 
care by establishing birthing facilities as well as the training of the traditional birth 
attendants to become part of the formal health system. It seeks the improvement of local 
health facilities towards services that can provide comprehensive care in order to 
encourage underserved or underprivileged women access to safe m aternal and newborn 
care delivery system.
SEC. 4. Definition of Terms. -  As used in this Act, the following shall mean:
a. Birthing Center - a health facility that provides m aternity service on pre-natal 
and post-natal care, spontaneous delivery and care of newborn babies.
b. Neonatal Mortality -  num ber of deaths within the first 28 days of life per 1000 
live births in a given period.
c. Maternal Mortality -  num ber of women who die from any cause related to or 
aggravated by pregnancy or its managem ent during pregnancy and childbirth 
or within 42 days of termination of pregnancy.


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d. Traditional Birth A ttendants (TBAs) -  independent, non-formally trained 
community-based providers of care during pregnancy, childbirth, and 
postpartum  period using conventional method.
e. Newborn -  a child from the time of complete delivery to 30 days old.
f. Health Care Practitioner -  refers to a physician, nurse, midwife, nursing aide 
and traditional birth attendant.
g. Certification -  a process and procedure of external assessm ent or examination 
by which an individual or facility is determined to possess a minimally 
acceptable body of knowledge an d /o r skills or the capacity to provide the 
standard of care with adequate resources.
h. Local Health Board -  its creation and composition are m andated under R.A. 
7160 or the Local Government Code of 1991.
i. 
Geographically Isolated and Disadvantaged Areas (GIDA) -  refer to 
communities with marginalized population physically and socio-economically 
separated from the m ainstream  society and characterized by physical factors 
(distance, weather conditions, transportation difficulties) and socio-economic 
factors (high poverty incidence, recovering from situation of crisis or armed 
conflict).
j . 
Department of Health Physical facility requirem ent for Birthing Home -  Annex 
D, DOH Administrative Order No. 2012-0012
SEC. 5. Role of the Local Government Unit. -  The Local Health Board of every 
province, city or municipality, in accordance with their m andate, shall make an 
inventory of its existing facilities and ensure that health clinics shall be compliant with 
DOH standards in term s of strategic location, infrastructure and manpower. These 
facilities m ust be constructed in locations m ost accessible to women. It m ust upgrade 
existing infrastructures to accommodate improvements in facilities and equipment. 
With the support of the Department of Health, it shall provide technical assistance and 
advisory services in tlie continuous ti-aining of health workers or to conh-act out skilled 
health practitioners for an integrated system that addresses the risks identified with 
m aternal and childbirth mortality, in term s of capability of health service providers.


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SEC. 6. Role o f the D epartm ent of Health. -  The DOH shall ensure that the 
LGU Rural Health Units, Barangay Health Stations, District Hospitals, Birthing Centers 
are fully compliant with the amenities and infrastructure requirem ents set by the DOH.
The DOH shall, within two (2) years after the effectivity of this Act, train the 
traditional birth attendants with the m odem  method of delivery, to properly equip them 
with the skill to provide care during pregnancy, childbirth and postnatal periods in 
health clinics or birthing stations. The conduct of these trainings shall be made every 
two (2) years hereafter to facilitate the training of new ones upon the retirem ent of the 
other TBAs. A certification by the DOH of compliance with this requirem ent shall give 
the TBAs the authority to work alongside healthcare practitioners of the LGU.
SEC. 7. B irthing Centers. -  There shall be established birthing facilities that 
shall address obstetric care and delivery in Geographically Isolated and Disadvantaged 
Areas (GIDA), where distance and transportation m akes travelling to a health facility 
unsafe and poses greater risk and danger to the m other and her unborn child. These 
birthing facilities shall be required to operate twenty-four hours for seven days (24/7) 
or on an on call or as needed basis, depending on the pregnancy tracking.
These centers shall be compliant with the Physical Facility requirem ents of the 
DOH with regards to the General Administrative and Clinical services. The facility shall 
likewise be supported by competent health care practitioners including DOH-trained 
traditional birth attendants.
Clinical services to be rendered in these centers shall include pre-natal and post­
natal care, normal spontaneous delivery for low-risk pregnant women, care of newborn 
and other similarly-related health care.
There shall be barangay health workers formed into team s who shall regularly 
check on pregnant women in the community. They shall continuously advocate quality 
health care by accessing the m aternal care delivery system established by the 
government and dissem inate educational tools to facilitate the shift from basic societal 
dynamics of home-deliveries to childbirth in these centers equipped with facilities and 
skilled personnel.
These ante-natal check-ups m ust identify at-risk pregnancies or anticipate 
complications in deliveries, which should directly be referred to clinics or tertiary 
hospitals with well-equipped facilities to handle emergencies.


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SEC. 8. Lay-Away Program. -  In order to make these birthing centers 
sustainable, expectant m others shall, during pre-natal visits, pay in portions the cost 
for her delivery. The scheme shall cover expenses for electricity and water bills, as well 
as paym ent for attending health workers. The cost shall be minimal and implementable 
through socialized user fees.
Nothing in this Section shall however prevent the city, municipality or barangay 
with the capacity to provide full subsidies to its constituents to forego user fees, or seek 
for private partnerships, aid or donations to cut costs or subsidize the expenses for the 
deliveries in birthing centers.
SEC. 9. Home-Births. -  Pursuant to the objectives of this Act, home births shall 
be disallowed where health clinics and birthing centers are present in the community, 
and where there is absence of the risk contemplated under Section 7 paragraph 1. In 
cases where greater risk and danger to the life of the m other and the unborn is imminent 
if transport to a health facility is made, midwives and trained traditional birth 
attendants shall attend to the childbirth to ensure m aternal and neonatal safety.
SEC. 10. Incentives to B arangays. -  The commitment to reduce m aternal and 
neonatal mortality m ust generate the coordinated effort of the community, hence, the 
local health board shall assess and recommend economic incentives to promote the 
initiative and make zero m aternal and neonatal death possible.
SEC. 11. A ppropriations. -  The primary source of funding for the operation, 
m aintenance and improvement of the health facilities shall be the LGU. It shall likewise 
cover the salaries and other benefits of the local hum an resource including the 
incentives for the barangay health workers and other community volunteer workers.
The capital outlay for the birthing centers, 
additional health clinics, 
improvements of existing health facilities in term s of equipment and the am ount to be 
expended for the training of the traditional birth attendants shall be included in the 
budget of the DOH in the year following the effectivity of this Act.
SEC. 12. Im plem enting Rules an d  Regulations. -  Within ninety (90) days from 
the approval of this Act, the Secretary of Health and the Secretary of the Interior and


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Local Government shall promulgate the necessary implementing rules and regulations 
(IRR) for the effective implementation of this Act. The IRR shall cover the implementation 
of performance-based incentive of rural communities toward achieving zero m aternal 
and neonatal mortality and the program of training for the traditional birth attendants. 
The DOH shall provide the m anual for the minimum requirem ents in term s of facilities 
and hum an resource for an efficient health clinic or birthing center.
SEC. 13. Separability Clause. -  If any section or provision of this Act is held 
unconstitutional or invalid, the remaining sections or provisions not affected shall 
remain in full force and effect.
SEC. 14. Repealing Clause. -  All laws, presidential decrees, executive orders 
and rules and regulations, or parts thereof, inconsistent with the provisions of this Act 
are hereby repealed or modified accordingly.
SEC. 15. Effectivity. -  This Act shall take effect fifteen (15) days from the date 
of its complete publication in at least two (2) newspapers of general circulation.
Approved,