Childbirth in the Perspective of the Ayangans in Aguinaldo, Ifugao, Philippines

Sunday, 22 July 2018: 1:30 PM

Carielle Joy Rio, PhD
Faculty of Nursing, Universitas Pelita Harapan, Karawaci, Tangerang, Indonesia


The population of indigenous peoples in the Philippines is estimated at fourteen (14) to seventeen (17) million (United Nations Development Programme, 2013). Article 24 of the United Nations Declaration on the Rights of Indigenous Peoples (2008) states that “indigenous peoples have the right to their traditional medicines and to maintain their health practices”. Health care delivery should consider culture as a significant influencer of people’s concepts of corporeality, the function of the human body, and how the body should be cared for throughout a person’s lifespan (Naidu & Nqila, 2013). Today, the delivery of culturally sensitive care remains a significant challenge for health workers as the current health care delivery systems tend to be biased towards western medicine (United Nations Inter-Agency Support Group on Indigenous Issues, 2014).

The implementation of standardized health policies, such as the No Home Birthing Policy, contribute to the widening gap of inequality in health care delivery. Maternal and newborn care, to be more effective, should consider biomedical science, indigenous knowledge, culture and context (Palaganas, 2016). It is vital to understand indigenous people’s worldviews, beliefs and practices and examine the safety and clinical appropriateness of these practices.


This study presents the emic perspective of the Ayangans in Aguinaldo, Ifugao, Philippines regarding childbirth. The worldviews, beliefs and experiences of Ayangan women who have experienced childbirth, the women’s family members, village health workers, folk healers, and health professionals in the community were explored using Leininger’s Ethnonursing methodology. Data were gathered from eight (8) key informants, twenty-three (23) general informants and four (4) focus group discussions. The data gathered were then compared to existing scientific literature to assess the safety and clinical appropriateness of the identified indigenous beliefs and practices.


Care during childbirth, in the perspective of the Ayangans, is defined by three (3) unique but interrelated attributes: the women’s exercise of autonomy and empowerment, the involvement of the family and the community, and the protection of women and their offspring. In Ayangan culture, respect for the body’s natural processes is highly valued during childbirth. Pregnant women are encouraged to “listen to their bodies’ and are regarded as the most important decision-makers for matters concerning their birthing experience.

Respecting the women’s choices is vital in providing care during childbirth. Traditionally, Ayangan women have the freedom to choose any position they deem comfortable during labor and delivery. The women may opt to shift from one position to another until they find the position that they feel enhances the descent and expulsion of the baby and allow them to maximize their force in bearing down during delivery. Ayangan women also strongly value their freedom in choosing their companions during childbirth. It is believed that the presence of people or sounds that a woman in labor or delivery finds unpleasant would cause difficulty in the labor or delivery process. The husband may directly assist his wife during labor and delivery if she desires his presence or he may be tasked to assist the birth attendant. Birth attendants can be family members or traditional midwives known as hilot. Neighbors may also be tasked to assist women during delivery, to inform the hilot of the impending delivery or to assist in transporting women to a birthing facility when referral is necessary. For the Ayangans, respecting women’s autonomy is crucial not only for empowering women but also for promoting the wellness of the women and their offspring. It is believed that allowing women to select their birthing positions and companion can help in promoting ease during labor and delivery. During the post-partum period, women “listen to their bodies” to determine their readiness to resume activities such as eating, bathing and performing chores.

It was found that the women’s choice of birthing facility was largely dependent on the extent of autonomy that a facility allows. The hospital is perceived as a place where health workers impose their preferences on patients, leaving very little room for them to exercise autonomy. The lack of freedom to choose their desired birthing position is a major reason why most women do not prefer hospital-based delivery. The indigenous care system is based on knowledge passed down through generations and experience. The professional care system, on the other hand, adheres to standards of practice and the current health programs and policies of the Department of Health. Although there are differences in the beliefs and practices of the professional and the traditional care systems, both aim at protecting the wellbeing of women and their offspring. The most commonly cited reason for the traditional birth attendants’ openness to the No Home Birthing policy is their belief that the competence of health professionals and the availability of medical interventions in birthing facilities can enhance safety during deliveries. The professional health system in Aguinaldo recognizes the knowledge and skills of traditional birth attendants and designated most of them as barangay (village) health workers. Health professionals are aware of the need to provide culturally-congruent care to women and families during childbirth. However, full implementation of culturally-congruent care is limited due to lack of formal training on assisting women in non-lithotomy birthing positions, the lack of physical structures that facilitates indigenous birthing positions in the birthing facilities and the existing policy that mandates facility-based birthing.


This study provides insights on the beliefs and practices of the Ayangans in Aguinaldo, Ifugao during childbirth. No evidence from literature was found to support the effectiveness of divination practices performed by the Ayangans. There is, however, a plethora of evidence that support the clinical value of many aspects of their indigenous practices such as birthing positions, birthing companions, autonomy of women during childbirth, umbilical cord severance and umbilical cord care. Efforts should be made to assimilate indigenous beliefs and practices that are safe and clinically appropriate into the mainstream health care system. Integration of indigenous knowledge and skills in the professional health system and in nursing education has the potential to improve the overall care experience of women during childbirth.