Hammocks make a difference to maternal health

Hammocks are helping an increasing number of women in the remote mountains of Ifugao, a province in the northern Philippines, reach hospital to give birth.

The ayod, an improvised hammock, is an indigenous tradition used to transport the sick and elderly through mountainous terrain. A formalized ayod initiative, the Ayod Community Health Teams (ACHT), is helping an increasing number of rural women deliver their babies in health centres.

"The ayod has always been there, but now, institutionalized as a community effort, it has mitigated the two factors that greatly affect maternal health, namely: the decision to seek care and the means of transportation to get it," said Hector Follosco, a provincial programme officer for UN Population Fund (UNFPA) in Ifugao.

According to 2006 figures released by the National Statistical Coordination Board, Ifugao has a maternal mortality ratio of 260 per 100,000 live births, far above the national average of 162 per 100,000. The National Demographic Health Survey of 2008, the most recent, reported 70 percent of births in rural areas of the Philippines take place at home.

The Japan International Cooperation Agency (JICA), which supported the ACHT project in 2008 and other maternal health initiatives starting in 2006 in three Ifugao municipalities - Alfonso Lista, Aguinaldo and Mayoyao - reported the number of deliveries in these birthing facilities increased from 17 percent in 2006 to more than 34 percent now.

"Solid community efforts have made facility-based deliveries the norm, rather than the exception. And we are seeing the results of that," said Nobuko Yamagishi, JICA health programme coordinator.

"Foot ambulance"

Often referred to within the community as an ambulance on foot, the ayod is carried by male relatives and accompanied by others - relatives or neighbours - who carry food and water and take turns when the carriers need to rest.

Its use became official under a provincial order passed in 2008, together with a national mandate requiring all pregnant women to go to a health centre for pre-natal care.

The order established the ACHT, tasked with monitoring and tracking the health of pregnant women in their community. The volunteers become part of a birth plan, and are on call for emergencies, including trips to the nearest hospital via hammock.

Ifugao ACHT, now managed by local government, has 185 teams and an estimated 2,865 members.

"We have a record of the pregnant women in our village, monitor their progress and remind them about getting their monthly pre-natal exams," said Albert Dangpahon, captain of Boliwong, a village in Ifugao. Under the mandate, such village captains are part of the ACHT.

"It is tiring and it makes us all very anxious when a pregnant woman is in labour, but it is also very fulfilling," said Dangpahon who, along with companions, has carried numerous pregnant women in a hammock, sometimes for eight hours, to the nearest health facility.

Slow but sure progress

At first, mothers accustomed to the tradition of home deliveries were sceptical.

"Mothers were still hesitant to give birth at the birthing health centres because it was too far and there was no way to get them there. They thought they would be better off delivering at home under the care of a traditional birth attendant who can also cook and clean for them. At home, their husbands would also be near them," Mary Josephine Dulawan, a provincial health officer, told IRIN in Ifugao.

To address that, the ACHT launched community awareness campaigns on the importance of birth facility deliveries. Such campaigns have helped young mothers like Auri, who preferred to go by one name, decide to give birth in a healthcare facility, rather than at home. "It's better in the centre. It is clean and they take care of you and your baby," the 21-year-old said.

Elsa Palang, a mid-wife in the Boliwong birthing health centre, delivered Auri's baby.

"There are more and more women giving birth at the birthing health centre," Palang said. "Before, giving birth in a hospital or birthing health centre was out of the question because the travel was too long and it would be expensive. But now, there is the ayod."

The women do not pay for being carried on the ayod, but often give food to the carriers.