In the municipality of Palauig in Zambales, the absence of a functional birthing facility has become more than an administrative issue—it has become a matter of life, distance, and survival. Despite the implementation of a strict No Homebirth Policy, the town’s birthing station remains non-operational because it has not completed the Department of Health (DOH) licensing requirements. As a result, Aeta mothers living in geographically isolated and disadvantaged areas are left with even fewer safe options for maternal healthcare.

Years ago, the local government enforced a policy prohibiting home births in response to maternal deaths and complications linked to unsafe deliveries. Midwife Menchie recalled how the policy was formalized,

“Nagkaroon talaga kami ng memorandum of agreement sa pagitan ng mayor at ng Sangguniang Bayan na may hawak ng health, kaya gumawa siya ng policy na ‘No Homebirth Policy.’ Tapos pinatawag namin lahat ng hilot. Pinatawag namin.”

The rationale behind the policy was grounded in medical realities.

As Dr. Kristine explained, “All homebirths are high risk. Ang daming deaths related to homebirth kasi yung mga nanganak sa bahay, wala namang nag-attend sa kanila na medical professionals. Kasi there are many complications in pregnancy, so for example, pwede mag-seizure yung mommy—stroke. Sometimes, ayaw mag-stop ng bleeding, so pwede ring mamatay si mommy. So sa ganung scenario, wala namang equipments sa bahay. Walang medications to stop the bleeding, walang operating room.”

The message was clear: childbirth without proper medical supervision can quickly turn fatal. However, while home births were officially discouraged, the alternative—a fully licensed and operational birthing facility within Palauig—gradually disappeared.

Nurse Jocelyn stated plainly, “So, sa ngayon po, ang birthing station namin ay hindi pa functional. Kasi nga po, hindi pa namin natatapos yung mga requirements ng DOH, gaya ng license to operate, ganun po.”

The facility once had a license.

According to Ms. Menchie, “Nag-start kasi kami dito 2010, nagpapaanak na kami dito. 2014, may license pa kami, so 2015, wala na kaming license kasi kailangan naming i-renew yung license namin.”

When the lying-in clinic was active, home births significantly decreased.

“Noong mayroon kaming lying-in, yun, wala talagang nanganganak sa bahay. Noong wala na kaming lying-in, doon, dumami yung nanganganak sa bahay.”

Without the renewed License to Operate and compliance with updated DOH standards for birthing homes—including requirements for proper infrastructure, complete delivery equipment, emergency medications, adequate staffing, and documented clinical protocols—the building could no longer legally function.

Ms. Menchie emphasized the burden of compliance: “Itong building na ‘to, wala nang permit dahil sa dami ngang hinahanap ng DOH.”

According to Administrative Order No. 2012-0012, a health facility must secure and maintain a valid License to Operate (LTO) issued by the Department of Health before it can legally function. Failure to comply with licensure requirements may lead to suspension or revocation of the LTO.

“14. License to Operate (LTO) – a formal authority issued by DOH to an individual, agency, partnership or corporation to operate a hospital or other health facility. It is a prerequisite for accreditation of a health facility (regulated by BHFS) by any accrediting body recognized by DOH.

IX. VIOLATIONS
Facilities found violating any provision of these rules and regulations and its related issuances, and/or commission/omission of acts by personnel operating a hospital or health facility under this Order shall be penalized and/or its LTO suspended or revoked. The guidelines on violations shall be in accordance with A.O. No. 2007 – 0022 entitled “Violations Under the One-Stop Shop Licensure System for Hospitals”, its related issuances, other relevant policy guidelines and this Order.”

According to Annex C of Administrative Order No. 2012-0012, birthing homes must comply with minimum standards in infrastructure, staffing, equipment, clinical capability, and infection control prior to securing or renewing licensure. The Order outlines human resource requirements (pp. 3–4), equipment and instruments including emergency drugs and supplies (pp. 5–7), physical facility requirements (pp. 8–9), and waste management and infection control protocols (pp. 10–11). Additionally, the Service Capability section (p. 2) requires proper referral systems, record-keeping, and documented policies. These standards collectively define the operational requirements that a birthing facility must meet to comply with Department of Health regulations.

The irony is difficult to ignore. The DOH requirements are designed to ensure safety: sterile delivery rooms, proper infection control systems, emergency drugs like oxytocin, trained personnel, and clear referral systems. These standards are critical in preventing maternal deaths. Yet in a geographically isolated municipality like Palauig, where resources are limited and infrastructure gaps persist, failing to meet these standards does not simply mean delayed compliance—it means no facility at all. And when there is no facility, the burden shifts back to families.

For Aeta mothers living in upland communities, distance is not measured only in kilometers but in terrain, weather, and money. The Aeta mothers’ stories reveal a stark gap between regulatory ideals and lived reality. The absence of a licensed birthing facility does not eliminate childbirth; it only relocates it to homes, riverbanks, and roadside vehicles. Even health workers feel the strain.

Ms. Menchie admitted that at times they conduct emergency deliveries in the Rural Health Unit despite limitations:

“Mayroon kaming delivery table doon, tsaka yung bed doon, side bed niya. Yun lang ang ginagamit namin, which is hindi dapat, kaso lang, pag andyan na siya, manganganak na, hindi na kaya, pinapaanak na namin.”

They operate within constraints, aware that practicing without a proper license risks professional consequences.

As another midwife, Ms. Elizabeth stressed, “May batas na eh, kaya dapat po yung isang komadrona, talagang susunod na siya sa batas. Hindi ba, pag nawalan ka ng lisensya, hindi ka na kapani-paniwala. Nakakatakot naman, Ma’am, ang mangyayari kapag mawalan ng lisensya.”

The situation creates a painful contradiction. The government discourages home births to protect mothers, yet the lack of a compliant facility leaves some families with no practical alternative. For Aeta mothers who already face structural disadvantages, the closure of the birthing clinic compounds long-standing barriers to healthcare access. What was intended as a safety measure has, in practice, widened inequities.

The story of Palauig underscores a broader public health question: how can national standards be upheld without rendering essential services inaccessible in marginalized communities? The DOH requirements for birthing homes are undeniably important for quality and safety. But until the municipality completes these requirements and secures a renewed License to Operate, the town remains without a functional birthing clinic. In that gap between regulation and reality, Aeta mothers continue to labor—sometimes for hours, sometimes on mountainsides—relying on trust, improvisation, and the resilience of midwives who, even without permits and complete equipment, remain the first line of care.