JOCELYN LAZILLA is a youthful-looking midwife, especially when she?s on a motorcycle that she uses to reach the more remote areas of three barangays she covers in Maitum, Sarangani. So it comes as a surprise when she tells us that she has three children and that the eldest is taking up nursing.

Even more surprising?and heartening?is that in the 18 years she has been serving the mothers in the area, some of whom belong to the T?boli tribe, there have been no maternal deaths. This, even if at times she found herself in the middle of warring groups. ?But when the combatants see me rushing to look after a mother giving birth, they stop firing and warn the others to let me and my companions pass,? she recalls matter-of-factly.

Lazilla?s immediate superior, municipal midwife Rosalina Dungca, is three years from retirement and is chock-full of stories to tell about her years spent ?mothering? the mothers of Maitum. ?I can tell you about dodging bullets and mortar on my way to deliver a child, or holding on to the tail of a carabao while crossing a flooded field,? she recounts. The day before, she crept home at past 11 p.m. after delivering two babies at the Maitum Maternity Home, then reported for work at 6 a.m. as two other women had come ready to deliver.

At present, Maitum has nine midwives covering 19 barangays, which are home to Christian, Muslim and indigenous communities. Dungca and the municipal health officer, Dr. Junie Basmillo, say their fondest wish is to have one midwife per barangay who would be willing to reside within the barangay itself, plus three more midwives especially for maternity cases. The current Department of Health directive is to allocate one midwife per 5,000 population, but Dungca says the allocation of midwives ?should not be population-based, but also based on the terrain of the area and the distance between settlements.?

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OBVIOUSLY, the conditions that mothers face during pregnancy and childbirth vary tremendously depending on, among other things, where they live, access to hospitals, clinics or other medical facilities, and the amount of care they receive during pregnancy and delivery.

But no other variable counts as much as the woman?s economic and social status. In a presentation, Unicef health officer Dr. Martha Cayad-An said the biggest gaps between mothers in the wealthiest sector and those in the poorest are found in the areas of pre-natal care (7 percent among the poorest, 100 percent among the richest), pre-natal care from a doctor (10 percent vs 80 percent), and deliveries with a skilled birth attendant (25 percent vs 90 percent).

Three UN agencies?the UN Population Fund, WHO and Unicef?have formulated a Joint Program on Maternal and Neonatal Health together with the DoH and with funding from AusAid, the Australian agency for international development.

The overall strategy of the program is to strengthen local health systems with a view to improving access to ?quality continuum of care and services,? from pre-pregnancy to pregnancy, delivery and post-partum care for the mother, to newborn and childhood care for the infant. The ?continuum? also covers the family, the community, the health facility and the local government unit.

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AMONG Unicef?s inputs to the joint program are training sessions for hospital staff and staff of health centers, especially midwives and barangay health workers, as well as providing equipment to birthing centers, such as special birthing tables and chairs, incubators, sterilizers and the like. When I asked the staff of a birthing center if they have ultra-sound machines, they looked at me with eyes wide with astonishment. ?Our blood pressure machines are already outdated. We can?t even dream of ultra-sounds,? said one midwife.

Unicef officials (Vanessa Toobin, head of Unicef in the Philippines joined our group on the second day) also quite strongly advocate for careful and accurate data gathering and recording. ?So that we know exactly what we are dealing with and what our people need,? explained Sarangani Gov. Miguel Dominguez, who hosted us for dinner at his home.

Under the helm of Dominguez and the provincial health officer, Dr. Antonio Yarana, Sarangani is moving towards ?aggressively? replacing home-based deliveries with skilled birth attendance, improving local health systems, addressing cost barriers to safe motherhood, achieving universal PhilHealth coverage, and harnessing community members in the care of mothers and babies.

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ONE observation made during the trip was how breastfeeding seemed much more acceptable to mothers in rural communities than in cities and urbanized towns. In Kiamba and Maitum, in mothers? homes or isolated health posts, mothers gathered in groups and breastfed in public, nonchalantly lifting their blouses when their babies wanted to suckle.

But in towns closer to urban centers, said Dr. Yarana, mothers increasingly chose to bottle-feed, enticed by commercials touting the ?virtues? of infant formula. Although, given what we had seen in our visits to more remote barangays, it seemed puzzling how mothers could think they were doing their babies a favor by bottle-feeding considering the expense of infant formula, the lack of safe water and even of firewood for sterilizing the bottles and nipples.

Unicef spokesperson Daphne Osena Paez, a TV personality and blogger, exchanged experiences and views with the young mothers, proudly proclaiming that she was currently breastfeeding her youngest daughter and that she had done so with her two older daughters ?even while I was working.?

Whether in the city or the remotest barrio, the mother who breastfeeds is a mother who is obviously committed to giving the best for her child.