The high maternal mortality in the Philippines in the past decades prompted intervention strategies to curb unwanted deaths of mothers and improve health and social conditions of women. Such introductions however have begun to challenge traditional reproductive health practices creating confusion among practitioners and incipient transitions in healthcare. Our aim in this study was to document the herbal therapies practiced by indigenous Ati Negrito women and discuss the implications of social and conventional healthcare intervention programs on reproductive healthcare traditions by conducting semistructured interviews. Fidelity Level index was used to determine culturally important plants (i.e., the most preferred). Review of related studies on most preferred plants and therapies was further carried out to provide information regarding their safety/efficacy (or otherwise). Determination of informants’ traditional medicinal knowledge was done using Mann-Whitney
Cultural traditions of healthcare among women during pregnancy, birth, postpartum, and neonatal periods are common in Southeast Asia. These traditions in many rural areas in this region form the core of women’s primary healthcare [
In the Philippines, one of the many ethnic minorities with rich traditional knowledge about the use of medicinal plants and herbal medications are the Ati Negrito people of Guimaras Island [
However, the use of CAM, although it is common among women of reproductive age, still has unresolved underlying mechanisms behind its effects, if not lacking strong evidence of effectiveness [
Various factors may have spurred the changes in women’s traditional healthcare practices in the Philippines. The main driver for this cultural transition is maternal mortality. Studies in the past decades reported high maternal mortality especially for women in rural areas, indicating poor reproductive health services and suggesting the need for more efficient intervention strategies to reach the underserved subgroups [
The conditions of having low socioeconomic status highly qualify ethnic minorities, such as the Ati women of Guimaras Island to these modern healthcare and social welfare programs, which we think are challenging and gradually transforming ethnomedicinal traditions. These factors motivated us to conduct this research with the specific aims (1) to document the herbal therapies for female reproductive healthcare and their cultural importance; (2) to evaluate the informants’ traditional medicinal knowledge in this aspect; and (3) to raise issues about the implications of social-health policies on indigenous women’s health and traditional healthcare practices.
The study was conducted in two Ati communities of about 80 households. The communities are officially recognized as indigenous by the National Commission for Indigenous Peoples (NCIP) Region 6-7, the agency which protects the welfare of indigenous and ethnic minorities in central Philippines, including those in the study area, Guimaras Island. The island province lies between 10°25′00′′ and 10°46′09′′ north latitude, and 122°28′20.99′′ and 122°28′40.53′′ east longitude, with a great part of its land area about 100 meters above the mean sea level. The doctor to population ratio on the island is over than the standard of 1 : 20,000, while the rural health midwife ratio of 1 : 2,520 is lower than the standard of 1 : 5,000, indicating that there are more than enough midwives to handle deliveries and birth [
The study sites (
A total of 36 Ati women, each one representing a single household aged 18 to 80 years, were selected as informants. Samples were grouped according to age, educational level, and number of children for statistical comparability and computation. Approximately 67% of the women are subscribed to the national insurance service (or covered by the short-term local insurance program), while about 56% are beneficiaries of government financial assistance. The data presented here were drawn from the first author’s master’s thesis which was conducted from 2013 to 2014 [
Only informants who accepted the request for interview became part of the study and were asked using semistructured questionnaires in a local language, which the Ati people more commonly use, and the primary author’s mother tongue. Interviews were conducted separately to minimize the possibility of one informant’s answer directly influencing another’s. Only the informants’ personal experiences in the direct application or assistance in herbal preparations were recorded. It was unfortunate however that none of the informants was a traditional midwife (“hilot”) since the last practitioner had died a few years before the research was conducted. Nevertheless, we were able to interview eleven key informants (
Demographic data of the informants.
Information |
|
---|---|
Education | |
None to complete elementary | 18 (50) |
Secondary to tertiary | 18 (50) |
Age | |
18 to 29 | 12 (33.33) |
30 to 48 | 12 (33.33) |
49 and above | 12 (33.33) |
Number of children | |
0 to 2 | 15 (41.67) |
3 to 5 | 11 (30.56) |
6 and above | 10 (27.78) |
Plant specimens were collected together with the key informants or when possible with the nonexpert participants themselves for identification purposes. Pictures (and videos) on how some plants are prepared into crude herbal products and on how some therapies are administered were also taken when given consent. Local names of plants and indigenous terms of their uses were also documented by the first author during the data collection period which required direct community observation and participation. Samples of plants were pressed, dried, and brought to South Korea for taxonomic documentation in compliance with phytosanitary requirements. After plant scientific names were determined, specimens were deposited as vouchers at the Herbarium of Hallym University (HHU).
To evaluate and compare informants’ knowledge about medicinal plants and phytotherapies, use-reports were computed and analyzed using PASW Statistics 18 software [
To determine the relative cultural importance of plants and herbal therapies, Fidelity Level (FL) was utilized. FL is a quantitative ethnobotanical index based on informant consensus method. This index assumes that citation frequency is an indicator of importance and effectiveness of phytotherapies. It is the ratio between the number of informants who suggested the use of a plant for a particular purpose (herein termed as use-mention) and the total number of informants who mentioned the use of plant for any purpose [
To facilitate the computation of relative cultural importance of medicinal plants and phytotherapies, we established four categories based on the reported reproductive health-related syndromes found below.
Plant therapies reported in this category are used to treat (a) dysmenorrhea and (b) delayed menstruation syndromes. Dysmenorrhea is a condition characterized by pain during menstruation, while delayed menstruation syndromes, such as amenorrhea, are disorders associated with changes in the length of menstrual cycle [
Plants and therapies used in this category are employed as (a) delivery inducers or as (b) tools during birth. Health conditions similar to the latter are categorized by the WHO International Classification of Diseases 10 as factors influencing health status and contact with health services [
Phytotherapies in this category are employed to stop bleeding after childbirth and cleanse the womb from unwanted blood and impurities, among other perceived symptoms. The subcategories are postpartum-related (a) abdominal pain; (b) headache; (c) hemorrhage; (d) postpartum relapse, a setback that occurs during period of health progress; and (e) postpartum wash applications.
Plant therapies in this category are applied as (a) galactagogues, substances that increase the production or flow of milk and (b) newborn baby care applications. Some herbal therapies for neonatal care include remedies to expulse infant’s swallowed discharges during delivery and other perceived illnesses, or as infant wash preparations. Therapies administered during growth from infanthood to babyhood are not discussed here.
In this part, we present the plants and phytotherapies which recorded the highest consensus from informants (by counting use-mentions), discuss their cultural importance, and present related studies supporting (or refuting) their claimed effectiveness or safety in treating reproductive health-related syndromes. Implications of social and healthcare policies on informants’ traditional healthcare practices are also discussed.
A total of 7 plant species for treating (a) dysmenorrhea and (b) delayed menstruation syndromes were reported in this category. The plants which recorded the highest informant consensus are discussed as follows.
(a)
(b)
It is highly probable however that plants used for menstruation-related syndromes possess muscle-relaxing characteristics. These plants were found to be uterine spasmolytics which alleviate uterine cramps and uterine spasmogenics which ease menstrual pains by inducing the menses [
There is high possibility that most reported plants in this category can cause abortion since all applications are taken orally, some in pure concentration, others infused in liquors with high alcohol content. The use of these potential herbal abortifacients should be carefully considered because most often this leads to serious consequences for women. About 13% of maternal deaths are attributed to unsafe abortions in Southeast Asia [
During our interview, participants willingly disclosed the plants used in treating menstruation-related syndromes, but they became hesitant to answer when asked if the same plants were also used as contraceptives or abortifacients because assisting or participating in abortion is illegal (nonetheless practiced) in predominantly Catholic Philippines. Some admitted that plants and oral remedies with bitter taste are taken as contraceptives but could trigger abortion when taken in high dosage. The same informants however clarified that the therapy is not being practiced by Christianized Ati women.
The implementation of the RH bill is also seen to influence how Ati women and couples plan the number of children they desire as education on contraception options and contraceptives like pills are provided in government health centers free of charge. These provisions however are seen to have negative implications on the use of TM and related herbal therapies, not to mention the dangers when uninformed practitioners combine conventional medications with traditional herbal treatments. According to Lai et al. [
Only 3 medicinal plants used as (a) delivery inducers or as (b) tools during birth were reported in this category and are all discussed below.
(a)
The slimy properties of parts of
(b)
These days, however, young Ati women and mothers prefer the hospital as a place to give birth for convenience and safety reasons. If residence is rather remote during labor, the patient has the option to ask for services of a medically trained midwife (“paltera”) who is most often non-Ati. Pregnant women who are beneficiaries of the government financial aid program however are strictly required to give birth in hospitals or birthing centers and to undergo prenatal and postnatal checkups [
A total of 31 medicinal plants for the treatment of postpartum-related syndromes such as (a) abdominal pain, (b) headaches, (c) hemorrhage, (d) postpartum relapse, or (e) postpartum wash applications were reported in this category. The plants which recorded the highest informant preference are discussed below.
(a)
(b)
In applications like steam baths, hot compress, or aroma therapies, essential oils can be absorbed through the skin or by aromatic inhalation, where they travel through the bloodstream, stimulate brain functions, and promote whole-body healing [
(c)
(d)
(e)
Ati Negrito medicinal plants and phytotherapies for female reproductive healthcare.
Reproductive health category | Plant scientific (and family) name | Local name | Preparation and administration | Use-mention | FL (%) |
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Menstruation syndromes | |||||
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Rosas de baybayon | Oral application after decocting leaf | 19 | 100 |
|
Mahogani | Oral application after powdering dried seed | 11 | 100 | |
|
Kamias | Oral application as tonic after infusion of bark in local rum | 10 | 50 | |
|
Bita | Oral application after powdering dried bark | 9 | 100 | |
|
Albutra | Oral application as tonic after infusion of dried stem in alcohol | 6 | 37.5 | |
|
Haroy-haroy | Oral application after decocting leaf | 5 | 38.46 | |
|
|
Kamias | Oral application after infusion of bark with |
10 | 50 |
|
Albutra | Oral application after infusion of stem with |
10 | 62.5 | |
|
Haroy-haroy | Oral application after decocting leaf | 5 | 38.46 | |
|
Manunggal | Oral application of fresh stem extract | 5 | 100 | |
|
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Birth/delivery uses | |||||
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Nipay | Topical application of scraped bark and stem mixed with coconut oil | 3 | 100 |
|
Tugabang | Topical application of crushed leaves | 2 | 100 | |
(b) Delivery tool |
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Bagakay | Stem used as tool in cutting umbilical cord | 17 | 73.91 |
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Postpartum syndromes | |||||
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Alibhon | External application as wash or hot compress after boiling leaves | 21 | 53.85 |
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Montawi | Oral application after decocting dried stem | 11 | 100 | |
|
Agoparit/Magoparit | Oral application after decocting dried stem | 7 | 100 | |
|
Star apol | External application as wash or hot compress after boiling leaves | 6 | 50 | |
Oral application after decocting leaves | 6 | 50 | |||
|
Alibotbot | Topical application of heated leaves on abdomen as poultice | 6 | 100 | |
|
Kadios | Topical application of crushed leaves as poultice | 3 | 100 | |
|
|
Salong | Oral application after decocting dried stem resin | 24 | 50 |
External application as aromatherapy by burning dried stem resin | 24 | 50 | |||
|
Bunlaw | External application as wash or hot compress after boiling leaves with |
15 | 100 | |
|
Kamoy-kamoy/Kalangkang | External application as wash or hot compress after boiling leaves and stems with |
10 | 100 | |
|
Alibhon | Oral application after decocting leaves with |
7 | 17.95 | |
|
Sulamyog | Oral application after decocting stems with |
7 | 50 | |
|
Tabuyog | Oral application after decocting dried stems | 6 | 33.33 | |
(Moraceae) | |||||
|
Lagundi | Oral application after decocting leaves | 4 | 100 | |
|
|
Tagpo-bayi | Oral application after decocting dried stems | 8 | 100 |
|
Tagpo-laki | Oral application after decocting dried stems | 8 | 100 | |
|
Sibukaw | Oral application after decocting dried stems | 3 | 100 | |
|
|
Saging-saging/Kalansaging | External application as wash or hot compress after boiling stems | 16 | 100 |
|
Tanglad | External application as wash or hot compress after boiling whole plant | 11 | 100 | |
|
Banawak | Oral application after decocting dried stems | 5 | 26.32 | |
|
Adgaw/Agdaw | External application as hot compress after boiling leaves | 4 | 100 | |
|
Buri | External application as hot compress after boiling young shoots | 3 | 100 | |
|
Malaumau | Oral application after decocting dried stems and leaves | 3 | 100 | |
|
Banagan | Oral application after decocting stems | 1 | — | |
|
|
Kawayan | External application as wash or hot compress after boiling leaves | 24 | 100 |
|
Madre cacao | External application by sitting on heated leaves to remove discharges | 22 | 100 | |
|
Kabugao | External application as wash or hot compress after boiling leaves | 19 | 100 | |
|
Banawak | External application as wash or hot compress after boiling dried stems | 14 | 73.68 | |
|
Balingkawayan | External application as wash or hot compress after boiling leaves | 12 | 100 | |
|
Sulamyog | External application as wash or hot compress after boiling stems | 7 | 50 | |
|
Bugnay | External application as wash or hot compress after boiling leaves | 6 | 100 | |
|
Agho | External application as wash or hot compress after boiling leaves | 4 | 100 | |
|
Bunga | External application as wash or hot compress after boiling leaves | 3 | 100 | |
|
Haroy-haroy | External application as wash or hot compress after boiling leaves | 3 | 23.08 | |
|
Anino | External application as wash or hot compress after boiling dried stems | 3 | 100 | |
|
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Neonatal care uses | |||||
|
|
Tabuyog | Oral application after decocting stems | 12 | 66.67 |
|
Balunggay | Consumed after boiling leaves (sometimes with young |
8 | 100 | |
|
Saging (sab-a) | Topical application of young leaves on breast as poultice | 6 | 100 | |
|
Kapayas | Consumed after boiling young fruit (sometimes with |
4 | 100 | |
|
Kamote (pula) | Consumed after steaming young leaves | 3 | 100 | |
|
Balinghoy | Topical application of young leaves on breast as poultice | 3 | 100 | |
|
|
Tino-tino | Topical application of heated leaves on infant stomach as poultice | 22 | 100 |
|
Suha | External application as infant wash after boiling leaves | 10 | 100 | |
|
Margoso | Internal application of leaf extract to expulse swallowed lochia | 8 | 100 | |
|
Bagakay | Topical application on infant's freshly-cut navel of ash from burnt stem | 6 | 26.09 | |
|
Pandan | Topical application on infant's freshly-cut navel of ash from burnt dried leaves | 1 | — |
We have observed that reported herbal therapies for postpartum relapse and preparations for postpartum wash have overlapping perceived efficacy. For example, hot compress and wash applications, drawn from different plant candidates and prepared as mixture, are also administered to prevent the occurrence of postpartum relapse. The substitution of a particular plant for another may imply that the replaced plant has little (or no) therapeutic properties and may have been selected only due to its accessibility in the first place. These signs of merely having placebo-like effects of therapies concerning women’s reproductive health are occurring even in codified TM [
In comparison with other Southeast Asian postpartum therapies [
A total of 11 plants used as (a) galactagogues or used for (b) newborn baby care were reported in this category. The plants that recorded the highest consensus from informants are discussed below.
(a)
(b)
As an effort to lessen neonatal death in the Philippines, children (up to 5 years old) from families that are beneficiaries of the conditional cash transfer program are required to undergo regular health checkups and to get vaccinated. In return, the families receive financial assistance (about 11 to 32 USD) for health, nutrition, and education per month, depending on the number of eligible children per household [
Over all, this study was able to identify 49 plant taxa used in 4 categories concerning Ati women’s reproductive health syndromes. The most frequently used plant parts were the leaves (49%), stems (38%), and barks (6%) perhaps due to the availability of these aerial organs all year round in tropical Philippines. Botanically, most leaves, stems, and barks contain phytochemicals which act as toxins protecting the plant from herbivores, but we humans economically utilize them as medicines. External administration (52%) was slightly preferred to internal one (48%) more likely due to safety concerns and ease of preparation.
A total of 37 plant taxa recorded 100% FL values indicating the importance and therapeutic effectiveness of these plants. The species which recorded the highest use-mentions were
When grouped according to education, descriptive and inferential statistics revealed that informants with lower level (none to complete elementary) of education (
When grouped according to age, results revealed that informants from the age group of 49 years and above (
When grouped according to the number of children, statistics revealed that informants with 6 and more children (
Statistical limitations of the analyses discussed above, however, are acknowledged by the authors. First, since the interview of indigenous people was bound by free and prior informed consent ethics, random sampling could not be applied. Second, the inferences made on informants’ knowledge in TM do not attempt to decontextualize their deeper understanding of culturally established phytotherapies. The interpretations, however, may aid concerned organizations in creating programs to protect ethnomedicinal traditions.
This research not only presents the diversity of medicinal plants used by the Ati women in traditional herbal medicine, but also emphasizes the cultural importance of plants and phytotherapies used for women’s reproductive health. Review of related studies on medicinal plants which recorded the highest informant consensus was also carried out to provide additional information regarding their botanical efficacy, safety, and mechanism of action when available. We hope that the study could stimulate social and cultural interests about the implications of changes happening in indigenous peoples’ traditional healthcare practices and, more importantly, raise awareness on safety concerns when TM is applied together with conventional medicine. Nevertheless, we believe that the need for improvement on health services for the safety of women during menstruation, pregnancy, delivery, and postpartum periods should be the first priority especially to the seemingly underserved indigenous cultures in the country.
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors give their sincerest appreciation to the informants for participating and sharing their knowledge. The researchers are also grateful to NCIP Region 6-7 and the local government of Guimaras Island and DA Region 6, for facilitating the conduct of this study and assistance in the processing of necessary permits. This research was supported by Hallym University Research Fund (HRF-201501-013).