CHAPTER I

INTRODUCTION

Background of the Study

Prenatal care, also known as antepartum care, refers to the health services that a

pregnant woman receives before a baby’s birth. This program is widely accepted as an

important element in improving pregnancy outcome. It includes health care, along with

education and counselling about how to handle different aspects of pregnancy. A health

care provider may discuss issues, such as nutrition and physical activity, what to expect

during the birthing process, and basic skills for caring for an infant (Pillitteri, 2010).

Health care providers know from numerous studies that prenatal care is important

because potential problems that may endanger the mother or her baby may be

discovered and treated prior to birth. In many cases, potential problems can be prevented

altogether. Because of this, it is important that the pregnant woman not only begins

prenatal care early, but also receives continuous care throughout her pregnancy.

The United States (U.S.) Department of Health and Human Services, Maternal and Child

Health Bureau, in their report states that babies born to mothers who received no prenatal

care were 3 times more likely to be born at low birth weight and 5 times more likely to die

than those whose mothers received prenatal care (Huth et al, 2003).

The dangers of childbearing can be greatly reduced if a woman is healthy and well-

nourished before becoming pregnant; if she has received a complete prenatal care by a

trained health worker during her pregnancy; and, if a skilled birth attendant assists the
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birth (Rogan, et. al, 2004). Prenatal care provides health education and evidence-based

interventions and care which can prevent and treat complications of pregnancy. This also

aims to encourage mothers to give birth in a birthing facility or be assisted by skilled birth

attendants (USAID, 2012). Thus, the prenatal care plays a vital role in ensuring the health

of expectant mothers, more especially if their nutritional status is safeguarded and

avoidable complications of pregnancy are prevented or treated (Claudio, et. al, 2013).

Some studies showed that non-compliance to prenatal care had effects on both

the mother and her baby. One study from the Centers for Disease Control Birth (2003)

showed that it had a twofold increase in infant mortality relative to incomplete prenatal

care. As the evidence showed in this study, if there was a decrease in the prenatal care,

there was an increased chance for stillbirth, early neonatal death, late neonatal death,

and infant deaths. Another study done by the Centre for Clinical Epidemiology and

Community Studies, Jewish General Hospital at Montreal, Quebec, Canada (2012)

showed that compared to adequate prenatal care, inadequate prenatal care was

associated with increased risk of prematurity 3.75 (3.73 to 3.77); stillbirth 1.94 (1.89 to

1.99); early neonatal death 2.03 (1.97 to 2.09); late neonatal death 1.67 (1.59 to 1.76);

and, infant death 1.79. Therefore, noncompliance with prenatal care could lead to

undesirable outcomes and this should be a focus of intervention.

The World Health Organization recommends a minimum of four (4) antenatal visits.

The Department of Health (DOH), too, follows the same protocol and this is also

implemented in DOH ARMM, as follows:

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Prenatal Visits Period of Pregnancy

As early in pregnancy as possible before four months or
1st visit
during the first trimester
2nd visit During the 2nd trimester
3rd visit During the 3rd trimester
Every 2 weeks 8th month of pregnancy till delivery.

Prenatal care has existed in different methods since the beginning of man.

Midwives have attended women in labor during most of history, and continue to do so up

to the present day. Although physicians did not normally attend to a pregnant woman until

the 1700’s, they did attend to women who were dying during childbirth, in an attempt to

save the child. As years passed by, guidelines for prenatal care were established and

today, it is used as one of the key components in meeting one of the eight Millennium

Development Goals 2015 (MDG) which is to improve maternal health. Within the MDG

monitoring framework, the international community commits itself to reducing the

Maternal Mortality Ratio (MMR) and sets a target of a decline of three quarters between

1990 and 2015 (DOH, 2000).

Corollary to MDG 5, the DOH aims to increase the proportion of pregnant women

having at least four antenatal care visits to 80%, in its attempt to improve maternal health,

thereby reducing MMR.

Globally, while 82 percent of pregnant women access antenatal care at least once

with a skilled health personnel, only 51 percent receive at least four antenatal visits – the

recommended minimum. In regions with the highest rates of maternal mortality, such as

sub-Saharan Africa and South Asia, even fewer women receive at least four antenatal

visits (45 percent and 35 percent, respectively) (UNICEF, 2015).

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In the Philippines, only 78% among mothers who received prenatal care had been

attended to at least once by skilled health personnel as of 2012. Infants and maternal

mortalities are still major problems nationwide, where 26 infants in every 1000 live births

die (NSCB, 2010) and maternal mortality rate is 221 women per 100,000 die due to

child birth as of 2011. The Philippines Health Statistics revealed that maternal deaths are

mainly caused by Hypertension (25%) and postpartum haemorrhage (20.3%) which are

directly related to inadequate care during pregnancy (Lincetto, et al, 2006).

In Lamitan City, prenatal care services are available in every Barangay health

station. Each health station is manned by at least three (3) barangay health workers, one

(1) visiting public health midwife and one (1) visiting public health nurse. Like in any other

health stations, prenatal care services in each of the barangays in Lamitan City include

thorough physical, health history and current health status assessment of pregnant

mothers upon their first visit. Every health station also provides tetanus toxoid vaccination

and vitamins and minerals supplementation.

Barangay Sabong and Barangay Baas are two of nine barangays in Lamitan City

that belong to the Geographically Isolated and Disadvantaged Areas (GIDA). Each of

these barangays has a health center that provides prenatal care services similar to any

other barangays in the City. Despite the availability of prenatal care services in these two

barangays, there have been four (4) reported maternal deaths due hemorrhage and

twelve (12) reported infant deaths since 2012 approximately 4 women die in every 1,000

live births. These two (2) barangays, have similar problems when it comes to health care

services being rendered, especially prenatal care. The midwife assigned in every health

station visits the area once a month. According to her, most of the people who live in this
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area are hesitant to come and visit the health center for several reasons, one of which is

misconception about prenatal care. Focusing on prenatal care services, she also states

that they are having a hard time in reaching out to the pregnant women in these

barangays. Accordingly, the pregnant mothers rarely visit the health center for prenatal

care, especially during the first trimester; hence, the recommended four antenatal visits

are not achieved. The second dose of tetanus toxoid vaccine is also not completely

administered because according to her, after the first visit of the pregnant women, they

do not come back for their next visit. Only a few among the said population comply with

the four prenatal visits. Aside from that, the midwife also says that accessibility to the

health center is also a problem for some, since there are also a lot of the general

population who live in the far flung areas of the two barangays.

There were also some unreported cases of maternal and infant death in the said

barangays, according to one of the BHWs’ in Barangay Sabong. “Ekka pe hep uh masi

ne hadja Ma’am meh matey inah in si panganakan atawa isab meh baby den matey.

Sugah na gai isab siye mag aka si kami, saddi aa ne hadja mag aka si kamihin hangkan

bang patekka gai ne tareport.” (“There are other cases of maternal and infant deaths, too,

Ma’am, that are not being reported because most of the time, they do not inform us.”)

Hence, the researchers felt the need to do something about the present problem

in Barangay Sabong and Barangay Baas.

With this information, this study will benefit the health personnel and health care

providers to increase the compliance with prenatal care services among the mothers to

prevent and reduce the number of maternal and infant mortality cases. Determining the
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compliance with prenatal care among the pregnant women will be needed in developing

actions to improve maternal health thus, decreasing maternal deaths in Lamitan City.

Objectives of the Study

General Objective:

The primary objective of this study was to determine the compliance with prenatal

care among one hundred (100) mothers of Barangay Sabong and Baas, Lamitan City,

Basilan Province.

Specific Objectives:

1. Identify the demographic profile of the mothers in terms of:

a. Age

b. Civil Status

c. Educational Attainment

d. Proximity of their residence to the Health Center

e. Socio economic Status (Monthly Income)

2. Determine factors that motivate their compliance with prenatal care.

3. Identify factors that hinder their compliance with prenatal care.

4. Determine the compliance rate of mothers with the following components of

prenatal care:

a. Prenatal visits (based on the TCL and questionnaire)

b. Tetanus Toxoid Vaccine and Ferrous Sulfate Supplementation (based on

questionnaire)
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Significance of the Study

This study is significant to the following for these reasons:

To the City Health of Lamitan, this will provide a picture of how prenatal care services

are being rendered in Barangay Sabong and Barangay Baas and how it is accepted by

the mothers as a means of health promotion, maintenance, and disease prevention. The

results of this study can identify factors, issues, and concerns in the delivery of prenatal

care services in the said barangays, as this will help to create solutions based on the

present problems by the Lamitan City Health Office, hence, addressing the current

problem in meeting the MDG 5 which is to improve maternal health. The result will give

the health workers some ideas on how to plan effectively the health teachings in the

compliance with prenatal care in the community which will greatly support the Department

of Health and the MDG 5’s goal.

To the Local Government Unit of Lamitan City, this will provide information, evidence

and statistics in relation to maternal health that will serve as an insight for the modification

of plans and policies for future development as necessary. The result of this study will

provide a reality check in every community of the country. This can lead to the creation

of realistic strategies and goals in order to achieve the MDG 5 goal.

To the readers and other students, its findings will challenge them to conduct related

studies in the compliance with prenatal care among mothers in Barangay Sabong and

Barangay Baas, Lamitan City with greatest impact on maternal health.

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Scope and Limitations of the Study

The study focused on the compliance with prenatal care and its components

among mothers who were married, separated and single-parents and residing in

Barangays Sabong and Baas, Lamitan City, Basilan Province.

This study limited its respondents and covered only 100 mothers from the two

barangays who were aged 15-49 years old, with or without history of prenatal care, and

who were pregnant or had a pregnancy within the past 2 years.

The tool used in this study was limited only to the standard procedures accepted

in DOH-ARMM.

Definition of Terms:

The terms relevant to this study are operationally defined:

1. Compliance – refers to the ability of the mothers to follow the recommended

prenatal care program by the Department of Health (DOH) like having the

recommended minimum of four antenatal visits (one visit recorded in the first to

third trimester; every two weeks during the 8th month of pregnancy; and, weekly

during the 9th month); at least have been injected with 2 doses of tetanus toxoid

vaccine for the first pregnancy and has received ferrous sulfate supplementation

monthly.

2. Mothers – a group of people who were married, separated and single parents and

pregnant or had a pregnancy within the past 2 years, and with or without history of

prenatal care.
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3. Prenatal care – healthcare service recommended by the Department of Health for

the pregnant mothers which includes the following:

a. Assessment (Profiling, Obstetrical history, Vital signs, Leopold’s maneuver,

and others)

b. Administration of Tetanus Toxoid Vaccine

c. Ferrous Sulfate supplementation

d. Health Teaching (Nutrition, clean and safe delivery, breast feeding program

and family planning counselling, and others)

4. Target Client List (TCL) – This consists of the different programs being

implemented by the Department of Health such as prenatal care; postpartum care;

family planning; expanded program on immunization; under six children and sick

children. The demographic profile of the clients in the community is written on it

and what services they have received.