BARRIERS TO PRE-NATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANGALANG, LEYTE : BASIS FOR RECOMMENDATION

___________________________

A Thesis proposal Presented to the Faculty Of the College of Nursing of Holy Infant College Tacloban City ____________________________ In Partial Fulfillment Of the Requirements for the Degree of BACHELOR OF SCIENCE IN NURSING ___________________________

by Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis

March 2012

APPROVAL SHEET This Thesis proposal entitled BARRIERS TO PRE-NATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAY OF ALANGALANG, LEYTE: BASIS FOR RECOMMENDATION prepared and submitted by Arao W. Renejaney Marie, Cue Kim Dit M. Brent, Dueas C. Josephine, Empie B. Ma. Joan, Espejon B. Bay Ann, Jaya J. Ysvette Reichardt Marie, and Viacrucis R. Isagani Pedro, in partial fulfillment of the requirements for the degree, Bachelor of Science in Nursing has been examined and recommended for acceptance and approved for ORAL EXAMINATION. THESIS COMMITTEE PORTIA A. LAPIDARIO, MAN, RN, RM Adviser DIANELLE A. TANCONTIAN, MAN, RN, RM Member ELNORA C. QUEBEC, MAN, CHPed, RN, RM Chairman PANEL OF EXAMINERS Approved by the committee on Oral Examination with a grade of ________. PORTIA A. LAPIDARIO, MAN, RN, RM Adviser DIANELLE A. TANCONTIAN, MAN, RN, RM Member ELNORA C. QUEBEC, MAN, CHPed, RN, RM Chairman Accepted and approved in partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing. ELNORA C. QUEBEC, MAN, CHPed, RN, RM Dean of Health Sciences Department

March 22, 2012

ACKNOWLEDGEMENT The researchers would like to express their sincere and utmost gratitude to the following people who made this research study a successful, fruitful and possible: First of all, to the Almighty God, for providing everything and for divine graces wisdom and knowledge He showered to us, most especially the heart to pursue despite of obstacles along the way. Mrs. Portia A. Lapidario, the research adviser and instructor, in her continuous guidance and motivation granted to us and for sharing her concern and expertise to the researchers. Mrs. Dianelle A. Tancontian, member of the panel of examiners who showed her careful statistical analysis, critiques, and valuable suggestions that contributed for the betterment and approval of this research. Mrs. Elnora C. Quebec, Chairman and Dean of Health and Sciences Department for sharing her expertise to the researchers and for her support and words of encouragement to accomplish this study. Hon. Loreto T. Yu, Municipal Mayor of Alangalang, Leyte and to all Barangay Captains of five (5) selected barangay of Alangalang, Leyte for

granting the researchers the permission and facilitating the conduct of the data gathering through interviews of the respondents.

To the pregnant women of the selected barangay of Alangalang, Leyte, as the respondents of this study, who have participated to make the gathering of data possible. To our Dear Parents and Benefactors for their never-ending

encouragement, support and understanding during the moments of completing this project. To our groupmates, for the support and effort to finish this research despite of difficulties.

THE RESEARCHERS

TABLE OF CONTENTS Page TITLE . i APPROVAL SHEET .. ii ACKNOWLEDGEMENTS .. iii DEDICATION .. iv TABLE OF CONTENTS .. v LIST OF TABLES .. viii LIST OF FIGURES .. ix LIST OF APPENDICES . x ABSTRACT xi CHAPTER 1 INTRODUCTION Rationale 1 Theoretical Background . 4 THE PROBLEM Statement of the Problem .. 30 Conceptual Framework of the Study . 32 Significance of the Study . 34 RESEARCH METHODOLOGY Research Design 36 Research Locale ... 37

Research Respondents .. 37 Research Instrument .. 38 Research Procedures .. 39 Gathering and processing of Data . 39 Statistical Treatment and Analysis of Data 39 2 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA Respondents Demographic Profile Respondents Barriers to Prenatal Care: Environmental Factors .. Socio-economic Factors Psychological Factors . Social Factors . Cultural Factors .... Respondents Degree of Compliance To Prenatal Care .. Respondents Degree of Importance To Prenatal Care . Respondents Prenatal Care Providers .. 3 SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS Summary . Findings

Conclusions . Recommendations .. DEFINITIONS OF TERMS . BIBLIOGRAPHY .. APPENDICES . CURRICULUM VITAE ..

DEDICATION

This is dedicated to our PARENTS, TEACHERS, and FRIENDS

for their continued support and inspiration.

LIST OF FIGURES

Figure 1

Page

Conceptual Framework of the Study 23

LIST OF APPENDICES Appendix A B Letter to the Dean Transmittal Letter to the Municipal Mayor of Alangalang, Leyte B-1 Transmittal Letter to the Barangay Captain of Barangay Dapdap Alangalang, Leyte ............................... B-2 Transmittal Letter to the Barangay Captain of Barangay Milagrosa Alangalang, Leyte .. B-3 Transmittal Letter to the Barangay Captain of Barangay Salvacion Alangalang, Leyte .. B-4 Transmittal Letter to the Barangay Captain of Barangay San Antonio Alangalang, Leyte .. B-5 Transmittal Letter to the Barangay Captain of Barangay Lingayon Alangalang, Leyte .. C D Letter to the Respondents Research Instruments . Page

CHAPTER 1 INTRODUCTION

Rationale Pre-natal care, essential for ensuring the overall health of newborns and their mothers. It is major strategy for helping to reduce the member of low birth-weight babies born yearly (Wessel, Endvikat, and Buscher, 2003). Pre-natal care includes balanced nutrition with adequate intake of calcium and vitamin D during infancy and childhood to prevent rickets (which can be distort pelvic size); adequate immunization against contagious disease for protection against viral diseases such as rubella during pregnancy; and a healthy daily diet to ensure the best state of health possible for woman and her partner when entering pregnancy. As all pregnancies involve some risks to the mother or infant and it is important to prevent, detect and manage complications early before they become life threatening emergencies. Prenatal care is a part of maternal care. Among the goals of maternal care is to ensure that every expectant mother and nursing mother maintains good health, learns the art of the child care, has a normal delivery and bears healthy children. Maternal care consists of the care of the pregnant woman, here safe delivery, her postnatal care and examination and the care of her lactation. It begins much broadly earlier with measures to

promote the health and well being of the young people who are potential parents and help them develop the right approach to family life and the place of the family in the community (Reyala, et. al., 2002). Antenatal care is an opportunity to inform woman about the danger signs and symptoms for which assistance should be slough from a health care provider without delay. One of the most important functions of antenatal care is to offer the women advice and information about the appropriate place of delivery given her own particular circumstances and health status (WHO, 1996). More specifically, Reyala, et. al. (2000) underscored that the objectives of prenatal care are to reach all pregnant women, to give sufficient care to ensure a healthy pregnancy and the birth of a full term healthy baby. Part of the goal of pre-natal care are health promotions including developing positive attitudes about sexuality, woman-hood, and child bearing. Once a woman becomes sexually active preparation for successful pregnancy includes practicing safer sex, regular pelvic examinations, and prompt

treatment of any sexually transmitted infection to prevent complication that could lead to infertility. Acquisition and use of reproductive life planning information may help to ensure that each pregnancy is planned. The causes of mortality rate could be directly or indirectly related to the quality of prenatal care. This means that if prenatal care is only effective, these

figures could have been lower. These data prove the need for expectant mothers to comply with prenatal care practices. A number of national Health Goals speak directly to the importance of prenatal care: which are; to increase at least 80% the proportion care and counseling; increase to at least 90% the proportion of all pregnant woman

who receive prenatal care in the first trimester of pregnancy from a baseline of 76% (DHHS, 2000). This data somehow provided a substance for this study. The researchers intends to investigate ways to promote pre-natal care or to enlarge the

scope of nursing involvement in prenatal care would be important to help the community to meet this goals.

Theoretical Background This study is anchored on the following theories: Penders Health Promotion Theory; Sister Callista Roys Adaptation Model; and Madeleine Leiningers Culture Care Diversity and Universality Theory. Penders Health Promotion Model (HPM) (1982; revised, 1996) was designed to be a complementary counterpart to models of health protection. He defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a clients level of well-being. He also describes the multidimensional nature of person as they interact within their environment to pursue health. The model focuses on following three areas such as individual characteristics and experiences, behavior specific cognitions and affect, and behavioral outcomes. These variables can be modified through nursing actions. Health promoting behavior is the desired behavioral outcome and is the end point in the Health Promotion Model. Health promoting behaviors should result in improve health, enhanced functional ability and better quality of life at all stages of development. The final behavioral demand is also influenced by the intermediate completing demand and preferences, which can derail an intended health promoting actions (http://currentnursing.com). This theory signifies that health is not merely the absence of disease but it encompasses the whole well-being of a person. A person must be physically, mentally, emotionally and spiritually fit in order to be known as a healthy person who can easily cope and adapt changes in life or within self like pregnancy.

Sister Callista Roys Adaptation Model defines that adaptation as the process and outcome whereby the thinking and feeling person uses conscious awareness and choice to create human and environmental integration. Roys work focuses on the increasing complexity of person and environmental self-organization, and on the relationship between and among persons, universe and what can be considered a supreme being or God. Adaptive responses contribute to health, which she defines as the process of being and becoming integrated; ineffective or maladaptive responses do not contribute to health. Each persons adaptation level is unique and constantly changing. (Kozier, Erb, Synder, & Berman., 2008) This shows that relationship between or among persons can contribute an effective adaptation to the pregnancy, that might be later on become a hindrance in accepting her pregnancy especially to teenage pregnancy and she will not submit herself to prenatal check up due to less attachment to the

unborn child on her womb. Madeleine Leiningers Cultural Care Diversity and Universality theory states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. She emphasizes that human caring, although a universal phenomenon, varies among cultures in its expressions, processes, and patterns; it is largely culturally derived. This model emphasizes that health and care are influenced by elements of the social structure, such as technology, religious and philosophical factors, kinship and social systems, cultural values, political and legal factors, economic factors, and educational factors. These social

factors are addressed within environmental context, language expressions, and ethno history. Each of these systems is part of the social structure of any society; health care expression, patterns, and practices are also integral parts of these aspects of social structure. (McFarland., 2006) Leiningers Theory of Culture Care Diversity and University, which is based on Transcultural Nursing also, in part, bears relevance to the present study According to her, care is the essence of nursing, and dominant distinctive, and unifying feature of nursing. She further opined that there can be no cure without caring, but there may be caring without curing. She emphasize that human caring, although a universal phenomenon, varies among cultures in its expressions, processes and patterns it is largely cultural derived (Kozier, 2002). The health of pregnant mother is a paramount importance since it directly affects the health of the baby in the womb. Quality prenatal care should therefore be availed by the mother during pregnancy. The care is to ensure the health of the baby and the mother. Through prenatal care does not normal delivery, expectant mothers subject themselves to this with the hope of having a normal delivery. The recent study tried to identify some factors which may have relationship with compliance to pre-natal care. One of those consider is the beliefs of the mothers. This, in a way, is a part of culture. This research, therefore, embraces the idea that mothers could have different ways of caring

for their babies in their womb, or they could have different degrees of compliance to pre-natal care and these differences could be attributed to their beliefs and practices. It is vital that a study been made understandable to the readers, and the barriers that have been important to the problem. With this, the present study is relevant upon the previously mentioned theories. To have an understanding of the study, related literature will be discussed here. Pregnancies possess a risk to life for every woman. Pregnant women may suffer from complications and die. In order to address the problem, packages of health services are provided to the clients. These essential healthcare packages are available and are in place in the health system, one of which is the antenatal registration, wherein every woman has to visit the nearest health facility to seek prenatal checkup. In obtaining prenatal care services they need to register themselves. It is important to seek prenatal checkup because it is the only way to guide her in pregnancy care to make her prepare for childbirth. Pregnant women should have at least four (4) prenatal visits with time for adequate evaluation and management of diseases and conditions that may put the pregnancy at risk, it reduces womens exposure to health risk through the institutionalization of responsible parenthood and provision of appropriate healthcare package to all women of reproductive age specially those who are less than eighteen (18) years old and over thirty five (35) years of age, women

with low educational and financial resources, women with unmanaged chronic illness and women who had just given birth in the last eighteen (18) months. The standard prenatal visits that a woman has to receive during pregnancy were divided into four (4) antenatal visits. Initial visit should be as early in pregnancy as possible before four (4) months or during the first trimester, the second visit is obtained during second trimester, the third visit is at the third trimester and lastly prenatal visit is every two (2) weeks after eighth (8) month of pregnancy till delivery. (Reyala & et al., Public Health Nursing in the Philippines, 2007) Structural barriers and demographic risk factors believed to decrease the likelihood of women obtaining adequate prenatal care have been considered extensively. In addition, several health behavior theories have been developed and applied to pregnant women in an attempt to describe and predict individual influences and determinants of health behavior and utilization patterns among various populations. Structural barriers are primarily associated with financial and environmental factors. Private insurance holders are more likely to obtain care early and utilize it consistently whereas public clients are least likely to obtain care especially at first trimester. Medicaid clients also tend to have the most inconsistent patterns of utilization which believed due to demographic risk factors that many of these women are likely to experience (Oberg, 1991). Contributing to this pattern are institutional problems within the health care delivery system, which seem to be more prevalent in the public health arenas in which women with other risk factors commonly receive care. These problems include knowing

where to seek prenatal care, having prolonged time intervals between the first attempt to initiate care and the first actual appointment, finding transportation to clinics, having difficulty obtaining and paying for child care, and having problems associated with taking time away from work to attend daytime clinic appointments such as long clinic waits and poor or lack of employer flexibility. (Aved, Barriers to Prenatal Care, 1993). Nonstructural barriers are less well-discussed personal factors that influence a womans ability to seek and continue prenatal care. Much of what is known in the literature about these factors have been derived from studies centered around general barriers, which have primarily used short, structured and closed-ended interviews or surveys in postpartum data collection (Fisher et al., 1991). Psychological factors found to act as barriers include the attitude a woman has about her pregnancy; problems with accepting or acknowledging in the pregnancy; beliefs regarding the importance of obtaining prenatal care for herself; attitude towards her care provider or the health care system in general; the presence of depression or extreme stress; the fears related to medical procedures, the discovery of drug abuse, or penalty for undocumented status. (Conrad, 1998). Social factors associated with inadequate or no prenatal care involve the degree of social support that a pregnant woman has in terms of her significant others. The research data suggest that emotional assistance and fiscal assistance

from significant others are important motivators in obtaining prenatal care for low-income women. Without this encouragement, women may not obtain the care they need. (Curry, 1990) Cultural factors are especially important to women who associated closely with given cultural group. This factors include groups beliefs and definitions regarding health and illness, the perceived value of pre-natal care among group members, the ethnicity of the clinic staff and care provider, language barriers between client and provider, the use of traditional remedies or folks beliefs about pregnancy, and the role of kin in influencing health care choices. (Curry, 1990) Vulnerable population of childbearing women may be less likely to overcome perceived and actual barriers in obtaining prenatal care. Vulnerable childbearing women, in general, are defined as being low socioeconomic status or any woman who is not empowered or is in disenfranchised position. Socioeconomic status is one of the most powerful risk factor for poor health outcomes, with poverty consistently being associated with insufficient prenatal care. In addition to reduced access to health care, poverty is also associated with ethnic minority status, poor nutrition, low education, and inadequate housing. Women living in this condition without social resources are more likely to suffer adverse birth outcomes than the more advantaged women (Hughes & Simpson, 1995). Demographic risk factors reported by the Institute of Medicine (1988) and the majority of studies conducted on barriers to prenatal care include women with the following characteristic: (a) less than 150% of the federal poverty level,

(b) Non-White race, (c) less than 20 years old, (d) less than high school education, (e) unmarried, and (f) multiparous (prenatal care being inversely proportional to the number of living children). (Alexander & Korenbort, 1995). The age of the childbearing couple may have a significant influence on their physical and psychosocial adaptation to pregnancy. Normal developmental processes that occur in both very young and older mothers are interrupted by pregnancy than that of the woman of typical childbearing age. Although the individuality of each pregnant woman is recognize, special needs of expectant mothers aged 15 years or younger or those aged 35 years or older. (Hatfield, 2006). Complications during pregnancy are more common when women reach age 35. (www.webmd.com/baby/pregnancy) According to the United States Department of Health and human Services (2000), teenage mothers are less likely to get or stay married, less likely to complete high school or college, and more likely to require public assistance and to live in poverty than their peer who are not mothers. (Hatfield, 2006). Gravida is a term reflecting the number of pregnancies, regardless of duration or outcomes. A client who is pregnant for the first time thus is a Gravida 1, a client experiencing her second pregnancy is a Gravida 2, and so on. Sometimes, the Gravida 1 client is referred to as Primigravida, meaning, literally that this is her first pregnancy (Wong, et.al 2002). Para is the number of births after 20 weeks gestation, whether live births or stillbirths. Additionally the term para, when expressed as a single number,

does not reflect the number of infants born at the delivery but rather the number of pregnancies that have gone past 20 weeks gestation. Thus, the client who has had only one pregnancy and gave birth to term twins could be considered a Para 1 (one birth past 20 weeks gestation), Gravida 1 (reflecting her only pregnancy to date) (Littleton, 2002). Abortion, any interruption of a pregnancy before the fetus is viable (a stage of development that will enable the fetus to survive outside the uterus if born at that time) (Pilliteri, 2007). Age of Gestation, gestational age, or the age of the baby, is calculated from the first day of the mother's last menstrual period. Since the exact date of conception is almost never known, the first day of the last menstrual period is used to measure how old the baby is. Source During first trimester pregnant women is vulnerable to harbor teratogens from any factor, chemical, or physical that adversely affects the fertilized ovum, embryo, or fetus. To reach maturity of optimal health, a fetus needs sound genes and a healthy intrauterine environment that protects it from the influence of teratogens. It is also marked by an invisible yet an amazing transformation. Hormones trigger the body to begin nourishing the baby even before tests and a physical exam that can confirm the pregnancy. Knowing what physical and emotional changes to expect during the first trimester can help to face the months ahead with confidence. Most miscarriages happen in the first trimester

and experts believe that the majority of those are caused by random genetic abnormalities that cannot be prevented. (Kranes, 2010) Bodily and hormonal changes happen that affects almost every organ in the body. Pregnant women might need to make changes in daily routine such as going to bed earlier, eating small frequent meals, avoidance of exposure to teratogens because it can cause harm to an unborn or breastfeeding baby, it can be alcohol, tobacco use, prescription/nonprescription medications, illegal drugs, vaccines, illnesses, environmental exposures, occupational exposures, or maternal autoimmune disorder. SOURCE Specific factors found to impact the use of prenatal care among Hispanic American women largely involve the degree to which acculturation, the process of change that occurs as a result of continuous contact between cultural groups (Solis et al., 1990, p. 11), has been experienced by the individual. In general, the less acculturated the Hispanic woman is to be surroundings; the less likely she will be to seek prenatal care. This lack of awareness regards how and where to obtain care, a decreased ability to communicate with care providers, and a less modified health care belief system that may not value prenatal care as necessary for a healthy pregnancy outcome. (Curry, 1990) The use of antenatal care services is highly influenced by the antenatal careseeking behavior of women, which is influenced by individual client characteristics as well as demographic factors (Rahman et al 1997).

Adequate prenatal care begins in the first trimester and continues on a regular schedule until delivery. Lack of adequate prenatal care is associated with poor pregnancy outcomes, including high rates of infant and neonatal death, premature birth, birth defects, maternal death, and birth

complications. The use of health care is not only dependent on the actual needs and health status of women, but it is also influenced by how a person perceives her own health status (HGI, 2001). However, the type and quality of antenatal care those women receive is also important for safety outcomes. Most importantly, poor antenatal care is an important risk factor for adverse pregnancy outcomes among women who have easy access to health care service (Blondel and Marshall, 1998). Moreover, appropriate antenatal care is important for identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. (Magadi et al, 2000). Prenatal care seems to be the most important practice of a mother should do to ensure the healthy development of the child. However, compliance to prenatal care may remain to be desired. There could be several factors that contribute to the low compliance to prenatal care among pregnant mothers. Some could be socio-economic status, availability of health care facilities and health care workers, among others. Wong, et.al (2000) elaborate the prenatal care is sought routinely by women of middle of high socio-economic status.

However, women living in poverty or lack health care insurance may not be able to use public medical services or gain access to private care. Likewise, women from cultures in which prenatal care is not emphasized may not know to seek routing prenatal care. Birth outcomes in these populations are thus less positive, with higher rates of maternal and fetal or newborn complications. Wong, et.al. further emphasized that barriers to obtaining health care during pregnancy include in adequate numbers of health care provides, distance from health care facilities, lack of transportation, fragmentation of services, inadequate finances, and personal attitudes. Access to health service is an important factor influencing their health status. However, womens health also suffers from the factors that constrain their access to health service. As in the case of all resources, access to health service is a function both of the resources at the overall disposal of a society or community, as well as its distribution across social groups and individuals. Within a given social setting and a given availability of health services, an individuals access to services may be determined by factors such as distance, availability, affordability, and the appropriateness and adequacy of services as perceived by users. In many settings, the physical distance between services and women is associated with service utilization (McCarthy and Maine, 1992). However, accessibility is a much broader concept than physical distance. The physical distance imposes another cost to the consumer, that is opportunity cost of time spent on obtaining these services and accessibility of health service

in terms of location and distance is very important in the use of reproductive health service (Shariff and Singh, 2000). Another possible factor that may have significant influences on the degree of compliance to prenatal care among pregnant mothers is their beliefs regarding pregnancy. Some of these beliefs may have scientific bearing; however other are just superstitious without any medical explanation or are not medically acceptable. Bhattacharya (1992) averted that all societies have traditional beliefs regarding harmful and beneficial foods for women during pregnancy. There are also beliefs regarding the optional amount of food to be taken during pregnancy for a successful productive outcome. These beliefs may or may not conform to the modern biomedical notions about the proper types and amount of food needed by pregnant women to safeguard maternal nutrition, ad equate growth of fetus and safe delivery. Bhattacharya (1992) further elaborated that beliefs and practices are linked to culture, environment and education. Pregnancy in the case of women is the midpoint of life and death, Therefore, there are many practices, rituals, beliefs and offerings that are meant to protect a mother from influences of evil spirits and supernatural powers. There are certain cultural beliefs and practices affecting the utilization of health services during pregnancy. Intake of milk, green leafy vegetables were thought to be good for the fetus. Socio-religious functions such as Saddah were performed by relatives during pregnancy which included performing rituals like offering new clothes, and various types of foods.

Traditional beliefs and cultural practices that are common to a community may contribute to the variability in the use of health services. Women in some cultures may not use antenatal care because they perceived that the modern health sector is intended for a service only. Women sometimes may feel shy to discuss their reproductive health problems with their husbands or senior members of the household, and postpone care seeking until it is too late (WHO, 2001). In obtaining prenatal care several tests are performed during these visits. Tests performed during the first visit include blood tests to check blood type, Rh factor, anemia, and immunity to several diseases including rubella (German measles) and hepatitis B. Urine tests to check for sugar and protein as signs of diabetes and kidney changes, respectively, are also performed. A Pap test may be done to detect changes in the cervix that could be forerunners to cancer. Subsequent visits will include the collection of urine samples to continue to check for sugar and proteins, measuring blood pressure, measuring weight to make sure the expectant mother is gaining enough, listening to the fetal heartbeat (typically after 12 weeks) and checking the size and position of the uterus and fetus. The doctor can also perform various tests to check the fetus for birth defects. Prenatal care consists of much more than just monitoring the mother's diet and weight. Keep in mind that during pregnancy it is not just the health of the pregnant woman that must be watched, but also the health of the unborn baby. Maternal difficulties such as diabetes (which can develop as a result of

being pregnant even if diabetes was not present before), insufficient weight gain, and high blood pressure, if gone untreated, can be harmful to the fetus. A doctor can also monitor the baby's well being directly by listening to the fetal heartbeat, checking the size and positioning of the uterus and fetus, and testing for various abnormalities. Some conditions, if detected prenatally, can be treated in-utero (i.e., before the baby is born). In other instances, early detection can allow the proper medical facilities to be present at the time of birth to allow the baby full access to the help it needs. It is very important to receive proper prenatal care in order to ensure the health of both you and your baby. (www.womenshealth.gov/publications/our.../fact.../prenatal-care.cfm). The standard prenatal physical examination per visit shall include the following: weight, height, and blood pressure taking, examination of the eyes (conjunctiva) and palms of the hand for pallor, abdominal examination to include fundic height, fetal position, presentation and fetal heart tones when applicable; face, hands, and lower extremities for edema, examination of the breast, and examination of the neck for thyroid gland enlargement (goiter). Basic prenatal service delivery at the hospitals, rural health unit, and barangay health stations should include the following: history taking, physical examination, treatment of disease, tetanus toxoid immunization, iron supplementation, health education, and proper referral to the next higher level when applicable. (Reyala, et al., 2000).

Similarly, Matthews et al (2001) indicated that the possibility of complications may occur potentially so serious and routine checks are highly desirable during pregnancy. Rooney (1992) argued that, whether prenatal care can also prevent maternal mortality and serious morbidity is a difficult question to answer. In contrast, to reduce maternal mortality it is important to reduce the likelihood that a pregnant woman will experience a serious complication of pregnancy or childbirth. However, the complications of pregnancies frequently occur among women with no risk factors, and therefore some complications cannot be predicted, although many may be prevented (Maine, 1993 and WHO, 1993 cited in Shiffman, 2000). Advise the mother to keep the newborn in the room with her, in her bed or within easy reach, exclusively breastfeed on demand day and night (> 8 times in 24 hours except in the first day of life when newborn sleeps a lot), do not give sugar water, formula or other prelacteals, do not give bottles or pacifiers. Explain to the mother that babies need an additional layer of clothing compared to older children or adults. Keep the road or part of the room warm, especially in cold climate. During the day, dress up or wrap the baby. At night, let the baby sleep with the mother or within easy reach to facilitate breastfeeding, do not put the baby on any cold or wet surface, do not swaddle or wrap too tightly, and do not leave the baby in direct sunlight (DOH, 2009)

Shiffman (2000) suggested that antenatal care enable health personnel to provide women with information about nutrition and hygiene, and about signs that may suggest problems requiring medical care. This study is guided by the following related studies. Demographic studies services are indicate that the typical nonusers with more of prenatal than four

black women, teenage girls, women

previous births, single women, poor women, and

women with less than a

high school education. (Department of Health and Human Services, Center for Vital Statistics, 1988). Most problems, in addition of these descriptors indicate that multiple pregnancy

to nonuse

of prenatal care, may affect

outcome and postnatal care of the baby. Nevertheless, during the past two decades, local, state, and federal programs have attempted to improve

pregnancy outcome statistics almost solely through efforts to make prenatal care programs affordable and accessible. Despite substantial funding, vital statistics continue to show that a significant number of women do not obtain adequate prenatal care. This study was designed to more fully

describe this population to make recommendations for service approaches. Most studies program of non- use of prenatal care poor either assess prenatal

effectiveness

in reducing

pregnancy

outcome or identify

demographic characteristics of nonuse of services. To date, few studies have addressed reasons for nonuse of prenatal care. Bracken (1968) used a

structured questionnaire, based on demographics identified in vital statistics, to

interview 228 maternity patients in metropolitan Salt Lake City. This study showed that levels of education and lack of understanding of need for care were associated with lack of adequate prenatal care, and financial ability and transportation and child care availability were associated with use of prenatal care. Berns (1982) studied 10 Indianapolis women who arrived at

Community Hospital with no previous prenatal care. The womens level of pregnancy denial; was so high that they professed either no awareness or a slight suspicion of pregnancy up to the time of delivery. After the birth, the

women immediately requested the adoption of their babies. A retrospective study of 43 nonusers of prenatal care was conducted by hospital social workers (Joyce, 1984) at Cleveland Metropolitan

General/Highland View Hospital during 1978. The sample was composed of almost equal members of white and nonwhite women. Eighty-one percent of the women department. had their medical expenses paid by the county welfare internal

Reasons

charted

for nonuse were categorized as

barriers such as depression or denial (20 women) and external barriers such as lack of money, transportation, and child care (10 women); 13 women said they felt fine and saw no need for care. An extensive marketing study was conducted by Juarez and Associates (1982) to determine why certain groups of women were at high risk for

inadequate use of prenatal care. The information was to be used by the U.S.

Department of Health and Human Services to improve infant and maternal health. Fifteen focus groups of planning to be pregnant were women who were used. pregnant or who were this

Several themes emerged from

qualitative study. Many of the women lived day to day, and their priorities were food and shelter. Pregnancy was seen as natural and not requiring special attention unless problems arose. Also, stress was more an issue than was the pregnancy, especially among black urban respondents. Womens health issues in general and womens health care needs in particular are foremost among the public health priorities of the countries around the world (Ulincy and Simmons, 1993). A study based on exploratory and descriptive in nature of the Institute of Medicine (1988) , a convenience sample of 28 pregnant, low-income

women meeting selected criteria using (a) selected demographic information obtained through medical chart reviewers and (b) taped in-home interviews to identify perceived barriers reported by women who registered for

prenatal care in each of the three trimesters and a selection of women who received no prenatal care. Basic descriptive statistics were used to delineate the prenatal care registrants at both of the clinic sites and the study sample. Transcribed interviews were analyzed by extracting significant statements that were clustered nonstructural into 12 themes: barriers. (a) 3 structural barriers and (b) 9

Field notes from the interviews were reviewed and

coded to assist with the verification of themes and to give a global sense of

each participants experience. A complex picture of the womens experiences with living in poverty while trying to obtain adequate prenatal care emerged as the data were analyzed. Women initially tended to identify and describe structural barriers as their primary problems, but also recognized the impact nonstructural barriers had on their ability to obtain care later in the

interviews. Participants with inadequate care were relatively unable to perceived available options outside of a very limited set of choices. In the face of insufficient knowledge and resources, the participants barriers to adequate prenatal care. In general, the greater perceived multiple the numbers of

obstacles present for each participant, the less the likely they were able to overcome them and the more likely they were to enter prenatal care late. Many of the barriers were interrelated, creating a self-perpetrating cycle the inhibited the womens ability to overcome these barriers and to obtain

adequate prenatal care (Publisher University of Utah; Defense Date 1999-09). Magadi et al (2000) also identified the significant association between demographic factors and frequency of antenatal care visits. Rahman et al (1997) pointed out that antenatal visit is positively associated with parity. Authors argued that women with higher parity understand that they are at higher risk of pregnancy-related complications, and more likely to receive antenatal care visits. Magadi et al (2000) further pointed out that there is a strong association between the level of antenatal care and delivery care. It suggests that the use of

antenatal care visits, especially adequate antenatal care visits is an important factor for safety outcomes. Based on the statistical study of the Center for Bio-Ethical Reform the result showed that the number of abortion per year is approximately 42 million and the number of abortions per year is approximately 115,000 worldwide. Their study also reveals that 83% of all abortions are obtained in developing countries and 17% occur in developed countries (Abortionno.org). According to Noah Chalfin for many women entering pregnancy, their initial excitement is often confronted by the secondary anxiety raised by wanting to do it right. Most moms-to-be know not to use drugs, drink alcohol or smokes cigarettes while theyre pregnant. But despite of this fact, still there are pregnant women who dont seek prenatal care because of many factors with regards to environmental hazards. However, in a comparative study between Morocco and Tunisia, Obermeyer (1993) revealed that early age at marriage and higher parity is negatively correlated with prenatal care. Furthermore, many authors have illustrated that the number of children in the household has significant and negative effect on prenatal care. (Potter, 1993) Many researchers explained the relationship between client and provider in order to find its effect on health service utilization. El-Gilany and Aref (2000) found that the registration of antenatal care at the local health center

was found higher in rural than urban areas. They argued that in the small settled rural communities, there might be a more intimate relationship between women and health teams in the health center. Contrary to the above finding, in a study of utilization of antenatal care, Mondal (1997) found that the place of residence did not emerge as a significant factor in explaining the difference in service utilization after controlling all the variables. This result is consistent with the findings of Celik and Hotchkiss (2000) that urban/ rural living status of women did not emerge as statistically significant role on prenatal care service utilization after controlling other variables. Bhatia and Cleland (1995) also revealed urban rural differential in the health service utilization and argued that urban rural residence is also an indicator of geographical proximity to services. In a study in Kenya, Magadi et al (2000) found the association between place of residence and frequency of antenatal care visits. They also argued that rural urban residence could also act as a proxy for access to health service, since many developing countries have disproportionate numbers of health service in favor of urban communities. The Koenig et.al. (1988) findings raised important question about the potential for family planning programs to reduce maternal mortality levels. However, it is very clear that family planning is an integral part of maternal health. In a study in Karnataka, family planning knowledge differentials were found among antenatal care acceptors and non-acceptors.

Mishra et al (1998) illustrated that, women who had utilized antenatal care were almost three times as knowledgeable with respect to family planning as those who had not. In this study authors found the strict association between the acceptance of antenatal care and a wider knowledge of contraceptive methods. This suggests that knowledge of family planning is the proximity about the knowledge about antenatal care service utilization. A study of Maternal Health in Mali, Clemmons and Coulibaly (1999) identified that women and men were not well aware of the risks and dangers associated with pregnancy and childbirth, however they were worried about the outcomes. Moreover, an adequate knowledge of health care seeking behavior of women during the entire reproductive process can facilitate the management of maternal health service (Bhatia and Cleland, 1995). Some studies show that there are still a significant number of mothers who dont comply with pre-natal care. The report by the Philippine National Statistics Office (1999) disclosed that the mothers of 86 percent of infants born in five years preceding the survey in 1998 had obtained pre-natal care from health professionals (which implies that 14 percent did not), usually a nursemidwife. Of the births to women who received prenatal care, 48 percent were to women who made their initial visit within the first three months of pregnancy, and the report also disclosed that majority of births took place in the womans home, the remainder occurred at a health facility.

Prenatal care had significantly lower death rate compared to those with no prenatal care. Moreover, the results showed that some other factors affect death rates of infants and children such as mothers level of education and being in rural or urban areas. It suggests that children of parents with higher level of education are healthier, that is, with lesser mortality rate, than those whose parents with lesser education. This connotes also that parents with higher education tend to cloy more to prenatal care than those with lower level of education. Also those in the rural areas have higher mortality rate than those in the urban. This could be due to the absence or scarcity of the health care services and facilities in the rural areas. These finding, therefore, suggest that these factors affect the parents compliance to prenatal care. A qualitative study of reasons for non- use of prenatal care was

conducted over a 10-month period in 1988 and 1989. Through personal interviews with 44 women who did not obtain prenatal care, four categories of reasons for nonuse were identified: (1) the womens lifestyles different from mainstream society, (2) the women believed prenatal care was

important, but stressful events in their lives took priority; (3) the women attempted to receive care but were discouraged, turned away, or given poor information by service delivery system personnel (4) the women did not want the baby. intervention. These reasons clearly indicate a need for social services

The above related literatures and related studies will serve as a guide in the interpretation and analysis of the results of the present studies.

THE PROBLEM

Statement of the Problem

This study aims to determine the Factors Affecting the Compliance to Prenatal Care Among Pregnant Women in Selected Leyte: Basis for Recommendation. Specifically, the study seeks to answer the following questions: 1. What is the demographic profile of each respondent in terms of; 1.1 age; 1.2 civil status; 1.3 educational attainment; 1.4 economic status; 1.4.1 occupation; 1.4.2 family monthly income; 1.5 religion; 1.6 obstetrical profile; 1.6.1 gravida; 1.6.2 term; 1.6.3 para; Barangays of Alangalang,

1.6.4 abortion; 1.6.5 living child; 1.6.5 last menstrual period (AOG)? 2. What are the barriers of prenatal care as perceived by the respondents: 2.1 environmental factors; 2.2 socio-economic factors; 2.3 psychological factors; 2.4 social factors; 2.5 cultural factors? 3. What is the degree of respondents compliance to prenatal visit? 4. What is the degree of importance to prenatal visit as perceived by the respondents? 5. Who are the prenatal care providers of the respondents? 6. What recommendation can be derived from the results of the study?

Respondents Profile: Age Civil Status Educational attainment Economic status o Occupation o Family monthly income Religion Obstetrical profile o gravida o term o para o abortion o living child o last menstrual period (AOG)

B A S I S F O R R E C

Pregnant woman in selected Brgy. Of Alangalang, Leyte

Barriers to prenatal check-up Structural barrier Nonstructural Barrier

O M M E

Degree of respondents compliance to pre-natal visit

N D A

Degree of importance to pre-natal visit as perceived by the respondents. Prenatal care provider

T I O N

Figure 1. Conceptual Framework of the Study

Figure 1 shows the direction of the study, first, the pregnant women in selected barangays of Alangalang Leyte will be the respondents of the study then the barriers to pre-natal care in terms of: structural barriers and nonstructural barriers. Next, the degree of respondents compliance to prenatal visit. Followed by the degree of importance to prenatal care as perceived by the respondents and lastly, who are the prenatal care providers of the respondents. Results of the study will be used as the basis for recommendation. Significance of the Study The information of the research study to be conducted will be very relevant to the following: Pregnant Women. The result of the study will improve the awareness on what are the barriers that can affect to prenatal care, so that they will know the significance of pre-natal care. Rural Health Midwives/Public Health Nurses. Finding of the study will help them identify what are the most common factors why most of the pregnant mother do not comply prenatal check-ups. Local Government Unit. Results of the study will help them implement putting even one midwife in every barangay, so that the pregnant women can avail such pre-natal check-up and monitor their health status. Nursing Students. The information that will be revealed out of this

research study will enhance them to promote and elaborate to pregnant women the need and benefits of such compliance to pre-natal check up.

Clinical Instructors. The information that will be rendered based on this research study can help them impart knowledge to the students as well as to the pregnant women about the possible health risk of non- compliance to prenatal check-up. Future Researchers. This will serve as reference and guide for further studies regarding barriers to prenatal care.

RESEARCH METHODOLOGY This section presents the method and procedures to be used in this research study, which includes the research design, research locale, research respondents, data gathering procedures, data processing and analysis, and statistical treatment. Research Design This study will utilize a descriptive method to identify the Barriers to Prenatal Care Among Pregnant Women in Selected Barangays of Alangalang, Leyte. Descriptive method of research provides accurate portrayal or account of characteristics of particular individuals, situations, or groups. Descriptive study offer researchers a way to discover new meaning, describe what exist, determine the frequency with which something occurs, and categorize information (Venzon, 2010). This study will use descriptive method to determine the profile of the respondents such as: age, civil status, educational attainment, economic status, religion and obstetrical profile, the barriers to prenatal care in, the degree of compliance of the respondents to prenatal care, the importance of prenatal care, and lastly, the prenatal care provider. Based on the findings of the study, basis for recommendation may be drawn.

Research Locale Municipality of Alangalang Leyte is composed of 54 Barangays, having 41,245 population as of year 2000 presently headed by Mayor Loreto T. Yu. Alangalang is said to be the big producer of copra and rice that makes the towns growth steady. The survey will be conducted in five (5) Selected Barangays of Alangalang, Leyte such as; Barangay Salvacion, Barangay Milagrosa, Barangay San Antonio, Baranagay Lingayon, Barangay Dap-dap. The rationale for selecting these Barangays as the locale of the study is based on the pre-survey, several pregnant women in their Barangays do not submit to prenatal care, despite accessibility to prenatal care. Research Respondents Pregnant women from five (5) selected barangays of Alangalang, Leyte such as Barangay Salvacion, Barangay Milagrosa, Barangay San Antonio, Barangay Lingayon, Barangay Dapdap were the respondents of the study. Presurvey was done with an estimated of 10 or more pregnant women per barangay, with a total of 50 respondents. So complete enumeration will be employed. Research Instrument The study made use of a researcher will utilize structured interview with the use of interview guide as a tool in data gathering.

It was initially written in English and translated in Waray waray dialect for us to deliver clearly the questions. It consists of five parts. The Part I is a checklist about demographic profile of the respondents. The questions are those about the respondents age, civil status, educational attainment, economic status (occupation and family monthly income), religion, and lastly, the obstetrical profile in terms of number of pregnancy (gravida, para, term, abortion, living child, and LMP (AOG) . Part II consists of questions which ask regarding barriers to prenatal care a checklist used to identify the respondents barriers. Part III contains the schedule of prenatal visit and the importance of prenatal care using a checklist. Part IV is intended to elicit the responses to determine the importance of prenatal care to the respondents using a 4 point Likert-type scale wherein (4) very important, (3) important, (2) less important, (1) not important. Part V consists of statements regarding the prenatal care provider. The respondents will be asking who perform prenatal care. Research Procedure Gathering and Processing of Data. The data will be gathered by administering the questionnaires to the respondents of the study. Prior to the data gathering process it is necessary to gain permission from the Dean of the Health Science Department of the Holy Infant College Tacloban City, after approval has been granted, researchers will ask permission from the Municipal Mayor, Municipal Health Officer and to the Barangay Captains of selected Barangays of Alangalang, Leyte. The researchers will be distributing

questionnaires and the respondents will be encouraged to answer the questions honestly and will be treated with utmost confidentiality, after the questionnaires will be accomplished and the data needed are gathered, the data will be tallied and tabulated for data analysis and statistical treatment. Treatment and analysis of Data. To answer the first, second and fifth questions in the statement of the problem on the demographic profile of the respondents, barriers to prenatal check-up and their source of information, frequency count and to pre-natal care percentage will be used. The following formula will be utilized: P = f/N x 100 Where: P= percentage F= frequency N= total population To answer the fourth question in the statement of the problem, on the respondents degree of importance of pre-natal check-up, weighted mean will be utilized the formula that will be used is as follows:

WM = fx/N

Where: = sum of F= frequency X= weight of N= total population The interpretations scheme below will be used in Part IV: MEAN RANGE 3.26 - 4.00 2.51 - 3.25 1.76 - 2.50 1.00 1.75 QUALITATIVE INTERPRETATION Very important Important Less important Not important

CHAPTER 2 PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA This chapter presents, analyses, and interprets the collected data from the survey using guided questionnaires to the thirty seven (37) pregnant women in selected barangays of Alangalang, Leyte as our respondents. This includes Demographic Profile, Barriers to Prenatal Care, Degree of Compliance to Prenatal Care, Degree of Importance of Prenatal Care, Prenatal Care Providers. Researchers intended to obtain fifty (50) pregnant women to be the respondents of the study yet; we only come up with thirty seven (37) respondents from selected barangays of Alangalang, Leyte because during the proper survey some of them had gave birth. DEMOGRAPHIC PROFILE OF THE RESPONDENTS The following profiles were considered in this study: age; educational background; economic status: occupation, family monthly income; religion; and obstetrical profile: gravida, term, para, abortion, living child, last menstrual period and age of gestation (AOG). The demographic characteristics are considered in this study for two reasons: one is for profiling purposes, which would provide clearer picture of the respondents; and these profile variables could be the possible factors which would be considered as barriers to prenatal care. This means that these profile

variables may be related to the extent to which pregnant women comply with prenatal care practices. Wong, et.al. (2002). Risk factor in pregnancy according to age is under 18 or more than 35. (Reyala & et al., Public Health Nursing in the Philippines, 2007) TABLE 1.1 Demographic Profile: Age Age 12 20 21 25 26 30 31 35 36 40 Above 40 TOTAL Frequency 5 17 9 5 1 0 37 Percent 13.51 45.94 24.32 13.51 2.70 0 100.00

Table 1.1 reveals that out of thirty seven (37) respondent pregnant women, majority seventeen (17) or 46% are aged 21 25 pregnant women, nine or 24.3% aging 25 30, both pregnant women aging 12 20 and 31 35 were five (5) or 13.5% are at aged 36 40 and there are no pregnant women aging forty one (41) and above. This implies that most adolescents engaged in pregnancy because the fertility peaks from age 21 to 25 and begins to decline at the age of 30s. The age of the childbearing women may have a significant influence on their physical and psychosocial adaptation to pregnancy. Normal developmental processes that occur in both very young and older mothers are interrupted by

pregnancy than that of the woman of typical childbearing age. Although the individuality of each pregnant woman is recognize, special needs of expectant mothers aged 15 years or younger or those aged 35 years or older. (Hatfield, 2006). Complications during pregnancy are more common when women reach age 35. (www.webmd.com/baby/pregnancy) TABLE 1.2 Educational Backgrounds Education Elementary level Elementary Graduate High school level High school graduate College level College graduate TOTAL Frequency 2 4 9 18 2 2 37 Percent 5.41 10.81 24.32 48.65 5.41 5.41 100.00

In terms of educational background, the respondents have generally acquired of at least elementary level. The table shows that the educational attainment of the respondents ranges from elementary level to college graduate. Among the respondents majority of them are high school graduates (48.65%), followed by the high school level (24.32%), then elementary graduate (10.81%), the rest (5.41%) reached elementary level, college level and college graduate respectively.

This implies that there are more pregnant women reach only high school level since most of them engaged with intimate relationship that would result to early pregnancy. According to the United States Department of Health and human Services (2000), teenage mothers are less likely to get or stay married, less likely to complete high school or college, and more likely to require public assistance and to live in poverty than their peer who are not mothers. (Hatfield, 2006) Demographic risk factors reported by the Institute of Medicine (1988) and the majority of the studies conducted on barriers to prenatal care include women with the following characteristics: (a) less than 150% of the federal poverty level, (b) non-white race, and (c) less than high school education. (Alexander & Korenbrot, 1995). TABLE 1.3 Demographic Profile: Religion Religion Roman Catholic Seventh Day Adventist Latter Day Saints (Mormons) Protestant Iglesia ni Cristo Born Again Christian TOTAL Frequency 36 0 0 0 0 1 37 Percent 97.30 0 0 0 0 2.70 100.00

The table clearly indicates that majority of the respondents are Roman Catholic which consisted thirty-six (36) or 97.30% and there is only one (1) or 2.70% respondent who is a Born Again Christian. This implies that Philippines is a dominant Christian country in Asia and majority of its people are Roman Catholics. TABLE 1.4 Demographic Profile: Occupation Occupation Housewife Self-employed Private employee TOTAL Frequency 34 1 2 37 Percent 91.89 2.70 5.41 100.00

Table shows the occupation distribution of the respondents. It reflects that most of the respondents are housewives thirty-four 34 or 91.89%, and then there were a private employee two (2) or 5.41% and one (1) or 2.70% is a selfemployed. This implies that being housewives connote that these mothers have no other occupation and are just full time housewives whose work are focused on babysitting and doing all the household chores. Families with these housewives solely rely their livelihood on husbands income. Every housewife should engage to livelihood activities to augment family income. To alter daily routine like babysitting and doing household chores she

must do diversional activities to obtain additional family income like having sarisari store. TABLE 1.5 Demographic Profile: Family Income Income 500 1,000 2,000 5,000 6,000 10,000 Above 10,000 TOTAL Frequency 16 12 8 1 37 Percent 43.24 32.43 21.62 2.70 100.00

Table 1.5 shows the monthly income of respondents family. In terms of income profile of the respondents, majority of them have families with gross income of 500 1,000 pesos per month. This consists of 43.24% of the respondents. Twelve (12) or 32.42% of them have gross monthly income of 2,000 5,000, followed by eight (8) or 21.62% of respondents with a gross monthly income of 6,000 10,000 and only one (1) or 2.70% with a monthly income of 10,000 and above. This implies that in considering the present prices of commodities and based on the socio-economic index, these families have income that is considered to be below poverty levels. Vulnerable childbearing women, in general, are defined as being low socioeconomic status or any woman who is not empowered or is in disenfranchised position. Socioeconomic status is one of the

most powerful risk factor for poor health outcomes, with poverty consistently being associated with insufficient prenatal care. (Simpson, 1995) In order to enhance family income head of the family should employ to any job with a sufficient profits to sustain the family needs. Gravida Is a term reflecting the number of pregnancies, regardless of duration or outcomes. A client who is pregnant for the first time thus is a Gravida 1, a client experiencing her second pregnancy is a Gravida 2, and so on. Sometimes, the Gravida 1 client is referred to as Primigravida, meaning, literally that this is her first pregnancy (Wong, et.al 2002). TABLE 1.6 Demographic Profile: Obstetrical Data (Gravida) Gravida 1 2 3 4 5 6 7 TOTAL Frequency 13 14 5 3 0 1 1 37 Percent 35.14 37.84 13.51 8.11 0 2.70 2.70 100.00

As shown in the table, the number of pregnancies range from one to seven, fourteen (14) or 37.84% had their second pregnancy, thirteen (13) or 35.14% is a primi gravida, five (5) or 13.51% had their third pregnancy, then

three (3) or 8.11% had had their fourth pregnancy and one respondent each for sixth and seventh pregnancies. The result showed that the average number of pregnancies of the thirty-seven (37) respondents was two (2). This implies that majority of our respondents experienced previous pregnancy or had their second pregnancy wherein they are more open to their pregnancy, followed by the pregnant for the first time, they are most likely have inadequate knowledge about pregnancy. Some of them even admitted that they dont know they are pregnant already because they dont have adequate knowledge about the signs and symptoms of pregnancy and some of them try to hide their pregnancy especially those teenage pregnancy and they does not submit for prenatal check-up. Delayed entry to prenatal care has been associated with adverse outcomes for infant and the mother like increased risk of prematurity, low birth weight and infant and maternal mortality (Dietz, 1997) Every woman should have adequate information about the signs and symptoms of pregnancy for them to know when to submit for prenatal care. Para Is the number of births after 20 weeks gestation, whether live births or stillbirths. Additionally the term para, when expressed as a single number, does not reflect the number of infants born at the delivery but rather the number of pregnancies that have gone past 20 weeks gestation. Thus, the client who has had only one pregnancy and gave birth to term twins could be considered a Para

1 (one birth past 20 weeks gestation), Gravida 1 (reflecting her only pregnancy to date) (Littleton, 2002). TABLE 1.7 Demographic Profile: Obstetrical Data (Para) Para 0 1 2 3 4 5 TOTAL Frequency 15 13 4 2 1 2 37 Percent 40.54 35.14 10.81 5.41 2.70 5.41 100.00

The table reveals that fifteen (15) or 40.54% of the respondents are nulliparous (number of first time pregnancies) and the least is one or (1) or 2.70% had delivered for four (4) times. This implies that majority of the respondents did not gave birth yet. Rahman, et al., (1997) pointed out that antenatal visit is positively associated with parity. Authors argued that women with higher parity understand that they are at higher risk of pregnancy-related complications, and more likely to receive antenatal care visits. Abortion

Any interruption of a pregnancy before the fetus is viable (a stage of development that will enable the fetus to survive outside the uterus if born at that time) (Pilliteri, 2007). TABLE 1.8 Demographic Profile: Obstetrical Data (Abortion) Frequency () 2

Abortion

The table reflects that out of thirty-seven (37) respondents two claimed for having previous abortion. This implies that base on the statistical study of the Center for Bio-Ethical Reform the result showed that the number of abortion per year is approximately 42 million and the number of abortions per year is approximately 115,000 worldwide. Their study also reveals that 83% of all abortions are obtained in developing countries and 17% occur in developed countries (Abortionno.org). If a woman is responsible enough to have sex, then she should be responsible enough to think of the consequences and do the right thing. Health advocates should educate about healthy pregnancy. Age of Gestation Gestational age, or the age of the baby, is calculated from the first day of the mother's last menstrual period. Since the exact date of conception is almost

never known, the first day of the last menstrual period is used to measure how old the baby is.

TABLE 1.9 Demographic Profile: Obstetrical Data (AOG) AOG in Months 1 4 months 6 months 8 months 9 months TOTAL Frequency 18 8 4 7 37 Percent 48.65 21.62 10.81 18.92 100.00

It shown from the table that most of our respondents eighteen (18) or 48.65% are pregnant for 1 4 months. Few of them are in their 8 months of pregnancy. This implies that as of first trimester is marked by an invisible yet an amazing transformation. Hormones trigger the body to begin nourishing the baby even before tests and a physical exam that can confirm the pregnancy. Knowing what physical and emotional changes to expect during the first trimester can help to face the months ahead with confidence. Bodily and hormonal changes happen that affects almost every organ in the body. Pregnant women might need to make changes in daily routine such as going to bed earlier, eating small frequent meals, avoidance of exposure to teratogens because it can cause harm to an unborn or breastfeeding baby, it can

be alcohol, tobacco use, prescription/nonprescription medications, illegal drugs, vaccines, illnesses, environmental exposures, occupational exposures, or maternal autoimmune disorder.

RESPONDENTS BARRIERS TO PRENATAL CARE According to Noah Chalfin for many women entering pregnancy, their initial excitement is often confronted by the secondary anxiety raised by wanting to do it right. Most moms-to-be know not to use drugs, drink alcohol or smokes cigarettes while theyre pregnant. But despite of this fact, still there are pregnant women who dont seek prenatal care because of many factors with regards to environmental hazards. TABLE 2.1 Barriers to Prenatal Care: Environmental Factors

1. House is too far from RHU/BHS. 2. Less access of transportation/vehicle. 3. Long clinic waits. 4. Language barriers

YES % 9 24.32 4 10.81 8 5 21.62 13.51

NO % 28 75.68 33 89.19 29 32 78.38 86.49

TOTAL % 37 100.00 37 100.00 37 37 100.00 100.00

Table shows that majority of respondents does not consider above environmental factors as barriers to prenatal care. It gives the impression that majority of the respondents has an accessible transportation to the nearest

barangay health station with the high percentage of 89.19% or 33 and the least percentage of 75.68% or 28 respondents answered that distance of their houses is one of the factor that seems to be one of the barriers to prenatal care. This implies that access to health service is an important factor influencing their health status. However, womens health also suffers from the factors that constraint their access to health service. As in the case of all resources, access to health service is a function of both of the resources at the overall disposal of the society or community, as well as its distribution across social groups and individuals. Within a given social setting and a given of availability of health services, an individuals access to services may be determined by factors such as distance, availability, affordability, and appropriateness and adequacy of services perceived by users (McCarthy and Maine, 1992). They are advised to seek prenatal care despite of the distance or location of the health care services to promote fetal and maternal health. TABLE 2.2 Barriers to Prenatal Care: Socio-economic Factors YES % 4 10.81 10 6 27.03 16.22 NO % 33 89.19 27 31 72.97 83.78 TOTAL % 37 100.00 37 100.00 37 100.00

1. Difficult access to prenatal care providers. 2. Taking time away from work to attend daytime clinic appointments. 3. Inadequate finances in fare for transportation.

Table reveals that most of the respondents thirty-three (33) or 89.19% didnt acknowledge above socio-economic factors as barriers to prenatal care. While, other respondents highest of ten (10) or 27.03% consider difficulty in

taking time away from work to attend daytime clinic appointments for prenatal care services. This implies that accessibility is a much broader concept than physical distance. The physical distance imposes another cost to the consumer, that is opportunity cost of time spent on obtaining these services and accessibility of health service in terms of location, distance is very important in the use of reproductive service (Shariff and Singh, 2000). Seeking prenatal care is a beneficial factor to the mother and to the child. Through prenatal care, risk to the mother or infant is prevented, detected, and managed complications early before they become life-threatening emergencies therefore, cost is minimized. Antenatal care is an opportunity to inform woman. It is suggested for the pregnant women should prioritize and set time to attend day time clinic appointments for prenatal care.

TABLE 2.3 Barriers to Prenatal Care: Psychological Factors YES % 5 13.51 6 11 3 1 16.22 29.73 8.11 2.70 NO % 32 86.49 31 26 34 36 83.78 70.27 91.89 97.30 TOTAL % 37 100.00 37 100.00 37 100.00 37 100.00 37 100.00

1. Problems in accepting or acknowledging pregnancy. 2. Presence of depression or extreme stress. 3. Attitude of a woman about her pregnancy. 4. Fears related to medical procedure e.g. leopolds maneuver. 5. Negative attitude or perception towards prenatal care or prenatal visit.

The table illustrates that among the respondents with the peak of thirtysix (36) or 97.30% stated that negative attitude or perception towards pregnancy is not a barrier in obtaining prenatal care services , her pregnancy do affect behavior to seek for prenatal care. It implies that prenatal care had significantly lower death rate compared to those with no prenatal care. Moreover, the results showed that some other factors affect death rates of infants and children such as mothers level of education and perception about her pregnancy. A study of Maternal Health in Mali, Clemmons and Coulibali (1999) identified that women and men were not well aware of the risk and dangers associated with pregnancy and child birth, however they were worried about the outcomes. An adequate knowledge of health care seeking behavior of women during the entire reproductive process can facilitate the management of maternal health service (Bhatia and Cleland, 1995). TABLE 2.4 Barriers to Prenatal Care: Social Factors YES % 1 2.70 1 9 3 8 2.70 24.32 8.11 21.62 NO % 36 97.30 36 28 34 29 97.30 75.68 91.89 78.38 TOTAL % 37 100.00 37 37 37 37 100.00 100.00 100.00 100.00 while other respondents of eleven (11) or 29.73% confirmed that attitude of a woman about

1. Negative attitude towards RHM/PHN. 2. Shy to discuss about reproductive health problems which postpones health seeking. 3. Role of kin influenced health care choices. 4. Number of children. 5. Years of marriage.

The table reveals that respondents who confirmed above social factors as barriers in obtaining prenatal care are lesser than those who refute it. Most of those who confirmed that role of kin can influence their health care choices were nine (9) or 24.32%. The table implies that most of the respondents rarely claims that negative attitudes of the RHM/PHN are barrier to complying prenatal visit. They are freely comfortable discussing discussing reproductivity health problems. However, theyre decisions relating their health care choices are mostly influenced by their kins. It is suggested that emotional assistance and fiscal assistance from significant others are important motivators in obtaining prenatal care for low income women. Without this encouragement, women may not obtain the care they need (Curry, 1990). TABLE 2.5 Barriers to Prenatal Care: Cultural Factors YES % 24.32 48.65 45.95 32.43 NO % 75.68 51.35 54.05 67.57 TOTAL % 37 100.00 37 100.00 37 100.00 37 100.00

1. Ethnicity of the clinic staff and care provider. 2. Uses traditional remedies or folks beliefs about pregnancy. 3. Having beliefs regarding the optional amount of food to be taken during pregnancy for a successful outcome. 4. Perform rituals like offering new clothes and various types of foods.

9 18 17 12

28 19 20 25

The table shows that most of the respondents use traditional beliefs or folks beliefs during their pregnancy with the high percentage of 48.65% or eighteen (18) and with the least percentage of 24.32% or nine (9). It implies that traditional belief and cultural practice are common to community that may contribute to the variability in the use of health services. Women in some cultures may not use antenatal care because they perceived that the modern health sector is intended for the service only. Women sometimes may feel shy to discuss their reproductive health problems with their husbands and senior members of the household, and postpone care seeking until it is too late (WHO, 2001). Health care providers should health educate pregnant women in terms of beliefs regarding pregnancy. Unless the belief cannot harm the pregnant women and its child health care providers do not need to correct it.

RESPONDENTS DEGREE OF COMPLIANCE TO PRENATAL CARE Every women has to visit the nearest health facility for antenatal registration and to avail prenatal care services. This is the only way to guide her in pregnancy care to make her prepare for child birth. Pregnant women should have at least four (4) prenatal visits with time for adequate evaluation and management of diseases and conditions that may put the pregnancy at risk, it reduces womens exposure to health risk (Reyala & et al., Public Health Nursing in the Philippines, 2007).

TABLE 3.1 Degree of Compliance to Prenatal Care: Prenatal Visit YES % 1. Visit the clinic or hospital as scheduled. 1.1 First visit before 4 months 1.2 Second visit 6 months 1.3 Third visit 8 months 1.4 Fourth visit 9 months TOTAL 15 6 2 5 28 83.33 75 50 71.43 75.67 NO % 3 2 2 2 9 16.67 25 50 28.57 24.32 TOTAL % 18 100.00 8 4 7 37 100.00 100.00 100.00 100.00

This table indicates that the degrees of compliance to prenatal care of pregnant women are increased during the first visit with high percentage of 83.33% or fifteen (15). This implies that most of the respondents are ranging from 1 4 months pregnant, discomforts such as nausea and vomiting, feeling sick in the morning that happens in this period. Nausea and vomiting is another subjective sign that can appear after the missed period and continue into the fourth month of pregnancy. Adequate prenatal care begins in the first trimester and continues on a regular schedule until delivery. Lack of adequate prenatal care is associated with poor pregnancy outcomes, including high rates of infant and neonatal death, premature birth, birth defects, maternal death, and birth complications (Brann, 1981).

Magadi, et al., (2000) further pointed out that there is a strong association between the level of antenatal care and delivery care. It suggests that the use of antenatal care visits, especially adequate antenatal care visits is an important factor for safety outcomes. TABLE 3.2 Degree of Compliance to Prenatal Care: Importance of Prenatal Care YES % 94.59 100.00 91.89 100.00 91.89 86.49 78.38 86.49 NO % 5.41 0 8.11 0 8.11 13.51 21.62 13.51 TOTAL % 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00

1. Daily intake of iron and folate as prescribed by the doctor. 2. Eating nutritious foods and drinks. 3. Enough rest and sleep. 4. Adapt proper personal hygiene like daily taking a bath, tooth brushing, daily bowel movement, etc. 5. Perform daily exercise like walking, doing light household chores, etc. 6. Avoidance of alcoholic beverages and cigarettes. 7. Avoidance in exposure to crowded places. 8. No prenatal check-up may lead to development of complications in pregnancy and delivery.

35 37 34 37 34 32 29 32

2 0 3 0 3 5 8 5

37 37 37 37 37 37 37 37

As reflected in Table 3.2, majority of the respondents believes that both Eating nutritious foods and drinks and Adapting personal hygiene like daily bathing, tooth brushing, daily bowel movement,etc. are considered.

This implies that although a good diet cannot guarantee a good pregnancy outcome, it makes an important contribution. A poor diet, such as one deficient in folic acid, is associated with birth anomalies such as neural tube defects. Both the nutritional state that a woman brings into pregnancy has a direct bearing on her health and on fetal growth and development (Pilliteri, 2007). The health of a fetus and the health of the mother are inextricably linked. Generally, a woman eats well and takes care of her own health during pregnancy provides a healthy environment for fetal growth and development. However, she may need instructions of exactly what constitutes a healthy lifestyle for herself and for her baby. Most women have questions regarding how much extra rest they need, what type of exercise they can continue, and whether all the changes going within their bodies, some of which bring them daily discomfort, are normal. Therefore, a major role in promoting maternal and fetal health is education (Pilliteri, 2007). Proper nutrition during pregnancy can help in preventing some of the problems posed by multiple pregnancies. Some tips to improve nutrition and weight gain is eating regularly and more often in a small frequent feeding, take in more fiber to avoid constipation, and choose healthier snacks (Eating right, March - April 2011).

During pregnancy your body experiences dramatic physiological changes that require a carefully designed exercise program. These naturally occurring changes are not permanent, and the benefits of regular exercise are many. Always check with your health care provider for any limitations on your activity before attempting any exercises. (http://www.babies.sutterhealth.org/

during/preg_exercise.html) RESPONDENTS DEGREE OF IMPORTANCE TO PRENATAL CARE Prenatal care, essential for ensuring the overall health of newborns and their mothers, is a major strategy for helping to reduce the number of low birth weight babies born yearly (Wessel, 2003). Idealy, prenatal care begins during the mothers childhood. It includes balanced nutrition with adequate intake of calcium and vitamin D during infancy and childhood to prevent rickets (which can distort pelvic size); adequate immunizations against contagious diseases for protection against viral diseases such as rubella during pregnancy: and a healthy diet to ensure the best stateof health possible for a woman and her partner when entering pregnancy. Woman who maintain a healthy lifestyle come to a first prenatal visit prepared to follow health promotion strategies (Pilliteri, 2007).

TABLE 4.1 Degree of Importance of Prenatal Care: Services Performed During First Visit Indicators 1. History taking and physical examination serves as baseline data. 1.1. Checking of BP. 1.2. Weighing. 1.3. Checking of palms of the hands and eyes for pallor. 1.4. Examination of neck for thyroid gland enlargement/goiter. 1.5 Examination of breast. 2. Laboratory examinations: 2.1 Blood test for blood typing. 2.1.1 Complete blood count. 2.1.2 Hepa B surface antigen 2.2 Urine test: 2.2.1 Sugar test and protein test as sign of diabetes and kidney changes. 2.3 Pap smear done to detect changes in the cervix that could be forerunners to cancer. 3. Treatment of the disease if any. 4. Giving Iron supplementation. 5. Dental care. 6. Give healthy instruction and counselling. AGGREGATE MEAN Mean Score 3.43 3.57 3.57 3.43 3.16 3.30 3.54 3.38 3.54 3.54 3.54 3.62 3.57 3.49 3.57 3.48 Interpretation Very important Very important Very important Very important Important Very important Very important Very important Very important Very important Very important Very Very Very Very Very important important important important important

It can be gleaned from the table that the respondents that the services rendered during the first visit Treatment of disease if any got a mean score of 3.62 and interpreted as very important and the lowest is in the service

Examination of neck for thyroid gland enlargement/goiter indicated by the mean score level of 3.16 interpreted as important. This implies that this services and tests are performed during the first visit. Women should seek prenatal care as soon as they discover that they are pregnant. By starting prenatal care during the first three months of pregnancy, a woman increases her chances of having a safe, healthy pregnancy. Prenatal care consists of regular examinations to check the expectant mother's blood pressure, weight, changes in the size of the uterus, and to check the urine for signs of infection or too much sugar. It also includes monitoring the baby's heartbeat, checking the baby's growth, and determining the baby's position during the last trimester. Prenatal care also includes counseling about the nutritional requirements of pregnancy, preparation for labor and delivery, and the care of the newborn (http://www.nj.gov/health/fhs/prenatal

/prenatalcare.shtml). Prenatal care is very important because during the period when the infant is in-utero, a diagnosis of disease and developmental defects can be made.

TABLE 4.2 Degree of Importance to Prenatal Care: Subsequent Visit Indicators 1. Measuring BP. 2. Measuring weight to make sure the expectant mother is gaining enough. 3. Tetanus Toxoid immunization. 4. Abdominal examination: 4.1 Measuring the fundic height. 4.2 Checking the size and position of the uterus and fetus. 4.3 Listening to the fetal heartbeat. 4.4 Fetal presentation. 5. Assessing the face, hand, and lower extremities for edema. 6. Collection of urine sample to continue to check for sugar and protein. 7. Monitoring mothers diet. 8. The doctor also perform various type of tests to check the fetus for birth defects. 9. Insufficient weight gain and increase blood pressure, if gone untreated can be harmful to the fetus. 10. Some abnormalities, if detected prenatally, can be treated in utero (before the baby is born). 11. Early detection can allow the proper medical facility to be present at the time of birth to allow the baby full access to the health it needs. 12. Giving proper referral to the next higher level when applicable. 13. Health education and counselling. AGGREGATE MEAN Mean Score 3.51 3.48 3.64 3.62 3.56 3.56 3.67 3.45 3.37 3.48 3.45 3.48 3.37 3.54 Interpretation Very important Very important Very important Very important Very important Very important Very important Very important Very important Very important Very important Very important Very important Very important

3.54 3.59 3.52

Very important Very important Very important

This study shows that fetal presentation has the highest mean score of 3.67 and the lowest mean score goes to the statement collecting urine sample

and some abnormalities, if detected prenatally, can be treated in utero as indicated by the mean score level of 3.37. As a whole, all respondents considered very important services performed during subsequent prenatal visit towards the degree of importance of prenatal care which indicated an aggregate mean of 3.52. This implies that these services are being rendered during the subsequent visit. Prenatal care is an important part of a healthy pregnancy. As your pregnancy progresses, you'll continue to visit your health care provider regularly, probably once a month throughout the second trimester. Here's what to expect at your second-trimester prenatal appointments (http://www.mayoclinic

.com/health/prenatal-care/PR00093). Prenatal care services that rendered in subsequent visit are much more important as the services performed by the prenatal care providers during the first visit. In order to obtain the overall fetal and maternal health, pregnant women must solely engage to prenatal care programs. Antenatal care is an opportunity to inform woman about the danger signs and symptoms for which assistance should be slough from a health care provider without delay. One of the most important functions of antenatal care is to offer the women advice and information about the appropriate place of delivery given her own particular circumstances and health status (WHO, 1996).

RESPONDENTS PRENATAL CARE PROVIDERS All women expecting a baby need prenatal care. Prenatal care can be provided by a doctor, midwife or other health care professional. The progress of a pregnancy and to identify potential problems before they become serious for either mom or baby is the reason you need prenatal care. You as the mother will benefit from prenatal care. Women who receive appropriate prenatal care generally have healthier babies and are less likely to deliver prematurely. The chance of having serious problems related to pregnancy is also decreased with appropriate prenatal care. (http://www.selfgrowth.com/articles/The_Importance_of_Prenatal_Care_and_W hat_to_Expect.html)

TABLE 5 Prenatal Care Providers 1. Health workers: 1.1 Doctor 1.2 Public Health Nurse 1.3 Rural Health Midwife 1.2 Barangay Health Workers 2. Traditional Birth Attendant 5 6 31 10 11 % 13.51 16.22 83.78 27.03 29.73

Majority of pregnant women submit their prenatal care to the Rural Health Midwife with 83.78% or 31 and least submit to the doctor with 13.51% or 5. This implies that Midwives provide midwifery services in the barangay. Gives direct care to normal child bearing women during pregnancy until the end of puerperium as well as to normal newborn infants. Many researchers explained that relationship between client and provider is important to promote optimal health service utilization. Health care provider especially nurses can help the nation to achieve health goals in speaking directly to the importance of prenatal care through educating women and their families about the importance of prenatal care and by making sites of prenatal care receptive to women and families.

CHAPTER 3 SUMMARY, FINDINGS AND CONCLUSIONS This chapter presents the summary, findings and conclusions of the study. SUMMARY Generally, the study determined the barriers to prenatal care among pregnant women in selected barangays of Alangalang, Leyte: Basis for Recommendation. Specifically, this study answered the following questions: 1. What is the demographic profile of each respondent in terms of; 1.1 age; 1.2 civil status; 1.3 educational attainment; 1.4 economic status: 1.4.1 occupation; 1.4.2 family monthly income; 1.5 religion; 1.6 obstetrical profile; 1.6.1 gravida;

1.6.2 term; 1.6.3 para; 1.6.4 abortion; 1.6.5 living child; 1.6.5 last menstrual period (AOG)? 2. What are the barriers of prenatal care as perceived by the respondents: 2.1 environmental factors 2.2 socio-economic factors 2.3 psychological factors; 2.4 social factors; 2.5 cultural factors? 3. What is the degree of respondents compliance to prenatal visit? 4. What is the degree of importance to prenatal visit as perceived by the respondents? 5. Who are the prenatal care providers of the respondents? 6. What recommendation can be derived from the results of the study? This study utilize a descriptive method of research using a researchers self made questionnaire as an instrument to gather data from thirty seven (37) respondents of selected barangays of Alangalang, Leyte.

FINDINGS After careful analysis of the data gathered, the researchers generated the following findings: 1. Demographic Profile 1.1 Age Out of thirty seven (37) respondent pregnant women, majority seventeen (17) or 46% are aged 21 25 pregnant women, nine or 24.3% aging 25 30, both pregnant women aging 12 20 and 31 35 were five (5) or 13.5% are at aged 36 40 and there are no pregnant women aging forty one (41) and above. 1.2 Educational Background Educational attainment of the respondents ranges from elementary level to college graduate. Among the respondents majority of them are high school graduates (48.65%), followed by the high school level (24.32%), then elementary graduate (10.81%), the rest (5.41%) reached elementary level, college level and college graduate respectively.

1.3 Religion

Majority of the respondents are Roman Catholic which consisted thirty-six (36) or 97.30% and there is only one (1) or 2.70% respondent who is a Born Again Christian. 1.4 Occupation Most of the respondents are housewives thirty-four 34 or 91.89%, and then there were a private employee two (2) or 5.41% and one (1) or 2.70% is a self-employed. 1.5 Family Income Majority of the respondents have families with gross income of 500 1,000 pesos per month. This consists of 43.24% of the respondents. Twelve (12) or 32.42% of them have gross monthly income of 2,000 5,000, followed by eight (8) or 21.62% of respondents with a gross monthly income of 6,000 10,000 and only one (1) or 2.70% with a monthly income of 10,000 and above. 1.6 Gravida The number of pregnancies range from one to seven, fourteen (14) or 37.84% had their second pregnancy, thirteen (13) or 35.14% is a primi gravida, five (5) or 13.51% had their third pregnancy, then three (3) or 8.11% had had their fourth pregnancy and one respondent each for sixth and seventh pregnancies. The result showed that the average number of pregnancies of the thirty-seven (37) respondents was two (2).

1.7 Para Fifteen (15) or 40.54% of the respondents are nulliparous (number of first time pregnancies) and the least is one or (1) or 2.70% had delivered for four (4) times. 1.8 Abortion Out of thirty-seven (37) respondents two claimed for having previous abortion. 1.9 Age of Gestation Most of our respondents eighteen (18) or 48.65% are pregnant for 1 4 months. Few of them are in their 8 months of pregnancy. 2. Barriers to Prenatal Care 2.1 Environmental Factors Majority of respondents does not consider above environmental factors as barriers to prenatal care. It gives the impression that majority of the respondents has an accessible transportation to the nearest barangay health station with the high percentage of 89.19% or 33 and the least percentage of 75.68% or 28 respondents answered that distance of their houses is one of the factor that seems to be one of the barriers to prenatal care. 2.2 Socio-economic Factors

Most of the respondents thirty-three (33) or 89.19% didnt acknowledge above socio-economic factors as barriers to prenatal care. While, other respondents highest of ten (10) or 27.03% consider difficulty in taking time away from work to attend daytime clinic appointments for prenatal care services. 2.3 Psychological Factors Among the respondents with the peak of thirty-six (36) or 97.30% stated that negative attitude or perception towards pregnancy is not a barrier in obtaining prenatal care services , while other respondents of eleven (11) or 29.73% confirmed that attitude of a woman about her pregnancy do affect behavior to seek for prenatal care. 2.4 Social Factors Respondents who confirmed above social factors as barriers in obtaining prenatal care are lesser than those who refute it. Most of those who confirmed that role of kin can influence their health care choices were nine (9) or 24.32%. 2.5 Cultural Factors Most of the respondents use traditional beliefs or folks beliefs during their pregnancy with the high percentage of 48.65% or eighteen (18) and with the least percentage of 24.32% or nine (9). 3. Degree of Compliance to Prenatal Care 3.1 Prenatal Visit The degrees of compliance to prenatal care of pregnant women are increased during the first visit with high percentage of 83.33% or fifteen (15).

3.2 Importance of Prenatal Care Majority of the respondents believes that both Eating nutritious foods and drinks and Adapting personal hygiene like daily bathing, tooth brushing, daily bowel movement,etc. are considered. 4. Degree of Importance to Prenatal Care 4.1 Services performed during First Visit The respondents that the services rendered during the first visit Treatment of disease if any got a mean score of 3.62 and interpreted as very important and the lowest is in the service Examination of neck for thyroid gland enlargement/goiter indicated by the mean score level of 3.16 interpreted as important. 4.2 Subsequent Visit Fetal presentation has the highest mean score of 3.67 and the lowest mean score goes to the statement collecting urine sample and some abnormalities, if detected prenatally, can be treated in utero as indicated by the mean score level of 3.37. 5. Prenatal Care Providers Majority of pregnant women submit their prenatal care to the Rural Health Midwife with 83.78% or 31 and least submit to the doctor with 13.51% or 5.

CONCLUSIONS The following conclusions were logically derived from the findings of the study: 1. Majority of the respondents are aging 21-25, with less educational background, plain housewives, have very low monthly family income, dominantly Roman Catholic, with an obstetrical data of gravida majority of 2, para 0 or havent gave birth yet, abortion 2 and AOG in months majority are pregnant for 1 4 months. 2. Respondents considered distance to the RHU/BHS, taking time away from work to attend day time clinic appointments, attitude towards her pregnancy, role of kin in influencing health care choices and traditional remedies or folks beliefs about pregnancy are barriers for seeking prenatal care. It is therefore concluded that many factors affects in obtaining prenatal care services. The use of antenatal care services is highly influenced by the antennal care seeking behavior of women which is highly influenced by environmental factors, socioeconomic factors, psychological factors, social factors, and cultural factors. 3. Most of the respondents are ranging from 1 4 months pregnant. They consider good diet through eating nutritious food, exercise and performing personal hygiene as an important factor that guarantees good pregnancy outcome and makes an important contribution health of the pregnant women and child. It is therefore concluded that pregnant women in these stage are

vulnerable to teratogenic factors since they least likely consider alcoholic beverages consumption, cigarette smoking and avoidance to crowded place as a health threat to pregnancy. They also doesnt believe that poor antenatal care may lead to development of complications in pregnancy and delivery. Major role in promoting maternal and fetal health is education. 4. Respondents considered very important prenatal care services done for the entire visit is an important part of a healthy pregnancy.. By starting prenatal care during the first three months of pregnancy, a woman increases her chances of having a safe, healthy pregnancy. As your pregnancy progresses, you'll continue to visit your health care provider regularly, probably once a month throughout the second trimester. Here's what to expect at your second-trimester prenatal appointments, it is therefore concluded that every women should seek prenatal care as soon as they discover that they are pregnant. 5. Midwives provide midwifery services in the barangay and in the Rural Health Units. Gives direct care to normal child bearing women during pregnancy until the end of puerperium as well as to normal newborn infants, it is therefore concluded that midwives has a significant role in providing prenatal care services to the pregnant women from selected barangay of Alang alang Leyte. RECOMMENDATIONS Based on the conclusions taken from this study the following

recommendations are proposed:

1. Pregnant women should be prepared enough for childbirth and parenting. She must be physically, emotionally and intellectually matured, financially prepared in order to cope up changes that occur in the entire pregnancy and to support the child she bears. In order to enhance family income head of the family should employ to any job with a sufficient profits to sustain the family needs. Every woman should have adequate information about the signs and symptoms of pregnancy for them to know when to submit for prenatal care. 2. Seeking prenatal care is a beneficial factor to the mother and to the child. Through prenatal care, risk to the mother or infant is prevented, detected, and managed complications early before they become life-threatening emergencies therefore, cost is minimized. Antenatal care is an opportunity to inform woman. They are advised to seek prenatal care despite of the distance or location of the health care services to promote fetal and maternal health. It is suggested for the pregnant women should prioritize and set time to attend day time clinic appointments for prenatal care. An adequate knowledge of health care seeking behavior of women during the entire reproductive process can facilitate the management of maternal health service. It is suggested that emotional assistance and fiscal assistance from significant others are important motivators in obtaining prenatal care for low income women. Without this encouragement, women may not obtain the care they need. Health care providers should health educate pregnant women in terms of beliefs regarding pregnancy. Unless the belief cannot harm the pregnant women and its child health care providers do not need to correct it. 3. Lack of adequate prenatal care is associated with poor pregnancy outcomes, including high rates of infant and neonatal death, premature birth, birth defects, maternal death, and birth complications. It is suggested that the use of antenatal

care visits, especially adequate antenatal care visits is an important factor for safety outcomes. Woman eats well and takes care of her own health during pregnancy provides a healthy environment for fetal growth and development, proper nutrition during pregnancy can help in preventing some of the problems and always check with your health care provider for any limitations on your activity before attempting any exercises, regular exercise has a lot of benefits to a pregnant woman. 4. Prenatal care is very important because during the period when the infant is in-utero, a diagnosis of disease and developmental defects can be made. Prenatal care services that rendered in subsequent visit are much more important as the services performed by the prenatal care providers during the first visit. In order to obtain the overall fetal and maternal health, pregnant women must solely engage to prenatal care programs. Antenatal care is an opportunity to inform woman about the danger signs and symptoms for which assistance should be slough from a health care provider without delay. One of the most important functions of antenatal care is to offer the women advice and information about the appropriate place of delivery given her own particular circumstances and health status. 5. Health care provider especially nurses can help the nation to achieve health goals in speaking directly to the importance of prenatal care through educating women and their families about the importance of prenatal care and by making sites of prenatal care receptive to women and families.

DEFINITION OF TERMS The following terms used in this study were herein conceptually and operationally defined for better perception of the study: Compliance to Prenatal Visit. As used in the study, degree of compliance are: very often complies, often complies, rarely complies and never complies to prenatal check-up. Degree of Importance. The extent of information acquired and understanding of the respondents towards prenatal check-up. Level of knowledge as used in the study are as follows: very important, important, less important and not impportant. Barriers to Prenatal Check-up. In this study, we are referring to environmental, socio-economic, psychological, social and cultural factors. Prenatal Care Providers. This pertains to the health workers: the Doctor, Public Health Nurse, Rural Health Midwife, and Barangay Health Workers; and Traditional Birth Attendants.

BIBLIOGRAPHY BOOKS Bhattacharya, D.C. Sociology. Calcutta: Vijoya Publishing House, 1992. B., K., G., E., & A., S. S. (2008). Fundamentals of Nursing 8th edition. Pearson Education, Inc., . DOH. (2009). Newborn Care until the First Week of Life. World Health Organization Press. Kozier, Erb, Synder, & Berman., a. (2008). Fundamentals of Nursing 8th edition. Pearson Education, Inc. McFarland., L. a. (2006). Cultural Care Diversity, 3rd edition. Pearson Education Inc. South Asia. Pilliteri, A. (2007). Maternal and Child Health Nursing. Philadelpia: Library of Congress Cataloging-in-Publication Data. Reyala, Cruz-Earnshaw, Bonito, & Serafica, S. &. (2007). Public Health Nursing in the Philippines. Qeuzon city: National League of Philippine Governement Nurses, Incorporated. Reyala, Nisce, Martinez, Hizon, Ruzol, Dequina, et al. (2000). Community Health

Nursing Services in the Philippines, 9th edition.

Venzon, L. M. (2010). Introduction to Nursing Research. 839 EDSA, South Triangle, Quezon City: C & E Publishing, Inc. JOURNALS Curry, M. A. (1990). Factors associated with inadequate prenatal care. Journal of Community Health Nursing. Johnson, J. L., Primas, P. J.,& coe, M. K.(1999). Factors that prevent women of low socioeconomic status from seeking prenatal care. Journal of the Academy of Nurse Practitioners.

Kogan, M. D.,Alexander, G. R., Kotelchuch, M., & Nagey, D. (1999).Relation of the content of prenatal care to the risk of low birth weight. Journal of the American Medical Association. Magadi M, Diamond I, Madise N: Analysis of factors associated with maternal mortality in Kenyan hospitals. Journal of biosocial science 2001. Ministry of Health (Nepal), New ERA, and ORC Macro: Nepal Demographic and Health Survey 2001. Calverton, Maryland, USA: Family Health Division, Ministry of Health; New ERA; and ORC Marco; 2002. Myer L, Harrison A: Why do women seek antenatal care late? Perspectives from rural South Africa. Journal of midwifery & women's health 2003. National Statistical Service [Armenia], Ministry of Health [Armenia] and ORC Macro: Armenia DHS 2000. Calverton, Maryland; 2001. Poland, M. L., Ager, J. W., & Olson, J. M. (2008). Barriers to receiving adequate

prenatal care. American Journal of Obstetrics and Gynecology.

Regional and Social Economic Trends, 2005. World Health Organization / SEARO: Making Pregnancy Safer. Delhi: WHO/SEARO; 2001. World Health Organization (WHO): Unsafe abortion - Global and regional 2004.

estimates of the incidence of unsafe abortion and associated mortality in 2004. 4th edition. Geneva: Word Health Organization;

UNPUBLISHED THESES Reynolds HW, Wong EL, Tucker H: Adolescents' use of maternal and child health services in developing countries. International family planning perspectives 2006. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Social science & medicine (1982) 1994.

ELECTRONIC SOURCES http://current nursing.com www.content.lib.utah.educ.com

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APPENDICES

Appendix A Letter to the Dean

February, 2012

ELNORA C. QUEBEC, RM, RN, MAN Dean of the Health and Sciences Department Holy Infant College, Tacloban, City Dear Madame, Greetings! The undersigned BSN 4th year students of Holy Infant College, Tacloban, City are conducting a research entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN OF SELECTED BARANGAYS OF ALANGALANG, LEYTE : BASIS FOR RECOMMENDATION, in partial fulfillment of the requirements in Nursing Research, for the degree of Bachelor of Science in Nursing. In this connection, the researchers would like to ask permission to please allow us to conduct a research study. We are hoping for your positive response in this matter. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Approved by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of the Health Sciences Department

Appendix B Transmittal Letter

February, 2012 HON. LORETO T. YU Municipal Mayor Thru: DR. EGIDIO E. CABALONA Municipal Health Officer Alangalang, Leyte Sir, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANGALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of Health Sciences Department Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix B-1 Transmittal Letter

February, 2012
HON. REYNALDO PEJA Barangay Captain Barangay DapDap, Alangalang Leyte Sir, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer

Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of Health Sciences Department

Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix B-2 Transmittal Letter

February, 2012

HON. ESMERALDO ALBERTO Barangay Captain Barangay Milagrosa, Alangalang Leyte Sir, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer

Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of Health Sciences Department

Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix B-3 Transmittal Letter

February, 2012 HON. REBECCA BALASANOS Barangay Captain Barangay Salvacion, Alangalang Leyte Maam, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer

Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of Health Sciences Department

Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix B-4 Transmittal Letter

February , 2012 HON. BETHSAIDA PULMA Barangay Captain Barangay San Antonio, Alangalang Leyte Maam, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer

Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM Dean of Health Sciences Department

Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix B-5 Transmittal Letter

February, 2012 HON. LOLITA PULMA Barangay Captain Barangay Lingayon, Alangalang Leyte Maam, Greetings! The undersigned are conducting research a study entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. In this connection, the researchers would like to ask permission from your good office to administer their survey questionnaires to the Barangay residents involved in the study. The respondents will be asked to answer the survey questionnaire and some questions during the interview. We would appreciate it very much if this request will be given favorable consideration. Thank you and God Bless Respectfully yours: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser Recommending Approval: Dr. Egidio E. Cabalona Municipal Health Officer

Concurred by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN,RM Dean of Health Sciences Department

Approved by: Hon. Loreto T. Yu Municipal Mayor

Appendix C Letter to the Respondents

February, 2012 Dear Respondents, Greetings! The undersigned are conducting a research entitled BARRIERS TO PRENATAL CARE AMONG PREGNANT WOMEN IN SELECTED BARANGAYS OF ALANG ALANG, LEYTE: BASIS FOR RECOMMENDATION. This questionnaire checklist will provide us with the necessary information needed for us to finish our study regarding the said topic. We are seeking for your cooperation and participation by answering the questions. Rest assured that your answers will be treated with outmost confidentiality. Thank you and God Bless! The Researchers: Renejaney Marie W. Arao Brent M. Cue Kim Dit Josephine C. Dueas Ma. Joan B. Empie Bay Ann B. Espejon Ysvette Reichardt Marie J. Jaya Isagani Pedro R. Viacrucis

Noted by: Mrs. Portia Lapidario, MAN, RN, RM Research Adviser

Approved by: Mrs. Elnora C. Quebec, MAN, CHPeD, RN, RM DEAN, Health Sciences Department

Appendix D BARRIERS TO PRE-NATAL CARE AMONG PREGNANT WOMEN OF SELECTED BARANGAY OF ALANGALANG, LEYTE: BASIS FOR RECOMMENDATION QUESTIONNAIRE

PART I: PROFILE OF RESPONDENT A. Demographic Profile 1. Name(Ngaran): _____________________________________ ( Optional ) 2. Age(Edad):

(alayun paki-check ha linya kun hain natungod an imo edad)

___ 12 20 ___ 31 35 3. Educational Background ___ 21 25 ___ 36 40 ___ 26 30 ___ 41 & above

(alayun paki-check ha linya kun anu an imo natapos)

___ Elementary Level ___ High School Level ___ College Level ___ Elementary Graduate ___ High School Graduate ___ College Graduate ___ Others (Specify)

4. Economic Status 4.1 Occupation(Trabaho): ____________________ 4.2. Family Monthly Income

(pira an kada bulan niyo nga sweldo)

___ 500 1,000 ___ 2,000 5,000

___ 6,000 10,000 ___ Above 10,000

5. Religion

(alayun paki-check kun anu it imo relihiyon)

___ Roman Catholic ___ Adventist ___ Mormon 6. Obstetrical profile ___ Protestant ___ Iglesia ni Cristo ___ Others: (please specify)

(alayun pakisurat an baton han mga pakiana ha ubos)

________ ________ ________ ________ ________ ________ Gravida (Ika-pira nga pag-burod) Term (Pag-burod hin kompleto nga 9 ka-bulan) Para (Nakapira pag-anak) Abortion (Napunit nga bata) Living Child (Buhi nga anak) Last menstrual period (una nga adlaw han imo katapusan nga

regla)
________ Age of Gestation (Pira na ka-semana an im pagburod)

PART II: BARRIERS TO PRE-NATAL CARE (Nakakaulang ha pagpapa-prenatal) Direction: Please check () the corresponding statement below on either YES or NO.

Direksyon: Alayun pag-tsek () an mga paki-ana ha ubos nga natugon hit OO o DIRE nga iyo baton.
ENVIRONMENTAL FACTORS 1. House is too far from RHU/BHS YES NO

(Harayo an balay ha RHU o ha Brgy health station). (waray masasakyan o makuri it panakayan) (Maiha nga paghinulat kay halaba it pila). (dire pag-kakasinabot)

2. Less access of transportation/vehicle. 3. Long clinic waits.

4. Language barriers.

5. Others (please specify) SOCIO-ECONOMIC FACTORS 1. Difficult access to prenatal care providers.

(dire madali pag-daop ha mga nahatag hit prenatal nga serbisyo).

2. Taking time away from work to attend daytime clinic appointments. 3. Inadequate finances in fare for transportation.

(nagagamit an oras ha trabaho ha pag attender han pagpa prenatal) (waray sakto na kwarta pamasahe para transportasyon)
4. Others specify PSYCHOLOGICAL FACTORS 1. Problems in accepting or acknowledging pregnancy.

( Namroblema han pagkarawat han pagburod). (Pag-abat han ka-depres o sobra ka-stress).

2. Presence of depression or extreme stress.

3. Attitude of a woman about her pregnancy.

(Maupay an panhuna-huna mahitungod han pagburod). (Kahadlok ngadto hit mga proseso medical sugad hin paghiram han tiyan kun anu an posisyon han bata). (Dire maupay nga pagsabot mahitungod han pagpapaprenatal).

4. Fears related to medical procedure e.g. leopolds maneuver 5. Negative attitude or perception towards prenatal care or prenatal visit.

6. Others: (Please specify) SOCIAL FACTORS 1. Negative attitude towards RHM/PHN.

(Dire maupay nga pagtrato ngadto han komadrona o nars).

2. Shy discussing about reproductive health problems which postpones health seeking. 3. Role of kin in influenced health care choices.

(Naawod pagpasabot mahitungod han problema han pagkababaye nga naresulta hin urhi nga pagpakonsulta).
4. Number of children. (Kadamu han anak). 5. Years of marriage. (Tuig o kaiha nga mag upod nga mag-asawa). 6. Others: (Please specify) CULTURAL FACTORS 1. Ethnicity of the clinic staff and care provider. 2. Uses traditional remedies or folks beliefs about pregnancy.

(Nainpluwensyahan han mga sakop-balay ha pag desisyon ).

(Pagkakaiba-iba hin mga tino-ohan han mga taga-sentro ngan an mga doctor, nars ngan komadrona). (Nagamit hin mga kadaan nga mga remedyo o han kadaan nga tino-ohan han mga kag-anak mahitungod hit pagburod).
3. Having beliefs regarding the optional amount of food to be taken during pregnancy for a successful productive outcome.

(Nagkaada hin mga tino-ohan parte han kadamo hin pagkaon nga kakaonon han burod para magmahinampuson an panganganak).
4. Perform rituals like offering new clothes, and various types of foods. 5. Others: (Please specify)

(Naghimo hin mga ritwal sugad hin paghalad hin bag-o nga bado ngan mga iba-iba nga pagkaon).

PART III: DEGREE OF COMPLIANCE TO PRENATAL CARE

(Lebel han pagtugon ha pagpapapre-natal)

Direction: Please check () the corresponding statement below on either YES or NO.

Direksyon: Alayun pag-tsek () an mga paki-ana ha ubos nga natugon hit OO o DIRE nga iyo baton.

PRE-NATAL VISIT 1. Visit the clinic or hospital as scheduled:

YES

NO

(an pagbisita ha RHU di ngani ha hospital)

1.1 First visit before 4 months (una nga pagbisita - bago mag upat kabulan) 1.2 Second visit 6 months (ika -duha nga pagbisita - unom kabulan) 1.3 Third visit 8 months (ika -tulo nga pagbisita - walo kabulan) 1.4 Fourth visit 9 months (ika -upat nga pagbisita - siyam kabulan)

PART IV: DEGREE OF IMPORTANCE OF PRENATAL CARE

(Lebel han importansya han pagpapaprenatal)

Direction: Please check () the number in the box based on the degree of importance of the statements before the number using the scale below.

Direksyon: Alayon pag butang hin tsek () ha kahon kon ano ka-importante an pagpapa pre-natal nga natungod han mga pakiana gamit an mga grado/numero ha ubos.

LEGEND: IMPORTANCE OF PRE-NATAL CARE 1. Daily intake of iron and folate as prescribed by the doctor. (Adlaw adlaw nga pagtumar han bitamina nga YES NO

gin resita han doktor)

(nakaon hin masustansya nga pagkaon ngan irinmom hin masustansya nga irimnon) 3. Enough rest and sleep.(insakto nga pagpahuway ngan pagkaturog)
4. Adapt proper personal hygiene like daily taking a bath, tooth brushing, daily bowel movement, etc.(an pagkarigo

2. Eat nutritious foods and drinks.

adlaw-adlaw, pagtotooth brush ngan an kada adlaw nga pagbawas ngan iba pa)

5. Perform daily exercise like walking, doing light household chores, etc. (an pagehersisyo adlaw-adlaw sugad hin

paglakat-lakat, paghimo hin di gud mabug-at nga hirimuon ha balay ngan iba pa)

6. Avoidance of alcoholic beverages and cigarettes. (Iwasi an nakakahubog na irimnon ngan sigarilyo) 7. Avoidance in exposure to crowded places. (Pag iwas ha

mga matawo nga lugar)

(it dire pagpapre-natal puydi mag resulta hin pagkaada komplikasyon hit pagburod ngan panganak)
9. Others (specify)

8. No pre-natal check-up may lead to development of complications in pregnancy and delivery.

Degree of importance. 4 Very important (Pinaka-importante) 3 Important (Importante) 2 Less important( Dire gud importante) 1 Not important (Waray importansya)

Services performed during first visit:

(Mga ginbubuhat dida hit una nga pagpapa-prenatal).

1. History taking and physical examination serves as baseline data. (Pagkuha hin impormasyon parte hit kalugaringon ngan

pagbuhat hit eksamenasyon ha lawas). 1.1 Checking of BP.(Pagkuha han BP) 1.2 Weighing.(Pagtimbang) masabtan kon nangangapay o namumusag). buyuko).

1.3 Checking of palms of the hand and eyes (conjunctiva) for pallor. (Pagkita han palad ngan mata para 1.4 Examination of the neck for thyroid gland enlargement/goiter. (Pag-eksamen hit liog kon may-ada 1.5 Examination of the breast. (Pag-eksamen hit suso). 2. Laboratory examinations: (Laboratoryo nga mga

eksamenasyon)

masabtan kon ano nga type tim dugo) dugo ha lawas).

2.1 Blood test for blood typing. (Pagkuha hin dugo para 2.1.1 Complete Blood Count. (Sakto nga ihap hit

2.1.2 Hepa B Surface Antigen. (Para masabtan kon may-ada sakit nga hepa ha dugo). 2.2 Urine test: (Eksamenasyon han ihi) 2.2.1 Sugar test and protein test as sign of diabetes and kidney changes. (Para masabtan kon may-ada

sakit nga diabetes ngan sakit ha batu/kidney)

2.3 Pap smear done to detect changes in the cervix that could be forerunners to cancer. (Pag-eksamen ha sakob hit

pwerta para masabtan kon may-ada problema nga tikadto hit pagkaada hin kanser ha matres). 3. Treatment of the disease if any. (Pagtambal hit sakit kon may-ada).

4. Giving Iron supplementation. (Paghatag hin Iron

supplement).

5. Dental care. (Pag-atiman hit ngipon). 6. Giving healthy instruction and counselling. (Paghatag hin

mga instraksyon mahitungod han maupay nga panlawas ha pagburod). Subsequent visit:(Sunod nga mga pagbisita) 1. Measuring BP. (pagkuha hin BP).
2. Measuring weight to make sure the expectant mother is gaining enough. (Pagkuha hit timbang para makita kon may

kadugangan hit timbang). toxoid). tiyan).

3. Tetanus Toxoid immunization. (Pag-bakuna hin tetanus 4. Abdominal Examination: (Eksamenasyon ha tiyan). 4.1 Measuring fundic height. (Pagsukol hit kadako hit 4.2 Checking the size and position of the uterus and fetus. (Pagsukol han bata ngan pagkita kon ano it posisyon han

bata ha sakob han tiyan).

4.3 Listening to the fetal heartbeat (typically after 12 weeks). (Pagpamati hit pulso han bata ha sakob han tiyan). 4.4 Fetal presentation. (Presentasyon han bata ha

sakob han tiyan).

5. Assessing the face, hand, and lower extremities for edema.

(Pag-eksamen hit nawong, kamot ngan mga tiil o bitiis kon may pamanas).
6. Collection of urine sample to continue to check for sugar and protein. (Padayon nga pag-eksamen hit ihi). 7. Monitoring mothers diet. (Pagkita kon ano it urog nga

kinakaon hit nagbuburod).

8. The Doctor also performs various type of tests to check the fetus for birth defects. (An doktor nagbubuhat hin iba-iba nga

mga eksamenasyon para masabtan kon may problema an bata ha sakob han tiyan).
9. Insufficient weight gain and increase blood pressure, if gone untreated can be harmful to the fetus. (It dire sakto nga

timbang ngan hataas nga BP pwede mgresulta hin problema ngadto hit bata ha sakob han tiyan). nga makita hit pagpa-prenatal pwede tambalon ha sakob hit matres).

10. Some abnormalities, if detected prenatally, can be treated in-utero (before the baby is born). (Kon may-ada mga problema 11. Early detection can allow the proper medical facility to be present at the time of birth to allow the baby full access to the

health it needs. (Kon may-ada problema ha pagburod nga sayo

masabtan matutugunan it mga panginahanglan didto hit panganganak).

12. Giving proper referral to the next higher level when applicable. (Paghatag hin eksakto nga reperal ngadto ha

pinakalabaw nga makakahatag hin serbisyo sugad hit nga hospital kon kinahanglanon). 13. Health education and counselling. (Pagtutdo hin mga makakaupay ha panlawas).
14. Others: (Please specify) PART V: PRENATAL CARE PROVIDERS (Nag bubuhat han pagpapapre-natal) Direction: Please check () the corresponding column that provides you prenatal care. Direksyon: Alayon paki-tsek () an mga kahon kon hin o an nagbuhat han omi pagpapre-natal.

1. Health Workers: 1.1 Doctor (Doktor). 1.2 Public Health Nurse (Nars). 1.3 Rural Health Midwife (Komadrona). 1.4 Barangay Health Workers. 2. Traditional Birth Attendant (Hilot)