INTRODUCTION

Background

One of the most significant considerations in ensuring a healthy growth all throughout our

human development phase is to give primary importance in accessing a safe and accurate practices

of prenatal care services rendered by healthcare providers in order to attain a healthier pregnancy

and safer birth outcomes. This is because, despite pregnancy being considered a normal

physiological process, various studies have still proven that pregnancy could pose a wide variety of

health risks to both the pregnant mother and the fetus inside her womb. This basically heightens the

need to give an emphasis to the crucial role of prenatal care services as an effective means of

possibly preventing and/or reducing complications brought by gestation, labor, and postnatal period

among reproductive age women.

The World Health Organization states that prenatal care is one of the most essential health

care services being rendered by healthcare providers in order to be able to protect the welfare of

women and their unborn children, wherein such care is mandated to be given to every pregnant

woman to sufficiently cater their healthcare needs during pregnancy. This emphasizes the need in

having a complete access to prenatal care services during pregnancy that must be monitored

periodically in order to integrate a safer and accurate means of rendering prenatal care services to

all pregnant mothers. In line with the primary goal of World Health Organization, ensuring a safe

and accurate practice of prenatal care services will better prevent pregnancy-induced health

problems in both the mother and the fetus (World Health Organization, 2020).

Wherein specifically in countries of Western Europe and North America, they have

mandated their prenatal care services to include 12 to 16 visits to health care services by the

pregnant woman and as well as provider visits to her home. This involves first visit which ordinarily

focuses on obtaining a detailed social, family, medical and also obstetric history, as well as making

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a risk assessment and carrying out thorough and full physical examination that requires a wide range

of laboratory tests. The subsequent visits that are involved in prenatal care among these countries

include simpler examinations but there are some examinations that are still done at every visit. The

later part in pregnancy that are included in their prenatal care services focuses on the status of the

developing fetus inside the mother’s womb and the development of preparatory strategies for a safe

delivery. Thus, as a result, the average number of pregnant women in many countries across the

world received about 150 or even more specific tests, examinations, and interventions during

pregnancy as a part of prenatal care (World Health Organization, 2020).

Unlike in the majority of Southeast Asian countries, pregnancy practices are highly

influenced with their respective religious and cultural belief wherein particularly most of the

Southeast Asian countries who practice Buddhism has actually encourage tolerance and suffering

resulting for most pregnant women in these countries to not seek medical treatment because they

believe that their pain must be endured rather than something that can be alleviated. Furthermore,

oftentimes pregnant women among the majority of Southeast Asian countries will rather choose to

have the baby delivered at home to save money. In addition, Cambodians believed that it is

important that women in labor must have someone with her at all times as they perceive women are

especially vulnerable to evil spirits during childbirth and this makes the protective rites that they

believe to are necessary to ward off the evil spirit that often cannot be done in the hospital.

Therefore, this makes the reproductive health among the majority of the Southeast Asian countries

to still be at a lower level as compared to Western countries because their prenatal care services are

highly influenced by different religion, beliefs, socioeconomic and cultural factors which affects

the pregnant mother’s attitude and perception on prenatal care, and as well as accessibility of proper

prenatal care services (Mattson, 2022).

However, in the Philippines, prenatal care is actually a widely accepted practice during

pregnancy because it serves as an essential mandatory preventive care service among pregnant

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women that is being given free by the Philippine Government. Wherein it is reported that almost

96% of pregnant Filipino mothers had complied prenatal visit to healthcare providers. The prenatal

care in the Philippines is actually done by various health professionals which includes doctors,

midwives, and nurses. However, there are some pregnant women in the Philippines who would still

choose to go to traditional birth attendant also called as “hilots” as their prenatal care attendant.

The official 2019 survey of the Department of Health has reported that about 39% of women who

had live births in during the five years preceding had reported that they visited a doctor for their

prenatal care, whereas about 52% of them had visited either a nurse or a midwife, and about 4%

went to traditional birth attendant. However, the aim of the Department of Health is to have about

80% of pregnant women in the Philippines to be given at least 4 prenatal care visits (Department of

Health, 2019).

Although despite the available prenatal care services rendered by healthcare providers in

the Philippines, many Filipino pregnant mothers still continue to receive insufficient prenatal care

which leads to pregnancy-induced morbidity and mortality to remain unacceptably high in the

country starting from 2016 even up to present time. About 78% of women who had at least 4

prenatal care visits has been recorded even though it is found out to be incomplete but still it was

considered a success by the Department of Health which loses the integrity and effectiveness of the

healthcare system in the country. The identified factors that have negatively affected the prenatal

care system in the Philippines has mainly included poverty, distance, lack of information,

inadequate services and traditional cultural practices which basically prevents a lot of Filipino

pregnant mothers from receiving or seeking appropriate or proper medical care during pregnancy.

In Bicol Region, one of the 13 Regions in the Philippines, pregnant mothers particularly in

rural regions require motivation and incentives for them to be able to understand the importance of

having prenatal check-ups and delivery in health facilities. Among the cities in Bicol Region, Iriga

City had been reported to have the highest Maternal Mortality Rate of 5 out of 1,000 live births. On

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the other hand, Tabaco City had been reported to have the lowest maternal mortality rate in the

Bicol Region of about 1 out of 1,000 live births. According from the study conducted by the College

of Nursing from Bicol University, both cities of Iriga and Tabaco has been excellent in performing

assessments of history taking, physical examinations and care provisions except for oral health care

examination, tests for syphilis, stool examination, acetic acid wash, safe sex education and oral

health checkups, and prophylaxis. The identified problems included financial constraints, busy

taking care of the children, forgetfulness, inadequate and/or lack of support system, illness,

unwanted pregnancy, struggles during first trimester, drunkard husband, inappropriate or bad

attitude of midwives, nurses and doctors which includes unequal treatment of poor patients (Sande,

2022).

According to the official data of the City Health Unit in Legazpi City for the year of 2022,

Barangay Rizal St. Ilawod was the one identified who have the least rating of accomplishment in

rendering prenatal care services among the 44 total barangays in Legazpi City, Albay. Barangay

Rizal St. Ilawod had a target of 46 reproductive age women in the year 2022 but only 5 had seek

prenatal care in their respective barangay accumulating a total of 11% accomplishment rate.

However, it was reported later that a total of 13 reproductive age women had live births in their

respective barangay. This clearly emphasizes the fact that not all pregnant mothers in Barangay

Rizal St. Ilawod, Legazpi City seek prenatal care services in their barangay due to the various

reasons that could be influencing and/or hindering them from accessing or seeking prenatal care

services rendered by healthcare providers in their barangay (City Health Unit, 2022).

Therefore, the general purpose of this research study focuses on assessing the effectiveness

of the prenatal care services rendered by healthcare providers within Barangay Rizal St. Ilawod,

Legazpi City. Specifically, all rendered prenatal care services should be safely and accurately

utilized to all pregnant mothers to ensure effective prenatal care all throughout their pregnancy.

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Rationale

Due to the emergence of various diseases in the present time, there is a need for the proper

implementation, good quality, as well as equal accessibility of community healthcare services as an

important method in controlling the spread of diseases in a larger scale and addressing the health

needs of each and every people. Maternal and newborn mortality and morbidity rate has been one

of the leading health issues prevalent in our country, thus, this highly demands for the need of

receiving prenatal care services as a basic human right of all pregnant mothers and infants.

Furthermore, there is a need to conduct this research study in order to assess and determine the level

of effectiveness of these rendered prenatal care services to the residents of Barangay Rizal St.

Ilawod, Legazpi, City under the legal laws of Republic Act No. 10354 or also known as the

Responsible Parenthood and Reproductive Health Law as well as the Republic Act No. 11148

which shall be known as the “Kalusugan at Nutrisyon ng Mag-nanay Act of 2018”.

The Republic Act No. 10354 also known as the Responsible Parenthood and Reproductive

Health Law states the importance of ensuring the health status of families which serves as the

fundamental unit of society in the aspect of maternal care, contraception, sexual education and

fertility control that plays a vital role in addressing discrimination, inequality, and the combat on

the maternal mortality and morbidity rate which is still a debate within the country.

The law emphasizes the right of every family for reproductive health with equitable access

to quality health care services that is safe, affordable, effective, and legal most especially to

maternal and child health, safe pregnancy to birth, and well-being of the unborn; Sustainable human

development and education in respect to modern and effective family planning methods considering

their religious and cultural beliefs; and programs that would enable them to decide for the number

of children they desire in which will support the study in securing the health of the mother and

infant by promoting and protecting their rights on obtaining health care services such as quality

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antenatal care in all birthing centers and facilities providing maternity care services that is

accessible, affordable and against inequality and discrimination.

In addition, the Republic Act No. 11148 which shall be known as the “Kalusugan at

Nutrisyon ng Mag-nanay Act of 2018” aims to increase the nutrition intervention programs in the

first one thousand days of a child’s life and allocate resources through a sustainable manner in order

to improve the nutritional status and address the malnutrition among infants and young children,

adolescent females, as well as pregnant and lactating women.

In line with this, the law supports the study in ensuring the optimum health and promoting

the needs of the mother and infant in the aspect of growth and development by providing a policy

environment, evidence-based nutrition interventions, and institutionalized first 1000-day program

in all development plans within both the national and local government.

Current State of the Study

Safe and Accurate practice of prenatal care services is very essential because it has a

beneficial impact on reducing maternal mortality rate. In the Philippines, women who resides in

rural areas are more likely to have regular antenatal care visits as compared to those in the urban

areas of the country which could be due to different existing programs or policies related to

antenatal care that are enforced in the country. Basically, the Philippine government has a specific

financing policy in both rural and urban area wherein such financing policy include giving of

incentives, free services were provided by PhilHealth, cash grants are offered, and more were

provided in order for pregnant mothers to be encouraged to visit for their prenatal appointments

(Wulandari, 2021).

The theory explained the different supporting factors that the government offers for

pregnant mothers in order for them to be encouraged to go to health facilities, seek antenatal care,

and delivery at the facility. However, there are several factors identified why pregnant mothers

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ended up not visiting healthcare facilities and that includes monetary issues or financial constraints.

It was also found out that some pregnant mothers were given enough support system, however,

their participation on the said prenatal care or visit will still highly depend on their willingness and

full cooperation to the procedures in the rendered prenatal care services which will also be assessed

in this present research study.

Maternal morbidity and mortality rate is still one of the alarming issues in the Philippines

regardless of the implementation of health care programs and service delivery networks. This study

state that in order to gradually decrease the rate and sufficiently provide the needs of the country, it

is important to identify the factors that hinders the progress towards its success because through

this it will help in formulating measures that will contribute to the enhancement of the effectivity

of the rendered prenatal care services. By acknowledging this and through a collaborative effort

with local health officers, it may help in ensuring a better maternal health outcome during the course

of pregnancy (Cagayan, Cagayan, Castro, Facun, Nisperos, et al., 2022)

The results of this study emphasized the importance and function of utilization centers in

terms of monitoring the needs of maternal health services. In this context, this has a significant

relevance to this present research study to be conducted because this emphasizes the crucial role of

barangay healthcare services in terms of efficient and effective detection, prevention, and treatment

of maternal problems being experienced by pregnant mothers in the country. Collaborative efforts

with barangay health workers will better help to determine what aspect needs more assistance that

can be used to further improve it in order to meet the holistic health needs of all pregnant mothers.

It will also serve as a guide to better identify the barriers that could interfere or hinder the

pregnant mother’s access to prenatal care services which includes willingness or participation,

behavior, and cultural beliefs of the pregnant mother in accessing or seeking prenatal care.

Otherwise, these factors are not properly identified and analyzed, it may hinder with the overall

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progress of the development of prenatal care which inevitably affect the level of participation of

pregnant mothers to their needed prenatal care.

Objectives of the Study

This study aims to assess the effectiveness of the Prenatal Care Services rendered by

Healthcare Providers. Specifically, this will answer the following objectives:

1. To determine the prenatal care services rendered by healthcare provider.

2. To identify the level of effectiveness of the Prenatal Care Services rendered by the

Healthcare Providers in terms of:

a. Safety

b. Accuracy

3. To propose measures that will enhance the effectiveness in providing Prenatal Care

Services.

SYNTHESIS OF THE ART

In this section of the research study, various related literatures and studies were reviewed within

the context of previous knowledge. This strives to understand what is already known about a

research problem and provides a concrete foundation upon which to base the new knowledge which

will help to identify the particular aspects of a problem that will require more research.

One of the highlights of the arriving discussion was that it emphasizes the significance

of determining the antenatal care services rendered by healthcare providers to pregnant women

and babies within the community in order to guarantee optimum growth and development.

Access to education similar as group meetings, mindfulness programs, unbiased life- saving

medicine and paraphernalia, knowledge on the influence of discernment, accessibility of

professed health care interpreters, conditioning related to motherly care, admission and

interview processes, and impulses are some of the demands enforced on similar antenatal care

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services whereas the outgrowth of the antenatal care services varies on the requirements of the

community. The review established enriched maternal health issues where manly community

mobilisers were involved in home- grounded community interventions. former attestation

suggests that the need to prioritize manly involvement in motherly health care education in

addition to measures that aim to ameliorate women’s education and their status in the family.

Involvement of the male family members in motherly health care education is of particular

significance in low socioeconomic and uninstructed community surroundings. Intervention

strategies involving men and community leaders in motherly health care programs in Bolivia

redounded in bettered motherly health issues in a low resource terrain. The involvement of

misters in the application of motherly care needs to be included as inversely important as the

enhancement of women’s education and their status in the family. Our meta- analysis showed

that the figures of women attending at least one prenatal visit were lesser among women

entering any type of community intervention and intervention sub groups. This finding is

supported by a study conducted in Nepal that demonstrated enhancement in motherly health

care issues in pastoral communities using a womanish facilitator in organizing yearly meetings

with women’s groups. Increased access to prenatal care, provision of professed birth attendants

and gestation care mindfulness programs at original position contributes to safer gravidity and

parturition. former studies have concluded that delivery in a health care installation offers

important demanded emotional support to pregnant women. Presence of professed

professionals, lifesaving medicines and outfit help to reduce the threat of complications and

death of mother and newborn. A range of community interventions are likely to be successful

in enhancing prenatal care attendance. Pregnant women taking women’s education group

interventions were more probable to deliver at a health care establishment. (Booth, Jones,

Loxton, Sharma, & Smith, 2018).

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 High mortality and morbidity rate during gestation were caused by varied reasons

frequently circulating on perception of mothers, availability of facilities, and accessibility of

professed health care interpreters. A woman’s perception regarding their antenatal visits is

affected by varied factors which includes women’s lack of decision-timber capacity, low

socioeconomic status, and reliance on their misters for monetary support. Health care facilities

also is of significance and long distances to health care facilities, high transportation costs,

logistical challenges, and low quality of care frequently times affect the mama's participation

and amenability to seek medical help. (Hamer, Horstkotte, Massar, Ruiter, & Sialubanje, 2017)

Antenatal care played an important function in securing maternal and child safety and

minimizing the risk health problems, impairment, and fatality in mothers and their infants.

Findings based on the collected maternal and newborn monitoring system at 8 provinces in

China shows low optimal status and further improvement in the aspect of quality and

systematization (Hu et al, 2021).

Previous research has shown that antenatal care is a cost-effective method of lowering

MMR in low-income nations. During pregnancy, the World Health Organization recommends

at least four visits to antenatal care services (4+). An obstetrical checkup to rule out problems,

a tetanus toxoid vaccine, intermittent malaria preventative medicines throughout pregnancy,

and the diagnosis and care of illnesses such as HIV, syphilis, and other sexually transmitted

infections are all part of antenatal care. Furthermore, obtaining 4+ antenatal care visits at health

institutions can enhance overall MCH. According to previous studies, it was found that the

main issue with MCH interventions in low-income countries is the frequent turnover of health

workers. Doctors, chief nurses, pharmacists, and midwives in Kenge had turnover around every

2 years. We confirmed that some of the health workers who had completed their intervention

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training had been moved out to other areas, which may have reduced specific possible outcomes

in the intervention area due to provider turnover (Lee, Park, Ndombi et al., 2019)

Volunteer Barangay Health Workers have progressed into an integral part of the

nation's healthcare workforce and have been critical to the success of Primary Health Care in

the country, able to operate at the level of barangays the smallest unit of governance in the

Philippines. In general, Barangay Health Workers managed to perform two functions:

representing as frontline health center staff and acting as community health mobilizers. The

balance of activities, however, was determined by the priorities of the health center manager to

whom the Barangay Health Workers was assigned. Barangay Health Workers were frequently

involved in a variety of health center activities such as immunization, maternal care, family

planning, and hypertension management. Their weekly schedules varied by barangay, but they

usually spent the entire day in health centers 2-3 times per week. Barangay Health Workers are

frequently the first point of contact for patients as frontline staff at local health centers. They

greet clients and undertake a variety of specific tasks, such as admitting and interviewing them,

as well as recording patient information and/or vital signs, before they are seen by a doctor or

nurse, if one is available. Barangay Health Workers confirmed that they had no role in

diagnosing or prescribing. As community health mobilizers, Barangay Health Workers act as

a link between the community and their local health center, promoting health and engaging

people in existing programs and frequently working house-to-house. (Mallari, 2020).

Antenatal Care is an essential mandatory preventive care service freely given to

pregnant women by the Philippine government. It is also known as prenatal care, which is

preventive healthcare provided regularly to pregnant women allowing doctors, nurses, and

midwives to identify, prevent and treat potential health problems throughout the pregnancy. It

also promotes healthy lifestyles that benefit both mother and child. In 2016, at the start of the

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Sustainable Development Goals era, pregnancy-related preventable morbidity and mortality

remained unacceptably high. Many mothers continue to receive insufficient prenatal care. The

fact that roughly half of the deliveries were made at home supports this theory. Pregnant

mothers, particularly in rural regions, require motivation and incentives to understand the

necessity of antenatal check-ups and delivery in health facilities. Despite the available antenatal

care service in the country, not all pregnant women still avail of the service. In the Philippines,

78% of women had at least 4 antenatal care visits recorded in 2014; though incomplete, still

considered a success by the Department of Health. Although it improved in 2017 to 87% of

women who had four or more antenatal care visits. Poverty, distance, lack of information,

inadequate services, and cultural practices prevent women from receiving or seeking care

during pregnancy and childbirth. Even with the hindrances mentioned, the skilled health care

workers are doing their best to provide quality antenatal care services from the urban to the

farthest rural areas of the community. (Sande, 2022).

The growing acceptance of women's rights to choose and autonomy in maternity care

in many high-income countries has resulted in a more woman-centered approach to antenatal

care. Several RCTs have incorporated continuity of care elements, often involving team or

caseload midwifery, to reflect the growing emphasis on woman-centered care. A team midwife

is a group of midwives who provide care and share responsibility for women from the antenatal

period to labor and postnatal care. In case loading, a midwife is entrusted with a small number

of women's care throughout pregnancy, birth, and the postnatal period. Two recent studies in

this category compared 'group antenatal care' to individual care. Jafari et al. reported favorable

clinical outcomes such as a lower risk of caesarean delivery and a shorter time to diagnosis for

hypertension and urinary/vaginal infections. In the intervention group, satisfaction ratings were

much higher (Symon, 2017)

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 Adequate visit for antenatal care is important for operative discovery and operation of

different complications that might be underwent during gestation. The said antenatal care

services could be effective for the discovery and operation of different complications but it

requires facility- grounded, professed care within prenatal care services. Antenatal care could

appreciatively impact birth issues by producing changes in mother’s behaviors, enhancing

mother’s nutritive input, reducing morbidity dangers, and terminating gestation that could lead

to poor birth issues through the operation of its four aims: early discovery of pregnant women

at threat, action to help any unborn difficulties, opinion and treatment of preexisting medical

conditions, and prompt referral in case of complications developed. The volume and quality of

the procedures performed at each visit for antenatal services also impacts antenatal care on

mothers and newborns along with circumstance of a visit of mothers. (Tadele & Teka, 2021)

Unequal access to quality health services has an impact on maternal mortality rate in

several regions around the world. The maternal mortality ratio in the Philippines stood at 121

deaths per 100,000 live births in 2017 to 124 deaths per 100,000 live births in the previous year.

Data shows that in our country (Philippines), women who resides in rural areas are more likely

to have regular antenatal care visits than those in the urban area, it could be due to the different

existing specific programs or policies related to antenatal care that are enforced in the country.

It is also noted that the Philippine government has a specific financing policy in both rural and

urban area. Incentives were provided by the government and that is in the form of free maternal

services and cash grants. This specific policy encourages mothers to go to health facilities for

antenatal care and delivery at the facility. There are also free services provided by PhilHealth

(state social health insurance). Cash grants are offered through government and other

community partners’ conditional cash transfer programs. Disincentive policy has also been

enforced in the form of local regulation in some areas in the country and this local regulation

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prohibits childbirth at home and when mothers and birth attendants were caught giving birth

outside of a health facility, they’ll be given a penalty which include fines for the mentioned

individuals. (Wulandari, 2021).

The crucial role of the community-based healthcare services in actively enhancing the overall

well-being of both the mother and the newborn as well as reducing maternal and neonatal

mortality and morbidity rate within the local and global scale was also to further enhance the

prenatal care services by identifying the level of effectiveness in terms of safety and accuracy.

One of the primary factors that greatly influence in the effectiveness of the prenatal care

services is the cooperation of the pregnant women based on perception and satisfaction.

Amongst all the developed alterations in systems, alternatives for the lacking facilities and

resources and different innovations used to enhance the implementation of such services, the

personal perception of the pregnant women based on their cultural and social beliefs affects

their motivation in obtaining such services. In addition, the level of satisfaction of the pregnant

women based on their prior experience in obtaining such services also influence their attitude

towards the continuation of prenatal care throughout pregnancy. Thus, the decline in these

factors could lead to detrimental and inconsistent results on prenatal care which could harm

both the mother and the infant.

Level of satisfaction of pregnant mothers to the utilization of prenatal care they are

receiving is also considered as a barrier in providing accurate and sufficient maternal care. It

affects the rate of utilization of prenatal care, sufficiently, low levels of satisfaction from the

said pregnant mothers could result a low utilization of prenatal services. It was shown that

dissatisfaction with prenatal care services could affect the mother’s compliance and

participation. There are various contributing factors for the satisfaction of people who wish to

seek medical help and factors include satisfaction with clinic services, clinic accessibility, and

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physician interactions. If the pregnant women were not satisfied especially with the patient-

provider interaction, they are less likely to follow the prenatal care regimen; she is also less

likely to utilize prenatal care in future pregnancies. Dissatisfaction with prenatal care may

impact both individual behavior and the behavior of a woman’s peers because dissatisfaction

may cause the mother to have endless complaints and the likes. (Adeyinka, Faiai, Hawley,

Jukic, McGarvey, et al., 2017).

In spite of the discovered scientific evidences and data that has demonstrated the

benefits of prenatal care for ensuring optimum health of mothers and newborns, there are still

a number of unexplored avenues that could bring more perspective on enhancing the

effectiveness of prenatal care such as exploring the quality and content dimension. In the

Philippines, the quality of prenatal care is not actually commonly used as a part of major health

indicators. This can be evidently seen in the field health service information system where the

quantity and periodicity are included, however, there is no direct indicator that evaluates and

measures the quality and content of prenatal care. Evaluating the caliber of prenatal care is

indeed important as this has a major role in ensuring effective ways in preventing and treating

maternal and infant health problems, enhancing overall maternal satisfaction, and maximizing

proper healthcare utilization. The overall quality of prenatal care in the Philippines is found out

to be low in accordance to some studies conducted, therefore the promotion of focused prenatal

care and increasing infrastructure, encouraging maternal education, and as well as

compensating for the healthcare costs for women with low household income might actually

help in enhancing the quality of care rendered to pregnant women and newborns. (Alexander,

2017).

Antenatal care is essential in ensuring the health of the mother and the infant in

collaboration with the health care providers. It includes identification and assessment of

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probable risks of pregnancy and education on preventing complications. In Uganda, a minimum

of four visits is required for life-saving antenatal care, with 69% of African mothers attending

on average, while delivery of health services is still lacking, particularly in rural areas. In

economically developing countries, the quality of prenatal diagnosis is not guaranteed by

antenatal care and such services are inconsistent, insufficient, and vary in type and quality

across geographical regions. Factors that affect the implementation includes distance from

health facilities, perceptions on antenatal care, culture, level of education and resources

(Atuhaire & Mugisha, 2020).

Despite the continuous movement in combating the morbidity and mortality rate

present within the country, there is not much of an improvement. Barriers that hinder the

progress of the services still persists such as lack of funds and resources which made it even

more difficult to address with the socio-economic conditions brought by the pandemic.

Discourses on health related to community participation is one approach in developing new

strategies to attain better antenatal care service. (Balahadia-Mortel & Nisperos, 2022).

Prenatal care in the Philippines is typically provided by a variety of healthcare provider

or medical specialists which includes nurses, midwives, and as well as doctors. The advantages

of having prenatal care are widely acknowledged because of its considerable impact on

improving health outcomes and as well as infant survival. According to several research

projects, they have determined how prenatal care affects birth weight wherein specifically

mothers who have received quality and proper prenatal care are less likely to have babies with

low birth weights. This is mainly due to the reason that those pregnant women are more likely

to learn about their nutritional requirements if they had received adequate prenatal care and

consultations. Expectant mothers who did not receive prenatal care are more likely to give birth

to their babies before full-term. Infants who are born too soon are at increased likelihood of

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developing both short-term and long-term health issues such as growth and developmental

impairments, and as well as mental disabilities. (Barros & Tavares, 2018).

Health-care systems around the world had to rapidly adjust to cope in response to the

COVID-19 pandemic and in response to it, a new antenatal care was developed and

implemented integrating telehealth across all models of pregnancy care. Health services for

many subacute aspects of health care were cancelled or completely shifted to telehealth for care

delivery, however, prenatal and maternity care pose a different problem because it cannot be

postponed nor converted to a completely digital format. Telehealth has been enforced for the

provision of gestation care in high- income, low- income and middle- income countries. The

use of telehealth interventions has also been associated with a reduced number of unplanned

in- person visits in high- threat gravidity, while maintaining analogous gestation issues. The

integration of telehealth into the delivery of prenatal care for both low- threat and high- threat

gestation care models is attainable. Telehealth integrated prenatal care was attainable in an

intimately funded health- care system. Telehealth can be incorporated into prenatal care

delivery for both low- threat and high- threat gravidity, not only for targeted strategies similar

as diabetes operation and smoking conclusion, but also for routine prenatal care visits. Findings

indicate that antenatal care that were delivered through telehealth is likely to produce same

improved outcomes. Application of telehealth in prenatal services are associated with a high

level of patient satisfaction. (Brown, Davies-Tuck, Diamandis, Fradkn, Giles, et al., 2021).

Prenatal care also plays a crucial role in stopping newborn mortality wherein, infants

whose mothers had received proper prenatal care during their pregnancy have a lesser

probability of sudden infant death syndrome. In addition to this, previous research has also

indicated that prenatal care can protect mothers against the complications that pregnancy may

possibly bring to them. In the study that was conducted in the Philippines has determined that

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mothers who undertaken prenatal care have a lesser incidence of experiencing hemorrhage and

pre-eclampsia which are the most common factors of maternal mortality brought by pregnancy

complications. This concludes that prenatal care contributes a wide variety of benefits in

ensuring optimum fetal growth, reducing the risk of contracting infections and diseases, and

overall promoting mother and infant survival. (Campbell & Graham, 2019).

One of the government's initiatives is to reduce maternal and infant mortality faster by

enhancing the knowledge and modifying the behavior of mothers and families. It is believed

that as knowledge and behavior change rise, so will awareness of the significance of good

health during childbirth. The program developed by the Ministry of Health to endorse this step

is Prenatal Class. This class's activity is based on the learning approach of discussing maternity

and child health book content. The implementation of the Maternal and Child Health Book is

anticipated to enhance the quality of Maternal and Child Health services and nutrition so that

one of the sustainable national development goals, namely health of all ages with indicators of

decreasing Maternal Mortality Rate and Infant Mortality Rate can achieve. (Dahlan & Herien,

2020).

Women who have at least one antenatal care visit have a 1.04% lower risk of their

newborn dying within the first month of life and a 1.07% lower risk of their kid dying within

the first year of life. Following the World Health Organization recommendations for antenatal

care visits is associated with lower death rates. In comparison to attending less than four

antenatal care visits (regardless of provider quality), having at least four antenatal care visits

and seeing a skilled provider at least once reduces the probability of neonatal deaths by an

additional 0.56% point and is associated with an additional 0.42%-point reduction in the

possibility of infant deaths. The association between antenatal care and short-term and long-

term nutritional outcomes of the child. If the mother attends at least one antenatal care visit,

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this is associated with 3.82% points reduced probability of giving birth to a low-birth-weight

baby. Stunting and underweight outcomes are reduced by 4.11% and 3.26% points,

respectively. Attendance at a skilled provider during at least one of at least four antenatal care

visits further reduces the probability of having a low-birth-weight baby by 2.83% points, for

stunting by 1.41% points and for underweight by 1.90% points. The attendance at antenatal

care services might lead to better survival chances of those babies that would have otherwise

died before birth. (Kuhnt, 2017).

Public sector hospitals operate under government actions because the government only

finances public service healthcare facilities, whereas private sector organizations are founded

as for-profit businesses that can provide more high - quality care and services to their patients.

Private hospital patients must pay more money in order to receive the desired service quality.

Currently, exact and complete details are required for the patient's demands before utilizing any

type of services by a specific health care institution. Since they are paying a higher amount for

treatment options, patients are becoming more perceptive and expect supplementary services

to gain the service quality that is beyond their expectations, and simply any occurrence of

discontentment tends to push them to move towards other competitors. Nevertheless, the

quality-of-service delivery is seen as an important aspect in ensuring general patient satisfaction

with hospitals. It has been suggested that physicians and hospital staff (medical or non-medical)

should all focus on improving and improving the quality-of-service delivery. It was proposed

that having provided impactful training to service providers on interpersonal skills and realistic

communication increases patient satisfaction. In hospitals, the development of service quality

is compulsory for accomplishing a reliable identity for patients. Zeithaml stated that when

service delivery was assenting for service evaluation, it influenced the patients' attitude and

expectations, which reinforced their connection with the caregivers. As a result, the procedure

19
of service delivery has had a great impact on the supervision of all the associated services and

institutions which ought to be particularly essential in providing detailed hospital treatment. In

addition, it is necessary to focus on providing the greatest service quality to the public for

satisfaction. (Manzoor et al., 2019).

It was expressed by the World Health Organization that most of the poverty-stricken

women in the country are prone to still experience the highest risk rate in maternal death due

to pregnancy and childbirth. One reason why there are so many marginalized women is

unfairness in significant exposure to maternal healthcare provisions and services is induced by

women's social status. Women who are refugees or migrants may lack the legal status required

to obtain the necessary health care. Regional differences were also found to play a significant

role in having complete antenatal care use and deliveries in government facilities. Household

income continues to be the primary component to the arising disparities in health-care

utilization. (Paredes, 2018).

Antenatal care aims to ensure the safety of pregnant women and fetuses through a range

of medical, educational, nutritional and health system interventions. Thus, antenatal care is a

well-proven internationally accepted strategy used in several countries to improve maternal and

neonate outcomes. Effective and timely implementation of antenatal care alone has been

projected to minimize maternal and neonatal mortality by 10%–20%, given satisfactory quality

of the care provided and given regular attendance. One study found that utilization of antenatal

care at least once during pregnancy reduced the risk of neonatal mortality by 39% in sub-

Saharan African countries. A timely first antenatal care visit creates an opportunity for a woman

to connect with formal health services and provides the possibility that early screening of

pregnant women can identify those who will require specialized care. In addition, the first visit

also helps the provider identify those pregnant women who are very likely to experience

20
unfavorable obstetrical outcomes like hemorrhage. The first visit is the proper time to provide

preventive interventions, for example providing iron tablets and explaining why and providing

counselling if there are any danger signs. In spite of these benefits, the contribution of first

antenatal care contact in improving perinatal outcomes is blurred and requires further

evaluation. (Seyoum, 2021).

Prenatal care in ensuring transport and childbirth in facilities that provide an adequate

level of maternity care at risk of directly impacting infant mortality by reducing birth weight-

related mortality. may play an important role. In particular, the experience of antenatal care

may have a positive impact on postnatal maternal and child health status, postnatal health

behaviors, and utilization of health services. Through educational messages and related support

services, prenatal care can help reduce infant injury rates and other preventable causes of infant

morbidity and mortality, such as breast cancer. B. SIDS. For example, prenatal education that

addresses home and vehicle safety, cleanliness, stress management, infant care and feeding

may reduce infant injury and illness rates. Benefits of prenatal care may not be equal for all

population subgroups. Many researchers have observed that prenatal care use and impacts vary

by socioeconomic, demographic, cultural, and medical risk group, preexisting health status,

age, education, and poverty and suggest these characteristics, including environmental

conditions that may alter prenatal care. (Stalberg et al., 2022).

In this time of unprecedented crisis, an alternative approach was implemented

regarding antenatal care. Clinical consultations, programs, and economical medical services

are conducted through the use of technological advancements. Online antenatal care is more

convenient and affordable which shows improvement in diminishing inequality. On the other

hand, some mothers are uncertain with the reliability of information distributed online. In line

21
with this, the importance of ensuring the safety and quality of antenatal services is a must as

well as establishing rapport between client and health care provider (Wu et at., 2020).

Numerous strategies and approaches should be implemented in order to raise the standard of

the various prenatal care services rendered in communities. In line with this, proven and tested

measures in previous conducted studies is reviewed to be able to propose more effective and

applicable measures for the study regarding prenatal care. Some of the highlights that was

proven to be an effective approach in conducting prenatal care services includes education and

information, social support groups and collaboration between patient and health care provider.

Previous research has demonstrated that group prenatal care can complement standard

individual prenatal care by facilitating support networks, social engagement, and additional

education while improving postpartum outcomes. Group prenatal care is an integrated method

that incorporates peer support and health education to deliver prenatal care in a group setting,

encouraging free interchange and developing collaborative efforts among peers. A notable

endpoint of group prenatal care in the current study is that the program managed to eliminate

family barriers to accessing regular pregnancy care, as indicated by some participants. An

earlier study found that knowledge of mothers-in-law and husbands of women, who were

usually the decision makers for antenatal care, had a considerable influence on antenatal care

seeking. (Akram, Ali, Islam, Jahir, Mahumud, et al., 2019).

As part of the celebration of “Safe Motherhood Week” during the second week of May,

the Department of Health – Center for Health Development Bicol has urged various local

government unit to improve more the quality of healthcare services rendered to all pregnant

women. This program highly promotes effective strategies in improving the health and overall

wellbeing of all pregnant women in every community wherein they must receive sufficient

health services that will ensure equitable access to acceptable and high-quality maternal and

22
newborn healthcare services especially to those underprivileged women. Furthermore, this

aims to bridge the disparities in immediate accessibility to healthcare services by enabling them

to safely give birth in health facilities nearby their homes. They have also emphasized that the

community must work together in order to be able to protect the welfare of every pregnant

woman which will guarantee the protection of both the mother and the unborn child. (Ang-

Bon, 2021).

The National Maternal and Child Health Workforce Development Center’s Health

Equity Team has curated eight (8) approaches to promote health equity and will as a guidance

for the healthcare providers including the Maternal and Child Health Workforce, community

health workers and researchers in working especially in communities. The 8 Approaches

contain expand the understanding of the drivers of health and work across sectors, take a

systems approach, reflect on your own association, follow the lead of communities who witness

inequities, work with community members, decision- makers, and other stakeholders to

prioritize action, foster agency within individualities and collaborative action within groups,

identify and collect data to show where health injuries presently live to inform indifferent

investment of coffers, and be responsible to issues that reflect real advancements in people’s

lives. (Batdorf-Barnes, Calancie, Cilenti, Corbie, Mullenix, et al., 2022).

Maternal and fetal mortality rates in the Philippines especially in rural and isolated

communities are a result of understaffing in health services, lack of funds and resources in

health centers. In addition, health services are more accessible in developed urban areas than

of rural areas which is often overseen. With this, a Telemedicine approach was used for prenatal

care in reaching and accommodating more patients by analyzing the inputted information in

patient’s profile. Results showed productivity in the health care system such as faster

23
analyzation of patient’s case and visualization of possible high-risk pregnancy. (Bautista,

Quiwa, & Reyes, 2020).

One of the alarming health issues the Philippines is facing today is the increasing rise

of the maternal morbidity and mortality rate despite the implementation of health care programs

and service delivery networks. In order to slowly decrease the rate and provide the needs of the

country is to identify the factors that hinders its progress to be able to propose measures that

will contribute to the effectivity of the services. In line with this, an eight-focus group

discussion was conducted in Luzon, Philippines, participated by 78 pregnant mothers wherein

their experiences, perspectives, and suggestions were compiled and evaluated. Results shows

that utilization centers are essential in monitoring the needs of maternal health services such as

financial resources, accessible immunizations and medicines, and support to health workers.

Acknowledging this will lead to better maternal health outcomes by collaborating with local

health services. (Cagayan, Cagayan, Castro, Facun, Nisperos, et al., 2022).

Absolute healthcare can only be accomplished by the delivery of health commodities

as well as services. As a result, the Department of Health must ensure a fully operational supply

chain of medicines, vitamins, vaccines, and other health supplies that minimizes or eliminates

stock outs. The Service Delivery Network should include poor patients' access to medicines

and commodities in private facilities during stock outs. Furthermore, during material shortages

or the absence of government health workers, public transport should be made available

through the Service Delivery Network to transport poor patients to private or nongovernment

facilities with the necessary personnel. In this case, the private facilities should agree not to

charge the patient, but rather to charge the Rural Health Unit or the government facility that is

beginning to experience a stock out or a shortage of staff. (Cheng, de Vera, Farrales, Lam,

Miguel, et al., 2018).

24
 It is very important to improve the maternal and neonatal health, for that to be possible,

existing interventions related to maternal and neonatal care should be enhanced. According to

previous studies, maternal and neonatal mortality could be affected and influenced by various

factors including timely and adequate prenatal care visits. The quality of prenatal and maternal

care could be useful in the prevention, monitoring, and early detection, and treatment of

maternal health complications. It could also facilitate in the follow-up and monitoring of fetal

growth and overall maternal health. All this could enhance the maternal satisfaction and

healthcare utilization. (Debie, Geveru, & Kassaw, 2020).

Maternal health issue has been one of the most prevalent issues globally. One of its

great factors is the maternal mortality and to act with that or to improve maternal health, the

solution is mainly focused on addressing the direct causes of pregnancy-related death. The

World Health Organization has developed the Safe Childbirth Checklist to support health

workers to perform essential tasks and improve quality of care for mothers and newborns during

childbirth. The said checklist supplies the people with an organized list of evidence-based

essential birth practices targeting the major causes of maternal deaths globally. (Diba, Doria,

Monfared, Susanti, & Vollmer, 2019).

Healthcare services especially those related to prenatal and newborn care provided by

the government should be given to all citizens, however, isolated communities could be

difficult to reach. This could result to lack of access to health care services. Collaboration with

the local government and other private and international organizations are essential in order to

improve the basic health care services for maternal and child health which are to be provided

to the people living in the farthest barangay (village) in the Philippines. (Delivering Maternal

Health Services in a Remote Community in Mabini, 2018).

25
 The World Health Organization has previously published effective methods and

suggestions in order to ensure the well-being of the mother and the infant wherein specific

prenatal and postpartum services are prescribed to be carried out by pregnant women.

Furthermore, World Health Organization emphasized that all expectant mothers must adhere

to these guidelines for prenatal care where it is important that mothers should have at least a

total of 4 prenatal visits or consultations in order to ensure proper care is practiced. In line with

the established standard of quantity and periodicity of prenatal care, the World Health

Organization also further acknowledged the importance to standardize the content of prenatal

care wherein the recommended content of prenatal care has been further categorized into three

components which includes (1) assessment such as history-taking, physical examination and

laboratory tests which will help to determine the problems or risk factors, (2) health promotion

including providing advice on nutrition, planning the birth, and heightening the awareness

about the related danger signs of pregnancy and contingency planning, subsequent

contraception, and as well as breastfeeding, (3) and lastly is care provision which includes iron

and folate supplements, administration of tetanus toxoid, infant immunizations, establishment

of psychosocial support and record-keeping. (Department of Health, 2019).

Preventing maternal and neonatal mortality through antenatal care continues to be a

key public health strategy in countries like Ethiopia despite the high prevalence of pregnancy-

related complications. In this study, the determinants and magnitude of adequate utilization of

antenatal care is assessed. Findings reveals the slow progress of utilizing antenatal care

services. In order to enhance the effectiveness and safety of such services, social networks,

level of education, and support of family or spouse are some factors needed to be examined

(Gebrekirstos et al., 2021).

26
 The World Health Organization now recommends community participation in quality

improvement and health services planning and implementation in order to improve and provide

the use of skilled care for ensuring women and newborns during pregnancy, childbirth, and the

postnatal period, increase timely use of facility care for obstetric and newborn risks, and

enhance maternal and newborn health. (Howard-Grabman, Marston, Miltenburg, & Portela,

2017).

Philippine health sector is divided into private and public health sectors, the latter offers

more accessible price, often provide free consultations, medicines, and other prenatal care

services to the poor. Rural health units and village health stations are often used and visited by

people in the less fortunate sector in the society unlike those in the upper sector. However,

those mentioned health units and stations deliver a low-quality health service where the

diagnosis is poor which could result to continuous visits, medicines are limited, and the

personnel and trained practitioners are not sufficient. (Macaraeg, Vargas, & Vera Cruz, 2021).

It is generally accepted that every community must actively participate in enhancing

their own health outcomes and the Community Health Workers has a crucial role in fulfilling

this process towards achieving optimum health. The National Government have implemented

and/or began exploring national programs for Community Health Workers due to their

realization of the significant potential of Community Health Workers to better help accomplish

the established child survival goals since 2000. For instance, Ethiopia has trained hundreds of

local health extension personnel since 2003 with a focus on maternal, neonatal, and child

health. In order to better improve maternal and neonatal health, community health workers

must be able to provide quality prenatal care services and immunization as this will serve as a

firm groundwork to protect the health of both the mother and child as well as prevent the risk

of life-threatening health problems. The long distance between the local hospitals from the

27
community resident’s houses located in far-flung areas has led to a limited access to maternal

and infant healthcare services due to the lack of infrastructures of healthcare facilities nearby

their homes which makes it difficult for the expectant mothers to efficiently access prenatal and

immunization services especially in times of emergency cases. Thus, this led to establish the

important role of the community-based healthcare system in offering easier accessibility to

maternity care where expectant mothers and newborns who reside in isolated areas of the

community are guaranteed with accessible and immediate medical attention. Therefore,

community health workers must be equipped with adequate skills and knowledge that is

important in ensuring optimum maternal and child health. (Medhanyie, 2018).

Patients who wanted more antenatal care also wanted more postpartum visits, implying

that some patients may be heavy users throughout pregnancy. Apart from minor, clinically

insignificant differences in race and insurance status, few other discernible differences existed

between groups, making it difficult to identify these women as a priority. Many aspects of

prenatal care delivery lack enough evidence to back up a single approach. Instead of

recommending a one-size-fits-all prenatal care strategy for women, we presume that

customized approaches that incorporate women's preferences with medical and social needs

through shared decision-making can better manage costs, outcomes, and patient outcomes.

Current prenatal care delivery guidelines of 12 to 14 visits are likely of poor benefit to patients,

health care professionals, and health systems due to the known safety of decreased visit

schedules and the fact that the majority of patients prefer fewer visits. Patients may lose access

to appointments if they are forced to miss work or arrange childcare due to needing unnecessary

prenatal care. Still, patient-centered result, such as satisfaction with care, must be considered

in comprehensive definitions of significance. Patient preferences should be integrated into care

delivery guidelines; however, safety,) must also be considered. (Peahl, 2020).

28
 One of the factors that contributes to the decline in the safety of the mother and infant

during childbirth is the low rate in antenatal care visit. An average of 4 clinical visits is a must

to achieve safe pregnancy. In order to address this barrier, findings show factors including

social culture, level of knowledge, and geographical location can improve and encourage

pregnant women to have their antenatal care. (Putra & Prasetyo, 2022).

Rural women have considerably minimal or even completely lacking transportation

system that further renders healthcare access complicated and may contribute to the

discrepancy. The study also discovered that vast distances to health centers and a lack of media

exposure among rural women contributed to inadequate antenatal care components obtained.

Furthermore, health facilities in urban settings are better endowed with resource allocations,

which may be due to rural women's lower socioeconomic status, less accessibility, and limited

healthcare services. There should be a concerted effort to improve ease of access, availability,

and quality of antenatal care services among rural women and create awareness among key

stakeholders for adequate received antenatal care components (Shiferaw et al, 2021).

Problem in the Field

The most common problem that has been stated in the studies is mainly about the

ineffective and the poor access to a good quality prenatal care services rendered in the barangay.

There are several factors that causes the identified problem which basically limits the pregnant

mother to gain an effective prenatal care services in order to meet their specific needs during

pregnancy (Sande, 2022 and Evans, L., 2021). These include poverty, distance, lack of information,

inadequate services, lack of infrastructures and cultural practices have made it difficult for the

expectant mothers to have an easier access on prenatal care services.

According to Yamashita and Alexander (2017), various socioeconomic factors can also

negatively affect marginalized women on accessing healthcare services, especially one’s social

29
status has also been identified as a major factor that contributes to inadequate and/or lack of

accessibility to prenatal care services which affects the level of effectiveness of the rendered

prenatal care service by healthcare providers. Unfortunately, this is actually being experienced by

a lot of pregnant women who belongs in a marginalized and unprivileged sector of our country

which suppresses their basic human rights in practicing a healthy and safe pregnancy. Therefore,

due to the disadvantaged status of most women in the Philippines, it is seen to be scientifically

lowering the women’s reproductive health.

The other identified factors that led to the insufficient effectiveness of the prenatal care

services rendered by healthcare providers in the country include the lack of infrastructures of

healthcare facilities nearby their homes which makes it difficult for the expectant mothers to

efficiently access prenatal care services especially in times of emergency cases. Furthermore, it also

includes the problems in limited number of skilled health care workers, poverty, lack of

information, inadequate services, and cultural practices. According to the study, complications in

obtaining assistance are associated with low socioeconomic position, insufficient awareness about

maternity care, and low rural earnings.

According to Balahadia-Mortel & Nisperos, (2022) & Medhanyie (2018), another main

reason is the willingness of the pregnant mother to comply to prenatal care due to financial

constraints and their insufficient availability as a parent. It was also mentioned that the families

who are underprivileged and have little educational opportunity, in particular, are excluded from

accessing medical and biological healthcare services. As a result, mistrust in the healthcare system

have continuously increased. This has led for women to overlook the importance of receiving

appropriate medical attention during pregnancy, which brought a harmful impact on their pregnancy

and childbirth outcomes. Pregnant women, especially those in rural areas, need encouragement and

incentives to appreciate the need of antenatal checkups and giving birth in medical facilities. But

30
despite the available antenatal care service in the country, not all pregnant women can avail the

prenatal care service (Sande, 2022).

These inequalities highlight maternal healthcare disparities. The disparities in healthcare

particularly refers to various healthcare gaps in the availability of health-care services or health

outcomes that are deemed avoidable, unfair, and unjust. According to Macaraeg, Vargas, & Vera

Cruz (2021), the low quality of prenatal healthcare services has resulted in multiple substandard

diagnosis and as well as limited access to appropriate medical interventions. However, the

fundamental common problem in this field is predominantly about the lack of effective prenatal

care services in terms of safety and accuracy (Mabini, 2018). That is why community participation

is essential in order to be able to improve the planning and implementation of the prenatal care

services so that all expectant mothers will be provided with accurate, safe, and effective obstetric

care during pregnancy.

Research Gap

It was observed in the synthesis of the art that majority of the previous studies that have

been conducted focuses more on the accessibility and availability of health care facilities and the

overall health care services they provide and should be provided, its benefits in reducing maternal

mortality and morbidity rate, factors affecting the attitude and compliance of mothers in prenatal

visits, and the important role of Barangay Health System and Barangay Health Workers in

disseminating healthcare services to the people. Previous studies have also revealed the

consequences of lack of health services rendered in the Barangay, especially in terms of prenatal

and newborn services which is the focus of this current study.

The main subject of this present study will be the identified reproductive age women ages

17-38 and had live birth reported for the year 2021 to 2022 in Barangay Rizal St. Ilawod, Legazpi

City. Through visiting the City Health Unit of Legazpi City, the Barangay to be part of this study

31
were identified and that is the Barangay with the lowest percentage of antenatal care provided to

target identified reproductive age women in the respective barangay. Along with that, the

researchers aim to determine the prenatal care services rendered by the health care providers, its

level of effectiveness in terms of safety and accuracy, and to propose measures that will enhance

the level of effectiveness of the Prenatal Care Services rendered by Healthcare Providers.

Quantitative descriptive research design will be used as well as purposive sampling and stratified

random sampling in order to choose the respondents of this study. And a structured survey

questionnaire will be used and distributed to the respondents. Through those said sampling methods,

the researchers will be able to gather the needed and accurate data.

After a thorough review of related studies, it was identified that there was nothing yet

conducted similar study related to the said focus and subject of the present study. The researchers

were unable to find any previously conducted studies related to identifying the healthcare services

being rendered by healthcare providers specifically prenatal care services in Legazpi City, Albay.

There were also no conducted studies that focuses among Reproductive Age Women who are

residing in Barangay Rizal St. Ilawod, Legazpi City. This is the gap that the researchers is trying to

bridge to be able to further contribute to the current state of the research field.

Theories

In this part of the research study, previous theories related to the research problem of this

study has been used as a basis for generating predictions which will be helpful in identifying the

regularities of the relationships among variables.

“Motive-Facilitation Theory of Prenatal Care Access” states that the mother's motivation

to initiate and continue care is her choice, and the clinic's facilitation goal is to offer a simple, easy

accessibility to person-centered beneficial treatment. This mid-range theory engages with the

woman-clinic interface and promotes practice-level interventions that makes it easier for women to

32
start and continue prenatal treatment. It can operate as a unifying factor in the face of the numerous

variables that significantly influence an action. It has enormous potential for maximizing the

complimentary of both the mother and the clinic. In other words, if internal drive or motivation is

high enough, a woman might access care even when it may be quite difficult. However, if the

mother’s motivation is low, the degree of ease must be greater to achieve the desired behavior which

is the utilization of care.

This theory is relevant to this research study because it suggests a wide variety of methods

that doctors, nurses, and other healthcare professionals might use to envision and construct a more

effective prenatal care. The diverse attitudes of pregnant mothers seeking independent prenatal care

are operationalized in this model which is comprehensive and helpful in this study. This emphasizes

that the pregnant mothers’ level of desire for prenatal care serves as a powerful motivator and/or a

barrier to obtaining it. Knowing a mother's particular requirements and desires will help a woman

feel more motivated to have prenatal care. By using this information, the facilitators, especially

those under the supervision of the clinic staff or simply the healthcare providers, will be able to

facilitate the development of conditions that will allow women to have prenatal care in an efficient,

accurate, and safe manner. Thus, this theory can significantly be used as a guide to properly address

and resonate with the specific health needs of the mothers as well as improve, educate, and promote

more health measures in prenatal care.

“Health Belief Model” was developed to explain the failure of people in participating in

programs to prevent and detect disease and was further expanded to study people’s behavioral

response to health-related conditions. A belief-based model that focuses on the cognition of the

pregnant women with regards to their health problems and needs. The model also suggests that the

belief of a person with regards to the personal threat of an illness or disease along with their belief

in the effectiveness of the recommended health behavior or action will predict the likelihood the

person will adopt to the said behavior. The theory has several constructs which includes perceived

33
susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-

efficacy. These constructs are of use to predict why people engage in prevention, screening, and/or

controlling health conditions.

Health belief model can be applied to our research study with the use or application of the

model’s constructs. The said constructs will help us to determine what influences the participation

and attitude of pregnant woman in relation to their required prenatal care. By identifying this, we

will identify which prenatal care services were needed in order to address their needs and which

services are beneficial to their current state. Awareness of their condition and changes to their body

will enable them to perceive that they are susceptible to certain illness or disease thus their feelings

and desire in terms of accessing medical assistance will change. In this sense, pregnant women were

aware of their high susceptibility to different type of diseases because of their condition. This

awareness will lead to them weighing the seriousness of the condition and be mindful of the possible

consequences if they leave it be. With being aware, the pregnant women will weigh the benefits of

various actions available to reduce the threat of illness or disease which is the prenatal services

offered by the government. It is highly suggested that if the recommended health action was

perceived by the pregnant woman as beneficial, then the she will accept the action and participate

in it. Barriers will then be assessed; wherein this barrier affects their participation in the

recommended health action. Different stimulus experienced by the pregnant women will trigger

them and their decision-making process into accepting the recommended prenatal services. And the

model will help express how the participation and attitude of pregnant women are affected by their

confidence in their ability to successfully perform a certain behavior. These behaviors serve as

essential components of the health belief model and can be used to create new programs for illness

prevention or health promotion.

34
Conceptual Framework

This study aims to determine the various prenatal care services rendered by healthcare

providers to the Barangay Rizal St. Ilawod, Legazpi City, and as well as identify the status of the

implementation of the rendered prenatal care services in terms of safety and accuracy. In

conjunction to Motivation-Facilitation Theory of Prenatal Care Access and Health Belief Model,

this study will be able to identify the barriers that simultaneously affects the effectiveness and/or

utilization of the prenatal care services based on the model’s constructs which explains the great

impact of perception in the decision-making of pregnant women in their desire to have prenatal

care. This also suggests a significant effect in terms of ensuring the safety of the mother, the fetus

inside the mother’s womb and strictly examining the accuracy of the implementation and/or

utilization of the prenatal care services.

In line with this, a quantitative approach was used in this study wherein the various

responses and suggestions of the respondents regarding the rendered prenatal care services will be

tallied and analyzed. The researchers will conduct survey interviews to the selected reproductive

age women focusing on assessing the safety and accuracy of the prenatal care services being

rendered to them by the healthcare provider in their community.

THE MOTIVATION-FACILITATION HEALTH BELIEF MODEL BY JULIA C.

THEORY OF PRENATAL CARE BY SOCIAL PHILLIPPI, CNM, PhD & MARIAN W. ROMAN,
PSYHOLOGISTS HOCKBAUM, PhD, RN, PMHCNS-BC
ROSENSTOCK, AND OTHERS

TO DETERMINE THE TO IDENTIFY THE LEVEL

SAFETY
QUANTITATIVE PRENATAL CARE OF EFFECTIVENESS OF
DESCRIPTIVE STUDY SERVICES RENDERED BY PRENATAL CARE
THE HEALTHCARE SERVICES ACCURACY
PROVIDER

PROPOSED MEASURES

ENHANCE THE EFFECTIVENESS OF THE PRENATAL CARE SERVICES

Figure 1. Conceptual Framework Model

35
Succeeding the assessment, the researchers will interpret the results and suggestions that are tallied

and analyzed to be able to provide strategies on how to improve and enhance the implementation

of the prenatal care services based on the status of the respondents living within the community.

Therefore, the Conceptual Framework Model illustrates the general process that will serve as the

guide in addressing the problem of this research study.

METHODOLOGY

The methodology that will be used in collecting and analyzing the needed data for this research

study will include the Research Design, Sample and Setting of the study, Data Collection and

Analysis, Ethical Consideration, and Survey Questionnaire. The chosen methodology for this study

is expected to generate useful information through the process of gathering and analysis of the

collected data based on the acquired knowledge and information from the target respondents of this

study.

Research Design

A quantitative descriptive research design will be used in this research study and a

structured survey questionnaire will be used as the research instrument to collect the needed data

for this quantitative research study. Before the actual conduct of this study, a dry run will be

undertaken on five pregnant mothers at another nearby barangay of the chosen setting of this study

to identify any area that needs improvement and validation of the research instrument. The coverage

of this research study is limited only to the identified reproductive age women who had live birth

reported for the year of 2021 to 2022 in the chosen barangay of this research study. Specifically,

this will involve the process of organizing, summarizing, and presenting the collected data in an

informative way.

36
Sample and Setting

The location of this study will be conducted in Barangay Rizal St. Ilawod, Legazpi City

due to the fact that this specific barangay has accumulated the least rating in the total rendered

prenatal care services among all 44 total barangays in Legazpi City, Albay for the year of 2022,

which garnered them a total of 11% in terms of accomplishment rate in rendering prenatal care

services to pregnant mothers in their respective barangay. Given the fact that they have accumulated

the least rating among all barangays in Legazpi City, they are the most suitable location for this

study as they will best generate the information needed to be able to meet the objectives of this

current study.

Purposive sampling was employed in order to specifically identify the specific sample that

will be most effective in generating the needed data for this study. Hence, the identified target

respondents will be limited only among reproductive age women who had live birth within the year

of 2021 to 2022, specifically around 17 to 38 years old reproductive age women in Barangay Rizal

St. Ilawod, Legazpi City, regardless of complete utilization, partial utilization or even non-

utilization of the prenatal care services rendered by healthcare providers in the chosen barangay of

this study. Mothers who were currently pregnant and had a history of abortion will be excluded

from the target respondents of this study in order to avoid the possible risk of undue delivery

brought about by the discomfort of the survey interview session and psychological trauma to the

mother as they may possibly recall an unfortunate event of loss of pregnancy.

Furthermore, a Slovin’s formula using a proportionate sampling of 10% was computed

from the estimated number of Reproductive Age Women who had live births from the year of 2021

to 2022 in order to get the proportional sample size as shown in Table 1. A stratified random

sampling was also used to get the specific sample size of this research study from which the

respondents will be obtained from.

37
Table 1. Sample Size

Estimated Number of Reproductive

Proportionate Sample
Purok Age Women who had live births
Size (10%)
(2021 to 2022)
1 0 0

2 8 3

3 20 18

4 17 10

TOTAL 45 31

Purok 1 has 0 as its number of population due to the reason that it is mainly a commercial

area of Barangay Rizal St. Ilawod, Legazpi City. Followed by Purok 2 with the second least number

of population since majority in this area is composed of establishments. Whereas both Purok 3 and

4 encompasses the biggest population of reproductive age women as both Puroks have the highest

number of households with 193 and 161 total no. of households respectively. Hence, the computed

sample size of this study is about 31 respondents.

Data Collection and Analysis

The researchers of this study will make a draft of the survey questionnaire in the form of a

checklist and Likert scale which will be submitted to the researcher adviser first for checking. Once

the survey questionnaire has been approved by the researcher adviser, the researchers will write a

letter addressed to the Barangay Captain of Barangay Rizal St. Ilawod, Legazpi City in order to ask

for permission to be able to conduct the survey interview among the selected respondents of the

chosen barangay about the study entitled “Effectiveness of the Prenatal Care Services rendered by

the Health Care Providers”. The process of data collection will commence after obtaining an

approval from the Barangay Health Officers, Barangay Captain, and the Respondent’s consent. In

addition, the Barangay Health Workers will serve as survey guides during the data collection

procedure.

38
 A survey questionnaire was made based on the World Health Organization’s prenatal care

recommendations under the Department of Health Administrative Order 0035 in formulating the

survey questionnaire. The questions will be further translated into the native language of the

respondents of this study so that it will be easier for the respondents to better understand the stated

questions. The researchers will also clearly administer and explain the mechanics and concept of

the survey-questionnaire which particularly will be using a Checklist and a Likert scale. The survey-

questionnaire in the form of a checklist will contain dichotomous questions offering two options of

answers following the format of Yes or No, and as well as in the form of a Likert scale will

specifically contain a 5-point scales following the format of (1) Very Poor, (2) Poor, (3) Acceptable,

(4) Good, and (5) Very Good.

Furthermore, to ensure that there are no such errors in the collected data, data editing using

basic data checks and editing the raw research data will be conducted in order to identify and clear

out any data that could hamper the accuracy of the results of the study. After checking the obtained

data, a creation of age brackets through categorizing the collected responses in to each categorized

age brackets of the respondents will also be conducted as a means of data coding in order to easily

analyze and summarize the results of the entire survey questionnaire.

Afterwards, once all the target respondents of this study have successfully completed the

survey-questionnaire, the researchers will collect it and the collected responses will be computed,

tabulated, and interpreted. Hence, during the analysis of the data, a descriptive statistic will be used

to summarize the data and find patterns. Each response of the survey questionnaire will be tallied

using frequency counting by counting the number of times that the same responses have occurred

and will be divided over the total number of responses collected, followed by getting the percentage

of each response by multiplying the computed quotient to 100, and then ranking the responses from

lowest value to the highest value in a set of values. At the end of this study, the findings from the

analyzed data will now be presented and conclusions will be formulated from it.

39
Statistical Tool

All the obtained responses from the survey-questionnaire answered by the respondents of

this study will be carefully computed, tallied, and tabulated through the application of various

statistical tools specifically the use of Likert Scale, Mean Average, and Frequency Percentage

Distribution.

The Likert Scale will be used in this study as a rating scale in order to measure the opinions,

attitudes, or behaviors of the respondents of this study in relation to identifying the level of

effectiveness of the prenatal care services rendered by the Healthcare Providers among the

reproductive age women who had live birth within the year of 2021 – 2022 in the chosen Barangay

of this study in terms of safety and accuracy. This tool specifically consists of 5 options wherein

the Respondents are expected to choose the answer among (1) Very Poor, (2) Poor, (3)

Acceptable, (4) Good, (5) Very Good that best corresponds to how they feel regarding the level

of effectiveness of the prenatal care services rendered by Healthcare Providers in terms of safety

and accuracy. Hence, in order to get accurate findings, the words on every stated question presented

in the Likert Scale will be stated clearly, precisely and will only measure one aspect of the topic

such that the level of effectiveness in terms of safety and accuracy will be separated from one

another in order to avoid confusions or misunderstandings on the part of the respondents.

The Mean Average will be used in this study to determine the arithmetic average score of

the responses which will provide information regarding the typical score for the respondents’

perception on the level of effectiveness of the prenatal care services rendered by healthcare

providers. This is done by computing the sum of all values and divided by the total number of

values.

The Frequency Percentage Distributions will be used to present the data which will

specify the percentage of observations that exist for every data point or grouping of data points.

This method is particularly useful in expressing the relative frequency of the responses and other

40
gathered data from the survey-questionnaire. The formula to compute the frequency percentage

distribution is done by dividing the frequency of a particular response over the total number of

results and then multiply the quotient by 100 to get the percentage of each finding. Specifically,

this statistical tool is applied in determining the prenatal care services rendered by the Healthcare

Providers to reproductive age women in Barangay Rizal St. Ilawod, Legazpi City and as well as in

identifying the level of effectiveness of the prenatal care services rendered by Healthcare Providers

in terms of safety and accuracy which are shown in the Part I and Part II of the survey-questionnaire

in order to easily get the frequency and percentage of every obtained response in the first two parts

of the survey-questionnaire. At the end, the percentage rating of each response will be ranked from

the highest value down to the lowest value.

Ethical Consideration

Written informed consent will be given to every respondent of this study before the actual

survey-interview commenced. The respondents will be informed about the study's objective and

nature, advantages, and as well as potential risks or challenges in participating in this research study.

The respondents will also be instructed that anytime they feel uncomfortable or disturbed during

the conduct of the survey interview, they may refuse or withdraw from participating in the research

study without receiving any consequences or punishment from the researchers. Utmost assurance

will also be given to all the respondents wherein confidentiality of information obtained at all levels

will be maintained at all times and personal identifiers such as their real names will not be publicly

disclosed in the research study. Thus, all of the information recorded or obtained from the

respondents will be exclusively utilized for research purposes only. The researchers uphold the

value of honesty all throughout the different research parts and processes. Above all, the researchers

give great importance in respecting the work of others by giving appropriate credit to whom it

rightfully belongs in order to be able to avoid plagiarism.

41
Survey Questionnaire

Respondent No.: ____

Dear Respondent,

This survey questionnaire is all about identifying the level of effectiveness of the prenatal

care services rendered by healthcare providers in your respective barangay in terms of safety and

accuracy. This will specifically include three parts; the first part is a checklist of all the prenatal

care services being rendered by healthcare providers based on WHO’s Antenatal Care guidelines

under the DOH Administrative Order 0035; the second part used a Likert scale in order to identify

the level of the effectiveness of the prenatal care services rendered by healthcare providers in terms

of safety and accuracy; and the third part will focus on the elaboration of suggestions and/or

proposed measures to enhance the effectiveness of the prenatal care services rendered by the Health

Care Providers in Barangay Rizal St. Ilawod, Legazpi Albay.

Utmost confidentiality and privacy will be assured at all times to all the respondents during

and after the conduct of the research study, wherein specifically all of the collected data will strictly

be used for Research Purposes only and assure to never disclose the real identity of the respondents

to the public.

The Researchers,

__________________ __________________
Sofia Mikaela Balazon Jenny Borbe

__________________ __________________
Piel Mae Barcelon Alyssa Carmela Bermudo

42
 Effectiveness of the Prenatal Care Services rendered by Healthcare Providers

Name (Optional): _______________________________ Age: ________

Part I. Prenatal Care Services

Instruction: For each statement in the survey questionnaire, please kindly check (/) YES if you

have completely received the indicated Prenatal Care Service given by the healthcare providers in

your barangay during the course of your pregnancy, and NO if not received at all.

PRENATAL CARE SERVICES YES NO

I. History Taking Services
1. Asked about last menstrual period
2. Computed for expected date of delivery
3. Asked about Obstetrical History
II. Physical Examination Services
4. Vital Signs Taken such as Blood Pressure, Temperature, Respiratory
Rate, Pulse Rate and etc.
5. Assessment of nutritional status during the first trimester through
computing Body Mass Index (BMI)
6. Assessed fetal growth and movement
7. Checked for multiple pregnancy
8. Checked for oral health (dental caries and loosening)
9. Checked for thyroid enlargement
III. Laboratory Examination Services
10. Test for Hemoglobin count (Hgb ct)
11. Test for Complete Blood Count (CBC)
12. Test for Syphilis
13. Screening test for Hepatitis B
14. Screening test for HIV and Sexually transmitted infection (STI)
15. Screening test for gestational diabetes
16. Blood Typing
17. Urinalysis (proteinuria, albuminuria)
18. Stool Examination
19. Acetic Acid Wash
IV. Care Provision Services
20. First time given 2 doses of tetanus and diphtheria (Td) Vaccination
21. Second or more times given at least 3 doses of tetanus and diphtheria
(Td) vaccination (Td2 Plus)
22. Complete dose of Iron with folic acid supplementation
23. Complete dose of Calcium carbonate supplementation

43
 24. Given with Iodine capsules
25. Oral Health check-up and prophylaxis
V. Health Promotion Services
26. Buntis Class and Health Education on self-care
27. Health education on balanced and nutritional diet, and supplemental
feeding
28. Birth Plan
29. Advised on safe sex
30. Advised on healthy lifestyle

Part II. Effectiveness of the Prenatal Care Services Rendered

Instruction: Please kindly rate the level of effectiveness of the following indicated Prenatal Care

Services in terms of (a) Safety and (b) Accuracy by shading the boxes of your corresponding rating.

Likert Scale Legend:

1 – Very Poor (Indicates that the rendered prenatal care services are inaccurately done and there is

lack of safety protocols while rendering the prenatal care services before, during and after

performing the procedures.)

2 – Poor (Indicates that the rendered prenatal care services are insufficiently done in terms of

accuracy and there’s little importance given to safety protocols while rendering the prenatal care

services before, during, and after performing the procedures.)

3 – Acceptable (Indicates that the rendered prenatal care services are moderately done in terms of

accuracy and there’s moderate importance given to safety protocols while rendering the prenatal

care services before, during, and after performing the procedures.)

4 – Good (Indicates that the rendered prenatal care services are done with good accuracy and has

given good importance in administering safety protocols before, during and after performing the

procedures.)

44
5 – Very Good (Indicates that the rendered prenatal care services are done with complete accuracy

and complete safety protocols before, during, and after performing the procedures.)

A. Level of Effectiveness of the Prenatal Care Services rendered by Healthcare Providers

in terms of Safety

Questions 1 2 3 4 5
1. How safe is the environment in terms of the aspects of
sanitation before, during and after performing the
procedures in every prenatal care services you have
received?

(Gaano kaligtas ang kapaligiran sa aspeto ng kalinisan bago, habang, at

pagkatapos ginawa ang mga hakbang sa bawat serbisyong iyong
natanggap?)
2. How safe are the equipment used in the aspect of sanitation
before, during, and after performing the procedures in each
rendered prenatal care services?

(Gaano kaligtas ang mga ginamit na kagamitan sa aspeto ng kalinisan

bago, habang, at pagkatapos ginawa ang mga hakbang ng bawat
serbisyong iyong natanggap?)
3. Based on your experience with regards to the rendered
prenatal care services you have received, what is your level
of knowledge about the safety of the procedures done in each
service provided by the barangay health care providers?

(Base sa iyong karanasan ukol sa mga ibinigay na serbisyong iyong

natanggap noong ikaw ay buntis, ano ang antas ng iyong kaalaman
tungkol sa kaligtasan ng mga hakbang na isinagawa sa bawat serbisyong
ibinigay ng mga healthcare providers sa inyong barangay?)
4. Did you feel safe and comfortable with the barangay
healthcare provider assigned as they rendered the prenatal
care services you have received?

(Naramdaman mo bang ikaw ay ligtas at nasa maayos na kalagayan sa

pangangalaga ng mga healthcare providers sa inyong barangay habang
isinasagawa nila ang mga hakbang ng bawat serbisyong pangangalaga
sa buntis na iyong natanggap?)
5. Did you feel anxious before/ during and/or after receiving
each prenatal care services rendered by the barangay
healthcare provider?

(Naramdaman mo bang ikaw ay hindi komportable at hindi mapakali

bago/ habang at/o pagkatapos mo matanggap ang mga serbisyong
pangangalaga sa buntis ibinigay ng mga healthcare providers sa inyong
barangay?)

45
 6. Were you informed and guided properly about the
procedures, benefits, and potential risks before/ during/
and/or after receiving the prenatal care services rendered by
the healthcare providers?

(Nabigyan ka ba ng sapat at tamang impormasyon patungkol sa mga

hakbang na isasagawa, kaakibat na benepisyo at posibleng problema na
iyong mararanasan bago, habang at pagkatapos matanggap mo ang mga
serbisyo?)
7. How satisfied are you in the prenatal care services rendered
by healthcare providers in terms of safety in your barangay?

(Gaano ka kakuntento sa mga serbisyong pangangalaga sa mga buntis

na ibinigay ng mga healthcare providers sa inyong barangay ukol sa
aspeto ng pangkaligtasan?)
8. Are your personal space and privacy have been given
importance and respect by the barangay healthcare
providers without violating your rights in the application of
performing the necessary procedures in the rendered
prenatal care services?

(Sa iyong palagay, nabibigyan ba ng karampatang importansya at

respeto ng mga healthcare providers sa inyong barangay ang iyong
pansarili at pribadong buhay ng walang paglabag sa iyong mga
karapatang-pantao habang isinasagawa ang mga hakbang ng mga
serbisyong iyong natanggap?)
9. Are your cultural and religious beliefs have been considered
and respected by the barangay healthcare providers in the
application of performing the necessary procedures in the
rendered prenatal care services?

(Sa iyong palagay, nabibigyan ba ng karampatang respeto at

konsiderasyon ng mga healthcare providers sa inyong barangay ang
iyong relihiyon at kulturang paniniwala habang isinasagawa ang mga
hakbang ukol sa pangangalaga ng mga buntis?)

10. Do you find difficulty in discussing personal health issues

and concerns such as HIV, Pregnancy, and other similar
confidential matters with your healthcare provider?

(Nahihirapan ka bang ibahagi sa iyong healthcare provider ang mga

personal na pangkalusugang problema kagaya ng HIV, Pregnancy, at iba
pang konpidensyal na isyu?)

46
B. Level of Effectiveness of the Prenatal Care Services rendered by Healthcare Providers
in terms of Accuracy

Questions 1 2 3 4 5
1. Based on what you’ve experienced on the received prenatal
care services rendered by the barangay healthcare
providers, have you encountered any issues or problems
with regards to the procedures done before/ during and/or
after receiving the services in terms of accuracy?

(Base sa iyong karanasan ukol sa natanggap na mga serbisyong

pangangalagasa buntis na isinagawa ng mga healthcare providers sa
inyong barangay, ano-ano ang mga isyu o problemang iyong kinaharap
sa mga hakbang na isinagawa bago/ habang at/o pagkatapos matanggap
ang mga serbisyo sa aspeto ng “accuracy” ?)
2. How detailed are the barangay healthcare providers in
terms of providing accurate information on planning for
safe birth, pregnancy self-care, and dealing with
emergencies or health issues of pregnancy?

(Gaano kadetalyado ang mga healthcare providers sa inyong barangay

sa pagbabahagi ng tamang impormasyon sa iyo patungkol sa ligtas na
panganganak, pangangalaga sa sarili sa mga panahong buntis, at
paglutas ng mga isyung ukol sa kalusugan sa panahong buntis ang isang
babae?)
3. How accurate are the results of the different diagnostic and
laboratory tests rendered as part of prenatal care services
that you have undertaken in terms of providing valuable
information about yours and the fetus’ health status?

(Gaano katumpak ang mga resulta ng iba’t-ibang diagnostic at

laboratory tests na isinagawa bilang bahagi ng mga serbisyong
pangangalaga sa buntis na iyong natanggap patungkol sa pagbibigay ng
mahahalagang impormasyon sa kalusugan mo at ng fetus?)
4. How accurate and clear is your understanding about the
following potential risks and benefits of each prenatal care
service that you have received?

(Gaano katumpak at kalinaw ang iyong kaalaman patungkol sa mga

posibleng isyu o problema na mararanasan at benepisyo ng bawat
serbisyong pangangalaga sa buntis na iyong natanggap?
5. How effective are the barangay healthcare providers in
performing all the necessary care provision procedures of
the prenatal care services before/ during and/or after
receiving it in terms of accuracy?

(Gaano kaepektibo ang mga healthcare providers sa inyong barangay sa

pagsasagawa ng mga importanteng hakbang ng mga serbisyong
pangangalaga sa buntis bago/ habang at/o pagkatapos matanggap ito sa
aspeto ng tumpak na pagsasagawa?)

47
 6. How well did your healthcare provider in your barangay
performed the procedures of the prenatal care services that
you have received in terms of accurate skills and
knowledge?

(Gaano kahusay ang mga healthcare providers sa inyong barangay sa

pagsasagawa ng mga hakbang ng mga serbisyong pangangalaga sa
buntis na iyong natanggap sa aspeto ng tumpak na karunungan at
kaalaman?)
7. How precise is your barangay healthcare provider in
assessing the critical variables that you have encountered
during your pregnancy?

(Gaano kasigurado ang iyong healthcare provider sa inyong barangay sa

pagsasagawa ng assessment sa mga kritikal na bagay na iyong kinaharap
noong ikaw ay buntis?)
8. How satisfied are you with your experience about the
prenatal care services rendered by the healthcare providers
in your barangay health unit in terms of accurate execution
of procedures?

(Gaano ka kakuntento sa iyong mga karanasan ukol sa iyong natanggap

na serbisyong pangangalaga sa buntis na ibinigay ng healthcare
providers sa inyo Barangay Health Unit ukol sa aspetong tumpak na
pagsasagawa ng mga hakbang nito?)
9. How accurate is your healthcare provider in your barangay
in terms of addressing your physical needs and as well as to
your unborn fetus during pregnancy?

(Gaano katumpak at kahusay ang mga healthcare providers sa inyong

barangay ukol sa pagpunan ng mga pisikal na pangangailangan mo sa
mga panahong ikaw ay buntis?)
10. How accurate is your healthcare provider in your barangay in
terms of addressing your mental and emotional needs during
pregnancy?

(Gaano katumpak ang iyong healthcare provider sa inyong barangay

ukol sa pagpunan ng mga emosyonal at mental na pangangailangan mo
sa mga panahong ikaw ay buntis?)

Part III. Proposed Measures to enhance the level of effectiveness in rendering Prenatal Care

Services

Instruction: Please kindly state and elaborate your suggestions on how would the rendered

Prenatal Care Services by the Health Care Providers can be further enhanced in order to safely and

accurately meet the needs of pregnant women in your Barangay.

48
 What measures can you propose or suggest to be able to enhance the

effectiveness of the Prenatal Care Services rendered by the healthcare providers in

your barangay?

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

49
 RESULTS AND DISCUSSION

The following data presented in this part of the study are the results interpreted from the obtained

answers of the respondents in the survey-interview questionnaire. Specifically, the data were

gathered from a total of 31 respondents in Barangay Rizal St. Ilawod, Legazpi City wherein the

respondents was limited only within 17 to 38 years old reproductive age women who had live birth

in the previous years of 2021 to 2022. The results of this study will present the list of the utilized

prenatal care services of the respondents of this study rendered by the healthcare providers, the level

of effectiveness of the prenatal care services in terms of safety and accuracy, and as well as the

proposed measures in enhancing the effectiveness of the prenatal care services rendered by

healthcare providers in terms of safety and accuracy.

PRESENTATION OF FINDINGS

I. The Utilization of Prenatal Care Services by Pregnant Mothers in Barangay Rizal St.

Ilawod, Legazpi City, Albay

The following data presented in each table below (Figures 1-5) shows the frequency and

percentage of the respondents’ tallied answers according to the selected variables by tabulating all

the gathered information. Whereas, the results of the survey-interview conducted in this current

study has shown that the tallied results from the answers of the respondents, particularly ages 17 to

38 years old reproductive age women in Barangay Rizal St. Ilawod, Legazpi City, have resulted to

different levels of percentage of utilization on 5 different aspects of services that is generally

included in the prenatal care services rendered by the health care providers in their barangay. The

assigned registered midwife and a registered nurse under the government’s Nurse Deployment

Program (NDP) for every barangay is the one in-charge of ensuring that pregnant mothers in every

50
barangay are provided with prenatal care services based on WHO’s Antenatal Care guidelines under

the DOH Administrative Order 0035 that are indeed essential in achieving a safe and optimum

pregnancy of the pregnant mother. The Prenatal Care Services rendered by Health Care Providers

covers the overall health assessment of pregnant mothers which specifically includes 5 different

aspects such as history taking, physical examination services, laboratory examination services, care

provision services, and health promotion services.

History Taking Services

On History Taking (Figure 1), there were total of 30 (97%) respondents who answered Yes

in asked about last menstrual period and 1 (3%) respondent answered for No, a total of 27 (87%)

answered Yes for Computed Expected Delivery Date and 4 (13%) respondents answered for No,

and about 24 (77%) answered Yes for obtained Obstetrical History and 7 (23%) respondents for

No.

Physical Examination Services

On Physical Examination Services (Figure 2), 27 (87%) among the total respondents

answered Yes for complete vital signs taken and 4 (13%) respondents answered No, about 26 (84%)

answered Yes for computed Body Mass Index (BMI) and 5 (16%) respondents answered for No,

27 (87%) respondents answered Yes for assessed fetal growth and movement while about 4 (13%)

respondents answered No for it, about 28 (90%) respondents answered Yes for checked for multiple

pregnancy and only 3 (10%) respondents answered for No, about 22 (71%) respondents answered

Yes for checked for oral health and 9 (29%) respondents answered for No, and about 15 (48%)

respondents answered Yes for assessed for thyroid enlargement while 16 (52%) respondents

answered No.

51
Laboratory Examination Services

On laboratory examination services (Figure 3), a total of 24 (77%) respondents answered

Yes in tested for Hemoglobin Count and 7 (23%) respondents answered for No, about 27 (87%)

respondents answered Yes in tested for Complete Blood Count (CBC) and only 4 (13%)

respondents answered for No, about 20 (65%) respondents answered Yes in tested for Syphilis and

11 (35%) respondents for No, 22 (71%) respondents answered Yes in given Screening Test for

Hepatitis B and 9 (29%) respondents answered for No, 24 (77%) respondents answered Yes in

given Screening test for HIV and Sexually Transmitted Infection (STI) and 7 (23%) respondents

answered for No, about 20 (65%) respondents answered Yes in given Screening test for Gestational

Diabetes and 11 (35%) respondents answered for No, 22 (71%) respondents answered Yes in given

test for Blood Typing and 9 (29%) respondents answered for No, about 27 (87%) respondents

answered Yes in given test for Urinalysis and only 4 (13%) respondents answered No, 18 (58%)

respondents answered Yes in given test for Stool Examination and 13 (42%) respondents answered

for No, and there were about 15 (48%) respondents answered Yes in given test for Acetic Acid

Wash and 16 (52%) respondents answered for No.

Care Provision Services

On Care Provision Services (Figure 4), a total of 31 (100%) respondents answered Yes in

given 2 doses of tetanus and diphtheria (Td) Vaccination for the first time, about 26 (84%)

respondents answered Yes in given at least 3 doses of tetanus and diphtheria (Td) vaccination (Td2

Plus) for the second time and only 5 (16%) respondents for No, 29 (94%) respondents answered

Yes in given complete dose of Iron with folic acid supplementation and 2 (6%) respondents only

answered for No, about 29 (94%) respondents as well answered Yes in given complete dose of

Calcium carbonate supplementation and only 2 (6%) respondents answered for No, 20 (65%)

52
respondents answered Yes in given with Iodine capsules and 11 (35%) respondents answered for

No, and about 20 (65%) respondents as well answered Yes in checked for Oral Health and

Prophylaxis and 11 (35%) respondents answered for No.

Health Promotion Services

On Health Promotion Services (Figure 5), about 22 (71%) respondents answered Yes in

provided with Buntis class and health education on self-care and 9 (29%) respondents answered for

No, 24 (77%) respondents answered Yes in provided with health education on balanced and

nutritional diet, and supplemental feeding and there were about 7 (23%) respondents who answered

for No, 25 (81%) respondents answered Yes in given health education regarding birth planning and

6 (19%) respondents only answered for No, 26 (84%) respondents answered Yes in given advise

on practicing safe sex and 5 (16%) respondents answered for No, and about 28 (90%) respondents

answered Yes in given advise on practicing healthy lifestyle and there were still 3 (10%) among the

total respondents who answered for No.

History Taking
(% Percentage of Utilization)
120%

97%
100%
87%
77%
80%

60%

40%
23%
20% 13%
3%
0%
Asked about last menstrual period Computed Expected Delivery Date Asked about Obstetrical History

YES NO

53
0% - 20% - Very Poor Utilization (VP); 21% - 40% - Poor Utilization (P); 41% - 60%

Acceptable Utilization (A); 61% - 80% - Good Utilization (G); 81% - 100% - Very Good

Utilization (VG).

Figure 1. Percentage of the utilization of Prenatal Care Services under History Taking Services

rendered by Health Care Providers among 17 to 38 years old reproductive age women who had live

birth in the year of 2021 – 2022 in Barangay Rizal St. Ilawod, Legazpi City.

Physical Examination Services

(% Percentage of Utilization)
100%
90%
90% 87% 87%
84%
80%
71%
70%

60%
52%
48%
50%

40%
29%
30%

20% 16%
13% 13%
10%
10%

0%
Complete Vital Computed Body Assessed Fetal Checked for Checked for Oral Assessed for
Signs Taken Mass Index (BMI) Growth and Multiple Health Thyroid
Movement Pregnancy Enlargement

YES NO

0% - 20% - Very Poor Utilization (VP); 21% - 40% - Poor Utilization (P); 41% - 60%

Acceptable Utilization (A); 61% - 80% - Good Utilization (G); 81% - 100% - Very Good

Utilization (VG).

54
Figure 2. Percentage of the utilization of Prenatal Care Services under Physical Examination

Services rendered by Health Care Providers among 17 to 38 years old reproductive age women

who had live birth in the year of 2021 – 2022 in Barangay Rizal St. Ilawod, Legazpi City.

Laboratory Examination Services

(% Percentage of Utilization)
100%
90%
87% 87%
77% 77%
80%
71% 71%
70% 65% 65%
58%
60% 52%
48%
50% 42%
40% 35% 35%
29% 29%
30% 23% 23%
20% 13% 13%
10%
0%

YES NO

0% - 20% - Very Poor Utilization (VP); 21% - 40% - Poor Utilization (P); 41% - 60%

Acceptable Utilization (A); 61% - 80% - Good Utilization (G); 81% - 100% - Very Good

Utilization (VG).

Figure 3. Percentage of the utilization of Prenatal Care Services under Laboratory Examination

Services rendered by Health Care Providers among 17 to 38 years old reproductive age women who

had live birth in the year of 2021 – 2022 in Barangay Rizal St. Ilawod, Legazpi City.

55
 Care Provision Services
(% Percentage of Utilization)
120%

100%
100% 94% 94%
84%
80%
65% 65%

60%

40% 35% 35%

20% 16%
6% 6%
0%
0%
Given 2 doses of Given at least 3 Given Complete Given Complete Given with Checked for Oral
Tetanus and doses of Tetanus Dose of Iron with Dose of Calcium Iodine Capsules Health and
Diphtheria and Diphtheria Folic Acid Carbonate Prophylaxis
Vaccine for the Vaccination for Supplementation Supplementation
1st time the 2nd time

YES NO

0% - 20% - Very Poor Utilization (VP); 21% - 40% - Poor Utilization (P); 41% - 60%

Acceptable Utilization (A); 61% - 80% - Good Utilization (G); 81% - 100% - Very Good

Utilization (VG).

Figure 4. Percentage of the utilization of Prenatal Care Services under Care Provision Services

rendered by Health Care Providers among 17 to 38 years old reproductive age women who had live

birth in the year of 2021 – 2022 in Barangay Rizal St. Ilawod, Legazpi City.

56
 Health Promotion Services
(% Percentage of Utilization)
100%
90%
90%
84%
81%
80% 77%
71%
70%

60%

50%

40%

29%
30%
23%
19%
20% 16%
10%
10%

0%
Provided with Buntis Provided with Health Educated with Birth Advised on Safe Sex Advised on Healthy
Class and Health Education on Planning Lifestyle
Education on self- Balanced and
care nutritional diet

YES NO

0% - 20% - Very Poor Utilization (VP); 21% - 40% - Poor Utilization (P); 41% - 60%

Acceptable Utilization (A); 61% - 80% - Good Utilization (G); 81% - 100% - Very Good

Utilization (VG).

Figure 5. Percentage of the utilization of Prenatal Care Services under Health Promotion Services

rendered by Health Care Providers among 17 to 38 years old reproductive age women who had live

birth in the year of 2021 – 2022 in Barangay Rizal St. Ilawod, Legazpi City.

57
II. The level of Effectiveness of the Prenatal Care Services rendered by Health Care

Providers to the Respondents of this study in terms of Safety & Accuracy

The respondents of this study have also given their individual perceptions and assessment

with regards to the effectiveness of the Prenatal Care Services rendered by the Health Care

Providers in their Barangay in terms of Safety and Accuracy. In order to determine the level of

effectiveness of all the prenatal care services rendered by the Health Care Providers in terms of

safety and accuracy respectively, a Likert scale has been used to allow the respondents to give their

assessment on how effective are the rendered prenatal care services by answering 10 questions

related to safety and accuracy through a 1 to 5 rating scale.

In this part, it will deal with the presentation and analysis of the data specifically collected

from the field. This will also specifically present the summary of the findings after the analysis.

The discussions of data analysis and implementations of the findings in the study are to be discussed

afterwards. The raw data and the calculations will be presented in the appendix III.

Statistical Procedure for Mean Rating Average

The statistical procedures are discussed as following: the collected questionnaires have

been arranged and tallied in order to get the total number of each item in following the order; Very

Good (VG) which is equivalent to 5 points; Good (G) equivalent to 4 points; Acceptable (A)

equivalent to 3 points; Poor (P) equivalent to 2 points; and Very Poor (VP) equivalent to 1 point.

Take note that n.o. will stand for “number of”

• In order to get the mean:

(5 x n.o. VG) + (4 x n.o. G) + (3 x n.o. A) + (2 x n.o. P) + (1 x n.o. VP) then divide the number

of respondents (n) = mean

58
 • In order to get the Standard Deviation, use the scientific calculator as follows:

Press √ and then press the value of the mean.

For example:

VG = 0, G = 0, A = 45, P = 34, VP = 50

• Mean = (5 x 0) + (4 x 0) + (3 x 45) + (2 x 34) + (1 x 50) and then divide by the number of

respondents (n) = 129

Mean = 253 divided by 129

Mean = 1.961 or 1.96

The concepts of the mean and standard deviation (sd) are explained briefly below:

• Mean – This simply refers to the arithmetic average of the scores that is specifically

obtained through dividing the sum of the scores by the total number of the scores.

• Standard Deviation (sd) – This is simply the most commonly used measure of variability.

It is because it is the most reliable estimate of variability and it is also employed in

numerous other statistical calculations. Hence, it provides some sort of the average of all

the deviations from the mean.

A. Level of Effectiveness of the rendered Prenatal Care Services in terms of Safety

Presented below are the total number of scores for each item in every rating based from the

tallied answers of the respondents by tabulating all the gathered information. Furthermore, the first

research question that has been assessed in this study is determining the level of effectiveness of

the rendered prenatal care services in terms of Safety which were answered by obtaining the

statistical weighted average mean as shown in Table 2.

59
 Total Number Of:

(n.o.) Standard
S/N Questions Mean
VG G A P VP Deviation

(5) (4) (3) (2) (1)

1 How safe is the environment in

terms of the aspects of sanitation 4.225 or 2.056 or
before, during and after 15 11 2 3 0
performing the procedures in 4.23 2.06
every prenatal care services you
have received?
2 How safe are the equipment used
4.322 or 2.078 or
in the aspect of sanitation before,
20 4 5 1 1
during, and after performing the
4.32 2.08
procedures in each rendered
prenatal care services?
3 Based on your experience with
regards to the rendered prenatal
care services you have received, 4.354 or 2.085 or
what is your level of knowledge 19 7 2 3 0
about the safety of the 4.35 2.09
procedures done in each service
provided by the barangay health
care providers?
4 Did you feel safe and
4.612 or 2.147 or
comfortable with the barangay
25 3 1 1 1
healthcare provider assigned as
4.61 2.15
they rendered the prenatal care
services you have received?
5 Did you feel anxious before/
2.870 or 1.694 or
during and/or after receiving
8 5 4 3 11
each prenatal care services
2.87 1.69
rendered by the barangay
healthcare provider?
6 Were you informed and guided
properly about the procedures,
4.290 or 2.071 or
benefits, and potential risks
19 6 4 0 2
before/ during/ and/or after
4.29 2.07
receiving the prenatal care
services rendered by the
healthcare providers?
7 How satisfied are you in the 4.387 or 2.092 or
prenatal care services rendered 22 5 1 1 1
by healthcare providers in terms 4.38 2.09
of safety in your barangay?

60
 8 Are your personal space and
privacy have been given
importance and respect by the 4.322 or 2.078 or
barangay healthcare providers 21 5 2 0 3
without violating your rights in 4.32 2.08
the application of performing the
necessary procedures in the
rendered prenatal care services?
9 Are your cultural and religious
beliefs have been considered and
4.516 or 2.126 or
respected by the barangay
24 3 1 2 1
healthcare providers in the
4.52 2.13
application of performing the
necessary procedures in the
rendered prenatal care services?
10 Do you find difficulty in
discussing personal health issues 3.290 or 1.813 or
and concerns such as HIV, 12 6 2 2 8
Pregnancy, and other similar 3.29 1.81
confidential matters with your
healthcare provider?

Table 2. Mean Scores of the level of effectiveness of the Prenatal Care Services rendered by Health

Care Providers on reproductive age women (ages 17-38 years old) in terms of Safety.

B. Level of Effectiveness of the rendered Prenatal Care Services in terms of Accuracy

Presented below are the total number of scores for each item in every rating based from the

tallied answers of the respondents by tabulating all the gathered information. Furthermore, the

second research question that has been assessed in this study is determining the level of

effectiveness of the rendered prenatal care services in terms of Accuracy which were answered by

obtaining the statistical weighted average mean as shown in Table 3.

Total Number Of:

(n.o.) Standard
S/N Questions Mean
VG G A P VP Deviation

(5) (4) (3) (2) (1)

61
1 Based on what you’ve
experienced on the received
prenatal care services rendered
by the barangay healthcare 3.129 or 1.769 or
providers, have you encountered 7 11 2 1 10
any issues or problems with 3.13 1.77
regards to the procedures done
before/ during and/or after
receiving the services in terms of
accuracy?
2 How detailed are the barangay
healthcare providers in terms of
4.322 or 2.078 or
providing accurate information
18 10 1 0 1
on planning for safe birth,
4.32 2.08
pregnancy self-care, and dealing
with emergencies or health issues
of pregnancy?
3 How accurate are the results of
the different diagnostic and
laboratory tests rendered as part 4.322 or 2.078 or
of prenatal care services that you 20 6 2 1 2
have undertaken in terms of 4.32 2.08
providing valuable information
about yours and the fetus’ health
status?
4 How accurate and clear is your
4.451 or 2.109 or
understanding about the
19 10 0 1 1
following potential risks and
4.45 2.11
benefits of each prenatal care
service that you have received?
5 How effective are the barangay
healthcare providers in
4.322 or 2.078 or
performing all the necessary care
18 9 2 0 2
provision procedures of the
4.32 2.08
prenatal care services before/
during and/or after receiving it in
terms of accuracy?
6 How well did your healthcare
provider in your barangay 4.580 or 2.140 or
performed the procedures of the 22 7 1 0 1
prenatal care services that you 4.58 2.14
have received in terms of
accurate skills and knowledge?
7 How precise is your barangay
4.451 or 2.109 or
healthcare provider in assessing
22 6 1 0 1
the critical variables that you
4.45 2.11
have encountered during your
pregnancy?

62
 8 How satisfied are you with your
experience about the prenatal
4.870 or 2.206 or
care services rendered by the
26 5 0 0 1
healthcare providers in your
4.87 2.21
barangay health unit in terms of
accurate execution of
procedures?
9 How accurate is your healthcare
provider in your barangay in 4.451 or 2.109 or
terms of addressing your 21 8 0 0 1
physical needs and as well as to 4.45 2.11
your unborn fetus during
pregnancy?
10 How accurate is your healthcare
3.935 or 1.984 or
provider in your barangay in
15 9 2 1 3
terms of addressing your mental
3.94 1.98
and emotional needs during
pregnancy?

Table 3. Mean Scores of the level of effectiveness of the Prenatal Care Services rendered by Health

Care Providers on reproductive age women (ages 17-38 years old) in terms of Accuracy.

III. The proposed measures to enhance the level of effectiveness of the Prenatal Care

Services rendered by Health Care Providers

The respondents of this current study have proposed various measures based on the various

issues they have faced when seeking the Prenatal Care Services rendered by Health Care Providers

in their Barangay in order to enhance its level of effectiveness particularly in terms of Safety and

Accuracy. There were some respondents who choose not to give any suggestions due to the fact

that they are already satisfied with the rendered prenatal care services to them, however, majority

of the respondents gave their suggestions with regards to enhancing the level of effectiveness of the

Prenatal Care Services rendered by Health Care Providers. The most commonly suggested

measures by the respondents of this study to enhance the level of effectiveness of the Prenatal

Care Services rendered by Health Care Providers are shown below.

63
Respondent 1: Kung sakali na mapaiwas su facility kasi medyo sadayot. Dae nagkakasya

pagdakol nagpapacheck-up na bados.

Translation 1: “It would be better to make the facilities wider for it to become more

spacious since the current space is not enough to accommodate all pregnant women who are having

their prenatal check-up all at once.”

Respondent 2: Pagpapaliwanag ng mabuti sa mas simpleng salita ang mga laboratory tests

procedures pati yung mga resulta para naman mas maintindihan namin.

Translation 2: “Properly explain in a simpler language all the necessary information

about the laboratory tests procedures to be done and as well as the indications of its results to help

us better understand it.”

Respondent 3: Dapat palaging maayos at updated ang schedule nila para alam namin kung

kailan kami dapat pumunta.

Translation 3: “Their schedule must be properly organized so that we will be able to know

our correct schedule of prenatal care check-up. It will help us to know when are we going to go to

the barangay health care facility if only the schedules were properly updated and organized.”

Respondent 4: Mas marami pang maibigay na sapat na payo para sa mga madadali mag-

buntis

Translation 4: “Give more health advice (such as safe sex and birth plan) to those women

who are easily impregnated.”

Respondent 5: Madalas late ang mga staff, dapat hindi ganun dapat maging maaga sila.

Dapat ayusin din nila yung kilohan ng baby kasi luma na.

64
Translation 5: “The health care staff are often late, but it shouldn’t be that way, they have

to come earlier instead. They should also check whether the weighing scale for baby is still working

correctly since it’s too old already and fix it if there are any malfunctions with it already.”

Respondent 6: Dapat mas mauna sila sa pagpasok para mas mabigyan ng tamang pansin

ang mga buntis na nagpapacheck-up sa kanila kasi minsan 30 minutes na wara pa sinda.

Translation 6: “They should have come earlier than us to give proper and adequate care

and medical attention to all pregnant mothers seeking for prenatal check-up. Since most of the time,

even though 30 minutes have already passed, the healthcare providers were still not around.”

Respondent 7: Sundin nila ang tamang schedule na ginawa nila para dae magkarilibong.

Translation 7: “They should properly follow the correct schedule to avoid confusions.”

Respondent 8: Iimprove pa ninda su availability kang mga bulong na kaipuhan kang mga

bados.

Translation 8: “They should improve more the availability of the needed medicines for

adequate supply to all pregnant mothers who need it.”

Respondent 9: Maging humble sila sa pagbibigay ng mga instructions sa amin at sana mas

maging malinis pa sana ang facility nila.

Translation 9: “They should be humble when giving instructions to us and I hope they

can make the facilities cleaner.”

Respondent 10: Sana consistent yung pagbibigay ng services nila para mas matulungan ang

mga buntis.

Translation 10: “I hope they can be more consistent in providing the prenatal care services

to help all pregnant women.”

65
DISCUSSION OF RESULTS

This part of the study presents all the interpretation and discussion of each presented result

above. These will serve as the basis for the Summary of the Findings.

I. The Utilization of the Prenatal Care Services rendered to Pregnant Mothers in

Barangay Rizal St. Ilawod, Legazpi City

History-Taking Services

During the health assessment, the midwife or the assigned nurse in their barangay inquired

first about the pregnant mother’s medical history under the history taking services included in the

Prenatal Care Services being rendered. The history-taking assessment began with interviewing the

pregnant mothers regarding their current and as well as their previous pregnancies or obstetric

history which includes their last menstrual period, computation of the expected delivery date, and

obstetrical history of the pregnant mother.

The history-taking has established rapport and trust between the Health Care Provider and

the pregnant mother. It entailed good communication skills from the Health Care Provider while

taking the obstetrical history of the pregnant mothers, whereas based on the results, the respondents

attested very good utilization of the prenatal care services on history-taking.

Physical Examination Services

The Physical Examination Services rendered by Health Care Providers proceeded after

conducting a thorough history taking during Prenatal Check-up. This basically involves the

computation of the Body Mass Index (BMI), taking of blood pressure of the pregnant mother,

assessing fetal growth and movement, checking for multiple pregnancies, checking of oral health

and assessment for thyroid enlargement. Based on the results, the poor to good utilization of

66
reproductive age women in Barangay Rizal St. Ilawod Legazpi City for checking of oral health and

assessment for thyroid enlargement reflected a low percentage of mothers who received the care.

Furthermore, the Dental Health Program of the Department of Health (DOH), as mandated

by the AO 2007-0007 of the DOH, it covers the fact that every lifecycle group should be provided

with the basic oral health care package either in health facilities, schools, and etc. wherein it

includes oral examination, oral prophylaxis, permanent fillings, gum treatment health instruction.

However, the respondents of this current study have affirmed that they didn’t receive regular dental

examinations. The problem is due to the lack of adequate dentists in every city or barangay; hence,

it was impossible to conduct routine dental examinations regularly for pregnant mothers.

In addition to this, it was also known that pregnancy brings various physiologic changes

which may also result in changes in the oral cavity of the pregnant mother. According to the

American College of Obstetrician and Gynecologists, these physiological changes in the oral cavity

of the pregnant mother include pregnancy gingivitis, benign oral lesions, tooth mobility, tooth

erosion, dental caries, and severe gum infection. Therefore, it is indeed essential to conduct routine

oral examination on pregnant women during antenatal care. This emphasizes the important role of

nurses and midwives in helping the dentist through providing health education that specifically

about the different changes in the gums and teeth during pregnancy in order to be able to reinforce

good oral health habits which will greatly help to keep the gums and teeth healthier. Nonetheless,

an addition number of dentists is still highly needed in order to be able to perform the routine oral

examinations which can improve the dental care services being rendered by health care providers

especially among pregnant mothers.

The respondents of this study also didn’t receive examination of their necks for the

assessment of thyroid enlargement. Based on the tabulated results presented, the majority of the

respondents of this study confirmed that they did not know they needed to include thyroid

examination in prenatal care. This makes it critical since a pregnant mother with no thyroid

67
examination is more likely vulnerable to developing fetal abnormalities. The possibility of fetal

abnormalities occurrence can’t be prevented easily due to the lack of needed examinations including

thyroid examination to ensure optimum health of the pregnant mother. Furthermore, thyroid

dysfunction is more common in women during early pregnancy due to the fact that pregnancy

increases thyroid activity and lacking or in excess of the thyroid hormone during pregnancy can

result to health complications. Therefore, the importance of neck palpitation and overall assessment

of the neck during Prenatal Care Visit of the pregnant mother must always be included as part of

the physical examination procedures.

Laboratory Examination Services

The respondents of this study were also examined through laboratory tests which included

the Hemoglobin Count (Hgb ct), Complete Blood Count (CBC), Urinalysis, (for proteinuria and

albuminuria), Test for Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections

(STI), Blood Typing, Syphilis, Acetic Acid Wash and Stool Examination. Under the DOH AO

2016-0035 on the Guidelines on the Provision of Quality Antenatal Care in all birthing centers and

Health Care Facilities that provides maternity care services, these indicated laboratory tests must

be performed during the first prenatal care visit of the pregnant mother which is about 8 to 12 weeks

of the pregnancy. Basically, these laboratory tests are important for the Health Care Providers in

identifying possible abnormalities or pregnancy complications. Unfortunately, based on the

tabulated results, the respondents attested that the acetic acid wash test followed by the stool

examination were the least done among all the laboratory tests that must be performed during

pregnancy.

The Acetic Acid Wash is actually a visual inspection with the use of Acetic Acid. Through

the naked eye inspection of the cervix after the application of about 3-5% of acetic acid, the

healthcare provider will use a good source of light in order to check for any sign of cervical cancer

68
and decide on treatment or referral for further diagnostic work. This test doesn’t require anesthesia

and it is generally safe, rapid, reliable and inexpensive. Another test that is Poorly utilized based on

the tallied results was the stool examination. Basically, stool examination is performed to check for

intestinal parasites. Unfortunately, the respondents of this study were not able to submit stool

specimens due to the fact that the healthcare providers did not give them any instruction to do so.

Therefore, when there is lacking laboratory test during the antenatal care of pregnant mother, there

is a high chance of difficulty in assessing for any complications that may occur during pregnancy.

As presented in the study by Lee, Abellera, Triunfante, and Mirandilla, only a fraction of women

had their urine (about 28.3%) or even blood samples (about 18.1%) collected. This led for the

conclusion that the unsatisfactory antenatal care laboratory services have greatly affected pregnancy

outcomes that is causing mothers’ dissatisfaction and delays in seeking and obtaining a focused

antenatal care service.

Care Provision Services

The respondents of this current study have indeed received iron or folic acid

supplementation, tetanus toxoid immunization, and prophylaxis as preventive measures of prenatal

care based on the tabulated results of this study. However, the low percentage of mothers who

received oral health examination was still consistent resulting to Poor to Good utilization. As

mentioned above, it was primarily due to the lack of adequate number of dentists assigned in every

barangay that leads to a limited dental service.

Health Promotion Services

The Health Promotion Services for pregnant mothers were performed through conducting

a health education and counseling. The tabulated results of this study have presented Very Good

utilization of the rendered health promotion services on antenatal care. The data also showed that

69
the Health Care Providers performed well with the conduct of health education and counseling on

pregnant mothers.

II. The Level of Effectiveness of the Prenatal Care Services rendered by Health Care

Providers

A. The Level of Effectiveness of the rendered Prenatal Care Services in terms of Safety

The weighted average mean score of each item regarding the effectiveness of the rendered

prenatal care services in terms of safety was done to determine the item’s relative importance

instead of treating every item equally. Based on the tabulated results presented above (Table 2),

among the items under the effectiveness of the prenatal care services in terms of safety, item no. 4

“felt safe and comfortable with the barangay health care provider” generated the highest weighted

mean average score that is equivalent to 4.61 out of the total 10 items asked, while item no. 5 “felt

anxious before/during/and after receiving the prenatal care services” generated the lowest weighted

mean average score that is equivalent to 2.87 out of the total 10 items asked.

The respondents of this study further attested that even though they may have felt safe and

comfortable with the personality of the health care staff or how they were positively approached by

the health care providers, nonetheless, the respondent of this study still can’t help themselves to

feel anxious mostly during and after every procedure of the prenatal care services is being done.

Majority of the respondents explained that it is because they are anxious whether the results of the

laboratory tests and physical examinations might show a possible pregnancy complication or fetal

abnormalities which they fear about. Hence, despite the fact that the healthcare providers are

approachable and good communicators, but feeling anxious emotionally and mentally regarding the

possibility of receiving a bad result from the physical examinations and laboratory tests done that

70
indicates complication or fetal abnormalities is indeed an overwhelming feeling that oftentimes

being overlooked by their health care providers in their barangay.

B. The Level of Effectiveness of the rendered Prenatal Care Services in terms of Accuracy

The weighted average mean score of each item in line with the effectiveness of the rendered

prenatal care services in terms of accuracy was done to determine every item’s relative importance

instead of treating every item equally. Based on the tabulated results presented above (Table 3),

among the items under the effectiveness of the prenatal care services in terms of accuracy, two

items generated a low weighted average mean scored as compared to the other items which

generated a weighted average mean score of 4 above. Item no. 1 “encountered issues or problems

with regards to the procedures of the prenatal care services done in terms of accuracy” generated a

total weighted average mean of 3.13 and item no. 10 “accuracy of addressing mental and emotional

needs during pregnancy” generated a total weighted average mean of 3.94 wherein both items

generated the lowest average mean score among all the items asked.

As attested by the majority of the respondents of this study, their mental and emotional

health is not given with adequate attention or care by the healthcare providers in their barangay.

They feel anxious during their pregnancy especially when seeking prenatal check-up and it is indeed

an overwhelming feeling which negatively affects their pregnancy but, unfortunately, it is still

oftentimes being overlooked by their health care providers in their barangay. The results also shows

that majority of the respondents encountered issues or problems regarding the procedures of the

prenatal care services done in terms of accuracy. Some of the respondents explained that it is mainly

due to the lack of sufficient equipment needed and good quality facilities which could help in

addressing the immediate needs of pregnant mothers in their barangay.

71
III. Proposed Measures to enhance the level of Effectiveness of the Prenatal Care Services

rendered by the Health Care Providers

The respondents of this study pinpointed the various measures that needs to be emphasized

and implemented in order to help enhance the level of effectiveness of the prenatal care services

rendered by the Health Care Providers. The results of this study confirmed that the problems

oftentimes being encountered by pregnant mothers when seeking prenatal care services in their

barangay includes insufficient supply of medicines and needed equipment to be able to properly

perform the prenatal care services being rendered, not enough facility space to accommodate all

pregnant mothers who are having their prenatal check-up, and healthcare providers coming late

than the scheduled appointment of time.

This has led for the majority of the respondents to propose measures like upgrading or

improving the quality of the health care facilities and equipment needed in prenatal care services,

increasing the supply of needed medicines to address the needs of the pregnant mothers, properly

organize the schedule of prenatal check-up and strictly following the correct scheduled time of

appointment for prenatal care, and health care providers must come earlier to better accommodate

all pregnant mothers seeking for prenatal care and check-up in their barangay. Whereas, all

suggested measures by the respondents were believed to be the most needed solutions that must be

imposed in order to enhance the level of effectiveness of the prenatal care services rendered by

healthcare providers.

72
 CONCLUSION

This part of the study overall summarizes the interpretation of data presented in the previous

chapter of this study. The following conclusions will therefore directly answer the objectives of this

current study.

I. The utilization of the Prenatal Care Services rendered by Health Care Providers

Not all prenatal care services were excellently utilized by the respondents of this current

study as there were still some of the essential prenatal care services rendered that have

been poorly utilized or were not given to them at all. Among these were the poor

utilization of the laboratory tests for stool examination and acetic acid wash; physical

examination for oral health care and prophylaxis, as well as assessment for thyroid

enlargement.

II. The Level of Effectiveness of the Prenatal Care Services rendered by Healthcare

Providers in terms of Safety and Accuracy

Not all variables that measures the effectiveness of the prenatal care services rendered

by health care providers in terms of safety and accuracy have garnered a perfect 5 score

rating from the respondents of this current study. There were various rating scores

obtained per variable which resulted to a typical weighted average mean score of 3 to

4. The least weighted average mean score generated under the effectiveness in terms

of safety is equivalent to 2, whereas, the least weighted average mean score for

accuracy is equivalent to 3. This basically indicates that the level of effectiveness of

the rendered prenatal care services in Barangay Rizal St. Ilawod Legazpi City is not

73
 that sufficiently effective to be able to meet the needs of all the pregnant mothers that

are seeking for prenatal care services in their barangay.

III. Proposed Measures to enhance the level of effectiveness of the prenatal care

services rendered by healthcare providers

In order to be able to overcome the most commonly encountered problems of pregnant

mothers in Barangay Rizal St. Ilawod, Legazpi City while they seek for prenatal care

services in their barangay, there were various improvements suggested to be able to

enhance the effectiveness of the prenatal care services rendered by the health care

providers which include upgrading the barangay healthcare facilities’ space to be able

to accommodate all pregnant mothers who are seeking for prenatal care services in their

barangay, increasing the supply of medicines needed, improving the quality of

equipment needed to ensure a safe and accurate function of it, and increasing the

commitment of the healthcare providers to their working hours of duty and

responsibilities such as coming earlier to work in order to be able to better and

immediately accommodate all pregnant mothers who needs medical attention in their

barangay. Above all, the researchers have also concluded that the government’s

financial support to every barangay health care will greatly help in fostering a safer and

healthier pregnancy experience of pregnant mothers in every barangay.

RECOMMENDATIONS

From the presented results of this study, there are several policy recommendations that have

been formulated. First, the content and quality of prenatal care are significantly important in order

to be able to achieve better maternal and neonatal health outcomes. This emphasizes the health

74
service delivery reforms to increase the capacity of the nurses and midwives to provide a more

sufficient prenatal care in all aspects (history taking, physical examination, laboratory

examinations, care provision and health promotion) at every Barangay Health Station and Rural

Health Units.

Second, the effectiveness of the prenatal care services in terms of safety and accuracy must

not be overlooked. It is one of the most important indicators that the prenatal care services being

rendered are with utmost quality which will ensure a healthier pregnancy outcome of the pregnant

mother. These two aspects of effectiveness are comprised of various variables; hence, every

variable must be given with great importance in order to be able to ensure that the prenatal care

services are indeed rendered safely and accurately.

Third, the various proposed measures must also be emphasized by carefully taking into

consideration all its benefits as well as the possible efficient ways to be able to implement those

solutions with utmost effectivity. The government and other local authorities concern must

cooperate with one another to be able to make these proposed measures into reality so that pregnant

mothers are provided with quality prenatal care services. This will not be possible if cooperation

and consistent efforts are not done, thus, in order to improve and solve the most commonly

encountered issues or problems in the health care, each and every one of us has their own significant

role to play in order to make a change for the better.

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