Safer Pregnancies in the Philippines

Chapter 2

Related Literature

This chapter include Foreign and Local Studies, and Foreign and Local Literature in which will relate our study.

Local Literature

According to the philstar, CEBU, Philippines – To ensure safer pregnancy for expecting women, the Philippine Health Insurance Corporation (PhilHealth) made prenatal care a key component in its benefit package for normal child birth.

Prenatal care is important not just for pregnant women but also for their unborn babies. Maternal difficulties such as diabetes and high blood pressure which are harmful both to the mother and the child may be detected earlier through prenatal visits with a skilled or trained health care provider. Constant check-up and monitoring during these visits ensure a healthier pregnancy and delivery for both the mother and child.

Members may avail themselves of P1,500 as prenatal care benefit covering drugs and medicines, laboratory tests and ancillary procedures. Reimbursement for prenatal expenses is generally paid to the member. But corresponding official receipts for the procedures and/or drugs and medicines availed of must be submitted in support of the claim.

Prenatal care in lying-in clinics has been an integral part PhilHealth’s maternity care package. But it was only with the recent expansion of its normal delivery package that expenses for prenatal care in hospitals also became reimbursable. This is PhilHealth’s way of encouraging pregnant womven to really undergo prenatal care in support of the Department of Health’s safe motherhood campaign.

This literature is related to the study because many Filipinos were a member of a health insurance company in which a member of it will have a discount and a benefit if they use it when necessary. Philhealth(Philippine Health Insurrance Corporation) has made a benefit package for the pregnant mothers who is a member of it that will encourage them to undergo prenatal check-up that they will avail only 1500 for the drugs and medicines, laboratory tests and ancillary procedures because it is also for their health and for the health of their baby. It is a very nice idea of Philhealth because they helping the pregnant mothers to undergo prenatal check-up.

According to Mec Arevalo, Maternal mortality is defined as death of a woman during pregnancy or within 42 days of giving birth due to complications arising from, or aggravated by, pregnancy). Perinatal mortality, on the other hand, is death of a fetus after 20 weeks of gestation, during the birth, or 7-28 days after delivery. Both continue to be health issues that need to be prioritized in the country.

Maternal deaths are often due to haemorrhage, sepsis, obstructed labour, hypertensive disorders in pregnancy, and complications arising from unsafe abortions. Lack of trained birth attendants or access to proper facilities also contributes to the loss of lives.

Factors contributing to our high maternal mortality rate are either cultural or economic. Women, especially from urban poor areas and far-flung provinces, usually lack decision-making power over their own bodies. Their choices are limited by an equally inadequate education, and Catholic upbringing that prohibits other family planning methods other than abstinence and natural family planning.

Poverty often results in poor nutrition and overall health in the mother, aside from cultivating early marriages and teen pregnancies. According to a UNICEF report in 2009, only 60% of all births in the Philippines are supervised by a qualified birth attendant such as a physician or midwife.

All of these end up compromising perinatal health as malnourished women, and women who have borne many children already, are more likely to give birth pre-term. Based on 2009 statistics, infant mortality rate in the Philippines is at an alarming rate of 20.56 babies for every 1,000 live births.

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Jennifer is just one of the millions of women around the world who had successful pregnancies but not all pregnant women end up the way Jennifer did with her two pregnancies. Why do some pregnancies fail and how can pregnancy be successful? According to American Pregnancy Association, 6 million pregnancies happen each year in the United States and almost 2 million of which are pregnancy losses. Meanwhile, United Nations Population Division recorded more than 2 million births per year in the Philippines. As documented by the World Indicators Development database, the rate of infant death in the said country is 25 per 1,000 live births. Thousands of American pregnant women each year take their health and nutrition for granted through using illegal drugs, drinking alcohol, and smoking cigarettes. No wonder why 875,000 women in the US go through one or more pregnancy problems, which results to various complications like birth defects, low birth weight, premature births, and even worse, infant and maternal deaths.

Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) stated that from 1998 to 2002, 20% of infants in the Philippines have low birth weight, weighing less than 2.5 kilograms. According to American Pregnancy Association, more than 450,000 babies are born to mothers with poor prenatal care in the US. In the meantime, the World Development Indicators database (2003) stated that 87.6% of pregnant women in the Philippines receive prenatal care. Still, many women fail their pregnancies. With insufficient knowledge and support, more and more women in the world will experience pregnancy complications together with its risky effects.

This Literature is related to the study because Pregnant mothers who follow the doctors order like her diet, exercise and regularly undergo prenatal check-up will have a healthy body and healthy baby. Because mothers want their baby to become normal, smart, full of life and lastly cute and they are not prone to risk especially their baby. Healthy moms and Healthy babies will have a Healthy and wonderful life.

According to the DOH Maternal Health Program, they launch and implement the Basic Emergency Obstetric Care or BEMOC strategy. The BEMOC strategy entails the establishment of facilities that provide emergency obstetric care for every 125, 000 population and which are located strategically. The strategy calls for families and communities to plan for childbirth and the upgrading of technical capabilities of local health providers.

Pregnant women should have at least four prenatal visits with time for adequate evaluation and management of diseases and conditions that may put the pregnancy at risk. Post-partum care should extend to more women after childbirth, after a miscarriage or after an unsafe abortion.

According to the UNICEF, a new report on maternal mortality highlights the risks faced during pregnancy and childbirth by women in developing countries. In the Philippines, an estimated 4,500 women die every year because of complications from pregnancy and childbirth. This is because public reproductive health service is not comprehensive enough, too few mothers receive skilled care before, during, and after pregnancy and lastly, most mothers do not always have access to quality emergency obstetric care services. Although over 90 percent of Filipino mothers do seek prenatal care, only 60 percent deliver babies with properly trained skilled birth attendants and less than 40 percent deliver either in a public or private health facility.

Most maternal deaths are avoidable. A key to avoiding them is better health care – particularly during pregnancy, delivery and in the post-partum period. They should understand the importance of going to the health center for the prenatal check.

Foreign Literature

According to the japantimes, When women become pregnant, they normally start receiving regular checkups at clinics or hospitals. But the number of cases in which women whose contractions have begun suddenly visit medical institutions for the first time is increasing. Failure to receive regular checkups not only raises health risks but also puts additional burdens on obstetricians.

Because of the nationwide shortage of obstetricians working under a tight schedule, sudden visits by women in labor can cause a confusion in obstetrics wards. Obstetricians in such a situation are likely to be reluctant to take care of such women because they don’t have previous checkup records.

Local governments are shouldering part of the costs for such checkups, although they are not obligated to do so. To help both pregnant women and obstetricians, the central and local government should increase financial assistance for pregnancy-related regular checkups. Consideration should also be given to extending the public health insurance program to cover prenatal care.

This article is related to the study because in the economy right now, its hard to earn money cause of crisis. Only few health professionals were rendering their free services to those who in need like the poor, those pregnant mothers who really can’t afford to have their prenatal check-up cause of the lack of financial. Most of the pregnant mothers like in the Philippines especially women who have their early pregnancy and who belong in the poorest sector of the society doesn’t receive their regular prenatal check-up because they can afford it and the health center/hospital is far from their home and they lack information about their health that they may take the risk and their baby of not receiving their regular prenatal check-up.

According to the wikipedia, Many health professionals consider prenatal care a nearly essential practice for pregnant women; however, there are wide gaps in the American population regarding who has access to these services and who actually utilizes these services. For example, African-American expectant mothers are 2.8 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care during the entirety of the pregnancy. Similarly, Hispanic expectant mothers are 2.5 times as likely as non-Hispanic white mothers to begin their prenatal care in the third trimester, or to receive no prenatal care at all. These are the following factors impact a woman’s likelihood of acquiring prenatal care: Health Insurance, Formal Education, Trust & Comfort with Healthcare Industry, and Understanding of Prenatal Testing.

Without timely, thorough, and appropriate prenatal care, the racial minorities of the United States continue to face severe consequences for the birth outcome of both infant and mother: Delivery Complications, Low Birth Weight, Congenital Malformations, Infant Mortality and Pregnancy and Exercise.

This article is related to the topic because there are different races in the world which in some races like black, they can’t afford to have prenatal check-up, some were have no knowledge about it and it also depends to their culture.

According to the reproductivehealth, It has been recognized as the cornerstone of our health-care system for pregnant women since the beginning of the twentieth century. During the first decade of the century, Mrs. William Lowell Putnam initiated the importance of prenatal service at Boston Lying-In Hospital in which pregnant women were visited by a nurse every 10 days and instructed in self-care. Women were urged to report as early in pregnancy as possible. Meanwhile, in New York City, a program of organized prenatal care was begun in 1907 by Dr. Josephine Baker. In 1915, J. Whitbridge Williams found that dystocia, toxemia, and preterm birth could be reduced if prenatal care included instruction for the pregnant woman in personal hygiene, rest, and diet, along with a competent obstetrical examination. The approach to prenatal care was based originally on the detection and treatment of preeclampsia, and later, preterm birth. The emphasis in the delivery of prenatal care services has continued to change from focusing on conditions of the mother to conditions of the fetus, as disparities in birth weight and infant mortality have remained or increased.

According to Lisa Simonelli Rennie, Prenatal checkups are an integral part of a woman’s pregnancy. These appointments will allow the medical practitioner to monitor the health of both the mother and the baby.

The schedule of these visits increases in frequency as the pregnancy progresses. The reason for this is to be able to address any concerns or complications as they arise so they can be dealt with right away.

The schedule of doctors’ appointments may vary from doctor to doctor, or patient to patient depending on the circumstances. However, the general schedule would be First 28 weeks: once per month, 28 weeks to 36 weeks: every two weeks and 37 weeks to birth: once per week.

Generally, most prenatal visits will be rather consistent. In certain weeks, special tests may be conducted, but in general the visits will consist of the following: Urine sample, Blood pressure, Nutrition and weight, Fetal heart rate and Fundal height. These prenatal checkups will also give the mother an opportunity to ask any questions she may have, or discuss anything that she may be curious about.

According to Connie Limon, All women expecting a baby need prenatal care. Prenatal care can be provided by a doctor, midwife or other health care professional. The progress of a pregnancy and to identify potential problems before they become serious for either mom or baby is the reason you need prenatal care. You as the mother will benefit from prenatal care. Women who receive appropriate prenatal care generally have healthier babies and are less likely to deliver prematurely. The chance of having serious problems related to pregnancy is also decreased with appropriate prenatal care.

As soon as you suspect you are pregnant you should call a health care provider to set up appointments to confirm your pregnancy and/or to find out when you should come in for your prenatal care appointments. Be sure to keep all health care appointments during your pregnancy even if you are feeling fine. Make getting prenatal care a priority.The best time to see your health care provider is actually before you become pregnant to give your health care provider a chance to get to know you and the present status of your health. These visits can address concerns and/or issues before you become pregnant.

Everything you tell your health care provider will be held in confidence. This means your health care provider cannot tell anyone else what you say without your permission. Do not be afraid or embarrassed to talk about issues that might be embarrassing. You need to tell your health care provider if you smoke, drink alcohol or take any drugs. It is safe to tell your health care provider if your partner hurts you or if you are afraid of your partner.

Researchers do not know exactly why women who get early and regular prenatal care have healthier pregnancies and healthier babies. Experts agree it does work. Make prenatal care a priority during your pregnancy for the sake of yourself and your baby.

A dental check-up early in pregnancy is also a good idea to help your mouth remain healthy. Your dentist may even recommend more checks during pregnancy.

LOCAL STUDY

According to the sciencedirect, This paper examines the direct and indirect effects of patterns of prenatal care usage on birth weight and gestational age for a randomly selected sample of 3,080 rural and urban women. We analyze indirect effects of prenatal care on intermediate maternal factors (nutritional, stress, smoking, and drinking), then the impacts of these factors along with prenatal care on pregnancy outcome. The simultaneous equations statistical approach corrects for endogeneity of prenatal care and the intermediate maternal factors. Results of simulations of the effects of changes in the number of prenatal visits on intermediate and health outcome factors have important policy implications.

According to Wong EL, Popkin BM, Guilkey DK, and Akin JS., The patterns and determinants of prenatal care are examined through the use of a randomly selected sample of 3000 rural and urban women who were studied prospectively during pregnancy and at three or four days postpartum. A large number of policy factors were found to influence the choice of most frequently used type of traditional, modern public or modern private prenatal care and the number of visits to each type of care, but few affected the first month of visit. The quality of care provided, accessibility to this care, and insurance available to the mother all had important effects on prenatal patterns. Large differences exist in the set of feasible policy options for improving prenatal care in urban and rural areas.

According to Cielito,C.Reyes-Gibby and Lu Ann Aday, This study reports the results of a household survey requested by the mayor and community health officials in an under-served and understudied rural town in the Philippines. The study examines the extent and determinants of access to care. Results showed that 15% had a check-up in the previous year, despite 63% reporting a family history of chronic diseases. Multivariate regression analyses showed that having a usual source of care (P5.006) and education (P5.04) were predictors of having had a checkup the previous year. This study, which represents the ®rst household survey assessing access to care in this rural Filipino population, provides empiric evidence supporting the need for health programs that will improve access to care and routine monitoring of chronic illness in this under-served, rural population.

Differential access to health care is one of the correlates of poor health outcomes, especially among socially and economically disadvantaged populations. Populations lacking access to health services are at a greater risk for the adverse health consequences of untreated chronic and acute diseases. In developing countries such as the Philippines, lack of access to health care is a major public health problem. Rural areas in particular are disproportionately affected. To improve health services through increased community participation and governance, the Philippine government initiated a decentralized system of governance by enacting Republic Act No. 7160, also known as the Local Government Code of 1991.1 The enactment transferred the responsibilities for planning, organizing, delivering, and financing public health services from the Philippine Department of Health (DOH) to local government units. These units created local health boards that would serve as the main mechanism for community participation and involvement in community development. The boards included the mayor as chairman, the municipal health officer as vice-chairman, local councilor for health, a representative of the Department of Health, and a member of a nongovernmental health organization who represents the community. The local health boards’ functions included proposing annual budgetary allocations for health services and serving as advisory committees to the legislative council.

This study reports the results of a household survey conducted in May 1998. The study was requested by the town mayor and community health officials to serve as a basis for developing health programs and services in the rural town of San Antonio, Nueva Ecija, Philippines. Little empiric data exist with which to base healthcare programs and allocate healthcare resources, especially in light of the enactment of the Code. The study aims to determine the extent of, and factors associated with, access to health care and to assess the likely magnitude of unmet needs in an underserved and understudied rural area of the Philippines.

According to Ibrahim Kasirye, Sarah Ssewanyana, Juliet Nabyonga and Lawson, David, Using the 2002/03 Uganda National Household Survey data we empirically examine the nature and determinants of individuals’ decisions to seek care on condition of illness reporting. The major findings include: first, cost of care is regressive and substantially reduces the health care utilization for any formal provider by the poorer individuals after controlling for other factors. In other words, even among public facilities cost of care remains a barrier to utilization of these services. Second, there is no doubt that putting in place strategies aimed at increasing the income of the poor will increase their utilization of the health facilities, though the impact will be higher for private care. Third, besides income and cost of care, other factors, in particular education and physical access proxied by distance to the facilities are important determinants of health care utilization.

According to Rouselle F.Lavado and Leizel Lagrada, To demonstrate the inequity in access to maternal and child health services across regions and economic classes in the Philippines. Using the National Demographic and Health Survey, concentration index for each program indicator which includes prenatal care, iron supplementation, skilled birth attendance, delivery in medical facility and fully immunized child is computed to measure the extent of inequality.

Results show inequality in maternal and child health services utilization across economic classes and across regions. Pregnant women in richest quintile are two times more likely than the pregnant women in the poorest quintile to have prenatal check up, 4 times more likely to have skilled attendance during child birth and 9 times more likely to deliver in a medical facility. However, there is not much difference between the richest and poorest quintiles in accessing iron supplementation during pregnancy and full immunization for children under one year of age. Patterns of exclusion within each region are also examined. For regions where highly urbanized cities are located, high utilization rates and high concentration indices are observed. The two poorest regions have low utilization rates but different patterns of inequality is discerned: one has massive deprivation for all income levels in health care access leading to low levels coverage while another has only the richest quintile accessing health care.

While the uptake of maternal and child health services in the Philippines has been reasonably satisfactory, the focus on the poor remains low as shown by vast differences in patterns of utilization across economic classes and across regions. It is possible that as the national average for health service utilization shows improvement, it is likely that only those in the richest quintile are showing improvement while the poor remain to be marginalized. Knowing the patterns of inequality within an area can help in determining appropriate policies to improve access to health care.

FOREIGN STUDY

According to the biomedcentral, the United States has a high infant mortality rate. Lack of adherence to prenatal care schedules in vulnerable, hard to reach, urban, poor women is associated with high infant mortality, particularly for women who abuse substances, are homeless, or live in communities having high poverty and high infant mortality. This issue is of concern to the women, their partners, and members of their communities.

This qualitative study used focus groups with four distinct categories of people, to collect observations about prenatal care from various perspectives. There are 169 subjects and a process of coding and recoding using ethnograph and counting ensured reliability and validity of the process of theme identification. Barriers and motivators to prenatal care were identified in focus groups. Pervasive issues identified were drug lifestyle, negative attitudes of health care providers and staff, and non-inclusion of male partners in the prenatal experience.

Designing prenatal care relevant to vulnerable women in urban communities takes creativity, thoughtfulness, and sensitivity. System changes recommended include increased attention to substance abuse treatment/prenatal care interaction, focus on provider/staff attitudes, and commitment to inclusion of male partners.

According to Gina Novick, A search of online databases and relevant citations for research published from 1996−2007 was conducted to identify, synthesize and critically analyze published research on women’s experiences of prenatal care. Thirty-six articles were reviewed. Qualitative analysis methods were used, assisted by research software. Some women were treated respectfully and reported comprehensive, individualized care. However, some women experienced long waits and rushed visits, and perceived prenatal care as mechanistic or harsh. Women’s preferences included reasonable waits, unhurried visits, continuity, flexibility, comprehensive care, meeting with other pregnant women in groups, developing meaningful relationships with professionals, and becoming more active participants in care. Some low income and minority women experienced discrimination or stereotyping as well as external barriers to care. Further research is recommended to understand women’s experiences and to develop and implement evidence-based, women-centered approaches. Clinicians should inquire regarding women’s needs and modify care accordingly and also advocate for institutional changes that reduce barriers to care. Implementing comprehensive, redesigned models of care may be one effective way to simultaneously address a variety of women’s needs and preferences. If prenatal care becomes more attractive as well as more accessible, women’s experience and pregnancy outcomes may both improve.

According to Zhuochun Wu, Kirsi Viisainen, Xiaohong Li and Elina Hemminki, Studies on prenatal care in China have focused on the timing and frequency of prenatal care and relatively little information can be found on how maternal care has been organized and funded or on the actual content of the visits, especially in the less developed rural areas. This study explored maternal care in a rural county from Anhui province in terms of care organization, provision and utilization. A total of 699 mothers of infants under one year of age were interviewed with structured questionnaires; the county health bureau officials and managers of township hospitals (n = 10) and county level hospitals (n = 2) were interviewed; the process of the maternal care services was observed by the researchers. In addition, statistics from the local government were used.

The county level hospitals were well staffed and equipped and served as a referral centre for women with a high-risk pregnancy. Township hospitals had, on average, 1.7 midwives serving an average population of 15,000 people. Only 10–20% of the current costs in county level hospitals and township hospitals were funded by the local government, and women paid for delivery care. There was no systematic organized prenatal care and referrals were not mandatory. About half of the women had their first prenatal visit before the 13th gestational week, 36% had fewer than 5 prenatal visits, and about 9% had no prenatal visits. A major reason for not having prenatal care visits was that women considered it unnecessary. Most women (87%) gave birth in public health facilities, and the rest in a private clinic or at home. A total of 8% of births were delivered by caesarean section. Very few women had any postnatal visits. About half of the women received the recommended number of prenatal blood pressure and haemoglobin measurements. Delivery care was better provided than both prenatal and postnatal care in the study area. Reliance on user fees gave the hospitals an incentive to put more emphasis on revenue generating activities such as delivery care instead of prenatal and postnatal care.

According to Rosebud O. Roberts, Barbara P. Yawn, Susan L. Wickes, Charles S. Field, Melissa Garretson and Steven J. Jacobsen, Barriers to prenatal care have been extensively investigated in low-income and inner-city communities. Less attention has been directed to the study of prenatal care among middle- and upper-class pregnant women. This study describes perceived barriers and factors associated with late initiation of prenatal care in a predominantly middle- to upper-class midwestern community. Consenting women in Olmsted County, Minnesota, who were attending a clinic for their first obstetric visit completed a self-administered questionnaire that queried the presence of factors making it difficult to receive prenatal care, perception about the importance of prenatal care, expectations at the first prenatal care visit, and sociodemographic factors.

Of the 813 women aged 14 to 47 years, 692 (86%) had their first prenatal visit within the first trimester of pregnancy. Only 98 (12%) women reported external barriers to receiving prenatal care. These factors included difficulty in getting an appointment (46.9%), problems finding child care (26.5%), and lack of transportation (14.3%). In multivariable logistic regression analyses, late initiation of care was associated with patient perception of prenatal care as being less than very important (odds ratio [OR] = 4.1, 95% confidence interval [CI], 1.7 – 9.7); external barriers to prenatal care (OR = 2.9, 95% CI, 1.6 – 5.4); annual income [is less than] $17,000 (OR = 2.9, 95% CI, 1.5 – 5.7); and an unintended pregnancy (OR = 2.1, 95% CI, 1.3 – 3.5). Multiparous women and women older than 35 years were more likely to perceive prenatal care as less than very important (OR = 3.9, 95% CI, 2.5 – 14.6 and OR = 2.9, 95% CI, 1.2 – 6.8, respectively).

These findings suggest that perceptions about the importance of prenatal care may play a greater role in the initiation of care among this group of women than is recognized. Women with more experience with pregnancy appear to place slightly less importance on prenatal care.

In this study, it discusses about the reasons about a pregnant woman who can’t go to the clinic to have a prenatal check-up, these are some of the reasons why a pregnant woman can’t have a check-up difficulty in getting an appointment, problems finding child care and lack of transportation.

According to Mark Schlesinger and Karl Kronebusch, The 1980s witnessed a troubling rise in infant mortality rates in the United States, reversing a decades-long decline. Overall, the U.S. infant mortality rate ranks behind those of many other wealthy, developed nations; moreover, for minority populations and in certain regions of the country, the rates more closely resemble those of the Third World. By middecade, Congress had begun to act on the advice of numerous expert panels that convened to address infant mortality and related issues. A series of expansions of Medicaid eligibility begun, the most recent of which was passed into law with the 1990 budget reconciliation legislation.

In this article, MurkSchlesinger and Karl Kronebusch explore the extent to which policymakers may have “thrown out the baby with the bathwater” in attempting to improve infant mortality rates. They examine the links between low birthweight, infant mortality, and economic status. They charge that requiring states to expand Medicaid eligibility, while resulting in only minor improvements in access to cure, may actually “create counterproductive side effects that could outweigh the benefits of increased eligibility.” They write, “Piecemeal reforms hold benefits that are more illusory than tangible.. . .Policymakers must recognize how current efforts to hold down health cure costs through cutting Medicaid reimbursements and promoting competition are likely to spill over to reduce the adequacy of cure to our most vulnerable citizens.” Schlesinger, an economist , received his doctoral degree in economics from the University of Wisconsin. He is a lecturer in public policy at the John F. Kennedy School of Government, Harvard University; assistant professor of health policy at Harvard Medical