Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines

Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines Background: The maternal mortality ratio (MMR) in the Philippines is higher than in most other Southeast Asian countries, and home delivery is a major factor contributing to the high MMR. This study aims to explore the determinants for choice of delivery location in Ifugao Province, where people have poor access to health services. Findings: A household interview survey using a structured questionnaire was conducted to identify the factors associated with delivery location among 354 women. In all, 44.4% of the respondents delivered at a health facility. Using logistic regression analysis, parity (odds ratio [OR] 3.0, 95% confidence interval [C.I.] 1.6-5.6), higher education (OR 5.9, 95% C.I. 2.7-12.9), distance to a health facility (OR 6.9, 95% C.I. 3.4-14.2), health problems identified at antenatal care (OR 2.4, 95% C.I. 1.3-4.6), and the person deciding on the delivery location (e.g., for the husband OR 3.2, 95% C.I. 1.1-9.4) were found to be statistically associated with facility-based delivery. Conclusion: Involving the husband and other people in the decision regarding delivery location may influence a woman’s choice to use facility-based delivery services. Our findings have useful implications for improving the existing Safe Motherhood program in the Philippines. Keywords: Maternal health, Delivery location, Decision making, Women’s autonomy Findings MMR is largely attributable to the fact that 56% of Background women in the Philippines delivered at home [8]. From Every year, 536,000 maternal deaths occur worldwide, 2006 to 2010, the Japan International Cooperation Agency and 99% of these occur in developing countries [1]. Most (JICA) implemented a health project directed at maternal maternal deaths occur because of delays in obtaining ad- and childcare practices, whereby facility-based delivery equate medical care. Delays in obtaining obstetric emer- was promoted in two representative provinces in the gency care have been identified as comprising three Philippines, Billiran and Ifugao. In Billiran, the proportion types: (1) delay in the decision to seek care; (2) delay in of facility-based deliveries increased dramatically from 30% arrival at a health facility; and (3) delay in the provision in 2005 to 89% in 2009. However, the response was less of adequate care [2]. To reduce maternal deaths, the marked in Ifugao where facility-based deliveries increased most efficient strategy for lower-income countries is from 19% to 34% over the same period [9]. to promote childbirth at health facilities with a referral We conducted an exploratory study in Ifugao to deter- capacity [3-5]. mine sociodemographic characteristics and details of de- Although a policy for promoting facility-based de- livery location, and to explore the factors affecting the livery has been introduced by the government of the use of facility-based delivery services from the women’s Philippines [6], the maternal mortality rate (MMR) was viewpoint. 230 per 100,000 live births in 2008, still higher than in most other Southeast Asian countries [7]. Such a high Methods Study area The study was conducted in the municipality of Mayoyao, * Correspondence: akikomat@nagasaki-u.ac.jp Ifugao Province, in northern Luzon Island. Mayoyao is Graduate School of International Health Development, Nagasaki University, 2,000 km from Manila, and its population was 16,990 in 1-12-4, Sakamoto, Nagasaki 852-8523, Japan Full list of author information is available at the end of the article 2006. Rugged mountains characterize the topography, with © 2013 Shimazaki et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 2 of 5 http://www.apfmj.com/content/12/1/5 elevations ranging from 400 to 1,800 meters above sea The ethical committee of the Graduate School of Inter- level. Agriculture, especially rice cultivation, is the major national Health Development, Nagasaki University, ap- occupation in the area. Markets, high schools, and medical proved the research proposal and the Ifugao Provincial facilities are located in the central part of Mayoyao, which Health Office also granted permission for the research. All is a maximum of 1 day’s travel on foot or by motorcycle respondents were asked to provide written informed con- from the most remote villages. sent prior to taking part in the interviews. The municipality consists of 27 villages called barangays. A district hospital and a municipal health office, which Table 1 Women’s sociodemographic factors and functions as a rural health unit (RHU), are located in the characteristics by delivery location central area. A barangay health station (BHS) is located in Home-delivery Facility-delivery every two to four villages, and in total, eight BHSs are in group group operation in the municipality. A midwife is allocated to (n = 197) (n = 157*) each BHS, except for the five barangays in the central part Age of woman (years) of the municipality, which are under the jurisdiction of the ≤25 45 (23.3%) 54 (34.6%) RHU. Taking accessibility issues into account, 15 baran- 26-30 54 (28.0%) 29 (18.6%) gays, serviced by the RHU and three BHSs, were selected for the study. ≥31 94 (48.7%) 73 (46.8%) Unknown 4 1 p = 0.150 Study participants Parity The names of 388 women who gave birth from August Primipara 27 (13.7%) 60 (38.2%) 2006 to July 2009 were listed in the birth registry of the Multipara 170 (86.3%) 97 (61.8%) p < 0.001 Mayoyao Municipal Health Office. Thirty-four women No. of family members were excluded because either they delivered their babies outside Ifugao or they were absent during the research 1-4 53 (26.9%) 56 (35.7%) period. Therefore, the study included 354 women. The 5-7 93 (47.2%) 71 (45.2%) women’s health team, including local traditional birth ≥8 51 (25.9%) 30 (19.1%) p = 0.046 attendants (TBAs) and midwives organized by the JICA Monthly income per capital project had endeavored to identify all pregnant women ≤500 pesos 118 (59.9%) 44 (28.0%) in the area, so not only those who delivered at health 501-1,000 pesos 41 (20.8%) 36 (22.9%) facilities but also women who delivered at home were theoretically included in the registry. ≥1,000 pesos 38 (19.3%) 77 (49.0%) p < 0.001 Household asset score Data collection and analysis ≤2 76 (50.7%) 28 (18.3%) A household interview survey using a structured ques- 3-4 49 (32.7%) 42 (27.5%) tionnaire was conducted from September to November ≥5 25 (16.7%) 83 (54.2%) 2009 for all 354 women listed in the birth registry. Eight Unknown 47 4 p < 0.001 data collectors were hired and trained by one of the au- thors. During their 3-day training period, the data col- Education level lectors translated the questionnaire from English into Elementary or lower 67 (34.0%) 14 (9.0%) the local languages of Majawjaw and Ilocano. Respon- High school 73 (37.1%) 38 (24.4%) dents were asked about their sociodemographic back- Post-high school 57 (28.9%) 104 (66.7%) ground, their household income and assets (including Unknown 0 1 p < 0.001 possession of radios, televisions, cellular phones, refrig- Time required to reach the nearest birthing facility erators, and motorcycles), about their perceptions of delivery risk and maternal death, and their care-seeking ≤10 min 38 (19.4%) 79 (50.3%) behavior during pregnancy and childbirth (including 11-30 min 65 (33.2%) 57 (36.3%) the type of birth attendant, delivery location, antenatal ≥31 min 93 (47.4%) 21 (13.4%) care visits, and who made the decision regarding deliv- Unknown 1 3 p < 0.001 ery location). a b Cochran-Armitage test. Chi-square test. *Including 144 women who delivered at Categorical data were analyzed using chi-square and a hospital, six women who delivered at a RHU/BHS, and seven women who Cochran-Armitage tests. Multiple logistic regression ana- delivered at other facilities, mainly Ifugao provincial hospital. Household asset score was calculated by summing each household asset lysis was performed using Akaike’s information criteria to item including radios, televisions, cellular phones, refrigerators, and identify factors affecting the delivery location. SPSS version motorcycles. These items were selected from Philippines Demographic and 17.0 (SPSS Japan Inc., Tokyo, Japan) was used. Health Survey [8]. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 3 of 5 http://www.apfmj.com/content/12/1/5 Table 3 Decision maker on delivery location Results Baseline characteristics Home-delivery Facility-delivery group group The characteristics of the women by delivery location (n = 197) (n = 157) are shown in Table 1. Of the respondents, 55.6% deliv- ered at home and 44.4% delivered at a facility. There Only myself 188 (95.9%) 119 (79.9%) were significantly more multiparas in the home-delivery Mainly husband 6 (3.1%) 19 (12.8%) p < 0.001 group than in the facility-delivery group (p < 0.001). Mainly others 2 (1.0%) 11 (7.4%) Women who delivered at home were significantly more Unknown 1 8 likely to have larger families (p = 0.046), to be economic- Cochran-Armitage test. ally worse off (p < 0.001), to need a longer time to travel to the nearest birthing facility (p < 0.001), to have lower household asset scores (p < 0.001), and to have lower behavior and women’s autonomy have yielded mixed re- education levels (p < 0.001). The associations between sults. Women with greater autonomy generally have an antenatal care-related issues and delivery location are increased ability to make favorable reproductive health shown in Table 2. Health problems were discovered decisions, particularly in South Asia [10-13]. However, more frequently during antenatal care among women this was not the case in a study in Kenya [14]. The social who delivered at a facility (p < 0.001). Women who deliv- status of women in the study area is generally high, as it ered at a facility were more likely to involve their hus- is elsewhere in the Philippines [15], and the bayanihan bands and other people in the decision about delivery spirit of mutual help is an old and very strong value [16]. location (p < 0.001) (Table 3). The data in Table 3 indicate that 80% of women in the facility-delivery group made the decision on where to Supportive factors for facility-based delivery give birth alone compared with 96% in the home-delivery Five variables were selected for logistic regression using group. In this study, the results may have reflected not Akaike’s information criteria. These independent variables only women’s autonomy per se but also the level of sup- were parity, educational level, time required to reach the port and shared understanding of their husbands and nearest birthing facility, decision maker about delivery lo- other community members in the decision regarding cation, and health problems found during antenatal care. facility-based delivery. Unfortunately, we did not clearly The results are presented in Table 4. define others in the decision maker question, and add- itional factors involved in the decision-making process Discussion were not explored further. Our results reveal that involving family members, such as their husband, or other community members, in the decision-making process is important for women when seeking facility-delivery services. Previous studies Table 4 Logistic regression analysis of the association on the relationship between reproductive health-seeking between facility delivery and several variables Variable Odds 95% C.I. ratio Table 2 Antenatal care-related issues by delivery location Parity Multipara 1 Home-delivery Facility-delivery Primipara 3.0 1.6-5.6 group group Education level Less than primary school 1 (n = 197) (n = 157) Secondary school 2.1 0.9-4.9 Antenatal care visit (High school) At least once 190 (96.4%) 157 (100.0%) Higher than secondary 5.9 2.7-12.9 Never 7 (3.6%) 0 (0.0%) p = 0.016 school Health problem found at antenatal care Time required to reach the ≥31 min 1 nearest birthing facility Yes 32 (16.8%) 56 (35.7%) 11-30 min 3.3 1.7-6.6 No 158 (83.2%) 101 (64.3%) p < 0.001 ≤10 min 6.9 3.4-14.2 Experienced health problems during pregnancy Decision maker on location Myself 1 of delivery Yes 124 (63.3%) 105 (66.9%) Husband 3.2 1.1-9.4 No 72 (36.7%) 52 (33.1%) p = 0.480 Others 6.0 1.1-31.3 Unknown 1 0 Health problem found at No 1 a b antenatal care Chi-square test. This question was asked only if the woman had received Yes 2.4 1.3-4.6 antenatal care. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 4 of 5 http://www.apfmj.com/content/12/1/5 Parity is a strong predictor of delivery location, as indi- Acknowledgements The authors wish to thank the midwives in Mayoyao, Ifugao for their assistance. cated in a number of previous studies [17-19]. The health staff in this study tended to recommend that women Author details should deliver at a facility, at least for the first childbirth, Department of Nursing, School of Health Sciences, Nagasaki University, Nagasaki, Japan. Department of Community-based Rehabilitation Sciences, which may have affected the results. The educational level Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 3 4 of women as an important predictor of health-service use Japan. JICA-MCH Project, Ifugao, Philippines. Mayoyao Municipal Health has been documented elsewhere [20-23]. In Mayoyao, Office, Ifugao, Philippines. Graduate School of International Health Development, Nagasaki University, 1-12-4, Sakamoto, Nagasaki 852-8523, most information sources are not in the local dialect, Japan. Majawjaw, but in the national language, Tagalog, or English. Less-educated individuals sometimes need to be Received: 18 April 2012 Accepted: 13 October 2013 Published: 24 October 2013 assisted by health staff in reading health educational mate- rials. Geographic accessibility is another determinant of maternal care-seeking behavior [2,24]. References 1. WHO, UNICEF, UNFPA, World Bank: Maternal mortality in 2005. Geneva: There were some limitations to the present study. WHO, UNICEF,WHO,UNFPA, and the World Bank; 2007. First, the study site, which occupies the central part of a 2. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc local municipality, is geographically more advantageous Sci Med 1994, 38(8):1091–1110. 3. Danforth E, Kruk M, Rockers P, Mbaruku G, Galea S: Household than remote mountainous areas, and more women tend decision-making about delivery in health facilities: evidence from to go to hospital rather than to the RHU or a BHS for Tanzania. J Health Popul Nutr 2009, 27(5):696–703. delivery. Therefore, the study results cannot be general- 4. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Lerberghe WV: Going to scale with ized to all regions. Second, although skilled birth atten- professional skilled care. Lancet 2006, 368(9544):1377–1386. dants (SBAs) assisted women with home delivery in 5. WHO: The world Health Report 2005. Geneva: WHO Press; 2005. some cases (27 of 197), these women were included in 6. Philippines Department of Health: Women's Health and Safe Motherhood the home-delivery group. We performed an analysis of Project. [http://www.doh.gov.ph/node/1076.html] 7. UNICEF: The state of the world’s children 2008. New York: UNICEF; 2008. the relationship between the type of birth attendant, 8. Philippines National Statistics Office and ORC Macro: Philippines National SBAs, including those who attended at home, versus Demographic and Health Survey. Maryland: Philippines National Statistics non-SBAs (TBAs), and a number of factors. The results Office and ORC Macro; 2003. 9. JICA: Annual Report 2008. Manila: Maternal and Child Health Project; were identical to those for delivery location indicating that the type of birth attendant did not alter the out- 10. Mistry R, Galal O, Lu M: Women’s Autonomy and pregnancy care in rural come (data not shown). Third, this study was analyzed India: a contextual analysis. Soc Sci Med 2009, 69(6):926–933. 11. Schuler SR, Hashemi SM: Credit programs, women’sempowerment, based on the responses from women only, and their hus- and contraceptive use in rural Bangladesh. Stud Fam Plann 1994, bands’ perception was not examined. 25(2):65–76. 12. Jejeebhoy S: Women’s Education, autonomy, and reproductive behaviour: experience from developing countries. Oxford: Clarendon; 1995. Conclusions 13. Upadhyay U, Hindin M: Do higher status and more autonomous women In Mayoyao, one-third of pregnant women selected a have longer birth intervals?: results from Cebu, Philippines. Soc Sci Med facility-based delivery. Involvement of the husband and 2005, 60(11):2641–2655. 14. Fotso J, Ezeh A, Essendi H: Maternal health in resource-poor urban other support people in the decision regarding delivery settings: How does women’s autonomy influence the utilization of location is essential in promoting facility-based delivery. obstetric care services? Reprod Health 2009, 6(1):9. Husbands and other community members should be 15. Mason K: How family position influences married women's autonomy and power in five Asian countries. In Meeting Report of Committee for empowered with substantial action plans, including prepar- International Cooperation in National Research in Demography: 24-26 ation for obstetric emergencies. In addition, further studies February 1997; Paris. Edited by Eugenia M. Paris: East-West Center; to address gaps in the research, particularly with regard to 1997:353–371. 16. Andres TD: Understanding Ifugao values. Manila: A Giraffe Book; 2004. the perceptions of both men and women on women’sre- 17. Wagle RR, Sabroe S, Nielsen BB: Socioeconomic and physical productive health issues, are essential. distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth Competing interests 2004, 4(1):8. The authors declare that they have no competing interests. 18. Rogan SEB, Olvena MVR: Factors affecting maternal health utilizaiton in the Philippines, 9th National Convention on Statistics. Manila: National Statistics Authors’ contributions Office; 2004. AS worked on this research for her graduate degree program. MMD and 19. Gage AJ: Barriers to the utilization of maternal health care in rural Mali. JBC coordinated the field study. SH participated in the design of the study Soc Sci Med 2007, 65(8):1666–1682. and performed the statistical analysis. AM proposed the concept of the 20. Nwakoby B: Use of obstetric services in rural Nigeria. J R Soc Health 1994, study and helped to draft the manuscript. All authors read and approved 114(3):132. the final manuscript. 21. Raghupathy S: Education and the use of maternal health care in Thailand. Soc Sci Med 1996, 43(4):459–471. Authors’ information 22. Ikeako L, Onah H, Iloabachie G: Influence of formal maternal education on AS, M.P.H., Nurse Midwife, preformed midwifery services for 2 years and the use of maternityservices in Enugu, Nigeria. J Obstet Gynaecol 2006, worked for JICA technical cooperation projects in Sudan, Fiji, and Vanuatu. 26(1):30–34. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 5 of 5 http://www.apfmj.com/content/12/1/5 23. Onah H, Ikeako L, Iloabachie G: Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med 2006, 63(7):1870–1878. 24. Gabrysch S, Campbell OM: Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9:34. doi:10.1186/1447-056X-12-5 Cite this article as: Shimazaki et al.: Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines. Asia Pacific Family Medicine 2013 12:5. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Asia Pacific Family Medicine Springer Journals

Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines

Loading next page...
 
/lp/springer-journals/factors-associated-with-facility-based-delivery-in-mayoyao-ifugao-2buiCMh14h
Publisher
Springer Journals
Copyright
Copyright © 2013 by Shimazaki et al.; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; General Practice / Family Medicine; Primary Care Medicine
eISSN
1447-056X
DOI
10.1186/1447-056X-12-5
pmid
24156527
Publisher site
See Article on Publisher Site

Abstract

Background: The maternal mortality ratio (MMR) in the Philippines is higher than in most other Southeast Asian countries, and home delivery is a major factor contributing to the high MMR. This study aims to explore the determinants for choice of delivery location in Ifugao Province, where people have poor access to health services. Findings: A household interview survey using a structured questionnaire was conducted to identify the factors associated with delivery location among 354 women. In all, 44.4% of the respondents delivered at a health facility. Using logistic regression analysis, parity (odds ratio [OR] 3.0, 95% confidence interval [C.I.] 1.6-5.6), higher education (OR 5.9, 95% C.I. 2.7-12.9), distance to a health facility (OR 6.9, 95% C.I. 3.4-14.2), health problems identified at antenatal care (OR 2.4, 95% C.I. 1.3-4.6), and the person deciding on the delivery location (e.g., for the husband OR 3.2, 95% C.I. 1.1-9.4) were found to be statistically associated with facility-based delivery. Conclusion: Involving the husband and other people in the decision regarding delivery location may influence a woman’s choice to use facility-based delivery services. Our findings have useful implications for improving the existing Safe Motherhood program in the Philippines. Keywords: Maternal health, Delivery location, Decision making, Women’s autonomy Findings MMR is largely attributable to the fact that 56% of Background women in the Philippines delivered at home [8]. From Every year, 536,000 maternal deaths occur worldwide, 2006 to 2010, the Japan International Cooperation Agency and 99% of these occur in developing countries [1]. Most (JICA) implemented a health project directed at maternal maternal deaths occur because of delays in obtaining ad- and childcare practices, whereby facility-based delivery equate medical care. Delays in obtaining obstetric emer- was promoted in two representative provinces in the gency care have been identified as comprising three Philippines, Billiran and Ifugao. In Billiran, the proportion types: (1) delay in the decision to seek care; (2) delay in of facility-based deliveries increased dramatically from 30% arrival at a health facility; and (3) delay in the provision in 2005 to 89% in 2009. However, the response was less of adequate care [2]. To reduce maternal deaths, the marked in Ifugao where facility-based deliveries increased most efficient strategy for lower-income countries is from 19% to 34% over the same period [9]. to promote childbirth at health facilities with a referral We conducted an exploratory study in Ifugao to deter- capacity [3-5]. mine sociodemographic characteristics and details of de- Although a policy for promoting facility-based de- livery location, and to explore the factors affecting the livery has been introduced by the government of the use of facility-based delivery services from the women’s Philippines [6], the maternal mortality rate (MMR) was viewpoint. 230 per 100,000 live births in 2008, still higher than in most other Southeast Asian countries [7]. Such a high Methods Study area The study was conducted in the municipality of Mayoyao, * Correspondence: akikomat@nagasaki-u.ac.jp Ifugao Province, in northern Luzon Island. Mayoyao is Graduate School of International Health Development, Nagasaki University, 2,000 km from Manila, and its population was 16,990 in 1-12-4, Sakamoto, Nagasaki 852-8523, Japan Full list of author information is available at the end of the article 2006. Rugged mountains characterize the topography, with © 2013 Shimazaki et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 2 of 5 http://www.apfmj.com/content/12/1/5 elevations ranging from 400 to 1,800 meters above sea The ethical committee of the Graduate School of Inter- level. Agriculture, especially rice cultivation, is the major national Health Development, Nagasaki University, ap- occupation in the area. Markets, high schools, and medical proved the research proposal and the Ifugao Provincial facilities are located in the central part of Mayoyao, which Health Office also granted permission for the research. All is a maximum of 1 day’s travel on foot or by motorcycle respondents were asked to provide written informed con- from the most remote villages. sent prior to taking part in the interviews. The municipality consists of 27 villages called barangays. A district hospital and a municipal health office, which Table 1 Women’s sociodemographic factors and functions as a rural health unit (RHU), are located in the characteristics by delivery location central area. A barangay health station (BHS) is located in Home-delivery Facility-delivery every two to four villages, and in total, eight BHSs are in group group operation in the municipality. A midwife is allocated to (n = 197) (n = 157*) each BHS, except for the five barangays in the central part Age of woman (years) of the municipality, which are under the jurisdiction of the ≤25 45 (23.3%) 54 (34.6%) RHU. Taking accessibility issues into account, 15 baran- 26-30 54 (28.0%) 29 (18.6%) gays, serviced by the RHU and three BHSs, were selected for the study. ≥31 94 (48.7%) 73 (46.8%) Unknown 4 1 p = 0.150 Study participants Parity The names of 388 women who gave birth from August Primipara 27 (13.7%) 60 (38.2%) 2006 to July 2009 were listed in the birth registry of the Multipara 170 (86.3%) 97 (61.8%) p < 0.001 Mayoyao Municipal Health Office. Thirty-four women No. of family members were excluded because either they delivered their babies outside Ifugao or they were absent during the research 1-4 53 (26.9%) 56 (35.7%) period. Therefore, the study included 354 women. The 5-7 93 (47.2%) 71 (45.2%) women’s health team, including local traditional birth ≥8 51 (25.9%) 30 (19.1%) p = 0.046 attendants (TBAs) and midwives organized by the JICA Monthly income per capital project had endeavored to identify all pregnant women ≤500 pesos 118 (59.9%) 44 (28.0%) in the area, so not only those who delivered at health 501-1,000 pesos 41 (20.8%) 36 (22.9%) facilities but also women who delivered at home were theoretically included in the registry. ≥1,000 pesos 38 (19.3%) 77 (49.0%) p < 0.001 Household asset score Data collection and analysis ≤2 76 (50.7%) 28 (18.3%) A household interview survey using a structured ques- 3-4 49 (32.7%) 42 (27.5%) tionnaire was conducted from September to November ≥5 25 (16.7%) 83 (54.2%) 2009 for all 354 women listed in the birth registry. Eight Unknown 47 4 p < 0.001 data collectors were hired and trained by one of the au- thors. During their 3-day training period, the data col- Education level lectors translated the questionnaire from English into Elementary or lower 67 (34.0%) 14 (9.0%) the local languages of Majawjaw and Ilocano. Respon- High school 73 (37.1%) 38 (24.4%) dents were asked about their sociodemographic back- Post-high school 57 (28.9%) 104 (66.7%) ground, their household income and assets (including Unknown 0 1 p < 0.001 possession of radios, televisions, cellular phones, refrig- Time required to reach the nearest birthing facility erators, and motorcycles), about their perceptions of delivery risk and maternal death, and their care-seeking ≤10 min 38 (19.4%) 79 (50.3%) behavior during pregnancy and childbirth (including 11-30 min 65 (33.2%) 57 (36.3%) the type of birth attendant, delivery location, antenatal ≥31 min 93 (47.4%) 21 (13.4%) care visits, and who made the decision regarding deliv- Unknown 1 3 p < 0.001 ery location). a b Cochran-Armitage test. Chi-square test. *Including 144 women who delivered at Categorical data were analyzed using chi-square and a hospital, six women who delivered at a RHU/BHS, and seven women who Cochran-Armitage tests. Multiple logistic regression ana- delivered at other facilities, mainly Ifugao provincial hospital. Household asset score was calculated by summing each household asset lysis was performed using Akaike’s information criteria to item including radios, televisions, cellular phones, refrigerators, and identify factors affecting the delivery location. SPSS version motorcycles. These items were selected from Philippines Demographic and 17.0 (SPSS Japan Inc., Tokyo, Japan) was used. Health Survey [8]. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 3 of 5 http://www.apfmj.com/content/12/1/5 Table 3 Decision maker on delivery location Results Baseline characteristics Home-delivery Facility-delivery group group The characteristics of the women by delivery location (n = 197) (n = 157) are shown in Table 1. Of the respondents, 55.6% deliv- ered at home and 44.4% delivered at a facility. There Only myself 188 (95.9%) 119 (79.9%) were significantly more multiparas in the home-delivery Mainly husband 6 (3.1%) 19 (12.8%) p < 0.001 group than in the facility-delivery group (p < 0.001). Mainly others 2 (1.0%) 11 (7.4%) Women who delivered at home were significantly more Unknown 1 8 likely to have larger families (p = 0.046), to be economic- Cochran-Armitage test. ally worse off (p < 0.001), to need a longer time to travel to the nearest birthing facility (p < 0.001), to have lower household asset scores (p < 0.001), and to have lower behavior and women’s autonomy have yielded mixed re- education levels (p < 0.001). The associations between sults. Women with greater autonomy generally have an antenatal care-related issues and delivery location are increased ability to make favorable reproductive health shown in Table 2. Health problems were discovered decisions, particularly in South Asia [10-13]. However, more frequently during antenatal care among women this was not the case in a study in Kenya [14]. The social who delivered at a facility (p < 0.001). Women who deliv- status of women in the study area is generally high, as it ered at a facility were more likely to involve their hus- is elsewhere in the Philippines [15], and the bayanihan bands and other people in the decision about delivery spirit of mutual help is an old and very strong value [16]. location (p < 0.001) (Table 3). The data in Table 3 indicate that 80% of women in the facility-delivery group made the decision on where to Supportive factors for facility-based delivery give birth alone compared with 96% in the home-delivery Five variables were selected for logistic regression using group. In this study, the results may have reflected not Akaike’s information criteria. These independent variables only women’s autonomy per se but also the level of sup- were parity, educational level, time required to reach the port and shared understanding of their husbands and nearest birthing facility, decision maker about delivery lo- other community members in the decision regarding cation, and health problems found during antenatal care. facility-based delivery. Unfortunately, we did not clearly The results are presented in Table 4. define others in the decision maker question, and add- itional factors involved in the decision-making process Discussion were not explored further. Our results reveal that involving family members, such as their husband, or other community members, in the decision-making process is important for women when seeking facility-delivery services. Previous studies Table 4 Logistic regression analysis of the association on the relationship between reproductive health-seeking between facility delivery and several variables Variable Odds 95% C.I. ratio Table 2 Antenatal care-related issues by delivery location Parity Multipara 1 Home-delivery Facility-delivery Primipara 3.0 1.6-5.6 group group Education level Less than primary school 1 (n = 197) (n = 157) Secondary school 2.1 0.9-4.9 Antenatal care visit (High school) At least once 190 (96.4%) 157 (100.0%) Higher than secondary 5.9 2.7-12.9 Never 7 (3.6%) 0 (0.0%) p = 0.016 school Health problem found at antenatal care Time required to reach the ≥31 min 1 nearest birthing facility Yes 32 (16.8%) 56 (35.7%) 11-30 min 3.3 1.7-6.6 No 158 (83.2%) 101 (64.3%) p < 0.001 ≤10 min 6.9 3.4-14.2 Experienced health problems during pregnancy Decision maker on location Myself 1 of delivery Yes 124 (63.3%) 105 (66.9%) Husband 3.2 1.1-9.4 No 72 (36.7%) 52 (33.1%) p = 0.480 Others 6.0 1.1-31.3 Unknown 1 0 Health problem found at No 1 a b antenatal care Chi-square test. This question was asked only if the woman had received Yes 2.4 1.3-4.6 antenatal care. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 4 of 5 http://www.apfmj.com/content/12/1/5 Parity is a strong predictor of delivery location, as indi- Acknowledgements The authors wish to thank the midwives in Mayoyao, Ifugao for their assistance. cated in a number of previous studies [17-19]. The health staff in this study tended to recommend that women Author details should deliver at a facility, at least for the first childbirth, Department of Nursing, School of Health Sciences, Nagasaki University, Nagasaki, Japan. Department of Community-based Rehabilitation Sciences, which may have affected the results. The educational level Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, 3 4 of women as an important predictor of health-service use Japan. JICA-MCH Project, Ifugao, Philippines. Mayoyao Municipal Health has been documented elsewhere [20-23]. In Mayoyao, Office, Ifugao, Philippines. Graduate School of International Health Development, Nagasaki University, 1-12-4, Sakamoto, Nagasaki 852-8523, most information sources are not in the local dialect, Japan. Majawjaw, but in the national language, Tagalog, or English. Less-educated individuals sometimes need to be Received: 18 April 2012 Accepted: 13 October 2013 Published: 24 October 2013 assisted by health staff in reading health educational mate- rials. Geographic accessibility is another determinant of maternal care-seeking behavior [2,24]. References 1. WHO, UNICEF, UNFPA, World Bank: Maternal mortality in 2005. Geneva: There were some limitations to the present study. WHO, UNICEF,WHO,UNFPA, and the World Bank; 2007. First, the study site, which occupies the central part of a 2. Thaddeus S, Maine D: Too far to walk: maternal mortality in context. Soc local municipality, is geographically more advantageous Sci Med 1994, 38(8):1091–1110. 3. Danforth E, Kruk M, Rockers P, Mbaruku G, Galea S: Household than remote mountainous areas, and more women tend decision-making about delivery in health facilities: evidence from to go to hospital rather than to the RHU or a BHS for Tanzania. J Health Popul Nutr 2009, 27(5):696–703. delivery. Therefore, the study results cannot be general- 4. Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, Achadi E, Adjei S, Padmanabhan P, Lerberghe WV: Going to scale with ized to all regions. Second, although skilled birth atten- professional skilled care. Lancet 2006, 368(9544):1377–1386. dants (SBAs) assisted women with home delivery in 5. WHO: The world Health Report 2005. Geneva: WHO Press; 2005. some cases (27 of 197), these women were included in 6. Philippines Department of Health: Women's Health and Safe Motherhood the home-delivery group. We performed an analysis of Project. [http://www.doh.gov.ph/node/1076.html] 7. UNICEF: The state of the world’s children 2008. New York: UNICEF; 2008. the relationship between the type of birth attendant, 8. Philippines National Statistics Office and ORC Macro: Philippines National SBAs, including those who attended at home, versus Demographic and Health Survey. Maryland: Philippines National Statistics non-SBAs (TBAs), and a number of factors. The results Office and ORC Macro; 2003. 9. JICA: Annual Report 2008. Manila: Maternal and Child Health Project; were identical to those for delivery location indicating that the type of birth attendant did not alter the out- 10. Mistry R, Galal O, Lu M: Women’s Autonomy and pregnancy care in rural come (data not shown). Third, this study was analyzed India: a contextual analysis. Soc Sci Med 2009, 69(6):926–933. 11. Schuler SR, Hashemi SM: Credit programs, women’sempowerment, based on the responses from women only, and their hus- and contraceptive use in rural Bangladesh. Stud Fam Plann 1994, bands’ perception was not examined. 25(2):65–76. 12. Jejeebhoy S: Women’s Education, autonomy, and reproductive behaviour: experience from developing countries. Oxford: Clarendon; 1995. Conclusions 13. Upadhyay U, Hindin M: Do higher status and more autonomous women In Mayoyao, one-third of pregnant women selected a have longer birth intervals?: results from Cebu, Philippines. Soc Sci Med facility-based delivery. Involvement of the husband and 2005, 60(11):2641–2655. 14. Fotso J, Ezeh A, Essendi H: Maternal health in resource-poor urban other support people in the decision regarding delivery settings: How does women’s autonomy influence the utilization of location is essential in promoting facility-based delivery. obstetric care services? Reprod Health 2009, 6(1):9. Husbands and other community members should be 15. Mason K: How family position influences married women's autonomy and power in five Asian countries. In Meeting Report of Committee for empowered with substantial action plans, including prepar- International Cooperation in National Research in Demography: 24-26 ation for obstetric emergencies. In addition, further studies February 1997; Paris. Edited by Eugenia M. Paris: East-West Center; to address gaps in the research, particularly with regard to 1997:353–371. 16. Andres TD: Understanding Ifugao values. Manila: A Giraffe Book; 2004. the perceptions of both men and women on women’sre- 17. Wagle RR, Sabroe S, Nielsen BB: Socioeconomic and physical productive health issues, are essential. distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal. BMC Pregnancy Childbirth Competing interests 2004, 4(1):8. The authors declare that they have no competing interests. 18. Rogan SEB, Olvena MVR: Factors affecting maternal health utilizaiton in the Philippines, 9th National Convention on Statistics. Manila: National Statistics Authors’ contributions Office; 2004. AS worked on this research for her graduate degree program. MMD and 19. Gage AJ: Barriers to the utilization of maternal health care in rural Mali. JBC coordinated the field study. SH participated in the design of the study Soc Sci Med 2007, 65(8):1666–1682. and performed the statistical analysis. AM proposed the concept of the 20. Nwakoby B: Use of obstetric services in rural Nigeria. J R Soc Health 1994, study and helped to draft the manuscript. All authors read and approved 114(3):132. the final manuscript. 21. Raghupathy S: Education and the use of maternal health care in Thailand. Soc Sci Med 1996, 43(4):459–471. Authors’ information 22. Ikeako L, Onah H, Iloabachie G: Influence of formal maternal education on AS, M.P.H., Nurse Midwife, preformed midwifery services for 2 years and the use of maternityservices in Enugu, Nigeria. J Obstet Gynaecol 2006, worked for JICA technical cooperation projects in Sudan, Fiji, and Vanuatu. 26(1):30–34. Shimazaki et al. Asia Pacific Family Medicine 2013, 12:5 Page 5 of 5 http://www.apfmj.com/content/12/1/5 23. Onah H, Ikeako L, Iloabachie G: Factors associated with the use of maternity services in Enugu, southeastern Nigeria. Soc Sci Med 2006, 63(7):1870–1878. 24. Gabrysch S, Campbell OM: Still too far to walk: literature review of the determinants of delivery service use. BMC Pregnancy Childbirth 2009, 9:34. doi:10.1186/1447-056X-12-5 Cite this article as: Shimazaki et al.: Factors associated with facility-based delivery in Mayoyao, Ifugao Province, Philippines. Asia Pacific Family Medicine 2013 12:5. Submit your next manuscript to BioMed Central and take full advantage of: • Convenient online submission • Thorough peer review • No space constraints or color figure charges • Immediate publication on acceptance • Inclusion in PubMed, CAS, Scopus and Google Scholar • Research which is freely available for redistribution Submit your manuscript at www.biomedcentral.com/submit

Journal

Asia Pacific Family MedicineSpringer Journals

Published: Oct 24, 2013

References