Abstract
In the Philippines, the "no home-birthing policy" implemented in 2008 has encouraged local governments to endorse ordinances that prohibit noninstitutional deliveries (NIDs). The Philippines' social insurance scheme has also enabled them to provide incentive payments to women who deliver at birthing facilities (BFs). This study evaluated whether these positive and/or negative incentives were associated with an increased facility-based delivery (FBD) rate and examined challenges in implementing those incentive measures in the Eastern Visaya Region of the Philippines. Cross-sectional data were collected regarding delivery locations during 2017, and barangay-level data were collected regarding positive and negative incentives and the characteristics of 4,371 barangays in the region. Multivariate logistic regression analysis, using "ordinance with nonmonetary sanction" as the reference category, indicated that no ordinance to prohibit NIDs was significantly associated with a lower FBD rate (odds ratio [OR]: 0.90, P=.013), and ordinance with low cash penalty (OR: 1.37, P<.001) and high cash penalty (OR: 2.52, P<.001) had higher FBD rates. Positive incentives were not associated with FBD rates (OR: 1.02, P=.563). The FBD rate was also significantly associated with urban barangay status (OR: 1.45, P<.001), availability of a vehicle (OR: 3.19, P<.001), availability of public transportation to a government BF (OR: 1.25, P<.001), and distance to the most accessible government BF (OR: 0.89, P<.001). Substantial proportions of barangays had no vehicles available for transportation (34.1%) or no available vehicles and no public transportation to a government BF (5.5%). Although negative incentives for NIDs could motivate pregnant women to seek FBD, local governments in the Philippines should be aware of barriers that limit access to government BFs in underserved barangays before introducing those negative incentives. Above all, barangay-level investments in making a vehicle for transporting pregnant women might help address these barriers and increase the FBD rate.
Highlights
Access to quality maternal care throughout pregnancy is the key to reduce preventable mortality and morbidity among pregnant women.[1]
The documents resulted in several local governments endorsing ordinances to prohibit home-based deliveries assisted by traditional birth attendants (TBAs) and often to penalize TBAs and/or pregnant women who participate in noninstitutional deliveries (NIDs).[7]
The results indicated that 43.2% of the barangays provided incentive payments for facility-based delivery (FBD) and 77.6% had implemented a local ordinance or policy supported by a written official order to prohibit NIDs
Summary
Access to quality maternal care throughout pregnancy is the key to reduce preventable mortality and morbidity among pregnant women.[1] In particular, facility-based deliveries (FBDs) are considered a crucial contributor to improving the maternal mortality ratio in low- and middle-income countries (LMICs).[2,3,4] In the Philippines, the Department of Health (DOH) issued the Maternal, Newborn and Child Health and Nutrition (MNCHN) Strategy in 2008 to reduce maternal mortality. Some ordinances prohibit home-based deliveries without specifying penalties
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