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CHAPTER I THE PROBLEM Introduction Over 20 million children worldwide are born with low birth weight (less

than 2500 grams at birth). This represents 16% of all new born babies, of which 96% are born in developing countries. The percent of low birth weight deliveries in developing countries (17%) is more than double that in developed countries (7%). Low birth weight babies face greater mortality risk and are more likely to be neglected by caregivers (Zeskind & Ramey 1978; Zeskind & Lester 1981). The survivors have higher probabilities of retarded motor development, neurological impairment and chronic illness (Adair 1989, 1997; Barker 1995, 2007; Barker et. al. 1989; De Boo et. al 2006) and lower IQ, worse labor force and educational outcomes, and even pregnancy complications (Black et. al. 2007, Oreopoulos et. al. 2008, Royer 2009). Prenatal care is one of the most popular public health interventions aimed at improving birth outcomes. It has been extensively studied in industrialized countries (e.g. Warner 1995; Liu 1998; Rous et. al.; Smith Conway et. al. 2004; Lin 2004; Krueger and Scholl 2000). Nevertheless, there is no consensus about its impact on birth outcomes. Studies for developing countries have been scarce because of the lack of reliable data on birth outcomes, (WHO. 2008. World Health Statistics 2008. WHO ) but these show inconsistent results as well. For example, Guilkey et. al. (1989) found both positive and negative effects on birth weight depending on geographical area, type of provider and facility where the care was supplied. Using data from Mexico, Deb and Sosa-Rubi (2005) found that early initiation of prenatal care had no impact on

birth weight, while the number of visits (defined as the quality of care) had a large and positive effect. Consequently, the availability of prenatal care services will be correlated with the mothers economic status and her personal endowment or preferences. These unobserved maternal preferences might influence birth outcomes. This is a particularly acute problem in developing countries where the availability of health services is highly correlated with the living standards in the mothers residence area. Prenatal care could positively influence birth outcomes through three main channels: 1) behavioral (elimination of harmful habits such as smoking); 2) nutritional (improvement of mothers nutritional intake); and 3) medical (reduction of morbidity risks) (Alexander and Korenbrot 1995). Bergs 1995 Report on Prenatal Care in Developing Countries consists of four basic components: (i) early detection of pregnant women at risk of any potential complications; (ii) action in order to prevent any future difficulties; (iii) diagnosis and treatment of preexisting medical conditions and (iv) prompt referral to the appropriate specialist when complications develop during pregnancy. Basic prenatal care ensures adequate nutrition and vitamin intake, proper vaccination, exercise, negative behavioral modification and, when necessary, bed rest. Vitamins and minerals help repair and maintain cells and tissues. For example, iron tablets help prevent iron deficiency anemia which could make pregnant women feel weak, tired and dizzy.

Prenatal check up can detect serious conditions than can affect both the mothers and the babys health. These include gestational diabetes, preeclampsia and Rh incompatibility. According to the American College of Obstetricians and Gynecologists (ACOG) women with uncomplicated pregnancies should visit their prenatal care provider every 4 weeks until the 28th week of pregnancy, then every 2 weeks until 36 weeks and then once a week until delivery. The ACOG standard is not viable in a developing country context. A more realistic set of recommendations has been developed by the WHO in the recent past (Berg 1995). In 1995, the World Health Organization Technical Working Group on Antenatal Care established four as the minimum number of prenatal care visits for women without identified problems. These visits should be provided by skilled health personnel and completed at specified times during the pregnancy: one at 16 weeks, one at 24-28 weeks, one at 32 weeks and one at 3638 weeks. During those visits physical examinations are performed. They should consist of the following procedures: collection of maternal medical history, anthropometric measurements, assessment of fetal heart sounds, a blood pressure check up, a pelvic exam, and blood and urine tests. Finally, a delivery plan should be formed especially if the birth is going to be a breech or transverse. The impact of prenatal care will then depend not just on the mere occurrence of a visit but on the quantity and quality of the procedures performed. This premise is supported by the historic trend of prenatal care and birth weights for the Philippines. The percentage of women aged 15-49 years examined at least once by a skilled health provider during pregnancy has been quite high and constant in recent years. In 1993, this number border 83%, rising to 86% in 1998, staying at that level during 2000 and increasing again in 2003 to 88%5. In contrast, the proportion of women who attended at least four antenatal

visits provided by skilled health personnel has been decreasing during this period. During the nineties adequate antenatal care coverage, as defined by the WHO, bordered on 77%. This percentage decline to 70% between 1999 and 2000 and for the year 2006 dropped to 59.5%7. The opposite trend has been experienced by birth weight in this time See Rasmussen and Stoltzfus (2003) and Scholl and Reilly (2000) Data collected from the Demographic and Health Surveys (Department of Health, National Statistics Office in the Philippines) UNICEF and WHO.(2004) Three different selection processes can bias the observed relationship between prenatal care use and birth outcome. Favorable selection will occur if the women who exhibit all kinds of positive health behaviors are also more likely to initiate prenatal care early and to maintain a regular schedule of visits. These health-conscious women will probably influence the impact of their prenatal care visits by selecting high quality providers and firmly adhering to their advice. Consequently, positive birth outcomes will be a function not only of prenatal care adequacy but in addition of these health-promoting behaviors and attitudes. This could potentially lead to a positive bias on estimates of prenatal care adequacy (Frick and Lantz 1996; Alexander and Korenbrot 1995). This study accounts for the endogenous nature of the mother's decision to seek prenatal care by using accumulated rainfall shocks during the mothers pregnancy as a source of exogenous variation. This instrument is not related to the availability of health services but to the opportunity cost and feasibility of accessing those services in a country where road conditions are poor. In addition, this study will attempt to control for the quality of the service provided. The researchers also aimed to assess the pregnant mothers perceptions on seeking prenatal care

and its extent of effects to the health of their yet unborn child. The researchers alleged that through the evaluation of their opinions, a better health for them and their yet unborn child may be proposed. Theoretical Framework Based on previous works, which illustrated the significance of nonstructural barriers in seeking prenatal care, an explanatory model the Social Pregnancy Interaction Model to help explain cultural and personal influences on seeking care was developed. This model integrates Ajzen and Fishbein's Theory of Reasoned Action with the concept of social pregnancy. The Theory of Reasoned Action can be considered an expansion of the Health Belief Model. In addition to describing an individual's beliefs about health threats and behaviors, the Health Belief Model includes the components of subjective social norms about those health behaviors, thus describing a more complete sociocultural context for the behaviors. Of the various models in health psychology that are used to explain health behavior, the Health Belief Model provides the most appropriate theoretical framework in which to examine how mothers think and act about prenatal care and check ups and how does it affect the health status of the babies even before they are born. It is a framework for analyzing beliefs that motivate health behaviors and is well established as a model for understanding health behavior decisions. The Health Belief Model (HBM) is a social-cognitive model developed in the 1950s by the U.S. Public Health Service (Mullen, Hersey, & Iverson 1987), which is often used to explain and predict health related behaviors (stretcher & Rosenstock, 1997). This model has been often used to predict a variety of preventative health behaviors.

The concept of social pregnancy, which was originally described by Miller, refers to the social process of acknowledging a pregnancy and acquiring a "pregnancy identity." According to this concept, a woman acquires and develops a social pregnancy identity by recognizing and interpreting the physiologic events of pregnancy: suspecting that she is pregnant, discussing the pregnancy with significant others, having the diagnosis confirmed, accepting the pregnancy, and altering her health behaviors to accommodate the pregnancy. Ordinarily, a woman's social pregnancy identity will have developed substantially before the initiation of prenatal care. Conceptual Framework The study focused on the determination of the pregnant mothers compliance on prenatal check up. The demographic profile of the respondents in terms of age, educational attainment and gravidity, and their perceptions on prenatal care in terms of benefits and barriers, and the extent of its effects on the health status of their newborn child. Comparison of the mothers compliance to prenatal check up and its effect on the health status of their newborn child with respect to their profile variables is also included in this study.




Mothers of newborn babies

Assessment Relationship between

Demographic profile in terms of Age,

the mothers profile and health status of newborn. Relationship Health Development Program between for pregnant mothers and

educational attainment, and gravidity. Perceptions mothers on of having


mothers newborn babies

perceptions on prenatal care and the health status babies. Relationship of the of newborn

prenatal check up in terms of benefits and barriers. Beliefs of mothers

mothers regarding the effects of prenatal check up on


on prenatal check ups and the health status of the health status of their newborn babies. their newborn babies.

Figure1. Conceptual Paradigm of the Study Statement of the Problem

The study aimed to determine the mothers perceptions and compliance on prenatal check up and its effect to the health status of their newborn babies. 1. What is the demographic profile of the respondentsin terms of: 1.1 Age 1.2 Educational Attainment 1.3 Gravidity 2. What are the mothers perceptions on prenatal check up in terms of: 2.1 benefits 2.2 barriers 3. How do compliance of mothers on prenatal check up affect the newborn babies in terms of infections: 3.1 Present 3.2 Absent 4. Are there significant relationship on the mothers perceptions on prenatal check up and its effect to the health status of their newborn babies? 5. Are there significant relationship on the mothers compliance on prenatal check up and its effect to the health status of their newborn babies? Hypotheses There is significant relationship between the mothers perceptions on prenatal check up and its effect to the health status of their newborn babies.

There is a significant relationship between the mothers compliance on prenatal check up and its effect to the health status of their newborn babies. Significance of the study The researched perceived that the study would benefit mothers, babies, community, nursing students, The result of the study would be of great help particularly for pregnant women and mothers in understanding the importance of prenatal care. It will educate them on how their compliance on prenatal check ups greatly affects their babies health. This study will change any misconceptions of mothers in complying with prenatal check ups. This study will be significant to the residents of Rosario, Batangas for it would endow mothers certain informations on how to take care for their babies even before they are born. It would improve their conditions by enhancing their perceptions on prenatal care through a proposal of a suitable health program for mothers and newborns. This study could be beneficiary to mothers for his can serve as an opportunity for them to air their perceptions and compliance to prenatal care and its effects on their newborns that would further improve their conditions. To the babies, this would lessen the possibility of the number of babies being born with abnormal health status, their mortality and morbidity. To the nursing students, this would enrich their knowledge and serve as basis in determining the aspect of care that needs emphasis in dealing with pregnant mother.

The outcome of this study could contribute to the clinical instructor by giving them information that they could utilize in the process of imparting knowledge to students in a formal classroom discussion essentially in the importance of prenatal care and its effects. To the health care providers this would also serve as reminder o improve preventive health aspects of care and to strengthen the implementation of the expanded program of the government to minimize infant mortality and to ensure the well-being of mothers. Lastly, to the researchers, the study could give them chance to learn and be exposed to the actual research proceedings and method that could enhance their expertise and knowledge in preparation for their future professions. Scope and Limitation of the Study The study dealt with the mothers perceptions on prenatal check up, how they comply with it and its effects on their newborn babies. It focused on the mothers perceptions on the benefits and barriers of prenatal check up and how these benefits and barriers influence the mothers compliance on prenatal check up. It also focused on the effects of the mothers compliance on the health status of their newborn babies. It also includes the demographic profile of the respondents in terms of age, educational attainment and gravidity. The data gathered and presented in this study are limited from those obtained from 100 postpartum mothers of Rosario, Batangas.

Definition of Terms For clarity and appreciation of the study, the following terms are identified: Age The length of time that an organism has lived Barriers is a natural formation or structure that prevents or hinders movement or action. Compliance refers to the willingness to follow a prescribed course of treatment. The act of complying; a yielding; as to a desire, demand, or proposal; concession; submission. Educational Attainment is a term commonly used by statisticians to refer to the highest degree of education an individual has completed Gravidity (gr-vid-iti) n. the status of a woman regarding the total number of pregnancies she has had (including the current one). Health status is the current state of your own health. It includes the status of your wellness, fitness, and any underlying diseases or injuries. Newborn is an infant who is within hours, days, or up to a few weeks from birth. In medical contexts, newborn or neonate (from Latin, neonatus, newborn) refers to an infant in the first 28 days of life (less than a month old). [2] The term "newborn" includes premature infants, postmature infants and full term newborns. Perception is the process of attaining awareness or understanding of sensory information. Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the uterus of a female. Prenatal care refers to the medical and nursing care recommended for women before and during pregnancy.

CHAPTER II REVIEW OF RELATED LITERATURE This chapter present the review of related literatures and studies that are sighted by the researchers to be important in the progress of the concept of the study. Conceptual Literature Prenatal care is a program of care for a pregnant woman before she gives birth to her baby. Most women begin their prenatal care in the first trimester of pregnancy. Visits to the doctor occur about once a month during the first six months. The frequency of visits increases to every two or three weeks for the remainder of the pregnancy. Several tests are performed during these visits. Tests performed during the first visit include blood tests to check blood type, Rh factor, anemia, and immunity to several diseases including rubella (German measles) and hepatitis B. Urine tests to check for sugar and protein as signs of diabetes and kidney changes, respectively, are also performed. A Pap test may be done to detect changes in the cervix that could be forerunners to cancer. Subsequent visits will include the collection of urine samples to continue to check for sugar and proteins, measuring blood pressure, measuring weight to make sure the expectant mother is gaining enough, listening to the fetal heartbeat (typically after 12 weeks) and checking the size and position of the uterus and fetus. The doctor can also perform various tests to check the fetus for birth defects. (http://www.womenshealth.org/a/pre_natal_care.htm) Prenatal care consists of much more than just monitoring the mother's diet and weight. Keep in mind that during pregnancy it is not just the health of the pregnant woman that must be watched, but also the health of the unborn baby. Maternal difficulties such as diabetes (which

can develop as a result of being pregnant even if diabetes was not present before), insufficient weight gain, and high blood pressure, if gone untreated, can be harmful to the fetus. A doctor can also monitor the baby's well being directly by listening to the fetal heartbeat, checking the size and positioning of the uterus and fetus, and testing for various abnormalities. Some conditions, if detected prenatally, can be treated in-utero (i.e., before the baby is born). In other instances, early detection can allow the proper medical facilities to be present at the time of birth to allow the baby full access to the help it needs. It is very important to receive proper prenatal care in order to ensure the health of both you and your baby. (http://www.mamashealth.com/pregnancy/prenatal.asp) The goal of prenatal care is to monitor the progress of a pregnancy and to identify potential deviations from normal before they become serious for either mom or baby. All mothers-to-be benefit from prenatal care. Women who see a health care provider regularly during pregnancy have healthier babies, are less likely to deliver prematurely, and are less likely to have other serious problems related to pregnancy. During prenatal visits, the health care provider:

Teaches the woman about pregnancy Monitors any medical conditions she may have (such as high blood pressure) Tests for problems with the baby Tests for health problems in the woman (such as gestational diabetes) Refers the woman to services such as support groups, the WIC program or childbirth education classes (Johnson & Niebyl, 2002).

The U.S. Public Health Service recommends that women of childbearing age get at least 400 micrograms of folic acid each day, through food sources and/or supplements. For women who are thinking about getting pregnant, health care providers recommend supplementing the diet with folic acid for three months before pregnancy, and then for at least the first three months of pregnancy. Prenatal vitamins are a good way to get extra folic acid into the diet. Prenatal supplements often contain high amounts of folic acid and other compounds, such as iron and vitamin A. (But, women should take care in choosing a supplement, to make sure that no more than 5,000 IU of vitamin A is included.) Findings from research supported by the NICHD and other agencies indicate that the right amount of folic acid can help prevent certain types of birth defects and other problems during pregnancy.(Shaffer,2002) A healthy diet, weight level, and regular physical activity level can help to reduce problems for both mother and fetus during pregnancy (Peterson,2006). For this reason, many health care providers suggest that women who are thinking about getting pregnant take steps to improve or maintain their own level of health before they get pregnant. A healthy diet helps to ensure that the fetus has all the nutrients it needs to grow and develop normally. Maintaining a healthy weight, both before and during pregnancy, can help to reduce stress on the mother's body and lower the risk of certain disorders of pregnancy. Being active before and during pregnancy, if approved by a health care provider, can help women maintain their healthy weight and can improve the function of the circulatory, cardiovascular, and skeletal systems (Ladewig, 2004). Just as important is keeping things that can be dangerous out of the mother's body. For instance, medications used to treat various diseases and conditions can affect the growth and development of the fetus. Certain herbal supplements and high amounts of vitamins can also

make it harder for a woman to get pregnant, and can impact the fetus' health during pregnancy. Even being around certain materials, such as paint and pesticides can put the health of the fetus at risk (Davidson,2002). Research shows that smoking, drinking alcohol, or using drugs, even now and again or in small amounts during pregnancy can cause health problems for the fetus, some of them severe(Smith,2005). Many of these problems can have life-long effects. Alcohol and drug use may also make it harder for some women to get pregnant. To reduce the risk of problems during pregnancy, health care providers recommend that women stop smoking, stop drinking alcohol, and stop using drugs, completely, as early as possible before they start trying to get pregnant. They should maintain this tobacco-free, alcohol-free, and drug-free lifestyle throughout their pregnancies and after birth, as many of these substances can get into the baby's system through breast milk. (http://www.mamashealth.com/pregnancy/prenatal.asp) Barriers to obtaining Health care during pregnancy include lack of transportation, unpleasant clinic facilities or procedures, inconvenient clinic hours, and personal attitudes (Braveman et al., 2000; Chandler, 2002) Much effort has been focused on finding ways to improve access and quality of care to ensure that all women and infants have the best opportunity for the most positive outcomes. The availability and the accessibility to prenatal care may be improved by the increasing use of advanced practice nurses in collaborative practice with physicians (Mvula & Miller,2003). The healthcare community recognizes the value of providing a primary care nurse in these settings to coordinate holistic care for each child bearing family(London,2007). The nurse

in the clinic or health maintenance organization may be the only source of continuity for the woman, who may see a different physician or certified nurse-midwife at each visit. The nurse can be extremely effective in working with the expectant family by answering questions; providing complete information about pregnancy, prenatal healthcare activities, and community resources; and supporting the healthcare activities of the woman and her family (Davidson,2006). Communities often have a wealth of services and educational opportunities available for pregnant woman and their families, and the knowledgeable nurse can help expectant mothers to assess and access these services. This approach supports the familys assumption of equal responsibility with healthcare providers toward common goal of a positive birth experience (Smyke,2000). The current model for provision of prenatal care has been used for more than a century. The initial visit usually occurs in the first trimester, with monthly visits through 28 weeks of pregnancy. Thereafter, visits are scheduled every 2 weeks until week 36, and then every week until birth. This model is currently being questioned, and in some practices, there is a tendency to have fewer visits omen who are at low risk for complications (Villar et al.,2002).

Research Literature A study conducted by Morris (2002) shows that although prenatal care appears to improve perinatal outcome, many women do not seek care. Twenty-six percent of all expectant mothers in the United States during year 2000 failed to receive care during the first trimester. This figure has remained virtually unchanged since 1988, and falls far short of the Healthy People 2000 goal of 90% receiving care in the first trimester. Only 73% of white expectant mothers and 52% of African-American expectant mothers received adequate prenatal care in 2001. Efforts to increase adequate prenatal care rates have lowered structural barriers, such as affordability, transportation, child care, and availability of providers. In particular, the Medicaid program has been expanded to provide health insurance access for pregnant women and incentives for providers to care for these women. Even when structural barriers are greatly reduced, however, a large group of pregnant women still do not make optimum use of the health care system. In 1992, for example, 36.7% of Missouri women on Medicaid received inadequate prenatal care compared with 9.6% of women not on Medicaid, and 12.6% of white expectant mothers received inadequate prenatal care compared with 35.6% of African-American expectant mothers. Several other studies have also shown that recipients of Medicaid do not obtain prenatal care as early or as often as women with private insurance. It appears that a set of cultural and personal hindrances remain. Consistent with this, a research by the Institute of Medicine found that women's attitudes and beliefs as well as personal and cultural experiences significantly influence decisions about

seeking prenatal care during the first trimester. This review strongly recommended that further research be conducted to explore such nonstructural barriers to prenatal care. A study by Barba (2002) Assessment of Folate Status of Some Filipino Pregnant Women aimed to assess the folate status of pregnant women at different stages of pregnancy. Eighty six percent (86%) pregnant women who were seeking prenatal check-up in five different health centers in Paranaque City, Metro Manila showed that better folate status, estimated by RBC folate, was found in pregnant women who are regularly having their check ups compared to those who are not. This could be due to the long term beneficial effects derived from continuous use of prenatal supplements which contained a combination of 250 g folate and 60mg iron prescribed by physicians and continuous intake of food rich in folate. The prevalence of folate deficiency was 12.4% based on RBC folate and 43.5% based on serum folate. Using RBC folate which is a better measure of folate status, showed a higher prevalence of folate deficiency among pregnant women who were not attending prenatal check ups. Blood samples were collected in a non-fasted state. Folate was assessed using red blood cell (RBC) and serum folate. Subclinical folate deficiency was identified by the following criteria: RBC and plasma folate level lower than 175 nanogram per milliliter (ng/mL) and 3.0 ng/mL, respectively. For hemoglobin, a value less than 11.0 g/dL was indicative of anemia. The high folate deficiency based on serum folate in this study indicated that low maternal blood folate is not simply a consequence of normal physiological process of pregnancy but could also be a sign of increased risk of folate deficiency. The findings recommended a need to adopt measures such as counseling and teaching women of the importance of choosing a variety of foods in the diet in order to improve and satisfy their mineral and vitamin requirements.

A study by Belsky (2004) entitled Transition to Parenthood shows that META-analysis and review of pregnancy complications and behavioral risk factors associated with infant low birth weight and other poor outcomes which occur during adolescent pregnancy was undertaken using the published literature. Studies were eligible for inclusion if they: 1) utilized a clearly defined sample of teenagers 2) provided numeric data on complications of interest or the proportions needed to compute this information 3) included a control or comparison group. Many behavioral risk factors (smoking, drinking and drug use) appeared to be less prevalent among teenage gravidas, particularly when the young women were ethnic minorities. An increased risk of preterm delivery was associated with young maternal age in both developed and developing countries. In the developed world, risk of cesarean delivery was reduced for teenagers and there was a secular decline in maternal anemia and pregnancy induced hypertension in comparison to the risk sustained by more mature women. Programs of comprehensive prenatal care appeared to have the potential to diminish risk of many complications. In the developing world, teenagers were at increased risk of maternal anemia, preterm birth and cesarean delivery. Although future research efforts will need to address the issues of bias inherent in much of the published research, the published literature suggests that prenatal care regimens which provide social and behavioral services along with medical care could improve both the health of the mother and the outcome of her pregnancy. A meta-analysis of pregnancy complications and behavioral risk factors associated with infant low birth weight during adolescent pregnancy was undertaken using the published literature. Studies were included which 1) utilized a clearly defined sample of teenagers 2) provided

numeric data on complications 3) included a control or comparison group. Many behavioral risk factors (smoking, drinking and drug use) appeared to be less prevalent among teenage gravidas, particularly when the young women were ethnic minorities. Teenagers enrolled in comprehensive programs of prenatal care showed a diminished risk of pregnancy-induced hypertension (PIH) in comparison to those enrolled in traditional care programs. The summary relative risk for PIH with comprehensive prenatal care was 0.59. Current publications indicated a slight, but not statistically significant, recent diminution in risk of anemia for those with young maternal age (Summary Relative Risk = 0.80). There was no overall increase in risk of anemia with young maternal age (Summary Relative Risk = 1.13). The overall relative risk for the eight controlled clinical studies reporting information on maternal anemia was 2.00 for a significant overall association between anemia and young maternal age, both currently in developing countries and in the past in the developed world. Apart from disproportion in young black women, other complications of labor and delivery where the relative risk was at least 10% higher in teenagers compared with mature women included fever, seizures, and, for whites, fetal distress. Rates at least 10% lower included those for placenta previa, precipitous labor, breech or malpresentation, and, for blacks, cord prolapse and complications of anaesthesia. Overall, the summary relative risk showed a diminution in preterm delivery with comprehensive care, after adjustment for study and time (Summary Relative Risk = 0.81). The published literature suggests that prenatal care regiments which provide social and behavioral services along with medical care could improve both the health of the mother and the outcome of her pregnancy. The study of Fullerton (2004) entiled Pregnant mothers out of the perinatal regionalization's reach showed that the health-promoting effects of prenatal care, and its importance as a contributing factor to the health and well-being of women and infants has been

extensively investigated (limited and recent references are provided). A substantial body of literature addresses the effects of participating in (entering and sustaining) a program of prenatal care. A similar body of literature reviews the essential elements of the content of that care. The factors that promote or impede women's access to prenatal care have also been documented. Findings from these studies provided evidence in support of the Healthy People 2010 objective that 90% of women should enter prenatal care during the first trimester. Nevertheless, disparities remain between communities, and between women of varying ethnicities and cultures in both access to and utilization of prenatal care services. A study conducted by Ellencweig (2001) entitled Factors affecting the Utilization of Prenatal Health Care Services in Jerusalem showed that health services patterns during pregnancy were studied among 780 women from selected neighborhoods of Jerusalem who delivered between December 1, 2000 and June 30,2001. Factors affecting the choice of care providers, the timing of the first contact with the prenatal care surveys in the frequency of visits to prenatal care centers were studied with respect to several demographic socio economic and needs variables. About one half of the women visited the family health centers, the traditional site for delivery of prenatal care. Forty percent visited their regular doctor during pregnancy when about thirty percent sought private care in all. In all, fifty two percent of women consulted more than one source of medical care service during pregnancy. Logistic regression analysis showed that the choice of care was determined by the type of insurance, need factors and education. The timing of the first visit depended o origin, level of education and parity. The frequency of visits was related to the type of insurance and to perceive health.

The study conducted by Roberts (2000) entitled Barriers to prenatal care: factors associated with initiation of care in a middle-class midwestern community showed that 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.

The study conducted by Sharsftein (2008) showed that that prenatal care is positively associated with improved birth outcomes including reduced incidences of premature births and infant mortality. The author points out that low birth weight is a key indicator of infant health, as low birth weight babies have much higher mortality rates. The paper relates that research also shows that, of all the environmental threats to a fetus, the most harmful clearly is smoking, which women can control. Synthesis This study is related to the study of Morris (2002) that although prenatal care appears to improve perinatal outcome, many women do not seek care. Only this study deals with the mothers perception on seeking prenatal check up and how they comply with it based on their beliefs. This study is also parallel to the study of Ellencweig (2001) entitled Factors Affecting Utilization of Prenatal Care in Jerusalem which shows that factors affecting the choice of care providers, the timing of the first contact with the prenatal care surveys in the

frequency of visits to prenatal care centers were studied with respect to several demographic socio economic and needs variables.

Questionnaire I Demographic Profile Direction: please write and check [/] the necessary information in the space provider. Panuto: punan ng kaukulang impormasyon ang bawat puwang at lagyan ng check [/] ang bawat kahon ng inyong sagot. Age (edad) [ ]above 60 y/o [ ] 50-59 y/o [ ] 40-40 y/o Educational attainment (antas ng natapos) [ ] college graduate [ ] college undergraduate [ ] highschool graduate [ ] highschool undergraduate [ ] elementary graduate [ ] elementary undergraduate [ ] 30-39 y/o [ ] 18-29 y/o [ ] 15-17 y/o

Gravidity (bilang ng pagbubuntis) [ ]1 [ ]2 [ ]3 [ ]4 [ ]5 [ ] 6 above ( pataas)

Answer the questions based on the following: 5-Strongly Sgree 4-Agree 3-Moderately Agree 2-Disagree 1-Strongly agree II. What are your perceptions regarding the benefits of having prenatal check-up? Perceptions on the Benefits of Prenatal Check up 5 Prenatal Check up will help me and my child to be healthy. Prenatal Check up will help identify possible barriers on my delivery. Prenatal Check up will help identify and cure complications of my pregnancy that can affect my baby. Prenatal Check up will help me monitor the child that Im conceiving. 4 3 2 1

Perceptions on the Barriers of Prenatal Check up 5 I believe that prenatal check up has bad effects on my baby. I believe that I do not have enough knowledge about prenatal check up and the new trends in the field of medicine. I believe that prenatal check up has will bring no good to my baby. I believe that prenatal check up will only consume my time. I believe that prenatal check up in only for rich people.

Perceptions of mothers on preventive aspect of prenatal check up 5 I believe in the ability of the doctors, nurse and midwifes I believe that the traditional birth attendant can help me to recover in the illnesses that I will encounter while I am pregnant I believe that my baby will be in good condition even without prenatal check up

CHAPTER III RESEARCH METHOD AND PROCEDURE This chapter presents the research design, respondents of the study, data gathering instrument and data gathering procedures as well as the the statistical treatment utilized. Research Design To have a reliable and valid data, the researchers made use of the descriptive method of the research.

Respondents of the Study A total population of 100 postpartum mothers were given questioners from Rosario, Batangas. The gathered information on the total number of respondents was from the Research and Planning Department of Batangas City. A survey was conducted to locate the respondents. Research Instrument The researchers made use of a validated self-instructed questionnaire consisting of three parts. The first part deals with the demographic profiles of the respondents. The second part deals with the beliefs of mothers on immunization, and the third part deals with the perceptions of the mothers about Prenatal Check ups and their pregnancy. The questionnaires were distributed to the respondents and the gathered data were tallied, tabulated and interpreted through appropriate statistical procedure. Statistical Treatment of Data The data gathered from the administered questionnaire were analyzed and interpreted through the use of the following statistical procedures: Percentage. It was used to determine the respondents who fall under each category on the demographic profile of the respondents. Weighted Mean. It was used to determine the average on the perceptions of mothers on having Prenatal Check ups.

To interpret the computed mean, the researchers set the following scale: Range 4.5-5.0 3.5-4.49 2.5-3.49 1.5-2.49 1.0-1.49 Verbal Interpretation Strongly Agree Agree Moderately Agree Disagree Stongly disagree

ANOVA. It was used for the comparison of the perceptions of mothers to prenatal check up and its effect to their childs health status with respect to their profile variables.

Bibliography Books Ladewig, J.T. A Look at Contemporary MaternalNew Born and Nursing Care, 6th ed.,2006. Lowderville, P.Maternity and Womens Health Care, 8th ed.,2000.. Smyke,Patricia.Women and Health.,New York:Plenum,2001. Website (http://www.womenshealth.org/a/pre_natal_care.htm)

(http://www.mamashealth.com/pregnancy/prenatal.asp) http://www.mamashealth.com/pregnancy/prenatal.asp)