Vol.

3 January
2013
IAMURE
International
Journal of Health Education
Print ISSN 2244-1840 Online ISSN 2244-1832
International Peer Reviewed Journal
doi: http://dx.doi.org/10.7718/iamure.ijhe.v3i1.581
This Journal is produced by IAMURE Multidisciplinary Research,
an ISO 9001:2008 certified by the AJA Registrars Inc.

Compliance to Prenatal Care among

Mothers in Santa, Ilocos Sur, Philippines
EVELYN AGUILO CLAUDIO
ORCID No. 0000-0003-2646-2695
evelynclaudio.unp@gmail.com
MERCEDES PALO ANICAS
ORCID No. 0000-0002-9895-9951
mercyanicas.unp@gmail.com
MARJORIE BORJE RIDAO
ORCID No. 0000-0003-3542-3436
marjorieridao.unp@gmail.com
EPIFANIA MARLENE REFUERZO PURISIMA
ORCID No. 0000-0001-6478-0227
epifaniapurisima.unp@gmail.com
CLAUDINE CECILIA ALMACHAR ALARDE
ORCID No. 0000-0002-9721-5168
claudinealarde.unp@gmail.com
University of Northern Philippines
Vigan City, Ilocos Sur, Philippines

ABSTRACT
Compliance to prenatal care is one way of improving maternal health according
to the Department of Health, which is related to the fifth Millennium Development
Goals. The study aimed to determine the compliance to prenatal care among the 93
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pregnant mothers from all the local communities in Santa, Ilocos Sur during calendar
year 2012. The study utilized the descriptive-correlational method of research. The
main instrument of this study is a questionnaire. The data gathered were treated
and interpreted using frequency and percentage, mean and simple linear correlation
analysis. Results of the study revealed that the level of awareness on the importance of
prenatal care among the respondents is Very High and that the level of compliance
to prenatal care is Low. However, the level of compliance to prenatal care yielded
a significant relationship with the number of pregnancy, age of gestation in weeks,
broadcast media and print media. Moreover, the distance from the residence of the
respondents to the hospital showed an inverse significant relationship with the level
of compliance to prenatal care. In conclusion, the low compliance to prenatal care
indicates that the aim of DOH to at least have four antenatal care visits to improve
maternal health was not achieved.
KEYWORDS
Health Education, compliance to pre-natal care, descriptive-correlational
design, Philippines
INTRODUCTION
Guidelines for routine prenatal care were initially developed by the American
College of Obstetrics and Gynecology in 2005. The guidelines have since been
periodically revised. The guidelines of the US Public Health Service, published in 2009,
are the most specific guidelines for the content of routine prenatal care. The Public
Health Service guidelines incorporate all of the procedures and tests recommended
by the current American College of Obstetrics and Gynecology guidelines with the
exception of routine ultrasound, which has recently been shown not to improve birth
outcomes. Also, although they do not include specific recommendations for the
management of clinical problems that arise during pregnancy, they serve as a marker
for comprehensive care.
Prenatal Care is a program of care for a pregnant woman before she gives birth
to her baby and is widely accepted as an important element in improving pregnancy
outcome. It includes health care, along with education and counseling about how to
handle different aspects of pregnancy. A health care provider may discuss issues, such
as nutrition and physical activity, what to expect during the birthing process, and
basic skills for caring for an infant (Pillitteri, 2010).

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IAMURE International Journal of Health Education

Prenatal care is one of the DOH programs that has already been institutionalized
and adopted by all LGUs in Northern Philippines. Its objective is to reduce
complications during pregnancy. Prenatal care ensures healthy and safe pregnancy and
delivery of the baby through continued assessment, physical examination, laboratory
testing and counseling in the different aspects of childbearing (DOH,2O11).
In 2005, the DOH noted a flux in the percentage of women with at least four
(4) prenatal visits: 77% in 1998 to 70% in 2003 and 88% in 2005. However, the
National Demographic and Health Survey (NDHS) shows that a significant number
from the 88% of women who saw a health professional for prenatal care in 2005
eventually ended up giving birth at home, attended by a Trained Birth Attendant
(TBA).
The dangers of childbearing can be greatly reduced if a woman has a health checkup by a trained health worker during pregnancy, and if a skilled birth attendant assists
the birth. Thus, knowledge on prenatal care-practice protocol significantly affects the
compliance and utilization of the health service.
One of the eight, Millennium Developmental Goals (MDG) to global
development involves improving Maternal Health (MDG5). Within the MDG
monitoring framework, the international community committed itself to reducing
the Maternal Mortality Ratio (MMR) and set a target of a decline of three quarters
between 1990 and 2015 (DOH, 2000).
Corollary to MDG5, the DOH aims to increase the proportion of pregnant
woman having at least four antenatal care visits to 80% in its attempt to improve
maternal health thereby reducing MMR.
In the Philippines, eleven (11) women die every 24 hours from almost entirely
preventable causes related to pregnancy and childbirth. MMR ratio continues to be
staggeringly high, at 162 maternal deaths for every 100,000 live birth. (NSO, 2006)
The slow decline on MMR in the country maybe traced to inadequate access to
integrated reproductive health (RH) services by woman (WHO, 2004).
Aware of the situations cited, this study is deemed important and timely. The
awareness of the importance of prenatal care and compliance of mothers to prenatal
care is one way of improving maternal health thus reduce MMR.
Results of the study could provide policy makers information that serves as an
insight for the modification of plans and policies for future development regarding
maternal care.

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FRAMEWORK
The following readings guided the researchers in the conceptualization of the
study.
The American College of Obstetrics and Gynecology (ACOG) as presented in the
study of Ribeiro et al., (2009), revealed that in developed countries the traditional
model of prenatal care has been based on a large number of visits with their doctors
and this is from the beginning of their early stage of pregnancy. This is resulted as well
in developing world where persistent lack of medical and laboratory resources may
hamper prenatal effectiveness.
Ogueh O. et. al. (2006) pointed out in their study that the intrapartum related
to umbilical cord nuchal loops (nuchal cord) with particular reference to shoulder
dystocia. And they concluded that this umbilical cord nuchal loop are associated
with the induction of pregnant mother labor act, a very slow progress of labor,
and shoulder dystocia. It is further expounded with the result of the study by the
abnormal fetal heart rate patterns which are higher in the presence of nuchal cord.
MedSolutions, Inc. Clinical Decision Support Tool Diagnostic Strategies (2009)
formulated a tool entitled: Obstetrical Ultrasound Imaging Guidelines to address
common symptoms and symptom complexes. An imaging request for pregnant
patients with typical symptoms or clinical presentations that are not specifically
addressed will require an OB-gyne review. This is a great help for pregnant mothers as
a way as well in complying for prenatal care. The pregnant mothers after consultations
with their OB-gyne are subject to visit a specialist and/or pregnant patients Primary
Care Physician for providing additional insight. MedSolutions, Inc. do believed that
this Obstetrical Ultrasound Imaging Guidelines will help the pregnant mother aware
of her gestation to avoid possible risk factors most specially if the pregnant mother
age is less than 18 or greater than 34 years old; using insulin, having two or more low
birth weight infants; having a maternal blood clotting disorder (Antiphospholipid
Syndrome, Factor V Leiden mutation, Antithrombin III deficiency, Protein C/
Protein S deficiency, etc); history of two or more early fetal deaths (less than 20
weeks) or two or more elective terminations of pregnancy; having a heart disease;
high pressure; and having a sickle cell disease.
With the personal experiences as well of the researchers as mothers and nurses,
they found out that prenatal care is very necessary more especially if theres a family
history of miscarriage, birth defects, and multiple births, the doctor must know.
With this they are maybe things in prenatal care to test for and treat anything wrong
with the baby. With observations as well during community duties in the different
barangays, it is noted that for teenage mother and old pregnant mother from age
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bracket 14 to 17 and 40 and above they pregnancy is very risky so that the reason
why they were advised to have a regular visit and check-up with their doctors of in
the Rural Health Unit of the municipality.
Based on the above readings, the researchers were guided with the research
paradigm as having the independent and dependent variables. The independent
variables were the a) socio-demographic profile in terms of: age, civil status, educational
attainment, occupation, religion and family monthly income; b) obstetrical-related
factors in terms of: age at first pregnancy, number of pregnancy, number of live
birth, and age of gestation in weeks; c) sources of information in terms of: human
source, broadcast media, and print media; and d) accessibility of health facilities in
terms of: accessibility to the nearest hospital, and accessibility to RHU, respectively
and the awareness on the importance of pre-natal care. The dependent variable is
the level of compliance to pre-natal care in term of: pre-natal visits, micronutrient
supplementation, laboratory examination, and immunization schedule.

OBJECTIVES OF THE STUDY
This study was conducted to: 1)determine the profile of the respondents in terms
of sociodemographic profile, obstetrical related factors, sources of information, and
accessibility of health facilities; 2) ascertain the level of awareness on the importance
of prenatal care among the respondents; 3) determine the level of compliance
to prenatal care among the respondents along prenatal visits, micronutrient
supplementation, laboratory examinations, and immunization schedules; and, 4)
find out significant relationship between the level of compliance to prenatal care
among the respondents and their socio demographic factors, obstetrical related
factors, sources of information, Accessibility of health facilities, and level of awareness
on the importance of prenatal care.
METHODOLOGY
The descriptive research design was used in this study. A total of one-hundred
three (103) pregnant mothers in the Municipality of Santa, Ilocos Sur were the
respondents of this study during the calendar year 2012 but only ninety-three (93)
responded.
A questionnaire-checklist was the main instrument in gathering data which was
formulated by the researchers patterned from literatures and the Public Health Nursing
book by the Department of Health (2007). The content of the questionnaire was
validated by three experts having a high validity index that makes the questionnaire
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valid and reliable to be used as a tool for this study.

The level of awareness on the importance of prenatal care and the level of
compliance to prenatal care was measured utilizing the arbitrarily set scale as follows:
2 Yes and 1 No.
For convenience of analysis and interpretation, the five-point scale was used
to determine the perceptions of the respondents. The ranges of scores with their
corresponding descriptive equivalents are presented below:
Range of Scores

Descriptive Rating

81 100
61 80
41 60
21 40
0.0 20

Very High (VH)

High (H)
Moderate (M)
Low (L)
Very Low (VL)

Data Gathering Procedure

To get pertinent data, the researchers secured permission from the Municipal
Mayor and the Municipal Health Officer of Santa, Ilocos Sur. During the securing
the approval from the Municipal mayor and to the Health Officer of Santa, Ilocos
Sur, it passed through a thorough discussion for the benefits of this study which
will health the community to determine if pregnant mothers of the community are
complying such prenatal care during their pregnancies. After permission was granted,
the researchers distributed the questionnaires to the respondents. The researchers
personally retrieved the accomplished questionnaires from the respective respondents
in the Municipality of Santa, Ilocos Sur. After all the responses were collected, analysis
and interpretation of data was performed. Collected responses were treated with high
level of confidentiality wherein the identification of the respondents was kept with
utmost anonymity throughout the conduct of the research study.
Statistical Treatment of Data
The data collected was tabulated, organized, analyzed and interpreted. The
following statistical tools were utilized in the statistical treatment of the data gathered:
1. Frequency and percentage to describe the socio demographic profile,
obstetrical related factors, sources of information and accessibility of
health facilities;
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2. Mean to describe the level of awareness on the importance of prenatal care

and level of compliance to prenatal care among mothers; and
3. Simple Linear Correlation Analysis to determine the significant relationship
between the dependent and independent variables.
RESULTS AND DISCUSSION
The following were the results of the gathered data from the respondents as
to their compliance to prenatal care. The profile of the respondents in terms of
socio-demographic factors, obstetrical-related factors, source of information and
accessibility of health facilities are as follows: majority (53 or 57%) belong to 15-24
years of age bracket, single (50 or 53.8%), semi-skilled workers (51 or 54.8%) (Loom
and basket weaving, embroidery, grape farming and other small cottage industry),
Catholic (89 or 95.7%), receiving monthly income lower than 116 US $ P5,000
(53 or 57%) and most are high school graduates (38 or 40.9%).They had their first
pregnancy at 19 years of age (15 or 16.1%), most of them had one pregnancy (45 or
48.4%), have no live birth yet during the conduct of the study (47 or 50.6%) and
fall under the 24-31 weeks age of gestation (31 or 33.33%). They obtain information
on prenatal care from the midwife (90 or 25.4%), television (74 or 44.8%) and from
the newspaper (34 or 58.61%). Respondents reach the nearest hospital for about
20 minutes or more (89 or 95.7%) while it takes 15-19 minutes to reach the Rural
Health Unit in the municipality (37 or 39.8%).
Level of Awareness on the Importance of Prenatal Care and Compliance to
Prenatal Care
Table 1. Level of awareness on the importance of prenatal care and compliance
to prenatal care among the respondents in Santa, Ilocos Sur

Awareness on the Importance of Prenatal Care

Compliance to:
Prenatal Care Visits
Micronutrient Supplementation
Laboratory Exams on 1 3 months
Laboratory Exams on 4 - 6 months
Immunization Schedule
Overall
40

%
91.94

Descriptive Rating
Very High

73.09
35.03
6.65
12.55
45.24
34.51

High
Low
Very Low
Very Low
Moderate
Low

International Peer Reviewed Journal

Table 1 dealt with the level of awareness on the importance of prenatal care and
compliance to prenatal care. It is evident that there is a Very High (91.94%) level
of awareness on the importance of prenatal care.
This implies that the respondents are conscious or knowledgeable on the value of
prenatal care, knowing that prenatal care is essential in ensuring their overall health
and their babies. Thus, complications during pregnancy and post-partal period are
reduced if not prevented.
The overall level of compliance to prenatal care among the respondents is Low
(34.51%). Taken singly, the respondents had a High compliance to Prenatal
Care visits (73.09%); Moderate to immunization schedule (45.24%); Low to
micronutrient supplementation (35.03%); Very Low to laboratory examinations
on 4 6 months (12.55%) and during 1 3 months (6.65%) as well.
The findings imply that although the respondents are highly aware on the
importance of prenatal care, they are not submissive in complying with the
components of prenatal care. Hence, the risk of possible complications of pregnancy,
by anticipation and preventing problems before they occur is not possibly minimized.
It further implies that respondents need to improve prenatal health specifically
on developing positive attitudes on micronutrient supplementation and indicated
laboratory examinations during pregnancy.
The results of the study could also mean that the respondents focused more on
prenatal visits. This could be attributed to the fact that through regular prenatal
visits, the respondents may believe that gestational age of the fetus can be determined
and fetal development is monitored.
The findings are in conformity with Huth, et al. (2005) that low level of
compliance to prenatal care maybe attributed to geography, transportation, lack of
obstetrical providers and health insurance and social and domestic issues like cultural
differences, perinatal depression and lack of family support.
Thirukkanesh and Zahara (2010) explained that the compliance level with
vitamins and mineral supplementation among pregnant women in both urban and
rural areas are found to be low and majority of them addressing side effects and
forgetfulness as the main contributing factor towards non compliance.
Lutsey et al. (2007) found out in their study that compliance was positively
related to hemoglobin (Hb) concentrations. Several factors associated with greater
compliance were identified, including marital status, number of children, health
program knowledge, side effects, perceived health benefits, and dislike of taste. Some
of these factors may serve as avenues for interventions to increase compliance, and
ultimately Hb concentrations.

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According to Kulkarni et al. (2010), poor, undernourished, uneducated women

can have high compliance to antenatal supplementation if they are supplied with the
tablets and reminded them regularly, and counseled about side effects.
Ribiero et al. (2009) emphasized that prenatal care coverage was high. However, a
significant number of women still had inadequate prenatal care use. Socio economic
inequalities, demographic factors and behavioral risk factors are still important factors
associated with inadequate prenatal care use.
Pregnant women receiving prenatal care (%) in Philippines was 78.00 as
of 2011. Its highest value over the past 18 years was 91.00 in 2008, while its
lowest value was 78.00 in 2011. Pregnant women receiving prenatal care are the
percentage of women attended at least once during pregnancy by skilled health
personnel for reasons related to pregnancy (UNICEF, 2011).
Relationship between the level of compliance to prenatal care
and the respondents profile
Table 2 presents the relationship between the compliance to prenatal care and
the socio-demographic profile, obstetrical related factors, sources of information
and accessibility of health facilities. To further understand if there is a significant
relationship between the level of awareness and compliance to prenatal care and the
socio-demographic profile of the respondents the simple linear correlation analysis
was used were resulted to the following:
The overall r-value of .144 along age, .159 along civil status, .148 along educational
attainment, .055 along occupation, -.142 along religion, and -.002 along income did
not attain significance at 0.05 level of probability. Hence, the null hypothesis which
states that there is no significant relationship between the compliance to prenatal care
and the socio-demographic factors is not rejected. This means that the compliance
to prenatal care is not related to the socio-demographic factors of the respondents.
However, taken singly, religion was found out to have an inverse significant
relationship with the compliance to laboratory examinations during the first trimester
and second trimester. This is backed up by the r-values of -.222 and -.269 which had
reached significance at 0.05 probability level respectively. The findings could mean
that those with high faith in God had a very low compliance to prenatal care. Prayers
made them feel safe and secured during pregnancy. As stated by Pillitteri (2010),
religion is culturally determined and because religion guides a persons overall life
philosophy, it influences how he/she feels about health and illness especially during
pregnancy.

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Table 2. Relationship between the compliance to Prenatal Care

and the Socio-demographic Profile, Obstetrical Related Factors, Sources
of Information and Accessibility of Health Facilities

Prenatal
Visits

Micronutrient
Supplementa-tion

Laboratory Exams (1-3

mos)

Laboratory
Exams (4-6
mos)

TT
Immunization

Overall

Socio-Demographic Profile
Age

-.083

-.085

-.169

-.132

.155

.144

Civil Status

-.159

.033

.144

-.012

.136

.159

Educational
Attainment

.130

.168

.152

-.039

-.143

.148

Occupation

-.117

.008

-.167

.019

.086

.055

Religion

-.012

.050

-.222*

-.269**

.092

-.142

Income

-.112

-.073

-.050

-.052

-.004

-.002

Obstetrical-Related Factors
Age at First
Pregnancy

-.018

.019

-.107

-.133

.012

.111

Number of
Pregnancy

-.040

.072

-.077

.007

.166

.321**

Number of Live
Birth

-.197

-.023

-.087

-.023

.137

.173

Age of Gestation in
Weeks

.129

.168

.103

.002

.019

.320**

Sources of Information
Human Sources

.254*

.191

.066

.049

.167

.183

Mass Media

.159

.225

.062

.119

.173

.299**

Print Media

-.083

.362

.022

.207

.248

.415**

Accessibility of Health Facilities

Distance from
Residence to RHU

.051

.168

-.036

.126

-.318**

.088

Distance from
Residence to
Hospital

.038

-.325**

-.093

-.164

-.021

-.219*

Only the number of pregnancy (r=.321) and age of gestation in weeks (r=.320)
yielded significant relationships with the level of compliance to Prenatal Care. The
r-values attained significance at 0.05 level of probability. The findings imply that
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regardless of the number of pregnancies and age of gestation in weeks, the respondents
comply with prenatal care. Regular prenatal care helps keep the mother and the
baby healthy. Prenatal care is a type of preventive care with the goal of providing
regular check-up that allow doctors or midwives to treat and prevent potential health
problems throughout the course of pregnancy while promoting healthy lifestyle that
benefits both mother and child.
The availability of the routine prenatal care has played a part in reducing maternal
death rates and miscarriages as well as birth defects, low birth weight and other
preventable health problems. This is supported by Pillitteri (2010) that prenatal care
is important because lack of it is associated with the birth of infants and various
complications for the woman. It further states that an important focus of all prenatal
visits, therefore, is to screen for danger signs that might occur during pregnancy.
The overall r-values of .299 and .415 for broadcast media and print media
respectively had attained significance at 0.05 probability levels which suggest that
there is a significant relationship between the level of compliance and broadcast
media and print media. Therefore, the null hypothesis is rejected. The results could
mean that information from broadcast and print media on prenatal care can very
much encourage mothers to submit themselves for prenatal check-up, laboratory
examinations and tetanus toxoid immunization.
When taken singly, human sources yielded significant relationship with prenatal
visits (r = .254). Likewise, print media was found to be related significantly to
micronutrient supplementation (r = .362). The findings imply that the respondents
obtain information on prenatal visits from the midwife and family members. On
the other hand, information on micronutrient supplementation is acquired from
television and radio. The result could further mean that information from human
sources, broadcast and print media can make the respondents aware of the importance
of prenatal care and stimulate them to comply with the scheduled prenatal visits and
micronutrient supplementation.
Pillitteri (2010) stated that it is helpful to give a pregnant woman and her partner
pamphlets or books that covers nursing implementations at prenatal visits, teaching
women and their families about safe pregnancy lifestyle. This helps to ensure that a
pamphlets advise is consistent with what the nurse or doctor have said and with the
views of pregnant womans primary care physician or midwife. During prenatal check
up, the waiting time is made educational by providing materials such as pamphlets
and videotape in the waiting area.
An inverse significant relationship existed between the overall compliance
to prenatal care among the respondents and distance from residence to hospital
as backed up by the R-value of -.219 which reached significance at 0.05 level of
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probability. This could mean that the shorter the distance from the residence of the
respondents to the hospital, the lower is the compliance to prenatal care.
Taken singly, distance from residence to hospital yielded an inverse significant
relationship with the compliance to micronutrient supplementation as supported by
the computed correlation coefficient of -.335 which is far beyond the 0.01 level of
probability.
The findings imply that the shorter the distance from the residence of the
respondents to the hospital, the respondents may or may not go for prenatal checkups comply with micronutrient supplementation.
Moreover, taken singly, the distance from the residence of the respondents to
RHU manifested an inverse relationship with the compliance to tetanus toxoid
immunization as manifested by the r-value of -.318 which attained significance
at 0.05 probability level. This could mean that the shorter the distance from the
respondents residence to RHU, the respondents may or may not comply with
tetanus toxoid immunization.
Pregnant women near the hospital/health care centers have the lower compliance
to prenatal care because they can go anytime for it is accessible to them. Pillitteri
(2010) added that with the modern technology or gadgets, pregnant women can
just call, e-mail or text message to the health care setting if they have questions or
problems between visits.
Relationship between the awareness on the importance of prenatal care and
compliance to prenatal care among the respondents
Table 3. Relationship between the level of awareness and the level
of compliance among the respondents in Santa, Ilocos Sur
r-value

r-prob

Prenatal Care Visits

.041

.693

Micronutrient Supplementation

-.008

.942

Laboratory Exams on 1 3 months

-.006

.952

Laboratory Exams on 4 - 6 months

-.064

.544

Immunization Schedule

.152

.166

.079

.450

Overall

As a whole (r=.079) and taken singly, the level of awareness on the importance of
prenatal care is not significantly related to the level of compliance of the respondents
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to prenatal care as evidenced by the computed correlation coefficient of .041 along

prenatal visits, -.008 along micronutrient supplementation, -.006 along laboratory
examination on 1 3 months, -.064 along laboratory examinations on 4 6 months
and .152 along immunization schedule.
The r-values did not attain significance at 0.05 level of probability. Therefore,
the level of awareness on the importance of prenatal care did not affect the level of
compliance to prenatal care.
With regards with the relationship between the level of awareness and the level of
compliance, pregnant mothers should consider the importance of prenatal care during
their pregnancy period. That proper prenatal care is an essential aspect throughout
their entire pregnancy and this is more than enough just of taking care of the growing
child. Prenatal care is also considered about taking care of the pregnant mothers self,
as it is a crucial to the health and well-being of the child in the womb. Complying
prenatal care can give doctors and specialists the opportunity to be conscious with
the health concerns and will allow them to treat any problems. In this sense, it will be
beneficial to both mother and the baby. Lastly, complying with prenatal care is giving
the child a healthy start by taking care of the pregnant mothers life throughout her
pregnancy.

CONCLUSIONS
The Very High level of awareness on the importance of prenatal care could
be attributed to the information obtained by the respondents from the midwife,
television and newspapers. The Low level of compliance to prenatal care could be
related to the accessibility of health facilities since the respondents reach the nearest
hospital from their residence for about 20 minutes ride or more and there might
be other factors that could affect the level of compliance of the respondents. This is
in conformity with Huth, et al. (2005) who said that in recent studies low level of
compliance to prenatal care maybe attributed to geography, transportation, lack of
obstetrical providers and health insurance and social and domestic issues like cultural
differences, perinatal depression and lack of family support.
The number of pregnancy, age of gestation in weeks, broadcast media and print
media indicate a positive correlation with the level of compliance to prenatal care.
There is an inverse correlation between the level of compliance to prenatal care
and the accessibility of health facilities. Pillitteri (2010) stated that it is helpful to
give a pregnant woman and her partner pamphlets or books that covers nursing
implementations at prenatal visits, teaching women and their families about safe
pregnancy lifestyle. This helps to ensure that a pamphlets advise is consistent with
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International Peer Reviewed Journal

what the nurse or doctor have said and with the views of pregnant womans primary
care physician or midwife. During prenatal check up, the waiting time is made
educational by providing materials such as pamphlets and videotape in the waiting
area.
Pregnant women near the hospital/health care centers had the lower compliance
to prenatal care because they can go anytime for it is accessible to them. Pillitteri
(2010) added that with the modern technology or gadgets, pregnant women can
just call, e-mail or text message to the health care setting if they have questions or
problems between visits.

RECOMMENDATIONS
The Rural Health Unit Officers and staff should consider at least the information
that World Health Organization (WHO) provide especially on how to comply
rigorously to prenatal care programs and it must be disseminated widely the
importance and benefits of practicing and complying with the prenatal care activities.
The Rural Health Unit Officers should undergo series of trainings, seminars or
workshops along with prenatal care programs in order to have an ample knowledge
and information on how to further encourage pregnant mothers in their respective
municipalities concerning the relevancy of this prenatal care compliance.
And to further improve the level of compliance to prenatal care from Low to
Very High, continues information dissemination on the importance of prenatal
care be undertaken through: a) regular conduct of mothers class by the Rural Health
Unit personnel to be sponsored by drug companies/medical representatives, b)
conduct of home visits by midwives or barangay health workers, c) distribution of
pamphlets to all pregnant mothers, and) informing mothers who have internet access
of the websites that provide information on pregnancy and prenatal care.
The Department of Health should formulate policies pursuant to disciplinary
actions for non-compliance to prenatal care program of the government; further
study should be undertaken to include other variables that could pinpoint the reasons
for the low compliance to prenatal care; and, similar study should be undertaken
in another municipality of Ilocos Sur to determine if the level of compliance of the
pregnant mothers to prenatal care in that certain municipality is influenced by their
level of awareness on the importance of prenatal care.
Then in collaboration, student nurses having their community duty and immersion
should keep on inculcating the importance of prenatal care during their visits. With
the supervision of their Clinical Instructors, they can conduct a small group discussion
about the importance and by presenting as well the disadvantages once a pregnant
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mother is not complying prenatal care. By continues extending information it will

further enhance and enrich their knowledge and it will help them to have a good state
of their pregnancy periods. Prenatal care among pregnant mothers should be fully
implemented and they should comply about it in order to avoid costly complication
of pregnancy that may occur during the period. Compliance with Rural Health Unit
and hospitals should be followed strictly to avoid inadequate prenatal care problems.
It is also recommended that a research study on Prenatal Hospitalization and
Compliance with Prenatal Guidelines for Prenatal Care should be conducted to
further find out the vulnerability of prenatal care program among pregnant mothers
and to further investigate what are the determining factors that may serve as barriers
to prenatal care compliance.
Lastly, a follow-up study will be conducted based with the result of the study,
to further validate and investigate the collected data what makes religion a factor
having a significant relationship to the compliance of prenatal care; wherein it needs
a thorough explanations as well.
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Pursuant to the international character of this publication, the journal is indexed by the
following agencies: (1)Public Knowledge Project, a consortium of Simon Fraser University
Library, the School of Education of Stanford University, and the British Columbia
University, Canada; (2) Philippine E-Journals; (3) Google Scholar (4) Index Copernicus; (5)
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