A Comparative Study on the Compliance

in Maternal and Child Health Care

Services among 4Ps and Non 4Ps Mothers
in Tanauan, Leyte
● A researcher-made questionnaire was used in gathering background data of the respondents and their
compliance with the variables such as: prenatal visit, place of delivery, delivery handled by skilled health
professionals, immunization, postpartum check-up with postnatal care of her newborn, family planning and
nutritional assessment. After gathering and collating the data, the researchers analyzed the results utilizing Chi-
Square Test in order to determine the association between the compliance (non-compliance) of the respondents
to the parameters being tested.
● The study reveals that there is no significant association between compliance (or non-compliance) in maternal
and child health care services of 4Ps and non-4Ps in relation with the prenatal visit, place of delivery, deliveries
handled by a skilled health professional, postnatal visits, and immunization. However, the researchers found out
that there is a significant association between the type of compliance and nutritional assessment as well as
family planning variables which rejects the null hypothesis.

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 ABSTRACT
● Maternal and Child Health has become increasingly important in the past decades
in the Philippines. In order to strengthen its health system, the country has
initiated multiple programs.
● To determine the association between the compliance (or non-compliance) with
the Maternal and Child Health Care Services and each of the profile variates of
the 4Ps and non-4Ps mothers, the researchers utilized a descriptive method. One
hundred fifty 4Ps and one hundred fifty non-4ps mothers were selected through
Multi- Stage Systematic Sampling method. Frequency and Percentage was used to
determine the demographic profile of the respondents.
 

3
 INTRODUCTION
● Maternal and Child Health has become increasingly important in the past decades
in the Philippines. In order to strengthen its health system, the country has
initiated multiple programs.
● To determine the association between the compliance (or non-compliance) with
the Maternal and Child Health Care Services and each of the profile variates of
the 4Ps and non-4Ps mothers, the researchers utilized a descriptive method. One
hundred fifty 4Ps and one hundred fifty non-4ps mothers were selected through
Multi- Stage Systematic Sampling method. Frequency and Percentage was used to
determine the demographic profile of the respondents.
 

4
 I- Background of the Study
Over the past few decades in the Philippines, the topic of health has become
increasingly important. In order to strengthen its health system, the country has
initiated multiple reform rounds (Dayrit M. et al., 2018). Through the continued
expansion of the Pantawid Pamilyang Pilipino Program (4Ps), the Philippines '
version of the conditional cash transfer (CCT) program modeled on Latin American
countries, the Philippine government is showing its serious efforts to combat poverty.
The 4Ps is by far the Philippine government's most ambitious and divisive poverty
reduction plan due to the enormous amount of money that the government spends on
it (Tabuga and Reyes, 2013).

 
5
 The plan is administered by the Department of Social Welfare and Development, with collaborators being the
Department of Health, Education Department and the National Economic and Development Authority. Beneficiaries are
chosen objectively through the National Household Targeting System, also known as Listahanan, based on a survey of
their houses ' physical structure, number of rooms and inhabitants, access to running water and other factors affecting their
living conditions. (World Bank.org, 2017).
The Pantawid Pamilyang Pilipino Program Act No. 11310 was signed by President Rodrigo Roa Duterte on April
17, 2019 but it was showed to the public on April 22 on the same year which is now a permanent government program
requiring regular funding from the Department of Social Welfare and Development (DSWD) budget it aims at providing
financial assistance to poor households with certain qualifications, improving the health, nutrition and education aspects of
their lives (Ranada, 2019).

6
 According to the Maternal and child wellbeing systematic review of CCT studies outcome it shows the CCTs have increased
antenatal visits, increased birth attendance, delivery to health care facilities, and increasing the occurrence of low birth weight tetanus
toxoid vaccination for mothers. While compliance among 4Ps and non-4Ps mothers in relation with maternal and newborn health care
service has not been well documented so far (Glassman, A et al, 2017).
The statistic shows the infant mortality rate in the Philippines from 2007 accounts 25.6 deaths per 1,000 livebirths while in year
2017 it reduces to 22.2 deaths per 1,000 livebirths (Plecher, 2019). There has been no decrease in the number of mothers who die from
pregnancy and instead risen to higher levels than when the MDGs started in 1990. The maternal mortality ratio was 209 per 100,000 live
births and was gradually reduced to 162 in 2006, but rose to 221 in 2011, higher than in 1990. (Santos, 2014). However, there are still
maternal and infant mortality cases despite of the reducing number of deaths in the Philippines.
Thus, the researchers of this paper would like to determine the compliance of beneficiaries and non-beneficiaries of conditional
cash transfer program through 4P’s in relation with the Maternal and Child health care services and help the health care system in the
Philippines to reduce maternal and infant mortality rates.

7
 CONCEPTUAL FRAMEWORK

4P’s Beneficiaries
 
Compliance on Maternal and
Child Health Care Services
-Prenatal Visit
Confounding Variables: -Delivered in Health Facility
Demographic and Socioeconomic -Delivered handled by skillful
Factors health care profession
-age - Postpartum check-up with
-educational attainment postnatal care of her
newborn -Family Planning
-Immunization and
Nutritional Status
assessment of children
Non-4P’s Beneficiaries  

8
 The conceptual framework of the study is schematically presented in Figure 1 upon which the
study focused on illustrating the following variables: the 4Ps beneficiaries and non-4Ps beneficiaries
as independent variables which is referred as a factor that is presumed to create an effect to the
utilization of maternal and child health care services such as: Prenatal visit, Delivered in health
facility, Delivered handled by skilled health care profession, Postpartum check-up with postnatal care
of her newborn, Family Planning, Immunization and Nutritional Status assessment of children in
relation to the confounding variables such as the demographic and socioeconomic factors which can
influence and change the effect of the independent variable to the compliance with maternal and
health care services.

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 Objectives of the Study
With the aforementioned background and the statement of the problem, this research aims to determine the compliance on maternal and child health care
services among 4P's and non-4P's mothers in 5 barangays of the Municipality of Tanauan, Leyte. Specifically, the research would like to address the
following objectives:
1. What is the respondents ' demographic profile as follows:
a. age
b. educational attainment
2. To describe if 4P's member aging 25-49 yrs. old mothers are more compliant than to non-4P's in terms of:
a. prenatal services
b. deliveries in health facility
c. deliveries attended by skilled health professional
d. postpartum check-up with postnatal care of her newborn
e. family planning services
3. To describe if mothers with children aging 0-5 yrs. Old under the 4Ps program are more compliant than non-4P's in terms of receiving regular health
services such as:
a. immunization
b. nutritional assessment
4. To determine the significant association between the compliance (or non-compliance) in maternal and child health care services between 4P's and non-
4P's mother.

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 METHODOLOGY
Research Design
This study utilized a Descriptive Research Design to gather the necessary information for this study. In
particular, the researchers will use a researcher-made questionnaire that enables them to gather information from
respondents. The study will also describe the compliance among 4Ps and non-4Ps mothers in utilizing maternal and
child health care services specifically with the following variables such as prenatal check-up, mothers who
delivered in health facility, deliveries handled by skilled health professionals, postpartum check-up with postnatal
care of her newborn, family planning, postnatal care of newborn, immunization and nutrition assessment.
Further, the design will be employed to describe the profile of the respondents on the variables being tested and
determine the association between the compliance (or non-compliance) among 4Ps beneficiaries and non 4Ps
mothers in utilizing maternal and child health care services.

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Research Locale
The study will be conducted in Tanauan, Leyte. A coastal town situated at 11.11° North latitude, 125.02°
East longitude with an elevation of 6.5 meter above sea level. It is classified as a 2nd class municipality based on
its income with an estimate populace 53,310 and 12,386 households coming from 54 barangays. (Neussner, 2014).
Specifically, the study was conducted at the randomly selected 5 barangays namely: Brgy. Bantagan, Brgy.
Mohon, Brgy. Pago, Brgy. Salvador and Brgy. Sacme in the municipality of Tanauan, Leyte.
Variables of the Study
The variables described in this study were the demographic characteristics of 4P's and non-4P's and their
compliance in maternal and child health care services such as prenatal check-up, delivered in health facility,
deliveries handled by skilled health professionals, postpartum check-up with postnatal care of her newborn, family
planning, newborn care, child immunization and nutritional assessment.
 

  12
Research Respondents
There will be a total of 150 4Ps and 150 non-4Ps respondents in the randomly selected 5
barangays namely: Brgy. Bantagan, Brgy. Mohon, Brgy. Pago, Brgy. Salvador and Brgy. Sacme
in the municipality of Tanauan, Leyte.
The respondents will be chosen randomly from the lists provided by the RHU Tanauan. The
respondents were selected based on the following inclusion and exclusion criteria.
 
INCLUSION:
Mothers aging 25-49 years old.
Mothers who have at least 1 child aging 0-5 years old. Regardless of the number of children,
the mother will only be counted once.
Mothers who are residents of the randomly selected barangays namely: Brgy. Bantagan, Brgy.
Mohon, Brgy. Pago, Brgy. Salvador and Brgy. Sacme in the municipality of Tanauan, Leyte.
 
EXCLUSION:
Mothers who are aging below 25 years old and the teenage mothers.
Mothers who delivered less than a month, which is not yet complete with postpartum visit, and
having a child aging less than 11 months who is currently receiving vaccinations.
 
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Sampling Design
The respondents were selected by Multi- Stage Systematic Sampling Design by four stages.
The first stage was the arbitrary selection of the municipality of Tanauan, Leyte. The choice is
based on its accessibility to the researchers. Second stage was the random selection of the
 
barangays. Third stage was the identification of 4P’s and non- 4Ps mothers who gave birth for
the past 5 years from the randomly selected barangays. The respondents of the study were
identified 4P’s and non-4P’s mothers aging 25-49 years old who qualify based on the inclusion
and exclusion criteria. And the last stage was the identification of the sample size of the study
that was 4P’s and non- 4P’s mothers of the randomly selected 5 barangays namely: Brgy.
Bantagan, Brgy. Mohon, Brgy. Pago, Brgy. Salvador and Brgy. Sacme in the municipality of
Tanauan, Leyte. Eventually, 150 4P’s and 150 non-4P’s mothers were selected in the study.
 
.
 

14
The data will be summarized in tables wherein the data analysis consists of descriptive
statistics with the aid of Statistical Package for the Social Sciences (SPSS) Version 2.0
statistical software. It will describe the demographic profile such as age and educational
attainment which will be tabulated according to frequencies and percentages. It will also
 
describe the compliance in maternal and child health care services such as prenatal check-up,
delivered in health facility, deliveries handled by skilled health professionals, postpartum
check-up with postnatal care of her newborn, family planning, child immunization and
nutritional assessment which will also be computed in their frequencies and percentages. The
researchers utilized a Chi-Square Test to analyze the results and determine the significant
association between the compliance (or non-compliance) in maternal and child health care
services between 4P's and non-4P's mother. However, since chi-square usually indicates
statistical significance but does not express the magnitude of relationship, the coefficient of
contingency was used in determining the strength of relationship.
 
 

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 RESULTS AND DISCUSSION
Postpartum Visit. The 4Ps member- and non-4Ps member-respondents perceptions as regards their compliance (or non-compliance) of maternal services
in terms of postpartum visits are presented in Table 6.

 Table 6
Compliance (Non-Compliance) of 4Ps and Non-4Ps Members as regard Maternal Services in terms of Postpartum Visits

Response Taken 4Ps Members Non-4Ps Members

Frequency Percentage Frequency Percentage
Compliant 40 26.67 33 22.00
         
Non-Compliant 110 73.34 117 78.00

Total 150 100.00 150 100.00

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It is given in Table 6 that out of the 150 4Ps member-respondents, only 40 or 26.67 percent were compliant of
maternal services in terms of postpartum visits whereas 110 or 73.34 percent were non-compliant. The data
suggested that majority of the 4Ps member-respondents were not compliant of postpartum visits. The finding is
contrary to the provision of the Republic Act Number 11310 on 4Ps which states that all qualified household-
beneficiaries,
  especially mothers, have to comply with postpartum care as a requirement for continued program
eligibility. Hence, this meant that the eligibility of the majority of the 4Ps members of this study might be
questioned because of their non-compliance of postpartum care. The finding also affirms the ideas espoused
by Yamashita, Suplido, Llave, Tanaka, Senba, and Matsuo (2014) that there are no reports regarding utilization
of postpartum health care services or the challenges associated with seeking such services in the Philippines.
In fact, they averred that this underutilization of postpartum care is the cause of approximately two-thirds of all
maternal deaths.
In the same manner, Table 6 shows that even non-4Ps members were non-compliant with postpartum
care with 117 or 78 percent out of the 150 total non-4Ps member-respondents. Only 33 or 22 percent of the
non-4Ps members were compliant of postpartum care. This finding, indeed, confirmed the above idea of
Yamashita, et al (2014) that postpartum care is not typical among mothers.
 
 

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Family Planning. Table 7 yields the data on the compliance (or non-compliance) by the 4Ps members and non-4Ps members as regard maternal and
child care services in terms of family planning.

Table 7
Compliance (Non-Compliance) of 4Ps and Non-4Ps Members as regard Maternal Services in terms of Family Planning

Response Taken 4Ps Members Non-4Ps Members

Frequency Percentage Frequency Percentage
Compliant 93 62.00 69 46.00
         
Non-Compliant 57 38.00 81 54.00

Total 150 100.00 150 100.00

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The results yielded in Table 7 show that 93 or 62 percent of the 4Ps members were compliant
of the services of family planning with the remaining 57 or 38 percent who were non-compliant.
The findings of the study indicated that most of the 4Ps members were compliant of the family
planning efforts of the Philippine government. The compliance with the family planning effort by
  4Ps member could be understood in reference to the policy of the State as mandated in
the
Republic Act Number 11310 which emphasizes to break the intergenerational cycle of poverty
through investment in human capital and improved delivery of basic services to the poor in
terms of education, health, nutrition, and early childhood care and development (Republic Act
Number 11310).
Even the 2016 Research Colloquium of the Department of Social Welfare and
Development (DSWD) showed high compliance rates for the 4Ps member-beneficiaries. This
compliance by 4Ps member is translated into data that showed women beneficiaries trying
modern family planning method at least once, with contraceptive prevalence rate at 74 percent
compared to the 68 percent of non-4Ps member-counterparts. Likewise, there was a high
awareness of modern family planning methods at 43 percent against the 39 percent for the
4Ps members versus the non-4Ps members (Bautista & Yap, 2017).
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However, the data in Table 7 revealed that 81 or 54 percent of the 4Ps member-respondents
were non-compliant of the family planning efforts of the government, with only 69 or 46 percent
of the non-4Ps members who were compliant. This meant that most of the non-4Ps member-
respondents were non-compliant of the family planning services of the government. This is
 
supported by the findings of Bautista and Yap (2017) which highlighted that 4Ps member-
respondents were more compliant with family planning efforts than their non-4Ps counterparts.
One of the barriers that inhibit women from complying with the family planning programs of the
government is their attitude toward family planning per se.
In summary, the 4Ps and non-4Ps members had complied with almost all the parameters
of maternal and child care services, except as regards family planning to which 4Ps members
were more compliant than the non-4Ps members. However, both 4Ps and non-4Ps mothers
are not compliant in utilizing postnatal services provided.

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 Association between Type of Compliance of the 4Ps and Non-4Ps Members and
Parameters of the Maternal and Child Health Care Services
The succeeding tabular presentations and discussions are focused on the results of the test of hypothesis made in this study.
Type of Compliance and Family Planning Services. Table 14 provides the Chi-square test results to determine the association between the
type of compliance of the 4Ps and non-4Ps members and family planning services.
Table 14
Type of Compliance and Family Planning Services

Category of Respondents
Type of Compliance  Total 2 value
Non-4Ps Beneficiary 4Ps Beneficiary
Compliant
69 93 162 (54.00%)
7.7295
Not compliant
81 57 138 (46.00%)
Total 150 150 300
*Figures in parentheses represent total share

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Table 14 shows that the association between type of compliance and family planning services
was high implying that there is significant association between type of compliance and family
planning. The calculated value of 2 (7.7295) is higher than the chi-square table value of 2
(3.84) at P ≤ 0.05 level, df = 1. Therefore, we reject the null hypothesis “Type of Compliance
  Family Planning are independent” and accept the alternative hypothesis “Type of
and
Compliance and Family Planning are not independent”. The coefficient of contingency is C =
0.15, therefore the strength of the relationship is weak. The highest rate of respondents came
from compliant respondents with 54.00 percent. There is a significant association which means
the type of compliance has an effect with the family planning of 4P’s and non 4Ps beneficiary.
Therefore, it can be implied that 4Ps beneficiaries are more compliant when it comes to family
planning.

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The significance of the association between type of compliance and family planning services
among compliant 4Ps members implied a strong desire on their part to break from the
intergenerational cycle of poverty. It can be construed that one of the policies of Republic Act
Number 11310 is to break the cycle of poverty that has long embed in Filipino families through
 
investment in human capital and improved delivery of basic services, particularly in health and
nutrition. The DSWD also emphasized a high compliance rates among 4Ps members of family
planning services with women beneficiaries trying modern family planning method at least
once, with contraceptive prevalence rate at 74 percent compared to the 68 percent of non-4Ps
member-counterparts. Likewise, there was a high awareness of modern family planning
methods at 43 percent against the 39 percent for the 4Ps members versus the non-4Ps
members (Bautista & Yap, 2017).

23
Type of Compliance and Nutritional Assessment. Table 16 provides the Chi-square test results to determine the association between the
type of compliance of the 4Ps and non-4Ps members and nutritional assessment.
Table 16
Type of Compliance and Nutritional Assessment

Category of Respondents
Type of Compliance  Total 2 value
Non-4Ps Beneficiary 4Ps Beneficiary

Compliant 262
121 141 (87.33%)
12.053
Not compliant 38
29 9 (12.67%)
Total 150 150 300

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Table 16 shows that the association between type of compliance and nutritional assessment was high implying
that there is significant association between type of compliance and nutritional assessment. The calculated
value of 2 (12.053) is higher than the chi-square table value of 2 (3.84) at P ≤ 0.05 level, df = 1. Therefore,
we reject the null hypothesis “Type of Compliance and Nutritional Assessment are independent” and accept the
alternative
  hypothesis “Type of Compliance and Nutritional Assessment are not independent”. The coefficient
of contingency is C = 0.20, therefore the strength of the relationship is weak. The highest rate of respondents
came from compliant respondents with 87.33 percent. There is a significant association which means the type
of compliance has an effect with the Nutritional Assessment of 4Ps and non 4Ps beneficiary. From this, it can
be implied that 4Ps beneficiaries are more compliant when it comes to nutritional assessment.
The provision of proper nutritional care to the family is closely associated to the socio-economic capacities of
the families. Implicit from the preceding premise that the degree to which families could provide proper
nutritional care to the family depends to some extent on their financial resources to buy basic necessities such
as food. Hence, the higher degree of compliance of 4Ps members, which also showed significant association,
could be understood with respect to the fact that they are provided with financial assistance to buy for their
children’s health and nutritional needs.
 

25
 SUMMARY, CONCLUSIONS AND RECOMMENDATION
Summary
This study aimed to determine and compare the compliance and involvement among beneficiaries of 4P’s
and non 4P’s mothers in utilizing maternal and child health care services among Tanauan residents for the last five
years (2014-2019).
Specifically, it would like to address the following objectives: (1) What is the respondents ' demographic
profile according to: a. age; b Educational attainment; (2) To describe if 4P's member aging 25-49 yrs. old mothers
are more compliant than to non-4P's in terms of: a. prenatal services; b. deliveries in health facility; c. deliveries
attended by skilled health professional; d. postpartum check-up with postnatal care of her newborn; e. family
planning services; (3) To describe if mothers with children aging 0-5 yrs. Old under the 4Ps program are more
compliant than non-4P's in terms of receiving regular health services such as: a. immunization; b. nutritional
assessment and (4) To determine the significant association between the compliance (or non-compliance) in
maternal and child health care services between 4P's and non-4P's mother.

  26
 Majority of the respondents from 4Ps were in their early 30s to 40s, indicating that they were in their early
adulthood. It is at this phase of human development where individuals explore their choices concerning their
marriage and family, and hence are most likely to avail of the maternal and child care services (“Development in
Early & Middle Adulthood). The result also implied that this is the age range which fits the requirement of the law
for 4Ps which states that the grantee of 4Ps refers to the most responsible adult member of the qualified household-
beneficiary authorized to receive the conditional cash transfer (Republic Act Number 11310, 2019). However,
majority of the non-4Ps respondents were aged between 25 and 32 years old, ages in early adulthood as well.
Majority of the 4Ps respondents reached and completed their secondary level of education same with non-
4Ps mothers. Based on the data, this further confirmed the findings of the Philippine Institute for Development
Studies which found out that there are relatively more members in 4Ps who have lower educational attainment
compared with non-4Ps mothers.

 
27
 The 4Ps and non-4Ps members had complied with almost all the parameters of maternal and child care
services, except as regards with family planning to which 4Ps members were more compliant than the non-4Ps
members. However, the data suggested that majority of the 4Ps member-respondents, as well as non-4Ps mothers,
were not compliant of postpartum visits. The finding is contrary to the provision of the Republic Act Number
11310 on 4Ps which states that all qualified member-beneficiaries, especially mothers, have to comply with
postpartum care as a requirement for continued program eligibility.
This study also proved that there is no significant association between compliance (or non-compliance) in
maternal and child health care services of 4Ps and non-4Ps in relation with the prenatal visit, place of delivery,
deliveries handled by a skilled health professional, postnatal visits, and immunization. However, there is a
significant association between the compliance and nutritional assessment as well as family planning variables
which rejects the null hypothesis. This implies that there is a higher degree of compliance among 4Ps mothers in
relation with family planning and nutritional assessment of their children.

28
 
 Conclusion
Based on the presented facts and findings of this study, the researchers arrived with the following conclusions;
a. The socio-demographic profile among 4Ps and non-4Ps mothers like age and educational attainment
affect their utilization in the maternal and child health care service provided to them.
b. Except with postnatal visit, 4Ps mothers are compliant in all variables. However, non-4Ps mothers are not
compliant both in postnatal visit and family planning.
c. Aside from family planning and nutritional assessment, there is a no significant association between
compliance (or non-compliance) with the maternal and child health services and each variates of 4Ps and non-4Ps
mothers.
d. The data also showed that implementation of Republic Act 11310 or also known as Pantawid Pamilyang
Pilipino Program (4Ps) was successful and effective to the 4Ps member-beneficiaries.

 
29
 Recommendation
The results showed that 4PsThis study revealed that 4Ps and non-4Ps mothers are not compliant in terms of postpartum check-up
and postnatal visit in the selected barangays of Tanauan, Leyte. The result implied that despite of the implementation of the
Republic Act Number 11310 on 4Ps mothers, which states that all qualified member-beneficiaries, especially mothers, have to
comply with postpartum care as a requirement for continued program eligibility, it is not utilize by the members of the program.
However, the results also showed that non-4Ps mothers are not compliant in utilizing family planning services. Hence, the
researchers recommend that the Department of Social Welfare and Development (DSWD) should strengthen its guidelines on
monitoring the beneficiaries in complying and abiding the law being implemented. The health care providers should also employ
more intensive demands generation strategies which shall focus on increasing knowledge of the 4Ps beneficiaries, as well as non-
4Ps mothers, on the advantages of availing postpartum check-up to prevent further maternal health problems and strengthen family
planning counseling, not only for 4Ps members but also to non-4Ps mothers, to ensure successful execution of the program and
increase the compliance in utilizing maternal and child health care services and also to have a strict implementation on Republic
Act Number 11310 on 4Ps member-beneficiaries provided by the government.

 
30
THE END..