Women's Health Facility Choices for Antenatal, Delivery, and Postnatal Care in Eastern Visayas, Philippines

Ahreum Choi¹Heunghee Kim²Sherlyn Mae P. Provido²Hee Sun Kim²Romil Jeffrey Juson³Diana Lucas³Heyeon Ji⁴Jihwan Jeon⁴Yunhee Kang^5,6*

• ¹Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
• ²Research Institute of Human Ecology, Seoul National University, Seoul, Republic of Korea
• ³world vision international, Tacloban City, Philippines
• ⁴World Vision, Seoul, Republic of Korea
• ⁵Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
• ⁶Department of Food and Nutrition, College of Human Ecology, Seoul National University, Seoul, Republic of Korea

Background: This study aims to identify socioeconomic factors associated with the choice of antenatal care (ANC) facilities and to analyze trends in the utilization of health facilities for delivery and postnatal care (PNC) based on the type of ANC facility in Eastern Visayas, Philippines.Methods: This secondary data analysis uses baseline and one-year follow-up survey data from a quasi-experimental study conducted in September 2023 and 2024. Data from 1,414 women with information on maternal health facility utilization was analyzed. ANC facilities were categorized into four groups: Barangay Health Station (BHS), Rural Health Unit (RHU), hospital/clinic and others. Multinomial logistic regressions were applied, adjusting for socio-economic status and Barangay location, to examine associations between socio-economic factors and ANC facility choice, as well as trends in delivery and PNC facility utilization based on ANC facility type.Results: Among 1,414 postpartum mothers, 35.6% received ANC at BHS, 34.1% at RHU, 32.7% at hospital/clinic, and 0.6% did not receive ANC. Most deliveries (83.3%) and PNC (61.4%) services occurred in hospital/clinic settings. Mothers who received ANC at a hospital/clinic were more likely to have higher education (aRRR=7.04, 95% CI: 3.97, 12.50) and be wealthier (aRRR=2.00, 95% CI: 1.09, 3.69) compared to those who received ANC at BHS. Mothers receiving ANC at RHU (aRRR=0.52, 95% CI: 0.34, 0.79) or hospital/clinic (aRRR=0.55, 95% CI: 0.38, 0.78) were less likely to be single with a partner compared to those receiving ANC at BHS. Mothers who received ANC at hospital/clinic were more likely to deliver at a hospital/clinic (aRRR=8.49, 95% CI: 3.56, 20.26) than at a RHU/BHS, and to receive PNC at a hospital/clinic (aRRR=2.07, 95% CI: 1.32, 3.24) instead of at a BHS, compared to those receiving ANC at BHS. Mothers receiving ANC at RHU were more likely to also receive PNC at an RHU (aRRR=16.13, 95% CI: 7.80, 33.36) compared to those receiving ANC at BHS.Conclusions: Socioeconomic disparities are associated with ANC facility choice, which in turn affects subsequent decisions regarding facilities for delivery and PNC in Eastern Visayas. As such, facility selection should be guided by healthcare needs rather than socioeconomic status.