2024 Volume 12 Issue 2 Pages 28-36
Aim: This study co-developed a Maternal and Child Health (MCH) Handbook among Tagbanua mothers in Coron, Palawan, and assessed its effectiveness in improving maternal and child health outcomes within the indigenous community and ensuring Universal Health Care (UHC) coverage for marginalized populations.
Methods: An action research approach was used with Tagbanua mothers to tailor an MCH Handbook to their cultural context. Its effect on maternal and child health knowledge, attitudes, and practices pre- and post-introduction was analyzed, alongside the handbook’s effectiveness in improving UHC access among the rural and indigenous population of Tagbanua. Data were collected through field surveys, key informant interviews, focused group discussions, and observations during field activities.
Results: The Tagbanua-specific MCH Handbook significantly improved mothers’ knowledge and attitudes toward MCH, except for breastfeeding aspects, and led to enhanced maternal and child health practices, with some exceptions in antenatal and delivery care. This collaborative effort resulted in improved maternal and child health outcomes, showcasing the potential of community-specific MCH Handbooks in promoting UHC among marginalized populations.
Conclusion: The community-specific MCH Handbook was effective in improving MCH outcomes among the Tagbanua, supporting UHC. This underscores the importance of tailored interventions in public health and advocates for developing population-specific MCH Handbooks.
Universal Health Care (UHC) is a fundamental principle in public health that aims to ensure everyone has access to comprehensive healthcare services, regardless of their economic status, geographical location, and cultural background.1) These services cover a wide range of medical needs, including preventive care, treatment for various health conditions, mental health support, access to essential medications, and maternal and child health services. UHC prioritizes the needs of populations who cannot afford such services,2) thereby reducing disparities in healthcare access and promoting well-being and overall health outcomes of individuals and communities. Due to its substantial benefits, it has emerged as a driving force behind global health initiatives and agendas in numerous countries across all levels of development, particularly within Sustainable Development Goal 3 (SDG 3).
As part of the 2030 Agenda for Sustainable Development, the United Nations established SDG 3 along with 17 other interconnected goals in 2015.3) SDG 3 emphasizes the importance of healthcare equity and quality across nations and aims to ensure health and wellness for all.4) The goal encompasses various health-related targets, including combating communicable diseases, ensuring universal access to sexual and reproductive healthcare services, achieving universal health coverage, and reducing child mortality.
Building upon UHC principles and the global commitment to healthcare equity, maternal and child health is critical in achieving SDG 3. One of the specific targets set by the United Nations under SDG 3 is to attain a Maternal Mortality Ratio (MMR) below 70 per 100,000 live births by 2030.5) This target reflects the international community’s dedication to improving maternal and child health outcomes and ensuring the well-being of mothers and children. Despite progress in many countries, challenges persist. For instance, in lower-middle-income countries like the Philippines, 78 women are still dying for every 100,000 live births.6) Meanwhile the MMR in low-income countries like South Sudan was reported to be 1,223 deaths per 100,000 live births.7)
Recent findings from Bihar, India, further highlight these challenges, revealing significant disparities in maternal and child health outcomes among marginalized women despite efforts to improve healthcare access.8) This is supported by the results of another study, which shows that socially marginalized groups encounter substantial barriers to accessing maternal healthcare services, resulting in higher maternal mortality rates and poorer maternal health outcomes compared to more privileged groups. Factors such as low household income, lack of education, inadequate water facilities, and geographical disparities contribute to these inequalities. Moreover, rural areas with limited healthcare infrastructure and insufficient training of healthcare providers exacerbate the challenges faced by vulnerable communities.9) Additionally, a study comparing indigenous women with non-Hispanic white women also highlights the elevated risk among indigenous populations, particularly in rural areas, where the incidence of severe maternal morbidity and mortality is higher than in urban areas.10) These findings suggest that healthcare disparities and maternal health outcomes are more pronounced, especially for vulnerable and marginalized populations, highlighting the need for targeted interventions.
Recognizing the magnitude of maternal and child health challenges, affected countries, including the Philippines, have implemented significant initiatives, particularly the Safe Motherhood Program and the Strengthening Health Care Provider Network (HCPN) with Enhanced Linkage to the Community for Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH). The Safe Motherhood Program ensures access to comprehensive health services for mothers, focusing on safe deliveries and regular check-ups. Aligned with the Department of Health’s strategies and UHC, the program aims to offer high-quality maternal and newborn health services, collaborating with local government units for sustainable healthcare delivery to disadvantaged women.11,12) Similarly, the HCPN initiative aims to improve maternal, child, and adolescent health by supporting communities in delivering essential health services effectively.13,14) However, despite progress, the pursuit of maternal and child health in the Philippines necessitates a continued commitment to attain its SDG 3 target. This context highlights the need to integrate UHC principles with targeted interventions to address disparities among marginalized groups for better maternal and child health outcomes.
According to the World Health Organization, home-based records such as the MCH Handbook are crucial targeted intervention tools for achieving each country’s maternal and child health goals.15) Originating from Japan in 1948, the MCH Handbook serves as a comprehensive health record and home-based information guide used by healthcare workers and families to track a pregnant mother’s health from pregnancy through the postnatal period and her child’s health from birth to age five. It also contains vital information on nutrition, immunization, breastfeeding, newborn care, and other relevant topics, making it an indispensable resource for promoting optimal health outcomes. Furthermore, the MCH Handbook is a culturally appropriate tool in terms of language and content, allowing users to understand and apply the information on safe pregnancy, delivery, and child health effectively, thus ensuring continuity of care.16) Moreover, aside from supporting risk detection, enhancing communication between healthcare providers and caregivers,17) and showing effectiveness in improving MCH-related indicators,16) it also provides several opportunities to ensure UHC coverage for marginalized populations.
Several global studies, including those conducted in Indonesia, Bangladesh, Cambodia, and Kenya, have evaluated the effectiveness of the MCH Handbook among rural populations. For instance, in rural Java, Indonesia, users of the MCH Handbook exhibited improved antenatal care attendance, sought professional childbirth care more frequently, and provided better diets for their children, resulting in enhanced child health outcomes.18) Similarly, in rural Bangladesh, the MCH Handbook significantly enhanced the utilization of continuum of care, potentially reducing neonatal mortality rates and benefiting mothers and offspring.19) Additionally, a study in Cambodia assessed the impact of the MCH Handbook on maternal knowledge and behavior, showing increased antenatal care attendance, delivery with skilled birth attendants, and facility-based deliveries, supporting its efficacy as a superior alternative to current maternal records.20) Moreover, in Kenya, a study emphasized the positive impact of handbook possession on health knowledge and proper health-seeking behavior, underlining the importance of effective community health strategies, including the role of community health workers (CHWs), in promoting maternal and child health through MCH Handbooks.21) While there are existing MCH Handbooks in several countries, these findings underscore the need for culturally significant and community-specific MCH Handbooks to enhance their effectiveness.
In line with this, this study employed an action research approach to develop a community-specific MCH Handbook for the Tagbanua indigenous group in Coron Island, Palawan, Philippines, addressing challenges like limited healthcare access due to its geographically isolated and disadvantaged area. The aim was to assess the Handbook’s effectiveness on improving maternal and child health outcomes within the indigenous community, aligning with the goal of ensuring UHC coverage for marginalized populations. This initiative was guided by the Universal Health Care Act (Republic Act No. 11223) and the Philippine Development Plan (PDP) 2023–2028 under the 8-Point Socioeconomic Agenda of the current administration,22,23) reinforcing existing health programs and facilities and working towards the target of reducing maternal and child morbidity to zero.
In this study, a participatory action research (PAR) design was employed with Tagbanua mothers in Coron, Palawan, aiming to foster cultural change in maternal and child health outcomes. This method was chosen to underscore the significance of engaging stakeholders effectively in research and policy implementation.24) Collaborative partnerships were forged with community members to identify key maternal and child-related issues and co-create a community-specific MCH Handbook. The study also focused on assessing changes in knowledge, attitudes, and practices among Tagbanua mothers by comparing baseline data with post-evaluation findings. Additionally, the research aimed to ensure UHC coverage among the rural and indigenous Tagbanua population through the co-developed MCH Handbook.
The research focused on Tagbanua mothers who had been pregnant within the last six years in Barangay Cabugao, Coron Island, Palawan. Municipal health officers, midwives, and health volunteers were also included as respondents to provide a comprehensive perspective on maternal and child health in the community. The participants were identified through a memorandum of agreement signed during community engagement. The principal investigator, supported by the Municipal Health Officer and staff from the Coron Municipal Health Center, led the data collection. Two additional data collectors assisted, with a Tagbanua guide aiding in communication and navigation.
Data collection methods included a field survey with 50 Tagbanua mothers, interviews with key informants such as municipal health officers, public health nurses, local midwives, and health volunteers, as well as group discussions among pregnant and new Tagbanua mothers, fathers, and community elders. Observations during field activities contributed to secondary data collection.
Raw data collected from interviews, surveys, and discussions were processed using Epi Info 7 and Stata 18. Statistical analysis, including McNemar’s Change Test, was conducted to assess significant changes in knowledge, attitudes, and practices among mothers, with a P-value of less than 0.05 considered statistically significant.
It assumed no significant MCH interventions occurred concurrently with the study. However, the study did not delve into the cost-effectiveness or economic sustainability of the MCH Handbook program.
In adherence to the Indigenous People Rights Act (IPRA) in the Philippines, ethical considerations were paramount throughout the study. Free Prior and Informed Consent (FPIC) was diligently obtained from indigenous communities, including collective informed consent, memorandum of agreement, and verbal informed consent before data collection began. Rigorous measures were in place to maintain the confidentiality of all respondents, upholding ethical standards at every stage of the research. The study received ethics clearance from the Graduate School of Human Sciences of Osaka University in Japan, supplemented by the FPIC secured in the Philippines.
This section presents the results of the study aimed at assessing the effect of a co-developed MCH Handbook among Tagbanua mothers in Coron, Palawan. The results are structured into four parts: development of the MCH Handbook, sociodemographic characteristics, baseline and post-evaluation data, and usefulness of the MCH Handbook.
The development of the MCH Handbook involved collaborative efforts with community members, healthcare professionals, and core group members such as mother leaders, midwives, and Barangay Health Workers (BHWs). Together, they finalized the MCH Handbook’s contents, including essential components like the antenatal care card, immunization card, growth card, existing health information materials, and additional guidance. Structured into four main sections, the MCH Handbook covers key components: basic information, pregnancy, delivery and newborn care, and childhood care. Each section is divided into recording and guidance subsections, ensuring comprehensive support for maternal and child health needs.
The MCH Handbook’s implementation involved reviewing records, creating community-specific content, printing, collaborating with community partners for distribution, and training health workers. Ongoing monitoring and supervision at health centers ensured its effective use as a primary resource for maternal and child healthcare. Mothers and fathers attended orientations, midwife-led classes, and received personalized assistance to enhance usability, maximizing the MCH Handbook’s effectiveness among Tagbanua mothers in Coron, Palawan.
The study collected sociodemographic data from 50 Tagbanua mothers, including age (majority aged 21–25, 34%), education level (66% with elementary education), marital status (majority Catholics, 56%), occupation (38% unemployed, husbands mostly fishermen), and income (ranging from Php 100 to Php 6,000, mean Php 1,428.89). Health expenditures ranged from Php 15 to Php 5,000, with a mean of Php 455.14. Among surveyed mothers, 74% were not pregnant, while 26% were pregnant, primarily in the third trimester (83%). Nine of the 50 (18%) mothers experienced pregnancy twice, while 16% had been pregnant thrice. One mother was pregnant 11 times. Most (80%) have never experienced stillbirths. Detailed characteristics are presented in Tables 1 and 2.
| Respondent Characteristics | Frequency | Percentage | ||
|---|---|---|---|---|
| Age group | ||||
| ≤20 years | 4 | 8.0 | ||
| 21–25 years | 17 | 34.0 | ||
| 26–30 years | 12 | 24.0 | ||
| 31–35 years | 11 | 22.0 | ||
| 36–40 years | 3 | 6.0 | ||
| ≥40 years | 3 | 6.0 | ||
| Religion | ||||
| Baptist | 19 | 38.0 | ||
| Born Again | 3 | 6.0 | ||
| Catholic | 28 | 56.0 | ||
| Level of Education | ||||
| No formal education | 3 | 6.0 | ||
| Elementary level (Completed less than 6 years of schooling) | 33 | 66.0 | ||
| Elementary graduate | 13 | 26.0 | ||
| High school level (Completed less than 4 years of schooling) | 1 | 2.0 | ||
| Mother’s Occupation | ||||
| Working | 31 | 62.0 | ||
| Gardening | 18 | 36.0 | ||
| Farmer | 10 | 20.0 | ||
| Fisherman | 2 | 4.0 | ||
| Own a store | 1 | 2.0 | ||
| Not Working | 19 | 38.0 | ||
| Husband’s Occupation | ||||
| Fisherman | 44 | 88.0 | ||
| Farmer | 2 | 4.0 | ||
| Others | 4 | 8.0 | ||
| Pregnancy Status | ||||
| Recently pregnant | 13 | 26.0 | ||
| Not recently pregnant | 37 | 74.0 | ||
| Total Number of Experienced Pregnancies | ||||
| Once | 6 | 12.0 | ||
| Twice | 9 | 18.0 | ||
| Thrice | 8 | 16.0 | ||
| 4 times | 7 | 14.0 | ||
| 5 times | 9 | 18.0 | ||
| 6 times | 4 | 8.0 | ||
| 7 times | 4 | 8.0 | ||
| 8 times | 2 | 4.0 | ||
| 11 times | 1 | 2.0 | ||
| Total Number of Pregnancies | ||||
| 4 times or less | 30 | 60.0 | ||
| 5 times or more | 20 | 40.0 | ||
| Experience of Abortion | ||||
| Never | 42 | 84.0 | ||
| At least once | 8 | 16.0 | ||
| Total Number of Experienced Abortions | ||||
| None | 43 | 86.0 | ||
| At least once | 7 | 14.0 | ||
| Total Number of Deliveries | ||||
| Once | 9 | 18.0 | ||
| Twice | 9 | 18.0 | ||
| Thrice | 8 | 16.0 | ||
| 4 times | 6 | 12.0 | ||
| 5 times | 7 | 14.0 | ||
| 6 times | 4 | 8.0 | ||
| 7 times | 5 | 10.0 | ||
| 10 times | 1 | 2.0 | ||
| Not applicable (currently pregnant, first pregnancy) | 1 | 2.0 | ||
| Experience of Stillbirths | ||||
| Never | 40 | 80.0 | ||
| At least once | 9 | 18.0 | ||
| Not applicable (currently pregnant, first pregnancy) | 1 | 2.0 | ||
| Socioeconomic Characteristics of Respondents | Value | |
|---|---|---|
| Average family monthly income | ||
| n | 50 | |
| Mean | 1,428.89 | |
| Standard Deviation | ±1,172.82 | |
| Min, Max | 100, 6,000 | |
| Median | 1,000 | |
| Average family monthly income | ||
| n | 50 | |
| Mean | 455.14 | |
| Standard Deviation | ±712.60 | |
| Min, Max | 15, 5,000 | |
| Median | 300 | |
In comparing the baseline and post-evaluation data, significant improvements in maternal knowledge regarding antenatal care, birth care, postnatal care, and child care were observed from baseline to follow-up (P<0.05). Specifically, there was notable improvement in understanding antenatal care, birth attendants, pregnancy complications, postnatal care, and various aspects of child care. However, the knowledge about the importance of breastfeeding for babies remained high and unchanged, possibly due to a pre-existing awareness among mothers. Detailed findings are presented in Table 3.
| KNOWLEDGE OF MOTHERS | Baseline | Post-evaluation | P-value | ||
|---|---|---|---|---|---|
| n | % | n | % | ||
| Antenatal Care | |||||
| Health personnel should provide prenatal care | 35 | 70 | 50 | 100 | 0.0001 |
| First prenatal consultation should be done during the first trimester of pregnancy | 14 | 28 | 38 | 76 | <0.0001 |
| A pregnant woman should consult a healthcare provider more than three times during the duration of her pregnancy | 18 | 36 | 46 | 92 | <0.0001 |
| Knowledge on risk factors | 5 | 10 | 42 | 84 | <0.0001 |
| A pregnant woman needs TT immunizations | 36 | 72 | 46 | 92 | 0.0020 |
| TT immunization at least twice during pregnancy | 11 | 22 | 44 | 88 | <0.0001 |
| Additional iron sources are needed during pregnancy | 26 | 52 | 46 | 92 | <0.0001 |
| The amount of iron that must be consumed should be equal to or more than 90 tablets during pregnancy | 8 | 16 | 42 | 84 | <0.0001 |
| Mothers should consume more food during pregnancy | 12 | 24 | 37 | 74 | <0.0001 |
| Birth Care | |||||
| Appropriate birth attendants are the health personnel | 25 | 50 | 45 | 90 | <0.0001 |
| Knowledge on pregnancy/delivery complications | 7 | 14 | 35 | 70 | <0.0001 |
| Postnatal Care | |||||
| Mothers know that medical consultations are needed after pregnancy and the reasons why | 21 | 42 | 41 | 82 | <0.0001 |
| Knowledge of family planning methods | 23 | 46 | 45 | 90 | <0.0001 |
| Child Care | |||||
| Mothers’ knowledge on the immediate initiation of breastfeeding | 30 | 60 | 49 | 98 | <0.0001 |
| Mothers know that exclusive breastfeeding should continue for 4–6 months | 4 | 8 | 36 | 72 | <0.0001 |
| Know the importance of breastfeeding for babies | 46 | 92 | 50 | 100 | 0.1250 |
| Mothers know that food other than breastmilk should be introduced to the baby at 6 months | 12 | 24 | 43 | 86 | <0.0001 |
| Importance of regular monthly weighing of the youngest child | 35 | 70 | 48 | 96 | 0.0002 |
| Importance of vaccines | 38 | 76 | 48 | 96 | 0.0020 |
| BCG immunizations should be given 3 times | 5 | 10 | 43 | 86 | <0.0001 |
| DPT immunizations should be given 3 times | 2 | 4 | 38 | 76 | <0.0001 |
| Polio immunizations should be given 3 times | 1 | 2 | 36 | 72 | <0.0001 |
| Measles immunization should be given | 5 | 10 | 36 | 72 | <0.0001 |
| Importance of Vitamin A | 32 | 64 | 48 | 96 | <0.0001 |
Regarding the mothers’ attitude toward family support, there was a substantial increase in mothers considering family support during pregnancy as very important, rising from 40% at baseline to 100% post-introduction of the MCH Handbook. Similarly, the percentage of mothers valuing their spouse’s support during pregnancy significantly rose from 38% to 96%.
Results also indicated that while antenatal and birth care practices showed no significant changes post-MCH Handbook introduction due to most mothers receiving it after birth, a notable gap in desired antenatal behaviors was observed, with few mothers having prenatal consultations. Similarly, birth care practices remained unchanged, indicating limited access to health personnel and pregnancy complications. However, substantial improvements were seen in postnatal care practices, including family planning, early breastfeeding initiation, colostrum feeding, complementary feeding, monthly child weighing, Oresol provision for diarrhea, and continued breastfeeding during diarrhea. Record-keeping practices notably increased, except for information dissemination support, which remained high. These findings suggest a positive impact of the MCH Handbook on maternal knowledge and healthcare practices, signaling areas for ongoing improvement in maternal and child healthcare within the community.
The study also assessed the usefulness of the Tagbanua MCH Handbook among mothers, focusing on their feedback, experiences, and the perceived benefits or challenges encountered while using the MCH Handbook (Table 4). Of the 50 surveyed mothers, 62% read the MCH Handbook completely, 30% read some parts only, and 8% did not read it. The majority (96%) found it useful, and 82% of husbands also read it. Regarding information adequacy for fathers, 66% of mothers felt it was adequate, while 34% suggested including more information for fathers. Additionally, 94% of mothers reported satisfaction with the MCH Handbook.
| Usefulness of Tagbanua MCH Handbook | Frequency | Percentage | |
|---|---|---|---|
| Use of Handbook | |||
| Read the MCH Handbook completely | 31 | 62.0 | |
| Read some parts only | 15 | 30.0 | |
| Did not take time to read it | 4 | 8.0 | |
| Perceived Usefulness among Mothers | |||
| Found the MCH Handbook useful | 48 | 96.0 | |
| Did not find the MCH Handbook useful | 2 | 4.0 | |
| Husband’s Use of MCH Handbook | |||
| Read the MCH Handbook | 41 | 82.0 | |
| Did not read the MCH Handbook | 9 | 18.0 | |
| Perceived Adequacy of Information in MCH Handbook for Fathers | |||
| Found information for fathers adequate | 33 | 66.0 | |
| Felt more information for fathers should be included | 17 | 34.0 | |
| Mother’s Satisfaction | |||
| Satisfied with MCH Handbook | 47 | 94.0 | |
| Not Satisfied with MCH Handbook | 3 | 6.0 | |
Overall, results demonstrate the positive effect of the co-developed MCH Handbook on improving maternal and child health knowledge, attitudes, and practices among Tagbanua mothers in Coron, Palawan. Its contribution to promoting UHC and coverage also underscores its potential as a valuable tool for improving health outcomes and advocating for inclusive healthcare delivery in indigenous communities.
The study’s key finding underscores the critical role of the MCH Handbook as an effective targeted intervention tool for advancing UHC among marginalized and vulnerable populations, specifically highlighting its impact on the indigenous Tagbanua group in the Philippines. This finding is consistent with prior research, including studies conducted in various rural communities in Indonesia, Bangladesh, Cambodia, and Kenya, where results consistently demonstrate the positive impact of the MCH Handbook on improving maternal and child health outcomes. This reinforces its significance in promoting UHC through comprehensive and accessible healthcare services for marginalized communities.
The study’s data from Tagbanua mothers in Coron, Palawan, further substantiate the effectiveness of the MCH Handbook in achieving UHC objectives. Among Tagbanua mothers, using the MCH Handbook led to notable improvements in maternal and child health knowledge, attitudes, and practices. Specifically, there was a significant increase in understanding antenatal care, birth attendants, pregnancy complications, postnatal care, and various aspects of child care. This highlights the MCH Handbook’s pivotal role in enhancing health literacy and promoting informed decision-making among Tagbanua mothers regarding maternal and child healthcare, extending its impact to achieving SDG 3 by promoting continuity of care, early intervention, and evidence-based practices.
The MCH Handbook served as a tool for cross-provider information sharing on maternity care within the Tagbanua community. Given the distinct utilization patterns between rural and urban areas among Tagbanua mothers, the MCH Handbook facilitated the seamless sharing of crucial health information among healthcare providers, ensuring continuous and coordinated care throughout the maternal and child health continuum. This integrated approach to healthcare delivery significantly improved health outcomes and reduced fragmentation in healthcare services, particularly in remote and underserved areas where access to healthcare may be limited. Additionally, the MCH Handbook has proven to be a reliable data source for estimating service coverage, including antenatal care and child vaccination, among Tagbanua mothers. This capability facilitates more accurate monitoring and evaluation of healthcare services. Furthermore, an important feature of the MCH Handbook is its role in promoting health insurance enrollment among pregnant women through the National Health Insurance Program in the Philippines. This initiative ensures pregnant women can access hospitals without financial concerns, particularly during emergencies.
The policy implications of the study’s results are significant, especially considering that MCH Handbooks are recognized in a policy in the country. Integrating co-developed, as demonstrated in the study, would further enhance the impact on maternal and child health outcomes. By adding co-developed handbooks tailored to local communities, policymakers can reinforce existing health programs and facilities while working towards reducing maternal and child morbidity rates to zero.
In the broader context, the discussion delves into the pivotal role of localized MCH Handbooks in advancing UHC objectives in the Philippines. As it recognizes the crucial shift in the responsibility for MCH Handbook production and dissemination to Local Government Units (LGUs), the transition underscores the imperative of implementing community-specific interventions tailored to the unique healthcare landscapes of each locality. Such an approach is strategically designed to bolster the targeted and efficient delivery of maternal and child health interventions, aligning seamlessly with the core tenets of UHC to ensure universal access to high-quality healthcare services for all individuals, with a particular emphasis on marginalized populations.
By acknowledging the value of community-driven interventions and placing priority on maternal and child health outcomes, policymakers can greatly enhance healthcare equity, quality, and accessibility for all individuals across the Philippines. The inclusion of community-specific handbooks aids healthcare providers in delivering culturally sensitive care and effectively addressing specific health needs. This strategy fosters stronger community trust and engagement in healthcare services, thereby boosting the healthcare system’s ability to tackle various healthcare challenges. Ultimately, integrating localized MCH Handbooks into national policies will align them with national development goals and global health priorities.
The MCH Handbook is a tool to realize UHC among marginalized indigenous pregnant women, mothers, and children. It led to their improved maternal and child health knowledge, attitudes, and practices. This underscores the importance of tailored interventions in public health and advocates for developing population-specific MCH Handbooks.
This paper was presented at the 22nd Congress of the Federation of Asia and Oceania Perinatal Societies (FAOPS) and we thank Prof. Mamoru Tanaka, the Congress Chair of FAOPS 2023, for the opportunity.
We also wish to acknowledge the University of the Philippines Manila and Osaka University for the institutional support, which has been instrumental in facilitating and advancing this research. We thank the International Committee on Maternal and Child Health (MCH) Handbook for the continued collaboration which has enriched the research process and opened avenues for sharing insights and knowledge within the global maternal and child health community.
Finally, to Mrs. Erlinda de los Reyes, an amazing Filipina mother of three, and the Tagbanua mothers of Coron Island, Palawan, thank you for inspiring this research, a true labor of love.
The author declares no relationships with companies or entities that could have a financial interest in the information presented. The absence of any conflicts of interest is hereby disclosed. This statement is made to affirm that no competing financial interests or personal relationships could bias the work or the interpretation of its results.
If any potential conflicts of interest arise during the review process or publication of the manuscript, the author commits to disclosing such information to the editors promptly. The author is committed to transparency and integrity in reporting research findings and acknowledges the responsibility to provide a clear and accurate account of the work without any undue influence.
