Correlates of facility-based childbirth: A health belief model approach using the National Demographic and Health Survey - Philippines

BACKGROUND: Facility-based delivery (FBD) is a key intervention for reducing maternal and neonatal mortality. Despite policies discouraging home births, 11% of all deliveries in the Philippines occur outside health facilities. The health belief model (HBM) suggests that healthcare-seeking is influenced by perceived risks, benefits and barriers, and cues to action. OBJECTIVES: To examine how HBM indicators are associated with the likelihood of FBD and to assess the added value of increasing antenatal care (ANC) contacts from four to eight in line with recommendations by the World Health Organization. METHODOLOGY: Using data from the 2017 National Demographic and Health Survey, we ran logistic regression models on a sample of 6551 women with a recent live birth to estimate how HBM indicators were linked to the probability of FBD. RESULTS: FBD was more likely among women with higher pregnancy risks (first birth and delivery complications) and those facing fewer barriers to health care (higher education, wealthier households, public health insurance coverage, urban residence, and not Muslim). Being Muslim had the largest negative impact on the probability of FBD (−19% points). Having at least eight (instead of four) ANC contacts increased the probability of FBD by 6% points. CONCLUSIONS: FBD in the Philippines is shaped by perceived risks, socioeconomic and cultural barriers, and ANC contacts as cues to action. Increasing antenatal contacts was associated with a higher likelihood of FBD. Policies should therefore prioritize expanding affordable, accessible, and culturally responsive maternal healthcare services to reduce inequalities, rather than penalizing home births.