PT - JOURNAL ARTICLE AU - Shogo Kanamori AU - Marcelyn D. Bonhaon AU - Minerva Peregrino Molon TI - Negative Incentives for Noninstitutional Births Are Associated With a Higher Rate of Facility-Based Births in the Eastern Visaya Region, Philippines AID - 10.9745/GHSP-D-20-00616 DP - 2021 Sep 30 TA - Global Health: Science and Practice PG - 565--574 VI - 9 IP - 3 4099 - http://www.ghspjournal.org/content/9/3/565.short 4100 - http://www.ghspjournal.org/content/9/3/565.full SO - GLOB HEALTH SCI PRACT2021 Sep 30; 9 AB - Key FindingsNegative incentives to prohibit noninstitutional deliveries were significantly associated with higher facility-based delivery rates.No significant association was found between positive incentives and the facility-based delivery rate.Key ImplicationsAlong with introducing penalties for noninstitutional deliveries, investing limited resources to make a vehicle available at the barangay level could effectively address these barriers and increase the facility-based delivery rate.In the Philippines, the “no home-birthing policy” implemented in 2008 has encouraged local governments to endorse ordinances that prohibit noninstitutional deliveries (NIDs). The Philippines’ social insurance scheme has also enabled them to provide incentive payments to women who deliver at birthing facilities (BFs). This study evaluated whether these positive and/or negative incentives were associated with an increased facility-based delivery (FBD) rate and examined challenges in implementing those incentive measures in the Eastern Visaya Region of the Philippines. Cross-sectional data were collected regarding delivery locations during 2017, and barangay-level data were collected regarding positive and negative incentives and the characteristics of 4,371 barangays in the region. Multivariate logistic regression analysis, using “ordinance with nonmonetary sanction” as the reference category, indicated that no ordinance to prohibit NIDs was significantly associated with a lower FBD rate (odds ratio [OR]: 0.90, P=.013), and ordinance with low cash penalty (OR: 1.37, P<.001) and high cash penalty (OR: 2.52, P<.001) had higher FBD rates. Positive incentives were not associated with FBD rates (OR: 1.02, P=.563). The FBD rate was also significantly associated with urban barangay status (OR: 1.45, P<.001), availability of a vehicle (OR: 3.19, P<.001), availability of public transportation to a government BF (OR: 1.25, P<.001), and distance to the most accessible government BF (OR: 0.89, P<.001). Substantial proportions of barangays had no vehicles available for transportation (34.1%) or no available vehicles and no public transportation to a government BF (5.5%). Although negative incentives for NIDs could motivate pregnant women to seek FBD, local governments in the Philippines should be aware of barriers that limit access to government BFs in underserved barangays before introducing those negative incentives. Above all, barangay-level investments in making a vehicle for transporting pregnant women might help address these barriers and increase the FBD rate.