1

CHAPTER 1

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale

Just to give birth to a child is one thing to be a

mother is totally different. Any woman can give birth to a

child; thats a very simple phenomenon. But to be a mother

needs great art, needs great understanding. (Osho, 2011)

There is no doubt that one of the most crucial

relationships in human dynamics is the relationship between

a mother and her child. Secure attachment of the infant to

his mother or her surrogate is crucial to normal growth and

development and an integral part of a childs ability to

develop a sense of mastery, identity and self-worth.

According to Copeland and Harbaugh(2004) Mercer stated

that Women who have a positive sense of their own maternal

competency in early parenthood feel more comfortable with

performing infant skills and interpreting their infant's

cues. Perceived maternal competency has been shown to

facilitate maternal role attainment and to promote positive

infant nurturing and development. Promoting maternal

2

competency and maternal role attainment is a premier aim of

perinatal educators.

According to UNICEF (2004), Philippines more mothers

in the urban areas go to prenatal check ups compared to

women in the rural areas and 8 out of 10 births in rural

areas are delivered outside a health facility.

Maternal mortality offers a litmus test of the status

of women, their access to health care and the adequacy of

the health care system in responding to their needs. As

primary caregivers, mothers are crucial to infant survival

and the childs optimal development. But in order for them

to become effective in this role, their rights too have to

be addressed.

This indeed has become a vicious cycle. Malnourished

pregnant women give birth to underweight infants. Mothers

who are iodine-deficient suffer frequent miscarriages,

still births, and early infant deaths. Babies who survive

will most likely be born deformed and mentally challenged.

Women are crucial to guarding childrens health and

nutrition. Ill health in women often translates to not

being able to properly take care of the children. (UNICEF,

2004)

3

Furthermore, significant number of Filipino women lack

access to qualified reproductive health services. Over half

of births in the country occurred at home, and a third of

them were assisted by traditional birth attendants. Poor

women are greatly disadvantaged with around 75 percent of

the poorest quintile have no access to skilled birth

attendants compared to only 20 percent of the richest

quintile. (UNDP, 2013)

Studies on maternal competence comparing urban and

rural areas would be beneficial as we would know which area

to focus on. It would also be apparent on which area, more

education is needed to be taught.

Considering the above phenomenon and the researchers

actual experience as student during duty in the rural and

urban areas, it has motivated the researcher to conduct a

study on the maternal role attainment and competence of

primiparous mothers in the rural and urban areas in early

parenthood.

Theoretical Background

This study is anchored mainly on Ramona Mercers

theory of Maternal Role Attainment. According to

4

Figure 1: Theoretical Conceptual Framework of the Study

Theory:

Ramona Mercers theory of

Maternal Role

Attainment

Reva Rubins Transition to

Motherhood

theory

Legal Basis:

Republic Act 10354 Sec. 2 and

3 (Responsible

Parenthood Act)

Primiparous Mothers of Cogon District, Tagbilaran

City and Maribojoc, Bohol

Demograpic Profile:

Age

Income

Marital Status

Place of Residence

Maternal Role

Attainment in terms of:

Attachment

Self confidence

Infant Health Status

Mother-Father relationship

Maternal Competency in

terms of:

Skill

Knowledge

Comfort

Proposed Enhanced Maternal Education Program

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Mercer (2004) the Maternal Role Attainment Theory is

defined as an interaction and developmental process

occurring over time, in which the mother becomes attached

to her infant, acquires competence in the care-taking tasks

involved in the role, and expresses pleasure and

gratification in the role.

It is also as defined a process of binding in or being

attached to the child and Maternal Role Identity or seeing

oneself in the role and having a sense of comfort about it.

Rubin (1967)

To Mercer (1995 in Parrat and Fahy, 2011), developing

the maternal role was a specifically cognitive process and

therefore dependent on the womans ability to problem-

solve, gather information, communicate effectively, project

into the future, and establish trusting relationships that

were nurturing.

Mercer, May, Ferketich and De Joseph(1986 in Parrat

and Fahy, 2011) describe self-esteem as an individuals

perception of how others view one and self-acceptance of

the perception. Mercer (1986) outlines self-concept, or

self-regard, as The overall perception of self that

includes self-satisfaction, self-acceptance, self-esteem,

and congruence or discrepancy between self and ideal self.

6

Mercer selected both maternal and infant variables for

her studies on the basis of her review of the literature

and findings of researchers in several disciplines. She

found that many factor may have a direct or indirect

influence on the maternal role. Maternal factors in

Mercers research included age at first birth, birth

experience, early separation from the infant, social

stress, social support, personality traits, self-concept,

childrearing attitudes, and health. She included the infant

variables of temperament, appearance, responsiveness,

health status and ability to give cues. Alligood and Tomey

(2010).

Mercers model of Maternal Role attainment was placed

within Brofenbrenners nested circles of the microsystem,

mesosystem, and macrosystem. The microsystem is the

immediate environment in which maternal role attainment

occurs. It includes factors such as family functioning,

mother-father relationships, social support, economic

status, family values, and stressors. The variables

contained within this immediate environment interact with

one or more of the other variables in affecting the

transition to motherhood.

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The microsystem is the most influential on maternal

role attainment. In 1995, Mercer expanded her earlier

concepts and model to emphasize the importance of the

father in role attainment, stating that he helps diffuse

tension deceloping within the mother-infant dyad. Maternal

role attainment is achieved through the interactions of

father, mother, and infant.

The mesosystem encompasses, influences, and interats

with persons in the microsystem. Mesosystem interactions

may influence what happens to the developing materal role

and the child. The mesosystem includes day care, school,

work, setting, places of worship, and other entities within

the immediate community.

The macrosystem refers to the general prototypes

existing in a particular culture or transmitted cultural

consistencies. The macrosystem includes the social,

political, and cultural influences on the other two

systems. The health care environment and the curreny health

care system policies that affect maternal role attainment

originate in this system. National laws regarding women and

children and health priorities that influence maternal role

attainment are within the macrosystem. Alligood and Tomey

(2010 p.588)

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From a theoretical perspective, maternal competence

is a component of the maternal role and is embedded within

the microsystem of the mother. Maternal role attainment is

a process in which the mother achieves competence in the

role and integrates the mothering behaviors into her

established role set, so that she is comfortable with her

identity as a mother Mercer (1985 in Copeland and

Harbaugh, 2004)

According to Copeland and Harbaugh (2004), Bullock and

Pridham stated that successfully obtaining infant care-

taking skills and being able to read infant cues are

important to the development of maternal competence.

Through interaction with the infant, the mother's self-

confidence is influenced by the infant's responsiveness to

her care-taking skills. Learning how to read and respond to

her baby's cues, such as how to soothe a crying infant,

facilitate the mother's maternal competence. Furthermore,

mothers who report more maternal competence report more

positive feelings about their infant.

To Rubin the maternal identity was fundamental to a

womans feminine identity. Rubin considered the maternal

identity as a womans sense of comfort about where she

has been and where she is going. Achieving the maternal

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identity involved a series of developmental tasks

accompanied by cognitive changes that reorient the self

through pregnancy During this reorientation process Rubin

said that womens energy for the world around them

reduces and they turn inward. This altered conscious

state was, to Rubin, a change in cognitive style.

Transition was conceptualized as involving internal

cognitive processes that limited a womans power to

whatever orientated her to becoming mother. Rubin did

perceive that bodily aspects of childbearing impacted on

reorientation, but the process itself was definitively a

cognitive reorientation. The reorienting self was theorized

by Rubin only as an ego. Rubins concept of ego had three

parts: the ideal image, the self image, and the body image.

She also identified that a childbearing womans ideal image

and body image were vulnerable to loss. For example, Rubin

noted that for some women the turn inward was a worrying

separation from their past accomplishments and future

aspirations. The primary role of the maternity nurse was to

provide ego maintenance and support so that the

vulnerable childbearing woman could still achieve the

maternal identity. Parrat and Fahy (2009)

10

Republic Act 10354 Section 2 and 3 states that The

State recognizes and guarantees the human rights of all

persons including their right to equality and

nondiscrimination of these rights, the right to sustainable

human development, the right to health which includes

reproductive health, the right to education and

information, and the right to choose and make decisions for

themselves in accordance with their religious convictions,

ethics, cultural beliefs, and the demands of responsible

parenthood.

Pursuant to the declaration of State policies under

Section 12, Article II of the 1987 Philippine Constitution,

it is the duty of the State to protect and strengthen the

family as a basic autonomous social institution and equally

protect the life of the mother and the life of the unborn

from conception. The State shall protect and promote the

right to health of women especially mothers in particular

and of the people in general and instill health

consciousness among them. The family is the natural and

fundamental unit of society. The State shall likewise

protect and advance the right of families in particular and

the people in general to a balanced and healthful

environment in accord with the rhythm and harmony of

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nature. The State also recognizes and guarantees the

promotion and equal protection of the welfare and rights of

children, the youth, and the unborn.

Moreover, the State recognizes and guarantees the

promotion of gender equality, gender equity, women

empowerment and dignity as a health and human rights

concern and as a social responsibility. The advancement and

protection of womens human rights shall be central to the

efforts of the State to address reproductive health care.

The State recognizes marriage as an inviolable social

institution and the foundation of the family which in turn

is the foundation of the nation. Pursuant thereto, the

State shall defend:

(a) The right of spouses to found a family in accordance

with their religious convictions and the demands of

responsible parenthood;

(b) The right of children to assistance, including proper

care and nutrition, and special protection from all forms

of neglect, abuse, cruelty, exploitation, and other

conditions prejudicial to their development;

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(c) The right of the family to a family living wage and

income; and

(d) The right of families or family associations to

participate in the planning and implementation of policies

and programs.

The State likewise guarantees universal access to

medically-safe, non-abortifacient, effective, legal,

affordable, and quality reproductive health care services,

methods, devices, supplies which do not prevent the

implantation of a fertilized ovum as determined by the Food

and Drug Administration (FDA) and relevant information and

education thereon according to the priority needs of women,

children and other underprivileged sectors, giving

preferential access to those identified through the

National Household Targeting System for Poverty Reduction

(NHTS-PR) and other government measures of identifying

marginalization, who shall be voluntary beneficiaries of

reproductive health care, services and supplies for free.

The State shall eradicate discriminatory practices,

laws and policies that infringe on a persons exercise of

reproductive health rights.

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The State shall also promote openness to

life; Provided, That parents bring forth to the world only

those children whom they can raise in a truly humane way.

SEC. 3. Guiding Principles for Implementation. This

Act declares the following as guiding principles:

(a) The right to make free and informed decisions, which is

central to the exercise of any right, shall not be

subjected to any form of coercion and must be fully

guaranteed by the State, like the right itself;

(b) Respect for protection and fulfillment of reproductive

health and rights which seek to promote the rights and

welfare of every person particularly couples, adult

individuals, women and adolescents;

(c) Since human resource is among the principal assets of

the country, effective and quality reproductive health care

services must be given primacy to ensure maternal and child

health, the health of the unborn, safe delivery and birth

of healthy children, and sound replacement rate, in line

with the States duty to promote the right to health,

responsible parenthood, social justice and full human

development;

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(d) The provision of ethical and medically safe, legal,

accessible, affordable, non-abortifacient, effective and

quality reproductive health care services and supplies is

essential in the promotion of peoples right to health,

especially those of women, the poor, and the marginalized,

and shall be incorporated as a component of basic health

care;

(e) The State shall promote and provide information and

access, without bias, to all methods of family planning,

including effective natural and modern methods which have

been proven medically safe, legal, non-abortifacient, and

effective in accordance with scientific and evidence-based

medical research standards such as those registered and

approved by the FDA for the poor and marginalized as

identified through the NHTS-PR and other government

measures of identifying marginalization:Provided, That the

State shall also provide funding support to promote modern

natural methods of family planning, especially the Billings

Ovulation Method, consistent with the needs of acceptors

and their religious convictions;

(f) The State shall promote programs that: (1) enable

individuals and couples to have the number of children they

desire with due consideration to the health, particularly

15

of women, and the resources available and affordable to

them and in accordance with existing laws, public morals

and their religious convictions: Provided, That no one

shall be deprived, for economic reasons, of the rights to

have children; (2) achieve equitable allocation and

utilization of resources; (3) ensure effective partnership

among national government, local government units (LGUs)

and the private sector in the design, implementation,

coordination, integration, monitoring and evaluation of

people-centered programs to enhance the quality of life and

environmental protection; (4) conduct studies to analyze

demographic trends including demographic dividends from

sound population policies towards sustainable human

development in keeping with the principles of gender

equality, protection of mothers and children, born and

unborn and the promotion and protection of womens

reproductive rights and health; and (5) conduct scientific

studies to determine the safety and efficacy of alternative

medicines and methods for reproductive health care

development;

(g) The provision of reproductive health care, information

and supplies giving priority to poor beneficiaries as

identified through the NHTS-PR and other government

16

measures of identifying marginalization must be the primary

responsibility of the national government consistent with

its obligation to respect, protect and promote the right to

health and the right to life;

(h) The State shall respect individuals preferences and

choice of family planning methods that are in accordance

with their religious convictions and cultural beliefs,

taking into consideration the States obligations under

various human rights instruments;

(i) Active participation by nongovernment organizations

(NGOs), womens and peoples organizations, civil society,

faith-based organizations, the religious sector and

communities is crucial to ensure that reproductive health

and population and development policies, plans, and

programs will address the priority needs of women, the

poor, and the marginalized;

(j) While this Act recognizes that abortion is illegal and

punishable by law, the government shall ensure that all

women needing care for post-abortive complications and all

other complications arising from pregnancy, labor and

delivery and related issues shall be treated and counseled

17

in a humane, nonjudgmental and compassionate manner in

accordance with law and medical ethics;

(k) Each family shall have the right to determine its ideal

family size: Provided, however, That the State shall equip

each parent with the necessary information on all aspects

of family life, including reproductive health and

responsible parenthood, in order to make that

determination;

(l) There shall be no demographic or population targets and

the mitigation, promotion and/or stabilization of the

population growth rate is incidental to the advancement of

reproductive health;

(m) Gender equality and women empowerment are central

elements of reproductive health and population and

development;

(n) The resources of the country must be made to serve the

entire population, especially the poor, and allocations

thereof must be adequate and effective: Provided, That the

life of the unborn is protected;

(o) Development is a multi-faceted process that calls for

the harmonization and integration of policies, plans,

18

programs and projects that seek to uplift the quality of

life of the people, more particularly the poor, the needy

and the marginalized; and

(p) That a comprehensive reproductive health program

addresses the needs of people throughout their life cycle.

In a study on Parental Role Attainment with Medically

Fragile Infants, Findings suggest that the development of

the parental role with infants who are seriously ill during

infancy encompasses a process of developing ones identity

as a parent (maternal identity); establishing ones

presence as reflected in physical closeness with the child

(parental presence), and becoming competent in normal and

illness related caregiving (parenting competence). Miles et

al. (1998)

Fotwe (2010) stated in the findings of his study that

women residing in rural areas tend to receive less

information on maternal health from community-based sources

of information. As a result of the paucity of maternal

health information, women resident in rural areas tend to

score lower on maternal health literacy appraisal and,

hence, exhibit lower levels of maternal health literacy.

19

The researcher wishes to determine the level of

maternal role attainment and maternal competency of those

primiparous mothers in the rural and urban areas as well as

the differences. Moreover, as a nurse, the researcher also

wishes to come up with a proposed enhanced maternal

education program based on the result of the study in order

to augment the level of knowledge among those mother in the

rural or urban areas particularly in Cogon District,

Tagbilaran City and Maribojoc, Bohol.

Statement of the Problem

The study aims to determine the maternal competencies

of Primiparous mothers in the urban areas compared to rural

areas in early parenthood.

Specifically, it will answer the following questions:

1. What are the respondents demographic profile in terms

of:

1.1 age

1.2 income

1.3 place of residence

1.4 marital status

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2. What are the differences in maternal role attainment

between primiparous mothers in early parenthood in the

rural and urban areas in terms of:

2.1 Attachment

2.2 Self confidence

2.3 Infant health status

2.4 Mother-Father relationship

3. What are the differences in maternal competence between

primiparous mothers in early parenthood in the rural and

urban areas in terms of:

2.1 Skill

2.2 Knowledge

2.3 Comfort

3. Is there a significant difference in maternal role

attainment between primiparous mothers in early parenthood

in the rural and urban areas?

4. Is there a significant difference in maternal competence

between primiparous mothers in early parenthood in the

rural and urban areas?

21

5. What program can be proposed based on the findings of

the study?

Statement of the Hypothesis

The study seeks to test the null hypothesis that

states: there is no significant difference in maternal role

attainment and competence between primiparous mothers in

early parenthood in the rural and urban areas.

Significance of the Study

The researcher believes that the study contains

several information and valuable implications for the

improvement of maternal and infant health status which will

be very helpful to the promotion and maintenance of their

optimal health as well as to the family. Besides, the

findings generated in this study may be useful to the

health care providers and other sectors in the community.

In particular, the study will be helpful to the

following:

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Mothers. The result of this study will help them be

more aware of their transition to motherhood which could

somehow affect their health as well as their child.

Family members. Knowing the importance of maternal

role attainment and competence, the members of the family,

particularly the spouse will participate in the delivery of

health through giving their continued support in the

physical, emotional and social aspects of the mother.

Healthcare Providers. This material may prove helpful

to them as a reference material in giving care to the

mother. This may enable them to better understand

individuals, and in turn, to provide holistic care.

Community. Through this, the condition of the

community may be improved by means of promoting the health

of most delicate members in the society. This may assess

the community whether it is functioning adequately or not

and taking the right steps on how to improve the maternal

health and to the great society as a whole.

Scope and Limitation

The study covered all the mothers aging 18-40 years

old who had their first child within a year from delivery

23

in Cogon District, Tagbilaran City and Maribojoc, Bohol.

The primary focus of the study is to determine if there is

a difference in the maternal role attainment and maternal

competence of primiparous mothers in the urban and rural

areas.

The limitation of this study covers the accessibility,

the collaboration, willingness to participate, and the

honesty of our respondents in answering the questionnaires.

The study will also be limited to the findings of

those chosen as respondents of the study and the

instruments being used

RESEARCH METHODOLOGY

Research Design

This study will use descriptive research design, which

is the most effective method used to describe an existing

condition or a phenomenon and tends to explore a certain

fact that influence the variables of the study, with the

questionnaire as the major data gathering methodology.

Descriptive as it seems at describing the learning whether

there is significance in the influence of parenting styles

24

in the academic achievement of 3rd year BSN students at the

time of the study.

Research Environment

The location of this study for the urban area will be

in Cogon District, Tagbilaran City. Located centrally in

the city, Cogon overlooks Tagbilaran Bay to the west, to

the south, it is bounded by Poblacion 2, to the east by

Barangay Dampas and Dao and to the north by Barangay Booy.

The total land area is 204.4508 hectares, with a

population in 2007 of 17,266, the most in the city. It is

generally believed that more than one-half of its present

population are no longer native Cogonhanons.

Furthermore, the rural area will be conducted in

Maribojoc, Bohol. According to the 2010 census, it has a

population of 20,491 people. The town has a land area of

5,192 hectares (12,830 acres).

Research Respondents

The respondents of the study will be all the

primiparous mothers within 1 year of early parenthood of

Cogon District, Tagbilaran City and Maribojoc, Bohol.

25

From the list, the respondents will be drawn by

stratified sampling data. Total number of respondents will

be determined by the use of the formula:

Sample Size by Cochran

ss=

2

2

(1 )z p p

c

Where:

Z = Z value (e.g. 1.96 for 95% confidence level)

p = percentage picking a choice, expressed as decimal

(.5 used for sample size needed)

c = confidence interval, expressed as decimal , acceptable

margin of error for the proportion being estimated (degree

of precision)

(e.g., .04 = 4)

Correction for Finite Population

New ss = 1

1

ss

ss

pop

Where: pop = population size

26

Research Instrument

A questionnaire that will be designed by the

researcher will be used in gathering the data for the

study. Questionnaires will be translated in vernacular and

duly submitted for validation to the team of experts in

designing research tools.

It will b made up of 3 parts. Part 1, will deal with

the demographic profile of the respondents. Part 2, will

consist of the questions about the mothers maternal role

attainment factors and Part 3 will be all about the

maternal competence of these primiparous women. Open-ended

items will also be provided for additional opinions and

ideas from the respondents.

The interview questionnaires will be distributed to

all the participants and at the same time a one-on-one

interview will be done with the mothers while answering the

questionnaire.

Research Procedures

Gathering of Data. The researcher will sought

permission from the Municipal Health Officer, the Public

Health Nurses and to the Public Health Midwives to conduct

a research before questionnaires distributed and interview

27

will be done to the participants. After asking permission,

the questionnaires will be administered to the primiparous

mothers. Sufficient time will be given to the participants

to answer the interview questionnaires and will be

collected after. Te data gathered will be then classified

and tabulated to arrive at the numerical picture of the

phenomenon under study.

Treatment of Data. After the questionnaires will be

retrieved, the data will be tallied and tabulated. The

following statistical procedures will be used.

1. For the respondents demographic profile:

Simple Percentage

P = f

N

Where: P- Percentage

- Summation

f- Frequency

N- Number of cases

2. For differences in maternal role attainment between

primiparous mothers in early parenthood in the rural

and urban areas in terms of attachment, self

confidence, infant health status, Mother-Father

relationship and the differences in maternal

28

competence between primiparous mothers in early

parenthood in the rural and urban areas in terms of

skill, knowledge and comfort; Analysis f Variance

(ANOVA) was used.

Analysis of Variance (ANOVA)

F= Msb Msw

Where: F- Frequency

Msb- Mean Squares between groups

Msw- Mean Squares within groups

3. For the significant relationship between the maternal

role attainment and maternal competence in early

parenthood among rural and urban primiparous mothers

the Chi Square was used.

Chi Square formula:

X2= (f1-f0)

2

fe

Where: X2- Chi Square

- Summation

f0- Observed frequency

fe- Expected frequency

29

Definition of Terms

For clearer understanding of the terms to be used in

this

study, below are their meanings:

Early Parenthood

It means the time of birth of the child to one year

of

age.

Maternal Competency

Is a component of the maternal role and is factored

into skill/knowledge, valuing/comfort, infant feeding

and infant responsiveness and mothers self-esteem.

Maternal Role Attainment

Is a process in which the mother achieves

competence

in the role and integrates the mothering behaviors

into

her established role set, so that she is comfortable

with

her identity as a mother.

Multipara

Is a woman who has given birth to more than one

child past the age of viability.

Perinatal

It means happening during of around the time of

birth.

30

Postpartum

It means the period of time following the birth

of a

child.

Primigravida

Is a woman during her first pregnancy.

Primipara

Is a woman who has given birth to one viable

infant.

Rural

Refers to people who live in Maribojoc, Bohol.

Urban

Refers to the people who live in Cogon District,

Tagbilaran City, Bohol.

31

BIBLIOGRAPHY

Alligood, M.R. and Tomey, A.M. Nursing Theorists and their

work. 7th Edition. Maryland Heights, Missouri. Mosby

Elesvier

Copeland, D.B., & Harbaugh, B.L. (2004). Transition of

Maternal Competency Married and Single Mothers in

Early Parenthood. Journal of Perinatal Education,

13(4).

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595220/#!

po=85.0000

Fotwe, E. E. (2010). Comparison of Maternal Health Literacy

between Rural and Urban women in Komenda-Edina-Eguafo-

Abrem District of Ghana. University of Cape Coast

Mercer, R. (2004). Becoming a mother versus maternal role

attainment. Journal of Nursing Scholarship. 36(3).

228-232

Miles, M. S. (1998). Parental Role Attainment with

Medically Fragile Infants. National Institute of

Nursing Research, National Institutes of Health.

http://www.unc.edu/~mmiles/prasum.htm

Osho (2011). The Delicate Art of Motherhood.

http://oshotimes.blog.osho.com/2011/05/the-delicate-

art-of-motherhood-osho/

Parrat, J.A. and Fahy, K. (2009). A feminist critique of

foundational nursing research and theory on transition

to motherhood. School of Health and Human Sciences.

http://epubs.scu.edu.au/cgi/viewcontent.cgi?article=19

08&context=hahs_pubs

Republic Act No. 10354 (2012).

http://www.gov.ph/2012/12/21/republic-act-no-10354/

32

Rubin, R. (1967). Attainment of the maternal role. Nursing

Research, 16(3), 243

UNDP Philippines (2013). Improve Maternal Health.

http://www.ph.undp.org/content/philippines/en/home/mdg

overview/overview/mdg5/

UNICEF Philippines (2004). The Mother and the Unborn

Child.

http://www.unicef.org/philippines/children/