Despite policies promoting facility births, home deliveries attended by traditional birth attendants (TBAs/hilot) persist in rural Philippines. We examined determinants of home delivery and the continuing role of TBAs in Palawan.

We used a convergent mixed-methods design: a survey of 48 postpartum mothers and 48 in-depth interviews (45–90 minutes). The survey captured socio-demographics, delivery histories, and preferences; interviews explored decision-making, experiences with TBAs and facilities, and barriers to care. Descriptive statistics summarized quantitative patterns; inductive thematic analysis generated qualitative themes. Findings were integrated via a joint-display matrix to produce meta-inferences.

Respondents reported 141 lifetime deliveries; 85.8% (121/141) occurred at home and 81.0% (98/121) of home births were TBA-attended. Three-quarters lived >1 km from the nearest facility, and 89.6% had monthly household income below the provincial poverty threshold. Over half (54.2%) planned their most recent birth at home and 81.3% intended to deliver at home again. Qualitatively, mothers valued TBAs' accessibility, flexible/low payment, and relational care. Facilities were associated with indirect costs, distance, scolding, invasive procedures, and loss of dignity; decisions were commonly joint with partners/elders, reflecting relational autonomy.

Home birth in Palawan represents a constrained preference shaped by structural barriers (poverty, distance), cultural trust in TBAs, and relational decision-making. Safety messaging alone is insufficient without respectful, affordable, and accessible facility care. Policy actions should: (1) reduce non-fee costs (transport/food; maternity waiting homes), (2) institutionalize Respectful Maternity Care, and (3) integrate TBAs as trained community referral partners within UHC.