Abstract
BackgroundIndonesia’s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the “Three Delays” model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region.MethodsThis qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death.ResultsFor maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level.ConclusionsFor maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite.
Highlights
Indonesia’s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas
Knowledge on recognition of postpartum hemorrhage was probably dependent upon previous obstetric delivery experience, since most Postpartum hemorrhage (PPH) cases included occurred among multi-parous women
Based on the careseeking patterns shown by participant families, the strongest barrier to early skilled care-seeking was not lack of danger sign recognition, but rather cultural beliefs related to ideas of what causes newborn illness
Summary
Indonesia’s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, at the facility level, is crucial Accessing such care is often delayed when maternal and newborn complications arise. Every poskesde must be served by one midwife and one nurse [1] In this area of the country, most health service delivery is provided by government facilities. According to the WHO Partnership for Maternal, Newborn and Child Health (PMNCH) [4], reductions in newborn mortality require access to quality and skilled care, at the facility level [5]. Accessing such care is often delayed when newborn complications arise. Evidence on access to care is lacking from Indonesia, and from the Papua province, as to how women and families identify maternal and newborn complications, the factors behind the decision-making process to seek care, and the influential role of cultural beliefs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
