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. 2017 Dec 21;36(Suppl 1):44.
doi: 10.1186/s41043-017-0122-0.

Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study

Alfonso Rosales  1 , Sigit Sulistyo  2 , Oktarinda Miko  3 , Lila K Hairani  3 , Meita Ilyana  3 , Joanne Thomas  4 , Emily Hirata  4 , Rhonda Holloway  4 , Michael Bantung  2 , Kristina Pabate  2 , Candra Wijaya  2 , Dennis Cherian  4
Affiliations

Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study

Alfonso Rosales et al. J Health Popul Nutr. .

Abstract

Background: 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, 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.

Methods: This 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.

Results: For 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.

Conclusions: For 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.

Keywords: Care-seeking; Illness recognition; Indonesia; Maternal and newborn mortality; Maternal health; Newborn health; Qualitative study.

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Conflict of interest statement

Ethics approval and consent to participate

Because the research in this study involved human participants, Institutional Review Board (IRB) clearance was obtained from the Expert Committee on Research and Research Ethics from the University of Indonesia to approve the procedures as ethical. This approval was effective during the research period of this study, for up to a year (April 2015–April 2016). To further the ethical soundness of this study, verbal informed consent was received before the start of every interview.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Timeline of maternal cases and patterns of care-seeking and treatment for maternal complications
Fig. 2
Fig. 2
Timeline of newborn cases and patterns of care-seeking and treatment for newborn complications
See this image and copyright information in PMC

References

    1. Statistics Indonesia, National Population and Family Planning Board, Ministry of Health Indonesia and ICF International. Indonesia Demographic and Health Survey 2012. Jakarta (ID); 2013.
    1. Statistics Indonesia, UNICEF. Multiple indicator cluster survey selected districts of Papua and Papua Barat. Jakarta (ID); 2012.
    1. BPS–Statistics of Riau Province. Riau Province in Figures 2016. (ID); 2016. Available from: https://jayawijayakab.bps.go.id/websiteV2/pdf_publikasi/Statistik-Daerah....
    1. Partnership for Maternal Newborn and Child Health. A global review of the key interventions related to reproductive, maternal, newborn and child health (RMNCH). Geneva (CH); 2011.
    1. Center for Epidemiological Research and Surveillance. Health for the poorest quintile, under five mortality, and coverage of child survival interventions in Jayawijaya, Buru, Timor Tengah Selatan, and Brebes districts of Indonesia. Jakarta (ID); 2011.

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