Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study|
Rosales, Alfonso; Sulistyo, Sigit; Miko, Oktarinda; Hairani, Lila K.; Ilyana, Meita; Thomas, Joanne; Hirata, Emily; Holloway, Rhonda; Bantung, Michael; Pabate, Kristina; Wijaya, Candra & Cherian, Dennis
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
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.
Maternal and newborn mortality; Indonesia; Qualitative study; Illness recognition; Care-seeking; Maternal health; Newborn health