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Open Access Research article

Maternal deaths in eastern Indonesia: 20 years and still walking: an ethnographic study

Suzanne Belton1*, Bronwyn Myers2 and Frederika Rambu Ngana3

Author Affiliations

1 Menzies School of Health Research, Casuarina, Darwin, NT, Australia

2 Department of Research Institute for the Environment and Livelihoods, Charles Darwin University, Casuarina, Darwin, NT, Australia

3 Nusa Cendana University, Kupang, Nusa Tenggara Timur, Indonesia

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BMC Pregnancy and Childbirth 2014, 14:39  doi:10.1186/1471-2393-14-39

Published: 22 January 2014

Abstract

Background

The delays in receiving adequate emergency maternal care described by Thaddeus and Maine twenty years ago are still occurring, as exemplified in this study of cases of maternal deaths in a subdistrict in rural eastern Indonesia.

Methods

An ethnographic design was conducted, recruiting eleven families who reported on cases of maternal deaths in one sub-district of Indonesia, as well as assessing the geographical and cultural context of the villages. Traditional birth attendants and village leaders provided information to the research team which was thematically and contextually analysed.

Results

Two stages to the first and second delays have been differentiated in this study. First, delays in the decision to seek care comprised time taken to recognise (if at all) that an emergency situation existed, followed by time taken to reach a decision to request care. The decision to request care resided variously with the family or cadre. Second, delays in reaching care comprised time taken to deliver the request for help and then time for help to arrive. A phone was not available to request care in many cases and so the request was delivered by walking or motorbike. In two cases where the decision to seek care and the delivery of the request happened in a timely way, help was delayed because the midwife and ambulance respectively were unavailable.

Conclusions

This study, although a small sample, confirmed that either a single delay or a sequence of delays can prove fatal. Delays were determined by both social and geographic factors, any of which alone could be limiting. Initiatives to improve maternal health outcomes need to address multiple factors: increased awareness of equitable access to maternal health care, village preparedness for emergency response, improved access to telecommunications and geographic access.

Keywords:
Maternal mortality; Indonesia; Stigma; Health-seeking; Fatalism; Geo information systems