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Identifying Barriers and Facilitators to Skilled Care Seeking

Midwives attend a birth asphyxia management training in Jayawijaya District, Papua, Indonesia

Research Overview

Despite efforts to improve healthcare access in remote areas of Indonesia, access to basic health services has remained low. The district of Jayawijaya in the Papua province is particularly burdened by high rates of maternal, newborn, and child mortality. The present study seeks to identify the barriers to and factors supporting appropriate care seeking in a setting with low health service coverage and poor maternal and newborn health outcomes. TRAction is supporting a study to describe recognition and care-seeking behaviors related to maternal and newborn complications in the Jayawijaya District, Indonesia.



Project Location

Indonesia: Jayawijaya District, Papua Province

Research Objectives 

The aim of this study is to describe recognition and care-seeking behaviors related to maternal and newborn complications. Research questions include:

  • What was the process of illness recognition and care seeking for mothers and newborns?
  • What was the sequence of actions for seeking care and treatment for mothers and newborns?

Study Approach

This study will use both qualitative and quantitative methods in order to describe recognition and care seeking behaviors related to maternal and newborn complications. Qualitative data will be gathered from families who have experienced a maternal or neonatal death, as well as from families where the woman had post-partum hemorrhage or the newborn developed an  illness. In addition, focus group discussions will be conducted with community health workers and community leaders in order to gain a comprehensive understanding of the community perceptions of maternal and neonatal illness and care seeking behaviors. These data will be combined with quantitative data that provide background information related to understanding the local context, including a socio-economic and geographic profile of the study area, the maternal and neonatal mortality rates, proportion of women receiving appropriate prenatal care and who deliver in a health facilities with a skilled birth attendant. Information will also be sought on the level of care available to the involved communities as well as any data on the quality of the services provided at these facilities. Finally, an inventory will be conducted to identify any existing programs in the study area that may potentially affect recognition and care-seeking.

Key Findings

Results showed that participants recognized bleeding as a sign of danger when present during labor and a sign of severity during the postpartum period. Severity of maternal illness was determined by visual observation by midwives and mostly based on previous experience. Recognition of danger signs among newborns was lacking and mainly performed by the mother. care seeking decisions were mostly dominated by the husband in the case of maternal health, with a time interval of less than six hours. Most care was started at home by birth attendants, but the majority sough care outside the home within the public system. Most maternal deaths were associated with delays in receiving appropriate treatment at the public health facilities. In the case of newborns, the decision to seek care was dominated by the mother, with a time interval greater than 24 hours, with the majority seeking care at home. Most newborn deaths were associated with delays in all three components: illness recognition, care-seeking, and receiving appropriate care.

Lessons Learned

This research suggests that several action should be taken to improve recognition and care seeking for maternal and newborn health in this region.  It is important to strengthen the capacity of competent healthcare workers at the village level and to increase the capacity of community health workers to recognize symptoms as danger signs for mothers or newborns.  In addition, it is necessary to increase equitable distribution of equipment, providers, and health facilities so that disadvantaged populations have access to care.  The influence of religious and community leaders should also be considered as these highly respected figures could play a role in health outreach and education.  Finally community-based transportation to access health care should be provided so that families can reach the necessary healthcare providers if they experience complications.

Research into Action

This case study described recognition and care seeking behaviors related to maternal and newborn complications. Findings will provide valuable information to health authorities in Indonesia that can guide future efforts to reduce maternal and neonatal deaths. The results will be disseminated at workshops at both district and national levels. World Vision will produce and implement an action plan to address some of the limitation in seeking appropriate care based on discussion taking place during local and national dissemination activities. Activities include international conferences such as APHA 2016, Women Deliver 2016, and CORE Group 2016 Spring conference. In addition, TRAction will synthesize the findings from this and four other recognition studies in order to facilitate understanding of community-oriented approaches for improving recognition and care seeking. Experience from this study and other TRAction projects will be used to inform the development of interventions that address maternal and newborn health in low and middle income countries.

Research Partners

World Vision

Principal Investigator: Alfonso Rosales

Project Status


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