Sydney School of Public Health, Edward Ford Building A27, University of Sydney, NSW 2006, Australia.
BMC Pregnancy Childbirth. 2010 Aug 11;10:43. doi: 10.1186/1471-2393-10-43.
Trained birth attendants at delivery are important for preventing both maternal and newborn deaths. West Java is one of the provinces on Java Island, Indonesia, where many women still deliver at home and without the assistance of trained birth attendants. This study aims to explore the perspectives of community members and health workers about the use of delivery care services in six villages of West Java Province.
A qualitative study using focus group discussions (FGDs) and in-depth interviews was conducted in six villages of three districts in West Java Province from March to July 2009. Twenty FGDs and 165 in-depth interviews were conducted involving a total of 295 participants representing mothers, fathers, health care providers, traditional birth attendants and community leaders. The FGD and in-depth interview guidelines included reasons for using a trained or a traditional birth attendant and reasons for having a home or an institutional delivery.
The use of traditional birth attendants and home delivery were preferable for some community members despite the availability of the village midwife in the village. Physical distance and financial limitations were two major constraints that prevented community members from accessing and using trained attendants and institutional deliveries. A number of respondents reported that trained delivery attendants or an institutional delivery were only aimed at women who experienced obstetric complications. The limited availability of health care providers was reported by residents in remote areas. In these settings the village midwife, who was sometimes the only health care provider, frequently travelled out of the village. The community perceived the role of both village midwives and traditional birth attendants as essential for providing maternal and health care services.
A comprehensive strategy to increase the availability, accessibility, and affordability of delivery care services should be considered in these West Java areas. Health education strategies are required to increase community awareness about the importance of health services along with the existing financing mechanisms for the poor communities. Public health strategies involving traditional birth attendants will be beneficial particularly in remote areas where their services are highly utilized.
在分娩时受过培训的接生员对于预防产妇和新生儿死亡非常重要。西爪哇是印度尼西亚爪哇岛上的一个省份，那里许多妇女仍然在家中分娩，没有受过培训的接生员的帮助。本研究旨在探讨社区成员和卫生工作者对西爪哇省六个村庄使用分娩护理服务的看法。
2009 年 3 月至 7 月，在西爪哇省三个区的六个村庄进行了一项使用焦点小组讨论（FGD）和深入访谈的定性研究。共进行了 20 次 FGD 和 165 次深入访谈，共有 295 名参与者参加，代表母亲、父亲、医疗保健提供者、传统接生员和社区领袖。FGD 和深入访谈指南包括使用受过培训的接生员或传统接生员的原因，以及在家中或在医疗机构分娩的原因。
尽管村里有村助产士，但一些社区成员还是更喜欢使用传统接生员和在家分娩。身体距离和经济限制是阻止社区成员获得和使用经过培训的接生员和在医疗机构分娩的两个主要制约因素。一些受访者报告说，经过培训的接生员或在医疗机构分娩仅针对经历过产科并发症的妇女。偏远地区的居民报告说，医疗保健提供者的数量有限。在这些环境中，村助产士有时是唯一的医疗保健提供者，经常离开村庄。社区认为村助产士和传统接生员的作用对于提供产妇和保健服务都是必不可少的。
应考虑在这些西爪哇地区制定一项增加分娩护理服务的供应、可及性和可负担性的综合战略。需要开展健康教育战略，提高社区对卫生服务重要性的认识，同时为贫困社区建立现有的筹资机制。涉及传统接生员的公共卫生战略在他们的服务高度普及的偏远地区将是有益的。
