Pardosi Jerico Franciscus, Parr Nick, Muhidin Salut
Department of Marketing and Management, Faculty of Business and Economics,Macquarie University,Sydney,Australia.
J Biosoc Sci. 2015 Nov;47(6):780-802. doi: 10.1017/S0021932014000522. Epub 2014 Dec 15.
Indonesia's infant mortality rates are among the highest in South-East Asia, and there are substantial variations between its sub-national regions. This qualitative study aims to explore early mortality-related health service provision and gender inequity issues based on mothers' pregnancy, delivery and early-age survival experience in Ende district, Nusa Tenggara Timur province. Thirty-two mothers aged 18-45 years with at least one birth in the previous five years were interviewed in depth in May 2013. The results show most mothers have little knowledge about the danger signs for a child's illness. Mothers with early-age deaths generally did not know the cause of death. Very few mothers had received adequate information on maternal and child health during their antenatal and postnatal visits to the health facility. Some mothers expressed a preference for using a traditional birth attendant, because of their ready availability and the more extensive range of support services they provide, compared with local midwives. Unprofessional attitudes displayed by midwives were reported by several mothers. As elsewhere in Indonesia, the power of health decision-making lies with the husband. Policies aimed at elevating mothers' roles in health care decision-making are discussed as measures that would help to improve early-age survival outcomes. Widening the public health insurance distribution, especially among poorer mothers, and equalizing the geographical distribution of midwives and health facilities are recommended to tackle geographical inequities and to increase early-age survival in Ende district.
印度尼西亚的婴儿死亡率在东南亚地区位居前列，其各次国家级区域之间存在显著差异。本定性研究旨在根据东努沙登加拉省恩德地区母亲们的怀孕、分娩及幼儿期生存经历，探讨与早期死亡相关的卫生服务提供情况及性别不平等问题。2013年5月，对32名年龄在18至45岁之间、在过去五年中至少生育过一次的母亲进行了深入访谈。结果显示，大多数母亲对儿童疾病的危险信号知之甚少。幼儿期死亡孩子的母亲通常不知道死亡原因。在产前和产后到医疗机构就诊期间，极少有母亲获得过关于母婴健康的充分信息。一些母亲表示更倾向于请传统助产士，因为她们随时可得，且与当地助产士相比，提供的支持服务范围更广。几位母亲报告了助产士表现出的不专业态度。与印度尼西亚其他地方一样，医疗保健决策的权力掌握在丈夫手中。讨论了旨在提升母亲在医疗保健决策中作用的政策，认为这些政策有助于改善幼儿期生存结果。建议扩大公共医疗保险的覆盖范围，尤其是在较贫困的母亲中，并使助产士和卫生设施的地理分布更加均衡，以解决地理不平等问题并提高恩德地区的幼儿期生存率。
