"Maybe it was her fate and maybe she ran out of blood," Indonesia.
Article Type: Brief article
Subject: Maternal health services (Usage)
Maternal health services (Research)
Pub Date: 05/01/2010
Publication: Name: Reproductive Health Matters Publisher: Reproductive Health Matters Audience: General Format: Magazine/Journal Subject: Family and marriage; Health; Women's issues/gender studies Copyright: COPYRIGHT 2010 Reproductive Health Matters ISSN: 0968-8080
Issue: Date: May, 2010 Source Volume: 18 Source Issue: 35
Topic: Event Code: 290 Public affairs; 310 Science & research
Geographic: Geographic Scope: Indonesia Geographic Code: 9INDO Indonesia
Accession Number: 236247748
Full Text: This paper examines access to care in obstetric emergencies by interviewing the final caregivers of 104 women who died during pregnancy or childbirth in two rural districts of Indonesia, using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements and low public pay acted as disincentives to treat the poor. For users, the schemes were poorly understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were generally unavailable or unaffordable. The multiple barriers to access resulted in exclusion, which was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that understanding access as a complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, could help with health planning. Planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control regarding their health in people's feelings and behaviours. (1)

(1.) D'Ambruoso L, Byass P, Qomariyah SN. "Maybe it was her fate and maybe she ran out of blood": final caregivers' perspectives on access to care in obstetric emergencies in rural Indonesia. Journal of Biosocial Science 2010;42(2):213-41.
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