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The decision to seek care antenatally and during labour and birth – Who and what influences this in Timor-Leste? A qualitative project exploring the perceptions of Timorese women and men
journal contributionposted on 2023-04-28, 06:37 authored by HJ Wallace, S McDonald, S Belton, AI Miranda, E da Costa, LDC Matos, H Henderson, A Taft
Background: While global maternal deaths have decreased significantly, hundreds of thousands of women still die from pregnancy and birth complications. Interventions such as skilled birth attendants, emergency transportation to health facilities and birth preparedness have been successful at reducing such deaths, however barriers to seeking, reaching, and receiving respectful care persist. Objective: This study aimed to identify what influences people's decisions to seek antenatal care and care during labour and birth in Timor-Leste, a low-middle income newly independent nation in South East Asia with a high maternal death rate. The study aimed to provide emic/local insights to help midwives and maternal health providers tailor care and resources appropriately, thus improving maternal health. Design: This qualitative study with a decolonising methodology, was designed to explore the perceptions of reproductive aged Timorese women and men, situating Timorese worldviews in the centre of the research process. Data collection occurred in four municipalities of Timor-Leste in October 2015 and included 9 focus group discussions with 80 men, and 17 individual reproductive history interviews with women. Findings: An expanded ‘Three Delays’ model was used to frame the findings. The study found multiple factors impacting on decisions to seek antenatal care and care during labour and birth. Husbands, history, minimal birth preparedness, ethno-physiological beliefs (personal perceptions of how the body works), infrastructure limitations, geographical location, hospital policies and staff attitudes influenced and potentially delayed the decision to seek or reach care. Key conclusion and implications for practice and policy: Policies and programs that increase accessibility of midwives and encourage birth preparedness are vital. Given the current locus of power in families in Timor-Leste, it is imperative that men are educated regarding the importance of care from skilled providers, and supported to access such care with their partners. Culturally respectful, inclusive and quality care needs to be emphasised so that trust is established between health providers and communities.
Publication classificationC1.1 Refereed article in a scholarly journal
PublisherELSEVIER SCI LTD
Science & TechnologyLife Sciences & BiomedicineNursingTimor-LesteMaternal mortalityDecolonisingThree DelaysAntenatal careBirth placeMATERNAL MORTALITYREPRODUCTIVE HEALTHSAFE MOTHERHOODDEVELOPING-COUNTRIESSERVICESSCALEAdultAttitude of Health PersonnelDecision MakingFemaleFocus GroupsHealth Knowledge, Attitudes, PracticeHumansInterviews as TopicMaleMaternal MortalityParturitionPatient Acceptance of Health CarePregnancyPrenatal CareQualitative ResearchSpousesYoung AdultHealth ServicesClinical Research8 Health and social care services research8.1 Organisation and delivery of servicesReproductive health and childbirthGeneric health relevance3 Good Health and Well Being4 Quality EducationPublic Health and Health Services not elsewhere classifiedNursing not elsewhere classifiedPaediatrics and Reproductive Medicine not elsewhere classified