Access and Utilization of Health Facilities and Services for Poor Women
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Current Project / Maternal Mortality Rate / Women & Health
Women Research Institute (WRI) had conducted a research under the topic “Access and Utilization of Health Facilities and Services for Poor Women”. This research was conducted from April 2007 until April 2009 in 7 research areas namely Indramayu, Sumba Barat, Surakarta, Lombok Tengah, Jembrana, Lebak, and Lampung Utara. This research utilized quantitative method− survey and qualitative.
In general, this research was conducted with the aim of investigating the problems faced by poor women in accessing and utilizing health facilities. These problems were closely related to health facilities and services, family, and other social and cultural factors. This research was also aimed at finding the ways to improve health facilities so that women could utilize and have the access to good health services.
Quantitative Method (Survey)
Two districts: low Human Development Index (Sumba Barat, Lombok Tengah)
Two districts: good policy (Surakarta, Jembrana)
Three districts: Gakin (poor family), difficult access, low level of health (Lebak, Lampung Utara, and Indramayu).
Population: group of poor people especially women (with infants) in poor area (SMERU indicator and Gakin indicator/BPS)
Sample: 300 for each district (5% precision). Two sub-districts and four villages for each district
Deep interview with 30 respondents: women, paraji (traditional birth attendant), female figures, village leaders, cadres of posyandu (integrated health post), village midwives, assisting community health center (pustu), community health center (puskesmas), transparency and participation commission, health agency, Indonesian Midwives Association (IBI), and Local Development Planning Agency (Bappeda).
Focus Group Discussion (FGD) which involved women, female figures, village leaders, cadres of posyandu, village midwives, pustu, puskesmas, NGOs, KTP, Health Agency, IBI, Family Planning and Demography Agency, and Bappeda.
The Access and Utilization of Reproductive Health Services for Poor Women (WRI’s research results in 7 districts namely Lampung Utara, Lebak, Indramayu, Solo, Jembrana, Lombok Tengah, and Sumba Barat) 2007
Tentative Conclusions of the Quantitative Research
The lower the level of education and the income of women is, the more likely women will choose traditional birth attendant (dukun bayi).
The more children women have, the more likely they will choose dukun bayi.
The farther the distance and the more difficult the access to health facilities and health workers is, the more likely dukun bayi becomes the main option.
Even though there is a free health service, this does not necessarily reduce the poor women’s preference for dukun bayi as can be seen in Lebak, Lampung Utara, and Sumba Barat since the dissemination of the free health service is still uneven and the dukun bayi are more accessible.
People’s preference to go to dukun is influenced by the distance, available services for mother and infants after the birth, payment flexibility (in-natura), and the strong belief and tradition among the people.
There hasn’t been any special policy related to women’s reproductive health particularly one that is on the implementation of stay-at-the village midwives.
The cost of labor which is still considered expensive is one of the reasons why people choose to give birth with the help of dukun bayi.
There should be an improvement in regular reproductive health education to enable midwives to provide childbirth service, service related to contraception, and adequate and reliable sexually transmitted infection checkup.
In general, budget allocation for health is still low and is only approximately 4%-7% from the total APBD.
The allocation for reproductive health is very low. It’s only 3% from the total direct budget allocation of health agency.
The Availability and Utilization of Maternal Health Service for Women (Research Results from 7 Districts: Lombok Tengah, Indramayu, Surakarta, Jembrana, Lampung Utara, Sumba Barat, Lebak), 2008.
Tentative Conclusion of the Qualitative Research
There hasn’t been special policy on women’s reproductive health especially one which puts emphasize on the implementation of stay-at-the-village midwives, improvement of midwives’ welfare, transportation for midwives who stay in remote areas, and security assurance for midwives in remote areas.
The policy of partnership between midwives and traditional birth attendance (dukun bayi) is not applied in all regions even though it has been proven to work well in Indramayu and Lombok Tengah where the number of births assisted by midwives is higher compared to in Lampung Utara, Sumba Barat, and Lebak. The number in Indramayu and Lombok Tengah is even close to the number in Surakarta and Jembrana.
There is a need to improve reproductive health education for midwives to enable them to provide childbirth service, service related to contraception, and adequate and reliable sexually transmitted infection checkup.
There hasn’t been a policy on the implementation of standard Village Clinics (Polindes) which are livable and conform to the basic cleanliness standards such as a room that is detached from the midwives’ houses, a minimum of two available rooms, clean water, lighting, and refrigerators to store medicines.
There hasn’t been a policy that requires the claim of childbirth services cost by midwives to be paid directly so that the midwives do not have to work voluntarily without the certainty that their claim for the childbirth services they perform will be paid.
For the complete research results, please download WRI’s Health Study Results and Quantitative Study Results
Also read: Seminar on Health Service for Poor Women Research Results