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

Heather Julie Wallace, Susan McDonald, Suzanne Belton, Agueda Isolina Miranda, Eurico da Costa, Livio da Conceicao Matos, Helen Henderson, Angela Taft

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)35-42
    Number of pages8
    JournalMidwifery
    Volume65
    Issue numberOctober
    DOIs
    Publication statusPublished - 1 Oct 2018

    Fingerprint

    Parturition
    Reproductive History
    Maternal Death
    Prenatal Care
    Midwifery
    Attitude of Health Personnel
    Health Services Accessibility
    Far East
    Pregnancy Complications
    Quality of Health Care
    Health Facilities
    Focus Groups
    Spouses
    Timor-Leste
    Emergencies
    Interviews
    Mortality
    Health
    Research
    Maternal Health

    Cite this

    Wallace, Heather Julie ; McDonald, Susan ; Belton, Suzanne ; Miranda, Agueda Isolina ; da Costa, Eurico ; Matos, Livio da Conceicao ; Henderson, Helen ; Taft, Angela. / 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. In: Midwifery. 2018 ; Vol. 65, No. October. pp. 35-42.
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    abstract = "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.",
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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. / Wallace, Heather Julie; McDonald, Susan; Belton, Suzanne; Miranda, Agueda Isolina; da Costa, Eurico; Matos, Livio da Conceicao; Henderson, Helen; Taft, Angela.

    In: Midwifery, Vol. 65, No. October, 01.10.2018, p. 35-42.

    Research output: Contribution to journalArticleResearchpeer-review

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