Background: There are many challenges women face to be able to give birth in health facilities in many parts of
Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other
community members on potential barriers faced by women to deliver in health facilities in two districts within The
Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus
group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages
in Cianjur, in the West Java province. The participants included village midwives, Posyandu volunteer (village health
volunteers), traditional birth attendants (TBAs), mothers, men, village heads and district health officials. Results: The
main findings were mostly similar in the two study areas. However, there were some key differences. Preference for
TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and
indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of
their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth
and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations
between midwives and TBAs, and responsiveness to traditional practices within health facilities and effective health
promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in
both study areas.
