- Title
- Barriers and enablers to women's access to services during childbearing in Timor-Leste
- Creator
- King, Rosemary
- Date
- 2019
- Type
- Text; Thesis; PhD
- Identifier
- http://researchonline.federation.edu.au/vital/access/HandleResolver/1959.17/169995
- Identifier
- vital:14082
- Identifier
- https://library.federation.edu.au/record=b2797631
- Abstract
- Background: In Timor-Leste the maternal mortality ratio (MMR) is one of the highest in Southeast Asia, in some districts only 15-25% of women birth in a facility with a skilled birth attendant (SBA). Care from SBA is the international benchmark for quality maternity care. Purpose: Determine the barriers and enablers to women's access to services during childbearing in Timor-Leste, including women’s expectations and needs. Methodology: Qualitative research using focused ethnography, data collection methods included semi-structured interviews, focus groups and participant observation. Seventeen stakeholders and thirty women from three districts in Timor-Leste participated. Thematic analysis and coding of data with triangulation of the findings between separate participant groups. Results: Barriers to woman’s access to SBA include poor roads, lack of transport, costs associated with accessing SBA, lack of availability and poor quality services. Lack of privacy, multiple care-givers and poor interpersonal communication from SBA were also noted. Stakeholders emphasise health promotion and antenatal care to counteract the influence of traditional beliefs and promote demand for SBA. Many women demonstrate their agency in health seeking behaviours and choices for care during pregnancy and childbirth. Discussion: Women understand that pregnancy and childbirth poses potential risks to their health. Rural women, women from low socio-economic and other marginalised groups have less access to services. Perceptions of poor quality services also reduce women’s demand. Conclusion: Barriers and enablers to woman’s access to services are identified using an amended AAAQ framework introducing the domain of Antecedents in addition to domains of Access, Availability, Acceptability and Quality (AAAQA). Further expenditure on health service infrastructure, staff training and community outreach will improve access and quality SBA. Culturally safe SBA services may also improve the uptake of SBA service in Timor-Leste. Key words: Timor-Leste, Skilled birth attendance, cultural safety, women’s agency, quality maternity care.; Doctor of Philosophy
- Publisher
- Federation University Australia
- Rights
- Copyright Rosemary King
- Rights
- Open Access
- Rights
- This metadata is freely available under a CCO license
- Subject
- Maternal care; Childbearing; Women; Timor-Leste; Maternal mortality ratio (MMR); Health services
- Full Text
- Thesis Supervisor
- Jones, Linda
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