Abubakari A, Agbozo F, Abiiro GA Factors associated with optimal antenatal care use in Northern region, Ghana. Women Health. 2018; 58:(8)942-954

Acharya D, Khanal V, Singh JK, Adhikari M, Gautam S Impact of mass media on the utilization of antenatal care services among women of rural community in Nepal. BMC Res Notes. 2015; 8:(1)

Anwar KU Takhrij Hadits: Ridho Allah Ridhonya Orangtua. Landraad J Syariah Huk Bisnis. 2023; 2:(2)114-124

Astari AM, Hamid AYS, Damayanti R The qualitative study on family decision making related to the perinatal complication in Cianjur, West Java. J Kedokt Brawijaya. 2009; XXIV:(3)1-6

Astuti SP Pola pengambilan keputusan keluarga dan bidan dalam merujuk ibu bersalin ke RUmah Sakit pada kasus kematian ibu di Kabupaten Demak.Indonesia: Universitas Diponegoro Semarang; 2008

Astutik H, Santoso B, Agil M The effect of anastatica hierochuntica l. extract on the histology of myometrial cells and prostaglandin levels (PGE2, PGF2α) in pregnant mice. Adv Heal Sci Res. 2020; 22:(Ishr 2019)81-86

Aziz Ali S, Aziz Ali S, Feroz A, Saleem S, Fatmai Z, Kadir MM Factors affecting the utilization of antenatal care among married women of reproductive age in the rural Thatta, Pakistan: findings from a community-based case-control study. BMC Pregnancy Childbirth. 2020; 20:(1)

Banul MS, Halu SAN Analysis of abdominal massage practice performed by traditional birth attendants in Mamba Community Health Center, East Nusa Tenggara. J Matern Child Heal. 2020; 5:(6)715-724

Basharat J, Kamal A, Manzoor I, Nauman U Socio-demographic differentials for utilization of antenatal health care among pakistani women: a negative binomial-logit hurdle (HNBLOGIT) regression model approach (1990-2013). Pak Pediatr J. 2016; 40:(4)242-253

Carvalho OMC, Junior ABV, Augusto MCC Delays in obstetric care increase the risk of neonatal near-miss morbidity events and death: a case-control study. BMC Pregnancy Childbirth. 2020; 20:(1)

Chi PC, Bulage P, Urdal H, Sundby J A qualitative study exploring the determinants of maternal health service uptake in post-conflict Burundi and Northern Uganda. BMC Pregnancy Childbirth. 2015; 15:(1)

Devy SR, Rachmayanti RD, Putri FK Maternal care among Madurese through the form of culture. Indian J Public Heal Res Dev. 2019; 10:(3)650-655

Fouly H, Zaghloul MG, Alshiekh N, Masoud A A simple awareness for women about (SAWA) stages of labor on women's childbirth experience using the childbirth roadmap tool: a quasi-experimental study. J Ners. 2023; 18:(2)159-168

Fulpagare PH, Saraswat A, Dinachandra K Antenatal care service utilization among adolescent pregnant women–evidence From Swabhimaan Programme in India. Front Public Health. 2019; 7

Gunawan J Ensuring trustworthiness in qualitative research. Belitung Nurs J. 2015; 1:(1)10-11

Ha BTT, Tac PV, Duc DM, Duong DTT, Thi M Factors associated with four or more antenatal care services among pregnant women: a cross-sectional survey in eight South Central Coast provinces of Vietnam. Int J Womens Health. 2015; 7:699-706

Haque MA, Dash SK, Chowdhury MAB Maternal health care seeking behavior: the case of Haor (wetland) in Bangladesh. BMC Public Health. 2016; 16:(1)

Hennink M, Kaiser BN Sample sizes for saturation in qualitative research: a systematic review of empirical tests. Soc Sci Med. 2022; 292

Profil Kesehatan Indonesia Tahun 2017.Jakarta, Indonesia: Kementerian Kesehatan Republik Indonesia; 2018

Kibesa JS, Kitua WY, Kitua WD Determinants of antenatal healthcare services utilisation: a case of Dodoma, Tanzania. East Afr Health Res J. 2022; 6:(2)155-161

Kifle D, Azale T, Gelaw YA, Melsew YA Maternal health care service seeking behaviors and associated factors among women in rural Haramaya District, Eastern Ethiopia: a triangulated community-based cross-sectional study. Reprod Health. 2017; 14:(1)

Lestari NDR, Emilia O, Nurdianti DS, Padmawati RS A protocol study of participatory action research: Midwife empowerment in improving the quality of maternal referral in Indonesia. Bali Med J. 2023; 12:(3)2957-2962

Li X, Deng L, Yang H, Wang H Effect of socioeconomic status on the healthcare-seeking behavior of migrant workers in China. PLoS One. 2020; 15:(8)

Listiowati D, Rejeki S, Nurrahina A Gambaran Pengambilan Keputusan Keluarga Bersuku Jawa Dalam Menghadapi Tanda Bahaya Kehamilan. Unissula Nurs Conf Call Pap Natl Conf. 2018; 1:203-209

Miles MB, Huberman AM, Saldaña J Qualitative data analysis: a methods soucebook.Thousand Oaks, California: SAGE Publications Inc; 2014

Mueller SM, Grunwald M Effects, side effects and contraindications of relaxation massage during pregnancy: a systematic review of randomized controlled trials. J Clin Med. 2021; 10:(16)

Nabieva J, Souares A Factors influencing decision to seek health care: a qualitative study among labour-migrants' wives in northern Tajikistan. BMC Pregnancy Childbirth. 2019; 19:(1)1-10

National Population and Family Planning Board, Statistics Indonesia, Ministry of Health, The DHS Program. Indonesia Demographic and Health Survey 2017. 2018. https// (accessed 14 March 2024)

Neubauer BE, Witkop CT, Varpio L How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019; 8:(2)

Noviani A, Sari M, Hardianto Septina HR Profil Kesehatan Ibu Dan Anak 2020. In: Harahap IE, Astuti SP, Ponco SH (eds). Jakarta, Indonesia: Badan Pusat Statistik; 2020

Rosmalia D, Sriani Y Sosiologi Kesehatan.Jakarta: Kementrian Kesehatan Republik Indonesia; 2017

Sahoo KC, Pati S, Negi S, Patel K, Mishra BK, Palo SK Challenges in maternal and child health services delivery and access during pandemics or public health disasters in low-and middle-income countries: a systematic review. Healthcare. 2021; 9:(7)

Shahabuddin A, Nöstlinger C, Delvaux T Exploring maternal health care-seeking behavior of married adolescent girls in Bangladesh: a social-ecological approach. PLoS One. 2017; 12:(1)

Sharma A, Meshram PK, Pandey D, Kasar PK, Tiwari R Utilization of antenatal services and concerning factors: a community based study. Indian J Community Health. 2018; 30:(1)56-62

Stahl NA, King JR Expanding approaches for research: understanding and using trustworthiness in qualitative research. J Dev Educ. 2020; 44:(1)26-28

Suryana A, Silvana T, Erlandia DR The health communication orientation of poor community in rural areas on West Bandung District, West Java BT - Proceedings of the International Conference on Media and Communication Studies (ICOMACS 2018).Amsterdam: Atlantis Press; 2018

Triyana M The effects of Indonesia's ‘Midwife in the Village’ programme 10 years post-launch. Population Studies. 2016; 70:(3)365-376

UNICEF Data: monitoring the situation of children and women.New York: UNICEF; 2019

United Nations. Take action for the sustainable development goals. 2015. https// (accessed 5 March 2024)

Maternal mortality: level and trends 2000 to 2017.Geneva: World Health Organization; 2019

Widayanti AW, Green JA, Heydon S, Norris P Health-seeking behavior of people in Indonesia: a narrative review. J Epidemiol Glob Health. 2020; 10:(1)

Zin SRM, Kassim NM, Alshawsh MA, Hashim NE, Mohamed Z Biological activities of Anastatica hierochuntica L.: a systematic review. Biomed Pharmacother. 2017; 91:611-620

Family decision making for Madurese women with pregnancy complications: a qualitative study

02 April 2024
Volume 32 · Issue 4



A delay in referring women with pregnancy complications to medical care is a significant contributor to maternal mortality worldwide. In Madura, Indonesia, these delays can be exacerbated by the role of a woman's family in decision making. This study aimed to explore family decision making in seeking healthcare for women with pregnancy complications in Madura.


Using a descriptive qualitative approach, in-depth interviews were conducted to explore the decision-making experiences of 12 pregnant women, 12 of their family members and 10 midwives.


Three themes were identified: women empowerment issues, cultural factors, and important considerations in seeking healthcare for women with pregnancy complications.


Continuous health education is needed to increase knowledge of appropriate maternal care for pregnant women and their families. The involvement of religious leaders in programmes to enhance referral decision making would be beneficial.

Approximately 15% of pregnant women will develop complications, which can result in maternal and fetal death (Noviani et al, 2020). Delays in referring pregnant women with complications for medical care remain a significant health service issue, particularly in developing countries (Sahoo et al, 2021). Delays in accessing and receiving appropriate medical care result in maternal and neonatal morbidity and mortality (Carvalho et al, 2020). Improving referral systems is an important strategy to reduce maternal mortality ratios.

The Indonesian Demographic Health Survey reported that in 2017, Indonesia's maternal mortality ratio was 305 per 100 000 live births (National Population and Family Planning Board et al, 2018). The United Nations' (2015) Sustainable Development Goals aim to reduce the global maternal mortality ratio to less than 70 deaths per 100 000 live births, with no country having a ratio higher than 140 per 100 000 live births by 2030 (Kementerian Kesehatan Republik Indonesia, 2018). In light of this target, efforts to reduce the maternal mortality ratio in Indonesia must be optimised.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month