Birth choices in Timor-Leste: A framework for understanding the use of maternal health services in low resource settings
Abstract
The high rate of maternal mortality in Timor-Leste is a persistent problem which has been exacerbated by the long history of military occupation and ongoing political crises since independence in 1999. It is similar to other developing countries where there have been slow declines in maternal mortality despite 20 years of Safe Motherhood interventions. The national Ministry of Health, United Nations (UN) agencies and non-government organisations (NGOs) have attempted to reduce maternal mortality by enacting policies and interventions to increase the number of births in health centres and hospitals. Despite considerable effort in promoting facility-based delivery, most Timorese women birth at home and the lack of midwives means few women have access to a skilled birth attendant. This paper investigates factors influencing access to and use of maternal health services in rural areas of Timor-Leste. It draws on 21 interviews and 11 group discussions with Timorese women and their families collected over two periods of fieldwork, one month in September 2006 and five months from July to December 2007. Theoretical concepts from anthropology and health social science are used to explore individual, social, political and health system issues which affect the way in which maternal health services are utilised. In drawing together a range of theories this paper aims to extend explanations around access to maternal health services in developing countries. An empirically informed framework is proposed which illustrates the complex factors that influence women's birth choices. This framework can be used by policy-makers, practitioners, donors and researchers to think critically about policy decisions and where investments can have the most impact for improving maternal health in Timor-Leste and elsewhere.
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Facility delivery is valued for obstetric complications, acting as a facilitator to facility-based delivery.
“Facilitator: Facility delivery valued for obstetric complications”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Lack of supportive attendance during facility delivery acts as a barrier to facility-based delivery.
“Barrier: Lack of supportive attendance during facility delivery”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Health insurance schemes, national population policies, and national policies aimed to shift deliveries from the home to a facility act as a facilitator or barrier to facility-based delivery.
“Facilitator/barrier: Health insurance schemes, national population policies, and national policies aimed to shift deliveries from the home to a facility”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Previous birth experiences affect subsequent delivery locations, acting as a facilitator or barrier.
“Facilitator/barrier: Effects of previous birth experiences on subsequent delivery locations”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Intergenerational continuity and the role of elder women act as a barrier to facility-based delivery.
“Barrier: Intergenerational continuity and the role of elder women”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Lack of access to funds in an emergency acts as a barrier to facility-based delivery.
“Barrier: Lack of access to funds in an emergency”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Perceived high cost of facility birth compared to home birth acts as a barrier to facility-based delivery.
“Barrier: Perceived high cost of facility birth compared to home birth”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Poor proximity and access to a facility act as a barrier to facility-based delivery.
“Barrier: Poor proximity and access to a facility”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Delays in accessing referral services act as a barrier to facility-based delivery.
“Barrier: Delays in accessing referral services”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Indirect and hidden costs associated with facility delivery act as a barrier to facility-based delivery.
“Barrier: Indirect and hidden costs associated with facility delivery”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Facilities perceived as providing high quality care acts as a facilitator to facility-based delivery.
“Facilitator: Facilities perceived as providing high quality care”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Mistreatment and abuse by health workers act as a barrier to facility-based delivery.
“Barrier: Mistreatment and abuse by health workers”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Inadequate health facility staffing and infrastructure act as a barrier to facility-based delivery.
“Barrier: Inadequate health facility staffing and infrastructure”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women who had previous cesarean sections or obstetric complications may desire future facility delivery due to higher perceived risk.
“Women who had previous cesarean sections or obstetric complications may desire future facility delivery due to higher perceived risk.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
In many contexts, a woman's first delivery is considered the riskiest since she has no prior experiences with childbirth.
“In many contexts, a woman’s first delivery is considered the riskiest since she has no prior experiences with child birth.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Across a variety of contexts, women determined their level of risk for complicated deliveries based on their prior delivery experiences and birth outcomes, and these previous birth experiences may act as either a facilitator or barrier to future deliveries.
“Across a variety of contexts, women determined their level of risk for complicated deliveries based on their prior delivery experiences and birth outcomes, and these previous birth experiences may act as either a facilitator or barrier to future delivery deliveries.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Previous negative experiences with facility births may deter women from delivering at a facility during a future birth.
“Likewise, previous negative experiences with facility births may deter women from delivering at a facility during a future birth.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
If a woman gave birth to her first child without complications, utilizing a facility for subsequent births may be viewed as unnecessary or illogical.
“However, if a woman gave birth to her first child without complications, utilizing a facility for subsequent births may be viewed as unnecessary or illogical.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Some women believed that they should choose the same delivery location that their mothers and grandmothers experienced, in order to maintain their identity and intergenerational continuity.
“Some women believed that they should choose the same delivery location that their mothers and grandmothers experienced, in order to maintain their identity and intergenerational continuity.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Other women may be pressured by the elder women to deliver at home.
“Other women may be pressured by the elder women to deliver at home.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Across a variety of contexts, elder women, including mothers, mothers-in-law and grandmothers of parturient women, hold the greatest influence and decision-making power regarding delivery location.
“Across a variety of contexts, elder women, including mothers, mothers-in-law and grandmothers of parturient women, hold the greatest influence and decision-making power regarding delivery location.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
The perceived far distance to health facilities may create a dependency on home birth as some women report that the facility is too far to travel to during labor, particularly given the restricted transportation options.
“The perceived far distance to health facilities may create a dependency on home birth as some women report that the facility is too far to travel to during labor, particularly given the restricted transportation options.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Geographical distance to a health facility is an influential factor affecting a woman's delivery location, explored in 16 studies across 11 countries.
“Geographical distance to a health facility is an influential factor affecting a woman’s delivery location, explored in 16 studies across 11 countries.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women residing in both urban and rural areas where health services do not exist at the community level may face considerable traveling time to reach a facility.
“Women residing in both urban and rural areas where health services do not exist at the community level may face considerable traveling time to reach a facility.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Even in settings where direct delivery costs were subsidized, families were expected to pay for transportation to the facility, drugs, medical supplies (i.e.: gloves, needles, gauze), blood for transfusions, laboratory services, food during the hospital stay, bribes to health providers, and laundry services.
“Even in settings where direct delivery costs were subsidized, families were expected to pay for transportation to the facility, drugs, medical supplies (i.e.: gloves, needles, gauze), blood for transfusions, laboratory services, food during the hospital stay, bribes to health providers, and laundry services.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Instead, family members were often sent around the community to collect money from their neighbors or try to sell property or livestock.
“Instead, family members were often sent around the community to collect money from their neighbors or try to sell property or livestock”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Collecting the necessary money was a difficult task as few banks or moneylenders would lend money to the poor, and if they did, exorbitant interest rates could make the principle escalate rapidly in just a few months.
“Collecting the necessary money was a difficult task as few banks or moneylenders would lend money to the poor, and if they did, exorbitant interest rates could make the principle escalate rapidly in just a few months.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Organizing referrals for obstetric complications was a time-consuming and arduous process, complicated by a lack of access to transportation, good roads, adequate funds, and communication systems.
“Organizing referrals for obstetric complications was a time-consuming and arduous process, complicated by a lack of access to transportation, good roads, adequate funds, and communication systems.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Low-SES families often did not plan in advance for costs associated with child birth and few families had assets or savings to devote to health expenses, thus causing a scramble to raise funds during obstetric complications.
“Low-SES families often did not plan in advance for costs associated with child birth and few families had assets or savings to devote to health expenses, thus causing a scramble to raise funds during obstetric complications.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Where women viewed childbirth as a non-medical event, the cost of childbirth is considered extraneous and unnecessary.
“Where women viewed childbirth as a non-medical event, the cost of childbirth is considered extraneous and unnecessary.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
The lack of coordination between different health system actors also contributed to delays in reaching care.
“The lack of coordination between different health system actors also contributed to delays in reaching care.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Direct costs associated with childbirth were perceived to be unaffordable for many women and some women perceived themselves as too poor to deliver in a facility.
“Direct costs associated with childbirth were perceived to be unaffordable for many women and some women perceived themselves as too poor to deliver in a facility.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
In addition to the extra point-of-care costs associated with facility birth, families experienced opportunity costs due to absence from work and domestic responsibilities.
“In addition to the extra point-of-care costs associated with facility birth, families experienced opportunity costs due to absence from work and domestic responsibilities.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
These additional costs often came as a surprise to women after they attended the facility, which may impact their future choice of delivery location.
“These additional costs often came as a surprise to women after they attended the facility, which may impact their future choice of delivery location.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Within the same study area, perceptions of facility-based care vary greatly and participants more commonly perceived facilities to have low quality of care than high quality of care.
“It is important to note that within the same study area, perceptions of facility-based care vary greatly and participants more commonly perceived facilities to have low quality of care than high quality of care.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
In contexts where facilities are perceived as providing high quality care, women may seek facility delivery to ensure positive birth outcomes.
“In contexts where facilities are perceived as providing high quality care, women may seek facility delivery to ensure positive birth outcomes.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
They may view facilities as providing efficacious and respectable care, and health workers as compassionate experts.
“They may view facilities as providing efficacious and respectable care, and health workers as compassionate experts.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women who perceived facilities as providing high quality care reportedly felt more comfortable seeking facility-based delivery.
“However, women who perceived facilities as providing high quality care reportedly felt more comfortable seeking facility-based delivery.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women described providers as verbally abusive, rude, bossy, unhelpful, disrespectful, critical, easily angered, having a poor attitude, and lacking compassion.
“Women described providers as verbally abusive, rude, bossy, unhelpful, disrespectful, critical, easily angered, having a poor attitude, and lacking compassion.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Respondents reported that facility-based providers shout at, physically abuse, and insult women during delivery.
“Respondents reported that facility-based providers shout at, physically abuse, and insult women during delivery.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Many women referred to poor patient-provider interactions as a barrier to seeking delivery care.
“Many women referred to poor patient-provider interactions as a barrier to seeking delivery care.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Inadequate staffing and infrastructure in the facilities contributed to the perceived low quality of care.
“Inadequate staffing and infrastructure in the facilities contributed to the perceived low quality of care.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
The lack of adequate staffing led to overburdened lower-level providers and often prompted women to visit untrained traditional providers to respond to the gaps in service.
“The lack of adequate staffing led to overburdened lower-level providers and often prompted women to visit untrained traditional providers to respond to the gaps in service.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Many women attempted home delivery first and considered facility birth only if complications arose.
“Many women attempted home delivery first and considered facility birth only if complications arose [18, 19, 26, 29–38].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
The lack of supportive attendance during facility-based delivery was a major concern.
“The lack of supportive attendance during facility-based delivery was a major concern [23, 24, 29, 34, 36, 39, 41, 43].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women commonly referred to their families and TBAs as providing supportive care during home births.
“Women commonly referred to their families and TBAs as providing supportive care during home births.”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Caesarean sections are also believed to be used indiscriminately without thorough consideration regarding individual cases.
“Caesarean sections are also believed to be used indiscriminately without thorough consideration regarding individual cases [25, 34, 51, 54].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
A woman may be more likely to deliver at a facility if she had a previous obstetric complication.
“A woman may be more likely to deliver at a facility during her first birth [34] or if she had a previous obstetric complication [25, 32, 34, 44].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Elder women hold the greatest influence and decision-making power regarding delivery location across Asia and sub-Saharan Africa.
“Elder women hold the greatest influence and decision-making power regarding delivery location across Asia and sub-Saharan Africa [16–19, 21, 34, 39, 43, 45].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Elder women may pressure younger women to deliver at home.
“Some women believed that they should choose the same delivery location as their mothers and grandmothers to maintain intergenerational continuity, and elder women may pressure younger women to deliver at home [18, 21, 34, 39, 45].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
A woman may be more likely to deliver at a facility during her first birth.
“A woman may be more likely to deliver at a facility during her first birth [34] or if she had a previous obstetric complication [25, 32, 34, 44].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
If a woman delivered her first child without complications, utilizing a facility for subsequent births is often viewed as unnecessary.
“However, if a woman delivered her first child without complications, utilizing a facility for subsequent births is often viewed as unnecessary [20, 21, 24, 30, 34, 36, 39, 46, 47].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Some women believed that they should choose the same delivery location as their mothers and grandmothers to maintain intergenerational continuity.
“Some women believed that they should choose the same delivery location as their mothers and grandmothers to maintain intergenerational continuity, and elder women may pressure younger women to deliver at home [18, 21, 34, 39, 45].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Geographical distance and considerable travel times to health facilities are influential factors affecting women's delivery locations.
“Geographical distance and considerable travel times to health facilities are influential factors affecting women’s delivery locations [18, 20, 25–27, 29, 32–36, 39, 41, 45, 46, 49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Seven studies addressed the effects of government policies and programs on a woman's delivery location, including national health insurance schemes, social welfare programs, population policies limiting the number of children allowed per couple, and national programs designed to increase facility-based deliveries.
“Seven studies addressed the effects of government policies and programs on a woman’s delivery location [21, 23, 31, 33, 34, 46, 48], including national health insurance schemes [23], social welfare programs [31, 33, 46, 48], population policies limiting the number of children allowed per couple [21], and national programs designed to increase facility-based deliveries [34].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Lack of access to transportation, good roads, adequate funds, and communication systems make organizing referrals for obstetric complications a time-consuming process.
“Lack of access to transportation, good roads, adequate funds, and communication systems also make organizing referrals for obstetric complications a time-consuming process [17, 29, 34, 45, 49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Direct costs associated with childbirth were prohibitively high for many women who viewed themselves as too poor to deliver in a facility.
“Direct costs associated with childbirth were prohibitively high for many women who viewed themselves as too poor to deliver in a facility [17, 20, 23, 24, 26, 28, 30, 32–37, 39, 41, 42, 46, 48, 49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Even in settings where direct delivery costs were subsidized, families were expected to pay for transportation to the facility and other costs related to treatment at the facility.
“Even in settings where direct delivery costs were subsidized, families were expected to pay for transportation to the facility, and other costs related to treatment at the facility [25, 30, 31, 34, 41, 43, 48, 49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women viewed costs outside of the direct cost for a delivery as "hidden" and said they were difficult to prepare for.
“Women viewed costs outside of the direct cost for a delivery as “hidden” and said they were difficult to prepare for [16, 19, 20, 24, 25, 30, 31, 34, 41, 43–45, 47–49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Low-resource households may have trouble acquiring funds to pay for facility-based care at the time-of-service, particularly those families who rely on seasonal labor.
“Low-resource households may have trouble acquiring funds to pay for facility-based care at the time-of-service, particularly those families who rely on seasonal labor [28, 32–34, 37, 41, 48, 49].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Observing traditional practices did not preclude women from utilizing modern medical care.
“Observing traditional practices did not preclude women from utilizing modern medical care [16–19, 22, 26, 32–34, 39, 44].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Women described providers as verbally and physically abusive, rude, bossy, disrespectful, insulting, easily angered, having poor attitudes, and lacking compassion.
“Women described providers as verbally and physically abusive, rude, bossy, disrespectful, insulting, easily angered, having poor attitudes, and lacking compassion [17–21, 24, 28, 34, 36, 37, 41, 42, 45–48].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Some women viewed facilities as the safest and most respectable location for a delivery, believing that facilities were able to ensure positive outcomes.
“Some women viewed facilities as the safest and most respectable location for a delivery, believing that facilities were able to ensure positive outcomes [16–19, 21, 24, 29, 30, 33–35, 39, 41, 45, 47].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Inadequate facility infrastructure and staffing contributed to an overall perception of low quality of care.
“Inadequate facility infrastructure and staffing contributed to an overall perception of low quality of care and many women complained of overcrowded wards without dedicated labor and delivery areas [17, 18, 24, 34, 35, 37, 39, 41, 45–47].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
Many women complained of overcrowded wards without dedicated labor and delivery areas.
“Inadequate facility infrastructure and staffing contributed to an overall perception of low quality of care and many women complained of overcrowded wards without dedicated labor and delivery areas [17, 18, 24, 34, 35, 37, 39, 41, 45–47].”
From Facilitators and barriers to facility-based delivery in low- and middle-income countries: a qualitative evidence synthesis (2014) · cites this paper as [34]
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Flagged first, then by citations
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- Authors
- Wild, K., Barclay, L., Kelly, P., & Martins, N.
- Affiliations
- Charles Darwin University (AU)
- The University of Sydney (AU)
- Australian National University (AU)
- Corresponding author
- Wild, Kayli
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2010-12
- Volume
- 71
- Issue
- 11
- Pages
- 2038-2045
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2021954224
- Semantic Scholar
- b5d7513422d7bdd685266cecd98bbceadf782ede
- Cited by
- 50
- References
- 39
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 3 · 2018: 5 · 2017: 5 · 2016: 4 · 2015: 7 · 2014: 6 · 2013: 1 · 2012: 5
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- maternal health service utilization, birth choice, institutional delivery, home birth, skilled birth attendants, midwives, maternal mortality, Timor-Leste, rural health, health care access, health policy, political instability
- MeSH terms
- Choice Behavior, Developing Countries, Female, Health Resources, Health Services Accessibility, Home Childbirth, Humans, Indonesia, Male, Maternal Health Services, Maternal Mortality, Pregnancy, Rural Health Services, Empirical Research, Delivery, Obstetric
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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