Analysis on the Reasons for Selecting Birth Attendants by Delivery Mothers at Semarang Regency

Abstract

AKI dan AKB di Kabupaten Semarang masih tinggi yaitu 146,24/100.000 KH dan 13,40/1000 KH pada tahun 2011. Pertolongan persalinan oleh tenaga kesehatan menurun dan masih terdapat 410 persalinan oleh dukun dengan 0,24 % kematian ibu pada tahun 2011. Hal ini terjadi meskipun sudah dilakukan kemitraan bidan dukun dan jampersal. Tujuan penelitian ini untuk menganalisis alasan pemilihan penolong persalinan oleh ibu di Kabupaten Semarang. Penelitian dilakukan dengan metode kualitatif. Pengumpulan data dengan wawancara mendalam dan observasi. Subyek penelitian terdiri dari informan utama sejumlah 8 ibu bersalin (4 ibu bersalin oleh dukun dan 4 ibu bersalin oleh bidan) dan 17 informan triangulasi (4 suami/keluarga dari ibu bersalin dengan dukun, 4 suami/keluarga dari ibu bersalin dengan bidan, 4 tokoh masyarakat/ tokoh agama, 4 bidan koordinator dan Kepala Seksi Kesehatan Keluarga Dinas Kesehatan. Metode analisis data dengan content analysis. Hasil penelitian menunjukkan tingkat pengetahuan ibu tentang persalinan sehat dan aman masih kurang. Ibu yang memilih dukun sebagai penolong persalinan bersikap negatif terhadap bidan karena bidan merobek jalan lahir. Ibu yang memilih bidan berpersepsi baik karena bidan ramah, trampil dan cekatan, ibu yang memilih dukun berpersepsi baik dalam hal perawatan post partum. Tidak ada
budaya khusus dalam pertolongan persalinan baik oleh bidan maupun dukun. Kemudahan akses pada saat melahirkan merupakan faktor penentu pada pemilihan penolong persalinan. Biaya persalinan dukun terjangkau karena bersifat suka rela dan dapat berbentuk barang. Dukungan suami dan keluarga cukup kuat dalam pemilihan penolong persalinan. Disimpulkan bahwa pemilihan dukun sebagai penolong persalinan berkaitan dengan pengetahuan, sikap, persepsi mutu pelayanan, biaya dan kemudahan akses bagi ibu bersalin.

AKI and AKB in Semarang district were still high, 146.24/100 000 live-birth and 13.40/ 1000 live-birth in 2011. Delivery assistance by health workers deceased, and 140 deliveries were assisted by dukun (traditional delivery assistance) with 0.24% maternal mortality in 2011. Although collaboration between dukun and jampersal (maternity insurance), yet this situation still happened. Objective of this study was to analyze reasons for selection of delivery assistance by maternities in Semarang district. Qualitative method was applied in this study. Data were collected through in-depth interview and observation. Study subjects were main informants and triangulation informants. The main informants were eight maternities (four maternities were assisted by dukun, and 4 maternities were assisted by midwives); 17 triangulation informants (four husbands/ family of maternity assisted by dukun, four husbands/ family of maternity assisted by midwives, four coordinator midwives, and a head of family health section of Semarang district health office. Content analysis was applied in the data analysis. Results of the study showed that knowledge level of mothers about healthy and safe labour was deficient. Mothers who chose dukun as their delivery assistance had negative attitude towards midwives because midwives torn the birth canal. Mothers who chose midwives had good perception towards midwives; they said that midwives were kind and skillful. Mothers who chose dukun had good perception on the post-partum management. No special culture in the delivery assistance by midwives or dukun. Accessibility to the delivery assistance when mothers were in labour was a determinant factor in the selection of the delivery assistance. Fee of delivery by dukun was reachable because it was voluntary and could be substituted by goods. Support from husband and family in the selection of delivery assistance was strong enough. In conclusion, selection of dukun as delivery assistance was related to knowledge, attitude, perception on the quality of service, fee, and accessibility for in labour mother.