Respectful maternal and newborn care for Indonesian adolescents: A qualitative study.

BACKGROUND: Globally, adolescents experience higher rates of mistreatment than adult women when accessing maternal and newborn care. Indonesia has one of the highest adolescent pregnancy rates in Southeast Asia, but no research has explored respectful care in Indonesian adolescents. OBJECTIVE: To explore Indonesian adolescents' and health workers' perceptions and experiences of respectful maternal and newborn care, and factors affecting its provision. METHODS: A qualitative study was conducted in two regions of Indonesia: Yogyakarta (Bantul) and West Nusa Tenggara (Mataram). Participatory photo-elicitation workshops and in-depth interviews were undertaken with a purposive sample of 21 pregnant and postpartum adolescents. In-depth interviews were conducted with a purposive sample of 26 health workers. Data were analysed thematically and triangulated across workshops, interviews, and photo captions. FINDINGS: We developed two overarching themes: 1) perceptions of respectful care and care experiences, and 2) factors contributing to mistreatment. Adolescents and health workers held different views on respectful care, suggesting a limited shared understanding. All adolescents reported experiencing at least one form of mistreatment, and health workers confirmed that mistreatment occurred. Contributing factors to mistreatment included an overcrowded health system, inadequate health infrastructure, stressful working conditions, limited training and education, stereotypes and stigma, the acceptability of mistreatment, and imbalanced power dynamics. CONCLUSIONS: Indonesian adolescents experienced mistreatment during maternal and newborn care. Addressing the factors contributing to this mistreatment requires implementing and adapting WHO interventions in Indonesia to eliminate mistreatment, achieve respectful care, and improve maternal health outcomes.