Praktik obstetri tradisional dan keterlambatan rujukan pada suku Akit, Riau
Keywords:
dukun bayi, komunitas adat, kesehatan maternal, rujukan obstetri, three delaysAbstract
Abstrak
Kematian maternal dan neonatal masih menjadi tantangan kesehatan masyarakat di komunitas adat, meskipun cakupan persalinan di fasilitas kesehatan terus meningkat. Tujuan: Penelitian ini bertujuan menganalisis bagaimana praktik obstetri tradisional dan pengambilan keputusan rujukan beroperasi sebagai mekanisme sosial yang meningkatkan risiko maternal dan neonatal pada masyarakat adat Suku Akit di Riau. Metode: Penelitian menggunakan pendekatan kualitatif dengan desain etnografi. Data dikumpulkan melalui wawancara mendalam semi-terstruktur, observasi etnografis terbatas, serta telaah dokumen terhadap 29 informan (ibu, dukun bayi, bomoh, tenaga kesehatan, kader, dan tokoh adat). Analisis dilakukan menggunakan reflexive thematic analysis dan diinterpretasikan melalui kerangka Three Delays. Hasil: Hasil menunjukkan dua mekanisme utama pembentukan risiko. Pertama, praktik antenatal tradisional seperti urut diposisikan sebagai jalur perawatan utama, termasuk pada kondisi berisiko (misalnya posisi janin tidak normal), sehingga menunda pemantauan klinis dan rujukan dini. Kedua, respons non medis pada fase intrapartum hingga neonatal awal seperti tindakan manipulasi abdomen/tolak, penafsiran ketuban pecah dini sebagai normal, perawatan bayi tradisional, serta penundaan rujukan menjadikan rujukan sebagai pilihan terakhir. Kesimpulan: Temuan ini menegaskan bahwa keterlambatan rujukan dipengaruhi legitimasi praktik komunitas, keputusan kolektif keluarga, pengalaman layanan, dan kelemahan sistem rujukan.
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