Village Midwives’ Experiences with Maternal Emergency Management and Digital Health Systems: A Phenomenological Study in Rural Indonesia
DOI:
https://doi.org/10.55018/janh.v8i1.471Keywords:
Maternal Health Science, Midwives, Emergency Medical Services, Digital Health, Qualitative ResearchAbstract
Background: Maternal and neonatal mortality remain significant challenges in low- and middle-income countries, particularly in rural Indonesia, where village midwives serve as the first responders to obstetric emergencies. Despite numerous digital health initiatives, fragmented systems and poor usability often hinder timely emergency management. This study aimed to explore the lived experiences, challenges, and expectations of community midwives in designing an effective maternal–neonatal emergency digital application in Tanah Laut District, South Kalimantan, Indonesia.
Methods: This qualitative study employed a Husserlian descriptive phenomenological approach. Ten active village midwives were recruited through purposive sampling; inclusion required at least one year of experience, while those unable to attend or refusing participation were excluded. Data were collected in August 2024 through a focus group discussion (FGD) lasting 120 minutes. Data were analyzed using Colai
zzi’s phenomenological analysis method, and reporting followed the COREQ guideline.
Results: Five interrelated themes emerged: (1) Maternal emergencies as multidimensional crises, (2) Informal communication as the real emergency network, (3) Fragmented and burdensome reporting systems, (4) Digital and infrastructural barriers in rural practice, and (5) Expectations for an integrated, user-friendly digital solution. These themes progress conceptually from the initial crisis experience, through the mobilization of informal networks due to systemic barriers, culminating in user-driven expectations for digital design.
Conclusion: The study highlights midwives’ resilience amid digital fragmentation. Policymakers and developers should adopt participatory co-design approaches involving midwives to ensure the usability and sustainability of maternal emergency digital systems
Downloads
References
Adidharma, A. F., Shelim, N., Anqita, S. T., & Handayani, P. W. (2024). Designing Indonesian Maternal and Child Health Mobile Applications using User-Centered Design. Jurnal Sistem Informasi, 20(1). https://doi.org/10.21609/JSI.V20I1.1386
Alonge, O., Rodriguez, D. C., Brandes, N., Geng, E., Reveiz, L., & Peters, D. H. (2019). How is implementation research applied to advance health in low-income and middle-income countries. BMJ Global Health, 4(2). https://doi.org/10.1136/BMJGH-2018-001257
Ameyaw, E. K., Amoah, P. A., Asiama, A. A., & Agbadi, P. (2025). m-Health knowledge and usage in maternal healthcare delivery: Perspectives and experiences of healthcare practitioners in Ghana. BMJ Open, 15(1). https://doi.org/10.1136/BMJOPEN-2024-092746
Black, C. J., Berent, J. M., Joshi, U., Khan, A., Chamlagai, L., Shrivastava, R., Gautam, B., Negeye, A., Iftin, A. N., Ali, H., Desrosiers, A., Bhan, A., Bhattacharya, S., Naslund, J. A., & Betancourt, T. S. (2023). Applying Human-Centered Design in Global Mental Health to Improve Reach Among Underserved Populations in the United States and India. Global Health Science and Practice, 11(1). https://doi.org/10.9745/GHSP-D-22-00312
Burka, D., Gupta, R., Moran, A. E., Cohn, J., Choudhury, S. R., Cheadle, T., Mullick, R., & Frieden, T. R. (2023). Keep it simple: designing a user-centred digital information system to support chronic disease management in low/ middle-income countries. BMJ Health and Care Informatics, 30(1). https://doi.org/10.1136/BMJHCI-2022-100641
Chamberlain, S., Dutt, P., Mitra, R., Godfrey, A., Lefevre, A. E., Scott, K., Katiyar, S., Mendiratta, J., & Chaturvedi, S. (2022). Lessons learnt from applying a human-centred design process to develop one of the largest mobile health communication programmes in the world. BMJ Innovations, 8(3), 240–246. https://doi.org/10.1136/BMJINNOV-2021-000841
Coleman, T., Till, S., Farao, J., Shandu, L., Khuzwayo, N., Muthelo, L., Mbombi, M., Bopape, M., van Heerden, A., Mothiba, T., Norris, S., Verdezoto, N., & Densmore, M. (2023). Reconsidering Priorities for Digital Maternal and Child Health: Community-centered Perspectives from South Africa. Proceedings of the ACM on Human-Computer Interaction, 7(CSCW2), 1–31. https://doi.org/10.1145/3610081
Dada, S., De Brún, A., Chelwa, N., Okpara, N., Zulu, M., Vwalika, B., & Gilmore, B. (2025). We move together: a realist evaluation of the Safe Motherhood Action Groups in Eastern Province, Zambia. BMJ Global Health, 10(4). https://doi.org/10.1136/BMJGH-2024-015961
Danquah, E., & Morgan, A. K. (2025). Midwives’ experiences with implementation of active management of third stage of labor in Sub-Saharan Africa: a systematic review. BMC Pregnancy and Childbirth, 25(1). https://doi.org/10.1186/S12884-025-07331-7
Erjino, D. S., Mekiso, A. B., Woiloro, L. A., Arficho, T. T., Watumo, A. M., Katiso, N. A., & Ermolo, T. L. (2022). Maternal delays and unfavourable newborn outcomes among skilled deliveries in public hospitals of Hadiya Zone, Southern Ethiopia: A case-control study. BMJ Open, 12(5). https://doi.org/10.1136/BMJOPEN-2021-055569
Göttgens, I., & Oertelt-Prigione, S. (2021). The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices. JMIR MHealth and UHealth, 9(12). https://doi.org/10.2196/28102
Hazfiarini, A., Akter, S., Homer, C. S. E., Zahroh, R. I., & Bohren, M. A. (2022). ‘We are going into battle without appropriate armour’: A qualitative study of Indonesian midwives’ experiences in providing maternity care during the COVID-19 pandemic. Women and Birth, 35(5), 466–474. https://doi.org/10.1016/J.WOMBI.2021.10.003
Herwansyah, H., Czabanowska, K., Schröder-Bäck, P., & Kalaitzi, S. (2023). Barriers and facilitators to the provision of maternal health services at community health centers during the COVID-19 pandemic: Experiences of midwives in Indonesia. Midwifery, 123. https://doi.org/10.1016/J.MIDW.2023.103713
Kementerian Kesehatan Republik Indonesia. (2022). PROFIL KESEHATAN INDONESIA 2022.
Khan, B. A. A., Mahmood, H., Ahmed, J. M., Anwar, B., Muhammad, A., & Jabeen, R. (2025). Exploring challenges in accessing primary healthcare for pregnant women in Pakistan: a qualitative descriptive study. BMC Health Services Research, 25(1). https://doi.org/10.1186/S12913-024-11637-1
Labrique, A. B., Wadhwani, C., Williams, K. A., Lamptey, P., Hesp, C., Luk, R., & Aerts, A. (2018). Best practices in scaling digital health in low and middle income countries. Globalization and Health, 14(1). https://doi.org/10.1186/S12992-018-0424-Z
Landeiro, F., Silva, M., Moura, C. V. e., Martins, C., Miller, P., Ferraz, S., de Azevedo, A. P., Gancho, S., Rocha, L., Patrício, R., & Nunes, I. (2025). Human-centered design and maternity care: is this a possible interplay?—a systematic review. BMC Pregnancy and Childbirth, 25(1). https://doi.org/10.1186/S12884-024-07119-1
Mohammed, M. M., El Gelany, S., Eladwy, A. R., Ali, E. I., Gadelrab, M. T., Ibrahim, E. M., Khalifa, E. M., Abdelhakium, A. K., Fares, H., Yousef, A. M., Hassan, H., Goma, K., Ibrahim, M. H., Gamal, A., Khairy, M., Shaban, A., Amer, S., Abdelraheim, A. R., & Abdallah, A. A. (2020). A ten year analysis of maternal deaths in a tertiary hospital using the three delays model. BMC Pregnancy and Childbirth, 20(1). https://doi.org/10.1186/S12884-020-03262-7
Moise, I. K., Ivanova, N., Wilson, C., Wilson, S., Halwindi, H., & Spika, V. M. (2023). Lessons from digital technology-enabled health interventions implemented during the coronavirus pandemic to improve maternal and birth outcomes: a global scoping review. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/S12884-023-05454-3
Owoyemi, A., Osuchukwu, J. I., Azubuike, C., Ikpe, R. K., Nwachukwu, B. C., Akinde, C. B., Biokoro, G. W., Ajose, A. B., Nwokoma, E. I., Mfon, N. E., Benson, T. O., Ehimare, A., Irowa-Omoregie, D., & Olaniran, S. (2022). Digital Solutions for Community and Primary Health Workers: Lessons From Implementations in Africa. Frontiers in Digital Health, 4. https://doi.org/10.3389/FDGTH.2022.876957
Puspitasari, I. W., Rinawan, F. R., Purnama, W. G., Susiarno, H., & Susanti, A. I. (2022). Development of a Chatbot for Pregnant Women on a Posyandu Application in Indonesia: From Qualitative Approach to Decision Tree Method. Informatics, 9(4). https://doi.org/10.3390/INFORMATICS9040088
Reynolds, C. W., Lee, H., Sieka, J., Perosky, J., & Lori, J. R. (n.d.). Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia. https://doi.org/10.2196/58624
Rudiyanti, N., & Utomo, B. (2024). Challenges of health workers in primary health facilities in implementing obstetric emergency referrals to save women from death in Indonesia: A qualitative study. Belitung Nursing Journal, 10(6), 644–653. https://doi.org/10.33546/BNJ.3525
Susanti, A. I., Ali, M., Hernawan, A. H., Rinawan, F. R., Purnama, W. G., Puspitasari, I. W., & Stellata, A. G. (2022). Midwifery Continuity of Care in Indonesia: Initiation of Mobile Health Development Integrating Midwives’ Competency and Service Needs. International Journal of Environmental Research and Public Health, 19(21). https://doi.org/10.3390/IJERPH192113893
Tamrat, T., Chandir, S., Alland, K., Pedrana, A., Shah, M. T., Footitt, C., Snyder, J., Ratanaprayul, N., Siddiqi, D. A., Nazneen, N., Syah, I. F., Wong, R., Lubell-Doughtie, P., Utami, A. D., Anwar, K., Ali, H., Labrique, A. B., Say, L., Shankar, A. H., & Mehl, G. L. (2022). Digitalization of routine health information systems: Bangladesh, Indonesia, Pakistan. Bulletin of the World Health Organization, 100(10), 590–600. https://doi.org/10.2471/BLT.22.287816
Till, S., Mkhize, M., Farao, J., Deborah Shandu, L., Muthelo, L., Lauren Coleman, T., Mbombi, M., Bopape, M., Klingberg, S., van Heerden, A., Mothiba, T., Densmore, M., Xavier Verdezoto Dias, N., & Network, C. (2023). Digital Health Technologies for Maternal and Child Health in Africa and Other Low-and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation. Journal of Medical Internet Research, 25. https://doi.org/10.2196/42161
Vidler, M., Kinshella, M. L. W., Sevene, E., Lewis, G., von Dadelszen, P., Bhutta, Z., Sevene, E., Macete, E., Munguambe, K., Sacoor, C., Vala, A., Boene, H., Amose, F., Pires, R., Nhamirre, Z., Macamo, M., Chiaú, R., Matavele, A., Vilanculo, F., … Sotunsa, J. O. (2023). Transitioning from the “Three Delays” to a focus on continuity of care: a qualitative analysis of maternal deaths in rural Pakistan and Mozambique. BMC Pregnancy and Childbirth, 23(1). https://doi.org/10.1186/S12884-023-06055-W
Waddell, A., Seguin, J. P., Wu, L., Stragalinos, P., Wherton, J., Watterson, J. L., Prawira, C. O., Olivier, P., Manning, V., Lubman, D., & Grigg, J. (2024). Leveraging Implementation Science in Human-Centred Design for Digital Health. Conference on Human Factors in Computing Systems - Proceedings. https://doi.org/10.1145/3613904.3642161
Xiong, S., Lu, H., Peoples, N., Duman, E. K., Najarro, A., Ni, Z., Gong, E., Yin, R., Ostbye, T., Palileo-Villanueva, L. M., Doma, R., Kafle, S., Tian, M., & Yan, L. L. (2023). Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries. Npj Digital Medicine, 6(1). https://doi.org/10.1038/S41746-023-00764-4
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sumarti Endah Purnamaningsih Maria Margaretha, Dhiya Urrahman, Chrisnawati, Y. Yohakim Marwanta, Fahmi Baiquni
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
