Better Preparedness for Better Responses: Integrating Maternal and Reproductive Health into Disaster Risk Management: A Qualitative Case Study from Indonesia

This thesis explores the process of integrating maternal and reproductive health (MRH) into disaster risk management (DRM) in Indonesia. This thesis contributes to Indonesia achieving the Sustainable Development Goals, including ensuring universal access to sexual and reproductive healthcare services and the integration of reproductive health into national strategies and programmes. This single case study of one site in Indonesia provides an understanding of the current integration of MRH into DRM from the perspectives of those affected by and involved in a disaster event. The 2013 eruption of Mount Sinabung in North Sumatera province was selected as the case for this study, as it represented a frequent type of disaster in Indonesia. This case study is underpinned by a diagnostic event approach that examined tensions and dynamic relationships between the past, present and future, and explained the relationships between events, times and processes of integrating MRH into DRM. The objectives of the case study were to: 1) analyse experiences of accessing and providing MRH services during the 2013 eruption, 2) examine perspectives of current DRM practice and 3) explore views for a future DRM model. Participants were women who were pregnant during the 2013 eruption, community leaders, health personnel in the relocation site of Siosar and policymakers working at district, provincial and central levels. Data were obtained from focus groups and individual interviews, and analysed using thematic analysis. Data were triangulated and the results presented using a socio-ecological approach. This allowed understanding of participants’ experiences and perceptions at the micro-level, the provision of MRH services at the meso-level, the environments surrounding temporary shelters and relocation site at the exo-level, and finally overall DRM policies and systems at the macro-level. The findings showed that during the 2013 eruption response, efforts were made to provide MRH services through establishing health teams and clinics in designated temporary shelters. Unfortunately, these temporary shelters were perceived as lacking standards as there were privacy, security, hygiene and sanitation issues that affected the MRH needs of pregnant women and other affected population groups. Furthermore, the relocation changed lifestyles, traditions and the way people earned their livelihood. Pregnant women and other affected people face ongoing challenges, including access to MRH services. Overall, this study highlights the ongoing efforts to integrate MRH services into DRM in Indonesia, and reveals some room for improvement. A significant contribution of this study is the implications of the findings for transforming approaches to the integration of MRH into DRM in Indonesia. These findings include policy and programme recommendations pertaining to the need for community education on disasters, improvement of health sector readiness and strengthening of collaboration across sectors. This study demonstrates the importance of using a case study as a methodology and a diagnostic event as an approach to explain relationships between events, times and processes in integrating MRH into DRM