Immunisation for children in Indonesia: it is the father's decision

Abstract

Background: In Indonesia, free of charge basic immunisation programmes can be accessed through various health facilities, including community-based integrated child and maternal care post (Posyandu), village maternity clinics (Polindes), primary health centres (Puskesmas), and government hospitals. However, in 2012, only about 37% of children aged 12-34 months completed basic immunisation, and 8% did not received any immunisation at all. We examine mothers’ perception and experiences in immunising their children. Methods: Exploratory qualitative study with six focus group discussions involving 51 mothers with child(ren) under 5 years old in East Nusa Tenggara and West Sumatera Provinces. Focus groups were conducted in Bahasa Indonesia, or a combination of Bahasa Indonesia and local language. They were recorded, then transcribed in the original language, translated into English, and thematically analysed. Findings: The success of the immunisation programme depended on community-based health post cadres or village midwives to personally approach mothers and their family. Three main problems related to unwillingness to immunise the children were: lack of understanding about immunisation and disease prevention, religious belief, and unsupportive fathers. Within a family, the decision whether or not to immunise lay mostly with the fathers. Discussion: Interventions to increase immunisation coverage in Indonesia should target fathers, not just mothers. Further, structural changes were identified, including government policy to fully support and empower community-based integrated child and maternal care post (Posyandu).