title: Indonesian infertility patients' health seeking behaviour and patterns of access to biomedical infertility care: an interviewer administered survey conducted in three clinics.
abstract: BACKGROUND
  Indonesia has high levels of biological need for infertility treatment, great sociological and psychological demand for children, and yet existing infertility services are underutilized. Access to adequate comprehensive reproductive health services, including infertility care, is a basic reproductive right regardless of the economic circumstances in which individuals are born into. Thus, identifying and implementing strategies to improve access to assisted reproductive technology (ART) in Indonesia is imperative. The principle objectives of this article are to improve our understanding of infertility patients' patterns of health seeking behaviour and their patterns of access to infertility treatment in Indonesia, in order to highlight the possibilities for improving access.
  
  
  METHODS
  An interviewer-administered survey was conducted with 212 female infertility patients recruited through three Indonesian infertility clinics between July and September 2011. Participants were self-selected and data was subject to descriptive statistical analysis.
  
  
  RESULTS
  Patients identified a number of barriers to access, including: low confidence in infertility treatment and high rates of switching between providers due to perceived treatment failure; the number and location of clinics; the lack of a well established referral system; the cost of treatment; and patients also experienced fear of receiving a diagnosis of sterility, of vaginal examinations and of embarrassment. Women's age of marriage and the timing of their initial presentation to gynaecologists were not found to be barriers to timely access to infertility care.
  
  
  CONCLUSIONS
  The findings based on the responses of 212 female infertility patients indicated four key areas of opportunity for improving access to infertility care. Firstly, greater patient education about the nature and progression of infertility care was required among this group of women. Secondly, increased resources in terms of the number and distribution of infertility clinics would reduce the substantial travel required to access infertility care. Thirdly, improvements in the financial accessibility of infertility care would have promoted ease of access to care in this sample. Finally, the expansion of poorly developed referral systems would also have enhanced the efficiency with which this group of patients were able to access appropriate care.
authors.affiliation: Nossal Institute for Global Health, The University of Melbourne, Parkville 3010, Australia. lbennett@unimelb.edu.au
authors.forename: Linda Rae
authors.initials: LR
authors.lastname: Bennett
authors.forename: Budi
authors.initials: B
authors.lastname: Wiweko
authors.forename: Aucky
authors.initials: A
authors.lastname: Hinting
authors.forename: I B Putra
authors.initials: IB
authors.lastname: Adnyana
authors.forename: Mulyoto
authors.initials: M
authors.lastname: Pangestu
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods; D006801:Humans; D007214:Indonesia; D007246:Infertility / Q000191:economics / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000592:standards; D012017:Referral and Consultation / Q000706:statistics & numerical data; D034121:Reproductive Health Services / Q000191:economics / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000191:economics / Q000706:statistics & numerical data*; D012737:Sex Factors; D013997:Time Factors; D014195:Travel; D055815:Young Adult