title: Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia.
abstract: The Three Delays Model has proven a useful framework for examining barriers to seeking obstetric care and preventing maternal and child mortality. This article demonstrates the applicability of the Three Delays Model to the case of civil registration in rural Indonesia and examines ways that efforts to strengthen civil registration services can draw on lessons from maternal and child health programming. Twenty focus group discussions were conducted using a participatory ranking exercise in four Indonesian districts. Focus groups were stratified into four groups: (1) government officials involved in civil registration, (2) civil society organization members that assist communities in civil registration, and (3) female and (4) male community members. Transcripts were analyzed using constant comparative method and thematic analysis, revealing barriers that communities commonly faced in accessing civil registration services. In examining the categories and themes related to these barriers, the research team found a significant overlap with the factors and phases of the Three Delays Model. Participants were delayed from seeking registration services by a range of sociocultural factors and by the perceived inaccessibility and poor quality of services. Once they decided to seek care, long distances to services and poor transportation options delayed their access to registration offices. Finally, a series of bottlenecks in service provision created extended delays once applicants reached registration offices. Ownership of civil registration documents in Indonesia remains exceptionally low, with just over half of children and youth possessing a birth certificate. To strengthen civil registration and health systems more generally, it is important to understand the factors that enable and constrain civil registration, how these factors relate to one another, and how they change over a child's life.
authors.affiliation: Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Depok, Indonesia.
authors.forename: Cyril
authors.initials: C
authors.lastname: Bennouna
authors.affiliation: Program on Forced Migration and Health (PFMH), Mailman School of Public Health, Columbia University, New York, NY, United States of America.
authors.forename: Brooke
authors.initials: B
authors.lastname: Feldman
authors.affiliation: Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Depok, Indonesia.
authors.forename: Rahmadi
authors.initials: R
authors.lastname: Usman
authors.affiliation: Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Depok, Indonesia.
authors.forename: Rama
authors.initials: R
authors.lastname: Adiputra
authors.affiliation: Center on Child Protection and Wellbeing, Universitas Indonesia (PUSKAPA), School of Social and Political Sciences, Depok, Indonesia.
authors.forename: Santi
authors.initials: S
authors.lastname: Kusumaningrum
authors.affiliation: Program on Forced Migration and Health (PFMH), Mailman School of Public Health, Columbia University, New York, NY, United States of America.
authors.forename: Lindsay
authors.identifier: http://orcid.org/0000-0003-2027-8862
authors.initials: L
authors.lastname: Stark
mesh_terms: D000328:Adult; D001294:Attitude to Health; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D007214:Indonesia; D008297:Male; D000068101:Maternal-Child Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011787:Quality of Health Care; D011996:Records / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012424:Rural Population