What the study found
The study found that spiritual legitimacy functioned as a symbolic infrastructure in maternal referral pathways among the Akit Indigenous community in Riau, Indonesia. The authors describe five connected mechanisms: ritual kinship (anak inang), ritual cleansing and sealing/opening rites (bedekeh-libun), blessing mixtures and amulets, the bomoh as a collective decision-maker, and a hierarchy in which biomedical interventions usually required prior spiritual approval.
Why the authors say this matters
The authors conclude that maternal referral delays did not mainly reflect rejection of biomedical care. Instead, the findings indicate that referrals were shaped by culturally mediated efforts to secure spiritual safety and moral accountability, and the study suggests a need for culturally safe referral governance.
What the researchers tested
The researchers conducted an interpretivist ethnography between September 2024 and March 2025 in the Akit Indigenous community in Riau, Indonesia. They used in-depth interviews with 29 participants, participant observation, and reflexive fieldnotes, and analyzed the data with Reflexive Thematic Analysis (RTA). Participants included bomoh, pregnant and postpartum Akit women, traditional birth attendants, community health workers, biomedical providers, and customary leaders.
What worked and what didn't
The analysis identified five interlocking mechanisms that organized maternal decision-making around spiritual legitimacy. These mechanisms generated what the authors call moral time, meaning the timing of clinical escalation was socially legitimate only after spiritual approval had been secured.
What to keep in mind
The abstract does not describe limitations in detail. The study is specific to one Indigenous community in Indonesia and to the period and participants described, so the findings are presented within that context.
Key points
- Spiritual legitimacy was described as a symbolic infrastructure shaping maternal referral pathways.
- Five mechanisms were identified: anak inang, bedekeh-libun, selusuh and amulets, the bomoh, and a hierarchy requiring spiritual approval before biomedical care.
- Referral delays were described as negotiations for spiritual safety and moral accountability rather than simple refusal of biomedical treatment.
- The study used interpretivist ethnography, interviews, observation, and reflexive fieldnotes.
- Participants included spiritual authorities, women, birth attendants, health workers, biomedical providers, and customary leaders.
Disclosure
- Research title:
- Spiritual legitimacy shaped maternal referral decisions in the Akit community
- Authors:
- Hamidah Hamidah, Evi Martha, Indra Supradewi, Besral Besral
- Institutions:
- Politeknik Kesehatan Kemenkes Semarang, Royal College of Midwives, University of Indonesia
- Publication date:
- 2026-03-07
- OpenAlex record:
- View
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