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Abstract
Background. Maternal-perinatal mortality in decentralized Indonesia is shaped not only by obstetric complications but also by breakdowns in emergency informed consent, defensive medicine, fear of criminalization, and fragmented death audits, which remain underexamined.
Objective. To examine the clinical bioethics dilemmas, medicolegal impediments, and statutory implementation gaps governing maternal-perinatal death surveillance in Indonesia.
Methods. In this qualitative descriptive-analytical and medicolegal study, semi-structured interviews were conducted with 15 purposively sampled stakeholders in South Sulawesi: consultant obstetricians (n = 4), midwives (n = 4), health regulatory officials (n = 2), civil society advocates (n = 3), and health policy researchers (n = 2). Interview data were triangulated with a documentary analysis of six national legal and policy instruments, including Law No. 17 of 2023 and the national death surveillance and response (AMP-SR) guidelines, using reflexive thematic analysis.
Results. Informants described emergency consent reduced to coercive administrative compliance under spousal veto during acute hemorrhage and eclampsia; confidentiality protections colliding with death-reporting mandates, encouraging concealment; an absence of perinatal palliative care after intrauterine fetal death; and AMP-SR audits constrained by blame culture and fear of prosecution under the Indonesian Penal Code, prompting defensive referral refusal. Of all deaths, 72.4% were officially notified, 38.6% reached inter-agency AMP-SR audit, 16.1% yielded executed systemic responses, and 9.3% escalated into adversarial grievances.
Conclusion. Reducing preventable maternal mortality in Indonesia requires a shift from punitive litigation to restorative clinical governance through statutory emergency consent waivers, evidentiary safe-harbor protection for AMP-SR proceedings, and dedicated archipelagic emergency referral corridors.
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