Community perceptions of pregnancy-related illnesses and the integration of biomedical and indigenous care in Kei Besar Island, Maluku, Indonesia

Rural areas of Indonesia continue to experience persistent maternal health disparities, yet little is known about how pregnancy-related illnesses are understood and managed in remote settings such as Kei Besar Island in Maluku Province. Indigenous healing practices remain widely used alongside biomedical treatments, but the ways in which communities classify illnesses and decide between treatment options have not been well documented. We conducted a qualitative study in Kei Besar in January 2023, including in-depth interviews and cognitive interview methods with 12 pregnant women, and interviews with five local practitioners (traditional healers and community health volunteers). Data were thematically analyzed and used to construct ethnomedical models. Women identified 10 pregnancy-related illnesses, of which high blood pressure, diabetes, and two cultural illnesses ( darah putih and sawang ) were perceived as most severe. These were organized into two community-defined categories: binakit malhen (“common illnesses”), managed through hybrid use of biomedical medicines and herbal remedies, and binakit rudan (“illnesses caused by curses”), treated exclusively through ritual and indigenous practices. Ethnomedical models showed that illnesses were conceptualized as interconnected systems linking causes, prevention, manifestations, and treatment. Maternal care in Kei Besar unfolds within a plural therapeutic landscape shaped by both biomedical authority and indigenous understandings of illness causation. Recognizing these locally meaningful categories and existing patterns of hybrid care can inform culturally legitimate maternal health programs. Engaging community members, families, and traditional healers may further support service uptake and strengthen maternal health strategies in remote settings.