Invisible Families in Universal Health Coverage: Multilayered Exclusion of Underage Couples in Rural Bali, Indonesia

Authors

  • Desak Putu Yuli Kurniati Doctoral Study of Biomedical Sciences, Faculty of Medicine, Udayana University, Bali, Indonesia. Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Pande Putu Januraga Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Ni Made Swasti Wulanyani Department of Psychology, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Dyah Kanya Wati Department of Pediatrics, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Anak Agung Sagung Sawitri Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Ni Made Utami Dwipayanti Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Ni Wayan Tianing Department of Biochemistry, Faculty of Medicine, Udayana University, Bali, Indonesia
  • Ni Luh Putu Rita Primayuni School of Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia
  • I Made Ady Wirawan Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia

DOI:

https://doi.org/10.56338/jphp.v6i3.9765

Keywords:

Administrative Invisibility, Child Marriage, Conditional Humanitarian Enrollment, Universal Health Coverage, Indonesia

Abstract

Introduction: Despite Indonesia’s commitment to Universal Health Coverage (UHC), adolescents involved in customary marriages often remain beyond the reach of state protection. This study explores the "multilayered exclusion" experienced by these couples in accessing maternal health services in Munti Gunung, Bali.

Methods: This exploratory qualitative case study involved 16 purposively selected participants, including early-married adolescent mothers (n=5), family gatekeepers (husbands/in-laws, n=5), health workers (n=5), and a community leader (n=1). Data were collected through in-depth interviews and analyzed using thematic analysis to identify barriers across the socio-ecological spectrum.

Results: Inductively derived from localized empirical data, this study presents 'Administrative Invisibility' as an emergent conceptual construct describing how the lack of civil marriage certificates systematically excludes newborns from the National Health Insurance scheme. This qualitative exploration indicates that structural vulnerability is mediated by rigid household hierarchies and a mismatch in institutional capacity within resource-constrained primary care services. To secure immediate healthcare, families and local administrative actors navigate this socio-legal limbo by employing pragmatically effective yet legally high-risk informal workarounds.

Conclusion: Within this single-site qualitative scope, the intersection of customary child marriage and legal identity exclusion appears to form a compounded structural node within the multi-layered matrix of healthcare exclusion for newborns. Achieving health equity requires proactive, affirmative structural reforms, specifically, piloting a 'Conditional Humanitarian Enrolment' model powered by an API-driven digital bridging framework to formally decouple an infant’s constitutional right to healthcare from parental marital status, safely integrating immediate neonatal survival with long-term socio-legal safeguards.

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Published

2026-09-08

How to Cite

Kurniati, D. P. Y. ., Januraga, P. P. ., Wulanyani, N. M. S. ., Wati, D. K. ., Sawitri, A. A. S. ., Dwipayanti, N. M. U. ., … Wirawan, I. M. A. . (2026). Invisible Families in Universal Health Coverage: Multilayered Exclusion of Underage Couples in Rural Bali, Indonesia. Journal of Public Health and Pharmacy, 6(3), 439–450. https://doi.org/10.56338/jphp.v6i3.9765

Issue

Vol. 6 No. 3 (2026): In Progress

Section

Research Article

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