<![CDATA[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.]]>
