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    Trends and inequities in use of maternal health care services in Indonesia, 1986-2012

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    Author
    Nababan, HY; Hasan, M; Marthias, T; Dhital, R; Rahman, A; Anwar, I
    Date
    2018-01-01
    Source Title
    International Journal of Women's Health
    Publisher
    DOVE MEDICAL PRESS LTD
    University of Melbourne Author/s
    Marthias, Tiara; Nababan, Herfina
    Affiliation
    Melbourne School of Population and Global Health
    Metadata
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    Document Type
    Journal Article
    Citations
    Nababan, H. Y., Hasan, M., Marthias, T., Dhital, R., Rahman, A. & Anwar, I. (2018). Trends and inequities in use of maternal health care services in Indonesia, 1986-2012. INTERNATIONAL JOURNAL OF WOMENS HEALTH, 10, pp.11-24. https://doi.org/10.2147/IJWH.S144828.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/255946
    DOI
    10.2147/IJWH.S144828
    Abstract
    Purpose: Overall health status indicators have improved significantly over the past three decades in Indonesia. However, the country's maternal mortality ratio remains high with a stark inequality by region. Fewer studies have explored access inequity in maternal health care service over time using multiple inequality markers. In this study, we analyzed Indonesian Demographic and Health Survey (DHS) data to explore trends and inequities in use of any antenatal care (ANC), four or more ANC (ANC4+), institutional birth, and cesarean section (c-section) birth in Indonesia during 1986-2012 to inform policy for future strategies ending preventable maternal deaths. Methods: Indonesian DHS data from 1991, 1994, 1997, 2002/3, 2007, and 2012 surveys were downloaded, merged, and analyzed. Inequity was measured in terms of variation in use by asset quintile, parental education, urban-rural location, religion, and region. Trends in use inequities were assessed plotting changes in rich:poor ratio, rich:poor difference, and concentration indices over period based on asset quintiles. Sociodemographic determinants for service use were explored using multivariable logistic regression analysis. Findings: Between 1986 and 2012, institutional birth rate increased from 22% to 73% and c-section rate from 2% to 16%. Private sector was increasingly contributing in maternal health. There were significant access inequities by asset quintile, parental education, area of residence, and geographical region. The richest women were 5.45 times (95% CI: 4.75-6.25) more likely to give birth in a health facility and 2.83 times (95% CI: 2.23-3.60) more likely to give birth by c-section than their poorest counterparts. Urban women were 3 times more likely to use institutional birth and 1.45 times more likely to give birth by c-section than rural women. Use of all services was higher in Java and Bali than in other regions. Access inequity was narrowing over time for use of ANC and institutional birth but not for c-section birth. Conclusion: Ongoing pro-poor health-financing strategies should be strengthened with introduction of innovative ways to monitor access, equity, and quality of care in maternal health.

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