Expanding the scope beyond mortality: burden and missed opportunities in maternal morbidity in Indonesia

ABSTRACT

Background: Indonesia still faces challenges in maternal health. Specifically, the lack of information on community-level maternal morbidity. The relatively high maternal healthcare non-utilization in Indonesia intensifies this problem.

Objective: To describe the burden of community-level maternal morbidity in Indonesia. Additionally, to evaluate the extent and determinants of missed opportunities in women with maternal morbidity.

Methods: We used three cross-sectional surveys (Indonesian Demographic and Health Survey, IDHS 2002, 2007 and 2012). Crude and adjusted proportions of maternal morbidity burden were estimated from 43,782 women. We analyzed missed opportunities in women who experienced maternal morbidity during their last birth (n = 19,556). Multilevel mixed-effects logistic regressions were used to evaluate the determinants of non-utilization in IDHS 2012 (n = 6762).

Results: There were significant increases in the crude and adjusted proportion of maternal morbidity from IDHS 2002 to IDHS 2012 (p < 0.05). In 2012, the crude proportion of maternal morbidity was 53.7%, with adjusted predicted probability of 51.4%. More than 90% of these morbidities happened during labor. There were significant decreases in non-utilization of maternal healthcare among women with morbidity. In 2012, 20.0% of these women did not receive World Health Organization (WHO) standard antenatal care. In addition, 7.1% did not have a skilled provider at birth, and 25.0% delivered outside of health facilities. Higher proportions of non-utilization happened in women who were younger, multiparous, of low socioeconomic status (SES), and living in less-developed areas. In multilevel analyses, missed opportunities in healthcare utilization were strongly related to low SES and low-resource areas in Indonesia.

Conclusion: The prevalence of maternal morbidity in Indonesia is relatively high, especially during labor. This condition is amplified by the concerning missed opportunities in maternal healthcare. Efforts are needed to identify risk factors for maternal morbidity, as well as increasing healthcare coverage for the vulnerable population.

KEYWORDS:

• Maternal morbidity
• missed opportunity
• maternal health
• determinants
• sociodemographic

Responsible Editor Nawi Ng, Umeå University, Sweden

Responsible Editor Nawi Ng, Umeå University, Sweden

Acknowledgments

This paper was written as part of the Maternal Morbidity Study project funded by Universitas Sebelas Maret, Surakarta. We thank the Demographic and Health Survey (DHS) program that has provided access to the data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consents

This study was approved by Ethics Committee in Faculty of Medicine, Universitas Sebelas Maret. Data was obtained from Indonesian Demographic and Health Survey.

Paper context

In developing countries, maternal health interventions have been more focused on mortality, with limited data on maternal morbidity. We addressed the information gap in Indonesia by showing the high prevalence of community-level maternal morbidity, specifically during labor. Additionally, we demonstrated the presence of socioeconomic and geographic disparities in maternal healthcare utilization among women with maternal morbidity. Further efforts should focus on identifying risk factors for maternal morbidity and improving healthcare utilization for vulnerable population.

Additional information

Funding

This study was funded by Universitas Sebelas Maret research funding.

Notes on contributors

Vitri Widyaningsih

VW conducted the data analysis and interpretation, K and B provided assistance with the analysis and interpretation. VW drafted the manuscript with K and B providing critical revision. All authors read and approved the final manuscript.

Khotijah

VW conducted the data analysis and interpretation, K and B provided assistance with the analysis and interpretation. VW drafted the manuscript with K and B providing critical revision. All authors read and approved the final manuscript.

Balgis

VW conducted the data analysis and interpretation, K and B provided assistance with the analysis and interpretation. VW drafted the manuscript with K and B providing critical revision. All authors read and approved the final manuscript.