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

Figures & data

Table 1. Weighted proportion of women’s sociodemographics characteristics.

Characteristics (weighted %, SD)	IDHS
	2002	2007	2012
Live born	15,834	18,437	15,222
(weighted live born)	14,778	16,358	15,203
Total number of women	13,128	15,249	13,215
Weighted number of women	12,580	13,975	13,484
Age (mean, SD)*	29.12 (6.32)	29.71 (6.25)	30.00 (6.52)
Parity (mean, SD) *	2.52 (1.74)	2.42 (1.55)	2.15 (1.38)
Live births last five years (mean, SD)*	1.18 (0.40)	1.17 (0.40)	1.13 (0.37)
Wealth (weighted %, SD)*
Richest	18.3 (0.5)	18.7 (0.5)	20.9 (0.5)
Richer	19.0 (0.6)	19.0 (0.5)	22.2 (0.5)
Middle	19.8 (0.6)	19.7 (0.5)	20.5 (0.5)
Poorer	19.3 (0.5)	19.6 (0.5)	19.3 (0.5)
Poorest	23.6 (0.5)	23.0 (0.4)	17.1 (0.4)
Have insurance (weighted %, SD)	n/a	n/a	37.6 (0.6)
Education (weighted %, SD)*
College and higher	6.2 (0.3)	8.0 (0.3)	13.7 (0.4)
Secondary school	40.9 (0.7)	47.8 (0.6)	55.9 (0.6)
Primary school or lower	52.9 (0.7)	44.3 (0.6)	30.4 (0.6)
Region (weighted %, SD)*
Java–Bali	56.7 0.6)	54.5 (0.5)	57.9 (0.5)
Other islands – more developed	30.6 (0.5)	30.5 (0.4)	28.1 (0.4)
Other islands – less developed	12.7 (0.3)	15.0 (0.3)	14.0 (0.3)
Area (weighted %, SD)*
Urban	46.7 (0.7)	41.6 (0.6)	53.3 (0.6)
Rural	53.3 (0.7)	58.4 (0.6)	46.7 (0.6)
Distance to healthcare*
Big problem	13.4 (0.4)	16.6 (0.4)	8.9 (0.3)
Not a big problem	86.6 (0.4)	83.4 (0.4)	91.1 (0.3)
Know danger in pregnancy (weighted %, SD)*	40.6 (0.7)	48.2 (0.6)	61.2 (0.6)

* p-value for differences between the three IDHS waves were significant at p < 0.05.

Table 2. Weighted proportions of self-reported morbidities among live births.

Period of morbidity (weighted %, SD)	IDHS
	2002	2007	2012
Live born	15,834	18,437	15,222
(weighted live born)	14,778	16,358	15,203
Crude estimates^a
Crude maternal morbidity^a	38.3 (0.6)	50.5 (0.6)	53.7 (0.6)
Crude pregnancy morbidity^a	7.2 (0.3)	10.8 (0.4)	13.2 (0.4)
Crude labor morbidity^a	35.4 (0.6)	46.7 (0.6)	49.4 (0.6)
Both pregnancy and labor morbidity^a	4.2 (0.3)	7.0 (0.3)	8.9 (0.3)
Estimates without PROM^b
Maternal morbidity^b	38.3 (0.6)	47.9 (0.6)	50.1 (0.6)
Labor morbidity^b	35.4 (0.6)	43.6 (0.6)	45.1 (0.6)
Both pregnancy and labor morbidity^b	4.2 (0.3)	6.5 (0.3)	8.2 (0.3)

All comparisons of weighted morbidity proportion between the three IDHS waves were significant at p < 0.05.

^a Crude labor morbidity from self-reported data of IDHS.

^b Maternal and labor morbidity with exclusion of PROM for 2007 and 2012 (PROM was recorded only in 2007 and 2012).

Table 3. Weighted proportion of non-utilization of maternal healthcare for women experiencing maternal morbidity during the last pregnancy.

Healthcare non-utilization (weighted %, SD)	IDHS
	2002	2007	2012
N	5089	7705	6762
Weighted n	4855	7070	7301
No WHO standard ANC^a	30.0 (1.1)	27.4 (0.8)	20.0 (0.7)
No SBA^b	27.6 (1.0)	19.5 (0.7)	7.1 (0.5)
Delivery outside of health facility^c	55.6 (1.1)	46.2 (0.9)	25.0 (0.7)
No SBA and delivered outside of health facility^d	27.6 (1.0)	19.3 (0.7)	6.9 (0.4)

All comparisons of healthcare non-utilization between the three IDHS waves were significant at p < 0.01.

^a Missing data on ANC (overall) = 1252(6.4%); missing data on ANC (by IDHS) = 395(7.8%) in 2002, 635(8.2%) in 2007, and 222(3.7%) in 2012.

^b Missing data on SBA (overall) = 67 (0.3%); %); missing data on SBA (by IDHS) = 10 (0.2%) in 2002, 44 (0.6%) in 2007, and 13(0.2%) in 2012.

^c Missing data on facility birth/FB (overall) = 10 (0.05%); missing data on FB (by IDHS) = 0 (0%) in 2002, 8 (0.04%) in 2007, and 2 (0.03%) in 2012.

^d Missing data on SBA and FB (overall) = 74 (0.4%); missing data on SBA and FB (by IDHS) = 10(0.2%) in 2002, 49 (0.6%) in 2007, and 15 (0.2%) in 2012.

Table 4. Weighted proportion and multilevel logistics regression of sociodemographic factors related with maternal healthcare non-utilization, IDHS 2012.

Sociodemographics Determinants	No WHO standard ANC			No SBA			No FB
	n	Weighted % (SD)	aOR (95%CI)	n	Weighted % (SD)	aOR (95%CI)	n	Weighted % (SD)	aOR (95%CI)
Total women	6762	20.0 (0.7)	–	6762	7.1 (0.5)	–	6762	25.0 (0.7)	–
Age (years)
< 20	214	34.2 (4.7)	2.5 (1.8–3.3)	223	12.4 (3.3)	1.5 (1.0–2.4)	223	31.7 (4.3)	1.2 (0.8–1.6)
20–35	4986	18.5 (0.8)	Ref	5133	6.8 (0.5)	Ref	5141	24.5 (0.8)	Ref
> 35	1340	21.2 (1.5)	0.9 (0.8–1.1)	1393	7.4 (1.0)	0.8 (0.6–1.1)	1396	25.8 (1.6)	0.8 (0.7–1.0)
Parity
1	2660	16.7 (1.0)	Ref	2726	5.4 (0.6)	Ref	2728	21.2 (1.0)	Ref
2	1927	17.7 (1.2)	1.2 (1.0–1.4)	1973	7.0 (0.8)	1.3 (1.0–1.6)	1977	22.6 (1.3)	1.1 (1.0–1.3)
>2	1953	26.4 (1.4)	1.7 (1.4–2.0)	2050	9.9 (0.9)	1.3 (1.0–1.8)	2055	33.9 (1.5)	1.5 (1.2–1.8)
Wealth
Richest	1166	11.5 (1.3)	Ref	1173	1.4 (0.5)	Ref	1176	8.5 (1.1)	Ref
Richer	1367	16.6 (1.4)	1.3 (1.0–1.6)	1388	3.9 (0.8)	1.1 (0.9–1.4)	1388	17.4 (1.4)	1.6 (1.3–2.0)
Middle	1335	19.5 (1.5)	1.5 (1.2–1.8)	1380	5.8 (1.0)	2.5 (1.5–4.1)	1381	25.9 (1.7)	2.1 (1.7–2.7)
Poorer	1345	21.3 (1.5)	1.5 (1.2–1.9)	1395	8.6 (1.1)	3.5 (2.1–5.9)	1397	29.3 (1.6)	2.1 (1.6–2.6)
Poorest	1327	33.9 (1.8)	2.5 (1.9–3.2)	1413	19.5 (1.5)	7.6 (4.6–12.8)	1418	52.5 (1.9)	3.8 (3.0–5.0)
Insurance
Yes	3891	16.5 (1.0)	Ref	4028	6.6 (0.7)	Ref	4033	23.2 (1.1)	Ref
No	2644	21.3 (0.9)	1.4 (1.2–1.6)	2716	7.4 (0.6)	1.1 (0.9–1.4)	2722	26.0 (0.9)	1.1 (0.9–1.2)
Education
College and higher	976	11.0 (1.3)	Ref	985	0.9 (0.4)	Ref	986	8.4 (1.0)	Ref
Secondary school	3836	18.2 (0.8)	1.3 (1.1–1.7)	3934	4.4 (0.5)	2.6 (1.3–5.2)	3939	21.2 (0.9)	2.0 (1.5–2.6)
Primary school or lower	1728	26.1 (1.4)	1.7 (1.3–2.2)	1830	15.2 (1.2)	5.7 (2.8–11.8)	1835	39.7 (1.6)	3.5 (2.6–4.7)
Region
Java–Bali	2162	15.8 (1.0)	Ref	2196	6.7 (0.7)	Ref	2199	18.1 (1.0)	Ref
Other more-developed	2511	23.9 (1.0)	1.5 (1.1–1.9)	2590	6.0 (0.5)	0.7 (0.4–1.2)	2596	34.4 (1.1)	2.1 (1.2–3.7)
Other less-developed	1867	30.1 (1.2)	2.1 (1.6–2.8)	1963	11.2 (0.8)	1.4 (0.8–2.4)	1965	40.6 (1.1)	3.4 (1.9–5.9)
Area
Urban	3532	17.2 (0.9)	Ref	3599	4.1 (0.5)	Ref	3604	15.0 (0.9)	Ref
Rural	3008	22.4 (1.0)	0.9 (0.7–1.2)	3150	10.7 (0.7)	1.9 (1.2–3.1)	3156	63.1 (1.2)	2.6 (1.6–4.1)
% poor women in community
< 20% *	2233	16.3 (0.9)	Ref	2284	2.5 (0.4)	Ref	2287	12.3 (0.8)	Ref
≥ 20% *	4307	20.2 (0.8)	1.2 (0.8–1.6)	4465	8.0 (0.5)	1.4 (0.8–2.7)	4473	27.5 (0.8)	1.4 (0.8–2.3)
Random effects
ICC unadjusted (%)			7.0			24.2			30.9
ICC adjusted (%)			2.1			9.7			13.8

All comparisons of the weighted proportion in Table 4 were significant at p < 0.05.

aOR = Adjusted Odds Ratio, CI = Confidence Interval.

ICC = Intra Class Coefficient

ICC adjusted = obtained from model with all covariates.

ICC unadjusted = obtained from unconditional model.

*Showing the frequency of women who lived in the community with the defined contextual characteristics, and their proportion of non-utilization.

Missing data on ANC = 222 (3.7%).

Missing data on SBA = 13 (0.2%).Missing data on facility birth = 2 (0.03%).