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

Figures & data

Table 1 Trends in sociodemographic characteristics in Indonesia (1986–2012)

Sociodemographic characteristics	1986–1989 (N=11,929)	1990–1993 (N=23,517)	1994–1997 (N=15,983)	1998–2001 (N=12,837)	2002–2005 (N=15,684)	2006–2009 (N=15,226)	2010–2012 (N=9,044)	P-value
Maternal education								<0.001
No education	15.3	11.8	8.9	4.9	4.0	2.3	2.2
Primary	63.7	60.7	57.6	48.6	43.2	35.5	30.5
Secondary	19.0	24.9	29.9	40.5	45.5	51.5	54.4
Higher	2.0	2.6	3.6	6.0	7.4	10.7	12.9
Paternal education								<0.001
No education	9.8	7.6	5.5	3.3	3.1	2.3	1.4
Primary	61.0	57.4	53.4	46.4	40.3	34.2	31.5
Secondary	25.4	30.4	35.8	42.7	47.7	52.9	55.1
Higher	3.9	4.7	5.3	7.6	8.9	10.7	12.0
Area of residence								<0.001
Java and Bali	56.1	56.5	57.1	56.4	54.9	54.5	55.1
Sumatera	24.4	23.3	22.8	23.8	22.2	22.9	22.7
Nusa Tenggara	4.8	5.3	5.3	4.8	5.2	5.3	4.8
Kalimantan	5.6	5.6	5.6	6.6	6.6	6.2	6.3
Sulawesi	6.6	7.2	6.9	8.5	9.0	7.9	7.8
Maluku and Papua	2.4	2.1	2.2	0.0	2.1	3.1	3.4
Place of residence								<0.001
Urban	29.1	26.9	28.0	46.2	42.6	47.1	48.8
Rural	70.9	73.1	72.1	53.8	57.4	53.0	51.2
Age group of the mother (years)								<0.001
10–19	2.3	4.2	6.4	2.8	2.8	2.8	5.2
20–29	53.1	52.8	53.5	50.8	48.2	47.0	51.7
30–39	37.3	36.0	34.3	38.3	40.8	41.4	37.3
40–49	7.4	6.9	5.8	8.1	8.2	8.9	5.8
Religion								<0.001
Islam	87.6	87.7	88.3	89.3	86.7	85.7	0.0
Others	12.4	12.3	11.7	10.7	13.3	14.3	0.0
Birth order								<0.001
1	15.8	22.5	28.2	27.7	27.4	30.8	37.6
2	25.8	25.0	26.3	30.0	30.6	32.5	32.3
3	18.6	18.0	17.1	19.2	19.6	18.0	16.2
4	14.0	11.7	10.5	9.0	9.6	9.0	6.8
5	9.6	8.0	6.5	5.3	5.5	4.5	3.4
≥6	16.2	14.8	11.4	8.7	7.3	5.2	3.7
Asset quintiles								<0.001
Poorest	21.46	16.06	13.71	15.85	16.1	15.45	15.05
Poor	21.79	21.96	19.77	19.85	20.3	18.6	19.04
Middle	19.58	20.07	21.33	21.42	20.53	22.77	24.7
Rich	22.4	22.98	26.11	23.97	22.52	20.98	19.31
Richest	14.77	18.92	19.07	18.92	20.56	22.19	21.9

Figure 1 Trend in the use of any ANC, ANC4+, institutional delivery, and c-section (1986–2012).

Abbreviation: ANC, antenatal care.

Table 2 Annual trends in any ANC, ANC4+, institutional birth, and cesarean birth in Indonesia (1986–2012) stratified by asset quintile, area of residence, and place of residence

Covariates	Annual trends
	Any ANC		ANC4+		Institutional birth		Cesarean birth
	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
	1.00 (0.99–1.00)	0.95 (0.95–0.96)	1.04 (1.03–1.04)	1.00 (0.99–1.00)	1.11 (1.10–1.11)	1.05 (1.04–1.06)	1.09 (1.09–1.10)	1.04 (1.03–1.05)
Asset quintiles
Poorest	1.02 (1.02–1.03)	1.00 (0.99–1.01)	1.05 (1.05–1.06)	1.04 (1.03–1.04)	1.14 (1.13–1.15)	1.09 (1.07–1.11)	1.07 (1.04–1.09)	1.03 (1.00–1.07)
Poor	1.01 (1.00–1.02)	0.97 (0.96–0.98)	1.04 (1.04–1.05)	1.02 (1.01–1.02)	1.16 (1.14–1.17)	1.11 (1.09–1.12)	1.11 (1.08–1.13)	1.04 (1.01–1.07)
Middle	1.01 (1.00–1.01)	0.95 (0.94–0.97)	1.05 (1.05–1.06)	1.01 (1.00–1.02)	1.14 (1.13–1.15)	1.08 (1.07–1.10)	1.09 (1.07–1.11)	1.03 (1.02–1.05)
Rich	0.97 (0.96–0.98)	0.90 (0.89–0.91)	1.03 (1.02–1.04)	0.98 (0.97–0.98)	1.12 (1.11–1.13)	1.06 (1.05–1.07)	1.11 (1.09–1.13)	1.06 (1.04–1.08)
Richest	0.93 (0.92–0.94)	0.86 (0.85–0.87)	0.99 (0.98–1.00)	0.93 (0.92–0.93)	1.09 (1.09–1.10)	1.04 (1.03–1.05)	1.08 (1.07–1.10)	1.05 (1.03–1.06)
Area of residence
Java and Bali	1.01 (1.00–1.02)	0.94 (0.94–0.95)	1.05 (1.05–1.06)	0.99 (0.98–1.00)	1.13 (1.12–1.14)	1.06 (1.06–1.08)	1.10 (1.08–1.11)	1.04 (1.03–1.05)
Sumatera	0.98 (0.97–0.99)	0.93 (0.93–0.94)	1.02 (1.02–1.03)	0.98 (0.98–0.99)	1.08 (1.07–1.09)	1.03 (1.02–1.04)	1.10 (1.09–1.11)	1.04 (1.03–1.05)
Nusa Tenggara	1.03 (1.02–1.05)	0.99 (0.98–1.00)	1.08 (1.07–1.09)	1.05 (1.04–1.06)	1.13 (1.11–1.15)	1.10 (1.07–1.12)	1.11 (1.08–1.14)	1.07 (1.04–1.10)
Kalimantan	1.02 (1.02–1.04)	0.98 (0.97–1.00)	1.05 (1.04–1.06)	1.02 (1.01–1.03)	1.07 (1.06–1.09)	1.03 (1.02–1.06)	1.08 (1.06–1.11)	1.03 (1.01–1.06)
Sulawesi	1.01 (0.99–1.02)	0.97 (0.96–0.98)	1.04 (1.03–1.04)	1.00 (0.99–1.01)	1.04 (1.03–1.06)	1.00 (0.99–1.01)	1.07 (1.05–1.09)	1.02 (0.99–1.03)
Maluku and Papua	0.98 (0.96–1.02)	0.94 (0.92–0.95)	0.99 (0.97–1.01)	0.96 (0.95–0.97)	1.02 (1.01–1.05)	0.99 (0.97–1.00)	1.04 (1.02–1.07)	1.02 (0.99–1.05)
Place of residence
Rural	1.01 (1.00–1.01)	0.97 (0.96–0.97)	1.04 (1.04–1.05)	1.01 (1.01–1.02)	1.12 (1.11–1.13)	1.07 (1.05–1.08)	1.08 (1.07–1.10)	1.03 (1.03–1.04)
Urban	0.96 (0.95–0.97)	0.89 (0.88–0.89)	1.00 (0.99–1.00)	0.94 (0.93–0.95)	1.08 (1.07–1.09)	1.03 (1.02–1.04)	1.08 (1.07–1.09)	1.04 (1.04–1.05)

Abbreviations: ANC, antenatal care; OR, odds ratio.

Figure 2 Trends in distribution of place of delivery.

Table 3 Determinants of any ANC, ANC4+, institutional birth, and cesarean birth in Indonesia (1986–2012)

	Any ANC			ANC4+			Institutional birth			Cesarean birth
	% use	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	% use	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	% use	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	% use	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
Survey year groups
1986–1989	79	Ref	Ref	56	Ref	Ref	20	Ref	Ref	1.3	Ref	Ref
1990–1993	86	1.53 (1.34–1.73)	1.35 (1.20–1.53)	63	1.34 (1.21–1.49)	1.19 (1.08–1.31)	18	0.88 (0.77–1.01)	0.69 (0.61–0.77)	2.4	1.89 (1.44–2.49)	1.71 (1.32–2.22)
1994–1997	92	2.85 (2.36–3.45)	2.34 (1.94–2.82)	70	1.83 (1.59–2.10)	1.45 (1.27–1.65)	21	1.04 (0.87–1.23)	0.73 (0.62–0.85)	4.4	3.56 (2.69–4.72)	2.96 (2.25–3.90)
1998–2001	77	0.86 (0.74–0.99)	0.47 (0.41–0.54)	67	1.58 (1.40–1.79)	0.94 (0.83–1.06)	39	2.48 (2.10–2.92)	1.53 (1.29–1.80)	3.7	2.96 (2.20–3.98)	1.87 (1.41–2.47)
2002–2005	79	0.93 (0.81–1.08)	0.52 (0.46–0.60)	68	1.65 (1.47–1.85)	0.95 (0.85–1.07)	44	3.10 (2.67–3.60)	2.01 (1.74–2.32)	5.9	4.84 (3.72–6.31)	3.00 (2.32–3.88)
2006–2009	82	1.17 (1.01–1.34)	0.84 (0.73–0.96)	74	2.17 (1.94–2.43)	1.36 (1.21–1.53)	55	4.86 (4.23–5.59)	2.16 (1.86–2.51)	10.3	8.91 (6.95–11.42)	4.04 (3.13–5.21)
2010–2012	93	3.38 (2.85–4.00)	3.04 (2.55–3.62)	85	4.34 (3.83–4.95)	3.24 (2.82–3.71)	68	8.16 (6.99–9.52)	3.27 (2.77–3.88)	13.2	11.75 (9.11–15.16)	4.82 (3.68–6.31)
Asset quintiles							0
Poorest	68	Ref	Ref	42	Ref	Ref	10	Ref	Ref	1.5	Ref	Ref
Poor	82	2.14 (1.96–2.34)	1.65 (1.20–1.53)	60	2.02 (1.87–2.19)	1.55 (1.43–1.67)	19	2.03 (1.81–2.28)	1.64 (1.46–1.85)	2.9	1.88 (1.49–2.36)	1.55 (1.23–1.95)
Middle	86	2.94 (2.67–3.23)	1.99 (1.77–2.23)	69	3.11 (2.87–3.36)	1.97 (1.81–2.14)	33	4.32 (3.85–4.84)	2.47 (2.20–2.76)	5.0	3.38 (2.73–4.19)	2.05 (1.64–2.57)
Rich	90	4.34 (3.91–4.82)	2.77 (2.45–3.13)	77	4.58 (4.19–4.99)	2.59 (2.35–2.85)	42	6.40 (5.66–7.24)	3.31 (2.91–3.76)	5.7	3.83 (3.10–4.74)	2.15 (1.70–2.71)
Richest	92	5.53 (4.92–6.21)	3.31 (2.88–3.80)	87	8.79 (7.94–9.73)	3.63 (3.22–4.08)	67	17.97 (15.82–20.42)	5.45 (4.75–6.25)	11.2	8.09 (6.57–9.97)	2.83 (2.23–3.60)
Maternal education							0
No education	63	Ref	Ref	36	Ref	Ref	7	Ref	Ref	1.1	Ref	Ref
Primary	83	2.90 (2.62–3.21)	1.94 (1.73–2.18)	62	2.87 (2.61–3.15)	1.78 (1.60–1.96)	19	3.00 (2.58–3.49)	1.45 (1.22–1.72)	2.6	2.42 (1.66–3.54)	1.54 (0.98–2.43)
Secondary	89	4.58 (4.09–5.14)	2.03 (1.78–2.30)	80	7.24 (6.54–8.02)	2.46 (2.19–2.76)	55	15.17 (13.01–17.68)	2.77 (2.31–3.33)	7.6	7.35 (5.09–10.62)	2.18 (1.36–3.49)
Higher	87	3.79 (3.27–4.38)	1.02 (0.85–1.23)	85	10.12 (8.83–11.61)	1.71 (1.43–2.03)	83	62.90 (52.10–75.95)	4.36 (3.46–5.50)	20.0	22.48 (15.33–32.96)	3.12 (1.89–5.15)
Paternal education							0
No education	64	Ref	Ref	37	Ref	Ref	8	Ref	Ref	1.5	Ref	Ref
Primary	82	2.61 (2.32–2.94)	1.58 (1.39–1.81)	60	2.55 (2.28–2.86)	1.46 (1.28–1.65)	19	2.74 (2.27–3.32)	1.18 (0.95–1.45)	2.6	1.74 (1.11–2.71)	0.93 (0.55–1.59)
Secondary	88	4.20 (3.69–4.77)	1.84 (1.59–2.11)	78	5.95 (5.27–6.71)	1.92 (1.68–2.18)	50	11.72 (9.65–14.22)	1.82 (1.47–2.26)	6.9	4.79 (3.03–7.56)	1.11 (0.64–1.92)
Higher	88	4.18 (3.56–4.91)	1.56 (1.28–1.90)	85	9.81 (8.43–11.41)	1.96 (1.63–2.35)	78	41.01 (33.13–50.77)	2.64 (2.07–3.37)	17.2	13.33 (8.38–21.20)	1.58 (0.91–2.76)
Age group of the mother (years)							0
10–19	86	Ref	Ref	61	Ref	Ref	23	Ref	Ref	2.6	Ref	Ref
20–29	85	0.94 (0.81–1.10)	2.51 (2.09–3.02)	70	1.47 (1.32–1.65)	2.47 (2.17–2.82)	34	1.72 (1.49–1.99)	1.44 (1.21–1.71)	4.4	1.75 (1.30–2.36)	1.60 (1.18–2.19)
30–39	83	0.80 (0.68–0.94)	4.80 (3.93–5.83)	68	1.38 (1.22–1.55)	4.55 (3.93–5.27)	38	2.09 (1.80–2.42)	2.20 (1.82–2.66)	6.7	2.70 (2.01–3.63)	3.04 (2.20–4.19)
40–49	78	0.59 (0.49–0.71)	6.32 (5.00–8.00)	59	0.93 (0.82–1.07)	5.85 (4.93–6.96)	31	1.47 (1.25–1.74)	2.75 (2.19–3.45)	6.6	2.68 (1.94–3.72)	5.12 (3.51–7.46)
Birth order							0			0.0
1	95	Ref	Ref	83	Ref	Ref	45	Ref	Ref	7.5	Ref	Ref
2	84	0.26 (0.24–0.27)	0.21 (0.19–0.22)	71	0.51 (0.49–0.54)	0.43 (0.41–0.45)	41	0.85 (0.80–0.90)	0.75 (0.70–0.82)	6.1	0.79 (0.71–0.89)	0.65 (0.57–0.74)
3	81	0.21 (0.19–0.22)	0.15 (0.13–0.17)	65	0.39 (0.38–0.41)	0.31 (0.29–0.33)	34	0.64 (0.60–0.69)	0.58 (0.53–0.64)	5.0	0.64 (0.56–0.73)	0.52 (0.44–0.61)
4	79	0.18 (0.17–0.20)	0.12 (0.11–0.14)	61	0.32 (0.30–0.34)	0.26 (0.24–0.28)	26	0.43 (0.39–0.47)	0.47 (0.42–0.53)	3.4	0.42 (0.35–0.51)	0.38 (0.31–0.48)
5	76	0.15 (0.14–0.17)	0.10 (0.09–0.11)	54	0.24 (0.23–0.26)	0.20 (0.18–0.21)	20	0.31 (0.28–0.35)	0.41 (0.36–0.48)	2.6	0.32 (0.25–0.41)	0.33 (0.25–0.43)
≥6	69	0.11 (0.10–0.12)	0.06 (0.05–0.07)	42	0.15 (0.14–0.16)	0.11 (0.11–0.12)	14	0.19 (0.17–0.21)	0.30 (0.25–0.36)	2.2	0.27 (0.21–0.36)	0.30 (0.21–0.43)
Religion	0						0
Islam	85	Ref	Ref	67	Ref	Ref	28	Ref	Ref	3.6	Ref	Ref
Others	81	0.75 (0.69–0.81)	0.57 (0.53–0.63)	70	1.15 (1.07–1.24)	0.72 (0.67–0.77)	53	2.94 (2.68–3.24)	1.91 (1.71–2.14)	9.9	2.91 (2.60–3.26)	1.38 (1.19–1.59)
Area of residence							0			0.0
Java and Bali	88	Ref	Ref	74	Ref	Ref	40	Ref	Ref	5.9	Ref	Ref
Sumatera	82	0.62 (0.56–0.68)	0.87 (0.79–0.97)	63	0.59 (0.54–0.64)	0.74 (0.68–0.80)	32	0.70 (0.63–0.77)	0.79 (0.71–0.89)	5.4	0.90 (0.80–1.02)	1.12 (0.99–1.26)
Nusa Tenggara	74	0.39 (0.34–0.44)	0.95 (0.82–1.10)	56	0.43 (0.38–0.48)	0.90 (0.80–1.02)	23	0.43 (0.37–0.51)	0.74 (0.63–0.87)	3.1	0.50 (0.40–0.62)	0.82 (0.66–1.01)
Kalimantan	80	0.53 (0.47–0.60)	0.88 (0.77–1.01)	63	0.57 (0.51–0.64)	0.85 (0.76–0.94)	24	0.47 (0.41–0.53)	0.51 (0.44–0.59)	4.3	0.71 (0.60–0.84)	0.97 (0.81–1.15)
Sulawesi	78	0.48 (0.43–0.54)	0.79 (0.70–0.89)	64	0.39 (0.35–0.43)	0.52 (0.47–0.58)	27	0.54 (0.47–0.62)	0.61 (0.52–0.71)	3.8	0.62 (0.53–0.73)	0.82 (0.70–0.97)
Maluku and Papua	61	0.21 (0.17–0.26)	0.45 (0.36–0.55)	47	0.30 (0.25–0.36)	0.52 (0.45–0.60)	21	0.39 (0.31–0.49)	0.42 (0.34–0.51)	3.4	0.56 (0.45–0.69)	0.76 (0.61–0.94)
Place of residence							0
Rural	81	Ref	Ref	61	Ref	Ref	20	Ref	Ref	3.1	Ref	Ref
Urban	89	1.80 (1.66–1.96)	1.11 (1.02–1.21)	81	2.67 (2.46–2.89)	1.31 (1.21–1.41)	61	6.52 (5.90–7.20)	3.00 (2.70–3.33)	9.1	3.10 (2.75–3.48)	1.45 (1.28–1.64)

Abbreviations: ANC, antenatal care; OR, odds ratio.

Figure 3 Trend in use inequity for any ANC.

Abbreviation: ANC, antenatal care.

Figure 4 Trend in use inequity for ANC4+.

Abbreviation: ANC, antenatal care.

Figure 5 Trend in use inequity for institutional birth.

Figure 6 Inequity in use of cesarean section over time.