Determinants of Facility-Based Childbirth in Indonesia.

Ferry Efendi,Linlin Lindayani,Sarni Maniar Berliana,Heri Kuswanto,Setho Hadisuyatmana,Ani Rihlatun Ni’Mah

doi:10.1155/2019/9694602

Abstract

Background Reducing maternal mortality remains a significant challenge in Indonesia, especially for achieving the country's Sustainable Development Goals (SDGs) by 2030. One of the challenges is increasing delivery at healthcare facilities to ensure safe and healthy births. In Indonesia, research on factors affecting women's use of facility-based childbirth services is scarce. Objective This study was conducted to identify the determinants of facility-based deliveries in Indonesia. Methods This study used data from the Indonesia Demographic and Health Survey of 2012, with a cross-sectional design. An odds ratio with 95% confidence intervals (CI) was employed to outline the independent variables for the determinants, including maternal age and education, place of residence, involvement in decision-making, employment status, economic status, and number of antenatal care visits. The dependent variable in this study was the place of delivery: whether it took place in healthcare or nonhealthcare facilities. The statistical significance was set at p<0.05 using bivariate analysis and binary logistic regression. Results This study showed that a high level of education (OR: 3.035, 95% CI: 2.310–3.987), high economic status (OR: 6.691, 95% CI: 5.768–7.761), urban residence (OR: 2.947, 95% CI: 2.730–3.181), working status (OR: 0.853, 95% CI: 0.793–0.918), involvement in decision-making (OR: 0.887, 95% CI: 0.804–0.910), and having more than four visits to antenatal care centers (OR: 1.917, 95% CI: 1.783–2.061) were significant determinants of delivery at healthcare facilities. Conclusion Efforts to improve facility-based childbirth in Indonesia must strengthen initiatives that promote women's education, women's autonomy, opportunities for wealth creation, and increased uptake of antenatal care, among others. Any barriers related to maternal healthcare services and cultural factors on the use of health facilities for childbirth in Indonesia require further monitoring and evaluation.

Highlights

Maternal and infant mortality remains a significant global health concern
More than half of the births were by women who were aged 25–34 years (53%), had secondary education (52.8%), were living in rural areas (54.7%), were not working for a week before enumeration (51.7%), were involved in decisionmaking (84.6%), were from middle to lower economic groups (68%), and had more than four ANC visits during pregnancy (57.6%)
The percentage of births in health facilities is greater for women who live in urban areas, do not work, are involved in decision-making, and carry out pregnancy checks at least four times during pregnancy

Summary

Introduction

Maternal and infant mortality remains a significant global health concern. From 1990 to 2015, the global maternal mortality ratio (MMR) decreased by about 44%, from an estimated 385 to 216 deaths per 100,000 live births. Indonesia has made good progress in the area of maternal healthcare services by the increased percentage of deliveries at health facilities from 20.9% in 1991 to 46.6% in 2007 [4, 5]. This study showed that a high level of education (OR: 3.035, 95% CI: 2.310–3.987), high economic status (OR: 6.691, 95% CI: 5.768–7.761), urban residence (OR: 2.947, 95% CI: 2.730–3.181), working status (OR: 0.853, 95% CI: 0.793–0.918), involvement in decision-making (OR: 0.887, 95% CI: 0.804–0.910), and having more than four visits to antenatal care centers (OR: 1.917, 95% CI: 1.783–2.061) were significant determinants of delivery at healthcare facilities. Any barriers related to maternal healthcare services and cultural factors on the use of health facilities for childbirth in Indonesia require further monitoring and evaluation

Methods

Results

Discussion

Conclusion