Abstract

Background: In Indonesia, maternal mortality remains high, significantly 61.59% occur in the postnatal period. Postnatal care (PNC) provision is a critical intervention between six hours and 42 days after childbirth and is the primary strategy to reduce maternal mortality rates. However, underutilization of PNC in Indonesia still remains high, and limited studies have shown the regional disparities of PNC in Indonesia. Method s: This study aims to explore the gaps between regions in PNC service for mothers who have had live births during the last five years in Indonesia. This study was a secondary data analysis study using the Indonesian Demographic and Health Survey (IDHS) in 2017. A total of 13,901 mothers aged 15-49 years having had live births within five years were included. Chi-squared test and binary logistic regression were performed to determine regional disparities in PNC. Results : Results indicated that the prevalence of PNC service utilization among mothers aged 15-49 years was 70.94%. However, regional gaps in the utilization of PNC service were indicated. Mothers in the Middle of Indonesia have used PNC services 2.54 times compared to mothers in the East of Indonesia (OR = 2.54; 95% CI = 1.77-3.65, p<0.001). Apart from the region, other variables have a positive relationship with PNC service, including wealth quintile, accessibility health facilities, age of children, childbirth order, mother's education, maternal occupation, husband's age, and husband's education. Conclusion: Structured policies are needed to reduce gaps in areas with low service utilization. Developing innovative strategies to address PNC inequality in maternal services to improve maternal health is expected.

Highlights

  • Maternal morbidity and mortality are a serious global health challenge

  • Half of participants who live in the East of Indonesia did not use the Postnatal care (PNC) services

  • Most participants who live in the East of Indonesia stated that there was no problem with access to the health facility

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Summary

Introduction

Maternal morbidity and mortality are a serious global health challenge. In 2019, the World Health Organization (WHO) revealed that 94% of maternal mortality occurred in low and middle-income countries, of which Indonesia is one (World Health Organization, 2019; World Health Organization et al, 2015). In the Indonesia context, the government determined a target to reach an important goal of reducing maternal mortality rate to 102 per 100,000 live births in 2015 (Bappenas, 2015; Ministry of Health Republic of Indonesia, 2018). In 2015, maternal mortality deaths in Indonesia were three times higher than the MDGs target (Ministry of Health Republic of Indonesia, 2018; UNICEF & World Health Organization, 2015; World Health Organization et al, 2015). Reducing maternal mortality ratio to less than 70 per 100,000 by 2030 as one of the Sustainable Development Goals (SDGs) target could be a critical challenge for Indonesia (UNICEF & World Health Organization, 2015; United Nations, 2017; World Health Organization, 2012). Methods: This study aims to explore the gaps between regions in PNC service for mothers who have had live births during the last five years in Indonesia.

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