Abstract
BackgroundAlthough efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal.MethodsThe study takes advantage of data from long series of population censuses and large-scale surveys that are available in few other low- and middle-income countries. We use the decomposition method suggested by (Matern Child Health J, 16:456–463, 2012) and regression-based policy simulations to estimate the number of maternal deaths averted during 1970–2017 due to contraceptive use and project potential future contributions to the year 2030.ResultsIt is estimated that between 523,885 and 663,146 maternal deaths were averted from 1970 to 2017 due to contraceptive use, a 37.5–43.1% reduction. If the contraceptive prevalence rate (CPR) were to rise from 63% in 2017 to 70% in 2030 and unmet need for family planning were to fall to from 10 to 7%, an additional 34,621–37,186 maternal deaths would be averted, an 18.9–20.0% reduction. A 2030 CPR of 75% and unmet need for family planning of 5% would result in 51,971–54,536 maternal deaths being averted, a 28.4–29.4% reduction. However, the CPR growth rate would have to nearly double the 2000–2017 rate to reach 70% CPR by 2030 and more than triple to reach 75%. Achieving the most ambitious target would still leave the maternal mortality ratio at 125 in 2030 without corresponding improvements in maternal health services.ConclusionsAlthough substantial reductions in maternal mortality between 1970 and 2017 can be attributed to contraceptive use and further contributions to the year 2030 are probable, smaller contributions are likely due to the already relatively high CPR and the challenges that must be overcome to move the CPR significantly higher. The ability of Indonesia to reach the 2030 SDG maternal mortality target of 70 maternal deaths per 100,000 live births will depend primarily upon health system effectiveness in addressing health risks to women once they are pregnant.
Highlights
Both the number of maternal deaths and the rate at which maternal deaths occur have declined dramatically since 1990 [3, 29]
Ross and Blanc show that the number of maternal deaths in any given year can be decomposed into three statistical components: the number of women of reproductive age (WRA), the general fertility rate (GFR), and the maternal mortality ratio (MMR)
Where: Maternal deaths (MD) = number of maternal deaths during a specified year WRA = number of women at reproductive age at midpoint of a specified year GFR = general fertility rate, defined as number of births during a specified year divided by number of WRA at the mid-point of a specified year maternal mortality ratios (MMR) = maternal mortality ratio in the specified year, defined as number of maternal deaths divided by number of live births during the same year Data on WRA, GFR, and MMR for the years 1970 to 2017 needed for the maternal death decomposition analysis were gathered from multiple data sources
Summary
Both the number of maternal deaths and the rate at which maternal deaths occur have declined dramatically since 1990 [3, 29]. Various methods of estimating maternal mortality in Indonesia during the past decade have consistently produced maternal mortality ratios (MMR) between 200 and 350 maternal deaths per 100,000 live births [10, 17]. The current official Government of Indonesia estimate of the maternal mortality ratio based on the 2015 InterCensal Population Survey (SUPAS) is 305 maternal deaths per 100,000 live births [19]. The global Maternal Mortality Estimation Inter-Agency Group, using a different methodology than the Government of Indonesia, put the MMR at 126 per 100,000 live births in 2015 [29]. Efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal
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