Is Labor Improvement Strategy at Health Facility Needed?

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Illustration by Republika
Illustration by Republika

Until now, the Maternal and Infant Mortality Rate is still a major health problem in the world. In Southeast Asia alone, according to the World Health Organization (WHO), in 2015, there were 164 deaths per 100,000 live births. Although there has been a decline, Maternal Mortality Rate in Indonesia is still in the range of 305 per 100,000, still very far from the target of Sustainable Development Goals (SDGs) to reach under 70 deaths per 100,000 live births by 2030. Tragically, there are still many deliveries conducted outside health facilities. So the question is, what are the factors associated with increasing delivery performed in a health facility?

Indonesia has made good progress in the field of health services for mothers which is indicated by the increase in the percentage of deliveries performed in health facilities year by year. The latest data from the Ministry of Health also shows that 86% of mothers give birth at health facilities in 2018. However, this condition still leaves questions, specifically what affects the pregnant women determines to perform delivery in health facilities.

The high mortality rate in Indonesia has been in the spotlight of world health experts. However, not much literature contains research that examines the factors affecting women in using health facilities for delivery, especially in Indonesia. We see that the utilization of health facilities for safe delivery has not been maximized. WHO reports that the use of good health facilities can significantly reduce the mortality rate. Data in 2012 showed that only 55.2% of mothers in Indonesia chose to deliver their babies in health facilities provided by the government and the private sector.

Although the government has tried to increase the reach of health facilities to rural and remote areas, the effort is not accompanied by a shift in the choice of mothers to give birth in the facilities. There are still many mothers who choose to give birth at home. Several previous studies stated that this was related to the influence of the closest family role, midwife, maternal social and demographic factors, and family accessibility to health facilities. Therefore, we conducted research on related factors in selected health facilities for maternity to represent conditions in Indonesia. We evaluate the determinants on how mothers decide to deliver at health facilities in Indonesian territory.

This study used data from the Indonesian Health Demographic Survey (IDHS) in 2012. During the exploration of data, the 2012 IDHS was chosen because the 2017 IDHS data has not been officially released. It is done by considering the validity of the data to be used. IDHS data is part of the International Demographic Health Survey (IDHS) organized by the Inner City Fund, whose data collection is carried out by the Indonesian Central Bureau of Statistics (BPS) in collaboration with the National Population and Family Planning Board and the Ministry of Health of the Republic of Indonesia.

Our exploration classifies urban and rural areas in each province. We limit the sample involved in the analysis process to married women and the age range of 15 to 49 years. We carried out univariate, bivariate, and logistic regression analysisOur univariate analysis was conducted to find the descriptive data of women as samples. Our bivariate analysis was done using a chi-square test to test the correlation of independent and dependent variables, and we conducted logistic regression analysis to see a significant factor in the decision of mothers to choose their delivery services.

Mother’s age, education, place of residence, mother’s involvement in decision making in the household, occupation, economic status and number of visits to health facilities were positioned as predictors and then analyzed concerning the decision of mothers to choose health services for childbirth. The results of our analysis show that age, education, place of residence, economic status, number of visits to antenatal care, employment status, and the involvement of mothers in decision making in the household are the determinants of where the mother will give birth. The better predictor conditions will determine the mother to use health facilities as an option for safe delivery.

The implications of findings in our study emphasize that maternal health care programs should be expanded and promoted to reach groups of poor women who live in rural areas and campaign for safe labor that is sensitive to local wisdom. Strategies that focus on improving the quality of pregnancy visits are highly recommended as it also determines the mother to choose health facilities as the main service in assisting safe delivery. We recognize that efforts to improve the welfare of mothers and children in labor are also influenced by availability, utilization, and quality of access. Therefore, cross-sectoral coordination to improve predictors in this study is the main strategy to reduce the Maternal and Infant Mortality Rate,

Author: Ferry Efendi RN, M.Sc, Ph.D

Details of this research can be viewed here:

Ferry Efendi, Ani Rihlatun Ni’mah, Setho Hadisuyatmana, Heri Kuswanto, Linlin Lindayani, and Sarni Maniar Berliana, “Determinants of Facility-Based Childbirth in Indonesia,” The Scientific World Journal, vol. 2019, Article ID 9694602, 7 pages, 2019.

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Media komunikasi dan informasi seputar kampus Universitas Airlangga (Unair).

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