BACKGROUND: The decreasing maternal mortality rate (MMR) is an important indicator in achieving health development. The Ministry of Health has mandated delivery assistance by competent health personnel to achieve the MMR targets set out in the UN sustainable development goals. AIM: This study aims to determine the relationship between maternal participation in household decision-making and the selection of birth attendant in Indonesia. METHODS: The study uses secondary data from the 2017 Indonesia demographic and health survey, as part of a cross-sectional and large-scale national survey. The study involved ever-married women of reproductive age (15–49 years) and had given birth in the last 5 years prior to the survey (n = 14,193). RESULTS: Of all birth attendants, 4,630 (32.6%) were non-health workers and 9,563 (67.4%) were health workers. Midwives account for the largest proportion of the health workers (61.8%). Decisions in healthcare, household expenses, visits to family/relatives’ decisions are significantly associated with birth attendant selection. However, husband’s income use decision had no significant relationship with birth attendant selection. The final multivariate model found that grand multipara mothers had a 1.9 times higher risk of choosing non-health birth attendants than primipara mothers (OR = 1.90, 95% CI = 1.60–2.25). CONCLUSION: Findings demonstrated the importance of improving health education for men and women as well as women’s decision-making autonomy. Health workers (especially midwives) should improve knowledge and communication between couples in choosing skilled birth attendants, especially for mothers with grand multiparity.

Maternal Mortality Rate (MMR) still a concern, especially in Indonesia. The decreasing of MMR is an important indicator in achieving health development in Indonesia. Delivery assistance by health personnel is important because health workers have the appropriate skills and tools to provide safe and clean assistance. The Ministry of Health has obliged delivery assistance assisted by competent health personnel to achieve the Sustainable Development Goals (SDGs) targets. However, study on women's participation in household decision-making to choose birth assistants is still lacking. This study aims to determine the relationship between participation in maternal health care decision-making and the selection of mothers' birth assistants in Indonesia. This study used secondary data from 2017 Indonesian Demographic and Health Survey (IDHS) using a cross-sectional research design. The sample of this research was mothers aged 15-49 years who had given birth in the last five years before the survey in 34 provinces in Indonesia, with a total of 3.042 respondents. The independent variable was participation in maternal healthcare decision-making, and the outcome variable was the selection of birth assistants. The potential covariates were mother's age, residence, living with a partner, number of children who are still alive, knowledge during pregnancy, women's education, women's occupation, husband's education, husband's occupation, and the socio-economic. This study was analyzed using multiple logistic regression. The proportion of skilled birth attendants was 88,6% and traditional birth assistants were 11,4%. The majority of husbands indicated that they made the healthcare decision (46,9%). Our study showed that mothers and other people was 1.5 times more likely to choose traditional birth assistants than the decision made by mothers (OR = 1.5; 95% CI = 1-2.1; p-value 0.044). Also, the participation in health care decision-making by partners was 1.4 times higher than participation by mothers (OR = 1.4; 95% CI = 1.1-1.7; p-value 0,009). However, in the final model of multivariate, participation maternal health care decision-making variable has a significant relationship with the birth assistants variable after controlling for the covariates (p-value > 0.05). Health workers need to improve health education during pregnancy and delivery, openly or even personally through classes for pregnant women and increase knowledge from families, especially husbands, in choosing birth assistants in professional birth assistants.