Traditional practices influencing the use of maternal health care services in Indonesia

Abstract

Background Maternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia. Methods We used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates. Results Traditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services. Discussion Not all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

Factors associated with birth registrations in Indonesia

“…This finding corresponds with study in Uganda, which showed exposure with the healthcare provider were significantly associated with birth registration [32]. Childbirth at home (nonhealth facility) by skilled birth attendants is still common in Indonesia, particularly in rural areas [37,38].…”

A repeated cross-sectional study of the association of community health worker intervention with the maternal continuum of care in rural Liberian communities.

“…These results support previous literature indicating the baseline presence of disparities in continuum of care outcomes associated with differences in wealth and distance to health care facilities(7)(8)(9)(10)(11)(12)(13)17), while strengthening the evidence that community-based interventions are important strategies for achieving equity (36).The data from 2021 importantly demonstrated no decrease in reported maternal care during a time period that overlapped with the rst 19 months of the COVID-19 pandemic (surveys in October/November 2021 included births from fall of 2019 to fall of 2021). This is in contrast to a report that health care facilities in Liberia experienced a decline in ANC and FBD rates from March and April 2020 until December 2020(37), as well as a global review illustrating declines in antenatal care and mixed reports of postnatal care rates during the pandemic (38).…”

“…Based on previous literature, we included covariates that could impact the relationship between a CHA program and the maternal continuum of care (7)(8)(9)(10)(11)(13)(14)(15)(16)). Community-level characteristics included distance to a health facility (from county-level mapping data determining each community's distance from the nearest health facility, split into those greater than 5 but less than 10 kilometers from a facility, those at least 10 kilometers but less than 20 kilometers from a facility, and greater than 20 kilometers from a facility), accessibility by motorbike, (given the additional travel barriers faced when accessing health care facilities for communities only accessible by walking) and whether the community was a mining community (given the socioeconomic and geographic differences for these communities) (33).…”

“…Studies examining factors associated with rates of completion of the triad of the full maternal continuum of care in countries in Asia and Africa found that increased household wealth (7)(8)(9)(10)(11)(12)(13), maternal education (7-11, 14, 15), increased maternal age (7,10,14,16), birth order (7)(8)(9)(10)(11), mass media exposure (8-10), and living in urban areas (7,9,14) were associated with completion of the maternal continuum of care. In 2012, Kenny et al found that Liberians who lived farthest from health facilities had lower rates of antenatal care (ANC), facility-based delivery (FBD), and postnatal care (PNC) than those who lived closer to a facility (odds ratios for farthest quartile ranged from 0.04 to 0.44 compared to reference quartile of those closest to a facility) (17).…”

Optimal utilization of maternal health service in Indonesia: a cross-sectional study of Riskesdas 2018

“…Aside from the three delays due to the late decision to seek care, late reaching the healthcare facility, and late receiving qualified care at the facility,3 another probable factor that emerged in Indonesia was the access to traditional birth attendance (TBA), the dukun . Our last published article depicted that mothers who lived in a high population of TBA density significantly used the lower cascade of the use of Maternal Health Services density population, irrespective of the economic quintiles 4…”