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Antenatal Visit Coverage (K1, K4, K6) and Its Association with Maternal Mortality Rates Across Provinces in Indonesia Yuliwati Yuliwati; Ayu Endang Purwati
International Research of Multidisciplinary Analysis Vol. 3 No. 10 (2025): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v3i10.92

Background. Indonesia’s Maternal Mortality Rate (MMR), based on the 2020 Long Form Population Census, is 189 per 100,000 live births, with a range across provinces from 48 (DKI Jakarta) to 565 (Papua). Antenatal visits (K1, K4, and, since 2021, K6) are the primary midwifery services for early detection of pregnancy risks. Objective. To analyze the relationship between K1 and K4 coverage and MMR across provinces in Indonesia, and to contextualize the K6 standard within this framework. Methods. A cross-sectional ecological study using downloadable secondary data: the 2020 Indonesia Health Profile (K1 and K4 coverage, number of maternal deaths, and live births in 34 provinces) and MMR data from the Long Form of the 2020 Population Census (SP2020) by the Central Statistics Agency (BPS). Relationships were tested using Spearman’s correlation. Results. National coverage rates were 93.3% for K1 and 84.6% for K4. K4 coverage was negatively correlated with the MMR from the Long Form 2020 Population Census (rho = −0.57; p = 0.007; n = 21 provinces) and with facility-reported maternal mortality (rho = −0.41; p = 0.017; n = 34). Papua (K4 27.5%; MMR 565) and West Papua (K4 34.5%; MMR 343) ranked second-worst on both measures. Conclusion. Provinces with lower antenatal care coverage tend to have higher MMRs. Strengthening the role of midwives to ensure pregnant women continue to attend visits from K1 through K4/K6, particularly in eastern Indonesia, should be a priority.

The Role of Midwives in Childbirth at Health Facilities: An Analysis of Trends in Childbirth Attendants in Indonesia, 2017–2023 Yuliwati Yuliwati; Bela Novita Amaris Susanto
International Research of Multidisciplinary Analysis Vol. 3 No. 11 (2025): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v3i11.93

Background. Childbirth attended by health care providers at health care facilities is a key strategy for reducing maternal mortality. Midwives are the most common birth attendants in Indonesia, but current policies emphasize that all births should take place at health care facilities. Objectives. To describe trends in birth attendants and delivery settings in Indonesia from 2013 to 2023, the proportion of midwives as birth attendants, and interprovincial disparities between births attended by health workers and births occurring at health care facilities. Methods. A descriptive-analytical study using trend analysis and Spearman’s correlation on downloadable secondary data: Riskesdas 2013 and 2018, SDKI 2017, the 2023 Indonesian Health Survey (SKI), and the 2020 Indonesian Health Profile for data from 33 provinces, as well as the 2020 Population Census (SP2020) Long Form on maternal mortality. Results. Deliveries at health facilities increased from 66.7% (2013) to 79.3% (2018) and 90% (2023), while deliveries attended by health personnel reached 96.1% in 2023. Midwives assisted in about six out of ten births (61% in the 2017 SDKI; 62.7% in the 2018 Riskesdas), while obstetricians accounted for about 29%. According to routine data from 2020, the coverage of deliveries at health facilities ranged from 31.4% in Maluku to 99.6% in DKI Jakarta, and 12 out of 33 provinces remained below 80%. The rate of deliveries at health facilities showed a strong negative correlation with the Long Form SP2020 maternal mortality rate (rho = −0.69; p < 0.001; n = 20). Conclusion. Midwives remain the backbone of childbirth care, and their role has shifted from providing care at home to providing care at health facilities and serving as referral liaisons. Provinces in eastern Indonesia require support to ensure that midwife-assisted deliveries can take place at health facilities.

Availability of Midwives per Capita and Maternal Health Service Coverage in Each Province in Indonesia Yuliwati Yuliwati; Rizki Hallifah Ashri
International Research of Multidisciplinary Analysis Vol. 3 No. 12 (2025): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v3i12.94

Background. Midwives are the primary providers of maternal health care in Indonesia, and the ratio of midwives to population is often used as a measure of workforce adequacy. However, the relationship between this ratio and maternal and child health (MCH) service outcomes at the provincial level has not been extensively studied using the latest publicly available data. Objective. To calculate the ratio of registered midwives per capita and per live birth in each province and to analyze its relationship with maternal health service outcomes. Methods. A cross-sectional ecological study across 34 provinces using data on the number of registered midwives (STR) and population from the 2026 Ministry of Health Directorate General of Health Workforce dashboard, K1 and K4 coverage, deliveries attended by health workers, deliveries at health facilities, and complete postpartum visits (KF lengkap) from the 2020 Indonesia Health Profile, as well as the Long Form Maternal Mortality Rate (AKI) from the 2020 Population Census (SP2020). Analyses employed the Mann–Whitney U test and Spearman’s correlation with a 95% confidence interval, accompanied by sensitivity analyses. Results. The national ratio was 199.0 midwives per 100,000 population, with an interprovincial median of 265.9 (IQR 194.3–315.1), ranging from 119.1 in West Java to 541.9 in Aceh. The ratio in Java–Bali was lower than in other provinces (median 135.3 vs. 286.8; p < 0.001), but its MCH indicators were higher. The midwife-to-population ratio was negatively correlated with K4 (rho = −0.52; p = 0.002) and complete KF (rho = −0.59; p < 0.001), and positively correlated with AKI (rho = 0.61; p = 0.006). Conclusion. The number of registered midwives per capita is not the primary determinant of MCH outcomes at the provincial level. Midwifery workforce planning needs to consider active midwives, competencies, the number of births, geographic accessibility, and the strength of the referral system.

A Comprehensive Overview of Postpartum Visits and Postpartum Complications Among Mothers in Indonesia Yuliwati Yuliwati; Lina Marliana
International Research of Multidisciplinary Analysis Vol. 4 No. 1 (2026): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v4i1.95

Background. Most maternal deaths occur during the postpartum period, making postpartum visits (PPV) a critical opportunity to detect complications. However, PPV coverage in Indonesia varies depending on the data source and region. Objectives. To describe the coverage of the first postpartum visit (KF1) and complete postpartum visits by province; to analyze their association with antenatal care, delivery services, and the maternal mortality rate (MMR); and to compare routine reporting data with survey data. Methods. A cross-sectional ecological study across 33 provinces using data from the 2020 Indonesia Health Profile, the 2020 Population Census (SP2020) Long Form on MMR, and national figures from the 2023 Indonesia Health Survey (SKI). Analyses employed the Mann–Whitney test and Spearman’s correlation with a 95% confidence interval, accompanied by sensitivity analyses. Results. National coverage of complete antenatal care (ANC) in the 2020 routine reports was 88.3%, with an interprovincial median of 83.3% (IQR 77.5–91.1); 12 provinces were below 80%, with the lowest rate in West Papua (30.7%). Complete postpartum care was strongly correlated with K4 (rho = 0.89) and delivery at a health facility (rho = 0.94), and was negatively correlated with maternal mortality (rho = −0.76; p < 0.001; n = 20). The 2023 SKI reported a complete postpartum care rate of only 26.8%, postpartum complications at 9.1%, and knowledge of postpartum danger signs at 47.8%. Hemorrhage (28.6%) and hypertension during pregnancy (23.9%) were the leading causes of maternal mortality in 2020. Conclusion. Postpartum care is the weakest link in the maternal health care continuum, particularly in eastern Indonesia. Strengthening postpartum visits by midwives, counseling on danger signs, and routine data validation are necessary to reduce maternal mortality.

Essential Neonatal Examinations and Early Breastfeeding Initiation as Indicators of the Quality of Midwifery Care in Indonesia Yuliwati Yuliwati; Siti Nurbaiti
International Research of Multidisciplinary Analysis Vol. 4 No. 2 (2026): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v4i2.96

Background. Most neonatal deaths occur during the first week of life and can be prevented through essential newborn care, early initiation of breastfeeding (EIB), and comprehensive neonatal visits (NV). These indicators reflect the quality of midwifery care, as midwives assist in the majority of deliveries in Indonesia. Objectives. To describe the neonatal care cascade, the extent of care discontinuation, and trends in early breastfeeding initiation (EBI), low birth weight (LBW), and exclusive breastfeeding in Indonesia. Methods. A descriptive-analytical study using cascade analysis of national estimates from the 2023 Indonesian Health Survey (SKI), the 2018 Riskesdas, and the 2007–2017 Indonesian Demographic and Health Survey (SDKI). Results. In the 2023 SKI, 89.9% of deliveries took place at health facilities, and 87.6% of infants received KN1; however, coverage dropped to 67.9% for KN2 and 45.0% for KN3, with 40.5% receiving the full KN series. For every 100 infants who received KN1, only 51 received KN3. Coverage for congenital hypothyroidism screening was only 20.7%, low birth weight (LBW) was 6.1%, and 23.6% of LBW infants did not receive specialized care. IMD increased from 39.6% (2007) to 56.5% (2017). Conclusion. The weakest points in neonatal care are the completeness of essential care at health facilities and the continuity of monitoring after the infant is discharged. Early breastfeeding initiation, SHK, and complete KN should be used as indicators of the quality of midwifery care.

Causes of Maternal Mortality in Indonesia: Hemorrhage, Hypertension, Infection, and Their Implications for Midwifery Practice Yuliwati Yuliwati; Diani Maryani
International Research of Multidisciplinary Analysis Vol. 4 No. 3 (2026): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v4i3.97

Background. According to the 2020 Long Form Population Census, Indonesia’s maternal mortality rate (MMR) remains at 189 per 100,000 live births. Strategies to reduce this rate require up-to-date and reliable information on causes of death. Objectives. To describe trends in causes of maternal mortality in Indonesia from 2019 to 2023, to examine shifts in the proportion of deaths due to pregnancy-induced hypertension (PIH) versus hemorrhage, and to assess the quality of data on causes of death. Methods. A descriptive-analytical study with a trend design using freely downloadable secondary data from the 2019–2023 Indonesia Health Profile. The proportion of each cause was calculated relative to total deaths. Changes in the composition of PH and hemorrhage were tested using the chi-square test and the Cochran–Armitage trend test, with 95% Wilson confidence intervals and sensitivity analysis. Results. The number of reported maternal deaths was 4,221 (2019), 4,652 (2020), 7,389 (2021; 40.4% due to COVID-19), 3,572 (2022), and 4,482 (2023). Hemorrhage, preterm birth, and infection accounted for 84–88% of deaths with specific causes from 2019 to 2022. The proportion of HDK relative to the combined total of HDK and hemorrhage rose from 45.4% (95% CI 43.4–47.5) in 2019 to 53.4% (95% CI 49.8–56.9) in 2023 (z = 4.72; p < 0.001), and PHE has surpassed hemorrhage as the leading cause since 2022. The proportion of deaths due to “other” causes rose from 31.1% to 63.0%. Conclusion. Hypertension in pregnancy has now become the leading specific cause of maternal mortality in Indonesia, while the quality of data on causes of death has declined. Midwifery care needs to strengthen the early detection and management of preeclampsia, continue to prioritize the management of postpartum hemorrhage, and contribute to improving data recording through surveillance and maternal mortality response.

A Comparison of Maternal Health Indicators in Indonesia and ASEAN Countries: Lessons for the Development of the Midwifery Profession Yuliwati Yuliwati; Masayu Delta Sarimalini
International Research of Multidisciplinary Analysis Vol. 4 No. 4 (2026): International Research of Multidisciplinary Analysis
Publisher : Nindikayla Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.57254/irma.v4i4.98

Background. SDG 3.1 calls for a maternal mortality ratio (MMR) below 70 per 100,000 live births by 2030. Indonesia has long developed the midwifery profession, but its status compared to neighboring countries has not been extensively analyzed quantitatively. Objectives. To compare Indonesia’s MMR, its rate of decline, and maternal health service indicators with those of ASEAN countries, and to identify lessons for the development of the midwifery profession. Methods. A comparative ecological study of 11 ASEAN countries using data from the World Bank’s World Development Indicators (MMR for 2000 and 2023, births attended by health personnel, ANC4, nurse and midwife density, health expenditure, and GNI per capita at PPP). The analysis included the average annual rate of decline (ARR), Spearman’s correlation with a 95% confidence interval, and log-log regression of the MMR against income. Results. Indonesia’s MMR in 2023 was 140, the third highest in ASEAN, above Cambodia (137) and Laos (112). During 2000–2023, Indonesia’s MMR decreased by 55.0% (ARR of 3.5% per year), while the ARR required to achieve the 2030 target is 9.9%. The MMR is strongly correlated with births attended by health personnel (rho = −0.87), ANC4 (rho = −0.84), and GNI per capita (rho = −0.88). Indonesia’s MMR is 1.96 times higher than expected given its income level, even though the coverage of births attended by health personnel is already 94.7%. Conclusion. Indonesia’s gaps lie more in the quality and continuity of care than in the number of birth attendants. The development of the midwifery profession needs to focus on emergency care competencies, robust education and regulation, equitable distribution to regions with high MMRs, and integration with the referral system.

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