<![CDATA[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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