The Determinants of Four or More Antenatal Care Visits Among Working Women in Indonesia

Factors influencing late antenatal care of Muslim pregnant women: A predictive correlational study in Aceh, Indonesia

Background

Late antenatal care (ANC) has significant implications for maternal and infant morbidity and mortality among Muslim pregnant women in Indonesia. Existing literature has primarily focused on gestational weeks at the first ANC contact, with limited attention to the total number of ANC visits.

Objective

This study aimed to explore the factors predicting late antenatal care contact among Muslim pregnant women, including the gestational weeks of the first ANC contact and the total number of ANC visits in Aceh, Indonesia.

Methods

A predictive correlational study design was utilized. Eighty postpartum women who received late ANC were purposively sampled and included in the study. Data were collected in May 2023 using ANC knowledge, beliefs, and social support questionnaires. Statistical analyses included descriptive statistics, Spearman's rank correlation, Chi-Square tests, and binary logistic regression with the enter method.

Results

Pregnant women residing farther from home to ANC services were more likely to have their first ANC contact after 20 weeks than those with a shorter distance (AOR = 1.06; 95% CI: 1.02-1.10; p = 0.007). Additionally, women with a history of multiple abortions were more inclined to have four or more ANC visits compared to those with fewer abortions (AOR = 6.78; 95% CI: 1.64-28.09; p = 0.008).

Conclusion

Distance from home to healthcare services emerged as a significant barrier to ANC contact, while a history of abortion appeared to motivate pregnant women to seek ANC more frequently. To address these issues effectively, nurses should consider implementing telemedicine services for ANC provision, integrating information on pregnancy complications to better support pregnant women in their care journey.

Factors related to intrapartum/delivery care in Southeast Asia: A cross-sectional study in the Philippines and Indonesia

Background

Policy encouraging healthcare intrapartum/delivery care is critical to accelerating the decline in maternal mortality. The study analyzes intrapartum/delivery care factors in Indonesia and the Philippines.

Methods

The investigation included 15,346 Indonesian and 7992 Filipino women (ages 15 to 49 who delivered during the previous five years). Aside from the location of intrapartum/delivery care as a dependent variable, additional factors investigated included domicile, marital status, age, occupation, education, parity, wealth, and ANC-the conclusion of the study utilizing binary logistic regression.

Results

Women in both countries predominantly do healthcare intrapartum/delivery care. Both countries' urban women are more likely to receive intrapartum/delivery care than rural women. The higher the amount of schooling, the greater the likelihood of receiving intrapartum/delivery care. The lower the parity, the higher the chance to do healthcare intrapartum/delivery care. The higher the wealth position, the greater the likelihood of receiving intrapartum/delivery care. Furthermore, women in both nations who had four or more antenatal visits were more likely to receive intrapartum/delivery care.

Conclusion

The study concluded five factors related to healthcare intrapartum/delivery care in the Philippines: residence, education, parity, wealth, and ANC. Meanwhile, there are six factors related to healthcare intrapartum/delivery care in Indonesia: place, age, education, parity, wealth, and ANC.

Role of Socioeconomic Status in National Health Insurance Ownership in Indonesia's Rural Areas

BACKGROUND

National Health Insurance (NHI) is one of the Indonesian Government's policies to increase public access to health services. The study analyzed the role of socioeconomic status in NHI ownership in rural Indonesia. Study Design: A cross-sectional study.

METHODS

The study population included residents of rural Indonesia. The study examined secondary data from the survey entitled "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in Implementing National Health Insurance in Indonesia in 2019", involving 33225 respondents representing Indonesia's rural areas. The study was conducted from March to December 2019. The variables analyzed included NHI, socioeconomic level, age group, gender, education level, employment status, and marital status. In the final step, the study employed binary logistic regression to explain the relationship between socioeconomic status and NHI ownership.

RESULTS

The results show that 63.8% of the population in rural Indonesia participated in the NHI. The poorer residents were 1.235 times more likely to have NHI than the most impoverished population (AOR 1.235; 95% CI 1.234-1.237). People with middle wealth status were 1.086 times more likely to have NHI than the poorest (AOR 1.086; 95% CI 1.085-1.087). The richer residents were 1.134 times more likely to have NHI than the poorest (AOR 1.134; 95% CI 1.133-1.136). The richest residents were 1.078 times more likely to have NHI than the poorest residents (AOR 1.078; 95% CI 1.077-1.079).

CONCLUSION

The study concluded that socioeconomic status is related to NHI ownership in rural Indonesia. The analysis indicated that all socioeconomic categories were more likely to become NHI participants than the poorest in Indonesia.

Factors Associated with the Place of Delivery among Urban Poor Societies in Indonesia

Background

Pregnant women in urban poor societies are vulnerable groups. Due to low financial capacity, there are obstacles to accessing delivery in an institution for poor women in urban areas. The study analyses factors associated with the delivery place among pregnant women in urban poor society in Indonesia.

Materials and Methods

The study analyzed secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 1,562 samples were childbearing-age women (15-49 years) who gave birth in an urban poor society in Indonesia in the last 5 years. The study examined some variables, such as delivery place, age, education, employment, marital status, parity, insurance, knowledge of pregnancy danger, antenatal care (ANC), the autonomy of health, and family finance autonomy. The study employed binary logistic regression in the final stage.

Results

The results show that age is associated with the place of delivery. The higher the education, the higher the possibility for delivery in an institution. Being employed and having partners are protective factors for women in institution delivery. The likelihood of giving birth in a medical facility decreases as more children are born alive. In addition, having health insurance, thorough ANC visits, knowledge of pregnancy danger symptoms, and health autonomy are protective factors for pregnant women having deliveries in medical facilities. On the contrary, pregnant women who rely solely on family financing have a higher chance of delivering in a medical facility.

Conclusion

The study concluded that 10 variables were associated with pregnant women's delivery in Indonesia's urban poor society: age, education, employment, marital, parity, insurance, pregnancy danger knowledge, ANC, health autonomy, and family finance autonomy.

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study

BACKGROUND

Proper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15-49 years.

METHODS

This study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15-49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16.

RESULTS

Overall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services.

CONCLUSIONS

Findings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women's economic empowerment and education to reduce the barriers.

Regional disparities in hospital utilisation in Indonesia: a cross-sectional analysis data from the 2018 Indonesian Basic Health Survey

OBJECTIVES

Policymakers must ensure that the entire population has equal access to health services, and efforts to minimise inequalities are needed. This study aimed to analyse the regional disparities in hospital utilisation in Indonesia.

DESIGN

A cross-sectional study analysing secondary data from the 2018 Indonesian Basic Health Survey.

SETTING

National-level survey data from Indonesia.

PARTICIPANTS

A total of 629 370 participants were included in the study.InterventionWe employed no interventionPrimary and secondary outcome measuresThe primary outcome was hospital utilisation. Aside from region, we utilise residence type, age, gender, marital status, educational level, occupation, wealth, insurance and travel time as control variables. We used binary logistic regression in the final analysis RESULTS: The respondents in Sumatra were 1.079 times (95% CI 1.073 to 1.085) more likely than those in Papua to use the hospital. Furthermore, compared with the respondents in Papua, those in the Java-Bali region (1.075 times, 95% CI 1.069 to 1.081), Nusa Tenggara (1.106 times, 95% CI 1.099 to 1.113), Sulawesi (1.008 times, 95% CI 1.002 to 1.014) and Kalimantan (1.212 times, 95% CI 1.205 to 1.219) were more likely to use the hospital. However, those in Maluku were less likely than those in Papua to use the hospital (0.827 times, 95% CI 0.820 to 0.835). Six demographic variables (age, gender, marital status, educational level, occupation and wealth) and three other control variables (residence type, insurance and travel time to the hospital) were found to be associated with hospital utilisation.

CONCLUSIONS

Our findings highlight the existence of regional disparities in hospital utilisation in Indonesia.

Policy to expand hospital utilization in disadvantaged areas in Indonesia: who should be the target?

BACKGROUND

The disadvantaged areas are one of the government's focuses in accelerating development in Indonesia, including the health sector. The study aims to determine the target for expanding hospital utilization in disadvantaged areas in Indonesia.

METHODS

The study employed the 2018 Indonesian Basic Health Survey data. This cross-sectional study analyzed 42,644 respondents. The study used nine independent variables: residence, age, gender, marital, education, employment, wealth, insurance, and travel time, in addition to hospital utilization, as a dependent variable. The study employed binary logistic regression to evaluate the data.

RESULTS

The results found that average hospital utilization in disadvantaged areas in Indonesia in 2018 was 3.7%. Urban areas are 1.045 times more likely than rural areas to utilize the hospital (95% CI 1.032-1.058). The study also found age has a relationship with hospital utilization. Females are 1.656 times more likely than males to use the hospital (95% CI 1.639-1.673). Moreover, the study found marital status has a relationship with hospital utilization. The higher the education level, the higher the hospital utilization. Employed individuals have a 0.748 possibility to use the hospital compared with those unemployed (95% CI 0.740-0.757). Wealthy individuals have more chances of using the hospital than poor individuals. Individuals with all insurance types are more likely to utilize the hospital than those uninsured. Individuals with travel times of ≤ 1 h are 2.510 more likely to use the hospital than those with > 1 h (95% CI 2.483-2.537).

CONCLUSION

The specific targets to accelerate the increase in hospital utilization in disadvantaged areas in Indonesia are living in a rural area, being male, never in a union, having no education, being employed, being the poorest, uninsured, and having a travel time of > 1 h. The government should make a policy addressing the problem based on the research findings.

Spatial distribution and predictive factors of antenatal care in Burundi: A spatial and multilevel baseline analysis for the third burundian demographic and health survey

INTRODUCTION

The use of antenatal care by pregnant women enables them to receive good pregnancy monitoring. This monitoring includes counseling, health instructions, examinations and tests to avoid pregnancy-related complications or death during childbirth. To avoid these complications, the World Health Organization (WHO) recommends at least four antenatal visits. Therefore, this study was conducted to identify predictive factors of antenatal care (ANC) among women aged 15 to 49 years and its spatial distribution in Burundi.

METHODS

We used data from the Second Burundi Demographic and Health Survey (DHS). A Spatial analysis of ANC prevalence and Mulitlevel logistic regressions of determinants factors of ANC with a medical doctor were done. The ANC prevalence was mapped by region and by province. In unsampled data points, a cluster based interpolation of ANC prevalence was done using the kernel method with an adaptive window. Predictive factors of ANC were assessed using Mulitlevel logistic regressions. The dependent variable was antenatal care with a medical doctor and the explanatory variables were place of residence, age, education level, religion, marital status of the woman, household wealth index and delivery place of the woman. Data processing and data analysis were done using using Quantum Geographic Information System (QGIS) and R software, version 3. 5. 0.

RESULTS

The ANC prevalence varied from 0. 0 to 16. 2% with a median of 0. 5%. A highest predicted ANC prevalence was observed at Muyinga and Kirundo provinces' junction. Low prevalence was observed in several locations in all regions and provinces. The woman's education level and delivery place were significantly associated with antenatal care with a medical doctor.

CONCLUSION

Globally, the ANC prevalence is low in Burundi. It varies across the country. There is an intra-regional or intra-provincial heterogeneity in term of ANC prevalence. Woman's education level and delivery place are significantly associated antenatal care. There is a need to consider these ANC disparities and factors in the design and strengthening of existing interventions aimed at increasing ANC visits.

Health insurance ownership among female workers in Indonesia: does socioeconomic status matter?

BACKGROUND

Female workers are vulnerable groups in the Indonesian context, and female workers must be responsible for domestic problems and earn a living. The study aimed to analyze the role of socioeconomic on health insurance ownership among female workers in Indonesia.

METHODS

The study population was all female workers in Indonesia. This cross-sectional study involved 7,943 respondents. The study analyzed health insurance ownership as an outcome variable and socioeconomic status as an exposure variable. The study also involved five control variables: residence, age, marital, education, and occupation. The research used multinomial logistic regression in the final step.

RESULTS

The results show the poorest female workers have a possibility of 0.735 times more than the richest to have NHI (AOR 0.733; 95% CI 0.733-0.737). The poorer female workers have 0.939 times less likely than the richest to have NHI (AOR 0.939; 95% CI 0.937-0.942). Female workers with middle socioeconomic status are possibly 0.833 times less than the richest to have NHI (AOR 0.833; 95% 0.831-0.835). Moreover, the richer female workers have 1.028 times more likely than the richest to have NHI (AOR 1.028; 95% CI 1.025-1.030). Moreover, all socioeconomic statuses have a lower possibility than the richest of having other health insurance.

CONCLUSIONS

The study concluded that socioeconomic has a role in health insurance ownership among female workers in Indonesia.

Factors Influencing the Utilization of Antenatal Services among Women of Childbearing Age in South Africa

Access to quality care before, during, and after childbirth remains an effective means of reducing maternal and neonatal mortality. Therefore, the study identified factors influencing the utilization of prenatal care services among women of childbearing age in South Africa. This is a retrospective study based on secondary data from the South African Demographic Health Survey (DHS) conducted from 1998 to 2016. In South Africa, 21.0% of mothers had used ANC services. Higher odds of seeking prenatal care were found in women aged 35 years and older (cOR = 1.26, 95% CI; 1.08–1.47, p = 0.003), married or cohabiting (cOR = 1.13, 95% CI; 1.004–1.27) observed, p = 0.043), higher level of education (tertiary education: cOR = 0.55, p = 0.001), female residents in urban areas (cOR = 1.35, 95% CI; 1.20–1.52, p = 0.001), higher wealth index (cOR = 1.32, 95% CI; 1.15–1.51, p = 0.001), employed (cOR = 1.48, 95% CI; 1.29–1.70, p = 0.001) and media exposure (cOR = 1.27, 95% CI; 1.12–1.44), p = 0.001). The findings of this study provide insight into the need to make maternal health services more accessible, more widely used, and of a higher quality. This requires effective strategic policies that promote patronage to reduce maternal mortality and improve newborn outcomes in South Africa.

Hospital utilization in Indonesia in 2018: do urban-rural disparities exist?

Background

The government must ensure equality in health services access, minimizing existing disparities between urban and rural areas. The referral system in Indonesia is conceptually sound. However, there are still problems of uneven service access, and there is an accumulation of patients in certain hospitals. The study aims to analyze the urban–rural disparities in hospital utilization in Indonesia.

Methods

The study used secondary data from the 2018 Indonesian Basic Health Survey. This cross-sectional study gathered 629,370 respondents through stratification and multistage random sampling. In addition to the kind of home and hospital utilization, the study looked at age, gender, marital status, education, occupation, wealth, and health insurance as control factors. The research employed multinomial logistic regression to evaluate the data in the final step.

Results

According to the findings, someone who lives in an urban region has 1.493 times higher odds of using outpatient hospital services than someone in a rural area (AOR 1.493; 95% CI 1.489–1.498). Meanwhile, someone who lives in an urban region has 1.075 times higher odds of using an inpatient facility hospital than someone who lives in a rural one (AOR 1.075; 95% CI 1.073–1.077). Furthermore, someone living in an urban region has 1.208 times higher odds than someone who lives in a rural area using outpatient and inpatient hospital services simultaneously (AOR 1.208; 95% CI 1.204–1.212).

Conclusion

The study concluded there were urban–rural disparities in hospital utilization in Indonesia.

Husband’s involvement in wife’s antenatal care visits in Indonesia: What factors are related?

Background:

Involving husbands in maternal and child health programs can reduce maternal morbidity and mortality. The study aimed to analyze the factors related to the husband’s involvement in antenatal care (ANC) visits in Indonesia.

Methods:

The study was a cross-sectional study. The research employed secondary data from the 2017 Indonesian Demographic and Health Survey. The analysis units were wives aged 15–49 years old, married, and pregnant in the past 5 years, and the final samples obtained were 14,319 respondents. In addition to the husband’s involvement were residence, age, education, occupation, wealth, and parity. The study used a binary logistic regression test in the final stage.

Results:

Husbands who lived in urban areas have odds of being involved in ANC visits 1.2 times greater than those in rural areas. The better the husband’s education was, the more involved they were in ANC. The results show husbands who work in any field were better at being involved in ANC. Poorer husbands had odds of being engaged in ANC visits 2.0 times more likely than the husbands’ lowest group. The most prosperous husbands have odds of being involved in ANC visits 5.4 times than the poorest husbands. The husbands’ wealth is better, the more the husbands were engaged in ANC. The more children were born, the less frequent the husbands’ involvement in ANC is.

Conclusion:

The study concluded five variables associated with husbands’ participation in ANC in Indonesia, including residence, education, occupation, wealth, and parity.

Determinants of optimal antenatal care visit among pregnant women in Ethiopia: a multilevel analysis of Ethiopian mini demographic health survey 2019 data

Background

Optimal antenatal care (ANC4+) needs to be used throughout pregnancy to reduce pregnancy complications and maternal mortality. The World Health Organization (WHO) recommends eight ANC contacts, while Ethiopia has the lowest coverage of at least four ANC visits. Therefore, this study aimed to identify factors associated with optimal ANC visits among pregnant women in Ethiopia.

Methods

This study is a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). A multilevel logistic regression model is set up to identify factors associated with optimal ANC visits. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated to estimate the strength of the association between the outcome and the predictor variables.

Results

Overall, 43% of women had optimal ANC visits during their last pregnancy. Higher educated women are 3.99 times more likely (AOR = 3.99; 95% CI: 2.62–6.02) to have optimal ANC visits than women with no formal education. The wealthiest women are 2.09 times more likely (AOR = 2.09; 95% CI: 1.56–2.82) to have optimal ANC visits than women in the poorest quintile. The odds of optimal ANC visit is 42 percent lower in rural women (AOR = 0.58, 95% CI: 0.41–0.83) compared to women living in urban areas.

Conclusion

Women's educational status, wealth status, mass media exposure, place of residence and region are factors that are significantly associated with optimal ANC visit. These findings help health care programmers and policymakers to introduce appropriate policies and programs to ensure optimal ANC coverage. Priority should be given to addressing economic and educational interventions.

Optimal antenatal care means attending at least four antenatal care visits during pregnancy. In Ethiopia, evidence on factors affecting the use of at least four antenatal care services has not been adequately documented. Using the 2019 Ethiopian Mini Demographic and Health Survey data, this study attempted to uncover factors associated with optimal antenatal care visits among pregnant women in Ethiopia.

Data for women aged 15–49 who gave birth five years before the survey and attended antenatal care visits for their last pregnancy were taken from the 2019 Ethiopian Mini Demographic and Health Survey. Accordingly, 3927 women were included in the analysis.

Coverage of optimal antenatal care visits is low among pregnant women in Ethiopia. In this study, only 43% of pregnant women received optimal antenatal care. Women’s educational status, household wealth status, household size, mass media exposure, place of residence, and administrative region were associated with optimal antenatal care visits.

Strategies to increase access and availability of antenatal care services are important, especially for communities in rural areas and disadvantageous regions. Financial assistance that allows mothers from poor families to access antenatal care services can be beneficial. Health promotion programs targeting uneducated mothers are important to raise awareness of the importance of receiving a minimum of four antenatal care services.

Barriers to Expanding the National Health Insurance Membership in Indonesia: Who Should the Target?

Background:

The Indonesian government initiated National Health Insurance (NHI) to reduce health service barriers. The study aimed to analyze specific targets for expanding the NHI’s membership in Indonesia.

Methods:

The study population was all populations in Indonesia. Meanwhile, the study involved a 47 644 weighted sample. The analyzed variables included NHI’s membership, residence, age, gender, education, employment, marital status, and wealth. The study employed binary logistic regression in the final step.

Results:

The urban population was 0.608 times less likely than the rural population to become a non-member of NHI. Aging younger was one of the barriers to becoming an NHI member, and the male gender is one of the barriers to becoming an NHI member. Meanwhile, the lower the education level, the greater the obstacles to becoming an NHI member in Indonesia. Besides, the unemployed population was 1.002 more likely than the employed population to become a non-member of NHI. The result shows that never married or married have a higher chance of becoming a non-member of NHI. Finally, all wealth status categories are more likely to become barriers to the most prosperous population becoming an NHI member.

Conclusions:

The study concluded that 7 population characteristics become specific targets for expanding NHI membership in Indonesia. The 7 characteristics are the population who live in rural areas, are young, male, poor education, unemployed, never married or married, and poor.