Background: Improving breastfeeding practice is important for reducing child health inequalities and achieving several Sustainable Development Goals. Indonesia has enacted legislation to promote optimal breastfeeding practices in recent years. We examined breastfeeding practices among Indonesian women from 2002 to 2017, comparing trends within and across sociodemographic subgroups. Methods: Data from four waves of the Indonesia Demographic and Health Surveys were used to estimate changes in breastfeeding practices among women from selected sociodemographic groups over time. We examined three breastfeeding outcomes: (1) early initiation of breastfeeding; (2) exclusive breastfeeding; and (3) continued breastfeeding at 1 year. Multivariate logistic regression was used to assess changes in time trends of each outcome across population groups. Results: The proportion of women reporting early initiation of breastfeeding and exclusive breastfeeding increased significantly between 2002 to 2017 (p < 0.05), with larger increases among women who: were from higher wealth quintiles; worked in professional sectors; and lived in Java and Bali. However, 42.7% of women reported not undertaking early initiation of breastfeeding, and 48.9% of women reported not undertaking exclusive breastfeeding in 2017. Women who were employees had lower exclusive breastfeeding prevalence, compared to unemployed or self-employed women. Women in Java and Bali had higher increase in early initiation of breastfeeding and exclusive breastfeeding compared to women in Sumatra. We did not find statistically significant decline in continued breastfeeding at 1 year over time for the overall population, except among women who: were from the second poorest wealth quintile; lived in rural areas; did not have a health facility birth; and lived in Kalimantan and Sulawesi (p < 0.05).
BackgroundThe COVID-19 pandemic has challenged the resilience of Maternal, Neonatal, and Child Health (MNCH) care in Indonesia. Mobility restriction policy and obligatory preventive measures practices could influence the service implementation. Previous literature suggested that communicable diseases outbreak brought fear and mistrust to the health system which resulted in the decrease of service coverage during emergency situations. As one of the world’s worst-hit COVID-19 countries, Indonesia faces considerable challenges in maintaining health services, including MNCH care. This study investigated multi-level factors which become barriers to the implementation of MNCH care during the COVID-19 pandemic in Indonesia.MethodQualitative case study was conducted in three Kabupaten (districts), namely Sidoarjo, Gowa, and Manggarai Barat. The selection of these areas was based on the high COVID-19 cases and different achievements in MNCH indicators’ coverages. Individual in-depth interviews were conducted with 133 people involved in MNCH services, such as women as the main users of the services, health workers, cadres, village representatives, as well as staff from local district health offices. Data were analyzed using the Socio-Ecological Model (SEM) Framework and constant comparative techniques to triangulate information among informants. ResultA total of 133 people participated in the study, of which 67% were women who were pregnant, giving birth, or having children aged under-5 during the COVID-19 pandemic. The factors that affect the utilization of MNCH services were categorized in five socio-ecological levels of analysis, namely individual factors (fear of COVID-19 contraction and awareness of the importance of MNCH services); interpersonal factors (unsupportive extended family and financial barriers); community-based factors (local norms and beliefs, limited transportation services, and geographical barriers), organizational factors (unequal distribution of health resources, ineffective implementation of preventive measures in the health facility, and impractical innovation of services approach), and policy (rapid development of guidelines and ‘one size fits all’ policy issues). ConclusionsFear of COVID-19 contraction and persistent barriers from multi-faceted factors had hindered the effective implementation of MNCH care during the COVID-19 pandemic in Indonesia. The Government of Indonesia, along with local governments, are required to develop specific solutions based on the capacity of health resources as well as interactive and multilevel factors which inhibit women’s decision and practice to seek MNCH care in a volatile situation.
Greater female labour market participation has important positive implications not only for women’s empowerment and the well-being of their families but also for the economy they live in. In this paper, we examine the various effects of internet availability on women’s labour market outcomes in Indonesia. As each worker subgroup tends to respond differently to changes in technology, examining the heterogeneity in the impact of internet availability on female labour market outcomes is central to our research. By constructing a district-level longitudinal dataset covering the period 2007–18, we find that internet availability has only a small significant effect on the female labour force participation rate and no statistically significant effect on the employment rate. However, internet availability increases the probability of women having a full-time job, especially for women aged 15–45 and those with a low level of education. Our study shows that internet availability does not always bring favourable labour market outcomes for women. We find that internet availability lowers the probability of women with a low level of education working in a high-skilled job and in the formal sector. Our results are robust to several robustness checks. Analysis of our qualitative interviews with a subsample of recent mothers supports the conclusion that the ability to be prepared for and attain flexible working conditions are two important values provided by the internet. We argue that a women-friendly working environment and adequate IT infrastructure are crucial elements in maximizing the role of the internet in helping women to achieve more favourable labour market outcomes.
BackgroundWe assessed the effect of Indonesia’s national health insurance programme (Jaminan Kesehatan Nasional(JKN)) on effective coverage for maternal and child health across geographical regions and population groups.MethodsWe used four waves of the Indonesia Demographic and Health Survey from 2000 to 2017, which included 38 880 women aged 15–49 years and 144 000 birth records. Key outcomes included antenatal and delivery care, caesarean section and neonatal and infant mortality. We used multilevel interrupted time-series regression to examine changes in outcomes after the introduction of the JKN in January 2014.FindingsJKN introduction was associated with significant level increases in (1) antenatal care (ANC) crude coverage (adjusted OR (aOR) 1.81, 95% CI 1.44 to 2.27); (2) ANC quality-adjusted coverage (aOR 1.66, 95% CI 1.38 to 1.98); (3) ANC user-adherence-adjusted coverage (aOR 1.80, 95% CI 1.45 to 2.25); (4) safe delivery service contact (aOR 1.83, 95% CI 1.42 to 2.36); and (5) safe delivery crude coverage (aOR 1.45, 95% CI 1.20 to 1.75). We did not find any significant level increase in ANC service contact or caesarean section. Interestingly, increases in ANC service contact and crude coverage, and safe delivery crude coverage were larger among the poorest compared with the most affluent. No statistically significant associations were found between JKN introduction and neonatal and infant mortality (p>0.05) in the first 3 years following implementation.InterpretationExpansion of social health insurance led to substantial improvements in quality of care for maternal health services but not in child mortality. Concerted efforts are required to equitably improve service quality and child mortality across the population in Indonesia.
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