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Background: Universal and equitable access to safe and affordable drinking water and adequate sanitation and hygiene in Indonesia are vital to ensure healthy lives and promote well-being for all at all ages. Objectives: To quantify subnational regional inequality in access to improved drinking water and sanitation in Indonesia. Methods: Data about access to improved drinking water and sanitation were derived from the 2015 Indonesian National Socioeconomic Survey (SUSENAS) and disaggregated by 510 districts across the 34 provinces of Indonesia. Two summary measures of inequality, mean difference from mean and weighted index of disparity, were calculated to quantify within-province absolute and relative inequality, respectively. Results: While the majority of Indonesian households had access to improved drinking water (71.0%) and sanitation (62.1%), there were large variations between and within provinces. Access to improved drinking water ranged from 93.4% in DKI Jakarta to 41.1% in Bengkulu, and access to improved sanitation ranged from 89.3% in Jakarta to 23.9% in East Nusa Tenggara. Provinces with similar numbers of districts and similar overall averages showed variable levels of absolute and/or relative inequality. Certain districts reported very low levels of access to improved drinking water and/or sanitation. Conclusions: There are inequalities in access to improved drinking water and sanitation by subnational region in Indonesia. Monitoring within-country inequality in these indicators serves to identify underserved areas, and is useful for developing approaches to improve inequalities in access that can help Indonesia make progress towards the 2030 Agenda for Sustainable Development.

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Anemia in Indonesia is high. One of two pregnant women suffers from anemia as highest prevalence (85%) was among pregnant women aged 15-24. Maternal anemia are at risk of maternal death and giving birth to premature infant with low birth weight. Among age group 15-24 years, 32% is anemic (both men-women). The prevalence of anemia among women higher than men. The Ministry of Health has determined the consumption of iron tablet as nutrition program among adolescents, but only 8% of female teenagers who received iron tablet. Among adolescents who didn't consume iron tablets, 26% thought that it is unnecessary. The study aims to provide information about the knowledge profile of female adolescents on anemia, and disparity among them in Indonesia. We used the 2012 and 2017 IDHS which was held in all provinces. We analyzed unmarried women aged 15-24 (weighted) descriptively to identify knowledge about anemia from knowledge adolescent reproductive health section. Disparity analysis based on the results of difference percentage of knowledge of anemia according to age group, residence, education level and region. Most female adolescents (77% and 82%) have had heard of anemia. Adolescents who lived in urban areas and aged group 20-24 had higher percentage of having knowledge, and its percentage increased along with the increasing of education. High disparity of knowledge was found by educational background. Highest knowledge of terminology of anemia is blood deficit (69% and 73%). Knowledge of how someone become anemic ranged between 1% and 39%, while more 20% didn't know. Among female adolescent, 94% knew how to treat anemia, as 18% to 63% treated anemia by consuming iron and pills to increase blood. This study indicates that knowledge of female adolescent about anemia still a challenge to reduce prevalence of anemia in Indonesia. Low education as the sub group who need intervention.

Antenatal care (ANC) is a major component of maternal health services for preventing adverse pregnancy outcomes. As one of maternal health indicator for universal health coverage and Sustainable Development Goals (SDGs), it is important to monitor the distribution of the coverage among social dimension stratification. The study aims to examine inequality trends in the use of ANC services of Indonesian women aged 15-49 years based on the data from the Indonesia Demographic Health Surveys (IDHS) 2002, 2007 and 2012. Inequalities are measured using socioeconomic and demographic stratification variables such as urban-rural, mother's education and household wealth index. We also performed analysis of social determinants of health and their relationship with ANC. The trend of ANC utilization shows narrower gap according to social dimension stratification. The urban-rural difference for ANC has been reduced from 15 to 10.5 percentage points. The education-related inequality in ANC also declined nearly 40% from 2002 to 2012. A similar downward trend was observed for wealth-related inequality merely between the last two periods of survey. The trend in ANC use was entirely confounded by socioeconomic and demographic changes over time. The adjusted odds ratios for wealth quintile and education substantially decreased. A reduction in the inequality dimension through time suggests that both access and equality are improving in ANC use. Monitoring of trends needs to be continuously done among disadvantaged groups so that programs are in place for more targeted health development plans.

Abstract Age-Specific Death Rate (ASDR) cases of maternal death are highest in the adolescent group (<20 years). Adolescent pregnancy is a risky pregnancy, so it is necessary to deliver at health facilities.   A complication of pregnancy in adolescents is also at risk of childhood mortality. The study aims to assess the access of pregnant adolescents with complications to delivery facilities and the relation with the survival of the child. This study is a secondary data analysis of the 2017 Indonesia Demographic and Health Survey (IDHS). The unit of analysis of live births five years preceding survey, and mother's age birth before 35 years (14,634 live births). There are 2 dependent variables: access to delivery services (skill birth attendant and health facilities); and survival of the child (neonatal, infant and under-five mortality). Interest variables is multiple high-risk category, a combination of morbidity status (complications during pregnancy) and age adolescents (<20 years) compared adults (20-34 years). Covariate variables are parity and characteristics (mother’s education, residence and wealth index). Statistical test with logistic regression, 95%CI. All pregnancies with complications were significant association with neonatal and infant mortality. Specifically adolescent pregnancy with complications is also significantly associated with under-five mortality. In adolescents with pregnancy complications had OR neonatal mortality=7.4, OR infant mortality=4.56 and OR infant mortality=3.73, compared with adults pregnant without complication. Pregnancies ages 20-34 with complications having neonatal OR=1.95 and OR infant mortality=1.64. Pregnant adolescents are significantly associated with facilities of delivery (OR<1). The conclusions are: the access of adolescents with pregnancy complications to childbirth at the health facility is still low; adolescent pregnancy with complications is significantly related to childhood mortality and the highest risk of neonatal mortality. ABSTRAK  Age Spesific Death Rate (ASDR) kasus kematian maternal tertinggi pada kelompok remaja (<20 tahun). Kehamilan pada usia remaja merupakan kehamilan berrisiko, sehingga mereka perlu akses ke fasilitas persalinan yang aman. Kehamilan dengan komplikasi pada remaja juga berisiko terhadap kematian anaknya. Tujuan studi untuk menilai akses remaja yang hamil dengan komplikasi terhadap pelayanan persalinan dan mengetahui status kelangsungan hidup anaknya. Studi ini merupakan analisis data sekunder Survei Demografi dan Kesehatan Indonesia (SDKI) 2017. Unit analisis adalah kelahiran hidup periode lima tahun sebelum survey dan saat dilahirkan usia ibu belum mencapai 35 tahun (14.634 kelahiran hidup). Variabel dependen yang diteliti ada 2: akses ke pelayanan persalinan (tenaga kesehatan dan fasilitas pelayanan kesehatan); dan kelangsungan hidup anak (kematian: neonatal, bayi, dan balita). Variabel interes adalah status ganda yaitu kombinasi status komplikasi kehamilan dan umur risiko remaja dibandingkan umur tidak berisiko (20-34 tahun). Variabel kovariat: paritas dan karakteristik (pendidikan, tempat tinggal dan indeks kekayaan). Uji statistik dengan regresi logistik, 95%CI. Semua kehamilan dengan komplikasi berhubungan signifikan dengan kematian neonatal dan bayi bila dibandingkan dengan kehamilan usia 20-34 tanpa komplikasi. Khusus kehamilan remaja dengan komplikasi juga berhubungan signifikan dengan kematian balita. Pada remaja dengan komplikasi kehamilan mempunyai OR kematian neonatal=7,4, OR kematian bayi=4,56 dan OR kematian balita=3,73. Kehamilan usia 20-34 dengan komplikasi mempunyai OR neonatal=1,95 dan OR kematian bayi=1,64. Remaja hamil berhubungan signifikan dengan persalinan di fasyankes (OR<1). Kesimpulan studi ini adalah akses remaja dengan kehamilan komplikasi terhadap persalinan di fasyankes masih rendah. Kehamilan remaja dengan komplikasi berhubungan signifikan dengan kematian anak, dan risiko paling tinggi terhadap kematian neonatus.