Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007

Abstract

BackgroundAntenatal care aims to prevent maternal and perinatal mortality and morbidity. In Indonesia, at least four antenatal visits are recommended during pregnancy. However, this service has been underutilized. This study aimed to examine factors associated with underutilization of antenatal care services in Indonesia.MethodsWe used data from Indonesia Demographic and Health Survey (IDHS) 2002/2003 and 2007. Information of 26,591 singleton live-born infants of the mothers' most recent birth within five years preceding each survey was examined. Twenty-three potential risk factors were identified and categorized into four main groups, external environment, predisposing, enabling, and need factors. Logistic regression models were used to examine the association between all potential risk factors and underutilization of antenatal services. The Population Attributable Risk (PAR) was calculated for selected significant factors associated with the outcome.ResultsFactors strongly associated with underutilization of antenatal care services were infants from rural areas and from outer Java-Bali region, infants from low household wealth index and with low maternal education level, and high birth rank infants with short birth interval of less than two years. Other associated factors identified included mothers reporting distance to health facilities as a major problem, mothers less exposed to mass media, and mothers reporting no obstetric complications during pregnancy. The PAR showed that 55% of the total risks for underutilization of antenatal care services were attributable to the combined low household wealth index and low maternal education level.ConclusionsStrategies to increase the accessibility and availability of health care services are important particularly for communities in rural areas. Financial support that enables mothers from poor households to use health services will be beneficial. Health promotion programs targeting mothers with low education are vital to increase their awareness about the importance of antenatal services.

Exploring Determinants Influencing the Utilisation of Antenatal Care in Indonesia: A Narrative Systematic Review

“…In contrast, women with higher education level are reported to have more antenatal care visits [15]. Lack of knowledge about healthy pregnancy and the importance of antenatal care during pregnancy have been reported as the hindering factors for low number of access to antenatal care services among Indonesian pregnant women [9].…”

“…Barber and Gertler [14] have suggested that the least educated women groups in outer Java and Bali regions are the least likely to seek antenatal care and underutilising of antenatal care services has increased significantly among mothers with low levels of education. Those mothers with low educational attainment are likely to take less than four antenatal care visits as recommended [9]. In contrast, women with higher education level are reported to have more antenatal care visits [15].…”

“…A number of studies have found that women's level of education is positively associated with antenatal care visits. Educated pregnant women are more likely to use antenatal care than the uneducated ones [9,12,13]. Barber and Gertler [14] have suggested that the least educated women groups in outer Java and Bali regions are the least likely to seek antenatal care and underutilising of antenatal care services has increased significantly among mothers with low levels of education.…”

“…Pregnant women involved in decision-making within their households are more likely to use antenatal care compared to the ones who are not involved in the decision-making about their own health [9]. Thus, women's participation in decision-making about their health within households which reflects women's autonomy appears to be a key supporting factor for antenatal care uptake [13,16].…”

“…The perceived cost of health services is predicted as one of the factors hindering Indonesian pregnant women from using antenatal care [8]. In regards to medical cost, the Government of Indonesia has launched the Health Insurance Scheme for the Population particularly poor communities in order to provide them with free access to health services [9]. However, financial difficulties associated with indirect costs of seeking antenatal care such as transportation costs are still significant barriers for pregnant women with lower family incomes to using antenatal care services [10].…”