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Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census
- Source :
- PLoS ONE, PLoS ONE, Vol 14, Iss 6, p e0217386 (2019)
- Publication Year :
- 2018
-
Abstract
- BackgroundFor countries to contribute to Sustainable Development Goal 3.1 of reducing the global maternal mortality ratio (MMR) to less than 70 per 100,000 live births by 2030, identifying the drivers of maternal mortality is critically important. The ability of countries to identify the key drivers is however hampered by the lack of data sources with sufficient observations of maternal death to allow a rigorous analysis of its determinants. This paper overcomes this problem by utilising census data. In the context of Indonesia, we merge individual-level data on pregnancy-related deaths and households' socio-economic status from the 2010 Indonesian population census with detailed data on the availability and quality of local health services from the Village Census. We use these data to test the hypothesis that health service access and quality are important determinants of maternal death and explain the differences between high maternal mortality and low maternal mortality provinces.MethodsThe 2010 Indonesian Population Census identifies 8075 pregnancy-related deaths and 5,866,791 live births. Multilevel logistic regression is used to analyse the impacts of demographic characteristics and the existence of, distance to and quality of health services on the likelihood of maternal death. Decomposition analysis quantifies the extent to which the difference in maternal mortality ratios between high and low performing provinces can be explained by demographic and health service characteristics.FindingsHealth service access and characteristics account for 23% (CI: 17.2% to 28.5%) of the difference in maternal mortality ratios between high and low-performing provinces. The most important contributors are the number of doctors working at the community health centre (8.6%), the number of doctors in the village (6.9%) and distance to the nearest hospital (5.9%). Distance to health clinics and the number of midwives at community health centres and village health posts are not significant contributors, nor is socio-economic status. If the same level of access to doctors and hospitals in lower maternal mortality Java-Bali was provided to the higher maternal mortality Outer Islands of Indonesia, our model predicts 44 deaths would be averted per 100,000 pregnancies.ConclusionIndonesia has employed a strategy over the past several decades of increasing the supply of midwives as a way of decreasing maternal mortality. While there is evidence of reductions in maternal mortality continuing to accrue from the provision of midwife services at village health posts, our findings suggest that further reductions in maternal mortality in Indonesia may require a change of focus to increasing the supply of doctors and access to hospitals. If data on maternal death is collected in a subsequent census, future research using two waves of census data would prove a useful validation of the results found here. Similar research using census data from other countries is also likely to be fruitful.
- Subjects :
- Maternal Health
Social Sciences
Health Services Accessibility
Midwives
Geographical Locations
Labor and Delivery
0302 clinical medicine
Sociology
Pregnancy
Health care
Medicine and Health Sciences
Public and Occupational Health
030212 general & internal medicine
Medical Personnel
030219 obstetrics & reproductive medicine
Multidisciplinary
Schools
Mortality rate
Obstetrics and Gynecology
Census
Middle Aged
Socioeconomic Aspects of Health
Professions
Geography
Maternal Mortality
Research Design
Community health
Medicine
Maternal death
Female
Live birth
Live Birth
Research Article
Adult
Asia
Adolescent
Death Rates
Science
Oceania
Research and Analysis Methods
Education
03 medical and health sciences
Population Metrics
medicine
Humans
Quality of Health Care
Survey Research
Population Biology
business.industry
Biology and Life Sciences
medicine.disease
Health Care
Standardized mortality ratio
Socioeconomic Factors
Indonesia
People and Places
Birth
Women's Health
Observational study
Population Groupings
business
Demography
Subjects
Details
- ISSN :
- 19326203
- Volume :
- 14
- Issue :
- 6
- Database :
- OpenAIRE
- Journal :
- PloS one
- Accession number :
- edsair.doi.dedup.....5e71b31f333a2e966fd6206dfde78507