Disparities in utilization of maternal health services in the rural areas of indonesia: An analysis among provinces with low, middle, and high poverty rates

Abstract

© 2020, Mahidol University - ASEAN Institute for Health Development. All rights reserved. High maternal mortality in Indonesia is a serious issue, as it is indicative of health disparities. Moreover, maternal mortality is closely related to the use of maternal health services (MHS). This study aimed to assess disparities in MHS utilization and to identify factors associated with MHS utilization in rural areas of Indonesian provinces with low, middle, and high poverty rates. A cross-sectional study was conducted among 768 mothers with children younger than one year old. The respondents were selected using a multistage sampling technique. The methods used in this study included interviews of respondents using a questionnaire, a proportional comparison of the disparities, and multiple logistic regression to examine the factors associated with MHS utilization. The study found disparities in MHS utilization among the three selected provinces, except for the utilization of family planning services. The factors of health insurance (Adj.OR: 9.22), knowledge (Adj.OR: 6.39), availability (Adj.OR: 6.27), and affordability (Adj.OR: 8.81) were associated with the utilization of antenatal care services, while education (Adj.OR: 4.86), health insurance (Adj.OR: 4.83), availability (Adj.OR: 3.70), and affordability (Adj.OR: 13.22) were significantly associated with the utilization of delivery services. Similarly, health insurance (Adj.OR: 5.02), knowledge (Adj.OR: 2.41), availability (Adj.OR: 3.39), affordability (Adj.OR: 5.91), and acceptability (Adj.OR: 2.21) were factors associated with postpartum follow-up services. Finally, health insurance (Adj.OR: 3.62), availability (Adj.OR: 2.26), and affordability (Adj.OR: 2.06) were associated with the use of family planning services. Strengthening policies to reduce these disparities is urgently needed to improve access to MHS in rural areas of provinces with high poverty rates in Indonesia.