Maternal Health Inequality in West Java Province, Indonesia: A Macro and Micro Level Analysis

Author: Teguh Sugiyarto

Sugiyarto, Teguh, 2016 Maternal Health Inequality in West Java Province, Indonesia: A Macro and Micro Level Analysis, Flinders University, School of the Environment

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Abstract

This study examines the levels and determinants of maternal health inequality in West Java, Indonesia. The data come mainly from the 2010 Indonesian Population Census and a household survey conducted in Bekasi and Indramayu districts from December 2012 to May 2013. The analysis is done at macro and micro levels. At the macro level, district is used as a unit analysis. A maternal health index is calculated by Factor Analysis of seven indicators of maternal health – maternal mortality ratio, female life expectancy at birth, total fertility rate, percentage of women marrying before age 17 years, percentage of women using effective contraception, percentage of births assisted by a doctor, and percentage of pregnancies receiving sufficient antenatal care. The Gini Ratio of maternal health index shows inequality across the districts of West Java. Education, urbanization and poverty have strong associations with the inequality. Further analysis, based on households as units of analysis shows that maternal death is clustered in the lower socio-economic status households. A decomposition of the concentration index reveals that education and age of the household head and household size account for 37.22% of the inequality in maternal health across households. At the micro level, this study analyses factors influencing the incidence of maternal deaths by comparing the characteristics of women surviving and dying from pregnancy and child birth. Five variables - women’s involvement in decision making, education of the household head, women’s health status prior to pregnancy and during delivery, and the number of children ever born are significantly associated with the incidence of maternal deaths. Until this stage, utilization of health care appears to have a weak association with maternal health. This anomaly is explainable by the low effectiveness of health seeking behaviour of the population in the research areas. By examining the process of candidacy to obtain health care, it is clear that the mere use of maternal health care services does not guarantee adequate care. The lack of adequacy of maternal healthcare stems from delays in deciding to seek care and getting the appropriate quality of care at the health facility. The lack of association of the healthcare utilisation with maternal health should not lead to the conclusion that healthcare is not important for women’s health. Rather, it is more likely caused by the culture, health seeking behaviour and other local conditions which cannot ensure the provision of adequate care even when people are using health care facilities. This finding is supported by the low availability and low quality of health care facilities which have adverse associations with maternal health status in Bekasi and Indramayu. An analysis of contextual factors shows the importance of the presence of health facilities in influencing appropriate health care behaviour and better maternal health status. Educational achievement of the population is associated with maternal health status. Women’s education is linked to better reproductive and health status while education of household head influences better support for maternal healthcare and mediates the impact of women’s involvement in decision making in influencing maternal health.

Keywords: Maternal Health, Inequality, West Java, MMR
Subject: Environmental Health thesis

Thesis type: Doctor of Philosophy
Completed: 2016
School: School of the Environment
Supervisor: Associate Profesor Gour Dasvarma