Regional Disparities in Access to Maternal and Child Health Services in Indonesia: An Ecological Analysis of 34 Provinces

Abstract

Background: Geographical disparities, including those between rural and urban areas and between Java and non-Java regions, hinder the equitable distribution of maternal and child health services in Indonesia. Rural–urban tables by province from the 2023 Indonesian Health Survey (SKI) and the National Socioeconomic Survey (Susenas) are not yet publicly available; therefore, disparities were examined at the regional level. Objective: To describe interprovincial and interregional disparities in antenatal care, facility-based deliveries, postpartum care, and complete basic immunization (IDL), and to examine their association with the midwife-to-population ratio. Methods: A cross-sectional ecological study across 34 provinces. Indicators K1, K4, deliveries at health care facilities, and complete postpartum visits (KF) for 2022 were obtained from the 2022 Indonesia Health Profile; IDL for 2021 from routine immunization reports; and the midwife-to-population ratio for 2020 from the 2020 Health Profile. Analyses used the median and interquartile range (IQR), the Mann–Whitney, Kruskal–Wallis, and Wilcoxon tests, and Spearman’s correlation with a 95% Fisher-z confidence interval (CI), along with sensitivity analyses excluding Papua and West Papua. Results: The median K1 was 85.5% (IQR 77.3–89.7), while the median K4 was only 63.8% (IQR 53.4–74.9); the difference between K1 and K4 had a median of 15.8 percentage points (p < 0.001). The median K4 in Java–Bali was 74.9%, and in Nusa Tenggara–Maluku–Papua, it was 42.7%. Provinces in the eastern region had lower K1, K4, facility-based deliveries, and complete KF scores (p = 0.008–0.044), but these differences were no longer statistically significant after excluding Papua and West Papua. Facility-based deliveries correlated with complete antenatal care (ρ = 0.77) and with IDL (ρ = 0.62). The midwife-to-population ratio showed a weak negative correlation with K4 (ρ = −0.36). Eleven provinces fell below the median for K4, facility-based deliveries, and IDL simultaneously. Conclusion: The largest disparities were observed in the completeness of antenatal visits and in the easternmost provinces. A rural–urban analysis by province requires microdata from the 2023 SKI or Susenas surveys.