Copyright (c) 2025 Yuliwati, Ayu Endang Purwati

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Antenatal Visit Coverage (K1, K4, K6) and Its Association with Maternal Mortality Rates Across Provinces in Indonesia
Corresponding Author(s) : Yuliwati Yuliwati
International Research of Multidisciplinary Analysis,
Vol. 3 No. 10 (2025): International Research of Multidisciplinary Analysis
Abstract
Background. Indonesia’s Maternal Mortality Rate (MMR), based on the 2020 Long Form Population Census, is 189 per 100,000 live births, with a range across provinces from 48 (DKI Jakarta) to 565 (Papua). Antenatal visits (K1, K4, and, since 2021, K6) are the primary midwifery services for early detection of pregnancy risks.
Objective. To analyze the relationship between K1 and K4 coverage and MMR across provinces in Indonesia, and to contextualize the K6 standard within this framework.
Methods. A cross-sectional ecological study using downloadable secondary data: the 2020 Indonesia Health Profile (K1 and K4 coverage, number of maternal deaths, and live births in 34 provinces) and MMR data from the Long Form of the 2020 Population Census (SP2020) by the Central Statistics Agency (BPS). Relationships were tested using Spearman’s correlation.
Results. National coverage rates were 93.3% for K1 and 84.6% for K4. K4 coverage was negatively correlated with the MMR from the Long Form 2020 Population Census (rho = −0.57; p = 0.007; n = 21 provinces) and with facility-reported maternal mortality (rho = −0.41; p = 0.017; n = 34). Papua (K4 27.5%; MMR 565) and West Papua (K4 34.5%; MMR 343) ranked second-worst on both measures.
Conclusion. Provinces with lower antenatal care coverage tend to have higher MMRs. Strengthening the role of midwives to ensure pregnant women continue to attend visits from K1 through K4/K6, particularly in eastern Indonesia, should be a priority.
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- Cameron, L., Contreras Suarez, D., & Cornwell, K. (2019). Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLOS ONE, 14(6), Article e0217386. https://doi.org/10.1371/journal.pone.0217386
- Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299. https://doi.org/10.1016/S0140-6736(06)69381-1
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- Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 2016(4), Article CD004667. https://doi.org/10.1002/14651858.CD004667.pub5
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- Souza, J. P., Day, L. T., Rezende-Gomes, A. C., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J. P., Campbell, O., Mugerwa, K. Y., Lumbiganon, P., Tunçalp, Ö., Cresswell, J., Say, L., Moran, A. C., & Oladapo, O. T. (2024). A global analysis of the determinants of maternal health and trends in maternal mortality. The Lancet Global Health, 12(2), e306–e316. https://doi.org/10.1016/S2214-109X(23)00468-0
- Sudaryo, M. K., & Sam, A. Q. (2022). The association between antenatal care (ANC) visits and the incidence of obstetric complications in Indonesia: A secondary data analysis of the 2017 Indonesia Demographic and Health Survey (IDHS). Journal of Community Health Epidemiology, 7(2), 587–595. https://doi.org/10.14710/jekk.v7i2.11866
- Susiarno, H., Adnani, Q. E. S., Khaerani, I., Nurdiawan, W., Nisa, A., & Adepoju, V. (2026). Qualitative analysis of maternal mortality reporting gaps and the emerging fourth delay in Garut Regency, Indonesia. International Journal of Women’s Health, 18, 1–13. https://doi.org/10.2147/IJWH.S552705
- Syairaji, M., Nurdiati, D. S., Wiratama, B. S., Prüst, Z. D., Bloemenkamp, K. W. M., & Verschueren, K. J. C. (2024). Trends and causes of maternal mortality in Indonesia: A systematic review. BMC Pregnancy and Childbirth, 24(1), Article 515. https://doi.org/10.1186/s12884-024-06687-6
- Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110. https://doi.org/10.1016/0277-9536(94)90226-7
- Wenang, S., Emilia, O., Wahyuni, A., Afdal, A., & Haier, J. (2024). Obstetric care in Indonesia: Determinants of maternal mortality and stillbirth rates. PLOS ONE, 19(7), Article e0303590. https://doi.org/10.1371/journal.pone.0303590
- World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.
- World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, the World Bank Group, and UNDESA/Population Division. World Health Organization.
- Zenitasari, S., Ganap, E. P., & Hadijono, S. (2026). Quality of antenatal care and maternal mortality: A mixed-methods study in Purwakarta District, Indonesia. BMC Public Health, 26(1), Article 2875. https://doi.org/10.1186/s12889-026-28555-y
References
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Azhar, K., Dharmayanti, I., Tjandrarini, D. H., & Hidayangsih, P. S. (2020). The influence of pregnancy classes on the use of maternal health services in Indonesia. BMC Public Health, 20(1), Article 372. https://doi.org/10.1186/s12889-020-08492-0
Health Development Policy Agency. (2024). The 2023 Indonesian Health Survey (SKI) in Figures. Ministry of Health of the Republic of Indonesia. https://www.badankebijakan.kemkes.go.id/ski-2023-dalamangka/
Central Bureau of Statistics. (2023). Mortality in Indonesia: Results from the 2020 Population Census Long Form. Central Bureau of Statistics. https://indonesia.unfpa.org/sites/default/files/pub-pdf/mortalitas-di-indonesia-hasil-long-form-sensus-penduduk-2020.pdf
Cameron, L., Contreras Suarez, D., & Cornwell, K. (2019). Understanding the determinants of maternal mortality: An observational study using the Indonesian Population Census. PLOS ONE, 14(6), Article e0217386. https://doi.org/10.1371/journal.pone.0217386
Campbell, O. M. R., & Graham, W. J. (2006). Strategies for reducing maternal mortality: Getting on with what works. The Lancet, 368(9543), 1284–1299. https://doi.org/10.1016/S0140-6736(06)69381-1
Fauzi, R., Kyi, Y. P., Mon, M. M., Munira, L., Herman, B., Hounnaklang, N., & Viwattanakulvanid, P. (2021). Factors affecting optimal antenatal care utilization in Indonesia: Implications for policies and practices. Journal of Public Health Policy, 42(4), 559–573. https://doi.org/10.1057/s41271-021-00307-9
Ministry of Health of the Republic of Indonesia. (2021a). Indonesia Health Profile 2020. Ministry of Health of the Republic of Indonesia. https://layanandata.kemkes.go.id/file/profil-kesehatan/2020/bab-5.pdf
Ministry of Health of the Republic of Indonesia. (2021b). Minister of Health Regulation No. 21 of 2021 on the Provision of Health Services During the Pre-pregnancy, Pregnancy, Childbirth, and Postpartum Periods, Contraceptive Services, and Sexual Health Services. Ministry of Health of the Republic of Indonesia.
Ministry of National Development Planning/Bappenas. (2020). National Medium-Term Development Plan 2020–2024 (Appendix to Presidential Regulation No. 18 of 2020). Ministry of National Development Planning/Bappenas.
Kompas.com. (2024a, February 23). Maternal mortality rate in Papua is the highest in Indonesia. https://lestari.kompas.com/read/2024/02/23/120000786/angka-kematian-ibu-di-papua-tertinggi-di-indonesia
Kompas.com. (2024b, February 26). Maternal mortality rate in DKI Jakarta is the lowest in Indonesia. https://lestari.kompas.com/read/2024/02/26/110000086/angka-kematian-ibu-di-dki-jakarta-terendah-se-indonesia
Laksono, A. D., Rukmini, R., & Wulandari, R. D. (2020). Regional disparities in antenatal care utilization in Indonesia. PLOS ONE, 15(2), Article e0224006. https://doi.org/10.1371/journal.pone.0224006
Mahmood, M. A., Hendarto, H., Laksana, M. A. C., Damayanti, H. E., Suhargono, M. H., Pranadyan, R., Santoso, K. H., Redjeki, K. S., Winard, B., Prasetyo, B., Vercruyssen, J., Moss, J. R., Bi, P., Masitah, S., Warsiti, Pratama, A. W., Dewi, E. R., Listiyani, C. H., & Mufidah, I. (2021). Health system and quality of care factors contributing to maternal deaths in East Java, Indonesia. PLOS ONE, 16(2), Article e0247911. https://doi.org/10.1371/journal.pone.0247911
Renfrew, M. J., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., Silva, D. R. A. D., Downe, S., Kennedy, H. P., Malata, A., McCormick, F., Wick, L., & Declercq, E. (2014). Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129–1145. https://doi.org/10.1016/S0140-6736(14)60789-3
Sandall, J., Soltani, H., Gates, S., Shennan, A., & Devane, D. (2016). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, 2016(4), Article CD004667. https://doi.org/10.1002/14651858.CD004667.pub5
Satyawan, D. C., Setyaningsih, W., Supangat, R. W., Ernawaty, & Wulandari, R. D. (2023). The correlation between the quality of antenatal care, maternal COVID-19, and maternal mortality during the pandemic period in East Java, Indonesia. The Indonesian Journal of Public Health, 18(3), 432–444. https://doi.org/10.20473/ijph.v18i3.2023.432-444
Souza, J. P., Day, L. T., Rezende-Gomes, A. C., Zhang, J., Mori, R., Baguiya, A., Jayaratne, K., Osoti, A., Vogel, J. P., Campbell, O., Mugerwa, K. Y., Lumbiganon, P., Tunçalp, Ö., Cresswell, J., Say, L., Moran, A. C., & Oladapo, O. T. (2024). A global analysis of the determinants of maternal health and trends in maternal mortality. The Lancet Global Health, 12(2), e306–e316. https://doi.org/10.1016/S2214-109X(23)00468-0
Sudaryo, M. K., & Sam, A. Q. (2022). The association between antenatal care (ANC) visits and the incidence of obstetric complications in Indonesia: A secondary data analysis of the 2017 Indonesia Demographic and Health Survey (IDHS). Journal of Community Health Epidemiology, 7(2), 587–595. https://doi.org/10.14710/jekk.v7i2.11866
Susiarno, H., Adnani, Q. E. S., Khaerani, I., Nurdiawan, W., Nisa, A., & Adepoju, V. (2026). Qualitative analysis of maternal mortality reporting gaps and the emerging fourth delay in Garut Regency, Indonesia. International Journal of Women’s Health, 18, 1–13. https://doi.org/10.2147/IJWH.S552705
Syairaji, M., Nurdiati, D. S., Wiratama, B. S., Prüst, Z. D., Bloemenkamp, K. W. M., & Verschueren, K. J. C. (2024). Trends and causes of maternal mortality in Indonesia: A systematic review. BMC Pregnancy and Childbirth, 24(1), Article 515. https://doi.org/10.1186/s12884-024-06687-6
Thaddeus, S., & Maine, D. (1994). Too far to walk: Maternal mortality in context. Social Science & Medicine, 38(8), 1091–1110. https://doi.org/10.1016/0277-9536(94)90226-7
Wenang, S., Emilia, O., Wahyuni, A., Afdal, A., & Haier, J. (2024). Obstetric care in Indonesia: Determinants of maternal mortality and stillbirth rates. PLOS ONE, 19(7), Article e0303590. https://doi.org/10.1371/journal.pone.0303590
World Health Organization. (2016). WHO recommendations on antenatal care for a positive pregnancy experience. World Health Organization.
World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: Estimates by WHO, UNICEF, UNFPA, the World Bank Group, and UNDESA/Population Division. World Health Organization.
Zenitasari, S., Ganap, E. P., & Hadijono, S. (2026). Quality of antenatal care and maternal mortality: A mixed-methods study in Purwakarta District, Indonesia. BMC Public Health, 26(1), Article 2875. https://doi.org/10.1186/s12889-026-28555-y