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The Role of Midwives in Childbirth at Health Facilities: An Analysis of Trends in Childbirth Attendants in Indonesia, 2017–2023
Corresponding Author(s) : Yuliwati Yuliwati
International Research of Multidisciplinary Analysis,
Vol. 3 No. 11 (2025): International Research of Multidisciplinary Analysis
Abstract
Background. Childbirth attended by health care providers at health care facilities is a key strategy for reducing maternal mortality. Midwives are the most common birth attendants in Indonesia, but current policies emphasize that all births should take place at health care facilities.
Objectives. To describe trends in birth attendants and delivery settings in Indonesia from 2013 to 2023, the proportion of midwives as birth attendants, and interprovincial disparities between births attended by health workers and births occurring at health care facilities.
Methods. A descriptive-analytical study using trend analysis and Spearman’s correlation on downloadable secondary data: Riskesdas 2013 and 2018, SDKI 2017, the 2023 Indonesian Health Survey (SKI), and the 2020 Indonesian Health Profile for data from 33 provinces, as well as the 2020 Population Census (SP2020) Long Form on maternal mortality.
Results. Deliveries at health facilities increased from 66.7% (2013) to 79.3% (2018) and 90% (2023), while deliveries attended by health personnel reached 96.1% in 2023. Midwives assisted in about six out of ten births (61% in the 2017 SDKI; 62.7% in the 2018 Riskesdas), while obstetricians accounted for about 29%. According to routine data from 2020, the coverage of deliveries at health facilities ranged from 31.4% in Maluku to 99.6% in DKI Jakarta, and 12 out of 33 provinces remained below 80%. The rate of deliveries at health facilities showed a strong negative correlation with the Long Form SP2020 maternal mortality rate (rho = −0.69; p < 0.001; n = 20).
Conclusion. Midwives remain the backbone of childbirth care, and their role has shifted from providing care at home to providing care at health facilities and serving as referral liaisons. Provinces in eastern Indonesia require support to ensure that midwife-assisted deliveries can take place at health facilities.
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- Adnani, Q. E. S., Maulina, R., Ramadhan, K., Argaheni, N. B., Kennedy, H. P., & Telfer, M. (2025). Trends and determinants of antenatal, intranatal, and postnatal care utilization among Indonesian women (2012–2017): Associated factors in midwifery service utilization between midwives and other health professionals. BMC Nursing, 24(1), Article 912. https://doi.org/10.1186/s12912-025-03527-6
- Aryastami, N. K., & Mubasyiroh, R. (2021). Traditional practices influencing the use of maternal health care services in Indonesia. PLOS ONE, 16(9), Article e0257032. https://doi.org/10.1371/journal.pone.0257032
- 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
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- National Population and Family Planning Agency, Central Statistics Agency, Ministry of Health, & ICF. (2018). 2017 Indonesia Demographic and Health Survey. BKKBN. https://www.dhsprogram.com/pubs/pdf/FR342/FR342.pdf
- Central Statistics Agency. (2023). Mortality in Indonesia: Results from the 2020 Long-Form Population Census. Central Statistics Agency. https://indonesia.unfpa.org/sites/default/files/pub-pdf/mortalitas-di-indonesia-hasil-long-form-sensus-penduduk-2020.pdf
- Betrán, A. P., Ye, J., Moller, A.-B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing trend in cesarean section rates: Global, regional, and national estimates: 1990–2014. PLOS ONE, 11(2), Article e0148343. https://doi.org/10.1371/journal.pone.0148343
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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
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- Hatt, L., Stanton, C., Makowiecka, K., Adisasmita, A., Achadi, E., & Ronsmans, C. (2007). Did the strategy of skilled attendance at birth reach the poor in Indonesia? Bulletin of the World Health Organization, 85(10), 774–782. https://doi.org/10.2471/BLT.06.033472
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- Ministry of Health of the Republic of Indonesia. (2014). Minister of Health Regulation No. 97 of 2014 concerning Health Services During the Pre-pregnancy, Pregnancy, Childbirth, and Postpartum Periods. Ministry of Health of the Republic of Indonesia.
- Ministry of Health of the Republic of Indonesia. (2019). 2018 Riskesdas National Report. Agency for Health Research and Development. https://www.kemkes.go.id/id/potret-sehat-indonesia-riskesdas-2018
- 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
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- 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
- 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
- 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
- Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2012). Type of delivery attendant, place of delivery, and risk of early neonatal mortality: Analyses of the 1994–2007 Indonesia Demographic and Health Surveys. Health Policy and Planning, 27(5), 405–416. https://doi.org/10.1093/heapol/czr053
- Law of the Republic of Indonesia No. 4 of 2019 on Midwifery. (2019). Official Gazette of the Republic of Indonesia, 2019, No. 56.
- 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
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Aryastami, N. K., & Mubasyiroh, R. (2021). Traditional practices influencing the use of maternal health care services in Indonesia. PLOS ONE, 16(9), Article e0257032. https://doi.org/10.1371/journal.pone.0257032
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. (2024a). The 2023 Indonesia Health Survey (SKI) in Figures. Ministry of Health of the Republic of Indonesia. https://www.badankebijakan.kemkes.go.id/ski-2023-dalamangka/
Health Development Policy Agency. (2024b). A Portrait of Indonesia’s Health Through the Lens of the 2023 SKI. Ministry of Health of the Republic of Indonesia. https://www.badankebijakan.kemkes.go.id/potret-sehat-indonesia-dari-kacamata-ski-2023/
National Population and Family Planning Agency, Central Statistics Agency, Ministry of Health, & ICF. (2018). 2017 Indonesia Demographic and Health Survey. BKKBN. https://www.dhsprogram.com/pubs/pdf/FR342/FR342.pdf
Central Statistics Agency. (2023). Mortality in Indonesia: Results from the 2020 Long-Form Population Census. Central Statistics Agency. https://indonesia.unfpa.org/sites/default/files/pub-pdf/mortalitas-di-indonesia-hasil-long-form-sensus-penduduk-2020.pdf
Betrán, A. P., Ye, J., Moller, A.-B., Zhang, J., Gülmezoglu, A. M., & Torloni, M. R. (2016). The increasing trend in cesarean section rates: Global, regional, and national estimates: 1990–2014. PLOS ONE, 11(2), Article e0148343. https://doi.org/10.1371/journal.pone.0148343
Brooks, M. I., Thabrany, H., Fox, M. P., Wirtz, V. J., Feeley, F. G., & Sabin, L. L. (2017). Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: A mixed-methods study. BMC Health Services Research, 17(1), Article 105. https://doi.org/10.1186/s12913-017-2028-3
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
Efendi, F., Sebayang, S. K., Astutik, E., Hadisuyatmana, S., Has, E. M. M., & Kuswanto, H. (2020). Determinants of safe delivery utilization among Indonesian women in eastern Indonesia. F1000Research, 9, 332. https://doi.org/10.12688/f1000research.23324.2
GoodStats. (n.d.). 2023 SKI Survey: 70% of mothers in Indonesia give birth vaginally. Retrieved October 31, 2026, from https://data.goodstats.id/statistic/survei-ski-2023-70-ibu-di-indonesia-melahirkan-secara-normal-26FJV
Hatt, L., Stanton, C., Makowiecka, K., Adisasmita, A., Achadi, E., & Ronsmans, C. (2007). Did the strategy of skilled attendance at birth reach the poor in Indonesia? Bulletin of the World Health Organization, 85(10), 774–782. https://doi.org/10.2471/BLT.06.033472
Katadata. (April 21, 2021). Midwives are the primary referral for childbirth. https://databoks.katadata.co.id/en/consumer-services/statistics/7929f5acacf689d/midwives-are-the-primary-referral-point-for-maternal-delivery
Ministry of Health of the Republic of Indonesia. (2014). Minister of Health Regulation No. 97 of 2014 concerning Health Services During the Pre-pregnancy, Pregnancy, Childbirth, and Postpartum Periods. Ministry of Health of the Republic of Indonesia.
Ministry of Health of the Republic of Indonesia. (2019). 2018 Riskesdas National Report. Agency for Health Research and Development. https://www.kemkes.go.id/id/potret-sehat-indonesia-riskesdas-2018
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.
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
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
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
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
Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2012). Type of delivery attendant, place of delivery, and risk of early neonatal mortality: Analyses of the 1994–2007 Indonesia Demographic and Health Surveys. Health Policy and Planning, 27(5), 405–416. https://doi.org/10.1093/heapol/czr053
Law of the Republic of Indonesia No. 4 of 2019 on Midwifery. (2019). Official Gazette of the Republic of Indonesia, 2019, No. 56.
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