Issue

Vol. 3 No. 12 (2025): International Research of Multidisciplinary Analysis

Copyright (c) 2025 Yuliwati, Rizki Hallifah Ashri

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Availability of Midwives per Capita and Maternal Health Service Coverage in Each Province in Indonesia

https://doi.org/10.57254/irma.v3i12.94
Yuliwati Yuliwati
Universitas Salakanagara, Tangerang
Rizki Hallifah Ashri
Universitas Bakti Asih Tangerang

Corresponding Author(s) : Yuliwati Yuliwati

yuliwati@unsaka.ac.id

International Research of Multidisciplinary Analysis, Vol. 3 No. 12 (2025): International Research of Multidisciplinary Analysis

Abstract

Background. Midwives are the primary providers of maternal health care in Indonesia, and the ratio of midwives to population is often used as a measure of workforce adequacy. However, the relationship between this ratio and maternal and child health (MCH) service outcomes at the provincial level has not been extensively studied using the latest publicly available data.


Objective. To calculate the ratio of registered midwives per capita and per live birth in each province and to analyze its relationship with maternal health service outcomes.


Methods. A cross-sectional ecological study across 34 provinces using data on the number of registered midwives (STR) and population from the 2026 Ministry of Health Directorate General of Health Workforce dashboard, K1 and K4 coverage, deliveries attended by health workers, deliveries at health facilities, and complete postpartum visits (KF lengkap) from the 2020 Indonesia Health Profile, as well as the Long Form Maternal Mortality Rate (AKI) from the 2020 Population Census (SP2020). Analyses employed the Mann–Whitney U test and Spearman’s correlation with a 95% confidence interval, accompanied by sensitivity analyses.


Results. The national ratio was 199.0 midwives per 100,000 population, with an interprovincial median of 265.9 (IQR 194.3–315.1), ranging from 119.1 in West Java to 541.9 in Aceh. The ratio in Java–Bali was lower than in other provinces (median 135.3 vs. 286.8; p < 0.001), but its MCH indicators were higher. The midwife-to-population ratio was negatively correlated with K4 (rho = −0.52; p = 0.002) and complete KF (rho = −0.59; p < 0.001), and positively correlated with AKI (rho = 0.61; p = 0.006).


Conclusion. The number of registered midwives per capita is not the primary determinant of MCH outcomes at the provincial level. Midwifery workforce planning needs to consider active midwives, competencies, the number of births, geographic accessibility, and the strength of the referral system.

Keywords

midwives, health workforce ratio, health human resources, antenatal care, postpartum visits, maternal health
Yuliwati, Y., & Ashri, R. H. . (2025). Availability of Midwives per Capita and Maternal Health Service Coverage in Each Province in Indonesia. International Research of Multidisciplinary Analysis, 3(12), 1321–1332. https://doi.org/10.57254/irma.v3i12.94
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX
References
  1. Achadi, E., Scott, S., Pambudi, E. S., Makowiecka, K., Marshall, T., Adisasmita, A., Deviany, P. E., & Ronsmans, C. (2007). Midwifery provision and uptake of maternity care in Indonesia. Tropical Medicine & International Health, 12(12), 1490–1497. https://doi.org/10.1111/j.1365-3156.2007.01957.x
  2. 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
  3. Central Bureau of Statistics. (2023). Mortality in Indonesia: Results of the 2020 Long-Form Population Census. Central Bureau of Statistics. https://indonesia.unfpa.org/sites/default/files/pub-pdf/mortalitas-di-indonesia-hasil-long-form-sensus-penduduk-2020.pdf
  4. 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
  5. 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
  6. 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
  7. Ensor, T., Quayyum, Z., Nadjib, M., & Sucahya, P. (2009). Level and determinants of incentives for village midwives in Indonesia. Health Policy and Planning, 24(1), 26–35. https://doi.org/10.1093/heapol/czn040
  8. Gausman, J., Ramesh, S., Adanu, R. M., Bandoh, D. A. B., Blossom, J., Chakraborty, S., Kenu, E., Khan, N., Langer, A., Odikro, M. A., Saggurti, N., & Jolivet, R. R. (2023). Measuring the adequacy of the midwifery workforce using standards of competency and scope of work: Exploring the density and distribution of midwives in three low- and middle-income countries using cross-sectional and geospatial data. PLOS ONE, 18(4), Article e0284034. https://doi.org/10.1371/journal.pone.0284034
  9. 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
  10. Heywood, P., Harahap, N. P., Ratminah, M., & Elmiati. (2010). Current situation of midwives in Indonesia: Evidence from 3 districts in West Java Province. BMC Research Notes, 3, Article 287. https://doi.org/10.1186/1756-0500-3-287
  11. 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
  12. Ministry of Health of the Republic of Indonesia. (2021b). Minister of Health Regulation No. 21 of 2021 concerning 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.
  13. Ministry of Health of the Republic of Indonesia. (2026). Ratio of health workers to population: Midwives [Dashboard]. Directorate General of Health Workforce. Retrieved October 2026, from https://eplanning-ditjennakes.kemkes.go.id/indikator/user/rasio_populasi/?nakes=2
  14. 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
  15. 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
  16. 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
  17. Makowiecka, K., Achadi, E., Izati, Y., & Ronsmans, C. (2008). Midwifery provision in two districts in Indonesia: How well are rural areas served? Health Policy and Planning, 23(1), 67–75. https://doi.org/10.1093/heapol/czm036
  18. Muharram, F. R., Sulistya, H. A., Swannjo, J. B., Firmansyah, F. F., Rizal, M. M., Izza, A., Isfandiari, M. A., Ariningtyas, N. D., & Romdhoni, A. C. (2024). Adequacy and distribution of the health workforce in Indonesia. WHO South-East Asia Journal of Public Health, 13(2), 45–55. https://doi.org/10.4103/who-seajph.who-seajph_28_24
  19. 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
  20. 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
  21. 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
  22. Law of the Republic of Indonesia No. 17 of 2023 on Health. (2023). Official Gazette of the Republic of Indonesia, Year 2023, No. 105.
  23. 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
Read More
Author biographies is not available.
Download
PDF
Statistic
Read Counter : 8 Download : 5

Downloads

Download data is not yet available.