Copyright (c) 2026 Yuliwati, Siti Nurbaiti
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Essential Neonatal Examinations and Early Breastfeeding Initiation as Indicators of the Quality of Midwifery Care in Indonesia
Corresponding Author(s) : Yuliwati Yuliwati
International Research of Multidisciplinary Analysis,
Vol. 4 No. 2 (2026): International Research of Multidisciplinary Analysis
Abstract
Background. Most neonatal deaths occur during the first week of life and can be prevented through essential newborn care, early initiation of breastfeeding (EIB), and comprehensive neonatal visits (NV). These indicators reflect the quality of midwifery care, as midwives assist in the majority of deliveries in Indonesia.
Objectives. To describe the neonatal care cascade, the extent of care discontinuation, and trends in early breastfeeding initiation (EBI), low birth weight (LBW), and exclusive breastfeeding in Indonesia.
Methods. A descriptive-analytical study using cascade analysis of national estimates from the 2023 Indonesian Health Survey (SKI), the 2018 Riskesdas, and the 2007–2017 Indonesian Demographic and Health Survey (SDKI).
Results. In the 2023 SKI, 89.9% of deliveries took place at health facilities, and 87.6% of infants received KN1; however, coverage dropped to 67.9% for KN2 and 45.0% for KN3, with 40.5% receiving the full KN series. For every 100 infants who received KN1, only 51 received KN3. Coverage for congenital hypothyroidism screening was only 20.7%, low birth weight (LBW) was 6.1%, and 23.6% of LBW infants did not receive specialized care. IMD increased from 39.6% (2007) to 56.5% (2017).
Conclusion. The weakest points in neonatal care are the completeness of essential care at health facilities and the continuity of monitoring after the infant is discharged. Early breastfeeding initiation, SHK, and complete KN should be used as indicators of the quality of midwifery care.
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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
- Health Development Policy Agency. (2024). Key Findings of the 2023 SKI. Ministry of Health of the Republic of Indonesia. https://www.badankebijakan.kemkes.go.id/daftar-frequently-asked-question-seputar-hasil-utama-ski-2023/hasil-utama-ski-2023/
- Health Development Policy Agency. (n.d.). Maternal Health Factsheet: 2023 Indonesia Health Survey [Factsheet]. Ministry of Health of the Republic of Indonesia. https://repository.badankebijakan.kemkes.go.id/5525/1/01%20factsheet%20Kesehatan%20Ibu_bahasa.pdf
- 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
- Baten, A., Biswas, R. K., Kendal, E., & Bhowmik, J. (2025). Continuum of maternal healthcare services utilization in low- and middle-income countries: A multi-level analysis. Midwifery, 149, Article 104549. https://doi.org/10.1016/j.midw.2025.104549
- Edmond, K. M., Zandoh, C., Quigley, M. A., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R. (2006). Delayed breastfeeding initiation increases the risk of neonatal mortality. Pediatrics, 117(3), e380–e386. https://doi.org/10.1542/peds.2005-1496
- Gayatri, M., & Dasvarma, G. L. (2020). Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey. PLOS ONE, 15(9), Article e0239446. https://doi.org/10.1371/journal.pone.0239446
- Ministry of Health of the Republic of Indonesia. (2014a). Minister of Health Regulation No. 25 of 2014 on Child Health Efforts. Ministry of Health of the Republic of Indonesia.
- Ministry of Health of the Republic of Indonesia. (2014b). Minister of Health Regulation No. 78 of 2014 on Screening for Congenital Hypothyroidism. 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
- Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A. C. C., Waiswa, P., Lalli, M., Bhutta, Z., Barros, A. J. D., Christian, P., Mathers, C., & Cousens, S. N. (2014). Every Newborn: Progress, Priorities, and Potential Beyond Survival. The Lancet, 384(9938), 189–205. https://doi.org/10.1016/S0140-6736(14)60496-7
- Nurokhmah, S., Middleton, L., Februhartanty, J., & Hendarto, A. (2023). Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis. PLOS ONE, 18(11), Article e0294900. https://doi.org/10.1371/journal.pone.0294900
- Probandari, A., Arcita, A., Kothijah, K., & Pamungkasari, E. P. (2017). Barriers to the utilization of postnatal care at the village level in Klaten District, Central Java Province, Indonesia. BMC Health Services Research, 17(1), Article 541. https://doi.org/10.1186/s12913-017-2490-y
- 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
- Smith, E. R., Hurt, L., Chowdhury, R., Sinha, B., Fawzi, W., Edmond, K. M., & Neovita Study Group. (2017). Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLOS ONE, 12(7), Article e0180722. https://doi.org/10.1371/journal.pone.0180722
- Syahri, I. M., Laksono, A. D., Fitria, M., Rohmah, N., Masruroh, M., & Ipa, M. (2024). Exclusive breastfeeding among Indonesian working mothers: Does early initiation of breastfeeding matter? BMC Public Health, 24(1), Article 1225. https://doi.org/10.1186/s12889-024-18619-2
- Titaley, C. R., Dibley, M. J., Agho, K., Roberts, C. L., & Hall, J. (2008). Determinants of neonatal mortality in Indonesia. BMC Public Health, 8(1), Article 232. https://doi.org/10.1186/1471-2458-8-232
- Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2009). Factors associated with non-utilization of postnatal care services in Indonesia. Journal of Epidemiology and Community Health, 63(10), 827–831. https://doi.org/10.1136/jech.2008.081604
- Titaley, C. R., Hunter, C. L., Heywood, P., & Dibley, M. J. (2010). Why don’t some women attend antenatal and postnatal care services?: A qualitative study of community members’ perspectives in Garut, Sukabumi, and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy and Childbirth, 10(1), Article 61. https://doi.org/10.1186/1471-2393-10-61
- World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization. https://www.who.int/publications/i/item/9789240045989
References
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
Health Development Policy Agency. (2024). Key Findings of the 2023 SKI. Ministry of Health of the Republic of Indonesia. https://www.badankebijakan.kemkes.go.id/daftar-frequently-asked-question-seputar-hasil-utama-ski-2023/hasil-utama-ski-2023/
Health Development Policy Agency. (n.d.). Maternal Health Factsheet: 2023 Indonesia Health Survey [Factsheet]. Ministry of Health of the Republic of Indonesia. https://repository.badankebijakan.kemkes.go.id/5525/1/01%20factsheet%20Kesehatan%20Ibu_bahasa.pdf
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
Baten, A., Biswas, R. K., Kendal, E., & Bhowmik, J. (2025). Continuum of maternal healthcare services utilization in low- and middle-income countries: A multi-level analysis. Midwifery, 149, Article 104549. https://doi.org/10.1016/j.midw.2025.104549
Edmond, K. M., Zandoh, C., Quigley, M. A., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R. (2006). Delayed breastfeeding initiation increases the risk of neonatal mortality. Pediatrics, 117(3), e380–e386. https://doi.org/10.1542/peds.2005-1496
Gayatri, M., & Dasvarma, G. L. (2020). Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey. PLOS ONE, 15(9), Article e0239446. https://doi.org/10.1371/journal.pone.0239446
Ministry of Health of the Republic of Indonesia. (2014a). Minister of Health Regulation No. 25 of 2014 on Child Health Efforts. Ministry of Health of the Republic of Indonesia.
Ministry of Health of the Republic of Indonesia. (2014b). Minister of Health Regulation No. 78 of 2014 on Screening for Congenital Hypothyroidism. 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
Lawn, J. E., Blencowe, H., Oza, S., You, D., Lee, A. C. C., Waiswa, P., Lalli, M., Bhutta, Z., Barros, A. J. D., Christian, P., Mathers, C., & Cousens, S. N. (2014). Every Newborn: Progress, Priorities, and Potential Beyond Survival. The Lancet, 384(9938), 189–205. https://doi.org/10.1016/S0140-6736(14)60496-7
Nurokhmah, S., Middleton, L., Februhartanty, J., & Hendarto, A. (2023). Trends and determinants of early initiation of breastfeeding in Indonesia: A multivariate decomposition analysis. PLOS ONE, 18(11), Article e0294900. https://doi.org/10.1371/journal.pone.0294900
Probandari, A., Arcita, A., Kothijah, K., & Pamungkasari, E. P. (2017). Barriers to the utilization of postnatal care at the village level in Klaten District, Central Java Province, Indonesia. BMC Health Services Research, 17(1), Article 541. https://doi.org/10.1186/s12913-017-2490-y
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
Smith, E. R., Hurt, L., Chowdhury, R., Sinha, B., Fawzi, W., Edmond, K. M., & Neovita Study Group. (2017). Delayed breastfeeding initiation and infant survival: A systematic review and meta-analysis. PLOS ONE, 12(7), Article e0180722. https://doi.org/10.1371/journal.pone.0180722
Syahri, I. M., Laksono, A. D., Fitria, M., Rohmah, N., Masruroh, M., & Ipa, M. (2024). Exclusive breastfeeding among Indonesian working mothers: Does early initiation of breastfeeding matter? BMC Public Health, 24(1), Article 1225. https://doi.org/10.1186/s12889-024-18619-2
Titaley, C. R., Dibley, M. J., Agho, K., Roberts, C. L., & Hall, J. (2008). Determinants of neonatal mortality in Indonesia. BMC Public Health, 8(1), Article 232. https://doi.org/10.1186/1471-2458-8-232
Titaley, C. R., Dibley, M. J., & Roberts, C. L. (2009). Factors associated with non-utilization of postnatal care services in Indonesia. Journal of Epidemiology and Community Health, 63(10), 827–831. https://doi.org/10.1136/jech.2008.081604
Titaley, C. R., Hunter, C. L., Heywood, P., & Dibley, M. J. (2010). Why don’t some women attend antenatal and postnatal care services?: A qualitative study of community members’ perspectives in Garut, Sukabumi, and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy and Childbirth, 10(1), Article 61. https://doi.org/10.1186/1471-2393-10-61
World Health Organization. (2022). WHO recommendations on maternal and newborn care for a positive postnatal experience. World Health Organization. https://www.who.int/publications/i/item/9789240045989