Copyright (c) 2026 Yuliwati, Diani Maryani
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Causes of Maternal Mortality in Indonesia: Hemorrhage, Hypertension, Infection, and Their Implications for Midwifery Practice
Corresponding Author(s) : Yuliwati Yuliwati
International Research of Multidisciplinary Analysis,
Vol. 4 No. 3 (2026): International Research of Multidisciplinary Analysis
Abstract
Background. According to the 2020 Long Form Population Census, Indonesia’s maternal mortality rate (MMR) remains at 189 per 100,000 live births. Strategies to reduce this rate require up-to-date and reliable information on causes of death.
Objectives. To describe trends in causes of maternal mortality in Indonesia from 2019 to 2023, to examine shifts in the proportion of deaths due to pregnancy-induced hypertension (PIH) versus hemorrhage, and to assess the quality of data on causes of death.
Methods. A descriptive-analytical study with a trend design using freely downloadable secondary data from the 2019–2023 Indonesia Health Profile. The proportion of each cause was calculated relative to total deaths. Changes in the composition of PH and hemorrhage were tested using the chi-square test and the Cochran–Armitage trend test, with 95% Wilson confidence intervals and sensitivity analysis.
Results. The number of reported maternal deaths was 4,221 (2019), 4,652 (2020), 7,389 (2021; 40.4% due to COVID-19), 3,572 (2022), and 4,482 (2023). Hemorrhage, preterm birth, and infection accounted for 84–88% of deaths with specific causes from 2019 to 2022. The proportion of HDK relative to the combined total of HDK and hemorrhage rose from 45.4% (95% CI 43.4–47.5) in 2019 to 53.4% (95% CI 49.8–56.9) in 2023 (z = 4.72; p < 0.001), and PHE has surpassed hemorrhage as the leading cause since 2022. The proportion of deaths due to “other” causes rose from 31.1% to 63.0%.
Conclusion. Hypertension in pregnancy has now become the leading specific cause of maternal mortality in Indonesia, while the quality of data on causes of death has declined. Midwifery care needs to strengthen the early detection and management of preeclampsia, continue to prioritize the management of postpartum hemorrhage, and contribute to improving data recording through surveillance and maternal mortality response.
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- Akbar, M. I. A., Gumilar, K. E., Aziz, M. A., Pribadi, A., Bachnas, M. A., Aryanda, R. A., & Dekker, G. (2025). Maternal death associated with preeclampsia in Indonesia. Pregnancy Hypertension, 42, Article 101400. https://doi.org/10.1016/j.preghy.2025.101400
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- Cresswell, J. A., Alexander, M., Chong, M. Y. C., Link, H. M., Pejchinovska, M., Gazeley, U., Ahmed, S. M. A., Chou, D., Moller, A.-B., Simpson, D., Alkema, L., Villanueva, G., Sguassero, Y., Tunçalp, Ö., Long, Q., Xiao, S., & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: A WHO systematic analysis. The Lancet Global Health, 13(4), e626–e634. https://doi.org/10.1016/S2214-109X(24)00560-6
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- Rolnik, D. L., Wright, D., Poon, L. C., O’Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K., & Nicolaides, K. H. (2017). Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. New England Journal of Medicine, 377(7), 613–622. https://doi.org/10.1056/NEJMoa1704559
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- 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
- World Health Organization. (2012). The WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-MM. World Health Organization. https://www.who.int/publications/i/item/9789241548458
- World Health Organization. (2013). Maternal Death Surveillance and Response: Technical Guidance. Information for Action to Prevent Maternal Death. World Health Organization. https://www.who.int/publications/i/item/9789241506083
- World Health Organization, UNICEF, UNFPA, World Bank Group, & UNDESA/Population Division. (2025). Trends in maternal mortality 2000 to 2023: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. World Health Organization. https://www.who.int/publications/i/item/9789240108462
- Note: Details on the causes of maternal deaths in the 2021 Indonesian Health Profile (Indonesian Ministry of Health, 2022) and the 2023 Indonesian Health Profile (Indonesian Ministry of Health, 2024) were cited from secondary sources, namely Kusnandar (2022) and Irnawati et al. (2024), in accordance with APA 7 secondary citation guidelines.
References
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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
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
Cresswell, J. A., Alexander, M., Chong, M. Y. C., Link, H. M., Pejchinovska, M., Gazeley, U., Ahmed, S. M. A., Chou, D., Moller, A.-B., Simpson, D., Alkema, L., Villanueva, G., Sguassero, Y., Tunçalp, Ö., Long, Q., Xiao, S., & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: A WHO systematic analysis. The Lancet Global Health, 13(4), e626–e634. https://doi.org/10.1016/S2214-109X(24)00560-6
Gallos, I., Devall, A., Martin, J., Middleton, L., Beeson, L., Galadanci, H., Alwy Al-beity, F., Qureshi, Z., Hofmeyr, G. J., Moran, N., Fawcus, S., Sheikh, L., Gwako, G., Osoti, A., Aswat, A., Mammoliti, K.-M., Sindhu, K. N., Podesek, M., Horne, I., . . . Coomarasamy, A. (2023). Randomized trial of early detection and treatment of postpartum hemorrhage. New England Journal of Medicine, 389(1), 11–21. https://doi.org/10.1056/NEJMoa2303966
Homer, C. S. E., Friberg, I. K., Dias, M. A. B., ten Hoope-Bender, P., Sandall, J., Speciale, A. M., & Bartlett, L. A. (2014). The projected effect of scaling up midwifery. The Lancet, 384(9948), 1146–1157. https://doi.org/10.1016/S0140-6736(14)60790-X
Irnawati, Dyastuti, N. E., & Amastasya, S. (2024). The use of WhatsApp as a teleconsultation platform for addressing the discomforts of pregnant women, women in labor, and postpartum women at the Dolo Community Health Center in Sigi Regency. Indonesia Berdaya, 5(3), 1141–1150. https://doi.org/10.47679/ib.2024902
Ministry of Health of the Republic of Indonesia. (2020). Indonesia Health Profile 2019. Ministry of Health of the Republic of Indonesia. https://layanandata.kemkes.go.id/file/profil-kesehatan/2019/bab-5.pdf
Ministry of Health of the Republic of Indonesia. (2021). 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. (2023). Indonesia Health Profile 2022. Ministry of Health of the Republic of Indonesia. https://layanandata.kemkes.go.id/file/profil-kesehatan/2023/bab-5.pdf
Kusnandar, V. B. (September 29, 2022). 7,000 maternal deaths in 2021, the highest number due to COVID-19. Databoks Katadata. https://databoks.katadata.co.id/en/consumer-services/statistics/70da1ef9073e99b/7000-maternal-deaths-in-2021-highest-number-due-to-covid-19
Magpie Trial Collaborative Group. (2002). Do women with preeclampsia, and their babies, benefit from magnesium sulfate? The Magpie Trial: A randomized placebo-controlled trial. The Lancet, 359(9321), 1877–1890. https://doi.org/10.1016/S0140-6736(02)08778-0
Musarandega, R., Nyakura, M., Machekano, R., Pattinson, R., & Munjanja, S. P. (2021). Causes of maternal mortality in Sub-Saharan Africa: A systematic review of studies published from 2015 to 2020. Journal of Global Health, 11, Article 04048. https://doi.org/10.7189/jogh.11.04048
Nove, A., Friberg, I. K., de Bernis, L., McConville, F., Moran, A. C., Najjemba, M., ten Hoope-Bender, P., Tracy, S., & Homer, C. S. E. (2021). Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: A Lives Saved Tool modeling study. The Lancet Global Health, 9(1), e24–e32. https://doi.org/10.1016/S2214-109X(20)30397-1
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
Rolnik, D. L., Wright, D., Poon, L. C., O’Gorman, N., Syngelaki, A., de Paco Matallana, C., Akolekar, R., Cicero, S., Janga, D., Singh, M., Molina, F. S., Persico, N., Jani, J. C., Plasencia, W., Papaioannou, G., Tenenbaum-Gavish, K., Meiri, H., Gizurarson, S., Maclagan, K., & Nicolaides, K. H. (2017). Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. New England Journal of Medicine, 377(7), 613–622. https://doi.org/10.1056/NEJMoa1704559
Say, L., Chou, D., Gemmill, A., Tunçalp, Ö., Moller, A.-B., Daniels, J., Gülmezoglu, A. M., Temmerman, M., & Alkema, L. (2014). Global causes of maternal death: A WHO systematic analysis. The Lancet Global Health, 2(6), e323–e333. https://doi.org/10.1016/S2214-109X(14)70227-X
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
World Health Organization. (2012). The WHO application of ICD-10 to deaths during pregnancy, childbirth, and the puerperium: ICD-MM. World Health Organization. https://www.who.int/publications/i/item/9789241548458
World Health Organization. (2013). Maternal Death Surveillance and Response: Technical Guidance. Information for Action to Prevent Maternal Death. World Health Organization. https://www.who.int/publications/i/item/9789241506083
World Health Organization, UNICEF, UNFPA, World Bank Group, & UNDESA/Population Division. (2025). Trends in maternal mortality 2000 to 2023: Estimates by WHO, UNICEF, UNFPA, World Bank Group, and UNDESA/Population Division. World Health Organization. https://www.who.int/publications/i/item/9789240108462
Note: Details on the causes of maternal deaths in the 2021 Indonesian Health Profile (Indonesian Ministry of Health, 2022) and the 2023 Indonesian Health Profile (Indonesian Ministry of Health, 2024) were cited from secondary sources, namely Kusnandar (2022) and Irnawati et al. (2024), in accordance with APA 7 secondary citation guidelines.