Copyright (c) 2026 Yuliwati, Masayu Delta Sarimalini
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
A Comparison of Maternal Health Indicators in Indonesia and ASEAN Countries: Lessons for the Development of the Midwifery Profession
Corresponding Author(s) : Yuliwati Yuliwati
International Research of Multidisciplinary Analysis,
Vol. 4 No. 4 (2026): International Research of Multidisciplinary Analysis
Abstract
Background. SDG 3.1 calls for a maternal mortality ratio (MMR) below 70 per 100,000 live births by 2030. Indonesia has long developed the midwifery profession, but its status compared to neighboring countries has not been extensively analyzed quantitatively.
Objectives. To compare Indonesia’s MMR, its rate of decline, and maternal health service indicators with those of ASEAN countries, and to identify lessons for the development of the midwifery profession.
Methods. A comparative ecological study of 11 ASEAN countries using data from the World Bank’s World Development Indicators (MMR for 2000 and 2023, births attended by health personnel, ANC4, nurse and midwife density, health expenditure, and GNI per capita at PPP). The analysis included the average annual rate of decline (ARR), Spearman’s correlation with a 95% confidence interval, and log-log regression of the MMR against income.
Results. Indonesia’s MMR in 2023 was 140, the third highest in ASEAN, above Cambodia (137) and Laos (112). During 2000–2023, Indonesia’s MMR decreased by 55.0% (ARR of 3.5% per year), while the ARR required to achieve the 2030 target is 9.9%. The MMR is strongly correlated with births attended by health personnel (rho = −0.87), ANC4 (rho = −0.84), and GNI per capita (rho = −0.88). Indonesia’s MMR is 1.96 times higher than expected given its income level, even though the coverage of births attended by health personnel is already 94.7%.
Conclusion. Indonesia’s gaps lie more in the quality and continuity of care than in the number of birth attendants. The development of the midwifery profession needs to focus on emergency care competencies, robust education and regulation, equitable distribution to regions with high MMRs, and integration with the referral system.
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- 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
- 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., Calvert, C., Testa, A., Strehlow, M., Benova, L., Keyes, E., Donnay, F., Macleod, D., Gabrysch, S., Rong, L., Ronsmans, C., Sadruddin, S., Koblinsky, M., & Bailey, P. (2016). The scale, scope, coverage, and capability of childbirth care. The Lancet, 388(10056), 2193–2208. https://doi.org/10.1016/S0140-6736(16)31528-8
- 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
- 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
- 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
- Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the era of universal health coverage: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. https://doi.org/10.1016/S0140-6736(18)31668-4
- 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
- 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
- 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
- Souza, J. P., Tunçalp, Ö., Vogel, J. P., Bohren, M., Widmer, M., Oladapo, O. T., Say, L., Gülmezoglu, A. M., & Temmerman, M. (2014). Obstetric transition: The pathway toward ending preventable maternal deaths. BJOG: An International Journal of Obstetrics & Gynecology, 121(S1), 1–4. https://doi.org/10.1111/1471-0528.12735
- 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
- ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C. S. E., Kennedy, H. P., Matthews, Z., McFadden, A., Renfrew, M. J., & Van Lerberghe, W. (2014). Improvement of maternal and newborn health through midwifery. The Lancet, 384(9949), 1226–1235. https://doi.org/10.1016/S0140-6736(14)60930-2
- United Nations Population Fund, International Confederation of Midwives, & World Health Organization. (2021). The state of the world’s midwifery 2021. United Nations Population Fund. https://unfpa.org/state-worlds-midwifery-2021
- Van Lerberghe, W., Matthews, Z., Achadi, E., Ancona, C., Campbell, J., Channon, A., de Bernis, L., De Brouwere, V., Fauveau, V., Fogstad, H., Koblinsky, M., Liljestrand, J., Mechbal, A., Murray, S. F., Rathavay, T., Rehr, H., Richard, F., ten Hoope-Bender, P., & Turkmani, S. (2014). Country experience with strengthening health systems and deploying midwives in countries with high maternal mortality. The Lancet, 384(9949), 1215–1225. https://doi.org/10.1016/S0140-6736(14)60919-3
- World Bank. (2025). World Development Indicators [Data set]. World Bank. Retrieved October 31, 2026, from https://api.worldbank.org/v2/country/IDN;MYS;THA;VNM;PHL;KHM;LAO;MMR;BRN;SGP;TLS/indicator/SH.STA.MMRT
- 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
References
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
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., Calvert, C., Testa, A., Strehlow, M., Benova, L., Keyes, E., Donnay, F., Macleod, D., Gabrysch, S., Rong, L., Ronsmans, C., Sadruddin, S., Koblinsky, M., & Bailey, P. (2016). The scale, scope, coverage, and capability of childbirth care. The Lancet, 388(10056), 2193–2208. https://doi.org/10.1016/S0140-6736(16)31528-8
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
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
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
Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the era of universal health coverage: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212. https://doi.org/10.1016/S0140-6736(18)31668-4
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
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
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
Souza, J. P., Tunçalp, Ö., Vogel, J. P., Bohren, M., Widmer, M., Oladapo, O. T., Say, L., Gülmezoglu, A. M., & Temmerman, M. (2014). Obstetric transition: The pathway toward ending preventable maternal deaths. BJOG: An International Journal of Obstetrics & Gynecology, 121(S1), 1–4. https://doi.org/10.1111/1471-0528.12735
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
ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C. S. E., Kennedy, H. P., Matthews, Z., McFadden, A., Renfrew, M. J., & Van Lerberghe, W. (2014). Improvement of maternal and newborn health through midwifery. The Lancet, 384(9949), 1226–1235. https://doi.org/10.1016/S0140-6736(14)60930-2
United Nations Population Fund, International Confederation of Midwives, & World Health Organization. (2021). The state of the world’s midwifery 2021. United Nations Population Fund. https://unfpa.org/state-worlds-midwifery-2021
Van Lerberghe, W., Matthews, Z., Achadi, E., Ancona, C., Campbell, J., Channon, A., de Bernis, L., De Brouwere, V., Fauveau, V., Fogstad, H., Koblinsky, M., Liljestrand, J., Mechbal, A., Murray, S. F., Rathavay, T., Rehr, H., Richard, F., ten Hoope-Bender, P., & Turkmani, S. (2014). Country experience with strengthening health systems and deploying midwives in countries with high maternal mortality. The Lancet, 384(9949), 1215–1225. https://doi.org/10.1016/S0140-6736(14)60919-3
World Bank. (2025). World Development Indicators [Data set]. World Bank. Retrieved October 31, 2026, from https://api.worldbank.org/v2/country/IDN;MYS;THA;VNM;PHL;KHM;LAO;MMR;BRN;SGP;TLS/indicator/SH.STA.MMRT
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