Pregnancy-related risk and birth setting trends: Insights from Indonesian Demographic Health Survey data

BackgroundMost maternal and neonatal deaths occur in low- and middle-income countries and are largely preventable with quality care. In Indonesia, 98% of pregnant people receive antenatal care and birth commonly occurs in community settings or hospitals. Outside of high-income countries, few studies identify where women with pregnancy-related risk factors give birth. Accurate identification of pregnancy risk factors and referral to an appropriate birth setting is considered an essential element of quality antenatal care, though its efficacy in Indonesia is unknown. MethodsThis study aimed to identify suitable indicators of pregnancy risk factors for Indonesia and examine population-level patterns in pregnancy-related risk, care and appropriateness of birth setting. Risk factors in pregnancy based on internationally relevant referral guidelines were identified from literature search and mapped to available indicators. Using self-reported data from three waves of the Indonesian Demographic Health Survey (2007, 2012, 2017), a representative survey of women aged 15-49 years, we examined receipt of maternity care, prevalence of pregnancy risk factors and time trends in birth setting, overall and by presence of risk factors. ResultsIn the weighted sample (n=43,846), one quarter of women reported pregnancy risk factors. From 2002-2017, numbers of births in hospitals have doubled and births at home have halved. However, the proportions of women with pregnancy risk in each setting remains largely unchanged. DiscussionThese findings identify opportunities for shifting care in Indonesia to ensure women are receiving the appropriate level of care at birth.