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High maternal mortality in Indonesia is a serious issue, as it is indicative of health disparities. Moreover, maternal mortality is closely related to the use of maternal health services (MHS). This study aimed to assess disparities in MHS utilization and to identify factors associated with MHS utilization in rural areas of Indonesian provinces with low, middle, and high poverty rates. A cross-sectional study was conducted among 768 mothers with children younger than one year old. The respondents were selected using a multistage sampling technique. The methods used in this study included interviews of respondents using a questionnaire, a proportional comparison of the disparities, and multiple logistic regression to examine the factors associated with MHS utilization. The study found disparities in MHS utilization among the three selected provinces, except for the utilization of family planning services. The factors of health insurance (Adj.OR: 9.22), knowledge (Adj.OR: 6.39), availability (Adj.OR: 6.27), and affordability (Adj.OR: 8.81) were associated with the utilization of antenatal care services, while education (Adj.OR: 4.86), health insurance (Adj.OR: 4.83), availability (Adj.OR: 3.70), and affordability (Adj.OR: 13.22) were significantly associated with the utilization of delivery services. Similarly, health insurance (Adj.OR: 5.02), knowledge (Adj.OR: 2.41), availability (Adj.OR: 3.39), affordability (Adj.OR: 5.91), and acceptability (Adj.OR: 2.21) were factors associated with postpartum follow-up services. Finally, health insurance (Adj.OR: 3.62), availability (Adj.OR: 2.26), and affordability (Adj.OR: 2.06) were associated with the use of family planning services. Strengthening policies to reduce these disparities is urgently needed to improve access to MHS in rural areas of provinces with high poverty rates in Indonesia.
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2. WHO. Maternal Mortality. Geneva: World Health Organization; 2018 [cited 2019 May 6, 2019]; Available from: https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality.
3. Hanson C, Gabrysch S, Mbaruku G, Cox J, Mkumbo E, Manzi F, et al. Access to maternal health services: geographical inequalities, United Republic of Tanzania. Bulletin of the World Health Organization. 2017;95 (12):810.
4. Mezmur M, Navaneetham K, Letamo G, Bariagaber H. Individual, household and contextual factors associated with skilled delivery care in Ethiopia: evidence from Ethiopian demographic and health surveys. PloS one. 2017;12(9):e0184688.
5. Wiseman V, Thabrany H, Asante A, Haemmerli M, Kosen S, Gilson L, et al. An evaluation of health systems equity in Indonesia: study protocol. Int J Equity Health. 2018;17(1):138.
6. Agustina R, Dartanto T, Sitompul R, Susiloretni KA, Achadi EL, Taher A, et al. Universal health coverage in Indonesia: concept, progress, and challenges. The Lancet. 2018.
7. MoH RI. Indonesia Health Profile 2017. Jakarta: Ministry of Health Republic of Indonesia 2018.
8. UN. Sustainable Development Goals: ensure healthy life and promote wellbeing for all at all ages. New York: United Nations; 2017 [March 17, 2017]; Available from: https:// sustainabledevelopment.un.org/sdg3.
9. WHO. Sexual and Reproductive Health. Geneva: World Health Organization; 2019 [cited 2019 April 14, 2017]; Available from: http:// www.who.int/reproductivehealth/publications/monitoring/infographic/en/.
10. WHO. Maternal Mortality. Geneva: World Health Organization; 2017 [cited 2017 April 14, 2017]; Available from: http://www.who.int/ mediacentre/factsheets/fs348/en/.
11. Girum T, Wasie A. Correlates of maternal mortality in developing countries: an ecological study in 82 countries. Matern Health Neonatol Perinatol. 2017;3(1):19.
12. WHO. 10 facts on maternal health. Geneva: World Health Organization; 2019 [cited 2019 April 14, 2019]; Available from: http://www.who. int/features/factfiles/maternal_health/en/.
13. Biswas A, Halim M, Dalal K, Rahman F. Exploration of social factors associated to maternal deaths due to haemorrhage and convulsions: Analysis of 28 social autopsies in rural Bangladesh. BMC Health Serv Res. 2016;16(1):659.
14. UN. Universal Declaration of Human Rights. New York: United Nations; 2017 [cited 2017 March 14, 2017]; Available from: http://www.un.org/ en/universal-declaration-human-rights/.
15. WHO. Health and human rights. Geneva: World Health Organization; 2017 [March 18, 2017]; Available from: http://www.who.int/ mediacentre/factsheets/fs323/en/.
16. UN. Adopting Consensus Text, General Assembly Encourages Member States to Plan, Pursue Transition of National Health Care Systems towards Universal Coverage. New York: United Nations; 2017; Available from: https://www.un.org/ press/en/2012/ga11326.doc.htm.
17. Andersen RM, McCutcheon A, Aday LA, Chiu GY, Bell R. Exploring dimensions of access to medical care. Health Serv Res. 1983;18(1):49.
18. Clark DW. Dimensions of the concept of access to health care. Bull N Y Acad Med. 1983;59(1):5.
19. Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9(3):208.
20. Ibrahim SA. Health inequities: a global concern. Am J Public Health. 2009;99(7):1162.
21. Escolar-Pujolar A, Bacigalupe A, San Sebastian M. European economic crisis and health inequities: research challenges in an uncertain scenario. Int J Equity Health. 2014.
22. Harimurti P, Pambudi E, Pigazzini A, Tandon A. The Nuts & Bolts of Jamkesmas, Indonesia’s Government -Financed Health Coverage Program for the Poor and Near-Poor. 2013.
23. MoH RI. Indonesia Health Profile 2015. Jakarta: Ministry of Health Republic of Indonesia2016.
24. MoH RI. Data and Information-Indonesia Health Profile 2017 "Data dan Informasi-Profil Kesehatan Indonesia 2017". Jakarta: Ministry of Health Republic of Indonesia 2018.
25. UNDP. Human Development Report. New York2018.
26. Agus Y, Horiuchi S, Porter SE. Rural Indonesia women’s traditional beliefs about antenatal care. BMC Res Notes. 2012;5(1):589.
27. Brooks MI, Thabrany H, Fox MP, Wirtz VJ, Feeley FG, Sabin LL. Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study. BMC Health Serv Res 2017;17(1): 105.
28. WHO. State of health inequality: Indonesia: World Health Organization; 2017.
29. BPS. Statistical Yearbook of Indonesia 2018. Jakarta: Central Bureau of Statistics Indonesia "Badan Pusat Statistik Indonesia"; 2018.
30. MoH RI. Basic Health Research "Riset Kesehatan Dasar". Jakarta: Ministry of Health Republic of Indonesia 2013.
31. MoH RI. Indonesia Health Profile in 2016 "Profil Kesehatan Indonesia Tahun 2016". Jakarta: Ministry of Health Republic of Indonesia 2017.
32. Ferezagia DV. Analisis Tingkat Kemiskinan di Indonesia. J Sos Hum Ter. 2018;1(1):1-6.
33. Bloom BS. Taxonomy of educational objectives. New York: David McKay Company. Inc BloomTaxonomy of Educational Objectives1956. 1956.
34. Singh DR, Harvey CM, Bohara P, Nath D, Singh S, Szabo S, et al. Factors associated with newborn care knowledge and practices in the upper Himalayas. PloS one. 2019;14(9).
35. MoH RI. Strategic Planning of Ministry of Health "Rencana Strategis Kementerian Kesehatan 2015-2019", Revision 1 2017. Jakarta: Ministry of Health, Republic of Indonesia; 2017.
36. Soewondo P, Johar M, Pujisubekti R, Halimah H, Irawati DO. Inspecting Primary Healthcare Centers in Remote Areas: Facilities, Activities, and Finances. J Administrasi Kesehat Indonesia. 2019;7(1):89-98.
37. Kamal N, Curtis S, Hasan MS, Jamil K. Trends in equity in use of maternal health services in urban and rural Bangladesh. Int J Equity Health. 2016;15(1):27.
38. Thida T, Liabsuetrakul T, McNeil E. Disparity in utilization and expectation of community-based maternal health care services among women in Myanmar: a cross-sectional study. J Public Health (Oxf) 2018;41:183-91.
39. Okonofua F, Ntoimo L, Ogungbangbe J, Anjorin S, Imongan W, Yaya S. Predictors of women’s utilization of primary health care for skilled pregnancy care in rural Nigeria. BMC Pregnancy Childbirth. 2018;18(1):1-15.
40. Mpembeni RN, Kakoko DC, Aasen HS, Helland I. Realizing women´ s right to maternal health: A study of awareness of rights and utilization of maternal health services among reproductive age women in two rural districts in Tanzania. PloS one. 2019;14(5):e0216027.
41. Kazanga I, Munthali AC, McVeigh J, Mannan H, MacLachlan M. Predictors of utilisation of skilled maternal healthcare in Lilongwe district, Malawi. Int J Health Policy Manag. 2019;8(12):700.
42. Bhowmik J, Biswas R, Woldegiorgis M. Antenatal care and skilled birth attendance in Bangladesh are influenced by female education and family affordability: BDHS 2014. Public Health. 2019;170:113-21.
43. Mon AS, Phyu MK, Thinkhamrop W, Thinkhamrop B. Utilization of full postnatal care services among rural Myanmar women and its determinants: a cross-sectional study. F1000Res. 2018;7:1167-.
44. Wu Y, Zhou H, Wang Q, Cao M, Medina A, Rozelle S. Use of maternal health services among women in the ethnic rural areas of western China. BMC Health Serv Res. 2019;19(1): 179.
45. Agus Y, Horiuchi S, Iida M. Women's choice of maternal healthcare in Parung, West Java, Indonesia: Midwife versus traditional birth attendant. Women Birth. 2018;31(6): 513-9.
46. Zhang R, Li S, Li C, Zhao D, Guo L, Qu P, et al. Socioeconomic inequalities and determinants of maternal health services in Shaanxi Province, Western China. PloS one. 2018;13(9):e0202129.
47. Kikuchi K, Yasuoka J, Nanishi K, Ahmed A, Nohara Y, Nishikitani M, et al. Postnatal care could be the key to improving the continuum of care in maternal and child health in Ratanakiri, Cambodia. PloS one. 2018;13(6):e0198829.
48. Paul P, Chouhan P. Association between child marriage and utilization of maternal health care services in India: Evidence from a nationally representative cross-sectional survey. Midwifery. 2019; 75:66-71.
49. Bibi S, Shoukat A, Maroof P, Mushraf S. Postpartum contraception utilization and its impact on inter pregnancy interval among mothers accessing maternity services in the public sector hospital of Hyderabad Sindh. Pak J Med Sci 2019;35(6):1482.
50. Joshi AK, Tiwari DP, Poudyal A, Shrestha N, Acharya U, Dhungana GP. Utilization of Family Planning Methods Among Postpartum Mothers in Kailali District, Nepal. Int J Womens Health. 2020;12:487.
51. Nuamah GB, Agyei-Baffour P, Mensah KA, Boateng D, Quansah DY, Dobin D, et al. Access and utilization of maternal healthcare in a rural district in the forest belt of Ghana. BMC Pregnancy Childbirth. 2019;19(1):6.
52. Gebremedhin AY, Kebede Y, Gelagay AA, Habitu YA. Family planning use and its associated factors among women in the extended postpartum period in Addis Ababa, Ethiopia. Contracept Reprod Med. 2018;3(1):1.
53. WHO. Postpartum family planning: essential for ensuring health of women and their babies. Geneva: World Health Organization; 2020 [cited 2020 July 28, 2020]; Available from: https://www.who.int/ reproductivehealth/topics/family_planning/world-contraception-day-2018/en/.
54. Al Kindi RM, Al Sumri HH. Prevalence and sociodemographic determinants of contraceptive use among women in Oman. East Mediterr Health J. 2019;25(7):495-502.
55. BKKBN. BKKBN Compact faces Corona Pandemic "BKKBN Kompak Hadapi Pandemi Corona". Jakarta: Demographic and Family Planning Board "Badan Kependudukan dan Keluarga Berencana Nasional (BKKBN); 2020 [cited 2020 July 31, 2020]; Available from: https:// www.bkkbn.go.id/detailpost/penyuluh-kb-petugas-lapangan-kb-plkb-harus-semangat-bekerja-pantang-menyerah.
56. Gafar A, Suza DE, Efendi F, Has EMMa, Pramono AP, Susanti IA. Determinants of contraceptive use among married women in Indonesia. F1000Res. 2020;9.
57. Zhao P, Han X, You L, Zhao Y, Yang L, Liu Y. Maternal health services utilization and maternal mortality in China: a longitudinal study from 2009 to 2016. BMC Pregnancy Childbirth. 2020;20:1-10.
58. Hull TH. Reducing maternal and neonatal mortality in Indonesia: saving lives, saving the future. Washington, D.C.: Taylor & Francis; 2015.