Determinants of low birthweight in Indonesia: a provincial-level ecological study 10.55131/jphd/2026/240304
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Abstract
Low birthweight (LBW; <2500 g) serves as a significant indicator of maternal and fetal health, with implications for predicting mortality, stunting, and the development of chronic conditions in adulthood. Inadequate maternal nutrition during pregnancy is a key contributing factor to LBW. However, the determinants of LBW are complex and context-specific, and evidence at the subnational level in Indonesia remains limited. This ecological study aimed to analyze the determinants of LBW in 34 provinces of Indonesia from 2019 to 2023 using panel data analysis. The results of this study indicated that the factors that significantly influenced the decline in LBW were antenatal care visits 4+ (ANC4+), antenatal care visits 6+ (ANC6+), diphtheria, tetanus, and pertussis (DTP) immunization, iron supplement consumption, supplementary feeding programs for pregnant women, health insurance, mean years of schooling, social assistance, sanitation, public health centers, hospitals, and midwives. The factors that significantly influenced the increase in LBW cases were unemployment, early marriage, smoking, and forest fires. These determinants spanned the health system and socioeconomic, environmental, and climatic domains, reflecting the multidimensional nature of LBW at the provincial level in Indonesia. Policy recommendations focus on two areas. First, health service-level interventions include strengthening health infrastructure and resources, integrating cross-sectoral LBW case surveillance data, and implementing performance-based budget allocation in priority provinces. Second, interventions should address socioeconomic and environmental determinants by improving living standards and employment opportunities, implementing conflict-of-interest tobacco control governance, and mitigating air pollution. Further ecological studies should utilize microeconomic data, analyze them quantitatively, and systematically explore them using a qualitative approach.
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