Assessing the determinants of maternal mortality in Indonesia.

Maternal mortality is one of the basic health indicators that reflect a nation's health status. It is estimated that 2.5 million women become pregnant in Indonesia each year and approximately 10,700 of these women die from pregnancy-related causes. In this dissertation there are two studies which are presented. Study one is an estimation of the levels and trends of the maternal mortality ratio (NMR = maternal deaths per 100,000 live births) over the last several decades. Study two is an examination of correlates of maternal deaths, reviewing various risk factors such as maternal-age, socioeconomic status, health-service access and utilization, as well as several other factors. The 1994 Demographic and Health Survey and the 1995/1996 Household Health Survey data sets were the source of data for these studies. The main finding of study one has shown that the development in techniques for estimating maternal mortality from the respondent's sisters have contributed to the usefulness of secondary-type data sets. It found the data are relevant enough to illustrate the trends of fertility and maternal mortality. Precise identification of the number of maternal deaths requires serious attention to detail in order to correctly evaluate the trends in maternal mortality. The basic argument is that with an additional analytical effort one can obtain a set of fertility and maternal mortality estimates from birth histories. Study one found that the MMR was 376 per 100,000 live births in 1990--1994. This ratio may indicate a substantial underestimation of maternal mortality. The statistical analysis using regression approach illustrated a likelihood of decreasing trends in the MMR from 1968 to 1994. This study detected several factors that might help improve the quality of estimates of the MMR in the future. Study two used a logistic regression approach to determine which of various factors were most strongly associated with maternal health problems. The main findings from study two clearly support the argument that improving access to maternity care and availability of quality of information and services, particularly among high risk groups such as women under age 20 and over age 35, and those of high parity, will help to reduce maternal mortality. More detailed results suggest priority areas for improvement of program strategies. Maternal health care can be made more effective by integrating some of the following services: (1) screening to detect women at high risk, (2) referring women with complicated pregnancies to a higher level of care, (3) encouraging mothers to use health services, (4) improving quality of care at delivery, (5) training of birth attendants, (6) improving the skill of health service staff, (7) the use of modern methods in family planning, (8) providing information that help uneducated women to avoid problems during pregnancy. In addition, the analysis identified programs outside of the domain of the ministry of health that might help improve maternal health outcomes by implementing programs that: (1) improve health education to the whole family, (2) strengthen efforts to improve food security, (3) increase the ability of women to control their own fertility, (4) enhance general education, and (5) reduce poverty among the poorest of the poor in the Indonesian population.PhDDemographyHealth and Environmental SciencesPublic healthSocial SciencesUniversity of Michigan, Horace H. Rackham School of Graduate Studies, School of Public Healthhttp://deepblue.lib.umich.edu/bitstream/2027.42/131592/2/9926227.pd