Determinants of Birth Delivery Assistance in Six Indonesian Provinces, 2012

To address the high maternal mortality rate, the Indonesia government requires that birth deliveries be attended by skilled birth attendants at health facilities. However, some studies still show gaps. To improve strategy and policy, the question has arisen whether the determinants of birth delivery assistance exist at the individual or the sub-national level. This study was aimed at determining its contextual determinants. Secondary data from the 2012 Indonesia Demographic and Health Survey on a sample of 2542 females who gave birth in six provinces in Indonesia were analysed. The dependent variable was a composite of delivery location and the presence of birth attendants. Multilevel multinomial logistic regression analysis was performed to calculate the adjusted odds ratio (OR) and decrease in variation. The results showed that 43% of the respondents gave birth at health facilities assisted by skilled birth attendants. Individual factors that predisposed or enabled individuals to use healthcare service affected birth delivery assistance with an OR of 2 to 3. The provincial-level factors of the health facility ratio, population density and hospital beds to births ratio had substantially less effect. Nevertheless, these contextual variables produced a positive 24% decrease in variations of delivery location and the presence of birth attendants, with an OR of 1.7. These results support the conclusions that the programme needs to focus more on rural areas, promote the importance of birth delivery at healthcare facilities, especially during antenatal care and improve the distribution of healthcare professionals and the provision of healthcare facilities by taking into account population density