Determinants of non-use of antenatal care services in eastern Indonesia: analysis of the 2023 Indonesia health survey

Introduction: Although Indonesia has made significant progress in improving maternal and child health nationally, regional disparities persist, particularly in eastern Indonesia, where maternal and neonatal health outcomes remain suboptimal compared with the western regions. This study examined factors associated with non-use of antenatal care (ANC) in eastern Indonesia. Methods: We analyzed data from 3,261 mothers with infants under one year of age in eastern Indonesia who were interviewed in the 2023 Indonesia Health Survey. The primary outcome was maternal non-use at ANC during pregnancy with an infant younger than 12 months at the time of the survey. Eighteen potential predictors of non-use of ANC were assessed using a multilevel analysis. Results: Approximately 5% (95% CI: 4.14–6.09) of the mothers with infants 0–11 months did not seek antenatal care. Non-use was associated with infant age, region, socioeconomic status, health checks, knowledge of stunting, and pregnancy-related complications. Mothers with infants aged 6–11 months were 63% less likely to forgo ANC [adjusted odds ratio (aOR) = 0.63, p = 0.049]. Living in Sulawesi (aOR = 2.66, p = 0.001), Maluku (aOR = 13.76, p < 0.001), and Papua (aOR = 17.72, p < 0.001) increased ANC non-use. The poorest households had 9.90 times higher odds of non-use than the richest households (p < 0.001). Higher non-use was also linked to no prior health checks (aOR = 2.54, p = 0.006), low stunting knowledge (aOR = 2.93, p = 0.004), and no pregnancy complications (aOR = 4.30, p = 0.001). Conclusions: Socioeconomic and geographic disparities drive non-use of antenatal care in eastern Indonesia. Improving healthcare access, education, and early screening are crucial for reducing regional inequalities and enhancing maternal health.