Professional assistance during birth and maternal mortality in two Indonesian districts.


Ronsmans, C; Scott, S; Qomariyah, SN; Achadi, E; Braunholtz, D; Marshall, T; Pambudi, E; Witten, KH; Graham, WJ; (2009) Professional assistance during birth and maternal mortality in two Indonesian districts. Bulletin of the World Health Organization, 87 (6). pp. 416-23. ISSN 0042-9686 DOI: https://doi.org/10.2471/blt.08.051581

[img]
Preview
Text - Published Version
License:

Download (655kB) | Preview

Abstract

OBJECTIVE: To examine determinants of maternal mortality and assess the effect of programmes aimed at increasing the number of births attended by health professionals in two districts in West Java, Indonesia. METHODS: We used informant networks to characterize all maternal deaths, and a capture-recapture method to estimate the total number of maternal deaths. Through a survey of recent births we counted all midwives practising in the two study districts. We used case-control analysis to examine determinants of maternal mortality, and cohort analysis to estimate overall maternal mortality ratios. FINDINGS: The overall maternal mortality ratio was 435 per 100,000 live births (95% confidence interval, CI: 376-498). Only 33% of women gave birth with assistance from a health professional, and among them, mortality was extremely high for those in the lowest wealth quartile range (2303 per 100,000) and remained very high for those in the lower middle and upper middle quartile ranges (1218 and 778 per 100,000, respectively). This is perhaps because the women, especially poor ones, may have sought help only once a serious complication had arisen. CONCLUSION: Achieving equitable coverage of all births by health professionals is still a distant goal in Indonesia, but even among women who receive professional care, maternal mortality ratios remain surprisingly high. This may reflect the limitations of home-based care. Phased introduction of fee exemption and transport incentives to enable all women to access skilled delivery care in health centres and emergency care in hospitals may be a feasible, sustainable way to reduce Indonesia's maternal mortality ratio.

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Maternal Health Group
PubMed ID: 19565119
Web of Science ID: 267097500007
URI: http://researchonline.lshtm.ac.uk/id/eprint/5184

Statistics


Download activity - last 12 months
Downloads since deposit
183Downloads
309Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item