# Exploring the Multilevel Determinants of Suboptimal Maternal and Child Continuum of Care in Indonesia

## TL;DR

This study examines factors affecting maternal and child healthcare access in Indonesia, finding that young age, large family size, low income, and rural location reduce the likelihood of complete care.

## Contribution

The study introduces a nuanced multilevel analysis of maternal care and child vaccination, adjusted for age-specific vaccination doses in Indonesia.

## Key findings

- Only half of the women had complete maternal care, and one-third had both maternal care and child vaccination.
- Younger women, those with four or more children, and those in rural areas had lower odds of completing care and vaccination.
- Multilevel factors like socioeconomic status and regional disparities significantly influence care completeness.

## Abstract

Understanding the multilevel factors associated with completeness of care across the continuum of maternal and child health is needed in order to reduce maternal and child mortality and morbidity in Indonesia. This study aims to assess the multilevel determinants of continuum of care (CoC) and its contextual factors in Indonesia.

Data from the 2017 Indonesian Demographic and Health Survey were analyzed. A total of 14,398 women aged 15–49 years who had live births 5 years preceding the survey were analyzed for maternal CoC, while data from 9,206 women and their children (aged < 36 months) were analyzed for maternal CoC and vaccination. Maternal CoC include antenatal care visits, safe facility delivery, and postnatal care. Vaccination includes the 10 recommended dosages of vaccination adjusted for age. Multilevel logistic regression was used to analyse variations in maternal CoC at the individual, household and community levels.

Our findings showed that only half of the women in our study had the complete maternal CoC, and only one-third had both the complete CoC and vaccination for their children. The odds of completing CoC and vaccination are lower among women aged < 20 years, have ≥ 4 children, have low socioeconomic status, and live in rural areas or outside Java-Bali. Pregnancy-related factors were also associated with CoC completeness.

Targeted interventions to improve awareness and increase access that go beyond the individual factors should be developed. In addition to awareness campaigns, interventions aimed at reducing disparities across the different regions in Indonesia should be implemented to improve completeness of maternal CoC and vaccination.

The online version contains supplementary material available at 10.1007/s10995-025-04110-w.

What is already known on this subject?

What this study adds?

Several determinants of the maternal continuum of care (CoC) have been identified by previous studies.

For the outcome measures, we analyze child vaccination which had been adjusted to the 10 doses recommended by the Indonesian government and calibrated for the child’s age to provide more comprehensive insights into the continuum of care for maternal and child health. Furthermore, multilevel analyses of determinants of maternal CoC and maternal CoC and vaccination—including sociodemographic, socioeconomic, pregnancy-related, and contextual factors—offer a more nuanced understanding of the factors related to CoC. These findings can inform more targeted and specific recommendations for tailored interventions aimed at priority populations.

The online version contains supplementary material available at 10.1007/s10995-025-04110-w.