Barriers to Institutional Delivery in Urban Poor Society: Findings From Indonesia’s National Survey

TL;DR

This study identifies key barriers to institutional delivery among Indonesia's urban poor, including low education, unemployment, and lack of insurance.

Contribution

The study provides new insights into specific socioeconomic and demographic factors affecting institutional delivery in Indonesia's urban poor population.

Findings

Approximately 38.1% of Indonesian pregnant women had non-institutional deliveries.

Uninsured women were 2.364 times more likely to give birth outside healthcare institutions.

Seven factors were identified as barriers to institutional delivery, including low education and unemployment.

Abstract

The urban poor represent a vulnerable population within society, particularly in terms of maternal health. Economic and access-related limitations often prevent this group from accessing healthcare services, especially in the institutional delivery process. This study aimed to analyze the barriers to institutional delivery among Indonesia’s poor urban society.

This study employed a cross-sectional design.

Data were obtained from the 2023 Indonesian Health Survey, including 7,548 participants. Eight independent variables were analyzed, including age, education, marital status, employment, wealth, insurance, and parity, with institutional delivery used as the dependent variable. Binary logistic regression was employed for analysis.

Approximately 38.1% of Indonesian pregnant women had non-institutional deliveries. All age groups showed a higher likelihood of non-institutional delivery compared to those aged≥45. Lower education levels were associated with a heightened probability of choosing non-institutional delivery. Married women were 0.704 times less likely than divorced or widowed women to give birth in non-institutional settings (AOR: 0.704; 95% CI: 0.693-0.716). Unemployed women had 1.218 times higher likelihood of engaging in non-institutional delivery compared to employed women (AOR: 1.218; 95% CI: 1.1210-1.226). The poorest women were 0.973 times less likely than the poorer group to have non-institutional delivery (AOR: 0.973; 95% CI: 0.967-0.980). Uninsured women were 2.364 times more likely than insured women to give birth outside of healthcare institutions(AOR: 2.364; 95% CI: 2.345-2.379). Women with all other parity levels were less likely than grand multiparous women to have non-institutional deliveries.

Seven barrier factors to institutional delivery were younger age, low education, divorced/widowed marital status, unemployment, lower wealth status, lack of insurance, and grand multiparity.

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