Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter?

BACKGROUND: Early initiation of breastfeeding (EIBF) is a starting point that lays the foundation for breastfeeding and bonding between mother and baby. Meanwhile, working mothers are one of the vulnerable groups for the success of exclusive breastfeeding (EBF). The study analyzed the role of EIBF on EBF among Indonesian working mothers. METHODS: The cross-sectional study examined secondary data from the 2021 Indonesian National Nutritional Status Survey. The study analyzed 4,003 respondents. We examined EBF practice as an outcome variable and EIBF as an exposure variable. We included nine control variables (residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight). All variables were assessed by questionnaire. The study employed a binary logistic regression test in the last stage. RESULTS: The result showed that the proportion of EBF among working mothers in Indonesia in 2021 was 51.9%. Based on EIBF, Indonesian working mothers with EIBF were 2.053 times more likely than those without to perform EBF (p < 0.001; AOR 2.053; 95% CI 2.028-2.077). Moreover, the study also found control variables related to EBF in Indonesia: residence, maternal age, marital, education, prenatal classes, wealth, infant age, sex, and birth weight. CONCLUSION: The study concluded that EIBF was related to EBF. Indonesian working mothers with EIBF were two times more likely than those without to perform EBF. The government needs to release policies that strengthen the occurrence of EIBF in working mothers to increase EBF coverage.

Factors related to intrapartum/delivery care in Southeast Asia: A cross-sectional study in the Philippines and Indonesia.

Background: Policy encouraging healthcare intrapartum/delivery care is critical to accelerating the decline in maternal mortality. The study analyzes intrapartum/delivery care factors in Indonesia and the Philippines. Methods: The investigation included 15,346 Indonesian and 7992 Filipino women (ages 15 to 49 who delivered during the previous five years). Aside from the location of intrapartum/delivery care as a dependent variable, additional factors investigated included domicile, marital status, age, occupation, education, parity, wealth, and ANC-the conclusion of the study utilizing binary logistic regression. Results: Women in both countries predominantly do healthcare intrapartum/delivery care. Both countries' urban women are more likely to receive intrapartum/delivery care than rural women. The higher the amount of schooling, the greater the likelihood of receiving intrapartum/delivery care. The lower the parity, the higher the chance to do healthcare intrapartum/delivery care. The higher the wealth position, the greater the likelihood of receiving intrapartum/delivery care. Furthermore, women in both nations who had four or more antenatal visits were more likely to receive intrapartum/delivery care. Conclusion: The study concluded five factors related to healthcare intrapartum/delivery care in the Philippines: residence, education, parity, wealth, and ANC. Meanwhile, there are six factors related to healthcare intrapartum/delivery care in Indonesia: place, age, education, parity, wealth, and ANC.

Unmarried Women and Unintended Pregnancy: An Indonesian Cross-Sectional Study.

Background: Indonesia has moral norms consider pregnancy among unmarried women a disgrace. The study analyzes the factors influencing unintended pregnancies among unmarried women in Indonesia. Material and Methods: The study examined 1,050 women. The author analyzed unintended pregnancy and six other variables (residence, age, education, employment, wealth, and parity). Multivariate analysis used binary logistic regression. Results: 15.5% of unmarried women in Indonesia have experienced an unintended pregnancy. Women living in urban areas are more likely to experience unintended pregnancies than women in rural areas. The 15-19 have the highest chance of experiencing an unintended pregnancy. Education is a protective factor from unintended pregnancy. Employed women are 1.938 times more likely than unemployed. Poverty is a risk factor for experiencing an unintended pregnancy. Multiparous is 4.095 times more likely than primiparous. Conclusion: The study identified six variables that affect unintended pregnancy among unmarried women in Indonesia: residence, age, education, employment, wealth, and parity.

The choice of delivery place in Indonesia: Does home residential status matter?

Background: To care for their health needs, women in Indonesia who live with their parents or in-laws frequently lose their independence, including the choice of delivery place. Aim: The study aimed to analyze the effect of home residential status on the choice of delivery place in Indonesia. Methods: The study design was a cross-sectional study. The study employed secondary data from 2017 Indonesian Demographic and Health Survey (IDHS). The research included 15,357 women aged 15-49 with live births in the last five years. Meanwhile, the study used place of delivery as an outcome variable and home residential status as an exposure variable. Moreover, the research employed nine control variables: type of residence, age group, education level, employment status, marital status, parity, wealth status, health insurance, and antenatal care visits-the final analysis using binary logistic regression. Findings: The result shows that women with home residential status in the alone category were 1.248 times more likely than those in the joint category to choose to give birth to healthcare facilities (AOR 1.248; 95% CI 1.143-1.361). In addition to home residential status, the study also found seven control variables to have a relationship with the choice of place of delivery. The seven control variables were the type of residence, age group, education level, parity, wealth status, health insurance, and antenatal care. Conclusion: The study concluded that home residential status affects the choice of delivery place in Indonesia.

Development of contextual learning models through collaboration between lecturers, students, and village governments in nursing education.

PURPOSE: This study aims to develop a contextual learning model through a collaboration between lecturers, students, and the village government for nursing education. METHODS: This study used a qualitative design. The process of collecting the data was done through focus group discussions with 12 informants representing four stakeholders. There were four focus groups, namely universities, village governments, community health centers, and students. The discussion used open-ended questions that were developed through two parameters, the learning outcomes and learning activities. The data analysis undertaken used thematic analysis specifically. RESULTS: There were 11 grouped concepts found in this study which were able to be divided into three categories. The learning outcome category was formed of four concepts, including attitudes, mastery of knowledge, skills, and values. The learning process category was formed of five concepts, namely learning resources, learning methods and forms, learning media, learning time, and learning subjects. The main sources of contextual learning were found to be programs and maternal and child health (MCH) issues in the village. Techniques and instruments were the two concepts in the assessment category. A collaboration between lecturers and the village government to help students and to provide learning resources in the village integrates the program (MCH) with the learning outcomes. CONCLUSION: These concepts are the initial framework to help the head of the study program to integrate the MCH programs and cases in the curriculum and to facilitate the contextualization of the knowledge from the nursing students.

Relationship between family support, personal communication, shared decision making, and breastfeeding in low birth weight babies.

Breastfeeding promotion is done in the form of education, not shared decision making. Consequently, breastfeeding while in hospital is still so low that problems arise after being discharged from the hospital. Researchers aimed to analyze the relationship between family support, personal communication, shared decision making, and breastfeeding in low birth weight babies. This study was a cross-sectional design conducted in three hospitals in the East Java province of Indonesia. Two-hundred mothers who have babies were selected as samples using simple random sampling. The variables were collected by a questionnaire. The data were then analyzed using path analysis. Breastfeeding showed a direct and positive relationship with shared decision making (b = 0.53; 95% CI = 0.25 to 0.81; p = <0.001). Shared decision making was directly and positively related with personal communication (b = 0.67; 95% CI = 0.56 to 0.77; p = <0.001). Personal communication showed a direct and positive relationship with family support (b = 0.40 95% CI = 0.24 to 0.57; p = <0.001). Yet, breastfeeding showed an indirect relationship with family support and personal communication. Breastfeeding increases with shared decision making and excellent personal communication between nurses and mothers. Personal communication will increase when getting support from the family.

Regional differences in primary healthcare utilization in Java Region-Indonesia.

BACKGROUND: Policymakers must understand primary healthcare utilization disparity to minimize the gap because they must seek fair service for every citizen. The study analyzes regional differences in primary healthcare utilization in Java Region-Indonesia. METHODS: The cross-sectional research analyzes secondary data from the 2018 Indonesian Basic Health Survey. The study setting represented Java Region-Indonesia, and the participants were adults 15 years or more. The survey explores 629,370 respondents. The study used primary healthcare utilization as an outcome variable and province as the exposure variable. Moreover, the study employed eight control variables (residence, age, gender, education, marital, employment, wealth, and insurance). The study evaluated data using binary logistic regression in the final step. RESULTS: People in Jakarta are 1.472 times more likely to utilize primary healthcare than those in Banten (AOR 1.472; 95% CI 1.332-1.627). People in Yogyakarta are 1.267 times more likely to use primary healthcare than those in Banten (AOR 1.267; 95% CI 1.112-1.444). In addition, people in East Java are 15% less likely to utilize primary healthcare than those in Banten (AOR 0.851; 95% CI 0.783-0.924). Meanwhile, direct healthcare utilization was the same between West Java, Central Java, and Banten Province. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta. CONCLUSION: Disparities between regions exist in the Java Region-Indonesia. They are sequentially starting from the minor primary healthcare utilization: East Java, Central Java, Banten, West Java, Yogyakarta, and Jakarta.

Predictors of national health insurance membership among the poor with different education levels in Indonesia.

BACKGROUND: Indonesia has made significant progress in expanding universal health coverage (UHC) through its National Health Insurance (NHI) mechanism. However, in the context of NHI implementation in Indonesia, socioeconomic disparities caused its subpopulations to have different literacy of NHI concepts and procedures, increasing the risk of healthcare access inequities. Hence, the study aimed to analyse the predictors of NHI membership among the poor with different education levels in Indonesia. METHODS: This study used the secondary dataset of the nationwide survey "Abilities and Willingness to Pay, Fee, and Participant Satisfaction in implementing National Health Insurance in Indonesia in 2019" by The Ministry of Health of the Republic of Indonesia. The study population was the poor population in Indonesia and included a weighted sample of 18,514 poor people. The study used NHI membership as a dependent variable. Meanwhile, the study analysed seven independent variables: wealth, residence, age, gender, education, employment, and marital status. In the final step of the analysis, the study used binary logistic regression. RESULTS: The results show that the NHI membership among the poor population tends to be higher among those who have higher education, live in urban areas, are older than 17 years old, are married and are wealthier. The poor population with higher education levels is more likely to become NHI members than those with lower education. Their residence, age, gender, employment, marital status, and wealth also predicted their NHI membership. Poor people with primary education are 1.454 times more likely to be NHI members than those without education (AOR 1.454; 95% CI 1.331-1.588). Meanwhile, those with secondary education are 1.478 times more likely to be NHI members than those with no education (AOR 1.478; 95% CI 1.309-1.668). Moreover, higher education is 1.724 times more likely to result in being an NHI member than no education (AOR 1.724; 95% CI 1.356-2.192). CONCLUSION: Education level, residence, age, gender, employment, marital status, and wealth predict NHI membership among the poor population. Since significant differences exist in all of those predictors among the poor population with different education levels, our findings highlighted the importance of government investment in NHI, which must be supported with investment in the poor population's education.

Hospital utilization among urban poor in Indonesia in 2018: is government-run insurance effective?

BACKGROUND: An urban poor is a vulnerable group that needs government financing support to access health services. Once they are sick, they will fall deeper into poverty. The study aims to analyze the effectiveness of government-run insurance in hospital utilization in urban poor in Indonesia. METHODS: The research analyzed the 2018 Indonesian Basic Health Survey data. This cross-sectional survey collected 75,970 participants through stratification and multistage random sampling. Meanwhile, the study employed hospital utilization as an outcome variable and health insurance ownership as an exposure variable. Moreover, the study looked at age, gender, marital status, education, and occupation as control factors. The research employed a binary logistic regression to evaluate the data in the final step. RESULTS: The results show that someone with government-run insurance is 4.261 times more likely than the uninsured to utilize the hospital (95% CI 4.238-4.285). Someone with private-run insurance is 4.866 times more likely than the uninsured to use the hospital (95% CI 4.802-4.931). Moreover, someone with government-run and private-run insurance has 11.974 times more likely than the uninsured to utilize the hospital (95% CI 11.752-12.200). CONCLUSION: The study concluded that government-run insurance is more effective than the uninsured in improving hospital utilization among the urban poor in Indonesia. Meanwhile, private-run is more effective than government-run and uninsured in improving hospital utilization among the urban poor in Indonesia. Moreover, the most effective is to combine the kind of health insurance ownership (government-run and private-run).

Regional disparities in hospital utilisation in Indonesia: a cross-sectional analysis data from the 2018 Indonesian Basic Health Survey.

OBJECTIVES: Policymakers must ensure that the entire population has equal access to health services, and efforts to minimise inequalities are needed. This study aimed to analyse the regional disparities in hospital utilisation in Indonesia. DESIGN: A cross-sectional study analysing secondary data from the 2018 Indonesian Basic Health Survey. SETTING: National-level survey data from Indonesia. PARTICIPANTS: A total of 629 370 participants were included in the study.InterventionWe employed no interventionPrimary and secondary outcome measuresThe primary outcome was hospital utilisation. Aside from region, we utilise residence type, age, gender, marital status, educational level, occupation, wealth, insurance and travel time as control variables. We used binary logistic regression in the final analysis RESULTS: The respondents in Sumatra were 1.079 times (95% CI 1.073 to 1.085) more likely than those in Papua to use the hospital. Furthermore, compared with the respondents in Papua, those in the Java-Bali region (1.075 times, 95% CI 1.069 to 1.081), Nusa Tenggara (1.106 times, 95% CI 1.099 to 1.113), Sulawesi (1.008 times, 95% CI 1.002 to 1.014) and Kalimantan (1.212 times, 95% CI 1.205 to 1.219) were more likely to use the hospital. However, those in Maluku were less likely than those in Papua to use the hospital (0.827 times, 95% CI 0.820 to 0.835). Six demographic variables (age, gender, marital status, educational level, occupation and wealth) and three other control variables (residence type, insurance and travel time to the hospital) were found to be associated with hospital utilisation. CONCLUSIONS: Our findings highlight the existence of regional disparities in hospital utilisation in Indonesia.

Factors Associated with the Place of Delivery among Urban Poor Societies in Indonesia.

Background: Pregnant women in urban poor societies are vulnerable groups. Due to low financial capacity, there are obstacles to accessing delivery in an institution for poor women in urban areas. The study analyses factors associated with the delivery place among pregnant women in urban poor society in Indonesia. Materials and Methods: The study analyzed secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 1,562 samples were childbearing-age women (15-49 years) who gave birth in an urban poor society in Indonesia in the last 5 years. The study examined some variables, such as delivery place, age, education, employment, marital status, parity, insurance, knowledge of pregnancy danger, antenatal care (ANC), the autonomy of health, and family finance autonomy. The study employed binary logistic regression in the final stage. Results: The results show that age is associated with the place of delivery. The higher the education, the higher the possibility for delivery in an institution. Being employed and having partners are protective factors for women in institution delivery. The likelihood of giving birth in a medical facility decreases as more children are born alive. In addition, having health insurance, thorough ANC visits, knowledge of pregnancy danger symptoms, and health autonomy are protective factors for pregnant women having deliveries in medical facilities. On the contrary, pregnant women who rely solely on family financing have a higher chance of delivering in a medical facility. Conclusion: The study concluded that 10 variables were associated with pregnant women's delivery in Indonesia's urban poor society: age, education, employment, marital, parity, insurance, pregnancy danger knowledge, ANC, health autonomy, and family finance autonomy.

The Role of Government-run Insurance in Primary Health Care Utilization: A Cross-Sectional Study in Papua Region, Indonesia, in 2018.

Health development in the Papua region often lags behind other areas of Indonesia. The study aims to analyze the role of government-run insurance in primary health care utilization in the Papua region, Indonesia. The study examined 17,879 Papuan. The study used primary health care utilization as an outcome variable and health insurance ownership as an exposure variable. The study also employed nine control variables: province, residence, age, gender, marital status, education, employment, wealth, and travel time to primary health care. The research employed data using binary logistic regression in the final analysis. The results show that Papuans with government-run insurance were three times more likely to utilize primary health care than uninsured Papuans (AOR 3.081; 95% CI 3.026-3.137). Meanwhile, Papuan with private-run insurance were 0.133 times less likely to utilize primary health care than uninsured Papuans (AOR 0.133; 95% CI 0.109-0.164). Moreover, Papuans who have two types of health insurances (government-run and private-run) were 1.5 times more likely to utilize the primary health care than uninsured Papuan (AOR 1.513; 95% CI 1.393-1.644). The study concluded that government-run insurance increases the chance of primary health care utilization in the Papua region, Indonesia. Government-run insurance has the most prominent role compared to other health insurance categories.

Health insurance ownership among female workers in Indonesia: does socioeconomic status matter?

BACKGROUND: Female workers are vulnerable groups in the Indonesian context, and female workers must be responsible for domestic problems and earn a living. The study aimed to analyze the role of socioeconomic on health insurance ownership among female workers in Indonesia. METHODS: The study population was all female workers in Indonesia. This cross-sectional study involved 7,943 respondents. The study analyzed health insurance ownership as an outcome variable and socioeconomic status as an exposure variable. The study also involved five control variables: residence, age, marital, education, and occupation. The research used multinomial logistic regression in the final step. RESULTS: The results show the poorest female workers have a possibility of 0.735 times more than the richest to have NHI (AOR 0.733; 95% CI 0.733-0.737). The poorer female workers have 0.939 times less likely than the richest to have NHI (AOR 0.939; 95% CI 0.937-0.942). Female workers with middle socioeconomic status are possibly 0.833 times less than the richest to have NHI (AOR 0.833; 95% 0.831-0.835). Moreover, the richer female workers have 1.028 times more likely than the richest to have NHI (AOR 1.028; 95% CI 1.025-1.030). Moreover, all socioeconomic statuses have a lower possibility than the richest of having other health insurance. CONCLUSIONS: The study concluded that socioeconomic has a role in health insurance ownership among female workers in Indonesia.

Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia.

BACKGROUND: Multiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia. METHODS: The study population was women aged 15-49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression. RESULTS: In both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM. CONCLUSION: The study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.

Hospital utilization in Indonesia in 2018: do urban-rural disparities exist?

BACKGROUND: The government must ensure equality in health services access, minimizing existing disparities between urban and rural areas. The referral system in Indonesia is conceptually sound. However, there are still problems of uneven service access, and there is an accumulation of patients in certain hospitals. The study aims to analyze the urban-rural disparities in hospital utilization in Indonesia. METHODS: The study used secondary data from the 2018 Indonesian Basic Health Survey. This cross-sectional study gathered 629,370 respondents through stratification and multistage random sampling. In addition to the kind of home and hospital utilization, the study looked at age, gender, marital status, education, occupation, wealth, and health insurance as control factors. The research employed multinomial logistic regression to evaluate the data in the final step. RESULTS: According to the findings, someone who lives in an urban region has 1.493 times higher odds of using outpatient hospital services than someone in a rural area (AOR 1.493; 95% CI 1.489-1.498). Meanwhile, someone who lives in an urban region has 1.075 times higher odds of using an inpatient facility hospital than someone who lives in a rural one (AOR 1.075; 95% CI 1.073-1.077). Furthermore, someone living in an urban region has 1.208 times higher odds than someone who lives in a rural area using outpatient and inpatient hospital services simultaneously (AOR 1.208; 95% CI 1.204-1.212). CONCLUSION: The study concluded there were urban-rural disparities in hospital utilization in Indonesia.

Barrier to contraceptive use among childbearing age women in rural Indonesia.

INTRODUCTION: The contraceptive prevalence rate in Indonesia has not experienced much improvement, which has led to an increase in the number of pregnancies. This study aimed to analyse the barriers to contraception use among women of childbearing age in rural Indonesia. METHODS: This study used a cross-sectional design with data from the Indonesian Demographic and Health Survey (IDHS) of 2017. The independent variables were age, employment status, education, marital status, wealth status, health insurance and parity. The dependent variable was the use of contraception. The statistical significance was set at p <0.05 using bivariate analysis and binary logistic regression. RESULTS: The study showed that the age group of 45-49 years (OR 0.199; 95% CI 0.149-0.266), secondary education (OR 2.227; 95% CI 2.060-2.514), women married/living with their partner (OR 43.752; 95% CI: 35.484-53.946), wealth status: middle (OR 1.492; 95% CI 1.400-1.589) and multipara (OR 2.524; 95% CI: 2.328-2.737) exhibited the increased use of contraception among women of childbearing age in rural Indonesia. CONCLUSION: The variables proven to represent obstacles to contraceptive use among women of childbearing age in rural Indonesia include old age, no education, no husband/partner, poverty and already having one child.

Urban-rural disparities of antenatal care in South East Asia: a case study in the Philippines and Indonesia.

BACKGROUND: The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. METHODS: The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15-49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. RESULTS: The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC's use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. CONCLUSIONS: The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.