Objective To assess whether the strategy of \"a midwife in every
village\" in Indonesia achieved its aim of increasing professional
delivery care for the poorest women.
Methods Using pooled Demographic and Health Surveys (DHS) data from
1986-2002, we examined trends in the percentage of births attended by a
health professional and deliveries via caesarean section. We tested for
effects of the economic crisis of 1997, which had a negative impact on
Indonesia's health system. We used logistic regression, allowing for
time-trend interactions with wealth quintile and urban/rural residence.
Findings There was no change in rates of professional attendance or
caesarean section before the programme's full implementation
(1986-1991). After 1991, the greatest increases in professional
attendance occurred among the poorest two quintiles - 11% per year
compared with 6% per year for women in the middle quintile (P = 0.02).
These patterns persisted after the economic crisis had ended. In
contrast, most of the increase in rates of caesarean section occurred
among women in the wealthiest quintile. Rates of caesarean deliveries
remained at less than 1% for the poorest two-fifths of the population,
but rose to 10% for the wealthiest fifth.
Conclusion The Indonesian village midwife programme dramatically reduced
socioeconomic inequalities in professional attendance at birth, but the
gap in access to potentially life-saving emergency obstetric care
widened. This underscores the importance of understanding the barriers
to accessing emergency obstetric care and of the ways to overcome them,
especially among the poor.
Did the strategy of skilled attendance at birth reach the poor in Indonesia? Bulletin of the World Health Organization, 85 (10).
Did the strategy of skilled attendance at birth reach the poor in Indonesia?