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Abstract

This study assessed socioeconomic inequalities in maternal healthcare utilization in Indonesia and identifies key factors driving these inequalities. We used data from 2013 and 2023 Indonesian Health Surveys, comprised of a total unweighted sample of 15,638 and 9,923 women aged 15-49 in the 2013 and 2023, respectively. Concentration index (CI) measured wealth-based inequality, and decomposition analysis identified primary drivers of inequalities in maternal healthcare access. Overall maternal healthcare service utilization has increased, but significant inequalities persist. Antenatal care showed minimal improvement, with the CI rising from 0.059 to 0.079, indicating a persistent higher socioeconomic distribution. Facility-based deliveries improved, with the CI decreasing from 0.115 to 0.039. Cesarean section inequality, though reduced, remains high, with CI declining from 0.299 to 0.158. Decomposition analysis revealed that socioeconomic status, women’s education, and geographic location were the primary drivers of inequalities in maternal healthcare utilization. While Indonesia has made progress in increasing facility-based deliveries, especially among the poorest women, inequalities persist in antenatal care and cesarean section. Pro-poor policies must address these multidimensional barriers by improving access to education, particularly for women, and implementing region-specific interventions, especially in eastern Indonesia, which lags in healthcare development

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Bahasa Abstract

Studi ini menilai ketimpangan sosial ekonomi dalam pemanfaatan layanan kesehatan ibu di Indonesia dan mengidentifikasi faktor utama yang mendorong ketimpangan tersebut. Data yang digunakan berasal dari Survei Kesehatan Indonesia tahun 2013 dan 2023, dengan total sampel tidak berbobot sebanyak 15.638 dan 9.923 perempuan usia 15–49 tahun pada tahun 2013 dan 2023. Indeks Konsentrasi (CI) digunakan untuk mengukur ketimpangan berdasarkan kekayaan, dan analisis dekomposisi digunakan untuk mengidentifikasi faktor utama ketimpangan dalam akses layanan kesehatan ibu. Secara keseluruhan, pemanfaatan layanan kesehatan ibu mengalami peningkatan, namun ketimpangan yang signifikan masih tetap ada. Pemanfaatan layanan antenatal menunjukkan perbaikan yang minimal, dengan CI meningkat dari 0,059 menjadi 0,079, menandakan distribusi yang masih condong ke kelompok kaya. Persalinan di fasilitas kesehatan mengalami perbaikan, dengan CI menurun dari 0,115 menjadi 0,039. Ketimpangan pada persalinan sesar, meskipun menurun, tetap tinggi, dengan CI turun dari 0,299 menjadi 0,158. Analisis dekomposisi menunjukkan bahwa status sosial ekonomi, tingkat pendidikan perempuan, dan lokasi geografis merupakan pendorong utama ketimpangan dalam pemanfaatan layanan kesehatan ibu. Meskipun Indonesia telah menunjukkan kemajuan dalam meningkatkan persalinan di fasilitas kesehatan, khususnya di kalangan perempuan miskin, ketimpangan masih terjadi pada layanan antenatal dan persalinan sesar. Kebijakan yang berpihak pada kelompok miskin harus mengatasi hambatan multidimensi ini dengan meningkatkan akses terhadap pendidikan, terutama bagi perempuan, serta menerapkan intervensi spesifik wilayah, terutama di wilayah Indonesia bagian timur yang masih tertinggal dalam pembangunan layanan kesehatan.

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