PROVINCIAL DISPARITIES IN MATERNAL HEALTH: ANALYZING THE RELATIONSHIP BETWEEN ANTENATAL CARE VISIT, IRON SUPPLEMENTATION, AND MATERNAL HAEMORRHAGE IN INDONESIA

Abstract

Maternal mortality rate (MMR) is a key health measure. In Indonesia, maternal haemorrhage was a leading cause of maternal deaths in 2023. Comprehensive pregnancy care, including six antenatal visits (K6) and daily iron supplementation, is essential to ensure healthy pregnancies and reduce complications like haemorrhage. This study aimed to analyse the spatial distribution of maternal mortality due to haemorrhage in Indonesia and its correlation with antenatal care (K6) and iron supplementation (90 tablets). Spatial analysis was conducted using data from 38 provinces in Indonesia. Analysis was performed in ArcGIS with a bandwidth of 518.56 km and 999 permutations for sensitivity. Global Moran’s I and Local Indicators of Spatial Association (LISA) were used to evaluate spatial autocorrelation and clustering. In 2023, maternal mortality due to haemorrhage in Indonesia was 23.12 per 100,000 live births. The highest incidence was in Papua Pegunungan, and the lowest in Jambi. Spatial analysis showed weak positive autocorrelation for maternal mortality (Moran's I = 0.089). Antenatal care K6 and iron supplementation showed strong positive spatial autocorrelation (Moran's I = 0.697 and 0.572). Bivariate analysis revealed negative spatial correlations between maternal mortality and both antenatal care K6 and iron supplementation. This study identified spatial clustering in maternal mortality due to haemorrhage, with weak positive spatial autocorrelation. Strong clustering was found for antenatal care K6 and iron supplementation, with better coverage in western provinces. Improving antenatal care and supplementation in underperforming regions could reduce maternal mortality due to haemorrhage.