Sociodemographic disadvantage and low healthcare access as contributing factors to high maternal death in Papua, Indonesia: multilevel analysis of census population data
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Maternal mortality remains a major public health challenge in Indonesia, with Papua province experiencing the highest provincial maternal mortality ratio. Evidence on how both individual- and community-level factors contribute to maternal deaths in this context remains limited. METHODS: This study analyzed data from the 2020 Indonesian Population Census, including 18,886 women aged 15-49 years in Papua, of whom 169 experienced maternal death. Maternal deaths were identified using the census mortality module. Descriptive statistics and χ2 tests examined bivariate associations. Multilevel logistic regression models were applied to estimate the effects of individual- and community-level determinants, accounting for district-level clustering. Sensitivity analysis using modified Poisson regression with robust variance was conducted to assess robustness of estimatesResults: Maternal mortality was significantly associated with advanced maternal age (>35 years, adjusted odds ratio (aOR) 2.92, 95% confidence interval (CI): 2.45-3.47), nulliparity (aOR 5.94, 95%CI: 4.74-7.44), unmarried status (aOR 2.79, 95%CI: 2.19-3.56), low education (aOR 2.03, 95%CI: 1.38-3.00), and rural residence (aOR 1.95, 95%CI: 1.56-2.45). None of the community-level variables were statistically significant. Substantial between-regency variation persisted in the final multilevel model (intraclass correlation coefficient = 0.61; median odds ratio = 8.95), indicating strong contextual disparities. CONCLUSION: Maternal mortality in Papua is driven primarily by sociodemographic disadvantage and rural residence, while community-level health system factors alone did not explain between-regency variation. Policies should prioritize improving access and quality of care for first-time and unmarried mothers, enhancing youth-friendly health services, and addressing rural barriers through referral strengthening, maternity waiting homes, and integration of traditional birth attendants. Long-term investments in education and health workforce retention in remote areas remain critical to reducing maternal deaths in Papua.
Source: Rural and Remote Health
DOI: 10.22605/rrh9349
Institution: Yonsei University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4415889347
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