Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia

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Yunisa Astiarani
Giovani I.G. Putri
Nur Fitriah
Felicia Kurniawan


The study examines the association of unwanted pregnancy and the utilization of maternal-child health services, and the adverse health outcomes in urban and rural settings. The study employed data from the 2017 Indonesia Demographic Health Survey that included 13,806 live births; the mothers were not pregnant at the interview and were married participants. The multiple logistic regression analysis concerning residential areas was conducted separately to compare outcomes related to unwanted pregnancy. Non-standard antenatal care visits (adjusted odds ratio [AOR]=1.7; 95% confidence interval [CI]=1.2–2.4), prolonged labor (AOR=1.6; 95% CI=1.2–2.1), the absence of child’s birth documentation (AOR=1.3; 95% CI=1.0–1.6), and smaller baby size (AOR=1.2; 95% CI=1.0–1.4) are associated with unwanted pregnancy in urban areas. In rural settings, on the other hand, unwanted pregnancy is associated with non-standard antenatal care (AOR=1.6; 95% CI=1.2–2.2). Therefore, in Indonesia, urban areas lack maternal-child healthcare services utilization and higher adverse events due to unwanted pregnancy than rural areas. An adjustment approach is required in maternal-child health-related programs in both areas, particularly for women living in urban.


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Astiarani, Y., Maybelline, Putri, G. I., Fitriah, N., & Kurniawan, F. (2021). Under-Utilization of Maternal-Child Healthcare Services and Adverse Outcomes of Unwanted Pregnancies in Urban and Rural Areas of Indonesia. Journal of Population and Social Studies [JPSS], 30, 170 - 182. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/256990
Author Biography

Yunisa Astiarani, Department of Public Health and Nutrition, School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia

Corresponding author


• Abame, D. E., Abera, M., Tesfay, A., Yohannes, Y., Ermias, D., Markos, T., & Goba, G. (2019). Relationship between unintended pregnancy and antenatal care use during pregnancy in Hadiya Zone, Southern Ethiopia. Journal of Reproduction & Infertility, 20(1), 42–51. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6386792/
• Acharya, P., Gautam, R., & Aro, A. R. (2016). Factors influencing mistimed and unwanted pregnancies among Nepali women. Journal of Biosocial Science, 48(2), 249–266. https://doi.org/10.1017/s0021932015000073
• Ayele, E., Gebreayezgi, G., Mariye, T., Bahrey, D., Aregawi, G., & Kidanemariam, G. (2020). Prevalence of undernutrition and associated factors among pregnant women in a public general hospital, Tigray, Northern Ethiopia: A cross-sectional study design. Journal of Nutrition and Metabolism, 2020, 2736536. https://doi.org/10.1155/2020/2736536
• Bahk, J., Yun, S. C., Kim, Y., & Khang, Y. H. (2015). Impact of unintended pregnancy on maternal mental health: A causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy and Childbirth, 15, 85. https://doi.org/10.1186/s12884-015-0505-4
• Beyene, G. A. (2019). Prevalence of unintended pregnancy and associated factors among pregnant mothers in Jimma town, southwest Ethiopia: A cross sectional study. Contraception and Reproductive Medicine, 4, 8. https://doi.org/10.1186/s40834-019-0090-4
• Bishwajit, G., Tang, S., Yaya, S., & Feng, Z. (2017). Unmet need for contraception and its association with unintended pregnancy in Bangladesh. BMC Pregnancy and Childbirth, 17, 186. https://doi.org/10.1186/s12884-017-1379-4
• Channon, A. A. R. (2011). Can mothers judge the size of their newborn? Assessing the determinants of a mother’s perception of a baby’s size at birth. Journal of Biosocial Science, 43(5), 555–573. https://doi.org/10.1017/s0021932011000198
• Channon, A. A. R., Padmadas, S. S., & McDonald, J. W. (2011). Measuring birth weight in developing countries: Does the method of reporting in retrospective surveys matter? Maternal and Child Health Journal, 15(1), 12–18. https://doi.org/10.1007/s10995-009-0553-3
• de Oliveira, A. A., de Almeida, M. F., da Silva, Z. P., de Assunção, P. L., Silva, A. M. R., dos Santos, H. G., & Alencar, G. P. (2019). Fatores associados ao nascimento pré-termo: da regressão logística à modelagem com equações estruturais [Factors associated with preterm birth: From logistic regression to structural equation modeling]. Cadernos de Saúde Pública, 35(1), e00211917. https://doi.org/10.1590/0102-311X00211917
• Dibaba, Y., Fantahun, M., & Hindin, M. J. (2013a). The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: Evidence from rural Southwestern Ethiopia. BMC Pregnancy and Childbirth, 13, 135. https://doi.org/10.1186/1471-2393-13-135
• Dibaba, Y., Fantahun, M., & Hindin, M. J. (2013b). The effects of pregnancy intention on the use of antenatal care services: Systematic review and meta-analysis. Reproductive Health, 10, 50. https://doi.org/10.1186/1742-4755-10-50
• Dott, M., Rasmussen, S. A., Hogue, C. J., Reefhuis, J., & National Birth Defects Prevention Study. (2010). Association between pregnancy intention and reproductive-health related behaviors before and after pregnancy recognition, National Birth Defects Prevention Study, 1997-2002. Maternal and Child Health Journal, 14, 373–381. https://doi.org/10.1007/s10995-009-0458-1
• Exavery, A., Kanté, A. M., Njozi, M., Tani, K., Doctor, H. V., Hingora, A., & Phillips, J. F. (2014). Predictors of mistimed, and unwanted pregnancies among women of childbearing age in Rufiji, Kilombero, and Ulanga districts of Tanzania. Reproductive Health, 11, 63. https://doi.org/10.1186/1742-4755-11-63
• Guspaneza, E., & Martha, E. (2019). Determinant of unwanted pregnancy in Indonesia 2017 (A secondary data analysis of 2017 IDHS). Proceedings of the International Conference on Applied Science and Health, 4, 1135–1144. https://publications.inschool.id/index.php/icash/article/view/474
• Guterman, K. (2015). Unintended pregnancy as a predictor of child maltreatment. Child Abuse & Neglect, 48, 160–169. https://doi.org/10.1016/j.chiabu.2015.05.014
• Hajizadeh, M., & Nghiem, S. (2020). Does unwanted pregnancy lead to adverse health and healthcare utilization for mother and child? Evidence from low- and middle-income countries. International Journal of Public Health, 65, 457–468. https://doi.org/10.1007/s00038-020-01358-7
• Hall, J. A., Benton, L., Copas, A., & Stephenson, J. (2017). Pregnancy intention and pregnancy outcome: Systematic review and meta-analysis. Maternal and Child Health Journal, 21(3), 670–704. https://dx.doi.org/10.1007%2Fs10995-016-2237-0
• ICF International. (2012). Demographic and Health Survey Sampling and Household Listing Manual. MEASURE DHS. ICF International. https://www.dhsprogram.com/publications/publication-dhsm4-dhs-questionnaires-and-manuals.cfm
• Islam, M., & Sultana, N. (2019). Risk factors for pregnancy related complications among urban slum and non-slum women in Bangladesh. BMC Pregnancy and Childbirth, 19, 235. https://doi.org/10.1186/s12884-019-2392-6
• Kimmel, M. C., Ferguson, E. H., Zerwas, S., Bulik, C. M., & Meltzer-Brody, S. (2016). Obstetric and gynecologic problems associated with eating disorders. International Journal of Eating Disorders, 49(3), 260–275. https://doi.org/10.1002/eat.22483
• Lesnoff, M., & Lancelot, R. (2012). aod: Analysis of Overdispersed Data. R Package Version, 1.3.1. https://cran.r-project.org/web/packages/aod/aod.pdf
• Marston, C., & Cleland, J. (2003). Do unintended pregnancies carried to term lead to adverse outcomes for mother and child? An assessment in five developing countries. Population Studies, 57(1), 77–93. https://doi.org/10.1080/0032472032000061749
• Mkandawire, P., Atari, O., Kangmennaang, J., Arku, G., Luginaah, I., & Etowa, J. (2019). Pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda. Midwifery, 68, 30–38. https://doi.org/10.1016/j.midw.2018.08.017
• Mohamed, E. A. E. B., Hamed, A. F., Yousef, F. M. A., & Ahmed, E. A. (2019). Prevalence, determinants, and outcomes of unintended pregnancy in Sohag district, Egypt. Journal of the Egyptian Public Health Association, 94, 14. https://doi.org/10.1186/s42506-019-0014-9
• Mohanty, I., & Gebremedhin, T. A. (2018). Maternal autonomy and birth registration in India: Who gets counted? PLoS ONE, 13(3), e0194095. https://doi.org/10.1371/journal.pone.0194095
• Mondal, D., Karmakar, S., & Banerjee, A. (2020). Women’s autonomy and utilization of maternal healthcare in India: Evidence from a recent national survey. PLoS ONE, 15(12), e0243553. https://doi.org/10.1371/journal.pone.0243553
• National Population and Family Planning Board (BKKBN), Statistical Indonesia (BPS), Ministry of Health (Kemenkes), & ICF. (2018). Indonesia Demographic and Health Survey 2017. BKKBN, BPS, Kemenkes, and ICF. http://dhsprogram.com/pubs/pdf/FR342/FR342.pdf
• Naveed, S., Lashari, U. G., Waqas, A., Bhuiyan, M., & Meraj, H. (2018). Gender of children and social provisions as predictors of unplanned pregnancies in Pakistan: A cross-sectional survey. BMC Research Notes, 11, 587. https://doi.org/10.1186/s13104-018-3696-8
• O’Donnell, J., Goldberg, A., Lieberman, E., & Betancourt, T. (2018). “I wouldn’t even know where to start”: Unwanted pregnancy and abortion decision-making in Central Appalachia. Reproductive Health Matters, 26(54), 98–113. https://doi.org/10.1080/09688080.2018.1513270
• R Core Team. (2019). A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria. http://www.R-project.org/
• Rahman, M. (2012). Women’s autonomy and unintended pregnancy among currently pregnant women in Bangladesh. Maternal and Child Health Journal, 16, 1206–1214. https://doi.org/10.1007/s10995-011-0897-3
• Rahman, M. M. (2015). Is unwanted birth associated with child malnutrition in Bangladesh? International Perspectives on Sexual and Reproductive Health, 41(2), 80–88. https://doi.org/10.1363/4108015
• Rahman, M. M., Rahman, M. M., Tareque, M. I., Ferdos, J., & Jesmin, S. S. (2016). Maternal pregnancy intention and professional antenatal care utilization in Bangladesh: A nationwide population-based survey. PLoS ONE, 11(6), e0157760. https://doi.org/10.1371/journal.pone.0157760
• Rahman, M., Nasrin, S. O., Rahman, M., Rahman, A., Mostofa, G., Jesmin, S. S., & Buchanan, F. (2019). Maternal pregnancy intention and its association with low birthweight and pregnancy complications in Bangladesh: Findings from a hospital-based study. International Health, 11(6), 447–454. https://doi.org/10.1093/inthealth/ihz010
• Rutstein, S. O., & Rojas, G. (2006). Guide to DHS Statistics. ORC Macro. https://www.ophi.org.uk/wp-content/uploads/OPHI-HDCA-SS2012-Guide_DHS_Statistics.pdf
• Sarder, A., Islam, S. M. S., Maniruzzaman, Talukder, A., & Ahammed, B. (2021). Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries. PLOS ONE, 16(2), e0245923. https://doi.org/10.1371/journal.pone.0245923
• Shah, I., & Åhman, E. (2009). Unsafe abortion: Global and regional incidence, trends, consequences, and challenges. Journal of Obstetrics and Gynaecology Canada, 31(12), 1149–1158. https://pubmed.ncbi.nlm.nih.gov/20085681/
• Shreffler, K. M., Spierling, T. N., Jespersen, J. E., & Tiemeyer, S. (2021). Pregnancy intendedness, maternal-fetal bonding, and postnatal maternal-infant bonding. Infant Mental Health Journal, 42(3), 362–373. https://doi.org/10.1002/imhj.21919
• Statistics Indonesia (SI), & National Population and Family Planning Board (NPFPB). (2018). Indonesia: Standard DHS, 2017 [Data set]. https://dhsprogram.com/methodology/survey/survey-display-522.cfm
• Wado, Y. D., Afework, M. F., & Hindin, M. J. (2014). Effects of maternal pregnancy intention, depressive symptoms and social support on risk of low birth weight: A prospective study from Southwestern Ethiopia. PLoS ONE, 9(5), e96304. https://doi.org/10.1371/journal.pone.0096304
• Yargawa, J., Machiyama, K., Ponce Hardy, V., Enuameh, Y., Galiwango, E., Gelaye, K., Mahmud, K., Thysen, S. M., Kadengye, D. T., Gordeev, V. S., Blencowe, H., Lawn, J. E., Baschieri, A., Cleland, J., & Every Newborn-INDEPTH Study Collaborative Group (2021). Pregnancy intention data completeness, quality and utility in population-based surveys: EN-INDEPTH study. Population Health Metrics, 19, 6. https://doi.org/10.1186/s12963-020-00227-y
• Yazdkhasti, M., Pourreza, A., Pirak, A., & Abdi, F. (2015). Unintended pregnancy and its adverse social and economic consequences on health system: A narrative review article. Iranian Journal of Public Health, 44(1), 12–21. https://pubmed.ncbi.nlm.nih.gov/26060771/