Understanding the drivers associated with maternal delivery choices: comparative study between urban and rural women in Indonesia

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BACKGROUND: Indonesia faces significant maternal and child health challenges, including a high maternal mortality ratio. The country's vast geography results in disparities in healthcare facility availability. This study aimed to identify factors influencing maternal delivery choices in health facilities across Indonesia's rural and urban areas. METHODS: This cross-sectional study analyzed data from the 2017 Indonesia Demographic Health Survey. The study population included women aged 15-49 who had given birth within 5 years preceding the survey. A total of 14,162 women were included, with 6,339 from urban and 5,009 from rural areas. Logistic regression was performed to identify factors associated with maternal delivery locations. RESULTS: The findings showed that 91.37% of urban and 69.33% of rural mothers delivered in healthcare facilities. All analyzed variables were significantly correlated with maternal delivery in health facilities across both areas. In rural areas, the sex of the household head (adjusted odds ratio [AOR], 1.32; 95% confidence interval [CI], 1.02-1.71; P=0.031) and the absence of barriers to healthcare access (AOR, 1.31; 95% CI, 1.07-1.60; P=0.008) were significant factors. Conversely, in urban areas, only maternal age was significantly associated with delivering in health facilities. CONCLUSION: Determinants of maternal delivery choices vary between rural and urban settings. In rural areas, healthcare access and household head sex are key factors, while maternal age is significant in urban areas. The government should prioritize equitable healthcare facility distribution, particularly in rural areas, and promote family involvement, especially among husbands, during antenatal care to encourage facility-based deliveries.

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