Department of Population and Biostatistics, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia.
Center for Health Research, Universitas Indonesia, Depok, Indonesia.
Popul Health Metr. 2021 Jan 11;19(1):2. doi: 10.1186/s12963-020-00245-w.
Although efforts to reduce high maternal mortality in countries such as Indonesia tend to focus on addressing health risks among pregnant women, family planning has been shown globally to reduce maternal mortality by reducing both total and higher-risk pregnancies. This article assesses past contributions of family planning to the reduction of maternal mortality in Indonesia and the potential future contribution toward achieving the 2030 SDG maternal mortality goal.
The study takes advantage of data from long series of population censuses and large-scale surveys that are available in few other low- and middle-income countries. We use the decomposition method suggested by (Matern Child Health J, 16:456-463, 2012) and regression-based policy simulations to estimate the number of maternal deaths averted during 1970-2017 due to contraceptive use and project potential future contributions to the year 2030.
It is estimated that between 523,885 and 663,146 maternal deaths were averted from 1970 to 2017 due to contraceptive use, a 37.5-43.1% reduction. If the contraceptive prevalence rate (CPR) were to rise from 63% in 2017 to 70% in 2030 and unmet need for family planning were to fall to from 10 to 7%, an additional 34,621-37,186 maternal deaths would be averted, an 18.9-20.0% reduction. A 2030 CPR of 75% and unmet need for family planning of 5% would result in 51,971-54,536 maternal deaths being averted, a 28.4-29.4% reduction. However, the CPR growth rate would have to nearly double the 2000-2017 rate to reach 70% CPR by 2030 and more than triple to reach 75%. Achieving the most ambitious target would still leave the maternal mortality ratio at 125 in 2030 without corresponding improvements in maternal health services.
Although substantial reductions in maternal mortality between 1970 and 2017 can be attributed to contraceptive use and further contributions to the year 2030 are probable, smaller contributions are likely due to the already relatively high CPR and the challenges that must be overcome to move the CPR significantly higher. The ability of Indonesia to reach the 2030 SDG maternal mortality target of 70 maternal deaths per 100,000 live births will depend primarily upon health system effectiveness in addressing health risks to women once they are pregnant.
尽管印度尼西亚等国为降低高孕产妇死亡率做出了努力，但这些努力往往侧重于解决孕妇的健康风险，而全球范围内的计划生育已被证明可以通过减少总妊娠和高风险妊娠来降低孕产妇死亡率。本文评估了计划生育过去对印度尼西亚降低孕产妇死亡率的贡献，以及其对实现 2030 年可持续发展目标孕产妇死亡率目标的潜在未来贡献。
本研究利用了在其他几个中低收入国家很少有的人口普查和大规模调查的长期数据。我们使用（《母婴健康杂志》，16:456-463，2012）建议的分解方法和基于回归的政策模拟来估计 1970 年至 2017 年期间因使用避孕药具而避免的孕产妇死亡人数，并预测 2030 年的潜在未来贡献。
据估计，1970 年至 2017 年期间，因使用避孕药具而避免了 523885 至 663146 例孕产妇死亡，减少了 37.5-43.1%。如果避孕普及率（CPR）从 2017 年的 63%上升到 2030 年的 70%，并且计划生育未满足的需求从 10%下降到 7%，则还可以避免另外 34621-37186 例孕产妇死亡，减少 18.9-20.0%。2030 年 CPR 为 75%，计划生育未满足的需求为 5%，则可避免 51971-54536 例孕产妇死亡，减少 28.4-29.4%。然而，CPR 增长率必须接近 2000-2017 年的增长率的两倍，才能在 2030 年达到 70%的 CPR，要达到 75%的 CPR，增长率必须增加两倍以上。即使实现最雄心勃勃的目标，到 2030 年，孕产妇死亡率仍将保持在每 10 万活产儿 125 例，而孕产妇保健服务却没有相应的改善。
尽管 1970 年至 2017 年期间孕产妇死亡率大幅下降可以归因于避孕药具的使用，并且 2030 年可能还会有进一步的贡献，但贡献较小的原因可能是 CPR 已经相对较高，并且要显著提高 CPR 还必须克服挑战。印度尼西亚实现 2030 年可持续发展目标孕产妇死亡率目标（每 10 万活产儿 70 例死亡）的能力主要取决于卫生系统在妇女怀孕后应对其健康风险的有效性。
