UNFPA Indonesia, Jakarta, Indonesia.
Department of Population and Biostatistics, Faculty of Public Health, University of Indonesia, Jakarta, Indonesia.
Reprod Health. 2021 Feb 17;18(1):42. doi: 10.1186/s12978-020-01022-6.
Prior studies have shown that contraceptive use reduces maternal mortality independently of other maternal health services. The present study took advantage of geographically detailed Indonesian data to study the interplay between contraceptive use and other risk and protective factors for maternal mortality at the community level, a level of analysis where the protective effects of family planning can be best understood.
Data from the 2015 Intercensal Population Survey (SUPAS) and the 2014 Village Potential Survey (PODES) were used to construct a series of census block-level variables measuring key risk and protective factors for maternal mortality. The relationships between these factors and maternal mortality, measured via natural log-transformation of past five-year maternal mortality ratios in each of the 40,748 census blocks were assessed via log-linear regressions.
Higher community maternal mortality ratios were associated with lower community contraceptive prevalence, higher percentage of parity four-plus births, higher proportion of poor households, lower population density of hospitals, higher density of traditional birth attendants (TBA), and residence outside of Java-Bali. For every percentage point increase in CPR, community maternal mortality ratios were lower by 7.0 points (95% CI = 0.9, 14.3). Community-level household wealth was the strongest predictor of maternal mortality.
Community contraceptive prevalence made a significant contribution to reducing maternal mortality net of other risk and protective factors during 2010-2015. Increased health system responsiveness to the needs of pregnant women and reductions in socioeconomic and geographic disparities in maternal health services will be needed for Indonesia to reach the 2030 SDG maternal mortality goal.
先前的研究表明，避孕措施的使用可以降低孕产妇死亡率，而与其他孕产妇保健服务无关。本研究利用印度尼西亚详细的地理数据，在社区层面上研究了避孕措施的使用与其他孕产妇死亡率的风险和保护因素之间的相互作用，在这一分析层面上，可以更好地理解计划生育的保护作用。
本研究使用了 2015 年人口普查（SUPAS）和 2014 年村庄潜力调查（PODES）的数据，构建了一系列衡量孕产妇死亡率关键风险和保护因素的普查区层面变量。通过对每个普查区过去五年孕产妇死亡率的自然对数转换，使用对数线性回归评估这些因素与孕产妇死亡率之间的关系。
社区孕产妇死亡率较高与社区避孕普及率较低、四胎及以上生育率较高、贫困家庭比例较高、医院人口密度较低、传统接生员密度较高以及居住地不在爪哇-巴厘岛有关。社区孕产妇死亡率每增加 1%，社区孕产妇死亡率就会降低 7.0 个点（95%CI=0.9, 14.3）。社区家庭财富是孕产妇死亡率的最强预测因素。
在 2010-2015 年期间，社区避孕普及率在降低孕产妇死亡率方面做出了重要贡献，净除了其他风险和保护因素的影响。印度尼西亚需要增加卫生系统对孕妇需求的响应，并减少孕产妇保健服务在社会经济和地理方面的差距，以实现 2030 年可持续发展目标的孕产妇死亡率目标。
