The patterns of self-reported maternal complications in Indonesia: are there rural–urban differences?

Introduction: Specific and targeted intervention is needed to reduce the relatively high maternal mortality and morbidity in Indonesia. The apparent rural–urban disparities might require different intervention strategies. Therefore, this study aims to assess patterns and sociodemographic determinants of self-reported maternal morbidity in rural and urban areas.

Methods: Data from Indonesian Demographic and Health Survey (IDHS) 2012 was analyzed. In this cross-sectional survey, maternal morbidity status and sociodemographic factors were obtained through questionnaire-based interviews. Women who completed the maternal morbidity questionnaire was included in the analyses (n = 12679). Descriptive statistics were used to assess differences in proportion, mixed-effects regression was used to evaluate the association between sociodemographic factors and maternal morbidity.

Results: Approximately53.3% of women reported experiencing pregnancy and/or labor complications, with lower proportion in rural areas (51.3%) compared to urban areas (55.1%). The patterns of pregnancy morbidities were similar for rural and urban women. The highest proportion of pregnancy morbidity was ‘other pregnancy morbidity', followed by bleeding. Meanwhile, there were slight differences in the type of labor morbidities. Compared to urban women, women in rural areas reported a higher prevalence of bleeding and infection, but a significantly lower prevalence of Pregnancy Rupture of Membrane (PROM). Nulliparity was a dominant factor for self-reported maternal morbidity. Younger urban, but not rural, women had a higher proportion of maternal morbidity. In urban areas, women with social disadvantage reported a relatively higher proportion of morbidity. However, in rural areas, a higher prevalence of maternal morbidity was reported by women of higher socioeconomic status. These rural–urban disparities might be partially caused by significant differences in knowledge of maternal morbidities and sociodemographic status between rural and urban women.

Conclusions: This study found similar patterns in pregnancy morbidity, but slight differences in labor morbidity patterns. Specific intervention targeted at major maternal complications within rural or urban areas are important. There were also differences in the proportion of self-reported maternal complications by sociodemographic factors, which might be caused by differences in reporting. Intervention to improve knowledge and awareness of maternal complication is needed, specifically for socially disadvantaged women and women living in rural areas.