Inequalities in facility-based delivery in Indonesia: evidence from the 2023 Indonesian Health Survey based on...

Facility-based delivery is essential for reducing maternal and infant mortality, particularly in low- and middle-income countries. However, evidence remains limited on how structural and socioeconomic inequalities shape access to delivery services in Indonesia. Based on Andersen's health services utilization framework, this study examined structural and individual determinants of facility-based delivery in Indonesia using nationally representative data, with particular attention to access-related and socioeconomic inequalities.

This cross-sectional study analyzed nationally representative data from the 2023 Indonesian Health Survey and included 68,884 women aged 10-54 years who had given birth. Predisposing, enabling, and need factors were analyzed according to Andersen's framework. Univariate, bivariate, and multivariate analyses were performed, and multiple logistic regression was used to identify factors associated with non-facility delivery.

Substantial inequalities in facility-based delivery were observed. Overall, 7.2% of women in Indonesia delivered outside a health facility. After adjustment, rural residence (adjusted odds ratio [AOR] = 1.980; 95% CI: 1.715-2.287), lower education (AOR = 2.236; 95% CI: 2.010-2.547), longer travel time to health facilities (AOR = 2.292; 95% CI: 2.000-2.634), lack of health insurance (AOR = 2.253; 95% CI: 1.983-2.560), and inadequate antenatal care (AOR = 2.786; 95% CI: 2.461-3.154) were strong predictors of non-facility delivery.

Facility-based delivery in Indonesia was shaped by contextual and enabling factors, rather than by individual characteristics alone. Integrated policies are needed to improve geographic access, increase health insurance coverage, strengthen community-based health education, and improve antenatal care programs, particularly in rural areas, to expand access to delivery services at health facilities.