Background: The adoption of the Sustainable Development Goals in 2015 has renewed interest in maternal mortality reduction. Indonesia"'s maternal mortality ratio is among the highest in Southeast Asia. While skilled birth attendance (SBA) reduces the risk of maternal death, few studies have been done on SBA utilization in Indonesia using nationally representative data. This study estimated the own-price, cross-price, and income elasticities of demand for SBA in Indonesia. The effects of community and health system factors on SBA were also explored. Methods: Data from the 2004 wave of the Indonesia Family Life Survey, were used as the primary source of information. These data were supplemented with information from reports produced by the Indonesian Ministries of Health and Finance and the World Bank. The polytomous outcome variable was choice of attendance at last birth. Three estimation strategies were used to estimate the elasticities"u2014multinomial logit, multinomial probit, and an instrumental variable multinomial probit model. Statistical significance was determined at the 5% level. Results: The own-price elasticities of the facility-based delivery alternatives were between -1 and 0, indicating that demand is own-price inelastic for those alternatives. Two cross-price elasticities"u2014price of skilled home deliveries on demand for unskilled home deliveries and price of public facility deliveries on demand for skilled home deliveries"u2014indicated that women chose lower priced alternatives as the price of an alternative is increased. Increased income reduced demand for unskilled home deliveries and increased the demand for skilled home and private facility deliveries. Community and health system-level factors had small but significant effects on delivery attendance. Increases in the percentage of women in the community with SBA were associated with higher likelihood of using skilled delivery alternatives over unskilled home deliveries. Health worker density increased likelihood of choosing public facility deliveries over unskilled home deliveries. Finally, government health expenditure was positively associated with choosing skilled home and public facility deliveries over unskilled home deliveries, but was negatively associated with choosing private facility over unskilled home deliveries. Discussion: The elasticities revealed that women substituted for lower-priced alternatives as the price of an alternative increased and that they increased utilization of skilled delivery alternatives as household income increased. These findings can be interpreted as evidence that price is still a barrier to accessing SBA in Indonesia. The findings from the community and health system-level variables suggest extra-individual characteristics also affect individual decision-making on choice of delivery attendance. / 1 / Rieza Hawarina Soelaeman
| Identifer | oai:union.ndltd.org:TULANE/oai:http://digitallibrary.tulane.edu/:tulane_58000 |
| Date | January 2016 |
| Contributors | Soelaeman, Rieza H. (author), Hotchkiss, David (Thesis advisor), School of Public Health & Tropical Medicine Global Health Systems and Development (Degree granting institution) |
| Publisher | Tulane University Digital Library |
| Source Sets | Tulane University |
| Language | English |
| Detected Language | English |
| Type | Text |
| Format | electronic |
| Rights | Embargo |
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