ORIGINAL RESEARCH article
Front. Glob. Women’s Health
Sec. Maternal Health
Volume 6 - 2025 | doi: 10.3389/fgwh.2025.1649276
Determinants of non-use of antenatal care services in eastern Indonesia: Analysis of the 2023 Indonesia Health Survey
Provisionally accepted
Christiana Rialine Titaley1*
Dwi Hapsari Tjandrarini2
Maxwell Landri Vers Malakauseya1
Iwan Ariawan3
Ressita Fannia Iwan1Sean Samuel Istia1
Michael J. Dibley4- 1Faculty of Medicine, Pattimura University, Ambon, Indonesia
- 2National Research and Innovation Agency Republic of Indonesia, Bogor, Indonesia
- 3Universitas Indonesia Fakultas Kesehatan Masyarakat, Depok, Indonesia
- 4The University of Sydney School of Public Health, Sydney, Australia
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Although Indonesia has made significant progress in improving maternal and child health nationally, regional disparities persist, particularly in eastern Indonesia, where maternal and neonatal health outcomes remain suboptimal compared with the western regions. This study examined factors associated with non-use of antenatal care (ANC) in eastern Indonesia.We analyzed data from 3,261 mothers with infants under one year of age in eastern Indonesia who were interviewed in the 2023 Indonesia Health Survey. The primary outcome was maternal nonuse at ANC during pregnancy with an infant younger than 12 months at the time of the survey. Eighteen potential predictors of non-use of ANC were assessed using a multilevel analysis.Results: Approximately 5% (95% CI: 4.14-6.09) of the mothers with infants 0-11 months did not seek antenatal care. Non-use was associated with infant age, region, socioeconomic status, health checks, knowledge of stunting, and pregnancy-related complications. Mothers with infants aged 6-11 months were 63% less likely to forgo ANC (adjusted odds ratio (aOR) =0.63, p=0.049). Living in Sulawesi (aOR=2.66, p=0.001), Maluku (aOR=13.76, p<0.001), and Papua (aOR=17.72, p<0.001) increased ANC non-use. The poorest households had 9.90 times higher odds of non-use than the richest households (p<0.001). Higher non-use was also linked to no prior health checks (aOR=2.54, p=0.006), low stunting knowledge (aOR=2.93, p=0.004), and no pregnancy complications (aOR=4.30, p=0.001).Conclusions: Socioeconomic and geographic disparities drive non-use of antenatal care in eastern Indonesia. Improving healthcare access, education, and early screening are crucial for reducing regional inequalities and enhancing maternal health.
Keywords: Antenatal care services, Maternal health, health care utilization, Public Health, Pregnancy, Community Health
Received: 27 Jun 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Titaley, Tjandrarini, Malakauseya, Ariawan, Iwan, Istia and Dibley. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Christiana Rialine Titaley, Faculty of Medicine, Pattimura University, Ambon, Indonesia
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