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Tantangan terbesar di sektor kesehatan yaitu menurunkan angka kematian ibu dengan target Millenium Development Goals/MDGs 102 per 100.000 kelahiran hidup. Saat ini angka kematian ibu di Indonesia 228 per 100.000 kelahiran hidup. Tingginya angka kematian ibu terkait dengan rendahnya pemanfaatan layanan persalinan di fasilitas kesehatan. Penelitian ini menganalisis lebih lanjut mengenai determinan pemilihan persalinan di fasilitas kesehatan. Penelitian ini dilakukan terhadap ibu yang melahirkan anak terakhir dalam kurun waktu 5 tahun (2005-2010) dengan menggunakan data riset kesehatan dasar 2010. Determinan pemilihan persalinan di fasilitas kesehatan dapat dilihat dari faktor predisposing, enabling dan need. Metode penelitian yang digunakan adalah crosssectional dengan menggunakan analisis regresi logistik. Jumlah sampel dalam penelitian ini sebanyak 15.418 sampel. Hasil penelitian menunjukkan bahwa ibu yang memilih persalinan di fasilitas kesehatan sebesar 54,5% responden, ibu yang memilih persalinan di fasilitas kesehatan bertempat tinggal di daerah perkotaan sebanyak 73,8%, yang memeriksakan kehamilan pada tenaga kesehatan sebanyak 61,9%, dan yang frekuensi pemeriksaan kehamilan lebih dari atau sama dengan empat kali 62,6%. Penelitian ini menyarankan untuk mengevaluasi mengenai kebijakan biaya persalinan di fasilitas kesehatan dan peningkatan akses masyarakat ke fasilitas kesehatan, melakukan pelatihan untuk bidan mengenai bagaimana berkomunikasi dan berinteraksi sosial yang baik terhadap masyarakat sehingga masyarakat mempunyai persepsi yang baik dan kepercayaan yang tinggi terhadap bidan, melakukan monitoring dan evaluasi kinerja bidan desa secara kontinyu untuk meningkatkan kinerja bidan, mensosialisasikan kepada masyarakat khususnya suami mengenai pentingnya persalinan ditolong oleh tenaga kesehatan di fasilitas kesehatan melalui rapat desa atau kelompok tani.
Abstract The biggest challenge in the health sector is reducing maternal mortality ratio in line with the Millennium Development Goals (MDGs) target of 102 per 100,000 live births. Presently, the maternal mortality ratio in Indonesia is 228 per 100,000 live births. The high rate of maternal mortality is related to underutilization of health facilities for deliveries. This research further analyzes the determinants of deliveries in health facilities. This research was performed on mothers who gave birth to their last child in the last 5 years (2005-2010) by using basic health research of 2010 data. The determinant use in selecting delivery process in health facilities can be seen from predisposing, enabling and need factors. The method used was a cross sectional study with logistic regression analysis. The number of samples included in this research was 15,418 samples. The results showed that mothers who choose to give birth in health facilities is 54.5% of respondents, 73.8% of these live in urban areas, and 61.9% of these chooses to do ante natal checkup with health care professional, 62.6% of these performed checkup at least four times during pregnancy. This study suggests to evaluate the cost of delivery at the health facilities and improved public access to health facilities, conduct training for midwives on how to communicate and socially interact well to the public so the public has the perception of good and high confidence of midwives, monitoring and evaluating the performance of village midwives to continuously improve the performance of midwives, socialize to people especially husbands about the importance of birth attended by skilled health care at health facilities through village or farmer group meetings.
Background: Maternal mortality can be prevented by delivering in a health care facility. Women who are not involved in decision making are barriers to using health facilities. Pregnant women often cannot determine the place of delivery because the decision is determined by their husband, parents-in-law or other family members. The delays of decision- making at the family level results in delays in getting help at health facilities. Objective: To determine the relationship between women's participation in household decision making with the selection of place of delivery based on analysis of the 2017 Indonesian Demographic Health Survey data. Methods: Designs study was sross-sectional and data was obtained from the Indonesia Demographic Health Survey 2017. Sample was women of childbearing age 15-49 years who had given birth to the last child in 2012-2017 with complete data, total 14,310 respondents. Data were analyzed using Cox regression and the effect was expressed by prevalence ratio (PR) with a 95% confidence interval (CI). Results: The proportion of women giving birth in non-health facilities was 26.5%, and 30.7% of women were not involved in in household decision making. After controlling residence and economic status, women who did not participate in household decision making had a risk of 1,633 (1,531-1,741) times to give birth in non-health facilities compared to women who participated in household decision making. Conclusion: Women who did not participate in household decision making were significantly related to deliveries in non-health facilities. Therefore, the government needs to promote women's reproductive, gender equality, and conduct a study of regions that still birth in dukun.
Tesis ini membahas tentang pemilihan tempat persalinan di rumah oleh ibu dengan riwayat ANC lengkap di Kecamatan Cimanuk Kabupaten Pandeglang, pada tahun 2012. Pelayanan kesehatan, fasilitas dan informasi kesehatan sudah tersedia, pemanfaatan terhadap pelayanan ANC dan bidan sebagai penolong persalinan sudah tinggi namun belum sepenuhnya dapat mendorong masyarakat untuk memilih fasilitas kesehatan sebagai tempat persalinannya. Penelitian ini adalah penelitian kualitatif, yang menggunakan pendekatan Rapid Assesment Procedures (RAP). Hasil dari penelitian ini menemukan bahwa sebagian dari masyarakat memilih rumah sebagai tempat persalinannya, namun sebagiannya lagi memilih fasilitas kesehatan sebagai tempat persalinannya. Penelitian ini juga menyarankan untuk meningkatkan peran lingkungan keluarga, masyarakat dan petugas dalam mendukung pemanfaatan fasilitas kesehatan untuk persalinan.
This thesis discusses the selection of the delivery at home by mothers with a history of complete ANC in Cimanuk sub district, Pandeglang District, year 2012. Health services, facilities and health information is available, the utilization of the ANC and the midwife as a birth attendant is high but has not been fully able to encourage people to choose a health facility as a place of confinement. This research is a qualitative study, which uses the approach of Rapid Assessment Procedures (RAP). The results of this study found that the majority of people choosing a home as a place of confinement, but partly choosing health facility as a place of confinement. This study also suggested to increase the role of the family, the community and staff in supporting the utilization of health facilities for delivery.