Main Article Content
Abstract
Purpose: This study aims to examine the limitations of access to health services and their relationship to increased pregnancy risk in Indonesia, highlighting the interacting geographical, socioeconomic, cultural, and policy factors that shape maternal access disparities.
Research Method: This study employs a qualitative approach, utilizing the Systematic Literature Review (SLR) method to analyze academic literature published between 2015 and 2025. The search was conducted comprehensively through searches in reputable international journals from publishers Elsevier, Emerald, Wiley, and Springer.
Results and Discussion: The study's results indicate that structural factors, including low socioeconomic status, geographical isolation, and a shortage of trained healthcare workers, primarily cause limited access to maternal health services. In addition, socio-cultural factors such as the dominance of non-medical personnel and gender norms also contribute to delays in accessing medical services. The mismatch between national policies and local needs exacerbates service gaps and increases the risk of pregnancy complications.
Implications: This study highlights the importance of a multidisciplinary and contextual approach in developing maternal health policies. Community-based strategies that take into account the socio-cultural context and strengthen primary services and health literacy are needed as long-term, sustainable interventions.
Keywords
Article Details

This work is licensed under a Creative Commons Attribution 4.0 International License.
References
- Adnan, Y., & Ekasari, R. (2025). Socioeconomic Disparities in Maternal Health Facility Utilization at Hospital: Evidence from Indonesia’s 2018 Basic Health Research. Social Medicine, 18(1), 32–42. https://doi.org/10.71164/socialmedicine.v18i01.2025.1763
- Ali, B., Debnath, P., & Anwar, T. (2021). Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4. Clinical Epidemiology and Global Health, 10, 100672. https://doi.org/https://doi.org/10.1016/j.cegh.2020.11.005
- Anindya, K., Lee, J. T., McPake, B., Wilopo, S. A., Millett, C., & Carvalho, N. (2020). Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services: A propensity score matched analysis. Journal of Global Health, 10(1), 10429. https://doi.org/10.7189/jogh.10.010429
- Anindya, K., Marthias, T., Vellakkal, S., Carvalho, N., Atun, R., Morgan, A., Zhao, Y., Hulse, E. S., McPake, B., & Lee, J. T. (2021). Socioeconomic inequalities in effective service coverage for reproductive, maternal, newborn, and child health: a comparative analysis of 39 low-income and middle-income countries. EClinicalMedicine, 40, 101103. https://doi.org/10.1016/j.eclinm.2021.101103
- Anshari, M. (2021). E-Health Management Services in Supporting Empowerment. ArXiv Preprint ArXiv:2102.04558. https://doi.org/10.48550/arXiv.2102.04558
- Aranda, Z., Binde, T., Tashman, K., Tadikonda, A., Mawindo, B., Maweu, D., Boley, E. J., Mphande, I., Dumbuya, I., & Montaño, M. (2022). Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Global Health, 7(1), e007247. https://gh.bmj.com/content/7/1/e007247
- Aryastami, N. K., & Mubasyiroh, R. (2021). Traditional practices influencing the use of maternal health care services in Indonesia. PLoS One, 16(9), e0257032. https://doi.org/10.1371/journal.pone.0257032
- Badakhsh, M., Hastings-Tolsma, M., Firouzkohi, M., Amirshahi, M., & Hashemi, Z. S. (2020). The lived experience of women with a high-risk pregnancy: A phenomenology investigation. Midwifery, 82, 102625. https://doi.org/https://doi.org/10.1016/j.midw.2019.102625
- Baten, A., Biswas, R. K., Kendal, E., & Bhowmik, J. (2025). Utilization of maternal healthcare services in low- and middle-income countries: a systematic review and meta-analysis. Systematic Reviews, 14(1), 88. https://doi.org/10.1186/s13643-025-02832-0
- Binuko, R. S. D., & Fauziyah, N. F. (2024). Pengaruh Faktor Ekonomi dan Sosial Terhadap Akses Pelayanan Kesehatan di Rumah Sakit. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 8(2), 123–134. https://doi.org/10.52643/marsi.v8i2.4182
- Dwi Wulandari, R., Putri, N., & Laksono, A. (2020). Socioeconomic Disparities in Antenatal Care Utilisation in Urban Indonesia. 498. https://www.researchgate.net/publication/343850679_Socioeconomic_Disparities_in_Antenatal_Care_Utilisation_in_Urban_Indonesia
- Gube, A. A., Murányi, E., Vitrai, J., & Lohner, S. (2024). Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis. Frontiers in Public Health, 12, 1415092. https://doi.org/10.3389/fpubh.2024.1415092
- Haddrill, R., Jones, G. L., Mitchell, C. A., & Anumba, D. O. C. (2014). Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy and Childbirth, 14(1), 207. https://doi.org/10.1186/1471-2393-14-207
- Hapsari, D., Dharmayanti, I., & Kusumawardani, N. (2014). Faktor-faktor yang berpengaruh terhadap risiko kehamilan “4 terlalu (4-t)” pada wanita usia 10-59 tahun (analisis riskesdas 2010). Media Penelitian Dan Pengembangan Kesehatan, 24(3), 143–152. https://doi.org/10.22435/MPK.V24I3.3649.143-152
- Johar, M., Soewondo, P., Pujisubekti, R., Satrio, H. K., & Adji, A. (2018). Inequality in access to health care, health insurance and the role of supply factors. Social Science & Medicine, 213, 134–145. https://doi.org/https://doi.org/10.1016/j.socscimed.2018.07.044
- Kudarti, F., & Rahmaningtyas, I. (2024). Peningkatan Akses dan Kualitas Pelayanan Kesehatan Maternal di Wilayah Nusantara: Tinjauan Multidisiplin. Jurnal Kesehatan Dan Kebidanan Nusantara, 2(2), 30–32. https://doi.org/10.69688/jkn.v2i2.104
- Lamichhane, B., & Neupane, N. (2022). Improved healthcare access in low-resource regions: A review of technological solutions. ArXiv Preprint ArXiv:2205.10913. https://doi.org/10.48550/arXiv.2205.10913
- Misnaniarti, Sariunita, N., & Idris, H. (2024). Regional perinatal mortality differences in Indonesia: Evidence from Indonesian demographic health survey. Public Health in Practice, 7, 100501. https://doi.org/https://doi.org/10.1016/j.puhip.2024.100501
- Misu, F., Gasbarro, D., & Alam, K. (2025). Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature. Maternal and Child Health Journal. https://doi.org/10.1007/s10995-025-04111-9
- Nanda, K. R. (2025). Maternal Age and Risk of Pregnancy Complications: A Qualitative Study. Advances in Healthcare Research, 3(2 SE-Articles), 132–147. https://doi.org/10.60079/ahr.v3i2.488
- Nurrizka, R. H., Nurdiantami, Y., & Makkiyah, F. A. (2021). Akses ibu hamil terhadap pelayanan kesehatan di masa pandemi covid-19. Jurnal Kebijakan Kesehatan Indonesia: JKKI, 10(2), 94–99. https://doi.org/10.22146/JKKI.62752
- Palinski, W. (2014). Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease. Circulation, 129(20), 2066–2077. https://doi.org/10.1161/SIRKULASIAHA.113.001805
- Rahmawati, T., & Hsieh, H.-M. (2024). Appraisal of universal health insurance and maternal health services utilization: pre-and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia. Frontiers in Public Health, 12, 1301421. https://doi.org/10.3389/fpubh.2024.1301421
- Rahut, D. B., Singh, A., & Sonobe, T. (2024). Continuum of maternal and new-natal health care: empirical evidence from 10 developing countries in South and South East Asia. Journal of Population Research, 41(2), 11. https://doi.org/10.1007/s12546-024-09327-0
- Rajia, R. (2024). Pregnancy and Preterm Birth: A Systematic Review of Risk Factors and Prevention. Advances in Healthcare Research, 2(2), 88–102. https://doi.org/10.60079/ahr.v2i2.337
- Rizkianti, A., Ika, S., & and Rachmalina, R. (2021). Perceived Barriers in Accessing Health Care and the Risk of Pregnancy Complications in Indonesia. International Journal of Women’s Health, 13(null), 761–772. https://doi.org/10.2147/IJWH.S310850
- Sagala, R. A. S., Vanda, M. E., Hariyani, E., Syahadah, R. F., & Purba, S. H. (2024). Analisis Implementasi Kebijakan Program BPJS Kesehatan Dalam Meningkatkan Kualitas Pelayanan Kesehatan: Studi Literatur. Indonesian Journal of Health Science, 4(4), 281–291. https://doi.org/10.54957/ijhs.v4i4.933
- Salsa, N. R., & Dhamanti, I. (2022). Akses pelayanan kesehatan ibu dan anak di puskesmas selama pandemi covid-19. Poltekita: Jurnal Ilmu Kesehatan, 15(4). http://repository.unair.ac.id/id/eprint/125384
- Shah, V., Hatamyar, J., Hidayat, T., & Kreif, N. (2025). Exploring the heterogeneous impacts of Indonesia’s conditional cash transfer scheme (PKH) on maternal health care utilisation using instrumental causal forests. ArXiv Preprint ArXiv:2501.12803. https://doi.org/10.48550/arXiv.2501.12803
- Susianto, I. A. (2023). Sistem Penapisan Prenatal Dalam Mengantisipasi Stunting: Aplikasi Progam Antenatal Care Plus Pada Sistem Kesehatan Di Rumah Sakit. Pranata Biomedika, 2(2), 105–114. https://doi.org/10.24167/jpb.v2i2.10800
- Syam, A. Z., Suriah, S., & Abdullah, M. T. (2019). Perilaku pengambilan keputusan oleh ibu hamil dalam pencarian pelayanan kesehatan di wilayah pesisir Kota Palu. Jurnal Kesehatan Masyarakat Maritim, 2(2). https://doi.org/https://doi.org/10.30597/jkmm.v2i1.10061
- Tajvar, M., Hajizadeh, A., & Zalvand, R. (2022). A systematic review of individual and ecological determinants of maternal mortality in the world based on the income level of countries. BMC Public Health, 22(1), 2354. https://doi.org/10.1186/s12889-022-14686-5
- Utomo, B., Romadlona, N. A., Naviandi, U., BaharuddinNur, R. J., Makalew, R., Liyanto, E., Nanwani, S., Dibley, M. J., & Hull, T. H. (2025). Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010–2021. Scientific Reports, 15(1), 9397. https://doi.org/10.1038/s41598-025-91942-9
- Zhang, Y., Ding, W., Wu, T., Wu, S., Wang, H., Fawad, M., Adane, A. A., Dai, X., Zhu, X., & Xu, X. (2025). Pregnancy with multiple high-risk factors: a systematic review and meta-analysis. Journal of Global Health, 15, 4027. https://doi.org/10.7189/jogh.15.04027
References
Adnan, Y., & Ekasari, R. (2025). Socioeconomic Disparities in Maternal Health Facility Utilization at Hospital: Evidence from Indonesia’s 2018 Basic Health Research. Social Medicine, 18(1), 32–42. https://doi.org/10.71164/socialmedicine.v18i01.2025.1763
Ali, B., Debnath, P., & Anwar, T. (2021). Inequalities in utilisation of maternal health services in urban India: Evidences from national family health survey-4. Clinical Epidemiology and Global Health, 10, 100672. https://doi.org/https://doi.org/10.1016/j.cegh.2020.11.005
Anindya, K., Lee, J. T., McPake, B., Wilopo, S. A., Millett, C., & Carvalho, N. (2020). Impact of Indonesia’s national health insurance scheme on inequality in access to maternal health services: A propensity score matched analysis. Journal of Global Health, 10(1), 10429. https://doi.org/10.7189/jogh.10.010429
Anindya, K., Marthias, T., Vellakkal, S., Carvalho, N., Atun, R., Morgan, A., Zhao, Y., Hulse, E. S., McPake, B., & Lee, J. T. (2021). Socioeconomic inequalities in effective service coverage for reproductive, maternal, newborn, and child health: a comparative analysis of 39 low-income and middle-income countries. EClinicalMedicine, 40, 101103. https://doi.org/10.1016/j.eclinm.2021.101103
Anshari, M. (2021). E-Health Management Services in Supporting Empowerment. ArXiv Preprint ArXiv:2102.04558. https://doi.org/10.48550/arXiv.2102.04558
Aranda, Z., Binde, T., Tashman, K., Tadikonda, A., Mawindo, B., Maweu, D., Boley, E. J., Mphande, I., Dumbuya, I., & Montaño, M. (2022). Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries. BMJ Global Health, 7(1), e007247. https://gh.bmj.com/content/7/1/e007247
Aryastami, N. K., & Mubasyiroh, R. (2021). Traditional practices influencing the use of maternal health care services in Indonesia. PLoS One, 16(9), e0257032. https://doi.org/10.1371/journal.pone.0257032
Badakhsh, M., Hastings-Tolsma, M., Firouzkohi, M., Amirshahi, M., & Hashemi, Z. S. (2020). The lived experience of women with a high-risk pregnancy: A phenomenology investigation. Midwifery, 82, 102625. https://doi.org/https://doi.org/10.1016/j.midw.2019.102625
Baten, A., Biswas, R. K., Kendal, E., & Bhowmik, J. (2025). Utilization of maternal healthcare services in low- and middle-income countries: a systematic review and meta-analysis. Systematic Reviews, 14(1), 88. https://doi.org/10.1186/s13643-025-02832-0
Binuko, R. S. D., & Fauziyah, N. F. (2024). Pengaruh Faktor Ekonomi dan Sosial Terhadap Akses Pelayanan Kesehatan di Rumah Sakit. Jurnal Manajemen Dan Administrasi Rumah Sakit Indonesia (MARSI), 8(2), 123–134. https://doi.org/10.52643/marsi.v8i2.4182
Dwi Wulandari, R., Putri, N., & Laksono, A. (2020). Socioeconomic Disparities in Antenatal Care Utilisation in Urban Indonesia. 498. https://www.researchgate.net/publication/343850679_Socioeconomic_Disparities_in_Antenatal_Care_Utilisation_in_Urban_Indonesia
Gube, A. A., Murányi, E., Vitrai, J., & Lohner, S. (2024). Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis. Frontiers in Public Health, 12, 1415092. https://doi.org/10.3389/fpubh.2024.1415092
Haddrill, R., Jones, G. L., Mitchell, C. A., & Anumba, D. O. C. (2014). Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy and Childbirth, 14(1), 207. https://doi.org/10.1186/1471-2393-14-207
Hapsari, D., Dharmayanti, I., & Kusumawardani, N. (2014). Faktor-faktor yang berpengaruh terhadap risiko kehamilan “4 terlalu (4-t)” pada wanita usia 10-59 tahun (analisis riskesdas 2010). Media Penelitian Dan Pengembangan Kesehatan, 24(3), 143–152. https://doi.org/10.22435/MPK.V24I3.3649.143-152
Johar, M., Soewondo, P., Pujisubekti, R., Satrio, H. K., & Adji, A. (2018). Inequality in access to health care, health insurance and the role of supply factors. Social Science & Medicine, 213, 134–145. https://doi.org/https://doi.org/10.1016/j.socscimed.2018.07.044
Kudarti, F., & Rahmaningtyas, I. (2024). Peningkatan Akses dan Kualitas Pelayanan Kesehatan Maternal di Wilayah Nusantara: Tinjauan Multidisiplin. Jurnal Kesehatan Dan Kebidanan Nusantara, 2(2), 30–32. https://doi.org/10.69688/jkn.v2i2.104
Lamichhane, B., & Neupane, N. (2022). Improved healthcare access in low-resource regions: A review of technological solutions. ArXiv Preprint ArXiv:2205.10913. https://doi.org/10.48550/arXiv.2205.10913
Misnaniarti, Sariunita, N., & Idris, H. (2024). Regional perinatal mortality differences in Indonesia: Evidence from Indonesian demographic health survey. Public Health in Practice, 7, 100501. https://doi.org/https://doi.org/10.1016/j.puhip.2024.100501
Misu, F., Gasbarro, D., & Alam, K. (2025). Inequality in Utilization of Maternal Healthcare Services in Low‑ and Middle‑Income Countries: A Scoping Review of the Literature. Maternal and Child Health Journal. https://doi.org/10.1007/s10995-025-04111-9
Nanda, K. R. (2025). Maternal Age and Risk of Pregnancy Complications: A Qualitative Study. Advances in Healthcare Research, 3(2 SE-Articles), 132–147. https://doi.org/10.60079/ahr.v3i2.488
Nurrizka, R. H., Nurdiantami, Y., & Makkiyah, F. A. (2021). Akses ibu hamil terhadap pelayanan kesehatan di masa pandemi covid-19. Jurnal Kebijakan Kesehatan Indonesia: JKKI, 10(2), 94–99. https://doi.org/10.22146/JKKI.62752
Palinski, W. (2014). Effect of maternal cardiovascular conditions and risk factors on offspring cardiovascular disease. Circulation, 129(20), 2066–2077. https://doi.org/10.1161/SIRKULASIAHA.113.001805
Rahmawati, T., & Hsieh, H.-M. (2024). Appraisal of universal health insurance and maternal health services utilization: pre-and post-context of the Jaminan Kesehatan Nasional implementation in Indonesia. Frontiers in Public Health, 12, 1301421. https://doi.org/10.3389/fpubh.2024.1301421
Rahut, D. B., Singh, A., & Sonobe, T. (2024). Continuum of maternal and new-natal health care: empirical evidence from 10 developing countries in South and South East Asia. Journal of Population Research, 41(2), 11. https://doi.org/10.1007/s12546-024-09327-0
Rajia, R. (2024). Pregnancy and Preterm Birth: A Systematic Review of Risk Factors and Prevention. Advances in Healthcare Research, 2(2), 88–102. https://doi.org/10.60079/ahr.v2i2.337
Rizkianti, A., Ika, S., & and Rachmalina, R. (2021). Perceived Barriers in Accessing Health Care and the Risk of Pregnancy Complications in Indonesia. International Journal of Women’s Health, 13(null), 761–772. https://doi.org/10.2147/IJWH.S310850
Sagala, R. A. S., Vanda, M. E., Hariyani, E., Syahadah, R. F., & Purba, S. H. (2024). Analisis Implementasi Kebijakan Program BPJS Kesehatan Dalam Meningkatkan Kualitas Pelayanan Kesehatan: Studi Literatur. Indonesian Journal of Health Science, 4(4), 281–291. https://doi.org/10.54957/ijhs.v4i4.933
Salsa, N. R., & Dhamanti, I. (2022). Akses pelayanan kesehatan ibu dan anak di puskesmas selama pandemi covid-19. Poltekita: Jurnal Ilmu Kesehatan, 15(4). http://repository.unair.ac.id/id/eprint/125384
Shah, V., Hatamyar, J., Hidayat, T., & Kreif, N. (2025). Exploring the heterogeneous impacts of Indonesia’s conditional cash transfer scheme (PKH) on maternal health care utilisation using instrumental causal forests. ArXiv Preprint ArXiv:2501.12803. https://doi.org/10.48550/arXiv.2501.12803
Susianto, I. A. (2023). Sistem Penapisan Prenatal Dalam Mengantisipasi Stunting: Aplikasi Progam Antenatal Care Plus Pada Sistem Kesehatan Di Rumah Sakit. Pranata Biomedika, 2(2), 105–114. https://doi.org/10.24167/jpb.v2i2.10800
Syam, A. Z., Suriah, S., & Abdullah, M. T. (2019). Perilaku pengambilan keputusan oleh ibu hamil dalam pencarian pelayanan kesehatan di wilayah pesisir Kota Palu. Jurnal Kesehatan Masyarakat Maritim, 2(2). https://doi.org/https://doi.org/10.30597/jkmm.v2i1.10061
Tajvar, M., Hajizadeh, A., & Zalvand, R. (2022). A systematic review of individual and ecological determinants of maternal mortality in the world based on the income level of countries. BMC Public Health, 22(1), 2354. https://doi.org/10.1186/s12889-022-14686-5
Utomo, B., Romadlona, N. A., Naviandi, U., BaharuddinNur, R. J., Makalew, R., Liyanto, E., Nanwani, S., Dibley, M. J., & Hull, T. H. (2025). Census block based loglinear regression analysis of health and social determinants of maternal mortality in Indonesia 2010–2021. Scientific Reports, 15(1), 9397. https://doi.org/10.1038/s41598-025-91942-9
Zhang, Y., Ding, W., Wu, T., Wu, S., Wang, H., Fawad, M., Adane, A. A., Dai, X., Zhu, X., & Xu, X. (2025). Pregnancy with multiple high-risk factors: a systematic review and meta-analysis. Journal of Global Health, 15, 4027. https://doi.org/10.7189/jogh.15.04027