Examining the association of unwanted pregnancy, maternal health service utilization, and low birth weight in Indonesia

Background: Unwanted pregnancies, which contribute to poor maternal and child health outcomes, are a significant issue in low- and middle-income countries. Although the association between pregnancy intention and maternal health service utilization, as well as low birth weight (LBW), has been well established, the underlying mechanisms remain unclear. In addition, most studies have failed to account for certain contextual factors. This study aimed to fill this gap in our knowledge of the relationship between unwanted pregnancy, maternal health service utilization, and LBW.
Methods: This study employed data from the 2017 Indonesia Demographic and Health Survey (IDHS), specifically focusing on 15,237 women whose youngest child was under the age of 5 and born as a singleton. In Study I, the analysis explored the role of maternal antenatal care (ANC) completeness as a potential mediator in the relationship between unwanted pregnancy and LBW among Indonesian women, while also assessing the moderating effect of family support during pregnancy. In Study II, the investigation focused on identifying individual- and neighborhood-level factors associated with incomplete and delayed initiation of ANC.
Results: The results from the generalized structural equation modeling indicated that incomplete ANC mediated the relationship between unwanted pregnancy and LBW. Additionally, family support during pregnancy was found to moderate the indirect effect of unwanted pregnancy on LBW, with incomplete ANC serving as the mediator. Findings from the two-level multilevel logistic regression with a random intercept model revealed that residing in a community with low levels of family support during pregnancy increased the odds of incomplete ANC. Additionally, women's likelihood of experiencing incomplete ANC was affected by low neighborhood healthcare utilization levels. Living in rural areas also increased the odds of women experiencing incomplete ANC and delayed ANC initiation.
Conclusion: The completion of ANC and family support significantly influence the relationship between unwanted pregnancy and LBW among women in Indonesia. Both contextual factors and individual characteristics play a vital role in explaining the utilization of maternal health services during pregnancy. Improving ANC utilization and reducing LBW require culturally sensitive contraceptive services to prevent unwanted pregnancies and expand male involvement in family planning. Strengthening the healthcare infrastructure, providing financial assistance, and implementing community-based programs to enhance family and peer support are essential. Multi-sectoral collaboration can address social, cultural, and economic barriers, empowering women and their families to access timely and comprehensive maternal care.