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"[ABSTRAKPenanganan kematian bayi merupakan salah satu target sasaran pemerintah dalampembangunan kesehatan jangka panjang. Sebagai indikator derajat kesehatanmasyarakat, kematian bayi dipengaruhi salah satunya oleh faktor layanan kesehatan.Dalam penelitian ini faktor layanan kesehatan terdiri dari tenaga kesehatan sebagaipemberi layanan kesehatan dan layanan kesehatan sendiri yaitu layanan kesehatan yangdiberikan pada ibu dan bayi sebagai bagian dari program KIA (kesehatan ibu dan anak)yaitu pelayanan antenatal, persalinan ditolong tenaga kesehatan, dan penanganankomplikasi neonatus. Hasil analisis data profil kesehatan Kota Serang tahun 2009 ?2013 dengan menggunakan model regresi data panel menunjukan bahwa terdapathubungan signifikan negatif antara faktor layanan kesehatan dengan kematian bayi. Halini berarti bahwa peningkatan jumlah tenaga kesehatan akan berpengaruh dalammenurunkan kasus kematian bayi. Demikian juga halnya dengan peningkatan cakupanpelayanan antenatal, persalinan ditolong tenaga kesehatan, dan penanganan komplikasineonatus akan berpengaruh terhadap penurunan kasus kematian bayi.;

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ABSTRACTHandling infant mortality is one of the government's target in long-term healthdevelopment. As an indicator to public health, one of the factors that affect infantmortality is health service. In this study health service factors consist of healthpersonnel as a health care provider and health care itself namely the health careprovided to the mother and baby as part of the KIA program (mother and child healthprogram) i.e antenatal care, assisted delivery of health personnel, and management ofcomplications of neonatus. The results of the analysis from Serang City health profiledata in 2009-2013, using panel data regression model, shows that there is a negativesignificant correlation between the health service factors with infant mortality. Thismeans that an increasing number of health workers will have an effect in reducing infantdeaths. Likewise, an increasing number in coverage of antenatal care, births assistedhealth personnel, treatment of neonatal complications will affect to the decline in infantdeath case., Handling infant mortality is one of the government's target in long-term healthdevelopment. As an indicator to public health, one of the factors that affect infantmortality is health service. In this study health service factors consist of healthpersonnel as a health care provider and health care itself namely the health careprovided to the mother and baby as part of the KIA program (mother and child healthprogram) i.e antenatal care, assisted delivery of health personnel, and management ofcomplications of neonatus. The results of the analysis from Serang City health profiledata in 2009-2013, using panel data regression model, shows that there is a negativesignificant correlation between the health service factors with infant mortality. Thismeans that an increasing number of health workers will have an effect in reducing infantdeaths. Likewise, an increasing number in coverage of antenatal care, births assistedhealth personnel, treatment of neonatal complications will affect to the decline in infantdeath case.]"

"Kematian ibu tidak hanya menjadi masalah kesehatan masyarakat, tetapi juga menjadi masalah sosial karena akan berpengaruh besar terhadap keluarga, terutama anak- anak. Di negara maju dengan status sosial ekonomi yang tinggi kematian ibu telah turun mencapai tingkat minimal kurang dari 10 per 100.000 kelahiran hidup. Hal tersebut belum terjadi di negara-negara berkembang, termasuk Indonesia. Di samping pertumbuhan ekonominya yang terus membaik, kematian ibu di Indonesia masih tergolong tinggi, bahkan di antara sesama negara Asia Tenggara. Berdasarkan data SDKI, telah terjadi penurunan angka kematian ibu, tetapi dengan penurunan seperti sekarang target Pembangunan Milenium tidak akan tercapai. Dari aspek demand, supply, maupun kebijakan, penurunan kematian ibu masih mengalami berbagai hambatan. Untuk mempercepat penurunan kematian ibu perlu dikembangkan kebijakan yang dapat mengatasi hambatan utama berupa kelangkaan petugas pelayanan kesehatan yang terampil, infrastuktur pelayanan kesehatan ibu yang belum memadai, kualitas pelayanan yang sub-standar, dan keengganan para ibu untuk menggunakan fasilitas pelayanan kebidanan karena biaya yang sangat tinggi dan pelayanan yang masih buruk atau karena masih lebih menyukai pelayanan dukun dengan berbagai alasan lingkungan yang spesifik. Dalam mempercepat penurunan kematian ibu, kebijakan dan manajemen di tingkat kabupaten berperan sangat menentukan."

"Angka Kematian Ibu (AKI) di Kabupaten Merangin, Provinsi Jambi masih cukup tinggi sampai sekarang dibandingkan dengan kabupaten lain di Provinsi Jambi. Penelitian ini bertujuan untuk melihat hubungan antara perilaku kesehatan yang berupa: kunjungan ANC dan penolong persalinan pertama dengan kematian maternal di Kabupaten Merangin, Provinsi Jambi periode 2012 ? 2015 dengan menggunakan data Audit Maternal Perinatal atau AMP. Penelitian ini menggunakan desain penelitian case control yang terdiri dari 40 kasus dan 40 kontrol. Kelompok kasus adalah ibu yang mengalami kematian akibat kehamilan, persalinan dan nifas periode 2012 ? 2015 sedangkan kelompok kontrol adalah ibu yang tidak mengalami kematian akibat kehamilan, persalinan dan nifas periode 2012 ? 2015. Penelitian ini menemukan terdapat hubungan antara kunjungan ANC (OR=0,049 95% CI: 0,002 - 1,006) dan terdapat hubungan antara penolong persalinan pertama dengan kematian maternal (OR= 0,105, 95% CI: 0,012 - 0,908) setelah di kontrol dengan variabel riwayat penyakit kronik, riwayat obstetri, gravida, paritas, cara persalinan dan rujukan.

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Maternal Mortality Ratio (MMR) in Merangin Regency, Jambi Province is currently still rather high compared to the other regencies in Jambi Province. This research was conducted in order to observe the relationships between health behaviors in the form of: visitation from ANC and labor paramedics towards maternal mortality in Merangin Regency, Jambi Province period of 2012 ? 2015 by utilizing the Audit Maternal Perinatal data or AMP.

This research uses case control research design which is comprised by 40 cases and 40 controls. Included in the case group is mothers who experienced death due to pregnancy, childbirth and childbed period 2012 ? 2015 whereas the control group comprises of mothers who did not experience death by pregnancy, childbirth and childbed period 2012 - 2015.

This research found that there is no relationship between ANC visits (OR=0,049 95% CI: 0,002 - 1,006) and there is correlation between the labor paramedics towards maternal (OR= 0,105, 95% CI: 0,012 - 0,908) after being controlled with variables such as chronic disease history, obstetric history, gravida, parity, labor mode and reference."

"ABSTRAKPendahuluan: Sebagian besar kematian ibu dapat dicegah jika kelahiran dilakukan di fasilitas pelayanan kesehatan. Wanita yang tidak dilibatkan dalam pengambilan keputusan menjadi hambatan dalam pemanfaatan layanan persalinan. Seringkali ibu hamil tidak dapat menentukan tempat persalinannya karena keputusan tersebut ditentukan suami, mertua atau anggota keluarga lainnya. Keterlambatan mengambil keputusan pada tingkat keluarga berdampak pada keterlambatan memperoleh pertolongan difasilitas kesehatan.Tujuan: Mengetahui hubungan antara partisipasi wanita dalam mengambil keputusan di rumah tangga dengan pemilihan tempat persalinan berdasarkan analisis data Survei Demografi Kesehatan Indonesia tahun 2017.Metodologi: Penelitian ini menggunakan desain cross-sectional dengan sumber data berasal dari data sekunder Survei Demografi Kesehatan Indonesia tahun 2017. Sampel penelitian ini yaitu wanita usia subur 15-49 tahun yang pernah melahirkan anak terakhir pada tahun 2012-2017 dengan data yang lengkap yakni 14.310 responden. Data dianalisis menggunakan regresi cox dan besar pengaruh dinyatakan dalam bentuk prevalensi rasio dengan confident interval (CI) 95%.Hasil: Proporsi wanita yang melahirkan pada bukan fasilitas kesehatan sebesar 26,5%, dan sebanyak 30,7% wanita tidak dilibatkan dalam mengambil keputusan di rumah tangga. Setelah mengendalikan variabel tempat tinggal dan status ekonomi. wanita yang tidak berpartisipasi dalam pengambilan keputusan di rumah tangga memiliki risiko 1,633 (95%CI 1,531-1,741) kali untuk melahirkan di bukan fasilitas kesehatan dibandingkan wanita yang berpartisipasi dalam pengambilan keputusan di rumah tangga.Kesimpulan: Wanita yang tidak berpartisipasi dalam pengambilan keputusan di rumah tangga berhubungan signifikan dengan persalinan di bukan fasilitas kesehatan. Oleh karena itu, pemerintah perlu melakukan upaya promosi kesehatan mengenai hak-hak reproduksi wanita, kesetaraan gender, serta melakukan kajian mengenai daerah yang masih menyakini persalinan di dukun.

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ABSTRACTBackground: 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 pengaruh kehamilan tidak diinginkan terhadap kejadian kematian bayi di Indonesia dengan menggunakan data sekunder hasil SDKI tahun 2012 yang mencakup 33 provinsi. Analisis dilakukan pada wanita usia subur yang melahirkan anak dalam 5 tahun terakhir sebelum survei. Variabel dalam analisis akan dibatasi pada wanita usia subur, anak terakhir dan tidak kembar. serta beberapa variabel kovariat seperti faktor maternal (wilayah tempat tinggal, pendidikan terakhir ibu, umur pada saat melahirkan, status ekonomi, jarak lahir, paritas dan komplikasi kehamilan), faktor gizi (ASI Segera), dan faktor pelayanan kesehatan (Imunisasi Tetanus Toxoid, pemeriksaan kehamilan sesuai standar, penolong persalinan dan kunjungan neonatal pertama (KN-1)). Hasil penelitian menyarankan bahwa kehamilan tidak diinginkan dapat dicegah dengan melakukan sosialisasi menyeluruh meliputi Komunikasi, Informasi, dan Edukasi (KIE) terhadap program Keluarga Berencana (KB); membuat kelompok pemberdayaan wanita; melakukan intervensi pra-konsepsi berupa pendidikan kesehatan reproduksi untuk siswa tingkat pendidikan menengah; mengarahkan ibu yang sudah melahirkan untuk menggunakan KB pasca-persalinan dengan MKJP (Metode Kontrasepsi Jangka Panjang); dan meningkatkan peran posyandu.

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This thesis studies the influence of an unintended pregnancy on infant mortality in Indonesia by using secondary data from the Demographic and Health Survey in 2012 that covers 33 provinces. The analysis was performed in women of childbearing age who gave birth in the last 5 years prior to the survey. Variables in the analysis will be restricted to women of childbearing age, the last child and not twins. as well as variables covariates such as maternal factors (region of residence, last education of mothers, age of childbirth, economic status, birth interval, parity and pregnancy complications), nutritional factors (breast milk immediately), and Health Services factors (Tetanus Toxoid Immunization, antenatal care, give birth care, and first neo natal visit (KN-1)).

Results of the study suggest that unintended pregnancies can be prevented by socialization includes Communications, Information and Education for the Family Planning Program; create a group of women's empowerment; Pre-conception intervention in the form of reproductive health education for secondary level students; Directing mothers who had given birth to use post-natal Contraception with LTCM (Long-Term Contraceptive Methods); and enhance the role of Posyandu."

"[ABSTRAKSalah satu tujuan pembangunan milenium dari tahun 1990 sampai dengan2015 adalah mengurangi tingkat kematian balita hingga dua per tiga. Sampaidengan saat ini, Indonesia telah berada pada jalur yang tepat dalam mencapaitarget tersebut. Akan tetapi, perkembangan yang lambat pada penurunan kematianbayi menunjukkan bahwa diperlukan perhatian lebih untuk meningkatkankeselamatan pada bayi usia muda. Termotivasi oleh kondisi tersebut, penelitian inihendak mengidentifikasi determinan kematian bayi di Indonesia pada tahun 1997sampai dengan 2012 menggunakan data Indonesia Demographic and HealthSurvey (IDHS) periode ke 4, 5 dan 6. Disamping itu, penelitian ini juga bertujuanuntuk mengidentifikasi eksternalitas yang dapat diperoleh dari investasi padapendidikan ibu, sarana dan prasarana yang memadai pada sumber air minum dansanitasi, serta vaksinasi anak di lingkungan sekitar rumah tangga. Kerangkakonseptual dari penelitian ini didasarkan pada kerangka teoritis Mosley dan Chen(1984). Penelitian ini menggunakan regresi logistik untuk mengestimasi pengaruhdari berbagai macam faktor yang mempengaruhi kematian bayi.Hasil regresi menunjukkan bahwa faktor bio-demografis, yaknikarakteristik ibu dan anak adalah faktor kunci dalam memprediksi kematian bayidi Indonesia. Bayi berjenis kelamin pria, anak kembar, ibu dengan tingkatkelahiran tinggi, jarak kelahiran yang pendek antar bayi, usia ibu diatas 35 tahun,dan komplikasi kehamilan merupakan faktor-faktor yang terbukti berhubunganpositif dengan kematian bayi. Faktor perilaku antara lain institusi kelahiran,pengetahuan tentang cairan rehidrasi oral, dan praktek kontrasepsi merupakanfaktor-faktor penting yang memiliki hubungan negatif dengan kematian bayi.Selain itu, higienitas pada tempat tinggal seperti ketersediaan sumber air minumyang bersih, kepemilikan toilet pribadi, dan penggunaan material lantai yanglebih baik juga merupakan faktor penting yang dapat meningkatkan statusketahanan hidup bayi di Indonesia. Beberapa variabel sosio ekonomis jugaterbukti merupakan determinan penting dari tingkat kematian bayi di Indonesia.Diantara berbagai jenis faktor tersebut, jumah anggota rumah tangga merupakanfaktor yang memiliki keterkaitan yang paling kuat dengan kematian bayi. Padalevel komunitas, regional Sumatra dan Kalimantan pada periode 2012 memilikitingkat keterjadian kematian bayi yang lebih rendah dibandingkan denganregional Jawa dan Bali sedangkan regional Sulawesi pada periode 2007 memilikitingkat keterjadian kematian bayi yang lebih tinggi. Lebih lanjut, penelit ian inimenemukan bahwa partisipasi masyarakat pada program imunisasi pemerintahnasional memberikan efek eksternalitas yang positif pada tingkat ketahanan hidupbayi di Indonesia

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ABSTRACT

Reduction of under-five mortality rate by two-thirds between 1990 and 2015

is a Millennium Development Goal (MDG). Indonesia has been on track in

achieving the MDG target on under-five mortality. However, slower progress on

infant mortality reduction shows that more attention should be given in order to

improve the survival of younger children. Motivated by this situation, this study

attempts to identify determinants of infant mortality in Indonesia between 1997

and 2012 using the 4th, 5th and 6th rounds of the Indonesia Demographic and

Health Survey (IDHS) data. In addition, the study aims to identify externalities

which may be generated by investments in mother’s education, water and

sanitation, and child vaccination by a household’s neighbors. The conceptual

framework is based on Mosley and Chen (1984). Logistic regressions are used to

estimate the effect of a variety of factors on infant mortality.

The regression results shows that bio-demographic factors which include

child and maternal traits are key predictors of infant mortality in Indonesia. Male

sex, birth multiplicity, higher birth rank, shorter birth interval, mother age above

35 years, and complication during pregnancy are positively related to infant

mortality. Behavioral practices such as institutional delivery, knowledge of Oral

Rehydration Solutions (ORS), and especially contraceptive practice are also

important factors that negatively related to infant mortality. Moreover,

household’s hygiene characteristics such as safe drinking water source, private

toilet, and improved flooring materials are also important factors that increase

infant survival status in Indonesia. Some socio economic variables are also found

to be significant determinants of infant mortality in Indonesia. Among the various

factors, the number of household members is the strongest factors related to infant

mortality. At the community level, Sumatra and Kalimantan regions in 2012 have

lower odds of infant mortality, whereas Sulawesi region in 2007 has higher odds

of infant mortality as compare to Java and Bali. Furthermore, the study finds that

immunization participation in the community has a positive spillover effect on

infant survival status.

Relevance to Development Studies

Beside economic achievement, the level of development in a country is also

reflected in the health status of its people. Several health indicators, including

mortality rate in young children, have been used by the United Nation

Development Programme (UNDP) as measurements of poverty. The literature

suggests that the high numbers of Child Mortality Rate (CMR), Infant Mortality

Rate (IMR), and Neonatal Mortality Rate (NMR) exist in the Less Developed

Countries (LDCs). Indonesia, a middle income country in South East Asia has

been successful in reducing child mortality, but has not yet made enough progress

in reducing infant and neonatal mortality. Situation analysis is needed to identify

factors which may provide insights on how greater progress may be achieved.

, Reduction of under-five mortality rate by two-thirds between 1990 and 2015

is a Millennium Development Goal (MDG). Indonesia has been on track in

achieving the MDG target on under-five mortality. However, slower progress on

infant mortality reduction shows that more attention should be given in order to

improve the survival of younger children. Motivated by this situation, this study

attempts to identify determinants of infant mortality in Indonesia between 1997

and 2012 using the 4th, 5th and 6th rounds of the Indonesia Demographic and

Health Survey (IDHS) data. In addition, the study aims to identify externalities

which may be generated by investments in mother’s education, water and

sanitation, and child vaccination by a household’s neighbors. The conceptual

framework is based on Mosley and Chen (1984). Logistic regressions are used to

estimate the effect of a variety of factors on infant mortality.

The regression results shows that bio-demographic factors which include

child and maternal traits are key predictors of infant mortality in Indonesia. Male

sex, birth multiplicity, higher birth rank, shorter birth interval, mother age above

35 years, and complication during pregnancy are positively related to infant

mortality. Behavioral practices such as institutional delivery, knowledge of Oral

Rehydration Solutions (ORS), and especially contraceptive practice are also

important factors that negatively related to infant mortality. Moreover,

household’s hygiene characteristics such as safe drinking water source, private

toilet, and improved flooring materials are also important factors that increase

infant survival status in Indonesia. Some socio economic variables are also found

to be significant determinants of infant mortality in Indonesia. Among the various

factors, the number of household members is the strongest factors related to infant

mortality. At the community level, Sumatra and Kalimantan regions in 2012 have

lower odds of infant mortality, whereas Sulawesi region in 2007 has higher odds

of infant mortality as compare to Java and Bali. Furthermore, the study finds that

immunization participation in the community has a positive spillover effect on

infant survival status.

Relevance to Development Studies

Beside economic achievement, the level of development in a country is also

reflected in the health status of its people. Several health indicators, including

mortality rate in young children, have been used by the United Nation

Development Programme (UNDP) as measurements of poverty. The literature

suggests that the high numbers of Child Mortality Rate (CMR), Infant Mortality

Rate (IMR), and Neonatal Mortality Rate (NMR) exist in the Less Developed

Countries (LDCs). Indonesia, a middle income country in South East Asia has

been successful in reducing child mortality, but has not yet made enough progress

in reducing infant and neonatal mortality. Situation analysis is needed to identify

factors which may provide insights on how greater progress may be achieved.

]"