Determinants of adverse pregnancy outcomes : a case study in selected rural areas of West Java, Indonesia

Abstract

The study addresses the determinants of adverse pregnancy outcomes, especially neonatal deaths and stillbirths, in developing countries. The study is conducted in the Indramayu Regency of West Java Province, Indonesia. A wide range of quantitative and qualitative methods was employed to study this important public health issue. Using community-based longitudinal data derived from the Indramayu Health and Family Planning Prospective Study and the MotherCare Study (1990 to 1993), a series of bivariate and multivariate analyses was conducted. It was found that the level of neonatal deaths and stillbirths in the study area was higher than the national average. Socio-demographic as well as bio-medical factors were significantly related to the high level of neonatal deaths and stillbirths. While school attendance had the direct effect of reducing the risk of stillbirth, teenage pregnancy increased the risk of neonatal death through the indirect effects of short pregnancy intervals and low birth weight. Neither the maternal nutritional depletion theory, nor the excess of preterm deliveries in the short pregnancy interval group explained the mechanism through which a short pregnancy interval increased the risk of neonatal death. It is likely that an intrafamilial mortality effect was the causal mechanism. The findings suggest that efforts to alleviate the level of neonatal deaths and stillbirths should not only focus on medical initiatives but also on specific social interventions. Although extensive public health campaigns and the provision of adequate maternal and child health care are necessary, they alone are not sufficient. Social interventions designed to promote late marriage and delay of first birth through improving women's education are required to enhance medical efforts to reduce the high level of neonatal deaths and stillbirths in the study area or areas with similar conditions.