Poverty Still Decides Survival

In Indonesia, maternal mortality remains a sobering paradox: despite decades of progress, a woman still faces an unacceptably high risk of dying from pregnancy-related causes. The Borgen Project’s 2025 profile outlines that Indonesia’s maternal mortality ratio (MMR) stands at 140 deaths per 100,000 live births, a figure that outpaces many neighbors and reflects persistent gaps in health equity. Over the past decades, Indonesia has steadily chipped away at maternal deaths. In 1990, the national MMR was as high as 450, and by 2020 it had declined by roughly 45 percent. But this decline has not been uniform. Some regions—particularly in eastern Indonesia, Sulawesi, Maluku, and Papua—still suffer maternal death rates more than twice the national average, while the more developed Java–Bali region maintains much lower volumes. (National data show that non-Java provinces can have 11 percent to 44 percent higher maternal risk). Part of the difficulty lies in conflicting statistics. The World Health Organization and other official sources estimate the MMR in 2020 at 173 per 100,000 live births, while national surveys place it lower at 189 or even 256 depending on method and definition. These discrepancies arise largely from underreporting, especially of deaths occurring outside hospital settings or misclassified owing to limited surveillance systems. Just as important as the numbers is the shifting pattern of causes. Two or three decades ago, nearly half of maternal deaths were due to obstetric haemorrhage, with infections making up another sizable share. But more recent analyses have showed that haemorrhage now accounts for only around 18 percent, and infections about 5 percent. In their place, hypertensive disorders (such as eclampsia) and so-called non-obstetric causes—cardiovascular, diabetes, and other chronic ailments exacerbated by pregnancy—are playing an ever larger role, now making up nearly half of maternal deaths. To worsen matters, Indonesia’s maternal surveillance infrastructure is still limited. A robust Maternal Death Surveillance and Response (MDSR) system—a continuous cycle of reporting, investigation, and response—is central to reducing preventable deaths, yet is not uniformly implemented across the islands. Geography, poverty, and social factors further compound the burden. Women in remote or poor districts face difficulties reaching skilled care in time, and poorer populations continue to see higher maternal risk—even though gaps have somewhat narrowed in recent years. Between 2010 and 2021, socioeconomic disparities shrank, likely bolstered by the expansion of social health insurance. Policy innovations are trying to close these gaps. Indonesia’s conditional cash transfer program (PKH), for example, has shown promise in increasing utilization of maternal health care: births assisted by professionals, facility-based delivery, prenatal and postnatal visits all improved, especially in districts with better medical staffing. Meanwhile, international and grassroots efforts—such as the clinics run by midwife Robin Lim and the Bumi Sehat foundation—offer free or low-cost prenatal and birthing care to marginalized women, helping reduce financial and geographic barriers to safe motherhood. Yet, Indonesia still has a long way to go. The Sustainable Development Goals (SDGs) target a global maternal mortality ratio below 70 by 2030. To approach that, Indonesia must push harder on several fronts. First, it needs to close surveillance and reporting gaps so that no maternal death goes uncounted or unexplained. Second, quality of care must improve—not just access—so that skilled birth attendants truly can prevent and manage the most dangerous complications, especially from hypertension and chronic disease. Third, health equity must be at the heart of expansion: remoter islands, poorer households, and underserved groups deserve priority in infrastructure, staffing, and financing. Indonesia’s journey toward safer motherhood is a story of both achievement and ongoing struggle. The fall from 450 to 140 in maternal mortality (per current national data) is commendable, yet the persistence of regional disparities, changing causes of death, and underreporting reflect both technical and systemic challenges. In an archipelago of thousands of islands, the greatest test will be weaving a health system that ensures that no woman’s life is lost simply because she lives too far from a hospital, lacks means, or faces an invisible medical complication.