Unequal Progress in Maternal and Child Health in Indonesia, 2013 - 2023: Evidence from National Health Surveys

<ns5:p>Background Indonesia has achieved substantial improvements in maternal and child health (MCH) over the past decade. However, whether these gains have been equitably distributed across socioeconomic groups remains unclear. Method This study analyzed data from the 2013 and 2018 Basic Health Surveys (Riskesdas) and the 2023 Indonesian Health Survey (SKI) to assess trends and socioeconomic inequalities in MCH outcomes and healthcare utilization. Indicators included child mortality, nutritional status, maternal health, infectious diseases, and service coverage (antenatal care, skilled birth attendance, immunization, and postpartum care). Inequality was assessed using wealth quintile ratios and concentration indices, with comparisons across wealth quintiles and rural–urban residence. Results Between 2013 and 2023, most MCH indicators improved nationally, including declines in infant mortality and childhood stunting. However, socioeconomic inequalities persisted and, for several indicators, widened. Quintile ratios for stunting and low maternal body mass index increased, indicating growing disparities disadvantaging poorer households. Utilization of skilled birth attendance expanded substantially, particularly among the poorest quintiles. In contrast, coverage of antenatal care and full childhood immunization declined over time and became increasingly concentrated among wealthier populations. A marked increase in reported postpartum complications was observed across all wealth groups, especially among urban women. Conclusions Despite overall progress in MCH, wealth-related inequalities remain substantial in Indonesia. Improvements in health outcomes and service coverage have disproportionately benefited higher socioeconomic groups, underscoring the need for targeted, equity-oriented policies to ensure that vulnerable populations are not left behind.</ns5:p>