Education, Parity, and Health Worker Support Associations to Postpartum Care in Indonesian Context
Abstract
Introduction: Maternal mortality during the postpartum period remains a significant public health concern. In 2022, most cases of maternal deaths in Semarang City occurred during postpartum period. Maternal knowledge and attitudes regarding postpartum selfcare are essential for preventing complications. Midwives’ visit to postpartum mothers’ program in Indonesia can be improved to increase mothers’ knowledge and attitude on postpartum care. This study aimed to investigate the factors associated to postpartum care in urban area of Indonesia.
Methods: A cross-sectional study was conducted involving 90 postpartum mothers selected from three primary health care centers in Semarang City, which were chosen based on high numbers of postpartum mothers and demographic variations. Data were collected using validated, structured interviews to assess maternal knowledge, attitudes, and health worker support. Data were analyzed using Pearson correlation tests and multiple linear regressions to determine the associations between socio demographic factors and postpartum care indicators.
Results: The average maternal knowledge score (8.2 ± 1.16), and the attitude score were good (22.2 ± 2.82). The knowledge of mothers was lack in face’s sign of preeclampsia. The attitude of mothers was lack in self-assessment on breast inflammation. Educational attainment (p = 0.061) and parity (p = 0.015) positively correlated to knowledge. Age (p = 0.014), parity (p = 0.049), and support from health workers (p = 0.041) significantly associated to maternal attitudes.
Conclusion: Higher levels of education and strong support from health workers were associated to improved maternal knowledge and attitudes toward postpartum care. These findings showed the importance of interventions on postpartum care. Focusing on less educated mothers and enhancing healthcare engagement are important to reduce postpartum related complications and maternal mortality.
References
WHO. Trends in maternal mortality 2000 to 2020: estimates [Internet]. WHO, Geneva. 2021. 12 p. Available from: https://www.who.int/reproductivehealth/publications/maternal-mortality-2000-2017/en/
Maryam Sadat Shojaei, Seyedeh Belin Tavakoly Sany, Vahid Ghavami HT. An educational intervention based on family-centered empowerment model to modify high-risk behaviors of brucellosis via mother education. Sci Rep. 2022;12(1):1–11.
Halder A, Jose R, Vijayselvi R. Maternal mortality and derivations from the WHO Near-Miss tool: An institutional experience over a decade in southern india. J Turkish Ger Gynecol Assoc. 2014;15(4):222–7.
Manik H, Triyoga RS, Siregar MFG, Rochadi RK, Poddar S. Sustainability in Transformation of Maternal Mortality by Interaction Based Approach in Dairi, Indonesia. J Public health Res. 2021;10(2_suppl).
Kemenkes RI. Rencana Strategis (Renstra) Kementerian Kesehatan Tahun 2020-2024 (revisi 2022). Kementerian Kesehatan Republik Indonesia. 2022.
Kementerian Kesehatan RI. Indikator Program Kesehatan Masyarakat dalam RPJMN dan Rentra Kementerian Kesehatan 2020-2024. Katalog Dalam Terbitan Kementeri Kesehat RI [Internet]. 2020;1–99. Available from: https://kesmas.kemkes.go.id/assets/uploads/contents/attachments/ef5bb48f4aaae60ebb724caf1c534a24.pdf
Page MR, Cozzi GD, Blanchard CT, Lu MY, Ausbeck EB, Casey BM, et al. Venous thromboembolism and adverse outcomes in highest thromboembolism risk patients compared with those at lower risk. Am J Obstet Gynecol MFM [Internet]. 2022;4(6):100720. Available from: https://doi.org/10.1016/j.ajogmf.2022.100720
Park JE, Park Y, Yuk JS. Incidence of and risk factors for thromboembolism during pregnancy and postpartum: A 10-year nationwide population-based study. Taiwan J Obstet Gynecol [Internet]. 2021;60(1):103–10. Available from: https://doi.org/10.1016/j.tjog.2020.11.016
Pearce G, Bell L, Pezaro S, Reinhold E. Childbearing with Hypermobile Ehlers–Danlos Syndrome and Hypermobility Spectrum Disorders: A Large International Survey of Outcomes and Complications. Int J Environ Res Public Health. 2023;20(20).
Kolin DA, Shakur-Still H, Bello A, Chaudhri R, Bates I, Roberts I. Risk factors for blood transfusion in traumatic and postpartum hemorrhage patients: Analysis of the CRASH-2 and WOMAN trials. PLoS One [Internet]. 2020;15(6):1–15. Available from: http://dx.doi.org/10.1371/journal.pone.0233274
Wahyu Susanti L, Sulistiyanti Akademi Kebidanan Citra Medika Surakarta Lien A, Abstrak yahoocoid. ANALISIS FAKTOR-FAKTOR PENYEBAB TERJADINYA BABY BLUES SYNDROM PADA IBU NIFAS 1. INFOKES. 2017;(2).
Gezimu W, Bekele F, Habte G. Pregnant mothers’ knowledge, attitude, practice and its predictors towards nutrition in public hospitals of Southern Ethiopia: A multicenter cross-sectional study. SAGE Open Med. 2022;10.
Chen X, Mi MY. The impact of a trial of labor after cesarean versus elective repeat cesarean delivery: A meta-analysis. Med (United States). 2024;103(7):E37156.
Symonds NE, Vidler M, Wiens MO, Omar S, English LL, Ukah UV, et al. Risk factors for postpartum maternal mortality and hospital readmission in low ? and middle ? income countries : a systematic review. BMC Pregnancy Childbirth [Internet]. 2023;1–10. Available from: https://doi.org/10.1186/s12884-023-05459-y
Beraki GG, Tesfamariam EH, Gebremichael A, Yohannes B, Haile K, Tewelde S, et al. Knowledge on postnatal care among postpartum mothers during discharge in maternity hospitals in Asmara: A cross-sectional study. BMC Pregnancy Childbirth. 2020;20(1):1–10.
Gomora Tesfaye D, Geta G, Kene C, Seyoum K, Tekalegn Y, Desta F, et al. Maternal Health Care Seeking Behavior for Neonatal Danger Signs and Associated Factors Among Post-Partum Mothers in Southeast Ethiopia: A Cross-Sectional Study. Inq (United States). 2022;59.
Idris H, Syafriyanti W. Determinants of Postnatal Care Service Utilization in Indonesia: A Secondary Analysis Using the Indonesian Health and Demographics Survey. Makara J Heal Res. 2021;25(1).
Amana IG, Tefera EG, Chaka EE, Bulto GA. Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study. BMC Womens Health. 2024;24(1):1–9.
Zalukhu J, Girsang BM. Kajian Faktor Perilaku Kesehatan Ibu Nifas Yang Mempengaruhi Kunjungan Masa Nifas Di Indonesia. J Kesehat Masy. 2023;11(6):645–60.
Syaripah P, Rindu R, Noviyani EP. Hubungan Motivasi Ibu, Dukungan Keluarga Dan Peran Bidan Terhadap Kunjungan Nifas Di Puskesmas Maripari Kabupaten Garut Tahun 2023. SENTRI J Ris Ilm. 2024;3(5):2492–506.
Syamson MM, Harita. THE INFLUENCE OF EDUCATION OF POSTPARTUM MOTHERS ON THE KNOWLEDGE OF POSTPARTUM RISK SIGNS. Med Technol Public Heal J. 2023;7(2):122–8.
Eluri S, Baliga BS, Rao SS, Vinayagamoorthy V, Kamath N. Can Flip-Chart Assisted Maternal Education Improve Essential New Born Care Knowledge and Skills? A Randomized Controlled Trial. Matern Child Health J. 2022;26(9):1891–906.
Uwiringiyimana E, Manirambona E, Byiringiro S, Nsanzimana A, Uhawenayo N, Ufitinema P, et al. Pregnant women’s knowledge of obstetrical danger signs: A cross-sectional survey in Kigali, Rwanda. PLOS Glob Public Heal [Internet]. 2022;2(11):1–12. Available from: http://dx.doi.org/10.1371/journal.pgph.0001084
Alhassan AR. Knowledge, attitude, and practice regarding postpartum care among mothers attending an Egyptian family health unit. Menoufia Med J. 2022;35(April):190–5.
Diarsvitri W, Utomo ID. Medical perspective of reproductive health education in Indonesian schoolbooks. Front Public Heal. 2022;10(3).
Farhati F, Fatimah YU, Sriyanti C. PENGARUH PENERAPAN APLIKASI “BIDANKU” TERHADAP PENINGKATAN PENGETAHUAN DAN EFIKASI DIRI IBU NIFAS. J Ris Kesehat POLTEKKES DEPKES BANDUNG [Internet]. 2023 Oct 11;15(2):423–31. Available from: https://juriskes.com/index.php/jrk/article/view/2407
ElHanim AN, Oktavianti DS. Pengaruh Pendidikan Kesehatan terhadap Pengetahuan dan Sikap Tentang Perilaku Hidup Bersih dan Sehat pada Rumah Tangga di RT 005 RW 002 Jurang Mangu Timur Kota Tangerang Selatan. J Nurs Heal Sci [Internet]. 2023 Aug 8;2(2):37–43. Available from: https://e-journalstikes-pertamedika.ac.id/index.php/jnhs/article/view/59
Malinda D, Rismayanti T. Relationship between Education, Parity Status and Mother’s Knowledge of Booster Immunization with Complete Basic Immunization of Children in the Work Area of the Tanjungsiang Health Center Subang Regency in 2023. Int J Heal Pharm. 2024;4(1):19–27.
Ketema DB, Leshargie CT, Kibret GD, Assemie MA, Petrucka P, Alebel A. Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: A systematic review and meta-analysis. BMC Pregnancy Childbirth. 2020;20(1):1–9.
Molla W, Mengistu N, Wudneh A. Pregnant women’s knowledge, attitude, and associated factors toward obstetric ultrasound in public hospitals, Ethiopia, 2021: Multi-centered cross-sectional study. Women’s Heal [Internet]. 2022;18. Available from: https://pubmed.ncbi.nlm.nih.gov/35356812/
Adeola OA, Mojisola AA, Jamila Y. Impact of maternal demographics on knowledge of exclusive breastfeeding among nursing mothers in Ifelodun local government, Nigeria. Afr Health Sci. 2023;23(2):694–702.
Abdullahi HM, Usman NO. Attitude and utilization of postnatal care services among women of reproductive age in the rural and urban communities in Northern Nigeria. Calabar J Heal Sci. 2022;6(2):72–9.
Xu R, Wang J, Li Y, Chen Y, Zhang W, Pan X, et al. Pre- and postpartum fear of childbirth and its predictors among rural women in China. BMC Pregnancy Childbirth. 2024;24(1):1–12.
Ilmianti I, Pamewa K, Pertiwisari A. Hubungan Faktor Sosial Demografi Terhadap Kesiapan Ibu Untuk Memulai Perawatan Preventif Kesehatan Gigi Dan Mulut Anak. Sinnun Maxillofac J [Internet]. 2021 Oct 30;3(02):27–34. Available from: http://e-jurnal.fkg.umi.ac.id/index.php/sinnunmaxillofacial/article/view/6
Wang K, Li R, Li Q, Li Z, Li N, Yang Y, et al. Knowledge, attitude, and practice toward postpartum depression among the pregnant and lying-in women. BMC Pregnancy Childbirth. 2023;23(1):1–8.
Cheng GZ, Chen A, Xin Y, Ni QQ. Using the teach-back method to improve postpartum maternal-infant health among women with limited maternal health literacy: a randomized controlled study. BMC Pregnancy Childbirth [Internet]. 2023;23(1):1–14. Available from: https://doi.org/10.1186/s12884-022-05302-w
Nastiti AA. Postpartum Fatigue: A Critical Challenge for New Mothers. Pediomaternal Nurs J. 2024;10(2):48–50.
Teslim SA, Adeola A salam R, Adesina O. Attitude of postpartum women towards multiple postnatal clinic schedule in south-west Nigeria. Eur J Obstet Gynecol Reprod Biol X. 2023;18(April).
Asumah MN, Abubakari A, Abdulai AM, Nukpezah RN, Adomako-Boateng F, Faridu AW, et al. Sociodemographic and Maternal Determinants of Postnatal Care Utilization: A Cross-Sectional Study. SAGE Open Nurs. 2023;9.
Humairah A. HUBUNGAN PENGETAHUAN, SIKAP DAN TINDAKAN POLA ASUH IBU TERHADAP STATUS GIZI BATITA USIA 6-36 BULAN DI POSYANDU KASIH IBU KABUPATEN SOLOK. Al-Tamimi Kesmas J Ilmu Kesehat Masy (Journal Public Heal Sci [Internet]. 2022 Jul 30;11(1):76–9. Available from: https://jurnal.stikes-alinsyirah.ac.id/index.php/kesmas/article/view/2197
Alfikrie F, Hidayat UR, Wahyuningtyas EP. Edukasi Metode Demonstrasi dan Role Play Terhadap Pengetahuan Polisi Lalu Lintas (Polantas) Tentang Pertolongan Pertama Gawat Darurat Kecelakaan Lalu Lintas. Khatulistiwa Nurs J [Internet]. 2019 Jul 15;1(2). Available from: https://ejournalyarsi.ac.id/index.php/KNJ/article/view/12
Hasanah SN, . T, Suwita IK. Literature Review Penyuluhan Gizi terhadap Pengetahuan dan Kepatuhan Konsumsi Tablet Tambah Darah pada Ibu Hamil. Nutr J [Internet]. 2023 May 22;2(1):42. Available from: https://ojs.poltekkes-malang.ac.id/index.php/Nutriture/article/view/3527
Febriana T. Hubungan Karakteristik Ibu Dengan Kejadian Komplikasi Masa Nifas. Indones Scintific J Midwifery [Internet]. 2023;1 No 2(2). Available from: https://ejournal.umpri.ac.id/index.php/ISJM/index
Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review. BMC Womens Health [Internet]. 2024;24(1):1–15. Available from: https://doi.org/10.1186/s12905-024-03177-x
Finlayson K, Sacks E, Brizuela V, Crossland N, Cordey S, Ziegler D, et al. Factors that influence the uptake of postnatal care from the perspective of fathers, partners and other family members: A qualitative evidence synthesis. BMJ Glob Heal. 2023;8:1–18.
Souza JP, Day LT, Rezende-Gomes AC, Zhang J, Mori R, Baguiya A, et al. A global analysis of the determinants of maternal health and transitions in maternal mortality. Lancet Glob Heal. 2024;12(2):e306–16.
Kilanowski JF. Breadth of the Socio-Ecological Model. J Agromedicine [Internet]. 2017;22(4):295–7. Available from: https://doi.org/10.1080/1059924X.2017.1358971
Armaya R. Kepatuhan Ibu Hamil dalam Melakukan Kunjungan Antenatal Care dan Faktor yang Mempengaruhi. J Ilmu Kesehat Masy [Internet]. 2018 Mar 20;7(01):43–50. Available from: http://journals.stikim.ac.id/index.php/jikm/article/view/51
Setiyorini A, Yuliana Sijabat F, Anita Sari M. Faktor yang Mempengaruhi Kepatuhan Ibu Hamil dalam Melakukan Kunjungan Antenatal Care (ANC) di Layanan Kesehatan.pdf. I Care J Keperawatan STIKes Panti Rapih [Internet]. 2021;2(1):1–12. Available from: http://ejournal.stikespantirapih.ac.id/index.php/jurkes/article/view/147
Fauziah N. Keberhasilan Dukungan Tenaga Kesehatan saat Perawatan Pasca Persalinan Terhadap Pemberian ASI Eksklusif. J Sains dan Teknol Kesehat. 2024;3(1):15–21.
Rahayu SP, Yulyana N, Dewi R. Hubungan Pengetahuan Dan Dukungan Suami Dengan Kepatuhan Kunjungan Nifas. Midwifery Care J. 2023;4(4):142–50.
Dewi PS. Pengaruh Penyuluhan Kesehatan dengan Metode Ceramah tentang Manajemen Laktasi Disertai Buku Panduan Terhadap Pengetahuan dan Sikap Ibu Hamil Trimester I dan II dalam Memberikan ASI. Midwifery J STIKES Insa Cendekia Med Jombang Vol [Internet]. 2015;10(1):9–16. Available from: https://jurnal.itskesicme.ac.id/index.php/jib/article/view/165
Brodribb W, Hawley G, Mitchell B, Mathews A, Zakarija-Grkovi? I. Face-to-face health professional contact for postpartum women: A systematic review. Women and Birth. 2020;33(6):e492–504.
Prautami ES, Febrianti A, Anggraini D. PENGARUH PENYULUHAN TENTANG ASI EKSKLUSIF TERHADAP PENGETAHUAN DAN SIKAP IBU HAMIL PRIMIGRAVIDA TRIMESTER III DI DESA SIDOMULYO 18. J Keperawatan Sriwij [Internet]. 2023 Jan 31;10(1):10–6. Available from: https://jks-fk.ejournal.unsri.ac.id/index.php/jk_sriwijaya/article/view/170
Sitti Nurhidayanti Ishak. Strategi Inovatif untuk Meningkatkan Kesadaran dan Dukungan Ibu dalam Praktik Pemberian ASI Eksklusif dan MP-ASI: Studi Kasus di Wilayah Kerja Puskesmas Gambesi. Media Publ Promosi Kesehat Indones [Internet]. 2023 Oct 2;6(10):1999–2004. Available from: https://jurnal.unismuhpalu.ac.id/index.php/MPPKI/article/view/3770
Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
