MOTHERS' PARTICIPATION IN COMMUNITY GROUPS, THE QUALITY OF PRENATAL CARE SERVICES, AND INFANT HEALTH: ECONOMETRIC ANALYSIS (Preliminary Finding)

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L A P O R A N P E N E U T IA N
FAKULTAS

J U R U S A N IL M U E K O N O M I

E K O N O M IK A D A N B IS N IS

U N IV E R S iT A S G A D J A H M A O A
TAHUN2014

M O TH ERS' PA RTICIPA TIO N IN CO M M U N ITY G RO U PS, TH E
Q U A LITY O F PREN A TA L CA RE SERV ICES, A N D IN FA N T
H EA LTH : ECO N O M ETRIC A N A LY SIS
(Prelim inary Finding)

by
H e n i W a h y u n i, S .E .s M .E c .D e v ., P h D
N ID N 0 0 0 5 0 1 7 5 0 2
F a ra h A m a lia Y u s m a w a n

(S tu d e n t N o . 1 1 /3 1 1 3 7 2 /E K /1 8 1 9 2 )

U N IV E R S IT A S G A D J A H M A C A
D ecem ber 2014

O bjectives
To investigate the effect of m others' participation in com m unity groups
m aternal health care services and infant health using econom etric analysis.

on the utilization

of

M ethods
Estim ate the relationship betw een m others' participation and outcom e variables (prenatal visit
and birth w eight), w hile controlling for the factors that affect m others' participation in the
com m unity

groups.

com m unity
m aking.

The estim ation

characteristics.

uses com m unity

fixed

effect

to control

The findings are used to design recom m endations

for unobserved

for policy decision

Lessons Learned
M others'

participation

outcom es.

in an inform al

w om en gathering

group has a significant

The results suggest that trust and sharing of health know ledge

im portant for increasing

the utilization

im pact on the

from participation

is

of prenatal care services and birth w eight, especially

in

the context of a lack of access to health inform ation

through governm ent

channels.

Im plications
A dvertising/dissem ination
of the governm ent program s related to m aternal and infant health in

the com m unity groups w ill have a m ultiplier effect-affecting the behaviour on the utilization of
prenatal care services and infant health. A lso, through these com m unity groups, the health
providers

m ay share tools to educate

w om en

about the treatm ent

of pregnancy.

These

tools

address issues such as w here and w ith w hom to get prenatal care services and give birth, any
financial support that the m others can use to access the services, prevention and treatm ent for
high risk or com plicated
participation in com m unity

pregnancies,
and postpartum
treatm ent and services. Thus, the
groups m ay offer an effective w ay for health prom oting activities to

m others.

U nderlying

theory explains that the production

related to individual behavior,
M others' participation

in com m unity

of m edical care through
production

of individual

linking participation

nutrition,

physical activities,

access to health-related
health.

and the utilization

of m edical care.

groups is one possible pathw ay to increasing the utilization

K aw achi

inform ation,

and Berkm an

and health is the prom otion

cohesive com m unities

of health is a function of choices, such as those

(m ore trust or beliefs)

and influencing

(2000) suggest

of health inform ation.
health

inform ation

choices

and the

that the m echanism

They argue that in m ore

is rapidly diffused

and m ay

influence health seeking behavior. W here there are barriers to access health inform ation
governm ent channels and individual

education,

as com m only

happens in the developing

through
w orld,

1 ihgfedcbaZYXWVUT

individual

involvem ent

in a com m unity

group

m ay provide

health inform ation on m edical care and to understand
In the Indonesian
m others'

context, participation

participation

com m only

the resources

health practitioner's

in com m unity

in integrated

health

to seek

advice.

groups has a long standing tradition and

can be seen in m any types of com m unity

participate

necessary

activities

groups. For exam ple,

(Pas Pelayanan

or posts

w om en

Terpadu

or

Posyandui, w om en's inform al gatherings (arisan), and a form al w om an's gathering tPendidikan
Kesejahteraan Keluarga or PKK). These types of com m unity participation
strong cohesion am ong m em bers w ho are involved
relationship betw een participation

in these groups.

H ow ever,

the study of the

in these groups and infant health has received little attention in

the literature. This includes in Indonesia w here the participation
the potential strong netw orks

m ay enhance trust or

associated

in com m unity

w ith the access to health services,

groups is one of

health inform ation

and sharing know ledge.

Tn this research I investigate

w hether and to w hat extent m others'

groups in Indonesia translates

into benefits

participation

in term s of the utilization

services, the quality of m aternal health care services and the im provem ent
results

m ay contribute

participation
particular,

to the policy

on the utilization
w hether the benefits

decision

of m aternal

m aking

regarding

of m aternal

health

know ledge

health care

of birth outcom es. The

the effects

health care and the production

of gaining

in com m unity

of com m unity

of infant health. In

and inform ation

from

inform al

education im prove m aternal health care utilization and infant health in Indonesia.

The results dem onstrate

that m others'

participation

in arisan has a significant

im pact on the

utilization of prenatal care services and birth w eight. These results m ay suggest that trust and
sharing

of health

know ledge

in Indonesia,

from

participation

in arisan,

increasing the utilization

of prenatal care services and birth w eight. Therefore,

channel for governm ent

to dissem inate

health related inform ation

is im portant

for

arisan can be a

that m ay im prove

m others'

utilization in prenatal care and in turn im prove infant health.

Indonesia Fam ily Life Survey (IFLS) data (bJ.U 2Jj~~\\\\';E~nd,or12!J.;!..b~~ljl· LS1IFl,-,~)
is used in this
study to analyze the relationship

betw een m others'

participation

in com m unity

groups and infant XWVUTSR

2

\

health. IFLS is a longitudinal
individuals,

households,

survey that began in 1993. The data includes inform ation

and

econom ic, dem ographic,

com m unity

facilities;

and health inform ation.

characteristics,
pregnancy

outcom es

w hich

responses of ever-m arried

pregnancy

and dem ographic

and infant characteristics.
ended

w elfare,

history, m others'

characteristics

socio-

the years

2002

participation

of m others, m others'

The sam ple for the em pirical

betw een

education,

For the purpose of this study, I use inform ation

from IFLS 2000 and 2007 that relates to m others'
com m unity groups, socio-econom ic

representing

related to

in

health

analysis is restricted

and 2008

inclusive,

to

using

the

w om en in IFLS4 (2007). The sam ple size used in this study is 4436

childbirths w ith reported birth w eight.

The literature that investigates

the relationship

lim itations regarding interpretation
w ell-designed

experim ent.

betw een

the observed

spurious

correlation

m others'

com m unity

of a causal relationship

In particular,

factors

it is difficult

represent

due to unobserved
group

betw een com m unity

participation

to determ ine

correlation

factors.

In the context

participation

is if there

are characteristics

and her utilization

of prenatal

Posyandu,

exam ple, m others w ho participate in com m unity
respect to socio-econom ic

background

m ay also influence her pregnancy
sources of bias, the resulting

estim ates

outcom es.

w ill m isrepresent

socio-econom ic

dem ographic

status

(outcom e

health.

variables).

(disadvantaged)

I

For
w ith

health condition

If w e fail to control for these

the role of participation

and health

betw een

both the m other's

w hile a m other's

capital. In order to address this issue, I begin the analysis by exam ining
a m other's

and infant

a

betw een those tw o.

groups m ay be advantaged

and the pregnancy

they are actually

that affect

w eight

and health condition

the relationships

of the relationship

and PK K )

of the m other
care and birth

w hether

or w hether

consider som e potential sources of bias that com plicate the relationship

O ne possibility

and health has

betw een the tw o in the absence of a

a causal

(arisan,

participation

the relationship

characteristics

of social
betw een

and the m other's

participation in com m unity groups.

The second potential source of bias arises if there are unobserved
are correlated w ith m others' participation
leaders in the com m unity

characteristics

that

and prenatal visits or birth w eight. For exam ple, if the

w here the m other lives effectively

com m unity as w ell as participation

com m unity

in com m unity

prom oted

hygiene conditions

groups, then the estim ated coefficient

in the

from the XWVUTSR

3

\

analysis

of group

of the hygiene
issue,

participation

prom otion

I estim ate

(prenatal

visits

participation
estim ates

the
and

instead

birth

participation

that

econom etric

m ay

w hile

groups

equations

and the outcom es

com m unity

betw een

w eight),

in the com m unity

specifications

using

sim ply

be due to the effectiveness

in the groups.

a

participation

m other's
for

com m unity

the

m others'

and

the

relationship

a

m other's

fixed

betw een

effect

m others'

characteristics

the outcom es,

this

variables

affect

Com m unity

for constant

and

to address

outcom e

that

effects.

controlling

participation

In order

factors

fixed

an explanation

com m unities,

both

m ay

participation

controlling

provide

w ithin

influence

outcom es

of m others'

relationship

in the outcom e

Prenatal

and pregnancy

I thus

of the

form ulate

as follow s:

care equation:

( I ) ihgfedcbaZYXWVUTSRQPON

Birth w eight

W here

M P ic

econom ic

variables;

For

variables

dependent

com m unity

Table
of

factors

that affect

w ho

PCe

errors
(I)

are presented

I describes

m others

i characteristics.

is the birth

PC;e in equation

for

and

is

i in

the

BW ic

groups'
those

m other's

of child

table

com m unity

c;

(I) and BW ic

factors
(2).

is m other's
is

of prenatal

health

care facilities

all unobserved,

for

c. The error

term s

that change

over

variable

tim e-

(2) respectively.

utilization

D etailed

SO CIO -

m other's

in equation

care

i in com m unity

equation

Zie

a, and be capture

prenatal

are unobserved
in

c; X ic

c; A P ic is the availability

The variables

w eight

in appendix

in

I In com m unity

PC iL · in equation

w hich

the com m unity
participate

child

i in com m unity

variables,

the idiosyncratic

for child

variables

for child

c and BW ic

m easurem ents

participation

dem ographic

com m unity

represent

m other's

and Y ic is child

the

affect

is the

and

endow m ent

constant

equation:

child

i in

and flie

fie

individual
definitions

and
and

A.

variables
three

definitions
com m unity

and show s
groups

by

the sum m ary
socio-econom ic

statistics
and

4