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Location Matters: Trends in Inequalities in Child Mortality in Indonesia. Evidence from Repeated Cross-Sectional Surveys

Author

Listed:
  • Andrew Hodge
  • Sonja Firth
  • Tiara Marthias
  • Eliana Jimenez-Soto

Abstract

Background: Considerable improvements in life expectancy and other human development indicators in Indonesia are thought to mask considerable disparities between populations in the country. We examine the existence and extent of these disparities by measuring trends and inequalities in the under-five mortality rate and neonatal mortality rate across wealth, education and geography. Methodology: Using data from seven waves of the Indonesian Demographic and Health Surveys, direct estimates of under-five and neonatal mortality rates were generated for 1980–2011. Absolute and relative inequalities were measured by rate differences and ratios, and where possible, slope and relative indices of inequality. Disparities were assessed by levels of rural/urban location, island groups, maternal education and household wealth. Findings: Declines in national rates of under-five and neonatal mortality have accorded with reductions of absolute inequalities in clusters stratified by wealth, maternal education and rural/urban location. Across these groups, relative inequalities have generally stabilised, with possible increases with respect to mortality across wealth subpopulations. Both relative and absolute inequalities in rates of under-five and neonatal mortality stratified by island divisions have widened. Conclusion: Indonesia has made considerable gains in reducing under-five and neonatal mortality at a national level, with the largest reductions happening before the Asian financial crisis (1997–98) and decentralisation (2000). Hasty implementation of decentralisation reforms may have contributed to a slowdown in mortality rate reduction thereafter. Widening inequities between the most developed provinces of Java-Bali and those of other island groupings should be of particular concern for a country embarking on an ambitious plan for universal health coverage by 2019. A focus on addressing the key supply side barriers to accessing health care and on the social determinants of health in remote and disadvantaged regions will be essential for this plan to be realised.

Suggested Citation

  • Andrew Hodge & Sonja Firth & Tiara Marthias & Eliana Jimenez-Soto, 2014. "Location Matters: Trends in Inequalities in Child Mortality in Indonesia. Evidence from Repeated Cross-Sectional Surveys," PLOS ONE, Public Library of Science, vol. 9(7), pages 1-10, July.
    • Handle: RePEc:plo:pone00:0103597
    DOI: 10.1371/journal.pone.0103597
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    References listed on IDEAS

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    1. Zoe Dettrick & Hebe N Gouda & Andrew Hodge & Eliana Jimenez-Soto, 2016. "Measuring Quality of Maternal and Newborn Care in Developing Countries Using Demographic and Health Surveys," PLOS ONE, Public Library of Science, vol. 11(6), pages 1-20, June.
    2. Fatine Ezbakhe & Agustí Pérez Foguet, 2020. "Child mortality levels and trends: A new compositional approach," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 43(43), pages 1263-1296.
    3. Indunil De Silva & Sudarno Sumarto, 2018. "Child Malnutrition in Indonesia: Can Education, Sanitation and Healthcare Augment the Role of Income?," Journal of International Development, John Wiley & Sons, Ltd., vol. 30(5), pages 837-864, July.
    4. Pavitra Paul & Ulrich Nguemdjo & Armel Ngami & Natalia Kovtun & Bruno Ventelou, 2022. "Do efficiency and equity move together? Cross-dynamics of Health System performance and Universal Health Coverage," Humanities and Social Sciences Communications, Palgrave Macmillan, vol. 9(1), pages 1-8, December.
    5. Raoul Bermejo III & Sonja Firth & Andrew Hodge & Eliana Jimenez-Soto & Willibald Zeck, 2015. "Overcoming Stagnation in the Levels and Distribution of Child Mortality: The Case of the Philippines," PLOS ONE, Public Library of Science, vol. 10(10), pages 1-13, October.

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