Spatial determinants affected maternal mortality of East Java province during the COVID-19 pandemic era, in 2020-2021


  • Eka Diah Kartiningrum Doctoral Program of Public Health Faculty, Airlangga University, Surabaya
  • Hari Basuki Notobroto Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya
  • Lutfi Agus Salim Department of Epidemiology, Biostatistics, Population and Health Promotion, Faculty of Public Health, Airlangga University, Surabaya
  • Bambang Widjanarko Otok Departement of Statistics, Sepuluh November Institute of Technology, Surabaya



COVID-19, determinant, maternal, mortality, spatial


Background. Every life aspect and group of the community have changed during the COVID-19 pandemic, including the group of pregnant, childbirth, and postpartum woman. COVID-19 Pandemic occurred in 2020-2021. Maternal mortality in East Java Province was the highest in Indonesia during the pandemic. Objective. This study analyzed the effect of spatial determinants that consist of antenatal, childbirth, and post-partum care on maternal mortality in East Java Province during the Pandemic. Methods. This study used a crossectional method with the unit of analysis in this study was all pregnant, childbirth and postpartum women in 38 districts of East Java Province from 2020 until 2021. Data were analyzed with spatial regression by using Geographically Weighted Regression Software. Results. Maternal mortality in East Java had a spreading pattern and negative value of the diff criterion, so we concluded that there was a spatial influence. The variables of antenatal care, accessibility of healthcare service, third postpartum visit, and complication service had significant effects on maternal mortality in all regions (P<0,05). There were four groups of districts that showed a similarity of significant factors. This result showed that each region’s diversity of the accessibility of health services affects maternal mortality during the COVID-19 era. Antenatal services, access to health facilities and complication services affected maternal mortality in regions with high maternal mortality rate. Conclusion. Every region has its spatial determinants of maternal mortality. The top government should give authority to local government to have programs to reduce maternal mortality according to the condition in their region.

Download data is not yet available.


WHO WHO. Maternal mortality: Evidence brief. 2019; 1.

Corbett GA, Milne SJ, Hehir MP, et al. Health anxiety and behavioural changes of pregnant women during the COVID-19 pandemic. Eur J Obstet Gynecol Reprod Biol 2020; 249: 96–97. DOI:

Lim G, Lasorda KR, Farrell LM, et al. Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study. BMC Pregnancy Childbirth; 20. Epub ahead of print 22 April 2020. DOI: 10.1186/S12884-020-02943-7. DOI:

Phoswa WN, Khaliq OP. Is pregnancy a risk factor of COVID-19? Eur J Obstet Gynecol Reprod Biol 2020; 252: 605. DOI:

Mei C-L. Geographically Weighted Regression Technique for Spatial Data Analysis. School of Science Xi’an Jiatong University, (2005, accessed 19 December 2022).

Mendez-Dominguez N, Santos-Zaldívar K, Gomez-Carro S, et al. Maternal mortality during the COVID-19 pandemic in Mexico: a preliminary analysis during the first year. BMC Public Health 2021; 21: 1297–1297. DOI:

Siqueira TS, Silva JRS, Souza M do R, et al. Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study. Lancet Reg Heal - Am 2021; 3: 100076. DOI:

John AE, Nilima, Binu VS, et al. Determinants of antenatal care utilization in India: a spatial evaluation of evidence for public health reforms. Public Health 2019; 166: 57–64. DOI:

Pelaez Freire JA, Carillo MH, Castillo LA, et al. Social Determinants and Ethnic Factors Associated with a New Spatial Distribution of Maternal Mortality for a City of Colombia (2000-2019). Eur J Med Heal Sci 2021; 3: 1–5. DOI:

Yaya S, Anjorin SS, Adedini SA. Disparities in pregnancy-related deaths: Spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries. BMJ Glob Heal; 6. Epub ahead of print 2021. DOI: 10.1136/bmjgh-2020-004233. DOI:

Tian F, Pan J. Hospital bed supply and inequality as determinants of maternal mortality in China between 2004 and 2016. Int J Equity Health 2021; 20: 1–15. DOI:

Reis-Muleva B, Vilela Borges AL, Simões Duarte L, et al. Assessment of the quality of antenatal care in Mozambique. Midwifery 2023; 118: 103598. DOI:

Bantas K, Aryastuti N, Gayatri D. Artikel Penelitian The Relationship between Antenatal Care with Childbirth Complication in Indonesian’s Mothers (Data Analysis of The Indonesia Demographic and Health Survey 2012). J Epidemiol Kesehat Indones 2019; 2: 55–64. DOI:

Ministry of Health RI. Basic Health Research. Jakarta, 2013.

Juan J, Gil MM, Rong Z, et al. Effect of coronavirus disease 2019 (COVID-19) on maternal, perinatal and neonatal outcome: systematic review. Ultrasound in Obstetrics and Gynecology 2020; 56: 15–27. DOI:

Fauziah & Sutejo. Pregnancy Maternity Nursing. Jakarta: Kencana Prenada Media Group, 2012.

Oyerinde K. Can Antenatal Care Result in Significant Maternal Mortality Reduction in Developing Countries? J Community Med Health Educ; 2013. Epub ahead of print 11 March 2013. DOI: 10.4172/2161-0711.1000E116. DOI:

Kumar N. Postpartum hemorrhage; a major killer of woman: review of current scenario. Obstet Gynecol Int J; Volume 4. Epub ahead of print 3 May 2016. DOI: 10.15406/OGIJ.2016.04.00116. DOI:

Marabele PM, Maputle MS, Ramathuba DU, et al. Cultural Factors Contributing to Maternal Mortality Rate in Rural Villages of Limpopo Province, South Africa. Int J Womens Health 2020; 12: 691. DOI:

Menéndez C, Quintó L, Castillo P, et al. Quality of care and maternal mortality in a tertiary-level hospital in Mozambique: a retrospective study of clinicopathological discrepancies. Lancet Glob Heal 2020; 8: e965–e972. DOI:

Hida Nurrizka R, Yunis T, Wahyono M. Disparitas Kematian Maternal di Indonesia: Studi Ekologi dengan Analisis Spasial. Media Kesehat Masy Indones 2018; 14: 119–127. DOI:

Astuti SK, Aziz MA, Arya IFD. Maternal Mortality Risk Factors in Dr. Hasan Sadikin General Hospital, Bandung in 2009−2013. Int J Integr Heal Sci 2017; 5: 52–56. DOI:

Musa J, Mohammed C, Ocheke A, et al. Incidence and risk factors for pre-eclampsia in Jos Nigeria. Afr Health Sci 2018; 18: 584–595. DOI:

Joseph KS, Boutin A, Lisonkova S, et al. Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations. Obstet Gynecol 2021; 137: 763–771. DOI:

Abraham T, Romani AMP. The Relationship between Obesity and Pre-Eclampsia: Incidental Risks and Identification of Potential Biomarkers for Pre-Eclampsia. Cells; 11. Epub ahead of print 2022. DOI: 10.3390/cells11091548. DOI:

Berhan Y, Berhan A. Antenatal Care as a Means of Increasing Birth in the Health Facility and Reducing Maternal Mortality: A Systematic Review. Ethiop J Health Sci 2014; 24: 93. DOI:

Wahyuni I. Perilaku Perawatan Luka Perinium, Pola Hidup Sehat dan Kondisi Kesehatan Ibu Post Partum Masa Pandemi Covid-19. J Kebidanan Harapan Ibu Pekalongan 2020; 7: 64–77. DOI:

Sultan P, Jensen SE, Taylor J, et al. Proposed domains for assessing postpartum recovery: a concept elicitation study. BJOG An Int J Obstet Gynaecol 2022; 129: 9–20. DOI:

Janevic T, Maru S, Nowlin S, et al. Pandemic Birthing: Childbirth Satisfaction, Perceived Health Care Bias, and Postpartum Health During the COVID-19 Pandemic. Matern Child Health J 2021; 25: 860–869. DOI:

Mundhra R, Bahadur A, Sharma S, et al. Emergency Peripartum Hysterectomy During COVID-19 Pandemic. Cureus; 13. Epub ahead of print 20 December 2021. DOI: 10.7759/CUREUS.20524. DOI:

Stuebe AM, Kendig S, Suplee PD, et al. Consensus Bundle on Postpartum Care Basics: From Birth to the Comprehensive Postpartum Visit. Obstet Gynecol 2021; 137: 33–40. DOI:

Nurjannah, N., Maria, I., E, Rildayani, Sari E. Spatial Analysis of Maternal Mortality Rate (MMR) with Midwife Ratio, and Delivery Coverage by Health Workers in Aceh Province 2017. J Kedokt Nangroe Med 2018; 1: 7–14.

McCauley H, Lowe K, Furtado N, et al. Essential components of postnatal care – a systematic literature review and development of signal functions to guide monitoring and evaluation. BMC Pregnancy Childbirth 2022; 22: 448. DOI:

Anger HA, Durocher J, Dabash R, et al. Postpartum infection, pain and experiences with care among women treated for postpartum hemorrhage in three African countries: A cohort study of women managed with and without condom-catheter uterine balloon tamponade. PLoS One; 16. Epub ahead of print 1 February 2021. DOI: 10.1371/JOURNAL.PONE.0245988. DOI:




How to Cite

Kartiningrum, E. D., Notobroto, H. B., Salim, L. A., & Otok, B. W. (2023). Spatial determinants affected maternal mortality of East Java province during the COVID-19 pandemic era, in 2020-2021. Journal of Public Health in Africa, 14(s2).