The effects of access to health care on infant mortality in Indonesia

Health Transit Rev. 1995 Oct;5(2):143-63.


This paper examines the impact of access to health facilities and personnel on infant and child mortality in Indonesia. Demographic and Health Survey data are combined with village-level censuses of infrastructure collected by the Central Bureau of Statistics. Because the village-level data are available from two points in time, it is possible to analyse the effects on mortality risks within the village of changes in access to health care. Factors about villages that might affect both access to health care and mortality risks are held constant. Adding a maternity clinic to a village decreases the odds of infant mortality by almost 15 per cent, in comparison to the risk before the clinic was added. An additional doctor reduces the odds by about 1.7 per cent.

PIP: Data sources included community-level data on access to health services from the 1983 and 1986 censuses of village infrastructure and information on levels of socioeconomic development collected from village leaders of 63,000 villages. Individual-level data on infant mortality were derived from the 1987 Demographic and Health Survey of 11,884 women. These women gave birth to almost 13,000 children between 1980 and September 1987. Using a pairing process an analysis file was constructed with 652 pairs of children (298 neonatal observations and 354 post-neonatal observations) from 269 villages. If the data set of pairs was a subset of the cross-sectional data set, a Hausman statistic could be constructed to test formally whether the cross-sectional estimates were inconsistent. The focus was on 3 community variables: maternity clinics, doctors, and health workers. The fixed estimated effects indicate that a decline in mortality risks has occurred over time in Indonesia. Of the children born 1 month apart, the later child's odds of death were 0.5% lower than the earlier child's. Male children had about 29% higher odds of death than female children. First births faced mortality risks comparable to those of second-order births with prior-interval lengths of 34 months or more. Each year of maternal education decreased the odds of death by about 7%. The availability of health care decreased mortality: the coefficients on maternity clinics and doctors were negative and significant (p 0.03 and p 0.06, respectively). Within a village an increase of 1 maternity clinic decreased the odds of death of an infant with access to that clinic by about 15% relative to that of an infant born before the clinic existed. An additional doctor decreased an infant's odds of death by around 1.7%. An infant born after health workers were added to a village had about 1.3% greater odds of death than the infant born before. The Hausman statistic rejected the hypothesis that the estimates from the pooled cross-sectional data were consistent.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Demography
  • Female
  • Health Services Accessibility* / statistics & numerical data
  • Humans
  • Indonesia / epidemiology
  • Infant
  • Infant Mortality*
  • Infant Welfare / statistics & numerical data
  • Infant, Newborn
  • Male
  • Risk Factors