Determinants of maternal mortality: Analysis of maternal characteristics and health service factors

Maternal health is a key indicator of public health status and a global priority in achieving the Sustainable Development Goals (SDGs), which aim to reduce the Maternal Mortality Ratio (MMR) to less than 70 per 100,000 live births by 2030. In Indonesia, the MMR remains high at 305 per 100,000 live births (SUPAS 2020). Maternal deaths are commonly caused by postpartum hemorrhage, hypertensive disorders of pregnancy, infections, and other comorbidities. Pekalongan Regency, Central Java, has shown fluctuating maternal mortality trends influenced by complex factors, including delays in medical treatment and limited health services. This study aimed to describe the determinants and causes of maternal mortality in Pekalongan Regency in 2024. A descriptive analytic design was used involving 18 maternal death cases. Data were collected through interviews with family members and health workers and through document reviews from the District Health Office, then analyzed using univariate analysis with SPSS version 23. The results showed that most maternal deaths occurred during the postpartum period (72%). The majority of mothers were aged 20–35 years (89%), had grand multiparity (50%), and had ≥6 antenatal care visits (67%). Comorbidities included hypertension (11%), infection (6%), and diabetes mellitus (6%). The leading cause of maternal death was severe preeclampsia (39%), followed by hemorrhage (11%) and infection (11%). Maternal mortality in Pekalongan Regency is influenced by both medical and non-medical factors; therefore, improving the quality of antenatal care, strengthening early risk detection, and enhancing the maternal referral system are essential strategies to reduce maternal mortality.