Birth outcomes and the demand for prenatal care in Indonesia: A latent variable approach

One essential component of the maternal and child health program in Indonesia is the provision of prenatal care, which has long been a high priority of the government in their efforts to reduce the incidence of adverse birth outcomes, including low birthweight. However, the empirical evidence supporting the association between the demand for prenatal care and low birthweight is not conclusive, and the subject of controversy in public health literature.; This study is an attempt to better understand the causal functions between exogenous variables and maternal behavior variables or health inputs to the birthweight production process; and the subsequent relationship between these health inputs and birth outcomes in the presence of population heterogeneity. Structural equation models with latent variables have been developed to investigate the effectiveness of prenatal care in improving birth outcomes and the pathways through which maternal education affects the health characteristics of a newborn. The 1994 and 1997 Indonesian Demographic and Health Surveys (IDHS) meet most of the data requirements for this investigation.; The findings show that by controlling the unobserved variable maternal health endowment, we are able to identify the presence of motivation /accessibility selection bias in prenatal care use among mothers. This selection bias shows that high-risk mothers for an adverse pregnancy outcome use prenatal care at a relatively lower rate. As a result, the estimated elasticity of birth outcomes with respect to the use of prenatal care is overstated if unobserved maternal health risk effects are not controlled. The analysis indicates that prenatal care is positively associated with favorable birth outcomes and negatively correlated with low birthweight. Another important finding is that the latent variable household capital demonstrates a strong relationship with maternal health-related behavior variables. The impact of household capital on birth outcomes, mediated by prenatal care and maternal risk factors, is presented. The relative stability of fundamental parameters of birth outcome production technology over the 1994–1997 period is also examined.