Empowering Women through Maternal Health Education: Impacts on Decision-Making and Health Outcomes

Authors

  • Rifka Ramadhani Kesehatan Masyarakat, Institut Ilmu Kesehatan STRADA Indonesia

DOI:

https://doi.org/10.37899/mjdh.v2i1.242

Keywords:

Maternal Health Education, Decision-Making Autonomy, Health Outcomes

Abstract

Maternal health remains a major challenge in low and middle income countries, where efforts to reduce maternal mortality are hindered by uneven service use, gender norms, and structural disparities. This study examines how maternal health education supports women’s decision making autonomy and improves maternal health outcomes in Indonesia. A quantitative cross sectional design was used, involving women of reproductive age who had experienced pregnancy or childbirth within the past two years. Autonomy was measured using an index of household health related decisions, while maternal health outcomes included antenatal care attendance, facility based delivery, postnatal care, and neonatal immunization. Statistical tests such as t tests, ANOVA, multiple regression, and logistic regression showed that maternal health education significantly increased autonomy scores, especially among women attending three or more sessions. Higher autonomy was associated with greater likelihood of giving birth in a health facility and adequate use of maternal health services. The findings emphasize that maternal health education should function not only as knowledge sharing but as an intervention that strengthens intra household decision power and supports health system performance. Program managers are encouraged to integrate empowerment indicators, ensure continuous engagement, and enhance community health worker training to include empowerment and communication skills.

References

Adesina, O. O., Brunson, A., Fisch, S. C., Yu, B., Mahajan, A., Willen, S. M., ... & Wun, T. (2023). Pregnancy outcomes in women with sickle cell disease in California. American journal of hematology, 98(3), 440-448. https://doi.org/10.1002/ajh.26818

Ara, I., Maqbool, M., & Gani, I. (2022). Reproductive Health of Women: implications and attributes. International Journal of Current Research in Physiology and Pharmacology, 8-18.

Atukunda, E. C., Mugyenyi, G. R., Haberer, J. E., Siedner, M. J., Musiimenta, A., Najjuma, J. N., ... & Matthews, L. T. (2025). Integration of a Patient-Centered mHealth Intervention (Support-Moms) Into Routine Antenatal Care to Improve Maternal Health Among Pregnant Women in Southwestern Uganda: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 14(1), e67049. https://doi.org/10.2196/67049

Beussink-Nelson, L., Baldridge, A. S., Hibler, E., Bello, N. A., Epps, K., Cameron, K. A., ... & Khan, S. S. (2022). Knowledge and perception of cardiovascular disease risk in women of reproductive age. American journal of preventive cardiology, 11, 100364. https://doi.org/10.1016/j.ajpc.2022.100364

Bhatia, B., Hossain, S., Ghosh, U., & Salignac, F. (2024). Reimagining gendered community interventions: the case of family planning programs in rural Bangladesh. Global Health Research and Policy, 9(1), 3. https://doi.org/10.1186/s41256-023-00337-8

Chakole, S., Akre, S., Sharma, K., Wasnik, P., Wanjari, M. B., Wasnik Sr, P., & Wanjari, M. (2022). Unwanted teenage pregnancy and its complications: a narrative review. Cureus, 14(12).

Cresswell, J. A., Alexander, M., Chong, M. Y., Link, H. M., Pejchinovska, M., Gazeley, U., ... & Say, L. (2025). Global and regional causes of maternal deaths 2009–20: a WHO systematic analysis. The Lancet Global Health, 13(4), e626-e634. https://doi.org/10.1016/j.amepre.2021.10.009

Crump, C., Sundquist, J., & Sundquist, K. (2024). Adverse pregnancy outcomes and long-term mortality in women. JAMA internal medicine, 184(6), 631-640.

Dadisman, K., Nickow, A., & Oreopoulos, P. (2024). The Impact of Early Childhood Parenting Interventions on Child Learning: A Systematic Review and Meta-Analysis.

Embiyale, M. (2025). Intra-household Gender Dynamics and Time Poverty: Implications for Farm Income and Well-Being in Rural Ethiopia (Doctoral dissertation, Justus-Liebig University of Giessen).

Farnworth, C. R., Jumba, H., Otieno, P. E., Galiè, A., Ouma, E., Flax, V. L., ... & Colverson, K. (2023). Gender roles and masculinities in leveraging milk for household nutrition: Evidence from two districts in Rwanda. Food Policy, 118, 102486. https://doi.org/10.1016/j.foodpol.2023.102486

Faye, S. L. B., & Sow, G. H. C. (2025). Reclaiming voices, rethinking change: a decolonial and knowledge-ecological analysis of SBCC nutrition interventions in Senegal. Frontiers in Nutrition, 12, 1609237. https://doi.org/10.3389/fnut.2025.1609237

Felisian, S., Mushy, S. E., Tarimo, E. A., & Kibusi, S. M. (2023). Sociocultural practices and beliefs during pregnancy, childbirth, and postpartum among indigenous pastoralist women of reproductive age in Manyara, Tanzania: a descriptive qualitative study. BMC Women's Health, 23(1), 123. https://doi.org/10.1186/s12905-023-02277-4

Garcia, I. L., Fernald, L. C., Aboud, F. E., Otieno, R., Alu, E., & Luoto, J. E. (2022). Father involvement and early child development in a low-resource setting. Social science & medicine, 302, 114933.

Gemmill, A., Berger, B. O., Crane, M. A., & Margerison, C. E. (2022). Mortality rates among US women of reproductive age, 1999–2019. American journal of preventive medicine, 62(4), 548-557. https://doi.org/10.1016/j.amepre.2021.10.009

Hinkle, S. N., Schisterman, E. F., Liu, D., Pollack, A. Z., Yeung, E. H., Mumford, S. L., ... & Zhang, C. (2023). Pregnancy complications and long-term mortality in a diverse cohort. Circulation, 147(13), 1014-1025. https://doi.org/10.1161/CIRCULATIONAHA.122.062177

Jejeebhoy, S. J. (2024). Gender norms and the wellbeing of women and girls in India: A review. United Nations Population Fund.

Kalindi, A. (2024). Population Level Burden and Inequities in Maternal Health in Zambia.

Kansanga, M. M., Bezner Kerr, R., Lupafya, E., Dakishoni, L., & Luginaah, I. (2024). Can gender transformative agroecological interventions improve women’s autonomy?. Agriculture and Human Values, 41(3), 1161-1175. https://doi.org/10.1007/s10460-024-10544-9

Kotit, S., & Yacoub, M. (2021). Cardiovascular adverse events in pregnancy: a global perspective. Global cardiology science & practice, 2021(1), e202105. https://doi.org/10.21542/gcsp.2021.5

Langley‐Evans, S. C., Pearce, J., & Ellis, S. (2022). Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review. Journal of Human Nutrition and Dietetics, 35(2), 250-264. https://doi.org/10.1111/jhn.12999

Lawn, R. B., & Koenen, K. C. (2022). Homicide is a leading cause of death for pregnant women in US. bmj, 379. https://doi.org/10.1136/bmj.o2499

Lu, Y., Li, Y., Chen, Y., & Hamilton, J. (2025). Son Preference and Elder Sisters’ Subjective Well-being: Inequality in Intra-household Resource Allocation. Journal of Happiness Studies, 26(7), 1-26.

Majeed, R., Iqbal, J., Haq, Z. U., & Shahzad, M. F. (2025). Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa’s Conditional Cash Transfer Program. Evaluation Review, 49(2), 209-236. https://doi.org/10.1177/0193841X241246826

McNestry, C., Killeen, S. L., Crowley, R. K., & McAuliffe, F. M. (2023). Pregnancy complications and later life women's health. Acta Obstetricia et Gynecologica Scandinavica, 102(5), 523-531. https://doi.org/10.1111/aogs.14523

Miller, F., Sethi, V., Hazra, A., Schoenaker, D., Chowdhury, R., Hirst, J., ... & Saville, N. M. (2025). Bridging the gaps: advancing preconception nutrition in South Asia through evidence, policy, and action. The Lancet Regional Health-Southeast Asia, 36. https://doi.org/10.1007/s10460-024-10544-9

Musarandega, R., Nyakura, M., Machekano, R., Pattinson, R., & Munjanja, S. P. (2021). Causes of maternal mortality in Sub-Saharan Africa: a systematic review of studies published from 2015 to 2020. Journal of Global Health, 11, 04048. https://doi.org/10.7189/jogh.11.04048

Pemjean, I., Hernández, P., Mediano, F., & Corvalán, C. (2024). How are intra-household dynamics, gender roles and time availability related to food access and children's diet quality during the Covid-19 lockdown?. Social Science & Medicine, 345, 116661. https://doi.org/10.1016/j.socscimed.2024.116661

Rahman, A., & Pingali, P. (2024). Early life interventions for intergenerational prosperity. In The Future of India's Social Safety Nets: Focus, Form, and Scope (pp. 167-202). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-50747-2_6

Rahman, A., & Pingali, P. (2024). Social welfare ‘schemes’ to an economic security ‘system’. In The Future of India's Social Safety Nets: Focus, Form, and Scope (pp. 357-425). Cham: Springer International Publishing. https://doi.org/10.1007/978-3-031-50747-2_10

Rashid, A. T. (2022). Roles of NGOs, State and For-Profit Actors in Improving Maternal and Child Sector in Bangladesh: Towards a Division of Labour?. In Deepening Democracy (pp. 105-119). Routledge India.

Rizkianti, A., Saptarini, I., & Rachmalina, R. (2021). Perceived barriers in accessing health care and the risk of pregnancy complications in Indonesia. International Journal of Women's Health, 761-772. https://doi.org/10.2147/IJWH.S310850

Serra, R., Kendall, M., Towns, A., & Hummer, J. (2023). Promoting gender equity in livelihoods projects: Practitioners’ perspectives through the lens of a socio-ecological model. Progress in Development Studies, 23(1), 82-98. https://doi.org/10.1177/14649934221129427

Sitaula, S., Basnet, T., Agrawal, A., Manandhar, T., Das, D., & Shrestha, P. (2021). Prevalence and risk factors for maternal mortality at a tertiary care centre in Eastern Nepal-retrospective cross sectional study. BMC Pregnancy and Childbirth, 21(1), 471. https://doi.org/10.1186/s12884-021-03920-4

Tazinya, R. M. A., El-Mowafi, I. M., Hajjar, J. M., & Yaya, S. (2023). Sexual and reproductive health and rights in humanitarian settings: a matter of life and death. Reproductive Health, 20(1), 42. https://doi.org/10.1186/s12978-023-01594-z

Thoma, M. E., & Declercq, E. R. (2023). Changes in pregnancy-related mortality associated with the coronavirus disease 2019 (COVID-19) pandemic in the United States. Obstetrics & Gynecology, 141(5), 911-917.

Udenigwe, O. (2023). Social norms and power structures: Exploring mobile health technologies for maternal healthcare in Nigeria (Doctoral dissertation, Université d'Ottawa/University of Ottawa). http://dx.doi.org/10.20381/ruor-29625

Wallace, M., Gillispie-Bell, V., Cruz, K., Davis, K., & Vilda, D. (2021). Homicide during pregnancy and the postpartum period in the United States, 2018–2019. Obstetrics & Gynecology, 138(5), 762-769.

Downloads

Published

2025-03-25