Peer-reviewed article

Determinants of adequate antenatal care for underage mothers in Indonesia: Urban-rural inequities.

Tety Rachmawati, Stefanus Supriyanto, Dede A Musadad, Asep Kusnali, Yunita Fitrianti et al. · 25 Apr 2026

Abstract

INTRODUCTION: Child marriage and adolescent pregnancy are significant public health concerns in Indonesia associated with increased obstetric and perinatal risks. Adequate antenatal care (ANC) is essential to mitigate these risks. The objective of this study was to identify the predictors of adequate ANC utilization by underage mothers in Indonesia, with specific focus on rural-urban disparities. MATERIALS AND METHODS: This cross-sectional study utilized the secondary data from the 2023 Indonesian Health Survey. The sample comprised 2927 underage mothers (<20 years) consisting of 1873 rural and 1054 urban residents, who had at least one pregnancy. Adequate ANC was defined in accordance with the Indonesian Ministry of Health guidelines as at least six visits throughout the stages of pregnancy. Data were analyzed using SPSS; descriptive statistics were used to describe the study variables. Chi-square test assessed the associations between ANC utilization and various independent variables. Logistic regression analysis determined the factors associated with adequate ANC, adjusting for potential confounders; separate models were developed for urban and rural subsamples. RESULTS: Only 33.0% of underage mothers received adequate ANC and only 6.5% received all 10 essential ANC components. Higher educational attainment, health insurance ownership, and better economic status were significantly associated with likelihood of adequate ANC, particularly in rural areas. Urban residence was marginally associated with higher ANC adequacy (odds ratio = 1.19). Underage mothers with separated marital status were less likely to have adequate ANC utilization, particularly in the urban settings. Knowledge of the danger signs in pregnancy was not significantly associated with ANC adequacy. CONCLUSION: Adequate and comprehensive utilization of ANC by underage mothers in Indonesia remains low, with persistent urban-rural inequalities. There should be targeted, adolescent-friendly interventions that focus on education, insurance coverage, and socioeconomic support, especially for rural and disadvantaged adolescents.