Of the 200 questionnaires distributed, 147 (73.5%) were returned and after questionnaires with incomplete data were excluded, 145 remained for the final analysis. In keeping with the trend of previous studies about what influences antenatal clinic visits, items in the questionnaire are referred to as factors and should not be confused with the term factors resulting from scale development.
Characteristics of women
The average age of the women was 29.7 years (SD = 5.6). The majority of the sample was age 21 to 34 (75.9%) and 22.1% of women 35 or older. All of the women were Muslim. Most of the women lived with their husbands (94.5%). Sixty-six percent of the women had more than two children and 31% were experiencing their first pregnancy. Living in an extended family were 52.4% and 47.6% lived in a nuclear family. A majority of the women (65.5%) finished secondary education and only 34.5% finished basic education. However, the majority of the women (74.5%8) did not work, and only 11% worked in the farming sector.
More than half of the women (55.9%) used public transportation for ANC visits. The average distance from their home to hospital was 1,570 m (SD = 2,009, M = 1,000). The number of women who were encouraged by their family to receive ANC (44.8%, n = 65) was almost same compared to those who encouraged themselves (55.2%, n = 80). Only 13.1% of respondent used ASKESKIN (health insurance for poor families) as their usual health care payment and the majority were self pay (86.9%). Midwives assisted 65.5% of the women while TBAs assisted only 3.4%. The government hospital was chosen for delivery by (44.1%), followed by village midwives practice (29.0%), and private hospitals (18.6%). There were no statistically significant differences comparing women's socio-demographic.
Scores of knowledge, traditional belief, preference for TBAs and preference for midwives
The questionnaire used in this research had four sections; (1) knowledge, (2) traditional beliefs, (3) preference for TBAs and (4) preference for midwives. The average mean score of basic knowledge was 7.1 out of 8 (SD = 8.8) range of 5-8. Traditional belief mean score was 10.31 out of 25 (SD = 2.61) range 5-21. Preference for TBAs mean score was 25.52 out 60 (SD = 7.25) with a range 12 to 50. Preference for midwives mean score was 36.84 out 50 (SD = 4.45) with a range 14 to 46.
Basic knowledge of pregnancy
The majority of subjects scored highly in the knowledge section (Table ). Most of the subjects gave the correct answer to items on basic health knowledge. In seven out of eight items, women answering correctly was over 80%: "ANC is important", "eating iron containing food prevents anemia, "pregnant women need calcium", "pregnant women must have their blood pressure checked", "pregnant women need to go to the hospital if they have high blood pressure" and "bleeding is a normal sign during pregnancy (false)". However, for the item "headache is normal sign during pregnancy (false)", only 62% answered correctly.
Distribution of ANC visit during pregnancy
The Indonesia government recommends ANC four times during pregnancy. Nearly 80% (77.9%) of respondents received ANC more than four times. The other 22.1% received ANC less than four times.
The researcher divided the sample into two groups for analysis: women who had less than four ANC visits and women who had four or more ANC visits. Women aged 21 to 34 were more likely to receive less than four ANC visit (87.5%) compared to those who were over 35 years old. As a group primiparous received less than four ANC visits, which was statistically significant compared to multiparous (p = 0.001). Women who finished basic education tended to receive fewer than four ANC visits compared to women who finished secondary education (p = 0.07). Women who accessed ANC services by walking were more likely receive less than four ANC visits compared to women who used transportation (p = 0.069). See Table for specific details.
Distribution of ANC visits during pregnancy by socio-demographic characteristics in rural area of Indonesia, 2010 (N = 145)
Factors related to the family income
The average monthly family income was Rupiah (Rp.) 831,034 (SD = 587,316) (1 USD = Rp. 9,070). This was lower than the minimum wage of West Sumatra (Rp. 1,055,000).
Among the three factors which were significantly different we found that: 1) The basic education group had lower incomes than the secondary education group (M = Rp. 591,000, SD = 343,99; M = Rp.957,368, SD = 679,954, respectively, t = 3.5, p = < 0.001), 2) Women who walked to receive ANC had lower income compared to the other group (M = Rp.703,125, SD = 486,718, M = Rp.932,098, SD = 678,753, respectively, t = 2.27 p = 0.024),3) Not surprisingly, women who used ASKESKIN as their usual source of payment revealed significantly lower incomes compare to women who were self pay (M = Rp.407,894, SD = 235,267; M = Rp.894,841, SD = 624,462, respectively, t = 3.35, p = 0.001).
Factors related to preference for TBA
Table shows the scores of preference for TBA which were analyzed between women's choice about delivery settings. It was found that women going to TBA ("yes" group) (n = 32) had a significantly higher mean score than the "never" group (M = 31.34, SD = 7.49; M = 23.87, SD = 6.30, respectively, t = -5.66, p < 0.000). Women who chose the government hospital to deliver had a significantly higher scores than women who delivered at the village midwives practice and private hospital (F = 7.80, p = 0.001). In addition, women who delivered with the assistance of TBA, had a statistically significant higher score compared to the others (t = 4.61, p = 0.011).
Factors related to preference for TBA in rural area of Indonesia, 2010 (N = 145)
Encouragement to receive antenatal care
What factors were associated with encouraging women to receive antenatal care? Data were divided into two groups based on who encouraged the woman to seek ANC services: self or family. The scores on the factors, knowledge, traditional belief, preference for TBAs and preference for midwives, were compared between women who encouraged themselves and those who were encouraged by their family. Knowledge and preference for TBA was not significant. Interestingly, women who were encouraged by their family to receive ANC had statistically significant higher traditional belief scores compared to those who encouraged themselves (M = 9.13, SD = 2.40), (t = 3.03, p = 0.003). On other hand, women who encouraged themselves to go to ANC had statistically significant higher score in preference for midwives compared to those who were encouraged by their family (M = 37.62 SD = 3.96; M = 35.89, SD = 4.85, t = 2.36, p = 0.019).
Multiple regression analysis
The results of multiple regression analysis are presented in Table . Variables such as traditional belief, distance to hospital and family income were significantly related to a preference for midwives. Traditional belief made the greatest contribution (ß = -0.492, t = 7.01, p < 0.001). Women's age and knowledge were excluded.
Multiple regression analysis of preferences for midwives and preferences for TBAs in rural area of Indonesia, 2010 (N = 145)
Three items associated with preference for TBAs were traditional belief, women's age and family income with traditional belief making the greatest contribution (ß = 0.432, t = 5.93, p < 0.001). This trend was the same as preference for midwives. Regarding the preference for TBAs, two items knowledge and distance to hospital were excluded.
The results showed that traditional belief and family income were influential for women who chose both preference for TBAs and preference for midwives.