Multilevel Analysis on the Determinants of Antenatal Care Visit at Community Health Center in Madiun, East Java


  • Sinta Ayu Purbaningrum Masters Program in Public Health, Universitas Sebelas Maret
  • Isna Qadrijati Faculty of Medicine, Universitas Sebelas Maret
  • Rita Benya Adriani School of Health Polyctechnics Surakarta
  • Hanung Prasetya School of Health Polyctechnics Surakarta


Background: Antenatal care (ANC) is an important determinant of high maternal mortality rate and one of the basic components of maternal care. However, some pregnant women still had low awareness about the importance of ANC. The purpose of this study was to examine determinants of ANC visit in community health center, Madiun, East Java, and to determine the contextual effect of the community health center on the ANC visit.

Subjects and Method: This was a case-control study conducted in Madiun, East Java, from November to December 2018. A sample of 200 pregnant women was selected by simple random sampling. The dependent variable was ANC visit. The independent variables were knowledge, occupation, number of children, attitude, income, and husband support. The data were collected by questionnaires and analyzed by a multilevel linear regression.

Results: The likelihood of ANC visit increased with employment status (b= 1.97; 95% CI= 0.81 to 3.13; p= 0.001), good knowledge (b= 1.56; 95% CI= 0.41 to 2.72; p= 0.008), positive attitude (b= 1.74; 95% CI= 0.52 to 2.96; p= 0.005), higher family income (b= 1.42; 95% CI= 0.29 to 2.55; p= 0.014), and stronger husband support (b= 1.29; 95% CI= 0.16 to 2.43; p= 0.260). ANC visit decreased with larger number of children (b= -1.05; 95% CI= -2.17 to 0.07; p= 0.067). Community health center had strong contextual effect on ANC visit in pregnant women with ICC= 41.85%.

Conclusion: ANC visit increases with employment status, good knowledge, positive attitude, high family income, and strong husband support. ANC visit decreases with large number of children. Community health center has strong contextual effect on ANC visit in pregnant women.

Keywords: antenatal care, determinants, pregnant women



Acharya D, Khanal V, Singh JK, Adhikari M, Gautam S (2015). Impact of Mass Media on the Utilization of Antenatal Care Services among Women of Rural Community in Nepal. BMC Research Notes, 8(345).doi: 10.1186/s1310401513128.

Dinas Kesehatan Provinsi Jawa Timur, Kementrian Kesehatan Republik Indonesia (2018). Profil Kesehatan Provinsi Jawa Timur 2017. diakses pada 11 November 2018

Ejigu T, Woldie M, Kifle Y (2013). Quality of antenatal care services at public health facilities of Bahir Dar Special Zone, Northwest Ethiopia. BMC Health Service Research.

Fauk NK, Cahaya IB, Merry MS, Damayani AD, Debora SL (2017). Exploring determinants influencing the utilizetion of antenatal care in Indonesia: A Narrative Systematic Review. Journal of Healthcare Communications, 2(4): 1

Forbes F, Wynter K, Wade C, Zeleke BM, Fisher J (2018). Male partner attendance at antenatal care and adherence to antenatal care guidelines: Secondary Analysis of 2011 Ethiopian Demographic and Health Survey Data. BMC Pregnancy and Childbirth, 18(145). doi: 10.1186/s1288401817754.

Ghaffar A, Pongponich S, Ghaffar N, Mehmood T (2015). Factors associated with utilization of antenatal care services in Balochistan Province of Pakistan: An Analysis of the Multiple Indicator Cluster Survey (MICS) 2010. Pakistan Journal of Medical Sciences, 31(6): 14471452. doi: 10.12669/pjms.316.8181.

Gitonga E (2017). Determinants of focused antenatal care uptake among women in Tharaka Nithi County, Kenya. Hindawi. doi: 0.1155/2017/3685401.

Gulema H, Berhane Y (2017). Timing of first antenatal care visit and its associated factors among pregnant women attending public health facilities in Addis Ababa, Ethiopia. Ethiopia Journal of Health and Science, 27(1): 139-146. doi: 10.4314/ejhs.v27i2.6.

Hajizadeh S, Tehrani FR, Simbar M, Farzadfar F (2015). Factors influencing the use of prenatal care: A Systematic review. Journal of Midwifery and reproductive Health, 4(1).

Kemenkes RI (2014). Pelayanan kesehatan masa sebelum hamil, masa hamil, persalinan, dan masa sesudah melahirkan, penyelenggaraan pelayanan kontrasepsi, serta pelayanan kesehatan seksual. Jakarta: Peraturan Menteri Kesehatan Republik Indonesia Nomor 97 tahun 2014.

Muindi K, Mberu B, Elung

Murti B (2018). Teori promosi dan perilaku kesehatan. Surakarta: Program Studi Ilmu Kesehatan Masyarakat Program Pascasarjana, Universitas Sebelas Maret.

Nsibu CN, Manianga C, Kapanga S, Mona S, Pululu P, Aloni MN (2016). Determinants of antenatal care attendance among pregnant women living in endemic malaria settings: Experience from the Democratic Republic of Congo. Hindawi, (2016).doi: 10.1155/2016/5423413.

Osorio AM, Tovar LM, Rathmann K (2014). Individual and local level factors and antenatal care use in Colombia: A Multilevel Analysis. Cad.Sa

Rahman A, Nisha MK, Begum T, Ahmed S, Alam N, Anwa I (2017). Trends, determinants and inequities of 4+ ANC Utilisation in Bangladesh. BMC Research Journal of Health, Population dand Nutrition, (36)2. doi: 10.1186/s4104301600785.

Sakeah E, Okawa S, Oduro AR, Shibanuma A, Ansah E, Kikuchi K, Gyapong M, Owusu Agyei S, Williams J, Debpuur C, Yejia F, Kukula VA, Enuameh Y, Asare GQ, Agyekum EO, Addai S, Sarpong D, Adjei K, Tawiah C,

Yasuoka J, Nanishi K, Jimba M, Hodgson A, the Ghana EMBRACE Team (2017). Determinants of attending antenatal care at least four times in rural Ghana: Analysis of a Cross-Sectional Survey. Taylor and Francis Global Health Action, 10.doi: 10.1080/16549716.2017.1291879.

Shabila NP, Ahmed MH, Yasin MY (2014). Women

Tsegay Y, Gebrehiwot T, Goicolea I, Edin K, Lemma H, Sebastian MS (2013). Determinants of antenatal and delivery care utilization in Tigray Region, Ethiopia: A Cross-Sectional Study. BMC Central International Journal for Equity in Health, 12(3).

Waller A, Bryant J, Cameron E, Galal M, Quay J, Sanson Fisher R (2016). Women

World Health Organization (2016).WHO recommendations on antenatal care for a positive pregnancy experience. WHO Library Cataloguing in Publication Data. diakses pada 6 Agustus 2018




How to Cite

Purbaningrum, S. A., Qadrijati, I., Adriani, R. B., & Prasetya, H. (2019). Multilevel Analysis on the Determinants of Antenatal Care Visit at Community Health Center in Madiun, East Java. Journal of Maternal and Child Health, 4(3), 180–189. Retrieved from