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Abstrak :
Masalah kesehatan maternal terutama masalah kematian ibu masih menjadi masalah prioritas Bangsa Indonesia dalam meningkatkan kualitas Sumber Daya Manusia (SDM). Angka kematian ibu yang tinggi sering dikaitkan dengan pemanfaatan layanan kesehatan ibu bersalin. Pemanfaatan pelayanan kesehatan ibu bersalin di Indonesia menunjukkan variasi antar wilayah regional, diduga berhubungan oleh faktor lingkungan dan perbedaan karakteristik dari populasi. Penelitian ini mengukur pemanfaatan pelayanan kesehatan ibu bersalin dan mempelajari besar hubungan lingkungan dan karakteristik populasi terhadap pemanfaatan pelayanan kesehatan ibu bersalin. Penelitian ini menggunakan data sekunder SDKI 2017 yang mencakup 3.586 wanita usia subur (15–49 tahun) yang pernah melahirkan dalam waktu satu tahun sebelum survei. Analisis regresi logistik multinomial digunakan untuk menguji hipotesis adanya perbedaan pemanfaatan pelayanan kesehatan ibu bersalin berdasarkan perbedaan kondisi lingkungan dan perbedaan karakteristik responden. Penelitian ini menunjukkan bahwa lingkungan dan karakteristik populasi berhubungan signifikan terhadap pemanfaatan pelayanan kesehatan ibu bersalin. Dari analisis multivariat wanita yang paling berpeluang bersalin di rumah dengan bukan tenaga kesehatan yaitu wanita dengan karakteristik suami bekerja di sektor pertanian / wirasuasta (aOR: 7,56 95% CI: 1,69-33,80), dan wanita yang paling berpeluang untuk bersalin di rumah dengan tenaga kesehatan yaitu wanita bertempat tinggal di Pulau Kalimantan (aOR: 11,43 95% CI: 6,13-21,28). Dari hasil analisis hubungan lingkungan dan karakteristik populasi pada penelitian ini disimpulkan bahwa adanya ketidakmerataan akses kesehatan maternal (inequitable access to maternal healthcare) khususnya pada pemanfaatan pelayanan kesehatan ibu bersalin di Indonesia. Untuk mewujudkan pemeratan akses kesehatan maternal perlu adanya komitmen pemerintah pusat dan daerah dengan memaksimalkan anggaran di daerah khususnya pada Pulau di luar Jawa-Bali.

Kata kunci: Pelayanan kesehatan Ibu bersalin, Lingkungan Wilayah Tempat Tinggal, dan Karakteristik Populasi, ketidakmerataan akses kesehatan maternal. ......Maternal health problems, specially maternal mortality, are one of the most important problems that need to be addressed for the Indonesian people in order to improve the quality of their human resources. Indonesia has a high mortality rate, which is often associated with the utilization of maternal health services. Utilization of maternal health services in Indonesia shows variations between regional areas, which might be influenced by environmental factors and differences in the characteristics of the population. This study examines the relationship between environmental factors and population characteristics with the utilization of maternal health services. This study used secondary data from the 2017 IDHS which included 3,586 women of childbearing age (15–49 years) who had given birth within one year prior to the survey. Multinomial logistic regression analysis was used to test the hypothesis of whether the use of maternal health services had significant differences between different environmental conditions and different respondent characteristics. This study showed that environmental factors and population characteristics are significantly associated with the utilization of maternal health services. Based on multivariate logistic regression analysis, women who are most likely to give birth at home with non-health workers are women whose husbands work in the agricultural sector / self-employed (aOR:7.56 95% CI: 1.69-33.80), and women who are most likely to give birth at home with health workers are women who live on the island of Borneo. (aOR: 11.43 95% CI: 6,13-21,28). Based on the analysis of the relationship between environmental factors and population characteristics in this study, it was concluded that inequality of access to maternal healthcare was evident, especially the utilization of maternal health services in Indonesia. To achieve equal / equitable access to maternal health services, commitment from the central and local governments to optimize their budget especially in provinces outside Java and Bali island is absolutely needed.