Analysis of determinant factors of referral to maternal mortality in Indonesia: a retrospective cross-sectional study

Introduction: Maternal mortality is still quite high in Indonesia. It recorded 305 per 100,000 live births in 2015. An effective and efficient referral system can reduce maternal mortality by up to 80%. The problem in the referral system that is often faced is the limited accessibility to health services. This study analyzed the referral determinants factors that influence maternal mortality at Dr. Soetomo Hospital and Airlangga University Hospital for 2021-2022. Methods: This is a retrospective cross-sectional study conducted at Dr. Soetomo Hospital and Airlangga University Hospital on 113 cases of maternal mortality that met the inclusion and exclusion criteria. The data was then processed and analyzed using the Structural Equation Modeling (SEM) test with JASP software. Result: Patient as a factor significantly correlates to maternal mortality (p < 0.001). Patient factors contribute 70% to maternal mortality. Decision-making time, economic status, and travel time correlated with patient factors (p < 0.001) with contributions of 72.5%, 27.5%, and 38.1%. Patient factors and health system factors were able to explain 29.2% of maternal mortality, while other risk factors explained 70.8%. Conclusion: Patient and health system factors contributed to maternal mortality at Dr. Soetomo General Hospital and Airlangga University Hospital.