MATERNAL HEALTHCARE UTILIZATION AMONG MOTHERS AGED 15-24 YEARS IN INDONESIA: A LITERATURE REVIEW

Introduction: The use of health care services in mothers was a very important concern in developing countries because it was very beneficial in terms of declining maternal mortality rate, but the use of maternal health services in mothers aged 15-24 years In Indonesia was still not maximized. The purpose of this review was to analyze best practices in the use of maternal health services in mothers aged 15-24 years. Method: The systematic review of this search was done by the publication range was five years ago. Article criteria were articles reviewed by Bestari Partners, government documents and research locations in developing countries. Acquired 10 references that meet predefined criteria. Results: The analysis obtained was the use of maternal health services in mothers aged 15-24 years needs to be increased by looking at the factors that influence among them were seeing from the socio-demography of mothers and husbands, household factors, access to health services and regional factors. Conclusion: These recommendations are aimed at governments, health professionals and families that efforts to increase not only can be done by a single community line, but the whole must also be able to cooperate by the role in the efforts to increase the use of Health care services.


INTRODUCTION
The use of maternity health services for mothers is very beneficial, especially in developing countries, one of which is in Indonesia, it is related to the reduction in maternal mortality that continues to be an important concern in health (Agus, Horiuchi, & Iida, 2018).One of the factors that play a role in the high maternal mortality rate is the existence of pregnancy at a young age (Paul & Chouhan, 2019), whereas pregnancy in young mothers has a high risk of health problems (Erfina, Widyawati, McKenna, Reisenhofer, & Ismail, 2019).Looking at these problems, the use of maternal health services is one policy solution that can reduce maternal mortality (Chol, Negin, Agho, & Cumming, 2019) because these health services include services for women's reproductive health, maternal health during pregnancy, childbirth, and the health of babies born (Flanagan, Cunningham, Lewis, Tobin, & Ickovics, 2019).However, in practice, mothers aged 15-24 years in developing countries are still not maximally using these facilities (Paul & Chouhan, 2019).
Currently, the use of health services in developing countries that classified as not optimal, one of the developing countries, namely Myanmar, recorded an Antenatal Care (ANC) visit rate of only 59%, Intranatal Care (INC) in health facilities was only 37%, and only 36% had Postnatal Care visits (PNC) (Zaw, Mon, & MacQuarrie, 2019), while in India, that stated only 22% of young mothers came to the ANC health service (Ziblim, Yianda, & Mohammed, 2018).Data on ANC, INC, and PNC visits according to the 2017 IDHS for mothers aged 15-24 years in Indonesia only reached less than 80%, 75%, and 66%, this is still lacking the targets set by the Indonesian government.The targets to be achieved by the Indonesian Ministry of Health in 2019 are 80% for ANC, 85% INC, and 90% for PNC (Kemenkes, 2015).
The Indonesian government has strategic objectives that recorded in PERMENKES No. 97 of 2014, which is about improving public health several maternal health service actions that have implemented are supervising mothers through ANC, INC, and PNC activities (Kemenkes, 2015).Maternal health services are very important activities because they aim to fulfill the rights of every mother to obtain quality health services during pregnancy, childbirth, and healthy birth (Kemenkes, 2014).
According to research on the use of ANC services for mothers aged 15-24 years in Indonesia, that influenced by socioeconomic factors, namely age, wealth, education, place of residence, and number of children affecting the use of ANC services for mothers (Efendi, Chen, Kurniati, & Berliana, 2016).Another study from India also states that the younger a mother is, the less likely it is to use maternal health services (Paul & Chouhan, 2019).Many studies on maternal health services utilization have been carried out, literature review to compare past research gaps with the current using Indonesian Health Demographic Survey data has never been conducted.In the end, it is hoped that the research results can be used as consideration for policymakers so that maternal health services utilization can be increased.The purpose of this literature review is to find out what are the determinants of maternal health service use that include the use of ANC, INC, and PNC in mothers aged 15-24 years.

METHOD
In this study, the literature review methodology used to identify, assess and compile evidence from research to analyze the determinants of maternity service use in mothers aged 15-24 years in Indonesia.This study also describes and evaluates interventions or policies in other countries to find out what factors affect input for policymakers in Indonesia to formulate policies that are following the conditions.
The stages in conducting this systematic review consist of 5 stages: a. Mapping questions: The problem to be analyzed must be specific, clear and the researcher prepares structured questions before conducting a review.
b. Identification of relevant publications: The search for literature or studies is carried out as much as possible from various sources, both print and online.The criteria of study based on the review questions, the reasons for inclusion and exclusion should also be noted.In this study, the authors used references obtained online at Scopus, Pubmed, BMJ, Science Direct, and several other databases using keywords using maternity health services, ANC, INC, and PNC.Of the 40 references obtained from the search, the researcher determined ten articles that met the inclusion criteria, namely a period of 5 years, namely 2016-2020 that used Indonesian and English, the place of research was a developing country.c.Assessing research quality: describing the minimum acceptable level of design.Accepted study designs range from observation to experiment.Researchers also filter when searching, for scientific publications only articles that have been reviewed by peer-reviewed partners are displayed.Other articles are government reports, theses, and dissertations that contain research results related to retention in developing country contexts.d.Summing up the evidence: Data synthesis consists of tabulating study characteristics, quality, and results as well as statistical methods to explore differences between studies and combine the results.e. Interpretation of findings Issues found at each of these stages must be addressed and the risk of bias or potential bias explored.

RESULTS
The search results are analyzed and categorized into four major themes.In general, the themes related to the factors that influence the use of maternity health services for mothers aged 15-24 years in Indonesia are grouped into : 1. Maternal demographic factor consisting of age, education, and occupation.2. Husband's demographic factor, which consists of age differences between mother and husband, husband's education, and husband's occupation 3. Household factors consist of the number of children and the wealth index 4. Access to health services 5. Regional factors consisting of residence and province

Age
The age factor is one of the factors that influence the use of maternal health services because if the lower a person's age, the lower the experience obtained, early age mothers tend to make decisions in the use of health services by husbands, mother-in-law, or older relatives than mother (Paul & Chouhan, 2019).In addition, the chances of pregnancy are greater for mothers aged> 18 years (Sarker, Sheikh, Mahumud, & Sultana, 2018).

Educational level
The chance of pregnancy can decrease due to the increase in the level of education of a mother is related to increased knowledge about pregnancy and childbirth (Sarker et al., 2018).Besides, higher education can increase maternal awareness about the benefits of maternal health services (Emelumadu et al., 2014).

Region factor
Adolescent mothers who are pregnant in urban areas are 1.34 times more likely to use maternal health services than mothers in rural areas (Sarker et al., 2018), t is influenced by the ease of access.Besides, several mothers in the village said that services on nonmedical services are of higher quality than medical services related to interpersonal communication (Emelumadu et al., 2014).

Wealth index
The economic status good influences the use of facilities, from the study that was found that poor adolescent mothers tended to be low in the utilization of services with better wealth (Sarker et al., 2018).Even though there is health insurance provided by the government, the economic situation is related to the transportation costs incurred to reach health service places (Machira, 2017).

Husband
Husband's support is very influential during pregnancy, although it does not affect birth outcomes, husband's support can increase the use of maternal health services.The higher the husband's knowledge will increase the husband's preparation in preparation for pregnancy and childbirth, besides that the difference in the husband's age is also very influential, the older the husband's age, the higher the use of maternal health services because the older husband tends to be more mature in making decisions (Kurniati, Chen, Efendy, Ku, & Berliana, 2017).

Healthcare facilities access
Access to services greatly affects mothers in using health services (Koroglu, Irwin, & Grepin, 2019), Riskesdas data analysis states that mothers who have less ≤than 247 m distance from the house tend to take advantage of health services 1,147 times compared to mothers whose house is > 247 m apart.Geographical factors, distance, and infrastructure greatly affect the ease with which mothers reach health services (Adriana, Wulandari, & Duarsa, 2014).

Number of children
The number of children determines the level of household dependence, it can be one of the obstacles for mothers to use health services, the more children make the mother's responsibility in terms of caring good this, of course, can be a reason that can prevent mothers from utilizing health services (Machira, 2017).

DISCUSSION
The use of maternity health services for mothers aged 15-24 years must be considered properly, strategies that can be implemented must be following the factors that often influence the use of these services.There are several common themes identified and consistent with previous findings or other systematic reviews, almost all studies suggest that maternal socio-demographics affect the use of maternity health services, this is associated with the higher a person's age, the better the level of education obtained, Of course, this also has an effect related to getting better the job one has because of the high level of education (Asamoah & Agard, 2017).Husband's socio-demographic factors also influence efforts to increase the use of maternity health services, given the husband's role as a decision-maker in a family pengalamannya (Sekine & Carter, 2019).
The household factor, which consists of the wealth index and the number of children, certainly has a big role in increasing health services utilization.The wealth index according to the 2017 IDHS questionnaire is measured from the ownership of assets, ranging from livestock, property, electronic goods, transportation equipment, to financial accounts.Mothers who have high wealth are more able to access health services because with a good wealth they will not be afraid if things happen that will result in large expenses, especially if the mother has a financial account that can be used at any time as savings if she needs expenses.many, besides that mothers, can choose quality health services and of course have a higher cost (Effendy et al., 2019), ownership of private transport makes it easier for mothers to deliver labor which can occur at any time.
Mothers will be more comfortable coming to a health facility that has a distance of minutes (Tesfaw, Gizachew, Kassa, & Abajobir, 2017), it is related to the costs that can be incurred during the trip.healthcare services utilization was mostly used by urban mothers that related to the ease of access to health facilities in urban areas (Efendi et al., 2016).A large number of health facilities in urban areas causes the distance between health facilities to be close together so that mothers can easily choose a place to do ANC, besides that, well infrastructure conditions cause mothers to feel safer on their way.

CONCLUSION
Maternal health services utilization for mothers aged 15-24 years in Indonesia requires more attention from various lines of society, not only the government as a public policymaker who can move, but from health workers and the community, especially the family, is very important in efforts to increase its use.The government together with health workers needs to further analyze the factors that influence the use of health services as an effort to find the dominant problem spots, so that later in determining policies, it can be adjusted by pressing factors that can hinder efforts to increase the use of health services.
The research identified from the Scopus database, Google Scholar, Science Direct, PubMed, and BMJ (n = 39,108) Data after eliminating duplicates (n = 34that discusses the determinants of the use of maternal health services 2. The research site is a developing country Total = (n=10)Socio-demographic, economic, and health-related factors are factors that influence mothers in utilizing maternity health services, some of the things that influence are age, type of delivery, education, ethnicity, economic status, region, residence, religion, and work(Ulfa, Kuswardinah, & Mukarromah, 2017).