Digital Connectivity as a Structural Factor Associated with Adequate Antenatal Care Utilization in Indonesia: A Multilevel Analysis of Linked SDKI–Podes Data

Abstract

Maternal mortality in Indonesia remains high, particularly in rural areas with limited access to quality antenatal care (ANC). Digital health approaches, including telemedicine, require adequate digital infrastructure to support implementation. This study examined whether community-level digital connectivity was associated with adequate ANC utilization in Indonesia and assessed its relevance as an indicator of telemedicine readiness. Methods: A cross-sectional study linked individual-level data from the 2017 Indonesia Demographic and Health Survey (SDKI) with village-level communication signal data from the 2018 Village Potential Survey (Podes), involving 14,621 women across 1,912 clusters. Adequate ANC was defined as completion of at least four visits (K4). Multilevel logistic regression was used to estimate associations while adjusting for sociodemographic and access-related factors. Results: Overall K4 coverage was 77.1%. Women living in areas with strong 4G/LTE signal had higher odds of completing adequate ANC (aOR=1.38; 95% CI: 1.14–1.67), and internet use was positively associated with ANC utilization (aOR=1.27; 95% CI: 1.06–1.52). Conclusions: Community-level digital connectivity was associated with adequate ANC utilization and may support telemedicine readiness. However, telemedicine was not directly measured, and the temporal mismatch between SDKI 2017 and Podes 2018 limits causal interpretation.