Characteristics of Mothers Which Affect The Low Coverage of Comprehensive Postpartum Service In The Working Area of Community Health Center of Kayen Kidul in Kediri Regency From January to August 2019

The utilization of postpartum maternal services in a complete manner in several regions still has not reached the target that has set by the government. Some factors that affect the coverage of comprehensive postpartum service is mother characteristics. The purpose of this research is to determine the characteristics of mothers who affect the low coverage of comprehensive postpartum service in the working area of Community Health Center of Kayen Kidul in Kediri Regency from January to August year 2019. This research was conducted in September 2019 in the working area of Kayen Kidul Community Health Center of in Kediri Regency. The design of the research used is analytical observational with a case control approach. The sampling techniques used are random sampling clusters. ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY


INTRODUCTION
Maternal Mortality Rate (MMR) is an approach to improve maternal health and end maternal mortality which is used as a reference in several countries to determine strategies for the prevention and control of maternal mortality (1). The reduction of MMR has long been a global health priority with targets set in accordance with the Millennium Development Goals of 75% (MDGs) (2). When the MDGs ended in September 2015 the number of maternal deaths worldwide declined by 44% from 1990 to 2015 so that the target for a reduction in the MMR of the world by 75% was not achieved (3). In fact, most countries fail to reach the MDGs target to reduce maternal mortality (4). The samples in this study were mothers who had finished their postpartum period (more than 6 weeks to 9 months after giving birth). Independent variables are characteristic of mothers while dependent variables are coverage of the comprehensive postpartum service. Collection of data using data collection sheets with structured interview techniques and medical records in the form of maternal and child health books. Then the data is processed and analyzed univariate, bivariate and multivariate. Statistical results of bivariate statistics showed that the work (P = 0.023), pregnancy complications (P = 0.026), labor complications (P = 0.03) and the type of childbirth (P = 0.01) have an influence on the low coverage of comprehensive postpartum service. Multivariate Office in 2018 showed the number of maternal   deaths as many as 17 people, where the number   has increased compared to 2017, which was 15 people. The cause of maternal death from 2017 to 2018 did not change where bleeding was 50%, followed by severe preeclampsia was 33%, heart disease was 17% and ileus was 12.5% (9).
Postpartum hemorrhage is the leading cause of maternal and infant morbidity and mortality worldwide with 25-30% of all maternal deaths with an estimated 127,000 deaths each year (10). Postpartum hemorrhage is often classified into two namely primary postpartum hemorrhage occurring within 24 hours after delivery (11) and secondary postpartum hemorrhage as bleeding that exceeds normal lochia after 24 hours of labor for up to six weeks postpartum (12). The incidence of primary postpartum hemorrhage is 5% while secondary postpartum hemorrhage is 0.5 to 1.3% (13). The lower incidence of secondary postpartum hemorrhage compared to primary postpartum hemorrhage received little attention among obstetricians and other health professionals. The main danger for patients is that bleeding occurs mostly between first and second weeks after giving birth when the patient is often at home and is unaware that the secondary postpartum hemorrhage is also potentially life-threatening (14).
One of strategy to detect early and prevent secondary bleeding is by utilizing postpartum services. Postpartum care services at least four times, namely on the 6-8 hours, the sixth day, the second week after and six weeks after

Characteristics of Mother
Based on Table 1 While the group of respondents whose target coverage for comprehensive postpartum services was fulfilled most had an age that was not at risk (20-35 years

Relationship between Mother Characteristics and Comprehensive Postpartum Services
Coverage Based on Table 2 shows that job (p = 0.023),  Hence, the impact was not very enthusiastic to get postpartum care services (22).

Services
The analysis showed that the type of delivery had a significant influence on the low coverage of comprehensive postpartum  (25).

The Effect of Age on Low Coverage of Comprehensive Postpartum Services
The results showed that maternal age  (19).

Comprehensive Postpartum Services
The analysis showed that education did at the elementary and secondary school levels compared with mothers who take informal education or do not take education (21).

The Effect of Parity on Low Coverage of Comprehensive Postpartum Services
The analysis showed that parity did not Most studies report that many mothers do not report physical or psychological problems to health workers or even to their family members who indicate that these mothers should receive more care as needed during the postnatal period (31). So that there are problems in the postpartum in the form of psychological and psychological problems are not considered by the mother as a complication during the postpartum who need to get postpartum maternal care in a complete manner.

Services Coverage
The results of multivariate statistical tests using binomial logistic regression based on

Most Influential About Low Coverage of Comprehensive Postpartum Services
The results of multivariate analysis with binomial logistic regression showed age (predisposing characteristics) and type of delivery