Social Determinants of Maternal Mortality Trends in Banyumas Regency: A Qualitative Study

Objective: To explore the underlying social determinants contributing to the post-2020 increase in maternal mortality in Banyumas Regency. Specifically, it seeks to examine how systemic, workforce-related, and sociocultural factors particularly those exacerbated by the COVID-19 pandemic have influenced maternal healthcare delivery, referral processes, and care-seeking behaviors. Methods: This qualitative study employed the Standards for Reporting Qualitative Research (SRQR) framework. In-depth interviews were conducted with 45 purposively sampled stakeholders including healthcare providers, policymakers, midwives, and community health cadres across four sub-districts in Banyumas Regency. One focus group discussion was conducted for triangulation. Hybrid thematic analysis was performed using NVivo12 software. Results: Most participants were aged 40-50 with over three years of experience. Five interconnected social determinants emerged: healthcare workforce adequacy and competency, emergency training continuity, referral system effectiveness, hospital standardization, and sociocultural influences on care-seeking behavior. Key findings included workforce training programs hindered by COVID-19, coordination delays affecting 70 of surgical response times, family reluctance toward PONEK-accredited hospitals, and resource constraints disrupting community programs. Despite quantitative workforce adequacy, qualitative competency gaps and geographic distribution inequities persisted. Conclusion: Findings reveal that systemic and cultural factors, amplified by pandemic disruptions, significantly contribute to rising MMR. Evidence supports integrated interventions targeting workforce strengthening, referral system optimization, hospital standardization, and culturally sensitive community engagement to reverse adverse trends and advance Indonesia's SDG commitments. © 2025, Indonesian Society of Obstetrics and Gynecology. All rights reserved.