p–ISSN: 2723 – 6609 e-ISSN: 2745-5254
Vol. 5, No. 12, December 2024 http://jist.publikasiindonesia.id/

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5743

A Literature Review on Determinant Factors Related to
Midwifery Performance in Antenatal Care (ANC) Services in

Health Centers

Ni Putu Arik Diantari
Universitas Udayana, Indonesia

Email: [email protected]
*Correspondence

ABSTRACT
Keywords: midwifery
performance, antenatal
care (ANC) services.

The maternal mortality rate (MMR) is one of the indicators
that shows how the quality of health services is. Based on
the results of maternal and perinatal audits, in general, cases
of death due to obstetrics can still be prevented if health
service efforts are adjusted to standards. The ability of health
service facilities to carry out early detection and readiness of
health workers, especially midwives, is important in
comprehensive and quality pregnancy, childbirth, and
postpartum services through continuous midwifery services.
ANC examination services are one of the four safe
motherhood concepts carried out to reduce AKI and need to
be carried out in an integrated manner to improve the quality
of ANC services at Puskesmas. The low coverage of KIA
services by health workers is linked to midwifery
performance problems. Midwifery performance problems
are greatly influenced by various factors. The purpose of this
study is to further explore the determinant factors related to
the performance of midwives in antenatal care (ANC)
services in Puskesmas. The approach used in this study is a
study of literature with data sources in the form of original
articles published in national/international journals through
electronic databases such as Google Scholar and Garuda.
The results of the study show that the individual factors are
significantly related, namely ability, experience, and age;
psychological factors that are significantly related, namely
attitude and motivation; significantly related organizational
factors, namely leadership, remuneration, length of service,
employee status, facilities, and workload. The results of this
study can be used as input for health service provider
institutions to improve the quality of midwives in providing
antenatal care (ANC) services.

Introduction

Death and pain in pregnant, childbirth, and postpartum women are still a big
problem in developing countries including Indonesia. Maternal mortality accounts for

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Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5744

nearly 95% of deaths in low- and middle-income countries. Prenatal, intrapartum, and
postpartum care performed by medical personnel can prevent maternal and newborn
deaths (Malaikosa, Fatimah, & Astarie, 2022).

The Maternal Mortality Rate (MMR) is one of the indicators to see the success of
maternal health efforts. Maternal mortality is the result of the interaction of various
aspects, both clinical aspects, aspects of the health service system, and non-health factors
that affect the optimal delivery of health services. (Hanifah & Natalia, 2023). Therefore,
a common perception and understanding from all parties is needed regarding the
importance and role of various aspects in handling the problem of maternal mortality so
that the strategy to overcome it must be a comprehensive integration for all parties.
(Yuniarti & Suharto, 2024).

The number of maternal deaths is currently a major problem, and the best solutions
are constantly being sought to reduce the number of cases. The Safe Motherhood
program, which has been running since 1997, is one of the government's efforts to reduce
AKI. The purpose of this concept is to ensure that the mother and baby are secure and
safe during pregnancy, childbirth, and the postpartum period. The four concepts of safe
motherhood are Antenatal Care (ANC) examination services, family planning services,
childbirth at health facilities, and postpartum examinations. (Nasution & Santosa, 2024).

ANC examination services are one of the four safe motherhood concepts carried
out to reduce AKI and need to be carried out in an integrated manner to improve the
quality of ANC services in Puskesmas (Sukirman, Wahyono, & Shivalli, 2020). The
concept of integrated ANC is one of the right actions in suppressing various pregnancy
problems that are carried out regularly and planned (Shitaw, 2020).

The role of midwives has a very high contribution in meeting the achievement of
KIA service targets. Midwives as health workers at the forefront and by their functions
are expected to be able to increase the coverage of KIA services The low coverage of
KIA services by health workers is linked to midwifery performance problems. (Rizqi,
Djannah, & Suryani, 2023). Performance is the result of the quality and quantity of work
achieved by an employee in carrying out his duties according to the responsibilities given
to him, while midwifery performance is a health service carried out by midwives to
improve maternal health. (Pusporini et al., n.d.). Midwifery performance problems are
greatly influenced by various factors. There are internal and external factors that can
affect a performance (Mangkunegara, 2017) External factors are everything that comes
from a person's surrounding environment, including training, while internal factors are
everything related to a person's personality, such as ability. There are seven aspects
according to (Rahayu Tri Utami, Wulandari, & Wibowo, 2022) That affects the
performance required to carry out routine organizational tasks. Training and competence
are one of the factors that require efforts to achieve these goals. (Susanti, 2023).

Until now, there are still many differences in results about factors that affect the
performance of midwives in antenatal care (ANC) services. Some studies state that there
is a relationship between factors related to midwifery performance, but there is also the
opposite. Therefore, the researcher wants to further explore the determinant factors

A Literature Review on Determinant Factors Related to Midwifery Performance in Antenatal
Care (ANC) Services in Health Centers

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5745

related to the performance of midwives in antenatal care (ANC) services in Puskesmas.
This is expected to be able to plan preventive efforts/actions in preventing and reducing
AKI in Puskesmas so that it can provide information related to strategies in planning
maternal health activity programs for KIA managers in Puskesmas, especially in
improving the performance of midwives.

Method

This study uses a literature review method to explore determinant factors related to
the performance of midwives in antenatal care (ANC) services in Puskesmas. The
research method by reviewing or summarizing empirical or theoretical literature uses a
systematic approach to conduct data analysis in a simplified approach to provide a more
comprehensive understanding of the literature review in ANC services. This review stage
includes problem identification, literature search, processing, and presentation. The
literature search was carried out by analyzing articles obtained from Google Scholar and
the Garuda Portal. The search for articles was carried out using the following keywords:
"midwifery performance in ANC services", "factors influencing midwifery performance
in antenatal care" and "analysis of factors in ANC services". This study examines the
relationship of several determinant factors that affect the performance of midwives in
antenatal care (ANC) services.

The inclusion criteria in the search for articles in this study are the bound variable
is the performance of midwives in antenatal care (ANC) services, the articles were
selected using a quantitative research method with a cross-sectional design. Articles are
written in Indonesian or English, published in the last 5 years (2019-2024), available in
full PDF text format, and can be accessed for free. Meanwhile, the exclusion criteria of
this study include articles that examine the performance of midwives in ANC services
other than puskesmas, which have been published for more than 5 years (before 2019)
and cannot be fully accessed at no cost.
Article selection flow diagram based on inclusion criteria in this study:

Search and identify literature relevant
to research objectives through Google

Scholar with the 2019-2024 range

There were 5 articles that were
eliminated because the research

subject was not a midwife working
at the health center

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Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5746

Figure 1
Flow of the selection stages of article search

Results and Discussion

Here are 6 articles that have passed according to the research inclusion criteria to
be analyzed in the literature review

Table 1

Literature review based on samples, sampling techniques, and statistical tests

First
author

and
Research

Year

Research
Design

Sample

Bound
Variables

Independe
nt Variable

Sampli
ng

Techniq
ues

Statisti
cal

Test

1
Sri Astuti
Siregar
(2021)

Observationa
l analysis
with a cross-
sectional
approach

56
respond

ents

Midwifery
Performanc

Knowledge,
motivation,
leadership,
rewards/inc
entives and

training

Probabi
lity
samplin
g

Test
Chi-
Square

Sri Yunita
Wind
Wind
(2023)

Observationa
l analysis
with a cross-
sectional
approach

49
respond

ents

Midwifery
Performanc

Knowledge,
motivation,
leadership,
incentives/r

ewards,
colleague

relationship
s

Not
listed

Test
Chi-
Square

Screening articles by reading

abstracts with the subject of the study
being a health center midwife who

carries out ANC services

Collect and analyze literature that has

met the eligibility requirements
according to the inclusion criteria and
then include it in a literature review

A total of 2 articles were eliminated

because they did not meet the
criteria for inclusion of the study

A Literature Review on Determinant Factors Related to Midwifery Performance in Antenatal
Care (ANC) Services in Health Centers

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5747

3
Anisa Nur
Cahyanti
(2023)

Observationa
l analysis
with a cross-
sectional
approach

14
respond

ents

Midwifery
Performanc

Age,
knowledge,

attitude,
and

motivation

Purposi
ve

Samplin
g

Bivaria
te
analysi
s of the
Pearso
n
correlat
ion test

4
Josina
Hattu
(2023)

Observationa
l analysis
with a cross-
sectional
approach

23
respond

ents

Midwifery
Performanc

Age,
Employee

Status,
working
period,

knowledge,
and attitude

Total
Samplin

Bivaria
te
analysi
s test
and
multiva
riate
analysi
s test.

Maria
Esther
Malaikosa
(2022)

Quantitative
with a cross-
sectional
approach

30
respond

ents

Midwifery
Performanc

Skills,
motivation,

and
rewards/wa

ges

Purposi
ve

Samplin
g

Test
Chi-
Square

6
Mera
Marhama
h (2022)

Observationa
l analysis
with a cross-
sectional
approach

31
respond

ents

Midwifery
Performanc

Knowledge,
Motivation Total

Samplin
g

Test
Chi-
Square

Table 2

Literature Review Based on Factors Related to Midwifery Performance in Health
Centers

Independ
ent

variables
analyzed

Author's Name

Sri Astuti
Siregar
(2021)

Sri Yunita
Wind Wind

(2023)

Anisa Nur
Cahyanti

(2023)

Josina
Hattu
(2023)

Maria
Esther

Malaikos
a (2022)

Mera
Marha

mah
(2022)

1
Knowledg
e

p = 0.037,
PR = 1.93
(Related)

ρ=0,043 (ρ <
0,05)

(There is a
connection)

ρ=0,0001 (ρ
< 0,05)

r = 0.853
(There is a
connection)

p-value
= 0.704;

RP =
1,471;

CI 95%
(0,704 –
3,071)

(No
relations

hip)

ρ=
0,004
(ρ <
0,05)

(There
is a
connec
tion)

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Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5748

2
Motivatio
n

p = 0.000,
PR = 4
(There is a
connection)

ρ=0,016 (ρ <
0,05)

(There is a
connection)

ρ=0,009 (ρ <
0,05)

r = 0.670
(There is a
connection)

ρ= 0,01(ρ
< 0,05)

(There is a
connectio

ρ=
0,000
(ρ <
0,05)

(There
is a
connec
tion)

3
Leadershi
p

p = 0.240,
PR = 1.4
(No
relationship
)

ρ=0,007 (ρ <
0,05)

(There is a
connection)

4
Rewards/i
ncentives/
wages

p = 0.013,
PR = 2.0
(There is a
connection)

ρ=0,025 (ρ <
0,05)

(There is a
connection)

ρ= 0,02 (ρ
< 0,05)

(There is a
connectio

5 Training

p = 0.010,
PR = 2.25
(There is a
connection)

Collaborat
ive
relationshi
ps

ρ=0,002 (ρ <
0,05)

(There is a
connection)

7 Age

ρ=0,004 (ρ <
0,05)

r = 0.714
(There is a
connection)

p-value
= 0.00;
RP =

2,200;
CI 95%
(0,990 –
4.888)

(There is
a

connecti
on)

8 Attitude

ρ=0,006 (ρ <
0,05)

r = 0.690
(There is a
connection)

p-value
= 1.474;

RP =
5,444;

CI 95%
(1.474 –
20.110)

(No
relations

hip)

9
Employee
Status

p-value
= 0.018;

RP =
5,870:

CI 95%

A Literature Review on Determinant Factors Related to Midwifery Performance in Antenatal
Care (ANC) Services in Health Centers

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5749

(0,903 –
38,153)

(There is
a

connecti
on)

10
Working
Period

p-value
= 0.004;

RP =
4,789;

CI 95%
(1,302 –
17,624)

(There is
a

connecti
on)

11 Skills

ρ=0,936
(ρ < 0,05)

(No
relationshi

Based on the results of the analysis of the literature review according to Table 1 and

Table 2, it is known that 6 articles are included in the inclusion criteria with the type of
quantitative research in the form of observational analysis with a cross-sectional approach
with most of them using chi-square analysis tests, bivariate analysis, and multivariate
analysis tests and some using Pearson correlation tests. The number of samples used in
the study varied between 14 to 56 respondents with the sampling techniques used were
probability sampling, purposive sampling, and total sampling.

Midwife performance is a health service provided by a midwife to ensure optimal
maternal health which can be accounted for in quality and quantity. Midwifery
performance is influenced by a variety of individual and organizational factors, including
leadership, work location, organizational structure, and rewards and compensation.
Psychological factors include perception, attitude, personality, learning, motivation, and
job satisfaction. Individual factors include abilities, skills, family background, work
experience, social level, and demographics (Gibson, 2008)

Based on the results of the research from the six articles analyzed, it can be found
that from several independent variables studied, there are variables related to the
performance of midwives in antenatal care (ANC) services which are determined in 5
articles using the chi-square statistical test and 1 article using the Pearson correlation test
at a significance level of α = 0.05 (95% confidence level), where the decision is taken
based on the sig p value < 0.05. The variables related to the performance of midwives in
ANC services include:
1. Knowledge

A total of 5 out of 6 articles discussed the relationship between knowledge and
midwifery performance in antenatal care (ANC) services in health centers, of which 5

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Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5750

articles there were 4 articles stating that there was a relationship between knowledge and
midwifery performance with a ρ < value of 0.05 (Hasalia, Noerjoedianto, & Hubaybah,
2022); (Syafputri, 2023) ; (Reni Sulung Utami, 2019) while 1 other article (Hattu et al.,
2023) stated that there was no relationship between knowledge and midwifery
performance in ANC services at health centers.

Knowledge is a factor that influences a person to behave positively and produce
good output. With the increasing level of knowledge of midwives, it is believed that it
will improve the performance of midwives in antenatal care (ANC) services. The success
of a midwife in providing ANC services is positively correlated with her level of
expertise; Conversely, a limited knowledge base can also have a detrimental impact on
its performance.
2. Motivation

3 elements form motivation, namely the need for power, the need for affiliation,
and the desire to achieve. Motivation is a driver for midwives in carrying out antenatal
care such as pregnancy checkups, and K1 and K4 visits. A total of 5 out of 6 articles
discussed the relationship between motivation and midwifery performance in antenatal
care (ANC) services at health centers, where of the 5 articles all stated that there was a
relationship between motivation and midwifery performance with a ρ value of < 0.05
(Hasalia et al., 2022); (Syafputri, 2023); (Yubiah, Nurwati, Astuti, & Bima, 2022);
(Malaikosa, Fatimah and Astarie, 2022); (Reni Sulung Utami, 2019).

In this study, we can find out that the average midwife officer at the health center
has good motivation in providing services. Good motivation can improve midwifery
performance, while lack of motivation also decreases midwife's performance in providing
ANC services. Midwives who have good motivation are encouraged by several things,
including supportive environmental conditions, good direction and guidance from the
leadership, rewards, and awards for midwives.
3. Leadership

A total of 2 out of 6 articles discussed the relationship between leadership and
midwifery performance in antenatal care (ANC) services at health centers, of which of
the 2 articles there was 1 article stating that there was a relationship between leadership
and midwifery performance with a ρ < value of 0.05 (Syafputri, 2023) While 1 other
article stated that there was no relationship between leadership and midwifery
performance in ANC services at health centers (Hasalia et al., 2022).

Midwives in carrying out their duties are responsible to their leaders, namely the
Head of the Health Center. So the Head of the Health Center must also provide guidance
to all midwives in their work area. In this case, it is hoped that the leadership can influence
the midwife through a good communication process so that the midwife follows his
decision because a leader will probably be considered effective and ineffective from the
point of view of the satisfaction of his subordinates so that leadership is used as one of
the driving factors for midwives in providing antenatal care (ANC) services by standards.
4. Rewards/incentives/wages

A Literature Review on Determinant Factors Related to Midwifery Performance in Antenatal
Care (ANC) Services in Health Centers

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5751

Based on the analysis of the literature review conducted, it can be found that as
many as 3 out of 6 articles discussing rewards/incentives/wages received by midwives
where the three articles stated that there is a relationship between the
remuneration/incentive/wage variables and the performance of midwives in providing
antenatal care (ANC) services with a ρ < value of 0 (Syafputri, 2023); (Malaikosa et al.,
2022).

In general, most employees want their performance to be synergistic with the
rewards they receive. Most of the three articles show the relationship between
rewards/incentives/wages and midwifery performance in antenatal care (ANC) services
at health centers. Rewards are considered something that the boss gives after they can
provide their abilities, expertise, and efforts by the targets to be achieved.
5. Age

Age is one of the factors related to the performance of midwives in antenatal care
(ANC) services at health centers. The older they are, the better the midwife is at providing
antenatal care (ANC) services. There were 2 out of 6 articles studied that discussed the
relationship between age and midwifery performance where the two articles were
significantly related to the ρ < value of 0.05 (Yubiah et al., 2022); (Hattu et al., 2023).

As midwives grow older, they will mature their psychological and physical
aspects, so that their thinking will develop and easily accept all forms of information. In
addition, with a more mature age, problem-solving will also be carried out better, and
calmer, and pregnant women who get services will be more comfortable and confident
because the midwives who handle them are mature and experienced midwives.
6. Attitude

A good midwife's attitude is an attitude that does not deviate from the rules of the
code of ethics and health disciplines. In addition, the attitude of health workers must be
accompanied by patience, firmness, quickness in action, ease of getting along with others,
and so on. Attitude is also a midwife's response in antenatal care (ANC) services.
Midwives who have a good response to their work will also maximize their practice in
providing services.

There were 2 out of 6 articles studied that discussed the relationship between age
and midwifery performance, where the two articles were significantly related to the ρ <
value of 0.05 (Yubiah et al., 2022) and (Hattu, Razak, Palutturi, Mallongi, & Russeng,
2023). This shows that attitude has an important role that very much behaves a person at
work.
7. Worker status, employment period, and relationship with co-workers

In this literature analysis, there are 1 of 6 articles that discuss the relationship
between worker status factors, working period, and relationships with colleagues related
to the performance of midwives in providing antenatal care (ANC) services. The article
shows the relationship between worker status, length of service (Hattu et al., 2023), and
the relationship between colleagues and midwifery performance with a significant value
ρ < 0.05 (Syafputri, 2023).

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Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5752

The work status factor that shows the existence of a relationship has a role where
the lack of performance of midwives in ANC services is due to employees who have the
status of permanent employees with a fixed salary with incentives according to
performance. Meanwhile, employees with non-permanent status are compensated
according to the policy of the health center. In addition, the actual working period factor
can determine whether a midwife is right or not in carrying out her duties as a midwife.
The longer a midwife's working period, the more she is expected to be able to master the
situation in her work area. However, the working period is also related to the
responsibility of implementing ANC where the longer the working period, the more
experience or lessons are obtained, and the better the performance will also be in carrying
out services in the examination of pregnant women, midwives can carry out according to
standards.
8. Training and Skills

Another determinant factor analyzed was training and skills, where of the 6 articles
that met the inclusion criteria, 1 article each discussed training and skills. The article
(Hasalia et al., 2022) Stated that there was a relationship between training and midwifery
performance in ANC services with a value of p = 0.010 and PR = 2.25 (ρ < 0.05). This
shows that training plays an important role in improving performance where with more
types of training followed by midwives, it will have a good impact on improving the
competence and performance of midwives.

In addition, there is another factor that is analyzed, namely skills, where there are 1
out of 6 articles discuss skills with midwifery performance in ANC services whereas the
article. (Malaikosa et al., 2022) States that there is no significant relationship ρ=0.936 (ρ
< 0.05).

Conclusion

Based on a study from six journals that are included in the inclusion criteria of this
study, which specifically examines the performance of midwives in antenatal care (ANC)
services with a range of 2019-2024, it can be concluded that the determinants related to
the performance of midwives in antenatal care (ANC) services in health centers are
knowledge, motivation, rewards/incentives/wages, training, age, worker status and
relationships with colleagues. The researcher's suggestion for the future needs to involve
the Health Office and professional organizations (Indonesian Midwives Association/IBI)
involved in coaching and supervision in the form of standardization, technical guidance,
and evaluation monitoring which is carried out at least 2 times a year by the Regulation
(Permenkes RI No. 28, 2017) and is obliged to carry out credentialing and credentialing
by the Decree of the Director General of Health Services Number HK.01.07/I/4719/2020
so that it can improve quality health center from the aspect of human resources (Ministry
of Health of the Republic of Indonesia, 2021).

A Literature Review on Determinant Factors Related to Midwifery Performance in Antenatal
Care (ANC) Services in Health Centers

Indonesian Journal of Social Technology, Vol. 5, No. 12, December 2024 5753

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