State Capacity and Public Provision in a Socially Fragmented Nation: A Subnational Analysis of Maternal Mortality Disparities in Indonesia

Much research has demonstrated that progress in socioeconomic development and health infrastructure is instrumental in reducing maternal mortality. However, the effects on the maternal mortality ratio of state capacity and social fragmentation, which might change socioeconomic and health factors, are still under-studied. This study examines the extent to which state capacity (at the local level) and social fragmentation affect maternal mortality disparities across districts in Indonesia. By using district-level data and a separate analysis of old and new districts resulting from the proliferation of local government after decentralization, I find that local state capacity does matter for public health care provision. Districts that have stronger state capacity are more likely to have less maternal mortality. Also, variations in local state capacity are responsible for the prevalence of inter-regional disparities in maternal mortality in the country, in particular between old and new districts. Therefore, improvements in local state capacity, especially for new districts, will be necessary for the country to minimize the inter-regional gaps in health outcomes like maternal mortality. Unexpectedly, I do not find a significant link between social fragmentation and maternal mortality.