The Effect of Environmental Deterioration and Demographic Pressure on Obstetric Complication Severity Amplified by Infectious Disease: Lessons Learnt from Lampung Province Public Choice Guided Policy

Abstract

Environmental degradation and demographic pressures are increasingly recognized as important determinants of public health outcomes in low- and middle-income countries. Deforestation, declining sanitation, and rapid urban expansion exacerbate ecological pressures, while population density, poverty, and limited health resources intensify vulnerability among women of reproductive age. Infectious diseases such as malaria, dengue fever, and tuberculosis remain endemic in many regions of Indonesia, further complicating maternal health outcomes. Lampung Province, Sumatra, represents a microcosm of these intersecting challenges, making it a relevant locus for examining the combined effects of environmental and demographic stress on obstetric complications.

Objective:
This study aims to determine: (1) the direct effect of environmental deterioration (ENV) on pregnancy complications (COMP) and infectious diseases (DISEA); (2) the impact of demographic pressure (DEMG) on pregnancy complications and infectious diseases; (3) the effect of infectious diseases on pregnancy complications; and (4) the role of infectious disease mediation in amplifying the effects of environmental damage and demographic pressure on pregnancy complications.

Methods:
The study was conducted between January and April 2026 in Lampung Province. Data preparation and analysis were carried out at the Forest Inventory and Management Laboratory of the University of Lampung. Smart PLS-SEM is used for parameter optimization using 5,000 iterations of bootstrapping. ENV is measured through indicators such as declining forest quality, increased deforestation, deteriorating sanitation, barren land expansion, and housing growth. DEMG is reflected in increasing population density, concentration of modern sector workforce, increasing number of pregnant women, and declining disposable income. DISEA was measured by the number of occurrences of pneumonia, dengue fever, pulmonary tuberculosis, and acute respiratory infections. COMP is reflected in bleeding, anemia, preeclampsia/eclampsia and many obstetric complications. DEMG and ENV data were collected from www.bps.go.id (2019–2023), while DISEA and COMP data were obtained from the Lampung Provincial Health Office with a one-year gap (2020–2024).

Results:
Findings show that: (1) environmental deterioration (ENV) directly increases pregnancy complications (COMP) by about 0.231 cases per 10,000 population (p = 0.139) and infectious diseases (DISEA) by about 0.265 cases per 10,000 population (p = 0.002); (2) demographic pressure (DEMG) directly increases pregnancy complications (COMP) by about 0.144 cases per 10,000 population (p = 0.563) and infectious disease (DISEA) by about 0.660 cases per 10,000 population (p = 0.000); (3) the effect of infectious diseases (DISEA) on pregnancy complications was statistically significant (p = 0.074), with an estimated increase of 0.360 cases per 10,000 women of reproductive age.

Conclusion:
This study highlights the complex interplay between environmental degradation, demographic pressures, and infectious diseases in shaping maternal health outcomes. While environmental and demographic stress provide significant immediate effects, infectious diseases appear to play a limited mediating role. These findings underscore the need for integrated policies addressing ecological sustainability, demographic management, and infectious disease control to reduce obstetric complications in vulnerable populations.