Reaching Every Pregnant Woman: Lessons from Indonesia’s Approach to Malaria in Pregnancy

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Malaria in pregnancy remains an important public health challenge in Asia Pacific. In Indonesia, the burden has historically been concentrated in eastern provinces, including Papua, where malaria contributes to maternal anaemia, low birth weight and adverse neonatal outcomes.

Indonesia’s Approach to Malaria in Pregnancy

In 2012, Indonesia became the first country in the Asia Pacific region to introduce a national Single Screening and Treatment (SST) policy for malaria in pregnancy. Pregnant women attending their first antenatal care (ANC) visit in malaria-endemic areas are screened regardless of symptoms. Those who test positive receive treatment, while all women receive a long-lasting insecticidal net.

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Integrating malaria screening into routine ANC has proved feasible and acceptable. However, implementation gaps remain. Screening coverage varies across districts and facilities, while conventional diagnostics may miss low-density and asymptomatic infections. A single screening at the first ANC visit also cannot detect infections acquired later in pregnancy or protect women from reinfection.

Lessons for Strengthening Protection and Elimination

Evidence from Indonesia suggests that complementary approaches can strengthen protection in higher-transmission settings. A clinical trial conducted in Sumba Island and Papua between 2013 and 2016 found a 41–44% relative reduction in malaria infection at delivery among women receiving intermittent screening and treatment (IST) or intermittent preventive treatment (IPTp), compared with SST.

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Yet effectiveness depends on more than the intervention itself. Refusals of IPTp were linked to community perceptions, rumours and concerns about taking medication during pregnancy when women were not ill. This highlights the importance of understanding social and cultural contexts.

Way Forward

Indonesia’s experience points towards a differentiated strategy: strengthen SST in low-transmission and elimination settings, while considering targeted IPTp in higher-transmission areas. Across both approaches, adopting gender, equity, disability, and social inclusion (GEDSI) principles are essential to address geographical, financial, social and cultural barriers and ensure equitable access to ANC and malaria prevention.

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Ultimately, Indonesia's experience demonstrated that accelerating malaria elimination requires approaches that are not only epidemiologically appropriate, but responsive to the realities of health systems and the communities they serve.

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We acknowledge with appreciation Indonesia’s Ministry of Health for reviewing this case study.

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