Abstract Indonesia’s achievement of near-universal population coverage through Jaminan Kesehatan Nasional (JKN) has reshaped access to maternal health services, yet maternal and neonatal mortality remain uneven and stubbornly high in specific regions and risk groups. At the same time, Indonesia is actively institutionalizing Health Technology Assessment (HTA) to inform benefit design and resource allocation. These two trajectories – expanded coverage and evidence-based priority setting – have not fully converged in the domain of advanced maternal–fetal medicine. This systematic review examines how evidence on maternal–fetal interventions is generated, assessed, and ultimately translated (or not translated) into JKN benefit decisions. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance, we systematically identified and synthesized 37 studies spanning clinical effectiveness, health economics, policy analysis, and health system implementation relevant to Indonesia and comparable settings. Rather than aggregating effect sizes alone, the review maps evidence across the maternal–fetal care continuum, linking intervention value to system readiness, equity implications, and real-world delivery constraints. Consistent patterns emerge. Low-cost, high-impact interventions such as antenatal corticosteroids and magnesium sulfate are often underutilized despite coverage, while more advanced technologies – fetal echocardiography and prenatal genetic testing – remain limited by tariff misalignment, workforce concentration, and fragmented referral pathways. HTA processes are advancing, but maternal–fetal technologies are rarely assessed as integrated care pathways, weakening their influence on benefit design. By combining systematic evidence synthesis with benefit design mapping, this review reframes maternal–fetal care as a core test case for fetus-inclusive universal health coverage. It argues that mortality reduction depends not only on what interventions are effective, but on how HTA, financing, and delivery systems are aligned to enable timely and equitable use.
Andonotopo et al. (Thu,) studied this question.