Implementing the International Academy of Perinatal Medicine New Delhi 2025 Professional Responsibility Principles in Perinatal Care: Insights from a Systematic Review of Indonesian Health System Evidence
Muhammad Alamsyah Aziz, Wiku Andonotopo, Adhi Pribadi, Anita Deborah Anwar, Muhammad Adrianes Bachnas, Wisnu Prabowo, Eric Edwin Yuliantara, Sri Sulistyowati, Mochammad Besari Adi Pramono, Julian Dewantiningrum, Efendi Lukas, I Nyoman Hariyasa Sanjaya, Anak Agung Gede Putra Wiradnyana, Anak Agung Ngurah Jaya Kusuma, Khanisyah Erza Gumilar, Ernawati Darmawan, Muhammad Ilham Aldika Akbar, Dovy Djanas, Dudy Aldiansyah, Aloysius Suryawan, Ridwan Abdullah Putra, Theresia Monica Rahardjo, Rizna Tyrani Rumanti, Roland Frederik Lengkey, Sarma Nursani Lumbanraja, Cut Meurah Yeni, Aryani Aziz, Nuswil Bernolian, Waskita Ekamaheswara Kasumba AndanaputraAbstract
Professional responsibility is widely invoked in perinatal medicine, yet seldom examined as a health system implementation discipline rather than only a professional ideal. Following the International Academy of Perinatal Medicine New Delhi 2025 declaration, attention has shifted from ethical consensus to practical translation within real service environments. Indonesia – an archipelagic middle-income health system with persistent maternal and neonatal disparities – provides a useful empirical setting from which transferable implementation insights may be derived. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. PubMed/MEDLINE was searched using a predefined Boolean strategy, with the final search performed on December 20, 2025, supplemented by manual reference screening. From 450 records, duplicate removal and eligibility screening yielded 25 empirical Indonesian studies included in the PRISMA dataset. Five additional publications on the professional responsibility framework were incorporated for conceptual interpretation but were not part of the PRISMA-screened dataset nor subjected to risk-of-bias assessment. Two reviewers independently evaluated study quality using A Measurement Tool to Assess Systematic Reviews 2, Newcastle–Ottawa Scale, and adapted Risk of Bias in Nonrandomized Studies of Interventions-I approaches. Evidence was synthesized narratively across ethical, clinical, and system-level domains. Across the included studies, timely referral pathways, continuity of antenatal care, equitable service access, and structured diagnostic counseling were repeatedly associated with improved maternal–neonatal outcomes. Conversely, fragmented care pathways, geographic inequities, and weak escalation systems constrained ethical implementation. Professional responsibility emerges as a system-level implementation challenge rather than solely an ethical commitment. Aligning ethical obligations with referral design, diagnostic governance, and population surveillance may strengthen perinatal safety in Indonesia and health systems facing similar structural constraints.