A Matter of Life and Death - Article from The Jakarta Post

This article was published about a year ago and it highlights the tragedy of maternal mortality in Indonesia. 

Published on The Jakarta Post (http://www.thejakartapost.com)

A matter of life and death

The Jakarta Post   |  Wed, 01/13/2010 6:25 PM  |  Life

Rita A. Widiadana

Choirunissa, 38, was nine months pregnant. She was also poor, malnourished and anemic. The expectant mother — also known as Nissa — already had five children and did not want another baby. When her due date arrived, her husband Lukman called a traditional birth attendant to help his wife deliver the baby at their modest home in a remote village in Jember, East Java. During the delivery, Nissa started bleeding but the birth attendant did not recognize the seriousness of the problem until she collapsed. Lukman decided to take her to a nearby hospital but he had no money and no transportation. He finally he got a loan from a neighbor and took her to the hospital only to find that the medical staff could not save either mother or baby.

Thousands of women in Indonesia stretching from the western-most Nanggroe Aceh Darussalam to eastern Papua provinces share Nissa’s sad story — they died due to complications related to pregnancy and childbirth. The majority of Indonesian women living in rural areas delivered their babies at home, about six in 
every 10 births. Many families prefer to use a dukun (traditional healer or shaman) because of traditional beliefs and because it is cheaper than using a trained midwife or going to the hospital. These traditional birth attendants usually perform household chores while the mother recovers. In many rural areas in Indonesia, traditional ways of delivering babies still exist.
Village women in Papua are aided by traditional midwives in the middle of lush tropical forests. The local midwife usually uses bamboo fibers to cut the umbilical cord and wipe the newborn babies with guava leaves.The delivery instruments used are certainly not sterile and can lead to serious infection.

The traditional midwife may not be able to deal with complications during child labor and by the time the mother gets to a local clinic, it may be too late. As a result, according to Health Ministry data, the country’s maternal mortality rate (MMR) remains high at 307 maternal deaths per 100,000 live births, with about two women dying every hour during pregnancy and delivery. In comparison, the maternal mortality rate reached only 39 per 100,000 in Malaysia and 6 per 100,000 in Singapore. (The rate in the US is estimated to be around 11-15%). Indonesia is among the 11 countries that contribute 65 percent of world maternal deaths.

The main cause of maternal death in Indonesia is bleeding (28% of maternal death), followed by pre- and post-eclampsia (24%), infection (11%), and the complications of abortion (8%) and prolonged labor (5%). Most of these deaths occur with births handled by traditional birth attendants rather than by medically trained healthcare professionals. Dr. Saramma Thomas Mathai, United Nation for Population Affairs (UNFPA) Asia-Pacific Regional Office, said that maternal mortality is an indicator of gross inequality, human rights abuse and development failure. “It is clear that when a woman in most of Asia becomes pregnant, her survival cannot be assured. All maternal health problems are preventable as long as the government pays attention and prioritizes maternal health.”Of the 11 countries that contribute to 65 percent to global maternal death, five are Asian countries including Indonesia, Bangladesh, Pakistan, India and Afghanistan. A high mortality rate is an indicator of the status of poor functioning of a country’s health system including lack of supportive and protective legal and policy environment, Mathai said. Dr. Sri Hermiyati, director of maternal health at the Health Ministry, admitted Indonesia still faces tough challenges in dealing with maternal health. “Reducing the MMR has become the first priority in the Indonesian health care system. But we have to admit the roads are still very long and rough,” Hermiyati said.