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 8
November 2007,
Curbing the country’s high maternal deaths need to highlight
the uneven distribution of services, the limited capacity
of health workers and weak referral care which remain as serious
challenges in ensuring skilled assistance at birth in underserved
communities. In addition to these, the lack of public awareness
on maternal health, financial and cultural barriers has contributed
to the low utilization of the existing maternal services by
community members.
Dr. Gianfranco Rotigliano, UNICEF Country Director said that
women are still dying because of the 3 delays: the delay in
making the decision to seek care, the delay to reach health
facility and delay to get care at the hospital because of
lack of life saving drugs, equipment of the absence of doctor
at the facility. “These are further complicated by other
barriers like geographical, financial and cultural barriers,”
he told participants of the International Meeting on Skilled
Assistance at Birth in Underserved Areas, jointly organized
by UNFPA, UNICEF and WHO in Bali from 6 – 8 November
2007.
The International meeting is held to share lessons learned
and recommendations among the participating organizations
in improving maternal health in underserved areas across the
country.
The tough working environment resulting from difficult geographical
condition, unsupportive cultural factor and financial limitation
indeed affect the morale of health workers. “(These
factors) have also influenced the quality of services provided
by health workers,” Director for Women’s Health
with the Ministry of Health Dr. Sri Hermiyanti, Msc.
This year MoH announced that the maternal mortality rate is
262/100,000 live births, dropped from 2002-2003 rate at 307/100,000
live births. But data from different institutions still show
that women do not enjoy accessible maternal care since only
43% of 69,900 villages in Indonesia have village midwives
and 1 in 3 pregnant Indonesian women still rely on the assistance
of traditional birth attendants (TBA). Women, mostly in rural
areas prefer home delivery (60%) to delivery at health facility
(40%).
Skilled care at births is one of the important interventions
to slash maternal mortality, besides emergency obstetric care
and family planning, explained UNFPA Representative Dr. Zahidul
Huque. Combined with emergency obstetric care, skilled care
at births can reduce about 75% of maternal mortality, while
family planning can reduce one third of maternal deaths caused
by complications from unwanted pregnancies.
Head of Children’s Health Division with South Sulawesi
Health Office Andi Mappatoba stresses for partnership between
midwife and TBA. “In many places, TBA may be women’s
only sources of care. They can be providers of culturally-appropriate
care and serve as first-line link with the health care system.
Priorities at district level need to include validated data
on the number of TBA, trainings of both TBA and health center
staffs and mapping of pregnant women,” he said.
Community participation proves to be key that determines the
success of safe pregnancy and childbirth efforts. “Effective
management of complications also relies on individual women,
families and communities ability to recognize complications
and take decisions to seek timely care. For this to happen,
women, their families and communities must be well informed
and believe that their needs will be met in a way that is
acceptable to them as well as fulfilling their human rights,”
said Dr. Laura Guarenti from WHO.
Advocacy to the decision makers, religious and community leaders
would be useful to mobilize their supports and involve them
in the efforts. “Religious leaders can effectively spread
health messages to community members and mobilize the participation
of elements of community in programme activities. This fosters
the sense of ownership to (health) programmes that in turn
ensure the sustainability of (health) programmes,” explained
Oliphina Rumbekwan, head of Family Health Division, Jayawijaya
District Health Office, Papua.
Programme interventions will not be effective without addressing
gender inequality in various aspects of community lives. “Many
women in underserved areas do not have a say over their own
health and wellbeing, and in cases of pregnancy complications
and childbirth, it is a mater of life and death. Empowering
women, especially through education and health information
would allow them to exercise their reproductive health right,”
explained Dr. Huque.
In her closing remarks, Dr. Sri Hermiyanti underlined expert
recommendations from the meeting, including promoting deliveries
at a health facility: either a rural childbirth clinic, primary
health center, community clinic or a hospital; ensure referral
to health facilities with the capacity to provide basic or
comprehensive emergency obstetric and neonatal care; provide
trainings to improve the skills of health workers; and identify
gender- and cultural-biased issues and design an appropriate
intervention. “These recommendations will be used as
reference in planning for follow up actions,” she said.
For further information please contact:
Maria Endah Hulupi
UNFPA Communications Officer: 0812 1115 116
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