Every year, midwives across Indonesia respond to about 4.7 million births, more than half of them in rural settings. These committed professionals, all of them women, overcome challenges of geography, resources and staffing to provide the best possible care to mothers and their children.

However, several challenges remain to improving midwifery services in Indonesia, particularly in terms of reducing child and maternal mortality and increasing access to services related to sexual and reproductive health and family planning.

To discuss these and other challenges, midwives from 33 provinces across Indonesia gathered in Jakarta on 8 September 2014 for a seminar hosted by UNFPA, the Indonesian Midwives Association (IBI), the World Health Organization (WHO).

The National Workshop on the State of the World’s Midwifery (SoWMy) report was attended by midwives from 33 provinces in Indonesia, with the aim of improving the quality of midwifery care in the country.

The seminar was held to disseminate the results of International Confederation of Midwives (ICM) congress, held in June this year, and the updated State of the World’s Midwifery (SoWMy) report, which was launched at the congress. The report includes Indonesia among 73 low- and middle-income countries that together share the burden of 91 per cent of the world’s stillbirths, 93 per cent newborn deaths and 96 per cent of maternal deaths.

As seen by the enthusiastic participation of IBI members at the conference in Jakarta, the commitment is there among Indonesia’s midwives to improve the quality of their services and meet Millennium Development Goals (MDGs) number 4 and 5 – to significantly reduce the child mortality rate and maternal mortality rate by 2015. What they need now is the training and support to make it happen.

At the seminar opening, IBI chairperson Dr. Emi Nurjasmi expressed her expectations for the event: “After this workshop we hope there will be better understanding of the role of midwifery within the health system,” she said.

Desty’s story

During the seminar, young midwife and IBI member Ms. Desty Ariyani shared her experiences of working in Bengkulu, South Sumatra. She showed photographs of the muddy roads and floodwaters that sometimes got in the way of her delivering her services.

Apart from environmental obstacles, Desty also reported social and cultural challenges in her work, such as a lack of general knowledge about maternal and child health among the community, marriage and childbearing among young women under the age of 20, and the distrust of some families towards recent midwifery graduates like herself.

Desty told the story of an 18-year-old woman in Bengkulu who was 32 weeks pregnant with her first child when a local midwife detected severe pre-eclampsia, a condition characterised by high blood pressure and signs of organ damage. The midwife suggested that the woman be taken directly to the nearest hospital. Instead, the woman insisted on returning home first by motorcycle to gather her belongings and inform her husband and family.

On the way home, the young woman fell from the motorcycle and began having seizures. Bystanders found a car and rushed her back to the midwife, who was able to give an injection to stop the seizures before accompanying the woman to hospital. Tragically, the young woman died on the way.

Desty said that this case showed the importance of improving infrastructure to handle severe cases in remote areas, of enhancing midwives’ communication skills, and of gaining community trust for the advice of midwives as trained professionals.

Providing support

UNFPA is committed to helping Indonesia reach the MDGs on child and maternal mortality, as well as universal access to reproductive health. Recognising that midwives will play a major role in achieving these goals, including in the Post-2015 development agenda, UNFPA supports better working conditions, community acceptance and updated training for Indonesia’s midwives.

Left to right: Mr. Marc Lucet (UNICEF Indonesia), Mr. Jose Ferraris (UNFPA Indonesia), Ms. Ambar Rahayu (BKKBN), Ms. Emi Nurjasmi (IBI), Ms. Lidia Gomes (Timor-Leste Midwives Association) and Mr. John Pile (UNFPA Timor-Leste) at the National Workshop on the State of the World’s Midwifery (SoWMy) report in Jakarta.

By inviting IBI members and government stakeholders to receive and discuss the proceedings of the ICM congress and the latest SoWMy report, it is hoped that these results can be widely disseminated among midwives across the country and help to inform better practice, improving the state of midwifery in Indonesia.

Also at the seminar, departing Unicef Indonesia representative Ms. Angela Kearney, herself a trained midwife, was presented with an award from IBI and UNFPA recognising her contributions to midwifery in Indonesia. Having already moved for her next posting in Pakistan, Ms. Kearney delivered a thank you message via video at the seminar.

Mr. Marc Lucet receiving a Special Recognition Award on behalf of Ms. Angela Kearney, UNICEF Representative in Indonesia 2009-2014, presented by UNFPA and the Indonesian Midwives Association (IBI).

“It’s really important for us midwives to stay abreast of what is happening, to learn from other countries, to learn from within Indonesia and to look forward at the partnerships that we must have here,” she said.

Addressing midwives present at the event, representative Mr. Jose Ferraris offered UNFPA’s support in keeping Indonesia’s midwives up-to-date.

“Let us work together – with the Government of Indonesia, UN agencies, professional associations, civil society organisations and individuals − to ensure that no woman in this country is left behind,” he said. “With the progress made so far, improving the lives and dignity of women and their children and families, we know this goal is now within reach.”