Clinics tackling maternal health in Central Java

Kendal, Central Java – Salis is eight months pregnant with her first child, and has been diagnosed with a potentially high-risk pregnancy, in part because of swelling in one of her feet. She is one of dozens of expectant mothers who have taken advantage of health services provided by Cepiring Community Health Center in Kendal, Central Java, where maternal mortality is among the highest in the country.

The 24-hour clinic was designated a site for Basic Emergency Obstetric and Neonatal Care (PONED) in 2012 as part of an initiative to address maternal health in Central Java province, and Cepiring’s nine midwives now handle dozens of births every month.

Highlights

  • Indonesia’s Maternal Mortality Ratio (MMR) is considered high compared to other countries in the region
  • Central Java is the pilot province for the MDG Acceleration Framework (MAF) that is tackling women’s health. Densely populated Central Java is one of nine provinces with the highest MMR in the country
  • The MAF, spearheaded by the Ministry of Health and the Ministry of National Development Planning (BAPPENAS) and facilitated by UNDP, diagnoses problems and designs solutions to reducing maternal deaths
  • Following the adoption of the MAF model, midwife trainings have increased and the referral system to obstetricians has improved

The move to improve maternal health outcomes started in 2011 after the government recognized accelerated efforts were required to address Indonesia’s targeted maternal mortality ratio (MMR) of 102 deaths per 100,000 live births by 2015, part of the country’s Millennium Development Goal (MDG) commitment. The MMR has decreased from 390 in 1991 to 220 in 2010, but recent studies indicate the number has been on the rise, and remains high compared to other countries in the region.

Because of its high MMR, Central Java is the pilot province for the MDG Acceleration Framework (MAF) that is tackling women’s health. The framework, spearheaded by the Ministry of Health and the National Development Planning Agency (BAPPENAS) and facilitated by UNDP, diagnoses problems and designs solutions to reducing maternal deaths, and there is now a budget in place that includes increased funding to community health centers and hospitals.

Kendal Health Office head Widodo said in order to continue to improve maternal healthcare, “We are pushing for 24-hour care at health centers in Kendal.” He added that doing so would require more general practitioners practicing in the regency, as well as additional trainings for midwives.

Not far from Kendal, in the provincial capital of Semarang, a new mother Sri is relaxing in a shared room at the Halmahera Community Health Center after giving birth to an underweight 2.2-kg baby boy. Her as-yet-unnamed infant is sleeping soundly nearby, covered in a rust-colored batik. Sri’s left arm is wrapped in a bandage, covering the birth control implant just placed in her arm, the decision to do so made after consultation with Halmahera’s midwives.

Increasing contraception usage is part of the MAF model, as free and accessible birth control is central to improving women’s health. At Suwondo Hospital in Kendal, a sign read “Free Birth Control Implants Every 3rd Tuesday Here” – demonstrating the progress made in the province’s clinics and hospitals.

In Kendal, the number of maternal deaths has been decreasing every year, from 24 in 2012 to 21 in 2013 to 19 in 2014, out of approximately 900,000 residents. At the Cepiring clinic, posters were on display providing patients with information about their pregnancies and guiding caregivers. Clinic head Sri Inayati said, “The midwives created the posters on their own initiative” – one prominently displayed in the exam room listing indications when to refer pregnant women for further evaluation.

This improved awareness of complicating factors during pregnancy, as well as a better referral system to obstetricians, are achievements of the government-led MAF.

At Semarang Hospital, where approximately 300 babies are delivered every month, there have been seven maternal deaths so far this year. After every death, the hospital performs an in-depth audit to determine how to improve care. In Kendal, there is a sub-district-wide meeting every week to evaluate the high-risk pregnancies that also functions as a way for midwives to compare notes.

Seated in the simple waiting room of the Cepiring clinic, Armayani says she had planned to give birth at home with a midwife, as she had done with her first child. When she went into labor her midwife was at a wedding and did not answer the phone. A second midwife also did not answer her call, so Armayani turned to Cepiring, which she knew was open 24 hours.

It is Cepiring’s increased working hours and trained staff that ensured Armayani gave birth to a health baby boy – part of the increased efforts in the province since 2012 – and the health center has had no maternal deaths in the last few years.

Seven-months-pregnant Anita says she has a birth plan created in consultation with health workers at the Halmahera clinic. She plans to have this baby – her second – at a midwife’s home if everything with the delivery goes smoothly. If not, she is prepared to go to Halmahera. Her husband – who drove her on the back of his motorcycle to the midwife’s house after she went into labor the first time – is also fully informed when the time comes.

Because of the government and UNDP’s work in the province, awareness of maternal health and the necessity of preparation are front and center for pregnant women and their families. The number of women giving birth with skilled attendants has increased, as has the percentage of couples using contraception, and midwife trainings and referrals have improved.

This work means women like Salis, Sri, Armayani and Anita will continue to get the support they need during and after their pregnancies, and similar efforts are now underway in other provinces with high maternal deaths like Banten and East Java, helping to ensure women around the country are healthy and informed.

Story by: Deanna Ramsay / UNDP Indonesia

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