Indonesia’s maternal mortality rate remains the highest among ASEAN countries. West Java, East Nusa Tenggara, West Nusa Tenggara and Papua are among Indonesia’s provinces with the highest maternal mortality rates.
The current maternal mortality rate had dropped to 228 deaths per 100,000 live births from 307 maternal deaths per 100,000 live births in 2003. But the current rate is still far from reaching the Millennium Development Goal of 125 deaths per 100,000 live births by 2015.
Therefore, the Indonesian government had targetted to reduce the maternal mortality rate to 102 deaths per 100,000 live births by 2015. However, despite greater control of reproduction, one of the more dispiriting signs of continuity in Indonesia is still the persistence of high maternal mortality.
According to White Ribbon Alliance, it was estimated that every year 20,000 women died during pregnancies and deliveries. Excessive bleeding contributed 42 percent to the maternal mortality rate, followed by eclampsia (13 percent), infection (10 percent), complications during abortion (11 percent), prolonged labour (9 percent) and others (15 percent).
Kartini, Indonesia’s national heroine and first feminist who fought for women’s rights in the eighteenth century, whose birthday is commemorated each year on April 21, died at the age of 25 during childbirth. And it is sad that problems related to maternal mortality persist until today.
The causes of maternal deaths are medically well understood, and ways to prevent them have been known for decades. However, the quality and accessibility of health facilities in Indonesia remains poor. Furthermore, because reproductive health messages mostly target women, there is a major reproductive health knowledge gap between men and women.
Poor rural women are encouraged to identify the danger signs of pregnancy, the importance of antenatal visits, and the timing to go to the community health clinic for delivery. However, acting on this knowledge is hindered when the husband and the rest of the family as well as the community do not have the same level of awareness. Her decision-making power in the household is often limited by the demands of other actors.
A rural woman might have to wait for her husband’s approval before starting off the journey to a health facility to give birth, and if he is away her departure can be delayed, potentially with serious consequences. Sometimes, members of the extended family, a religious leader or a traditional birth attendant must be consulted before seeking emergency help during childbirth. Such complex decision-making processes can cost lives. These decision-making processes are the product of gender-role construction and traditional norms and beliefs.
Government policies and programs play an important role in encouraging better care, but these are embedded in the same gender framework. Ironically, programs that call for more “culturally sensitive” approaches at times find themselves reinforcing the very factors that pose a threat to women’s autonomy and ultimately to women’s health.
Even when a woman has the support to get to a hospital, there is no guarantee that she will receive adequate care. Across Indonesia, there are shortages of trained personnel, inadequacies of supplies, and chronically inadequate procedures for supplying blood in emergency cases. Until the whole system is reformed, the maternal mortality rate will remain high.
Lynda K. Wardhani
Jakarta