Pregancy classes in West Java and West Timor
Lowering maternal risk associated with pregnancy and delivery directly improves a child’s survival. Babies whose mothers die during the first six weeks are far more likely to die in the first two years of life than babies whose mothers survive. Maternal complications in labour also increase the risk of neonatal deaths.
In Indonesia, the Maternal Mortality Ratio (MMR) of 228/100,00 live births (countdown to 2015 report, 2012) is higher than in neighbouring countries such as Malaysia (62), Sri Lanka (58), and The Philippines (230); and continues to be greater than the Millennium Development Goal No. 5 of 124/100,000 live births by 2015. The leading causes of maternal mortality are haemorrhage, eclampsia, anaemia and infection. Unsafe abortion contributes to about 11% maternal deaths, caused by bleeding, and pre-existing conditions ie malnutrition or other diseases contribute to approximately 20% of maternal deaths. MMR is higher amongst rural populations, the poorest quintile and-interestingly- where babies are delivered by Skilled Birth Attendant (SBA) compared to those who delivered by a non-SBA.
Factors which influence MMR in Indonesia have been identified as ‘the four toos’ or ‘Empat terlalu’ (too young-giving birth under 20 years of age, too old-giving birth over 34 years of age, too many-giving birth more than 4 times, and too near-interval of birth of less than 24 months) and ‘the three delays’ or ‘tiga terlambat’ ie delay in deciding to seek care, delay in seeking care, and delay in receiving care/services. Although 73% of live births were attended by skilled health personnel, many births still took place at home (52.7%). The introduction of village-based midwives did not automatically result in shifting of births to health care facilities. Maternal and child health issues were not alleviated due to the lack of awareness within communities of the services of village midwives, the need to pay for these services, the shortage of village midwives in some areas (only 60% of villages have a village midwife), poor quality of service, and the lack of clinical skills. These factors have contributed to the problems. As a result, Birth Preparedness and Complication Readiness (BPCR or P4K) programmes can only be implemented on a limited scale.
In Semarang in West Java and in West Timor, ante-natal services are either absent or inaccessible for many people. The Foundation for Mother and Child Health Indonesia, known locally as Yayasan Balita Sehat, has developed an education programme for pregnant women to give them the knowledge and confidence to improve their experience of pregnancy and child-birth and prepare them for their new baby.
Classes include ante-natal training, preparation for childbirth, yoga and cooking classes.
Ronsmans C, et al, 2009. Professional assistance during birth and maternal mortality in two Indonesian districts. WHO Bulletin 2009; 87.
Delay in deciding to seek care-caused by failure to recognize signs of complications, failure to perceive severity of illness, cost considerations, previous negative experiences of the health system, as well as transportation difficulties and low value of women in society; Delay in seeking care-lengthy distance to health service providers, the condition of roads, and the lack of available transportation; Delay in receiving care-Unavailability of health personnel, indifferent attitudes of health care providers, poor skills of health providers, and shortages of supplies and basic equipment.
 IDHS, 2007
 WHO, 2008
D’Ambruoso, et al, 2008. Assessing quality of care provided by Indonesian village midwives with a confidential enquiry. Midwifery Journal.