Health Quality Remains Low

KOMPAS/TOTOK WIJAYANTO

University of Indonesia (UI) nutrition graduate school head Inge Permadi (left), Siloam TB Simatupang Hospital andrology and sexology specialist Mira Krishtania and UI Medical Faculty obstetric and gynecology staff member Andon Hestiantoro speak at a discussion titled Planning for Pregnancy to Have a Healthy Fetus in Jakarta on Saturday. The discussion, which was organized by Kompas and Siloam Hospital, was hosted by Kompas journalist Yovita Arika and Laura Siska from Radio Sonora Jakarta.

JAKARTA, KOMPAS – Indonesia has failed to reduce the maternal mortality rate, which has been persistently high over the past three decades. It needs to involve all parties considering the fact that maternal death is not just about health, it is also about culture, religion and infrastructure.

The number of women dying during pregnancy and childbirth reached 349 per 100,000 live births, according to the 2010 Population Survey. The Intercensal Population Survey (IPS) of 2015 showed that 305 women died during delivery per 100,000 live births. Based on that data, maternal deaths were estimated to have reached between 120,000 and 150,000 from live births.

Besides the 2015 IPS data, the maternal mortality rate is generally based on data from the Indonesia Demographic and Health Survey (SDKI), which had been conducted several times since the 1990s until 2012.

Based on SDKI data from 2012, the maternal mortality reached 359 per 100,000 live births.

Whatever data was used, they all showed the high maternal mortality rate in Indonesia, said Akmal Taher, the chairman of the Executive Committee of Evidence Summit on Reducing Maternal and Neonatal Mortality at the Indonesian Academy of Sciences (AIPI), in Jakarta on Wednesday.

Health Minister Nila Djuwita Anfasa Moeloek said with the high maternal mortality rates, Indonesia failed to achieve the Millennium Development Goals (MDGs) target to reduce post-natal deaths to 102 per 100,000 by 2015.

Therefore, the government is looking to reduce maternal mortality to 306 per 100,000 live births by 2019 through the National Medium Term Development Plan 2015-2019. Although the maternal mortality rate is high, Indonesia still lacks data and information on maternal and newborn deaths. Therefore, the AIPI and the United States Agency for International Development are conducting an evidence summit to reduce maternal and newborn deaths.

Recommendation

The AIPI gathered evidence by tracking 7,831 maternal and neonatal deaths in Indonesia over the last 20 years. It found that the causes of maternal mortality are diverse, one of which is uneven access to quality health services. "Health facilities should be improved based on the principle of continuum care," it said.

The emergency referral systems for pregnant women are expected to be excluded from the tiered referral system in the National Health Insurance program. With the exception, pregnant women can be immediately taken to obstetricians and gynecologists in the event of an emergency.

The quality of delivery in public and private hospitals should also follow the standard of comprehensive neonatal obstetric emergency care. In addition, more than 60 percent of births are handled alone, especially by a midwife. This should be carried out jointly by a health team involving doctors, nurses and other personnel. Many maternal deaths are caused by birth complications such as bleeding, hypertension and infection.

Eni Gustina, the director of family health at the Health Ministry, said the deaths of mothers and babies in Indonesia could not be separated from the classic problems -- “four toos and three lates”. The four “toos” are too old, too young, too often and too close, while the three “lates” are late decision, late referral and late handling.

Reducing the death of women during pregnancy and childbirth also requires an active role from the local government. At present, the reduction of maternal mortality is uneven because it is very dependent on the leadership and the attention of the local government.

A good example is the Surabaya city government, which has introduced a midwife assistance program for brides. The midwives provide information to the bride and groom about the importance of maintaining nutrition in the first 1,000 days of infant life to reduce maternal and infant mortality rates. There is also an additional feeding program for pregnant women.

Non-medical problems must also be resolved because of their impact on maternal mortality rates. One of them is the high rate of early marriages, which can increase various medical risks.

The AIPI also proposed the establishment of the National Committee for the Acceleration of Decrease of Maternal and Newborn Mortality Rate. The committee will be used as a communication forum between health professionals, researchers and policy makers to facilitate policy alignment and address issues.

(MZW/SYA/ETA/ELN/ADH)