Tradition remains strong in a province where more than seventy communities have their own distinct language and customs. In terms of maternal and neonatal health (MNH) in Nusa Tenggara Timor (NTT), sometimes bringing in tradition is the best way to change it.
|Midwife Rahayu and Magdalena Imput|
Wae Banka village, nestled in the forested hills of West Manggarai district in Flores Island, is one of fourteen communities throughout NTT where the Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH) is engaging traditional birth attendants (TBAs) to support the province’s aim to decrease maternal and neonatal mortality.
“I’ve been helping women give birth in this village and two other villages my whole life “ said 65 year-old Magdalena Imput, a TBA in Wae Bunka. “I cannot even count how many babies I’ve delivered over the last forty-odd years.”
Called dukun bayi in Indonesian, village TBAs may provide care to mothers from the time they know they are pregnant up until the day they give birth. Through this contact, TBAs tend to have close emotional ties with mothers in rural communities, but they lack the skills of a professionally trained midwife. And when they administer these births at home, the chances of maternal and neonatal mortality increase substantially.
In 2010, AIPMNH began supporting the district government’s initiative to create partnerships between village midwives and TBAs.
|Magdalena Imput, traditional birth attendant in Wae Bangka, Labuan Bajo|
The government, midwives, and AIPMNH realized that rather than shun the TBAs and their methods, bringing them into the process would be essential to help NTT achieve its goal of getting all women to deliver in a health facility with trained health staff.
According to midwife Rahayu Pakeng Veronika, who runs the village health facility, or pustu, in Mae Bunka, the partnership has helped both sides.
“This partnership has really taken a burden off of my shoulders,” she explained. “Before, I had to go house to house and village to village to persuade women to come give birth at this pustu.”
But with the help of Magdalena, the two women are convincing pregnant women in nearby villages to come to the pustu or another health center rather than risk giving birth at home. It’s a delicate balance to bring these two parties together. According to Rahayu, most of the TBAs are in their 50s and 60s and are respected figures in their communities.
Therefore, AIPMNH supports the planning process between midwives and TBAs, where the two groups develop a birth plan together and pledge to ensure that pregnant women in their communities give birth in a health center.
Instead of working separately, midwives like Rahayu encourage TBAs to bring pregnant women to receive antenatal care and help guide the women through delivery while the midwife manages the actual birth.
‘‘We TBAs have made an agreement with the midwife and the village that deliveries must be assisted by a midwife in the pustu,” Magdalena said. “Now we refer the mother to the midwife right away.”
And for Magdalena, whose mother was also a dukun bayi, that’s a shift in tradition that can save lives.