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Vero Fetu, a 30-year-old mother of two in Tuabatan Village, TTU. If not for the Desa Siaga network recently mobilized with support from AIPMNH, Vero may have died from haemorrhage after giving birth to her third child.

Veronika (Vero) Fetu woke up feeling dizzy and bleeding profusely the morning after giving birth to her third child. She collapsed on the floor of the small village health clinic close to death from post-partum haemorrhage, and awoke a few hours later in the care of doctors and nurses at the Timor Tengah Utara (TTU) District Hospital in Kefamenanu, Nusa Tenggara Timur Province (NTT), Indonesia.

Motherhood has not been easy for Vero, a 30 year-old farmer from a rural village in the mountains of north central Timor. Her second child died from asphyxia a month after he was born. Sadly, Vero’s situation is all too common in NTT, which has one of the highest rates of maternal and neonatal deaths in Southeast Asia. Haemorrhage and asphyxia are the two main causes of death for pregnant women and newborns respectively in NTT, where health facilities are often a great distance from the province’s remote villages.

That’s why the Australia Indonesia Partnership for Maternal and Neonatal Health Program’s (AIPMNH) support to create more “Alert Villages,” or Desa Siaga, is so crucial to saving mothers’ and babies’ lives.  Through its Desa Siaga program, AIPMNH supports communities to build financing, family planning, transportation and blood donor networks that ensure women give birth safely at health facilities rather than at home with an unskilled birth attendant – one of the main factors contributing to the high mortality rates of mothers and newborns.  It was this type of network in Tuabatan village that saved Vero’s life.

“I believe the best solution to save mothers and babies in villages like ours is through Desa Siaga – like the system built for us by AIPMNH,” said Paulinus (Linus) Bana, the Head of Tuabatan.

The health of women and babies has always been a priority for Linus, who was a volunteer at Tuabatan’s monthly village health post, or posyandu, for more than 20 years. He has brought his firsthand knowledge of maternal and neonatal health (MNH) issues to his role as Village Head, challenging some very deeply entrenched gender norms in this patriarchal community.

Afriana Kope, the Midwife Coordinator at a nearby AIPMNH-supported health centre, Puskesmas Eban, has been a midwife in this area for 18 years and knows how these norms affect pregnancy and birth.  “Mothers don’t really have a voice about their own health,” she explained. “Husbands and uncles hold power over mothers here.”

“Their lack of knowledge leads them to ignore pregnant women,” she said. “They don’t realize that pregnant women need serious attention.”

Naketi Naho’e gathering in Tuabatan village, TTU, NTT. This decision-making meeting typically involved only the village’s male leaders, but the Village Midwife, pregnant women and Desa Siaga members have started to attend since AIPMNH began supporting the Desa Siaga program here in 2011. Involving women in this kind of discussion in a heavily male-dominated society is an important step towards giving women more choice over how and where they give birth

But soon after AIPMNH began supporting the Tuabatan Desa Siaga, Linus began to shift some of this decision making power through a dramatic revision of the village’s traditional “Naketi Naho’e” ritual. For hundreds of years, the village’s male leaders have gathered for the monthly Naketi meeting to make decisions for the community. But in 2011, Linus invited the Village Midwife, Desa Siaga network members and parents-to-be to join the meeting to discuss issues and decisions related to MNH.

This kind of change goes hand in hand with building a strong Desa Siaga, explained Nikodemus Noel, the Head of the Tuabatan Desa Siaga.
“Now at the Naketi, family members publicly solve any issues that stand in the way of a woman getting good health care,” Nikodemus said. “The family and Desa Siaga team commit to making sure the woman will access health services when the time comes to give birth – and that she will receive post-partum care.” “The experience with Vero really motivated us,” he added. “We started to strengthen our networks from the moment we realized that we could actually save someone’s life.”

AIPMNH’s support to local government complements these efforts to build a strong Desa Siaga. By training staff from the Village Community and Government Empowerment Agency (BPMD) and the National Program for Community Strengthening (PNPM) in community organizational skill and budgeting for MNH, the Program ensures better harmonization of efforts to improve MNH in villages like Tuabatan. 

According to Yati Tabelak, who has worked as a PNPM Facilitator since 2007, “The two trainings enabled me to facilitate better in planning sessions, because I understand MNH related issues much more now.”

Based on her surveys in Tuabatan, one of the biggest barriers to women giving birth at a health centre is that they lack money for even the most basic preparations to get to and stay at a Puskesmas.  Now, however, the Tuabatan Desa Siaga pays for women’s transport to and from the health centre, and the local PNPM Fund provides them with a packet of clean clothes and soap so that they are more comfortable during their stay.

A family with the red Desa Siaga flag in front of their house in Tuabatan. The flag signals that the woman’s pregnancy is high risk; in this case, because she is pregnant very soon after giving birth to her last child. The red flag alerts the community that the woman is in her last trimester of pregnancy and will need to be taken to a health facility relatively soon to deliver her baby. Through Desa Siaga, more women are being educated about birth spacing and other methods of family planning

Clara Boleng, Head of Puskesmas Eban, believes that strengthening Desa Siaga networks is crucial to reducing the number of deaths of pregnant women and babies in these rural areas. “The Desa Siaga networks ensure that a pregnant woman from a remote village can get to a health centre in time,” she explained. “Last year, in a non Desa Siaga village, one woman died of haemorrhage.”

“She was pregnant out of wedlock and kept the pregnancy secret,” Clara said. “She delivered her baby alone at home, and they both died – this wouldn’t have happened if she lived in a village with Desa Siaga.”

AIPMNH is now supporting Desa Siaga in eight out of 12 villages in the Puskesmas Eban coverage area and more than 270 villages in total in 14 districts of NTT.

“Seeing the success of implementing Desa Siaga at a relatively low cost, the District Government now plans to add three more Desa Siaga with its own budget,” Clara said

In just two years, Tuabatan has seen results. Before AIPMNH began supporting the network in 2011, 24 women gave birth at home compared to only three in a health centre in 2010. In 2011, five women gave birth at home compared to 25 at the health centre. And in 2012, only 1 woman gave birth at home compared to 26 at a health facility.

Holding back tears, Vero described the day she returned from the TTU District Hospital.
“When I saw the Desa Siaga team waiting for me at home, I just cried – I couldn’t even say thank you,” she said. “I’m a poor woman, and what they did for me was a noble deed.”  “That network saved my life,” she said

AIPMNH is managed by Coffey on behalf of the Australian Government

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