|Marselina and her husband Raja stand next to the Desa Siaga flag in front of their house. This red flag alerts the village to the fact that a pregnant woman lives there and may need help very soon in getting to a clinic to have a safe deliveryMarselina and her husband Raja stand next to the Desa Siaga flag in front of their house. This red flag alerts the village to the fact that a pregnant woman lives there and may need help very soon in getting to a clinic to have a safe delivery|
Marselina Radjakota’s baby could come at any moment. Smiling proudly with one hand on her round stomach, she shows a large, red flag in front of her house. This flag signals to the village of Oenoni in Kupang District, Nusa Tenggara Timur (NTT) that she’s in her last trimester of pregnancy and will soon give birth.
But is a woman’s pregnancy really the rest of her community’s business? According to the Head of Oenoni Village, who has played a crucial role in implementing one of AIPMNH’s most important programs, it most certainly is.
“There has always been a tradition here that neighbours help out pregnant women in their time of need,” said Yulianus Resi Tato.
“When a woman would give birth at home, people would come to bring food or firewood to heat water,” he said.
“We are building on that now to change people’s mindsets about where and how to give birth.”
Just over a year ago, this village of 317 households was at high risk for maternal and neonatal deaths.
There was no midwife available locally and a strong preference for births at home, which leaves women vulnerable to complications during childbirth and contributes to NTT’s high maternal and neonatal death rate.
But in October 2010, the Australia Indonesia Partnership for Maternal and Neonatal Health (AIPMNH) began supporting activities to make Oenoni an “Alert Village”, or Desa Siaga.
Desa Siaga is originally a government program that empowers communities to make their own preparations to keep mothers and babies safe during delivery. Through AIPMNH’s Community Engagement Program, the Partnership is empowering communities in 14 districts on the four main islands of NTT.
But what makes a village “alert”? Through its Desa Siaga program, AIPMNH addresses the most common clinical and behavioural causes of maternal and neonatal deaths in NTT, such as a lack of antenatal care, lack of financial preparation for delivery, a tendency for women to deliver at home, haemorrhaging, delays in finding transportation from the home to medical care, and delays in finding adequately qualified staff upon arriving at medical facilities.
“We’ve made a lot of simple but important changes,” said Helda Radja Kota, Head of Desa Siaga in Oenoni. “We have flags to show who is pregnant, and mothers know now that they shouldn’t give birth at home”.
“Everyone even the men – are more alert and more careful with pregnancies,” she said.
What stands out about Oenoni is how many innovations the village implemented on its own to maximise the cultural, economic and administrative resources of the community.
The village has established fixed rates with local motorcycle drivers and taxis for transporting pregnant women to primary health care centres, known as puskesmas, and to the hospital in Kupang. Payment can be made at a later date through the Desa Siaga network, which gives pregnant women access to transportation at any time of the day or night. The Village Head has also passed a local law forbidding births at home, and even requires the neighbours of a pregnant woman to pay a fine if there is a home birth, emphasizing that safe deliveries are the entire community’s responsibility.
“It’s not always easy to change mindsets, “ Helda explained. “People just don’t understand the risk of a birth that is not attended by trained health staff ” .
“So we show them how the reward for these small changes is healthy mothers and babies,” she explained. Another remarkable feature of the Desa Siaga program in Oenoni is the large amount of community funds that are collected to support safe pregnancy.
The network collects community funds through compulsory contributions of Rp 5000 per family, per month. The equivalent to $0.55 AUD/month is not as small as it seems in a province where the average annual income hovers around $340 AUD. Taking this into account, the village also has innovative fundraisers at the local primary school and accepts non cash contributions such as crops, which can then be sold at the market.
But the most striking thing about Oenoni’s success is that all these innovations have come from the community, starting with basic support from AIPMNH in awareness raising and training and in only 12 months since beginning the program. Thus, the chance for sustainability of the program is high. Oenoni has had no maternal or neonatal deaths in the last year, and AIPMNH is working to achieve the same outcome in 272 other villages in NTT. But it’s women like Marselina who are the living proof of a change in mentality of those most affected by the risks of delivery.
She gave birth to her first two children at home seven and eight years ago but will go to a clinic this time.
Why the change? “It’s because of Desa Siaga,” Marselina said. “After I heard about Desa Siaga, I learned about the risk”