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Reducing child and maternal deaths appears to be one of the most challenging issues in maternal health as many women in Indonesia choose home birth, causing complications during labor to be left untreated, a health official says.
Kirana Pritasari, director of children’s health management efforts at the Health Ministry, said last Friday that hemorrhage, or bleeding, during labor remained the leading cause of maternal deaths although it was actually preventable.
Ministry data from 2010 shows that about 82 percent of births occurred with the assistance of health workers such as doctors, nurses or midwives, a substantial increase from 77 percent in 2009. The remainder took place with the assistance of traditional birth attendants.
More than half of births occurring with the assistance of health workers took place at home.
“Home birth is very risky because we don’t know when complications may arise. At any time, we may see a condition that, although the mother is in good health, the baby’s condition is critical and requires immediate medical care, or vice versa,” Kirana told a media briefing at the Health Ministry.
In the absence of medical equipment at the patients’ home, even well-trained health workers cannot provide adequate medical care once they face an emergency situation during childbirth, such as postpartum hemorrhage.
Women without pregnancy complications may also face a medical emergency during childbirth, however, as they can arise without warning. “Safety is the only reason for us to promote childbirth at health-care facilities instead of at home,” she added.
Despite improvements, the decrease in the infant mortality rate slowed during the period of 1997-2007. Between 2002 and 2007, the infant mortality rate decreased to only 34 per 1,000 live births from 35 per 1,000 live births. Meanwhile, the country’s quite high maternal mortality rate which stands at 228 per 100,000 live births has also sparked serious concern.
To cope with the high rate of child and maternal deaths, the ministry is promoting child delivery which is not only assisted by health workers but also takes place at health-care facilities.
“Jaminan Persalinan [Jampersal]”, a recently launched childbirth insurance package, is one of the initiatives taken by the ministry to encourage expectant mothers to give birth at health-care facilities rather than at home.
According to the ministry, at least 170 regencies especially in remote areas, outer islands and cross-border provinces face health-related problems. As of July, the number of community health-centers in Indonesia reached 9,137 and continues to increase; however, only 25 percent of them have physicians.
To cope with maternal medical emergencies, at least four community health-centers with a capacity for basic emergency services in neonatal obstetrics (PONED) should be provided in each regency.
Unfortunately, there are only 1,558 PONED community health centers that are still functioning while about 1,330 PONED centers have stopped operating due to badly maintained premises and the lack of health workers and medical equipment.
Bambang said that incentive schemes applied by the ministry would hopefully encourage health workers, especially physicians, to agree to working at community health-centers especially in remote areas.
“We subsidize non-specialist doctors working in remote areas to pursue their specialist degrees. They should go back to their working areas once they have graduated as specialist physicians,” he said, adding that training programs called “Doctor Plus” were also provided.


Publisher : The Jakarta Post

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