High maternal death rate receives poor attention

High maternal death rate receives poor attention

By Rita A. Widiadana

JAKARTA (JP): As her ignorant and irresponsible husband looks
on, young villager Siti Zubaedah dies a painful death from
hemorrhaging during childbirth.

It is a scene from a TV drama, Perkawinan Siti Zubaedah (The
Marriage of Siti Zubaedah), but it remains the terrible reality
for millions of Indonesian women.

They endure severe complications during pregnancy and
childbirth due to undesirable physical, mental and social
factors. Many lose their struggle.

Many maternal deaths in the country, especially in poor and
remote areas, are unreported and unrecorded, said Kumara Rai,
director general of community health of the Ministry of Health,
in a recent meeting here.

"It is like a jumbo jet full of women crashing every week, but
nobody hears of it, no one makes a fuss," said Kumara.

Perkawinan Siti Zubaedah, screened last year, directed by
Teguh Karya and jointly produced by the National Family Planning
Board, the private TV station TPI and John Hopkins University, is
a cinematic means of educating the public about the problem.

Every year, more than 20,000 women in Indonesia die during
pregnancy and childbirth. The average national maternal mortality
rate (MMR) is 400 per 100,000 live births, by far the highest
among Association of Southeast Asian Nations (ASEAN). By
comparison, Singapore has 10 per 100,000 live births, Malaysia 40
and even Vietnam, one of the region's poorest nations, has 110.

The figure for Indonesia, estimated by the World Health
Organization (WHO) and the Ministry of Health, is even higher in
the eastern provinces. In Irian Jaya, the rate is estimated to be
between 575 to 874 per 100,000 live births.

Most of them die of hemorrhaging or other complications, and
unsafe and unhygienic childbirth delivery due to lack of access
to professional medical assistance.

About 99 percent of all maternal deaths in the world occur in
developing countries, and 40 percent are accounted for by
Southeast Asia, including Indonesia.

WHO identified lack of basic medical facilities, nutritional
deficiencies and social conditions as contributing factors.

Suffers

More than 50 percent of women in developing countries suffer
from iron, vitamin and protein deficiencies which lead to serious
anemia. These predisposing conditions will also increase the
risks of other complications like eclampsia, high blood pressure
and goiter, further endangering the development of the fetus and
the newborn.

In Indonesia, 51.3 percent of pregnant women and lactating
mothers suffer from acute anemia due to poor nutrition.

Proper nutrition is not merely dependent on the availability
of food but also good sanitation and, more importantly, a caring
environment. This is often grossly deficient, especially in the
case of young women.

More than 65 percent of Indonesian women live in villages
where basic medical facilities are still a luxury and social
discrimination against women persists.

In Indonesian and other Asian countries, female children and
young women, particularly those living in rural areas, are
commonly discriminated against in all matters, including the best
portions at meals. When these girls grow up, they are often
physically weak and unhealthy adults.

The nutritional deficiencies are often combined with a
disproportionate share of the workload. In the region's villages,
it is women who must wake up before dawn and walk several
kilometers to fetch water for their families. Young girls must
stay at home while their brothers go to school because their
parents are too poor to educate everyone. Most girls are married
off young when their reproductive organs are not yet developed
fully.

This is of little concern for their parents, who are keen to
see them marry young because that relieves them of the
responsibilities of looking after them.

For the girls, an early pregnancy means not just the end of
their childhood, but it also exposes them to serious risks.
According to a United Nations survey, girls aged 15 to 19 were
twice as likely to die of prenatal and postnatal problems
compared to women aged over 20.

Despite the alarming number of maternal deaths, many people
still regard these tragic fatalities as natural and ordinary
occurrences for a woman during motherhood.

Not everybody agrees: Robert J. Kim Farley, WHO's
representative for Indonesia, is among them.

"Pregnancies and childbirth are not only women's problems and
responsibilities. They are ours. All members of the society have
a daunting task to help ease these women's burden."

Problems relating to pregnancies have garnered global
attention, he added.

WHO dedicated this years's World Health Day, which fell on
April 7, to medical care for mothers with a target to cut the
maternal fatality rate by half in 2000. The current world average
MMR is 430 per 100,000 live births.

Priority

The Indonesian government has made a positive response by
running several health programs to provide basic medical
facilities and a desirable social environment for women.

Minister of Health Farid Anfasa Moeloek has committed as his
first priority the attainment of the WHO target in 2000.

"It is high time for us to pay very serious attention to the
improvement of health conditions of Indonesian women in general,
and children and women of reproductive years in particular," he
said.

The government, supported by international agencies like WHO,
the United Nation Children's Fund (Unicef), World Bank, Asian
Development Bank (ADB) and various non-governmental
organizations, has been running intensive programs called Gerakan
Sayang Ibu (Mother Friendly Movement) and Safe Motherhood since
the early 1990s in addition to its National Family Planning.

The programs have been implemented in the country's 27
provinces although their effectiveness has yet to be studied due
to the current social, economic and political crisis.

Stephen J. Woodhouse, Unicef's area representative for
Indonesia and Malaysia, previously said that Unicef and other
international donor agencies would be willing to support safe-
motherhood programs in the country.

"Providing basic medical facilities will not only save these
mothers's lives but also those of at least 1.5 million babies
every year," Woodhouse noted.

Unicef, he said, had made reductions in maternal mortality its
highest priority. Health is part of women's empowerment, along
with education, employment and social reform.

"Women's health is more than just reproductive health. It
involves a wide range of issues covering the entire life span of
women's lives," Woodhouse said.