Sat, 05 Jul 2003

Kedungsana people join hands to save mothers

Sari P. Setiogi, The Jakarta Post, Cirebon, West Java

One mother dies out of every 299 live births in Cirebon, the second highest maternal mortality in West Java province, after Bogor.

Considering that some 20 years ago, the mortality rate was one for every 235 births, Cirebon is hardly making any progress to save the lives of mothers.

By now, the rate should have dropped by 50 percent," said Inang Wahyudi of the Cirebon branch of the Maternal and Neonatal Health office (MNH), a non government organization that aims to reduce deaths during childbirth.

Inang said that since the 1980s, the maternal mortality rate should have dropped from 425 to 212 deaths for every 100,000 births. Now it was still 334 deaths for every 100,000 births.

However in Kedungsana, a small village in Cirebon, progress is underway.

Kedungsana is one of several villages in the area that have embraced the Suami Siaga and Warga Siaga programs, Inang said.

Supported by the government and the United States Agency for International Development (USAID), SIAGA encourages communities to participate in helping mothers deliver babies safely.

SIAGA stands for Siap Antar Jaga, meaning "ready to deliver and take care of (mother)".

While Warga SIAGA encourages communities to develop a support system designed around helping pregnant women. The system may cover transportation to hospitals, savings and blood donors.

SIAGA is the result of MNH's efforts to raise awareness about birth preparedness and possible complications through village institutions.

The program began in 1998 in Indonesia and is available mainly in West Java and Banten but also in South Sulawesi, South Sumatra, Lampung, South Kalimantan and West Nusa Tenggara.

In Indonesia, MNH focuses on the important role of midwives.

At Kedungsana, the SIAGA program was first introduced in Dec. 2002, said village chief M. Surjaya.

The village has one midwife and two traditional witch doctors who often help in child births.

Kedungsana lies about 30 minutes by car from the heart of Cirebon. Just over 3,000 people live here, and two-thirds of its population have only an elementary school education or less.

Surjaya said he was surprised to see how positive response was.

"Today we always have one or two cars ready to rush pregnant women to the hospital in case of a complications," he said. "The cars belong to our residents and they lend them to us at night."

A list of 75 blood donors hangs on the wall of his office, said Surjaya: "if a hemorrhage happens, we'll ask the donors to donate their blood."

He said that most donors on the list were already regular donors at the Indonesian Red Cross (PMI).

Hemorrhage, obstructed labor, eclampsia (pregnancy induced hypertension), and unsafe abortions account for nearly two-thirds of maternal deaths, according to the United Nations Population Fund (UNFPA).

It said that some 15 percent of all pregnancies led to complications which, if left untreated, could be fatal.

In Kedungsana, regular check-ups by the midwives have helped reduced cases of complications. Saeroh, a volunteer who helps contact midwives, said that complications occurred most often with women over 35-years-old, or those who had more than four children.

"We will refer them to either the Gunung Jati Hospital or the Arjawinangun Hospital, or the Puskesmas (community health center) Plumbon, which is open 24 hours," she said.

Part of the SIAGA program is to encourage parents to open a savings account in case the mother needs hospital treatment.

"A family who is expecting a new member usually opens a savings account with us. They pay about Rp 1,000 per day, depending on how much they can afford," she said.

"If the pregnant mother needs hospital treatment, we'll make use of the savings. If not, we'll return the money."

As Kedungsana has only one midwife, Saeroh said that others from nearby villages could be reached in case of an emergency.

Thanks to the SIAGA program, maternal mortality rates are coming down in villages like Kedungsana. However elsewhere in Indonesia, the rates remain high.

According to MNH data, the nation's average maternal mortality rate is 390 for every 100,000 births. The rate ranks among the poorest in Asia.