Maternal mortality
"It's like a jumbo jet full of women crashing down every week, but nobody hears of it, no one makes a fuss."
This comment was made by Dr. Kumara Rai, the director general of community health, at a luncheon with the theme Businesses who care. The event was sponsored by the Menteng Rotary Club and the World Health Organization (WHO) in commemoration of WHO's 50th anniversary and mother's day.
Dr. Kumara Rai was referring to the maternal mortality rate (MMR), i.e. deaths caused by pregnancy and childbirth complications. In Indonesia, the national MMR is 400 per 100,000 live births -- that is 20,000 mothers dying every year with many more children becoming motherless.
This is appalling, you may think.
Even though Indonesia's rate is not the worst (Papua New Guinea's rate is 700 per 100,000 live births), it is disturbing if compared to neighboring countries: Vietnam's MMR is 60 per 100,000 live births, Malaysia's is 80, while Singapore's is 10.
Why isn't anybody doing something about it? Well, they are. There are currently various provincial and national health projects and programs led by the Ministry of Health that are aimed at reducing the MMR.
You may ask "Why are so many women still dying? Who's to blame?" Reducing the MMR is not an easy task. As with most things, it is a very complicated issue.
If I were a poor, uneducated woman, a farmer's wife, and living in a remote village, I would have been "aboard" one of those jumbo jets -- ironically, twice! But because I had access to health care facilities, both of my babies were born healthy, though the deliveries were potentially life-threatening.
Many other women and their children are not so lucky.
I recently witnessed a young mother dying in a provincial hospital due to hemorrhaging from giving birth at home to her sixth child two days previously. Hemorrhaging is the most common cause of maternal death in Indonesia. Although she had lived in a village only 10 minutes away from the hospital, her family finally brought her in only when it was too late.
Access to adequate health facilities and prenatal care is only one of the determinant factors of MMR. The other three factors are education of the mothers and the family in recognizing a life-threatening situation, access to family planning and obstetricians and new-born care. These factors are called the "four pillars" of safe motherhood.
There are also factors that increase the risk of pregnancy related complications such as: pregnancy before the age of 20 and after 30, poor nutrition (anemia), having many children, short intervals between pregnancies and a history of complications.
Unfortunately the dying woman I witnessed was not identified previously as having a high-risk pregnancy.
Any intervention programs aimed at reducing the MMR need to be comprehensive and must comprise these "four pillars". However, safe motherhood programs by themselves are not sufficient to reduce MMR. To do that, they must include interventions to improve the health and welfare of future mothers and fathers starting early in life.
Thus we need the adoption of a concept of reproductive health which encompasses the whole life-cycle, from womb to tomb. Since the determining factors involve many sectors of society, improvement of the reproductive health status of our country requires a concerted effort. Currently, a five-year reproductive health project is being prepared with a possible loan from the Asian Development Bank. It is planned to be implemented in West Java, North and Southeast Sulawesi.
However, each and everyone of us should do something and not be content to let formal programs do all the work. Factory managers can look into improving the reproductive health of their workers, employers can inform and educate their household staff and parents can inform their children to better avoid unplanned pregnancies and to delay marriage.
We can help change traditional Indonesian perceptions that pregnancy is biasa (an ordinary occurrence) to a perception that pregnancy is special. Let's make it safe.
JULIE MARSABAN
Jakarta