Maternal mortality rate decreases by 17 percent

Maternal mortality rate decreases by 17 percent

Dewi Santoso, Jakarta

A program known as Maternal and Neonatal Health (MNH) has
significantly curbed the maternal mortality rate in Indonesia by
17 percent to 307 per 100,000 births this year, and has also
reduced the incidence of postpartum hemorrhage to 1.7 percent
against an expected 18 percent, an official says.

Data from the Ministry of Health shows that the maternal
mortality rate in 2003 was 373 per 100,000 births. It also shows
that each year, 46 percent of 18,000 women who die during
pregnancy and childbirth do so due to postpartum hemorrhage.

Director General of Public Health in the Ministry of Health
Azrul Azwar said on Friday that the reason behind the decline was
due to the increasing number of trained midwives.

"The program has trained many midwives in skills that they
need to provide safe delivery and has resulted in a declining
maternal mortality rate," said Azrul.

Carried out by the Ministry of Health and Johns Hopkins
Program for International Education in Reproductive Health
(JHPIEGO), the MNH program commenced in November 1999 and was
expected to last for five years.

The MNH program, which was funded by the United States Agency
for International Development (USAID), was first implemented in
West Java province, especially Cirebon and Kuningan regencies and
Cirebon city, as the locations were considered sufficiently large
in population terms, yet lagged behind other province in Java.

With total funding covering US$21 million-worth of technical
assistance, the MNH program implements three approaches:
performance and quality improvement, behavior change
intervention, and advocacy and policy.

For performance and quality improvement, clinical knowledge
and skills of midwives, obstetrics residents and specialists have
been upgraded and standardized at hospitals and clinics in the
three areas.

As a result, the percentage of providers practicing specified
skills during delivery increased to 85 percent in 2003 from 35
percent in 2001. The program started with the training of fewer
than 100 people.

Data from the Ministry of Health shows that 61,000 midwives
were spread throughout the country in 2003.

Through the Desa Siaga campaign, behavior change intervention
raised residents' awareness on birth preparedness and
complication readiness actions within the communities where they
lived.

These interventions contributed to an increase in the number
of births attended by skilled providers to 66.2 percent in 2003,
from 43.2 percent in 1997. The program, however, failed to
provide figures on the number of skilled providers in remote
areas.

The last approach used advocacy and policy to raise the
awareness of other areas of the importance of the MNH program. As
a result, East Java, North and South Sumatra, South Kalimantan
and West Nusa Tenggara have replicated the program.

JHPIEGO chief executive officer Leslie D. Mancuso said that
the centerpiece of the program was the enhancement of skills
provided at birth in order to save the lives of women and newborn
babies.

MNH director Judith Robb-McCord agreed with Leslie, saying
"the positive thing is that this (message) is getting to the
people".

JHPIEGO country director Abdulah Cholil said that, hopefully,
with the program's positive outcome it could help to achieve the
government's target of a mortality rate of 125 per 100,000 births
in 2010.