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.