Mother's Day: It's time to focus on maternal deaths

Mother's Day: It's time to focus on maternal deaths

By Mehru Jaffer

JAKARTA (JP): After the colorful plastic and cardboard homage
is paid to mother and the party is declared over, what does not
go away is the fact that every minute a woman dies somewhere
around the globe during childbirth.

In Indonesia approximately two women die every hour giving
birth, which is comparable to one jumbo jet carrying 400 women
crashing each week, leaving at least 1,600 children motherless
every eight days.

Mother's Day is an opportunity to ponder why maternal
mortality rates remain so high even in these high-tech, ultra
modern times. "What is saddest about maternal mortality is that
it can be prevented," says Julie Marsaban, 46, coordinator of
Pita Putih, or The White Ribbon campaign for safe motherhood.

Julie, who worked with the Program for Appropriate Technology
in Health for over a decade, is a vigorous campaigner for safe
motherhood, joining with a group of organizations worldwide that
have combined forces to raise international awareness about the
need to make pregnancy and childbirth safe for women and infants.
The conclusion is that death due to negligence during childbirth
is a form of violence against women.

"Safe motherhood is an issue of fundamental human rights:
children's rights, families' rights, and women's rights,"
declares James D. Wolfensohn, World Bank president. And Hillary
Clinton last World Health Day called for a reduction in maternal
mortality rates through sustained, long-term commitments from
communities, governments, volunteer agencies and local leaders to
develop health care strategies that promote safe motherhood.

The global Safe Motherhood Initiative was introduced at an
international conference held in Nairobi in 1987, with the aim of
drawing attention to the consequences of poor maternal health in
developing countries and mobilizing action to address the high
rate of maternal deaths. The White Ribbon Alliance is a
grassroots effort that builds upon the work of the Safe
Motherhood Initiative.

It was last October that the idea of starting the movement was
first floated in Indonesia and Pita Putih was launched formally
the same year on Dec. 22, national Women's Day. Julie was named
country coordinator because she was already familiar with
maternal and neonatal health programs. Also because she feels so
strongly about the issue, having been saved from death two times
in her life.

"I am lucky to have survived and to be enjoying my children
only because I received immediate medical help," says Julie, a
mother of two who suffered an obstructed pregnancy with her first
child and required an emergency caesarean section in her second
pregnancy.

It has become her passion to try and save as many lives as
possible, especially after she was forced to watch a woman die.

"After giving birth to her sixth child at home the woman did
not stop bleeding, and by the time the doctor came it was too
late," recalls Julie, who feels that the poor, ignorant woman
died because no one, including herself, was aware of the risks
involved in pregnancy and childbirth.

Few are able to recognize the danger signs that lead to
obstetric hemorrhaging, even today.

In many developing countries complications related to
pregnancy and childbirth are the leading causes of death among
women of reproductive age. As many as 300 million women, more
than one quarter of all adult women living in the developing
world, currently suffer from short or long-term illnesses and
injuries related to pregnancy and childbirth.

Maternal mortality has always been a serious problem in
Indonesia, although the rate is on the decline, according to
Julie. However it still has the highest maternal mortality rate
in Southeast Asia.

The 1994 Indonesian Demographic Health Survey estimated 390
maternal deaths per 100,000 live births between 1989 and 1994.

The majority of maternal deaths in Indonesia are caused by
bleeding during and after childbirth or early in the pregnancy.
What makes this fatal is the reluctance to treat each pregnancy
as a risk. Then there is often a delay in identifying and
diagnosing life-threatening illnesses during pregnancy and
childbirth and in seeking immediate help. There are only about
70,000 trained midwives in the country, far short of the required
200,000 if every village is to have one midwife as promised.

Needless to say that a mother's death greatly influences the
health and livelihood of her surviving children. When a mother
dies her surviving children are three to 10 times more likely to
die within two years than those with two living parents. And the
children who do survive often do not receive adequate health care
or education as they grow up.

The death of a mother, in fact, has an impact far beyond that
of her immediate family, leaving an entire community destabilized
as an important emotional anchor to the next generation
disappears forever.

What makes the task of volunteers difficult is the low self-
esteem of women themselves, who are often reluctant to make use
of facilities even when they are provided.

Many women have perished waiting for their husbands to return
home from work to receive his permission before seeking medical
help.

"Besides, transportation and communication is a big problem in
this island country of ours," sighs Julie, who continues to work
tirelessly to see that individual women, families and communities
are empowered at the grassroots level. Her hope is that
eventually all women will be able to take care of themselves and
realize the ultimate dream of Ibu selamat, bayi sehat dan
keluarga bahagia (if mother is safe, the baby is healthy and the
family is a happy one).