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).