Putting lives in the hands of 'Paraji'

BANDUNG (JP): While doctors believe that unlicensed midwives contribute largely to the high mortality rate among newborns, most women in West Java prefer to use the services of the traditional midwives when giving birth.

The barrage of information on health which can be easily obtained from various media and improved health facilities have yet to diminish this practice.

Dedeh, as an example, was completely unaware that using the services of an unlicensed midwife, known locally in Sundanese as paraji, in childbirth can prove fatal.

The 42-year-old housewife says she never had any problem with using the services of a well-known unlicensed midwife in her hometown Cipanas, Garut, located some 95 kilometers south of Bandung, the capital of West Java province.

She said she never thought twice about asking her husband to fetch the midwife each time she was ready to give birth.

"Thank God, I've given birth to 12 children (using the help of a midwife). All of them were delivered safely and have always been healthy. Look, I am fine, too and have never had a serious illness," Dedeh said.

Dedeh recommended the midwife to her daughter and daughter-in- law to deliver their babies.

There are several reasons why women use the services of a midwife.

One of them is practicality, since those who wish to get help from a midwife do not have to deal with any formalities. Midwives can also be asked for help at any time.

Women also prefer midwives than doctors because their services cost less.

"You only have to pay as much as you can afford. When I couldn't afford to pay cash, I paid the midwife with rice or some fabric," 19-year-old Elis, a resident of Dago in south Bandung, said.

Elis added that she could not afford the services of a doctor, since her husband had lost his job a few months ago.

The practice of hiring a midwife is also common in the province's capital.

This is in contrast to the fact that people living in Bandung have easy access to modern medical facilities, which abound all over the city.

"My mom said that delivering babies with the help of a midwife was not as painful (as when a doctor attends the birth). Besides, I hate needles," Elis said, speaking for young women who prefer to use traditional midwives.

The head of health resources of the West Java Health Office, Dr. Ilsa Nelwan, said that there was also a psychological factor between the midwives and the women who used their services.

"A midwife acts as a mother to a women during childbirth. Midwives can be asked to bathe the baby. This is something that a trained nurse cannot be asked to do," Ilsa said.

Data from the health office shows that there are more botched deliveries than successful ones attended by unlicensed midwives. However, there is no exact figure on this.

Ilsa said there were 56 deaths to every 1,000 safe deliveries. This is equal to one dead in 17 newborns.

"Even Colombo (Sri Lanka), a poor country, has a low newborn mortality rate because most women there deliver their children at the hospital," Ilsa said.

"Sixty percent of pregnant women in West Java use the services of midwives," Ilsa said, adding that there were about 12,000 midwives practicing in the province.

Twenty-nine-year-old Yuni, a resident of Bunisari, south Bandung, said that she would not use the help of a midwife again after the traumatic experience of losing a baby after consulting a well-known midwife during pregnancy.

"I was seven months pregnant when I got this pain in my stomach. It was midnight and my husband went to get the midwife. She said that my baby was wrongly positioned so she decided to manipulate it into the right position," Yuni said.

"Three days later, there was no movement at all from my baby. I went to the hospital. It turned out that my baby had been dead for three days after being strangled by the umbilical cord," Yuni sadly added.

Ilsa said that direct observation would prove that midwives did nothing to help the childbearing process besides wait for the babies to be born and then cut the umbilical cord.

Ilsa, who is also a lecturer at Padjadjaran University in Bandung, said that many cases of tetanus were reported in new mothers in 1993 because of midwives' unhygienic practices.

"(The midwives) claim they sterilize their tools, such as scissors and knives, by boiling them. But they have also admitted that they later rinse the tools with cold water because they are afraid they would be too hot for the pregnant women," Ilsa said.

"We also found some midwives wiped their tools on the clothes they were wearing," Ilsa said, adding that his office had given midwives courses on how to help women through childbirth in a hygienic way.

But the courses had failed to change their less hygienic methods, Ilsa said.

Ilsa acknowledged that the flexibility in midwives' charges had made hospitals, doctors, trained nurses and local health centers less popular.

Ilsa said that childbirth cost at least Rp 50,000 at a modern facility.

The head of a local health center in Cikajang, Garut, Dr. Asep Maryaman, said that the charge for childbirth in the health center was Rp 15,000.

If a woman had to stay overnight at the health center, she would have to pay an extra Rp 6,000 per night, Asep added.

"We have to collect the fee because we have to maintain the tools and pay the medical staff. Patients also have to pay cash, while with a midwife they can negotiate, or even pay the midwife later when they have the money," Asep, who has been practicing medicine in Garut for 10 years, said.

Ilsa said that the health sector contributed some 70 percent to the province's revenue, but the money was not returned to the sector.

Only 3 percent of the province's health budget comes from the provincial government while the rest comes from the central government, Ilsa said.

"The province only subsidizes US$1.70 per person. This is much less than the average US$2.50 in other provinces in the country," Ilsa said.

"I'm worried about the upcoming implementation of regional autonomy, since it is not clear yet whether the budget for the health sector will be allocated by the provincial or the central government," Ilsa added.

However, Ilsa said that there had been efforts to eliminate the services of unlicensed midwives by improving health facilities and disseminating information on the subject.

The effort has had a slight impact, with the number of women using the services of midwives decreasing from 70 percent to 60 percent last year.

Improving health facilities have forced midwives to prepare for the possibility that they may someday be left without a job.

Eroh, 53, who has been a midwife for more than 20 years in Dago, said that she had opened another business, and now gives body treatments, using traditional herbs called luluran, to students.

She says her new business gives her more money than midwifing because she charges Rp 15,000 for luluran.

So these days, the mother of five can be seen carrying a big tray holding knives, scissors, cotton wool, small towels, bandages and alcohol one day.

And the next day she can be spotted carrying a small plastic bag containing traditional herbs offering her new services door- to-door. (Yuli)