Midwifery Added to Health Scheme, but More Still Needed

Jakarta Globe, Herman Genie & Dina Manafe, Mar 19, 2015

Women in rural Indonesia depend on midwives, particularly in remote areas
without adequate health care facilities. (Photo courtesy of World Vision Indonesia)

Jakarta. Indonesian mothers who give birth assisted by a midwife will soon be covered by the universal health insurance scheme BPJS Kesehatan, after the state insurer signed an agreement with the Indonesian Midwife Association.

The deal is crucial, BPJS Kesehatan president director Fachmi Idris said on Thursday, to combat the maternal and infant mortality rates, given that many women in rural Indonesia depend on midwives, particularly in remote areas without adequate health care facilities.

Fachmi also said the deal would allow mothers to register their unborn children with the BPJS scheme. Currently, parents can only apply for their children after they are born, meaning any congenital ailments are not covered.

Midwives — trained only to handle the natural childbirth process — will also be able to quickly transfer their patients to clinics and hospitals under the scheme.

Midwives association chairwoman Emi Nurjasmi said there were currently 300,000 midwives in the organization, 47,000 of whom worked individually.

“In terms of quantity it’s enough. However, they’re not well distributed,” she said. The majority of midwives are concentrated in Java, Indonesia’s most populous and developed island.

“Meanwhile, in other islands we don’t have enough. Approximately 20 percent of villages [in Indonesia] do not have access to midwives,” Emi said.

She added midwives working in remote areas were usually contract workers.

“Once their contracts are over, they leave. So [these midwives] should be made permanent staff or public officials,” she said.

Emi said midwives were often neglected by the government and considered outside the regular health system, despite aiding some 87 percent of all pregnancies and 65 percent of all natural childbirths.

“Many clinics refuse to create a network with midwives. They see us as competition. But clinics must realize it’s about providing better services,” she said.

Midwives at China-built hospital bring solace to Somali women

Want China Times, Xinhua 2015-03-16

The Banadir Hospital. (Internet photo)

When China constructed the maternity wing of Somalia's biggest public referral hospital four decades ago, little did they know that this department would stand to be the source of hope for Somali mothers.

The dream of providing quality and affordable maternity services for Somali women did not stop there, as several Somalis flew to China to study various courses in the medical field in order to realize this dream.

Maryam Omar Salad, a midwife at Banadir Hospital, is among a number of medical practitioners who were trained in China and are now applying the knowledge they acquired in China to save lives in their own country.

"My trip to China to study midwifery for three years was transformative. I did not only return with the knowledge and skill but also with a more expanded world view," Salad told Xinhua in an interview at the hospital in Mogadishu.

"I got a good experience from China on best midwifery practices and I am able to apply them here for the betterment of our mothers and children," she added.

Salad, however, paints a rather gloomy picture of the state of the midwifery department which has been overstretched over the years, saying most of the only existing facilities were donated by the Chinese government some years ago and there has been no expansion despite increasing usage.

Ruqiya Jamac, midwifery department officer shares the same opinion. Having worked at the department for the last three decades, Jamac is part of the history of the hospital. She said lack of facilities and space is a matter of urgency in the hospital.

Congestion is another challenge. "Thirty women deliver in this hospital every day. Some cases are normal while others bear some complications," Salad said.

"We also have to deal with cultural issues since some women and their husbands don't allow us to carry out cesarean section. But we tell them the need and the importance especially when the lives of the mother and child are at risk," she added.

The story of the midwifery department transcends the difficult times in Somalia. "Even in the face of the war, we were still able to help mothers deliver their children," said Salad.

Sharifa Haji, a displaced mother whose sister is recuperating after delivery, said Banadir hospital is the only option she and her sister have.

"The services here are totally free and for us as displaced people, this means a lot," said Sharifa.

The midwifery department of Banadir Hospital has 5 doctors and 15 midwives who work on a 24-hour basis.

Caesarians too often used for breech babies: research

DutchNews.nl, Thursday 04 September 2014

(Volkskrant/AFP)

Just 8% of pregnant women with a breech baby are being offered help to turn the child round in some parts of the Netherlands, despite its high success rate in cutting Caesarian births.

On average 75% of pregnant women undergo an attempt to the turn the baby around, and that is successful in up to 50% of cases, researchers Ageeth Rosman and Floortje Vlemmix say in Thursday’s Volkskrant.

Turning a baby reduces the risk of the mother having to undergo a Caesarian section. Better information for mothers and training for midwives could reduce the number of breech babies at birth by 300 a year to 4,500, the researchers say.

‘A Caesarian is an operation,’ Radboud university professor Frank Vandenbussche told the paper.

Bonding

'After a Caesarian, the baby is often less fit and its lungs can be less well developed. In addition, the bonding beween mother and child can be more difficult because the mother cannot move freely,' he said.

Even though turning breech babies is recommended, Rosman and Vlemmix found there is a shortage of specialised midwives in some parts of the country. Some midwives do not offer the process and others fail to convince pregnant women of the benefits.

In addition, Rosman said, some women have decided they want a Caesarian delivery and a breech baby then becomes a good excuse.

Let them drink milk: Ministers rule on breast-feeding workers

The Jakarta Post, Jakarta | Tue, 12/23/2008 7:34 AM

MOTHER'S MILK: Young women take part in a breast-feeding competition at a public health center in Kelapa Gading, North Jakarta, on Monday. The event, sponsored by Mercy Corps Indonesia, was held to raise awareness of the importance of exclusive breast-feeding for infants up to six months old. (JP/J. Adiguna)

The government had a special gift for mothers this Mother’s Day — a joint ministerial decree to make it easier for female workers to breast-feed their babies, albeit indirectly.

The stated aim of the decree, issued Monday, is to encourage breast-feeding of infants until they are six months old, as highly recommended by the World Health Organization for the development of healthy children.

Under the decree, employers are encouraged to give breast-feeding employees time to pump their breast milk during work hours and the facilities to store it for their babies whom they have to leave at home.

The joint decree mandates the State Minister for Women’s Empowerment to disseminate information about breast-feeding among workers and employers and asks the Health Ministry to provide field workers to teach breast-feeding women how to pump their breast milk.

The decree was signed by Manpower and Transmigration Minister Erman Suparno, Health Minister Siti Fadilah Supari and State Minister for Women’s Empowerment Meuthia Hatta during a Women’s Day event at the Jakarta Convention Center, led by President Susilo Bambang Yudhoyono.

Soeharno, a spokesman for the manpower ministry, said the decree referred to Law No. 13/2003 on manpower, which requires employers to recognize the right of female workers to breast-feed their babies.

“The decree avoids placing too much of a burden on employers, but on the other hand promotes breast milk as the best yet cheapest food for babies in times of crisis,” Soeharno said.

A WHO survey found that breast milk is more effective than formula milk in boosting babies’ immune systems.

During the ceremony, President Susilo Bambang Yudhoyono also conferred state awards on several institutions and local governments for their contribution to women’s empowerment.

The Parahita Ekapraya award was presented to those who had shown commitment to gender equality and gender-responsive policies.

For the first time this year, several ministries and state institutions won awards. The Public Works Ministry, the Manpower and Transmigration Ministry and the Attorney General’s Office won the inaugural award for demonstrating strong commitment to improving gender equality through their policies.

Also awarded were several provinces — Central Java, Lampung, East Java, West Kalimantan, West Sumatra, Banten, Jambi and Riau Islands — and regents and municipalities — South Lampung, Temanggung, Brebes, Sragen, Tulung Agung, Magelang, Malang and Bandung.

In his speech, the President urged women to do their bit through their work to help the country tackle the effects of the global financial crisis.

“I call on women nationwide to participate in the joint efforts to deal with the crisis to save our economy. The government will always be in the vanguard in these efforts,” Yudhoyono said.

The President also expressed his appreciation and support for women for their concrete efforts in food diversification, energy saving and tree-planting movements in preparation for global food and environmental crises.

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Low-income pregnant women still frequent midwives

The Jakarta Post, Jakarta | Sat, 12/13/2008 11:05 AM  

Betty, 25, delivered a cute baby girl last week, and she and her husband are so excited about being new parents. 

"The midwife helped me deliver the baby. She was so gentle and nice, helping me to be brave and strong," she told The Jakarta Post on Wednesday. 

Betty said she chose to have a midwife help her deliver the baby because the midwife's clinic was close to her house and she had gone for prenatal checkups there. 

"The clinic is small but nice and the price is affordable. I think the place is even better than maternity hospitals." 

Like Betty, many women in Jakarta still employ midwives, although the city has many obstetricians. The greater expense is the main reason why they are reluctant to visit obstetricians. 

Betty, whose husband works as a private employee for a small salary, said she only paid Rp 60,000 (US$5) for every checkup. 

"Obstetrician fees are usually more than Rp 150,000," she said. 

The financial consideration was also the reason she opted to give birth at the midwife's clinic rather than at a hospital. 

"The hospital fee is almost Rp 5 million. It is expensive. In the clinic, I just paid Rp 1.4 million," Betty said, adding that the price included medicine, services and a bed. 

Winda, 27, another new mother, said she would prefer to deliver her baby with a midwife's help rather than going to an obstetrician. 

"But unfortunately I am a high-risk mother because I have a heart problem, so I had to visit an obstetrician like my midwife suggested," Winda said. 

Although women with low incomes still trust midwives, the profession is losing ground because women from middle and high-income levels prefer the care of obstetricians. 

"Usually pregnant women from low-income families decide to have prenatal checkups with midwives," Sumiharti Soetrisno, a midwife from Pasar Rebo, East Jakarta, told the Post in a recent interview. 

She said she worked at a private hospital in Jakarta where only 20 babies were delivered by midwives this year. 

"The rest of the births were assisted by obstetricians," Sumiharti said. 

Sumiharti runs a small health clinic at her house. She often receives patients from her neighborhood. Usually patients pay Rp 20,000 rupiah for their prenatal checkups. 

Sumiharti also helps women give birth at her small clinic, which contains two single beds. She charges only Rp 500,000 for services and medicine. 

"The number of patients coming to me has slightly decreased lately," she said. 

Widya, a midwife from Pasar Minggu, South Jakarta, has had a similar experiences. She said that most of her patients had changed their minds about visiting midwives. 

"Probably the obstetrician has modern equipment like ultrasonography, the thing that we don't have" she said. 

Harni Koesno, National Midwife Association chairwoman, said there was actually no competition between midwives and obstetricians. 

"We have our different tasks to do," she explained. 

She pointed out that obstetricians helped with high-risk childbirths, which midwives could not manage. 

According to the association, Indonesia has 104,000 midwives. 

Besides providing prenatal checkups, midwives often help mothers manage medical complaints like diarrhea, colds and throat infections. 

For many women they are also the easiest place to access information about HIV/AIDS. 

"I even take my children to my midwife when they have colds, because they give me medicine for free and my children get better," said Riri, the mother of three. 

Both Widya and Sumiharti get patients suffering from a variety of minor illnesses. 

"Actually it is forbidden for us to treat other medical conditions, but we try to help them with simple over-the-counter medicines," Sumiharti said.(naf)