‘Miss, miss! Mari ke sini membantu kelahiran.’
My Ibu has found me gorging on papaya in the kitchen and asks me to join her in the birth clinic. I follow her to the clinic, located in the front of our home. I love this space. The small room has a birthing bed, an examination table, a desk, and cabinets with various healthcare essentials. Women (and some men) seek out this clinic as their first stop for healthcare needs. I have lived with a my village’s midwife since March of this year. I moved from my first home stay to my current house and chose to live with Ibu bidan (the midwife) because of my ever-increasing interest in maternal and child health.
Ibu bidan received her Indonesian government assignment to work in our village as the resident midwife, part of a larger program that places midwives in Indonesia’s villages. The program has showed success in most areas of Indonesia, providing access certified midwives to people in areas that may not have said access to proper healthcare otherwise.
Women and children come to our house to receive care and drugs form the midwife every day, around the clock. About a dozen women per month give birth in the small clinic. Birth here is handled quite differently than in the U.S. Everything is natural and there are no restrictions on who can accompany mom at her bedside. Often, husbands drive their laboring wives here on motorcycles. The mothers are often well dilated and an hour (or minutes) away from giving birth. Family members and neighbors crowd the space in the clinic. The front door to the clinic is often left open immediately after the birth so that people may visit the mother and coo over the new person. During the birthing process, the midwife helps the mother into proper birthing positions, monitors mom’s condition, administers no drugs, and initiates breastfeeding as soon as the little one is out and gulping in the air. I feel lucky to experience births here as the procedure is a far cry from the white-washed, epidural-filled birthing environment of America’s hospitals.
The government program placing midwives throughout Indonesia’s 60,000+ villages is already over two decades old. Becoming a Bidan Desa (village midwife) requires 3 years of study and about a year of practice before the midwife can be certified to practice. Using a certified midwife is much safer than village women’s alternatives – home births or birth by dukun (a spiritual healer who is not medically certified). Despite the relative success of the bidan desa program, Indonesia still faces a number of threats to maternal and child health. The most recent global reports show that while infant mortality rates are down, maternal mortality rates are still unsafe.
In my regency, with a population of 1.75 million people, eight women have died so far this calendar year giving birth.
The most common cause of maternal mortality is blood loss, something that many women in Indonesia are at risk of due to anemia caused by poor nutrition.
Indonesia has some fantastic resources available for expecting mothers, including a free book published by the Ministry of Health called the ‘Women and Child Health Book’. These books contain simple, picture-based explanations about what mothers-to-be should do and expect from their pregnancy and subsequent motherhood. Even though the book is great maternal health teaching tool, my Ibu claims that many of her patients in our area rarely open the book and read the information. This apathy to reading the health information I think should be noted as midwives and healthcare providers search for new ways to educate parents about pregnancy and child care.
Apart from the village midwife, my neighbors can also visit the Puskesmas, or the community health center. These centers are government funded and located all around the country. Originally a USAID initiative responding to Indonesia’s health needs, the Puskesmas is the first stop for healthcare when home remedies or the village midwife isn’t sufficient. For all government-funded healthcare, poor citizens can register for health care coverage giving them free basic and drugs for very cheap. How cheap? One month’s supply of birth control is 6,000 Indonesian Rupiah, or about 50 cents.
Registration for health coverage is difficult due to the amount of paperwork, but many endure it in order to access the free family planning and basic drugs. In addition to the health centers, there are also private hospitals, which tend to offer the best, most up-to-date care. Hospitals, however, tend to be more much more costly and are completely out of the financial range of many people in my village, who are mostly farmers. Because hospitals can by costly, anytime someone enters the hospital in my community a money collection is circulated at their place of work and around their home. One of my students recently went to the hospital because she was hit by a motorcycle while crossing the street. My school’s student council diligently visited each classroom to collect money for her cause. I have come to really admire the community effort to support one another’s hardships here as a beautiful feature of the culture. Just as my Ibu midwife leaves her door open to my villages maternal population, the Javanese spirit of giving radiates everywhere to make sure no one is left wanting.