The Midwife Association of Indonesia had its 64th Anniversary in Jakarta this month. Because UNFPA supports the association of over 40,000 midwives in the country, I went along with the reproductive health team staff to show support for the midwives and the work their association does.
The celebration was set up outside of the midwife Association’s office in Central Jakarta. A large tent covered the road with midwives and other local health officials attending in matching batik uniforms. On the day of their anniversary, the association’s office, based in a community health clinic, decided to open its doors wide open to provide free contraceptive and cervical cancer screening services.
Providing compulsory screenings for free when women go to a health clinic for family planning services is one way to ensure that they are getting checked for cervical cancer. Particularly in low- and middle-income countries, bundling maternal health services and providing multiple services in one visit is on strategy to ensure that women get the care they need.
On the day of their anniversary celebration in Jakarta, the midwife association had planned for around 200 women to come in for contraceptives and cervical cancer screenings. By 10am, almost 800 women had already registered to receive the services. When we arrived, the midwives were boisterous in the spirit of their celebration, regardless of the lines out their doors of women waiting their turn to be seen by a midwife. One of the head midwives of the association showed us into the clinic where injectable contraceptives and cancer screenings were being conducted. The room was filled with women waiting, small children, and even a husband or two.
“We had so many people sign-up. Much more than the 200 we planned for. We don’t have enough supplies today so we had to turn many away,” this midwife explained about the large crowd.
Regardless of the supply shortage, the leadership of the association seemed pleased with the huge turnout. Servicing hundreds of women in one neighborhood in Jakarta for a day, however, is a mere dent in the total maternal population of Indonesia’s capital city. A major challenge in Indonesia’s health system for women and family planning is supply shortage, rooted in fractured supply-chain management. Often, large orders of contraceptives will be made once or twice a year in a given region. If the supplies are not enough, there is not yet a means to quickly order and receive more.
Outside of the health clinic, a community health van was parked in the middle of the street. The head of the midwife association eagerly invited us to take a look inside. “We have inserted four IUDs (intrauterine devices) and one implant already today,” one of the head midwives said when I asked how many people their mobile health clinic had serviced so far that day. The patient in the van was receiving an implant. Implants are one of the more effective contraceptives. Their effectiveness lasts for years and are good for women who know they do not want to become pregnant anytime soon. For women who know they are done having children, IUDs or sterilization are the best options. IUDs are long-lasting, reversible, and effective. Sterilization is permanent. IUDs have not yet taken off in Indonesia as the most popular form of birth control, as they have in many other countries.
Organizations like UNFPA are trying to increase the uptake of IUDs for a number of reasons. Unlike other forms of contraceptives that require frequent or multiple visits to a health professional, IUDs are inserted once and last for a period of up to 10 years. Different cultures have various opinions about certain contraceptives, however, making the most logical choice not always the most common choice. Just look at the U.S. The U.S. has an unplanned pregnancy rate of 51 percent. That means that over half of pregnancies in the U.S. are not planned. The Pill is the most common form of birth control currently in the U.S., but it’s also one of the lease effective contraceptives. It is not long-lasting and requires continuous effort from the user in order to work effectively.
Luckily in Indonesia, more women use longer lasting methods of contraception. And their longer lasting contraceptive choices means more success in planning pregnancies and births. Indonesia, along with the rest of the globe, outshine the U.S. with lower rates of unintended pregnancy. Longer-lasting contraceptive methods means more effective family planning, more control over choosing when to become pregnant, and better health for women and their families. The midwife association in Indonesia contributes greatly to helping women control their fertility – 74 years-worth of their work is certainly a reason to celebrate!