Nafsiah Mboi: (JP/Elly Burhaini Faizal)

Despite regional autonomy that aims for better public services, women are still facing great risks of pregnancy-associated deaths due to poor access to healthcare services. The Jakarta Post'€™s Elly Burhaini Faizal recently talked with Health Minister Nafsiah Mboi about the government'€™s efforts to reduce infant and maternal mortality, the latter reached 359 deaths per 100,000 live births last year. Below are the excerpts.

Under regional autonomy 20 out of 34 provinces in Indonesia recorded the highest number of maternal deaths, despite the local governments being supported by huge funding. What is the cause of the persistent high maternal mortality rate?

In the decentralization era, statistics relating to child and maternal deaths posted in reports are often inaccurate. If each childbirth or death during childbirth is reported by all levels of government and stakeholders, starting from provincial administrations to community health centers at the village level, we would have much more reliable data on maternal mortality rates. However, the fact is, no reliable data on child and maternal mortality rates exists.

Therefore, we will strive to support maternal health programs wherever they are needed, without distinguishing whether the responsibility belongs to the central or local government. This is because we do not want women dying in labor anymore. The problem is that many local administrations are not aware that the quality of pregnancy and childbirth, as well as the welfare of a newborn, depends on the health of the mother.

Can we say that the lack of commitment to health among local administrations perpetuates the high maternal mortality rate in the 20 provinces?

Officials in several provinces said that it was '€œOK'€ to have high birth rates, because since the areas were still relatively large people should have the opportunity to have large families, which could settle into the areas. It is not a wise idea, however, because a woman who is pregnant in an unhealthy condition or with pre-existing medical problems could further affect maternal mortality levels in the community. We know that most maternal deaths are due to hemorrhage, which are often a case of '€œtoo many, too young'€ [women who are too young giving birth too often '€” Ed.].

It is still widely assumed by sections of our society that if a female can get pregnant as soon as possible, she will have a better chance of a good life. It is totally baseless. Indeed, a woman'€™s reproductive tract is fully developed at around 19 to 20 years of age. Although a female aged under 20 already begins her menstrual cycle, her reproductive organs are not mature enough for pregnancy. However, early marriage and early pregnancy rates in Indonesia are still quite high,.

Poor access to health care facilities and skilled health workers are factors blamed for unsafe deliveries across Indonesia. How do you cope with the issue?

These are the two main issues we really care about. There are growing concerns among local governments about the way women and children die every day and they are trying to solve the problems. It seems, however, that some local administrations at the regency and municipal levels do not care at all about the importance of infant and maternal health. No medical care with special emphasis on maternal health is available at the rural primary care level [in many areas].

This is why during the last several years, improving primary care clinics has become our main target due to our commitment to reducing the maternal mortality rate. Childbirths should take place in a healthcare facility often as possible, assisted by a skilled birth attendant.

There are no longer any excuses for pregnant women to give birth to their babies at home without the help of midwives or other skilled healthcare workers, because with the government-funded childbirth coverage program Jaminan Persalinan (Jampersal), the Health Ministry provides full coverage for residents seeking medical help with childbirth in third-class facilities at state and private hospitals as well as a community health centers.

Do you see any local administration that has moved from the focus of achieving health-related targets, in particular in reducing maternal risks?

I think healthcare services are of prime concern to almost all local administrations in Indonesia. In terms of budgetary allocations, unfortunately, the reality is often different to what has already been said, especially in newly created regencies and municipalities.

They tend to spend the budget in the development of physical assets for government use, such as office buildings, or private residences for new regents and mayors, instead of allocating them for public services, including health.

It seems that Indonesia may fail to achieve the 2015 target of reducing the maternal mortality rate to 102 deaths per 100,000 live births. What is your view on the matter?

We should not be too focused on statistics, mainly because we lack any reliable data on maternal mortality. So, it is much more important for us to save the life of every pregnant woman. We need to pay attention to women'€™s nutrition both before and during pregnancy, give them adequate access to health care services and smoke-free environments. We will help local administrations with funding and guidelines; but, please keep in mind that it is their responsibility to ensure women gain appropriate services in relation to infant and maternal health.

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