The high profile investigation into corruption in Banten province brings to attention the widespread poverty in the former part of West Java. The Jakarta Post'€™s Elly Burhaini Faizal recently visited villages in Pandeglang regency, Banten, to look into maternal health, following her selection as a recipient of the In-depth Reporting Grant Program from the United Nations Development Program'€™s (UNDP) Provincial Governance Strengthening Program in cooperation with the Alliance of Independent Journalists (AJI). Her related article, '€œWomen, children in Banten yet to benefit from regional autonomy,'€ was published on Nov. 6.

Many women in Mogana village feel comfortable giving birth in their own home with support from a traditional birth attendant, locally known as paraji.

It is poverty that makes home birthing popular in the village, which is located in Pandeglang regency, Banten, about three hours drive from Jakarta.

Yayah Nurhayah, a 60-year-old paraji from Kampung Nagrek in Mogana, said many women asked for her help during labor partly due to a lack of money.

'€œSometimes they'€™re afraid to go to a midwife, probably as they are worried they don'€™t have enough money to pay for the service,'€ Mih Yayah '€” as she is known '€” told The Jakarta Post.

A patient usually pays her around Rp 30,000 (US$2.64) per labor period and around Rp 50,000 for antenatal care during the 40-day recovery period.

Mih Yayah, who learned her skills from Siti Sukarah, her late mother and also a paraji, has been in practice for 20 years. Nevertheless, she admitted it remained difficult to help women during emergencies although she had received training on delivery in 1992-1993.

'€œThe most difficult situation is when the placenta is left inside [the uterus] during labor,'€ said Mih Yayah, referring to placenta retention.

In such a situation, she can do nothing but gently massage her patient'€™s stomach. '€œUsually, the placenta will eventually come out,'€ said Mih Yayah, as if she did not know the high risks of massaging in such conditions.

Among the risks of a retained placenta are hemorrhaging, one of the most common causes of maternal deaths.

In Pandeglang, officials blame women'€™s heavy dependence on paraji for the high risk of mortality during and following pregnancy and childbirth, due to their harmful and unhygienic traditional practices and the absence of a referral system.

According to official data, 45 women in Pandeglang died during and following pregnancy and childbirth in 2012 alone, while 262 babies died on the day of birth in the same year.

Pandeglang and Lebak, the two poorest regencies in Banten, have a high contribution to the infant and maternal mortality rates in the province.

Although 98 percent of 1,535 villages and subdistricts in the province have village midwives, Banten'€™s maternal mortality rate reached 187.3 per 100,000 live births in 2010 while infant mortality stood at 22.8 per 1,000 live births. Banten is one of 20 provinces with the country'€™s highest maternal and infant deaths.

'€œTraditional birth attendants are still highly esteemed among local residents, especially those in remote areas where medical care is still lacking,'€ said Enniyati, head of the special healthcare services department at Pandeglang Health Agency.

She said last year 85 percent of women in the regency received help from trained health workers during childbirth, while the remainder still gave birth at home with the help of paraji. They are mostly much older than many young midwives in their 20s, and are relied on for their patience and psychological support well after delivery.

In 2009, the Health Ministry introduced a Traditional Birth Attendant-Midwife Partnership Program aimed at increasing the proportion of births attended by skilled health personnel. Under the program, traditional birth attendants assist pregnant women but only in non-medical treatment.

As many as 114,290 or 75 percent of total traditional birth attendants in Indonesia participated in the partnership program in 2011, up from 60.5 percent in 2010.

The proportion of births attended to by skilled health personnel stood at 86.3 percent in 2011, up from 82.3 percent the previous year.

In Pandeglang, however, 163 out of 763 traditional birth attendants still refused to participate in the program.

Renny, a midwife in an auxiliary community health center in Kampung Pajagan, Mogana village, said: '€œWhile more women have births attended to by skilled health workers, adverse health outcomes among women who still depend on traditional birth attendants remain a huge challenge.'€

She said it was still quite common to see a mother slowly recovering from childbirth as her paraji gave her medically inaccurate advice, such as avoiding nutritious food like egg, fish and fruit, saying that such food could hamper recovery.

Supported by volunteers from integrated health post Posyandu Cempaka III in Mogana village, Renny also strives to keep pregnant women in nearby communities well informed as to the dangerous signs of pregnancy.

Physical examinations during antenatal care include repeated measurements of maternal height and weight in pregnancy, blood pressure readings and height measurement. Iron tablet supplementation and Tetanus Toxoid immunization are provided as well.

'€œOnce we determine that something is wrong with a pregnant mother, we directly refer her to hospital without having to wait for a hemorrhage to occur,'€ Renny said.

Hypertensive disorders in pregnancy and eclampsia are the other leading causes of preventable deaths. Pregnant women may suffer eclampsia if hypertension occurs during their pregnancy and is not diagnosed early and treated properly.

The 2010 Basic Health Research (Riskesdas) shows that only 44.5 percent of pregnant women in Indonesia said they received information on dangerous signs of pregnancy.

Poor coverage of comprehensive prenatal counseling is among the factors blamed for high maternal deaths in Banten.

Of the 474 maternal deaths that occurred in Banten in 2006, 45 percent resulted from delays in deciding to seek medical help at a time of complications, a study found.

In Mogana, pregnancies in quick succession and older-age pregnancies are the two most common problems among women.

'€œMany women here have children at a young age. I'€™ve often encountered a thin, malnourished looking pregnant mother, possibly lacking nutrition because the family has too little food for her and her children,'€ said Eni Suheni, 44, a health volunteer.

Pandeglang Health Agency is seeking Rp 1.5 billion (US$132,000) for infant and maternal health in the regency'€™s budget (APBD) in 2014.

Enniyati said Pandeglang'€™s maternal and infant budget amounted to only Rp 620.79 million in 2013, down from Rp 623.31 million last year.

'€œWe used most of this year'€™s maternal and infant budget to strengthen the One Village One Midwife program, to increase women'€™s access to reproductive health,'€ she said.

Like previous years, Pandeglang covered most of the infant and maternal health budget in 2013 while the state budget (APBN) covered the remainder.

'€œThis year, the APBN covered three infant and maternal health activities, amounting to Rp 40 million,'€ said Enniyati.

Under autonomy, Banten has not only received continuous increases in regional transfers but also allocated 6 percent of its provincial budget to the health sector annually, surpassing the national average of 2.1 percent.

Popular

Volcano erupts in North Sulawesi, hundreds evacuated

Dubai roads, airport reel from floods after record rains

Ramadan boosts consumer confidence, retail sales