Jakarta – To achieve improved maternal health, in pursuit of the Millennium Development Goals (MDGs) involves overcoming several hurdles, with the maternal mortality rate still at 2.28 per 1,000 live births.

The National Development Planning Agency aims at 1.02 per 1,000 by 2015.

Nina Sardjunani, National Development Planning Agency deputy minister for human resources and cultural affairs, said that this fifth objective as part of the MDG cluster of social objectives could not be achieved by 2015.

"The target to reduce maternal mortality rates by three-quarters between 1990 and 2015 is off track," she said on Monday during a public discussion on MDGs in Jakarta.

The high maternal mortality rate in Indonesia is caused by several factors, including the fact that delivery is not always handled by professional health workers.

"There are no professional health workers, such as doctors and midwives, in remote areas," she said.

Although data indicates that the percentage of births attended by professional health workers increased from 38 percent in 1992 to 74 percent in 2008, the situation remains far from ideal.

"Filling this gap is to be addressed by giving more attention to providing professional human resources," Nina said.

Another problem causing the much higher rate of maternal mortality in Indonesia, as compared to its neighbors Malaysia and Singapore, is gender inequality.

Minister of Women's Empowerment and Child Protection, Linda Amalia, said that women were not the decision makers in matters of maternal health.

"Normally, they wait for their husbands or parents' decisions," she said.

She cited the example that most wives would not dare go to the midwife for delivery without being accompanied by their husbands. "The wife will wait for the husband who is working in the field and this could cause the death of the wife."

Other factors cited as causing the high maternal mortality are lack of transportation, lack of easy access to proper facilities, giving birth too often or at too young an age, and the patriarchal attitudes entrenched in the culture.

Nina Sardjunani also explained several strategies to accelerate the achievement of the MDG goals for maternal health, such as providing obstetrics health workers and increasing the role of the Integrated Service Posts in improving the health of mothers and children. (map)