Dessy Sagita – Almost half of pregnant Indonesian women chose to give birth at home in 2012 rather than at health facilities that could help minimize infection risks, according to the Health Ministry.
Health Ministry data reveal that 55.4 percent of births in Indonesia occurred at health facilities, while the remainder took place at home.
"More than 40 percent of labors in Indonesia still took place at home. That's not hygienic. Don't be surprised to see mothers' mortality [rate] still very high as the result of infection," said Slamet Riyadi Yuwono, the Health Ministry's director general for nutrition and child and maternal health, on Thursday.
Slamet said limited access to hospitals and clinics, as well as cultural beliefs contributed to the high home birth rate.
"Some of the mothers' houses are far from the health facilities or [they have] limited transportation access because they are located in remote areas. [Home births] may also have been [driven] by limited economic access, where pregnant women were worried to go to health facilities because they didn't have money," Slamet said.
Slamet added that the strong patriarchal culture in Indonesia was also a contributing factor because men often decide where pregnant women give birth. "Women have to ask the husbands or the elders if they want to give birth at the hospital," Slamet said.
To overcome the geographic challenges, the Health Ministry has required the establishment of at least one polyclinic or one health post in every village. Slamet said mothers should no longer worry about giving birth at health facilities due to money problems.
"We already have Jampersal [childbirth insurance program]. Basically we don't want to see any pregnant woman be worried about going to health facilities because they are now free of charge," he said.
Slamet said the Health Ministry had also made an effort to tamp down the cultural factors contributing to unsafe births.
Meanwhile, the ministry lamented regional governments' underpayment of midwives, saying the practice was counterproductive to efforts to reduce mothers' mortality rate, as midwives are specifically trained to help with pregnancies and labor.
"There are regional governments that pay midwives only Rp 200,000 [$21] per labor," said Slamet, adding that the central government budgeted Rp 680,000 through Jampersal for every pregnant woman, of which Rp 500,000 is allocated mainly to pay midwives.
Slamet said the low pay caused midwives to simply refer patients to hospitals when encountering difficult labors, resulting in delays for the patient and longer hospital queues.