Elly Burhaini Faizal, Jakarta – Indonesia is liable to fail to meet its Millenium Development Goals (MDGs) target in reducing mother and infant mortality rates by 2015, given the lack of access to skilled midwives and obstetricians and poor health facilities, a senior health official says.
Slamet Riyadi Yuwono, director general of Nutrition, Child and Maternal Health at the Health Ministry, said on Thursday that progress had been less evident in reducing maternal and infant deaths.
"We've seen a degree of progress in reducing maternal and child deaths but it has not been in line with the efforts that we have made," he said on the sidelines of the launch of the Expanding Maternal and Neonatal Survival (EMAS) program, a five-year scheme funded by the US Agency for International Development (USAID).
The US$55 million program aims to reduce the number of Indonesia's maternal and neonatal deaths by 25 percent over the next five years.
Currently, Slamet said, about 74 percent of the total number of childbirths were aided by skilled birth midwives, and that 65 percent of births took place in health facilities. However, maternal deaths remain high as obstetric services are often of poor quality.
"About 85 percent of villages have skilled midwives, but the maternal deaths in villages have not yet declined significantly. It's a big problem and we are looking into it," he said.
Indonesia is aiming to reduce its maternal mortality rate to 102 per 100,000 live births by 2015, from the current 228 per 100,000 live births. "We are unlikely to achieve this target as we have not yet made any significant progress," said Slamet.
The EMAS program will be established at 150 hospitals and 300 community health centers in 30 regencies across six provinces: Banten, Central Java, East Java, North Sumatra, South Sulawesi, and West Java, areas with the largest concentration of maternal and child deaths.
USAID director Glenn Anders said EMAS would help ensure that health workers, both in hospitals and community health centers, had sufficient skills and knowledge to deal with emergency procedures.
In Indonesia, more than 10,000 women and 80,000 newborns die either during or shortly after childbirth every year. "Almost 70 percent of women give birth to their children with skilled midwives in attendance but it has not been sufficient to reduce maternal and infant mortality to a level that Indonesia could achieve today," he said.
Nila Djuwita F. Moeloek, the President's special envoy for the MDGs, said it would be difficult for the country to achieve its target in reducing maternal and infant mortality rates, while it needed to also give attention to other areas of development, such as nutrition, infrastructure, and education for women and girls.
"Factors other than the quality of health care services may also affect the country's success in reducing maternal mortality," she explained.
Hemorrhaging and infection, two leading causes of maternal deaths, could occur if a woman suffered malnutrition during pregnancy, she said. "Thus, healthy conditions, both before and during pregnancy, remain just as important in preventing the risk of internal bleeding and infections," said Nila.
Infrastructure was another crucial factor as improvements could enable people to access better-quality health services. Many local authorities, however, unfortunately paid little attention to the importance of infrastructure development, Nila added.
"I think this is the reason why the rate of maternal deaths has not yet declined significantly," she added.
Anne Hyre, USAID's chief of party for EMAS, said that the program aimed at strengthening the quality of services at hospitals and community health centers.
"We will be working with midwives, doctors and others to make sure that they are implementing evidence-based practices for emergency maternal and newborn health care."