Indonesia has been able to cut by more than half the annual mortality among women and children in just over two decades, but too many of them continue to die, Unicef said on Thursday.
Since 1990, annual mortality among Indonesian women and children has declined by more than half, according to global estimates in "Building a Future for Women and Children," published overnight by the Countdown to 2015 initiative, Unicef said in a press release.
"Indonesia has made important progress to improve the health of its mothers and children, since making its own commitment to a World Fit for Children," said Dr. Robin Nandy, Unicef's chief of child survival and development in Indonesia.
In Indonesia, improved health policy and legislation, a renewed focus on reducing malnutrition and improved coverage of key services such as prenatal care are all contributing to reductions in overall mortality. "But even today, it is estimated that 150,000 children die in Indonesia every year before they reach their fifth birthday, and nearly 10,000 women lose their lives annually to problems in pregnancy and childbirth," Nandy said.
"We must look closely at the barriers that are slowing progress toward preventing these deaths, especially in relation to maternal health, in order to build on previous achievements."
Disparities between communities and socioeconomic groups in Indonesia are clearly apparent in the health sector, the Unicef release said. Under-5 mortality rates among poorer families are more than three times those in the wealthiest households. Among mothers with no education, only 15 percent give birth in a health facility – a proportion that increases through the levels of education to 71 percent of mothers with secondary or higher level education.
The percentage of births attended by a skilled worker also increases with a mother's income or educational status.
Unicef said Indonesia must focus on system-wide approaches that address all components – human resources, health and nutrition education, access to care, quality of services, regulation and standardization of services, governance and adequate levels and targeting of financing. Along with health insurance and other social protection mechanisms, these efforts will build a more responsive and equitable public health system.
"Investing in a more equitable health sector, and strengthening the safety nets for the most vulnerable, will deliver long-term benefits to Indonesia," Nandy said.
Nandy said healthier mothers delivered healthier children and healthier children stayed in school. Mothers also tended to have fewer but healthier children themselves in later life, and are more productive members of society.
"Together, this provides a solid foundation for eliminating poverty, reducing social exclusion and sustaining economic growth and stability," she said.
In 2010, UN Secretary General Ban Ki-moon launched a Global Strategy for Women's and Children's Health, an effort that has generated $40 billion in commitments to meet key goals supporting women's and children's health. These goals include more trained midwives, greater access to contraceptives and skilled delivery care, better nutrition, prevention of infectious diseases and stronger community education.
Indonesia has committed to the program, and President Susilo Bambang Yudhoyono has played a leading role in the Every Women, Every Child Initiative to mobilize and intensify global action to improve the health of women and children around the world, stating in 2010 that "the health-related [Millennium Development Goals], particularly MDGs 4 and 5, are cornerstones for achieving all others."