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Indonesia saving infants but losing mothers, report says

Source
Jakarta Globe - May 11, 2013

Dessy Sagita – Though Indonesia has made significant progress in saving the lives of newborns over the past two decades, the country has been struggling to rescue mothers during childbirth, a report said this week.

The annual report, released by Save the Children, stated that Indonesia managed to reduce its infant mortality rate by 48 percent between 1990 and 2011.

Also contained in the report is the first ever Birth Day Risk Index, which includes the death rate for newborns during their first day of life in 186 countries. About 23,000 Indonesian babies die during their first day outside the womb, accounting for more than one-third of all newborn deaths.

The three major causes of death for newborns – premature birth, severe infection and complications during birth – were identified in the report. These causes were responsible for roughly 80 percent of all infant mortalities.

"Indonesia has made dramatic cuts in the rate of newborn deaths over the past two decades. However, it is still one of 10 countries accounting for nearly two-thirds of the three million newborn deaths that happen globally every year, partly due to its large population," Ricardo Caivano, the country director for Save the Children in Indonesia, noted.

Still, Indonesia ranks 106th out of 176 countries as the best place to be a mother.

Based on the United Nations Development Program's Gender Development Index, Indonesia's current maternal mortality rate of 228 per 100,000 live births remains one of the highest in Southeast Asia.

The country's maternal mortality rate must decrease to 102 per 100,000 by 2015, as stipulated by its Millennium Development Goals. However, experts have predicted Indonesia will not be able to meet its MDG target.

Furthermore, a source familiar with the yet-to-be-released 2012 Demographic Health Survey, conducted by the Central Statistics Agency (BPS) with assistance from Macro International, revealed that Indonesia's maternal mortality rate has actually risen to 313 per 100,000.

"The minister of health has spent months trying to suppress the spike in maternal mortality," the source, who asked not to be named for fear of retaliation, said on Friday.

"Indonesian women are very progressive in saving their children's lives, which is why the newborn mortality rate has declined rapidly over the past two decades. However, unfortunately, [women] are completely powerless in saving their own lives, especially during childbirth," Kartono Muhammad, a health expert and former chairman of the Indonesian Doctors Association, told the Jakarta Globe on Thursday.

While Indonesian parents are generally well-informed about their children's health, there are still many cultural barriers that prevent women from making their own decisions to save their own lives, Kartono said.

"Women will be blamed if their children get sick, which is why they are extra careful in attending to their children's needs. But women do not have enough power to make decisions about their own health," he said.

For instance, a woman needs approval from her husband, father or even father-in-law to have a pregnancy checkup, he said. "A woman must consult her family on where she should have the delivery," he remarked.

Kartono added that misguided interpretations of religious values sometimes also put women's lives in jeopardy. "It's not the religion that puts women in danger, it's the people misconstruing the values. They think women should rely on men for making every decision, including childbirth," he said.

Following the report, Save the Children called on Indonesian leaders to invest in low-cost solutions that can dramatically reduce newborn mortality, like proper umbilical cord care and newborn/pediatric doses of antibiotics.

The organization also encouraged exclusive breastfeeding and "kangaroo mother care." Such parenting methods cost nothing, but they can save hundreds of thousands of babies' lives each year.

A 2007 study found that only 32 percent of Indonesian mothers breast-fed their babies exclusively for six months. In 2011, the figure rose to 42 percent, but it is still lower than the rate recorded in neighboring countries like Singapore and Malaysia.

Kartono suggested that Indonesia should intensify its family planning program to slow down the country's birth rate, as well. Previously, Health Minister Nafsiah Mboi admitted that Indonesia's family planning program was a failure for its inability to control the country's fertility rate.

As mentioned in the country's MDGs, Indonesia aims to reduce its fertility rate to 2.1 by 2014. The rate indicates the average amount of births per Indonesian woman. However, in 2012, the fertility rate in Indonesia was still stuck at 2.6.

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