At a glance: Indonesia

Traditional Birth Attendants and midwives partner for women’s health in Indonesia

© UNICEF Indonesia/2008

Noni (left), 27, with her newborn twin boys and Sanro Nurma, a Traditional Birth Attendant in Indonesia.

SULAWESI, Indonesia, 9 April 2008 – Approximately 1 in 97 women in Indonesia will die during childbirth or because of complications related to pregnancy. Thankfully, Noni, a 27-year-old mother of four, is alive and well due to proper medical treatment from her local health centre.

One recent day, Noni was proudly holding her newborn twin boys while making friendly conversation with Sanro Nurma, a Traditional Birth Attendant (TBA). As a TBA, Ms. Nurma delivered Noni’s previous two children in her home. But giving birth to twins involves some serious risks, so Ms. Nurma brought Noni to the Galesong Health Centre in South Sulawesi in orderto deliver the babies safely with the help of hospital professionals.

“After hearing an announcement that we should give birth at a health centre, not at home, we decided that we would go to the nearest health centre to seek professional help when the time to deliver came,” said Noni, whose husband, a fisherman, was away at sea when the twins were born.

In the past, like millions of other Indonesian mothers, Noni would have relied on a birth attendant alone to assist her during birth. Approximately 40 per cent of deliveries in Indonesia today are assisted only by TBAs. This practice is the predominant contributing factor to the country’s high maternal mortality rate – one of the highest in the region.

Uniting for maternal health

In 2007, a joint partnership between local midwives and TBAs was spearheaded by the ‘Improving Maternal Health in Indonesia’ programme.

A meeting was organized by the district government and UNICEF for the two groups to share their concerns about maternal mortality and to pledge to work together.

Under the agreement, the traditional roles of TBAs, which include reciting prayers, providing herbal drinks and providing postpartum care, would remain intact. However, all the medical procedures would be handed over to the midwives, who also agreed to pay the birth attendants’ fees out of their own compensation.

A positive impact

With close to 100 per cent of the deliveries in Galesong now being assisted by midwives at a health facility, this new partnership is already gaining traction and having a positive impact on the community.

“Before the partnership was established, midwives and TBAs would compete for clients,” explained UNICEF Health Officer in South Sulawesi Dr. Willy Kumulur. “Now they are working together to save mothers’ lives. TBAs are part of the community and provide important services like psychological and spiritual support, so the partnership aims to respect local values and seek win-win solutions.”

With nearly 350 districts, many of which are remotely located, there is still much work to be done to save the lives of Indonesian mothers.

UNICEF is working with nearly 30 local governments across the archipelago to train more midwives and to encourage the community as a whole to seek professional maternal health care.