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Cutting The Risk of Cutting The Cord: Tetanus Vaccine Makes Births Safer

© UNICEF Indonesia/2008/Edy Purnomo
24-year-old Titi is 9 months pregnant. The tetanus vaccine will provide vital protection for her and her baby.

By Jennifer Butterfield
20 November, 2008
Kepahiang, Bengkulu - On the shady wooden balcony of her local posyandu health clinic, 24-year-old Titi waits with a noisy crowd of mothers and babies. She is nine months pregnant with her second child, and the bright batik of her long blouse barely contains the swell of her stomach. Although it is only early, the clinic’s hall is filled with rows of women who sit and gossip while they wait for their names to be called. Like these women, Titi has come to receive a free vaccination against tetanus, protecting herself and her unborn baby from this potentially deadly disease.

Minor cuts can be major threats

Tetanus is caused when bacteria gets into an open wound and produce a toxin which attacks the central nervous system. Sufferers experience severe seizures and muscle spasms, and have difficulty swallowing and breathing. Tetanus is a particular risk for babies delivered by traditional birth attendants in homes which are not sterile; they are also at risk when unclean tools are used to cut the umbilical cord or traditional balms like herbs and ashes are applied to it. 

But mothers who have been vaccinated during pregnancy pass on this protection to their babies, significantly lowering the risk of contracting tetanus during their first few days of life. The protection is enough to last until they are two months old, when they are given a combined vaccine against diphtheria, pertussis and tetanus as part of the Indonesian Government’s routine vaccination program.

Because of the vital protection offered by the vaccine, UNICEF and the Government have been working together to stage a series of immunization drives in 27 districts in 13 provinces where the vaccination rate is currently very low. In Kepahiang district, government statistics show that only 3 out of 10 pregnant women had received at least 2 doses of the tetanus vaccine during their pregnancy – the minimum number needed to protect themselves and their babies.

But at immunization posts across Kepahiang, UNICEF and health authorities are working to boost this to 100 per cent coverage by offering free tetanus vaccines to every woman aged between 15 and 39. At 24, Titi is right in the middle of her child-bearing years, and it is women like her that need the vaccine most. 

© UNICEF Indonesia/2008/Edy Purnomo
Just two quick shots will protect a mother for up to three years, while also giving vital protection for a baby’s first few days of life.

Reaching out to those at risk

She plans to give birth to her baby at home, with the help of the community’s midwife. She gave birth to her first child this way too, but with one important difference: she had not been vaccinated against tetanus. Luckily, her son did not get sick despite the midwife using an ordinary pair of scissors to cut the umbilical cord, but this time around she isn’t taking any chances.

“I heard about the free injections from my friends and so I came here. I thought, anything that can make me and my baby healthier is a good thing.
“I didn’t have this with my first pregnancy because I didn’t know that it was necessary, but now that I know that tetanus can be dangerous I am happy to be able to get vaccinated.”

The immunization drive is accompanied by a public awareness campaign which tells women the importance of the tetanus vaccine and the risk to their babies if they do not have it. This message has clearly made an impact in Kepahiang, where women flocked to immunization posts across the district, sometimes waiting more than half an hour to receive their shot.
Local health workers like Srimulyanti, the midwife in little Tangsi Duren village, have been integral to spreading the word and encouraging nervous mothers to come in for the vaccine. 

“When I deliver babies I am very careful to make sure that the environment is clean, but this is not always enough. If women are vaccinated, it lowers the risk of tetanus significantly, so I have been encouraging all the women that I see to come here today.

“I tell them: ‘women have a very important role in our community, but you must take care of yourself before you can take care of others’.”  
By working to protect every woman from the threat of tetanus, UNICEF is not only helping tomorrow’s mothers care for themselves, but for their unborn babies as well.    





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