The Millennium Development Goal on reducing maternal mortality rates by 75% globally is in jeopardy. This fact has prompted a significant focus on emergency measures to rapidly increase improvements addressing maternal mortality.
Currently only 5% of Indonesia’s poorest 5,000,000 pregnant women receive professional care services 1. Indonesia’s current rate of maternal mortality is 230 per 100,000 live births2. In order for the UN Millennial Goals to be achieve Indonesia needs to reduce their maternal mortality rates to under 102 maternal deaths. In order to facilitate this progress by 2015, Indonesia recently announced emergency spending measures to pay for three million births for poor women to take place in hospitals with trained professionals. While their commitment is admirable there are at least three concerns for the current plan.
First is geography. Only 52% of Indonesia population lives in an urban area3 close to hospitals and medical services. Travel from the rural to urban areas can be quite precarious in much of Indonesia. Because the national plan calls for paying for health care services at hospitals by trained professionals there will necessarily be a limit to how effective this plan will be. Rural women will already be limited in their access to cities because of distance, traveling conditions, and the cost of transportation. Because of the distance concerns a mother cannot wait until the day of her birth to leave for a hospital. She would likely need to leave at least several days earlier. This additional time requirement adds an additional cost to those already severely disadvantaged by poverty.
Second, a significant factor in maternal mortality is the care received during pregnancy. Anemia, preeclampsia, teen pregnancy, multiple births, gestational diabetes etc all increase the likelihood of a maternal death, and have nothing to do with a skilled attendant at birth.
Third, what happen’s after 2015. The current plan appears to be a limited investment, not a continuous commitment to the future. After 2015 no guarantees are in place to ensure that every year thereafter mother’s will continue to receive the care the urgently need.
While there are certainly concerns with the plan Indonesia’s actions are admirable. Hopefully the Indonesian government will include in this and future plans actions that will bring the health care to the mothers throughout their pregnancy and for all future generations of mothers to come.