Seeking a better lot for Indonesian midwives, mothers and babies
by Charlotte Knottenbelt
A UniSA-led team of midwifery experts is working to lower Indonesia's infant and maternal mortality rate through a major World Health Organization project.
Headed by chief consultant Helen Bradley, a senior lecturer from UniSA’s School of Nursing and Midwifery, the team recently completed an 11 week study across Indonesia to evaluate the country’s midwifery training programs.
Bradley says that while an overhaul of Indonesia’s midwifery training system in 1996 was a step in the right direction, more needed to be done to address alarmingly high infant and maternal mortality rates.
“The maternal mortality ratio in Indonesia is about 300 to 350 deaths per 100,000 births, and in some regions it’s as high as 1,000 which is absolutely appalling when compared to countries such as Vietnam (which has a maternal mortality rate of around 130 per 100,000), let alone Australia (where approximately five mothers per 100,000 die during childbirth annually),” says Bradley.
She says a three year midwifery diploma program introduced in 1996 had gone some way towards a more effective and disciplined approach to midwives’ training, and previously trained midwives have been provided with updated courses, but the people in rural and isolated areas that most needed the training were missing out.
“It’s good to see that midwives are now being taught active management of the third stage (delivery of the placenta) because 45 per cent of all deaths are from haemorrhage and this has no doubt prevented some women bleeding to death as they did previously,” says Bradley, “however they need to improve their provisions for distance education.”
“The target group for the update training was village midwives, who live and work in rural areas, but we found that the people benefiting from training were those who lived close to the large towns and facilities, because it’s cheaper than paying for travel or accommodation for rural midwives.”
Furthermore, Bradley says a lack of adequate caseload for practice was hampering many midwives’ training.
“Hospitals get paid to take the students, and in many cases they are taking on more students than they can provide caseloads for. In one hospital they had 150 beds and 100 students. Both midwifery updates and training are money-making businesses and this aspect is jeopardising the entire future of midwifery in Indonesia.”
“We are recommending that they look very closely at accreditation of the private midwifery academies that have grown exponentially since ‘96. The training is good but they need to clean up their act and bring down the number of students in hospitals.”
Bradley has completed a report on the evaluation, which was presented to the Indonesian Ministry of Health at a major conference in Bandung in July.
“It has been a privilege to work with the World Health Organization on such an important project,” she says. “I’ve learned a lot, and I really hope that our evaluation will contribute towards a better deal for midwives, mothers and babies in Indonesia.”
Run by the World Health Organization, the project was funded by UNICEF, the United Nations Population Fund, AusAID and the World Bank.