Presentation at the Global Maternal Newborn Health Conference, October 20, 2015
As Indonesia strives to meet its Millennium Development Goal of reducing maternal mortality by 75 percent by 2015, the maternal mortality rate increased in 2012 to 359 per 100,000 live births. UNFPA has categorized Indonesia as one of the ten most dangerous countries for pregnant women. Childbirth without professional health assistance is one driver of high maternal mortality. Aceh Singkil, a district in Aceh province, is one place where maternal death remains common. Its 110,000 residents are served by 11 basic health clinics; 38.28% of deliveries were handled by TBAs in 2010. Discussions on unskilled deliveries and maternal mortality were held in Aceh Singkil, and TBA-midwife partnerships were offered as a potential solution. The idea was supported by village heads, religious leaders, health volunteers, and TBAs and midwives themselves. The district health office then issued an instruction for developing TBA-midwife partnerships, providing formal support for the initiative. Decrees were issued by village heads, legislating that TBAs would receive honoraria to assist midwives with deliveries. TBAs would also receive compensation from the national insurance scheme. MoUs were developed between TBAs and midwives in 31 villages, representing an official agreement between partners, and including information on roles and responsibilities of TBAs and midwives, and compensation due to TBAs. MoUs were signed during public events. Partnerships between TBAs and midwives have led to a decrease in births assisted by TBAs. TBAs are now involved in births at local health clinics, providing spiritual support to mothers. Mothers report feeling more at ease now that they can be assisted by both TBAs and midwives. No maternal deaths have occurred during births assisted by TBA-midwife partners. TBA-midwife partnerships have a positive impact on reducing maternal mortality when they are participatory, are based on strong incentive systems, and permit the involvement of TBAs in facility-based births.