This article is a summary of a case study of an issue in reproductive health services and childbearing mothers. This case study is taken from one of seven Districts in Indramayu, Surakarta, Lampung Utara district, West Sumba district, East Lombok district, Jembrana district, and Lebak district. It is describing the life story of Ponirah who lives in Lebak, Pasir Tanjung Village, Rangkasbitung subdistrict, Lebak regency.
Ponirah and the Story of her Reproductive Health
During her menstruation, Ponirah admitted to often experiencing problems relating to it. She often suffered from convulsion whose pain was like that of what was experienced by childbearing mothers. She felt painful colic’s. Ponirah said that during her girlhood, her menstruation blood was so much. But after getting married the amount of blood decreased.
Beside menstruation, Ponirah also had problems during her pregnancy. The problem she faced was the pain that she suffered from for one month. On her first childbirth, Ponirah acknowledged that she often had colic’s, since early morning. On that very moment her husband went to pick up a traditional birth attendant. But the baby in her womb did not yet want to pop out. Only in the late afternoon, did the baby come out. But the birth was not normal. The abnormality was caused by the fact that the buttocks of the baby came out first, not the head. When the buttocks were already outside, the head got strangled for 2 two hours making the baby breathless and dead.
Other problems relating to her reproductive health were dizziness on the head and bleeding from using the pills as contraceptives. Ponirah later replaced it with injection, but her menstruation blood was only a little, whereas before the injection, Ponirah often had one week of menstruation period.
Ponirah’s choice to overcome her health problems
When Ponirah had the menstruation problems, she did not have herself checked by the midwife. She did not either go to other health services. She said she could overcome the problems by consuming jamu (traditional drinks/medicine). Sometimes she overcame the problems by drinking Sprite. Ponirah felt OK with the methods, which she learned from her friend.
As soon as Ponirah realized that she was pregnant, she went to the midwife in the Posyandu (integrated health services) to have her pregnancy examined. She said she had her pregnancy checked up by the midwife on regular basis every month. But she also went to the traditional birth attendant when her pregnancy was 4 months. This is what mostly done by the people in her village. The pregnant women under 4 months are not allowed to have themselves checked up by the traditional birth attendant. According the the prevailing myth, the 3 months pregnancy is still in the form of blood, making it prohibit able to be massaged. If one dared to go the traditional birth attendant, her belly would be massaged by the dukun to position the baby.
When giving birth, Ponirah was attended by the traditional birth attendant. For her second parturition, she also looked for help from the traditional birth attendant although she had heard and known that a parturition assisted by a midwife could be free of charge if a Gakin card (association of poor families) was used. Anyhow, she had been more familiar with the traditional birth attendant who assisted her during the childbirth compared to midwife.
When confronted with the problems of dizziness and the bleeding after using the pills, Ponirah acknowledged she did not have herself examined by the midwife. She did not either go to the traditional birth attendant. She overcame the problem herself by drinking jamu. To overcome the dizziness that she felt, she overcame the problem herself by buying medicines in the kiosks. She then decided not to use the contraceptives any more. But after the second childbirth, Ponirah tried to request again the use of the injection contraceptives for 3 months to the midwife.
Ponirah’s Handicaps in Overcoming her Health Problems
In her efforts to overcome her reproductive health problems, Ponirah confessed as having come through some problems and handicaps to access health services facilities or paramedics.
Ponirah acknowledged that she had difficulties in accessing the midwives who live in her village. The village midwife who was assigned to work in her village, now lives in an urban area. This has caused her to be able to meet the midwife only once a month during the Posyandu activities. Sometimes she could have an access to a midwife who was assigned in the Pustu (a sub-division of Puskesmas) of her village. According to Ponirah it rarely happened that they could meet a midwife in their village.
The unavailability of midwives in her village had made Ponirah look for other midwives in neighboring villages or in the city. The distance between her village and neighboring villages is 2 kilometers. The distance cannot be passed through by public transportation means. This is because there is no means of public transportation in her village. She can only use an ojek (motorbike transportation). This condition had made it very difficult for herself who is pregnant because of difficult geographic condition in her village. Ponirah’s village is located in a mountainous area with steep and winding roads. Most of the roads have not been constructed with asphalt making it very slippery during the rainy season. Other than this, the roads that pass through forests and plantations are vulnerable to criminal actions. Another reason that made it more difficult for Ponirah to visit her midwife was the transportation cost to the place where the midwife lives, be it in the village or in the city.
The unavailability of midwives in Ponirah’s village has become another reason for Ponirah to resort to the traditional birth attendant's help although she knows that there is no parturition cost for the midwife because she has the Gakin-card. The unpresence of a midwife and the difficulty to access the midwife have become other reasons for Ponirah to choose a traditional birth attendant, where 5 persons are in her village.***