Women mostly become the poorest of the poor. Poverty is the reason underneath difficulties for them to have access for their rights, particularly for good health services. For more than 10 years there has not been a significant decrease for maternal mortality ratio (MMR) towards the target 115 in 2015.
Women’s health issues cannot be separated from policy issues, availability of infrastructure, affordable and accessible basic health care. The result of Women Research Institute’s (WRI) research in seven regions in Indonesia (2009) shows there are still many obstacles for poor women, particularly for them in remote areas, to access public facilities. Besides poverty, lack of information, knowledge and uneven availability of health workers, such as doctors or midwives also become obstacles for women to access health facilities. According to Ikatan Bidan Indonesia (IBI – Indonesian Midwives Association) the numbers of midwives in villages keep decreasing from 62.812 to 39.906 midwives in 2000 to 2003 respectively. Indonesia’s Health Profile 2000 notes around 80% Indonesian lives in 69.061 villages which 22.906 of them do not have midwives. (Executive Summary of SMERU Research Institute “Strategi Akselerasi Pencapaian Target MDGs 2015” – “Acceleration of 2015 MDGs Goals Strategy”).
One Village, One Midwives, and One Village’s Maternity Hut Program can be a commitment to be achieved together. Hopefully, this program could help reducing maternal and child/baby mortality rate. Therefore, it needs synergistic effort from many society’s elements in addressing reproduction health issue in Gunungkidul district and Central Lombok district.
A mapping of reproduction health issue to villages, at least sub-district, is required to support this program. Besides, a research of maternal mortality rate issue and its relation to socio-cultural also needs concern. A mapping of the number of reproduction health officer is needed, as well as its distribution, type of service, and its fare. Further, data from the research and its database can be a step toward collective actions to improve quality of women’s lives which are supported by society’s organizations and local government.
- Availability of reproduction health advocacy data
- Reproductive health mainstreaming in policy and regional budgeting
- Formation of district-level multi-stakeholder forum to oversee policies related to reproductive health.
- The existence of two villages which are responsive to reproduction health, which indicator are:
- The existence of gender budgeting and reproductive health training.
- The existence of Development Planning Discussion (Musyawarah Perencanaan Pembangunan – Musrembang) in health sector.
- The existence of regular specific theme discussion.
- Violence at home, unwanted pregnancy, early latch, and contraception campaign.
- The existence of village’s policy of One Village and One Midwives.
In order to achieve these objectives WRI conduct reproductive health programs in Gunungkidul-Yogyakarta and Central Lombok-NTB. The programs such as initiating government policies, oversee policies implementation and knowledge capacity building for both local government and villagers toward sexuality and reproductive health.
Gunungkidul-Yogyakarta district and Central Lombok-NTB district are the regions where maternal mortality rates exist due to poverty. Therefore, these two regions are chosen to be the pilot project.
Forum Group Discussion (FGD)
FGD becomes a forum to assess reproductive health issue in Badan Perencanaan Pembangunan Daerah (Bappeda) (Regional Development Planning Board) Gunungkidul with Regional Legislative Members and stakeholders. Thirty people from many agencies and community institutions attend this event to find out Gunungkidul society’s reproduction health issue and need. The results from this discussion are:
- Lack of society’s knowledge and education towards how to use of contraception from health workers, insensitive policies toward reproduction health.
- Lack of information and services
- Lack of sex education
- Lack of infrastructure: Gunungkidul consists of 144 villages but it only has 128 midwives.
- The increasing of HIV/AIDS
- The increasing of maternal mortality rate every year
- The existence of rape and violence at home cases
- Reproduction health has not been put to school curriculum
- Lack of women’s lives quality
- Lack of doctor or specialist in local hospital
Limited Discussion with community groups
The meeting was attended by 23 representatives of civil society organizations in Gunungkidul, such as the Network of Women, youth groups and women's groups, representatives from several villages. This meeting is in order to find the needs of residents and customize programs to the needs of the community at the village level. Some of the issues that arise at the district level also exist at the village level, such as limited understanding of the community on contraception and pregnancy.
Village Residents’ Discussion
Aims of this meeting are focused to gain society’s knowledge and Village Development Planning Discussion assistance. Furthermore, we also hold gender budgeting training so residents can think critically toward village budgeting planning process to make it more gender responsive.
Meeting with the Regent of Gunungkidul
This meeting is made to influence and approached the local government to harmonize local government policies and WRI’s program aims in this village; and to get local government support for WRI’s program. Furthermore, it is intended to encourage local government to launch public policies that are stood for poor women in reproduction health, such as Regent’s regulations which guarding active standby village policies. In the Regent’s regulations which put technical guidelines of the active standby village policy, WRI has succeeded in getting the local government's commitment to put a permanent midwife in every village. Recent developments of Gunungkidul, the Regents approved regulations on standby village in which there is WRI’s proposal regarding permanent midwife.
Central Lombok District
Forum Group Discussion (FGD)
Similarly, this discussion is a meeting to uncover reproductive health issues. The FGD is attended by executive representation (Regional Development Planning Board, Department of Health), legislative, NGO, public society groups, health practitioners (midwives, doctors) and society. The forum was organized in collaboration with the Regional Poverty Reduction Coordination Team (TKPKD) Central Lombok. In this meeting, it is known that the Central Lombok has launched AKI NO (MMR NO) program which means no maternal deaths due to childbirth and the existence of free delivery assurance policies that have been set out in Regional Regulation. What is needed in the future is monitoring the policies, considering that not all residents get the right policies’ socialization. Besides, WRI also encourages stakeholder such as Central Lombok Department of Health to monitor the implementation of the local government policies toward free labor to village level.
In the beginning of year 2012, WRI begins the program in Central Lombok with a reflection. This event aims to share experiences and results in the effort reducing MMR in Central Lombok district. It required commitment, concept formulation and joint program to accelerate efforts to reduce maternal mortality through pro-people and pro-gender policy. The achievement and the follow-up from this meeting are the strategy and division of labor in regional district between government, legislative, and public to reduce MMR in Central Lombok.