By Sagita Adesywi, ChildFund Indonesia
Yuliana, a mother of five, lives in far eastern Indonesia in a simple house made with bamboo, tree bark and other wood.
Like many others in her community, Yuliana’s family has a wooden rumah bulat or “roundhouse” that serves as a kitchen and a storage place for harvested crops. The outbuilding has a door but no windows, and the walls and ceiling are black from smoke.
Aside from these uses, the rumah bulat is also a birthing room. According to local tradition, mothers and their newborns need to be “baked” to become strong and healthy. Mother and child lie on a wooden platform with a fire burning underneath it — often for a month or more.
Yuliana did this for all five of her children, but now she discourages other mothers from doing the same. “It was so hot, I felt like dying, but we didn’t dare to say no to our village elders,” Yuliana recalls. “It was such a miserable time. My children fell ill easily when they were younger, coughing all the time. As I now know the harmful impacts, I want people here to stop doing this.”
Today, Yuliana is a volunteer with a health project in the village called REACH. ChildFund and UNICEF work in partnership with community-based organizations, training health volunteers to raise awareness about proper health care for expectant mothers and young children.
The rumah bulat practice contributes to a significant number of young children suffering from chronic respiratory diseases and malnutrition. “It is not easy to change people’s views, since traditional norms are held in high esteem in the community,” Yuliana notes. “From the training, I understand it is not just about what a bad experience it is, but most importantly how badly it impacts the health of the mother and the baby. I want people here to understand this too.”
As part of her efforts, Yuliana helps the local midwife facilitate counseling sessions at the village health post. She carries a first-aid kit and keeps information about basic health care with her at all times.
“I am very happy to have Yuliana as a health volunteer,” says Adel, another community member. “She visits pregnant mothers regularly and discourages the rumah bulat practices.” It’s difficult to break old habits, though.
“I still underwent this practice for my niece when she gave birth,” Adel says. “I know it is wrong, but I was terrified of going against the village elders here. Yuliana has been telling us we shouldn’t keep doing this, but we’ve been told we will be cursed and that if we don’t follow the practices we will go crazy.”
However, Adel did make some adjustments to the norm. Her niece was confined to a rumah bulat with a bamboo wall that allowed more ventilation than the customary solid wood wall, and Yuliana checked on mother and baby.
Indonesia’s government supports the abolition of this practice, having introduced a new fine of US$30 if a woman gives birth at home instead of at a health center. This is a hefty fine in Yuliana’s province, where the average income is US$17 a month. The government’s regulations and the sharing of health information among mothers are helping to reduce the harmful custom.
“I was really scared of the rumah bulat practice. I chose to stay at my uncle’s house in town so that I could give birth at the health center,” says Dorsila, who, inspired by Yuliana, has also become a community health volunteer.
By Sagita Adesywi, ChildFund Indonesia
In Indonesia’s low-income communities, the expenses related to childbirth lead to difficult decisions. Mulyana, a trained health-care volunteer (locally known as cadres) in Pakan Sari, had a miscarriage when she was three months pregnant.
“The treatment at the hospital cost me about US$400,” she recalls. “We have enough money for food, but we couldn’t afford to pay the hospital. Thank the Lord, I received an allowance from the government and have a childbirth savings account as well. Otherwise, I don’t know how I would be able to pay.”
Many women in Mulyana’s region go to traditional birth attendants instead of the hospital, which is often better prepared if a mother or baby encounters complications during birth. Improper medical treatments have contributed to the high number of deaths of mothers and babies. Indonesia’s maternal mortality rate, 228 deaths per 100,000 births, is among the highest in Southeast Asia; its infant mortality rate is 28 deaths per 1,000 live births.
Traditional birth attendants charge much less than a hospital, but that advantage sometimes comes at the expense of current medical knowledge, properly maintained equipment and even good hygiene.
To reduce the number of maternal and infant mortalities, a government program called Desa Siaga (Alert Village) has been rolled out by the Indonesian Ministry of Health targeting rural and poor regions.
Desa Siaga programs aim to encourage self-reliant communities that actively address their own health challenges, such as maternal and infant mortality. Through this initiative, the government provides a childbirth allowance that pays all expenses incurred at a state hospital. Women must first go to their health post for prenatal appointments to receive the allowance.
In Pakan Sari, community members started a forum to discuss needs and healthy practices surrounding childbirth and pregnancy. Everyone in the community — husbands, neighbors, community leaders, midwives and health cadres — has a role to play in promoting birth preparedness. This participatory approach is aimed at raising awareness that pregnancy should not be a private concern affecting women only.
Supporting this initiative, ChildFund works with its local partner organization, Warga Upadaya, strengthening the health cadres’ capacity to assist midwives in the community. Health cadres attended training on monitoring of pregnant mothers, breast feeding, nutrition for children from birth to age 5, household economy management and community organization.
Each pregnant woman’s health status and due date is recorded, as well as who will assist with transportation or give blood if it’s needed. The record also shows the family’s financial resources, aside from the government allowance.
“We have endorsed the rollout of the Desa Siaga program in our neighborhood for the last year,” says Sigit Murjati, a community leader. “We have developed a community savings system to prepare for the costs of childbirth.”
These financial contributions are used to offset the costs of transportation and medical care during and after childbirth.
When a state hospital is full, and the mother is then referred to a private hospital, the savings play a critical role since the government pays only for a stay at a state facility.
With the community preparedness system in place and health cadres all trained, Pakan Sari can better meet the needs of mothers and newborns. At the launch of the Desa Siaga program on May 15, 99 health cadres from 22 health centers came to Pakan Sari, as well as the sub-district head.
“This launching of Desa Siaga by the sub-district head is recognition from the government to the health cadres and the entire community,” says Sri Dwi Lestari, a community leader who works for the local health department. “This makes the community feel that they own the program, since the health cadres are all community volunteers. If the community doesn’t feel like they own the program, the program would not run so well.”