Rebuilding a safety net for new mothers in Indonesia

By Steve Nettleton

TANJONG VILLAGE, Indonesia, 20 April 2007 - On the outskirts of Banda Aceh, midwife Radliana is making a house call. She climbs the steps to a white house with a bright green door and knocks. "Salaam Alaikum," she calls.

When the door opens, Radliana is welcomed by Asri, 30, who is eight months pregnant. Asri is expecting her second child. She has little money for health care and is too far along in her pregnancy to travel to a clinic.

Radliana checks Asri's vital signs and listens to her abdomen through a silver cone. Everything seems normal, she reports.

Midwives like Radliana have traditionally served as primary caregivers for families in Indonesia. In Aceh, however, decades of unrest, followed by the 2004 tsunami, have led to a scarcity of proper medical resources.

Maternity services and essential care

But a new arrival to Tanjong village is changing that. Previously, mothers and children walked to Radliana's home for treatment. Today, they are heading somewhere else: to a gleaming new health centre built by UNICEF.

It is among the first of some 227 health centres UNICEF is building across Aceh and Nias Island. The centres are designed to combine maternity services with essential care, including giving immunizations, boosting nutrition and promoting healthy behaviour. Most centres will also offer learning activities for preschool-age children.

The new and planned facilities are part of an effort to restore Indonesia's 30-year-old 'Posyandu' system - a network of community-based health teams that collapsed in the late 1990s.

"In previous years, the Posyandu only had health services for mothers and children, but now, with this 'Posyandu Plus', we also give education, especially for children under five, and child protection services," says UNICEF Health and Nutrition Officer W. Niken Sasanti. "In other regions of Indonesia, the midwife sometimes doesn't live in the village. So it will improve the access of the community to health services."

Peace of mind for new mothers

Radliana says the new centre gives her more capacity to treat her patients. She and her family live in one half of the building, separated from the examination rooms.

"The response from the community has been very good," she notes. "They really like the building and it offers more convenience and privacy for them to come and check their health. Before, many were not comfortable coming to my house because there was only one room and my family was there."

Setia, one of seven pregnant women counting on Radliana's care, is worried about her unborn baby. Her first pregnancy ran into complications and required a caesarean section during delivery. She hopes to avoid surgery a second time. Setia is comforted knowing there's an improved health centre in case of trouble.

"Several years ago the midwife had to go from door to door. But now the service is better," says Setia. "The new midwife is more experienced in dealing with patients and we can get more medicine and more equipment."

The centre and its services also offer something hard to quantify: a little more peace of mind for new mothers in rural regions of Aceh.