âCan you imagine what would happen if we couldn’t continue to provide family planning services? How many would have failed and resulted in unwanted pregnancies? ”
The question posed by Emi Nurjasmi, president of the Indonesian Association of Midwives (IBI) reflects the critical need to continue family planning and sexual and reproductive health (SRH) services during the COVID-19 pandemic. The United Nations Population Fund (UNFPA) Indonesia and IBI have worked together to mitigate the impacts of the pandemic on women and other vulnerable groups, and to ensure that women’s family planning and SRH needs are met. are continuously satisfied.
Maintaining access during a pandemic has not been easy. Midwives, like other health workers, face high risks of transmission and therefore need to ensure the safety of both their patients and themselves while providing services.
âA lot of midwives have been affected. A midwife who was 28 weeks pregnant when she was infected died in January, ârecalls Sri Helmi of IBI South Jakarta. Since the start of the pandemic, 472 midwives have been infected with COVID-19 in South Jakarta, five of whom have died, according to the IBI’s Jakarta Provincial Council.
The situation is similar outside of Jakarta. âIn Tangerang district, 169 midwives have tested positive for COVID-19. One died in January. In Banten province, 1,634 midwives have been infected, âexplains IBI Tangerang’s Een Setianah.
Unfortunately, purchasing personal protective equipment (PPE) can be difficult with rising prices and scarcity. As a result, services have been discontinued. âIn March, when the pandemic started, we all panickedâ¦ Some closed their practices, while others reduced their hours,â recalls Emi. âThe number of patient visits has fallen sharply by almost 50 percent,â describes Een.
Midwives also face challenges in following regulations that require them to refer pregnant women entering the 37th-38th week of their pregnancy to the public health center (puskesmas) to prepare for a safe delivery. âIt is difficult to provide referrals, especially for pregnant women and childbirths, as not all hospitals in Tangerang accept patients with positive rapid tests,â says Een.
UNFPA Indonesia distributed PPE consisting of hazmat suits, safety glasses, face shields, KN95 masks, medical masks, cloth masks and disinfectants to 1,780 midwifery offices. independent women in Jakarta, Depok, Tangerang, Bekasi, Karawang, Serang and Bandung, with support from Global Affairs Canada (through a joint initiative with UNICEF: Better Sexual and Reproductive Health and Rights for All in Indonesia / BERANI) and the Australian Department of Foreign Affairs and Trade (DFAT). UNFPA Indonesia is also supporting online midwifery training in collaboration with the IBI and the Knowledge Hub of Reproductive Health of the Faculty of Public Health of Universitas Indonesia (FKMUI).
âFortunately, we were given PPE to protect us,â says Sri. âWe feel more confident in providing serviceâ¦ Now we can continue our regular practice hours. It also helps us with our expenses, âsays Een.
The provision of PPE also enabled Een to offer free services in his clinic. âWe discovered that the reason why the number of patients dropped drastically was mainly due to the economic situationâ¦ So we decided to provide free services every Friday from 8 am to 4 pm,â Een describes.
When the second wave hits, midwives persevere
The COVID-19 pandemic worsened in June-August 2021 in Indonesia, when the number of new infections increased dramatically and peaked at 56,757 new cases per day in mid-July. Een and Sri were both infected, along with a number of staff at their midwifery clinic. âSo many people got sickâ¦ We saw a lot of midwifery deaths in Banten,â Een recalls. âI had to close my clinic for a week, but I still accepted patients who needed urgent services,â says Sri.
Sri saw a decrease in the number of patient visits during this period. âWe have seen less than 10 deliveries, whereas we would usually have more than 20,â says Sri. Now that the situation has improved, more patients have sought antenatal care (ANC) and delivery services at the clinic in Sri. Sri found that due to disruptions in service delivery, many pregnancies went unchecked for months, leading to health problems such as breast pain in pregnant women and fetal macrosomia. or newborns with excessive weight. To remedy this, Sri referred patients to obstetrics specialists, whose services are covered by Social Health Insurance (JKN).
Meanwhile, at Een’s clinic in Tangerang, the number of patients has almost doubled. âWe didn’t have enough health workers, so we had to cut our hours of operation for about a week. She still manages to provide free maternal health and family planning services every Friday, as well as her other charitable activities, despite these challenges.
The work continues
By disrupting essential sexual and reproductive health services, the COVID-19 pandemic has contributed to an increase in the maternal mortality rate in Indonesia, which is already one of the highest in Southeast Asia. With 305 maternal deaths per 100,000 births, two women in Indonesia die every hour from complications during pregnancy, childbirth and after childbirth (2015 Intercensal Population Survey / SUPAS 2015).
âWe need to work with all sectors so that the burden does not fall only on health workers and midwives,â says Een firmly. Een also stresses the critical need to improve public access to knowledge through information, education and communication (IEC) programs. âIf we just improve the services but access to knowledge is still limited, it won’t work.
Sri stresses the urgent need to build the capacity of midwives. âWe need special training to improve our skills and update our knowledge,â she says. Ultimately, this will contribute to better maternal health in Indonesia. âMy hope is that women can enjoy a healthy pregnancy, give birth safely and get help when they need it,â says Sri.
With all the progress made despite the challenges, there is good reason to be optimistic about a better future for midwives and women’s sexual and reproductive health. âAll the support leads to capacity building and services and to guaranteeing women’s rights to access reproductive health servicesâ¦ It’s a whole circle in which we all have to work and support each other,â Emi concludes.