Midwives

Though it hasn't even been one week in Jakarta, it feels like it's been two! I went to work the day after I arrived and met my translator, Ibu Isti along with some of my co-workers. Isti is a bidan, or midwife, who works her family's private clinic. She's also a former member of Indonesia's national women's basketball team member, and translator extraordinaire. Isti went to medical school but decided to become a midwife instead.

Midwifery in Indonesia is really widespread, and in fact there are too many midwives. Previously, the midwifery schools had better standards, but they've popped up everywhere making it very easy, and pretty inexpensive to get a certificate/degree. Midwifery jobs are pretty easy to come by, and midwives can either work independently as village midwives, work at government-run clinics and hospitals, or work privately in their own, or others', clinics. Access to medical care is different in Jakarta, but in the rural areas, many women still give birth at home with traditional birth attendants (women with no formal education) and consequently the maternal mortality rate (MMR) is still very high for Asian countries. More and more, women are using midwives, private clinics or government-run clinics, but the numbers are still dismally low. In January of this year, the government created an free insurance scheme called jampersal that makes it free for women to go to both public and private facilities to give birth. Once the facility claims the birth, they government reimburses them. The problem is that many women still don't know about this free service and so they aren't using it. I hope that we can educate women about it and encourage them to go to facilities instead of staying at home.

Not surprising, the cost of giving birth is much lower than in the US. But the prices vary depending on if you stay at home with a TBA or with a midwife, if you go to a public facility or to a private facility. The cost can range from 250,000 rupiah (RP) to 1,000,000 RP (approximately $27 to $120). One of the problems with jampersal is that the government will only reimburse 350,000 RP so the private clinics that normally earn 750,000 for one birth are having a difficult time and are trying to discourage the use of jampersal in their clinics.

Isti and I are working on a survey to ask women about their perceptions of giving birth in a facility. We are going to investigate the different reasons (cost, transportation, cultural values, etc) that influence women's decisions. Few surveys have been conducted about women's perceptions of health care, but we found a few that helped us to create the survey.

We're now in the final stages of creating the survey and we'll meet to discuss the content and to decide which districts we're going to visit to deliver the survey. The MCHIP project works in three districts in Indonesia: Bireun in Aceh, Kutai Timor in Kalimantan and Serang in Java. The map below isn't very detailed, but Bireun is just east of Banda Aceh, Kutai Timor is north of Samarinda and Serang is due West of Jakarta near the dot for Merak.

Hopefully we'll know our destinations and schedule today or tomorrow and can plan our interview schedule. Isti has worked as a translator with three other midwife volunteers here and I'm really looking forward to working with her and learning from her.