By: Kurnia Ramadhani
The sad phenomenon
Yayuk, a pregnant woman in Tongas Wetan village, cried because she lost her newborn baby because of anencephaly. She said she deeply regretted not taking iron with folic acid (IFA) regularly. In her house, she showed us a couple of packs full of pills she had gotten since early pregnancy. Meanwhile, Nikma a pregnant woman in the same area feels worried about her pregnancy. She wants her baby to be born safe and healthy. Yayuk’s experience should not happen to Nikma or other pregnant women.
“Cases of maternal and neonatal mortality in Indonesia remain high among Southeast Asia countries. East Java becomes one of the provinces with the highest case with Probolinggo District in the top position. Tongas, as one of the sub-districts is facing the same problem. Every year, we sadly face neonatal mortality because of congenital anomalies. Every month, we cry at low-birth-weight babies because some of them are at risk of death and some have died. The main cause is anemia, which is preventable for pregnant women. And how to prevent it? The answer is adherence to taking Iron-Folic Acid (IFA) tablets.”
IFA is an important micronutrient for the growth, development, and maintenance of health for the mother and her fetus during pregnancy. The need for IFA increases during pregnancy to meet the daily requirement for the development and growth of the fetus during pregnancy. Increased adherence to IFA supplementation during pregnancy was associated with a reduced risk of anemia for the mother and congenital anomaly and low birth weight for the newborn.
How can we change this phenomenon?
Healthy mothers and baby are the dream of Tongas, Indonesia, and the world.
As a public health promoter, it is sad to see the phenomenon of maternal and neonatal morbidities and mortality; however, I believe that there must be something that can be done to better pregnant women’s health behavior and change this situation.
I had a discussion with health providers in primary health care (PHC) facilities in Tongas about cases of neonatal mortality due to congenital anomalies and low birth weight. They stated various factors, including nutrition, medication adherence, and environmental health. Finally, we found a similarity in the causal factors, which is that almost all cases showed that the mother had poor adherence to taking IFA. A pregnant woman has predisposing factors such as knowledge, education, socioeconomic status, and age. Meanwhile, she has enabling factors such as access to information, access to health facilities, and other supports (either family or peer).
The PHC doctor said that she often found pregnant women who did not know the importance of IFA, so they often forgot to consume it once a day. When they have to travel to another city or visit their parents, they did not bring IFA.
Village midwives said that they were sad and frustrated to see the truth of neonatal mortalities because of the mother’s non-adherence to taking IFA. The midwives said that they could not monitor the adherence for each pregnant woman since there are hundreds of pregnant women at the same time that they need to monitor.
I discussed with three pregnant women the approach they need, and they said they want something as easy as possible, more private, with no need to go far, and free of charge. I asked how, if there will be regular assistance, to monitor IFA adherence, and they said they will be very happy to have it.
Who will provide the assistance? I see community volunteers or cadres in each sub-village as potential. They are superwomen who are willing to help the community improve their health, including mother and child health. They come from various levels of education, communication skills, and motivation. Some of them feel doubtful to assist. Thus, training health cadres to assist is crucial before starting to assist. To get more information, I discussed with three health cadres about the mechanism, and they said it would be easier if more cadres were involved and assisted pregnant women who live in the same sub-village.
How does the initiative work?
Through ThinkWell’s Samya Stumo Fellowship, I desire to empower the community to improve the knowledge and adherence of all pregnant women toward IFA through an initiative called Pregnant Women Buddies. The health cadre will perform a weekly home visit to give motivation and education about the importance of IFA and support dietary behavior. This assistance will be given to all pregnant women from the beginning of pregnancy until postpartum. The health cadres will also be willing to accompany pregnant women in accessing health services at the village midwife’s facility or PHC. Through this initiative the following will be true:
I am looking forward to the future of Pregnant Women Buddies for mothers’ and babies’ health, and I am inviting other visionary partners to join this initiative.