Maternal and neonatal health and women’s burden

Maternal and neonatal mortality remains high in Indonesia and globally. The sustainable development goals have targets of reducing maternal mortality and reducing newborn and child mortality. The high number of maternal deaths in some areas of the world potentially reflects inequalities in access to quality health services due to a lack of information or other factors. Mothers die because of complications and most of these complications develop during pregnancy and are preventable. To prevent these complications, barriers that limit access to maternal health services must be identified and addressed at both the health system and societal levels. Moreover, maternal health and newborn health are closely linked. There is potential to improve the survival and health of newborns by reaching quality antenatal care.

Women have a huge burden from the beginning of pregnancy to the post-partum period. Women have significant roles in their baby’s health and safety; thus, women are an important group to be helped to improve their health. These efforts include the raising of awareness and knowledge, attitude, and behavior towards health as well as creating a support system for pregnant women’s health.

Pregnant women’s health problems such as anemia and chronic energy deficiency become a huge risk that influences the quality of their newborn’s health. The baby has the risk of low birth weight, stunting, or even death. Pregnant women’s health is also influenced by their nutrition status, their adherence to taking their vitamins, and their utilization of health services. In the preliminary research, data showed a significant correlation between knowledge and adherence to iron-folic acid (IFA) among 238 pregnant women in eight villages in Tongas, Probolinggo, Indonesia. I also found that there is a perception that mothers and pregnancy health are the responsibility of the women; however, men need to be involved more in health efforts as health is the responsibility of all.

Local women’s potential and community health center

A health cadre is a group that is mostly local women who care about their community health; they live with the local language and culture. Administratively, cadres are part of the village government, but they are community volunteers. In Indonesia, one district (or city or town) consists of several subdistricts, and each subdistrict consists of several villages, and each village consists of several sub-villages. For years, in Indonesia, the community health center (CHC) has had a strong partnership with the health cadre, especially in community-based health services for children under the age of five. Cadres are an important asset for public health. Their potential is huge given their strong motivation and empathy to be involved in health efforts. Moreover, they are comprised of women that naturally have a caring sense for other women that need help with their health. A cadre has the potential to provide a buddy or sister for pregnant women in their neighborhoods. While they mostly have little educational background, their skill could be improved through training and monitoring.

Generally, in Indonesia, one CHC working area covers around 26,000 residents. A CHC is placing health workers in each village so they can create partnerships including cadres. Every sub-village has a minimum of five health cadres, and in one sub-village there are one to ten pregnant women. Every pregnant woman knows the cadre as their neighbor, and through this initiative, the neighbor will become their sister or buddy. This role will make pregnant women more aware and adherent to their IFA intake, food consumption, and health service access.

This initiative is like a sisterhood chain where we, together with CHC women’s health workers, train 50 local women cadres, to make them feel empowered and confident to educate hundreds of pregnant women. Moreover, hundreds of pregnant women will feel more confident to improve their and their baby’s health.

Increasing the cadres’ capacity to assist as a sister

It is exciting to see 50 health cadres that were enthusiastic to enroll in the training to assist all pregnant women in their neighborhood. There are various skills and knowledge given to cadres including the following:

  • IFA importance
  • Monitoring adherence
  • Good food for pregnant women
  • Assistance methods for weekly home visits
  • How to measure the mid-upper arm circumference
  • Screening for anemia signs
  • How to use health education media and interpersonal communication
  • Building family commitment for mother and baby’s health

Based on pre- and post-test analysis, there is a significant increase in the average knowledge score among cadres in the pre-test (64) compared to the post-test (94).

Raising attention for pregnant women and their families

In the early stages of bringing assistance to pregnant women, the cadres faced difficulties, but in the next few weeks, they felt like sisters to the pregnant women and are grateful for this initiative. Pregnant women are looking for their buddy to ask for health information, including health service information, and assistance when accessing health services. Thus, the cadre has the potential to be the connector between CHCs or health providers for pregnant women. I believe that this initiative could be scaled up and will be implemented in other CHC working areas in partnership with the private sector. For these five months of assistance, we have seen the impact including the improvement of maternal health service utilization in village health services and CHCs, the improvement of pregnant women’s health condition in CHCs, women who give birth have mostly good conditions without anemia, and the number of low-birth-weight babies was also lower. Sisterhood in the neighborhood is our hope.