Infant and maternal mortality cases continue to haunt poor people. They cannot afford proper medical treatment. With a sprig of jasmine, midwives in the remote villages of Jepara attempt to prevent it.
Twenty-five pregnant mothers gathered at the house of Supomo, 74, resident of Karanggondang village, Mlonggo district, Jepara regency in Central Java on Saturday (18/3) morning. The wives of laborers and fishermen were ready to do pregnancy exercises. They were women with high-risk pregnancies.
Dewi Pusporini, a village midwife, instructed the more than five-month pregnant women. The women were asked to lie on the floor, with their left leg bent upward, which they would slowly lift, while their right leg was straight.
“Let’s do it with the right leg now. This must be practiced frequently at home. Pregnancy exercises can reduce muscle tension in the joints and can ease births,” Pusporini said.
The exercises were part of the pregnant mother class (KIH). This program was the idea of doctors and midwives in the village to reduce infant and maternal mortality rate. Mlonggo was a district with a high infant and maternal mortality rate.
However, due to lack of transportation, many pregnant women in the Karanggondang fisherman village find it hard to attend the exercise class. Ultimately, they were picked from their home to the location. That morning, a health worker in the village, Nurhidayati, picked Sumini, 37, a resident of RT 008 neighborhood in Karanggandong village. “I was picked because my husband was not at home,” said Sumini, who is eight months pregnant.
Sumini said she was pregnant with her third child. Coming from a poor family, she understands the risk of maternity, especially for older mothers. By participating in the exercise class, she said she would be better prepared for maternity.
High risk
The prenatal class runs for about six hours. The class also saw the presence of Sunami, 34, and Yuni, 37, both of whom attended the 2016 class and had given birth to healthy babies.
In fact, their pregnancies were high risk. Aside from their ages, they also suffered from anemia, a low level of hemoglobin in their blood. One of the causes was the low nutrition of their daily intake.
Yuni came with her 7-month-old Iksan Agus Setiawan, while Sunami brought Moh Teguh Wiji Sampurna, also 7 months old. Their presence boosted the spirit of the pregnant women. “I was glad to be able to attend the class and give birth safely. Previously, we did not know that the exercises could help reduce risks during birth,” said Yuni, the wife of a construction worker. After the session ended, the pregnant women sat on a carpet. They shared information and gained knowledge from the midwives and doctors.
According to Sunarti, midwife coordinator in Mlonggo district, the class covered the facts and myths of pregnancy through post-maternity. “The first meeting discussed pregnancy, the myths and how to breast-feed babies. In the second meeting, the women are taught about sexually transmitted disease, health treatment, pregnancy exercises and healthy food,” she said.
In Mlonggo district, there are around 80,000 families, 55 percent of which were from medium-and lower-income families. They are recipients of insurance aid (PBI), a kind of Social Health Insurance (Jamkesmas) for poor families. Most of them are furniture artists and fisherman families.
Mlonggo Community Health Center (Puskesmas) head Eko Cahyo Puspeno said the exercise class was first introduced in 2013 by rural doctors and midwives. They agreed to call the movement Setangkai Melati (A Sprig of Jasmine), an acronym for Save and Spirit to Reduce Infant and Maternal Mortality Through Kind Services.
Keep declining
Data from the Jepara Health Agency shows the infant mortality rate stood at 191 cases in 2013. That figure decreased to 147 in 2014. In 2015, there were 134 infant mortality cases or 6.35 percent from 21,116 births. Meanwhile, maternal mortality stood at 26 cases in 2013 and 19 cases in 2014. In 2015, it declined to 11 cases from 21,116 births.
Eko said health workers regularly held meetings to discuss how to deal with pregnancy. Each midwife reported the condition of pregnant women in her field of work. They have data about high-risk pregnancy. Intensive treatment is continued until after birth. There is no limit for health treatment for maternity. The post-natal mortality rate is high. In 2015, for example, from 15 maternity mortality cases, six of them were post-natal mortality.
Pregnant women were also encouraged to register with the Healthcare and Social Security Agency (BPJS Kesehatan). The membership is crucial because if a pregnant woman gets Hepatitis B, she would bear high costs. “Each injection of immunoglobulin costs Rp 2 million to Rp 3 million. It is too costly without insurance,” Eko said.
In order to ease coordination, regency level doctors at Puskesmas, hospitals, gynecologists, pediatric and other health workers are connected to a Whatsapp group in order to deal with emergency cases. The progress of high-risk pregnancy can be monitored from early pregnancy to birth.
“This is to know who handles which pregnancy. Considering the pregnant women mostly come from poor families, the availability of rooms for BPJS Kesehatan patients in each hospital can be known,” Eko said.
Through the exercise class, pregnant women in Jepara can differentiate between the facts and myths of pregnancy. For example, a myth about pregnant women not being allowed to consume fish because babies would end up smelling fishy. The fact is that fish is a good source of protein, vitamins and minerals. “The class for pregnant women makes me confident in preparing for the birth of my fourth child,” said Sumiharsih, 38.
