Maternity and Infant Care: It Takes a Village

KOMPAS/MEGANDIKA WICAKSONO

Darmin

Childbirth can be a life-and-death experience for a woman. A woman may need help during and after childbirth, not only from her family but also from her community, both of which may have a limited capacity to do so. Darmin, 73, a retired teacher in Kalisasak village, has started a fund-raiser to ease the process and experience of childbirth for women.

“We must prevent mothers from dying during childbirth,” Darmin said on Friday (21/9/2018) at his home on Budaya alley in Kalisasak village, Kebasen district, Banyumas regency, Central Java.

Through the Mother and Children’s Health Forum (FKIA), which he founded in 2012 in collaboration with the USAID’s Expanding Maternal and Neonatal Survival (Emas) program, Darmin asked each family to set aside Rp 1,000 a month to raise community funds to provide maternity care for women in the village.

“It is not [community] dues, but infaq [alms]. Dues are usually large, but infaq is voluntarily and can be lower or higher than the set amount. Sometimes, people donate Rp 5,000 or Rp 10,000,” said Darmin, who has four children and 10 grandchildren.

In the first three months, the village raised Rp 9 million from its population of around 3,700 households. By September, the village had raised a total of Rp 456.45 million, of which Rp 351,175,000 had been distributed to 809 women.

“The assistance is not much, only Rp 150,000 for women giving birth at a puskesmas [community health center] or Rp 300,000 for childbirths at a hospital. There are 15 to 25 births in the village every month,” said Darmin.

In the beginning, Darmin said he was pessimistic that the initiative would take off amid the skepticism among many residents. Still, Darmin and FKIA volunteers campaigned in the village’s neighborhood (RT) and community units (RW), as well as in its hamlets, on the importance of maternity and prenatal care.

“At first, I was pessimistic because I had to take care of pregnant women, who didn’t know their due date. We didn’t know if she was healthy or not. However, after [the initiative] started, I spoke to the villagers, for instance, about how they would feel if a member of their family died during labor, that they would surely mourn,” he said.

Later, the infaq initiative for maternity care was regulated under Kalisasak Village Regulation No. 05/2013 on fund-raising. The regulation stipulates that the infaq is collected to support the Emas program to help improve maternity health and lower the infant mortality rate in Kalisasak village.

“Each RT collected the money and the RW [head] deposited and managed the funds,” he said.

In addition to the infaq collection, Darmin and 27 FKIA motivators working at posyandu (integrated health post) in 13 RWs worked actively to remind pregnant women to get regular check-ups, maintain their diet and keep their environment clean. “When a woman becomes pregnant, the team will go to her house and place a sticker on it. The sticker indicates that there is a pregnant woman in the family, which puts the family and their neighbors in ‘alert mode’,” said Darmin.

Their efforts did not stop there, and he also campaigned for a blood drive in the village and persuaded those who owned cars to volunteer in transporting pregnant women to puskesmas or hospitals when they commenced labor.

“Only 13 cars were on standby in 13 RWs. But today, there are 97 cars ready to transport the pregnant women,” he said.

The availability of cars and drivers is crucial, as Kalisasak village is located 4 kilometers from the nearest puskesmas in Kebasen. If the woman requires emergency care, the nearest hospital is around 10 kilometers from Kalisasak village in Notog, Banyumas.

“If a resident needs a car to transport a woman in labor, they need only ask the RT [chief], who will locate an available car,” he said.

For his holistic efforts, Darmin received an award from the Central Java governor on Jan. 27, 2015, during the Saving Mothers and Newborns Emergency Meeting-Mini University in Semarang.

Personal experience

Darmin’s drive and motivation in maternity health and healthcare in his village comes from personal experience. In 1998, his younger sister Samidah, who was 30 years old, died during childbirth.

“She was having her fourth child with the help of an uncertified midwife. The baby lived, but the mother died. The placenta did not emerge. My sister was taken to a hospital in Purwokerto, but died on the way,” Darmin recalled.

Darmin said care and monitoring for pregnant women was critical. Pregnant women usually felt anxious, fear and pain during their pregnancy or during labor. The presence of others like health workers or posyandu motivators helped them a lot.

“I want people to care more for pregnant women. This is humanity,” he said.

Villagers Ika Maryanti, 33, and her husband Sudar, 38, felt they were greatly helped by FKIA motivators, who reminded her regularly to get a check-up, take vitamins or attend maternity sessions with other pregnant women, and to maintain her health during her pregnancy with her third child. Today, the child is 5 months old.

Ika paid Rp 700,000 when she gave birth at a puskesmas. The Rp 150,000 maternity assistance from the village’s infaq fund helped reduce the financial cost.

The efforts of the health motivators and Darmin have helped reduce the village’s maternity and infant mortality rate. No maternal deaths have occurred in Kalisasak village since 2013. While infant deaths still occurred, the number had declined.

Puskesmas Kebasen’s 2015 data recorded 961 births in Kebasen district and 11 infant deaths. Of the 11 infants that died, three were from Kalisasak village (27.3 percent), apparently because they were born underweight.

There were 898 births and five infant deaths in 2016. Of the five infants that died, one infant was from Kalisasak village (20 percent). In 2017, nine infant deaths were recorded among 942 live births; of these, one infant from Kalisasak died (11.1 percent) from respiratory complications.

“The FKIA in Kalisasak has become an example for other villages. The residents have a high awareness of paying close attention to the health of pregnant women. They will closely monitor high-risk cases,” said Puskesmas Kebasen midwife Retno Wijayati.

Banyumas Health Office head Sadiyanto appreciated the efforts of the Kalisasak villagers, and said that better maternity care was needed in all villages. “We need many other Darmin,” he said.

KOMPAS/MAGANDIKA WICAKSONO

Darmin

Born: Banyumas, July 19, 1945

Wife: Hadmiyah, 70

Children: Hadirin, 53; Haryanto, 51; Daryanti, 47; Mintarsih, 43

Education: Major in elementary education, Purwokerto Open University (1998)

Occupation: Civil servant, elementary school teacher (retired, 2005)

Organization: FKIA chairman and founder, Kalisalak village, Kebasen, Banyumas