Baby Incubator Box Story

Premature babies, low birth weight, and maternal mortality rates are closely related.

KOMPAS/NINA SUSILO

A mother brings her toddler child to Kayubulan Village, Gorontalo Regency, Gorontalo Province, Friday (14/4/2023). Regularly measure the weight and height of toddlers to monitor the child's development while anticipating stunting.

Learning from a box of baby incubators which are lent for free can actually open up and explore real basic problems in the field. Prof. Raldi Artono, the owner of the free incubator, through a short discussion has revealed many problems that arise in practice in the field, which may have escaped our attention.

The birth problem of premature babies and low birth weight (LBW) in Indonesia is still a big problem and is still at a relatively high level. Premature babies always have LBW babies. The prevalence of premature babies in Indonesia is 7-14 percent, even in some districts it reaches 16 percent (Director General of Health Care, Ministry of Health 2022).

Premature birth, low birth weight, and maternal mortality rates are closely related. Based on data from the Maternal Perinatal Death Notification (MPDN), a record-keeping system for maternal deaths at the Ministry of Health, the number of maternal deaths in 2022 reached 4,005, and increased to 4,129 in 2023. Meanwhile, there were 20,882 infant deaths in 2022 and 29,945 recorded in 2023. The increase over the past two years indicates that this situation is not good.

Personal efforts in the journey of this free incubator program have apparently saved around 6,500 premature babies over 10 years, meaning almost 540 babies per year. However, compared to the annual birth of premature babies which reaches 600,000 people (Ministry of Health, 2024), this effort can only save 0.091 percent. This may not be a large number, but from the 10-year journey, the circle of problems can then be uncovered.

The first circle of issues concerns the nutritional adequacy of mothers and premature babies–tengkes (stunting). One of the causes of premature babies is that while they are still in the womb, the mother does not receive enough nutritional intake or healthy food. A premature baby is often at risk of experiencing various health problems. One of them is having less height, as well as having a stunted body, when starting to grow. Stunting? According to Prof. Dr. Rinawati (2023), premature babies contribute one-third of babies to tengkes and two-thirds contribute to the infant mortality rate. What this means is that the problem of stunting is not the child experiencing stunting, but rather the nutritional adequacy of the mother during pregnancy.

The second circle of problems concerns the incubator-mother's emotional-baby confusion. Two-thirds of the infant death rate due to premature babies is a large proportion. Why are so many premature babies not saved? This is also a circle of problems in itself. Premature babies really need warmth because there is a temperature pressure from the comfort zone in the stomach of 37degrees Celsius then to the outside environment where the temperature can change from cold to hot. An artificial warmer that is made to mimic stomach temperature is an incubator.

Unfortunately, what's on the mother's mind is "being put in an incubator requires money." The mother will definitely be anxious and emotional. What will be the consequences of an anxious mother? Emotionally, the relationship with the baby becomes uncomfortable. The baby will surely feel it even though they cannot speak yet. However, babies need a healthy emotional and physical environment. Once again, like the proverb "when it rains, it pours," premature babies are already physically vulnerable to disease, coupled with emotional disturbances and disruptions.

KOMPAS/PRADIPTA PANDU

Professor at the Faculty of Engineering, University of Indonesia, Raldi Artono Koestoer with a home incubator for premature babies.

As a curative measure (after the fact), the cost of incubators certainly has an impact. Those who are able - the upper social segment - may not have too much of a problem paying even if they use imported incubators at high prices. In this segment, cases of prematurity are also rare because the nutrition of the mother and baby is guaranteed to be good. The middle social segment often weighs the "rental cost" of incubators, and it can also be ensured that there are not many cases of prematurity.

What about the lower social segment? This may be covered by the BPJS social security program, but what about their babies and their parents? Babies certainly do not have ID cards, so are they covered by BPJS? Administrative issues may become a hindrance for the baby. And what about the lowest social segment? It may exist, but certainly not covered by BPJS, coupled with poverty levels that prevent babies from being covered.

Welfare level supply chain

So, the important point that must always be reminded is that the first curative action is through the availability of baby incubator medical equipment, usually accompanied by bilirubin boxes which are affordable to rent, even free, and in large quantities. "We are in this segment," said Prof Raldi. Second, preventive action by maintaining the nutrition of pregnant women which is the root of the problem of prematurity, tengkes, and ultimately affects the quality of Indonesian people.

Premature-about-malnutrition-poor economics is a supply chain of low levels of welfare. The national problem related to tengkes which has been explained above, especially due to malnutrition, must be resolved. The mother must be given good nutrition, especially during pregnancy. What European countries are doing with maternity benefits should be used as a benchmark.

Based on data analysis for 10 years, the factual distribution of free incubator lending areas also reflects the level of poverty in the area. This means that poverty is closely related to the birth of premature babies. And continuing, if we look more deeply, it is also in that area that many cases of stunting occur. In fact, being a physically and emotionally healthy human being is the right of all human babies.

Inviting countries to get involved

Providing free incubators through personal activities is not enough. Affordable and available incubators are just a small part of curative activities. Meanwhile, there are other activities that complement it, namely preventive activities. The target is clear: providing affordable incubators for premature babies, ensuring the nutrition of mothers during pregnancy, and targeting poverty-stricken areas where mothers and babies may be located.

This movement clearly needs to be massive and of course requires a special program due to the cost involved. This is the most possible way to cut the chain of fundamental problems that affect the quality of Indonesians' lives. The country must certainly be involved in this movement.

The issue of the government's upcoming efforts to improve the quality of Indonesia's population through a free school lunch program directed towards students should certainly be appreciated. However, considering the aforementioned problem, attention should also be paid to the root cause of students experiencing malnourishment, which is the insufficient nutrition of their mothers.

It would be great if this program is also equipped with a proper nutrition program for pregnant women, especially in areas prone to malnutrition. It can be called the Free Lunch Program Plus, making it a more comprehensive program. The issue should be solvable. The involvement of the state through this new government program should be encouraged and supported. Lastly, I dedicate this article to Prof Raldi Artono Koestor, a teacher, friend, and Kick Andy Heroes 2022.

ARSIP PRIBADI

Sri Bramantoro Abdinagoro

Sri Bramantoro Abdinagoro is a senior lecturer at the Binus Business School Management Doctoral Program and a member of the Indonesia Strategic Management Society