Both districts are in mostly rural areas far from the city. This causes the public’s understanding of high-risk mothers to be poorly understood. With the factors of wide geography and far away health care facilities, delays in treatment can lead to maternal mortality. Essential trainings for health care workers are not covered in the local budget, and the districts do not support community empowerment activities.
The Grobogan District has more complicated maternal and overall health problems. There’s poverty, high infectious disease rates, high turnover rates among staff, and a special challenge of high rates of early marriage in Grobogan, which correlates with low birth weights. Women who get married before 20 have a much higher risk of giving birth to a child with low birth weight compared to women who are married at 20-30 years old.
During the second wave of the pandemic from March 2021 to December 2021, the mortality rate increased almost eight times in Banyumas, jumping from 11 to 84 deaths. In Grobogan, the mortality rate more than doubled, from 31 to 69 deaths. The majority of the deaths were from COVID-19. It was incredibly sad to know that the health system we just built was crushed by the pandemic. Before the pandemic, maternal death was decreasing.
Other than the mortality rate increase, the pandemic changed most of how we implemented the program. We couldn’t conduct on-site training due to government regulations on how many people can be in a room, and most maternal and neonatal training, especially in emergency response, needs to be face-to-face. Because of this, some of the activities were delayed.
There is a lack of education to the public when it comes to maternal health, a lack of skilled health care workers who handle the problems of mothers’ health, and there is a poor system used in handling maternal health in Indonesia.
During the implementation of the program, we found that the health system in place for the maternal and neonatal health program was not comprehensive. Even though maternal and neonatal health is a health-in-all policy, this doesn’t happen regularly in Indonesia. The local government should be the one taking the lead in each district, but it involves a lot of levels of approval from all levels of government, private- and government-owned health facilities, NGOs, and academicians in the district.
