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Breaking Down Myths and Cultural Barriers to Save Mothers’ Lives in Rural Indonesia

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A disproportionate number of women die from preventable pregnancy-related causes in rural Indonesia. Most of them deliver at home with traditional birth attendants who are not equipped to handle complications during labor and childbirth, contributing to Indonesia’s high maternal mortality rate—one of the highest in Southeast Asia.

Meet Fani Fitri Yanti, 34, a village midwife at a government-run community health center in Serang, Indonesia. She has been a midwife for 12 years. Yanti describes rushing, a few years ago, to attend to a woman who had given birth in her bathroom. By the time Yanti arrived, the woman had fallen into shock from excessive bleeding. Thankfully, Yanti managed to administer emergency first aid and get her to the hospital in time, and mother and baby survived.

“It was a near-death experience,” Yanti recalls. “The 25-year-old unmarried mother had not told anyone about the pregnancy and was trying to deliver the baby on her own. I was very scared that she could die.”

Recently, Yanti was called to attend to a pregnant woman with pre-eclampsia whose husband would not allow her to go to the health center. He was afraid she would be referred to the hospital. With six children already, he didn’t have money for hospital bills. Yanti had to come in the middle of the night and get the authorities to intervene to get her to the health center. The situation became critical and the woman had to be transported to the hospital. Sadly, the baby died but the mother’s life was saved.

Since 2013, Johnson & Johnson Foundation has been partnering with Project HOPE to improve maternal, child and newborn health in Indonesia, and better position community health centers in rural areas to manage childbirth emergencies. Yanti is one of more than 3,000 midwives and community health workers who have received the “Saving Lives at Birth” emergency obstetric and neonatal care training through this partnership. Now, Yanti says, she and her colleagues can confidently handle most pregnancies and deliveries, including emergencies, and can administer lifesaving procedures such as neonatal resuscitation when babies are born unable to breathe on their own.

When she is not delivering babies, Yanti is educating her community about health-seeking behaviors that build awareness and provide access to primary care services, including prenatal care, childbirth services and immunizations.

From stigma to poverty, the reasons why families choose to give birth at home are many. Deeply entrenched social and historical practices play a big part, as well as long-held myths such as telling pregnant women to not eat too much—not taking into account that good nutrition is essential for a healthy pregnancy, or a common fear that hospitals should be avoided because they force women to get C-sections.

“We are really struggling to break these myths,” Yanti says. “The most challenging part is to gain people’s trust.” She is grateful for support from Project HOPE and the religious and community leaders who have joined in to help change minds and socialize healthy behaviors in her community.

One by one, Yanti is able to get women to attend pregnancy classes and convince them that delivery at the health center would be more comfortable, hygienic and safe for mother and baby. With outreach, more and more women are delivering safely at the health center instead of at home, and mortality rates are dropping in her village.

“They begin to trust me more when they work with me and then tell each other about me,” she says.

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Yanti providing immunization for babies, with minimum and modified PPE including a homemade face shield

This kind of frontline work that Yanti and her colleagues do in their communities has become harder with COVID-19, but all the more essential. She battles some of the same cultural challenges while dealing with the pandemic. “Many in our communities consider it an urban disease and believe that the virus will not come to their village,” says Yanti.

She takes the same grassroots approach of educating and changing minds when it comes to COVID-19, reminding people to follow government health protocols including wearing masks, handwashing and physical distancing. With limited access to PPE and testing, Yanti and her colleagues are anxious they could get infected and infect their own families. “Without free testing, providing healthcare to the community is risky as we don’t know who in the community is infected or not,” she says.

But regardless of the risks, Yanti says, the work must go on. “To withdraw my work as village midwife when the community trusts us and they come to us first to seek information—that is not my way. People in my village depend on me, and my work is my passion. When faced with difficulties, I face them by seeking solutions.”