Friday, April 21, 2006

Worst health service? High maternal mortality rate?

Which of these countries has the worst health service:

Singapore, Malaysia, Thailand, Philippines or Indonesia?

The Indonesian governement spends very little on health and government hospitals tend to be dirty and corrupt.

The following is taken from

Why is maternal mortality rate in Indonesia still so high?

By Indraswari, Bandung

According to Indonesia's Demographic and Health Survey, in 2002 the maternal mortality rate (MMR) was 307/100,000, meaning that for every 100,000 births, 307 mothers died from maternity-related causes.

Compared to her Southeast Asian neighbors, Indonesia's MMR is currently 65 times Singapore's, 9.5 times Malaysia's, 8.9 times Thailand's, and 2.3 times that of the Philippines.

Why is our MMR getting so high?

Part of the reason is the patriarchal society, in which there is a strong tendency to see pregnancy and childbirth as women's business rather than a part of the society. As a result there is ignorance of problems related to pregnancy and childbirth.

Culturally, there is also a belief that maternal death is God's will. It is not uncommon to hear people saying that it is a blessing for a woman who dies during childbirth and that she will be rewarded with heaven.

Subordination takes place in many aspects of women's lives, and leads to the negligence of their reproductive rights. Women become powerless to make decisions related to childbirth and pregnancy. In a patriachal society, it is the husbands or other male figures of authority who make the final decisions for the women.

In terms of family planning programs, we should be aware that the use of contraception in developing countries differs to that in developed countries. In developed countries, contraceptive methods give more control to women with regard to their reproductive capacity: Whether or not they want to have children, and, if they do, when and how often they want to get pregnant.

In developing countries, the use of contraceptives does not necessarily aim to serve women and to support them to be more autonomous with their bodies. Critics of the family planning program in Indonesia highlight the fact that the program is still not implemented for the sake of women.

Instead it is more as a tool to serve political and economic interests -- that is to say, population control. As a result, more than three decades after its implementation, the program has done little to reduce the country's MMR -- a task which is supposed to be one of its main goals.

Women lack access to and control of information, education, employment and financial resources (among many other issues). Their limited access to information is closely related to literacy and educational levels, of which data from the Human Development Report shows that in 2000 Indonesia's women's literacy rate reached 82 percent, while the rate for men was 7 percent higher. In all educational levels the female student participation rate was lower than that of male students, and became worse the higher the level of education.

Society tends to consider education to be more important for boys than girls.

When girls are denied schooling as adults they tend to have limited exposure to information, including on reproductive health matters.

With low educational qualifications, women only have access t jobs as the bottom of the employment hierarchy, jobs that often lack welfare services. Even work does not automatically grant economic independence, since women do not always have control of their income. This lack of control of financial resources makes women unable to make independent choices about their reproductive health or seek necessary services.

Poverty makes the situation worse. There is considerable evidence that women comprise the majority of the poor. UN data shows that women account for 70 percent of the 1.3 billion people worldwide who live in absolute poverty.

As for Indonesia, the United Nations Development Fund for Women estimates that within the period of 1965-1988, 68 percent of the rural poor were women. Among the poor, women are the poorest because their poverty is likely to be affected by factors that do not affect men.

Subordination and lack of access and control lead to women getting less than men in intra-household distribution of resources such as nutrition and healthcare. Poverty and patriarchal norms lead women to prioritize to give the limited resources to their children and husbands first.

This situation systematically denies women adequate nutrition and healthcare, which contributes to the lower quality of women's life and causes various problems later when they reach a childbearing age. Reproductive health is a matter of concern not only when a woman gets pregnant, but is an accumulated process started from childhood.

Of all human development indicators, the MMR shows the greatest gap between developed and developing countries. Data from the United Nations Fund for Population Activities says the world's average MMR is 400/100,000, but there is a sharp contrast between the developed regions' average of 20/100,000 and the developing regions' 440/100,000. In every country, MMR is closely linked to macro economic conditions and women's relative position to men. Therefore it is no coincidence that the UN's Millennium Development Goals listed the reduction of MMR as a targeted program. By improving women's status and alleviating poverty, together in this country we can make the high MMR history.

The writer is a lecturer at Department of Public Administration, Faculty of Social and Political Science, Parahyangan Catholic University, Bandung.