Increasing access to trained birth attendants is vital to address high maternal and infant mortality rates in developing countries, something Indonesia is working hard to provide.

According to the World Health Organization (WHO): “Children in developing countries are ten times more likely to die before the age of five than children in developed countries.”

One of the reasons behind this, especially in rural areas, is related to access to health centers where pregnant women have to walk long distances, in some cases more than 15 kilometers to the nearest hospital.

This is one of the issues under scrutiny at the International Conference on Family Planning currently taking place in Bali, Indonesia (25-28 January) where the focus is on discussing global solutions through local actions.

Speaking at the conference, Benoit Kalasa, director of UNFPA, said: “There is a lot of positive work [family planning and birth delivery systems] taking place in local communities and all these integrate to ensure that we all achieve the 17 sustainable development goals.”

Bidan Delima in Indonesia 

One success story of local communities in action is the midwifery concept in Indonesia that has, for many decades, actively assisted women in giving birth.

Since 1967, Suri Wayan has been practising as a midwife in Denpasar helping her patients with quality service at an affordable fee.

She has been accredited for more than 10 years by Bidan Delima, a midwife accreditation programme run by the Indonesian Midwives Association. Bidan Delima works with private midwifes to maintain a standard of care, and aims to improve the quality of midwifery services in Indonesia.

Midwives accredited by Bidan Delima are authorised to provide obstetric care, family planning services and community health services. When it comes to family planning they also provide integrated HIV services. This includes safe conception counseling to couples planning to conceive (where one partner is living with HIV), antenatal care, and once pregnant conducting testing, including for HIV, to determine whether specific treatment will be needed to protect the baby from the virus and to provide treatment to the mother for her own health if needed.

As a Bidan Delima midwife, Wayan provides family planning and reproductive health services in accordance with WHO standards of safe delivery, which means having a trained birth attendant, at an affordable fee to hundreds of people in her community.

This work has been Wayan’s life for more than four decades and she demonstrates what the president of Population Services International Karl Hofmann was talking about when he said: “Health care is more about quality provided at an affordable price.”

With standard delivery rooms room, proper medication and supported by her team of local midwives Wayan assists around 30 women a day to give birth. Only when there are complications are women referred to bigger hospitals.

Bidan Delima is a success story of how supporting local communities can assist governments especially in developing countries to deal with maternal health and family planning related challenges.

Lessons for Africa

According to the World Health Organization: “Almost all maternal deaths (99 percent) occur in developing countries. More than half of these deaths occur in sub-Saharan Africa and almost one third occur in South Asia.”

One of the reasons for this in Africa is that most people offering midwifery services are not registered with authorities responsible for health and in most cases they do not meet WHO standards for safe delivery.

Others are largely traditional and unprofessional and the result has been increased maternal deaths and high infant mortality rate in some communities.

To address the challenges of high maternal and infant mortality, African governments must support local communities to set up midwifery services that will reduce risks faced by women especially those in rural areas.

Governments and development organisations should work together to assist communities in the development of primary health centers and training workshops, and ensure more traditional birth attendants are trained to meet WHO standards of midwifery.