MATERNAL MORTALITY IN
INDONESIA
In most undeveloped countries the
joy of bringing a new life into the world is often replaced with the sorrows of
a mother passing. Health officials have struggle in creating approaches to
combat the staggering rates. Many of the approaches designed to lower rates focus
heavily on biomedical care. Biomedical approaches improving these causes have
not substantially lowered rates. The
problem lying heavily in its weak ability to connect the approach to the social
reality of the people. In this review I will explore the ways in which cultural
factors prohibit the use of biomedical care and the need to create a framework
that addresses socio-cultural factors in Indonesia. Using the medical
anthropology approach allows us to understand why strategies proven effectively
in developed countries are falling short in undeveloped nations. Ethnographic
research shows the areas in which biomedical approaches have failed in order to
modify for a better solution.
Maternal mortality rates have
produced serious public health concerns, over half a million women die every
year from giving birth. An overwhelming 99
percent of those deaths happen in developing countries. The World Health Organization
defines maternal mortality as, “the death of a woman while pregnant or within
42 days of termination or from any cause related to or aggravated by the
pregnancy or its management. (2011).” The WHO states that causes are due to
medical complications, health policies that affect availability, accessibility,
quality of reproductive health services and underlying socio-legal conditions (Global
Health Watch 125). Solutions include family planning and medically training
midwives. Also, the Safe Motherhood Initiative that gives planned parenthood option
like contraceptives to rural women. Global representative pose the issue as a
human rights issue. It states that, “failure to address preventable causes of
maternal death is a violation of women’s rights (Global Health Watch 130).”
Although global health representatives do classify maternal death as a public
health issue, little focus is given on why biomedical care alone isn’t making
much of a difference as well as the underlining causes.
My
approach of this problem is stemmed from the article written by M. Cameron Hay.
In the article, Dying mothers: Maternal
mortality in rural Indonesia the
author argues that the perception of death, cultural stigma and social
relationships prevent individuals from utilizing biomedical care, ultimately
leading to maternal death. He also
argues that simple biomedical fixes have not caused mortality rates to
decrease. Hay conducted his ethnographic research by doing fieldwork in a rural
village Pelocok in Indonesia where maternal mortality rates are high and through
extensive interviews. He follows the journey of two mothers Inaq Hin and Inaq
Marni who lose their life while giving birth.
DYING MOTHERS
Cameron Hay, in his article, Dying
mothers: Maternal mortality in rural Indonesia describes child delivery as a
cultural event and shows how biomedical interventions made no impact on saving
a mother’s life. In the Indonesian culture, midwives are responsible for the
maternal health and delivery of a child. These midwives are women who are
trained mainly through experience and little on science. After the delivery of
Inaq Hin the midwives experienced problems on getting the “afterbirth” placenta
to come out and immediately started to experience heavy bleeding. When asked to
take her to the hospital the midwives refuted it saying it’s too far, no
transportation, and little money. They stressed if Inaq Hin didn’t survive it
was her Allah’s fate to let her go. In a panic with nothing else to resort to the
midwives called upon Hay for guidance from his biomedical book, Where there is no Doctor (Werner 1992). Although
Hay tried to apply various techniques from the book, Inaq Hin eventually passed
away due to hemorrhage bleeding. After questioning the cause of her death the
midwives answered, “her time was finished. It is certain if her time wasn’t
gone the medicine would have been strong enough for her (Hay 254).” In the
second delivery of Inaq Marni who lived easily accessible to a hospital decided
to give birth in her hut at home. After giving birth to the first unborn child
the midwives realized she had another child inside of her not wanting to come
out. When Hay’s instructs to go to the doctor Inaq Marni says, “why would I
want to die over there (Hay 261).” After the midwives pulled the unborn fetus
out similar to Inaq Hin the placenta did not come out and experienced
hemorrhage bleeding. Inaq Marni and her two children passed away. When asking
the midwives about the cause of her death they placed the blame on the mother
for taking contraceptive pill and the midwives for their delivery mistakes.
Hay then analyzes the Pelocok people’s perception of death and
concludes the ways in which the biomedical approach needs improvement. He
advocates the need for better government training, communication regarding
midwives, increased access and cost, and the need for health care to be
familiarized more within the community. Child delivery in Pelocok is a
community event. He explain that it is important to make note of the way
communication between community members influences the midwives decision on how
to care for the mother. When creating an approach we must respect that some
religions have social hierarchy positions try to work along it and not force
them to assimilate to the biomedical culture we have in the U.S.
EXPLAINING DEATH: MEDICAL
ANTHROPOLOGY PERSPECTIVE
Medical anthropology allows us to frame maternal mortality
from multiple perspectives. It analyzes the ways in which members of the
community contribute and influence to maternal mortality. It shows the need for
solutions beyond the quick fix of simply placing hospitals in rural towns. For
example, in the suggestions implemented in the article, Hay’s makes account of
how in both cases of the mother their death was perceived as fate or through
error. Instead of dismissing their reasons as not logical because the lack of
evidence in science, it is important that we develop an understanding of their
cultural view and show where “fate” can be hope. Even when they did all they
could possibly do the people of Pelocok didn’t consider taking the women to the
hospital. Using medical anthropology concepts will allow us to see why midwives
would watch the mother pass than commute to a hospital. Medical anthropologists
surpass the excuse that fate determines ones death. Often times health
officials perceive that the women deny biomedical care because of their
distrust in it. In this case that was false, the midwives called upon Hay desperately
to look up medical solutions in his book. It is not that they are unsure of the science
behind the medicine but rather the cultural factors that keep them at a
distance. Medical anthropology shows us that the difference between the perceptions
of the people from biomedical specialists is one the reasons why maternal
mortality rates are increasing even more healthcare access. It also shows us
that social relationships and cultural meaning play a significant role in
maternal care. Through the medial anthropology perspective it is evident that
frameworks need to address socio-cultural forces affecting women in Pelocok
from receiving care.
COMPARING THE TWO
When comparing the
approach used by Hay to The Global Health
Watch Report 3, I found several differences on the perception of what is
causing the problem. In The Global Health
Watch Report 3 it discussed the Safe
Motherhood Initiative, which was designed to draw attention to important
factors like women’s reproductive cyle, pre-pregnancy, antenatal, delivery and
post-partum periods. The initiative however doesn’t provide a framework of how
women can receive care for their cycles rather on increasing awareness (Global
Health Watch 127). Another approach in the report included a framework for
maternal mother health and family planning. The frameworks focus is on health
systems and policies affecting the socio-political context of health (Global
Health Watch 131). Suggesting that increased access, more contraceptive methods,
and medical training would help decrease the rates of mortality. Interesting
enough the ethnographer refutes these claims, stating increased biomedical antenatal
care, trained caregivers, and increased access “do not effect whether or not a
woman dies (Hay 246).” Unlike global health representatives he shifts the focus
on how we can integrate biomedical care into the social reality of Pelocok. The
ethnographer’s work shows that research is not just about results. Global health
representatives are looking at the high rate of mortality in regards to how
they can improve the healthcare system. Through medical anthropology we see
that the people who do have access to the healthcare programs installed by the
government are still not utilizing them due to socio-cultural reasoning’s. Hay shows that a framework for trust is needed
to shift people’s perception about death in order for them to use the
biomedical care provided by the government. Rather than just training
caregivers on medicine, more training is needed on communication and comfort. The
medical anthropology approach differs from the Global Health approach, because
it takes into account the cultures way of life and tries to connect biomedical
care to them by emphasizing with their conditions.
MY THOUGHTS
From a conceptual perspective,
examining maternal mortality through medical anthropology concepts allowed me
to see the ways in which socio-cultural factors contributed to the increased
mortality rate. Prior to the concepts, when hearing about women dying in
undeveloped countries from pregnancy my initial reaction would be similar to global
health representatives. My frameworks would focus on advocating for more access
to hospitals, healthcare policy reform, and better training. However, the
medical anthropology approach allowed me to see the culture’s perspective of
maternal care. It brought more focus on how maternal care is a social role of
the community, extending far beyond a visit to the doctor like in the U.S. In
the Pelocok culture, the midwives are given the responsibility of caring for
the mothers using religious factors. Applying the medical anthropology concepts
shows that in different societies where cultural factors are different, special
frameworks are needed that cater to that culture’s beliefs.
In a practical perspective, frameworks
for maternal mortality need to include the socio-cultural position and beliefs
within a society. The global health approach of reforming healthcare and
forcing biomedical care onto the people is proven effective in the United
States however; the cultural differences between nonwestern societies are
dramatic. Pushing for solutions that work in one society onto others without
taking into consideration their difference in their social, economic/political,
and cultural infrastructure will not decrease mortality rates. Through
ethnographic research one can attest that in order to reduce maternal death we
have to include factors like perception. We must look at the perspective of the
individual, culture/community, and global health representatives. Viewing the
problem from more than one standpoint will allow us to not only understand but
make a more grounded solution. The medical anthropology perspective suggests
that in addition to the global health approach more work is needed
CONCLUSION
Thousands of women are dying every year and in some cases
leaving a newly born child behind. The skyrocketing mortality rate is extremely
hard to face knowing that we have the resources and tools to help save the
lives of these women. Only by creating frameworks that recognize socio-cultural
factors that create a road block for women to receive the medical care they
need, will the numbers start to decrease. In Cameron Hay’s work he shows that
the government’s solutions of building more hospitals in rural towns did not
help save mother Inaq Hin and Inaq Marni. The mothers refused to go to the
hospital. Using medical anthropology we can break down conflicts regarding
maternal care like different perceptions of death, cost/ access, and issues of
trust. In this way, people in undeveloped countries will not feel like they are
going out of their cultural, political/economic, and social comfort zones in
order for them to receive maternal care. The medical anthropology approach does
not dismiss the global health approach. It instead makes light of more socio-cultural
areas of concern than biomedicine and calls for improvement on relating the
approach to the social reality of people who live in rural environments.
Denden
Embaye
WORKS CITED
"Maternal Mortality: Need
for a Broad Framework of Intervention." Global Health Watch 3: An
Alternative World Health Report. N.p.: Zed, 2011. 124-32. Print.
Hay, M. Cameron. "Dying
Mothers: Maternal Mortality in Rural Indonesia." Medical Anthropology:
Cross-Cultural Studies in Health and Illness 18.3 (1999): 243-79. Taylor
& Francis Online. Web. 12 Dec. 2012.
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