Program En

Improving Women’s Health and Nutritional Status

Attempts to Improve Women’s Health and Nutritional Status

Meeting the women’s health and nutritional status, specifically maternal and reproductive health needs of women in Indonesia remains a challenge, especially among the poor. Despite substantial government effort, Indonesia’s maternal mortality ratio (MMR) is 228 per 100,000, amongst the highest in the region. [1]

Variance in maternal health statistics is extremely high across Indonesia, with the worst outcomes in Papua, which has a MMR of 1116 per 100,000 births. Maternal mortality represents the tip of the iceberg within the broader scope of reproductive health, which includes family planning and contraception for prevention of unwanted pregnancies, sexually transmitted diseases and HIV/AIDS, early marriage and pregnancy, unsafe abortion, and more. [2]

Issues related to reproductive rights have a long and controversial history in Indonesia. New Order programs to control fertility were intimately connected to social definitions of women’s role in society as supporters of male leaders rather than as leaders themselves. At the same time, civil society organisations such as the PKBI (Indonesian Family Planning Group) used global dialogue through forums such as the landmark 1994 Cairo International Conference on Population and Development to challenge gender stereotypes and to launch a national network of grassroots organisations that used reproductive rights to promote local level dialogue on the role of women. These debates continue through to the present day, with issues of reproductive and sexual rights becoming one of the major controversies between fundamentalist organisations and advocates for gender equality.

Women and girls living in poverty in Indonesia face significant challenges in accessing their reproductive health rights.[3] The key social determinants of reproductive health outcomes are financial means, education, and decision-making power/the status of women within the family.[4] The Government’s health and reproductive policy and legal framework reinforce gender stereotypes about women and motherhood with laws and policies that discriminate on the grounds of marital status and exclude unmarried women and girls from full access to reproductive health services. Other laws require the husband’s consent for married women and girls to access certain reproductive health services.[5]

Design consultations and research have found that without external pressure, internal health system reforms will not make sufficient progress towards remedying Indonesia’s unsatisfactory health performance, particularly in the poorest parts of the country. There are still gaps between what women need/want, what reproductive health care is available (and how it is provided), and what support the community provides (and how it is provided).

Constrained by multiple funding channels with different reporting requirements, health agencies staffed by people with poor or biased training on issues of reproductive and sexual health, and by the centralised control over human worker regulations and placements, few districts have developed the capacity to plan and manage their health budgets, to identify local health needs or to set targets and monitor progress.

Despite the overall obstacles to better health care for poor women, there are also a growing set of cases where reforms have been launched and have produced noticeable improvements. National initiatives such as the “Desa siaga” (“prepared village”) program run by the Ministry of Health and the Prosperous Family conditional cash transfer program hold the potential to focus resources and a delivery system that can overcome some of the macro level barriers.

AusAID’s Logica program has provided incentives to local health centres to cost and meet minimum service standards. The Ford Foundation and other mid-tier donors also have a growing body of experience of multi-stakeholder partnerships between local governments and NGOs that focus on reproductive health. In many if not the majority of these cases, the success of government and non-government programs at the local level is being driven by local champions who have the vision, commitment, and capacity to bring people together around a common approach to problem-solving. The program will support efforts to identify these local champions and provide them with the necessary skills and resources to work with others to create even greater positive impacts on their community. The program will collaborate closely with other partners, such as UNFPA and USAID, who are also working in this field.

This program will approach maternal and reproductive health through five possible entry points:

(i) research and analysis on the maternal and reproductive health needs from the perspectives of women and girls living in poverty themselves;

(ii) developing an advocacy agenda and follow-up program for the 2014 International Conference on Population and Development;

(iii) the provision of information to poor women on critical maternal and reproductive health issues and services

(iv) supporting emerging leaders in the community, government and within CSOs to plan, manage, and document innovative initiatives related to improving reproductive health; and

(v) supporting local and national advocacy to produce legal, budgetary and systemic reforms.

Proposed outcomes from work in this thematic area include:

(i) improved access to reproductive health information and services for adults and adolescents, particularly women and girls living in poverty in the areas of coverage (e.g. women receiving antenatal and postnatal checks, access to contraceptives and information on family planning);

(ii) more effective national advocacy for increased investment in maternal and reproductive health services;

(iii) improved maternal and reproductive health outcomes in the areas of coverage particularly reduced cases of maternal death from preventable/addressable causes such as hemorrhage and infections;

(iv) and improved redress and grievance processes and systems to monitor reproductive health service policies and practice.

Depending on dialogue with AusAID’s Papua working group, this component may also develop a free-standing program of activities for dealing with the health consequences of violence against women in Papua. This program will also cooperate closely with AusAID’s health sector programs in the design and implementation of partner activities, particularly the health systems strengthening and upcoming reproductive, maternal and child health programs.

[1] Indonesia Demographic and Health Survey 2007, Statistics Indonesia (Badan Pusat Statistik – BPS).Calverton, Maryland, USA: BPS and Macro International, 2008.

[2] As defined and outlined in the 1994 International Conference on Population and Development (ICPD) in Cairo

[3] Left Without Choice, 2010. Amnesty International

[4] World Bank. 2010. “…and then she died” Indonesia Maternal Health Assessment.

[5] Left Without Choice. 2010. Amnesty International