Policy Brief: Improving Maternal and Neonatal Survival in Indonesia

The country's maternal mortality ratio is 305 maternal deaths per 100,000 live births, which is far above the Sustainable Development Goals (SDG) target of 70 per 100,000 live births. The leading causes of maternal death in Indonesia are hypertension, hemorrhage, non-obstetric complications, and obstetric complications. In contrast, a more recent study from Jember district found that obstetric hemorrhage caused the most maternal deaths, followed by pregnancy-related hypertension, and pregnancy-induced sepsis. The study also found that most mothers who died were not assisted by a doctor during delivery, and that over 90 percent of women who experienced a serious illness or complication did not delay seeking care. However, once they reached a health provider, 76 percent of these cases had to be referred on, or the women voluntarily sought care at more than one facility, resulting in delays in provision of appropriate care. Neonatal mortality in Indonesia is also unacceptably high, with a rate of 15 per 1,000 live births. Most neonatal deaths occur in hospitals, followed by deaths at home, in other health facilities, and while on the way to health facilities. The leading causes of neonatal mortality in the EMNC study were prematurity, respiratory conditions including birth asphyxia and neonatal pneumonia, and infections/neonatal sepsis. The Government of Indonesia should select among measures to address the leading preventable causes of maternal and neonatal deaths. These measures include increasing coverage of quality antenatal care (ANC) to identify hypertension in pregnancy at the earliest stage, improving hypertension management in pregnancy and childbirth, implementing early recognition of risks for hemorrhage, implementing early recognition of neonatal respiratory distress and effective referral, and ensuring implementation of continuum of care for maternity and neonates. Policies may be implemented starting in Java and Bali, where 52 percent of all maternal and neonatal deaths occur. The focus should be on delivery and the following 24-hour period, as over one third of maternal deaths occur during this critical window. Accelerating the implementation of proper continuum of care, improving hypertension management in pregnancy, strengthening ability to treat hemorrhage at facilities of first contact, identifying risks in pregnancy for premature birth, managing neonatal respiratory disorders, and managing neonatal sepsis and infections are the six main policy options to address maternal and neonatal mortality in Indonesia. The characteristics of these policy options include addressing all pregnancy-related maternal mortality, most neonatal mortality, approximately 33% of all pregnancy-related maternal mortality, pregnancy, childbirth, and postpartum hemorrhage to prevent maternal mortality, neonatal deaths related to the risk of preterm birth, neonatal deaths related to neonatal respiratory distress, and neonatal deaths related to neonatal infection and sepsis. Areas for capacity strengthening include identification of pregnancy-related complications, identification and mitigation of potential risks of neonatal deaths, neonatal emergency care, community education, effective referral, quality care at hospital, community education, quality of antenatal care, refining guidelines for hypertension management in pregnancy and childbirth, vocational training of maternity staff in managing pregnancy, childbirth, and postpartum hemorrhage, identification of risks of pregnancy, childbirth, and postpartum hemorrhage, establishing guidelines for hemorrhage management, provision of quality care at hospital, availability of blood transfusion unit, community education, early recognition of risks of premature birth, and quality of antenatal care.