‘Letter to a friend’ campaign promotes healthy pregnancies in Indonesia

By Ahmad Pathoni

TIDORE, Indonesia, 22 July 2010 – Nafisa, 30, lost two of her four children before they turned one year old. They had fever and she took them to the local community health centre. “They could not be saved,” she says. “I was very sad.”

Nafisa is pregnant again, but this time she has every reason to believe that her baby will be born healthy, because she recently received a written invitation to attend an antenatal clinic in Tidore.

She can’t read, so she took the note to a neighbor who could. It came just in time. A check-up by village midwife Siti Fara revealed that Nafisa had an extremely low red blood cell count – an indication of severe anemia, which could lead to potentially fatal complications during pregnancy.

“So they gave me pills for my blood and asked me to eat a lot of vegetables and fish,” says Nafisa.

‘Respected and honoured’

Ms. Fara and two other health workers are behind a new UNICEF-supported campaign to send formal invitations to pregnant women asking them to come in for ante-natal check-ups. They developed the idea for the ‘Letter to a friend’ campaign at a UNICEF-sponsored workshop in 2008.

© UNICEF Indonesia/2010/Purnomo
Midwife Siti Sara monitors Nafsia’s pregnancy at a community health centre in Tidore, eastern Indonesia, where UNICEF is promoting innovative ways to lower child mortality and improve maternal health.

The programme is having a significant impact in Tidore, a small island town in the far flung eastern Indonesian archipelago that suffers from a lack of skilled midwives.

“In our society, people feel respected and honoured when they are invited through a letter,” says the head of the Tidore Kepulauan Health Office, Dr. Harun Konaras, “so it’s an innovative way to encourage women to have pregnancy check-ups.”

Inequalities in maternal health

Almost 20,000 women die from every year in Indonesia from complications relating to pregnancy, the rate is amongst the highest in Asia.

© UNICEF Indonesia/2010/Purnomo
After receiving a formal invitation from UNICEF, Nafsia has an antenatal check-up at a community public health centre in Tidore, Indonesia.

And while the latest data show that more than 70 per cent of deliveries in Indonesia are attended by skilled medical practitioners, it also reveals the deep inequalities between provinces. Jakarta has 97 per cent coverage compared to just 33 per cent in the Maluku islands, where Tidore is located.

Tidore Kepulauan’s district officer for maternal and newborn health, Sukma Albanjar, says past reliance on traditional birth attendants, or ‘dukuns’, was also complicating efforts to improve maternal health in remote areas. UNICEF is helping to address that issue.

Under a new local partnership between traditional birth attendants and midwives, dukuns no longer assist delivery directly. Instead, they refer their patients to skilled midwives or doctors. Dukuns also help deliver the ‘Letter to a friend.’

“Through the partnership, deliveries assisted by skilled health workers have reached nearly 100 per cent,” says Ms. Fara, “and so far in my village no mother has died during childbirth.”

Averting needless tragedy

Ms. Albanjar notes that Nafisa’s case highlights how effective a simple idea can be. Without the invitation campaign, she says, “it would be very difficult to reach women like her because there’s a shortage of health workers.”

© UNICEF Indonesia/2010/Purnomo
Fahria Mustafa 29, and her daughter Aisha Gurabati village, located in the Maluku islands of Indonesia, where UNICEF’s ‘Letter to a friend’ initiative promotes maternal and young child health.

Meanwhile, Nafisa remains optimistic that her fifth pregnancy will not end in needless tragedy as two others have done.

“I was proud and happy to receive the letter,” she recalls, smiling broadly. “I hope my baby is healthy.



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