English Reading Text For Midwifery Students
In Indonesia, Midwifery plays a particular role in
improving community, maternal and neonatal health, as well as contributing
towards the health targets set by the Ministry of Health. However, despite
their acknowledged importance, in 2001/2002 there were still only 26 midwives
per 100 000 of the population, which in absolute and relative terms represents a
severe shortfall.
One consequence of this is the high
maternal and perinatal mortality rates, the former being estimated at 307 per
100.000 live births in 2003. Infant
mortality rates for 2001 ranged from 51/1000 live births, to 46/1000 live
births, while the under-five death rate is estimated to be 68/1000 live births.
To assist deliveries the community
looks to traditional birth attendants (or Dukuns), who, despite limited
training and a low skills base, may be responsible for an estimated 34% of
deliveries. This is in direct contravention of the Midwifery Ministerial Decree
of 2000, which stipulated that only trained midwives be responsible for
deliveries. The basic education, training and skill base of the Dukuns are well
below the national standard of the trained Bidan Desa (also known as village
midwife).
Further midwifery support for remote
rural communities is provided by the Bidan Desa programme, consisting of a
one-year basic programme for graduates of a junior high school nursing
programme (which leads to a health certificate). Starting in 1989 and finishing
in 1996, when it was replaced by a three-year post-high school Diploma
Programme (D3) for midwives, the programme trained 59 000 midwives for rural
practice.
However, those midwives trained
under the system require regular updating, in order to enhance their skill
base. Data collected in 2001 suggested that over 90% of nurses and midwives
sampled had had no postbasic or continuing professional development (CPD)
training in the past three years, which in a global era of rapid health care
developments means that much midwifery care in Indonesia may not be conducted according
to current evidence-based best practice. This synopsis demonstrates the current
significant shortfall in provision, some of which may be suboptimal, and
confirms the need to train and develop increasing numbers of competent
midwives.
