Abstract

Kematian ibu tidak hanya menjadi masalah kesehatan masyarakat, tetapi juga menjadi masalah sosial karena akan berpengaruh besar terhadap keluarga, terutama anak-anak. Di negara maju dengan status sosial ekonomi yang tinggi kematian ibu telah turun mencapai tingkat minimal kurang dari 10 per 100.000 kelahiran hidup. Hal tersebut belum terjadi di negara-negara berkembang, termasuk Indonesia. Di samping pertumbuhan ekonominya yang terus membaik, kematian ibu di Indonesia masih tergolong tinggi, bahkan di antara sesama negara Asia Tenggara. Berdasarkan data SDKI, telah terjadi penurunan angka kematian ibu, tetapi dengan penurunan seperti sekarang target Pembangunan Milenium tidak akan tercapai. Dari aspek demand, supply, maupun kebijakan, penurunan kematian ibu masih mengalami berbagai hambatan. Untuk mempercepat penurunan kematian ibu perlu dikembangkan kebijakan yang dapat mengatasi hambatan utama berupa kelangkaan petugas pelayanan kesehatan yang terampil, infrastuktur pelayanan kesehatan ibu yang belum memadai, kualitas pelayanan yang sub-standar, dan keengganan para ibu untuk menggunakan fasilitas pelayanan kebidanan karena biaya yang sangat tinggi dan pelayanan yang masih buruk atau karena masih lebih menyukai pelayanan dukun dengan berbagai alasan lingkungan yang spesifik. Dalam mempercepat penurunan kematian ibu, kebijakan dan manajemen di tingkat kabupaten berperan sangat menentukan.

Maternal mortality is both public health and social problem. The death of a mother will affect the family, especially the children. In the developed countries, with their high socio-economic status, maternal deaths have declined to its minimal level, less than 10 deaths among 100,000 life births. That is not the case in the developing countries, Indonesia included. Despite its continued economic growth, maternal death in Indonesia is still high, even within Southeast Asian countries. According to IHDS data, maternal mortality eduction happened over time, however, with its current rate of decline the MDGs target on maternal mortality will unlikely be met. Maternal mortality reduction is still facing various demand, supply, and policy constraints. In order to accelerate maternal mortality reduction, policies are required to overcome various barriers, which include shortage of skilled health providers, inadequate maternal health infrastructures, sub-standard service quality, and unwillingness women to use maternity facilities due to its high cost and inadequate services, or their preference towards traditional birth attendant (TBA) services. Role of district policies and management on maternal health is crucial in accelerating maternal death reduction.

References

  1. BPS and Macro International. Survei demografi dan kesehatan Indonesia (Indonesian Demographic Health Survey/IDHS) 2002-2003. Calverton, Maryland, USA: BPS dan Macro International; 2003.
  2. BPS and Macro International. Survei demografi dan kesehatan Indonesia (Indonesian Demographic Health Survey/IDHS) 2007. Calverton, Maryland, USA: BPS dan Macro International; 2008.
  3. Pathmanathan I. Investing in maternal health – learning from Malaysia and Srilanka. Washington D.C: The World Bank ; 2003.
  4. WHO. Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and The World Bank. WHO: Geneva; 2007.
  5. Lerberghe WV dan Brouwere VD. Of Blind Alleys and things that have worked: history’s lessons on reducing maternal mortality. In safe motherhood strategies: a review of the evidence. Studies in Health Services Organisation & Policy. 2001; 17.
  6. Bappenas. Laporan perkembangan pencapaian millennium sevelopment goals Indonesia. Jakarta: Bappenas; 2007.
  7. Qomariyah SN. Besaran dan karakteristik kematian ibu di Kabupaten Serang dan Pandeglang, Provinsi Banten, tahun 2004 – 2005. Policy Brief. Immpact Indonesia. 2007; 1.
  8. Filippi V. Health of women after severe obstetric complications in Burkina Faso: a longitudinal study. The Lancet. 2007; 370: 1329-37.
  9. Adisasmita A, Deviany PE & Ronsmans C. Near-miss obstetrik sebagai indikator alternatif outcome kesehatan ibu. Depok: Immpat Indonesia; 2007.
  10. DBrouwere V & Lerberghe WV, ITM. Materi pelatihan reproductive health. Antwerp: Institute of Tropical Medicine; 2003.
  11. D’ Ambruoso L, Byass P Qomariyah SN. Maybe it was her fate and maybe she ran out of blood: final caregivers. Perspectives on access to care in obstetric emergencies in rural Indonesia. J Biosoc. Sci., 2010; 42: 213-41.
  12. The World Bank. “... And then she died”. Indonesia maternal health assessment. Washington DC, USA: 2010.
  13. Health Services Program. The 2008 annual report for the health service program. Arlington, Virginia, USA : USAID and John Snow International: 2008.
  14. Hatt L, Stanton C, Makowiecka K, Adisasmita A, Achadi E, Ronsmans C. Did the skilled attendance strategy reach the poor in Indonesia?. Bulletin of the WHO. 2007.
  15. Makowiecka K, Achadi E, Izati Y, Ronsmans C. Midwifery provision in Two districts ijn Indonesia: how well are the rural villages served? Health Policy and Planning. 2008; 23: 67-75.
  16. Immpact. Laporan Hasil Penelitian Immpact di Indonesia. Depok: PUSKA FKMUI; 2007.
  17. Ronsmans C, Scott S, Qomariyah SN, Achadi E, Braunholtz D, Marshall T, et al. Professional assistance during birth and maternal mortality in two Indonesian districts. Bulletin of the World Health Organization. 2009; 87.
  18. PUSKA FKM UI. Pengembangan model “penguatan sistem pelayanan kesehatan ibu dan neonatal di Provinsi Jawa Barat”. Makalah dipresentasikan dalam Lokakarya Penyamaan Persepsi tentang Konsep SafeMotherhood: dalam rangka pengembangan model “Penguatan sistem pelayanan. Depok : PUSKA FKM UI; 2007.

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