Reducing Maternal and Neonatal Mortality in Indonesia Saving Lives, Saving the Future (2013) / Chapter Skim
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2 Following common usage, we use the abbreviation MMR for maternal mortality ratio, the number of maternal deaths per 100,000 live births, and NMR for neonatal mortality rate, the number of newborn deaths per 1,000 live births. The analogous maternal mortality rate is obtained by dividing maternal deaths by person-years of exposure.
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Because maternal and neonatal mortality and some of their major determinants vary considerably among districts and municipalities, designing locally appropriate solutions is all important for program success. One striking example is the disparity in mortality rates between the more densely populated areas of the country and those that are more sparsely populated and thus face far more substantial transport and communications challenges.
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BEmONC facilities, by contrast, lack the capability to perform a cesarean section and to administer a blood transfusion -- the actions necessary to prevent the most common direct causes of maternal death in Indonesia. As an immediate first step toward realizing universal access to comprehensive emergency obstetric and newborn care when necessary, clear, rapid referral links should be estab lished between certified BEmONC facilities and their CEmONC counterparts throughout Indonesia.
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Within the resources of Indonesia, and probably those of any country, it is inevitable that technology and services-centered indicators such as maternal mortality ratio and neonatal mortality rates will vary. Technical strategies, implementa tion plans, and a road map to achieving high coverage with quality maternal and neonatal health (MNH)
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Sufficient and effective financing mechanisms for obstetric and newborn services should be established under the supervision of the government of Indonesia to en sure universal access to quality MNH care and strengthen the organization of that care. These mech anisms should include sufficient overall funding for the needed services; the appropriate incentives for women to deliver at a certified facility capable of providing optimal care and for providers to re duce unnecessary or inappropriate care; and effective monitoring and accountability mechanisms to plan and track financing, including some mechanisms for peoples' participation.
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This high-priority initiative must include clearly measurable and frequently as sessed indicators of progress, with additional resources provided whenever needed. In addition, a re invigorated family planning program should constitute an integral part of safe childbirth services of fered to Indonesian women to reduce the number of high-risk pregnancies associated with unwanted births, the number of underage and overage mothers, and very short and very long birth intervals.
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