Saving Newborns in Indonesia

Indonesia

State of Indonesia's Newborns

Issues Influencing Newborn Health in Indonesia

Nearly 90,000 Indonesian children — or more than half of the country’s children who die each year before reaching the age of five — die as newborns, during their first month of life, based on data from Indonesia’s 2002-2003 Demographic and Health Survey. Most of these babies die from ailments safely managed in wealthier parts of the world — infections, birth asphyxia and complications from prematurity and low birth weight. In fact, three out of four of these deaths could be averted with affordable and practical care, as reported in the Lancet's 2005 Series on Neonatal Survival.

The problem of newborn deaths in Indonesia can be approached with lessons learned from the country’s past solutions to public health challenges. For example, according to Jeremy Shiffman’s "Generating Political Will for Safe Motherhood in Indonesia." when government officials learned in the 1980s that most Indonesian mothers gave birth without the help of a skilled birth attendant, Indonesia launched an innovative program to recruit, train and place midwives — or bidan di desas — in each of its villages. The home-grown program received international support, and by 1996, served nearly all of Indonesia’s communities.

Save the Children’s Newborn Health Accomplishments in Indonesia

Bidan di Desas and Birth Asphyxia

The Bidan di Desa program was successful, but more needed to be done. Though skilled in providing elements of antenatal, childbirth and postnatal care to Indonesia’s mothers and newborns, the bidans had neither the training nor the equipment to manage birth asphyxia, the condition responsible for almost a third of newborn deaths in Indonesia.

In 2003, Indonesia’s Cirebon District — where birth asphyxia caused 46 percent of the district’s 1,100 newborn deaths — became a model for saving newborn lives. There, the Indonesian government partnered with Save the Children and the Program for Appropriate Technology in Health (PATH) to train Cirebon’s 422 bidan di desas in identifying, resuscitating or referring newborns who suffered from birth asphyxia. Equipped with the affordable Tekno resuscitation device and thorough training, the bidans successfully managed 85 percent of Cirebon’s birth asphyxia cases through resuscitation or referral. The result: a 47 percent drop in birth asphyxia-specific newborn deaths (PATH, Reducing Birth Asphyxia Through the Bidan di Desa Program in Cirebon, Indonesia).

The project also standardized the system for training and supervising bidan di desas in managing birth asphyxia as well as documenting results, thereby improving the feasibility of implementing similar programs in the future.

Influencing National Policy

Save the Children provided technical assistance to the Indonesian government’s draft of the National Neonatal Health Strategy (2005-2010). The strategy serves to guide the government, donor agencies, professional organizations and non-governmental organizations in the planning and implementation of newborn health programs.

Save the Children’s Current Activities in Indonesia

Save the Children is working to strengthen the evidence base and collaborate with government and other partners to scale up newborn care interventions.

Bidan di Desas and Postnatal Care

In the Garut District, West Java, Save the Children is conducting a demonstration study where bidan di desas receive comprehensive training in providing postnatal care and making timely referrals. Since the majority of births take place at home, bidan di desas counsel mothers, family members and health providers on how to care for newborns at home, including how to recognize maternal and newborn danger signs, initiate immediate and exclusive breastfeeding and provide extra care for small babies.

Checking-up on Resuscitated Newborns

Since completing the project to evaluate the feasibility and efficacy of training bidan di desas in newborn resuscitation, Save the Children and PATH are conducting a follow-up study to determine the current health status of the original cohort of newborns resuscitated by the bidan di desas. If the study demonstrates a lack of adverse outcomes in infants who were resuscitated at birth by bidans, the evidence will be used to advocate for widespread acceptance of training bidan di desas to manage birth asphyxia in communities.

Advocacy

Save the Children is collaborating with the Ministry of Health, UNICEF, USAID, WHO and several NGOs and professional associations to promote the adoption of the national newborn health strategy, plans and guidelines in Indonesia. Save the Children recently assisted the group in developing national training materials on essential newborn care.