Maternal Engagement Program: Innovation 'woman-to-woman

marking' to enforce Birth Preparedness and Complication Readiness

for implementing the action cycle of maternal death audit
Background: Birth Preparedness and Complication Readiness (BPACR) is a health promotion intervention to reduce
delays in seeking care the obstetrics complication. The challenge to implement this program was conducted it based on
local problems to innovative solution through maternal audit cycle approach. This study was conducted to improve the
effectiveness of BPACR by accelerated maternal engagement innovation 'woman -to-woman marking' of trained community
midwife, as an activity of implementing the audit cycle of maternal death.

Method: A mixed methods study was conducted from 2017 until 2018 in Semarang, Central Java, Indonesia. The
intervention recruited 180 community midwifes based on assessment of knowledge and skill competency. During
intervention, they participated in an initial interactive workshop and quarterly educational focused on evidence of maternal
death recommendation and best practice implementation by local review. The primary outcome was reduction of matemal
mortality by improving access to antenatal, appropriate referral st abilization and communication during referral process
that identified by a structured recommendation of maternal audit. A focus group study was undertaken to evaluate an
intervention by assessing community midwife's reflection to this programme.

Results: There was significantly reduction of maternal mortality 121.50 (2016), 88.28 (2017) and 75.78 (2018) per 100,000 live
births. Effort was resulted in improvement of access to quality antenatal care, appropriate referral stabilization and communication
during referral and referral-back process (48.8%, 57.1%, 34.2%) before implementation to (87.4%, 90.7%, 86.2%) afterwards
that significantly reduced cases of direct obstetric causes (p<0.01). The reflection of community midwives shared that midwife
felt confident to promote community about BPACR by improving their knowledge and skill of high-risk pregnancy and post-
partum assessment in the community settings.

Conclusion: Improvement of matemal engagement to accelerate BPACR can do effectively by regular educatio n and
communication of community midwife and local review based on the recommendation of maternal audit cases. The
implementation of maternal audit cycle had an impact to promote local innovative solution in developing capacity building
of community midwife to assign women's preparedness during their pregnancy and post -partum period.

Keywords: BPACR, matemal death audit, community midwife

Cahyanti R 1 , Wiyati P 2 , Hadijono S 1
Obstetrics & Gynecology Department, Faculty of Medicine, University of Diponegoro, Semarang Jawa Tengah,
Indonesia