ENGLISH IN MIDWIFERY PRACTICE II

“Midwifery And The Challenges: In Indonesia, Tanzania, India, And Europe ”

Supporting lecturer : 

Drs. M. Irfan Burhani, M.Pd.

Made by : 

Faizatul Azimah P17321183026

Diajeng Fenti Setiawan P17321183017

MINISTRY OF HEALTH OF THE REPUBLIC OF INDONESIA

HEALTH POLYTECHNIC MINISTRY OF HEALTH MALANG

DEPARTMENT OF MIDWIFE
A. In Indonesia

The definition of maternal death according to the World Health Organization

(WHO) is death that occurs during pregnancy or within 42 days after the termination of
pregnancy due to all causes related to or aggravated by the pregnancy or its management,
but not due to accident or injury. Globally, efforts to reduce maternal mortality have been
carried out since the 1980s such as the International Safe Motherhood Initiative (SMI) in
1987, the International Conference on Population and Development (ICPD) in 1990, the
Fourth World Conference on Women, in Beijing in 1995, the United Nations Millennium
Development Goals (MDGs) in 2000 and Sustainable Development Goals (SDGs) in
2015, and various specific programs in each country, but still found the infant and
maternal deaths during pregnancy and childbirth in developing countries including
Indonesia.

Many activities have been carried out by the government to reduce maternal
mortality and infant mortality, for example in the Yapen Islands, Papua. The Decree of
the Minister of Health No.564/2006, states that to accelerate the achievement of the 2010
vision of a healthy Indonesia, it is necessary to develop standby villages as a basis for
developing healthy villages. A standby village is a village whose residents have the
readiness of resources and capabilities and the willingness to prevent and overcome
health problems, disasters, and health emergencies independently. The purpose of the
village alert program, in general, is the realization of a village with a healthy community,
caring and responsive to health problems such as disasters and health emergencies in the
village. Because in Yapen Islands Regency, the geographical conditions are mountains
and beaches with difficult land transportation infrastructure, so that access to villages is
mostly only by sea. Until 2008, thirty villages had been designated to be developed into
standby villages spread over twelve districts.

The challenges of midwives in Indonesia:

1. Because many regions in Indonesia are geographically located in mountains and

oceans, access to health facilities is very difficult, this is a challenge for midwives in
referring patients if the patient's condition has complications. The main obstacle in
 referring patients from the village to the puskesmas or the hospital is the problem of
transportation and transportation costs because no one has managed the transport or
the cost to refer patients. If there are patients who need to be referred, the family itself
takes care of everything from vehicles to transportation costs, there has been no
involvement of village officials in helping the poor or pregnant women from the
village to the puskesmas or the hospital.

2. Advances in technology will shift so many jobs and professions. Even the medical
profession will be largely taken over by technology. For example, such as injecting,
there will be technology that uses Artificial Intelligence that will be able to measure
the precision of how deep, which molecule, what dose, whether it is right in the vein
or not, all of which will be represented by precision by technology.

3. The limited number of health workers involved as well as the overlapping of the tasks
performed are obstacles in the implementation of the maternal mortality reduction
program.

4. The next challenge is the lack of cross-sectoral involvement to support the

acceleration of the maternal mortality program, one of which is due to opinions that
are not in line with the objectives of the acceleration program for reducing maternal
mortality. So that serious efforts are needed both from the Puskesmas and related
parties to jointly equalize perceptions and opinions about the importance of reducing
MMR in the community so that this program can run synergistically. More
intensively involving personal references (religious leaders, community leaders) in
educating the community on the importance of social support in pregnancy, childbirth
and post-natal care.

B. In Tanzania

Maternal and infant mortality rates in Tanzania have declined in recent decades.
Tanzania has a total population of 45 million people, of which women of childbearing
age make up 47.1%. The maternal mortality ratio (MMR) is estimated to be 556 per
100,000 live births in 2016. This is higher than the ratio reported in 2010, but decreased
from 2005 levels of 578 per 100,000. although declining, the maternal and infant
mortality rates are still considered high. One of the main challenges is that there are only
four midwives per 10,000 population, which is much lower than the minimum 23 per
10,000 recommended by WHO. This shortage of qualified personnel affects healthcare
professionals and their patients. High fertility rates and a large number of fertile women
exacerbate this problem and make the shortage of midwives a challenge.

The most prevalent findings in this study was the feeling of demoralization. Other
factors of importance were personal struggles, shortage of staff, equipment availability,
and unawareness and challenges in society. The challenges is :

1. Feelings of demoralization, The midwives felt that when something went wrong, e.g.
maternal death or stillbirths, the patients and their relatives would always blame them.
They reported to have been verbally abused by their patients, something that made
them feel that their hard work was being undermined.

2. Lack of support from superiors. One of the midwives said that their leader was on the
side of the patient, they also said that they were not compensated for working
overtime. this is one of the reasons for the midwives to lose their motivation

3. Shortage of resources. The participants described a shortage of personnel, equipment

and facilities that leads to problems with overwork and risk of infections for the
midwives, and poor monitoring, delays in treatment and unnecessary complications
for the patients

4. Societal challenges. During the FGDs it became clear that there were several societal
factors that made the working situation at the hospital difficult. The midwives found
the low education level in the population especially challenging. They thought that
insufficient education caused delayed arrivals at the hospital. Lack of cooperation
between health care facilities was another problem, especially the lack of a well-
functioning referral system

5. Personal struggles. The midwives reported that the heavy workload and stressful
situation at work affected their personal and family lives in several ways. They
 experienced both physical and mental health problems, limited personal development
and trouble with their families.

C. In Indian

The nursing and midwifery workforce in India faces many chal- lenges in each of these
three areas, especially poor quality of education stemming from a weak regulatory
structure that needs to adapt to changes over time. The lack of leadership role and decision-
making power for nurse-midwives’ further weakens the governance of these profes- sions
dominated by doctors. India does not have a professional midwifery workforce or direct
entry midwifery educa- tion yet. Hence, regulation is currently targeted at nurses who are
playing a dual role of nurse and midwife. As more evidence is generated on the advantages
of midwifery for maternal and neonatal health, it becomes important for the INC to make
legitimate efforts to start direct entry midwifery education that will create a cadre of
midwives independent of their nursing role.

 Midwifery as a part of nursing: A regulatory challenge

Midwifery is usually practiced on rotation with other nursing roles. Participants shared
mixed opinions on the requirement and future of midwifery in India as an independent
profession. While most participants seemed to be in favour of independent midwifery,
there were limited and unclear responses on the regulatory challenges it entails. Another
participant mentioned the lack of a legal framework as a key challenge for inde- pendent
midwifery in India. This is due to a lack of legal protection for midwifery practition- ers,
unlike with doctors.

D. In Europe

As with all sectors of education, midwifery has been greatly affected by the lockdown
measures imposed by governments throughout Europe. Despite the COVID-19 period, all
students were expected to acquire professional midwifery competencies. The prescribed
national lockdowns in most European countries has led to a disruption that caused rapid,
dramatic changes in the nature of midwifery education. In the short term different
approaches have been adopted to mitigate the impact on current midwifery students’
theoret- ical and clinical education and seek the best approaches for both mid- wifery
students and lecturers during the COVID-19 pandemic .Throughout Europe, the changes of
increased digitalisation and distance learning can definitely be highlighted as opportunities
to improve the current ways of delivering midwifery education. These changes might also
extend to a diverse population, such as potential students who are looking for part-time
education.

 Challenges for the near future and longer term

The teaching of specific midwifery skills remains a clear challenge. Universities are
beginning to open up again across Europe and the im- portant question arises as how to
guarantee contact-free education and social distancing. One common theme is the need
for personal protective equipment for staff and stu- dents as social distancing is mainly
not possible in midwifery work. An- other highly relevant question is whether or not to
replace real clinical learning with simulation . In the short term it may be used without
such attention to detail but if it were to become a permanent feature, the burden on the
academic stuff needs to be considered as well as the experience of the students.
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