Women's health care: A flaw in Indonesia’s system

Healthier and stronger underprivileged women only make their communities and the country better.

Women's health care: A flaw in Indonesia’s system Photo: Unsplash

Indonesian women face many obstacles and acts of discrimination, ranging from the office place to religious figures preaching morality, to streetside sexual harassment. Yet the biggest challenge of all, it can be argued, is accessing basic health care. Like other less economically developed countries, Indonesian women living in rural regions do not have access to modern medicines or the professional care they need. The lack of access among underprivileged women in Indonesia is defined by two qualities: poverty and gender inequality.

The Indonesian government, along with nongovernmental organizations and other institutions, have taken the proper steps to remove obstacles that Indonesian women face when it comes to health care. Nonetheless, there is still much work to do in terms of access to and the standards of women's health care, while eliminating social stigmas surrounding women's health.

In a society ruled for generations by cultural tradition, women in rural Indonesia are often misinformed and have little to no education regarding their health and hygiene. For this reason, many women in villages typically opt for a traditional midwife, more like a faith healer (dukun), as opposed to a trained health expert, during pregnancy and childbirth. Although rooted in local traditions and cultures, home births are carried out by these traditional birth attendants and may be fatal for both the mother and the baby. Maternal mortality is still prevalent across Indonesia, with the maternal mortality rate reported at 177 per 100,000 live births in 2017 - one of the highest in Southeast Asia, according to the World Bank. This high figure is because many conventional birth attendants only have an elementary school level of education and no professional health care training. The Indonesian Ministry of Health has discouraged the use of dukuns for childbirths. Alternatively, it has advocated for the presence of a dukun and a certified midwife to ensure the safety of both the child and mother during delivery. Despite attempts by the ministry, the lack of education surrounding women's health care boils down to this: systemic poverty.

The availability of health care in rural areas is in particular an issue that the Indonesian government has attempted to address, but without much success.

The sheer lack of health care access for lower-income women and expectant mothers is perhaps the biggest challenge. The type of health care available to women in Indonesia remains subpar. The availability of health care in rural areas is in particular an issue that the Indonesian government has attempted to address, but without much success. For example, in 1989, the Indonesian government implemented the Bidan di Desa, or Village Midwife program, to tackle high infant mortality rates throughout the country. The agenda specifically targeted the most remote regions, by building birth centers and placing trained midwives in every village to support local communities.

However, in recent years the plan has proven faulty, as only around 70 percent of midwives assigned stayed in their designated villages, according to the US National Center for Biotechnology Information. Unfortunately, many midwives took higher paying jobs, or opened independent practices in more densely populated areas where their services were of higher monetary value, thus emphasizing the complete absence of women’s health care available among underprivileged women.

One may ask: why? In a country where in 2019 more than 25 million Indonesians were living below the global poverty line, according to the World Bank, Indonesian women generally do not have the economic means to receive the professional health care they need.

Yet, there is another impediment that explains the high maternal mortality rate among Indonesian women: gender inequality. According to a report in The New Humanitarian a decade ago, an expectant mother with high blood pressure was advised to have a Cesarean section, but the family could not afford the $1,000 procedure. Instead, the father brought his wife to a midwife where the woman subsequently died of complications after birth. It is stories such as these that shine light upon the distressing effects that gender inequality and poverty have on women's health care.

Generally speaking, Indonesian women do not have the final say in the type of medical treatment they receive, or on health-related decisions. This is the direct result of the patriarchal system that is embedded in the Indonesian culture. Men are perceived to have greater knowledge in domestic matters (as they usually have a higher level of education), although they do not know what women are experiencing. For women to gain better access to health care, they must be able to make their own decisions independently. They, and they alone, know what is best for them. For women to have the freedom to make their own medical decisions, a certain level of equity between genders must be achieved.

Nongovernmental organizations and local communities in Indonesia have been attempting to achieve equality among genders, but regarding women's health care, it is crucial to strive for equity. For men and women to be of equal status in Indonesian society, women have distinct needs concerning health care that men do not have for instance, the many stigmas surrounding menstrual health. As a consequence of the conservative climate in Indonesia, menstruation is seen as a taboo topic, and regarded as “dirty” and ‘impure.” From a young age, girls are taught not to speak out about menstruation and, in some cases, to feel ashamed of it. To change the access to and degree health care among women and young girls, issues specific to women's health must be spoken about. Without such recognition, women will never be able to access the health care that they need, at the same standard that Indonesian men have.

From a young age, girls are taught not to speak out about menstruation and, in some cases, to feel ashamed of it.

 

This essay merely highlights a sliver of the problems that low-income Indonesian women and young girls face in terms of the kind of access to the health care they receive. By providing women with the proper health care that they need, not only will women be healthier and stronger, but it will also have a positive effect on the community and country as a whole. The coronavirus pandemic has also highlighted the challenges for women around the world to access proper access to health care. This is no new obstacle for women in Indonesia.



Madeline Suindah is a researcher with Strategic Review journal.

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