Meeting the frontliners

The best-known secret in Indonesia’s successful family planning and reproductive health program is the role of midwives, who are the frontliners in delivering health services to the country’s mothers and their children.

On the last day of the Indonesia visit of our group of women journalists (under the “Women’s Edition” program administered by the Population Reference Bureau), we visited a clinic belonging to the “Bidan Delima” or Midwives Association, a private organization of midwives committed to providing quality, standardized reproductive health services.

Ibu (a fond term for “mother”) Hanik Luthfiya, 42, manages the clinic in a middle-class neighborhood in Surabaya. She says she raised the money for the clinic’s construction by taking out a loan, although the clinic’s layout and facilities were finalized with inputs from the association. Indeed, an officer of Bidan Delima drops by regularly to check on the quality of services provided and was present that morning.

The clinic provides pre-natal consultations and check-ups and post-natal services, including sessions on such matters as breastfeeding, immunization, umbilical cord care, maternal hygiene, and “warning signs of infant’s illness.” Also part of the post-natal package are consultations on family planning, although this is also provided for clients who wish to delay or prevent pregnancy.

The clinic has a delivery room, but risky cases and complicated deliveries are referred to a hospital just three kilometers away.

Most interestingly, says Ibu Hanik, they require the husband to be present during the delivery to support his wife, but failing this they require at least one other family member to be present. Indeed, studies have shown that mothers (and babies) do better during and immediately after delivery when their anxieties are eased.

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Three satisfied clients of the clinic also spoke to our group. Zamnathul, 25, Lely, 36, and Khusarel, 34, have been long-time clients, mainly accessing family planning services and counseling. “Better services and more privacy” are among the reasons they gave for patronizing the Bidan Delima clinic, even if family planning counseling and services are available at government-run clinics.

“I heard about the clinic from friends,” said  Khusarel, who added that “the service I receive here is good.”

This isn’t true of any of the clients who gave their testimonies, but Ibu Hanik admits that at times, during family planning counseling, some couples start quarreling, mainly over their individual preferred methods. But Ibu Hanik says the most preferred method used by clients in her clinic is an injectable contraceptive, whether one that requires a monthly injection or once every three months.

This is probably due to religious restrictions, since for now many Indonesian Muslims believe permanent methods are not allowed by their religion. The three women we talked to said they preferred temporary methods for now, as they still had childbearing plans.

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There are local counterparts to the Bidan Delima network of midwife-owned and -managed clinics, one of which is the “Well Family Midwife” network of clinics around the country.

Indeed, some of the Well-Family clinics report earning millions in income, with some even being able to employ doctors and nurses as consultants, if not employees. But in this country, much has still to be done to lift the image of midwives, who are often seen as mere “helpers” to other medical professionals. This, even though the backbone of public health services is the midwife in private and public health clinics and is the “frontliner” in service delivery.

One of the lessons I took away from our visit to Indonesia is how government and public opinion support is key to the success of a family planning program. This support takes the form not only of funding and infrastructure (even if this helps immensely), but also of policy backstopping and public declarations of support not just by politicians but also by respected social figures.

A key factor in the success of Indonesia’s family planning program is the cooperation of religious leaders, be they Islamic, Catholic, Protestant or Buddhist. At the same time, the BkkbN, the country’s population office, has tailored its messages to the sensitivities of religious leaders and their flock, providing services for methods that are publicly acceptable and used by couples with a clean conscience.

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The final say on the issue of “visa-free” entry for Taiwanese into the Philippines is with the Department of Foreign Affairs, I have been told. This, even if at least formally the country doesn’t maintain foreign relations with the Chinese republic.

The People’s Republic of China considers Taiwan a “renegade” province, although it seems relations between the Mainland and Taiwan have improved considerably over the years. But better relations between the two have not prevented Taiwanese officials, especially President Ma Ying-jeou, from seeking to bolster Taiwan’s image in the world. They are ready to negotiate to gain visa-free entry for its citizens. President Ma reportedly promised during his campaign for reelection to win this privilege with 100 countries, the Philippines included.

Maybe this is why Teco Representative Raymond Wang has been loudly and brashly pressuring Filipino officials to grant visa-free entry to Taiwanese despite the misgivings of many. Indeed, a dialogue has begun among Meco, Teco and the DFA to discuss the issue. Among the matters being discussed is how to facilitate travel of Taiwanese to the Philippines, while ensuring that adequate measures are in place to guard against transnational crimes, including those committed by illegal Taiwanese entrants.