Traditional birth attendants and the problem of maternal mortality in Indonesia

Since the 1980s, maternal mortality in Indonesia has declined. However, it has always been high by regional standards, and its decline is now stalling. This makes it unlikely that by 2015 Indonesia will have reduced maternal mortality to the level set by the fifth United Nations Millennium Development Goal. In Indonesia, the role of the traditional birth attendant (TBA) in childbirth has been the subject of debate and controversy since colonial times. In efforts to reduce maternal mortality, subsequent health administrations have tried to replace TBAs with modern-trained midwives. Contrary to expectations, however, even in the present era certified midwives have not fully replaced TBAs. Particularly in rural areas, the TBA remains a key actor in birthing care, although now more often in collaboration with the modern midwife. Taking an anthro pological and a historical perspective, the involvement of the TBA in birthing and maternal care, at different times and in different areas of Indonesia, is investigated and, where relevant, compared to that of TBAs in other parts of Southeast Asia. The emergent picture does not support the opinion that the TBA is to blame for high maternal mortality. Poor referral facilities, bad infra structure and insufficient means are the more likely causes. To resolve the maternal mortality problem, governmental health policies should treat the TBA as an ally. How ever, such policies, and promising approaches such as partnerships and village maternity houses, can only be effective when their implementation is adequately backed up by resources