Implementation of Making Pregnancy Saver (MPS) Policy to Reduce
Maternal Mortality in Sampang Regency
Ni Luh Putu Nindy Puspita Dewi
Faculty of Public Health, Universitas Airlangga, Mulyorejo, Surabaya, Indonesia
Keywords: Health policy, Maternal mortality, Making pregnancy safer, Partnerships medicaster & midwives.
Abstract: Maternal mortality in Indonesia is still high. One of the highest maternal mortality rates in the country is in
the Sampang regency. The high number of deliveries performed by the medicaster is detrimental and
endangers the safety of both mother and baby. This is because the medicaster does not have the sufficient
skills and/or ability to deal with complications that can occur during and after childbirth. To reduce the rate
of maternal mortality, it is necessary to develop a policy that can overcome the barriers against the efforts to
make pregnancy safer. One of the strategies is Making Pregnancy Safer (MPS), in order to overcome
maternal problems. Being assisted by health personnel will reduce the risk of maternal morbidity and
mortality. This study has used qualitative methods using secondary data from other research studies. The
findings have been analysed using descriptive analysis. The evaluation and assessment of the success of the
program was conducted by the health services in cooperation with the government. The policy can be
measured using the key indicators: K-4 coverage, delivery by skilled health personnel, and the maternal and
infant mortality rates.
1 INTRODUCTION
In an effort to accelerate the reduction of Maternal
Mortality Rate (MMR), as well as to achieve the
MMR target of 125/100,000 live births in 2010, and
Millennium Development Goals (MDGs) target
102/100,000 live births in 2015, Making Pregnancy
Safer (MPS) was initiated by the WHO. It is a health
sector strategy aimed at reducing MMR.
The complications and/or emergencies that occur
in childbirth and the first week postnatal are
estimated to account for 60% of all maternal deaths.
WHO research results in 97 countries in 2002-2003
concluded that there was a significant correlation
between the quality of the delivery assistance and
maternal mortality. The results suggest that the
higher the number of deliveries performed by
medicaster, the higher the risk that there is of
jeopardising the safety of mothers and infants. This
is because the medicaster does not have a sufficient
enough ability to deal with complications that occur
during and after childbirth. To reduce the morbidity
and mortality of mothers and new-borns, the WHO
has made Safe Motherhood efforts. Safe delivery
assistance by trained health personnel is an effective
way to reduce MMR. Nevertheless, it is undeniable
that many Indonesians, especially those living in
remote villages and areas, entrust delivery assistance
to those who are a part of the belief system and
culture of the community. Therefore the role of
medicaster cannot be eliminated, but they can be
invited to partner with and divert some of their roles
as a birth attendant to a trained midwife.
One of the strategies focused on in this study is
Making Pregnancy Safer (MPS), which was set up to
overcome maternal and infant health problems. By
ensuring a safe delivery assisted by health personnel,
it will reduce the risk of maternal morbidity and
mortality. The partnership between midwives and
medicasters in rural areas will also further reduce the
risk that occurs during childbirth.
Dewi, N.
Implementation of Making Pregnancy Saver (MPS) Policy to Reduce Maternal Mortality in Sampang Regency.
In Proceedings of the 4th Annual Meeting of the Indonesian Health Economics Association (INAHEA 2017), pages 205-208
ISBN: 978-989-758-335-3
Copyright © 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved
205

2 METHODS
This study using a study literature method from
existing studies. The aim of this study is to get
explanation about the policy for making pregnancy
safer and “Kemitraan Bidan Dukun” in the Sampang
Regency.
3 RESULT AND DISCUSSION
3.1 Maternal Mortality and Causes
One of the causes of high MMR is the low
utilisation of health services and delivery by trained
health personnel. Geographical conditions,
population distribution, socio-cultural and a low
level of education are some of the factors causing
the low utilisation of health workers by the
community. According to Riskesdas’ data in 2010,
the gap of birth attendants to health workers based
on residence was wide; i.e. 91.4 percent in urban
areas and 72.5 percent in rural areas. As many as
55.4 percent of deliveries occurred in health
facilities, while 43.2 percent gave birth at home. Out
of the pregnant women who gave birth at home 51.9
percent were helped by midwives and 40.2 percent
by midwives.
The role of medicaster in the community in
relation to helping a mother during pregnancy,
during delivery and after childbirth is closely related
to the local culture and customs. Medicasters are
mostly well-known people in the village, who are
respected and regarded as trustworthy, experienced
parents. In addition to prenatal care, attending births,
and taking care of the mother and baby after birth,
medicasters are generally believed to provide rituals
of indigenous accomplishments, so as to provide
comfort and security in childbirth. . Facts that exist
in the field are that the number of medicasters is far
more than the number of midwives. This is inversely
related to the presence of a relatively limited number
of midwives, especially in remote villages and areas.
Midwives have recognised expertise in assisting in
childbirth. However, despite their experience, their
comparatively young age alongside that of the
medicasters, especially for those located in remote
areas, is often an obstacle to achieving public trust
3.2 Making Pregnancy Safer Policy
In an effort to improve the health of mothers and
new-borns, the government has launched the
National Movement to Making Pregnancy Safer
(MPS) as the Strategy of Public Health
Development towards Healthy Indonesia 2010, as
part of the Safe Motherhood program. The goal of
the MPS Policy is to protect human rights by
reducing the pain, disability and death rate
associated with pregnancy. MPS is a health sector
strategy, which focuses on health planning and
service approaches. MPS has been implemented
based on existing efforts with an emphasis on
partnerships between government sectors,
development agencies, the private sector, families
and community members. Based on the lessons
learned from the Safe Motherhood program, one of
the important objectives of MPS is to guarantee that
every delivery is assisted by health personnel.
Based on these facts and the government's policy
that every mother's delivery should be handled by
health personnel, efforts to build midwife and
medicaster partnerships has become very necessary.
Medicasters are willing to shift their role as birth
attendants to the midwives, but still play a role in
the care of the mother during pregnancy, assisting at
the delivery (by performing traditional rituals to
make the mother feel calm and safe), and caring for
mothers and babies after birth (postnatal).
3.3 Partnership of Midwives and
Medicasters
The partnership of midwives and medicasters is a
form of collaboration with a mutual benefit that has
been developed by the Ministry of Health of the
Republic of Indonesia through the principles of
openness, equality and trust in an effort to save
mothers and babies. The partnership places
midwives as the helper in childbirth and converts
the role of medicaster from birth attendants to
partners in caring for pregnant women,
accompanying mothers at the time of delivery, and
caring for the mothers and babies after childbirth.
This established partnership is based on agreements
made between midwives and medicasters through
the involvement of various elements of the
community. The program is called “Kemitraan
Bidan Dukun” (KBD).
The purpose of KBD is as follows:
1. Improving the services offered to pregnant
women, nursing mothers and infants.
2. Increasing community participation in supporting
the progress of health development in the
villages.
3. Establish cooperation between midwives and
medicasters when providing services to pregnant
women, nursing mothers, and infants.
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3.4 Reduce the Maternal Mortality Rate
in Sampang Regency
The Maternal Mortality Rate (MMR) in Sampang
Regency is high. To overcome this problem, in
accordance with the mission of the Making
Pregnancy Safer program, each delivery is assisted
by skilled health personnel. Each obstetric and
neonatal complication should receive adequate
services, and every fertile woman has access to
unwanted pregnancy prevention and treatment for
miscarriage complications. Problems when
implementing safe labour performed by health
workers is the traditional Madurese culture. For
example, traditional healers, herbal remedies and
pregnancy myths. There is still the belief in the
community that when it comes to maternity and
infant-related problems, shamans are more
comfortable to deal with and cheaper.
3.5 Implementation of the Making
Pregnancy Saver (MPS) Policy
The implementation of policies has been initiated in
order to decrease MMR in Sampang. One of these
policies is the Midwives and Medicaster Partnership
program called “KBD”, which is the formation of
midwifery cooperation with medicasters in the
community to ensure that all the deliveries can be
helped by health personnel. The midwife's activities
cover the medical aspects, while the medicaster’s
activities cover the non-medical aspects. The
medical aspect is the process of managing and
servicing maternal and child health programs
through planning, implementation, monitoring and
assessment (evaluation). The non-medical aspect is
to mobilise the involvement of individuals, families
(including the partners of pregnant women), and
communities in the maternal and child health
services, and empowering pregnant women and their
families. Maternal and child health services include
activities undertaken by the midwife in performing
midwifery care in accordance with the authorities,
and the ethics and responsibilities of the midwife.
The medicaster's duty to help deliver has become
referring pregnant women to the service and caring
for postpartum and newborn babies based on the
agreement between midwives and medicasters.
The support of the stakeholders at the Sampang
regency level can encourage the acceleration of the
partnership formation, mainly through program
support, the budget and moral support. Direct
support from the Head of the Region towards the
medicaster in the village and the midwife is very
influential. The form of activities conducted to
obtain the support of the involved parties has been
done through intensive consultation and
coordination with the Head of the Region and in the
form of hearings with the District Legislative of the
Sampang Regency.
Output from the KBD programs show good
results. The coverage of K1 and K4 have each
passed the ANC coverage standard. There has been
an increase in deliveries assisted by health
personnel. It shows that the KBD Program is a good
program for controlling pregnant women’s health in
the Sampang Regency.
4 CONCLUSION
Childbirth performed by a medicaster endangers the
mother and baby. This is because the medicaster
does not have the sufficient skills and ability to deal
with complications that occur during and after
delivery. To reduce the morbidity and mortality rate
of mothers and newborns, strategies have focused on
Making Pregnancy Safer (MPS) to overcome
maternal and infant health problems. By ensuring a
safe delivery assisted by health personnel, the
program will reduce the risk of maternal morbidity
and mortality. The partnership between midwives
and medicasters in rural areas will reduce the risks
that occur during childbirth. Alongside the program
called “Kemitraan Bidan Dukun” (KBD), it will
establish cooperation between the midwife and
medicaster to help promote safer deliveries in
accordance with the MPS policy in the Sampang
Regency. The output from the KBD programs show
good results and have reduced MMR in the
Sampang Regency.
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