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 anthro­pological 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 infra­structure and insufficient means are the more likely causes. To resolve the maternal mortality problem, governmental health policies should treat the TBA as an ally. How­ever, 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.

印度尼西亚的传统接生员与产妇死亡率问题

印度尼西亚的产妇死亡率自上世纪八十年代以来已经有所下降。但以地区标准来衡量，它的数字始终是偏高的，而且目前它的下降趋势也处于停滞状态。这使得2015年印尼的产妇死亡率不太可能降低到联合国第五个千年发展目标所设定的水平。

自殖民时代起，印尼传统接生员在妇女分娩过程中的作用就一直备受争议。为降低产妇死亡率，历任卫生行政管理机构都试图以经过现代医学培训的助产士来取代传统接生员。然而事与愿违，即便在今天，执证的助产士也未能完全取代传统接生员的角色。尤其是在农村地区，尽管传统接生员现在通常是与现代助产士合作，但仍然在妇女分娩保健中起到关键的作用。

本文采取人类学和历史视角，对不同时期和不同地区印尼传统接生员在接生及产妇保健中的作用进行了考察，并与其它东南亚地区传统接生员的作用加以比较。由此得到的事实表明，传统接生员并不是导致产妇高死亡率的原因。产妇死亡率的居高不下更多可能是转诊设施低劣、基础设施差以及医疗手段不完备等原因造成的。要解决产妇高死亡率的问题，政府的卫生政策应该将传统接生员视为同盟伙伴。然而，相应的政策以及与传统接生员建立合作伙伴关系并在村庄中设置产妇之家等富有前景的举措，只有在执行过程中得到充分的资源保证，才能真正发挥效用。

Translated from English by Li Guo