Kartini, champagne, and maternal mortality Julia Suryakusuma  ;   The author of Julia’s Jihad

JAKARTA POST, 30 April 2014

                                                

                                                                                         

                                                             

Births in Java are normally celebrated with a selamatan (ceremonial meal), a traditional tumpeng rice cone surrounded by assorted vegetable and meat dishes. But Raden Ajeng Kartini (1879 –1904), Indonesia’s national heroine of women’s emancipation whose birthday is celebrated nationally every 21st April, drank champagne after giving birth to her son. Yep, champagne. The image of Kartini in kebaya and batik sarong, hair done in her iconic “Kartini sanggul” (traditional hair bun), sipping bubbly from a champagne glass, is truly mind-blowing. Was it Dom Perignon, Bollinger Blanc De Noirs or Cristal Brut, I wonder? I mean, this was 1904, on the north coast of Java. Turns out Kartini had a Dutch doctor, who brought a bottle of champagne. So she and her husband, Raden Adipati Joyodiningrat, the regent of Rembang, and the doctor, toasted and drank champagne. The baby survived, but tragically Kartini died four days later, on Sept. 17. Was she cursed because she went against tradition and celebrated with champagne provided by the colonizers instead of a tumpeng? Perhaps the champagne was spiked, if you believe the conspiracy theories claiming her husband’s other wives poisoned her. More likely, she died simply because she had suffered all sorts of illnesses during her pregnancy. Drinking champagne was fun no doubt, but what Kartini really needed were antibiotics, which were only widely used after 1945. In fact, Kartini’s tragic post-partum death reflects what was a very common occurrence at the time. And guess what? Not that much has changed since. Prof. Terence Hull is a demographer and expert on reproduction and fertility with over four decades of research experience in Indonesia. He says that even now you find lots of women in Indonesia who have spent many years in poor health by the time they become pregnant. Malaria, dengue fever, typhoid, poor diet, high rates of iron deficiency and anemia, hypertensive diseases, pneumonia, domestic abuse, sexual violence and emotional stress — all take their toll. The situation here is actually similar to other Southeast Asian nations but our maternal mortality rate (MMR) is way higher than theirs. Some of our neighbors had very high MMRs a few decades ago, but Brunei, Singapore, Malaysia and Thailand have since slashed them right back. By contrast, Indonesia’s MMR has actually increased! In 2007 it was 228, but now in 2014, one year before the deadline for the Millennium Development Goals (MDGs), it’s reportedly 359 per 100,000 live births. So much for being a member of G20. The reasons for this tragic trend are many, and complex. One big reason is that there is endless discussion on the MDGs target figure of 110 in 2015, at the cost of paying attention to the detail and putting effort into maternal health services. Imagine, MDGs propaganda seminars are being held in kabupatens (districts) across Indonesia, when in fact MDGs indicators were meant to be national level targets. A second reason relates to the level of health services available to village women. This goes back to a scientific debate in 1940 on how to reduce maternal mortality. A certain Dr. Purwo Sudarmo argued that only highly trained young nurse professionals could handle the inevitable complex medical challenges encountered in village deliveries. Dr. Mochtar, his opponent, argued for merely upgrading the illiterate village women (dukun bayi) who were already routinely assisting births. Dr. Purwo lost the debate. In 1989, Haryono Suyono, then head of the National Population and Family Planning Board (BKKBN) invented the bidan desa (rural midwife) program, based on the low training notion. There was a strong push to churn out bidan quickly. So tens of thousands of young city women were trained specifically to deal with the basic needs of delivery and family planning in the villages. Some of these women were really caught in a trap. They had never actually delivered a baby because there just weren’t enough births near the school for everybody. So they all sat around and watched but didn’t get hands-on practical skills. Would you want to be attended by such a “midwife”? No way! Then there were other problems. In the villages, some midwives suddenly found themselves confronted by a lurah (village head) whose son needed a wife. Or sometimes the lurah himself wanted a second wife! The girls were under pressure; they were being chased around. Soap opera or what? So the bidan desa program is fraught with problems, and turned out to be a decision that put Indonesia on a path that has taken a long time to correct. When Hull interviewed Dr. Purwo in 1995 at age 93, he was still bitter over his loss in this debate. Looking back over four decades he felt that the women of Indonesia had been let down by the medical profession in favor of pseudo-populist rhetoric. Tara Chetty, program director of the Fiji Women’s Rights Movement, points to other factors that harm women’s reproductive health in the Oceania region: low government spending on health; lack of access to comprehensive sexuality education; high rates of gender-based violence; unavailability of safe and legal abortion; and conservative interpretations of cultural traditions and practices. No wonder there are such massive problems. Kartini is a symbol of women’s emancipation in Indonesia. It would be pretty sad if she were also a symbol of the millions of Indonesian women who still needlessly die tragically at childbirth. As Hull says, if we’re going to look at numbers, then it should be zero — zero maternal mortality that is, as most of the deaths are preventable. Pass the bubbly — I’ll drink to that! ●