Independen -- The Indonesian Association of Obstetrics and Gynecology (POGI) warned against the country’s population surge as a side effect of the Covid-19 pandemic.
POGI greater Jakarta (POGI Jaya) Secretary-General dr. Ulul Albab, SpOG, said that the birthing boom predicted in December has become one of his Association’s concerns during the pandemic.
“We are worried about the [boom,] the pandemic that has not ended, and the society’s general indifference towards health issues. I am worried about the increasing number of pregnant women who tested positive for Covid-19 and would need special treatment. Suppose in six months, and the pandemic does not end [with the initial estimate, it had started in March]. In that case, we need to prepare for the surge of babies who would be born in December-January,” said Albab.
He continued, POGI Jaya and the Executive Board of the Indonesian Doctors Association (PB IDI) had written to the Ministry of Health to appoint designated hospitals for pregnant women with Covid-19. However, the Ministry had not approved the request.
“I think there is a difference between treating a pregnant woman and non-pregnant patients. Because [being with a child], we have to provide antenatal care, during the birthing process, and post-delivery. They are all different. Until now, I have not received any information whether [the government] has designated hospitals for pregnant patients with Covid-19,” Albab continued.
Farida Masrurin just gave birth in Blitar, East Java. She admitted that going to the hospital for antenatal checks and seeing many patients caused anxiety in many women like her.
“A lot of people are complaining. There were many patients, 35 to 38, all heavily pregnant, and had to go to the hospital for their checks. Because they are not allowed to see a midwife, so all [pregnant women] have to go to the hospital for their check-up and birthing preparation,” Masrurin told Independen.id (18/08/2020).
According to her, the government should allow village midwives to handle labors and deliveries on low-risk mothers to avoid patient buildup at the hospital.
In addition to a higher risk caused by patients’ buildup, Masrurin also said that new hospital regulations due to the Covid-19 pandemic further weighed patients like her down. Masrurin said after her Caesarean delivery, only one person was allowed to accompany her.
“The thing that upset us was the restriction on one accompanying person per patient. Whereas with Caesarean [patients], even getting up is hard. So [we need] a minimum of two people. But there could only be one,” Masrurin added.
Another hassle that she experienced was the postnatal check. Before the pandemic, patients did not have to queue themselves physically. But now, they have to come and register on their own, which certainly inconvenienced patients who just had an operation like Masrurin.
“Before, we didn’t have to come by ourselves to register because it was hard after a c-section to walk. Especially when there’s a long queue, but now, patients have to register on their own, their body temperature is taken, and [signed] a statement. For every visit, we have to pay Rp6,000 [40 cents] for stamp duty,” she added.
Aditya Widya Putri, who currently lives at Entikong, West Kalimantan, is pregnant. She said that she got enough information on pregnancy but needed more on childbirth options because she was concerned that delivering in a general hospital increases the risk of exposure to Covid-19.
“[I’ve begun] to look for childbirth options because general hospitals have more patients other than pregnant or delivering women. So, the risk of Covid-19 exposure is higher. So, maybe [we] will go to a mothers and children hospital or maternity clinic instead,” said Putri.
“One Million Family Planning Acceptors” Program to Suppress Pregnancy Rate
To avoid a birth boom, the government is working on a “One Million Acceptor” program by offering door-to-door access to contraceptives.
“On June 29, family day, we collaborated with midwives, the national army, and the national police. The one million acceptor movement targeted 20 [new] acceptors per village. Indonesia has 74,000 villages. By having 20 acceptors per village, that made it a million,” Head of the National Population and Family Planning Board (BKKBN) Hasto Wardoyo told Independen (28/07/2020).
In the interview, Wardoyo supposed that the one million acceptor program could have suppressed the pandemic’s pregnancy rate. He also reasoned that the door-to-door initiative already solved the people’s apprehension in going to the hospital and getting contraceptives. In addition to that, family planning counselors are now allowed to provide contraceptive medications, unlike before.
Even with BKKBN’s one million acceptor program, women’s reproductive health issues during the pandemic did not stop there.
According to Yanti Indra, one of the Family Planning (KB) counselors in Padang Jaya, West Sumatra, the increase in pregnancy in her area was because of most women’s reluctance in using available contraceptive methods. Many ended up with natural birth control, such as the calendar method or the withdrawal method.
While the calendar method calculates a woman’s ovulation period and avoids sexual intercourse during those periods, the withdrawal method avoids getting semen anywhere near or inside the vulva or vagina.
“However, natural birth control methods are not 100 percent effective. That is why there is an increase in pregnancy. Those who usually have birth control shots changed to pills, then [because of the side effects], they stopped [taking the pills] and got pregnant,” Indra told Independen.id (18/08/2020).
The government’s one million acceptors program had been running in Indra’s work area. Additionally, her village’s polyclinic (Polindes) also provided contraceptive tools. However, that did not necessarily make the women more comfortable in utilizing the available health services.
“Last month, the BKKBN officers had a ‘KB safari’ in our subdistrict. This month the program is still on-going. Even though there is no patient restriction at the Polindes, people are afraid. Things had run pretty smoothly before. But since the ‘new normal,’ we have many villagers coming back from other places. Now Tanah Datar is a red zone. Every day we have new cases. So, people begin to worry again. They are afraid of going to the Polindes,” explained Indra.
Similarly, Nurjanah, a cadre at a Posyandu (Integrated health care and family planning post) in Selamat subdistrict, Jambi, have been recording contraception use in each household with her colleagues. They found that the limited operational time for the local Puskesmas (health community centers) was a problem.
“The problem was the opening hours of the Puskesmas. They are only open after eight. So, [people] found it inconvenient to go there [that late],” Nurjanah told Independen.id (18/08/2020).
Besides, Nurjanah said, even though the government had provided free contraceptives for one million acceptors, many women opted for using no birth control at all. The women also preferred purchasing other brands or methods from the local clinic. They often complained about the side effects of the government-subsidized medication.
“Some did not [participate] in KB programs because of the [side effects]. Those who had joined KB before preferred to pay for other methods on their own. The problem with the one-month free program [was the side effect]. They did not want that and chose to pay on their own,” continued Nurjanah.
Hellina, another KB cadre in the Broni subdistrict, Jambi said that women had no other choice than to pay for their contraceptives if their body disagrees with the government-subsidized contraceptive’s side effects.
“It’s true that we collected data from the village. We don’t have many pregnancies in my area because those who do not want to use one contraceptive method will look for other methods. Because they are aware of their economic situation, so they just use other [methods],” said Hellina in a phone conversation with Independen.id (18/08/2020).
Of course, the insertion of the contraceptives is not as straightforward as it used to. Women had to apply and register for the service way ahead.
“It was difficult because [the women] did not come on time. They have to follow the schedule from the Puskesmas, and they need to be registered first. But nobody was on time, so it got delayed. They faced difficulties during [Ramadan fasting month]. I told [the villagers] that the KB service was open, but they have to follow a schedule. We prioritized the new ones, but many also came for removal,” Hellina continued.
Teza Farida, one of the doctors at Jakarta’s Family Planning Association (PKBI) clinic, said that in big cities such as Jakarta, the supply of contraceptives is not a problem. But, in remote areas, the distribution process faced some obstacles.
“Usually it only takes two weeks, this time it took one-two months,” Farida told Independen.id (28/07/2020).
Also, Farida said, some women were afraid of going to the hospital or Puskesmas. They chose to go to the midwife instead. To address the women’s concerns, Farida’s clinic set appointments with the patients to avoid overcrowding.
“Each patient is allocated between half to one-hour examination depending on their needs. For KB, it depends on the type. Shots usually take half an hour. Removal and insertion of IUD, about one hour. Depending on the method,” she added.
Independen.id had tried to confirm all female reproductive health rights issues during the Covid-19 pandemic to the Ministry of Health and the Ministry of Women Empowerment and Children Protection (KPPPA) but received no response.
It had also submitted an official interview request to the KPPPA, made phone calls and WhatsApp messages to the public relations staff and related deputies on July 20. But until the time of publication, there has been no response.
Independen.id also tried to confirm the Ministry of Health’s readiness in facing the upcoming baby boom and access to women’s reproductive health rights. But as of July 28--the time of publication, the Ministry has also yet to respond.
Also read: Pregnant Women Challenges in Time of A Pandemic
Reporter: Widia Primastika
This reporting is part of the COVID-19 response transparency and accountability program supported by the Alliance of Independent Journalists (AJI) Indonesia and UNESCO.
*This article was published in Bahasa at Independen.id in September2020
