We Are Project HOPE: Dr. Anne Chasny, Indonesia

Indonesia boasts the largest economy in Southeast Asia, but access to health care and resources is not equal across the country, especially in rural districts. Project HOPE, through the Saving Lives at Birth program, is changing maternal health in Indonesia by empowering communities, health care workers, and women to learn more about maternal and neonatal care. Because of this work, thousands of pregnant women have been able to access the care they need before, during, and after delivery.

Dr. Anne Chasny is a general practitioner who has been overseeing Saving Lives at Birth as a Program Manager since 2019. Prior to joining Project HOPE, she worked for the World Health Organization for 11 years where she focused on health system strengthening. Her interest in maternal health began 22 years ago after the birth of her daughter, a birth that could have gone differently had her own neighbor not been a midwife.

Read on to learn more about how the challenges of being a mother in Indonesia and how Project HOPE is helping thousands of women find the support they need to bring their children into the world safely.

What made you want to work in maternal health specifically?

As a mother of two, I know how many sacrifices it takes to be a mother. Although I’m interested in maternal health for a few reasons, the beginning of the story starts with the delivery of my second baby. Despite having routine check-ups throughout my pregnancy, I still had a bad experience with delivery. It was midnight and no health care facilities were open.

I was very fortunate that my close neighbor was a midwife. Because of her talent, skills, and ability to stay calm, she successfully helped me deliver my baby safely. Since then, I have always thought about supporting midwives, especially those who live in rural and remote areas to increase their capacity, skills, and knowledge, because all pregnant mothers are relying on them.

Saving Lives at Birth is now in Phase III. Can you tell us about the maternal and newborn health issues the program addresses?

I became the Program Manager for Phase III of Saving Lives at Birth in 2019. During Phase I and II, the program focused on the overall maternal health issues in Indonesia and the limited scale of the health system. In Phase III, the program is improving the health system in the Banyumas and Grobogan Districts to save pregnant mothers and newborns.

The program also includes providing education to the public about maternal health so they understand the risks and dangers pregnant women may face, providing training to health workers, and providing personal protective equipment to ensure check-ups and childbirth are hygienic. Lastly, the program aims to create a system that will smoothly work with government programs.

Why does Indonesia lag in addressing these issues despite its economic growth?

There is a lack of education to the public when it comes to maternal health, a lack of skilled health care workers who handle the problems of mothers’ health, and there is a poor system used in handling maternal health in Indonesia.

During the implementation of the program, we found that the health system in place for the maternal and neonatal health program was not comprehensive. Even though maternal and neonatal health is a health-in-all policy, this doesn’t happen regularly in Indonesia. The local government should be the one taking the lead in each district, but it involves a lot of levels of approval from all levels of government, private- and government-owned health facilities, NGOs, and academicians in the district.

One of the objectives of our work is to increase maternal health interventions for high-risk pregnant mothers and newborns. What puts a woman or child at high risk? Are the risks specific to this part of Indonesia?

The most common causes of death for pregnant mothers are post-partum bleeding, preeclampsia, eclampsia, other communicable diseases such as HIV and AIDS, and sepsis. For newborns, asphyxia and low birth weight are the most common causes of death. These risks are issues all over Indonesia, not just in these districts.

Death is preventable. Pregnant mothers and newborns can be helped by early screening and detection, quick response, and an in-place referral system. Health programmers need to understand the reproductive life cycle of a woman and where in the cycle a woman needs proper intervention to avoid having an at-risk pregnancy that can cause death. Complications can occur when a woman is pregnant at an unproductive age (under 20 or above 35), when she is anemic, or has poor nutrition. These can all put women at a higher risk for pre-eclampsia and post-partum bleeding as well as delivering babies with low birth weight, asphyxia, and sometimes birth defects.

Why do the Banyumas and Grobogan Districts account for the first- and second-highest maternal and neonatal deaths in the Central Java Province?

Both districts are in mostly rural areas far from the city. This causes the public’s understanding of high-risk mothers to be poorly understood. With the factors of wide geography and far away health care facilities, delays in treatment can lead to maternal mortality. Essential trainings for health care workers are not covered in the local budget, and the districts do not support community empowerment activities.

The Grobogan District has more complicated maternal and overall health problems. There’s poverty, high infectious disease rates, high turnover rates among staff, and a special challenge of high rates of early marriage in Grobogan, which correlates with low birth weights. Women who get married before 20 have a much higher risk of giving birth to a child with low birth weight compared to women who are married at 20-30 years old.

How has COVID-19 impacted women in Indonesia?

During the second wave of the pandemic from March 2021 to December 2021, the mortality rate increased almost eight times in Banyumas, jumping from 11 to 84 deaths. In Grobogan, the mortality rate more than doubled, from 31 to 69 deaths. The majority of the deaths were from COVID-19. It was incredibly sad to know that the health system we just built was crushed by the pandemic. Before the pandemic, maternal death was decreasing.

Other than the mortality rate increase, the pandemic changed most of how we implemented the program. We couldn’t conduct on-site training due to government regulations on how many people can be in a room, and most maternal and neonatal training, especially in emergency response, needs to be face-to-face. Because of this, some of the activities were delayed.

Do you have any memorable stories from your time overseeing this work? Are there any women or health care workers who stick with you?

Every person dealing with this program in both districts has special moments to remember. One of our staff members, Avie, who works in the Banyumas, shared a memorable story that he experienced at the puskesmas (public health center). There was a pregnant woman who was about to give birth, and the birth went smoothly because health workers had received training carried out by the Saving Lives at Birth program. Health workers have become more cooperative and patient with patients, and this makes patients feel more comfortable and secure when being treated by more professional health workers.

What do you wish people knew about being a midwife, or about being pregnant in Indonesia?

Being a midwife is an asset is for Indonesia. A midwife is a Wonder Woman for other women in pregnancy. All pregnant mothers are people at risk. They need all the support and help they can get to help ensure a healthy pregnancy, delivery, and life post-delivery. All risks during pregnancy can be prevented by a healthy lifestyle, good nutrition, routine antenatal care, proper treatment, and care from health care systems. No mother should lose her life after delivering another life.