DYING TO HAVE A BABY

PREGNANCY AS A DEATH SENTENCE Duncan Graham

Mother Dead in Childbirth, by the Spanish sculptor Josep Dalmau (1867-1937

Genuine good news stories involving government initiatives are rare. Here’s an exception.

It’s a common plea from barren Australian women: ‘I’m dying to have a baby.’ The throwaway line is delivered with a sigh of frustration at the time and cost of in-vitro fertilisation, drugs, and surgery.

When that same phrase is used in Indonesia the meaning is literal.

The nation next door has one of the highest rates of maternal mortality in the world at close to 200 for every hundred thousand live births. In North Sulawesi and the Eastern Islands, it’s almost double the national rate.

Around 5.8 million babies were born last year – so more than 11,000 mothers died bringing new life into the world - the most natural and essential experience of being human.

The figure is huge and horrific; enough to fill 44 Air India passenger jets and every fatality a woman? With these risks who’d ever get pregnant voluntarily?

What about the kids who never get a chance to wear the hand-me-down red and white uniforms, to grow, to play, to learn? They die early, hungry and diseased.

Christian cemeteries in the archipelago are social historians’ heavens, because most headstones list the occupant’s arrival and departure, along with marriages, siblings, and sometimes career paths.

Muslim graveyards rarely record more than the death dates of adults while unmarked low earth mounds show where unnamed kids rest.

North Sulawesi province (south of the Philippines) is dominated by Protestants and Catholics so burial grounds tell hectares of tragedies. Tombs of kiddies and graves of teenage girls too young for pregnancy, often victims of haemorrhage and sepsis.

Giving birth is universally celebrated – the start of a new generation that will hopefully do better than the last and bring joy to the families. Yet many Mums never get to feel the love.

There’s no one factor responsible; malnutrition, poor education and lack of medical care are obvious, but there are cultural factors involved like underage marriage and myths spread by dukun – (paranormals).

The legal age with parental consent is 19, the same for girls and boys. If thumbs down from the oldies, it’s 21.

Fine in the big cities where controls are exercised, but not in remote villages where religious leaders can tick boxes, particularly if the lass is pregnant, for abortions are illegal.

A just-released UN Child Rights Committee report claimed it was “seriously concerned .. at (early betrothal) rates above the national average” in four provinces with a “rise in marriage dispensation requests, unregistered marriages, and permissive cultural norms that hinder efforts to end child marriage.”

These include … “limited access to contraception for unmarried adolescents, and cultural traditions that ban discussions on sexuality.”

Statisticians enjoy confusing by mixing ratios of one to 100,000 with than 10,000 or 1,000. The average Indonesian woman has 2.2 children when the figure must be either two or three. This is above the replacement level so the population – now 286 million will keep growing.

Not so Down Under where the Mum-Child rate is 1.5, the lowest it’s ever been; without migration we’d disappear.

Australia’s much smaller population, Medicare, high class hospitals and annual birth numbers of below 300,000 mean that fewer than five die during parturition.

Now we are using our knowledge to do something. Not call a committee or write a report but actually do.

From whence came the surprising genesis for betterment? We’d like to think it’s P & I stories like this, but the local media has been banging the drum for months. Now the Embassy has caught the rhythm.

The dangers of childbirth are well known from the brief life of a 19^th-century Javanese intellectual; today she’d be called an ‘influencer’. Her story is on the curriculum and widely taught.

Raden Adjeng Kartini was a victim of a patriarchal colonial society; despite being kept in isolation she garnered progressive ideas from friends in the Netherlands and shared her concerns in Dutch.

But she couldn’t escape cultural pressures and eventually married a local aristocrat 26 years her senior and with 12 children.

She gave birth to a son and bled to death four days later. She was 25. Soesalit Djojoadhiningrat lived till he was 57.

His mother was elevated to hero status by founding President Soekarno to appease the feminists; her birthday on 21 April is a national holiday. Kartini was the ideal candidate, demure and respectful, a putri sejati (an obedient daughter), advocating for education but not embarrassing society.

Grace Tame she was not.

Commented a German academic: “Soekarno’s Old Order chose Kartini to be the model of a progressive native woman … she gave sharp criticism against imperialism. Although she was the golden girl of the ethical policy elite, Kartini was clearly aware of the Dutch colonial rhetoric.”

Many of the issues she highlighted more than two centuries ago remain, though girls now get a better education and are seen as equals, at least in bureaucracy’s lower ranks. She campaigned against polygamy but eventually accepted an arranged marriage.

The issue of child and mother deaths should jump boundaries and cultures. With Oz experience in maternal health, we can advise.

We’ve offered the Indonesian military use of training facilities in the Northern Territory to practice killing imagined invaders.

This new midwife deal seems better, purer – teaching techniques to save lives, not fight fantasies. Taxpayers will fund 344,000 Indonesian midwives to enhance their skills and knowledge and identify the real enemy - ignorance.

It’s the first commitment under the new Australia-Indonesia Partnership for Health Transformation. Till now the Embassy’s priorities have been security, trade and defence – the blokey stuff:

“Australia and the UN Population Fund together with Indonesian agencies will improve midwifery services across Indonesia, supporting the country’s efforts to reduce maternal and newborn mortality and prevent stunting.”

Just 237 words. No blah about security or threats on the horizon. No grinning polis hoping for unearned credit.

It should have happened earlier, but for once we’re quietly responding to a real need – and that’s a story worth telling.

First published in Pearls & Irritations, 23 June 2025

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