adhi.akto

In the absence of a vital registration and health information systems, Indonesia does not have complete, accurate, and continuous data to summarize the mortality statistics of the population, nor determine the exact cause of death. Verbal autopsies performed in a community-based mortality surveillance have been used to provide information on the cause of deaths in such context. However, physician review of verbal autopsy can be expensive, time-consuming, and give inconsistent results, raising concern about its reliability. We used the Purworejo Health and Demographic Surveillance System’s (HDSS) mortality data collected between 2000 and 2002 and assigned causes of death for all age groups using Interpreting Verbal Autopsy-4, analytic software that applies a probabilistic model. A total of 1,999 deaths were identified among 55,581 individuals surveyed in 14,409 households; 830 deaths were able to be recorded using the standardized World Health Organization (WHO) verbal autopsy questionnaire. We calculated the proportion of different causes of death and its incidence rate (IR) ratios with 95% confidence interval (CI) to compare the IR per person-years-observation (PYO). The IR of stroke was 126.7 per 100,000 PYO (95% CI: 109.7, 143.7); acute respiratory infection including pneumonia was 70.8 per 100,000 PYO (95% CI: 58.1, 83.5); and the IR of other and unspecified cardiac diseases was 57.7 per 100,000 PYO (95% CI: 46.2, 69.2). Stroke was indicated as the leading cause of death among elderly people aged 50 years and above. Meanwhile, pneumonia as a communicable disease was found to be the most common cause of death among both 0–14-year-old children and elderly people.

This qualitative study explored in depth the lived experiences of middle class women in Yogyakarta, Indonesia as they attempted to juggle their unpaid reproductive work with paid work in the formal sector or with university study. Our analysis reveals the challenges encountered by middle class women when they decide to exclusively breastfeed whilst also participating in work and tertiary study. We explicate the legal framework underpinning exclusive breastfeeding and maternity leave, and identify significant gaps between labour and exclusive breastfeeding legislation and the implementation of these laws in workplaces and universities. The tensions between the gendered expectations of women's contributions to reproductive and productive work are also exposed. Drawing on our findings, we assert the importance of social support and the collective nature of reproductive agency exercised by Indonesian women who seek to exclusively breastfeed while working or studying.

Exclusive breastfeeding is embedded in National Health Law and Regulation in Indonesia and is vigorously promoted by health workers, breastfeeding counsellors and religious leaders. This article explores the transformation of state legislation into breastfeeding promotions that are imbued with moralising assumptions directed at expectant women, new mothers and their partners. Drawing on an 18-month ethnographic study, the rhetoric of breastfeeding promotion messages is contrasted with the narratives of urban middle-class mothers in Yogyakarta. This article highlights the challenges women experience in their attempts to breastfeed and the divergence between the moralising rhetoric of breastfeeding promotions and women’s imperfect lived realities. It demonstrates how dominant health promotion messages construct breastfeeding as a moral issue, insist women are obligated to breastfeed their infants, and fail to acknowledge women’s choice, reproductive agency and bodily autonomy. Such messaging assumes the right of infants to be breastfed, and emphasises the developmental problems likely to befall children who are not breastfed. Gendered expectations that all mothers will assume their breastfeeding role selflessly and dutifully are also embedded in breastfeeding promotion messages. We conclude that breastfeeding promotion messages need to be more inclusive and less moralising in their substance and delivery to better serve Indonesian women. Women are likely to feel more supported and less alienated by breastfeeding promotion messages that recognise the possibility of common breastfeeding challenges, such as difficulty establishing successful breastfeeding, the baby blues, the likelihood of suffering discomfort from breastfeeding in public, and issues with the premature cessation of breastfeeding.

Indonesia’s commitment at London Summit 2012 was to reduce TFR by increasing contraceptive users by 2020. This paper aimed to estimate the number, trend and possibility to achieve RPJMN and FP2020 targets in Indonesia. This was a descriptive study using secondary data from Indonesia national survey. Data are presented in line, bar, and pie graphs, also table to explain trend and possibility of Indonesia FP to achieve 2020 targets. Using 2012 data as the baseline, RPJMN and FP2020 targets will be achieved if CPR grows 0.5 point/year. However, recent growth was insufficient, only 0.3 additional points. The current CPR is behind the target and 1 point/year growth rate is needed to approximate the target trajectory. Based on three surveys in 2015 (PMA, SUSENAS and SUPAS), Indonesia’s CPR was predicted to be 61.1% on 2020. This is five points lower than the 2020 target, 66.3%. This discrepancy shows that Indonesia would not achieve FP target on RPJMN 2015-2019. Based on recent survey in 2015, CPR trajectory is predicted to be 5 points below the target. 1.5 points annual growth is needed to achieve the 2020 goals.

Background: Progesterone-Only Pill (POPs) is one of the ideal oral contraceptive methods for breastfeeding women. Discontinuation of POPs was mostly due to bleeding pattern disorders. Objective: The purpose of this study is to identify the prevalence and pattern of uterine bleeding on breastfeeding women using contraceptive pills containing progesterone derivatives. Methods: This study is a double blind block randomized controlled trial for the treatment group (levonorgestrel or lynestrenol pills) and non-randomized controlled trial for the control group, 6-8 weeks’ postpartum women, 20 to 35- year-old, and breastfeeding. Monthly follow up was done for 6 months. Analysis was done using survival analysis, X2 , and Cox’s Proportional Hazard. Results: A hundred and seven women were involved with a drop-out rate of 17.8%. Subjects characteristics were ≤ 32- year-old, multiparous, ever used contraception with birth spacing of >60 months. Spotting and amenorrhea was the most common pattern. Levonorgestrel causes bleeding/menstrual resumption sooner in breastfeeding women than Lynestrenol. Conclusion: The most common uterine bleeding on women using Progesterone-only Pills were spotting and amenorrhea. By recognizing such effects, for Indonesian women, POPs was expected to be produced in the country and can be included in the national family planning programs.

Background: Despite several decades of investment into family planning and maternal health systems strengthening, Indonesia’s maternal mortality ratio remains among the highest in Southeast Asia. Among postpartum women unmet need for family planning is greater than at any other time, thus there is great potential to improve the reproductive health outcomes of Indonesian women through enhanced postpartum family planning access.