Improving care for Indonesia’s pregnant women and their infants

Aug 8 2014

By Professor Roger Smith

Indonesian Children

In late 2013, I was invited to go to Indonesia, to speak to the Department of Obstetrics and Maternal Fetal Medicine at the main hospital at the University of Indonesia.

I was invited to go by an obstetrician who I met at a meeting in Singapore. I was already going to Indonesia as part of our project to study endangered primates. There are a number of endangered primates in Indonesia – slow lorises, tarsiers, gibbons, siamangs, and of course the orangutans.

So it was fortuitous that they also wanted me to speak to the obstetric department. When I spoke, I discovered that Indonesia faces huge problems in the area of maternal and neonatal health. Each year 30,000 Indonesian women die in relation to childbirth. This is an astonishing number – in comparison, in Australia perhaps 15 women die in relation to childbirth. Of course Indonesia has a bigger population than Australia, but not that much bigger.

In the hospital that I was visiting, they had already had 60 deaths so far that year. At John Hunter Hospital in Newcastle, there has been one maternal death in the last three years, so it really is dramatically different. It’s like a war zone in the obstetrics unit.

Their rates of premature birth are also much higher than Australia – more than double – so that around 25% of the babies born at the hospital in Jakarta are premature.

I was naturally disturbed by these statistics and wondered in what way we might be able to help.

From this, we have developed a collaboration. I have visited Indonesia again in March of this year, going to Sumatra and attending the Indonesian Annual Scientific Meeting for Maternal Fetal Medicine, where I spoke on the mechanisms of human birth, and also the mechanisms that may underlie stillbirth.
Subsequently three obstetricians from Jakarta have come and visited the Hunter Medical Research Institute (HMRI), and gave talks to our department of obstetrics as well as an HMRI lecture, about the situation of maternal and infant health in Indonesia.

One of the aspects I think we may be able to help with is understanding how poor maternal nutrition may lead to poor outcomes for pregnant women and particularly their babies.

In Newcastle, Alexis Hure, Clare Collins, myself and a number of others have been involved in a study – called the WATCH Study – where we followed pregnant women and related their nutritional intake to the well-being of their babies and children. This study has now been going for six years, and we have data even on the intellectual performance of the children that we can relate back to the nutritional intakes of their mothers.

We know that many of the women in Indonesia are poorly nourished, and we would like to try to define the ways in which they are poorly nourished to see if that is part of the reason behind their rates of premature birth. We are also interested in understanding how to improve care to the pregnant women to reduce the high death rates, and in this we are hoping to use mobile phone technology and apps to allow the pregnant women to get good advice on the management of their pregnancies.

We have submitted application for funding for this to our Federal Government, and we are planning on having further visits by the Indonesian doctors to work in Newcastle on projects related to premature birth. We hope that this will lead to an increasing engagement between Indonesian researchers and our own, leading to improvements in the health of Indonesian mothers and their children, and will also help us to improve our knowledge of mechanisms of premature birth.

***Professor Roger Smith is Director of the Department of Endocrinology John Hunter Hospital and Co-Director of the University of Newcastle Priority Research Centre in Reproductive Science, and Director of the Mothers and Babies Research Centre.

This post was originally published as part of the HMRI 24-7 “research never rests” campaign highlighting the international collaborations and links of HMRI-affiliated researchers.