The COVID-19 pandemic has made sexual and reproductive health services more challenging. However, midwife Nur Hidayah, known by her nickname Bidan Aya, is not deterred by the challenges. The 36-year-old midwife from Sidenreng Rappang, South Sulawesi, who has been providing services in her private clinic in Sidenreng Rappang for 11 years, is determined to do her best to serve her patients.
Bidan Aya continues to develop and innovate itself. The training she participated in as part of UNFPA’s Leaving No One Behind (LNOB) program helped her respond to the challenges posed by the health crisis.
Challenges in delivering services during the pandemic
Bidan Aya admitted that the start of the COVID-19 pandemic was difficult for her. The lack of knowledge about how to deal with COVID-19 led to concerns and confusion. In 2020, she assisted a delivery where the patient later tested positive for COVID-19. “I wore PPE (personal protective equipment, ed.) when I helped give birth, but I was still worried,” she recalls. “After that I shut down my practice for three days. My assistant and I self-isolated until we received our COVID-19 test results.”
That incident reminded her that her job exposes her and her staff to the risks of COVID-19 transmission. “We can’t just assume that a patient is fine because someone who looks fine could be a suspect.”
Despite the fear of COVID-19 contamination, Bidan Aya continues to provide its services under strict conditions. “If a patient has no symptoms, I advise her to just read the KIA, the maternal and child health guide, and follow the recommendations,” said Bidan aya. She also encourages pregnant women to observe their own pregnancies and be aware of signs of pregnancy danger.
“If they find any distressing symptoms, I recommend they immediately seek medical attention at our midwifery practice with prior appointment,” she explained. Bidan Aya also provides online service through WhatsApp and Instagram platforms where her patients can make appointments and consult with her.
The inspiring and life-changing workout
In August 2021, Bidan Aya enrolled in a midwifery training program organized by the Faculty of Public Health of the University of Indonesia (FKM UI) and the Indonesian Association of Midwives (IBI) with the support of UNFPA and the Government of Japan. The training was part of the LNOB program, which ensured the continuity and inclusiveness of access to sexual and reproductive services for people most affected by the COVID-19 pandemic.
Bidan Aya did not expect the training to teach her new knowledge in a way she had never experienced before. She admitted that the training significantly increased her knowledge of personal protective equipment and infection management.
“The training turned out to be extraordinary… I like participating in webinars and trainings, but this one is different, because this training is really really good!,” she exclaimed.
“When I saw the list of participants, I just realized that the many participants come from all over Indonesia. Eight training modules, delivered in five days. From module 1 to 8 we learned the basics,” she recalls. “About the pandemic, antenatal care (ANC), services during COVID-19, childbirth, contraception, medical waste management, psychosocial support, infection prevention. They are all very relevant to the current situation and very well delivered by the trainers,” she continued.
The discussions in break-out rooms and WhatsApp groups with other participants quickly inspired her to another innovation. “I made ‘Paman Maco’,” said Bidan Aya. The catchy acronym stands for “Papan Pengumuman Praktik Mandiri Bidan (PMB) Cegah COVID” (“Independent Midwifery Practice’s Announcement Board for Preventing COVID”), a board providing information on COVID-19 prevention and vaccination for visitors to her clinic. “This training also allowed me to see how other midwives run their clinic. They look beautiful, so I was inspired to improve mine as well,” she said.
She also received constructive input for “Kurindu Bumil”, a WhatsApp group she founded and uses to communicate with expectant mothers. Established before the pandemic, Bidan Maya initially used “Kurindu Bumil,” which literally translates to “I miss pregnant mothers” in Indonesian, but actually an abbreviation that stands for “pregnant mothers who routinely gather after visiting an integrated health center” , to share information about pregnancy classes and ultrasound (USG) schedules. The platform later grew its function of connecting its participants with healthcare providers, including obstetricians, general practitioners and obstetricians/gynecologists (OBGYNs). The participants, who have joined the group from when they were pregnant until their babies have grown to 5-year-olds, can ask questions about their health issues on the platform. The emergence of the pandemic has increased the importance of this online communication platform. More than 300 participants have now joined the group.
For Bidan Aya, innovation in sexual and reproductive health services is important to ensure that no pregnant woman and young person is left behind in accessing health services. “If you don’t innovate, you’re stuck, there’s no progress. (We should innovate) to support, for example, Puskesmas programs (local health centers, ed.) In motivating pregnant women to routinely take iron supplements,” she illustrated. “Pregnant women used to not use iron supplements regularly. In 2018-2019, there were 12 cases of bleeding, 2 maternal deaths and 5 low birth weight (LBW) babies. Consuming iron supplements may reduce bleeding rates, miscarriages, LBW and maternal deaths,” continued she.
Turning inspiration into action
Furthermore, the principles of respectful midwifery taught in the training led Bidan Aya to reflect on the way she treated her patients. “Before this training, I sometimes felt annoyed when patients came in in the middle of the night, when I was exhausted,” she recalls. “I learned that I was not supposed to behave this way towards members of the community, especially my patients. The training taught me ways to regulate my emotions… I hope I can be more patient now,” she said.
Bidan Aya admitted that being a midwife in a village means being ready to serve as a caregiver, friend, advisor, public health advocate. “Apart from those intense duties, we still have a family to care for, and now COVID.” Fortunately, the training also reminded her to take care of herself. “After the mental health and self-care training, I went on holiday with my husband and gave my assistant 2 days off.”
During the training she also learned about gender-based violence (GBV) and harmful practices. The module made Bidan Aya realize that the practices of female genital mutilation (FGM) and child marriage still prevalent in her area are actually harmful to women and girls.
“There are a lot of teenage pregnancies here. In 2018, there were 15 teens who became pregnant, five of them out of wedlock… Some of them were only 13 years old and had to have a caesarean section because their pelvis was still small,” she recalls. “A child who drops out of school early can be seen as a signal that they are ready to get married. For example, if you are not in secondary or high school, it means that you are waiting for a marriage proposal,” Bidan Aya gave context. to the prevalence of child marriage in her village.
“Female circumcision is also common… I discussed what happened here with the trainers and other participants during the training, and they agreed that we should end FGM because it is harmful,” she continued.
That realization drove her to reach out to adolescents and further create a reproductive health network for educating girls named after a famous martial art cartoon character, “Wiro Sableng 212”. The name stands for “educational center for adolescent girls to prevent pregnancy at an early age through education about reproductive health and prevention of stunted growth”. She uses the number “2+1+2” to refer to five essentials for the reproductive health of adolescents in her village: 1) weighing and physical examination, 2) birth control pills to delay pregnancies in married adolescents, 3) education for grandparents raising adolescents, 4) adolescent literacy (books on reproductive health), and 5) adolescent anemia control chart.
“I identified 58 young girls who were already out of school and started educating them about reproductive health to prevent sexual violence and child marriage,” explains Bidan Aya. “I hope it will turn out well and help them think about other options for their future, and shift their focus from seeing marriage as the only option available to them,” she affirmed.
She is also rolling out a monthly health survey for young people with local Puskesmas cadres. “I also coordinated with the Women’s Empowerment and Child Protection District Office to discuss female circumcision. It is part of our tradition, but we will try to change it slowly.”
The journey continues
As innovative and hardworking as she is, Bidan Aya still faces major challenges. “Of those eight modules, preventing sexual violence and child marriage is the most difficult to implement.” She has tried to prevent instances of child marriage in her village, but failed because institutions authorized the marriages despite her testimony about the children’s unfitness to marry.
“If only we could implement all eight modules of the training, it would be possible for us to achieve zero maternal and neonatal mortality…but it is impossible for me to do everything alone,” she said. “But I’m not giving up. I will continue my service and innovation,” she concluded optimistically.
Asri Wijayanti, (former) communication and knowledge management officer,
Ria Ulina, Sexual and Reproductive Health in Emergency Officer