Upaya penurunan angka kematian ibu di Kabupaten Ende Propinsi Nusa Tenggara Timur

KUSWOYO, Rusno, Prof.dr. Mohammad Hakimi, SpOG.,PhD

2005 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Berdasarkan kajian program Maternal and Neonatal Health Indonesia sampai tahun 2002 angka kematian ibu berkisar 373 per 100.000 kelahiran hidup. Sebab-sebab kematian diantaranya adalah perdarahan (45%), eklamsi atau kejang-kejang, dan tekanan darah tinggi (12%), infeksi (12%), gagal aborsi (10%). Meskipun AKI di Kabupaten Ende terjadi penurunan, namun dirasakan angka kematian ibu masih sangat tinggi yaitu mencapai 345 pada tahun 2003. Masih tingginya AKI di Kabupaten Ende lebih disebabkan oleh rendahnya pelayanan kesehatan ibu dan anak. Upaya menekan angka kematian ibu diantaranya dilakukan melalui berbagai macam gerakan dalam rangka safe motherhood. Perumusan masalah dalam penelitian ini yaitu: bagaimana upaya penurunan angka kematian ibu di Kabupaten Ende Nusa Tenggara Timur dari tahun 1999 – 2003. Metode: Penelitian ini dilaksanakan dengan metode kualitatif. Data primer dikumpulkan dengan cara wawancara kepada pelaksana pelayanan kesehatan ibu dan anak, yaitu dokter Puskesmas, bidan, dukun. Data sekunder diperoleh dari literatur atau arsip yang ada. Hasil: sumber daya pelayanan dalam penyelamatan ibu berasal dari masyarakat maupun dari pemerintah. Disamping dalam bentuk sarana kesehatan, dana, dan tenaga, sumber daya pelayanan juga dalam bentuk peran serta masyarakat dalam memanfaatkan pelayanan kesehatan. Pelaksanaan pelayanan kebidanan dilakukan dengan memanfaatkan dukun dan kader kesehatan. Masyarakat di Kabupaten Ende masih membutuhkan tenaga dukun untuk mendapatkan pertolongan persalinan. Budaya masyarakat yang menganggap tabu memeriksakan kehamilan usia kurang dari 4 bulan menjadikan terhambatnya deteksi dini terhadap kehamilan risiko tinggi. Kesimpulan: Proses pertolongan persalinan belum semua dilayani oleh tenaga kesehatan, sebagian masih ditangani oleh dukun. Untuk meningkatkan mutu pertolongan dukun maka bidan puskesmas perlu memberikan pelatihan atau pembinaan. Dukungan pemerintah setempat ditunjukkan dengan kesediaan pemerintah desa dalam memberikan insentif bagi kader di posyandu. Pemeriksaan kehamilan usia kurang dari 4 bulan yang dianggap tabu merupakan budaya yang menghambat gerakan safe motherhood.

Background: According to a study on Indonesian Maternal and Neonatal Health, until 2002 mothers' mortality is 373 per 100.000 births. Causes of death are among others bleeding (45%), ecclampsia and hypertension (12%), infection (12%), failed abortion (10%) (Radjab 2003). Although mothers' mortality at Ende District is decreasing, it is still as high as 345 per 100.000 births in 2003. This is mainly caused by limited services of mother and child health. Efforts have been made to reduce mothers' mortality through various activities for safe motherhood. Objectives: The study was meant to identify efforts to decrease mothers' mortality at Ende District, Province of Nusa Tenggara Timur in 1999 – 2003. Methods: The study was of qualitative type. Primary data were collected through interview with staff of mother and child health service, i. e. doctors at Community Health Center, midwives and traditional birth attendants. Secondary data were collected through literature or records available. Results: Service resources for safe motherhood came from both the community and government. Resources consisted of not only health facilities, fund, and human resources but also community's participation in the utilization of health services. Midwifery service was given through the utilization of traditional birth attendants and health cadres. The community of Ende District still needed traditional birth attendants. The local community considered that it was taboo for pregnant mothers to have a check up at their early pregnancy (less than 4 months). This caused problems in early detection of high risk pregnancy. Conclusion: Not all childbirth processes were handled by health staff, some were handled by traditional birth attendants. To improve quality of childbirth provided by traditional birth attendants, training and supervision was given by midwives at community health center. Support from local government was given by providing incentive for cadres of integrated health service center. The tabooing of check up at early pregnancy had created constraints of safe motherhood promotion

Kata Kunci : Kesehatan Ibu,Kematian, safe motherhood, health service resources, community’s participation