00074918.2015.1023418

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TANJUNGPINANG, KEPULAUAN RIAU] Date: 17 January 2016, At: 23:09

Bulletin of Indonesian Economic Studies

ISSN: 0007-4918 (Print) 1472-7234 (Online) Journal homepage: http://www.tandfonline.com/loi/cbie20

Reducing Maternal and Neonatal Mortality in

Indonesia: Saving Lives, Saving the Future

Terence H. Hull

To cite this article: Terence H. Hull (2015) Reducing Maternal and Neonatal Mortality in Indonesia: Saving Lives, Saving the Future, Bulletin of Indonesian Economic Studies, 51:1, 154-155, DOI: 10.1080/00074918.2015.1023418

To link to this article: http://dx.doi.org/10.1080/00074918.2015.1023418

Published online: 30 Mar 2015.

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154 Book Reviews

Reducing Maternal and Neonatal Mortality in Indonesia:

Saving Lives, Saving the Future. By the Joint Committee on Reducing Maternal and Neonatal Mortality in Indonesia. Washington, DC: The National Academies Press, 2013. Pp. 112. Paperback: $40.00. PDF available at http://www.nap.edu/openbook.php?record_id=18437.

This collaboration between the national scientiic academies of the United States and Indonesia is analytically sound, but the conclusions and recommendations are not encouraging. Indonesia’s maternal and neonatal mortality rates are high compared with those of its neighbours, and the causes and consequences of these trends have persisted over a long period of time. What this volume does, in a masterful way, is to marshal all the evidence up to 2012 and point out the lessons for policymakers. The long list of experts contributing to the work is a Who’s Who of Indonesian and American specialists on the medical, demographic, social, and cultural dimensions of maternal and neonatal mortality. The quality of the report can be attributed in part to the very thorough review process—12 substantive experts ensured that the content and the format were up to the standards of the National Academies. That alone should be suficient to encourage Indonesianists, and specialists in Asian reproductive health, to buy or download this publication. That is all well and good, but should the readers of BIES be interested in the report, beyond the general interest shown by any member of the community in maternal mortality trends and the millennium development goals? The answer is a resounding yes. This report has three qualities that will attract the attention of even the driest of economic researchers. First, it opens with a clear-eyed con-sideration of Indonesian statistics, in a chapter called ‘The Data Conundrum’. This chapter not only compiles the major data sources to examine the fragility of methods and contradictions of results; it is also meticulous in warning the reader about the inevitable deep gaps in time reference for estimates of rates based on surveys. For instance, the child mortality estimates for the 2012 Demographic and Health Survey refer to the periods between 1999 and 2009. For policymakers look-ing for annual igures this is a salutary lesson. Equally, for economists plugglook-ing health variables into regression equations, it sets up a warning sign: beware inter-temporal slippage.

Second, chapters 4 and 5, on the health-care system and the quality of care, are brief, pithy, and provide a good introduction to the shortcomings of numbers and quality of health-care personnel across Indonesia. This problem has been magni-ied by the last dozen years of decentralisation, in which promised improvements in health and education have failed to materialise (chapter 6). While policymakers may complain that this is a harsh judgement, chapter 7 summarises recent stud-ies of health-care inances and shows that the levels of expenditure are low by international standards, the data to manage health-sector inances are seriously inadequate, and the various innovative insurance schemes are faltering and in practice have not been able to overcome persistent inequities.

Third, the eight recommendations are directed not to the doctors and midwives at the coalface of maternal and child health services but to the economists, plan-ners, and politicians in the back ofices where resource decisions are made. They are the people who have to understand the demographic data, irst by accepting

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Book Reviews 155

the uncertainty of estimates and then by using the uncertain data to shape sound policy decisions. The authors of this volume give priority to facilities, setting out the following recommendations to address the infrastructure: the need for strategies and plans to reduce regional and class disparities; the application of standards and accreditation to improve quality of care; the improvement of the content and quality of training; the assurance of adequate and effective inance mechanisms to eliminate corruption; the collection, compilation, and distribu-tion of valid and reliable data; and, inally, the educadistribu-tion and empowerment of women, who are the primary consumers of maternal and child health-care ser-vices. This last recommendation stands out from the others as being more general and timeless, but it addresses one of the key issues in health services, where a cowed or passive consumer allows governmental inadequacies to persist unchal-lenged. The authors believe that better education will make women better deci-sion-makers and more insistent consumers.

The appendix (pp. 101–8), written by demographer Peter Gardiner, summa-rises recent fertility estimates and links these to the reduction of high-risk births. As women marry later, complete childbearing earlier, have fewer births, and have longer periods between births, the various dangers of childbearing associated with maternal deaths are avoided. These recent important social changes are at the heart of the strong advocacy for funding family-planning services as a means to reduce maternal and child deaths.

The Indonesian and US academies have here made a very useful contribution to the Indonesian health system, and they have also demonstrated the value of such international collaborations.

Workers, Unions and Politics: Indonesia in the 1920s and 1930s. By John Ingelson. Leiden: Brill, 2014. Pp. xvii + 352. Hardback: $163.00.

This is a ine sequel to John Ingelson’s 1986 book In Search of Justice: Workers and

Unions in Colonial Java, 1908–1926. I am in awe of Ingelson’s ability to pick up some of the themes of his irst book and write about them with such commitment, clar-ity, and apparent enthusiasm almost 30 years later. The irst book dealt with the labour movement from the turn of century to the ultimately unsuccessful wave of strikes and the Indonesian Communist Party rebellion of 1926–27. Workers, Unions and Politics is about a much different period, when unions were for the most part divorced from direct links with political parties and the nationalist movement.

Ingelson focuses here on union organisation and relations with the colonial government during three very different periods: the economic boom of the late 1920s, when unions were still closely watched in the aftermath of the radical-ism of the mid-1920s; the Great Depression, when workers suffered greatly and unions struggled to survive; and the recovery period after the depression, when