Published: 30/07/2008

This article is a summary of a case study of an issue in reproductive health services and childbearing mothers. This case study is taken from one of seven Districts in Indramayu, Surakarta, Lampung Utara district, West Sumba district, East Lombok district, Jembrana district, and Lebak district. It is describing the life story of Sudarmi who lives in Sangkrah village, Pasar Kliwon subdistrict, Surakarta


Sangkrah village, Pasar Kliwon subdistrict, Surakarta

Sudarmi is the sixth child of six siblings. She is an elementary school graduate and it is her final education. She got married at 18 to Basuki who is also an elementary school graduate. Sudarmi’s husband works as a parkman in the parking lot of a garment outlet with unsteady income while Sudarmi works as a vegetable vendor. Although both of them work, their monthly income is less than Rp. 600 thousand making them categorized as a poor family. Now they are registered as holders of Askeskin card, a health insurance card for poor family.


In the threshold of her 35th birthday Sudarmi had been pregnant for 6 times and never had a miscarriage. Her youngest child is now 15 months. Sudarmi revealed that she did not want to have many children, and therefore she used contraceptives to prevent pregnancy. Several kinds of contraceptives she had tried beginning with natural breastfeeding, but this method was not proven effective to prevent pregnancy. After giving birth to her second child, Sudarmi tried to use injection which was given to her by Sangkrah People’s Health Center (Puskesmas) for one month period, where Sudarmi paid Rp 4,000 for each injection.


After using the injection method Sudarmi felt that her menstruation was at odds. Sudarmi consulted her problem to a midwife in the Puskesmas, but nothing changed, making Ani stop using the method. Not long afterwards Sudarmi became pregnant again with her third child. After the birth of her third child Sudarmi ventured to use the IUD that was inserted by a physician with a cost of Rp. 10,000. Sudarmi used the IUD for 5 years. Asked why she used the contraceptive, Sudarmi explained that she chose it because a midwife showed the picture of it to her. That time the midwife just explained the use of the IUD without exposing the risks of using it. Accordingly, Sudarmi just felt OK using the IUD.


As a matter of fact, when Sudarmi used the IUD she felt some disturbing inconveniences such as the fact that when she had menstruation she experienced excessive and longer bleeding, and the pain was even worse. Other complaints had to do with the pain on the vulva, inflammation in the vagina, and irritation on the lower part of the belly. Sudarmi tried to have this checked to the Puskesmas, but since there was no change in what she felt, she decided to stop using the IUD and switched again to injection which she could obtain for free at the Puskesmas by using the Askeskin. Sudarmi’s husband also participated to prevent pregnancy by using condoms, but it turned out that the methods used by both Sudarmi and her husband were not proven effective to avert pregnancy and this made Sudarmi give birth to her fourth child.


After giving birth to her fourth child, Sudarmi decided to do sterilization by using the tubectomy that was operated on to her in Jebres State Hospital. Sudarmi was interested in doing the sterilization after being offered with the method by a cadre working in an integrated health service (Posyandu) with a cost of Rp. 60,000. This cost was considered inexpensive compared to sterilization cost in the hospital (not a family planning safari) that might amount to Rp.500,000 to Rp. 700,000.


Sudarmi finally chose to follow family planning safari programs in order to be sterilized in Jebres hospital. Before the sterilization operation Sudarmi was told to fast one day prior to it and not to drink coffee. Together with Sudarmi were three mothers who also wanted to have the sterilization. The midwife and the doctor told Sudarmi not to be afraid because this operation was safe. But Sudarmi acknowledged that she did not know what was done by the doctor with that small operation. Sudarmi did not know precisely whether the sterilization meant that her oviduct was tied or cut off, because this was not informed to her by the doctor. She just believed that by this operation she would not have more children. Sudarmi had this operation at 11 a.m, but strange enough until 8 p.m. Sudarmi had not recovered consciousness, while the other three mothers had resumed their consciousness and returned home. Sudarmi’s condition had worried her husband and her family. Sudarmi’s husband followed her to the hospital to find out her condition. He felt that he had never signed an approval when asked by Sudarmi. Sudarmi’s father did not either, fearing that the operation would fail. But Sudarmi was determined to have the operation without her husband’s and her parents’ approvals. She went to the hospital escorted by a midwife from the local Puskesmas. Therefore Basuki became angry and startled by Sudarmi’s condition that had not recovered consciousness after the sterilization surgery.


The nurse that took care of Sudarmi explained that it was difficult for Sudarmi to recover consciousness because of the anesthetics. According to the doctor, when Sudarmi was anesthized for the first time, Sudarmi did not become unconscious so that when her belly was cut open by the doctor she screamed from pain. That’s why the doctor gave her once more anesthizing injection just to make sure that Sudarmi had become insensitive and did not scream when the operation was done on her. But the anesthetics was so strong that Sudarmi did not regain her consciousness after the operation, causing the doctors to have her brought to the ICU to be given heart pacemaker for her pulse happened to stop for a while. Sudarmi was almost declared dead. Sudarmi herself after recovered consciousness said that she was slightly conscious after the heart pacemaker was applied to her but she felt so weak and powerless making her unable to respond to the surroundings but was able to hear voice.


The process of sterilization operation that almost caused Sudarmi’s death was over. But the tubectomy/sterilization had failed because Sudarmi was pregnant again for the fifth time after 6 months of the sterilization (tubectomy) surgery. Sudarmi set forth her complaints to Jebres hospital where she had the tubectomy operation and it finally got a response from the hospital. But she regretted the fact that there was no further policies to overcome the impact of unsuccessful contraceptives. The paramedics in Sangkrah were even afraid and reluctant to handle Sudarmi’s case when she wanted to reuse the contraceptives. Sudarmi had to go to a doctor where she had to pay Rp. 75 thousand for the IUD insertion, a price which was felt as very expensive as Sudarmi had always been using her Askeskin to get a free health service in the Puskesmas. ***