Advocacy, Gender Equality and JEDI, South-East Asia

A Capture of Midwifery Care in Women with Disabilities in Southeast Asia 

ICM
1 April 2024

By Kusmayra Ambarwati, Gita Nirmala Sari, and Feri Anita Wijayanti from the Indonesian Midwives Association and  Subasna Sharestha, Maiya Shoba Manandhar from the Midwifery Society of Nepal 

Women with disabilities often face significant barriers in accessing sexual and reproductive health services. These barriers stem from discriminatory laws, healthcare practitioners’ misconceptions, and physical accessibility issues. In this article, we shed light on the landscape of midwifery care for women with disabilities in two countries within the Southeast Asia Region, specifically in Indonesia and Nepal, and advocate for inclusive practices to ensure the rights and well-being of all women. 

Indonesia’s rich midwifery heritage, spanning over two centuries, has resulted in a workforce of over 300,000 midwives. Most midwives work within community maternity health facilities and primary health centers, and private practices are less common. In 2016, Indonesia took a significant step forward with the introduction of legislation providing guidelines for sexual and reproductive health services for people with disabilities. This legislation enables women with disabilities to make informed decisions about contraception and provides protection against discrimination and violence. Midwives across the country have embraced these guidelines, with a focus on making midwifery care for disabled women accessible and inclusive. While commendable progress has been made, further measures are necessary to ensure universal access to healthcare facilities for all women. 

Nepal has only recently embarked on the journey of professional midwifery education. Following concerted efforts by the government and stakeholders, professional midwifery education was introduced in 2016 at Kathmandu University. However, the implementation of the midwifery model of care in clinical settings remains challenging. Nepal’s vision includes the establishment of onsite midwifery-led birthing units in hospitals with high birth rates.  

Despite these strides in midwifery care, Nepal still lacks specific provisions or laws protecting the health rights of women with disabilities. However, there is a strong commitment to delivering equitable services to all women. Nepal can and should learn from Indonesia’s example to enact formal laws ensuring accountability and protection for women with disabilities in the context of sexual and reproductive health. 

Continuity of midwife care is fundamental to promoting, protecting, and supporting women’s sexual and reproductive health rights, regardless of their disability status. It is based on the ethical principles of justice, equity, and respect for human dignity. While challenges persist, midwives can play a transformative role by prioritizing individualized care, fostering innovation, and actively involving disabled women in decision-making processes about their health and bodies. Comprehensive regulations and support from stakeholders are essential to overcoming barriers and ensuring that women with disabilities receive the care and support they deserve. As members of the Southeast Asia Region, the Indonesian Midwives Association and the Midwifery Society of Nepal are committed to championing inclusive healthcare practices and encourage others to do the same.