Utilization of Maternal and Child Health (MCH) Books For Pregnant Women in The Working Area of The Siulak Gedang Health Center

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Utilization of Maternal and Child Health (MCH)


Books for Pregnant Women in the Working
Area of the Siulak Gedang Health Center
Nadila Zikra Wahyuni1, M. Ridwan1, Ismi Nurwaqiah Ibnu1, Puspita Sari1
Public Health Sciences Study Program, Faculty of Medicine and Health Sciences, Jambi University
Jl. Jambi - Muara Bulian No.KM. 15, Mendalo Darat, Kec. Jambi Luar Kota, Kabupaten Muaro Jambi, Jambi

Abstract:- The Maternal Mortality rates (MMR) and I. INTRODUCTION


Infant Mortality rates (IMR) in Indonesia are still very
high. This can be influenced by various factors. The MCH Indonesia's Crude Mortality Rate (AKK) based on
Handbook functions as an information tool and health National Research (RISKESDAS) in 2007 pointed to
screening for pregnant women, infants, and toddlers. 4.6/1000 out of a total population of 973662 with the number
Currently, the utilization of the MCH Handbook for of deaths reaching 4445. Meanwhile, the Infant Mortality Rate
pregnant women is still very low. considering that this (IMR) showed 22/1000 and the Child Mortality Rate 41/ 1000
book influences the Knowledge and Attitudes of Pregnant from all provinces in Indonesia. Jambi Province's Crude
Women in improving their health status. The research Death Rate (AKK) was found to be 3.5/1000. When compared
method used is qualitative, with an analytic descriptive with other provinces in Indonesia, Jambi Province is in the
approach. The informants for this study consisted of medium category. The Infant Mortality Rate (IMR) is 22/1000
pregnant women, heads of the Health Center, and the Child Mortality Rate (AKA) is 40/1000 [1]. The
coordinators of the MCH Poly, Health Center midwives, maternal mortality rate (MMR) in Indonesia is still high. In
Practical Midwives, and Clinical Midwives. Data 1991 the MMR reached 390/1000. This figure decreased in
collection through in-depth interviews, observation, and 1997 to 334/1000. The same thing happened in the following
document review. The analytical approach used is content 5 years, namely in 2002 it reached 307. A decrease in the
analysis. Qualitative data analysis using the help of Open maternal mortality rate (MMR) also occurred in 2007 up to
Code software. The knowledge of pregnant women in 228/100. In 2015 it decreased to 305/100 live births. The
using the MCH handbook regarding the contents, maternal mortality rate in 2019 reached 4,221 deaths per year.
functions, benefits, and activities is good, but the In 2020, MMR in Indonesia reached 4,627 deaths [2].
understanding is still not correct. The attitude of
pregnant women in using the MCH handbook is still Meanwhile, the MMR in Jambi Province until 2020 was
lacking. It can be seen from the interest in reading and 96/100,000 live births over the last 7 years. The Maternal
the lack of understanding of the contents of the MCH Mortality Rate (MMR) in Jambi Province from 2014 to 2019
handbook. In addition, the role of health workers is still has increased from 50-59 cases [3]. Kerinci Regency has the
lacking because they have not explained the functions and second largest number of MMR, namely 9 cases when
contents of the MCH handbook. The knowledge of compared to Regencies/Cities in Jambi Province [4].
pregnant women regarding the use of the MCH
handbook is good because pregnant women already In addition to the maternal mortality rate (MMR), the
understand the contents, functions, benefits, and activities infant mortality rate (IMR) also needs to be considered
of the MCH handbook. But they still don't understand together. In Indonesia, the Infant Mortality Rate (IMR) has
the meaning of the MCH handbook. The attitude of decreased, based on data from the Directorate of Family
pregnant women in utilizing the MCH handbook is still Health in 2020 of 20,266 deaths out of 28,158 under-five
lacking because they rarely read and use the MCH deaths. Percentage 72% of total under-five deaths. Based on
handbook in an effort to prevent IMR and MMR. The reports on the number of infant deaths in Jambi Province in
role of health workers in utilizing the MCH handbook is 2019 there were 290 cases with an infant mortality rate (IMR)
still less visible than not conducting counseling regarding of 4.41 from all Regencies/Cities in Jambi Province. In line
the MCH handbook to pregnant women. with these data, Kerinci Regency shows a high number of
infant deaths after Tebo Regency [5]. This is because the
Keywords;- Utilization of the MCH Handbook; Pregnant capacity of health workers and the management of maternal
Women; Siulak Gedang Health Center. and child health services are still not optimal in their
implementation. Even though this death rate is far below the
national rate, it only needs to be an evaluation and concern for
the community and the government.

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
One of the efforts used as a means of improving Supporting informants were MCH Poly Midwives,
maternal and child health is the MCH book. The book Heads of Community Health Centers, Midwife Clinics and
contains health information for mothers, from pregnancy, Midwife Practices. in 2023. The number of informants for the
birth, the postpartum period, and continues to record the MCH Book is 1 MCH Poly Midwife Coordinator, 2 MCH
health of newborn babies until the child is 6 years old. This Poly Midwives at the Public health center and the Head of
means that the MCH book is a health detection tool for the Siulak Gedang Community Health Center, 1 Clinical
pregnant women and children. The MCH book must be used Midwife and 3 Practicing Midwives in the working area of
properly by mothers, fathers and all other family members [6]. the Siulak Gedang Community Health Center, while pregnant
The use of MCH books can influence knowledge and prevent women are the informants. totaling 15 people in the working
death for pregnant women. Based on research conducted by area of the Siulak Gedang Community Health Center. The
Siti Najmah in 2022, it is stated that the MCH book can be a research informant selection technique uses purposive
media for information and knowledge in preventing the risk of sampling. After observations and interviews were carried out,
death for pregnant women [7]. The function of the MCH book the data was then managed using the triangulation method.
is to provide communication, information and education This research uses data triangulation. Activities in data
regarding the health of pregnant women and babies. analysis are data reduction, presentation, and verification.

As in the initial observations made in the Siulak Gedang III. RESULTS AND DISCUSSION
Health Center Work Area, regarding the use of MCH Books.
Pregnant and breastfeeding mothers do not understand how to The Siulak Gedang Community Health Center is one of
use the MCH book. It can be seen that there are still pregnant the Community Health Centers in the Kerinci Regency, Jambi
women who have not read and do not include the book when Province. The Siulak Gedang Health Center provides services
consulting the Community Health Center. This is in line with in the health sector in the form of promotive, preventive,
previous research by Sistiarani 2014, that the use of maternal curative, and rehabilitative with a number of activities in
and child health (MCH) books are still not optimal, this can be accordance with the function of the public health center,
seen from the lack of use and ownership of MCH books for namely as a center for driving health-oriented development, a
pregnant women [8]. Meanwhile, cadres of pregnant women center for community empowerment and a center for first-rate
have a role in increasing the possibility of using MCH books health services. In order to improve healthy living and provide
by 1.6 times [9]. Agreeing with Amalia, 2021 explains that comprehensive and integrated health services to the
midwives have not been optimal in implementing health community.
services using MCH books [10].
This research was conducted on 15 mothers who were
The MCH book should be used as a means of attending services at the Siulak Gedang Community Health
communication for pregnant women and to establish good Center. The following are the characteristics of the informants
communication in improving the quality of services. There is used:
a lack of consultation opportunities so communication
between pregnant women and MCH polyclinic midwives is Table 1. Characteristics of Research Informants Utilization of
less than optimal. This can be seen from initial observations Maternal and Child Health (MCH) Books for Pregnant
of MCH poly midwives and pregnant women in the Siluak Women in the Working Area of the Siulak Gedang Health
Gedang Community Health Center Work Area which did not Center
show any communication between MCH poly midwives and Informant Age Level of Education Work
pregnant women. Therefore, it is necessary to conduct IBH01 32 Senior High School Housewife
research on "Utilization of Maternal and Child Health Books IBH02 32 Senior High School Housewife
(MCH) for Pregnant Women in the Working Area of the IBH03 29 Bachelor Profession Pharmacist
Siulak Gedang Health Center". IBH04 29 Senior High School Housewife
IBH05 37 Senior High School Teacher
II. METODE IBH06 29 Bachelor Teacher
IBH07 30 Bachelor Teacher
The type of research used in this research is qualitative IBH08 30 Senior High School Housewife
research. The research approach uses descriptive analysis. 20 Senior High School Housewife
IBH09
This research was conducted by interviewing pregnant
IBH10 28 Junior High School Housewife
women, MCH polyclinic midwives, and the Head of the
IBH11 24 Bachelor Housewife
Siulak Gedang Community Health Center. So that from these
answers you can then answer existing problems. The place IBH12 26 Bachelor Housewife
where this research was carried out was at the Siulak Gedang IBH13 27 Bachelor Teacher
Kerinci Community Health Center, Jambi Province. The time IBH14 28 Bachelor Teacher
this research was carried out was January-July 2023. The IBH15 35 Bachelor Teacher
informants in this research were pregnant women in the
working area of the Siulak Gedang Health Center, Midwife Based on Table 1 it is known that the informants in this
Clinic and Midwife Practice in 2023. study were pregnant women aged 20-35 years. In addition,
most of the education levels of pregnant women entered the
middle and high levels with 6 junior high schools, 8 graduates
or professions, and 1 lower education level. Most of the jobs

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
owned by pregnant women were unemployed, totaling 8 seen that the respondents in this study varied from different
people, namely Housewives and the rest were working with 6 backgrounds. The Characteristics of Informants which include
teachers and 1 pharmacist. Based on the data above, it can be Health Workers as follows:

Table 2. Characteristics of Health Worker Research Informants


Informant Age Level of Education Work
KP01 42 Bachelor Head of Public Health Center
BDK01 49 Bachelor Midwife Coordinator of MCH Poly
BDP01 42 Bachelor Midwife Public Health Center
BDP02 31 D3 Midwife Public Health Center
PB01 34 Bachelor Midwife Praktek
PB02 48 D3 Practice Midwife
PB03 36 D3 Practice Midwife

The research was carried out on 3-29 May 2023 at the "to check blood type, for Hb, for ee.. especially ee.. to
Siulak Gedang Community Health Center and Main Clinic. see if we have any complaints or not, everything is filled in the
This research was carried out in 2 places, namely the Siulak book" (IBH11, 24 yrs, Bachelor, Housewife)
Gedang Community Health Center and the Nanti Serak Main
Clinic, Jambi Province. Information for this research was "What's it called, um.. medical history, patient data
obtained from interviews with pregnant women and health um..the stages of child development, then there's um..good
workers (Public health center midwives, practice midwives, food for mothers and children like that" (IBH13, 27 Years,
and heads of health centers). Bachelor, Teacher)
The results of the study showed that most pregnant
 Pregnant Women's Knowledge of the Use of MCH Books women were correct in explaining the benefits of the MCH
Based on the research results, it can be seen that the handbook, namely as a tool to help monitor the growth and
informants are mostly pregnant women who already know the development of the baby and the dangers to the mother during
MCH handbook. Respondents answered that the MCH book is pregnancy. Based on interviews, pregnant women mentioned
a book that contains information about pregnancy, womb, and that the MCH handbook could be used as a tool for measuring
child care. After conducting in-depth interviews with pregnant weight and height as well as immunization for children.
women, it was discovered that pregnant women had
insufficient knowledge of the meaning of the MCH handbook. "Monitoring the progress of pregnancy, monitoring the
According to pregnant women, the meaning of the MCH book completeness of maternal and child vaccines, ee... whether the
is a book that discusses mothers during pregnancy. Several child's growth and development is normal or not, such as
informants have answered correctly that the MCH Handbook height, head circumference and weight of the child" (IBH03,
is a book on maternal and child health. 29 years, Bachelor Profession, Pharmacist)

"Know about the development of the fetus in the womb "Can provide information related to the health of
and the child's growth and development after birth" (IBH03, mothers and children, one of which is how to maintain
29 years, Bachelor Profession, Pharmacist) children's growth and development so that it remains good"
(IBH04, 29, Senior High School, Housewife)
Results of interviews with pregnant women regarding
the function of the MCH book. From the interview, the  Attitudes of Pregnant Women towards the Use of MCH
pregnant mother explained that the function of the MCH book Books
is as a tool to find out the child's development and as a The majority of respondents did not read and used the
nutritional guide. Apart from that, pregnant women answered MCH book independently. This was revealed by pregnant
that the function of the MCH book was to find out about women that the MCH handbook was only read when it was
pregnancy complaints and about pregnancy. handed over to the midwife to fill it out. This means that
pregnant women are less motivated to diligently read MCH
"The function of this MCH handbook is, uh... we can see books. Of all the informants interviewed, the majority
how... um... the development of the fetus, the development of answered that they had read the MCH book. However, the
the womb is like that" (IBH14, 28 years, Bachelor, Teacher) reading intensity is low. In fact, quite a few have read just one
MCH book.
Pregnant women's knowledge regarding the contents of
the MCH book is generally good. This can be seen from the “no ah, “yes, never, nothing, because there was nothing
answers of pregnant women that the contents in the MCH in my opinion so I didn't read it” (IBH05, 37 yrs, high school,
book are health records either before or after pregnancy. teacher)
Another informant answered that the MCH book could be a
medical history tool for mothers and children. Apart from "I did, but I wasn't very diligent" (IBH07, 30 years old,
children, pregnant women also said that the MCH book Bachelor, teacher)
contained information regarding health during childbirth.

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
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The obstacles experienced by pregnant women are "ee..examination ee..just check ee..tension, right, then
because they are busy. Busy with home matters and other jobs check ee..growth and development ee..the baby's growth and
such as teacher and pharmacist. development is mostly done by measuring what kind of fluid it
is, ee..after that, check the fetal heart rate, and now there are
"Sometimes I don't have time, because sometimes there's more ultrasounds at health centers, even though two-
a lot of homework, right" (IBH07, 30 years old, Bachelor, dimensional ultrasound is an ultrasound test, sometimes with
Teacher) a doctor (IBH13, 27 years, Bachelor, teacher)

This research also looked at the extent to which pregnant "Usually it's sneezed ee... if you're pregnant, it's checked
women brought MCH books to health services (Integrated ee... what kind of equipment do you use ee... to see if the
Healthcare Centers, Community Health Centers, or Clinic). baby's heartbeat is active inside or not, whether it's healthy or
Data from interviews obtained that all pregnant women not. "If the child is too big in the womb, we are told to eat
carried an MCH book when consulting with a Midwife or less" (IBH07, 30 years, Bachelor, Teacher)
Health Officer.
The role of health workers is good in providing services.
"Yes there is, there is no book, people don't want to Midwives always carry out examinations well and provide
check it" (IBH02, 32 years old, Senior High School, medication according to pregnant women's complaints.
Housewife)
The research results showed that the majority of
Based on the research results, it can be found that pregnant women answered that health workers did not provide
pregnant women respondents do not know clearly about IMR information and explanations regarding the function, benefits,
and AKI. So efforts have not been made to prevent infant contents, and how to fill out the MCH book.
mortality and maternal mortality. However, there are still
many pregnant women who have not implemented AKB and "By providing counseling, carrying out examinations...
AKI because they do not know about this. carrying out curative measures if for example there is
something that needs to be treated" (IBH03, 29 years,
"Um..for mothers, by eating nutritious food, maintaining Bachelor Profession, Pharmacist)
weight ee..even though every girl wants to be skinny all but
pregnant women don't want to be thin, let the body get fat first “Ee..as long as this book is, yes, many of them don't
right (IBH13, 27 yrs, Bachelor, Teacher) understand so they just fill in this if it's an old book ee..yes the
service is good" (IBH12, 26 years, Bachelor, Housewife )
From the interview results, there were pregnant women Based on all the variables above, it can be concluded that
who answered that they had carried out activities to prevent the role of health workers in carrying out examinations is
MMR and IMR, namely by means of nutritious food good. By doing an inspection. However, midwives have not
according to the recommended 4 Healthy 5 Perfect. And socialized or explained the MCH book to pregnant women.
always keep food clean and healthy. Next, do light exercise
regularly, such as gymnastics or walking. Immunization or The MCH book is a notebook used with the aim of
vaccine is also important as a simple step in efforts to prevent improving maintenance or health care for mothers and
or reduce IMR and MMR in Indonesia. MCH books play an children and improving the quality of MCH services.
important role as home-based tools to ensure sustainable Utilization of the MCH handbook is not only for health
maternal and child health. workers but also for pregnant women. The utilization is based
on the results of interviews that there is still a lack of use of
"Yes, it's effective, because in the book you can say that the MCH handbook in daily life.
it's complete, right? Information about maternal and child
health... so it can be used for guidelines on maternal and child Utilization of the MCH handbook The indicator of
health. There is also a check column for each pregnant observation is ownership of the MCH handbook. Based on the
woman taking blood-boosting vitamins. do you know if you results of interviews with pregnant women, all informants
drink or not" (PB03, 36 years old, D3) already had MCH books. Ownership of the book from the
pregnancy of the first child was given by the Siluak Gedang
 The Health Workers in Utilizing the MCH Handbook Health Center. This is supported by the statement of Sistiarani
Based on the results of interviews conducted with et al 2014 that the use of maternal and child health books can
pregnant women, health checks were carried out during visits be observed from the ownership of the MCH book. This
to the Community Health Center or Integrated Healthcare means that it is mandatory for every pregnant woman to have
Center. During pregnancy, there are several examinations a MCH book [8].
carried out by health workers on pregnant women. These
activities include ultrasound examination, measuring LILA, Utilization of the MCH handbook is said to be effective
checking heart rate, measuring blood pressure and weighing if the mother has read, understood and applied the contents of
pregnant women. Apart from that, pregnant women also the MCH handbook. The availability of MCH books at
measure the uterine fundus. Community Health Centers is sufficient and facilitates
pregnant women in obtaining health facilities. Based on the
results of interviews, pregnant women still do not bring MCH

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Volume 8, Issue 9, September – 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
books to the Public health center. Based on what the Midwife Health officers are required to explain the meaning of
and Head of the Community Health Center said, it is the MCH Book. The role of health workers must also explain
mandatory for pregnant women to always bring the MCH the benefits of the MCH Book. Pregnant women need to be
book to the Community Health Center and Integrated accompanied by a midwife or health worker when filling out
Healthcare Center. The results of this research are in line with the MCH book. This is supported by technical instructions
research conducted by Mariyana in 2019 which explained that from the Ministry of Health that the task of health workers is
mothers' compliance with carrying MCH books was still to assist cadres, mothers, and families in understanding the
lacking. This lack of compliance is caused by, among other contents of the book, filling it out, and making optimal use of
things, age, low education level, employment level and lack of it to get higher quality services [4].
understanding of the mother [11].
Apart from that, health workers need to explain the
Many pregnant women are still lazy about reading MCH health programs in the MCH book. So the task of health
books, this is because they are busy at home or work. If we workers is not only to prescribe drugs but also to provide
look at the benefits of the MCH book for pregnant women, it information and education (IEC) to pregnant women about the
is very large, so it can help mothers and families in preventing MCH handbook and how to fill out the book. In line with this
health problems. In this case, it is supported by research research, Karwati et al in 2021 explained that counseling
conducted by Herfanda and Subiyatun in 2021 which explains conducted by midwives must use MCH books in order to
that pregnant women use the MCH book as a form of increase the knowledge of pregnant women [16].
preparation for pregnant women in childbirth [12]. Apart from
that, research conducted by Karminingsih in 2021 explained Based on observations at the Public health center, all of
that pregnant women respondents had made good use of the the 3 midwives provided explanations about the contents of
MCH book [13]. the MCH handbook to pregnant women. In contrast to the
statement by the health center midwife who explained the
All pregnant women in the Siluak Gedang work area contents of the MCH handbook after conducting a health
have a MCH book. This means that the Community Health screening. This lack of support could be caused by the lack of
Center and the Government have provided good facilities to counseling skills of health workers in providing information
pregnant women, one of which is the availability of MCH on MCH books to pregnant women. These results are in line
books. However, the availability of these facilities is not with research conducted by Bonita et al 2020 which obtained
matched by an increase in pregnant women's interest in the influence of midwives' attitudes towards the use of MCH
reading MCH books. This is in line with research conducted books with a percentage of 75% in the poor category [17].
by Effendi 2020 that the distribution of MCH books has been
evenly distributed in all health centers and midwives in the Therefore, the role of health workers or midwives must
district. East Belitung, Batu City and Kab. Cianjur [14]. always be to motivate pregnant women to read MCH books
independently at home. In addition, midwives at Public health
The MCH handbook is used by pregnant women as centers and clinics midwives should be reminded to always
additional information on pregnancy health. What pregnant bring their MCH books to health care facilities. This agrees
women must read in the MCH handbook is about rest with research presented by Fitriyaningsih 2021 that health
patterns. In addition, physical activity for pregnant women, workers play a major role in contributing to the effective use
preparation for childbirth, a balanced nutritional menu pattern of MCH books by pregnant women [18].
that must be consumed daily to meet the needs of both the
mother and the fetus during pregnancy, preventing anemia, IV. CONCLUSION
and preparing for lactation, understanding how to maintain
cleanliness to prevent infection, recognizing and Based on the results of the research and discussion
understanding signs the dangers of pregnancy so that mothers above, several things can be concluded that the knowledge of
can detect the dangers of pregnancy as early as possible and pregnant women regarding the use of the MCH handbook is
prevent the risk of pregnancy. This is supported by a good because pregnant women already understand the
statement from Napitupulu et al 2018 that in the MCH contents, functions, benefits, and activities of using the MCH
handbook, there is information that provides knowledge of the handbook. But I still don't understand the meaning of the KIA
danger signs experienced by pregnant women [15]. book. The attitude of pregnant women regarding the use of
MCH books is still lacking because they rarely read and use
Health workers are one of the main components in MCH books in an effort to prevent IMR and AKI. The role of
providing health services for pregnant women. From the health workers in the use of MCH books is still less visible
results of interviews with pregnant women, so far health than not providing counseling regarding KIA books to
workers or midwives have provided good service. Although it pregnant women.
is still not optimal in providing consultations or health
promotion regarding MCH books. In this study, pregnant
women did not receive support from health workers in using
MCH books.

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