Strengthening Community-Based Early Warning for Postpartum Maternal Mortality Prevention in Brebes

Abstrak

Postpartum maternal mortality remains a critical public health and health-law issue in Indonesia, particularly in districts where deaths persist after facility-based childbirth. This article examines postpartum maternal deaths in Brebes Regency, Central Java, and analyzes how failures in early detection, referral coordination, community surveillance, and legal-policy implementation contribute to preventable deaths. Using a qualitative case study design supplemented by document review of maternal death audit materials, health profiles, and MPDSR data, the study draws on focus group discussions, interviews, and policy analysis. The findings show that postpartum deaths are driven not only by clinical complications—hypertensive disorders, hemorrhage, infection, and non-obstetric conditions—but also by systemic vulnerabilities: passive postpartum monitoring, delayed family decision-making, fragmented referrals, weak data integration, and limited community-based surveillance. Although Indonesian health law recognizes maternal care across pregnancy, childbirth, and the postpartum period, it has not yet operationalized a specific community-based early warning mechanism for postpartum follow-up. The article argues that integrating a community-based Early Warning System (EWS) with Maternal and Perinatal Death Surveillance and Response (MPDSR) can transform maternal death review from a retrospective audit into a preventive governance tool. It recommends risk-based postnatal monitoring, referral reform, strengthened community health literacy, and rights-based maternal health regulation to reduce preventable postpartum deaths.

Kata kunci

• Maternal Mortality
• Postpartum Care
• Early Warning System