Kemenkes<\/a>). The training was conducted using a team-based approach, with each hospital or Puskesmas designating a team to serve as pioneers of APK services at their respective healthcare facilities. <\/p>\n[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Number of women who accessed APK services” _builder_version=”4.27.7″ _module_preset=”default” title_level=”h2″ global_colors_info=”{}”][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_3,1_3,1_3″ _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_number_counter title=”March\u2013December 2024″ number=”133″ _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][\/et_pb_number_counter][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_number_counter title=”January\u2013December 2025″ number=”442″ _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][\/et_pb_number_counter][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_number_counter title=”January\u2013June 2026″ number=”207″ _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][\/et_pb_number_counter][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”]For Dr. Devi, these changes were immediately evident in her daily practice. \u201cAfter the IPAS Indonesia program was implemented, APK services became more organized in terms of record-keeping and reporting. We also became more confident in treating patients and in prescribing misoprostol to them,\u201d she said. <\/p>\n
Healthcare workers\u2019 confidence stems from having clearer knowledge and guidelines for treating patients who have had miscarriages based on their specific medical conditions. After the training, an increasing number of cases could be managed more quickly at primary-care facilities, as Dr. Devi did by using misoprostol. \u201cAt that time, the patient showed no signs of a medical emergency requiring the use of instruments, so the choice was to administer misoprostol,\u201d she recalled. [\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.6″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”][et_pb_image src=”https:\/\/ipasindonesia.org\/wp-content\/uploads\/2025\/10\/dr.-Desi-Sintella-Muli-memberikan-penjelasan-medis-kepada-pasien-wanita-di-UPT-Puskesmas-Oinlasi-di-Kabupaten-Timor-Tengah-Selatan-scaled-e1791103668547.jpg” alt=”A woman talking to a doctor” title_text=”Dr. Desi Sintella Muli provides a medical explanation to a female patient at the-Oinlasi Community Health Center in South Central Timor Regency-scaled-e1791103668547 ” align=”center” force_fullwidth=”on” _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Improving Service Management Through Standards ” _builder_version=”4.27.7″ _module_preset=”default” title_level=”h2″ global_colors_info=”{}”][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.6″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.6″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”]The changes go beyond simply improving the skills of healthcare workers. In addition to clinical training, the IPAS Indonesia Foundation also assists healthcare facilities in developing Standard Operating Procedures (SOPs) for integrated post-abortion care services in hospitals, covering clinical aspects, hospital management, and integration with community health centers. <\/p>\n
\u201cOur SOPs, before we received guidance from IPAS Indonesia, were not comprehensive. After the guidance, the SOPs became standardized\u2014for example, the use of antibiotics in this hospital is now consistent with that in other hospitals,\u201d said Dr. Herwinda. <\/p>\n
With clear and mutually understood procedures in place, the quality of care no longer depends on the individual practices of healthcare providers, but is supported by a robust and more consistent system.[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”The Community\u2019s Role in Improving Services” _builder_version=”4.27.7″ _module_preset=”default” title_level=”h2″ global_colors_info=”{}”][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”]Changes to APK services are also driven by the community as service users. From January through December 2025, IPAS Indonesia, together with local partner organizations, facilitated opportunities for the community to provide feedback on APK services during meetings with health workers, health facility management, village officials, and health department officials. <\/p>\n
Through a feedback mechanism, health facilities receive direct information about the barriers the community continues to face. One issue with APK services in South Central Timor is the long distance to the community health center (Puskesmas), which takes three to four hours by vehicle from the farthest villages. In response, health workers at the Puskesmas are training midwives to identify miscarriages that require emergency care and to determine when patients should be referred to the Puskesmas. <\/p>\n
\u201cIf there\u2019s a patient who has had a miscarriage in the village, the village health workers will examine her. Then, depending on whether there are any warning signs, if there are, she\u2019ll be taken directly to the community health center,\u201d Dr. Devi emphasized. [\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesia.org\/wp-content\/uploads\/2025\/10\/Sekelompok-warga-perempuan-fokus-membaca-dan-mendiskusikan-dokumen-berupa-kertas-warna-ungu-di-Desa-Riang-Baring-di-Kabupaten-Flores-Timur-scaled-e1791103585596.jpg” alt=”A group of healthcare workers looking at a sheet of paper” title_text=”A group of women is focused on reading and discussing a purple-colored document in Riang Baring Village in Flores-East-scaled-e1791103585596″ align=”center” force_fullwidth=”on” _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_heading title=”Changes to APK Services Tailored to Women\u2019s Needs” _builder_version=”4.27.7″ _module_preset=”default” title_level=”h2″ global_colors_info=”{}”][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”]Changes in the healthcare workforce, service procedures, and referral systems ultimately affect the experiences of women accessing these services. One such woman is Arianti Selan, a resident of Oinlasi Village who suffered a miscarriage in August 2024 when she was three months pregnant. <\/p>\n
When she experienced cramps and abdominal pain, she and her husband went to the community health center to get checked out. After being examined, she was given medication and sent home because she wasn\u2019t bleeding. However, the pain returned. \u201cI was already bleeding when I left home. So I thought I might be having a miscarriage or something, and when I went back to the community health center, the midwife and doctor confirmed that I had miscarried,\u201d she recalled. <\/p>\n
Arianti said she nearly had a miscarriage during her previous pregnancy. Her doctor had warned her that another pregnancy would be too risky and recommended that she undergo sterilization. However, at the time, she and her husband weren\u2019t ready for that. Eventually, she did have a miscarriage. <\/p>\n
She shared her experience receiving APK services at the Oinlasi Community Health Center: \u201cIn my opinion, the APK services at the Community Health Center met my expectations. We were welcomed and treated well, and I was given a detailed explanation of my health condition.\u201d<\/p>\n
\u201cWhen I was at the community health center, the doctor already knew I had a history of near-miscarriages. So the doctor offered me a method of contraception. We agreed on sterilization, so I was referred to the hospital to have the procedure done at the same time,\u201d she said.<\/p>\n
Experiences like Arianti Selan\u2019s show that APK services are not just about managing complications from miscarriage. These services also include providing information, counseling, follow-up care, and support so that women can make informed decisions about their reproductive health.[\/et_pb_text][et_pb_image src=”https:\/\/ipasindonesia.org\/wp-content\/uploads\/2026\/10\/Arianti-Selan-bersantai-bersama-anggota-keluarga-di-luar-rumah-tradisional-di-Desa-Oinlasi-di-Kabupaten-Timor-Tengah-Selatan-scaled-1.jpg” alt=”A family sitting outside their home.” title_text=”Arianti and Selan relaxing with family members outside a traditional house in Oinlasi Village, South Central Timor Regency\u2014scaled-1″ align=”center” force_fullwidth=”on” _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_image][et_pb_heading title=”Changes to APK Services in NTT” _builder_version=”4.27.7″ _module_preset=”default” title_level=”h2″ global_colors_info=”{}”][\/et_pb_heading][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.27.7″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.27.7″ _module_preset=”_initial” global_colors_info=”{}”]Changes in maternal health services in NTT demonstrate that improvements in women\u2019s health care do not result from a single intervention. Strengthening the capacity of health workers can serve as a starting point for transforming maternal health services, while clarifying the referral system helps women access services tailored to their needs. Community involvement is also necessary to ensure that the needs of those accessing services are heard. This is because service transformation does not end with the mere availability of services, but rather with ensuring that services meet women\u2019s needs and are convenient for them. For women like Arianti Selan, changes in APK services mean access to services that are safe, high-quality, timely, and respectful of women\u2019s needs. [\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"
For women who experience a miscarriage, access to prompt, safe, and high-quality health care can be a matter of life and death. A study published in The Lancet in 2021 showed that one in nine women has experienced a miscarriage. However, until a few years ago, post-miscarriage care services were very limited in most areas of East Nusa Tenggara (NTT). <\/p>\n","protected":false},"author":3,"featured_media":4282,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[167],"tags":[],"topic":[],"class_list":["post-4281","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-stories"],"_links":{"self":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts\/4281","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/comments?post=4281"}],"version-history":[{"count":4,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts\/4281\/revisions"}],"predecessor-version":[{"id":4302,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/posts\/4281\/revisions\/4302"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/media\/4282"}],"wp:attachment":[{"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/media?parent=4281"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/categories?post=4281"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/tags?post=4281"},{"taxonomy":"topic","embeddable":true,"href":"https:\/\/ipasindonesia.org\/en\/wp-json\/wp\/v2\/topic?post=4281"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}