Hi everyone, come back with me with my research journal some time ago in Bireuen District of Aceh Province.
Pregnancy is a time of commencement of conception to the birth of the fetus. Old normal pregnancy is 280 days (40 weeks or 9 months 7 days) is calculated from the first day of last menstruation. Pregnancy is a physiological state can be followed pathological processes that may threaten the state of the mother and fetus (Prawirohardjo, 2002).
Pregnancy involves emotional and physical changes of the mother as well as social changes within the family. Risk assessment system can not predict whether pregnant women could be problematic during pregnancy (Prawirohardjo, 2002).
In general, pregnancy is developing normally and produce healthy full-term baby's birth through the birth canal, but this is sometimes not as expected. Difficult once it is known beforehand that the pregnancy would be a problem. Therefore, antenatal / prenatal care is an important way to monitor and support the health of pregnant women and detecting normal women with normal pregnancies (Kusmiyati et al, 2009).
Maternal and infant mortality is not only a health problem but a social injustice for women, the WHO estimates that the number of deaths caused by pregnancy reaches 500,000 people each year, meaning mother died each day from childbirth complications. Yardstick of success ANC one of which is the amount of coverage visit 4 (K4) that antenatal care at least 4 times with the proviso 1 time in trimester 1 (K1), one trimester 2 (K2) and at least 2 times in trimester 3 (K3 & K4).
The high maternal mortality rate is partly due to the low level of knowledge of the mother and the frequency of irregular antenatal care. There are several factors why pregnant women are less motivated to do antenatal care, namely: Busyness, low socioeconomic level, husband support the less, the lack of convenience for maternal care, poor medical care, lack of trained personnel (Prawirohardjo, 2002).
One indicator to assess the quality of antenatal care services can be assessed on the level of utilization of antenatal care services by the public. This can be seen in the coverage of K4 pregnant women with the number of visits at least four times (or more), to obtain antenatal care according to established standards, provided that at least one time in the first trimester (K1) and one contact in the second trimester (K2 ), twice the contacts in the third trimester (K3 and K4) (Meilani et al, 2009).
Women during pregnancy need time to adapt to the various changes that occur in him, the changes that occur during pregnancy usually cause discomfort and concern for most pregnant women. Changes in body size, shape of the breast, skin pigmentation, and an enlarged abdomen overall make pregnant women look ugly and self-esteem, anxiety and this fear was not unfounded, for the pregnant women need the advice and suggestions, especially from midwives and doctors to explains the changes that occur during pregnancy that the mother was not concerned with the change that happened (Helen, 2001).
Pregnancy is divided into the third trimester, pregnant women during pregnancy are encouraged to conduct antenatal visit at least 4 times to find health problems during pregnancy, whether the problem is physiological or pathological those problems which can threaten the pregnancy. Complications that may occur during pregnancy include hyperemesis gravidarum, bleeding, anemia, eclampsia, severe abdominal pain (Sarwono, 2006).
High risk pregnancy can be anticipated at the time of antenatal care (ANC). ANC or antenatal care is care given to mothers during pregnancy on a regular basis. ANC can be achieved if there is a joint effort between the officer and the woman is pregnant, so it takes a high awareness in the antenatal (Prawiroharjo, 2002).
According Kusmiyati (2008, p. 169), minimum standards of care Antenatal Care (ANC) includes "7T", namely:
- Considering weight,
- Measuring blood pressure,
- Measure the height fundus,
- Provide immunization Tetanus Toxoid (TT) is complete,
- Provide iron tablets, minimum 90 tablets during pregnancy,
- Test against Sexually Transmitted Diseases (STDs),
- Gathering of speech in preparation for referral.
The ANC is expected condition of maternal health can be monitored and in case of emergency will allow action to be taken. Based on the policy program of the government, the ANC held at least four times during pregnancy, namely the one in the first quarter, one in the second quarter and twice in the third quarter (Prawirohardjo, 2002).
According to Anderson (2002), most of the causes of maternal death can be overcome with proper antenatal care, deliveries and maternal ability in finding or choosing health care delivery assistance.
There are several key factors that affect a person's characteristics, among others, such as demographics, social conditions, beliefs, family circumstances and conditions of the community. Matters related to the main factors are age, education, income, parity, employment, and mileage (Notoadmojo, 2002).
According Manalu (2007), the age associated with certain age groups that tend to use health services for consideration the degree of vulnerability. The level of education has an essential relationship to the level of health education, the higher the education level the more easily accept the concept of healthy living independently and creatively. Revenue has a great contribution in the utilization of health services, because the higher the income level the more freely choose the health service. Employment, parity and maternal pregnancy risk level is also something to do with the direction of search and selection of aid delivery.
According to Azwar (2006), that the use of a person to health services is influenced by the level of education, socio-cultural, socio-economic of the person. When the level of education, socio-cultural and socio-economic well then relative service utilization will be high.
Based DG of Community Health, Kepmenkes RI in 2009, in 2009 the highest K4 are Jakarta (96.53%) and the lowest was West Papua (10.55%), since 2004-2009 the gap between K1 and K4 are likely to narrow, meaning that the number of mothers pregnant first examination K1 continue to visit all four (K4) is increasing. Minister of Health of the Republic of Indonesia Number 741 / Menkes / PER / VIII / 2008 on the minimum health service standards in the field of health in the district or city, especially maternal and child health services in the form of coverage of pregnant women K4 K1 and K4. K1 is the visit of pregnant women for the first time during pregnancy. K1 below 70% (compared to the target number of mothers in the period of 1 year) showed that antenatal care affordability is low, which may be caused by the pattern of services that have not been active enough. Low K1 shows that access to pregnant women officers still need to be improved. While the K4 coverage that visit at least 4 times during pregnancy to get antenatal, which consists of a minimum of one-time visit in the first trimester, one in the second trimester, and twice in the third trimester. K4 coverage below 60% (compared to the target number of mothers in the period of 1 year) indicates the quality of antenatal care is not adequate. Low coverage K4 indicates a low health to capture and handle high-risk obstetric (MOH, 2005).
Based on data from the Aceh government health department number recapitulation mother visits for antenatal care at the Government of Aceh from January to December 2012 with coverage K4 as much as 364 231 people (41%), ie K1 as many as 452 425 people (50.21%), K2 as many as 99 975 people (10 %), K3 as many as 69 098 people (8.02%), K4 as many as 221 658 people (32.47%) while the number of visits for antenatal mothers in Bireuen district with K4 coverage as much as 88 990 people (34%) is the K1 as many as 127 161 people (47%), K2 as many as 24 349 people (9%), K3 as many as 32 466 (12.60%) and K4 as many people 83.8743 (31.40%). Number of visits diruang coverage of maternal and child health centers health Teupin July Mane period from January to December 2012 with the total number of pregnant women 215 people, with K4 coverage for 103 people (48%), K1 115 people (54.8%) ,, K2 as much 32 people (15%), K3 as many as 25 people (12%), and K4 as many as 109 people (45.2 and away from the target service to%) it shows that the quality of antenatal care is still very low health, especially maternal and child health.
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