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Culturally entrenched gender inequality and a lack of bargaining power has kept much of Asia, and Indonesia in particular, from meeting the UN Millennium Development Goal on reducing the maternal mortality rate, an official says.

“Gender inequality has long been a problem,” Budiharja, the Indonesian Ministry of Health’s director general for community health and education, said on Wednesday during a special ministerial meeting in Jakarta to review progress in the region in meeting the MDGs.

“Women don’t have the right to make important decisions, even decisions that affect their own lives,” he said.

Budiharja said the Indonesian maternal mortality rate was unacceptably high, even in places served by adequate health facilities, simply because most women needed permission from their husbands to seek treatment.

“The decision-making process is a nightmare for many women, and they risk death by just waiting for their husbands to get home,” he said.

Indonesia’s maternal mortality rate is 228 out of every 100,000 births — almost 10 times as high as in Malaysia and Thailand, and 65 times that of Singapore.

Ajay Chhibber, assistant secretary general and assistant administrator at the United Nations Development Program, said gender bias was one of the most important issues that needed to be addressed in the Asia-Pacific region in order to attain the development goals.

“Asia has a very strong gender bias, in fact it’s probably the worst in the world, where women don’t have access to economic and political rights,” he said.

Nila Djuwita Moeloek, President Susilo Bambang Yudhoyono’s special envoy for MDGs, said education and women’s empowerment were the keys to addressing this gender disparity and reaching the MDGs.

“Women must be agents of change for their families because they’re the ones who are responsible for educating the children,” she said.

“If they don’t have enough information, then the whole family lacks the proper knowledge.”

Chhibber said that in terms of educating women, Indonesia had shown some progress.

“The enrollment is there, girls get to enjoy education at schools,” he said. “But it’s not enough as long as the systematic discrimination still exists.”

Chhibber added that despite the improved access to education, most women in Indonesia were still paid less than men for the same jobs. He also said quotas for women in the House of Representatives and local legislatures, though a noble effort, were not being enforced.

Taufik Hanafi, director of education and religious affairs at the National Development Planning Agency (Bappenas), said studies had shown that well-educated women tended to have more confidence in making their own decisions regarding maternal health.

“Educated women know more about their environment, medical facilities, as well as the kinds of health services they need,” he said. “That’s exactly why gender equality is a crucial issue. Indonesian women need to be educated properly.”

Chhibber called for better maternal and infant health education in the provinces of Papua, Aceh and East Nusa Tenggara, where inordinately high mortality rates are keeping the national average from going down.