Medical waste management in Independent Midwifery Clinics: A discussion paper on the implications for planetary health and maternal and newborn health in Indonesia.

BACKGROUND: Climate change significantly threatens planetary health and sexual, reproductive, maternal, and newborn health (SR/MNH). The healthcare sector contributes substantially to global carbon emissions. In Indonesia, Independent Midwifery Clinics (PMBs), crucial community SR/MNH providers, generate diverse healthcare waste, including infectious materials. Despite national mandates, PMBs face persistent barriers to proper waste handling, leading to practices like open burning that cause contamination, infection, and contribute to carbon emissions, impacting SR/MNH outcomes. Midwives' vital role and potential for climate mitigation in PMBs are largely unaddressed.

AIM: This manuscript examines medical waste management issues in Indonesian PMBs, identifying feasible, evidence-informed solutions to reduce their environmental and carbon impacts, thereby advancing sustainable maternal healthcare and planetary health commitments.

DISCUSSION: Analysis reveals significant challenges in PMB waste management: structural limitations, financial and logistical barriers, and knowledge gaps. Cultural practices, like placenta burial, add complexity. These issues cause environmental contamination and health risks, including exposure to carcinogens, infectious diseases, and endocrine-disrupting chemicals, impacting reproductive health.

CONCLUSION: Achieving environmental sustainability in SR/MNH in Indonesia requires integrating PMBs into formal waste management. Solutions must be scalable, prioritising strengthened primary-level waste segregation, collective management models, and comprehensive waste management training and environmental literacy within midwifery education and accreditation. This will position PMBs as essential contributors to a sustainable and climate-resilient maternal healthcare system.