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The world is healthier than ever. Women like Ati are why.

Ati Pujiastuti in her health clinic
As a midwife in one of Indonesia’s rural mountain villages, Ati Pujiastuti’s commute to work was often a harrowing one, especially during the rainy season. There was the time she slipped on a muddy path precariously close to the edge of a cliff. There was the time she lost her footing while crossing a rushing river and had to cling to a boulder until help came. There were several times she fell off a motorbike on the unpaved roads. But still, she beams when she tells you that no other midwife assigned to the region stayed there as long as she did.

When Ati first arrived in the village, it was a place she describes as having rampant malaria, no healthcare to speak of, and a deep distrust of outsiders. But by the time she left years later, she had won the community’s trust and become a vital part of village life. Like many midwives in areas where healthcare is sparse, she even had some men who relied on her services. Tears pool in her eyes when she describes the day that she said goodbye and moved away.
The most remarkable part of Ati’s story to me is that it is not altogether unusual.
The most remarkable part of Ati’s story to me is that it is not altogether unusual. The world is measurably healthier than it has ever been before, and that is in large part due to the hundreds of thousands of frontline health workers who are insisting that there is no place on earth too poor, too remote, or too dangerous to reach with quality healthcare.

In Indonesia and around the world, health workers like Ati have helped drive the maternal mortality rate steadily downward and dramatically reduced the number of children dying before their fifth birthday. According to the most recent estimates, about 81 percent of Indonesian children are now vaccinated against a number of childhood’s deadliest diseases, setting them up to live better, more productive lives.
Ati and Melinda Gates pose for a photo
Empowered Women Transform Societies
But in Indonesia, as in many developing countries, progress has been uneven. And as part of the country’s efforts to expand that progress, health workers are now focusing on one of the most effective ways to improve health outcomes for women and children: expanding access to contraceptives.

Although the number of Indonesian women using family planning tools has skyrocketed from 1 in 10 in 1950 to about 1 in 2 today, there are still millions of women across the country who lack access, information, or options that fit their contraceptive needs. During my last trip to Indonesia, I met three women who told me that they had had unintended pregnancies.

Ati, as always, is determined to be a part of the solution. Today, she runs a small clinic near the city of Yogyakarta, where she provides prenatal care, performs deliveries, vaccinates babies, and counsels women about their contraceptive options.

When I visited her at her clinic, she told me that she had just received a special certification allowing her to insert two forms of long-acting contraceptives: IUDs and implants. Many women in Indonesia — and around the world — prefer these longer-acting methods because they are an inexpensive and efficient way to reliably prevent pregnancies without relying on clinics or pharmacies for an injection or a daily pill.

Ati was so confident that these long-acting contraceptives would be in high demand that she inserted the first one for free, only asking that the recipient tell her friends. But despite her entrepreneurial instincts, Ati also mentioned that she never turns away a woman who can’t afford to pay. For her, being a midwife is more than a career — it’s a calling.
The world owes a debt of gratitude to these fiercely determined frontline health workers, but their stories too often go untold.
The world owes a debt of gratitude to these fiercely determined frontline health workers, but their stories too often go untold. When we reflect on the progress humanity has made to ensure that more people in more places are living healthier, better lives, let’s also remember that this progress begins with women like Ati, whose everyday acts of courage are quietly transforming the world.