Sharing the Wealth – Thoughts on Global Sustainability in Maternity Care

Maternal mortality is mainly a tragedy of the “third world”. There are half a million deaths world-wide due to cause’s related to pregnancy and birth and [approximately] 99% of them occur in undeveloped countries. (Omran, 91) In saying this, it is not denying the fact that over-medicalized births can be a tragedy of the “developed world” or that maternal and infant death sadly happens in every country, it is just not the focus of this particular post. Instead the focus here is that in developing countries many women and babies are dieing from complications which could be avoided with adequate maternity & birth care. Arguably, in order to improve the maternity care for women in the under-developed parts of the world as well as lower the mortality rate among these women, a redistribution of the global wealth as well as equitable resource allocation based on the individual needs of particular communities is required. Furthermore, issues of race and class as well as patriarchy need to be addressed in order to solve the inequality experienced by women globally.

When discussing the need for up-to-date technologies in maternity care for developing countries we first need to understand what appropriate health technologies are. Appropriate health technology is procedures and equipment that are in-line with the principle of self reliance. (Shah, 146) In other words, it means that technology in regards to maternity care must be scientifically sound but also adaptable to the local needs of women in order for it to be sustainable. These technologies must be “acceptable to those who apply it and to those for whom it is used.” (Shah, 146) Most importantly as Shah points out, in order to be sustainable, technologies and health services must be “maintained by the people with resources the community and country can afford.” (Shah, 146) Affording heath care options that can help women give birth is one of the many reasons that a sharing of the global wealth is essential to global birth equality.

The health of women and the health of babies is tied to the over-all prosperity of a community. In other words, poverty has a significant impact on the health of birthing women and infants and women die in pregnancy and childbirth due to the complex interaction of medical and logistical causes, such as failure in health care services as well as socio-cultural factors, such as racism and poverty that “collectively determine the health status of women in a given community.” (Osborn, 81) A woman’s maternity care varies drastically from place to place. The size of the burden caused by inadequate care is determined by a variety of factors. As seen in the work of Kelsey A. Harrison “where living standards are good, health care facilities are adequate and are well-used, and gender discrimination is not pronounced, the burden’s on women’s health is light.” (Harrison, 76) Kusum Shah also points out that in addition to proper technology that is adapted to local needs, community health workers and supervisors need to be trained in community diagnosis in-order to support primary health care, which will consequently also solve many of the problems associated with ill health of mothers and infants. (Shah, 146-147) Logically, a successful technology is something that can be made available to women on their own terms without over-using or misusing them. For example, although caesarean sections are a valid technology during emergencies, the staggering number of c-sections in Canada & the US has been argued by many as a misuse of the technology.

Currently, statistics reveal that most deaths associated with birthing could be prevented through adequate maternity care. In the developed countries with the best infant and mother survival rates (such as France and Australia), adequate maternity care is made possible with the use of a midwifery system for normal births and the availability of a hospital, used mainly for complicated births. One might be shocked to discover that in developed countries that rely mainly on a hospital-based birth system, they do not have the highest rates of maternal and infant wellness. (Refer to The Business of Being Born for more information on this particular topic). None the less, what we see from developed countries (especially ones with a combination hospital and midwifery system) is that great maternity care is possible. Therefore, the conclusion here is that when deaths are not prevented globally it is because women are not given the same level of care. In fact, “each year more than 200 million women become pregnant and approximately 130 women bear children. Of these it has been estimated that 500,000 will die from the complications of pregnancy and childbirth.” (Osborn, 80) It has been argued that these 500,000 women die mostly from preventable complications that only continue to occur on such a large scale in the “third world”. Additionally, maternal deaths take place mainly in developing countries.

“More than 99% of all maternal deaths will
occur in developing countries which
account for 86% of global births. Uneven
distribution of maternal death is also
observed within those nations- well over
half (300,000) take place in Asia, nearly
three quarters of these in South Africa, and
most of the remaining deaths will affect
women in Africa.” (Osborn, 80)

Furthermore, research shows that the risk for maternal death in industrialized areas of the world is somewhere between 1 in 4000 and 1 in 10,000, compared with a risk of 1 in 15 to 1 in 50 in developing countries (Osborn, 77). As Osborn points out, that is a 200-fold increase. (Osborn, 80) The staggering statistics of infant and maternal mortality rates in the “third world” is what has created the international maternal and infant welfare movement of the last decade. (Fildes et. al, 1)

Clearly, a new approach to international maternity care is necessary. A new approach is additionally necessary since most often there is an unspoken belief that all international work is always a benefit to the countries that need to be “developed” and the “primitive” people receiving care are lucky to be saved. Solutions to maternity care problems globally have to start at the local, grass roots level in order to be effective (McCarthy, 110), which is something that international and local maternity care often falls short of accomplishing. A grass roots approach is needed and would instead include the local community and people. Sadly, research reveals that the appalling state of maternity care in under developed countries is aggravated by a hospital based model that overlooks “the importance of less expensive community-based maternal and child health care delivery systems.” (Osborn, 81) Brian McCarthy argues that we need an international maternity care model that is based on the individual needs of women and their communities. (McCarthy, 108) However, international maternity care givers are limited in their ability to address a woman’s cultural needs. As seen in the work of Yvonne Lefeber and Henk W.A. Voorhoever, only traditional, local midwives are able to address and care for a woman in ways that only a member of her own community can.

“The midwife’s participation in the cultural
matrix of the social group to which the
mother and the midwife belong resulting in
for example the right performance of
certain protective ceremonies or rituals
before, during and after delivery and
providing in this way a sense of
psychological security for the mother.” (Lefeber & Voorhoever, 6)

There are cultural practices that international maternity care providers cannot offer women. In order to create sustainable maternity care and give women maternity care providers who are culturally relevant to them, international maternity care should be concentrated on building local organizations and training local midwives so that they may create a practice that is run on a local system. These local practices should have access, training and knowledge in current technology and medicine. Many women believe that we must find ways for international maternity care providers and local ones to work cooperatively, sharing knowledge and learning from one another.

Birthing systems should also be set by the local women who are receiving the care. Birthing women should have a voice in the care they receive and local people should create safe practices that support their particular cultural beliefs. There simply must be ways to incorporate modern technologies with local birth customs in a non-evasive way. It seems the right things to do it to put power back in the hands of the birthing women and make technologies available to every community globally, regardless of cost. How do we do that? Perhaps we should start with valuing every woman and with sharing the wealth.

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