Tag Archives: maternal health

Maternal Health and the Status of Women

Both globally and domestically, maternal health and the standing of women are inextricably linked. If women do not have the means and access to give birth safely, with trained and educated midwives, physicians and nurses, with appropriate prenatal education and care, it is often indicative of the standing of women in their communities and countries overall. Women’s inequality is also linked to the soaring population growth in developing countries, which will pose a range of new challenges for the next few generations.

Some may point to the United States as an anomaly, citing women’s increasing economic and financial independence, education, and leadership roles in America, while in terms of maternal health rankings, we remain pathetically far down the line for our resources (49 other countries are safer places to give birth than the U.S. – despite us spending more money on healthcare than anywhere else). Of course, the recent and incessant attacks on allowing women to access credible, accurate, up-to-date and comprehensive sexual and reproductive health education and services makes this statistic not entirely…surprising, shall we say.

So, I found the incredibly detailed and visually impressive infographic by the National Post, pulled from spectacular data and research done by Save the Children to be particularly fascinating. What they did was combine information on the health, economic, and education status of women to create overall rankings of the best and worst countries for women, splitting the countries into categories of more developed, less developed, and least developed, and the countries were ranked in relation to the other countries in their category (the divisions were based on the 2008 United Nations Population Division’s World Population Prospects, which most recently no longer classified based on development standing). While these divisions and the rankings can certainly be contentious and may incite some disagreement (nothing unusual there, these kind of rankings usually are), I thought the results were interesting. Some highlights – Norway is first, Somalia is last. The United States was 19th, and Canada was 17th (Estonia fell in between us and the Great White North) in the most developed. Israel is first in the less developed category, and Bhutan is first in the least developed category. The full report with data from Save the Children is also available, if you want to learn more about the information combined to make this image. Take a look:

A Woman’s Place – Courtesy of the National Post

One thing that I thought was particularly great was that the researchers combined women’s health and children’s heath data to create rankings specific to being a mother, when that category is sometimes only assessed based on access to reproductive care.The specific rankings of maternal health highlights largely mimics the overall standing of women, as seen here – Norway is number one, again, and Niger falls into last place:

Mother’s Index, Courtesy of Save the Children

I think these images and graphs are particularly moving given one of the top health stories coming out of the New York Times today, which showed that a recent Johns Hopkins study indicated meeting the contraception needs of women in developing countries could reduce maternal mortality (and thereby increase the standing of women in many of the nations doing poorly in the above ranking) globally by a third. When looking at the countries in the infographic that have low rates of using modern contraception and the correlation between that and their ranking in terms of status of women, it’s not surprising what the JH researchers found. Many of the countries farther down in the rankings have rates below 50%, and for those countries filling the bottom 25 slots, none of them even reach a rate that is a third of the population in terms of contraceptive use – which of course in most cases has to do with availability, not choice. Wonderfully, the Gates Foundation yesterday announced that they would be donating $1 billion to increase the access to contraceptives in developing countries.

Also of note, and in relation to maternal and newborn health, is a new study recently published by Mailman researchers that showed PEPFAR funded programs in sub-Saharan Africa increased access to healthcare facilities for women (particularly important for this region, as 50% of maternal deaths occur there), thereby increasing the number of births occurring in these facilities – reducing the avoidable (and sometimes inevitable) complications from labor and delivery, decreasing the chance of infection and increasing treatment if contracted. This has clear implications for children as well (and why I think this study relates to the National Post infographic and the NY Times article), since newborns are also able to be assessed by trained healthcare workers and potentially life-threatening conditions averted – including HIV, if the newborns have HIV+ mothers and need early anti-retroviral treatment and a relationship with a healthcare worker and system. And it goes without saying that if a new mother is struggling with post-delivery healthcare issues, including abscesses and fistulas, or was dealing with a high-risk pre-labor condition like preeclampsia, the child will have an increasingly difficult early life, perhaps even a motherless one.

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Filed under Child Development and Child Health, Health Education, International, Politics, Public Health, Reproductive and Sexual Health, Women's Health

Child Mortality – What Are the True Biggest Causes?

A great image from Population Services International‘s most recent issue of their magazine, Impact, from the cover article written by Desmond Chavasse, Ph.D, Vice President, Malaria Control & Child Survival, PSI, about causes of child mortality globally.

Causes of Child Mortality – Image courtesy of Population Services International

One of the purposes of the image, of course, is to show the stark contrast between directed funding for treatment and eradication of certain diseases and the number of children afflicted with these illnesses. How does this impact our understanding of global health and of the marketing around certain hot topic health issues and ways in which donors feel as though they are contributing to a decline in preventable deaths?

When I worked in development for HIV/AIDS organizations, it was fascinating to speak with donors about their reasons for giving and their understanding of the prevalence and incidence (and the general audience grasp of the word incidence, which is the measure of risk of contracting a certain illness or disease within a specified time frame) of HIV. Contrast this with the understanding of malaria, TB, diarrhea, deaths due to childbirth complications (for the mother and the infant), and the gap between perception and reality was startling. In no way do I want to deny the importance of consistent development support for all diseases on a global scale, but I do think there is something lacking in terms of the education around these issues for donors and even some advocates.

Solutions? Come chat with me on Twitter.

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Filed under Child Development and Child Health, Health Education, International, Public Health

Bill O’Reilly, You So Crazy

Oh, Bill. I never cease to be amazed by some of the things you teach me. For example, how the brutal and horrifying rampage in Norway was not committed by a Christian (despite the rambling Christianity-soaked manifesto, and your O’Reilly-esque insistence that all terrorist attacks are carried out by Muslims regardless of any indication of their Islamic faith), simply because you don’t think a Christian would do that. Or like how your three visits to Africa assured you that you just can’t “bring Western reasoning into the culture.” Oh, and that the ACLU is second only to Al-Qaeda in how dangerous and threatening it is. And that poverty is a result being lazy and irresponsible, and if you just work hard and go to school, then, you know, you’ll make bags and bags of money and be just fine regardless of anything else or circumstance. Which sounds totally on point, since you also taught me that conservatives “see things in black and white, and liberals see gray.” Which sounds like nuance, and uh-oh, you’ve made me see that nuance makes things complicated…

And this past week, O’Reilly taught me this: “Many women who get pregnant are blasted out of their minds when they have sex and [are] not going to use birth control anyway.”

(First of all, if the women O’Reilly and the men he knows are having sex with are blasted out of their mind, I’d be interested in hearing how that consent discussion went. Perhaps his definition of consent is a little hazy. Recall – if she’s too drunk to consent, it’s not consensual sex.) 

But back to what he’s taught me. With this latest statement, I’ve learned that women – regardless of their sobriety level – are exclusively the ones who need to be concerned with contraception and infection (and that, in fact, they do a terrible job of this). Only one person in a two-person sexual encounter is responsible for ensuring the woman doesn’t get pregnant (hint – it is not the man). He’s also informed me that contraception is something only considered the exact moment before a sexual encounter occurs – not hours or days or months before – just in that whisper of a moment before the magic happens. If O’Reilly had actually engaged in sexual activity with the woman he harassed, maybe he would have just crossed his fingers that she was both sober and using birth control and not have give it a second passing thought or considered it his concern. So let’s all just do the same moving forward.

More seriously now – it’s unconscionable that someone supposes men should be able to have sex with a woman (a drunk or sober one) whenever they want and also not have to worry about or share the burden of responsibility to avoid pregnancy. We need to utilize as many tools as we can to prevent pregnancy, and that prevention should be shared equally between the two partners engaging in sexual activity. It would be great if health insurance took the lead and incorporated 50% (or 100%, if they were so inclined) of the cost of a partner’s contraception of choice into a man’s health insurance plan. I think that would be even more of a fighting point than co-pays being covered under plans.

Nancy Northrup, CEO of the Center for Reproductive Rights, did a great job and broke it down over at CBS News about why the hysteria over insurers now eliminating co-pays for women with contraceptive prescriptions that is bubbling over is not actually all that hysterical. In fact, it’s something that 28 states require to be covered by health insurance, something already covered (with those pesky co-pays) by government health insurance, and something that 99% of all women have used, regardless of religious affiliation.

Additionally, under the Affordable Care Act, virtually all of us will be required to have or purchase health insurance (a contentious point, still, largely among Republicans, but others as well). With what will be an added cost to the personal budget of many Americans, let’s take a snapshot of what the cost of birth control is: the pill is up to $50 a month (over $500/year), the NuvaRing is up to $70 a month (over $800/year) $500 – $1,000 for an IUD; even the morning after pill, used if other birth control methods failed or were forgotten, costs up to $70.  If you are currently one of the millions without healthcare and one of the millions without a job and an income, these costs are likely to be the first that are cut as you struggle to keep you and your family afloat. However. Pre-natal care costs, the cost of delivery, well visits for a newborn – and, you know, the food and clothing needs of a baby – are not going to be cheaper than the contraception options. Bottom line – prevention can be costly, and beneficial to all. Absence of prevention is even more costly, and frequently puts a lot of burden on all parties involved.

Remember how in O’Reilly’s world everyone is super wasted when they’re having sex – too wasted to worry about a condom? All these methods – the IUD, the birth control pill, the NuvaRing – can be taken or inserted well before sex. Some don’t ever come out, some devices like the NuvaRing are changed monthly. This is why these are called preventive measures. You are utilizing them well before you engage in sexual activity, so when you’re in O’Reilly’s alcohol-soaked sex fiesta and about to engage in consensual sexual activity, pregnancy is already well on the way of being stopped in its tracks. (Not STIs, let’s not forget. None of these protect against sexually transmitted diseases.) His excuse that they aren’t thinking about using contraception holds no water in the argument of preventive techniques like these that take the worry about pregnancy prevention out of the immediate sexual encounter (not 100%, though – no method is 100% effective, and I actually recommend using one of these birth control methods as well as condoms). I’d also add here that many women when drunk are still concerned with pregnancy prevention, so that weasle-y move of trying to make intoxicated women look like reckless players shooting for a fertilized egg is also inaccurate.

Bill’s “black and white” take on the issue of contraception seems to boil down to: women need to pay for their birth control, they need to pay for their pre-natal care costs and gynecological exams, they need to pay for the cost of having the baby. But the fetus was not put there by her alone. The desire to not get pregnant is not hers alone. Communicative partnerships and cost coverage in these areas leading to happy, healthy mothers and children would benefit everyone.

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Filed under Defining Gender, Feminism, Health Education, Media, Politics, Pop Culture, Public Health, Sexism, Women's Health