After eight years of practicing obstetrics and researching childbirth in the United States, I know as well as anyone that the American maternal health system could be better. Our way of childbirth is the costliest in the world. Our health outcomes, from mortality rates to birth weights, are far, far from the best.
The reasons we fall short are not obvious. In medicine, providing more care is often mistaken for providing better care. In childbirth the relationship between more and better is complicated. Texan obstetricians, when compared to their counterparts in neighboring New Mexico, are 50% more likely to intervene on the baby’s behalf by performing a cesarean section. Nonetheless, Texas babies still have a lower survival rate than New Mexican babies.
I long assumed that our most puzzling American health care failures were idiosyncrasies–unique consequences of American culture, geography, and politics. But a trip to India for the 2017 Human Rights in Childbirth meeting led me to a humbling realization: when it comes to childbirth, both countries fall short in surprisingly similar ways.
Human rights in childbirth
I take care of patients in at a well-funded teaching hospital in Boston, where pregnant women seem well-respected and have clear, inviolable rights.
We are very pleased and excited to announce our new weekly chats all about maternal health with some of the leading maternal health experts, researchers, practitioners, and organizations in the world under the #maternalhealthchat hashtag.
Starting on Tuesday, November 8 at 1 PM EST with Jacaranda Health we will host 30-minute chats each week all about maternal and reproductive health as well as the health of newborns. We will dig into statistics, best practices, innovative tools and programs that save lives as well as feature and highlight the people and organizations that are making a difference to save the lives of women the world over.
Join us on November 8 at 1 PM EST with our first featured organization, Jacaranda Health. Jacaranda Health is a nonprofit social enterprise that provides high-quality, respectful, and low-cost maternity services to women in Kenya. Their innovations have resulted in 99.9% survival rates for newborns and mothers, 45% fewer maternal complications than nearby public hospitals in Kenya, and postpartum family planning rates that are 4x higher than the national average. To learn more about Jacaranda’s progress, view their 2015 impact report.
Nepal, while being a hotbed for adventure seekers, trekkers, tourists, and mountaineers, faces many economic struggles that heavily plague low-and-middle income countries. The vast majority of Nepal’s economy is based on remittances with 25 percent of its working population living outside of the country. Additionally, with an average population age of 23, Nepal has a dismal 50 percent unemployment rate. These systemic economic struggles, of course, disproportionately affect women and subsequently their children and families. Couple that with a stringent caste system and some Nepali women remain inherently stuck on the lowest rung of the class ladder and are subject to some of the basest forms of work available to them.
The Himalayan Climate Initiative (HCI), a youth-driven environmental NGO based in Kathmandu, is working with some of these women whose only other economically viable life option may be selling themselves sexually to the nearest customer, working in the illegal scrap waste trade, or going abroad to find work and then enduring whatever fate awaits them. HCI employs socially discriminated women waste workers at its PET Bottle Recollection Social Enterprise (Nagar Mitra) allowing them to create a livelihood beyond what might traditionally befall them.
Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable – including obstructed and protracted labour and one of its side-effects, obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother’s pelvis is too small or the baby is too large.
In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.