Giving birth is a significant life event that should aim for a healthy baby and mother. There are growing calls for women to give birth in their preferred birth positions. But this requires midwives to be trained in a way that enables them to respect the choices that women make. The Conversation Africa’s health editor Joy Wanja Muraya asked Lydia Mwanzia to explain why women have the right to make choices, and the important role played by midwives.
Throughout my visits to clinics in Africa I have seen the work of Marie Stopes International in South Africa, Tanzania, Ethiopia as well as Zambia. They provide a full range of quality reproductive health services for women. I have always been impressed by the comprehensive care they provide. Now, their work will be hampered because of an imposed policy of the new administration.
Yesterday morning President Trump signed an executive order to reinstate the Global Gag Rule, or Mexico City Policy, that prevents international NGOs that accept USAID (taxpayer) money from advocating for the legalization of abortions, provide abortions, mention the word, or even refer women to health practionioners that provide safe, legal abortions.
The Global Gag Rule was instated during the Reagan admininstration in 1984 and since then there has been a virtual seesaw effect between Republican and Democratic administrations regarding whether the Rule is reinstated or revoked. According to the WHO, 78,000 women die every year from unsafe abortions. Under Obama’s eight year administration, that number was reportedly decreased by more than half. Now, that President Trump has signed this executive order reinstating the Global Gag Rule, the fear among the global health community is that that number will rapidly skyrocket again.
When everyday Americans think about women dying during childbirth it is probable that their initial thoughts travel directly to Africa where it is quite well known that maternal mortality is rife. Chances are their thoughts never focus on the deaths and near deaths during childbirth that women experience right here in the United States. After all, the overwhelming consensus is that the United States has the best medical care, superior health workers and health system in the world despite some of its inherent challenges. This thinking renders maternal mortality in the US thoroughly inconceivable to many even while data reveal it should not be inconceivable at all. In fact, maternal mortality is on the rise in America having doubled over the past 25 years all while global maternal deaths are steadily declining. Globally, maternal mortality was effectively reduced by 44 percent according to the World Health Organization.
The United States, while not the overall leader in maternal mortality among all countries, it is the leader among all developed nations. The United States ranked number 33 out of 179 countries in Save the Children’s 2015 Mothers’ Index Ranking and 46th in the world due to the rate of women who die from pregnancy and childbirth complications. Compared to other developed countries, the United States’ ranking is abysmal, especially with Norway, Finland, and Iceland ranking in the top three overall. Even countries like Estonia and Belarus, whose GDPs are considerably lower than ours, far outrank America.
For years researchers who study maternal morbidity and mortality have been stumped as to why rates continue to rise and why women of color are adversely affected despite education, health care, and socio-economic factors.
A new report and the first of its kind released in May, New York City 2008 – 2012: Severe Maternal Morbidity, shows the myriad reasons why women of color, especially low-income, Black non-Latina, women fare the worse with severe maternal morbidity (SMM). While most studies in the past across the country focus on maternal mortality, this report focused on maternal morbidity, the causes of maternal mortality.
Sub-Saharan Africa has the highest level of food insecurity in the world. An estimated 220 million people lack adequate nutrition. The nature of the problem is shifting rapidly, with overweight status and obesity emerging as new forms of food insecurity while malnutrition persists. But continental policy responses do not address this changing reality.
Food insecurity is the outcome of being too poor to grow or buy food. But it’s not just any food. According to the United Nations’ Food and Agriculture Organisation’s definition, people need:
… sufficient, safe, nutritious food to maintain a healthy and active life.
Current policy focuses on alleviating undernutrition through increased production and access to food. It does not focus on the systemic issues that inform the food choices people make. This may result in worsening food insecurity in the region.