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.
PET bottles, one of the most widely used materials in the world, are used to package foods and drinks from soda and juices to salad dressings and cooking oils. It is also completely recyclable. In the United States alone, 1.5 billion pounds of PET bottles are recycled annually.
Throughout my travels to low and middle-income countries I see PET bottles thrown haphazardly in fields and streams clogging waterways and dirtying sidewalks and walking paths. In countries such as Nepal (where I visited last year with Coca-Cola), there are concerted educational efforts by environmentally focused NGOs to change behaviors around discarding PET bottles. There are recycling centers in Nepal, but not enough to completely clean its streets and countryside. It seems to be a sisyphean battle to combat PET bottle waste, but there are some who are using the bottles in innovative ways.
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.