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.
Last week we partnered with the Liya Kebede Foundation, a nonprofit foundation that supports safe motherhood initiatives, on an Instagram takeover to discuss maternal health in India. I was delighted to share photos from Delhi where I saw Save the Children’s maternal health work in one of Delhi’s slums, Okhla.
Below see the photos and facts about maternal health in India.
To kick off World Health Worker Week (April 5 – 11) we are sharing photos and stories of some of the health workers we’ve met around the world over the years who work tirelessly to keep women, children, and families healthy and most importantly alive.
In the sub-Saharan and Asian countries where we have met these health workers, many of the ailments they treat every day can cause severe illness in their patients and even death. That is why it is important to not only provide the much-needed resources and support health workers need to do their jobs effectively and train many more health workers, it’s also important to thank them for the work they do. That is why World Health Worker Week was started — to celebrate health workers, but also to acknowledge the challenges they face every day and help rally the world’s global health community, civil society, and governments to fix those health worker challenges.
The first time I saw open defecation was in a slum in Delhi. I was taken aback. I had always heard about open defecation, but until that point I had never seen it and couldn’t imagine it happening in an overly crowded urban area. It was also at that moment that I knew I had to learn as much as possible about the ways in which people use the bathroom, if they have one at all.
2.5 billion people lack improved sanitation and 1 billion people do not have access to a bathroom and must resort to the undignified practice of open defecation. There are 7 billion people on the planet.
Women who must defecate in the open and who also have to use the community toilets are at increased risk of violence and rape.
When I visit communities and families in low-income countries I always look for toilets and latrines to see the conditions in which people relieve themselves. Below are some photos of toilets I took in India, Ethiopia, Philippines, and South Africa.
This month begins a massive scale-up of Pentavalent vaccine for India’s children. With the largest rate of child mortality in the world, this new, national immunization effort will help reduce the number of child deaths in India. The Pentavalent vaccine combines diphtheria-tetanus-pertussis (DTP) with hepatitis B (hepB) and Haemophilus influenzae type b (Hib). Haemophilus influenzae type b kills 72,000 Indian children each year. Currently there are 6.8 million unimmunized children in India.
With the help of GAVI, the Vaccine Alliance, India will roll out free Pentavalent shots in 12 states during its first phase. 8 states already have free Pentavalent immunizations. By the end of phase one 2/3 of all India’s children will have access to the Pentavalent shot, according to GAVI. Phase two will cover the remaining 16 states with the Pentavalent shot. Phase two begins in 2015.
“India’s decision to expand access to Pentavalent vaccines through the Universal Immunization Programme will have a major long-term positive health impact by averting the deaths associated with Hib pneumonia, meningitis and hepB liver cancer,” said Dr Seth Berkley CEO of Gavi.
India has already shown that massive immunization roll-outs are in its citizens’ best interest in order to have a healthier populace. India was recently declared polio free because of its willingness to scale-up its polio vaccination programs.