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.
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.
World Pulse, a social network connecting women who work for change, is currently looking for stories on reproductive health and choices.
World Pulse’s story prompt:
How do the laws in your country affect your reproductive health and choices? What are the most important victories, setbacks, and pressing issues you face?
Do you have a story about legislation that affects you personally or someone you know? Or if the laws protect your rights, are there cultural attitudes that undermine them? Have you witnessed grassroots efforts to increase access to reproductive health care or change policy?
Join voices from across the globe speaking out for women’s autonomy, health, and wellbeing.
Deadline: January 19, 2017 by 11:59 PST
If your story is chosen you will be a featured storyteller on WorldPulse.com and will receive a $100 USD honorarium.
This morning for breakfast, I joined the PSI India team with their partners and The Bill and Melinda Gates Foundation to learn that they are building toilets and developing a sanitation system in Bihar by turning the traditional nonprofit model on its head. PSI India has developed a social enterprise and is treating the open defecation problem like a business problem.
The idea is to make toilets convenient, affordable and attractive in a state where 80% of the population currently lives without them.
When communities lack basic sanitation, kids die (more than 450,000 did in India last year due to diarrheal disease), people get sick, and girls and women are at greater risk of rape and violence when they’re simply trying to find a private place outdoors to relieve themselves.