Re: maternal mortality in the first world
As with so many issues, we cannot do justice to the problem as it affects people in the third or fourth worlds, if we examine the problem only there. We must also recognize how this persists in the first world, affecting the affluent as well as those less so, and particularly prevalent among the third / fourth world pockets within the first world. In part this helps us understand reasons for maternal mortality that may not have to do with money or state-of-the art facilities. What are the factors related to attitudes, inequality, that contributed to this? How can cultures moving towards affluence and superior technology take care along the way to overcome or avoid the factors that allow maternal mortality to persist in the first world?
Maternal Morality rates in the US – ranked 20th according to CDC and 41st according to UN & WHO – are believed to be under-reported (only 21 US states record on the death certificates if the deceased was recently pregnant). Currently CDC reports maternal mortality rate to be 13 / 100,000 live births, up from 12 in 2003. It is also up from 8 in 1982, and once again higher than 10 , which was the rate in 1977. [A UN / WHO report (2007) places the US maternal mortality rate at 1 / 4800 or 21 / 100,000]. Maternal mortality in the African American community in the US is double, or more – one source reported 34 / 100,000 live births. Poor pre- and post-natal care, in-hospital neglect, denied right to information for patients, and low status of women, vulnerability of pregnancy / motherhood all play a role in this.
Midwife Ina May Gaskin has studied maternal mortality and complications in pregnancy and birth in the US and the social and political factors that cause these to persist and, in recent years, increase. She has raised awareness through the Safe Motherhood Quilt Project.
In “Masking Maternal Mortality, “(Mothering, March-April 2008, pp64-71), Ina May Gaskin asks the crucial question – WHY are we not talking about this serious issue in the United States? Why are we not alarmed that it persists? To her questions, I would add, what can developing countries like India learn from the persistence of maternal mortality in the US, as birth practices are rapidly changing – reducing risks in some spheres, while perhaps unkowingly increasing risks in others?
She writes about shocking cases of maternal death in the US. One case is that of Army soldier Tameka McFarquar who was transferred to New York from her tour of duty in South Korea after becoming pregnant. However, 10 days after being discharged from Samaritan Hospital in New York, she was found dead in her apartment, her newborn also dead from dehydration as there was no one else to notice that the mother was unable to care for her.
Just one follow-up visit would have detected the problem that cost her her life. Tragically, her chances of survival might have been higher had she not transferred to the US. South Korea has a lower maternal mortality rate than the US.
In May Gaskin, “Masking Maternal Mortality,” Mothering, March-April 2008, pp 64-71.
U.S. ranks 41st in maternal mortality
Maternal Mortality Shames Superpower US
Racial And Ethnic Disparities In Maternal Mortality – American Medical Association
Pregnancy-Related Mortality Surveillance — United States, 1991-1999
Pioneering midwife crusades for natural birth
When the heavily pregnant woman had complications during labour, the villagers of Shattak faced a problem. The nearest hospital was 60km (37miles) away and they had no car.
“We got a ladder,” says Abdul-Majid, the head of the village’s health shura (council) recalling the incident over four years ago.
The villagers then laid the woman on the ladder and 20 men took turns to carry the make-shift stretcher along a rutted, windy track that rarely sees vehicles. The pace was agonisingly slow.
“We didn’t make it to the hospital,” says Mr Abdul-Majid. “The mother died on the way.”
For almost 16 babies born, one woman will die in labour. As a country, Afghanistan is ranked second in the world for maternal mortality rates after Sierra Leone.
But health professionals in the province are optimistic that a new project is reducing the numbers of deaths.
Run by the Aga Khan Health Services, a midwife trainee programme selects bright young women from districts across the province.
The students take an 18 month course in the provincial capital, Fayzabad, before returning to their villages as trained midwives.