The viewpoints offered in  Born in the USA  and A Walk to Beautiful are important to understanding the underlying factors that contribute to health outcomes for women and their children in different settings. Perhaps the starkest contrast in these films is access to medical care available to the mothers. The young mother’s in Ethiopia had to travel many hours to reach a hospital. It is likely that most women in these areas are not receiving any type of prenatal care, and have probably not received much medical care for most of their lives. This compounded with the fact that many of these girls are stunted due to lack of access to necessary nutrition, and the young age of many of the mothers the first time they give birth creates a perfect storm of risk factors. A study conducted in 2010 found that the major contributing factor to maternal death in rural southwest Ethiopia was a lack of referral care for mother’s in distress during pregnancy. This was due to the fact that families often did not understand the severity of certain situations because conditions such as fever, dizziness, and pain are considered normal during pregnancy.. Of the 94.4% of births that occur in the home in Ethiopia, 67.5% are attended by untrained neighbors, 20.5% untrained relatives, and 4.7% traditional birth attendants (Deribe et al, 2010). On a policy level, many of these issues could be addressed through the extension and improvement of the capacity of frontline health workers and midwifes. These individuals could attend to women and provide prenatal care, catching warning signs in early stages when they can hopefully be attended to without the amenities of a large hospital. They would also be present to help the mother’s during birth, better equipped to respond to difficulties in labor than an untrained neighbor or family member may be. They could also lead educational efforts focused on maternal and newborn health care. If mother’s and communities have a deeper knowledge of their bodies and their needs during pregnancy they will hopefully be empowered to have a healthier pregnancy. Extension of education on newborn care would hopefully promote better nutrition for newborns which could help to prevent stunting and lead to better health in the future.

The U.S. seems to be confronting the opposite end of the spectrum, over medicalization of the process of child birth. Opposite to what I expected when I first learned about infant and maternal mortality rates in the U.S., the over emphasis on medical care has not led to better outcomes. Despite spending more on medical care than any other country in the world, the U.S. ranks 50^th in maternal mortality and the rates have increased 25% since 1998 (Amnesty International, 2010). According to a report released by the Foundation for the Advancement of Midwifery, many women in the U.S. do not understand the options available to them when giving birth. A hospital is seen as the safest place other options are not explored. Many American women are taught to be afraid of the natural pain that accompanies childbirth. Epidurals to treat pain slow labor, leading to the use of pitocin to push the labor along (Foundation for the Advancement of Midwifery, 2013). These conflicting events push many women to expensive and invasive cesareans that may not be necessary. The high cost associated with child birth in the U.S. has another affect. African American women are four times more likely to die in child birth than any other race. A study done by Amnesty International showed that many African American women cannot afford the care they need during pregnancy and childbirth. Insurance companies turn these women away, and many doctors don’t take Medicaid (Amnesty International, 2010). The first and what I believe the most important policy that needs to be implemented are programs like the Affordable Care Act that will ensure that women have guaranteed lifelong access to quality health care. Policies that support the advancement of the visibility of midwifes could help alleviate many of the problems that are faced. Extending midwifes would cut down on hospitalization, the use of unnecessary cesareans, and provide excellent care at a fraction of the price.

Amnesty International. (2010) Deadly Delivery: The Maternal Health Care Crisis in the USA. http://www.amnestyusa.org/sites/default/files/pdfs/deadlydelivery.pdf

Kebede Deribe, Sibhatu Biadgilign, Alemayehu Amberbir, Tefera Belachew, Kifle Woldemichael. The Road to Maternal Death In Rural Southwest Ethiopia. Ethiopa J Health Sci. 2010 March; 20(1): 71–74.

Foundation for the Advancement of Midwifery. (2013). The Pregnant Elephant in the Room:The U.S. Maternity Care Crisis.  http://www.gih.org/files/FileDownloads/US_Maternity_Care_Crisis_FAM_October_2013.pdf

There were clear differences between birth in A Walk to Beautiful and Born in the USA. Here, I would like to call attention to the within nation differences and use that to address the between nation differences. During Born in the USA we saw several different types of births in America. Though it wasn’t a complete list it definitely gave enough perspectives to be labeled as birth in America. In A Walk to Beautiful, only one type of birth was seen and we have labeled it, in our class, birth in Ethiopia. I think this is an unfair label.  As stated in class, a lot of women in Ethiopia, especially in cities, give birth in a hospital. Though the problem of fistulas is a grave one, it presents only one view. I think we should be cautious in taking one view, especially our first and only view, to be the beacon of truth for an entire people.

In comparing childbirth in Ethiopia and the US in today’s world, there is obviously a tremendous discrepancy between the two.  Ethiopia is on one end of the spectrum, with many rural areas with very limited access to any medical care, while in the US the pendulum has swung too far the other way where birth has become almost entirely medicalized.  As far as what policy could be implemented in either place to improve outcomes, I think that Ethiopia would benefit most from education–about prenatal care, nutrition, the labor process, fistulas, etc–whether this is on the level of nurses, midwives, or the general population.  I think that the US would most benefit from bringing back midwives to the full scope of their practice outside of the hospital, following Europe in returning to a bit more traditional way of childbirth. Additionally, I think that formula companies in the US should be banned from providing free samples to new mothers, as this drive for business can lead to poorer health outcomes for infants.

I have gotten relatively far into Monique and the Mango Rains but, what has stood out to me is Anita Diamant’s immersion into the culture of Mali. In her introduction she lays out the history of Mali from its kingdoms and world famous landmarks, to its colonial roots. I felt this relates to what we have discussed in class. We talk a lot about education which is huge for developed countries, as well developing. But as I read on I see Diamant’s everyday learning such as the pagnes, Monique’s marriage, etc. So, I believe it is very important to learn the customs and culture of wherever you intend to do work such as midwifery, because something like birth is so sacred and special. By learning the customs and culture of wherever you work you are able to teach the people in communities and empower them.

Welcome to the wordpress site for Birth and Global Health! This site is new for me, so I will be learning as we go along. The main purpose of this site is to allow you to blog your responses to the readings and/or discussions that we are having in class. You may blog as often as you like, but you must enter a blog at least five times during the semester, and respond five times to a blog.