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 50th 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