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.
Birth and Global Health
There is a movement to do just that that is happening in the US right now. It is the establishment of “Baby Friendly” hospitals. I encourage you to look into this movement. DeKalb Medical Center in Decatur is trying to become Baby Friendly. So is Grady Memorial Hospital. It is amazing how difficult it can be, because it involves a lot of cultural change.
Also, I encourage you to learn about the MaNEP project in Ethiopia, which Dr. Lynn Sibley leads, funded by the Gates Foundation, and now the Canadian Agency for International Development. It is described in detail on the last week of the COURSERA course.
I agree that birthing in Ethiopia and the United States are virtually polar opposites of one another. I also agree with your thought that education would benefit the outcomes of childbirth in Ethiopia. I believe that education is the root of culture-a child learns from its mother and its mother learns from the community-but it can also be the root for change within a culture. If I were to implement education about childbirth, I would focus on the causes of infant mortality during childbirth in Ethiopia. According to trends found in an article in the BMC Public health http://www.biomedcentral.com/1471-2458/13/483, the risk of neonatal death is more than twice as high among infants born less than 2 years after the previous sibling as those born after 2 years, and infants born to mothers younger than 18 were at a 41% higher risk for mortality than those born to mothers between 18 and 34. So, it would be beneficial to target these problems by providing education about the spacing between infants and the dangers of having children before the body is mature enough, along with other factors that maximize the health of the infant-such as nutrition, prenatal care, etc.
Article citation:
Mekonnen, Y., Tensou, B., Telake, D.S., Degefie, T., & Bekele, A. (2013). Neonatal mortality in Ethiopia: trends and determinants. BMC Public Health, 13(483), 1-14. Retrieved from http://www.biomedcentral.com/content/pdf/1471-2458-13-483.pdf
While I agree with your comments saying that Ethipoa would benefit from pregnancy and birthing education and that the U.S. would benefit from incorportating more midwifery practices, I would like to comment on the idea of banning free samples of formula. There are times when formula is necessary. Although breast feeding is a natural process, it does not mean that it comes easily to all mothers. Sometimes formula is necessary if a baby isn’t able to latch and successfully breastfeed, depriving the baby vital nutrients. Formula is also beneficial for babies if the mother is addicted to drugs or alcohol. Otherwise, these harmful substances would be fed to the baby through breastmilk. So while formula may lead to poorer health outcomes for some, there are situations that must be taken into consideration before banning formula sample.
Lorraine, I completely agree with you, that there are times when formula is definitely needed, such as if the mother is receiving chemo or has an active lesion on her breast, etc. However, there is a difference between providing free formula samples to all women who give birth in the hospital, and having formula available for purchase for those women who need it.
Valerie and Lorraine, I agree with both of your points! I think that formula must also be provided to malnourished mothers who are unable to provide the full amount of nourishing breast milk needed by their babies. However, I believe the culture of breastfeeding in hospitals needs to change. Health workers need to actively encourage healthy mothers to breastfeed before giving women formula samples and (indirectly!) encouraging them to feed their babies formula.