In honor of World Aids Day, which happens to be tomorrow, and Brenna’s presentation last Monday, I was doing a little reading about HIV/AIDS and PMTCT. It’s amazing to read how far we have come in the past 20 years against fighting this virus. Even though we still have a ways to go before eliminating it, it’s amazing to think what impact has already been made. Even “UNICEF believes that the elimination of mother-to-child transmission of HIV is possible by 2015, this means reducing the MTCT rate to below 5% and the number of children contracting HIV from their mothers by 90%” (Mbabazi, 2014). I couldn’t help but think about how we can start to make a similar impact on maternal health and why it is so difficult to raise awareness about this general problem seen globally. Why is it that everyone knows what the red and pink ribbons are for, but they can’t seem to remember what the white ribbon is for? What can we do to change this? What if there was an organization that helped to draw attention to safe motherhood on the coattails of other causes that reach peoples attention. Maternal health is affected by most health situations and so why not have a group that highlights how the big things affect maternal health?

I looked up online top 10 global health issues and came across this article titled “Top 10 Global Health Issues to Watch in 2014.” The top three were 1) Youth, 2) The lasting damage of war, and 3) Universal health coverage. We have talked about all of these things throughout the semester. It is clear to me that maternal health is embedded throughout all global health aspects. What can we do to highlight this fact to the rest of the world?

Mbabazi, D. (November, 2014). World Aids Day: How effective is PMTCT? The NewTimes. Retrieved from http://www.newtimes.co.rw/section/article/2014-11-24/183346/

Top 10 Global Health Issues to Watch in 2014. (January, 2014). IntraHealth International. Retrieved from http://www.intrahealth.org/page/top-10-global-health-issues-to-watch-in-2014

Is breast best?

We have touched upon the highly controversial debate of breast milk versus formula, but we have not discussed the matter in detail. Thus, I want to provide the forum to share thoughts and opinions about breastfeeding a baby or formula feeding a baby.

Many argue that mothers should breastfeed their baby. To begin with, breast milk can improve the child’s health, for the mother passes antibodies from herself to the child through the breast milk. As a result, the child builds his or her immune system to help fight off infections. In addition, due to the nature of the breast milk, the baby digests the milk more easily than formula. Moreover, the act of breastfeeding benefits not only the child but the mother as well. For example, through breastfeeding, the mother can bond with the child, which can improve the mother’s emotional health. Although breastfeeding appears as an ideal option for feeding an infant, various problems exist. For instance, as we discussed on Monday, the mother can pass harmful chemicals or viruses through the breast milk as well. Thus, the breast milk could actually cause the child more harm than good.

Individuals argue the aforementioned point about transmitting substances to the child to promote the use of formula for feeding the child. For example, the formula would provide the child with the necessary nutrients without the risk of transmitting fatal viruses. In addition, the mother can consume anything that she wants or needs, such as alcohol or medication, without the fear of passing it along to her infant. Furthermore, formula-feeding would enable both parents to develop a bond with the baby, for both partners can feed with a bottle. On the other hand, however, formula-feeding presents obstacles. For instance, parents must pay for the formula, which may cause financial stress. In addition, a mother can access breastmilk at any time, limited by the debate over breastfeeding in public, but she must travel to the store to purchase formula.

Thus, with all of the aforementioned information in mind, what would you all recommend: breastfeeding or formula-feeding? I would argue that a simple answer does not exist. Personally, I would follow the American Academy of Pediatrics’ recommendation of feeding a baby breastmilk until the age of one year old. However, this recommendation alludes to the debate about the age at which a child should stop breastfeeding. Moreover, mothers who abuse drugs or alcohol should use formula instead of breastmilk to eliminate the risk of transmitting the chemicals in the substances to the baby.

http://www.webmd.com/baby/breastfeeding-vs-formula-feeding?page=2

In reading the article by Shiffman and Smith that was on our course reserves it reminded me of our discussion about getting a political group in place solely for advocating on the behalf of women and their maternal needs. Having a focused group that would be there in place just for policies that would benefit mothers and potential mothers will be a step in the right direction. That said, there is one point of discussion that Smith and Shiffman express in their articles that I found to be disappointing. In the article the two address why certain global health initiatives receive more attention and success then others. They break  down the reasons down to 4 distinct categories for frameworks on determinants of political priority. One of the categories mentioned is Actors, otherwise known as the strength of individuals or organizations concerned with the issues. For safe motherhood the actors are of course the mothers and mothers to-be. However these women globally do not have much political power locally or globally. Another thing mentioned was that there is no historic or powerful organization that behaves as an actor when it comes to safe motherhood. I had to ponder this notion, and I was not able to think of any large over aching entity or institution that has advocated for safe motherhood. There are NGO’s and community organizations certainly, but no big well known name putting mothers on their list of things to be concerned about globally. With that stated, I am just wondering what kind of company/organization could you all see fit to take the issue of safe motherhood and make it a global priority? Do you think that it is even possible with just one?

Hey, all.

We briefly touched upon the idea of maternal or family leave after childbirth in Cami’s presentation about Sweden. As she explained, Sweden implements a paid maternity leave policy for several weeks, something that we all envied. As a result, I decided to investigate the policies on maternity leave or parental leave around the world.

The first link shows an infographic for paid maternity leave in various countries. The following data really made an impression on me: Uzbekistan with 114 weeks, Mongolia with 156 weeks, Azerbaijan with 165 weeks, and Ukraine with 166 weeks. Due to the countries’ economic status within the world, I did not expect the aforementioned countries to implement such paid policies for multiple weeks. Furthermore, Finland surpassed all of the other countries with its policy of 167 weeks of paid maternity leave. Finland, a high-income country with a healthcare ranking of 31 according to the World Health Organization, offers an attractive maternity leave policy without compromising the economy or health care of the country, two common criticisms of paid maternity leave.

Unfortunately for us, not only does the United States rank lower on the health care list, but they also fail to provide paid maternity leave. According to the infographic, the United States offers ZERO WEEKS of paid maternity leave. This statistic confused me, for we discussed the maternity leave, minimal but existent, in the United States during Cami’s presentation. Thus, I inquired about the leave in the United States. During my research, I discovered the difference between our country and the rest of the countries in the world. According to the United States Department of Labor and the Family Medical Leave Act passed by President Bill Clinton, companies must provide employees with 12 WEEKS OF UNPAID maternity leave. Therefore, although the United States may offer more maternity leave than the Philippines (nine weeks paid) or the United Arab Emirates (six weeks paid), the latter two pay their employees unlike the United States. Thus, I pose the following question to you all: What influences the maternity or family leave policies in various countries? I believe that the culture in the United States contributes to the current policy in the country.

http://www.buzzfeed.com/laraparker/this-is-what-paid-maternity-leave-looks-like-around-the-worl

https://www.cia.gov/library/publications/the-world-factbook/geos/fi.html

http://www.businessinsider.com/best-healthcare-systems-in-the-world-2012-6?op=1

http://www.dol.gov/dol/topic/benefits-leave/fmla.htm

Earlier in the semester, we have had class discussion about racial health disparities. We’ve discussed many of the ways racial experiences determine biological and social health of pregnant women, mothers, and infants. I briefly mentioned in class that the killing of black youth and young men by police officers could be a direct stressor to black mothers or soon-to-be mothers. The recent murders of black men and children (including Tamir Rice, age 12) and the failure of the justice system to indict their murderers is a violation of reproductive freedom, which includes the ability to choose to parent. Every mother is entitled to raise her child a safe environment. No mother should ever have to watch her child be murdered for existing and then watch his killer walk free. No woman should be afraid to become a mother out fear of bringing a child into a racist, violent system that will target him as a thug, a predator or a criminal.

Reflecting over the failure to indict Darren Wilson over the past week has caused me to wonder why some lives matter and why some don’t matter to our government. This question is connected to our last class discussion about what causes a political issue to receive attention or not. The murder of Michael Brown and the Ferguson protests have certainly gained attention in the media. But action against racial police violence has not received agency in our government. People are putting themselves in danger to protest racial injustice just as they have been doing for decades, but the government is taking little action. I believe that the answer to my initial question lies in century-old institutional racism that values white lives over black lives.

This article was posted in August, five days after Michael Brown was fatally shot. The following quote resonates with me conceding the connection of reproductive justice to racial justice:

It is here where the question of “Whose lives are valued?” enters into the picture, for how cheap must a life be if millions of onlookers can think that stolen cigars justify a murder? Can we have reproductive justice if the children of some are considered inherently less valuable by several orders of magnitude? If the life of a child or a young man or woman is so cheap that misunderstandings, small mistakes, or false accusations justify their deaths, what can then be said about the rights they enjoyed in life and how valuable they turned out to be?

Reproductive justice is about more than the right to choose whether or not to be pregnant. It includes ensuring that all lives are valued and each person has access to safety- free from violence against the body or livelihood. This can be applied globally; people deserve the right to reproductive justice no matter where they live, how much money they have, or where they stand in society. To ensure that reproductive justice is reached, we must work to dissolve the disproportionate violence faced by people of color and poor people. We must dissolve the devaluation of lives based on color. In America, we must start by protecting black lives from systematic violence and attaining justice for the lives that have already been lost.

In our last class we briefly discussed how giving birth is not celebrated, or recognized as a great feat like battling of cancer or surviving a disease. I thought about this some more over the course of the week and realized that we should be celebrating motherhood and one’s ability to deliver a baby safely. However, the difference between labor and diseases like cancer is that cancer is intended to kill you,childbirth on the otherhand is not.

I read a BBC article on how scientists are working towards understanding the reasons why some women have very easy births and some women have long hard labors that end in emergency delivery. The scientists are trying to figure out in detail, exactly how the womb works, so that they can learn more about prematurity, miscarriages, stillborns etcetera. According to the article, emergency caesarean births have risen by 50% in the last 30 years. At the centre for better births at the women’s hospital in Liverpool, a team of 20 scientists are looking at how the womb’s contractions are regulated and controlled. The article discussed determining having predictors for when a birth would be difficult (like the way they have biomarkers for diseases).

Going back to the class discussion on how and why certain people don’t die in childbirth, would expecting mothers in low income countries be a part of this research? Is this research going to encompass all people? are environmental and economic factors considered? ( availability of personnel and equipment/medicine, and like what happened with Monique?) How can these women be included? would this research only include women in middle/high income countries where maternal mortality is not as high?

http://www.bbc.com/news/health-22327882

Niger is a country in West Africa with the highest birth rate in the world – approximately seven children per woman. The government has recognized that fast population growth hampers the country’s development. Along with advocacy groups, the government has campaigned to delay marriage for teenage girls and encourage the use of contraception. However, in patriarchal societies, men are the primary roadblocks to social change. The “School for Husbands” is a program for husbands to discuss birth control, family planning, prenatal care, breastfeeding, etc. When the school started, only 5% of women in Niger used contraception. Now, up to 13% of women use contraception.

http://www.npr.org/blogs/goatsandsoda/2014/11/27/358113783/school-for-husbands-gets-men-to-talk-about-family-size

Do you have any additional ideas/suggestions for how husbands can be included in maternal health initiatives?

An article from Thanksgiving Day in the New Haven Register echoes the discussion we had in class on Monday. According to researchers, one in five new mothers may experience mental health challenges that impact their ability to effectively care for their children. A pediatrician is in a unique position to assess a mother’s mental state because that physician sees her so often at monthly well-baby visits. Generally, pediatricians believe it is important to promote maternal mental health at these visits because a mother’s mental well-being affects her child’s mental development. However, pediatricians sometimes struggle with how best to address maternal mental health concerns. Can you share any ideas/suggestions that were sparked by Monday’s discussion and/or the following article?

http://www.nhregister.com/health/20141127/study-pediatricians-could-help-identify-mental-health-illnesses-in-moms

PRONTO (a Spanish acronym for “Obstetric and Neonatal Training Program”) is a simulation-based training program in Emergency Obstetrics supported by the Bill & Melinda Gates Foundation. The basis for this training program is that healthcare workers in poor regions often do not get to practice for life-threatening emergencies. Read the following article for an example from Guatemala’s geographical “Corridor of Death”, where maternal mortality is triple the national average: http://www.impatientoptimists.org/Posts/2013/01/Combating-the-Daily-Tragedy-of-Maternal-Mortality-in-Guatemalas-quotCorridor-of-Deathquot.

Why do you think these simulations can lead to correct responses in actual life-threatening emergencies?

Bihar, India is the state with the highest fertility rate – 3.6 children per woman. Dr. Anita, a recorded voice, is a tool for community health workers that are reaching out to Bihar’s 27 million women of reproductive age. This mobile initiative is part of a Bill & Melinda Gates Foundation program to reduce maternal, neonatal, and infant deaths in Bihar by 2017. Health workers dial a toll-free number and ask women to listen to Dr. Anita, who validates the credibility of these community health workers. What do you think are other potential benefits of this audio tool?

Read the article here: http://www.hindustantimes.com/comment/sanchitasharma/a-mobile-key-to-maternal-health/article1-1284139.aspx