I had been thinking about our class discussion on the lack of priority given to the Safe Motherhood Initiative, and in particular, how difficult it is to show the burden of infant and maternal mortality.  Interestingly enough, when looking at recent articles on birth and global health, I came across several articles on a report in The Lancet on the toll of prematurity.  Researchers from the World Health Organization, the Johns Hopkins Bloomberg School of Public Health and the London School of Hygiene and Tropical Medicine looked at the causes of child mortality in 194 countries from 2000 to 2013, and found that premature birth was the single greatest cause of death among babies and young children.

For the first time, an infectious disease is not the leading killer of children under five.  This could drastically shift the focus of most international health organizations from solely targeting infectious diseases to broader and longer-term health solutions that would combat infectious diseases and the underlying causes of preterm birth.  As an NPR article noted, “Babies born premature are more fragile, more susceptible to infection.  This may not happen at the time of birth but can happen soon after, during the first month of life.  They may get pneumonia, sepsis, a systemic infection.”

In looking at preventions for preterm births and deaths, the NPR article discusses many of the same maternal health interventions we looked at in our class, such as improving nutrition, reducing infections (especially syphilis), and reducing smoking.  On the newborn side, thermal care is imperative, such as keeping preterm babies warm by wrapping them in a blanket.  These ideas are central to many of the programs implemented by the Safe Motherhood Initiative, with an educational focus.  With reports like this, do other students think there might be a greater international focus on maternal and newborn health programs?  Does this reflect a greater epidemiological shift in developing countries that require deeper and overarching health systems?

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61698-6/abstract

http://www.npr.org/blogs/goatsandsoda/2014/11/17/364720281/for-babies-preterm-birth-is-now-the-number-one-cause-of-death

During one of the class presentations, I remember our class getting into an important discussion about breastfeeding and the factors that can influence a woman’s decision to breastfeed a child or not.  After coming across an article on the same topic, “Inviting African-American Mothers to Sell Their Breast Milk, and Profiting,” I had a few thoughts regarding this program to increase breastfeeding amongst African American women in Detroit, and I was curious to see if any of our classmates had any other thoughts to contribute.

While this program has a noble-sounding cause of increasing breastfeeding amongst a group with historically low rates of breastfeeding, the author makes the argument that this program is ethically questionable in how it is profiting from the program.  Medolac, the Oregon-based company working with the Clinton Global Initiative, claims to “seek to increase breast-feeding rates among urban African-American women” and promote “healthy behavior and prolonged breast-feeding within their communities” by starting a local campaign to grow members of the Mothers Milk Cooperative, the only milk bank owned and operated by nursing mothers.  The milk bank pays approved members (screened and blood tested) $1 an ounce for their milk.  The cooperative has an agreement with Medolac, which processes the milk into a commercially sterile, shelf-stable product and sells it to hospitals for about $7 an ounce (a 600% markup).

At 40%, Detroit has one of the lowest breast-feeding rates for black women in the country.  Medolac’s goals of more breast-feeding and economic empowerment sound promising, but the author argues that the economic and racial elements of the Medolac plan “make it look more like a modern-day breast milk marketing scheme than a public benefit.”  While Medolac officials argue that paying women for their breast milk will increase the likelihood that they will breast-feed their own babies, there is no research behind this claim.  Additionally, the author argues that selling breast milk will likely take the priority over breastfeeding children for these women: “Rare is the mother who will produce enough excess milk, at $1 an ounce to affect her family’s economic situation significantly…the average mother produces 200 ounces of oversupply every two months.”

When thinking about the types of Safe Motherhood interventions we have studied this semester, many have had unintended negative consequences.  With the involvement of a for-profit company, the likelihood of maternal health being the primary motivation seems significantly smaller.  I’m curious to hear what other students think – is this program taking advantage of women in vulnerable financial situations or will this incentivize women who might not otherwise breastfeed to do so?  What would be a better way to incentivize breastfeeding in communities that may not have a strong history of breastfeeding?

Going back a few months to the discussion on birth location, today’s New York Times had an interesting article that advocates for home births in Great Britain.  In “British Regulator Urges Home Births Over Hospital for Uncomplicated Pregnancies,” it is described how Britain’s national health service has reversed a generation of guidance on childbirth to advising healthy women that it is safer to have babies at home or in a birthing center, rather than in a hospital.  According to new guidelines by the National Institute for Health and Care Excellence, an executive body of the Department of Health in the UK, women with uncomplicated pregnancies were better off in the hands of midwives than hospital doctors during birth.

The article mentions a lot of the points we discussed in our debate over birth location, such as the higher risk of unnecessary cesarean sections and epidurals.  However, the statement by such a highly regarded government health authority could have a large influence on the birth location decisions made by hundreds of thousands of British women each year.  More importantly, it reflects a change in health perspectives by developed countries regarding hospital births and the medicalization of birth.  According to the article, few developed countries have significant numbers of women opting for nonhospital deliveries: “In the United States, where a culture of litigation adds a layer of complication, only 1.36 percent of births took place outside a hospital in 2012.  Two-thirds of those non-hospital births took place at home and 29 percent at free-standing birthing centers.”

With a country like Great Britain encouraging a return to midwives and home births and birthing centers for healthy pregnancies, it may be plausible to hope for such a change in the United States.  While such a cultural change may take some time to take place, if more birthing centers were to open in the U.S., the option would be easier to consider for women looking for a nontraditional birth.  I am curious to hear what others think – do you think in the near future we could see a shift in births from hospitals to birthing centers and home births in the U.S.?

Article: http://www.nytimes.com/2014/12/04/world/british-regulator-urges-home-births-over-hospitals-for-uncomplicated-pregnancies.html?ref=health

After our class conversation about the demographic transition and the attempt to control population growth in Iran, I came across an interesting article in The New York Times that applied the same concepts to the United States: “U.S. Birthrate Declines for Sixth Consecutive Year; Economy Could Be Factor.” (http://www.nytimes.com/2014/12/05/us/us-sees-decline-in-births-for-sixth-year.html?ref=health)  This article was reporting how the number of women in the U.S. who gave birth dropped in 2013, down slightly from 2012 but down 9% below the high in 2007.  It quoted several demographers that related the drop in American fertility rate to the state of the economy.

An economic relationship with the number of children born each year is well explained with the concept of the demographic transition:  as a country’s economy develops, women have fewer children.  This is generally due to the fact that as a country becomes more developed, children’s health outcomes improve, and the risk of a child dying becomes reduced.  Additionally, more developed countries tend to have fewer agriculturally based economies and more professional jobs, so it becomes less economically sensible to have numerous children for economic purposes like working in a farm, and more sensible to have fewer children with the high costs of education.

This article introduces a more complex idea on the idea of the demographic transition: what happens to birthrates when developed countries have economic ups and downs?  William Frey, a demographer at the Brookings Institution argues “On just about every demographic indicator involving young adults, whether it’s marriage, buying a home or delaying childbearing, it’s all been on hold since the beginning of the recession.  I think it’ll come back up, and each time new numbers are coming out, I think maybe this will be the moment.”  However, what I found to be one of the most interesting points of the article is how much later in life women are having children.  While the teenage birthrate has dropped substantially, and the birthrate for women in their 20s has been declining as well, births to older women are on the rise.  The report found a 14% increase in births to women ages 45-49.  So it is certainly possible that as countries develop, the birthrate not only drops, but that women will wait longer to have children as well.

After my initial research and the class discussion for my presentation last week, I wanted to delve further into the prevalence of female genital mutilation (FGM) in the United States.  The collective shock of our class that the practice exists in the United States hugely echoed my own surprise.  Looking into statistics of FGM brought me to the website of Equality Now, an international human rights organization “dedicated to action for the civil, political, economic, and social rights of girls and women.”  Their report on FGM was further eye opening for me on this subject.

In 1997, the U.S. Department of Health and Human Services (HHS) estimated that over 168,000 girls and women living in the U.S. have either been, or are at risk of being, subjected to FGM.  However, there is little information known on how many of these procedures have actually occurred on American soil.  In fact, even the HHS estimate is from speculations based on populations from FGM affected communities in the U.S.  There have only been a couple of reported cases of FGM in Georgia, one in 2003 and another in 2010.  The cutting can happen when girls are on vacation in their parents’ countries of origin or when circumcisers are brought into the country to cut girls, but some reports also indicate that a few doctors may be performing FGM on girls in hospitals in the U.S.  Unfortunately, the silence surrounding the issue makes it extremely difficult for girls and women who oppose the practice within communities to speak out openly against it.

The video, which unfortunately did not work in class, was a reflection of an effort to create an awareness campaign on FGM in the U.S.  The hope of such campaigns is that increased awareness and understanding will lead to greater openness on the discourse of FGM, and as a result could lead to better prevention and education regarding the practice.  The video is included in the links below if anyone is still interested in watching it!

http://www.equalitynow.org/sites/default/files/EN_FAQ_FGM_in_US.pdf

http://www.theguardian.com/society/video/2014/may/13/fgm-us-girls-american-female-genital-mutilation-video