Not sure if others have, but I have been following quite closely the recent news about rape allegations at the University of Virginia. Today’s news stated that Rolling Stone magazine retracted their article which featured the horrible account of one student’s sexual assault in 2012. As shocked as I was to hear this, I have found myself reading several articles about the situation which led me to start thinking about how this might relate to our class. We are all aware of sexual violence and I’m sure this topic has been addressed in classes we have taken or has affected us to some degree in our lives.

As I started looking around for “sexual violence and birth”, I found that it is common that sexual violence survivors will have symptoms of the trauma re-emerge during labor. I want to clarify that this is not directed specifically at women having babies that resulted from sexual assault, but, in general, sexual violence survivors who later in life go through labor. There are many factors of the experience that can trigger memories or nightmares of the prior attack from vaginal exams to constantly rotating hospital staff. Some have described their experience of labor in hospitals as “strangers standing over them.” Whatever it is, the personal care (or lack thereof), the painful experience (pain that might be similar to the traumatic experience), or the exposure of a woman’s body and her vulnerability, many sexual violence survivors go through this experience without the support or recognition of this re-traumatization.

While we addressed obstetric violence in class and have touched on sexual violence in general, I think its interesting to think about how prior events could be triggered during the experience of labor. It brings me to wonder about how this affects populations around the world. I guess I wanted to share my findings and see what others have to say about this topic. There’s a great article below from a nurse who did a study on helping survivors of sexual abuse through labor. Thoughts?

Burian, J. (2014) Gentle Birth. Helping Survivors of Sexual Abuse Through Labor. Retrieved from http://www.gentlebirth.org/archives/abuselbr.html.

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

I came across this article online and the story was also featured on NPR: All Things Considered. It discussed the reality of maternal health in an epidemic as deadly as Ebola. Most of us probably are aware of the effects of this outbreak and the implications it is having on the countries in West Africa. What’s important to remember is that this disease is not only taking lives, but it is causing damage to entire communities, economics, health systems, and much more.

As most people know, Ebola is transmitted through bodily fluids, including amniotic fluids, vaginal secretions, placenta, and blood, and so can be transmitted very easily through OB and OR cases. Ebola has been stated as a “death sentence” for pregnant women as this article states that “one small study found a fatality rate around 95 percent” (NPR, 2014). Usually the fetus dies before labor or immediately after birth because the virus not only infects mom, but infects the fetus and the amniotic fluid that surrounds the baby.

As one could imagine, the death of healthcare workers in this outbreak has been significant and even more so with healthcare workers helping with deliveries. Because of this, there is a huge fear and stigma of pregnant women in Ebola infected countries. Many women are refused to be treated at healthcare centers just because of the possibility that they could be infected. As a result, many women are dying due to childbirth or having stillborn babies. Many are not supported at all during their pregnancy. That said, if the virus doesn’t kill them, many times their pregnancy will due to lack of healthcare.

This among many other healthcare situations are going untreated because of the stigma against Ebola and the fear of the disease. Even if the global community can begin to contain this outbreak, there will be huge repercussions to the communities and health systems in the countries. I believe the more we can educate and spread awareness of these realities, the more we can help to fight this stigma. What do you think about how we can move forward to support these women to get the access to care that they need?

Doucleff, M. (2014, November). Dangerous Deliveries: Ebola Leaves Moms and Babies Without Care. NPR: National Public Radio. Retrieved from http://www.npr.org/blogs/goatsandsoda/2014/11/18/364179795/dangerous-deliveries-ebola-devastates-womens-health-in-liberia

After our brief discussion at the end of class, I found myself searching for recent news about obstetric violence, and came across this article in XXXX written on October 1^st, 2014. It discusses how there are several cases of women speaking out because they were either forced into c-sections or received episiotomies without being asked. Shocking as it is that this would occur, it presents the idea of who are we really treating during birth. Is the focus the fetus—to make it out in the best condition possible—so the decision is made by the medical provider? Or is the focus the mother—to honor her preferences—and risk some fetal factors to satisfy her desires/needs for birth? Do we really have to choose?

I think many times when women give birth in the US, the relationship between provider and patient is established and decisions have already been clear in case things progressed to certain situations. But what if they have not? It is my understanding that it is the provider’s responsibility to ensure a healthy state for both parties. What if their lives aren’t at risk, but some things would just “make it easier?” Who do you make it “easier” for?

The article also refers to an Australian organization Birthtalk, which describes traumatic birth as, “A birth that you can’t let alone. It stays with you…It might not look ‘that bad’ to an outsider. It might not look ‘that bad’ to your partner…It could have been a caesarean or a natural birth. It might have taken 30 hours or 3 hours. A bad birth is defined by the way you feel not just the events that occurred.” How do you set standards and give suggestions for this situation if birth is not to be based on any one person’s interpretation of an already very difficult process? Is this the approach to have? One could argue….isn’t the mother healthy and leaving with a happy, healthy baby?

I also was interested to keep the discussion going about culture and how one’s understanding of their own culture might affect their perception of other cultures. The article mentioned above continues “our cultural view of pregnancy and birth, it seems, stems from a patriarchal attitude that feminism seeks to dismantle: that women must be submissive, passive, and let the experts who know better do the work.”

So where do we go from here? How do we advocate for women in their birthing experience, but empower them to trust the medical team?

Lock, K. (2014, October). We Need to Talk About Obstetric Violence. Daily Life.  Retrieved from http://www.dailylife.com.au/news-and-views/dl-opinion/we-need-to-talk-about-obstetric-violence-20140930-3gydt.html

I have noticed that sex education has been a common topic that has arose in class whether we are talking about birth and politics, abortion, or public policy and services. I came across this article written by a journalist, Jemimah Steinfield, who talks about sex education, or the lack there of, in China. Sex discussion and education was strictly forbidden in China until around the time of the cultural revolution when the Ministry of Education allowed some sex education, but mainly to teach children about the differences between men and women. They were to be taught mainly about the anatomical differences only. Even in recent years in China, schools are discussing these same topics and including  nothing about contraception, sexually transmitted diseases, or sexual abuse. The problem is that since no one learns about it, no one grows up to be able to teach about it and the vicious cycle continues. Unfortunately, even though there is no education, this doesn’t mean that people are not engaging in sexual activity. The article states that a survey done in 2012 “showed that 70% of Chinese have engaged in pre-marital sex, up from just 15% of those surveyed in 1989” (Steinfield). So its clear that the population is sexually active and without proper protection and education of risk comes the potential unwanted infections and pregnancies. “Sexually transmitted infections (STIs) are on the ascent and China has particularly high rates of syphilis, while sexual transmission now accounts for 81.7% of all new HIV infections” (Steinfield). As well, the article reports that in 2013, 13 million annual abortions were performed with one patient who reportedly had already had 13 abortions throughout her lifetime.

I found this article especially interesting based on the facts. You’d think figures like this would be making a more profound impact on a population. I found it particularly interesting in comparison to discussions we had had in class and different sexual educations experiences each student has had. The article ends stating that there has been more focus on sexual education in China in the past year, but mostly focused on protection against sexual abuse as the cases of child abuse have drastically rise throughout the past decade.

Steinfield, J. (2014, June). Do Chinese Classrooms Need to Talk About Sex? CNN. Retrieved from CNN website http://www.cnn.com/2014/06/19/world/asia/china-sex-education/index.html?iref=allsearch