The idea of attempting to change potential harmful maternal social norms in developing countries has come up multiple times in class discussion. How effective and, in a way, how ethical is it to try and change a social norm or local custom that may lead to poorer maternal health outcomes?

An article I have read recently discussed the role of educational campaigns with a focus on human rights and empowerment on changing potentially harmful social norms. One such custom that was mentioned was from Senegal, where women believed that working harder than normal during pregnancy would lead to a brighter future for their child. As has been mentioned in class, overworking mothers during their pregnancy can have detrimental health outcomes for themselves and their unborn child. Changing this norm appeared to be imperative to bettering maternal health outcomes in the community.

But westerners can’t just go in and tell pregnant mothers that their customs are wrong and hope that they will change their ways. Mothers should be provided with better information through educational campaigns so they can make the best decision for themselves. In this way, mothers may feel more empowered and wouldn’t feel as if foreigners are telling them how to live their life.

Source: http://www.huffingtonpost.com/molly-melching/jnj-tostan-maternal-health-social-norms_b_3390216.html

I have recently read an article discussing the importance of patient confidentiality in the context of HIV status for South African women receiving antenatal care.

It is clear that women receiving antenatal care should inform a doctor of their HIV status in order to receive proper information and learn about preventative measures to ensure that their child does not become infected with HIV. However, this conversation between doctor and patient should be held entirely in confidence. If a woman’s HIV status is disclosed to the community, she may faced a large amount of stigma against her and her family. Especially in a located like South Africa where the adult HIV prevalence rate is 19.1% (http://www.unaids.org/en /regionscountries/countries/southafrica), releasing that type of information could have detrimental social repercussions for the patient. It is gravely important that doctor patient confidentiality agreements are upheld especially with disease like HIV, which has a lot of stigma surrounding it.

Source: http://www.theguardian.com/global-development/2014/oct/09/hiv-stigma-maternal-deaths-south-africa-amnesty

Japan and Sweden have some of the lowest rates of maternal and infant mortality in the world, and yet, their cultural practices and behaviors vary widely between the countries. While both nations encourage mothers to stay at home with their families after giving birth, there seems to be a lack of choice for mothers in Japan compared to Sweden. As Ugochi mentioned in her presentation, only 3% of mothers take pain relieving medications and are told that it is not appropriate to scream out during labor. I feel like telling mothers that they have little choice in reliving their pain, whether through medication or screaming, is not a healthy cultural behavior. While it seems that Japan is beginning to incorporate more paternal involvement in the birth process, their inclusion of fathers doesn’t seem to compare to the Swedish model.

How then are both countries so successful in maternal outcomes when their practices seem to vary widely? Do you think encouraging mothers to not take any pain reliving medication is a healthy practice?

As with any intervention that includes a distribution of goods or service, I always bear in mind the sustainability of the project. Although a certain program may have many beneficial short term outcomes, how can we be sure that the program will sustain these outcomes? In the Nepal program that we read about for this week, the idea of distributing clothing to mothers who give birth in the presence of trained health workers was presented. Although the authors cited many incredible outcomes, including that fact that over half of all births in the region were attended by trained health workers, I wonder about the long-term effects of the program. The authors stated that a private donor was needed to fund the buying and distribution of the clothes. What will happen when, inevitably, that donor decides to stop funding the project? What if the NGO is unable to acquire sufficient funds to buy clothes for the mothers? I worry about how this project can be sustained for the near future.

The key to providing a sustainable project would be finding a different incentive to have mothers change their behaviors towards maternal health that could be implemented by community members rather than NGO workers.

How can birth outcomes be improved in regions plagued with sexual violence, mass killings, and low levels of security? In countries such as Liberia and the Democratic Republic of the Congo (DRC), war has consumed the nations for past several years. Maternal mortality rates are among the highest in the world and many women are not able to seek medical care immediately after experiencing sexual and/or war-related violence. So many of the citizens in these countries have limited socioeconomic resources and therefore are unable to seek assistance in times of despair. Aiding those most in need in these countries should be a top priority in the field of maternal care.

Establishing clinics like in the Liberia case study seems to be a very promising solution, however, I worry about the fees placed by Ruth on her patients. I understand the need to provide income to sustain the clinic and supplies, but I worry that many individuals, especially in times of war, would not be able to afford any type of medical care. Would there be any effective way of running a clinic like Ruth’s without having to charge patients with a fee for goods and services?