Semester Reflection & Future Directions

Throughout the semester, this course has taught me much about the importance of birth as well as its concern within the public health sector. One important idea that I feel I’m taking from this course is that birth affects everyone. For most, they either take part in the birth practice by having a baby of their own, their partner does, their parent or sibling does, and so on. For this reason, I feel it is of great importance that we all acknowledge and work to reduce problems facing birth across the globe. One such application of this idea I came across while researching for my presentation topic, postpartum depression. While it is to the most part overlooked, postpartum depression can affect fathers as well as mothers, and to those having a surrogate carry and delivery their baby as well as those going through the birthing process themselves. Paternal postpartum depression is most affected by their partner having postpartum depression. New statistics note that rates of paternal depression when a partner also suffers from the disease ranges from 24% to 50%, a significant percentage of the population. In this way, one’s actions, feelings and state of wellness affects not only themselves but those around them, such as their partner or children. However, many people are unaware of the intricacies involved with the birthing process, from before to during pregnancy and even its affects after delivery of the baby. For this reason, I think it is imperative that public health officials work to increase knowledge and awareness surrounding the importance and necessity of healthy birth practices to ensure health outcomes of babies and their mothers. While this is a big undertaking, what specific steps can we take to increase awareness and knowledge about birth and its importance as a public health necessity?


Goodman, J. (2003). Paternal postpartum depression, its relationship to maternal postpartum depression, and implications for family health. Journal of Advanced Nursing, 45(1): 26-35. DOI: 10.1046/j.1365-2648.

Intimate Partner Violence Affecting Fetal & Maternal Outcomes in LAC

Another reading on maternal and fetal outcomes as affected by partner violence in Latin America and the Caribbean opened my eyes up to the horrors and prevalence of this issue, which occurs in many nations around the world. According to the study done in Latin America, this issue is most highly associated with unplanned pregnancies. Also uncovered in the study was the overlapping of the issue with the disempowerment of women, which has been shown to increase prevalence of partner violence. Interestingly, whether a woman sought prenatal care was shown to decrease the prevalence of the issue, which may or may not be due to access and affordability of care. The study sought to define the issue in one region of the world, in order to effectively add intervention strategies to decrease the issue and its negative effect on fetal and maternal outcomes. Wanting to know more about the issue, I decided to look into the prevalence of this issue in the USA. As a citizen in this country, I believed there was a small magnitude of this problem. Upon investigation, however, I realized how prevalent the issue truly is. According to the CDC’s report in March of 2003, there are approximately 5.3 million victims of IPV each year. Out of this number 550,000 injuries require medical attention.  I would interested in learning if the results of this study were implemented in a way that greatly decreased the prevalence of this issue. In addition, I am now increasingly more aware of the dangers of IPV both in my own country and others.


Reproductive Health in Islamic Iran

This week’s reading on reproductive health in Iran brought me some insight in the intersection of health and religion, which can be a difficult area for many. While blatantly ignoring religion and its importance in many regions and cultures creates problems, I was curious to learn more about how health professions tackle this issue. One source states that over 90% of the population in Iran practice Islam, and as such their religious beliefs and texts are believed to play a large role in their life practices, which include to some extent those of reproductive health. In working with religious officials, health professionals were able to create great change and increase in health in Iran. As such, the nation won the 1998 UN Population Award for successfully reducing population growth with the implementation of the Population and Family Planning Program. I decided to look into whether this award was still being given out, and found that in 2014 it went to Italy, for their development in the category of obstetric care. However, the nation did not accept the redefinition of the family, only including one man and one women joining together, and was not willing to accept and implement sex education for all adolescents and young adults who are not currently getting married. I found the cultural aspects of population growth and its solutions in this nation interesting. For example, at first Iran was not willing to combat its increasing population as a problem, as in previous years a large population was the sign of a strong nation and no problem was detected. Also, a major player in reducing population growth by implementing family planning measures such as contraception was when Islamic clergy members deemed it acceptable. This was notable because they were able to use religious texts and historical evidence to back the acceptance of contraception as a method of family planning. Therefore, I am very intrigued to learn more about the overlapping of religious ideals and modern health practices, as often they can clash but with careful interactions can be successfully done to better the health outcomes of a nation.


Birth Settings & Beliefs Regarding Birth in the US and India

This week’s reading on Labor, Privatization and Class opened my eyes to the differences socially and culturally between America and various countries. Notably, there exists a high importance of intra-household hierarchies and the division of labor between family members in countries such as India, while in America there exists a more relaxed and malleable description of family life. The case study in Calcutta, India shows that domestic and kin relationships affect a pregnant woman’s access, use and knowledge of the healthcare system. The common trend found among pregnant women in India show a high percentage giving birth in a private institution as well as a high percentage of women having elective C-sections. This was shown to be more prevalent in middle- and high-class families, as well as in urban verses rural areas. I found it interesting that more women choose private birth centers over hospitals, given our recent class discussion of birthplace ranging from hospital, birth center, and home birth. Notably, the chapter bases these decisions on Indian women’s lack of trust and credibility of hospitals, whereas birth centers give the comfort and personal interest in wellbeing that the women are looking for. In addition, modern technology is seen as a blessing, and a way to enable a healthy infant born at a suitable time for the parents. It is shown as a prestigious technique, allowing women to avoid pain, shame and the cultural belief in pollution that follows a natural vaginal birth. In 2012, research shows that in Indian private institutions women are 3 to 10 times more likely to have an elective C-section than in hospital settings. In comparison to the US, more elective C-sections occur at hospitals than private institutions. The difference in these statistics may be due to differences in the wishes of pregnant women, who may prefer C-sections more in India than in the US. However, I believe this difference may be based on the characteristics of women who choose to give birth in each setting, while in the US most women attend a hospital birth women in India prefer a private institution and thus have different expectations of care.


Training Midwives in Guatemala

        Reading in “Maternal & Child Health” regarding the balance of tradition and midwifery in Guatemala opened my eyes to the reality of giving birth in other nations outside of the United States. While most Americans seek modern technology before, during and after pregnancy and childbirth, this is not the case in many less developed and economically struggling nations. Notably, I was surprised to find that although approximately 71% of births in Guatemala are attended by midwives, a high percentage of these personnel do not meet WHO or UNICEF criteria for skilled birth attendants. When reading the statistic about having midwifes attend the majority of births, I was under the influence that because of this the nation’s infant and maternal mortality rates must be lower than in other nations without the help of birth attendants. However, as the chapter points out Guatemala is among the highest in maternal and infant mortality rates in the Western Hemisphere.  The initiatives taken in the nation helped to train midwives in proper techniques, acknowledging signs of obstructed labor, and help to reduce these rates. One concept I found interesting was the need for support given to midwives, in return for the support they give to pregnant women and their families. For this reason the program Midwives for Midwives was developed, giving them an area for open and honest communication for the work they do and how it affects them. Looking more into this program, I found that between 2007 and 2010 a total of 450 midwives were trained in Guatemala. I find this statistic very hopeful for the future, and the possibility of sustaining the work and dedication numerous health officials have shown the region.