Hey Guys,

After our class discussion on obstetric violence and recent test, I was interested to see if scholars in the United States have adopted the term. When going through journals in search of articles about obstetric violence I did not find an article specifically using the term ‘obstetric violence’ in context of the United States. However, I did find an article from The American Journal of Bioethics, “Obstetricians and Violence Against Women” that focuses on how some obstetrical practices mirror and perpetuate the attitudes of abusive men and violence against women. The practices referenced in this article are obstetrician response to alcohol use during pregnancy and court-ordered medical treatment. Author Sonya Charles argues throughout the article that “forced medical treatments is a form of violence against women.” She states that abstinence-only approach to alcohol use during pregnancy and certain medication use overstates the risk of alcohol use to manipulate women in attempt to control their behavior. Charles also references Gavaghan’s “You Can’t Handle the Truth” quoting: “To continue preaching total abstinence because of a fear that women will misunderstand the truth, or regard a reassuring message about low-level consumption as a “green light” for unrestrained overindulgence, is patronising and paternalistic to a degree that is hard to reconcile with any real respect for autonomy and informed decision-making” (Gavaghan 2009, 303). In the case of court-ordered medical treatment “obstetricians use the power of the state to keep women under medical surveillance and/or perform medical treatments on behalf of the fetus against the women’s wishes.” Charles links these two OB practices to abusive men through “ideas of male supremacy, control of women, and violence against women” and “patriarchal and misogynistic attitudes.”                                                                                                                 When I did a more general Google search I came across a website article “We need to talk about obstetric violence”, from 2014, that spoke about examples in California, Ireland, and Australia. Similar to the obstetrician and violence article, this article discusses the force of medical practice on women and women’s lack of decision-making over births and their bodies. It will be interesting to see how widely the term “obstetric violence” is adopted and used among different cultures, especially among developing and industrialized countries.Do you guys think this is a term or if there is a definition that will be universally used?

For reference the definition of obstetric violence from the Venezuela article is: “the appropriation of the body and reproductive process of women by health personal, which is expressed as dehumanized treatment, an abused of education, and to convert the natural process into pathological ones, bringing with it low of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women”

“Obstetricians and Violence Against Women” http://www.tandfonline.com/doi/full/10.1080/15265161.2011.623813                       “We need to talk about obstetric violence” http://www.dailylife.com.au/news-and-views/dl-opinion/we-need-to-talk-about-obstetric-violence-20140930-3gydt.html

As Dr. Foster mentioned on Monday, prematurity is now the leading cause of child mortality.  Looking into some of the links I came across the Every Preemie: SCALE (Scaling, catalyzing, advocating, learning, and evidence-driven). This really got me thinking about our Shiffman reading on political priority for global health initiatives. Before reading this article and looking to SCALE I did not truly realize how much went into advocating for specific causes and the work that goes into getting an initiative started. I knew there was a lot to it but I did not know how much political backing and the actors involved dictated the success of an initiative. In terms of premature births, SCALE aims to catalyze global uptake of preterm/low birth weight interventions, overcome bottlenecks and significantly increase coverage to decrease newborn mortality. Having political and global support is key in receiving funding and quicker implementation of intervention programs. I’m curious to see how the finding that pre-term birth is the number one cause of child mortality is going to influence upcoming policies in the Post-2015 Agenda.

Every Preemie: SCALE Facts

SCALES Expected Outcomes:

1. Improved translation of evidence into action through consolidation of                               evidence and focused implementation research to advance global understanding               of how to implement and scale up preterm/LBW services and commodities.

2. Increased capacity of local, national and global entities (health care                                 providers, community groups) to scale up and sustain the utilization of high                         impact interventions.

3. Increased prioritization of preterm/low birth weight with in-country decision                     makers and policy makers and other stakeholders at global and national levels.

SCALE Strategic approaches

1. A core package/toolkit of preterm material that will be offered to all                                 USAID-supported countries

2. A country demonstration package for up to four countries that will serve as                     learning laboratories for scaling up high impact preterm interventions.

3. A custom package to respond to request from countries for specialized                         technical assistance.

Prematurity Number 1 Cause of Child Mortality:

-Every year, 1.09 million children under the age of 5 die due to health complications that are linked to premature birth (gestational age <37 weeks).

-The baby’s organs aren’t fully developed. Immature lungs don’t open as well.

-They are more fragile and susceptible to infection.

-In well-developed countries these babies can survive with neonatal intensive care, but in low-income countries this care is not available.

-The study suggests Kangaroo mother care as an easy and cost-effective way to prevent preterm newborn deaths.

Link to original article/study: http://ac.els-cdn.com/S0140673614616986/1-s2.0-S0140673614616986-main.pdf?_tid=ea63920a-7078-11e4-ac0d-00000aacb360&acdnat=1416462716_2aed48b562461ae0b3bcd2658a925878

Link to Every Preemie: SCALE information: http://www.usaid.gov/what-we-do/global-health/maternal-and-child-health/every-premie-scale-scaling-catalyzing-advocating

One of the things I found most interesting from our RAMs reading about health politics in Iran was the distribution of the reproductive health educational textbooks by the Family Planning Association of the IRI.  These books were aimed at those of reproductive age, meaning girls aged 10-19 and boys aged 15-19 according to Iranian law.  I found this to be particularly interesting given the recent and continuous discussion about sex education in the United States. When to start educating children about sex and reproductive health is a controversial topic in the U.S. How young is too young? In Iran they faced a similar problem. While they were open about reproductive education and were willing to teach children, the definition of what constituted a child left out young girls and boys who were partaking in sexual activities. Although the legal age of marriage for girls was 9 years and 14 years for boys, there was a large population of children marrying much younger; many marriages were only documented if the children were 16 and older. It was not stated if these educational textbooks were distributed to only this age range or to all children in the areas they were given out in. However, if children are marrying before the legal age of marriage, then they will also need education material geared towards them. The Iranian government worked to increase reproductive knowledge to those deemed the appropriate age, but what about those who may be sexually active within and outside of wedlock that are not in the target age ranges?

Hey Guys,

I just wanted to bring this article to everyone’s attention. For my presentation in a few weeks I will be discussing alcohol and substance use during pregnancy, but I just wanted to share this since it was published a little over a week ago in a magazine (Cosmopolitan) that caters to women of reproductive age. The article discusses how the author, Michelle Ruiz, would casually drink a couple glasses of wine or beer a week during her pregnancy and even suggests that up to 8 glasses is acceptable. Drinking during pregnancy has been an increasing topic as there have been a few new pregnancy books published that say drinking is okay. She sites one danish study and references many of her doctor and nurse friends that say casually drinking a little everyweek is okay. As you read the article it becomes clear that the use of alcohol during pregnancy is rooted in culture. She talks about how generations before drank and smoked during their pregnancy and “here we all are”. Drinking during pregnancy is a growing topic as more and more people are testing this “dirty little secret” that is happening among “college-educated, employed women in their late 30s” according to Michelle Ruiz.

http://www.cosmopolitan.com/sex-love/news/a32292/why-i-drank-while-i-was-pregnant/

The reading about pregnancy and birth in Rajasthan from “Reproductive Agency, Medicine and the State” gave a new perspective about pregnancy and the relationship a baby has with its family, in particular the mother. While many of our readings have spoken to how in many societies males are central to the decision making, I found it very interesting how in this culture they not only decided when and what medical attention was sought out, but the relationship between the mother and the baby. Interestingly though babies here are not considered a real person until they are born; in contrast to Western societies where fetuses are often times considered part of the family before the 2nd trimester. However, it is noted that this is because of the high rates of miscarriage and infant mortality in Rajasthan. Here, women are considered to be the “vessels”  for the baby and the men are the “creators” putting more importance on them, furthering the nurturing roles of women in the society. As we have heavily discussed how the head male’s dominance has greatly influenced seeking medical attention in birth there has been little on how a mother see’s the pregnancy and the relationship of seeking medical attention. I have found this perspective of a baby being a “non-person” to be a new insight to this relationship. Mother’s were less inclined to seek medical and prenatal care until they felt the pregnancy would come to term. I feel it is very important to considered cultural aspects like this even though it is still linked to the issue of male dominated society. Education is still the root to improving pregnancy and infant mortality rates. This reading really shows that it is not only important to educate midwives and skilled attendents but educate the mothers. The more they know the more inclined they may be to help/make better decisions about the pregnancy.