In reading the article by Shiffman and Smith that was on our course reserves it reminded me of our discussion about getting a political group in place solely for advocating on the behalf of women and their maternal needs. Having a focused group that would be there in place just for policies that would benefit mothers and potential mothers will be a step in the right direction. That said, there is one point of discussion that Smith and Shiffman express in their articles that I found to be disappointing. In the article the two address why certain global health initiatives receive more attention and success then others. They break  down the reasons down to 4 distinct categories for frameworks on determinants of political priority. One of the categories mentioned is Actors, otherwise known as the strength of individuals or organizations concerned with the issues. For safe motherhood the actors are of course the mothers and mothers to-be. However these women globally do not have much political power locally or globally. Another thing mentioned was that there is no historic or powerful organization that behaves as an actor when it comes to safe motherhood. I had to ponder this notion, and I was not able to think of any large over aching entity or institution that has advocated for safe motherhood. There are NGO’s and community organizations certainly, but no big well known name putting mothers on their list of things to be concerned about globally. With that stated, I am just wondering what kind of company/organization could you all see fit to take the issue of safe motherhood and make it a global priority? Do you think that it is even possible with just one?

The other day I watched a documentary screenings from NOVA entitled “Vaccines: Calling the Shots” The movie was essentially about parents, even though it mainly featured mothers, withholding or spacing out vaccines for their children. Due to the decrease in vaccines, infectious diseases that had all but disappeared, such as measles, are cropping back up in North America.

The films overarching purpose was to convert non-believers to the vaccine train. From the production and editing you go the sense of them sending the message that vaccines do more good then harm and parents need to understand that and set aside their fears. As I said, it was mothers being showcased as the voice of the anti-vaccin charge. Some of the reasons they gave for not wanting to spacing out vaccines and not following the physician recommended schedule is because they did not want to tax their child’s immune system. One woman also attested that one of her children had a seizure (which happens sometimes, but usually has no recurrence or adverse affects) after receiving a vaccine so she did not complete the vaccine regimen or vaccinate her subsequent children. Viewers are also shown the tale of a mother who’s 4  month old child is suffering from whooping cough. We watch as the new born falls into fits of coughing so severe he has to be propped up and given oxygen.

I think this film is relevant to birth and global health because of some of the biases that were apparent in the film Some things that were not addressed. For instance, most of the mothers portrayed were white, middle to upper class woman who have the privilege to decide whether or not to vaccinate a child. Other mothers of different racial and ethnic backgrounds were not shown. But I imagine infants in those households may miss vaccination as well but not by choice. Or there are others who don’t vaccinate for religious and cultural reasons, their stories were also left out of the film.

All that said, I am someone who was vaccinated as a child and will more than likely be vaccinating my children. I am curious to know what others opinion’s are on not vaccinating a child. If the child ends up contracting a preventable infectious disease and suffering or worse passing away do you feel this is grounds to make vaccines required? Should it be a mothers decision whether or not to inoculate her child and/or forego the vaccine schedule?

http://www.pbs.org/wgbh/nova/body/vaccines-calling-shots.html if you are interested in watching the film, heres a link to what its about.

While reading The State of The Worlds Midwifery report there was mentions of the progress improved maternal health has had on countries. With better maternal health, in part due to midwives, economies have improved as well as other MDG’s. The report was mentioning some ways that midwives could continue to foster progress in nations that the MDG’s are aimed toward. One method for helping improvement mentioned was midwives having political standing. I think that would be a wonderful idea for there to be a group of people focused solely on policy and legislation for midwives and mothers. I think this group could focus on getting training to regions that practice midwifery in an unskilled manner, such as Guatemala. Providing instruments and education to places that need more skilled midwives or even education to places like that US that midwifery is still around and only beneficial to women and birth outcomes. That stated, I realize midwives have been around for quite some time and so has the government. I am not very savvy on how organizations like the one they have mentioned in the midwife report would start or carry on. So, I am wondering what has stopped this from not already being an established area of policy and what barriers would a coalition like this face? It is clear to see that midwives are beneficial to communities in more ways than just attending births. Also, on this report itself I think it is a wonderful publication and very important to show the strides the practice of midwifery makes in the world of health. I just wonder whom this publication goes out to, and are the parties that need to see it being made aware of the benefits that midwifery provides to a nation.

It was really disheartening to hear about all the issues that rural women and birth attendants in Guatemala face. After reading the second chapter of MCH, I realize that I still have much to learn with how birth looks in different parts of the world. I am aware that not everywhere is going to have hospitals, birthing centers, or even skilled attendants handling the births.  That written, I did not think about a place where so little is known about birth, even those who are seen as the authorities on birth. Most of the examples of birth that take more of a cultural approach that we have seen knew for the most part the basics of pregnancy. For instance, the movie we watched with the black midwives, although the material used might not have been as advanced as a hospital they were extremely skilled and knowledgeable about how pregnancies should go and how to handle emergencies. Same thing goes for Monique in the book we read, even though the setting was rural and she lacked a lot of tools and medication she was skilled in what she was doing when it came to delivering a child. So, with reading this chapter it makes me wonder how the black midwives and Monique got to be so skilled. I am aware the aforementioned characters most likely went through extensive training and assisted on births before becoming so adept- but who taught their teachers? What I am asking is, how does that cycle start? How can you begin a tradition of being aware of things like a fetal heart rate, or what to do during hemorrhage and pass it down? Assuming there are no interventions such as MFM or the like. While pondering this, I came across the idea of an established tradition of birth is what the previous examples had and what the women in Guatemala lacked. I am sure no one came in and had a program of how to teach Monique’s predecessors, as that is not the norm in many parts of the world. In Guatemala, from what I have read, it appears there is really no tradition of birth, like in New Zealand where the community aspect of birth was extremely heightened. I did not get the same sense of the birth of a child being a community experience or really any experience. It seemed that there are traditional midwives who tend to those who are far removed from hospitals but nothing much past that. There are many factors that contribute to this such as illiteracy, no formal training, and the extremely low regard women are held in. I think having such a pronounced low place in society contributes heavily to poor maternal and fetal outcomes. So more community and better appreciation of women could be a solution outside of intervening and just bringing in technology and education.

While I was reading the maternal and child health chapter about Haiti about healthcare services and costs. The chapter pointed out that women in Haiti felt healthcare services (including those pertaining to birth) should be free of charge. Conversely, the healthcare workers had the notion that payment is important because the services would be rendered worthless (179). This was a really striking statement and I personally do not really understand it. If you provide a service for free, especially one as beneficial as healthcare or maternal care I do not see that as detracting from its value. If one thinks about the terrible rates of mortality Haiti has for health issues brought on by poverty its interesting that free services making things worth less is the mindset of health workers. These health care workers are in direct contact  with poverty and see the effects of it as well as insufficient maternal care everyday. This also speaks to a bigger issue, which relates to infrastructure. This ideal must be something that is being taught among healthcare professionals  or a conclusions drawn sparked by misconception and a break in communication between workers and mothers. Whatever it is something that needs further consideration outside of this project. I say this because this project sponsor made sure to have pre-natal services and the like provided for free, which is nice for those in Torbeck Plain but what about those living in other areas with the same fee for value system? Finding some common ground on maternal care costs and needs are essential. The progress of women being able to properly take their children to term, survive the birth, and raise the child into adulthood are dependent on things like healthcare workers and fees in rural areas.