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.

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

Last Thursday, President Obama announced an executive order that will protect approximately 4 million United States immigrants from deportation. The executive action will also grant those protected- those who have lived in the country for 5 years or more or who are parents to American citizens- temporary visas, which will allow them to legally work in the country.

What does this mean for reproductive health of immigrant women in the U.S.? Well, it increases the likelihood that immigrants will receive insurance benefits, if they have an employer who provides health insurance to employees. Hopefully, it will mean that many more immigrant women have access to affordable contraception, gynecological care, and maternal care.

However, I don’t think this executive order does enough to protect immigrant women’s sexual and reproductive health. The 4 million immigrants that are protected will still not be eligible for Obamacare. Although able to legally work, many of them will have low-wage jobs that do not offer insurance benefits. Although this order will improve the lives of the immigrants it protects, it does not fully address their right to healthcare. As the National Latina Institute for Reproductive Justice commented, Obama “can and should do more” to protect immigrants as he seeks to expand universal healthcare.

Since my view on this issue is pretty clear, I was wondering what you all think. Do you think universal healthcare should apply to immigrant women? Why is it important (or not) to provide healthcare to immigrant women?

Sources:

A Washington Post Article with some general information about Obama’s executive action (including a short video of his speech): http://www.washingtonpost.com/blogs/wonkblog/wp/2014/11/19/your-complete-guide-to-obamas-immigration-order/

Center for Reproductive Right’s reaction to the decision: http://reproductiverights.org/en/press-room/administrative-action-on-immigration-provides-relief-to-millions&s_src=E15SOC111419F&s_subsrc=datasync&utm_medium=social&utm_source=twitter&utm_campaign=E15SOC111419F

A Politico “blurb” about the decision: http://www.politico.com/politicopulse/1114/politicopulse16205.html

Family Planning is an issue that we have discussed briefly in this class, especially in the beginning. Although this is not a large issue in the US, developing countries are really struggling to control this. Nigeria is one of those countries, seeing as I did my presentation on the birthing practices in Nigeria, I decided to share this.

I read an article on Family Planning in Nigeria recently. The UN was advising that family planning be encouraged so that population growth can be managed. With a population of over 170 million (A figure that is expected to double in about 20 years and surpass the US in 2050), living in a country thats only a bit over two times the size of California, Nigeria is quickly becoming overpopulated.

The article also discussed how the country could benefit economically if family planning was promoted and encouraged. According to the director of the United Nations Population Fund Babatunde Osotimehin, Nigeria would benefit a great deal from a “Demographic Dividend” This demographic dividend occurs when “The working population of a country is larger than the younger dependent population”  According to Osotimehin “A slight decline in fertility would raise output per capita by 5.6 percent over a span of 20 years and 11.9 percent over a 50 year span”

What are some policies that can be put in place to encourage family planning in Nigeria?

http://abcnews.go.com/Health/wireStory/agency-encourages-family-planning-nigeria-27002356

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

Hey, all.

During my presentation, a few of you inquired about pregnancies in prisons in other countries. Thus, I conducted some research on the treatment and outcomes in other systems. While perusing the literature, I came across some intriguing articles. Although I could not determine whether or not the prison systems in other countries operated comparably to the state prison system in the United States, the treatment of and outcomes for the pregnant prisoners appeared rather similar.

To begin with, I discovered a powerful article about shackling. The first link tells the story of Meriam Ibrahim, a Sudanese woman. She claims that she gave birth to her daughter while shackled to the floor of a prison. As a result, the child may suffer from various disabilities. Although the United States’ prison system does not require a woman to give birth shackled to the floor, the majority of the states do not have policies that prohibit shackling during labor and delivery. Thus, I pose the following question: Should the United States implement the same practices as a war-torn, developing country?

In addition to treatment during labor and delivery, I researched information on the postpartum period. The second link discusses residential childcare programs in the United Kingdom, as shown in Washington State for example. It states that the United Kingdom allows women to raise their children in special units as well. However, the prisons only accept children up to eighteen months of age to live in the “mother and baby” units, with the exception of one prison that prohibits children greater than nine months old. Furthermore, it appears that the child does not have to be born in the prison.Thus, the mother can raise her children (up to eighteen months old) from her life before incarceration in the programs as well. Again, this scenario raises the same question from my presentation. Should a child suffer for his or her mother’s crime? Even though the mother has parental rights, should a child be confined to the walls of a prison (especially if a relative could raise the child)?

Due to the similarities between the United States’ prison programs and the United Kingdom’s prison programs, I chose to research the birth outcomes of incarcerated women in the UK. The last link leads to an article in the Lancet that compares the birth outcomes of incarcerated women and women on probation. The study reports that the prison experienced 669 live births and 6 stillbirths. On the other hand, the women on probation only had 426 live births and 12 stillbirths. Thus, the women in prison had a higher percentage of live births, better outcomes, than the women on probation. As speculated in my presentation, the study concludes that the greater outcomes stem from the cessation of alcohol and drugs and greater access to healthcare among populations of similar socioeconomic status.

http://www.theguardian.com/world/2014/jul/01/meriam-ibrahim-child-disabled-born-shackled-floor

https://www.gov.uk/life-in-prison/pregnancy-and-childcare-in-prison

http://ac.els-cdn.com/S0140673687918046/1-s2.0-S0140673687918046-main.pdf?_tid=177ccbaa-6fb4-11e4-8667-00000aab0f02&acdnat=1416378180_dbdb53e62b7401cdcf9544c11389ee3c

A nursing student in our cohort posted this article to our class Facebook page this week and I found it very interested and wanted to share with you all. The article begins by discussing the Healthy People 2020 goal to decrease the number of infant deaths to 6/1000 and tells how currently the US is at 6.1/1000. However, as we have discussed in class, the U.S. infant death rate is still relatively high compared to other developed countries such as Austria whose has a rate of 3.8, Finland who has a rate of 2.3, and Monaco who has a rate of 1.8 (the lowest in the world.) However, the article brings up an important concept that we have only briefly touched upon in class… how these data/stats are collected. The article states that there is often a discrepancy in the definition of a live birth and claims that the US rate may actually be lower (around 4.2). U.S. statistics include babies born before 24 weeks (even though chance of survival is very low for babies born before 23wks) while other countries may classify extremely low birth weight babies as a stillbirth/miscarriage; thus, if the ELBW babies die they are not included in the infant death rate.

While this in itself is interesting to think about, and can spark conversation about policies that perhaps need to be in place to insure more accurate data collection and parameters defining how we calculate infant death rate, the article goes even further to discuss an issue I find even more intriguing.

The article claims that the majority of infant deaths in the U.S. actually do not occur in the neonatal period (first 28 days) while the babies are still in the hospital, but over time after they are home. Furthermore, they examined how this is particularly true with babies born to women of lower socioeconomic status. While we have discussed how socioeconomic status contributes to birth outcomes across the globe, I found it interesting that the article claims that in comparing outcomes between the U.S., Austria, and Finland that children born to poor minority women in the U.S. “were more likely to die within the first year than children born to similar mothers in other countries.” So, I am wondering what you all think may play in to this. What makes infants (and women) of lower socioeconomic status in the U.S. more vulnerable than women of lower socioeconomic status in other developed nations?

Here is the link to the article:

Romm, C. (2014, October 1). Why American Babies Die. Retrieved November 18, 2014, from http://www.theatlantic.com/health/archive/2014/10/why-american-babies-die/381008/

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

After my initial research and the class discussion for my presentation last week, I wanted to delve further into the prevalence of female genital mutilation (FGM) in the United States.  The collective shock of our class that the practice exists in the United States hugely echoed my own surprise.  Looking into statistics of FGM brought me to the website of Equality Now, an international human rights organization “dedicated to action for the civil, political, economic, and social rights of girls and women.”  Their report on FGM was further eye opening for me on this subject.

In 1997, the U.S. Department of Health and Human Services (HHS) estimated that over 168,000 girls and women living in the U.S. have either been, or are at risk of being, subjected to FGM.  However, there is little information known on how many of these procedures have actually occurred on American soil.  In fact, even the HHS estimate is from speculations based on populations from FGM affected communities in the U.S.  There have only been a couple of reported cases of FGM in Georgia, one in 2003 and another in 2010.  The cutting can happen when girls are on vacation in their parents’ countries of origin or when circumcisers are brought into the country to cut girls, but some reports also indicate that a few doctors may be performing FGM on girls in hospitals in the U.S.  Unfortunately, the silence surrounding the issue makes it extremely difficult for girls and women who oppose the practice within communities to speak out openly against it.

The video, which unfortunately did not work in class, was a reflection of an effort to create an awareness campaign on FGM in the U.S.  The hope of such campaigns is that increased awareness and understanding will lead to greater openness on the discourse of FGM, and as a result could lead to better prevention and education regarding the practice.  The video is included in the links below if anyone is still interested in watching it!

http://www.equalitynow.org/sites/default/files/EN_FAQ_FGM_in_US.pdf

http://www.theguardian.com/society/video/2014/may/13/fgm-us-girls-american-female-genital-mutilation-video

In another one of my classes, we talked about adoption and it occurred to me that it’s quite relevant to our class. In this instance I am speaking of giving a child up for adoption right after birth. In many states, the mother is not allowed to consent to adoption for up to 72 hours. Meaning that even if a mother wants to give her child up for adoption right after birth, she cannot legally do so until three days after the baby is born. I think this is very interesting because the mother would either have to care for the child for three days and then give it up or have the child be taken care of by the state until the timer is up.

I saw this kind of like the abortion debate. Clearly different, but still a woman is being coerced by the government to take care of and keep a child she does not want. Even if a woman is sure she does not want to, or cannot afford to keep the child, caring for the child for three days could be very confusing. I’ve included a link that lists each state and when the birth mother can consent to adoption. Do you all think this is a way for the state to convince a mother to keep a child or if having a time frame is ok?

http://www.adoptionbirthmothers.com/adoption-truth/adoption-facts-faqs/adoption-laws-by-state/