Safe Motherhood in a Globalized World

Barbara Wejnert, Suzanne K. Steinmetz, Nirupama Prakash, Barbara Wejnert, Suzanne K. Steinmetz, Nirupama Prakash

• Publisher: Taylor & Francis
• Year: 2013
• Print ISBN: 9780415488167
• eBook ISBN: 9781317989813
• Edition: 1
• Topic: Social Sciences
• Subtopic: Gender Studies
• Index: Social Sciences

This book provides cutting edge information on safe motherhood in a global context. The chapters focus on research, program development and implementation, and policy dealing with various aspects of pregnancy, labor and delivery. Safe motherhood is a critical issue since healthy, safe motherhood is the prerequisite for a healthy, productive society. Writing about the situation in their countries, the authors are from Eastern Europe, America, Asia and Africa and are academic scholars and health practitioners. The book is multidisciplinary with scholars from sociology, gender studies, economics, social policy, social geography, population management and political science. Topics include lactation policy and misunderstandings of lactations in African countries and in the United States; postnatal stress disorder that is either understudied or not considered as a problem in many developing countries; potential causes of a decline of maternal health in democratizing states; the effect of geographical environment on reproductive health; and revelation of mysteries of consequences of pre-birth pain in the early life of children. Case studies provide examples of successful model programs. Solutions offered are based on utilizing available resources and technology in ways that maximize education and training of local health professionals and family members.

This book was published as a special issue of Marriage and Family Review.

GENERAL CONCEPTS OF SAFE MOTHERHOOD IN RELATION TO GLOBALIZATION

Conceptual Framework for Integrating Holistic Perspectives and Approaches to Problems of Safe Motherhood

Barbara Wejnert
Suzanne K. Steinmetz
Nirupama Prakash

INTRODUCTION

This collection, edited by Barbara Wejnert, Suzanne Steinmetz, and Nirupama Prakash, examines safe motherhood in a globalized world. The collection is divided into four parts. The first part contains eight articles and examines the impact of globalization on safe motherhood. The second part presents four articles on case studies, the third part, consisting of six articles, examines strategies and policies needed from the practitioners view and the fourth part discusses program and policy recommendations.

The issue of safe motherhood is interconnected with all aspects of human life, with individual abilities and capacities to develop physically, psychologically and intellectually. Women’s health is necessary for social and economic growth not only to reduce gender disparities, but also because mothers’ health cannot be separated from the health of children throughout their lives. This article provides the foundation for an examination of a variety of macro-level factors that impact women’s health in general as well as how it affects motherhood. The first section, Concept of Maternal Health in Relation to Globalization, reviews the effects of global democracy, strategic messaging, cultural influences on lactation, public–private partnerships for improving maternal health, consequences of pain in early life, and prenatal care.

CONCEPTUALIZATION OF MATERNAL HEALTH ISSUES

The Millennium Development Goals provide a shared vision of a much improved world by 2015, where extreme poverty is cut in half, child and maternal mortality is greatly reduced, gender disparities in primary and secondary education are eliminated, women are more empowered, and health and environmental indicators are improved. The last few years have seen a change in the concept of development that now encompasses health, social, political, technological, economic, and human growth and not merely economic growth. In the midst of all the spectacular progress in development, we are faced with many conflicts and challenges that need to be addressed.

Only minimal efforts have been made to directly integrate health concerns as a priority into development processes. The interface between health, technology, and wider society can play a pivotal role in enhancing the quality of life of all people. The relationship between health and development has undergone renewed scrutiny. There is an ongoing search for new models to deal with global threats, soaring medical costs, technological costs, gender disparity, poverty, and disease. Technological innovations offer unique opportunities for partnerships between health and development sectors to change the pattern of work and enhance health-promoting habits.

A study conducted by The World Bank on “Development in Practice, Improving Women’s Health in India” has pointed out that investing in women’s health is now being recognized as an essential component of social and economic growth. The benefits of investments in women’s health can be argued on several grounds, such as equity and human rights and existing gender disparity and multiple benefits of women’s improved health, such as the impact of the mother’s health on her offspring and cost-effectiveness of reproductive health interventions. It is essential to view the health of women in a holistic way within the social, economic, and political context of their lives. The health of a country’s female population ensures health and education of the next generation and the economic well-being of households.

Research and experience from several countries have shown that most maternal deaths occur in the postpartum period and more than half within a day of delivery. However, a skilled attendant at every birth is the single critical factor that could save many lives. Unfortunately, the National Family Health Survey conducted in 1998–1999 in India found that only 14.8% of pregnant women delivered at a health facility, whereas the rest did so at home.

It has been argued that maternal deaths could be reduced by addressing health factors alone. Emergency care services, including transport, regular visits by nurses, trained attendants, safe abortion services, and postnatal care, can make a huge difference. Half the girls in Rajasthan (India) conceive at an average of 17.6 years. Almost half of Nepalese women are married and have children before they are 18 years old, whereas in Hindu communities early marriages before menstruation (girls aged 13–14) are the most preferred. A girl conceiving before her 18th birthday has a 2.5-fold higher chance of dying than one over 18. As reported in Time of India on April 3, 2006, most young females are undernourished, anemic, and cannot sustain healthy pregnancies. The health of women throughout the world is impacted by social, cultural, and economic variables. Most women still lack decision-making power at family and community levels and do not have control over resources. They ultimately lack control over their reproductive rights, which leads to higher maternal mortality rates.

There is an urgent need to understand various issues concerning maternal health and consequently to alert policy, institutional, and peoples’ initiatives at various levels worldwide to ensure sustainable, equitable, and just development for women and their families. This situation needs the urgent attention of academicians, medical professionals, women’s studies centers, social scientists, nongovernmental organizations (NGOs), administrators and policymakers, national governments, the United Nations, and other international agencies.

For the purpose of this book, maternal health issues were grouped into the three thematic areas shown in Table 1. There are also other possible categorizations and approaches to safe motherhood that this volume was unable to cover. Not all issues listed in Table 1 are discussed at length in this book. Rather, we have tried to cover the most important ones in each of the categories in Table 1 that are less frequently addressed or that need urgent attention.

TABLE 1. Maternal Health Issues by Thematic Area

Thematic Area	Maternal Health Issues
Maternal health in relation to globalization	Influences on maternal health: diffusing democracy and market economy, global communication system, local vs. global culture including Western biases, global development, technological innovations
Exemplification of maternal health problems in case studies	Cross-world practicing of unsafe motherhood: transitional societies, developing peripheries, postindustrial modern countries, totalitarian and democratic regimes
Reports from research and practice	Medical professionals and practitioners remediation

Maternal Health in Relation to Globalization

Beginning with a general analysis of the processes of worldwide democratization and their effects on maternal health, this book offers many concrete suggestions and recommendations that could accelerate the process of safe motherhood, understood as holistic, affordable health for women and their families based on an application of appropriate measures and technology. The chapter on worldwide democratization addresses the needed revisiting of the processes of diffusing democratization. It answers an important issue of democratic diffusion and its effect on protecting mothers and newborn children, arguing that diffusing democracy is costly to safe motherhood. It also indicates that implementation of gender equality exemplified by safe motherhood could reverse the trends reported by the UN Commission on the Status of Women (Morgan, 1984). These trends indicate that although women represent half of the global population, one-third of the labor force, they perform 60% to 80% of all agricultural work in the world and in the developing countries, produce more than 50% of the food (in African countries over 90%), and constitute the majority of 22 million people that die yearly from starvation, malnutrition, and lack of medical care.

In her article “Effects of Global Democracy on Women’s Reproductive Health: 1970–2005, Cross-World Analysis,” Barbara Wejnert raises the possibility that there are costs as well as benefits associated with democratization. She notes that because developing societies are often experiencing transitions in the degree of democratization at a given point in time, measurement of women’s health is problematic. Using information from a large number of databanks, Wejnert examined how levels of democratization and global economic development can impact women’s health and society’s well-being. She found that during the initial stages of global democratization and a move to a global capitalist economy, the economic difficulties that occurred resulted in changes in policies and a reallocation of resources that were often detrimental to women’s health.

Following the discourse on democratization, the article on communication strategies addresses a need for more adequate and appropriate information regarding maternal health. As the article argues, accurate strategic messaging at the national as well as global level could enable planners and policymakers to take appropriate action in relation to population and sustainable development. At the most basic level, more adequate and appropriate information concerning maternal health is conducive to informed, responsible decision-making concerning sexual and reproductive behavior, family planning and family life, and the protected, healthy, and safe lives of mothers and children.

Santosh Vijaykumar in “Communicating Safe Motherhood: Strategic Messaging in a Globalized World” notes three forms of behavior change communication: entertainment education, social marketing, and advocacy. The author reviews the theories that form the foundation for these strategies and provides case material to illustrate success stories. A particularly successful example discussed consisted of a television serial about a young woman whose adventures helped the audience accept more gender-neutral attitudes regarding women’s health, reproductive choices, and work options.

Most health care professionals agree that breast-feeding is preferable for infants, but there is widespread disagreement about how long a baby should be nursed or whether a baby should be nursed if the mother has serious health problems (e.g., is HIV positive). In some cases ignorance and a lack of scientific information result in policies (both formal and informal) that negatively impact breast-feeding, whereas in other cases cultural or social norms drive policy decisions. Three examples of policies that impact breast-feeding negatively are discussed, focusing on correct information about human physiology and human sexual response as critical not only in developing lactation policies that are appropriate and effective, but also in preventing ill-informed decisions that impact negatively on the lives of people worldwide.

The importance of appropriate communication is found in “Impact of Culture on Lactations Policies: The Case of the United States and Liberia,” an article by Andrea Parrot. Parrot notes that breast-feeding advice given to HIV-positive mothers differs in developed versus developing nations. In developed nations, formula prepared with safe water and refrigeration reduces the likelihood of death from HIV-positive mothers. However, in developing nations without adequate resources, the likelihood of the baby dying from HIV contracted during nursing is far less than death from infections and diarrhea leading to dehydration and malnutrition. In addition, Parrot examines an issue of cultural misinterpretation of lactation policies that frequently overlap HIV concerns. Using an example in the United States, a country sensitive to problems of sexual abuse of children, she presents a case study of a mother who lost her child when she requested information on sexual arousal during breast-feeding. Instead of reassuring the women that this was a natural occurrence, it was reported to the authorities as a form of sexual abuse. The author also described a situation where an American health care practitioner working in Nigerian villages provided a lecture to the males in a biology class in which she explained that sexual intercourse with their wife was safe a few months after delivery. This information was not provided to the women, who continued to believe that semen would poison the milk and worried after the safety of their infants.

The concept of public and private partnership (PPP) raises attention and hope from development agencies, governments, and communities as an alternative strategy in service delivery. It is increasingly promoted as a panacea to build and capitalize on the tangible and intangible assets inherent in social organizations and communities, individually and collectively.

Marieme Lo, in her article “Public–Private Partnership for Maternal Health in Africa: Prospects and Challenges,” states that many African countries are faced with decentralization challenges, growing retrenchment from the state, and scarcity of financial and human resources in the health sector that call for innovative approaches and sustainable solutions to pervasive deficits in health and social service delivery. Drawing from empirical field research conducted in Senegal and Mali, Lo discusses the importance of public–private partnerships in providing equity in health care delivery in developing countries. Although there are strong cultural values assigned to motherhood, resources are not made available to women. The author notes a number of success stories in which indigenous women have pooled their resources and former residents who have migrated to developed nation sent money to those back home, enabling the establishment of health clinics. The author reminds us that communities receiving assistance should have a strong voice in decision-making and that standard indicators of wealth are not sufficient because they do not take into account local knowledge and health care practices, which are valuable resources.

The last three articles discuss various medical innovations and research findings that facilitate better understanding of women’s reproductive health but which are not always recognized, or acknowledged, by policymakers as emerging issues in the thematic area of safe motherhood. “Consequences of Pain in Early Life and Its Remedy: Maternal Responsibility,” by Manasi Bhattacharjee, Suman Jain, and Rashmi Mathur, explains how neonatal pain can have later childhood consequences on development and behavior. Therefore it is pertinent to minimize pain if it is unavoidable in early life. The authors note that sucrose is an effective short-term p...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• CONTENTS
• Note from the Editor
• GENERAL CONCEPTS OF SAFE MOTHERHOOD IN RELATION TO GLOBALIZATION
• CASE STUDIES
• REPORTS: PRACTITIONERS’ VIEW
• CONCLUSIONS AND POLICY RECOMMENDATIONS
• Index