Motherhood, It's Complicated

A colleague on maternity leave recently sent an e-mail saying what an incredible experience pregnancy is and how she can't help thinking of the millions of women who go through it without the support we take for granted in the U.S. "Here I am focusing on tummy time and music groups; talk about perspective when you consider that more than half a million women die every year during pregnancy and childbirth because they don't have access to the simplest of health services and supplies."

I had a similar moment of awareness after the birth of my daughter in 2007. I enjoyed a relatively easy pregnancy until my 32nd week when I was diagnosed with preeclampsia (a dangerous condition related to high blood pressure that is one of the top causes of maternal death worldwide). I was monitored accordingly and induced at 36 weeks. A friend asked if I had been administered magnesium sulfate, a compound used to treat preeclampsia. I was not, but her question reminded me how complicated maternal health supplies issues can be.

For 10 years Population Action International (PAI) has been at the forefront of the Reproductive Health Supplies Coalition, a global partnership working to ensure that all people in low- and middle-income countries can access and use affordable, high-quality supplies to meet their reproductive health needs. And while PAI has long recognized the role of family planning in improving maternal health, a specific focus on maternal health supplies emerged in 2009, when PAI partnered with the Maternal Health Task Force. The Task Force asked us to explore who was taking up the issue of maternal health supplies and if PAI could share lessons learned from our reproductive health supplies experience.

Our maternal health research is currently underway, starting with two country case studies in Bangladesh and Uganda. What we have already learned is humbling:

• Unlike family planning, there is very little direct donor funding for maternal health supplies. The shift to broader health sector and direct budget support, as well as financing from national governments' own resources, means maternal health issues can fall prey to other priorities in a budget process.

• Women and their families are often expected to pay out of pocket for essential maternal health medicines, such as oxytocin for post-partum hemorrhage, even when government facilities are supposed to provide free health care. This adds another obstacle for poor women in efforts to ensure safe delivery.

• No coordinated system exists for maternal health supplies in many countries and they are often not integrated into supply systems for other drugs, such as for family planning or newborn and child health.

• Furthermore, human resource issues -- having staff positions filled, ensuring providers are trained, and particularly being able to improve maternal health at the community level for the women who deliver at home -- are a tremendous challenge. Ensuring sufficient access to supplies alone is not enough when a health system is broken.

It is no wonder that Millennium Development Goal 5 -- improving maternal health-- is the most off track of all the millennium development goals.

These early findings remind me of the truth of my colleague's e-mail -- how much we take for granted. I am expecting my second child in June and it is not lost on me that access to family planning services and supplies has allowed me to delay childbearing until desired, and afforded our family the chance for proper birth spacing. It's more than the miracle of the pill. It's the fact that I can find the pill, afford it, and switch between brands to find one that suits me best. These facts form part of my daily motivation to mentally and emotionally connect to the real lives of the women and families. Over the long term, we at PAI are looking to achieve the Millennium Development Goal on maternal health, and adequate supplies are critical for this to happen.

 

Follow Suzanne Ehlers on Twitter: www.twitter.com/popact

Comments

[DJMWT]

02:02 PM on 02/20/2010

While the need for better access to medicine, family planning and maternity care is real and urgent, Americans should not rush to export our culture of birth. Women in America need to take a serious look at the consequences and effects of the medical model that dominate prenatal and labor "care", before deciding they have the solution. We are not meeting many of the World Health Organization's standards and recommendations for maternal and infant health care.

I have been shocked to compare the differences between the care, respect and education I am receiving while being pregnant in Canada with the intervention and fear-mongering my pregnant American friends are receiving. Medical innovation and intervention has an important place in birth, but until America is more responsible with their use at home, we should be wary of arrogantly exporting our bad practices.

[faithnj]

09:27 PM on 02/19/2010

I had a special, maternal-fetal medical group help me through my first unplanned and surprising pregnancy at 39. (No, I didn't delay childbirth on purpose. I had been married 15 years, and had a long period of "unexplained infertility", that resolved itself for reasons unknown.) With my second unplanned and equally surprising pregnancy at 41, I had a regular OB/Gyn group. There was no comparison between the care I received with the special group, and the care I received with the "regular' group. I had pre-eclampsia with both pregnancies. The specialized group caught and resolved 3 serious problems after I gave birth, and I was monitored in a special antenatal care unit for 7 days after birth. The second group never took my complaints seriously. Despite my rise in blood pressure, they let me go home after 5 days. The next morning my BP went through the roof, and I spent the following six days hospitalized in a cardiac care unit, where doctors fought to bring my BP down from the 200's/100's.

I said all that just to say that I agree with the person who said we Americans don't get as much health care as we sometimes think we are getting. The quality of care varies greatly, and you certainly don't always get what you pay for.

[singermuse]

10:26 AM on 02/19/2010

What's ironic about this article, is that women in the US do not get nearly the support and quality of care that women in Europe get. They get comprehensive reproductive services including contraception, maternity leave for BOTH parents, a doula if needed, child care, well baby care, and all because THEY have single payer health care systems....the mortality rate in the US is much higher than in western Europe.

[Cherie King]

09:22 PM on 02/19/2010

i agree with you. Women in the US may get basics at a bare minimum, barely nothing while single anyways, married maybe more maybe not. as I have said and keep repeating is that Family Values is just a PowerPoint Presentation in this country. I think at minimum we should get 1 year of paid leave sort of like short-term disability, as not everyone can get childcare after a few weeks. Welfare is NOT what we should be reduced to, but that seems to be all that gets offered. if you are married but uninsured, you likely do not qualify for Medicaid to cover prenatal care and delivery. Welfare is a locked in system that holds women back and keeps them in poverty.

[MamaBird62]

12:04 AM on 02/21/2010

It's hard to see how we can focus on differences between infant mortality rates in the US v. western Europe (5 v 4 per thousand, something like that) when in African nations the rates are between one and two hundred deaths per thousand. We could take steps to help more babies (and mothers) stay alive. We have the resources and the knowledge, we need to send it to the right places.

[wietog8]

04:50 PM on 02/18/2010

While it really important to support women in pregnancy the true goal has GOT to be education and birth control.