Maternal mortality is not sexy enough for the media

Photo credit: Marco Vernaschi, Pulitzer Center


Sometimes being a feminist academic and living in a wealthy industrialised country can screw up your view of the world.

Seriously, hear me out.

I've spent the last few weeks, recovering from a hangover of media blitzing about homebirthing and thinking about where women's interests are really best served when it comes to birth in Australia. It's so easy for me to say (and trust me, I have been) that women should be encouraged to have alternative birthing plans outside of the hospital. At the same time, however, as I teach a university subject about a history of medicine (and I hate myself a little bit for saying this) medicine has done great things for women when it comes to birth.

Don't get me wrong. I've always harbored a healthy skepticism for biomedicine and particularly obstetrics/gynecology. But before I get inundated with a barrage of emails about how evil obstetricians are and what a bad feminist I am, I have to say that each day as I scan the daily news items looking for inspiration for the blank space in front of me, every single day I flick through stories about women dying in birth in the far reaches of the world. Sometimes I write about them and sometimes my mouse keeps moving because I have the luxury (and many of you do as well) to fast forward on from tragedy if I feel like it.

But not today.

Marco Vernaschi, an Italian photographer, started off photographing war but has since moved his focus to maternal health care, particularly in Guinea-Bissau, one of the world's most dangerous places in which to be pregnant. One in eight women die giving birth and babies often don't survive the first two days of their lives.

"Standing in the only operating room in the only medical hospital in all of Guinea-Bissau, Marco Vernaschi watched a nurse take an unsterile needle out of her pocket and, without anesthetic, suture a woman’s vagina after a difficult childbirth. The woman screamed. Mr. Vernaschi took a photograph. Moments later, she was required to walk out of the filthy room and go home."

Vernaschi is now trying to shed light on the absolutely heart wrenching stories of life and death, of both mothers and babies with his photos. As I looked through these images, of women waiting on a dirty floor to give birth, of seeing women on rusty gurneys, babies dead and waiting for burial, it makes me feel very lucky to have the opportunity to live in a country where, even though birthing options are not perfect, at least women have the hope for change.

Hospitals have never been the perfect solution to such a natural process, but living in Australia, we rarely worry about dying from unsterile needles or just from having to wait too long for medical care. Medicine still saves women from pain and death and suffering.

Look at these pictures and thank your lucky stars for your life.

Babies without mothers

Quadruplets whose mother died after childbirth — from left, Theo, Willy, Stella and Idda — live at the Berega Orphanage.

Not so long ago, I wrote about the alarming maternal mortality rate in Tanzania.

There are close to 50 million orphans in Africa--notes the New York Times , thanks to unprecedented AIDS, war and pregnancy and childbirth related deaths. In Tanzania, many of the babies abandoned because their mothers died in birth are being looked after in an innovative new orphanage programme in which teenage girls from the children's extended families live with them at the orphanage. The babies are not put up for adoption. Dr. Peter Ngatia, the director of capacity building for Amref, the African Medical and Research Foundation, a nonprofit group based in Nairobi, Kenya said "similar programs for AIDS orphans had worked well in Uganda, looking after the children until age 5 and then sending them back to their families or volunteers in their communities."

Photo credit: Béatrice de Géa for The New York Times

Tanzanian women dying in alarming numbers

What can I say. Heartbreaking. Horrifying.

13,000 deaths annually in Tanzania due to what are knows as the 3 delays: delaying going to the hospital, the time lost getting to the hospital and delays once at the hospital in getting treatment. Many hospitals have no obstetricians. Only 20% of Tanzanian women give birth in hospitals, and usually this is only if they need a caesar. Most women cannot afford to go to the hospital, instead giving birth at home or at a local clinic. Women in Africa, in general, have the highest death rate in pregnancy and birth. Nearly 536,000 women die annually. A shortage of qualified doctors has left thousands of women without help during birth. According to the New York Times:

"It is not uncommon for a woman in labor to arrive after a daylong, bone-rattling ride on the back of a bicycle or motorcycle, sometimes with the arm or leg of her unborn child already emerging from her body.

Some arrive too late. In October, a mother who had been in labor for two days died of infection. In November and December, two bled to death. Doctors say they think that more deaths probably occur outside the hospital among the many women who try to give birth at home.

A few minutes’ walk from the hospital is an orphanage that sums up the realities here: it is home to 20 children, all under 3, nearly all of whose mothers died giving birth to them."

This is unacceptable. Half a million African women do not need to die every year.

Vertical birthing in Peru

The Peruvian government is encouraging poor indigenous women to travel to birth centres to have their babies as opposed to having them at home. Too many women are dying or suffering from complications. In Peru, 185 die per 100,000 births. As a result, the birth centres are finding ways to integrate indigenous birthing practices into a medical environment, including vertical birthing, which is basically having the baby while standing up.

"Western science is unaware of the priorities and needs of women, particularly rural women, who consider childbirth a natural event and do not think changes to the traditional vertical delivery are needed," the ministry said in a small book extolling the benefits of standing during childbirth.
One photographer has documented the births of a number of Incan women in Cuzco and the images are spectacular:

Check them out: http://blogs.reuters.com/photo/2008/07/12/old-birthing-in-the-new-world/

Read more about vertical birth: http://uk.reuters.com/article/lifestyleMolt/idUKN7B38571520080711

Pregnancy and obesity: moral panic?

"Obesity is one of the "greatest threats" to women of childbearing age in the UK, experts have warned. A new report showed that more than half of women who die in pregnancy or shortly after birth are overweight or obese.
These women are putting themselves and their babies at risk of complications that could lead to death, the study warned."

The Guardian reports (again) that obese women are in essence, selfish for 1) getting pregnant 2) even attempting to give birth. Whilst there are plenty of medical studies reporting the risks inherent in obesity for both pregnant and non-pregnant women alike, I find it particularly troubling that no one bothers to report the immense health risks implicit in both the British and American maternity systems. Sure, being overweight can complicate your birth...but so can over-monitoring, unnecessary medical intervention, 'elective' caesarean and induction. Overweight women have unnecessarily been dealt the bad hand when it comes to prenatal care. It is hard enough for overweight pregnant women to find a doctor or midwife that will look after them without suggesting that they lose weight before the birth. Moreover, the idea that obese women are knowingly putting their unborn children in danger by even wanting to become mothers is offensive. In addition, what the reports fail to mention in their vague soundbites is that the 'obese' women who are at most risk are refugee and immigrant or poor women who have little access to quality maternity care. This little bit of information completely changes the timbre of the original report.

Of course women who have poor health care are going to be more at risk; obesity only compounds the risk. Obesity, on its own, does not necessarily produce a higher maternal mortality rates. If you look at the maternal morality rates among Anglo-Celtic and African-American women in the US, the disparity is astounding and the difference really comes down to prenatal health care (not the amount of weight gained). There are plenty of 'healthy' fat people in this world. Obesity is not necessarily a cause of maternal mortality; fatness is inconvenient for doctors and big women are and always will be a problem for hospitals that do not have the facilities to look after these 'special' cases.

Source: http://www.guardian.co.uk/uklatest/story/0,,-7124334,00.html
http://www.guardian.co.uk/society/2007/dec/04/health