What’s Not So Normal About It . . . by Nuzhat Shahzadi

A news recently caught my attention. Maternal care services are becoming a challenge in rural America as hospitals are closing maternity centers. This is like double jeopardy for women––adds to their hardship of being pregnant, and unavailability of urgently needed healthcare support. Access to available, adequate, applicable healthcare is not a concern only in developing countries––it's happening in America as well!! (See link below).
We are in the same boat, sisters!

(In 2022, maternal deaths in the United States: 22/100,000 live births).

Maternal care is not only birthing of a baby––it includes healthcare extended to women, their spouses/partners, families and babies before, during and after childbirth. Its goal is to improve the overall well-being of the mother and baby . . .

Why are women in this wealthiest nation facing maternal-care obstacles? The reasons indicated are decrease in birth rates, lack of staff and high cost of services as the government health insurance for the poor doesn't pay the health providers enough for their services.

. . . I began my career in a grassroots-NGO. My job was to develop communication materials for health workers for raising awareness among low income, semi/non-literate women residing in slums or rural Bangladesh. My first assignment was to develop a flip-chart on antenatal care.

With colleagues, I travelled in the heart of rural locations to conduct focus group discussions with women and caregivers (usually mothers in law). In those meetings I saw a wider, more complex universe––the contexts from a different lens. I learned.

We sat on mats under the jackfruit or mango trees in the summer heat, inhaling the smell of village life––cooking on the stove, grains spread out to dry, the damp-humid paddy fields, cow dung . . . hanging /open toilets. I didn't mind––it was an inevitable journey.

"Apa, do you have children? How many?" The women were curious. Some of them brought their babies.

"I do! One son––a tiny fellow." It was an icebreaker. We spoke about our children. There was so little difference––so relatable . . .

"I am hungry all the time. My mother-in-law says to eat less . . . if I eat more my baby will grow bigger . . . will create difficulty at delivery." This was the common misinformation. The incorrect knowledge handed over through generations of women.

After our focus groups, we usually tried to dispel misinformation. Sometimes the older women joined us. We had to address the inaccurate beliefs with sensitivity, some diplomacy. There was no reason to make the mothers in law look foolish to the younger women.

(In 2022, maternal deaths in Bangladesh: 156/100,000 live births; neonatal mortality: 20 deaths/1,000 live births.)

In all my duty stations, maternal health remained in my heart––up, close and personal. Pregnancy has been normalized in our societies into a mundane activity. So many times, I have heard ––childbirth is a natural thing . . . happens to all women . . .

Sorry! . . .

Pregnancy+childbirth is a venture into the unknown––it is embroiled in fear, hope, pain, love, challenges, ecstasy and peril––every step harbors a discovery. Mundaneness of this exhilarating creation-feat has possibly contributed to low or poor attention to maternal health care needs.

Afghanistan had/has high rates of maternal and infant mortality. To encourage women to access safe childbirth we built and promoted maternal waiting homes/centers. I personally oversaw this project––was involved in discussion with engineers, builders and selection and training of staff. We tried.

Maternal waiting home under construction, Herat, Western Afghanistan

 

"Our husbands make decisions." Women told me. "If they agree, we can come to the clinic."

"Mother-in-law says all her children were born at home. Why do I need to go to the hospital?" Some women voiced. Some of the pregnant ones were mere girls.

(In 2022, maternal deaths in Afghanistan: 620/per 100,000 live births; 80 of every 1,000 girls ages 15-19 gave birth in 2022).

In Kiribati, we undertook a verbal autopsy––a neonatal death review to understand what led to the catastrophe, what went wrong in the process. After all the struggles of pregnancy and childbirth why a mother lost the baby. We needed to learn, recognize and rectify the tragic mistakes.

(In 2020 maternal deaths in Kiribati: 76/100,000 live births; 40 of every 1,000 girls ages 15-19 gave birth in Kiribati in 2022).

South Sudan has the highest maternal mortality rate in the world, with 1,223 deaths per 100,000 live births.

Women die unnecessarily in pregnancy, childbirth. So do their babies.

Also . . . I can't stop thinking . . . I stress over a lot of things . . . is the 3-month-old tiny infant girl's mother still alive in Gaza? Or has her mom died in the IDF bombing? Who feeds her now? Who rocks her to sleep . . . my heartbreaks over and over and over––zillions of times.

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