For pregnant women in developed nations, emphasis is placed on having healthy, satisfying, gratifying and empowering birth experience. Birthing centers, unassisted births, water birth, hypnobirthing concepts roll off our tongues in casual conversation and in birthing circles.
But for women in other parts of the world, birth is a very different event. It can be a catastrophic experience plagued by ill health, hardship, complications, and even death.
The state of birthing worldwide
Worldwide, nearly 830 women die every day from pregnancy-related complications. While every life is precious, we also need to put that number in perspective by understanding that about 353,000 babies are born each day. It is also important to distinguish that according to the World Health Organization (WHO) 99% these maternal deaths are occurring in developing countries.
Many of these deaths are linked to preventable causes; lack of access to prenatal care, poor nutrition, pre existing conditions and diseases, and mismanaged complications in childbirth. The Maternal Mortality Ratio (MMR), a ratio of maternal deaths per 100,000 births, can also give us a clearer picture of what some women are facing in their respective communities. While estimated at an average of 16 for all developed nations (for example, 9 in France, 4 in Iceland, 8 in the UK) that mortality ratio increases 100 fold when analyzing the death ratio of pregnant women in Sierra Leone (1100), Chad (980), or the Central African Republic (880).
This means that for approximately every one woman that you might hear about dying during labor, or in the weeks immediately after childbirth, in a developed nation, nearly 50-100 women are dying in other less privileged communities around the globe.
Any discussion of worldwide birth issues needs to take into account the realities of birth on a global scale.The main concern of a rural woman living in internal Sindh, Pakistan is just to survive her pregnancy and postpartum period while also praying that her child will live to see his 5th birthday.
What can we learn from infant and child mortality rates?
Assessing and understanding infant and child mortality rates also gives a clearer picture of the struggles families are facing in many parts of the world.
While worldwide childhood mortality has generally decreased by 50 percent in the last half decade. However, in some areas UNICEF reports that rates have actually increased since 1990 – in countries from sub-Saharan Africa as well as in Iraq and former members of the Soviet Union. Diarrhea, malaria, neonatal infection, pneumonia, preterm delivery, or lack of oxygen at birth, remain the main causes of death for infants.
As children age, inexpensive prevention measures like mosquito netting, and easy treatments like vitamin A supplementation and oral rehydration therapy, are saving the lives of over 5 million children a year. But the main sources of the various crises, like poor nutrition, lack of clean water, and poor or non-existent sanitation, still remain to be solved in many communities
Some areas rely heavily on community health workers, like Charlotte Disukini below, to check in with families and distribute these needed simple fixes and over the counter medications as part of inexpensive home health kits. Charlotte lives in a suburb of Mbanza Ngungu, four hours from Kinshasa, capital of the Democratic Republic of the Congo (DRC).
[UNICEF Community health worker Charlotte fights child mortality in DRC.]
Hierarchy of needs
To better understand what many pregnant women are facing from a psychological perspective we have to first understand a concept coined by Abraham Maslow in his 1943 paper "A Theory of Human Motivation." Maslow's hierarchy of needs is a theory in psychology that outlines human development in relation to how well these needs are being met.
Unfortunately, many in the developing world are unable to meet even the first two crucial building blocks for personal development: physiological needs and safety. Billions of pregnant women worldwide do not have access to adequate food, water, medicines, or even shelter – all basic physiological needs for survival. This creates a suffocating worry for these women and their families.
According to the Food and Agriculture Organization (FAO) of the United Nations 795 million people were estimated to be chronically undernourished in 2012–14. Being malnourishmed in pregnancy can lead to low birth weight, preterm labor, and other more devastating conditions like obstetric fistulas – a condition all but eradicated in developed nations but still a very real problem for much of the developing world.
The inadequate life needs situation also perpetuates cutthroat societies that offer little in the form of safety and security from harm, or access to needed medical help if required. Safety and Security needs include; personal security, financial security, health and well-being, and a safety net against accidents/illness and their adverse impacts. Living in a developed society provides many of these securities, ensuring that few are turned away from emergency services and other help. However, in many developing, or war-ravaged societies these assurances do not exist.
What can we do?
One of the first steps towards adequately addressing these issues involves setting up community support networks to make medical advice and care more readily available. The United Nations News Center recently reported that more people have access to cellphones than toilets. This is a disheartening thought when it comes to sanitation, but welcome when it comes to mobile health programs that are utilizing the power of these abundant cell phones to connect families in need with the care providers that can help them.
We each also have a responsibility to educate ourselves on critical issues – It is essential that we brainstorm ways to help impoverished communities, while also helping our own local communities as well (if we don’t happen to be living in the thick of it). No matter where we live there are women who will be immensely helped by compassionate, knowledgeable, and timely care. Being well-educated ourselves means that we are better prepared to offer help to others who need it, and spread beneficial information into the communities in need.
Work must move towards fulfilling basic human needs, which will in turn reduce and eliminate other costly health crises. The good news is that many health issues are quite inexpensive to solve. Home health kits cost only a few dollars to disburse to families in need. One new water well can cost from USD$100-$200 and provide clean fresh water to entire communities. Campaigns like End7 (and the treatments they provide) cost only 50 cents to treat and protect one individual for an entire year. The solutions are simple and subsidized. This makes it easy for individuals to fund and participate in helping others live healthy, fulfilling, lives - and contribute to building up their respective societies.
Lastly, as professional birth workers we need to make their messages of hope and empowerment relatable to the women that need them most. Language needs to be compassionate and understanding of the unique needs facing many pregnant women in the developing world – taking their devastating situations into account before offering routine advice. Efforts also need to be concentrated on addressing the base issues and needs before attempting to explain concepts that speak to a higher state of being.
With compassion, understanding, knowledge sharing, and most importantly, action, we can work to end the trials of pregnant women in developing nations and help them see birth for the powerful and transforming experience all women deserve.