Reproduction & women s health issues Readings: McElroy & Townsend Chapter 6 (pages 218-263) 263) The Cost of Childbirth Culture, Scarcity, and Maternal Thinking: Maternal Detachment and Infant Survival in a Brazilian Shantytown
Reproduction & Women s Health Issues Like other life processes, conception, pregnancy and birth are rooted in biology but patterned by culture. Cultural expectations during pregnancy vary. (McElroy & Townsend p218). Cultural expectations surrounding pregnancy & childbirth vary widely, as 3 birth stories from Southern Africa, Mexico, & Russia illustrate. Alba Casama gives a demonstration of the traditional Embera birthing method relying upon help of a partera, or midwife Women s UN Report Network Panama: Pregnancy & Birthing Traditions of the EmberaPeople of Panama
Reproduction & Women s Health Issues McElroy & Townsend cite tendency in Western biomedicine to medicalize & pathologize physiological processes such as: Pregnancy (page 226-230) childbirth (page 234-236) breastfeeding (page 206-209) menopause (page 236-237). One World Birth MicroBirth Indiegogo Campaign http://www.indiegogo.com/projects/microbirth http://www.oneworldbirth.net/
Malawi How secret mothers make childbirth safer By law, women in Malawi must give birth in hospital or medical clinic if they fail to do so, the village chief can fine them. In 2006, the country launched a series of measures to make motherhood safer Since then rate of maternal death has declined from 840 deaths per 100,000 births in 2000, to 460 per 100,000 in 2010, according to the World Health Organization. MamaYe
Men perform a traditional 'nsindo' dance, while singing about the importance of giving birth in a hospital. This group has written several songs about safe motherhood and performs them in villages around central Malawi. Chief Kwataine (left) spends much of his time speaking with other traditional leaders about the importance of secret mothers. He is assisted by Timothy Bonyonga (right), the community mobilization coordinator for Malawi s Safe Motherhood Initiative. Georgina Paul walked for more than two hours to give birth at this rural medical clinic run by the Christian Health Association of Malawi. She arrived three weeks before her due date and stayed in a maternity waiting home at the clinic. Sister Masoya, who oversees the delivery room at this rural medical clinic, is trained as a midwife. She says she and the other nurses have seen fewer complicated deliveries since Malawi's Safe Motherhood Initiative began in 2006.
Peru: The Waiting Home To prevent women from giving birth at home, where they face a higher risk of death, Peru has established a network of maternal "waiting houses." These residential facilities host women during their final weeks of pregnancy so they can give birth in the presence of skilled attendants. Ana MaríaBolege, 21, has come to a waiting house in the Andean town of Ayacucho, eight hours by road from Peru's capital, Lima.
Reproduction & Women s Health Issues Reproductive health has both biological & cultural aspects. Wide variety of issues concerning women: Obstetric practice in childbirth & risk of maternal mortality. Video: Birth of a Surgeon Video: Ghana: Midwives Deliver Cultural beliefs about menstruation & health, diet, infertility, abortion, contraception, menopause.
Childbirth in developing world In lesser developed countries complications of pregnancy & childbirth are leading causes of death & disability among women of reproductive age (15-44). ~ half of 120 million women giving birth each year experience some complications during pregnancies. Between 15-20 million develop disabilities such as severe anemia, incontinence, damage to reproductive organs or nervous system, chronic pain, & infertility. Dead Women Walking
Dead Women Walking Many women with obstetric fistulas suffer social stigmatization for years, sometimes decades. But they can get their lives back with a relatively simple surgery. After surgery, the women stay for at least two weeks to recover. During that time they learn new skills, like crocheting. 18 women are selected each year to stay in Dar es Salaam to be trained in sewing, printing & jewelry-making. The Mabinti Training Center also teaches English & run a small business.
Every day, approximately 800 women die from preventable causes related to pregnancy & childbirth. In 2010, 287, 000 women died during & following pregnancy & childbirth. 99% of all maternal deaths occur in developing countries. Maternal mortality is higher in rural areas & among poorer communities. Adolescents face higher risk of complications & death than older women. Skilled care before, during & after childbirth can save lives of women & newborn babies. Between 1990 & 2010, maternal mortality worldwide dropped by almost 50%. Key Facts
Maternal mortality ratio (per 100,000 live births)
Reproduction & Women s Health Issues McElroy & Townsend discuss the speciesspecific reproductive patterns of humans: Loss of estrus cycle; replacement with menstrual cycles. Encephalization brain size & complexity. Bipedalism and fetal head size rhesus monkey brain is 75% of adult size at birth human infant s brain is only 25% of adult size at birth Narrow range of birth weights A fetus over 9 pounds is difficult to deliver. An infant born under 5 pounds will need neonatal intensive care.
Species-specific reproductive patterns Human infants are born neurologically immature & helpless. Low reproduction rates K selection emphasis on quality over quantity; prolonged & intense parental care; high investment in each individual offspring. R selection large numbers at high rate over short periods of time; very little parental investment in individual offspring.
Reproduction & Women s Health Issues Fecundity refers to potential reproduction Female s physical ability to become pregnant or male s ability to produce viable sperm. Usually high in young, healthy adults. Disease and malnutrition can reduce fecundity dramatically. Fertility actual reproduction, giving birth to live offspring, in absence of deliberate birth control or abortion. Measurement of fertility Crude birth rate = # of live births per 1000 people per year. Total fertility rate = # of children a woman would bear at prevailing fertility rates if she would survive to end of her childbearing years (~45). Average completed fertility = average # of live births in a cohort of women.
Reproduction & Women s Health Issues Factors affecting fecundity and fertility: Length of reproductive span Delayed menarche reduces length. Nutrition /food intake. Women s productive roles and physical work entailed. Seasonal stress affecting workload and/or food availability. Contraception/abortion Modern options birth control pills, IUD, amniocentisis. More traditional practices, Post partum sexual taboos Extended breastfeeding (in women who are less well nourished nursing may stimulate production of prolactin, hormone that promotes milk production and inhibits ovulation).
Reproduction & Women s Health Issues Average gestation period of about 270 days, 38-42 weeks. First trimester (90 days) is most critical. Risks stem from: Poor maternal nutrition Tobacco usage undersized placenta leads to low birthweight and premature birth. Alcohol consumption Fetal Alcohol Spectrum Disorders Drug usage Pregnancy sickness &cravings Pica compulsive eating of nonfood substances, such as clay. Craving Earth' book talk by Sera Young
Reproduction & Women s Health Issues Post-partum depression Could be partly related to fatigue caused by lack of sleep? Co-sleeping does not accord with our values but is common in other societies. Allows for easier nursing and less sleep disruption and may significantly decrease risk of Sudden Infant Death Syndrome. Maternal bonding/attachment not unusual for there to be a period of indifference toward infant. http://www.postpartum.net/
Culture, Scarcity and Maternal Thinking: Maternal Detachment and Infant Survival in A Brazilian Shantytown Nancy Scheper Hughes A critique of models of maternal bonding based on ideas of psychobiological innateness and/or universal emotion Uncritically derived from assumptions & values implicit in structure of modern, western bourgeois family. Need a more contextualized model of maternal thinking & sentiments. Ethnographic research in Northeast Brazilian shantytowns. Heart of the Third World in Brazil. 72 women, 686 pregnancies, 251 childhood deaths.
Culture, Scarcity and Maternal Thinking: Maternal Detachment and Infant Survival in A Brazilian Shantytown Nancy Scheper Hughes Infant and childhood mortality in developing world is a problem of political economy, not of medical technology. Alternative model of maternal thinking give birth to many children, invest selectively based on culturally derived favored characteristics & hope that a few survive infancy & early years of life. Scheper-Hughes argues that maternal thinking & practices are socially produced rather than determined by a psychobiological script or universal emotions.