Maternal Mortality Final Paper

Introduction

                For many years maternal mortality has been a global health concern. Evidence to support this is in the World Health Organization (WHO) reported in their World Health Statistics 2012. This topic has also appeared in the Global Health Watch 3 (GHW3) report presenting the statistics and concerns for maternal mortality. The views in which these two articles present and address this issue are with the obvious causation's of child mortality.  This could be in the range of economic issues to political issues that affect maternal mortality. Global Health Watch 3 does report the need in social aspects leading to maternal mortality but aren't addressed in description. From an anthropological view there are more underlying issues in maternal mortality. This is exemplified in Cameron M. Hay’s article, Dying Mothers: Maternal mortality in Indonesia. In his twenty months of studying the Indonesian people he witnessed two maternal deaths where the mother and child died during or shortly after birth. Through attending and observing these two similar yet different events, Hay concluded using anthropological logic that maternal mortality deals with a great amount of cultural and social aspects. I definitely would have to agree with the major aspects presented by WHO and the GHW3 that maternal mortality is caused by things such as expenses, availability of health clinics etc. On the other hand with the anthropological knowledge that I have gained I realize some of the biggest contributors to maternal mortality are social cultural aspects not largely focused on by these two statistical articles.

Background Knowledge and Statistics from WHO and Global Watch 3

                For many years there have been different approaches and there still are different approaches in trying to improve the maternal mortality rates around the world. It is estimated that about 500,000 women die each year in pregnancy, 3 million newborns die each year, and 4 million stillbirths.(Global Health Watch 3 124) WHO presents this data and it is used in various academic and statistical articles. WHO even has its own definition of what maternal mortality is as  “the death of a women while being pregnant or within 42 days of termination of pregnancy or from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes” (Global Health Watch 3 124). It is clear that most of global maternal deaths occur in developing countries in fact a whopping 99 percent of maternal deaths occur in developing countries. Some countries that are big contributors to maternal mortality are Sub-Saharan African countries such as Angola, Burundi, Cameroon, and Chad just to name a few. (GHW3, 124) There are many different causes to maternal mortality and every situation obviously can have very different causes of death. But in classifying the main causes of maternal mortality WHO and Global Health Watch 3 concluded in three main causes to maternal mortality. The first one is very evident and that is medical conditions such as malaria and anemia. These exist especially in developing countries and are most likely global issues themselves. The second cause is the economic and political systems that result in the lack of “availability, acceptability, and quality of reproductive health care services” (GHW3, 124). Lastly they do present that socio-legal conditions is one of the main three causes in maternal mortality. As stated before WHO addresses this issue more in the context of availability of money, health clinics, health systems, health professionals etc.

Cameron Hay’s Anthropological Research in Indonesia

                In Dying Mothers: Maternal Mortality in Rural Indonesia, Hay’s research addresses all of the aspects and issues that WHO and GHW 3 address as well. Hay clearly addresses the obvious contributors of maternal mortality which include: no accessibility to birth control, lack of safe abortion alternatives, access to biomedical care, bad use of biomedical facilities, poorly trained midwives, lack of equipment in medical facilities and many more. (Hay 1-2) But Hay also presents that from previous studies “anthropologists have shown that human reproduction is a cultural event, dependent on social relationships and cultural meaning”. (3) Hay uses a lot of outside sources to compare and contrasts reasons contributing to maternal mortality to support his conclusion.  His main points in this article are derived from his studies and witness of two pregnant women who ended up dying along with their child. In order for you to understand not only Hay’s conclusion along with my own, I will have to briefly describe each of the two cases in which our conclusions were derived from.

The first case involved a Sasak women of Indonesia named Inaq Hin who lived in the town Pelocok. Due to the little accessibility to a hospital which was distant as well as the non-paved roads, many Pelocok women delivered babies at home with midwives. This was the norm for them. In this case Inaq Hin had a well-known and experienced midwife; Inaq Isa who helped her deliver her baby. Inaq Han delivered the baby fine, but the problem occurred when the placenta did not come out. The midwife tried and tried along with Hay who was called in to help but there was no progress. Inaq Hin eventually died. Around town and between the villagers it was said that the cause of her death was due to “fate”. It was Inaq Hin’s bad fate to die because her husband’s mother had died not long before her pregnancy, this was her eighth child and she had had previous still births. No one was to blame for her death. Not the midwife. Not Hay. The cause of death was fate. The child died a few weeks later as well, and not surprisingly his cause of death followed in the steps of his mother as the cause of fate. (Hay)

The second case involved Inaq Marni. Unlike in Inaq Hin’s situation there was now a childbirth post recently built nearby that had been opened for a month, and the roads were now paved. She did not use the facility for her birthing but instead chose to use a midwife Inaq Hapim who completed the government training in proper delivery in homes. As Inaq Marni went into labor she had the help of Inaq Hapim. The baby was delivered and died after birth. The placenta had not come out either so the villagers and the midwife took Inaq Marni to the childbirth post. There the nurse Rini had found out that the mother in fact was still in labor because she was having twins. She eventually delivered the baby, but the baby was very undeveloped and deformed. Later the mother and child died. The cause of death in this case was due to the inexperienced midwife who “only” completed the government training. Rini was also to blame for not using traditional birthing processes. (Hay)

Through these two events Hay grasped an understanding that otherwise wouldn't have been easy to retrieve. I say this because through observation and interaction in a real life situation as a lot of anthropologist do, Hay found that there is a huge role of cultural and social aspects that contribute to maternal mortality. In comparison, although WHO addressed in both articles that there is a social issue that comes into play with maternal mortality the main ways in addressing the global health issue was dealt more with corporations, groups of people that can provide assistance, NGO’s that can built clinics in developing countries etc. From an anthropologist perspective Hay found that in fact it is much more than these.

Examining Hay’s Observations and Conclusions

In both cases various social cultural aspects played a role in the two deaths as well as how the death was interpreted. A way to explain this is demonstrated with the explanatory model defined as “each person’s or social groups understanding of a health condition, in terms of its definition, etiology, causes, onset, symptoms, pathophysiology, course and treatment” (Ceron Lecture WK 4) An example of this that Hay presents is in the two different midwives in the two different situations. In Inaq Hin’s case, the etiology differed in that the midwife was not to blame at all, but Inaq Marni’s midwife was blamed for her death. The Sasak people believe that experience over education/training is greater and more reliable. Inaq Isa was well known and called upon for many deliveries because she had had children of her own and most importantly had delivered many live babies in her time as a midwife. This made her a reliable and trustworthy midwife. On the other hand Isa Hapin who was ill experienced because she had not delivered many babies and only known for her completion in the government training on safe and proper delivery. Even though she had this knowledge this meant so much less than the experience of Inaq Isa. She was only called upon to deliver a baby when no other midwife was available. This is the Sasak people’s “understanding of a health condition” because trust in a midwife has evolved from experience since to begin with there is a lack in education.

This point transitions to a topic that we learned in class this quarter about knowledge. “Knowledge is situated knowledge” (Haraway). As Professor Ceron put it, “knowledge comes from a specific context… knowledge has meaning depending on context”. The knowledge through experience was much more important to the Sasak people than actual knowledge. The Sasak people are uneducated due to many reasons beyond this topic, but they don’t know the importance of knowledge. Therefore even if a new yet educated trained doctor were to unsuccessfully deliver a baby the etiology of death is the doctor.

It can be said in Inaq Hin’s death that the cause was the unavailability of a nearby health clinic and trained professionals around. In contrast in the case of Inaq Marni, even though the nurse at the childbirth clinic had told her to come to her when it was time to deliver a week before her actual delivery, she did not. Her reasons were that she didn’t have the money and didn’t want to be in debt. Money is a clear issue for the Sasak people with the poor economy, which is clearly a contributor to the maternal mortality rates. This is not only in Indonesia but other developing countries as well. Even when rushed into the childbirth clinic Iniq Marni kept repeating that she wanted to go home. 

Hay perfectly exemplified anthropological thinking when he turned the typical issue of money into the view of an anthropologist in his statement, “it was less a matter of money than of fear” (Hay 20). It is out of the normality for the Sasak people had never had a childbirth clinic to use it. Even in everyday things such as trying a new restaurant I rarely will ever just walk into a new restaurant. A lot of it comes down to trust. I don’t have trust the food and service in this unfamiliar restaurant will be good. In a sense this is the same reason Inaq Marni wanted to leave and not come to the clinic in the first place. She had little trust in the people and the place which are great reasons for her to be uncomfortable. A lot of this comes down to perception as discussed in class. Perceptions can be shaped by many things one in which is culture. The Sasak’s perception of biomedicine’s safe or correct way to give birth is out of their normality. Our perception of giving birth at home is abnormal because it isn’t done every day, it is not our norm. Even though in the United States home births with nurses are being practiced more, still many people are skeptical because it is so out of the ordinary. This ties back into knowledge as well in which I addressed previously. The lack of knowledge in something creates the imbalance in trust in someone or something.

The Effect of Anthropology on My Views

In my understanding of medical anthropology I have not only applied it to this global health issue but to my everyday life, new, and old information that I am given. In this topic of maternal mortality before taking medical anthropology and reading this article I would be a lot more oblivious to social and cultural concepts in any sort of global health problem. I would definitely think practically and infer the causes are mainly due to the lack of health care and supplies which relates to the economy, the political issues in a country, or the environment such as paved roads, and accessibility just to name a few. Now I can think conceptually to understand that there are definitely a lot more underlying reasons which sometimes I personally think are even more of a problem than the ones I have listed above. I enjoyed Hay’s article a lot because I have a very strong agreement with his conclusions. I have definitely stressed this in my other assignments in this class because I truly think that education on both ends of the spectrum are needed to come to a consensus on the most proper medical procedures for the patient. We addressed this in class with in the concept of episteme which is defined as the “configuration of knowledge in a particular episteme is based on a set of fundamental assumptions that are so basic to the episteme so as to be invisible to people operating it” (Wikipedia). The way I interpret this is in the example of Inaq Hin’s death. It was would seem that the death of Inaq Hin was due to biomedical reasons a natural way of thinking to us because it is the way we American’s operate and think. This is so basic to us but so new to people of developing countries who have no or little knowledge of biomedicine. Our natural ways of thinking are not even considered in the mindset of someone who does not have the knowledge we do.  This hold true for the reverse roles as well.

With the presentation of conceptual views from this article, now practically what needs to be done to address this issue is first and foremost education on both ends is definitely needed. As people of knowledge of biomedicine we need to understand the cultural and more conceptual sides to a problem. In return people like the Sasak people need proper education in the importance of biomedicine in all aspects in addressing maternal mortality. Proper education that is, because in the case with the midwife Inaq Isa even though she supposedly finished the government training in a severe situation she should’ve saw to take Inaq Marni to the clinic but didn’t. This called into question the quality of education and training that the Indonesian government has provided. There needs to be an understanding on both ends to create trust and therefore lead to compliance on both parts. We see an example of this in the class reading by Borovoy and Hines where there is an increase in support of doctors educating in different cultures as well as the availability to immigrants on importance of biomedical procedures and medication in illnesses such as diabetes. This all results in “trust, mutual respect, and communication between representatives of biomedicine and rural Sasak’s are part of what is needed to decrease maternal mortality on Lombok” (Hay 29).

Maternal mortality is a big issue in global health. As someone who is very passionate about children this issue definitely draws my attention. The health of the child is in the hands of the mother. To emphasize this and optimize the health of mothers and babies, there definitely needs to be biomedical care and access to health professions and supplies. In a broader spectrum though, all global health issues have underlying issues in the cultural and social aspect. Although these aspects are very important aspects they are not always evident and addressed. With the numerous cultures and countries around the world it is difficult to understand all aspects of one’s social and cultural beliefs.  But when focusing on one country and group of people like Hay did with the Sasak people of Indonesia, it is a must.

Cultural and social aspects are just as important as economy and politics are to biomedicine. In the emerging world culture is being added to a lot of the learning in medical school and health professions because people are now realizing the importance of it. The attack on reducing maternal mortality just is not going to be resolved immediately. Neither is any other global health issues presented in WHO and GHW3. The importance of anthropological thinking in addressing social and cultural aspects is so much broader than just the issue of maternal mortality. It is important for NGO’s to understand to properly fund people and research to solve global health issue. It is important to educate health professionals not only mechanically but also culturally in working in developing countries. It is important for everyone to familiarize themselves in cultural social aspects of any global health issue.

Blibliography

Hay, M. Cameron. "Dying Mothers: Maternal Mortality in Rural Indonesia." Medical Anthropology 18.3 (1999): 243-79. Print.

Borovoy, Amy, and Janet Hine. "Managing the Unmanageable: Elderly Russian Jewish Émigrés and the Biomedical Culture of Diabetes Care." Medical Anthropology Quarterly. 22.1 (2008): 1-26. Print.

Global Health Watch 3: An Alternative W Report (2011)orld Health

World Health Organization - World Health Statistics 2012