Momentum for improving maternal health outcomes has risen on the global policy agenda since the 1990‘s. Still, a woman dies every two minutes from complications during pregnancy and childbirth. Her children are left motherless from a death that could have been prevented (up to 98% of maternal deaths are preventable) and a community suffers the irreversible consequences.
In sub-Saharan Africa, which remains the riskiest region of the world to give birth, Rwanda is something of an anomaly, reducing it’s Maternal Mortality Ratio (the number of women who die during pregnancy and childbirth per 100,000 live births) from 1,000 in 1995 to 340 in 2010 according to the No Ceilings data. A gigantic leap in saving mothers’ lives! This Overseas Development Institute briefing paper highlights how they are doing it: getting more mothers to attend pre-natal and antenatal consultations, creating a community health insurance scheme that covers 90% of the cost of ambulance transfers, and improving the quality of health centers by using good hygiene practices, keeping them well staffed and providing respectful care. Another key factor is that local problem solving initiatives are encouraged and well-received: “The state facilitates local participatory problem-identification and action – Ubudehe mu kurwanya ubukene, or ‘collective action against poverty’ – and provides mechanisms for feeding lesson-learning back into policy.”
So part of Rwanda’s dramatic improvement is because citizens are engaged. When everyone in a community is empowered and participating, outcomes improve.
Unlike Rwanda that stands as a positive outlier in sub-Saharan Africa, the United States stands as an outlier for its lack of progress, and was ranked as the worst-performing developed nation in the world for maternal health in the 2015 State of the World’s Mothers Report. In 2010, our MMR was at 21, much lower than Rwanda’s, but the number of deaths each year is increasing.
The key component of community empowerment and participation points to one possible reason why Rwanda is making tremendous progress and we have not improved in twenty years.
American women continue to face barriers to full participation in pregnancy and childbirth and it spans across all socio-economic statuses. For women of low-income, it is the red tape that comes with obtaining health insurance and accessing care that is a huge obstacle. As for the average American woman, despite ostensible empowerment, when it comes to birth she often defaults to the ill-informed and passive patient. It’s not always outer barriers- she has access to midwives, doulas, doctors, 911, transportation, childbirth classes, well-equipped hospitals, birthing centers and all that good stuff. It is her belief that birth is not something she knows how to do, but rather a medical event that someone else must handle (just tell her what to do and quickly if you please). This is the cultural norm and it is another huge obstacle because it makes her susceptible to birth violence (anything from a forced episiotomy to plain disrespect) and to a cascade of medical interventions which put her life at risk.
In 1976, at a hospital in the state of Kentucky, my mom birthed me naturally. Growing up a girl in the US, her decisions and the natural labor that brought me into the world became, in my mind, a serious deviation from everything I heard around me, and I nestled comfortably into the notion that childbirth would be too much for me to bear, that I would have to avoid the pain at all costs. Then in 2007 I stepped out of society’s script for me as a childbearing woman, overcame my fears, sought out care that was evidence-based and respectful of my active participation and I birthed my daughter in the most empowering event of my life.
Labor was hard and I was vulnerable but I was beautiful and true in my expression of creative power, in my connection to the mystery of life. Talk about full participation and empowerment! Giving birth while connected to that great mystery and to my own internal wisdom and mind-blowing capacities captured that force to the max.
Now I support pregnant women in overcoming the internal obstacles that prevent their full participation in childbirth. As part of an international group of certified BOLD Method for Birth facilitators, I create a space for women to access their inner knowing so that they may be actively involved in their birth experience from a place of their own deep truth. BOLD facilitators give women the tools to connect with their bodies, find their internal voice and create an action plan that puts them at the center of birthing. There is no one way for every woman to give birth, yet every woman can approach it with awareness, with a knowing that they are capable and can communicate their own needs.
I advocate for evidence-based birth practices and human rights in childbirth. A mother must be knowledgable of her options, of the healthy birth process and of risks. Equally important, her voice must be respected in the birthing room. Because again, bottom line: when mothers are not active participants in their own birth experience, the results aren’t good. The United States has the data to support it- even when the outer world is seemingly set up to serve women, if it is not matched at the personal level- if her voice, her decisions, her wisdom, authority and sovereignty are not respected, valued, and given a space- outcomes continue to worsen.
My work now is in examining this intersection of expectant mothers’ internal and external worlds and its implications for global maternal health. I imagine a world that reveres the birth process, setting up outer structures to support it AND where powerful women access their internal birth wisdom, participating fully in all decisions and actions in relation to their pregnancy and birth. Not only does this create the conditions for healthy and safe birth, it ignites a woman’s creative power, power that if unleashed will innovate new solutions to the challenges in her community, power that changes the world.The Path to Participation Initiative from World Pulse and No Ceilings