College of Western Idaho
Global
Issue
Midwifery
Accomplishing Millennial Developmental Goal 5 in India
Rough
Draft
Sondra
Jones
English
102 034W
Leslie
Jewkes
5 December
2011
Abstract:
In
America, there are few people who truly understand the tragic reality of infant
and material death, but perusing life in a country as the women of India this
fact presents itself daily. Expectant mothers ponder if they are doing enough
to keep the child inside of them healthy and if when the child is born it will
survive. Because there are not enough healthcare professionals to go around,
women remain lost in the ways of the past and the ignorance that is at times
unhealthy for both mother and child. One solution to this problem is to
integrate midwifes into communities that can both deliver babies and teach
mothers healthy practices for themselves and for their families.
While
contemplating childbirth, one may consider many settings. Images of doctors,
nurses, midwifes all welcoming a new life into the world may come to mind, as
well as a setting such as a peaceful home, hospital, or birthing center. Even
thoughts of pregnancy, checkups, and smiling newborns bring happiness and joy
to the remembrance of this occasion. In India, however, childbirth is a much
more dangerous occasion.
The Central Intelligence Agency
estimates that in 2011, in India, 47.57 out of every 1,000 live births resulted
in infant death as opposed to 6.06 per 1,000 in the United States. (“Infant
Mortality Rate” 1) That means 21% of infants died within the first five months
of being born. The CIA also reports in 2008, 230 out of 100,000 Indian mothers
died while pregnant, during childbirth, or up to 42 days after childbirth. A
report published in 2011 stated, “Approximately one-quarter of all
pregnancy-and delivery-related maternal death worldwide occur in India which
has the highest burden of maternal mortality for any single country.” (Goldie, et al. 1-16) The CIA also reported only 24 out of
100,000 women in the United States die as a result of childbirth. (“Maternal
Mortality Rate” 2)
Because of India’s high
population, reaching over 1 billion in 2000 (Bowden, Humble) and accounting for
17% of the worlds population in 2006 (Bowden, Humble), there are not enough
medical professionals to go around. India is largely split into two sectors,
North and South. The southern half of India is generally more devolved and has
better healthcare. In the north, a generally less populated area, it is
increasingly more difficult to find skilled birth attendants. According to Nora
Kropp, a Certified Practical Midwife with a Masters of Public Education
specializing in maternal and child health, this shortcoming is dominantly due
to the rural environment and culture of these regions. Water quality, lack of
reliable electricity, bugs, wild animals, lack of education opportunities for
children, and lack of social companionship all present themselves as obstacles
to educated and skilled men and women who are familiar with life saving measures
for both mother and infant. (Kropp) In addition to these, some specific
stumbling blocks for midwives are proper training and continuing education,
financial insufficiencies, and basic number of women each midwife has to serve.
Due
to these and other crippling shortcomings in global development, the United
Nations has come up with a series of goals for the world, they are known as the
Millennial Development Goals. The MDG’s are as follows: Goal 1- End Poverty and
Hunger, Goal 2- Universal Education, Goal 3- Gender Equality, Goal 4- Child Health,
Goal 5- Maternal Health, Goal 6- Combat HIV/AIDS, Goal 7- Environment Sustainability,
and Goal 8- Global Partnership. (“We Can End” 1) The United Nations hopes to
complete these goals by 2015. Though progress is being made, there is still
much work to be done
Goals
4 and 5 were put in place because of high maternal and infant mortality rates
all over the world. The United Nations hopes that these goals will make
pregnancy and childbirth a joyful process and remove the fear and danger.
Specifically the United Nations hopes to reduce maternal mortality by three
quarters and make access to maternal health care universally available. (“Goal
5” 2)
The
leading causes of maternal death are Hemorrhage, Anemia and Sepsis; but there
are other causes as well. Nora Kropp believes that the “3 Delays” are the main
problem. “Delay in recognizing a problem. Delay in seeking care. Delay once
care is sought.” (Kropp) Recognizing a problem for mother or baby is often
overlooked; however, if they are identified correctly, these problems can be easily
treated. Once a problem is recognized many women will choose to wait and see
what happens or try to care for themselves at home. Once care is sought issues
of transportation can come into play, and once the destination is reached a
families inability to pay or the sheer volume of clients can cause a delay in care.
(Kropp) All of these things play a major role in maternal mortality.
One
way that that has been suggested to accomplish both goals 4 and 5 is the
presence of a skilled birth attendant at every birth. This would be a properly
trained medical professional such as a Doctor, Nurse Midwife, or other approved
midwife such as Licensed Midwives and some Auxiliary Midwives. In 2008 only
46.9% of all Indian women gave birth with a skilled attendant, (World Health
Organization) and according to a study recorded in the Indian Medical Journal
of Community Medicine, “Fifty percent of the home deliveries were attended by
Trained Birth Attendants and 40% were attended by Untrained Birth Attendants. A
Private Nurse attended 10% of the home deliveries.” (Zulfa et al. 102-107) This
shows a drastic need for home birth attendants in India.
Sadly
these numbers will be slow to diminish because there are not enough healthcare
professionals to meet the needs of the people. Nora Kropp shares her opinion,
“the biggest problem in India is there are not enough skilled birth
attendants.” The World Health Organization reports that there are only 13
nurses and midwives per 10,000 people in India. It is a staggering realization
of the terrific need that is facing this country.
Doctors
are valuable resources but can be hard to find. Nora Kropp states “the main problem is hiring
and keeping specialists like OB’s, anesthesiologists, surgeons, and other
healthcare professionals for lifesaving measures.” Many doctors are employed by
government institutions yet both doctors and nurses are “over worked and under paid.”
(Kropp) Kropp also reveals many doctors will have private practices on the side
because there is more money in the private sector.
Teaching
women to live healthy lives and care for themselves and their families is one
of the key aspects that a midwife can provide aside from childbirth. Midwives
have the opportunity to teach women natural family planning and therefore
decrease both infant and maternal mortality because women who do not wish to be
pregnant and cannot afford to be pregnant will know what to do to prevent
pregnancy. A study shows:
Increased family planning to
reduce the unmet need (for spacing and limiting births) by amounts ranging from
25% to 100%, reduced maternal deaths by amounts ranging from 7.0% to 28.1% in
rural India and 5.8% to 23.5% in urban India. In rural India, eliminating the
unmet need for family planning decreased the TFR (Total Fertility Rate)1 from 2.97 to 2.14, the proportion of deaths that
are pregnancy related from 16.4% to 12.3%, and the lifetime risk of maternal death from 1 in 65 to 1 in 90.” (Goldie, et al. 1-16)
This data shows that teaching women how to manage
their bodies and prevent unwanted pregnancy alone can reduce mortality rates.
In
addition to family planning, midwives can be wonderful teachers of healthy ways
for women to care for themselves and their families. Knowledge of appropriate
hygiene, proper nutrition, and first aide skills for the entire family as well
as quality parenting techniques can be instrumental in lessening the
unnecessary deaths of mothers and children. A study conducted by Khoushabi and
Saraswathi and reported in Pakistan Journal of Nutrition shows that when women
have proper nutrition both the mother and child benefit. (1124-1130). Thus the
role of educating mothers remains a key to not only decreasing infant and
maternal mortality but also the rest of the Millennial Development Goals.
Midwives
can be an instrumental part of accomplishing the MDG’s in India and around the
world. A skilled birth attendant can act as a catalyst to bring about healthier
and more powerful generations; however, there is a great need for finances to
both pay these hard working women and to help families with the costs resulting
from pregnancy and childbirth. Americans must recognize the inequality of care
for mothers and children in the rest of the world and take action. Donating
time, finances, and resources to organizations who are dedicated to the cause
of fighting infant and maternal mortality as well as improving access to
skilled birth attendants will aide both the UN and the world in achieving the
Millennial Development Goals.
Works
Cited
CIA. “The World Factbook: Country Comparison: Infant
Mortality Rate”. Central Intelligence
Agency. Central Intelligence Agency, 2011. Web. 27 September 2011.
- “The World Factbook: Country Comparison: Maternal Mortality
Rate.” Central Intelligence Agency. Central
Intelligence Agency, 2011. Web. 8 November 2011.
Draper, Allison Stark. Primary
Sources of World Cultures: India: A Primary Source Cultrual Guide. New
York: The Rosen Publishing Group, Inc., 2003. Print.
Bowden, Rob, Darryl Humble. Changing World: India. Minnesota: Arcturus Publishing, 2008. Print.
Goldie, Sue J..Steve Sweet. Natalie Carvalho. Uma Chandra
Mouli Natchu. Delphine Hu. “Alternative Strategies to Reduce Maternal Mortality
in India: A Cost-Effectiveness Analysis” PLoS
Medicine 7.4 (2010): 1-16. EBSCOhost.
Web. 9 November, 2011
Khoushabi, Fahimen and G Saraswathi. “Association Between
Maternal Nutrition Status and Birth Weight of Neonates in Selected Hospitals in
Mysore City India.” Pakistan Journal of
Nutrition. 9.12 (2010): 1124-1130. EBSCOhost.
Web. 11 November 2011.
Kropp, Nora. CPM, Masters of Public Health Specializing in
Maternal and Child Health. Personal Interview. 12-13 November 2011.
UN, We Can End Poverty 2015, United Nations, 2010, Web. 11
November 2011.
-“Goal 5
Improve Maternal Health” United Nations.
n.d. Web. 11 November 2011.
World Health Organization. “India, Country Statistics” World Health Organization. Would Health
Organization, 2010. Web. 8 November 2011.
Zulfia, Khan, Saria Mehnaz, Najam Khalique, Mohd Athar
Ansari, Abdul Razzaque Siddiqui. “Poor Perinatal Care Practices in Urban Slums:
Possible Role of Social Mobilization Networks” Indian Journal of Community Medicine. 34.2 (2009): 102-107. EBSCOhost. Web. 8 November 2011.
Notes
1.
Parenthesize added.
Table 1. Source: National Rural Health Mission. National Program Implementation Plan RCH
Phase II-Program Document. NRHM. N.d. Web. 13 November 2011
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