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Friday
Jun102011

"Abuse and Neglect" as Deterrents to Skilled Care in Childbirth?

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By ANaturalAdvocate

The United States Agency for International Development (USAID) (through Translating Research into Action and University Research Co., LLC) recently awarded two $600,000 grants to determine the effect of “abuse and neglect” of pregnant and laboring mothers has on their obtaining skilled attendants at childbirth. 

The Population Council and the Averting Maternal Death and Disability (AMDD) Project at Columbia University’s Mailman School of Public Health will use the grants to study childbirth in Kenya and Tanzania, working closely with local resources and healthcare providers to determine the extent of disrespect in childbirth in these areas and what interventions would be most suitable for minimizing the effects of this abuse and neglect. 

USAID describes “abuse and neglect” as encompassing humiliation; lack of respect for the woman; discrimination based on race, ethnicity, or socio-economic status; and physical and verbal abuse, among others. A report accompanying the press release quotes an interviewee as stating,  “I think most of our women don’t know they have the right to respectful treatment….They accept what they get.” The report also goes into further detail about the treatment of laboring women as a human rights issue and the role that leadership plays in bettering care and the access to care.

The overall purpose of the grants is to further United Nations Millennium Development Goal Five, which is to improve maternal health, including reducing the maternal mortality rate by three-quarters. A major stumbling block in achieving this goal has been the lack of skilled care available to women, particularly in parts of Asia and Africa, and a general reluctance to utilize the care available, often thought to be a result of the lack of respect with which the birthing women are treated.

TRAction, the Population Council, and the AMDD Project will also work with the White Ribbon Alliance for Safe Motherhood to create a leadership council and promote respectful and appropriate care during childbirth. 

Check out the press release here, and the recent study “Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth” here (PDF).

 


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Reader Comments (8)

I am so glad this is getting attention. Abuse, lack of cultural competence, and discrimination are all factors that prevent women in both the developed and the developing world from seeking care.

I'm not naming names, but in the major hospital where our doulas do work, we see a marked difference in the way immigrants are treated during birth, especially African immigrants. (Meaning, they're generally treated worse than even the poor black teenage moms, which usually are the most disrespected). For example, a Kenyan immigrant's baby went to the NICU after a 36 hour labor that ended in cesarean, maternal infection, long story, anyway, the baby was in the NICU, the mom was on the ONCOLOGY floor for recovery (not postpartum...???), and no one told either parent that they were allowed to hold the baby FOR THREE WHOLE DAYS!!!! The baby laid in the NICU for THREE DAYS without the parents holding her or the mom nursing, until the doula came for a visit and realized what was going on and got the nurses to explain things and let the parents hold her.

I have other stories, but I will save them for another day.

Craziness.

June 11, 2011 | Unregistered CommenterStacey

Yes, I FINALLY saw BOBB a couple of nights ago. When the excuse that "we have a different population" came up (why the US has higher infant mortality rates, etc.) what I yelled at the screen (as I always want to when this comes up) is "YES. WHICH 'WE' DISCRIMINATE AGAINST."

Similarly, there was a recent in-depth discussion of HB on MDC and someone brought up the idea that some authority had told her, that relatively poorer outcomes in the US "had something to do with black people." I.e., that the US has more black people than the UK, the Netherlands, Japan, etc. Now, she said this "neutrally," not meaning to suggest black people somehow caused the poor outcomes, but there was still an undercurrent of "they're throwing off our numbers." I was like, really? Is it that difficult to see that this is an issue of institutional, systemic, longstanding racism? Yes, the more oppressed people in your population, the worse your averages. Solution: stop oppressing people.

June 12, 2011 | Unregistered CommenterDreamy

My understanding is that women of African descent are more likely to experience premature birth and the cause of that has not be fully figured out.

For example, see the following:

Genetic variant is associated with higher rate of premature delivery in African-American women
RICHMOND, Va. (Aug. 21, 2006) -– A team of researchers have identified a genetic variant that may account for the higher rates of premature delivery experienced by African-American women compared to European-American women, according to findings to be published online this week in the Proceedings of the National Academy of Sciences.

The findings may help physicians identify patients who may benefit from therapeutic interventions and preventative measures including lifestyle change or medical therapy to reduce the risk of premature birth.

Jerome F. Strauss III, M.D., Ph.D., dean of the Virginia Commonwealth University School of Medicine, and colleagues found that a change in a single nucleotide in the gene sequence, known as a single nucleotide polymorphism (SNP), in the SERPINH1 gene may be responsible for the increased risk of preterm premature rupture of membranes (PPROM) in women of African descent. The SERPINH1 gene encodes a heat shock protein known as Hsp47, which is essential for collagen production. Collagen lends strength to the membranes that surround the fetus and amniotic fluid.

The genetic variant identified reduces the amount of Hsp47 made and thus the collagen in the membranes, making them more prone to rupture. Other published research has reported that reduced collagen content has been found in PPROM fetal membranes. PPROM is the leading identifiable cause of preterm birth and occurs more frequently in African-American women.

"Our discovery of an association between a gene variation that is more common in individuals of African descent and a cause of premature birth, can explain in part the disparity in prematurity rates in African-Americans," said Strauss, who led the study......

June 13, 2011 | Unregistered CommenterEllie

That may be, and I'm all for that sort of research. It does not explain a C/S rate double that of white women an infant mortality rate of black infants (note, not all born to black women) 2.5x that of "non-Hispanic" white infants. The researchers themselves say the study "can explain in part the disparity in prematurity rates." Prematurity rates are only a fraction of what we are talking about here, and this study, at best, explains a fraction of that.

I mean, there are also a whole host of diseases and conditions that are associated with poor neonatal outcomes and are almost exclusive to white people... yet again, black folks have almost 2.5x the infant mortality rate. 2x the C/S rate.

A couple of other things that always seem to get lost in these attempts to explain everything away with genetics (not that that's necessarily what you were doing)...

1) Black Americans are among the most "racially" mixed people in the world and thus, as a population, are at very LOW risk for quite a few disadvantageous genetic conditions associated with more "closed" populations. They are also one of the groups about which it is hardest to make distinct "genetic" generalizations. Not that it can't be done, it's just not as easy or useful to generalize based solely on genetic information. Considering there are plenty of black and white and other folks running around with the exact or nearly the same amount of "African blood," well...

2) It's not like the effect of racism on health and health care have not been studied. Black immigrants from Africa show marked increases in hormonal stress, heart disease, stroke, etc. after they immigrate to the US, in far greater numbers than white immigrants from Europe, et al. And that's the more direct effect of systemic inequality on health, not health care per se. As Stacey references, direct and indirect, conscious and not-so-conscious racism (and classism, sexism, homophobia, etc.) is alive and well among health "care" providers.

June 13, 2011 | Unregistered CommenterDreamy

Just had to comment -
If it's a genetic variant, then we would expect to see the ENTIRE CONTINENT of African experiencing pre-term birth/low birth weight. Since we don't, it makes no sense to assume that only the African people who were stolen and brought to our country have a magic genetic variant that increases risk for poor birth outcomes. Then there is the rather important point that race is not a genetic category accepted by any scientist, but a socially created category based on external appearance.

Several researchers have actually done retrospective cohort studies examining preterm birth in African American women, recent African immigrants, and found that very recent African immigrants have PTB rates closer to white women than to black women. However, the longer they live in this country, the more their rates look like African American women suggesting that there is an underlying process at work. Any of the work by Tyan Parker -Dominguez would be helpful in thinking about this issue.

I'm all for the study. I think the power relationships between clinicians and patients is unexplored and needs more study.

June 15, 2011 | Unregistered CommenterJenny

Actually, Jenny, while I agree in principle with your greater point, your first paragraph contradicts itself IMO. The "ENTIRE CONTINENT" of Africa does not come close to sharing all of the same genetic characteristics. Not even close. As you pointed out, race is not a genetic, scientific reality, but rather a social one (I would argue not primarily based on "appearance" per se, but that's another discussion). Thus, the assumption that a native of Ethiopia has any more in common genetically with a native of South Africa than with a native of Italy or India (approximately equidistant) is flawed thinking based in the notion of race as anything more than a social construct. In point of fact, not only is any continent going to be home to genetically diverse and distinct peoples, this is arguably truer of Africa than any other. Given the fact that it was essentially the cradle of human life, we had tens and hundreds of thousands of years of time for peoples to become more and more genetically distinct in the vastly different environments there.

In addition, there actually is evidence that a good chunk of black Americans sometimes share genetic characteristics related to their primarily West African heritages, and this is well worth examining. The key, unscientific words there being "a good chunk" and "sometimes." As long as it's understood that A) not all black Americans are of West African heritage, B) there are a lot of diverse West African groups from which black Americans are descended, C) those groups obviously intermixed in the "Western Hemisphere," sometimes over many generations and D) the overwhelming majority of black Americans have at least some European, Native and/or Asian ancestry as well, and in some cases, more of those than of African ancestry. So... E) any useful generalization can only be limited.

But I would strongly disagree that if we did find something to be true among black Americans, that we would somehow logically expect to see it borne out across all of Africa-- or else know that there was no genetic component. That really imbues "race" with way too much genetic credibility, so to speak.

June 15, 2011 | Unregistered CommenterDreamy

If this genetic variant "may" make premature rupture more likely for mothers of African descent, why did this high rate of premature rupture never appear amongst the indigent mothers who followed Dr. Tomas Brewer's eating plan? His "diet" reduced the rate of PROM, miscarriage, low weights for gestational age, prematurity, etc. If a simple dietary intervention can sucessfully combat a genetic variation, it's hard to use the variation as an excuse.

June 19, 2011 | Unregistered CommenterHelen
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