reproduction & women’s health issues

Reproduction & Reproduction & Reproduction & Reproduction &

women’s health issues women’s health issues women’s health issues women’s health issues

ReadingsReadingsReadingsReadings::::

McElroyMcElroyMcElroyMcElroy & Townsend & Townsend & Townsend & Townsend ChapterChapterChapterChapter 6 (pages 2186 (pages 2186 (pages 2186 (pages 218----263) 263) 263) 263)

The The The The CostCostCostCost of of of of ChildbirthChildbirthChildbirthChildbirth

Culture, Scarcity, and Maternal Thinking: Maternal Culture, Scarcity, and Maternal Thinking: Maternal Culture, Scarcity, and Maternal Thinking: Maternal Culture, Scarcity, and Maternal Thinking: Maternal

Detachment and Infant Survival in a Brazilian Shantytown Detachment and Infant Survival in a Brazilian Shantytown Detachment and Infant Survival in a Brazilian Shantytown 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

midwifeWomen’s UN Report Network

Panama: Pregnancy & Birthing Traditions

of the Embera People 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

http://www.oneworldbirth.net/

MicroBirth Indiegogo Campaign

http://www.indiegogo.com/projects/microbirth

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

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.

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.

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.

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.

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 María Bolege, 21, has come to a waiting house in the Andean town of Ayacucho, eight hours by road from Peru's capital, Lima.


� 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 WalkingDead Women WalkingDead Women WalkingDead 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 FactsKey FactsKey FactsKey Facts

Maternal mortality ratio (per 100,000 live births)

Reproduction & Women’s Health IssuesReproduction & Women’s Health IssuesReproduction & Women’s Health IssuesReproduction & Women’s Health Issues

� McElroy & Townsend discuss the species-

specific 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.


� 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.


� 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).


� 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 birthweightand premature birth.

� Alcohol consumption – Fetal Alcohol Spectrum Disorders

� Drug usage

� Pregnancy sickness &cravings� Pica – compulsive eating of non-

food substances, such as clay.

Craving Earth' book talk by Sera Young


� 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.

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