Mobilizing for Maternal Health: Delivering on a Global Promise to Moms Everywhere

"It's a good thing you're not having this baby in North Dakota!" my silver-tongued obstetrician declared jauntily.  "This baby" turned out to be a tiny spark of a girl, born 11 weeks early and weighing 1 1/2 pounds, considerably less than she should have in the 29th week of pregnancy.  "My little chickie," the neonatal intensive care nurse, who held my daughter long before I did, would croon. When Jan began work as a NICU nurse decades earlier, there were no needles or tubes small enough to fit the little birds who'd fallen so soon from the nest. I had landed in a lucky spot on the space-time continuum: in 2002, I lived a few miles from a Connecticut teaching hospital with a high-level, high-volume NICU. Apparently, in other parts of the 21st century United States, hospitals still did not always

With my daughter in the NICU 

have the appropriate equipment or the experienced staff to give pregnancies and babies like mine the best chances of a "positive outcome."

"It's a good thing we didn't have either of our babies in Guatemala!" I mused to my husband.  There was no hint of jauntiness to his reply, as he knew that I almost certainly would not have made it out of my first pregnancy alive. A little over a year prior to the premature emergency delivery of my son, we had lived in the central highlands of Guatemala. I was doing anthropological fieldwork on community health promoter training in rural Maya communities. I was particularly interested in women's involvement in health activism, including the work of traditional Maya midwives and healers.

Maya midwives inspired me with their deep cultural knowledge of pregnancy and birthing, their nurturing relationships with women and families, and their tireless work under extremely difficult circumstances. They also shared stories of fear, mostly of ethnic discrimination, violence, and poverty but sometimes of the challenges of helping mothers and infants through the risky endeavor of reproduction. I think of their warm, wise faces and know that I would have been one of their professional nightmares. Honestly, my high-risk obstetrics specialists probably felt the same way.

Maya midwife

In both of my pregnancies, I developed one of the most common and least understood of pregnancy complications known as pre-eclampsia. In addition to posing serious risks to the mother's health, pre-eclampsia can cause growth restriction and other problems in the developing infant, including the need for a premature delivery. Difficult to detect, it can develop -- often quite rapidly -- into the seizures and coma of eclampsia, one of the leading causes of maternal death. According to the Preeclampsia Foundation, the condition causes an estimated 13% of maternal deaths and up to 20% of preterm births worldwide. It remains one of the reasons why every year nearly 300,000 women across the globe die and many more are disabled from pregnancy and birth-related causes.

That statistic is an improvement. The United Nations focused global attention on maternal death in 2000 when it established the 5th Millennium Development Goal (MDG 5), calling on nations to reduce the maternal mortality ratio by three quarters between 1990 and 2015. Increased global activism and investments have contributed to a 47% decline in maternal deaths in this period, but progress has been slow and inequities persist. The vast majority of maternal deaths, which are largely preventable, occur in developing regions as a result of unequal access to healthcare and other resources.   

http://www.un.org/millenniumgoals/maternal.shtml

At the end of this month in which we honor mothers, Women Deliver, a global advocacy group dedicating to improving the health of women and girls, will convene its third international conference. Thousands of representatives from government, NGOs, healthcare, academia, community groups, and other spheres will gather in Kuala Lumpur, Malaysia to brainstorm about how to continue to mobilize the international community to improve maternal health and the overall well-being of girls and women. As Women Deliver's President Jill Sheffield stated in a recent Huffington Post blog with Jennifer James that is part of the Global Mom Relay, "We have the solutions....We just need to scale them."

Musicians, writers, filmmakers, and other artists have joined this global movement to improve maternal health. For example, filmmaker Lisa Russell and singer Maya Azucena developed an innovative platform uniting artists and activists in their work to achieve MDG 5. Their interactive website, MDGFive.com, includes content by singers, poets, photographers and artists that can be remixed to create videos that raise awareness about maternal health and women's rights. As Russell and Azucena state, "we believe in the power of imagery, sound and the spoken word to inspire cultural exchange, unite international communities, and to promote social progress worldwide."

Like the dedicated Maya midwives and health promoters I came to know, these creative artists and activists inspire me to join in their efforts to understand, prevent, and solve maternal health challenges.  The pain within my own journey of pregnancy and birthing has no doubt lefts its scars, but by virtue of my privileged location within our global geography, history, and economy I was gifted with a tremendously positive outcome for my own life and that of my children. While I sometimes may forget amidst the busyness of raising my now 10-year-old daughter and 16-year-old son, my own aging face in the mirror and their vibrant, growing faces are my call to action: to increase the opportunities for health for all mothers, infants, fathers, and families, no matter whether they live in the inner cities of Connecticut or the highlands of Guatemala, in rural North Dakota or rural Nigeria, or in any other spot on our remarkable globe.

To learn more about the signs and consequences of pre-eclampsia, see the Preeclampsia Foundation.

The Women Deliver website has further information about the 2013 conference and other projects such as Catapult, a crowdfunding platform for advancing gender equality.

Information and resources related to MDG 5 are available at: United Nations Millennium Development Goal 5 and MDGFive.com 

Smaller than Before: The Politics of Post-Partum Bodies

[Editor's Note: This is a guest post by Dr. Jessica Zucker,a licensed clinical psychologist in Los Angeles specializing in women's health with a focus on fertility, prenatal and postpartum adjustments, attachment, and transitions in motherhood. Learn more about Jessica at her website. 


This story is part of a new, ongoing series of guest posts about motherhood. Visit IMOW's new online exhibition MAMA: Motherhood Around the Globe at mama.imow.org ]

Flickr/ huberson

A close friend of mine from graduate school was in town over the weekend, someone I hadn’t seen since I was mid-way through my pregnancy. As we briskly walked toward each other, arms outstretched, brimming with wild enthusiasm about our long overdue rendezvous, Amalia blurts out from across the toddler trafficked park, “Oh my God, look at you, you don’t even look like you had a baby! You’re smaller than you were before.”

I wasn’t sure how I felt as we hugged, in the midst of awkwardly digesting her jubilant albeit off the cuff comment about the apparent erasure of my pregnancy. The embrace was cut short as she gently pushed me back to scan every inch of my postpartum body, unable to contain her energized description of how “little” I look, how “tiny” I am – spilling with words she defines as every woman’s dream. Or more to the point, every woman’s goal.

I want to be marked, in some way, by pregnancy, by the birth of my child. This is not to say that I would have wanted to maintain all the weight gained during pregnancy, but I do feel the body as well as the mind/psyche/heart go through a series of metamorphoses as life is being nourished inside and outside of the body.

Women are constantly shamed for their shape. Prepartum, postpartum, and never-partum. All but the smallest sizes are viewed as less than, not driven enough to surveil every morsel of food ingested, not vigilant enough to carve out time for daily workouts. Even women I know who do embody the cultural ideal – trotting around in the smallest sizes the jean manufacturers are producing these days- even they don’t feel at home in their bodies.

The droning laundry list of things that women say about how they “got their bodies back” include and sadly are not limited to: “breastfeeding is definitely what made the baby weight fly off”, “I got the food delivery service straight away. I was determined to return to my pre-baby wardrobe as quickly as possible and that way I didn’t have to think about what I was eating, it was done for me”, “I started counting calories while in the hospital. I was surprised by how long it took for the weight to come off but I feel like it’s the only thing I can control right now so my focus is sharp”, “not even a moment goes into thinking about my food intake. I guess I lost it all while running after my rambunctious toddler. He never gives me a break.”

Amalia is freshly married, 38, ambivalent about having kids. As she blithely puts it as she considers raising a family, “I could take it or leave it.” The ubiquity of psychological disconnection and body disenchantment is illuminated in Amalia’s detailing of my presence. My physicality is noticed first. My size is experienced and discussed in relationship to banishing pregnancy. The absence of body change is asserted as an enviable compliment. Meanwhile, my darling toddler is resting on my hip and I look into his eyes knowing that he grew inside of me and together we altered the feel and shape of my body. And then I think to myself, “Why would we want to erase that?”

Amalia provoked me to reflect on hundreds of fragmented interactions I’ve had with women since my baby was born. Women who are mothers themselves, women dying to get pregnant, women who share their horror of giving birth, “getting fat”, “staying fat”, women who asked me how much weight I gained while pregnant, my own mother reflecting on her speedy loss of “baby weight” and curious about why mine wasn’t slipping off as quickly. The dynamics of women and what we unwittingly do to each other is devastating. Paralyzing. A cultural vestige all too pervasive.

And then of course we are inundated with endless magazine images of emaciated post-pregnancy “stars” who “got their bodies back instantly.” They pontificate about the various ways women must expunge maternity. The pride taken in shrinking one’s body at any cost is emblematic of a cultural obsession with women not being real women.

The intimacy I experienced with my body and my developing baby during pregnancy was perhaps the most compelling transformation I have ever known. It became, in a way, a metaphor for how I feel about parenthood—a striking awareness of loss of control, simultaneity of surrendering to change on a moment-to-moment basis while experiencing more joy and more fear than the heart can contain. Pregnancy and parenthood invoke an unprecedented heightening of anxiety—excruciating awareness of vulnerability, altering one’s perspective on the fragility of life, as well as a depth of love that redefines the concept. Why would we erase all of this complexity– the physical and psychological makings and markings of pregnancy and parenthood?

I am not necessarily idealizing the experience of pregnancy. I’m not saying women should necessarily enjoy gaining weight, being tattooed with stretch marks, or relish the postpartum belly jiggle. I am attempting to call attention to cultures calamitous requirement that women erase the life giving process.

As Amelia and I make our way through the throngs of sweaty and spirited toddlers and exit the park, she turns to me and reiterates, “You’re so lucky, you look exactly like you did before.” There’s a pregnant pause. And I say, “Actually, my body’s changed from having a baby, and that is why I’m lucky.”


Dr. Jessica Zucker is a clinical psychologist in Los Angeles specializing in women’s health with a focus on transitions in motherhood, perinatal and postpartum mood disorders, and early parent-child attachment. Dr. Zucker received graduate degrees from Harvard and New York University. Jessica is an award-winning writer and is a contributor to The Huffington Post and PBS This Emotional Life. Dr. Zucker is currently writing her first book about mother-daughter relationships and issues surrounding the body (Routledge). Jessica consults on various projects pertaining to the motherhood continuum. www.drjessicazucker.com