The planetary health we need: revealing the challenges of maternal and child health
By Bruna Bastos
Photo: : Sven Torfinn for H6 Partners
“To change the world, we must first change the way babies are being born”. - Michel Odent
Since the notion of “planetary health” unfolds on sustainability and human life on the planet, it is inescapably concerned with human rights. Women's rights are human rights. Although this is not a new issue, these rights continue to be overlooked. Women around the world have suffered from institutional violence and a lack of access to health care. The birth experience, which is a human important moment, has become an often distressing one. In this sense, our efforts towards planetary health must focus on altogether, and this requires improving women's health and guaranteeing their human rights.
The problem of high rates of cesarean surgery
In 2019, during the World Health Assembly, the World Health Organization (WHO) and the Pan American Health Organization (PAHO) declared 2020 as the International Year of the Nurse and the Midwife. The commemorative mark aims to recognize the work done by nurses and midwives around the world, defend more investments for these professionals, and improve their working conditions, education, and professional development. However, 2020 presented itself as a year of even greater challenges. The topic was overshadowed by the emergence of the COVID-19 pandemic.
The paper ‘The Tragedy of COVID-19 in Brazil’ reveal that from the beginning of the pandemic until June 18th, 2020, 160 women, either pregnant or who had recently given birth, died due to COVID-19 worldwide; 124 happened in Brazil, which corresponds to 77% of these deaths all over the world. According to the survey, the mortality rate was higher regarding cases identified in the postpartum period, probably reflecting the onset of symptoms of the infection.
Based on data from Takemoto et al.. The Tragedy of COVID-19 in Brazil: 124 maternal deaths and counting. International Journal of Gynecology and Obstetrics, 2020.
The authors argue that the rate of cesarean surgeries in the country is among the highest in the world and, therefore, doubts remain about the increased risk of postoperative morbidity and mortality for patients with COVID-19 undergoing surgery. These results draw attention to the risks of cesarean surgery, but this is not a new problem created by the pandemic. It is an old issue and it is not a matter that concerns only Brazil.
Source: The Lancet and BBC News
Studies prove that cesarean surgeries can save lives in high-risk births, but without clinical indication, it can be associated with an increased risk of uterine rupture, abnormal placentation, ectopic pregnancy, stillbirth, and preterm birth. Furthermore, the babies born can have different hormonal, physical, bacterial, and medical exposures that can subtly alter neonatal physiology. The short-term risks include altered immune development, an increased likelihood of allergy, atopy, and asthma, and reduced intestinal gut microbiome diversity.
Since 1985, WHO has considered the ideal rate for cesarean sections to be between 10-15%. Currently, Latin America is the region with the highest rate of C-sections (44.3%) in the world. Based on these data, the World Congress of Gynecology and Obstetrics attributes the "epidemic" of cesarean sections to the existing medical teams less competent to monitor difficult normal births, the convenience of scheduling the day of delivery, the greater economic benefits for private clinics, amongst other aspects.
Obstetric violence: a silent issue
Obstetric violence is an often-overlooked issue. Although violence has the potential to occur anywhere and at any time, some spaces are particularly vulnerable. One of them is the hospital environment, from small to large health centers, where patients are in the most vulnerable conditions. According to PAHO, violence can be defined as any act or use of power that results or may result in physical, sexual, or mental harm or suffering, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether in public or private life.
Also according to the organization, reports from pregnant women confirm the presence of different forms of violence, ranging from negligence to abuse, disrespect, mistreatment both before birth and during the process, which occur in both public and private institutions, taking advantage of a sensitive moment of vulnerability. Forcing or embarrassing a woman to have an unnecessary cesarean surgery is also a form of violence. Most expectant mothers are cisgender women, a term for people whose gender identity matches their sex assigned at birth. But it is always important to remark that transgender men and non-binary people are even more likely to suffer obstetric violence. It is necessary to address this issue and seek solutions in partnership with those who are affected by the theme.
Ecofeminism, also known as ecological feminism, is a branch of feminism that examines the connections between women and nature. The word 'ecofeminism' was first used in the 1970s, but the relationship between ecology and women's lives has always been especially important, especially for women in the Global South who live in traditional communities.
Birth is one of the cycles in nature. Childbirth is a natural human phenomenon, but unnecessary, forced hospitalization and excessive use of medicines may deprive women of having this experience. Women need the freedom to live this moment, surrounded by respect and affection. Moreover, they should have the right to choose how and where they want to deliver. That is why ecofeminism engages with the search for humanized childbirth.
Humanized childbirth and the valorization of traditional midwives: some possibilities
Discussions about humanized childbirth also became expressive in the 1970s, due to feminist movements that demanded sexual and reproductive rights, and by some obstetricians who understood the importance of natural childbirth. Humanized childbirth is a set of practices and procedures that seek to readjust the birth process based on a less medicalized perspective, seeing both the woman and the baby through a more human and empathic lens.
The obstetricians who defended humanized childbirth referenced the work of traditional midwives, who treated women with patience and respected their labor time. They provided holistic care, made it possible for women to choose the birth position, allowed them to eat and drink, and sometimes even sang or prayed. For many, a real warm and touching care. The profession of traditional midwives has diminished due to the excessive hospitalization during childbirths and the social and political barriers they face created by the stigma of their practices being very “old” and “outdated,” which is a misconception. That is why it is so important to value and strengthen their work.
The high rates of unnecessary cesarean sections and obstetric violence is a worldwide problem and have affected women's health and prevented them from exercising their human rights. So, the planetary health we need is one that gives adequate attention to this issue.
About the author: Bruna Bastos is a MA student in Development, Society, and International Cooperation at the University of Brasília and a mentee at the Women Leaders for Planetary Health 2020 class.