Motherhood in modern society and the impact on women’s lives

Part C – Global inequalities Not all women are able to access high quality midwifery care. There are wide variations in

standards of midwifery care across the globe.

By Bernadette Gregory

Global inequalities• Wide disparities by region and wealth • Maternal mortality ratios show the greatest gap

between rich and poor countries of all health indicators (WHO, 2012)

• Ninety-nine per cent of maternal deaths occur in developing countries, primarily in Africa and South Asia.

• The probability that a 15-year-old female will die from a complication related to pregnancy & childbirth

- Highest in Niger (1 in 7), - In stark contrast to Ireland, which has the lowest lifetime

risk of 1 in 48,000

How are things going to improve in the future?

• Rise of pressure groups and organizations• Government involvement• The White Ribbon Alliance for Safer Motherhood

(www.whiteribbonalliance.org) • Rise of feminism (www.gofeminist.org.uk)• Increase in groups discussing marginalised groups

(www.invo.org.uk)

What of the developing world?

Pause for thought

What are the major causes of maternal mortality and morbidity in the developing world?

Answer: Do the statistics make good reading?

• Maternal mortality is difficult to measure accurately, especially in the poorest countries, which tend to have the highest maternal deaths, and the estimates are bounded by wide measures of uncertainty

• Rate of maternal deaths globally has been falling at less than one per cent

- In 1990 576,000 women died of maternal causes globally - In 2005 536,000 women died of maternal causes globally (Figures from

UNFPA/WHO/UNICEF)

What can we do to help?The White Ribbon Alliance for Safe Motherhood is:

• An international coalition of individuals and organizations formed to promote increased public awareness of the need to make pregnancy and childbirth safe for all women and newborns in the developing, as well as, developed countries.

• The white ribbon is dedicated to the memory of all women who have died

in pregnancy and childbirth

• In some cultures, white symbolises mourning and in others it symbolizes hope and life

• The white ribbon represents this dual meaning globally

• The White Ribbon Alliance not only works to sustain life and hope for all women, but also mourns and honours those women who did not survive pregnancy or childbirth.

www.whiteribbonalliance.org

Features of maternal morbidity • Headaches• Tiredness• Anaemia • Incontinence • Fistulas• Wound healing • Dyspareunia • Mental health – depression, suicide attempts • Lack of attachment to infant

(APPG, 2009)

All women are different

• Every individual woman is composed of a unique combination of different cultural orientations and influences, and every person belongs to many cultural groups.

• It is important to be self aware and recognise

these cultural influences on our lives and how we have developed our own cultural identities.

Pause for thought : Can you describe yourself in terms of cultural identity?

Remember to include; • Age• Gender• Nationality• Race• Religion• Health status • Educational achievements

Each of the above will influence who you are, how you perceive the world, and how you behave

Do you think gender the most important factor?

Sociological theories ‘Feminism emerged in the 18th century and feminists were

concerned with extending the central concept of liberalism- freedom from coercion and the right to individual happiness. Classical sociology sees the individual as being constituted by society. In the 1960’s onwards feminists blamed society and its influence on shaping our individual values and behaviours and so rallied against the idea that sexual inequality was a natural and therefore unchangeable fact of life. Aspects of women's lives that had been accepted without question e.g. unequal pay, domestic violence, rape and discrimination were identified as needing social change’

(Bilton et al 2002:489)

Let us look at some feminist perspectives

• Liberal feminism …suggest legal reform to remove discriminatory practices in education, employment and more equality of roles

• Does society have gender differences or gender inequalities?

(Bilton et al, 2002)

Suggested activity on gender inequalities/ differences

• Look up some statistics on women’s roles For example: .

How many women in the UK are in the following professional roles?- firefighters - armed forces- Chief Executive- Primary School Teachers- Head Teachers- Members of Parliament

What do you think stops more women joining these professions?

Feminist Perspectives

The following slides outlines the major feminist theories

Radical feminists

• Collective and systematic oppression of women and want to make the personal political.

• Patriarchy is at fault and gender conflicts and men’s desire to control is at the crux of all societies problems

(Bilton et al, 2002)

Marxist feminism

• Women’s oppression is to do with capitalism making sexuality and reproduction a political issue.

• Post modernism- Enlightenment concept suggest that white western men are obsessed with wanting to dominate and control “others” whether that is women, nature or other racial groups .

(Bilton et al , 2002)

The cultural melting pot

• Modern society is comprised of individuals from different combinations of national, ethnic, racial, socio economic, occupational, generational and health status cultural orientations.

• We use terms for grouping casually but we need to be clear of the terminology we are using and be accurate in our usage

Why is multi culturalism an issue for midwifery?

• Professional obligation : NMC Code (2008:2) states “ you must treat people as individuals and respect their dignity.”

• Equality Act 2010 http://www.equalityact.com • Ethical obligation: concepts of equality, justice & non

maleficence• Ethos of the NHS is one of equal access• Inequality agenda/social exclusion agenda suggests we could

be more inclusive • Public health agenda• Ethos of holism/salutogenesis in our approach to care see

www.rcm.org.uk

What reports and statistics say Saving Mothers’ Lives (2007) cites• Black African women had a mortality rate 6 times higher

than white women (p2).

• Asylum seekers and refugees identified as “particularly vulnerable group” as “new to this country and who have little or no command of the English language.”

• Women who were unemployed ,or whose partners were unemployed , were 7 times more likely to die

Saving Mothers’ Lives (2007)

• Vulnerable women with socially complex lives who died were far less likely to seek antenatal care early in pregnancy or to stay in touch with maternity services

• 17 % (direct causes) booked after 22 weeks or had missed 4 ANC appointments

• 14% declared they were victims of DV• 11 % had problems with substance abuse• 10% lived in families known to child protection

services

National Service framework for children, young people and maternity services (DH 2004)

• Acknowledges that asylum seeking women, amongst

others, are disadvantaged because of multiple social problems, including difficulty accessing and maintaining contact with maternity services.

Issues with multi cultural health care systems

• Communication

• Cultural ethnocentrism

• Inter professional cultural barriers

• Equality issues – can be problematic as NHS based on Judo –Christian calendar e.g. some areas will close over Easter and Christmas

• Health beliefs and how we accommodate these within the majority culture

• New problems emerge e.g. Female genital mutilation

• May have complex needs

Influences on how we treat people differently

• Primary socialisation • Secondary socialisation • Peer pressure • Occupational socialisation • Media influences • Lack of education/awareness

How can racism, prejudice or discrimination manifest itself ?

• Language• Stereotyping• Judgemental attitudes • Sweeping generalisations• Fear• Isolation • Politicisation• Anger• Inequalities

(Bilton, 2002)

What is the best approach ? • Universality of provision –an assimilationist

approach to care- make available to all that which is geared to the majority

• Cultural pluralism or “special needs” • Multiculturalism• Celebration of other cultures

(Bilton, 2002)

ReferencesAll Party Parliamentary Group (UK) on Population, development and Reproductive health (2009) Better off dead? May

accessed at www.appg.popdevrh.org.uk

Bilton T, Bonnet, K, Jones P., Lawson T, Skinner D, Stanworth M, Webster, A (2002) Introductory Sociology 4th Edition Basingstoke, Macmillan.

DH (2007) Saving Lives Our Healthier Nation at www.dh.org.uk

DH (2004) National Service framework for children, young people and maternity services at www.dh.org/uk

Equality Act (2010) www.legislation.gov.uk/ukpaga/2010/15/contents

Nursing and Midwifery Council (2008) The Code: standards of conduct, performance and ethics for nurses and midwives May www.nmc-uk.org

United Nations Population Fund ( UNFPA) ww.unfpa.org

United Nations International Children’s emergency Fund (UNICEF ) www.unicef.org.uk

World Health Organisation (2012) www.who.int/topics/maternal_health/en/ (accessed 22/3/12)