Making Maternal Health Safer

About a month ago, the NYT published an op-ed by Nicholas Kristof called Crisis in the Operating Room.

The conditions Kristof describes in Karachi, Pakistan highlight why organizations such as LifeSpring fill such an urgent need.  But of course, this is needed not just in India and Pakistan, but around the world.

The problem isn't just about lack of finances -- although that's surely a huge part.  Just as big are challenges relating to cultural norms and ideals -- in this case, views around gender.  This is certainly something I've come across myself in the short time I've been here.

Last year, John and I filmed videos of interviews with low-income Indians, speaking about their views of health and healthcare.  In interviewing the village's local health provider, he himself admitted to feeding his sons more than he fed his daughters when they were growing up!  

When his eldest daughter was pregnant for the first time, the family believed it would be a girl (sex determination by ultrasound has been illegal in India since the 1994).  They took her to the free government hospital. 

For her next pregnancy, the family was convinced the baby would be a boy.  They sold their assets and went into debt to admit her to the expensive, high quality private hospital.  The baby boy soon died upon delivery, and the local health provider talks about how much debt they still have.

What's heartbreakingly amazing is how easy it was to get this village health provider to share his story -- as though of COURSE they would pay for high quality care and go into debt if the baby were a boy.

These thoughts went through my head in reading Kristof's op-ed.  He tells the heartbreaking story of Shazia Allahdita, aged 19, whose baby died during an emergency C-section.  

He writes:

Shazia’s suffering is typically unnecessary. It all would have worked out fine if she had gone to a hospital to deliver her baby. She wanted to. Her husband and relatives all agreed, when I interviewed them later, that she had had her heart set on delivering at the public hospital here. It’s also free, so long as supplies haven’t run out (other times, family members have to rush out to buy supplies).

But Shazia’s female in-laws thought that a hospital birth was a silly extravagance, and a young Pakistani woman is at the mercy of her mother-in-law and sisters-in-law. (In Pakistan, men are little involved in such decisions about childbirth.) It didn’t help that the in-laws resented Shazia because she and her husband, Allahdita, had breached tradition by marrying out of love rather than by family arrangement.

When Shazia went into labor, the family summoned a traditional birth attendant to help with the delivery. Hours passed. Nothing happened. Shazia asked to go to the hospital, but it was far away and would require what for them would be an expensive taxi fare of 300 Pakistani rupees, equivalent to about $3.75.

“If she went to the hospital, then every time the family visited it would be a long way to go and very inconvenient,” explained an aunt, Qamarunnisa. “It was so much easier to go to the local health post. It seemed easier.”

So the family eventually took her to a local clinic, where Shazia struggled to deliver for another 24 hours of labor. The family discussed taking her to the hospital, but the obstacle was the 300 rupee taxi fare. “If it hadn’t been for the money, she would have come here,” said Qamarunnisa.

But nobody wanted to pay. Shazia’s in-laws truly are poor, but it’s hard to imagine that they would have balked if it had been a man in the family who was in danger — or if they had known that Shazia was carrying a baby boy.

“If they had known it was a son, they would have come up with 500 rupees,” said Dr. Sarah Feroze, as her colleagues struggled to save Shazia and her baby.

Full op-ed here.