Shades of Grey

Just got back from the communities with Priya and Grace, one of our outreach workers. We had recently found out that a couple of our Foundation cases ultimately delivered at home, despite having their delivery sponsored, and we wanted to better understand why.

The resulting conversations confirmed what three years living here have taught me: a) there are no easy answers, and b) it's never just about the price.

Theory would say that given the chance to deliver at a high quality private hospital, very low-income women with no alternatives other than delivering at home or at a government hospital would jump at the chance. But reality is not so straight-forward.

Of course, many low-income women do jump at the opportunity and are thrilled to deliver at our hospital, speaking to us about their dreams for their babies.

But others are not. We spoke to one woman today who is pregnant, but not interested in birth sponsorship, although she lives in a small shack given by the government as free housing. When asked, she said that her neighbor will come and deliver the baby at her house for her. Is her neighbor any sort of clinician or nurse? "No, she is poor and uneducated" was the reply... "She is in her 80s" -- her age, then, makes her a key influencer and decision-maker in the community. She has delivered other babies here, in a community where delivering at home is what's considered "normal." To shift the paradigm, then, "normal" must be redefined.

When asked if she was fearful of delivering at home, she replied: "Why would I be fearful? All my family will be with me."

In the public health space, a lot is always talked about regarding "education." Information is clearly important. But there are also considerations based on some degree of logic, which also must be addressed. For instance, why travel to a hospital if your neighbor can deliver your baby? -- AND she has experience doing this with people you know and love? -- nevermind she has no medical background.

And thus the tip of the iceberg, in the challenge of converting need to demand.