The Political Complexities of Safe Motherhood
17 Pages Posted: 13 Aug 2009 Last revised: 18 Sep 2009
Date Written: 2009
Abstract
In this paper I will examine the political and public health dimensions of global Safe Motherhood initiatives in order to: 1) consider the full range of implications for public health action in this area of women’s health. The leading cause of maternal death, hemorrhage (WHO 2005: 62), is associated with, if not a proxy for, induced (often illegal) abortion, yet availability of safe abortion services is a cautiously stated (at best) objective of the initiatives. Further, Safe Motherhood programs aim to improve pregnancy and birthing outcomes through various means (namely by promoting family planning, emergency obstetrical care, universal access to skilled birth attendants, improved education), but do not adequately address the (pro)natalist bent of the programming. The language of “Safe Motherhood” reinforces the primacy of the role of mother for women (Rance 1997: 10), which can narrow the scope of policy intervention to improve health; and 2) consider the extent to which Safe Motherhood initiatives attend to both inequality and identity. According to Costello, Azad and Barnett, there are many “reasons why a policy of health centre-based interpartum care might not be the most successful or cost-effective approach to reduce mortality in high mortality settings during the next decade” (2006: 1477). They cite various cultural and other contextual factors that interact with patterns of care and health status, which are often neglected in public health discussions of MMR reduction. Similarly, cultural preferences for “natural,” “traditional,” or “normal” birth often compete with or contradict Safe Motherhood initiatives, and should be considered in relation to public health protocols and objectives.
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