Tag: maternal health

Bioethics Blogs

Special Issues! The Publics of Public Health in Africa | Anthropological Interrogations of Evidence-Based Global Health by Anna Zogas

I’d like to highlight a pair of Special Sections in the early 2017 issues of Critical Public Health. The first is “The Publics of Public Health in Africa,” guest edited by Ann H. Kelly, Hayley MacGregor, and Catherine M. Montgomery. The second is “Anthropological Interrogations of Evidence-Based Global Health,” guest edited by Elsa L. Fan and Elanah Uretsky. Here are the abstracts for the articles in both sections!

 

The Publics of Public Health in Africa 

The publics of public health in Africa (open access)
Ann H. Kelly, Hayley MacGregor & Catherine M. Montgomery

Excerpt: How do we understand the public character of public health in contemporary Africa? What are the parameters of community engagement in health care delivery, medical research and disease control programmes? To what extent is public health in Africa a project led by African Governments? Through what political processes and deliberative practices can African publics influence the priorities of research in health sciences and interventions which aim in broad terms to improve the health of such publics? Drawing insight from empirical research conducted with African scientists, nurses, community members, clinical trialists and policy-makers, this special section examines the multiple ways in which the publiccomes into being around public health provisioning and investigation in sub-Saharan Africa, its role and political reach. Collectively, these papers show how contestation and negotiation around different ideas about who the public is and what being public means can lead to the emergence of conflicting understandings, with implications for who and what is seen to represent the public interest, and for the acceptance of research and other interventions.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Web Roundup: Public Health by Lily Shapiro

I assume everyone is, like me, tired of (and stressed out about) the US election, so let’s take a break from that to take a quick look around at some interesting recent public health stories.

According to data released last month by the Institute for Health Metrics and Evaluation at the University of Washington, the maternal mortality rate in the US is rising, “defying global trends.” In a related article, Newsweek has a long piece on the ways that racism disproportionately disadvantages women of color in terms of maternal health care, exposing them to riskier pregnancies and deliveries; “even when controlling for age, socioeconomic status and education, the U.S. Centers for Disease Control and Prevention (CDC) reports that African-American women…face a nearly four times higher risk of death from pregnancy complications than white women.”

New research published in Radiology shows that playing football can affect the brains of children as young as 8. And, CMV Is a Greater Threat to Infants Than Zika, but Far Less Often Discussed.

Many of you perhaps heard about the fact that Médecins Sans Frontières this month turned down a donation of one million Prevnar13 vaccines from Pfizer. Prevnar13 is a vaccine which protects against a particular bacteria that causes pneumonia, the leading cause of death of children under 5 (1.4 million deaths per year), and is recommended for all infants. Pfizer makes USD 6.245 billion in revenue per year from this drug alone, but it is too expensive for MSF to purchase regularly. This article in The Atlantic details the problems with donations of this kind, the reasons for which MSF turned it down, and the opacity of vaccine prices on the global market.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Top of the Heap: Anna Waldstein by Hannah Gibson

[For this installment of the Top of the Heap series, I spoke with Anna Waldstein, who is an ecological anthropologist and lecturer in medical anthropology and ethnobotany at Kent University, UK.]  

In response to discussions with my colleagues about ways to encourage our students to read more ethnographies, I designed a new assignment for “Anthropology of Health, Illness and Medicine,” the last time I taught it. Students were asked to read an ethnographic study with a medical anthropology theme (i.e. a “medical ethnography”) and to present a synopsis to their seminar group. My ulterior motive was to encourage students to read some of the medical ethnographies at the top of my heap, so that I could at least learn more about them, if I could not get around to reading them myself. In this respect, the assignment was only partially successful. The books at the top of my list were either not selected by any of the students, or were read by students in the seminar groups led by my colleague. However, several books that were (originally) much closer to the bottom of the heap (and some not even on the list of recommended ethnographies) generated memorable class discussions and have piqued my interest.

As I am getting ready to send my publisher the final version of my own forthcoming book on the “Hispanic health paradox” and “health sovereignty” in the United States, Gálvez’s (2011) Patient Citizens, Immigrant Mothers: Mexican Women, Public Prenatal Care, and the Birth-weight Paradox is at the top of the heap of books that I need to finish reading.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Critical interventions in birth in the first 1000 days by Jennifer Rogerson

Choice and the assigning of value in the practices and crafting of life-giving work

In healthy birthing initiatives described by, among others, the World Health Organization, emphasis has been placed on the importance of ‘the golden trio’: vaginal birth, breastfeeding and immediate skin to skin contact after birth. These three experiences are said to seed a baby’s immune system with good bacteria, preventing diseases from allergies through to diabetes and obesity, and facilitating neuroplasticity and brain development. In resource-poor countries, these are cheap and effective public health interventions. Despite these benefits, South Africa’s middle class caesarean section rate is extremely high.

My research is part of the University of Cape Town’s First 1000 days research cohort led by Fiona Ross and focuses on midwife assisted birth. While the WHO recommends that a country should not have a caesarean-section rate higher than 10-15% of all births, South Africa has extremely high rates of c-section birth, largely testament to the highly medicalized private health care system enjoyed by the rich. In some private sector hospitals, particularly in metro centers, the rates vary between 70% and 95%, despite a strong push by the state for so-called ‘natural delivery’ (vaginal birth). Given the prevalence of c-sections in the private sector, and that sector’s broad refusal of midwife attended (rather than obs/gynae attended) birth, middle class women who want a vaginal birth find it difficult to have the ‘natural birth of their dreams’. Private midwife consultation is one of the few options available to them. With a powerful rhetoric encouraging c-sections in the South African context (obstetricians have extremely high medical malpractice insurance fees with increasing legal suits, convenience for doctor and patient in choosing a birth date and the perception that c-sections are safer), women who chose vaginal birth with a midwife are making important medical choices that they understand in political terms.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Global maternal mortality: significantly reduced in the last 15 years

A study that included data from 171 countries showed a reduction in maternal mortality, with 385 deaths per 100,000 births in 1990 compared to 216 in 2015. Percentage-wise, the reduction varied in this time period from an annual reduction of 1.8% in the Caribbean region to 5% in East Asia (The Lancet 387; p462–474, 2016).

This, of course, is encouraging news, since around nearly 830 women die each day of preventable causes related with pregnancy and childbirth. Ninety-nine percent of maternal mortality occurs developing countries, and is higher in rural areas and the poorest communities, according to data from the World Health Organisation (WHO).

Improvement in maternal health was one of the eight Millennium Development Goals (MDGs) adopted by the international community in 2000. With respect to these, countries committed to reducing maternal mortality by 75% between 1990 and 2015.

Exemple. Uganda rates by years

Exemple. Uganda rates by years

Since 1990, the number of maternal deaths has fallen by 43%. Several sub-Saharan countries reduced their maternal mortality to half, while in other regions, such as Asia and North Africa, the progress has been even greater. Between 1990 and 2015, world maternal mortality rates (MMR) i.e. the number of maternal deaths per 100,000 live births, only fell by 2.3% per year. However, an acceleration in this reduction was observed from 2000, and in fact in some countries, the annual reductions in maternal mortality between 2000 and 2010 exceeded the 5.5% necessary to reach the MDGs.

La entrada Global maternal mortality: significantly reduced in the last 15 years aparece primero en Observatorio de Bioética, UCV.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Zika: An opportunity to improve pre-conception care.

by Andrea L. Kalfoglou, Ph.D.

The Zika virus is spreading rapidly throughout parts of South and Central America. Public health officials are concerned because there is a correlation between the emergence of the Zika virus and a dramatic increase in number of babies born in Brazil with a severe birth defect called microcephaly.

The CDC has warned women from the U.S. who are pregnant or thinking about becoming pregnant not to travel to certain areas in Central and South America. Additionally, infectious disease specialists are concerned that Zika may adapt to transmission by a type of mosquito common in 32 states in the U.S.

There is no commercial test available to diagnose Zika; however, there are testing protocols available through the CDC and some state health departments.

According to Francis Collins, Director of the National Institutes of Health, researchers are working to develop a diagnostic test that could be widely available. If such a test becomes available, pregnant women may seek out this test to determine whether they have been infected. Additionally, because microcephaly is such a severe birth defect, women considering pregnancy may begin to request diagnostic testing for Zika. This consumer-driven demand for pre-conception testing could create a window of opportunity to improve delivery of pre-conception care should primary-care providers seize on this opportunity.

Pre-conception care is not routinely provided to women of reproductive age. Primary-care providers have said this is because women do not seek out this care and primary-care providers do not have time to provide this care given all of the competing health-prevention needs.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Using birth control to combat Zika virus could affect future generations

Written by Simon Beard
Research Fellow in Philosophy, Future of Humanity Institute, University of Oxford

This is a cross post of an article which originally appeared in The Conversation.

In a recent article, Oxford University’s director of medical ethics, Dominic Wilkinson, argued that birth control was a key way of tackling the Zika virus’s apparently devastating effects on unborn children – a strategy that comes with the extra benefit of meeting the need for reproductive health across much of the affected areas.

However, although this approach might be one solution to a medical issue, it doesn’t consider the demographic implications of delaying pregnancy on such an unprecedented scale – some of which could have a significant impact on people and societies.

In most of the world, Zika outbreaks have had no noticeable effect on children, but the most recent outbreak in Brazil was associated with a significant spike in the incidence of microcephaly, a condition that causes babies to have small heads and underdeveloped brains. This rose from a background incidence of around 0.07% of live births to 2% – around 4,000 new cases since October in a country of just over 200m.

Microcephaly causes intellectual impairment in almost all cases and can also cause developmental problems and mild seizure. Life expectancy is also thought to be reduced, although whether this is caused by microcephaly itself or its associated disability is unknown.

Let us assume that children born with microcephaly suffer a reduction in life expectancy. And each year of life lived with microcephaly is also associated with an 82% reduction in quality of life.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

In the Journals, January 2016 by Aaron Seaman

In addition to our regular roundup of journal offerings, the current issue of Medical Anthropology is a special issue, entitled “Diversions of Biomedical Technologies in a Globalized World,” on which we have posted here.

Critical Public Health

Blood and the public body: a study of UK blood donation and research participation

Simon Cohn

This paper draws on interview and ethnographic data to describe donor accounts of blood donation in England, and how this contrasts to their responses when invited to also participate in two associated public health research studies. Donor views about usual blood donation combine the general, if flexible, theme of altruism with powerful notions of the social collective, giving rise to the sense that they are making tangible, physical ties and constructing a social body through the act of donation. However, their accounts of research participation are more open and ambiguous. At the core of this is the sense that they do not know what exactly they are ‘giving’, since the research is ultimately about collecting information, rather than substance. Equally, the donor-participants are not sure who they are giving it to, since they have no sense of the social collective that potentially might benefit from the research. The paper argues that the concept of ‘the population’ in public health is not only a term that is alien and abstract for the blood donors, but increasingly is a post hoc category for large-scale epidemiological studies. As a result, rather than supporting the obvious assumption that individual bodies make up populations, in practice, particular population renderings determine the nature of individual bodies.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics Blogs

Conference review: MAGic 2015 Anthropology and Global Health: Interrogating Theory, Policy and Practice by Josien de Klerk

“Global Health is like a containership. The multiple actors —international and local NGOs, humanitarian organisations, scientists, activists, politicians — operate the tugboats, attempting to nudge, tug and pull the ship into its dock, where it will be offloaded and transported, i.e. implemented, by those who were able to demonstrate the greatest technical skill and advantage. […]As anthropologists, we must continue to engage in the Sisyphean task of trying to steer the Global Health container ship, but we should also not forget that we are on the ship, nor that it is often easier to shape both the trade routes and shipping manifesto before the ship gets under way.” –Eileen Moyer

This metaphor, brought forward by Eileen Moyer in a panel on containment organized by Alex Nading and Rebecca Marsland, is just one of the many creative proposals about the relationship between global health and medical anthropology that circulated at MAGic2015. The conference, jointly organized by the EASA Medical Anthropology Network and the RAI Medical Anthropology Committee, was held at Sussex University September 9-11. The MAGic conference aimed to interrogate the paradigms and practices of Global Health.

From Wednesday to Friday, opening keynote lectures were followed by six parallel panel sessions for a total of 52 panels and lunchtime events, including the Sussex Glocal Health Hive, the annual meeting of the EASA Medical Anthropology Network and a Wellcome trust presentation on funding opportunities. The conference drew 350 participants, of whom almost a third were young scholars working in Global Health. The third meeting of its kind — in 2011 the EASA medical anthropology network held a conference on the theme of medical pluralism in Rome and in 2013 EASA and SMA joined to discuss “Engagements and Encounters” in Tarragona — the conference again offered a rich platform for formal and informal debate, the start of new collaborations and initiatives, and the space for interdisciplinary engagements.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

Bioethics News

Rohingyas battle population control

Somewhere between 6,000 and 20,000 Rohingya refugees from Myanmar are drifting in the Andaman Sea while neighbouring countries take turns to deny them entry.

“What we have now is a game of maritime Ping-Pong,” Joe Lowry, of the International Organization for Migration in Bangkok, told the New York Times. “It’s maritime Ping-Pong with human life. What’s the endgame? I don’t want to be too overdramatic, but if these people aren’t treated and brought to shore soon, we are going to have a boat full of corpses.”

Why are they fleeing? “It’s a combination of things,” says one observer. “Their lives have become worse and worse.”

One reason is probably old-fashioned population control. The parliament of Burma (officially known as the Union of Myanmar) recently passed a new “population control” bill that could represent a serious setback for the country’s maternal health advances if implemented in a coercive or discriminatory manner, according to Physicians for Human Rights (PHR).

The bill, which introduces the practice of “birth spacing” or a three-year interval for women between child births, is expected to be signed by President Thein Sein in the near future.

Although the bill seems designed to implement the Millennium Development Goals, which will expire in 2015, it could easily be used as a tool to oppress Myanmar’s ethnic minorities, especially the Muslim Rohingyas in the north.

Regional authorities will be able to impose population policies if population growth, accelerating birth rates, or rising infant or maternal mortality rates are negatively impacting regional development. According to The Irrawaddy newspaper, an “imbalance between population and resources, low socio-economic indicators and regional food insufficiency because of internal migration” are also reasons to invoke the law.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.