2/20/2021 1 Comment Gender Inequality and Birth TraumaFollow on from '1/9/2021 - LOCAL AND GLOBAL BIRTH TRAUMA AND UN SDG#5' The United Nation’s (UN’s) Sustainable Development Goal 1 of achieving gender equality and empowering all women and girls is an important goal to focus on in my future midwifery profession as the disparities in maternity care are still to be resolved. In this essay I will identify the challenges to the common good in these disparities. I will then discuss the solutions I feel most relevant to help achieve this goal. I will describe how proposed solutions contribute to the realisation of the common good and what the barriers may be in achieving them.
Gender equality means that women and girls enjoy the same rights, resources, opportunities and protections as men and boys. This is important when addressing the common good of a local and global community. Common good is when the inherent human dignity of each individual within that group is acknowledged and is able to flourish to its full potential 2. It also acknowledges that ‘all human beings are born free and equal in dignity and rights ‘ 3. This includes how woman are treated in childbirth. Woman who have been mistreated in their birth process suffer short and long-term physical and psychological health problems 4. These can have an effect on the infant and future child 5 and affect their capacity to thrive and be an active participant in their community. When the common good and therefore gender equality are realised, we will see safer, healthier populations 6. Women will birth feeling empowered to make informed, autonomous choices and will be supported through those choices and whatever outcome follows. This is an ideal situation applicable to the local and global maternal environment. Anecdotal evidence from my local community of public hospitals in Melbourne reflects that women’s birthing processes are far from this ideal. The research tells us that post-traumatic stress rates are as high as 9% for post-natal women 7 and suicide is the third highest cause of maternal deaths in Australia 8. Globally, evidence of the rate of acquiescence and subsequent mistreatment of women in maternity care settings is as high as 40% 9,10. Those joining the midwifery profession have many ways as individuals and groups to address these poor outcomes. We are front-line providers with substantial reach and have the direct capability to help achieve and sustain the UN’s gender equality development goal 11. I will propose three of these solutions within the local and global environment. The first is working within a midwifery-led, continuity of care (COC) model and ensuring that woman have access to woman-centred care. This model is where the midwife is the primary carer from the initial maternity appointment, up to six weeks post-partum 12. Within this model a trust relationship can be established, and midwives can offer person specific knowledge, empowering women to make informed, autonomous choices about their care. Women who participate in COC have better healthcare outcomes and higher satisfaction rates 12,13. The partnering relationship empowers women and is endorsed by the International Confederation of Midwives and the Nursing and Midwifery Board of Australia 14,15. Even with the positive research results concerning this model of supporting woman, it is still only experienced by a very few. Care providers are becoming more specialised and therefore women are more likely to receive fragmented care from different carers 16. This form of fragmented care can be a barrier to establishing a safe, trusting environment where women feel equal and empowered to disclose their thoughts and choices around their care 17. My second proposal addresses barriers to achieving gender equity in our health system. Decisions relating to women’s care should be facilitated with the inclusion of the community it directly relates to. This is referred to as ‘subsidiarity’ and involves the participation and willingness of people to contribute to the consultation process, while keeping in mind the principle of the common good 18. Involvement may include advisory groups within professional employment, joining and being active with the Australian College of Midwives, offering time to projects with the International Confederation of midwives and getting involved with non-government organisations like Human Rights in Childbirth. It is imperative to increase the involvement of midwives in policy and decision-making forums on an institutional, national and international level 11. By being a part of larger organisations, we can advocate for health care policy development, planning, and funding that promotes human rights in childbirth and supports gender equity in places where decisions are made. This advocacy gives a voice to those who often do not have the capacity to be heard in a particular setting 19. A third solution is community engagement. This is an action or process to build relationships with the intention of benefitting the values of a community or group brought together by location, interest, circumstances or vision 20. We can come together as a global family to care for the common good by generating a strong sense of solidarity and connection to offer women a louder voice to address the disparities of those whose rights are extremely compromised. This leads to improved outcomes for communities 21 and stimulates greater international collaboration to attain the UN’s Social Development Goals. Professionals are also able to acquire new skills through mutual learning to bring back to their home environments 11. There are many maternity care engagements internationally to be involved in, particularly in third world countries where resources are lacking, and where women are often not receiving the needed treatment. These engagements may be ‘on the ground’ clinical support, but we can also utilise our own networks to advocate for these people and promote their needs and procurement of resources to improve women’s chances of flourishing within these populations. Some organisations I have become involved in include Birth For Humankind (Melbourne), Birth Time: the documentary (Australia), Loas Birthwork (Loas) and Bumi Sehat (Indonesia). Barriers to involvement in decision making and community engagement groups may include accessibility issues by way of location, skills, resources or language. Realising and agreeing on what constitutes the common good may also be a challenge when many ideas are shared in the community, but ‘free societies do not stay free without the involvement of their citizens’ 22. We can however be open to these challenges and create good conditions for relationship, participation, and community 22. In summary I have examined the gender equity issues for women in my future midwifery profession in my local and the global community. I have addressed how realising the common good is related to achieving the UN’s Sustainable Development Goal of achieving gender equity and empowering all women and girls. I have proposed ways that my professional community can contribute to achieving these goals by working in and advocating for continuity of care models, participating in decision making groups and engaging in community to improve outcomes. As a global midwifery community, we are brought together by focusing on the UN’s goals, but through individual connection to the woman we are working with, we can make these aspirations grow, one woman and baby at a time. References (1) United Nations. Goal 5: Achieve gender equality and empower all women and girls https://www.undp.org/content/undp/en/home/sustainable-development-goals/goal-5-gender-equality.html (accessed Jan 10, 2020). (2) Part Three: Life in Christ https://www.vatican.va/archive/ccc_css/archive/catechism/p3s1c2a2.htm (accessed Jan 28, 2021). (3) United Nations. Universal Declaration of Human Rights https://www.un.org/en/universal-declaration-human-rights/index.html (accessed Aug 29, 2020). (4) Curtin, M.; Savage, E.; Leahy‐Warren, P. Humanisation in Pregnancy and Childbirth: A Concept Analysis. J. Clin. Nurs. 2020, 29 (9–10), 1744–1757. https://doi.org/10.1111/jocn.15152. (5) Anderson, C. A. The Trauma of Birth. Health Care Women Int. 2017, 38 (10), 999–1010. https://doi.org/10.1080/07399332.2017.1363208. (6) The benefits of gender equality https://www.vic.gov.au/benefits-gender-equality (accessed Jan 9, 2021). (7) Simpson, M.; Schmied, V.; Dickson, C.; Dahlen, H. G. Postnatal Post-Traumatic Stress: An Integrative Review. Women Birth 2018, 31 (5), 367–379. https://doi.org/10.1016/j.wombi.2017.12.003. (8) Australian Institute of Health and Welfare. Maternal Deaths in Australia. 2019. https://doi.org/10.25816/7Q4E-G697. (9) Bohren, M. A.; Mehrtash, H.; Fawole, B.; Maung, T. M.; Balde, M. D.; Maya, E.; Thwin, S. S.; Aderoba, A. K.; Vogel, J. P.; Irinyenikan, T. A.; Adeyanju, A. O.; Mon, N. O.; Adu-Bonsaffoh, K.; Landoulsi, S.; Guure, C.; Adanu, R.; Diallo, B. A.; Gülmezoglu, A. M.; Soumah, A.-M.; Sall, A. O.; Tunçalp, Ö. How Women Are Treated during Facility-Based Childbirth in Four Countries: A Cross-Sectional Study with Labour Observations and Community-Based Surveys. The Lancet 2019, 394 (10210), 1750–1763. https://doi.org/10.1016/S0140-6736(19)31992-0. (10) Betron, M. L.; McClair, T. L.; Currie, S.; Banerjee, J. Expanding the Agenda for Addressing Mistreatment in Maternity Care: A Mapping Review and Gender Analysis. Reprod. Health 2018, 15 (1), 143. https://doi.org/10.1186/s12978-018-0584-6. (11) Rosa, W. E.; Kurth, A. E.; Sullivan-Marx, E.; Shamian, J.; Shaw, H. K.; Wilson, L. L.; Crisp, N. Nursing and Midwifery Advocacy to Lead the United Nations Sustainable Development Agenda. Nurs. Outlook 2019, 67 (6), 628–641. https://doi.org/10.1016/j.outlook.2019.06.013. (12) Sandall, J.; Soltani, H.; Gates, S.; Shennan, A.; Devane, D. Midwife-Led Continuity Models versus Other Models of Care for Childbearing Women. Cochrane Database Syst. Rev. 2016. https://doi.org/10.1002/14651858.CD004667.pub5. (13) Jeffers, H.; Baker, M. Continuity of Care: Still Important in Modern-Day General Practice. Br. J. Gen. Pract. 2016, 66 (649), 396–397. https://doi.org/10.3399/bjgp16X686185. (14) International Confederation of Midwives. International Code of Ethics for Midwives https://www.internationalmidwives.org/assets/files/general-files/2019/10/eng-international-code-of-ethics-for-midwives.pdf. (15) Nursing and Midwifery Board of Australia. Code of Conduct for Midwives. Nursing and Midwifery Board of Australia. 2018. (16) Jairath, N.; Donley, R.; Shelton, D.; McMullen, P.; Grandjean, C. Nursing and the Common Good. Soc. Justice Cathol. Health Care 2006, November-December 2006, 59–63. (17) Viveiros, C. J.; Darling, E. K. Barriers and Facilitators of Accessing Perinatal Mental Health Services: The Perspectives of Women Receiving Continuity of Care Midwifery. Midwifery 2018, 65, 8–15. https://doi.org/10.1016/j.midw.2018.06.018. (18) Carter, D. What is Subsidiarity? https://leocontent.acu.edu.au/file/5097fe6c-c77e-4787-bfe9-bf98714d060d/21/UNCC100Refresher.html (accessed Jan 28, 2021). (19) UNCC300 Module 3: Principles of Advocacy. Australian Catholic University 2018. (20) Moore, T.; McDonald, M.; McHugh-Dillon, H.; West, S. Community Engagement: A Key Strategy for Improving Outcomes for Australian Families. 2016, 39, 25. (21) Burton, P.; Goodlad, R.; Croft, J. How Would We Know What Works?: Context and Complexity in the Evaluation of Community Involvement. Evaluation 2006, 12 (3), 294–312. https://doi.org/10.1177/1356389006069136. (22) Mortensen, J. N.; Bech, E. M.; Godrim, F. The Engaged Human: You Are Free for Community. In The Common Good : An Introduction to Personalism; Vernon Press, 2017; pp 57–79.
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