Michelle Anderson, Editor, Essentially MIDIRS
Hello, and welcome to this month’s midwifery blog – in which myself and Midwifery Digest editor Cathy Ashwin discuss topical issues in midwifery.
The ‘dissolution of responsibility’ is a psychological phenomenon referring to the fact that individuals are less likely to take action in a given situation when large groups of people are involved. It is quite simply a thought process which (whether consciously or not) allows a person to justify not taking responsibility because it is anticipated that others will do so.
I believe this is quite common practice, and although I only have anecdotal evidence to support my statement, primarily based on my own observations of human behaviour, I can perhaps share some thoughts which might convince you.
Quite recently I was extremely disturbed by the BBC film Shooting dogs, which gave a graphic and true account of the Rwandan genocide in 1994. However, what really perturbed me was that many members of the film crew had not only experienced and survived the genocide, but they lived with the aftermath of having seen their loved ones mutilated by extremists in a barrage of racial hatred that could be compared to the Holocaust.
Children were hacked to death by machetes in front of their mothers, wives were raped in front of their husbands and through all of it the United Nations stood by and watched. Why? Political leaders did not use their authority to challenge the atrocity of what was happening in Rwanda. In short, it was a dissolution of responsibility on a massive scale.
Responsibility
The ugly remnants of extremism which, throughout history, has caused pain, suffering and death, led me to think about maternal and newborn mortality. Do we, as midwives, take enough responsibility in acknowledging women who are dying in childbirth on a global level?
For those of us who work in the UK and have the luxury of excellent training and a well-equipped National Health Service, maternal and newborn death is a relative rarity, but for millions of women in developing countries, death caused by easily preventable complications during labour and birth is a harsh reality.
Is it uncomfortable to ask if we, as trained professionals, are doing enough to help eliminate the atrocity of maternal and newborn mortality in the 21st century?
The World Health Organisation states that globally ‘maternal mortality is unacceptably high’ (WHO 2012). In fact, 350,000 women die every year from complications relating to labour and birth. This is almost 1,000 women per day (UNFPA 2011).
The most common causes of these deaths are conditions such as: pre-eclampsia, postpartum haemorrhage, sepsis and unsafe abortion, and other conditions include malaria and AIDS (WHO 2012).
However, it doesn’t end here, an estimated eight million more women su”er serious illnesses and lifelong disabilities as a result of complications during childbirth. Just as worrying are the figures for newborn deaths, which are in the region of three million babies every year, furthermore at least two million babies are stillborn (WHO 2014).
Needlessly dying
So why are these women and babies needlessly dying? There are the obvious reasons, such as: poverty, reduced access to health care services and a lack of education and training. Cultural practices also have a huge impact.
I remember talking to an American obstetrician based in the Republic of Chad a few years ago. He told me that many of the women he looks after refuse to feed their babies during the first few days of life because they believe the colostrum is dirty! As you might expect, this results in some very unwell, dehydrated infants, many of whom — unsurprisingly — die.
The pioneering organisation Half the Sky argues that government spending on maternal and newborn health has never been a priority and that ‘not enough resources are being dedicated to address the lack of medical accessibility and care for women worldwide. Americans today spend on maternal health less than one-twentieth of a percent of the amount we spend on our military’ (Half the Sky 2014).
In 2010 the health of women and children was a predominant feature at the World Health Assembly, the G8 Summit, the Paci!c Health Summit and the African Union Summit.
This led to the Secretary General of the United Nations launching a global strategy for women and children’s health and consequently the Millennium Development Goals, specifically 4 and 5, were set to improve maternal and newborn health.
Although better outcomes for mothers and babies have been seen, there are large disparities in mortality rates between developing countries which suggests there is much work still to do (UNFPA 2011).
Thankfully, many midwives and other health professionals do share in the responsibility of helping to reduce maternal and newborn mortality and work hard to raise awareness of key issues in order to make positive changes worldwide.
ICM Congress
The International Confederation of Midwives (ICM) is one excellent example of this. The ICM works closely with midwives and midwifery associations globally to secure women’s right and access to midwifery care, before, during and after childbirth (ICM 2014).
June see’s the ICM’s 30th Triennial Congress in Prague, which promotes the theme ‘improving women’s health globally’; this is also where the second UNFPA report, The state of the world’s midwifery 2014, will be launched.
To celebrate the theme, the ICM are opening the Congress by staging a fantastic event that aims to encapsulate the strength and unity of midwifery worldwide, called ‘Voices of Midwives’. Attendees of the ICM Congress will be asked to join and sing together in Prague accompanied by a 40-piece orchestra, and the event will be streamed live so that midwives around the world can join in.
Therefore, to support the ICM Triennial Congress, it seems only appropriate that June’s EM should be our very first Special Edition, which focuses on improving maternal and newborn health across the globe.
Perspective
As a final word, it is not my intention to trivialise the deaths of innocent human beings from two of the most atrocious humanitarian crimes in the 20th century by presenting the number of deceased in cold-blooded figures. However, it is time to put some perspective on the harsh reality of maternal and newborn mortality.
For example, between April and June 1994, 800,000 Rwandans were killed in the space of 100 days during the genocide (BBC News Africa 2011) and between 1933 and 1945 over six million Jews were murdered in the Holocaust, which equates to an average of 500,000 innocent people annually.
Today, in the 21st century, over 350,000 women and three million babies die every year from mainly preventable complications in childbirth (UNFPA 2011). Whilst this is not comparable to ethnic cleansing, it is confined to two minority groups, ‘mothers and babies’, who have no choice but to suffer a fate completely beyond their control.
And whilst I do not suggest that there has been an implemented government strategy to purposely ignore the plight of these vulnerable human beings, I do, without hesitancy, posit the question of whether the unacceptably high numbers of maternal and newborn mortality could be considered a neglectful crime against humanity, in short, yet another example of dissolution of responsibility on perhaps the largest scale to date.
