"DEVELOPING A ‘HEALTHY MOTHER’ TO HAVE A HEALTHY BABY”
Introduction :
Health is the level of functional and/or metabolic efficiency of an organism at both the micro(cellular) and macro(social) level.
In the medical field, health is commonly defined as an organism's ability to efficiently respond to challenges (stressors) and effectively restore and sustain a "state of balance," known as homeostasis.
The World Health Organization (WHO), defines health as ‘ a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". In more recent years, this statement has been modified to include the ability to lead a "socially and economically productive life." The WHO definition is not without criticism, as some argue that health cannot be defined as a state at all, but must be seen as a process of continuous adjustment to the changing demands of living and of the changing meanings we give to life.
It is true that only a healthy mother can have a healthy baby. So, who is a healthy mother…or a woman who is a potentially healthy mother?
Issues of woman’s health –
Historically and traditionally, women's health was thought to include only issues of childbirth and reproductive health.
Gender-specific health research has demonstrated major differences between the male and female systems in the dimensions of physical, psychological, economic, social, moral & spiritual. The study portrayed women as a distinct group that has unique health concerns over a lifetime.
The current focus is to garner attention to improve the overall quality of women's life and health.
Several issues relevant to women’s health are –
• Reproductive Health - Having access to gynecological services greatly affects the degree to which they are used.
• Heart Disease and Strokes – Post-menopausal women are at greatest risk.
• Diabetes - Women face increased risks of complications from diabetes at every milestone of life.
• Depression - Women report a higher rate of depression than men.Many factors contribute, including family care responsibilities, economic stress, physical illness, violence or abuse, and lack of social support.
• Violence and Abuse - Violence against women cuts across socioeconomic lines, affecting all classes and races.
• Long-Term Care and Medicare - On an average, women have longer life expectancies than men and, as a result, they rely on the health care delivery system
• Caregiving - The vast majority of family caregivers are women-a burden that can result in financial, emotional and physical strains that adversely affect the caregiver's health.
• Economic Status - the lower a woman's income, the higher her risk for physical and mental illness.
• Access to Health Care and Insurance Coverage –
Today, there’s a need to go beyond……..
• Reducing maternal mortality and improving care to women during child birth
• Encouraging family planning
• Upgrading childbirth care – Interventions that save babies lives
• Preventing anemia – good health through good nutrition
• Propagating breast feeding
It is not just enough to make the connection between Maternal Health and Child Survival. What we need is quality in every dimensions of life – be it physical, psychological, social, financial, moral or spiritual
So, when should one begin working towards making a healthy mother? Does it start at the time the woman conceives her first child and comes for her first anta natal check up?...... or, before that, when the girl is poised to tie the marital knot…or even before that….?
We need to trace her life way back to the time when she was born. Today’s mother is that girl child of yesterday. This ‘mother to be’ needs to be assured a healthy life, when she begins her life cycle, so that she can later on, bring forth a healthy child. Yes, the care of that potentially healthy mother should begin from the time she is born and should continue through out her childhood, into adolescence and through adulthood, till she becomes a mother and after. This mother will then qualify to provide good care for her child(ren).
Today’s girl child is tomorrow’s mother, housewife, citizen, teacher, doctor, laborer, and peasant. To protect tomorrow’s mothers, we must nurture the girl children of today and ensure that they are secure in every dimension – physical, psychological, social, financial, spiritual and moral.
The health of the girl child is certainly a concern for paediatricians and obstetrician-gynecologists. Pediatric gynecologic conditions deserve special attention. The obstetric performance of the adult woman depends in large part on the health and healthcare of the girl child. But the need of the day is to educate the girl children and women, and to empower them, make them aware that they are whole human beings, not ‘just girls’ who should be reproductively healthy, but humans who can participate in sports, music and dance and in public arenas with independence and competence, who can create and control their own lives in a beautiful way.
Several issues need to be addressed to ensure a healthy life for the girl child to be a healthy mother -
Today, the critical areas of concern are -.
• The persistent and increasing burden of poverty on women
• Inequalities and inadequacies in and unequal access to education and training
• Inequalities and inadequacies in and unequal access to health care and related services
• Violence against women
• The effects of armed or other kinds of conflict on women, including those living under foreign occupation
• Inequality in economic structures and policies, in all forms of productive activities and in access to resources
• Inequality between men and women in the sharing of power and decision-making at all levels
• Insufficient mechanisms at all levels to promote the advancement of women
• Lack of respect for and inadequate promotion and protection of the human rights of women
• Stereotyping of women and inequality in women's access to and participation in all communication systems, especially in the media
• Gender inequalities in the management of natural resources and in the safeguarding of the environment
• Persistent discrimination against and violation of the rights of the girl child
Discrimination and neglect in childhood can initiate a lifelong downward spiral of deprivation and exclusion from the social mainstream.
The United Nations Fourth World Conference on Women held at Beijing, China in September 1995 for Action for Equality, Development and Peace, had the following strategic objectives -
1. Eliminate all forms of discrimination against the girl-child.
2. Eliminate negative cultural attitudes and practices against girls.
3. Promote and protect the rights of the girl-child and increase awareness of her needs and potential.
4. Eliminate discrimination against girls in education, skills development and training.
5. Eliminate discrimination against girls in health and nutrition.
6. Eliminate the economic exploitation of child labour and protect young girls at work.
7. Eradicate violence against the girl-child.
8. Promote the girl-child's awareness of and participation in social, economic and political life.
9. Strengthen the role of the family in improving the status of the girl-child.
After more than 10 years, few countries have lived up to the commitment made by them. A kind of “gender equality fatigue” and complacency has set in
• Gender discrimination against the girl child violates her human rights and adversely impacts on her health and her life. We as citizens of the country, and as proessionals in every walk of life, have a social and moral responsibility to advocate for the girl child’s right to health and dignity in life.
The kishori Shakti Yojana is one such scheme that seeks to empower adolescent girls, so as to enable them to take charge of their lives. It seeks to provide them with an opportunity to realize their full potential in a wholistic way. The scheme is a redesign of the already existing Adolescent Girls (AG) Scheme being implemented as a component under the centrally sponsored Integrated Child Development Services (ICDS) Scheme. It aims to improve the nutritional, health and development status of adolescent girls, promote awareness of health, hygiene, nutrition and family care, link them to opportunities for learning life skills, going back to school, help them gain a better understanding of their social environment and take initiatives to become productive members of the society
Developing gender equality –
The starting point for reaching a state of healthy mothers and children is the empowerment of women and gender equality. Gender equality and women’s empowerment in health must consider the extent to which women and men have the same ability and access to exercise their right to health and realize their potential to be healthy, contribute to and have control over their healthy development, benefit from medical and technological developments that affect their health, make decisions about their health needs and care, and participate in decision-making that affects their health and that of their children.
More specifically, enabling and ensuring women’s equal access to (equality) and ability to utilize (empowerment) sexual and reproductive health services are fundamental to safeguarding their health and that of their children.
Gender equality and women’s empowerment are integral to the reduction of maternal and child mortality and ensuring healthy mothers and children.
Women and men need to work together with children and youth to break down persistent gender stereotypes, taking into account the rights of the child and the responsibilities, rights and duties of parents.
Expanding Beyond "Mother-Child" Services -
Bolivian studies indicate how male involvement and other "gender awareness" steps can improve services.
There is a need to introduce ‘father-craft’. Family roles continue to change, especially in today's over-scheduled, stressful environment
• Fathers should play a crucial role in the upbringing of children.
• Fathers should emerge from the confines of man's traditional function as a breadwinner and provider
• They should have an active and involved role in their children's lives. The conflict between career and family continues, and child care from dad is especially needed in a two-career family.
"Mother-father" and "mother-doctor" relationships are also vitally important for reproductive health.. Studies by FHI's Women's Studies Project in Bolivia highlight the need to explore multiple relationships in the reproductive health arena, rather than focusing on women alone or on women and their children.
Attempts to reach beyond women clients to the men in their lives call for innovative reproductive health services. La Casa de la Mujer (The Women's House) organized in Santa Cruz, Bolivia by women to empower women brought to light the fact that focusing on women exclusively rarely solved women's problems and, in some cases, created new difficulties for them.
"When the man does not participate, problems arise," explained Ane Mie van Dyke. a La Casa nurse. "A woman learns something new that the husband doesn't understand, and he does not like to feel stupid in front of his wife." When one client refused sexual relations in order to adhere to the rhythm method of contraception, her partner hit her and forced her to have sex. When she became pregnant, he hit her again. Another client's husband accused her of being unfaithful when she brought home condoms in an effort to space births.2
Hence working only with women doesn't solve the problems. In terms of family dynamics, reproductive health needs to involve both partners. In medical terms, as well, men need to participate.
La Casa's efforts to involve men in education and services include conducting family planning workshops for couples, working with young men and women, and attempting to incorporate partners of female clients in center activities
With all that’s said and done, dads in most cases no longer want the singular role of "breadwinner." Fathers are trying to spend more quality time with their kids. According to an article, "Promote Father Participation in Early Child Care Programs," from Parents, Inc., while more fathers are becoming more involved in their children's lives, over half of all fathers in two-parent families have no significant involvement at their child's school (including child care).
The Beach Center reported five strategies that promote participation by dads in programs. Care providers should take note and parents can make these requests to their child's caregiver or program to help facilitate involvement by fathers. They include:
1. Offer activities for both parents. These types of activities include preschool parties, PTA, volunteer position that husband and wife can do together, parenting classes, and projects.
2. Schedule activities after work hours on weekdays or on weekends. If additional father involvement is sought, care programs and activities should be scheduled accordingly.
3. Sponsor activities that teach fathers how to help their children learn. Parenting programs that encourage the "learning" process in addition to the emotional side of child care helps to reach out to dads.
4. Showcase pictures of fathers and children around the daycare, school, home and in a child's room. This simple visual method reinforces the importance of fatherhood.
5. Tell dads how much you appreciate their involvement. Fathers should be told thank you and given support throughout the year and not just on Father's Day. Dads contribute to the financial, emotional and academic success of children, and need to be praised for their efforts.
Body and mind - Sexual biology influences the development of cultural roles and relationships in complex ways. That women bear and nurse children, for example, is a fundamental factor in the development of gender identities and symbols, although these identities vary tremendously across cultures and through time.
Likewise, gender practices affect women's physiological development and functioning. While the use of modern contraceptives has many important benefits, methods can sometimes produce undesirable side effects. As such, they can affect women physiologically.
Psychological factors also play a role. Dr. Uriona of La Casa believes that shame, fear and guilt can harm the woman’s health. A repressive social environment, she says, discourages open conversations to help resolve psychological and physical problems. "The stress and oppression that women experience in their lives are often manifested in physical problems, especially gynecological problems," she says. This condition not only harms marital relations but interferes with her performance as a healthy mother.”
In order to improve the population's health in sustainable ways, however, gender sensitive services must be complemented by structural changes in educational, legal, religious and other institutions that generate and reinforce shame, fear and misinformation, hindering sound reproductive health.
Recognizing differences -
A gender perspective also helps providers recognize and respond to crucial differences among clients. Two kinds of gender differentiation are generally identified. The first involves qualitative differences in the lifestyles and experiences of groups distinguished by their sexual identities, such as wife/mother, single professional mother, or male homosexual. The second involves sexual discrimination in legal, political, religious, educational and economic institutions, where policies and practices tend to transform gender differences into inequalities.
Care needs to help equalize the balance of power between providers and clients.
Conclusion :
That a healthy mother is an assurance for the reward of a healthy child is a known fact. What needs further emphasis is that care of this healthy mother should begin from her childhood by reaching out beyond the confines of just reproductive health . A girl child who enjoys care in all the dimensions of her life viz the physical, psychological, social, financial, spiritual and moral, is sure to grow into a confident and healthy mother, ready to have a healthy child. Further, she would be directly motivated (from her childhood experiences) to give the best to her child. Such a practice is sure to launch a new generation of healthy mothers who are not only obliged to bear healthy children, but also to continue their nurturing skills to make her girl child a healthy mother to be.
Reproductive health and reproductive rights extend beyond family planning. From a gender perspective, women and men are not just reproductive beings, but multifaceted individuals with complex concerns, needs and expectations, all of which are influenced by their gender roles and relationships, developed in specific cultural contexts.
The role of the father in this respect is not to be overlooked. In the present male dominated society, where a woman needs the nod by the ‘man of the family’ to reach out to the horizon, it is necessary that the father is involved in the care of the girl child from the time of birth. The sustenance of the family depends on the income of both the father and the mother. Hence, both the parents need to share the responsibility of bringing up children, especially the girl child, so that she grows up into a healthy woman capable of starting and nurturing a family.
So, today there is a need to involve the father to make it ‘healthy family – healthy babies’ slogan, so that the paediatric and obstetric team actively includes the father in every matter concerning the family health, so that the newborn babies can enjoy the benefits as they grow to prepare to be healthy parents. Introduction of father-craft in the antenatal period alongside mother-craft , or even merging of the two to make it a ‘parent-craft’, would go a long way to ensure a healthy life for the progeny.
The obstetric team and the paedeiatric team need to work hand in hand to ensure a safe journey through life for the girl child to grow into a healthy woman and a healthy mother.
This means that the healthy girl child, if given good care will become a healthy mother and will bear healthy babies. Hence, a ‘healthy mother healthy baby’ equation could be read in a different way –
‘The healthy baby – healthy mother – healthy baby formula’. Here, the healthy baby, when well supported, would grow into a healthy mother, who will then bear a healthy baby. Today we need to modify the adage to a more relevant one – ‘Behind every healthy mother is a healthy child’. This child is not anyone, but the mother to be….
- Nirmala Roberts
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