Widening the network – connection to community

The maternity health service has a broad reach – it’s not just those on the ‘inside’ – the midwives, doctors, consumers, management and health service operators – who are involved.

Politicians, health policy planners, consumer groups, government agencies and health bodies – all have a stake in maternity care provision and all impact the actual experience of the end-user of the system: the women and families at the centre.

For example, in order to get funded for a new birth centre, or a new model of care requiring new staff, decisions need to be made at many levels. Consumer groups need to be consulted. Agreements need to be made at a political and government level. Communities will be consulted. Even a midwife working in private practice is impacted at the level of community and politics: from governmental regulatory bodies for midwives, to professional associations and community-run birth support groups.

Women must be heard

In some countries (and some would argue this remains a global pattern), gender disparity issues limit the resources spent on women. Birth, being an inherently female activity, is at risk of being under-funded and not well resourced. As Dr Mahmoud Fathalla, maternal advocate for the WHO, asserts about the current global maternal morbidity and mortality statistics:

“Women are not dying because of diseases we cannot treat… they are dying because societies have yet to make the decision that their lives are worth saving.”

(M.F. Fathalla, 2006)

Women need the opportunity to be heard and contribute at every level – from community to government stakeholder meetings. Being heard, understood and respected within communities and by community leaders results in inherently women-centered issues (such as maternity care) being appropriately resourced and adequately funded.

This is dependent upon strong, trusting, respectful relationships at every level: at the macro level – women being respected in their community and by their community leaders, with clear lines of communication and accountability – right down to the grassroots level of community. Within the framework of maternity care provision there are relationships among different players, integrated at every level of care. Again, these relationships exist whatever the model of care: from homebirth to tertiary hospital care.

Through grassroots, locally-led initiatives, as well as through decisions made a political levels, integration and communication are key in making a system that works at the level of community.

Over to you

Dr Mahmoud Fathalla said that “women are not dying because of diseases we cannot treat… they are dying because societies have yet to make the decision that their lives are worth saving.”

Do you see any truth to this statement? Share your thoughts with the group.