Funding Equity: Learning from the Global Grassroots to Save Mothers & Newborns
By Kay Sandberg, the Founder/Executive Director of the Global Force for Healing, and convener of the global Compassionate Birth Network
“Every baby’s first breath on earth could be one of peace and love. Every mother should be healthy and strong. Every birth could be safe and loving. But our world is not there yet. The situation is bad…babies are left unattended, deliveries have become commercialized, and mothers die from hemorrhage after childbirth because they cannot afford proper care.” – Ibu (Mother) Robin Lim, Midwife and Founder/Director, Yayasan Bumi Sehat, Indonesia (Compassionate Birth Network partner)
Robin Lim’s observation above points to the regularity with which violations of personal autonomy and safety occur when birthing families are not in a position to advocate for themselves or have an advocate by their side. Article 7 of the Respectful Maternity Care Charter states that everyone has the right to liberty, autonomy, self-determination & freedom from arbitrary detention. But violations of these crucial human rights occur in all 11 countries in Africa, the Americas and Asia where our partners live and work, and across much of the world. In fact, there is evidence that suggests that, in countries with high maternal mortality rates, the fear of disrespect and abuse that women often encounter in facility-based maternity care is a more powerful deterrent to the use of skilled care than commonly recognized barriers such as cost or distance. Simply put, respectful care saves lives.
“Motherhood in Chains: Detention and Other Violations of Liberty,” the latest episode of Brave Voices, Bold Actions, is a deep-dive into Article 7 of the Respectful Maternity Care Charter, and begins with Marie*, a young Haitian woman who experienced forced detention and other human rights abuses after losing her first baby in childbirth. Compassionate acts by Network partner MamaBaby Haiti included paying for Marie’s bill to release her from the hospital and nursing her back to health.
The false distinction of “U.S.” vs. “global” perpetuates neocolonial patterns that serve only the dominant (often White) power structure, and unduly influence spending on maternal and newborn care. Mainstream media in the U.S. has finally begun to cover widespread disparities in access to quality, affordable, care with dignity as defined by the birthing mother for Black, Indigenous, and People of Color. In fact, there are more similarities than differences in experiences from those marginalized communities in the U.S. and low-resource countries, resulting in needlessly poor birth outcomes.
Our recent collaborative publication, “Funding Equity: Birth Justice and Human Rights in Maternal and Infant Health”, addresses this issue and the effects on funding decisions.
The causes for poor outcomes are many and complex, including poverty and racism. Where our partners live and work, women and girls often have limited access to education and leadership roles, and are considered second-class citizens because of their gender. Often the staff in hospitals where women’s rights are not respected themselves are not treated with respect, are underpaid, overworked, and lack training in respectful care. Assuring human rights during the childbearing years and closing the education gap for girls and healthworkers are highly effective ways to lift communities out of poverty.
Funding for quality care is another critical component, as the report, “Funding Equity” illustrates. Global Force for Healing commissioned the study on funding trends for maternal and newborn health we hope will be published by year-end.**
Here are a few preliminary findings to look out for, thanks to research partner Global Health Visions:
- While U.S. government funding for international maternal health programs steadily increased from 2012 – 2017, the current administration significantly reduced maternal health funding. In FY2020, it was the lowest it has been in ten years.
- The picture for grassroots organizations may be quite different than overall funding trend #1. Some major donors in maternal health are looking to shift funding to the local level, but this shift is happening slowly. This is a big missed opportunity to strengthen the capacity of grassroots organizations, while tapping into what they do best– effectively connecting with and elevating the voices of communities.
- Of roughly $15·9 billion spent on reproductive, maternal, newborn, and child health in 2017, maternal and newborn health only received $3.1 billion or 19% of total aid – by far the lowest amount.
WHAT HAPPENS WHEN ARTICLE 7 IS RESPECTED
What does liberty, autonomy and self-determination actually look like in the birthplace? Here are some examples and remarkable results from grassroots communities, despite chronic underfunding:
- The birthing parent chooses her position in labor, who accompanies her, where she gives birth, and use of pain medication vs. alternative ways of coping with the pain and discomfort of childbirth, to name a few.
- Self-determination means “voice and choice” over all birth-related decisions the person’s physiology allows, after being informed of choices, then ensuring they are respected and confidential. This is person-centered, compassionate care as modeled by our Compassionate Birth Network partners in 11 countries who operate birth/midwifery centers and sexual & reproductive health-focused programs. In our experience, human rights of mamas and babies are respected most often under the midwifery model of care, where personal relationships are formed from the first prenatal visit through six weeks postpartum or longer, by birth-workers from the same community and often, cultural traditions—or health care professionals who deeply respect those traditions.
- Birth outcomes of all Compassionate Birth Network partners are far better than the norm in their countries, in terms of the numbers of mothers and babies who survive childbirth and other key indicators. Most of these grassroots community-based programs have never lost a mother, even after thousands of births! Newborn deaths are typically dramatically lower than the statistical norm for their country.
It is my passionate hope you are inspired to learn and advocate with us, and to support what is already working at the grassroots level, for the well- being of our communities and the world we all call home.
* Name has been changed to protect privacy.
** To learn more about the study when it is published later this year, please subscribe to our e-newsletter: https://globalforceforhealing.org.
The Global Force for Healing convenes the Compassionate Birth Network of autonomous, community-led midwifery (birth) centers and sexual & reproductive health programs in low-resource settings. The Network collaborates to support each others’ sustainability and thriving through educational offerings, joint programming, and connecting Partners to valuable external resources.