As mobile and web technologies become increasingly accessible to those living in remote poverty around the world, the potential to expand access to health care to underserved populations becomes ever more real.

It’s exciting to see the many ways that innovative people and organizations are able to take advantage of the spread of technology to make positive social change. Ushahidi, an open-source platform that can be used by anyone to collect and visualize user-generated information, is an excellent example. They’re using mobile and web technology – including social media platforms like Twitter – to capture critical up-to-date reports from individuals in crisis areas through crowd-sourcing and filtering.

Check out this short video for Erik Hersman’s brief introduction to Ushahidi:

Ushahidi creates a hub for user-generated crisis information that comes in through text messages, tweets, and emails around a given crisis in a specific geographic area. Their team then uses the “Swift River” filtering system to determine which reports are legitimate and group them thematically. The reports are placed on an interactive map so that users can see exactly where emergencies are being reported. Right now, for example, this tool is making a difference in Haiti by helping aid workers and first responders identify where and for what the needs are greatest.

What if this tool was used for women going through labor or labor-related complications?

There are already some open-source map-based initiatives being built for the maternal health field. The Maternal Health Task Force has designed three interactive, user-generated maps that depict maternal health knowledge hubs, MPH programs offering a maternal health concentration, and organizations working in maternal health. Another key contributor is Maternova, one of the Changemakers early entry prize winners for the Healthy Mothers, Strong World competition, which is building an open-source map of maternal health care facilities around the world.

By combining these maps, which outline the maternal health “supply” worldwide, with information and interactive maps that visually depict demand, perhaps we could create a clearer, more visual picture of the true gaps in health access.

Pregnant women in need of care – or their friends and family – could text an emergency alert to a number assigned by Ushahidi. This would then be transmitted to health professionals in the region, and made widely available on the internet. Though ensuring an immediate response to the requests will take time and a larger overarching strategy, the reporting of this information alone can help direct health care facilitators to the areas most in need.

Let me know what you think about the potential to use mobile and web technologies to crowd source information for maternal health by responding to this post. To learn about other innovative ideas for maternal health, visit www.changemakers.com/maternalhealth.

This story was originally posted on Ashoka’s Change InSight Blog (2/18/10).

Last year, the US debate over health reform took an ugly turn over the issue of maternity care, when Senator Jon Kyl of Arizona blithely declared “I don’t need [it].” Senator Debbie Stabenow of Michigan replied: “I think your mom probably did.”

The media furor over this exchange has long since died down. But I personally cannot stop thinking about it. This exchange raises issues far too important and enduring for just a flash of media attention, issues essential to the search for common ground on abortion and the fostering of universal human rights. Pro-choicers in the US pointed out Kyl’s hypocrisy as someone who calls himself “pro-life.” Many pro-lifers condemn the same contradiction.

Problem of maternal healthcare

There is plenty of scientific evidence to back up the outrage against Kyl. According to data gathered by United Nations agencies like United Nations Population Fund (UNFPA), the US ranks 29th globally in infant mortality and 41st in maternal mortality, in large part because of racial and class disparities in health care access, and because of US providers who have economic incentives not to follow the best practices available.

Healthcare for mothers: A basic right

In support of universal health care, Childbirth Connection points out that 85% of US women give birth at some point in their lives and 4.3 million do so in any given year. Twenty-three per cent of hospital discharges are of childbearing women and newborns, who account for a far larger proportion of total hospital charges than any other group of patients. As well as involving so much of the population and the health services sector, maternity care offers unique opportunities to improve the life courses and health outcomes of mothers, fetuses, and newborns.

Globally embraced documents of the universal human rights movement also support the outrage against Kyl, even though the last two of these have yet to be ratified by my country, shamefully enough. The Universal Declaration of Human Rights identifies “medical care and necessary social services” as human rights, and “motherhood and childhood” as “entitled to special care and assistance.”

CEDAW, the Convention of the Elimination of All Forms of Discrimination Against Women, asserts the responsibility of states to “ensure to women appropriate services in connection with pregnancy, confinement and the post-natal period, granting free services where necessary.” According to the Convention on the Rights of the Child, states have a responsibility to implement every child’s right to ’special safeguards and care…before as well as after birth.” This includes the “diminish[ment] of infant and child mortality” and the ensuring of “appropriate pre-natal and post-natal health care for mothers.”

A way of reducing abortion?

As a pro-lifer who affirms all of these universal human rights, I also recognize another dimension to guarantee maternity care for all, something that concerns pro-choicers, too, for different but often overlapping reasons. Along with being a right on its own, universal, guaranteed maternity care is also, not one whit less importantly, an indispensable way to alleviate situational pressures upon women towards abortion. In particular, it is helpful to reduce pressure upon the poor, including the global poor, women who have disabilities or who carry disabled babies, women of color, immigrants and refugees, and students.

According to the Guttmacher Institute, 57% of US women who have abortions are economically disadvantaged. Lack of access to free/affordable health care, including family planning services and both maternity and pediatric care, is both a cause and consequence of economic disadvantage. This also helps to explain, for example, the fact that African American women have five times as many abortions as white women.

Consequences on the poor

The consequences of denying maternity care are even more dire for the global poor. Although the withheld funds have thankfully been restored, my own government quite recently withheld $34 million per year from UNFPA, the world’s largest force for proper maternity care and other solutions to abortion, like family planning. (Contrary to what some US pro-lifers believe, UNFPA has an official policy of not promoting abortion.)

This defunding may have caused nearly 800,000 induced abortions, as well as 2 million unsought pregnancies, 4700 maternal deaths, nearly 60,000 cases of serious maternal illness, and over 77,00 neonatal and child deaths.

Even in such a wealthy nation as the US, many women’s and children’s own life and death stories also validate the right of maternity care. Although my poverty was nothing like the deep poverty of so many in the world, I vividly remember how challenging it was for me in 1986-87 as a student with disabilities to hold onto the expensive private insurance plan my daughter and I so desperately needed throughout and beyond that medical and emotional roller coaster of an unplanned, high-risk pregnancy.

Two decades later, when my college student daughter became pregnant herself, she and her baby–who turned out to have a life-threatening but correctable gut impairment– were also subjected to uncertain coverage. My grandson is a year and a half now, but we are *still* fighting the plan’s refusal to pay for his mom’s emergency asthma treatment in the eighth month of pregnancy.

And yet we were all the “lucky” ones. I can’t imagine how any of us would be alive today without the access to proper health care we somehow managed to have. I shudder to think what might have happened otherwise. This inter-generational story is but one deep source of my conviction that US society, not only Senator Kyl, must stop already in its dismissal of maternity care, a matter of life and death, as some lightweight thing that one can access only via fluke.

A universal problem

To regard maternity care as simply an option that “I don’t need” is to wash one’s hands of collective responsibility for mothers and babies and therefore to have complicity in those situational pressures towards abortion. This responsibility extends beyond those who are mothers or wish to become mothers, to every member of society. Countries that regard maternity care as everybody’s business and everybody’s concern, such as the Netherlands, have abortion rates that are a small fraction of the high US rate.

Every single one of us grew inside the body of a woman who needed access to proper health care to keep both herself and her baby alive and well. I only need to look at the faces of my daughter and grandchild and my own in the mirror to know that universal, guaranteed maternity care is a moral and political imperative everywhere. A rich country like mine must do all it can to make guaranteed maternal healthcare a reality not only for its own residents, but all women and children throughout the world.

This post is a response to the post Are pregnant women expendable?

As mobile and web technologies become increasingly accessible to those living in remote poverty around the world, the potential to expand access to health care to underserved populations becomes ever more real.

It’s exciting to see the many ways that innovative people and organizations are able to take advantage of the spread of technology to make positive social change. Ushahidi, an open-source platform that can be used by anyone to collect and visualize user-generated information, is an excellent example. They’re using mobile and web technology – including social media platforms like Twitter – to capture critical up-to-date reports from individuals in crisis areas through crowd-sourcing and filtering.

Check out this short video for Erik Hersman’s brief introduction to Ushahidi.

Ushahidi creates a hub for user-generated crisis information that comes in through text messages, tweets, and emails around a given crisis in a specific geographic area. Their team then uses the “Swift River” filtering system to determine which reports are legitimate and group them thematically. The reports are placed on an interactive map so that users can see exactly where emergencies are being reported. Right now, for example, this tool is making a difference in Haiti by helping aid workers and first responders identify where and for what the needs are greatest.

What if this tool was used for women going through labor or labor-related complications?

There are already some open-source map-based initiatives being built for the maternal health field. The Maternal Health Task Force has designed three interactive, user-generated maps that depict maternal health knowledge hubs, MPH programs offering a maternal health concentration, and organizations working in maternal health. Another key contributor is Maternova, one of the Changemakers early entry prize winners for the Healthy Mothers, Strong World competition, which is building an open-source map of maternal health care facilities around the world.

By combining these maps, which outline the maternal health “supply” worldwide, with information and interactive maps that visually depict demand, perhaps we could create a clearer, more visual picture of the true gaps in health access.

Pregnant women in need of care – or their friends and family – could text an emergency alert to a number assigned by Ushahidi. This would then be transmitted to health professionals in the region, and made widely available on the internet. Though ensuring an immediate response to the requests will take time and a larger overarching strategy, the reporting of this information alone can help direct health care facilitators to the areas most in need.

Let me know what you think about the potential to use mobile and web technologies to crowd source information for maternal health by responding to this post. To learn about other innovative ideas for maternal health, or to submit your own, visit www.changemakers.com/maternalhealth before the competition deadline, March 17th.

This piece was originally posted on the Ashoka Change InSight blog at www.ashoka.org/changeinsight.

These videos, by different human rights organizations, go beyond statistics to tell us the stories of women and their families as they struggle to understand why it is that so many women are dying during childbirth and what needs to be done to stop this.

First, the White Ribbon Alliance produced a four minute video titled Birth and Death explaining the seriousness of Maternal Mortality and how it can be stopped:

Click here to view the embedded video.

UNICEF also created a two minute video to raise awareness about this issue, with 5 steps that can be taken to diminish maternal mortality: education, respect, empowerment, investing and protection.

Click here to view the embedded video.

In this next video, In Silence: Maternal Mortality in India by Human Rights Watch, photographer Susan Meiselas and reporter Dumeetha Luthra traveled to India to follow the story of a woman who died after giving birth:

Click here to view the embedded video.

In Peru, as told by this piece done for CARE by Phil Borges, the Watchmen for Lives program to decrease maternal mortality has proven to be a success: by empowering and educating women from within the communities in the importance of healthcare during pregnancy and by making a chart for midwives with warning signs on when to send women to a clinic, more are going to clinics to give birth, dramatically reducing the numbers of deaths due to complications during labor.

Click here to view the embedded video.

Amnesty International has this documentary piece, 18 minutes long, about Maternal Mortality in Sierra Leone. One in 8 women die in Childbirth there: the inability to pay for medical attention, a practically non-existent healthcare system, lack of trained medical practitioners and understaffed and understocked clinics are the main reasons. As the women in the video tell: everyone there knows a woman who has died during pregnancy or labor.

Click here to view the embedded video.

And from Australia, students from the Nursing and Midwife program at the University of Sydney have created Birthing Kits that they’ve delivered to developing countries to try and prevent unnecessary deaths. It includes a plastic sheet to put under the mother, surgical gloves, scalpel blades, gauze, soap and string to tie off the umbilical cord. In the video, they tell of their initiative and the successful experience they’ve had in Bangladesh.

Click here to view the embedded video.

Imagine a woman giving birth handcuffed and her feet shackled. Do pregnant women in prison deserve human rights, or can pregnancy become a way to avoid jail?

All over the world, pregnant women struggle for basic human rights.

In chains

In the US, pregnant women serving time have been routinely shackled during labor and childbirth, despite the danger to the mother and child, according to Malika Saada Saar, founder and executive director of the Rebecca Project for Human Rights. In a blog-post published at RH Reality Check, she tells us that the issue of shackling pregnant women is still being debated.

The Bureau of Prisons (BOP) in September 2008 ended shackling mothers as a matter of routine course in all federal correctional facilities. State legislatures and Departments of Correction have also responded to the sea change in shackling policy. Most recently, New Mexico, New York, and Texas have enacted laws prohibiting the practice of shackling pregnant women in nearly all circumstances.

Fighting the system

Malika Saada Saar features a video on her blog-post at RH Reality Check about a mother,  Shawanna Nelson, who was shackled during labor, but who brought a lawsuit against the Arkansas Department of Corrections for cruel and unusual punishment:

Click here to view the embedded video.

Malika Saada Saar says:

Thanks to [Shawanna Nelson's] courage and the common sense of a panel of judges, the 8^th Circuit Court of Appeals recently ruled and the shackling of prisoners during labor is unconstitultional.

Pregnancy as a bargaining tool

Why are rights for pregnant women in prison so controversial? Different countries have different viewpoints about the debate.

In Russia Today, a Russian broadcasting channel,  the subject is mentioned:

Skeptics think some mothers deliberately get pregnant simply to ease life in prison. Hospital leave, then lots of scheduled time with your child – it is all better than sitting in a stone cell, they claim.

And there are women for whom it seems that pregnancy is the only way to escape a sentence, as was the case back in June, when a British woman incarcerated and sentenced to death in Laos due to drug smuggling got pregnant in prison and escaped being executed, since the Laos government would not execute a pregnant woman. The claims made according to the Daily Express, a British newspaper, are that she got artificially inseminated “to secure a more lenient term”.

Pregnancy as a get out of jail free card?

In Argentina, according to Ajintem, an information portal for  migration information, a law was passed last year specifying that pregnant women, women with children younger than 5 and those with handicapped children would benefit from spending their prison term at home under house arrest.

This law would benefit not only the mother, who in prison wouldn’t receive suitable health care during her pregnancy. It would also help the child, who would either be raised without a mother, or in prison, an unsafe environment.

However, the message is for magistrates to follow the spirit of the law and grant this permission to those women not involved in violent crimes. The rest of the civilian population shouldn’t see pregnancy as a get out of jail free card.

Children growing up without mothers

In the Canary Islands, according to Prisiones y Penas, a blog about the issues surrounding jails and prisons, women are allowed to keep their children of up to 3 years of age in their cells, but in the company of other inmates – an unsafe environment.

Thus, pregnant women or women with children under 3 are encouraged, upon entry to the prison, to send their child off to family members because it isn’t good for the child to grow up behind bars.

This is also the case in Peru and Russia.

Why doesn’t the US allow women to keep their babies in prison?

In the US, there are only two correctional facilities which allow prison inmates to keep their babies with them, in New York and in Nebraska, as told by renowned photographer Jane Evelyn Atwood in her 3 part photo documentary for Amnesty International,  called Too Much Time, where she visited dozens of prisons all over the world to record and document the lives of inmates.

Atwood explains that the reason the US correctional system does generally not allow women with babies to keep them, is due to the hostage situation. In the Prison Photography Blog they address this claim:

Children are excluded from all but a couple of US prisons. The security threat is cited as the reason: a child inside a prison is a constant vulnerable life and constant hostage target. The claim seems a little bogus when penal systems of other countries are brought into consideration.

The Atwood documentary in the Amnesty International site features both a section on the process of giving birth in shackles as told in Vanessa’s Baby and another on prison systems and motherhood.

Women speak out about their children and prison life

Geraldin Rodríguez, an Argentinean spending time in an Ecuadorian jail due to drug trafficking tells Marcos Brugiati, a writer who contributes with the art related online publication Plastica-Argentina, a story about getting pregnant in prison. She was allowed to keep her baby with her, but decided that the child needed to grow up free:

I decided he should leave to live, I was afraid he would suffer the same traumas I have today. After a year my brother took him away and is caring for him along with his wife.

A motherless child
Juvinete is in a Spanish prison, and was pregnant when she was incarcerated for drug trafficking. She tells her story to regional Spanish newspaper NorteCastilla. Three years after giving birth to her baby in prison, her child had to leave her side, and was sent to a foster family. Juvinete sees her daughter every 15 days and every two months she gets a 2 week leave to spend time with her.

However, things don’t seem to be looking up: there is a chance Juvinete will be deported to her natal Brazil, and she fears for the consequences this change would have on her child. She does have advice for any woman who decide to get pregnant while in jail:

I try to convince them not to get pregnant while inside because seeing a child deprived of their freedom is very hard, it’s irresponsible. They don’t have to pay for our mistakes.

“My family didn’t even know I was in labor”

In Woman and Prison, a website dedicated to women’s experiences in the correctional system, inmate Kebby Warner speaks of her own pregnancy while doing time in a US prison and having her child taken away from her. Here is an excerpt where she writes about the birthing process:

During the labor, no one is allowed in the delivery room. My family didn’t even know I was in labor or had her until after I left the hospital. During the three days some of the guards stayed in the room, but most of the time, when the nurses asked them to sit outside the door, they complied. I have heard horror stories of women being chained to the delivery bed. I am so grateful as to have not experienced this. Most of the nurses treated me as a human instead of a prisoner.

You can read more testimonies about growing up with a parent in prison in Women and Prison.

So what do you think?

There are a few questions that come to mind:

• What is it like to be pregnant and have a child behind bars?
• Should women in prisons be a priority when there are other women outside of correctional facilities without medical assistance?
• Should maternity overrule any other legal conditions to ensure a pregnant woman’s human rights?

Image used to illustrate post is “17 de noviembre” by daquella manera.

An estimated two million women are living with fistula in developing countries, with an additional 50,000 to 100,000 new cases occurring each year. Even more tragic is the fact that every minute a woman dies in childbirth. All most all of these deaths and injuries could be prevented.

In Kristof’s article he recounts a Pakistani saying, “If your cow dies, that is a tragedy; if your wife dies, you can always get another.” We can all agree that this statement is outrageous. But what’s worse, is the reality that that the sentiment is echoed in many countries around the world.

UNFPA’s Global Campaign to End Fistula is now working in more than 45 countries in Africa, Asia and the Arab region to prevent fistula, while also treating and rehabilitating those who endure this devastating childbirth injury. UNFPA is also leading efforts to improve access to contraception, skilled birth attendants, and emergency obstetric care to ensure that no woman dies living life.

But more support is needed to elevate the status of women globally. I encourage American readers to visit www.americansforunfpa.org/iam to get involved.

That’s because everybody needs clean water but only women can die in childbirth (currently one every minute). So decision makers choose to help the most number of people.

But this is shortsighted policy. Women are the caregivers for both young and old. If children get health care it’s because their mother’s have ensured it. And women are the ones who send the children to school.

When women are left without resources, they cannot access family planning services to limit their families, have limited access to skilled birth attendants during childbirth and cannot invest in the well-being of their families. Just as an example, if the women who want to plan their childbearing had access to contraceptives, 1 in 3 deaths related to pregnancy and childbirth could be avoided.

Between $5.5 billion and $6.1 billion in additional funding is needed by 2015 to substantially improve maternal health. It’s hard to imagine that will happen in this economy.

I’m both delighted to have a Secretary General who truly understands that need to address global women’s health and furious that we – the international community – were not already allocating this kind of funding specifically for women. Donor assistance to international family planning dropped from $723 million in 1995 to $442 million in 2004.

We really have our priorities out of whack when we allow 10 million women in a generation to die from preventable causes of pregnancy and childbirth. And what’s more, the solutions are not so complicated: modern contraception, skilled attendance at birth, access to emergency obstetric care. For example, one in 3 deaths related to pregnancy and childbirth could be avoided if women who want to plan their childbearing had access to contraceptives.

Of course, it gets more complicated. Emergency obstetric care is of little use if there is no road to it or if a husband will not take his wife to get help. But my point is, these challenges are not insurmountable and rather than fret about the complexity, we should dig in and start with what we know works.