Amtul Aziz Tahseen
PhD Research Scholar, Dr.NTR-University
of health sciences,Vijaywada.
 |
Abstract:
Ecofeminism is
a term that links feminism with ecology. Its advocates say that paternalistic/capitalistic society has led to a harmful split
between nature and culture. It is also an activist and academic movement that
sees critical connections between the exploitation of nature and the domination
over women both caused by men.Ecofeminism describes movements and philosophies
that link feminism with ecology. This movement seeks to eradicate all forms of social
injustice, not just injustice against women and the environment
Keywords
Eco-femeinsm, Oppression, motherhood
Perspectivesof Ecofeminism
Mann associates
the beginning of ecofeminism not with feminists but with women of different
race and class backgrounds who made connections among gender, race, class and
environmental issues. Woman have been subjected to oppression, domination,
exploitation, and colonization from the Western patriarchal society that
emphasizes and values men.
Ecofeminism was
coined in 1970s.Women participated in the environmental
movements, specifically
preservation and conservation, "Land Ethic" (1949).
Vandana Shiva, Maria Mies and Evan Bondi on ecofeminism
considered modern
science and its acceptance
as a universal and value-free system. Instead, they view the dominant stream of
modern science as a projection of Western men's values.The privilege of
determining what is considered scientific knowledge has been controlled by men,
and for the most part of history restricted to men. Bondi and Miles list
examples including the medicalization of childbirth and reproduction.
Bondi argues that
the medicalization of childbirth has marginalized midwife knowledge and changed the natural process of
childbirth into a procedure dependent on specialized technologies and
appropriated expertise. A common claim within ecofeminist literature is that
patriarchal structures justify their dominance through binary opposition, these
include but are not limited to: heaven/earth, mind/body, male/female, human/animal, spirit/matter, culture/nature and white/non-white. Oppression is reinforced by assuming
truth in these binaries and instilling them as 'marvellous to behold' through
religious and scientific constructs.
Safe Motherhood
Safe
motherhood encompasses a series of initiatives, practices, protocols and
service delivery guidelines designed to ensure that women receive high-quality
gynaecological, family planning, prenatal, delivery and postpartum care, in
order to achieve optimal health for the mother, fetus and infant during
pregnancy.
The inauguration
of the Safe Motherhood Initiative in Kenya in 1987 marked the beginning of
concerted international efforts to reduce maternal mortality. Since that time,
reducing maternal mortality has continued to be the aim of many international
health programs. Over time, policies and strategies to achieve safe motherhood
have changed as knowledge and understanding about the determinants of maternal
health have become clearer.
Improving
maternal health was included as the fifth Millennium Development Goal (MDG),
which calls for a 75 percent reduction in maternal mortality between 1990
and 2015. And reducing maternal mortality by 30 percent across assisted
countries is one of the targets for USAID's Global Health Initiative (USAID,
2011).
Although safe
motherhood has remained high on the political agenda, the scope of what
constitutes "safer" motherhood has changed considerably. A major
factor has been the incorporation of a human rights approach into the
definition of Safe Motherhood following the agenda set at the
International Conference on Population and Development (ICPD). By
defining maternal death as social injustice, programs for "Safer
Motherhood" are able to invoke a much broader range of political,
social, and economic initiatives than was previously possible (UNFPA et al.,
1997).
Policies and
strategies to achieve safe motherhood have also changed as knowledge and
understanding about the determinants of maternal health lack of
education for girls; early marriage; lack of access to contraception; poor
nutrition; and women's low social, economic, and legal status (Starrs, 2006).
Maternal
death or maternal mortality is defined by the World
Health Organization (WHO)
as "the death of a woman while pregnant or within 42 days of termination
of pregnancy, irrespective of the duration and site of
the pregnancy, from any cause related to or aggravated by the pregnancy or its
management but not from accidental or incidental cause.
There is a
distinction between a direct maternal death that is the result of a
complication of the pregnancy, delivery, or management of the two, and
an indirect maternal death,[9] that is a pregnancy-related death in a patient with a
pre-existing or newly developed health problem unrelated to pregnancy.
Fatalities during but unrelated to a pregnancy are
termed accidental, incidental, or nonobstetrical maternal deaths.
According to a
study published in the Lancet which covered the period from 1990 to 2013, the most
common causes are postpartum
bleeding (15%),
complications from unsafe abortion (15%), hypertensive disorders of pregnancy (10%), postpartum
infections (8%),
and obstructed
labour (6%). Other
causes include blood clots (3%) and pre-existing conditions
(28%). Indirect causes are malaria, anaemia, HIV/AIDS, and cardiovascular
disease, all of which may
complicate pregnancy or be aggravated by it.
According to a
2004 WHO publication, sociodemographic factors such as age, access to
resources and income level are significant indicators of maternal outcomes.
Young mothers face higher risks of complications and death during pregnancy
than older mothers, especially adolescents aged 15 years or
younger. Adolescents have higher risks for postpartum haemorrhage,
puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants,
all of which can lead to maternal death. Structural support and family
support influences maternal outcomes. Furthermore, social disadvantage and
social isolation adversely affects maternal health which can lead to increases
in maternal death. Additionally, lack of access to skilled medical care during childbirth, the travel distance to the nearest
clinic to receive proper care, number of prior births, barriers to accessing
prenatal medical care and poor infrastructure all increase maternal deaths.
Unsafe abortion is another major cause of maternal death. According
to the World Health Organization in 2009, every eight minutes a woman died from
complications arising from unsafe abortions. Complications include hemorrhage,
infection, sepsis and genital trauma.
By 2007,
globally, preventable deaths from improperly performed procedures constitute
13% of maternal mortality, and 25% or more in some countries where maternal
mortality from other causes is relatively low, making unsafe abortion the
leading single cause of maternal mortality worldwide
Four elements are
essential to maternal death prevention, according to UNFPA. First,
prenatal care. It is recommended that expectant mothers receive at least four
antenatal visits to check and monitor the health of mother and fetus. Second,
skilled birth attendance with emergency backup such as doctors, nurses and
midwives who have the skills to manage normal deliveries and recognize the
onset of complications. Third, emergency obstetric care to address the major
causes of maternal death which are hemorrhage, sepsis, unsafe abortion,
hypertensive disorders and obstructed labour. Lastly, postnatal care which is
the six weeks following delivery. During this time bleeding, sepsis and
hypertensive disorders can occur and newborns are extremely vulnerable in the
immediate aftermath of birth. Therefore, follow-up visits by a health worker to
assess the health of both mother and child in the postnatal period is strongly
recommended.
Maternal Death
Surveillance and Response is another strategy that has been used to prevent
maternal death. This is one of the interventions proposed to reduce maternal
mortality where maternal l deaths are continuously reviewed to learn the causes
and factors that led to the death. The information from the reviews is used to
make recommendations for action to prevent future similar death. Maternal and
perinatal death reviews have been in practice for a long time worldwide and the
World Health Organization (WHO) introduced the Maternal and Perinatal Death
Surveillance and Response (MPDSR) with a guideline in 2013. Studies have shown
that acting on recommendations from MPDSR can reduce maternal and perinatal
mortality by improving quality of care in the community and health facilities.
Medical
technologies:
The decline in
maternal deaths has been due largely to improved asepsis, fluid management and blood transfusion, and better prenatal care.
Technologies have
been designed for resource poor settings that have been effective in reducing
maternal deaths as well. The non-pneumatic anti-shock garment is a low-technology pressure device that decreases
blood loss, restores vital signs and helps buy time in delay of women receiving
adequate emergency care during obstetric
hemorrhage.It has proven
to be a valuable resource. Condoms used as uterine tamponades have also been
effective in stopping post-partum hemorrhage.
Public health
Most maternal
deaths are avoidable, as the health-care solutions to prevent or manage
complications are well known. Improving access to antenatal care in pregnancy, skilled care
during childbirth, and care and support in the weeks after
childbirth will reduce maternal deaths significantly. It is particularly
important that all births be attended by skilled health professionals, as
timely management and treatment can make the difference between life and death.
To improve maternal health, barriers that limit access to quality maternal
health services must be identified and addressed at all levels of the health
system. Recommendations for reducing maternal mortality include access to
health care, access to family planning services, and emergency obstetric
care, funding and intrapartum care.Reduction in unnecessary obstetric surgery
has also been suggested.
Family planning
approaches include avoiding pregnancy at too young of an age or too old of an
age and spacing births. Access to primary care for women even before they become
pregnant is essential along with access to contraceptives.
Policy
The biggest
global policy initiative for maternal health came from the United Nations'
Millennium Declarationwhich created the Millennium
Development Goals. The
fifth goal of the United Nations' Millennium Development Goals (MDGs)
initiative is to reduce the maternal mortality rate by three quarters between
1990 and 2015 and to achieve universal access to reproductive health by 2015.
The Millennium
Development Goals (MDGs) are eight international development goals that were officially
established following the Millennium Summit of the United Nations in 2000.
Trends through
2010 can be viewed in a report written jointly by the WHO, UNICEF, UNFPA, and
the World Bank
maternal health
depends on three key factors: 1. reviewing all maternal health-related policies
frequently to ensure that they are internally coherent; 2. enforcing standards
on providers of maternal health services; 3. any local solutions to problems
discovered should be promoted, not discouraged.
In terms of aid
policy, proportionally, aid given to improve maternal mortality rates has
shrunken as other public health issues, such as HIV/AIDS, have become major
international concerns. Maternal health aid contributions
tend to be lumped together with new born and child health, so it is difficult
to assess how much aid is given directly to maternal health to help lower the
rates of maternal mortality. Regardless, there has been progress in reducing
maternal mortality rates internationally.
Maternal deaths
and disabilities are leading contributors in women's disease burden with an
estimated 275,000 women killed each year in childbirth and pregnancy
worldwide. In 2011, there were approximately 273,500 maternal deaths
(uncertainty range, 256,300 to 291,700).Forty-five percent of postpartum deaths
occur within 24 hours.Ninety-nine percent of maternal deaths occur in developing
countries.
Conceptual Model
The "Three
Delays Model" identifies the points at which delays can occur in the
management of obstetric complications at the community and facility level.
The first
"delay" (delay in deciding to seek care) may relate to a number
of factors, including the lack of knowledge about obstetric danger signs,
community perception of poor quality facility care, or the lack
of health services availability which increases the opportunity costs and
therefore reduces the likelihood of care seeking.
The second
"delay" (delay in identifying and reaching a medical facility)
relates to the geographical proximity and accessibility of health services and
includes factors such as the availability of transportation.
The third
"delay" (delay in receiving appropriate care at health
facilities) is related to factors in the health facility, including the
availability of staff, equipment, and resources as well as the quality and
(in some cases) the cost of services.
Motherhood Interventions
In addition to
the changes in the definition, policies, and strategies as well as the
emergence of new public health problems that drive the need for an
increasingly wide range of indicators, monitoring and evaluating
safe motherhood programs
Safe motherhood
outcomes need to be measured for two individuals: the mother and baby
Under most
circumstances interventions that benefit or harm the mother similarly
affect the baby and vice versa. Some exceptions are notable. For example,
a caesarean section for fetal distress may be critical to ensure a
good neonatal outcome
Interpreting
whether outcomes are attributable to program interventions is difficult,
because most interventions consist of "bundled" services
Demonstrating
change because of a safe motherhood program is difficult because programs
usually provide a package of care to communities rather than
providing one single intervention.
The provision of
appropriate maternity care is a complex process that requires multiple
indicators to monitor
The occurrence of
an emergency sets into motion a complex chain of events to ensure that a
woman receives adequate care. First, the family needs to recognize the
problem and be able to access the appropriate services. Second,
the equipment, supplies and medicines must be available at the
facility to enable the care provider to make the correct diagnosis and to
provide appropriate treatment promptly. If definitive care cannot be
provided at the first level, then transport needs to be available quickly to
take the woman to a higher level of care that must also deliver the
appropriate services.
A series of
indicators is required to reveal whether a problem occurs on the
"demand" or "supply" side of the equation, and hence,
whether the interventions need to address community mobilization,
behaviour change, health system performance, or a combination of
these factors.
