Deliveries, Deliberate Decisions and Development

3 11 2011

I watched my first birth today! Yes, at 9:35 this morning, a healthy beautiful boy was born in the health center where I work. I have to say, it was far less emotional than I had anticipated. The mother was nearly silent during the entire process, breathing loudly only during the most painful contractions. She never once moaned, let alone screamed. There was no celebration when the baby arrived either. No “Congratulations!” or “It’s a boy!” There were no words said or tears shed as the woman’s torn skin was stitched together afterward either. It seemed like a fairly normal procedure, which it is I guess—if you can forget about the whole miracle of life aspect of it.

As I watched the lead-up to the birth, blood spilling out of the woman as she calmly waited for the next contraction to come, I couldn’t help but think of the shocking statistics around maternal mortality in Cambodia. Childbirth-related deaths account for one-fifth of all deaths among Cambodian women. Worse yet is that the infant mortality rate, 63 deaths for every 1,000 live births, is the worst in the region. The woman today stood much better chances because she was delivering her child in a health facility, unlike the majority of Cambodian women; however, chronic malnutrition and inadequate prenatal care make women susceptible to complications regardless of where they deliver.

Infant Mortality Rates around the World; Cambodia is Yellow-Green

I was thinking of these things as I left the delivery room, and I was taken back to a conversation that had occurred during training. Our group facilitator had asked us what the word “development” meant to us. As someone who studied during a time when “empowerment” and “personal agency” were unavoidable buzzwords, I immediately responded that development, as I saw it, was an individual’s ability to make deliberate decisions about his/her life. It’s an individual’s ability to access knowledge and services in a way that allows him/her to have some semblance of control over his/her situation.

It’s difficult for me to imagine not having some level of control over such a life-altering event such as childbirth. In the US, many times women make dozens upon dozens of decisions before having babies. Will I deliver in a hospital or at home? With a doctor or a midwife? In a bed or in water? Who will be in the room? Will I use painkillers? What playlist will be playing? In fact, many of us can even plan, to a certain degree, when we will get pregnant in the first place. Or at least, maybe, when we won’t.

This level of choice, this level of control, is the best indicator of development for me. The vast majority of Cambodian women are in positions that don’t allow them to decide if or when they want children. Should they become pregnant, many have no option of prenatal care. And many do not ever make a conscious decision about where they will deliver.

Maternal Mortality around the World; Cambodia is Orange

Luckily for her, the woman who delivered today made the decision to deliver her baby in the health center and, even more fortunately, she had the social, economic and community resources to do so. It might seem like a simple decision, but take a moment to really analyze what had to be in place to allow this woman to really have an option.

First of all, a road existed that led from her village to the health center—and, especially important this time of year is the fact that it was accessible. If that road, like so many others, had been flooded out, she would have been left without a real choice. That road alone wasn’t enough though. Think, too, of the moto that her family owned and used to transport her, plus the wages—and job—that allowed the family to purchase it. And don’t forget about the flexibility the family had that allowed them to leave home and work for a day to accompany her to the health center.

Think about the midwife who was able to undergo expensive training, and who made the decision to go to work today. Furthermore, the mother had to know that it was safer to deliver in the health center in the first place. This means that some level of health education had to happen, whether through community meetings or mass media campaigns. Either way, she knew that going to the health center was a safer option, knowledge that not all Cambodian women have.

And, finally, think of the woman’s body. In order to survive such a taxing experience, her body needed to be strong and healthy, full of nutrients and free from injuries inflicted by a partner or from hard labor in the fields.

All of these things, together, allowed that woman to make a choice about her baby. And, really, about her life. And all of these things, together, are development. Obviously women were giving birth before motorcycles or mass media campaigns, but these developments help keep more women safe and more babies alive. Ultimately, it is these developments that let women take a little more control over their lives.





5 responses

4 11 2011
Nancy Andrade

Excellent post, Katie. I think your development indicator is one of the best I’ve heard yet! I really enjoy reading about your work and lives there! :)

4 11 2011

Thanks, Nancy! Would love to hear all about life in Atlanta and, of course, the new job! Keep me posted.

4 11 2011

Your maps are fabulous! Where did you get them?

4 11 2011

I must confess, I just did a Google Images search, nothing fancy. Glad you like them though.

22 10 2013
Our Favorites | TimKat's Travels

[…] one delivery can represent the entire development […]

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