“ In the developing world, safe motherhood could have been better named safe womanhood, as the dangers she faces begin at birth and continue through childhood and adolescence, and into adulthood and old age.”
Just as the idea of safety can be interpreted to mean more than just physical safety; encompassing the mental, emotional, and even spiritual well-being of a person, so too the term “motherhood” cannot be cut off from everyday female existence. The different stages of a woman’s life overflow into maternal health, and if the goal is to lessen the gap between the terms “safe” and “motherhood”, we must look at what it is to be a woman in this world.
When I was a girl growing up in Liberia, West Africa, it didn’t take me long to figure out that my life was on a different trajectory than that of my playmates. While at at age eleven my white skin made me stand out it a crowd, so did my knowledge of long division. While I begrudgingly did my schoolwork at home, my female childhood friends started to stay home for different reasons: to keep house, work the garden, and provide free childcare for siblings and relatives. They were already being put in a cultural box labeled “women” even though many of them had yet to start menstruation.
In many societies, when a female rather than a male is conceived, that pregnancy is at a much higher risk to end in an abortion or infanticide, due to a prevalent preference for male children. It is estimated that around the world, 160 million girls are “missing” due to this tragic preference. If women are killed before they can even become women, than safe and motherhood can never go together. As girls grow, they are less likely to be prioritized for education. When times get hard, and schools both cost money and are far from home, the common narrative is that the girl children are kept home. Their education is not valued because they are most often seen as workers and wives instead of for their earning potential. In adolescence, girls are more likely to be pulled out of school for child marriage, and are at an even greater risk of being exploited for work or sexual favours; the trauma of which can affect their development and growth potential. Through the teenage years, a lack of accurate and culturally appropriate reproductive education and access to birth control means that girls often give birth too young, and with greater frequency than recommended for safe motherhood. If complications arise in pregnancy, many traditional cultures take a fatalistic approach to maternal care “If she dies, it's God’s will."
This delays or precludes access to health care, and separates the mother from the safety which could be hers, if only her family and community placed greater value on her life. Older women are treated differently in different cultures, but sadly in many parts of the world they are also seen as disposable. Less effort is spent on sending them to the hospital as compared to their male compatriots. Their wisdom and experience is not given voice in their community, and they cannot and do not bless the women who are becoming mothers, in the way that they might if they had been given greater status and opportunity through their lives.
In order for us to see Safe Motherhood become a global reality, gender equality is paramount. Equal access to nutrition, education, and health care, as well as love and nurture at home, are all key in laying a foundation for Safe Motherhood. When girls do not thrive, mothers cannot thrive, and vice versa. We will see Safe Motherhood realized only when it is “safe” to be a woman.
Guest post by Janelle Oppel, CPM
About Janelle Oppel: At the age of 16, Janelle started shadowing midwives in rural Liberia (West Africa). She later attended a midwifery program through the Newlife International School of Midwifery, and completed her CPM requirements after spending two years working with midwives in the Philippines. Now she is a mother of four boys, and hopes to move with her family to Laos next year, with a dream of learning and contributing to Maternal/Infant health care in that landlocked South East Asian nation.
Photo: A picture of the author as a young girl, playing with friends from the neighbourhood.
 Prakash, N. (2013). Training Camp on Safe Motherhood in Rural India: A Research Note. In Safe motherhood in a Globalized World. essay, Prakash.
 Douthat, R. (2011, June 27). 160 million and counting. The New York Times. Retrieved December 10, 2021, from https://www.nytimes.com/2011/06/27/opinion/27douthat.html.
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.