A LIFE-AFFIRMING CURRICULUM FOR MATERNAL AND FAMILY HEALTH CARE
We are a group of international colleagues and organizations invested in improving family and maternal health. We bring to these project years of experience and a deep desire to address the disparities and injustices which exist in health care development. These disparities exist globally, dividing continents and countries with vast health care resources from those who have few. These injustices exist in the deliberate exclusion of a class of human persons, the unborn, from protection.
A red line has been crossed by the powers that direct, prioritize and fund international health care development: the blood red line which begins at conception and marks the beginnings of human life. Once crossed, other lines blur, the circle of what is human is narrowed, and the obligation to respect the life and dignity of all human persons is relativized.
Our intent is three-fold. First is to recapture the moral and ethical foundations of health care, a foundation which recognizes human life and dignity as inviolate. Second, is to offer a life-affirming alternative to the existing health care paradigms which discriminate against unborn human life. Third, is to offer a relational health paradigm which recognizes, affirms and supports marriage and family as key contextual components of community health development.
“The best criticism of the bad is the practice of the better.” Respecting human life and dignity in all persons is radically better than denying it. When we build on this foundation, better things are possible: more just health care, reduced maternal and newborn mortality, healthier, more secure and stable families. Centering health care education and behavioral change within the domain of the couple and family leads to possibilities for health care prevention and promotion that otherwise would not exist. Every person affected by a disease, from HIV to diabetes to mental illness, lives within a community of persons. Such a community can “make or break” treatment access, adherence and disease stabilization. A respectful, faithful, intact marriage with both mother and father committed to the care of their children is the surest foundation for physical, mental and emotional health.
Our paradigm is presented metaphorically through “three windows” which illuminate critical time frames within the lives of human beings. Examining, understanding and working within the Three Windows offers a better way to practice maternal and family health. Looking through them, we are able to see with more human eyes the needs of others and the beauty and fragility of life. As we go forward we invite the participation of health care professionals, community, religious and pastoral leaders, government policy makers, funding partners and most critically, couples and families who hold within their hands their own health and the health of generations to come.
An Overview of Three Windows
We are using a window as a metaphor for a “critical time frame” in the life of a human person. Perhaps you have heard the expression, “a window of opportunity.” The expression refers to a brief and passing time when we can influence an outcome or an event. The three windows we are speaking of present an opportunity to understand and influence a critical time frame within human development and existence.
The Three Windows are
1. The Fertile Window
2. The Window Encompassing the 1st 1000 Days of Life
3. The Window of Birth (Onset of Labor through Seven Postpartum Days)
In your role as a midwife, a nurse, an obstetrician, a primary care provider, a pediatrician, a health care administrator or a public health official, it is critical to work within three windows. If we are open to these three windows, we can “see” our way to providing effective and sustainable maternal and family health care. Conversely, if we are blind to these three windows, health care development is compromised and what is prioritized may destroy rather than enhance human life.
Let’s examine the windows in more detail
1. THE FIRST WINDOW, “The Fertile Window”
The first window refers to the six day time frame a woman can conceive each menstrual cycle. This window consists of the five days before a woman ovulates and the day of ovulation itself. If a couple has intercourse during the fertile window, conception is possible. If they have intercourse outside of the fertile window, then conception is not possible. As a woman only ovulates once a cycle, once ovulation has occurred, she will not be fertile until the ovulation phase of her next menstrual cycle.
The prevailing paradigm of “reproductive health” erases this window. Hormonal based contraception and intrauterine devices work by preventing the normal physiologic processes of egg release, and can also work to kill a human embryo after that embryo has been created. Women are rarely given informed consent about the risks of either hormonal contraception or the IUD, much less provided with education and support to recognize the natural signs of their body which indicate if they are in the fertile or infertile phase of their cycle.
A better way to practice child spacing and family planning is working with and not against a woman’s fertile window. Knowledge of the fertile window can be mastered by women of all education and literacy levels, empowering them to make healthy decisions about conceiving and child spacing. Such an approach frees women from the short and long term side effects of hormonal contraception and does not require that women and couples with scarce resources use their limited funds for ongoing contraceptive supplies.
Within a larger context, the aggressive promotion of artificial contraception has led to the closure of the fertile window on a demographic level. Throughout Europe, Russia, Japan and many Asian countries, the fertility rate is below replacement. Many countries face the prospect of a demographic collapse, with fewer young people available to support an aging population. In China, the combination of abortion technology, a one-child policy and cultural preferences for males has led to selective female feticide and a gender imbalance of 116 males to every 100 females.
Knowledge of the fertile window can be seen as fertility literacy. It is as important as written and oral literacy, as it empowers women and couples to have control over a fundamental aspect of their lives. We believe all health care personnel should be educated about the fertile window, as should all women and couples. At least a small fraction of the vast financial resources spent on artificial birth control should be used to educate women and couples with knowledge of the fertile window. Let’s make a practical and working knowledge of the fertile window the rule and not the exception!
Questions and Reflections:
1. In your training and experience to date, have you been given information about the “fertile window?”
2. Have you heard of natural family planning or fertility awareness as methods of family planning?
3. Have you seen women who have had side effects from artificial methods of family planning?
4. Why do you think so few people have heard of the fertile window?
5. Why do you think there is little information about natural family planning available?
The most critical days of a human being’s life are the first 1000, from conception to two years. What happens during this time frame affects a child for the rest of his or her life:
· A healthy maternal diet, breast feeding and a well-balanced toddler diet allow for the optimum physical and neurological development of a child.
· Prevention of prematurity, a safe birth and proper resuscitation of an asphyxiated newborn protects a child’s brain from damage during the critical transition from life inside the womb to life outside the womb.
· Secure bonding and attachment of the baby with his or her mother leads to a life-long foundation of emotional security and well-being
What can happen in this window is the difference between a child flourishing and a child being “stunted.” Stunting is a technical term which defines a condition in which a child never reaches their full height. Yet is also a term which conveys something much more consequential than short stature. Stunted children are more likely to be sick, to do poorly in school and to be unhealthy as adults. Stunting can generally be traced to a factor or multitude of factors within the first 1000 days of life. A child’s mother may have been poorly nourished herself. The child may not have been breast fed. A child may have been deprived of healthy foods after six months. Beyond physical stunting, a child may also have been neglected or had little emotional attachment to his or her parents. This child could become “emotionally stunted.”
The first 1000 days of life is a sacred time. It is a time which should be honored, protected and nurtured. Women and their babies should be protected from abortion, the most direct assault on the first 1000 days of a human being. Pregnant women should be protected from domestic violence and neglect. Mothers and their babies should receive a well-balanced diet, physical security and emotional support as a necessary platform their own health and for the healthy development of their child.
Questions and Reflection:
1. Look at your own community. What do you see as problems which compromise the first 1000 days of life?
2. What barriers are there to pregnant women receiving a well-balanced diet?
3. Is exclusive breast feeding the norm in your community? What prevents women from continuing to breast feed?
4. What are children fed after 6 months? Is their diet adequate?
5. If you could design a program to improve awareness of the first 1000 days of life, what would the program look like?
Development priorities from food aid to prenatal care services should be prioritized to the “First 1000 Days,” a window in which the future of a child is shaped for the rest of his or her life. “Family Planning” needs to be restructured from simply “pregnancy prevention” to encompass “Family LIFE Planning” which provides knowledge and support for pregnancy preparation and care of mother, child and family during this time frame.
3. THE THIRD WINDOW: The onset of labor through seven postpartum days.
As illustrated in this graph, the majority of maternal deaths occur from the onset of labor through the first seven postpartum days. While the graph demonstrates a small increase in maternal deaths before 22 weeks, these deaths are primarily from ectopic pregnancies or miscarriages leading to hemorrhage and not from abortion. Multiple studies demonstrate that legalizing and promoting does not reduce maternal mortality.
Within the window, the four leading causes of maternal death are:
· Hemorrhage (most commonly postpartum hemorrhage)
· Hypertensive diseases
· Sepsis and Infection
· Obstructed labor
Recent data from the World Health Organization demonstrate that over half of maternal deaths are from the first two causes, hemorrhage and hypertensive diseases. In addition, approximately a quarter of women also die from pre-existing conditions such as HIV, malaria or diabetes. Overall the lifetime risk of a woman dying from complications of pregnancy and childbirth is 1 in 40 in Africa compared to 1 in 4000 in the United States and Europe, a hundred fold difference. In several African countries the lifetime chances are as high as 1 in 16.
Maternal death rates are paralleled by high rates of perinatal and newborn deaths. It is within this window that newborns die from late stillbirths, utero-placental insufficiency, birth related asphyxia and sepsis.
Questions and Reflections:
1. In your experience, what has led to a maternal death? Could the death been prevented?
2. In your experience what has led to a newborn death? Could the death been prevented?
3. What three things do you think are most necessary to reduce maternal deaths?
4. Why do women in your area choose to deliver with a traditional birth attendant instead of deliver at a health center or hospital?
Within this window, we believe every woman and baby is entitled to a “safe passage,” a pregnancy and birth free of death and serious injury. This safe passage can only be realized through the presence of professional, skilled and equipped midwives and physicians who can recognize and manage obstetrical complications. Providing resources and training for a safe passage should be a leading developmental priority!
The First Window: Family LIFE Planning
It is strange and frightening that in the modern age we now have to declare what was previously obvious: health care is to be directed to saving lives and not destroying them. From ancient times, the healer was never to be the slayer, the physician was not to be the executioner. Even the language has its own strangeness. The World Health Organization promotes abortion as a means of “fertility control.” A mass of international aid agencies promote abortion as a “reproductive right,” yet the right has nothing to do with reproduction and everything to do with the killing of an innocent human being within the womb.
At the outset, we declare human life is a good – it is sacred – and needs to be safe guarded from conception to natural death. As we build our curriculum and programs, we return again and again to the touchstone of human life. Life is beautiful and to nurture human life and bring healing to those who suffer is worthy of our highest calling and noblest efforts!
Human life from its very beginnings is relational. A human person is conceived within the relationship of a mother and father. A child in the womb is in a profound biological relationship with his or her mother. This same child is born into a web of relationships with a mother, a father, brothers and sisters, relatives and friends.
As human beings grow and develop, their health continues to be relational:
· The healthy physical and emotional development of children is dependent upon the security and integrity of their parental relationships. Children raised in a single parent household face a future more likely to entail poverty, poor school performance, malnutrition, obesity, ill health and incarceration.
· Data from studies of “Adverse Childhood Experiences” indicate that children who grow up in a household where there is abuse, neglect, violence, alcoholism or drug use experience life-long emotional, mental and physical consequences.
· The health of women is more than “reproductive health,” it is also “relational health.” Women can only be healthy if there are positive, healthy and respectful relationships between men and woman.
· Positive health behaviors such as exercise, proper nutrition, and maintaining a healthy weight are more likely to occur and be sustained within a supportive marriage and family environment.
What leads to health is not simply the absence of disease but the quality of relationships within marriage and family. Human life flourishes when human relationships are positive, nurturing and self-giving!