Fathers’ Role in Achieving Gender Equality

Women in OECD countries spend, on average, 4.5 hours per day doing unpaid work such as cooking and caring for children. This compares to about 2 hours for men. Even if the division of unpaid labor has become more equal over the years, women are still doing more, and this results in unequal health outcomes for everyone.

“Women, even full-time working women, spend fewer hours on average doing paid work than their husbands or partners do. That may be due in part to the fact that there’s this expectation or default arrangement where they are doing more of the child care or housework.” – Kim Parker, Pew Research Center

When I attended WABA’s Global Breastfeeding Forum in October 2016, I was a struck by Duncan Fisher’s (Family Initiative UK) enthusiasm towards fathers’ role in advancing breastfeeding progress globally.

In this year’s International Confederation of Midwives (ICM) Congress, I was pleased to see that Fisher was invited to a plenary session on women’s rights where he spoke about engaging fathers in maternal and newborn health, and the impact this has on advancing gender equality. Because, as Fisher put it, “the unequal sharing of caring roles is a major global driver of gender inequality”. And we know for sure that gender inequality damages both the physical and mental health of millions of women and girls worldwide.

Fathers are interested, they want information and they do want to be close to their children. Why then are women still the ones taking on the majority of the responsibility, and what consequences does this have? According to Fisher, there is a lack of public information and services directed at the fathers. They simply don’t know about all the benefits of engaging in caring for their children.

The evidence is out there – and it’s abundant!

Everyone wins when fathers engage, both in the short and long-term:

  • a father’s testosterone levels drop after the baby is born if he is physically present with the baby (i.e. cuddling!)
  • his oxytocin levels rise and so does the baby’s
  • breastfeeding rates increase
  • maternal mortality rates reduce
  • the mental health of mother and child improves
  • access to services improve
  • violence and abuse decrease

Fisher spoke about the neurobiological impact involvement has not only on the father’s brain, but also the mother’s. Caring for babies changes the brains of both parents, and the change lasts for the rest of their lives. And the more a parent cares for their baby, the more their brain changes. As if this wasn’t evidence enough: the more the parents’ brain changes, the better the child’s social skills are when they reach school.

Fisher also stressed the importance of midwives in fathers’ engagement, and said that midwives play an imperative role in encouraging fathers to cuddle skin-to-skin with their babies within the first few hours of life, and in informing men of the benefits of their involvement.

The unequal division of the responsibility of caring for, managing and educating children is unsustainable, and it undeniably affects mothers’ and babies’ health. Mothers should not be solely responsible for caring for their families – fathers must engage in order for us to achieve optimal health for women and children, as well as gender equality.

I am certain that the redistribution and reduction of unpaid care work and improved gender equality at home will improve quality of life, not only for women, but also for children and men. It most certainly is a win-win situation.

Family Initiative UK have launched an online course delivered by midwives and trainers which explores these issues. If you’re present in Toronto at this year’s ICM Congress, make sure to visit Family Initiative UK’s booth and learn more about the course! 

Girls’ Globe is at the 31st ICM Triennial Congress in Toronto, Canada. See all of the Girls’ Globe LIVE coverage here

Babies are Born. Then they Breastfeed!

The baby let out a wild cry the moment it came out. We felt triumphant. After a four week period of intensive supervision, the mother had finally delivered a healthy baby. I was a resident doctor in obstetrics and had stayed up for several long nights, struggling to help this woman to complete her nine months – complications constantly threatening to sabotage our plans. But now there was relief and joy as it had all turned out ok.

Or so I thought.

The next day, I found the new mother anxious. Desperately, she said: “I am unable to breastfeed. I don’t know what to do.” I tried giving her some tips but immediately realised I was as unable to get this baby to breastfeed as she was. Giving out a few customary instructions I moved ahead, knowing I had hardly made any difference to her anxiety.

The following day, the baby was in the Intensive Care Unit, having convulsed due to low sugars. I knew that meant potential for future intellectual disability. I glanced through the glass windows of the ICU and saw the mother standing besides the incubator. I had a sick feeling which I could neither deny nor escape; I had failed her. We had all failed her. Our moment of triumph was now no more. We had poured in all our collective efforts pre-delivery to bring forth a ‘healthy’ baby, but had ignored her post-delivery struggle with breastfeeding. We all assumed that it just happens naturally; every mother just knows how to do it. But this is far from true. They all need personal support and guidance.

I was suddenly acutely aware of my deficient skill set. As resident doctors, there had been more important things to update ourselves on; the newest infertility treatments and best ways to deliver high risk pregnancies. Breastfeeding was not something we were told to consider actively in our rounds or spend hours training ourselves in. Our singular focus as obstetricians had become to help deliver a ‘healthy live baby’ and as neonatologists, to ace resuscitation protocols when babies weren’t breathing at birth and then get busy with the incubators. With doctors’ alternative priorities and nurses’ preoccupation with injections and clerical work, whose job was it to look at breastfeeding?

The void in lactation support was glaring. I was restless. How can we make breastfeeding a breeze for mothers; a joyful journey of bonding and nourishment rather than a nightmare? That’s when our lactation consultant asked me to try ‘Breastcrawl’, a term I had never heard before.

Apparently, just like newborns of all animals, our babies have an innate capability to seek out the breast and feed; if left undisturbed and ‘skin-to-skin’ with the mother for the first crucial hour after birth. This is called ‘early initiation’ through Breastcrawl. I felt stunned by the potential behind this beautiful miracle of nature. It seemed to have all the answers for a successful start and continuation of breastfeeding! I attempted it in our labour room and sure enough, the baby crawled up from the mother’s abdomen to the breast, latched on its own and smoothly drank its first precious drops. Its reflexes were the only coach it needed. What a perfect start it was!

Breastcrawl has deep implications on health of newborns. As I started following up these ‘Breastcrawled’ babies in the wards, I saw that even the first time mothers breastfed with the confidence of a woman who had just had her third child! Science supports the impact of this technique way beyond just nutrition – sensory-neural development, immune priming, bonding, temperature control and more.

Photo credit: Dr Taru Jindal
Every mother and newborn deserve this experience. But in our hurry to complete paper work and protocols, we had been thoughtlessly separating the mother and baby in those critical first moments and preventing this beautiful miracle from manifesting itself. Our support had been inconsistent and ill-timed. We were either getting in the way of mothers when we needed to step aside or we were simply too far away for help when mothers were desperately seeking us.

The experience with breastfeeding in my residency taught me how ‘lactationally illiterate’ I was. I learnt that supporting mothers in breastfeeding is as critical as doing a perfect caesarean surgery. Ensuring a ‘live birth’ was indeed just the first step.

As WABA keeps reminding us so rightly, babies are born, what do they do next? They breastfeed!

 

Celebrating Midwives & Partnerships that Matter

The lifetime risk of a woman dying from pregnancy and childbirth related complications in Kenya is high, at 1 in 55. According to latest data by UNICEF, the maternal mortality ratio in Kenya is 488 per 100,000 live births is unacceptably high. Only approximately 44 per cent of births are assisted by a skilled health worker, mainly a nurse or a midwife. Skilled attendance and particularly the role of the midwife continues to be advanced as a global priority and effective intervention for safer motherhood.

The IMG-20170503-WA0003International Day of the Midwife, May 5th, is a day to celebrate the wonderful work midwives are doing around the world. I, Felogene Anumo, a Girls Globe Blogger had the opportunity to speak to Rachel Odoro who has over sixteen years of midwifery practice and is currently the Assistant Chief Nurse at Kenyatta National Hospital (KNH). She shares the highs and lows of her career and offers crucial perspectives on this year’s theme Midwives, Mothers and Families: Partners for Life!

What inspired you to be a midwife?

If a midwife has the passion for midwifery and is empathetic, all they require are the capabilities, skills and competencies and they can perform in the utmost. Delivering quality care for the mother and her family is what matters most.

I developed my passion while I was still young in my career as a community health worker. I really love the mother and the child and it saddens me that so many mothers are dying from mostly preventable maternal-child related causes. I believe that midwives and midwifery skills are very important for preventing maternal, neonatal deaths, stillbirths and birth related complications. My experience has taught me that in order to increase the survival rates during birth, midwives require adequate support, proper infrastructure and up-to-date training.

What makes you proud of being a midwife?

There is something special about providing care for a mother during the journey of pregnancy and childbirth. Being a midwife is not only about clinical skills but being empathetic, passionate, respectful, culturally sensitive to a woman’s needs during pregnancy. I recall some of my trying moments at Pumwani Maternity Hospital, one of the largest maternity hospitals in the country, where we would handle up to 100 mothers delivering within 24 hours. These numbers would go up during the nights when up to 60 mothers would deliver. Needless to say that midwives do not only deliver babies, they significantly contribute to women’s sexual and reproductive health, through the prevention of unwanted pregnancies, pre- and post-natal care and health education. Midwifery is also equally important for newborns during the critical first few weeks of life.

What change do midwives make in the community?

Midwives are essential in the healthcare workforce. A mother who is delivering a baby is not something that can wait. Well-trained, well-equipped, well-supported and regulated midwives working in communities are uniquely positioned to save so many lives in their communities. Most maternal deaths are preventable as the health-care solutions to prevent or manage birth-related complications are well known.

However, we have to overcome certain challenges in order to work better with communities. More specifically, strengthening interpersonal relationships with mothers by improving attitude and practices when they seek care and working with Traditional Birth Attendants (TBA) to avoid mismanagement of mother and child. Other factors that prevent women from seeking or receiving care during pregnancy or childbirth include poverty, distance to health unit, lack of information, inadequate services and cultural practices. To improve maternal health outcomes, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system.

The Lancet maternal health series highlights that we will require more than 18 million additional health workers to meet targets set out in the Sustainable Development Goals by 2030. The series further highlights that Kenya is among the countries that has some of the lowest densities of midwives and obstetricians (WHO recommended one skilled birth attendant for every 175 pregnancies). What kind of partnerships are vital to support the work that you do?

  1. Families – Women need access to antenatal care in pregnancy, skilled care during childbirth, and care and support in the weeks after childbirth. This support can be provided by families or the community. Community support groups are able to identify expectant mothers, share their experience and intervene for example by providing transport during emergencies. telecommunication, transport during emergencies etc. The midwife in this case needs to form strong partnerships with the community so that emergencies can be referred on time
  2. Governments – To improve transport and telecommunication infrastructure. These would include proper road networks to health units as well availability of ambulances. The devolved system of governance in Kenya has enabled health units to be built in remote areas but a lot more still remains to be done. There is still a lot of congestion in the labor wards as a result of the free provision of maternal and child health care by government but our role is to reassure them that they will receive the highest form of care.
  3. Non Governmental Organizations (NGOs) – NGOs can partner with midwives to build competency and ensure that they are well-trained and well-supported especially for midwives working in low-resource settings. I have benefited from several trainings including by PRONTO International . There is no one who doesn’t require training. If I don’t read my books and update myself on the latest practices, I will decay.

We conclude this interview with a powerful reflection by Cathy Moore (in Sisters Singing). To all the Midwives at the frontlines, making motherhood safe – we love you, we appreciate you and we cherish you. Happy International Day of the Midwife.

“…As we ready ourselves to accept new life into our hands,
Let us be reminded of our place in the dance of creation.
Let us be protectors of courage.
Let us be observers of beauty.
Let us be guardians of the passage.
Let us be witnesses to the unfolding…”

World Prematurity Day 2016 – The Simplest of Interventions that Saves Lives

Each year more than 15 million babies are born prematurely, many of whom die within their first few days of life. Today, on World Prematurity Day 2016, we are shedding light on one of the most effective, yet basic interventions: Kangaroo Mother Care (KMC). With exclusive breastfeeding being one of its essential components, this method has the potential to save the lives of babies born prematurely.

This week, in connection with World Prematurity Day, Save the Children announced that representatives of major international and U.S. associations for health professionals will come together and endorse a joint statement recommending the universal use of KMC for all preterm and low birth weight infants.

So, what does Kangaroo Mother Care entail and why do we need it?

KMC is a method of care practiced on newborn children – usually preterm (born before 37 weeks of pregnancy), low birthweight infants – where the mother, father or another carer functions as a natural incubator, providing heat, stimulation and feeding to the baby. The newborn, only wearing a nappy and a baby bonnet, is attached skin-to-skin to the mother’s and other carers’ chests, and is kept upright 24 hours a day.

unsplash

The method was developed in 1978 by Edgar Rey Sanabria, a Colombian paediatrician who recognized the problems arising from a shortage of incubators and from separating newborns from their mothers in neonatal care units. Some of the method’s key features are:

  • Early, continuous and prolonged skin-to-skin contact between the mother/father and the baby;
  • Exclusive breastfeeding (ideally);
  • Initiation in hospital, with guided continuation at home;
  • Adequate support and follow-up.

Today, almost 40 years after the development of this powerful, cost-effective and universally available technique, research and implementation have proven that KMC is at least equivalent to conventional care, in terms of safety and thermal protection. And while it was originally intended to premature babies, it is now known that all babies benefit from the effects of KMC.

The WHO estimates that over 75% of babies born prematurely, or babies born with low birthweight, can be saved with cost-effective and feasible care, with KMC being one of the most basic interventions. In low-income countries and regions where the death rate of preterm babies is disproportionately high, and where access to health care and/or medical equipment often is limited, KMC is expected to have the greatest outcome. In these poorly resourced settings, KMC can halve the risk of infection, compared to incubator care.

So, while it seems as if we live in a time where modern medical technology is constantly developing, in certain cases we might have to take a few steps back and truly acknowledge the most basic and gentle, yet effective interventions, such as Kangaroo Mother Care and exclusive breastfeeding that have the potential to save the lives of our tiniest children.

Read more posts on prematurity and World Prematurity Day published by Girls’ Globe bloggers Emma Saloranta and Holly Curtis, and more about breastfeeding here. You can also join the global conversation using #WorldPrematurityDay on social media. 

Featured Photo Credit: Mother and baby, Save the Children (Flickr/CC)