Baby Season

Marina is doing a project right now in her Public Health class where she has to make a project proposal (the whole thing, with the Gant charts, the budget, etc) for a Maternal Health project in a fictional health district in a fictional country in Africa.

As we were discussing it, I came up with a question… what is the variation in pregnancy over the course of a year? Is it seasonal? If so, in which cultures yes and which cultures no? Why?

It’s important because if you expect 52 complex births a year and each mother needs 7 days in a bed, do you need one bed in your hospital or three? At that scale, it doesn’t matter so much, but add a zero or two onto the end of the figures, and the question of “10 or 30 beds” makes a great deal of difference to budget, logistics, HR, etc.

So you can imagine how I chuckled when this came into my mailbox:

HAITI. The team is struggling to respond to needs of women giving birth these days, as it is the yearly peak resulting from Carnaval festivities in February. For example, yesterday 158 women were in labor at Jude-Anne hospital (60 bed hospital). This means that women were giving birth in every available corner of the hospital property, from the rooftop and stairwells, to the triage space outside. The family caregivers could not enter the hospital due to lack of space and frenetic activity. Also local health structures in Port-au-Prince are still not fully functional, as they are either without proper medical equipment or on strike. This means that MSF is the only hospital functioning in the city for women giving birth. It also means that MSF cannot refer patients to these structures.

(This is from an internal report that I am not normally allowed to forward. But seeing as this information is not security sensitive, I feel comfortable bending the rule this one time.)

At first glance, the idea of carnavale making so many babies they have to be born on the roof sounds a little funny… you imagine a yearly baby boom and who doesn’t smile at the thought of a hundred cute newborn babies?

But to understand why this situation is sad and dangerous for Haitian mothers, you need to understand this: Worldwide, the vast majority of births are not done in a hospital. They are done at home, or perhaps in a health post. Only complex pregnancies (perhaps 10%) need to be seen in a hospital setting. The maternity ward in a resource poor context is only occasionally a scene of joy with beautiful new babies popping out of healthy mothers. More often, it is a scene of fear, uncertainty, pain, and loss. Women who end up in the hospital as a result of a pregnancy have drawn the short straw and are at risk of losing their baby, their future fertility, or even their own life.

If I’ve rained on your parade too much, go visit The White Ribbon Alliance and watch one of their movies. You can get cheered up by hope and strength and get educated at the same time!