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on April 25, 2013
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The Healthy Newborn Network Blog provides timely information and insights from the global newborn health field and seeks to promote dialogue on important newborn health issues. The blog is a platform for the HNN Editors and guest contributors to post commentaries on current happenings in the newborn health field. The content of each post and comments expressed on the HNN blog are those of the individual contributors and do not necessarily represent the views and opinion of the HNN or its Partner Organizations. >>Read a note on leaving comments
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In 2007, with one two and half-year-old child, my husband and I decided it was time to have another baby. My first miscarriage occurred at six weeks. My second was at almost eleven weeks. The grief was alarming but I did what many women do - my best to quietly “carry on.”
Simple tasks became challenging. I’d stand in the cereal aisle frozen by the choice between honey-nut and plain. The question, “Paper or plastic?” should not make a person cry. Maintaining this external “everything-is-ok” façade was agonizing.
It was the tension - between façade and grief - which inspired my short film about miscarriage, stillbirth and early infant loss. “The House I Keep” is a story of transformation during one woman’s struggle to come to terms with the loss of her child.
My hope is that this film frees people to talk more openly about what remains stubbornly taboo. When people hear about my film total strangers let loose regardless of location: be it the gym or in a grocery store. Their stories are always deeply moving and I am honored by their candor.
What do they say?
They tell me there is no appropriate place to mourn this loss. While family and community are powerful sources of comfort, the silence on this subject prevents women from accessing that healing power. Consequently, the mental health of not only mothers but also their children suffers.
Consider this stigma magnified around the globe. In some developing countries, superstitious beliefs lead women to be blamed for a stillbirth or miscarriage. Some communities feel more people will die if the bereaved mother is in contact with other women and children. Subsequently, access to the healing power of family and community becomes greatly restricted. As we move forward with the important work of improving global maternal and newborn health, the long term effects of stigma on the mental health of women and their surviving children cannot be over looked or marginalized.
Talking heals. Women want to feel reassured that their child’s too-short life had a place in the world and that the world is different because of that child’s absence. You can help mark that life by just being willing to talk and listen. The landmark Lancet Stillbirth Series released in April is already impacting the worldwide perception of stillbirth.
In my own community of Seattle, Washington, in the United States, nonprofits that counsel women postpartum will be using my film as a starting place for open discussions. The ripple effect of community efforts, combined with the work of organizations including PATH, UNICEF, Save the Children, and the Bill & Melinda Gates Foundation, will undoubtedly lessen the stigma of a tragedy for which no woman should ever be held accountable.
By letting women talk openly, and by listening, our communities around the world can help women – including me - begin to heal.
As an NGO worker, one of the most inspiring parts of my job is meeting health workers – doctors, nurses, midwives and community health workers working in some of the world’s toughest places, the frontline of development, serving local communities and saving lives. Properly supported and equipped they can prevent most newborn, child and maternal deaths. They are vital too for fighting HIV, TB and Malaria, for tackling the rising challenge of non-communicable diseases, and indeed for addressing all important health issues. It is no exaggeration at all to describe health workers as life savers, heroes, the backbone of healthcare.
But world leaders have not so far done nearly enough to ensure a health worker is in reach of all who need them. As the UN Secretary-General has noted, the world is suffering from a massive gap of more than 3.5 million health workers. This includes a pressing need for at least 1 million community health workers and 350,000 midwives. Millions more existing health workers lack the support, equipment and training they need.
The UN General Assembly meetings this September will be a crunch moment for health workers. Bold leadership is needed. World leaders each need to make new, substantial and specific commitments to expand the number of health workers and better support those workers who are already in place.
We know from experience that to motivate this kind of bold leadership requires a powerful coalition with strong public support. That’s why over 200 organisations have come together in issuing an urgent call for more health workers, better supported. It’s a really diverse coalition including health workers themselves, affected communities, business representatives, Ministries of Health, local grassroots organisations and international advocacy groups – and it gets larger and more diverse every day.
The full list of organisations signed up to the call are at www.healthworkerscount.org - if your organisation is not yet one of the more than 200 who’ve signed up, you can do so on the site. On 20th July, a toolkit to support campaigning and advocacy will be added to the site to help people take action around the world. You can also follow @healthworkers on twitter.
We’re working together in this way because we’ve all learned that the most important changes can’t be achieved by any one organisation, or even sector, working in isolation – we need civil society, governments, the private sector and citizens across the world to work together; and we need leaders to feel encouraged to be bold in achieving change. By bringing our voices together in this way we’re helping to ensure the message is heard and acted upon: that the world needs more health workers and better support for those in place. In the coming months we’ll be advocating together, campaigning together, and enabling millions of people around the world to show their support for ensuring a health worker within reach of every one.
A mountain of evidence, from the world’s best experts and from agencies working on the frontline, confirms this truth: health workers save lives – and by joining together in common cause, we can help them save even more.
Ben Phillips is helping to coordinate efforts by over 200 organisations for more health workers, better supported
Find out more about the campaign at www.healthworkerscount.org and twitter @healthworkers
Photo: Andy Hall
The following piece was originally published in the Bill & Melinda Gates Foundation Blog.
On New Year’s morning in January 2003, my life took a shocking turn with my obstetrician uttering three simple but devastating words: no fetal heartbeat. Several attempts to induce labor finally lead us to my first and only daughter’s stillbirth at dawn on Friday, January 3, 2003.
Malika as guest speaker on 100th celebration of International Women’s Day at a fundraising event for the Cape Town launch ofThe Bigshoes Foundation, a South African NGO focusing on palliative care for children.
I named her Iman (Faith) Bongiwe (Gratitude) and she was buried at noon on that same day.
Being a writer, I wrote for my own relief and sanity several times a day; at other times, I could manage to eke out only a word for weeks. It helped immensely to have a place to go to release my overwhelming tides of grief, a space where I did not have to censor my thoughts and feelings for the sake of those around me. Six years later a book emerged entitled Invisible Earthquake: a woman’s journal through stillbirth, published by new South African women’s press Modjaji Books in 2009. It is not only a poetic memoir, but includes a medical perspective and support resource information.
Above all, it is a tribute to my daughter, made with immeasurable love.
With another year since her passing, I can reflect on how far I have come on this path of recovery, although never certain of the day or moment when sudden sadness will sink me again, taking me back to remembering what must never be forgotten – about her or about what happened to me, to us. With this book finding its way onto bookshelves and into cyberspace, unexpected doors have opened, welcoming my daughter and me in with intensity and urgency.
My intimate perspective as a mother has begun to cross communication gaps and pain-filled silences within women, families and within medical fraternities across the world. People’s responses to these interactions have covered the entire spectrum from devastation to healing release and deep inspiration. In the two-way process of sharing I am both the giver and the receiver.
Numerous mothers and a few fathers have shared their experiences of stillbirth with me. I encourage them to give permission to their grief and remembrance and to reach out for professional bereavement support. I have felt authentically useful to others in making the connections between clinical responses, cold statistics, and documentation of stillbirths, and the raw humanity of the experience, a mother’s voice, which still remains widely blanketed in silence.
Within many African communities, however, there are a range of social and cultural factors which inhibit women from speaking about their experience or accessing emotional as well as basic practical support.
While there is pervasive inaccessibility to services as a consequence of poverty, in many cases simply addressing the lack of information, support, and ongoing education – both of mothers, medical staff and the public – could save babies’ and mother’s lives and begin to ease the protracted suffering stillbirth can lead to.
Compounding this situation are prevailing perceptions that therapy is for the elite, that depression is not a valid medical condition, dominant religious or cultural beliefs that may deem stillbirth as “God’s will” which must not be questioned, or this tragedy is seen as a curse upon a family.
In a context where children are considered part of one’s wealth and community status and in some ways proof of one’s womanhood, the shame of infertility, miscarriage and stillbirth can mean death in more ways than one for an African woman.
Ironically, as has been my experience, once one woman breaks the silence with her testimony, many others find the courage to reveal their own pain and difficulties with finding the comfort and support they so desperately need. The profoundly healing impact of one mother sharing her experience with another can also never be underestimated. Even if initially they are strangers, across small or great distances, this shared journey of a very particular womb loss offers immense comfort by virtue of sharing with one ‘who knows’.
With growing exposure to the research, facts, and updated global statistics about stillbirth, particularly through the recently launched Lancet series on stillbirth, I am driven to break the silences, stigma, and misconceptions around stillbirth wherever and wherever possible.
Our collective "noise-making" about the reasons for stillbirth, the preventable causes, and the need for global government and private sector investment in this relatively neglected area of health care can change the numbing statistics from today, even if it means saving one baby’s life at a time.
Even in the delivery room in January 2003, I knew my daughter did not come to bring me sorrow. I recognize the gifts and life lessons that she continues to bring, from that very rupture in my heart and the inner earth of my body. I will never be the same and the direction of my life, the depth of my living has irrevocably changed.
Though she was not destined to stay, I can never ever regret that she came.
The following post has been pubslished in WRA's Blog and the Bill & Melinda Gates Foundation Blog.
This month, the White Ribbon Alliance (WRA) has partnered with the HNN to draw attention to the 2.6 million stillbirths that occur worldwide each year. This past April, the Lancet launched a new series on stillbirths to draw attention to a public health crisis that has been widely overlooked.
The Lancet Series included a 2020 vision, calling on the international community, individual countries, and communities and families to take the necessary steps to reduce stillbirth rates by the year 2020.
Now, WRA and HNN are calling on you, as advocates for safe maternal and newborn health, to play your partand break the silence on the tragic toll of stillbirths. Participate in June's Action of the Month!
HNN is also featuring a series of blogs highlighting papers examining the state of political priority for newborn survival globally and in 4 low-income countries: Bangladesh, Bolivia, Malawi and Nepal. The case of newborn survival provides insight into what it takes to generate political priority around health issues globally and in country contexts.
The following post was originally published in the Bill & Melinda Gates Foundation Blog.
In the months after losing my son at 40 weeks gestation, I received tremendous support from women whose babies had died many years before. At the time, it was difficult for me to appreciate our commonalities since my grief was so raw while theirs seemed so very far removed.
Today, I understand. My son would have been 17 years old this year. I do not miss the infant son so much as the teenager who would be standing alongside his brothers, now 16 and 14 years old. As an anonymous poet wrote years after her baby’s death, “I do not mourn for what you were, but for what cannot be – the unfinished life we did not share.”
That is why I was so gratified to read about Melinda Gates’ support of the landmark Lancet Stillbirth Series, designed to bring attention to a problem that affects 2.6 million women every year.
The series serves as a powerful acknowledgement that the consequences of stillbirth extend far beyond the initial grief. While it remains very much a silent sorrow, the loss of a baby brings pain into the lives of a mother and her family that cannot be erased by having more children.
However, as women who experienced such a loss proved to me so long ago, we can use our experiences to help others. In the weeks after I buried my son, I resolved to follow in the footsteps of those women who reached out to me when I needed it most.
In the early years, that resolve took the form of a book I wrote to guide women through the journey of the next pregnancy. More than 12 years after the publication of Pregnancy After a Loss, women continue to write and tell me how thankful they are to know that someone else shares their feelings.
I now plan to heed the Bill & Melinda Gates Foundation’s call to action and join other parents in the global initiative designed to both break the silence around stillbirths and reduce them by half over the next decade. Having recently completed my PhD with plans to specialize in public health research, the Lancet series inspires me to find ways to contribute to this movement. I invite others to do the same.
While I am forever grateful to those mothers who reached out to me so long ago, I am optimistic that this new research initiative will succeed in its goal of diminishing the number of women in need of such comfort in the years ahead. In the meantime, it is good to see so many joining together in giving voice to the voiceless.