I stepped up onto the bus, my arms weighed down by my three-year-old daughter and the numerous bags that I seem to have inherited with motherhood. As I entered, struggling with laptop, handbag, changing bag, lunch kit and oh yes, my child, I heard the conductor shouting to the passengers to clear a path and let the "Baby Mother" pass through. No matter how many times I am called this, I still chuckle to myself, amazed that I have now been culturally elevated to such a position of respect; one in which paths are sometimes cleared, our bags may be carried and seats are vacated for my precious child and her "Baby Mother."
The irony for me lies in the socio-cultural position that I now occupy as "Mother." On one hand, as a mother, I am now seen as a "real" woman. The once dubious nature of my womanhood has now been cemented, with my mini-me daughter providing evidence of my fertility. On the other hand, the perceived "naturalness" of the woman equals mother designation also serves to hide the value of the work (yes, I said it, work) that we do as mothers.
Because we live in societies that take it for granted that women will willingly and happily give birth no matter what, we by extension live in societies that also take us, as mothers, for granted, while penalizing those women who fail to fulfill this maternal obligation. From the world of policymakers to physicians, we exist within climates which fail to provide large numbers of women with adequate support systems, simply because of the notion of "motherhood" as natural; an organism operating independent of intervention. This endemic failure to see motherhood as an institution - complete with guidelines, values and norms - often translates into policies and practices that overlook the complex and diverse needs of women as mothers.
One of the areas in which much work remains to be done in order to meet the needs of mothers is that of maternal health care. The Caribbean, with maternal mortality rates ranging from 60-170/100,000 live births (and Jamaica with an annual rate of 45 maternal deaths for every 50,000 live births), has indeed come a far way in the provision of safer maternal health care as mandated by the UN Millennium Development Goals. However, much remains to be done to not only reduce the existing numbers, but further to improve the quality and scope of care received by pregnant women and new mothers. What is maternal health? How do we define a healthy birth? Is it one in which both mother and child survive the birth experience, or does it extend to a wider, more holistic approach to women, mothering and childbirth? Can maternal mortality rates in themselves capture the nuances of birth? Or does maternal health - in its truest sense - refer to an environment in which mothers are valued not only for the content of their wombs, but also as feeling, thinking human beings with valid and individual concerns and conditions?
Such a conceptual shift in the perception of motherhood would go beyond the current approach which focuses on the quantitative deliverables of maternal health (eg. infant and mortality rates) to include the provision of care and services that meet the needs of mothers, as defined by mothers themselves. In all areas of development we speak to the need for a bottom up approach; yet in maternal health, an area that cuts across all communities, women have not been actively engaged in the shaping of programmes or policies.
Despite this, there seems there could be a light at the end of the tunnel. According to Jamaican health care officials, initiatives are underway that could re-shape the ways in which we as a society perceive and manage safe motherhood. Incorporating a multi-pronged approach which will include media advocacy (PSAs, informational videos etc), there may be a recognition of the need to engage the key stakeholders in maternal health, with women and their partners being included in that number. As noted by Dr. Karen Lewis-Bell, Director of Family Health Services in the Jamaican Ministry of Health, the achievement of safe motherhood will necessitate a collaborative approach, one that goes beyond the inclusion of hospitals and UN agencies to include families. I am urging us all to press for a re-conceptualization of the way we see motherhood in general, and mothers in particular. It seems to me that maternal health, in its truest sense, cannot be achieved without an integrative approach that is based on the needs of mothers, fathers and their unborn children.
Additional information on maternal health care in Jamaica can be found here and here.
