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Safe Delivery, Not Guaranteed

Analysis Haley Nicholson, Legislative Analyst

In the past year, a number of my friends have become pregnant. All of them are in committed relationships and have established careers. Some are new moms, and others are having their second child. My friends can take for granted the competency of their provider and the quality of care they will receive. This is in stark contrast to the women my work exposes me to—women who live in some of the harshest and most unforgiving reproductive and maternal health situations in the world. This includes women who must give birth in facilities where they are abused by staff, women whose prolonged labor leads to complications like fistula, and too often I hear about 13 and 14-year-old girls giving birth before their bodies are fully developed.

And now, running parallel to what I have dubbed my “year of the baby,” is the Zika virus and reports on its potential impacts on women and newborn health. It has also spurred a conversation on reproductive rights in Latin and Central America, where the outbreak has hit the hardest and a number of governments have told women to avoid getting pregnant as a solution. Not only is this not an option for many women in these countries for several reasons, it is also an absurd recommendation. First, their countries have highly restrictive abortion laws, meaning often only women with the financial means are able to get an abortion by traveling to a country where it is legal and safe. Second, these laws are enforced in environments with limited reproductive health access, unstable contraceptive supplies, and a stretched health workforce, especially in rural areas. Maternal mortality rates (MMR) and contraception usage in most of these countries have improved over the past 40 years, but they are not matching the global benchmarks they should.

Sadly, these governments pay little attention to the reality of their country’s reproductive and maternal health situations, and these realities are also not apparent to a number of U.S. policymakers either. Some U.S. politicians have said there is no reason to discuss revoking highly restrictive abortion laws in the midst of the crisis. Others say that if a woman who contracted Zika gave birth to a baby with microcephaly, it isn’t that bad. The state of reproductive health access and maternal health services for many women in Latin and Central America is that bad. If access to antenatal care, delivery services, and post-delivery services are lacking, what kind of assistance can be available to women who have children with disabilities? Simply saying “don’t have a child,” or the situation “isn’t that bad” is easy for those who do not have to worry about access to essential health care services.

As health agencies like the Center for Disease Control and the World Health Organization are learning about the reach and impact of Zika, there should be a pivot to help the populations most vulnerable to the disease. Until a vaccine can be created and distributed—not a short-term project—there are services that can be provided now including access to a full range of reproductive health services. For U.S. policymakers worried about the financial implications of investing in this outbreak, our work there can inform current and future U.S. investments in reproductive and maternal health services not only in emergency situations but in low-resource countries as well. This type of work is already underway by U.S. agencies and donors.

In the meantime I will continue to appreciate the safe delivery and support my friends will receive while continuing my work to ensure their same experience can be afforded to women and girls everywhere.

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