It is truth universally acknowledged that there is no more skilled builder than a mother, whose hands build the foundation of life. Builders, guides, teachers and nurses- there’s not one job description that a mother does not tick off at some point in her life, but, are these worker bees truly cared for? Do they reap the rewards of their hard labour (pun alert!)? Maternal and child health is an issue emphasised on a global scale by WHO through Sustainable Development Goal number 3, and on a local scale with the Strategic Plan on Accelerated Reduction of Maternal and Child Mortality in Africa*. Now, with the commencement of Community Block, Fledgling OT (me) has had the opportunity to investigate the issues surrounding maternal and child health and how this has had an impact on the micro-society I work in.
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This week, being my first week working and experiencing
occupational therapy within a community setting, has highlighted for me the
desperate need that exists to support mothers and their children- a problem
which had never been on my radar before. For millions of mothers living in
low-income communities, a visit to a clinic is the only support they will
receive for themselves and their child. I had the opportunity to speak to a
many mothers this week, and the reality is there is no one out and about
with their self-help books, blog references and Facebook support groups to work
through the trials and tribulations of motherhood- there is only that one
clinic visit, when the weather is not acting up, and there’s a bit of taxi
money left over this month. The contrast between my own experiences with
friends and family and their journey through motherhood in suburbia is a
jolting one… will we ever bridge that divide? An eye-opening moment for me this
week was during a screening of The World’s Cutest 6-Week-Old. I had only
realised halfway through my session that I hadn’t written down a note with the
World’s Cutest 6-week Old’s name. I turned to the mom and asked for that
information and was met with shock and defeat as she quickly searched for her clinic card. She had forgotten his name.This
is the reality of motherhood at a community level, and it’s a pattern that’s
seen in varying degrees in many of the mothers that I’ve been granted the
wonderful opportunity to work with. Mothers are stressed. Mothers are tired.
Mothers are barely making ends meet. Mothers need help and cannot begin to tell
you what they need help with- the list is that long.
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| Image taken from: http://buildingmynestofscotts.blogspot.com/2011/01/does-your-house-always-stay-clean-if-so.html |
You can’t throw a stone in a community clinic without it
landing on a mother, but one really ought not to throw stones at people. My
point is, there is a HIGH demand for clinic services by mothers and children
due to the much higher birth-rates in these communities (low resources + boredom= babies?). The good news is that
women are utilising their local healthcare services, but whether these services
are resulting in healthier mothers and children remains to be seen. This issue
was investigated by Shippee, Rowan, Sivagnanam & Oakes (2015), who found in
a study over the course of 36 years, that mothers’ health significantly influenced their daughters’
self-rated health, and that mothers of low socioeconomic status had a
significant influence on daughters’ scoring low on self-rated health. This is
of great significance to healthcare service planning in low socio-economic
settings because it supports the need for a strong foundation of maternal
healthcare services in these areas (which includes OT services!) in order to
prevent a domino effect decades down the line.
Most noticeably in my work at our community clinic has been
the lack of overt health promotive materials and initiatives concerning postnatal
maternal and child health. Maternal healthcare is not a 9-month issue, it is a
lifelong issue, as mothers have physical and mental health care needs during and
after pregnancy. Life-long maternal health is discussed by Bick, Bastos &
Diniz (2017), who note that in the journey of motherhood, priority is only
placed on supporting in the first phase i.e. pregnancy and the first years of
life. This has a profound impact on society as a whole. With no emphasis on
regular screenings and check-ups after the first few years of life, older
children’s mental and physical health go unnoticed and mothers face the
increased demands that accompany raising aging children largely unsupported. Life-long
support of mothers is not something that I feel is emphasized in OT until we begin
working at a community level, where you don’t treat a condition but a person. Life-long maternal and child health needs to
be emphasised far more across clinical training. Mothers who are healthy are more
likely to raise healthy children, and more likely to impart good habits unto
their offspring- who will then go on to change the world! If revolution isn’t
in the cards, a mother who is physically and psychologically sound will, at the
very least, model behaviour and empower her children to care for their own
health, and from a young age be emphasizing the practice of going for
check-ups, following up on health concerns and being a responsible citizen.
It’s easy to identify a cycle, it’s harder to break it.
Mothers in low-income communities face an uphill battle in the struggle to keep
their family’s safe, clothed and fed, therefore it’s not surprising that the
emphasis is never on their own mental and physical health or the intricacies
that go along with ensuring their child is living a balanced life. We begin to
see evidence of neglected aspects of their own life and oversight in the
upbringing of their children- not due to disinterest by mothers, but rather due
to an environment and lifestyle that doesn’t support maternal and child health.
Occupational Therapy becomes a lifeline to mothers that didn’t even know they
were drowning. I saw that clear as day on the face of The World’s Cutest Baby’s
mom. There’s a strange phenomenon that exists within us as women- this idea
that we automatically know how to be a great mom, and once the baby comes all
the pieces will miraculously fall into place. In her TED talk (https://www.youtube.com/watch?v=jOsX_HnJtHU),
Alexandra Sacks (a reproductive psychiatrist) tackles this issue. It is
well worth a watch and emphasises the upheaval that motherhood causes
emotionally for mothers and how health professionals fail to prepare mothers
for this transition, an intriguing problem that I have only just begun to
understand since working with first-time mothers as well as a general need for
support in the overall journey through motherhood.
Mothers need guidance, tips, tricks and techniques not only
for the sake of raising a happy and healthy child, but for ensuring their own
wellbeing. Here lies the opportunity for OT. We can’t alleviate poverty or stamp
out all the injustices in the world, but we can impart knowledge, raise flags
and offer a smile or a shoulder to cry on. We have an incredible opportunity as a
profession, in that we can consider people holistically, and as a result we can intervene on multiple levels within
their lives. Our duty is to ensure that where other professions fail to see the
big picture, we highlight it and wave it about. Mothers and children are not
just visitors in our department, they’re residents, and we need to be there
throughout their journey- from start to finish.
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| Image taken from: https://giphy.com/gifs/TheFourOnFox-diddy-meghan-trainor-the-four-14e12M0engNjQbgAv0 |
*You can read more about the Strategic Plan on Accelerated
Reduction of Maternal and Child Mortality in Africa here: http://www.kznhealth.gov.za/family/CARMMA_South_Africa_Strategy.pdf.
It’s a plan with numerous shortcomings, noticeably, only an emphasis on new-born
health and not nearly enough practical ways to continue these efforts throughout childhood.
References:
Bick, D., Bastos, M. H., & Diniz, S. G. (2008).
Unlocking the potential of effective care for life-long maternal and infant
health: the need to address the ‘invisible’ service after birth. Revista
Escola de Enfermagem USP, 42, 420-421.
Shippee, T. P., Rowan, K., Sivagnanam, K., & Oakes, J.
M. (2015). Examining the impact of maternal health, race, and socioeconomic
status on daughter’s self-rated health over three decades. The
International Journal of Aging and Human Development, 81(3),
155-175.
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