Protecting Our First Environment
The mother’s body, womb, breasts, arms
When we talk about the environment, we usually refer to the natural world outside of ourselves, but let’s consider our first environment, the one that lays the foundation for all other relationships with nature. As Tekatsi’ tsiah:khwa Katsi Cook, an Elder Mohawk grandmother and midwife says,
“Women are the first environment. We are an embodiment of our Mother Earth. From the bodies of women flow the relationship of the generations both to society and the natural world.”
Our first environment is the mother’s body: her womb, her breasts, her arms. The baby in the womb is a bud that blossoms according to its habitat. Good food, plenty of water, rest, lack of stress and kind, nurturing care are the biological imperatives that allow an infant to thrive.
Premature birth
An increasing number of babies leave the womb early because they or their mothers feel threatened. In fact, the pregnant woman signals to her unborn baby about its future world.
Premature birth is the most significant and intractable problem in maternal-child health in the United States. The United States and 14 other countries, all from sub-Saharan Africa and South Asia, account for two-thirds of the world’s prematurity.
About 10% of US babies are born prematurely, 14.4% among Black mothers. Though health officials tend to blame preterm birth on mothers, it is, in fact, caused by stress.
Feelings of stress and worry are particularly high in the US, comparable only to African nations like Niger and Sierra Leone, and some in the Middle East, such as Iraq and Iran. This stress translates to interrupted pregnancies. According to one study:
“Evidence from population-based epidemiological and clinical studies suggests that after accounting for the effects of other established socio-demographic, obstetric and behavioral risk factors, women reporting higher levels of psychological stress during pregnancy are at significantly increased risk of preterm birth.”
Infant mortality
Too many babies die during their first year of life and many deaths could be prevented with early diagnosis and treatment of diseases during pregnancy, and by better care conditions for pregnant women.
Countries with the highest survival rates for infants have strong, well-resourced health systems, plenty of highly skilled health workers, and a well-developed infrastructure. These countries are Iceland, San Marino, Estonia, Slovenia, Norway, Japan, Singapore, Finland, and Montenegro, all of which have infant mortality rates of less than 2 per 1,000 live births. In the US, infant mortality is 5.44 per 1,000 births.
The rates for infant mortality among indigenous women and women of color are much higher, however. In the United States, Black mothers have an infant mortality rate of more than twice that of white mothers: 10.6 per 1,000, and indigenous mothers have a rate that is 7.5 per 1,000.
In addition, the rates of infant mortality vary widely by state. The states of Massachusetts, New Hampshire and New Jersey, for example, have infant mortality rates of less than 4 per 1,000, while poorer states have higher rates. Mississippi has the highest rate at 9.11 per 1,000.
Maternal mortality
Maternal mortality, the rate of women dying during childbirth or within 42 days afterwards, is mostly preventable. While the rates of maternal mortality vary among countries, US women are more likely to die in childbirth than are women in 10 other high-income countries.
In fact, maternal mortality in the US has been rising for over 20 years. In 2020, it was 23.8 maternal deaths per 100,000 —14 times the New Zealand rate of 1.7 per 100,000.
One obvious contrast between the US and other countries is the number of maternal care providers. The US has just 15 maternal care providers for every 1,000 live births. In contrast, New Zealand has 55 maternal care providers per 1,000 live births.
In the US, there are nearly three times as many Ob-Gyns as there are midwives. This translates to only four midwives for every 1000 live births. In most other high-income countries, there are between 30 and 70 midwives for every 1000 live births.
This is important because midwives visit the new mother within 36 hours of coming home from the hospital or after a homebirth and weekly for the first six weeks postpartum. Ob-Gyns, on the other hand, may not see a new mother for a follow-up visit until 12 weeks after birth.
Breastfeeding
The World Health Organization and UNICEF recommend early initiation of breastfeeding within one hour of birth, exclusive breastfeeding for the first six months of life and continued breastfeeding (along with solid food) up to two years and beyond.
Exclusive breastfeeding is important because the outstanding health benefits afforded by breastmilk apply only to exclusively breastfed babies. The addition of formula or any other food changes the baby’s gut, which may impact long-term health.
Almost all babies in low and middle-income countries are breastfed, but in high income countries 20% of babies are never breastfed at all. According to WHO, among the poorest families worldwide, 64% of babies are still breastfed at age two, compared to 41% among the richest families.
In the United States, 46.9% are exclusively breastfeeding at three months and 26.6% at six months.
Formula marketing
In 2022, WHO issued a report on the formula industry’s aggressive and misleading use of social media to erode new mothers’ confidence in breastfeeding. Companies spent more on digital marketing to sell infant formula in 2021 than on any other type of advertising, nearly doubling what was spent just four years before.
The WHO report analyzed four million social media posts about infant feeding between January and June 2021. The posts reached 2.47 billion people and generated more than 12 million likes, shares, or comments. The report monitored 264 breast-milk substitute brand accounts and found that they posted content 90 times a day, reaching 229 million users daily. This is three times as many people as are reached by informational posts about breastfeeding from non-commercial accounts.
In 1981, the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes, a landmark public health agreement designed to protect the public in general and mothers in particular from aggressive marketing practices by the baby food industry, practices that negatively impact breastfeeding. Since 1981, 136 (70%) of UN member countries have legislated at least some of the Code provisions. The United States has enacted no provisions. In fact, the US was among only Chad and Bangladesh in voting against the Code in 1981.
Family friendly policies
A 2016 study in The Lancet found that universal breastfeeding would prevent more than 800,000 child deaths a year across the globe and yield $300 billion in savings from reduced health care costs and improved economic outcomes for those raised on breastmilk.
Women are 2.5 times more likely to breastfeed when breastfeeding is protected, promoted, and supported by strong policies and programs. In fact, family-friendly policies are critical to increasing breastfeeding rates worldwide.
According to UNICEF, too few countries provide paid parental leave. Eighteen weeks of paid maternity leave and workplace supports are recommended for breastfeeding families, but only 12% of countries provide adequate paid maternity leave. The US offers no paid maternity leave.
Women with six months or more maternity leave are at least 30% more likely to maintain breastfeeding for the first six months. In one survey, each week of maternity leave increased the duration of breastfeeding by almost one-half week.
Protecting the first environment
Protecting our first environment means ensuring that all women, regardless of race, ethnicity, or income, receive universally excellent prenatal, perinatal, and postpartum care.
Pregnant women need healthy food to eat, freedom from stress, universal health care, access to culturally competent midwives and doulas, postpartum care for at least six weeks after birth, paid maternity and paternity leave, breastfeeding information support without formula marketing, and family friendly policies in society and the workplace.
A healthy society will ensure that the baby’s first environment, the natural world of their mother’s bodies, is fiercely protected. Only then can the baby’s biological imperative be realized.
For more on this topic, see “Childbirth Deaths on the Rise,” and “Too Many Black Women are Dying in Childbirth.”
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