Every year more and more families are choosing home birth over the hospital. There is a growing movement, in person and online, of parents opting-out of hospital birth, sharing their stories, and encouraging others to do the same. At the same time, the United States is reckoning with its abysmal maternal mortality rates- the majority of which are the result of poor management of dangerous pregnancy complications. How can these two phenomena exist within the same social and cultural conversation? The landscape of home birth in the United States is complex. Data on the safety of home birth is limited, but it appears to be more dangerous than hospital birth. Further complicating the picture is a fractured, private American healthcare system, but families choosing to birth at home are highly motivated to navigate through it. We present multiple theories to explain why so many birthing people are opting for the home, some of which include feminist philosophical arguments, the romanticization of birth, the contemporary all-natural movement, and a strong distrust of our racist medical system. These arguments shed light on the flaws and inadequacies of our maternal healthcare system, and as a medical community we must actively work to alleviate them. We need to nationally and locally address maternal safety and implement practices to dismantle systemic racism within our institutions. While we address maternal mortality, we must also take steps to make home birth an equally safe option for parents who choose it. / Urban Bioethics

Introduction & Background Black infant mortality rate is 122% higher than that of non-Hispanic white infants. In a 2021 CDC study, Black women’s maternal mortality rate was 69.9 deaths per 100,000 live births, 2.6 times the rate for non-Hispanic White women. Purpose Statement & Research Question The purpose of our research was to explore reasons why Black maternal mortality is higher than White and non-Hispanic populations and what contributing health disparities are causing higher mortality rates in black infants and mothers compared to their non-Hispanic white counterparts, in the United States. Literature Review: We found articles under 5 years old from Cinhal database. Findings Examples of inclusion and exclusion criteria in our studies included: ages between 18-39, whether they had hypertension during pregnancy, or were between 22-43 weeks of gestation. Main findings from our studies include mistrust between health providers and the black pregnant women negatively impacted their adherence to safe sleep practice, and 32% of women in another study reported that they were not able to initiate their first prenatal care visit as early as preferred due to a myriad of barriers. Conclusions & Nursing Interventions The take-home message of our studies was that disparities are multifactorial. Some major nursing implications we found are that perinatal nurses should assess the psychological wellbeing in Black women throughout pregnancy and advocate for Black women who report high levels of stress, depressive symptoms, or psychological distress.

Background  Maternal health is described as the health a woman experiences during pregnancy, delivery and after the baby is born. Every year an estimation is made that 210 million women are pregnant and 140 million babies are being born. However, the care around pregnant women and during deliveries varies depending on what country a woman is located in. Above all, science shows that pregnant women in Sub-Saharan regions have a 46 times higher risk of suffering from maternal morbidity and mortality compared to women in high-income countries. Tanzania is a country within the Sub-Saharan region with the highest numbers of births, yet with limited access to both hospitals and staff which affects mothers and children. Limitations are caused because of poverty, for instance the majority of Tanzania's population live in rural areas where no healthcare is accessible, if the healthcare does not go to those areas.  Aim  The aim was to describe healthcare workers' experiences of reproductive and maternal health at Nkinga Referral Hospital in Tanzania.  Methods  This study was based on a Minor Field Study [MFS] in Tanzania. The chosen method was a qualitative study design with an inductive approach. The interview questions were of semi structured character and in total eight healthcare workers were interviewed at Nkinga Referral Hospital. The data was analyzed with the help of a manifest content analysis.  Findings  The data analysis resulted in three main categories and eight subcategories that reelected the healthcare workers' experiences. Overall, healthcare workers described the preventive work, experienced difficulties, maternal healthcare in general as well as the wishes regarding possible changes in today's reproductive and maternal health.  Conclusion  The healthcare workers' experiences regarding the provision of care for pregnant women differ. Existing deficiencies that have been discovered within reproductive and maternal health are insufficient economic resources as well as equipment. While this unavailability, the healthcare workers experienced the care provided was remarkably affected and the inability to provide good quality care. Because of this, the provision of resources is essential for the ability of healthcare workers to provide good quality care to pregnant women. / Bakgrund  Mödrars hälsa beskrivs som den hälsa kvinnan upplever sig ha under graviditet, förlossning och efter födseln. Varje år uppskattas det att cirka 210 miljoner kvinnor blir gravida och att 140 miljoner nyfödda föds. Däremot ser vården kring den gravida kvinnan och under förlossningen olika ut beroende på vilket land kvinnan befinner sig i. Framförallt visar forskning att gravida kvinnor i Sub-Sahara Regionen har en 46 gånger så hög risk att drabbas av maternell sjukdom och död jämfört med kvinnor i höginkomstländer. Tanzania är ett land i Sub-Sahara som har höga födelsetal, dock med en begränsad tillgång till både sjukhus och personal vilket påverkar mödrar och barns hälsa. Begränsningen beror bland annat på fattigdom, men också på grund av att större delen av befolkningen lever på landsbygden där ingen hälso- och sjukvård finns att tillgå, om inte hälso- och sjukvården tar sig till dem.  Syfte  Syftet var att beskriva sjukvårdspersonalens upplevelser av reproduktion och mödrahälsovård på Nkinga Referral Hospital i Tanzania.  Metod  Denna studie baserades på en Minor Field Study [MFS] fältstudie i Tanzania. Den valda metoden var en kvalitativ studiedesign med induktiv ansats. Intervjufrågorna var av semistrukturerad karaktär och sammanlagt intervjuades åtta hälso- och sjukvårdspersonal på Nkinga Referral Hospital. Datan analyserades med hjälp av en kvalitativ manifest innehållsanalys.  Resultat  Dataanalysen resulterade i tre huvudkategorier och åtta subkategorier som återspeglade hälso- och sjukvårdspersonalens upplevelser. Sammantaget beskrev hälso- och sjukvårdspersonalen det preventiva arbetet, upplevda svårigheter, den generella mödrahälsovården samt vilka önskningar de upplevde skulle kunna förändra dagens reproduktion och mödrahälsovård.  Slutsats  Hälso- och sjukvårdspersonalens upplevelser av att vårda gravida kvinnor skiljer sig åt. Befintliga brister som uppdagats inom reproduktiv- samt mödrahälsovård är bristfälliga ekonomiska resurser likväl som redskap. När detta var otillgängligt upplevde hälso- och sjukvårdspersonalen att vården som gavs till de gravida kvinnorna påverkas avsevärt då en vård av god kvalitet inte kunde tillhandahållas. Således är det av stor vikt att resurser finns tillgängliga så att hälso- och sjukvårdspersonalen kan erbjuda en kvalitativ vård till de gravida kvinnorna.

There is a lack of consensus on the empirical findings in research examining the so-called ‘guns and butter’ argument – does military expenditure crowd out social expenditure or not? Feminist scholars have been arguing that militarism, affects women’s welfare in a negative way. This study investigates whether countries' increase in military expenditure leads to a deterioration in women's health and education, based on the guns and butter argument. The study intends to find out what a possible correlation looks like for two different models, one that represents the impact on women's health and another that represents the impact on women's education, by using maternal mortality and school enrollment (with a gender parity index) as dependent variables. The survey is conducted for a sampling of countries in Africa, the Middle East, and South Asia for the period 1988 to 2020. The main findings of this study indicate that increased military expenditure leads to increased maternal mortality, however, the study finds no linear relationship between military expenditure and girls' school enrollment. The study also finds no correlation between health care, education expenditure and maternal mortality. Nevertheless, it indicates that education expenditure has a positive effect on girls’ school enrollment, and health care expenditure has a negative effect on girls’ school registration.

Females of childbearing age are overrepresented in the population of the Kellis 2 cemetery (100-450 AD) in the Dakhleh Oasis, Egypt (Wheeler 2009). The demographic overrepresentation found here may be the result of complications related to childbirth. Clinical literature demonstrates that fetal size is rarely an explanation for failed labor (Cunningham et al. 2001) and the fetuses buried in the Kellis 2 Cemetery at the Dakhleh Oasis were not larger than average (Tocheri et al. 2005), directing the focus to dimensions of the maternal pelvis for evidence of obstetrical issues, such as abnormally compressed pelvises. To formulate a test for this hypothesis, a total of 50 adults, 24 of which are female, were examined for this study. The sample consisted of individuals from an archaeological population from the Dakhleh Oasis, Egypt as well as from six populations housed in the American Museum of Natural History (NYC). These include archaeological populations from the sites of El Hesa and Sai Island in the Sudan, also South Africa, Nubia, and India, as well as a medical collection from North America. Pelvic dimension and asymmetry was determined through nine measurements of the pelvis and sacrum. Kruskal-Wallis tests were used to analyze variance and assess whether the younger females in this group may have been at a higher risk of death during childbirth due to fetal-pelvic disproportion. Mann-Whitney-Wilcoxan nonparametric tests were used to assess differences in asymmetry in young and old groups. A MANOVA test assessed overall variation in the population. Results indicate significant differences between young and old females in pelvic outlet anteroposterior diameter, a measure of midpelvic contraction, as young females had smaller pelvic outlet anteroposterior diameters. There were also significant differences between iv young and old females in alar-pubis length asymmetry; the young females were more asymmetric. These differences were not found in the male groups. It is suggested that these differences could impact childbirth as a contracted midpelvis, such as that found in the young female group, can cause transverse arrest of the fetal head (Cunningham et al. 2010) and pelvic asymmetry can contribute to obstetrical complications (Campbell et al. 2011).

This thesis seeks to investigate the 2014 Medicaid expansion’s effect on maternal mortality rates for New York and California. The CDC reported in 2019 that maternal mortality rates have been increasing. These findings are concerning for mothers and are a problem for developed nations like the United States with improved healthcare. Furthermore, women of color are disproportionately affected relative to white women. Previous research has indicated that healthcare expansions positively affect decreasing death rates among pregnant women. In this study, I investigate how increased access to healthcare through the 2014 Medicaid expansion under the Affordable Care Act affects maternal mortality for New York and California. I utilize the publicly available CDC Wonder Underlying Cause of Death 1999-2020 data to conduct my research for this analysis. For my analysis, I chose to observe the years 2006-2016. I plotted each state’s mortality rates by year to observe any visual trends or changes in reported data and then after ran regressions of each race on deaths. The results exhibited that women of color tend to experience higher maternal mortality ratios. When observing how deaths have changed post-expansion, the coefficients were not statically significant to a degree that would allow me to make confident conclusions that mortality rates had improved. This study contributes to the literature that women of color are more likely to suffer worse maternal health outcomes than white women. It brings to light the importance of attaining a solution to this issue.

<p dir="ltr">Maternal mortality (MM) is a pressing global health issue that results in thousands of mothers dying annually from pregnancy-related complications. Despite spending trillions of dollars on the healthcare industry, the U.S. continues to experience one of the highest rates of maternal death (MD) compared to other developed countries. This ongoing public health crisis highlights the urgent need for innovative strategies to detect and mitigate adverse maternal outcomes. This study introduces a novel approach, utilizing admission to the ICU as a proxy for MM. By analyzing 14 years of natality birth data, this study aims to explore the complex web of factors that elevate the chances of MD. The primary goal of this study is to identify features that are most influential in predicting ICU admission cases. These factors hold the potential to be applied to MM, as they can serve as early warning signs that complications may arise, allowing healthcare professionals to step in and intervene before adverse maternal outcomes occur. Two supervised machine learning models were employed in this study, specifically Logistic Regression (LR) and eXtreme Gradient Boosting (XGBoost). The models were executed twice for each dataset: once incorporating all available features and again utilizing only the most significant features. Following model training, XGBoost’s feature selection technique was employed to identify the top 10 influential features that are most important to the classification process. Our analysis revealed a diverse range of factors that are important for the prediction of ICU admission cases. In this study, we identified maternal transfusion, labor and delivery characteristics, delivery methods, gestational age, maternal attributes, and newborn conditions as the most influential factors to categorize maternal ICU admission cases. In terms of model performance, the XGBoost consistently outperformed LR across various datasets, demonstrating higher accuracy, precision, and F1 scores. For recall, however, LR maintained higher scores, surpassing those of XGBoost. Moreover, the models consistently achieved higher scores when trained with all available features compared to those trained solely with the top features. Although the models demonstrated satisfactory performance in some evaluation metrics, there were notable deficiencies in recall and precision, which suggests further model refinement is needed to effectively predict these cases.</p>

This research establishes a statistically significant connection between maternal mortality rates and abortion restrictions from a reproductive injustice perspective, integrating the theory of necropolitics. Using a time-series cross-sectional analysis of all 50 U.S. states from 2009 to 2019, this study highlights the impact of restrictive abortion policies during a period of intensified legislative activity, including pre-abortion counseling requirements, TRAP laws, and trigger laws. Data from the Guttmacher Institute's hostility scale and the Institute for Health Metrics and Evaluation's maternal mortality statistics reveal that states with higher hostility toward abortion experienced increased maternal mortality. Notably, a 1% increase in state hostility is associated with a 0.45% rise in overall maternal mortality rates (p < 0.001). The analysis further demonstrates that each marginalized racial and ethnic group examined face heightened risks from higher abortion hostility, with maternal mortality rising among Hispanic women by 0.40% (p < 0.001); among non-Hispanic American Indian and Alaskan Native women increasing by 0.29% (p < 0.05); among non-Hispanic Asian, Native Hawaiian or Other Pacfic Islander women by 0.53% (p < 0.001); and non-Hispanic Black women by 0.39% (p < 0.001) per 1% increase in state hostility. However, the largest increase was found among non-Hispanic White women (p < 0.001). This study contributes to reproductive justice scholarship by incorporating a feminist and sociological perspective on the relationship between abortion restrictions and maternal mortality, particularly as moderated by race and ethnicity. The findings call for urgent policy interventions to dismantle systemic inequities in healthcare access, ensuring the protection of reproductive rights and the reduction of maternal mortality across all communities. / Master of Science / This study explores how abortion restrictions affect maternal mortality rates in the United States, focusing on the period between 2009 and 2019. It shows that stricter abortion laws, such as requirements for pre-abortion counseling, targeted regulations on abortion providers, and laws designed to ban abortion if federal protections are overturned, are linked to higher maternal death rates. States with more restrictive abortion policies had notable increases in maternal mortality, with even greater risks for certain racial and ethnic groups. For example, for every 1% increase in state-level hostility toward abortion, overall maternal mortality rose by 0.45%. The impact was pronounced for Hispanic women, non-Hispanic American Indian and Alaskan Native women, non-Hispanic Black women, and non-Hispanic Asian, Native Hawaiian, or Pacific Islander women. Among non-Hispanic White women, the increase was even greater. By examining the relationship between abortion restrictions and maternal health through a feminist and sociological lens, this research highlights systemic inequalities in healthcare access. The findings emphasize the need for policies that protect reproductive rights and improve maternal health outcomes for all communities, especially those historically underserved.

The maternal mortality ratio (MMR) and neonatal mortality rate (NMR) have been persistently high in South Africa, with black, poor, rural women and neonates mostly affected. The MMR and the NMR are indicative of the health of the population and reflect deeper issues such as inequitable distribution of the country’s resources, social exclusion, deprivation, and lack of access to quality public services. The purpose of the study was to develop a model to meet the overall health needs of the socially excluded, the deprived and the vulnerable women by listing those factors that influence maternal and child health outcomes. From the point of view that individual reproduction and health decision-making takes place in a milieu comprising multiple socio-economic and cultural factors, this study attempts to add to the body of knowledge on maternal and child health in order to influence policies and interventions. Data was collected through a multi-staged, qualitative research design. The results show how structural factors result in high risk for poor maternal and child health outcomes, suggesting that the high rates of poor health outcomes are evidence of deprivation of women’s needs due to poverty leading to an inability to cope with pregnancy and childbirth. The results are used to develop a model that proposes pathways for policy action to confront both the structural and intermediary determinants of maternal and child ill health and mortality. These pathways operate through integrative and inter-sectorial mechanisms intended at empowering women and enhancing female reproductive health care activities. / Sociology / D.Litt. et Phil. (Sociology)

Les objectifs de notre étude étaient d’identifier et décrire les obstacles à la planification familiale ; d’analyser et déterminer les facteurs associés aux non recours par les femmes; et d’analyser l’attitude des professionnels de santé en matière de planification familiale. Une recherche bibliographique sur le thème et une enquête par questionnaire administrée lors d’entretiens face-à-face auprès des femmes en âge de procréer et auprès des professionnels de santé ont été réalisées. Les analyses statistiques ont été réalisées à l’aide d’EPI INFO 6 et SAS version 9.4. Une régression logistique a permis de mesurer l’association entre l’utilisation et non de méthodes de planification familiale. Au total, 314 femmes et 17 professionnels de santé ont été interrogés. L’accès aux services, l’âge, et l’ethnie étaient significativement associés au non recours à la planification familiale. Les obstacles, dont l’opposition du conjoint, manque d’information, manque de personnel qualifié limitaient le recours à la planification famille. La mise en oeuvre des interventions ciblées devront permettre de surmonter les obstacles et seraient les principaux déterminants au recours des services de planification par les femmes. / The objectives of our study were identified and describe the barriers to family planning; analyze and identify factors associated with non-use by women; and to analyze the attitude of health professionals regarding family planning. A literature search on the topic and a questionnaire survey administered in face-to-face interviews with women of childbearing age and health professionals were conducted. Statistical analyzes were performed using EPI INFO 6 and SAS version 9.4. Logistic regression measured the association between the use and non-use of family planning methods. A total of 314 women and 17 health professionals were interviewed. Access to services, age, and ethnicity were significantly associated with non-use of family planning. Barriers, including spousal opposition, lack of information, lack of qualified staff, limited the use of family planning. The implementation of targeted interventions will need to overcome barriers and be key determinants of women's use of planning services.