Why does it have to be like this?

My neighbour in Bardai gave birth at home in her yard, just an hour or so after  I had been round at her house chatting. We had discussed the need to go to the hospital for the birth, the fact that she had often had difficulty delivering the placenta and had been taken to the hospital before for emergency treatment. There was a risk to her life if it happened again. In the end the desire to deliver in her own home, with her younger sister, won over. For many generations Teda women have given birth this way.  When they were travelling in the desert or living in isolated communities, who could be there to deliver the baby? Not a midwife or a doctor, so best to deliver alone on the sand .This time the placenta finally delivered just after she had called for help and as we had her husbands car ready to take her down to the hospital, a mere 5 minutes away. Her delight at not having to go to the hospital, with the risk of being seen by a male nurse or doctor and perhaps some shame at not achieving a delivery at home, was almost palpable.

Rapidly the main room was made ready with drinks, biscuits and sweets and the best seats and a low table bought out making a place where she could receive friends each day.  She remained  behind a curtain in one corner of the room so she would not be seen. After a week more celebration again as the baby was named and a big feast held. Then another month at home resting and being looked after by her family, her only responsibility feeding her new born.

It all sounds idyllic but what if the placenta had not delivered ,what if she had started to bleed and even if she had arrived at the hospital there hadn’t been a trained midwife or someone who  could organise a blood transfusion. All of which can easily be the case in towns like Bardai.

What if she had been forced to travel across the desert to another hospital and what if she like many women in Chad hadn’t made it  and had left her 5 children motherless. Maternal mortality remains a huge  problem in Chad with a maternal mortality ratio of 1,140 deaths /100,000 births making it one of the riskiest places in the world to give birth.

It seems a long way from the NHS with it's  clean hospitals, blood banks and doctors and midwives that we  know. With  ambulances ready  to rush you to help if you do decide to have a home birth and there are complications. As a consequence the UK the maternal death rate is 7 deaths /100000 births, 150 times lower than Chad

But there is also another statistic here hidden away, the sad fact that if you are a black woman in England you are also at a much  higher risk of death in pregnancy. In fact according to the latest MBRRACE report, the risk is 4 times higher. Many factors are of course involved such as a predisposition amongst black women to high blood pressure and diabetes as well as other illnesses. There are  also the many social determinants of health such as poor housing and low levels of  education but these don’t explain everything. The Royal College of Obstetricians is of course seeing what can be done in the medical world and has set up a race equality task force. But it seems there is so much more to it than that and we all have a part to play in how we behave towards  people of different ethnicities than  our own.

What can we make of the fact that  a study in America has shown that  black babies in the first 28 days  die at 3 times more often than white babies. However when black  doctors look after black neonates this disadvantage was reduced by 50%, an unbelievable number, what does it reflect? However the same effect is not seen amongst pregnant women when they are cared for by doctors of the same race. It is felt that for women  the effect of  structural racism is already too deeply ingrained to allow this to have any further  effect. Of course you may say these figures don’t compare to Chadian levels of maternal death , but that doesn’t stop it from being a huge injustice that needs to be  righted.

So lets look at an example of a pregnant woman in the Bible and see what lessons we can  learn about how we could act. Many people look at Mary as the Holy Virgin calm and serene at all moments. Actually she was likely a  teenage mother of Jesus who had a very risky birth far from home and then became a refugee. She was also the inspired author of the Magnificat, full of references to justice and peace and to over throwing the powers of the age. So the true  reality may be that, far from being meek and mild,  she was a revolutionary figure. In the past the British in India forbade the singing of the Magnificat from fear it was too revolutionary; it was also banned in Guatemala in the 1980s for the same reason. Nowadays apparently almost all the songs we sing which include the Magnificat stop before we arrive at the parts mentioning bringing down rulers and sending the rich away. We need to stand up to the truth both in the way we use the  Bible and what we see in society.

We need to ask what is it we want, the Virgin Mary as mother of Jesus meek and mild or Mary as mother of Jesus, a revolutionary, challenging us to speak out against injustice in the U.K or in Chad? Challenging us to think what we will  do when faced with the injustices of our world?