Poverty

My best friend growing up suffered from poverty. Her mom had Multiple Sclerosis and was unable to work. Since her father was not in her life and they did not had any close family, they survived on assistance programs. I know they were eligible for WIC benefits and then later were on disability income. They also used local resources like food pantries and thrift programs (which provided other services like Christmas gifts and reimbursement for summer camps). Even still, they had little food, were always extremely tight on money, and made every effort to get by. They did things like cut laundry sheets in half, planted a huge garden every year, and picked up cans from the side of the road to sell. My friend would mow people's lawns all summer and babysit any time she was available. This economic hardship had a lot of impact on her and her family, which included affects to each domain. There are obvious biosocial effects, including malnutrition, but also, for this family in particular, a tighter maternal bond. They relied on one another more than any materialistic endeavor. Cognitively, my friend learned to cope with 'less' than others. She developed skill-sets and dispositions that I do not have that relate to her growing up in a family that often had inadequate shelter and food, moved houses quite often, and sometimes lived out of their car for short periods of time. Psychosocially, she coped with the influence of stress and a sense of what she describes as "never feeling grounded" which relates to having to move so often because they were short on rent. Poverty has staggering effects on children in my community and others.

In South Africa the effects of poverty seem tragic and surreal. As much as half of the country's population suffers from poverty, and even despite the fact that they have sufficient food resources, many of those in poverty also suffer from food insecurity (Machethe, 2004). Machethe (2004) points to skewed distribution of income while Aliber (2003) implicates the detrimental effects of HIV, AIDS, and other diseases and viruses as main contributors to these statistics. South African News (2006) illustrates the life Khanyi Dlomo, whose family cannot afford for her to attend school, and despite laws against it, has been turned away by schools. South African News describes the slums in Khanyi's hometown as being lined with the mansions of the rich and of another location, Khayelitsha, where nearly everyone lives below the poverty line in shacks or brick structures that do not have running water and has become the epicenter of crime in the area. In this town, the effects of poverty include disease, food insecurity, inadequate safety, and pollution, among others. Though the effects of poverty are prominent and harmful, there exists differences in experiences cross-culturally; the experience of my childhood friend differs greatly from the experience of Khanyi in South Africa.  

Aliber, M. (2003). Chronic poverty in South Africa: Incidence, causes and policies. World Development, 31(3), 473-490. Retrieved from http://www.researchgate.net

Machethe, C. L. (2004, October). Agriculture and poverty in South Africa: Can agriculture reduce poverty. In Paper presented at the Overcoming Underdevelopment Conference held in Pretoria (Vol. 28, p. 29). Retrieved from http://www.psu.edu

South African News (2006, July 2). Poverty in the land of affluence. The Southern Times. Retrieved from http://southernafrican.news/2006/07/02/poverty-in-the-land-of-affluence/

SIDS

I chose to explore the topic Sudden Infant Death Syndrome (SIDS). This topic is meaningful to me because when I was working at an Early Head Start Program, I had to advocate for safe sleep practices because the teachers in the infant room were placing very young children on their bellies to sleep before they were able to roll over. The recommendations for safe sleep are still reaching caregivers and parents- we need to advocate for education on this topic. I know a mother who lost her son 20 years ago to SIDS and it’s obvious the level of devastation this can bring to a family- Fraser, Sidebotham, Frederick, Covington, and Mitchell (2014) suggest that each and every SIDS death is a tragedy for the family, the professionals caring for the child, and for the community as a whole. I think there can be more public health policies that will continue to lessen the impact of SIDS on our society. I explore the phenomenon of SIDS in New Zealand, which has been reduced by a variety of preventative strategies.

According to Moon, Horne, & Hauck (YEAR), SIDS is the leading cause of death of infants (1 month to 1 year) in developed countries. The cause of SIDS is unknown, but is thought to be a combination of risk factors rather than one single cause. Moon, Horne, & Hauck (2007) point to recent studies that suggest babies are at risk for SIDS if they sleep on their bellies or on their sides, are exposed to smoke, and sleep with soft bedding or on soft surfaces. This research has led pediatricians to recommend safe sleep practices, like placing babies on their backs to sleep and removing soft materials, which have reduced SIDS deaths by 50-90% (Moon, Horne, & Hauck, 2007).

In 1991, a national cot death prevention program was established in New Zealand that put forth recommendations that infants should sleep on their side or their back, that women should breastfeed if possible, and that babies (prenatally and within the first year of life) should not be exposed to cigarette smoke (Mitchell, Brunt, & Everard, 1994). It also suggested that sleeping in the same bed as parents may, too, be harmful. According to Mitchell, et. al (1997), the program quickly found success- the number of infants sleeping on their bellies was reduced from 43% to less than 5%. This decrease is linked with a decrease in the number of SIDS deaths in New Zealand after the inception of the prevention program (Mitchell, et. al, 1997).

Fraser, Sidebotham, Frederick, Covington, and Mitchell (2014) identify mandatory child death review as a means for significantly reducing SIDS. By investigating every infant death, more data is collected to influence research for SIDS prevention. In New Zealand, child death reviews are mandatory and receive funding from the government- specific agencies handle the investigations, which are thorough (Fraser, Sidebotham, Frederick, Covington, & Mitchell, 2014). In contrast, the United States investigates only some child deaths because the Federal Law only encourages investigations where child abuse is suspected; though some US states have laws and funding that support child death review, it is not a requirement (Fraser, Sidebotham, Frederick, Covington, & Mitchell, 2014).

This information will impact my future practice because I appreciate the need for advocacy on this topic. If the US adopted federal regulations that mandate and fund child death investigations, or if we had better programs to educate parents and caregivers about SIDS and safe sleep, we might reduce infant deaths even more. I notice posters and brochures at various health organizations around my community and I think my community could benefit from having more of these in a variety of locations. I will also make sure to help parents understand safe sleep practices if it ever comes up in my work.

References

Fraser, J., Sidebotham, P., Frederick, J., Covington, T., & Mitchell, E. A. (2014). Learning from child death review in the USA, England, Australia, and New Zealand. The Lancet, 384(9946), 894-903.

Mitchell, E. A., Brunt, J. M., & Everard, C. (1994). Reduction in mortality from sudden infant death syndrome in New Zealand: 1986-92. Archives of disease in childhood, 70(4), 291-294.

Mitchell, E. A., Tuohy, P. G., Brunt, J. M., Thompson, J. M., Clements, M. S., Stewart, A. W., ... & Taylor, B. J. (1997). Risk factors for sudden infant death syndrome following the prevention campaign in New Zealand: a prospective study. Pediatrics, 100(5), 835-840.

Moon, R. Y., Horne, R. S., & Hauck, F. R. (2007). Sudden infant death syndrome. The Lancet, 370(9598), 1578-1587.

Birth

I don't have any firsthand experience with birth, and I can't ask anyone about my own birth. I chose to discuss a birth story that has been told to me many times. My coworker tried for a long time to have a baby with no success, and at age 39 she decided it was time to try in vitro fertilization. It worked, and her baby was born on Christmas Eve, but with many complications. She was first placed on bedrest three weeks before her daughter's birthday and then had to have a C-Section because her daughter was breech. Going through the struggle of trying to have a child and not being able to was difficult for her. This definitely has affected her daughter's development and their relationship. They have a very close bond and her mother is very protective of her. All the same she is a very loving, affectionate, and nurturing mother. The time, effort (and unfortunately, money) it took to have her daughter has made her more appreciative of her life- she views her daughter as a gift. Her daughter will develop with a strong maternal relationship and a family very attentive to her wellbeing. There was also a strong parent-infant bond when the child was born because it had been such a long time waiting for a child, and so to first hold her baby was a long-anticipated moment.

I was interested to learn more about the birthing practices of Finland because I have heard that they have very low infant-mortality rates and higher satisfaction among parents and families of newborns. Indeed, Callister, Lauri, and Vehvilainen-Julkunen (2000) suggest Finland's success at birthing, evidenced by parent satisfaction and a low infant-mortality rate, is due to the lack of distinction in social class (a uniform birthing procedure), advanced nurses capable of performing births, excellent (and free) prenatal care, and because technology is only used during birth when indicated by evidence and research. During childbirth in Finland, a team of nurse midwifes attends to the process with a physician's consult only when complications arise (Callister, Lauri, & Vehvilainen-Julkunen, 2000).  The woman's autonomy is respected in Finland and her freedom of choice is encouraged (Callister, Lauri, & Vehvilainen-Julkunen, 2000). Hastie (2010) notes that the aesthetic hospital environment in Finland is a great contributor to the Finnish success of childbirth.

I think the birthing process would have looked different for my coworker if she was in Finland. Her daughter's birth involved a lot of technology to monitor the baby because it was such a high risk birth. Perhaps in Finland the circumstances of this birth would have merited the use of these technologies, but even so I don't think it would have been as panicked. Though my coworker is grateful for her experience at the hospital, she describes the experience as chaotic and very stressful. I think in Finland, she would have been encouraged to be more comfortable. I also speculate that there's a greater rate of continuity of care in Finland- such that you know who you expect to deliver your baby well in advance, and you have worked with this nurse or doctor for a period of time. This can help lessen stress, in my opinion, because you have developed trust and rapport with the birthing expert. I think the birth of my coworker's daughter was highly memorable for this new mother, but I think that Finland overall has a more relaxed and effective method for delivering children.

References

Callister, Lauri, & Vehvilainen-Julkunen (2000). A description of birth in Finland. The American Journal of Maternal/Child Nursing, 25. Retrieved from Walden Library Databases.

Hastie, C. (2010). The birthing environment. Sustainability, Midwifery and Birth. Retrieved from http://www.academia.edu/download/37204809/Sustainability_Midwifery_and_Birth_Hastie_The_Birthing_Environment.pdF