Family Inclusive Maternal Health Care: What it Is and Why it Matters

first_imgPosted on September 15, 2016October 4, 2016By: Sarah Hodin, Project Coordinator II, Women and Health Initiative, Harvard T.H. Chan School of Public HealthClick to share on Facebook (Opens in new window)Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Reddit (Opens in new window)Click to email this to a friend (Opens in new window)Click to print (Opens in new window)Duncan Fisher (Family Initiative) and Dr. Ana Langer (Women and Health Initiative)Not surprisingly, public health professionals, researchers and clinicians in the maternal and child health field have traditionally focused primarily on the mother and the child. Interventions aimed at encouraging antenatal care attendance, facility-based delivery and exclusive breastfeeding have generally targeted the pregnant woman or mother, often without much attention to her partner, surrounding family or social network.Duncan Fisher, Co-Founder and Director of the Family Initiative, traveled from the United Kingdom to give a lecture at the Women and Health Initiative at the Harvard T.H. Chan School of Public Health about the importance of expanding the focus of maternal health. While there has been some effort to engage men in maternal health, few studies examining this issue have been conducted and even fewer interventions have been designed, implemented or evaluated.Fisher noted that throughout human history, even before we were homo sapiens, child rearing has been a communal effort: fathers, family and even other community members have been instrumental in helping mothers to raise children. In fact, fathers experience similar hormonal changes to mothers (albeit somewhat less intensely) when they hold their babies, triggering a biological, instinctual sense of attachment. “An aspect of patriarchy and gender inequality,” Fisher suggested, “is suppressing that nurturing activity in men.”Engaging fathers, family members and women’s communities of care during pregnancy, delivery and postpartum may have numerous health benefits for mothers and babies. Not involving fathers during pregnancy is one missed opportunity. Fisher recalled a visit he made to a clinic in Nigeria where fathers rarely accompanied their pregnant wives to antenatal care appointments. When he asked a large room full of pregnant women, “Do you think your husband should be here?” the room erupted into chaos: “Do not ask us to tell him everything because he just thinks we’re nagging—you tell him!” many of the women responded. In many settings around the globe where men typically do not accompany their pregnant wives to antenatal care appointments, health care providers assume that their pregnant patients will relay all of the information discussed to their husbands. In reality, as the women at the Nigerian clinic stated, this assumption more often results in fathers being uninformed and uninvolved. Similarly, despite the important role that fathers and family members play in supporting mothers to breastfeed, efforts to encourage breastfeeding often target new mothers in isolation.Because of the potential negative consequences of promoting male involvement in maternal health and the diversity of family structures—particularly those that do not include a father—focusing on women’s families and communities of care more broadly is crucial. In its 2015 report, the World Health Organization (WHO) emphasized the importance of engaging families and communities to improve maternal and child health outcomes. Much work is needed to mobilize efforts to address these WHO recommendations, including developing consensus on the definition of “family inclusive maternal health care”, conducting research to understand global perspectives on the issue and designing effective, inclusive interventions that improve not just the health of mothers and babies, but also the functioning of family units and communities of care.—Learn more about engaging fathers and families in maternal and infant health from Family Included.Explore perspectives on the Child and Family Blog.Subscribe to receive updates from the Women and Health Initiative.Share this: ShareEmailPrint To learn more, read:last_img read more

Cities Can Save Money by Investing in Natural Infrastructure for Water

first_imgBy 2030, the world is projected to spend an estimated $10 trillion on repairing and expanding water infrastructure. Dams and treatment plants are aging, water demand is surging, and more frequent extreme weather events threaten our water security—each driving up water management costs.As costs increase, cities are realizing that investing solely in traditional, built infrastructure isn’t always the best use of tight budgets. Instead, some urban areas are benefitting from natural infrastructure or “green” infrastructure, a strategically planned and managed system of natural lands, working landscapes and other natural soil and vegetation systems across a watershed or within a city, that perform many of same functions as built or “gray” infrastructure. These essential functions, often carried out by the deep roots and multi-layered tree canopies of healthy forests, include purifying water, minimizing sedimentation, regulating flow and stormwater runoff, and reducing the impact of floods and droughts.Natural infrastructure helps to provide high-quality source water and well-regulated flow, which can not only lead to several potential areas of cost savings—such as avoided capital costs, lowered maintenance costs, and reduced treatment costs—but also generate social and environmental benefits. Furthermore, integrating natural infrastructure with engineered solutions can protect and restore ecosystem services, enhance resilience to climate change, bolster local economies, and help cities save money. Benefits added from natural infrastructure are estimated at around $29 trillion per year globally.Four cities in particular are making a compelling case for investing in natural infrastructure:Philadelphia, Pa. São Paulo, Brazil, needs to restore the Cantareira Water System to combat worsening water crisis. Brazil’s largest and most important economic region, the Greater São Paulo Metropolitan Region, has a population of 20 million people, and recently experienced its worst water crisis in 80 years. This occurred in part because the Cantareira supply system, the region’s primary source of water, receives its water from the severely degraded Piracicaba-Capivari-Jundiaí (PCJ) watershed. Nearly 70 percent of the native vegetation in the PCJ watershed has been cleared, harming the quality, quantity and timing of the fresh water supply – while also increasing water treatment costs and reducing the lifespan of its reservoirs due to siltation.Natural infrastructure offers the city a chance to save both water and money. Based on a model from InVest, The Nature Conservancy estimated that over 10 years, protection and restoration of at least 14,300 hectares (35,000 acres) of hydrologically sensitive land in the PCJ watershed would lead to a 50 percent reduction in sedimentation, saving $2.5 million every year and reducing water treatment costs by 15 percent.New York City New York City, NY looks to increase coastal resiliency by expanding investment in natural infrastructure and in hybrid combinations in the wake of Hurricane Sandy (Photo credit: Daniele Pieroni via Creative Commons.)In late October of 2012, storm surges from Hurricane Sandy overwhelmed beaches, bulkheads and seawalls, resulting in flooded homes, subways and tunnels, which ultimately cost the city $19 billion in damages. While the tragic hurricane revealed New York’s inadequate coastal defense, it also revealed the benefits natural infrastructure can provide.As public services collapsed along the storm’s paths, water supply remained largely intact, thanks to natural infrastructure. New York City invests around $100 million annually in protecting its upstate watershed, which supplies approximately 1.4 billion gallons of water to the city, while avoiding the multi-billion dollar cost of a filtration plant. Built infrastructures are often more costly, less resilient (especially in the face of climate change), and thus less efficient than natural infrastructure alternatives.In the wake of the storm, the city’s forested watershed provided clean, gravity-fed water (the water flows downhill and no electricity is needed for pumping) without interruption in service and, as a result, few people lost potable water. Meanwhile, in New Jersey, damaged pumps, filtration plants and contaminated intakes left residents without potable water for weeks after the storm, and cost the city $2.6 billion.And near the coast, communities located behind stretches of restored sand dunes and wetlands experienced less damage than those that did not have protective dunes. With heightened awareness of the benefits of nature, the NYS 2100 Commission and PlaNYC have strongly recommended the expansion of natural infrastructure to protect New York City’s shoreline with sand dunes, tidal wetlands and oyster reefs.Cities are increasingly learning to put their money in a winning strategy. Natural infrastructure offers urban areas a flexible way to manage water that benefits ecosystems, people and municipal bank accounts. Philadelphia, PA deploys green infrastructure to reduce stormwater pollution and saves billions of dollars (Source: Philadelphiaift.org).Integrating nature into city planning is nothing new for Philadelphia. Back in the 19th century, the city acquired 9,000 acres (approximately 3,600 hectares) of natural areas to help filter and regulate its potable water, and the land remains protected as parkland.Confronted with challenges from combined sewer overflows during storms, Philadelphia recently conducted a cost-benefit analysis comparing green infrastructure options—such as tree planting, permeable pavement and green roofs—against conventional gray options, such as storage tunnels. The economic benefits associated with green infrastructure ranged from $1.94 billion to $4.45 billion, compared to just $0.06 billion to $0.14 billion from gray infrastructure. In 2011, the city adopted the plan “Green City, Clean Waters” to reduce storm water pollution by greening public spaces, creating a living landscape that slows, filters and consumes rainfall. City officials expect to reduce stormwater and sewage pollution entering the waterways by 85 percent when the project is completed.Medford, Ore.Medford, OR, to restore 30 miles of river bank to meet temperature TMDL requirements, saving about $8 million compared with lagoon storage and $12 million compared to installing mechanical chillers. (Source: Wikimedia Commons) Home to more than 75,000 people, the City of Medford discharges its wastewater into the Rogue River, which passes the city to the north. Because discharge from the city exceeds maximum temperature load requirements, Medford evaluated three alternatives: lagoon storage for discharge later in the year, mechanical chillers, and restoring vegetation along rivers and streams to provide shading along the river. An economic analysis showed that restorating vegetation was three times more cost-effective than mechanical chillers for reducing thermal loads into the river, and would provide additional benefits such as improved wildlife habitat and water filtration. As a result, the city plans to work with 100 landowners through the The Freshwater Trust to restore 30 miles of stream bank at a cost of $8 million. Overall, this natural approach was $8 million cheaper than lagoon storage, and $12 million less than installing mechanical chillers—which also emit greenhouse gases.São Paulo, Brazillast_img read more