Introduction
Over the past decade, the world has made some significant strides in improving global health. However, maternal and infant mortality rates particularly in low and middle-income economies are still proving to be a mirage. The well-being of mothers, children, and infants is not only a determinant of the status of a country’s health care system but also a prediction of the future public health challenges that the next generation will confront. Almost all countries in the world have prioritized the improvement of the well-being of mothers, children, and infants as their number one public health goal. Indeed, goal number 3 of the Sustainable Development Goals seeks to improve maternal health (“The surgeon general’s call,” 2011).
To improve maternal, child, and infant health involves, several conditions, health system indicators, and health behaviors that affect the quality of life of these people should be addressed. However, such an effort is often confronted by various challenges, including political, sociological, cultural, and economic forces of respective countries. This paper will explore the political forces that impact maternal child health against the 7 Universal Principles of Ethics.
The Political Factor
The issue of health always occupies center stages in political debates especially when elections are close. It is not unusual for a presidential candidate for instance to address the electorates on his plans for health care of his country if he becomes president. In the United States for instance, maternal and child health has often remained a significant political priority. One year into office, the Biden administration has outlined key areas of priority that it would take to address the issue of maternal health. The maternal mortality rates in the United States rank as among the highest globally. African American mothers and children are unfortunately the most affected. According to Biden, the provision of quality and equitable health care to all Americans is a right that should be enjoyed by all, and not the privileged few.
Both Joe Biden and Harris have a history of championing equitable health care policies in their political careers. While serving as a Senator, the current Vice President advocated for legislation that would bridge the gaps when it comes to accessing quality mother and child health care.
She also proposed that health care providers should be educated and informed of the existing biases. On his part, Joe Biden advocated the strengthening of Medicaid and the implementation of the Affordable Care Act while serving as the country’s Vice President during President Obama’s administration. Both ensure that critical services that support mother and child health are equitable and fairly accessed by all, including the low-income citizens.
Within only a few years of the implementation of the Affordable Care Act, the rates of African Americans who were uninsured dramatically dropped. This was a crucial indicator in ensuring that mother and child health outcomes were improving. It also narrowed the gap between the insurance coverage of African Americans vs their white counterparts. The disparities in mother and child health care provision between Blacks and whites could be attributed to systematic racism, which is a political force. In recognizing this fact, the president called on all Americans to acknowledge that black mother and child mortality rates were a crisis and needs to be addressed urgently.
While marking his first 100 days in office, President Biden issued a couple of executive orders, some of which called for the implementation of a comprehensive approach to racial equity advancement. He also created the White House Gender Policy Council to mainstream gender equity. Both of these are interagency processes that the president looked forward to working towards ending disparities that negatively affect African American women and girls, including maternal and child health crises.
President Biden’s administration has increased investments directed towards mother and child health. Particularly, the president has invested $200 million towards the implementation of implicit bias training targeted at health care providers (National Library of Medicine, 2011). This is in addition to the creation of programs for state pregnancy medical homes. Besides, the money was also meant to go into the expansion of programs for Rural Maternity and Obstetrics Management Strategies and bolstering Maternal Mortality Review Committees. Part of the money was also required to help higher early childhood development specialists across all cities’ pediatrician offices.
The HHS Office for Civil Rights has also seen a 24% increase in funding to ensure that health care’s civil rights are also protected. This is in addition to the provision of $340 million towards the Title X Family Planning Program to improve access to crucial preventive and reproductive health care services as well as to advance health and gender equity (Chauhan & Jungari, 2021). The president did not stop there. He additionally provided $6 billion towards the Special Supplement Nutrition Program for Women, Infants, and Children to assist vulnerable families to afford food as well as addressing racial inequalities that characterize mother and child health outcomes.
All these efforts by President Biden’s administration were a departure from his predecessor whose policy agenda on health largely ignored women and children. Particularly, President Trump began by repealing and replacing the Affordable Care Act, an action that threatened to roll back the gains that had been made to guarantee women and children quality health care. He also reduced the Medic aid by $880 billion in his first 100 days in office (Stevens et al., 2009). As a result, such services as newborn care, pediatric, and maternal care were put at risk. In addition, President Trump withheld access to the Title X Family Planning Program’s basic health and preventive care services. He disregarded the vital role played by Title X providers in ensuring health care access to underserved families and women.
The actions highlighted above by both President Biden and Trump illustrate the important role played by the political force and its impacts on maternal and child health. The policies advanced by President Biden attempt to right the wrongs that his predecessor has pursued. President Trump’s approach to health care did not put mothers and children at the center stage. Later, towards the sunset of his presidency, Trump pulled the United States out of the WHO, undermining the global leadership played by the U.S in the provision of health care to mothers and children over the years.
Throughout the globe, there is a correlation between the health of mothers and children. Incidentally, the health of the two is affected by a myriad of factors, including politics. Each year, millions of new mothers, pregnant women, and children suffer serious illnesses, primarily from treatable and preventable diseases. Sadly, 99% of all global child deaths take place in less developed countries (Torche & Rauf, 2021). Sub-Saharan Africa is the worst affected by this crisis.
Governments are aware that improving mother and child health is a critical element in fostering the economic growth of their countries. To this effect, several interventions have been used across many nations to ensure maternal and child mortality rates are significantly reduced, if not eradicated completely. However, despite these interventions, many countries still grapple with poor health care provision challenges. The health care departments in many countries do not get allocated sufficient resources that they deserve.
Political formations in many countries are responsible for running government affairs. This means that politics determines crucial aspects of health care, including the amount of budgetary allocations to health and how the country responds to health emergencies. For instance, the COVID-19 pandemic has severely disrupted the health care systems in almost all countries in the world. In 2020 when countries were in lockdowns, immunization efforts for children were affected, and this further fueled malnutrition. Whereas some governments put up efforts to take care of mother and child health, others accorded more priority to COVID-19 patients.
The well-being of the mother and child can only be guaranteed if there are appropriate policies in place for intervention. First, it is the duty of governments to ensure that individuals servicing in emergency obstetric care and care at birth are skilled and well-trained for the job. Sometimes, reducing newborn deaths does not cost much but only requires simple intervention measures such as ensuring that the newborns are kept warm and dry and breastfeeding them. It also requires that newborn infections are timely treated. It is the duty of the government to provide a conducive environment for mothers to enjoy these simple but effective intervention measures. Indeed, such interventions as oral rehydration therapy (ORT), insecticide-treated mosquito nets (ITNs), and immunizations have significantly led to the decline in child mortality rates.
Government should also ensure that their citizens access improved access to clean water and sanitation services. Unfortunately, this has not been realized in several countries across Sub-Saharan Africa especially within low-income neighborhoods where people live in congested houses. One of the most effective ways of ensuring that this is avoided is for governments to initiate affordable housing programs where citizens can get access to clean water and sanitation services. However, this is a political factor that depends on the policies, goodwill, and priorities of the government of the day. Besides, it is important to encourage children to adopt such hygiene practices as the washing hands as often as possible.
Political goodwill is often an important requirement that is instrumental in driving key agendas forward. Over the last five decades, the United States government have successively been involved in global mother and child health. The very first global effort in the mother and child field that the U.S took part in happened during the 1960s (Bartick & Reinhold, 2010). The main focus of the event was research on child survival. Incidentally, the ORT’s pioneering research was conducted here by the U.S Agency for International Development (USAID), the National Institutes of Health (NIH), and the U.S military. There were some early programs as well where the U.S deliberately entered into programs that aimed at fortifying vitamin A into the international food aid as well as malaria control efforts.
As early as the 1985 financial year, the U.S increased its budgetary allocation for child health support programs by injecting $85 million towards activities related to child survival (National Library of Medicine, 2011). The USAID followed in the year 1989 by developing its pioneer maternal health project before introducing a newborn survival strategy 12 years later. Over time, funding has drastically increased reaching $1.385 billion in 2021. The government of the U.S has committed to ending child-mother deaths that result from preventable diseases by 2035. Other than the budget allocations, the other political bearing that demonstrates US’ commitments to improving mother and child health is its organizations. USAID leads all the efforts that the US has put in place to improve maternally and child health. The Centers for Disease and Prevention (CDC), the Peace Corps, and the NIH complement USAID’s efforts.
There are several interventions aimed at improving mother and child health that are funded by the USAID, especially in Africa and Southern Asia. USAID pursues a strategy of reaching out to the most vulnerable populations and ensuring that mothers and children receive access quality health care. It identified priority countries that it planned to save the lives of at least 15 million between the years 2012 to 2020. Statistically, this comprises 70% of all maternal and child fatalities across the globe (Torche & Rauf, 2021).
This way, it also hoped to achieve both goals 2 and 3 of the SDGs (Hamal et al., 2020). In addition, the agency released a nutritional strategy that cut across multiple sectors and focused on improving global health, development efforts, and humanitarian linkages. The strategy aimed at addressing both the underlying and direct causes of malnutrition in addition to building food security and resilience among susceptible communities.
On its part, the CDC mainly operates programs associated with immunization. It also offers technical and scientific assistance and builds capacities within the broader mother and child health array areas. The US government has also mandated CDC to be its link to the World Health Organization (WHO), particularly when it comes to prenatal, child, maternal, and reproductive health. Meanwhile, NIH’s contribution to mother and child health is through conducting basic science and executing some research in conjunction with other countries (Smith et al., 2017). On its part, the Peace Corps are known to perform volunteer projects related to mother and child health around the world.
It is, thus, apparent that the political factor is significantly demonstrated through partnerships with other global organizations or countries. Indeed, the U.S government has partnered with different bodies to support the funding of mother and child health around the world. For instance, the Gavi is a vaccine alliance that aims to step up immunization efforts in the least developed countries (Torche & Rauf, 2021). The United States is the largest donor in this multilateral alliance. The partnership, Global Financing Facility (GFF) aims to improve women, adolescents, and children’s health through finance innovations.
Application of the 7 Universal Principles of Ethics
From the discussions above, it has emerged that racial inequality in the provision and access to quality health care is one of the most predominant social justice issues that face mothers and children in the U.S. In the United States, for instance, black mothers and children are more disadvantaged when it comes to accessing quality health care as compared to their white counterparts. Each of the seven principles of health care ethics can help put this social injustice issue in its right context. The first principle calls for autonomy or self-determination whereby an individual is expected to make her own independent decisions without being manipulated by anyone.
However, since the provision of health care follows a system, this ethical principle cannot apply to an underserved mother and child who must rely on the political decisions of the state to determine whether they access quality and affordable health care or not.
The second ethical principle is that of beneficence, which seeks to promote patient health above all other considerations. According to this act, the health of the mother and child is of utmost importance regardless of their racial backgrounds and socioeconomic status. Thus, the state and the medical fraternity must perform actions that are geared towards helping mothers and children remain healthy (Varkey, 2021). The nonmaleficence principle calls upon health care practitioners to “do no harm” to their patients. Unfortunately, this principle is often difficult to follow partially because of the influx of technology in the patient treatment process.
Whereas most drugs prescribed for mothers and daughters can heal various ailments, there are also side effects associated with their usage. If a mother or child suffers from the side effects of drugs, it becomes a social justice issue.
The fourth ethical principle is about confidentiality that mandates that patients’ medical records must be accorded the privacy that they deserve. This principle is anchored on the Health Information Portability and Accountability Act (HIPAA) and seeks to protect the mother and child against violation of their confidentiality. It must be noted that one of the reasons why black mothers are slow in their uptake of medical insurance is their immigration status. Many are afraid that if they expose their immigration status to health care professionals, their covers might be blown out.
The fifth ethical principle is about justice and it raises fundamental questions about who should be responsible for an individual’s health. Incidentally, health care is a basic human right that should be extended to everyone. The Affordable Care Act indeed sought to accomplish this by ensuring that everyone can access health care whether they can pay for it or not. In the United States, this is the position held by President Obama and now Biden. However, President Trump held a different view, which argued that every individual should take responsibility for her actions for justice to prevail. If the rich are overtaxed to raise money for treating the poor for free, it can be argued that the rich are denied justice. Therefore, the fifth principle of justice is an ethical dilemma.
The role fidelity ethical principle calls upon health care providers to remain faithful to their service scopes for which they were registered to perform. This way, a lot of medical mishaps that affect maternal and child health would be avoided. For instance, a specialist who is not qualified to offer expert advice on nutrition should not recommend to a mother what to eat and what to avoid out of guesswork (Schröder-Bäck et al., 2014). The last ethical principle is that of veracity and it entails telling the truth. Indeed, this is what patients and their caregivers need since it also contributes to the healing process.
In conclusion, maternal and child health is a crucial determinate of the efficacy of a country’s health care system. It is the responsibility of every government to ensure that mothers deliver their babies in a safe and healthy environment and those babies are taken care of till maturity since they are the next generation. However, this can only be ensured if there are the right policies and procedures in place, both of which can be availed if there is sufficient political goodwill. Political factors will thus influence maternal and child health while their interactions with physicians will be affected by the 7 ethical principles.
References
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