Maternal Health and Household Environmental Issues for Public Policy
Tam, Sandra, Women & Environments International Magazine
Households as Environments
Of all the environments women are exposed to on a daily basis, why should policy-makers attend to what happens in the household environment? Most people do not even think of households in environmental terms. Generally, one views the environment as air, water and trees. Environmental health specialists are more likely to investigate the health impacts of human exposure to smog and ozone depletion than household hazards. Nevertheless, home is where we live and where we spend lots of time; thus, households are spaces that matter to women's health.*
When people think of homes, most of us envision solid brick houses surrounded by white picket fences on quiet residential streets. Most of us think of warm, safe places to relax with loving families after a long day's work. Of course, not all households meet this idyllic image. Some homes are located in poor neighbourhoods or polluted areas where flowers and gardens do not grow. In some cases, women, children or other vulnerable household members face domestic violence and abuse at home. Regardless of where people's household experiences fall between the extremes of "home as safe haven" and "home as oppressive structure," where homes are physically located, as well as what happens within households, it will affect women's experiences of maternal health and well-being.
Maternal Health: Beyond Reproductive Health
Traditional biomedical studies tend to view maternal health in terms of women's reproductive system. Biomedical researchers tend to examine the adverse effects of contaminants on rates of infertility, premature births or miscarriages. Studies also aim to explain the mechanisms by which pregnant and post-partum women pass on health risks to developing fetuses and infants, for example through lactation.
Focusing on issues affecting expectant and new mothers is justified, given that the developing fetuses represent a window of vulnerability; that is, a life stage of rapid cell growth and division when environmental contaminants exist can have particular long-term subtle or dramatically acute health impacts. Any abnormalities discovered during this developmental period of heightened sensitivity alerts health practitioners, policy-makers and the public about potentially hazardous elements or environments to avoid.
However, women are more than reproductive vessels, and maternal health is more than an issue of biology. In contrast to biomedical models of health, the social determinants of health perspective assert that socioeconomic variables such as early life experiences, education, employment and working conditions, food security, access to health care services, housing, income levels, social safety net, social exclusion and employment security are just as important as biomedical or lifestyle factors in predicting health outcomes.
For example, the World Health Organization's Safe Motherhood Initiative linked quality of life and reproductive issues in a human rights framework. The project's goal was to ensure that all women worldwide receive the care they need to be safe and healthy throughout pregnancy and childbirth. The initiative included consideration of the impacts of social, economic and biophysical hazards as well as reproductive risks on maternal morbidity and mortality, and menstrual health. The projects recognized how the women's burden of caring for children and families, and their socially devalued, economically disadvantaged position led women to neglect their own health.
Social determinants of health recognize that gender roles and expectations interact with social structures and systems to affect maternal health outcomes. In addition, women are not just women; they belong to racialized or Aboriginal groups, and may be poor, immigrants or have a disability. These dimensions of social location also interact to produce health disparities among different groups of women.
Notwithstanding the tensions between the biological and social approaches to maternal health, for the purpose of this study, maternal health is seen to encompass both the biological and social reproductive processes. …