Hello Group E,

This week the article “Childbirth traditions and cultural perceptions of safety in Nepal: Critical spaces to ensure the survival of mothers and newborns in remote mountain villages” by Sabitra Kaphle, et al was given us to reflect our thoughts. The key facts of the article were concerns about safety and risk during childbirth are critical for both the pregnant women and healthcare providers, preference of many women in rural settings of Nepal to give birth in family settings with locally available help following their cultural belief. They believed that giving birth to a child in cowshed will provide spiritual protection to both the mother and the child. These practices are a reason for infection and other associated risks factors for mortality and morbidities.Exclusion of socio cultural concepts of childbirth in medical policy, pregnant women as powerful actors who decide their place of delivery which plays an important role in dealing with risks during the childbirth.

I have come up with three ethical issues and would like to discuss these with you.

Ethical issue 1: The rightful maternal health services aren’t delivered to the deserved pregnant women in rural Nepal. These pregnant women are also not involved in building and improving their healthcare services. In addition to that, policy makers/healthcare providers did not consider their socio cultural and spiritual believes while formulating policies. One strong reason for not availing these services. Relevant Ethical concept: Human Rights

Ethical issue 2: The autonomy of the women in deciding pregnancy and its outcome is not always preserved. Often it is forced by husband, mother in laws and other family members. In this study, mother in laws set an example and the daughter in law is forced by her circumstances and belief also to follow her foot steps. Relevant Ethical concept: Autonomy

Ethical issue 3: The health of pregnant women is at risk, while medical care can be made available to these women by inclusion of locally based primary maternity care. But the service is not provided to those women and it is affecting the outcome of their pregnancy. Relevant Ethical concept: Beneficence

Actor with Decision-Making Authority: Healthcare Providers, Policy makers

Available Course of Action:

  1. Provision of locally based maternity care to increase the acceptance of healthcare services by the pregnant women
  2. Inclusion of socio cultural and spiritual aspects of the area to increase the coverage of maternal health services.
  3. Provision of inclusion of locally influential people of the community (especially with pregnant women) to create awareness about hygienic deliveries at institutional level and to increase the acceptance of the healthcare services.

These (above mentoned) are ethical concept which according to me are important while deciding or formulating any policy. The above mentioned course of action if taken by the healthcare providers/policy makers, will increase the acceptance of the healthcare services and hence will greatly reduce the mortality and morbidity of maternal and child health. I understand that Nepal has a long way to go but it is not unachievable. What according to you can play an important role in reduction of maternity related morbidity and mortality in rural Nepal? Do you think that the points (course of action) mentioned by me are important and can play a significant role in the reduction of maternal mortality and morbidity, if taken care of by the healthcare providers?

The above is the leader discussion you have to response to it

Your job : The remaining students (I’m one of them) in the discussion group will then have until the end of the week to leave at least one comment in response to the discussion leader’s. Remaining group members must comment at least once to discuss ethical considerations of the courses of action proposed by the discussion leader. Students are welcome to respond to any of the material presented by the discussion leader but must also contribute something to the discussion of ethical arguments for and against the proposed courses of action. Alternatively, students may propose a different course of action and discuss why it might be preferable, ethically speaking. The purpose of discussion is to work together to formulate a course of action that best resolves the ethical concerns in the case. All group members may contribute to the discussion and leave multiple comments, depending on how frequently they review the forum as the discussion progresses. Remaining group members must post their comments by 11:59 pm THURSDAY Eastern US time. Please find the article attached

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