Celebrating motherhood in postal stamps

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A child is born

Childbirth is a beginning, of an independent human life. This event is universal to all creatures. It has its beginnings in conception, a union of two cells in human body, that have a capacity to create all the other organ systems and eventually an entire human body. After nine long months of gestation, and struggles of labour dawn of childbirth lies in cries of a new born. Postage stamps have depicted this event as a newborn being presented to a mother, or both parents engrossed in their moments of joy.

Maternal health is a prelude to a healthy and happy childbirth. Well-nourished mothers, who have had fewer, spaced out births have better outcomes. But this fact has become a rule, only in the last century.

Prior to 1900s, death of a pregnant woman, or of a child in first year of life were not uncommon events. This was probably one of the reasons to over-produce, as families did not know who would survive.

Historic improvements in maternal mortality

Historic accounts of maternal mortality narrate a tale of struggle and survival. We count maternal death as number of mothers dying for every 100,000 child births. In Great Britain this number was about 2000 in 1700s, and had declined to 850 by the beginning of 20th century. Real decline in maternal deaths took place between 1935 and 1955, when the number of deaths dropped to less than 50, and today in high income countries the number of maternal deaths is less than 10 for every one lakh births.

These improvements were slow to percolate to low income countries. For instance, maternal mortality was 2000 for every 100,000 births in India in 1940s. This number improved to 556 in the year 1990. (See trends) Today in India, for every one lakh childbirths, 97 women die. These improvements in many low-income countries are only a few decades old.

This decline in maternal mortality is attributed to safe birthing techniques, prevention of infection, structured ante-natal care, and a mandatory training for all doctors and nurses in obstetrics and midwifery. All these developments were an achievement for obstetricians, who focus on healthy mothers as well as a successful childbirth.

Weeks following childbirth

Weeks that follows childbirth, is a vulnerable period for both mother and her child. First six weeks after birth (42 days to be precise) is postpartum period for the mother. Any health issues that take place during pregnancy and till six weeks after childbirth are counted towards maternal health. On the other hand, for a newborn child, first four weeks (28 days to be precise) is a vulnerable period. During this period birth defects, infections and injuries during childbirth are important concerns.

Throughout history of mankind, about a quarter of all children born would not live to see their first birthday. This estimate comes from the fact, that despite large number of births- population was more or less static. By 1950s, of every 1000 children born in the world, about 157 would die by one year. This metric, Infant mortality rate had improved to about 65 in 1990. Half of these deaths were in first four weeks of life. Today we rather focus on neonatal mortality rate (or NMR) as a preferred metric of progress in maternal care.

In 1990, NMR was about 36. This number means that of every 1000 childbirths, 36 would die within four weeks of birth. This number has halved in last three decades. In 2017, global NMR was 18 and in 2020 it was 17. Improvement in this rate is an important sustainable development goal (SDG) for 2030. Globally we aspire it to be 12 per 1000 childbirths, by the year 2030. In high income countries, this number was about 3 in the year 2020.

Numbers for India

Today in India, for every one lakh childbirths, 97 women die. This is remarkable, as for the first time it is less than 1 in every 1000 births. As per 2020 figures, 20 newborn children die in India before reaching an age of 28 days. Six states in India have already attained global targets due in 2030. These states are: Kerala (4), Delhi (9), Tamil Nadu (9), Maharashtra (11), Jammu & Kashmir (12) and Punjab (12). These figures show a remarkable progress, and also road ahead.

Sustainable development goals (SDGs) for 2030 include reducing maternal mortality to less than 70 per 100,000 childbirths. Today about 84% births worldwide are supervised by trained personnel. In India about 90% of all births are taking place in health-facilities. The concept of safe motherhood is an important women’s rights issue and already is a major landmark in history of mankind.

Death of either mother or her newborn are tragic events. As we see less and less of such tragedies, a debated ethical dilemma of early 1900s is a thing of the past. Theologists and Ethicists debated for years, on whom to save first mother, or her child. In history, many powerful and famous women in history have died during childbirth. Improvements and achievements today are an ode to their historic struggles for survival.

Services for healthy mothers and children

Almost all countries in the world have worked hard to improve maternal and neonatal mortality. Maternal and child health services have focussed on this continuum. Maternal health became an issue of woman’s rights. Child health was seen as an issue related to child’s rights.

In 1985, Allan Rosenfield a physician and a women’s rights advocate wrote a famous opinion piece in the Lancet – Missing “M” in MCH. He reported on tragic state of maternal-care, especially in developing world. Till this time entire focus was on child-health and family planning. Initiatives for safe motherhood were lacking. Concerned with this glaring gap, WHO launched Safe-motherhood initiative in 1987. Focus of this initiative was to ensure ante-natal care, minimal standards of care during birthing, proper referrals, and post-natal care unto six weeks after delivery. Various countries launched their additional initiatives such as Janani Suraksha Yojna (JSY) in 2005 in India. JSY provides financial incentives to promote institutional deliveries.

Mother, child, and religious paintings

Madonna (a representation of Mary) and her child (Jesus) is one of the common themes in Christianity. Many paintings of Maddona and her child are from 13-15th century, and are seen across convents, churches and museums across Europe. Many such religious paintings are used in maternal and child health philately. Some of these are presented in following panels. These paintings also show various motor milestones. Most children can stand by about 9-12 months of age. It is initially with support, usually of mother – and later on their own. After one year, child will begin to walk.

Beyond first year

As children cross infancy (one year of age), they become more playful. Now they are toddlers and will begin to talk, run, hop, skip and swim. Please find more of them here, in upcoming blogs.