THE IMPORTANCE OF MATERNAL AND CHILD HEALTH IN SOCIETY AND THE IMPLICATIONS OF OCCUPATIONAL THERAPY IN A RURAL COMMUNITY SETTING:

Let us clearly understand the concepts concerning the topic being explored in this reading.

Maternal health: "Maternal health refers to a woman's health and well-being before, during, and after pregnancy and encompasses aspects of physical, mental, emotional, and social health" (RHIHub, 2022)".

Child health: "Child health is a state of physical, mental, intellectual, social and emotional well-being and not merely the absence of disease or infirmity, of the child from birth to adolescence" (FTF, 2007).

Society: "A community, nation, or broad grouping of people having common traditions, institutions, and collective activities and interests" (Webster, 2022).

Hence, a society/community consists of several family units. Within those family units, mothers play a significant role in attending to the health and well-being of the other individuals. Hence, they lay the foundation of the community by birthing the life which inhabits the community. Now, how solid or unsteady that foundation is, depends on the overall health and well-being of the mother. This is because, just like how an imbalance in the physical environment leads to climate change and catastrophes when motherhood falters or is removed from the social equation of societies, it leads to much chaos in the family unit, which ultimately affects societies. Therefore, mothers are the silent architects of society. They are the indispensable builders of society, who lay the foundation of confidence, faith, and moral values in our youth. However, this is rarely acknowledged due to the deeply embedded patriarchy, misogynistic attitudes and subsequent cultural schools of thought. This generational trauma is a perilous problem as it hinders the mothers from acknowledging their problems clearly, hinders them from standing up for themselves without a second thought, and subsequently limits the acquisition of necessary healthcare and social changes in the long term. However, is it realistic to pour into another cup when there is scarcity or emptiness in yours? Likewise, mothers cannot give from a depleted source. Every mother needs emotional, mental, physical and spiritual validation, nourishment and support. Her health determines the quality of care she can provide to her infant to ensure he/she grows into a skilled, competent, dignified member of society. When a mother is respected and well- cared for, she and her whole family will benefit. The impact of this family unit then ripples onto other family units and essentially society as a whole. 

Analysing the Cato Crest community, just from a superficial level it is evident how overpopulated and poverty-stricken the township is. Linking this to our topic of maternal and child health today, at least 700 000 pregnant women in South Africa live in poverty (Laurenzi, 2021). Hence, this poverty affects the access to healthcare and the quality thereof for the mother and foetus/infant from the time the mum is pregnant, the duration within which she births life, up to the time she walks into the community with her new-born and nurtures the infant up until adolescence. The food insecurities leading to vitamin/mineral deficiencies such as low iron levels affect fetal health leading to stunted growth. Furthermore, geographical hindrances limit her access to timeous healthcare and risk maternal health and fetal health, thereby leading to maternal mortality and/or developmental delays. Furthermore, this increases the likelihood of home deliveries wherein semi-skilled or unskilled members are involved, leading to further health complications. Now the solution could be as simple as providing nutritious food, adequate access to healthcare and the delivering of babies by skilled members. However, it does not end there as aside from materialistic poverty, there exists poverty of the heart and mind as well. Subsequently, the community wilts away due to the harshness of these poverties as explained below through a scenario.

Asiphe, a 15-year-old teenager, was brought up in a dysfunctional family and experienced emotional trauma and role confusion by having to constantly be the mediator in her household disturbances. Unable to look to positive parental role models, she was clouded by aimlessness, insularity, and depression. These psychological disturbances manifested in a romanticised idea of seeking love and a happily ever after elsewhere. In her youth, she was manipulated by her "boyfriend" and was appalled to discover she fell pregnant. Asiphe, is the eldest of three children of a single mother who was stranded by her multiple boyfriends in her early youth. Her mother was only a teenager at the time of her birth, who did not seek professional medical help due to (1) fear of her family and societal stigmatisation and (2) obvious inexperience. Hence, she walks out on them to save her skin and start life afresh, far from her present turmoil. How does Asiphe grow up? This will highlight the importance of maternal and child health in society:

•       She had taken on the parental role and the role of breadwinner in her house due to the absence of any adult guidance/assistance. Due to this pressure, she attempted theft, contributing to a statistic of the crime rate within the community. Furthermore, she battles with depression, anxiety and PTSD thereby affecting her learning and performance at school. Due to the gush of pressures, she leaves school. Additionally, she turns to substance abuse as a coping mechanism.
•     Her child was born with major developmental delays due to poor maternal health during pregnancy. She does not know what is wrong with her child, how to help her child and believes that this was her form of punishment for her reckless behaviour.
•     She experiences post-partum depression (PPD) and subsequent lack of motherly instincts, manifesting in feeling disconnected from the child and wanting to hurt the child.  
•     Her battle with her mental health is exacerbated by the stigmatisation of teenage pregnancy and mental along with the cynical cultural beliefs against it. 
•     This flows into the expectations of her new role as a mother when she returns into the community. She is required to immediately resume her roles of breadwinner, student and friend in addition to navigating this new role of motherhood to a disabled child. And sadly, the anguish of the innocent infant who is given no choice or say in the upcoming chapters of his life. A common saying goes that a mother's lap is the first school of a child. By now, we can conclude how this is going to end up for the child- He is likely to encounter stunted growth and is at risk of growing up unskilled or even worse, unloved.

 If this is any indication of the population within the community, what does it say about the mindsets, attitudes and actions of the community members. This brings us back to the poverty of the heart and mind causing the community to wilt instead of blossoming if the root of the problem, maternal health, was to be addressed.

Watch this video should you like to enrich your understanding of the factors which impede maternal health in a rural setting and the measures that can be implemented to improve the societal future:-  https://www.ted.com/talks/sadia_malick_how_to_reduce_maternal_and_newborn_mortality_to_save_our_future

What implication does this have for Occupational Therapy practice at community level? 

If a woman experiences long-term complications (physical and mental) from her pregnancy, she will not be able to care for her child properly or raise them healthily. This then affects the child's upbringing and development, as these children experience deficits in cognition, attachment, emotional skills, and social skills (Dowshen, 2016). The added responsibility of attending regular clinic appointments in addition to the caregiver burden is an added stressor to her life, causing the community to regress. This is where our group of student OTs would like to intervene to provide paediatric therapy inside the home or nearby local point such as the Cato Crest Library in this case, to facilitate the child's development and functional progress, thereby also relieving some of the caregiver burden and subsequently aiding the development of the community. Furthermore, this is a location which is convenient and central to the community as it is in the midst of amenities such as local shops, crèche, preschool and the soup kitchen thereby, which is particularly beneficial due to the lack of transport. Moreover, having sessions in this location allows for young mums to attend lessons or remedial classes at school whilst their child is being seen by OT in a session. 

Furthermore, the mothers are in constant anguish. They are often neglected/gone unrecognised in society due to pressures, guilt and time element of juggling several roles. Hence, we as a group of OT students aim at intervening in the form of weekly group therapy sessions aimed at emotional support, breaking down and managing stigmatisation, extensive caregiver training and assisting in building a supportive network by bringing together mums with similar concerns and filling the gaps by using individual strengths and weaknesses strategically in a group. By doing the above mentioned, we can also change the conversations that are being held in the community. Moreover, whilst the mums are engaging in a culturally appropriate activity during the group sessions, the library allows for a section of children to been overseen by half the students thereby simultaneously tackling maternal AND child health. 

Lastly, maximising health promotion, and emphasising maternal health and child health within the community, has the potential to address the issue thereof by equipping them with the ability to acknowledge their challenges and working collectively to tackle the issues to combat their vulnerability in society thereby leading to the empowerment of the community. 

Consequently, this would enhance maternal health, subsequent child health, and the overall health and well-being of other family members in the family unit, and society as a whole.

Although Asiphe was fictional, she was fabricated from the threads of hundreds and thousands of real-life stories, and women who encounter identical fates. Therefore, it is entirely relevant to the community and life within the Cato Crest setting. Asiphe is the poster child for most young mothers in the community. She and her child then contribute to the macrocosm as statistics in the educational, infant health, mental health, and unemployment statistics of South Africa.

Reflecting back on this first week of community block, I notice how taking my knowledge out onto the streets, working more closely within the community and critically analysing this topic, a burning issue in the community, has revolutionised my thinking and subsequent attitudes in life. I feel a newfound calling and enthusiasm to intervene for mothers and their children, as I have access to them in a controlled environment, and the ability to assist on a primary level.

REFERENCES:

•            https://kidshealth.org/en/parents/teen-pregnancy.html
•           FTF. (2007, October ). Child Health - Definition. Retrieved from Health Workgroup, First Things First: http://www.azftf.gov/WhoWeAre/Board/Documents/Program%20Committee/Health/January%2013,%202011%20Meeting%20-%20Health/07%20Child%20Health%20Definition%20Recommendation.pdf
•           Laurenzi, C. (2021, March 25). One year into lockdown, pregnant women remain the most vulnerable and need support. Retrieved from Institute for Life Course Health Research : https://www.lifecoursehealthresearch.org/post/one-year-into-lockdown-pregnant-women-remain-the-most-vulnerable-and-need-support
•           RHIHub. (2022). Defining Maternal Health. Retrieved from Rural Health Information Hub : https://www.ruralhealthinfo.org/toolkits/maternal-health/1/definition
•           Webster, M. (2022). Society . Retrieved from merriam-webster: https://www.merriam-webster.com/dictionary/society