My wife is 34 weeks pregnant. We took a tour of our local hospital’s obstetrics wing today, as the culmination of the baby care basics ($65), breastfeeding (another $65) and Lamaze classes ($185) they offer to new parents. As a part of the tour, we got to see the different tiers of private recovery rooms available:
I can’t help but contrast this with two other experiences of bringing babies into the world that I’ve seen or been told about.
Fries, Virginia, 1948:
My dad was born on the second story of a wooden boarding house at the bottom of a hill in rural southside Virginia. It was not really in Fries (pronounced “freeze”) per se, but that’s the closest town. Grandmother Reeves had spent three weeks there prior to going into labor. They weren’t sure when she would “go,” and getting her down from the farmhouse (the Reeves/Bond ancestral farm, which is a whole different story) at a moment’s notice wasn’t really an option – a horse-drawn cart was involved – so she was sent early. There was no doctor in Fries. Rather, one visited on occasion from Wytheville, which is 20 miles away as the crow flies, but several hours away by crappy, windy roads in those days. As my dad related it to me, this traveling country doctor was summoned when she went into labor, and he eventually delivered my dad. There was probably little or no anesthesia involved. Lots of women in rural Virginia in those days gave birth either by midwife or simply with family members at home. My grandmother lived a hard life, but she was a wonderful lady. She made the best bread I’ve ever had.
Ambam, Cameroon, 2006:
Ambam is a large town/small city in southern Cameroon where I lived for most of my Peace Corps service. As a health volunteer, I spent a lot of time at the hospital there. This was no small clinic (like in Nyabessan, my first post). There was at least one full-time doctor assigned there and several nurses (though whether they showed up, or even lived in Ambam, is a different matter). It handled cases referred from around the whole department (like a collection of counties).
When you’re pregnant in Cameroon, giving birth in a hospital can be expensive. You are expected to pay the doctor and nurses, preferably in advance, in cash. You pay for sheets, and the bed (almost no one gets their own room), pretty much on an a-la-carte basis. You pay for your own drugs, or bring your own. You’re expected to bring your own food and water. Don’t have all of this stuff? Then you’re not going to the hospital/clinic. You give birth at home, with family, and maybe a traditional healer, who also expects to be paid, but is a lot cheaper (and less competent). All-in, you’re probably talking maybe $100-$200 for a hospital/clinic birth, which is why most babies in Cameroon are not born in a hospital, and stories like this are not uncommon.
Family and community ties have paramount importance in Cameroonian culture, and this is one example of why.
Anyway, I met and saw a lot of women give birth at our hospital in Ambam. The staff there was pretty competent and able to help – but only if someone could pay for supplies, which the government did not. The government also said that prenatal care was supposed to be free, which of course has never been true.
The clinic where I worked before moving to Ambam was much, much more rural and basic. When the current presidential administration reinstated the global gag rule earlier this year, I recounted this story from my time there:
New York City, 2017:
I spent part of the other evening volunteering down at the Bowery Mission, one of NYC’s homeless shelters. When you spend enough time at shelters here, you notice that a small but noticeable number are there recovering from some medical disaster. The other night, I talked to one middle-aged woman who had been going through chemo. She was in the line for a hot supper. Her cancer was in remission, but it had made her bankrupt, and she was now homeless and without much recourse. She pointed out two other women in the dining hall who she knew who were pregnant. One had a partner with her, the other didn’t. With my newfound judgment, I’d say both were probably about 6-7 months. I have no idea what will happen to them.
My wife and I have excellent insurance and will probably pay little or nothing out of pocket for the birth of our child at Lennox Hill Hospital. I don’t know if our insurance will put us up in a standard private room or spring for the luxury one on the 4th floor – I don’t think they’ll go for the suite, but a lactation consultant is definitely covered.
I struggle to make room for this experience of birthing babies along with the others I remember. There’s no way to make them fit together, rationally, or in any way that squares with any morality I recognize. It’s hard to grasp how immorally unequal and cruel the unfair access to health resources is until you see vulnerable people suffer without them. Those of us with them have to do better. That’s all.