Glory to the Newborn

Madonna

I have been thinking a lot lately about the birth of Jesus. There is of course an obvious reason for this: the recent Christmas season with the full-on gift buying, festive food and drink consumption, decorated trees, store windows of lavish jewels and designer attire in snow filled glass enclosures, and perpetual email blasts of seductive sales and free shipping from the Amazon and the Beyond of Beds and Baths, as well as every other online shopping site.   In the air were the strains of Silver Bells and Sleigh Bells and Joy to the World, a Silent Night Away in a Manger with Herald Angels Singing, “Hark!” And scattered here and there were Nativity scenes on billboards, in front of churches, along my daughters’ street in Jersey City, a lovely one in front of their neighbors’ house. I have two Nativities: one from Ireland, the figures of Mary, Joseph and the baby accompanied by a sheep and a cow simply carved in stone, and one from Brazil, each of the collection of shepherds, wise men, cactuses, cows, sheep, lambs, camels, as well as the Holy Family and an Angel crafted by hand out of clay and painted in bright colors. In all of these crèches and scenes, the baby Jesus is swaddled in a little bed, sometimes of actual straw, sometimes he is sleeping, sometimes reaching up to touch Mary, a lamb or Heaven. And this is what got me really thinking about the birth of Jesus, the actual birth of Jesus.

 

I think everyone pretty much knows the story of Christmas, even non-Christians since it is proclaimed, preached, advertised, and I am sure tweeted just about every place. My sister Rosemary lovingly sends the account of the story by the Apostle Luke ever year with her Christmas card in some very creative way.  Here it is:

Luke 2:1-20 New International Version: The Birth of Jesus 

In those days Caesar Augustus issued a decree that a census should be taken of the entire Roman world. (This was the first census that took place while Quirinius was governor of Syria.) And everyone went to their own town to register.  So Joseph also went up from the town of Nazareth in Galilee to Judea, to Bethlehem the town of David, because he belonged to the house and line of David. He went there to register with Mary, who was pledged to be married to him and was expecting a child. While they were there, the time came for the baby to be born, and she gave birth to her firstborn, a son. She wrapped him in cloths and placed him in a manger, because there was no guest room available for them.

 

All of the accounts are pretty similar. Mary and Joseph in the manger, baby Jesus is born, shepherds show up and a few days later following a star, the wise men come for a visit bringing gifts. But there is a gap in this story and in that gap is the birth of Jesus, yes, Mary in labor and giving birth.

 

Now I am not faulting the authors of the New Testament, Matthew, Mark, Luke and John. They were men, writing for men, so it makes sense that there would not be a detailed description of Mary’s labor and delivery, not to mention what was probably unmentionable at the time and perhaps even now, that Mary was a woman, with a woman’s anatomy, and she ached just like a woman, she gave birth just like a woman, to paraphrase Bob Dylan.

 

Since I couldn’t find a specific account of the birth of Jesus, just based on common knowledge and my own experience of child birth, there are only two ways that babies are born. And since there is no documentation that Mary had a C-section, there is only one way that Jesus left Mary’s body, was then swaddled and placed in that bed of straw. In “Hark the Herald Angels Sing” there is the line, “Off-spring of the Virgin’s Womb.” Womb is about as graphic as anyone gets about Mary’s lady parts.

 

Now I don’t want to get into a theological debate here, because this really isn’t about theology it’s about childbirth in Israel in first century AD. There is apparently a belief that Jesus without opening, tearing, or causing any pain, simply passed through Mary’s uterus and landed in that bed of straw all neatly dressed and tidy. I have to say that this falls into the same category as Athena as an adult woman fully clothed in armor springing from the head of Jove or the golden haired voluptuous Venus floating onto a beach in a big clam shell. This may be the way male Greco-Roman gods gave birth, but that is not quite the stuff of Humanity.

 

To back me up on this there is an account in this article from Our Redeemer Lutheran Church in Lexington, Kentucky:

There is absolutely nothing in this text or any other text that speaks of Christ’s birth that suggests that His birth was anything but normal. Mary would have gone into labor, would have encountered the pains of childbirth; Jesus would have born naturally as all children at this time. Any accounts that speak of Jesus passing miraculously through the walls of the uterus must be dismissed as pious superstition that detracts from the reality of our Lord’s incarnation and human nature.

(I was raised a Lutheran so I’m going with it.)

There may be great disagreement about how and by whom Jesus was conceived and certainly much disagreement about his death/resurrection, but his birth is pretty straightforward.

So I did some research on childbirth in Israel in the time of Jesus. This is from a site called Childbirth in the Bible:

 

Hebrew women gave birth in their own tents or houses. During labor they were surrounded by other women: a midwife, their relatives and friends, and female servants of the family. They would certainly have seen other women give birth, so they knew what to expect and what to do.

Hebrew women gave birth in a squatting position, above a hole hollowed out of the ground. On either side of the hole were bricks or stones for the woman to stand on. She was supported at her back and under her arms by other women, either midwives or family members. As soon as the baby was born its umbilical cord was cut, then it was washed and wrapped in long bands of cloth (swaddling bands) which held the limbs of the baby firmly, though not tightly.

It was obvious to the ancient Israelites that the central task of women, one that could not be taken over by anyone else, was childbirth. It was also obvious that women suffered in the process of giving birth. The explanation for this, according to Genesis, was that the original balance of creation had been disturbed: in an ideal world (that is, the Garden of Eden) birth would not bring suffering.

(Before I go on, I can’t help myself from commenting on the issue of labor pain having to do with anything in Genesis. Human birth is painful because unlike our quadruped friends, i.e., cats, dogs, sheep, cows horses, whose unborn babies hang slinglike in the hammock of a uterus suspended between four posts/their four legs, our human babies hang between two legs in a uterus that has to be kept tightly closed until the appropriate time of birth, or they would just be pulled out by gravity at anytime and would not survive; the human race would not have made it past Adam and Eve. Opening up and pushing against those tight muscles that have held the baby in for 9 months is painful. I learned this in an undergraduate anthropology class taught by a wonderful professor and anthropologist named Dr. Margaret Wheeler at Stony Brook University, and since have personally experienced this three times with the births of each of my big, beautiful, brainy daughters.)

 

So back to Israel: first of all kudos to the women and midwives delivering babies at home who knew that the best position for birthing was squatting and not lying on one’s back in stirrups, which became the “modern way” to give birth about 200 years ago as dictated by predominantly male doctors in hospitals.

 

Here’s an excerpt from an article on evidence based positions for childbirth:

Researchers hypothesize that pushing in an upright position is beneficial for multiple reasons. In an upright position, gravity can assist in bringing the baby down and out. Also, when a woman is upright, there is less risk of compressing the mother’s aorta and thus a better oxygen supply to the baby. Upright positioning also helps the uterus contract more strongly and efficiently and helps the baby get in a better position to pass through the pelvis. Finally, X-ray evidence has shown that the actual dimensions of the pelvic outlet become wider in the squatting and kneeling/hands-knees positions (Gupta et al. 2012). However, despite these proposed benefits of pushing in an upright position, most women in the U.S. give birth either lying on their backs (57%) or in a semi-sitting/lying position with the head of the bed raised up (35%). A small minority of women give birth in alternative positions such as side lying (4%), squatting or sitting (3%), or hands-knees position (1%) (Declercq, Sakala et al. 2007). It is thought that most women are encouraged to push in a lying or semi-sitting positions because it is more convenient for the doctor. October 2, 2012 by Rebecca Dekker, PhD, RN, APRN
© Copyright Evidence Based Birth.  http://evidencebasedbirth.com/what-is-the-evidence-for-pushing-positions/

Put succinctly by Hannah Dahlen, Professor of Midwifery at University of Western Sydney:

So, what began as a change in birth positions for the convenience of men has been shown scientifically to be an inconvenience for women and babies. It’s time for Australian women to stand and deliver once again.   (This is an excellent article. You can read it at http://theconversation.com/stand-and-deliver-upright-births-best-for-mum-and-bub-13095 )

The writings of the Roman doctor, Soranus of Ephesus (which I have visited and is now in Turkey), who in first century AD wrote a four volume treatise on Gynecology, may have reflected practices in Israel, that it was common for midwives and women to have supplies available to assist in labor and delivery:

For normal labour one must prepare beforehand: olive oil, warm water, warm fomentations, soft sea sponges, pieces of wool, strips of cloth, a pillow, things to smell, a midwife’s stool or chair, two beds and a proper room:

  • oil for injection and lubrication
  • warm water in order that the parts may be cleansed
  • warm fomentations for alleviation of the pains
  • sea sponges for gently washing the body
  • pieces of wool in order that the woman’s parts be covered
  • bandages the so new born may be swaddled
  • a pillow in front of the woman, on which the baby is placed till the afterbirth has been taken care of
  • good things to smell, such as penny royal, a clod of earth, barley groats, as well as an apple and a quince … to revive the labouring woman.’
  • (Soranus, Gynaecology, What Must One Prepare for Labour?)
  • Except for mentioning a clean blade, these could be items in a birthing kit.

But although these Israeli women had the advantage of upright deliveries, midwives, and supplies to ease pain and promote healing, the lack of prenatal care and healthy nutrition due to extreme poverty resulted in deaths of 25% to 30% mothers and babies. Mary and Joseph were poor as depicted in the Christmas story having to stay in the “manger” or the lower level of a private home where the animals were kept. The young 15 year old Mary must have been healthy, with a pelvis large enough accommodate a safe birth, and the survival of herself and her baby. The straw and flooring, and the blade used to cut the umbilical cord must have been clean enough so that neither of them contracted a life threatening infection.   One way or the other, survival of mother and baby was a miracle.

There is a video produced by National Geographic that aired on June 11, 2012 called Mysteries of the Bible: The Birth of Jesus that you may want to watch: http://channel.nationalgeographic.com/channel/episodes/birth-of-jesus

So why does any of this matter? What difference does it make how the baby Jesus, adored as a Savior by many and by many more honored as a child who grew into a great man and teacher, was born 2000 years ago? It matters because every baby has the right to be born safely, to be adored and to grow into someone to be honored for their gifts. It is my hope that Mary during the birth of Jesus was surrounded by shepherds, women who knew how to give the best care to a woman during labor and “shepherd” the baby through all of the stages of birth: contractions, crowning and delivery; that wise people brought the supplies needed to reduce pain and promote healing: olive oil, soft clean sponges, a pillow, things to smell, a birthing stool, a clean blade; that the animals gave off heat from their bodies to keep mother and baby warm; and that after Jesus was born, Mary was held and comforted by the women around her and by Joseph, and she was able to rest and adore her baby. This is the beautiful story we have missed in the Gospels and the Nativities. The birth of Jesus.

 

My hope is also that we continue to commit ourselves to the safe and loving birth of every baby, especially babies and their mothers at risk, who need the shepherds of midwives and community health workers, trained birth attendants and doctors. Who need wise people to provide the clean supplies of birthing kits and birthing places in their homes or clinics or hospitals where mothers can rest, and heal and adore their babies.

Glory to the Newborns and their Madonnas.

Peace on Earth

Nepali Madonna

Mother and Child, photo by Karel Amaranth, Kathmandu, Nepal, December 2010

top of post:  Madonna and Child, painting by David Saintus, Haiti, December 2008

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On the Road in Uganda


on the road

I arrived at Entebbe Airport on Saturday night June 7, 2014 after about 26 hours of flights and stopovers. Was picked up by David and Joseph and immediately taken to a party at the home of Dr. Sarah Nkonge to celebrate the work we had been doing together, the Rotary of Makindye and me. Thus began my journey in Africa. The following is from a few days later when we traveled to the Lwengo District.

 

I didn’t sleep much last night and got through some of the toss and turn hours by reviewing my suitcase contents…why did I pack Catwalk Sleek hair spray?  Maybe for my visit to the King of Tororo…but more about that another time.  We left Kampala for a 3 hour drive out to Lwengo; of course it takes well over an hour just to get out of Kampala, the city of no public transportation or beltways so all roads lead to massive “jams.”  Our driver Joseph is amazing (the best, except maybe for Mahindra who drove me from Kathmandu to Hetauda for 8 hours over hairpin turns up very steep, narrow mountain roads with no guard rails.)  Sarah, David and a reporter from a local TV station and I all loaded in the four wheel drive Ford.  Sometimes beautiful landscape of rolling green mountains and then the villages of rusted tin sheeting and concrete blocks, the ubiquitous charcoal smell and piles of mostly plastic garbage, rotting foods and road kill.  A strange occasional battered phone booth, odd because almost everyone seems to have a flip phone and there are ads for “mobile money” everywhere. Always the sad lost discarded flip flops.  Traffic of cars, mini buses, bicycles, motorcycles piled with people, bananas, mountains of plastic containers; on one, a man and a women; on another, a man, a woman, a baby and a goat; on one several boxes of condoms that spilled out in a trail along the side of the road precipitating, among those in our car, several hilarious adaptations of and responses to, “why did the chicken cross the road?” which during all drives was prominent as many chickens actually crossed the road right in front of our wheels. Women walking with massive bundles of sticks, huge plastic jugs of water or gasoline, and bowls of cassavas on their heads, and babies scarfed onto their backs, the little baby feet peeking out on both sides of his or her mother’s breasts. Children playing in the gravel alongside the roadway and a few elderly people crawling.  All this takes place at dizzying speeds in a dangerous dance of near misses, and every moment that someone isn’t killed is a miracle, proving that Uganda is actually overflowing with miracles.

 

We arrived at a Girls School, a collection of large low buildings and toward the back of the “campus” was a large barn with a dirt floor and about 50 women and their children waiting for our presentation and distribution of the birthing kits.  The women are beautiful and the children adorable.  They were all obviously dressed in their best colorful clothes, some very worn but still bright and bespangled with sequins, decorated with embroidery.  The clinic director introduced me in Luganda, one of the several languages in Uganda that vary from district to district. She said I was bringing the kits from Australia, short cut for I am from the United States and I got the kits donated from the Birthing Kit Foundation in Australia.  I told them I was so pleased and honored to be there, that I had been all around the world but they were the most beautiful women and then I went through the contents of the kits.  The little piece of soap, a pair of latex gloves, black plastic sheet for the birth area, 4 cord ties, and the one clean wrapped razor blade  “Please don’t use this for anything but cutting the umbilical cord,” I pleaded, knowing that some research had indicated that the blades were sometimes used prior to the birth for any number of household tasks like cleaning fish.

womens group 2

I marveled that the babies and children actually looked quite well and healthy and were very playful and engaging.  When I commented to a few of the mothers later they told me that it is the healthiest babies that survive, the ones that are “right sized;” the others that are too small die at birth or shortly thereafter, the ones that are too big die with their mothers since they often can’t be delivered at a hospital that can perform C sections.  Other children that aren’t really strong die in the first year of malnutrition, malaria, dehydration or accidents…so it is the healthiest, most resilient that are with them.  Tragic Darwinism.

 

The women so were appreciative of the kits, but said they needed more than one pair of gloves, because they sometimes tear, and more pads for the bleeding after birth.  I said I would try.  Someone delivered bottles of soda. Fantas all around.

 

Then we went over to the Girls’ School to distribute sanitary pads and soap during the student lunch break, which I was told would be chips and soda.  There were about 50 girls in red uniforms.  This was outside on a hill and the breezy atmosphere was an opportunity to have a good time with them.  The girls all spoke English, so I could speak with them without a translator. I talked to them about staying in school, staying strong and being sisters.  Having babies when they were really ready and in a good relationship.  I found myself saying the same things I had said to kids in the Bronx:  Your body is your own. If someone hurts or touches you, tell an adult you trust.  I had an almost imperceptible heart pang thinking of my work at the Child Advocacy Center in the past.  They sang a song for me and we all danced and I taught them to kick like the Rockettes. Then we gave out the sanitary pads and soap which was like giving out party favors on someone’s birthday.

 girls kicking

The women had talked to me about how bad a local clinic was and that was why they would rather have their babies at home, so before we drove back to Kampala I asked to visit the clinic.  We drove to the clinic and on first sight I could see why.  It was literally a hole in the wall shack attached to other shacks.  The crumbling concrete steps alone spoke volumes about how difficult it would be to give birth there.  The clinic director showed me around and said she had been trying to get more support from the Ugandan government so she could improve the facility. She also has to charge 15,000 Ugandan Shillings for a delivery, the equivalent of about $6 US, and some women just can’t afford to pay. There was a small room of deteriorating concrete for the exams, the labor room with a damaged table and stirrups, and a room with 4 little beds side by side for recovery.  The women can stay for 6 hours after the birth to recover before they have to leave. I asked if (since there was a long drive back to Kampala) I could use the bathroom and was shown a rocky path to a shack beyond a stubbly field.  Let’s just say it was much more rocky than path.  The toilet inside the shack was a squat hole. Now I have used many squat toilets and they can be quite nice, tiled, clean and you get a good stretch workout in your quads while peeing. This one was covered with excrement and urine and dirt and full of insects.  Mosquitoes and flies and any number of unidentified winged things buzzed around my head. A caterpillar that could have morphed into an exotic butterfly or something that would rip my leg off humped past my foot as I stepped onto the two bricks on either side of the hole.  I did a quick flashback of all the meds I had taken: Hep A, Hep B, Polio booster, Yellow Fever, Typhoid capsules with live bacteria, Cipro in my bag and antibacterial wipes at the ready.  The women who gave birth there and the staff who delivered the babies did not quite have these advantages.

 

The four hour ride back to Kampala was quiet.  I perused a local newspaper:  Article “Uganda Fails to Achieve the Millennium Goals and Reduce Maternal Mortality.”  17 women and 106 babies die every day during childbirth.  That is a maternal mortality rate of 370 per 100,000. Most “economically developed” countries have a rate of between 5 and 10 per 100,000. The United States has a rate of 26 per 100,000 which has been increasing.

 

As the Ugandan landscape sped by my window, I needed a little “normal” and slipped in my earbuds, turned on my Ipod and slid the power bar.  It was on Shuffle, which i call Random.  Paul Simon’s most tender, sad, wrenching lyrics:  In a phone booth in some local bar and grill, rehearsing what I’ll say my coin returns.  How the heart approaches what it yearns.

 

 

 baby

MPH Cupid

Heart and Blade

My name is Karel and I am an Internet dating failure.   Yes, I have met a few nice men on OK Cupid for the requisite coffees, drinks or dinners and “nice meeting you, good-bye.”  There of course have been the fascinating respondents who live in “New York, New York” but only write back at 2:00 AM and have no idea where the George Washington Bridge is.  The men who live in suburban apartments who had very lavish life styles and were very financially successful, but “lost everything in the divorce.”  (I don’t know which planet these men are from since, having been divorced myself, I happen to know first hand that wives definitely do not “get everything” as these men claim was their judicial fate.)   There was the very attractive somewhat familiar looking man who was wearing an Eddie Bauer shirt with the logo prominently displayed in every photo; nicely scanned from the catalogue.

My profile remains on OK C and I check in from time to time approximately once a month because though not an enthusiast, I am sort of academically interested in the process, maybe even a little bit hopeful.  And recently to refresh my memory, I checked in few times before writing this blog.

Of course I have heard the various urban legends of a cousin of a friend of someone’s sister-in-law who found true love, got married and had five children and lived happily ever after with a man she met on eHarmony. Or the neighbor of a woman in yoga class who is engaged to a man she met on Match.  There was even an article in the New York Times “Weddings” about two people who met on OK Cupid.  Read it, Believe it!  If it is in the New York Times it must be true. http://www.nytimes.com/2013/06/09/fashion/weddings/malini-sur-arpan-jhaveri-weddings.html

Alas, I have not even come close to this experience, although I suppose it would help if I updated my profile from time to time (I went to St Petersburg, Russia two years ago.)  Maybe I need to add something really compelling like my broken ankle last winter with a photo of my scar.  Kind of makes me think of Ben Stiller’s Walter Mitty trying to get a wink on eHarmony, although I actually have been to the Himalayas and Iceland.

In spite of this failure to find true love on my computer, two years ago I met David and since then we have exchanged I am sure hundreds of emails, photos, ideas, feelings, thoughts, plans.  We have written sometimes several times in one day.  About year ago when I wanted to set up a meeting, he disappeared for over a month and I thought it was over.  I was pretty angry.  And there have been times when he has been angry and critical and seemingly very demanding.  But still we continue and in fact I just received an email from him this morning.  “Good morning,” he wrote.  “Thank you for your humble reply.  We have much work to do.”  David lives in Uganda and I live in New York.

David and I didn’t meet on a dating site.  We met on the Global Health Forum of LinkedIn when I posted my MPH thesis in 2011.  Over the two years we have been working together to establish Holistic Care for Mothers, a project of the Makindye Rotary and soon to be an independent not for profit registered with the Ugandan government.  I am more than academically interested; I am hopeful that we can make some positive change for women and girls.

This is not my only Internet relationship.   Early in my thesis process at New York Medical College, probably around 2008, I found the Birthing Kit Foundation and Dr. Joy O’Hazy.  Joy and I have written to each other over the years about the distribution and efficacy of birthing kits,, but also about her travel, her singing and dancing; her wisdom and experiences.  There are often long gaps in our correspondence, but I always feel a connection to her and every day I look at the beautiful appointment book she sent me last year with her photographs and poems.  It was Joy who was my contact to the Foundation that yielded the donation of birthing kits to Holistic Care for Mothers that David has distributed in rural Uganda. http://www.birthingkitfoundation.org.au/

I met Kirtiman Tumbahangphe in Nepal, the director of  MIRA, Mother and Infant Research Activities http://www.mira.org.np/mira/ and after many emails and exchange of phone numbers, Kirti and I did meet in Hetauda where I visited several women’s projects out in the beautiful lush mountains of southern Nepal.  We talked about maternal mortality in Nepal and the very successful MIRA project using women’s empowerment, peer health education and community leadership.  Kirti and I even had dinner together at the Hotel Avocado and Orchid Resort where I stayed.  We said goodbye in the parking lot and he rode off on his motorcycle.

Diana Nabiruma is a health writer for the Ugandan newspaper The Observer.  I was researching health in Uganda when I found one her articles about violence against women and girls.  Thinking she might be interested in Holistic Care for Mothers I sent an email to the address in her by-line; an arrow shot into the cyber dark for sure, but she wrote back.  She was interested and interesting and funny and smart.  And, she interviewed David and Dr. Sarah Nkonge.  And….she did indeed write an article about maternal mortality in Uganda, about the Holistic Care for Mothers. The%20Observer%20-%20No%20more%20%E2%80%98labour%20suites%E2%80%99%20in%20banana%20plantation.html

And then there is Mike Cook who is one of the most amazing Internet contacts I have ever had.  I was thinking about how razor blades in birthing kits might be replaced with natural, local sustainable materials.  I thought about repurposing broken glass bottles; could blades be made from glass? So I searched “GLASS BLADES.”  And there was Mike Cook.  His website states, “Hi I am Mike Cook and I was born to be a flintknapper.”  Mike lives in Portland, Michigan and has a company called Art of Ishi www.artofishi.com He in fact makes blades from glass and stone, but not the kind of glass I was thinking of.  He uses natural volcanic glass, obsidian, flint, chert.  Take a look at his website and you will be totally astonished.  You can watch his videos about how he makes these blades.  For those of you who are not faint of heart, watch him shave with a blade he strikes off of a hunk of  obsidian http://www.youtube.com/watch?v=QWSTE6WLB0Y  All I can say is “DON”T TRY THIS AT HOME.”  So I wrote to Mike.  Generous, thoughtful and expressing interest in birthing kits, Mike sent me a few of his blades.   I have them on my desk (although I have not used them on my legs,) and there is the possibility of natural blades to cut umbilical cords safely, cleanly, sustainably.  Thanks, Mike.

These are some of my Internet relationships.  I don’t think any of them will lead to a date for New Years Eve, dinner on Valentines Day, not even the cup of coffee or drink.  I have not found my one true love, but I have found passion.

As I, a la Joseph Campbell follow my (Internet) bliss, I think of a web perhaps not so different from our www in Walt Whitman’s “A Noiseless Patient Spider”:

A noiseless patient spider,

I mark’d where on a little promontory it stood isolated,

Mark’d how to explore the vacant vast surrounding,

It launch’d forth filament, filament, filament, out of itself,

Ever unreeling them, ever tirelessly speeding them.

And you O my soul where you stand,

Surrounded, detached, in measureless oceans of space,

Ceaselessly musing, venturing, throwing, seeking the spheres to connect them,

Till the bridge you will need be form’d, till the ductile anchor hold,

Till the gossamer thread you fling catch somewhere, O my soul.

50 Shades of Designer Bags

My children could tell you just how nerdy I am since they have experienced my crazy obsession with their school projects (“Oh, no, not foam core again, Mommy!”) and my over-preparedness for classes I have taken (at least half the text book read and HIGHLIGHTED before the semester started).  My  friends, fortunately for me, welcomed me back after I had spent months in the cocoon of writing my MPH thesis. My reading material tends to be the daily New York Times, The New Yorker and the American Journal of Public Health. (I actually have a once a week date night with The New Yorker; I have found it some mornings stuck to my face.)  I have been known (or hopefully unknown) to steal copies of Journal of the American Medical Association from my doctor’s office.  The most recent book I read is Classified Woman by Sibel Edmunds.  Although I do have to confess to having read……no actually I am going to take the 5th on the 50 Shades books.   When I fly I do totally indulge in something like Vogue or Glamour, but that is in response to my suppressed fear of flying and is for purely medicinal purposes.  So when 4 times a year The New York Times has a fashion supplement I feel completely justified in wallowing through those pages of luscious, colorful, crazy expensive designer clothes and accessories because after all, it’s The New York Times.  The Fall 2012 issue arrived last weekend.  I continue to wallow.

It seems that darling little designer clutch bags are very much in style for the Fall.  There’s a page of them in yummy colors and another section called Grab Bags:  Know when to hold ‘em and when to fold ‘em, with no apparent apologies to Kenny Rogers.   Somehow I did not fashion forecast well when I bought that big red Prada knock off in Hong Kong for $15.  These little bags are of course very pricey.  They are designed by Celine ($2,100,) Phillip Lim ($625,) Victoria Beckham ($650,) Marc Jacobs ($550,) and Coach (only $148,) among others.  My guess is they are just big enough for a credit card, a lipstick, a cell phone and a couple of condoms…maybe a box of Tic Tacs.   Just the basics for survival at some soignée soirée.

Of course I know what little bags can carry and the impact on health outcomes they can have because I spent about two years of my life studying the contents of little bags about 6” by 4”.  These darling little bags, not so pricey, not so pretty, carry things like a razor blade, string, a piece of soap, a sheet of black plastic: not really contents for a fun evening out, but pretty useful if you are going to have a baby at home in a rural region of Nepal or India or Uganda or Ghana or Rwanda or Afghanistan. At least 350,000 women a year die in childbirth internationally.   One of the leading causes of death is infection which can result from unsanitary delivery conditions.  So these little bags of useful items, called birthing kits, have been developed by several organizations including Zonta International, the World Health Organization and UNICEF. More than a million of these kits are distributed annually, especially in developing countries where maternal deaths are the highest in the world.

The kits have been designed by medical providers and organizations.   They are standardized and able to be mass produced, inexpensive and extremely compact.  Dr. Joy O’Hazy who works with Doctors Without Borders and Zonta told me that, “While quantifiable data is difficult to acquire what we have received is a large amount of anecdotal evidence from our partners about reduced infections and deaths in places like Kenya and Afghanistan.”  (Joy by the way is an amazing person and I have been fortunate to be able to stay in touch with her since completing my thesis.  “Hello, Joy!!!!”)

So here’s the thing I just can’t stop wondering about.  We know that birthing kits save lives, but to save lives they not only have to be available, they have to be used.  If rather than having a pretty little clutch bag, the only thing you could carry your evening supplies for a party in was a plain plastic baggie would want to do that or would you just leave your stuff home? Do you want someone to pick out that plastic bag for you or would you want to shop for something you like or you feel expresses who you are?  Do these seem like silly questions in relation to clean birthing supplies?  I don’t think so.

Social design is based on the understanding that for products to be effective they must include user end participation in the design, i.e., if you are going to design something ask the people who are going to use it to be involved with the design of that product.  How do I know this? I have a brilliant neighbor named Dan Formosa, Ph.D., who is one of the founders of Smart Design, and he told me about social design and he helped me with my thesis.  So I know this is true.  For birthing kits to be truly effective in saving the lives of women and babies, the design of the kits has to include the women who will use them.  They need to be social designer bags.  Not mass produced but in at least 50 shades.   The bags that women use in Uganda need to be Ugandan.  The bags that women use in Afghanistan need to be Afghan.  The bags that women use in Nepal need to be Nepali.  Not only is this social design, it is beautiful design.  All of these countries have wonderful traditional designs, colorful crafts, amazing creativity.

So here’s the challenge for designers.  Design beautiful, inexpensive, small birthing kits that can be distributed and used and can save lives.  You can include women from their countries, you can use some of the proceeds from your $600 pouches, you can engage the design community in saving women’s lives.  You can make preventing maternal mortality sexy and cool.  That’s what designers do.

Here are some direct challenges:

Hey, Prabal Gurung, do it for Nepalese women.

Mimi Plange, for women in Ghana.

Georgio Armani, Louis Vuitton, Channel, Estee Lauder, Gucci, Calvin Klein, Hermes, Prada, Marc Jacobs, Tod’s, Salvatore Ferragamo,  Celine, MaxMara, Michael Kors, Balenciaga, Missioni, Chloe………pick a country and get to know the women there.  And design with them.

And Kenneth Cole, how about some really cool compelling billboards.  You are so very clever.

Perhaps Tyler Brule, the editor of the hip international travel, design, political magazine Monocle would take on the coordination.

So I guess it is just my inherent nerdiness that got me from those darling little clutch bags to preventing maternal deaths.  Or maybe it was the women I met in Nepal and India and Brazil and my friend David in Uganda and Joy O’Hazy , who constantly inspire me and make me think, actually believe, that “it only seems impossible until it is done.”

PS…Hey, Prada, so sorry about buying the knock off.  I promise never to do it again.