Monday, June 17, 2013

Childbirth and Infant Mortality Abroad: Monaco

by Marley Phillips, ANM intern                Monaco is the 2nd smallest country in the world. Bordered by France on 3 sides, this le petite country has a population of about 36,000 people. The population of Madison, AL is about 43,000, just so you have a comparison. Monaco has an unemployment rate of 0% and the highest number of millionaires and billionaires per capita in the world. (I’m beginning to see the appeal…)

So, why am I rambling on about this fairytale oasis full of billionaires and beaches, you ask? I ramble because, in addition to all of these amazing attributes, Monaco also has the lowest infant mortality rate in the world. With only 1.8 out of every 1,000 infants under the age of 1 dying every year, we had to know what in the world (pun intended) is going on across the pond. So, I went researching to find out what Monaco is doing so completely right.
I should articulate before I give you these facts and statistics that, since Monaco is such a microscopic country, I’m not sure if it’s fair that we compare it to the United States. Instead of comparison, let’s call this an insight into another country’s maternal health practices. A trip away from the reality we may know as victims of the USA’s poor maternal healthcare or as advocates for a change in the broken system.

For starters, Monaco has the lowest poverty rate in the world. Poverty rates can seriously affect infant mortality rates for many reasons such as lack of prenatal care, tobacco use, and preexisting conditions like obesity or depression. To follow up on some of these health-related issues, I went searching for Monaco’s smoking and obesity rates. While I could not find data for tobacco use on any national or international organization’s website, I did manage to snag the obesity rates in women ages 15 and older for nearly every country in the world.  Monaco came in with 30%. Not great, but not as bad as the U.S. (48%).

So…What is it like to give birth in Monaco?  There is a government-funded healthcare system available to all citizens and long-term residents, although most residents have a small private insurance claim to cover what the government insurance won’t. There are only 2 hospitals in Monaco, and both offer similar services in the maternity ward. I chose to research The Princess Grace Hospital in Monaco, for no other reason than I adore Grace Kelly. (Side note: if you like celebrity news check out this article reporting Brangelina’s experience with a Monaco birth. Or should I say Monaco’s experience with a Brangelina birth!)

Antenatal services at The Princess Grace Hospital include a midwife who is with you throughout the pregnancy, a tour of the facilities, consultation with an anesthesiologist (if that is the mother’s wishes), pregnancy classes, and information packets explaining options for your childbirth, labor, and follow-up care. During labor, there are both midwifes and obstetricians on staff, although the OBs are only there for high-risk pregnancies or emergency situations. They have all the tools and equipment so that a mother’s birth may be as invasive or hands-off as she chooses. After the baby is born, the mother can stay with the baby for as long as she desires, even throughout the night (it’s kind of sad that I have to say EVEN throughout the night, like it’s an amenity).
The key phrase that I have found in my research of giving birth in Monaco is “if the mother so chooses”. These mothers aren’t pressured or scared into having a certain kind of birth. They are educated and make informed decisions with the medical professionals about what is best for them and for their baby. I know that’s not necessarily a causation for the low infant mortality rates, but it sure can’t hurt to work harmoniously together. *steps off soapbox* Next time, I’m going to feature a country that can actually be compared to the powerhouse that is the United States of America and how we can possibly follow suit to improve our maternal healthcare.   


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