"Call the Midwife": Public Health in the 1950s and Today

Are other people in love with "Call the Midwife" like I am?  I started watching last year during a break between Downton Abbey seasons.  The show follows the lives and work of nurse/midwives working in the Poplar community of east London in the 1950s.  The community has a high poverty rate and limited resources.  The series is based on the memoirs of Jennifer Worth, who like the main character Jenny Lee, became a midwife at the age of 22.

Season 2 of Call the Midwife (airing in the U.S. March 31-May 19, 2013) has been packed with public health issues.  I have been struck by how many of the highlighted issues still challenge us today:

• Season 2, Episode 1: Jenny Lee begins to care for a young mother named Molly, pregnant with her second baby.  In the course of their visits, Jenny realizes that Molly is a victim of domestic violence.  In one especially poignant scene, Jenny soothes and encourages Molly via a conversation held through the family's mail slot. Molly has been ordered by her husband not to let Jenny in the house.

Domestic violence (or intimate partner violence- abuse by a current/former partner or spouse) is still a problem today.  The Centers for Disease Control & Prevention (CDC) estimates that it affects millions of Americans.  This violence has long-term economic and health consequences for individuals, families, and communities.  The CDC offers many resources focused on public health's role in the prevention of intimate partner violence.

• Season 2, Episode 5: Jenny Lee provides prenatal care to Nora, a mother of 8, living in poverty.  The family of 10 crowds into a 2 room flat.  When Nora finds out that she is pregnant again, she is desperate to end the pregnancy.  With the family's financial situation, she feels that it is impossible for her family to take care of another child.  Jenny confronts Nora after seeing evidence of self harm.  Jenny reminds her that there is only one way to terminate a pregnancy (abortion), but it is illegal.  Nora risks her life seeking the services of a local woman who performs abortions.

Abortion remains a hotly debated public health issue in the U.S. both at the state and federal level.  This episode of "Call the Midwife" is a grim reminder of what can happen when women do not have access to safe, legal abortions.

• Season 2, Episode 6:  After diagnosing several late-stage Tuberculosis (TB) infections in Poplar, the community physician (Dr. Turner) advocates for a screening program in the form of an x-ray van.  Dr. Turner and Sister Bernadette (a nun/midwife) make a wonderful public health argument for the resources they need.  They cite the risk factors, specifically poverty in their community, noting that families may have up to 12 people in one apartment.  The close living quarters increase the chance of spreading this infectious disease.  In fact, we meet one family in the episode that lost 6 children to TB.  As a public health professional, it was fascinating to see the promotional materials that the clinicians created to recruit people for the screening.  They papered local bars with flyers and set a large sign outside the van reading, "Stop. 2 minutes may save your life. Get a chest x-ray".

Infectious diseases and their screening, treatment, and vaccination remain key public health issues in the U.S. and around the world.  Many infectious diseases like measles or chickenpox can be prevented by vaccines.  Over the past 15 years, there has been much discussion between the public and public health communities about the safety of vaccines for children.  In January 2013, the Institute of Medicine released a report reaffirming that the current childhood vaccine schedule is safe.  In fact, they report that "vaccines are one of the safest public health options available".

Tell Me What You Think:

• What have been your favorite episodes of "Call the Midwife"?
• What other public health issues are portrayed in the 1950s that still challenge us today?

More about → "Call the Midwife": Public Health in the 1950s and Today

Baby on Board Badges May Reduce Awkwardness...But Can They Also Increase Safety?

Yesterday many media outlets were thrilled to report that Kate Middleton, Duchess of Cambridge received a "Baby on Board" badge during a visit to the London Underground (the city's subway system).  The badge initiative, first piloted almost a decade ago, was developed after internal research by Transport for London (TfL) showed that pregnant women often felt awkward or uncomfortable asking if they could sit down.  The research also revealed that most travelers believed that mothers-to-be should be offered a seat.  The developers hoped that the badges would give women confidence to ask for a seat and encourage fellow passengers to offer theirs without being asked.

In all the coverage of this initiative, I have (unfortunately) not seen any discussion of evaluation.  The badges are used broadly in London (and other countries like Ireland use them as well).  However, we do not know if they have successfully increased women's confidence to ask for seats or increased a non-provoked seat offer by their fellow travelers.  In addition to these goals, I wonder about how these badges could also be connected to the safety of pregnant women riding public transportation.

This week I had the pleasure of meeting a friend's 11-week old son.  She rode the subway to work all through her pregnancy and we discussed the potential risks that the ride entailed.  While she was comfortable with the ride, her co-workers were often worried about her choice of transportation.  What if she couldn't get a seat?  What if she fell?  What if someone fell into her on the crowded train?  My friend described the experience of having a student's backpack pressed up against her belly late in her pregnancy...which then prompted her to take an alternate mode of transportation to work the next day.

So what if the "Baby on Board" badges could do more than just reduce awkwardness for pregnant women and their fellow passengers?  What if this badge initiative could also reduce the number of pregnant women standing on crowded trains, putting them at risk for falls and other injuries?

First, we would need strong baseline data to determine if a public transportation prenatal injury problem even exists.  Then we would need to evaluate that data during and after the initiation of a badge program in the U.S.  We would also need to evaluate the effectiveness of the badges as a visual cue (e.g., Do passengers recognize the badges?  Do they understand what action they should take upon seeing the badges? i.e.,- giving up their seats).

What do you think?

• Are you aware of research/studies on public transportation prenatal injury?  If so- please share!
• For those readers/friends/colleagues that have ridden public transportation while pregnant:  Did you feel at risk for injury?  Did you ever suffer an injury?
• What do you think about the potential for "Baby on Board" badges to prevent injury?  Are there other strategies that may be more effective?

 

More about → Baby on Board Badges May Reduce Awkwardness...But Can They Also Increase Safety?