โIzindaba zezokwelapha ezijwayelekile ezithinta abesifazane boMdabu zibonisa omama abangancelisi futhi abangenabo ophathina. Ngokwalo mfanekiso, abesifazane bomdabu abazivocavoci, abadli kahle futhi banesifo sikashukela. Sibonakala singenathemba,โ kusho uMarinah Farrell, umbelethisi womdabu waseChicana ozinze ePhoenix.
โNgesikhathi ngisebenza esibhedlela, ngabona omama abaningi boMdabu ababeyopha futhi babe nemiphumela ebuhlungu lapho bezalwa. Kwakubonakala kuhlukumeza kakhulu; baphathwe sengathi sebevele begula ngesikhathi bengena eminyango yesibhedlela,โ kusho uRebekah Dunlap, oyilungu le-Fond du Lac Band yase-Ojibwe osebenza njenge-doula futhi ongumhlengikazi obhalisiwe, umhlengikazi wesayensi, kanye nomhlengikazi wezempilo yomphakathi. eMinnesota.
Okwaqala buthule njengoba imizamo yabesifazane abambalwa abazinikele eminyakeni yamuva iye yakhula ngobukhulu, ububanzi, kanye nokushesha. Namuhla, abesifazane boMdabu kulo lonke elase-United States nase-Canada basebenzisa amakhono abo ukuze baphonsele inselelo isimo esikhona semithi evamile.
Ukuzalwa sekuyimpilo eyingozi kubo. Njengoba benqanyuliwe ekudleni kwendabuko, inethiwekhi yokusekela, kanye nababelethisi bomphakathi ngenxa yekoloni kanye nokutholwa, abesifazane abaningi boMdabu banezimo zempilo ezingalapheki ezisho ukuthi ukubeletha kuwumsebenzi oyingozi kakhuluโfuthi odinga uhambo oluya ezibhedlela ezihlomele kahle.
Abesifazane abaningi bomdabu e-United States naseCanada babelethela ezikhungweni zezempilo zikahulumeni ezenganyelwe yi-Indian Health Service (IHS) e-United States, kanye negatsha le-First Nations ne-Inuit Health eCanada.
Izinqubomgomo zokunakekelwa kwempilo kwa-IHS kanye ne-First Nations kanye ne-Inuit Health ziqhathaniswa nalezo ezitholakala ezikhungweni zezempilo ezivamile kuwo womabili la mazwe.
Abesifazane bomdabu noma bomdabu, ikakhulukazi labo abase-United States, bahlukaniswa kakhulu njengabantu abasengozini enkulu. ECanada, ngokusho Statistics Canada, imiphumela yokuzalwa phakathi kwabantu bomdabu ayithandeki ngokuqhubekayo kunabantu okungebona abomdabu. Abesifazane boMdabu baseMelika nabase-Alaska banakho amanani aphezulu yokugula noma ukulimala komama uma kuqhathaniswa nomphakathi jikelele, ngokusho kweCenters for Disease Control and Prevention (CDC). Ingozi yokufa komama kwabesifazane boMdabu iphindwe kabili kunabesifazane abamhlophe e-United States.
The izinga lokufa kwezingane ezinganeni zaboMdabu baseMelika kanye nase-Alaska zingamaphesenti angu-.83, okwesibili kuphela kumazinga ezingane ezingezona ezase-Hispanic Black American ezingamaphesenti angu-1.13.
Umkhuba wokuphoqa abesifazane boMdabu ukuthi baye ezibhedlela ngenxa yokuthi izindlela zabo zendabuko zokunakekela abakhulelwe zingekho emthethweni unomthelela ekutheni kube nemiphumela emibi engapheli. Naphezu kwemizamo emihle kakhulu yemboni yezempilo yomphakathi yokubhekana nesimo esisengozini enkulu yabesifazane boMdabu, lo mjikelezo awukwazi ukusingathwa yizikhungo ezifanayo zaseNtshonalanga ezibambe iqhaza ekuqhubekiseni izinkinga kwasekuqaleni, ngokusho kwababelethisi bomdabu okuhlanganisa noKatsi Cook wase. isizwe samaMohawk.
Isibonelo, izinqubomgomo zikahulumeni ezifana nokuphoqwa ukuya ezikoleni ezihlala amaNdiya eCanada nasesikoleni okuhlalwa kuso samaNdiya e-United States zazihloswe ngokusobala ukuqeda nokululaza amasiko endabuko, izilimi, nezindlela zokwelapha nokuzala. Izingane eziningi kulezi zikole baphathwa ukuhlukunyezwa ngokocansi nangokomzimba futhi banqatshelwe ukufinyelela emindenini yabo, ngaleyo ndlela kudala izizukulwane zesifo sokucindezeleka sangemva kokuhlukumezeka okungalashwa noma ukuhlukumezeka komlando. Ngemva kokuhlukaniswa nemindeni kanye indlela yokuphila yendabuko nokudla, abanye abasikisela ukuthi inikeza izinzuzo zokudla okunomsoco, abantu bomdabu baqala ukuba nezinga eliphezulu lesifo sikashukela kanye nemiphumela engemihle yezempilo, njengamazinga aphezulu amaphaphu, isifuba, nokuphazamiseka kwamathumbu.
Ukuphoqa abesifazane boMdabu ukuthi bazalele ezibhedlela kungenye yezenzo zodlame ezinde zekoloni, kuchaza u-Kanahus Manuel, ilungu le-Neskonlith Indian Band ye-Secwepemc Nation e-British Columbia, e-Canada. "Ukuzalwa kuyisenzo sokugcina sokuqeda ubukoloni nokumelana," kusho yena.
Ukubuyisa Isiko
Imizamo yababelethisi bomdabu e-Canada nase-United States isebenzisa izinhlobo eziningi zezitayela nezinqubo. Nokho, ngokukaNicolle Gonzales, umhlengikazi ongumNavajo, โAbantu bomdabu banombono wezwe ngokuphathelene nomhlaba. Ukuzalwa kanye nokuba ngumama sikubheka njengomcimbi,โ kusho yena.
โAbabelethisi bendabuko bazinika isikhathi sokuhlala futhi baxoxe nomama ngezimpilo zabo, imindeni nezinselele zabo,โ kuphawula u-Dunlap .
โAbesifazane bethu banikezwa isikhathi nokusekelwa ukuze bathole izingane zabo; yayingekho i-ajenda ebeka izigaba ezahlukene zomsebenzi,โ kusho yena, eveza umehluko ocacile phakathi kokuhlangenwe nakho kokubeletha ezibhedlela uma kuqhathaniswa nemiphakathi yase-Ojibwe. Ngokusho kwe I-American Association Ukukhulelwa, kunezigaba ezintathu zokubeletha okuhlanganisa ukusikwa kwangaphambi kwesikhathi lapho umlomo wesibeletho usuya ekuvulekeni okuphelele okungamasentimitha ayi-10, ukusikwa okumatasa lapho umntwana ebeletha ngomlomo wesibeletho ovuleke ngokugcwele, kanye nesigaba sesithathu esihlanganisa ukulethwa kwe-placenta. Isigaba sokuqala sokubeletha ngokuvamile isikhathi eside kakhulu futhi singathatha imizuzu embalwa kuya emahoreni amaningi.
Phakathi kwabantu bomdabu, njengoba abesifazane ababelethayo bedlula ezigabeni zokusikwa, banikezwa ukudla okuthile ukuze banikeze amandla angokwenyama, angokomzwelo, nangokomoya.
Lapho umntwana ezalwa, izinyawo zakhe zazithinta umhlaba ngisho nangaphambi kokuba zinikezwe unina.
โZonke lezi zindlela zinezincazelo ezibalulekile ezingakalahleka ngokuphelele,โ kusho yena.
"Owesifazane yindawo yokuqala," kusho u-Cook, enanela imizwa kaDunlap. โNgemizimba yethu sondla, sisekela, futhi sakhe ubudlelwano obuxhumene nokuncikelana. Ngalendlela uMhlaba ungumama wethu, kwasho okhokho bethu. Ngale ndlela, thina njengabantu besifazane siwumhlaba.โ
U-Cook ube nomthelela futhi wagqugquzela izizukulwane zababelethisi ukuthi zamukele izindlela zabo zendabuko zaboMdabu. โNginomsila omude ekukhuthazeni ukubelethisa komdabu kusukela ngiqala ukukhulelwa ngo-1973,โ kusho uCook.
U-Cook usebenze njengommeli wezempilo kanye nokubelethisa kwabesifazane bomdabu iminyaka eminingi. Ngo-1983, wasiza ekudaleni โIqembu Lokuzalwaโ labadala bendawo nababelethisi endaweni yakhe yokubhuka e-Akwesasne eNew York naseCanada. Abasebenzi bahlinzeka ngezinsizakalo zokubelethisa kanye nemfundo yezempilo kumalungu ezizwe. Ngo-1985, ngemva eseduze St. Lawrence River kwaba ingcolile ngama-polychlorinated biphenyls (PCBs) avela kwaGeneral Motors, u-Cook usungule i-Motherโs Milk Project. A cwaningo ithole ukungcoliswa kwe-PCB yobisi lwebele lwabesifazane bakwa-Mohawk abadla izinhlanzi zoMfula i-St.
Namuhla, abalandeli abaningi bakaCook nabafundi bayaqhubeka nokuthatha inselele yokuvuselela ababelethisi bomdabu.
Umbelethisi womMdabu uKanahus Manuel uzibize njengeqhawe, umlweli wenkululeko, kanye nomvikeli wendabuko owaziwayo womdabu namanzi.
UManuel wayekhulelwe ingane yakhe yokuqala ngesikhathi ephikisana nohlelo lukahulumeni waseCanada lokwakha izikhungo zama-Olympics Wasebusika ka-2010 emazweni aseSecwepemc. Lapho ezwa ukuthi iziphathimandla zazikhiphe incwadi egunyaza ukuba aboshwe ngalezi zenzo, wabalekela entabeni yaseMarble ekujuleni kwesifunda saseSecwepemc lapho kufika isikhathi sakhe. โNgangazi ukuthi ngifuna ukuzalwa ngaphandle kokusizwa njengoba okhokho bami benza amakhulu eminyaka; Ngangingafuni ukuba nengane yami esitokisini,โ kusho yena.
Uzifundise ngezindlela zokuzalwa ezijwayelekile nezendabuko futhi usezale zonke izingane zakhe ezine ngendlela ye-Secwepemc, ekhaya ehanjelwa umndeni kanye/noma ababelethisi.
KuManuel, ukuvuselela ababelethisi bomdabu kuyisimemezelo sobukhosi phezu kwemizimba yabesifazane kanye nokuzimela okuvela ezinhlelweni zikahulumeni wamakoloni.
Abanye abameli bathola izindlela zokusebenza ngaphakathi kwezinhlelo zokuvuselela izindlela zokuzalwa zaboMdabu.
UGonzales usebenza ngaphakathi kwemithetho nemithetho yezokwelapha yase-U.S. ukuze enze lokho akuchaza njengesikhungo sokuqala sokuzalwa esigxile emasikweni aboMdabu emazweni ezizwe. Umsunguli kanye nomqondisi omkhulu we-New Mexico-based Ukushintsha Woman Initiative, uGonzales uthole iziqu zakhe zesayensi kwezobuhlengikazi kanye neziqu ze-master in nurse-midwifery evela eNyuvesi yaseNew Mexico futhi uyilungu le-American College of Nurs-Midwives futhi ugunyazwe ne-American Midwifery Certification Board. Nakuba kufanelekile ukuqeqeshelwa esibhedlela esivamile, u-Gonzales ubona ngeso lengqondo ukudala indawo yokuzalwa enobungani neyamukelekayo nalapho abesifazane boMdabu bengaba nomcimbi, badle ukudla kwesintu okuzungezwe umndeni, futhi babuyise izindlela zabo zendabuko zokuzala nokuphulukisa.
Ngokusho the CDC, ngo-2015, amaphesenti angu-98.5 abantwana abazalwa e-United States atholakala ezibhedlela. Ukubelethela ngaphandle kwasesibhedlela bekumele amaphesenti angu-1.5 wokubeletha ngo-2015. Kubantwana abazalelwa ngaphandle kwesibhedlela abangaphezu kuka-61,000, amaphesenti angu-63 avela ekhaya kanye namaphesenti angu-31 ezikhungweni zokubelethela ezimile mahhala. Kodwa-ke, izinkampani eziningi zomshuwalense azibandakanyi ukuzalwa kwasekhaya futhi kungenzeka kuphela ukunikeza ukufakwa okulinganiselwe ezikhungweni zokubeletha.
U-Gonzales wethemba ukuthi angakwazi ukusungula isitifiketi se-Medicaid sesikhungo sokubeletha abasakhayo futhi asungule enye imali eqhubekayo ukuze anikeze izinsizakalo zabesifazane okungenzeka bantule omunye umshwalense wezempilo.
Yena kanye nabasekeli bakhe kanye nasebenza nabo ku-Changing Woman Initiative balinganisa amalungelo abesifazane boMdabu bokuzalwa ngezindlela zabo njengamalungelo emvelo nangenakuphikwa aqinisekiswa Isimemezelo Sezizwe Ezihlangene Samalungelo Abantu Bomdabu.
Banethemba lokuqeda isikhungo sokuzalwa, ePojoaque Pueblo, enyakatho ye-Albuquerque, kulo nyaka.
Ukuhlinzeka Ngokunakekelwa Okubucayi Ngokwesiko Kwangempela
UGonzales nozakwabo baphikisa ngokuthi nakuba i-Indian Health Service inomsebenzi wokuhlinzeka ngosizo lwezempilo kubantu boMdabu baseMelika, ayikwazi ukuhlangabezana ngempumelelo nomsebenzi wayo. I-IHS iyisikhungo sombuso esingaphakathi koMnyango Wezempilo Nezinsizakalo Zabantu sikahulumeni esibhekene necala lokuhlangabezana nezivumelwano zezivumelwano phakathi kwezizwe eziqashelwa uhulumeni kanye nohulumeni wase-U.S., othembisa ukunikeza amalungu ezizwe ukunakekelwa kwezempilo. Lezi zithembiso zinesisekelo sazo I-athikili I, Isigaba 8 soMthethosisekelo wase-U.S imisebenzi ebusayo namandla kaKhongolose.
Nokho, ukugxekwa kohlobo lokunakekelwa kwezempilo olunikezwa yi-IHS, kungase kufakwe kwezinye izikhungo zezempilo ezivamile e-United States nazo ezingaphansi kwemikhawulo nemithetho efanayo mayelana nezinhlobo zezinsizakalo ezinganikezwa.
Isitatimende esihlinzekwe yi-Phoenix Indian Medical Center sibonisa ukuthi iqashe abahlengikazi abaqeqeshiwe abayishumi abahlinzeka ngezinsizakalo ezizwelayo ngokwamasiko nezisekelwe kubudlelwane. Ngokwesitatimende lesi sikhungo sezempilo sihlinzeka abantu abakhulelwe imishanguzo yokwelapha, i-hydrotherapy, kanye nokwesekwa kokuncelisa. U-Gonzales, nokho, uphikisa ngokuthi nakuba i-IHS igcizelela ukuthi inikeza izinqubo zokubeletha ezizwelayo ngokwesiko, ababelethisi abaningi ababona aboMdabu futhi izikhungo zisabuswa izimiso eziqinile zesitayela sasesibhedlela njengozakwabo abavamile. Ngakho-ke kungakhathaliseki ukuthi umuntu woMdabu okhulelwe angase ahlale kuphi, ukufinyelela kwakhe ekunakekelweni okubucayi ngokwesiko kuzonqunyelwa, uma kungekho. Omama ababelethayo banemingcele mayelana nokudla kanye nokusebenzisa imililo evulekile, futhi ukulungiswa kokudla okungokomkhosi kuvinjelwe.
Ababelethisi boMdabu baseCanada, nokho, sekuyisikhathi eside baqashelwa izinhlangano ezijwayelekile njengeKholeji Lababelethisi base-Ontario. Ikolishi elibhekele ukubhalisa ababelethisi esifundazweni, limemezele isitatimende sombono ka-2001 ukuthi ukunakekelwa kwababelethisi e-Ontario, okuhlanganisa nababelethisi bomdabu, kwachazwa ngokusekelwa okuqhubekayo kwababelethisi abasemphakathini abasebenza ngokubambisana nabesifazane abazala abantwana. Umbelethisi we-Aboriginal kubhekwa njengendlela ebalulekile hhayi nje ukuthuthukisa imiphumela yezempilo yesiguli nezinsana, kodwa futhi njengendlela yokusiza ukubuyisela ukungalingani kwezempilo phakathi kwaboMdabu.
Ngo-1994, izifundazwe eziningi zaseCanada zengeza ukukhululwa okukhethekile kuMthetho Wokubelethisa WaseCanada. Ivumela ababelethisi bomdabu abahlinzeka ngezinsizakalo zokubelethisa bendabuko emiphakathini yezizwe ukuthi baziqeqeshe ngaphandle kokubhalisa Umthetho Olawulwayo Wobuchwepheshe Bezempilo. Isenzo siyehluka ngokwezifundazwe kodwa sidinga ababelethisi ukuthi baqedele isethi yezifundo eziyimpoqo futhi bahambisane nemithetho yomthetho. Ababelethisi boMdabu bangakwazi ukuzijwayeza ngokusemthethweni ngaphandle kokugunyazwa ngaphansi kwezidingo ezivame ukuqina ezibekwa yileso senzo.
"Ukubelethisa bomdabu kanye nezinqubo zokuphulukisa ziyizinsika ekubhekaneni nempilo yokuzala kanye nezinkinga osekunesikhathi eside emiphakathini efana nokulutheka, izifo, amahloni kanye nokuhlukunyezwa," kusho u-Cook, owasiza ukudala ukukhululwa kwe-1994.
Idatha yokuqala nokuhlola kubonisa ukuthi imiphumela yokuzalwa ibe ngcono selokhu kwanezelwa ukukhululwa. Isibonelo, i-Inuulitsivik Health Centre's Midwifery Service endaweni yaseNunavut inikeze ukunakekelwa ngababelethisi bendabuko abangama-Inuit kumakhasimende kusukela ngo-1986. Ngokocwaningo oluxhaswe yi-Health Canada futhi lwanyatheliswa ku- Izinkinga Zokuzalwa Ekunakekelweni Kokubeletha, okutholwe ibonise amazinga aphansi okungenelela ekuzalweni naphezu kokuqokwa okuyingozi kakhulu komama abaningi abangama-Inuit. Amaphesenti angamashumi ayisishiyagalolunye nesikhombisa okuzalwa abhalwe njengokuzala okuzenzakalelayo; Ababelethisi abangama-Inuit baba ngamaphesenti angu-85.
Ukubelethisa e-United States, nokho, akwamukelekile njengaseCanada. Imithetho elawula ukusebenza kwawo ihlukahluka kakhulu kuye ngokwezifundazwe. Abahlengikazi abaqinisekisiwe kuphela (ama-CNM), hhayi abanye ababelethisi, abangazijwayeza ngokusemthethweni kuzo zonke izifundazwe ezingama-50. Banikezwa amalungelo asesibhedlela ezifundazweni ezingama-30. Ngemuva kokuthola iziqu ze-bachelor's in certified nurses, iningi labafundi be-CNM liphinde liqedele izifundo zeziqu ezinhlelweni ezigunyazwe yi-American College of Nurse-Midwives.
Abanye ababelethisi bangase baqeqeshe ngaphansi kokunye ukubizwa, okuhlanganisa ababelethisi abangena ngqo, ababelethisi abanezitifiketi, noma ababelethisi abaqeqeshiwe, abangasebenza ezikhungweni zokubelethela kanye/noma ukusiza ngokubelethela ekhaya. Ukuqeqeshwa kanye nokutholwa kwalezi zihloko kuyehluka ngokwezifundazwe. Kwezinye izifundazwe, ababelethisi abaningi basengozini yokuboshwa ngokwenza umuthi noma umhlengikazi ngaphandle kwelayisensi.
Kwabesifazane abaningi e-United States, indlela eya ekubelethweni iqala ngohambo oluya esibhedlela sendabuko. Omama bomdabu ngokuvamile kufanele bahambe amabanga amade besuka emiphakathini yasemaphandleni futhi ngokuvamile bangakwazi ukuletha imindeni noma abanye abantu abasekelayo. Nokho, okucashile ngokwengeziwe, ngokusho kwababelethisi bomdabu, umthelela wokuhlukumezeka okuqhubekayo okuvela ekuhlukunyezweni ngokocansi kanye nokuhlukumezeka okungakaxazululwa okudalwe yizinqubomgomo zikahulumeni wase-U.S. eziklanyelwe ukuhlukanisa aboMdabu emazweni abo, amasiko nezilimi zabo. Ngokusho kwe UMnyango Wezobulungiswa, AboMdabu baseMelika banamathuba angu-2.5 okuba nokuhlukunyezwa ngokocansi uma kuqhathaniswa nezinye izinhlanga. Oyedwa kwabathathu besifazane boMdabu ubika ukuthi udlwenguliwe empilweni yakhe.
Indawo yasesibhedlela enemithetho eqinile, eyinyumba evimbela ukudla; imithethonqubo mayelana nenani labavakashi; ama-ajenda anquma ukuthi kunini lapho kufanele kuncedwe ukuzalwa noma ukwenza izigaba zokuhlinzwa kubukeka njengenye emgqeni omude wezenzakalo ezibuhlungu.
NgokukaCook, aboMdabu ngeke babe nempilo futhi bephelele kuze kube yilapho abazalisi boMdabu, esiza ekulweni nokuhlukumezeka okuthinta abantu abaningi abayizisulu, bebuyiselwa emiphakathini yabo.
Ngaleyo ndlela, u-Dunlap kanye nedlanzana labanye besifazane boMdabu endaweni yakhe benza umzamo wendawo wokuchitha isikhathi nababelethisi bendabuko kanye nabelaphi futhi bakhuthaze abantu abakhulelwe ukuthi bafunde okwengeziwe ngezindlela zabo zokubeletha zase-Ojibwe.
"Izindaba zethu ze-Ojibwe zichaza ukuthi obaba babegcina kanjani umlilo uvutha ngenkathi owesifazane ebeletha ukuze umoya wengane uthole indlela." Ukuba nendima enqunyelwe ubaba kumnikeza umuzwa wokuxhumana nenjongo ngokuzalwa.
โKu-Ojibwe, ukuzalwa kuwumkhosi; umntwana usohambweni lukamoya ngaphambi kokuba afike,โ kusho uDunlap.
"Sinolwazi lwamadlozi abesifazane base-Ojibwe abangabelana ngalo," wengeza.
Ukubuyiswa kabusha kwemithi yabesifazane bomdabu kuwumsebenzi wangempela wangempela, uCook waphawula.
โEmiphakathini yendabuko, impilo iqala ekhaya, etafuleni lasekhishini, kusetshenziswa ulimi lwansuku zonke lwabantu,โ kusho yena.
UKULUNGISA: Lesi siqeshana sibuyekeziwe ukuze kucace u-Kanahus Manuel uyilungu le-Neskonlith Indian Band. Inguqulo yangaphambilini yesiqephu iphinde yabala u-Rebekah Dunlap njengegama lakhe elingelona iqiniso eliku-inthanethi elithi R.A. I-Mackelberry.
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