CRASSH

The focus of this conference will be on two main areas: 

Biological mechanisms determining birth outcomes

Birth in humans is particularly dangerous for mother and child because of the opposing constraints that bipedalism imposes on the pelvis, and the large size of the human brain.  These constraints lead to the ‘obstetric dilemma’ where pregnancies with large babies are at risk of obstructed labour due to cephalo-pelvic disproportion.  In contrast, pregnancies with poor fetal growth and small babies are at risk of pre-eclampsia, still-birth and neonatal death from infections. Both obstructed labour and pre-eclampsia occur more commonly in Africa and an understanding of how birth weight is regulated is critical to an evaluation of the risks associated with birth. We will discuss recent evidence indicating that birth weight is mediated by an interaction of the mother’s immune system with the fetally-derived placenta. There are particular variants of immune system genes in Africans that may have complementary functions which have been maintained by balancing selection.

In addition we will also explore how the anatomical relationship between the fetal head and the pelvis has changed during human evolution and migration out of Africa. How birth has evolved during the emergence of primates and how these immune system genes have varied will also be discussed as this may reveal new ways to prevent and treat obstetric problems.  The theme of this section could be summarised as follows: even if policies are in place that have worked successfully in developed nations the problems for birth in African mothers require that special biological factors are understood and taken into account.

The social and historical context for maternal mortality in Africa

A body of social anthropological and medical historical work on Africa has investigated the meanings of fertility, childbirth and motherhood, and places maternal mortality within this context. This work also traces the impact, at local levels, of interventions into childbirth practices from the colonial period onwards, and of the variety of policy prescriptions addressed to the problem of maternal mortality. The emphasis of much of this work is on the perceptions of the women who are at the receiving end of policy and on the institutional, social and political contexts in which they are pursued.

The history of the evolution of midwifery services in Africa can be viewed alongside comparative historical studies of the factors that brought about the eventual decline of maternal mortality in Europe and in other parts of the world.