B!RTH Festival Manchester – October 2016

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Anahita Sharma, 4th-year medical student and Editor of the Global Health Society, reviews attending the B!RTH Festival held at the Royal Exchange Theatre in Manchester on October 22nd, 2016.


In some countries in this world, women of nineteen are waking up in the morning, hoisting children upon sinewed backs, and getting them ready for school. In others, women of the same age are grappling with a different set of responsibilities, contemplating when and how a family will fit into their harried lives, themselves the school-goers. At each end of this spectrum, regardless of when and if women cross the threshold into motherhood – a threshold dictated by a multiplicity of factors that include educational attainment, a range of socioeconomic factors, and sexual norms – these decisions are bound together by the decisive impact they have on the societies unfolding before us.

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I arrived at the B!RTH festival on a Saturday evening. This was taking place within the confines of the Royal Exchange Theatre, a beautiful and ornate building on Deansgate. I found myself, this evening, considering for the first time the effects the public health agenda, health policy, healthcare systems, and finally, the attitudes and practices of healthcare professionals,  also had on sociocultural norms surrounding maternity and childbirth.

 

BIRTH Panel Wednesday

The B!RTH Debate Panel – Control

The festival was the brainchild of a conversation between the Royal Exchange Theatre and the Oglesby Charitable Trust, in the wake of the renewed Sustainable Development Goals (SDGs). Emma Callander, Creative Director, posited that ‘[B!RTH] is using theatre is as a tool to raise awareness around global health inequality’. Committed to this ethos, the scripts of all seven plays, written by playwrights heralding from China, India, Syria, Kenya, the United Kingdom, the United States of America, and Brazil,  are freely available for the next 3 years (see thebirthdebate.com) upon request. The festival spanned 4 days (19th — 22nd October), took a multi-pronged approach to maternal and infant health, and included 3 panel discussions, which sought to answer:

  • Is the enforced control of population a necessary tactic or a tool of oppression?
  • What responsibility do we have as a global community for the health and wellbeing of women?
  • What effect has global capitalism had on birth practice in the developed world?

After watching two plays, Ouroboros and Choices, I was moved by how theatre brings to light the struggles and anxieties of daily life that remain concealed from clinics, operating rooms, and fertility clinics. As a young woman, and aspiring medical professional, the content related to me on both these levels.


BIRTH figuresI found myself following the Stage Manager, who was walking around the hall and ringing a bell to herd the audience into the theatre. At the back of the stage was a large and clear panel, upon which was projected a rotating globe; on the floor, a ticking population counter. Together, these struck home the immediacy and relevance of the issues at hand. Bordering the theatre, within the forum, were numerous charities, educational stalls and installations, well-placed to engage the audience with wider initiatives. Notably, underneath a staircase was a makeshift refugee tent, within which one could listen to an ongoing audio projection of  a multifaceted collection of poetry and prose that contained experiences of raising children in a climate of  such insecurity.

The University of Manchester was represented by the Obstetrics & Gynaecology Society (OGSOC), our team from the Manchester Global Health Society, and the Global Development Institute.

Ouroboros

Ouroboros, written by Swati Simha, dealt with sensitive issues surrounding sterilisation programmes in India. The play consisted of four speakers, each in dramatic conversation with one another, and focused on the story of a doctor arriving in a remote village. The doctor meets a suspicious and cynical midwife (dai), whose role is described of as ‘the spinal reflex of the healthcare system’. The dai, by this stage, is jaded by the endless conveyor belt of doctors sent to the village. The doctor’s motives, and underlying sense of guilt, are cross-examined. The lines sent chills down my spine;

My hands that have pulled death from wombs… I want to know what brought her here, and if I can trust her. Is she here for us, or here to save herself?

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As it turns out, the village is woefully under-equipped; vaccines are not stored in a refrigerator – not for a lack of a refrigerator, but of electricity. Without surgical instruments, theatres, sterilised equipments, and beds, the challenges faced by the doctor are entrenched and systemic. The incongruity of a trained medical professional turning up in isolated environs, and the irony of these basic fundamentals having been not been accounted for, are palpable from the outset. In a dark twist, the play reveals a discrepancy between what the doctor follows as ethical practice, and the dai and community’s own beliefs.

Your protocol is to save the mother… [but] you’ll be saving a sick mother who wouldn’t want to live… 

She can’t imagine she makes mistakes about things outside of her practice.

Under these circumstances, death is interwoven into birth. As a result, there exists a tension over who is or what forces are accountable for perinatal infant and maternal mortalities. The doctor tries, yet fails, to address these important questions, ultimately turning upon the dai and leaving the village, as foreshadowed. The play culminates by drawing the audience’s attention to how policy and people are intertwined; the doctor, however, was unable to recognise her role within this wider context.

And you never once saw that your hands were tentacles of the state, operating on our bodies, having more control than we ever will… and all along you thought you were doing us a favour.

Choices

Choices, written by Irish playwright Stacey Gregg, was a powerful and engaging monologue about the stories of two Irish women as they navigate the endless cacophony of choice that pervades the public system and private fertility market, and over what a woman can and cannot do concerning both her morality and fertility. Armed only with a microphone, the monologue was honest and cutting, prising open the psychological journeys of these women. On one hand, she dealt with issues spanning abortion and casual sex.  Underlying this is the hard statistic that 4,500 women from Ireland travel to England per year, to obtain a legal abortion – described as an:

unspoken conversation across living rooms

On the other, she tackles the shame experienced by women who are sub-fertile, and the psychological circus experienced by those engaging with the private fertility sector – specifically, the conversations taking place around egg freezing, intrauterine insemination, in-vitro fertilisation, often within online communities based around these reproductive technologies. She satires the insensitive and unaccountable approach taken by social media and the press (including the coverage of ‘Octo-mom’),  and magazine covers (‘Tragic Jen [Aniston], cheated out of motherhood, again‘), and the implications these messages have for our expectations around motherhood.

It’s all digital, media, everything on tap, bingeing, one big hashtag pathway… we’re poised for more choice… a one-stop shop for embryos.’

Ultimately, these themes are universal. B!rth helped me examine my own beliefs, and a number of issues that I suspect are not necessarily covered in the medical curriculum. Yet, it is difficult to think about perinatal physical and mental health problems without considering the social context within which they take place, a social context of which we are a fundamental part.


Further resources of interest

  • A World Without Down’s Syndrome
    This hour-long BBC documentary investigates the impact healthcare professionals and their attitudes around screening and congenital anomalies can have on the psychological distress experienced by parents.
  • Verbal autopsies
    A UNFPA article entitled ‘Grim but essential autopsies are saving lives in Bangladesh’.
  • Ending Preventible Stillbirths
    This video produced by the London School of Hygiene & Tropical Medicine addresses a silent issue.
  • Pregnancy Twinning
    Find out more about the charitable organisation ‘Pregnancy Twinning’, and about how you can get involved to improve the maternal care and outcomes of a mother and her child in Malawi.

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