Be Inspired

 

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Throughout the semester I have focused on writing about maternal mortality within the United States. I have gained a better sense of understanding of the factors that contribute to maternal deaths within the U.S. For my last post on maternal mortality, I’ve decided to analyze the film “Sister” (picture) by Brenda Davis. The film raises awareness of the global issue of maternal mortality, as it provides stories of “health experts” within Ethiopic, Haiti, and Cambodia that fight to reduce maternal deaths. After watching the film “Sister” I believe it’s a very inspiring film that reveals the harsh reality within maternal mortality.

 

The film motivates us to help make a change as it shows how uneducated midwives are leaders within their communities helping prevent maternal deaths. The film presents, “Madam Bwa, a 65 year old TBA (Traditional Birth Attendant), living in Haiti, (who) started delivering babies when she was 12 years old.” Although Bwa contains no formal medical training through her years of experience and great devoted to helping prevent maternal deaths, she has become a great leader within her community. She provides her patients with birth control shots and vaccines. Bwa promotes change within the community by educating women about hygiene and nutrition, while also providing maternal and prenatal health care. She believes God called her to serve the people of that community by blessing her to help “prevent (women) from dying during delivery.” Just like Bwa, Hirity Belay from Ethiopia also serves her community by providing care for pregnant women. Not only does she provide care for mothers, but she also educates her patients on how to care for themselves through nutrition lessons and hygiene information. She is fully devoted to making a change within her community as she “travels from home to home, sometimes up to eight hours on foot to reach her patients.”  The film inspires us to make a difference within our communities, through the stories if Madam Bwa and Hirity Belay as it shows us that these women are able to make “difference between a life and death during delivery,” through their great determination and devotion. “Sister” ultimately inspires us to become a leader within our own communities.

 

 

 

 

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Madam Bwa 

 

 

The film inspires us to become more open minded towards the meaning of pregnancy, as it shows the profound experiences women encounter during pregnancy in rural areas. The film begins by showing the experience of a woman in Ethiopia suffering from tremendous pain, yelling “I’m dying, I’m dying,” in order to highlight the idea that pregnancy for many women in rural areas includes tremendous pain. This woman suffers from laboring for more than twenty-four hours at home and, now lies there with dead fetus inside of her. Her pregnancy experience included having a long dreadful labor to a successful emergency Caesarean operation. Another profound experience shown within the film is about a woman from Ethiopia who never delivered the placenta during labor. “The nearby center had tried to manage it, but they couldn’t,” (Goitom Berhane) and as a result of not receiving the proper attention needed her uterus became gangrenous. This woman’s pregnancy experience resulted in her uterus being damaged,  her abdominal being distended, and her abdominal wound being infected. These women’s profound experiences during pregnancy shown with the film allow us to realize that the term pregnancy is often misunderstood. Many like myself automatically think “baby” when hearing the word pregnancy, but this film has inspired me to have a greater understanding of the term. After watching the film, I now understand that during pregnancy the mothers counts as much as the baby because both are at risk of encountering complications.

 

 

The filmmaker Brenda Davis created an effective movie through honest filming, as she reveals the brutal reality within maternal mortality. Davis “gives a breathtaking and often heartbreaking (look) into the complications of pregnancy and childbirth,” by showing the pain, loss, and challenges women encounter during pregnancy. For example, she includes the stories of women in her film that face numerous challenges, such as  the lack of appropriate care during delivery, the lack of nutrition, and the lack of transportation. Through showing real life experiences women face throughout pregnancy Davis is able to capture society’s attention as she reveals that some mothers struggle for survival. As she reveals that these women suffer from tremendous poverty conditions, she creates an emotional effect on society. Beautifully shot, Sister captures both agonizing and ecstatic moments in birth and delivery,” as Davis presents life threatening moments these women encounter as well as successful operations and deliveries that occur due to devoted health experts who fight to end maternal mortality. For example, in the film she shows the story of a woman who suffers from labor for more the twenty-four hours never losing hope that her baby is dead, and has a successful emergency caesarian operation. This woman’s story emphasizes the idea that these women fight till the end for their lives. Her honest filming allows us to understand the harsh reality behind statistics that represent maternal deaths. Her filming highlights the idea that maternal mortality is a serious global issue.

 

 

I believe that everyone should take the time to watch the film “Sister” because it’s very inspiring. The film allows one to explore the true reality within the global issue of maternal mortality. It allows us to truly appreciate what we have as it shows us that women struggle for survival while carrying a child, because they lack the basic necessities of life. The film motivates us to make a change as it teaches us that through true determination and devotion one can help make a difference. After watching the film, I felt inspired to pay closer attention to the global issues occurring and it motivated me to have a greater determination to become a  nurse. Becoming a nurse will allow me to contribute towards making a difference in one’s health. “Sister” is an important film that helps raise awareness of the harsh reality within the maternal deaths. I believe others should watch this film to have a greater understanding of the challenges women encounter during pregnancy.

 

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Improving Maternal Mortality

 

After exploring my question “whether the lack of attention or lack of access to health care is the cause of maternal mortality,” I came to the conclusion that both contribute towards the increasing maternal mortality rates within the United States. I believe that with the new reforms being brought forth by Republicans that include making budget cuts to health programs, the lack of access to health care will only increase and potentially put more mothers at risk from suffering from maternal mortality. Therefore, it is important that hospitals prepare for the worst. Although both factors contribute towards the increasing rates of maternal mortality, I believe the best way to approach the issue is by creating guidelines that will help nurses address common maternal complications, this will help nurses improve their care within maternity.

 

 

 

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I believe that as nurses are well guided and prepare for maternal complications, they will help prevent further maternal deaths from occurring. For example, California Maternal Quality Care Corballotion created a “toolkit” built like a guideline in order to teach health professionals how to improve their care and how to manage life threatening complications that arise within childbirth. Each toolkit designed was made with various forms of information such as care guidelines and  hospital level implementation guides. CMQCC’s main goal in creating the toolkits is to improve health care responses in order to help prevent deaths among pregnant and postpartum women.

 

 

CCMQC has created the most efficient method for helping decrease maternal deaths. They have created individual guidelines for the most common maternal death complications. For example, they created a toolkit for maternal hemorrhage as they believe that in order to prevent deaths for this complication, “one key… was to make sure hospitals were armed with all the best protocols and necessary tools that might save those mom’s lives in the event of a bleed.” St Joseph Hospital in California contains “the hemorrhage cart, ”which is filled with the necessary tools needed to treat a hemorrhage. The cart contains medicines that slow the flow of blood and instruments that repair a tear or laceration as well as intrauterine balloons that can control bleeding from a uterus. The hemorrhage provides all the necessary tools to help save a mother’s life.

 

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In addition to encouraging having hemorrhage carts within hospitals, the CMQCC emphasized that it’s important for nurse to measure blood loss during pregnancy. In order to ensure that the nurses know how to do measure blood loss carefully CMQCC suggested that nurse does “quantitative blood loss” practices, which can be done by weighing dry sponges or pads on blood before surgery and after in order to calculate how much blood the mother lost. As nurses improve their techniques and expand their knowledge on how to treat maternal complications they’ll be able to prevent more maternal deaths from occurring.

 

I believe that this solution will be the best towards decreasing maternal deaths because CMQCC has proven that by creating guidelines (toolkits) nurses can help prevent maternal deaths in California. Stanford Medicine states that CMQCC’s toolkits have made a great difference in decreasing maternal deaths within California and “have led on-the-ground efforts to prepare California hospitals for obstetric emergencies.” Through the use of the toolkits California has succeeded in spreading awareness on the issue of maternal mortality and has taught many nurses how to prepare for maternal complications. Not only will the lack of attention be addressed through the usage of guidelines as nurses expand their knowledge on how to improve their care, but this will also help prepare for the worst as many more mother will lack affordable health care through the Republicans new reforms.

 

Women Suffer From A Lack of Access to Healthcare

 

Maternal mortality is a recurring tragic within the United States that has resulted in labeling the country as worst in having maternal deaths. As the rates within maternal mortality have greatly increased over the years, society began to wonder whether mothers suffered from a lack of attention or whether the lack of access to health care was responsible for the increasing mortality rates. Health professionals make their best argument in responses to the assumptions about the cause of maternal mortality rates, when they say that mothers lack access to health care services due to the lack of fundings.

 

 

The lack of funding within health care programs has failed to make prenatal care affordable for low income mothers. Budget cuts have prevented low-income women from receiving prenatal care, an important factor that informs mothers on what nutrition and behavioral risks can impact her and the baby. With the lack of prenatal care mothers are in danger of suffering from maternal complications, as they areseven times more likely (to) give birth to premature babies.” The lack of access to prenatal care puts the mother at risk of not having a healthy pregnancy. Prenatal care allows the mother to be monitored throughout her pregnancy by doing routine testing “to help find and prevent possible problems.” As budget cuts target programs that provide affordable health service to women more mothers are prone to suffer from threatening complications during pregnancy.

 

 

 

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Health Pregnancies Include Prenatal Care

 

 

Health Professionals believe that the lack of funding within healthcare programs has doubled maternal deaths. The drastic reduction of funding within women’s health clinics has caused “the numbers and (rates) of pregnancy-related deaths in Texas women (to) nearly (double).”  The doubling of maternal deaths within Texas shows that due to the lack of access to healthcare programs women are more likely to suffer from maternal mortality. As the legislature slashed 66 percent of funding with clinics in the state, it resulted in a total of eight-two clinics closing putting many low-income in danger. According to researchers the doubling of maternal mortality seemed unlikely “in the absence of war, natural disaster, or severe economic upheaval… in a state with almost 400,000 annual births,” as data showed a drastic number of deaths occurring. The lack of funding within healthcare programs has proven to greatly affect many low-income women who are unable to afford healthcare services.

 

 

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The lack of funding in health care programs has put low income women  in danger of suffering from maternal mortality. “Cutting programs and closing clinics (will) likely ( prevent) women from receiving potentially life-saving medical care” as many low-income women rely heavily on public health programs. Health Professionals argue that improving women’s access to prenatal care and health programs could help reduce maternal death rates within the United States as, the lack of access to healthcare is reduced.

 

Proponents State That Mothers Lack Attention

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The United States has the highest maternal mortality rates within developed countries. Does the lack of attention or the lack of access to healthcare cause maternal deaths within the United States? Maternal patients make their best argument for the cause of maternal mortality rates within the United States when they say, mothers lack attention during childbirth.

 

Proponents believe that there is a greater focus on infant safety during childbirth than on the mother’s health. According to ProPublica and NPR’s reporting, there has been a great emphasize of fetal care as an assumption has been made over the years that maternal mortality has been conquered. Barbara Levy, a member of Council on Patient Safety in Women’s Health Care, stated that during childbirth, they worry a lot about the little babies because they’re vulnerable. “Meanwhile, we don’t pay enough attention to those things that can be catastrophic for women,”(Barbara Levy) which shows that the mothers during childbirth are at risk as not enough attention is provided to them because doctors and nurse believe the baby is more vulnerable.

 

 

Postpartum Nurse

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Mothers lack attention during childbirth because nurses are too focused on the infant. For example, a mother is supposed to be taught how to care for her infant and for herself after childbirth, but often times the nurses only focus on educating mothers about their new infants. A postpartum nurse’s responsibility is to care for the infant and the mother after childbirth. They are also supposed to provide the mother with information on how to care for herself and her new infant, but oftentimes fail to do so. Sometimes nurses only spend 10 minutes or less educating mothers about the risks they may encounter and the rest of the time educating them on how to care for their newborn. Although all mothers receive written materials to take home after childbirth that informs them on how to take care of themselves, those materials are often inconsistent and do not provide enough information. As nurses and doctors tend to focus more on informing the mother about her newborn, they fail to inform mothers about the threatening complications they may encounter.

 

 

 

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Mothers Face Life Threatening Complications

Nurses and doctors often times forget that during childbirth, the mother can also face complications. “A study published Tuesday in MCN…surveyed 372 postpartum nurses nationwide and found that many of them were ill-informed about the dangers mother’s face after giving birth,” (Nina Martin) which shows that mothers lack attention during childbirth because many of their nurses are not well informed about the complications their patients may occur after childbirth. As many nurses lack the knowledge of life threatening complications that may occur after pregnancy, many mothers have suffered from maternal mortality as nurses fail to detect the symptoms of the life threatening complications within their patients.

 

Life Threatening Symptoms During Childbirth

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                           Lauren Bloomstein

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For example, the story of Lauren Bloomstein demonstrates how mothers lack attention during childbirth. Lauren Bloomstein, a neonatal nurse and her husband, a doctor were expecting a girl on September 30th 2011. On that day the couple drove down to Monmouth Medical Center, the place where she had spent her career as a nurse. Lauren figured that, “If anyone would watch out for her and her baby…it would be the doctors and nurses she worked with on a daily basis.” Her deliver went great, but 90 minutes later she told her husband she wasn’t feeling well. After twenty hours of delivering her baby, she was dead. Her husband stated, “Lauren’s ob/gyn and nurses had failed to recognize a textbook case of one of the most common complications of pregnancy — not once, but repeatedly over two days,” showing how the lack of attention Lauren received caused her death. She did not die due to lack of access to healthcare, she died because her nurses and doctor failed to recognize the symptoms to her pregnancy complication. Just like Lauren’s story there are many that demonstrate the lack of attention that occurs during childbirth for mothers.

 

 

The various stories of mothers who suffered from maternal mortality demonstrate that a lack of attention for mothers is occurring during childbirth. Nurses and doctors have a greater focus on infant care, putting the mother at risk as not enough attention is evenly distributed between the two patients. The lack of attention is allowing threatening complications to advance within mothers as their symptoms are not identified on time, resulting in maternal deaths.

 

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What’s Causing Maternal Deaths?

 

 

For the next four post, I want to explore the question of whether the lack of attention or lack of access to health care is the cause of maternal mortality. Exploring this question will allow me to determine which factor is affecting the increasing maternal mortality rates within the United States.

 

 

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Maternal Mortality Rates Arise in 1990

 

 

 

As maternal mortality rates in the United States have been dramatically increasing since the 1990’s. “More U.S. women are dying from pregnancy or childbirth complications today than in recent history, causing alarm stateside as maternal mortality drops worldwide,” ( Alexandra Sifferlin). As rates continue to increase, the U.S. has been identified as the worst in having maternal mortality rates. The continuous increasement of rates, has encouraged two important questions to arise. The first question being on whether a lack of attention may be occurring within hospitals that’s putting mothers at risk or whether the lack of health care is causing maternal deaths.

 

 

Many maternity patients believe that there is a lack of attention occurring within mothers during childbirth is the causing of maternal mortality. They believe that a lack of attention and care occurs because various cases have shown that nurses and doctors have failed to identify life threatening symptoms within their own patients. These life threatening complications that nurses and doctors have failed to recognize, many times have resulted in deaths. However, health professionals believe that the main cause to maternal mortality rates within the United States is women’s lack of access to health care. They believe that the lack of access to healthcare has affected many women, as women are unable to afford basic healthcare services.

 

 

The topic of maternal mortality within the United States has been greatly discussed within the national radio station NPR. The radio station broadcasted a live discussion discussing possible factors that contribute to the causes of maternal mortality. One of the reports during the broadcast stated that the lack of recognition may be occurring within hospitals about maternal mortality. The discussion of maternal mortality continues to develop as health professionals are worried that due to the lack of funding within health care programs more women are in danger of suffering from maternal mortality as they lack access to healthcare.

 

 

As both sides of the question are being discussed, it maye be possible that each factor contributes towards the argument are being debated, it may be possible that each factor contributes towards the increasing rates within the United States. Identifying whether mothers lack attention during childbirth can possibly help decrease maternal death rates. However, if the lack of access to healthcare is causing maternal deaths, it is important that something is done in order to provide an opportunity for every woman to be able to receive basic medical services. As the rates of maternal mortality continue to increase more and more mothers’ lives are at stake.

 

 

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Reporting on the Thoughts of the Nation Towards Nicholas Kristof’s Article

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The author, Nicholas Kristof wrote,“If Americans Love Mothers, Why Do They Let Them Die?” Throughout the article Kristof  persuades his readers that Americans lie about loving their mothers.  The New York Times article contained a total of 436 comments provided by the public, in which they expressed their opinions on the article. The commenters believe that, in regards to maternal mortality, American’s must become more empathic towards women to begin decreasing rates of this tragic healthcare issue.

 


 

Many tactics were discussed by the commenters on how to address maternal mortality; none more widely discussed than sexual education. Such services, they believed, should be provided for all young adults in order to help prevent unwanted pregnancies. According to the commenter laMissy, one of the problems within our society is that “women receive the message that sex is wrong” and that they should guard their virginity. Many women have been brainwashed with this idea causing them to avoid taking any precautions against unwanted pregnancies. Women who are taught that sex is wrong only receive the abstinence sex education.“Abstinence. It just ain’t working,” according to David B. He states that although many women are taught this idea of abstinence there are still a great number of teenagers becoming pregnant. He feels that tax money should be spent on educating teens about sex. The commenter Bellinghamster also agrees that sex education should be provided for all teens. “Boys and girls are going to have sex,” so why not educate them ahead of time in order help them avoid risks. Educating teens on sex will help them make educated decisions on whether or not to have sex and how to do so safely. It is important that no matter what beliefs one may have, sex educations is important for every individual to receive in order to help prevent unwanted pregnancies.

 

 

Many commenters agreed that many Americans do not feel responsible for helping women within their own country. The commenter, Mrs Pea states that many Americans within our society do not think that they should be obligated to help women. Americans believe that they are not obligated to help save the lives of women nor should they provide prenatal care for them. In fact they do not feel that they have a “responsibility to help women and girls get access to contraceptives.” Mrs Pea mentions that many times Medicare births do not receive empathy because our society does not care about poor women dying.  Many other commenters like Mrs. Pea believe that oftentimes society views that healthcare is a privilege to be earned not one to be given away freely. Society does not sympathize with poor women who become pregnant because they believe that it’s their fault for not being responsible. When it comes to viewing who deserves to have healthcare there is always a division between the less and more fortunate. Americans often times only think about themselves and what benefits them, if it doesn’t affect them they have no interest in it.  The commenter LarryGr states, “Until societal ethos change regarding personal responsibility, ethics and morality the government can do nothing to alleviate problems surrounding unwanted pregnancies.” He feels that the government is not responsible for unwanted pregnancies because women should be responsible for their own decisions.

 

 

A major problem within our society according to commenters is that our own politicians influence our ideas of motherhood. The commenter Henry states, “That blinds most of us…to the fact that women, for all their ability to bear children, need to be able to receive medical care during pregnancy… because they’re are very real risks involved in child bearing,” portraying the idea that politicians romanticize motherhood. Many commenters like Hen3ry agree that our society has this idea that motherhood completes a women, but fail to realize that with motherhood come true responsibilities and risks. According to Deborah Weinstein, our own political leaders do not respect women. She states that our own president talks about women as objects “ physically handled as opposed to treating women as human,” which devalues women within our society. As a society we need to learn to value women and most importantly value motherhood, in order to avoid maternal deaths.

 

 

Not only have politicians romanticized motherhood, but the idea of Pro-Life expressed within Republicans is not correctly identified according to commenters. Sally, a commenter presents the idea that anti-abortion republicans are not identified correctly because they are actually pro-fetus. “They clearly do not care about any life outside the womb,” (Sally).  Republicans who claim to be pro-life do not support birth control, nor do they want to pay prenatal care. “They don’t want to pay for the ongoing health care of women who are caring for the children they seem to want us to have so badly (i.e. the pro-life movement),” (Karen) proposes a conflicting idea that may only make maternal deaths increase. If Republicans claim to be Pro-Life they should support health care and food assistance programs like WIC that provide food assistance for families that have babies and that are low income. Everyone deserves to have access to healthcare.

 

 

I believe that healthcare is a right, everyone should have access to it. Everyone should be provided with healthcare- whether young or old, pregnant or not, poor or rich, everyone deserves to receive medical care. I believe that providing sex education for young individuals of all beliefs is an important factor that will ultimately help many young women avoid risks and succeed. Access to birth control will contribute towards preventing unwanted pregnancies. I also believe that although Kristof mentioned good factors that may help reduce pregnancies, we need to look at the issue of maternal mortality with a bigger perspective. We will not solve the issue of maternal deaths with just focusing on how to prevent pregnancies. Maternal deaths occur within all mothers, even in the ones that want to give birth. As a society we should recognize that our own people are dying because we are selfish and ignorant. It is important for us as a society to take action and contribute towards reducing maternal deaths within in our country through the simple act of educating others and providing health care.

 

 

 

Rhetorical Analysis On Why Americans Are Mommy Loving Liars

 

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The author, Nicholas Kristof, wrote “ If Americans Love Moms, Why Do We Let Them Die?” effectively.  Kristof persuades his readers that Americans are lying about loving their mothers through creating a friendly reader article.

 

 

The author’s credentials and background allowed him to write the article effectively on maternal mortality as he demonstrates to be a man of great knowledge. Kristof has been a part of the New York Times as a longtime foreign correspondent, and is currently a columnist. He has won two Pulitzer Prizes for having great achievements within the newspaper and two humanitarian awards, the Dayton Literary Peace Prize and the Anne Frank Award. The humanitarian awards were presented to him for promoting peace through his writing and for being  an exceptional leader in preventing injustices. Kristof has also written several books with his wife. One of the most inspiring books Kristof and his wife have written about women is ,“Half the Sky.” The book discusses human rights violation through addressing the oppression women/ girls face within the developing world. Through his great education, accomplishments, and knowledge he has demonstrated to be an effective writer addressing the injustice of maternal mortality within the United States.

 

 

Kristof’s Books

 

 

Kristof organized his article well through the use of repetition emphasizing the issue of maternal mortality within the United States. Throughout his article he is constantly using the words “pregnancy” and “women” to sum up the idea of motherhood being in danger. For example, in the beginning of his article he states, “An American woman is about five times as likely to die in pregnancy or childbirth as a British woman — partly because Britain makes a determined effort to save mothers’ lives, and we don’t.” He uses the words pregnancy and women to show that his main idea throughout the article with revolve around those factors. His usage of repetition highlights major ideas that help him demonstrate his sub-points. For example, he demonstrates how outrages maternal deaths are specifically in Texas in order to prove that Americans are lying about loving mothers as they are allowing many of their own to die. Kristof also states that society lacks responsibility in helping women and suggests that America can help it’s women/girls through helping prevent unwanted pregnancies. He concludes his article with the phrase, “The Republican health care plans would instead… making motherhood more dangerous across America,” in order to sum up the main  idea he is trying to show through his repetition of the words “pregnancy” and “women.” His usage of repetition emphasizes the idea that women in America during motherhood are in danger of dying because of our health plans.

 

 

 

The author used credible sources within his article to prove that American’s health care is affecting the lives of mothers. For instance, he uses Glamour as one of his sources and refers back to one of his previous articles “Politicians, Teens, & Birth” within the statement, “Almost half of pregnancies in America are unintended. And almost one-third of American girls will become pregnant as teenagers. (Meanwhile, President Trump slashed $213 million in funding for teenage pregnancy prevention programs.)” Through the usage of  the source Glamour, Kristof is able to demonstrate how health care changes in the United States will make women/girls become more in danger during motherhood.  As Trump cuts funding in teen pregnancy prevention programs rates of maternal mortality will only increase. Kristof also refers back to one of his own articles to discuss the idea of teen pregnancies being prevented through providing birth control. Kristof usage of credible sources helps show his readers that reforming our health care plan is an important step towards helping prevent maternal mortality rates from increasing.

 

 
The author was able to create a reader friendly article through providing clear transitions within the article. He first begins my stating his main point and makes it clear to identify as he then follows with an example, “Here in Texas, women die from pregnancy at a rate almost unrivaled in the industrialized world,” in order to persuade his readers that Americans are lying about loving mothers. Kristof makes clear transitions within his article through clearly stating his sub-points, providing evidence for each claim he makes, and generally analyzing what he wanted to emphasize within each specific claim. For instance, he makes the claim, “Women die unnecessarily in Texas for many reasons, but it doesn’t help that some women’s health clinics have closed and that access to Medicaid is difficult,” which reflects back to the idea of health care plans being a reason for maternal mortality and shows how some women have difficulty accessing medical health. After stating his claim he explains how he shadowed the president-elect of the American Congress Of  Obstetricians and Gynecologists, Dr. Lisa Hollier and explained an impacted she had as a young resident, that made her realize something had to be done to make motherhood safer. As Kristof analysis Dr. Lisa Hollier story of her experience, he was able to build up to highlighting the idea that there’s one simple thing we can do in order to help make a change in the United States – and that is “to help women or girls avoid pregnancies they don’t want. “You can’t die from a pregnancy when you’re not pregnant.” (Dr. Hollier)

 

Kristof wrote an effective article on the topic of maternal mortality. Kristof qualifications contributed to helping him create a reader friendly article as he contains experience in creating well written articles with credible sources for the New York Times. His structure within the article makes it easy to comprehend as he clears states his main point and provides well written sub-points that reflect back to his overall point. Through his usage of repetition, he is able to emphasize some of the main factors that contribute to the issue of maternal mortality within the United States, in order to prove that Americans lie about loving mothers.