Prof. Candace Johnson
Prof. Candace Johnson

It was the birth of her first child that inspired Prof. Candace Johnson, Department of Political Science, to study maternal health care in developed and developing countries. Her research encompassed four countries: Canada, the United States, Cuba and Honduras, and compared women’s preferences for health-care providers during pregnancy and childbirth.

She found that some women preferred to give birth with the assistance of a midwife at home, while others preferred the care of a doctor in a clinic or hospital. Sometimes these trends occurred within the same population in the same country, she says. “My research tries to figure out why these women have certain preferences and the political dynamics underneath those stated preferences.”

Researchers interviewed two groups of women in the Rio Grande Valley, Texas. One group consisted of English-speaking women who were born in the United States; the second group was made of Spanish-speaking women who were either born in the United States or Mexico. The first group was more affluent and tended to have greater access to private medical insurance, whereas the other group relied on publicly funded health care.

Johnson found that many women in the first group preferred the services of a midwife. Those born in Mexico with access to fewer medical options were less likely to question the health care they received in Texas. “They tended to not be critical of the care they received because they were grateful to have access to services at all,” she says.

Even those women who previously gave birth in Mexico, where they had access to health insurance, were not always treated by a doctor when they went to the hospital. “There are some very bad outcomes,” she says, referring to stories of women who gave birth with little medical assistance. “They had births that did not go well.”

Johnson found that Cuban women also lacked choice and didn’t question the health-care system. Before the revolutionary government came to power in 1959, says Johnson, urban women who could afford maternal health care could access doctors and hospitals, whereas women who lived in the countryside “were left to their own devices.”

Today, all Cuban women have access to maternal health services, but problems still exist, she says, because they need to bring their own supplies and often give birth in unhygienic conditions. Women paid in foreign currencies, such as those who work in the tourism industry, can afford better care. “A lot of women mentioned that if you don’t have the money to buy doctors little gifts when you go for your appointments or invite them to your house for a nice dinner, you’re not going to get good care,” says Johnson.

In Copán, Honduras, maternal and infant mortality rates were higher than the national average. Most women there preferred to give birth in a hospital or clinic, but only 50 per cent actually did, often because they lacked transportation. “Especially in developing country contexts, getting women to a clinic is one of the best ways of reducing maternal mortality.”