This morning I had my 32-week appointment with the midwives who’ll be attending the birth of my first baby. They’re in a private practice, which my employer-subsidized medical insurance pays for. My appointment was at the private Genesis Clinic, nicknamed the “birthing hotel” due to its luxurious facilities, however for the birth I’m booked into Park Lane Hospital, which also boasts a private maternity ward that you couldn’t be faulted for mistaking with an upscale hotel.
On my way home from the appointment I stopped into Woolworths, South Africa’s high-end grocery store modeled on Marks & Spencer in the UK. The only necessity I had to buy was toilet paper, the rest was middle-class frivolity: cranberry juice, brie, Diet Coke, a single-serving bag of chips, a bar of Cadbury chocolate.
I was debating whether to buy the 18- (slightly cheaper per roll) or 9-roll pack of toilet paper (easier to carry to the car) when an African man tapped me on the shoulder. He wanted to know whether the box of baby cereal (labelled for babies six months and older) and a bottle of full-cream cow’s milk would be okay for his two-month-old child, because the infant formula was too expensive.
I tried to use, simple, sympathetic language to compare the prices, pointing out that when it came to price per gram, the (age-appropriate) infant formula really wasn’t much more expensive than the (inappropriate) baby cereal. I talked about babies’ sensitive tummies, and how the wrong food might make its tummy sore and cause it to cry even more. I asked if he had any way to get to Makro (South African Costco/Wal-Mart), where there would be more brands available in cheaper, bulk quantities (he didn’t).
Now, why wasn’t his wife breastfeeding? I didn’t ask, but I can guess. Maybe she has HIV/AIDS. Maybe she struggled to make breastfeeding work, and had no guidance on how to do it or support to keep at it. Maybe she had to go back to work, probably as a maid in a private home, shortly after the baby was born, so isn’t available to feed the baby, can’t afford pumping supplies and/or has no education on how to use them.
In the end I couldn’t persuade him – and really, maybe it wasn’t a question of persuasion. Maybe there was no way he could afford the R146 ($12) infant formula over the R30 ($2.50) baby cereal and he just wanted assurance that he wouldn’t kill the baby (a question he asked me repeatedly).
South Africans optimistically refer to the ‘born free’ generation, children born after 1994 who’ve never known the oppression of apartheid. Nelson Mandela was a huge advocate for children’s rights, and famously declared, “There can be no keener revelation of a society’s soul than the way in which it treats its children.” Yet 20+ years after the first round of ‘born free’ babies came screaming into the world, South Africa is one of the most unequal countries in the world, and this is especially evident in models of maternity care and childbirth.
A few months ago the Guardian published an article that confirmed what I’d gleaned anecdotally: inequality starts even before the moment of birth, in the very means by which South African babies emerge into the world. Babies born in the private healthcare system (which consumes 60% of total health spend yet serves only 15% of the population) are overwhelmingly more likely to be born by c-section, many of which are elective.
From the moment I found out I was pregnant, I’ve planned for a minimal-intervention birth. My fantastic obstetrician is a renowned champion of natural birth, and I’ve hired the midwives in order to have low-intervention advocates with me during the birthing process. Whether I’ll be able to deliver naturally remains to be seen, but I’ve been amazed by what’s felt like the need to defend my preference, both informally and in terms of literally building a medical team I can trust. The South African (private) obstetric community seems so ready to encourage women to ‘simply book in for a caesar,’ how do you find the line where your doctor’s medical expertise ends and profit-hunting begins?
It’s easy to feel self-righteous and skeptically alert to the ‘business of childbirth’ as I thumb through my imported copy of Our Bodies, Ourselves: Pregnancy Edition, or enjoy a workout in my immaculate, brand-new gym, or buy calcium supplements without looking at the price, or tip the Zimbabwean painters who’re doing up the baby’s room (in the house that I own, in an affluent neighborhood, on a quiet street).
The truth is, I’m so privileged. I can choose to have a low-intervention birth. I have access to whatever medical care might be necessary to facilitate that birth. And if it all goes pear-shaped, I can have an epidural and a c-section and a private room to recover in at a moment’s notice, without a thought for how much it’s going to cost.
I’ve spent the whole afternoon thinking about the two-month-old baby who’ll be fed cereal and cow’s milk tonight, and wishing I’d just given the man R100 to buy the infant formula. That baby will have so many more obstacles in its life, I wish I’d had the presence of mind to give it a little bit of a head start.
Instead I’m reminded to check my privilege, to be grateful, to see my house/work/traffic stresses as great luxuries. My baby will be born into the South Africa with world-class medical care, spacious homes and brand-name strollers. I won’t sacrifice to keep it fed, I won’t worry about access to clean water, I won’t have to choose between a tin of formula and taxi fare for a trip to the doctor. I’m on the right side of this hopelessly imbalanced scale, and for that I’m unbelievably, undeservedly lucky.