Editor’s note: This is a CBE 2021 Writing Contest Top 15 Winner!
In speaking these words to Adam and Eve in Genesis 1, God commissions reproduction as a shared work of the first humans. While their biology necessitates different roles in the process, the command is still addressed to both man and woman. Yet before the story of humanity can fully begin, the consequences of sin taint their shared mission. God tells Eve, “I will make your pains in childbearing very severe; with painful labor you will give birth to children” (Gen. 3:16). What was commanded by God as a shared work between the genders has become a risky undertaking with repercussions that primarily affect Eve and her successors.
The manifestation of the fall of humanity has been evident in maternal health outcomes throughout time, and the COVID-19 pandemic has accentuated the mental and emotional impact of God’s words to Eve. But even the church does not treat the pursuit of maternal health as a worthy, holistic, ongoing endeavor. Gender, race, and socioeconomic status should be considered as aspects of maternal health, then viewed through the Christian values of justice and the sacredness of all life. Only then can we develop a thicker ethic of maternal health, centered on the imago Dei in women, to inform the church’s ongoing care for all women, and mothers in particular.
Maternal Health Issues Throughout the World
The threats to women’s maternal physical health are well-documented. The World Health Organization defines maternal health as, “the health of women during pregnancy, childbirth and the postnatal period.”1 While the English word “pain” in Genesis 3:16 suggests the physical pains of labor, the Hebrew more closely aligns with the WHO's broader definition. Eṣeb, used to describe Eve’s pain in childbearing, encompasses agony, grief, and anxiety.2 The Hebrew word hêrōnêk, translated “childbearing” in the NIV, can mean both pregnancy and conception.3 What Genesis 3:16 and the WHO both communicate is that maternal health is not bound to the physicality of childbirth alone. Rather, from conception through child-raising, women's physical and emotional health are vulnerable.
There is a staggering cost of life caused by insufficient care between conception and postpartum. Each day, about 810 women die in childbirth, and 94 percent of these deaths occur in lower- and middle-income countries, all in the Global South.4 An even more alarming undercurrent of these deaths is that the causes are largely preventable. According to the WHO, the attendance of a skilled healthcare worker at birth “can make the difference between life and death for the mother as well as for the baby.”5 Globally, the highest risk to maternal health exists at the intersection of geography and financial status, not to mention the role colonization and Eurocentrism have contributed to the underdevelopment (and therefore the increased risk to maternal health) in the Global South.
In the United States, there is a chasm in maternal health outcomes that mirrors what we see globally. Black women die at a rate of three to four times more than white women during childbirth, and Indigenous women die at twice the rate of white women.6 Again, the role of colonization and systemic racism cannot be overstated when confronted with such data. Similar to their sisters in the Global South, women of color in the United States often lack access to sufficient medical care. Yet race is not the only telling factor in maternal health outcomes in the US. Women of a lower socioeconomic status experience poorer maternal health outcomes, regardless of race.7
The Overlooked Maternal Health Issue: Mental Health
The physical aspects of maternal health affect hundreds of thousands of women each year. However, an oft-overlooked aspect of maternal health became evident during the COVID-19 pandemic (especially in the US): maternal mental health. In Genesis, God foretells the consequence of Eve’s sin: she will experience eṣeb, great emotional pain, in motherhood. The heartbreak of infertility and miscarriage, the sleepless nights of crying newborns, and the stress of bearing her family’s invisible labor8 are modern expressions of Eve’s eṣeb.
In the US, about 2.2 million women have left the workforce because of the COVID-19 pandemic, many to care for their children.9 The Census Bureau reports, “During the pandemic, women ages 25 to 44 are almost three times as likely as men of the same age group to not be working due to child care demands.”10 This doesn’t even account for the experiences of single or stay-at-home mothers, but the concerns for their holistic wellbeing are also urgent.
Regarding their emotions, women in the US report being both more anxious and more worried than men.11 One mother stated, “I’ve lost the image of myself as a strong, independent, self-sufficient woman and mother.”12 Women are not only sacrificing their career aspirations, but also their mental wellbeing to care for their children. And they are more likely to bear this burden alone. When women are prevented from exercising agency in their lives, their humanity is staunched.
The combined effects of injustice, mental health, and social expectations that women bear the brunt of childcare greatly decrease holistic maternal health. Worry about finances, future career progress, their health, and the health of their children is endlessly stressful, further contributing to their health issues and ability to thrive. Maternal health even affects whole communities: better maternal health decreases poverty, helps to ensure healthy lives, and contributes to gender equality.13
The Church’s Call to Action
Christians proclaim that all people are made in God’s image, as written in Genesis 1. Therefore, the church must recognize and defend the imago Dei in women. When care for maternal health does not extend from conception and beyond, the image of God in her is stifled, for she cannot live abundant life. Genesis 3:16 reminds us that the experience of motherhood, from conception (or the struggle to conceive) to raising children, will cause anguish. This is why the church’s support must address the full imago Dei of mothers: their emotional, physical, and spiritual wellbeing.
The protection of maternal health is an act of love that recognizes and seeks to cultivate the image of God in women’s ability to give birth. Yet the church must bear in mind that although women are specially created to be mothers, the church too often reduces them to only being mothers. Becoming a mother does not need to become a woman’s whole identity; women are full humans who can envision a life that includes motherhood and other vocational pursuits. In order to completely support women, the church must recognize the sacred nature of motherhood as just one facet of the imago Dei that women embody.
Maternal health exists at a complex intersection of justice, mental health, and physical health. Therefore, in order to develop a full ethic of maternal health, Christians must consider each of these concerns in a way that supports the holistic wellbeing of all mothers, both individually and systemically. With such a breadth of concerns at hand, the church would be wise to ground its ethic of maternal health in Scripture, beginning with the truth that women are made in the image of God (Gen. 1:27) and then being informed of the difficulties women face in motherhood (Gen. 3:16). Through this understanding of the imago Dei in women, the church can develop plans of action that nurture the full humanity of mothers.
This article is from “Motherhood,” the Spring 2022 issue of Mutuality magazine. Read the full issue here.
- “Maternal Health,” World Health Organization, accessed 31 December 2021, https://www.who.int/health-topics/maternal-health#tab=tab_1.
- Denise T. Plichta, “An Anguishing Process,” Redemptive History and Theology, accessed 13 January 2021, https://redemptivehistorytheology.com/blog/chapter-8-pain-and-desire-genesis-316-20/an-anguishing-process/.
- Plichta, "An Anguishing Process."
- “Maternal Mortality,” World Health Organization, 19 September 2019, https://www.who.int/en/news-room/fact-sheets/detail/maternal-mortality.
- “Maternal Mortality.”
- “Maternal Health in the United States,” Maternal Health Task Force at the Harvard Chan School, accessed 31 December 2021, https://www.mhtf.org/topics/maternal-health-in-the-united-states/.
- “Maternal Health in the United States.”
- Arlie Russell Hochschild and Anne Machung, The Second Shift (New York: Avon Books, 1990). Although “invisible labor” is now widely used, the use of the term in relation to female household labor is attributed to Hochschild’s work.
- Claire Ewing-Nelson, “Nearly 2.2 Million Women Have Left the Labor Force Since February,” National Women’s Law Center, November 2020, https://nwlc.org/wp-content/uploads/2020/11/October-Jobs-Day.pdf.
- Jason M. Fields and Misty L. Heggeness, “Working Moms Bear Brunt of Home Schooling While Working During COVID-19,” United States Census Bureau, 18 August 2020, https://www.census.gov/library/stories/2020/08/parents-juggle-work-and-child-care-during-pandemic.html.
- Fields and Heggeness, “Working Moms Bear Brunt of Home Schooling While Working During COVID-19.”
- Katherine Goldstein, “’I Thought It Was Going to Break Me’: Covid’s Brutal Toll on Working Mothers,” The Guardian, 24 February 2021, https://www.theguardian.com/world/2021/feb/24/covid-toll-working-mothers.
- Chandler Green, “7 Facts About Maternal Health You Should Know,” United Nations Foundation, 10 May 2018, https://unfoundation.org/blog/post/7-facts-about-maternal-health-you-should-know/.