Hiding Under the Bed Is Not the Answer

Are Racism, Poverty and Prejudice the Underlying Causes of Maternal Mortality in Mexico?

Mexico has a poor record in tackling the problem of high levels of maternal mortality. Research and associated statistics demonstrate the underlying problems of this issue are racism, poverty and a widespread prejudice against abortion. It seems clear that the government will be unable to successfully reduce the rates of maternal mortality unless these questions are addressed.


This post has been published as part of blogger Salt and Caramel’s blog hop about the importance of access to maternal health services and contraception. Join here: http://saltandcaramel.com/people-not-numbers/

(You can see her Twitter profile here)

Maternal Mortality Rates in Mexico

International research shows that the overwhelming majority of maternal deaths can have been avoided through prompt medical attention. For this reason, maternal mortality rates are considered to be a indicator of access to health services and their quality. Basic measures requires to reduce maternal mortality include: access to contraception to prevent unwanted pregnancy; easy access to emergency obstetric care in case of complications; as well as qualified and respectful care from health care providers.

When Mexico signed up forthe UN’s Millennium Development Goals in 2007, the government promised to work to towards achieving a maternal mortality rate (MMR) of 22.3 deaths for every 100, 000 births. However, it is far from reaching this target, the MMR was 57.2 in 2008, 62.2 in 2009 and 51.5 in 2010 [1]. Maternal morality is the fourth most likely cause of death amongst women in Mexico, only more die in traffic accidents (10%), suicide (8.5%) and murder (7%) [2].

According to IPAS, the MMR rate in Mexico is determined by the following factors:

  1. Ethnicity: indigenous women are at higher risk than any other group (see below).
  2. Level of Education: the less education a women has received the more at risk she from dying of a complication relating to pregnancy.
  3. Access to health services: around one in three women who die during pregnancy have no access to state health services. A further 39.2% only have access to basic state services (called Seguro Popular, or People’s Insurance).
  4. Age: women at both ends of their reproductive lives are more at risk of maternal mortality [3].

Maternal Mortality Amongst Indigenous Women in Mexico

According to the Observatorio de Mortalidad Maternal (Maternal Mortality Watchdog), 14% of Mexican women who died in 2010 as a result of their pregnancy were indigenous women. This global figure is small because that the indigenous population is not evenly distributed throughout the Mexican Republic. States with large indigenous populations like Chiapas, Guerrero and Oaxaca have the highest mortality rates in Mexico; they are home to around 20% of all maternal deaths in Mexico. In Guerrero and Oaxaca around half the maternal deaths occur amongst indigenous women [4].

Indigenous women are most likely to be unable to access full public health services during their pregnancy. In fact, around 20% of indigenous women who died from complications related to pregnancy had no access at all to public health services. It is estimated, furthermore, that indigenous women are the group most unlikely to receive contraceptive education or products. They are also more likely to begin sexual activity at a young age (national average is 18 years old, amongst indigenous women it is 16) and typically become pregnant within in a year of having sexual relations. Indigenous women also have on average more children than other Mexican women (3.23 as opposed to the national average of 2.1) [5]. Finally, they also have more difficulty acquiring reliable contraception. In Guerrero it has been estimated that there is a unmet contraceptive need of up to 25.8%, for example [6].

Teenage pregnancy in Mexico

In Mexico, 83% of all cases of hospitalisation amongst young women between 10 and 19 years old are related to pregnancy. In the case of girls between 10 and 14 years of age, one out of every three cases are a result of pregnancy. By the age of twenty, around half the female population has at least one child [7].

Teenage pregnancy is a particular feature of Mexico’s northern states (San Luis Potosi, Nuevo León, Tamaulipas and Chihuahua especially). IPAS calculates that between 20 and 30% of maternal deaths occur amongst teenagers in these states. One of the reasons for the large numbers of teenage pregnancies in Mexico is due the low use of contraception amongst this age group (40% as opposed to a national average of 70.9%). This is, in itself due to poor sexual education and an inadequate distribution of contraception [8].

Unsafe
Abortion As A Risk Factor

The NGO Maternidad sin riesgo (Risk Free Maternity) estimates that there are approximately 4, 200, 000 pregnancies in Mexico each year, of which only 60% are carried to term. The rest end in abortion, miscarriages or still birth [9]. The Guttmacher Institute reckons that 19% of Mexican women will end a pregnancy at least once during her reproductive life [10]. Abortion is severely restricted in most parts of Mexico, except in certain circumstances such as rape and even then can be difficult to obtain). Only the capital, Mexico City, permits elective abortion up to 12 weeks. As a result, the vast majority of abortions in Mexico are carried out in unsafe conditions by unqualified people.

Officially, complications due to abortion in Mexico make up between 6 and 7% of all maternal mortality deaths. However, the World Health Organisation calculates that maternal mortality related to abortion accounts for 13% of worldwide deaths and 24% in Latin America. Recent research published in Mexico suggests that deaths related to abortion are generally not reported as such, but rather classified as haemorrhages or infections [11]. This can be explained by the fact that abortion is not generally accepted in Mexico and women who are accused of procuring an abortion can face murder charges and life imprisonment. It would seem likely that health care providers often prefer to turn a blind eye to abortion related deaths in many cases.

Public Health Policies

The Mexican government has undertaken a number of policies in its attempt to reduce maternal mortality in Mexico. For example, it has instigated a programme which aims to provide free healthcare in pregnancy to all women, even those without public health insurance. It has attempted to increase the number of healthcare professionals available and even taken up schemes to train lay midwives.

However, the problem remains grave. The NGO IPAS, for example, considers that the issue is not the lack of public policy, but rather their inadequate realisation by state health authorities. It also complains that money destined for maternal health programmes is not always properly distributed and that investment from the government is falling [12]. Those groups which work with indigenous women insist that healthcare professionals should be trained to offer respectful and dignified care; most importantly, explications, diagnosis and treatment should be offered in indigenous languages. Cultural sensitivities should also be respected during examinations [13].

In conclusion, therefore, it would seem evident that Mexico’s high maternal mortality rate is a result of inadequate care offered to the most vulnerable sectors of society: the poor, who don’t have health insurance; the young, whose access to contraception and sexual education is limited and, above all indigenous women, who usually feature in the first two categories also, and who are unable to access health services in a language they can understand.

Fuentes

[1] Presentation given by IPAS Mexico on 9 May 2012 in a press conference organized by Coalición para la Salud de las Mujeres (Coalition for Women’s Health). Full test is available here: http://www.fundar.org.mx/mexico/pdf/mmrsipas.pdf

[2] “En 18 años, murieron más de 3 mil niñas por causas maternas”, article at CIMAC Noticias, 14 April 2011, http://www.cimacnoticias.com.mx/site/11041406-En-18-anos-muriero.46785.0.html

[3] http://www.fundar.org.mx/mexico/pdf/mmrsipas.pdf

[4] http://www.omm.org.mx/index.php/indicadores.html

[5] Powerpoint presentation given by Lina Rosa Berrío Palomo of the NGO, Kinal Antzetik, Mexico, DF. Available here: http://fundar.org.mx/clases/destacado/post-1

[6] Octavio Mojarro Dávila y Doroteo Mendoza Victoriano, “Tendencias y cambios en las políticas contraceptivas en México y el mundo. ¿Qué hemos logrado y adónde se pretende llegar?” in Salud pública de México, no. 49 (edición especial), pp. 238-240. Available here: http://redalyc.uaemex.mx/pdf/106/10649089.pdf

[7] http://www.fundar.org.mx/mexico/pdf/mmrsipas.pdf

[8] http://redalyc.uaemex.mx/pdf/106/10649089.pdf

[9] R. Lozano, B. Hernández, y A. Langer, “Factores sociales y económicos de la mortalidad materna en México,” en: A. Langer (ed.)Maternidad sin Riesgos en México, México,Comité Promotor de la Iniciativa por una Maternidad sin Riesgos en México/Instituto Mexicano de Estudios Sociales, 1994. pp. 43-52.

[10] “Population Council. Datos sobre el aborto inducido en México,” Mexico, Alan Guttmacher Institute/Colegio de México, 2006. Available here: http://www.guttmacher.org/pubs/2008/10/01/FIB_IA_Mexico_

[11] Sonia B. Fernández Cantón, Gonzalo Gutiérrez Trujillo, y Ricardo Viguri Uribe, “La mortalidad materna y el aborto en México,” in Boletín de Medicina del Hospital Infantil Mexicano, vol. 69, no. 1, 2012, pp. 77-80. Available here: http://www.medigraphic.com/pdfs/bmhim/hi-2012/hi121k.pdf

[12] http://www.fundar.org.mx/mexico/pdf/mmrsipas.pdf

[13] Powerpoint presentation given by Lina Rosa Berrío Palomo of the NGO, Kinal Antzetik, Mexico, DF. Available here: http://fundar.org.mx/clases/destacado/post-1

Filed under: Feminism, Violence Against Women, Women's Right to Choose, , ,

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  1. [...] HidingUnderTheBed talks of the situation for women in Mexico [...]

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