WUNRN
Childbirth Still a Gamble, Despite Care
Efforts
Franz Chávez
LA PAZ, Jun 12 (IPS) - While the birth of a child generally
represents joy and life, in Bolivia, new motherhood is all too often plagued
with fear, uncertainty and even death of mothers and newborns, report
organisations dedicated to maternal and child health.
These social
institutions and international organisations, grouped under the National Plan
for Safe Births and Maternal Health , paint a picture of a few encouraging
improvements on an otherwise bleak landscape.
Haiti and Bolivia have the
highest pregnancy and birth risk levels in Latin America, according to the State
of the World's Mothers 2006 report, published by the international Save the
Children organisation.
The 2003 National Demographic and Health Survey
conducted by Bolivia's National Institute of Statistics (INE) revealed a rate of
229 maternal deaths for every 100,000 live births. The next survey will be taken
in 2007.
This figure represents a reduction in the number of women who
died as a result of pregnancy, birth or post-partum complications, but it still
falls well short of cutting maternal mortality by three quarters by 2015, as
outlined in the Millennium Development Objectives (MDGs) adopted by the
international community in 2000.
In 1989, maternal mortality stood at
416 women per 100,000 live births; it dropped slightly by 1998 to 390.
The Health Ministry estimates that by 2015, the lives of 144 women out
of 100,000 will still be at risk due to maternity complications; the goal calls
for bringing the ratio down to 104 per 100,000.
Several government
initiatives and plans have been adopted since 1993, culminating in the 2002
implementation of the Universal Insurance for Mothers and Children (SUMI), which
owes part of its success to the financial management and direct support of 328
municipal governments throughout the country, the programme's department head,
Ivett Mendoza, explained to IPS.
While the central government, through
the nine Departmental Health Services, pays the salaries of doctors and support
staff, under the SUMI legislation municipalities are responsible for
maintenance, equipment and supply costs incurred for the free treatment of women
before, during and up to six months after birth.
The government also
develops training programmes for staff, provides professional development for
health-clinic managers, and transfers administrative know-how to mayors,
explained Mendoza.
However, despite the increase in SUMI's budget funded
by 10 percent of the Direct Hydrocarbons Tax that came into effect last
September, income levels vary wildly among the 328 municipalities.
While
the Amazon city of Cobija in the country's north has an annual per capita income
of more than 600 dollars, the 356 residents of the highlands municipality of
Nazacara in the department (province) of La Paz make an average of 14 dollars
per year.
"These differences mean we must find additional funding
sources to cover free healthcare services," said Mendoza.
The government
now provides free health coverage, in 27 areas of medicine, to females from the
time they are born until they turn 60, while males receive free healthcare only
up to age five.
"The goal is to establish universal coverage and extend
benefits for males up to the age of 21," explained Mendoza.
"Since Mar.
8, public health services have reached more women by expanding the free care
programme, which represents a shift in public policy towards mothers,"
Congresswoman Elizabeth Salguero, a member of the governing Movement Towards
Socialism party, told IPS.
Through the Chamber of Deputies' health
commission, of which she is a representative, Salguero has worked to strengthen
public health services, particularly pushing the increase in the health budget,
estimated at some 220 million dollars - equivalent to one-third of national
public spending.
The extension of SUMI benefits for women to the age of
60 is not an insignificant accomplishment, and signals the first changes in
state health policy, she added.
Salguero leads a group of female
legislators who promote women's rights, improvements to public healthcare,
family planning services and prevention of teen pregnancy.
During the
previous government, which ended its term in January, Congress approved, with
the agreement of all parties, a law addressing access to family planning
methods, birth control and confidential information for teens. But then
president Carlos Mesa (2003-2005) sent it back to Congress with a general
observation that it required more debate.
The analysis by the National
Plan for Safe Births and Maternal Health identifies the actual birth and
post-natal period as posing the highest risks, both for the woman and the
newborn, but paradoxically there are fewer post-natal care services. In Bolivia,
barely 13 percent of mothers receive post-natal health support, according to the
study.
Health Ministry estimates attribute the major causes of maternal
mortality in Bolivia to haemorrhaging (23 percent), birth-related infections (14
percent), complications from unsafe abortions (16 percent), and eclampsia (12
percent).
All of these are largely preventable from the medical
perspective, with the exception of unsafe abortions, which falls outside the
scope of health measures, as it is a direct consequence of the country's laws
against terminating pregnancies.
The infant mortality rate has also
improved, but government projections show that it is unlikely to reach the MDG
objective of a two-thirds reduction. From 1989 to 2003, the infant mortality
rate was almost halved, falling from 120 deaths to 54 per 1,000 live births.
Projections for 2015 are for 34 per 1,000 live births.
"These national
averages conceal major gaps of exclusion, where rural mothers living in poverty
-- many of them indigenous and poorly educated -- are at a much greater risk
during childbirth and the postnatal period. They are up to 30 percent more
likely to die than women in urban areas with more education," indicates the
report by the social organisations.
In Bolivia, rural communities are
harder hit by poverty and illiteracy. According to the INE, 67.3 percent of the
population lives in poverty overall, a figure that rises to 79.5 percent when
considering only rural areas. The national illiteracy rate, meanwhile, is 13.28
percent, but it jumps to 25.77 percent in rural areas.
In rural zones,
average per capita income is 600 dollars per person -- roughly one dollar and 60
cents per day, said Bolivian Vice President Álvaro García Linera. But in the
impoverished city of El Alto, basically a suburb of La Paz, some people survive
on just 50 cents per day, according to private social support organisations.
The current government's first diagnostic report on the issue announced
policies designed to reduce maternal mortality, and recognised the importance of
providing pre- and post-natal healthcare services to women as a "matter of human
rights and social justice."
Likewise, the government report defends its
budget allocations for reproductive health and policies for women, by calling
maternal health a "vital socioeconomic investment" and emphasising the necessity
of empowering Bolivian women in areas of decision-making and public policy.
______________________________________________________________________________
================================================================
To
leave the list, send your request by email to:
wunrn_listserve-request@lists.wunrn.com. Thank you.