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For the indigenous Ngöbe people,
childbearing can be perilous. |
Photo: Carina
Wint/UNFPA | | Infant
and maternal mortality for indigenous groups tends to be far higher
than in the general population of their countries. Deeply rooted
cultural traditions and belief systems – as well as physical and
social isolation – may complicate the delivery of quality obstetric
and neonatal care. In many countries throughout Latin America (see
below), UNFPA is working to improve reproductive health and make
motherhood safer.
CHIRIQUÍ PROVINCE, Panama — Giving birth to
her twelfth child in her family’s straw hut in the remote mountains
of Western Panama, hours away from medical services, turned deadly
for Cristobalina Santos. Her husband, Severino Caballero, recalls
how contractions started at about seven o’clock one evening. After
Cristobalina had given birth to a healthy baby, she developed an
aggressive infection. By three the next morning, she was dead. She
was 36 years old.
“I tried to get together enough people to carry
her to the clinic, but there was no one around,” her husband said.
“After she died, I felt sad for a long time. I could not work. The
children suffered too. We survived on handouts from the church.”
Cristobalina’s death happened several years ago,
but the scenario is a familiar one for members of the Ngöbe tribe,
an indigenous group living in the Chiriquí Province, near the border
with Costa Rica. They live in a scarcely populated region. Walking
on steep trails across ravines, cutting through clusters of banana
trees, coffee plants and other tropical vegetation is the only way
to reach the nearest town or village for most of them.
The Ngöbe are among the poorest of Latin America’s
people. The picture-perfect beauty of their straw huts nestled in
Panama’s exuberantly green Cordillera Central [central mountain
range], with its stunning views of the Pacific Ocean, belies a
rugged lifestyle where easily treatable conditions, such as
complications during childbirth, can quickly become
life-threatening.
But a lack of transportation is not the only
issue. Some indigenous people view modern health services with
suspicion and swear by traditional medicine and giving birth at
home, even when a clinic is within reach.
Salina Sanchez is a 33-year-old mother of seven
who is nine months pregnant. She lives about a 30-minute walk from a
clinic in Hato Chamí, but says she prefers to give birth at home,
with the help of her husband and a sister-in-law. “Giving birth has
always been quick for me, so I prefer to do it at home.”
On the other side of the spectrum is Domitila
Rodriguez, a 27-year-old mother of six. She has to walk for an hour
and a half from her house in Boca del Monte to get a check-up at the
clinic. She has never given birth at home. “It scares me,” she said.
“I’m afraid I could die.”
The maternal mortality rate for Panama is a
moderate 70 deaths per 100,000 live births (ranking among the ten
best in Latin America and the Caribbean), but in some of the mainly
indigenous areas, the death rate skyrockets to 658, higher than the
average rate for Haiti, which holds the dubious distinction of
having the highest maternal mortality rate in the Western
Hemisphere, at 520 deaths per 100,000 live births.
High maternal mortality rates usually indicate
high levels of poverty, marginalization and inequality. An estimated
98 per cent of the indigenous population in Panama lives in extreme
poverty, defined as living on less than $2 per day. Panama, like
most countries in Latin America, is a land of contrasts and
inequities.
Social and economic indicators place
the country among a group of relatively wealthy middle-income
countries, but figures for the indigenous population alone reveal a
stark contrast between rich and poor. On average 92.5 per cent of
births in Panama were attended by skilled medical personnel. In
indigenous areas only 57.4 per cent of births received medical
attention.
“We classify all pregnancies here as high risk,
because of the extreme poverty,” said Dr. Yaiset Joseph, a general
practitioner at the small clinic in Hato Chamí, in the heart of the
Ngöbe community.
She normally attends 30-40 patients a day, but
sometimes as many as 80. She lists the lack of spacing between
births, as well as the high birth rate among Ngöbe women, among the
factors that put them at risk.
"Most women here give birth to nine or more
children,” she said. “In cases when a woman is giving birth to her
ninth or tenth child, we refer her to the hospital in order to avoid
complications.”
Few Ngöbe women are open to using birth control
methods, either for religious reasons, or because they fear their
husband will leave them if they do.
Cultural norms come into play as well: Indigenous
women are used to giving birth standing up, or squatting, not lying
down, a practice that is uncommon in hospitals and for which most
medical staff have not been trained.
“Indigenous people also sometimes experience
racial discrimination in urban hospitals,” says Doris Gallardo of
the Ngöbe women’s organization, ASMUNG.
UNFPA, the United Nations Population Fund,
provides training to sensitize medical personnel to cultural
traditions so that indigenous women can feel more comfortable
seeking skilled medical assistance.
As part of an overall strategy to fight extreme
poverty, UNFPA and the International Fund for Agricultural
Development (IFAD), in cooperation with the Panamanian government
will invest $800,000 over the next four years to improve maternal
health services among the Ngöbe and Buglé populations, the two
predominant indigenous groups in Western Panama.
UNFPA is coordinating efforts among the
Government, ASMUNG, IFAD and the private sector. “We are also
providing equipment and family planning commodities for rural
clinics, as well as training of health personnel,” said Laura
Flores, UNFPA’s Assistant Representative in Panama. The organization
hopes to raise additional funds from coffee growers and other
private sector sources to further improve maternal health services
in indigenous communities.
— Trygve Olfarnes |