Rural Health Care in Mexico: Cultural Differences in Childbearing

Irma Alejandra Coronado Zarco

Instituto Nacional de Perinatologa

MexicoBiodiversity (third world place)

First place in reptiles

2nd mammals 4th amphibians and vascular plants

10th in butterflies

20th birds

MexicoPopulation: 103.7 million

Considerated one of the most populated countries in the world: 11th place

Population density: 53 persons/km2Mexico City: 5,799 persons/km 2Chihuahua: 13 people/km 2

INEGI 2004

Mexico

2.1 million births in a year

Life expectancy at birth 77.4 72.4

Growing rate1970 3.4%2004 1.3%

INEGI 2004

Mexico

General mortality rate 4.5/1000 people (60.6% chronical diseases)

Average schooling (> 15 years old): 7.8 years 7.6 8.1

Illiteracy : 8%

INEGI

Mexican society60% Mestizos (mixture of European and Amerindians)

85 recognized languages (At least 56 indigenous)

Catholic 89%, Evangelist 6% (syncretism with native religions)

Definitions ?Culture: The totallity of socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought characteristic of a community or population.

Mexican society:Multicultural societyDiversificationHeterogeneityComplexityPotential

54 Mexico 0.79634 Argentina 0.84438 Chile 0.831114 Bolivia 0.653120 Guatemala 0.6311 Norway 0.9422 Switzerland 0.9413 Canada 0.940

6 United States 0.939

54 Mexico 0.796171 Burundi 0.313172 Nigeria 0.277173 Sierra Leona 0.275Human development index

Conapo. Human development report 2002. New York. 2002 03- 30.70.80.91ChiapasGuerreroOaxacaMexico CityNuevo LeonHuman development index

51.4 % of the whole population

Illiteracy rate 9.7% ( 6.1)

Economically active 14,894,400

Family leaders in 4,683,000 homes

Men studying= women houseworking

>52% of graduates from University

Fecundity rate1970 6 1987 3.82004 2.2

INEGI 2004

Women

Rural Mexico1 out of 4 people live in rural area (25,925 million)

40% of rural population are indigenous groups (10,370 million)

Agricultural activities from indians 75%, rest of the country 22%

2/3 of coffee production comes from indigenous groups

INEGI 2004

Rural Mexico8th country with more indigenous groups in the world

The fifth part of the territory belongs to indigenous groups ( 12% of natural reserves and 60% tropical rainforest)

Most settlements < 500 people

Illiteracy 46% and 76% havent completed elementary school Tlahui-Politic No.2,II/1996

Children Population < 15 years old: 33,184 million

35% live in 3 of the poorest states (11,614 million)ChiapasOaxacaGuerrero INEGI 2004

Children6% Labor force (10-14 years old)

32% of children in rural areas works (13-17 years old) vs. 15.7% in urban areas

Teenager pregnancy 17.2% UNICEF, 2000

ChildrenExclusive breast-feeding (6 months)General 20 %Urban 15%Rural 33%

Complete vaccination 94% (

United StatesCubaMexicoPanamaArgentinaVenezuelaBoliviaPeru5.2 9.817.1 29.99.9 13.830 80.313.9 - 17ChileColombiaInfant Mortality Rate (1000 born alive)Panamerican Health Organization 2002

Infant mortality rates in ChihuahuaInstituto de Salud Publica 2003

Infant mortality rates in OaxacaPer 1000 born aliveInstituto de Salud Publica 2003

Children

Each year 65,380 infants die

35,911 died in the first year of life

22,089 died before 28 days of life

16,452 died in the first week

7,417 in the first 24 hours

INEGI

Principal death causes infant

Capacitated personal84%2.1 millonbirthsin 1 yearTraditional methods30%

DoctorT. MidwifeOtherNo specifiedBirths in hospital or clinic %Labor assistance

55%Perinatal deathsPoorest states

ChiapasOaxacaGuerreroPueblaHidalgoMichoacn

The decrease observed in IMR in Mexico during the last years was due to a declining pediatric mortality rate

Neonatal mortality rate was virtually unchanged.

It is well-known that there are important problems in the vital statistics in Mexico due to underregistry of deaths in the first year of life, and particularly those that occur in the first month.

Salud pblica Mxv.39n.1Cuernavacaene./feb.1997

DemedicalizedAppropriate technologyRegionalizedEvidence basedHolisticFamily centeredAppropriate culturallyMultidisciplinaryEuropean Perinatal Care Task Force 1998Perinatal care

Lacandon

Rarramuris

AztecsMarriage 14-16 years old

Abortion was allowed

Delivery is considerated a private and intimate event

They prefer trustful companion

Careful atention of pregnancy by ticitl (midwife)

First pregancy was full of counceling about nutrition and excercise

Increased caring the last 3 months

When you feel that the seed sown in you blossoms.

Extreme you hygienic habits so your child will learn to be neat

Walk through the gardens and classrooms so your child will learn that school is also home

Try to see only nice things so your child will appreciate beauty

Control impulse and anger so your child will learn to dominate himself

Learn all you can about science and arts so your child will learn to study

Ask with respect to your mother and grandmother and the mother and grand mother of your husband to tell you about their experiences so your child will learn to respect older people and will feel proud of them

You and your husband gather with the family so your child will know that he is part of it

Embroid the clothes your child will use, to make him notice that he will have a good reception when he comes out of you into life.

AztecsAt the end the ticitl verified position of the fetus and if necessary practiced version

Ticitl arrived in advance to birth to the house of pregnant women and got ready(special diet)

During labor she offered a drink with oxytocin effects

Elaborated methods to avoid fear during labor

Fear lowers contraction intensity and prolongs delivery: asphyxia and infection

Gracious baby, the gods rised you in the highest place of heaven; but you must have in mind that life is sad, painful, full of evil and misery; you wont be able to eat bread without working. May God help you in the many adversities that are waiting for you.

One of the conditions of the human being with more potentialSpiritualBiologicalSocialEconomicalPsychologicalAffective

Human beingConcern with the needs of mankind and the alleviation of its suffering

Show compassion, sympathy, consideration for another creature

Health care (quality)Birth settingsEducationInformationSocial supportEconomical supportCultureReligionEmotional supportWell-beingEnvironment

Health care resourcesUneven distribution

Resources destinated to health care Mxico 6.1 Colombia 5.5 Argentina 9.5 United States 13.9%

WHO 2001

Alternatives?Avoiding stereotyping

Respect for differences

Sensitive and intelligent understanding

Intention for improvement

Coatlicue